Classification of chest radiographs for pneumoconiosis: a comparison of two methods of reading.
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Biomedical subjects
Publications and source records attributed to W K Morgan.
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Scanty irregular opacities are not uncommonly observed on the chest roentgenogram in the absence of interstitial fibrosis of the lungs. In such circumstances the irregular opacities, when present, tend to be relatively scanty and seldom, if ever, exceed an ILO category of 1/1. They are found in association with cigarette smoking, especially when emphysema is also present. The development of irregular opacities is also related to exposure to various mineral and other dusts, and although their prevalence increases with cumulative dust exposure, in general the type of dust, whether fibrogenic or relatively inert, seems to be of little moment. The presence of irregular opacities remains a troublesome confounding factor in epidemiologic studies of both dust-exposed and nonexposed populations. The morbid anatomic changes that occur in the lungs of nondust-exposed workers and which are responsible for the development of irregular opacities in the chest roentgenogram remain unknown.
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Arterial blood gas analysis is one of the criteria used by the Department of Labor to award total and permanent disability for coal workers' pneumoconiosis (Black Lung). We have observed that Black Lung claimants often undergo several blood gas analyses with widely differing results that sometimes range from complete normality to life-threatening hypoxemia in the same subject. We concluded that blood gas analysis in occupationally related disability determination is unreliable, in that quality control and instrumentation are variable; that severe hypoxemia is rare in coal workers' pneumoconiosis; and that such hypoxemia is nonspecific and correlates poorly with breathlessness.
As a result of the intrapleural pressure gradient that exists in the human lung, both ventilation and particle deposition increase from apex to base. Since the intrapleural gradient varies with the height of the subject, it was decided to compare regional particle deposition in tall, short, and obese subjects to ascertain whether it was influenced by height and weight. Surprisingly, deposition in the vertical plane was not significantly influenced by the height of the subject when corrected for ventilated lung volume. In addition, it was shown that in obese subjects there was increased deposition in the middle zones relative to the apices and bases. This finding persisted after correction for ventilated lung volume and differential attenuation resulting from non-uniform thickness of the fat layer in the obese subject's chest. In the tall and short groups there was a consistent pattern in the concentric deposition of particles with there being a gradient from the central or hilar region to the periphery of the lungs, with the latter showing the most deposition.
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Changes in electromyographic (EMG) activity between successive bites in the jaw-closing muscles of cats are described for the reduction of food with different textures. Plots of these data suggest, and statistics confirm, that one cannot predict the magnitude of EMG activity from one bite to the next, but that predicting the direction of change in EMG activity (i.e. increases or decreases) may be possible, given the relative magnitude of a bite. The patterns observed also show that the degree of variability between masticatory cycles differs among the jaw-closing muscles and with food texture. These patterns of muscle activity are related to the neural control of jaw movements.
We studied seven subjects with certain manifestations of cobalt-induced lung disease. All worked with cobalt and were involved in either the production or use of hard metal. The mode of presentation varied from an acute hypersensitivity pneumonitis that cleared completely when exposure ceased to progressive severe interstitial fibrosis of the lungs. In one subject reexposure was followed by a recurrence of the symptoms. All subjects showed restrictive ventilatory impairment and a reduction of their diffusing capacity. The radiologic appearances varied greatly. While two subjects had clear roentgenograms with small lung volumes, others had a micronodular pattern or small blotchy nodular infiltrates, and one had diffuse reticulonodulation as is seen in cryptogenic fibrosing alveolitis. The pathologic appearances varied between desquamative interstitial pneumonia and overt mural fibrosis of the alveoli. Six of the seven patients had multinucleated giant cells in their biopsy specimens or bronchoalveolar lavage fluid.
The effect of varying particle size on the site of deposition of inhaled particles in the human lung was measured in 11 young healthy male subjects. The simultaneous inhalation of two chemically inert, radiolabelled particles, differing in size but in no other respect, controlled for all other variables including airways geometry, breathing pattern and posture. Under conditions of quiet respiration the larger particles (3.5 microns) were preferentially deposited in the upper rather than the lower zones of the lungs as compared with the smaller particles (1.1 microns). Furthermore, the penetrance of the larger particles beyond the mucociliary escalator was greater for 3.5 microns particles in all lung zones and particularly at the apex. These findings may be of significance in the pathogenesis of those diseases induced by the inhalation of particles, vapours or fumes.
The various exposures, hazards, and diseases that may be accounted by welders are described. The hazards of welding may be subdivided conveniently into acute toxic effects, chronic toxic effects, chronic respiratory effects, and carcinogenetic effects. Each is considered in turn and their effects on morbidity and mortality are discussed. The evidence suggests that welding is not a particularly hazardous occupation provided care is taken to limit exposure to the toxic effects of any fumes that are generated. Nonetheless, the technical aspects of welding are constantly undergoing change, and continual vigilance is necessary lest a new process introduces a formerly unrecognized hazard.
Patients with ankylosing spondylitis may uncommonly develop apical fibrobullous lung disease, the cause of which is unknown. It is postulated here that rigidity of the thoracic cage leads to reduced apical clearance of inhaled particles and may thereby predispose to chronic infection. Deposition and clearance of inhaled technetium-99m sulphur colloid particles were studied in eight male patients with ankylosing spondylitis who had chest wall rigidity (mean (SD) chest expansion 1.8 (1.07) cm) but normal chest radiographs. As a reference population eight healthy male volunteers were also studied. Particle deposition showed an increasing gradient from apex to base, with no significant difference between patients and controls. Clearance was assessed by comparing absolute counts, corrected for decay, at 24 hours with the baseline values. No delay in particle clearance in those with ankylosing spondylitis was apparent.
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