LaMedicina del Lavoro - Fondazione IRCCS Ca` Granda

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Medicina del Lavoro
La
Novembre - Dicembre 2010
Volume 101, n. 6
Issn 0025 - 7818
Rivista fondata nel 1901
da Luigi Devoto
Medicina del Lavoro
La
Rivista Bimestrale di Medicina del Lavoro e Igiene Industriale
Italian journal of Occupational Health and Industrial Hygiene
N
409
Mesothelioma and asbestos, fifty years of evidence: Chris Wagner and the contribution of the Italian
occupational medicine community Mesotelioma ed amianto, cinquanta anni di evidenze: Chris Wagner e il
contributo della medicina del lavoro italiana M.A. Riva, F. Carnevale, V.A. Sironi, G. De Vito, G. Cesana
6
La marcia dell’allergia. Rapida evoluzione di una dermatite da contatto da ammonio persolfato in airborne
contact dermatitis con rinite ed asma bronchiale Occupational allergic “march”. Rapid evolution of contact
dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser
Anna Poltronieri, L. Patrini, P. Pigatto, L. Riboldi, Chiara Marsili, M. Previdi, M. Margonari, P. Marraccini
NOVEMBRE - DICEMBRE 2010
ARTICOLI ORIGINALI / ORIGINAL ARTICLES
416
Asbestos-related diseases in entertainment workers Patologie asbesto-correlate in lavoratori dello spettacolo
Carolina Mensi, Anna Garberi, L. Bordini, Claudia Sieno, L. Riboldi
419
An outstanding female figure in occupational health: Ersilia Majno Bronzini
nella storia della medicina del lavoro: Ersilia Majno Bronzini Silvana Salerno
427
Rischio biologico ed operatori sanitari: analisi dell’interferenza tra cronobiologia lavorativa e sistema
immunitario Biological risk and health care workers: analysis of the effects of work chronobiology on the immune
system A. Copertaro, M. Bracci, Monica Amati, E. Mocchegiani, Mariella Barbaresi, Benedetta Copertaro, Lory Santarelli
437
La movimentazione manuale dei carichi nel comparto alberghiero: l’esperienza della ASL di Milano Manual
handling of loads in the hotel trade: the experience of the ASL (Local Health Unit) Milan S. Fontani, Irene Mercuri,
R. Salicco, Silvia Veratti, L. Sorrentino
446
Colpo di calore in ambito lavorativo: descrizione di un caso con esito fatale Heat stroke in the workplace:
description of a case with fatal outcome L. Roccatto, A. Modenese, V. Occhionero, A. Barbieri, Donata Serra,
Elena Miani, F. Gobba
453
Collaboration between centres of the World Health Organization. Italy supports a Mexican University Una
collaborazione Italia-Messico in ambito dell’Organizzazione Mondiale della Sanità J. Alegria-Torres, A. Baccarelli
458
Infermieri di camera operatoria e infermieri di medicina generale: la diversa percezione della propria salute
organizzativa Operating theatre and medical ward nurses: two different ways of perceiving one’s organizational health
A. Sili, E. Vellone, Roberta Fida, Rosaria Alvaro, F. Avallone
LETTERE
471
474
IN
REDAZIONE / LETTERS
TO THE
Una straordinaria figura femminile
EDITOR
L’esposizione ad Anisakis simplex nell’industria ittica: un aspetto emergente in medicina del lavoro? (G. Arcangeli, N. Mucci,
V. Cupelli) - Tumori delle cavità nasali e dei seni paranasali: un caso di esposizione lavorativa atipica a polveri di legno
(Carolina Mensi, C. Sieno, L. Riboldi, Laura Bodini, C. Boni, B. Sarzilla, L. Terziotti)
CONFERENCE REPORT
4th International Conference on the History of Occupational and Environmental Health San Francisco (USA), June 19-22, 2010
(M.A. Riva, Daniela Fano)
476
NOTIZIARIO / NEWS
Mattioli 1885 casa editrice
Prossimi appuntamenti / Coming events - Benvenuto al SH@W, un nuovo giornale di salute occupazionale / Welcome to
SH@W, a new journal devoted to occupational health
La Medicina del Lavoro è entrata nel circuito ISI Web of Knowledge con Impact Factor per il 2009
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POSTE ITALIANE S.P.A. - SPED. IN A. P. - D.L. 353/2003 (CONV. IN L. 27/02/2004 N. 46) ART. 1, COMMA 1, DCB PARMA - FINITO DI STAMPARE NEL MESE DI OTTOBRE 2010
VOLUME 101 /
ARTICOLI SPECIALI / SPECIAL ARTICLES
403
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Novembre - Dicembre 2010
Volume 101, n. 6
Issn 0025 - 7818
Rivista fondata nel 1901
da Luigi Devoto
Medicina del Lavoro
La
Rivista Bimestrale di Medicina del Lavoro e Igiene Industriale
Italian journal of Occupational Health and Industrial Hygiene
Già diretta da Luigi Devoto (1901-1935)
Luigi Preti (1936-1941)
Enrico C. Vigliani (1942-1991)
DIRETTORE Vito Foà
REDATTORI Lorenzo Alessio, Pier Alberto Bertazzi,
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Medicina del Lavoro
Med Lav 2010; 101, 6: 416-418
Asbestos-related diseases in entertainment workers
CAROLINA MENSI*, **, ANNA GARBERI***, L. BORDINI*, CLAUDIA SIENO*, L. RIBOLDI*, **
* Clinica del Lavoro “Luigi Devoto”, Dipartimento di Medicina Preventiva, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milano (Italy)
** Centro EBPI (Effetti Biologici Polveri Inalate), Dipartimento di Medicina del Lavoro, Università degli Studi di Milano, Milano
(Italy)
*** Scuola di Specializzazione in Medicina del Lavoro, Dipartimento di Medicina del Lavoro, Università degli Studi di Milano,
Milano (Italy)
KEY WORDS
Asbestos; occupational exposure; cinemas; theatres
SUMMARY
Objectives: To investigate asbestos exposure in 4 patients (3 cases of malignant mesothelioma and 1 case of pleural
plaques) previously employed in the entertainment business. Methods: The patients were seen at the Occupational
Health Unit of the “Clinica del Lavoro Luigi Devoto” in Milan (Italy). Information regarding exposure to asbestos
(occupational, environmental, and familial) was collected through a standardized questionnaire administered to the
patients by an occupational physician. Results and conclusion: The presence of asbestos in the building structures
and its use were described by all patients. The presence of asbestos in public buildings used for entertainment such as
cinemas and theatres was in fact confirmed by the Occupational Health Services of the Local Heath Unit. An occupational aetiology was recognised in all the cases mentioned above, thus leading to the identification of an atypical
occupational sector at risk in the past for asbestos exposure.
RIASSUNTO
«Patologie asbesto-correlate in lavoratori dello spettacolo». Obiettivi: verificare l’esposizione ad amianto in 4
pazienti (3 casi di mesotelioma maligno ed 1 di placche pleuriche) che avevano lavorato nel pubblico spettacolo.
Metodi: I pazienti erano afferenti all’Unità Operativa di Medicina del Lavoro della “Clinica del Lavoro Luigi
Devoto” di Milano (Italia). Informazioni inerenti l’eventuale esposizione ad amianto (occupazionale, ambientale o
familiare) sono state raccolte attraverso un questionario standardizzato somministrato ai pazienti da medici del lavoro. Risultati e conclusioni: La presenza e l’utilizzo di amianto nell’ambiente di lavoro è stata descritta da tutti
e 4 i casi ed è stata confermata dai Servizi PSAL. Per tutti questi casi si è posta diagnosi di malattia professionale
avviando le pratiche per il riconoscimento assicurativo.
INTRODUCTION
Occupational exposure to asbestos has been documented in most sectors of industry and its health
effects are well known worldwide. Italy, like many
other western countries, is currently suffering the
asbestos-related diseases epidemic, considering the
extensive use of asbestos in the years 1950-1980 in
numerous jobs and the long latency period (around
40 years for malignant mesothelioma) from the beginning of exposure.
Three cases of pleural malignant mesothelioma
(MM) and one case of pleural plaques are described that occurred in subjects who had worked
Pervenuto il 7.7.2010 - Accettato il 27.9.2010
Corrispondenza: Carolina Mensi, Clinica del Lavoro “Luigi Devoto”, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milano (Italy) - Tel +39 02 55032595 - Fax +39 02 50320139 - E-mail: [email protected]
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ASBESTOS EXPOSURE IN ENTERTAINMENT WORKERS
exclusively in theatres or cinemas, where occupational asbestos exposure was apparently unthinkable. To our knowledge there has been no previous
report of similar cases in the literature.
All these cases were seen at the Occupational
Heath Unit of the “Clinica del Lavoro L. Devoto”
in Milan (Italy); 3 cases were included in the Regional Mesothelioma Registry (the Lombardy Region has a total population of 9.1 million).
For each case information regarding exposure to
asbestos was collected through a standardized
questionnaire administered to the patient by an occupational physician; a detailed occupational history, data on lifestyle habits and a residential history
were collected.
CASE REPORTS
Case 1
The subject, an opera singer since the age of 22,
began suffering from dyspnoea at the age of 72.
She had never smoked; her clinical history showed
that she had suffered from right breast carcinoma
at the age of 56, for which she underwent local
surgery and radiotherapy successfully. A Computer
Tomography (CT) of the chest showed left pleural
effusion and thickenings. A video-thoracoscopy
showed multiple pleural adherences. The thoracotomic biopsy resulted in the diagnosis of epithelial
MM. She had worked in many theatres, both in
Italy and abroad, but in fact spent 18 years of her
career, 8 hours a day for 10 months a year, in the
same theatre, where it was possible to confirm the
presence of a large (more or less 17 x 12 metres)
and heavy (more than 200 kilos) asbestos curtain,
in addition to the fabric one, that was used to
achieve better acoustic insulation. No other asbestos exposure was recorded in her free time (neither environmental nor familial).
Case 2
A fireman working in the same theatre as the
opera singer from the age of 21 to 42. He had never smoked. At the age of 55 he suffered a tight
417
chest trauma. He presented dyspnoea and chest
pain at the age of 58. CT of the chest revealed
right pleural effusion with a large nodular parietal
mass, initially of unclear interpretation; no left
pleural nor pericardial effusion were detected. During video-thoracoscopy the pleura appeared hyperaemic and the large nodular parietal mass looked
whitish; it was confirmed following histological investigations to be an epithelial MM. The patient
had worked in the theatre fire-team full-time,
wearing asbestos overalls once every 2 weeks during fire drills; he reported finding many asbestos
threads on his clothes after taking off the overalls.
He also used asbestos gloves and covers every day
when assisting scenery technicians during welding
and grinding operations, ready to step in should
there be a fire emergency. He reported, furthermore, that every morning he placed 8-12 asbestos
covers on the balustrades where the spotlights had
to be positioned; these covers were cut by the firemen themselves according to requirements. He also
remembered that when the asbestos curtain was
lowered on the stage, a great amount of dust arose.
No other asbestos exposure was recorded in his free
time (neither environmental nor familial).
CASE 3
The subject, a theatre actor since his teens, developed symptoms of “unspecific pleural disease” at the
age of 76; radiological (X-Ray and CT) investigations showed multiple bilateral nodular thickenings
and plaques, partially calcified, affecting both the
parietal and the diaphragmatic pleurae. He reported
that in the theatres were he worked asbestos was
used in the scenery, in the form of raw mineral contained in bags, to create artificial snow, sand, dust,
webs, etc. No other asbestos exposure was recorded
in his free time (neither environmental nor familial).
Case 4
The subject, a cinema cashier from the age of 15
to 30, for 10 hours a day. She had never smoked. In
her clinical history she reported pleurisy at the age
of 25, and had never suffered from tuberculosis.
She began suffering from cough, dyspnoea and
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MENSI ET AL
chest pain at the age of 69. There was radiological
evidence of large pleural effusion (2/3 of a
hemithorax) with lung displacement to the opposite side, and bilateral pleural thickenings, the
greatest of which was as thick as 1.7 cm. Moreover
there was radiological evidence of pericardial effusion, while nothing that might lead to suspect a
neoplasm was found in the abdomen. She underwent pleurectomy which macroscopically confirmed the large pleural thickenings and the histological investigations confirmed an epithelial MM.
No asbestos exposure was recorded in her free time
(neither environmental nor familial).
The cinema was located on the ground floor of a
civil building, where asbestos had been sprayed on
the ceiling as soundproofing to reduce the noise
during film projections. The use of asbestos in the
cinema was prescribed in that time, according to
Italian law, for fire prevention in public places.
DISCUSSION
Owing to its physical and chemical properties
asbestos was widely used in the past in many industrial sectors and in the construction industry. In
particular its property of sound absorption and
heat insulation meant that asbestos was recommended for use in public buildings intended for
recreational, cultural and sporting events, such as
theatres, cinemas and gyms. The types of asbestos
mostly used as insulation material in these buildings were chrysotile and crocidolite, often in friable
form. Another use of asbestos in theatres and cinema was in the fire-resistant fabrics of curtains and
upholstery, etc.
Following our description of the cases of asbestos-related diseases observed in entertainment
workers investigated by the Occupational Heath
Unit of the “Clinica del Lavoro L. Devoto” in Milan (Italy), for which an occupational asbestos aetiology was recognised in all cases, they were notified as occupational diseases to the National Institute for Insurance against Occupational Diseases
and Accidents (INAIL).
Thanks to the work carried out by the Regional
Mesothelioma Registry it was possible to obtain a
detailed occupational, residential, familial, and
leisure time history from the patients using a standardized questionnaire so as to identify all factors
that might be responsible for an asbestos exposure.
Occupational exposure to asbestos in the entertainment business was already reported in a cinema
projectionist (1) and in a juggler working in a circus (2) who whirled burning wooden clubs, bound
together with an asbestos rope that he personally
cut and tied up.
The Local Occupational Health Service carries
out inspections in the workplaces suspected to be
unsafe: therefore, in the last few years theatres and
cinemas have been inspected and samples taken in
order to detect asbestos presence. Recently in Italy
many entertainment buildings were restructured,
revealing the presence of large quantities of asbestos, particularly chrysotile and crocidolite, frequently used in the friable form at concentrations
up to 85-100%. During the renovation and improvement of the theatre where the opera singer
and the fireman worked, asbestos was also found
around the lights immediately under the vault of
the hall at the back of the last gallery.
In the past asbestos was widely used in Italy in
public places designated for recreational and cultural activities such as theatres and cinemas, also
because until 1975 it was permitted to smoke in
these buildings.
Thanks to the collaboration between the Local
Occupational Health Service and the Occupational Health Unit of the “Clinica del Lavoro”, it has
been possible to identify an occupational aetiology
of these diseases that would have otherwise gone
unrecognized.
NO
POTENTIAL CONFLICT OF INTEREST RELEVANT TO
THIS ARTICLE WAS REPORTED
REFERENCES
1. BIANCHI C, BIANCHI T, TOMMASI M: Mesothelioma of
the pleura in the Province of Trieste. Med Lav 2007; 98:
374-380
2. STOPPONI R: A “particular” case of exposure to asbestos
in the circus profession. Med Lav 2007; 98: 345