Document jaJ4Kd41K7wX046602KL5MLR

TRAH5L A T I 0 I! rWHJMOCONIODIS DEVELOPING AFT1H INHALATION OF POLYVINYL CHLORIDE by Csende 0, Lapis K., Pinter A., NemosA. ond TarJan E. (Scmmclwcis Medical University. 1st Institute of Pathological Anat n\y, Hh Surgical Clinic, and the Lung Clinic) Orv. Hctil. 112:05-6, Jon. 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 cdie,x. . Generally specking, FVC is inert to the tissues and has been .regarded, os 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 In one of these publications the authors reported t'<at granulation tissue developed around PVC particles implanted into' the muscle tissue of experimental rabbit3 [l]. According to Roe et al. (2), subcutaneous implantation of polyvinyl nlantic 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 FVC powder. CAGE RETORT ' 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 doited shadows becoming Censer toward .the hilus (Fig. l); pneumound ar.locnrdioar.rnphy 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 6,600,000, leukocytes 6000, Mb 13.52, color index 0.9, ESR: 9 mm/h. To investigate the changes in the lings, biopsy was taken from the tip of 2 the lingula. Two light-gray pieces of lung tissue of pea size and plumstonc size respectively were investigated. Morbid histolocieal investigations of the lunc samples revealed diffuse fibrosis of moderat decree and several lesions arranged in small foci. * ' i At several points it could be seen that the center of the lesion was occupied by a foreign material. Some of this material van 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 ishapc* and 15 - 23 in diameter. The foreign material vao surrounded by granulation tissue consisting of histiocytes, lymphocytes, plasma cells, eosinophil cells, and foreign-body giant cells. In the same granulosis there were olso connective tissue fibers, lh places arranged concentrically In other parts of the lungs numerous heart failure cells containing hemosiderin could be seen in the Vunens of the alveoles (Pigs. 2 and 3). Table 1 Patient B.S. Results of examinations concerning the respiratory function before the biopsy VC: 4600 ml ( 10S) . mi*: 3950 ml (792) . -- Residual volume: 730 ml - Residual volunc/total capacity: 14J Total capacity: 5330 ml (972) Resistance: 26.6 so HpO/liter/scc. Ct? 0*032 i/am HpO Oxyergospirometric investigation: 45 V; V0p 900 ml P0O2 * 72 Ilg mm P0CO2 4l Hg mm At 90 V the patient becomes cyanotic and his PO2 , . . 4* to 49 HG mm. . ucc _______________________________ 06S186 Translator's note: Abbrevlati n uncertain, possibly "inspiratory reserve v lumc" 3 ATtcr the arrival of the histological rep rt the patient van 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 10S solutions of cyclohcxunone in benzene, 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. i ; ' , !t -- Fig. 1 - Chest X-ray of patient. BS: on both sides the structure seemed to consist of strands and small dots. ucc 06^81 h V* , '*.* * , **%.. < , ' ; r *' ,v*vr V \. ./V \.`r^* r-. < * : * * *. t * ** i ^ ` II Fig.2 - Foreign-body granuloma in the lung tissue (11.E. x 100) r>isc-.:r.;;ion On the basis of the case history and the histological picture ve regarded the lesions as pneumoconiosis caused by aspiration of rvC dust. The shap 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 eellular elements are clearly visible (11.E. x 150) ucc 065188 As it seemed liBpvssible to demonstratc cv n by chemical means the 7*rescnce of PVC in the lung samples investigated hy u::, we collected samples of r/C dust from the place where the patient had been working. Microscopic examination of the dust particles showed them to he morpho- locieally similar to the foreign-body particles found in the lung3* This material is treated with solvents and stabilizers -only at later stages of the production, and thus the harmful influence of these fuetors, assumed by other authors [l) could, not possibly play a part in our case. ... Vc believe that thc'bcst approach to this problem would be aspiration of the PVC dust, iu question by experimental animals followed by histological 'investigation of their .lung tissue, and we arc now carrying out export w.-ulr. in this .direction. Our present observations can of courr.e onjy be confirmed by oxjtcri mental investigations and possibly further observation:', n 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 ogentj 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 ease the foreign bodies found in the lung tissue -- presumably PVC -- were surrounded by marked and severe tissue reaction: this indicates that the material can irritate the tissues. It can be assumed that after prolonged 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 . hung 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 corr sponding to foreign-body granulomas. The authors raise the assumption that aspiration of PVC dust msy lead to pneumoconiosis. ucc 065189 Ve nrc in'lobto; t Hiss rtam Tarexy (Plasties Research Institute) for valuable nuvicc on questions f chemistry* References -- I, (ii.-.'x, U\ I. anil 1:hI, JCV. K J. (.V. i " <; Mi:rh;. ;i. h. C. V..* ;,li;ir.i::.i-l I:*u7. /<!. iijT. -- 3. . J.. fhrjHnni. /., .M.: J.SJt. Sul. -- -l. ili il. Mcl. lSfc*S, 5. I*ul. Swji'K. K*i-l. _ *| 11 * * ucc 065190