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Cureus Nov 2021Primary pericardial mesothelioma (PPM) is an extremely rare malignancy with a very poor prognosis. It poses a diagnostic challenge given its often late and non-specific...
Primary pericardial mesothelioma (PPM) is an extremely rare malignancy with a very poor prognosis. It poses a diagnostic challenge given its often late and non-specific presentation. This report describes a 74-year-old man who presented with central pleuritic chest pain and mild breathlessness. The patient was febrile and mildly tachycardic with crepitations in the right lung base. Blood tests revealed raised inflammatory markers and chest X-ray showed no acute pathology. Following admission, CT pulmonary angiogram showed a large left-sided mediastinal mass (approximately 110 x 70 x 85 mm) centered on the pericardium. Further post venous phase CT imaging identified possible myocardial invasion alongside suspicious liver nodules. Later, outpatient fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging highlighted further FDG avid pleural and liver lesions. CT-guided biopsy of the pericardial lesion was undertaken, with histology and immunohistochemistry indicating epitheliod-type mesothelioma. A significant malignant pericardial effusion was also identified, which ultimately required pericardial window formation. Immunotherapy was commenced utilizing dual nivolumab and ipilimumab, a novel regime for the treatment of mesothelioma. Palliative radiotherapy to the pericardial lesion will also be performed. Here, we demonstrate the diagnostic challenge of this vanishingly rare condition, which is usually diagnosed upon the development of associated complications. Early recognition gives the best chance of improved mortality, however, diagnosis requires a high index of clinical suspicion alongside prompt investigation, primarily involving cross-sectional imaging.
PubMed: 34984126
DOI: 10.7759/cureus.19966 -
American Journal of Industrial Medicine Mar 2022Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%),...
BACKGROUND
Vermiculite ore from Libby, Montana contains on average 24% of a mixture of toxic and carcinogenic amphibole asbestiform fibers. These comprise primarily winchite (84%), with smaller quantities of richterite (11%) and tremolite (6%), which are together referred to as Libby amphibole (LA).
METHODS
A total of 1883 individuals who were occupationally and/or environmentally exposed to LA and were diagnosed with asbestos-related pleuropulmonary disease (ARPPD) following participation in communitywide screening programs supported by the Agency for Toxic Substances and Disease Registry (ATSDR) and followed up at the Center for Asbestos Related Disease (CARD) between 2000 and 2010. There were 203 deaths of patients with sufficient records and radiographs. Best clinical and radiologic evidence was used to determine the cause of death, which was compared with death certificates.
RESULTS
Asbestos-related mortality was 55% (n = 112) in this series of 203 patients. Of the 203 deaths, 34 (17%) were from asbestos-related malignancy, 75 (37%) were from parenchymal asbestosis, often with pleural fibrosis, and 3 (1.5%) were from respiratory failure secondary to pleural thickening.
CONCLUSIONS
Asbestos is the leading cause of mortality following both occupational and nonoccupational exposure to LA in those with asbestos-related disease.
Topics: Asbestos; Asbestos, Amphibole; Asbestosis; Humans; Montana; Pleural Diseases
PubMed: 34961951
DOI: 10.1002/ajim.23320 -
International Journal of Medical... Dec 2021Early detection of asbestosis is important; hence, quick and accurate diagnostic tools are essential. This study aimed to develop an algorithm that combines lung...
BACKGROUND
Early detection of asbestosis is important; hence, quick and accurate diagnostic tools are essential. This study aimed to develop an algorithm that combines lung segmentation and deep learning models that can be utilized as a clinical decision support system (CDSS) for diagnosing patients with asbestosis in segmented computed tomography (CT) images.
METHODS
We accurately segmented the lungs in CT images of patients examined at Seoul St. Mary's Hospital using a threshold-based method. Lungs with asbestosis and normal lungs were classified by applying the segmented image to the long-term recurrent convolutional network deep learning model. Performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 score from the test data.
RESULTS
The algorithm developed using the DenseNet201pre-trained model showed excellent performance, with a sensitivity of 0.962, specificity of 0.975, accuracy of 0.970, AUROC of 0.968, and F1 score of 0.961.
CONCLUSIONS
We developed an algorithm with significantly better diagnostic accuracy than a radiologist (0.970 vs. 0.73-0.79). Our developed algorithm is expected to be an excellent support tool if used as a CDSS to diagnose asbestosis using CT images.
PubMed: 34952282
DOI: 10.1016/j.ijmedinf.2021.104667 -
Jornal Brasileiro de Pneumologia :... 2021To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath...
OBJECTIVE
To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD).
METHODS
Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach's alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman's or Pearson's correlation coefficient.
RESULTS
Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (-0.40 ≤ r ≤ -0.74); six-minute walk distance (r = -0.38); and quadriceps muscle strength (r = -0.41).
CONCLUSIONS
The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.
Topics: Aged; Brazil; Dyspnea; Humans; Idiopathic Pulmonary Fibrosis; Lung Diseases, Interstitial; Male; Middle Aged; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34932719
DOI: 10.36416/1806-3756/e20210172 -
Immunotherapy, the promise for present and future of malignant pleural mesothelioma (MPM) treatment.Therapeutic Advances in Medical Oncology 2021Due to occupational asbestosis exposure, the incidence of malignant pleural mesothelioma (MPM) has continuously increased over the last 30 years, with a plateau... (Review)
Review
Due to occupational asbestosis exposure, the incidence of malignant pleural mesothelioma (MPM) has continuously increased over the last 30 years, with a plateau anticipated around the year 2030 in Western countries. Molecular MPM carcinogenesis involves alterations of NF2, RASSF1, LATS2WT1, p16, as well as BAP-1tumor-suppressor genes, which usually regulate apoptosis, cell invasion, motility, cell division, chromatin remodeling, as well as control of DNA repair. In few selected patients, debulking surgery consisting of pleurectomy-decortication is carried out, resulting in unsatisfactory long-term results. For about 15 years, first-line chemotherapy has been primarily based on a doublet of pemetrexed and cisplatin. Adding the monoclonal antibody bevacizumab (Avastin), which targets vascular endothelial growth factor (VEGF), has been shown to improve overall survival (OS) by nearly 19 months. The emergence of immune check-point inhibitors (ICIs) in MPM treatment has recently been associated with substantial survival improvements in both second- and first-line settings. Similarly to non-small-cell lung cancer (NSCLC) patients, on-going trials are presently exploring the chemotherapy-ICI combination in MPM management, and depending on their results, this combination could represent a further major advance in this previously orphan disease. The current article reviews recent clinical trial results, as well as future clinical developments in this moving field.
PubMed: 34917175
DOI: 10.1177/17588359211061956 -
Industrial Health Oct 2022The requirement for compensation for diffuse pleural thickening in benign asbestos pleural effusion include five computed tomography findings of organized pleural...
The requirement for compensation for diffuse pleural thickening in benign asbestos pleural effusion include five computed tomography findings of organized pleural effusion: [1] heterogeneity in the pleural effusion, [2] declined chest capacity, [3] "crow's feet" sign at the pleura, [4] immobilization of effusion volume, and [5] air in the effusion. Pleural effusion is diagnosed as organized, immobilized, and in the state of diffuse pleural thickening if at least three of these items are fulfilled, ([1] and [3] compulsory + one of the remaining items). This retrospective study investigated whether the requirement to confirm no organized pleural effusion changes after a follow-up of >3 months were available for cases fulfilling three of the five items; i.e., the confirmation of only [2] with [1] and [3]. Of 302 cases recognized by the Japanese laws, 105 cases with diffuse pleural thickening with organized effusion were enrolled. The number of subjects who fulfilled the diagnostic requirement for organized pleural effusion was confirmed. Eight subjects had a full score of 5 points, 82 subjects scored 4 points, and only 15 subjects scored 3 points. Furthermore, no changes were observed in the organized pleural effusion volume after a follow-up of >3 months.
Topics: Asbestos; Asbestosis; Humans; Japan; Pleural Diseases; Pleural Effusion; Retrospective Studies
PubMed: 34803129
DOI: 10.2486/indhealth.2021-0099 -
Journal of Clinical Medicine Oct 2021The early diagnosis of malignant mesothelioma (MM) could improve the prognosis of MM patients. To confirm an MM diagnosis, an immunohistochemical analysis of several...
The early diagnosis of malignant mesothelioma (MM) could improve the prognosis of MM patients. To confirm an MM diagnosis, an immunohistochemical analysis of several tumor tissue markers, including calretinin, is currently required. Our aim is to evaluate serum calretinin as a potential biomarker in asbestos-related diseases, especially in MM. Our study includes 549 subjects: 164 MM patients, 117 subjects with asbestosis, 195 subjects with pleural plaques and 73 occupationally asbestos-exposed subjects without asbestos-related diseases. The serum calretinin concentration was determined with a commercially available enzyme immunoassay. Data on the soluble mesothelin-related peptides (SMRP) concentration are available from previous studies. MM patients had a significantly higher calretinin concentration than subjects without disease, subjects with pleural plaques or subjects with asbestosis (all < 0.001). The histological type was significantly associated with serum calretinin: patients with sarcomatoid MM had lower calretinin than patients with the epithelioid type ( = 0.001). In a ROC curve analysis, the area under the curve for calretinin concentration predicting MM was 0.826 (95% CI = 0.782-0.869; < 0.001). At the cutoff value of 0.32 ng/mL, sensitivity was 0.683, while specificity was 0.886. The combination of calretinin and SMRP had the highest predictive value. Calretinin is a useful biomarker that can distinguish MM from other asbestos-related diseases and could, therefore, contribute to an earlier non-invasive diagnosis of MM.
PubMed: 34768395
DOI: 10.3390/jcm10214875 -
International Journal of Molecular... Oct 2021Exposure to Libby amphibole (LA) asbestos-like fibers is associated with increased risk of asbestosis, mesothelioma, pulmonary disease, and systemic autoimmune disease....
Exposure to Libby amphibole (LA) asbestos-like fibers is associated with increased risk of asbestosis, mesothelioma, pulmonary disease, and systemic autoimmune disease. LGM2605 is a small molecule antioxidant and free radical scavenger, with anti-inflammatory effects in various disease models. The current study aimed to determine whether the protective effects of LGM2605 persist during the late inflammatory phase post-LA exposure. Male and female C57BL/6 mice were administered daily LGM2605 (100 mg/kg) via gel cups for 3 days before and 14 days after a 200 µg LA given via intraperitoneal (i.p.) injection. Control mice were given unsupplemented gel cups and an equivalent dose of i.p. saline. On day 14 post-LA treatment, peritoneal lavage was assessed for immune cell influx, cytokine concentrations, oxidative stress biomarkers, and immunoglobulins. During the late inflammatory phase post-LA exposure, we noted an alteration in trafficking of both innate and adaptive immune cells, increased pro-inflammatory cytokine concentrations, induction of immunoglobulin isotype switching, and increased oxidized guanine species. LGM2605 countered these changes similarly among male and female mice, ameliorating late inflammation and altering immune responses in late post-LA exposure. These data support possible efficacy of LGM2605 in the prolonged treatment of LA-associated disease and other inflammatory conditions.
Topics: Adaptive Immunity; Animals; Asbestos, Amphibole; B-Lymphocytes; Butylene Glycols; Chemokine CCL2; Female; Glucosides; Immunity, Innate; Immunoglobulin Isotypes; Immunoglobulins; Inflammation; Interleukin-6; Male; Mice; Mice, Inbred C57BL; Oxidative Stress; T-Lymphocytes
PubMed: 34681644
DOI: 10.3390/ijms222010982 -
Journal of Occupational and... Mar 2022To describe mortality trends of men and women working in various petrochemical and refinery operations of a U.S.-based company.
OBJECTIVE
To describe mortality trends of men and women working in various petrochemical and refinery operations of a U.S.-based company.
METHODS
The cohort consists of full-time employees with at least 1 day of service during 1979 through 2010. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for 111 possible causes of death studied.
RESULTS
SMRs for malignant mesothelioma and asbestosis were highest for the 1940s decade of hire. Increased SMRs were observed for malignant melanoma and motor neuron disease with no obvious work patterns. Decreasing mortality patterns were observed for aplastic anemia and acute nonlymphocytic leukemia.
CONCLUSIONS
Mortality surveillance of this large established cohort aids in assessing the chronic health status of the workforce. Identifying methods for incorporating job-exposure matrices and nonoccupational risk factors could further enhance interpretations for some findings such as motor neuron disease.
Topics: Asbestosis; Cause of Death; Cohort Studies; Female; Humans; Male; Mesothelioma, Malignant; Neoplasms; Occupational Diseases; Petroleum
PubMed: 34670258
DOI: 10.1097/JOM.0000000000002416 -
International Journal of Environmental... Sep 2021Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was...
Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
Topics: Asbestos; Asbestosis; Humans; Italy; Mesothelioma; Occupational Diseases
PubMed: 34639316
DOI: 10.3390/ijerph181910012