[Systemic sclerosis and occupational exposures: About a case in a driller-powderman].

Introduction: Erasmus' syndrome is the association between systemic sclerosis and silica exposure.

Case Report: We report a case of this syndrome in a driller-powderman exposed to silica and nitro compounds contained in explosives.

Conclusion: Physiopathology and etiologies of systemic sclerosis are still not well known.

Inter-reader agreement in HRCT detection of pleural plaques and asbestosis in participants with previous occupational exposure to asbestos.

Objectives: To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos.

Methods: The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation.

Differential mutation profiles and similar intronic TP53 polymorphisms in asbestos-related lung cancer and pleural mesothelioma.

Given the interest in defining biomarkers of asbestos exposure and to provide insights into asbestos-related and cell-specific mechanisms of neoplasia, the identification of gene alterations in asbestos-related cancers can help to a better understanding of exposure risk. To understand the aetiology of asbestos-induced malignancies and to increase our knowledge of mesothelial carcinogenesis, we compared genetic alterations in relevant cancer genes between lung cancer, induced by asbestos and tobacco smoke, and malignant pleural mesothelioma (MPM), a cancer related to asbestos, but not to tobacco smoke. TP53, KRAS, EGFR and NF2 gene alteration analyses were performed in 100 non-small cell lung cancer (NSCLC) patients, 50 asbestos-exposed and 50 unexposed patients, matched for age, gender, histology and smoking habits.

Pleural plaques and the risk of pleural mesothelioma.

Background: The association between pleural plaques and pleural mesothelioma remains controversial. The present study was designed to examine the association between pleural plaques on computed tomography (CT) scan and the risk of pleural mesothelioma in a follow-up study of asbestos-exposed workers.

Methods: Retired or unemployed workers previously occupationally exposed to asbestos were invited to participate in a screening program for asbestos-related diseases, including CT scan, organized between October 2003 and December 2005 in four regions in France.

[Compensation for occupational diseases after tomodensitometry screening for benign pleuro-pulmonary disease in a multiregional post-occupational medical surveillance program of asbestos-exposed retired workers].

Background: Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme.

Methods: Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010.

[What tools should be used for follow-up post occupational exposure? What should be the frequency?].

As long as the value of screening for cancers related to asbestos is not proven in the population at risk, the medical benefits of follow-up post-professional exposure remain uncertain and the only justification is to answer the questions of anxious retired workers concerning the consequences of their past-exposure and to provide compensation for any abnormalities that are demonstrated. In this country, to answer the questions posed in the title of this contribution in the case of pathologies related to asbestos, it is necessary, after verifying the fact and the level of exposure, to identify the pleural or pulmonary fibrosis and, above all, the pleural plaques, which constitute the essential lesions currently screened for. Thoracic CT scanning without contrast is the examination of choice to achieve this objective.

Pulmonary nodules detected by thoracic computed tomography scan after exposure to asbestos: diagnostic significance.

Objective: To analyse the relationship between pulmonary nodules detected by radiologists using computed tomography and cumulative exposure to asbestos or asbestos-related pleuro-pulmonary diseases in 5662 asbestos-exposed subjects, and the relationship between pulmonary nodules and thoracic cancer, to determine whether a specific surveillance strategy based on cumulative asbestos exposure should be adopted.

Design: Standardised incidence and mortality ratios (SIR) for lung cancer and pleural mesothelioma were calculated in patients with and without mention of pulmonary nodules and compared using comparative morbidity figures.

Results: A significant excess incidence of primary lung cancer and pleural mesothelioma was observed among subjects presenting with pulmonary nodule(s) (SIR respectively 1.

Asbestos-related cancer risk in patients with asbestosis or pleural plaques.

Introduction: The relationships between benign asbestos-related diseases (asbestosis and pleural plaques) and thoracic cancers are still debated. The aim of this paper was to review the epidemiological data relevant to this issue.

Current Knowledge: Published studies show a significant relationship between occupational exposure to asbestos and lung cancer risk, even in the absence of abnormalities consistent with asbestosis on the postero-anterior chest x-ray.

Do asbestos-related pleural plaques on HRCT scans cause restrictive impairment in the absence of pulmonary fibrosis?

Background: It is uncertain whether isolated pleural plaques cause functional impairment.

Objective: To analyse the relationship between isolated pleural plaques confirmed by CT scanning and lung function in subjects with occupational exposure to asbestos.

Methods: The study population consisted of 2743 subjects presenting with no parenchymal interstitial abnormalities on the high-resolution CT (HRCT) scan.

Cancer incidence within a cohort occupationally exposed to asbestos: a study of dose--response relationships.

Objectives: The aim of our study was to analyse the dose-response relationship between occupational asbestos exposure and risk of cancer.

Methods: Our study was a retrospective morbidity study based on 2024 subjects occupationally exposed to asbestos, conducted over the period 1 January 1978 to 31 December 2004. Analysis of the dose-response relationship between occupational asbestos exposure, as a time-dependant variable, and risk of cancer was performed using a Cox model.

CT scan screening is associated with increased distress among subjects of the APExS.

Background: The aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers.

Methods: A HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires.

Does asbestos exposure cause airway obstruction, in the absence of confirmed asbestosis?

Rationale: Whether occupational exposure to asbestos causes airway obstruction remains controversial.

Objectives: This study evaluated lung function in relation to cumulative exposure to asbestos in a large cohort of retired or unemployed workers exposed to asbestos.

Methods: The study population consisted of 3,660 volunteer subjects.

Comparative analysis of medicolegal compensation for occupational cancers in France and other western European countries: development proposals.

In France, contemporary medicolegal reparation system of occupational diseases--in particular occupational cancer--has been questioned, constantly, due to changes in the state's legal system. For a long time, associated legislation was considered as a genuine social breakthrough. However, it shall remain acknowledged that over the past 15 years, it has been the French legal system itself that generated a certain level of inequality among victims of occupational diseases.

Children employed in the performing arts, advertising and fashion industry: what legal protection do they have?

Ill-treatment can sometimes take on an unfamiliar face. Particularly, this is the case for certain types of child employment. In France, as in most European countries, there are laws for protecting children and guaranteeing their right to schooling.

The French medico-legal concept of aptitude and fitness appraisal by occupational physicians: an ethical issue?

For many years, medical aptitude in occupational health, a French exception, did not raise any particular issue. However, from the 1980's onwards, this concept has been approached from a more critical point of view, authors questioning its compatibility with personal liberty. The increase in precarious working conditions have but reinforced such criticism, raising the question of the confrontation of such a concept with due respect of the right to work and the right for health protection.

Occupational asbestos exposure and digestive cancers - a cohort study.

Background: Although the role of asbestos in the genesis of mesothelioma and primary bronchopulmonary cancers has been established, results from studies focusing on the relationship between occupational exposure to asbestos and digestive cancer remain contradictory.

Aim: To determine whether occupational asbestos exposure increases the incidence of digestive cancers.

Methods: Our study was a retrospective morbidity study based on 2024 subjects occupationally exposed to asbestos.

[Asbestos-related cancer risk in the presence of asbestosis or pleural plaques].

Introduction: The relationships between benign asbestos-related diseases (asbestosis and pleural plaques) and thoracic cancers are still debated. The aim of this paper is to analyse epidemiological data which investigate this topic.

State Of The Art: Published studies show that there is a significant relationship between occupational exposure to asbestos and lung cancer risk, even in the absence of abnormalities consistent with asbestos exposure on postero-anterior chest x-ray.

p16INK4A inactivation mechanisms in non-small-cell lung cancer patients occupationally exposed to asbestos.

Epidemiological studies have shown that asbestos fibers constitute the major occupational risk factor and that asbestos acts synergistically with tobacco smoking to induce lung cancer. Although some somatic gene alterations in lung cancer have been linked to tobacco smoke, few data are available on the role of asbestos fibers. P16/CDKN2A is an important tumor suppressor gene that is frequently altered in lung cancer via promoter 5'-CpG island hypermethylation and homozygous deletion, and rarely via point mutation.

Reliability of the proposed international classification of high-resolution computed tomography for occupational and environmental respiratory diseases.

Purpose: We have developed a classification of high-resolution computed tomography (HRCT) images for screening, surveillance and epidemiological studies of respiratory diseases caused by occupational and environmental factors. The proposed classification consists of three parts: a guideline explaining the elements of the classification scheme, a reading sheet, and reference films to aid in assessing thin-section CT films. We assessed the reliability of the proposed classification system by blinded, independent trial reading.

Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers.

Objectives: The aim was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low-radiation helical chest CT scan with chest radiograph for the biennial screening of bronchopulmonary cancer, according to the size of detected nodules.

Material And Methods: The screening procedure consisted of biennial chest radiograph and monodetector chest CT scan, given to 972 individuals who had been highly exposed to asbestos. A total of 2555 screening procedures were performed.

Professional photosensitive eczema of fishermen by contact with bryozoans: disabling occupational dermatosis.

Eczema associated with bryozoans is a form of occupational dermatosis caused by a living animal, involving contact eczema, occasionally associated with photosensitivity and concerning fishermen on a quasi-elective basis. This affection can prove to be extremely disabling, frequently generating disastrous social consequences, since the eviction of the responsible allergen is very often synonymous to occupational reclassification, a measure which fishermen, highly attached to their profession, have great difficulty in accepting. Based on the description of three cases of photosensitive eczema associated with contact with the bryozoan, Alcyonidium gelatinosum, identified in fishermen from the English Channel coastline, we describe the characteristics and the specificities of this occupational dermatosis, then approach the issue of its prevention, which, unfortunately, remains limited.

Factors associated with cancer distress in the Asbestos Post-Exposure Survey (APEXS).

Objectives: CT-scan screening programs for lung cancer detection have been proposed in high-risk subjects, and more recently in former asbestos-exposed subjects. However, to date no data are available on psychological impact of such programs. The aim of this study is to examine the risk factors of psychological distress at baseline of a CT-scan screening program among asbestos-exposed subjects.

Pleural plaques and asbestosis: dose- and time-response relationships based on HRCT data.

Most studies on asbestos-related diseases are based on chest radiographs, and dose-response relationships are still controversial. The aim of this study was to describe the most relevant parameters of asbestos exposure linked to pleural plaques and asbestosis diagnosed by high-resolution computed tomography (HRCT). A large screening programme including systematic HRCT examinations was organised from 2003 to 2005 in France for formerly asbestos-exposed workers.