[Occupational injuries and diseases in transport industry]. / Infortuni e malattie professionali nel settore dei trasporti.

In order to identify the specific risk and injury factors related to rail freight/transport, road haulage/transport, and business conveyance, the INAIL data/memory bank was searched for occupational diseases and injuries/accidents. In road haulage and business conveyance, osteoarticular diseases prevail, while in rail freight asbestos diseases are predominant. The permanent disability is more severe in road haulage than in business conveyance. Occupational injuries are more frequent in road transport and business conveyance in northern regions of Italy and consisted mainly in sprains/strains and dislocations. More frequently the workers recovered without serious hangovers.

[Epidemiologic surveillance in occupational bladder cancer: a Tuscan experience]. / Intervento di ricerca attiva delle neoplasie vescicali di origine professionale: una esperienza toscana.

The percentage of bladder cancer as occupational disease in West-Europe is of 5/10%, but only a few amount of them are recognized as occupational disease from INAIL. The above mentioned research project is realized in order to decrease the gap between expected and claimed cases of occupational disease and it is conducted with the collaboration of ASL of Pisa, ASL of Empoli, Azienda Ospedaliera Universitaria Pisana and INAIL. 677 patients with bladder cancer were interviewed by phone, among them 64 subjects had a working experience compatible with neoplastic risks because had a previous occupational exposure to aromatic amines and metal working fluids. These cases were discussed into a Medical Staff and 40 cases were considered "probable" for occupational disease, 18 "possible", 3 cases are suspended for more research, 3 cases are considered "no professional disease". The research allows finding out a great number of bladder cancer, increasing the total amount of workers with occupational disease. The integrated approach with the collaboration among different institutions is surely the best way to allow and guarantee a suitable and right protection of workers with occupational disease.

Design of advanced ultrasonic transducers for welding devices.

A new high frequency ultrasonic transducer has been conceived, designed, prototyped, and tested. In the design phase, an advanced approach was used and established. The method is based on an initial design estimate obtained with finite element method (FEM) simulations. The simulated ultrasonic transducers and resonators are then built and characterized experimentally through laser interferometry and electrical resonance spectra. The comparison of simulation results with experimental data allows the parameters of FEM models to be adjusted and optimized. The achieved FEM simulations exhibit a remarkably high predictive potential and allow full control of the vibration behavior of the transducer. The new transducer is mounted on a wire bonder with a flange whose special geometry was calculated by means of FEM simulations. This flange allows the transducer to be attached on the wire bonder, not only in longitudinal nodes, but also in radial nodes of the ultrasonic field excited in the horn. This leads to a total decoupling of the transducer to the wire bonder, which has not been achieved so far. The new approach to mount ultrasonic transducers on a welding device is of major importance, not only for wire bonding, but also for all high power ultrasound applications and has been patented.

[Pharmacological and clinical aspects of S-adenosylmethionine (SAMe) in primary degenerative arthropathy (osteoarthrosis)]. / Aspetti farmacologici e clinici della solfo-adenosil-metionina (SAMe) nella artropatia degenerativa primaria (osteoartrosi)

After some preliminary remarks of a biochemical and pharmacological nature, the authors have started a clinical study to test the antiinflammatory activity of the S-adenosyl-methionine (SAMe). An open trial, carried out on 90 patients with severe degenerative arthropathies has shown that 30 mg SAMe intravenously twice a day for 14 days have a marked anti-inflammatory effect a rather term and no side-effects. In a "double-crossover" investigation, SAMe was next compared to indomethacin by i.m. administrations to 15 arthropathic patients. The therapeutic responses of the two drugs proved exactly alike, whereas the side-effects following indomethacin administration were not present after SAMe. In 9 patients affected with rheumatoid arthritis administrations of SAMe have proved less effective, although some clinical parameters showed improvements.

Ultrasonography in the study of pathological conditions of the hip.

The authors describe the use of real-time ultrasonography in the investigation of the hip joint. The study involved 25 patients with traumatic, inflammatory or degenerative lesions. It was possible to evaluate effusion and capsular changes in 13 cases and to correlate these findings with the type of pathology involved. The ultrasonographic findings in the patients with degenerative or inflammatory joint disease were confirmed at operation. The method described is simple, quick and devoid of risk to the patient. It is therefore a useful investigation in the study of disorders of the hip joint.

Ultrasound examination of haematomas after total hip replacement.

We have used ultrasound after 84 total hip replacements to define the site and size of any haematoma present. Repeated examination after operation indicated when the haematoma had occurred. We have demonstrated that two suction drains were more effective than one in preventing haematomas around the prosthesis in the first week after operation. The early detection of a haematoma allows rational treatment which should reduce the risk of deep infection.

Ultrasonography in the investigation of loose hip prostheses.

Twenty-two patients with severe pain in the hip on weight-bearing after prosthetic replacement were investigated by radiography, arthrography, scintigraphy and ultrasonography to determine the accuracy of these diagnostic methods in detecting loosening of infective or mechanical origin. In two cases, ultrasonography revealed superficial infections that were resolved with antibiotic therapy. Of the remaining 20 cases, 12 involved a deep infection and in 8 the loosening was of mechanical origin. In the deep infections, standard radiography provided a diagnosis in 66% of cases, arthrography in 75% and scintigraphy in 83%, while ultrasonography detected the deep infection in all 12 cases. In the patients with mechanical mobilization, arthrography and ultrasonography were 100% accurate. Since ultrasonography is able to detect discrete or diffuse lesion of the soft tissues around a prosthesis it should be included among the methods used to screen patients with painful hips after prosthetic replacement.

[Role of computerized tomography in the evaluation of the stability of the glenohumeral articulation]. / Ruolo della tomografia computerizzata nella valutazione della stabilità dell'articolazione gleno-omerale.

CT scans of the shoulder were performed on 30 normal subjects. The bony architecture of the glenohumeral joint and of the shoulder as described by definite angles and index was determined. Attention was primarily drawn upon the parameters often implicated in the mechanism of glenohumeral stability, namely: the glenoid antero-posterior tilt and the anteversion angle of the scapula. While the former is a static determinant, the latter is a dynamic determinant of joint stability. An inversely proportional relationship was found to exist between these two components of glenohumeral stability. It may be speculated that an high glenoid tilt, which is unstable, may be counterbalanced by a functional reduction in anteversion of the scapula, thus improving the joint stability.

The calcaneal index in the determination of osteoporosis.

The authors tested the reliability of a new method of evaluating osteoporosis and osteopenia radiographically. This is based on the calcaneal index, which can be correlated directly with Singh's femoral neck index and is inversely proportional to the age of the subjects tested.

[Ultrasonography and computerized tomography in the determination of the femoral angle of anteversion. Experimental and clinical comparative study]. / Ultrasonografia e TC nella determinazione dell'angolo di antiversione femorale. Studio comparativo sperimentale e clinico.

A comparative study of the femoral neck anteversion angle as determined by ultrasonography and CT was conducted on 40 unpaired dry bone specimens and 5 normal subjects. Since ultrasound cannot penetrate bone, the anterior surface femoral neck orientation was determined and correlated well (r = 0,95) with the corresponding measurements as imaged by CT. However, a weaker correlation (= 0,76) existed between it and the true femoral neck axis, as measured on CT display. The latter is a function of the posterior surface femoral neck orientation as well, since the two femoral surface are rarely parallel, but converge at the femoral shaft. It is concluded that the ultrasonographic modality will overestimate the true femoral neck anteversion beyond the 5-degree error acceptable for clinical purposes.

Growth disturbances following fractures of the femur and tibia in children.

The authors reviewed 477 diaphyseal fractures of the long bones in the lower limbs of children between the ages of one to 11 years treated at our Institute between 1976 and 1982. The objective was to evaluate the incidence and extent of post fracture lengthening and its possible relationship to the method of treatment. The amount of lengthening observed never exceeded 2 cms. and this always occurred in the early months after injury and then ceased. There was no statistical relationship with the method of treatment or with the type of fracture. For any valid assessment of such statistics, however, it would be necessary first to know the incidence of lower limb dysmetria in a similar group of normal children who had not sustained fractures.

Vitamin D concentrations in women of postmenopausal age with fractures of the femoral neck.

Thirty-eight women of postmenopausal age, suffering from fractures of the femoral neck or vertebral bodies were studied in relation to differences in bone metabolism. The blood and urinary changes concerned in mineral and bone metabolism were recorded within 10 days of trauma, and in some femoral neck fractures, a histological study of the femoral heads removed in the course of prosthetic substitution was carried out. The patients with femoral neck fractures were older than those with vertebral fractures and had metabolic and histological findings suggestive of osteomalacia. A particularly significant difference between the two groups was the plasma level of 25 hydroxycholecalciferol, which was lower in femoral neck fractures, and the urinary excretion of calcium, which was also more reduced in femoral neck fractures. A deficit of vitamin D hepatic metabolite thus appears to be a risk factor for femoral neck fractures in old patients.

Allergy to components of total hip arthroplasty before and after surgery.

Sensitivity to a series of haptens was studied in two groups of patients by means of patch tests. The first group was made up of 66 patients with total hip replacements, 12 of whom had aseptic loosening of the implant. The second group, which was used as a control, consisted of 41 patients scheduled to undergo total hip replacement. Ten patients (15.1%) in the first group tested positive; one of these had aseptic loosening. In the control group, two patients (4.8%) tested positive. The theory that an allergy may be the cause of loosening has a biologic foundation, but it can only be used to explain a few cases. However, since considerable vanadium sensitivity was found, we suggest that this material be used as little as possible in the manufacturing of prosthetic components.