Asbestos-related diseases are disorders of the lung and pleura caused by the inhalation of asbestos fibres. Asbestos-related diseases include non-malignant disorders such as asbestosis, diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma. People who worked in jobs with high asbestos dust exposure are at the highest risk of developing asbestos-related disease. However, exposure to asbestos may occur in the worker’s home due to dust that has accumulated on the worker's clothing. Asbestos-related diseases can occur as a result of non-occupational, environmental exposure. Asbestos was extensively used in many building materials, therefore large quantities of asbestos still remain in buildings that were built prior to the restriction of asbestos use that applies in many countries; the weathering and aging of such buildings may cause asbestos fragments to be released in the air and create a potential hazard.

Anyone who disturbs the asbestos-containing material during home maintenance and renovation can be affected, although the exact risks are difficult to quantify. Inhaled asbestos fibres enter the upper and lower respiratory tracts when asbestos is released into the air; some of the inhaled fibers are cleared by the mucociliary clearance mechanism but long thin asbestos fibers may reach the lower airways and alveoli, can be retained in the lungs for many years. Amphibole fibers are not cleared as as serpentines and therefore accumulate more in the distal lung parenchyma. Asbestos fibres are recognised by the lungs as foreign bodies and cause the activation of the lung’s local immune system leading to inflammation and tissue damage. In the long term, this can lead to fibrosis, or to malignancy. From the lungs, some asbestos fibres can migrate to pleural and peritoneal spaces. Benign asbestos-related pleural abnormalities encompass four types of pleural changes: Pleural plaques Diffuse pleural thickening Benign asbestos pleural effusions Rounded atelectasis The pleura appears to be more sensitive than the lung parenchyma to the effects of asbestos fibres.

Thus asbestos-related pleural diseases can result from much lower doses than the fibrotic changes in the lung. Pleural plaques are the most common manifestation of asbestos exposure, affecting up to 58% of asbestos-exposed workers; the prevalence among the general population exposed environmentally ranges from 0.53 to 8%. Pleural plaques are discrete circumscribed areas of hyaline fibrosis of the parietal pleura and the visceral pleura that develop 20 to 40 years after first exposure. Over time more than 30 years, they become calcified, they consist of mature collagen fibers arranged in an open basket-weave pattern and are covered by flattened or cuboidal mesothelial cells. They have a white or pale yellow shaggy appearance and are distributed on the posterolateral chest wall and mediastinal pleura; the number and size varies. Pleural plaques are asymptomatic, there is still some controversy on this topic. An association between pleural plaques and chest pain has been reported, but this has not been confirmed in more recent studies.

An association between pleural plaques and a restrictive impairment with diminished diffusing capacity on pulmonary function testing has been described. This has not been a consistent finding and it has been postulated that this might be related to undetected early fibrosis; the pathogenesis of pleural plaques remains uncertain. The most explanation is that asbestos fibres reach the parietal pleura by passage through lymphatic channels where they excite an inflammatory reaction; the chest X-ray is the usual tool for diagnosing pleural plaques but chest CT scan is more sensitive and specific in this regard. Pleural plaques are evidence of past asbestos exposure and indicate an increased risk for the future development of other asbestos-related diseases. Pleural plaques in themselves are not pre-malignant. Individuals with pleural plaques are not compensated in most compensation systems. Diffuse pleural thickening is non-circumscribed fibrous thickening of the visceral pleura with areas of adherence to the parietal pleura and obliteration of the pleural space.

It extends over the area of an entire lobe or lung, with fibrotic areas involving costophrenic angles, lung bases, interlobar fissures. The thickness ranges from less than 1 mm up to 1 cm or more and may extend for a few millimeters into the lung parenchyma. Fibrous strands extending from the thickened pleura into the lung parenchyma can be detected on CT scan. Diffuse pleural thickening develops 20 to 40 years after first exposure. All types of asbestos can cause diffuse pleural thickening and a dose-related relationship has been described, it is thought that asbestos fibres that reach the pleura induce subpleural fibroblasts and mesothelial cells to produce scar tissue and collagen deposition, resulting in subpleural thickening. Pleural plaques coexist with DPT although the latter is rare compared with pleural plaques. According to the Australian Surveillance of Australian Workplace Based Respiratory Events scheme, DPT accounted for 22% of all asbestos-related diseases, it begins with an inflammation of the pleura, accompanied by a pleural effusion.

Most patients complain of exertional breathlessness, chest pain has been associated with this disorder. DPT has a significant impact on pulmonary function, causing a decrease in forced vital capacity, reducing total lung capacity and diffusing capacity; the rest

Emmanuel Villaume is a French orchestra conductor. He is chief conductor of the Prague Philharmonia. Villaume began his musical education at the Strasbourg Conservatory, he continued his studies in Paris at Khâgne and the Sorbonne where he studied literature and musicology. At age 21, he became stage manager and dramaturg at the Opéra National du Rhin, where he met Spiros Argiris, the music director of the Festival dei Due Mondi in Spoleto. Villaume subsequently studied conducting with Argiris, became an assistant conductor to Seiji Ozawa. Villaume made his American conducting debut in 1990 with Le nozze di Figaro at the Spoleto Festival USA, he was named music director for opera and orchestra of the Spoleto Festival USA in October 2000, held the post from 2001 to 2010. He made his Carnegie Hall debut in 2002 conducting the Montreal Symphony, he first conducted at the Metropolitan Opera in September 2004 in Madama Butterfly. Villaume first conducted at Dallas Opera in 1998, he made his debut with the Chicago Symphony Orchestra in 2007.

In April 2013, Villaume was named music director of the Dallas Opera, with immediate effect. In November 2015, the Dallas Opera announced that Villaume's contract as music director had been extended through June 2022. Internationally, Villaume made his Orchestre de Paris debut in 2000 as well as his debut at the Royal Opera House, Covent Garden conducting Les Contes d'Hoffmann in October 2000. In January 2007 he made his conducting debut at La Fenice in Venice with Meyerbeer's Il crociato in Egitto, he became chief conductor of the Slovenian Philharmonic Orchestra in 2008, held the post through 2013. He became chief conductor of the Slovak Philharmonic in 2009, held the post through 2016. In October 2014, the Prague Philharmonia announced the appointment of Villaume as its fourth chief conductor, effective with the 2015-2016 season, with an initial contract of 3 years. Villaume holds an honorary doctorate from the University of Indianapolis. Maurice Emmanuel: Ouverture pour un conte gai / Symphony 1 & 2 / Suite française.

Timpani Recordings 1C1189. French Heroines Decca Records CD Puccini: La Rondine. Decca B001Q2RVTY DVD Souvenirs:. Deutsche Grammophon 4777451 CD Duets:. Deutsche Grammophon 4776635 CD Massenet: Le Cid. House of Opera, 2005 DVD Massenet: Chérubin Dynamic CDS 508/1-2 CD and DV 33508 DVD Offenbach: La Grande-Duchesse de Gerolstein Dynamic CDS173 CD Meyerbeer: Il crociato in Egitto Dynamic DV 33549 DVD Gian Carlo Menotti: Goya Gustav Mahler: Symphony No.9 in D Major. Slovenska filharmonija, 2011 Maurice Ravel: Daphnis et Chloé, NYOC, 2014Heroique:. Warner Classics, 2015Echo Klassik Newcomer of the Year Bundesverband Musikindustrie Preis der deutschen Schallplattenkritik Académie Charles-Cros Grand Prix du Disque AllMusic Best of 2015Pyotr Ilyich Tchaikovsky: Iolanta.. Deutsche Grammophon, 2015Académie Charles-Cros Grand Prix du DisqueSaint Saens, Gershwin: concertos.. Warner Classics, 2016 Mark Adamo: Becoming Santa Claus. Dallas Opera DVD, 2017 Giacomo Meyerbeer: Grand Opera. Warner Classics, 2017 Singer of the year Opus Klassik Eternamente:.

Erato, Warner Classics, 2017 Maurice Ravel, Georges Bizet, Claude Debussy: Ma mère l'Oye, Symphony in C, Fantaisie for piano and orchestra. Prague Philharmonia. Warner Classics. 2018 Benjamin Bernheim, Arias. Prague Philharmonia. Deutsche Grammophon, 2019 Emmanuel Villaume official web site Emmanuel Villaume interview by Bruce Duffie