Document LovKq2zOVj4eqgRagzXQ9Rnxq

THABSL A T I 0 1? pneumoconiosis developing aftj* inhalation of polyvinyl chloride by Sscndc B, Lapis K., Pinter A., Nemos;A. and TarJan E. (Sommclwcis Medical University. 1st Institute of Pathological Anat my, Uth Surgical Clinic, and the Lung Clinic) Orv. Hctil. 112:05-6, Jan. 10, 1971 In the course of the last few decades polyvinyl chloride (I'Ve) jias become widely used not only in industry but also in clinical medicine. Generally speaking, PVC is inert to the tissues and has been .regarded as & 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 tt,3). In one of these publications the authors reported t'-'at granulation tissue developed ar und PVC particles implanted into'the muscle tissue of experimental rabbits fl). According to Roe ct al. [2), subcutaneous implantation of polyvinyl nlantic 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 res mbling pneumoconiosis in the lungs following prolonged inhalation of PVC powder. CAGE ReTORT ' B.S., a man aged 31, vas 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); pneumound (uigiocardioagraphy failed to show right-sided or left-sided shunt. Respiratory function: at rest the findings were normal, but on effort the function appenred to be impaired (see tabic). Blood picture: erythrocytes 6,800,000, leukocytes 6000, lib 13.5?, color index 0.9* ESR: 9 mra/h. To investigate the changes in the lines, biopsy was token from the tip f 2 the lingula. Two light-gray pieces of lung tissue of pea size and plumstone size respectively were investigated. Morbid histolocical investigations cf the lung samples revealed diffuse fibrosis of moderate degree and severmal lesions arra'nged in small foci. m " l At several points it could be seen that the center of the lesion was occupied by a foreign material. Some of this material was slightly eosinophilic and some shoved weak basophilic staining. There were 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 and 15 - I?5 n > diameter. 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, ih places arranged conccntricall In other parts of the lungs numerous heart failure cells containing hemosiderin could be seen in the bunens of the alveoles (Pigs. 2 and 3). t* Table 1 m Patient B.$. Results of examinations concerning the respiratory function before the biopsy ` VC: >600 ml (* 102) , '-- . KIVI*: 39*0 ml (792) Residual volume: 730 ml - Residual volumo/total capacity: lb# Total capacity: 5330 ml (97*) Resistance: 2u.6 sra iljO/liter/sec. C|? 0.033 t/mra HgO Oxyergospiroxetric investigation: *5 V; V0g 900 ml Pn02 * 72 Hg mm PaCOj bl Rg mm At 90 V the patient becomes cyanotic and his PO2 . ia equal to b9 HG mm. . ,, -_ ________________________________ 065186 `Tronslat r'i note: Abbreviation uncertain, possibly "inspiratory roe rvo v lumc" 3 ATtcr the arrival or the histol cical report the patient van questioned and stated that about 1 year earlier he hod 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 anojnncstic,data, we treated the secti ns with 10? solutions of cyclohexanone in benzene, which is a solvent f r 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 the whole remained unchanged. \I Fig. 1 - Chest X-ray of patient. BS: on both sides the structure seemed . to consist of strands and small dots. ucc u Fie*2 Foreign-body granuloma in the lung tissue {JI.E. x 100) Pisev.r.uion On the basis of the case history and the histological picture ve regarded the lesions as pneumoconiosis caused by aspiration of rvc dust. The shape and the staining properties of the fnreign-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. Tig. 3 - The granuloma under higher power. -Foreign material and the surrounding cellular elements are clearly visible ()I.E. x ^50) f ucc 085188 As it seemed Impossible to demonstrixtc even by chnmical means the +* presence of rvc in the lunc samples investigated by u:;t we collected samples of PVC dust from the place vhcrc the patient had been working. Microscopic examination of the dust particles choired them to be morpho- logically similar to the foreign-body particles found in the lungs. This material is treated vith solvents and stabilizers only at later stages of the production, and thus the harmful influence of these factors, assumed by other authors [1], could not possibly play a part in our ease. >i We believe that the-best approach to this problem would be aspiration nr the I'Ve dust, in question by .experimental animals followed by histological 'investigation of their lunc tissue, and vn arc now earryinr. <out experira-.-ntr. in this .direction. Our present observations can of course oniy be etnirinacil 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 pneumoeonic-sis-causing agent* could be enlarged by inhaled PVC. Suci; 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 prblongcd 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 . ' '' * ' Lung 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 pneumoconiosis. ucc 065189 We fire indebted to Kiss Mona Tarezy (Plastics Research Jnr.i.j tut'*) f r valuable advice on questions f chemistry. References i. (iiu-t. W. U nml m. J. 4,\ma. >:hu. ;a i. wm. -- K. J. **. It. C. v.: IWT. 11., h!7. -- 3. .''.'itfiii. J.. tUrjniiiii, I., Vtilarkci, M.l Moi. <-*'* lain. SS. -- -1. llrii. Mol. J. I Sufi. 5. !hU. Kiwi. I ucc 065190