How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.

BACKGROUND: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available. OBJECTIVES: The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization. METHODS: In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis. RESULTS: Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a. CONCLUSIONS: SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.

Evaluation of commercial skin prick test solutions for selected occupational allergens.

BACKGROUND: Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS: SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS: Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS: There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.

Assessment of airway hyperresponsiveness: comparison of spirometry and body plethysmography.

While methacholine (MCH) testing is commonly used in the clinical diagnosis of asthma, the detection of airway narrowing often relies on either spirometry or body plethysmography, however comparative studies are rare. In this study we performed MCH testing in 37 patients with variable shortness of breath at work and in 37 patients with no history of airway disease. The inclusion criteria were: no acute respiratory infection within 6 weeks, no severe diseases, normal baseline specific airway resistance (sR(aw)), normal baseline forced expiratory volume in 1 s (FEV(1)), Tiffeneau index >70%, no previous treatment with steroids within 14 days and no short acting bronchodilators within 24 h. Cumulative doses of 0.003, 0.014, 0.059, 0.239 and 0.959 mg MCH were inhaled by a dosimeter method. A FEV(1) decrease of ≥20% from baseline and a 100% increase of sR(aw) to ≥2.0 kPa/s was defined as end-of-test-criterion. Provocation doses were calculated by interpolation. Performance of lung function parameters was compared using receiver-operating-characteristic (ROC) analysis. ROC analysis resulted in an area under the ROC curve (AUC) of 0.74 for FEV(1) vs. 0.82 for sR(aw). The corresponding Youden Indices (J) were 0.46 for FEV(1) and 0.57 for sR(aw). The Youden Index of sR(aw) was higher and sensitivity and specificity (73%/84%) were rather well-balanced, in contrast to FEV(1) (54%/92%). In conclusion, in cumulative MCH challenges sR(aw) was found to be the overall most useful parameter for the detection of bronchial hyperresponsiveness. Body plethysmography yielded a balanced sensitivity-specificity ratio with higher sensitivity than spirometry, but comparable specificity.

Lung function at age 18-25 years: a comparison of different reference value systems.

The anthropometrical data of the Caucasian population have significantly changed within the last five decades. The European Community for Coal and Steel (ECCS) assumes a plateau phase and recommends the entry of 25 years old for calculation of reference values in this age range. The question arises if the commonly used reference recommendations for lung function of the ECCS can still be accepted. In the present study standardized spirometric lung function tests were performed by pneumotachography, recording lung volumes and flows (MasterScreen Pneumo, CareFusion, Höchberg) in asymptomatic nonsmoking subjects (202 females, 201 males), aged between 18 and 26, according to the ATS/ERS criteria. The results were compared with the reference recommendations of ECCS, SAPALDIA, LuftiBus, and Bochum (only males). All absolute lung function values showed a correlation (p< 0.05) with height. With respect to FVC and FEV(1), SAPALDIA and Bochum reference values were comparable and close to a 100 (range 97.6-101.4) %pred, whereas both ECCS and LuftiBus showed higher values (range 103.6-109.9%pred). The FEV(1)/FVC ratio was close to a 100 (range 97.6-101.7) %pred in all reference systems, whereas flows showed a wide variability between the reference systems (77.1-114.6%pred), single flows (e.g., 96.9-114.2%pred for MEF(50)) and males/females (males: 93.6-114.6%pred; females: 77.1-107.9%pred). We conclude that SAPALDIA reference values for FVC and FEV(1) should be used, as they better represent lung function in the age group. ECCS and LuftiBus reference values are appreciably (4-10%) lower. Differences between reference systems were less important for the FEV(1)/FVC ratio and lung flows.

Multiple wheat flour allergens and cross-reactive carbohydrate determinants bind IgE in baker's asthma.

BACKGROUND: Several wheat flour allergens relevant to baker's asthma have been identified in the last 25 years. The aim of this study was to determine the frequency of sensitization to these allergens in German bakers. METHODS: Using recombinant DNA technology, the following wheat flour allergens were cloned, expressed in Escherichia coli and purified: five subunits of the wheat α-amylase inhibitors (WTAI-CM1, WTAI-CM2, WTAI-CM3, WDAI-0.19 and WMAI-0.28), thioredoxin, thiol reductase or 1-cys-peroxiredoxin homologues, triosephosphate-isomerase, αß-gliadin, serpin, glyceraldehyde-3-phosphate-dehydrogenase, a nonspecific lipid transfer protein (nsLTP), dehydrin, profilin and peroxidase. In addition, ImmunoCAPs with the recombinant allergen ω-5-gliadin and two cross-reactive carbohydrate determinants (CCDs), horse radish peroxidase (HRP) and the N-glycan of bromelain (MUXF), were used. Specific IgE was measured in wheat flour-positive sera from 40 German bakers with work-related asthma/rhinitis and 10 controls with pollinosis. RESULTS: Thirty bakers (75%) had IgE to at least one of the 19 single allergens. Most frequent was IgE to WDAI-0.19, HRP and MUXF (25% each), followed by WTAI-CM1 (20%), thiol reductase (16%), WTAI-CM3 (15%), WTAI-CM2 and thioredoxin (12.5%), WMAI-28, triosephosphate-isomerase, αß-gliadin (10%), 1-cys-peroxiredoxin (7.5%), dehydrin, serpin, glyceraldehyde-3-phosphate-dehydrogenase (5%), ω-5-gliadin, nsLTP and profilin (2.5%). Fifteen bakers (38%) had IgE to any α-amylase inhibitor and 12 (30%) to at least one CCD. The controls reacted exclusively to CCDs (80%), profilin (60%), thioredoxin (30%), triosephosphate isomerase and nsLTP (10%). CONCLUSIONS: The single allergen sensitization profiles obtained with 17 recombinant wheat flour allergens and two CCDs revealed no major allergen for German bakers. The highest frequencies were found for α-amylase inhibitors and CCDs.

Lung function in our aging population.

UNLABELLED: AIMS OF INVESTIGATION: The chronological age of the Caucasian population and their anthropometrical data have significantly changed within the last five decades. Therefore the question arises whether or not the commonly used reference values of the European Community (ECCS) for lung function may still be accepted today. Since these values were obtained in the 1960s from subjects in a limited age range. For the elderly, the measured values are deduced by extrapolation beyond the range of reference equations which had been obtained in a different population. Therefore decisions concerning elderly and smaller subjects concerning remuneration due to impaired lung function after industrial exposure on the basis of EGKS values are questionable. METHODS: Lung function tests were performed by pneumotachography, recording static lung volumes and flow-volume-curves in 262 asymptomatic non smoking males, aged 20 to 90 years. Measurements were performed with the MasterLab, or PneumoScreen systems (CareFusion, Höchberg). RESULTS were compared to the reference values of ECCS, SAPALDIA and LuftiBus. - RESULTS: For simplicity analysis of age and height dependence of investigated respiratory parameters (VC, FVC, FEV⊂1, FEV⊂1%FVC, PEF, MEF⊂75,50,25) can be described by linear functions (y = a * height ? b * age + c). The forced expiratory vital capacity, FVC, was calculated by FVC = 0.0615*H - 0.0308*A - 4.673; r = 0.78. Mean FVC for younger subjects was found to be 104.7 ± 10.7% of the ECCS reference values and 96.5 ± 11.8 % in older subjects. For most parameters investigated linear regressions on age were steeper than described by the ECCS reference values. The regression of lung function to height largely follows the ECCS prescriptions. SUMMARY: Bochum lung function values of younger healthy subjects were higher compared to the reference values of the ECCS and showed a steeper age descent. The alternatively discussed reference values of the SAPALDIA-, or LuftiBus-Study are higher, but do not cover all necessary parameters and/or the age range. A multi centre study for contemporary reference values is recommended.

[Efficiency as a new parameter of physical fitness of patients in 6-minute-walk-test]. / Effizienz als ein neuer Parameter zur Objektivierung der körperlichen Leistungsfähigkeit mittels 6-Minuten-Gehtest.

UNLABELLED: AIMS OF THE INVESTIGATION: The 6-minute-walk-test (6-MWT) is an effective tool for measuring physical fitness in elderly patients. The increased walking distance is taken as a parameter for improved physical conditions. Frequently an unaltered walking distance is found after participation in a rehabilitation measure, but heart rate is significantly lower in the second challenge, indicating an improved physical fitness. This positive effect is not recognized when only the walking distance is considered. METHODS: We therefore carried out a retrospective analysis of the 6-MWT tests performed by 303 male patients (69.2 ± 8.7 years) before and after 3-4 weeks of clinical rehabilitation. Instrumented by a mobile pulse oximeter for recording oxygen saturation and heart rate, patients were instructed at the outset and at the end of their rehabilitation stay to walk as fast as they could during 6 min. Measurements were performed every 30 s and printed. A new parameter, efficiency (E = S/6/f (C)) was introduced: the ratio of the walking distance, S, divided by 6 min and divided by the mean heart frequency, f (C) (beats/minute). RESULTS: The patients group walked 351 ± 79 m at 106.2 ± 12.7 beats/min in the initial 6-MWT and 362 ± 76.0 m at a heart rate of 104.0 ± 12.2 beats/min in the final test. Along with the increase in walking distance, efficiency E increased from 0.56 ± 0.13 m/beat to 0.59 ± 0.12 m/beat. Efficiency significantly correlates with the walking distance (p < 0.01). 54 patients (18%) had an increased efficiency in the final test at the end of rehabilitation although they walked a shorter distance compared to the initial test value: they walked with a lower heart frequency. CONCLUSIONS: The patient's performance of the second walk test with an unchanged distance at a lower heart frequency reveals an improved physical fitness. This is solely described by an increase of the parameter of efficiency, E. Calculation of this parameter delivers a quantification of the effect of exercise training irrespective of the patient's cooperation. Efficiency, hence, is a meaningful complement to the sole consideration of the distance walked in the assessment of physical fitness as a benefit of rehabilitation.

[A new procedure for the estimation of physical fitness of patients during clinical rehabilitation using the 6-minutes walk test]. / Zur Reproduzierbarkeit der Wegstrecken beim 6-Minuten-Gehtest im Rahmen eines stationären Rehabilitationsaufenthaltes.

UNLABELLED: AIMS OF THE INVESTIGATION: The repetition of the 6-minutes walk test (6 MWT) in older patients is frequently performed in order to document the maximal walking distance, although it is not recommended in any guidelines on exercise tests and although there is common consent to save clinical resources in terms of time and staff. Therefore, we have examined whether and to what extent the repetition of the walk tests helps patients to get more familiar with this kind of exercise test. Thus the acquired physiological data should reliably describe the physical fitness of the patients at the beginning and at the end of their clinical rehabilitation. METHODS: 35 patients performed their walk tests before and after 3 - 4 weeks of clinical rehabilitation. Each test has been repeated after one hour of recovery. The patients were instructed to walk during 6 minutes as fast as possible. They were equipped with a mobile pulse oximeter for recording oxygen saturation and heart rate. The distance, S, and the heart rate, fc, were measured. Measurements were performed every 30 seconds and recorded. The efficiency, E (E = S/6/fc), was calculated as the ratio of distance per minute and the mean heart rate during the test. RESULTS: In the first test the patients walked 416 +/- 63 m at a heart rate of 104.7 +/- 15.7 beats/min, in the first repeated test 454 +/- 71 m at a heart of 106.3 +/- 17.4 beats/min. In the second test, after clinical therapy, they walked 438 +/- 58 m at a heart rate of 106.3 +/- 17.4 beats/min, in the second repeated test 473 +/- 56 m at 108.6 +/- 13.2/min. The difference of the walking distances of the tests at the entrance were found to be 38.4 +/- 26.2 m (+ 9.3 +/- 6.2%), at the end of clinical rehabilitation 35 +/- 26 m (+ 8.4 +/- 6.4%). Both differences are found to be independent from the distance of the first test. They are not significantly different. The efficiency was not significantly different in the initial and final test (0.673 +/- 0.129 and 0.689 +/- 0.085 m/beat, respectively). The difference in efficiency, when repeating the tests at the beginning, was: 0.053 +/- 0.062 m/beat; at the end of the rehabilitation: 0.042 +/- 0.047 m/beat. They are found to be similar. CONCLUSIONS: The distances the patients walked in the repeated tests at the entrance and at the end of their clinical rehabilitation were, besides the calculated efficiency, E, significantly increased. However, the increases in distance and efficiency are identical on both occasions, therefore the repetition delivers no further information. The test should be performed without repetitions in clinical routine investigations. The patient's performance in the second walk test with an unchanged distance at a lower heart rate reveals an improved physical fitness. This is solely described by an increase of efficiency, E. Therefore the introduction of E is a suitable measure of the quantified effect of exercise training, even if the patient is not cooperative during the tests. E is proved to be a suitable estimation for the assessment of physical fitness as a benefit of clinical rehabilitation.

[Examples for asbestos-related findings in HRCT - criteria for the assessment of causal relationships in surveillance programmes and medical expert opinion]. / Beispiele asbestfaserstaubbedingter Veränderungen im HRCT - Anhaltspunkte für die Kausalzuordnung bei Vorsorgeuntersuchungen und bei der gutachterlichen Beurteilung.

The increasing use of high-resolution computed tomography in formerly asbestos-exposed workers requires valid diagnostic criteria for the findings which have to be reported as suspicious for being asbestos-related in surveillance programmes and for the assessment of causal relationships between former asbestos exposure and findings in computed tomography. The present article gives examples for asbestos-related findings in HR-CT and discusses the specificity of parenchymal and pleural changes due to asbestos fibres.

[Recommendations for reporting benign asbestos-related findings in chest X-ray and CT to the accident insurances]. / Anzeigekriterien asbestfaserstaubbedingter Erkrankungen gemäss BK-Nr. 4103 BKV.

Asbestos-related diseases still play an important role in occupational medicine. The detection of benign asbestos-related diseases is one condition for the compensation of asbestos-related lung cancer in Germany. Due to the increasing use of computed tomography, asbestos-related diseases are more frequently detected in the early stages. The present article proposes recommendations for the findings which have to be reported as suspicious for being asbestos-related based on a) chest X-rays and b) computed tomography using the International Classification System for Occupational and Environmental Respiratory Diseases (ICOERD).

[Digital radiography in chest imaging of occupational and environmental lung diseases]. / Digitale Radiografie in der Untersuchung von arbeits- und umweltbedingten Lungen- und Pleuraerkrankungen.

The classification of pneumoconiosis according to ILO standard - comparing a X-ray of the lung with ILO radiographs - is well established in Germany. The extension of digital imaging is a challenging task in occupational medicine as well as in pneumology. Technical requirements are not known sufficiently and the necessary equipment is not well distributed. This paper describes the current position on recording, assessment and documentation of digital imaging of the lung and pleura.

[Lung function in the elderly: do we need new reference values?]. / Lungenfunktion im Alter: Brauchen wir neue Referenzwerte?

INTRODUCTION: The structure of our aging population has significantly changed in the last three decades as have also the anthropometric data. Therefore, the question arises as to whether or not the largely accepted reference values for ventilatory lung function, which were suggested by the European Community for Coal and Steel (EGKS), may still be used today, since these values were obtained in the 1960s from subjects in a limited age range. For the elderly, the measured values are deduced by extrapolation beyond the range of reference equations which had been obtained in a different population. Therefore decisions concerning elderly and smaller subjects concerning remuneration due to impaired lung function after industrial exposure on the basis of EGKS values are questionable. METHODS: We have examined lung function using pneumotachography for recording static lung volumes and flow-volume curves in 176 asymptomatic non-smoking males, aged 20 to 90 years, and correlated the results to the reference values of the EGKS, SAPALDIA and LuftiBus. RESULTS: The age dependence of respiratory parameters (VC, FVC, FEV (1), FEV (1) %FVC, PEF, MEF (75,50,25)) for the healthy subjects can be described with a linear function (y = - m x age + n). The forced expiratory volume in one second, FEV (1), is calculated by FEV (1) = - 0.046 x age + 6.11; r = 0.88. Mean FEV1 for younger subjects was found to be 108 +/- 9.9 % of the EGKS reference values, 105 +/- 13.7 % in the middle-aged group and 97.3 +/- 12.4 % in the older subjects. All measured parameters concerning lung function can be described as linear functions of age which are steeper than those described by the EGKS reference values. The steeper slope in age dependency was also seen in other investigated parameters. The correlation of lung function parameters to height largely follows the EGKS predictions. CONCLUSIONS: Measured lung function values of healthy younger and elderly subjects showed a close correlation to the extrapolated reference values of the EGKS. Our results relating to normal lung function justify an extrapolation of the reference equations beyond the common ranges of age while applying the same limitations as described for subjects in the middle-age range. Our results permit an extrapolation of EGKS values beyond the range of the reference values and can be used for the classification of impaired lung function in older subjects. The alternatively discussed reference equations of the SALPADIA Study, of NHANES and partially of the LuftiBus Study are higher, but do not cover all the necessary parameters and/or age ranges. A multicentric study for contemporary reference values should be performed in order to solve the problems concerning valid reference values.

Time for new reference values for ventilatory lung function.

OBJECTIVE: The anthropometrical data of our aging population has significantly changed within the last five decades. Therefore the question arises whether or not the commonly used reference values of the European Community (ECCS) for lung function, may still be accepted today. Measured values for elderly are classified by extrapolation beyond the range of reference equations. MATERIAL AND METHODS: Lung function was examined by pneumotachography for recording static lung volumes and flow-volume-curves in 257 asymptomatic non smoking males, aged 20-90 years. Results were compared to the reference values of ECCS, SAPALDIA, LuftiBus, and NHANES. RESULTS: For analysis age and height dependence of investigated respiratory parameters (VC, FVC, FEV(1), FEV(1) %FVC, PEF, MEF(75,50,25)) can for simplicity be described by linear functions (y = a . height(H)-b . age (A)+c). The forced expiratory volume in one second, FEV(1), was calculated by FEV(1) = 0.0432 . H-0.0347 . A -2.114; where H - height, A - age; r = 0.78. Mean FEV(1) for younger subjects was found to be 106.1 +/- 11.2% of the ECCS reference values and 97.8 +/- 11.7% in older subjects. For all parameters investigated linear regressions on age were steeper than described by the ECCS reference values. The regression of lung function to height largely follows the ECCS prescriptions. SUMMARY: Bochum lung function values of healthy subjects showed a steeper age descent compared to the reference values of the ECCS. The alternatively discussed reference values of the SAPALDIA-, NHANES- or LuftiBus-Study are higher, but do not cover all necessary parameters and/or the age range. A multi centre study for contemporary reference values is recommended.

[A new procedure for the estimation of physical fitness of patients during clinical rehabilitation using the 6-minute-walk-test]. / Ein numerisches Verfahren zur Objektivierung der körperlichen Leistungsfähigkeit im Rahmen eines stationären Rehabilitationsaufenthaltes mittels 6-Minuten-Gehtest.

UNLABELLED: AIMS OF THE INVESTIGATION: The 6-minute-walk-test (6-MW) is an effective tool for measuring physical fitness in elderly patients. The increased walking distance is taken as a parameter for improved physical conditions. Frequently an unaltered walking distance is found after clinical treatment, but heart rate is significantly lower in the second challenge, indicating an improved physical fitness. This positive effect is not recognised when only the walking distance is analysed. METHODS: An analysis of the 6-MW test was performed on 263 patients before and after 3 - 4 weeks clinical rehabilitation. In a control group of 26 patients 6-MW was repeated after recovery at the beginning and the end of the clinical treatment. Instrumented by a mobile pulse oximeter for recording oxygen saturation and heart rate, patients were instructed to walk as fast as they can do during 6 minutes. Measurements were performed every 30 seconds and printed out. Two new parameters, efficiency (E = S/f (C)), the ratio of distance and mean heart rate, and the theoretical increase in walking distance (S (z) = Delta f (C1)/Delta f (C2) x S (2) - S (1)) were introduced and tested. S (z) = theoretical increase in distance, Delta f (C1) = difference in heart rate at rest and mean heart rate at steady state during the first walk test with distance, S1. Delta f (C2), and S2 are measured during the second walk. Thus, the increase in distance is calculated under the assumption that the second walk test would have been performed by the patient with the same difference in heart rate that he/she achieved in the first walk. RESULTS: The patient groups walked 353 +/- 80 m at 106 +/- 14.3 beats/min in the 1st. 6-MW and 368 +/- 76.9 m at a heart rate of 105 +/- 14.0 beats/min in the final test. The increase of the walking distance was most significant in patients with shorter distances in the 1st 6-MW. A significant increase in the walking distance and in efficiency was found in patients with shorter walking distances or lower heart rates in the final test, using the numerical procedure described above. CONCLUSIONS: The patient's performance of the second walk test with an unchanged distance at a lower heart rate reveals an improved physical fitness. This is solely described by an increase by the parameter of efficiency, E. The calculation of the parameter, Sz, theoretical difference in walking distance (i. e., theoretical increase in almost all tests) provides a quantification of the effect of exercise training, even if the patient is not cooperative during the tests. Both parameters have proved to be suitable estimations for the assessment of physical fitness as a beneficial effect of clinical rehabilitation.

Sputum screening for lung cancer in radon exposed uranium miners: a comparison of semi-automated sputum cytometry and conventional cytology.

Preparing for a prospective study on early lung cancer, correlation between semi-automated sputum cytometry (ASC) and conventional cytology (CY) was examined in 1517 former uranium miners with posterior-anterior and lateral chest roentgenograms. A hundred and twenty sputum specimens were classified as suspicious (grade II) and another 18 as highly suspicious (grade III) by ASC. Within grade III group, 9 samples were classified by CY as tumor cell positive, 7 severe, and 1 mild and 1 moderate dysplasias. In the group of grade II ASC, 7 were tumor cell positive, 27 classified as severe dysplasia or CIS, 20 as moderate and 19 as mild dysplasia. Twenty seven contained metaplasias and 18 were normal or inflammatory. Of the 1358 samples classified as benign (grade I) by ASC, only 5 samples were classified by CY as severe dysplasia, 6 as moderate and 34 as mild dysplasia, 173 as metaplasia, the others were normal or inflammatory. Twenty one samples were judged as inadequate for ASC and CY. At present, 23 tumors were found in final diagnosis. Sensitivity of ASC was 87% at a specificity of 92%, while CY, at high grade alterations as a threshold, had a sensitivity of 83% at 97% specificity. We conclude that, along with modern radiological procedures and molecular biological markers, ASC and CY should be included in a controlled prospective randomized study on early lung cancer.

Chromosomal aberrations in uranium and coal miners.

PURPOSE: To compare chromosomal aberrations in peripheral lymphocytes of Wismut uranium miners (WUM) and Ruhr coal miners (RCM). MATERIALS AND METHODS: Peripheral lymphocytes from 66 WUM and 29 RCM were cultured and analysed for structural chromosomal aberrations in Giemsa-stained M1 metaphases. Cytogenetic data from 23 male white-collar workers from public services were used as a historical control group. RESULTS: The frequencies of chromosomal aberrations and sister chromatid exchanges in WUM and RCM were quite similar. Compared with public services workers, WUM and RCM had significantly higher frequencies of chromosomal aberrations. CONCLUSIONS: Chromosomal aberrations in WUM are not induced by radioactive particles inhaled during underground mining but as in RCM rather result from factors such as age, lifestyle, illnesses, medications and diagnostic irradiations.

[Further development of the International Pneumoconiosis Classification--from ILO 1980 to ILO 2000 and to ILO 2000/German Federal Republic version]. / Die Weiterentwicklung der Internationalen Staublungenklassifikation - von der ILO 1980 zur ILO 2000 und zur ILO 2000/Version Bundesrepublik Deutschland.

The ILO (1980) Classification has been revised during recent years. The new version is now available as the International Classification of Radiographs of Pneumoconioses (Revised edition 2000). The Guidelines booklet is currently available only in English. Those involved felt it was important to maintain continuity with the ILO (1980) edition, in particular to retain the standard radiographs, despite their restricted quality, so as to ensure comparability with earlier national and international data sets. The standard films illustrating pleural abnormalities, and 'u'-shadows, have been modified and reconstituted. The most important changes relate to assessment of film quality, pleural abnormalities, and additional symbols. In Germany, film quality is characterised as "+", "+-", "+--" and "u" according to whether the ability to assess pneumoconiosis is judged to be unimpeachable ("+") to unusable ("u"). If a film is not classified as "+", then written comments regarding defects are required. For "diffuse" pleural thickening, the ILO (2000) edition now requires the presence also of obliteration of the costophrenic angle. This was not required in the earlier (1980) edition and, as previously, is also not stipulated in the German version. A minimum width of 3 mm (previously 0-5 mm), coded "a", is required both for plaques as well as for the margin to the lateral chest wall. Congruence is thus achieved for criteria, which, in German practice, lead to an indication of suspect occupational disease. Plaques on the diaphragm are not considered for measurement of extent; they are only coded as present or absent. If calcification is identified, then this must also be classified and measured as a localised plaque. Extent of calcification on its own, previously coded "0" to "3", is no longer specified. The following new symbols, illustrated by new diagrams, have been introduced: aa = atherosclerotic aorta; at = apical thickening; cg = calcified granuloma (or other non-pneumocononiotic nodules); me = mesothelioma (already previously differentiated from "ca" on the German record sheet); pa = plate atelectasis; pb= parenchymal bands; ra = rounded atelectasis; od = other disease. (Examples of the latter are illustrated diagrammatically by lobar pneumonia, aspergilloma, goiter and hiatal hernia.) Earlier national differences (ILO 1980/German Federal Republic) on particular issues have also been agreed among German "double-readers" ["Zweitbeurteiler"]. However, conformity between the original (ILO 2000) text and the national (German) modified text has been retained in large measure. The detailed descriptions of the standard films differ in certain respects from the German (1980) definitions. Some revision of individual descriptions of the films are proposed. Except for a few differences, agreement was reached here too. The definitive date for the change in Germany is expected to be in early 2004. The standard films are already available now through ILO offices in Geneva or Bonn (addresses in appendix.)

Can semi-automated image cytometry on induced sputum become a screening tool for lung cancer? Evaluation of quantitative semi-automated sputum cytometry on radon- and uranium-exposed workers.

The correlations between semi-automated sputum cytometry (ASC), conventional cytology and the final diagnosis was investigated in industrially-exposed workers. Slides of sputum samples from 201 former uranium miners with silicosis, 100 patients with asbestosis, 103 workers resected for lung cancer, and 200 controls (50% smokers), were stained using the Papanicolaou (Pap) method and the Feulgen reaction with thionin. Cytometry was performed using the Cyto-Savant automated system. Atypical nuclei were found in 72 of 404 patient samples, 327 samples were normal and five were inadequate for ASC analysis. Thirteen tumours (Pap IV, Pap V) and 11 cases of severe dysplasia were identified by cytology. Lung cancer was confirmed in 20 patients. Compared to the final diagnosis of lung cancer, the sensitivity of ASC was 75% (15 out of 20) and specificity 89.8% (520 out of 579). The results represent a diagnostic efficiency of 89.3%. The combination of ASC with cytology increased sensitivity to 80% (16 out of 20) without significant loss of specificity (89.7% or 523 out of 581). In this investigation of a limited number of patients with occupational radon or asbestos exposure, semi-automated sputum cytometry appears to be sensitive and reliable for the detection of malignant changes in the tracheobronchial mucosa. Together with conventional cytology, it would be reasonable to test the validity of the combined methods in a large-scale feasibility study of early lung cancer detection.