Document R2Y5KjZy256QBRVXpRKJmLK7X

FILE NAME: Pennsylvania (PA) DATE: 1967 Apr DOC#: PA033 DOCUMENT DESCRIPTION: Journal Article - Mesothelioma and Asbestos Exposure 08/06/2003 WED 09:39 FAX 312 996 1899 UIC LBS CHICAGO 002 oiled animal expothe literature. orted in part by eonn part by grant No. il Air Pollution, US ore Common Gases; y Tract, Areft Inurn r Effects of Gas Poi- x, W.C.: Permanent Warfare, Amenr Sn> . of Irritant Gases J Induat Hyg SiS90, donee of Pulmonaiy to Vesicant and / 2:862, 1993. tea and Fumes, Proc Gases and Chronic 610, 1954. ts of Gassing, Med > Accident in Brook- Respiratory of v>oa Poisoningi J to Long-term Effects A m tr Rev Keep DU s Pulmonary Inauffix Disease, Amar J ted Studiee on the g. New Haven; Yale ting, H.; Pulmonary i Phosgene, Amer J ;es on Experimental tft 28(1037,1947. a Moasanverglftoag OeuUch Med Wtchr UG- Hutopathology >atft 78(544,1864. i ; and Hatch, T.; jy Phosgene, Arch 1be willing to as and cora le action th a t roe / A lpha 659 Mesothelioma and Asbestos Exppsure Jan Lichen, MD. and Harry PUtauiha, MD, Harritburg, Pa W it h in the past five years several arti cles have called attention to the association between mesotheliomas of the pleura and peritoneum with asbestos exposure.1-1 ''W agner et al` studied 33 cases of meso thelioma. All but one had probable exposure to crocidolite, the blue asbestos. Asbestos bas become a ubiquitous materi al in our civilization. Cauna et als reported that asbestos bodies were found in the lung smears of 41% of 100 consecutive autopsies at the Presbyterian University Hospital in Pittsburgh. Sim ilar findings were reported by Thompson*7 in 500 consecutive lung smears from Capetown, South Africa, and Miami, Fla. Asbestos bodies were found in 30% of the men and 20% of the women. As bestos has been conclusively associated with increased incidence of lung cancer and other malignancies*'6 and an increasing number of studies associate its presence with m alig nant mesothelioma of the pleura and perito- Pathology Mesotheliomas of the pleura and perito neum are rare neoplasms. Controversy in volves histological types, nomenclature, ori gin, and their very existence. Recently, mesotheliomas as an entity have become generally accepted. Their morphologic vari ability makes classification difficult and dif ferentiation from other malignancies is often a problem. Submitted tor publication June 6, I960; accepted Sept 13. From the Division of Occupational Health, De portment of Health. Harrisburg, Pa. Read before the Ninth International Copper Con gress, Tokyo, October 1966. w Reprint requests to PO Box 90, Harrisburg, Fa 17120 (Dr. Lisbon), Sacconi and Coblenz10 give the incidence of pleural mesotheliomas as 1.1 cases per 1,000 autopsies. Campbell reported; four cases of pleural mesotheliomas in 3,633 con secutive autopsies.11 M esothelioma occurs primarily in dults and is twice as common in males as in fe m ales.16-12 Pleural mesotheliomas occur equally on the right and left though Weiasman feels that pleural mesothelioma occurs on the right more frequently than on the left sid e .12 T he criteria for diagnosis of pleural meso thelioma are presence of a firm pleural mass encasing the lung, histological structure compatible with mesothelioma, and absence of a demonstrable primary malignant neo plasm elsewhere. The histologic architecture may be mesenchymal, "epithelial," or m ixed. A com plete autopsy is necessary for une quivocal diagnosis, but for the purpose of this study, criteria were made less rigid in that unautopsied cases were accepted if a definite d iag n o sis o f / p le u ra l mesothelioma had been made by biopsy, and malignancy elsewhere had been' excluded clinically; chest x-ray examination, bronchoscopy, and cytologic studies of sputum or bronchial washing assisted in excluding the presence o( bronchial carcinoma. Primary tumors of the peritoneum are among the rarest of tumors. Generally called mesotheliomas, they form large spreading masses over the peritoneum and histologi cally appear the some as pleural mesothe liom as. As with pleural mesotheliomas, ex clusion of a primary tumor is necessary. T his study is an attempt to learn the ex tent of the relationship of asbestos exposure with mesothelioma diagnosed in southeast ern Pennsylvania. A rch E nuiron H ea lth -- V oi 14, A p ril 1967 SC-ALL-12901 SCF-FA-5921 n/nr>/20Q.l IIEP 09:41 FAX 312 996 189j UIC LHS CHICAGO @003 560 MESOTHELIOMA--LIEBEN & PISTAW KA M ethod T able 1.-- R eadings of C onsultant P atholopM tionai sects' One hundred and sixty-two hospitals serving Casa a population of BV4 million people were re No. Mesothelioma Asbettos B o d ie s of 8, besoi quested to report all mesotheliomas diagnosed ]-0 Yes No lung tissue p a ta between 1058 and 1968. R eplies were received 3 0 Not acceptable Yas age o! from 162 hospitals. Hospital records of 62 re 4-0 Probably not No lung tissue from ported cases were reviewed and only mesothe 5 0 Ye* Yes fot II liomas confirmed by operation, biopsy, or au 6-0 Probably not 9-0 Probably not YNooslong tissue Pal topsy were included in the study. Forty-two 10-0 Yes Yes eases satisfied our enters. There were 34 meso 2-N Ves No lung tissue beBloi theliomas of the pleura and eight of the perito ' 3-N Probably not No lung tissue he liv neum. Among the pleural mesotheliomas there 4-N Not acceptable 6-N Yes No lung tissue No lung tissue o thf was a definite preponderance for occurrence on 1-F Yea No lung iiaaug and 6 the right side of die cheat Of 34 pleural meso 2-F Yes No lung tissue ing W theliomas only seven occurred an the left side, 3-F Yes No lung tissue Pat 25 on the right ride, and two were not stated. I-Q Probably not 2-0 Yes No lung tissue Yes ' beatos Sections of as many of the tumors and lunge * Q Yes 1*0 hia dt as possible were borrowed and reviewed by a 5-Q Probably yes No the et single consultant pathologist familiar with mes otheliomas. In the 16 instances In which lung 6-0 Not acceptable 7-0 Yea 8-Q Yos No No lung tissue No in the Pat sections were available, they were examined for 9-Q . Probably not No street the presence of asbestos bodies. A ll slides were 10-Q May be Metast NO conne reviewed without the benefit of the complete 1-X Yes . 2-X Y*s Yes Pat No lung tissue history and autopsy protocol available to the 3-X Not acceptable No lung tissue tribub iryrl pathologists who made the original diagnosis. Results of the 33 cases reviewed (Table) by 4-X Not acceptable 6-X Anaplastic malignancy No lung tissue No familj withir our pathologist agreed with those of the outside 6 X Probably not No plants pathologists in 17 cases; he rejected seven cases 7 -X No epithelial calls No lung tissue Mesothelioma must be proven mesot hb unacceptable histologically, had serious B-X Probably not No lung tissue Pat doubts in nine cases (of these one slide was 9-X Yes No lung tissue storag read as metastasis and one slide as anaplastic 10-X Y es' Yes plant m alignancy). Ot the 15 cases in which lung tis sue was available, asbestos bodies were iden tified in seven. The discrepancies between the original pathological diagnosis and that of our patholo gist are reported to illustrate the difficulties and disagreements which are so frequent in the diagnosis of this tumor. For inclusion in this study the diagnoses, of the originally reporting pathologists have been accepted and cases re ported by them were investigated. Efforts were made to obtain a complete em ployment and residence history for each pa tient, Inquiry was also made into the employ ment history of family contacts. B ata were obtained from the individual if alive, from fam ily members, or employers. Of the 42 patients, ten1had definite occupa tional exposure, to asbestos during lifetim e, three were family contacts of asbestos workers, eight either lived in the immediate neighbor hood of asbestos plants or had been employed next to an asbestos p lan t Ten patients had a questionable asbestos exposure and, in the oth er 11 patients, either no asbestos exposure Exposure ot Ten M esothelioma Patients Who Worked W ith Asbestos.--Patient 1-0 worked 35 years in the textile department of a large as bestos plant. Patients 2-0, 8-0, and 4-0 worked more than 20 yean In asbestos insulation plants and pa tient 5-0 worked in an insulation plant for only one year. Patient'6-0 worked 16 years in a plant manu facturing acoustic tile and linoleum. . Patient 7-0 was a boiler maker in a railroad yard where, for 25 years, he worked on insula tion of steam engines. Patient 8-0 built bakery ovens in which large amounts of asbestos insulation were used. Patient 9-0 was a certified accountant who worked more than 30 years in the office of an asbestos textile plant Patient 10-0 was a plasterer who came in contact with a large amount of asbestos in his work. Of these ten men, patients 1-0, 8-0, and 10-0 had mesotbeliomaa of the peritoneum; the oth er aeven men had pleural mesotheliomas. no as' plant bestos cases Pat tienta pleare Me tacts I year-e eagim that i and 1, ally. Pat: any ot ther b plant works neigh! had v Pat any a an at work could be elicited on direct questioning or no Neighborhood Cases,.--Patient 1-N was a 55- survivor could be located. year-old woman who never had any occupa- years, prior Arch Environ Health-- P o l Jtf, April 1967 08/06/2003 WED 09:41 FAX 312 996 1899 UIC LHS CHICAGO i)004 ant Paihotaght Asbestos Bodies No lung tissue Yes No lung tissue Yes Yes No lung tissue Yes No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue, No lung tissue Yos No No No No lung tissue No No No Yos No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue No lung tissue Yes_________ Patients Who 1-0 worked 35 if a large pa id more than ants and pa tent for only plant manuun. . in a railroad d on lnsula- which large sre used. iuntant who office of an to came in estas in his 0, and 10-0 m; the othlitr \ a 55ay occupa- . > MESOTHELIOM A--LIEBEN & PIST A W K A 561 tional asbestos exposure. H er work was always secretarial; she was bom and lived until the age oi 8, in the im m ediate neighborhood of an as bestos textile and friction m aterial plant whore patient 1-0 had worked for 95 years. From the age of 18 she lived for 80 years across the Btreet from the plant where patient 8-0 had worked for 15 years. Patient 2-N , a clergyman from 1936 until his death in 1961. never had any occupational as bestos exposure. Prior to becoming a m inister he lived for 19 years within one half of a m ile of the insulation plant where patients 9-0, 4-0, and 5-0 had worked as insulation manufactur ing workers. Patient 3-N never had any occupational as bestos exposure except that, 20 years prior to his death, h e had worked for one year across the street from the insulation plant mentioned in the history of patient 2-N . Patient 4-N worked for 28 years across the street from the insulation plant mentioned in connection with patients 2-N and 3-N. Patients 6-N , a nurse, and 6-N, a meat dis tributor, had no occupational exposure nor fam ily contact w ith asbestos. T hey both lived within three fourths of a m ile of two asbestos plants in a town w ith the greatest incidence of mesothe' i'^mas in this study. Patier. 1 7-N and 8-N were both foremen in a storage battery plant. A careful cheek of the plant and their employment records revealed no asbestos exposure, past nor present. T he plant is located leas than 1% m iles from an as bestos textile plant. T he exposure of these two cases is questionable. Patients 1-N and 4-N had peritoneal and pa tients 2-N , 3-N, 6-N , 6-N, 7-N , and 8-N had pleural mesotheliomas. M esothelioma Patients W ith Fam ily Con tacts Exposed to Asbestos.--Patient 1-F, a 3- y ear-old child, was the daughter of a ceramic ..engineer who worked In an insulation plant that utilizes 400 tons of Canadian chrysotile and 1,600 tons of South African am esite annu ally. Patient 2-F, a 40-year-old nurse, never had any occupational asbestos exposure, but her fa ther had worked for 35 years In the insulation plant where patients 3-0, 4-0, and 5-0 had worked and which was also credited with three neighborhood coses. T he nurse's brother also had worked in this plant for one year. Patient 3-F, a 87-year-old woman, never had any asbestos exposure nor had she lived near an asbestos plant. She had two sons who worked as insulators in a shipyard for six yearn These sons lived at home until 16 years prior to their mother's death. Patients 1-F and 3-F had peritoneal and pa tient 2-F pleural mesotheliomas. M esotheliom a Patients W ith Questionable Asbestos Exposure.--A study of these ten men elicited either a relatively minor or question able exposure to asbestos. Patient 1-Q was a welder for 35 y ea n . Ac cording to a common reference,111 eight out of 12 welding electrodes contain asbestos, which is used as a filler. Patient 2-Q was a self-em ployed Swiss-born Swiss cheesamaker. A thorough study of the processes of Sw iss cheese manufacture revealed no use of asbestos. D urin g.th e study of the manufacturing process a 500-gal boiler was no ticed. This boiler was covered with a friable as bestos insulation which flaked off on con icf Patient 3-Q, a 14-year-old boy with meaoth. iiema, had no occupational contact with asbes tos nor did any of his fam ily. On questioning, the boy's father told the authors that his boy had lived w ith him and had helped him while ho had replaced m ost of the plaster board dur ing extensive remodeling of his house. Plaster board contains a high percentage of asbestos. Patient 4-Q is employed in industrial sales and never had any occupational asbestos expo sure. Extensive questioning revealed that, on (wo occasions several years before, he applied asbestos insulation to boilers in h is homo, mix ing asbestos cem ent him self. H is total exposure during these applications was only a matter of hours. Patient 5-Q was a brewery worker for 20 yean . The brewery was no longer In business when the case was investigated. Reviewing the literature of beer production the following paragraph was discovered: "When ready for packaging the beer is fil tered through pulp filters consisting essentially of cotton fibers and asbestos. A fter each filtra tion this -FILTE RMABB' is removed, mangled, and washed in clear, warm water, then bleach ed and sterilised at 160 to 180 F with chlorine. T he washed pulp then goes directly to a padforming m achine where it is compressed at 89 to 90 pounds per square inch to form new filter pads.1*" Asbestos-containing pipe insulation is used in breweries. Patients 6-Q, 7-Q, and 8-Q were all steel workers. Patient 6-Q was a crane operator; 7-Q a forger; and' 8-Q a foreman and supervisor. In all cases the companies did not recall any as bestos expoeuiB for these men. P ipe insulation containing asbestos is extensively utilized by steel companies. Patient 9-Q was a spinner in a silk company Arch Enuiron Health--Val 14. April 1967 3 8 / 0 6 / 2 0 0 3 tVED 09:43 FAX 312 996 1899 UIC LHS CHICAGO @1005 562 MESOTHELIOMA--LIEBEN & PISTAWKA from 1926 to 1938, and later in a plastic fabri cation plant which utjjized fiber glass; be also had bean a welder for 26 years. He thinks he has used asbestos but could not recall when and where. Patient 10-Q, a 63-year-old man, was a core-maker all his life. He worked In two foun dries in one of which asbestos cement ia used in small quantities but, according to the plant manager, the core-maker did not have any con tact with this material. The son stated that his father had used asbestos pipe insulation for pipes in the basement of their home several years prior to the onset of his illness and that he had done some sawing of this pipe insula tion material, All cases in this group had pleural mesothe liomas. Mesothelioma Patients Without Asbestos Exposure.--In the other 11 patients (1-X to 11X) no occupational, familial or neighborhood asbestos exposure evidence could be elicited. Ten of these patients had mesothelioma of the pleura and one peritoneal mesothelioma. Comment T his study presents a good deal of circum stantial evidence and m any unanswered questions. A sbestos is a ubiquitous m aterial used much more frequently than is generally real ised. Some uses, such as in the brewery, were not previously known to the writers. There are undoubtedly m any others. If we assume that asbestos m ay be the causative or trigger agen t for m alignant m esothelioma in som e o f th e cases described above, w e m ust adm it that the minimal dose-effect relationship and duration of a latent period are unknown. The. occupation al exposure of th e insulation workers' or as bestos textile workers w ere certainly many thousand tim es higher than those of the neighborhood cases or fam ily contacts. Sim i lar findings have recently teen reported from England.* T he attack rate for m esotheliom as is ex- Ciergyman Pillent Z-N -N4-N Nur Patient 2-F Occupational, neighborhood, and family contact patients with mesothelioma associated with one insulation plant. Arch Environ Health--Vol 14, April 1967 FAX 312 996 1699 UIC LHS CHICAGO @ oo i deal o f circumny unanswered i m aterial used a generally realn the brewery, to the writers, ly others, os m ay be the for malignant cases described t the minimal duration a! a Ire occupation- workers or asrta in ly many i those of the contacts. Simibeen reported leliom as is ex- . 1 MESOTHELIOMA--LIEBEN & PISTAW KA !' tremely low. N ot a ll mesotheliom as were re... .. ported to us by the hospitals, but, even if we double the incidence, only a m inute fraction of the exposed population was affected. Thera are precedents for this w ith beryllium disease which acts in a somewhat sim ilar pattern; occupational diseases, fam ilial con tacts, neighborhood cases plus a very low attack rate, and a long latent period be tween exposure and onset of disease. Another question which arises is why pleural m esotheliom as are so much more frequent than peritoneal m esotheliom as. T he m ost striking finding of this study was that of the 42 m esotheliom as which came from a geographical area of approxi m ately 30,000 aq m i, six were clustered in and around an insulation plant (F igu re). These included tw o insulation manufactur ing workers (C ases 2-0 and 3 -0 ), three neighborhood cases (C ases 2-N , 3-N , and 4N ) and one fam ily contact (C ase 2 -F )--the daughter of an Insulation worker. Sum m ary Forty-two cases of mesotheliom as report-1 ed from 152 hospitals over a fivB-year peri-1 od, were studied w ith regard to exposure to j asbestos. Survivors or employers, or b o th ,' were questioned regarding the possibility of asbestos exposure. T en patients actually worked in asbestos plants; eight lived or worked close to an asbestos industry; three patients were fam ily members of asbestos workers, h i ten patients a history of as sumed exposure to asbestos was obtained after prolonged questioning. In 11 other p a -. tients no history of asbestos exposure could be obtained. R eferen ce 1. Newtiouss, M l , and 'Hompaon, EL: Mesothe lioma of the Pleura and Peritoneum Following Bxpoauro to Asbestos in the London Area, B rit J Induetr M ed 221261-269, 1966. 2. Hburihane, P.O.: T he Pathology of Mesotheiiometa and an Analysis of T heir Association With Asbestos Exposure, Thorax 19:268-277, 1964. 8. SeUkoff, U .; Cburgh, J.; end Hammond, C.: Exposure to Asbestos and Mesothelioma, NeOi Eng J M ed 272i660-668 (M arch) 1966. 4. Wegner, J.C.; Sleggs, CIA.; and Marchand, P.; Diffuse Pleura) Mesothelioma and Asbestos Expo sure in N,W. Cape Province, B rit J Industr Med 17:260-271, 1960. 5. Cauna, D.; Totten, R.; and Grass, P.: Asbestos Bodies in Human Lunge et Autopries, JA M A 192371-378 (May 3) 1963. C Tiompsnn, T.G.; Kaacbula, R.O.; end MacDon ald, . J l ; Asbestos as a Modern Urban Hazard, S A fr M ed J. 37:77-81 (Jan ) 1909. 7. Thompson, J.Q.: Asbestos and Urban Dweller, read before the Conference on Biological Effects of Asbestos, Hew York, Oct 19, 1964. 8. Doll, R.: M ortality From Lung Cencar in AsbestOB Workers, B rit J Induetr M ed 12:81, 1966. 9. Iieben, J.: Asbestos end Malignancy, Arch E n viron H ealth 18319-621 (Nav) 1966. 10. Secconi, A., end Coblsnx, A : Endothelioma of the Pleura, W ith R eport of Two Cases, A m er J Clin Path 13:166-207, 1943. 11. Campbell, W.: Pleural Mesothelioma, Amer J Path 26)473-487. 1950. 12. Weissman, H .: Prim ary Endnthelia of the Pleura. Die Cheat 12:562-670, 1946. 18. Lyman, T . (ed.): M etals Handbook: I . Prop erties and Selection of Metals, ed 8, American Socie ty of M etals, 1961, p 6. 14. M odem Chemical Proceuea, New York: Reinhold Publishing Co-, 1852, vol 2, p 167. 4u rte alleni 2-F DISCOVERY OF QUININE Many of the drag sources known in ancient times were apparently discovered by acci dent. For example, according to an old South American Indian legend, the curative power of cinchona bark (containing quinine) for malaria was discovered by a sick, fe verish Indian lost in the jungle. He quenched his thirst by drinking from a pool of water. From -the bitter taste of the water, he recognised that it was tainted with the poison from the qnma-quina tree. Although he shared this fictitious belief, he drank deeply so as to bring about a quick death. To his great surprise, he recovered completely. When he returned to his village, he told the store of his cure and thereafter rinchnna bark was used as a medicine for the fever prevalent in that region. The Incas later taught the Spanish conquistadors that malaria could be cured with cinchona extract-- Rossman, R.E.: The History and Significance of Serendipity in Medical Discovery, Trans Coll Physicians Phila 33:104-120 (Oct) 1966. Arch Environ Health--Vol 14, April 1867