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ACUTE SILIKOSIS CASES RELATED TO JEAN STONING

ACUTE SILIKOSIS CASES RELATED TO JEAN STONING S.Şahbaz 1 , H. İnönü 1 , S. Öcal 1 , A. Yılmaz 1 , C.Pazarlı 1 , A. Yegınsu 2 , N. Filiz 3 , Z. Seyfikli 1 Gaziosmanpaşa University Faculty of Medicine 1 Pulmonary Medicine 2 , Chest Surgery , 3 Pathology AD. Tokat.

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ACUTE SILIKOSIS CASES RELATED TO JEAN STONING

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  1. ACUTE SILIKOSIS CASES RELATED TO JEAN STONING S.Şahbaz1, H. İnönü1, S. Öcal1, A. Yılmaz1,C.Pazarlı1, A. Yegınsu2, N. Filiz3, Z. Seyfikli1Gaziosmanpaşa UniversityFaculty of Medicine1Pulmonary Medicine2, ChestSurgery ,3Pathology AD. Tokat

  2. Sandblasting involves forcefully projecting a stream of abresive particles onto a surface and mostly silica sand is forced. It has been commonly used in abrading metal or glass. Recently it has been widely and increasingly used in sandblasting of jeans in Türkiye. 7M.Akgün, M. Görgüner, M. Meral, A. Türkyılmaz, F. Erdoğan, L. Sağlam, A. Mirici. Silicosis caused by sandblasting of jeans in Turkey: A report of two concomittant cases. J Occup Health 2005;47: 346-9.

  3. 2 young men worked in jean factory in a short period diagnosed silicosis were presented

  4. CASE 1 • 23 year old man • Symptom: Chest pain, exertion dispnea, hemoptysis • He worked for 8 months in a jean factory 1.5 years ago • Smoking: 10 pct/year

  5. FE; Bilateral decreased breath sounds

  6. Chest X-Ray • Bilateral reticulonodular opacities and minimal apical pneumothorax

  7. HRCT • Subcarinal and hilar lymphadenopathies • Reticulonodular opacities, interlobular septal thickening and minimal apical pneumothorax

  8. Laboratory • WBC: 9500 (Neu: %80.8, Lym: %12,8) • Plt: 339000 • Hgb: 16.7 g/dl • Htc: %45 • Sedim:15 mm/h • CRP: 10.5 mg/L

  9. Arterial Blood Gas Analysis PO2= 7.43 mm/Hg PCO2 =55.9 mm/Hg Saturation= %90.2

  10. Pulmonary Function Test FEV1= 1.32 ml (%33.4) FVC= 1.75 ml (%37.8) FEV1/ FVC= 75.6

  11. Bronchoalveolar lavage ; Lymphocytic Alveolitis • Bronchus mucosa biopsy; Metacromatic globules and amorphe deposition

  12. Lymphadenopathies; Chronic granulomatosis inflammation Particules intracellular and extracellular space

  13. Accelerate (acute ?) silicosis • Periodic examination ? • Decision to leave • Factory control ?

  14. CASE 2 • 25 year old man • Symptom : Dispnea, hemoptysis • He worked for 1.5 years in the same factory 5 years ago. • Pneumothorax 6 months ago

  15. FE • BP:110/60 mm/Hg HR:135/dk • Breath sounds decreased in bilateral hemithorax

  16. Chest X Ray • Bilateral reticulonodular opacities • Minimal apical pneumothorax in the left side

  17. HRCT • Hilar lymphadenopathies • Reticulonodular opacities, interlobular septal thickening

  18. Pulmonary Function Test FEV1= 1.25 ml (%30) FVC= 1.50 ml (%31) FEV1/ FVC= 102

  19. Arterial Blood Gas Analysis PO2= 65 mm/Hg, PCO2 =36.9 mm/Hg Saturation= % 92.5

  20. Symptoms Radiological findings Work history “acute (accelerate ?) silicosis”

  21. Silicosis is a debilitating, sometimes fatal, yet preventable occupational lung disease caused by inhaling respirable crystalline silica dust • No effective treatment for silicosis is available 1CDC. MMWR Weekly Reports Silicosis in Dental Laboratory Technicians Five States, 1994-2000. March 12, 2004/53(09);195-7 2CDC. MMWR Weekly Reports. April 29, 2005/ 54(16); 401-405. Silicosis Mortality, Prevention, and Control-United States, 1968-2002

  22. Rapid progression is seen if silica dust exposure is high. Respiratory failure and chronic cor pulmonale occur in the later stages3. • Two cases worked in jean factory in a short period, but their pulmonary function was impaired. Cases were accepted as “acute (accelerate ?) silicosis” 3SK. Jindal, AN. Aggarwal, D. Gupta. Dust-induced interstitial lung disease in the tropics. Curr Opin Pulm Med. 2001 Sep;7(5):272-7

  23. The diagnosis is easily established if the occupational history is available. Dense nodular opacities on chest roentgenograms • Pulmonary function test is important for eveluating pulmonary functional capacity3. 3SK. Jindal, AN. Aggarwal, D. Gupta. Dust-induced interstitial lung disease in the tropics. Curr Opin Pulm Med. 2001 Sep;7(5):272-7

  24. Silicotic dust particules can be seen in pathological specimen under polarized light.3 • We detected this finding in open lung biopsy specimen 3SK. Jindal, AN. Aggarwal, D. Gupta. Dust-induced interstitial lung disease in the tropics. Curr Opin Pulm Med. 2001 Sep;7(5):272-7

  25. Usage of silica for sandblasting was forbidden 40 years ago in Europe • Mortality and morbidity associated with silicosis and silicosis related tuberculosis. 2,5,6,7 2 CDC. MMWR Weekly Reports. April 29, 2005/ 54(16); 401-5. Silicosis Mortality, Prevention, and Control-United States, 1968-2002 5 E Hnizdo, V Vallyathan. Chronic obstructive pulmonary disease due to occupational exposure to silica dust: a review of epidemiological and pathological evidence. Occup Environ Med2003;60:237–243 6 KD. Rosenman, MJ. Reilly, DJ. Kalinowski, FC. Watt Occupational and environmental lung disease Silicosis in the 1990s Ches1997; 111:779-86) 7 M.Akgün, M. Görgüner, M. Meral, A. Türkyılmaz, F. Erdoğan, L. Sağlam, A. Mirici. Silicosis caused by sandblasting of jeans in Turkey: A report of two concomittant cases. J Occup Health 2005;47: 346-9

  26. Quartz is cheap in our country and it’s generally used for sandblasting in small work places8. • Routine control should be made especially in small work places. 6KD. Rosenman, MJ. Reilly, DJ. Kalinowski, FC. Watt Occupational and environmental lung disease Silicosis in the 1990s CHEST 1997; 111:779-86 7M.Akgün, M. Görgüner, M. Meral, A. Türkyılmaz, F. Erdoğan, L. Sağlam, A. Mirici. Silicosis caused by sandblasting of jeans in Turkey: A report of two concomittant cases. J Occup Health 2005;47: 346-9 8C.Sevinç, AH. Çımrın, M. Manisalı, E. Yalçın, Y. Alkan. Sandblasting under uncontrolled and primitive conditions in Turkey. J Occup Health 2003;45:66-69

  27. Occupational diseases such as silicosis frequently are not recognized or reported by physicians. Health-care providers and employers should be educated on the importance of screening and reporting silicosis to their state-based surveillance systems1 1CDC. MMWR Weekly Reports Silicosis in Dental Laboratory Technicians Five States, 1994-2000. March 12, 2004 /53(09);195-7

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