Automated tru-cut imaging-guided core needle biopsy of canine orbital neoplasia. A prospective feasibility study.

The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single centre. A complete ophthalmic examination was always followed by orbital ultrasound and computed tomography (CT) examination of the head. All masses were sampled with the patient still on the CT table using ultrasound (US) guided automatic tru-cut device. The most suitable sampling approach to the orbit was chosen each time based on the CT image analysis. One of the following different approaches was used: trans-orbital, trans-conjunctival or trans-masseteric. In all cases, the imaging-guided biopsy provided a sufficient amount of tissue for the histopathological diagnosis, which concurred with the biopsies obtained using the excisional technique. CT examination was essential for morphological diagnosis and provided detailed topographic information that allowed us to choose the safest orbital approach for the biopsy. US guided automatic tru-cut biopsy based on CT images, performed with patient still on the CT table, resulted in a minimally invasive, relatively easy, and accurate diagnostic procedure in dogs with orbital masses.

[Painting in construction and exposure to carcinogenic chemical agents: an Italian study in Lombardy]. / Esposizione ad agenti chimici e cancerogeni nelle attività di verniciatura in edilizia: i'esperienza dello Studio PPTP-Verniciatura.

The risk associated with exposure to chemical carcinogens (as classified by International Agency for Research on Cancer and/or the European Union), during painting activities in construction seems controversial. This study included all 43 activities of professional painting in this sector existing in the area of Cremona, in Lombardy region. The aim was to consider and promote preventive technical and medical solutions, basing on efficacy. The occupational exposure and the already adopted preventive measures were evaluated by investigations at workplaces, supported by standardized questionnaires and registrations. 860 commercial products (402 chemical substances) were classified: in 38% of cases the ingredients were not listed in the Material Safety Data Sheets (retrieved by the manufacturer). The real possibility of a risk exposure to carcinogens has been reported in a small proportion of situations. In all companies the presence of carcinogens was unrecognized or at least had not been taken into account in the risk assessment of workers.

[Nickel dermatitis, systemic nickel allergy syndrome, immuno-genesis, immune-tolerance: an Italian study]. / Dermatiti da nichel, sindrome sistemica, immunogenesi e immunotolleranza: studio Italiano.

Subjects with Nickel sensitization proved by patch test may suffer of contact eczema, but also of a Sistemic Nickel Allergy Syndrome (SNAS) consisting of urticaria-like troubles, itch, erythema, cutaneous rush, headache, intestinal symptoms, recurrent vesicular palmar dermatitis. 160 subjects (130 F, 30 M) were classified into three groups and underwent dosage of Nickel in urines (U-Ni) and blood (B-Ni). The two groups with SNAS showed an higher indicators of Nickel absorption, while the only-eczema group did not. 95 subjects with SNAS were enrolled for a Nickel-scanty diet: most of them improved. 24 ones again symptomatic were admitted to an experimental treatment, by a schedule of oral increasing microdose (nanograms) of Nickel sulphate: all of them improved. In conclusion Nickel pathology is changing, allergy seems to be due to different mechanism, dietary intake is important, an immune-tolerance can be induced.

[Asthma and baker's allergy: experience with health programs]. / Asma e allergopatie del panificatore: dalle esperienze alla programmazione sanitaria.

Wheat flour sensitization may lead to several occupational diseases: persistent rhinitis, intermittent or persistent asthma, conjunctivitis, urticaria, and contact dermatitis. The main allergenic components of wheat have been identified, the prevalent mechanism is IgE-mediated, the worsening after starting of sensitization shows the characters of the "allergy march" till the respiratory functional impairment and disability. Nowadays the occupational rhinitis is the first important step to begin to start prevention, but its relevance is also for quality of life of subjects. Data about the prevalence of the sensitization in Italy seem to be spread, ranging from 4% to 24% in the literature and till 32% in a recent our investigation. A complete and early diagnosis is essential to manage the allergic bakers, aiming relocation in their own activity. A specific immunotherapy by allergenic vaccine has been studied and it is now possible. In our experience 43 bakers and pastry makers were treated by the same vaccine (Lofarma Laboratories, Milan) and revalued after many years; 83% were still at work and 70% claimed only poor or no-symptoms during work, in any way with a tolerable condition. At present the baker's disease may be managed by included interventions "man-environment" avoiding the extreme choice of leaving the working activity. The Lombardy Government published specific Guide Lines on the prevention and proposed a planned project for three years, to be adopted according to local needs in collaboration with the public health service.

[Nickel risk in metal processing workers. Highlights on toxic and allergic effects]. / Rischio chimico da Nichel e lavorazioni metalmeccaniche: vecchie e nuove acquisizoni sugl effetti tossi e allergici.

Nowadays nickel is a global problem, related to occupations (mainly metalworkers) and to life habits. The dietary intake, more than environments, is the source of a basic immune identification and also of possible complications after occupational inhalation or contact. Nickel insoluble compounds are proved to be cancerogenic. Nickel ions are very reactive with proteins and oxidant, then also potential irritant for the airways. Metallic nickel and soluble compounds are sensitizers, causing dermatitis, rhinitis and asthma. Recently a Systemic Nickel Allergy Syndrome (SNAS) has been identified in allergic subjects, with a clinical picture of urticaria, general hitching, headache, gastrointestinal troubles. SNAS may affect allergic occupational or non-occupational ones. Studies are in progress aimed to an oral treatment inducing immunotolerance. Nickel in urine seems to be the best tool for monitoring nickel absorption.

[Assessment of exposure to cancerogenic aromatic hydrocarbon during controlled-access highways management activities]. / Valutazione dell'esposizione ad idrocarburi aromatici cancerogeni nell'attività di gestione autostradale.

The purpose of this study was an integrated assessment of exposure to benzene and Polycyclic Aromatic Hydrocarbons (PAH) in 29 workers employed to manage a controlled-access highways. A campaign was performed in summertime by environmental monitoring (active and passive airborne personal sampler), as well as by biological monitoring (urine samples of the beginning and of the end of daily shift, baseline after two days of vacation). The measured environmental levels did not differ from background environmental concentrations found in a metropolitan area (i.e. benzo[a]pyrene < 1 ng/m3; benzene < 5 mcg/m3), and the results of biological monitoring were in agreement and were compatible with extra-professional habits of the investigated subjects (1-hydroxipyrene 50-990 ng/g creatinine; unmetabolized benzene 15-2010 ng/I; t-t muconic acid < 4-222 mcg/g creatinine).

[The medical management of the allergic worker in small industries and for craftsmen]. / Il lavoratore allergico e la sua gestione nell'artigianato e nella piccola impresa.

This report is aimed to suggest how allergic subjects can be admitted to activities at risk and how workers affected by occupational allergy can be relocated. Allergy is a mechanism strictly joined with the individuality trough the immunologic system of protection of the organism Works are the background of a possible exposure to agents able to rouse a specific hypersensitivity, but also the purposes of everyone for having a normal way of life. Population studies demonstrated that 70% of adults that present themselves for working as craftsmen or in small industries are normally reactive, but about 30% have a condition of a diagnosed allergy or are hyperreactive to the environment. Therefore it is unfeasible to exclude the allergic ones from work even for preventive aims. The true prevention is linked to manage a methodology of assessing and grading the allergologic risk at the workplaces (four levels are proposed) and of classifying the subjects by medical parameters (five class are proposed). The individual job fitness may be so defined, either at the first examination or periodically during working activity, monitoring self-reported symptoms and changement of used materials or of specific tasks. Informal guidelines are proposed to manage three possible situations of occupational allergic diseases and the engagement of the occupational physician also to be connected with allergy specialists and family doctors is recommended.

Comparison of conservative management and juvenile pubic symphysiodesis in the early treatment of canine hip dysplasia.

OBJECTIVES: To evaluate the efficacy of juvenile pubic symphysiodesis (JPS) in a clinical setting for the early treatment of canine hip dysplasia (CHD), and to identify its indications and contraindications. METHODS: The final degree of CHD using the FCI (Fédération Cynologique Internationale) CHD classification in 5 Grades (A, B, C, D, E) was assessed at skeletal maturity in two homogeneous groups of dogs assessed at the age of 14 to 22 weeks and selected according to their susceptibility to CHD; one group was treated with JPS and one group was conservatively managed. Two hundred seventeen puppies completed the study; 81 were treated with JPS (group 1) and 76 were conservatively managed (group 2). A third group of 60 puppies with normal hips was followed as a negative control group. RESULTS: In group 1, 43.2% of the puppies had regression or a lack of progression of the disease in the final evaluation (Grade A & B), 25.9% had mild CHD (Grade C) and 30.9% had moderate and severe CHD (Grade D & E). In group 2, 23.6% of the puppies did not show any development of the disease (Grade A & B), 21.1% had mild CHD (Grade C) and 55.3% developed moderate to severe CHD (Grade D & E). Further investigation was done by comparing the severity of early signs of susceptibility to CHD with the final FCI Grades at adulthood in both groups. CLINICAL SIGNIFICANCE: The JPS procedure increased the odds of arresting or limiting the progression of CHD in mild to moderate grades of CHD, while it was less effective or ineffective in more severe forms.

[Biological monitoring in the molding of plastics and rubbers]. / Monitoraggio biologico nello stampaggio di plastiche e gomme.

This survey was carried out in the molding of plastics and rubbers, in the "Professional Cancer Prevention Project" sponsored by the Lombardy region with the objective of developing and implementing protocols for evaluating exposure to carcinogens through the biological monitoring. The realities of molding the thermoplastic polymer ABS, rubber, and thermosetting plastics containing formaldehyde were examined. The carcinogenic substances identified in these processes were: 1,3-butadiene, acrylonitrile and styrene in molding ABS, polycyclic aromatic hydrocarbons (PAH) in molding rubber, and formaldehyde in molding the thermosetting plastics. Only for some of these substances biological indicators are available. The limited exposure to airborne chemicals in molding ABS and the intrinsic characteristics of biological indicators available for 1-3 butadiene have determined the non applicability of biological monitoring to this situation. The absence of a biological indicator of exposure to formaldehyde has made this situation not investigable. Exposure in the rubber molding was studied in 19 subjects applying the determination not metabolized PAH in urine. The levels of these indicators were similar to those measured in other groups of subjects without occupational exposure to PAH, confirming a low airborne contamination in this workplace.

[Exposure to polycyclic aromatic hydrocarbons (PAH) in rubber forming industry]. / Esposizione ad idrocarburi policiclici aromatici nello stampaggio della gomma.

Among various chemical agents present at the workplaces in the rubber industry, a particular attention was adressed to the Polycyclic Aromatic Hydrocarbons (PAH) contained in oil and carbon black, but some questions regarding level of exposure are also controversially discussed. The literature reports that PAH may have irritant effects; moreover some of these have been recognized as probably or possibly carcinogenic to human by the International Agency for Research on Cancer, the European Union, and other institutions. In Lombardy, a study aimed to evaluate the occupational exposure in Benzo[b]fluorantene the rubber forming industry was planned during last two years. The results of environmental air monitoring (the 16 most relevant, according to the American Environmental Protection Agency, EPA) and biological monitoring (urinary 1-hydroxypyrene excretion) show that PAH exposure in these workers is not higher than that observed in other study regarding low level and acceptable exposure.

[Rubber industry and exposure to carcinogenic chemical agents: an Italian Multicentric Study in Lombardy]. / Stampaggio della gomma ed agenti chimici cancerogeni: l'esperienza dello Studio PPTP-Gomma.

Evaluating the chemical risks at the workplaces, the potential carcinogenic risk is a primary interest. Particularly, in the rubber forming industry the main attention was directed to the hot processing as a possible source of exposure to chemical agents, several of which were classified as carcinogens by the International Agency for Research on Cancer (IARC) and/or the European Union (EU). A study on occupational exposure to chemical carcinogens in the rubber forming industry was planned during last two years, involving a representative sample of firms. In the first step the occupational exposure and the use of preventive measures were evaluated by an investigation at workplace supported with standardized questionnaires. The presence of above 100 chemical agents was registered; 15 agents were classified to carcinogenic or probably carcinogenic to human. The evaluation of exposure by air sampling and monitoring of most substances of interest (acrylonitrile, 1,3-butadiene, styrene, Polycyclic Aromatic Hydrocarbons), demonstrated a low level of occupational exposure, the common hygienic prevention measure being applied.

[Analysis of work accidents during the years 1999-2006 in a hospital company in Lombardia]. / Analisi del fenomeno infortunistico 1999-2006 in un'Azienda Ospedaliera Lombarda.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

[Specific immunotherapy and relocation in occupational allergic bakers]. / Recupero professionale di panificatori allergici mediante vaccino verso farina di frumento.

Occupational allergy to components of wheat flour is the main cause of rhinitis and asthma of workers in bakeries and similar activities. An immunological mechanism IgE-mediated is involved and the sensitising properties of some proteins of wheat where assessed. Nowadays it is possible to have an extract to be used for specific immunotherapy. The aim of this treatment should be a reduction of individual immunological reactivity and the possibility of going on the particular activity of allergic bakers, pastry makers or pizza makers. An observational crossectional retrospective study was performed on 41 sensitised workers that were diagnosed in the same occupational health unit. All underwent a subcutaneous specific immunotherapy (SCIT) with the same schedule and the same extract (Lofarma Allergeni, Milan) for 4 or more years, without avoiding their work activity. The outcome was investigated after five or ten years. Data were collected by a questionnaire. 34 subjects on 41 are still at work with an acceptable quality of life and a normal working efficiency, mainly in their small enterprises. In the "old" subgroup (19 cases), treated in the past, several bakers still at work stopped SCIT even from 4-10 years. In the "new" subgroup (15 cases), still in treatment, symptoms and drug use during the work activity resulted to be reduced or absent in the majority of cases. According to results of other immunotherapies by allergenic vaccines (pollens, mites) also for wheat flour occupational allergy a specific treatment seems to be possible and SCIT may be an useful tool to reduce and control the biological individual effects of allergy. By the occupational point of view wheat flour SCIT allows a relocation in many of cases and may be associated to other intervention of environmental prevention at workplaces, improving the relocation of occupational allergic subjects when requested.

A pre-seasonal birch/hazel sublingual immunotherapy can improve the outcome of grass pollen injective treatment in bisensitized individuals. A case-referent, two-year controlled study.

BACKGROUND: The study tests the hypothesis of a reduction of priming due to tree allergy in patients sensitised to both birch/hazel and grass pollen undergoing an associated preseasonal Sublingual/Injective immunotherapy. METHODS: 36 out of 49 bisensitized candidates were pair-matched into 18 case-referent couples. During two years all patients were administered preseasonal grass-SIT and one patient in each couple received also birch/hazel-SLIT. Diary cards were fulfilled for three consecutive grass pollen seasons. Specific Nasal Provocation Test (NPT) for grass and aspecific bronchial challenge were done; sera were analyzed for specific IgE and IgG. RESULTS: During the peak of the grass pollen season both groups showed a significant improvement in total symptom-score. Conjunctivitis and cough improved significantly more in patients with associated therapies. While antihistamine score decreased significantly in both groups, antiasthmatics did only in the SLIT-SIT group. The follow-up documented a significant increase in grass- and birch-specific IgG and a decrease in grass-specific IgE. Grass-NPT threshold was clearly higher in SLIT-SIT-group (p = 0.01) and only in this group PD20 methacholine improved significantly (p < 0.05). CONCLUSIONS: Combined birch/hazel-SLIT and grass-SIT are safe and improve clinical outcomes of SIT alone in young bisensitized patients. Priming reduction is supported by specific NPT and bronchial hyperresponsiveness.

Occupational dermatitis in a highly industrialized Italian region: the experience of four occupational health departments.

There is a need for several research centers to carry out coordinated large-scale evaluation of the spread of occupational irritant and allergic dermatitis. The Occupational Health Departments of Bergamo, Brescia, Lecco and Cremona therefore decided to join their experiences and bring together all the cases of occupational irritant and allergic dermatitis diagnosed by these Departments between 1993 and 1998. In this period, 1169 cases of occupational dermatitis were diagnosed, subdivided into 768 cases of allergic contact dermatitis (ACD), 337 of irritant contact dermatitis (ICD), 54 of urticaria and 10 of airborne contact dermatitis, and there has not been a trend towards increase of occupational dermatitis over the years. Our population included 724 males and 445 females and average latency after the beginning of exposure to occupational allergens was 8.01 years for ACD, 6.4 for ICD, 3.22 for urticaria and 5.57 for airborne contact dermatitis. The frequency of atopy was 33.9%, in females and 19.5% in males. The frequency of atopy was particularly high (89%) in subjects with urticaria. Among subjects with allergic dermatitis, 362 had had only one sensitization while 406 had had two or more sensitizations. The working areas where we found the highest number of ACD were metal working industry, building, health care workers and hairdressers and the frequency of ICD was high in metal workers and health care workers. Most of the cases of urticaria were diagnosed in health care workers (68.5%) and the main causing agent was latex. These are only preliminary data but occupations at risk and the substances expected to be the most frequent etiological agents do not differ significantly from those reported in the literature. It is hoped that as a result of this project there will be in the future: standardization of diagnostic procedures, uniform assessment of allergological risk in working environments not yet fully investigated, standardization of preventative measures and proper evaluation of their effectiveness.

Specific inhalation challenge with wheat flour in workers with suspected baker's asthma.

OBJECTIVE: The aim of this study was to evaluate the outcome of the specific inhalation challenge test (SIC) in 160 subjects with suspected baker's asthma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisation, non-specific bronchial hyper-responsiveness (NSBH) and atopy. METHODS: We investigated the outcome of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flour, NSBH, atopy, forced expiratory volume at 1 s (FEV1) monitoring and airborne flour dust in the challenge chamber measured by the gravimetric method (total dust in mg/m(3)). RESULTS: The SIC test was positive for early asthma in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outcome to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1. 6-7.7) and skin sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3-7. 0). Exposure level to wheat flour was less than or equal to 10 mg/m(3 )in 12% of individuals, ranged between 11 and 30 mg/m(3) in 43% and exceeded 30 mg/m(3) in 45%. The outcome of SIC was always negative among workers not skin sensitised to wheat flour and without NSBH and atopy. An increasing prevalence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was greater than 10 mg/m(3) (P < 0.001). CONCLUSION: Procedures currently adopted for wheat flour dust exposure during SIC need to be better standardised in order to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, particularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.

[A model of occupational, environmental and community medicine. History and evolution of the Hospital Unit of Occupational Medicine (UOOML) in Lombardia]. / Un modello di "Occupational, Environmental and Community Medicine". Storia ed evoluzione delle Unità Operative Ospedaliere di Medicina del Lavoro (UOOML) in Lombardia.

The authors describe the historical evolution of the prevention in Lombardia, and the role of the Hospital Units for Occupational Medicine, not only on the clinical oriented fields, but also on the areas of formation and training. Hospital Units for Occupational Medicine are today the best synthesis of "occupational-environmental-community health". There development is based on adequate standards of human and instrumental resources, as so as a real financial budget. At last, it's important that these Units are allocated in a so-called "bipolar department", open to the hospital and also open to the territorial structures for prevention and safety (department of occupational health).

Preseasonal intranasal immunotherapy in birch-alder allergic rhinitis. A double-blind study.

A double-blind, placebo-controlled study was carried out to test the clinical efficacy and safety of local nasal immunotherapy (LNIT) in powder form. Twenty-two patients suffering from allergic rhinitis strictly associated with early spring symptoms, with positive skin prick tests and RAST for birch-alder, all responders to a specific nasal provocation test (NPT), received randomly active or placebo treatment for 4 months. Immunotherapy consisted of administration of a set of capsules containing progressively increasing amounts of birch (Betula pendula) and speckled alder (Alnus incana) allergens in powder form with controlled granulometry. The active (birch-alder) and placebo (lactose) group completed the treatment according to a similar schedule. During the pollen season (March-April), the patients who took the active treatment reported less sneezing and rhinorrhea than the placebo group, on the basis of a symptoms score, and the differences were statistically significant; the need for drugs (terfenadine) was also significantly reduced. These findings agreed well with the results of specific NPT after the treatment; only patients in the active group had a higher threshold dose of nasal specific reactivity to birch-alder allergens than in tests before the LNIT.

Cobalt-related asthma: clinical and immunological aspects.

Several clinical and experimental findings point to cobalt as the only sensitizer and causal agent of hard metal asthma. The clinical features have been clearly defined by bronchial provocation tests, with a prevalence of late phase responses. Epidemiology is still insufficient to configure prevalence and incidence rates for cobalt asthma. IgE and IgG antibodies with cobalt specificity have been demonstrated, but T-lymphocytes and eosinophils involvement seem to be important in the mechanism of an allergic inflammation in the airways. Such an immunological pathogenesis links cobalt asthma with other manifestation of hard metal disease.

[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.