BackgroundThe administration of anesthetics determines depression of the central nervous system and general anesthesia by inhalation may cause an environmental pollution of the operating rooms. It may therefore conceive a possible occupational etiology of Parkinson's Disease (PD).Case presentationIn a Caucasian male aged 59 years, PD was diagnosed by brain scans with a presynaptic radioactive tracer of the dopaminergic system. Family history was negative for Parkinson’s disease or essential tremor. He was a smoker, a moderate consumer of coffee and alcohol, and never exposed to pesticides/metals. For 30 years (since the age of 29 until today), he worked as an anesthesiologist in private clinics in the Veneto (Northern Italy), exposed to anesthetic gases. The time elapsed from first exposure to onset of disease is 22 years, fulfilling the requirement of the induction/latency period. A literature search demonstrated unacceptable levels of anesthetic gases in public hospitals of the Veneto region from 1990 to 1999. This exposure was presumably high also in private hospitals of the region until at least 2007, when an overexposure to sevoflurane was repeatedly measured in this patient. The association between occupational exposure to anesthetic gases and risk of Parkinson’s disease was supported by a case-control study (reporting a two-fold increase in the risk of PD associated with a clinical history of general anesthesia) and a cohort study comparing mortality from PD between US anesthesiologists and internists (showing a statistically significant excess (p=0.01) in anesthesiologists compared to internists). Numerous recent mechanistic studies (in vitro essays and in vivo short-term studies) strengthened the association between exposure to anesthetic gases (nitrous oxide, halothane, isoflurane, levoflurane) and PD.ConclusionIn view of the limited evidence of human studies and the sufficient evidence of experimental studies, the high exposure to anesthetic gases could have induced PD in the subject under study.
Background and aims: Sinonasal cancers (SNCs) are rare neoplasms, accounting for about 3 % of head and neck cancers, with squamous cell carcinoma (SCC) and adenocarcinoma (ADC) as the most common subtypes. ADCs present strong associations with occupational wood dust exposure. Preventive measures have progressively reduced wood dust concentrations in workplaces but no study has evaluated the effectiveness of such interventions. Few studies indicate associations between ADC and exposure to solvents, which is common in the shoe industry, but this hypothesis still needs confirmation. Methods: In a case-case study, we contrasted 32 ADCs against 21 Non-Adenocarcinoma Epithelial Tumors (NAETs) -all recruited from the same clinical setting (Padua's University Hospital; period 2004-2015) -using questionnaires and clinical records to collect information on potential predictors. Non-occupational factors were age, sex, smoking, allergy and chronic sinusitis. Occupational factors were intensity and frequency of wood dust exposure, protection from wood dust, type of wood (in woodworking); frequency of exposure to leather dust or mastic/solvent (in shoemaking). Odds-ratio (OR), 95 % confidence interval (95 % CI) and two-tail p-values were obtained through stepwise backward logistic regression for each industry, always using as reference patients never employed in either trade and adjusting for non-occupational risk factors. Results: Adjusted OR was 22.5 (95 % CI = 3.50-144; p = 0.001) and 9.37 (95 % CI = 1.29-67.6; p = 0.026), respectively, in patients with low or high degree of protection against wood dust. In the shoe industry, adjusted OR was 1 and 18.8 (95 % CI = 1.29-174; p = 0.030), respectively, in patients with low or high exposure to only mastic/solvent; and 1 and 22.5 (95 % CI = 2.07-244; p = 0.011), respectively, in patients with low or high exposure to only leather dust. Discussion and conclusions: The questionnaire used was able to estimate with simple algorithms past exposures in wood and footwear industries. The case-case design considerably increased the validity of this small study. Results in this study were always consistent with the extant literature; this could support reliability of novel findings. In woodworking, respiratory protective equipment and local exhaust ventilation reduced the risk of occupational SNC; in footwear manufacture, where preventive interventions were seldom adopted, SNC risk was significantly greater for high exposure from mastic/solvent and leather dust.
Notwithstanding the ban in 1992, asbestos exposure for workers in the construction sector in Italy remains a concern. The purpose of this study is to describe the characteristics of malignant mesothelioma (MM) cases recorded by the Italian registry (ReNaM) among construction workers. Incident mesothelioma cases with a definite asbestos exposure have been analyzed. Characteristics of cases and territorial clusters of crude rates of MM in construction workers have been described, as well as the relation between asbestos use before the ban and the historical trend of workforce in the construction sector in Italy. ReNaM has collected 31,572 incident MM cases in the period from 1993 to 2018 and asbestos exposure has been assessed for 24,864 (78.2%) cases. An occupational exposure has been reported for 17,191 MM cases (69.1% of subjects with a definite asbestos exposure). Among them, 3574 had worked in the construction sector, with an increasing trend from 15.8% in the 1993–98 period to 23.9% in 2014–2018 and a ubiquitous territorial distribution. The large use of asbestos in construction sector before the ban makes probability of exposure for workers a real concern still today, particularly for those working in maintenance and removal of old buildings. There is a clear need to assess, inform, and prevent asbestos exposure in this sector.
Case-control studies on malignant sinonasal tumors and occupational risk factors are generally weakened by non-occupational confounders and the selection of suitable controls. This study aimed to confirm the association between sinonasal malignant tumors and patients’ occupations with consideration for sinonasal inverted papillomas (SNIPs) as a control group. Thirty-two patients affected by adenocarcinoma (ADC) and 21 non-adenocarcinoma epithelial tumors (NAETs) were compared to 65 patients diagnosed with SNIPs. All patients were recruited in the same clinical setting between 2004 and 2016. A questionnaire was used to collect information on non-occupational factors (age, sex, smoking, allergies, and chronic sinusitis) and occupations (wood- and leather-related occupations, textile industry, metal working). Odds ratios (OR) with 95% confidence intervals (CI) associated with selected occupations were obtained by a multinomial and exact logistic regression. Between the three groups of patients, SNIP patients were significantly younger than ADC patients (p = 0.026). The risk of NAET increased in woodworkers (OR = 9.42; CI = 1.94–45.6) and metal workers (OR = 5.65; CI = 1.12–28.6). The risk of ADC increased in wood (OR = 86.3; CI = 15.2–488) and leather workers (OR = 119.4; CI = 11.3–1258). On the exact logistic regression, the OR associated to the textile industry was 9.32 (95%CI = 1.10–Inf) for ADC, and 7.21 (95%CI = 0.55–Inf) for NAET. Comparing sinonasal malignant tumors with controls recruited from the same clinical setting allowed demonstrating an increased risk associated with multiple occupations. Well-matched samples of cases and controls reduced the confounding bias and increased the strength of the association.
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