[Return to work of the cardiac patient: work fitness evaluation in Occupational Medicine Division including an Occupational Cardiology Unit and Work-Physiology Lab in Bergamo]. / Unità Semplice di Cardiologia del Lavoro ed Ergometria degli Ospedali Riuniti di Bergamo: percorso per la valutazione dell'idoneità lavorativa del cardiopatico.

Cardiovascular disease in working age still represent a major cause of morbidity and account for a number of fitness to work certificates expressing several limitations and prescriptions. To present the medical assessment conducted in an Occupational Medicine Division including an Occupational Cardiology Unit and work-physiology lab. It is described the history and the structure of the Occupational Cardiology Unit. Our almost forty years long-lasting experience allow us to point out the precious contribution of the Occupational Cardiology Unit to the Occupational Medicine Division, due to a highly specialised and qualified assessment of cardiac patients.

[Syncope and work: role of the occupational physician and global risk stratification]. / Sincope e rischio lavorativo: ruolo del medico del lavoro e stratificazione globale del rischio.

Safety risk for subjects suffering from syncope while working has not been as yet addressed by occupational medicine. The present study was aimed at evaluating a new developed methodology for job tasks risk stratification in patients with syncope. During a work-shop on syncope and occupational risk, 149 occupational physicians (OP) with about 10 years of clinical experience were asked to fulfil a Visual Analogue Scale (VAS) concerning the doctor's estimated potential damage (D) to the worker and the probability of a damage to occur (P) should syncope take place during the job task. Five job tasks characterized by different risk for safety (1, driving; 2, toxic products handling; 3, job performed closed to hot surfaces o free flames; 4, surgical activity; 5, office job) were identified. OP correctly stratified the risk associated to the different job tasks in patients with syncope. Unexpectedly, task #3 was given a risk similar to that obtained in drivers. This might be of paramount clinical and social importance when patients with syncope have to return to their job tasks.

[Syncope and occupational risk survey: the role of continuing education and multidisciplinary approach]. / Indagine conoscitiva sulla percezione del problema sincope in relazione al rischio lavorativo nella pratica clinica: ruolo della formazione e dell'approccio multidisciplinare.

Syncope is a common disorder characterized most of the times by a positive clinical outcome. However, it may turn to a life threatening event even for working colleagues and third party when occurring during an high risk job. We have recently found that, out of 670 patients admitted to the Emergency Department (ED) for syncope, about 50% were potential workers, being their age between 18 and 65 years. Also, we found that in this group of patients syncope recurrence was as high as 11% at 6 months. It is unknown how physicians address the problem of the occupational risk in patients suffering from syncope and how occupational aspects are taken into account in the clinical judgment before work readmission. One hundred eighty five doctors (149 occupational physicians, OP), participating in a work-shop on syncope, were asked to fulfill a questionnaire about their clinical experience and their attention to the occupational aspects in patients after syncope. Despite long lasting clinical experience, 41% of OP did not scrutinize syncope as a relevant symptom in their daily activity. 65% of the other specialists were used to address the occupational risk aspects in their syncope patients. A multidisciplinary approach involving continuing education on safety at work might reduce work accidents due to syncope relapse and promote a safe and suitable re-employment of patients with syncope. scrutinize syncope as a relevant symptom in their daily activity. 65% of the other specialists were used to address the occupational risk aspects in their syncope patients. A multidisciplinary approach involving continuing education on safety at work might reduce work accidents due to syncope relapse and promote a safe and suitable re-employment of patients with syncope.

[Syncope and work. STePS study (Short Term Prognosis of Syncope)]. / La sincope in età lavorativa. Studio multicentrico prospettico STePS.

BACKGROUND: Recurrent syncope is a common medical problem responsible for 3-5% of emergency department (ED) accesses and 1-6% of hospital admissions. If syncope occurs in a subject working in a critical safety task, the consequences of this event might be very dangerous for the worker, colleagues, others or for the environment. Therefore, syncope management is a major problem for occupational medicine, converning the general safety at work. AIMS: To evaluate the syncope events in a group of potential workers aged 18 to 65 years; to evaluate the symptoms preceding syncope and the presence of associated illnesses and recurrent events. POPULATION AND RESULTS: This study is part of the prospective study STePS (Short Term Prognosis of Syncope), and included 305 consecutive patients (aged 18-65 years, female 56%) who had syncope as a main symptom and presented at ED of four general hospitals in the Milan area, Italy, between the 23rd of January and 30th of June 2004. The 24% of subjects were hospitalized. In 21% the syncope occurs suddenly without any preceding symptom. The 67% of subjects didn't have any important illness at the time. 50% of subjects had recurrent syncope. In four subjects another syncope occurred in a 10 day follow-up. CONCLUSIONS: occupational medicine should consider syncope scrupulously. Proper diagnostic management is important to permit a correct evaluation of work safety issues.

[Cardiovascular assessment in building activities using an ergospirometer]. / Valutazione dell'impegno cardio-vascolare in alcune attività di cantiere edile mediante l'impiego di un ergospirometro portatile.

We report preliminary results of a current study aimed to evaluated peak oxygen consumption and others cardiopulmonary exercise test parameters, in some common and tiring building activities, with the use of a portable ergospirometer stress test (Metamax 3B, Cortex Biophysik). We tested 3 Building School's Teachers of Seriate (Bergamo): the materials handling and transport of cement bricks and to dig with pick and shovel reaches peak anaerobic threshold into few minutes while the activity of make molter permits an aerobic metabolism in all building workers tested.

Modifications of cardiac autonomic profile associated with a shift schedule of work.

BACKGROUND: Shift work is associated with an increased rate of cardiovascular diseases and accidents. Discordance between circadian rhythms of stress-related biological variables and the work-sleep schedule might explain the reduced efficiency of work. It is not clear whether a shift schedule of work may induce similar discordance in the 24-hour oscillatory pattern of the cardiac autonomic control in respect to the work-sleep periods. METHODS AND RESULTS: Twenty-two healthy male blue-collar shift workers underwent 24-hour ECG recordings during each of the 3 different shifts (first, 6 AM to 2 PM; second, 2 to 10 PM; third, 10 PM to 6 AM). Spectral analysis of heart rate variability over 24 hours provided the normalized markers of cardiac sympathetic (LF(nu)) and vagal (HF(nu)) modulation of the sinoatrial node activity and of the sympathovagal balance (LF/HF). LF(nu) and LF/HF exhibited 24-hour oscillations with different times of maximum and minimum in accordance with the working and sleeping periods, respectively. Lower values of LF(nu) and LF/HF suggestive of a reduced cardiac sympathetic modulation were present when the job task was performed at night compared with the values observed when the work was performed during morning and evening. CONCLUSIONS: Continuous weekly changes of time of maximum and minimum in the cardiac sympathetic and vagal autonomic control may play a role in the excessive rate of cardiovascular diseases in shift workers. The reduced values of the indexes of cardiac sympathetic modulation during night work might be related to the presence of sleepiness or diminished alertness, which in turn could facilitate errors and accidents.

Susceptibility to hard metal lung disease is strongly associated with the presence of glutamate 69 in HLA-DP beta chain.

Clinical, epidemiological and experimental data indicate that inhaled metal dust containing cobalt may produce an interstitial lung disease termed "hard metal disease" (HMD). Some aspects of this pathology such as the lack of correlation with dose exposure, the low frequency of the disease and the presence of T cells in the inflammation site, all suggest the existence of a genetic susceptibility, possibly to an immunological response to cobalt or to self proteins modified by cobalt. Here we report that HMD is strongly associated with residue Glu-69 of the HLA-DP beta chain. All patients, except for one with a rare genotype, possessed this marker as compared to 17 out of 35 exposed unaffected individuals (p = 0.0014). These data allow us to genetically distinguish a subgroup of cobalt-exposed individuals at risk for HMD, independently from the more common allergic reaction.

[Repetitive movement of the upper limbs: results of exposure evaluation and clinical investigation in wood sanding in Bergamo]. / Movimenti ripetitivi degli arti superiori: risultati della valutazione dell'esposizione e dell'indagine clinica nella carteggiatura del legno nel bergamasco.

The authors report their findings regarding a risk assessment study and clinical tests carried out among a group of 121 workers whose job was to sandpaper and buff timber products. The results of the risk assessment indicate that the job in question is at significant risk for the development of WMSDs in relation to the principal risk factors (repetitiveness, force, posture, short recovery periods). The clinical tests, undertaken by medical staff, complied with the anamnestic models proposed by EPM. The results showed that 21 workers were above the anamnestic threshold, and were thus referred for specialist examinations. As a result of the latter, the relevant diagnoses were made. A positive correlation was reported between the occupational exposure level and the clinical abnormalities detected.

Colour vision loss in workers exposed to elemental mercury vapour.

We evaluated colour vision in 33 workers exposed to elemental mercury (Hg) vapour and in 33 referents matched for sex, age, alcohol consumption and cigarette smoking. The results were expressed as colour confusion index (CCI). In the workers urinary excretion of Hg (HgU) ranged from 28 to 287 micrograms/g creatinine. Subclinical colour vision loss, mainly in the blue-yellow range, was observed in the workers. This effect was related to exposure, as indicated by the correlation between HgU and CCI (r = 0.488, P < 0.01). In the workers whose HgU exceeded 50 micrograms/g creatinine, mean CCI was significantly increased compared to the matched referents. The results suggest that exposure to elemental Hg inducing HgU values exceeding 50 micrograms/g creatinine can induce a dose-related colour vision loss.

Cobalt myocardiopathy. A critical review of literature.

Cobalt is regarded as being responsible for a form of myocardiopathy whose pathogenesis and clinical description must still find a specific place in the range of congestive myocardiopathies. In spite of this, epidemiological studies are not sufficient to prove the role of cobalt in inducing myocardiopathy in hard metal workers. This critical review intends to evaluate if hard metal exposure may induce toxic effects on the heart. In this context, the literature considered ranges from pioneer reports on 'beer drinkers' to the more recent papers concerning cases of patients occupationally exposed; subjects who, after a surgical operation died of fulminant heart failure and, lastly, hard metal workers who were examined for their cardiac function. Various pathogenetic mechanisms related to possible cardiac effects in hard metal workers have been analyzed. The most likely should be the inhibition of cellular respiration due to inhibition of the mitochondrial dehydrogenase.

Cardiac function study in hard metal workers.

The induction of cardiac effects in hard metal workers is uncertain. This study investigates cardiac function of a group of 31 hard metal workers with or without pulmonary disease. The average duration of exposure to cobalt containing dusts was 10.4 years (range 1-30), while the environmental levels of cobalt exposure ranged from 0.09 to 13.6 mg/m3 Co. Cardiac function has been studied by: ECG (electrocardiogram), exercise test (ET), ECG 24 h according to Holter (ECGH), echocardiogram (ECHO) and radionuclide angiocardiography with 99Tc (RNA). The aims of this work were (i) to show the existence of cobalt myocardiopathy in the workers analyzed and, (ii) to find an early indicator of cardiac dysfunction which could be used in the clinical examination of hard metal workers. Within the group of patients with hard metal lung disease, cases of myocardiopathy of doubtful aetiology have been found. The cardiac indexes obtained through RNA show ventricular dysfunction in healthy hard metal workers which could be a manifestation of initial pulmonary artery hypertension or of an early occult cor pulmonale due to an unknown fibrotic lung disease.

Hard metal disease: eight workers with interstitial lung fibrosis due to cobalt exposure.

Eight hard metal workers exposed to cobalt containing dust (four producers of stone-cutting cobalt-diamond wheels and four grinders of hard metal tools) and affected by interstitial lung fibrosis have been examined. A close relationship between cobalt exposure and clinical findings was observed in six patients who were still working. The clinical picture ranged from minor symptoms to manifestations resembling those of hypersensitivity pneumonitis, with fever, weight-loss, non-productive cough and dyspnea. A restrictive impairment of the ventilatory function was prevalent. The chest roentgenogram of one patient showed a diffuse reticular nodular pattern, while the others presented a mild reticular accentuation of the interstitium. In five patients, bioptic specimens of the lung parenchyma showed interstitial collagenic fibrosis with inflammatory cells infiltrating the alveolar septa. An increased number of lymphocytes and polymorphs was reported in the bronchoalveolar lavage (BAL) fluid from seven patients. Giant multinucleated cells were present in the BAL of four subjects while an inversion of the helper-suppressor ratio was evident in those patients who were still exposed to cobalt when BAL was performed. In this study, the causal role of metallic cobalt inhalation in the etiology of the lung disease is examined and discussed.

The European Congress on Cobalt and Hard Metal Disease. Conclusions, highlights and need of future studies.

This article summarizes the present state of the art and some recommendations for solutions to problems identified by the European Congress on Cobalt and Hard Metal Disease on the basis of the papers and posters presented, as well as a round table discussion which produced several dominant questions and revealed areas of weakness and uncertainty. The round table discussion (chairman, Professor E. Capodaglio) focussed on the following aspects: (i) Monitoring (opinion leaders: R. Lauwerys, E. Sabbioni). (ii) Mechanisms of toxicity (opinion leaders: B. Nemery, N.L. Sprince, G. Scansetti). (iii) Health effects (opinion leaders: G. Nordberg, I.B. Andersen). (iv) Diagnosis/health surveillance (opinion leaders: G. Chiappino, S. Hernberg, S. Brown).

Occupational dermatitis from isothiazolinones in the nylon production.

Kathon is a biocide consisting of a mixture of two isothiazolinone derivatives (5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one) in an approximate ratio of 3:1, respectively, and with MgCl2 and Mg(NO3)2 present as stabilizers. The isothiazolinones are marketed under several brand names, and the concentration of the active ingredient varies according to their intended application. At a concentration of 3-15 ppm it shows activity against a wide spectrum of fungi, gram-positive and gram-negative bacteria. Contact allergy to it has been caused by cosmetics and also by products used in the pottery and various other industries. Recently we had the opportunity to observe 6 cases of occupational allergic contact dermatitis from an isothiazolinone mixture named Grotan TK 2 in a large textile industry producing nylon. An oil emulsion containing isothiazolinones is used in the spinning phase of the work cycle to prevent bacterial contamination that would damage yarn quality; furthermore, it helps to decrease the electrostatic charge that is produced by high speed at which the yarn moves and also to decrease the breakage possibility.

Study of lung reactions in six asymptomatic workers occupationally exposed to hard metal dusts.

The description of one case of pulmonary fibrosis in a group of workers occupationally exposed to hard metal dusts with high concentrations of cobalt (50-90%), followed for five years, prompted us to perform a cytological examination on the bronchoalveolar lavage fluid plus determination of the lymphocytic subpopulations in six asymptomatic workers with the longest exposure. Bronchoalveolar lavage performed 16 hours (3 cases) or 48 hours (3 cases) after the end of the workshift showed a lymphocytosis with inversion of the helper/suppressor ratio in 3 cases. This demonstrates an immune response at deep lung level. No difference was observed between a subject with ascertained interstitial fibrosis and the other subjects. Furthermore, bronchoscopy revealed marked inflammatory reaction of the tracheobronchial mucosa.

[Sanitary surveillance of workers occupationally exposed to volatile anesthetics: proposal for a computerized program for data collection and processing]. / Sorveglianza sanitaria dei lavoratori professionalmente esposti ad anestetici volatili: proposta di un programma computerizzato per la raccolta ed elaborazione dei dati.

The aim of this work is to present a computerized program for an epidemiological evaluation of the data relevant to workers occupationally exposed to anesthetic gases and of the related occupational risks. The great handiness, the speed of execution, the possibility of carrying out researches by mean of multiple variables correlation and the prompt availability of the data, are the distinguishing features of this program.

[Clinico-anamnestic survey in health professionals exposed to volatile anesthetics]. / Indagine clinico-anamnestica in operatori sanitari professionalmente esposti ad anestetici volatili.

The authors describe the results of a preliminary clinical survey of a group of 220 health workers, physicians and 151 nursing and auxiliary staff members of a large regional hospital in Lombardia, who are exposed to volatile anaesthetics. Contact dermatitis, varices of the legs and arthrosis, particularly that of the cervical and lumbar tract, are the most frequently reported disease in our population. In 75% of cases these disturbances arose after the beginning of the job working in the operating-theatres. When compared with a control group there was a statistically significant difference for contact dermatitis (p less than 0.01) and cervical tract arthrosis (p less than 0.02). The statistical comparison among the subjects exposed to the anaesthetics gases, who were stratified on the basis of the level of exposure and of seniority, confirms a higher prevalence of symptoms due to a reduction of alertness and of psychological and psychomotorial performances in the more exposed personnel. The comparison between female staff exposed and not-exposed to the gases did not show an increase of abortivity, while a statistically significant difference was evident between the female staff (either exposed or not-exposed) and the wives of male workers not exposed to the anaesthetics gases.

[Acute hepatonephritis in a subject occupationally exposed to chloroform]. / Epatonefrite acuta in soggetto professionalmente esposto a cloroformio.

We describe a case of acute hepatonephritis in a worker of a pharmaceutical factory, due to sporadic and short exposures to chloroform at levels even 70 times higher than its TLV.