Alcoholic polyneuropathy: a clinical and epidemiological study.

In the present study, we investigated the frequency of polyneuropathy in a sample of 296 alcoholics who were admitted to the 'S. Maugeri' Medical Centre for detoxification from October 1997 to November 1999. Results revealed a high frequency of polyneuropathy in the sample under study. The disorder was often clinically asymptomatic and demonstrable only on electroneurographic investigation. Significant correlations were found between polyneuropathy, the duration of alcoholism, the type of alcoholic beverage consumed (wine) and the presence of liver disease and macrocytosis.

[Small cell carcinoma of the prostate. Description of a case]. / Carcinoma a piccole cellule della prostata. Descrizione di un caso.

The case of a 73-year-old man with metastatic small cell carcinoma (SCC) of the prostate is described. Seric neuron-specific enolase (NSE) was enhanced (75.4 ng/mL), while the prostate-specific antigen (PSA) was in the normal range. Therapy with etoposide and carboplatin induced a temporary partial remission, with fairly good quality of life and decrease of the NSE levels (down to 15.0 ng/mL). The patient died approximately 12 months after the initial diagnosis. The case confirms that prostatic SCC (a rare and very aggressive neoplasm) is usually diagnosed in an advanced stage. Treatment is problematic, however chemotherapy may prolong survival allowing, at least temporarly, an acceptable life quality. NSE measurement is useful to differentiate SCC from the more common adenocarcinoma (typically associated with elevated PSA values) and for follow-up.

[Alcoholism at the work setting]. / Alcolismo in ambito lavorativo.

Alcoholism is a nation-wide problem because of the variability and severity of its associated phenomena. In Western European countries, according to the WHO, the use of alcohol is the direct or indirect cause of approximately 20% of hospital admissions of male adults of working age. In Italy, the number of lost working days due to sickness is four times greater in drinkers, as is the risk of serious accidents. In addition, alcohol accounts for 5% of disability payments. In the authors' experience, alcohol abuse is a widespread problem in the work setting, however its social and medical impact is still underestimated.

[Work and alcohol: considerations on a caseload of patients undergoing treatment]. / Lavoro e alcol: considerazioni su una casistica di pazienti in trattamento.

An enquiry into alcohol dependent subjects admitted to the clinical wards of the first section of Occupational Medicine belonging to Medicina Preventiva Occupazionale e di Comunità of University of Pavia for an alcohol disaddiction treatment has been performed through a phone interview. 289 patients have been contacted and time elapsed from admission to interview was one to three years. The questions focused alcohol abstinence, occupational position before and after admission, any improvement in the work sphere (relationship with the collegues), any feeling of empowerment of the work abilities and any increase in the responsibilities load. From our results we can conclude that alcohol disaddiction carried on during admission has positively contributed to the reinstatement of alcoholics patients.

[High resolution computerized tomography in the diagnosis of asbestosis]. / La tomografia computerizzata ad alta risoluzione nella diagnosi di asbestosi.

The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. Asbestos fibers exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. A considerable statistical agreement (Cohen K) was observed between radiographic and tomographic I.L.O. classes. In conclusion, high resolution chest tomography doesn't appear to be an indispensable test for the diagnosis in admitted subjects, but we underline its importance in the evaluation of pleural thickenings.

[High resolution computerized tomography in the diagnosis of silicosis and mixed dust pneumoconiosis]. / La tomografia computerizzata ad alta risoluzione nella diagnosi di silicosi e di pneumoconiosi da rischio misto.

The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. 75 silica- and mixed dust exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. The statistical analysis (Cohen K) showed a satisfactory agreement between radiographic and tomographic I.L.O. classes. However, high resolution tomography appeared to be more accurate in the assessment of less severe clinical pictures. In conclusion, we underline the importance of high resolution chest tomography in the evaluation of individual clinical cases, particularly when forensic problems are involved.

[Professional anamnesis and information: considerations on a clinical case]. / Anamnesi professionale ed informazione: considerazioni su un caso clinico.

Work history and information about risks represent two main instances in occupational medicine, the first one in order to formulate the diagnosis of occupational disease, the second one for the health education of workers. As far as this is concerned we describe the clinical case of a patient admitted for a cutaneous manifestation of suspected allergic nature. After a careful evaluation of the work related risk factors it turned out to be a cutaneous rash caused by exposure to dimethylformammide and concomitant consumption of alcohol. A correct information about substances used in the workplace and about subsequent hygienic rules would have avoided the appearance of the clinical manifestation and a useless admission.

Allergic and Irritant Glove-related Diseases in Health Care Workers and Their Prevention.

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

[Evaluation of trends in occupational pathology in clinical cases]. / Valutazione della tendenza della patologia occupazionale in una casistica clinica.

The study considered all patients admitted to the 1st Division of Occupational Medicine, Department of Preventive, Occupational and Community Medicine of the University of Pavia between January 1st 1989 and December 31st 1995 with a diagnosis of occupational disease. It was useful in illustrating the evolution of occupational disease as regards both changes in etiology and in the symptoms and systems involved. A decrease in the number of occupational diseases diagnosed from 1993 to 1995 was revealed, but it is difficult to draw any significant conclusions from these data since the need for hospitalization when diagnosing this type of disease has diminished greatly. Changes in legislation which have obliged employers to take precise preventive measures could also be partly responsible for this downward trend. The patients were, in almost all cases, at an initial stage of their disease. This is reassuring as far as the therapeutic and legal need for an early diagnosis is concerned. However, it remains unknown how often the causal relationship between work and disease was not suspected and therefore how many cases did not arrive to observation. Finally, the study confirmed the disappearance of some occupational diseases, such as benzene intoxication, common in the past, and the increase in "emerging" pathologies like allergies.

Occupational asthma, rhinitis and urticaria due to piperacillin sodium in a pharmaceutical worker.

A 28 year old man with no history of atopy was referred to our hospital for possible work-related asthma. He had been employed in the production section of a pharmaceutical company for 2 yrs, and in the last 2 months he had complained of dyspnoea, wheezing, chest tightness, symptoms of rhinitis and a cutaneous rash when exposed to powdered antibiotics. Symptoms disappeared after being transferred to the packaging section. When the subject was admitted to our department he was asymptomatic. Basal lung function tests were in the normal range. Bronchial challenges with methacholine and with ultrasonically-nebulized distilled water were negative. Skin-prick test with piperacillin sodium gave a strong positive response at a very low concentration. Specific inhalation challenge with piperacillin sodium resulted in an immediate asthmatic reaction, and also reproduced rhinitis symptoms and the cutaneous rash. A control challenge with lactose, and the specific challenge test with cefuroxime sodium (another antibiotic to which the patient was exposed at the workplace) were negative. We conclude that piperacillin sodium is an agent that can cause occupational asthma.

[Employment and alcohol: analysis of a clinical casuistic]. / Lavoro e alcol: analisi di una casistica clinica.

The relationship between alcohol and work was studied in a group of 537 voluntary patients (393 male and 144 female) admitted to the department of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level. We can deduce how no working condition, low age and low education can constitute makers of risk for alcohol abuse.

[Acute alcoholic myopathy]. / Miopatia alcolica acuta.

A case of acute alcoholic myopathy in a subject with a 20 year history of alcohol abuse is described. The condition emerged during an episode of delirium tremens and had a quickly deadly outcome. The rapid evolution of the clinical situation accompanied by variation in the biohumoral indices (CPK, LDH, myoglobin) is stressed and although this prevented from obtaining anatomopathological samples of the rhabdomyolisis, the specific diagnosis was made with reasonable certainty. The onset of the condition was not foreseeable because of the absence of an accurate history of the subject's alcohol abuse on his admission and of significant biohumoral data indicating the existence of an alcohol correlated pathology.

Bronchial responsiveness to ultrasonic fog in occupational asthma due to toluene diisocyanate.

To determine the validity of ultrasonic nebulization of distilled water (UNDW, "fog") in comparison with methacholine challenge, in the assessment of toluene diisocyanate (TDI) asthma, we evaluated 75 subjects exposed to TDI with work-related respiratory symptoms. Subjects were submitted to bronchial challenge with methacholine at first, thereafter to UNDW inhalation and to specific challenge with TDI. The diagnosis of TDI-asthma was made in 30 of 75 patients (40 percent) who developed a bronchoconstrictive response to the specific challenge (reactors). Sensitivity and specificity of UNDW alone, methacholine alone, and of the combination of the two tests were determined with the results of the specific challenge with TDI as the "gold standard." Both frequency and severity of bronchoconstrictive response to UNDW (FEV1 decrease > or = 15 percent) and the degree (PD15 FEV1) and frequency of bronchial hyperresponsiveness to methacholine were significantly higher in TDI reactors than in nonreactors. The UNDW had higher specificity (82.2 percent vs 51.1 percent) but lower sensitivity (40 percent vs 76.7 percent) than methacholine. The combination in parallel (positivity of any of the two challenges) of methacholine and UNDW challenge did not change sensitivity to a great extent (80 percent vs 76.7 percent), whereas combination in series (positivity of both challenges) had considerably greater specificity (86.7 percent vs 51.1 percent) than methacholine alone. We conclude that in the assessment of TDI-asthma, the validity of UNDW challenge alone is limited since it is insufficiently sensitive. Instead, combining UNDW and methacholine challenge when methacholine is positive improves our ability in identifying subjects with TDI-asthma diagnosed with the specific challenge. This procedure constitutes a first objective confirmation of a suggestive history of TDI-asthma that is useful for clinical purposes. However, especially for medicolegal purposes, the definitive diagnosis requires the specific challenge.

[The psychosocial problems in a population of emigrant Italian workers]. / Problematiche psicosociali in una popolazione di lavoratori italiani emigrati.

The psycho-social problems of a group of 365 Italian emigrants to Switzerland, admitted to psychiatric hospitals, were studied. It was found that non professional subjects (housewives, unemployed, retired) and manual workers (builders, waiters, factory workers) were more likely to suffer from psycho-social disorders. Only 11.1% of those studied had received a secondary education, therefore it could be assumed that subjects having a low technical and cultural level were less prepared, psychologically, for their new situation and were thus more susceptible to psycho-social disorders. The most frequent diagnoses were found to be: affective disorders, alcohol addiction, opiate addiction and schizophrenia. The study revealed that emigrants ran a greater risk of first time admittance to psychiatric wards whereas the local population had a greater number of relapses. In conclusion it is stressed that assistance with an aim to improve work, social and relationship conditions and to integrate the emigrants into their host society can reduce some forms of psycho-social disorders.

Occupational asthma: fate and management after the diagnosis.

The clinical and socio-professional fate of subjects with occupational asthma is not univocal. We re-examined twenty-nine subjects diagnosed in our center as suffering from this disease an average 14 months, SE 1.54 after the diagnosis. At the follow-up examination each patient underwent interview, spirometry and methacholine challenge, 18 patients (group A) had ceased exposure to the sensitizing agent but among them only 7 had been relocated in another area of the plant, the others had resigned or retired. The other patients had not changed workplace, 7 (group B) having had intermittent exposure to the offending agent and 4 (group C) having continued to be exposed daily. At the follow-up examination only 9 patients were asymptomatic, each of them belonging to group A, whereas in the other 9 of the same group symptoms persisted, although reduced. In group B and C all patients were still symptomatic and required pharmacologic treatment. Within group A patients who became asymptomatic had shorter duration of symptoms before diagnosis (12.9 months, SE 6.4 vs 23.9, SE 9.7), higher FEV-1 (96.1, SE 6.7 vs 86.9, SE 5.6) and PD20FEV-1 (1773.4 micrograms, SE 590 vs 730.8, SE 295) at the time of the diagnosis and showed a significant (p < 0.01) increase in FEV-1 (from 96.1, SE 6.2 to 101.6, SE 5.5) and a tendency to decrease in bronchial reactivity to methacholine at the follow-up examination. At the time of the follow-up examination only 5 out of 29 patients (17.2%) had been contacted by the compensation board.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new environmental pathology: styrene-induced rhinitis]. / Una nuova patìa da vicinanza: la rinite da stirene.

We describe the case of a 36 ys aged woman complaining of symptoms of oculorhinitis with itching, occasional dyspnea and laryngeal constriction. The patient related her symptoms with the emission of dusts and steam from a factory in the neighbourhood producing manufactures using polyester resins dissolved in styrene. No bronchospastic response was obtained after challenge with methacoline and ultrasonic nebulization of distilled water, which instead provoked a significant increase of nasal resistance. The inhalation challenge with styrene produced a dual nasal response. To our knowledge this is the first case of non occupational neighbourhood rhinitis provoked by styrene.

[Indoor pollution: a report of 2 clinical cases of occult carbon monoxide poisoning]. / Inquinamento indoor: presentazione di due casi clinici di ossicarbonismo occulto.

A large part of the general population is potentially exposed to excessive concentrations of carbon monoxide (CO), both in the domestic and work environment. Beside acute, often fatal poisoning, the possibility of occult intoxication should be considered; this condition can affect people who are often unaware of the existence of a toxic exposure in their homes or work places. We describe two non-smoking patients, husband and wife, 53 and 57 years old, respectively, who suffered cephalea, nausea and neurobehavioural disturbances during a period of approximately one year; these symptoms were reported to improve or disappear on several occasions during the patients' absence from home. Careful anamnesis suggested a protracted exposure to nonlethal concentrations of CO contaminating the patients' bed-chamber from the misfunctioning flue of the heating system. It was not possible to measure carboxyhaemoglobinemia until approximately 24 hours since the last presumptive exposure. The levels found were therefore relatively low (4-5%), yet higher than the reference values for normal non-smoking subjects. Carboxyhaemoglobin concentrations almost returned into the normal range during the period of hospitalization. These two cases exemplify how low level CO exposure may cause aspecific pathological manifestations that are often misdiagnosed or overlooked.

[Early effects of exposure to anesthetic gases and vapors. A critical review on the suitability of several indicators of the effect]. / Effetti precoci dell'esposizione a gas e vapori anestetici. Una rassegna critica sull'applicabilità di alcuni indicatori di effetto.

Apart from a risk excess of liver disease among operating theatre personnel and of spontaneous abortion in women exposed during pregnancy, no definitive conclusion can be drawn regarding health impairment among anaesthesiology staff. However, many studies pointed out that several adverse effects occur as a consequence of experimental, therapeutic and occupational exposure to inhalation anaesthetics. This paper reviews the early changes of the organ systems (hepatobiliary, renal, cardiac, hematopoietic, reproductive systems; immunologic functions; cytogenetic effects), which are considered to follow anaesthetics exposure, to evaluate their possible use as biological indices of effect. The liver microsomal enzyme system has received particular attention with the aim of clarifying the mechanisms involved in anaesthetics hepatotoxicity. An increased microsomal enzyme activity was observed in experimental conditions and in humans. This inductive effect, which reflects metabolic changes affecting liver function, is commonly considered the earliest sign caused by exposure to several chemicals (other than anaesthetics) and may be evaluated by means of biomarkers, among which the measurement of urinary D-glucaric acid excretion is a well established non-invasive tool. Urinary D-glucaric acid excretion represents the most promising early metabolic effect of the exposure to anaesthetics. However, its measurement is not yet suitable as an index of effect for use in biomonitoring practice. The main aspects to be studied in the future are the following: (i) the evaluation of urinary D-glucaric acid excretion in the acute and chronic exposure to low-dose anaesthetics to check the existence of a dose-response relationship; (ii) the study of other parameters (urinary enzymes, immunological profile, chromosome aberrations) in selected groups of exposed and control subjects, in which both exposure and confounding factors (age, gender, life style, former diseases) as well as concomitant occupational exposures should be carefully taken into account.

[Alcohol and work: comments on a clinical case load]. / Alcol e lavoro: considerazioni su una casistica clinica.

The relationship between alcohol and work was studied in a group of 260 voluntary patients (186 male and 74 female) admitted to the unit of Medicina del Lavoro, Pavia University for alcohol rehabilitation. The highest incidence of alcohol abuse was found in non-working subjects (pensioners, unemployed, housewives) although the start of excessive drinking takes place after beginning a working activity; a cause-effect relationship between these two factors can not be clearly determined, however. It is true that the stress provoked by this new condition (introduction to the work experience) can, in certain subjects, be a contributing factor in alcohol abuse. The increasingly lower age of initiation to alcohol reconfirms the need for prevention and instruction even at scholastic level.