[Bronchial hyperreactivity to methacholine in a group of bakers sensitized to wheat flour]. / Studio della iperreattività bronchiale alla metacolina in un gruppo di panificatori sensibilizzati alle polveri di farina di frumento.

BACKGROUND: Bakers' allergic diseases are a well known occurrence. Wheat flour is the most important allergen responsible for rhinoconjunctivitis and IgE mediated asthma. The good correlation between atopy, wheat flour sensitization and allergic diseases is also well known. In a previous study we described the results concerning sensitivity to wheat flour in a group of 300 bakers, followed up for 8 years. In this study we showed that the same subjects who were sensitive to wheat flour had no symptoms. AIM: The aim of this study was to carry out the metacholine test for bronchial hyperreactivity in a group of 14 bakers selected from the group of 300 previously studied. METHODS: The subjects underwent: pulmonary function test, IgE test, skin prick test with grass pollen, Dermatophagoides farinae, Dermatophagoides pteronissinus, wheat flour, and the metacholine test. RESULTS: The results of the metacholine test showed only one positive case in a subject with positive skin prick test. This agreed with the assumptions of our previous study that showed a sensitization (10%) to wheat flour but a low prevalence of allergic symptoms. CONCLUSIONS: Limited to the subjects studied, the results indicate an absence of a relationship between positive prick tests and aspecific bronchial hyperreactivity. Recent research that suggest a probable different genetic control of atopy, bronchial hyperreactivity and asthma is discussed. In our opinion effective primary and secondary prevention could account for this absence of relationship.

Failure of urinary trans,trans-muconic acid as a biomarker for indoor environmental benzene exposure at PPB levels.

Benzene is a widespread pollutant whose main source in the environment is automotive emission. There is increasing interest in the exposure of the population to this pollutant as benzene is present also in the indoor environment due to cigarette smoke, drinking water, and food. The aim of this study was to evaluate, in an adult nonsmoking population not occupationally exposed to benzene, whether it is possible to detect differences in the urinary concentration of trans,trans-muconic acid (t,t-MA) between low and high environmental exposure to benzene. A study sample of 31 employees working in pharmacies in a large town in Italy with low environmental exposure to benzene (4.8 microg/m3) was compared to a high (8.1 microg/m3) benzene exposure group. Analysis of urinary t,t-MA was carried out by high-performance liquid chromatography (HPLC; photodiode array detector); analysis of environmental benzene samples was by gas chromatography/mass spectroscopy (GC-MS). The statistical analysis revealed no significant differences in urinary levels of t,t-MA of subjects with high (mean concentration: 157.9 microg/g creatinine) versus low exposure (mean concentration: 114.2 microg/g creatinine). Data show that it is difficult to correlate urinary t,t-MA with benzene exposure at parts per billion levels.

[Four-year follow-up of a group of workers with allergic sensitization employed in breeding of insects for biological pest control]. / Follow-up di 4 anni in un gruppo di lavoratori con sensibilizzazione allergica addetti alla produzione di insetti per la lotta biologica.

In two previous papers we reported allergic diseases in workers employed in breeding insects for biological pest control. It was found that Ephestia kuehniella, Orius laevigatus and other insects caused allergic rhinoconjunctivitis and asthma. The aim of this new study was to assess the relationship between the implementation of the recommended preventive measures and the decrease in sensitization in exposed workers. We performed a four-year follow-up of exposed workers, using the prick test and RAST with specific allergens and pulmonary function test at the end of the work shift. The results showed a decrease in skin test sensitization for Orius and Ephestia, a decrease in allergic diseases in the previously studied workers, and no symptoms in recently employed workers. These results confirm the validity of the recommended preventive measures: semi-closed cycles, gloves, protective masks, overalls and sunglasses.

Biomonitoring of exposure to nitrous oxide, sevoflurane, isoflurane and halothane by automated GC/MS headspace urinalysis.

OBJECTIVES: The goal of the present study was to develop an automated method to assess by biological monitoring, the volatile-anaesthetic exposure (nitrous oxide, sevoflurane, isoflurane and halothane) in operating theatre personnel. METHODS: Post-shift urine samples were analysed by gas chromatography-mass spectrometry coupled with static headspace sampling (GC-MS/ HSS); intra-assay %-RSD (n= 10) was less than 5% for nitrous oxide and less than 7% for each halogenated vapour. The biomonitoring method was validated with air monitoring data, obtained by personal samplers and a similar GC-MS method. The sensitivity achieved by single ion monitoring (SIM) was sufficient to reveal low biological and environmental exposure averages down to 1 microg/l(urine) and 0.5 ppm for nitrous oxide and 0.1 microg/l(urine) and 50 ppb for halogenated compounds, respectively. RESULTS: In 1998 we collected and analysed 714 post-shift urine samples for the biological monitoring of volatile anaesthetics in the urine of the operating-theatre personnel of Sant'Orsola-Malpighi Hospital (Bologna, Italy). Our data showed that nitrous oxide (N20), the anaesthetic most largely used in general anaesthesia, is still the decisive factor in operating-theatre pollution. Moreover, on the basis of our results, working in close contact with anaesthetics seems to be the main determinant of risk: surgical nurses and anaesthesiologists are the most-exposed professional categories (mean post-shift urinary N2O approximately 65 microg/l(urine)) while general theatre staff, surgeons, and auxiliary personnel have significantly lower exposure. CONCLUSIONS: The biological monitoring of post-shift unmodified urinary volatile anaesthetics was confirmed to be a useful tool for evaluating individual exposure to these chemicals. The urinary concentrations of N2O and of halogenated vapours might reflect, to a certain extent, the external exposure to these compounds, and respiratory air-monitoring data support the validity of biological monitoring. Furthermore, the good relationship between air and urinary concentration of anaesthetics in people working in closer contact with these chemicals may be a good indirect means of revealing the bad air conditions of operating rooms, and may contribute to the highlighting and correction of service defects in anaesthesiology equipment and of human errors.

Screening of health care workers for hepatitis B virus and hepatitis C virus: criteria for fitness for work.

The aim of this study was to propose a protocol for assessment of markers of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in exposed health care professionals and to define criteria for evaluation of fitness for the job of the infected personnel. The study comprised 800 persons involved in operative procedures, including 414 surgeons, 275 nurses, and 111 anaesthetists. A graduated protocol was created for monitoring markers of HBV and HCV infection. A well-defined combination of markers of antigen-antibody systems enabled identification of four groups of persons with HBV infection differing in fitness for work: 1) HBsAg-positive, HBeAg-positive, HBV DNA-positive; 2) HBsAg-positive, anti-HBe-positive, HBV DNA-positive; 3) HBsAg-positive, anti-HBe-positive, HBV DNA-negative; and 4) anti-HBs-positive, anti-HBc-positive, anti-HBe-positive group. For HCV infection, two groups with different job fitness were identified: 1) anti-HCV-positive, HCV RNA-negative and 2) anti-HCV-positive, HCV RNA-positive. Screening of hospital personnel at risk to HBV and HCV infection requires a well-defined protocol which may help to evaluate the fitness of the infected personnel for a specific job.

[Use of diverse diagnostic techniques in the study of silicosis]. / Utilizzo di diverse tecniche diagnostiche nello studio della silicosi.

This study would examine the efficiency of different diagnostic tools, imaging and functional, in the study of pulmonary system of workers exposed to silicotigen dusts. 24 male miners were examined with chest H.R.T.C., spirometry with study of DLCO and of total lung capacity. 13 of 24 miners were submitted to pulmonary ventilatory scintigraphy (99mTcDTPA). All 24 miners were previously yet submitted to two follow-up by means of chest radiography in conformity with ILO guidelines. The chest radiography, even evaluated in conformity with ILO guidelines, is subject to remarkable differences when performed and reported by different operator. Useful data are provided by functional studies. H.R.T.C. is necessary to evaluate the degree of parenchymal involvement and for medicolegal porpoises. Scintigraphy with 99mTc DTPA need of further studies in the evaluation of exposure to silicotigen dusts.

Gardening work and heavy metals in urban environment.

Urban soil may be a source of occupational exposure to various pollutants in gardening and land cultivation. This paper presents data of a one-year follow-up of lead, cadmium, nickel, chromium, and vanadium in the environment of the city of Bologna. Samples of soil and leaves were collected at three locations; gardens from the inner-city high-traffic area, parks in moderate-traffic area, and parks in suburban, low-traffic area. The top and deeper layers of soil and leaves were mainly polluted by lead at all locations, which corresponded to the traffic density. Personal samplers recorded greater concentrations of airborne metals than did the area samplers but the values kept below the threshold limit established by the American Conference of Governmental Industrial Hygienists for the working environment. Due to cumulative nature and interactive effects of toxic metals with other toxic and essential elements, long-term exposure to metals in the urban environment may be a health risk for occupationally exposed gardeners.

Ocular hypertonia and crystalline lens opacities in healthcare workers exposed to ionising radiation.

Some activities performed by healthcare workers may still involve total or partial exposure to ionising radiation exceeding the limit values. In addition to the appearance of crystalline lens opacities which may lead to rays-cataract, recent studies have indicated possible induction of ocular hypertonia in occupationally exposed subjects. The aim of this study was to establish the actual prevalence of ocular hypertonia and crystalline lens opacities in a group of healthcare workers exposed to ionising radiation. The collected data failed to show significant risk of ocular hypertonia and suggested that crystalline lens opacity was not an important indicator of exposure. Notwithstanding, preventive and periodic (every 5 years) ophthalmologic control may prove helpful for medicolegal purposes. Namely, such control would record congenital crystalline lens opacities in many individuals and would thus rule out unjustified claims of occupational disease due to exposure to ionising radiation. Additionally, ophthalmologic control should focus on different and probably more important ocular risks for the radiologists such as the ocular fatigue resulting from a prolonged use of a video display terminal or other diagnostic screens or electrodiaphanoscopes.

Use of ultrasound in occupational risk assessment of low-back pain.

The aim of the study was to evaluate ultrasound technique in preemployment medical assessment of the risk for low-back pain. Volunteers for the study were recruited among agricultural workers employed in the "Agraria Department" of the University of Bologna, Italy. The group consisted of 90 subjects, 52 male and 38 female, aged 25 to 58 years. The subjects filled in a questionnaire on medical history of low-back pain and were examined using an ultrasonograph equipped with a high linear frequency probe (3.5 MHz). The oblique parasagittal diameter of the lumbar spinal canal was measured by transabdominal ultrasonic imaging in the lumbar (L4-L5) and lumbosacral (L5-S1) region. Individuals with significantly narrower canals (< 14 mm) had an increased risk of low-back pain. The paper concludes that ultrasound imaging could become a valuable screening tool in industry, permitting selective job placement for workers at high risk for disorders of the back.

Improved respiratory CO2-He analysis for peripheral airways impairment detection. Utilization possibilities of a new computerized system in preventive medicine studies.

The authors illustrate the application possibilities in occupational and preventive medicine of a recently computerized system for the evaluation of peripheral ventilatory non-homogeneities with or without alveolar air trapping. The method consists of an improved individual multiple breath by breath test utilizing the analysis of the respiratory gases CO2 and He. It is based on the results of previous experimental measurements performed simultaneously in different pulmonary sectors an depends on the technical possibility of signalizing out-of-phase expired CO2-He mixtures at the end of the inert gas clearance when in subjects with peripheral respiratory disorders the two gases CO2 and He arrive at the mouth at different times, during the same expiration and cause different, opposite signals. The applied physiological reliability of the measurements was experimentally verified, their technical specificity was recently established. The use of a new computerized system allows actually automatic, on-line measurements under the control of the operator, following a standardized method. The resolution power of the signals is very high. The calculation of the results is performed by the software. The system is easy to transport and can be used in the field for screening on large groups of persons in preventive medicine inquiries and during occupational medicine checks. Quite recently it has been usefully employed during an investigation on 200 subjects, occupationally exposed (policemen of the city traffic department of the town of Bologna).

[Occupational asthma caused by dioctyl-phthalate in a bottle cap production worker]. / Asma occupazionale da dioctil-ftalato in una addetta alla produzione di tappi per bottiglia.

The authors describe a clinical case of occupational asthma due to dioctyl-phthalate in a worker using a conveyor belt for bottle stoppers. The dioctyl-phthalate is used for the production of PVC and as a compound of many other substances. The literature describes many cases of occupational asthma do to phthalate anhydride but few cases do to dioctyl phthalate. The clinical history, the environmental monitoring data, the pulmonary function tests such as bronchodilatation test by salbutamol, peak flow meter daily monitoring for three weeks, and stop and start work test showed a good correlation with the work and the worker's asthma. The authors emphasize that a detailed clinical history and a careful analysis of the production cycle are very useful and, as simple and non invasive tests, can play an important role in the diagnosis of occupational asthma.

Short-term neurobehavioural effects in anaesthetists with low exposure to nitrous oxide.

The aim of this study was to assess whether a sample of 37 anaesthetists occupationally exposed only to N2O showed any deterioration in vigilance and/or mood. The anaesthetists were examined with three neurobehavioural tests (Simple Reaction Time and Colour Word Vigilance to measure the vigilance and Mood Rating Scale to evaluate the level of stress and arousal) and underwent N2O biological monitoring (to correlate the test results with the N2O exposure) on the first and on the last day of the work week, before and after work in the operating room. No significant relationship was found between the biological monitoring and the test results. The only significant statistical difference was found between the beginning and the end of each workday in the arousal level, regardless of the result of the biological monitoring.

Evaluation of the impingement of the pronator muscle in occupational carpal tunnel syndrome by electromyographic and ultrasonographic techniques.

Normal flexion of the fingers involves an involuntary contraction of the pronator and lumbrical muscle. In individuals whose profession involves constant flexing of the fingers those muscles become hypertrophied, impinging on the carpal tunnel. The narrowing of the carpal tunnel yields well to ultrasonography. The objective of this investigation was to find an ultrasonographic index of occupational carpal tunnel syndrome. Thus "Index M" denotes the variation obtained in the "M Space" before and after flexion-extension of the fingers. The study included 45 subjects performing tasks which involved the risk of cumulative trauma disorders. The subjects were tested using the electromyography and ultrasonography. The method was based on relation between the decrease in conduction of the median nerve measured by electromyography and the ultrasonographically measured variation of "M Space" in terms of sensitivity and specificity. The sensitivity of ultrasonography was 85%, as it confirmed the pathologic findings determined by electromyography ("M Index" positive) in twenty-two out of 26 hands, but the specificity was not statistically significant. Ultrasonography seems to have found very important application as a screening technique in occupational medicine. It is non-invasive, sensitive, easily repeated, and costs little.

[Microtrauma radial thrombosis]. / Trombosi radiale microtraumatica.

The articles describes a case of radial artery thrombosis by repeated microtrauma. It describes, by one side, the occupational history, the personal habits and the typical movement and condition of the hands while working, on the other, the clinical and diagnostic picture of radial artery thrombosis. Then it shows the correlation between occupational factors and radial artery thrombosis and so the occupational genesis (repetitive microtrauma) of the disease.

Use of ultrasonography in monitoring work-related carpal tunnel syndrome: a case report.

Carpal tunnel syndrome (CTS) is a syndrome whose diagnosis is well established. One cause could be occupational factors, while others have no relation to work or the work environment. We present in this article a case report regarding a worker affected by CTS, which is of interest concerning the sensitivity of ultrasonography and electroneurography, applied as diagnostic methods, related in our protocol to the variations in occupational exposures. The case reports an agricultural worker, whose tasks required repetitive and high frequency movements of the hand-arm. Diagnosis of CTS used ultrasonography and electroneurography techniques. In our opinion, the clinical evolution of CTS encompasses three "work-related" phases (preclinical phase; phase of nerve compression; phase of irreversible damage). Ultrasonography provides greater information about the evolution of CTS, as well as other cumulative trauma disorders, and is able to discern tendinitis of flexors causing a compression on the median nerve in the carpal tunnel.

Cohort mortality study of rubber and plastics product makers in Italy.

A retrospective cohort mortality study was carried out in 20 industrial factories in the Local Health Unit Bologna Sud (Emilia Romagna, Italy), where different rubber and plastics products were manufactured. The cohort consisted of 925 subjects (578 males and 347 females) employed for at least six months continuously; follow-up was between the beginning of operation of each factory, ranging between mid fifties and mid seventies, and 31 December 1989. For those exposed more than one year cause specific Standardized Mortality Ratios (SMRs) were computed using regional rates for comparison, 90% confidence intervals (CI) were calculated assuming the Poisson distribution. Among the 748 subjects employed for more than one year (457 males and 291 females) there were no lost to follow-up, 54 individuals were dead (41 males and 13 females) and for three subjects the cause of death was unknown. The results showed that all causes mortality was above expectancy in the total cohort (SMR = 123; 54 Obs; 90% CI = 97-154), among males (SMR = 117; 41 Obs; 90% CI = 89-152) and females (SMR = 143; 13 Obs; 90% CI = 85-228). Increased mortality for all malignant tumours was observed in the total cohort (SMR = 150; 25 Obs; 90% CI = 104-209) and for both genders. All nine lung cancer cases were observed among males, the SMR was equal to 218 and was statistically significant; seven cases occurred at duration of exposure less than 10 years and six at latency up to 20 years. The interpretation in terms of causality of the present investigation is limited by the small number of observations and by exposure definition solely in terms of employment in the study factories; nonetheless the results are indicating the existence, in this group of rubber and plastics product makers, of an adverse health effect which deserve further investigation.

Airborne contact dermatitis from 2-amino-2-methyl-1-propanol in a cosmetic company.

The authors described two cases of airborne contact dermatitis caused by 2-amino-2-methyl-1-propanol (AMP 100) in two subjects with periorbital erythema and itching skin. The AMP 100 has been used to replace ammonia as a hair dye component in the cosmetic industry with the purpose to eliminate its smell. Patch tests proved positive only to dilutions of 10% and 20% in the two described patients, as well as in other six asymptomatic subjects operating in the same working environment. The authors have diagnosed an irritative airborne contact dermatitis by AMP 100.

[Sensitization and allergic pathology in a group of workers employed in insect breeding for biological pest control]. / Sensibilizzazioni e patologia allergica in un gruppo di lavoratori addetti all'allevamento di insetti utili per la lotta biologica.

On the basis of the results of a previous study and immuno-allergological tests, a group of workers employed in breeding insects for biological pest control were studied to ascertain whether any new sensitizations to arthropods recently included in the work cycle occurred and whether any new allergic diseases were observed. The results confirmed a high sensitization to Ephestia kuehniella and to Orius, the latter probably due to contamination; sensitization to Tetranicus urticae and to Planococcus citri were observed, although to a lesser degree. It is concluded that the insects used in biological pest control are highly allergogenic and that the protective devices used up to the present were ineffective; the authors therefore recommend the use of closed or semi-closed cycles along with local ventilation equipment.

[Biomechanical pathology of the upper limb: a new epidemic?]. / La patologia biomeccanica dell'arto superiore: una nuova epidemia?

Work-related upper limb disorders are one leading occupational diseases in many industrialized countries. The paper reviews the evidence of work-relatedness of the most common upper limb disorders (namely carpal tunnel syndrome, hand-wrist and shoulder tendinitis, trapezius myalgia, hand hammer syndrome). Attention is drawn to the difference in the number of reported cases in Italy and other countries, assuming, as an underlying cause, underreporting of such conditions in Italy.

Cumulative trauma disorders of the upper limbs in workers on an agricultural farm.

The work associated with repetitive efforts and inadequate resting periods, strong physical exertion, awkward postures or static positioning exposes workers to the risk of cumulative trauma disorders of the upper limbs. These risk factors are present in many agricultural activities. A study was carried out among workers on an agricultural farm. The workers' histories were taken and they were given periodical medical check-ups. The presence of upper limb disorders was shown in a group of workers. A sample of 42 people was selected for the study by means of specific tests: electromyography, ultrasonography and laser-doppler flowmetry. The tests showed a high incidence of carpal tunnel syndrome and microcirculation disorders. The study confirmed that electromyography, ultrasonography and/or laser-doppler flowmetry are highly useful tools for identifying cumulative trauma disorders.