Monday, 25 November 2013

Pleural disease – Pleural plaques – The Causes and Risk factors

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
C. Pleural plaques
Pleural plaques is a medical condition as a result of exposure to asbestos that lead to accumulated plagues within the pleural cavity(a). Many diseases such as pneumonia, breast cancer, and heart failure can affect the pleural space.,therefore, it is often a secondary effect of another disease process.
B. Causes and Risk factors
B.1. Causes
The common cause of pleural plaques development is exposure to asbestos.
1. ErioniteErionite, a fibrous zeolite mineral, has been categorized as a class I carcinogenic agent for its causative role in mesothelioma. According to the study by the University of Pittsburgh School of Medicine, in select villages in Turkey, erionite is the cause of more than 50% of mesotheliomas, but there is a report of a first case of a patient with erionite-associated pleural mesothelioma with classic pathologic changes typical of asbestos-related pulmonary and pleural pathology(5).
2. Chrysotile and tremolite
Environmental exposures to chrysotile and tremolite from the soil cause pleural plaques and mesothelioma in northeast Corsica, according to the study by the Chest Department, CUB Hôpital Erasme in a study of natural animal model to determine whether these exposures actually result in increased fibre burdens in the lungs and parietal pleura(6).
B.2. Risk factors
1. Occupations
People who work in prolonged environment in exposure to asbestos are at increased risk of pleural plaques. According to the study of Pleural plaques in dentists from occupational asbestos exposure, by the Pulmonary Clinic of Aristotle University of Thessaloniki, everyday occupational exposure for many years even to low asbestos levels, under poor ventilation conditions in a closed space, could cause pleural lesions(7).
2. “Take-home” asbestos
According to the study by the Occupational Medicine Clinic, General Health Services, Providers should recognize that due to the potential for “take-home” exposures, asbestos-related disease in a patient may be a marker for disease in household contacts. Patients with family members heavily exposed to asbestos should be strongly encouraged to quit smoking in an effort to reduce any further carcinogenic exposures. Additionally, workplace control and regulation of asbestos use should be emphasized to protect both workers and their families(8).
3. Asbestos exposure and Cigarette smoking
In a survey of 45 men aged 40 or over who had worked five years or more in an asbestos manufacturing plant, the prevalence of pleural plaques was studied with respect to age, duration of asbestos exposure, estimated cumulative asbestos dose, and smoking habit. Plaques were found in 38 to 53% of the men, depending on the interpretation of the chest film reader. Cigarette habit appeared to be the most important factor; the prevalence was lowest in non-smokers, intermediate in current smokers, and particularly high in exsmokers(9).
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