Donald Greenberg

Pulmonary asbestos body counts and electron probe analysis of asbestos body cores in patients with mesothelioma. A study of 25 cases

Malignant mesotheliomas of the pleura and peritoneum are well‐recognized risks of asbestos exposure. We determined the asbestos body content of the lungs from 24 cases of malignant mesothelioma (19 pleural, five peritoneal) and compared such to the content of lungs from 50 consecutive adult autopsies and four cases of overt asbestosis using a Clorox‐digestion concentration technique. The cores of 90 asbestos bodies were examined by energy dispersive x‐ray analysis and compared with similar data from 120 standard asbestos fibers and 20 fiberglass fibers. The malignant mesothelioma patients had asbestos body counts intermediate between those of the general population and those of patients with asbestosis, although some of the mesothelioma cases overlapped with the general population. These latter cases often lacked an identifiable occupational exposure to asbestos. EDXA studies demonstrated an amphibole core in 88 of the 90 asbestos bodies (amosite or crocidolite in 80 of 88, anthophyllite or tremolite in eight of 88), and chrysotile in two instances.

Carpal tunnel syndrome and chronic hemodialysis.

Carpal Tunnel Syndrome and Chronic Hemodialysis Dear Sir, Referring to the letter by Walts et al. [1] published in your journal, our work is at odds with theirs. In our clinic we have monitored 176 patients in a program of chronic hemodialysis for periods ranging from 3 to 144 months (x = 67.6). Eight patients (3 male and 5 female) manifested carpal tunnel syndrome (CTS); their ages ranged from 40 to 81 years (x = 61.1). The duration of dialysis treatment was 91.5 months (range 72–144). These results contrast with the 176 months (14.7 years) that the said authors [1] speak of. Our work coincides with previously reviewed literature [2–5]. In 5 of these cases the syndrome was bilateral and in 3 unilateral (a total of 13 occurrences). In each case it was the arm with a functioning arteriovenous fistula which was affected; given that this was the sole vascular access no further surgical intervention was required. We pursued 5 anatomopathological studies with Congo red and thioflavine T manifesting a total of 9 interventions (8 patients). In only 1 case did we find deposits of amyloid. None of the affected patients presented indices of systemic amyloidosis. In the development of CTS, the patients in a program of chronic hemodialysis showed a marked preference for the arm carrying the vascular access despite the fact that neither vascular alterations nor inflammatory changes were noted in the anatomopathological studies effected. We observed no statistically significant relation with any special type of nephropathy such as presented by our patients: hyperuricemic nephropathy (2 cases), glomeru-lonephritis (2 cases), nephroangiosclerosis (1 case, showing the only incidence of amyloid deposits), tubular aci-dosis (1 case) and undefined etiologies (2 cases). Nor was any relation observed with the dialytic procedure, hypervolemia, or the various biochemical parameters studied (urea, creatinine, phosphocalcic metabolism, PTH and hematocrit count). According to our experience, CTS is a complication of periodic hemodialysis that does not show an elevated incidence of amyloid deposits, and in general appears after the sixth year of substitutive treatment. References Walts, A.E.; Goodman, M.D.; Matorin, P.A.: Amyloid, carpal tunnel syndrome, and chronic hemodialysis. Am. J. Nephrol. 5: 225–226 (1985). Halter, S.K.; DeLisa, J.A.; Stolov, W.C; Scardapane, D.; Sher-rard, D.J.: Carpal tunnel syndrome in chronic renal dialysis patients. Archs phys. Med. Rehabil. 62: 197–201 (1981). Schwarz, A.; Keller, F.; Seyfert, S.; Poll, W.; Molzahn, M.; Dist-ler, A.: Carpal tunnel syndrome: a major complication in long-term hemodialysis patients. Clin. Nephrol. 22: 133–137 (1984). Kachel, H.G.; Altmeyer, P.; Baldamus, C.A.; Koch, K.M.: Deposition of an amyloid-like substance as a possible complication of regular dialysis treatment. Contr. Nephrol. vol. 36, pp. 127–132 (Karger, Basel 1983).