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Background: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. Objectives: To develop an updated evidence-based methodology for an appropriate health surveillance programme. Methods: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. Results: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). Conclusions: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

At present two of the most relevant problems of the therapy of HCV-related chronic active hepatitis are the retreatment of nonresponders to interferon-α (IFN-α) and the definition of a prognostic index of response. We treated 44 patients who previously were nonresponders to IFN-α alone with IFN-α plus ribavirin for 12 months. Among the tests performed, we included the serum level of soluble intercellular adhesion molecule-1 (sICAM-1) at the beginning of the trial and at 3 months thereafter. We obtained 56.81% end of treatment responses and 47.72% sustained responses. A decrease of at least 10% of the sICAM-1 serum level during the first 3 months of treatment strongly correlated to the results of therapy while the usual important prognostic factors (HCV genotype and viral load) did not show this relation.

Lo stress lavorativo percepito è un problema di salute frequente anche secondo indagini europee ed è correlato, secondo le teorie psicosociali, ad alta richiesta del compito (job demand, JD) e bassa autonomia decisionale (decision latitude, DL). Al fine di esaminare la possibile associazione tra queste due dimensioni ed infortuni sul lavoro ed assenza per malattia, è stato condotto uno studio in 30 aziende del Veneto, di dimensione compresa tra 10 e 500 addetti, appartenenti ai vari comparti dell’Industria e del Terziario. I circa 2200 lavoratori sottoposti a sorveglianza sanitaria in queste aziende sono stati intervistati con il questionario di Karasek, che includeva anche domande sul fumo e sul consumo di alcool e psicofarmaci. In caso di infortunio sul lavoro o di un’assenza dal lavoro per malattia di almeno 10 giorni consecutivi negli ultimi 12 mesi, il soggetto era invitato a focalizzare l’attenzione sugli aspetti psicosociali del lavoro occorsi prima dell’evento; in caso contrario, il lavoratore era invitato a riferire le circostanze del lavoro attuale. Il rischio di high strain lavorativo (alta JD e bassa DL) era più elevato nei lavoratori che avevano riferito un infortunio sul lavoro o un’assenza per motivi di salute. Controllando per i possibili confondenti tramite della regressione logistica multipla, il rischio di infortunio sul lavoro aumentava con l’aumento di JD e, in minor misura, con la riduzione di DL. Il rischio di assenza per malattia aumentava invece soprattutto con la riduzione di autonomia decisionale (DL). Dopo aver calcolato il population attributable risk (PAR), gli infortuni sul lavoro erano attribuibili ad elevata JD (22.4%), bassa DL (15.2%), fumo (28.3%), consumo di alcool (21.7%), tutti questi fattori (87.6%). Le assenze dal lavoro per malattia erano attribuibili ad elevata JD (9%), bassa DL (14%), fumo (8%), consumo abituale di psicofarmaci (6%), tutti questi fattori (37%). Mentre il 90% degli infortuni non è attribuibile a malfunzionamento di macchine, l’approccio alla prevenzione degli infortuni sul lavoro è invece basato su controlli tecnico-ingegneristici e aspetti amministrativi. I risultati di questo studio dovrebbero permettere di considerare altri percorsi di prevenzione, soprattutto per gli infortuni, ma anche per le assenze per malattia, in cui i medici competenti possano giocare un ruolo importante, essendo individuali e psicosociali i fattori da considerare.

Discussões sobre a expansão da agricultura no Centro-Sul do Brasil já começaram, as mudanças nas matrizes energéticas do mundo representam uma oportunidade única para o país na produção de etanol, o que pode ser combinado com a produção oleaginosas na reforma de cana de açúcar. O estudo avaliou a expansão da produção de etanol na escala necessária para o Brasil se tornar a "Arábia Saudita do etanol", resultando no deslocamento da fronteira agrícola no MS e MT. Unidades de observação (UO) foram instaladas em áreas de reforma nas usinas de açúcar localizadas nas principais regiões de produção de etanol no estado de Goiás e Mato Grosso do Sul em 11/10/2009. Foram avaliados oito cultivares de soja cultivadas em usinas de açúcar localizadas no país. Segundo o estudo, as variedades de soja que melhor se adaptam ao sistema de produção na reforma foram BRS 232 e BRS 282. O trabalho mostra que a rotação cana / soja no Centro-Sul é tecnicamente viável, nas áreas de reforma da cana que estejam dentro do zoneamento climático para soja.

Liver metastases are a very common event. Multiple choices of therapies can be used. The aim of this paper is to analyze results and methods of a single institution series of 228 consecutive patients with colorectal liver metastases.228 consecutive patients underwent hepatic resection for colorectal liver metastases. From different periods intraoperative ultrasound, intraoperative histological examination, locoregional intra-arterial chemotherapy, and radiofrequency thermal ablation were introduced.Operative mortality was 0.9%. Mean follow-up was 29.5 months. Overall survival was 16% and 9% at 5 and 10 years. 5-year survival was 23% and 6% for patients with single and multiple metastases respectively. For patients with extrahepatic metastatic single lesion 5-year survival was 15%. From the start of intraoperative ultrasound use, 5-year survival was 9% and 27% for patients with multiple and single metastases. Five-year survival for re-resected patients was 13%. Overall survival at 1 and 3 years was 90% and 58% in patients treated with HAI and systemic chemotherapy (disease-free 70% and 47%) and 94% and 12% in patients treated with systemic chemotherapy alone after radical resection (disease-free 53% and 0%).Aggressive approach, re-resections, intraoperative ultrasound staging, intra-arterial chemotherapy and radiofrequency thermal ablation are justified in multimodal therapeutic strategy of colorectal metastases and seem to improve patients' survival.

Background Radiofrequency ablation (RFA) is a novel technique for the treatment of liver malignancies that is becoming increasingly more popular because of its feasibility, effectivity, repeatability, and safety. However, an increased number of complications after RFA has been reported in literature. The aim of this paper is to discuss the possible role of RFA in rapid intrahepatic spreading of hepatocellular carcinoma (HCC). Patients and methods We treated a 66-year-old woman who had a 3.5-cm HCC with two courses of percutaneous RFA using a modified needle with seven hooks. The effectiveness of the treatment was assessed 1 month later by enhanced computed tomography. Results Two courses of treatment were needed owing to the nodule position (close to the inferior vena cava). Computed tomography scan performed 1 month after the second RFA showed an intrahepatic arteriovenous fistula. Angiography performed after 1 month showed a rapid intrahepatic spreading of HCC. Conclusions Radiofrequency ablation can create an arteriovenous fistula that can facilitate migration of tumoral cells from the nodule to the hepatic portal system and rapid intrahepatic dissemination of HCC.

Background and aims: The treatment of choice for hepatocellular carcinoma is surgical resection. Recurrence occurs in most patients. Aggressive treatment of liver recurrence increases patients' survival, but most frequently, these patients are not suitable for surgery. The aim of this study was to analyze the indications for and results of radiofrequency thermal ablation (RFTA) in the treatment of intrahepatic recurrences of hepatocellular carcinoma after surgical resection or after RFTA. Patients and methods: Seventy-nine patients with HCC were treated by RFTA (17 during laparotomy, 1 in video-laparoscopic surgery, and 61 percutaneously). Five (5/79) of these patients had recurrences after surgical resection and 1 patient had a recurrence (new lesion) after percutaneous RFTA. Fifteen of the 79 patients were treated for recurrence after transarterial chemoembolization (TACE) and, for the remaining 58 patients, RFTA was the first treatment. We used a radiofrequency generator with an expandable needle with four, seven, or nine hooks at its end. We followed up all patients with enhanced computed tomography (CT) scans and α-fetoprotein sampling 1 month after RFTA, and then every 4 months. Results: All 5 patients treated for recurrence after resection are alive, after a mean period of 43 months from liver resection. One patient is disease-free, 1 patient has controlled disease, and 3 patients are in progression. The patient treated for recurrence after RFTA is disease-free after 4 months. Conclusions: We treated all our patients with intrahepatic recurrence after surgical resection by a multimodal approach. We regard RFTA as the treatment of first choice in the management of intrahepatic recurrence. For superficial tumors, surgical resection is still the best treatment. For multifocal recurrence, TACE is needed. RFTA can be useful as a complementary technique for lesions not completely treated by TACE.

Intercellular adhesion molecule 1 (ICAM-1) is a marker of inflammation and tissue damage. Levels of soluble ICAM-1 (sICAM-1) were measured in 71 patients with chronic C hepatitis treated with interferon (IFN)-alpha-2a, at baseline and at every 3 months of therapy, and in 42 normal control subjects. The levels of sICAM-1 were significantly higher in the patient than in the control subject group, particularly among cirrhotics. Baseline sICAM-1 levels were similar in responders and nonresponders. By contrast, the concentration of sICAM-1 decreased significantly only in responders during the first 3 months of therapy. The probability of response to treatment, analyzed by Kaplan-Meier analysis, was much higher in the group showing a decrease of sICAM-1 than in the patients who did not show such a decrease. In conclusion, a "longitudinal" evaluation of serum levels of sICAM-1 in the first period of treatment is particularly useful in the identification of patients with high significant probability of response to treatment.

The majority of deaths in severe pancreatitis are the result of superinfection of necrotic tissue. The pathogen most commonly responsible for such infections is Escherichia coli. Antibiotic prophylaxis would appear a logical precaution. The antibacterial drugs of choice should possess two basic characteristics: they must be active against the flora responsible for the infections and must be capable of penetrating into the pancreas at adequate minimum inhibitory concentrations (MICs). Mezlocillin--which is active against E. coli--has been shown to possess the latter requisite, but achieving therapeutic concentrations requires administration at high doses. In the present study, pure human pancreatic fluid showed properties similar to those observed in the dog against E. coli (bacterial colony growth 100 times lower than in a control culture) and produced a 75% reduction in mezlocillin MICs against this organism. These enhancing characteristics might make the commonly used doses sufficient for prophylactic purposes.