[Malignant mesothelioma (MM) in women: findings of the Mesothelioma Register of the Friuli Venezia Giulia Region]. / Mesotelioma maligno (MM) nel sesso femminile: dati del Registro Mesoteliomi della Regione Friuli Venezia Giulia.

During the period 2000-2003, the Mesothelioma Register of the Friuli Venezia Giulia identified 248 cases of MM, 44 of which (18%) were female. In 36 cases the diagnosis was "certain" and in 8 "probable" or "possible". Mean age at diagnosis was 72.8 years (SD = 12.7), and the site of the disease was the pleura in 93% of cases. Information about previous exposure to asbestos was collected in accordance with the guidelines of the National Mesothelioma Register Occupational exposure to asbestos was documented in only 8 cases and family exposure in 6 others. In the remaining cases the source of exposure was "unknown" because of insufficient data, or there were no data at all. The study highlights the role played by extra-occupational exposure to asbestos among women and the need for careful investigation into previous asbestos exposure in all females with MM. In order to improve our knowledge of the part played by factors other than occupational exposure to asbestos in triggering the disease, it is crucial to reduce he number of cases with no information or "unknown" exposure to this dangerous substance.

[Respiratory function and smoking habit among shipyard and dock workers]. / Funzionalità respiratoria e fumo di sigaretta in lavoratori della navalmeccanica e del porto.

The aim of the study is to compare the loss of lung function in a group of 196 male workers employed in shipbuilding/repairing and port activities ("cases") with a group of 109 healthcare workers ("controls"). "Cases" were grouped by radiological examination (chest X-ray/HRCT) depending on the presence or absence of pleural plaques. Smoking habit was assessed in all subjects. Lung function assessment included two measures of VC, FEV1 and TLC (the latter for "cases" only). The mean interval between the two examinations was five years; changes in spirometric results (value at second examination minus value at first) were expressed as ml/year. The results showed that there was no difference in loss of lung function in the three groups over the follow-up period, even when differences in smoking habit were taken into account. The results suggest that radiological findings of pleural plaques had no bearing on deterioration in lung function. Lung function testing is widely accepted as an integral part of medical surveillance of occupational lung diseases, but the high inter and intra-subjects variability of spirometric data underlines the difficulties and limitations of lung function follow-up studies.

[Chronic obstructive pulmonary disease (COPD) and occupational exposure to mineral dust]. / Broncopneumopatia cronica ostruttiva (BPCO) ed esposizione professionale a polveri minerali.

The relationship between chronic obstructive pulmonary disease (COPD) and occupational exposure to mineral dust is still conflicting because COPD is multifactorial disease, relatively common in the general population. A number of studies have shown that in population exposed to mineral dust there is a greater prevalence of chronic bronchitis, even in the absence of radiographic evidence of pneumoconiosis. There is no agreement, however, that dust alone will induce significant chronic airflow limitation and increase in mortality. It is unlikely that medical evidence could ever provide conclusive "proof" of the work related less of COPD in the singular patient, but it is possible to provide evidence for reasonable statment of probability.

[Pleural plaques and ventilatory function: follow-up study]. / Placche pleuriche e funzionalità ventilatoria: indagine di follow up.

We have evaluated, over a mean follow up period of 3.7 (SD 1.8) years, the lung function in a group of 103 workers, according to the presence (36 workers) or absence (67 workers) of pleural plaques at chest Rx-films/HRCT. A Generalized Estimating Equation (GEE) approach was used to investigate the relation between the loss of pulmonary function and (i) presence/absence of pleural plaques, (ii) smoking status, and (iii) work seniority in work places with exposure to asbestos. The mean age, at the first examination, was 49 (SD 6) years and work seniority 25 (SD 7) years. Multivariate GEE approach to age- and height-adjusted spirometric data (236 measures of VC, FEV1 and 234 determinations of TLC), showed that pleural plaques were not associated with significant loss of pulmonary function. Smokers (> or = 15 py), when compared with no-smokers, showed significant loss of VC (-5.3%, p < 0.05), FEV1 (-8.4%, p < 0.001) and TLC (-4.0%, p < 0.05). An occupational history in work places with exposure to asbestos (ship building/repairing) was significantly associated with a slight, but significant (p < 0.05), 10-year decrease in VC (-3.1%) and FEV1 (-4.9%).

[Follow-up of symptoms, parameters of respiratory function, and data on specific sensitization in a group of subjects with latex-induced asthma and rhinitis]. / Follow up dei sintomi, dei parametri di funzionalità respiratoria e dei dati di sensibilizzazione specifica in un gruppo di soggetti con asma e rinite da lattice.

We re-investigated 13 workers 6 years (SD 2) after the first diagnosis of asthma or rhinitis caused by latex, to update the exposure to latex, the eventual symptoms, respiratory function (spirometry and metacholine PD20 FEV1), skin prick test to common allergens and latex, RAST to latex, total IgE levels and eosinophils count in the blood. At the follow up, all the workers stopped wearing powdered latex gloves, but for 10 an indirect exposure to latex was still possible. All cases referred improvement of respiratory symptoms at work, but 7 workers occasionally complained of mild symptoms. No statistically significant variations of respiratory function test and of the immunological parameters were found. The workers with persistent respiratory symptoms at work had a longer duration of symptoms before the diagnosis (p = 0.02), if compared with workers without symptoms.

[Asthma caused by cyanoacrylic glues]. / Asma da collanti cianoacrilici.

Cyanoacrylate-based glues have been reported as producing dermatitis and bronchial asthma. The paper describes the case of a patient occupationally exposed to Loctite 406, who developed irritation of the skin and mucosae of the face and late bronchial asthma. Preventive measures for subjects exposed to cyanoacrylic instant glues are discussed.

[Alpha-amylase as an occupational allergen in baking industry employees]. / L'alfa amilasi come allergene professionale negli addetti alla panificazione.

In a group of 226 bakers and pastry makers and in 88 students of a training school for bakers, we evaluated skin sensitization to the common allergens, wheat and alpha amylase. Skin prick tests were positive to the enzyme in 17 exposed subjects (7.5%) and in one student with previous occupational exposure as a baker; 27 exposed subjects (11.9%) and 2 students were sensitized to wheat. Among the 42 exposed workers who complained of work-related symptoms, 12 (28.6%) cases were skin positive to amylase and 17 (42.9%) to wheat. Among the 17 workers who were positive to amylase, 16 were also sensitized to wheat and/or common allergens, 12 complained of symptoms at work but since in many cases there was a positive response to wheat, too, it is impossible to speculate on the role of each allergen in inducing symptoms. One case, with work-related rhinoconjunctivitis, had skin sensitization only to alpha amylase but no specific IgE in the serum. These findings confirm that bakers are at risk of sensitization not only to wheat allergen but also to amylase from Aspergillus oryzae. The enzyme should be included in the list of substances to be tested among bakers in whom an occupational allergy is suspected, but particular care should be taken in evaluating the cutaneous response, especially if compared to wheat wheals. Further investigations are also needed to identify the source of risk and to better define the characteristics of the enzyme and the relationship between skin reaction to amylase, sensitization to wheat and atopy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in blood eosinophils and nonspecific bronchial reactivity after exposure tests to wheat flour and TDI]. / Variazioni degli eosinofili ematici e della reattività bronchiale aspecifica dopo test di esposizione a farina di frumento e a TDI.

We studied non-specific bronchial responsiveness (NSBR) and blood eosinophils before and 24 hours after a bronchoprovocation test (SBPT) with wheat flour (22 cases) and TDI (32 cases). Twelve patients developed asthma after exposure to wheat flour (7 early and 5 dual/late asthma), and 12 after exposure to TDI (6 early and 6 late/dual asthma). Responders and non responders to wheat flour exposure were similar for all general characteristics except IgE levels (p = 0.036) and NSBR (p = 0.047). A higher degree of airway responsiveness to methacholine was the only characteristic which differentiated responders from non responders to TDI exposure (p = 0.043). Airway responsiveness, assessed 24 hours after the SBPT (44 cases), did not show any change compared to pretest values; the data were similar both among non responders to wheat flour (Wilcoxon p = 0.1) or to TDI (p = 0.2) and responders to TDI (p = 0.6) or wheat flour (p = 0.3); also no significant changes were observed among early and dual/late asthma caused by wheat flour and TDI. Twenty-four hours after the SBPT, blood eosinophils were higher than pretest, but only among the 24 patients with asthma (Wilcoxon p = 0.002); the blood eosinophil increase was statistically significant among patients with early and late/dual asthma caused by wheat flour, and among those with early and late/dual TDI asthma. In our study, NSBR was confirmed as a common feature of occupational asthma, either IgE mediated (wheat flour) or non-IgE mediated (TDI). Twenty four hours after the specific exposure, among patients with asthma induced by wheat flour and TDI, there was an increase in blood eosinophils while in the same time interval no variation in non-specific bronchial responsiveness was observed.

[Follow-up of allergic symptoms in a group of health workers sensitized to latex]. / Follow-up dei sintomi allergici in un gruppo di operatori sanitari sensibilizzati al lattice.

We studied 28 health care workers sensitised to latex and complaining of respiratory symptoms at work. All were females, aged 32 y (median), and had worked in the hospital for 12 y, in departments with high exposures (22 cases), moderate exposure (4 cases) or low exposure (2 cases) to rubber gloves. Twenty also complained of latex skin symptoms. Twenty-five (89%) were atopical (by prick test), and 16 (57%) had a personal history of allergic disease. Nine (32%) also had symptoms from exposure to latex outside work and 3 (10%) from food cross-reacting with latex. The specific inhalation test with latex gloves confirmed the diagnosis of asthma in 4 cases (14%) and of rhinitis in 13 cases (46%). We reinvestigated the workers 14 months (median) after the first examination to update exposure to latex, any allergic symptoms and adverse effects of relocation. At the follow-up, 3 workers (11%) had retired, all the others had stopped wearing powdered latex gloves, and 12 had changed their duties or the work-place. Ten (40%) of the 25 subjects still at work were without symptoms, 14 (56%) occasionally complained of mild symptoms and one of frequent rhinitis. Overall, we observed improvement of skin symptoms in 74% (14/19) of the cases and of respiratory symptoms in 56% (14/25) of the cases. Symptoms from exposure to latex outside work were still present in 6 subjects. The persistence of symptoms at work was significantly higher among workers who continued to work in departments with high/moderate latex glove exposure. The results of the study show that skin and respiratory symptoms among health care workers are related to the use of powdered latex gloves and confirm the importance of primary prevention.

Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

[Respiratory symptoms and occupational sensitization in a group of trainee bakers: results of a 6-month follow up]. / Sintomi respiratori e sensibilizzazioni professionali in un gruppo di allievi panificatori: risultati di un follow-up a 6 mesi.

We investigated the prevalence of atopy by 4 different criteria (personal and family atopy, atopy by prick test and by serum IgE levels), and sensitization to wheat flour and alpha amylase in a group of trainee bakers and in a group of trainee graphic artists as controls (baseline check-up). The follow-up was performed 6 months later only among trainee bakers (90 cases), based on an updating questionnaire and on repeated skin prick test with wheat flour and alpha amylase extracts. Trainee bakers and controls were similar with respect to age, number of smokers, atopy evaluated by 4 different criteria, and detection of serum IgE (RAST) and IgG specific to wheat flour. Positive skin prick test to wheat flour (4%) and alpha amylase (1%) were found only among trainee bakers. At the baseline control 4 students (4.4%) complained of respiratory symptoms when working with wheat flour (WRS). At the six month follow up 6.6% of the trainee bakers complained of WRS: 3.3% had persistent symptoms, 3.3% were new cases and 1.1% had become asymptomatic. Five cases (5.5%) were skin positive to wheat flour or alpha amylase, but only one was unchanged, while 4.4% were new cases and 3.3% turned negative. None of these changes was statistically significant (McNemar test). The trainee bakers complaining of WRS at the baseline or at follow-up (7 cases, when compared with the non-symptomatics, showed a higher prevalence of personal atopy and skin sensitization to occupational allergens; there were no differences, however, with regard to atopy by prick test, IgE levels or the presence of wheat specific IgE and IgG. The trainee bakers skin positive to the occupational allergens (8 cases) showed prevalences of personal atopy and atopy by prick test significantly higher than trainee bakers skin negative to wheat flour or alpha amylase (p < or = 0.01). Evaluating wheat flour specific IgE and IgG in the serum of trainee bakers and controls provided us with more information about the specificity of such tests and suggests caution in attributing the presence of these immunoglobulins in the serum to specific occupational exposure or to specific occupational sensitization. A six-month follow up is likely to be too short an interval to observe significant changes in work-related symptoms and in skin sensitization to occupational allergens. The results, however, emphasize the important role of personal atopy as a predisposing factor in the development of occupational disease among trainee bakers.

[Radiological study of pleural plaques in asbestosis. Contribution of oblique projection views and computerized tomography]. / Lo studio radiologico delle placche pleuriche nell'asbestosi. Contributo delle proiezioni oblique mirate e della tomografia computerizzata.

Oblique views of the chest under scopic control and computed tomography have been obtained in 7 patients with a known history of exposure to asbestos fibers, and evidence of pleural plaques on the postero-anterior view of the chest. The distribution of the radiological findings is similar with both the techniques; however, CT is more sensitive in detecting small lesions at the margino-costal anterior and posterior level, both calcific or not. CT seems also more sensitive in detecting parenchymal lesions. The role of CT in this pathology is briefly discussed.

Asthma and rhinitis in wooding workers.

We present some cases of rhinitis and asthma in wooding workers exposed to hard or soft woods. The specific provocation test confirmed the diagnosis of rhinitis in three patients and of asthma in four. Rhinitis was caused by oak, beech, and pine, while asthma was caused by obeche, chestnut, acacia, and iroko. Occupational exposure to the specific wood, before onset of symptoms (symptom latency) was shorter for patients with asthma. All seven patients with respiratory symptoms were nonsmokers; three were atopics and four, all with asthma, had nonspecific bronchial hyperreactivity. Twenty-four hours after the test, PD20FEV1 had decreased in two cases with rhinitis and two with asthma, although the data did not reach statistical significance (Wilcoxon matched-pairs test: NS). After the SBPT, blood eosinophils increased in two cases with rhinitis and three with asthma, and the data were at the limit of statistical significance (P = 0.046). The study confirms that not only hard essences, but also soft woods can cause respiratory symptoms, although the pathogenetic mechanisms are still unclear. A specific provocation test is still the best and sometimes only means of diagnosing wood asthma; standardized protocols with repeated measurements of nonspecific airway responsiveness and of eosinophils in the blood may be helpful for a better understanding of the pathogenetic mechanism and predisposing factors.

Prospective study of work related respiratory symptoms in trainee bakers.

OBJECTIVES: To investigate the occurrence of work related respiratory symptoms and to assess the effect of atopy in a group of trainee bakers. METHODS: A prospective study of work related respiratory symptoms among 125 trainee bakers who were investigated with a questionnaire plus skin prick test with wheat flour and alpha-amylase allergens at baseline and then after 6, 18, and 30 months. RESULTS: At the baseline examination, four students (3.2%) complained of respiratory symptoms (cough and rhinitis) when working with flours and four were skin positive to wheat flour or alpha-amylase. The incidence of work related respiratory symptoms was 3.4% at 6 months, and the cumulative incidence was 4.8% and 9.0% at 18 and 30 months, respectively. The incidence of skin sensitisation to occupational allergens was 4.6% at 6 months and the cumulative incidence was 4.6% at 18 months and 10.1% at 30 months. The generalised estimating equation approach to longitudinal data showed that work related respiratory symptoms in the study population was significantly associated with a personal history of allergic disease (odds ratio (OR) 5.8, 95% confidence interval (95% CI) 1.8 to 18.2) and skin sensitisation to wheat flour or alpha-amylase (OR 4.3, 95% CI 1.2 to 14.9). Atopy based on prick test was not related to the occurrence of work related respiratory symptoms over time (OR 1.1, 95% CI 0.3 to 3.8). CONCLUSIONS: Personal history of allergic disease is a predisposing factor for the development of symptoms caused by exposure to wheat flour and may be a criterion of unsuitability for starting a career as a baker. Atopy based on the skin prick test is useful for identifying subjects with allergic disease, but should not be used to exclude non-symptomatic atopic people from bakery work.

[Description of several cases of preclinical lead poisoning in decorators of ceramic tiles]. / Segnalazione di alcuni casi di saturnismo preclinico in decoratrici di piastrelle ceramiche.

Tha AA report 10 cases of subclinical lead poisoning in a small ceramic factory for artistic painting of building tiles . The decoration was done by hand, using lead glazes . In spite of the extremely low lead air level, the decorators , whose time of exposure was 6-18 months had on average 1868 (SD: 810) micrograms Pbu EDTA/24h and 18,2 (SD: 14,8) mg ALAu /l. Hematochemical data were within the normal range, all but serum iron (144 +/- 33 micrograms %). The cases are presented as a clear example of working conditions where lead intake occurs mainly by gastrointestinal absorption. The AA emphasize the importance of biological monitoring as essential to complete the data of environmental pollution. Moreover the prevention of lead poisoning, especially in small factories, requires the implementation of those general hygienic measures recommended in the recent EEC directive.

Sensitization to green coffee bean (GCB) and castor bean (CB) allergens among dock workers.

Dock workers (n = 218) occupationally exposed to green coffee beans (GCB) were studied, using a specific questionnaire for allergic symptoms and skin tests for common and occupational allergens. Thirty-one workers (14.3%) complained of allergic symptoms of the eye, nose and bronchial system at the workplace. The prick tests, using both commercial allergens and specific extracts prepared from the most common types of coffee and their corresponding sacks, confirmed a sensitization in 21 workers (9.6%). A positive skin reaction to castor beans (CB) was found in nearly all these cases; in ten workers there was also a positive reaction to GCB allergens and in 14 cases prick tests were positive to extracts of sacks. There was a good concordance between prick tests and specific IgE for CB (95.0%) and also, but to a lesser extent, for GCB. The authors concluded that there is a significant risk of sensitization to CB and GCB allergens in dock workers occupied in handling green coffee bean, despite the fact that the exposure is not continuous. CB emerged as a common contaminant of GCB from various countries. For effective prevention, a modification of the methods of transport is required to avoid CB contamination to other products. Eliminating environmental dust during shipping operations is the most important preventive measure and it can be achieved by the use of containers, as some exporting countries are already doing.