Document V3GGkovvBXxw7xy8EZLexBkvo

T n A II S L A TIQH PNEUMOCONIOSIS DEVELOPING AFTER INHALATION OF POLYVINYL CHLORIDE by Gzcndc B, Lapis K., Pinter A., Nemos A. and TarJan E. (Scmmolwcis Medical University, 1st Institute of Pathological Anatomy, ^th Gurcical Clinic, and the Lung Clinic) Orv. Hetil. 112:05-6, Jan. 10, 1971 In the course of the last few decades polyvinyl chloride (I'Ve) has 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 [1,3]. In one of these publications the authors reported f'at 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 of the animals. As far as ve 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. l); pneumonnd angioeardioography 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 (see table). Blood picture: erythrocytes 6,800,000, leukocytes 6000, Ifb 13.52, color index 0.9, ESR: 9 mm/h. To investigate the changes in the lings, biopsy was taken from the tip of ucc 041568 2 the lingula. Two light-gray pieces of lung tissue of pea size and plumstonc size respectively were investigated. Morbid histological investigations of the lung samples revealed diffuse fibrosis of moderate degree and several lesions arranged in small foci. * 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 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 shape and 15 - 25 u 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 granulomas there were also connective tissue fibers, id places arranged concentrically. 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). Table 1 Patient B.$. Results of examinations concerning the respiratory function before the biopsy VC: h600 ml (+ 10S) . -- KIVI: 39!iO ml (79S) Residual volume: 730 ml Residual volumc/total capacity: lhJC Total capacity: 5330 ml (97>) Resistance: 26.6 mm HgO/llter/sec. C7 0.032 t/aa HgO Oxyergospirometric investigation: ^5 V: ' V02 * 900 ml Pa02 * 72 Hg mm PaC02 M bl Hg mm At 90 V the patient becomes cyanotic and his POg is equal to *9 HG mm. Translator's note: Abbreviation uncertain, possibly "inspiratory reserve volume" ^ (jCC 041569 3 . After the arrival of the hi3tolocic.il report the .jvillent was questioned and stated that about 1 year earlier he had been working in a plasties 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 cyclohcxunone in benzene, which is a solvent for PVC. Under this treatment the foreign bodies completely dissolved ond dis appeared from the sections. The patient was treated conservatively and kept under observation; his condition on tha whole remained unchanged. \t Fig. 1 - Chest X-ray of patient. BS: on both sides the structure seemed . to consist of strands and small dots. IJCC 041570 r h Fig.2 - Foreign-body granuloma in the lung tissue (H.E. X 100) rHscussion On the basis of the cose history and the histological picture we regarded the lesions as pneumoconiosis caused by aspiration of FVC 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 Known to . cause pneumoconiosis. There, is no specific stain suitable for the histo logical demonstration of PVC, but the successful dissolution of the foreign material with cyclohexanone suggested that the material was ' indeed FVC. Fig. 3 - The granuloma under higher power. Foreign material and the surrounding cellular elements are clearly visible (H.E. x 1*50) ucc 041571 As it seemed iiiijHAisible to demonstrate even by chemical means Uie presence of PVC in the lung samples investigated by us, ve collected samples of PVC dust from the place vherc the patient hud been working. Microscopic examination of the dust particles shoved them to be morpho- ' loGically similar to the foreign-body particles found in the lungs. Tiiis 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 [1], could,not possibly play a part in our cose. v.. We believe that the-best 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 wo arc now carrying out experiments in this.direction. Our present observations can of course onjy be confirmed by experimental investigations and possibly further observations on human patients. On the basis of the information available so far it may veil bo asked whether PVC dust eon cause pneumoconiosis, which would mean that the Group of pneumoconicsis-causing agenti 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 tissues. It can be assumed that after prblongcd exposure the described process may end in acor tissue formation. In our case the dyspnea, the secondary polyglobulia, os 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 corresp nding to foreign-body granulomas. The authors raise the assumption that aspiration of PVC dust may lead to pneumoconiosis* UCC 041572 We arc indebted to Kiss firjna Tarczy (Tinsties Research Institute) for valuable advice n questions of chemistry. Refjrenccs I. (lui'.m, W. I,. ,lnl J. H.f jama, :m. :.;m -- :v i:.\ K J. (.. Jilt, /!. V,: IHtiT, J>`, -- !i. ftirjiliitii, Vd.'HfA'rtl, M..* I-'lW 1 JliT, !>X, 2iil. -- -I. UriL .Veil, J. 1 !*">> J, S/xn'k. ucc 041573 ucc 041574