Search

The media occasionally reports on possible asbestos exposure during demolition of houses in an urban setting. The risk for the development of any asbestos-related cancer in these settings is considered to be lower than for that in occupational exposure. Offermans et al. examined a Dutch cohort of 58,279 workers in the period from 1986 to 2007. They concluded that the risk of lung cancer, laryngeal cancer and mesothelioma increased with exposure to asbestos. The risk of development of lung cancer was higher for anyone with increased years of exposure to asbestos fibre combined with a smoking habit. The study was well conducted, but exact data on fibre concentration and type of asbestos are lacking. We suggest that occasional exposure to asbestos poses hardly any risk for the general population. However, rules and regulations for the removal of asbestos-containing material remain important as asbestos exposure remains a serious health risk, especially in smokers.

Objective: To describe the experience with an indwelling pleural catheter in patients with pleuritis carcinomatosa., Design: Prospective follow-up study., Method: The placement of an indwelling pleural catheter was considered as a treatment possibility for patients who presented with symptomatic accumulation of pleural fluid that returned following previous drainage or pleurodesis or when the fluid had not been drained off previously but there were strong radiological indications for a 'trapped lung'. The intervention was considered to be contraindicated by the following: dyspnoea that had not been reduced by previous pleural punctures performed for relief, dyspnoea caused by many different factors, a tendency for haemorrhaging that could not be corrected. The drain used was a Pleurx indwelling catheter, a thorax drain that is tunnelled subcutaneously, can remain in situ for a long time and offers the patient the opportunity to drain off fluid himself at any desired moment., Results: In the period September 2003-May 2005, the treatment was considered in 40 patients. Ultimately, the catheter was inserted in 25 patients; the clinical deterioration of most of the other patients was too quick. Of the group, 33 patients (82%) died with a median survival of 70 days. All catheters functioned until they were removed or until the patient died. In 3 patients, the drainage procedure was complicated by empyema and in 1 patient by haemoptysis. From the total number of catheters, 9 were removed while the patient was still alive and in 6 patients, spontaneous pleurodesis occurred following 3, 4, 4, 5, 6, and 8 months respectively. In general, the patients were able to handle the catheter without problems and the symptoms were brought and kept adequately under control., Conclusion: The Pleurx indwelling pleural catheter was an efficacious treatment supplement for patients with malignant pleural effusion, in whom the standard pleurodesis was not effective.

Objective: To analyse the assessments of problematic cases reported to the Dutch Institute for Asbestos Victims (IAS) by the Mesothelioma Working Party of the Netherlands Association of Pulmonologists and Specialists in Tuberculosis (NVALT)., Design: Descriptive., Method: The pathological confirmation of a malignant pleural mesothelioma of occupational origin is difficult in about 10% of the cases. The IAS has requested the Mesothelioma Working Party of the NVALT to review these cases. When no definitive diagnosis can be made on histological or cytological grounds, three pulmonologists reach a conclusion on the basis of correspondence, X-ray examination and other information., Results: In the period January 2000--March 2004 the Working Party evaluated 132 cases, two-thirds of whom (n = 89) were assessed to be compatible with 'malignant pleural mesothelioma' and one-third of whom (n = 43) were felt to be non-compatible. In 69% of the cases (91/132) the conclusions of the three independent specialists were unanimous. The median time from request to report was 25 days (range: 1-185)., Conclusion: This approach was effective and rapid.

Over the last few years developments have been concentrated on the diagnostic and therapeutic properties of bronchoscopy. Autofluorescence and fluorescence bronchoscopy significantly enhance the detection rate of premalignant and early neoplastic endobronchial lesions. Unfortunately, this technique is hampered by a low specificity. Endobronchial ultrasound examination is the first tool that has enabled the bronchoscopist to get an impression of the tracheal wall beyond its epithelial surface including the mediastinal and the hilar structures. Currently, the complexity of the procedure prevents its widespread application. Intervention bronchoscopy involves mechanical and laser removal of processes that may impede the central airways. Electrocauterization and laser dissection are regularly used to remove intrabronchial tumour depositions. Airway stenting is indicated if there are stenoses caused by compression from abnormalities located externally to the airways.

About 50% of the pleural effusions diagnosed are caused by a malignancy, especially by thoracic, pulmonary and ovarian cancer and lymphomas. The accumulation of fluid is caused by metastasization to the pleura and obstruction of lymph vessels and nodes. The effusion generally decreases if the tumour responds to systemic treatment. However, frequently this does not occur and the fluid has to be removed, to alleviate symptoms such as dyspnoea, coughing and a heavy sensation in the chest. Possible surgical therapies are draining through a needle or a drain, (partial) pleural resection and the creation of a pleuro-peritoneal shunt. Disadvantages of these are early recurrences, the severity of the intervention and (or) the high morbidity and mortality. The current standard treatment is pleurodesis brought about by a sclerosing agent, usually via a drain. The substances preferably used for this purpose are, in the order of decreasing importance, tetracycline, bleomycin or talc, doxycycline or minocycline. The most frequent adverse effects are chest pain and fever during and after the pleurodesis.