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In recent years there has been growing attention to the importance of indoor air quality on which scientist and experts have no doubts since in modern society we tend to spend most of the time in various types of indoor environments (office, private homes, etc.). Laser printers, in particular, release an aerosol into the environment including solid and liquid particles and gaseous compounds. The measurement of all these components is not practically feasible. Therefore, it is necessary to identify a marker which, when measured, shows accurately the frequency, duration and magnitude of the exposure. The measure with an optical particle counter (OPC) and a condensation particle counter (CPC) is an indicator with high sensitivity and representativeness. The major advantage of using these tools is the ability to detect the presence of ultrafine particles and also detect the particles in the liquid phase. The continuous recording of submicron particulate matter emitted during the printing activity allows to measure the exposure of personnel, while the ratio between the peak values and the values without printing activity can be used to classify the printers according to their emissivity. The particulate generated during the processes of printing has size less than 0.3 micron and therefore extends in the size range of nanoparticles (ultrafine particles less than 100 nm). These activities lead to high concentrations of ultrafine particles with a variability related to factors such as type of printer, toner, paper type, frequency of maintenance and air exchange. The concentrations of ultrafine particles in office environments can be reduced by proper choice of the printers, with the use of appropriate filtration techniques and placing the equipment away from workstations.

Hereditary periodic fever syndromes are a group of systemic disorders characterized by recurrent attacks of systemic inflammation (autoinflammation) without infectious or autoimmune cause. The hyper-IgD syndrome (HIDS) is a rare autosomal recessive inflammatory disorder characterized by recurrent fever, increased serum IgD (normal value < 100 U/ml) and generalized inflammation (lymphadenopathy, arthralgias/arthritis, abdominal complaints, skin rash, and headache). The attacks persist during the entire life although frequency and severity tend to diminish with age. HIDS is caused by specific mutations in the gene encoding mevalonate kinase, resulting in depressed enzymatic activity. At present the therapy for the syndrome is only supportive. Other than HIDS, other hereditary systemic inflammatory disorders have been described: the Familial Mediterranean Fever, the tumour necrosis factor receptor associated periodic syndrome (TRAPS), a disease related to the mutations of one of the TNF receptors, the Familial Cold Urticaria and the Muckle-Wells syndrome. The differential diagnosis with other causes of periodic fever is crucial for assessing appropriate management and treatment.

Two cases of primary large B-cell non-Hodgkin's lymphoma are described. Both cases had typical symptoms: a sudden growth of thyroid in these female patients at their sixth decade of life. The differential diagnosis between undifferentiated carcinoma and lymphoma of the thyroid, uncertain with clinical and ultrasound examination, was defined by a fine needle biopsy (FNAB). Patients underwent a radical resection which permitted a correct cancer staging even in the presence of laterocervical lymph nodes swelling. Histological examination of the surgical specimen confirmed the presence of a large B-cell non-Hodgkin's lymphoma while the immunophenotypical analysis detected the expression of the common leukocytic antigen and B-correlated antigens CD20, CD74, CDW75 and CD79A. In both cases chemotherapy and radiotherapy were carried out.

In previous studies we reported evidence of subclinical exocrine pancreatic insufficiency in primary or secondary Sjögren's syndrome (SSI, SSII) and rheumatoid arthritis (RA). In present study we evaluated the occurrence of pancreatic duct antibodies (PDA), and their relationship to exocrine pancreatic function in 36 women. Of these patients, 12 were classified as SSI, 12 as SSII, and 12 as RA. Exocrine pancreatic function was evaluated using the Secretin-Caerulein test (S.Cae test). The indirect immunofluorescent technique was used to evaluate patient sera for PDA. S.Cae test results, compared to controls, showed a statistically significant decrease in duodenal juice volumes, bicarbonates and enzymes in 58.3% of SSI, in 58.3% of SSI and in 30% of RA, according to our previous trials. PDA were found in two patients, the former with SSI and the latter with SSII, both asymptomatic with regard to pancreatic diseases but with impaired exocrine pancreatic function as evaluated by S.Cae test. We discuss the possible causes of these results.

Materials and Methods: Sixty-seven patients with Crohn's disease underwent surgery in our department in the period 1989-1996. In this paper we evaluated only the first 20 patients. Ten were female and 10 male. There was single localization in 13 patients and multiple in 7. Surgery was limited to the macroscopically involved intestinal segment. Reconstruction of the intestinal tract has been carried out with a double layer polyglycolic acid end-to-end manual anastomosis., Results: We had no operative deaths and early morbidity. In the follow-up we observed 2 anastomotic recurrences respectively three and five years after the operation; none of them required surgical treatment. One patient of 20 had a colocutaneous fistula four months after operation because of the relapse of the disease at preanastomotic level., Conclusions: The results obtained in our limited experience allow us to affirm that, when elective surgery is possible, the most reliable surgical behaviour is a limited resection of the diseased segment. Quality of life improved after surgery in all patients.

The contribution of beta 2-agonist treatment per se and the effect of beta 2-agonists plus allergen exposure was evaluated in two groups of thirteen asthmatic children being treated respectively at sea level during the period of maximal allergen exposure and at high altitude in an environment free of the offending allergens. Bronchial hyperreactivity was evaluated by standardised exercise tests before and after treatment with salbutamol controlled release tablets (4 mg). Challenges were performed at the beginning and after 2 and 4 weeks of treatment. A fourth test was performed 2 days after stopping the treatment. Children treated with salbutamol at sea level (exposure to allergen) showed baseline delta PEF of 16.9 +/- 3.4 and 13.7 +/- 4.2, 20.7 +/- 4.3, 26.0 +/- 5.1 respectively for the second, third and fourth test. Children treated at high altitude showed respectively delta PEF of 34.9 +/- 5.1, 31.1 +/- 4.9, 26.5 +/- 5.4, 27.9 +/- 5.0. These data suggest that oral salbutamol per se is not responsible for an increase in bronchial responsiveness, but eventually suggest that treatment with beta 2-agonists at the same time as continued allergen exposure may be responsible for an increase in bronchial hyperresponsiveness.

Ultrasound is mandatory in the follow up of patients surgically treated for benign thyroid diseases. In this study the Authors have examined 87 patients who underwent different surgical treatments for goiter over 40 years. Ultrasound allowed a more accurate study of residual thyroid, particularly evaluating thyroid tissue morphology in symptomatic patients (43.6%) and detecting many recurrences in asymptomatic patients (37.3%). This study also confirms the advantage of a more extensive surgery to reduce recurrences without increasing complications.

The recent literature on prognostic factors in breast cancer was examined with regard to: early or delayed diagnosis, age, menopause, tumour site and size, histological type and grading, involvement of lymph nodes, clinical stage, local recurrence, and distant metastasis. With respect to prognostic factors connected with the response to therapy, the following points were considered: menopause, involvement of lymph nodes, dimensions, clinical stage, free interval, performance and loss of weight, particular sites of metastasis, radiotherapy, oestrogen receptors, prior endocrine management, and certain body fluid parameters (haemoglobin, total lymphocytes, platelets, and white cells, albumin, LDH, SGOT, alkaline phosphatase, blood bilirubin and calcium). Radiotherapy appears to make patients less responsive to subsequent antiblastic treatment, whereas premenopausal status, good psychological and physical efficiency, and prior endocrine management seem to play a positive role in the response to chemotherapy.

Sera obtained from 212 patients with rhinopathy and/or asthma of allergic origin (pollens and/or mites) and from 87 apparently healthy controls were studied for the presence of organ and non organ specific autoantibodies. These were determined by indirect immunofluorescence techniques (5) using test tissue from monkeys (thyroid) and rats (stomach, liver and kidney). Two groups were matched for age and sex and the tests were performed using the double-blind method. The incidence observed was not dissimilar to that detected in healthy subjects, with the exclusion of smooth-muscle antibodies. These were present to a lesser extent in patients with respiratory allergies (0.94%) in contrast with the incidence of 5.73% in normal subjects (P less than 0.01). On the basis of our findings, it seems possible to hypothesize that allergic patients have a lesser tendency to autoimmune diseases because the immune system is committed to the IgE-mediated immunoreactions. In conclusion, autoantibodies do not seem to play a role in the pathogenesis of respiratory allergies to inhaled allergens.

After a brief examination of the recent literature on plasma cell leukemia, the Authors describe the clinical features and the ultrastructural findings of the peripheral blood plasma cells, examined with transmission (T.E.M.) and scanning (S.E.M.) electron microscopes, of two patients with acute plasma cell leukemia. Both of them had a previous history of myeloma. T.E.M. confirmed the diagnostic value of the asynchronous plasma cells, and S.E.M. showed the characteristic microvilli and blebs, previously observed.

After a brief examination of the recent literature on non-secretory multiple myeloma, the Authors describe the immunohistologic study (peroxidase-antiperoxidase method) of a case of truly non producing plasmacytoma, interesting because of the presence of a small polyclonal plasma cell population within the neoplastic clone. Several possible explanations are considered.

The following parameters were studied in 41 Durie & Salmon staged patients with multiple myeloma: M component, bone lesions, marrow plasma cell %, Hb, leukocytes/mm3, lymphocytes/mm3, platelets/mm3, blood calcium, serum albumin, blood creatinine, BUN, total blood cholesterol. Linear correlation was adopted for the relation between two variables, using Pearson's coefficient, and Student's t test for unpaired data for comparison between the means. A significant (slight to excellent) inverse correlation was noted between total blood cholesterol and the M component. There was also a significant difference between the 1st and 2nd stage of the disease in this respect (P less than 0.05), between the 1st and 3rd (P less than 0.01), and between the 1st and the 2nd and 3rd combined (P less than 0.01). Progress of the disease appears to result in a fall in blood cholesterol. This parameter may be of assistance in differentiating slow-progressing forms from the more aggressive forms requiring treatment. The reasons for this change are discussed. Since cholesterol is an essential part of the cell membranes, attention is given to theories postulating a disorder in intracellular membrane metabolism.

The present retrospective study reports the results of a survey conducted on 130 patients given elective abdominal and urinary surgery together with the cultivation of routine intraperitoneal drainage material. The parameters considered were the type of pathology, the condition of the wound, any serohaematic material drained, the presence and duration of postoperative temperature increases and pre and post-operative leukocytosis levels. These parameters were considered in relation to the positive or negative results of the cultural examination. The aim was to demonstrate that routine drainage causes no appreciable infective or mechanical complications.

Immunoconglutinins (Ic) are a group of predominantly IgM antibodies formed towards antigenic determinants exposed in fixed complement components (C3b and C4). Ic production is stimulated by bacterial and viral infections; elevated titers were also found in a number of other diseases involving completement-fixing reactions in vivo. High titers have been associated with the infectious morbidity within a particular population. The object of this investigation was to determine the correlations of autostimulated Ic titre with several parameters in 100 atopic nondesensitized subjects with respiratory allergies and in 140 non atopic, healthy, individuals. Eighty of them had rhinitis and/or conjunctivitis, 9 asthma and 11 rhinitis and asthma. All the atopics were studied also after at least 6 months of specific immunotherapy. None of the subjects received any other therapy at the time of study. Atopic subjects with high titers of Ic are significantly more numerous than controls, without significant correlation with the kind and beginning of atopic syndrome, and with immunotherapy. These results might be attributed to a higher incidence of infections in the atopic population. The Ic might play an important role in the immunoregulation involving complement system.