Alyuminoz is the occupational disease from group of a pneumoconiosis developing at regular, long steam inhalation or dust of aluminum. The main signs of an alyuminoz are the progressing short wind, cough. The patient is disturbed by pains and weight in a thorax, symptoms of the general intoxication. The diagnosis is established on the basis of data of a X-ray analysis or KT of bodies of a thorax in the presence of accurate connection of a disease with professional activity. At an aluminum pneumoconiosis conservative therapy with use of bronchodilators, corticosteroids, mucolytics is appointed.
Alyuminoz (aluminum lung, bauxite lung, Sheyvera-Ridel's syndrome) treats subgroup of metallokonioz. The workers who are engaged in extraction of aluminum from bauxite ores, production of abrasive materials and pyrotechnics, aircraft construction get sick generally. In 1947 the American doctors S. Sheyver and A. Ridel for the first time described a pneumoconiosis as pulmonary pathology at shlifovalshchik of corundum. According to statistical data, the aluminum lung meets at men (68% of all diseased) more often 35 years are aged more senior. About 3% of all patients suffering alyuminozy die. Mortality among sick women is higher (5,3%).
Reasons of an alyuminoz
As direct etiologichesky factor of an alyuminoz serves inhalation of aluminum evaporations and fine dust. The workers extracting aluminum from bauxites by an electrolysis method are in most cases subject to harmful effects of vapors. However because of the additional maintenance of a large amount of silicon in aluminum ore at such workers occupational disease develops from the mixed influence of two components. The dust which is formed at extraction of bauxite ore also contains aluminosilicates.
Alyuminoz often arises at the persons working with a powder form of metal, producers of pyrotechnic powder, aluminum paint, artificial abrasive materials. As a causal factor of an occupational disease in this case serve microparticles of metal dust the sizes from 0,5 to 5 microns. Alyuminoz develops on average in 18-30 years from the beginning of work in harmful conditions. The accompanying pulmonary pathology and hypersensitivity to aluminum promote early (within 6-24 months) to emergence of a metallokonioz.
Microparticles of aluminum dust are capable to get deeply into the respiratory highway and to reach its terminal department. There dust is taken by alveolar macrophages. Reaction pulmonary an interstition on particles of aluminum can proceed as cellular proliferation or with formation of connecting fabric. In the first case granulyomatozny process, in the second – interstitsialny fibrosis develops. Because of gradual replacement of sites of interstitsialny fabric connecting lungs lose elasticity, gas exchange is broken, there is a gipoksemiya.
Macroscopically normal pulmonary parenchyma alternates with dense gray-black sites of fibrosis. Often, mainly in basal departments, meshotchaty and cylindrical bronkhoektaza, subpleural cysts meet. At a histologic research peribronkhialny and perivaskulyarny congestions of the macrophages filled with dust are found. At the remained alveoluses there are aluminum microparticles.
Symptoms of an alyuminoz
At the initial stage masks under frequent sharp respiratory diseases. The patient is disturbed by recurrent laryngitis, tracheitises and bronchitis. Later persistent painful dry or unproductive cough, the pricking and pressing character chest pains joins. In the beginning the pain syndrome has incidental character, becomes later a torakalgiya than a constant and is felt more in side departments of a breast. In a debut of occupational disease the bronchial secret departs hardly. After emergence of bronkhoektaz cough becomes damp with a large number of a yellowish phlegm.
The short wind arising at pneumoconiosis aggravations gradually progresses and becomes a constant. In the beginning the patient experiences difficulty of breath during the walking and rise on a ladder, then - at the slightest loading and at rest. Alyuminoz often is followed by belly-aches, disorders of digestion. The general condition of the patient suffers – appetite worsens, there is an unmotivated weakness, subfebrilitt, weight is lost.
Alyuminoz often is complicated by development of bronkhoektaziya. They are a constant source of an infection and provoke developing of pneumonia, a periodic blood spitting and sometimes pulmonary bleedings. Because of a rupture of subpleural cysts there is spontaneous pheumothorax which can recur. In rare instances against the background of an aluminum lung tuberculosis develops. If in due time not to stop contact with the harmful agent, aluminum collects in lungs and causes a further sklerozirovaniye of interstitsialny fabric. Respiratory insufficiency steadily progresses. The chronic pulmonary heart conducting to a deep invalidization of the patient develops.
At suspicion of pulmonary pathology the patient working at a harmful factory looks round the pathologist. During the poll the nature of professional harm and length of service on this specialty is specified. At survey in the started cases of an alyuminoz cyanosis of lips and nail plates comes to light, at the expressed pulmonary fibrosis – diffusion cyanosis. Chronic oxygen starvation is indicated by deformation of trailer phalanxes of fingers and nails as drum sticks and hour glasses. The diagnosis is confirmed with the help:
- Fizikalny research. Auskultativny data depend on expressiveness of process, existence of complications. At an early stage rigid breath, the dry whistling and buzzing rattles on both sides is listened. At the created interstitsialny fibrosis the sonorous krepitiruyushchy rattles which are localized in the lower departments of lungs join.
- Methods of functional diagnostics. Function of external breath is broken mainly on restrictive type. Gradually the vital capacity and the maximum ventilation of lungs decrease, the residual volume of air increases. Signs of an overload of the right departments of heart are defined on the ECG.
- Radiological researches. According to a X-ray analysis and KT of lungs the deformed mesh pulmonary drawing comes to light. On its background from two parties the spotty shadings located in the lower and average departments of lungs are visualized. Shadows can merge and form roundish or linear conglomerates. Emphysematous bulls are defined by Subplevralno. In basal pulmonary departments bronkhoektaza meet.
- Laboratory tests. Are used as auxiliary methods of diagnostics. In clinical blood test at an alyuminoza the increased quantity of lymphocytes and eosinophils quite often is found. Definition of gas composition of blood helps to specify degree of respiratory insufficiency. For an exception of pulmonary tuberculosis the phlegm research is appointed.
Except tuberculosis, it is necessary to differentiate with sarkoidozy lungs, an idiopathic fibroziruyushchy alveolit, oncological processes. The pulmonologist is engaged in differential diagnostics. In not clear cases are carried out a magnetic and resonant and positron and issue tomography of a chest cavity, the bronkhoskopiya with a transbronchial biopsy of a lung is appointed.
Treatment of an alyuminoz
To patients with the confirmed diagnosis it is strongly recommended to replace a type of work. Aluminum has cumulative property. At continuation of its impact on the patient's organism steadily progresses. Even after the termination of contact with a harmful factor the disease is not exposed to the return development. The main objectives of experts in the field of pulmonology and professional pathology – to slow down a current of a pneumoconiosis and to prevent emergence of complications.
Good high-calorie nutrition, physiotherapy exercises, massage, seasonal vaccination against flu is recommended to patients. At infectious aggravations antibiotics taking into account sensitivity of microflora of a phlegm are appointed. Bronchodilators and mucolytics are applied to improvement of drainage function of bronchial tubes. With the anti-inflammatory and immunosupressivny purpose inhalation and system corticosteroids are appointed. At dekompensirovanny pulmonary heart failure warm glycosides, antagonists of calcium, diuretics are applied.
Forecast and prevention
Alyuminoz is incurable, the forecast for recovery adverse. But the disease usually progresses slowly. After elimination of professional harm, at correctly picked up treatment the patient can lead active lifestyle for many years. In hard cases complex change donor heart and lungs is possible. For prevention of an alyuminoz it is necessary to follow safety regulations in a workplace and to use individual protection equipment.