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Biomedical subjects

F Toffoletto

Publications and source records attributed to F Toffoletto.

At least 19 recordsLinked to original sources
PubMed2003

Olfactory function in workers exposed to moderate airborne cadmium levels.

OBJECTIVE: The present study investigated the olfactory function in workers exposed to moderate airborne cadmium (Cd) levels, with the purpose of identifying possible early adverse effects of the metal, not demonstrable with the traditional diagnostic methods. METHODS: The exposed group consisted of 33 men employed in cadmium fusion, sintering and alloys lamination. Two reference groups were considered: the first consisted of 39 subjects assigned to manual workings, but not exposed to harmful substances for olfaction (drivers, warehousemen); the second was characterized by 23 subjects exposed to iron and steel welding fumes (iron base alloys), non-specific irritants on the respiratory tract. Olfactory threshold and odor identification ability were separately quantified. Individual occupational exposure was studied by calculating the mean blood and urinary cadmium values (CdB and CdU, respectively) of the five years period during which, for each worker, the highest levels of dose indicators were measured. As indicator of renal tubular damage, urinary beta(2)-microglobulin levels in the same quinquennium were monitored. RESULTS: Mean olfactory threshold scored significantly higher in Cd workers (-5.26 log(10)v/v, P=0.02) than did in controls (welders: -5.78 log(10)v/v; P=0.26 compared to non-exposed -6.37 log(10)v/v). The odor identification test findings for Cd workers were similar to those of the reference groups. Moderate blood and urine cadmium levels (mean CdB 3.7 microg/l; mean CdU 4.4 microg/g creatinine) accompanied threshold impairment. Olfactory threshold weakening was confirmed in the subgroup of Cd workers in which urinary beta(2)-microglobulin never exceeded 300 microg/l (-5.41 log(10)v/v; P=0.045 compared to non-exposed). CONCLUSIONS: These data suggested that possible early toxic effects of the metal can occur at low levels, close to the limits proposed by the American Conference of Governmental Industrial Hygienists (ACGIH), confirming the hypothesis that primary olfactory neuron may represent the early target for cadmium toxic action. The action of the metal seemed to be due to an elective tropism for the olfactory epithelium and not to a non-specific irritant effect on the nasal cavity. The mechanism of this effect did not appear linearly dose-related. These findings underline the importance of olfactory tests to identify the early effects of xenobiotics even at low-exposure levels, and to contribute to verify the adequacy of the current exposure limits.

Adult↗
PubMed1998

Trace elements and micropollutant anions in the dialysis and reinfusion fluid prepared on-line for haemodiafiltration.

Exposure to the trace elements and micropollutions of tap water may be very considerable in dialysis patients. As few data on trace elements in reinfusion and dialysis fluid for haemodiafiltration (HDF) have been reported, we studied nine trace elements (microg/l; Al, As, Cd, Cr, Cu, Hg, Pb, Se, Zn) and five anions (mg/l; F-, NO2-, NO3-, PO4(3-), SO4(2-)) in tap water, in water after two passages of reverse osmosis (2RO), in dialysate and in on-line prepared reinfusate. NO3- and SO4(2-) were somewhat elevated in our tap water (22.2+/-7.6 and 21.8+/-11.3 mg/l) but decreased (P<0.001) after 2RO (1.4+/-1.5 and 0.9+/-1.1 mg/l); the other anions, which were at a very low level, remained unchanged. All trace elements decreased, with statistical significance only for Al, Cr and Zn from 14.9+/-19.9, 2.6+/-0.6 and 35.1+/-41.1 microg/ to 3.2+/-2.1, 0.2+/-0.2 and 3.5+/-4.8 microg/l, respectively. Due to impurities in concentrate salts for Al (5.4+/-3.1), Cr (0.5+/-0.4) and SO4(2-) (2.4+/-1.8), greater concentrations were found in dialysate and reinfusate than in tap water after 2RO (P<0.03). For all measurements, trace elements and anions were at acceptable levels according to international standards. Simultaneous determinations of trace elements at inflow (Din) and outflow (Dout) of the dialysate as well as in plasma or in whole blood at the beginning of on-line HDF documented Dout/Din>1 for Al, Cu and Zn and a positive gradient between the concentration in blood and dialysate inlet. In conclusion, our dialysate and reinfusate can be considered safe regarding trace elements and micropollution: two passages through reverse osmosis reduces the concentrations of trace elements and anions. The impurities of concentrates are acceptable. Accumulation or depletion of trace elements should be evaluated after longitudinal studies of plasma concentrations.

Anions↗
PubMed1998

Plasma or whole blood concentrations of trace elements in patients treated by haemodiafiltration with on-line prepared substitution fluid.

Large membrane pores and large quantities of reinfusion fluids can influence the dialytic balance of trace elements in haemodiafiltration (HDF). As there are no studies in HDF with on-line produced reinfusate, we studied plasma or whole blood (*) concentrations of trace elements (Al, Cd*, Cr* and Se: microg/l; Cu, Pb* and Zn*: microg/dl) of 24 on-line HDF, 20 haemodialysis (HD) patients and 66 490 normal subjects (N). The concentrations of Al (11.7+/-9.5), Cd (0.73+/-0.59) and Cr (6.5+/-6.9) were significantly greater in on-line HDF patients than in normal subjects (6+/-0.4; 0.6+/-0.2; 0.5+/-0.02), but similar to those of HD patients. In on-line HDF patients, Cu (85.3+/-17.7), Pb (8+/-4.6), Se (68+/-27) and Zn (546+/-103) concentrations were less than in normal subjects (108+/-3.4; 11+/-0.8; 95+/-1.8; 673+/-23), and those of Cu and Zn were also less than in HD patients (99.5+/-16.8; 670+/-65). At the end of an on-line HDF treatment (42-69 studies), there was a significant increase in Al (from 12.8+/-9.1 to 15.4+/-8.3), Cr (from 7.2+/-6.4 to 9.5+/-7), Cu (from 97.3+/-21.5 to 109.4+/-27.2) and Zn (from 577+/-108 to 619+/-117). A longitudinal study (n = 16-18) for 12-30 months documented stable concentrations of Al, Cd, Cr, Se and Zn and a significant increase of Cu and Pb to normal concentrations. In conclusion, our on-line HDF patients have elevated Al, Cd, Cr and decreased Cu, Pb, Se, Zn concentrations in plasma or whole blood determinations. Cu and Pb normalize with time; the other trace elements remain stable as documented by numerous determinations. As the values for on-line HDF patients are similar to those of HD patients, the level of accumulation or depletion of trace elements in on-line HDF can be considered as safe as in HD; the increase in Al, Cd, Cu and Zn at the end of treatment may be an expression of the increase of those trace elements linked to proteins.

Dialysis Solutions↗
PubMed1997

Allergic and Irritant Glove-related Diseases in Health Care Workers and Their Prevention.

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

Journal Article↗
PubMed1996

Neurotoxicity in operating room personnel working with gaseous and nongaseous anesthesia.

Occupational exposure to high concentrations of anesthetic gases (more than 500 ppm of nitrous oxide and more than 15 ppm of halothane and enflurane) can cause neurobehavioral effects in operating room personnel. Factors such as stress and work organization play an additional role in reducing performance capacities. It is still unclear whether these conditions may become the predominant factor in behavioral impairment when exposure to anesthetic gases is reduced; in addition, we wished to ascertain the extent of neurobehavioral and neuroendocrine effects at relatively low levels of exposure to such gases. Therefore the same group of 30 operating room personnel was examined with neurobehavioral tests during gaseous and nongaseous anesthesia. In this way, the neuropsychological performance was examined under the same stress conditions, but with different exposure levels to anesthetic gases. Serum cortisol was measured as an additional "biological stress indicator." Prolactin secretion was examined to study possible interference of anesthetic gases with the dopaminergic system. The results were compared with those in a control group of 20 hospital workers from other departments, with similar characteristics in respect of age, sex, and education. During work with gaseous anesthesia, average airborne concentrations (geometric mean) of nitrous oxide were 50.9 ppm (SD 20.8) on the first day of the working week, and 54.2 ppm (SD 22.1) on the last day of the working week, whereas average urinary nitrous oxide (geometric mean) were 21.54 micrograms/l on the first day of the working week and 25.67 micrograms/l on the last day of the working week. The operating room workers showed slower reaction times at the end of the week with gaseous anesthesia, compared with workers using nongaseous anesthesia and the control group. At the same time they also showed increased secretion of prolactin, whereas cortisol remained unchanged. Therefore, it can be concluded that lower levels of exposure to anesthetic gases (and not only high exposure levels) cause an impairment of neurobehavioral performance, with the action of stress being less relevant. The mechanism of anesthetics' neurotoxic action seems to be related to interference with the dopaminergic system.

Adult↗
PubMed1995

Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle.

Spinal anesthesia in day-care surgery is still controversial because of the possibility of postdural puncture headache (PDPH). The use of the Sprotte needle with a conical tip that spreads the dural fibers may reduce the incidence of PDPH. The aim of this study was to compare the 22-gauge and 25-gauge Sprotte needles with respect to PDPH and postoperative complaints in out-patients undergoing arthroscopy. The rate of spinal anesthesia failure and the feasibility of unilateral spinal anesthesia when using a low dose of anesthesia was also verified. For this randomized, prospective study, 234 patients undergoing elective arthroscopy were chosen. Patients were allocated randomly to have spinal anesthesia with either a 22-gauge or 25-gauge Sprotte needle. Dural puncture was performed with the patient in a lateral flexed decubitus position. After the injection of anesthetic solution (0.5-1.2 mL of 1% bupivacaine in 8% glucose) patients remained in the lateral decubitus position for 30 min. The time to regression of analgesia, time of micturition, and all postoperative complaints were recorded. The most frequent side effect was backache (10.2%) with a more frequent incidence in the group using the 22-gauge needle (14.5% and 5.9%, respectively). PDPH was recorded in only one patient (0.8%) in the group using the 22-gauge needle. The failure rate was 0.8%. Unilateral anesthesia was achieved in 88% of 213 patients. Our data indicate that the use of spinal block is a suitable technique in the ambulatory setting, with a low rate of unplanned hospital admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Biological monitoring of cadmium exposure--an Italian experience.

Studies carried out over the last 12 years in northern Italy on a case list of 105 cadmium (Cd) workers showed that blood levels (B-Cd) were influenced not only by current exposure but also by body burden, while urinary levels (U-Cd) were influenced predominantly by body burden. Moreover, no advantages were gained by adjusting U-Cd for creatinine or specific gravity. The urinary beta 2-microglobulin levels were within the reference values when B-Cd and U-Cd were below the current threshold values. However, some indicators of early renal effect appeared to be altered. An increase in chromosome-type aberrations in lymphocytes occurred in workers with a heavy cadmium burden. Studies carried out on more than 600 subjects from the general population showed higher B-Cd levels in smokers than in nonsmokers. B-Cd levels were higher in men and in higher age groups. Identifying reference values for B-Cd through meta-analysis studies seems useful.

Cadmium↗
PubMed1993

[Subarachnoid anesthesia with Sprotte 24-G needle in ambulatory surgery].

In order to evaluate the possibility of using a selective subarachnoid anesthesia in ambulatory surgery we studied its feasibility with a Sprotte needle 24 G in 103 patients (range 15-67 years) undergoing a knee joint arthroscopy. The subarachnoid anesthesia was achieved with Sprotte needle 24 G with introducer with patient on lateral decubitus. Hyperbaric bupivacaine 1% (0.05 mg/cm height) was used in order to obtain a selective homolateral metameric anesthesia between L1 and S3. The numbers of attempts were 1.29 (range 1-4). We involved the homolateral determatomeres in 94% of our attempts, adding a weak anesthetic action on contralateral ones. In the remaining 6% of the patients the anesthesia was bilateral and extending in an overlying manner. Anesthesia was adequate for the time needed to perform all the surgical procedures. Nevertheless in 3 patients the tourniquet was painful. We registered systemic hypotension only in 2% of the patients (a reduced systolic pressure value > 30%). No cases of postdural puncture headache were registered. Non postural atypical headache was seem in 3.9% of the patients. Urinary retention necessitating catheterization was noted only in 3 cases. A weak backache was revealed in 8.8%. When interviewed after surgery, 98% of our patients fulfilled the technique. In spite of technical difficulties that the use of the Sprotte needle may present, the selective subarachnoid anesthesia may be a safe alternative to the other anesthetic procedures for ambulatory surgery of the legs.

Adolescent↗
PubMed1992

Plasma selenium levels of the general population of an area in northern Italy.

Plasma selenium (Se) levels of 293 subjects (160 males and 133 females) living in Desio (a small town near Milan) were determined. Analyses were performed by graphite-furnace atomic absorption spectrophotometry with Zeeman background correction. Plasma samples were not subjected to any treatment before analysis and serum samples containing a certified Se content were used as reference materials to control the quality of the analytical determinations. Plasma Se levels were found to be distributed normally with an average value of 118.8 micrograms/l and a S.D. of 27.2 (95% of the subjects lie between 64.4 and 173.2 micrograms/l). No statistically significant difference was found between males and females, and no correlation was found between plasma Se levels and age or smoking habits.

Adult↗
PubMed1992

Ten-year follow-up of biological monitoring of cadmium-exposed workers.

In this study, 105 workers exposed to cadmium for over 10 years were subjected periodically to environmental monitoring, biological monitoring and medical surveillance. They were divided into subgroups, one in which Cd-B and Cd-U exceeded 10 micrograms/l and 10 micrograms/g creatinine respectively and the other in which they were below these proposed biological exposure indices. Urinary beta 2-microglobulin was used as an indicator of tubular damage. Over the past 3 years 12 workers had raised urinary beta 2-microglobulin values (above 250 micrograms/l). Among workers with Cd-B and Cd-U levels always below the above limits, less than 3% had increased urinary excretion of beta 2-microglobulin, a percentage comparable with that of the reference population. When Cd-B exceeds 10 micrograms/l and Cd-U 10 micrograms/g creatinine on one or more occasions (although the median value still remains below this level), the frequency of tubular damage seems to be considerably higher (8.4 and 7.5% respectively). Thus the Cd-B and Cd-U limits proposed appear to be quite safe if strictly respected. However, median values appear too high to rule out the possibility of an increased incidence of tubular alterations.

Adult↗
PubMed1992

Occupational exposure to cadmium and lung function.

A total of 69 male subjects occupationally exposed to cadmium fumes in a factory producing silver-cadmium-copper alloys for brazing, were subjected to lung function tests, including ventilation (FVC and FEV1), residual volume (RV) and alveolar-capillary diffusion capacity (TLCO and KCO). For each subject, the cumulative exposure to cadmium was calculated as the product of the number of years in the job and the average atmospheric concentration of cadmium (expressed in micrograms/m3) encountered each year. Cadmium-exposed subjects had moderately higher mean values of RV (+ 8%) as compared with the control group; the increase was greater (+ 10%) in the subgroup of workers with greater cumulative exposure to cadmium. No significant differences were observed in FVC, FEV1, TLCO and KCO.

Adult↗
PubMed1990

Short latency evoked potentials: new criteria for brain death?

The aim of this study was to evaluate whether the auditory brain stem responses (ABR) and short latency somatosensory potentials (SEP) from median nerve stimulation are effective tools in the confirmation of brain death. Thirty six brain dead patients were submitted to ABR and 24 to SEP in the same session. All waves of the ABR were absent in 28 (77.8 per cent) patients, while only wave I was present in the others (22.2 per cent). In SEP recordings the components later than P13 were absent in 17 (70.8 per cent) of cases; in the remaining seven patients (29.2 per cent) a N13/P13 dissociation (namely, retention of the cervical N13 and absence of the far-field P13) was found. The results suggest that SEP and ABR are reliable tools in the diagnosis of brain death and should be included in the criteria: they enable the functional status of two pathways in the brainstem to be checked, which cannot be explored by the clinical examination.

Adolescent↗
PubMed1988

Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power.

ABRs have proved to be very accurate prognostic indicators in severe head injury, even when predictions are based on single ABR recordings. In this study we submitted 30 severely head-injured patients to serial ABR recordings (during the clinical course of posttraumatic coma) in order to verify whether the ABR prognostic power may depend on test timing in relation to the injury. 15 patients (50%) died, 5 (16.7%) remained vegetative, 2 (6.6%) severely disabled and 8 (26.7%) recovered. All recovered patients had normal ABR throughout clinical course, while severely disabled and vegetative patients showed at least transently ABR abnormalities (namely, an interpeak latency of waves V-I greater than 4.48 ms). Among dead patients, 8 showed steady and 3 transient ABR abnormalities during the clinical course, while 2 of 3 patients with normal ABR dead from extracranial complications. ABRs were significantly related to the outcome at any time, but gave more accurate prognostic indications on days 3-6 after the injury. The use of serial ABR recordings appeared to improve the outcome predictions in comparison with single ABR tests. Finally our result confirm the previously reported existance of a breakpoint between reversible brainstem dysfunction and irreversible brainstem damage defined by an IPL V-I of about 4.50 ms.

Adolescent↗