[Alcohol and work. Consensus Document of the La.R.A. (Workers representing a risk for others) group]. / Alcol e Lavoro. Documento di consenso del gruppo La.R.A.

AIM: Current Italian legislation obliges employers to prevent workers who are occupationally at risk or who perform jobs that may be hazardous for the safety or health of third parties from consuming alcohol. The LaRA Group undertook to assess whether the law fully safeguards the health and safety of both workers and third parties, without impinging upon the civil rights of workers. METHOD: A written document expressing agreement was produced following discussions between doctors, lawyers, bioethicists and social partners. RESULTS: There are gaps and inconsistencies in current laws; the differences in local and regional provisions prevent authorities from applying a single strategy at national level. There should be a change in existing rules under which the employer's obligation to enforce the ban on consumption alcohol in the workplace is enacted solely by the "competent" physician whose institutional role is to safeguard and promote health. Some occupational categories that are subject to a ban on alcohol consumption do not currently under-go health surveillance. For example, if road transport drivers are not exposed to a specific occupational risk foreseen under another law, they can be placed under health surveillance only in those regions where the local laws contemplate this type of control. In other cases, the practice of assessing the risk to third parties and providing for compulsory health surveillance in the Risk Assessment Document, is considered by some jurists to be a "consuetudo praeter legem" and therefore acceptable in a field not yet covered by a specific law, but to be "contra legem" or unlawful by other jurists. Moreover, the competent physician who uses a breathanalyser or tests for alcohol addiction faces an ethical dilemma, since by communicating the results to an employer or authorities responsible for the issuing of licenses, he may be violating his professional oath of secrecy. Furthermore, the emphasis placed on testing has induced companies and inspectors to overlook educational and rehabilitation aspects. It is essential to involve general practitioners, educators and specialist services in addressing the problems of alcohol abuse so as to inform/train, recover and rehabilitate. The few studies available indicate that the rules are poorly enforced and that non-compliance may go unobserved. CONCLUSIONS: The Group urges all employers to assess the risk for third parties caused by alcohol abuse and to devise a policy on alcohol. Controlling alcohol-related risks in the workplace calls for a better definition of the roles of Vigilance Bod-ies and Company Physicians together with a shift from a reactive to a proactive attitude of all the parties involved.

[Fitness, disability and mobbing]. / Idoneità, disabilità e mobbing.

Workers with handicap or psychological impairment are frequently submitted to mobbing. If causative factors of psychological disorders are not recognized, the physician charged of medical surveillance of workers may himself become a prosecutor and enhance the mobbing actions to the extent that the mobbed worker is discharged. In order to avoid this undue effect, the physician should strictly adhere to the body of legislation and to good occupational medicine practices. Health surveillance for occupationally exposed groups of workers is required under specific health and safety legislation. Workers unexposed to hazard in the workplace cannot be included in health surveillance programme, and declaring these workers unfit for their job is a patent violation of Workers' Statute Law. Psychological disorders should be carefully evaluated in order to clarify their relationship with work. The case of a worker affected with schizophrenia, already reported in the literature, is here re-analysed in order to emphasize these concepts.

Death due to a leiomyosarcoma of the pulmonary artery.

Leiomyosarcomas of the pulmonary arteries are rare neoplasms seldom diagnosed during the patient's lifetime. We report a case of unexpected death in a 44-year-old man due to a leiomyosarcoma originating from the main pulmonary trunk and involving the right and left arteries as far as the lobar ramifications. The patient died after a 2-year history of bronchiectasis and chronic bronchopneumonia with weight loss and occasional episodes of syncope during the last 4 months. Immunohistochemical demonstration for alpha-smooth muscle actin was necessary to make a histological diagnosis of leiomyosarcoma. A review of pulmonary artery leiomyosarcomas is also presented.

[A case of extrarenal angiomyolipoma with intestinal localization]. / Un caso di angiomiolipoma extrarenale a localizzazione intestinale.

The Authors present a case of extrarenal angiomyolipoma. The tumor arose from the pericolonic fat of the sigmoid colon and, increasing in size, caused intestinal obstruction by extrinsic lesion. Extrarenal angiomyolipoma is extremely rare and to our knowledge this is the first reported case arising from the colonic wall.

[Rare digestive hemorrhage caused by diverticular pathology of the small intestine]. / Emorragie digestive rare da patologia diverticolare del tenue.

The Authors report two cases of digestive hemorrhage secondary to diverticulosis of the small intestine. The incidence of this pathology in an overall population of 215 digestive hemorrhages was 0.9%. A clinical identity-kit is drawn of patients affected by jejunal diverticulosis, and the most important and characteristic anamnestic manifestations are defined. The most statistically significant complication is hemorrhage which was observed in 33% of cases. Clinical manifestations of hemorrhage are defined as variable and "bizarre", since they may appear as hematemesis, melena or enterorrhagia. The surgical procedure for radical definitive and prophylactic therapy is segmentary resection of the jejunum affected by pseudodiverticulosis.

[Digestive physiopathology of the pancreatectomized patient. Comparison of the results of total pancreatectomy and pancreaticoduodenectomy with preservation of the pylorus]. / La fisiopatologia digestiva del paziente pancreatectomizzato. Confronto dei risultati tra pancreatectomia totale e duodenocefalopancreatectomia con conservazione del piloro.

The authors analyze their experience with pancreatectomy, pointing out the digestive pathophysiologic sequelae of the operated patients. A follow-up protocol based on upper digestive endoscopy, laboratory tests, scintigraphic and pH-metric tests compares the results achieved after total pancreatectomy with the results of pancreaticoduodenectomy. Total pancreatectomy is complicated by peptic ulcer, stump gastritis and gastroenteric dyskinesia. The preservation of the pylorus and the separation of the gastric anastomosis from the biliary one avoid the pathologic biliary reflux and minimize the functional and organic sequelae of the operation.

Low voltage isoelectric focusing for the study of red cell acid phosphatase polymorphism: improved phenotyping and better agreement with the Hardy Weinberg distribution.

A low voltage isoelectric focusing (IEF) method for typing human red cell acid phosphatase (ACPl) polymorphism is reported. A clear differentiation of the ACPl*A, ACPl*B and ACPl*C allelic products is obtained by minimizing diffusion of the bands during electrophoresis and during enzyme visualization by using a hydrophilic cellophane film soaked with the substrate solution, heated to 50 degrees C, and by reading without incubation in a moist chamber. A population study of ACPl, carried out with this method, on a sample of 624 unrelated individuals of the population of Rome (gene frequencies: ACPl*A = 0.267; ACPl*B = 0.680; ACPl*C = 0.053), showed a good agreement between the observed and expected phenotype distribution (chi 2/2 = 1.35; 0.70 greater than p greater than 0.50).

The esterase D polymorphism by ultrathin layer isoelectric-focusing: frequency of the EsD5 allele in the population of Rome.

The distribution of EsD phenotypes in the population of Rome was investigated by cellulose-acetate electrophoresis and isoelectric-focusing. The gene frequencies were found to be: EsD1 = 0.8451, EsD2 = 0.1363, EsD5 = 0.0186. These frequencies were compared with those reported in other populations.

Antitrypsin and Gc polymorphisms in some populations of Congo: an unusual, highly frequent mutant, PIS, in Bateke and Babenga.

Four population samples from Congo (Beti and Bateke from Cuvette area, Bateke and Babenga from 'Pool' area) were typed for the electrophoretic mutants of protease inhibitor (PI) and group-specific component (Gc), as part of a general survey on the genetic structure of these ethnic groups. An unusual PI mutant (tentatively called PIS*) had a singularly high frequency in the Bateke and the Babenga. Data shown here will help in ascertaining whether genetic differentiation could exist in Congolese populations.

EsD in Negro and Caucasian populations: is the EsD5 a 'Caucasian allele'?

A total of 461 individuals, belonging to some Subsaharan populations (Beti, Bateke and Babenga Pygmies of Congo; Goun and Nago of Benin; Mbugu and Sango of the Central African Republic), and a sample of 231 individuals of the population of Rome (Italy) have been typed for red cell esterase D using conventional electrophoresis and isoelectric focusing. The Subsaharan populations showed a high variability of the frequency of the EsD2 allele (0.018-0.138) and the absence of the EsD5 allele which, on the contrary, reached a polymorphic frequency (0.017) in the Italian sample. These results suggest that the EsD5 allele has a Caucasian origin.

Improved typing of human serum transferrin by isoelectric focusing on ultrathin layer polyacrylamide slab gels.

An improved method for separating transferrin subtypes through the use of isoelectric focusing on ultrathin layer polyacrylamide gels is described. The most considerable problems encountered in the assessment of the Tf phenotypes after pretreatment with iron donor compounds are pointed out. Useful technical devices for reducing the occurrence of artifactitious extrabands are suggested. Finally, the gene frequencies in three samples from Italian populations are reported.