kar atmas :

2011 Kongre katlm destei2010 ERS kurs katlm destei

OLGU SUNUMU

DR.PEK ZMEN S. B. SREYYAPAA GS HASTALIKLARI VE GS CERRAHS ETM VE ARATIRMA HASTANES STANBUL

26 years old Male

Complaints : 5 month history of..

Cough Dyspnea Weihgt loss Fatigue

Fever

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

Past history:

Smoking : 10 pack years

Physical examination:

BP: 120/80mmHg Pulse :80/min RR:18/min Fever: 38,8 C

Normal breathing sounds No Organomegaly

Chest x-ray at hospitalisation

Pneumonia Tuberculosis Interstitial lung disease ?

Old lung graphy !

Chest x-ray 8 months ago

Denim sandblasting for 7 yearsOccupational history

Thorax CT

Thorax CT

Toraks CT de mediastinal LAPMedialstinal LAP in thorax CT

2 cultures were ( + )M.tuberculosis

Before treatmentAfter treatment

SILICON DIOXIDE(SILICA)

Crystalline form (quartz) Cristoballite Trydimite

SILICOSIS

The history of silicosis goes back to very ancient times , even silicotic nodules are found in Egyptian mummies

Silicon dioxide or silica, is the minerals most 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

Sources of silica exposure Mining and millingConstruction

Stone workingCeramics, craft work

Sand blasting

Glass manufacture

Dental technicianJewellery

AgricultureNon-occupational

Sandblasting

mechanism for silicosisTissue damageand fibrosisalveolar macrophagesMorphagocytosistal Alveolar space

polarizing microscopy

Sandblasting

Sandblasting

Beforesandblastinghttp://images.google.com/imgres?imgurl=http://

After sandblastinghttp://images.google.com/imgres?imgurl=http://

Jean fashion !

www.haberortak.comDenim sandblasting !

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

Silicosis According to the formation process of the disease:

Chronic silicosis : approximately 10 years after the start of exposureAccelerated silicosis : intense and short-term (5-10 years) exposureAcut silicosis : intense exposure (a few months-5 years)Int J Tuberc Lung Dis 2007 11(5):474-484

ILOInternational Labour Organization

Parenchymal Abnormalities Parenchymal large opacityA, B, C

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

Large opacities Shape (A,B,C) - size ( diameter 10 mm)

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

2006

2007

2008

2010ILO

Silicosis is often progressive even without further exposure !!! 20062007ARB +2008ARB -2010ARB -

Thanks for :

As.Prof.Dr.Haluk alrDr.Nlfer Kongar

Teekkrler

*5-6 aydr halsizlik, yorgunluk, kuru vasfl ksrk, itahszlk ikayetlerine son 1 haftadr ate ikayeti eklenmi. Verilen antibiyotik tedaviler ile ikayetlerigerilememi

*Mikronodler lezyonlar olan hastann eski akcier grafisinde de lezyonlar mevcut, ayrntl meslek anamnezi alnd****SLKOTK NODL: Alveolar makrofajlar ve silika partiklleri arasnda oluam etkileim sonras kemotaktik faktrler ve inflamtuar mediatrlerin salnm ile ortada silika partikl ve etrafnda sarmal ekilde kollajen ve fibroblastlar oluur****Kot kumlama : kotun andrlp renginin almas ve yumuatlmas iin basnl hava veya buhar verilerek kuma zerine kum partikllerinin pskrtlmesidir.*Maruziyet ne kadar younsa hastalk tablosu o kdar erken dnemde ortaya kar.**