PNEUMOCONIOSIS Bodnar R.Ya.

1. PNEUMOCONIOSIS Bodnar R.Ya.

2. NOTION ABOUT PROFESSIONAL DISEASES • Professional pathology is the section of clinical medicine that studies the question of etiology, pathogenesis, clinic, diagnostics, medical treatment and prophylaxis of professional diseases.

3. Professional harmfulness • Professional harmfulness - it is the factors of production environment or labor process, which cause an unfavorable action to the organism of working and at certain force and duration of their action are able to cause the pathological states or nosologic forms of diseases.

4. Professional harmfulness Professional harmfulness: • I. Chemical toxic substances. • ІІ. Industrial dust. • ІІІ. Physical factors (industrial noise, ultrasound, vibration, electromagnetic, laser and ionizing radiation, excessive or reduces atmospheric pressure, high and low temperature of external environment etc.) • ІV. Biological industrial factors (antibiotics, fungi, micro- and macro organisms). • V. Overstrain of separate organs and systems (physical, static and dynamic overload of locomotor system, muscles, nervous system, organs of eyesight, hearing, hypodynamia and others).

5. Professional harmfulness

6. History of professional diseases • Information about the influence of work conditions to a health and about the existence of peculiarities of professional diseases meet yet in the works of Egyptian, ancient Greek and the Roman scientists (Aristotle, Hippocrates, Pleniy, Lucretsiy, Galen and others. - VI-IV century B.C.). In works of Hippocrates, that lived approximately in 577-450 B.C., described disease of miners, that proceeded with the severe breathlessness.

7. HIPPOCRATES

8. ARISTOTLE

9. In the ХVІ century the works, in which was indicated to the professional diseases of that time, were known. In 1556 there was known the work of Agricola, devoted to disease of miners. In 1567 there was issued the work of Pretzels "About mountain scab and other mountain diseases". In the ХVІІ century the works of Martin Pans and some more late of Stockhausen were published, which described the diseases of miners, and also the poisoning, that met at smelting of metals, including the intoxication by the mephitis of lead. However, the first work, in which systematically were laid out the questions of occupational hygiene of people of different professions with the description of the proper professional diseases, was the book of Italian scientific Bernardino Ramazzini, published in 1700 under the name "About diseases of artisans".

10. Bernardino Ramazzini (1633­1714)

11. Bernardino Ramazzini (1633­1714)De Morbis Artificum (Diseases of Workers)Padua, 1713

12. In the second half ХІХ and in the ХХ century, in relation with development of great industry, professional morbidity grows sharply. • Among the researchers that worked in the branch of professional pathology and authors of the most known manuals we can mark Shevale, Tankerel de Planshet, Cussmaul, Zenker, Galfort. • In 1910 in Milan on a motherland of Ramazzini, the first specialized clinic of professional diseases, which exists to presently, was created

13. Examination of working capacity and question of rehabilitation at the professional diseases • The purpose of periodic medical examination is the early detection of initial signs of professional diseases, and also timely detection of early forms of unprofessional diseases, at which subsequent work in the conditions of influence of the proper harmful factors of industrial environment is contra-indicated.

14. General medical contraindications to admittance on the work related to the dangerous harmful substances and harmful industrial factors, following: • 1.     Inherent anomalies of organs with the evident insufficiency of their functions. • 2.     Organic diseases of the central nervous system with the stable evident dysfunction. • 3.     Chronic psychical diseases. • 4.     Diseases of the endocrine system with the expressed violations of functions. • 5.     Malignant neoplasm.

15. 6.     All diseases of the system of blood and hematosis. • 7.     Arterial hypertension of the ІІІ stage. • 8.     Cardiovascular diseases with heart insufficiency. • 9.     Respiratory diseases with the evident pulmonary-heart insufficiency. • 10. Bronchial asthma of severe form with the evident disturbance of breathing and blood circulation. • 11. Active forms of tuberculosis of any localization. • 12. Stomach and duodenal ulcer with chronic recurrent course and susceptibility to complications. • 13. Cirrhosis of liver and active chronic hepatitis.

16. 14. Chronic diseases of kidney with the kidney insufficiency. • 15. Collagenosis. • 16. Diseases of joints with the stable dysfunction. • 17. Pregnancy and period of lactation. • 18. Ordinary miscarriage and anomalies of fetus in anamnesis of women, which plan child-bearing. • 19. Disturbance of menstrual function that is accompanied by the uterine bleeding. • 20. Decompensated glaucoma.

17. The diagnosis of professional disease is determined according to the generally accepted nosologic forms of pathology and must represent a stage and course of pathological process, its expressiveness and localization, degree of functional disorders, peculiarities of clinical course, presence of complications and concomitant diseases.

18. Examination of working capacity at professional diseases includes three basic questions: determination of diagnosis, determination of relation of disease with the influence of professional factors, estimation of patient’s working capacity.

19. Definition • PNEUMOCONIOSIS(from Greek pulmon - lung and conia - dust) - is the generic term for the inhalation of occupational dust and the resultant diffuse, usually fibrotic, reaction in the acinar part of the lung.

20. CLASSIFICATION OF PNEUMOCONIOSIS • 1. SILICOSIS - pneumoconiosis, caused by inhalation of dust, composed of free silicon dioxide (SiO2). • 2. SILICATOSIS - pneumoconiosis, caused by inhalation of mineral dust, which includes dioxide of silicon and other elements: magnesium, aluminum, iron, calcium (asbestosis, talcosis, kaolinosis, cementosis).

21. CLASSIFICATION OF PNEUMOCONIOSIS • 3.METALOCONIOSIS – pneumoconiosis, caused by inhalation of metal dust: iron, aluminum, barium, manganese (siderosis, aluminosis, baritosis). • 4.CARBOCONIOSIS– pneumoconiosis, caused by inhalation of dust, composed of carbonaceous dust: anthracite coal, coke, graphite, soot (anthracosis, graphitosis).

22. CLASSIFICATION OF PNEUMOCONIOSIS • 5. PNEUMOCONIOSIS CAUSED BY THE MIXED DUST (anthracosilicosis, siderosilicosis). • 6. PNEUMOCONIOSIS CAUSED BY AN ORGANIC DUST (bisinosis, corn pneumoconiosis)

23. CLASSIFICATION OF PNEUMOCONIOSISaccording to the character of form, size and contours of opacity on roentgenogram

24. CLASSIFICATION OF PNEUMOCONIOSISaccording to thedegree of expressiveness of clinical and roentgenologic manifestations

25. COMPLICATIONS OF PNEUMOCONIOSIS • pulmonary tuberculosis; • pneumonia; • multiple bronchiectasis; • spontaneous pneumothorax; • bronchial asthma; • cancer of lungs.

26. Theories of the mechanism of development of pneumofibrosis • Mechanical • Toxic • -chemical • Biological

27. SILICOSIS • A silicotic nodule is composed of concentric whorls of dense, sparsely cellular collagen

29. Chest radiograph of quarry worker showing extensive simple silicosis(ІІ-ІІІ stage)

30. VARIANTS OF CLINICAL COURSE

31. COMPLICATIONS OF SILICOSIS • chronic bronchitis • emphysema of lungs • cardiopulmonary decompensation • pulmonary tuberculosis • bronchial asthma • Pneumonia • spontaneous pneumothorax • cancer of lungs

32. Medical treatment • Vitamin therapy • Physiotherapy methods (ultraviolet irradiation, ultrasound on a thorax) • Oxygen therapy • Glycoside and diuretics • Proteolytic enzymes (tripsin, chemotripsin, chemopsin), hyaluronidase, lydase, ronidase • Corticosteroids • Antibiotics and sulfanilamides • Sanatorium-and-spa treatment

33. Posterior–anterior (PA) chest radiograph of retired tunnel workershowing small nodules

34. PA chest radiograph of retired tunnel workerobtained shows progression in the profusion of the nodules. There is also more prominent egg-shell calcification of enlarged hilar lymph nodes (arrows)

35. Posterior–anterior (PA) chest radiograph of retired metal ore minershows multiple nodules (small rounded opacities – 3-10 mm) in both lungs.

36. PA chest radiograph of retired metal ore minershows more severe nodular profusion

37. A 78-year-old retired construction site worker. CT scan through theupper lobes shows typical silicotic nodules in a centrilobular distribution.

38. CT scan in mediastinal window shows denselycalcified (arrow) and hyperdense (arrowheads) lymph nodes in the mediastinum and hila

39. Macroscopic lung image in coronal section revealsblack-pigmented PMF in the right upper lung zone adjacentto and contiguous with the right hilar lymphadenopathy. Thereis moderate centrilobular emphysema but sparse silicotic nodules.

40. 56-year-old tunnel blaster with simple silicosisand lung cancer. CT scan shows small centrilobularnodules in both lungs, with an irregular mass in thesuperior left hilum.

41. ASBESTOSIS • A photomicrograph of the lung reveals irregular interstitial fibrosis

42. ASBESTOS BODY • These structures are golden-brown, beaded bodies, which represent asbestos fibers that have been encrusted with protein and iron.

43. ANTHRACOSILICOSIS • A whole mount of the lung of a coal miner demonstrates the presence of scattered, irregular, pigmented nodules throughout the parenchyma.

44. Mixed Dust Fibrosis Photomicrograph obtained at autopsy shows two pneumoconiotic nodules with stellate appearance.