ABSTRACT
ABSTRACT Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.
RESUMO Objetivo: Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Métodos: Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Resultados: Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Conclusões: Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.
Subject(s)
Humans , Male , Adult , Middle Aged , Alloys/adverse effects , Alloys/toxicity , Cobalt/adverse effects , Cobalt/toxicity , Lung Diseases, Interstitial/diagnosis , Occupational Diseases/diagnosis , Occupational Exposure/adverse effects , Tungsten/adverse effects , Tungsten/toxicity , Adrenal Cortex Hormones/therapeutic use , Biopsy , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/pathology , Lung/diagnostic imaging , Lung/pathology , Occupational Diseases/drug therapy , Occupational Diseases/pathology , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Based in the premise that Ti-6Al-4V orthodontic mini-implants can release metal ions into the body fluids, this research is aimed assess the cytotoxic effect of orthodontic mini-implant on L929 fibroblast cells. MATERIAL AND METHODS: Eighteen orthodontic mini-implants made of Ti-6Al-4V alloy were divided into 6 groups: 1 (golden colour, SIN), 2 (silver colour, SIN), 3 (Neodent), 4 (INP), 5 (Mondeal), and 6 (Titanium Fix). The mini-implants were immersed into Eagles minimum essential medium for 24 hours, where supernatant removal and contact with L929 fibroblasts were performed. Cytotoxicity was evaluated in four different periods of time: 24, 48, 72, and 168 hours. After being in contact with the mini-implants immersed, the cells were incubated for further 24 hours and then 100 ml of 0.01% neutral-red staining solution were added. After this period of time, they were fixed and a spectrophotometer was used for counting the viable cells. RESULTS: After the 24 hours period, statistical differences were found by comparing groups 1 and 2 to groups 3,4,5, and C+ (p < 0.05). After the 48 hours period, groups 1 and 2 were shown to be statistically different in relation to groups 3, 4, and C+. After the 72 hours period, statistical differences were found only in group 1 compared to groups 4, 5, 6, CC, and C+ (p < 0.05). After 7 days, no statistical differences were found between the mini-implants. CONCLUSION: Although mini-implants are made of the same alloy, there are differences in their cytotoxicity because of the different concentrations of chemical elements used for manufacturing them.
OBJETIVO: Baseando-se na premissa de que mini-implantes ortodônticos podem liberar íons metálicos nos fluidos corporais, pesquisou-se o efeito citotóxico de mini-implantes ortodônticos em fibroblastos L929. MATERIAL E MÉTODO: Dezoito mini-implantes ortodônticos confeccionados em liga Ti-6Al-4V foram divididos em seis grupos: 1 (dourados, SIN), 2 (prateados SIN), 3 (Neodent), 4 (INP), 5 (Mondeal) e 6 (Titanium Fix). Os mini-implantes foram imersos em meio mínimo essencial Eagle por 24 horas, onde efetuou-se remoção do supernadante e contato com fibroblastos L929. A citotoxicidade foi avaliada em 4 diferentes tempos: 24, 48, 72 e 168 horas. Após contato com os mini-implantes imersos, as células foram incubadas por mais 24 horas; então, 100 ml de solução corante neutra-vermelha foram adicionados. Após, foram fixadas e um espectrofotômetro foi usado para contar as células viáveis. RESULTADOS: Após o período de 23 horas, compararam-se os grupos 1 e 2 aos grupos 3, 4, 5 e C+. Após 72 horas, diferenças estatísticas foram encontradas somente no grupo 1, comparado aos grupos 4, 5, 6, CC e C+ (p < 0,05). Após 7 dias, não foram encontradas diferenças estatisticamente significantes entre os diversos mini-implantes.
Subject(s)
Humans , Animals , Rats , Alloys/toxicity , Dental Materials/toxicity , Orthodontic Anchorage Procedures/methods , Titanium/chemistry , Titanium/toxicity , Analysis of Variance , Cell Survival , Time FactorsABSTRACT
A pneumoconiose por metal duro, descrita pela primeira vez em 1964, é uma doença difusa causada por inalação de partículas de cobalto. A doença pode se manifestar de três formas diferentes: asma ocupacional, doença intersticial e alveolite alérgica. Relata-se um caso de um jovem do sexo masculino, afiador de ferramentas, com quadro de tosse seca e dispnéia progressiva há um ano, apresentando-se à admissão com pneumotórax espontâneo bilateral. O diagnóstico foi confirmado através de biópsia pulmonar a céu aberto.
Hard metal pneumoconiosis, first described in 1964, is a diffuse disease caused by the inhalation of cobalt particles. The disease can manifest as occupational asthma, interstitial disease or allergic alveolitis. We report the case of a young male, working as a tool sharpener, who presented with dry cough and progressive dyspnea for one year, as well as with spontaneous bilateral pneumothorax at admission. The diagnosis was confirmed by open lung biopsy.
Subject(s)
Adult , Humans , Male , Alloys/toxicity , Cobalt/toxicity , Occupational Exposure , Pneumoconiosis/pathology , Pneumothorax/etiology , Tungsten/toxicity , Pneumoconiosis/complicationsABSTRACT
A doença pulmonar por metal duro é uma pneumonia intersticial por células gigantes relacionada com a exposição à poeira composta por metais duros. Neste artigo é relatado o caso de um profissional da indústria petrolífera, diagnosticado com doença pulmonar por metal duro com base na documentação clínica, radiológica, funcional pulmonar e anatomopatológica.
Hard metal lung disease, which manifests as giant cell interstitial pneumonia, is caused by exposure to hard metal dust. We report the case of an oil industry worker diagnosed with hard metal lung disease. The diagnosis was based on the clinical, radiological and anatomopathological analysis, as well as on pulmonary function testing.
Subject(s)
Humans , Male , Middle Aged , Alloys/toxicity , Cobalt/toxicity , Lung Diseases, Interstitial/pathology , Occupational Diseases/pathology , Occupational Exposure/adverse effects , Tungsten/toxicity , Dust , Giant Cells, Foreign-Body/pathology , Lung Diseases, Interstitial/etiology , Occupational Diseases/etiologyABSTRACT
Cell culture system has been used to evaluate alloy cytotoxicity under different environments, testing the extracts, but the effect of temperature variation on the cytotoxicity of dental alloys has not been analyzed. OBJECTIVE: The aim of the present study was to investigate if temperature variation could affect dental alloy cytotoxicity, testing alloy extracts in an epithelial cell culture system. MATERIAL AND METHODS: Discs of Ni-Cr, Co-Cr-Mo, Ni-Cr-Ti, Ti-6Al-4V and commercially pure titanium (cp Ti) were cast by arc melting, under argon atmosphere, injected by vacuum-pressure. Discs were immersed in artificial saliva and subjected to different temperatures: 37ºC and thermocycling (37ºC/5ºC/37ºC/55ºC/37ºC). After thermocycling, extracts were put in a subconfluent culture during 6 h, and the number of cells and their viability were used to evaluate cytotoxicity in these temperatures. For each alloy, data from temperature conditions were compared by Student's t-test (α=0.05). RESULTS: The cytotoxicity tests with alloy/metal extracts showed that Ni-Cr, Co-Cr-Mo, Ti-6Al-4V and cp Ti extracts (p>0.05) did not affect cell number or cell viability, while Ni-Cr-Ti (p<0.05) extract decreased cell number and viability when the alloy was subjected to thermocycling. CONCLUSION: Within the limitations of the present study, the Ni-Cr-Ti alloy had cell number and viability decreased when subjected to temperature variation, while the other alloys/metal extracts did not show these results.