Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletes.

BACKGROUND: Asthma is frequently found in athletes, often associated with rhinitis and allergy. AIM: To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes. SUBJECTS AND METHODS: Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects. RESULTS: Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic - nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics - nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values. CONCLUSIONS: Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes.

[Risk perception and self-assessment of exposure to antineoplastic agents in a group of nurses and pharmacists]. / Percezione del rischio ed autovalutazione dell'esposizione ad antiblastici in un gruppo di infermieri e farmacisti.

Many antineoplastic drugs have shown to be carcinogenic, teratogenic and mutagenic to humans and exposure and absorption have been showed to occur during the preparation and administration in health care practise. More recently, in many countries, national health authorities concern has been focused on promoting actions aimed to protect health of the personnel handling these drugs. The present study reports the results of a survey carried out through a questionnaire among the pharmacists and nurses working in the health care settings located in the province of Rome (Italy), with the aim to survey: occupational risk perception of health care workers; their confidence in the safety measures adopted in the work practice; their knowledge of risk factor and the kind of training received regarding these specific agents. Among the respondents, most of the pharmacists (80%) and nurses (90.4%) show a high concern about antineoplastic drugs dangerousness. At the same time, they state not to have a satisfactory level of knowledge regarding the risk factor and, also that their main information source on occupational risk connected to antineoplastic drugs exposure is not the health care structure, where they are employed. Besides, they do not show a high level of confidence in the safety measures adopted in the health care structures with the aim to protect workers' health. The study results suggest the necessity to promote the development of preventive actions aimed to minimise occupational exposure to these substances through the implementation of procedures and controls in the hospitals, as well as the use of work practice and protective equipment, reinforced by workers education and training.

Localized augmentation of the maxillary sinus floor through a coronal approach for the placement of implants.

Excessive pneumatization of the maxillary sinus subsequent to the loss of teeth frequently interferes with the placement of osseointegrated implants. Many techniques have been developed and tested to reduce the size and alter the anatomy of the sinus to augment the quantity of bone available for an adequate number of prosthetically well-placed implants of a satisfactory length. Most of these describe extensive one- or two-stage sinus grafting procedures that are usually performed through a lateral approach. A technique of localized elevation of the maxillary sinus floor through a less-invasive crestal approach is presented here. Ninety-seven implants were placed with this technique between 1991 and 1998. The healing was always uneventful, without any sign of pathologic reaction in the maxillary sinus. Eighty-six implants were successfully loaded for a period between 6 and 90 months (mean 35 months). Eight implants failed to integrate, and three were lost after different periods of function, for a cumulative success rate of 88.6%.

Reduction in fertility in male greenhouse workers exposed to pesticides.

The paper examines the possible interference of pesticide exposure on male fertility, by studying the time to pregnancy (TTP) in the first pregnancy of 127 greenhouse workers and 173 controls. The TTP of exposed and control population, analysed by logistic regression model, has shown an increase in the risk of conception delay among the greenhouse workers with high exposure (OR:2.4; 95% CI: 1.2-5.1).

[Occupational exposure and male fertility. Results of an Italian multicenter study in an exposed population]. / Esposizioni occupazionali e fertilità maschile. Risultati di uno studio italiano multicentrico tra popolazioni esposte.

It was believed that occupational exposure to several toxic agents could negatively affect male fertility. This paper reports the results of a study on the fertility of couples in whom the man was occupationally exposed to three different toxics: metals, solvents and pesticides, having effects on reproduction. Fertility was evaluated during the time that elapsed between attempting and achieving the first pregnancy of the couple (time to pregnancy--TTP). Exposure to occupational risks during the period preceding conception was defined on the basis of data collected from 153 workers of a mint (exposed to metal and solvents), 322 agricultural workers licensed to handle pesticides and 127 greenhouse workers. Comparing the groups exposed during the conception period with comparable non-exposed groups, we found a slight delay in conception among couples with male exposure to metals (OR = 1.3; 95% CI 0.5-3.6), to solvents (OR = 1.7; 95% CI 0.6-4.6) and to pesticides among greenhouse workers (OR = 1.6; 95% CI 0.8-3.1 for the moderately exposed and OR = 2.4; 95% CI 1.2-5.1 for the heavily exposed). No increase in the risk of conception delay was observed in agricultural workers with generic exposure to pesticides. The results of this study suggest that the workers exposed to metals and solvents and greenhouse workers exposed to pesticides experienced a delay in conception at the time of their wives' first pregnancy.

Reproductive male-mediated risk: spontaneous abortion among wives of pesticide applicators.

This study was conducted among 32 pesticide applicators occupationally exposed to pesticides to determine whether paternal exposure is associated with an increased risk of spontaneous abortion. The ratio of abortion was compared between applicators and a group of 51 food retailers (control population). The ratio of abortions/pregnancies for applicators was 0.27 and for retailers 0.07. OR for spontaneous abortion adjusted for age of wife and smoking of parents is 3.8 times greater than for the control population in the multiple logistic regression model and 7.6 times with interaction effects model.

Fertility of male workers of the italian mint.

Fertility among workers exposed to metal fumes and solvents in the Italian mint (stampers, founders, and other technical workers) was compared to the reproductive experience of the administrative staff. Data on the reproductive history and time to pregnancy were collected by interview. For workers with children, data on the time to pregnancy (TTP) for the first pregnancy was assessed in relation to occupational risk factors. The groups with the highest prevalence of pregnancy delay beyond 6 months were stampers (21%) and those exposed to solvents (21.5%). Logistic regression did not show a significant association of these job exposures with pregnancy delay, but the power of the study to show an important difference was low. The data are not inconsistent with the hypothesis that male exposure to solvents and metal fumes is associated with an increase in the TTP.

Orocecal transit time and bacterial overgrowth in patients with Crohn's disease.

Bacterial overgrowth is frequent in patients with Crohn's disease (CD) and can contribute to symptoms. Motility abnormalities can predispose to bacterial overgrowth. The hydrogen (H2) and methane (CH4) breath test is a sensitive and simple tool for the diagnosis of bacterial overgrowth and for the evaluation of orocecal transit time (OCTT). In this study, we investigated the prevalence of OCTT modifications and bacterial overgrowth in a series of consecutive adult patients with CD. In 43 healthy subjects and 67 patients with CD. we performed the lactulose breath test using a gas analyzer that offers the opportunity of measuring both H2 and CH4. Of the patients, 24 had undergone an ileocolic resection before the test with ablation of the ileocecal valve. At the time of the test 15 patients had active disease, whereas in 52 subjects the disease was quiescent. Fifty-seven patients and forty controls were evaluable for OCTT and bacterial overgrowth. In 10 patients and in 3 controls, no H2 or CH4 peak was recorded during the 8-hour test. Out of 57 patients, 13 (23%) were affected by bacterial overgrowth. The prevalence of bacterial overgrowth was higher in patients with previous surgery (30%) than in nonoperated patients (18%). In all patients with bacterial overgrowth, an antibiotic treatment induced a normalization of the test and an improvement of the symptoms. We observed a longer OCTT in the patients compared to controls, although this difference was not statistically significant (154 +/- 45 vs. 136 +/- 45 minutes). OCTT was significantly longer compared to controls in the 14 CD patients with previous ileocolic resection ( 180 +/- 53 vs. 136 + 45 minutes; p < 0.004). In conclusion, we found that a significant proportion of unselected patients with CD has bacterial overgrowth and prolongation of OCTT. We suggest that the modifications in OCTT in patients with CD can predispose to bacterial overgrowth. The lactulose breath test is a simple method that can be more widely used in patients with CD.

[Exposure to pesticides in greenhouses and male fertility]. / Esposizione a pesticidi in serra e fertilità maschile.

We attempt to study fertility problems among workers exposed to pesticides, comparing the reproductive experience of greenhouse workers and administrative staff working in the Health Local Units of the same geographical area (reference population). Data on reproductive history and time to pregnancy (TTP) at first pregnancy were collected by personal interview. For workers with children, we collected data on TTP in relation to the occupational risk factors. The analysis of TTP was conducted among 127 greenhouse and 173 administrative workers married and aged 20-55. The greenhouse workers reported 232 pregnancies and a mean number of 1.8 children; the controls 270 and 1.6 respectively. For greenhouse workers the mean TTP in months (5.4 with SD 5.6) resulted longer than for controls (3.9 with SD 5.6). The risk for conception delay (beyond 3 months) by exposure category of the man adjusted for age of woman, smoking of man and woman at first pregnancy resulted 2.4 higher for a subgroup of greenhouse workers with higher exposition (CI 95% 1.2-5.1).

Prevalence of HNPCC in a series of consecutive patients on the first endoscopic diagnosis of colorectal cancer: a multicenter study. The Italian Collaborative Group.

BACKGROUND AND STUDY AIMS: It is difficult to measure the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in geographical areas that do not have tumor registers, as is the case in the present study, and it was therefore decided to assess the prevalence in Italy using different methods. PATIENTS AND METHODS: The pedigree was established for 485 of 501 colorectal cancer patients diagnosed with colorectal carcinomas. Patients were included consecutively in 13 gastroenterology centers; they had not taken part in prevention examinations. Information was collected regarding the neoplastic pathology observed in the families, confirmed in 90% of cases among 3515 first-degree relatives and in 79.5% of cases among 7068 second-degree relatives. RESULTS: In the 3515 first-degree relatives (1002 parents, 1560 siblings and 953 children), 61 colorectal carcinomas, 29 carcinomas in the digestive tract outside the colon, and 99 carcinomas in other locations were reported. Only five of the 485 patients (1%) satisfied the Amsterdam criteria (three cancers, two of which were in first-degree relatives in different generations and one in a relative younger than 50). When broadening the criteria that we are proposing (satisfying only two of the three Amsterdam criteria), the prevalence would increase to 3% (15 cases). CONCLUSIONS: Modifying the criteria makes it easier to identify new mutations or confirm the existence of those already known, as well as allowing preventative treatment in relatives who are apparently healthy.

[Human reproduction and environmental risk factors]. / Riproduzione umana e fattori di rischio ambientale.

Environmental pollution is a great cause of concern, in particular, growing attention is being paid to the potential of many chemicals to affect the reproductive system in humans. The key role of prevention and control of reproductive hazards is recognized world-wide. Many chemicals have been shown to impair fertility and/or prenatal and perinatal development in experimental studies. However, a sufficient evidence of an effect on human reproduction is available for some compounds only. The use of biological markers may improve the assessment of exposure to chemicals, contribute to identify mechanisms of action and put into evidence early, reversible, biological effects. Valid biological markers are also needed in epidemiological studies: without reliable data on the level of current and past exposures it is difficult to establish a causal relationship between a pollutant and the occurrence of adverse health effects. A multidisciplinary approach to risk assessment is required. Priorities for interdisciplinary research on environmental chemicals and reproduction include the identification of susceptible population subgroups and risk assessment of exposure to multiple chemicals.

Association of persistent bronchial hyperresponsiveness with beta2-adrenoceptor (ADRB2) haplotypes. A population study.

Bronchial hyperresponsiveness (BHR) is a hallmark of asthma and represents a strong risk factor for the disease. However, not all asthmatics have BHR and it can be observed in normal subjects too, probably because of genetic predisposition. Increasing attention is being focused on the beta2-adrenoceptor gene (ADRB2), whose genetic variability at amino acids 16 and 27 has been shown to correlate with some clinical features of asthma, including airways reactivity. To verify whether ADRB2 gene polymorphisms can influence BHR at a broader level, we studied a large, highly homogeneous sample of individuals sharing race, gender, age, and current living environment. BHR was strictly defined as a constant positive response to serial methacholine challenge tests and an improved definition of genetic variability at the ADRB2 locus was used, by identifying the haplotypic combinations of polymorphisms 16 and 27. We observed that the ADRB2 haplotype with a Gly at position 16 and a Gln at position 27 is associated with BHR in our sample. The association persisted also after correction for potentially confounding variables such as specific and total IgE levels. This observation suggests therefore that ADRB2 gene can confer genetic susceptibility to BHR, rather than having only a disease-modifying effect in asthma.

Primary systemic amyloidosis with giant hepatomegaly and a swiftly progressive course.

Although the involvement of the liver is common in systemic amyloidosis (AL), clinical features of hepatic dysfunction and liver chemistry abnormalities are often mild or absent. A mild increase in the serum alkaline phosphatase value is the most common finding. Hypertransaminasemia, hyperbilirubinemia, and portal hypertension with ascites and gastroesophageal varices occur late in the course of the disease and predict a short survival. We describe the case of a 58-year-old woman with AL, whose dramatic and unusual clinical picture, consisting of giant hepatomegaly, hypertransaminasemia, increase in alkaline phosphatase, esophageal varices, and ascites, was rapidly complicated by severe obstructive cholestasis.

A database on pesticides in Italy: a progress report.

An existing database on pesticides, running in the DOS/Windows environment, is operative at the National Institute of Health and has yielded useful informations for several published researches. The database is currently being restructured for the purpose of making it available on the Web. An HTML interface, allowing to formulate queries on the database from the Web is presently under development, and it will be made available, once the problems related to confidentiality of certain parts of the database are solved. The database in its present form is presented and necessary changes foreseen in the Web edition are discussed.

[Agricultural antiparasitics evaluated for their potential cancerogenic, mutagenic and toxic reproductive effects]. / Antiparassitari agricoli valutati per potenziali effetti cancerogeni, mutageni E tossico-riproduttivi.

This paper reviews the evaluations of the potential carcinogenic, mutagenic and toxic-reproductive effects of the active ingredients and solvents contained in the pesticide products used in Italy. The information on the products (name and CAS number of the active ingredients and of the solvents, number of the products in which they are present, and the range of concentration percentages of a.i.) were obtained from the Pesticide Registry, a database operating at the Italian National Institute of Health since 1985. The evaluations of the toxic effects of these products are those which have been formulated by the Italian National Advisory Toxicological Committee, the European Union, the International Agency for Research on Cancer, and the Environmental Protection Agency of the United States. The aim of this study was to present an ample organic review of the main information issued by national and international centers on pesticides, chemicals of wide occupational use and diffusion in the environment. The presence is highlighted of some substances with carcinogenic potential (for example, 1,3-dichloropropene, alachlor, formaldehyde) for which it is therefore, necessary to carry out a careful risk assessment regarding exposure to many substances for which further study is indicated, and for others which have not, so far, produced toxic effects (bentazon, cypermetrin). Benzene "a proven human carcinogen" was present in three products. In addition, the presence was observed out of mixtures of active ingredients and solvents for which clear evidence of carcinogenic and/or reproductive toxicity exists. This information can be useful to assess the carcinogenic risk associated to pesticides in the occupationally exposed population, as also established in official regulations.

Malignant mesothelioma in thermoelectric power plant workers in Italy.

Asbestos has been widely used in Italian thermoelectric power plants and instances of exposure to workers have been documented in a variety of jobs. Preventive measures were put into effect only in the late 1970s. We report here on four mesothelioma cases among workers of three Italian power plants where cohort studies were carried out, and on three additional cases recorded by a systematic survey carried out on this neoplasm in Tuscany. When the data of the cohorts sources are merged, a significant excess of lung cancer is also evident. Even without a quantitative assessment of exposure, this report shows the importance of asbestos risk in thermal power plants. The risk appears not to be restricted to any particular category of workers.

Anophthalmia and benomyl in Italy: a multicenter study based on 940,615 newborns.

Following the report on clusters of anophthalmia and microphthalmia in England and Wales and their possible relation to the pesticide Benomyl, we analyzed the situation in Italy for the period 1986 to 1990 using data from the Italian registries of congenital malformations and national data on Benomyl use. Of 940,615 consecutive births, 33 cases of clinical anophthalmia and 78 cases of microphthalmia were reported (birth prevalence: 0.35 and 0.83/10,000). Birth prevalence by region for 18 of Italy's 20 political regions was evaluated for the two malformations, grouped together after exclusion of defects associated with chromosomal anomalies, no dishomogeneity in space or time among registries or among regions was observed for the study period. In no region was a statistically significant difference identified between observed and expected overall birth prevalence. Correlation analysis between the prevalence of micro/anophthalmia and Benomyl use by region showed a negative, nonsignificant coefficient, and an inverse correlation was found when the 18 regions were divided into four groups by increasing levels of Benomyl use. Parental occupation in agriculture did not seem to be associated with micro/anophthalmia when compared to a control group affected with isolated prearicular tags (odds ratio 0.63; CL 0.07-2.52). On the basis of these results, though the limits intrinsic to ecologic correlation studies must be taken into account, an association between Benomyl use and congenital micro/anophthalmia appears to be unlikely.

Mortality among workers of three thermoelectric power plants in northern Italy: a retrospective cohort study.

During the last ten years, interest has been focussed on occupational exposure in thermoelectric power plants (i.e., coal dust, polycyclic aromatic hydrocarbons, dioxin, dielectric liquids, PCB's, asbestos, etc.), although available evidence on its effects on the health status of the occupational population are far from being definitive. A retrospective cohort study was carried out to investigate the association between exposure to risk factors and mortality for cancer in three thermoelectric power plants located in the north-east of Italy. The three plants studied started with oil and coal but since 1968 they utilized mostly coal as fuel. In spite of the different fuel used at the beginning, the production process has been fairly constant since the main conversion from oil to coal with a substantial increase in power production. A total of 1,772 male workers were included in the total study cohort and followed-up from 1968 to 1987, with a total of 22,090 person-years of exposure. Eighty percent of the cohort began to work in the plant before 30 years of age, and had a mean period of employment of 9.5 years. The cohort was completely traced to the end of the follow-up period by using an original computer system based on personal fiscal codes. Causes of death were ascertained in the municipalities where the deaths occurred and coded according to the International Classification of Disease, IX Revision. During the study period 68 deaths were observed with an SMR for all causes of death equal to 0.79.(ABSTRACT TRUNCATED AT 250 WORDS)