Document RpkZz11kZKj7RMzzZOzmBgMK7

PNEUMOCONIOSIS developing after inhalation of polyvinyl chloride by Sscndc 0, Lipis K., Pinter A., Nemos;A. oM TorJan E. (Sommclwcis Medical University. 1st Institute of Pathological Anat my, bth Surgical Clinic, and the Lung Clinic) Orv. ilctil. 112:05-6, Jan. 10, 1971 In the course of the last few decades polyvinyl chloride (I've) ehas become widely used not only in industry but also in clinical mcdir'lnc. Generally speaking, PVC is inert to the tissues and has been .regarded os a harmless substance,and consequently it has been used as the mat rial 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 t^,3). In one of these publications the authors reported tuat granulation tissue developed around PVC particles implanted into-the muscle tissue of experimental rabbits [l). According to Roe et al. [2], subcutaneous implantation of polyvinyl plastic sponge in rats was followed by the development of sarcoma in some f 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, filamentou finely doited shadows becoming denser toward the hilus (Fig. 1); pnriimoand nngiocardioagrnphy failed to show right-aided or left-sided shunt. Respiratory function: at rest the findings were normal, but on effort the function oppenred to be impaired (sec table). Blood picture: erythrocytes 6,800,000, leukocytes 6000, Jib 13.5?, color Index 0.9, ESR: 9 /h. To investigate the changes in the bugs, bi psy was taken fr m the tip of the lingula. Two light-gray pieces of lung tissue of pea size and plumstonc size respectively were investigated. Morbid histological investigations cf the lung samples revealed diffuse fibrosis of moderate degree and several lesions arranged in small foci. 0" 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 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 nlmpe nn.| 15 - n in 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 granulosis there were also connective tissue fibers, ih places arranged concentrically In other parts of the lungs numerous heart failure cells containing hemosiderin could be seen in the limens of the alveoles (Pigs. 2 and 3). Table 1 * Patient B.S. Results of examinations concerning the respiratory function before the biopsy VC: >600 ml (+10?) . -- . KIVI*: 3930 ml (79S) Residual volume: 730 ml - Residual volumc/total capacity: lb? Total capacity: 5330 ml (97*) Resistance: 26.6 am i^O/llter/scc. Ci? 0.032 1/mm HpO Oxyergotpirometric investigation: lij y. VOg 900 ml P0O2 * 72 Hg mm PaC02 1*1 Hg mm At 90 V the patient becomes cyanotic and his PO2 . . is equal to 1*9 HC mm. . ^ _________________________________ 065186 Translat r's note: Abbreviation uncertain, possibly "inspiratory reserve v lumc" 3 ATtcr the arrival of the histological rep rt the patient, vac 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 bentene, 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 the whole remained unchanged. Pig. 1 - Chest X-ray of patient. BS: on both sides the structure oecmed to consist of strands and small dots. fig.2 - Foreign-body granulosa in the lung tissue Ol.E. x 100) Pi scansion On the basis of the case history and the histological picture we regarded^ the lesions as pneumoconiosis caused by aspiration of rvc dust. The shape and the staining properties of the foreign-body particles seen in the center of the granulomas did not resemble any other particles knovn to . cause pneumoconiosis. There, is no specific stain suitable for the histo logical demonstration of FVC, but the successful dissolution of the foreign siaterial with cyclohexanone suggested that the material was ' indeed PVC. * tig. 3 - The granuloma under higher power. -Foreign material and the surrounding cellular elements ore clearly visible (ll.E. x **50) ucc 065188  *'** *. * -4- As it seemed litipwusible to demonstrate even by chnmical means the 7rescnce of T*VC in the lung samples investigated by u:;, we collected samples of PVC dust from the place where the patient had been workinn. Microscopic examination of the dust particles shoved them to be morpho logically 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 port in our case. *1.a>*-.i* We believe that the-best approach to this problem would be aspiration or the f*VC dust, iu question by .experimental animals followed by histological 'investigation of their lung tissue, and we arc now carrying out .experiments in this.direction. Our present observations can of course oniy 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 pncumoconic-sis-causing agent* could be enlarged by inhaled PVC. Such lesions could be important not only from the point of view of differential diagnosis 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 tiisues. It can be assumed that after prblongcd exposure the described process may end in scar tissue formation. In our ease the uyr.pnua, 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 arc inricbtca to Kior. Mona Tarczy (Plastics Research Jur.i.i LijC*) f r valuable nuvicc on questions of chemistry. References i. tnmi s:rj,' jama. ;in,, :oi, I!. C. V,: j;o.\ y. J. 1 :,;t. hi. -- 1 fiiniii, J., birjiihiii, I., Vainrfiit). Ai.i aT. AS. s,,i. -- -l. iliH. Mctl. J. llinl''. 5. !*' *I \JCC 065190