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Biomedical subjects

R Lucchini

Publications and source records attributed to R Lucchini.

71 records · Page 4Linked to original sources
PubMedDate not supplied

[Interstitial laser photocoagulation in liver tumours: our experience].

Interstitial lasertherapy (ILT) is one of the percutaneous thermal procedures allowing the ablation of primary or secondary hepatic lesions. This technique can be performed without general anaesthesia, since the patient is completely painless, in spite of the high temperatures reached, because there are no sensitive fibers around the lesion. This study includes patients with small hepatocarcinomas (< 2 cm) non peripherically sited, far from the gallbladder and the hepatic hilum. Twenty patients suffering from 24 cirrhotic hepatocarcinomas (two patients showed two nodules) have been enrolled for the present study. Mean diameter of lesions was 1.8 cm (1.3-2 cm). One or more 21 G (length 20 cm) Chiba's needles were inserted under sonographic view into the lesions. The laser energy was switched on at 4 Watts for 4-6 minutes, until an amount of energy of 900-1800 Joule was reached. All the patients were discharged 48 hours after the procedure. Triphasic CT-scan with contrast were performed 7 to 14 days after ILT, in order to check its efficacy. CT-scan showed complete necrosis in all the nodules ranging from 1.5 to 3 cm. All the patients received only one IL T session, whose longest duration was 20 minutes. No major complications occurred. ILT of small hepatocarcinomas is a safe, efficient procedure, also feasible without anaesthesia. Differently from percutaneous radiofrequency, in fact, it shows the advantage of less pain, that can avoid the need for general anaesthesia.

Aged↗
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[Bile leakage after laparoscopic cholecystectomy: report of three cases in our experience].

Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries. Anyway, external biliary decompression is a key factor in the treatment, in order to avoid an emergency intervention. The Authors report their experience concerning 3 cases of bile leakages among a series of 458 LC. Only in one of the three cases the subhepatic space was not drained and an emergency laparotomy was performed. The Authors, on the basis of their own experience and of the data reported in literature, suggest the routinary intraoperative placement of a drainage into the subhepatic space, to be removed, if no complications occur, one day after surgery.

Adult↗
PubMedDate not supplied

Fitness for work in difficult cases: an occupational medicine experience in a University Hospital.

BACKGROUND: Fitness for work (FW) in certain clinical cases poses significant professional challenges for Occupational Physicians (OPs). OBJECTIVES: to discuss the role of a public Institute of Occupational Medicine (IOM) in FW, thorough description of clinical cases. METHODS: the IOM at the University of Brescia is a public clinic available to general practitioners, OPs, other specialists, insurance companies, health authorities, employers, trade unions. IOM expert opinion on FW may be requested by OPs, employers or workers. In each case, occupational and clinical histories are taken, physical examinations, laboratory and instrumental tests might be performed, and technical and clinical documentation is acquired; expert opinions from other specialists might also be sought. Risk assessment (RA) stems from worksite inspections and information from company health and safety representatives, or health authorities. RESULTS: a few peculiar clinical cases are reported: tremors in a dental hygienist trainee, chorioretinitis in a welder, spasmofilia in a nursing aide, obstructive sleep apnoea in a steel worker, epilepsy in a metal engineering worker, as well as a number of cases fom the same workplace. CONCLUSIONS: FW judgement made by a IOM had several advantages from clinical and RA aspects. Work restrictions may not always be evidence based and it might be difficult to balance rights and duties of patients, employers and OPs; the IOM's wider experience, case discussion with the relevant parties, scientific and technical documentation of diagnostic and FW processes, strengthen the role of the IOM in dealing with difficult cases and as a guarantee from technical and ethical viewpoints.

Adult↗
PubMedDate not supplied

From clinical activities to didactics and research in occupational medicine.

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.

Academies and Institutes↗
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[Male breast cancer. Five years experience and literature review].

Male breast cancer is an uncommon disease and its aetiology, clinical behaviour and treatment is not well-known . Retrospective studies show that age and stage-matched breast cancer in men and women are compared. Nevertheless, the poor mammary tissue in man allow a rapid local infiltration, late diagnosis and poor survival rate. The Authors report their five years experience and with a short literature review they summarise what is currently known about this uncommon neoplasm in terms of prognostic factors, therapy and survival.

Breast↗
PubMedDate not supplied

[Lymphectomy in differentiated thyroid cancers: our experience].

INTRODUCTION: At present we are still debating on which is the most adequate therapeutic strategy concerning the size of the thyroidectomy and the extension of the lymphectomy in differentiated thyroid tumors. PATIENTS AND METHODS: From January 2000 to December 2005, 334 operations for thyroid neoplasms have been performed; 304 (91%) for differentiated tumors. In 124 cases (37%) the latero-cervical and/or the central compartment lymphectomy have been associated with thyroidectomy: 79 monolateral and central compartment lymphectomies (ML and CCL) (64%), 11 bilateral and central compartment lymphectomies (BL and CCL) (8%), and 34 central compartment lymphectomies (CCL) (28%) have been performed. RESULTS: Out of the 124 lymphectomies, in 44 cases (35.5%) we found the presence of metastasis in the lymph nodes of latero-cervical and central compartments, in 10 cases (8%) absence of metastasis in the lymph nodes of the latero-cervical and central compartments, in 25 cases (20%) presence of metastasis in the latero-cervical lymph nodes and absence of metastasis in the lymph nodes of the central compartment. In 11 cases of bilateral and central compartment lymphectomies, 5 of them (4%) had positive lymph nodes of the latero-cervical and central compartments, while the other, only 6 (5%), had positive latero-cervical lymph nodes on the same side as the neoplasia. In 34 central compartment lymphectomies there was absence of metastasis. Mortality rate was zero. There was one case (0.8%) of recurrent laryngeal nerve temporary bilateral palsy (RTBP); 4 cases (3.2%) of recurrent temporary monolateral palsy (RTMP); 2 cases (1.6%) of definitive monolateral palsy (DMP); 29 cases (23.5%) of temporary hypoparathyroidism (TH); 7 cases (5.5%) of definitive hypoparathyroidism (DH). CONCLUSIONS: Latero-cervical lymphectomy should be performed by necessity when clinical tests or pre-diagnostic exams show suspect lymph nodes, whereas central compartment lymphectomy should be performed in any case of thyroid neoplasia.

Adult↗
PubMedDate not supplied

[Granulomatous mastitis: diagnostic and therapeutic problems. Case report and review of the literature].

The granulomatous mastitis is uncommon inflammatory disease of the breast of unknown etiology. The diagnosis is obtained only through hystopathology. We report a case of woman, 41 years old, showing lesions of the breast, that caused strong pain with ulcerations sero-haematic secretion and axillary omolateral lymphadenopathy. The diagnostic workup (sonography, mammography, multiples FNAB of single lesions, the culture of cells and hormonal profile) showed an inflammatory aspecific lesions with presence of atipic cells in nipple's secretion and in FNAB of periareola lesion. We performed an excisional biopsy. The hystopathologic diagnosis showed a granulomatous mastitis, confirming the validity of our diagnostic and therapeutic choices. The excisional biopsy has allowed to avoid an overtreatment and obtain a good aesthetic result.

Adult↗
PubMedDate not supplied

[Effects on hearing in exposure to impulsive and high frequency noise].

Audiometric tests performed on 41 workers at a metal engineering factory producing tools for the wood manufacturing industry showed hearing loss at 6 kHz in 45.9% of the cases. A study was therefore carried out to check carefully the physical characteristics of the noise via statistical analysis and octave frequencies band analysis in real time. The measurements revealed higher noise levels at the high and medium high frequencies (3.15-6.3 Hz) both for impulsive and continuous noise. The results of the audiometric tests differed from those of a group of 50 workers employed in two different metal engineering factories, where the noise levels were similar but at medium-low frequencies, with no pure tones. In this group of subjects, hearing loss occurred at 6 kHz in 28% of the cases; the differences thus seemed to be related the particular physical characteristics of the noise levels measured in the first factory. The data are discussed against findings already reported in the literature, in relation to their prevention-related aspects and a more correct interpretation of the audiograms.

Adult↗
PubMedDate not supplied

Young drug addicts and the drug scene.

The drug scene generally comprises the following four distinct categories of young people: neophytes, addicts who enjoy a high status vis-à-vis other addicts, multiple drug addicts, and non-addicted drug dealers. It has its own evolution, hierarchy, structure and criteria of success and failure. The members are required to conform to the established criteria. The integration of the young addict into the drug scene is not voluntary in the real sense of the word, for he is caught between the culture that he rejects and the pseudo-culture of the drug scene. To be accepted into the drug scene, the neophyte must furnish proof of his reliability, which often includes certain forms of criminal activities. The addict who has achieved a position of importance in the drug world serves as a role model for behaviour to the neophyte. In a more advanced phase of addiction, the personality of the addict and the social functions of the drug scene are overwhelmed by the psychoactive effects of the drug, and this process results in the social withdrawal of the addict. The life-style of addicts and the subculture they develop are largely influenced by the type of drug consumed. For example, it is possible to speak of a heroin subculture and a cocaine subculture. In time, every drug scene deteriorates so that it becomes fragmented into small groups, which is often caused by legal interventions or a massive influx of new addicts. The fragmentation of the drug scene is followed by an increase in multiple drug abuse, which often aggravates the medical and social problems of drug addicts.

Adolescent↗
PubMedDate not supplied

[Breast feeding in Rome and its province in 1982].

A follow-up study was planned to evaluate the frequency of the breast feeding babies in Rome and its district. 918 subsequently born babies were followed for 6 months. At 3 months of age only the 35,4% of them was still breast fed. We point out that babies born from spontaneous delivery present a higher frequency and a prolonged breast feeding statistically significant v/s babies born from cesarean section, and that the early initiation of breast feeding has a marked positive influence.

Adult↗
PubMedDate not supplied

[Trisomy 18 with unusual clinical and chromosome features].

The Authors describe a newborn with costal hypoplasia and vertebral malformation, tracheoesophageal fistula, congenital heart disease and closed hands with the second and third finger overlapping. Cytogenetic findings indicated trisomy 18 [47, XX, -1, +der(1), +der(18), t(1;18) (q1.2; p11.3)] inherited by mother's carried balanced translocation 1q/18.

Abnormalities, Multiple↗
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Neurobehavioral functions in operating theatre personnel exposed to anesthetic gases.

Neurobehavioral functions in paramedical operating theatre personnel were assessed in a cross-sectional survey. Sixty-two subjects (40 males and 22 females) occupationally exposed to anesthetic gases were examined and compared to 46 unexposed hospital workers (18 males and 28 females). The Simple Reaction Time (SRT) test was selected from the MANS battery (Milan Automated Neurobehavioural System). In order to evaluate acute and subacute types of effects on performance, the test was administered before and after the work shift, at the beginning and at the end of the working week. In addition, the complete battery was administered during one working day without exposure to anesthetic gases. On the last day of the working week, atmospheric nitrous oxide (N2Oa) ranged from 7 to 553 ppm (geometric mean 62.6), atmospheric ethrane (ETHa) ranged from 0.1 to 18.8 ppm (geometric mean 1.3), and urinary N2O (N2Ou) ranged from 4 to 297 micrograms/l (geometric mean 26.8). An impairment of performance on the SRT test was observed at the end of the working week in subjects exposed to anesthetic gases compared to controls. This alteration was observed also considering only the subjects exposed to less than 55 micrograms/l (which is the Italian exposure limit for N2Ou, equivalent to 100 ppm for N2Oa). No significant differences were observed for the other psychometric tests. No dose-effect relationships where found between SRT test score and the indicators of exposure (N2Oa, ETHa, N2Ou).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Serum prolactin in subjects occupationally exposed to manganese.

To evaluate whether or not occupational exposure to manganese (Mn) affects basal levels of serum prolactin (PRL), a cross-sectional study was carried out in 31 occupationally-exposed workers, aged 39.2 years (DS 7.9) exposed to manganese (Mn) dusts for 14.5 years (range: 5 to 29 years) in a ferroalloy producing plant. Thirty-four industrial workers not exposed to neurotoxic chemicals and of comparable age composed the control group. Airborne Mn concentrations in dusts of the furnace area ranged 210 to 980 micrograms/m3, which is below the current American Conference of Governmental Industrial Hygienists (ACGIH)-recommended threshold limit value-time weighted average (TLV-TWA) of 1 mg/m3. Manganese concentrations in blood Mn (MnB) and in urine (MnU) were significantly higher in Mn-exposed workers as compared to control workers. The Mn-exposed workers showed significantly higher serum prolactin (PRL) levels with the geometric mean (GM) being 9.77 ng/ml with a geometric standard deviation (GSD) of 1.69 as compared to controls (GM 4.65 ng/ml, GSD 1.78, p < 0.001). Serum PRL was negatively related to age and positively correlated with both MnB and MnU. Dose-effect relationships were still significant in partial correlation analysis after control for age. The prevalence of abnormally high PRL values was consistent with a dose-response relationship. The observed increase in serum PRL among Mn-exposed workers suggests an impairment of tonic inhibition by tubero-infundibular dopaminergic neurons. The correlation between PRL and both MnB and MnU in samples collected at least 48 h from the last exposure suggests that such indices provide an estimation of the target dose.

Adult↗
PubMedDate not supplied

[Pathological effects due to antineoplastic drugs in workers engaged in their production, preparation or administration].

This article reviews the adverse effects of exposure to antineoplastic drugs in workers producing or administering them. Many antineoplastic drugs are carcinogenic or mutagenic to humans and exposure and absorption have been shown to occur during production in pharmaceutical industries or during the preparation and administration in veterinary and health practice. At present few studies have been made on the increased risk of cancer for workers handling these chemicals. However, available data suggest an increased risk of cancer due to exposure to antineoplastic drugs and increased risk of spontaneous abortions and offspring malformations among women workers. This poses a major problem since the majority of health care workers exposed to antineoplastic drugs are women. Therefore, because of these reported effects, it is of the utmost importance to avoid any contact with, and any absorption of these chemicals by using adequate protective equipment during their preparation and administration and by organizing preventive educational programs for the workers.

Acute Disease↗
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[Guidelines for the health protection and safety of workers exposed to antineoplastic drugs].

The guidelines must guarantee that occupational exposure to antineoplastic chemotherapeutic drugs is kept at the lowest level possible. Occupational exposure to these drugs can involve different categories of workers and different job tasks, such as stocking, preparation, administration, disposal, maintenance of safety cabinets and room cleaning where these activities are performed. Preventive measures should include the institution of "Centralized Units for handling antineoplastic chemotherapeutic drugs", where only specifically trained personnel are employed. Cleaning and decontamination procedures must be easily feasible and specific safety cabinets should be used in the rooms. Personnel must use adequate protective equipment and follow standardized working procedures. Information programs for the personnel should be carried out covering occupational risks, safe preventive measures and the explanation of environmental and biological monitoring.

Accidents, Occupational↗
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Neurobehavioral functions in operating theatre personnel: a multicenter study.

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

Adolescent↗