Hard metal lung disease: a case series / Doença pulmonar por metal duro: uma série de casos

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 All patients were withdrawn from exposure and treated with corticosteroid.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.

Fadiga cíclica flexural de instrumentos Hyflex CM e TF Adaptive em diferentes situações experimentais / Flexural cyclic fatigue of instruments Hyflex CM and TF Adaptive in diferente experimental situations

O presente estudo teve como objetivo avaliar a resistência à fadiga cíclica flexural dos instrumentos de níquel- titânio, Hyflex CM (Coltène, EUA) e TF Adaptive (SybronEndo, EUA) em diferentes situações experimentais. Todas as limas que foram selecionadas possuíam conicidade 0,04 e diâmetro de ponta 35. Utilizou-se um dispositivo desenvolvido especificamente para realizar o ensaio flexural dinâmico. Os instrumentos TF Adaptive foram divididos em 3 grupos de acordo com o ângulo de curvatura do ensaio: 45º, 60º e 90º e cada grupo subdividido em 2 subgrupos de acordo com o tipo de movimento: rotação contínua e Adaptive. Cada subgrupo era composto por 15 instrumentos TF Adaptive, totalizando 90 instrumentos. Quinze instrumentos Hyflex CM formavam o grupo 4, no ensaio com ângulo de curvatura 90 graus e rotação contínua. A simulação foi realizada em canais artificiais de aço com ângulo de 45, 60, 90 graus e raio 5m m. O número de ciclos e o tempo em segundos até a fratura foram tabulados e analisados. Entretanto, a fadiga cíclica flexural foi significante maior nos três grupos em movimento Adaptive. E as limas TF Adaptive em seu próprio movimento tiveram maior número de ciclos e tempo até a fratura quando comparadas as Hyflex CM no ensaio de 90 graus. Portanto, conclui-se que o sistema Adaptive (limas TF Adaptive + movimento Adaptive) foi mais seguro à resistência á fadiga flexural, e no ensaio de 90 graus o sistema Adaptive foi mais resistente quando comparado com as limas Hyflex CM no movimento de rotação contínua.

The aim of this work to evaluate the cyclic fatigue resistance flexural the instruments of nickel-titanium, HyFlex CM (Coltène, USA) and TF Adaptive (SybronEndo, USA) in different experimental situations. All files that were selected had 0.04 taper and tip diameter 35. We used a device developed specifically to perform the dynamic flexural test. The TF Adaptive instruments were divided into 3 groups according to the angle of curvature of the test: 45, 60 and 90 and further divided in two subgroups according to the type of movement: continuous rotation and Adaptive. Each group consisted of 15 instruments TF Adaptive totaling 90 instruments. Fifteen HyFlex CM instruments formed the group 4 in the trial of bend angle 90 degrees and continuous rotation. The simulation was performed in artificial steel angled channels 45, 60, 90 degrees and radius 5m m. The number of cycles and the time in seconds until fracture were tabulated and analyzed. However, the cyclical flexural fatigue was significantly greater in the three groups Adaptive motion. And the TF Adaptive files on your own movement had a higher number of cycles and time to fracture when the HyFlex CM compared in 90-degree test. Therefore, it is concluded that the adaptive system (TF Adaptive Motion + Adaptive files) was safer resistance to flexural fatigue, and 90 degrees test Adaptive system is more resistant when compared with the HyFlex files into continuous.

Treatment of Malignant Biliary Obstruction with a PTFE-Covered Self-Expandable Nitinol Stent

OBJECTIVE: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. MATERIALS AND METHODS: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). RESULTS: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. CONCLUSION: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.

Posibles efectos en la salud asociados con la metalurgia precolombina / Possible health effects associated with Pre-Columbian metallurgy

En el Viejo Mundo algunos investigadores piensan que los efectos adversos en la salud relacionados con la exposición a arsénico influyeron para que se cambiara de usar aleaciones de cobre con arsénico a otras menos tóxicas. En este artículo se evalúa esta hipótesis para las tres grandes tradiciones metalúrgicas precolombinas: Andes centrales, área intermedia y occidente mexicano. Los artefactos metálicos revelan que las concentraciones de arsénico en los Andes centrales fueron similares a las del Viejo Mundo (0,5 por ciento a 1 por ciento), en el área intermedia los valores eran muy inferiores, mientras en el occidente mexicano fueron muy superiores (7 por ciento a 25 por ciento). En los Andes centrales se observó inicialmente el uso de bronce arsenical, pero rápidamente se conocieron las aleaciones de cobre-estaño; estas últimas fueron cada vez más preferidas y difundidas por todo el imperio inca. Las evidencias, osteológicas y en objetos artísticos, de amputaciones de los pies entre individuos moches de los Andes centrales apoyan la idea de la presencia de la enfermedad del pie negroentre las poblaciones precolombinas. En conclusión, es posible que los efectos nocivos del arsénico se hayan observado en el Nuevo Mundo, y favorecido el cambio hacia aleaciones menos tóxicas. Se requieren nuevos estudios específicos para verificar esta hipótesis

Inhibiting effect of some dyes on corrosion of aluminum and aluminum-alloys in hydrochloric acid

The inhibiting effect of some dyes [fast blue R.R. salt, fast blue B.B. salt, fuchsine base, crystal violet and rhodamine G 6] on the corrosion of pure aluminum and two types of its alloy [Al-Mg-Mn and Al-Mg] in 0.5M HCI has been studied using potentiodynamic polarization method and open-circuit potential measurement.Comparison of the inhibitive efficiencies of different dyes in 0.5M HCI for pure Al has shown the following order Crystal violet

A presumptive case of lead poisoning in a brass-worker's child.

A one-year-old male child was admitted with the complaints of vomiting and irritability for 4 days, haematemesis and melaena for one day and had generalised tonic convulsions on the day of admission. Examination revealed exaggerated reflexes with group II coma. Blood film showed basophilic shippling. Straight x-ray showed lead lines in the metaphyses of ribs, humerii, scapulae, iliac crests and upper ends of femurs. The boy's father was an employee of brass industry where brass alloys used cotained lead in substantial amount. A presumptive case of lead poisoning (as diagnosed) was treated symptomatically. Chelating agent was called for but the patient left. In the present case the hands of the child were contaminated with lead dust brought home by his father either in person or in clothings. The child used his hands constantly in his mouth to get poisoned by lead.