Çıkar çatışması : 2011 Kongre katılım desteği 2010 ERS kurs katılım desteği

1. Çıkar çatışması : 2011 Kongre katılım desteği 2010 ERS kurs katılım desteği

2. OLGU SUNUMU DR.İPEK ÖZMEN S. B. SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ İSTANBUL

3. 26 years old • Male

4. Complaints : 5 month history of.. • Cough • Dyspnea • Weihgt loss • Fatigue • Fever

5. Born in Zonguldak • Living in Istanbul • Unemployed during hospitalisation • Had worked in textile workshop

6. Past history: • Smoking : 10 pack years

7. Physical examination: • BP: 120/80mmHg Pulse :80/min RR:18/min Fever: 38,8 C • Normal breathing sounds • No Organomegaly

8. Chest x-ray at hospitalisation

9. ? • Pneumonia • Tuberculosis • Interstitiallungdisease

10. Old lung graphy !

11. Chest x-ray 8 months ago

12. Occupationalhistory Denim sandblasting for 7 years

13. Thorax CT

14. Thorax CT

15. Toraks CT’ de mediastinal LAP Medialstinal LAP in thorax CT

16. 3 Balgam ARB (-) • FOB : Normal endobronşiyalsistem • Bronkoskopik lavaj ARB (+)

17. Treatment of tuberculosis 2 cultureswere ( + ) M.tuberculosis

18. After treatment Before treatment

19. SILICON DIOXIDE (SILICA) Crystalline form (quartz)CristoballiteTrydimite

21. SILICOSIS • Thehistory of silicosis goes back to very ancienttimes, evensilicotic nodulesarefound in Egyptian mummies • Silicon dioxide or silica, is the mineralsmost abundant in the world. • Inhalation of silica crystals in the structure of the worldcrust causes pneumoconiosis • Silicosis is a preventable but incurable disease • In non-crystalline form of silica does not cause silicosis

22. Sources of silica exposure Miningandmilling Construction Stone working Ceramics, craftwork Sandblasting Glassmanufacture Dentaltechnician Jewellery Agriculture Non-occupational

23. Sandblasting

24. mechanism for silicosis Tissuedamage andfibrosis alveolar macrophages Morphagocytosistal Alveolarspace

25. polarizing microscopy

26. Sandblasting

27. Sandblasting

28. Before sandblasting http://images.google.com/imgres?imgurl=http://

29. Aftersandblasting http://images.google.com/imgres?imgurl=http://

30. Jean fashion !

31. Denim sandblasting ! www.haberortak.com

32. Hazardous sandblasting by worker in Bangladesh.(Photo Courtesy of Allison Joyce Photojournalist

33. Silicosis According to the formation process of the disease: • Chronic silicosis:approximately 10yearsafter the start of exposure • Accelerated silicosis : intense and short-term (5-10 years) exposure • Acutsilicosis : intense exposure (a few months-5 years) Int J Tuberc Lung Dis 2007 11(5):474-484

34. ILO International LabourOrganization

36. ParenchymalAbnormalities size irregular(width) Round (diameter) 0-1.5 mm p s 1.5-3 mm q t 3-10 mm r u Parenchymal large opacity A, B, C

37. Small opacities ( round ) Shape (p,q,r) - size ( diameter ˂ 10 mm)

38. Largeopacities Shape (A,B,C) - size ( diameter ˃ 10 mm)

39. Silicosis and Tuberculosis • Functions of alveolar macrophages with silica particles and the local defense mechanisms are weakened • Patients with silicosis have higherrisk for tuberculosis ( 2-3 times ) compared to those without silicosis working in the same workplace • Isolating tuberculosis bacilli from patients with progressive massive fibrosis, can be more difficult • Non-mycobacterial infections are not uncommon... Int J Tuberc Lung Dis 2007 11(5):474-484

40. 2006

41. 2007

42. 2008

43. 2010 ILO

44. « Silicosis is often progressive even without further exposure !!! » 2006 2007 ARB + 2008 ARB - 2010 ARB -

45. Thanks for : As.Prof.Dr.Haluk Çalışır Dr.Nlüfer Kongar

46. Teşekkürler