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Progressive Massive Fibrosis

Progressive massive fibrosis is a lung disease that is predominantly reported in people who work in mines. Hence it is also called Coal worker's Pneumoconiosis. Fibrosis is a nodular formation in different regions of the body. Often lungs are the most vulnerable. This is because of aerosol initiation, which has a faster chance of nodule formation causing tissue damage.


Clinical Manifestations

Most conditions associated with massive fibrosis are coherent to silicosis and pneumoconiosis. Lesions are caused due to tissue necrosis, which leads to hardening of the tissue forming nodular structures. In case of progressive fibrosis, massive scars are noticed because of dense agglomeration of the thickened nodules. These nodules predominantly appear in the upper lobes causing respiratory difficulties.


The onset of this disease is triggered by macrophage proliferation in the respective regions. The macrophages engulf the inhaled silicon particles causing the production of interleukin -I which facilitates the chemical mediation for tissue necrosis. Silica is commonly found in these necrotic nodules. The adverse effects of these silica particles are the onset of Pulmonary Alveolar Proteinosis (PAP) causing the accumulation of large particles, which can be noticed as spaces on radiological examination. Along with the affected upper lobe, the interstitial zones of the lower lobe are also obstructed and bronchial regions are damaged with the infiltration of the nodules. Honeycomb lung or asbestos bodies are common references for progressive massive fibrosis as both these conditions have giant cells upon pathological examination. Bronchogenic carcinoma and mesothelioma are the associated adverse conditions of progressive massive fibrosis.


The evaluation of patients suffering progressive massive fibrosis includes the understanding of the type of chemical or particle inhaled as it enables the physicians to rule out diagnostic errors. In cases such as pleural plaques, calcified regions of the lungs are noticed which is another cause of asbestosis. The lower region of the lungs are predominantly affected. In case of interstitial fibrosis, the bronchus and alveoli are affected with characteristic nodules of the upper and mid region. The evaluation is based on the type of chemical and the respective interleukins it releases. Most patients associated with these conditions are miners, shipyard workers, automobile mechanics and petrochemical employees.


Diagnosis and Treatment

Most diagnostic evaluations are radiological in origin as the MRI provides detailed description about the zones of the fibrosis and the size of each nodule. Histopathological analysis studies the intensity of the necrosis, giant cell presence and the macrophagic proliferation patterns. The treatment pattern is based on symptomatic analysis. Since the condition includes both lower and upper lobes, any associated mycobacterial infection has to be treated. Oxygen is given as a critical care measure in patients with hypoxemia. Surgical interventions are applicable in case of intense and irreversible tissue necrosis. Patients with progressive massive fibrosis are advised to quit smoking if as it causes intense damage.


Necrosis

Necrosis refers to premature death of living cells and tissue. This usually occurs due to infection or toxin. This is not the natural process of cellular deterioration (apoptosis).


Paralysis

Paralysis is a neurological disorder which is associated with the impairment of voluntary functions of the muscles. The important cause for paralysis is metabolic disorders of the neuromuscular functionalities. The attack of paralysis in the body is categorized into various types such as paraplegia (lower body), hemiplegic (one side of the body) and quadriplegia which is localized only to the legs. The motor and sensory activities are impaired at respective regions where the onset of paralysis takes place.


Causes of paralysis

The onset of paralysis has many predisposing factors and medical conditions. Thorough understanding and evaluation of these conditions paves the way for comprehensive diagnosis and treatment.

Ischemic cerebral stroke: Stroke is one of the fatal causes for paralysis. It happens because of the lack of blood supply to the cerebral region. The neuromuscular junctions are subjected to damage because of oxygen deficiency and hence the nerve cells associated with the efferent and afferent functions are impaired.


Trauma: Injuries to the head and spinal cord result in blood vessel and neural cell damage. In some cases paralysis associated with trauma can be localized and affects one region of the body. This phenomenon depends upon the site of the head injury and the peripheral neuromuscular fibre associations.

Infections and other causes: Paralytic occurrences can happen in patients who have a history of meningitis and abscesses present in the brain because of bacterial infections. Other causes of paralysis include Guillian Barre syndrome, cerebral palsy and multiple sclerosis.


Diagnosis and treatment

The definitive diagnosis of paralysis depends upon the source of its onset and progression. Paralysis neuromuscular dysfunction for which many causes are possible. Pathologically, paralytic sites indicate appearances of tissue necrosis caused because of gangrene associated hypoxia and ischemia. Cellular pathology often indicates dead cells and tissue debris because of necrosis. Surgical intervention is recommended in order to remove the necrotic tissue present in the regions like central nervous system.

Diagnostic interventions to paralysis include radiological examinations of the necrotic sites, nerve conduction studies in order to understand the myogenic and neurogenic abnormalities along with sensory and motor functions of a respective region. If malignancies are suspected, fine needle aspiration, cytology and biopsy tests are recommended to understand cellular pathology.


Treat of paralysis is mostly therapeutic in origin. It is necessary to identify the cause of the paralytic disease and to treat it appropriately with antimicrobial drugs in case of infections. Physiotherapy is advised to facilitate motor and sensory functions.

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Collection of Pages - Last revised Date: December 11, 2017