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The term tropical ulcer, as applied to bone pathology, describes the specific pathologic phenomenon of the presence of a well-defined osteomatous shelf formation on the anteromedial aspect of the tibia. Despite the appellation 'tropical,' this pathology is not geographically limited to tropical regions, although it has not previously been reported from continental Europe. Observations of a 4583 BP burial from the Tanaro River area of Northern Italy represent the first such case. Dating of the site to the time of climate change at the end of the first Glacial suggests that hot-warm, humid conditions may have allowed the occurrence of this bone pathology, the first observed in continental Europe. A second explanation is the possible migration of an individual to Italy from an area that is more conventionally considered tropical. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The human T-cell leukemia virus type 1 (HTLV-1) was first described in 1980. It is spread in highly endemic regions in the world, such as the Southwestern part of Japan, sub-Saharan Africa and South America, Caribbean, Middle East, and Australo-Melanesia regions. HTLV-1 causes adult T cell leukemia and is associated with many inflammatory conditions, most notably HTLV-1-associated myelopathy/tropic spastic paraparesis. HTLV-2, first isolated in 1982, was recognized as a common infection in intravenous drug users, but a clear association with disease remains elusive. The first estimate of HTLV-1-positive individuals worldwide, in 1993, was around 10-20 millions. Due to the lack of global population-based prevalence studies, this is considered an underestimate at the moment. Furthermore, HTLV-1 prevalence in Europe is impacted by changing migration flows. Particularly, no data on HTLV-1 prevalence in the general population in Italy are available. Here, we report a systematic literature review of studies conducted in Italy on HTLV-1/2 from 1980 to 2023. Based on the criteria we adopted a total of 426 publications were found (64 reviews, 99 epidemiological, and 263 translational studies). The contents of some representative publications are summarized and discussed. Moreover, an approximate estimation of about 26,000 HTLV-1 positive foreigners living in Italy was obtained from updated data of foreigners from each single country officially registered as resident in Italy and from data on HTLV-1 prevalence among the general population in the corresponding countries.

The COVID-19 pandemic is threatening health systems worldwide, requiring extraordinary efforts to contain the virus and prepare health care systems for unprecedented situations. In this context, the entire health care workforce must be properly trained to guarantee an effective response. Just-in-time training has been an efficient solution for rapidly equipping health care workers with new knowledge, skills, and attitudes during emergencies; thus, it could also be an effective training technique in the context of the response to the COVID-19 pandemic. Because of the unexpected magnitude of this health crisis, the health care workforce must be trained in 2 areas: (1) basic infection prevention and control, including public health skills that are the core of population-based health management and (2) disaster medicine principles, such as surge capacity, allocation of scarce resources, triage, and the ethical dilemmas of rationing medical care. This Perspective reports how just-in-time training concepts and methods were applied in a tertiary referral hospital in March 2020, during the COVID-19 pandemic in Northern Italy, one of the hardest hit places in the world. The COVID-19 just-in-time training was designed to provide hospital staff with the competencies they need to work proficiently and safely inside the hospital, including an understanding of the working principles and standard operating procedures in place and the correct use of personal protective equipment. Moreover, this training was intended to address the basic principles of disaster medicine applied to the COVID-19 pandemic. Such training was essential in enabling staff to rapidly attain competencies that most of them lacked because disaster medicine and global health are not included in the curricula of Italian medical and nursing schools. Although a formal evaluation was not performed, this is a useful example of how to create just-in-time training in a large hospital during a crisis of an unprecedented scale., (Copyright © 2020 by the Association of American Medical Colleges.)

Background and Aims: Dysfunctional eating might impact on the management and metabolic control of type 2 diabetes (T2DM), modifying adherence to healthy diet and food choices., Methods and Results: In a multicenter study, we assessed the prevalence of dysfunctional eating in 895 adult outpatients with T2DM (51% males, median age 67, median BMI 30.3 kg/m 2 ). Socio-demographic and clinical characteristics were recorded; dysfunctional eating was tested by validated questionnaires (Eating Attitude Test-EAT-26, Binge Eating Scale-BES; Night Eating Questionnaire-NEQ); food intake and adherence to Mediterranean diet were also measured (in-house developed questionnaire and Mediterranean Diet Score-MDS). Obesity was present in 52% of cases (10% obesity class III), with higher rates in women; 22% had HbA1c ≥ 8%. The EAT-26 was positive in 19.6% of women vs. 10.2% of men; BES scores outside the normal range were recorded in 9.4% of women and 4.4% of men, with 3.0% and 1.5% suggestive of binge eating disorder, respectively. Night eating (NEQ) was only present in 3.2% of women and 0.4% of men. Critical EAT and BES values were associated with higher BMI, and all NEQ + ve cases, but one, were clustered among BES + ve individuals. Calorie intake increased with BES, NEQ, and BMI, and decreased with age and with higher adherence to Mediterranean diet. In multivariable logistic regression analysis, female sex, and younger age were associated with increase risk of dysfunctional eating., Conclusion: Dysfunctional eating is present across the whole spectrum of T2DM and significantly impacts on adherence to dietary restriction and food choices., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: In 2004 we performed the first robot-assisted laparoscopic prostatectomy (RALP) at Aosta, Italy., Methods: Data about our first 150 RALPs are presented., Results: Mean patient age was 65.2 (range 51-75) years; mean preoperative PSA level 7.9 (range 1.8-25.0) ng/ml. Nerve sparing was performed in 109 cases (72.7%) with lymph nodes dissection in 27 (18.0%). Operative time: patients 1-50, mean 213.3 (range 185-290) min; patients 51-100, 207.3 (range 185-335) min; patients 101-150, 171.7 (range 123-270) min. Two procedures were converted to open. Mean blood loss was 235 (range 20-1000) ml with two blood transfusions. One patient was reoperated for anastomotic leakage. Four patients were treated by colostomy and rectal suture for rectal injury (n = 3) or recto-urethral fistula (n = 1). The overall complication incidence was 13.3% (20 events), while mortality was nil., Conclusions: The incidence of complications is slightly higher than in major pilot centres but it is comparable, hence RALP also appears feasible in our italian peripheral centre.

Aim: The literature about pediatric robotic-assisted laparoscopic dismembered pyeloplasty (RALDP) is poor and limited to few series. This article reports the initial pediatric experience comparing it with the major series., Methods: Between January 2006 and January 2007 at Umberto Parini Hospital in Aosta three patients were treated for left RALDP by a single senior surgeon., Results: Mean age of the patients was 16.1 years (range 14.9-17.0). Mean body mass index was 21.6 kg/m2 (range 18.7-26.9). All patients were treated for left RALDP. Mean operative time (OT) was 160 minutes (range 120-185). Blood loss was null in all procedures and no interventions were converted to open. Mean postoperative hospitalization was 6.3 days (range 5-8). No intra- or postoperative complications occurred., Conclusions: This short series demonstrates that RALDP is feasible in adolescents as well and in a peripheral Centre high skilled in adult robotic urology. The OT is excellent in comparison with other series. A preliminary experience in adult robotic surgery and an initial collaboration with urologists for adults are strongly recommended.

Study Objective: The Italian Survey of the Dying of Cancer (ISDOC) was undertaken to evaluate the experiences of Italian people dying from cancer during their last three months of life in all settings of care., Study Design: A two-stage probability sample was used to estimate end-of-life outcomes of about 160 000 Italian cancer deaths. In the first stage, 30 of the 197 Italian Local Health Districts (LHD) were randomly selected after stratification. In the second stage, a fixed proportion of cancer deaths was randomly drawn from each LHD, and 2000 death certificates of patients who died of cancer were identified. The non-professional caregivers were identified and interviewed using a semi-structured questionnaire derived from the Views of Informal Carers--Evaluation of Services (VOICES)., Results: Caregivers were successfully identified for 95% of the sample (n=1900). The caregiver was the child (42.7%), the spouse (36.5%), another family member (17.3%), or a friend (1.5%). Only 3% of the sample had no non-professional support. An interview was obtained for 1289 (64.5%) of the sample, at a median time of 234 days after death (range: 103-374). Higher response rates were associated with home death (67.7%) and with a higher education (>70%). Conversely, a lower response rate was observed when the caregiver was the spouse (56.2%). Response rates ranged from about 80% for letters sent four to six months after the patients' death to about 60% for letters sent after eight months or more. A descriptive analysis of refusals, based on the transcripts of the telephone calls, allowed classification of 61% of refusals for at least one of the two dimensions examined: caregiver psychological suffering and quality of care received by the patient. Psychological suffering was present in 99% of refusals examined for this dimension (48%). Conversely, a poor quality of care was reported by 63% of the refusals examined for this dimension (23%)., Conclusion: The ISDOC survey provides a representative picture of the needs and problems associated with the last three months of life of Italian cancer patients.

S-Phenylmercapturic acid (S-PMA), is a urinary metabolite of benzene, thought to be derived from the condensation product of benzene oxide with glutathione. S-PMA may be determined by GC, HPLC (UV or fluorescence detection), GC-MS, LC-MS/MS or immunoassays. The limit of sensitivities of most of these techniques is 1 microg/l urine or below. It has been suggested that S-PMA may have value as a biomarker for low level human exposure to benzene, in view of the facts that urinary excretion of S-PMA has been found to be related to airborne benzene in occupationally exposed workers, and that only low background levels of S-PMA have been found in control subjects. We have evaluated the use of S-PMA as a biomarker, using a commercially available analytical service, in a multicentre European study of populations exposed to varying levels of benzene, in Italy (Milan, Genoa) and in Bulgaria (Sofia). These were filling station attendants, urban policemen, bus drivers, petrochemical workers and referents (a total of 623 subjects). S-PMA was measured at the end of the work shift by an immunoassay procedure. Urinary benzene (in Milan only) and the benzene metabolite trans,trans-muconic acid (t,t-MA) were measured before and after the work shift. Air-borne benzene was measured as a monitor of exposure. Urinary benzene was the most discriminatory biomarker and showed a relationship with airborne benzene at all levels of exposure studied (including groups exposed to <0.1 ppm benzene), whereas t,t-MA and S-PMA, as determined by immunoassay, were suitable only in the highest exposed workers (petrochemical industry, geometric mean 1765 microg/m3 (0.55 ppm) benzene). All three biomarkers were positively correlated with smoking as measured by urinary cotinine).

Background: A historical cohort mortality study was conducted among 3984 shipyard workers assigned to ship repair, refitting, and construction in the harbor of Genoa, Italy, between 1960 and 1981. These workers were exposed to asbestos fibers, welding fumes and gases, silica dust, polycyclic aromatic hydrocarbons, and solvents., Methods: Workers were classified in 20 different job-titles depending upon the type of activity. Standardized mortality ratios (SMRs) were computed using male residents of the Province of Genoa as the referent population., Results and Conclusions: For the whole cohort significantly increased SMRs were detected for all causes, all cancers, liver, larynx, lung, pleural and bladder cancers, respiratory tract diseases, and cirrhosis of the liver. The analysis by job-title showed increased SMRs not only for pleural cancer, but also for lung, laryngeal cancers and respiratory tract diseases in occupations entailing heavy asbestos exposure. Bladder and liver cancers and liver cirrhosis mortality also appeared to be related to occupational exposure., (Copyright 2001 Wiley-Liss, Inc.)

Pesticides are used to control pests and improve agricultural production. Despite their selectivity of action, a number of agrochemicals have been reported to be genotoxic using the (32)P-DNA postlabeling assay. Greenhouse floriculturists are suspected of being heavily exposed to agrochemicals during loading, mixing, and application of pesticides, as well as during manual activities by continuous contact with flowers and ornamental plants. We analyzed the DNA adduct formations in the white blood cells (WBCs) of 57 nonsmoker greenhouse floriculturists and 33 nonsmoker age-matched referents residing in the Western Liguria Region, Italy-the most important Italian greenhouse floriculture area. The averages of DNA adducts, expressed as relative adduct labeling (RAL), were 8.50 x 10(9) +/- 1.98 (SE) in floriculturists and 2.17 x 10(9) +/- 1.05 (SE) in referents. DNA adducts were significantly higher in floriculturists than in controls after adjustment for age and gender (P = 0.007). A specific adduct pattern, with up to six different spots, was observed in 60% of floriculturists, while no adducts were generally detected in controls. Our study represents an important contribution to the correct evaluation of the potential health risk associated with floriculture activity and supports the adoption of measures ensuring pesticide exposure reduction in greenhouses., (Copyright 1999 Wiley-Liss, Inc.)

Atmosphere in urban areas may be polluted by a number of combustion sources, including industries, vehicle traffic, and residential heating. Traffic police constitute a group of workers that is highly exposed to urban pollutants, especially those from motor vehicle exhaust. We conducted a biomonitoring study to simultaneously measure in 34 nonsmoking police officers and in 36 nonsmoking office workers, as referents, the individual benzo(a)pyrene [B(a)P] exposure using personal samplers and the formation of DNA adducts in peripheral WBCs using 32P-postlabeling techniques. Our results show that the police officers were exposed to significantly higher levels of B(a)P than were referents (P < 0.0001). No seasonal variation of the atmospheric levels of B(a)P was found throughout the year. The median relative adduct labeling x 10(-8) values of the controls and exposed police officers were 0.94 (range, 0.1-3.7) and 1.3 (range, 0.1-5.5), respectively, using the nuclease P1 technique. Although the DNA adduct levels of police officers were globally higher than those of referents (P < 0.05), the difference was entirely due to the summer difference [median values 0.80 (range, 0.1-1.8) and 2.8 (range, 0.7-5.5), respectively (P < 0.001)]. In winter, the DNA adduct levels were substantially identical, and in midseason, there was only a very small increase in police officers, with respect to controls (statistically not significant). Moreover, a more significant seasonal variation of bulky aromatic DNA adduct levels was observed in WBC DNA samples of police officers (P < 0.05) compared to those of referents. The seasonal variation of bulky aromatic adduct levels could be correlated with the reported seasonal variation of aryl hydrocarbon hydroxylase inducibility in human lymphocytes.

Traffic police workers, as a population exposed to urban atmosphere, were compared with a control population exposed to indoor air pollution levels. Sister chromatid exchanges (SCEs) as a biomarker of effect were measured in peripheral blood lymphocytes of 54 exposed subjects and 35 controls, and environmental concentration of polynuclear aromatic hydrocarbon (PAH) tracer compounds was detected by personal air samplers. The mean exposure level to benzo[a]pyrene in our group of traffic policemen (3.4 mg/m3) was in the range that has been estimated in urban areas in Europe during the last 10 years. No difference in SCE levels was found between exposed workers (7.36, SD 1.35) and controls (7.47, SD 1.28). No correlation was observed between SCE/cell and airborne PAH concentration in the traffic worker population. A positive regression of SCE on exposure estimate was found only in the non-smoking group of police workers. Our findings suggest that exposure to urban air pollution does not induce relevant cytogenetic effects.

The association between hematolymphopoietic cancers and occupational exposures to pesticides is being examined in a population based case-control study. 228 cases diagnose aged 20-74 years and 140 controls between 1/1/1990-31/12/1993 were eligible for the study in the west Liguria area. 163 cases and 109 controls were interviewed regarding use of pesticides and other possible risk factors and confounding variables. Expert agronomists assessed the job exposure to pesticides using the informations from questionnaires and the job-matrices.

Pesticides are widely used in agriculture to enhance crop yields and to control disease vectors. Floriculturists work frequently in greenhouses and may be exposed to high levels of pesticides, which may result in adverse health effects. To evaluate the relationship between exposure to pesticides and DNA adduct formation in peripheral WBCs of Italian floriculturists, the nuclease P1 modification of a (32)P-postlabeling assay was used to analyze WBC DNA from floriculturists (n = 26) and matched controls (n = 22). DNA adduct-positive samples were more frequent in floriculturists (11/26; 42%) than in matched controls (2/22; 9%) (P < 0.01). Slightly higher frequencies of DNA adduct-positive samples were observed in floriculturists > or = 44 years of age (53%) and in female floriculturists (57%). Floricultural practice was found to be associated with a significantly higher DNA adduct-positive rate in WBCs (rate ratio, 5.12; 95% confidence interval, 1.1-23.7) after allowing for the effects of age and gender. These two latter covariates were not significantly associated with DNA adduct-positive rates. The quantitative levels of DNA adducts were significantly higher in floriculturists than in matched controls according to the Mann-Whitney nonparametric statistic (P = 0.0052). The median adduct level for positive samples among floriculturists was 1.5/10(8) bases. A specific, well-visible spot, named alpha adduct, was detected in 7 out of the 11 DNA adduct-positive samples from floriculturists but in none of the (22 + 20) referent samples (P = 0.0004). The presence of pesticide-related DNA adducts was confirmed clearly using the butanol extraction procedure. Six of 8 floriculturists and 0 of 10 referents were found positive with this method. The median adduct level for positive samples was 6.0/10(8) bases. Two strong spots close to the origin could be identified in all six positive floriculturists, using the butanol extraction procedure. No association between DNA adducts and use of specific pesticides was observed.

The associations between selected biomarkers of biologically effective dose (32P-post-labelling-DNA adducts), early biological effects (Micronuclei, MN) and sister chromatid exchanges (SCE) and individual measurements of exposure to benzo(a)pyrene (a surrogate index of exposure to polynuclear aromatic hydrocarbons, PAHs) are investigated in a study being conducted among traffic police workers and referent subjects in the City of Genova, Italy. Preliminary findings show B(a)P mean values of 1.33 ng/m3, SD = 1.35 ng/m3 and 0.06, SD = 0.17 in traffic police workers and referent subjects, respectively. Micronuclei mean levels in peripheral blood lymphocytes of 26 traffic police workers and 25 referents were 3.30, DS = 1.24 e 3.90, DS = 1.50 (per 1,000 binucleated cells). Eleven subjects (61%) out of 18 had detectable levels of DNA adducts (32P-post-labelling technique, range 1.8-9.0 Relative Adduct Level (RAL) per 10(9) nucleotides).

A historical cohort mortality study conducted among 515 silicotic subjects revealed higher than expected risks for all causes [standardized mortality ratio (SMR) 1.89], respiratory tract diseases (SMR 8.89), silicotuberculosis (SMR 27.00), respiratory tract cancers (SMR 3.14), and lung cancer (SMR 3.50). Mortality from cardiovascular diseases was lower than that expected (SMR 0.51). Lung cancer risk increased with duration of occupational exposure (SMR 2.80, 2.99, and 5.02 for 14, 15-29, and 30 years of employment, respectively). Lung cancer risk was higher for the silicotics without tuberculosis (SMR 3.72) than for those with tuberculosis (SMR 2.83). Indirect adjustment for smoking habits, including number of cigarettes smoked per day, showed that smoking would have been responsible for a maximum risk of 1.77. Thus smoking may have explained 50% of the observed excess mortality from lung cancer.

A large part of the commercial flower production in Italy is located in the located in the western part of the Liguria region, near the French border. The use of pesticides in this area has been much higher than the national average. The frequency of micronuclei in peripheral blood lymphocytes was evaluated in a group of 71 floriculturists working in this area and in a control group of 75 healthy blood donors living in the same area. A significant increase of micronucleated lymphocytes was observed in floriculturists as compared to unexposed subjects (8.57 vs. 6.67, p < .05). Females showed a marked increase in MN frequency (45% higher than males) independently of the exposure. A dose-response relationship was observed between duration of exposure and MN frequency. The condition of exposure was also found to influence the micronuclei frequency. Increased relative risks in greenhouse workers (RR = 1.31) and in people working alternately in the greenhouse and in the open field (RR = 1.46) was observed with respect to the reference population.

We report on clinical features of 113 cases of pathologically confirmed Malignant Pleural Mesothelioma, observed in Genoa (Italy) between 1979 and 1985. Overall median survival was 10 months. Among the pretreatment variables studied (age, sex, asbestos exposure, pathological type, chest pain and dyspnea at the time of diagnosis), the only one of prognostic value in the univariate analysis was the histological subtype: median survivals were 12, 7 and 4 months for the patients in the epithelial, mixed, and fibrosarcomatous groups, respectively (p = 0.0012). A multivariate analysis confirmed the independent predictive power of the histotype (p = 0.0022). A review of literature data concerning prognostic factors in Malignant Pleural Mesothelioma is presented.

We examined the association of job title and duration of employment with the smoking-adjusted prevalences of chronic bronchitis, obstruction, restriction, and mixed pulmonary function impairment in 657 white male shipyard workers aged 20 to 60 years. Logistic regression was used to compute odds ratios (OR) and confidence intervals (CI) for risk of chronic bronchitis and pulmonary function impairment. Compared to employment for less than 20 years, employment for more than 20 years was independently associated with chronic bronchitis (OR = 2.0; 95% CI: 1.2-3.5), restriction (OR = 2.6; CI: 1.4-4.6), and mixed impairment (OR = 2.5; 95% CI: 1.1-5.5). Compared to metal-workers, which was the lowest exposure job category, four job categories were independently associated with restriction: gas welders (OR = 3.6; 95% CI: 1.5-8.9), arc welders (OR = 4.1; 95% CI: 1.5-11.4), masons (OR = 6.2; 95% CI: 1.0-39.0), and insulators (OR = 8.0; 95% CI: 1.8-35.2). These results suggest that exposure to pulmonary toxic agents in the shipyard environment can lead to both parenchymal inflammation (restriction) and airways inflammation (obstruction).

We conducted a retrospective cohort study among 1,022 refractory brick workers exposed to crystalline silica. Mortality from lung cancer (SMR = 1.77) and respiratory diseases (SMR = 3.15) was elevated in workers first employed less than or equal to 1957 who are likely to have shared the highest exposure to crystalline silica. Workers with at least 19 years of cumulative employment in the plant experienced particularly increased risks for lung cancer (SMR = 2.01) and respiratory diseases (SMR = 3.89). Relative mortality from these specific causes increased with years since first employment (that is, first exposure) and decreased with age at first employment. Indirect adjustment for smoking habits and the lack of excess mortality from cardiovascular diseases and emphysema indicated little effect of smoking on the increased risks for lung cancer and respiratory diseases.

A cluster of 7 lung cancer deaths among workers of a small tannery in Biella is reported. The major process in the plant, until the end of World War II, was chromium and vegetable tanning. A historical cohort study was carried out on a total of 353 male workers. The expected number of death was estimated on the basis of local mortality rates. An SMR for lung cancer of 449 (95% C.L. 180-925) was found for the entire cohort. Excluding workers non specifically employed in tanning operations, the SMR for lung cancer increased to 1087 (95% C.L. 352-2533). In order to control for potential confounders a nested case-control study was planned. The next-of-kin of 8 cases deceased for lung cancer and 32 controls matched by age were interviewed on smoking habits and previous jobs. Logistic regression analysis showed an O.R. of 6.94 (95% C.L. 1.18-40.73), adjusted for smoking habits and occupational history, for subjects involved in tanning operations. A registry of incident cases of cancer was established in order to avoid biased findings based on cluster cases.

A historical mortality study was conducted among 520 silicotic subjects diagnosed at the Department of Occupational Health of the San Martino Hospital, Genoa, Italy, between 1961 and 1980. Vital status was ascertained as of 1 January 1982. Age-, sex- and calendar-year-adjusted standardized mortality ratios (SMRs) for specific causes were computed using Italian as well as Genoa County male population death rates. The study shows statistically significant increased mortality from all deaths (SMR = 2.92), all cancers (SMR = 2.38), respiratory tract cancers (SMR = 6.85), respiratory tract diseases (SMR = 13.63), and from 'other diseases' (SMR = 6.81). The excess mortality from respiratory tract diseases and from 'other diseases' are mainly attributable to silicosis and silicotuberculosis, respectively. These findings confirm the existence of a causal association between silicosis and increased mortality from both malignant and non-malignant respiratory tract diseases. The high mortality from respiratory tract cancers was still present even after adjustment for smoking.

The association between occupational exposure to polycyclic aromatic hydrocarbons (PAH) and bladder cancer development was investigated in a population-based case-control study carried out in the Bormida valley, Italy. One hundred and twenty-one male cases and 342 male controls, matched age, were collected from local hospitals. Occupational exposure to PAH and aromatic amines (AA) was evaluated by means of a job exposure matrix, constructed specifically for this study. Subjects considered as sharing a "definite exposure to PAH" showed an increased risk even after adjustment for cigarette smoking and exposure to AA (OR = 2.14, 95% CL 0.82-5.60). No elevation in risk was found for the category "possible exposure to PAH" (OR = 1.05, 95% CL 0.45-2.44). The findings of this study are consistent with previous studies indicating PAH as a risk factor for bladder cancer. A possible residual confounding effect due to AA impurities is discussed.

The dockyards of Genoa are exposed to many known or suspect carcinogenic agents, namely, asbestos, silica, polycyclic aromatic hydrocarbons, and halogenated hydrocarbons; other possibly harmful substances are trace amounts of aromatic amines, welding smokes, paints, and lipid-removing solvents. A cohort study of causes of death of 2190 dockyard workers in Genoa was conducted between January 1, 1960 and December 31, 1975. Mortality rates were calculated for 20 different occupational categories, for which there exist different levels of exposure to noxious substances. Two control groups were selected: the general male population of Genoa and all male employees (462) of San Martino Hospital, Genoa for the same period of time. Causes of death that demonstrated significant excesses for both control groups were: cancer of the colon, excluding the rectum; cancer of the larynx; cancer of the lung, bronchus, and trachea; cancer of the kidney, urinary bladder, and other urinary organs; respiratory diseases; and cirrhosis of the liver. The data obtained from these 20 job categories revealed different types and levels of risk for various carcinogenic agents.