[Mesothelioma and acceleration]. / Il mesothelioma e la anticipazione degli eventi.

INTRODUCTION: Taking a publication by Berry in 2007 (3) as a cue, this paper presents in didactic form the topic of acceleration of events as a consequence of a harmful exposure and extends the proposed approach to the case of the asbestos-mesothelioma relationship. METHODS: Berry's approach was applied to lung cancer and mesothelioma data. RESULTS: The effects of the acceleration of events are presented as a function of age at onset in exposed subjects, relative risk, scale factor, in addition to age and geographical variability of the relationship between age and mesothelioma rates. DISCUSSION: The discussion regards the general characteristics of the method of acceleration, its meaning and interpretation, and the difficulties associated with its application in the context of diseases with low occurrence; the conditions, applicability constraints, and specific results in the case of mesothelioma; the epidemiologic meaning of acceleration and the difficulties of its extension to individual subjects.

[Health expenditures for cases of pleural mesothelioma]. / Quanto costa in prestazioni sanitare un paziente con mesothelioma della pleura?.

Through the study of 65 cases of probable pleural mesothelioma currently under discussion in 4 criminal trials in the Lombardy Region, who died between 2002 and 2015, this study aimed to provide economical information regarding the health expenditures sustained by the Regional Health Service (RHS) for providing hospitalization, outpatient services and drugs to such patients. Health information regarding the services provided for the cases under study were electronically retrieved from the RHS information system. For each pleural mesothelioma case the costs (on average) were about 67,000 euros, 37,000 of which were spent after the date of diagnosis. Drugs formed the largest part of health expenditure (about 37,000 euros per person). Per capita expenditures showed a peak near (before and after) the date of diagnosis, rising when approaching the date of death and with increasing age of the patient, and did not vary with survival time. This information, reported for the first time in detail in this paper, will be useful for out-of-court agreements and for setting up reimbursement schemes, and describe per capita expenditures which are higher than estimations proposed in recent criminal trials in Italy and to those reported in the international literature.

III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health and Occupational Medicine related issues.

The III Italian Consensus Conference on Pleural Mesothelioma (MM) convened on January 29th 2015. This report presents the conclusions of the 'Epidemiology, Public Health and Occupational Medicine' section. MM incidence in 2011 in Italy was 3.64 per 100,000 person/years in men and 1.32 in women. Incidence trends are starting to level off. Ten percent of cases are due to non-occupational exposure. Incidence among women is very high in Italy, because of both non-occupational and occupational exposure. The removal of asbestos in place is proceeding slowly, with remaining exposure. Recent literature confirms the causal role of chrysotile. Fibrous fluoro-edenite was classified as carcinogenic by IARC (Group 1) on the basis of MM data. A specific type (MWCNT-7) of Carbon Nanotubes was classified 2B. For pleural MM, after about 45 years since first exposure, the incidence trend slowed down; with more studies needed. Cumulative exposure is a proxy of the relevant exposure, but does not allow to distinguish if duration or intensity may possibly play a prominent role, neither to evaluate the temporal sequence of exposures. Studies showed that duration and intensity are independent determinants of MM. Blood related MM are less than 2.5%. The role of BAP1 germline mutations is limited to the BAP1 cancer syndrome, but negligible for sporadic cases. Correct MM diagnosis is baseline; guidelines agree on the importance of the tumor gross appearance and of the hematoxylin-eosin-based histology. Immunohistochemical markers contribute to diagnostic confirmation: the selection depends on morphology, location, and differential diagnosis. The WG suggested that 1) General Cancer Registries and ReNaM Regional Operational Centres (COR) interact and systematically compare MM cases; 2) ReNaM should report results presenting the diagnostic certainty codes and the diagnostic basis, separately; 3) General Cancer Registries and COR should interact with pathologists to assure the up-to-date methodology; 4) Necroscopy should be practiced for validation. Expert referral centres could contribute to the definition of uncertain cases. Health surveillance should aim to all asbestos effects. No diagnostic test is recommended for MM screening. Health surveillance should provide information on risks, medical perspective, and smoking cessation. The economic burden associated to MM was estimated in 250,000 Euro per case.

[Pier Luigi Viola and vinyl chloride: notes that were never published]. / Pier Luigi Viola e ii cloruro di vinile: alcuni appunti mai pubblicati.

The name and work of Pier Luigi Viola (1917-1985) are unequivocally connected with the history of the discovery of the toxic effects of vinyl chloride, cancer in particular. A biography and a bibliography of Professor Viola are still lacking but his work is well documented; equally well known is his professional career as an occupational physician who spent his entire working life as an employee of one single industrial group, Solvay; his work was dedicated firstly to taking care of the health of the workers of the Corporation and not only in Italy, and secondly to organizing the occupational health departments of all Solvay's establishments in Italy. This positive connection between occupational physician and scientist has recently been challenged in certain historical reconstructions of the discovery of vinyl chloride's carcinogenicity: in particular, these reconstructions (which we do not consider to be coherent with the facts) depict Viola as in constant conflict with his employer. As crucial support to this view are offered on the one hand a statement by Viola, in 1980, that "At the basis of every discovery there is frequently the poetical imagination of a researcher who is always alone in facing the difficulties of the research, difficulties that rise up against him like a wall reaching up to the sky"; and on the other the supposed failure to find some of Professor Viola's notes which should reflect his spiritual testimony, and from which should emerge "the suffering, the torments, and the pressures of that initial period". The true history is very different: the notes do exist: they were personally delivered to one of the authors (PB) by Viola's widow a few months after his death; they are in fact the first pages of a planned book on vinyl chloride that Viola never actually succeeded in writing. In these pages Viola developed some personal reflections from which it is clear that he was conscious of having been in the centre ofa fantastic adventure in the field of scientific research in which he also played the principal role; there is no mention whatsoever of any conflict or contrast between Viola and Solvay. In fact, the backdrop to this story reflects the typical dynamics of scientific research. The article continues with the publication of Viola's handwritten notes: in this way the supposed "mistery of the missing notes" is solved.

[Acroosteolysis in PVC autoclave cleaners: history of an occupational disease]. / Nascita, sviluppo e scomparsa di una malattia professionale: la acroosteolisi dei pulitori manuali di autoclavi nella produzione di PVC.

OBJECTIVES: This paper examines the history of an occupational disease which has now disappeared: acroosteolysis of manual tank cleaners in the production of polyvinyl chloride (PVC), which is a rare disease characterized by destructive alterations of the distal phalanges of the hands. METHODS: All the available literature on this disease was examined. The history of acroosteolysis was studied within the general framework of the history of the discovery of adverse health effects of exposure to vinyl chloride, and this history was studied up to the end of the 1960's. RESULTS: The disease was observed for the first time in mid-1963 in Belgium (Jemeppe) in a chemical plant operated by Solvay, and affected two workers whose job was the manual cleaning of vessels used for the polymerization of vinyl chloride; similar cases occurred in almost all PVC production plants all over the world, but not in the plants where the main activity was the production of vinyl chloride monomer (VCM). Little more than one hundred cases are described in the scientific literature, and this number increases by a few dozen if we consider known but unpublished cases. These figures confirm the rarity of the disease, which peaked at the end of the 1960's and disappeared during the 1970's, probably due to the complete elimination of manual reactor cleaning. Observation of the disease lasted no more than fifteen years and the disease was not replicated in experimental conditions on animals. DISCUSSION: The disease was clinically characterized, had a short latency (from several months to several years), was rare and unequivocally linked to the manual cleaning of PVC polymerization tanks. However many questions still remain open: the period when the disease first appeared (many years after the start of PVC production in the world), the etiology of the disease (the most accredited hypothesis considers three concomitant factors: a chemical factor--one of the many substances used during polymerization, and particularly vinyl chloride monomer, a physical factor--microtraumas of the fingers during manual cleaning, individual susceptibility), the pathogenetic mechanism (in particular: the role of skin, respiratory, or digestive system, as entrance door), a method (or test) to screen subjects potentially predisposed to the disease. In our view acroosteolysis of manual tank cleaners in PVC production is an occupational disease which is distinct from "vinyl chloride disease" as identified by Viola (1974).

[La Medicina del Lavoro: 100 volumes]. / La Medicina del Lavoro: 100 volumi.

With these pages La Medicina del Lavoro starts its 100th volume, so we have yet another historical occasion to celebrate the oldest occupational health journal in the world that is still publishing. Over the last few years we have had many occasions to celebrate, for example several anniversaries of the Journal (the 80th volume in 1989, 90 years in 1992, 100 years in 2001); the centenary of the foundation of the Clinica del Lavoro "Luigi Devoto" of Milan in 2001; the celebration of the 300 years' anniversary of the publication of De Morbis Artificum Diatriba by Bernardino Ramazzini, and we obviously hope to continue for many years to come in this positive outlook. One hundred volumes makes for a very large collection, with the highs and lows ofthe Journal's history (here we mean the variations in number of pages and physical size of the Journal). It is thanks to the Editors-in-chief(there have been very few so we can cite them all: Luigi Devoto, 1901-1936; Luigi Preti, 1936-1941; Enrico Vigliani, 1943-1992; e Vito Foà, 1992 to the present); the contributors who in various ways and with varying degrees of commitment but always with an exceptional personal participation, that it has been possible to reach 100 volumes, starting with C. Moreschi who, along with Luigi Devoto, was the first and sole editor at the Journal's foundation; up to the present extended and impressive editorial board; the printers (from the first. Tipografia Cooperativa, Via dei Molini in Pavia, to the latest: Casa Editrice Mattioli in Fidenza); the sponsors, including the most evident who, via advertising (rather limited as a matter offact), directly gave information about themselves, but also those who have often been or are behind the scenes, ensuring fundamental support which is not visible; content. articles, news, events, reports, ideas, opinions, photographs, tables, numbers... etc, which are really impossible to sum up. But the true collection which, for obvious reasons, cannot be individually named, consists of the people and the ideas that have enriched the history of the Journal in its over 100 years of existence. And the subscribers, above all, who by their almost anonymous presence have been the true guarantors of the Journal's ife. And of course the contributors who with their articles have consigned a part of their lives to history. Starting from 1925 we counted nearly 11.000, a really grand number. It would be wonderful if we could invite them all to a hypothetical (and impossible) grand convention to simply say "Thank you, your contributions will not be forgotten". There have been 100 volumes but in actual fact the Journal is more than 100 years old. It was founded in Pavia in 1901 as Il Lavoro-Rivista di fisiologia, clinica ed igiene del lavoro, and between 1901 and 1910 only three volumes were published, then, due to the difficulties during the First World War and the immediate post-war years, there were no issues in 1916, 1918 and 1919. Issues finally became regular in 1920 with volume 11; from that moment on not one issue was missed and the Journal even got through the Second World War without interruptions. In 1925, with volume 16, it took on the name that still distinguishes it to-day: La Medicina del Lavoro, "the official standard bearer of a work of enormous scientific, social and political content" as Luigi Devoto presented the event at the time. The first few years of the Journal were difficult ones (with only three volumes published in 10 years) to the effect that events such as the First International Congress on Occupational Diseases (Milano, 1906), the foundation of the International Commission for Occupational Health (1906), the First National Italian Congress on Occupational Diseases (Palermo, 1907), and above all the inauguration of the Clinica del Lavoro in Milano (20 March, 1910) are not reported in the Journal, which by 1911 had resumed publication but had moved to Milan. Many years have passed since those first three volumes and in the meantime we have moved on to another century and another millenium: this brings new opportunities, new responsibilities, new perspectives, new objectives, but also new subscribers, new contributors, new authors, and new topics. We would like to conclude by repeating the undertaking made "20 volumes ago": The Editorial Board wishes to thank everyone and take the opportunity to renew our unfaltering commitment to work well by ensuring our full respect for authors and readers so as to contribute, via the pages of La Medicina del Lavoro, to spreading love and knowledge of our discipline.

HIV infection and drug use: influence on cognitive function.

OBJECTIVE: To examine the involvement of cognitive function in HIV-seropositive drug users (DU) in a pre-AIDS state. DESIGN: Fifty-six HIV-positive DU were prospectively evaluated. They belonged to groups II, III and IV (subgroups A, C2 and E) of the 1987 Centers for Disease Control and Prevention classification, with anamnesis negative for neurological pathology. HIV-negative DU (n = 19) and non-DU (n = 27) were used as controls. Infection with HIV and use of toxic drugs were considered variables of influence on cognitive function. METHOD: Subjects underwent neuropsychological evaluation by tests designed to explore cortical and subcortical function. RESULTS: HIV-positive DU showed worse performance scores at the psychometric tests than HIV-negative non-DU, but there was no difference when compared with HIV-negative DU. Ex-DU showed better performance than active DU. No difference with regard to degree of disease evolution was observed among HIV-positive individuals (i.e., groups II and III versus group IV). CONCLUSIONS: There was no evidence of cognitive deficits in HIV-positive individuals in non-AIDS phases to indicate early involvement by HIV at the cerebral level. Progression of the disease, prior to the AIDS phase, did not determine a worsening of intellectual performance. Instead, cognitive function was affected by the chronic and current use of toxic substances. In HIV-positive DU, a decline in cognitive function was found to be attributable to the chronic use of toxic substances rather than HIV infection.

Cytochrome P4501A2: enzyme induction and genetic control in determining 4-aminobiphenyl-hemoglobin adduct levels.

Cytochrome P4501A2 (CYP1A2) activity may be related to bladder cancer risk through metabolic activation of aromatic amines, such as 4-aminobiphenyl (ABP), to reactive intermediates that can form DNA and hemoglobin (Hb) adducts. In the context of a study on smoking and bladder cancer risk, 97 healthy male volunteers were investigated. CYP1A2-dependent N-oxidation activity was measured using a molar ratio of urinary caffeine metabolites [(paraxanthine + 1,7-dimethyluric acid)/caffeine] obtained between the fourth and fifth h after drinking a standardized cup of coffee. N-Oxidation activity was induced by blond tobacco smoke, meat consumption the dinner before the test, or more than four cups of coffee a day. The regular use of medication appeared associated with a decrease in N-oxidation levels. Age and alcohol consumption were not related with CYP1A2 activity. A polymorphic distribution of the CYP1A2 and N-acetyltransferase-2 (determined by the caffeine metabolite ratio 5-acetylamino-6-formylamino-3-methyluracil:1-methylxanthine) phenotypes was examined in relation to susceptibility to ABP-Hb adduct formation. Rapid oxidizers and subjects with the combined slow acetylator-rapid oxidizer phenotype showed the highest ABP-Hb adduct levels at a low smoking dose. Blond tobacco smokers exhibited higher adduct levels compared with black tobacco smokers, after adjustment for the quantity of cigarettes smoked. At the highest levels of smoking exposure, no major difference in ABP-Hb adduct levels was found among the different combinations of CYP1A2 and N-acetyltransferase-2 phenotypes. In a subset of only 45 available samples, no association was seen between the ABP-Hb adduct levels and the glutathione S-transferase M1 genotype.

Models of interaction between metabolic genes and environmental exposure in cancer susceptibility.

Polymorphic metabolic genes that confer enhanced genetic susceptibility to the carcinogenic effects of certain environmental carcinogens act according to a type 2 interaction between genetic and environmental risk factors. This type of interaction, for which the gene has no effect on disease outcome by itself but only modifies the risk associated with exposure, must be treated differently from other types of gene-environment interaction. We present a method to analyze different dose effects often seen in studies involving these genes. We define a low exposure-gene effect, when a greater degree of gene environment interaction appears at lower doses of exposure (the interaction follows an inverse dose function), and a converse high exposure-gene effect, when the interaction increases as a function of dose. Using a standard logistic regression model, we define a new term, alpha, that can be determined asa function of exposure dose in order to analyze epidemiological studies for the type of exposure-gene effect. These models are illustrated by the use of hypothetical case-control data as well as examples from the literature.

Relationship between prevalence rate ratios and odds ratios in cross-sectional studies.

BACKGROUND: Cross-sectional data are frequently encountered in epidemiology and published results are predominantly presented in terms of prevalence odds ratios (POR). A recent debate suggested a switch from POR, which is easily obtained via logistic regression analysis available in many statistical packages, to prevalence rate ratios (PRR). We thought it useful to explore the mathematical relationship between PRR and POR and to evaluate the degree of divergence of the two measures as a function of the prevalence of disease and exposure. METHODS: With the use of some algebra and the common definitions of prevalence of the disease (Pr(D)), prevalence of the exposure (Pr(E)), PRR, and POR in a 2 x 2 table, we have identified a useful formula that represents the mathematical relationship between these four quantities. Plots of POR versus PRR for selected values of Pr(D) and Pr(E) are reported. RESULTS: Mathematically speaking the general relationship takes the form of a second order curve which can change curvature and/or rotate around the point POR = PRR = 1 according to the values of Pr(D) and Pr(E), with POR being always further from the null value than is PRR. The discrepancies are much more influenced by variations in Pr(D) than in Pr(E). CONCLUSIONS: We think that the choice between POR or PRR in a cross-sectional study ought to be based on epidemiological grounds and not on the availability of software tools. The paper offers a formula and some-examples for a better understanding of the relationship between PRR and POR as a function of the prevalence of the disease and the prevalence of the exposure.

Cancer in a young population in a dioxin-contaminated area.

An industrial accident in Seveso, Italy, in 1976, caused contamination of the residential community with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). We investigated cancer occurrence in the first post-accident decade (1977-1986) among nearly 20,000 subjects aged 0-19 years. People who left the area were actively followed with a 99% follow-up rate. For reported cancer cases confirmation was obtained through consultation with original medical records. Two ovarian cancers were observed versus none expected. A suggestive increase was seen for Hodgkin's lymphoma (relative risk [RR] = 2.0; 95% confidence interval [CI] = 0.5-7.6). Myeloid leukaemia showed a clear, but not statistically significant increase (RR = 2.7; 95% CI = 0.7-11.4). The most prominent result concerned thyroid cancer, not just for the magnitude of the increase (two cases, RR = 4.6; 95% CI = 0.6-32.7), but also for its consistency with experimental findings and previous observations in humans. Any conclusive interpretation would be premature because of the short time since initial exposure, ecological definition of exposure status, and limited number of events.

Mortality of a young population after accidental exposure to 2,3,7,8-tetrachlorodibenzodioxin.

The mortality experience of 19,637 people aged 1-19 years living in an area around Seveso, Italy, contaminated by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) after an accidental explosion in a chemical plant was examined for the period 1976-1986. For comparison, the mortality of the population of nearly 100,000 people living in the surrounding districts was examined. People who left the study area were followed up. Vital status ascertainment was successful in over 99% of the cases. A group of 186 children who contracted chloracne, a reversible marker of TCDD intoxication, shortly after the accident were in the study: none of them died during the observation period. Among the exposed, mortality owing to all causes, to all accidents and to all cancers failed to show major departure from expectations. Five leukaemia deaths were observed, four among males and one among females; the corresponding relative risks were 2.1 (95% confidence interval (CI): 0.7-6.9), and 2.5 (95% CI: 0.2-27.0), respectively. Two lymphatic leukaemias among males yielded a RR = 9.6 (95% CI: 0.9-106.0). Mortality owing to congenital anomalies showed a nearly twofold increase in the contaminated area; however, five out of seven observed cases were born before the accident. Interpretation is limited by the small number of deaths, short latency period and low validity of death certificate information for certain causes, and by the definition of exposure which was based merely on residence. The follow-up is continuing. A cancer morbidity study is in progress.

Influence of sex, age, and smoking habits on the urinary excretion of D-glucaric acid.

Reference values for urinary D-glucaric acid and the influence of sex, age and smoking habits were evaluated with a low-pH enzymatic method. D-Glucaric acid measured on spot urine samples from 573 healthy subjects gave mean concentrations (mumol/1) and D-glucaric acid/creatinine ratios (mmol/mol creatinine) of 56.1 (+/- 22.9) and 3.05 (+/- 0.99) for males and 53.3 (+/- 20.9) and 3.35 (+/- 0.95) for females. No difference between morning and evening was observed for urinary D-glucaric acid/1 values, but D-glucaric acid/creatinine was higher in the evening samples for both sexes. There was a negative correlation between D-glucaric acid/1 values and age in males but not in females: the decrease of D-glucaric acid concentration was, however, quantitatively very small. Smoking produced a significant increase in D-glucaric acid concentration and in the D-glucaric acid/creatinine ratio for males and also partially for females.

Prevalence and histologic features of transfusion transmitted virus and hepatitis C virus coinfection in a group of HIV patients.

BACKGROUND: A recently identified DNA transfusion-transmitted virus has been associated with post-transfusion non-A to G hepatitis. AIM: To determine the prevalence of transfusion-transmitted virus in patients with human immunodeficiency virus infection. Its clinical role in the pathogenesis of liver disease was also evaluated in patients with transfusion-transmitted-virus hepatitis C virus coinfection compared with those with hepatitis C Virus infection alone. PATIENTS AND METHODS: We evaluated 312 HIV-hepatitis C virus coinfected patients (225 males, 87 females). All underwent screening for transfusion-transmitted virus DNA using a nested polymerase chain reaction technique. In some transfusion transmitted virus-DNA positive patients, we performed a phylogenetic analysis. In 56 patients (20 transfusion-transmitted-virus-hepatitis C virus and 36 hepatitis C virus alone), liver biopsy was collected. RESULTS: The prevalence of transfusion-transmitted virus was 113/312 (36%). The genotype distribution was similar to that reported in other studies. No difference in liver histology was found between the two groups. CONCLUSION: Transfusion-transmitted virus infection is common in human immunodeficiency virus patients. We found no histologic differences between liver biopsy specimens from patients coinfected with transfusion-transmitted virus plus hepatitis C virus compared with those infected with hepatitis C virus alone. Transfusion-transmitted virus is not clearly associated with a distinct liver injury.

Exposure to formaldehyde and cancer mortality in a cohort of workers producing resins.

The mortality of 1,332 male workers employed at least 30 days in 1959-1980 in a resins-manufacturing plant was examined. Ambient measurements taken in the plant between 1974 and 1979 documented a potential for exposure to levels of formaldehyde as high as greater than 3.0 mg/m3. Vital status was ascertained for 98.6% of the cohort members, and their mortality was compared with expected deaths drawn from the national and local population rates. A statistically significant increase in lung cancer was observed, based on 18 deaths, which was not fully accounted for by possible confounding factors linked to personal habits or sociocultural characteristics. This elevated risk, however, could not be attributed specifically to exposure to formaldehyde. Mortality from digestive cancer (14 deaths observed) and hematologic neoplasms (5 deaths observed) was not substantially higher than expected. The study was limited by information bias due to incomplete work histories, by the small number of deaths from some relevant causes, and by the possibly insufficient length of the observation period. Therefore these results do not provide sufficient grounds either to link formaldehyde exposure in the plant to the increased cancer risk noted or to exclude that formaldehyde might pose such a risk to humans under certain exposure circumstances.

Cancer mortality of an Italian cohort of workers in man-made glass-fiber production.

This study was undertaken in order to examine possible long-term effects, particularly cancer, associated with working in the man-made glass-fiber production industry in Italy (glass wool and continuous filament). All male production workers employed for a minimum of one year between 1944 and 1974 were admitted to the study (1,098 subjects), and their mortality was examined in the period 1944-1983 (21,325 person-years). The vital status ascertainment was successful for 98.9%, of the cohort members. An increased risk of cancer of the larynx was noted based, however, on only four deaths. When contrasted with the values of the local population, the increase proved to be statistically significant after 25 years since first exposure. The higher than expected larynx cancer mortality was confined to workers hired before the age of 25 years, exposed for at least 15 years, who started exposure before 1960 (main production: glass wool), and who belonged to the highest cumulative exposure categories. Known confounding factors could not completely account for the excess observed. Among the numerous studies carried out on man-made glass-fiber workers, only one incidence study in France support our findings. No other increased cancer risks have been suggested by the present study.

Effects derived from long-term low-level chromium exposure in ferro-alloy metallurgy. Study of absorption and renal function in workers.

Ferro-chromium production is based on the use of chromium oxide (III) and it is generally accepted that chromium in this form is not able to cross biological barriers. However, the data on the toxic and carcinogenic effects of hexavalent chromium in man are now firmly established. Some studies have questioned these data, calling for a clarification as to whether exposure to trivalent chromium can also produce human effects, perhaps with different latency time. A study was carried out on the exposure conditions (type and degree) in a ferro-chromium foundry that had been in operation since 1972. The absorption levels in the working population of the foundry, and the possible toxic effects on the kidney have been investigated. A total of 236 workers (142 employed in production departments, 33 office workers and 61 sub-contractor employees) were examined with measurement of the indicators of dose (urinary-chromium) and of effect on the kidney (albumin, retinol binding protein, and renal tubular epithelium antigens in the urine). Environmental hygiene measurements showed relatively low values of total chromium in the air (always less than 0.160 mg/m3). Hexavalent chromium was absent or, if present, at levels below the sensitivity of the analytical method used (0.001 mg/m3). The values of urinary chromium measured at the beginning and at the end of the working day and at the end of the work shift were always less than 5 micrograms/g creatinine, which has been proposed as a biological limit in chromium exposure. However, differences were observed between groups of subjects employed on different jobs, which is indicative of an absorption process varying according to the degree of exposure. The indicators of effect did not reveal any renal impairment, even early, that could be attributed to the toxic action of chromium.

[Dyspepsia among the principal diseases of the upper tract of the digestive apparatus. Analysis of the symptom in 700 cases subjected to gastroduodenoscopy]. / La dispepsia nelle principali malattie del tratto superiore dell'apparato digerente. Analisi del sintomo in 700 casi sottoposti a gastroduodenoscopia.

700 cases subjected to endoscopic examination were investigated to find the relationship between dyspepsia and personal characteristics, lifestyle, family and pathological history and formulated diagnosis. Dyspepsia is taken to represent: epigastric heaviness following meals, prolonged and difficult digestion accompanied by the sensation of slow gastric emptying and fullness. Dyspepsia occurs with equal frequency in both series and is more common during the first decades of life. Dyspepsia is not affected by whether or not the patient lives in the town or the country, smokes, drinks significant amounts of alcohol or coffee. Neither a family history of gastroduodenal or intestinal complaints or gall bladder stones or chronic liver diseases have many bearing on dyspepsia. An attempt to connect endoscopic diagnosis with dyspepsia had no positive result. Dyspepsia was observed with the same frequency in subjects free from upper digestive tract diseases, subjects with organic disease and subjects with functional diseases.

[Pyrosis in major diseases of the upper digestive tract. Computerized analysis of symptoms in 700 cases subjected to gastroduodenoscopy]. / La pirosi nelle principali malattie del tratto superiore dell'apparato digerente. Analisi computerizzata del sintomo in 700 casi sottoposti a gastroduodenoscopia.

The prevalence of the symptom pyrosis was investigated in 700 cases subjected to gastroduodenoscopy. The incidence of pyrosis was considered in relation to sex, age, "vices" (consumption of coffee, alcohol, cigarettes), character traits, family and pathological medical histories and the diagnosis formed during endoscopy. The incidence of pyrosis proved to be identical for both sexes and slightly higher in the first decades of life. There was no correlation between familial gastroduodenal or intestinal diseases and pyrosis. There seems to be no connection between cigarette smoking and alcohol consumption (assessed quantitatively) and a higher incidence of pyrosis; the consumption of coffee, however, does appear to increase the incidence of pyrosis. When interpreting these data, it should be remembered that many subjects may have modified their habits as a result of pyrosis. The incidence of pyrosis was always found in cases of oesophagitis, current bulbar ulcers, the initial stage of gastric tumours (not advanced cases) and, although with less certainty, in pyloric stenosis and duodenitis. A low incidence was recorded for cases of hypotrophic gastropathies, and cicatricial gastric or duodenal ulcers, for males with oesophageal varices or with a history of chronic hepatopathies. To conclude, pyrosis does not seem to show any characteristics of specificity or sensitivity.