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We present some cases of rhinitis and asthma in wooding workers exposed to hard or soft woods. The specific provocation test confirmed the diagnosis of rhinitis in three patients and of asthma in four. Rhinitis was caused by oak, beech, and pine, while asthma was caused by obeche, chestnut, acacia, and iroko. Occupational exposure to the specific wood, before onset of symptoms (symptom latency) was shorter for patients with asthma. All seven patients with respiratory symptoms were nonsmokers; three were atopics and four, all with asthma, had nonspecific bronchial hyperreactivity. Twenty-four hours after the test, PD20FEV1 had decreased in two cases with rhinitis and two with asthma, although the data did not reach statistical significance (Wilcoxon matched-pairs test: NS). After the SBPT, blood eosinophils increased in two cases with rhinitis and three with asthma, and the data were at the limit of statistical significance (P = 0.046). The study confirms that not only hard essences, but also soft woods can cause respiratory symptoms, although the pathogenetic mechanisms are still unclear. A specific provocation test is still the best and sometimes only means of diagnosing wood asthma; standardized protocols with repeated measurements of nonspecific airway responsiveness and of eosinophils in the blood may be helpful for a better understanding of the pathogenetic mechanism and predisposing factors.

Two cases of paraoccupational asthma caused by toluene diisocyanate (TDI) are reported. The first patient was a metal worker in a machine shop situated near a factory producing polyurethane foam. Symptoms at work were not explainable by any specific exposure to irritants or allergens in the work site. As the patient recalled previous occasional work in the adjacent polyurethane factory with accompanying worsening of respiratory symptoms, a specific inhalation (SIC) test was performed with TDI, which confirmed the diagnosis of TDI asthma. The second case was a woman working part time as a secretary in the offices of her son's factory for varnishing wooden chairs. TDI was present in the products used in the varnishing shed. The SIC test confirmed the diagnosis of TDI asthma, despite the fact that the patient's job did not present risk of exposure to the substance. In both patients, symptoms disappeared when further exposure was avoided. These two cases confirm that paraoccupational exposure to TDI must be considered when evaluating patients with asthma not mediated by immunoglobulin E. They also suggest the need for more prospective studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI. Keywords: paraoccupational exposure; toluene diisocyanate; asthma

The aim of the study is to compare the loss of lung function in a group of 196 male workers employed in shipbuilding/repairing and port activities ("cases") with a group of 109 healthcare workers ("controls"). "Cases" were grouped by radiological examination (chest X-ray/HRCT) depending on the presence or absence of pleural plaques. Smoking habit was assessed in all subjects. Lung function assessment included two measures of VC, FEV1 and TLC (the latter for "cases" only). The mean interval between the two examinations was five years; changes in spirometric results (value at second examination minus value at first) were expressed as ml/year. The results showed that there was no difference in loss of lung function in the three groups over the follow-up period, even when differences in smoking habit were taken into account. The results suggest that radiological findings of pleural plaques had no bearing on deterioration in lung function. Lung function testing is widely accepted as an integral part of medical surveillance of occupational lung diseases, but the high inter and intra-subjects variability of spirometric data underlines the difficulties and limitations of lung function follow-up studies.

During the period 2000-2003, the Mesothelioma Register of the Friuli Venezia Giulia identified 248 cases of MM, 44 of which (18%) were female. In 36 cases the diagnosis was "certain" and in 8 "probable" or "possible". Mean age at diagnosis was 72.8 years (SD = 12.7), and the site of the disease was the pleura in 93% of cases. Information about previous exposure to asbestos was collected in accordance with the guidelines of the National Mesothelioma Register Occupational exposure to asbestos was documented in only 8 cases and family exposure in 6 others. In the remaining cases the source of exposure was "unknown" because of insufficient data, or there were no data at all. The study highlights the role played by extra-occupational exposure to asbestos among women and the need for careful investigation into previous asbestos exposure in all females with MM. In order to improve our knowledge of the part played by factors other than occupational exposure to asbestos in triggering the disease, it is crucial to reduce he number of cases with no information or "unknown" exposure to this dangerous substance.

We re-investigated 13 workers 6 years (SD 2) after the first diagnosis of asthma or rhinitis caused by latex, to update the exposure to latex, the eventual symptoms, respiratory function (spirometry and metacholine PD20 FEV1), skin prick test to common allergens and latex, RAST to latex, total IgE levels and eosinophils count in the blood. At the follow up, all the workers stopped wearing powdered latex gloves, but for 10 an indirect exposure to latex was still possible. All cases referred improvement of respiratory symptoms at work, but 7 workers occasionally complained of mild symptoms. No statistically significant variations of respiratory function test and of the immunological parameters were found. The workers with persistent respiratory symptoms at work had a longer duration of symptoms before the diagnosis (p = 0.02), if compared with workers without symptoms.

We have evaluated, over a mean follow up period of 3.7 (SD 1.8) years, the lung function in a group of 103 workers, according to the presence (36 workers) or absence (67 workers) of pleural plaques at chest Rx-films/HRCT. A Generalized Estimating Equation (GEE) approach was used to investigate the relation between the loss of pulmonary function and (i) presence/absence of pleural plaques, (ii) smoking status, and (iii) work seniority in work places with exposure to asbestos. The mean age, at the first examination, was 49 (SD 6) years and work seniority 25 (SD 7) years. Multivariate GEE approach to age- and height-adjusted spirometric data (236 measures of VC, FEV1 and 234 determinations of TLC), showed that pleural plaques were not associated with significant loss of pulmonary function. Smokers (or = 15 py), when compared with no-smokers, showed significant loss of VC (-5.3%, p0.05), FEV1 (-8.4%, p0.001) and TLC (-4.0%, p0.05). An occupational history in work places with exposure to asbestos (ship building/repairing) was significantly associated with a slight, but significant (p0.05), 10-year decrease in VC (-3.1%) and FEV1 (-4.9%).

The relationship between chronic obstructive pulmonary disease (COPD) and occupational exposure to mineral dust is still conflicting because COPD is multifactorial disease, relatively common in the general population. A number of studies have shown that in population exposed to mineral dust there is a greater prevalence of chronic bronchitis, even in the absence of radiographic evidence of pneumoconiosis. There is no agreement, however, that dust alone will induce significant chronic airflow limitation and increase in mortality. It is unlikely that medical evidence could ever provide conclusive "proof" of the work related less of COPD in the singular patient, but it is possible to provide evidence for reasonable statment of probability.

Background. The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis. Methods: Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992–97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded. Results: The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P

Haemopoietic effects of ethylene glycol monomethyl ether (EGME) are described in three young women employed in a frame factory where the substance was applied under apparently safe hygienic conditions. In a ventilated room they used a mixture of acetone (70%) and EGME (30%) to glue together cellulose acetate frame components. During a periodic medical examination their white blood cell count was found to be abnormally low, with a relative lymphocytosis, macrocytosis with red blood cells, and haemoglobin at borderline normal values. These findings persisted over the exposure period but the haematological parameters returned to normal on stopping exposure. The subjects remained clinically healthy during the exposure period. This exposure to EGME occurred in an industry where such toxicity had not been previously reported and describes a situation in which the risk did not come from the exposure to vapour but most likely from an insufficient skin protection.

We studied 28 health care workers sensitised to latex and complaining of respiratory symptoms at work. All were females, aged 32 y (median), and had worked in the hospital for 12 y, in departments with high exposures (22 cases), moderate exposure (4 cases) or low exposure (2 cases) to rubber gloves. Twenty also complained of latex skin symptoms. Twenty-five (89%) were atopical (by prick test), and 16 (57%) had a personal history of allergic disease. Nine (32%) also had symptoms from exposure to latex outside work and 3 (10%) from food cross-reacting with latex. The specific inhalation test with latex gloves confirmed the diagnosis of asthma in 4 cases (14%) and of rhinitis in 13 cases (46%). We reinvestigated the workers 14 months (median) after the first examination to update exposure to latex, any allergic symptoms and adverse effects of relocation. At the follow-up, 3 workers (11%) had retired, all the others had stopped wearing powdered latex gloves, and 12 had changed their duties or the work-place. Ten (40%) of the 25 subjects still at work were without symptoms, 14 (56%) occasionally complained of mild symptoms and one of frequent rhinitis. Overall, we observed improvement of skin symptoms in 74% (14/19) of the cases and of respiratory symptoms in 56% (14/25) of the cases. Symptoms from exposure to latex outside work were still present in 6 subjects. The persistence of symptoms at work was significantly higher among workers who continued to work in departments with high/moderate latex glove exposure. The results of the study show that skin and respiratory symptoms among health care workers are related to the use of powdered latex gloves and confirm the importance of primary prevention.

OBJECTIVES—To investigate the occurrence of work related respiratory symptoms and to assess the effect of atopy in a group of trainee bakers. METHODS—A prospective study of work related respiratory symptoms among 125 trainee bakers who were investigated with a questionnaire plus skin prick test with wheat flour and α-amylase allergens at baseline and then after 6, 18, and 30 months. RESULTS—At the baseline examination, four students (3.2%) complained of respiratory symptoms (cough and rhinitis) when working with flours and four were skin positive to wheat flour or α-amylase. The incidence of work related respiratory symptoms was 3.4% at 6 months, and the cumulative incidence was 4.8% and 9.0% at 18 and 30 months, respectively. The incidence of skin sensitisation to occupational allergens was 4.6% at 6 months and the cumulative incidence was 4.6% at 18 months and 10.1% at 30 months. The generalised estimating equation approach to longitudinal data showed that work related respiratory symptoms in the study population was significantly associated with a personal history of allergic disease (odds ratio (OR) 5.8, 95% confidence interval (95% CI) 1.8 to 18.2) and skin sensitisation to wheat flour or α-amylase (OR 4.3, 95% CI 1.2 to 14.9). Atopy based on prick test was not related to the occurrence of work related respiratory symptoms over time (OR 1.1, 95% CI 0.3 to 3.8). CONCLUSIONS—Personal history of allergic disease is a predisposing factor for the development of symptoms caused by exposure to wheat flour and may be a criterion of unsuitability for starting a career as a baker. Atopy based on the skin prick test is useful for identifying subjects with allergic disease, but should not be used to exclude non-symptomatic atopic people from bakery work. Keywords: follow up study; wheat flour; α-amylase sensitisation; work related respiratory symptoms

Objective: The aim of this study was to eval- uate the outcome of the specific inhalation challenge test (SIC) in 160 subjects with suspected baker's asthma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisa- tion, non-specific bronchial hyper-responsiveness (NSBH) and atopy. Methods: We investigated the out- come of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flour, NSBH, ato- py, forced expiratory volume at 1 s (FEV1) monitoring and airborne flour dust in the challenge chamber mea- sured by the gravimetric method (total dust in mg/m 3 ). Results: The SIC test was positive for early asthma in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outcome to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1.6-7.7) and skin sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3- 7.0). Exposure level to wheat flour was less than or equal to 10 mg/m 3 in 12% of individuals, ranged between 11 and 30 mg/m 3 in 43% and exceeded 30 mg/m 3 in 45%. The outcome of SIC was always negative among workers not skin sensitised to wheat flour and without NSBH and atopy. An increasing prevalence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was greater than 10 mg/m 3 (P < 0.001). Conclusion: Procedures currently adopted for wheat flour dust exposure during SIC need to be better standardised in order to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, particularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.

We investigated the prevalence of atopy by 4 different criteria (personal and family atopy, atopy by prick test and by serum IgE levels), and sensitization to wheat flour and alpha amylase in a group of trainee bakers and in a group of trainee graphic artists as controls (baseline check-up). The follow-up was performed 6 months later only among trainee bakers (90 cases), based on an updating questionnaire and on repeated skin prick test with wheat flour and alpha amylase extracts. Trainee bakers and controls were similar with respect to age, number of smokers, atopy evaluated by 4 different criteria, and detection of serum IgE (RAST) and IgG specific to wheat flour. Positive skin prick test to wheat flour (4%) and alpha amylase (1%) were found only among trainee bakers. At the baseline control 4 students (4.4%) complained of respiratory symptoms when working with wheat flour (WRS). At the six month follow up 6.6% of the trainee bakers complained of WRS: 3.3% had persistent symptoms, 3.3% were new cases and 1.1% had become asymptomatic. Five cases (5.5%) were skin positive to wheat flour or alpha amylase, but only one was unchanged, while 4.4% were new cases and 3.3% turned negative. None of these changes was statistically significant (McNemar test). The trainee bakers complaining of WRS at the baseline or at follow-up (7 cases, when compared with the non-symptomatics, showed a higher prevalence of personal atopy and skin sensitization to occupational allergens; there were no differences, however, with regard to atopy by prick test, IgE levels or the presence of wheat specific IgE and IgG. The trainee bakers skin positive to the occupational allergens (8 cases) showed prevalences of personal atopy and atopy by prick test significantly higher than trainee bakers skin negative to wheat flour or alpha amylase (por = 0.01). Evaluating wheat flour specific IgE and IgG in the serum of trainee bakers and controls provided us with more information about the specificity of such tests and suggests caution in attributing the presence of these immunoglobulins in the serum to specific occupational exposure or to specific occupational sensitization. A six-month follow up is likely to be too short an interval to observe significant changes in work-related symptoms and in skin sensitization to occupational allergens. The results, however, emphasize the important role of personal atopy as a predisposing factor in the development of occupational disease among trainee bakers.

We studied non-specific bronchial responsiveness (NSBR) and blood eosinophils before and 24 hours after a bronchoprovocation test (SBPT) with wheat flour (22 cases) and TDI (32 cases). Twelve patients developed asthma after exposure to wheat flour (7 early and 5 dual/late asthma), and 12 after exposure to TDI (6 early and 6 late/dual asthma). Responders and non responders to wheat flour exposure were similar for all general characteristics except IgE levels (p = 0.036) and NSBR (p = 0.047). A higher degree of airway responsiveness to methacholine was the only characteristic which differentiated responders from non responders to TDI exposure (p = 0.043). Airway responsiveness, assessed 24 hours after the SBPT (44 cases), did not show any change compared to pretest values; the data were similar both among non responders to wheat flour (Wilcoxon p = 0.1) or to TDI (p = 0.2) and responders to TDI (p = 0.6) or wheat flour (p = 0.3); also no significant changes were observed among early and dual/late asthma caused by wheat flour and TDI. Twenty-four hours after the SBPT, blood eosinophils were higher than pretest, but only among the 24 patients with asthma (Wilcoxon p = 0.002); the blood eosinophil increase was statistically significant among patients with early and late/dual asthma caused by wheat flour, and among those with early and late/dual TDI asthma. In our study, NSBR was confirmed as a common feature of occupational asthma, either IgE mediated (wheat flour) or non-IgE mediated (TDI). Twenty four hours after the specific exposure, among patients with asthma induced by wheat flour and TDI, there was an increase in blood eosinophils while in the same time interval no variation in non-specific bronchial responsiveness was observed.

OBJECTIVES--To assess the prevalence of atopy in a vocational school so as to evaluate the feasibility of pre-employment screening. METHODS--The prevalence of atopy by family diathesis, prick tests, immunoglobulin E (IgE) concentrations, and personal history of allergic respiratory diseases was investigated in 144 trainee bakers and 81 students on a graphic artists course (mean age 15.4 years). Skin sensitisation to wheat, rye, and barley flours, to alpha amylase, and to storage mites was also evaluated. RESULTS--Personal allergic symptoms were reported by 13.2% of the bakers and 14.7% of the graphic artists and there was a significant association between symptoms and atopy by prick tests (odds ratio (OR) 17.2; 95% confidence interval (95% CI) 5.27-56.4) and by family history (OR 3.11; 95% CI 1.02-9.53). When bakers were grouped according to the presence of allergic symptoms and results of immunological tests, 6.9% had asthma, 6.3% had rhinoconjunctivitis, and a high percentage (28.5%) were without symptoms but scored positive on prick tests or family symptoms. Skin sensitisation to storage mites had similar prevalences (16%) in the two groups of trainees and occurred nearly always in atopic people. Positive skin tests to wheat flour (3.5%), rye (0.7%), and alpha amylase (0.7%) were specific to bakers. CONCLUSIONS--Pre-employment screening is a useful source of medical information and allows for counseling. The presence of asthma, or of another allergic disease in a severe form, is suggested as a criterion for excluding students of a vocational school from training as bakers. Student bakers without allergic symptoms but atopic by other criteria should be informed about their risks of developing occupational asthma, and periodic check ups must be recommended. Screening studies in vocational school provide a better understanding of specificity of skin sensitisation to occupational allergens.

In a group of 226 bakers and pastry makers and in 88 students of a training school for bakers, we evaluated skin sensitization to the common allergens, wheat and alpha amylase. Skin prick tests were positive to the enzyme in 17 exposed subjects (7.5%) and in one student with previous occupational exposure as a baker; 27 exposed subjects (11.9%) and 2 students were sensitized to wheat. Among the 42 exposed workers who complained of work-related symptoms, 12 (28.6%) cases were skin positive to amylase and 17 (42.9%) to wheat. Among the 17 workers who were positive to amylase, 16 were also sensitized to wheat and/or common allergens, 12 complained of symptoms at work but since in many cases there was a positive response to wheat, too, it is impossible to speculate on the role of each allergen in inducing symptoms. One case, with work-related rhinoconjunctivitis, had skin sensitization only to alpha amylase but no specific IgE in the serum. These findings confirm that bakers are at risk of sensitization not only to wheat allergen but also to amylase from Aspergillus oryzae. The enzyme should be included in the list of substances to be tested among bakers in whom an occupational allergy is suspected, but particular care should be taken in evaluating the cutaneous response, especially if compared to wheat wheals. Further investigations are also needed to identify the source of risk and to better define the characteristics of the enzyme and the relationship between skin reaction to amylase, sensitization to wheat and atopy.(ABSTRACT TRUNCATED AT 250 WORDS)

A survey was carried out on respiratory symptoms and skin prick test response to common allergens (atopy), storage mites, and occupational allergens among 226 bakers and pastry makers from 105 small businesses in northern Italy. Atopy was present in 54 workers (23.4%); 40 workers (17.7%) were skin positive to at least one storage mite, 27 (11.9%) to wheat flour and 17 (7.5%) to alpha-amylase. Work related asthma was reported by 11 (4.9%) workers and rhinoconjunctivitis by 31 (17.7%); 22 workers (10.2%) complained of chronic bronchitis. The distribution of skin prick test results among bakers and among 119 white collar workers did not indicate (by logistic analysis) an increased risk for bakers to skin sensitisation to common allergens, storage mite, or to a group of five flours. Sensitisation to wheat flour, on the other hand, was present only among exposed workers. Skin sensitisation to occupational allergens was significantly associated with atopy (p < 0.001), smoking habit (p = 0.015), and work seniority (p = 0.027). The risk of work related symptoms was associated with sensitisation to wheat or alpha-amylase, and with atopy, but not with sensitisation to storage mites, work seniority, or smoking habit. The results of the study indicate that there is still a significant risk of allergic respiratory disease among Italian bakers. Not only wheat allergens, but also alpha-amylase must be considered as causative agents, although sensitisation to storage mites is not important in the occupational allergic response. Atopy must be regarded as an important predisposing factor for skin sensitisation to occupational allergens and for the onset of symptoms at work. The data confirm that for effective prevention, greater care should be taken not only in limiting environmental exposure, but also in identifying susceptible people.

Hypersensitivity to rubber is usually reported as contact dermatitis due to substances used in its processing; however, recent reports in patients attribute IgE mediated reactions specifically to latex and not to chemical additives. These patients were first seen with contact urticaria, but tissue contact with both medical and non-medical latex rubber may also precipitate anaphylactic reactions mediated by IgE.1"3 We describe a case of immediate hypersensitivity to natural latex in a nurse working in a dialysis unit.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

Cyanoacrylate-based glues have been reported as producing dermatitis and bronchial asthma. The paper describes the case of a patient occupationally exposed to Loctite 406, who developed irritation of the skin and mucosae of the face and late bronchial asthma. Preventive measures for subjects exposed to cyanoacrylic instant glues are discussed.

The authors report on pollution measures in some operating theatres and consider biological data for the hepatic and hemopoietic functions in operating room personnel and in control groups. Waste gas concentrations range from 17.3 to 22.6 ppm for enfluorane and from 500 to 1275 for N2O in theatres not equipped with antipollution systems. Pollution is 3-8 times lower when a scavenging system is present, while with horizontal laminar air flow exhaust in function, the gas concentration in the air is insignificant. Tests for the hepatic and hematological functions, done on 61 operating room personnel, 87 ward nurses, and 69 technicians and physicians of radiology services, do not show any significant difference between those exposed to anesthetic gases and controls.

Oblique views of the chest under scopic control and computed tomography have been obtained in 7 patients with a known history of exposure to asbestos fibers, and evidence of pleural plaques on the postero-anterior view of the chest. The distribution of the radiological findings is similar with both the techniques; however, CT is more sensitive in detecting small lesions at the margino-costal anterior and posterior level, both calcific or not. CT seems also more sensitive in detecting parenchymal lesions. The role of CT in this pathology is briefly discussed.

Dock workers (n = 218) occupationally exposed to green coffee beans (GCB) were studied, using a specific questionnaire for allergic symptoms and skin tests for common and occupational allergens. Thirty-one workers (14.3%) complained of allergic symptoms of the eye, nose and bronchial system at the workplace. The prick tests, using both commercial allergens and specific extracts prepared from the most common types of coffee and their corresponding sacks, confirmed a sensitization in 21 workers (9.6%). A positive skin reaction to castor beans (CB) was found in nearly all these cases; in ten workers there was also a positive reaction to GCB allergens and in 14 cases prick tests were positive to extracts of sacks. There was a good concordance between prick tests and specific IgE for CB (95.0%) and also, but to a lesser extent, for GCB. The authors concluded that there is a significant risk of sensitization to CB and GCB allergens in dock workers occupied in handling green coffee bean, despite the fact that the exposure is not continuous. CB emerged as a common contaminant of GCB from various countries. For effective prevention, a modification of the methods of transport is required to avoid CB contamination to other products. Eliminating environmental dust during shipping operations is the most important preventive measure and it can be achieved by the use of containers, as some exporting countries are already doing.

Tha AA report 10 cases of subclinical lead poisoning in a small ceramic factory for artistic painting of building tiles . The decoration was done by hand, using lead glazes . In spite of the extremely low lead air level, the decorators , whose time of exposure was 6-18 months had on average 1868 (SD: 810) micrograms Pbu EDTA/24h and 18,2 (SD: 14,8) mg ALAu /l. Hematochemical data were within the normal range, all but serum iron (144 +/- 33 micrograms %). The cases are presented as a clear example of working conditions where lead intake occurs mainly by gastrointestinal absorption. The AA emphasize the importance of biological monitoring as essential to complete the data of environmental pollution. Moreover the prevention of lead poisoning, especially in small factories, requires the implementation of those general hygienic measures recommended in the recent EEC directive.

Air-lead levels (PbA) and biological indices were studied in three ceramic factories (185 workers altogether). A difference in the pattern of lead exposure was found in the largest factory (A) and the other two smaller factories (B and C). PbA never exceeded 67 micrograms/m3 in factory A, but reached values as high as 378 micrograms/m3 in factory B. 19% of PbB values were higher than 40 micrograms/100 ml in factory A, 63% in factory B and 35% in factory C. As was expected, a closer analysis of the jobs confirmed a higher exposure level in people directly in contact with lead glazes (glazers and kiln operators). In factories B and C, however, there was also a significant lead uptake in selection and maintenance staff, who worked in areas at some distance from the glazing lines. This may be due in part to pollution spread over all departments, but also to the lack of hygiene and washing facilities whose importance is stressed for effective prevention. Biological monitoring is suggested as being useful for all workers, whatever the lead-air level, bearing in mind the possibility of lead intake orally through soiling.

A follow up study of VC, FEV and MMEF was performed by the authors in forty silicotic patients, mainly in order to find out if MMEF were more sensitive than VC and FEV 1 IN detecting respiratory function impairment in the follow up of silicosis. In patients with moderate bronchial obstruction, a statistically significant difference was found between themean values of MMEF measured in two different instances: such a finding suggests a greater MMEF reduction in the early stages of silicosis. In 22 subjects with moderate respiratory function impairment (VC and FEV1 less than or equal 40% predicted values), MMEF was found to be, percentually, more decreased than FEV1: the difference was statistically significant. It is therefore concluded that MMEF changes in the follow up examination of silicosis are more sensitive than other functional indexes.

Aims: To describe the cases of MM that occurred in the Friuli Venezia Giulia Region in the period 1995-2009 and evaluate the diagnostic contribution of autopsy findings. Methods: Via the Regional Register a search for MM cases was made following standardized criteria for diagnosis and past asbestos exposure assessment. Pleural plaques were identified by autopsy findings; the relationship between presence of pleural plaques and assessment of past asbestos exposure was analyzed. Results: 834 cases of MM were recorded and 458 autopsy findings were available; for 142 cases (15% of males and 23% of women) the first diagnosis was made at autopsy. Data were available on previous asbestos exposure in 91% (416 subjects) of cases with autopsy findings: 255 had “certain occupational exposure” (group 1), 116 “other occupational and non- occupational exposure” (group 2), 45 “negative and unknown exposure” (group 3). Logistic regression showed that significant predictors for pleural plaques were age at diagnosis (OR=1.03 each year (95% CI=1.01-1.05), asbestos exposure in group 1 versus group 2 (OR=6.8 (95% CI=4-12), and exposure in group1 versus group 3 (OR=6.4 (95% CI=3-13). Among subjects in groups 1 and 2, the presence of pleural plaques was significantly associated with latency (OR=1.03 for each year of latency; 95% CI=1.01-1.22) and asbestos exposure in group 1 versus group 2 (OR=7.8; 95% CI=4.4-13.0). Conclusions: Autopsy findings improved the diagnostic level of MM in elderly subjects, for whom reliable data on past asbestos exposure is often lacking. In subjects suffering from MM direct interview is always the best tool to evaluate past asbestos exposure; autopsy findings of pleural plaques cannot replace the anamnestic history when this is lacking, although such findings can act as a support

Aims and background. Malignant mesothelioma is a fatal cancer of increasing incidence in north-eastern Italy. Together with asbestos, the polyomavirus SV40 was hypothesized to contribute to the onset of malignant mesothelioma. To investigate the putative role of SV40 in the individual susceptibility to asbestos-induced malignant mesothelioma, we conducted a molecular epidemiological study on a series of malignant mesothelioma patients from an area in north-eastern Italy hyperendemic for malignant pleural mesothelioma. Methods and study design. We collected 63 mesothelioma samples from incidence cases of patients diagnosed with malignant pleural mesothelioma in the period 2009-2010. DNA was extracted from patients’ tissue biopsies using the BioRobot EZ1 Qiagen workstation. SV40 sequence detection and quantification was performed by real time PCR females (61.5%), who showed significantly higher cancer co-morbidity (46.1% vs 12%, P = 0.005). SV40 was detected in 22% of malignant mesotheliomas, with a low viral load. In SV40-positive patients, a threefold increased risk of asbestos exposure was observed, more evident in females (OR 4.32) than in males (OR 1.20). Conclusions. Our findings indicate that a high prevalence of SV40 was present in malignant mesothelioma incident cases from an area hyperendemic for malignant mesothelioma in north-eastern Italy. Although asbestos is considered the main risk factor in malignant mesothelioma onset, a role for SV40 could be hypothesized.