Documents Takahashi, Toru 2 results

This case report concerned a 21 year old man who was hospitalized in 1990 due to frequent attacks of wheezing and dyspnea at work. He worked in the press department of a hard metal factory and had been heavily exposed to powders of cobalt (7440484), tungsten (7440337), and other metals. His diagnosis was bronchial asthma due to cobalt exposure. After this diagnosis, he worked in another department of the same factory where he was seldom exposed to cobalt. He was free of symptoms several months later without using antiasthma drugs. However, 3 year later, he suddenly developed iridocyclitis and bilateral hylar lymph node swelling. A diagnosis of sarcoidosis was made, confirmed by the physiological findings, elevated serum angiotensin converting enzyme level, increased lymphocytes, and CD4/8 in bronchoalveolar lavage fluid, as well as the pathological characteristics of lung and lymph node specimens. His airway was desensitized to cobalt, but a skin test showed a positive response, suggesting that he was not desensitized at the systemic level. The authors note that the association of sarcoidosis with bronchial asthma is very rare, and it is reasonable to consider that a common etiological agent may exist when these diseases both develop in the same patient. However, his sarcoidosis may have been caused by cobalt through a different mechanism. This case may highlight the possible contributions of extrinsic agents to the development of sarcoidosis.

The case report of a male patient who developed pulmonary fibrosis after exposure to fiberglass for 41 years was presented. He had worked as a carpenter, and had packed fiberglass insulation into wall and roof spaces. A chest radiograph revealed shadows in the lungs, pleural adhesions in the upper lung fields, nodular shadows in the lower lung fields, and abnormal diaphragm margins. A computed tomograph (CT) also revealed nodular opacities in the lower lung fields and cystic lesions and low attenuation areas in the upper lung fields. Pulmonary function values ranged from 48 to 112% of the predicted values. Examination of a lung tissue sample with an electron microscope (EM) revealed fibrosis and an influx of lymphoid cells into the alveolar septa. Mineral analysis of the small, nonstructural substances discovered in the lung with an analytical electron microscope (AEM) indicated an elemental composition similar to that of glass fibers. An average of 20 fibers in every two or three fields was determined. The authors conclude that this patient's heavy smoking history and long term exposure to fiberglass have contributed to pulmonary fibrosis. The authors recommend the use of the EM and the AEM for the intensive examination of lung tissue.