[Radioprotection: doctrinaire references and medical surveillance]. / Radioprotezione: riferimenti dottrinari e sorveglianza medica.

The current statement of radioprotection, as formulated in the 60/90 ICRP Publication and confirmed in the recent 103/07 ICRP Publication, strengths the conceptual principle of the optimization, justification and limitation of doses, it analyses the risk and proposes the values of dose limitation, according to socio-medical considerations. The medical radioprotection's aim moved from the limitation of deterministic damages ("tissue reactions" according to ICRP 103/07) to the probability's reduction of stochastic effects appearance. The "tissue reaction problem" was solved maintaining the exposition limits under the threshold. All the Radiological Protection System is orientated toward the reduction of stochastic effects appearence based on epidemiological evidences (if findable) and caution: caution is represented by LNT (Linear No-Threshold Hypotesis). This hypothesis permits to apply criteria of risk's evaluation by mathematics intruments. Even if sometimes this hypothesis was scientifically criticized recently (ICRP 103/07) it's been considered valid for the prevention in the radiological protection sphere. The medical radioprotection is interested in worker's general state of health. This state of health should be compatible with specific work's conditions and permit to formulated a judgement of fitness. This compatibility (without contraindication) shall be kept and checked time by bringing about preventive measures and, in the same time, picking out the first signs of any pathologies. Therefore with the radioprotection we can talk about genetic individual susceptibility to neoplasia. Especially with the moleculer genetics we can recognize a quite big number of hereditary defects combined with family predisposition to cancer. The medical surveillance therefore has to be a prevention activity for each individual worker considering his ipersusceptibility, his specific working risk, his particular state of health, his habits, his family predisposition, his aspirations and his socio-cultural context.

[Epidemiologic surveillance in occupational bladder cancer: a Tuscan experience]. / Intervento di ricerca attiva delle neoplasie vescicali di origine professionale: una esperienza toscana.

The percentage of bladder cancer as occupational disease in West-Europe is of 5/10%, but only a few amount of them are recognized as occupational disease from INAIL. The above mentioned research project is realized in order to decrease the gap between expected and claimed cases of occupational disease and it is conducted with the collaboration of ASL of Pisa, ASL of Empoli, Azienda Ospedaliera Universitaria Pisana and INAIL. 677 patients with bladder cancer were interviewed by phone, among them 64 subjects had a working experience compatible with neoplastic risks because had a previous occupational exposure to aromatic amines and metal working fluids. These cases were discussed into a Medical Staff and 40 cases were considered "probable" for occupational disease, 18 "possible", 3 cases are suspended for more research, 3 cases are considered "no professional disease". The research allows finding out a great number of bladder cancer, increasing the total amount of workers with occupational disease. The integrated approach with the collaboration among different institutions is surely the best way to allow and guarantee a suitable and right protection of workers with occupational disease.

[Evaluation of a series of serum mesothelin in patients with pleural malignant mesothelioma]. / Valutazione di dosaggi seriati di mesotelina sierica in pazienti affetti da mesotelioma maligno della pleura.

Pleural Malignant Mesothelioma (MM) is a highly aggressive neoplasm with a poor survival rate, hard diagnosis and treatment. The incidence of MM in Western Europe countries is expected to increase drammatically in the next 10-15 years. In spite of this drammatic scenario, at this time the only instruments for screening and early diagnosis are based on radiological tests with evident ethical and economical problems. For this reason, some authors are evaluating biological indicators with the significance of screening and early diagnosis markers. One of the most promising marker is serum mesothelin (SMRP). SMRP levels appeares to be significantly related to MM and its clinical (diagnostic/prognostic) usefulnes has been suggested. The purpose of this research is to show SMRP trend in relation both to the course of the disease and the response to therapies in some Epithelioid MM patients. The analysis of SMRP levels in these patients suggests that it may be a useful marker for monitoring the response to treatment. In fact, it was observed that SMRP increases in patients who did not respond to therapy, it tends to remain stable when therapies results into a clinical stabilization, while it decreases after surgical procedure and in case of clinical improvement.

[Medical surveillance of previously asbestos-exposed workers: report of a case of lung cancer with high level of serum mesothelin]. / Sorveglianza sanitaria degli ex- esposti ad amianto: riscontro di un caso di tumore polmonare in un soggetto con elevati valori di mesotelina.

Recently, the number of previously asbestos-exposed workers performing, at our department, medical exams aimed at an early diagnosis of asbestos-related tumors, has been progressively increasing. The diagnostical protocol we propose to these subjects include both radiological exams and some serum markers such as mesothelin and osteopontin. In this case-report we illustrate the history of a worker who, after having diagnosed a pulmonary asbestosis, developed a Lung Cancer. The significance of this case is based on the importance of the high mesothelin dosage which prompted further radiological exams resulting into the final diagnosis. In spite of the early diagnosis and treatment the patient finally died. Nevertheless, serum markers like mesothelin and osteopontin (especially the first) may result very helpful in monitoring and screening the population of workers previously exposed to asbestos.

[Health surveillance guidelines after the European directive on electromagnetic fields]. / Linee guida di sorveglianza sanitaria dopo la Direttiva Europea sui campi elettromagnetici.

Directive 2004/40/CE of the European Parliament points out what an occupational physician has to do in case of scientifically evident effects of electromagnetic fields, meaning for evident effects, those one based on the agreement of the scientific community about their causal agents. The Directive, instead doesn't mention physician's tasks in case of possible effects for the exposure to occupational risk. Health surveillance is the estimation of the worker's state of health and it is indispensable to elaborate an evaluation of job-fitness. The clinical test must include the anamnesis, the medical examination and some diagnostic checks (diagnostic laboratory outline), which supply the occupational physician with a complete clinical picture showing any latent pathology or any conditions of individual hypersusceptibility. Anamnestic and clinical data are collected with a standardized system, all the several frequencies of the electromagnetic spectrum are analysed and the diagnostic protocols concerning eyes, skin, and hematopoietic system are established. Also data of periodical medical examinations and "minimum" complementary checks are established: for ELF, radiofrequencies and microwaves a medical examination with a hematological and biochemicals analysis and eye test and electrocardiogram are necessary every two years. Every occupational physician engaged in health surveillance has to keep up with the evolution of the scientific knowledge and he must observe the possible health damages for workers exposed to electromagnetic radiations: this is a deontological responsibility of the occupational physicians to respect the "precautionary principle".

[Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace]. / Esperienza di un centro per lo studio dei disturbi da disadattamento lavorativo in tema di patologie mobbing correlate.

BACKGROUND: The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon. OBJECTIVES: The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto". MATERIALS AND METHODS: The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions. RESULTS: The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing. CONCLUSIONS: The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.

[The point of view of the Italian Association of Medical Radioprotection: proposal of the Italian C.E.M. Observatory]. / Il punto di vista dell'Associazione Italiana di Radioprotezione Medica: proposta di Osservatorio italiano C.E.M.

Taking in consideration the suggested guide-lines for the health-surveillance on workers exposed to N.I.R. and in particular to ELF and radio-frequency, a work-group of A.I.R.M. suggests the constitution of an italian network for electro-magnetic fields. An observatory will be founded to value the professional exposures and the undue situations of risk, a parallel one will take the census of the workers subdivided into classes for exposure levels, pathologies or symptomatologies imputable to electro-magnetic fields. This suggestion is addressed to the national environmetal hygienists and occupational physicians that are interested.

[The occupational risk in IRCCS of Neurosciences]. / Il rischio professionale negli IRCCS di Neuroscienze.

The results of meta-analysis carried out on all documents for the valuation of the risk, recorded by IRCCS of Neuroscience, has led to identify a risk matrix for the medical personnel of the Scientific Institute of Neuroscience. Such analysis allowed to tackle the day to day risk faced by hospital staff. As a general rule the IRCCS of Neurosciences distinguishes themselves as structures of mainly neurologic typology and as structures of more typical psychiatric interest. In the first case the analogy with the traditional Hospital structures are more noticeable, in the second case instead the kind of patients and the particular relations between the health worker and the patient himself may represent an important differentiation factor. This is, above all, evident on the biological risk; for it's determinism has an important rule the interpersonal relationship between the health worker and the patient. Concerning other risk factors such as the chemical and the allergic one, it is noticeable a closed analogy with the actual Hospital reality. On work organization level, manual handling of patients is often necessary and also the relatives risks. In this kind of structures the stress factor is of the greatest importance, it should therefore have a strong consideration on the valuation of risk by the IRCCS.

[Knowledge of occupational risk in IRCCS of Neurosciences]. / Conoscenza del rischio professionale negli IRCCS di Neuroscienze.

A Professional Multicentric Audit, concerning Staff knowledge level about security on workplaces, was conducted by way of a standardized questionnaire given to 1022 (26.4%) IRCCS professional staff pertaining to Neurobiology. Four were the principal tasks of the questionnaire investigating the "sensibility" and "consciousness" concerning risk prevention on workplaces. It came out that there is a great variability in the knowledge level on this field, even if the "medium value" is "pretty good".

[Phenomenon of occupational accidents of workers of IRCCS of Neurosciences]. / Il fenomeno infortunistico negli operatori degli IRCCS di Neuroscienze.

On the basis of information collected from ten IRCCS, it has emerged altogether that the accident are not much frequent. Accident statistics indices from 1994 to 1998 were respectively: frequency rate 21.36, incidence rate 3.32, severity rate 0.24. In the "Neurology" Institutes we have above all needlestick injuries and cufs to the arms and hands. The workers most exposed are doctors, trained nurses, technicians. In the "Psychic" Institutes we have falling, impact, lifting and physical contact accidents. The injuries are contusions to legs and head. The most exposed workers are therapists and rehabilitation educators.

[SV40: a possible co-carcinogen of asbestos in the pathogenesis of mesothelioma?]. / SV40: un possibile co-cancerogeno dell'amianto nella patogenesi del mesotelioma?

BACKGROUND: The etiopathogenic role of asbestos in causing malignant mesothelioma of the pleura is clearly supported by an impressive amount of data. Despite the frequent association with previous exposure to asbestos, only a relatively small fraction of those exposed develop malignant mesothelioma. The long latency period between initial exposure and onset of the tumor suggests that human mesothelioma, like many other tumors, has a multi-stage evolution with the occurrence of many mutating events involving various tumorigenic agents, probably in part initiating and in part promoting development. Recently this has raised great interest in the scientific world, in an attempt to identify possible factors which together with asbestos may have a role in developing this rare malignant tumor. Ionizing radiations and genetic susceptibility have occasionally been identified as the culprits. A virus called SV40 has been gaining increasing scientific credibility since the mid 1990's as a potential co-carcinogen of asbestos. OBJECTIVES: The aim of this article was to examine the supposed interaction between asbestos and SV40 in the pathogenesis of mesothelioma and the way this simian virus has become a human virus. METHODS: All biomolecular and epidemiological data available from medical literature along with the results of the experiments performed during the last 7 years in our department laboratories were reviewed and compared. RESULTS: The first two pieces of experimental evidence of the presence of SV40-like DNA sequences in mesothelioma samples were obtained in 1994 in the United States, and one year later in our laboratories. After these two studies many research groups started carrying out similar experiments, obtaining comparable results in most cases. Moreover, beyond the mere detection of viral DNA sequences large amount of biomolecular data has recently been added in favour of its role in the pathogenesis of mesothelioma. Epidemiological studies published to date were unable to provide similar unanimous results. Data regarding the source of human infection are still debatable, even if the inadvertent administration of contaminated poliovaccines to millions of people in Europe and the United States between 1955 and 1963 remains one of the most reasonable hypotheses. CONCLUSIONS: On the basis of all the biomolecular data reviewed and partially on the basis of epidemiological studies, SV40 seems to be the best candidate as a cofactor with asbestos in the development of human mesothelioma.

SV40 can be reproducibly detected in paraffin-embedded mesothelioma samples.

We studied tissue sections from 18 paraffin embedded mesothelioma specimens diagnosed by the Pathology Department of S. Chiara Hospital of Pisa. Using PCR analysis and Southern blot hybridization we examined the specimens for the DNA regulatory region of the virus. 10/18 (55.5%) of the samples tested contained SV40 DNA regulatory sequences, and of these positive samples, 80% were found to contain Tag sequences by PCR and Southern Blot hybridization. These results confirm that SV40 can be amplified and detected in paraffin embedded mesothelioma samples.

Oncogenic risk in a chemical plant: a methological approach and preliminary results.

One of the major problems that occupational medicine has to deal with is cancer risk assessment. Recent Italian legislation requires the evaluation of occupational exposure to carcinogens in all workplaces, but a standardized method to be used in the environmental and biological criteria is generally lacking. The objective of this report is to identify a multidisciplinary approach to the research on this topic. The study is based on a chemical plant that produces pitch. The multidisciplinary approach is based on risk- and health-damage assessments. Ethical aspects are also taken into account, and the research design incorporates an informed consent for all employees. Some preliminary results are available. From the environmental point of view, all parameters provide an airborne concentration value below threshold limit values (TLVs), but biological monitoring demonstrates an increased urinary excretion of 1-OH-pyrene in all tested subjects. In conclusion, the first objective of our study is to demonstrate the carcinogenic risk of employees, searching for an agreement between environmental analysis, biological monitoring, and health effect data. A close collaboration between different professions is necessary.

A simple method to reveal possible ras mutations in DNA of urinary sediment cells.

Occupational and environmental exposure to carcinogens is reported to be responsible for 25% of all bladder tumors. Among many genetic alterations found in tumor bladder cells, chromosome aberrations and mutations of some oncogenes, such as ras genes, are common. Studies conducted to determine the rate and type of ras mutations involved reported rather contrasting results. Researchers agree that among the three members of the ras family, only H-ras is subject to mutations, mostly at codon 12. The rate of these mutations is still under investigation, although it has been evaluated as being between 6 and 76%. Using various techniques, some studies have shown that when a ras mutation occurs in a bladder tumor, it is also present in urinary sediment cells of the same patient. We suggest a simple method to directly detect ras mutations at codon 12 in urinary sediment.

Molecular biology studies on mesothelioma tumor samples: preliminary data on H-ras, p21, and SV40.

The ras gene is one of the oncogenes most commonly detected in human cancers; this protooncogene is converted to active oncogene by point mutations occurring at either codon 12, 13, or 61. SV40 is a DNA-transforming simian virus, a 105 bp sequence of which has been shown recently to be present in a significant fraction of human mesothelioma cells. Eleven human malignant mesotheliomas were examined for H-ras gene mutations at codon 12, 13, and 61 and for the presence of SV40-like sequences. DNA prepared from formalin-fixed and paraffin-embedded tissue was amplified by means of PCR and analyzed using designed restriction fragment length polymorphism. No mutation with respect to H-ras was found in any tumor sample, but the majority of mesothelioma cells contained SV40-like sequences.