Document 10BZOreqn5KBbDNDzLkwybN7E

l'l/AJNi wk's i.xiimri 9 translation H Data of material: f N/D Language: German translated by: Dele: Forwarded to: L. Saucedo 6/6/80 Writer: Addressee: Reports about cases Pleural Cancer In association with Lung Asbestosis, secured invivo morphologically. from the x-ray department (head physician Dr. habil. Pfeifer) and the Neurological Clinic (head physician Prof. Dr. Hessel) of the Oldenburg Landeskrankenhaus Sanderbusch i.O. Professor Doctor habil. Arnold Weiss, Head Physician of the Clinic Nordmann first expressed his opinion that lung cancer in asbestos workers was an occupation-related cancer on the basis of two cases of his own observation and four further cases from the Anglo-American literature. Approximately 1/5 of all asbestosis cases dissected up to 1938 had, according to Nordmann, a lung carcinoma, mostly of the t type of the squamous layer cancer of the epithelium, that is mcte- pl&stic and in several cases also multiple. In 1940, Nordmann and Sorge succeeded in making laboratory mice inhale air containing asbestos dust over a period of six and 13 weeks respectively. Thus creating new formations in the epithelium in all stages, up to the squamous mult-centered hardened carcinoma of the epithelium in the bronchi, the latter occurring in 1/5 of the surviving mice. This rendered the causal link of asbestosis in the lung and lung cancer so probable, that it was included as an occupation-related disease into the list number 18B in the 4. regulation for the inclusion of occupation-related diseases into accident insurance, which was dated January 29, 1943. Further important observations were published by Wedler and Linzbach, Bohne, and Welz. As far as we know, the last summarizing publication came out in 1947 with Wedler as the author, in which he reported that 31 cases of asbestosis had been dissected in Germany, among them six lung cancers, which means, again, approximately 1/5, but also in addition two malignant tumors of the pleura, both unpublished (quoted in Wedler, case 1. Teutschlander: "pseudo alveolar mesothlioma of the pleura with metastases," case 2. Alwens, Fischer-Wasels, Wedler: "Cancer of the Pleura"). This latter fact justifies already the assumption that the cancer of the pleura represents, beside the actual u t7 I 156-705 8003 1138 PRODUCED BY FORD SCF-FORD-2015 lung cancer, the bronchial carcinoma, with the above-mentioned special characteristics, a special form of the occupation-related cancer of the asbestos workers. It is, however, not listed by Koelsch, which can probably be explained with the fact that the two above-mentioned cases were not published. We have now observed a further case of cancer of the pleura in association with lung asbestosis, for which it was possible to secure the diagnosis in vivo morpholgoically in every respect. The tactic and technique that were developed by us in the last years to secure the diagnosis in vivo anatomicaly with active diagnostic measures for pleural cancer, has proved itself also with respect to proving the existence of asbestos particles in the tumor tissue and thus for the evaluation of the question about a possible link. (Lit. cf). a 62-year old worker was moved to our x-ray treatment department for radiation treatment from a different hospital because a malignant tumor of the pleura was suspected. The x-ray department consulted me in order to secure the diagnosis in reference to the type and extent of the disease with the help of a thoracoscope and possibly an exploratory excision. The previous history did not show any serious diseases in the past. Nine years ago there had been a double-sided operation for hernia rupture, eight years ago there had been an accident with a concussion and fracture of both lower legs. Since early age there had been a sensitive stomach with a tendency to a sour stomach and feeling of pressure in the area of the stomach, especially in on empty state. For eight to nine months there had been pain in the upper stomach, especially when coughing or sneezing, which was treated by the family doctor as a "gall problem." There was an increasing feeling of weakness with nausea and occasional vomiting with a bitter taste. Within the last eight months there was a weight loss of 7-8 kg. With the exception of on old duodenal ulcer there was outside the thorax, no clinical or x-ray diagnosis of any pathological organ. Height 168 cm., wieght 58 kg., blood pressure 150 90 mm Hg/ BSG 70 97 mm. Hgb. 1037., erythr. 5.2 mil., 18 600 leucocytes, of which 17. were baso, 17. rod, 587. segments, 36% lytnpho, 47. mon. Chemically and microscopically there was no find in the urine. The right half of the thorax lags somewhat when breathing, otherwise the thorax is symmetrical. There is the typical physical diagnosis of a pleural hemotoma of larger size on the right. Diagnosis of the x-ray transillumination (Dr. med. habil. Pfeiffer): medium sized almond shaped hemotema of the pleura on the right side with throughout interlobar participation of the thickness of the diameter of the saall finger. No signs of displacement, plastering of the diaphragm on the left side. 8003 1139 PRODUCED BY FORD For the x-ray reproduction of the pleura visceralis and parietalis, a tapping is done, if there is free gap in the pleura, to the maximum degree of the hematoma, with our proven diagnostic tactics, and a pneumothorax is performed. This method was already recommended by Teschendorf and P.G. Scmidt. During the procedure and afterwards there is no discomfort. The overall quantity of the hematoma 2 liters, color yellow, extraordinary gelling after cooling down. Tumor cells in the sediment. After this, x-ray of the thorax: the right lower and medium lobe is collapsed to the size of a goose egg, the upper to the size of a fist. The pleura costalis is hardly, the pleura pulmonalis is clearly increased in thickness above the medium and lower lobes, without certain wavy contours or nodular lumps. It is not possible to give a certain x-ray diagnosis of a pleural tumor. The x-ray film shows the lung sections as having an increased netstructure and smallish spot shadows in both medium and lower divisions As was already noted by the referring hospital, the latter create, after a specific etiology is ruled out, the suspicion of a dust lung disease. There is no reason to think of silicosis. The occupational anamnesis points in the direction of asbestosis. From 1920 to 1935 the patient performed insulation work for pipelines and valve groups with asbestos for the marine shipyard, later, till 1942, he supervised this type of work. When supervising, he was also, for 1^ hours daily, in rooms full of asbestos dust. Asbestos particles were then found in the scant, remarkably glassy and viscous morning sputum. In order to gain further diagnostic clarification, 1 then performed the thoracoscope. This showed the right pleura china white and shiny, and without callouses and increased in thickness. In the front diaphragm rib angle, close to the mediastinum, there was an approximately plum-sized, and beside it, an approximately pea-sized tumor node, which was irregular in shape, but smooth an the surface. From this location several excisions were taken. The pleura parietalis appears above the ribs, over the total area of the thorax increased in thickness and increased in injection, and presents a small nodular, relief of thickened areas, which glow somewhat withish in some places. Smooth healing of the incision. Histological finding of the excision material (Prof. Franz, HamburgEppendorf): a. ) excision specimen from the parietal pleura: specimen of fatty connective tissue infiltrated with large tumor cells in loose groupings. At the edges, small-celled. Inflammable infiltrations. Additionally, curdled masses permeated with fibrin with the same tumor cells: malignant blastoma. b. ) excision specimen from the pleura visceralis: tissue parts from tumor cells; among them asbestos particles: a 4 b malignanttblastoma and asbestos particles. The cells of the malignant blastoma look very much like those of a pleural endothelioma. 8003 1140 PRODUCED BY FORD Our method of diagnostic procedure gave. In this case, not only the radiologist insight into type, extent, and growth pattern of the tumor for his radiation plan,but it also presented the evidence for the existence of asbestos particles in the tumor tissue in vivo. Nordmanns studies with sections and animal experiments showed as a result of the effect of the asbestos in the tissue hyperplasiae, metaplasiae and finally carcinomae, mostly of multiple origin. Possibly the pleural cancer originates also multicentrically in the same side of the thorax, as we believe we cannot totally reject after our biopsy findings of overall ten cases in the lsst three years. Almost always do wd find, even in the early stages of the disease, the total pleura parietalis and visceralis of at least one side of the thorax affected, which is the reason why it is almost hopeless to treat these turtiors with surgery. The asbestos crystals which as is well known, also permeate the pleura, provide the chronic, carciogenic irritation, which leads to cancer in most cases only after a lengthy time interval-according to Nordmann 15 to 21 years after the beginning of working with asbestos. In our case, the interval between the diagnosis of cancer and the beginning of the work with asbestos is longer with 31 years, but the asbestos dust risk was overall 22 years and was especially strong in the first 15 years. Pleural Cancer is considered to be rare but if up to 1947 beside the six cases of the far more frequent bronchial cancer as occupationrelated cancer of the asbestos workers two of the rare pleural cancers were observed in association with lung asbestosis, the causal link between the latter and asbestosis can be assumed to be probable. Added to these should be our case, so that we can now assume almost with certainty that the pleural cancer is a special form of the asbestosis cancer. The proof of it, in vivo, was in our case not only of great use for the radiation plan, but also otherwise for the patient himself, who can now take advantage of the compensation for his occupation-related disease while still living. SUMMARY As far as we know, the first description of a case of lung asbestosis with cancer of the pleura, for which, in vivo, tumor tissue with asbestos particles could be diagnosed with the help of a thoracoscope with exploratory excision. Pro6f is rendered for the justification to take pleural cancer for a special form of an occupation-related cancer for asbestos workers. 8003 1141 PRODUCED BY FORD der link* Untcrsdienkrl ur.d FuB bliulidi vcrfirbt und kolt An prozcB so wcit fortgesdiritten ist, daD die Hauptertcricn der Votdersotie des linker) Untcrsdienkels land sub on tor* VO,, ticfo Utkut nm c*in*m DurcHmcor von 5 c*n DicAricriu .dcijlis pedis v.m metit te>ibar, die Artcnu tibums po* nut ichwacii au luhlen Norti /tagiQor Bchendlung nut DP bildeie ncJ) cm dicker Schorl, dcr dtn Dcickt loii) docile Zu diccm Zutpunkt war dcr PMicni borcits lubjokliv l>ochwerdcfrci 1m feciteren Verlau! schwftnd die blauiiclic V'orlarbung Bei Lo* tung dot Schorfet in der 0, Behandlur.r:*\>ochc londcn vut das sana threr Kollatcralon oblilcnert sino. Daunt sind die C.renzen einor DP-Wirkung klar aufgczcigt Unsere Unlcrsudtungen lasscn erkennen. daD durdi die Einfuhtung dcr Dcpotlorm das Indikationsgcbicl fur die Padulinbehandlung audt auf Flille nut sdiweren Durch- blutungsstbrungen ausgedchnt warden kann Bci rcditzeinge: Anuendung ist es moglidi, eine ausrcid.ende I'iius fladi und wcont!icn verkleinert (Durcnnieer - cm). Nacu wciicrcn Goben \on DP kom cs *u einer erm u'en Sthorfbitching uber dem Rcstulkus Patient orinclt msgc&umi 7*i lnjiA- tieSen DP. ' Obrnictil Blulversorgung des gesdtadigten Beztrkes wiederherzuslcllcn. sogar in Tallcn. bei denon bis jetzt cine clnrurgisdie Behandlung in Lrwagung gezogen werden niuDtu. Das wesentlidie Neue emer Behandlung nut der Dopotform des Padutms schen wir in dcr Einschrankung der Indika- ':vd i ihi Dugnoie gut uhbf befrtetiinerd einl'cOt tion zu einem dnrurgisdtcn Eingriff :M \ ^iOf>i.wtewroie 2 Eftutngilii 1 Arcrvi4*fotc * Antnobhleroie Diibctts 4 Ulkui cium 1151 : iij. u) 41 O1.H4 5.) : n> bi 4 117-:0| 1 |I6| -- -- S It. 31 : i7. toi --* -- 1 03) i ii -- Alt Qulen Bel Brvdlungif r.'olg betcldtncicn *ir die Wicderhcit'ellurtg cmer uvc.cbtnotr b.uu Uwiuug in Oct l-cnphene tm C.mntt &ruiMC*ir* tiMtu uid volUiAnuiyer trhuiurig dei beit*u ycifluJigicn Gt*cu Als ^kitihgenoti Beh*ndlungrrgct>n.s luMien wir d.e Julie in. bci Ocnen die iictvcuoryung so veil yeocttc'l wuict, ds0 due ducuigucti< Biheiodlurg sicbi mebr ootwsnoig vr Bcsondcrs bci den Fallen mil sichfbarer Durdiblutungsstdrung licO sidi ini Laufe dcr Behandlung der allmahlidie Eintntt emer bcsscren Blutversorgung veilolgen. Haufig wurrlc von den Palientcn sdion subjektivc Bcsriiwerde# liclheil angegeben, bevor nodi die bessete Durdiblutung objckliv fcstsicllbar wor. Chaiaklonstisdi lur die Be* hahdlung mit DP war die Abheilung der Gewebsdefekte Zusammcnfossuog Wir behandelten 20 Fallc vorwiegend pronnostisdi ung-jnstincr Durcubiutungsstorunren nut Depoi-padutin, bui denen es teilweise bereits zu einer crhcblidien Cewcbssdiudigung gekommen war Bci 3 Fallen war boreils cine dnrurgistne Behandlung (Ampuialion) :n Crwagung gnugen In 13 Falli.n beobadi* leten wir eme gute, in 5 fallen erne brfriedigende Wirkung 2 Fallc bliebcn unbecinfluOt In der Einsdirankung der Indikation zur oururgisdien Behandlung der senweren peripheren Durdiblutungsstorungcn nut Gewebs.dmd.gung sehen wir das neue der Therapie nut der Depotforni des Padutin. Voruusset* zung ist das Fehlen einer wcitgchcndcn Obliteration der I Iduptartcncn und ihrcr hullateraicn Nadi uuscren L'llahrungen 1st die li.ilic von taglidi einer Ampullc Dep'j' Padui.n ( -10 rmliciten kallikrein) ouch bei sdiweren peripheren Durdiblulungssloiuugcn au.rudiend 8003 1142 . msli Sdiorfbildung. Unter den Sdiorfen cnlwickelte sidi -rip festos Narbcngewcbc Gb cine Wirkung out die zu* gtlimleltegenden GcfhBleiden eingetreten 1st, bleibt naiur- li* zweilelhaft, da das Padutin nur uber die Erwcitcrung '* Oo nodi auf vasodilatatorisdie Reize rcektionsfahigen ^ Ga(lsystcms wirkt Diesc Wirkungsweise erklarl den 'K&Derfolg in Fall 12, bci weitgehendcr Obliteration sbmt- tSier Untersdienkelartcrien konnte durdi DP keine BesscSung der Durdiblutung erroidit werden Eine dururgt` sc^e Thorapto bleibt unumgangltdi, wenn der Gof&O- til.islur (1) A is u . Duo, iscil Wide J5 UK 1103:1 -- (J| Sites, r.ieb, Zl.erepi.wod,. lOtaSl. 4 IuIqc, 21? - (3) F r < y u kieuli k.ll Stem, ferd, Euke,Vcrl.g I9S0 -- |4) II i r 11 n 11 t h Dltd, oi.a Wiair ? 10K ItySli, om.luc Pud, rd Wtdu ?s 7SI |I9SU| -- |S) Htldi Weit.ra M.au.l Timet 1931 -- (61 H e I ai l Ucetfcr / Leeaer 1934 -- |?| H o a I Zb lur Heul und GeiOil krlu , 43 ?.v 119331 - Id) Litltl * Pcimetol Wodientdtrill 44 1476 (110b] -- (liloeveierlt M e a I e nc r . 2itchr I Cniturgie 241 700 II937| -- |ld| L u m n. e I i Revitl Med Germ ob Amenc 3 4 6? 1I938| - |it| N o r d eu e n n 2itdn I Cbuurgie 277 145 II93II - (121 Scbeudef. Murdi Nhd Wtdt4. tl 48} II9JII -- 1131 1 be i t ten Mui.it, Mrd Wtibr 2. 57 |l'136| - 114, 7 i e m e n n : Let ptubiitdie Aril I? (i93L| - 1151 7 ucblclj Wienri Med Widir 538 (19371 - (ICi ven der Veldcn Fnriulitme der Therapie 10 11932). -- |l?| Zorn: Dud. n.cd Wtdu. 47. 1978 |I93I|, 13 !|ASU1ST1SCHE MITTEILUNGEN C5) o & v Pleurokrebs bei Lungenosbesfose, in vivo morpKologisch gesicherf Auj der R6DtgeDabtelIung (Chefanl Dr. habit. Pfeller) sowle der Medlzlnlrdien und N'eurologlschen Kllnlk (Chetarzl ProL Dr. Hessel) des Oldenburglschen Landeskrankenhauses Sanderbusch L O. y Dozen! Dr. habll. ARNOLD WEISS. Oberarzt der Kllnlk ^ber den Lungcnkrebs der Asbestarbeiler bradite Nordinir. n zuerst auf Grund zweier Elgenbcobaditungen und vier wtjlerer Faile aus dcr anglo-anierikamsdien Literatur seine MSnung turn Ausdruck. daB hier ein Bcrulskrebs vorliege kd 1 alter bis 103B sezierten Asbestosefille hatten nadi ' NoSdniann ein Lungenkarzinom. meist vote lyp-des ver- bo&cnden Plattenepithelkrebses, also mctaplastisdi und -- in . meareren Fallen -- zudem multipel 1940 gelang Nordmann UT&'Sorge im Mbuseversudi durdi Einalmenlassen von <>&ttstaubhaltiger Lull uber 6 biw. 13 Wodien die Erzeugung ' eptflielialer Neubildungen alter Stadien bis zum verhornenden m^lizentusdicn Plattenepithelkarzinom der Bronduen. leute- 'b-evtsiederum bei ''i der ubcrlebendcn Maus" Danut war dcr ^psSchhdie Zusanunenheng zwisdien A.bcstosi der Lunger, und uiogcnkrcbs so wahrsdiemlidi geniadit, daD er als Beruls* krankheit unter Liste Nr 18b In der 4. Verordnung fur die Auidehnung der Unfallversicherung aul Berutskrankheiten von Z9-T. 1943 anerkannt wurde Weitere einsdil&gige BeobaditunjcS" verfillentliditen danadi Wed ter und Linz bach, ifjfthne und Welz. 1947 waren nadi der unseres Wissens letzlen zusanmenlassenden Verdffentlidiung von Wedler 31 Asbestosctaile in Deutsdiland sezicrt worden, darunter 6 Lungenkrcbse, also welter ctwa */*. auDerdem aber zwei bosartige Gesdiwuiste dcr Pleura, beide unverbfientlidit (zilierl nadi Wedler. Fall I Teutschlinder: .Pseudoalveo* lires Mesothehon dcr Pleura mit Metastasen*. Fall 2 Alwens. Fischer- Wasels. Wedler: .Bruslfellkrebs*) Diese letztere Tatsadie bereditigt sdion zu dcr Vermutung, daD der Pleurakrebs neben dem cigentlidien Lungenkrebs, den Brondiialkarzinom nut den oben erwShnicn besonderen Eigensdiaften, eine Sonderform dcs Bcrufskrebses der Asbestarbeiler darstelll. Bel Koelsch wird er jcdoch mcht aulgeluhrt. was wohl in der fuhlendcn Veroffentlidiunn dcr bcidcn oben er* wbhnten Faile seine Erklirung linden durlte Wir haben nun einen weiteren Fall von Pleurakrebs bei Lungenasbestose beobadilel, bei dem es in vivo gelang, die Diagnose morphologisch in jeder Hinsidit zu sidiern Die von uns in den letzlen Jahren entwickelte Taktik und Tcchmk der aktiven diagnostischen MaDnahmen zur anatoousdien Sichc- PRODUCF.D BY FORD 9J \\ c*ss I Yuick'onv ui L* ruict osbeMnve *r \ 'a o rio'p.ic.D^.sc4' gos cs.cr*. NurPhi ] lunn dor Dianrose Flom'kici>s :n v,\o Inn & c' t\lei au!i Dfu^*!i0111e serdt^i, eru.it vnn^lirt ri "irri r**tl rnnt c*n binuh:iich dc* N^liwe Si'i sun Auk kv i, v.vhcii i.'i k!o'.!.iua r,v SU .I \oi\ \ * rf,.vkm t.,vie sie'.vJiv cse cJuai im d lor do* 1* n .v.'.uwj c.vi ^ t% . ilS.* vl. 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In ** iuYr iua i Cofrctu u *i2c vi*. *i tliii* n \*in i u!k:i J.iuicn ur.d Nu-i.i, v*u Kitusutzt . i t.mlv I t.u t" hi* d* hr.u ndi*> St*,v...c`i 11 luiil In' * Insw* ' n ban f s<.t: :..c iki m'e** C `nu u *t C*cv\'v'lit.u jvi.pic iu t m lc*..di.) B Munition cl^u 7 -- . k| 0Tb M i 1 i i| 1.1 S !I ii s 1 n iii u v n \ *h . > 1 k u r p e r t 'i p l/iis Aii>m iu u d i J\ . n _ niuiiijuin t i in* * m lur Pi* : . ma! t om B v l u n cl Ai>f,L>ihrM von emom mien lieu* t'uodcr.* k!i* Unserc Me.hcu'v dc* du^.it*>*,att,K n \ oi. vhc > i .ill in die J nUth und ronlgcnolecjisth mli fhulb do* 71u.ic\ k n krunk* sen J\dle n thi rer dv .i b'l.h'i i ! . u n v*t'.e:en Bailor Orgoiiliettaid kurpcitjr me Ibb cm, GlwV'I 5li k'j Aulsdaub ubi*r Art. ^vtudchnuinj and Uf.hsP.ns'u*isc dcs BluU'ruc'x IwOiO nop 1 Ig BSC 7o b7 mi.i I'gb MU" >, tr litr lutnors lur sctrci Uc*li.il.aii^puin, scudem ... .c uucii zum U Mill, IBulO leukozuen. davon !* B.so, I"** Stabk.. 5li" v Nutiwcis del \'Lc*lkur,Kutieu im lu. uirevvclc iu vivo 8003 1U 3 Srnm , 30* L^r.ipho, *i" o Mono Lr.u thomtst.li und imkio- N o r d m o n r. Liucisuc*.u*r;en U* bvklurtn und ini Tier. skopisch o B \t\uih en.iLvn dl V\ .ki.u^en ilu /\sbcu in Ccwwbc * Do redue 7hora\hd"'o bleibl bei e'er Alimmcj eiwns zururk, 1perp'os if* McL.plosu n and sda.t ,t'i k.irrncine. meisl 4 %on>t i*t dor lliutuv e\ ;uun'r.ct. *1 p.^divr jli kmi*clut lie* uMia.pvi Ln>u..r i, \vldif PIcui *ki. cm >ii lit m.-ulicntr* fund ernes yroftcren r!curacri,ii se* redds wut^c l.iUliirei.trisili in dvr `j'cidicn *1 limuxseae, w*ie wir noth $ It u n i o e n d u r c h I o u c li I u n <j s I; c ( u n d foci ci t* r A u f unvrcn bsv<ptic.Hn Uci a. i* .. uu iu ! ,u,ui m ovn t m li in c (I )i in* d li.it it I IM i i I i i ) M.t* km. t 'i , l :/ii n l ) .'li. n n .a *, i.* u.%ihiu i. u :u k. .. . n ....... * CMiU<-ll.niMH|rr l; 11 |.M1 It IlfiMiilt it ill's Hilt tlimliv.rii klrim|iirf- So yiit \.u mmicr 1 ndv u ua uivh in ipIoIiv iiitlun bbidien ' ^`Qcrdickci inicrlubincr Bcleilic.uny Kcino \ vidiun^uiKjv die (jon/c I'kiu.i p.uu'jliv uml vumi.iIu wiiiimnIviis eiucr tT'tlti.nunqcn 2wt'idilclivcrklcl.iiruj linki vcUi'O: 7lioroslnillu. bcioltcn. wcahulb vbc uju i.rivc Ui 1 uuliiimj die** C71? , r. * ^5*?ur roniricnologikdicn Durslel'.iiny tier Pleurn visrctolis und r ^^iiitoli* vsird n.ich di*r Im*i uii> bctvuliricn (liitu.oli>(lu i\ ^/?^iktik im Tulle tines liticn lMeuroi|i.iUis dcr Ciriul rn.iviu.il 5^'pimkt.cfi und cm Pncmnollmrox rtrcjclcgt Dieses Vorrjehen beie.U 1 t* > c li v n ci u r I umi P. t* ^cll^.llul. @ul)tM und ddndrii ko ncrlei Do*chwcrdrn Cetunuim ihjc ties - ^frjust^ 2 Liltr, rufb.* ntlb, twdi Lrk*lten e ^cimrtig ptlic- scr CcAliwuitie lost in.mcr u>suh >los i*.t Die Avbeakiisbdlc, die bekurinlinh iuch die Picuio dmch>pit hen, bad. u den <hro ntsc.ten, kirnmn,> urn Keu. dir meisl vi ' n. ill 7eil* 1 dicn h.toi\c!! - noth Nurd hi o n n 15 bi .1 Julire r.uh .\ib Ikbvf, iii Mil Abisl - /mu kubs lut.it In im>cicin Tulle 1st di*r Zcaidun iwisckcu nutluji wieM*nc.u kubs und Arbe'tl#eotnn nut Avlrosi mil 31 J.ihren lunut^, doth wohilc die Atbejlsl.uih^ci.ilirduiuj iniji*smnl .2' julne mid war in den 4 fcmd lin Scdimer.i luinor^cUcn cislcn lo Juhrcii besouderd lUci.^iv onoch Bontccnoulnohmc dot Thorax* Dor ^-litc Un:cr- und NlatcUappcn isi ul Cdnsceiyr^Bc, Uci Ober- Dcr Plcurokrcbs gilt als scaen Wenn aber bis 1947 neben 90 r^ppen auf rouarjrunc kulltibicri Plcuui colnlis kuuni, Plcurn 0 FuJIcj) des dtui) wea liwiiliyeriMi Baii'tlunlkrebves ui* Deiuls* ^nmonahs ulier Mate!* uml L'litcrliipputi drutlitii verdu-kl, 43jie siclicre welligc Koniurcn odcr knoiifjc Aullagcrumion sitheic Bonigt*ndiO(,nosc ernes Pleuwaun'ors ist mdit ^OQlldl t krebj der A'bistorheitcr 2wli der se 'e* iii l'tt uiokieb^e bcl lunycnusbcsio^o beubadael wuren, wird i.uin cl. n urauihuclicn Zukdmmcnhung der letzleren mil der ALctose ul wnhrv!iein* ltd) annclancn duilcn lltcrzu komnil nodi unscr Tull, so da& wir den Pieurakrcbs c\> cine Sonderlorm des Aslc>lkrcbscs ^Dic lungcnfclder icigcn nun euf der Aulnahmc cine vet* nur.mehr lur nalieru stchcr holun luodacn Svin Ncicnweis in rite hric notiurtige Struktur und klc ncre riccka/iunttcn In bet vivo war :n unscreni Folic mdit nur lur den Uctrolilung>plan, * ftn Mutcl* und Unterle'dcrn Lctziere, beruits in dem ubet- sondern auc'i sons! fur don Palliation solbst ven grobcm veiscndcn Krankonhaus ouirjelallen. crvuckcn noth AussdmiB Nuuon. dor nun nodi zu Loiaoacn in don Cwnub dor ia>dta* ^ncr spczifistlicr. AmoIoqic den VefcJ*dn aul emc Siaublunncn- dtgung fur se.no Berulskrankhea kommen kunn ilkronkung Fur Silikosc kem Animll Die Deruls()nuinncc gOoist fiber fiul Asbcstoe Inn Von 1920 bi> IC3i hat der Fal. Isolicrarbeilcn nn RohrJerlunund Vcnlilgruppcn nut Asbest bei dcr Kiicgsm>inncwerlt 2usamnicnIossung Unseres VVissens ersdualigc Bc*rtuctbung emes Fdllcs von LumjcnasLctosc uu Krcb dcr Pleura, bwi dem in vivo durdi it ' #1bil auigefuhri, spilcr (bis 19i2) IcauUiditiyi Atidi bei der Thorakoskop'c r.ta Fruboexztsion au du IMeuro lumorgewcbe ^nfs'da hat er sich tiglidi eiuo I'.r Siunden m abe>tvcr- nut Asbctkorpcrdien donnoU2ic;{ w-pidcn konnic. Die Rc* S'tnublcn Rourncn eufQcliotlcn. redatgung. den Plcurokrcb* als einc Sonderlouu dcs Uerufs* i spirbdien. mornendlidicn, auflollcnd glasig*23hcn Aus* krtb/os der AsbcsiaibcMtor anzusehen, wud nacl'.gewiec*n * url Hcrdcn dorauJhin Asbciosckorperclien nochgewit'Acn .$?ur weaeren diagnostisdicn Klnrunr; t.rdc nun tl * Thorakoder rtdavn Diu.ihehle von im.* v*r*. i *i union Dabci *^?|i.d sidi das reside 2wcithIt*II poi/vihiiuteifi und yldiirend, ^eilcllos uUwic'Ikj verdickt Im vurderun -ZwiKhleUtippen* v.mkcl nohe dent McdifiMinum sieht inm cinen ciwu pfliiuincn* giohon und ritinchcn einen etuj crbsemfrullen, uimMielituOiy rsckttllcu*n. dedi an dcr Obeiluuln* et.iUon *1 uiiu>rkm>ii*n Atii Sidle ^erden mehrere tMisiontn yeiiiuda Die IMturo .'**ji5rjtifilis erdic.ca uber den Rippen in ganze/ Au>debnunQ der (1) Boh nr Ourti mrd \*. n *nv,, jl m**i |!9l0t - ttl K . c I v v I. L i *i lei ,l v'> ,t L v . < u*l 4 Stl.c 3./rituv* ij I *) * |j, > j in .. i, , , 1i >t .iv.i H. >j U is (UJiM * in n v r a in j ii H u x * * i . w. i .. %i.mvn.^i.r ia iu) tiyni * |.i Lmitah u w c it i u v.uh Aus i-U ju a '*ll -- mi s c :> m i >i i i cin. iv < it,t. Hi ,.. i 9*1 i,i i v l u w v * 11. ktft.|i 2i* II nl'.t/l lui ml. Mill 19.4 -- |.| I I t (It r ii i* >* i I in.iuuitt di I iiiiti.)i IM..J tin ii hiiii u uu. Itii.iijiiovr i.i.M.j 1 It>t Mt> \til.ty t`l,n *" (ill \V i l I t I lull i mtiii. itkl <i I . ,1.1m *.! i A i i.t mmlK.li ! 11*111| 1 .h Am.'i 1* i*, Lt i|.< i| -- |9| A t U i i |t \ . >1 Jii.'ltMMi. n .'if In tli Cw I uu MvJ l**>l - | Oi A i n u I >1 W ( i I) v v L. w= 2uciii I klu. MvJ 14V. (19321. -- (tl) Welz. AiOi 1 Geueioeyflib Hi (IS42) 1i l i i PRODUCED BY FORl^