Simian virus 40 is not a cofactor in the pathogenesis of environmentally induced malignant pleural mesothelioma in Turkey

Malignant pleural mesothelioma (MPM) continues to be a public health problem in Turkey, where exposure to environmental asbestos and fibrous zeolite (erionite) is the main cause of the disease. However, less than 5% of exposed individuals develop the disease, and numerous cases of MPM are documented each year in which the patient has no known exposure to either of these minerals. Thus, additional unknown factors act independently or as co-carcinogens in the development of MPM. Simian Virus 40 (SV40) may act as a co-carcinogen with asbestos in the pathogenesis of occupationally induced MPM. To determine if SV40 plays a role in the development of MPM in Turkey, we used PCR analysis to investigate if SV40 DNA sequences were present in 29 mesothelioma specimens from patients previously exposed to asbestos or erionite. PCR analysis revealed that all 29 tissue specimens from our patients did not contain SV40 DNA. 15 specimens from patients suffering from tuberculosis pleuresy were also SV40 negative. One mesothelioma and one osteosarcoma from Italy tested positive for SV40. Our results indicate that inorganic fibers, asbestos, and erionite remain the only known causal factors of mesothelioma in Turkey. The absence of SV40 in Turkish specimens and its presence in Italian specimens may be related to the fact that SV40-contaminated vaccines were not administered in Turkey.

Prevalence of asthma and allergic diseases in Turkish university students in Ankara

An epidemiological study was performed in the students of Hacettepe University from various parts of Turkey to find the prevalence of asthma and allergic diseases and search for geographical differences in Turkey. A questionnaire related with symptoms of asthma and allergic diseases was distributed to 4600 students and filled by 4331 students (1884 males, 43.5%-2447 females, 56.5%). Periodic prevalence of asthma or allergic disease during the last 12 months was 13.5%. The prevalence of awakening with chest tightness and/or feeling of retrosternal pressure in the last month was 2%. The current prevalences of the seasonal and perennial rhinoconjunctivitis, flexural eczema, food and drug intolerances, pollen and pet animal hypersensitivities were 6.4%, 1.6%, 0.8%, 4.5%, 3%, 5.2%, and 1% respectively. Drug, food, and pollen hypersensitivities were distinctively more common in the females, whereas wheezing was more common in males. Wheezing, wheezing associated shortness of breath, nocturnal asthma for the last 1 and 12 months were more common in the students from eastern region than those from western region. The highest asthmatic attack rate was reported in the eastern region. Seasonal rhinitis and pollen allergy were more prevalent in central region than northern region. No significant geographical difference was observed regarding the drug and pet hypersensitivities. Our study has shown the importance of asthma and allergic diseases as a public health problem. Explanation of the observed geographical differences aware for further studies.

Combined chemotherapy in pleurectomized malignant pleural mesothelioma patients

A phase II clinical trial of 20 cancer patients who presented with malignant pleural mesothelioma (MPM) between November 1991 and April 1993 was conducted. Of the histologically proven cases, 16 (80%) were epitheloid and 4 (20%) were mixed type MPM. Patients were treated with mitomycin C, cisplatin, and alpha interferon after pleurectomy. Our schedule consisted of 10 mg/m2 mitomycin C i.v. infusion, 50 mg/m2 cisplatin i.v. infusion, 10 mil Ur-alpha interferon i.m. and 10 mil Ur-alpha interferon i.v. infusion on the first day of treatment. Patients were given a mean of 4.5 chemotherapy cycles (range: 2-6). None of the patients showed complete or partial response. Stable disease was observed in 15 patients, while 5 patients had progressive courses. The overall median survival time after chemotherapy was 12 months (range: 3-31 months). Median survival after chemotherapy was 15 months (range: 4-31 months) in the stable disease group (n:15, 75%), and 5 months (range: 3-13 months) in progressive cases (n:5, 25%). The overall survival rates were 55% [95% Confidence Interval (CI):43%-88.8%] at one year and 15% (95% CI:5%-39.1%) at 2 years. Five patients had grade 3 alopecia, three had grade 2 vomiting and nausea, two had grade 2 leukopenia, one had grade 2 cardiotoxicity and another had discoloration on his fingernails. In our multimodal therapy protocol, we found no difference in survival and relapse rates between our combined modal therapy and other single modal therapies in the literature.

Carbon monoxide poisoning related to the use of steam coal in poorly ventilated bucket stoves

During the years 1986 to 1990, an increasing number of cases of acute carbon monoxide (CO) poisoning were encountered in the Emergency Department Hacettepe University Hospital in Ankara, Turkey. Between January 1 and March 31, 1991, all the patients presenting with complaints compatible with CO poisoning were evaluated; the diagnosis was confirmed in 55 of the 5795 people who attended the Emergency Department during this period. In all cases the source of CO intoxication was determined. Among these patients, nausea or vomiting and headaches were the most common complaints (occurring in 100% and 85%, respectively). At least transient impairment of alertness was observed in 29% of cases. The carboxyhaemoglobin levels ranged from 3.80 to 48.1% (median 14.2%). Two comatose patients who developed a non-cardiogenic pulmonary oedema required mechanical ventilation. One of them was discharged from the hospital with mild cerebral disability. Another patient developed an acute myocardial infarction. In all the cases in this series, the source of CO poisoning was identified as improper combustion of recently marketed steam coal in inadequately ventilated bucket stoves.

Birch pollen related food hypersensitivity: as a para-occupational syndrome

Two patients presented with allergy to birch pollen and hypersensitivity to hazelnut and apple. Since both of these patients developed pollen sensitivity when they were abroad for occupational purpose, we want to mention this situation as "a para-occupational syndrome".

Environmental asbestosis complicated by lung cancer

Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker. She originated from and was living in an area with a high prevalence of environmental diseases attributed to tremolite asbestos. Mineralogic analysis of lung tissue revealed very high concentrations of asbestos bodies (1.64 x 10(6)/g of dry tissue) and tremolite fibers (173.7 x 10(6) of dry tissue). This case illustrates the following points: (1) In some areas, environmental exposure can lead to cumulated fiber retention comparable to occupational exposure and thus can represent a risk for lung fibrosis (asbestosis). (2) Lung cancer as a complication of environmental asbestosis also should be considered as a potential environmental disease.

CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite)

Endemic malignant pleural mesothelioma (MPM) in Turkey is related to two mineral fibers, tremolite asbestos and fibrous zeolite (erionite). Thirteen cases of MPM from the Cappadocian area, where the soil is rich in erionite, and 29 cases of MPM, from villages whose occupants have high asbestos exposure, were examined by CT. The CT findings of the two groups of MPM were compared with respect to the configuration of the pleural lesions, stage of disease, fissural involvement, pleural effusion, presence of calcified pleural plaques, and chronic fibrosing pleuritis. In erionite-related MPM the pleural lesions were flat and smooth in 69.1%; in asbestos-related MPM the lesions were nodular in 55.1%. Stage IV disease, calcified pleural plaques, and chronic fibrosing pleuritis were more common in the erionite-related MPM. The rest of the findings were similar in both groups. The early radiological diagnosis of erionite-related MPM may be even more difficult because of the similarity of the pleural lesions to chronic fibrosing pleuritis.

Hypertrophic pulmonary osteoarthropathy in a patient with pulmonary alveolar microlithiasis

Hypertrophic pulmonary osteoarthropathy occurred in a patient with proved pulmonary alveolar microlithiasis, an association not previously reported.

Intrathoracic lipomas demonstrated by computed tomography

Nine cases of intrathoracic lipoma are reported. Computed tomography (CT) proved to be helpful in the diagnosis and management of these cases. The attenuations of the masses ranged from -70 to -140 Hounsfield units (HU). In 4 cases, needle biopsies were taken, confirming lipoma with mature fat cells. One patient also had a coelomic cyst with an attenuation of 20 HU, which was confirmed at thoracotomy. Another had an atypical lipoma which infiltrated the thoracic wall but was benign. In conclusion, we recommended investigation with CT scan for the diagnosis of lipoma.

Endobronchial hamartoma removed by rigid bronchoscope

An endobronchial hamartoma of the right lower lobe was discovered in a 60 yr old female patient. She had been diagnosed and treated for chronic intractable bronchial asthma for more than 10 yrs. The endobronchial hamartoma was successfully removed with a rigid bronchoscope.

Endobronchial hamartoma removed by rigid bronchoscope

An endobronchial hamartoma of the right lower lobe was discovered in a 60 yr old female patient. She had been diagnosed and treated for chronic intractable bronchial asthma for more than 10 yrs. The endobronchial hamartoma was successfully removed with a rigid bronchoscope.

Endobronchial tuberculosis. A report on 15 cases

Fifteen patients were diagnosed between 1973 and 1987 at Hacettepe University Hospital as having endobronchial tuberculosis. They were subjected to bronchoscopy because of provisional diagnoses of primary bronchogenic carcinoma in 7 cases, bronchial asthma in 3 cases, tuberculosis in 2 cases and hydatid cyst, foreign body aspiration and bronchiectasis in 1 case each. In those patients in whom the initial clinical diagnosis was primary bronchogenic carcinoma, it was difficult to differentiate endobronchial tuberculosis either by radiography or bronchoscopy.

An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos

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Byssinosis in carpet weavers exposed to wool contaminated with endotoxin

All the 303 full time day workers in a carpet weaving factory were submitted to a physical examination, chest radiography, and vitalograph test, and answered a respiratory questionnaire. Fifty four healthy non-exposed subjects served as controls. Dust concentrations and concentrations of bacterial endotoxin were measured. Of the 303 workers, 259 (85.5%) had airway symptoms and 62 (20.5%) had maximum mid-expiratory flow (MMF) values of less than 60% compared with 9.2% of the controls. The symptoms in 68 workers (22%) were compatible with byssinosis and 36 of these workers underwent vitalography before starting work and after four hours work on Mondays when significant reductions of their FEV1 and MMF were found. Twenty one of these 36 workers were tested on Tuesday and no differences in these measurements were found between measurements before work started and four hours later. The airborne dust concentrations in the factory were high and bacterial endotoxin was found. These findings suggest that a large number of workers in this carpet weaving factory suffer from a disease indistinguishable from byssinosis even though wool is used almost exclusively, the only cotton being the warp. The finding of endotoxin together with the absence of cotton confirms the theory that "byssinosis" is due to bacterial endotoxin rather than to cotton per se.

Radiological study of pleural changes in relation to mesothelioma in Turkey

In some villages in central Turkey pleural changes occur as a result of environmental exposure to mineral fibres. In most cases the fibre is asbestos but in some cases the non-asbestos fibre erionite, a zeolite, is responsible. The incidence of malignant mesothelioma is much higher in "erionite villages" than in "asbestos villages" despite similar frequencies of pleural changes. In this study chest radiographs from 466 people from asbestos villages, 549 from erionite villages, and 382 controls were compared. The frequency of pleural calcification was about the same in the two groups of villages studied, but the minor fissures were visible to a greater degree in erionite cases. In people from erionite villages "atypical" pleural calcification, due to calcification of the visceral rather than the parietal pleura, was more common. These differences may indicate that the fibres have different lengths and diameters.

Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study

This study was designed to determine the prevalence of pleural mesothelioma and other malignancies in the Anatolian village of Tuzköy, where neither asbestos nor any environmental carcinogen has been detected. Another village (Kizilköy) located 12 km from Tuzköy was selected as a control. Three hundred twelve subjects from Tuzköy who were at least 25 yr of age and 95 subjects from Kizilköy were studied. Analysis of X-rays of the Tuzköy group revealed that subjects had calcified pleural plaques (17%), pleural thickening (10.5%), obscured costophrenic angles (15%), and diffuse interstitial pulmonary fibrosis (12.1%). Sixty-seven deaths were records in Tuzköy during the previous 3 yr, 41 of which resulted from malignant diseases. There were no X-ray abnormalities or deaths resulting from malignancies in the control group. Because of the high incidence of mesothelioma and lung cancer which usually results from asbestos exposure, the presence of asbestos in Tuzköy was investigated, but none was detected in spite to Tuzköy's volcanic location. Nevertheless, zeolite, an asbestiform mineral, was detected in the stones of buildings and in the village soil, as well as in the lung and pleura of the patients during biopsy. Thus, this mineral was considered to be responsible for the fiber-induced pleuro-pulmonary diseases in Tuzköy. No zeolite was found in the soil and stones of the control village.

Malignant mesothelioma and radiological chest abnormalities in two villages in Central Turkey. An epidemiological and environmental investigation

A comparative epidemiological and environmental study in two neighbouring villages, Karain and Karlin, in Central Turkey showed an excess adult mortality, shortening of life expectancy, and an excess of pleural radiological abnormalities in Karain. This supports an earlier report of an endemic of pleural mesothelioma in the village. Concentrations of airborne respirable fibres were uniformly very low in Karlik and higher in some of the air samples from Karain, the fibres being similar in composition to those of erionite-a mineral of the zeolite family and the major contributor to the Karain clouds. This is compatible with the hypothesis of a causal association between endemic mesothelioma and inhalation of erionite fibres, but the fibre concentrations in all samples are so low as to leave in question the aetiological role of erionite. In addition to their local importance these results may have relevance for the wider scientific and public-health issue of long-term inhalation of mineral fibres at low concentrations.

Zeolite bodies in human lungs from Turkey

It is thought that the extremely high occurrence of malignant pleural mesothelioma in the two Turkish villages of Karain and Tusköy could be related to environmental zeolite fibers. Mineral fibers were assessed in lung samples from two cases of malignant pleural mesothelioma in Tusköy, using the light microscope and the analytical transmission electron microscope. Zeolite (erionite) fibers and ferruginous bodies, formed around zeolite fibers (zeolite bodies), were frequently encountered in these samples. Under the light microscope, zeolite bodies were morphologically identical to typical asbestos bodies. To document the zeolite exposure in this area of Turkey, it is suggested that a biologic monitoring study be performed in villages in which mesotheliomas occur and in control villages, by testing for the presence of zeolite bodies in sputum.

Clinical and radiological study in sepiolite workers

Radiological findings were evaluated on a mass survey (70 mm films) in four villages where mining and processing of sepiolite have occurred for more than 100 yr, together with a clinical and radiological study in 63 sepiolite trimming workers in Eskisehir, Turkey. Mineral fiber-related pleural diseases were not detected in those people who were exposed to sepiolite dust. Although pulmonary fibrosis was encountered in 10 of 63 workers, no relationship between pulmonary fibrosis and sepiolite inhalation could be established. In contrast, all fibrotic patients were smokers and came from dusty rural regions where tremolite (asbestos) and zeolites are present. Three of them had also worked in dusty fields.

An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia

The 575 inhabitants of the remote Anatolian village of Karain suffered 11 deaths from pleural mesothelioma in 1975/76 and there were five cases of fibrosing pleurisy. In the previous five years there had been 25 cases of mesothelioma. Calcified pleural plaques were common on survey radiography. Asbestos does not occur in the local soil or rock, nor is it handled in the village, but a few fibres were found in the water. Fibres were also found in the pleural tissue of two of five cases examined. Inhabitants of the neighbouring villages are free of mesothelioma.