[Cases of atypical pulmonary diseases under influence of industrial aerosols].

The article includes discharge epicrises of patients working in contact with quartz-containing dust, welding aerosol, cotton dust, irritant gases emitted in wood burning. Description covers cases of lung fibrosis, idiopathic interstitial pneumonia, systemic vasculitis with lungs involvement, sarcoidosis. The authors suggest that further accumulation of materials, further investigations of lung tissue state, epidemiologic studies will help to widen the list of occupational pulmonary diseases.

[Structure and dynamics of occupational lung diseases in workers of Moscow region under longstanding 50 years of observation].

The article covers data on occupational morbidity in Moscow region over last 50 years. Stable number of newly diagnosed occupational diseases was seen up to first half of 1990s. Afterwards, steady decrease in occupational morbidity is seen with closure of major industrial enterprises. Among occupational pulmonary diseases, dust fibrosis (pneumoconiosis--44%) prevail. Tuberculosis complication of silicosis decreased, additional general somatic concomitants (arterial hypertension, ischemic heart disease, malignancies) are more frequent. Prevalence of occupational bronchial asthma has increased 16 times vs. that in 1976.

[State of taste sensitivity to table salt in male workers with high blood pressure and in normotensive ones].

The article covers data on studies of sensitivity to common salt in machinery construction workers of Moscow suburb, to reveal individuals prone to arterial hypertension. Increased threshold of sensitivity to common salt was seen in 52.6% of the workers observed by occupational therapists as having arterial hypertension, among the normotensive workers the increased threshold was seen only in 18%. Being noninvasive and simple, the method detecting sensitivity to common salt, that obtained data in examination of workers exposed to occupational hazards and having increased or normal blood pressure, is recommended as a screening tool to identify workers prone to arterial hypertension. The workers with increased threshold of sensitivity to common salt are advised to reduce salt in diet.

[Risk factors of arterial hypertension in patients with vibrational disease in Moscow region].

The article covers results of study that involved 204 male patients of occupational pathology department over recent 6 years, with diagnosed vibration disease. 103 of the examinees (50,5%) had vibration disease combined with arterial hypertension. Parameters of the study were age, occupation, length of exposure to vibration, level of the vibration, endogenous risk factors according to literature data (body build index, heart rate, functional changes index, glomerular filtration rate, creatinine level, cholesterol level, HDL and LDL levels, triglycerids levels, WBC and RBC counts). No reliable correlation was seen between arterial hypertension and vibration jeopardy of the occupation, vibration level at workplace, length of exposure to vibration. Differences between groups were defined in endogenous

[Hand bones disorders in vibrational disease caused by local vibration should be considered as pathogenetic characteristic of the disease].

Opposite to the authors of the publication, that dystrophic changes in locomotory apparatus of hands and shoulders girdle could not be considered as vibration disease signs, the article authors believe that hand bone changes--tuberosity of distal finger bones, cystic transparency, local osteoporosis--could be pathogenetic signs of vibration disease, along with vascular and neurologic signs. The authors agree that periarthrosis, miofibrosis, if characterized properly through sanitary and hygienic regulations in new List of Occupational diseases, that will be put into practical medicine in the nearest future, could be considered as second occupational disease in the same patient.

[Chronic pain syndrome and sleep disorders in patients with occupational diseases of upper extremities].

Polling method revealed prevalence of chronic nightly pain syndrome and insomnia peculiarities in 126 patients having occupational hands diseases. Prevalence of chronic nightly pain syndrome in upper limbs among actively working patients with occupational hands diseases caused by functional overstrain was 68%; that among the vibration disease patients equalled 58%. The nightly pains were absent in the reference group. Prevalence of the nighly pains among the patients in post-contact period was 83.3%. Insomnia prevalence, according to polling data in the workers, equalled 76% in functional overstrain cases and 63% in vibration disease cases, in post-contact period 72%, in the reference group 60% without reliable difference. Pilot polysomnographic study before and after the treatment of insomnia in 6 patients with sleep disorders demonstrated improvement of qualitative characteristics of sleep after the treatment.

[Life quality as an additional criterion to evaluate efficacy of treating vibration disease patients].

Studies covered as an additional criterion to evaluate efficiency of treating vibration disease patients. Studies covered life quality in 40 males having vibration disease during the treatment course. Before the treatment, all the examinees demonstrated decrease in all life quality parameters especially of "role physical functioning" (16.89 points), general health (38.39 points), role emotional functioning (39.64 points). After the treatment most the parameters reliably improved, besides physical and social functioning. The authors recommend SF-36 life quality questionnaire to evaluate treatment efficiency for occupational diseases.

[Life quality of workers in machinery plants of Moscow region].

Questionnaires SF-36 and NJ-29 were used to examine 107 workers including 33 ones exposed to vibration, 27 ones - to various hazards mostly chemical, and 47 individuals without any exposure. Life quality corresponding to normal was pointed out by 80.4% of the examinees throughout the whole select, but the minimal one - by 75.8 % of the workers exposed to vibration. The latter group examinees had lower life quality in Pain scale (76 points), General Health scale (60.51), Vitality (63.3), Social functioning (72 points). In all the groups, psychic health was decreased, according to self-estimation of the examinees (69.01; 75.26; 71.92). The authors recommend inclusion of Questionnaire SF-36 into examination methods in periodic medical workups.

[Multiple local involvement of peripheral nerves in workers suffering from occupational hands disorders].

Stimulation and needle electromyography studies covered 102 patients with occupational hands disorders. 87% of the examinees showed tunnel syndromes signs: 44% of those had one tunnel syndrome, 36% - two synromes, and 7% - multiple ones. The results failed to demonstrate reliable difference in tunnel syndrome frequency for vibration exposure and functional hands overstrain. Sensitivity thresholds in vibration disease were increased in 86.7% of the examinees and in 61.5% of those with functional hands overstrain. Peripheral nerve disorders in residual defects with occupational hands diseases are persistent due to compression within physiologic tunnels.

[Ventilatory and gas exchange functions of the lungs in occupational and other pulmonary diseases].

AIM: To study lung ventilation and gas exchange in interstitional and obstructive diseases of dust-induced and non-occupational origin for correction of pulmonary diseases. MATERIAL AND METHODS: Diffuse lung capacity (Erich Jaeger unit) and biomechanical properties of the ventilation system (total plethysmography on the bodyplethysmograph made by Erich Jaeger) were investigated in 132 patients including 87 with occupational dust-induced pulmonary diseases (pneumoconiosis, dust bronchitis, exogenic allergic alveolitis, bronchial asthma) and 45 patients with non-occupational diseases: sarcoidosis (n = 28), exogenic allergic alveolitis (n = 10) and bronchial asthma (n = 7). RESULTS: The changes were of the same type but different severity. Diffuse capacity was subnormal in all the groups, most of all in patients with exogenic allergic alveolitis and sarcoidosis of stage 2-4. In patients with occupational diseases DLCO was reduced, residual volume, total lung capacity were elevated, they had hypoxemia. CONCLUSION: The changes in patients with dust-induced diseases of the lungs may be interpreted primarily as disorders of distribution, imbalance between ventilation and perfusion. Diffusion disorders in patients with alveolitis and sarcoidosis correlated with changes in alveolar-capillary membrane.

[Prevention of and coping with professional stress].

The article reviews publications dedicated to stress, especially professional one. The authors describe a severe form of stress, emotional burning-out syndrome, which is often found in doctors and nurses dealing with patients suffering from mental disorders, oncological diseases, AIDS, and those who are treated in intensive care units. Recommendations concerning stress prevention and medication support able to prevent or lower pathological consequences of chronic working stress are given.

[A case of complication of system scleroderma with AL-amyloidosis].

The article describes a case of systemic scleroderma complicated by a severe nephrotic syndrome after seven years in a 46-year-old patient. Rectal mucosal biopsy and right renal biopsy were performed to clarify the origin of the nephrotic syndrome and because amyloidosis was suspected. Massive amyloid deposits were found in biopsy material, colored with Congo red and studied in normal and polarized light. After processing with guanidine and coloring with Congo red, the material was studied in normal and polarized light; amyloid deposits preserved their congophilia and double refraction during two hours of incubation, which is typical of AL-amyloidosis. The patient was directed to a specialized nephrological department for the treatment of AL-amyloidosis.

[Case of asbestosis with massive benign pleural involvement].

UNLABELLED: The article contains a case of asbestosis in woman aged 65 and long exposed to asbestos at work. X-ray signs proved asbestosis of lungs. Nodular masses in pleura revealed on pulmonary CT scans were considered as malignant mesothelioma. For diagnosis verification, videothoracoscopy with target biopsy of the nodes was performed. Histologic diagnosis - fragments of dense fibrous connective tissue. FINAL DIAGNOSIS: Asbestosis, s/s, p/p, 2/2. Pleural asbestosis. The authors stress importance of contemporary diagnostic techniques in occupational pathology.

[On efficiency of local xidiphone in treating osteoporotic changes in hands of vibration disease patients].

The authors demonstrated that local electrophoresis of xidiphone for osteoporotic changes in hands of vibration disease patients results in preservation of bone mineral density. Treatment courses should occur 2-3-4 times annually.

[Value of new laser technologies in occupational diseases diagnostics].

The article deals with results of microhemodynamics assessment through new methods of noninvasive laser diagnostics--doppler flowmetry and spectrophotometry ("Spectrotest" device)--in vibration disease patients to verify origin of angiodystonic and angiospastic syndromes. The methods enable to define type of microcirculatory disorder, to evaluate quantity of revealed changes, to assess blood content of superficial tissues in fingers, blood oxygenation. Spastic type of microcirculation is indicative to include ACF inhibitors into treatment complex.

[Principles of rehabilitation in major occupational diseases].

The article deals with personal experience and literature data, basing recommendations on rehabilitation of patients with occupational diseases. Rehabilitation measures include better work conditions, job placement of individuals in whom the disease was not caused by etiology factor, rehabilitation through medical and nonmedical measures.

[State and prospects of evidence-based medicine and occupational pathology].

According to foreign literature data, contemporary methods of evidence-based medicine are insufficiently limited in use by occupational pathologists both in this country and abroad. This is due to restrictions of Occupational Diseases Register, difficulties in adding new entities into it, medical and social practice to use functional parameters for disablement definition, employers' obstacles to reveal early stages of occupational diseases through active employees' examinations, patients' wish to receive governmental annuity and not to get rehabilitated.

[Markers of asbestos exposure in workers].

Examination covered 213 workers of asbestos technical ware plant. Standard X-ray examination no pulmonary and pleural changes were revealed. External respiration studies demonstrated moderate ventilation disorders in half of the examinees: in hardware workshop workers--restrictive type disorders, in autofriction components workshop workers--obstructive type ones with hyperventilation. Lower diffusing lung capacity in one-third of the workers in one of two autofriction components workshops proves most likely distributive disorders. Moderately increased serum alveolar mucin 3EG5 in 20% of the examinees could be a predictive criterion of slow formation of chisotyle pulmonary fibrosis.

[Significance of laser dopplerometry in diagnostics of upper extremity occupational angiopathy].

The paper demonstrates the results of the application of laser dopplerometry supplemented with respiratory, thermal and occlusive functional tests, as a new non-invasive method of microcirculation evaluation. Initially the majority of patients have spastic or hyperemic microcirculation disturbances in the skin of the fingers. Functional tests allow specification of the mechanisms of these disturbances, such as microhemodynamic inertness and the suppression of slow circulatory rhythms, which demonstrate the presence of myogenic tonus disorder and prove that vibration has direct influence on vascular wall cells. The manifestation of neurogenic component is the dominance of sympatic vasomotor reflex. The paper also demonstrates the dominance of vasoconstrictor effect over vasodilatatory one.

[A vasoregulating function of the major vessels of the upper limbs in patients with vibration disease].

AIM: To investigate a vasoregulating function of the endothelium of the upper limbs' major arteries in patients with vibration disease (VD); to determine VD role in pathogenesis of vascular disorders. MATERIAL AND METHODS: A total of 54 VD men free of cardiovascular disease (age 42.4 +/- 0.98 years) with mean occupational local vibration contact 19.4 +/- 1.12 years entered the study. Diameter of the brachial and radial arteries and hemodynamics in them were measured with triplex scanning of the vessels. Hemodynamics in smaller vessels was examined with dopplerography. A vasoregulating function of vascular endothelium was assessed with a postocclusion test with reactive hyperemia, cold and nitroglycerin tests on sites distant from the sites exposed to vibration and close to such sites. RESULTS: Abnormal endothelium-dependent responses at distal parts of the radial artery as marked vasoconstriction in the phase of ischemia and in response to cold, inhibition of systolic and volume speed of blood flow in reactive hyperemia were found. The strongest changes were seen in finger hand arteries. No disturbances of endothelium-independent reactions in nitroglycerin test were seen. CONCLUSION: Vascular disturbances in the action of local vibration on the workers' hands are explained not only by systemic impacts but also by local disorders of endothelial function of hand vessels.