ABSTRACT
We describe a nonsmoking ceramic tile worker 25 yr of age who developed a worsening dry cough and dyspnea after 3.5 yr as a sorter and glazer of tiles. Open lung biopsy revealed an intense granulomatous interstitial pneumonia with mild fibrosis, compatible with hypersensitivity pneumonitis, and numerous very small birefringent crystals around the terminal airways and occasionally in granulomas. Pulmonary particle analysis revealed an inhaled dust burden nearly 100-fold the normal background level, mainly consisting of clay minerals and zirconium silicate. The patient had no history or clinical or laboratory findings suggesting any organic etiologic agent. A sarcoid granulomatosis type of chronic pulmonary hypersensitivity reaction is known after long-term exposure to zirconium, but this case demonstrates that zirconium can also cause an acute and fulminant allergic alveolitislike hypersensitivity reaction.
Subject(s)
Alveolitis, Extrinsic Allergic/chemically induced , Ceramics , Occupational Diseases/chemically induced , Occupational Exposure/adverse effects , Silicates/adverse effects , Zirconium/adverse effects , Adult , Alveolitis, Extrinsic Allergic/diagnosis , Alveolitis, Extrinsic Allergic/pathology , Biopsy , Chronic Disease , Dust/analysis , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Occupational Diseases/diagnosis , Occupational Diseases/pathology , Occupational Exposure/analysis , Radiography , Silicates/analysis , Zirconium/analysisABSTRACT
Several studies have confirmed that the contacts of sputum-smear-positive patients are a high risk group. We made a prospective survey to investigate the contacts of infectious cases of pulmonary tuberculosis in order to evaluate whether different grades of sputum-smear positivity have any consequence in the emergence of new cases. The number of contacts reported by 134 index cases was 609. These included 136 (22%) who had been in close contact to the index case, 69 of them to patients heavily positive by sputum smear. Tracing of 609 contacts over 2 yr revealed four (0.7%) new cases of active tuberculosis. All of them were close contacts, and, moreover, all four (5.8%) belonged to the group of 69 whose index case had a heavily positive sputum smear. This was significantly more than in other contacts, p = 0.0002. To be productive, tracing should be limited to close contacts of heavily smear-positive patients. This seems also to be the group in which chemoprophylaxis could be cost-effectively focused.
Subject(s)
Contact Tracing , Mycobacterium tuberculosis/isolation & purification , Sputum/microbiology , Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Child , Contact Tracing/statistics & numerical data , Finland/epidemiology , Humans , Incidence , Prospective Studies , Tuberculosis, Pulmonary/microbiologyABSTRACT
Serum neuron-specific enolase (NSE) and serum creatine kinase isoenzyme BB (CK-BB) were measured in 43 small cell lung cancer (SCLC) patients. The overall sensitivity of NSE (greater than 12.5 ng/ml) was 65%; in limited disease (LD) 48% and in extensive disease (ED) 100%. CK-BB was detected in 14 patients (32%); the sensitivity was 17% in LD and 64% in ED. During treatment NSE declined or stabilized to normal level in LD together with objective response in 75% (21/28), and rose again with progression in 28% (6/21). CK-BB fell to normal in all 5 patients with LD, in 3 of them with objective response. In ED elevated NSE and CK-BB declined to normal with objective response in 73% (8/11) and in 25% (2/8) of the evaluable patients respectively. We conclude that serum NSE is a potential marker for staging and response monitoring in SCLC, but that CK-BB gives additional information of limited value.
