[Epidemiology of tumors in the construction industry]. / Epidemiologia dei tumori in edilizia.

Many epidemiological studies, mostly with a case-control design, show an increased risk of cancer, in particular lung cancer, in construction workers. Asbestos is the occupational carcinogen considered for a long time the most important in this sector, but now it covers a residual role, at least in Italy. In this review the most recent studies are considered and the presence of other carcinogens, as crystalline silica, man-made mineral fibers, diesel exhausts, metals, solvents, UV rays, must be considered in risk evaluation also, possibly, for health and epidemiologic surveillance.

[Environmental and biological monitoring of exposure to PAHs in Taranto coke-oven workers and in two groups of the general population from Apulia]. / Monitoraggio ambientale e biologico dell'esposizione a IPA nei lavoratori della cokeria di Taranto e confronto con due gruppi della popolazione generale pugliese.

The exposure to PAHs was assessed by personal air sampling and urinary 1-hydroxypyrene (1-OHP) in 100 coke-oven workers (CW) of the Taranto plant and in subjects from the general population living close (NC, 18) and far away (FC, 15) from the plant. Median airborne benzo[a]pyrene (BaP) and 1-OHP levels were 152, 1.5, and 3.6 ng/m3 and 2.0, 0.5 and 0.6 microg/g creatinine in CW, NC, and FC, respectively. BaP exposure exceeded the German acceptable (70 ng/m3) and tolerable (700 ng/m3) limit risk based values in 82 and 11% of CW and the European target value for ambient air (1 ng/m3) in about 65% of NC and FC. 1-OHP levels exceed the proposed biological limit value for the coke-oven industry (4.4 microg/g crt) in 21% of CW and the Italian reference value (0.3 microg/g crt) in about 90% of NC and FC. The exposure resulted lower than in the past, but this study highlights that PAHs exposure from the coke plant still poses a health risk for workers and the general population.

Environmental and biological monitoring of PAHs exposure in coke-oven workers at the Taranto plant compared to two groups from the general population of Apulia, Italy.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) exposure in the coke industry poses a risk for workers' health as well as for subjects living in the plant vicinity. OBJECTIVES: To assess PAHs exposure in coke-oven workers (CW) at the Taranto plant, Apulia, and in subjects from the general population living near (NC) and far away (FC) from the plant. METHODS: Exposure was assessed by personal air sampling and urinary 1-hydroxypyrene (1-OHP) measured in 100 CW 18 NC and 15 FC. RESULTS: Median airborne benzo[a]pyrene (BaP) levels were 152, 1.5, and 3.6 ng/m3 in CW NC, and FC, respectively. In CW, median 1-OHP increased from 1.45 to 1.96 microg/g creatinine (crt) during the work shift (p > 0.05); in NC and FC, 1-OHP levels were 0.56 and 0.53 microg/g crt. No significant differences between NC and FC for both air and urinary indices were found. BaP exposure in CW exceeded the recently proposed German acceptable (70 ng/m3) and tolerable (700 ng/m3) risk-based limit values in 82 and 11% of subjects, respectively. In NC and FC, BaP exposure exceeded the European target value for ambient air (1 ng/m3) in 67 and 60% of subjects, respectively. Biomonitoring showed that 21% of CW had 1-OHP levels higher than the proposed biological limit value for the coke-oven industry (4.4 microg/g crt), while 93% of FC, and 88% of NC, had 1-OHP levels exceeding the Italian reference value (0.3 microg/g crt). Among non-smokers, a linear regression between 1-OHP and BaP (Pearson value r = 0.65, p < 0.05) allowed us to estimate levels of 1.2 and 1.9 microg/g crt for 1-OHP end-of-shift corresponding to acceptable and tolerable limit values. CONCLUSIONS: Although lower than in the past, PAHs exposure in the coke plant still poses a health risk for workers and the general population and requires further efforts to improve workplace conditions.

[Source apportionment of benzo(a)pyrene in Taranto and carcinogenic risk estimate in general population]. / Individuazione e caratterizzazione delle sorgenti di benzo(a)pirene nel comune di Taranto e stima del rischio cancerogeno associato all'esposizione della popolazione generale.

INTRODUCTION: In 2009 the limit value of benzo(a)pyrene (BaP) in ambient air of 1.0 ng/m3 has been exceeded in the urban district of Taranto near to the industrial area, where a several large plants are located, including an integrated cycle steel plant. OBJECTIVE: To identify emission sources and quantify relative contribution to the PAHs levels; to estimate health impact associated to PAHs exposure in general population. METHODS: Multivariate receptor models have been used. Concentration of PAHs measured in 4 location in Taranto in 2008-2009 have been analyzed. 5 different models estimated profiles of unknown sources and identified significant chemical species. To compute the lung cancer risk the WHO unit risk estimate for BaP (8.7 x 10(5) ng/m3) has been adopted. RESULTS: Models employed identify 3 to 4 emission sources. Estimated profiles have been compared with measured ones. Based on the average annual BaP level measured (1.3 ng/m3), 2 attributable cancer cases in the district Taranto population are estimated to result from a life-time exposure. CONCLUSIONS: Among different emissive sources, the analysis identifies theoretical sources whose profiles, compared with observed data, allow to identify dominant contributions to PAHs pollution and to design corrective actions to reduce environmental and health impact.

[Occupational exposure to formaldehyde in autopsy room and in pathologic anatomy laboratories]. / Esposizione professionale a formaldeide in sala settoria di medicina legale e in laboratori di anatomia patologica.

The aim of the present study is to evaluate the personal exposure to formaldehyde in an autopsy room and in three pathological anatomy laboratories. Passive sampling for the whole workshift and HPLC analysis were performed. The final result showed a remarkable exposure of the workers enrolled. All the data obtained exceeded the NIOSH-TWA and several cases personal of exposure levels above the ACGIH-Ceiling value (0,37 mg/m3) were observed in the anatomy laboratory.

[Biological monitoring in workers exposed to inorganic arsenic in a disused industrial plant in the area of Manfredonia]. / Monitoraggio biologico dell'esposizione professionale ad As inorganico in lavoratori di un impianto industriale dismesso nell'area di Manfredonia.

Inorganic arsenic and its methylated metabolities were measured in 108 spot urine samples obtained from the medical surveillance programme of workers exposed to inorganic Arsenic in July 2006. 15% of the samples showed levels higher than limit value of 35 microg/L (mean value 23,9 microg/L). After the improvement of the working conditions, in August-October 2006, we collected a urinary sample from each of the 108 workers enrolled. A questionnaire was also administrated, in order to investigate the influence of occupational and non occupational factors on the urinary arsenic excretion. The median value of urinary arsenic was 15,12 microg/L; among the 108 samples, 5% showed levels higher than limit value. A significant difference was observed in relation with sea-food consumption and aging stratification. In conclusion, we have described a significant reduction of urinary arsenic excretion between the two phases of biological monitoring, likely due to a proper hygienic work-related intervention.

An intensive monitoring campaign of PAHs for assessing the impact of a steel plant.

This study provided a useful approach for assessing the impact of industrial sources on surrounding, especially in a sensitive industrial area as Taranto (South of Italy). Taranto is one of the most industrialized Italian towns, where several emission sources operate simultaneously in proximity to the urban settlement. An intensive monitoring campaign of PAHs was carried out from January 28th to July 30th, 2011, in seven sites located in residential settlement around the industrial area and in the city center. The collected data were integrated with the information about wind direction and speed by means bivariate polarplot in order to characterize and localize the industrial sources. High BaP concentrations were detected especially when Benzene to Toluene ratio (B/T ratio) values excedeed 1 and all receptor sites were downwind to the steel plant. Moreover, in order to discriminate among PAH sources and quantify their contributions, a source apportionment analysis of the collected data was provided by means Principal component Analysis (PCA) and Positive Matrix Factorization (PMF) methods. Finally, the processing of PMF5.0 output by bivariate polar plot, confirmed the impact of steel plant on both industrial sites downwind the steel plant and the city center. B[a]P apportionment was quite similar for industrial and urban sites: the traffic source contributed only 11% and 24% to B[a]P measured at two sites, respectively. Therefore, the proximity of Taranto downtown to industrial pole makes negligible all other source contributions to PAH concentrations.

Life expectancy in patients with hereditary haemorrhagic telangiectasia.

BACKGROUND: There are few data on life expectancy in patients with hereditary haemorrhagic telangiectasia (HHT), a disorder with life-threatening complications. METHODS: Seventy HHT patients provided data on age and age at death of their HHT-affected parent, which was compared with that of the parent's non-affected partner. RESULTS: At the time of the study, 40 HHT parents (57.1%) vs. 36 (51.4%) non-HHT parents had died (p = 0.404). Median age at death was lower in HHT vs. non-HHT parents (63.2 vs. 70.0 years, respectively). The mortality of HHT parents showed an early peak in the under 50s and a late peak at 60-79 years. HHT was the main risk factor influencing life expectancy after 30 years (p < 0.05). No differences in survival probability were found in HHT patients with respect to sex (p = 0.37), or ENG vs. ALK-1 genotype (p < 0.9). DISCUSSION: Life expectancy appears to be significantly lower in HHT patients than in their partners. Prevention of HHT complications with screening programs could increase life expectancy.

Biological monitoring and allergic sensitization in traffic police officers exposed to urban air pollution.

Urban air pollution is associated with an increased incidence of allergic respiratory diseases. The aim of this study is to assess the occupational exposure to urban pollution through biological monitoring of PAHs and CO airborne levels in 122 traffic wardens in Bari, Italy and to investigate sensitization to inhaled allergens in a subgroup of workers. After filling in a questionnaire on lifestyle habits and occupational history, a medical examination, spirometry were carried out and blood samples were taken; the measurement of exhaled CO and urinary 1-hydroxypyrene (1-HOP) was performed and data on the air quality of Bari Municipality were obtained. Specific IgE dosage and skin prick tests were done on 18 workers giving altered values of spirometry or anamnestic allergic symptoms. Urinary 1-HOP showed median levels of 0.1 microMol/Mol(creat) (range 0.02-6.68) and was not influenced by smoking habits, work tasks, area of the city and environmental levels of PM10. Exhaled CO, with median value of 1 ppm (range 0-27), was significantly higher in smokers than in non-smokers, while no other variable seemed to play a role in modifying the levels. Specific IgE production versus inhalant allergens was found in 6 cases. Positive skin prick test results were observed in 11 cases. Allergic rhinitis was diagnosed in 6 cases. At least one of the allergometric tests performed was positive in 61 percent of the subjects. In conclusion, our results suggest the importance of introducing allergic status evaluation in this class of workers, exposed to several urban air pollutants.

[Acute pneumonia caused by aspiration of hydrocarbons in a fire-eater]. / Polmonite acuta da aspirazione di idrocarburi in un "mangiafuoco".

Accidental aspiration of fuel in fire eaters can cause an acute chemical pneumonitis known as 'fire-eater's pneumonia". We report a case in a 29 year-old fire-eater. Six hours after aspiration of kerosene, he developed fever up to 39,5 degrees C, dyspnea, cough and chest pain. Chest radiograph showed infiltrates in the middle and lower parts of the lungs and left pleural effusion. He was treated with an antibiotic and antipiretic therapy and then with corticosteroids. The acute stage lasted four weeks and the patient recovered without sequelae within 3 months. Hazard related to main fuels used for fire eating is discussed.

[Occupational Medicine Programme in the university degree on prevention techniques in living and working environments]. / La Medicina del Lavoro nel Corso di Laurea in Tecniche della Prevenzione nell'Ambiente e nei Luoghi di Lavoro.

This document has been prepared by a working group of University Professors belonging to the Italian Society of Occupational Medicine and Industrial Hygiene, with the aim of defining the role of this discipline in the university course on Prevention Techniques in Working and Living Environments. The course trains health professionals to apply risk assessment techniques, preventive measures and legislative tools for safety and health in working and living environments, food and beverages hygiene, and Public Health. The document describes the organization and the structure of the course, general and specific learning objectives, occupational medicine teaching and other organization aspects. Also, training of non-graduate technicians working for local health authorities is discussed.

Increased sensitivity for determination of polycyclic aromatic hydrocarbon-DNA adducts in human DNA samples by dissociation-enhanced lanthanide fluoroimmunoassay (DELFIA).

A competitive enzyme-linked immunosorbent assay (ELISA), the most frequently used immunoassay for the determination of polycyclic aromatic hydrocarbon-DNA adducts in human tissues, has been modified to achieve approximately a 6-fold increase in sensitivity. The new assay, a competitive dissociation-enhanced lanthanide fluoroimmunoassay (DELFIA) has utilized the same rabbit antiserum as the ELISA, antiserum elicited against DNA modified with benzo[a]pyrene. However, the alkaline phosphatase conjugate has been replaced with a biotin-europium-labeled streptavidin signal amplification system, and the release of europium into the solution forms a highly fluorescent chelate complex that is measured by time-resolved fluorometry. The DELFIA has achieved a 5- to 6-fold increase in sensitivity for measurement of DNA samples modified in vitro with benzo[a]pyrene, for cultured cells exposed to radiolabeled benzo[a]pyrene, and for human samples from occupationally exposed workers. The assay has been validated by comparison of adduct levels determined by DELFIA, ELISA, and radioactivity in DNA from mouse keratinocytes exposed to radiolabeled benzo[a]pyrene. Human lymphocyte DNA samples from 104 Hungarian aluminum plant workers were assayed by ELISA and compared to blood cell DNA samples from 69 Italian coke oven workers assayed by DELFIA. The standard curves demonstrated that the limit of detection of 4.0 adducts in 10(8) nucleotides for polycyclic aromatic hydrocarbon-DNA adducts by ELISA, using 35 micrograms of DNA/microtiter plate well, has been decreased to 1.3 adducts in 10(8) nucleotides by DELFIA, using 20 micrograms of DNA/microtiter well. If 35 micrograms of DNA were used in the DELFIA, the calculated detection limit would be 0.7 adducts in 10(8) nucleotides.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary hemifacial spasm and arterial hypertension: a multicenter case-control study.

In a case-control study, the authors found that arterial hypertension occurred more frequently among 115 patients with primary hemifacial spasm than among 115 neurologic controls matched for age (+/-5 years), sex, and referral center. The association was not confounded by education level, smoking history, diabetes, or other diseases (adjusted OR 2.64; 95% CI 1.3 to 5.33, p = 0.007). Hypertension was significantly associated with the outcome in the left-sided group (OR 4.0; 95% CI 1.4 to 11.5), but data concerning patients with right-sided spasm were inconclusive (OR 1.05; 95% CI 0.36 to 3.1). In our sample, hypertension either preceded or followed the onset of hemifacial spasm.

Biomarkers of carcinogen exposure and cancer risk in a coke plant.

To evaluate the association between an indicator of carcinogen exposure (peripheral blood leukocyte DNA adducts of polycyclic aromatic hydrocarbons) and an early indicator of neoplastic transformation (sputum epithelial cell membrane antigens binding by monoclonal antibodies against small cell lung cancer and against nonsmall cell lung cancer), a survey of 350 coke-oven workers and 100 unexposed workers was planned. This paper reports a pilot investigation on a subgroup of 23 coke-oven workers and 8 unexposed controls. A "gas regulator" worker with positive tumor antigen binding was identified. Results show that smokers, subjects with decreased pulmonary function (forced expiratory volume in 1 sec/forced vital capacity% < 80), and those with morphological dysplasia of sputum cells have higher levels of DNA adducts. The gas regulators showed the highest values for adducts; however, no significant difference of adduct levels was found between the coke-oven group and unexposed controls.

Feasibility and reliability of flow-cytometry (fcm) DNA analysis of fresh and fixed urine samples.

The qualitative results of FCM DNA analysis on fresh and fixed urine specimens (28 and 97, respectively) from 68 normal subjects and 10 patients with a past history of bladder cancer were compared. FCM DNA evaluability was not significantly different in fresh and fixed samples (63% vs 73%, respectively) whereas mean CV was significantly higher (7.3% vs 5.7%, respectively; p=0.04). A double FCM analysis on fresh and fixed urine was also performed in 16 cases. In this subgroup, the percentage of evaluable histograms from fixed urine specimens was slightly higher than that from fresh specimens. Aneuploid cases were found only in the fixed urine samples but the CVs from fresh and fixed cell suspensions did not differ. The absence of inflammatory cells with cytological analysis of the same samples was associated with low percentages of FCM evaluability and higher CVs. The use of fixed samples improves the quality of FCM DNA analysis permitting its use for screening programs.

Potential 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure of Seveso decontamination workers: a controlled prospective study.

In 1976, an explosion at the Industrie Chimiche-Meda-Società Azionaria (ICMESA) plant in Meda, near the Italian town of Seveso, released a cloud of aerosol containing 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), which contaminated the surrounding area. Clean-up of the highly polluted area of Seveso started on May 1980: in order to avoid exposure to significant levels of TCDD, safety measures are being used, but a potential exposure cannot be ruled out. A prospective study was set up at the beginning of the clean-up procedures, and laboratory tests are being used to evaluate trends among the decontamination workers. A reference group who met eligibility criteria at the preemployment examination was selected from employees of the same firm employing the decontamination was selected from employees of the same firm employing the decontamination workers. Medical examinations and laboratory tests have been performed on both the exposed and nonexposed groups at the same facilities. Analysis of the first follow-up period did not show any remarkable changes in a battery of laboratory tests of the exposed and nonexposed groups.

Sperm count suppression without endocrine dysfunction in lead-exposed men.

To determine if increased lead absorption was associated with sperm count suppression or perterbation of the hypothalamopituitary system, we compared battery workers (N = 18), who were exposed to high airborne lead levels, with cement workers (N = 18), who were exposed to ambient lead levels. Blood lead, urinary lead, semen lead, and zinc protoporphyrin concentrations were markedly elevated (p less than .001) in battery workers. Battery workers had a significantly shifted (p less than .025) frequency distribution of sperm count (median count, 45 vs. 73 X 10(6) cells/cc, respectively). There were no significant differences between the two groups in mean follicle-stimulating hormone, testosterone, prolactin, luteinizing hormone, or total neutral 17-ketosteroid levels. Potential confounding factors (alcohol, cigarette, and coffee consumption, frequency of intercourse, and days of abstinence prior to semen donation) were not significantly different between the two groups. These results suggest a direct toxic effect of increased lead absorption on sperm production or transport in man.

Sperm count suppression without endocrine dysfunction in lead-exposed men.

To determine if increased lead absorption was associated with sperm count suppression or perterbation of the hypothalamopituitary system, we compared battery workers (N = 18), who were exposed to high airborne lead levels, with cement workers (N = 18), who were exposed to ambient lead levels. Blood lead, urinary lead, semen lead, and zinc protoporphyrin concentrations were markedly elevated (p less than .001) in battery workers. Battery workers had a significantly shifted (p less than .025) frequency distribution of sperm count (median count, 45 vs. 73 X 10(6) cells/cc, respectively). There were no significant differences between the two groups in mean follicle-stimulating hormone, testosterone, prolactin, luteinizing hormone, or total neutral 17-ketosteroid levels. Potential confounding factors (alcohol, cigarette, and coffee consumption, frequency of intercourse, and days of abstinence prior to semen donation) were not significantly different between the two groups. These results suggest a direct toxic effect of increased lead absorption on sperm production or transport in man.

Workers' participation and control in Italy: the case of occupational medicine.

This article sets forth a historical and current analysis of (a) the occupational health services in Italy; and (b) the political, economic, and social forces that determined them. Special focus is placed on the analysis of the events leading to the establishment in 1969 of forms of direct democracy at the workplace, i.e. workers' committees, and their consequences for the occupational health services. Also described and analyzed are the responsibilities and modus operandi of these committees in the creation and reproduction of scientific knowledge at the point of production. The relationship between the workers' committees, the "experts," and the institutions of medicine, as well as that between the workers' committees, political parties, and the trade unions, is also discussed. An update on the impact that recent political developments have had on these workers' committees concludes the article.

[Surgical treatment of gonarthrosis]. / Trattamento chirurgico della gonartrosi.

Gonarthosis, a frequent complaint in women over 50, brings about changes in the knee which alter its macro and micro structure and are responsible for alteration of the anatomical axis of the lower limb. The most frequent consequence is knock-knee leading to overloading of the medial compartment and reduction of the internal interosseous space. Whereas in the initial forms symptomatic therapy is the treatment of choice, in severe and advanced cases with complete articular blockage arthroprosthesis is the alternative and in cases with minor limitations of joint movement the best results are obtained by osteotomy intended to restore the correct axis. In order to evaluate which of the surgical techniques available is the most appropriate, the authors analyzed 40 cases of tibial osteotomy performed between 1974 and 1984. On the basis of the results obtained, cupuliform osteotomy above the tuberosity appears to lead to the highest success rate.