[Promoting the quality of health surveillance of workers exposed to wood dust, with particular care to NPSC, in the territory of the Health Agency of Florence]. / Promozione della qualità della sorveglianza sanitaria dei lavoratori esposti a polvere di legno, con particolare riferimento ai TuNS, nel territorio di competenza della Azienda Sanitoria di Firenze.

Wood dust can cause occupational-related naso-sinusal cancer, characterized by a latency period of about 40 years. The Tuscany Cancer Registry estimates that cases of NPSC are from 20-25 per year into the Region (33% related to wood dust). These neoplasms are surgically treatable at early-stage and, for this reason, a rapid endoscopic diagnosis is considered to be reasonably useful for prognostic issues. We used a questionnaire to investigate nasal symptoms and NOSQ and SOLAR questionnaires to highlight respiratory/skins diseases, and a spirometry for each worker. Subjects with a working-age of more than 15 years, and those that were positive to the questionnaire and/or to the medical history were were referred to a specialist in otolaryngology. The prevalence of endoscopic positive findings--detected especially in subjects with a working age of more than 15 years--confirms the significance of the problem.

Excretory urography by intraosseous injection of contrast media in a rabbit model.

There are many indications for an intravenous excretory urogram. However, where intravenous access is not available, the intraosseous route to the circulation may be an alternative. We found that safe and diagnostic excretory urograms could be obtained in rabbits following the injection of different contrast media via the intraosseous route. In fact, these excretory urograms were indistinguishable from ones obtained by the conventional intravenous route. While the rabbits did not develop any abnormal clinical signs following the procedure, there were postmortem histologic lesions of osteochondrosis in 5 of 22 (22.7%) tibias receiving an intraosseous needle, but in none of the 14 tibias that did not receive an intraosseous needle. Further, the use of diatrizoate was associated with the development of osteochondrosis while the use of iopamidol was not.

Treatment of acute hyponatremia: ensuring the excretion of a predictable amount of electrolyte-free water.

BACKGROUND: Hypertonic saline is the recommended therapy to shrink swollen brain cells in patients with acute hyponatremia accompanied by seizures. OBJECTIVES: In the absence of hypertonic saline, hypertonic mannitol will shrink the cell volume. Because mannitol is excreted rapidly, our aim was to ensure that it would be excreted with electrolyte-free water (EFW) and to evaluate the renal mechanisms responsible for EFW excretion. DESIGN: A randomized, prospective, placebo-controlled study in rats was carried out in a research laboratory. SUBJECTS: Adult male Wistar rats. INTERVENTIONS: The control group of rats (n = 6) was administered hypotonic saline, a loop diuretic, vasopressin, and glucose by the intraperitoneal route; in the experimental group (n = 6), glucose was replaced with mannitol. Plasma electrolytes were measured at 0 and 210 mins, and balances for water, sodium, and potassium were obtained from 0 to 90 mins and from 90 to 210 mins. MEASUREMENTS AND MAIN RESULTS: Virtually 100% of the administered mannitol was excreted within 210 mins, and half was excreted in the first 90 mins. The urine contained EFW only in the mannitol group because of a larger volume in the first 90 mins (EFW, 3.7 mL) and to a lower excretion of NaCl in the next 120 mins (EFW, 3.5 mL). CONCLUSIONS: The combined use of mannitol and a loop diuretic caused the excretion of a predictable volume of EFW because the urine was iso-osmotic to plasma and contained all the administered mannitol. The calculated decrease in intracellular fluid volume was equivalent when mannitol was retained or excreted.

Rupture of the left aortic sinus into the pulmonary artery in a Dalmation dog.

An 18-month-old male Dalmatian dog was presented for veterinary evaluation after the pet owner observed a sudden onset of weakness. An acquired continuous cardiac murmur was detected on physical examination. Two-dimensional echocardiographic examination revealed structural abnormalities of the proximal aorta and pulmonic valve. Doppler echocardiographic studies and cardiac catheterization demonstrated the presence of a proximal aorticopulmonary shunt. A diagnosis of left aortic sinus rupture and aorticopulmonary fistula was made. Antemortem diagnosis of aortic sinus rupture in the dog has not, to our knowledge, been reported previously. The anatomical variant of left aortic sinus rupture resulting in the development of a fistula from the aorta to the main pulmonary artery is, apparently, uncommon in all species.

Presence and location of endothelin and endothelin-binding sites in human nasal mucosa under normal and metaplastic conditions.

The presence and site of production of endothelin-1 (ET-1) was investigated in biopsies obtained from the nasal mucosa of 10 healthy human subjects and 10 patients affected by chronic rhinitis. The presence and localization of receptors for ET-1 was also investigated. Bioptic fragments were examined by scanning electron microscopy. ET-1 was present in the vessels and in the respiratory epithelium of normal subjects, whereas in patients affected by epithelial metaplasia induced by chronic rhinitis, it was absent in the metaplastic epithelium and present in the endothelium and vascular wall. Receptors for ET (A- and B-receptor subtypes) were localized in the vessels of the nasal mucosa, both in normal and in pathological subjects. In particular, A-receptors were identified in the vascular wall, whereas B-receptors were mainly distributed in the endothelium. We suggest that ET-1 is involved in the homeostasis of nasal blood flow (shunting the blood toward the deep cavernous plexus and inducing mucosal swelling) by an autocrine and/or paracrine mechanism. Normal epithelium seems to be important in this mechanism, since it is able to produce ET. However, when pathologic conditions induce squamous or cuboidal metaplasia, the epithelium is no longer able to play this role.

Malignant parotid tumors. Diagnostic considerations and therapeutic suggestions.

This paper presents our experience of the problem of diagnosis and surgical treatment of malignant parotid tumors, based on a retrospective evaluation of a series of 478 parotid tumors, of which 100 were malignant. Out of 75 primaris malignant tumors of epithelial origin, 35 belonged to the "epidermoid" group (adenocarcinomas, undifferentiated carcinomas, malignant mixed tumors, squamous cell carcinoma), 20 were mucoepidermoid carcinomas, 15 adenoid cystic carcinomas and 5 were acinic cell carcinoma. Altogether, 58.7% of the treated patients do not at the moment present evidence of disease; 33.3% are dead from the disease or are alive with active disease; 5.3% are dead from other causes and 2.7% are lost to follow-up. Underlining the importance of histologic examination of the swelling by intraoperative biopsy, the authors propose a diagnostic and therapeutic protocol.

Electro-oculographic routine examination in Parkinson's disease.

The authors studied a group of 36 patients with idiopathic Parkinson's disease by electro-oculographic examination in order to evaluate the most frequent vestibular and oculomotor findings. Vestibular alterations were detected mainly in caloric nystagmus (82.9%). Hyperreflectivity was the most frequent evidence, but it does not necessarily represent the sign of a lesion. The occurrence of spontaneous and evoked nystagmus was not significant. Oculomotor findings were more interesting, as they were altered in two-thirds of the cases. Particularly, saccadic eye movements presented a "multiple step" morphology in 58.3% of the series. This saccadic disarrangement was scarcely found in neurological patients with brainstem and/or cerebellum pathology (7.7%). Moreover, in Parkinson's disease patients no other saccadic alterations typical of brainstem or cerebellum involvement were found. Such observations suggest a possible non-cerebellar origin of "multiple step". Vestibular and oculomotor findings were not significantly correlated with the clinical features of the patients.

[Otitis media in the child. Follow-up study and control of 104 cases]. / L'otite media nel bambino. Studio e controllo a distanza di 104 casi.

The authors report a case-study on 104 children admitted for many reasons to the I Department of Pediatrics of the A. Meyer Hospital in the period 1979-81. During their hospitalization, otitis media was diagnosed in all these cases. The children later underwent two check-ups including otorhinolaryngologic and tympanometric tests and in some cases an audiometric examination. A correlation between otitis media and enlarged adenoids was noticed and the results of the present case-study are compared with other international publications, following the short bibliography.