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Crawford JA, Sanyal S, Burnett BR, Wiesenfeld SL, Abraham JL. Accelerated silicosis in sandblasters: Pathology, mineralogy, and clinical correlates. Am J Ind Med 2024; 67:179-199. [PMID: 38265196 DOI: 10.1002/ajim.23561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND With increasing reports of accelerated and acute silicosis, PMF, and autoimmune disease among coal miners and silica-exposed countertop workers, we present previously incompletely-described pulmonary pathology of accelerated silicosis and correlations with mineralogy, radiography, and disease progression in 46 Texas oilfield pipe sandblasters who were biopsied between 1988 and 1995. METHODS Worker examinations included pulmonary function tests, chest X-ray (CXR), high-resolution computed tomography (HRCT), and Gallium-67 scans. Quantitative mineralogic analysis of pulmonary parenchymal burden of silica, silicates, and metal particles used scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM EDS). RESULTS Workers had clinical deterioration after <10 years exposure in dusty workplaces. Although initial CXR was normal in 54%, Gallium-67 scans were positive in 68% of those with normal CXR, indicating pulmonary inflammation. The histology of accelerated silicosis is diffuse interstitial infiltration of macrophages filled with weakly birefringent particles with or without silicotic nodules or alveolar proteinosis. Lung silica concentrations were among the highest in our database, showing a dose-response relationship with CXR, HRCT, and pathologic changes (macrophages, fibrosis, and silicotic nodules). Radiographic scores and diffusing capacity worsened during observation. Silica exposure was intensified, patients presented younger, with shorter exposure, more severe clinical abnormalities, higher lung particle burdens, and more rapid progression in a subset of patients exposed to recycled blasting sand. CONCLUSIONS Accelerated silicosis may present with a normal CXR despite significant histopathology. Multivariable analyses showed silica, and not other particles, is the driver of observed radiologic, physiologic, and histologic outcomes. Eliminating this preventable disease requires higher physician, public health, and societal awareness.
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Affiliation(s)
- Judith A Crawford
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Soma Sanyal
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Stephen L Wiesenfeld
- Department of Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
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2
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Corwin C, Waterhouse H, Abraham JL, Sanyal S, Crawford JA, Caddell M, Hodgson MJ. Interstitial pulmonary disease and aluminum trihydrate exposure: A single case report and detailed workplace analysis. Am J Ind Med 2024; 67:274-286. [PMID: 38253412 DOI: 10.1002/ajim.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Exposure to aluminum compounds is clearly associated with pulmonary function decrements, and several animal models document possible mechanisms of aluminum- compound-induced pulmonary toxicity. Nevertheless, disagreements remain about the precise mechanism by which exposures lead to damage. We present a strong case for attributing a case of interstitial pulmonary disease to occupational exposure to aluminum trihydrate. This report follows a 2014 publication of another case of interstitial pulmonary disease following a similar exposure. Our patient eventually underwent double lung transplantation nearly 5 years postexposure. Detailed pulmonary particulate elemental analysis suggested that aluminum metal, including aluminum trihydrate, was the most likely cause. A detailed assessment of the worker's relevant occupational exposures accompanies this case report.
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Affiliation(s)
- Claudia Corwin
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Jerrold L Abraham
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Soma Sanyal
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Judith A Crawford
- State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Matthew Caddell
- Occupational and Environmental Health Center, Albany, New York, USA
| | - Michael J Hodgson
- Occupational Safety and Health Administration, United States Department of Labor, Washington, District of Columbia, USA
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3
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Go LHT, Rose CS, Zell-Baran LM, Almberg KS, Iwaniuk C, Clingerman S, Richardson DL, Abraham JL, Cool CD, Franko AD, Green FHY, Hubbs AF, Murray J, Orandle MS, Sanyal S, Vorajee NI, Sarver EA, Petsonk EL, Cohen RA. Historical shift in pathological type of progressive massive fibrosis among coal miners in the USA. Occup Environ Med 2023; 80:425-430. [PMID: 37295943 PMCID: PMC10464845 DOI: 10.1136/oemed-2022-108643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pneumoconiosis among coal miners in the USA has been resurgent over the past two decades, despite modern dust controls and regulatory standards. Previously published studies have suggested that respirable crystalline silica (RCS) is a contributor to this disease resurgence. However, evidence has been primarily indirect, in the form of radiographic features. METHODS We obtained lung tissue specimens and data from the National Coal Workers' Autopsy Study. We evaluated specimens for the presence of progressive massive fibrosis (PMF) and used histopathological classifications to type these specimens into coal-type, mixed-type and silica-type PMF. Rates of each were compared by birth cohort. Logistic regression was used to assess demographic and mining characteristics associated with silica-type PMF. RESULTS Of 322 cases found to have PMF, study pathologists characterised 138 (43%) as coal-type, 129 (40%) as mixed-type and 55 (17%) as silica-type PMF. Among earlier birth cohorts, coal-type and mixed-type PMF were more common than silica-type PMF, but their rates declined in later birth cohorts. In contrast, the rate of silica-type PMF did not decline in cases from more recent birth cohorts. More recent year of birth was significantly associated with silica-type PMF. CONCLUSIONS Our findings demonstrate a shift in PMF types among US coal miners, from a predominance of coal- and mixed-type PMF to a more commonly encountered silica-type PMF. These results are further evidence of the prominent role of RCS in the pathogenesis of pneumoconiosis among contemporary US coal miners.
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Affiliation(s)
- Leonard H T Go
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Lauren M Zell-Baran
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
| | - Kirsten S Almberg
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Cayla Iwaniuk
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sidney Clingerman
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Diana L Richardson
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Jerrold L Abraham
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Carlyne D Cool
- Division of Pathology, National Jewish Health, Denver, Colorado, USA
| | - Angela D Franko
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Francis H Y Green
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ann F Hubbs
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Jill Murray
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute of Occupational Health, Johannesburg, South Africa
| | - Marlene S Orandle
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Soma Sanyal
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | | | - Emily A Sarver
- Mining and Minerals Engineering, Virginia Tech University, Blacksburg, Virginia, USA
| | - Edward L Petsonk
- Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Robert A Cohen
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Baur X, Abraham JL. A case of welder's lung with end-stage pulmonary fibrosis. Pneumologie 2023; 77:567-573. [PMID: 37308084 DOI: 10.1055/a-2028-6100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Welding, performed regularly by more than a million workers worldwide, is associated with exposures to irritative, fibrogenic and carcinogenic fumes and gases. METHODS AND RESULTS We present the case of a welder who had worked under extremely poor hygiene conditions for nearly 20 years and had developed end-stage lung fibrosis, finally requiring lung transplantation. Detailed histopathology and scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS) analyses of his lungs showed advanced interstitial fibrosis and dust deposits in the lungs and in peribronchial lymph nodes containing welding type bodies, Fe, Si (silica), Ti (titanium), SiAl (aluminum silicates), Fe with Cr (Steel), and Zr (Zirkonium). CONCLUSION In the absence of a systemic disorder and the failure to meet the criteria for diagnosis of idiopathic pulmonary fibrosis (IPF), these findings suggest welder's lung fibrosis as the most likely diagnosis.
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Affiliation(s)
- Xaver Baur
- European Society for Environmental and Occupational Medicine, Berlin, Germany
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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Baur X, Abraham JL. Correction: A case of welder's lung with end-stage pulmonary fibrosis. Pneumologie 2023; 77:e2. [PMID: 37619577 DOI: 10.1055/a-2158-0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Xaver Baur
- European Society for Environmental and Occupational Medicine, Berlin, Germany
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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6
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Zell-Baran LM, Go LH, Sarver E, Almberg KS, Iwaniuk C, Green FH, Abraham JL, Cool C, Franko A, Hubbs AF, Murray J, Orandle MS, Sanyal S, Vorajee N, Cohen RA, Rose CS. Mining Tenure and Job Duties Differ Among Contemporary and Historic Underground Coal Miners With Progressive Massive Fibrosis. J Occup Environ Med 2023; 65:315-320. [PMID: 36730599 PMCID: PMC10081940 DOI: 10.1097/jom.0000000000002746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize differences in mining jobs and tenure between contemporary (born 1930+, working primarily with modern mining technologies) and historic coal miners with progressive massive fibrosis (PMF). METHODS We classified jobs as designated occupations (DOs) and non-DOs based on regulatory sampling requirements. Demographic, occupational characteristics, and histopathological PMF type were compared between groups. RESULTS Contemporary miners ( n = 33) had significantly shorter mean total (30.4 years vs 37.1 years, P = 0.0006) and underground (28.8 years vs 35.8 years, P = 0.001) mining tenure compared with historic miners ( n = 289). Silica-type PMF was significantly more common among miners in non-DOs (30.1% vs 15.8%, P = 0.03) and contemporary miners (58.1% vs 15.2%, P < 0.0001). CONCLUSIONS Primary jobs changed over time with the introduction of modern mining technologies and likely changed exposures for workers. Elevated crystalline silica exposures are likely in non-DOs and require attention.
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7
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Zaccarini DJ, Lubin D, Sanyal S, Abraham JL. Barium Sulfate Deposition in the Gastrointestinal Tract: Review of the literature. Diagn Pathol 2022; 17:99. [PMID: 36585714 PMCID: PMC9805050 DOI: 10.1186/s13000-022-01283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Barium sulfate is utilized for imaging of the gastrointestinal tract and is usually not deposited within the wall of the intestine. It is thought that mucosal injury may allow barium sulfate to traverse the mucosa, and allow deposition to occur uncommonly. Most pathology textbooks describe the typical barium sulfate deposition pattern as small granular accumulation in macrophages, and do not describe the presence of larger rhomboid crystals. This review will summarize the clinical background, radiographic, gross, and microscopic features of barium sulfate deposition in the gastrointestinal tract. A review of the PubMed database was performed to identify all published cases of barium sulfate deposition in the gastrointestinal tract that have been confirmed by pathologic examination. CONCLUSIONS A review of the literature shows that the most common barium sulfate deposition pattern in the gastrointestinal tract is finely granular deposition (30 previously described cases), and less commonly large rhomboid crystals are seen (19 cases) with or without finely granular deposition. The fine granules are typically located in macrophages, while rhomboid crystals are usually extracellular. There are various methods to support that the foreign material is indeed barium sulfate, however, only a minority of studies perform ancillary testing. Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDS) can be useful for definitive confirmation. This review emphasizes the importance of recognizing both patterns of barium sulfate deposition, and the histologic differential diagnosis.
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Affiliation(s)
- Daniel J. Zaccarini
- grid.411023.50000 0000 9159 4457Departments of Pathology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY USA
| | - David Lubin
- grid.411023.50000 0000 9159 4457Departments of Radiology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY USA
| | - Soma Sanyal
- grid.411023.50000 0000 9159 4457Departments of Pathology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY USA
| | - Jerrold L. Abraham
- grid.411023.50000 0000 9159 4457Departments of Pathology, State University of New York (SUNY), Upstate Medical University, Syracuse, NY USA
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8
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Go LHT, Green FHY, Abraham JL, Churg A, Petsonk EL, Cohen RA. Coal mine dust lung disease in miners killed in the Upper Big Branch disaster: a review of lung pathology and contemporary respirable dust levels in underground US coal mines. Occup Environ Med 2021; 79:319-325. [PMID: 34880046 DOI: 10.1136/oemed-2021-107694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In 2010, 29 coal miners died due to an explosion at the Upper Big Branch (UBB) mine in West Virginia, USA. Autopsy examinations of 24 individuals with evaluable lung tissue identified 17 considered to have coal workers' pneumoconiosis (CWP). The objectives of this study were to characterise histopathological findings of lung tissue from a sample of UBB fatalities and better understand the respirable dust concentrations experienced by these miners at UBB relative to other US coal mines. METHODS Occupational pulmonary pathologists evaluated lung tissue specimens from UBB fatalities for the presence of features of pneumoconiosis. Respirable dust and quartz samples submitted for regulatory compliance from all US underground coal mines prior to the disaster were analysed. RESULTS Families of seven UBB fatalities provided consent for the study. Histopathologic evidence of CWP was found in all seven cases. For the USA, central Appalachia and UBB, compliance dust samples showed the geometric mean for respirable dust was 0.468, 0.420 and 0.518 mg/m3, respectively, and respirable quartz concentrations were 0.030, 0.038 and 0.061 mg/m3. After adjusting for quartz concentrations, UBB exceeded the US permissible exposure limit (PEL) for respirable dust in 28% of samples. CONCLUSIONS Although higher than average respirable dust and quartz levels were observed at UBB, over 200 US underground coal mines had higher dust concentrations than UBB and over 100 exceeded the PEL more frequently. Together with lung histopathological findings among UBB fatalities, these data suggest exposures leading to CWP in the USA are more prevalent than previously understood.
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Affiliation(s)
- Leonard H T Go
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA .,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Francis H Y Green
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Andrew Churg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward L Petsonk
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Robert A Cohen
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Vinnikov D, Blanc PD, Raushanova A, Beisbekova A, Abraham JL, Zlobina Y. Exposure to respirable dust among workers fabricating aluminium trihydroxide-containing synthetic countertops. Sci Rep 2021; 11:21219. [PMID: 34707188 PMCID: PMC8551245 DOI: 10.1038/s41598-021-00814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to characterize personal exposure of workers to respirable particulate matter (PM) generated in cutting and other fabrication activities when fabricating acryl polymer/aluminium trihydroxide synthetic countertops. We collected 29 personal full-day samples of respirable PM from three workers in a small private workshop. We tested differences between- and within-worker variances of mass concentrations using the Kruskall-Wallis test. We used segmented regression to test the means and medians 15-min interval concentrations changes over time and to identify a breakpoint. Respirable PM concentrations ranged nearly 100-fold, from 0.280 to 25.4 mg/m3 with a median of 2.0 mg/m3 (1-min concentrations from 13,920 data points). There were no statistical difference in daily median or geometric mean concentrations among workers, whereas the concentrations were significantly higher on days with three versus two workers present. The 15-min median concentrations (n = 974 measures) increased until 2.35 h (beta 0.177; p < 0.05), representing a 0.70 mg increase in exposure per hour. This was followed by a plateau in concentrations. The high levels of respirable PM we observed among workers fabricating aluminium trihydroxide-containing synthetic countertops highlight an unmet early prevention need.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan. .,Peoples' Friendship, University of Russia, RUDN University), Moscow, Russian Federation.
| | - Paul D Blanc
- University of California San Francisco, San Francisco, CA, USA
| | - Aizhan Raushanova
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
| | - Arailym Beisbekova
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan.,Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Yelena Zlobina
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
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10
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Wu BG, Kapoor B, Cummings KJ, Stanton ML, Nett RJ, Kreiss K, Abraham JL, Colby TV, Franko AD, Green FHY, Sanyal S, Clemente JC, Gao Z, Coffre M, Meyn P, Heguy A, Li Y, Sulaiman I, Borbet TC, Koralov SB, Tallaksen RJ, Wendland D, Bachelder VD, Boylstein RJ, Park JH, Cox-Ganser JM, Virji MA, Crawford JA, Edwards NT, Veillette M, Duchaine C, Warren K, Lundeen S, Blaser MJ, Segal LN. Evidence for Environmental-Human Microbiota Transfer at a Manufacturing Facility with Novel Work-related Respiratory Disease. Am J Respir Crit Care Med 2021; 202:1678-1688. [PMID: 32673495 DOI: 10.1164/rccm.202001-0197oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale: Workers' exposure to metalworking fluid (MWF) has been associated with respiratory disease.Objectives: As part of a public health investigation of a manufacturing facility, we performed a cross-sectional study using paired environmental and human sampling to evaluate the cross-pollination of microbes between the environment and the host and possible effects on lung pathology present among workers.Methods: Workplace environmental microbiota were evaluated in air and MWF samples. Human microbiota were evaluated in lung tissue samples from workers with respiratory symptoms found to have lymphocytic bronchiolitis and alveolar ductitis with B-cell follicles and emphysema, in lung tissue samples from control subjects, and in skin, nasal, and oral samples from 302 workers from different areas of the facility. In vitro effects of MWF exposure on murine B cells were assessed.Measurements and Main Results: An increased similarity of microbial composition was found between MWF samples and lung tissue samples of case workers compared with control subjects. Among workers in different locations within the facility, those that worked in the machine shop area had skin, nasal, and oral microbiota more closely related to the microbiota present in the MWF samples. Lung samples from four index cases and skin and nasal samples from workers in the machine shop area were enriched with Pseudomonas, the dominant taxa in MWF. Exposure to used MWF stimulated murine B-cell proliferation in vitro, a hallmark cell subtype found in the pathology of index cases.Conclusions: Evaluation of a manufacturing facility with a cluster of workers with respiratory disease supports cross-pollination of microbes from MWF to humans and suggests the potential for exposure to these microbes to be a health hazard.
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Affiliation(s)
| | | | - Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Randall J Nett
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Jerrold L Abraham
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Angela D Franko
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Francis H Y Green
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Soma Sanyal
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York
| | - Jose C Clemente
- Icahn Institute for Genomics and Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhan Gao
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey
| | - Maryaline Coffre
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Peter Meyn
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, New York
| | | | | | | | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Robert J Tallaksen
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | | | | | - Randy J Boylstein
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Ju-Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Judith A Crawford
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York
| | - Nicole T Edwards
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Marc Veillette
- Department of Biochemistry, Microbiology and Bioinformatics, Laval University, Quebec, Canada
| | - Caroline Duchaine
- Department of Biochemistry, Microbiology and Bioinformatics, Laval University, Quebec, Canada
| | - Krista Warren
- St. Luke's Department of Pathology, St. Luke's Hospital, Duluth, Minnesota; and
| | - Sarah Lundeen
- St. Luke's Department of Pathology, St. Luke's Hospital, Duluth, Minnesota; and
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey
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Caplan AL, Abraham JL. Ethical considerations for protecting the options of subjects in primary epidemic vaccine trials. J Med Ethics 2020; 47:medethics-2020-106851. [PMID: 32943477 PMCID: PMC8108278 DOI: 10.1136/medethics-2020-106851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Arthur L Caplan
- Division of Medical Ethics, NYU Langone Medical Center, New York, New York, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
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12
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Affiliation(s)
- Soma Sanyal
- SUNY Upstate Medical UniversitySyracuse, New York
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13
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Cummings KJ, Stanton ML, Nett RJ, Segal LN, Kreiss K, Abraham JL, Colby TV, Franko AD, Green FH, Sanyal S, Tallaksen RJ, Wendland D, Bachelder VD, Boylstein RJ, Park J, Cox‐Ganser JM, Virji MA, Crawford JA, Green BJ, LeBouf RF, Blaser MJ, Weissman DN. Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers. Am J Ind Med 2019; 62:927-937. [PMID: 31461179 DOI: 10.1002/ajim.23038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention.
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Affiliation(s)
- Kristin J. Cummings
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Marcia L. Stanton
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Randall J. Nett
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Leopoldo N. Segal
- Department of MedicineNew York University School of Medicine New York New York
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Jerrold L. Abraham
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Thomas V. Colby
- Department of Laboratory Medicine and PathologyMayo Clinic Scottsdale Arizona
| | - Angela D. Franko
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Francis H.Y. Green
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Soma Sanyal
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Robert J. Tallaksen
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | | | | | - Randy J. Boylstein
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Ju‐Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Jean M. Cox‐Ganser
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - M. Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Judith A. Crawford
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Brett James Green
- Health Effects Laboratory Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Martin J. Blaser
- Department of MedicineNew York University School of Medicine New York New York
| | - David N. Weissman
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
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Shue A, Joseph JM, Tao JP, Barker-Griffith AE, Abraham JL, Minckler DS. Massive Silicone-Induced Orbital Granuloma. Ocul Oncol Pathol 2019; 6:145-150. [PMID: 32258023 DOI: 10.1159/000501295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors' knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.
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Affiliation(s)
- Ann Shue
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Jeffrey M Joseph
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Jeremiah P Tao
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
| | - Ann E Barker-Griffith
- Department of Ophthalmology, SUNY, Upstate Medical University, Syracuse, New York, USA.,Department of Pathology, SUNY, Upstate Medical University, Syracuse, New York, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY, Upstate Medical University, Syracuse, New York, USA
| | - Donald S Minckler
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California, USA
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Baur X, Sanyal S, Abraham JL. Mixed-dust pneumoconiosis: Review of diagnostic and classification problems with presentation of a work-related case. Sci Total Environ 2019; 652:413-421. [PMID: 30368172 DOI: 10.1016/j.scitotenv.2018.10.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/03/2018] [Accepted: 10/06/2018] [Indexed: 06/08/2023]
Abstract
Environmental aerosolized particulates pose a potential risk to human health worldwide. Among others, high amounts of contaminants are generated especially in newly industrializing countries in the vicinity of industrial manufacturing, mining operations, but also during agricultural and natural processes. As an example of the needed multi-disciplinary diagnostic and differential diagnostic approach, we report a case of a 59-year old industrial worker who has suffered from chronic bronchitis and progressive dyspnea on exertion for 8years. He showed severe lung function impairment, a cavity in his right upper lung lobe, nodular and irregular opacities, fibrotic pleural changes and emphysema. According to the occupational history and the industrial hygiene report, he had been engaged in the production of various refractory materials and been exposed to very high levels of inorganic dust, especially to silica, silicon carbide and aluminum compounds, but also to carbon and other dusty materials for 28years. Histopathology of the two resected lung segments showed focally infarcted granulomas and chronic inflammation. Stains for organisms were negative. The lung tissue away from the granulomas showed significant dust deposition including dust macules. In spite of the inorganic dust deposits, with adjacent tissue lesions evident from the radiological findings (which were interpreted as atypical for pneumoconiosis) and the presence of granulomas in lung tissue, a diagnosis of necrotizing sarcoid granulomatosis was made, which was later changed to mixed-dust pneumoconiosis on further detailed examination. Scanning Electron Microscopy/Energy-Dispersive X-ray Spectroscopy (SEM/EDS) analysis of individual particles showed predominantly Si (silica or silicon carbide [SiC]) and Al particles (consistent with aluminum metal and/or oxide), as well as numerous Al silicates, Ti, and occasional Zr, Nb, V, steel, including Si fibers (consistent with SiC). We present the controversy about the pathogenesis of the lung disorder and whether it represents an occupational disease - which is more or less representative for many such cases.
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Affiliation(s)
- Xaver Baur
- European Society for Environmental and Occupational Medicine, Berlin, Germany.
| | - Soma Sanyal
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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16
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Cohen RA, Rose C, Petsonk EL, Abraham JL, Green FHY, Churg A. Reply: Coal Mine Dust Lung Disease That Persists below the Surface of Surveillance: Down Under. Am J Respir Crit Care Med 2017; 194:773-4. [PMID: 27628082 DOI: 10.1164/rccm.201604-0779le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Cecile Rose
- 2 National Jewish Health and University of Colorado Denver, Colorado
| | - Edward L Petsonk
- 3 West Virginia University School of Medicine Morgantown, West Virginia
| | | | | | - Andrew Churg
- 6 University of British Columbia Vancouver, British Columbia, Canada
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17
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Hoda RS, Sanyal S, Abraham JL, Everett JM, Hundemer GL, Yee E, Lauwers GY, Tolkoff-Rubin N, Misdraji J. Lanthanum deposition from oral lanthanum carbonate in the upper gastrointestinal tract. Histopathology 2017; 70:1072-1078. [PMID: 28134986 PMCID: PMC5450641 DOI: 10.1111/his.13178] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/09/2017] [Accepted: 01/25/2017] [Indexed: 12/13/2022]
Abstract
AIMS Lanthanum carbonate is used as an alternative to calcium-based phosphate binders to manage hyperphosphataemia in patients with renal failure. The deposition of lanthanum within gastroduodenal mucosa of patients treated with the medication has been described, but given the relative novelty of this entity, the histiocytic deposits in the gastroduodenal mucosa can be confused with a variety of other processes, including infections and other drug-induced forms of injury. METHODS AND RESULTS We describe five cases of lanthanum phosphate deposition in upper gastrointestinal (GI) tract biopsies. Three cases were confirmed with scanning electron microscopy and energy dispersive X-ray analysis, including one unique patient, status post-renal transplant for polycystic kidney disease, who had last taken lanthanum 7 years prior to biopsy. CONCLUSION Lanthanum deposition in the upper GI tract is a mimic of other drug-related forms of GI injury, including iron pill-related gastropathy. The key to making this diagnosis is a thorough drug history and awareness of the histological features.
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Affiliation(s)
- Raza S Hoda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Soma Sanyal
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jamie M Everett
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Gregory L Hundemer
- Department of Medicine, Nephrology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Yee
- Department of Pathology, Beth Israel Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gregory Y Lauwers
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Nina Tolkoff-Rubin
- Department of Medicine, Nephrology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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18
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Affiliation(s)
- Lauren Wright
- Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse2Department of Ophthalmology, University of Texas Health Science Center at San Antonio
| | - Ralph E Eagle
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerrold L Abraham
- Department of Pathology, State University of New York Upstate Medical University, Syracuse
| | - Ann E Barker-Griffith
- Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse4Department of Pathology, State University of New York Upstate Medical University, Syracuse
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19
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Cohen RA, Petsonk EL, Rose C, Young B, Regier M, Najmuddin A, Abraham JL, Churg A, Green FHY. Lung Pathology in U.S. Coal Workers with Rapidly Progressive Pneumoconiosis Implicates Silica and Silicates. Am J Respir Crit Care Med 2016; 193:673-80. [PMID: 26513613 PMCID: PMC4824937 DOI: 10.1164/rccm.201505-1014oc] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Recent reports of progressive massive fibrosis and rapidly progressive pneumoconiosis in U.S. coal miners have raised concerns about excessive exposures to coal mine dust, despite reports of declining dust levels. OBJECTIVES To evaluate the histologic abnormalities and retained dust particles in available coal miner lung pathology specimens, and to compare these findings with those derived from corresponding chest radiographs. METHODS Miners with severe disease and available lung tissue were identified through investigator outreach. Demographic as well as smoking and work history information was obtained. Chest radiographs were interpreted according to the International Labor Organization classification scheme to determine if criteria for rapidly progressive pneumoconiosis were confirmed. Pathology slides were scored by three expert pulmonary pathologists using a standardized nomenclature and scoring system. MEASUREMENTS AND MAIN RESULTS Thirteen cases were reviewed, many of which had features of accelerated silicosis and mixed dust lesions. Twelve had progressive massive fibrosis, and 11 had silicosis. Only four had classic lesions of simple coal workers' pneumoconiosis. Four had diffuse interstitial fibrosis with chronic inflammation, and two had focal alveolar proteinosis. Polarized light microscopy revealed large amounts of birefringent mineral dust particles consistent with silica and silicates; carbonaceous coal dust was less prominent. On the basis of chest imaging studies, specimens with features of silicosis were significantly associated (P = 0.047) with rounded (type p, q, or r) opacities, whereas grade 3 interstitial fibrosis was associated (P = 0.02) with the presence of irregular (type s, t, or u) opacities. CONCLUSIONS Our findings suggest that rapidly progressive pneumoconiosis in these miners was associated with exposure to coal mine dust containing high concentrations of respirable silica and silicates.
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Affiliation(s)
- Robert A. Cohen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Cecile Rose
- National Jewish Health, Denver, Colorado
- University of Colorado School of Medicine, Denver, Colorado
| | - Byron Young
- Charleston Area Medical Center, Charleston, West Virginia
| | - Michael Regier
- School of Public Health, West Virginia University, Morgantown, West Virginia
| | | | - Jerrold L. Abraham
- State University of New York, Upstate Medical University, Syracuse, New York
| | - Andrew Churg
- University of British Columbia, Vancouver, British Columbia, Canada; and
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20
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Breazzano MP, Fang H, Robinson MR, Abraham JL, Barker-Griffith AE. Vitreomacular Attachment Ultrastructure and Histopathological Correlation. Curr Eye Res 2015; 41:1098-1104. [DOI: 10.3109/02713683.2015.1085578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Hammar SP, Abraham JL. Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis. Am J Ind Med 2015; 58:1034-9. [PMID: 26374489 DOI: 10.1002/ajim.22512] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/07/2022]
Abstract
We reviewed the 2010 Asbestosis Committee's update on the diagnostic criteria for pathologic asbestosis. We must respectfully disagree with many of the criteria set forth therein, especially for recognizing asbestosis at its earliest stages; with statements focusing on the number of asbestos bodies needed in order to make a pathologic diagnosis of asbestosis; and regarding the benefits and pitfalls of relying on fiber analysis for diagnostic purposes, especially where chrysotile asbestos is concerned, including the methodology used for fiber determination. This critique has become even more relevant with the 2014 Helsinki criteria publication, which adopted the 2010 CAP/PPS criteria. Based on our review of these newer criteria and our experience in this field, we find that the CAP-NIOSH 1982 criteria is still the most acceptable method for the pathologic diagnosis and grading of asbestosis, which can be described as pulmonary fibrosis caused by inhalation of asbestos fibers.
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Affiliation(s)
- Samuel P. Hammar
- Diagnostic Specialties Laboratory, Inc. P.S; 700 Lebo Blvd., Bremerton; Washington 98310
| | - Jerrold L. Abraham
- SUNY Upstate Medical University; 750 E. Adams St., Syracuse; New York 13210
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22
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Lakis NS, Li Y, Abraham JL, Upton C, Blair DC, Smith S, Zhao H, Damon IK. Novel Poxvirus Infection in an Immune Suppressed Patient. Clin Infect Dis 2015; 61:1543-8. [PMID: 26243783 DOI: 10.1093/cid/civ643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human and animal poxvirus infections are being reported with increasing frequency. We describe a challenging case history and treatment of a previously unknown poxvirus rash illness in a renal transplant patient. METHODS A combination of classical microbiology techniques, including viral culture and electron microscopy, were used to provide initial clinical diagnosis. Subsequent standard polymerase chain reaction assays available in 2001 were noncontributory. Next generation sequencing was used to provide definitive diagnosis. RESULTS Retrospectively, next generation sequencing methods were used to ultimately provide the definitive diagnosis of a novel poxvirus infection initially identified by electron microscopy. The closest relative of this poxvirus, identified in North America, is a poxvirus collected from a mosquito pool from Central Africa in 1972. CONCLUSIONS This diagnostic quandary was ultimately solved using next generation DNA sequencing. This article describes the use of classical and next generation diagnostic strategies to identify etiologic agents of emerging infectious diseases and once again demonstrates the susceptibility of immunossupressed patients to novel pathogens. The virus identified is closely related to Yoka virus; these viruses appear to have independently diverged from a common ancestor of all known orthopoxviruses.
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Affiliation(s)
- Nelli S Lakis
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Yu Li
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Chris Upton
- Department of Biochemistry and Microbiology, University of Victoria, British Columbia, Canada
| | - Donald C Blair
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Scott Smith
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hui Zhao
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Inger K Damon
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Crawford JA, Rosenbaum PF, Anagnost SE, Hunt A, Abraham JL. Indicators of airborne fungal concentrations in urban homes: understanding the conditions that affect indoor fungal exposures. Sci Total Environ 2015; 517:113-24. [PMID: 25725196 DOI: 10.1016/j.scitotenv.2015.02.060] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 05/23/2023]
Abstract
Indoor fungal exposure can compromise respiratory health. Low-income urban areas are of concern because of high asthma and allergy rates and housing disrepair. Understanding the conditions that affect indoor fungal exposures is important for assessing health risks and for developing mitigation strategies. We examined the types and concentrations of airborne fungi inside and outside of homes in low-income areas of Syracuse, NY as well as the effect of snow cover on fungal levels. At 103 homes, air samples for viable fungi were collected, occupants were interviewed and homes were inspected for visible mold, musty odors, water problems and other factors. Multivariable logistic regression was used to relate high fungal levels to home conditions. Predominant indoor fungi included Cladosporium, Penicillium, Aspergillus, Alternaria and hyaline unknowns. Basidiomycetes and an uncommon genus Acrodontium were also found frequently due to analysis methods developed for this project. With snow cover, outdoor total fungal levels were depressed and indoor concentrations were three times higher than outdoor on average with a maximum of 29 times higher. Visible mold was related to elevated levels of Penicillium (OR 4.11 95% CI 1.37-14.0) and bacteria (OR 3.79 95% CI 1.41-11.2). Musty, moldy odors were associated with elevated concentrations of total fungi (OR 3.48 95% CI 1.13-11.6) and basidiomycetes. Cockroaches, an indicator of moisture, were associated with elevated levels of Penicillium (OR 3.66 95% CI 1.16-13.1) and Aspergillus (OR 4.36 95% CI 1.60-13.4). Increasing relative humidity was associated with higher concentrations of Penicillium, yeasts and basidiomycetes. Visible mold, musty odors, indoor humidity and cockroaches are modifiable factors that were important determinants of indoor fungal exposures. Indoor air investigators should interpret indoor:outdoor fungal ratios cautiously when snow cover is present.
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Affiliation(s)
- Judith A Crawford
- Graduate Program in Environmental Science, State University of New York (SUNY) College of Environmental Science and Forestry, Baker Laboratory, 1 Forestry Drive, Syracuse, NY 13210, United States.
| | - Paula F Rosenbaum
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, United States.
| | - Susan E Anagnost
- Department of Sustainable Construction Management & Engineering, SUNY College of Environmental Science and Forestry, 1 Forestry Drive, Syracuse, NY 13210, United States.
| | - Andrew Hunt
- Department of Earth and Environmental Sciences, University of Texas at Arlington, 500 Yates Street, Box 19049, Arlington, TX 76019-0049, United States.
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, United States.
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Balmes JR, Abraham JL, Dweik RA, Fireman E, Fontenot AP, Maier LA, Muller-Quernheim J, Ostiguy G, Pepper LD, Saltini C, Schuler CR, Takaro TK, Wambach PF. An official American Thoracic Society statement: diagnosis and management of beryllium sensitivity and chronic beryllium disease. Am J Respir Crit Care Med 2015; 190:e34-59. [PMID: 25398119 DOI: 10.1164/rccm.201409-1722st] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Beryllium continues to have a wide range of industrial applications. Exposure to beryllium can lead to sensitization (BeS) and chronic beryllium disease (CBD). OBJECTIVES The purpose of this statement is to increase awareness and knowledge about beryllium exposure, BeS, and CBD. METHODS Evidence was identified by a search of MEDLINE. The committee then summarized the evidence, drew conclusions, and described their approach to diagnosis and management. MAIN RESULTS The beryllium lymphocyte proliferation test is the cornerstone of both medical surveillance and the diagnosis of BeS and CBD. A confirmed abnormal beryllium lymphocyte proliferation test without evidence of lung disease is diagnostic of BeS. BeS with evidence of a granulomatous inflammatory response in the lung is diagnostic of CBD. The determinants of progression from BeS to CBD are uncertain, but higher exposures and the presence of a genetic variant in the HLA-DP β chain appear to increase the risk. Periodic evaluation of affected individuals can detect disease progression (from BeS to CBD, or from mild CBD to more severe CBD). Corticosteroid therapy is typically administered when a patient with CBD exhibits evidence of significant lung function abnormality or decline. CONCLUSIONS Medical surveillance in workplaces that use beryllium-containing materials can identify individuals with BeS and at-risk groups of workers, which can help prioritize efforts to reduce inhalational and dermal exposures.
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Rosenbaum PF, Crawford JA, Hunt A, Vesper SJ, Abraham JL. Environmental relative moldiness index and associations with home characteristics and infant wheeze. J Occup Environ Hyg 2015; 12:29-36. [PMID: 25068535 DOI: 10.1080/15459624.2014.933958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Possible relationships between mold contamination, as described by the Environmental Relative Moldiness Index (ERMI), home characteristics, and the development of wheeze in the first year of life were evaluated among a cohort of urban infants (n = 103) in Syracuse, New York. Pregnant women with a history of asthma were recruited in 2001-2002 for the "Assessment of Urban Dwellings for Indoor Toxics" (AUDIT) study. When the infants were approximately 3 months of age, a home inspection was carried out and indoor environmental samples collected, including vacuumed house dust. ERMI levels in the Syracuse cohort homes were higher than the U.S. average, with an overall mean of 11.4. ERMI levels were significantly higher in homes with visible water problems (p = 0.023) and visible mold (p = 0.023). ERMI levels in apartments were significantly lower than the values measured in houses (p = 0.0003). While infants experiencing wheeze (38%) tended to live in homes with higher ERMI values than those without wheeze (ERMI values of 12.3 and 10.9, respectively), the differences did not reach statistical significance. A subset analysis limited to infants with living room samples who remained in the same home during the study (n = 25) was suggestive of an association between higher ERMI values and wheeze (p = 0.10). In summary, the ERMI is a standardized metric which allows for comparison of moldiness levels in homes across studies and regions in the United States. ERMI levels in Syracuse homes were skewed to the high end of the national scale. Higher ERMI levels were indicators of water problems, mold, and type of housing.
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Affiliation(s)
- P F Rosenbaum
- a Department of Public Health & Preventive Medicine , State University of New York (SUNY) Upstate Medical University , Syracuse , New York
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26
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Abraham JL, Chandra S, Agrawal A. Quantification and micron-scale imaging of spatial distribution of trace beryllium in shrapnel fragments and metallurgic samples with correlative fluorescence detection method and secondary ion mass spectrometry (SIMS). J Microsc 2014; 256:145-52. [PMID: 25146877 PMCID: PMC4194148 DOI: 10.1111/jmi.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
Recently, a report raised the possibility of shrapnel-induced chronic beryllium disease from long-term exposure to the surface of retained aluminum shrapnel fragments in the body. Since the shrapnel fragments contained trace beryllium, methodological developments were needed for beryllium quantification and to study its spatial distribution in relation to other matrix elements, such as aluminum and iron, in metallurgic samples. In this work, we developed methodology for quantification of trace beryllium in samples of shrapnel fragments and other metallurgic sample-types with main matrix of aluminum (aluminum cans from soda, beer, carbonated water and aluminum foil). Sample preparation procedures were developed for dissolving beryllium for its quantification with the fluorescence detection method for homogenized measurements. The spatial distribution of trace beryllium on the sample surface and in 3D was imaged with a dynamic secondary ion mass spectrometry instrument, CAMECA IMS 3f secondary ion mass spectrometry ion microscope. The beryllium content of shrapnel (∼100 ppb) was the same as the trace quantities of beryllium found in aluminum cans. The beryllium content of aluminum foil (∼25 ppb) was significantly lower than cans. SIMS imaging analysis revealed beryllium to be distributed in the form of low micron-sized particles and clusters distributed randomly in X-Y- and Z dimensions, and often in association with iron, in the main aluminum matrix of cans. These observations indicate a plausible formation of Be-Fe or Al-Be alloy in the matrix of cans. Further observations were made on fluids (carbonated water) for understanding if trace beryllium in cans leached out and contaminated the food product. A direct comparison of carbonated water in aluminum cans and plastic bottles revealed that beryllium was below the detection limits of the fluorescence detection method (∼0.01 ppb). These observations indicate that beryllium present in aluminum matrix was either present in an immobile form or its mobilization into the food product was prevented by a polymer coating on the inside of cans, a practice used in food industry to prevent contamination of food products. The lack of such coating in retained shrapnel fragments renders their surface a possible source of contamination for long-term exposure of tissues and fluids and induction of disease, as characterized in a recent study. Methodological developments reported here can be extended to studies of beryllium in electronics devices and components.
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Affiliation(s)
- Jerrold L. Abraham
- Department of Pathology, SUNY Upstate Medical University,
Syracuse, New York U.S.A
| | - Subhash Chandra
- Cornell SIMS Laboratory, Department of Biomedical Engineering,
Cornell University, Ithaca, New York, U.S.A
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Bailey RA, Duncan JW, Tran AT, Abraham JL. Mega-granuloma After Using the Universal Clamp for Adolescent Idiopathic Scoliosis: What Is It and Can It Be Prevented? Spine Deform 2014; 2:392-398. [PMID: 27927338 DOI: 10.1016/j.jspd.2014.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/08/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Clinical case series. OBJECTIVE To characterize the postoperative course and histopathology of peri-implant tissue of adolescent idiopathic scoliosis patients who experienced postoperative development of an aseptic soft tissue reaction, with granulomas adjacent to the sublaminar polyethylene terephthalate strap-titanium clamp used in Zimmer's Universal Clamp (UC) spinal fixation system after spinal surgery. BACKGROUND SUMMARY The UC was designed for use with spinal deformity procedures in place of pedicle screws, hooks, or sublaminar wiring in fusion constructs. Recent studies of the UC lack emphasis on implant-related postoperative complications. METHODS A total of 26 consecutive patients who underwent spinal deformity correction for scoliosis were reviewed for implant-related postoperative complications. Histology, scanning electron microscopy with energy-dispersive X-ray spectroscopy, fractional culture/biopsy, and Gram stain examination of the peri-implant tissue of patients with complications was performed. RESULTS The authors reviewed 26 cases for correction of scoliosis. Two patients with adolescent idiopathic scoliosis who used the UC experienced implant-related complications with development of an aseptic soft tissue reaction with granulomas adjacent to the sublaminar polyethylene terephthalate straps-titanium clamp mechanism of the UC 8 months after AIS correction surgery. There were no signs or symptoms of wound infection. Gram stain revealed no organisms. There were many neutrophils and the surface of the wound revealed rare Staphylococcus aureus but the deep portions of the wounds were negative for organisms. Histopathology revealed extensive granulation tissue and histiocytes with engulfed birefringent particles or debris, and scanning electron microscopy with energy-dispersive X-ray spectroscopy analysis revealed macrophages containing many particles identified as titanium. CONCLUSIONS adolescent idiopathic scoliosis patients who use the novel UC construct may develop postoperative foreign-body reaction.
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Affiliation(s)
| | - Jan William Duncan
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 711 West College Street, Suite 625, Los Angeles, CA 90012, USA
| | - Alan T Tran
- Department of Plastic and Reconstructive Surgery, White Memorial Medical Center, 1720 East Cesar Chavez Avenue, Los Angeles, CA 90033, USA
| | - Jerrold L Abraham
- Department of Pathology, College of Medicine, State University of New York, Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA
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Breazzano MP, Fikhman M, Abraham JL, Barker-Griffith AE. Analysis of Schwalbe's Line (Limbal Smooth Zone) by Scanning Electron Microscopy and Optical Coherence Tomography in Human Eye Bank Eyes. J Ophthalmic Vis Res 2013; 8:9-16. [PMID: 23825707 PMCID: PMC3691978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/22/2012] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Implantation of intraocular devices may become critical as they decrease in size in the future. Therefore, it is desirable to evaluate the relationship between radial location and Schwalbe's line (smooth zone) by examining its width with scanning electron microscopy (SEM) and to correlate this with observations by optical coherence tomography (OCT). METHODS Full corneoscleral rings were obtained from twenty-six formalin-fixed human phakic donor eyes. SEM of each eye yielded a complete montage of the smooth zone, from which the area was measured, and width was determined in each quadrant. In three different eyes, time domain anterior segment OCT (Visante, Carl Zeiss Meditec Inc., Dublin, CA, USA) and spectral domain OCT (Cirrus 4.0, Carl Zeiss Meditec Inc., Dublin, CA, USA) were used to further characterize Schwalbe's line. RESULTS The overall smooth zone width was 79±22 µm, (n=15) ranging from 43 to 115 µm. The superior quadrant (103±8 µm, n=19), demonstrated significantly wider smooth zone than both the nasal (71±5 µm, n=19, P<0.001), and inferior (64±5 µm, n=18, P<0.0001) quadrants but not the temporal quadrant (81±7 µm, n=17, P>0.05). SEM findings of the smooth zone were correlated with visualization of Schwalbe's line by Cirrus and Visante OCT imaging. CONCLUSION The smooth zone appears widest superiorly and thinnest inferonasally, suggesting that as glaucoma surgical devices become smaller, their placement could be argeted clinically by using OCT with preference to the superior quadrant, to minimize damage to the corneal endothelium.
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Affiliation(s)
- Mark P Breazzano
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michael Fikhman
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jerrold L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ann E Barker-Griffith
- Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA,Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA,Correspondence to: Ann E. Barker-Griffith, MD, FRCSC. Professor of Ophthalmology & Pathology. 766 Irving Ave., Syracuse, NY 13210; Tel: +1 315 464-7156, Fax: +1 315 464-7137; e-mail:
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Fireman E, Shai AB, Lerman Y, Topilsky M, Blanc PD, Maier L, Li L, Chandra S, Abraham JM, Fomin I, Aviram G, Abraham JL. Chest wall shrapnel-induced beryllium-sensitization and associated pulmonary disease. Sarcoidosis Vasc Diffuse Lung Dis 2012; 29:147-150. [PMID: 23461078 PMCID: PMC4347841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic beryllium disease (CBD) is an exposure-related granulomatous disease mimicking sarcoidosis. Beryllium exposure-associated disease occurs mainly via inhalation, but skin may also be a source of sensitization. A 65-year-old male with a history of war-related shrapnel wounds was initially diagnosed with pulmonary sarcoidosis. Twenty years later, the possibility of a metal-related etiology for the lung disease was raised. A beryllium lymphocyte proliferation test, elemental analysis of removed shrapnel, and genetic studies were consistent with a diagnosis of CBD. This case demonstrates that retained beryllium-containing foreign bodies can be linked to a pathophysiologic response in the lung consistent with CBD.
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Affiliation(s)
- E Fireman
- Institute of Pulmonary and Allergic Diseases, National Service for Interstitial Lung Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Hunt A, Crawford JA, Rosenbaum PF, Abraham JL. Levels of household particulate matter and environmental tobacco smoke exposure in the first year of life for a cohort at risk for asthma in urban Syracuse, NY. Environ Int 2011; 37:1196-1205. [PMID: 21620473 DOI: 10.1016/j.envint.2011.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/21/2011] [Indexed: 05/30/2023]
Abstract
The Syracuse, NY, AUDIT (Assessment of Urban Dwellings for Indoor Toxics) study was designed to quantify asthma agent levels in the inner-city homes of a birth cohort whose mothers had a diagnosis of asthma. Risk of exposure to particulate matter (PM), particle number and tobacco smoke was assessed in 103 infants' homes. Repeat measurements were made in 44% of the homes. Infants also were examined on a quarterly basis during the first year of life to monitor their respiratory health and urine cotinine levels. Overall geometric mean (GM) values for PM(2.5) of 21.2 μg/m(3) and for PM(10) of 31.8 μg/m(3) were recorded in homes at visit 1. GM values for PM(2.5) and PM(10) in smoking homes were higher at 26.3 and 37.7 μg/m(3), while values in non-smoking homes were 12.7 and 21.2 μg/m(3) respectively. Fifty-four percent of mothers (55/103) smoked at some point in pregnancy (39% smoked throughout pregnancy). Environmental tobacco smoke (ETS) exposure occurred in 68% of homes during the infants' first year. Significant to this study was the size- and time-resolved monitoring of PM at 140 home visits and the classification of PM count data. PM number counts ranged from continuously low levels (little indoor activity) to continuously high counts (constant indoor activity), and recorded apparent instances of prolonged repeated cigarette smoking. Wheezing in the first year of life was recorded for 38% of the infants (39/103). Adjusted logistic regression modeling demonstrated that elevated levels of indoor PM(2.5) (≥ 15 μg/m(3)) were a significant risk factor for infant wheezing after controlling for infant gender, mothers' age and education level, season of home visit and presence of carpeting (OR 4.21; 95% CI 1.36-13.03; p=0.013). An elevated level of the nicotine metabolite cotinine in infant urine also was associated with infant wheezing after adjusting for infant gender, mothers' age and education level (OR 5.10; 95% CI 0.96-27.24; p=0.057). ETS exposure was pervasive in the AUDIT cohort and a risk for developing infants in this urban population.
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Affiliation(s)
- A Hunt
- Department of Earth and Environmental Sciences, University of Texas at Arlington, Arlington, TX 76019-0049, USA.
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Affiliation(s)
- Ann Barker-Griffith
- Department of Ophthalmology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
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George SJ, Webb SM, Abraham JL, Cramer SP. Synchrotron X-ray analyses demonstrate phosphate-bound gadolinium in skin in nephrogenic systemic fibrosis. Br J Dermatol 2011; 163:1077-81. [PMID: 20560953 DOI: 10.1111/j.1365-2133.2010.09918.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nephrogenic systemic fibrosis (NSF) is an incurable, debilitating disease found exclusively in patients with decreased kidney function and comprises a fibrosing disorder of the skin and systemic tissues. The disease is associated with exposure to gadolinium (Gd)-based contrast agents (GBCA) used in magnetic resonance imaging (MRI). Tissue samples from many patients with NSF contain micron-sized insoluble Gd-containing deposits. However, the precise composition and chemical nature of these particles is unclear. OBJECTIVES To clarify the precise chemical structure of the Gd-containing deposits in NSF tissues. METHODS Autopsy skin tissues from a patient with NSF were examined in situ using synchrotron X-ray fluorescence (SXRF) microscopy and extended X-ray absorption fine structure (EXAFS) spectroscopy and in correlation with light microscopy and the results of scanning electron microscopy /energy dispersive spectroscopy analyses. RESULTS The insoluble Gd deposits were shown to contain Gd no longer coordinated by GBCA chelator molecules but rather in a sodium calcium phosphate material. SXRF microscopy shows a clear correlation between Gd, Ca and P. EXAFS spectroscopy shows a very different spectrum from the GBCAs, with Gd–P distances at 3·11 A and 3·11 A as well as Gd–Gd distances at an average of 4·05 A, consistent with a GdPO4 structure. CONCLUSIONS This is the first direct evidence for the chemical release of Gd from GBCA in human tissue. This supports the physical–chemical, clinical and epidemiological data indicating a link between stability and dose of GBCA to the development of NSF.
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Affiliation(s)
- S J George
- Department of Applied Science, University of California, Davis, CA 95616, USA
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Case BW, Abraham JL, Meeker G, Pooley FD, Pinkerton KE. Applying definitions of "asbestos" to environmental and "low-dose" exposure levels and health effects, particularly malignant mesothelioma. J Toxicol Environ Health B Crit Rev 2011; 14:3-39. [PMID: 21534084 PMCID: PMC3118487 DOI: 10.1080/10937404.2011.556045] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although asbestos research has been ongoing for decades, this increased knowledge has not led to consensus in many areas of the field. Two such areas of controversy include the specific definitions of asbestos, and limitations in understanding exposure-response relationships for various asbestos types and exposure levels and disease. This document reviews the current regulatory and mineralogical definitions and how variability in these definitions has led to difficulties in the discussion and comparison of both experimental laboratory and human epidemiological studies for asbestos. This review also examines the issues of exposure measurement in both animal and human studies, and discusses the impact of these issues on determination of cause for asbestos-related diseases. Limitations include the lack of detailed characterization and limited quantification of the fibers in most studies. Associated data gaps and research needs are also enumerated in this review.
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Affiliation(s)
- B W Case
- Department of Pathology and School of Environment, McGill University, Montreal, Quebec, Canada.
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Xia D, Davis RL, Crawford JA, Abraham JL. Gadolinium released from MR contrast agents is deposited in brain tumors: in situ demonstration using scanning electron microscopy with energy dispersive X-ray spectroscopy. Acta Radiol 2010; 51:1126-36. [PMID: 20868305 DOI: 10.3109/02841851.2010.515614] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND gadolinium (Gd)-containing MRI contrast agents (GdCA) are widely used in studies of brain tumors, and a number of reports suggest that under certain conditions, such as renal failure, Gd may be released from GdCA into patient's tissues. Whether this may happen in abnormal tissues in the absence of renal failure has not been studied. PURPOSE to test the hypothesis that the local retention of GdCA resulting from brain tumor-associated alterations in the blood-brain barrier (BBB) may result in the deposition of Gd released from the GdCA, depending on stability. MATERIAL AND METHODS in this retrospective study, 30 selected brain tumor biopsies from 28 patients (taken before and after an institutional switch from a less stable to an intermediate stable GdCA) were searched for Gd-containing deposits using scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Relevant histories and laboratory results were obtained through institutional electronic records. Associations between the presence of deposits and other variables were tested for statistical significance using the two-tailed Fisher's exact test. RESULTS insoluble deposits containing Gd associated with phosphorus and calcium were found in seven biopsies from five patients. These deposits were found in patients with estimated GFRs above 53 ml/min, and were detected more often in those receiving GdCA before the switch from a less stable to an intermediate stable GdCA (P = 0.04), and may be more frequent in patients receiving more than one contrast-enhanced MR scan (P = 0.15). CONCLUSION Gd-containing deposits are present in brain tumors following contrast-enhanced MR scans in patients without severe renal disease. Further studies are needed to assess the clinical importance of the deposits we observed and to determine whether they are also found in other conditions that alter the integrity of the BBB.
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Affiliation(s)
- Daniel Xia
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Richard L. Davis
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Judith A. Crawford
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jerrold L. Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA
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Rosenbaum PF, Crawford JA, Anagnost SE, Wang CJK, Hunt A, Anbar RD, Hargrave TM, Hall EG, Liu CC, Abraham JL. Indoor airborne fungi and wheeze in the first year of life among a cohort of infants at risk for asthma. J Expo Sci Environ Epidemiol 2010; 20:503-515. [PMID: 19536075 DOI: 10.1038/jes.2009.27] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 03/25/2009] [Indexed: 05/27/2023]
Abstract
In studies worldwide, respiratory outcomes such as cough, wheeze and asthma have been consistently linked to mold exposure. Young children spend most of their time indoors and may be particularly vulnerable. We evaluated the associations between exposure to airborne fungal levels and episodes of wheezing in a cohort of 103 infants at risk for asthma (due to maternal history of asthma), living primarily in low-income urban settings. Using a new protocol that facilitates identification of rare and slow-growing fungi, we measured the type and concentration of cultured fungi in home air samples taken early in the infant's first year of life. We also inspected the homes for visible mold, water damage and other housing and environmental conditions. All homes had measurable indoor airborne fungi and 73%, had some sign of mold, water damage, dampness or a musty odor. One or more episodes of wheeze during the first year of life were observed in 38% of infants. Multiple logistic regression showed high indoor levels of Penicillium were a significant risk factor for wheeze (OR 6.18; 95% CI: 1.34-28.46) in the first year of life after controlling for season of sampling, smoking, endotoxin levels, day care attendance and confounders. Acrodontium, a rarely reported fungal genus, was detected in 18% of study homes, and was associated with wheeze in unadjusted models (OR 2.75; 95% CI 0.99-7.61), but not after adjustment for confounders. Total fungal levels, visually observed mold, dampness, water damage or musty odors were not significantly associated with wheeze.
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Affiliation(s)
- Paula F Rosenbaum
- Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse, USA.
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Thakral C, Abraham JL. Gadolinium-Induced Nephrogenic Systemic Fibrosis Is Associated with Insoluble Gd Deposits in Tissues:In VivoTransmetallation Confirmed by Microanalysis. J Cutan Pathol 2009; 36:1244-54. [DOI: 10.1111/j.1600-0560.2009.01283.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boyd AS, Sanyal S, Abraham JL. Tissue gadolinium deposition and fibrosis mimicking nephrogenic systemic fibrosis (NSF)-subclinical nephrogenic systemic fibrosis? J Am Acad Dermatol 2009; 62:337-42. [PMID: 19939504 DOI: 10.1016/j.jaad.2009.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 03/25/2009] [Accepted: 04/04/2009] [Indexed: 10/20/2022]
Abstract
Nephrogenic systemic fibrosis is a condition with significant and often debilitating cutaneous manifestations. Recent research on this disease has delineated an association between nephrogenic systemic fibrosis and exposure to magnetic resonance imaging studies using gadolinium-based contrast agents in patients with ongoing renal failure. This metal has been detected in cutaneous biopsy specimens taken from lesional skin suggesting that gadolinium provides an impetus for the deposition of circulating fibrocytes in the skin and subsequent fibrosis. We describe a hemodialysis-dependent liver transplant recipient who received a gadolinium-based contrast agent and demonstrated insoluble gadolinium deposition in a fibrotic dermis and subcutaneous septum using scanning electron microscopy/energy dispersive x-ray spectroscopy. He has yet to manifest symptoms and signs of nephrogenic systemic fibrosis 3 years after his magnetic resonance imaging study.
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Affiliation(s)
- Alan S Boyd
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, Tennessee, USA.
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Abstract
Lanthanum carbonate (LaCO(3)) is an oral phosphate binder widely used in end-stage renal disease (ESRD). Preclinical animal studies reported the highest La concentrations outside the gut to be in mesenteric lymph nodes. We observed previously unreported La deposition visible by light microscopy and confirmed by scanning electron microscopy with energy dispersive x-ray spectroscopy in a mesenteric lymph node at autopsy of a 38-year-old female ESRD patient 3 years following LaCO(3) administration. Although LaCO(3) is generally thought to be minimally absorbed, this demonstration suggests the need for further investigation of the extent and potential effects of such absorption.
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Affiliation(s)
- Richard L Davis
- Department of Pathology, Suny Upstate Medical University, Syracuse, NY 13210, USA
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Boyd AS, Sanyal S, Abraham JL. Gadolinium is not deposited in the skin of patients with normal renal function after exposure to gadolinium-based contrast agents. J Am Acad Dermatol 2008; 59:356-8. [DOI: 10.1016/j.jaad.2008.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 01/23/2008] [Accepted: 01/29/2008] [Indexed: 11/26/2022]
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Abraham JL, Thakral C. Tissue distribution and kinetics of gadolinium and nephrogenic systemic fibrosis. Eur J Radiol 2008; 66:200-7. [DOI: 10.1016/j.ejrad.2008.01.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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Naqvi AH, Abraham JL, Kellman RM, Khurana KK. Calcium pyrophosphate dihydrate deposition disease (CPPD)/Pseudogout of the temporomandibular joint - FNA findings and microanalysis. Cytojournal 2008; 5:8. [PMID: 18426573 PMCID: PMC2346483 DOI: 10.1186/1742-6413-5-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 04/21/2008] [Indexed: 11/10/2022] Open
Abstract
We report a case of a Calcium pyrophosphate dihydrate deposition disease (CPPD) presenting as a mass in the parotid and temporomandibular joint (TMJ) that simulated a parotid tumor. A 35 year-old man presented with pain in the left ear area. A CT Scan of the area showed a large, calcified mass surrounding the left condylar head, and extending into the infratemporal fossa. FNA of the mass showed birefringent crystals, most of which were rhomboid with occasional ones being needle shaped, embedded in an amorphous pink substance. Scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS) of these crystals showed peaks corresponding to calcium and phosphorus. SEM/EDS is a rapid method of diagnosing calcium pyrophosphate dihydrate deposition disease (CPPD) and an alternative to more commonly used method of special staining of cell block sections coupled with polarizing microscopy.
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Affiliation(s)
- Asghar H Naqvi
- Department of Pathology, SUNY-Upstate Medical University, Syracuse, NY 13210, USA.
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Naqvi AH, Hunt A, Burnett BR, Abraham JL. Pathologic spectrum and lung dust burden in giant cell interstitial pneumonia (hard metal disease/cobalt pneumonitis): review of 100 cases. Arch Environ Occup Health 2008; 63:51-70. [PMID: 18628077 DOI: 10.3200/aeoh.63.2.51-70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hard metal disease (HMD), the interstitial lung disease caused by dusts in the cemented tungsten carbide (WC) industry, has been attributed to cobalt. The rare histologic pattern of giant cell interstitial pneumonia (GIP) is characteristic in HMD. The authors reviewed the history of HMD and 100 cases of HMD that they have seen over 5 decades. GIP was proven in 59; analysis of the lung inorganic particle burden by scanning electron microscopy and energy-dispersive x-ray spectroscopy confirmed HMD in the other 41. Cases have been diagnosed by bronchoalveolar lavage, lung biopsy, and autopsy. Histopathology findings range from focal peribronchiolar inflammation to diffuse interstitial fibrosis and honeycombing. GIP cases in the WC industry reveal elevated concentrations of tungsten in all, but cobalt was detected in only 6 ( approximately 10%). Of the 746 diverse cases in the authors' analytical database, almost all cases with the highest tungsten concentration showed GIP. This study confirms that GIP is effectively pathognomonic for HMD.
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Kalb RE, Helm TN, Sperry H, Thakral C, Abraham JL, Kanal E. Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury. Br J Dermatol 2007; 158:607-10. [PMID: 18076707 DOI: 10.1111/j.1365-2133.2007.08369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (Omniscan) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue.
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Affiliation(s)
- R E Kalb
- Department of Dermatology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Williamsville, NY 14221, USA.
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Abraham JL, Thakral C, Skov L, Rossen K, Marckmann P. Dermal inorganic gadolinium concentrations: evidence for in vivo transmetallation and long-term persistence in nephrogenic systemic fibrosis. Br J Dermatol 2007; 158:273-80. [PMID: 18067485 DOI: 10.1111/j.1365-2133.2007.08335.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gadolinium (Gd)-based magnetic resonance contrast agents (GBMCA), including gadodiamide, have been identified as the probable causative agents of the serious disease, nephrogenic systemic fibrosis (NSF). OBJECTIVES To investigate retained Gd-containing deposits in skin biopsies from patients with NSF and to determine their relative concentrations over time from administration of GBMCA. METHODS An investigator-blinded retrospective study, analysing 43 skin biopsies from 20 patients with gadodiamide-related NSF and one NSF-negative gadodiamide-exposed dialysis patient, ranging from 16 days to 1991 days after Gd contrast dose. Utilizing automated quantitative scanning electron microscopy/energy-dispersive X-ray spectroscopy we determined the concentration of Gd and associated elements present as insoluble deposits in situ in the tissues. RESULTS We detected Gd in skin lesions of all 20 patients with NSF, whereas Gd was undetectable in the NSF-negative patient. Gd concentration increased over time in 60% of patients with multiple sequential biopsies (n=10), decreasing only when the initial sampling time was >23 months after first gadodiamide dose. All Gd-containing deposits contained phosphorus, calcium and sodium. The ratio of Gd to calcium in tissue deposits correlated positively with the gadodiamide dose and with serum ionized calcium at the time of Gd exposure. CONCLUSIONS These findings demonstrate the in vivo release (through transmetallation) of the toxic free Gd3+ from gadodiamide, and its retention in apatite-like deposits. We suggest that Gd may be mobilized over time from bone stores, explaining variably delayed onset of NSF and increasing skin concentration over time in patients with NSF.
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Affiliation(s)
- J L Abraham
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Naqvi AH, Shields JW, Abraham JL. Nasal argyria (deposition of silver-selenium) in the photographic film industry: histopathology and microanalysis. Am J Otolaryngol 2007; 28:430-2. [PMID: 17980779 DOI: 10.1016/j.amjoto.2006.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Accepted: 11/16/2006] [Indexed: 10/22/2022]
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Thakral C, Alhariri J, Abraham JL. Long-term retention of gadolinium in tissues from nephrogenic systemic fibrosis patient after multiple gadolinium-enhanced MRI scans: case report and implications. Contrast Media Mol Imaging 2007; 2:199-205. [PMID: 17712863 DOI: 10.1002/cmmi.146] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) is a painful and debilitating fibrosing disorder of the skin and systemic tissues. It is associated with exposure to Gd, used in MRIs and MRAs, in patients with renal insufficiency. We here present an illustrative example of a young patient who underwent multiple Gd-enhanced scans, both before and after developing severe NSF. We examined biopsy tissues for quantification of detectable insoluble Gd deposits using automated scanning electron microscopy/energy dispersive X-ray spectroscopy. High concentrations of Gd associated with calcium and phosphorus in skin persisted even 3 years after the last exposure to Gd. Such long-term retention of Gd raises further concerns about the utility and safety of Gd-based contrast agents. Residual Gd chelates, after initial and rapid renal clearance, can dissociate into insoluble, toxic Gd(3+) that precipitates with tissue anions. Bone serves as a site for Gd storage. Subsequent clearance and mobilization from such stores may explain the variable latency of onset of NSF. We hypothesize that long-term persistence and slow release of Gd(3+) from bone stores can be a cause for concern of Gd-associated toxicity with long latency.
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Affiliation(s)
- Charu Thakral
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY 13210, USA
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