Document njxQzEe998kB1wzqrmqbQnm6

T R A !! S L A T I 0 H PNEUMOCONIOSIS DEVELOPING AFTER INHALATION OK POLYVINYL CHLORIDE by Sicndc D, Lapis K., Pinter A., Nemcs A. and Tarjan E. (Gcmmclvcis Medical University. 1st Institute of Pathological Anatony, Hh Gurgical Clinic, and the Lung Clinic) Orv. Hctil. 112:85-6, 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 medicine. 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 [^,3l* In one of these publications the nuthors reported twat granulation tissue developed around PVC particles implanted into' the muscle tissue of experimental rabbits.(1). According to Roe et al. [2), subcutaneous implantation of polyvinyl elastic 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 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. 1); pneuraoand nnr.iocnrdion/'.rnphy failed to show rigiit-sidcd or left-sided shunt. Respiratory function: at rest the findings were normal, but on effort the function appeared to be impaired (see table). Dlood picture: erythrocytes 6,800,000, leukocytes 6000, lib 13*52, color index 0.9, ESR: 9 mm/h. To investigate the changes in theimgs, biopsy was taken from the tip of ucc 041575 2 the lingula. Two light-gray pieces of lung tissue of pea size and piurnstone size respectively were investigated. Morbid histological investigations cf the lung samples revealed diffuse fibrosis of moderate degree 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 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 -.-.Impo and 15 - 23 < 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, ip places arranged concentrically. In other parts of the lungs numerous heart failure cells containing hemosiderin could be seen in the linens of the alveoles (Pigs. 2 and 3). Table 1 _ Patient B.$. Results of examinations concerning the respiratory function before the biopsy VC: >i600 ml {* 10Z) . KIV1: 3950 ml (79'Z) Residual volume: 730 ml Residual volumc/total capacity: Total capacity: 5330 ml (97*) ll*Z ' --' * . Resistance: 26,6 mm HjO/liter/sec. G(? 0.032 t/naa HgO Oxyergospiroaetric investigation: to5 y. VOj =* 900 ml P0O2 * 72 Hg mm PaCOp * bl Hg mm At 90 V the patient becomes cyanotic and his POg is equal to 1*9 HG mm. Translator's note: Abbreviation uncertain, possibly "inspiratory reserve volume" ucc 041576 3 ATtcr the arrival of the histological report the ,pnlicnt_ was questi ned and stated that about 1 year earlier he^ had been w rking in a plasties factory where he hod to shovel FVC in the form f fine powder, generally in draughty places. Haying thus obtained additional anamnestic data, we treated the sections with 10? solutions of cyclohexanone in bensenc, 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 th> whole remained unchanged. fig. 1 - Chest X-ray of patient. BS: on both sides the structure seemed to consist of strands and small dots. ucc 041577 k / Fig.2 - Foreign-body granuloma in the lung tissue (H.E. x 100) Plscnr.sion On the basis of the case history and the histological picture ve regarded the lesions as pneumoconiosis caused by aspiration of FVC dust. The shape and the staining properties of the1fbreign-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 vith cyclohexanone suggested that the material was ' indeed FVC. % Fig. 3 The granuloma under higher power. Foreign material and the surrounding cellular elements ore clearly visible (II.L. x 1*50) ucc 047578 t\s it seemed juipybsible to demons trnte even by chemical means the presence f TVC in the" lunc samples investigated hy ur., we c lice ted ` samples of PVC dust from the place where the patient had been working. Microscopic examination of the uust particles showed them to he morpho- logically similar to the foreign-body particles found in the lungs. Tiiis material is treated with solvents and stabilisers -only at later stapes of the production, and thus the harmful influence of these factors, assumed by other authors [l], could not possibly play a part in our case. .... 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 vn are now carrying out experiw.nts in this.direction. Our present observations can of course onjy be confirmed by experimental 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 pneumoconic-sis-causing agentz could be enlarged by inhaled PVC. Such 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 narked 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 case the uyr.puca, the secondary polyglobulia, as well as the impairment of th* 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 chances corresponding to foreign-body granulomas. The authors raise the assumption that aspiration of PVC dust may lead to pneumoconiosis. ucc 0-41579 . r; We arc indebted to Hiss Eirjna Tarczy (Plastics 'Research Inr.i.] LjU') for valuable advice on questions of chemistry. Referon ecr. I. \Vt tt, ntid J. ** jama. zm, >:n,% yt j. c.. :Uit* AJiJrJiiV;/, /. I*. V\* i*. mi 3* J., t)n7*Mi*#i, /. Vn.'rtri'fii, A**# 1 JJ(", *x. -- *1. iint. AotL J. J&j:, J, Jvli. &ccrk, K**^L *" * ucc 041530 PVC INDUSTRY Dispersion PVC resin particle size ranges from 10 microns maximum to less than 1 micron. Surfactants are present on the resin particle In a 1 to 2* by weight concentration. Surfactants used are: 1. TERGITOL 08 sodium 2 ethyl hexyl sulfate 2. TERGITOL 4 sodium tetradecyl sulfate 3. Sodium Lauryl Sulfate 4. lauryl Alcohol - usually as a modifier 5. Aerosol OS-10 sodium dodecyl benzene sulfonate 6. Aerosol OT sodium dioctyl sulfosucclnate 7. Aerosol ? sodium dlhexyl sulfosucclnate 8. Ammonium laurate 9. Mersolat K-30 alkyl sulfonate (13-17 carbons) 10. TERGITOL NPY Polyoxethylene nonylphenyl ether 11. Tenneco - Hacker Maleic acid epoxidized amnonlum salt 14 4 ucc 041581