Document 4J32kk2waJnR0qva1N50EG53G

u4 rt " 0 ! Vf TRAUGLATI 0 U PNEUMOCONIOSIS DEVELOPING AFTJiR INHALATION OF POLYVINYL CHLORIDE by Gsendc B, Lapis K., Pinter A., Nemos A, and TarJan E. (Gemmclwcis Medical University. 1st Institute of Pathological Anatomy, lith Gurgical Clinic, and the Lung Clinic) Orv. Hetil. 112:05-6, Jan. 10, 1971 In tlic course of the last few decades polyvinyl chloride (l'VC) lias become widely used not only in industry but also in clinical medic\nc. Generally speaking, PVC is inert to the tissues and has been regarded as a harmless substance,and consequently it has been used as the material for medical instruments such as cannulas, and catheters. Quite recently, however, some reports have appeared according to which the vinyl polymers, and in particular PVC, may be damaging to health [14,3]. In one of these publications the authors reported fat granulation tissue developed around PVC particles implanted into the muscle tissue of experimental rabbits-[1]. According to Roe et al. [2], subcutaneous implantation of polyvinyl plastic sponge in rats was followed by the development of sarcoma in some of the animals. As far as we know so far there have been no reports in the ' literature concerning the development of granulomatous changes resembling pneumoconiosis in the lungs following prolonged inhalation of PVC powder. CAGE REPORT '~ B.S., a man aged 31, was admitted.to the clinic because of breathing difficulties. Chest X-ray: on both sides there were 'splintery, filamentous finely dotted shadows becoming denser toward .the hilus (Fig. 1); pnoumoand nngiocnrdiongrnphy failed to show right-sided or left-sided shunt. Respiratory function: at rest the findings were normal, but on effort the function appeared to be impaired (nee table). Blood picture: erythrocytes 6,800,000, leukocytes 6000, 31b 13.5?, color index 0.9, ESR: 9 mm/h. To investigate the changes in the lings, biopsy was token from the tip of s the lingula. Two light-gray pieces of lung tissue of pea size and plumstone size respectively were investisated. Morbid hictolocical investigations cf the lung samples revealed diffuse fibrosis of moderate degree and several lesions arranged in small foci. i At several points it could be seen that the center of the lesion was occupied by a foreign material. Some of this material war. slightly eosinophilic and some showed weak basophilic staining. There wore also parts positive to PAS. Part of the foreign material dissolved in the course of embedding and disappeared completely. No fat granules were found in sections at the various sites corresponding to the foreign material, and under the polarizing microscope the foreign material did not prove to have double refraction. Individual particles of the material did not reveal any crystal structure. They were oval or polygonal in shape ami .15 - 23 u in dinmeter. The foreign material was surrounded by granulation tissue consisting of histiocytes., lymphocytes, plasma cells, eosinophil cells, and foreign-body giant cells. In the same granulomas there were also connective tissue fibers, in places arranged concentrically. In other parts of the lungs numerous heart failure cells containing hemosiderin could be seen in thelumens of the alveoles (Figs, 2 and 3). Table 1 Patient B.S. Results of examinations concerning the respiratory function before the biopsy VC; >i600 ml (+ 102) , mi': 3950 ml (792) Residual volume: 730 ml Residual volume/total capacity; Total capacity: 5330 ml (972) Resistance: 26.6 mm i^O/liter/sec. Oxyergospirometric investigation: 1j5 W: V02 = 900 ml Pa02 = 72 Hg mm PaC02 - ^1 Hg mra -- C[? = 0.032 t/mra H20 At 90 V the patient becomes cyanotic and his P02 is equal to i>9 HO mm, . C:43 7 / - Translator's note: Abbreviation uncertain, possibly "inspiratory reserve volume" 3 After the nrrival of the histologicnl report the patient was questioned and stated that about 1 year earlier he had been working in a plastics factory where he had to shovel PVC in the form of fine powder, generally in draughty places. * Haying thus obtained additional anamnestic data, we treated the sections with 10? solutions of cyclohexanone in benzene, which is a solvent for PVC Under this treatment the foreign bodies completely dissolved and dis appeared from the sections. The patient was treated conservatively and kept under observation; his condition on thi whole remained unchanged. \\ I 1 Fig. 1 - Chest X-ray of patient. BS: on both sides the structure seemed . to consist of strands and small dots. 1. Fig.2 - Foreign-body granuloma in the lung tissue (H.E. x 100) Discussion On the basis of the case history and the histological picture ve regarded the lesions as pneumoconiosis caused by aspiration of FVC duct. The shape and the staining properties of the foreign-body particles seen in the center of the granulomas did not resemble any other particles known to . cause pneumoconiosis. There, is no specific stain suitable for the histo logical demonstration of FVC, but the successful dissolution of the foreign material with cyclohexanone suggested that the material was ' indeed PVC. V. \ r Fig. 3 i' The granuloma under higher power. Foreign material and the surrounding cellular elements are clearly visible (H.E. x !i`i0) As it. seemed impybsible to demonstrate even by chemical mean:: the ;/rescnce of PVC in the lung samples investigated by us, we collected samples of PVC dust from the place where the patient had been working. Microscopic examination of the dust particles showed them to he morpholocically similar to the foreign-body particles found in the .lungs. This material is treated with solvents and stabilizers only at later stages of the production, and thus the harmful influence of these factors, assumed by other authors [l], could not possibly play a part in our ease. f*>iyi*v,- * We believe that thc'bost approach to this problem would be aspiration of the PVC dust in question by experimental animals followed by histological investigation of their lung tissue, and we are now carrying out experiments in this.direction. Our present observations can of course onjy be confirmed by experimental investigations and possibly further observation:; on human patients. On the basis of the information available so far it may well be asked whether PVC dust can cause pneumoconiosis, which would mean that the Group of pneumoconiosis-causing agents could be enlarged by inhaled PVC. Such lesions could be important not only from the point of view of differential diacnosis but also as regards industrial hygiene. It should be emphasized that in our case the foreign bodies found in the lung tissue -- presumably PVC -- were surrounded by a marked and severe tissue reaction; this indicates that the material can irritate the tissues. It can be assumed that after prolonged exposure the described process may end in scar tissue formation. In our ease the dyspnea, the secondary polyglobulia, as well as the impairment of the respiratory function indicates the severity of the disorder. . f' ' Summary . hung biopsy on a 31-year-old male patient who over a period of a year had been exposed to the aspiration of PVC dust, revealed changes corresponding to foreign-body granulomas. The authors raise the assumption that aspiration- of PVC dust may lead to pncymoconiosis. * 0 '* t * . u V.'c are indebted to Minn riiana Tarcv.y (i'lnstics Research )nr,l,j tut**) for valuable advice on questions of chemistry. References 1. Ciit'jx. \V, U. nml A'fii. J ` JAMA. I'.m-J. CiU. J.-".-. f. J. ittlii iUitVJ.'tV:/. /. (?. V*.* iJ 1'Jm. J*'t i>iT. -- .`.'.-ion. f)irjin,in, Viitni-kr.i, M,; I.mV. 1 :h;7, :,S, 2iil.---- 1. lirii. .Med. J. J, Juli. S/.erk. 'i ' ' ;, 'i % l -- '-'CC