[Prevalence of occupational allergy to laboratory animals in two towns of northern and central Italy]. / Prevalenza dell'allergia professionale agli animali di laboratorio in due città del nord e del centro Italia.

BACKGROUND: Laboratory animal allergy (LAA) is a well known occupational hazard for workers employed in biological and medical research institutes, but few Italian data on this disease exist. OBJECTIVES: The aim of our study was to evaluate the prevalence of LAA in 45 workers in Trieste (NE-Italy) and in 80 workers in Perugia (Central Italy) and to assess factors predisposing to sensitisation among subjects occupationally exposed to animals. METHODS: All subjects underwent a physical examination and responded to a standardized questionnaire for the evaluation of allergic respiratory symptoms and exposure data. Skin prick tests with common allergens and with hair extract from laboratory animals were performed and specific IgE was measured. Atopy was defined as positive skin prick test to common allergens. RESULTS: There were 60% atopic subjects in Trieste and 55% in Perugia and sensitisation to laboratory animal hair was found in 24.4% subjects in Trieste and in 35% in Perugia. The prevalence rates of LLA were respectively 11.1% and 11.2%; 2.3% and 3.7% complained of asthma while 8.9% and 7.5% complained of rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to laboratory animal hair (odds ratio (OR) = 7.64; 1.83-44.5), to skin prick test positivity to common inhalant allergens (OR = 5.29; 1.09-50.2), to common allergic symptoms (OR = 3.95; 1.05-18.2) and to exposure time exceeding 5 hours per day (OR = 5.45; 1.31-22.0). CONCLUSION: The role of atopy and of exposure time in causing LLA was confirmed and the need of prevention measures to reduce exposure in people at risk was discussed.

Activity and isoenzyme profile of N-acetyl-beta-D-glucosaminidase in urine from workers exposed to cadmium.

The urinary excretion of N-acetyl-beta-D-glucosaminidase (U-NAG) and urinary Cadmium (U-Cd) concentration, a measure of the metal load in the body, were evaluated in 28 workers exposed to Cd, to determine the relation between the two parameters. In urine from 22 exposed workers with U-Cd<2 microg/g creatinine (Cr) there was no significant difference in U-NAG value (0.98+/-0.59 U/gCr) compared to non-exposed (0.73+/-0.48 U/gCr). In the six workers with 2 microg/gCr < or =U-Cd<10 microg/gCr the U-NAG (2.32+/-0.61 U/gCr) was statistically (P<0.05) higher than in other workers. In both the U-Cd intervals examined there were no altered values of beta2-microglobulin from urine of exposed workers compared to non-exposed (<0.30 mg/l). The U-NAG isoenzymes were separated by DEAE-cellulose chromatography from urine of non-exposed subjects and exposed workers. The U-NAG isoenzyme profile in urine of non-exposed subjects showed a high percentage (about 95%) of the A (acid) form, a much lower percentage (about 4.5%) of B (basic) form and a negligible percentage (about 0.5%) of I (intermediate) form. In the urine of 22 exposed workers with U-Cd<2 microg/gCr, the percentages of U-NAG isoenzymes were not different from non-exposed. In the urine of six workers with 2 microg/gCr< or =U-Cd<10 microg/gCr the percentage (8.34+/-0.91) of isoenzyme B (U-NAG-B), a marker of lesional enzymuria, was statistically increased (P<0.05) compared to non-exposed (4.42+/-0.56). These results suggest that adopting a biological limit for U-Cd equal to 10 microg/gCr might not be sufficiently protective. The increase in U-NAG-B content at 2 microg/gCr

Bilo-pancreatic Ascaris Lumbricoides infestation. Endoscopic discovery and removal.

Ascaris Lumbricoides infestation is relatively rare in industrialized countries, and it occurs mainly in conditions in which hygiene is lacking. We describe here a case of a 39-year-old female from ex-Jugoslavia affected by recurrent hepatic colic. At entry ultrasonography revealed microlithiasis in the gallbladder and widening of the pancreatic head. The subsequent ERCP showed slight filling defects in the choledochus and an inflammation-like stricture of the papilla of Vater, and after endoscopic sphincterotomy we saw an outflow of dense bile and microlitholits. Thus, a standard surgical cholecystectomy was carried out and the patient was dismissed on the 3rd postoperative day without any symptoms. However, the patient was admitted again after four days for a new coliky pain attack. An upper endoscopy showed a 23 cm long mobile parasite in the duodenum: it was caught with the polypectomy loap, extracted and identified as A. Lumbricoides. The patient's symptoms disappeared after the endoscopic removal of the worm and she was dismissed the day after the worm's removal. No recurrence of symptoms was noted during a 1-year follow-up. This case showed that A. Lumbricoides infestation of the biliary tree should be considered when biliary and/or pancreatic symptoms recur, especially in patients coming from undeveloped countries. At the same time we showed that endoscopic removal is a safe and effective treatment for this infestation.

Differential effects of iron load on basal and interferon-gamma plus lipopolysaccharide enhance anticryptococcal activity by the murine microglial cell line BV-2.

Here we evaluated the influence of intracellular iron levels on the constitutive and interferon (IFN)-gamma plus lipopolysaccharide (LPS) enhanced anticryptococcal activity by the murine microglial cell line BV-2. We demonstrated that iron loading via ferric nitrilotriacetate (FeNTA) resulted in a significant increase in the constitutive levels of anticryptococcal activity, while the enhancing effects by IFN-gamma plus LPS were prevented. Accordingly, a major increase was observed in the levels of thiobarbituric reactive substance (TBARS) produced upon iron loading under basal conditions, whereas IFN-gamma plus LPS treatment, that per se did not affect TBARS production, prevented by about 50% the enhancement otherwise occurring in response to iron loading. The potential involvement of multiple effector system and their relation to intracellular iron will be discussed.

Blood cadmium concentrations in the general population of Umbria, central Italy.

The aims of this study were (a) to assess blood cadmium (B-Cd) concentrations and to establish a tentative reference interval; (b) to identify significant determinants of B-Cd, in a population from Umbria, Central Italy, which was not occupationally exposed to cadmium (Cd). Four hundred and thirty-four healthy blood-donors volunteered to answer a questionnaire and provide a blood sample for B-Cd analysis, which was performed by graphite furnace atomic absorption spectrophotometry. Blood Cd concentrations ranged from non-detectable values, i.e. below 0.1 microgram/l up to 3.4 micrograms/l and were not normally distributed. The median values and the 95th percentiles were 0.7 and 2.0 micrograms/l, respectively. Concentrations of B-Cd were more than double in smokers than in non-smokers, median values being 1.1 micrograms/l and 0.5 microgram/l, respectively. In current smokers, B-Cd values correlated with the number of cigarettes smoked daily (rs = 0.40, P = 0.0001) and with the cumulative exposure to cigarette smoke (rs = 0.35, P = 0.0001). Concentrations of B-Cd correlated with age in the non-smokers, but not in the smokers and were significantly higher in women than in men only in the non-smokers. Both in smokers and non-smokers, B-Cd concentrations were similar in subjects living in urban or in rural areas. In the whole study population the lower and the upper tentative reference limit were < 0.1 and 2.2 micrograms/l, respectively, as computed by a non-parametric rank-based method. The upper limit was approximately double in smokers than in non-smokers (3.1 micrograms/l and 1.6 micrograms/l, respectively). Our results show that B-Cd concentrations in a general population from Umbria are in the range reported for general populations in Northern Italy and other European Countries. Smoking was the strongest determinant of B-Cd concentrations and age had a lesser effect.

[Lead absorption in an Umbrian population from 1982 to 1992]. / Assorbimento di piombo nella popolazione umbra nel 1982 e nel 1992.

This report assessed lead absorption in community samples of the general population in Umbria, central Italy, in 1982 and in 1992. Each participant (128 subjects in 1982 and 479 in 1992) answered a questionnaire providing details of personal information and life style. Blood lead levels were determined by atomic absorption spectrophotometry. In 1992 hematocrit and glutamyltranspeptidase (gamma-GT) levels were also measured. In 1982 the mean blood lead level was 226 micrograms/l in males and 167 micrograms/l in females, and in 1992 it was still higher in males than in females (98 micrograms/l vs 61 micrograms/l) as were hematocrit and gamma-GT levels. Multiple regression analysis showed sex and age were the main factors accounting for 42% of the total variation in blood lead levels. They were followed by alcohol consumption, gamma-GT levels and smoking in this order. In conclusion, blood lead levels decreased significantly in central Italy in the decade 1982-92 and persistent lead absorption seems to be due to individual characteristics such as male sex, advanced age and a personal life style which includes alcohol consumption and smoking.

Magnesium content of mononuclear blood cells in migraine patients.

Recent research has shown that magnesium levels in serum, salivary secretions and red blood cells are reduced in migraine patients with and without aura, both ictally and interictally. This suggests that lower magnesium levels can contribute to the etiopathogenetic mechanisms underlying migraine attacks. It has been suggested that mononuclear magnesium content is a reliable index of magnesium nutritional status, as it is more closely related to the total body stores than other biochemical indices. Therefore we determined mononuclear magnesium content in adult migraine patients with and without aura, in headache-free periods and, in a number of patients, during attacks. Migraine patients with and without aura, assessed in interictal periods, had a reduced mononuclear magnesium content compared to age-matched healthy control subjects. No significant variations were observed between ictal and interictal periods in migraine patients with aura and without aura. The lower magnesium content in mononuclear cells could indirectly indicate the reduction of brain magnesium concentration, which has recently been demonstrated in the course of migraine.

Red blood cell magnesium levels in migraine patients.

In the last few years, it has been suggested that magnesium plays a central role in establishing a threshold for migraine attacks and in intervening with the pathogenetic mechanisms involved in their onset. Accordingly, we determined red blood cell magnesium levels in adult migraine patients with and without aura interictally and in some of them also ictally. In comparison with normal subjects, migraineurs with and without aura had significantly lower red blood cell magnesium levels in the interictal period. Ictal red blood cell magnesium levels did not differ from the interictal values. Low red blood cell magnesium levels could be a peripheral expression of the reduced brain magnesium concentration observed in migraine patients.

Increased lead absorption in children living in an area with high concentration of ceramic workshops.

Children who live in contaminated areas or whose cohabitants are occupationally exposed to lead are at a higher risk of lead absorption. The present study examined the blood lead levels of 539 nursery and primary school children living in three towns in the Umbria region (central Italy): Deruta, Corciano and Perugia. Deruta is a small town with a high number of ceramic workshops; Corciano is a mainly agricultural centre; Perugia is the largest town in Umbria. The lead concentrations of house dust, soil, air and water ducts of Deruta and Corciano were also examined. The blood lead levels were significantly increased in children in Deruta (9.7 S.D. = 3.6 micrograms/dL, p < 0.05) and Perugia (9.6 S.D. = 4.0 micrograms/dL, p < 0.05) compared to Corciano (8.3 S.D. = 1.9 micrograms/dL). In Deruta the blood lead levels were higher in children whose cohabitants worked in small ceramic factories or workshops near or in the homes (10.7 S.D. = 4.1 vs 9.0 S.D. = 3.0 micrograms/dL, p < 0.05). The mean concentration of lead in the house dust in Deruta was higher than in Corciano (2.8 S.D. = 2.5 vs 0.8 S.D. = 3.8 micrograms/m2, p < 0.01); the highest values were found in the house dust of the homes of children whose cohabitants worked in small ceramic factories either near or in the same building. There was no significant difference between the concentrations of lead in street dust or tap water of Deruta and Corciano. We conclude that the production of handworked ceramics could lead to an increased risk of lead absorption in children, particularly those who live with workers from this sector.

Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients.

In the last few years a fundamental role for magnesium in establishing the threshold for migraine attacks and involvement in the pathophysiologic mechanisms related to its onset has become evident. We measured serum and salivary magnesium levels in juvenile migraine patients (with and without aura) and in a group of healthy young individuals by atomic absorption spectrophotometry. Migraineurs were studied in migraine-free (interictal) periods and during attacks. In comparison with normal subjects, migraine patients had lower levels of serum and salivary magnesium interictally. Serum magnesium levels tended to be further reduced during attacks. With respect to the values of interictal periods we observed a reduction, not statistically significant, of salivary magnesium levels for both migraine groups. Serum, and to a lesser extent salivary magnesium level reduction, could be an expression, at the peripheral level, of reduced cerebral magnesium levels which would contribute, at least in part, to defining the threshold for migraine attacks.

Serum and salivary magnesium levels in migraine and tension-type headache. Results in a group of adult patients.

It has been suggested that magnesium plays a central role in different etiopathogenetic conditions involved in the onset of migraine. We measured, by atomic absorption spectrophotometry, serum and salivary magnesium levels in drug-free migraine patients with and without aura and in tension-type headache patients. Migraine sufferers with and without aura and tension-type headache had significantly lower levels of serum and salivary magnesium concentrations in the interical periods than a group of healthy young individuals. Serum magnesium levels tended to be further reduced during attacks in all patient groups studied. A statistically significant decrease in salivary magnesium levels was evident only for migraine patients with aura. Serum magnesium levels and to a lesser extent salivary magnesium levels might express indirectly the lowering of brain extracellular magnesium concentration which occurs in migraine patients both in the intererictal periods and ictally.

Nutritional status of a group of self-sufficient institutionalized elderly people in Perugia (Italy).

The nutritional status of forty-six self sufficient institutionalized elderly people of Perugia was assessed. The diet of this group is slightly better than that of other groups of elderly people previously examined. As observed in other studies, the diet of the elderly from this region of Italy does not seem to be of the Mediterranean type. The location of subcutaneous fat in elderly men is prevalent in the upper trunk and in women in the arms. The clinical signs of nutritional status among this group of self-sufficient institutionalized elderly people are in general not specific and mostly associated with old age. The pathological conditions observed and the administration of drugs do not appear to substantially influence the nutritional status of this group.

[Duodenal ulcer, study of gastric secretion and rational treatment with famotidine in different doses]. / Ulcère duodénal, étude de la sécrétion gastrique et traitement rationnel par famotidine à doses différentes.

The authors report their experience with 50 patients affected by duodenal ulcer, 80% of them with a chronic relapsing ulcer. They all underwent endoscopy and study of gastric secretion (BAO and PAO) before beginning therapy with famotidine (40 mg nocturnal) and during this treatment. In 43 patients the secretory values of BAO and PAO resulted above the ulcerogenic limit during the treatment. In 2 cases the secretory values did not decrease under the ulcerogenic limit even during the therapy with 40 mg of famotidine. These 2 cases had been affected by relapsing duodenal ulcer, non responding to H2 antagonists and nocturnal doses of 60 and 80 mg famotidine till the secretory values decreased below the ulcerogenic limit. In such a way we obtained ulcer healing in 4 weeks. The therapy was prolonged for two years with the same dosage at the beginning and later with half doses without any relapse and secondary effects. We emphasize the utility of secretory studies in peptic ulcer and suggest that non-responding duodenal ulcer can depend on very high acid gastric secretion treated by too low doses of H2 antagonists.

Effects of low doses of lead on children's health.

An investigation has been carried out of the blood lead levels of children resident in three different municipalities of Umbria: Corciano, selected as a control area; Perugia, the largest town in Umbria (approx. 150,000 inhabitants), with intense automobile traffic; and Deruta a town in which there is a flourishing ceramic industry. The mean blood lead levels were found to be higher in children in Perugia (96 micrograms/l) and Deruta (97 micrograms/l) with respect to Corciano (83 micrograms/l); in Deruta the mean blood levels were raised in those children whose families are occupationally exposed to lead (107 micrograms/l). The concentration of lead in the air in Deruta was higher than in Corciano (0.19 vs 0.11 microgram/m3, respectively). The lead concentrations in house dust were higher in Deruta (2.8 micrograms/m2) than in Corciano (0.8 microgram/m2) and the difference was greater in the houses were the inhabitants were exposed to lead in factories (2.7 micrograms/m2) or in workshops which were adjacent to the houses (4.7 micrograms/m2). The blood lead levels of children included in this study have been compared with those obtained during a similar investigation in 1978. Over the last eight years primary school children in Corciano and Deruta have shown a marked reduction in blood lead levels (greater than 50%). This improvement should not lead to false optimism: in fact, it is impossible to establish the blood lead level at which no adverse effects are induced, especially in children. Numerous studies suggest that even sub-clinical levels of lead can cause alteration in heme synthesis, peripheral nervous system, kidney, immune system, skeleton and growth. Furthermore, with regard to the central nervous system, low blood lead levels can provoke neuropsychological deficits, which can result above all, in a decreased I.Q., and behavioural alterations.

Blood lead levels in children living in three communities, at different risks of lead pollution.

We carried out a survey on blood lead levels in children living in three different communities in Umbria, Italy: Corciano, a small community (12,500 inhabitants), free of lead-using factories and with light traffic; Perugia, a medium-sized city (146,500 inhabitants); Deruta, a small community (7500 inhabitants) whose economy is based mainly on the production of artistic pottery, mostly in small home-operated factories. The study sample was made up of 539 children (275 boys and 264 girls); 156 of them attended nursery school (aged 3-6) and 383 primary school (aged 6-11). The mean blood lead level was significantly higher in Deruta than in Corciano (9.7 vs 8.3 micrograms/dl); Deruta children whose parents were occupationally exposed to lead had significantly higher blood lead levels than children of lead-unexposed parents (10.7 vs 9.0 micrograms/dl). The mean blood lead level was higher in Perugia than in Corciano children. On the average boys had higher blood lead levels than girls in all of the groups. We conclude that blood lead levels were low in the groups of children studied. Nevertheless children of ceramic workers and children living in a medium-sized city had greater lead absorption than children living in the control area.

Evidence for a prostaglandin-mediated bone resorptive mechanism in subjects with fasting hypercalciuria.

This study was performed to assess whether treatment with prostaglandin synthesis inhibitors decreases calcium excretion in patients with idiopathic hypercalciuria. Nineteen hypercalciuric (12 with fasting hypercalciuria (FH), 7 with nonfasting hypercalciuria (NFH) and 8 control non-hypercalciuric stone formers were treated with sodium diclofenac, 50 mg t.i.d. for 2 weeks. After a washout phase, 7 FH patients received 200 mg/day of sulindac (a nonsteroidal antiinflammatory agent (NSAID) inactive on renal prostaglandin synthetase) for 14 more days. Diclofenac reduced urine calcium excretion in subjects with idiopathic hypercalciuria with either normal or elevated fasting urinary calcium (from 387 +/- 26 to 240 +/- 23 mg/day, P less than 0.001; and from 370 +/- 39 to 246 +/- 40 mg/day, P less than 0.05, respectively), whereas it was ineffective in normocalciuric stone formers. Similar antihypercalciuric effectiveness was exerted by sulindac in the seven FH patients. The antihypercalciuric action exerted by diclofenac in subjects with FH was associated with a significant increment in serum PTH (48 +/- 4 vs, 70 +/- 9 pmol/liter, P less than 0.05), whereas in NFH subjects, the antihypercalciuric effect of diclofenac on NFH was not associated with a change in parathyroid activity. Since the major effect of NSAIDs is to decrease prostaglandin synthesis, these data suggest that prostaglandins may play a pathogenetic role in idiopathic hypercalciuria. Furthermore, they suggest that PTH is suppressed in patients with FH, possibly due to stimulation of prostaglandin-mediated bone resorption process.

The effects of calcitonin on idiopathic nephrolithiasis. Evidence of bone involvement in fasting hypercalciuria.

This study was performed to evaluate the antihypercalciuric effect of calcitonin (CT), a potent inhibitor of bone osteoclastic activity, on idiopathic hypercalciuria (IH). Forty-two stone formers were studied: 18 suffered from fasting hypercalciuria (FH), 12 from nonfasting hypercalciuria (NFH) and 12 were normocalciuric stone formers (NSF). All patients received CT, 25 U/day sc for a period of 15 days. CT caused a statistically significant drop in urine calcium, phosphorus and hydroxyproline (OH-proline) excretion in FH patients and a concomitant increase in serum PTH levels. In this group the percentage variation (D%) of urine calcium decrease was linearly correlated with D% decrease in urine OH-proline. These results support the hypothesis that pathological bone reabsorption might be involved in the genesis of FH.