Document ym5NazMjEovGdbxL77YqbjDkD

Case Reports Pleural Mesothelioma and Neighborhood Asbestos Exposure Findings From Microchemical Analysis of Lung Tissue Alt Fischbein, MD, Arthur N. Rohl, PhD IN 1978, we reported a case of malig nant pleural mesothelioma with un usually long survival. In that report we detailed histopathologic and im munologic observations that may have been related to the long-term survival.' See also pp 68, 91, and 96. In this article, wp summarize the clinical course and relate the probable etiology of the disease to an unusual type of asbestos exposure. Report of a Case A male patient, born in 1924, was well until the beginning of 1970, when he noted a gradual increase in shortness of breath and sharp pain in the right side of the chest. He experienced repeated pleural effusions and was found to have malignant pleural mesothelioma. He was not given chemotherapy or any specific treatment for the disease, which showed a very slowly progressing course. In December 1979, there was a rapid deterioration in the patient's clinical status, with marked progress of the chest roentgenographic abnormalities (Fig 1). The patient had respiratory failure and died at the begin ning of January 1980. The occupational history did not reveal From the Environmental Sciencea Laboratory, Department ot Community Medicine, The Mount Sinai Medical Center. New York. Reprint requests to Environmental Sciences Lab oratory, Department ot Community Medicine, The Mount Sinai Medical Center, 1 Gustave Levy PI, New York, NY 10029 (Dr Fischbein). any direct occupational exposure to asbes tos, but the patient had been employed in a factory adjacent to a major navy yard in New York City from 1957 to 1966. During that period, the activity of ship building and ship repair was high at this navy yard. A section of lung parenchyma was digested in a solution of sodium hypochlo rite, and the residue, including inorganic mineral particles, was prepared for analy sis by polarized light microscopy (PLM) and transmission electron microscopy (TEM).1 The residue observed by PLM contained both coated fibers (ferruginous bodies) (Fig 2) and uncoated crystalline fibers (Fig 3), possibly amphibole fibers. They were 2 to 3 pm in length and 1 pm in diameter and could not, therefore, be positively identified by PLM. The residue was, therefore, also ana lyzed by TEM. A large number of amphi bole asbestos fibers were observed that were both uncoated and coated with ferri tin granules (asbestos bodies). The amphi bole identity of fibers was further con firmed by selected-area electron diffrac tion. Microchemical analyses were ob tained on both fibers and asbestos bodies. The uncoated amphibole fibers were iden tified as amosite, as were the cores of the asbestos bodies. Microchemical analysis and morphological characterization also confirmed the presence of lesser amounts of chrysotile asbestos. Comment Asbestos-related disease is emerg ing as a major public health problem in many countries throughout the world. Widespread use and occupa tional exposure to asbestos in US Fig 1 --Chest roentgenogram showing ad vanced stage ot mesothelioma. Right lurq is almost completely encased by pleural tur'y Note "scalloping" of pleura of left sioetypieal roentgenographic feature of mesothe lioma. shipyards, particularly during World War II, is one reason for the currentl; high incidence of asbestos-related diseases, including lung cancer anc mesothelioma.1 There is typical 1. long latency period between asbesro; exposure and resulting disease. The disease-causing potential of airborne asbestos has been proved to react beyond factory gates, and cases of mesothelioma have been reported it persons residing in the vicinity o1 asbestos-using industries.*' This case seport lends additional] credence to our earlier suggest lot1 that exposure to asbestos in tht| neighborhood of the shipyard may ^ related to the development of malig' nant mesothelioma in this particular 86 JAMA, July 6. 1984--Vof 252, No. 1 Pleural Mesothelioma--Fischbein 1 f f \ `t l ; .A;: r. Fig 2--Electron photomicrograph of asbestos body in lung tissue, entirety coated with ferritin except upper tip (arrow) permitting the core fiber to be identified as amosite by microchemical analysis (inset) Fig 3--Electron photomicrograph of amosite fiber found in lung tissue. Fiber about 6 pm in length is identified by its rrucrochemical analysis (inset) and crystal structure analysis patient. The identification of amosite asbestos fibers in the lung tissue of o 't patient provides plausible evid e for this etiologic connection. Amosite asbestos is not found in the lungs of persons from the general population, and its occurrence, there fore, indicates either an occupational exposure or an exposure to a specific environmental source. Although only a very small portion of the total amount of asbestos used consists of a iite, this asbestos type is com- r ly used in shipbuilding and repair and was used a great deal in the shipyard adjacent to which our patient worked. Of added interest is a previous but unpublished observation of ours of a patient who resided a few blocks from the same shipyard and who experienced the development of malignant mesothelioma at the age of 29 years. In that case, there was potential for neighborhood asbestos exposure since childhood, which ex plains the young age of that patient; amosite asbestos fibers were also found in the lung parenchyma. Reference* 1. Fischbein A, Suzuki Y, Selikoff IJ: Unex pected longevity of a patient with malignant pleural mesothelioma: Report of a case. Cancer 1978;42:1999-2004. 2. Linger AM, Ashley R. Baden V, et al: Identification of asbestos in human tissues. J Occup Med 1973;15:287-295. 3. Selikoff IJ: Occupational respiratory dis eases, in Last J (ed): Public Health and Preven tive Medicine 1980, ed 11. New York, AppletonCentury-Crofts, 1980, pp 568-644. 4. Wagner JC, Sleggs CA: Diffuse pleural mesothelioma and asbestos exposure in NW Cape Province. BrJInd Med 1960;17:260. 5. Newhouse ML, Thompson H: Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area. Br J Ind Med 196522:261. Hypotension and Cardiopulmonary Arrest Associated With Concurrent Haloperidol and Propranolol Therapy Harold E. Alexander. Jr. MD; Kathleen McCarty, MD; Martin B. Giffen, MO dditioJ1 lgges in d mayj sf ms iarticu( ain & ^ .OPERIDOL exerts its antipsy1 :ie effect presumably through po'tr.: blockade of central dopamine = me University of Texas Health Science '-enifrr Sen Antonio Reonnt requests to Department of Psychiatry. Un'vo-vTy of Taxes Health Science Center at Sen 7703 Floyd Curl Dr, San Antonio. TX 78284 ' " - lander) receptors' and has caused hypoten sion in some patients. Propranolol hydrochloride is a /3-adrenergic recep tor blocking drug that is widely used in treating hypertension. A review of the literature does not disclose ad verse effects in patients from a com bination of haloperidol and proprano lol. We report herein a patient who had three episodes of hypotension and two episodes of cart^opulmonary ar rest after taking concurrent oral doses of haloperidol and propranolol. Report of a Case A 48-year-old white woman with a 27year history of schizophrenia was first admitted to our hospital in 1980 At that time, the patient was treated with July 6. 1984 -- Vol 252, No 1 Haloperidol and Propranolol--Alexander et al 87