Risk management of HBsAg or anti-HCV positive healthcare workers in hospital.

Recommendations are made for controlling the transmission of the hepatitis B and hepatitis C viruses from healthcare workers to patients. These recommendations were based both on the literature and on experts' opinions, obtained during a Consensus Conference. The quality of the published information and of the experts' opinions was classified into 6 levels, based on the source of the information. The recommendations can be summarised as follows: all healthcare workers must undergo hepatitis B virus vaccination and adopt the standard measures for infection control in hospitals; healthcare workers who directly perform invasive procedures must undergo serological testing and the evaluation of markers of viral infection. Those found to be positive for: 1) HBsAg and HBeAg, 2) HBsAg and hepatitis B virus DNA, or 3) anti-hepatitis C virus and hepatitis C virus RNA must abstain from directly performing invasive procedures; no other limitations in their activities are necessary. Infected healthcare workers are urged to inform their patients of their infectious status, although this is left to the discretion of the healthcare worker; whose privacy is guaranteed by law. If exposure to hepatitis B virus occurs, the healthcare worker must undergo prophylaxis with specific immunoglobulins, in addition to vaccination.

Clinical case: Spinocellular carcinoma of the hand. Oncological considerations and reconstructive surgery.

The authors present a case report of a nurse who worked from 1993 to 1996 in a Metabolic Radiotherapy Unit. Five years later she developed a SCC tumor on the base of IIIrd finger of right hand. The patient was operated in "Regina Elena Plastic Surgery Unit" of I.C.P. Hospital of Milan. A vein dorsal flap of the hand was performed after a radical excision of the skin tumour and excellent reconstructive and aesthetic results was obtained. The purpose of the present case report was to stimulate generals doctors, dermatologist, and plastic surgeons to carefully evaluate patients with cutaneous tumor, due to contamination of medical radiation dose during and after dispensing of radiopharmaceuticals.

[Experimental data on radiofrequency]. / Dati sperimentali sulle radiofrequenze.

Since 1996, there has been a flurry of scientific activity to evaluate the possibility that cellular telephone use may cause brain tumors, reflecting the rapid increase in the use of these phones throughout the world. Overall, the epidemiologic and laboratory studies to date have ruled out with a reasonable degree of certainty that cellular telephones cause cancer, at least for durations of use up to 5 years. RF signals from cellular telephones are not genotoxic and cannot directly damage DNA, and are thus unlikely to be in itiators; hence the risk of cancer from a thermal or non-thermal mechanism would be one that, if anything, promotes tumor growth. However, there is no convincing evidence from animal experiments or epidemiologic research that RF signals can promote tumor growth. If RF exposure is assumed to act by promoting the growth of an underlying lesion, then the large numbers of recent cellular phone users who have been studied are likely to have been sufficient to detect such an effect, but none has been found and there is no known biological mechanism that supports a causal relation and no evidence of adverse effects in laboratory animals.

[Sources of ionizing radiation in dwellings]. / Fonti di radiazioni ionizzanti nelle abitazioni.

According to recent surveys made by the International Commission on Radiological Protection (ICRP) and the World Health Organization (WHO), it has been estimated that in temperate regions people spend only 20% of their time outdoors and spend the remaining 80% indoors (homes, schools, other buildings). It is therefore important to establish whether radiation sources exist inside buildings in order to assess risk for the population. The 238U and 232Th radioactive chains are of particular importance because of Radon and Radon daughter production and 40K as component of building materials. It has been estimated that about 4.5% of lung cancers observed in the population are associated with exposure to Radon daughters. In order to comply with international regulations it is estimated that 1.5% of the existing dwellings in temperate regions need to be improved.

[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.

[Occupational exposure to volatile anesthetics and reproductive effects: a bibliographic review of epidemiological studies]. / Esposizione professionale ad anestetici volatili ed effetti riproduttivi: rassegna bibliografica degli studi epidemiologici.

Up to the early eighties, a variety of epidemiological studies suggest that chronic exposure to low doses of anesthetic gases, as occurs in operating rooms, is an occupational risk factor for spontaneous abortion and congenital defects. Numerous and more recent epidemiologic studies are reviewed; currently it is suggested that there is inadequate evidence to conclude that occupational exposure to anesthetic gases causes increased rates of spontaneous abortion or congenital anomalies. The improvement of environmental conditions, that has reduced airborne levels of anesthetic gases in operating rooms, has been critical in reducing the risk of abortion and congenital defects. In agreement with recent epidemiological reports, we believe that the health surveillance of exposed workers must include the study of pregnancy outcome.

[Proposal of environmental and biological monitoring and health surveillance of the exposed to inhalation anesthetics. Consensus. A Study Group on Occupational Exposure to Inhalation Anesthetics]. / Proposta per il monitoraggio ambientale e biologico e per la sorveglianza sanitaria degli esposti ad anestetici per inalazione. Consensus. Gruppo di studio sull'Esposizione Professionale ad Anestetici per Inalazione.

The Study Group on Occupational Exposure to Inhalation Anaesthetics of the Lombardy Association of Occupational Health and Industrial Hygiene prepared a document that was discussed during the Congress "Occupational Risks due to Inhalation Anaesthetics", held in Brescia, Italy, on May 12, 1992. The same document was then approved by the Directory Council of the Lombardy Association of Occupational Health and Industrial Hygiene. Data on environmental concentrations of Nitrous Oxide collected from 1989 to 1991 in 269 operating rooms of 47 hospitals in Lombardy are reported. The measured levels are considerably lower than those collected from the same Study Group from 1985 to 1987 in 111 operating rooms. The methodologies for exposure control are discussed, regarding both environmental and biological monitoring. These two techniques are complementary and can be used with standardized methods. The review of the literature on the early effects showed, even with some uncertainty at the current exposure levels, effects on liver and Central Nervous System. Still controversial are the data regarding the reproductive toxicity. Health surveillance programs have been organized in the last 5 years in 18 Lombardy hospitals and they indicate no cases of pathologies due to inhalation anesthetics on 1498 subjects. Operative proposals are suggested on the methodology and the frequency of environmental/biological monitoring and health surveillance. The "technical limit values" reported in the document from the Italian Ministry of Health are also discussed. Finally, research topics are suggested in order to assess the early effects of exposure.

[Health surveillance of workers]. / La sorveglianza sanitaria dei lavoratori.

The main purposes of the health surveillance of workers exposed to anaesthetic gases are: a) the finding of disorders either reliable to the exposure or incompatible with the activity in the operating theatre; b) the epidemiological evaluation of the late effects. Simple and rigorous methods to estimate the previous and the current risk are suggested. The main data to be collected during the medical examination are indicated. The registration of the data of the reproductive function by a protocol of recording is proposed. For the health surveillance of workers in Health Care Institution it's advisable to establish an interdisciplinary group, referring to a specialist on occupational medicine.

Lentes de contato e algumas ocupaçöes / Contact lenses and some occupations

Em algumas atividades, o uso de lentes de contato pode acarretar riscos. A adesäo a lente de partículas suspensas no ambiente ou a absorçäo de vapores irritantes pela estrutura porosa do metacrilato podem causar lesöes na córnea, que sofre hipoestesia local induzida pela própria lente. Em ambientes quentes e secos, em situaçöes de descompressäo brusca e durante o uso de capacetes com ventilaçäo forçada, poderá verificar-se adesäo da lente a córnea, formaçäo de bolhas gasosas entre a lente e a córnea ou desprendimento repentino das lentes, respectivamente. As radiaçöes infravermelhas, em particular, seletivamente absorvidas pelas lentes, podem elevar a temperatura das mesmas, provocando sua adesäo a córnea. A umidificaçäo das lentes antes da remoçäo previne possíveis alteraçöes epiteliais de importância. Essas alteraçöes, por outro lado, säo reversíveis, com a rápida regeneraçäo do epitelio. O uso oportuno de protetores filtrantes é recomendável para os trabalhadores expostos a raios infravermelhos ou arcos elétricos