Las enfermedades pulmonares intersticiales difusas en el ámbito laboral / Diffuse interstitial lung diseasesin the workplace

La enfermedad pulmonar intersticial difusa (EPID) se refiere a un grupo heterogéneo de condiciones pulmonares caracterizadas clínicamente por disnea y empeoramiento de la función pulmonar y radiológicamente por una infiltración intersticial evidente que afecta predominantemente las bases pulmonares. No existe una clasificación estándar o internacional sobre la misma, pero muchos autores tienden a clasificarla en uno de los dos siguientes grupos: los de causa conocida, secundarios a enfermedades de causa desconocida y los idiopáticos (que son 7 identidades clínicas claramente descritas). Como se ha visto, una de las causas dilucidadas de esta condición se asocia directamente con materiales irritantes como agentes y sustancias químicas tales como: el asbesto, silicón, y carbón utilizadas comúnmente en distintos ámbitos laborales, por lo que aquellas personas que se vieran continuamente expuestas a estos tienen un riesgo aumentado de desarrollar dicha patología. Las EPID son alteraciones que, a pesar de medidas, precauciones y regulaciones impuestas en distintas organizaciones de la promoción de la salud continúan siendo una de las principales enfermedades adquiridas en ámbitos laborales y además es de suma importancia clínica dado que estos pacientes pueden tener un rápido deterioro de función pulmonar. Este factor, sumado al hecho que su fisiopatología, incidencia e historia natural no han logrado ser suficientemente esclarecidos, constituyen la base que soporta la revisión que se ha propuesto realizar. Finalmente, es importante destacar que puede existir un largo tiempo entre la exposición a los agentes causales de la enfermedad y el inicio de las manifestaciones clínicas, por lo que se han documentado pacientes con estos diagnósticos aún años o hasta décadas después de que ocurrió la exposición, por lo que una adecuada regulación (por ejemplo, vacaciones profilácticas) y prevención a la misma podría evitar las consecuencias...

Diffuse interstitial lung disease (ILD) refers to a heterogeneous group of lung conditions characterized clinically by dyspnea, worsening of lung function and radiologically by an evident interstitial infiltration predominantly affecting the lung bases. There is no standard classification on it, but many authors tend to separate it into one of two groups: those with known cause, secondary to diseases of unknown cause and those idiopathic (with 7 clinical identities described). It is known that the condition is also directly associated with irritating materials, agents and chemicals such as asbestos, silicon, and carbon commonly used in industrial fields, so that people continouslly working with these have an increased risk of developing this disease. Despite measures, precautions and regulations imposed by various organizations of health promotion, ILD remains one of the major diseases acquired in work environments and it is of great clinical importance since these patients may have a rapid impaired lung function. This factor, besides the fact that its pathophysiology , incidence and natural history have failed to be sufficiently understood , constitute the base supporting the following review. Finally, we must know that there may be a long time between exposure to the causative agents of disease and the onset of clinical manifestations so that patients could present the diagnoses years or even decades after exposure. Hence derives the importance of proper regulations (eg, prophylactic holidays) and prevention to avoid the possible consequences...

Pneumoconioses.

Occupational lung diseases are caused or made worse by exposure to harmful substances in the work-place. “Pneumoconiosis” is the term used for the diseases associated with inhalation of mineral dusts. While many of these broadspectrum substances may be encountered in the general environment, many occur in the work-place for greater amounts as a result of industrial processes; therefore, a range of lung reactions may occur as a result of work-place exposure. Physicians in metropolitan cities are likely to encounter pneumoconiosis for two reasons: (i) patients coming to seek medical help from geographic areas where pneumoconiosis is common, and (ii) pneumoconiosis caused by unregulated small-scale industries that are housed in poorly ventilated sheds within the city. A sound knowledge about the various pneumoconioses and a high index of suspicion are necessary in order to make a diagnosis. Identifying the disease is important not only for treatment of the individual case but also to recognise and prevent similar disease in co-workers.

Inhalational lung disease

Inhaiational lung diseases are among the most important occupational diseases. Pneumo-coniosis refers to a group of lung diseases result from inhalation of usually inorganic dusts such as silicon dioxide, asbestos, coal, etc., and their deposition in the lungs. The resultant pulmonary disorders depend on the susceptibility of lungs; size, concentration, solubility and fibrogenic properties of the inhaled particles; and duration of exposure. Radiographic manifestations of pneumoconiosis become apparent several years after exposure to the particles. However, for certain types of dusts, e.g., silicone dioxide crystal and beryllium, heavy exposure within a short period can cause an acute disease. Pulmonary involvement in asbestosis is usually in the lower lobes. On the contrary, in silicosis and coal worker pneumoconiosis, the upper lobes are involved predominantly. For imaging evaluation of pneumoconiosis, high-resolution computed tomography [CT] is superior to conventional chest x-ray. Magnetic resonance imaging [MRI] and positron emission tomography [PET] scan are helpful in those with suspected tumoral lesions. In this essay, we reviewed the imaging aspects of inhala-tional lung disease

An Outbreak of Acute Beryllium Disease in a Compound Metal Alloy Factory / 대한산업의학회지

OBJECTIVES: We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease. METHODS: The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography. RESULTS: The air concentrations of beryllium ranged from 0.42 microgram/m3 to 112.3 microgram/m3, and the mean concentration of urinary beryllium were 1.53+/-0.79 microgram/g of creatinine in the molding workers, 1.41+/- 0.50 microgram/g of creatinine in the casting workers, and 1.16+/-0.53 microgram/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (p=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (p=0.012). The time of employment for all patients was prior to December 1st, 2002. CONCLUSIONS: Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

An Outbreak of Acute Beryllium Disease in a Compound Metal Alloy Factory / 대한산업의학회지

OBJECTIVES: We conducted an epidemiological survey to inquire into an outbreak of acute pneumonitis after two reported cases of interstitial lung disease. METHODS: The study subjects were 45 workers from a compound metal alloy factory. We reviewed the factory's industrial hygiene data along with the results of a special health examination, including pulmonary function tests, simple chest X-rays, and high resolution computed tomography. RESULTS: The air concentrations of beryllium ranged from 0.42 microgram/m3 to 112.3 microgram/m3, and the mean concentration of urinary beryllium were 1.53+/-0.79 microgram/g of creatinine in the molding workers, 1.41+/- 0.50 microgram/g of creatinine in the casting workers, and 1.16+/-0.53 microgram/g of creatinine in the sorting workers. The rates for cough (p=0.054), dyspnea (p=0.030), and the use of medical services (p=0.018) were higher in the molding workers than in the non-molding workers. The incidence rate of acute interstitial lung disease was higher for the molding process (32.0%) than for the non-molding process (5.0%) (p=0.012). The time of employment for all patients was prior to December 1st, 2002. CONCLUSIONS: Since most of the patients were molding workers, and all of the patients had worked without a ventilation system, this outbreak of acute interstitial lung disease was regarded as acute beryllium disease. Although the direct cause of the epidemic was the beryllium fumes, the fundamental cause was improper control of the work environment. Therefore, the means for preventing avoidable epidemics of occupational diseases are discussed.

A saúde do trabalhador o contato com os metais / The health worker's contact with the metal

A sociedade humana atual, altamente industrializada, utiliza artigos obtidos através da manipulação de diversos metais. O contato com esses metais pode acarretar agravos à saúde. O níquel é utilizado especialmente na matalurgia e galvanização. A intoxicação pelos compostos de níquel desencadeia quadros variados incluindo demartite, carcinomas, pneumonia e necrose hepática. O tratamento baseia-se em medidas de suporte e o uso de agentes quelantes, como o dimercaprol e o CaEDTA. O alumínio constitui o segundo metal em importância para o Homem. A exposição crônica pode desencadear patologias pulmonares. O tratamento inclui o uso de quelantes, sendo a deferoxamina o mais indicado. O berílio é empregado em dispositivos tais como instrumentos de precisão, ordenadores, ferramentas não cortantes, reatores nucleares e isolantes térmicos. A principal manifestação da beriliose é a doença granulomatosa sistêmica, acometendo pulmões, medula óssea, fígdo e linfonodos. A doença aguda requer tratamento sintomático com excelente prognóstico. Quanto à forma crônica, emprega-se a corticoterapia. O ferro é o metal mais importante e o mais empregado atualmente. Extremamente suscetível à corrosão é associado a diversos elementos permitindo o seu uso em várias ligas com múltiplas aplicações. As patologias pulmonares são as principais consequências da exposição ao ferro, como a siderose e o câncer pulmonar. O tratamento pode incluir cirurgias, radio e quimioterapia, medicamentos e medidas de suporte. O agente quelante de escolha é a deferoxamina. A principal aplicação do cobre atualmente baseia-se na condução de eletricidade, embora também seja usado em venenos agrícolas, na confecção de mdalhas e troféus. A exposção ao cobre eleva o risco do desenvolvimento de neoplasias pulmonars, além de hepatotoxicidade, disfunçõ real e convulsões. O tratamento engloba o uso de agentes quelantes, medidas de suporte e especíicas (cirurgia, embolização, quimioterapia). O cromo encontra-se empregado em ligas metálias, pigmentos, tratamento do couro, proteção contra a oorrosão. Os efeitos tóxicos relacionados abrangem manifestações cutâneas, asma, câcer de pulmão, insuficiência renal e inflamação de mucosas. O tratamento envove o uso de corticóides, suporte ventilatório, diálise, terapia farmacológica, cirurgia, radio e quimioterapia. O cádmio é utilizado em pigmentos para tintas, galvanização, cinescópios e baterias recarregáveis. A exposição ao cádmio afeta principalmente os rins ,ossos e pulmões. O tratamento consiste em correção dos distúrbios metabólicos e terapia de suporte. O manganês é componente de várias ligas metálicas importantes, corantes, fertilizantes, pilhas secas. A inoxicação pode acarretar bronquite crônica, pneumonia, parkinsonismo e danos hepáticos. O CaNa2-EDTA é o quelante de escolha. O zinco é usadocomo pigmento, estabilizador de borrachas e plásticos, medicamento, baterias, cinescópios, galvanização e em ligas metálicas. As manifestações clínicas da intoxicação pelo zinco incluem a febre dos fmos metálicos, dor abdominal, vômitos, úlcera gástrica, anemia, fibrose pulmonar. O tratamento inclui medidas de suporte e o uso do quelante CaNa2-EDTA. No Regulamento da Previdência Social estes aspectos são parcialmente abrangidos,conferindo importância à necessidade de se preservar a saúde dos trabalhadores expostos a esses riscos à saúde. Eles podemser minimizados através de medidas integadas e coordenads envolvendo entidades relacionadas à saúde, meio ambiente, previdência e ao trabalho.

A Case of Idiopathic Granulomatous Pancreatitis / 대한소화기내시경학회지

Granulomatous pancreatitis is a rare disorder and recognized rarely during life or non-operatively. Noncaseating granulomas in the pancreas, histologically indistinguishable from sarcoidosis, can be seen in a variety of diseases such as tuberculosis, fungal infection, berylliosis, Hodgkin's disease, non-Hodgkin's lymphoma and Crohn's disease. Therefore, as with other granulomatous diseases, a tissue biopsy is essential for the diagnosis. Its clinical presentation is often similar to pancreatic cancer, with common presenting symptoms including abdominal pain, weight loss, jaundice, and anorexia. We report a case of idiopathic granulomatous pancreatitis in a 56-year-old women whose clinical and radiographic findings were suggestive of pancreatic cancer.

Comparative effectiveness of Tiron (4,5-dihydroxy benzene 1,3-disulphonic acid disodium salt) and CaNa2EDTA with time after beryllium poisoning.

The efficacy of two chelating agents (Tiron and calcium disodium EDTA) in the treatment of beryllium induced blood biochemistry and hepatic histopathological alteration was investigated at different duration in female albino rats. Single administration of beryllium nitrate at a dose of 50 mg/kg (im) showed significant decrease in haemoglobin percentage, blood sugar level, protein contents and activity of alkaline phosphatase. On the contrary significant elevation was found in the activity of transaminases (AST and ALT). Tiron was found to be more effective than CaNa2EDTA in reducing the beryllium induced haematological alterations and histopathological lesions in liver. These findings were further confirmed by AAS thus, in which reduced beryllium body burden was seen in liver and blood with Tiron.

Chronic berylliosis of the lung: report of a case.

We report a case of chronic berylliosis of the lung in a patient who was exposed to copper beryllium alloy, which was mistaken and being treated as miliary tuberculosis. The relevant literature is reviewed.

Efeitos da poluiçäo, tabagismo e poeiras minerais sobre o aparelho respiratório / Effects of pollution, smoking and mineral dusts on respiratory system

Doenças pulmonares intersticiais difusas e doenças crônicas das vias aéreas podem ser causadas por poeiras minerais, poluiçäo e fumo e säo discutidas neste trabalho. Doenças pulmonares ocupacionais e ambientais constituem assunto amplo e complexo, impossível de ser abordado em sua íntegra em um simples trabalho, de modo que daremos destaque a conceitos básicos envolvendo mecanismos de defesa pulmonar e um pouco da experiência prática na rotina diagnóstica. Nos pulmöes, doenças intersticiais ocupacionais säo o resultado final da composiçäo de lesöes focais. Esses sítios de lesöes focais traduzem a resposta do tecido pulmonar alveolado e condutor ao fumo, particulas ou minerais. Com a injúria pulmonar crescente e repetitiva, inflamaçäo e fibrose determinam distorçäo e remodelaçäo pulmonar, finalmente conduzindo a alteraçöes da fisiologia respiratória. Nos alvéolos, o macrófago pulmonar parece ter um papel central no desenrolar desses eventos, agindo tanto como fagócito incorporador de particulas quanto como mediador liberador de poderosas substâncias biológicas modificadoras da funçäo de outras células, como neutrófilos e fibroblastos