[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.

[Comparison of pulmonary compliance and the work of breathing with pulmonary function parameters in men]. / Vergleichende Messungen der Lungen-Compliance und der Atemarbeit mit anderen Lungenfunktionsparametern bei männlichen Probanden.

BACKGROUND: Dynamic and static pulmonary compliance as well as the work of breathing are essential parameters for describing respiratory mechanics. However, current reference values or correlations with other pulmonary function variables have been established only in studies with small numbers of participants. Therefore, the aim of the present study was to compare pulmonary compliance and the work of breathing with different pulmonary function parameters in a large number of men. METHODS: In 208 healthy men, aged 20 to 70 years, spirometry, bodyplethysmography and carbon monoxide transfer factor measurements were conducted. The esophageal pressure method was used to measure dynamic (C (dyn)) and static (C (stat)) compliance. RESULTS: C (dyn) and C (stat) were significantly correlated with total lung capacity (TLC), vital capacity (VC), forced expiratory volume in the first second (FEV (1)) and carbon monoxide transfer factor (T (LCO)). C (dyn) decreased with increasing age, while C (stat) was correlated with height. The elastic and non-elastic work of breathing were significantly correlated with airway resistance, but not with aging. CONCLUSIONS: Lung volumes are important for the interpretation of pulmonary compliance and the work of breathing and therefore have to be considered in the assessment of respiratory mechanics. In contrast, the work of breathing is essentially influenced by the airway resistance. With increasing age there is only a small decrease in pulmonary compliance and the work of breathing.

Reference values for dynamic and static pulmonary compliance in men.

The aim of the present study was to determine new reference values and predictive variables for dynamic and static pulmonary compliance in men. The investigation was conducted as a prospective study in healthy, non-smoking men with normal pulmonary function parameters including spirometry, bodyplethysmography and CO diffusing capacity. The esophageal pressure method was used to measure dynamic compliance (Cdyn), specific dynamic compliance (Cdyn/ITGV), static compliance (Cstat) and specific static compliance (Cstat/ITGV). Lung recoil pressures were recorded at different levels of total lung capacity (TLC). A total of 208 men aged 20-69 years were included in the study. The mean values for the compliance parameters were: Cdyn: 2.91+/-1.08 L/kPa; Cdyn/ITGV: 0.71 +/- 0.30 kPa (-1); Cstat: 3.34 +/- 1.04 L/kPa; Cstat/ITGV: 0.82 +/- 0.31 kPa (-1). Cdyn, Cdyn/ITGV and Cstat/ITGV were significantly correlated with age and Cstat was related to height, but in multiple regression analyses the predictability for compliance parameters was very low. Lung recoil pressures at all TLC levels significantly decreased with ageing. In conclusion, we demonstrated that the contribution of anthropometric variables to the regression equations of pulmonary compliance was low. With ageing the static pressure-volume curve of the lung shifted to the left without substantial alteration of the slope.

[Nose and paranasal sinus malignancies with reference to occupational medicine aspects. A case study]. / Nasen- und Nasennebenhöhlenmalignome unter arbeitsmedizinischen Aspekten. Eine Fallstudie.

Asbestos is a well known inhalant cancerogenic substance, causing not only mesothelioma but also cancer of the respiratory mucosa of the bronchi. Exposure can also cause non-malignant alterations of the pleura or lung, which can be assessed radiologically. Since asbestos can also induce malignant tumors of the nose and sinuses, we identified 50 patients from the files of the ENT Department Münster and tried to complete questionnaires concerning occupation and occupational hazards using informations from insurance companies as well as at least one chest x-ray. This material could be obtained in 19 patients. Nine of the 19 patients had x-ray findings that could be associated with asbestos exposure, but in none of these 9 cases was massive occupational exposure to asbestos probable. In only two of the nine cases was definite occupational exposure to asbestos not able to be excluded. A control group was not established, since statistical calculations of significance would have been problematic in a number of the 19 patients even if a control group did exist. From the questionnaires we have found an unexpected incidence of dusty workplaces (as seen with textile workers, wood-dust workers, cement workers, quarrymen and millers). A correlation between various types of sinonasal tumors and asbestos exposure could not be made.

Occupational-type exposure tests and bronchoalveolar lavage analyses in two patients with byssinosis and two asymptomatic cotton workers.

Two workers suffering from stage III byssinosis and claiming for compensation were examined. Bronchial obstruction was present in one case. MEF25-75 values were significantly reduced and bronchial hyperreactivity was present in both subjects. Occupational-type exposure tests with cotton dust resulted in significant decreases in arterial oxygen pressure for more than 2 h and were associated with an obstructive ventilation pattern in one of the patients. Prolonged hypoxemia which is not paralleled by lung function changes is probably typical for byssinosis patients since we have never seen this in inhalative challenge tests with various environmental antigens and other occupational substances including flour dust. No specific IgE or IgG antibodies could be detected. In the two patients a hitherto unknown significant increase in CD23+ lymphocytes and granulocytosis were detected by bronchoalveolar lavage (BAL). Corresponding investigations in two cotton workers without any evidence of byssinosis revealed neither lung function changes after the exposure test nor striking BAL findings. Our results demonstrate the diagnostic value of specific challenge tests and BAL investigations in patients suffering from byssinosis, which is often difficult to diagnose.