Fabrizio Scafa

Irritant vocal cord dysfunction and occupational bronchial asthma: differential diagnosis in a health care worker

OBJECTIVES Vocal cord dysfunction (VCD) is an uncommon respiratory disease characterized by the paradoxical adduction of vocal cords during inspiration, that may mimic bronchial asthma. The pathogenesis of VCD has not been clearly defined but it is possible to recognize non-psychologic and psychologic causes. The majority of patients are female but, interestingly, a high incidence of VCD has been documented in health care workers. A misdiagnosis with asthma leads to hospitalisation, unnecessary use of systemic steroids with related adverse effects, and sometimes tracheostomy and intubation. In a subset of VCD patients, the disease can be attributed to occupational or environmental exposure to inhaled irritants. MATERIALS AND METHODS We report the case of a 45-year-old woman, working as a nurse, who complained of wheezing, cough, dyspnoea related to inhalation of irritating agents (isopropylic alcohol, formaldehyde, peracetic acid). She underwent chest radiography, pulmonary function assessment both in the presence and in the absence of symptoms, bronchial provocation with methacholine and bronchodilation test with salbutamol to recognize asthmas features, allergy evaluation by skin prick tests and patch tests and video-laryngoscopy. RESULTS VCD diagnosis was made on the basis of video-laryngoscopy, that visualized the paradoxical motion of the vocal cords during symptoms, in the absence of other pathologic processes. CONCLUSIONS This case fulfils the proposed criteria for the diagnosis of irritant VCD (IVCD). This is the first report of VCD onset following exposure to several irritants: formaldehyde, glutaraldehyde, sopropylic alcohol, peracetic acid-hydrogen peroxide mixture. These substances are used as cleaning and antiseptic agents in healthcare settings and some ones can also be found in many indoor environments. A correct diagnosis is important both to give the appropriate treatment and for medical legal implications.

Ocular argyrosis in a silver craftsman.

Silver (Ag) is a rare, naturally occurring element. Because of its physical properties (hardness, ductility, malleability, high thermal and electrical conductivity) and antimicrobial activity, Ag has been extensively mined and utilized since antiquity in a wide variety of applications, including metallurgy, soldering, electroplating, photography, medicine and dentistry (wound and burn care, surgical devices, dental amalgams), water sanitation, cosmetics, electronics, production of coins, medals, jewellery, silverware and mirrors . Small Ag quantities are absorbed by humans through diet, even though the element fulfils no physiological role in any human tissue. In the case of occupational or iatrogenic exposure, Ag is less toxic than other xenobiotic metals (such as lead and mercury) and the most common clinical presentations are argyria (slate gray discoloration of the skin and other soft tissues, due to generalized accumulation of the metal) and argyrosis (discoloration of the eye, skin and/or external mucous membranes, caused by local Ag absorption and deposition). Additionally, soluble Ag compounds may cause liver and kidney damage, irritation of the eyes, skin, respiratory and intestinal tract, and haematological changes . Thanks to the improvement of hygiene in the workplace, and to the restrictive use of Ag-containing medications, Ag-related disorders are uncommon in current clinical practice. We describe here the clinical and pathological findings of an exceptional (nowadays) case of occupational argyrosis diagnosed in advanced age. Case Presentation

Return to Work After Coronary Angioplasty or Heart Surgery: A 5-Year Experience With the CardioWork Protocol

Objective:The “CardioWork” protocol, for work resumption after invasive heart procedures and subsequent cardiac rehabilitation, is presented. Methods:Over 5 years, 107 consecutive patients of working age were enrolled. Jobs were classified as multiples of basal metabolism according to the entity of physical strain. These data were integrated with instrumental evaluations to provide indications regarding time and modality of work resumption. Results:A total of 89.7% of patients resumed working. Other relevant findings include the correlation of time for work resumption with the kind of treatment and the task energy requirement; the earliness of return to work, even for older people and those performing heavy tasks; and the difficulty of work resumption for those who failed to restart work within 6 months. Conclusions:This study highlights the importance of a multidisciplinary rehabilitative approach to facilitate work resumption, adapting the work tasks to the changed psychophysical capabilities.

Ritorno al lavoro dopo un evento cardiaco acuto: valutazione della percezione di stress e della soddisfazione lavorativa

The aim of this prospective study was to investigate work stress perception, job satisfaction and psychological health in a sample of patients who returned to work after a cardiac intervention. The sample (n = 85) was evaluated using standardized questionnaires at baseline during the cardiac rehabilitation and at 6-month follow-up. Results showed that patients at 6-month after the cardiac intervention, perceived an improvement in their psychological health, a decrease in job satisfaction and type A behaviour scales. Low job satisfaction was the best predictor of delayed return to work and long duration of sickness absence Il presente studio di tipo prospettico valuta la percezione di stress, la soddisfazione lavorativa e la salute psicologica in un campione di pazienti che hanno ripreso il lavoro a seguito di un intervento di tipo cardiaco. Il campione (n = 85) e stato valutato al baseline durante la riabilitazione cardiaca e a un follow-up di 6 mesi mediante l’utilizzo di questionari standardizzati. I risultati evidenziano a 6 mesi dall’intervento cardiaco un miglioramento della salute psicologica, una diminuzione della soddisfazione lavorativa e dello stile di comportamento di tipo A. Un basso livello di soddisfazione per il proprio ambiente di lavoro e il predittore principale di un piu lento reinserimento lavorativo e di un prolungato periodo di assenza lavorativa.