Coalworkers' pneumoconiosis: correlation between opacity profusion and number and type of dust lesions with special reference to opacity type.

The relation between the profusion and predominant type of small rounded opacities on chest radiographs taken within four years of death and the postmortem counts of dust lesions in four classes (macules, "pinhead" fibrotic nodules, nodules 1-3 mm, and nodules greater than 3-9 mm in diameter) has been examined for 71 coalworkers without progressive massive fibrosis. The radiographs were categorised by four readers independently, according to the ILO classification. For subjects considered by each reader to present predominantly p type opacities, increasing opacity profusion was exclusively and significantly associated with an increase in the number of pinhead fibrotic nodules. Numbers of nodules measuring 1-3 mm and greater than 3-9 mm in diameter both showed significant linear associations with opacity profusion category in subjects presenting predominantly q opacities, the closer association being observed with the smaller lesions. These observations held true for all readers. Opacities of type r were rarely considered to be the predominant type. For the reader who recorded the maximum number of such cases, opacity profusion was not significantly related to the numbers of dust lesions in any of the lesion classes. Nevertheless, the closest association was observed with nodules measuring greater than 3-9 mm in diameter. An overall significant linear association between total lung dust content and opacity profusion was found to be due mainly to subjects presenting predominantly p type opacities and to a lesser extent to those with predominantly q opacities.

Dust exposure, dust recovered from the lung, and associated pathology in a group of British coalminers.

The relation between dust exposure, retained lung dust, and pneumoconiosis have been examined in 430 dead coalminers who had participated in a large scale epidemiological survey of respiratory health. The men were divided into three groups depending on the presence of particular lesions in their lungs. Lungs containing no fibrotic lesions in excess of 1 mm were included in the "M" group, those with fibrotic lesions of between 1 mm and 9 mm in diameter were included in the "F" group, and those with any lesion 10 mm or more were categorised as having progressive massive fibrosis (PMF). The men were further divided into four groups according to the rank of coal mined at the colliery of employment. The mean weight of lung dust increased over the pathological range (M----F----PMF) regardless of the rank of coal mined. The men with PMF had not received unusually high exposures to dust in life but were found to have accumulated more dust in their lungs per unit of dust exposure than men without PMF, providing further evidence for differences in the patterns of deposition or clearance, or both, of dust in these men compared with those who do not develop PMF. For men who had mined the higher rank coals there was no difference in the composition of the lung dust between the pathological groups. Lungs from men mining low rank coal, however, showed a striking increase in the proportion of ash over the pathological groups (M, F, and PMF). In men who had mined low rank coal the proportion of ash in the airborne dust to which they had been exposed and in the dust retained in their lungs was, as expected, greater than in men who had worked with higher rank coals. For the same men, and particularly associated with the presence of some dust related fibrosis, the proportion of ash in retained dust was higher than that in the dust to which the men were exposed suggesting the occurrence of selective deposition or retention of the mineral components of dust in this group.

Silicosis in barium miners.

Four men who mined barytes in Scotland and who developed pneumoconiosis are described. Three developed progressive massive fibrosis, from which two died; and one developed a nodular simple pneumoconiosis after leaving the industry. The radiological and pathological features of the men's lungs were those of silicosis and high proportions of quartz were found in two of them post mortem. The quartz was inhaled from rocks associated with the barytes in the mines. The features of silicosis in barium miners are contrasted with the benign pneumoconiosis, baritosis, that occurs in workers exposed to crushed and ground insoluble barium salts. Diagnostic difficulties arise when silicosis develops in workers mining minerals known to cause a separate and benign pneumoconiosis. These difficulties are compounded when, as not infrequently happens, the silicotic lesions develop or progress after exposure to quartz has ceased.

Microanalyses of lesions and lymph nodes from coalminers' lungs.

The dust content and composition of lesions and hilar lymph nodes from the lungs of British coalworkers have been examined. Samples of macules, fibrotic nodules, and massive fibrosis (both peripheral and central sites) were dissected from 49 lungs. The highest mean dust concentrations (about 20%) were found in nodules and massive fibrosis. Overall there were no significant differences between the selected lesion types and their respective whole lung dust composition, although the central sites of massive fibrosis were found to contain on average a higher proportion of coal and a lower proportion of ash and its measured constituents, quartz and kaolin plus mica, than the edge of the lesion (p less than 0.001 for each component). There were striking differences between recovered lung and lymph node dusts. An examination of 180 specimens showed a mean quartz in lymph node dust of 20.3% compared with 6.1% in lung dust. As expected the proportion of quartz was greater in lymph nodes and lungs from men who had worked "low" rank (high ash) coal. By contrast with the corresponding figures for lung dusts, however, the mean proportion of quartz in nodes did not increase over the pathological range of pneumoconiotic lung disease. On average the proportions of kaolin and mica in lymph nodes reflect those found in lungs. The lymphotrophic nature of quartz was clearly shown although it was not possible to show an association between this clearance pathway and any particular type of lesion.

Comparison of radiographic appearances with associated pathology and lung dust content in a group of coalworkers.

The pathology and dust content of lungs from 261 coalminers in relation to the appearances of their chest radiographs taken within four years of death were examined. Radiological opacities of coalworkers' pneumoconiosis were more profuse the more dust was retained in lungs. Among the men who had mined low rank coal--that is, with a relatively high proportion of ash--the increase in profusion was most closely related to the ash component of the dust, whereas in men who had mined high rank coal both coal and ash increased in the lungs in relation to radiological profusion. The fine p type of opacity was found to be associated with more dust and a higher proportion of coal and less ash than the nodular r opacity, and was also more likely to be associated with emphysema. The pathological basis of the different types of opacity found on the radiographs of coalminers related to the number, size, and nodularity of the dust lesions. Larger fibrotic lesions were likely to appear as r opacities, whereas fine reticular dust deposition was most likely to present as p opacities, q opacities showing a mixture of appearances. The study has shown that the composition of dust retained in the lung, as well as its amount, makes an important contribution to the radiographic appearances of pneumoconiosis. In particular, the r type of lesion on the radiograph of a low rank coalminer indicates the possibility of a silicotic like lesion.

Emphysema and dust exposure in a group of coal workers.

The lungs of 450 coal miners who had been studied previously in a long-term epidemiologic project at 24 British mines have been examined post-mortem for signs of dust-related fibrosis and emphysema. Reliable estimates of cumulative (working-life) exposures to respirable mine dust were available for 342 of the men. The relative frequency of emphysema increased with age at death, and both panacinar and centriacinar emphysema occurred more frequently in smokers than in nonsmokers. The proportion of subjects with any emphysema was 47% in 92 men with no palpable dust lesions, 65% in 183 with small, simple pneumoconiotic lesions, and 83% in 175 miners with massive fibrosis (PMF). The chance of finding centriacinar emphysema in those with PMF increased significantly with increasing exposure to coal dust in life (p less than 0.025). A similar but less convincing relationship was found in those with simple pneumoconiosis (p less than 0.11), but in both groups, increasing amounts of ash with a given exposure to coal reduced the probability of finding centriacinar emphysema. The occurrence of centriacinar emphysema was associated also with increasing amounts of dust retained in the lungs. A preliminary exploration of this association did not support the hypothesis that emphysematous lungs clear dust less efficiently. We conclude that the association observed between exposure to respirable coal dust and emphysema in coal miners indicates a causal relationship. However, because it can be demonstrated only for men whose lungs show some dust-related fibrosis, it is suggested that the extent and nature of such fibrosis may be a crucial factor in determining the presence of centriacinar emphysema.

Variations in the histological patterns of the lesions of coal workers' pneumoconiosis in Britain and their relationship to lung dust content.

The lungs of 490 British coal miners were examined for comparisons of the lesions of coal workers' pneumoconiosis with lung dust content and dust exposure. Variations were found in histological appearances that formed a range, the extremes of which indicated two separate patterns of disease. In men from high rank collieries, whose lung dust had a high carbon content and little ash, most of the nodules of simple pneumoconiosis were evenly pigmented with dust, and where progressive massive fibrosis (lesions greater than 1 cm in diameter) had developed, this appeared to be by the enlargement of a single lesion. In men from low rank collieries where the ash content of lung dust was high, the centers of the nodules were often free of dust particles and in extreme cases these lesions were very similar to silicotic nodules. If PMF developed in these cases, it often appeared to be by the fusion of closely spaced groups of smaller nodules. While there appeared to be little difference between the lung dust composition of men from high rank collieries and the dust to which they had been exposed, in men from low rank collieries the proportion of the noncoal minerals in the lungs was usually higher than it had been in the mine dust. This indicated some form of differential retention of these components, which was progressively more marked in men with the more serious grades of pneumoconiosis.

Right ventricular hypertrophy in a group of coalworkers.

The prevalence of right ventricular hypertrophy was studied in necropsy material from 215 coalworkers, a group which consisted of 115 men with simple or no pneumoconiosis and 100 with progressive massive fibrosis. Right ventricular hypertrophy was considered to be present if the ratio of the weight of the left ventricle plus septum to that of the right ventricle was less than 2:1. The prevalence of right ventricular hypertrophy was low (15%) in the absence of progressive massive fibrosis and appeared to be related to emphysema or airways disease or both, and not to simple pneumoconiosis. It was evident only in subjects who had smoked. In subjects with progressive massive fibrosis the prevalence of right ventricular hypertrophy was higher (34%) and it was occasionally seen in non-smokers. The prevalence increased with increasing size of lesion, and for any given size of lesion subjects with right ventricular hypertrophy had more panacinar emphysema than those without right ventricular hypertrophy. There was no relationship, however, between the extent of massive lesions or amount and type of emphysema and the degree of right ventricular hypertrophy.

Bronchial gland dimensions in coalminers: influence of smoking and dust exposure.

Bronchi from 94 coalminers were examined for enlargement of the mucous glands. The measurements used were the mean and maximum ratios of gland thickness to wall thickness, the mean acinar diameter, and the ratio of the gland area to the area of the non-cartilaginous portion of the bronchial wall. The relationships between these measurements and the subjects' smoking habits and their past exposure to dust in the coal mines were analysed. Smoking was found to be significantly related to mean and maximum gland-to-wall ratios. In addition, coalmine dust exposure was found to be significantly related to maximum gland:wall ratio. No significant relationships were found between gland dimensions and pneumoconiosis or dust retained in the lung. These results lend support to the view that irritants encountered in an occupational environment may play an important part in the development of hypersecretion of mucus.