Bronchial responsiveness to ultrasonic fog in occupational asthma due to toluene diisocyanate.

To determine the validity of ultrasonic nebulization of distilled water (UNDW, "fog") in comparison with methacholine challenge, in the assessment of toluene diisocyanate (TDI) asthma, we evaluated 75 subjects exposed to TDI with work-related respiratory symptoms. Subjects were submitted to bronchial challenge with methacholine at first, thereafter to UNDW inhalation and to specific challenge with TDI. The diagnosis of TDI-asthma was made in 30 of 75 patients (40 percent) who developed a bronchoconstrictive response to the specific challenge (reactors). Sensitivity and specificity of UNDW alone, methacholine alone, and of the combination of the two tests were determined with the results of the specific challenge with TDI as the "gold standard." Both frequency and severity of bronchoconstrictive response to UNDW (FEV1 decrease > or = 15 percent) and the degree (PD15 FEV1) and frequency of bronchial hyperresponsiveness to methacholine were significantly higher in TDI reactors than in nonreactors. The UNDW had higher specificity (82.2 percent vs 51.1 percent) but lower sensitivity (40 percent vs 76.7 percent) than methacholine. The combination in parallel (positivity of any of the two challenges) of methacholine and UNDW challenge did not change sensitivity to a great extent (80 percent vs 76.7 percent), whereas combination in series (positivity of both challenges) had considerably greater specificity (86.7 percent vs 51.1 percent) than methacholine alone. We conclude that in the assessment of TDI-asthma, the validity of UNDW challenge alone is limited since it is insufficiently sensitive. Instead, combining UNDW and methacholine challenge when methacholine is positive improves our ability in identifying subjects with TDI-asthma diagnosed with the specific challenge. This procedure constitutes a first objective confirmation of a suggestive history of TDI-asthma that is useful for clinical purposes. However, especially for medicolegal purposes, the definitive diagnosis requires the specific challenge.

Effects of lead on the visual system of occupationally exposed subjects.

A quantitative measurement of visual field in mesopic adaptation was performed for 35 workers occupationally exposed to lead and 35 referents matched for age, smoking, and alcohol consumption. The mean level (+/- SD) of lead in blood was 47 +/- 16 microgram/100 ml (2.25 +/- 0.77 mumol/l) [range 21-82 microgram/100 ml (1.01-3.94 mumol/l)]. In 10 exposed subjects a central scotoma was found that was not evidenced in any of the referents. A highly significant decrease in visual sensitivity was observed for the exposed subjects a central scotoma was found that was not evidenced in any of the referents. A highly significant decrease in visual sensitivity was observed for the exposed subjects. The results point to damage of central and peripheral optic nerve fibers. In the most severe cases, central vision is preferentially affected, and therefore the results are suggestive of subclinical optic neuropathy.

[Professional anamnesis and information: considerations on a clinical case]. / Anamnesi professionale ed informazione: considerazioni su un caso clinico.

Work history and information about risks represent two main instances in occupational medicine, the first one in order to formulate the diagnosis of occupational disease, the second one for the health education of workers. As far as this is concerned we describe the clinical case of a patient admitted for a cutaneous manifestation of suspected allergic nature. After a careful evaluation of the work related risk factors it turned out to be a cutaneous rash caused by exposure to dimethylformammide and concomitant consumption of alcohol. A correct information about substances used in the workplace and about subsequent hygienic rules would have avoided the appearance of the clinical manifestation and a useless admission.

[Alcoholism at the work setting]. / Alcolismo in ambito lavorativo.

Alcoholism is a nation-wide problem because of the variability and severity of its associated phenomena. In Western European countries, according to the WHO, the use of alcohol is the direct or indirect cause of approximately 20% of hospital admissions of male adults of working age. In Italy, the number of lost working days due to sickness is four times greater in drinkers, as is the risk of serious accidents. In addition, alcohol accounts for 5% of disability payments. In the authors' experience, alcohol abuse is a widespread problem in the work setting, however its social and medical impact is still underestimated.

[High resolution computerized tomography in the diagnosis of asbestosis]. / La tomografia computerizzata ad alta risoluzione nella diagnosi di asbestosi.

The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. Asbestos fibers exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. A considerable statistical agreement (Cohen K) was observed between radiographic and tomographic I.L.O. classes. In conclusion, high resolution chest tomography doesn't appear to be an indispensable test for the diagnosis in admitted subjects, but we underline its importance in the evaluation of pleural thickenings.

[High resolution computerized tomography in the diagnosis of silicosis and mixed dust pneumoconiosis]. / La tomografia computerizzata ad alta risoluzione nella diagnosi di silicosi e di pneumoconiosi da rischio misto.

The clinical observation, the work history, the analysis of pulmonary function tests and, mainly, the conventional x-ray chest radiograms have represented, til now, the diagnostic basis for pneumoconiosis (silicosis, mixed dust pneumoconiosis, asbestosis). Recently, the high resolution chest tomography (HRCT) has been introduced into the diagnostic procedures: such method seems to have its main application in the assessment of incipient clinical pictures of pneumoconiosis, particularly when characterized by normal pulmonary function tests. 75 silica- and mixed dust exposed workers were submitted to both radiologic methods. The great majority of them had already been recognized to be affected by asbestosis. The statistical analysis (Cohen K) showed a satisfactory agreement between radiographic and tomographic I.L.O. classes. However, high resolution tomography appeared to be more accurate in the assessment of less severe clinical pictures. In conclusion, we underline the importance of high resolution chest tomography in the evaluation of individual clinical cases, particularly when forensic problems are involved.

[Work and alcohol: considerations on a caseload of patients undergoing treatment]. / Lavoro e alcol: considerazioni su una casistica di pazienti in trattamento.

An enquiry into alcohol dependent subjects admitted to the clinical wards of the first section of Occupational Medicine belonging to Medicina Preventiva Occupazionale e di Comunità of University of Pavia for an alcohol disaddiction treatment has been performed through a phone interview. 289 patients have been contacted and time elapsed from admission to interview was one to three years. The questions focused alcohol abstinence, occupational position before and after admission, any improvement in the work sphere (relationship with the collegues), any feeling of empowerment of the work abilities and any increase in the responsibilities load. From our results we can conclude that alcohol disaddiction carried on during admission has positively contributed to the reinstatement of alcoholics patients.

[Thyroid function in bronchial asthma]. / Studio della funzionalità tiroidea nell'asma bronchiale.

The Authors report the results of an investigation on association between bronchial hyperreactivity to metacholine in asthmatic subjects and subclinical dysfunction of the thyroid gland. Although the T4 and free T3 values were higher in the control group than in asthmatic patients, all the hormone dosage results were within the normal range. These findings show that asthma is not associated with changes in thyroid function.

[Small cell carcinoma of the prostate. Description of a case]. / Carcinoma a piccole cellule della prostata. Descrizione di un caso.

The case of a 73-year-old man with metastatic small cell carcinoma (SCC) of the prostate is described. Seric neuron-specific enolase (NSE) was enhanced (75.4 ng/mL), while the prostate-specific antigen (PSA) was in the normal range. Therapy with etoposide and carboplatin induced a temporary partial remission, with fairly good quality of life and decrease of the NSE levels (down to 15.0 ng/mL). The patient died approximately 12 months after the initial diagnosis. The case confirms that prostatic SCC (a rare and very aggressive neoplasm) is usually diagnosed in an advanced stage. Treatment is problematic, however chemotherapy may prolong survival allowing, at least temporarly, an acceptable life quality. NSE measurement is useful to differentiate SCC from the more common adenocarcinoma (typically associated with elevated PSA values) and for follow-up.

[Acute alcoholic myopathy]. / Miopatia alcolica acuta.

A case of acute alcoholic myopathy in a subject with a 20 year history of alcohol abuse is described. The condition emerged during an episode of delirium tremens and had a quickly deadly outcome. The rapid evolution of the clinical situation accompanied by variation in the biohumoral indices (CPK, LDH, myoglobin) is stressed and although this prevented from obtaining anatomopathological samples of the rhabdomyolisis, the specific diagnosis was made with reasonable certainty. The onset of the condition was not foreseeable because of the absence of an accurate history of the subject's alcohol abuse on his admission and of significant biohumoral data indicating the existence of an alcohol correlated pathology.

[A follow-up study of 304 cases of suspected pathology caused by benzene seen in 1950-71]. / Studio a distanza di 304 casi di sospetta patologia da benzene osservati negli anni 1950-1971.

A group of 304 subjects admitted to the Institutes of Occupational Health of Milan and Pavia (Italy) between 1951 and 1970 for suspected benzene intoxication were retrieved from hospital records and their mortality experience was examined up to 31 December, 1986. The aims of the study were: 1) to estimate, in quantitative terms, the risk associated with benzene exposure in that area in the time period considered (these risks had already been reported, but merely as case reports); 2) to investigate the possibility of an increased frequency of neoplasms other than leukaemia; and 3) to further investigate the exposure history of these subjects. In the absence of data on the population at risk, mortality was analysed via the mortality odds ratio (MOR) method. A local population mortality experience was used as reference. Twenty-eight malignant neoplasms were observed (MOR = 2.2; 95% confidence interval = 1.3-3.7), 15 of which were haematologic neoplasms (MOR = 13.3; 95% confidence interval = 8.0-22.2). No odds ratio increases were observed for any of the other tumour sites or types. Eleven observed blood diseases represented a large numerical increase in the odds ratio. For all the haematologic neoplasms there had been an estimated exposure to airborne benzene concentrations above 20 ppm. However, no conclusions on dose-response relationships can be drawn from these data because of the approximate evaluation of individual exposure and, especially, because the study group most probably consisted of a highly selected sample of the exposed population.(ABSTRACT TRUNCATED AT 250 WORDS)