OSMAN ELBEK, MD (osmanelbek@yahoo)

1. OSMAN ELBEK, MD (osmanelbek@yahoo.com) Department of Pulmonary Medicine, Adnan Menderes University

2. CONFLICT OF INTEREST • Tobacco and Health Congress -2010 (Pfizer) • European Respiratory Society Annual Congress -2010 (Abdi İbrahim) • Turkish Thoracic Society -2011 (Çukurova Branch) (GSK) • Turkish Thoracic Society (Middle Black Sea) -2011 (AstraZeneca) • Turkish Thoracic Society (Çukurova Branch) -2011 (B. Ingelheim)

3. DISCUSSION • Evaluate lung diseases caused by PVC • Discuss case-based approach to occupational diseases • Emphasize preventive medicine • Remember that the problems in working life

4. “Yapıcılar türkü söylüyor…”

6. Gutters • Furniture • Credit Card •  Water Pipes •  Bottle – Bag •  Railways • Sewer Pipes • Floors •  Wall Covering • Mushroom Cover • Phonograph Records • Automotive Parts • Window Frame • Packing Material •  Artificial Leather – Footwear • Optical Fiber Case Envelope • Electrical Wire – Cables • Toys - Sports Equipment • Injector • Serum Tube • Transfusion Sets • Parenteral fluid - Blood Bags • Catheter - Cannula - Drain - Stoma Discovered by Victor Regnault (1830)Manufacturing principles developed by Fritz Klatte (1912)Large-scale production started (1938) www.petkim.com.tr Fernández-Nieto M, Allergol et Immunopathol, 2006. Attarchi S, J Occup Med Toxicol. 2007.

7. 90 million pounds of PVC per year is released into the atmosphere In Europe, production increased from 5.5 million tons in 1999 to 5.7 million tons in 2001 There are 1750 companies manufacturing PVC in Spain alone 542.000 workers are employed in the PVC manufacturing industry in Europe Cordasco EM, Chest 1980. Anonymous, PVC status report. Focus on Polyvinyl Chloride, 2002. Fernández-Nieto M, Allergol et Immunopathol, 2006.

8. PVC Requirements (Turkey): 800.000 tons / year Petkim Aliaga Petrochemical Complex : 200.000 tons / year

9. “Yapı türkü söyler gibi yapılmıyor ama Bu iş biraz zor. Yapıcıların yüreği bayram yeri gibi cıvıl cıvıl ama yapı yeri bayram yeri değil. ”

10. CASE-1 • A. A. • 35 year old male patient • Morning cough (3 years), and shortness of breath (3 months) • 30 pack-year smoking history • 19 years working for the PVC industry • Physical examination normal • TST: 11 mm (BCG scar + +) • Spirometry: Normal

11. Arnaud A, Thorax, 1978.

12. 35 year old male patient Morning cough (3 years), and shortness of breath (3 months) 30 pack-year tobacco 19 years working for the PVC industry Physical examination normal TST: 11 mm (BCG scar + +) Spirometry: Normal Chest Radiograph: Diffuse micronodular infiltrate APPROACH? • HRCT • HRCT + Bronchoscopy • HRCT + Bronchoscopy  VATS • Treatment and ve Follow-up CT Scan • Referred to the Social Security Institution

14. EM X 6800 EM X 46000

16. 18.9% Süyür H, Uzmanlık Tezi, 2009.

17. CASE-2 • H. L. • 65-year-old, female patient • Hemoptysis (1 month) • No smoking history • Worked 37 years for the PVC industry (now retired) • No hobby • Physical examination normal • Thoracic CT: Mass in the right upper lobe (peripheral) • TNB: Large Cell Lung CA

18. 65-year-old, female patient No smoking Worked 37 years for the PVC industry (now retired) No hobby Large Cell Lung CA APPROACH? • The profession has no effect on disease development • Impact of the disease in the development of the profession can not be known • The development of the profession probably has the effect of disease • Detailed analysis (DNA/Dust Analysis, etc.) is required • Must apply to the Social Security Institution

19. PVC & KANSER

20. No Effect of the Development of Cancer Increases Risk of Lung Cancer

21. CASE-3 • L. S. • 32 year old male patient • 4 pack-year smoking history • 14 years working for the PVC industry • Episodes of coughing and shortness of breath (5 years) • No complaints of rhinitis and conjunctivitis • Personal and family history does not identify a history of atopy

22. 32 year old male patient 4 pack-year smoking history 14 years working for the PVC industry Episodes of coughing and shortness of breath (5 years) No complaints of rhinitis and conjunctivitis Personal and family history does not identify a history of atopy APPROACH? • Pulmonary Function Test • Follow-up of Peak-Flow Meter • Investigating Detailed History • Non-specific Bronchoprovocation Test • Specific Bronchoprovocation Test

23. QUICK REVIEW • How working in a job? • Do you think that any health problems related to your job? • Is it better or worse complaints at work or home? • Dust, smoke, chemicals, radiation and exposure to noise did you?

24. OCCUPATIONAL HISTORY • Industry type, job description • Commencement and completion of work • Job chronology • Job description • Changes in the runtime and the seizure • Dust, smoke, radiation, chemical, biological or psychological danger • Protection equipment (clothing, gloves, goggles, respirator) • Workers whether or not a similar problem at the same location

25. Is there a relationship between wheezy breathing your job? • Can you begin to engage in work during or after symptoms worse do you anticipate? • Do your symptoms change in days, weeks, holidays or away from work? • Do your symptoms become a difference towards the end of work week?

26. Complaints started after a change in the workplaceWorked in the packaging Currently working mixer section Working Hour: 7:00 to 16:30Developing symptoms, such as 02:00 to 3:00Passes complaints on weekends and public holidays APPROACH? • Allergy Skin Test • Pulmonary Function Test • Follow-up of Peak-Flow Meter • Non-specific Bronchoprovocation Test • Specific Bronchoprovocation Test

27. Lee HS, Br J Ind Med, 1989.

30. PVC & AIRWAY Süyür H, Tuberk Toraks, 2011.

33. AIRWAY: TOBACCO Süyür H, Tuberk Toraks, 2011.

36. 43-year-old, maleDiagnosed with Chronic Bronchitis20 pack-year tobacco history Working in the PVC industry (180 months) • Developed related to tobacco use • Job has no effect on the development of the pathology • The effect of the job can not be known • A possible effect of the development work has pathology • More research is needed to make

37. Süyür H, Uzmanlık Tezi, 2009.

38. Süyür H, Uzmanlık Tezi, 2009.

39. Süyür H, Occup Med, in press.

40. 43-year-old, maleDiagnosed with Chronic Bronchitis20 pack-year tobacco history Working in the PVC industry (180 months) • Developed related to tobacco use • Job has no effect on the development of the pathology • The effect of the job can not be known • A possible effect of the development work has pathology • More research is needed to make

41. Süyür H, Uzmanlık Tezi, 2009. Süyür H, Occup Med, in press.

42. “Bir yürek çarpıntısı var her putrelinde her tuğlasında her kerpicinde. Yükseliyor, yükseliyor yapı kanter içinde.”

43. WORKING LIFE • Non-agricultural productivity increased by 25%, 12% loss in real wages (U.S.) • Child labor was 3% (Gaziantep) • Informal work: 51.5% (Gaziantep) • Nine out of every ten children, two of every three young and elderly people at informal (Gaziantep) • While the percentage of workers unionized in 1965, 58.2%, 20.9% in 1996 (Turkey) • Ratio of non-unionized workplace: 91.8 (%) (Gaziantep) Süyür H, Uzmanlık Tezi, 2009.

45. SUMMARY • PVC can cause pneumoconiosis. • Increased risk of cancer (PVC workers). • Occupational history is crucial. • Tobacco and PVC dust causes airway pathology. • Pleural changes caused by PVC, there is a need for new research. • We need a revolution in the mindset, so that it will accept human and his labor superior to money.