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Purpose: Evaluation of computed tomography (CT) pulmonary angiography parameters revealing pulmonary embolism (PE) severity with particular attention to pulmonary obstruction indexes. Comparison with clinical and hemodynamic data and determination of predictive role in the development of chronic pulmonary heart disease., Materials and Methods: This retrospective study analyzes 45 not consecutive patients from November 2007 to December 2008 with CT angiography diagnosis of acute PE. Included in the study are patients at the first documented episode of acute PE, with 6 month follow-up. Patients with severe pre-existent cardiopulmonary pathology or neoplastic diseases were excluded from the study. CT angiography evaluated right ventricular (RV)/left ventricular (LV) ratio, obstruction index according to Qanadli and Total Clot Burden (Ghanima score). PE indexes were compared with Troponin I measurement and echocardiography result; at last hospitalization and intensive care time were reported., Results: A significant association was found between Ghanima and Qanadli score: the two indexes are equivalent in quantification of pulmonary arterial obstruction (p<0.001). Among others CT parameters, the new Ghanima score evidenced the best accuracy to detect patients evolving to chronic pulmonary heart disease (76%). This value is higher than that of echocardiography (71%). Troponins showed highest accuracy (82%)., Conclusions: Ghanima score can be used in emergency CT angiography diagnosis as prognostic marker for a quickly risk stratification of pulmonary heart disease or death in patients with acute PE. This approach allows to obtain, with just one test, both the diagnosis and a rather accurate acute PE risk stratification.

Functional MRI is a new and exciting tool enabling non-invasive assessment of renal function. Diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), blood oxygen level-dependent (BOLD) MRI, and magnetic resonance elastography (MRE) are some of the techniques under investigation. In this article we review the basic principles of these techniques, their possible applications, and their limitations.

A key problem in clinical practice and research regards effective communication and comparison of results. This is particularly difficult between different specialities that use different definitions and terms for lower urinary tract dysfunction. We therefore tried to adapt the document on the "Standardisation of Terminology of Lower Urinary Tract Function" prepared by the International Continence Society for radiologists who need to acquire some basic clinical experience in the interpretation of the symptoms and signs encountered during simple urodynamic studies in order to increase the effectiveness of imaging studies of the lower urinary tract in men and women.

The effectiveness of t,t-muconic acid (t,t-MA) has been investigated as indicator of benzene exposure in workers of an oil refinery. 196 blue collar workers that operate in the field and 25 white collar workers who work in administration have been studied. Workers had not chronic diseases; all workers resulted fit to work. The environmental monitoring, effected with personal and fixed samplers (141 samplings), has shown that benzene air levels were lower than 170 mcg/m3. Biological monitoring was performed with measurements of blood benzene, urinary t,t-MA and urinary phenols. Each worker has been questioned regarding smoking habit, consumption of food containing sorbic acid and non-occupational exposure to benzene. Values of biological index were: t,t-MA 88 +/- 94.1 mcg/g cr, phenols 17.7 +/- 2.9 mg/g cr, blood benzene 25.4 +/- 4.3 ng/l. No significant differences were found between blue and white collars respect t,t-MA, phenols, blood benzene, non-occupational exposure to benzene, smoking habit, consumption of food containing sorbic acid. A meaningful correlation was found between the t,t-MA and the ingestion of the number of foods containing sorbic acid (r = 0.87). The results confirm that the t,t-MA seems incapable to distinguish occupationally exposed workers, at low levels of benzene exposure, from unexposed.

Improved detection methods for diagnosis of asymptomatic malignant pleural mesothelioma (MPM) are essential for an early and reliable detection and treatment of this disease. Thus, focus has been on finding tumour markers in the blood. 94 asbestos-exposed subjects, 22 patients with MM, and 54 healthy subjects were recruited for evaluation of the significance of 8-hydroxy-2'-deoxy-guanosine (80HdG) in white blood cells and plasma concentrations of soluble mesothelin-related peptides (SMRPs), angiogenic factors (PDGFbeta, HGF, bFGF, VEGFbeta), and matrix proteases (MMP2, MMP9, TIMP1, TIMP2) for potential early detection of MM. The area under ROC curves (AUC) indicates that 80HdG levels can discriminate asbestos-exposed subjects from controls but not from MPM patients. Significant AUC values were found for SMRP discriminating asbestos-exposed subjects from MPM patients but not from controls. VEGFbeta can significantly differentiate asbestos-exposed subjects from control and cancer groups. No diagnostic value was observed for MMP2, MMP9, TIMP1, TIMP2. The sensitivity and specificity results of markers were calculated at defined cut-offs. The combination of 80HdG, VEGFbeta and SMRPs best distinguished the individual groups, suggesting a potential indicator of early and advanced MPM cancers. The combination of blood biomarkers and radiographic findings could be used to stratify the risk of mesothelioma in asbestos-exposed populations.

Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased.

Three years from the approval of the law safeguarding pregnant workers and the foetus (D.Lgs. 151/01), awareness of these provisions and management of pregnancy in relation to their job were assessed in 160 pregnant workers using a questionnaire. Respondents were 147 subjects, mean age 29.4 +/- 4.6 years, employed as blue-collar workers (n=26); white-collar workers (n =47); health workers (n=16); school workers (n=14); workers in shops (n=6); policewomen (n =3) housewives (n=25). Moreprovisions and most of them took advantage of maternal leave. Pre-term birth (16%) and low birth weight (9%) were the mostfrequent events. There were no neonatal diseases. Blue-collar, white-collar work and work in the home were not associated with pre-term births or low birth weight. Analysis based on the fathers' job characteristics did not yield significant associations either. Although the small size of our sample does not allow to draw firm conclusions, it is interesting to note that more than 10% of respondents were not aware of the provisions protecting workers' pregnancy.

Background: Brucellosis is a world-wild zoonosis of bacterial origin. In Italy, where reporting of the disease is mandatory, the incidence is 2.1 cases every 100,000 inhabitants, but tends to be higher in southern regions. However, the incidence decreased from 1999 to 2002., Cases: Five cases of occupational brucellosis, four slaughter-house operators and one veterinary surgeon, were reported in a slaughter-house in south-eastern Sicily employing 15 people., Results: A study of the slaughtering process for sheep and goats led to identification of 23 different operations, some of which involved greater probability of infection: animal consignment; unloading and leading animals from the stable to the trap; strangling and bleeding; skinning and removal of mammary glands; removal and processing of abdominal viscera; post-mortem examination; mobile equipment and facility maintenance, and washing/disinfection. All affected workers had participated in one or more of these operations., Conclusion: Eradication of brucellosis in stock-farms should lead to the disappearance of the human disease, since the two are closely related. Despite legislation aimed at eradicating brucellosis in cattle, which has been in force since 1992, the prevalence of the human disease has risen in Italy, especially in Sicily. Within the framework of prevention, occupational physicians should exercise specific surveillance of brucellosis risk by carefully examining the plasma antibody content of workers involved in the slaughtering process. Occupational health physicians should also provide ad hoc information regarding the infectious agent and modes of transmission during slaughtering operations as well as specific training in the use of protective equipment, which is the only way of providing protecting from contagion by infected animals.

Thymulin is a thymic hormone that being activated by binding a zinc ion promotes differentiation and several functions of T lymphocytes. It has been demonstrated only in experimental animals that metallic lead (Pb) is able to cause adverse effects on thymocyte number and function. The objective of this study is to evaluate the plasmatic level of active thymulin of 58 male workers being exposed for more than one year to low lead doses with respect to 59 male never exposed workers. All these were subjected to anamnesis collection, medical examination and determination of blood lead (PbB), plasmatic lead (PbPl), plasmatic thymulin, urinary lead (PbU) and urinary zinc (ZnU) levels. The mean plasma concentration of active thymulin was significantly lower in lead exposed than in non exposed workers. Active thymulin was also significantly and negatively correlated to PbB, PbPl and PbU level and resulted to be significantly and negatively influenced by PbB. Lead exposed workers had slightly higher zinc concentration in urine than non exposed workers, increasing ZnU levels by class of PbB. It is the first time that a toxic effect of lead on plasmatic active thymulin levels is demonstrated in humans, particularly in occupationally exposed workers. This study opens perspectives for further research that would both confirm the results and verify the mechanisms of action of lead on thymulin either direct or indirect and the possible role of zinc.

Recent legislation regarding the safety of workers aboard fishing vessels requires the appointment by ship owners of a Reference Physician in charge of health surveillance, preventive inspections and related tasks. As maritime workers, especially fishermen, have always been excluded from legal protection of occupational health, there are no exhaustive data on the incidence of their occupational disease. Several epidemiological studies of fishermen have evidenced a high prevalence and incidence of occupational conditions, among which noise-related hypoacousia. We report data of a phonometric survey conducted aboard six fishing vessels carrying a crew of less than six fishing in the mid-Adriatic. Measurements were performed during fishing and navigation aboard five vessels fitted with a fixed-pitch propeller and during fishing only aboard one vessel fitted with an controllable pitch propeller. Measurements were conducted: 1) in the engine rooms; 2) in the work area on deck; 3) at the winch; 4) in the wheelhouse; 5) in the mess-room and kitchen; 6) in the sleeping quarters. Results show that the equivalent sound pressure level in the engine rooms consistently exceeded 90 dBA on all vessels. The speed of the vessels fitted with the fixed-pitch propeller is 3-4 knots in the fishing phase and around 10 knots during navigation to and from the fishing grounds; noise emission is lower with the former regimen because of the smaller number of engine revolutions per minute. Our survey demonstrated considerably different noise levels in the various areas of vessels. One key element in workers' exposure, the tasks assigned and the environmental working conditions is of course the type of fishing in which the vessel is engaged. Further phonometric studies are required to assess the daily level of exposure per crew member, which represents the reference for the noise-related risk of each subject. Knowledge of the sound pressure levels in the work environment and the length of daily exposure of each crew member will allow to assess the level of occupational exposure and consequently enact the proper prevention and protection measures by the Reference Physician.

Occupational exposure at low doses of lead induces a significant increase of TNF-alpha plasma levels. Recently has been showed the crucial role on atherosclerosis origin of this pro-inflammatory cytokine. It is assumable a contribution of lead in atherosclerosis course in exposed subjects.

Under two different experimental conditions (cleavage of C5 complement fraction and human endothelial cells cultures), crystalline and amorphous silica samples were tested. Different biological reactions were achieved.

Hand injuries exceed 20% of all occupational injuries. This article reviews the history of 237 hand injuries mostly occurred in craftsmen and farmers. The results allow us to make some considerations on the role of occupational physician in their prevention.

Background: Rhizarthrosis of the hand secondary to job-related static-dynamic stress is a rare occupational condition characterised by secondary osteoarthrosis., Objectives: We report 5 clinical cases of female ironers employed in small-scale laundries, who after more than 10 years on the job developed pain in the right thumb. Disease onset may have been favoured by the continuous functional stress exerted on the joint., Methods: Clinical examination, hand X-rays and ultrasonography of the trapezio-metacarpal joint led to the diagnosis of rhizarthrosis. The electromyographic and biomechanical analysis of work tasks was conducted by simulating normal ironing activity., Results: Patient history and electromyographic and biomechanical data showed a close causal relationship between age, job and diagnosis., Conclusions: In the case of workers over 50 years of age whose jobs have the characteristics described here, Finkelstein's test should be performed on occasion of occupational health surveillance to screen for the arising of the disease.

Isocyanates, particularly Toluene Diisocyanate (TDI), have been the most common cause of occupational asthma for decades. Fifty workers with a diagnosis of isocyanate-induced asthma were followed up for a mean period of 8.4 years. Pulmonary function testing for FVC and FEV1, allergological tests, nonspecific bronchial challenge to methacholine and specific bronchial challenge to isocyanates were performed at the time of diagnosis and during follow-up. Data on symptoms and drug response were rated on a scale. Patients were subdivided into two groups based on persistence of (A; 13 patients) or removal from (B; 37 patients) isocyanate exposure. There were no significant differences in any characteristic between the two groups at the time of diagnosis. At follow-up, group B subjects showed significant improvement in symptoms, consequent reduction in use of medications and increase in PD20. None worsened, sixteen (43.3%) remained stable, twelve (32.4%) improved and nine (24.3%) became asymptomatic. The latter subjects were generally younger, they had shorter duration of symptoms and exposure to the agents, and longer removal from exposure, although none of these differences was significant. In 67% of cases they had an immediate reaction to TDI challenge. By contrast, the condition of group A patients deteriorated significantly during the follow-up period in terms of symptoms, pulmonary function parameters, PD20 and use of medications. Overall, seven subjects (53.8%) worsened during follow-up and none improved. Group B subjects were further divided into subgroups B1 and B2 based on duration of removal from exposure: B1 < 10 years, B2 > or = 10 years. There were no significant differences between the two subgroups, even though PD20 was higher in B2. The present study confirms that early diagnosis and immediate removal from exposure are crucial, though not always sufficient, for a favourable evolution of the disease.

In a thorax surgery domain the V.A.T.S. is the important new treatment for particular thorax diseases. authors would like to show the advantages using V.A.T.S. for the therapy of peripheric lung nodules, also using a CT-guided extemporary cytologic tipization. The CT-guided biopsy and then an extemporary cytologic tipization, represent the first steps for lung nodules candidated to the V.A.T.S. These lesions have got singular aspects: benign lesions, methastasts, specific and unknown lesions. In that way traditional surgery is for primitive lung neoplasm in order to have a certain oncologic solution and because it is possible to test the complication of large resection. The CT-guided cytologic tipization can be done by a particular kit invented from the authors: a flessible needle works like an anchor and is a good repair of a nodule in order to proceed with V.A.T.S. This method has been utilized for 45 patients with good results.

The histopathologic study of 24 specimens of radiated rectal cancers suggested new histologic criteria to define tumor regression after neo-adjuvant therapy. Better than traditional UICC staging system (pTNM), such criteria have identified those patients at higher risk of failure. Moreover, the study has confirmed the known difficulties of imaging studies in assuring an accurate staging of radiated rectal cancer before surgery.

We have studied a sample of commercial sepiolite and two samples of commercial vermiculite, which are clay minerals advised to replace asbestos. We have in vitro tested their abilities to produce reacting oxygen species (ROS) after they have been added to suspension of human polymorphonuclear leukocytes and bovine alveolar macrophages. The behaviour of sepiolite and vermiculite have been compared with those of asbestos fibres given by Unione Internationale contre le Cancer (UICC) and with kaolin and illite. Sepiolite was not able to induce ROS production, while vermiculite was able to induce a relevant ROS generation, even if the values were always lower than that obtained from chrysotile. Kaolin was able to generate a high ROS production.

We have studied a sample of commercial sepiolite and two samples of commercial vermiculite which are advised to replace asbestos, and we have in vitro tested their abilities to activate the complement and to lyse erythrocytes. Their behaviours has been compared with those of asbestos fibres given by Union Internationale Contre le Cancer (UICC) as reference standards. We have first measured the specific surface area and the weight of each mineral. Sepiolite has been inactive in complement activation and little able to lysis red blood cells on the base of surface area; on the base of the weight it has been unreactive in complement activations but very reactive in red blood cells lysis. We believe that in the in vitro assays to evaluate the biological effects of the substitutes of asbestos it is very important to considerate as the weight and as the specific surface are of each clay mineral.

The paper analyses the rate and severity of accidents in a shipyard in the period 1 January-31 December, 1987. Data were collected by consulting the shipyards' accident register, which recorded each single case of injury, and the medical certificates sent to the shipyard management by the worker's physicians. The shipyard employed 996 blue collar workers and 210 white collar workers in 1987, all of whom were subject to obligatory industrial accident insurance. For each of the 1375 accidents that occurred in the period under study, the time, place and cause of the accident and the type and site of the injury were recorded. The aim of the statistical analysis of the data was to assess the risk in each area of the shipyard and the causes of the accidents in relation to the work station and job. The severity rate of injury increased in those workers recently assigned to new jobs; climate had a negative influence since accidents were more frequent in spring/summer. Accident prevention measures are suggested that can be achieved by improving work organisation and by a more appropriate use of personal safety devices.

Blood lead concentration was measured from 1979 to 1989 in 1148 subjects (834 males and 314 females) living in Regione Marche of Italy. Blood concentration lowered in the time from 34.6 mcg/100ml in 1979 to 12.3 mcg/100ml in 1989. The greatest decrease was measured after 1982 and this appears to be related to the reduction, on the basis of CEE dispositions, of lead concentration in gasoline. Blood lead concentration was higher in males than in females (18.2 mcg/100ml vs 16.5 mcg/100ml) and in people living in the cities with more than 50.000 inhabitants (18.3 mcg/100ml). The smoking habit, the wine assumption and the use of canned foods do not influence blood lead concentration, which is instead increased in subjects which usually drink water drawn from artesian wells.

Using a lucigenin-dependent chemiluminescence the authors have measured the "respiratory burst" in polymorphonuclear cells from psoriatic patients and controls. Measurements were performed under stimulation with zymosan, phorbol 12-myristate 13-acetate and latex beads. It has been revealed that the response after stimulation with zymosan increased although there was no significant difference between patients and controls, while the response after stimulation with phorbol 12-myristate 13-acetate and latex beads was significantly increased. Our results suggest an enhanced metabolic activity of polymorphonuclear cells induced by stimuli acting independently from cell-membrane receptors. Therefore an enhanced excitability of polymorphonuclear leukocytes of psoriatic patients is supposed.

A case of asthma due to a plastic blowing agent - azodicarbonamide - is discussed. Administration of disodium cromoglycate before exposure decreases the grade of bronchoconstriction: we suggest an immunopathological mechanism involved in the asthma.

Since previous studies reported that in vitro some proteins and phospholipids were absorbed by asbestos fibres, namely chrysotile, in this study, man made filamentous glass fibers are been tested in vitro at the presence of proteins. The objective was to obtain evidence to evaluate whether continuous glass fibers have a behaviour similar to asbestos fibres. A sample of chrysotile fibres was used as control. Uptake of bovine serum albumin and horse spleen ferritin on these continuous glass fibres has been observed. However on glass fibres adsorbed less proteins per weight unit (22 mg/g and 12 mg/g respectively for albumin and ferritin) than asbestos chrysotile fibres (42 mg/g and 49 mg/g respectively for albumin and ferritin).

During a cross sectional epidemiologic study the cholesterol and triglyceride plasmatic levels were measured in 207 workers employed in an oil refinery. Our results show high levels both for cholesterol and triglyceride. Emphasis has been laid on the serious dietary and hygienic problems for these workers. The finding of hyperlipidemia as well as obesity and over-weight do not seem to be related to exposure to any occupational chemical hazard.

The PMNs of fourteen patients undergoing general anesthesia for surgical operations were examined to determine whether abnormal chemotaxis occurs during these procedures. Neutrophil chemotaxis was determined immediately before anesthesia and after the anesthetic somministration. Anesthetic agents included 0.2-1% enflurane, 0.3-1% halothane or N20-02 (60:40). Neutrophil chemotaxis was reduced an average of 10.9% by fluorinated anesthetics, no significant modification (+8.1 +/- 13.0%) was detected by N20-02.