Diseases caused by dust. Professional diseases caused by the impact of industrial dust (pneumoconiosis). Dust bronchitis. Definition

Sections of the site

Editor's Choice:

Advertising

the main - Heart disease and vessels

Prevention of professional dust diseases should be carried out on a number of directions and includes :.

Hygienic rationing;

Technological measures;

Sanitary and hygienic measures;

Individual means of protection;

Medical and preventive measures.

Hygienic rationing. The basis for performing measures to combat production dust is hygienic rationing. The requirement of compliance with the MPC established GOST (Table 5.3) is the main in the implementation of warning and current sanitary supervision.

Table. 5.3. The maximum permissible concentrations of aerosols are predominantly fibrogenic action.

Name of substance	MP3, mg / m 3	Hazard Class
Silicon Crystal Dioxide: When it is contained in dust over 7 0%, the same from 10 to 70% "from 2 to 10%	2 4	3 4 4
Silicon amorphous dioxide in the form of condensation aerosol: when it is kept in dust over 6 0% the same from 10 to 6 0%
Silicates and silicap-containing dust: asbestos, asbestos cement, cement, apatite, clay talc, mica glass fiber	2 6 4 4	4 4 4 4
Carbon Dust: Diamond Metallized Stone Coal with Free Silicon Dioxide Container to 5%	4 10	4 4
Metals dust: aluminum and its alloys (in terms of aluminum) aluminum oxide with an admixture of silicon dioxide in the form of an aerosol condensation of aluminum oxide in the form of an aerosol of disintegration (alumina, electrocorundant) iron oxide with an admixture of manganese oxides up to 3% the same 3 - 6% cast iron Titanium, titanium dioxide Tantalum and its oxides	6 10 10	4 4 4 4 4 4 4 4
Dust of vegetable and animal origin: grain (regardless of the content of silicon dioxide) flour, cotton, wood, etc. (With a mixture of silicon dioxide less than 2%) cotton, cotton, linen, woolen, fluff, etc. (with an admixture of silicon dioxide more 10%) with admixture of silicon dioxide from 2 to 10%

Systematic control over the state of dusty level is carried out by the Laboratories of the SES, factory sanitary-chemical laboratories. The administration of enterprises is responsible for maintaining conditions that prevent the increase in dust PDC in the air.

When developing a system of recovery activities, basic hygienic requirements should be made to technological processes and equipment, ventilation, construction and planning solutions, rational medical care for workers, the use of personal protective equipment. At the same time, it is necessary to be guided by the sanitary rules of the organization of technological processes and hygienic requirements for production equipment, as well as industry standards for production with dust-finding at enterprises of various sectors of the national economy.

Events to reduce dust in the production and prevention of pneumoconiosis should be comprehensive and include technological, sanitary, technical, biomedical and organizational measures.

Technological events. Elimination of dust formation in workplaces by changing production technology - the main way to prevent dust lung diseases. The introduction of continuous technologies, automation and mechanization of production processes, eliminating manual labor, remote control contribute to significant relief and improving the working conditions of a large contingent of workers. So, the widespread use of automatic welding types of remote control, robots-manipulators on loading, crossing operations, packaging of bulk materials significantly reduces the contact of workers with sources of dusty. The use of new technologies - injection molding, electrochemical methods of metal processing, shot blasting, hydro- or electric cleaner eliminated operations associated with dust formation in foundry shops of plants.

Effective means Fight against dust are use in the process instead of powdered briquettes, granules, pastes, solutions, etc.; replacement of toxic substances on non-toxic, for example, in lubricating liquids, consistent lubricants, etc.; transition from solid fuel to gaseous; The widespread use of high-frequency electrical heating, significantly reduces the contamination of the production environment with smoke and flue gases.

The following activities are also facilitated to prevent air dustiness: replacing dry processes with wet, such as wet grinding, grinding, etc.; Sealing equipment, places of grinding, transportation; Selection of units that dust the working area, in isolated premises with a remote control device.

The main method of combating dust in underground workings, the most dangerous in relation to professional pulmonary diseases, is the use of no-water irrigation with water supply under pressure of at least 3 - 4 atm. Irrigation devices should provide all types of mining equipment - combines, drilling rigs, etc. Irrigation should be applied both in the places of loading and unloading coal, rocks, and during transportation. Water curtains are used immediately before explosive works and with suspended dust, and the water torch should be sent to towards the dust cloud.

Sanitary and technical events.Sanitary and technical activities play a very significant role in preventing dust diseases. These include local shelters of dusting equipment with suction of air from under the shelter. The sealing and shelter of the equipment with solid dustproof housings with effective aspiration are a rational means of preventing dusting in the air of the working area. Local exhaust ventilation (housings, lateral suction) applies in cases where the technological conditions cannot be moisturizing the processed materials. Dust removal should occur directly from dust formation. Before emissions into the atmosphere, the dusty air is cleared.

When welding metal structures and large-sized products, sectional and portable local suction are used. In some cases, ventilation is established in combination with technological measures. So, in the installations for a damn dry drilling, local exhaust ventilation is combined with the head side of the working tool. To combat secondary dust formation use pneumatic cleaning of premises. Flowing dust with compressed air and dry cleaning of rooms and equipment is not allowed.

Individual means of protection. In cases where measures to reduce dust concentration does not lead to a decrease in dust in the working area to permissible limits, individual means of protection must be applied.

Individual protective equipment includes: anti-free respirators, safety glasses, special anti-car wear. The choice of this or that means of protection of the respiratory organs is made depending on the type of harmful substances, their concentrations. Respiratory organs are protected by filtering and insulating devices. The most widely used feeder type respirator. In case of contact with powdered materials that adversely affect the skin, protective pastes and ointments use.

Closed or open glasses are used to protect the eyes. Closed-type glasses with durable skieblands are used in mechanical processing of metals (hardware, chasing, manual riveting, etc.). In the processes accompanied by the formation of small and solid particles and dust, metal splashes, closed-type glasses are recommended with sidewalls or masks with a screen.

Overalls are used: dustproof overalls - female and male with helmets for carrying out works related to the greater formation of non-toxic dust; suits - male and female with helmets; Spacelon autonomous to protect against dust, gases and low temperature. For miners employed in open mountain works, workwear and shoes with good heat-shield properties are issued for workers' careers during the cold period of the year.

Medical and preventive measures. Medical monitoring of health care workers is very important in the system of recreational activities. In accordance with the order of the Ministry of Health No. 700 dated 19.06.1984, it is obligatory to conduct a preliminary medical examination upon admission to work and periodic medical examinations. Contraindications for admission to work associated with the effects of dust are all forms of tuberculosis, chronic respiratory diseases, cardiovascular system, eyes and skin.

The main task of periodic examinations is the timely detection of early stages of the disease and preventing the development of pneumoconiosis, the definition of professionality and carrying out the most effective medical and preventive measures. The timing of inspections depend on the type of production, the profession and the content of free dioxide silicon in dust. The inspections of the therapist and the otolaryngologist are held 1 time in 12 or 24 months. Depending on the type of dust with the mandatory radiography of the chest and large-frame fluorography.

Among preventive measures aimed at increasing the reactivity of the body and resistance to dust lesions of the lungs, the UV irradiation in fotias, which slows down sclerotic processes, alkaline inhalations, contributing to the upper respiratory tract, respiratory gymnastics, which improves the function of external respiration, diet with the addition of methionine and Vitamins.

Indicators of the effectiveness of anti-test measures are a decrease in dusting, reducing the incidence professional diseases lungs.

D.M. Huseynov A.A.

From the history of the question

Until the middle of the XIX century. lung diseases
caused by dust that
observed at miners and
Kamenotesov, were known under
names "mountain illness", "mountain
Asthma "," CHAKHOTE OF RUDOPOKOV ".
For pulmonary fibrosis arising
from inhalation of various types of dust,
German doctor K. Basker in 1866
The collective concept of pneumoconiosis was introduced.

Factors defining dust pathogenicity

Particle sizes:
- large (6-25 microns) - settle, the main
way in the nasal cavity
- "Average" (0.5-6 microns) - in bronchi
- 0.1-5 μm - the cause of pneumoconiosis
- less than 0.1 - smoke
The most dangerous - from 0.1 to 5.0 microns
Geometric properties (better
spherical particles penetrate)
Penetrating ability
The form
Radioactivity

Definition

Pneumoconiosis - (Pneumon - Light and Konia dust), a group of diseases of lungs
(irreversible and incurable) caused by
Long inhalation production
dust and characterized by development in them
fibrous process; refer to
Professional diseases.
Found in workers mining,
coal, engineering and some
other industries.

Terms of development:
1. Dust type.
2. Profmashrut:
3.
4.
5.
6.
7.
8.
Duration of exposure:
4-6 years of work (\u003e 70% quartz dust);
12-15 years of work (30-70% of quartz dust).
Sanitary and hygienic characteristics of working conditions:
Dust concentration in the workplace:
\u003e 70% quartz dust - MPC 1 mg / m3
30-70% quartz dust - MPC 2 mg / m3
The presence of a respirable fraction (1-5 microns).
The presence of incorporation of dust in light.
Dust removal efficiency (bronchogenic,
lymphogenic path).
Use of funds individual protection (PPE).
Genetic predisposition.
Harmful habits (smoking, alcohol consumption).

Pathogenesis of pneumoconiosis

Pathogenesis theories:
- mechanical
- toxico-chemical
- biological,
-imnunological.
Currently recognized
Immunological theory.

Stages of pathogenesis:

inhalation of dust particles in bronchioles, Alveola;
Dust Elimination Violation and Education
"Dust depot" in lungs and lymph nodes;
Absorption (phagocytosis) dust particles with diameter
less than 5 microns alveolar macrophages;
Activation and death of macrophages with release
active forms of oxygen;
The release of the contents of the dead cells, in
TCD cytokines and dust particles;
Repeated phagocytosis of dust particles by others
macrophages and their death;
Toxic action of oxidants on the pulmonary
Fabric (connecting fabric, proteins, lipids,
DNA, surfactant);

Stages of pathogenesis 2.

excess mediators
inflammation, chemohotontes,
Fibronctin;
Activation and proliferation of others
Effector cells inflammation
(neutrophils, fat cells, lymphocyte I.
fibroblasts);
enhancing the synthesis of fibroblasts,
collagen, elastin and fibrosis
in the lungs;
appearance in focus fibrous focus
Hyalinized connective tissue
(Formation of pneumoconiotic
nodules).

10. Features of pathogenesis:

The severity of inflammatory processes
Determined by the properties of affecting
dust, degree of dust load and
Feature effector response
Immune system with the inclusion of 4 types
Immune inflammation.
Against the effect of dust factor series
Researchers celebrate high frequency
Secondary immunological
Insufficiency.

11. 12. Classification of pneumoconiosis by type of industrial dust:

Silicosis - pneumoconiosis due to inhalation,
quartz dust containing free dioxide
Silicon.
Silicatosis - pneumoconiosis arising from
Inhalation of dust of minerals containing dioxide
silicon in the associated state with different
elements: aluminum, magnesium, iron,
Calcium et al. (Kaolina, Asbestosis, Talcosis,
Cement, saliva pneumoconiosis, etc.).
Metallokoniosis - Pneumoconiosis from exposure
dust of metals, iron, beryllium, aluminum, barium,
tin, manganese, etc. (Siderosis, Berilliosis,
Aluminia, etc.).
Carboconiosis - pneumoconiosis, from exposure
Carbon-containing dust: coal, coke,
graphite, soot (antrase, graphitosis, scenic
Pneumoconiosis, etc.).

13. Classification of pneumoconiosis by type of industrial dust 2:

Pneumoconiosis from mixed dust:
a) pneumoconiosis due to the impact of mixed dust,
having a significant amount of free
silicon dioxide (from 10% or more), for example, antrachocycosis,
Siderosilicosis, silicosilicatosis, etc.;
b) pneumoconiosis due to the impact of mixed dust,
no free silicon dioxide or with
insignificant content (up to 5-10%), for example
Pneumoconiosis of grinders, etc.
Pneumoconiosis from organic dust. In this species
included all forms of dust lung diseases that
observed when inhaling various types of organic dust
(cotton, grain, cork, cane). This includes
Diseases caused by the effects of plant fibers,
various agricultural dusts, including so
Called farm lung.

14. In 1996, a new classification of pneumoconiosis was adopted

1. Pneumoconiosis arising from exposure to high and
moderately fibrogenic dust (with a free dioxide content
Silicon more than 10%): Silicosis, antrachocyciasis, sederosilicosis,
Sylikosilicatosis. These pneumoconiosis are most common
Among sandblastiers, bubbles, peckers, agricultures,
refractories. They are prone to fibrous progression
process and complication of tuberculosis infection.
2. Pneumoconiosis arising from exposure
weaklyobrogenic dust (with a free dioxide content
Silicon less than 10% or not containing it): silicatosis
(asbestosis, talcosis, coalinosis, pneumoconiosis from exposure
cement dust), carboconiosis (antrase, graphitosis, scenic
Pneumoconiosis, etc.), Pneumoconiosis of grinders and
sandrafts, metal coniosis or pneumoconiosis from
X-ray-contrast dust species (siderosis, including
aerosol with electrical welding or gas cutter of iron products
Baritosis, Staniosis, etc.). They are characterized by moderately pronounced
pneumophybroke, benign and slow-stroke
the flow is often complicated by nonspecific infection,
Chronic bronchitis.

15. New classification of pneumoconiosis 2

3. Pneumoconiosis arising from
The effects of aerosols of toxico-allergic
Actions (dust containing allergen metals,
Components of plastics and other polymeric
materials, organic dust, etc.), - beryllio,
Aluminous, "Easy Farmer" and others
Hypersensitive pneumonites. In the initial
The disease stages are characterized by clinical
Picture of the chronic bronchipoly, alveolitis
Progressive flow with outcome in fibrosis.
The concentration of dust does not have a decisive value in
Development of this group of pneumoconiosis.
The disease occurs with insignificant, but
long and constant contact with an allergen.

16. International Classification of Diseases of the 10th Review (ICD-10)

J60. Pneumoconiosis of the coil.
J61. Pneumoconiosis caused by asbestos and other minerals.
J62. Pneumoconiosis caused by dust containing silicon. Included:
Silicate fibrosis (extensive) lung. Excluded: Pneumoconiosis with
tuberculosis (J65).
J62.0 Pneumoconiosis caused by talc dust.
J62.8. Pneumoconiosis caused by another dust containing silicon.
J63. Pneumoconiosis caused by other inorganic dust.
J63.0. Aluminous (lung).
J63.1. Boxing fibrosis (lung).
J63.2. Berilliosis.
J63.3. Graphite Fibrosis (Lung)
J63.4. Siderosis.
J63.5. Stannas
J63.8. Pneumoconiosis caused by other unspecified inorganic dust.
J64. Pneumoconiosis is unspecified.
J67. Hypersensive pneumonite caused by organic dust.
Included: Allergic Alleolitis and Pneumonite caused by inhalation
Organic dust and particles of mushrooms, actinomycetes or other particles
Origin.

17. The main sections of the new classification of pneumoconiosis:

I - types of pneumoconiosis;
II - Clinical X-ray characteristic
Pneumoconiosis.
In the diagnosis of pneumoconiosis leading role plays
X-ray research method.
In X-ray classification, small and
Big blackouts. Small darkening of rounded shape
Clear contours, middle intensity. They
monomorphic, diffusely arranged mainly in
Upper and middle lung sections. Small linear
Dimming incorrect form reflect
Peribronchial, perivascular and intermediate fibrosis.
They have a mesh, cellular or tired-cellular shape and
located mainly in the middle and lower departments
lungs.
Large dimming (the result of a merger of rounded dimming
on the site of atelectasis, pneumonic focus, with
Complicating tuberculosis). Based on x-ray
Characteristics allocate interstitial, nodule and
Nodular forms of pneumoconiosis.

18.

19.

20.

21. 22. Classification of pneumoconiosis

Clinical X-ray characteristic:
Interstitial - I Stage
Nodule - nodules 1-10 mm - stage II
Nodal (nodes\u003e 10 mm) - stage III
Clinical and functional characteristic:
Chronic bronchitis, bronchiolitis.
Emphysema of the lungs.
Days I, II, III.
Chronic pulmonary heart.
HSN I, II, III.

23. Classification of pneumoconiosis 2

Course of the disease:
slowly progressive;
quickly progressive;
regressive;
Later development.
Complications:
tuberculosis, pneumonia, bronchial
asthma, rheumatoid arthritis, SLE,
Sclerodermia, tumors (asbest),
Pneumothorax, etc.

24. Diagnosis criteria:

1.
2.
3.
4.
5.
6.
PROFMSRUT (work experience in conditions
dust formation).
Sanitary hygienic characteristic
working conditions (dust with the exceedment of the PDC when
Pneumoconios from highly moderate and
weaklyobrogenic dust, work more than 20% in shift
In conditions of dust).
X-ray - fibrosis of lungs of varying degrees
expression
Pneumoconiosis.
The clinical picture of the defeat of the respiratory organs.
Functional disorders - respiratory
Insufficiency, pulmonary heart (FVD, ultrasound
Hearts, USDG of the Vessels of the Small Circle, ECG, Gas
blood composition).
Survey study (probability of complication
tuberculosis).

25.

26.

27. 28. Treatment:

No specific treatment methods.
Treatment methods are used
Related chronic
Bronchitis.

29. 30. Prevention of pneumoconiosis

1.
2.
3.
4.
5.
6.
Reducing the level of dusting in the source of its formation
Fighting smoking
Development and implementation of the most effective means
Individual protection against dust
Timely
Holding
preliminary
and

Wet and salt-alkaline inhalations, UFO, rational
meals, food vitaminization, organization of labor regime and
rest, shortened working day, extra
Paid vacation and earlier retirement
According to the Order of the Ministry of Health of the Russian Federation No. 90 of 1996 and No. 405 of 1996
years in contact with quartz dust periodic
Medical examinations of workers spend 1 time in 12 months
Therapist
and
otorinolarningologist
from
Mandatory
Lung Radiography and Research Function External
breathing

31. Opportunity Examination

All patients who are first diagnosed
Pneumoconiosis, subject to the direction in the institution
Medical and social
Examination
for
Examination
and
establishment
Groups
Professional disability and / or degree of loss
professional working capacity in need
medical
Social
and
Professional
rehabilitation, which regulates "Resolution
Government of the Russian Federation of October 16, 2000 No. 789 "
DEVICE OF LOSS OF PROFESSION
Installed as a percentage, based on the loss assessment
abilities
Patient
realize
Former
Professional activities in the same amount

32. Silicosis. Definition

Silicosis is the most common and hard
flowing view of pneumoconiosis, professional
Light disease due to long
Inhalation of dust containing free dioxide
Silicon. Characterized by diffuse arrangement
in lung connective tissue and education
Characteristic nodules. This foreign tissue reduces
The ability of lungs to recycle oxygen.
Silicos causes the risk of tuberculosis diseases,
bronchitis and emphysema lungs. Silicosis is
irreversible and incurable disease, and
The impact of quartz can promote development
Light cancer.

33. Silicosis 2.

Most often silicosis develops in workers
Following industries and
Professional groups:
- Mining industry - at miners,
mining gold, tin, lead, mercury, tungsten and
Other minerals that occur in the breed,
containing quartz (drillers, penetrations,
explosives and others);
- Machine-building industry - Workers
Foundry shops (sand- and shot blasts,
Cubs, agricultures, brokers, knockers
and etc.);
- in the production of refractory and ceramic
materials, as well as in the repair of industrial
furnaces and other operations in metallurgical
industry;
- when the tunnels arete, the processing of granite, other
breeds containing free silicon dioxide
Grinding sand.

34. Pathogenesis

Pathogenesis of this complex disease
Not clear to the present.
The incidence of siliciasis is in
direct dependence on quantity
(concentration) inhaled dust and
Free dioxide content
Silicon. The greatest aggressiveness
Put particles of 0.5 to 5 microns in size,
which falling into deep branching
bronchial wood achieve pulmonary
Parenhima (bronchiole, alveol, intermediate
Fabrics) and hold in it.

35. Pathogenesis 2.

The most adopted pathogenesis theories
silicosis were mechanical, chemical,
Biological, piezoelectric and others. IN
present, according to immunological
the theory of pneumoconiosis, it is established that
Silicosis is not possible without phagocytosis of quartz
particles macrophages. The speed of death
Macrophages are proportional to fibrogenic
Dust aggressiveness. The death of macrophages is the first and mandatory stage in education
Silicatical nodal. Necessary
Prerequisite for occurrence and
the formation of the nodule is considered repeatedly
repeated phagocytization of dust, which
Release from dying macrophages.

36. Pathogenesis 3.

Active immune restructuring takes place
organism in the early stages of formation
silicotic process. Development of silicosa
accompanied by different
immunological reactions of cellular and
Humoral types associated with
Predecessors of antibodies with vlimphocytes and cells reacting
directly with tissue antigens, T-lymphocytes. In patients with silicosis,
especially when progressing the process,
There are an increase in various classes
Immunoglobulinov

37. Clinical picture

Clinical picture during sylikosis monotonne,
typical poverty subjective and objective
Symptoms.
Silicosis patients typically impose little
complaints. With a detailed survey from most of them
Receive typical for any chronic
Powerful diseases complaints: shortness of breath, cough
(which are often connected not so much with the severity
developing fibrosis, how many concomitant
Silicosis bronchitis.
The sputum can be with an admixture of dark ruby
dust particles)
Pain in the chest (usually non-intensive,
self-tapping and often related to
By changing the pleura).

38. Clinical picture 2

Clinical symptoms grow as far as development
fibrous process, so far the basis
Silicose diagnostics remains x-ray
study, while there is no direct correlation with
radiographic changes.
The general condition of patients with silicosis remains for a long time
satisfactory. Chest often ordinary shape
(with a significant emphysema can be expanded in
frontwall department). As progressing
pneumophybosis or when attaching bronchitic
Syndrome can detect the thickening of the terminal phalange
fingers and feet in combination with a change in nail shape in
The form of watch glasses.
Percussively - a box shade can be marked, especially
In the lower surface departments. With pronounced fibrosis with
forming large fibrous knots percussion sound
may be shortened, especially above the blades and in
inter-pumping area (mosaic picture).

39. Clinical picture 3

With auscultation in I and especially in the II and III stage
Diseases listen to hard breath that
Massive fibrous fields may have
bronchial tint over emphysematous
Respiratory areas are weakened. 1/3 - 1/4 patients
Listened scattered dry wheels (usually
non-permanent). Often listened
Melkushard unvivaous wet wipes and
Capital (this is due to the defeat of bronchiol,
interstitial changes, pleural
Spikes).
Percussic and auscultation mosaic
Silicose is observed mainly in
pronounced stages of the disease.

40. Clinical picture 4

Progressive forms of silicose peculiar
an increase in the total protein in the blood (especially
Large fractions - globulins).
Patients with nodules silicosis marks
Increase in the blood of protein-bound oxyproline
When reducing excretion with my urine
peptide-associated and free fractions that
characterizes the predominance of collagen synthesis in
The body over its resorption.
In the serum, SRB is often determined.
However, it should be kept due to the nonspecificity of these
analyzes (such changes may occur when
A number of other diseases - tuberculosis, COPL
and etc.).

41. Clinical Picture 5

As a rule, respiratory failure is developing,
The degree of which often does not correlate with severity
pneumophibrosis.
Respiratory disorders, in particular obstructive type,
determined the degree of severity of bronchitic
Syndrome and emphysema of the lungs, location
Silicotic nodules, mediastinal syndrome
(comprehensive mediastinal organs large l / y and
fibrous formations).
The determining factor for silicose is
The aggressiveness of dust (its concentration and dispersion,
content in it SiO2).
The disease is characterized by an unfavorable course in individuals,
Began to work in very young and middle age.
Silicosis belongs to diseases prone to spontaneous
progression and after stopping contact with dust,
What is especially typical for a nodule form.

42. Clinical picture 6

Most frequent progression option
silicotic fibrosis consider the merge of the nodules in
Large nodes with the transition to the nodal form of the disease.
The origin of these nodes can play a role
Atelectases and inflammation.
When progressing a fibrous process
consistently passes from stage I in II, from II - in
III. In the III stage, the process continues to progress
due to further distribution and increase
volume of individual seals, wrinkling,
Cyrrosis and emphysema. Gradually aggravated
Respiratory failure caused by
The development of the "pulmonary heart" and its decompensation.
Compared to nodule silicosis
interstitial fibrosis (most
Common form of modern silicose)
Progresses 2-3 times less and slower.

43. Clinical Picture 7

By flow, you can allocate:
- a slow-stroke (transition from
one stage in another takes decades),
- fast-moving (transitions from
Stages to the stage take 5-6 years and less)
- Late silicosis (Development of late
reactions to the impact of large
concentrations of quartz-containing dust through
10-20 years and more after termination
Work).

44. Clinic Silicosis

І
stage.
Dyspnea
arises
for
Significant
Physical
load
non-permanent spiny pain in chest,
Minor dry cough. For
Radiography
lungs
Notes
Symmetric gain of the pulmonary pattern, its
deformation. Against the background of the messenger
Picture in the middle part of the pulmonary fields
Appeal
in
Little
Quantity
Nature shadows with a diameter of 1-3 mm. Roots
lungs
extended
compacted
Increased lymph nodes.

45.

46.

ІІ stage. Characteristic more pronounced shortness of breath,
which appears with a slight exercise.
Painfacing pain, dry cough or with
A small number of sputum mucosa.
When the lung radiography is determined by the amplification
Metage of pulmonary fields, increase in quantity and size
novel shadows that are placed mainly in
middle and lower lungs.
In nodule form - on the background of the mellenchy mesh
Fibrosis shows a large number of thick placed
novel shadows in the form, snow blizzes. " For
interstice - nodules are missing or in a small
quantities.

47.

48.

III stage. Clinically manifests in loss
deficiency.
Dyspnea
worried about the patient alone. Pain in chest
The cell is often intensive,
There is a cough with a wet, possible
Sunshine attacks.
Radiography
lungs
Indicates
on
Merge of native shadows into massive
homogeneous, intense shadows with unequal and
fuzzy contours that are placed
Mostly in the middle lung departments.
Meet
Massive
Pureral
layers, thickening interdolete pleura.

49. 50. Complications of Silicosa

Silicotuberculosis. With severe nodule
Silicose (III Stages) Tuberculosis complicates
The course of the disease in 60-70% of cases and more.
At stage I - at 15-20%, at stage II - in 2530%. In an interstitial form - 5-10%
patients. Purge of tuberculosis on the background
Silicotic fibrosis more often
unfavorable. Forecast of the disease depends
both from the form of tuberculosis and from the form
Silicosis and degrees of their severity.

51. Complications of Silicosis 2

Special complication of silicose is to attach
articular syndrome - silicoarthritis. Rheumatoid arthritis
precedes the development of silicose, arises with him
at the same time or (more often) in different times after establishing
Diagnosis of silicose. Silicosis in the presence of rheumatoid
Arthritis is called Colin-Kaplan syndrome. This form
Silicosis is prone to progression.
The simultaneous combination of silicosis is not excluded,
Rheumatoid arthritis and tuberculosis. For diagnosis
Silicarthritis matters in blood
rheumatoid factor in significant credits.
Silicose combination S. rheumatoid arthritis, and possibly, with
systemic lupus, sclerodermy, dermatomyositis,
probably not a random coincidence, but due to generality
some mechanisms of immunoreactivity disorders due
What can it be considered as a complication.
With a combination of silicose with sclerodermia disease
Call Erasmus syndrome (by the name of the author. For the first time
described it).

52. Prevention

Visit to the pulmonologist 2 times a year.
Radiography of lungs - 1 time per year.
Antioxidants, respiratory
gymnastics.
Spa treatment.
According to experts, the only
way to prevent this disease
- Prevent inhalation
Drained air.

53. Treatment

In the initial stages shown
Sanatorium-resort treatment (South
Coast of Crimea, Kislovodsk),
Catureness, physiotherapy,
Inhalation.
Oxygen inhalations are prescribed and
breathing exercises.
In the sharp form of silicose spend
Bronchoalveolar lavage.
For the treatment of obstructive syndrome
Broncholitics are prescribed.

54. Treatment 2.

For the treatment of silicotuberculeza
(combination of lung silicosis and
tuberculosis) patients appointed not
less than 3 anti-tuberculosis
drugs.
In case of severe illness with
The emergence of massive fibrosis
Doctors tend to necessity
surgical treatment that
lies in lung transplantation.

55. Treatment 3.

Forecasts for the treatment of silicose lungs depend on
The nature of the disease and its stage. Chronic
silicose form proceeds almost without
Symptoms and initial stages forecasts
Almost always favorable.
Acute or chronic progressive
The form of silicose lungs leads to development
Fibrosis of pulmonary fabrics, as well as secondary
pulmonary hypertension.
According to American specialists, the disease is inexorable and irreversible.

56. Ability to work

The question of the working capacity of patients with silicosis is solved
Differentiated with the stage, shape and flow
fibrous process in the lungs, presence and degree
severity of functional disorders, character
existing complications and concomitant diseases as well
Professions and working conditions of the patient. It should be borne in mind
that silicosis compared with other types of pneumoconiosis
characterized by the most unfavorable flow and
Often combined with pulmonary tuberculosis.
With uncomplicated silicosis I preparation
patients depend primarily from the clinical picture and form
Pneumoconiotic process. Patient interstitial
the form of silicose, which arose many years after the start
contact with dust (after 15 years or more), in the absence of
signs of respiratory and heart failure can
be left in its former work if dyingness
air in the workplace does not exceed the maximum permissible
Concentration. Periodic medical observation of such
Patients should be held at least 2 times a year.

57. Help Examination 2

Patients who have an interstitial form of silicose I
Stages developed with a small work experience in contact with
dust (less than 15 years), as well as patients with a nodule form
silicose stage I, despite the absence of their respiratory and
heart failure and complications are subject to translation
to work that is not associated with the effects of dust and substances,
possessing an irritant action. So patient

adverse meteorological factors and work,
requiring large physical stresses.
Remove from work in contact with dust patients with silicosis I
stages whose profession is associated with exposure
aggressive dust containing a large number
Crystalline silicon dioxide, i.e. With the so-called
Silico-hazard professions (drillers, peckers, etc.).
Silicosis patients stage I can be recognized
disabled when they have heavy flowing
Complications (chronic bronchitis, bronchial asthma,
lung emphysema, pulmonary heart) or accompanying
Diseases with pronounced functional disorders
(respiratory and heart failure).

58. Working Examination 3

Patients with silicosis stage II regardless of the form and
The flow of the pneumoconiotic process
Contraindicated work in the conditions of impact
Any kinds of dust. Disability of such patients
may be limited or completely
Lost, which is determined by the degree
The severity of the respiratory and heart
Insufficiency and severity of the current complications.
If the ability of the patient is recognized
limited, it should be rational
employed to work out of contact with dust
substances possess annoying
action, as well as not requiring large
physical stresses and stay in
adverse meteorological conditions.

59. Opportunity Examination 4

In silicose III stage patients usually
disabled, and some of them
need unauthorized care due to
development of severe respiratory or
heart failure, accession
active forms of tuberculosis.
However, among this contingent of patients
There are persons who throughout
Some time can be recognized
limitedly able-bodied. For them
These types of labor should be selected,
in which the impacts of any adverse factors are excluded.
production environment and large
Physical stresses.

60. Dusty bronchitis. Definition

Dusty bronchitis - chronic professional
Respiratory disease resulting from
long inhalation of industrial dust in elevated
concentrations and characterized by atrophic and
sclerotic change of all structures of bronchial
Tree with impaired Motoric Bronchi and availability
hypersecretion.
In Russia, dust bronchitis is included in the list of professional
Diseases in 1970. Dust bronchitis occurs when inhalation
predominantly moderate aggressive mixed species
dust. Diagnosis chronic bronchitis Based on such
Clinical criteria as the presence of cough and selection
sputum not less than 3 months. For 2 years
exclusion of other diseases of the upper respiratory tract and
lungs. Potentially dangerous spheres: foundry,
mining, engineering, construction
Industry, agriculture, etc. Potentially
Dangerous professions: miners, coils, metallurgists,
Cement manufacturers, workers of weaving factories, grains,
Elevators, etc.

61. Definition 2.

The question of inclusion in
List of occupational diseases
diagnosis "chronic obstructive
Lung disease professional
Genesis "and replacing them diagnoses
"Chronic dust bronchitis (HPS)",
"Chronic bronchitis toxicochmic etiology."

62. HPB.

Causes of HPB allocation in
Independent nosological
Form:
1. High prevalence of hB
workers of various production, on
which are elevated
Dust formation.
2. 2. Growing CPB cases as
Increased work experience in conditions
Dust in production.

63. Classification of PB.

On etiology, depending on the composition and nature
Activated industrial aerosol:
* Professional dust bronchitis from exposure to conditionally
inert dust that does not have toxic and annoying
action;
* Professional toxic-dust bronchitis from exposure
Dust, toxic, irritating and allergizing substances.
According to pathorphological and endoscopic features:
* Catarval
* Catarial atrophic
* Cataro-sclerosing
On clinical and functional data:
* Unstructive bronchitis
* obstructive bronchitis
* Astmatic bronchitis
* Emphysematous bronchitis with tracheobronchial dyskinesia

64. PHB development phases

1. The initial phase (aggression) - the effect of dust causes
Response reaction from the mucous membrane
Tracheobronchial tree. The secretion of mucus increases
cover epithelium and mucous glands of bronchi with
By changing its rheological properties (increase in viscosity).
In case of long exposure to dust disturbed
Structure and functions of the cell mucosa
Tracheobronchial Tree acquire irreversible
character, and physiological methods of removal
The bronchial secret becomes insufficient.
HyperSectionage and change of the rheological properties of mucus
may be exacerbated by an irritant action of dust on
parasympathetic system of bronchial tree.
In the initial phase of the HPB, a violation is detected
Mukiciliary apparatus leading to a change in normal
functioning of the escalator mechanism drainage
Bronchi functions. This period is clinically determined as
Endobronchitis from irritation, or dust katar bronchi.

65. Phase of the development of HPB 2

2. The phase of deployed inflammation. how
The rule is noted by accession
infections are noted exudation and
infiltration. Through the porous system
The capillary channel overlook water, salt,
Fibrinogen, immune proteins. They penetrate
in the intercellular space and cause
Infiltration and swelling.
3. Recovery phase. Characterized
formation of varying degrees
Sclerosis severity with obliteration
Small bronchi.

66. Phase of the development of HPB 3

The evolution of HPB is a replacement of hypertrophic
Changes in bronchi atrophic with consistent
development of catarrhal intramural deforming
Bronchitis.
Distribution of inflammatory changes to distal
Bronchial wood departments are accompanied by violation
production of surfactant - surfankanta,
which leads to the development of bronchospasm, which contributes
The emergence of severe complications - obstructive
Emphysema lungs.
When combining bronchitis and emphysema lungs occurs
One obstruction mechanism (valve) - falling small
Bronchi in exhalation due to loss of light elastic
Properties.
The degree of obstruction is greater than defined
The predominant localization of the lesion. Basically she
Defended by the defeat of the bronchi of the middle and small caliber.
Obstructive ventilation disorders arise relatively
early.
Respiratory failure and chronic "pulmonary heart"
- Finite stages of chronic bronchitis.

67. Clinical picture

-
-
-
HPB is one of the forms of primary chronic inflammation
Bronchi. This is determined by some clinical
Features of the disease:
Slow gradual start, which is characterized
non-permanent, periodically increasing cough, as
Rule dry, sometimes with poor sputum, in the absence
Increase body temperature and substantial change
General condition.
Some types of dust (vegetable, mineral), providing
Allergizing action contribute to early violation
bronchial patency. Inflammatory process
promotes the development and progression of obstruction,
Emphysema of lightweight, respiratory failure, chronic
"Light Heart."
In the period of exacerbation, characteristic changes are noted.
laboratory indicators (leukocytosis with shift
leukocyte formula left, moderate increase in ESP).
infection and violation of bronchial patency
also contribute to the peripocal flashes of pneumonia,
prone to a protracted flow with an outcome in the carnification,
Pneumophybrosis, bronchiectase.

68. The clinical picture depends on the nature of industrial dust:

coal dust causes a pronounced reaction
The mucous membrane of the bronchi. Therefore, early
Complaints on the cough with a mocroid and
superinimation (coal professions);
Silicon-containing
dust -
changes in
bronchial trees are manifested atrophic
process with fibrosis walls with meager
Clinical symptomatic (sump, dryness).
Organic
dust
Remote
Direct
annoying
act,
Allergy
Action - the symptoms of the secondary BA appear,
more than mixed character.

69. Diagnosis Criteria for HPB

1. Professional history - experience at least 10 years.
2.
3.
4.
5.
6.
7.
On average 15-20 years. But with a combination of dust with
Toxic substances can develop earlier.
Sanitary and hygienic characteristics of conditions
labor - harmful factors exceed the PDC, when
The device was healthy.
Simplicit diseases in the same groups of persons
Objective signs of bronchitis while working in
Harmful conditions
Radiography to eliminate other diseases
FBS detected a combination of atrophic bronchitis
with atrophic damage to the VDP
Research FVD, ECG, Ehocheg, Sputum, General
Blood analysis.

70. Treatment

Stop contact with dust and eliminate the impact of others
etiological factors, first of all smoking.
Treatment with drugs was to be directed to
Restoration of bronchial patency: removal of spasm
smooth muscles, edema mucous membrane,
Hyperproduction viscous secret.
Apply the following drug groups:
- sympathomimetics (salbutamol, phenoterol),
- Xanthines (Eutillin, Theophylline),
- cholinolitics (bromide and bromide, bromide tiotropia),
- expectorant and mercolitic agents (acetylcisteine,
Bromgexine).
In the case of attachment of infection, prescribe
Antibacterial drugs.
With pulmonary failure - dosage oxygen therapy.
With a chronic "pulmonary heart" - heart glycosides,
diuretic drugs (Veroshpiron, hypothiazide, furosemide and
Dr.).
Physiotherapeutic procedures, respiratory gymnastics.

71. Opportunity Examination

Leading criterion allowing
decide the question of professional
Bronchitis accessories, consider
Careful comparison of clinical
data, disease history with
Professional route.

72. Working Examination 2

1 stage - unstructive bronchitis - employment outside
Contact with dust is not subject to. Work in their former
professions, subject to dynamic observation and
appropriate treatment
2 stage - the conclusion about the need to transfer to
Work with favorable working conditions. Contraindicated
work under the conditions of exposure to dust irritating and
toxic gases, in adverse meteorological
Conditions with significant physical exertion. Highly
It is important to raise the question of retraining with the corresponding
Labor recommendations. Specprofmrek with HPB 2 stages
Recognizes
Patients
Lentimily
able-bodied
from
Definition of 3 groups of disability on prof. Disease.
This establishes the degree of loss of working capacity.
In case of severe the course of HPH, they are disabled in
normal production conditions. Sometimes allowed
Work in specially created conditions.
If the patient needs outsiders, he
1 group of disability and 100% loss are determined
disability.

73. Professional bronchial asthma (PBA). Definition.

PBA - chronic inflammatory
respiratory disease with
increased bronchial reactivity, which
caused by contact with chemical
Substances in the workplace.
Characterized by episodes of difficult
Breath, whistles in the chest and cough. PBA
should be determined as a disease,
etiologically determined substances
which affect respiratory
The tract in the workplace.

74. PBA

Pb is known since the beginning of the XVIII century, when it was
{!LANG-96a78d4a974168afa16148e8228a058a!}
{!LANG-09a5c1832dbee81795ca432d659b04ce!}
{!LANG-0f79be946f4f66abd96b1a54737876a1!}
{!LANG-bf6f516629a83734a401b021c5c2f465!}
{!LANG-1e8eb509253cf75241d9dd145b280f3e!}
{!LANG-6a5cce69def56ff0be0ca7ad51e0f31b!}
{!LANG-19c57fbd114fe4ee7c4a132b9e06ab18!}

{!LANG-2af28dd278483a4765eed88801231f0a!}

{!LANG-6ca2c45ea65ed6fb1e033b41625b6082!}
{!LANG-cffa137ded6877cbac99c2cf713f6d6b!}
{!LANG-a94a31a44dc51f59ee8b0b6fb432a7e2!}
{!LANG-720c959b4b99a0c82b97bda13a15291a!}
{!LANG-f885710de2019c648787a9540e14c72d!}
{!LANG-23d11ceafbc968ab9e405724fc98884f!}
{!LANG-60249b5b95584c1b0b421923f621c3ac!}
{!LANG-5d98c688b0c55dce97e1eb1dba9c9503!}
{!LANG-a568b9868205f409037b16941632c25d!}
{!LANG-320392264a14ff57e5e7b1d004b9d275!}

{!LANG-c3e056656a9c65f623bd2e83c82a80e4!}

{!LANG-b870d1117c9ab2b8b57b3625c961130b!}
{!LANG-4254767a837781ba7062877c0e7ef0c3!}
{!LANG-044897dc45d9b69fa75dc4bcaa56af0c!}
{!LANG-55b7296c0960b41290ffd0f1b8241684!}
{!LANG-4b49955bb9429014e441ab29a9c4e673!}
{!LANG-13c53d957e8ad6d3a29408ef783ed7f4!}
{!LANG-44dc3831b127674d71a2ff71623282fa!}
{!LANG-441c16743df4f918db2011de0a2feae6!}
{!LANG-61aa7fc6e0ab1d3d3d21f0b1cbad81b2!}
{!LANG-3620684d4e1cb05532afe33780cdb369!}
{!LANG-ee12d18c6b08135a786a1c7776821ad4!}
{!LANG-9820254907d6356fa1001742245e54a6!}
{!LANG-86daaa80f82d0b08da64f46747fb25b8!}
{!LANG-a4b5295abc9edcf1e8d585d975921e54!}
{!LANG-7f582ff557603562ec6c5053f9383f46!}
{!LANG-2113c19d31eab57488d8f5f295776a98!}
{!LANG-cc019c87b2eb9bff048980288e4acbed!}
{!LANG-74264c5c60bf0c027cfbb89fc6729f5c!}
{!LANG-ec367c2be918bdf32ab7dfae7a27bb79!}
{!LANG-0644691f99fa4fc58af242c4b427dabb!}
{!LANG-60b02a187fd6e3b5349be87d1b3e69f5!}
{!LANG-f30472f54bdce30d44ff5b2f7d50e3fe!}
{!LANG-a109f13580b848d73d337ce1555f3624!}
{!LANG-8c5b4c0dc3843e94df88aa89f81c0176!}
{!LANG-caea3576dfc1cde1dc8397e2a1c952e5!}
{!LANG-c3a7c396ff44158b9e55d44a31524d31!}

{!LANG-89274b7c380b0ea6d134f07b36e53bfc!}

{!LANG-6b63f75e67032f2a86e11a6951c6d335!}
{!LANG-00c097c5a1c671dcbc92f0c25f4f057c!}
{!LANG-367699affd12e6a7bfd24ce26c76adc4!}
{!LANG-86a65b2cfc9a03a62186c25f2d891a0c!}
{!LANG-55000f3de6064cc93d5be0a45faaa1ff!}
{!LANG-840089c1aae89e519b9eb55f22580652!}
{!LANG-0796d50ddc5b9aba39244a49f312d21f!}
{!LANG-eedf340e37726789e77215d062cab972!}
{!LANG-96044f93409e8abe66f7ba69001ae379!}
{!LANG-bcc68e02ad53adf225bdd29204f2dc53!}
{!LANG-8a5697d03c0b874046d456273b0d6ad7!}
{!LANG-da31bedcd54038922161d289d8fb7d00!}
{!LANG-2f793ae4e3a34656e482d464c5d5842b!}
{!LANG-b5e54d2f16ed9bafd564a17cbafa4f64!}
{!LANG-6ec8e9b360afa8e58bb5d7bd4dcde5d9!}
{!LANG-f4e892352b687f1435c1d8dd50b1a509!}
{!LANG-b4f9f09c5059a3d43b01e192f5369802!}
{!LANG-9be38e400c8cedaa7e11f8dfc9857605!}
{!LANG-927122a2f28db3f48b324c2471036591!}
{!LANG-ae00526e34f2473c7ddf9eecb8eace55!}
{!LANG-c590106c2e29d69f1249dfac8ceee19a!}
{!LANG-5501150c73cde7d5242e94b68ab93958!}
{!LANG-ca5e8d81f3e4e5057ff7bbd8cd26308e!}
{!LANG-075babd6fb9e74a461f32ba6e9d31b20!}

{!LANG-6d4e0b4e04d0ff1fa6a86cb2fe3c36ca!}

{!LANG-a836a281b6293e05aad0e12948948d44!}
{!LANG-71d756b22c87e6cbc34bb9a69744f47e!}
{!LANG-838fc894dd9be8261a4c113b0431053d!}
{!LANG-995526e42e2169062188892d5731627e!}
{!LANG-13ea0272e9b2a9bf527a79d690a14d33!}
{!LANG-f28119b99c9b5c100cca80d9a840aad2!}
{!LANG-e105704470e6a6591e551568ab2428ba!}
{!LANG-ecccf4d2f59da2ff4476026aca77ccc5!}
{!LANG-1dc0bd3d00a29d7a3fab9fd5ecfa0fd4!}
{!LANG-0d13a6ce5682cdaebc75e1e33195e133!}
{!LANG-226f67f27b16514d31912f0b3319c261!}
{!LANG-279c40a24ee2d0f8ac648060921db74c!}
{!LANG-e146ea516bb79f65edc9b14e99d8a11e!}
{!LANG-a5c2456b8b1d9ed7adc87458cbcc8ed2!}
{!LANG-dc9f85ea091cfcc34e29ca9ad4735ad5!}
{!LANG-be9f3fea0a7f713d48cbfb9d263776cf!}
{!LANG-d5b1ab41d02c76fcf2dad3df3640062d!}
{!LANG-5f2566a296b28817dad1b34dbdeb96cf!}
{!LANG-70d0921fc97a6163b83157bf857d210b!}
{!LANG-9cb743017ae8a9ca9f454ff10a84e5d4!}
{!LANG-74006d69166903cf7046d502c02dd190!}
{!LANG-5bb5d2ba8d2bbeda23895d9654672a7b!}
{!LANG-7b3050eeba10b1c243b8f6b515c6e2c9!}
{!LANG-1389bc8d0ea42e6406031b81d9e60194!}
{!LANG-cdec2f7aaf4aef8e762127437c4abe2e!}
{!LANG-76a32dc8f897b017e980d6ecbdf5dbd3!}
{!LANG-ebb2cdfb9671b08beb995eddd5ff9540!}
{!LANG-7caffe1c9021576a1e4bcc059091b4d4!}
{!LANG-066742b8c941d87032c7571d719d48d5!}
{!LANG-6ea57e7ed21982a21bf4421e3c088d6b!}

{!LANG-a6437600a2ac60b7c8edf5722795254f!}

{!LANG-f61bbecbfa82e4493174483219c7e6a8!}
{!LANG-9ba94cada8dab2db948e95f8ac22511c!}
{!LANG-f20d886df832d367e2508d9b3b70bf04!}
{!LANG-8cb7f2b4578b5f39d3f8a764297eeff6!}
{!LANG-c9e335574cc209e73757a04cb083d1a1!}
{!LANG-f6010ccc298c136437f1094b22c175a9!}
{!LANG-a9b9d736ab5f9cb125082de59b22fe0f!}
{!LANG-3832fccffac93e6063ed65395b971924!}
{!LANG-0881223d3592d165d9c06915736c641f!}
{!LANG-55542daf373247781d065044d7ed0cff!}
{!LANG-7bb32a556fe31b8d86e96f8bf283443f!}
{!LANG-f8a6661709ad9bad825062f982daccee!}
{!LANG-f86bbef4ec388078928c32c97a2e7b01!}
{!LANG-52422f2d9bd0432a0561f52e7e1b6f6a!}
{!LANG-b61102f4cd10baf704d0bce5875f5149!}
{!LANG-3f28611b65bd8c3d01755447214d8ca3!}
{!LANG-5a8b6a2c5c2e58cb7460ae05c481ccbc!}
{!LANG-9f2f42816b3dd329ff4c4553ec7b9438!}
{!LANG-faae8f7166386cd36d52a4ee8a8a94f6!}
{!LANG-ff93973fa74a7c440e69c35ab7f67219!}

{!LANG-4d8bb4bb9cf3fcb738250fcaf7bff638!}

{!LANG-b2587b111bb9b03f035be04019305c03!}
{!LANG-0f8a298c4528ba41513007cc0fbaa896!}
{!LANG-cd8edd062173d2ac2d3986bec1b18a9c!}
{!LANG-6d5a783a12491ac7a88b50c694727fb0!}
{!LANG-1b60908486d29b2ba1e4fff5a339738a!}
{!LANG-3b50401434a075269a45c52bb222ba5b!}
{!LANG-04a1d3ec2d2023c28684ca5d4d909fac!}
{!LANG-03b5d30cfe9c16857f747dafe63cc62a!}
{!LANG-3f5760ac93bb643b3b8b1941f856427c!}
{!LANG-ccc5cdd1e06b385af2dababdcf22af7c!}
{!LANG-f166e943a31b5f8a5693f6151a450899!}
{!LANG-197b5fb09816835d0ee2c26e89b8da33!}
{!LANG-3f45b04a339b67d4a654c571aaae5207!}
{!LANG-0fd38d63279266a4f08c4d03bb126d31!}
{!LANG-dbbb3db80e6c9445d3cc91cb17514808!}
{!LANG-9c04f7639cdc812164bc588660676b17!} {!LANG-c4621306473c48cc0a2e37931ae18a4f!}{!LANG-3daea8576b41efd80e545d0501f90f2c!}
{!LANG-a8649b1fdbc4a5924bb9b05e2a40810e!}
{!LANG-c289a30cb004043069005db71d3c2eea!}
{!LANG-4728eb7758cb6b7d495f7b7fba4791f4!}

{!LANG-57fffbdd350666e1558bbdd4823dccbd!}

{!LANG-da2355035e3ac52a9add8b9810ae0a81!}
{!LANG-11d74c90ccba314f3fc000e1c1ae9bb1!}
{!LANG-715ea742002de186eff58c50524ca9ff!}
{!LANG-772648cc0d345bbab5ffbb80c02479fa!}
{!LANG-f1f60c2b6b607bc698ed731057259aa6!}
{!LANG-4ebeff635973d1f65d4a50cf46dd930e!}
{!LANG-e73bf4478cbc5c2ba135c5aca5dca1dc!}
{!LANG-dec0a5caa9828d49b4d385be56aaf652!}

{!LANG-f22e7ce48699fc0faff40b38d6c1fedd!}

{!LANG-c2a3b26903e64c4598aaa03888153501!}
{!LANG-28f4c982466a471d99048cab0b9e5129!}
{!LANG-637204bb9655d731bdaa49677a4c024c!}
{!LANG-0a8b85c89917d4f127676a6bf18487fd!}
{!LANG-4ffa491c41861f2a34fc746d44b107c9!}
{!LANG-4fc39b6dbce20671b826f8c5506f5123!}
{!LANG-da4e67af81b640ef57810cd80319d4ea!}
{!LANG-15d5163ae257404dfea7b3330fb75dcb!}
{!LANG-23aaf732d320f5c83e1564bfa11dfbe8!}
{!LANG-6b42405a83247bf3e5babff1f49655f6!}
{!LANG-ae837f11c2ea86c911b59884f8a0a92e!}
{!LANG-08a337f1a9e7659ae2926e301a2a8ec7!}
{!LANG-d876478ac12592a2dd288e7bddd158b5!}
{!LANG-bfc315cefbdaafe250458dd1209dd2f5!}
{!LANG-320b8184e6fe40d297af71e2d2b46245!}
{!LANG-ee420cd1917bd3a7f3640100d8a37818!}
{!LANG-d7e55d4e6e7ea091b52a2ccfc519d3e1!}
{!LANG-6e182867812ac420a339abb0fd50c7c0!}
{!LANG-51c86d0388de2cadfc8f7c672cbfd447!}
{!LANG-8befa04fdf018b92f4bddadef7ce35b5!}
{!LANG-6e4bbaac77d87a4c10ac5fef7c599e7b!}
{!LANG-e3ed259fc8c83ad59f4acc498fe7235c!}
{!LANG-fad9db347e5e6988ef0a82f4fbd9aa3a!}
{!LANG-671bd28c299e669bed89656d8729addd!}
{!LANG-60d79e0539af58abc0bb34b14e562439!}
{!LANG-b6975c8cb2b1089b890e2880c2e9ca27!}

{!LANG-f86eeb8d835c072babb5a8f20ca92c2c!}

{!LANG-d8e37473193cf913984b1eed834b9fcc!}
{!LANG-39b8a52a8069107268d313cfa8da6138!}
{!LANG-4c89be733121c3d8732e90c485436ddd!}
{!LANG-21b8747955a8e6479cf5dc1b7b2baf50!}
{!LANG-6e1fece1f40ad299bc8ae425b7485a6f!}
{!LANG-04a54f32a7fbb9bfec1586b9576b65e2!}
{!LANG-85d67512a296358b46acf6121eb70731!}
{!LANG-b321f2000578b08138a1f5269911c736!}
{!LANG-76060056440d2089042cb83ef79a2e8d!}
{!LANG-103a11ea5600399b05a3360f0730e160!}
{!LANG-8b54b67edff55633cc8f6d6428ee72d5!}
{!LANG-f5e521edf5df41bb14423b36600830c6!}
{!LANG-45a6122fa0751e24513f8558b972dcf6!}
{!LANG-fb60a781676e975de71710b6a86b43c8!}
{!LANG-cb43747451ff4d213d53dbce80342fef!}

{!LANG-a3cc687b8cc271f012806bb855695684!}

{!LANG-eb54a888b89d46fdbac05132012808f8!}
{!LANG-287598d40254441dfea2527d7c4514b1!}
{!LANG-a80008f85b27bb118faf9f3f1c731078!}
{!LANG-e0f32e7ccb61d75418837e423118b123!}
{!LANG-b68b950f8cc0d970e7d2d32ebf98b524!}
{!LANG-5009087f9116e71ce2c90b9e472835d0!}
{!LANG-18308719cc4bf347edcbcb9527a39236!}
{!LANG-4379107791eac41c5564edb33ddb375f!}
{!LANG-915ca031e0ffbccf45ece705c238d986!}
{!LANG-42f3c0996d30f428eebb916fbc1b0e22!}
{!LANG-0ed28a8e4410ef1ee7960925cc7cbdef!}

{!LANG-6845c3779b78d025c23f156eb69b7ef7!}

{!LANG-e1290e2222ecfc6b3c87fca3ec4b6d87!}
{!LANG-21eea4a034f5627e8a5efce5b36743f4!}
{!LANG-523ae758bdb735f662619da205a38121!}
{!LANG-0a48b3b02b2260b54a32e1a5077264ef!}
{!LANG-d56de50afc382d6f24f65059716cf4a7!}
{!LANG-93c9470a5100f33a82dc9ceda9110266!}
{!LANG-63484b4d539bacd69101d3c8dff3bb96!}
{!LANG-bb61f547da71358b22c649791c567150!}

{!LANG-d4f4161578a73986e95b7e93a5f9c4b3!}

{!LANG-b546c46c492e7cbec80eb2ee34daff0b!}

{!LANG-976f44eb40d1155fe06b0a75dbcace69!}

{!LANG-69328e92af0cd74ad3ad3a3c6667a285!}

{!LANG-e25895a870c5ac1e04ca29e39aaa9b2c!}

{!LANG-a1f085d13cca5ccfb5f6a063aca8830d!}

{!LANG-7ac05991196f5a7a74798b8da0814be4!}

{!LANG-24b3217d8b2550eedbd4b289981db49b!}

{!LANG-460ccaefd777606c3db1f71c04db75ec!}

{!LANG-9d34e86c3e7bc06231803a80d57ea6d3!} {!LANG-1d668cdd464fbd58a8ffcdc5c98b297c!}{!LANG-3745246c607cc49711069be1f54ad20f!}

{!LANG-ce0f29936cf4d101875539ecd5d7efdb!}

{!LANG-f13da29b804557d2266df3653db17eee!}
{!LANG-8729eb3285fcc3d415e58b39c5591285!}
{!LANG-95774993a4b73ec1d49798bd878919ae!}

{!LANG-d1fb8730d53d8b23c2129329db83edae!}

{!LANG-fc635b0e38fb0ce4202cd951f668e59f!} {!LANG-3f6916394f0f4dcde6f2e54e273047f6!}{!LANG-b00f28c75c76d529d9ca8e3bbd41061e!} {!LANG-cc9bfa55f9767c15b9daeaebdb9d37dc!}{!LANG-ee979b0da444fc07fe9319fb910bc94d!}

{!LANG-8ab8b059ae12fe81420100cf4a77622e!}

{!LANG-6b67df53c4a92977cf894b016e1ad09c!}

{!LANG-4a4a846b54fd3f3b059c15a13523b1a3!}

{!LANG-8fc1ecd5eeda1bf6b5143136028aee77!}

{!LANG-8bf993aadd8db81ae53981f1a96b3d99!}
{!LANG-bc4e15a20482b32f3534f23de936d4bd!}
{!LANG-9dc79e886bc97ac7276f11bb9d1e864e!}
{!LANG-a9402d4146e12102fe605b8b018d6a6b!}
{!LANG-e405efab582d4237f037e1cf2557f8f3!}
{!LANG-aad83f7abb01c02231517f8c089e62d1!}

{!LANG-b1836b565e228df09fabde8f946b4167!} {!LANG-6320b5e5c7a23fe1f559e5cd58f8cebc!}{!LANG-0b87545a0ec44ee80d45e9f738b30b6c!} {!LANG-e26ee20d48195ca7ab25492969530012!}{!LANG-64916d8fecae9f6cad6dc34f8b0da4c4!}

{!LANG-8fad7d831a2601ff36f17367e3a86877!}

{!LANG-8bc42b5895ce5d8b6285819c392c093e!}

{!LANG-16d2b0eb5c314498d628de8f1dee88cd!}

{!LANG-31b756a2a901d1ee61dd9a7f8166505c!} {!LANG-bb4ee38af66808f1e8f04c67a3687174!}{!LANG-074ad651d2002f2745e7963b8366afbf!}

{!LANG-5694a24aa91abc2122e8b0c1b5cfe65f!}{!LANG-f6c456f2e16517796a52e603cfc247c3!}

{!LANG-2bf74b5148c6223b7aca28e2d7a8ae5e!} {!LANG-83c64d21c970ad2310e159955fd0dc3d!}

{!LANG-c2ae44cb0aaa5ae0b27fed5dce428754!}

{!LANG-1e662a61a157ae5f53be1a41e4289da8!} {!LANG-2db4c2d4613cdf9e07d5aedf00182ecb!} {!LANG-b2ecfd20a8351385de59a7689849baaa!} {!LANG-19b481f34a5ea48f01e0d1b1f54777db!}{!LANG-c67f6b59f0551613d94de020bc73c17a!}

{!LANG-7c9205c913aaa8b79f1c29ac4d151ae5!}

{!LANG-c18cdd0eb28d9386be34e6d3b891d2eb!}

{!LANG-c57bcca58c56e8a1accfa976ec51f232!}

{!LANG-4911ad9704811fc3faa683ebe882e621!} {!LANG-19e0fb725bf26b9ba4af7596d588db8b!}{!LANG-8d5494c091a48e034f04ecc4b2f75005!}

{!LANG-94add5bf58ea2c63d434f8a5c924f7a5!}

{!LANG-0808436398e62b28614e2618c7530d35!}

{!LANG-a23d8ef5c5ae14f74bc15e8723debe96!} {!LANG-87893712be6e3dc46960881bf71286e6!} {!LANG-e1be7cd20611b5f9836a8c59e4991492!}

{!LANG-49e88ea9cbd19d8a289c10f73839d028!} {!LANG-a806db8904811f33725759161f41846d!} {!LANG-61d5a36190d5d618db6ebd06bcdeec02!}

{!LANG-4cbd383417b6081770776f362023cc0a!}

{!LANG-a7e561181becfbe57c4d2ecf38463a09!}{!LANG-8ae0a389cd0a54fd88ebcaa10377764f!}

{!LANG-e88382235544249e8caccd0b909952d5!}

{!LANG-2f458881e0cb7ba6ba8186cdd03e81f5!} {!LANG-efbabfb7b9fb76f47ba0d4acb779ca4e!}{!LANG-2f3fb11dd8bb54b60fe9f05f163696a5!}

64. {!LANG-047c5e8e4fc62e5c8f3eb315757fa882!}

{!LANG-afdbad43a8f730aa15ca2cd1476f7ae9!} {!LANG-3c5976fa56c95a722bfb4aaee88deecb!} {!LANG-ebf92ba5bedf00ef02b689c3a8a45105!} {!LANG-3c2d6938f931c54ec0e2d5a5720d9835!}{!LANG-1ec8ace191be166a85e179fde756b7ee!} {!LANG-6ab48d258816ce2307883d94b855a290!}{!LANG-71ecfa405f005e485c6b1af66108d6f3!} {!LANG-cd4b2079787c2161983338232be879d2!}{!LANG-5397d23fa093829fd2afe421ee0a760b!}

{!LANG-7b2da05ac3ba0f026cc784ce8b4df1fa!}

{!LANG-12bf5d720e57128e177304f7d42efc9d!} {!LANG-e37eac02837ec162ace629e219deed6e!}{!LANG-0e7104c54a0330453a3c084ad96b37df!} {!LANG-8d104dd773bbdff651c7b1f1a18ad7f2!} :

{!LANG-92e6986d326b260336039a99ddf43bcb!}

{!LANG-d9d231885a7433297490882454875c52!}

{!LANG-c42bee97679ecc7f12faebc25138deaa!}

{!LANG-a136955093a6c2ec9a26d57874b1a4ab!}

{!LANG-fb36667ec293b4f1cc7f4782bdc0dd01!}

{!LANG-05e384f94d9a76f22fd3b51f5d62f57b!} {!LANG-b89c6fb558df125f7ab1fbb67df04952!} .

{!LANG-e3d313de089d14599388cdec4aea0892!}

{!LANG-47ca913fefad440309b78d6131a02316!}

{!LANG-5188cd8d7004f0773f0a3acdcd9021a5!}{!LANG-3ec8fc3e7060e3bc3e54dc22c467e4e5!} {!LANG-1623ad9ced7709a57707b35e59acb906!}{!LANG-7bde0987d57caa35bacf6ae3b248da24!} {!LANG-b3b197ac0bbc8ff8a683b2cf046d5d71!}{!LANG-04a551afb757cb8f6b0472c89efa862d!}

{!LANG-09bcff5225851e38821dd539bcadfa2d!} {!LANG-96d579d7088fc83983327410d96fbcf2!} {!LANG-43df2959f5a1f2e0532f94d03d391f05!}

{!LANG-08d1d69004eca1c8e69fcb640bec43f6!} {!LANG-883800cbd9357d42cf2b3ab80e47493e!}{!LANG-ee43f0515fd8f9990485f380a7cf3d29!}

{!LANG-5c59ff6a7a97540fc2f62b99b5bbfa2b!}

{!LANG-64a562c2ebafd728f0d92edf0c5a506d!}

{!LANG-74a8e7d6e21f11c1f15424d974595383!}

{!LANG-2e5d51d3f5573a6940d196ea711439d6!}

{!LANG-64997e5000734715b1f78c69ff3c2dad!}

{!LANG-a646e30908cfcde0b638a48af18c0be3!}

{!LANG-766caec3b5459f52bd5e2b80ef6e03d5!}

{!LANG-078e093fc70bc42385200ea287dc0ba2!}

{!LANG-2e42f3b19e7980a41ecf5b0b85bc0cc1!}

{!LANG-51edf82afe80b84eeee3eab551da902d!} {!LANG-d20217feb8fc6f0e221833786b7de652!}{!LANG-0a4874d229b5a71575e10aac993a4ea8!}

{!LANG-f37bdf137b627c0ff4db68ac1784859d!}

{!LANG-044cc194876fe42447b3f472d9d2caee!}

{!LANG-86a5897aa0150ec7d0d64d84b5d85746!} {!LANG-da294968a17cbf12679381d0d3988379!}{!LANG-f8a2d540ba3f977c955f96d717259779!}

{!LANG-dbc7a09d5327fc727d7006a60925b80b!} {!LANG-fdc1b9ff39fc62f8341b73199d4f3f29!}{!LANG-dd82af39b5e62d2e7e9d0c81ee338475!}

{!LANG-de034c3588b9aa8b13f3665a32f76180!}

{!LANG-b54f2b0e7de3b2f81d0e8f713ec6b9b4!}

{!LANG-3c1d0e85e04f8a17c547c98ba7b77837!}

{!LANG-10f855f0572f2b3719fe173e7c1e97ba!}

{!LANG-843b1692279fd04eb82b49a02eab0f93!}

{!LANG-537f16800221b7588632dc88b5343b8e!}

{!LANG-eca8c0d0936857076d14c8d94ece06a7!}

{!LANG-0257febb1d6098bf6e088ae4ba02bcb9!}

{!LANG-b325be30a260897800dd13d7d9d4f5d8!}

{!LANG-8bfb859a3acbc01c371dd6d4ed53b910!}

{!LANG-8acd17d3d8434615244450801819a668!}

{!LANG-dc96e59c9b18c0c32bfc83aa5f77f699!}

{!LANG-ef5e41610e41e1f3e8690aac3e471171!}

{!LANG-0ba110ca6cfdc53dbcfdc74a536a2699!}

{!LANG-1cc738d09d8d71a79cda104d436eb15e!}

{!LANG-c74a22a62c51a44b460b03f8c6bc4d9f!}

{!LANG-8a45337275fda153399d1abde803e7c0!}

{!LANG-a3ee59bd3c3aaa6f67c492190a4ffe32!} {!LANG-da00cff4bb82b49667a8e37c4675c16a!}{!LANG-e99fd74d02a98d91c0d6419c083b52ad!}

J60. Pneumoconiosis of the coil.

{!LANG-e197487e076ab878537b41b2db1e7cda!}

{!LANG-8ca05241df81808f82d13d88d0bdaf83!}

{!LANG-ba86a18022706cc8e31bda51819aa730!}

{!LANG-139c577fc2bac668f19a068853a18597!}

{!LANG-69b5898d2ba3bdc5f5c578841e1e3fba!}

{!LANG-f29b63a2986dca74aad71e3f6f937055!}

{!LANG-b5b871556d641d529e92e1261ec9fe8f!}

{!LANG-0ee6dbf9b4418ad591fb2a46eba14c4d!}

{!LANG-1e8b3fa54fb44fa342207a8376127def!}

{!LANG-f49c392aeef18d290e3b12d86e49a6ec!}

{!LANG-f94bd12ac927e8bdc37f362ff34f96f7!}

{!LANG-99d4d6c20cceb96bae45e150432e5b2b!}

{!LANG-abea070fc88590a2a419d39b48437012!}

{!LANG-bdaad70a92a56f24fbfc89be7ce47dc8!}

{!LANG-5599104aa9e9a6641b6761040ca35153!}

{!LANG-c0954fd6a059fd7083d80fa01ad22626!}

{!LANG-1b6e897ddb3019a2bc6b4419245bbdfe!}

{!LANG-9330444365da183da1a7d93e8a494bd8!}

{!LANG-55e4caef97a33973d65b5f956945bd69!}

{!LANG-a90b0a5c1b6395b2da9ad556c7a3397a!}

{!LANG-e51acd9fb264a7d15f036b56620a6e8e!}

{!LANG-a94414a8324197e3e3c9105fc3d7b9f9!}

{!LANG-5f61462efca3b3d03e96c676039f2595!}

{!LANG-5599104aa9e9a6641b6761040ca35153!}

{!LANG-0d12d744ae0f95518b1d5df6ca1d166f!}

{!LANG-557cc402696b49b28da745a84a2a1c2b!}

{!LANG-d3812c931281946cd0f7436126c25054!}

{!LANG-760e264fc533ce13c623cd754bd4f698!}

{!LANG-45f47f86f3cc3f7aa9a33674d61aadb8!}

{!LANG-82ba8908596ebd40455873dfb602b4c9!}

{!LANG-67563e3f4ba1f176ec2fdcb8f6365858!}

{!LANG-3baef5720e45a22d8f0cdf1bef2fe4d1!}

{!LANG-f0c39618eabfd2f2e6a34370d64b0a35!}

{!LANG-fa2e35a3449df56d277219216cdc1ab3!}

{!LANG-ebe6cf3d0dbf8e2f7d7ea0c157340b44!}

{!LANG-ce9f242643072092cc7967fd75a186a4!}

{!LANG-f36169d245d01d1bf789c50708e0a6bf!}

{!LANG-0324dfef9936aec3293a463e5d20141a!}

{!LANG-d4f6dede0d6723599c0a84da77a83c0e!}

{!LANG-b8c4b7d6fbd9d4e61134a774a885b717!}

{!LANG-eeef86eef47f914376dc369121f194be!}

{!LANG-18e15c393119cc62624d49ed6c7c038b!}

{!LANG-71a9ad4966dadd38b39ee4b8d68450db!}

{!LANG-d926cff9f70f81a379dec90edfaa4172!}

{!LANG-1dfcf42d2f8e10967a5963bb35d81b23!}

{!LANG-1287b7613a434f04dad89fd5af0bee4a!}

{!LANG-1feed6a67a4a0169984f040b22b18288!}

{!LANG-591272df765cce1f9e3419803327c950!}

{!LANG-c4416f57ed7a8e0738b07a01526912d9!}

{!LANG-b45fb0262926365f25bb6821b6a6c726!}

{!LANG-9d82c62a884b146abbfb8e48fc8567f3!}

{!LANG-975743e9ae8d010b119843b983172120!}

{!LANG-70fd709607d5dbc785625320ca0b9bc5!}

{!LANG-718d240b58238be5808fc4639ab32b50!}

{!LANG-ed29d4cb4466ad4ac862ba3971e096bc!}

{!LANG-ac18f028c7e1f11263590b7c38803e35!}

{!LANG-e7eb47e12d95d9f50e736f3ab163401a!}

{!LANG-9bfba926f5e83aa775c6d4046797d16e!}

{!LANG-3680e4a7136562b25ee12fa7b2abb028!}

{!LANG-1dbfb2894d4edc0838603e72260c3fb8!}

{!LANG-ab0d51c2bf7ad97f9744768bef4a9c85!}

{!LANG-92958a3d921277884e40e7926b1b10be!}

{!LANG-a511d2f9a67c3bf5e9be3b355336cd7e!}

{!LANG-afcf3667e64fcd5ef38f328c683d711c!}

{!LANG-289d86d3f45a85d837a8d3305685f304!}

{!LANG-640879239ca794e3fefa550f621672e7!}

{!LANG-03996a0bc61013cdc65d1ed73b289c2d!}

{!LANG-4bccef2a9c4173db84ff75ac2c665695!}

{!LANG-8727a73a370cda84fb3ce5edabdbc94e!}

{!LANG-2b32d834130211e32f669fe9ca489835!}

{!LANG-5f01a6fd4c2a7a1e3e255577651f8255!} {!LANG-3fca74596dd043e9753b2ddb2a676822!}{!LANG-6f157a5bf24075c30ba0ff3c1b2d6e80!}

{!LANG-224ab0592cecbc8e4332d56933b62150!}

{!LANG-80d6ada82d1745caf30771c9df4c8486!}

{!LANG-71ca7e63415576bb69245026bf0fde57!}

{!LANG-0425b67df04ea3b42f392a97051c48b8!}

{!LANG-7560e7fce002d94347652db0cce31185!}

{!LANG-610a9aac22235540f66dba8373a61d2a!}

{!LANG-e1ac1aab9dab5d3c5c226557480f7c23!}

{!LANG-8359fb1f95bb05a07b28b330ee5ef894!}

{!LANG-d0e0f403ffcf412e804ecc6bafc8db85!}

{!LANG-5ca46b57960b68f9e97d72c70ebef9c0!}

{!LANG-7a2c2734e8cc544aa37c5a7f2901be03!}

{!LANG-a89935eccb460b9ab64fdf4bae7e21e5!}

{!LANG-5950cff9671d379036b1501a03eb7362!}

{!LANG-74bf5dddf07c7b273b4a1fc4a8cc78e0!}

{!LANG-8595c017378324d69098ec5c700110bc!}

{!LANG-4e447dcc605e593b1d69f098f8c8c714!}

{!LANG-cf0d04747810d7dd02671c05861f08cb!}

{!LANG-e3f5b50c801d6199d8aeb874efec4b92!}

{!LANG-b9729bd67f1dee892112a2db55d13a68!}

{!LANG-7bee69fc0f7a8f6673de19b4c613230b!}

{!LANG-bb34e92e93c4cfc3d1b285cfb2d197f3!}

{!LANG-143ccd4538e01e5e76e0d0c361a980bb!} {!LANG-1cfba9e01a9154a5392c0fa50702f167!}{!LANG-165a7e88ee81bb841085ebf280ce5d48!}

{!LANG-faee1608b9007ef808bc7fa71277d071!}

{!LANG-bd2a9d4a63dcfd6474550b48d4e70223!}

{!LANG-f9ee5b4ed4d35e73dca6909372e27a7b!}

{!LANG-0da55e2b66c4a7043d95b9a6913ba707!}

{!LANG-009ebd04e2fe72a3533166fa1d0c817a!} {!LANG-4a219e74c0214da3f3b10927e5dd321b!}{!LANG-de0e07122d42d543f27df39fed17f966!} {!LANG-d98612cbae5077a26b9d7f6dd2173d25!}{!LANG-a25631f276408978515c06c5e2533300!} {!LANG-fe05b0d073a247dd4e83d460d0f82b68!}{!LANG-b90287adbc61c8f5bab25f028553a308!}

{!LANG-353d36114575d3e5c7d6a8f734bcc599!}

{!LANG-e5f0db2e329295313504e49592b1c3b4!}

{!LANG-702064c8cd9642f10afce53a9a105920!}

{!LANG-6a7209d6e8ca063c7c89cb3dd4f3d658!}

{!LANG-98264441bb5e6f87d887e60f6e912328!} {!LANG-2774a44f438017573192a1e74e4d357d!} {!LANG-906cf0a21cd255ebd0b4e91b20c4d526!} {!LANG-a60001ee1af8822b9bbb5853569ac8cf!} What means lives Queen of Great Britain: the main income of the royal family

{!LANG-f343a444d053ed433261b8f2b4b0aa16!}

{!LANG-15050374b54a0520e364ddb2f125f9a7!}

{!LANG-9fd4483b6e96ea6f45aed98a4d2e567a!}

How to restore the menstrual cycle after childbirth: