High Prevalence of Diffuse ParenchymalLung Diseases among Turkish Tinners: Oner DIKENSOY, et al. Department of Pulmonary Diseases, Gaziantep University, Turkey-The objective is to investigate the prevalence of parenchymal lung diseases among tinners. Twenty-four tinners who signed an informed consent form in the Gaziantep area were the subjects of this study. Demographics, spirometric test results, and high resolution computed tomography (HRCT) scans were obtained for all the tinners. Out of 24 tinners, eleven tinners (46%) had HRCTs consistent with DPLD. Of these 11 subjects, HRCT findings were consistent with respiratory bronchiolitis interstitial lung disease in nine, usual interstitial pneumonia pattern in one, and non-specific interstitial pneumonia in one. HRCT patterns consistent with DPLDs are significantly prevalent among Turkish tinners. This is the first field study reporting this occupational lung hazard in tinners. Future research is needed to uncover the underlying mechanisms. (J Occup Health 2008; 50: 208-211)

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Tin is commonly used as a coating on copper kitchen appliances, and "tinsmithing" as a trade is common in many non-Western countries, where cooking utensils are re-tinned when the cooking surface wears thin. Tinsmiths, or "tinkers," are commonly exposed to the following fumes during their work: stannic [tin(IV)] oxide, ammonium chloride, and hydrochloric acid. In this study we assessed workers from tinsmith workshops of our province for signs, symptoms, and laboratory evidence of cardiac end-organ damage. Between June 2002 and March 2003, researchers went to the main tinsmith workshop area of our province to interview tinsmiths in their workplaces and to gather addresses of their "traveling tinker" colleagues, who work with portable equipment. All workers were interviewed and underwent a complete physical examination, blood testing for lipid parameters, and echocardiography. Twenty-six tin workers (mean age 49+/- 10 y) and 25 control patients (convenience sample of hospital employees) were included in the study. Tobacco use, incidence of hypertension, and serum lipid parameters were not significantly different between the two groups (p < .05). The differences in myocardial performance index, systolic function, and mitral flow A velocity were also nonsignificant. However, the mitral inflow E velocity in the tinsmiths was significantly less than in controls (0.71+/- 0.1 vs. 0.95+/- 0.1 m/s, p < .001). The mitral deceleration time was also much longer in the tinsmith group (216+/- 71 ms vs. 143+/- 14 ms, p < .001). Eleven of the tinkers (23%) were found to have aortic valve sclerosis (severe in one, moderate in another, mild in the other nine), but aortic valve sclerosis was found in none of the control subjects. One tinsmith was found to have three-vessel coronary disease on angiogram. Another tinker with "myocarditis" in the past, and slow flow on angiography, had normalization of his cardiac tests after refraining from tin exposure for 6 mo. Thus, occupational exposure to heavy tin fumes is associated with left ventricle diastolic dysfunction and sclerosis of the aortic valve. Tin workers should minimize their exposure to tin fumes, and physicians should monitor tinsmiths closely for signs of heart disease.

A 52-year-old woman was referred to University hospital complaining of increasing shortness of breath, and after further detailed investigation, of a heart murmur. She reported having had recurrent shortness of breath for more than 15 years. She had no associated symptoms. She had been previously misdiagnosed with chronic obstructive pulmonary disease. On presentation, physical examination revealed an obese, alert women, with a respiratory rate of 25 breaths per minute, a heart rate of 110 beats per minute with regular rhythm, normal BP, no fever, clear lungs, mild systolic murmur over the pulmonary valve area. Laboratory data showed normal limits for the following values: WBC and differential cell counts, hemoglobin, hematocrit, platelet count, prothrombin and partial thromboplastin times, and blood chemistry studies. Arterial blood gas values, with the patient breathing room air, revealed a pH of 7.45, PCO 2 of 36 mmHg, PO 2 of 62 mmHg. Chest x-ray revealed a left hilar mass, with otherwise normal heart structures and lung paranchyme. An ECG showed sinus tachycardia Low pressure giant pulmonary artery aneurysm: a novel source of recurrent pulmonary embolism?