[Asbestos: fifty years of work exposure in Campania and other Italian regions through INAIL experience]. / Amianto: un cinquantennio di esposizione lavorativa in Campania e nelle altre regioni d'Italia attraverso le competenze INAIL.

The aim of the work is to proceed to the recognition of asbestos phenomenon in Campania and in the other regions with emphasis on the incidence and development of several related diseases. Using data from first INAIL Annual Report on the progress of occupational diseases until 1999, and the data provided by the INAIL CSA regarding the last 12 years (2000 to 2011), the incidence is illustrated for two-year periods, from 2000 to 2011, for the total of diseases and separately for: asbestosis, mesotheliomas, lung cancer and non-cancerous pleural lesions. The total of diseases by region for the period 2000-2011 has been reported. The survey results show a gradual increase in the total asbestos related diseases (15,998) due to the mesotheliomas portion (5739) while the trend of lung cancer is stationary (2,287). Pleural plaques have a variable growth in the various regions during recent years. Some significant case studies from Campania are reported.

[Fatal hydrogen sulphide (H2S) poisoning in "confined spaces"]. / Le intossicazioni professionali mortali da Idrogeno Solforato (H2S) in "ambienti cofinati".

This paper deals with the problem of fatal accidents that occur repeatedly in "confined spaces", with particular attention to exposure to hydrogen sulfide (H2S). This, at high concentrations, appears to be the most compatible with the dynamics of many recent incidents with sudden death. H2S offers little chance to escape at high concentrations because of the smell that causes paralysis of olfactory nerves and sudden loss of consciousness. Besides the problem of acute exposure to high concentrations, health effects may also be caused by prolonged and repeated exposures to lower doses: at low concentrations can occur eyes irritation with keratoconjunctivitis and, at higher concentrations, the risk of pulmonary oedema or chronic central nervous system sequelae. In this paper several aspects are detailed, including an interpretative analysis of the content of Articles 66 and 121 of Legislative Decree 81/2008 and subsequent amendments, the work contexts where H2S is present as a raw material or product of the process and the effects on human health. Moreover, due to few epidemiological initiatives at national level, some aspects related to the accident dynamics are taken into account through the reconstruction of cases of fatal accidents occurred in Italy in recent years and comparing it with that reported in the literature of other Countries.

[Diseases caused by repetitive trauma. Trends in accusations and recognitions in the field of INAIL]. / Le patologie da traumi ripetuti. Andamento delle denuncie e dei riconoscimenti in ambito INAIL.

In this report the authors describe the situation of the work-related illnesses, associated with repetitive manual work (CTD-Cumulative Trauma Disorders-), report to the INAIL after the introduction of the mixed system (sentence of Constitutional Court 179/88). They described the medical-legal criteriology that they follow, disorder report, occupational sectors, the most important regions and the connection between the cases arrived to the General Direction and the recognized cases in the last five years.

Detecting hibernated myocardium with SPECT and thallium-glucose-insulin infusion.

UNLABELLED: Because thallium kinetics, like potassium kinetics, may be affected by serum insulin levels, we performed two pilot studies to identify severely ischemic myocardium using different protocols based on the infusion of a thallium, insulin, potassium and glucose solution. Results were compared with those obtained with two currently used protocols based on rest injection or reinjection of 201Tl. METHODS: In the first study (Protocol 1) of 15 men with a previous large myocardial infarction, perfusion was evaluated by SPECT in 20 segments after a 30-min infusion of 201Tl (111 MBq), insulin (5 U) and potassium (10 mEq) in 10% glucose solution (250 ml). Imaging was repeated 30 min later and the results were compared with those obtained from stress and 3-hr reinjection images. In the second study (Protocol 2), 15 patients were evaluated randomly at rest and 3 hr later (rest-redistribution). On a separate day, the patients were then re-evaluated after infusion of 201Tl (111 MBq), potassium (10 mEq) and insulin (5 U) in 5% glucose (250 ml); images were obtained 90 and 180 min postinjection. RESULTS: In Protocol 1, radiotracer activity in segments with no uptake during stress was detected in 35% with the reinjection technique and 58% with the insulin solution protocol. In Protocol 2, 31% of segments revealed thallium activity after insulin infusion but not at rest or rest-redistribution. Serum measurements showed high insulin levels (444 +/- 138 in Protocol 1, 125 +/- 33 mU/ml in Protocol 2), although glucose levels were not significantly altered (149 +/- 32 versus 71 +/- 20 mg/dl, respectively). Potassemia was not affected and the patients tolerated the tests satisfactorily. CONCLUSION: These results confirm that continuous infusion of 201Tl with a low dose of insulin in a glucose/potassium chloride solution is safe and may enhance cellular uptake of the radiotracer in severe ischemic regions, thereby improving viable myocardium detection.

[The significance of acetylcholine test in occupational allergic asthma (author's transl)]. / L'importanza del test inalatorio all'acetilcolina nell'asma allergico professionale.

The authors studied the spirometric changes following acetylcholine inhalation in a group of subjects with history of paroxysmal dyspnea--apparently related to their working activity--and, at the same time, with negative skin tests. Acetylcholine inhalation test proved to be positive in 80% of the cases, showing an increased bronchial reactivity and therefore a tendency to functional bronchostenosis. The high percentage of positive responses in the suspect cases, the lack of side effects and the negative results in control subjects, recommend the acetylcholine inhalation test as a suitable ancillary diagnostic procedure in suspect cases of occupational allergic asthma.