. (1978). Thorax, 33,[219][220][221][222][223][224][225][226][227]. Pulmonary and hepatic granulomatous disorders due to the inhalation of cement and mica dusts. Hepatic and pulmonary granulomas were recognised in two workers exposed respectively to Portland cement and to muscovite dusts. The pulmonary lesions in the patient exposed to cement consisted of histiocytic granulomas and irregular fibrohyaline scars, and in the patient exposed to mica of a diffuse thickening of all interalveolar septa due to new formation of reticulin and collagen fibres and proliferation of fibroblasts and histiocytes. In the liver the following pathological findings were observed: focal or diffuse swelling of sinusoidal lining cells, sarcoid-type granulomas, and, in the case of mica exposure, perisinusoidal and portal tract fibrosis. Abundant inclusions of the inhaled material were identified within the pulmonary and hepatic lesions by histochemical and x-ray diffraction techniques.The inhalation of dusts containing silicon is known to produce different kinds of pneumoconiosis. Although free silica is sometimes the only pathogenic dust inhaled, in most situations there is exposure to silicates (for example, mica, asbestos, kaolin, talc) or to mixed dusts of free or combined silica and other inorganic dusts such as cement. The pathological findings produced by the latter type of dusts do not mimic the typical pattern of silicosis, and their diagnosis is based on the occupational history of the patient and on the identification of the inhaled foreign material within the lesions.The effects of cement and mica dusts on the human respiratory tract have been recognised in epidemiological surveys (Middleton, 1936;Sayers et al., 1937;Gardner et al., 1939;Dreesen et al., 1940;Vestal et al., 1943;Giuliani and Belli, 1955; Jenny et al., 1960Hublet, 1968 Kalacic, 1973).Nevertheless, there are few references to the pulmonary histopathology (Doerr, 1952;Vorwald, 1960;Pimentel and Gomes, 1973), and other possible causes of pneumoconiosis were not excluded in some reports (Doerr, 1952;Vorwald, 1960). There is also some controversy over the experi- mental pathogenic effects of cement and mica (Lemon and Higgins, 1935;Baetjer, 1947;King et al., 1947King et al., , 1950Einbrodt and Hentschel, 1966;Tripsa and Rotaru, 1966;Pimentel and Gomes, 1973).In addition to causing pulmonary lesions, exposure to pathogenic dusts may produce hepatic granulomas, as described in silicosis (Cisno et al., 1971), berylliosis (Chesner, 1950), and vineyard sprayer's lung (Pimentel and Menezes, 1975 A 46-year-old woman had been exposed to the inhalation of mica dust during grinding and packaging operations for seven years. In March 1971 she was admitted to hospital for dyspnoea on exertion, progressive weakness, and loss of weight. Symptoms had appeared two years before admission after a 'common cold'. There was no previous history of respiratory diseases. During this period antituberculosis drugs (streptomycin and isoniazid) were used without benefit; the sputum was pers...
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