VIBRATORNA BOLEST KOD PACIJENTA SA MIŠIĆNOM DISTROFIJOM: PRIKAZ SLUČAJA
Vuletin-Lekić V. 1,Bogdanović M. 1,Trikić R. 2,Stojanović-Rakočević V. 2
1 Klinički centar Srbije-Institut za medicinu rada i radiološku zaštitu Dr Dragomir Karajović Beograd, Srbija i Crna Gora
2 Klinički centar Srbije-Institut za neurologiju, Srbija i Crna Gora

Vibratorna bolest predstavlja skup poremećaja koji se javljaju pri dugotrajnom izlaganju lokalnim ili opštim vibracijama.U osnovi većine manifestacija bolesti leže vaskularni poremećaji, zatim neuromišićni i koštani. Klinički, vaskularni poremećaji ispoljavaju se angiospazmima, u vidu "belih prstiju", retko "plavih prstiju", trofičkim promenama kože; neuromuskularni, ispadom senzibiliteta i motorike (pleksitisi, radikulitisi, neuropatije) i koštani, oblikom cista, enostoza, egzostoza, aseptičnih nekroza.

CILJ: Prikaz retkog slučaja pojave vibratorne bolesti udružene sa mišićnom distrofijom.

PRIKAZ: Bolesnik, star 48 godina, čije su tegobe počele u četrdesetoj godini nemogućnošću dizanja ruku iznad ramena, i pri tome bi mu "virile lopatice", kočenjem i trnjenjem srednjeg prsta obe ruke, više levo, nemogućnošću ustajanja iz čučnja, bez pomoći. Objektivno, postojala je jako izražena hipotrofija i slabost mišića ramenog pojasa ("scapulae alate"), pelvifemoralnog pojasa i umereno mišića lica ("tapirske usne"). Hospitalizacijom u Institutu za neurologiju KCS-e, urađene su laboratorijske analize (CPK, LDH), EMNG-ija i neurološki pregled, te je potvrđena dijagnoza mišićne distrofije-facioskapulohumeralni oblik. EMNG-ski nalaz osim elektrofiziološkog nalaza miopatije pokazao je i postojanje senzorimotorne polineuropatije aksonalnodemijelinizacionog više demijelinizacionog oblika, umereno izraženu na donjim i blago izraženu na gornjim ekstremitetima. Ciljanim ispitivanjem radi dokazivanja vibratorne bolesti utvrđena je izražena insuficijencija periferne cirkulacije, zatim pomenuta senzorimotorna polineuropatija, čime su uz pozitivnu radnu anamnezu (ukupan radni staž 23 godine u "Livnici", od čega poslednjih 9 godina na brušenju i krajcovanju odlivaka, a zadnje dve godine na peskarenju) ispunjeni uslovi za priznavanje profesionalne bolesti. Na ovim radnim mestima bio je izložen direktnom uticaju vibracija, pognutom položaju i fizičkom naprezanju gornjih ekstremiteta, dugotrajnom stajanju.

ZAKLJUČAK: Ovo je ilustrativan primer radnika koji je na apsolutno kontraindikovanom mestu za njegovu osnovnu bolest, razvio profesionalnu vibratornu bolest i uspeo da ostvari 23 godine staža, što naglašava važnost profesionalne orjentacije.

VIBRATION WHITE FINGER SYNDROM AT THE PATIENT WITH MUSCLE DYSTROPHIA: REVIEW OF THE

CASE

Vuletin-Lekić V 1,Bogdanović M 1,Trikić R 2,Stojanović-Rakočević V 2.
1 Clinical Center Serbia -Institute of Occupational and Radiological Health Dr Dragomir Karajović Beograd, Serbia and Montenegro
2 Clinical Center Serbia-Institute of Neurology, Serbia and Montenegro

Disease vibration is the group of disorders, which become during long-term local or general vibrations. In the basis of majority manifestations are the vascular disorders then neuromuscular and bony. Clinical, vascular disorders to turn out angiospasmes, like the '"white finger" rarity ''blue finger'', a change troficals skin; neuromuscular, disorders sensibility and motorical (plexitis, radiculitis, neuropathy) and bony, to shape cysts, enosthosis, egzosthosis, aseptic necrosis.

AIM: Reports rarities are on phenomenon disease vibration together with muscle dystrophy.

REPORT: The patient, old forty eight years, whose difficulties begun in forty years, impossibility to raise hand upper than shoulder, and by doing that his shoulder blade sticks out, contracted and paresthaesie of the middle finger on the both hand, mostly left, impossibility getting up from squat, without help. Objective, there was strongly to express hypotrophy and weakness muscle shoulder waist (''scapulae alate''), pelvifemoral waist and moderate face muscle (''tapirs mouth''). Hospitalization in the Institute of Neurology Clinical Center Serbia, there have bin done analysis laboratory (CPK, LDH), EMNG and neurological checkup, confirmed diagnosis muscle dystrophy-FSH form. EMNG findings except Electro-physiological finding myopathia, should existing polyneuropathia sensorymotoria, aksonaldemyelinisation more demyelinisation form, moderate to express on the down and easily to express on the upper extremities. We found expressed insufficient circulation periphery, and polyneuropathiae sensorimotoria in position of work positive anamnesis (total work training twenty three years in the ''Foundry'', causing the last nine years on sharpening and to cast sculpture, and last two years on sanding) have bin profiled conditions for accepting disease (professional) occupational. On this work places he was exposure to direct influence vibration, to bow position and physical effort upper extremities, long-term standing.

CONCLUSION: This is to illustrate example of worker which is on the absolute contradictory place for his base disease, developed occupational vibration disease and he was successful to realize twenty three works training, what to accent importance professional orientation.