[Monoclonal gammopathy of uncertain significance (MGUS) and occupational risk factors: criteria to carry out the health surveillance]. / Gammopatia monoclonale di incerto significato (MGUS) e fattori occupazionali di rischio: criteri di attuazione della sorveglianza sanitaria.

SUMMARY: Monoclonal gammopathy of uncertain significance (MGUS) identifies a clinically asymptomatic and laboratory-based situation characterized by a modest monoclonal component (MC). In a limited percentage of cases, on a probabilistic basis, the asymptomatic genepremalignant stage could lead to multiple myeloma (MM). Materials and Methods. Based on literature data and available Guidelines on the subject, the diagnostic criteria and a methodological path are here suggested to the Occupational Physician to formulate a judgment of suitability for the task with exposure risk to RI or pesticides. Results. Some studies have evaluated the prevalence of MGUS in subjects exposed professionally to pesticides. Numerous other studies conducted on the survivors of the atomic bombing of Hiroshima and Nagasaki have highlighted a possible association with exposure to ionizing radiation (IR). The guidelines relating to the diagnosis and management of MGUS cases (with respect to the potential evolution in MM allow) to draw important operational indications for the competent/authorized physician. Conclusions. The routinely use of laboratory tests for subjects exposed to the studied risk factors is generally indicated starting from the worker's 50 years of age. The finding of a MGUS in the absence of further laboratory alterations represents the situation most frequently and does not require further measures, other than those of foreseeing even blood controls at least every two years. In this situation, there are no justified restrictions on work activities with exposure risks to IR or pesticides. If alterations suggestive for an increased risk of evolution in a neoplastic way could be identified, a close periodicity - every 3-6 months - of haematological checks is recommended. In these cases, it appears justified an abstention from activities involving exposure to ionizing radiation for a period of time that will be evaluated based on the evolution of the framework and by the progress of laboratory tests in the monitored period.

Description of a specific bronchial provocation test for the diagnosis of occupational asthma due to platinum salts.

BACKGROUND: Occupational exposure to platinum salts may cause the onset of skin and respiratory disorders with an IgE-mediated allergic mechanism. The diagnosis of occupational asthma due to platinum salts was, in a small number of cases, achieved also via occupational specific bronchial provocation tests (sBPT), which until now were conducted by pouring platinum salt dusts from one tray to another or by direct aerosoling of hexachloroplatinate solutions into the patient's airways. METHODS: Here we describe an original occupational sBPT based on atomization of solutions of ammonium hexachloroplatinate, at increasing concentrations, in a 5 m3 challenge room: the starting solution is a 1:100 dilution of the preset threshold of the patient's skin reactivity to the substance. In the absence of a bronchoconstrictive response, the following concentration is atomized (each time 10 times higher than the previous one), until the maximum concentration, 10(-2) M, is reached. The patient is not in the challenge room during atomization of the solutions, but enters when this operation has been completed and remains there for 15 minutes, unless he/she shows signs of respiratory trouble before that time. After each exposure, the patient is clinically monitored, with respiratory function tests at preset times, until at least 8 hours after the end of the exposure. RESULTS AND CONCLUSIONS: The test allowed identifying a respiratory hypersensitivity specifically to platinum as cause of asthma in two precious metal workers, with the onset of immediate bronchospasm in one patient and biphasic bronchospasm in the other. Compared to the sBPT by pouring a mixture of platinum salt dusts from one tray to another, the method we designed offers a better standardization of bronchial stimulation and, compared to direct aerosoling of hexachloroplatinate into the patient's airways, it has the advantage of reproducing the respiratory risk conditions occurring in the workplace and offers better safety guarantees for the patient, since it reduces the risk of onset of serious asthmatic or even systemic responses in subjects highly hypersensitive to this metal.

[The presence of asbestos bodies in induced sputum as an indicator of asbestos exposure]. / La presenza di corpuscoli dell'asbesto nell'espettorato indotto come indicatore di esposizione ad amianto.

BACKGROUND: Very few references on the usability of presence of asbestos bodies (AB) in induced sputum as an indicator of asbestos exposure are to be found in the scientific literature. OBJECTIVES: The purpose of this study was to prove whether the presence of AB in induced sputum is a valid assessor of asbestos exposure. METHOD: This was achieved by comparing the above-mentioned method with the search for AB in bronchoalveolar lavage (BAL) fluid and repeating the trials over time in order to study the reproducibility of the results. RESULTS: There was good agreement of results for the presence/absence of AB in induced sputum and in BAL among subjects who were environmentally exposed and those with 'a medium-high risk occupational exposure (100%), and poor agreement (66%) among subjects with a low risk occupational exposure. Agreement of results regarding the amount of particles per test was low. The method showed a sufficient reproducibility level (Cohen K=0.5). CONCLUSION: Although the presence of asbestos bodies in induced sputum cannot replace bronchoalveolar lavage, it can however be used as a screening test for selecting subjects who should undergo BAL.