[Medical and risk records]. / La cartella sanitaria e di rischio.

Aim of this report is to outline the importance of personal medical records collected from the occupational health surveillance practice. The Italian law D.Lgs. 81/08 puts a great emphasis on a national information system built up by health monitoring results in workplace as far as individual and general prevention is concerned. Private and public roles and duties are discussed.

[Communication of chemical and carcinogen risk at refinery maintenance companies]. / Comunicazione del rischio chimico e cancerogeno nelle ditte di manutenzione in una raffineria.

This short paper reports a communication experience about chemical/carcinogen risk aimed to characterize and to document different occasions and several ways of exposure of the workers employed in maintenance companies in a petrochemical factory. We utilized different source of information: from risk assessment document (VR) of the petrochemical plant and from job sheets of the companies on contracts of maintenance. Working this way it has been possible to create a database which includes information about chemical agents, length and the way of exposure for every worker. This database allows to improve the level of knowledge of the Occupational Health Doctors, Professionals and of the workers, moreover it is useful to take note of quality and way of exposure in the VR document.

[Occupational health physician and risk assessment in workplaces]. / Il ruolo del medico competente nella valutazione del rischio.

The aim of this report is to analyse and discuss about professional duties of occupational health physicians dealing with risk assessment and health surveillance in workplaces. There are specific regulatory standards today regarding safety and health surveillance and protection of workers in occupational settings; on the other hand no clear recommendation exist, from the regulatory and practical point of view, in defining the specific tasks of a company doctor in risk assessment and management. Generally speaking safety professionals more often required by employers in risk assessment are industrial hygienists or safety and security technicians or engineers. The role of occupational physicians is almost confined to the practice of health surveillance. The paper highlights some specific circumstances in which occupational company doctors must be involved in risk assessment and management, it also describes their unique role in chemical and carcinogen hazard and risk assessment and management. Interactions between occupational health physician, workforce and employers are also underlined, because of their relevance from educational and social point of view, mainly in small and medium enterprises. In these particular workplaces the company doctor is often the unique safety professional directly implied in a good relationship with workforce and may have some opportunity in promoting safe behaviour related to job risks. Methods and occupational settings are described in order to promote and enhance the occupational health physician duties in workplaces, other than the health surveillance alone.

Oncogenic risk in a chemical plant: a methological approach and preliminary results.

One of the major problems that occupational medicine has to deal with is cancer risk assessment. Recent Italian legislation requires the evaluation of occupational exposure to carcinogens in all workplaces, but a standardized method to be used in the environmental and biological criteria is generally lacking. The objective of this report is to identify a multidisciplinary approach to the research on this topic. The study is based on a chemical plant that produces pitch. The multidisciplinary approach is based on risk- and health-damage assessments. Ethical aspects are also taken into account, and the research design incorporates an informed consent for all employees. Some preliminary results are available. From the environmental point of view, all parameters provide an airborne concentration value below threshold limit values (TLVs), but biological monitoring demonstrates an increased urinary excretion of 1-OH-pyrene in all tested subjects. In conclusion, the first objective of our study is to demonstrate the carcinogenic risk of employees, searching for an agreement between environmental analysis, biological monitoring, and health effect data. A close collaboration between different professions is necessary.

[Role of tobacco smoking in the determination of CO diffusion impairment in silicotic patients]. / Rôle du tabagisme dans la détermination des troubles de la diffusion du CO chez les silicotiques.

Alveolar-capillary diffusion of CO was evaluated in 48 silicotics with predominantly small irregular opacities at low profusion. The mean value of CO diffusion lay between 82 and 87% of the reference values, except for DLCOSS2 which was slightly reduced (74% of theoretical). There was no correlation between the functional data and duration of work but there was a significant reduction of the CO diffusion values according to smoking, which was greatest in those smoking more than 15 pack-years. Subjects with small irregular opacities presented lower values than those with small "p" or "q" opacities, but this difference was not apparent when only non-smokers were considered.

[Description of an accident in the Carrara marble mines]. / Descrizione di un caso di infortunio nelle cave di marmo di Carrara.

New technological systems introduced in marble quarries have increased production but also the risk of accidents among the workforce. A case of an unusual accident is described that occurred in the marble quarries of Carrara (Italy) which we believe will be of interest to occupational health professionals in view of its medical and legal implications.

Pregnancy and birth outcomes in women with facioscapulohumeral muscular dystrophy.

Obstetric risk in facioscapulohumeral muscular dystrophy (FSHD) is not known. We surveyed 38 women with FSHD reporting 105 gestations and 78 live births. Review of medical records showed that pregnancy outcomes were generally favorable. The rates for low birth weight and total operative deliveries were statistically higher than the national rates in the general population. Worsening of FSHD was reported in 24% of gestations and did not usually resolve after delivery.

[Hepatic lesions caused by industrial chemical substances. New perspectives on research]. / Il danno epatico da sostanze chimiche industriali. Alcune nuove prospettive di indagine.

Many industrial chemicals can be able to interfere with metabolic systems and to damage biological cycle of the cell. However the increasing use of MAC and TLV in occupational toxicology, has greatly reduced the incidence of acute effects; but the problem rose of chronic damage, toxic or carcinogenic, due to a long exposure to chemicals in low doses. The comprehension of functional and anatomical changes occupping in the liver can be of great help in investigation of pathogenetic mechanisms of such effects.

Bronchial asthma and dermatitis due to spiramycin in a chick breeder.

A case of bronchial asthma and dermatitis due to spiramycin is described in a non-atopic woman who worked as a chick breeder and handling poultry feed containing antibiotic or chemoterapic drugs including spiramycin, chlortetracycline and sulfadimethoxine. Patch tests showed a vigorous delayed reaction to spiramycin. Inhalation challenge test with the chick feed containing spiramycin reproduced symptoms of late asthmatic response (FEV1 fell by 14% and FEF25-75 by 25% within the 4th and 6th hour) with leucocytosis. No significant modification of FEV1 and FEF25-75 was observed within 24 hours after challenge with chick feeds containing other antibiotic or chemotherapeutic agents but not spiramycin. On leaving her job, the patient had no further skin reactions or bronchial asthma episodes. This case suggests that allergic reactions to a chemical product may involve both type III and IV hypersensitivity.

[Chronic bronchitis in a fire-proof material plant]. / La bronchite cronica in una industria di materiale refrattario.

The prevalence of chronic bronchitis has been evaluated in a group of refractory material workers. Diagnosis was made on the basis of symptoms, signs and functional and radiologic evidence of the typical changes of the disease. The relationship with age, length of working activity and cigarette smoking habit were also investigated. It can be concluded that, in the examined people, chronic bronchitis was better attributable to the working exposure to dust, than to the age or smoking habit.

[Exposure to lead in workers in highway toll booths]. / Esposizione al piombo nei lavoratori dei caselli autostradali.

200 workers of the pay-toll stations of a Tuscan motorway were examined for PbB, FEP and urinary delta-ALA. The mean value of PbB was 37 +/- mcg/100 ml R.B.C., but in 39 subjects (19.4%) it was over 50 mcg/100 ml R.B.C. FEP showed a mean value of 23.3 +/- 8.9 mcg/100 ml and in 8 subjects (4.4%) it exceeded 40 mcg/100 ml. Urinary delta-ALA was always in the normal range. There was a light difference in the mean value of PbB in comparison with a group of 50 normal subjects; no difference was found in FEP levels. The distribution of PbB and FEP values was also studied in workers and in non exposed subjects.

Follow-up study of patients with respiratory disease due to toluene diisocyanate (TDI).

The outcome of the respiratory symptoms, pulmonary function tests and bronchial hyperresponsiveness was studied in forty-seven workers with respiratory disease due to toluene diisocyanate (TDI) (twenty-seven asthmatic and twenty non-asthmatic subjects) after about 2 years from the first examination. Eight of twelve asthmatic subjects who left the industry after the first examination complained at the follow-up of dyspnoea and wheezing, but pulmonary function tests were unchanged; bronchial hyperresponsiveness decreased in three, but most were still positive to challenge test with bethanechol at the follow-up. Fifteen subjects who continued their exposure to TDI showed at the follow-up a significant decrease of the spirometric parameters and an increase of the bronchial hyperresponsiveness, and symptoms of chronic bronchitis were more frequent at the second examination. Non-asthmatic subjects, both exposed and non-exposed to TDI at the second examination, showed a significant decrease of the pulmonary function tests but no relevant changes in bronchial hyperresponsiveness. Our data suggest that stopping occupational exposure to TDI frequently did not produce an improvement of the TDI bronchial asthma, and persistence of the occupational exposure causes a more rapid decline in the respiratory function.

High-performance liquid chromatography for the quantitative determination of the urinary metabolites of toluene, xylene, and styrene.

A new high-pressure liquid chromatography (HPLC) method for simultaneous quantitative determination of the urinary metabolites of toluene, m-xylene, and styrene (hippuric acid, m-methylhippuric acid, phenylglyoxylic acid, mandelic acid) is described. The extraction procedure was performed on acidified urines, after addition of 4-hydroxybenzoic acid as internal standard, using a butylchloride/isopropanol mixture and drying 0.5 ml of the organic layer under nitrogen flow. The residue obtained was dissolved in 0.1 ml water/acetonitrile and 5 microliters were injected into an HPLC apparatus equipped with a 0.26 X 25 cm HC ODS SIL X column. Absorbance measures were performed at 225 nm throughout the investigation. All metabolites were clearly separated in a short time (12 min) and the amounts of other urinary compounds affecting the analysis were so small that the measurement of low concentrations of the urinary metabolites could be easily performed. Linear calibration curves were obtained from 0.1 to 3 mg/ml and a correlation coefficient greater than 0.99 was found between concentrations of the standards and areas of the peaks. Statistical analysis confirms that this method, which has a high reproducibility, is simple, reliable, and useful for the biologic monitoring of industrial exposure to aromatic compounds.

Bronchial asthma due to inhaled wood dust: Tanganyika aningré.

Three cases of bronchial asthma due to wood dust from Tanganyika anigré are reported. All patients were woodworkers and had symptoms of dyspnoea, cough and wheezing, and sometimes itchiness and rhinorrhoea, after exposure to Tanganyika aningré. The intradermal skin tests were positive for antigenic extract of Tanganyika aningré. In two patients the bronchial provocation test with the wood dust and with the soluble extract inhaled by aerosol was positive showing an immediate reaction; in the same patients bronchial hyperreactivity was also found. Atopy was present in one subject. No precipitins or specific IgE were found in patient sera by the immunodiffusion technique or by RAST.

Absence of IgG antibodies to TDI-HSA in a radioimmunological study.

Sera of ninety-one workers with respiratory symptoms related to occupational exposure to toluene diisocyanate (TDI) were tested by a solid phase radioimmunoassay using polyvinyl plates, in an attempt to demonstrate specific IgG antibodies to a conjugate of TDI with human serum albumin (TDI-HSA). Different conjugates were prepared. In our radioimmunoassay a TDI-HSA 1600 (1600 micrograms TDI/mg HSA), obtained at alkaline pH with borate buffer, was used; this conjugate was immunologically reactive and did not contain protein macro-aggregates. No difference in percent of binding of radiolabelled anti-human IgG to TDI-HSA coated on plastic plates was found between exposed workers (asthmatic and non-asthmatic) and fifteen normal subjects. This may suggest that either TDI-induced bronchial asthma is not mediated by IgG antibodies, or TDI-HSA conjugate is unsuitable to be detected by anti-isocyanate IgG.