Mites in pulmonary cytology specimens.

Mites were observed in 55 pulmonary specimens examined routinely over a 4.5-yr period. The 55 specimens included 33 spontaneous and 12 aerosol-induced sputum samples, nine bronchial washings, and one fine-needle aspirate. Two specimens contained only fragments of mites; however, in most cases the mites were relatively intact. Many were identified as Tyrophagus sp, but a few were definitely not Tyrophagus sp. Although only a single mite was noted in most instances, eight specimens contained more than one, with the maximum being six. No patient was found to have a mite in more than one specimen. Mite eggs were found in five of the specimens containing mites. One specimen contained adults and a larval form. Mites appeared to be surrounded by acute inflammatory cells in 13 cases. Specimens were processed by the Saccomanno blending technique with smears prepared by pipetting a portion directly onto a slide or by utilizing a cytocentrifuge. No mites were found in nonpulmonary specimens. Both a seasonal variation and an interobserver variability were found. Mites often resemble specimen contaminants, such as food, and may be overlooked on routine screening. Mites are known to represent or produce a respiratory allergen, but the significance of their presence in pulmonary cytology specimens has not been determined.

Ultrastructural and Energy dispersive analysis of inorganic inclusions in a muscle biopsy.

A muscle biopsy that, by light microscopy, exhibited mild atrophy consistent with chronic denervating disease was submitted for ultrastructural analysis. Inorganic structures within the tissue were defined by energy dispersive analysis as aluminosilicates, magnesium silicates, and iron deposits. These structures were localized in the interstitial (intercollagenous) area and in high concentrations within degenerated muscle bundles. An alteration of the blood/muscle barrier has obviously occurred; however, the extent to which the end result commonly occurs in humans is unknown. Clarification of the question raised by this observation will have to be derived from animal studies, and clinicians must have an awareness of the need for electron microscopy/energy-dispersive x-ray analysis in muscle biopsies from patients with similar therapeutic backgrounds.

Comparison of sputum and lung asbestos body counts in former asbestos workers.

The asbestos (ferruginous) body content of lung tissues was compared to the number of asbestos bodies (AB) in sputum from 6 former amosite asbestos workers. Lung tissue was obtained at autopsy (5 subjects) and lobectomy (1 subject), and AB content was determined by a digestion-concentration technique. The sputum obtained was collected by both spontaneous cough (a pooled, 3-day specimen) and aerosolized hypertonic saline induction. Four slides treated with Papanicolaou's stain were prepared from each cytologic specimen and scored from 0 to 3 + on the basis of the total number of AB counted on the 4 slides. A significant correlation (P < 0.02) was found between the number of AB per gram of lung tissue and the percentage of sputum specimens from each worker than were positive for AB. Asbestos bodies were identified in 46% of sputum specimens from the 4 workers whose lungs contained 900 or more AB/g of lung tissue.

Pulmonary fibrosis, carcinoma, and ferruginous body counts in amosite asbestos workers. A study of six cases.

The Tyler Asbestos Workers Program is a continuing study of 1,105 former amosite asbestos workers. This report includes a study of six former workers, five of whom died and had autopsies, and one who underwent a lobectomy. Five of these men were exposed to asbestos for three months or less. Four had lung cancer, and one a rectal carcinoma. All were cigarette smokers. Ferruginous (asbestos) body content of the upper and lower lobes of the lungs was quantitated by a digestion technic. Tissue sections from upper and lower lobes were independently quantitated for fibrosis and ferruginous bodies, and chest roentgenograms were examined for interstitial fibrosis. (Control lung tissue was obtained from consecutive autopsies of 52 adults who did not have a known occupational exposure to asbestos.) Relatively low ferruginous body counts (less than 700/g lung tissue) were associated with mild degrees of fibrosis, and higher counts (greater than 10,000/g) with moderate to severe fibrosis. Mild to moderate pulmonary fibrosis could be identified on tissue sections before interstitial changes were detectable by chest roentgenograms.

The clinical significance of ferruginous bodies in sputa.

The clinical significance of ferruginous bodies in sputa was examined in a study of 674 former asbestos workers. Data from occupational histories and smoking behavior questionnaires, chest radiographs, spirometric measurements and counts of ferruginous bodies were obtained as part of a five-year surveillance program. Statistical analysis demonstrated that ferruginous bodies found in the sputa were significantly related to radiographic findings of interstitial pulmonary disease and pleural fibrosis and to spirometric findings of restrictive lung disease. Age and cigarette smoking were also found to be related to the presence of ferruginous bodies.

Strongyloides stercoralis in routine Papanicolaou-stained sputum smears.

Three cases are reported in which the initial detection of unsuspected Strongyloides stercoralis infestation was made on Papanicolaou-stained smears of sputum submitted for routine cytopathology. All cases were subsequently confirmed by the examination of stool specimens. A common factor in the three cases was long-term treatment with corticosteroids for chronic respiratory disease. All three patients responded to treatment with antihelminthics. The significance of this parasite is discussed, and its appearance in Papanicolaou-stained smears is described and illustrated.

The Tyler Asbestos Workers Program. I. A medical surveillance model and method.

An asbestos-exposed worker who smokes cigarettes has a high risk of developing cancer of the lung. One thousand ninety-five former workers at a plant manufacturing asbestos (amosite) insulation products were exposed to high levels of asbestos dust concentrations in the atmosphere. The workers have been identified and located. A semi-annual medical surveillance program has been developed with National Cancer Institute support. Examination of the worker includes the following: history (questionnaire), physical examination, sputum cytopathology, chest roentgenogram, pulmonary function studies, and other tests. Emphasis has been placed on understanding the role of sputum cytopathology in a cancer control program in former asbestos workers.