NYC-WTC_000195068

NYC 9/11 Public Portal Document

ASBESTOS MEDITEXT ® - Medical Management Page 2 of 4

postero-anterior view, 7 had normal pleura, 9 had circumscribed plaques, and 8 had diffuse pleural thickening (Schwartz et al, 1990a). Those with pleural thickening had lower FVC, total lung capacity, and CO-diffusing capacity. Those with plaques had reduced FVC. e. Significant pulmonary dysfunction (reduced FEVl, FVC, terminal flow, and increased thoracic gas volume) were associated with pleural asbestos signs (plaques or diffuse pleural thickening) among men who never smoked (Kilburn & Warshaw, 1990, 1990a). Current and ex-smokers had additional dysfunction, even after adjustment for duration of smoking. f. Patients with combined obstructive/restrictive patterns should be followed with studies of carbon monoxide diffusion capacity and static lung volumes (ATSDR, 1990). B. OTHER 1. LUNG BIOPSY - Open lung biopsy is the only definitive diagnostic test for asbestosis (ATSDR, 1990). a. Pathologic diagnosis requires the presence of diffuse interstitial fibrosis and asbestos bodies in tissue sections (Churg, 1989). b. Asbestos bodies identified on a histologic section of a hilar lymph node are generally indicative of a heavy asbestosis lung burden (Roggli & Benning, 1990). c. Asbestos fiber counts in lung may also be useful in confirming a diagnosis of asbestosis and appear in some studies to correlate with severity of pulmonary fibrosis (Green et al, 1997) and with other indices of exposure (Karjalainen et al, 1996). d. The asbestos lung burden has also been used for confirming asbestos-related mesothelioma (Kishimoto et al, 1989a; Warnock, 1989). 2. SPUTUM STUDIES - Sputum inspection for asbestos fibers or ferruginous bodies lacks sensitivity and specificity (ATSDR, 1990; McDonald et al, 1992). However, sputum cytology remains a useful diagnostic test for neoplasia and lung cancer (ATSDR, 1990). Election microscopy analysis of sputum may be effectively used to assess exposure to asbestos (Harber & Smitherman, 1991). 3. BRONCHOALVEOLAR LAVAGE - Bronchoalveolar lavage (BAL) has been recommended as an adjunct in the diagnosis of asbestos-related pulmonary diseases (Barbers & Abraham, 1989; Delclos et al, 1989; Hayes et al, 1989). a. Amosite fibers were noted in a sample obtained by bronchoalveolar lavage and analyzed with scanning electron microscopy-energy dispersive x-ray (Barbers & Abraham, 1989), confirming the diagnosis in a 55-year-old man who had typical clinical and radiologic evidence of asbestosis 36 years after exposure for less than a year, but a negative transbronchial lung biopsy. b. Bronchoalveolar lavage detected significant increases in neutrophils and T4/T8 ratios among 32 asbestos-exposed males compared to controls (Delclos et al, 1989). Because the simultaneously increased gallium scan activity did not correlate with radiological and functional parameters, BAL and gallium scan may reflect inflammation that is not clinically apparent. c. Bronchoalveolar lavage and gallium scans were abnormal in varying proportions of asbestos-exposed workers with definitive, equivocal, and no chest x-ray evidence of pneumoconioses, suggesting a possible role in detecting active subclinical inflammation (Hayes et al, 1989). 4. OTOLARYNGOLOGIC EXAMINATION - Asbestos workers with hoarseness, pain, or soreness of the throat should be referred for a detailed otolaryngologic examination of the upper respiratory tract looking for the presence of laryngeal cancer (HSDB, 1995).

http://www.toinescps.com/DATA/TMyTM356-4.htnn 1/4/2002

CITY_21MC100_011105067

NYC-WTC_000195085