1945 - 2000
HALF A CENTURY OF DIAGNOSTIC AND THERAPEUTIC PROGRESS
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 M. MARQUET
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MEANS OF DIAGNOSING PNEUMOCONIOSES AND TREIR COMPLICATIONS
A - Medical imagery
Radioscopy:
Used until the 1970s.
Advantages :
- Allows respiratory kinetics to be visualised.
Disadvantages:
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No filing of images, therefore no possibility of making a precise assessment
of evolutionary potential;
- Lack of precision of the images;
- A single examiner: short examination time;
- - High radiation of the patient and doctor.
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Radiophotography.
Adapted to mass screening; Mobile equipment; large output; small
size images easily filed; rapid interpretation. Evolution of films
- At the beginning: flexible 35 mm format;
- Progressively appearance of 7x7 cm then 10x10 cm and 11lx11 cm formats;
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Advantages:
- Possibility of double interpretation;
- Improvement of image definition with an increase of the film surface
- Lesser radiation of the patient.
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Disadvantages:
- Insufficient definition for fine images;
- Documents not accepted in expertise procedures;
- No reference image.
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Standard radiography.-
35x35 mm image.
- Made on paper film at the beginning (1945 / 1950), then use of transparent
negative films;
- Evolution of emulsions that have become ever finer and more sensitive
(shorter exposure times)
- Evolution of cassettes, of intensifying screens, and of grids;
- Switch froin low voltage images (60 kV) to high voltage images (110
kv) allowing the rib cage to be effaced in order better to show the
pulmonary parenchyma;
- ILO refèrence images.
Digitised images:
- Provide constant quality (penetration, contrasts);
- Image definition depends on the quality of the matrix (number of pixels);
- Definition lower than that of the silver grain;
- Ease of filing without any risk of spoiling documents;
- Possibility of processing images and absence of reference images.
Tomographies:
- Used until the beginning of the 1990s;
- Allow puknonary exploration by a slicing in successive vertical planes,
eliminating images built by superposing the various pulmonary structures.
The scanner:
- Has progressively replaced tomographies;
- Pulmonary exploration by horizontal sections froin 1 mm to 1 cm thick;
- Quality has considerably iniproved in the past five years (higher
performance matrices);
- Shorter acquisition time (spiral scanners);
- Possibility of processing images (e.g.: summation of contiguous millimetre
sections in order to assess a micronodular opacity);
- High sensitivity in diagnosing interstitial images and emphysematous
lesions barely visible in standard radiography and invisible in tomographic
sections;
- High sensitivity in diagnosing pleural images (pleural plaques in
asbestosis).
Echography:
- Uses the ultrasounds technique;
- Developed from the 1980s on;
- Interest in exploring the cardiac cavities (3D echo - Doppler echo).
AMR:
- Uses the magnetic fields technique;
- Supplies images of customarily radiotransparent soft tissues;
- Acquisition time currently too long, which does not allow its use
in pulmonary exploration.
B - Histology
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Interest in tables 30 bis': 30 A,C,D;
Allows a defmitive diagnosis;
Accepted as diagnostic proof in table 25'.
Sampling methods:
- Anatomic parts (surgery, autopsies);
- Transbronchial biopsies during fibroscopies;
- Transthoracic biopsies guided by scanner or brightness amplifiers;
- Biopsies by pleuroscopies (mesotheliomas);
- Bronchoalveolar lavages.
Endoscopy progress (from rigid endoscopy to fibroscopy)
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C - Serodiagnosties
- Immunoelectrophoresis used in diagnosing aspergillosis;
- Markers of cancer development;
- Search methods (sensitive crystallisation - search for markers
of development potential).
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D - Bacteriological diagnosis
- Mainly in the carly diagnosis of tuberculosis.
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THERAPEUTIC MANAGEMENT
A - Reminder on tests on stabilising the development of
silicosis
cf above: Present research and prospects
B - Management of respiratory insufficîency and its
complications
Treatment of chronic respiratory insufficiency
- Progress in treating infections;
- Progress in reanimation techniques;
- Progress in material means allowing patients to be kept at home
(mobility of heavy equipment such as assisted ventilation, oxygenotherapy);
- Progress in medical monitoring (blood gases. - respiratory kinesitherapy).
(1) French decree no. 96-446 of 22 May 1996 on accupational
diseases. The. table 30bis corxx-m branchopulmonary cancer caused by asbestosis.
(2) Occupational diseases caused by silica dust.
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Treatment of tuberculosis
- A major complication in 1945;
- Vaccinations;
- Earlier diagnosis;
- Treated effectively in general, without after-effects nowadays;
- - (Statistical results)-
Treatment of chronicpulmonary heart
- Currently the most serious complication;
- Use of long-term oxygenotherapy protocols.
Treatment of other complications (pneumothorax-aspergillomas,
aseptic necroses, etc...)
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C - Therapeutie management of MP 3W (Asbestosis)
Treatment of pulmonary fibrosis (30 A)
Treatment of bronchial cancers (30 C 30 bis)
- Place of surgery;
- Cherniotherapy,
- Notion of associated cancer cofactors:
- Non professional (tobacco)
- Professional (wood dust +asbestos in moulding powders).
Treatment of mesothetiomas
Essential dedramatisationfor table 30 B
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FUTURE PROSPECTS
- Above all, prevention of exposure;
- Early removal from the risk on the first signs of occupational
diseases (MP 25);
- More effective cancer treatment.
It should however be remembered that a destroyed lung does not regenerate
and that all you can do is make best use of what remains.
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(3) MP 30: Occupational Disease no. 30 in France (asbestosis),
(Commission des maladies professionnelles du. Conseil supérieur
de la prévention des risques profèssionnels)
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9
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