A cross sectional study on the vocal handicap index applied to a sample of teachers in nurseries and primary school.

BACKGROUND: Acoustic pollution is generally analysed in relation to the risks for the hearing apparatus, omitting the extra-auditory effects, such as the damage that the noise can cause to the speaker's voice and listening to the learning of the vocal message. These damages are mainly found in school environments among teachers. OBJECTIVE: A cross-sectional study was carried out to verify the influence that the noise of the classrooms can have on the physical and mental health of the teachers examined. METHODS: This study involved four schools of Rome, for a total of 60 teachers, who were interviewed via online questionnaires, which consisted of a socio-demographic data section and 3 other sections: Vocal Handicap Index (VHI), SF-12, Job Content Questionnaire. RESULTS: 50 responses were received. 68% of teachers exceeded the normative value of 2.83 and perceived a disorder of the voice, and only 32% had a value lower than the standard considered (mean=7.34; median=5). The medians of MCS12 and PCS12 scores (52.9 and 54.2) were very close to those of the general population, as well as the distribution of the scores obtained from the Job Content Questionnaire. Furthermore, there was a direct association between the VHI-10 score and the age (B=0.321 p=0.016), the marital status (B=0.345 p= 0.009), and an indirect association with the MCS12 (B=-0.283 p=0.033). CONCLUSIONS: In general, the teachers examined are exposed in the classrooms to a high acoustic climate (median=75 dB) and, consequently, to a vocal effort during the didactic activities. Although it has not been possible to verify whether teachers with a high vocal disturbance were in the classrooms with a worse acoustic climate, the descriptive analyses provide a solid basis for further studies on the association between noise pollution and vocal effort.

Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up.

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. MATERIALS AND METHODS: A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery. RESULTS: We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern. CONCLUSIONS: Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.

Inorganic contaminants from diffuse pollution in shallow groundwater of the Campanian Plain (Southern Italy). Implications for geochemical survey.

The Campanian Plain (CP) shallow aquifer (Southern Italy) represents a natural laboratory to validate geochemical methods for differentiating diffuse anthropogenic pollution from natural water-rock interaction processes. The CP is an appropriate study area because of numerous potential anthropogenic pollution vectors including agriculture, animal husbandry, septic/drainage sewage systems, and industry. In order to evaluate the potential for geochemical methods to differentiate various contamination vectors, 538 groundwater wells from the shallow aquifer in Campanian Plain (CP) were sampled. The dataset includes both major and trace elements. Natural water-rock interactions, which primarily depend on local lithology, control the majority of geochemical parameters, including most of the major and trace elements. Using prospective statistical methods in combination with the traditional geochemical techniques, we determined the chemical variables that are enriched by anthropogenic contamination (i.e. NO3, SO4 and U) by using NO3 as the diagnostic variable for detecting polluted groundwater. Synthetic agricultural fertilizers are responsible for the majority of SO4 and U pollution throughout the CP area. Both SO4 and U are present in the groundmass of synthetic fertilizers; the uranium concentration is specifically applicable as a tracer for non-point source agricultural fertilizer contamination. The recognition of non-geological (anthropogenic) inputs of these elements has to be considered in the geochemical investigations of contaminated aquifers.

Radon hazard in shallow groundwaters II: dry season fracture drainage and alluvial fan upwelling.

²²²Rn concentrations have been measured in a well located on the edge of a large Pleistocene-Holocene fan and belonging to the shallow pyroclastic aquifer of the Pietramelara Plain, southern Italy. The aim of this study has been both to characterise the hydrological inputs that determine the influx of ²²²Rn to the shallow aquifer and to understand the correlations between ²²²Rn, major ions, physical-chemical parameters and rainfall. Results obtained from the time series indicate that the studied well shows a ²²²Rn variability that is inconsistent with a mechanism of pure hydrological amplification, such as described in Radon hazard in shallow groundwaters: Amplification and long term variability induced by rainfall (De Francesco et al., 2010a). On the contrary, in this well hydrological amplification appears to be mainly tied to the upwelling of alluvial fan waters, rich in radon, in response to pistoning from recharge in the carbonate substrate. This upwelling of alluvial fan waters occurs during almost the whole period of the annual recharge and is also responsible of the constant increase in ²²²Rn levels during the autumn-spring period, when both the water table level and weekly rainfall totals drop. Furthermore, a rapid delivery mechanism for ²²²Rn likely operates through fracture drainage in concomitance with the very first late summer-early autumn rains, when rainfall totals appear largely insufficient to saturate the soil storage capacity. Results obtained from this study appear to be particularly significant in both radon hazard zoning in relation to the shallow aquifer and possibly also for indoor radon, owing to possible shallow aquifer-soil-building exchanges. Moreover, both the spike-like events and the long wave monthly scale background fluctuations detected can also have potential significance in interpreting ²²²Rn time series data as seismic and/or volcanic precursors. Finally, ²²²Rn has proved to be an excellent tracer for hydrological inputs to the shallow aquifer when combined with major ions, physical-chemical data and geological and geomorphological controls.

Radon hazard in shallow groundwaters: amplification and long term variability induced by rainfall.

(222)Rn concentrations have been determined with a RAD7 radon detector in shallow groundwaters of the Pietramelara Plain, north-western Campania, southern Italy, where pyroclastic deposits, along with recent stream alluvial sediments, come in contact with Mesozoic carbonate reservoirs. The aim of this study has been to study the annual variation of (222)Rn concentration in the shallow groundwaters, scarcely considered in the literature and of obvious relevance for radon hazard evaluation. Our results definitely show that (222)Rn levels are characterized by a clear annual periodicity, strictly related to rainfall and water table levels, with a pronounced difference between the dry and the wet season. In this last case with concentrations increasing up to two orders of magnitude (up to two times the lower threshold given in the Recommendation 2001/928/EURATOM for public waters). In relation to this, experimental field data will be presented to demonstrate that this variability is due to purely hydrological mechanisms, mainly rinse out and discharge that control leaching efficiency. The detected cycle (Radon Hydrological Amplification Cycle, RHAC) has been generalized for the Mediterranean Tyrrhenian climate. The marked and seasonally persistent amplification in (222)Rn levels poses the problem of evaluating the epidemiological risk brought up by this previously not yet reported mechanism. This mechanism, occurring in shallow groundwaters, very likely should strongly influence indoor radon levels via groundwater-soil-building exchange.

Is CT still useful in the study protocol of retinoblastoma?

BACKGROUND AND PURPOSE: Intralesional calcium deposition is considered a key element for differentiating retinoblastoma from simulating lesions. Our aim was to assess whether MR imaging associated with ophthalmologic investigations (ophthalmoscopy and ultrasonography) could replace CT in the detection of diagnostic intralesional calcifications in retinoblastoma. MATERIALS AND METHODS: Ophthalmoscopic findings, MR images, CT scans, and histologic examination of 28 retinoblastomas from 23 consecutive children (11 males, 12 females; age range at admission, 1-35 months; mean age, 11 months; median age, 9 months) were retrospectively evaluated. Ultrasonography was performed in 18 patients with 21 retinoblastomas. MR imaging included T2-weighted spin-echo and gradient-echo images, fluid-attenuated inversion recovery images, and T1-weighted spin-echo images with and without contrast enhancement. Clinical data were integrated with MR imaging data to evaluate the utility of both approaches to discover calcifications; particularly, a correlation between intralesional signal-intensity void spots on MR imaging and hyperattenuating areas on CT scans was performed. RESULTS: Ophthalmoscopy detected calcifications in 12 of 28 eyes (42.85%). Ultrasonography detected calcifications in 20 of 21 eyes (95.23%). CT showed hyperattenuating intralesional areas consistent with calcifications in 27 of 28 eyes (96.42%). MR imaging showed intralesional signal-intensity void spots in 25 of 28 eyes (89.28%). All spots detected with MR imaging matched the presence of calcifications on CT scans. Gradient-echo T2*-weighted and fast spin-echo T2-weighted images showed the highest degree of correlation with CT. When we put together ophthalmoscopy, ultrasonography, and MR imaging data, no calcifications detected on CT were missed, and the differential diagnosis was thorough. CONCLUSIONS: A combination of clinical data and MR images may remove potentially harmful ionizing radiation from the study protocol of retinoblastoma.

A case of coloboma in a newborn to a woman taking mycophenolate mofetil in pregnancy after kidney transplantation.

Recently, mycophenolate mofetil (MMF) has been introduced in the immunosuppressive strategy after kidney transplantation. Recently, the existence of a MMF associated embriopathy has been hypothesized, namely, multiple craniofacial malformations. Only 1 report has described chorioretinal coloboma. We report a case of woman who used MMF throughout pregnancy after kidney transplantation. Her newborn developed coloboma of the right eye associated with an ocular cyst without any other malformation. The other drugs used by our patient are not considered teratogenic. Therefore, it seems reasonable to conclude a causal relationship between MMF and the malformation observed in this newborn.

Retinoblastoma epidemiology: does the evidence matter?

It has been proposed that retinoblastoma is 'caused' by two sequential mutations affecting the RB1 gene, but this is a rather outdated view of cancer aetiology that does not take into account a large amount of new acquisitions such as chromosomal and epigenetic alterations. Retinoblastoma remains probably the only cancer in which the rather simplistic 'two hit' mutational model is still considered of value, although cancer is known to be associated with genomic and microsatellite instability, defects of the DNA mismatch repair system, alterations of DNA methylation and hystone acethylation/deacethylation, and aneuploidy. Moreover, as it is shown herein, the predictions made by the 'two hit' model, are not fulfilled by the clinical and epidemiological data reported so far. Moreover, while the role of mutational events in cancer has been largely questioned in the more recent literature, no serious effort has been done to investigate the role of epigenetic alterations and aneuploidy in retinoblastoma. Through the analysis of the specialised literature and a set of original epidemiological and biological data concerning retinoblastoma, the authors illustrate the evidences arguing against the 'two hit' hypothesis and propose that epigenetic factors and aneuploidy play central roles in the disease.

Retinoblastoma and mental retardation microdeletion syndrome: clinical characterization and molecular dissection using array CGH.

We describe three patients with retinoblastoma, dysmorphic features and developmental delay. Patients 1 and 2 have high and broad forehead, deeply grooved philtrum, thick anteverted lobes and thick helix. Patient 1 also has dolicocephaly, sacral pit/dimple and toe crowding; patient 2 shows intrauterine growth retardation and short fifth toe. Both patients have partial agenesis of corpus callosum. Patient 3 has growth retardation, microcephaly, thick lower lip and micrognathia. Using array-comparative genomic hybridization (CGH), we identified a 13q14 de novo deletion in patients 1 and 2, while patient 3 had a 7q11.21 maternally inherited deletion, probably not related to the disease. Our results confirm that a distinct facial phenotype is related to a 13q14 deletion. Patients with retinoblastoma and malformations without a peculiar facial phenotype may have a different deletion syndrome or a casual association of mental retardation and retinoblastoma. Using array-CGH, we defined a critical region for mental retardation and dysmorphic features. We compared this deletion with a smaller one in a patient with retinoblastoma (case 4) and identified two distinct critical regions, containing 30 genes. Four genes appear to be good functional candidates for the neurological phenotype: NUFIP1 (nuclear fragile X mental retardation protein 1), HTR2A (serotonin receptor 2A), PCDH8 (prothocaderin 8) and PCDH17 (prothocaderin 17).

Phthisis bulbi and buphthalmos as presenting signs of retinoblastoma: a report of two cases and literature review.

PURPOSE: To report two cases of bilateral retinoblastoma (RB) with unusual presentations. METHODS: The medical records of 321 patients from the Retinoblastoma Referral Center in Siena were reviewed. A total of 111 patients had bilateral RB, 2 of them presenting with phthisis bulbi and buphthalmos. Both patients underwent bilateral enucleation. Clinical features, imaging studies, and histopathology were reviewed. RESULTS: These 2 cases represent 0.62% (2/321) in our series. Histopathology did not reveal viable tumor cells in the phthisical eyes; in both buphthalmic eyes the tumor was active, infiltrating the choroid and optic nerve. CONCLUSIONS: Phthisis bulbi and buphthalmos are unusual presenting signs of RB. This very rare combination of these two signs in different eyes of the same patient is probably due to a delay in diagnosis.

Retinocytoma associated with calcified vitreous deposits.

PURPOSE: To report a case of bilateral retinocytoma associated with calcified vitreous deposits. METHODS: Case report. RESULTS: On routine examination, a 35-year-old asymptomatic father of a child with bilateral retinoblastoma presented bilateral retinocytoma associated with vitreous calcifications, in the vicinity of the retinocytoma in his left eye. Fundus photographic documentation and fluorescein angiography were performed. The patient has been followed up for 10 years. CONCLUSIONS: The lesions in both eyes have remained stable without signs of growth or malignant transformation. Calcified vitreous deposits are a recently described feature of retinocytoma in addition to the three classic features: translucent retinal mass, retinal pigment epithelial alteration, and calcification.

Pleomorphic adenoma of the lacrimal gland in an 18-year-old girl irradiated for bilateral retinoblastoma.

PURPOSE: To report a case of pleomorphic adenoma of the lacrimal gland following irradiation for bilateral retinoblastoma. MATERIALS AND METHODS: Case report. A 4-month-old girl, with bilateral retinoblastoma, underwent enucleation of the right eye, systemic chemotherapy and bilateral external beam irradiation with a lateral field. The right anophthalmic socket (because of infiltration of the optic nerve) and the left eye (for relapse) were irradiated;. 17 years later, she developed a mass in the superotemporal quadrant of the left orbit. The mass was completely excised. RESULTS: Pleomorphic adenoma is rare in children and teenagers; it usually presents as a painless, slow growing mass in healthy adults. In this case, it developed as a second primary tumor after irradiation for retinoblastoma.

[Anticipatory anxiety and interpersonal relations with the radiologist of patients undergoing diagnostic imaging]. / Ansia anticipatoria e rapporto interpersonale con il medico radiologo nei pazienti sottoposti a diagnostica per immagini.

A pilot study has been carried out with the aim of evaluating the impact of updated imaging techniques (CT and MRI) versus "simple" examinations (tomography, X-rays, US, and nuclear medicine) on the anticipatory anxiety of the patients, as well as on the radiologist-patient relationship. Ninety consecutive patients undergoing diagnostic imaging modalities were examined according to the following schedule: 1) preliminary interview and anxiety assessment according to HRSA; 2) diagnostic imaging investigation, and 3) filling out an "ad hoc" questionnaire. The collected data have been divided into two groups: the "simple" group (52 patients submitted to X-rays, tomography, US, and nuclear medicine), and the "complex" group (38 patients submitted to CT and MRI). Anticipatory anxiety was observed in all subjects and attained psychopathological rates in more than half of them. Anxiety proved to be related to the completion of the examination rather than to its complexity. The questionnaire has pointed out the need for a more interactive relationship between radiologist and patient during diagnostic imaging examinations.