Early lung function abnormalities in acromegaly

BACKGROUND

Acromegaly is an insidious disorder caused by a pituitary growth hormone (GH)-secreting adenoma resulting in high circulating levels of GH and insulin-like growth factor I (IGF-I). Respiratory disorders are common complications in acromegaly, and can severely impact on quality of life, eventually affecting mortality.

OBJECTIVES

The present study aimed to explore structural and functional lung alterations of acromegalic subjects.

METHODS

We enrolled 10 consecutive patients (M/F: 5/5) affected by acromegaly. In all patients, magnetic resonance imaging (MRI) revealed the presence of pituitary tumor. All patients underwent clinical, lung functional, biological, and radiological assessments. Ten healthy age-matched subjects also served as controls.

RESULTS

No statistically significant differences in lung function were detected between acromegalic and healthy subjects (p ≥ 0.05 for all analyses). However, the diffusing capacity for CO (TLCO) was significantly lower in the acromegalic group than in healthy subjects (TLCO% predicted: 78.1 ± 16 vs. 90 ± 6 %, respectively, p = 0.04; KCO% predicted: 77 ± 16 vs. 93 ± 5 %, p = 0.02, respectively). None of the lung function parameters correlated with duration of the disease, or with inflammatory marker of the airways. In acromegalics, biological (exhaled NO concentrations) and imaging (total lung volume, TLV, and mean lung density, MLD) evaluations were within normal values. The TLV measured by HRCT was 3540 ± 1555 ml in acromegalics, and the MLD was -711 ± 73 HU. None of the lung functional, radiological, and biological findings correlated with GH or IGF-I levels, and no correlation was found with duration of disease.

CONCLUSIONS

In the current study, lung function evaluation allowed to detect early involvement of lung parenchyma, as assessed by TLCO and KCO, even in the absence of parenchymal density alterations of the lung by HRCT. These findings suggest to routinely include the carbon monoxide diffusing capacity in the lung function assessment for an early intervention in acromegaly.

Prevalence of depression and its relationship with work characteristics in a sample of public workers

Occupation is a fundamental right, enabling social interaction and financial support for the individual. However, it is an undeniable source of stress, with consequences for physical and mental health. The prevalence of depression and somatic complaints were assessed in 1,013 public workers using the Beck Depression Inventory and a questionnaire investigating for the presence of somatic problems designed by the research team. The results were related to demographic characteristics, history of previous depressive episodes, work schedule (day work, night and day rotating shift work, day rotating shift work), and duration of current work schedule. There were more cases of moderate depression in the day rotating shift workers (84%) than in those working at night (83%). More women had mild or moderate depression than men (22% and 4% versus 10% and 3%, respectively). Severe depression was found only in men. Nearly 10% of depressed individuals reported previous depressive episodes. A link between depression and somatic complaints was also found. In particular, 59% of depressed subjects reported gastrointestinal complaints and 41% did not (P<0.001). In conclusion, the occurrence of depressive symptoms could be facilitated by occupation. A history of depressive symptoms should not be neglected, given the risk of recurrence. Somatic complaints could represent a "wake-up call" regarding depression. Global assessment and effective support are fundamental for promotion of a better quality of life in the at-risk category of workers.

Validation of lung densitometry threshold at CT for the distinction between senile lung and emphysema in elderly subjects

BACKGROUND AND AIMS

An ageing lung is characterised by distal airspace enlargement without alveolar wall destruction: therefore the anatomical distinction between senile lung and emphysema is clear-cut. In clinical settings the definition of precise boundaries between normalcy and pathology is more difficult with the risk of overdiagnosis. CT is an important diagnostic advancement in the field of COPD. Most methods for the evaluation of emphysema are based on the detection and measurement of areas characterised by a density level below a threshold assumed to characterize parenchymal destruction.

METHODS

Our retrospective study included 47 healthy subjects (65-91 years), 36 never smokers and 11 former smokers. As a reference sample we recruited 9 patients with emphysema (69-81 years). Thoracic scan was performed by single slice spiral CT and acquired without contrast enhancement. For each scan and on both lungs we sampled eighteen regions of interest in the upper, middle and lower field. Mean lung density (MLD) and lower limit of normal (LLN) of density distribution were calculated.

RESULTS

MLD for the whole study sample was -846 +/- 41 HU. -901 HU was the LLN of density distribution in the study sample. No significant correlation was noted between age and MLD. In the emphysematous sample the average lung density was -946 +/- 18 HU. The mean coefficient of variation was 3% in the healthy sample and 2% in the emphysematous one. The difference between groups was significant (p < 0.0001). In one healthy subject only we measured a value slightly below the threshold reported in literature for conventional CT; no emphysematous value fell above the LLN.

CONCLUSIONS

This study highlights the fact that in the elderly the threshold level of lung density commonly adopted in diagnostic algorithms of emphysema is fully applicable. When applying this method to older subjects the risk of misinterpreting areas of physiologic non-destructive reduction of density as emphysema is low.

[Health promotion and obesity in the workplace among health care workers of a hospital in Catania (Italy)]

BACKGROUND

Italian Legislative Decree No. 81/2008 foresees the involvement of a "specialised physician" in activities for the promotion of health at the workplace.

OBJECTIVES

These activities are aimed at modifying erroneous lifestyles (such as smoking, drinking, bad diet, etc.) which are responsible for serious illnesses and also for repercussions on the assessment of fitness for a specific task. Obesity, as we know, represents the major risk factor in the onset of metabolic, neoplastic, cardiovascular and respiratory diseases and also in the increased incidence of accidents at the workplace and sick absence.

METHODS

A specific questionnaire was administered to 700 health care workers of a Hospital in Catania to estimate the incidence of factors which favour the onset of these diseases: factors such as familiarity, endocrinal dysfunction problems (diabetes mellitus, hypothyroidism), shift work and little physical exercise.

RESULTS AND CONCLUSION

Statistical processing of the data confirmed, partially, that little physical exercise, hypothyroidism, diabetes mellitus, familiarity in the > 36 age group were the major risk factors in the onset of obesity, as reported in the literature. However, contrary to the literature reports, shift work did not seem to be a risk factor in the sample under study. A programme of rehabilitation, on a voluntary basis, will be offered to those workers who are overweight/obese. This programme will involve professionals such as nutritionists, endocrinologists and psychologists, and it will aim at improving workers' health conditions as well as their work performance.

A rare case of pedunculated bronchial hemangioma

We describe a rare case of pedunculated endobronchial hemangioma observed in a 60-years-old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.

Non-invasive diagnosis in a case of bronchopulmonary sequestration and proposal of diagnostic algorithm

The case of a 43-year-old woman with intralobar pulmonary sequestration, Pryce type one, is presented. The medical history was characterised by recurrent bronchopneumonia, productive cough with purulent sputum and hemoptysis in the last three years. Diagnosis was made by CT angiography: multiplanar, maximum intensity projection and volume rendering reconstructions were visualised. A volume reduction of middle and lower lobe with multiple cyst-like bronchiectasis was detected and no evident relationship with tracheobronchial tree was pointed out. Reconstructions aimed at evaluating bronchial structures demonstrated no patency of middle and lower lobar bronchi. The study carried out after contrast medium infusion in arterial phase showed a vascular disorder characterised by an accessory arterial branch arising from the upper portion of thoracic aorta which, after moving caudally to pulmonary hilus with a tortuous course, supplied the atelectatic parenchyma. No anomalous venous drainage was detected. The patient underwent surgery with resection of two pulmonary lobes. CT compares favourably with other alternative imaging technique for pulmonary sequestration as multiplanar reconstructions allow not only the detection of supplying vessel, but also the accurate description of heterogeneous characteristics of the mass and adjacent structures. Finally an imaging-based diagnostic algorhithm is proposed.

[Diagnostic protocol and special tests]

Diagnostic protocol and special tests to ionizing radiations have a preventive function in the medical surveillance of the exposed worker. This protocol must be provided with laboratory and special test assessing fitness for working at the risk of ionizing radiations. The health of workers must be compatible with working conditions and radiation risk. This healthiness of workers is evalued in the time to give an assessment fitness for working at ionizing radiations. For this purpose the basic diagnostic protocol must guarantee minimum information about state of organs and apparatus in addition to the normality of the metabolisms. The diagnostic protocol of the exposed worker to ionizing radiations must be adapted to the specific clinical situation so as to finally make a costs-benefits balance sheet.

[Radiation protection issues in brachytherapic treatment of prostatic cancer]

Brachytherapy is an effective radiotherapeutic treatment for localized prostatic cancer. The permanent brachytherapy is a particular kind of radiotherapy which, US guided, uses permanently implanted seeds containing radioactive sources (Pd103 or I 125). The procedure is minimally invasive and allows to obtain high percentage of success which is comparable to surgery. The possibility to confine permanent radioactive implants in a well delimitated area doesn't exclude the exposition of both the medical staff and family's members of implanted patients. The radiation exposure involves the medical physicists, the radiotherapists, the Medical Radiology Technician, the anaesthetists, the surgeons, the professional nurses but also, after the brachytherapy treatment, public and family members, comforters and cares. It's necessary to consider radiation safety aspects of brachytherapy in order to reduce the risks of exposition. At the end, several studies showed that cremation of bodies could be a possible radiation source that remains in the patient's ashes, potentially inhaled by crematorium staff or members of the public.

[Occupational hazards in management of an experimental constructed wetlands]

The sewage from urban settlements is an important cause of water pollution. Recent Italian legislation offers new possibilities for intervention in the purification of wastewater. The "Decreto Legislativo" 152 of April 3, 2006, indicating "Environmental Standards", recommends the possible use of constructed wetlands considered particularly suitable for small and medium communities according to low operating costs, lack of energy, and manageability. The Authors, after describing the characteristics of these facility, analyze the occupational risks associated with the control and maintenance of a experimental subsurface constructed wetland (H-SSF, SubSurface Horizontal Flow) coming to the conclusion that the management of this type of facility has a low risk of exposure to biological agents.

[Incidence of dysphonia in teaching staff of schools]

Some categories of workers (actors, teachers, singers) use a particular working tool: their voice. In order to assess the spread of dysphonia and its possible causes across a specific class of workers--the teachers of some schools in the city of Catania--we have set up a ad hoc questionnaire. A special database has been subsequently arranged, aimed at the statistical analysis of the responses obtained. The analysis of the responses shows that the phenomenon is more present in female than male teachers, 48% versus 30%. The dysphonia occurs mainly at the end of the working day, lasts throughout the school year and improves in summer, demonstrating the importance of teaching activity in its pathogenesis. One aspect especially stands out: dysphonia occurs exclusively in those individuals suffering from diseases with possible alterations of the voice, such as allergopathies, tireopathies and gastropathies. Therefore, work activity alone does not seem able to cause a chronic dysphonia, whereas the presence of diseases causing disability of vocal cords appears to play an important role.

[Silica carcinogenicity: description of a clinical case]

BACKGROUND

Until the early 1980's there was a general consensus that no relationship existed between occupational silica exposure and lung cancer, in spite of a number of reports to the contrary. Confirmation arrived later from animal experiments and in 1997 the IARC modified its carcinogenic agents classification to include silica in group 1, human carcinogens. This fact brought about a change in insurance practice regarding occupational diseases due to silica, with greater attention dedicated to pneumoconiosis-related lung cancers.

OBJECTIVE

To describe a clinical case of lung cancer due to occupational exposure to silica in a worker of a ceramics industry already receiving compensation for silicosis.

METHODS

Diagnosis and recognition of the occupational origin of the disease were achieved via assessment of exposure to silica in the past and review of the medical examinations over the years.

RESULTS

The pathogenesis and the causative relationship between pneumoconiosis and cancer is debated and lung cancer was recognized as an occupational disease.

CONCLUSIONS

It is concluded that a causative relationship can exist more due to the presence of silicosis than due to occupational exposure to silica.

Long-lasting neurotoxicity of prenatal benzene acute exposure in rats

Benzene is a common element of environmental pollution. Although this substance is not recognized as a teratogenic agent, it is not known whether prenatal exposure to benzene may induce neurobehavioral changes in the progeny. Benzene 0.1mg/kg was injected subcutaneously (s.c.) acutely at day 15 of gestation into pregnant female rats of the Sprague-Dawley strain and neurotoxicity of the substance was studied in pups and male adult animals of the same progeny. No change was found in total number of neonates, body weight and eye opening time between benzene-exposed animals and controls. No malformations were observed. At birth, neonatal reflexes (cliff aversion, forelimb placing, bar holding, forelimb grasping, startle) were scored in benzene-exposed pups and their percent appearance was found to be anticipated (more benzene-exposed pups exhibited reflexes each day) in comparison to that of control animals. Also, the completion (maximum appearance, i.e. 100% of the brood was found to exhibit each reflex) of neonatal reflexes in benzene-exposed animals preceded that of controls. Starting 2 months after birth, cognitive and motor performance was assessed only in male animals of the prenatally benzene-exposed progeny. The overall evaluation of motor activity in benzene-exposed animals in the open-field test revealed reduced ambulation in these rats as compared to control animals. Acquisition of active avoidance responses in the shuttle-box test, as assessed by the number of conditioned avoidance responses and the percent of learners, was impaired in benzene-exposed rats as compared to control animals. Prenatal exposure to benzene was also followed by reduced retention latency in a step-through passive avoidance task in two retention tests. These results suggest that acute exposure to benzene during gestational organogenesis may cause long-lasting changes in motor behavior and cognitive processes. This may be relevant for the assessment of benzene toxic profile for the progeny of pregnant subjects, although teratogenic effects are not observed.

Distinct response to ionizing radiation of human prostate cell lines

The purpose of this study was to determine in vitro the relationship between ionizing radiation (IR) treatment, reactive oxygen species (ROS) production, lipid peroxidation, glutathione (GSH) levels, and DNA damage of the human benign prostate hyperplasia BPH-1 cell line, and two prostate cancer cell lines, LNCaP, which is androgen-sensitive, and DU-145, which is androgen non-responsive. The cells were analysed after exposure to 1.0 or 2.0 Gy of X-ray radiations. The response to IR treatment was evaluated by examining: ROS production by quantitative analysis with fluorescent probe 5 and 6-carboxy-2'7'-dichlorodihydrofluorescein diacetate bis acetomethyl ester (DCFH-DA), GSH levels by 2,2'-dinitro-5,5'-dithio-benzoic acid (DTNB), and lipoperoxidation by thiobarbituric acid reactive substances (TBARS) analysis. To study IR-induced DNA damage, Single Cell Gel Electrophoresis or comet assay was performed. DU-145 cells were characterized by higher DNA damage, more evident extent of lipid peroxidation, and slighter levels of ROS and GSH compared to BPH-1 or LNCaP. Human benign BPH-1 and cancer LNCaP and DU-145 cell lines are not equal regarding their capability of IR resistance in terms of ROS production, antioxidant potential, IR-induced lipid peroxidation and DNA damage.

Airway remodelling assessed by sputum and high-resolution computed tomography in asthma and COPD

It is not known whether sputum elastase, metalloproteinase (MMP)-9 and tissue-inhibitor metalloproteinase (TIMP)-1 are related to structural changes of the airways, as assessed by high-resolution computed tomography (HRCT) scan. The relationships between these markers and the magnitude of structural changes of the airways in asthma and chronic obstructive pulmonary disease (COPD) were assessed. Induced sputum and HRCT scan were performed in 30 asthmatics (14 mild and 16 severe) and in 12 patients with COPD. A greater extent of HRCT scan abnormalities was found in COPD than in severe and mild asthmatics. HRCT scan abnormalities correlated with the degree of airway obstruction in COPD and in severe asthma. HRCT scan abnormalities also correlated with the levels of sputum elastase both in COPD and in severe asthma. HRCT scan abnormalities were associated with sputum MMP-9/TIMP-1 ratio in mild asthma, severe asthma and COPD. In conclusion, this study demonstrates that sputum elastase and the metalloproteinase-9/tissue-inhibitor metalloproteinase-1 ratio are associated with the magnitude of high-resolution computed tomography scan abnormalities of the airways in asthma and chronic obstructive pulmonary disease, and suggests that the levels of these markers reflect the extent of structural changes of the airways.

[The point of view of the Italian Association of Medical Radioprotection: proposal of the Italian C.E.M. Observatory]

Taking in consideration the suggested guide-lines for the health-surveillance on workers exposed to N.I.R. and in particular to ELF and radio-frequency, a work-group of A.I.R.M. suggests the constitution of an italian network for electro-magnetic fields. An observatory will be founded to value the professional exposures and the undue situations of risk, a parallel one will take the census of the workers subdivided into classes for exposure levels, pathologies or symptomatologies imputable to electro-magnetic fields. This suggestion is addressed to the national environmetal hygienists and occupational physicians that are interested.

The investigation of the significance of a positive direct antiglobulin test in blood donors

Sixty-two samples from 62 donors were investigated to determine the significance of warm IgG autoantibodies that were detected using a gel system during compatibility testing. The presence of autoantibodies on the red cells was confirmed by elution studies. Twelve of 23 strongly positive samples, 7 of 19 moderately positive samples, and 6 of 11 weakly positive samples were studied. The remaining nine samples were found positive during crossmatching, then negative when it was repeated. These nine samples were not included in this study. With a tube test, most of the antibodies had titers from 4 to 8. IgG subclass studies showed that 14 of 25 samples with reactive eluates contained IgG1, one contained IgG1+IgG2, one contained IgG1+IgG4, and two contained IgG1+IgG3 weak. The frequency of donors with a positive direct antiglobulin test (DAT) was approximately 1 in 3000 and males were twice as likely to be DAT positive (8 females vs. 17 males in this study). None of the donors had hemolysis. Two donors showed low-titer anticardiolipin antibodies. We conclude that DAT-positive donors can be a problem during compatibility testing when sensitive methods are used.

[Occupational allergic asthma in greenhouses. Report of a clinical case]

The Authors report a particular case of occupational asthma observed in a greenhouse worker. They describe the diagnostic procedure followed after identification on the cultivated plants of colonies of aspergillus niger, a fungus identified as an etiologic agent of the allergic disease. The peculiarity of the causative agent is stressed and it is recommended that environmental and health prevention measures be improved for this poorly protected class of workers.

Cardiac tamponade due to post-cardiac injury syndrome in a patient with severe haemophilia A and HIV-1 infection

An 18-year-old man with severe haemophilia A (FVIII:C < 1%) and human immunodeficiency virus 1 (HIV-1) infection was admitted to the hospital with fever and chest pain for 7 days. Eight weeks prior to his admission he had an accident for which he underwent, at another hospital, clinical and laboratory examination that revealed bone fractures of the nose cavity, and he was given factor VIII concentrates for seven days due to nasal bleeding. On admission, chest roentgenogram showed a large cardiac silhouette and echocardiography confirmed the presence of a large quantity of pericardial fluid. A presumptive diagnosis of the post-cardiac injury syndrome was made and he was given anti-inflammatory drugs plus infusion of recombinant factor VIII concentrate (35 units kg-1 b.i.d.). On the seventh day he exhibited cardiac tamponade for which he underwent subxiphoid pericardiotomy with drainage of approximately 1500 mL of bloody exudate. He had an uncomplicated recovery and 10 days later he left hospital. He was given a continuous prophylactic treatment of 15 units kg-1 of recombinant FVIII every 2 days for 6 months, and 30 months after this episode the patient is free of any symptom.

[Pigmentation of the oral mucosa from endodontic materials]

The Authors describe the clinical case in which a 30 years old male patient presents anomalous pigmentation of the oral mucosa after the endodontic treatment of the upper right central incisive. The mucosa's anomaly appeared at the height of the lower third of the root near the branch of an accessory endodontic canal previously filled and it was caused by the outlet of filling material. After the examination of this case, the Authors affirme the importance of an accurate anamnesis in order to obtain a correct diagnosis of the various kinds of pigmented lesions, distinguishing the etiology, the pathogenesis and the histologic patterns.

[Modification of malate dehydrogenase and glutamate dehydrogenase in hearts of rats exposed to a double stress (dry heat - fasting). III]

MDH and GLDH activity modifications have been studied in heart homogenized of rats exposed to double stress (dry heat and starvation). MDH activity shows statistically significant variations only after 72 hours. This induces to suspect a decrease of energetic metabolism due to a probable substratum lack. GLDH activity shows a statistically significant decrease after 24 hours, and this decrease increases after 72 hours. This behaviour could be explained by an acclimatization reaction of such an amount to delete the hunger effect on protein catabolism.

[Malate dehydrogenase and glutamate dehydrogenase activity modification in livers of rats exposed to a double stress (dry heat - fasting). I]

We have studied MDH and GLDH behaviour in liver homogenized of rats exposed to double stress (dry heat and starvation) for 24 hours respectively. Both enzyme showed a statistically significant activity increase, either after 24 and 72 hours. Such an increase is affected mainly by starvation. This behaviour reflects the metabolic needs of organism, related to increased energetic requirements.

[Modification of malate dehydrogenase and glutamate dehydrogenase in kidneys of rats exposed to a double stress (dry heat - fasting). II]

MDH and GLDH activity changes have been studied in kidney homogenized of rats exposed to double stress (dry heat and starvation) for 24 and 72 hours respectively. MDH behaviour activity decrease after 24 hours and increase to basic values after 72 hours leads to suspect the primer of a defence mechanism that precedes to face up increased metabolic needs. GLDH activity shows a constant decrease after 24 hours and after 72 hours; this was explained as a premature acclimatization reaction.