Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Vibration Disease caused by Physical agents

Vibration Disease caused by Physical agents

  • Loggen Sie sich ein, um Kommentare anzuzeigen.

Vibration Disease caused by Physical agents

  1. 1. Occupational diseases caused byOccupational diseases caused by physical agentsphysical agents
  2. 2. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Plan • Vibration disease • Occupational deafness • Altitude sickness and caisson disease
  3. 3. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Definition Vibration disease (T 72.2) – absolutely specific occupational disease caused by prolonged influence of vibration and characterized by polymorphous clinical manifestation with obligatory affection of nervous system and microcirculation (+ locomotor system)
  4. 4. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Synonyms Vibration disease Syndrome of “dead fingers” Vibration white finger Hand Arm Vibrations Syndrome (HAVS) Vibration (secondary) Raynaud Phenomenon Vibration induced vasospastic disease Grinders cramp Spastic anaemia
  5. 5. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Sponsored Medical Lecture Notes – All Subjects USMLE Exam (America) – Practice
  6. 6. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Pathogenesis • nervous - reflectory disorders; • disorders in microcirculation; • disorders of rheological properties of blood; • disorders in obtaining and utilization of oxygen; • disorders in hypothalamic-pituitary-adrenal system; • functional activity of sympathoadrenal system due to activation of adaptation mechanisms; • overexcitation of peripheral vegetative formations.
  7. 7. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Pathogenesis orthopedic disorders neurovascular disorders high frequencylow frequency ++ - overcooling - microtraumatization - physical overloads associated factors VIBRATION == • neurovascular disorders • changes in microcirculation & metabolism • affection of neuromuscular, locomotor apparatus
  8. 8. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Industries • metal-working • machine-building • metallurgical • building • mineral resource • agriculture • transport
  9. 9. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Occupations • polishers • grinders • cleaners high-frequency local vibration
  10. 10. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Occupations • croppers • riveters • tree breakers low-frequency local vibration
  11. 11. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Occupations • drivers of heavy machines • concrete workers low-frequency general vibration
  12. 12. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Occupations • polishers • grinders • cleaners • croppers • riveters • tree breakers • drivers of heavy machines • concrete workers high-frequency local vibration high-frequency local vibration low-frequency general vibration
  13. 13. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Classification • Vibrational disease caused by local vibration • Vibrational disease caused by general vibration • Vibrational disease caused by mixed vibration
  14. 14. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation • angiodystonic • angiospastic • syndrome of vegetative polyneuritis • vegetomyofascitis • myositis • osteoarthrosis • osteochondrosis • vestibular • encephalopathy (diencephal with neurocirculatory disorders) MAIN SYNDROMES
  15. 15. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (LOCAL) 1st DEGREE – initial manifestations: 1) peripheral angiodystonia of upper extremities, rare acrospasms; 2) sensory (vegetosensory) polyneuropathy of upper extremities. Complaints: - transient paresthesia (numbness, tingling, creepyness), - dull pain in distal parts of hands, chilliness of fingers, - rare whitening of fingers on cooling Physical examination: - cyanosis or mottled skin & hypothermia of hands - hyperhidrosis or dryness of hands - hyperesthesia  hypoesthesia for vibration - hyperkeratosis
  16. 16. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (acrospasm)
  17. 17. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (LOCAL) 2nd DEGREE – moderate manifestations: 1) peripheral angiodystonia of upper extremities, often acrospasm; 2) vegetative-sensory polyneuropathy of upper extremities: a) with often angiospasms of fingers; b) with stable vegetative-trophic disorders of hands; c) with dystrophic disorders of locomotor system; d) with cervicobrachial plexopathy; e) with cerebral angiodystonic syndrome.
  18. 18. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (Ligamentosis)
  19. 19. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (LOCAL) 3rd DEGREE – marked manifestations: 1) syndrome of sensomotor polyneuropathy of upper extremities; 2) syndrome of encephalopolyneuropathy; 3) syndrome of angiopathy with generalized acroangiospasms
  20. 20. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (GENERAL) 1st DEGREE – initial manifestations: 1) angiodystonic syndrome (cerebral or peripheral); 2) vegetative-vestibular syndrome; 3) sensor (vegetative-sensor) polyneuropathy of lower extremities.
  21. 21. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (GENERAL) 2nd DEGREE – moderate manifestations: 1) cerebral & peripheral angiodystonic syndrome; 2) syndrome of sensor (vegetative-sensor) polyneuropathy a) with syndrome of polyradiculopathy; b) with secondary lumbosacral plexus syndrome; c) with functional disorders of nervous system.
  22. 22. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Clinical manifestation (GENERAL) 3rd DEGREE – marked manifestations: 1) syndrome of sensomotor polyneuropathy of lower extremities; 2) syndrome of encephalopolyneuropathy; 3) syndrome of angiopathy with generalized acroangiospasms
  23. 23. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Diagnosis Set of “vibration tests”: • Nailfold capillaroscopy • Thermometry, thermography • Cooling rest • Hand aesthesiometry (palesthesiometry)
  24. 24. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Capillaroscopy
  25. 25. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Capillaroscopy
  26. 26. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Capillaroscopy norm 1st degree 2nd degree
  27. 27. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Cooling test
  28. 28. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Thermography
  29. 29. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Pallesthesiometry
  30. 30. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Dynamometry
  31. 31. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Dynamometry
  32. 32. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Diagnosis Differential diagnosis with: • Raynaud's syndrome • syringomyelia • vegetative polyneuritis • myositis
  33. 33. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Treatment • reasonable employment • physiotherapy • vitaminotherapy (C, PP, B-complex) • cholinolytics (spasmolytin, amyzil) • ganglioblockers (pachycarpin, benzohexonium) • vasodilatators (papaverinum, nicotinate) • calcium antagonists (cordafen, corinfar)
  34. 34. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Expertise of workability • 1st DEGREE – temporary (for 1 month) employment without contact with vibration • 2nd DEGREE – treatment in hospital (in-patient) and further temporary (for 1-2 month) employment without contact with vibration • 3rd DEGREE – limited working capacity, possible 3rd (or even 2nd ) invalidity group
  35. 35. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Vibration disease ⇒ Prophylaxis • technical measures • water procedures (bathes for hands) • gymnastics • periodical medical checkups
  36. 36. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Definition Occupational deafness (H 90.3) – occupational disease caused by prolonged influence of noise and characterized by perceptive symmetric decrease of hearing
  37. 37. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Etiology MPL = 80 dB high frequency low frequency 20000 Hz20 Hz middle frequency 300 Hz 800 Hz
  38. 38. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Pathogenesis intensity tonality periodicity character & degree of biological effect specific (affection of acoustic analyzer) non-specific (influence on nervous, cardiovascular systems)
  39. 39. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Pathogenesis Specific effects • affection of villae of lower cochlea of helix; • affection of support cells; • affection of spiral ganglion; • affection of vestibulocochlear nerve & plexus; perceptive type of deafness + disturbances of microcirculation & trophism
  40. 40. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Industries • metal-working • machine-building • metallurgical • building • mineral resource • agriculture • transport
  41. 41. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Occupations • fettlers • drillers • chippermen • riveters • polishers • grinders
  42. 42. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Diagnosis ComplaintsComplaints:: • neuritis – feeling of “noise”, “ringing” in ears; • neurasthenia – increased irritability, bad sleep, headache; • vestibular syndrome – dizziness; • neurosis – pain in heart region; • deafness – decrease of hearing in both ears. Physical examinationPhysical examination:: • vegetative disorders – stable red dermographism; • instability in Romberg position, tremor of arms; • decrease of perception of high frequencies (4-6 kHz); • reduction of bone conduction; • normal perception of usual speech; • normal otoscopy data;
  43. 43. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Diagnosis • audiometry – decrease of perception of high frequencies • ECG – pulse lability & disturbance of conductivity; • tendency to elevation of blood pressure. Stage, degree Tonal threshold audiometry Whisper teston 0.5; 1; 2 kHz on 4 kHz 1st , initial changes < 10 dB 50± 20 dB 5± 1.0 m 2nd , cochlear neuritis of mild degree 11 – 20 60± 20 dB 4± 1.0 m 3rd , cochlear neuritis of mean degree 21 – 30 65± 20 dB 2± 1.0 m 4th , cochlear neuritis of severe degree 31 – 45 70± 20 dB 1± 0.5 m
  44. 44. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Audiometry
  45. 45. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Audiometry
  46. 46. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Audiometry
  47. 47. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Audiometry
  48. 48. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Audiometry Volum Frequency, kHz Stage, degree Tonal threshold audiometry Whisper test on 0.5; 1; 2 kHz on 4 kHz 1st , initial changes < 10 dB 50± 20 dB 5± 1.0 m
  49. 49. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Audiometry Volume Frequency, kHz Stage, degree Tonal threshold audiometry Whisper teston 0.5; 1; 2 kHz on 4 kHz 2nd , cochlear neuritis of mild degree 11 – 20 60± 20 dB 4± 1.0 m
  50. 50. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Audiometry Volume Frequency, kHz Stage, degree Tonal threshold audiometry Whisper teston 0.5; 1; 2 kHz on 4 kHz 3rd , cochlear neuritis of mean degree 21 – 30 65± 20 dB 2± 1.0 m
  51. 51. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Audiometry Volume Frequency, kHz Stage, degree Tonal threshold audiometry Whisper teston 0.5; 1; 2 kHz on 4 kHz 4th , cochlear neuritis of severe degree 31 – 45 70± 20 dB 1± 0.5 m
  52. 52. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Treatment • reasonable employment • general health-improving therapy • vitamins C, PP, B-complex, glutamine acid and rutin • sedatives • physiotherapy
  53. 53. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Workability expertise 1st DEGREE – workability remains, dynamic medical follow-up should be performed; 2nd DEGREE – continue working under thorough medical follow-up OR transfer to another work not connected with noise; 3rd – 4th DEGREE – rational employment
  54. 54. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Occupational deafness ⇒ Prophylaxis • technical measures • anti-noise bushes (“earplug”), earphones, helmets • medical checkups
  55. 55. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Definition Occupational altitude disease (H 70.2) – occupational disease caused by sudden and significant decrease of oxygen in air
  56. 56. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Occupations
  57. 57. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Pathogenesis Acute decrease of pO2 in air Quick air pressure fall Acute increase of pCO2 in blood Irritation of chemoreceptors Reflectory reactions: ↑ heart rate ↑ breathing rate Acute decrease of pO2 in blood Hypoxia Disturbances of nervous system
  58. 58. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Clinical manifestation Collaptoid formCollaptoid form ComplaintsComplaints: - general weakness - feeling of “burning” - vision disturbances - dyspnea - feeling of “noise in ears” - dizziness & nausea Physical examinationPhysical examination: - excitement ⇒ sluggishness - paleness - sweating - decrease of blood pressure - usually no lose of consciousness Unconscious formUnconscious form
  59. 59. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Treatment • Oxygen therapy (+ 3 – 5 % of CO2) • Stimulation of blood circulation • Prophylaxis of complications • Symptomatic therapy
  60. 60. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Expertise of workability Transient collaptoid form – continue working after recovery Prolonged collaptoid or transient unconscious form – free from work for 1-2 weeks, no decrease of workability Prolonged unconscious form with residual changes – reasonable employment, decrease of workability
  61. 61. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Altitude disease ⇒ Prophylaxis • Use of oxygen equipment • Training in altitude chamber, in high mountains • Prophylactic medical checkups
  62. 62. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Definition Decompression disease (H 70.3) (syn. caisson disease) – occupational disease caused by sudden and significant decrease of air pressure
  63. 63. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Technology
  64. 64. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Technology
  65. 65. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Technology
  66. 66. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Technology
  67. 67. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Non-occupational
  68. 68. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Pathogenesis
  69. 69. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Clinics (ACUTE)
  70. 70. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Clinics (ACUTE)
  71. 71. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ X-ray (CHRONIC)
  72. 72. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ X-ray (CHRONIC)
  73. 73. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Threatment
  74. 74. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Decompression disease ⇒ Threatment
  75. 75. Occupational diseases caused by physical agentsOccupational diseases caused by physical agents PowerPoint presentation © Oleksiy Kalmykov, 2010, all rights reserved Thanks for attentionThanks for attention You may request this presentation...You may request this presentation... e-mail:e-mail: koleksiy@hnmu.org.uakoleksiy@hnmu.org.ua ICQ:ICQ: 75 17 17 2775 17 17 27 Skype, Gizmo, GoogleTalk:Skype, Gizmo, GoogleTalk: koleksiykoleksiy

×