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ASBESTOS-RELATED BENIGN PLEURAL DISEASE
85
Clinical Radiology (2001) 56, 84±85 CORRESPONDENCE doi:10.1053/crad.2000.0554, available online at http://www.idealibrary.com on
RE: IMPACT FACTORS OR COMMONSENSE
References
SIR ± Professor Ell hit several nails on the head in his Commentary, `Impact Factors or Commonsense? [1]. May I add a comment of my own? From the very start of my `publishing' career I have deliberately favoured the British journals, not as a patriotic, still less a nationalistic statement, but simply on the basis that I thought I should try to make a mark, if only a faint one, on my own imaging community. Over the years I have to a large extent continued this policy and still do so. It is true that `Impact Factors' and the `Research Assessment Exercise' did not until recently loom very large in our lives. If they had, I might have started off quite differently. The question is, though, what do I do now? Do I chase the points, given that points mean prizes, or do I continue loyally to support my `local' journals? And, most important question of all, if Peter Ell and I were to deprive Clinical Radiology and BJR of our work, how could they possibly continue to improve their impact factors?! PETER DAWSON
Dept of Radiology UCL Hospitals London, U.K. Reference
1 Ell PJ. Impact factors or commonsense? Clin Radiol 2000;55:413±414.
ASBESTOS-RELATED BENIGN PLEURAL DISEASE SIR ± I read with great interest the excellent review of Peacock et al. on asbestos-related benign pleural disease [1]. Although the review is comprehensive there is a minor omission of the interesting but uncommon observation of pleural ®brosis affecting mainly the upper lung zones in persons exposed to asbestos [2]. The presence of apical lesions does not imply heavy exposure to asbestos and individual factors may determine their development. Fibrosis in the upper lobes is often present in these cases as well as the common asbestos-related benign pleural changes. Upper lobe changes are relatively a rare complication of exposure to asbestos but important to recognize. Other possible causes of apical changes such as tuberculosis must always be excluded before the diagnosis is made [2]. S. K. MORCOS
Department of Diagnostic Imaging, Northern General Hospital NHS Trust, Shef®eld S5 7AU, U.K.
1 Peacock C, Copley SJ, Hansell DM. Asbestos-related benign pleural disease. Clin Radiol 2000;55:422±432. 2 Hillerdal G. Pleural and parenchymal ®brosis mainly affecting the upper lung lobes in persons exposed to asbestos. Respir Med 1990;84:129±134.
A REPLY doi:10.1053/crad.2000.0582, available online at http://www.idealibrary. com on SIR ± We thank Dr Morcos for pointing out the report by Hillerdal which describes prominent pleural thickening in the upper zones in some asbestosexposed individuals [1]. It is perhaps worth highlighting two points about this study: ®rst, this observation was made in 40 out of 1600 (2.5%) individuals with asbestos-related pleural plaques or pleural thickening, i.e., this unusual feature does not appear to occur in the absence of other more typical stigmata of asbestos-induced pleural disease. Second, reading between the lines of the results section, it seems that most, if not all, of the forty individuals had parenchymal ®brosis in the upper lobes. It is therefore possible that the radiographic appearance of upper zone pleural thickening re¯ects contraction of the upper lobes, with the extra-pleural fat being `dragged down' (the mechanism is more elegantly described by Im et al. in a study of patients with upper lobe scarring from tuberculosis [2]). Nevertheless, whatever the pathogenesis of this curious but rare feature, it is worth knowing about because, as Dr Morcos points out, there may be radiographic resemblance to tuberculosis. C. PEACOCK S. J. COPLEY D. M. HANSELL
Department of Radiology, Royal Brompton Hospital, London SW3 6NP, U.K.
References 1 Hillerdal G. Pleural and parenchymal ®brosis mainly affecting the upper lung lobes in persons exposed to asbestos. Respir Med 1990;84:129±134. 2 Im JG, Webb WR, Han MC, Park JH. Apical opacity associated with pulmonary tuberculosis: high resolution CT ®ndings. Radiology 1991;178:727±731.
Clinical Radiology (2001) 56, 84±85 CORRESPONDENCE doi:10.1053/crad.2000.0554, available online at http://www.idealibrary.com on
RE: IMPACT FACTORS OR COMMONSENSE
References
SIR ± Professor Ell hit several nails on the head in his Commentary, `Impact Factors or Commonsense? [1]. May I add a comment of my own? From the very start of my `publishing' career I have deliberately favoured the British journals, not as a patriotic, still less a nationalistic statement, but simply on the basis that I thought I should try to make a mark, if only a faint one, on my own imaging community. Over the years I have to a large extent continued this policy and still do so. It is true that `Impact Factors' and the `Research Assessment Exercise' did not until recently loom very large in our lives. If they had, I might have started off quite differently. The question is, though, what do I do now? Do I chase the points, given that points mean prizes, or do I continue loyally to support my `local' journals? And, most important question of all, if Peter Ell and I were to deprive Clinical Radiology and BJR of our work, how could they possibly continue to improve their impact factors?! PETER DAWSON
Dept of Radiology UCL Hospitals London, U.K. Reference
1 Ell PJ. Impact factors or commonsense? Clin Radiol 2000;55:413±414.
ASBESTOS-RELATED BENIGN PLEURAL DISEASE SIR ± I read with great interest the excellent review of Peacock et al. on asbestos-related benign pleural disease [1]. Although the review is comprehensive there is a minor omission of the interesting but uncommon observation of pleural ®brosis affecting mainly the upper lung zones in persons exposed to asbestos [2]. The presence of apical lesions does not imply heavy exposure to asbestos and individual factors may determine their development. Fibrosis in the upper lobes is often present in these cases as well as the common asbestos-related benign pleural changes. Upper lobe changes are relatively a rare complication of exposure to asbestos but important to recognize. Other possible causes of apical changes such as tuberculosis must always be excluded before the diagnosis is made [2]. S. K. MORCOS
Department of Diagnostic Imaging, Northern General Hospital NHS Trust, Shef®eld S5 7AU, U.K.
1 Peacock C, Copley SJ, Hansell DM. Asbestos-related benign pleural disease. Clin Radiol 2000;55:422±432. 2 Hillerdal G. Pleural and parenchymal ®brosis mainly affecting the upper lung lobes in persons exposed to asbestos. Respir Med 1990;84:129±134.
A REPLY doi:10.1053/crad.2000.0582, available online at http://www.idealibrary. com on SIR ± We thank Dr Morcos for pointing out the report by Hillerdal which describes prominent pleural thickening in the upper zones in some asbestosexposed individuals [1]. It is perhaps worth highlighting two points about this study: ®rst, this observation was made in 40 out of 1600 (2.5%) individuals with asbestos-related pleural plaques or pleural thickening, i.e., this unusual feature does not appear to occur in the absence of other more typical stigmata of asbestos-induced pleural disease. Second, reading between the lines of the results section, it seems that most, if not all, of the forty individuals had parenchymal ®brosis in the upper lobes. It is therefore possible that the radiographic appearance of upper zone pleural thickening re¯ects contraction of the upper lobes, with the extra-pleural fat being `dragged down' (the mechanism is more elegantly described by Im et al. in a study of patients with upper lobe scarring from tuberculosis [2]). Nevertheless, whatever the pathogenesis of this curious but rare feature, it is worth knowing about because, as Dr Morcos points out, there may be radiographic resemblance to tuberculosis. C. PEACOCK S. J. COPLEY D. M. HANSELL
Department of Radiology, Royal Brompton Hospital, London SW3 6NP, U.K.
References 1 Hillerdal G. Pleural and parenchymal ®brosis mainly affecting the upper lung lobes in persons exposed to asbestos. Respir Med 1990;84:129±134. 2 Im JG, Webb WR, Han MC, Park JH. Apical opacity associated with pulmonary tuberculosis: high resolution CT ®ndings. Radiology 1991;178:727±731.