The cause of pleural effusion was studied in 300 consecutive patients by clinical examination and laboratory tests. The three most common causes were found to be cancer 117 cases (metastatic 65, bronchogenic Pleural effusion represents a very common diagnostic problem. In all studies on the causes of this condition, apart from those that are evident, such as congestive heart failure and cirrhosis, the percentage of undetermined causes is still around 20%, even after complete diagnostic evaluation.We determined the origin of pleural effusion in patients with subacute or chronic conditions admitted to a department of thoracic diseases. The purpose of this study was to determine the specific cause-malignancy or tuberculous or bacterial infection-and ResultsThe most frequent causes of pleural effusion were cancer (39%), tuberculous infection (17 6%), and bacterial infection (126%): 20f6% were undiagnosed, and other causes represented 10% (table 1).

Pathological effects of asbestos are probably dependent on the size and surface properties of the fibers. Surface-modified chrysotile fibers were injected into the pleural cavity of rats to investigate the potency of the fiber to induce mesothelioma. Chrysotile fibers were modified by a phosphorylation process, resulting in the presence of phosphorus at the fiber surface. Phosphorylated samples were characterized by enhanced durability and reduced affinity for biological macromolecules. Five samples were tested: 1 untreated and 4 phosphorylated. ChrP1, ChrP2 and ChrP3 corresponded to phosphorylated samples obtained by first, second and third passages through an Alpine classifier; Pm was defibrillated ChrP1. The number of fibers per microgram and the size distribution were determined by transmission electron microscopy and classified in 4 size groups. Groups of 35 rats were inoculated with 20 mg of fibers suspended in 0.9% NaCl solution. No mesothelioma was found in the saline controls. All fiber samples were proficient in producing mesothelioma; the percentages were different between groups and untreated chrysotile but not significantly so. The differences may be explained on the basis of the number of fibers injected which were greater than 8 microns in length and less than 0.25 microns in diameter. The findings of a proficiency of long fibers to produce mesothelioma, previously reported by others for glass fibers, could be applied to chrysotile.

No abstract

Rat pleural mesothelial cells treated in vitro with chrysotile fibers have been successfully transplanted into nude mice. Three cultures (1 untreated, 2 treated) were injected at passage 75; a fourth culture was obtained from a mesothelioma induced in rat by chrysotile fibers. Overall, tumors grew in each series, but the delay between cell injection and tumor formation was 22 wk with untreated cells whereas only 1 or 2 wk were needed with treated cells, and 1 wk with cells from in vivo-induced mesothelioma. Pathological study by light and electron microscopy of tumors is reported here and showed the mesothelial nature of the cells. Comparison between the ultrastructure of the injected cells and tumor cells indicated that the morphology of injected cells was retained in tumors even if the delay in tumor formation was long. These results suggest that this model is useful for investigating mesothelial cell transformation resulting from in vitro or in vivo exposure to certain carcinogens.