Personal solar ultraviolet radiation dosimetry in an occupational setting across Europe.

BACKGROUND: Work-related solar ultraviolet radiation (UVR) is an important factor in the pathogenesis of non-melanoma skin cancer (NMSC). The World Health Organization, through the International Agency for Research on Cancer, has classified solar UVR as a group 1 carcinogen since 2012. The main problems encountered so far in the study of occupationally induced skin cancer include the lack of accurate occupational UVR dosimetry as well as insufficient distinction between occupational and leisure UVR exposure and underreporting of NMSC. OBJECTIVES: The aim of this study was to collect long-term individual UVR measurements in outdoor workers across European countries. METHODS: A prospective study was initiated through the European Academy of Dermatology and Venereology, Healthy Skin@Work Campaign, measuring UVR exposure doses at occupational settings of masons from five European countries. Measurements were performed for several consecutive months using the GENESIS-UV measurement system. RESULTS: The results identified alarming UVR exposure data. Average daily UVR doses ranged 148.40-680.48 J/m2 in Romania, 342.4-640.8 J/m2 in Italy, 165.5-466.2 J/m2 in Croatia, 41.8-473.8 J/m2 in Denmark and 88.15-400.22 J/m2 in Germany. Results showed an expected latitude dependence with increasing UVR yearly dosage from the north to the south of Europe. CONCLUSIONS: This study shows that outdoor workers from EU countries included in this study are exposed to high levels of occupational solar UVR, vastly exceeding the occupational exposure limits for solar UVR exposure, considered to be 1-1.33 SED/day in the period from May to September. This finding may serve as an evidence-based recommendation to authorities on implementing occupational skin cancer prevention strategies.

The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation.

STUDY DESIGN: Prospective study. OBJECTIVES: The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH4) production and orocecal transit time (OCTT) in children affected by myelomeningocele. SETTING: This study was conducted at the Catholic University in Rome, Italy. METHODS: Eighteen (6M/12F; 16.4±7.6 years) children affected by myelomeningocele were enrolled. All subjects underwent H2/CH4 lactulose breath tests to assess SIBO and OCTT. All patients performed a visual analog scale to investigate abdominal pain, bloating and flatulence, and maintained a diary of the frequency and consistency of the stool during the previous 7 days. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed. RESULTS: Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. Moreover 44.4% (8/18) produced high levels of CH4. Interestingly, all myelomeningocele children who produced CH4 showed a delayed OCTT and a higher incidence of UTI, with a lower frequency of evacuation, compared with those with a normal or accelerated OCTT. CONCLUSION: The association between CH4 and constipation suggests that CH4 has an active role in the development of constipation. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH4, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.

[Immediate radical re-resection of incidental T1b  gallbladder cancer and the problem of an adequate extent of resection (results of the German Registry "Incidental Gallbladder Cancer")]. / Die unmittelbare radikale Re-Operation bei inzidentellem T1b-Gallenblasenkarzinom und die Frage der angemessenen Radikalität (CAES / CAMIC-Zentralregister: "Okkultes Gallenblasenkarzinom").

INTRODUCTION: Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the other 70 % of cases are discovered incidentally by the pathologist (incidental or occult gallbladder cancer or IGBC). If gallbladder cancer is suspected preoperatively, an open cholecystectomy must be performed. The increasing rate of cholecystectomies via laparoscopy has lad to the detection of more gallbladder cancers in an early stage. Extended resection with regional lymph node dissection for T2 carcinomas and for more advanced cancer has been suggested. If IGBC is detected postoperatively by the pathologist after simple cholecystectomy, radical re-resection in cases of T2 tumours and more advanced stages is recommended. However, it has been argued that T1b cancers may have spread regionally or systemically at presentation and, thus, it remains debatable whether T1b cancers should be treated by simple cholecystectomy or by radical resection. PATIENTS / MATERIAL AND METHOD: This investigation was based on the German Registry of "Incidental Gallbladder Cancer" of the German Society of Surgery. In the present study, we evaluated whether T1 carcinoma patients do profit from a radical re-resection and if the different techniques of liver resection have comparable results in T1 carcinomas. RESULTS: We analysed 684 cases of IGBC including 124 patients with T1 cancer with a 5-year survival of 48 %. An extended re-resection increased the 5-year survival up to 68 % for T1-IGBC. The analysis shows no advantage for re-resection of T1a cancer. In contrast, the current analysis shows a statistically significant survival benefit for re-resection of T1b cancers from 34 % to 75 %. The Registry data show a trend of better survival for the patients treated with the wedge resection technique compared to other resection techniques. CONCLUSION: For T1a cancer a simple cholecystectomy is sufficient. An immediate re-resection is highly recommended for patients with IGBC in T1b stage. The wedge resection technique combined with a locoregional lymphadenectomy of the hepatoduodenal ligament seems to be the strategy of choice for T1b cancer. An extended re-resection is necessary to determine the nodal status exactly, and to determine an exact definite staging for patients with T1b cancer.

Treatment of pressure sores in spina bifida patients with calcium alginate and foam dressings.

STUDY DESIGN: Prospective study on local treatment of pressure sores using calcium alginate and foam dressings in spina bifida patients. OBJECTIVE: Investigate if this sequential approach is valid and safe for selected patients with neurological impairments. MATERIALS AND METHODS: Using European Pressure Ulcer Grading System, after clinical evaluation of local sore, selected patients of Spina Bifida Center of Rome were treated with sequential calcium alginate and foam dressings for 12 weeks. Pressure ulcere surfaces were measured monthly by ulcer tracing. The endpoints were the mean absolute areas surface reduction during every month and number of patients achieving a 50% or more during study. RESULTS: 14 patients (7 males aged 12-24 years) with spina bifida and pressure sores were treated. Mean and standard deviation of mean surface area reduction were 12.5 ± 7.5 cm 2 at start of the study versus 3.7 ± 5.2 cm 2 after 12 weeks, p < 0.001. 75% of the patients reached mean surface area reduction of 50% during trial. Dressing tolerance was good in every patient. CONCLUSIONS: Calcium alginate and foam dressings are valid and safe approach in the treatment of pressure sores in selected patients with spina bifida. In fact, they protect the wound and create an environment favorable to healing.

Post-natal ultrasound morpho-dynamic evaluation of mild fetal hydronephrosis: a new management.

BACKGROUND: Fetal hydronephrosis is the most common anomaly detected on antenatal ultrasound examination, affecting 1-5% pregnancies. AIM: A new management in mild antenatal renal pelvis dilatation (ARPD), using a technique based on both morphological and dynamical evaluation. MATERIALS AND METHODS: Prospective study conducted during a 36-months period in 180 consecutive newborns referred as having mild ARPD. Examinations consisted in a morphological ultra-sound (US) scan evaluating antero-posterior diameter, renal parenchyma, ureteral evidence and pelvis morphology and, subsequently, a dynamic evaluation to analyze any change of the urinary tract during bladder voiding. All children were evaluated both at 3rd day and 1 month after birth. They were divided among those with negative examinations and those with at least one positive scan, trying to discriminate within the latter, children suspected for transient pyelectasis from those suspected for organic pathology. RESULTS: 108 patients had normal US findings both at birth and at 1 month. The remaining 72 babies had at least one abnormal US examination: 54 were suspected for transient pyelectasis, while 18 suspected for organic pathology. At the end of the study, 61 babies (33.9%) had final diagnosis of transient pyelectasis and 11 cases (6.1%) of organic pathology. At one month the dynamic pattern of US findings had the highest negative predictive value, while renal parenchyma evaluation has the highest accuracy. CONCLUSIONS: a dynamic US approach allowed to better select among infants suspected for transient pyelectasis from those suspected for organic pathology, avoiding unnecessary and invasive examinations in healthy babies.

[Prevention of occupational dermatitis in an international perspective]. / La prevenzione delle dermatiti occupazionali in una prospettiva internazionale.

Occupational dermatitis (OD) have always been a significant part of the occupational disease with huge social and economic costs. Traditionally, the standard program of OD prevention takes place in the three phases of protection, cleansing and use of emollient creams and other products able to improve the cutaneous trophism (skincare) at the end of the shiftwork. However, in countries like Germany where protection measures and skincare were widespread, there was not a simultaneous decrease in the OD. In recent years pilot programs for the prevention of OD have been implemented with positive results. In particular the integrated approach that includes three steps of primary, secondary and tertiary prevention (Osnabrueck model) is of great interest. Primary prevention is represented by introduction of technical regulations, pre-employment counselling and specific initiatives to promote health (healthy skin campaign). In the case of initial/minor OD, secondary prevention is accomplished through the dermatological treatment of the patient and 1-2 days outpatient education initiatives/skin protection training. In severe cases of individual OD, tertiary prevention involves the hospitalization of the patient in a dermatology department. In 2009 the European network EPOS (European Initiative for the Prevention of Occupational Skin Diseases) of preventive dermatology has been organized basing on the integrated approach of primary, secondary and tertiary prevention.

[Dose and effect biomarkers in the diagnosis of asbestos-related diseases and health surveillance of exposed workers]. / Gli indicatori biologici di dose ed effetto nella diagnostica delle patologie asbesto-correlate e nella sorveglianza sanitaria degli ex-esposti.

The aim of the study was to assess the reliability of the indicators of dose and effect in the health monitoring of asbestos exposed workers. In 49 cases out of 158 studied workers (31%) asbestos-related diseases were diagnosed following ATS criteria (2004). Using nonparametric statistical methods (permutation tests) 6 variables were analyzed with respect to asbestos-related diseases and working sectors, demonstrating a difference in the concentration of amphiboles (p < 0.01), greater in patients with asbestosis and workers involved in asbestos removal from railway carriages. There was not a correlation between mesothelin and amphiboles, chrysotile and total fibers concentrations (Spearman test).

Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial.

PURPOSE: Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period. METHODS: Patients presenting with a symptomatic sigmoid diverticular disease stage II/III (Stock/Hansen) were randomly allocated to LSR or OSR in a prospective multicenter trial. Endpoints included the quality of life assessed with a standardized questionnaire, postoperative mortality, and complications within the follow-up of 12 months after operation. RESULTS: A total of 143 patients randomized between 2005 and 2008 in 12 centers could be analyzed. The recruitment was aborted for nonachievement of the planned sample size. Seventy-five patients were allocated to LSR, and 68 received OSR. Nine operations were converted to OSR (9%) and analyzed as intention to treat. Groups were comparable for age, gender, body mass index, comorbidity, and indication for surgery. Operation time was longer for LSR (p < 0.001). Quality of life did not differ between LSR and OSR, either during the early postoperative course or after 12 months (p = 0.172). Also, mortality and morbidity, including subgroups of major and minor morbidity, were compared. CONCLUSION: LSR was not superior to OSR regarding postoperative quality of life and incidence of complications in this trial.

Polycyclic Aromatic Hydrocarbons Exposure Assessment in a Refractory Brick Production.

In a refractory brick manufacturing company a qualitative and quantitative determination of the sources of occupational exposure to polycyclic aromatic hydrocarbons (PAHs) was obtained in order to validate targeted hygiene measurements. The study included the assessment of PAHs contamination of work surfaces by wipe-sampling, cutaneous exposure by hand washing, contamination of personal protective equipments (gloves) by extraction in solvent, and airborne PAHs concentration in atmospheric samples. Biomonitoring was also carried out by measurement of urinary 1-hydroxypyrene (1-OHPU) in three groups of workers (packaging, production, and controls). The surface contamination sampling was performed in production, packaging, and in other departments (external area) in theory less contaminated by PAHs. Two different areas were identified within the production, one included surfaces that were regularly cleaned (A area) and one included data from non-cleaned surfaces (B area). To confirm the source of exposure, a clear correspondence was observed between the percentage of the single compounds in the binder and those measured in wipes and air samples. As far as the wipes are concerned, the concentrations of phenanthrene, anthracene, fluoranthene, pyrene, benzo(a)pyrene (BaP), and the total PAHs mixture were higher in the B area than the A area of production. The same happened between the A area and the other two departments. According to results of the statistical analysis, these differences were significant. These results were confirmed by the hand washing data and the analysis of PPE. On the other hand, a marked difference does not exist between the packaging department and the external area. In air samples, the differences were much less evident with only higher concentrations of anthracene and total PAHs between production as a whole and the other two departments. Biological monitoring showed 1-OHPU values significantly higher in production workers than in packaging workers. In conclusion, the analysis of the wipes demonstrated that the production B area has a higher surface contamination compared to the production A area and the packaging department. In the absence of a significant difference in air concentrations of PAHs between A and B areas, this is attributable to surfaces not subject to cleaning. Results confirm that the measurement of surface contamination represents a valid tool for the assessment of sources of exposure to PAHs in the workplace.

Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry.

BACKGROUND: Incidental gallbladder carcinoma (IGBC) is a carcinoma first detected by the pathologist. The indication for cholecystectomy is a benign disease. The indication for immediate re-resection (IRR) in the case of T1b incidental gallbladder carcinoma (IGBC) is debated in the literature, and different recommendations often are drawn on the basis of data collected from only small groups. However, the management of IGBC is difficult because no guidelines have been established. This study aimed to determine whether T1b IGBC actually benefits from an IRR. METHODS: A registry was founded in 1997 for prospective recording of all IGBCs in Germany. All the patients who had a re-resection in this study were treated according to the effective guidelines in Germany. This study analyzes 502 cases of IGBC. Kaplan-Meier curves were used to determine whether an IRR improves the survival of patients with T1 and T1b IGBC. RESULTS: No benefit was found for 5 of the 21 T1a patients who had an IRR, but 23 of the 72 T1b patients who had an IRR experienced a significant benefit. The rate of tumor recurrence was three times lower in the T1b group that underwent IRR. CONCLUSION: An IRR should be highly recommended for patients with IGBC in the T1b stage.

[Estimate of the previous exposure to asbestos through mineralogical examination of the bronchoalveolar lavage (BAL) fluid in a population working in a sugar industry]. / Stima della pregressa esposizione ad asbesto mediante esame mineralogico del liquido di lavaggio broncoalveolare in una popolazione di lavoratori di uno zuccherificio.

In this study the past professional exposure and the health state of sugar refinery workers in Arezzo (Italy) are reviewed. The medical examinations, confirmed by chest CT, showed asbestos pleural thickening and one asbestosis case. Mineralogical analysis of bronchoalveolar lavage fluid (BALF) was carried out in this population to measure the pulmonary burden. Total fiber's concentration was not different in either subjects with or without asbestos-related disease. Notably, comparison between total fiber's concentration in sugar refinery workers and subjects employed in other industries, revealed a lower professional exposure of the former with respect to shipyard workers and electric plants. In other groups of Italian sugar refinery workers, a concentration of asbestos fibers higher than in the studied population was found. Thus, the study highlights the necessity to develop standardized methodologies to carry out health intervention programmes in workers previously exposed to asbestos.

Does laparoscopy worsen the prognosis for incidental gallbladder cancer?

BACKGROUND: More than 75% of cholecystectomies are done laparoscopically and less than one-third of gallbladder carcinomas are known presurgically. It is supposed that the laparoscopic technique could adversely affect the prognosis of gallbladder cancer. METHODS: The C-A-E has started a register of all cases of cholecystectomy with a postoperative incidental finding of gallbladder carcinoma. The aim is to compare the prospectively collected follow-up data on the outcome of these patients and to answer the question of whether laparoscopic cholecystectomy affects the prognosis of incidental gallbladder cancer. RESULTS: A total of 377 cases have been recorded so far. These include 201 patients treated by the laparoscopic procedure, 119 by an open procedure, and 57 by an intraoperative conversion. The survival shows a significantly better life expectancy for the patients treated laparoscopically. CONCLUSION: The life expectancy is higher for the laparoscopically treated patients and this cannot be explained by the fact that the laparoscopic technique is used to treat the earlier stages of cancer. The access technique does not seem to influence the prognosis for gallbladder carcinomas.

Carbon dioxide pneumoperitoneum is associated with increased liver metastases in a rat model.

BACKGROUND: In patients with primary colorectal cancer, liver metastases are the most important indicators of prognosis and survival; the effect of laparoscopic surgery on the development of hepatic tumor spread is still largely unknown. METHODS: Thirty WAG/Rij rats were randomly divided into 3 operative groups for intraportal tumor cell inoculation: carbon dioxide pneumoperitoneum (group I, n = 10), gasless laparoscopy (group II, n = 10) and open laparotomy (group III, n = 10). The total operating time was 90 minutes with tumor cell injection (50,000 CC531 colon carcinoma cells/mL) performed 45 minutes after the start of the procedure. Hepatic tumor growth and the total tumor load were evaluated 28 days after surgery. RESULTS: Hepatic tumor growth and total tumor load were significantly reduced in the gasless laparoscopy group (group II) as compared with the carbon dioxide pneumoperitoneum group (group I) and the open laparotomy group (group III) (P < .05). No significant difference was found between the carbon dioxide and the open laparotomy groups. CONCLUSIONS: Insufflation of carbon dioxide may actually stimulate metastatic disease of the liver. Gasless laparoscopy seems to preserve hepatic resistance against tumor growth.

[Endoscopic palliative tube and laser therapy in advanced cancer of the esophagus and cardia]. / Endoskopisch-palliative Tubus- und Laser-Therapie bei fortgeschrittenem Carcinom von Oesophagus und Kardia.

The treatment of patients with advanced carcinomas of esophagus and gastric cardia endoscopic palliation should restore the passage for normal oral uptake. We compared the results of two methods: endoscopic neodym-YAG-laser-therapy (group I: 24 patients) and endoscopic perturbation (group II: 56 patients). An initial recanalisation was achieved after 1-4 sessions in group I and after 1-2 sessions in group II. Recurrence of dysphagia caused in median 5 endoscopic interventions in group I and 2 in group II. We observed no complications in group I and 5 complications in group II. The median survival times were not significantly different. The results and the follow-up show no definite superiority of one of the two methods, the selection of treatment modality depends on the technical possibilities and the personal experience of the physicians.

["Routine" versus "on demand" ultrasonography in the surgical intensive care patient. A prospective randomized study]. / "Routine"-versus "On-demand"-Sonographie des chirurgischen Intensivpatienten. Eine prospektive randomisierte Untersuchung.

Between May 1988 und March 1989 all patients who underwent elective or emergency surgery followed by intensive care were randomly assigned to group A (n = 149): routine sonography at the postoperative day 1, 3, 7 and 9, group B (n = 151): sonography on demand. In these two groups, the following parameters were compared: number of relaparotomies, lethality of relaparotomies, total lethality, moment of relaparotomy, period of hospitalisation, time spent with sonography. In the analyzed parameters, our examination showed no difference between the two groups. For this we state that the routine sonographical control of the surgical patient with intensive care being opposed to the sonography on demand shows no significant advantage. The demand for a routine sonography as a postoperative control can not be generally supported.

[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"]. / Primär offene Therapie der akuten nekrotisierenden Pankreatitis durch das "offene Abdomem".

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.

[Potentially dangerous moments in use of esophageal balloon tamponade. 4 case reports with critical analysis of the literature]. / Potentielle Gefahrenmomente bei der Verwendung der Oesophagusballontamponade. 4 Fallbeschreibungen mit kritischer Analyse der Literatur.

In general, balloon tamponade is still part of the therapy of bleeding esophageal varices, despite effective sclerotherapy. Four case reports demonstrate that the application of balloon tamponade may be associated with severe complications. Moreover, a critical analysis of the literature shows a very different handling with respect to volume of gastric balloon, duration of blockade and traction to the tube. To prevent serious side effects, a safe way is described in detail when using balloon tamponade.

[Invagination of the small intestine due to leiomyoma. A case report of echographic diagnosis]. / Invaginazione del tenue da leiomioma. Descrizione di un caso di diagnosi ecografica.

The authors describe a case of intestinal invagination caused by leiomyoma of the small intestine. They make the diagnostic difficulties of the disease apparent and stress the importance of abdominal echography in cases of acute abdominal disorders.

[Incidental T1b-T3 gallbladder carcinoma. Extended cholecystectomy as an underestimated prognostic factor-results of the German registry]. / Inzidentelle T1b- bis T3-Gallenblasenkarzinome. Die radikale Cholezystektomie als unterschätzter Prognosefaktor - Ergebnisse des CAES/CAMIC-Zentralregisters.

BACKGROUND: The immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is debated in the literature. The German S3 guidelines recommend IRR in T2 and more advanced stages. Current literature recommends more extensive surgery even in T1b tumors. METHODS: The German registry database was used for this study. RESULTS: To date 883 cases of IGBC have been analyzed. In 8 out of 39 patients with a T1a tumor IRR was carried out as well as in 43 out of 109 patients with a T1b tumor. There was a significant survival benefit for re-resected T1b patients. There was also a significant survival benefit for the 215 T2 tumors and the 75 T3 patients with IRR compared to the 441 T2 tumors and 207 T3 tumors without IRR. Comparison of liver resection techniques showed good results for the wedge resection technique in T1b and T2 carcinomas. For T3 carcinomas more radical techniques showed better results. Less than 50 % of T2-3 tumors in the registry have been re-resection. CONCLUSIONS: The IRR should be highly recommended in patients with T1b and more advanced IGBC. The wedge resection technique is an attractive procedure for T1b and T2 IGBC due to the lower invasiveness in spite of oncological adequacy.

Nerve Growth Factor (NGF) up-regulation in the cerebrospinal fluid of newborns with myelomeningocele.

BACKGROUND: Neurotrophic factors, such as Nerve Growth Factor (NGF), play a key role in the stimulation of sprouting, synaptic plasticity, and reorganization after spinal cord damage. AIM: The aim of this study was to investigate the expression of nerve growth factor (NGF) in the cerebrospinal fluid (CSF) of newborns with myelomeningocele (MMC) and to determine its correlation with this spinal malformation. PATIENTS AND METHODS: To measure the expression of NGF, we collected CSF samples of 14 newborns with MMC taken immediately before the neurosurgical correction of the spinal malformation and of 14 matched controls. Endogenous NGF levels were quantified using a two-site immuno-enzymatic assay. The statistical analysis was performed using the Mann-Whitney two-tailed two-sample test. RESULTS: In the CSF of patients with MMC, NGF levels showed a significant increase compared to the mean levels of the control group (63.05 ± 7.3 vs 18.32 ± 4.5 pg/mL; (p < 0.001). No correlation was found between NGF expression and different types of MMC malformation, such as the level of spinal lesion and the association with Chiari II syndrome. CONCLUSIONS: Our study shows an over-expression of NGF in the CSF of newborns with MMC. The observed pattern of NGF up-regulation in this subset of patients may stimulate axonal sprouting and synaptic reorganization of the damaged neural cells at the site of spinal cord injury, thereby representing an important biochemical marker of spinal cord damage in MMC patients.