[The Bergamo experience of health surveillance in the bakery sector]. / L'esperienza bergamasca di Sorveglianza Sanitaria nel settore della panificazione.

The purpose of this study is to analyse the various risk factors present in the artisan and semi industrial bread making technological cycle as well as verify the kind of illnesses and ailments encountered amongst the workforce. The objective being to identify a preventive action programme together with the necessary Health support measures. Our case study, drew upon a sample of 428 workers (252 bread makers and 176 sales staff). Each of them was asked to complete a questionnaire about the production process, the kind of exposure to wheat flour particles, smoking habits, present or past common allergy pathologies, the symptoms connected to the work, both in the allergic and osteomuscular field. Those positive respondents were subjected to various medical tests so as to ascertain a definitive diagnosis of their ailments. As was easy to predict, the most common pathology (ailment), found amongst bread makers, related to the respiratory system--16.7% of the population. In particular, 7.5% was affected by eye rhinitis, 2.8% by allergic bronchial asthma, 3.2% indicated a mix between rhinitis and bronchial asthma and 3.2% by BPCO. Skin ailments affected 2% of workers and WMSDs more than 2.8%.

Structure, wettability and thermal degradation of new fluoro-oligomer modified nanoclays.

Quaternary ammonium salts based on monofunctionalized Perfluoropolyether (PFPE) oligomers were synthesized and used for the cation exchange process of sodium Montmorillonite nanoclays. The new fluoromodified nanoclays were characterized through X-rays diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), termogravimetric analysis (TGA), differential scanning calorimetry (DSC), electronic microscopy (SEM-EDS), and contact angle measurements (CA). In particular XRD showed rather complex patterns (presence of higher order reflections) which allowed the calculation of basal spacings, regularly increasing with the molecular weight of the fluorinated macrocation. Both IR and SEM confirmed the presence of fluorinated segments at clays interface, while TGA showed a limited thermal stability with an onset of degradation temperature which seems not dependent on the molecular weight of the macrocation. CA measurements showed a peculiar behaviour, with evident dynamic hysteresis phenomena and surface tension components quite different from those of commercially available, organomodified clays.

[Occupational skin allergies in 1993-1998]. / Allergopatie professionali cutanee 1993-1998.

There are few data on the frequency of occupational allergic dermatitis in the context of occupational diseases and there is a need for coordinated large-scale studies to compare the experiences of different Occupational Health Departments involved in the surveillance of allergic occupational diseases. Therefore 6 Occupational Health Departments of Northern Italy (Bergamo, Brescia, Cremona, Desio, Lecco and Milano-CEMOC) decided to bring together all the cases of occupational allergic dermatitis diagnosed between 1993 and 1998. In this report the main characteristics of these 961 allergic dermatitis (888 allergic contact dermatitis, 63 urticaria and 10 airborne contact dermatitis), the possible correlations with gender, age, length of employment, atopy and the occupations at high risk of acquiring allergic dermatitis have been described.

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.

Contact urticaria from latex in healthcare workers.

BACKGROUND: Latex allergy is an important medical problem for an increasing number of patients. It has been documented as causing immediate hypersensitivity reactions ranging from mild urticaria to life-threatening anaphylaxis after cutaneous, mucosal or visceral exposure. Recent studies in northern Europe and the USA suggest that between 2.8 and 16.9% of healthcare workers are affected by latex hypersensitivity type I reactions. OBJECTIVES: To test the prevalence of contact urticaria from latex gloves in a group of healthcare workers, to examine the factors associated with latex allergy and to evaluate some diagnostic methods used in latex allergy. METHODS: A total of 929 employees of the surgical units who used latex gloves on a regular basis, at least once a day, were invited to participate in this study including administration of a questionnaire, a prick test with a commercial extract of latex, a prick test with latex glove eluate, a use test, RAST and an immunoblotting system; moreover, a prick test with a group of common inhalant allergens and a prick-by-prick test with fresh fruit (banana, kiwi, avocado, chestnut) were employed. RESULTS: Of the 929 staff sent questionnaires, 313 (33.5%) replied; of those who responded, 118 gave a history of hand problems such as itch, erythema, wheals when wearing gloves, dryness and irritation most marked on the backs of the hands. Among these 118 workers, 16 refused skin testing and examination of blood, so 102 subjects were studied for latex allergy; 21/118 (17.8%) healthcare workers were found to be latex allergic. Eighty-one staff members gave a history of hand problems worsened by wearing gloves but were not latex allergic on testing. Those healthcare workers who completed the questionnaire and answered negatively (195/313) were not tested for latex allergy. Prick tests with the commercial solution were positive in 11 of the 21 subjects studied; prick tests with the eluate of glove, RAST and the use test were positive in all workers; 10 of the 21 sera showed positive immunoblot results. Atopy and a preexisting irritant contact eczema of the hands were present in a high percentage of the workers. CONCLUSION: In this study of healthcare personnel, we found that allergic contact urticaria from latex was present in 21 workers of the 313 (6.7%) who responded to the questionnaire and of the 102 (20.5%) who were tested for latex allergy. Atopy and irritant contact eczema of the hands were frequent in these subjects. Skin prick testing with latex glove eluate and the use test seem to be more sensitive than in vitro testing, particularly immunoblotting, and are biologically more relevant; skin testing with glove eluate must be preferred to testing with a commercial extract.

Multicentre study of allergic contact cheilitis from toothpastes.

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Chronic urticaria and Helicobacter pylori.

Chronic urticaria can result from multiple causes. A number of factors have been identified that can appear to be important in the pathogenesis of individual cases, including intolerance to food, drugs, some internal diseases and some infections. Recently a possible relationship between chronic urticaria and Helicobacter pylori has been suggested. One hundred and twenty-five patients were investigated for Helicobacter pylori infection by means of ELISA assay and 13C urea-breath tests. When the two tests were positive, gastric biopsy was performed after informed consent. Patients with Helicobacter pylori infection were randomly assigned to receive triple therapy for the eradication of bacterium for one week, or no treatment. As controls, 25 patients with chronic urticaria and with negative results on ELISA and urea-breath tests were treated with the same triple therapy course. Forty-six unrelated blood donors of both sexes were examined for the presence of anti-Helicobacter pylori antibodies in the normal population. Seventy-eight patients had circulating specific IgG antibodies against the bacterium and positive urea-breath tests. Among these patients, 31 received eradication therapy, 34 were enrolled in the control group, and 13 patients neglected the study. Three patients in the eradication therapy group showed complete remission of urticaria after 12 months of follow-up as compared with 1 patient in the control group. Twenty blood donors out of 46 were IgG anti-Helicobacter pylori positive. In conclusion, our data show that the prevalence of Helicobacter pylori infection is high in chronic urticaria patients, but eradication of the bacterium does not appear to influence the skin disorders nor the symptoms.

Porcine-derived surfactant treatment of severe bronchiolitis.

BACKGROUND: It is hypothesized that surfactant treatment helps to improve severe bronchiolitis by restoring surfactant system activity. This study aims to assess the effect of surfactant on gas exchange, peak inspiratory pressure and duration of mechanical ventilation and intensive care unit (ICU) stay in children with severe bronchiolitis. METHODS: Twenty children with bronchiolitis requiring mechanical ventilation were randomly assigned to one of two groups (10 patients each). Group A was treated with continuous positive pressure ventilation (CPPV) plus surfactant. Group B was treated with CPPV only. Porcine-derived surfactant, 50 mg/kg body weight, was instilled into the trachea. Arterial tension of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, arterial tension of carbon dioxide (PaCO2), and peak inspiratory pressure (PIP) were assessed. Heart rate and non-invasive arterial blood pressure were monitored. The duration of CPPV and the length of ICU stay were also recorded. Finally, the incidence of complications and the survival rate were assessed. RESULTS: In group A, the PaO2/FiO2 ratio significantly improved from 1 h and a reduction in PaCO2 was noted from 12 h. A reduction of PIP was observed from 3 h. The duration of CPPV and the length of ICU stay were reduced in group A. No complications were reported in either group and all children survived. CONCLUSIONS: Surfactant treatment of severe bronchiolitis appeared to improve gas exchange, reduce PIP and shorten CPPV and ICU stay. However, these initial results must be confirmed by a larger and more rigorously controlled study.

High-versus low-dose levo-leucovorin as a modulator of 5-fluorouracil in advanced colorectal cancer: a 'GISCAD' phase III study. Italian Group for the Study of Digestive Tract Cancer.

BACKGROUND: Although leucovorin (LV) + 5-fluorouracil (5-FU) is considered the treatment of choice for advanced colorectal cancer in most countries, the optimal schedule of this combination has not yet been established. Low-dose LV appears to be as active as high-dose LV in the daily-times-five regimen, but no randomized study of the levorotatory stereoisomer (6S-LV) given at two different dose levels has been published. PATIENTS AND METHODS: Between November 1991 and June 1994, 422 patients (all with measurable disease previously untreated with chemotherapy) were randomized to 6S-LV (100 mg/sqm/i.v.) + 5-FU (370 mg sqm/15 min i.v. infusion), both administered for 5 days every 28 days (arm A), or to 6S-LV (10 mg/sqm/i.v./5-FU (doses as above), also given for 5 days every 28 days (arm B). The primary endpoint of the study was the comparison of response rates (WHO criteria): the secondary endpoint was the assessment of survival and tolerability. No evaluation of the quality of life or the symptomatic effect of treatment was planned. RESULTS: The response rate was 9.3% in arm A (95% CI: 5.4-13.1), with 2 CR and 18 PR, and 10.7% in arm B (95% CI: 6.5-14.9), with 3 CR + 19 PR, without any significant difference (P = 0.78). The median time to progression was eight months in both groups and overall survival was 11 months, with no difference between treatments. Toxicity mainly consisted of gastrointestinal side effects (mucositis and diarrhoea), which were rarely severe (grade 3-4: 5%-10% of patients) and similar in the two groups. CONCLUSIONS: In this large-scale multicentre trial, the low and high doses of 6S-LV appeared to be equivalent in terms of the biochemical modulation of 5-FU in advanced colorectal cancer although, for several reasons (including the timing and the strict criteria of response evaluation, the high number of patients with unfavourable prognostic factors, the multi-institutional nature of the study, the dose and modality of 5-FU administration), the response rate was lower than that reported in some of the other published studies. Given the considerable difference in economic cost between the two dosages, the use of high-dose 6S-LV in the daily-times-five regimen is not recommended in clinical practice.

Autoimmune C1 inhibitor deficiency and angioedema.

C1 inhibitor (C1-INH) deficiency results in bouts of mucocutaneous edema and may be inherited (hereditary angioedema) or acquired (acquired angioedema). The syndrome of acquired angioedema, characterized by the adult onset of angioedema and by the lack of evidence of inheritance of the disease, may be associated with lymphoproliferative or other malignant diseases (type I) or with the presence of autoantibodies to C1-INH (type II); this is a rare variant form of C1-INH deficiency with angioedema. We report here a case of acquired C1-INH deficiency with angioedema, hypotension and abdominal discomfort observed in a 71-year-old man in whom complement abnormalities and autoantibodies against C1-INH have been observed and who was classified as having an autoimmune C1-INH deficiency. From the therapeutic point of view after resolution of the acute attacks, high doses of tranexamic acid have been able, at first, to decrease the frequency and the severity of the symptoms, and subsequently to provide a long symptom-free time.