Tumefactive Primary Central Nervous System Vasculitis: Dynamic Susceptibility Contrast Perfusion-Weighted Magnetic Resonance Imaging Findings With Histological Correlation

Purpose

Primary central nervous system vasculitis (PCNSV) is a rare inflammatory disease affecting the central nervous system. In some cases, it presents with large, solitary lesion with extensive mass effect that mimic intracranial neoplasms. This condition results in a diagnostic confusion for neuroradiologists because the differentiation is almost impossible on conventional MRI sequences. The aim of this study is to reveal the significance of dynamic susceptibility contrast (DSC) perfusion-weighted imaging in differentiating of tumefactive PCNSV (t-PCNSV) lesions from intracranial neoplasms such as glio-blastomas and metastasis.

Methods

In this retrospective study, DSC of 8 patients with biopsy-proven t-PCNSV has been compared with DSC obtained in 10 patients with glioblastoma, 10 patients with metastasis, who underwent surgery and histopathological confirmation. The ratio of relative cerebral blood volume (rrCBV) was calculated by rCBV (lesion) / rCBV (controlateral normal-appearing white matter) in the gadolinium-enhancing solid areas.

Results

The mean rrCBV was 0.86±0.7 (range: 0.76-0.98) in the patients with t-PCNSV, 5,16±0.79 in patients with glioblastoma (range: 3.9-6.3), and 4.27±0.73 (range: 2.8-5.3) in patients with metastases.

Conclusion

DSC-PWI seems to be useful in the diagnostic work-up of t-PCSNVs. A low rrCBV, i.e. a rCBV similar or lower to that of the contralateral normal white matter, seems to be consistent with the possibility of t-PCSNV.

Denosumab in elderly osteoporotic patients. A narrative review

Objective

Denosumab, an antiresorptive agent, has shown results in improving bone mineral density and reducing fractures in postmenopausal women. While bisphosphonates are commonly used as initial therapy for osteoporosis, some studies suggest that denosumab could be an alternative initial treatment for high-risk patients, particularly the elderly population. This narrative literature review aimed to assess the use of denosumab in elderly individuals with osteoporosis, excluding its oncology applications.

Method

Multiple online databases including Scopus, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PEDro were searched for relevant English-language trials.

Results

Between about hundred identified, the review selected 21 articles full-meeting the inclusion criteria. These papers all reporting that Denosumab demonstrated significant efficacy in reducing vertebral and nonvertebral fractures in postmenopausal and senile osteoporosis.

Conclusion

Even if limited evidence exists regarding its long-term effectiveness in elderly patients, nevertheless denosumab may be considered a first-line treatment for high-risk elderly patients with senile osteoporosis, particularly for those unable to take bisphosphonates. It has shown superior outcomes in improving bone density and reducing fracture risk, even in frail elderly individuals. Long-term use of denosumab has been reported as safe and effective, enhancing treatment compliance and outcomes.

"Klingon headache" - a case report of mimic new daily persistent headache associated to primary essential cutis verticis gyrata

BACKGROUND

Primary essential cutis verticis gyrata is a condition that usually affects healthy subjects associated to convoluted folds and furrows formed from thickened skin of the scalp resembling cerebriform pattern.

CASE

we describe a case of association between primary essential cutis verticis gyrata and new daily persistent headache.

DISCUSSION/CONCLUSIONS

In our knowledge this is the first description of new daily persistent headache associated with primary essential cutis verticis gyrata. We think that primary essential cutis verticis gyrata could be considered as a possible trigger factor, never described before, for the development of new daily persistent headache.

Evaluation of Tumor Necrosis Factor-Alpha and Granulocyte Colony-Stimulating Factor Serum Levels in Lead-Exposed Smoker Workers

Inorganic lead (Pb) is able to modulate the immune response even at low to moderate exposure levels. It inhibits in vitro and in vivo activities of neutrophil leucocytes and influences their blood count in humans. Neutrophil functions are governed by a number of cytokines. Pb has been shown to affect leukocyte production of some of these cytokines in vitro. The objective of this study is to assess serum tumor necrosis factor-alpha (TNF-α) and granulocyte colony-stimulating factor (G-CSF) levels of thirty-three male lead-exposed (E) workers at a lead recycling plant as compared with twenty-eight male non-exposed (NE) workers at a food processing plant, whose current smoking habit was known. Serum TNF-α and G-CSF levels were measured by a quantitative sandwich enzyme immunoassay. Blood lead levels (Pb-B) were significantly higher in E (geometric mean (GM) 30.7 μg/dl, GSD 1.7; min-max: 9.1–81.6 μg/dl) workers than controls (GM 3.6 μg/dl, GSD 1.7; min-max: 1.0–11.0 μg/dl). E workers had significantly higher serum TNF-α (median: 107.1; min-max: 11.1–623.0 pg/ml) and G-CSF levels (median: 53.0, min-max: 31.1–197.0 pg/ml) than NE workers (TNF-α: median: 12.0; min-max: 9.4–18.8 pg/ml; G-CSF: median: 34.3, min-max: 25.1–52.2 pg/ml). In particular, the TNF-α level was shown to be significantly influenced by lead exposure and smoking habit, as well as by interaction between these two factors. Both serum TNF-α and G-CSF levels were correlated with Pb-B and absolute neutrophil count. This study is the first to detect higher serum levels of G-CSF in E over NE workers. Our data confirm that exposure to low to medium doses of lead may interfere in the complex cytokine network involved in inflammation, especially in workers who are current smokers.

[Measurement of real personal noise attenuation using earplugs with the E-A-Rfit system]

BACKGROUND

The assessment of efficiency of hearing protection devices (HPDs), conducted above statutory limits, must be made using a standardized method while devices are worn; however, standardized and suitable laboratory conditions are difficult to encounter at the workplace. To overcome this problem, there are methods of measurement at the workplace such as "field-microphone-in-real-ear" (F-MIRE).

OBJECTIVES

The study was concerned with the measurement of real noise attenuation using earplugs and a new evaluation system: we checked the difference between "real" attenuation (at workplace) and "theorical" attenuation (reproduced in the laboratory) as stated by the manufacturer.

METHODS

We used the E-A-Rfit computerized method, which measures the loss of attenuation of earplugs in the ear, calculating the difference of sound pressure between an "outside" microphone and an "inside" one, in relation to the same earplug. The measurements at the workplace were carried out on eight subjects with good hearing levels (aged between 20 and 25 years), who were trained to wear the devices correctly. After the tests carried out with the E-A-Rfit system, which does not require a subjective answer, we obtained graphs and tables showing real noise attenuation.

RESULTS/CONCLUSIONS

We propose a comparison between hearing threshold for frequency, personal attenuation rating (PAR) and single number rating (SNR, provided by manufacturer): a difference of 10 dB (PAR 27 db vs. SNR 37 dB) was clearly evident although dissimilar methods were used to obtain such values. The instrument is rapid, simple and objective to use and also allows personalized information and training for every worker.

[Liver angiosarcoma from past exposure to vinyl chloride: a case report]

BACKGROUND

Experimental data and large occupational cohort studies in polyvinyl chloride (PVC) manufacturing plants have shown that vinyl chloride monomer (VCM) at high environmental concentrations, such as those measured in western chemical companies at least until the mid-1970's can cause liver angiosarcoma.

OBJECTIVE

To describe a recent, accurately diagnosed case of fatal liver angiosarcoma, for which it was possible to establish the causal relationship with past VCM exposure.

RESULTS

The deceased subject had been working as blue-collar for at least eleven years (1968-1979) in a PVC plant. VCM exposure was high on average and very high during autoclave cleaning, compared with VCM air measurements reported in those years at plants in Europe and the United States. The latency period was about 40 years. The duration of exposure, the cumulative exposure and the latency described were similar to those associated in the scientific literature with an excess risk for liver angiosarcoma.

CONCLUSION

The Italian Workers' Compensation Authority (INAIL) has already acknowledged the occupational origin of this neoplastic disease with clear advantages for all parties concerned, not only in economical terms.

Lead exposure in firearms instructors of the Italian State Police

BACKGROUND

Several studies evaluated exposure to lead in relatively small groups of firearms instructors and shooters, mainly operating at indoor ranges.

OBJECTIVE

To assess the levels of lead exposure in a large sample of firearms instructors of the Italian State Police (SP) operating at either indoor or outdoor ranges.

METHODS

A crosssectional study was conducted in firearms instructors working in indoor (No. 188) and outdoor (No. 188) ranges compared with 170 foodplant workers. The personal and work characteristics and current blood lead (Pb-B) levels were evaluated The concentrations of environmental lead (Pb-E) were measured using personal samplers in 6 indoor and 6 outdoor firing ranges.

RESULTS

The Pb-B levels in the two groups of firearms instructors were well below the ACGIH BEI, but significantly higher than in food plant workers. In the entire study sample the Pb-B level was seen to be influenced by age and job group. An excess risk of having Pb-B >100 microg/l was found in indoor range instructors and in those with greater job seniority. Pb-E <25 pg/m3 was measured in all the firing ranges examined.

DISCUSSION

The low Pb-B and Pb-E levels assessed are the result of primary and secondary prevention interventions carried out over the years by the Italian State Police. The current Pb-B levels also seemed to be poorly influenced by higher past environmental and/or occupational lead exposure. In fact a certain number of firearms instructors, mainly operating at indoor ranges and with greater job seniority, had Pb-B levels consistent with occupational exposure to lead. Environmental and biological monitoring of lead exposure and specific health surveillance are therefore still necessary in this job group topreventpossible adverse health effects of lead even at low doses.

The value of the D-Dimer assay for predicting vein thrombosis in rehabilitation patients receiving prophylactic low molecular weight heparin doses

PURPOSE

Early diagnosis and treatment of venous thrombosis biocontact="no" are essential in preventing pulmonary embolism (PE) and reducing the risk of recurrence. The objective was to assess the usefulness of the D-Dimer testing to rule out symptomatic VT in populations of patients receiving heparin in prophylactic doses.

METHODS

One hundred and twenty-three rehabilitation patients with medium or high risk for VT were investigated. Patients were affected by acquired cerebral diseases (n=31), severe brain damage (n=32) or orthopaedic surgical sequelae for major joint replacement or multiple limb fractures (n=60). All patients were receiving prophylactic heparin doses. D-Dimer levels were assessed using Dimertest Latex Agglutination Assay in citrated plasma. Single blinded compression Doppler Ultrasound (DUS) examination was performed in conformity with international standards.

RESULTS

In this specific setting, good sensitivity and specificity of the D-Dimer test was confirmed in patients with acquired cerebral diseases during rehabilitation, whereas false positive results were found in most patients who had undergone major joint replacement, until several weeks after surgery.

CONCLUSIONS

In rehabilitation patients receiving prophylactic heparin doses, the D-Dimer test seems to confirm high sensitivity and high negative predictive value for VT and PE. Relevant clinical variables seem to reduce the usefulness of the D-Dimer test as a screening tool for VT, at least in orthopaedic patients with joint prosthesis.

Effect of lead on the levels of some immunoregulatory cytokines in occupationally exposed workers

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-alpha and INF-gamma, were measured in healthy workers with very low (Pb-B=3.2-18.0 microg/dL) and low (Pb-B=9.1-46.0 microg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B=9.1 -46.0 microg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-alpha levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-alpha, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis.

Low back pain after unstable extracapsular hip fractures: randomized control trial on a specific training

AIM

This study compares the efficacy of a walking recovery rehabilitation program with or without specific back exercises in patients affected by unstable extracapsular hip fractures and secondary back pain. Further, it reports data and images about analysed tomographic changes of the psoas muscle ipsilateral to fractures.

METHODS

A prospective, randomized, parallel treatment trial was carried out. Patients admitted for rehabilitation after fractures were evaluated for secondary back pain. If clinically indicated, patients were further scheduled for a computed tomography (CT) scan of the lumbar spine by which we evaluated cross-sectional changes in density and fibroadipose degeneration of the body of the psoas muscle. When back pain matched cross-sectional changes in psoas density, the patient was eligible for our study, enrolled and randomly assigned to 1 of 2 study groups. Both groups were scheduled for hip rehabilitation and walking training plus a back protocol for the study group only. Pain was evaluated subjectively with a visual analog scale to calculate treatment effectiveness and Harris hip score was used to assess the outcome after surgery.

RESULTS

Thirty-seven patients out of about hundred were enrolled. In all cases CT scans showed age-related changes commonly seen in the lumbar spine and significant fibroadipose degeneration and altered density in the ipsilateral psoas muscles. With back exercises added to the standard rehabilitation protocol, all study patients recovered significantly better than control group patients (P<0.04) in only 4 weeks of treatment.

CONCLUSION

Results show how hip fractures may cause psoas changes that can be of relevance for a more rational choice of physical exercises. Causes of back pain may be more complex than described by the textbooks and prognosis is more favourable following specific back training.

[Evaluation of plans for reclamation from products containing asbestos to ensure safety to the workers and the general population]

Fifty-two working plans for abatement of asbestos-containing materials (ACM) were examined being presented over 12 months at a Public Occupational Health Service in Apulia (Italy) by authorized companies. Most of the interventions took place in urban areas and civil buildings and lasted few days with employment of a limited number of workers. They mainly consisted in removal practices. The weight of ACM abated varied from 30 to over 14,000 kg. Air monitoring of asbestos fibres was included not in all plans. When airborne fibres were detectable, the threshold of environmental pollution (20ff/L) was sometimes reached or exceeded. This finding appeared to be relevant for asbestos exposure of workers and general population. A higher fibre dispersion occurred during abatement of amounts of ACM more than 1,000 kg. The Occupational Health Service should be legally and operatively able to make regular workplace inspections, especially when large quantities of ACM have to be abated.

[A case of occupational lung disease (welder lung) in a mechanical worker]

A case of welder's lung is reported in a male hard smoker who had worked as welder-carpenter for almost 30 years. In order to establish an etiologic diagnosis, given the informed consent from the worker, open lung biopsy was performed that allowed to obtain sufficiently large specimens of affected lung to make histological, immunohistochemical and mineralogical examination. In such a way the pathologic features were accurately defined and a multidisciplinary approach was applied to differential diagnosis. The worker is recommended to undergo a strict health surveillance because of the reported association of welder's lung with lung cancer, especially in smokers.

[Chronic lumbago after unstable intertrochanteric femoral fracture: a new syndrome or sporadic feature of hip biomechanics after surgery? A case report]

OBJECTIVE

Only in 2002, more than 86,000 hip fractures were registered in Italy in male and female patients over 45 years old, with 9% progression compared to 1999. In this paper, we report a clinic case of a patient experiencing working problems for a chronic back pain after an unstable extracapsular hip fracture.

SUBJECT AND METHOD

The patient, a 54 years old woman, factory worker, complaining of low back pain weeks after the hip fracture, was evaluated and scheduled for a computer tomography examination of the lumbar spine. The C.T. scans were evaluated to assess eventual evidence of disc problems and/or cross sectional changes in density and fibro-adipose degeneration of muscular body of the psoas muscle.

RESULT

Because back pain matched with the evidence of cross sectional changes in psoas density without any evidence of disc herniation, the patient was scheduled for aspecific back pain training. After a specific rehabilitation protocol the patient had 75% pain relief after four weeks.

CONCLUSION

Age and diseases related changes are commonly seen in the lumbar spine, but the relationship between these changes and symptoms of back pain is not straightforward. Our case report suggest that back pain following extra capsular hip fracture may involve the psoas muscle. The prognosis might be favourable following a specific back training that is actually object of an ongoing controlled trial.

Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?

AIM

The purpose of the trial was to evaluate the efficacy of suprascapular nerve block (SSNB) to relieve the shoulder pain, ameliorate recovery after physiotherapy and reduce disability due to a rotator cuff tendinitis (RCT). A prospective, randomized, comparison cross over investigation was performed in the setting of a large inpatient rehabilitation unit with more than 200 admissions annually.

METHODS

A total of 40 potential study subjects, who complained of shoulder pain from a RCT, were enrolled and randomly assigned to standard rehabilitation treatment plus SSNB (Group A) or to standard rehabilitation treatment alone (Group B). The UCLA shoulder rating scale was used to assess the shoulder mobility on admission and discharge, and to calculate the percentage of potential improvement achieved during rehabilitation (effectiveness). A pain visual analogic scale was used to serially assess pain. At the end of the trial, a self-report questionnaire evaluated whether patients could sleep and achieve activity of day life carry out everyday activities better than they could before treatment.

RESULTS

Forty patients suffering from RCT entered the study. Those receiving nerve block from the beginning of the treatment in addition to standard rehabilitation therapy reported significantly less pain during physiotherapy and better final outcomes. During treatment with SSNBs, patients reported a more significant reduction in the intensity of pain and a better reduction of pain during sleep and rehabilitation exercises in comparison to with the standard therapy alone. A statistically significant inverse correlation was found between shoulder pain and mobility.

CONCLUSIONS

The results indicate that combining nerve block with standard rehabilitative therapy may improve the final outcome of painful RCT. It decreased the severity and frequency of the perceived pain, improved the compliance with physiotherapy, restored more normal sleep patterns, and increased compliance with the rehabilitation program. This result proves to be an effective, safe and inexpensive therapeutic option for patients suffering from painful disabling shoulder tendinitis.

[Exposure to low doses of inorganic lead and arterial pressure among fire arm instructors of the Italian State Police]

Firearm instructors represent a particular occupational group exposed to low lead (Pb) doses. Even low blood lead levels (PbB) of this metal can cause an increase of blood pressure (BP).

OBJECTIVE

To assess the Pb exposure of the firearm instructors of the Italian State Police (SP) and the effects of Pb on their PA.

SUBJECTS AND METHODS

376 instructors were studied, including 188 subjects working at indoor and 188 at outdoorfiring ranges. After obtaining informed consent, information on work, social and pathological history was collected and measurements of body mass index (BMI), BP and blood lead (PbB) level were obtained from the medical records.

RESULTS

The mean PbB level of the instructors of outdoor ranges (6.7 +/- 5.3 microg/dl) was significantly lower than those of indoor ranges (8.5 +/- 7.6 microg/dl). In the instructors of outdoor ranges the diastolic BP (DBP) was significantly influenced by BMI and PbB, also considering the common confounding factors.

DISCUSSION

The mean PbB level of the firearm instructors of the Italian SP resulted to be clearly below the biological limit value for Pb. In the instructors of outdoor ranges the even low PbB levels detected were able to determine a slight, but significant increase of DBP, also after correction for the main confounding variables. It is therefore necessary to keep on effecting biological monitoring and health surveillance of firearm instructors of SP and to promote the reduction of their body weight.

[Evaluation of myopia in a group of people working with video terminals: first results]

Since the 70's the occupational use of electronic systems equipped with visual display terminals (VDTs) became wide-spread also in Italy. Some longitudinal studies on large samples of VDT workers found no significant changes of myopia (M) with regard to years and daily hours spent working at a VDT.

OBJECTIVE

To evaluate the prevalence and the time course of M in 209 VDT workers employed in the service sector.

MATERIALS AND METHODS

After obtaining workers' informed consent their work, social, family and personal medical histories were collected. Myopia was defined as need of >0.25 D negative spherical correction. Average daily hours duringfollow-up and overall years spent working at a VDT were calculated as exposure indexes.

RESULTS

The mean baseline age was 39.2 years (SD: 8.7, min-max: 22-62) and the mean education was 14 years (SD: 2.2). The mean follow-up period was 5.5 (3-9) years. The prevalence of M was 45.5% at the start and 49.8% at the end of the study. It was higher in workers with >13 years of education and in those < 40 year-old. A slight but significant increase of the degree of M (dioptres) occurred during the follow-up. The change in the degree of M was not different between the classes of VDT exposure (< or = 4 and >4 daily hours; < or =15 and >15 years spent), of education and of age at the end of follow-up.

DISCUSSION

The high mean educational level can partly explain the higher prevalence of M detected in the workers on study with respect to the one described elsewhere on VDT workers and general population. The progression of the M seems not to be related to the professional and personal variables analyzed, but to depend on the natural evolution of M. Further studies are needed to confirm these preliminary data in larger groups of VDT workers.

[The role of the occupational physician in the prevention of the spreading of H5N1 virus avian influenza in exposed workers]

BACKGROUND

Avian influenza caused by H5N1 virus can be transmitted to exposed workers from contact with infected poultry, and is thus, like other zoonoses, the responsibility of occupational physicians (OP). The high pathogenicity of H5N1 virus has caused a 30-75% mortality among infected humans. Most of those subjects were occupationally exposed in different areas of poultry raising in Asian countries. At the moment, person-to-person transmission, even though possible, is unable to start a new human influenza pandemic due to the current genetic characteristics of H5N1 virus. However, its spontaneous tendency to mutate must alert the international community to the need of eradicating avian influenza in poultry as well as preventing transmission to humans.

OBJECTIVE

In Italy competent OPs are required to take part in prevention of H5N1 avian influenza infection of potentially exposed workers, such as poultry sector workers, workers engaged in poultry culling, litter management, carcass disposal, zoo and nature reserve workers, gamekeepers, veterinarians, biologists, laboratory technicians, and health workers caring for possible instances of human infection.

METHODS

According to Italian legislations, OPs must offer the national community their long-standing experience in the fields of workplace environmental monitoring, health surveillance, choice of personal protection equipment (PPE) and training and information of workers potentially exposed to H5N1 virus about occupational risks and correct use of PPE. They must also cooperate with other involved professionals to programme antiviral and vaccine prophylaxis.

RESULTS AND CONCLUSIONS

Occupational physicians can have an important role in contributing to the prevention of and scientific research on H5N1 avian influenza virus.

[Anemia in workers exposed to lead: update on differential diagnosis]

Occupational lead exposure can cause anemia at blood lead levels >50 microg/dl, as high as rarely occurs in industrialized countries nowadays. Whereas other forms of anemia are fairly probable to be found in lead exposed workers, especially in areas highly endemicfor extraoccupational anemias, such as beta thalassemia and iron deficiency anemia. The etiology of anemias has to be correctly defined in order to assess suitable therapeutical approaches and medicolegal consequences. The objective of this study is to verify in male lead exposed workers whether an accurate evaluation of hemocromocytometric parameters and of usual biological indices of lead exposure and effect on heme can differentiate the most common forms of anemia in Southern Italy. 68 workers occupationally exposed to low to moderate lead doses were studied and 59 workers of an alimentary plant have been taken as control group. On venous blood samples collected from these workers a complete hemocromocytometric test was performed and blood lead and erythrocytic zincoprotoporphyrin were determined. Anemia (Hb <l3 g/dl) was detected in six lead exposed workers and in a nonexposed worker. The reasoned evaluation of laboratory parameters led to identify among lead exposed workers four subjects with high probability of beta-thalassemic trait and two with lead poisoning anemia. Moreover a diagnostic algorithm was developed based on literature that seems to be able to discriminate lead poisoning from other causes of anemia in lead exposed workers in this study.

[Reduced thymulin production during occupational exposure to lead]

Thymulin is a thymic hormone that being activated by binding a zinc ion promotes differentiation and several functions of T lymphocytes. It has been demonstrated only in experimental animals that metallic lead (Pb) is able to cause adverse effects on thymocyte number and function. The objective of this study is to evaluate the plasmatic level of active thymulin of 58 male workers being exposed for more than one year to low lead doses with respect to 59 male never exposed workers. All these were subjected to anamnesis collection, medical examination and determination of blood lead (PbB), plasmatic lead (PbPl), plasmatic thymulin, urinary lead (PbU) and urinary zinc (ZnU) levels. The mean plasma concentration of active thymulin was significantly lower in lead exposed than in non exposed workers. Active thymulin was also significantly and negatively correlated to PbB, PbPl and PbU level and resulted to be significantly and negatively influenced by PbB. Lead exposed workers had slightly higher zinc concentration in urine than non exposed workers, increasing ZnU levels by class of PbB. It is the first time that a toxic effect of lead on plasmatic active thymulin levels is demonstrated in humans, particularly in occupationally exposed workers. This study opens perspectives for further research that would both confirm the results and verify the mechanisms of action of lead on thymulin either direct or indirect and the possible role of zinc.

[Assessment of neurobehavioral functions of workers exposed to low doses of metallic lead]

The effects of low-dose lead occupational exposure on neurobehavioral functions are still not well defined by international literature. The objective of this study is to assess by psychometric testing the presence of possible neuropsychological impairment in a group of male Italian workers with low blood lead levels in comparison to an adequate non exposed worker group. Given informed consent to take part to the study, all workers were interviewed about their working and clinical history and underwent determination of blood lead levels (PbB). An internationally validated computerized battery of psychometric tests and a standardized paper-and-pencil version of mood self-rating scale and WAIS-R Vocabulary subtest were also administered to the workers. Exposed workers had a geometric mean of PbB significantly higher than non exposed workers, but rather low (16.4 +/- 1.7 microg/dl). The results of psychometric tests were not significantly different between the two worker groups, even after adjusting for the main confounding factors. In workers exposed to low lead doses no neurobehavioral abnormalities were demonstrated by the administered psychometric test battery.

Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry

OBJECTIVE

To examine the influence of shift work on metabolic and cardiovascular risk factors in subjects working in an industry sited in Apulia, Southern Italy.

DESIGN

Cross-sectional study of metabolic effects of shift work in glucose tolerant workers in a chemical industry in southern Italy.

SUBJECTS

The subjects included 319 glucose tolerant male individuals, aged 35-60 y.

MEASUREMENTS

Anthropometric parameters (body mass index (BMI) and waist-to-hip ratio (WHR)), fasting concentrations of glucose, insulin, and lipids (total cholesterol, HDL-cholesterol, triglycerides), the sum of glucose levels during 75 g-oral glucose tolerance test (Sigma-OGTT), and systolic and diastolic blood pressure (SBP and DBP, respectively).

RESULTS

The prevalence of obesity was higher among shift workers compared to day workers, whereas body fat distribution was not different between the two groups. Shift workers had higher BMI than day workers, and shift working was associated with BMI, independently of age and work duration. Shift workers had significantly higher SBP levels, which were independently influenced by BMI, but not by shift work, thus suggesting that the difference in SBP may well be mediated by the increased body fatness.

CONCLUSION

In workers of an industry sited in Southern Italy, shift work may be directly responsible for increased body fatness and is indirectly associated with higher blood pressure levels and some features of metabolic syndrome.

Pneumoconiosis in a female worker exposed to a primer used in the production of non-stick pans: clinical case

The primary prevention programmes carried out in the 1950's and 1960's in industrialized countries brought about a significant reduction in the incidence of pneumoconiosis. Nevertheless, it is still possible to diagnose new cases, perhaps in relatively unusual working activities.

OBJECTIVE

To describe a case of q 2/2 pneumoconiosis associated with mixed powder containing less than 1% quartz that occurred in a 37 year-old female worker, who had been previously employed (1987-1994) in manually spraying a primer solution on the bottom of non-stick aluminium pans.

METHODS

The manufacturing firm supplied details of the composition of the primer. The physiological, pathological and occupational history was obtained for the worker, who also underwent: respiratory functional exploration, chest radiographs and HRCT of the thorax, fibrobronchoscopy, with transbronchial biopsy and BAL collection. The lung tissue sample was examined via light microscopy and scanning electron microscope analysis.

RESULTS

The primer contained 6.8% talc, free from asbestos or silica, 3.8% iron oxides and 0.6% bentonite which, in turn, contained less than 1% crystalline silica. The job was performed in a semi-confined environment, with an inefficient aspiration system. The worker had never complained of respiratory symptoms. Radiographs and HRCT showed widespread micronodulation. Light microscopy of pulmonary tissue showed multinucleate giant cell granulomas with intracytoplasmatic inclusions. Scanning electron microscope analysis revealed that these consisted of agglomerated particles, microanalysis of which showed the presence of a silicate.

CONCLUSIONS

Particular jobs performed up to few years ago in Italy in a semi-confined environment can still involve exposure to doses of mineral dusts such as to cause pneumoconiosis. This is the first case of mixed powder pneumoconiosis described in a worker employed in the production of non-stick aluminium pans.

[Increase of TNF-alpha in subjects occupationally exposed to lead]

Occupational exposure at low doses of lead induces a significant increase of TNF-alpha plasma levels. Recently has been showed the crucial role on atherosclerosis origin of this pro-inflammatory cytokine. It is assumable a contribution of lead in atherosclerosis course in exposed subjects.

[Effects on arterial pressure of exposure to low doses of inorganic lead: preliminary results]

The aim of this study is to evaluate the effects of occupational exposure to low inorganic lead (Pb) doses on blood pressure of exposed (E) workers. 44 workers of a foundry of lead wrecks and 14 workers employed in enameling and decoration of a manufacturing firm of artistic ceramics were examined. The group of non-exposed (NE) subjects is formed by 59 workers of packaging unit of a food industry. A questionnaire has been administered to all the workers on general characteristics and life habits. Systolic and diastolic blood pressure were also measured and venous blood collection performed for the determination of blood lead levels. Mean blood lead levels (PbB) and mean diastolic blood pressure (DBP) resulted significantly higher in the group of exposed workers of the foundry. Stratifing exposed workers with respect to the median of PbB (18 micrograms/dl), workers with PbB > 18 micrograms/dl presented a mean DBP significantly higher than exposed with PbB < or = 18 micrograms/dl and non-exposed subjects. PbB takes part significantly in determination of DBP, also considering main confounding factors as age, BMI, pack-years and alcohol consumption.

[Dose-response curve in the study of the effects of exposure to crystalline silica]

The cumulative exposure to crystalline silica (SiO2) implies a linear relation between duration of exposure and SiO2 concentration, not always suitable to working situations of the last decades. A more correct definition of dose-response curve has currently to consider also different characteristics of SiO2, specifically: possible short-term increases in environmental SiO2 concentration, different mineralogical and surface properties of natural silica polymorphs, age of SiO2 particles, presence of contaminants on the surface of silica particles or even in the respirable fraction of total dust, respirable dust concentration in which SiO2 is diluted and other conditions, also affecting the host, able to slow alveolar clearance and lengthen permanence time of particles in the lung. Many models of definition of cumulative exposure so conceived have been proposed. However, to define the occupational risk threshold to contract silicosis and other silica-related diseases a number of models of cumulative exposure, i.e. biologically effective dose of SiO2, are likely to be delineated that take into account only factors specifically present in different occupational situations.

[Epileptic disease and fitness for specific jobs involving driving motor vehicles]

OBJECTIVE

Analysis of the problems the occupational health physician meets in health surveillance of workers with a clinical history of epilepsy, in order to assess fitness for specific jobs requiring driving of motor vehicles.

METHODS

A health protocol was used which required acquisition of all information related to job features, work organization, past and current clinical-functional status of epilepsy and any treatment in progress.

SUBJECTS

The cases of four workers with clinical history of epilepsy were examined who were judged to be representative both of the most frequent forms of epileptic disease and of jobs requiring driving of motor vehicles.

RESULTS

Application of the chosen health protocol allowed us to make balanced assessments of fitness for the different specific jobs performed by the four workers.

DISCUSSION

With the use of this protocol it was possible to protect the health and the safety of both the workers concerned and their fellow workers and also, as far as possible, to respect the occupational competence of such workers. We also addressed the problems related to anti-epileptic drug consumption and in itinere road accidents. Lastly, the different medical-legal aspects of the problem were further investigated, analysing national and international legislation with respect to epilepsy and fitness for driving motor vehicles.

[Exposure to low doses of CS2 and cardiovascular risk factors]

The effects were studied on cardiovascular risk factors of occupational exposure to carbon disulfide (CS2) concentrations ranging from 0.05 to 1.60 mg/m3, 74 workers exposed (E) to CS2 and 79 non-exposed (NE) workers were examined. Information was obtained on age, working age and life habits (alcohol, smoke, etc.) through a questionnaire and height and weight were measured to assess body mass index (BMI). All the workers underwent blood collection for the assessment of total cholesterol, HDL cholesterol and triglyceride levels and electrocardiogram. No clinically evident heart disease were detected in the workers examined and the prevalences of obesity and hypertension resulted to be similar among workers of the two groups. Mean triglyceride levels and frequencies of hypertriglyceridemia and of HDL cholesterol values < 40 mg/dl were significantly higher in exposed workers than non-exposed. The triglyceride levels resulted to be significantly and directly influenced by BMI and exposure to CS2. Occupational exposure to low environmental CS2 concentrations seems to interacts with other factors to determine alterations of lipid metabolism.

[Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio in health surveillance of workers exposed to vinyl chloride monomer: preliminary results]

An AST/ALT ratio > 1 is predictive of liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection. The aim of this case-control study is to assess AST/ALT ratio in 150 workers exposed to VCM (E) from the beginning of the 1960s to the end of the 1990s. The non-exposed group (NE) consists in 150 male workers employed in the production of a food industry. At least since 1983 exposed subjects worked at VCM environmental concentrations < 3 ppm. All the workers underwent venous blood collection for assessment of AST and ALT. Exposed workers presented mean AST/ALT ratio and frequency of AST/ALT ratio > 1 significantly higher than non-exposed. The mean AST/ALT ratio results significantly higher in the exposed group, also after stratification for alcohol consumption. In exposed workers who consume alcoholic beverages and are operating since before 1983 AST/ALT ratio is significantly and positively influenced only by the working age until 1983. If these results will be confirmed, AST/ALT ratio could be proposed to be included in the periodic medical surveillance of VCM workers.

Plasma plasminogen activator inhibitor-I is associated with plasma leptin irrespective of body mass index, body fat mass, and plasma insulin and metabolic parameters in premenopausal women

Leptin, the satiety hormone expressed almost exclusively in adipose tissue, is a marker of body fat accumulation in humans. Recent studies have shown that plasminogen activator inhibitor-1 (PAI-1), a prothrombotic factor associated with atherosclerosis complications, is also produced in adipose tissue. The objective of the present study was to determine whether PAI-1 antigen plasma concentrations are associated with leptin plasma levels or the body fat mass (FM) independently of the variables known to influence PAI-1 production. Sixty-one nondiabetic women aged 18 to 45 years with a wide range of values for the body mass index ([BMI] 18.1 to 37.7 kg/m2) were evaluated for (1) body FM and fasting plasma levels of (2) PAI-1 antigen, (3) PAI-1 activity, (4) leptin, (5) insulin, (6) blood glucose, and (7) lipids (cholesterol, high-density lipoprotein [HDL]-cholesterol, and triglycerides [TG]). Body FM and fat-free mass (FFM) were estimated during fasting conditions by the bioimpedance analysis (BIA) method using a tetrapolar device. Body fat distribution was evaluated by the waist circumference and the waist to hip ratio (WHR). FM was directly associated with both PAI-1 antigen (r = .585, P < .001) and PAI-1 activity (r = .339, P < .001). Seemingly, leptin was positively related to both PAI-1 antigen (r = .630, P < .001) and PAI-1 activity (r = .497, P < .001). Moreover, both PAI-I antigen and PAI-1 activity were directly correlated with FFM (r = .285, P < .05, and r = .336, P < .01, respectively), BMI (r = .594, P < .001, and r = .458, P < .001, respectively), and WHR (r = .510, P < .001, and r = .391, P < .005, respectively). Insulin was directly related to PAI-1 antigen (r = .540, P < .001), PAI-1 activity (r = .259, P < .05), leptin (r = .447, P < .001), and FM (r = .435, P < .001). The association between PAI-1 antigen (dependent variable) and leptin or FM was tested by a stepwise regression model simultaneously including leptin, FM, BMI, WHR, age, FFM, and fasting insulin, blood glucose, TG, cholesterol, and HDL-cholesterol as independent variables. PAI-1 antigen maintained a significant positive independent relationship only with leptin (t = 2.923, P < .01), insulin (t = 3.489, P < .001), and fasting blood glucose (t = 2.092, P < .05), and a negative independent relationship with HDL-cholesterol (t = -2.634, P < .05). In conclusion, the strong relationship between PAI-1 antigen and leptin irrespective of other variables known to influence these factors seems to indicate that leptin per se may potentially increase PAI-1 plasma concentrations in obese subjects.

[Criteria and modalities of assessment of work fitness for jobs in food industry]

Current legislation establishes the general methods and standards of judgement concerning fitness of workers to perform particular jobs. The object of this study was to verify particular criteria and methods that, in observance of the law, allow the physician to maintain in productive activity workers with chronic disease or permanent consequences of industrial accidents in Apulia, Southern Italy. In accordance with the law, 156 workers and their work environment are regularly under surveillance. In the last few years it was possible to accurately diagnose all diseases that may be involved in particular work fitness checks. 3 workers suffered the permanent consequences of very serious labour accidents amputation of II, III, IV fingers of the right hand; a slight post-traumatic shortening (shrinkage) of the right femur; tympanic membrane perforation). 7 workers suffered from non-work related disease (substitution of aortic valve, allergic asthma, virus B chronic hepatitis, chronic glomerulonephritis, replacement of right knee, rheumatoid arthritis, thrombosis of the retinal central vein without a vision reduction). The criteria for an "fitness judgement" are: an accurate diagnosis and evaluation of residual functional ability, analysis of the original job, with an investigation in the field, and break down into the single operations in order to assess all work-related risks (concerning health, safety and physical resources), and evaluation of work organization per job. It was thus possible to define particular adjustments to the original job, so as to be compatible with the current physical conditions the workers. Workers, factory directors and union officers accepted these particular criteria and standard of "work fitness judgement, which made it possible to apply them in practice with consequent reinstatement of workers in productive activity.

[Minor and major work accidents in a Puglia business in the food sector: a 10-year study]

At present no official data are available for those occupational accidents which, according to current law, are not subject to notification to the Italian National Institute for Insurance of Occupational Accidents (INAIL) and which are conventionally called "minor" accidents. They can be divided into accidents with prognosis from 1 to 3 days (franchises) and accidents which do not cause absence from work (medications). The already mentioned lack of data, which is not confined to Italy, is reflected in the small number of articles published in Italian and international journals. Also information regarding the possible relationships between "minor" accidents and the life habits of injured workers, are rare. The aim of this study was to provide detailed data on the characteristics of the different kinds of occupational accidents occurring in a food factory in Apulia, southern Italy, from 1985 to 1994, as well as to verify whether any relationship existed between the different types of occupational accidents and the consumption of cigarettes and alcohol by injured workers. The company's accident register yielded data on injuries which caused absence from work; the nursing service register provided information about accidents which did not determine absence from work; personal health documents gave details of worker life habits; and the company pay roll showed the amount of "worked hours". "Minor" accidents represented 70% of all accidents occurring during the ten year period studied. "Blue collars" had more frequent and serious occupational injuries, in comparison with "technical employees". "Minor" accidents, and especially "medications", occurred more frequently during one-shift work than during three-shift work. As work seniority increased, the number of "major" accidents decreased and number of accidents without absence from work rose. Contusions were the most frequent lesions and were responsible for the majority of the 3 kinds of accidents. "Medications"" together with injuries notified to INAIL ("major" accidents), mostly involved upper limbs; "franchises" were mostly head interested. About 50% of all causes of occupational accidents were mainly associated with unsafe environmental and working situations, whereas the remaining 50% were mainly associated with unsafe behaviour by workers. Heavy smokers showed a higher frequency of "major" accidents. As alcohol consumption rose, she did number of accidents with absence from work. "Minor" accidents, particularly the "medicated" ones, represented the greatest part of occupational injuries. All the considered causes and circumstances contributed to determine the different kinds of accidents. Thereby, it appears necessary for prevention purposes to obtain information about any kind of injury in the different manufacturing sectors. Finally, it seems dutiful to inform workers about the relationships between life habits and occupational accidents.

Respiratory mucus transportability is impaired in foundry workers: a longitudinal study

Mucus transportability impairment can prolong the permanence of occupational inhalable noxae within ciliated airways. A reliable, non-invasive indicator of mucus transportability is the Normalized Frog Palate Transport Rate (NFPTR). The aim of this 3-year prospective study was to compare NFPTR between a group of 166 foundry workers (E) and a group of 133 power plant workers (NE). In the first and third years of the study, workers underwent: clinical examination, spirometry, NFPTR, chest radiography. In both plants, environmental concentrations of respiratory irritants were well below the limits set by the American Conference of Governmental Industrial Hygienists. Both groups were homogeneous for age and smoking habits. Mean NFPTR was significantly lower in E than in NE in the first and third years of the study, and in smokers in comparison with non-smokers, at the end of the follow-up. NFPTR impairment was significantly associated with occupational exposure in the first and third years of the study. In the third year, a decline in NFPTR was associated with exposure, smoking habits, FVC and FEV1/FVC.100. At the end of the study, the means of FVC, FEV1 and PEF were significantly lower in E. No cases of pneumoconiosis were observed. In this study, low doses of foundry respiratory irritants were associated with impairment of mucus transportability; the consequent slowing of mucociliary clearance increased internal doses of foundry airborne noxae.

Inhaled beclomethasone dipropionate administered through a new spacer device: a controlled clinical study

This 4-week, randomized, parallel-group study compared the efficacy and safety of a metered-dose inhaler equipped with a new spacer device (Jet spacer) with those of a standard actuator in the administration of inhaled beclomethasone dipropionate (0.5 mg twice daily) in 66 adults with chronic obstructive pulmonary disease (COPD) who were responsive to beta 2-agonists. Lung function values, symptom scores, and daily consumption of a beta 2-agonist determined efficacy. At baseline and after treatment, levels of morning serum and 24-hour urinary cortisol were measured in half of the patients (one center). Ease of use of the two devices was expressed by patients at the final visit. Lung function values and clinical symptoms improved in both groups (P < .01 at the final visit); the Jet group reported a better outcome (P < .05 between groups) than the standard-actuator group for predicted normal values of forced expiratory volume in 1 second, forced vital capacity, and bronchial noises. Salbutamol consumption decreased in both groups. One patient in the Jet group and 5 patients in the standard-actuator group reported adverse reactions. No significant between-group differences were found in plasma and urinary cortisol levels. The Jet device was judged easier to use (P < .05 between groups) than the standard actuator. In conclusion, the jet device was more effective than a standard actuator in reducing local adverse reactions to inhaled beclomethasone dipropionate in adults with COPD, with a better efficacy profile.

Lung cinescintigraphy in the dynamic assessment of ventilation and mucociliary clearance of asbestos cement workers

OBJECTIVES

To verify in vivo whether lung cinescintigraphy confirms the effect of asbestos on the patency of the smallest airways and on the efficiency of mucociliary clearance in asbestos cement workers.

METHODS

39 male subjects were examined: 30 asbestos cement workers and nine workers never exposed to occupational respiratory irritants. All subjects had a chest radiograph (International Labour Organisation (ILO) 1980); standard questionnaire on chronic bronchitis; spirometry; arterial blood gas analysis; carbon monoxide transfer factor (TLcosb); pulmonary O2 and CO2 ductances (DuO2, DuCO2); electrocardiogram; and lung cinescintigraphy after radioaerosol inhalation for the measurement of mucociliary clearance time in vivo in the smallest ciliated airways and for the assessment of radioaerosol deposition in alveoli (alveolar deposition index).

RESULTS

Apart from nine non-exposed subjects, the 30 asbestos cement workers were so classified on the basis of chest radiography: nine of them as healthy exposed, 10 with pleural plaques, and 11 with asbestosis. The four groups had similar ages, work seniority, and smoking habits. Exercise dyspnoea was significantly more frequent in asbestos cement workers. Lung function variables of workers with effects related to asbestos were significantly lower than the other two groups. The PaO2, TLcOsb and DuO2 mean values were significantly lower in exposed workers than non-exposed. The mean PacO2 value was significantly higher in the asbestosis group than in the other three groups. Workers with effects related to asbestos showed a significantly lower alveolar deposition index and a significantly higher mucociliary clearance time than the other two groups. Subjects with asbestosis showed similar differences from those with pleural plaques.

CONCLUSIONS

Lung cinescintigraphy confirms in vivo the effects of asbestos on bronchiolar and alveolar patency and on efficiency of mucociliary clearance in the smallest ciliated airways. Finally, lung cinescintigraphic variables are able to discriminate workers with asbestosis from those with pleural plaques.

Acute radiodermatitis from accidental overexposure to X-rays

Approximately 2 weeks after accidental overexposure to X-ray radiation, a worker developed acute radiodermatitis on fingers of both hands. Exposure simulation indicated that total ionizing radiation absorbed by his fingers amounted to about 20 Gy. After 2 years, acute radiodermatitis evolved to chronicity of lesions with presence of atrophic skin, teleangiectasia, alopecia, and dyskeratosis on three right-hand fingers. Cytogenetic dosimetry of peripheral blood lymphocytes, performed 2 months after acute radiation, showed an increase of micronuclei (7% vs. 1 +/- 0.4% according to laboratory reference data). The increase was ascribed to the high dose of ionizing radiation absorbed by circulating lymphocytes in the vessels of overexposed tissues. The cytogenetic examination was repeated 27 months after acute irradiation; it was found that the percentage of micronuclei had been restored to within reference levels. The possibility of using cytogenetic dosimetry, following acute partial exposure to X-rays, not just as an indicator of previous exposure, but also as an indicator of the absorbed radiation dose is examined. Lastly, the possible stochastic effects that may set in on the skin of the affected fingers and the need for periodically monitoring the evolution of chronic skin lesions, are discussed.

Auditory brainstem responses in thyroid diseases before and after therapy

The aim of this study was to evaluate through the auditory brainstem responses (ABRs) the electrical events generated along the auditory pathway in 56 adult patients affected with hyper- and hypothyroidism. Twenty-four normal-hearing hyperthyroid patients affected with Graves' disease and 32 normal-hearing hypothyroid patients (9 with subclinical and 23 with overt hypothyroidism) were subjected to standard (clicks at 21 pps) and sensitized ABR with masking wide-band (masking noise). In addition, thyroid scintiscan and ultrasonography, free T3 and T4, total T3 and T4, TSH, antimicrosomal and antithyroglobulin antibodies, audiogram and impedance tests were performed in all the patients. This study was repeated after 6-12 months of treatment in conditions of euthyroidism. The results showed changes of ABRs both in the standard procedure as well as in the sensitized test in 6 hyperthyroid (25%) and 8 hypothyroid patients (25%). All the patients with abnormal ABRs had overt hypothyroidism (8/23; 34.7%). The ABRs became normal in 5 out of 6 Graves' patients after 6-12 months of methimazole treatment. ABRs remained abnormal in all the hypothyroid patients despite their having been on L-thyroxine treatment for 6-12 months and were euthyroid for at least 5 months before the study was repeated. These findings suggest that ABR abnormalities are indicative only of a nonspecific injury in the bulbo-ponto-mesencephalic centers. Alterations of ABRs in thyroid diseases are not specific in relation to hyper- or hypothyroidism. Lastly, there is a relationship between ABR abnormalities and the degree of hypothyroidism, even if ABR alterations are not always reversible after long-term therapy.

[Mucociliary clearance and respiratory function in foundry workers]

The aim of the study was to establish whether changes occur in respiratory function, particularly mucociliary clearance, among second fusion smeltery workers. The research covered 93 male smelters employed in steel forming and casting and 116 male workers of an electric power station, considered as non-exposed. Physiological, pathological and occupational histories of all subjects under study were available. An ECCS respiratory symptoms questionnaire was administered to all subjects ad the two groups also underwent a general medical examination, a spirometry and a chest X-ray. During the medical examination sputum was collected from the subjects to measure mucus transport rate on frog palate, expressed as Normalised Frog Palate Transport Rate (NFPTR). For the environmental research, dust, fumes and gas samplings were taken either at a fixed station or by means of personal dosimeters. Environmental research revealed very low concentrations of respiratory irritants (total dust: 0.2-6.8 mg/m3; respirable dust: 0.1-4.9 mg/m3; total silica: < 2-15.5%; respirable silica: < 0.004-0.3 mg/m3; iron: 0.008-0.085 mg/m3; chromium and manganese: < 0.001 mg/m3; fumes and gases: well below the TLV. The two groups were homogeneous with regard to age and smoking habits. Exposed workers showed rales, dyspnoea and spontaneous phlegm more frequently than non-exposed workers. NFPTR alterations were checked in 49 out of 81 exposed and in 18 out of 81 non-exposed subjects (chi squared = 22.9; p < 0.001). Stratification of the results according to smoking habits further confirmed the strong association between occupational exposure and NFPTR alterations. Smelters showed significantly lower mean NFPTR values compared to non-exposed subjects; also, the mean value of NFPTR in the exposed was below 0.70, which is considered the lowest individual limit in normal subjects. The only variable which explains a large part of the variability of NFPTR is past work in a smeltery rather than in an electric power station. The spirometries showed that only the mean PEF values were significantly lower among the exposed. Stratified analysis of the results according to smoking habits in the two groups revealed a close association between smeltery work and reduction of PEF to under 80% of the ECCS 1983 theoretical values, independently of smoking habits. We also compared the mean PEF values, both as measured values and as percent values of the ECCS 1983 theoretical values, stratified for occupational exposure and smoking; the results again showed that differences between these mean values were mainly due to current or past work in the foundry.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of lithium treatment on hypothalamic-pituitary-thyroid axis: a longitudinal study

Lithium carbonate, widely used in the treatment of bipolar patients, is well known to induce thyroid alterations. In this longitudinal study the thyroid function was investigated during lithium treatment over a period of 12 months in 12 euthymic bipolar patients with a normal thyroid function and absence of thyroid antibodies. Nine of the 12 patients were further studied on the 15th month, 5 of these 9 on the 18th month and 4 of the last-mentioned 5 on the 24th month. The mean basal and TRH-stimulated TSH values during lithium therapy were significantly higher as compared to those at the beginning of the treatment. More particularly, during lithium therapy, a significant increase of basal TSH over the normal range was found in 10 out of the 12 patients. A rise of TRH-stimulated TSH was found in 11 out of the 12 patients. The impairment of the hypothalamic-pituitary-thyroid (HPT) axis was transitory in the majority of cases. Two patients developed a nodular goiter during the treatment. Plasma T3, T4, FT3 and FT4 levels did not change during the treatment. Thyroid antibodies remained undetectable. The conclusions of the study are twofold: 1) Subclinical hypothyroidism during lithium therapy is much more frequent than previous cross-sectional studies suggest; 2) Thyroxine replacement in lithium-treated patients is advisable in order to prevent subclinical hypothyroidism and the risk of a subsequent goiter.

[The inhalation of low concentrations of manganese powders produces changes in respiratory mucociliary clearance]

The aim of this study is to verify whether inhaling metallic dusts, containing a lower concentration of Mn (as Mn3O4) than current TLV can cause alterations in exposed workers tracheobronchial mucociliary clearance. We studied 20 grinders using an 11.5-13% Mn steel, and a control group of 21 standard steel grinders, employed in the same foundry. Environmental Mn dust was measured by personal samplers. All workers were administered a questionnaire about chronic bronchitis; the following examinations were also carried out: medical examination, spirometry, chest standard X-ray and urinary Mn dosage. Mucociliary clearance was measured by human respiratory mucus transportability on frog palate and expressed as normalized frog palate transport rate (NFPTR). Mucus was obtained through a sputum so protected as to avoid salivary contamination. Environmental measurements showed a Mn concentration from 0.1 to 1 mg/m3 with respect to a TLV of 5 mg/m3. Exposed workers and control group were homogeneous as far as age, working period, tobacco smoking habit and spirometric parameters are concerned. Chest X-ray examination showed no evidence of pneumoconiosis. Mn exposed workers showed a NFPTR reduction, if compared to normal level (0.70). NFPTR average value in exposed group has come out to be much lower than in control group. NFPTR alteration in Mn exposed group appears to be strictly linked to a longer than 15 years working seniority. Urinary Mn values resulted extremely low in each worker and their average was not significantly different between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Association of sporadic limb-girdle muscular dystrophy and autonomous thyroid nodule in 3 Germans]

The paper reports an association of limb-girdle muscular dystrophy and autonomous functioning thyroid nodule in two brothers and in one sister, a healthy carrier of this muscular dystrophy and with analogous thyroid pathology. It is interesting to outline the rarity of this association and the affinity of the clinical and electromyography pictures in thyrotoxic myopathy and in muscular dystrophy. In this three patients were studied: the muscular enzymes, electromyography and biopsy, HLA typing, thyroid scanning, thyroid hormone levels and TGA and TMA antibodies. However, the peculiarity of this case report may suggest the influence of genetic factors; moreover the existence of possible linkage between HLA system and association of two pathologies must be excluded, taking in account that the results of HLA types in these three Germans indicate different haplotypes.

[In vitro mucociliary clearance: observations in subjects exposed to acute inhalation of nitrous vapors]

Acute inhalation of nitrous vapours did not cause any damage to the respiratory apparatus detectable via spirometric or X-ray tests in the four workers who were actually exposed and kept under observation during the two months following the explosion of a tank containing nitric acid. However, measurement of the coefficient of relative transport speed in vitro of tracheo-bronchial secretions revealed alterations of the mucus related to specific situations, such as during acute inhalation of nitrous vapours and upon resuming work. The coefficient of relative speed, obtained with the in vitro technique on the palate of the frog, thus proved to be reliable in monitoring irritation of the mucus secreting apparatus of workers accidentally exposed to acute inhalation of nitrous vapours.