antimonyosis
Introduction
Introduction to stagnation Endimonypneumoconiosis or sputum pneumoconiosis is a lung lesion caused by long-term inhalation of metal strontium and strontium oxide dust during production. High concentrations of metal strontium and its oxides can cause irritating effects, causing conjunctivitis, keratitis, rhinitis, pharyngitis. , bronchitis and chemical pneumonia, and damage to the heart, liver, nervous system and other organs, it is believed that long-term inhalation of more than 10mg / m3 of sputum concentration can occur interstitial pneumonia and focal pulmonary fibrosis. basic knowledge The proportion of illness: 0.0001%-0.0005% (this disease is more common in the metallurgical industry workers) Susceptible people: no specific population Mode of infection: non-infectious Complications: emphysema
Cause
Cause of stagnation
(1) Causes of the disease
Pneumoconiosis is a lung disease caused by long-term inhalation of metal strontium and strontium oxide dust during the production process. In the industry, bismuth is mainly used to make alloys. Oxides can be used as pigments in enamel, ceramics, paint and rubber industries. Especially in the smelting, refining and alloy production process of bismuth, a large amount of smog can be generated.
(two) pathogenesis
The role of pneumoconiosis is different. Karajovic (1957) first reported that 31 people were exposed to sputum dust in a smelting plant in Yugoslavia. Many scholars have reported nearly 100 cases of pneumoconiosis, Bouffont ( 1987) Two cases of lung biopsy specimens diagnosed as septicosis were found to have fibrosis around the dust chamber. The reserves of cockroaches in China are abundant. In the 1960s and 1970s, more than 300 cases were reported in Guangxi, Guizhou and Hunan. Pneumoconiosis, and a more in-depth study of the biological effects of cockroaches, in 1983, Chinese scholars believe that the impact of dust on the lungs is more serious than tin dust, can cause acute or chronic interstitial pneumonia.
There are few pathological data of pneumoconiosis. In 1967, Mecallum reported that a pathological examination of a refining worker who died of lung cancer found alveolar cavities, alveolar septum and large blood vessels around the small blood vessels and dusty macrophage reaction, no fibrosis. In China, the pathological changes of four sputum workers who had not diagnosed pneumoconiosis before birth were chronic bronchitis, bullous emphysema, peribronchial and alveolar septal fibrosis, hilar lymph node dust, and several scholars in China in 1984. Repeated intratracheal injection of sputum into the rats, 50mg/each, ligament fibers without collagen fibers in the lung nodules 3 months after the second dusting, 6 months after the fourth dusting Collagen fibers appeared in the section, but by 9 months, the dusty lesions decreased, and the lesions decreased or disappeared, and most of the dust in the lungs was removed.
Prevention
Prevention of stagnation
Prevention is first of all to reduce the dust of the working environment, strengthen publicity and education, formulate a health cleaning system, and achieve civilized production. Pre-employment and regular physical examinations, regular chest radiographs, and regular follow-up for those who have been out of dust. For those with upper respiratory tract disease, bronchopulmonary disease, especially those with tuberculosis and cardiovascular disease, they should not engage in silica dust. Strengthen personal protection, pay attention to personal hygiene, carry out physical exercise, pay attention to nutrition and so on.
Complication
Complications of stagnation Complications emphysema
Combined emphysema, combined with infection is common.
Symptom
Symptoms of stagnation syndrome Common symptoms Shortness of breath, chest tightness, lack of appetite, chest pain
The symptoms of pneumoconiosis patients are generally mild, and there are no obvious signs, mainly cough, cough, chest pain, chest tightness, shortness of breath, etc. Some workers may have fatigue, loss of appetite, spastic dermatitis, etc., lung ventilation function has decreased, no Diffusion damage.
Examine
Examination of stagnation
Increased white blood cells in patients with bacterial infection.
Chest X-ray performance can be divided into three phases.
1. Initial stage of morphological change: There are irregular shadows with high density and circular shadows with low density in the lung field.
2. Spotting period: Both lungs are 2~4mm high in density, sharply spotted shadows on the edges, and high density of hilar shadows, similar to metal block shadows.
3. Lung gate metal block shadow formation period: There are various forms around the first level of the lungs of the hilar, and the block shadows with high density along the bronchus are the deposition of tin in the bronchi and lung lymph nodes. Pulmonary function tests mainly showed that the maximum ventilation and the first second time were significantly lower than normal.
Diagnosis
Diagnosis and diagnosis of stagnation
According to the history of contact with the dust, X-ray findings and clinical symptoms, it is generally not difficult to make a diagnosis of stagnation (or pneumoconiosis), but China has not classified the pneumoconiosis as an occupational disease.
Differential diagnosis
1. Acute miliary tuberculosis: no occupational exposure history, more common in children. It is part of acute hematogenous disseminated tuberculosis, with acute onset, severe poisoning symptoms, sometimes associated with tuberculous meningitis and tuberculosis in other areas. X-ray chest radiograph shows uniform distribution of double lung fields, uniform density and size, edge Clear miliary shadows, anti-tuberculosis treatment is better. The clinical manifestations of silicosis have no symptoms of systemic poisoning, and the small nodule shadow has a higher density on the chest radiograph and a history of occupational exposure.
2. Hemosiderinosis: more common in rheumatic heart disease mitral stenosis, a history of left heart failure, no occupational history. It is characterized by repeated episodes of hemoptysis, shortness of breath and unexplained ischemic anemia. It has signs such as clubbing (toe) and spleen. Chest radiographs can be seen in varying sizes, uneven distribution, a certain number of fine nodule shadows, high density, with a small number of cord-like shadows, and extensive pulmonary interstitial fibrosis in the late stage. Macrophages that phagocytose hemosiderin can be found in sputum and bronchoalveolar lavage fluids, often with signs of heart disease.
3. Sarcoidosis: a granulomatous disease of unexplained, non-caseous epithelial cells. Can invade many organs of the body, but mostly in the lungs and intrathoracic lymph nodes. There were no obvious symptoms or signs in the early stage. The stage II nodular disease had hilar lymphadenopathy with pulmonary infiltration. The lung lesions were widely distributed symmetrically on both sides, showing nodular, punctate or flocculent shadows. Stage III sarcoidosis showed fibrotic changes in the lungs, while hilar lymph nodes disappeared. There are often granuloma shadows in the fibrotic shadows. In a wide range of lesions, lung shrinkage, diaphragmatic elevation, and hilar elevation may occur. The diagnosis of sarcoidosis is based on chest radiograph, chest CT changes, histological biopsy, and positive Kvein test. Patients may be accompanied by other organ lesions, serum angiotensin-converting enzyme activity is increased, tuberculin skin test negative or weak positive can be used as a reference indicator.
4. Alveolar microlithiasis: There is often a family history, and there is no history of dust exposure. The X-ray chest radiographs are covered with fine sand-like shadows, the size is about 1mm, the edges are clear, the lungs are more common inside, the lungs are not big, the lung texture is not changed, and the disease progresses slowly.
5. Bronchioloalveolar carcinoma: often cough more white foam sputum, sometimes hemoptysis, see cancer cells in the sputum.
