Biomedical subjects
J L Abraham
Publications and source records attributed to J L Abraham.
Health hazard of poorly regulated exposure during manufacture of cemented tungsten carbides and cobalt.
Forty two of 125 former workers in a factory in Syracuse, New York, which manufactured hard metal parts from tungsten carbide and cobalt, were studied by chest radiographs, spirometry, and plethysmographically determined lung volumes. The plant was closed in 1982 and the studies were performed in 1983-5. Recorded measurements of carbide dust concentrations were only mildly excessive by modern standards, but deceitful efforts to reduce the apparent concentration of dust were known to have occurred during an inspection by the Occupational Safety and Health Administration. Lung biopsies in four cases in the study and necropsy in one of the 83 cases not studied during life showed giant cell interstitial pneumonia and appreciable concentrations of tungsten carbide. This information indicates that exposure was substantial. Four workers had evidence of pulmonary fibrosis by chest radiographs; two of these workers had normal pulmonary function. Fourteen had abnormal pulmonary function, five of whom had a restrictive pattern, eight a pattern of air trapping, and one a combined pattern. Thus radiographic, or functional abnormalities, or both occurred in 16 of the 42 cases studied. No correlation with duration of exposure was established. Progressive clinically important disease (one fatal) has been found in four ex-workers, two in each of the restrictive and air trapping groups. These findings suggest that poorly regulated dust concentrations in a hard metals factory possibly cause pulmonary abnormalities and sometimes severe illness.
Development and use of a pneumoconiosis database of human pulmonary inorganic particulate burden in over 400 lungs.
Over 400 cases with data from in situ electron microprobe quantitation of non-fibrous inorganic particles (e.g., silica, alumino-silicates, talc, metals) in pulmonary tissue sections, and data from quantitative digestion analyses for fiber content (e.g., asbestos, silica, alumino-silicates, man-made fibers, talc) comprise an extensive microcomputer data set of lung particle burden. When allied with demographic and histopathologic information the result is a comprehensive database of occupational pulmonary pathology. Examples of the kinds of information which can be extracted from the database include: 1) summary information on the types sizes and associations of particles in lungs with a variety of exposures, 2) concentrations of etiologic particle type in cases with recognized pneumoconioses, and 3) correlations between particle type, pathology, occupation and social history. The database provides a powerful tool for assessing such information on statistically meaningful sample sets.
Confusing labeling of food products.
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Silicone in gold-associated lymphadenopathy.
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Zirconium compound-induced pulmonary fibrosis.
Despite suspicion that inhalation of zirconium should be capable of causing human pulmonary disease, documentation of zirconium pneumoconiosis in humans has been lacking. We studied a likely case of zirconium compound-induced pulmonary fibrosis. The diagnosis was based on the following: (1) a history of gradual increase in symptoms and slowly progressing pulmonary fibrosis by chest roentgenogram compatible with a pneumoconiosis; (2) an appropriate history of exposure and a latency period of about 15 years before the onset of dyspnea and of roentgenographic changes; (3) analysis of open lung biopsy material revealing end-stage fibrosis and honeycombing, a moderate number of birefringent particles, and extremely high levels of a variety of zirconium compounds; and (4) no other potential cause of fibrosis. We conclude that zirconium should be considered a likely cause of pneumoconiosis and that appropriate precautions should be taken in the workplace.
Silicosis and lung cancer.
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Pulmonary fibrosis in aluminum oxide workers. Investigation of nine workers, with pathologic examination and microanalysis in three of them.
Epidemiologic surveys have indicated an excess of nonmalignant respiratory disease in workers exposed to aluminum oxide (Al2O3) during abrasives production. However, clinical, roentgenographic, histologic, and microanalytic description of these workers are lacking. This is a report of nine Al2O3-exposed workers with abnormal chest roentgenograms (profusion greater than or equal to 1/0, ILO/UC) from a plant engaged in the production of Al2O3 abrasives from alundum ore. Mean duration of exposure was 25 yr, and time since first exposure was 28 yr. in a subgroup of three, the severity of symptoms, reduction in the forced vital capacity (67% predicted) and diffusing capacity (51% predicted), and progressive roentgenographic changes (profusion greater than or equal to 2/2) prompted open lung biopsy. Lung tissue was analyzed by scanning electron microscopy and electron microprobe analysis. In each of the three biopsies, interstitial fibrosis with honeycombing was seen on routine section. In one biopsy, silica and asbestos fiber counts were at the low end of the range seen with silicosis and asbestosis; however, the absence of asbestos bodies and silicotic nodules suggested that the fibrosis was due to another cause. Metals occurred in amounts several orders of magnitude above background, and the majority was aluminum as Al2O3 and aluminum alloys. The findings in these nine workers suggests a common exposure as the possible cause. The nonspecific pathologic findings, absence of asbestos bodies and silicotic nodules, and the striking number of aluminum-containing particles suggest that Al2O3 is that common exposure. The possibility of "mixed dust" fibrosis should also be considered.
Superior limbic keratoconjunctivitis apparently related to particulate material from a ventilation system.
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Asbestosis occurring after brief inhalational exposure: usefulness of bronchoalveolar lavage in diagnosis.
A case of clinically and radiologically typical asbestosis manifesting in a 55 year old man occurred 36 years after a brief exposure period of less than one year. A transbronchial lung biopsy was performed but the samples were considered non-diagnostic. The diagnosis was supported by the use of bronchoalveolar lavage to obtain alveolar samples and scanning electron microscopy-energy dispersive x ray analysis of fibres found in the bronchoalveolar lavage fluid which showed a predominance of amosite.
Rheumatoid pneumoconiosis in a dolomite worker.
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Inorganic particulates associated with pulmonary alveolar proteinosis: SEM and X-ray microanalysis results.
Twenty-four cases of pulmonary alveolar proteinosis (PAP) were studied by light microscopy (LM) and scanning electron microscopy (SEM) to test the hypothesis that PAP was related to silica exposure. Increased numbers of birefringent particles (vs. controls) were found in 78% of PAP cases. SEM was used to locate inorganic particulates in situ, which were individually analyzed using energy dispersive X-ray analysis. When analyzed as an aggregate group of cases, no specific inorganic particulate was evidently associated with the PAP reaction. However, analysis of individual cases revealed more specific associations. The concentration of particles determined by SEM exceeded that found by LM by a factor ranging from 2.7 to 964. The concentration of inorganic particulates per cm3 in the areas of PAP ranged from 1.3 X 10(7) to 1.02 X 10(9). Controls all had less than 10(7) particles per cm3. Available environmental history correlated well with particulate analysis results, e.g., silica in a sandblaster, metal fumes in a welder, and cement particles in a cement finisher. Particulates with unique composition were also found in cases with unavailable histories, e.g. metal fumes suggestive of welding or soldering exposure, silicates suggestive of fine particle exposure (greater than 50% of particles less than 1 micron). Only 1 case (the sandblaster) showed greater than 50% of the particles to be silica. Of the 5 infants with PAP, 3 showed the major particulate to be talc, and 1 had evidence of toxic cadmium selenide fume exposure. These results are consistent with the hypothesis that PAP, at least in the majority of cases, is associated with exposure to small inorganic particulates of several types.
Hard metal disease: a multidisciplinary evaluation of two cases.
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Molecular microanalysis of pathological specimens in situ with a laser-Raman microprobe.
A laser-Raman microprobe has been used to identify microscopic inclusions of silicone polymer in standard paraffin sections of lymph node. This example of organic chemical microanalysis in situ in pathological tissue represents an extension of microanalytical capabilities from elemental analysis, performed with electron and ion microprobes, to compound-specific molecular microanalysis.
Documentation of environmental particulate exposures in humans using SEM and EDXA.
There is increasing awareness of health hazards from environmental and occupational exposures to particulates. Scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDXA) can document these exposures by analysis of small portions of cells, tissues and environmental samples. Previous work is briefly reviewed and special attention is given to discussion, with examples, of the various types of particulates which may be found in tissues (exogenous, endogenous, inhaled, injected, ingested, inorganic, organic), the different tissues in which they may be found (lung, heart, liver, skin, brain, kidney, lymph nodes, etc.), methods of tissue sampling (e.g. pulmonary lavage, transbronchial biopsy, open biopsy, percutaneous biopsy, autopsy), specimen preparation (fixation, embedding, sectioning, choice of substrate), SEM and EDXA data collection (backscattered electron imaging, etc.) data interpretation (artefacts, limitations of SEM and EDXA) and other new techniques (ion microprobe, laser Raman microprobe).
Silicate pneumoconiosis of farm workers.
Abnormal numbers of birefringent particles have been found in the lungs of seven patients (five vineyard workers, one farmer, and one rural resident) in association with a spectrum of early to late interstitial inflammation and fibrosis. Nodular granulomas of the type seen in silicosis were absent. Scanning electron microscopy and energy dispersive x-ray analysis of 177 individual particles (less than 5 micrometer.) in situ in the lungs of four of the patients showed mostly silicates (notably aluminum, silicon, and potassium), with 5 to 10 per cent silicon dioxide. An analysis of particles less than 5 micrometer. from both vineyard and non-vineyard soil showed lung and soil particles to have a similar composition. The presence of large amounts of silicates in the lung tissues, in association with chronic inflammation and fibrosis, implicates the silicates in the causation of the fibrosis. The silicate deposits may, in large part, be a marker, reflecting a mixture of toxic soil additives or pesticides found in commercial clay silicate products or in dusts from the soil itself. The findings do not exclude lung pathology of a similar nature in regions outside of the farm.
Diagnostic applications of scanning electron microscopy and microanalysis in pathology.
Microanalytical technology developed within the last decade provides important information in diagnostic pathology. Scanning electron microscopy, including backscattered electron imaging and energy dispersive X-ray analysis should become at least as valuable as polarized light microscopy, histochemistry and conventional transmission electron microscopy. Other as yet less available techniques such as the ion microprobe and laser Raman microprobe are also valuable. The pathologist should consider the use of microanalytic techniques in any disease process in which endogenous or exogenous materials may be present in the tissues, in the same manner in which one would perform stains for microorganisms. Cases are presented illustrating the tissue preparation and results of scanning electron microscopy and energy dispersive X-ray analysis in diagnosis.