Document EmR8N6yr1p4DVK87KBR2meqN

throughout. ii'o symptoms o? displacements. On l..ft .;idn diaphragm sticky (rlu-.y According to tho tried diagnostical tactics in c: of u free ?'-o :r.-.-rifo, for the roentgenological demonstration of pleura visceralis and paristails, ths effusion is maxim*]ly punctuated and a pneumothorax induced. This already recommended by TSSCdRNUOiiF and P.r. Durinr and afterward r.o troubles wkntsoovor. Entire amount of effusion 2 liters, color* yellow, after cooling strangely Jellying. Tumor oolls ins sediment. Thereafter x-ray of thorax: The right middle and lower lobes have collapsed to the sire of a goose eg*, the upper lobe to fist sire. Pleura cost ails h .rdl; pleura pulmonalis over middle and lower lobe clearly thickened without wavy contours or nodulous layers. The positive x-ray diagnosis of o. pleura-tumor is not possible. On the x-ray the lur.g areas now show an increased nut-like structure or.c s.-Tal'l spot-shadows in both middle and lower lobos. The latter -as already noticed by tho transfering hospital and after exclusion of a specific etiology- raises suspicion of a dust-lung illness. Ko evidence of silicosis, but tii-j occupation; anamnesis is pointing to asbestosis. % From. 1920 to 1935 the patient had v.-orked on insulating jobs v/it'n asbestos (on pipelines and valve-croups) at a Navy dock-yard; later, until 1942, ho wae su pervising the work. As a supervisor he also spent- daily approx. 1 1/2 hours in rooms full of asbestos dust. Consequently, asbestosis corpuscles were found in the scant, matutinal ana re markably tough and. classy sputum. Fcr furtner diagnostical clarification I now performed the thoracoscopy of the right thorax. Thereby the right diaphragm was found porcelain-white and shiny, doubtlessly callously thickened. In the frintal di*phragm-rib-corner (ungle), near the mediastinum, a tumor-knot of about plum-size and next to it unotr.er about the size of a pea, shaped irregularly, yet smooth on the surface, were visible. From this spot several oxcisio:i3 aro made. The pleura'appears to be thickened over the ribs extending throughout tho thorax, and a bit mere injectod, and shows small nodulous (knotty) condensations (thickenings) vvhich, in places, have a whitish shimmer. The pleura visceralis is moderately thicker.* over middle and lower lobe; on it. are fine, warty, fairly soft elevations. Thei were also exoi6lons made In several places of the pleura visceralis. Smooth healing of wound. -Histological findihrs of excision materials (Prof. FHAMZ, Hamburg): a) Te3t excision from pleura p&rietalis: Fottblnderowebestueck (piece of fat-tissue 7) with infiltration by big tumoroells in loosened formations. At the edge small-celled, in flammable infiltrations. iext to it coagulated masses with tho same tumor-cells: liali'nant blastema (7). (blastonere 7) b) Teat oxcision from pleura visceralis: Kags of tissue from tumor-coils among them asbestos corpuscles: a + b: Malignant blastema and asbestos corpuscles. The look of tho cells of the malignant blastema very much suggests ploura-cndotliolio-m.. Our method of diagnostical process not only gave the x-ray therapeutist a sure explanation with regard to kind, oxnansion and way of growing of the tumor for his x-u-ay plan but alGo led to the proving of asbestos corpuscles in the tumor tissue. HOKLKANN's investigations (examinations) with dissections, und experiments with