Document mBN4zqb1LpZGaeV9YVq950jaB
FILE NAME State of the Art Literature SAL
DATE 1956 DOC SAL065
DOCUMENT DESCRIPTION Book Excerpt - Occupational Pulmonary Diseases
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HINSHAW Clinical Professor CORWIN
M. D. PH
StanfSotarnfdord UnivUneirvseirstiytySchScohoooll Medicine . .asAS ofS s aee~.
of Medicine
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HENRY GARLAND M. B. B. CH Clinical Professor of Radiology
Stanford University School of Medicine
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Wendy
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634 Illustrations on 288 Figures
SAUNDERS COMPANY
1956 Philadelphia and London
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DIATOMITE FIBROSIS ~~~.
Diatomaceous earth infusorial earthearth consists of the remnants of
cellular
organisms
deposited
in
great great
quantity
during
geologic
times
skeletons
In
of
uni-
consists of silicon dioxide but the commercial material is often
its pure form it
used in the manufacture insulating insulating materials in
refining admixed with clay It is
of dynamite metal polishes
sugar
pottery glazing the making
dentifrices and for
stances It is often altered paper paint
the filtration of many sub
ash Considerable
during commercial preparation by heat in the presence of sod
form and when it aims ounts of dust may be created when the material is in a finely divided -
elaborate
transported by blowers Industry has found it necessary to provide
protective.equipment to insure the safety of workmen
;
. Diatomaceous earth is capable of producing diffuse pulmonary fibrosis The fibrous
tissue is not necessarily formed into nodules as in other types of silicosis Linear
first
fine
but
subsequently
coarse
and
massive
may
develop
within
year
or
two
strands
if
a
is excessive Others have worked in the material for many years without
expos evident
disease Dyspnea may be severe and some
of bullous
any
pai-
monary
cases
emphysema have
veloped spontaneous pneumothorax similar to that observed in bauxite disease
Fibrosis associated with diatomaceous earth inhalation probably has an unfavorable
effect upon ruberculous infection similar to that noted for miners silicosis The record *:
not entirely clear on this point however The complication of right heart strain and failure
may
occur
very
severe
cases
of diatomite
"
fibrosis
;
have The roentgenographic findings variable not been well classified in relation
duration to the type of material inhaled and the
and
intensity
of
exposure
Often
there
is
a
mere accentuation of the vascular markings but in severe cases massive linear fibrosis with
or without nodulatioins observed Conglomeration of shadows probably indicates
ciated infection 2
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ass
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7
." GRAPHITE FIBROSIS
but often including Graphite is crystallized carbon
contains considerable amounts of other mineral
including as much as % dioxide Different opinions have been expressed as to the
graphite pathogenicity of
some holding it to be harmless if silica is absent while other
believe that graphite is capable of causing disabling pulmonary fibrosis.10
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PNEUMOCONTOSIS DUE SILICATES
. Silicates are among the most abundant components of the earth's surface in hundreds of different compounds crystalline forms and combinations They occ
silicates
nonpathogenie most silicates are
nonpathogenie
but there are a few notable
exceptions
exceptions
When inhaled
Asbestosis .
7 aoe.
.
_-
Asbestos hydrated magnesium silicate is useful on account of its resistance >:
industrial lies heat and its insulating propertiesproperties Its great
value
in the fact that it is !.
fibrous mineral fibers being as long as six inches
be
a
fabrics
Asbestos
textiles
were
used
by
the
Egyptians
and
can Romans for
woven into fireprost
wicks and as cremation attire
such purposes as lamp lamp
.
A good quality of asbestos is that known as chrysolite and most of that used in the United States is derived from deposits in QuebecQuebec and more recently Vermont
Harding H.
and G. B. Oliver Brit ) Indust Med 6:91 1949 and L. Dunner and
Bagnall Brit J. Indust Med 100 1950 offer evidence that
D. J.
Brit J. Indust Med 7:42 1950 emphasized the
graphite is pathogenic L. Parmiggiani ,
Indust Med and Surg 483 1949 concluded importance importance of the silica in graphite C. P. McCord
o that disability from graphite had not been proved
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Chapter 40. OcCUPATIONAL PULMONARY DISEASES
667
where asbestos valve Asbestos is used as an insulator against heat and cold as a fireproofing material and as
asbestos products in the building industry It is also used extensively for
packings brake linings clutch facings etc. Asbestos may be mixed with other pathogenic
dusts especially diatomaceous earth Exposure occurs in industrial plants
products are fabricated and among those who install insulating materials The spinning and weaving of asbestos in combination with other textiles also results in
exposure
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Figure 288. Circumscribed Density in Left Upper Lobe
in Toe a. rjensr Male age 70 with intermittent left
,
-
=
lower chest pain for 2 months Has
a worked in firm handling asbestos for 46
fhe we
eet s =Ppt ee years No cough or hemoptysis Exer -- rcog
3
Ch
5
eT eee t
p wok, NS tional dyspnes for 3 years Chest ray
ve < B density and
show
with
3
fairly
cm
discrete
in deft
poets YG upper lobe with fairlyfairly discrete
margins .
-
one
A
margins Vel BES Ae er Bronchoscopy and cytology negative _
Left upper lobectomy disclosed a firm = which
section
Oras nares ex mass
which
on
section
showed
consider
consider
es a 4 e able scarring and numerous asbestos -
Fora fibers There was
oscopic oscopic oscopic ioe. evi- dence
of tumor
oscopic
C shot
e
5
eS.
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aeoe
a =
a
a
ert .
3S
rt
2078 Ya
SP We
ano By.
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7
i
ta
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Le
asbestos fibers in the frozen section
This asbestos
Fre
granuloma or as-
*t
~
7
PO Ht besioma is an uncommon form of pul-
Parra monary asbestosis
fp DQ Rae
tees a ae EE ae
e
ote
t oat
cond
e
ents
This dust produces a diffuse interstitial pulmonary fibrosis known
pathologic changes include generalized fibrosis with diffuse
as asbestosis The
wails there may be large areasareas of dense fibrous
thickening thickening of the alveolar
condensation and emphysematous changes
A striking feature is said to be the marked pleural reaction often with thick
ptylpaequoefs foifbrfoisbirsous tissue Unlike silicosis asbestosis apparently never produces saubnpoldeuulraalr
The pathognomonic feature of asbestosis is the finding of asbestos
of pulmonary tissue and these bodies
be found
bodies in sections
may
in the sputum during life The asbestos
aoe
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tome.
ee
mew
+O
ny as
e w
wm
668
Chapter 40. OCCUPATIONAL
PULMONARY OCCUPATIONAL
DISEASES
body is a fiber of the mineral surrounded
histology
do
not
demonstrate
asbestos
by
bodies
protein
deposits
The
ordinary
stains
used
in
may be helpful When seen in tissue
well , but the Prussian blue blue
staining procedure
nized by their beaded
sections or in sputum these elongated fibers
recog- = gated dumbbell
appearance and rounded bulbous ends which
are
may resemble an elon-
The clinical manifestations of
asbestosis
exertion cough weakness weight loss
include
progressive
shortness
of breath
pulmonary Emphysema tasis and occasionally
and clubbing of the fingers
on
bronchiec
generally believed that
tuberculosis
asbestosis predisposes
complete
the
clinical
picture
While
it
is
as in the case of silicosis It has
to ruberculosis the
tendency is not so striking
also
been bronchogenic carcinoma hypothesis
surmised that asbestosis
striking
may predispose
' The earliest radiographic signs of which has not been fully confirmed
to
predispose
fields due to called
asbestosis are those of fine haziness in the
Subsequently there is reticular nenwork of shadows creating a ground glass lower lung
variable degrees
increasing evidence of more extensive and
appearance
coarser
of the
of pleural thickening A feature sometimes noted is
fibrosis with
in
cardiac
later
silhouette
resulting
from
the
combination
of
a shaggy appearance
stages
parenchymal and pleural changes
The diagnosis diffuse pulmonary fibrosis histdoerpyends dusts and the
of biopsy finding may be
of asbestosis
a
asbestos
of
prolonged more bodies
upon in the
a radiographic radiographic radiographic radiographic radiographic radiographic appearance ap earance ap earance appearance appearance appearance appearance consistentconsistent consistent consistent consistent consistent consistent consistent with
exposure two years or
to asbestos
sputum In obscure
diagnosis
advisable cases There is no treatment known to be of
be removed from such exposure and it visalue Patients with early signs of asbestosis shoul; d '
nificantly after exposure is
probable that the disease will not
terminated Patients asbestosis should
ruberculosis and should be
at examined frequent intervals
detect to
the earliest
be be undertaken undertaken undertaken
antiuberculosi antituberculosis treatmenttreatment treatment treatment may
may
Pneumoconiosis due to Mica
2s
moins combihnataionswtiintamahneufanctvureirsuofrnfoamrceents containing duce disease of and The micas are a
least
group of complex aluminum silicate
some of these are known to be capable
compounds of several types At
finely divided form in high concentrationover producing pulmonary fibrosis if inhaled in
-
years to ordinary industrial
a prolonged period An exposure of
-
these substances is
several
uaenviroments Oem containing
-
-
The micas are used
manufacture of
.
necessary to pro-
paper which
surface
in the paper products especially that type of wall
production of some paint
insulating materials in
products products as lubri
electrical devices
-
condensors ~
A sudy the by
Public coniosiisn a
United States
Health Service revealed
group of 57 workmen who had been
10 cases of
pneumo- silica
Policard
found
that
the
inhalation
exposed of mica
to
mica
dust
which
was
free
from
the lungs which he believed to be identical
dust can produce
pathologic changes in
dust
to those produced by the inhalation of
:
silica
Talc Pneumoconiosis
ad
ae fe
eke Hk
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tare
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ato1
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2 5.
aay OB. ~f.
Tale is a natural
finely variable composition and is powdered hydrous magnesium silicate Commercial
often mixed with other
tale is of
in industry in the
of manufacture paint rubber
mineral substances Tale is widely used
Puh
paper insecticides and
12
Health Hult Nu 250 Washington D. U.
ceramics as well as
) Indust Hyg 160 1934
S. Public Health Service 1940
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