Formaldehyde-induced anaphylaxis after dental treatment?
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Biomedical subjects
Publications and source records attributed to F Candura.
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The authors report 2 cases of acute mercury intoxication due to accidental breakage of barometer on to a lit gas ring. Within 24-48 hours the subjects developed neurological, gastrointestinal and dermatological symptoms. A 24-hour urine sample contained 600 and 400 micrograms of mercury per liter respectively (reference value 0.1-6.9 micrograms/L); blood concentration of mercury was 130 and 100 micrograms per liter (reference value 1.7-9.9 micrograms/L). The patients were treated with penicillamine and daily excretion of mercury was monitored. The residual sources of pollution in the kitchen were identified and bonificated.
The authors examine cases of occupational diseases diagnosed between 1982 and 1988 in patients admitted to "Divisione di Medicina del Lavoro I Sezione di medicina del Lavoro del Dipartimento di Medicina preventiva, occupazionale e di comunità dell'Università di Pavia". The most frequent syndromes concerns the auditory apparatus (having losses or deafness due to noise) and the respiratory system, whereas new safety regulations have given rise to the disappearance of benzene-induced hematologic abnormalities. Most of, the "classical" features of occupational diseases have disappeared, since early diagnosis has permitted the adoption of opportune technical and sanitary measures. The authors emphasize the necessity for role of Occupational Medicine (ever following the sentences 179 and 206 of the "Corte Costituzionale") to be not prevention, but also diagnosis, treatment and rehabilitation; therefore there is a need, all over the country, for adequate structures for the diagnosis and treatment of the occupational diseases.
The main aspects of occupational exposure to chromium and chromium compounds are surveyed. Special attention is paid to the toxic action of this metal at the different target organs. The nutritional aspect of CrIII is examined preliminarily, and data detailing the metal contents in water and food are provided. As far the different working processes that entail occupational exposure to chromium are concerned, hygienic and environmental problems are discussed while identifying the average environment exposure to the different chemical forms of chromium (CrIII, CrIV, soluble and not soluble), as a function of the worker's tasks, and the relevant human response (total human Cr). Different hygienic and environmental standards in force in various countries and applicable to chromium compounds are compared. Additional information is given on the main aspects of chromium metabolism (absorption, distribution, excretion), and on the prevailing toxic actions, with specific reference to cancerogenesis. As far as biologic monitoring of the exposed people is concerned, the significance of Cr-U as dose-exposure indicator is discussed, also in the light of a critical review of the reference values. The report describes a series of analytical methods for the identification of chromium in aqueous and biologic matrices. The problems connected with health monitoring and fitness for work are eventually covered.
Two cases of occupational asthma due to styrene are described. The subjects complained of cough, breathlessness, and symptoms of asthma when coming into contact with styrene; in patient 1 the respiratory reaction was followed by a late cutaneous rash. The symptoms disappeared when the subjects were away from work on weekends or holidays. In both cases, inhalation challenge with styrene produced an immediate bronchospastic reaction which was followed by a late cutaneous rash in patient 1. Prior administration of disodium cromoglycate (40 mg from a spinhaler) prevented the respiratory reactions completely, but failed to prevent the late skin response in case 1. Styrene removal was followed by complete disappearance of the symptoms. We conclude that styrene can be a primary cause of occupational asthma.
Liver injury has long been associated with occupational exposure to a wide variety of chemicals. The controversial data existing in relation to hepatotoxicity of organic solvents might be explained as a consequence of the different exposures or it may well be that the tests used for evaluating liver function might not be sensitive enough to detect any mild changes at an early stage. To study liver function during exposure to solvent mixtures, we determined serum bile acid (SBA) concentrations as compared with conventional liver function tests in a selected group of workers (n = 30) occupationally exposed to a mixture of organic solvents (mostly toluene, xylene, acetone, n-butylacetate, n-butanol, ethylacetate) and in a reference group (n = 20). The mean levels of liver enzyme activities and bilirubin concentrations in the two groups were similar, whereas mean SBA levels increased in the exposed group (8.0 +/- 6.0 mumol/l vs 2.8 +/- 1.4 mumol/l) and the difference as compared with the controls was significant (P less than 0.01). In 73% of the exposed workers, SBA levels were higher than 5.6 mumol/l (the cut-off value) as compared with 5% of the controls. These results demonstrate the higher sensitivity in detecting liver dysfunction achieved with the SBA test as compared with conventional hepatic function tests. As increased SBA concentrations are considered to reflect an impairment of anion transport across the liver, higher SBA levels in the group of workers exposed to organic solvents might be explained as a slight and early sign of liver dysfunction. Therefore, SBA determination in biological monitoring of workers exposed to potentially hepatotoxic chemicals might be proposed.
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To test a method for assessing non-specific nasal hyperreactivity, we submitted 23 allergic rhinitis sufferers, 12 normal subjects, 2 patients with asthma and 3 patients with asthma and rhinitis to bronchial challenge with ultrasonic fog (UNDW), recording nasal resistance (NR) and specific bronchial conductance (sGaw) simultaneously by means of a plethysmograph. A significant post-challenge NR increase was observed in 19 of the 23 rhinitis patients, in every patient with asthma and rhinitis, but in only 2 of the 12 normals and in none of the patients with asthma. There was no disturbing increase of nasal secretion. A significant post-challenge sGaw decrease was observed in all the asthmatics and in the patients with asthma and rhinitis, but only in 1 of the 12 normals and in 3 of the 23 rhinitis patients. We conclude that bronchial UNDW could be a suitable method for assessing both nasal and bronchial hyperreactivity.
Recent reports in the literature suggest that disorders in the regulation of calcium ion concentration in airway smooth muscle may be at the basis of bronchial hyperreactivity. In order to evaluate whether nifedipine, a calcium channel blocking drug, could alter the bronchial reactivity to methacholine, nine patients suffering from occupational asthma were submitted to bronchial challenge with methacholine with and without premedication with nifedipine, 20 mg sublingually. The bronchial responses were followed by measuring FEV1 by means of a bell spirometer. The provocation dose of methacholine capable to induce a 15% decrease of FEV1, (PD15FEV1) was considered the bronchial threshold dose for each subject. Average PD15FEV1 increased from 310.6 micrograms (SD = 191.7) in the test without premedication with nifedipine to 1,012.3 micrograms (SD = 640.0) in the test with premedication (P less than .01). Subjectively, all the patients showed better tolerance to the bronchoconstriction during the test with nifedipine. Our data indicate that nifedipine decreases bronchial reactivity to methacholine.
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Oral cortisone glucose tolerance tests were performed in 66 CS2-exposed workers and in 66 individually matched control subjects. Results indicate a higher and significant (p less than 0.001) prevalence of latent diabetes in the CS2-exposed group (72.7%) as compared with the control group (16.7%), and the existence of a positive and significant (p less than 0.001) correlation between blood glucose values and exposure index. Possible mechanisms of action involving zinc metabolism and pyridoxine metabolism are discussed.
In order to evaluate alcoholic consumption in a group of young men from an area in northern Italy, 834 subjects (18 years old) were examined at their first military check up. They compiled a questionnaire dealing with their own and their fathers' alcoholic consumption, social status, cultural habits, tobacco and drug abuse. 14.3% of the group examined were teetotalers. The alcoholic consumption of the youths was 31.44 +/- 48.8 DS alcohol g/a day versus their fathers' consumption of 44.52 +/- 42.12 DS alcohol g/a day. This difference is statistically significant (t = -8.1 p less than 0.001). No difference in alcoholic consumption was found between employed and unemployed subjects. Artisans and traders evidenced the highest levels of alcohol consumption (F = 2.58, p less than 0.009). The youths changed their alcoholic habits with respect to their own parents, preferring beer to wine consumption, although no change was observed in their approach to the alcoholic problems. The beer, like alcohol, remains a sociable and reassuring drink with positive connotations, even tough it is not considered a traditional Italian drink.
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Several hemorheologic and plasma proteic features were analyzed in workers exposed to acoustic defilement. Whole-blood viscosity was significantly increased (at every shear-rate considered) in patients with severe sensorineural hearing impairment; whereas plasma, serum and relative viscosity remained unchanged. These variations were independent of erythrocyte deformability and aggregation, and of plasma fibrinogen levels, resulted indeed in the normal range. On the contrary plasma fibronectin was significantly increased in patients with sensorineural hearing impairment, suggesting a microvascular endothelial damage in these subjects. The exposition to acoustic defilement during work activity may be considered as aetiological factor for the development and progression of sensorineural hearing impairment, and more extensively for the occurrence of cardiovascular complications.
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