[Correlation of different types of emphysema in high-resolution computed tomography (HR-CT) with the ILO-classification of coal workers pneumoconiosis]. / Zusammenhang zwischen Empyhsemtyp und Schweregrad der Pneumokoniose bei Bergleuten: Korrelation von HR-CT-Befunden und ILO-Klassifikation.

PURPOSE: The complaints of patients suffering from pneumoconiosis and the decrease in cardio-respiratory function tests are related to the major complications, emphysema or bronchitis, resp. to a lesser degree the complaints are directly influenced by the silicotic process itself. Up to now, no large study has analysed the correlation of different types and severity of emphysema with the ILO-classification of pneumoconiosis in miners. MATERIAL AND METHODS: In 104 miners the severity of pneumoconiosis was classified by ILO. By HR-CT the type and severity of emphysema was analysed using a 4-point-scale. The correlation of emphysema with the ILO-classification was tested with Pearson-correlation. RESULTS: The centrolobular emphysema was the dominant type with 59 %, but there was no dependence on the severity of pneumoconiosis. Only the paracicatricial emphysema had a significant correlation (p < 0.05) with the degree of large opacities. On the other hand, the paracicatricial emphysema was only detected in 32 %; under quantitative aspects it was seen to be less common than the centrolobular, the parapleural and the paraseptal emphysema (46 %). There was no significant correlation with the size and distribution of the small opacities and the different types of emphysema. CONCLUSIONS: Only the large opacities had a significant correlation with the appearance of paracicatricial emphysema. The other types of emphysema, especially, the dominant centrolobular type had no obvious association with pneumoconiosis. The multifactoral genesis of emphysema has to be taken into account.

[Submaximal spiroergometric stress study in patients with mixed dust pneumoconiosis]. / Submaximale spiroergometrische Belastungsuntersuchung bei Patienten mit Mischstaub-Pneumokoniosen.

Disabilities of patients with coal-workers' pneumoconiosis (CWP) are currently estimated by changes in lung function at rest and the degree of dust equivalents in chest x-ray (ILO-classification 1980). Functional disturbances during exercise are not taken into consideration on a regular basis. We assumed that standardised sub-maximal exercise tests might be useful even in disabled patients to give additional information on functional disabilities of patients with CWP. The impact of low-grade anthracosilicosis on ventilation and gas exchange during exercise was assessed in 20 patients (all male, age 64.55 +/- 3.78 years) and 24 healthy volunteers (all male, age 58.13 +/- 4.68 years, never dust exposed). Data were also analysed according to ILO classification subgroups (group 1: ILO-classification 1/0 to 1/2, n = 11; group 2: ILO-classification 2/1 to 2/2, n = 9). Heart rate (HR), minute ventilation (VE), ventilatory equivalent for O2 (VE/VO2), ventilatory equivalent for CO2 (VE/VCO2), O2 uptake (VO2)CO2 output (VCO2), end-tidal oxygen partial pressure (PetO2), end-tidal carbon dioxide partial pressure (petCO2) and estimated dead space to tidal volume ratio (VD/VT) were determined breath-by-breath during a 50 watts constant work load protocol on an exercise bicycle. The VE/VO2 (patients: 32.9 +/- 4.2; controls: 25.7 +/- 2.9; p < 0.001), the VE/CO2 (patients: 39.4 +/- 4.6; controls; 31.0 +/- 3.9), the VE (patients: 30.1 +/- 5.6, controls: 23.5 +/- 3.0; p < 0.001) and the PetO2 (patients 115.6 +/- 4.8; controls: 99.1 +/- 27.4; p < 0.05) at an exercise of 50 watts were significantly higher in the patients' group, the PetCO2 (patients: 38.4 +/- 4.5; controls: 44.0 +/- 4.1) were significantly lower in the patients' group. The comparison of patients subgroups did not reveal any significant differences between group 1 and group 2. A higher VE/VO2 during 50 watts of exercise is attributable to an increased ventilation/perfusion mismatch. There was no correlation between the radiological grade of the CWP (ILO classification) and the ventilation and gas exchange during exercise. We conclude that a sub-maximal spiroergometry with a 50 watts constant work load might serve as a sensitive and easy to apply procedure add information about the functional impairment in CWP. The exercise test should be included in the evaluation for disability benefits.

[Interpretation of early radiological changes in the diagnosis of pneumoconiosis among coal miners]. / Interpretacja wczesnych zmian radiologicznych w diagnostyce pylicy górników kopaln wegla kamiennego.

Apart from certain changes which are typical for pneumoconiosis, the radiological picture of the lungs of sigma coal miners does frequently show some irregular small opacities of s, t and u types. The role and specificity of these changes in the early diagnosis of pneumoconiosis has not been too well defined by now. A 10-year study (conducted at 2 or 3 year intervals) was carried out among 150 miners from 2 mines characterized by different dust loading. Some irregular changes in the miners' lungs were observed. The control group derived from the same mines comprised 115 miners with no radiological changes found in their lungs. The evolution of radiological changes took place in 55.3% of the miners and was more intensive in the heavily dusted mine. Radiological changes were revealed in 38.3% of the controls. It was indicated that pneumoconiosis results much more frequently (38.6%) from the evolution of the irregular changes rather than directly from the proper radiological picture of the lungs (5.3%). In 44.7% of the subjects the changes of s, t and u type did not undergo any evolution, which may be due to their non-specific characteristics. The evolution of irregular opacities is dominating in the patients with bronchitis and emphysema. No significant correlation between smoking and the progress of irregular opacities was found. The observation of the further exposure to the dusts did not produce any clear results. The progress of the changes of s, t and u type was observed more frequently in those still working under ground, but more cases of pneumoconiosis were found in the miners who stopped working. This fact indicates that the further exposure affects the s, t and u type changes and confirms the observations by other authors concerning the manifestation of pneumoconiosis after the break of exposure. The results of the 10-year study prove that the miners with this sort of changes are exposed to a higher risk of pneumoconiosis, although the answer concerning specificity of irregular changes in the radiological picture has not yet been found.