Pleural Mesothelioma

from wikipedia

Mesothelioma is a malignant tumor of the mesothelium, envelope consists of two layers between which is a lubricating fluid. The mesothelium surrounding many organs: it called for the lung pleura, peritoneum for digestive viscera, pericardium to the heart.

The most common is that of the pleura: pleural mesothelioma is

It is almost always secondary to the inhalation of asbestos dust (this is known since the 60s) and possibly some RCFs. Microfibers inhaled asbestos will be housed deep within the respiratory tree in the cells, these high strength fibers migrate to the pleura where mechanical irritation of the pleura, the lesion base is primarily physical, not chemical. The time between exposure and disease, often by several decades, but may be shorter in some cases. This exposure can be short (one or two years) and therefore difficult to find and prove 40 or 50 years later.

Mesothelioma is one of the pathologies induced by asbestos (see our article on the subject)

Smoking increases the risk of lung injury but does not affect the risk of developing mesothelioma.

The signs of the disease are not very evocative and often late: Chest pain, neuralgia in the arm, back pain in the shoulder blade. Therefore considered to be rather banal
More evocative: pleural effusion (fluid between the often bloody layers of the pleura) with dyspnea (breathlessness)

The chest X-ray is rarely helpful except at an advanced stage.
Microscopic examination of aspirated fluid if effusion malignant cells can be found
CT and MRI examinations are the most useful and the diagnosis will be confirmed by a biopsy of the pleura or by thoracoscopy

Treatment: early surgery may be successful, then radiation therapy may slow the progression finally chemotherapy will be only palliative. The prognosis is generally awful (one year survival in many cases only).

Prevention is essential: removal of sprayed asbestos, protection of workers and their families (wife who cleans clothes for example)
Asbestos is banned in France since 1997 and in many Western countries (but there are other countries where everything needs to be done ...)

Occupations exposed are numerous.
Those who pay the highest price were, are and will (if the maximum is expected between 2010 and 2020):

Plumbers, welders, pipe fitters
Workers in the construction of iron or steel (carpenters, shipbuilding and rail car)
Sheet metal workers, boilermakers, auto mechanics and truck
Electricians
Construction workers in general
DIYers "madmen"
Employment in the manufacture of articles containing asbestos (asbestos cement, asbestos textile industry until 1996 with activity of carding, spinning or weaving)
Employment in the insulation (thermal or acoustic), in the manufacture of electrical insulators in power plants, refineries
Automotive repair and other vehicles (brake and clutch)
Assemblers in ventilation / heating / cooling, boiler installer
Steel industry (blast furnaces, coke ovens, steel mills)
Glass Industry
Dockers
And so on. ...

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Joints of the Upper limb

Shoulder joint:

The glenohumeral joint (colloquially called the shoulder joint) is the highly mobile ball and socket joint between the glenoid cavity of the scapula and the head of the humerus. Lacking the passive stabilisation offered by ligaments in other joints, the glenohumeral joint is actively stabilised by the rotator cuff, a group of short muscles stretching from the scapula to the humerus. Little inferior support is available to the joint and dislocation of the shoulder almost exclusively occurs in this direction.

The large muscles acting at this joint perform multiple actions and seemingly simple movements are often the result of composite antagonist and protagonist actions from several muscles. For example, pectoralis major is the most important arm flexor and latissimus dorsi the most important extensor at the glenohumeral joint, but, acting together, these two muscles cancel each other's action leaving only their combined medial rotation component. On the other hand, to achieve pure flexion at the joint the deltoid and supraspinatus must cancel the adduction component and the teres minor and infraspinatus the medial rotation component of pectoralis major. Similarly, abduction (moving the arm away from the body) is performed by different muscles at different stages. The first 10° is performed entirely by the supraspinatus, but beyond that fibres of the much stronger pectoralis major are in position to take over the work. Furthermore, to achieve the full 180° range of abduction the arm must be rotated medially and the scapula most be rotate about itself to direct the glenoid cavity upward.

Elbow joint:

The elbow joint is formed by three bones, the humerus, radius, and ulna. Articulations between the trochlea of the humerus with the ulna and the capitulum of the humerus with the head of the radius comprise the joint. The elbow is an example of a hinge joint, or a joint that moves in only one direction.

Wrist:

composed of the carpal bones, articulates at the wrist joint (or radiocarpal joint) proximally and the carpometacarpal joint distally. The wrist can be divided into two components separated by the midcarpal joints. The small movements of the eight carpal bones during composite movements at the wrist are complex to describe, but flexion mainly occurs in the midcarpal joint whilst extension mainly occurs in the radiocarpal joint; the latter joint also providing most of adduction and abduction at the wrist. 

How muscles act on the wrist is complex to describe. The five muscles acting on the wrist directly — flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, extensor carpi ulnaris, and palmaris longus — are accompanied by the tendons of the extrinsic hand muscles (i.e. the muscles acting on the fingers). Thus, every movement at the wrist is the work of a group of muscles; because the four primary wrist muscles (FCR, FCU, ECR, and ECU) are attached to the four corners of the wrist, they also produce a secondary movement (i.e. ulnar or radial deviation). To produce pure flexion or extension at the wrist, these muscle therefore must act in pairs to cancel out each others secondary action. On the other hand, finger movements without the corresponding wrist movements require the wrist muscles to cancel out the contribution from the extrinsic hand muscles at the wrist.

Sources: Wikipedia, Upper Extremity Anatomy Peter W. Johnson

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Anatomy of Upper limb

Tissues of the Upper Extremity:

Muscles
– Provide the forces for movement
• Tendons
– Connect muscles to bones
– Transmit forces to/from muscle and bones
– Relatively inelastic

Ligaments
– Connect bone to bone
– Stabilize joints
– Relatively elastic

Cartilage
– Protect and cover bones at the joints
– Devoid of nerves and blood vessels
– Takes a long time to heal

Bursa
– Fluid filled sac
– Protects and lubricates joints

Synovium
– Fluid filled sac
– Protects and lubricates tendons
crossing joints

Nerves
– Send signals to and from brain and
spinal cord

Sources: Wikipedia, Upper Extremity Anatomy Peter W. Johnson

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