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[The evaluation of serum angiotensin-converting enzyme in silicosis and silicotuberculosis].

In order to verify the value of the determination of serum angiotensin converting enzyme (ACEs) in the assessment of silicosis and silicotuberculosis, we studied 105 subjects: 61 suffering from silicosis, 12 from silicotuberculosis, 19 from tuberculosis and 13 from chronic obstructive pulmonary disease (COPD). The patients with silicosis and silicotuberculosis were classified into two categories on the basis of the radiological pattern of pneumoconiosis according to the ILO 1980 CLASSIFICATION: mild silicosis (from 1/1 to 2/1) and severe silicosis (from 2/2 to 3+ and/or conglomerate masses). ACEs values were higher in the subjects suffering from silicotuberculosis and silicosis; in the latter, however, we did not find any significant relation between ACEs values and the radiological pattern. The lowest values of ACEs were found in the COPD group. Our data showed a statistically significant difference between silicotic or silicotuberculotic patients and the COPD group (p less than 0.05). It can be supposed that COPD, which was also found in all subjects suffering from silicosis or silicotuberculosis, might have caused an underestimation of the observed ACEs values which, however, were higher than normal. This increase might have been caused by a numerical or functional enhancement of the macrophages, which produce ACE and play an important role in the pathogenesis of such diseases.

Bronchopneumonia

Cellular and humoral hypersensitivity reactions during silicosis and silicotuberculosis.

Together with the synthesis of specific antibodies and autoantibodies, effects of cellular allergy, such as damage to neutrophils, agglomeration of leukocytes and inhibition of migration of leukocytes with tuberculin and isologous pulmonary antigen were established in patients with silicosis and silicotuberculosis. Autoallergy becomes manifest already in the "pre-roentgenological" stage of development of silicosis; in silicotuberculosis it correlates with the stage of the specific process. In both silicosis and silicotuberculosis, it includes elements of immediate and delayed hypersensitivity. In clinical practice, allergic reactions of leukocytes with tuberculin can be of assistance in determining the stage of the specific process and in differential diagnosis of silicosis and silicotuberculosis.

Antibody Formation

Short-course chemotherapy for silicotuberculosis.

The use of short-course chemotherapy in silicotuberculosis in the goldmining industry in South Africa is described in a comparative trial of 94 cases of silicotuberculosis and two matched-pair control groups with pulmonary tuberculosis only. The theoretical and practical considerations of short-course chemotherapy are discussed. It is concluded that this is an effective means of treatment for pulmonary tuberculosis in patients with silicosis as well as in patients with pulmonary tuberculosis only, irrespective of previous exposure to silica dust. There are no valid reasons why the basic tenets of short-course chemotherapy for the treatment of pulmonary tuberculosis should not apply in silicotuberculosis.

Adult

Evaluation of surgical treatments for the major lesion of bilateral silicotuberculosis.

The present communication deals with the follow-up study of 24 patients with bilateral silicotuberculosis in whom only unilateral operation was carried out for major lesions. The operative procedure consisted of pulmonary resection, thoracoplasty or combined operation such as cavernostomy, intracavitary filling of a pedunculated muscle flap and thoracoplasty. The follow-up period ranged 1 year to 12 years and 5 months. The results of surgical treatment for unilateral major lesions and their effect on the contralateral minor lesions were clinically assessed by alterations in the chest x-ray findings and tubercle bacilli in sputum. In 16 of 24 patients (67%) alleviation was obtained, whereas no change occurred in 3 (13%) and aggravation in 5 (21%). The surgical treatment for unilateral major lesion brought about 41% of improvement in the contralateral minor lesions. Contralateral minor lesions remained unchanged in 46% of patients and aggravated in 14%. This shows a value of the surgical threatment for bilateral silicotuberculosis. It should be emphasized that surgical treatments more aggressive than have been heretofore practiced can be employed.

Adult

An attempt to eradicate silicotuberculosis in Ottawa County, Oklahoma.

In 1974 and 1975, a selective tuberculosis screening program was conducted in a small mining community in Ottawa County, Oklahoma. Former miners, 50 years of age and over, who had abnormal chest radiographs consistent with silicosis or inactive tuberculosis and positive tuberculin skin tests, were offered isoniazid preventive therapy. Since the project ended, morbidity from silicotuberculosis has declined but silicotuberculosis has continued to occur. In this report, we examine the reasons for the failure to eradicate this disease from the community.

Humans

[The clinical significance of red cell immune adherence function in patients with pulmonary tuberculosis and silicotuberculosis].

In our study, we observed that (1) High RCIA were discovered in these two groups. (2) In the group of pulmonary tuberculosis, the C3b receptor activities remained no change after antituberculous therapy, but the amounts of immune complexes bearing on RBC decreased. In the patients with the high RCIA, CIC was discharged rapidly and the lesions of tissue produced by CIC were prevented. In the patients with silicotuberculosis, both silica and tuberculous bacilli may act as immune adjuvant and enhance the hypersensitivity. So the C3b receptor activities were higher in silicotuberculosis patients.

Adult

[Roentgenological diagnosis of silicotuberculosis].

Possibilities of roentgenologic method of examination with the use of roentgenography and tomography in the diagnosis of current forms of silicotuberculosis and tuberculosis in workers of the industries highly exposed to silicosis are analysed. ++Clinico-roentgenological+ pictures of 305 patients were studied in their dynamics for the period of 3 to 10 years. Being characterized by a benign course, silicotuberculosis is most often diagnosed in persons who left their work. A follow-up at least at 6-month intervals is of great importance in assessing its activity.

Adult

The principles of predicting the individual risk of silicosis and silicotuberculosis.

A series of investigations conducted in different "silicosis-risk" industries using a methodology based on the mathematical theory of pattern recognition has shown that in the given conditions of dust exposure, the probability of contracting pneumoconiosis depends for each individual on a complex influence of many factors, both environmental and intrinsic for the individual. Genetic predisposition was one of the most important factors and while the direction in which a factor influences predisposition was the same in every industry, its relative contribution to predisposition to simple silicosis was different in the studied working populations. So a reliable prediction of the high probability of this form of pneumoconiosis on the basis of such a multifactorial analysis is possible only with respect to specific conditions of a particular industry. The complex of factors determining predisposition to silicotuberculosis is more general: this complex comprises both factors influencing susceptibility to silica dust and specially those influencing susceptibility to tuberculosis. Despite the low prevalence of genetic resistance to pneumoconiosis in working populations, the risk of contracting the disease in modern industrial conditions of relatively low dust exposure is high only for a proportion of workers for whom the genotype of predisposition to silicosis or to silicotuberculosis coincides with a most unfavourable combination of non-genetic factors enhancing this predisposition. In the opinion of the authors, the task of screening off those applicants for a "silicosis-risk" employment for whom the risk may be estimated as high on the basis of the developed methodology, is quite feasible.

Discriminant Analysis

[Diagnostic errors in silicotuberculosis (clinical-autopsy comparisons)].

Basing on 42 post-mortem examinations of silicotuberculosis cases, the contributors display the most frequently encountered errors in diagnosing this disease. Silicotuberculous bronchadenitis, conglomerate-cirrhotic lower-lobe silicotuberculosis and their complications (e.g. concomitant pericarditis and endobronchitis) are the most difficult cases for detection. To avoid diagnostic errors, a most detailed case history study is needed, along with a complex clinico-functional and tomography examinations, a wide use of endoscopy and bacteriological techniques.

Autopsy

[Diagnosis of silicotuberculosis activity].

Possible determination of silicotuberculosis activity with various clinico-laboratory, roentgenological, biochemical and immunological procedures was analyzed by the materials on observation of patients with silicotuberculosis. The authors considered 117 observations relating to 88 male and 29 female patients aged 43 to 67 years. High informative capacity of the complex investigation including determination of gamma-globulin levels in blood serum, the albumin-globulin coefficient, the absolute count of lymphocytes and T-lymphocytes and lymphocyte migration inhibition in the test with tuberculin before and after the provocative tuberculin test was shown.

Adult

[An autopsy case revealing the simultaneous coexistence of adenocarcinoma, malignant lymphoma and silicotuberculosis in the same lung].

A case of 70-year old male manifesting a simultaneous adenocarcinoma, malignant lymphoma and silicotuberculosis in the same lung has been reported. The patient, who had worked as a miner for 24 years and had been treated for silicosis 11 years previously, was found to have a new, abnormal shadow during a routine chest X-ray. Later, sputum cytology revealed the adenocarcinoma. He was treated with chemotherapy, but died 24 months later, his death attributed to lung cancer, complicated with respiratory insufficiency and weakness. An autopsy confirmed the presence of an adenocarcinoma and silicotuberculosis, and a histological examination revealed the coexistence of malignant lymphoma in the same lung.

Adenocarcinoma

A controlled clinical comparison of 6 and 8 months of antituberculosis chemotherapy in the treatment of patients with silicotuberculosis in Hong Kong. Hong Kong Chest Service/tuberculosis Research Centre, Madras/British Medical Research Council.

Patients with silicotuberculosis have been reported to respond poorly to antituberculosis chemotherapy. Therefore, in a study in Hong Kong, 240 Chinese male patients with both silicosis and pulmonary tuberculosis were all prescribed treatment three times weekly with streptomycin, isoniazid, rifampin, and pyrazinamide, allocated at random to be given for a total duration of either 6 (M6 regimen) or 8 months (M8 regimen) in a concurrent comparison. Those with a history of previous antituberculosis chemotherapy received ethambutol as well for the first 3 months. The intake in the M6 regimen was terminated when preliminary results showed that it was inadequate, and a further 53 patients were assigned to the M8 series. Of 91 assessable patients in the concurrent comparison with susceptible strains pretreatment, 44% were culture negative at 1 month, 80% at 2 months, and 98% at 3 months, and 1 had an unfavorable bacteriologic response during chemotherapy. During 3 yr of assessment, bacteriologic relapse after chemotherapy occurred in 22% of the M6 compared with 7% of the M8 patients (p less than 0.025, log-rank test). Inadequate chemotherapy was received by 12% of the 240 patients in the concurrent comparison because of default and by 22% because of adverse effects, but by 3 yr 92% of patients with susceptible strains pretreatment in each series had a favorable status following retreatment for relapse or for initially inadequate chemotherapy when required. The results show that patients with silicosis require at least 8 months of treatment.

Adult

[Tuberculin-cytochemical test in the differential diagnosis of silicosis and silicotuberculosis with intrathoracic adenopathy].

Cytochemical tuberculin-associated shifts along with their prognostic evaluation were studied in 30 patients with silicosis and silicotuberculosis with intrathoracic adenopathy. The study revealed that a decrease of alkaline phosphatase activity of neutrophils, alpha-glycerophosphate dehydrogenase and succinate dehydrogenase lymphocytes could serve as an early indicator of tuberculosis process in the pulmonary tissue and intrathoracic lymph nodes.

Adult

[Aspergillotic septic endocarditis of the mitral and trigeminal valves as a complication of silicotuberculosis].

Fungal endocarditis is caused by fungi Candida and Aspergillus. Continuous intravenous infusions, catheterization, open-heart surgery, tracheal injuries, artificial heart valves can serve as predisposing factors. Aspergillus endocarditis is more common in severe infectious diseases after a prolonged use of antibiotics, cytostatics, glucocorticoids. A case of aspergillus endocarditis of mitral and tricuspid valves is described in a 55-year old patient. The man had been long suffering from silicotuberculosis and had been on a prolonged antibacterial therapy. The aspergillus endocarditis must have developed in the patient due to marked dysbacteriosis.

Aspergillosis

[Preventive chemotherapy in persons with silicosis and silicotuberculosis (author's transl)].

In some countries extensive research is carried out on preventing tuberculous disease by administration of INH. In GDR since about 1960 chemopreventive measures were taken in cases of silicosis and silicotuberculosis too. More than 2000 patients of the Magdeburg Pneumoconiosis Center were followed-up from 1960 to 1969. The high risk of tuberculous disease of 21% in the group of silicosis patients without administration of INH could be reduced to 14% after preventive administration of INH. However, such clear effects were observed only under optimal conditions, that is sufficient dosage, duration and reliability of treatment. On the base of these results and other publications patients with silicosis with and without tuberculous residues should be included into the programmes of preventive chemotherapy of the chest clinics.

Aged