KAPLANA SYNDROME (A. Caplan, the modern English doctor) — the combined form of a pneumoconiosis and a pseudorheumatism which is characterized, along with the main displays of the specified diseases, also existence radiological the revealed roundish shadows in lungs and a high caption of a rhematoid factor in blood serum. In literature the first description of a pseudorheumatism at the woman suffering from a silicosis belongs belg. to the doctor Colin (E. Colinet, 1950). In 1953 Mr. Kaplan at inspection of the big contingent of miners noted a pseudorheumatism at 0,4% of patients with a pneumoconiosis. At the same time in 1/4 cases of the combined disease he found special kliniko-rentgenol. form of damage of lungs. In the subsequent the syndrome was described at miners, sandblasters, working foundry workshops and at persons of other silicosis hazardous professions. According to domestic and foreign literature To. the page meets in 0,1 — 0,6% of cases of a silicosis.
the Pathogeny To. the page remains not quite clear. Clear dominance of a pseudorheumatism at persons with quickly progressing clinically hard proceeding pneumoconiosis allows to assume a role changed immunol, reactivity of these patients. There is an opinion that dust particles can cause products of antiglobulinovy factors, W. h rhematoid, with the subsequent formation of rhematoid small knots in lungs.
According to Petri (Petri, 1954), H. And. Senkevich (1974) and other actors, development To. the page is inherent in a silicosis with a so-called immunoaggressive component.
Morphologically in lungs along with classical silikotichesky small knots also the granulomas with a fibrinoid necrosis in the center reminding rhematoid small knots are found.
To. the page is characterized by development of typical pseudorheumatism (see) in a combination to peculiar rentgenol, changes from lungs. Radiological against the background of diffusion, preferential intersticial, changes accurately delimited roundish blackouts from 0,5 to 5,0 cm in the diameter which are located with hl are defined. obr. on the periphery of both easy (fig). With progressing of a disease of blackout gradually increase in quantity and the sizes. Also others can be observed, inherent in a pseudorheumatism, visceral defeats (kidneys, a liver, heart). Feature To. the page is detection in blood serum of patients rhematoid factors (see).
The pseudorheumatism can join a pneumoconiosis, develop in parallel with it or (much more rare) to precede the first signs of the prof. of pathology of lungs with the subsequent formation the wedge, pictures K. page. The leader in a wedge, a picture K. the page can be as pulmonary process with heavy respiratory insufficiency, and a pseudorheumatism.
The differential diagnosis
the Differential diagnosis with primary and metastatic lung cancer is carried out taking into account characteristic for To. page rentgenol, manifestations and existence of a high caption of rhematoid factors.
To. the page should distinguish from a silicosis in combination with a joint form of a pseudorheumatism without signs of pulmonary manifestations, from damage of lungs as an intersticial rhematoid pneumonitis or a vasculitis in the absence of roundish shadows, characteristic of a syndrome, in lungs.
Treatment of patients To. the page is carried out taking into account a form and a stage of a silikoartrit according to the principles of treatment accepted at a silicosis and a pseudorheumatism.
the Forecast is defined by features a wedge, manifestations of a pneumoconiosis and pseudorheumatism. In most cases rather early resistant invalidism of patients is combined with the favorable forecast for life. At bystry progressing of pulmonary process the lethal outcomes caused by respiratory insufficiency and development hron, a pulmonary heart are possible. Less often the forecast is caused by rhematoid viscerites.
Bibliography K. P. prickly lettuces, etc. Rare forms of a pneumoconiosis, Gigabyte. work and the prof. having got sick., Jsfa 5, page 12, 1972, bibliogr.; Occupational diseases, under the editorship of E. M. Tareeva and A. A. Bezrodnykh, page 78, M., 1976; Senkevichn. A. Clinical forms of a silicosis and tuberculosilicosis, page 113, M., 1974; G and r 1 and p And. Certain unusual radiological appearances in chest of coal-miners suffering from rheumatoid arthritis, Thorax, v. 8, p. 29, 1953; Unge G. Mellner C. Cap-lan's syndrome, Scand. J. resp. Dis., v. 56, p. 287, 1975.
A. A. Bezrodnykh.