[Health surveillance of subjects formerly exposed to asbestos in Puglia]. / Sorveglianza sanitaria degli ex-esposti ad amianto in Puglia.

The massive use of asbestos affected several industrial areas of Apulian region in the last decade. It has been estimated that in our country there are thousands of asbestos exposed workers and about 10.000 of them received CONTARP-INAIL document attesting their asbestos exposure for over ten years ex D.L. 257/92. Owing to the lack of any regional rules and guidelines on the medical surveillance of asbestos ex-exposed people, since 1994 our operative hospital unit has activated a sanitary protocol in order to satisfy growing requests of assistance and emergent controls for this part of people. During a 12 year activity 629 asbestos ex-exposed workers have been examined. 21% of these workers had two checks, thanks to these the recognition of 22 new tumoral and non-tumoral asbestos-correlated pathologies has been possible. This experience makes it clear that the activation of new procedures for early diagnoses of some asbestos-correlated pathologies is necessary, in fact more proposals for a redevelopment of sanitary assistance in the regional field are suggested.

[Neonatal hearing screening during the first and second day of life]. / Screening audiologico neonatale in prima e seconda giornata di vita.

AIM: Congenital or acquired hearing loss in infanthood has been associated with lifelong deficits in speech and language acquisition, poor school performances and emotional and social maladjustments. The identification of hearing loss through neonatal and infant life can prevent or reduce many of these adverse consequences, permitting early intervention. METHODS: We performed the screening of hearing loss with a technical device, echo-screen Madsen, based on transient evoked otoacoustic emissions (TEOAE). The screening was carried out in 50 newborns during the 1st day of life and in 80 newborns during the 2nd day of life. RESULTS: The 2nd day of life showed a significant better stability of the test and a better symmetry (P<0.001), and less incidence of artefacts (P<0.001). CONCLUSIONS: The results obtained confirm that the 2nd day of life is the most appropriate time for the neonatal hearing assessment with TEOAE.

Autochthonous mucosal leishmaniasis in a hemodialyzed Italian patient.

A case of mucosal leishmaniasis in a 60-year old hemodialysis patient who had never lived outside Italy is described. The patient complained of fever, epistaxis and nasal obstruction. An anterior rhinoscopy disclosed a mass of two centimetres in diameter in the right nasal fossa. Histological examination revealed Leishmania amastigotes. Serology for Leishmania was positive with antibody titer of 1/320. A culture yielded a very slow growth of Leishmania infantum MON-24. In spite of a two-month treatment with oral itraconazole, the lesions progressively worsened. Treatment with topical paromomycin sulfate determined the complete resolution of the lesions within four months, with a residual perforation of the septum. This case demonstrates that localization of Leishmania spp must be considered in the differential diagnosis of mucosal lesions in hemodialyzed patients, even in countries not at risk for this parasite. Moreover, this case indicates the important role of the immune system in the evolution of the disease.

[Cisplatin ototoxicity: the experience of the Institute of Oncology in Bari]. / Ototossicità da cisplatino: l'esperienza dell'Istituto Oncologico di Bari.

The Authors report their experience, developed in the E.N.T. Unit of the Oncologic Institute of Bari, concerning the ototoxic effect of Diamminedichloroplatinum (CDDP). The Study was carried out on 74 patients with advanced cancer of the head and neck, treated according to the polychemotherapeutic scheme called "MBD" in 34 cases and in 40 cases according to the scheme called "Al Sarraf". The otologic evaluation was composed, in all the cases, of a complete series of audio-vestibular investigation, carried out prior to and immediately after every administration chemotherapy and periodically, during a 4 months period after interruption of therapy. Three patients (4%) showed significative acoustical damage, none showed vestibular deficit. Symptoms did not appear beyond the second administration of CDDP, which always followed subjective acouphenic symptomatology. The ototoxic effect of CDDP, resulting in the experience of the Oncologic Institute of Bari, is percentually very low: and seems to be influenced by the single dose, rather than by the total doses and in any case is not preventable by any profilatic measure.

ABR in multiple sclerosis. Ipsi- versus contralateral derivation.

Brainstem auditory evoked potentials (ABR) were recorded simultaneously between vertex and ear lobe, ipsi- and contralateral to the stimulated ear in 53 subjects with confirmed (19) or undefined (34) multiple sclerosis. Results were compared with those obtained in a control group of 20 normal-hearing adults. The control group showed that significant latency differences exist between ipsilateral and contralateral recordings. Definition of abnormality was based on absence and separation of waves. The results showed that the use of contralateral derivation in ABR recordings increased detectability from 74% to 89% in patients with confirmed MS and from 9% to 21% in cases of undefined MS. It is proposed that parameters of contralateral ABRs be included among the criteria used for the otoneurological diagnosis of patients with CNS lesions.

[Stapedial reflex under auditory masking of bone canal: 1- The effect of white noise on threshold values]. / Il riflesso stapediale sotto mascheramento uditivo per via osea: I-Effetto del rumore bianco sui valori di soglia.

The authors have studied the behaviour of the A.R. threshold under bone way masking sent to the vertex. The masking caused changings of the recorded track; a change of the compliance was observed in the 60% of the subjects and a rythmic waving of the (isoelectric) line was observed in 40% of the subjects. Upon these changes the A.R. were recorded for the tone test sent at similar values (almost equal) at those recorded without any kind of masker, even if a threshold shift sometimes big, existed because of the high intensity of the masking noise. The authors are making further researches to explain the meaning of these changes.

[Effects of diazepam on stapedius reflex: physiological research]. / Effetti del diazepam sulla reflessometria stapediale: ricerche fisiologiche.

The effect of diazepam (10 mg i.m. X 7 days) on crossed and uncrossed acoustic stapedius reflex parameters (threshold, amplitude and duration) has been studied in 7 normal hearing subjects. The results showed that diazepam has a not clinically significant damping effect on the threshold, the amplitude and, very often, the duration of both ipsilateral and contralateral acoustic stapedius reflexes.

[Cortical responses evoked by vibrotactile sensations in deaf children]. / Studio dei potenziali corticali evocati da sensazioni vibrotattili nelle sordita' infantili.

Vibrotactile evoked responses (VER) to 250 and 500 Hz presented respectively at 50 and 70 dB HL by BC vibrator placed on right thumb, were recorded in 20 children (10 with pathological EEG) with severe sensorineural hearing loss, or deaf since birth, both to control accuracy of cortical responses to high intensity auditory stimuli and to diagnose central non auditory pathways lesions. The results have shown that: VER are present in subjects with severe sensorineural hearing loss or deaf; in children with auditory lesions VER have parameters different from auditory evoked response (AER); VER recording is not related both to the presence of auditory lesions and to neurological pathology.