Bovine Serum Albumin: a double allergy risk.

We analyse two cases of Bovine Serum Albumin (BSA) allergy. The first regards a female laboratory technician with a history of bronchial asthma due to cat allergy, who developed an exacerbation of bronchial symptoms as a consequence of BSA powder inhalation at work. To date, sensitization to BSA as a cause of occupational asthma has rarely been reported in the scientific literature. The second case concerns a woman with a similar cat sensitivity, who presented an oral allergy syndrome-type clinical reaction, gastric pain and diarrhoea immediately after eating cooked pork meat. Subsequently, she developed the same reaction after eating goat meat and goat cheese, and then also after eating beef. Both patients resulted specifically sensitized to BSA and to other mammalian serum albumins which play a role as panallergens in animals. The two cases show that BSA, a well known cause of food allergy in childhood, may also provoke symptoms of food allergy in adulthood, though in case of powder inhalation, it may provoke respiratory symptoms. Prior animal sensitization appears to represent a risk factor.

[Sleepiness, safety on the road and management of risk]. / Eccessiva sonnolenza e rischio infortunistico alla guida.

Public health studies have shown that sleepiness at the wheel and other risks associated with sleep are responsible for 5% to 30% of road accidents, depending on the type of driver and/or road. In industrialized countries one-fifth of all traffic accidents can be ascribed to sleepiness behind the wheel. Sleep disorders and various common acute and chronic medical conditions together with lifestyles, extended work hours and prolonged wakefulness directly or indirectly affect the quality and quantity of one's sleep increasing the number of workers with sleep debt and staggered hours. These conditions may increase the risk of road accidents. Strategies to reduce this risk of both commercial and non-commercial drivers related to sleepiness include reliable diagnosis and treatment of sleep disorders, management of chronobiological conflicts, adequate catch-up sleep, and countermeasures against sleepiness at the wheel. Road transport safety requires the adoption of occupational health measures, including risk assessment, health education, technical-environmental prevention and health surveillance.

Induction chemotherapy in head and neck cancer patients followed by concomitant docetaxel-based radiochemotherapy.

Concurrent chemoradiotherapy has become the standard of care for patients with inoperable squamous cell head and neck carcinoma. More recently, induction chemotherapy has been adopted as an approach in the management of these patients. We report the results of a phase II trial associating induction chemotherapy and concomitant chemoradiotherapy in a series of patients with inoperable squamous cell head and neck cancer. Twenty-nine patients with advanced squamous cell carcinoma ineligible for surgery were enrolled. Induction chemotherapy with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) every 21 days was administered for two cycles. Radiotherapy followed the induction phase. During radiotherapy, docetaxel was administered weekly at the dose of 33 mg/m(2) . Primary end point of the study was feasibility of treatment. Six (18%) patients failed to conclude the treatment schedule. Although response rates in evaluable patients were very high (disease control rate >90%), toxicities were a matter of concern. The reported treatment schedule proved infeasible. However, some modifications in ancillary therapies aimed at exploiting its efficacy could make it practicable.

[Sleepiness, sleep disorders and risk of occupational accidents]. / Sonnolenza, disturbi del sonno e rischio infortunistico.

Sleepiness, a commonly symptom affecting up to one-fifth of the population chronically, is clearly an important cause of accidents in industry and transport inducing deterioration in performance and attention. The reason for Excessive Daytime Sleepiness (EDS) is either sleep pathology, voluntary (non-pathological) sleep reduction, or activity during the circadian low. Most of the professional accidents reported refer to the obstructive sleep apnea syndrome (OSAS). Our data confirmed higher prevalence of OSAS in truck drivers than general population and we elaborated a feasible screening tool for OSAS based on data by clinical and anthropometric variables, some items of Sleep Disorders Score and complete polysomnography. About commuting accidents (CA) in shift and non shift workers we found a strict significant relationship between shift-work condition and the presence of EDS (p < 0.0001) suggesting that CA are significantly influenced by ED in the hypothesis of disruption of the balance between circadian and homeostatic factors in shift work. In conclusion to improve safety in the workplace a standardized procedure to evaluate risks a work should be developed based on epidemiological and experimentalffindings focused on EDS.

[Rotator cuff diseases in occupational medicine between occupational diseases and accidents: medical-legal considerations]. / La patologia della cuffia dei rotatori in Medicina del Lavoro tra tecnopatia ed infortunio: considerazioni medico-legali.

The authors have gone through the complaints concerning all the cases of shoulder accidents at work filed by the Genoa office of the Italian Workers' National compensation Agency (INAIL) during the two years' period 2006-2007, reviewing in particular those somehow affecting rotator components. The aim of this paper is to assess the real role played by the occupational trauma in the rotator cuff tear. The data gathered so far have shown, on the one hand, a high prevalence of pre-existing inflammatory and degenerative diseases and, on the other, a rather modest influence of the trauma which, for this reason, has usually borne, as an immediate medico-legal consequence, the rejection of a cause-effect relationship between the accident and the rotator cuff lesion, without taking into any account whether the worker was likely to be affected by an occupational disease (ex table Ministerial Decree n. 81 April 9th 2008- item 78). In such cases a systematic and in-depth investigation of the occupational case history is suggested, in order to highlight the possible pre-existence of a former biomechanical overload of the upper limbs, so as to allow the physician to detect a pathology often misdiagnosed.

[Diagnosis in related pathologic asbestosis, clinical case of a suspected occupational neoplasm]. / Iter diagnostico nelle patologie asbesto correlate, considerazioni a margine di un caso clinico di sospetta neoplasia professionale.

In our country the rate of asbestos-related neoplasia, in particular pleural mesothelioma and lung cancer, is increasing; the data provided by INAIL concerning the complaints for occupational diseases filed in 2006 ex table D.P.R. 336/1994 (neoplastic diseases caused by asbestos: pleural, pericardial and peritoneal mesothelioma; lung cancer) are significant. The total number of such complaints in our country amounts to 753 (135 in Liguria and 384 in the north-western regions). As the issue of health following up of former exposed workers is actually an important concern of occupational medicine, some protocols have recently been proposed with the aim to early diagnose asbestos related neoplasia, thus getting a better prognosis. Under the medico-legal aspect, the need for fixing the proper criteria for aetiological attribution to asbestos of lung cancer in subjects previously exposed to that substance is a controversial issue, being the various approaches quite different; the incidental finding of a lung "coin lesion" in a subject who had been holding an annuity for years, as an indemnity granted by INAIL for asbestosis, has prompted the authors both to go over such a clinical case and to review the literature on the topic, in particular as to the complex medico-legal implications.

Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM).

BACKGROUND: The aim of this study was to evaluate the activity and toxicity of pemetrexed and carboplatin combination as first-line chemotherapy in malignant pleural mesothelioma (MPM). PATIENTS AND METHODS: Patients with measurable advanced MPM and a zero to two Eastern Cooperative Oncology Group (ECOG) performance status (PS) were enrolled. The schedule was pemetrexed 500 mg/m(2) in combination with carboplatin area under the curve 5, every 21 days. In all, 76 patients were treated. Median age was 65 years; median ECOG PS was zero. RESULTS: Grade 3 hematological toxicity according to World Health Organization criteria was seen in 36 (47.3%) patients; grade 4 hematological toxicity in 5 (6.5%) patients. There were 16 (21%) partial responses and 3 (4%) complete responses, for an overall response rate of 19 (25%) [95% confidence interval (CI) 15.3-34.7]. In all, 29 (39%) (95% CI 28-48) patients reported stable disease. The median survival was estimated at 14 months. CONCLUSION: This combination of carboplatin and pemetrexed is moderately active and the toxicity is acceptable.

[Workplace and psychoactive substances dependence: certificate of eligibility for work and perspectives of prevention in the light of recent innovative regulations]. / Lavoro e dipendenza da sostanze psicoattive: idoneità alla mansione e prospettive di prevenzione alloa luce delle recenti innovazioni normative.

The Authors consider a present widespread social problem i.e. the abuse and/or addiction to alcohol and drugs (psychoactive substances) with regard to the interferences and consequences it can have on one's working environment. In particular they look into the hardest problem an occupational physician has to face when required to pass judgement on a worker's specific duty fitness, which rightfully falls within the so-called "knotty qualifications". In addition the authors go over the rather complicated Italian laws regulating drugs, alcohol and their relevant problems, underlining how, despite the great number of regulations in force, it's still unclear what an occupational physician is allowed or not allowed to do in such cases. Although even the latest provisions fail to give a clue for correctly running such phenomena, the Authors suggest a diagnostic and rehabilitation/reinstating programme that, by involving the main operators in charge of prevention both at work and inside health territorial services, can set reasonable aims and feasible operating plans granting all due respect for the workers' dignity and self determination.

Lung cancer in subjects suffering from silicosis in the Province of Genoa from 1979 to 2004.

The Authors, after a survey of the latest experimental and epidemiological studies concerning the possible role of crystalline silica in lung carcinogenicity, examine the cases acknowledged by the INAIL in Genoa concerning subjects suffering from silicosis who, thereafter, developed a lung cancer in the period 1979 - 2004. Distribution of the degree of disability, of the length of occupational exposure to silica, of the workers' age at the time of death and of the different fields of activity have been tested; smoking habits and histological classification of the neoplasms have also been assessed, when available. Our data seem to agree with the point of view of the Authors who so far have expressed perplexities about the role played by silica in lung carcinogenesis, especially if associated with the exposure to powerful carcinogenic agents such as cigarette smoke. At present we share the opinion of those who think that a final regulation should be delayed up to the time when it will be possible to identify the occupational source of silica with such characteristic as to make it actually carcinogenic.

[Commuting accidents: the influence of excessive daytime sleepiness. A review of an Italian Police officers population]. / Infortuni in itinere: ruolo della sonnolenza in una popolazione di operatori della Polizia di Stato.

Commuting accidents (CA) play an important role in many systems of workers' compensation insurance and with good reason, as they generally bring about more serious consequences in terms of permanent disablement and death than ordinary occupational accidents; this usually leads to high social costs. Nevertheless, research investigations aimed at studying the possible causes underlying the phenomenon are not available in medical literature. Objective of the present study is to evaluate whether excessive daytime sleepiness (EDS) might influence the occurrence of CA. 463 CA occurred to 411 police officers in northern Italy during the period 1999 - 2002 were collected; 51.9% of the subjects were working on shifts, 48.1% were non-shift workers. The study was carried out by submitting a self-administered questionnaire to gather information on age and physical characteristics, working conditions, sleep-related problems and accidents occurrence; EDS was measured by the Epworth Sleepiness Scale (ESS). A large number of workers (36%) complained of EDS; a strict significant relationship between shift - work condition and the presence of EDS was found, thus suggesting that CA are significantly influenced by EDS. The shift work schedule adopted by Italian Police might be accountable for the disruption of the balance between circadian and homeostatic factors.

[Biomechanical risk for the upper limbs: experience at a factory of feeding electric cables]. / Rischio biomeccanico per gli arti superiori: esperienza in un'azienda produttrice di cavi elettrici per alimentazione.

Cumulative trauma disorders are found more and more frequently in working environments. Our examination concerns a factory of feeding electric cables, whose workers were subjected to a sanitary checking in 2001, 2002, 2003. The valuation of the risk due to a biomechanical overload of the upper limbs, carried out according to the OCRA method, pointed out, with reference to the specific task of pressing, a middle-high grade of exposure, while the clinical-instrumental results showed symptoms and objective signs of suffering on the median nerve of the wrist with regard to a significant percentage of workers. The following interventions on the production cycle and on the exposure times obtained a reduction of the risk with a subsequent decrease of the noticed troubles.

[Comparative study of maximal midexpiratory flow rate in normal smoking and non-smoking subjects]. / Studio comparativo del MMF in soggetti normali fumatori e non fumatori.

MMF is considered one of the most sensitive parameter to point out initial decay of small airways that should appear prematurely in smokers as compared with non smokers. To verify the above we tested male subjects apparently free from any respiratory disease. They were classed into two groups of equal number: the first group of smokers, the second one of non smokers. We did not find any statistically significant difference between the two groups: this is probably due to the young age of the subjects and consequently to the relative short period of exposure to tobacco smoke.

[Alveolaro-capillary gas exchange. Considerations on the evaluation of carbon monoxide diffusion]. / Scambi gassosi a livello alveolo capillare. Considerazioni sulla valutazione della diffusione del monossido di carbonio.

This study is based on 107 male individuals aged between 20 and 73 years, all of them exempt from any disease. They were submitted to instrument examination for measuring the CO pulmonary diffusing capacity with the single breath method. The data so obtained were then statistically elaborated considering the index value of CO transfer, the Helium partition (RHe) and the CO partition and diffusion (R&DCO). The CO transfer index has shown a particularly extensive range; if we take as normality level-20%, a consistent ratio of individuals (20,56%) falls in a range of deficitary pulmonary diffusion though in absence of aèny clinical evidence of pathology. The subsequent statistical elaboration of the data after logarithmic transformation, by the means of the linear regression model, has allowed to reduce the variance of the R&D CO index improving his classificative capability.

[Carbon monoxide alveolar-capillary diffusion: considerations on inter-personal variability]. / Diffusione alveolo capillare del monossido di carbonio: considerazioni sulla variabilita intra-individuale.

Twenty three male subjects 21 to 53 aged were undergone to lung diffusion test using breath holding method. Each subject was tested three times in different days. The results were evaluated by Bartlett's Chi-square test and by Kendall's coefficient of concordance. Correlation between the CO distribution and diffusion index (R&DCO), the Helium distribution index (RHe), the time of breath holding and the volume of "single breath" was found. It seems it will be possible to improve the inter-personal estimation to 1.25% about.

[The influence of helium concentration in determining respiratory function parameters]. / Considerazioni sull'influenza della concentrazione di elio nella determinazione di alcuni parametri di funzionalita respiratoria.

Before a research about normals values of lung diffusing capacity for CO in Italian people, the Authors investigate if different concentration of Helium in respiratory gases could have any influence on data. Experiments were performed by testing 8 male subjects. Each one repeated lung function tests three times using gas mixtures with different Helium percentage. Results were evaluated by meaning of t Studnt's and Bartlett's Chi-square tests. Results show no significant difference.

[Hyperbaric oxygen and the lung. Pulmonary diffusion in divers with intense and long-term exposure]. / Ossigeno iperbarico e polmone. La diffusione polmonare in sommozzatori con intensa e pregressa esposizione cronica.

The effect on pulmonary diffusing capacity of intermittent exposure to hyperbaric oxygen was evaluated in four subjects after 35-38 years from beginning of diving activity. Exposure was of 4600-6000 hours. Pressure till 4 ATA. No remarkable impairment of lung diffusing capacity was found