Document 1g2wZKMgYpmekO1JL2n03Xo5E

FILE NAME: ZW^W^ DATE: DOC#: W^ DOCUMENT DESCRIPTIONWZZ WZ - Norwegian Medicine NORWEGIAN MEDICINE Volume 12. 1q41. IV Helsingfors 1941. Mercators Printing A CASE OF ASBESTOSIS PULMONUM? By E.H. Schiotz In conjunction with the demonstration of the head doctor Schrumpf, I shall mention the case we dealt with in factory supervision. A 61 year old cement mixer visited a doctor in August of 1q3s due to coughing and difficulty in breathing. Tuberculosis bacilla were indicated in his expectorate, and later he reported in sick. An x-ray was taken for the first time in March of 193q_ It. showed disseminated condensations in both lung fields and parenchyrna condensation from a previous date with shrinkage in the upper right. "Silicosis tuberculosis" was first diagnosed by the x-ray technician, but this was ruled out later. The case was announced by the Federal Insurance Office to ,/ the Oslo Labor Committee, and in May 1939 I undertook an inspec- IiJ .IIII tion of the plant where the concerned party had worked for about I 25 years. It turned out that he had not worked with conventional cement, but so-called "acid-resistant cement". This consisted of about 72% ground iron slag, about 15% asbestos and about 13% litharge = PbO. (In this connection, I can mention that in 1q30, lead poisoning was indicated in all the workers in this plant--a total of 5--and one of them died from it). The work with mixing of the aforementioned mixtures went on until 1931, done with hand shoveling with a great deal of dust development, but later it was done in an enclosed machine. 2 I attempted to show asbestos bodies in the patient's expectorate, but with negative results. This is due to an incomplete technique, but it is worthy of note that according to American experiences they were successful in showing asbestos bodies in only half of the patients with x-ray indicated lung asbestosis. In the case of one worker with tuberculosis who for a series of years had been subjected to the inhalation of dust, which among other things contained asbestos, the x-ray technician described a picture which was reminiscent of silico-tuberculosis. In order to bring more clarity into the diagnosis, the picture was sent to Germany's foremost x-ray technician in the area of asbestosis--professor Saupe in Dresden--and his observations of May 20 1~3~ can be summarized as follows: "I asswne that slight asbestos changes exist which with regard to stage classification could belong to stage I, possibly on the boundary of state II. However may I say that the picture is not completely typical. Generally, in the case of asbestosis, one sees somewhat more tightly meshed network designs ''and very fine spots embedded more in a small veil". Whether it includes a slightly silicotic component is difficult to say ... Changes in the upper right top are already too large to pass as asbestosis, and I am assuming that older tubercular changes exist here." At the request of the Insurance Office, the patient was examined by an internist in July 1939 who stated the following: ''He acted weak and flaccid, became short of breath under strain and complained of dyspnea and weakness in the knees. There is 3 cm difference between the deepest breathing in and breathing out. Over both upper parts--especially the right upper part--there 3 is slight muffling with a large number of medium sized, nonresounding blisters, with lengthened respiration sounds. The x-ray diagnosis was silicosis, stage II. On the basis of the physicians' explanation he was declared 100% disabled by theFederal Insurance Office. His condition was found unchanged in a renewed study. His body weight was the same. Moreover he has full compensation. The quantitatively most important component in the acidfast cement is, as mentioned, iron slag, and the question remains if this dust can have played some etiological role in his sickness. The slag contains about 55% silica, but it is bound as silicate in connection with Ca and Al. Free SiO2 is not present. Of the silicates, up to now it has been only asbestos and sericite which has been shown with certainty to cause ~neumokoniosis. How safe Ca-silicate is, is clear from the studies of cement workers. Usually cement contains about 20% silicate, but despite this cement workers never get silicosis. The silica is bound as Ca-silicates. An x-ray study of about 2300 cement workers in the United States unveiled only 8 cases of pneumokoniosis, but all 8 of these workers had earlier been subjected to the inhalation of free Sio2 . As far as iron slag is concerned, mineralogy Professor Tom Barth stresses that these dust particles are much more sharp edged than conventional rock dust, and it is possible that this fact could have played a role. 4 Taking the professional anamnesis and the x-ray description into account, I am assuming here that we are dealing with a new atypical lung asbestosis combined with tuberculosis. To what extent a silicatosis of another origin can be involved cannot be stated here. If silicosis does not exist, he has not been subjected here to the inhalation of free silicic acid. I certify thot tho stdf member who translated the , fl,regoing is thoroughly familiar v,;t'.1 tf..,.,,t)):r,JE.,,),.;t:61/>r' ,ind English languages and that it i~ o lrue and co,nplete translation of the corre_sponrlrn:t.P4ti..2k3.- .:;.:,., document. ' ,. \J/7 \ .~',,,/7 : / iff,' '' l, ... '1/ \ \ ,0 c) Franklin W. Clark, Pre~W~l l.Mnguage ::iervtee oureau, lr.e. Dupont Circle Butlding Wmhington, O.C. 20036 NORDISK I I I MEDICIN BIND 121941IV I ' - ,1 1 /-: : HELSINUFORS 1941. ~IERCATORS TRYCKERI ,.i fl. , r. E. H. ScmoTZ: Et tilfelle av asbestosis pulmonum? ning, vii jq.( anla at cld hrr fonliggrr en noc atypi,k Junge- . . I ~ihlut'.1ing. tH 0.nrlt:gc. SCllllDil'r~ d~- 1'.:011 \tra:'l'.: 11 -~!..al rtsbC'sto,e komhinNt meet t nhcrkulosc. H\'onidt cu ,ihkato,C' a\' :llllll'll oppri111whc kan komrnc p,i talc, ,k,1! \'tcrc ieg fa omt.llc It t11ftllc , 1 h,tr hatt bcf,1t11111,... mrd I f,tlll 1kk-, u,agt. Siliko,l' for<'li!!grr ikkC', han har ikkc \'tHl ut;att for /2. tihynl't. En HI ;ir ga11111wl ,,mlntl>landl'r ,okte. legc augu,t in ,ncling av fri k"l'l,yrl'. 19:.18 pa ;:!runn av ho,lc og tung pmt. Det Llr pan,l tuberk1l-~ ,1 l,asilll'r i hans ekspl'ktorat, c)g han har s111crc vxrt ,ykm,; It. / 11.,1.1. Seu, ''.T~ ~t-IIA:-s_s~,:,;: Sternalpunksjonens betydnlng Hontl-(ruogram hie for,l l:1lt mar, H1:H1; cll'lll' ,btc di"cmi- for den lndrem~d1srnske khnikk. nertc fortctnirq.!cr i IHggc J1111gdcltcr og parc1why111torld1111,g llelt ,iden '.'\r:ntAXX i 1808 IHi\'i,te b111mar(!,{ornn<lringer av ddre dato med ,krumping i ho~ re tnpp. Sum diagno,c nd ll'1tklmi, og E11uuc11 like for i1rhundrcskiftrt offrnt lig- had<lc ronl!-(,nolng,-11 for,l sail ,,ilil,11-t11h,rl.11losc", nHn detll gjonll ,in fargc111do1k. wm har muliggjort et noycn ~tud1u111 ,ar ,troktt o\l'r h!jcn. Tilfrlkt hlt m Hik,trygd,\l'rkl'I nwldl til O,lo .\rhei,1' :iv J,J,:cllt-g.. m,m, morfologi, har klinikrre \'a-rt klar over al ,, 11 11111]('r,11kl'I"' a\' IHnn1argc11 intra Yilam Yilk \':ere a\' 11c11111tl. og j<'g fmdok i 111ai l! 1:H1 l'II 111,pel,,jon :t\ dl'II h<'dnll 111,gl'l ,tor hd~d11111g \l'll l'll nkkc ,~kd11111111er. i-:n rekkt hvori \"C'dl,omn1<1:clc !Jaddc arh,idd l':a :!5 ar. lJd \'i,tt- '"g forskere hnr ,krfor forsokt :'1 finnc mctockr 50111 ku1111c brukc, at han il,kc ha<lcle arlll'id,t med ,:wlig Hmcnt, 111en 111,-d st\ i l..li111kk111, men <le liar allt yart av en ,a i1111gripc111lc natur ]wit syrcfa,l scmcnt. Iknnc hl',tu av l':a 'i:! 0 ~ f111malt jl'rn;lagg, c:a 15 ?~ asbc.,/ og c:u 1:1 ~o ,olwrglod = l'hO. ( I -- i mm1gl tiir,lll rclll' kirurgiske inngnp -al ck ikkc har ku1111<'l Ht almi11111'lig au\ l'llddsr. Det \'ar !orst vcd den11c forbiuclrlsen kun ncvnes at dct i 1():.111 ble p;l\bl blyfor- ARIXKJXS innforelsc av ;ternalpunksjonen i 1920 at <let ble giftnmg hos sumtlige arbci1krc wd dcnnc bedriflen -- i alt 5 skapt cn metodc som ve<l sin cnkclhet muliggjor at bcn- - og en av elem <lode av clel.) .-\rbcidet med blanding av de marg,undcrwkcbcn na inng:\r som ct viktig Jedd i den hcma- nevntc hc,tanddelrr foregikk i11nt1l rn:H Y.hj.a. h:111cl,kuffing tologi,kl' diagnostikk. I de forlopnc .\r har mctoden vist sin under nkelig ,to,ut\'1kling, scnerc har det furcg,1tt i en fruhtlrnrl1d wd en rekkc 1111dcr,okl'l~er som har utdypct var innelukkct ma,kin. J,-g for,nkte :'1 p:"1\'ise a,be,to,l'lcgtmlr i pa,1t11te11s ck,pck- t01at, men med mgati, t rc,ultat. Dettc kan godt ,kyldes ufullkommtn tcl.nikk, Illl'II dd t'r \en! ,i IPr,gc mcrkc ti! at a \'id!'n om b(t1marg~organl'!. l\fin oppga\ c hc1 i dag l'r gi cn oversikt over en de! av dl funn ,om har prakti!,k bl'!ydni11g i den indrc-medisinske klinikh. ettcr a111criL1nsl,.e erfaringer l) kke;, <ll'l i1 pa\'ise a,b,,Lo,elei.(eml'l' han' ho, knapt hulvparttn a\' i11cltvicl1r med rontgcnologi;,k p:hi,t l1111gca,bc,losc. Jf,h t'll tuJ,..rl,ulo, arllt'i1ler "'Ill !.(jcnnom 111 t1rrekke liar v:1:rt uhatl for inn,rnding av ,to,, ,om hi.a. inne!Jold,r a,bcst, bc,krhc,; alh:'1 av rontg.. nolog d I.,illc-dl' ,om m11111,r om ,iliJ.o.tuh11 kt1l11st. For ,,m n1111lg :1 l1ri11gr ,torn 1,1:ir hct i diag11osc'll, lile hillcdl'lll' scndt 11ecl trl Ty,l,lantf, frt111,t, runlgl'110Jog p.'1 a,bc,to"11, nrnradt -- prof,s;or S.\l l'E i Drr,dcn - og lwns uttakl,, av :!U" mai l!J:lu l~dl'r i uldr,ig ;om folgl'r: ,Jeg antar alder foreliggt'r Idle a,IH,Loti,ke ioranclr111~,r ,om nud lun,\11 Iii ;tad11111111kl111g k1111111 ,,an Iii ,t:1d. I. De tmg ('fl Yed stcrnalp11nk,ju11cn kggf'r Vl'kt pa er: 1) aspira,jo11ss111r1 tc-11 21 p1111kt aids makro,kopi,kt> uhr<'ndc :q p1111ld:ttd, l'l'lkrikdo111 -1) ccll,111, nwrfologi. 1kt Jigger i ,al;(11, 11al11r al d<'l hlir C!'llc11r, morfologi ,om ltlir dd \'il,tig,tl', og ,0111 i cld foigenclc \l',rntlig ,k.11 0111tall',. .Jl'g \"ii 1!og !11r,1 ,i 110111 onl om 1k andrc pnnkll'r. I far 111:111 ul fort 111 del pu11k,joner, 111,rkl'r cn snarl at pa,i,11l l'llt' 1Tagl'nr p,\ for,kjl'llig ,is 11w,I Jw11,y11 ti! ,111rrtl'foh-h1 11:tr ,11 a,pi1 ,r 111art!. H,I~ d11i11ge11 a\ de1111c for,kjclkn ka1, I'll< r 1111n trlaring kort ultr~ kke, ,l1k: muligt11s p,1 gr~11,en til ;,lad. I I. J1111dkrlid 111:'1 jeg ,1 al l>illt-- 1111d 11on11al !J111111arg l'l':11:l'l'cr IIIPd lydl'lig '1lll'rl1, dd il,kc l'I' Ji.lt typisk. \"eel a,l,,~tnSt "r l'II mmlig i al111i1111, ,, hypl'rpla-.thk htnmarg reagrrer med nwgct hghl'l 111da llll'l'l' tr:111g111a,I,,dl' 11l'il-tq,11111gl'r 1111d 111<'111 111 ,t 011 c, I iltlt-1' ck,t"I\' ,111l'rl,, m,,l ult.tit wtl einen i(lri11ge11 Schkicr ci11gdllt letc fri11,tc Fledh,11. am1,111ia pc-rnil'io,a og kongl'11itt-he111ulyti,k Jl\111\'idl dd og,:1 inngar ,11 ll"ll ,1hk11t1,k l,1111q11111111l. ,r ll'lt-1'11,. ,amkclrg :1 ,i ... Fura11dr111g,1H i 1!\Tl', ho~re lopp c1 all for !ffO\'c ti! t'1 pa,;c ti! l'II a,bc,to,e, jl'g antnr at dd her P,i foreliuglr l'lclrP tulll'rkulo,e for:,11clringl'r., t,,,gjari11g a\' Hikqr) gcl,Yl'rkd bk pa,icnt,11 1111,krwkt av internbt i juli 1c1:_ig som 1 ;in crkl~~ring hi.a. an[onr: ,ll,111 Yirker S\al, og s]:1pp, blir kit andp11,te11 ,ed an,tr,11gehcr oJ.l kl:tgtr over tungpu~tenhl'l og "akhl't i l,narn,. Jkt l'f :l nn forskjPII nwllom <lypc,tc inn- og ut;i11d111g. Onr !Jl'l-(J!l' t11pp, r - ,:trlig ho} rl' !opp .... cr lid Id t dl llljllllg IIH'<l tallrikc middcbtore, ikkc l..lingen,k hl:tnr. n,pira,jo11,. .:.__ P,, ]vd,n forlcngett. Huntge111\iag11u\l'll var tla ,11,1,flsc. ,tact. I I. grunnlag av kgeerkJ,,,rin;:!C'11 ,r Jun a\' Hik,trygdeHrkrt t'rkhl'ft 100 ~;, it1\',1!i,I. \"td fc>rn~ d 1111ct,r,11kl'I" 1 jun. IU-IO fantrs tiblanden uforandrct, kglm,,1.'klcn var ckn samme. Ifan har fn,mdcles full ,r,tal11i11g. Den krnntilath"t viktig;tc be,ta11ddcl i lkll ,yrda,te ,,eml'nt, t'r som nevnt jl'rn,lagg, og ,p11r,111all'l hlir da om tldte ,towt kan ha ,pill 110111 diulog1,k mill' for h:lll5 ,ykclom, Sluggen innhulder c:a 55 ., ki,el, lllt'll cle111w ,r b1111del sum silikater i forhiluklse 111<'<1 Lt og .\I. I ri Sr<>~ tr il,h I II d11k. A\' ,i11J..,1te11c er clet h1ttil hare a,he,t og ,crie11t ,om llll'd siJ..l.l'rlll't har , i,t stg ,\ ku1111e frl'111!.alk cn p111\1110!.1J111osc. Hvor ufarlig c:a.,i]ik,1t er, frc111g{1r a\' u111Ier,nkthn av s111wntarlw1dcre. \"anhg sc111111t i1111,'holt1 ..r c;a :!O ::, k1,l'l, 111,11 t ii truss h,rior fM ,enwntarl>1id1n al1ln ,i!1!..o,t. l..helt-n tr nernlig huncld sc,111 C:1siilkall'r. l:11 ro11tg,111111<lt-r,11kl'I,, a, c:a :2:!110 ',(111,11tarbeicl,re i l >e Fon1tlt Stall'r a, ,torte l>.11 ,. 8 tilfl'll a, 1nt\'moko11io,r, 111111 ,:1111tl1ge cli"'' 1' arl"1d,n hadtll' l1cll1t!l'rl' \:trt 111':ill for i1111:111cli11g a, fri S1ll 2 Ii\ .1 Jcr11,t,11;1st11 an!(.ir, fre1i11!e, 1r rnmeralog,11 pr ot,"or To~1. BAHTII at <11,,e ,tovparlikln cr ll!l'gl'I llll'r ,l,arpl,.111ll'l ,1111 va11lil-( ,t,11,tov, c,g <ht er 111ul1g at dd tc for hold kan ha ,p!lt \'I'd apl:1,it-r, o:~ nHrkt>li:.( 110],: \ c1l en rekke lymfathkc int illrn,j"lll'I' :1\ h1'nmargc11, cr det praktisk talt 111gcu :1,pira,ju11,.,111rrt l'. :\f1cl hen,y11 Iii punktall'l~ m11kroskopiske 11/seende in11eholdc1 dl'l 11ormnlc punldat fetlpartiklcr ,amt margparliklcr :t\' cu ly, farg1 id forholcl l':a :_,; wd hypl'rpl.1,ic'r trltar innhol<llt av n1argparlik!tr, og h\'is dhst h) perpla,il'r er av erytropoct hk nat ur, a11 I.tr 111argpart il.lc1H oft,. ('11 rod fargc. \'l'tl a1,l,tsil'r "i1111,r 111argparl1ldl'111, 111,n, fl'lli11nholdl'l gjtrm t ii tar. l'1111ktatl'l, cdlrnf.,fum gir l'l tiln:crm<'l uttrykk !or hc11111arg,vi1 k,011111.-tcns intcn,itct. En ngnc'r gjlrnc at dct 11or111alt f11111C, c-:.1 ,ill- 2,iO tu,t'n Ct'lllr pr.mm3 i ,temalpunktatct. lll'!lt 1r dog r1111111Hllgl' grl'llSl'I', ,xrlil-( oppacl, og ka11 ikkc t:i~ ab,olutt, da hlocltilhlan11i11g111 ;,om oftc-st ,pilkr i1111. \'l'd hyperpla,it-r l'r antalltt furnkl, og \"ed ap!a,ier er antallct ll(d,at t. For omtalen av nllenrs mor/o/ngi ~kal ckre, fordcling og uht'l'lldc i dd 1101 mall' punktat kort ,trcifl'' T:tl,c-11 1 l'I' c11 ,a111m,11,tilli11:::i a, funn .1, normal hl'nmarg fra I forfatt,n. O\'l'fl'll"tc111111l'1,t11 11wllom disse l'r llll'!-(l't god, og j,g liar '-tlv , ,ti ,11 n-kkc u1t1kr,okelsrr fumll't tall "'111 li).!1-',l'I' i1111t11ror dhst grcn,er. Fotulwtningen for {1 hc- dommc di'( patologi,kl' ,trrnalpunktat, ,r s<lvfolgclig at <'II ,r hl'll forlrol1g med cll'l normal,. \",,I nmlahn av de palologi,k<' for:u11lri11gC'r ,om hat vi,t ,1g a ha ,tor,( i11lt-n," for klin1kk,n, \ ii dl'l \"tl'fl' h,11,ikhllllssig :'1 tkll' ,lo[ld i -I l1oveda\'s1titl, 11,mlig, for:1ndri11gtr i: l.l\ knpol''-1<'11 J>1 l reliculo-<.1Hlotelialc ,~ ,te111 'JI olllhO(lllt'>C'll E1) Iropo,,tfl. en mile. Yrkc,anamnl'S<'II og ron l !.'.t11h,,l-11\ll,e11l' t.1ll i bl'I 1.11,t - r,1l,n1ioru11: De slor,t, forandringrr frnner tll v,<I 1,uramyeloblas//c11hanirn - ..Jlcr Will dl'n oftl' Yl'cl ct d:'1rlrJ navn