Primary atrophic solitary morphea profunda.

Solitary morphea profunda (SMP) is a distinct form of localized scleroderma, a cutaneous disorder of unknown origin. Here, we describe a patient presenting with noninflammatory cupuliform depressed plaques, without any significant skin induration, pigmentation or texture change, that appeared on the left shoulder at a site of previous intramuscular vaccination. Light microscopy studies revealed excessive dermal collagen deposition with thickened hyalinized collagen bundles. Magnetic resonance imaging studies demonstrated tissue fibrosis with thinning of the subcutaneous fat tissue and involvement of the adjacent deltoid muscle, which was confirmed by electromyographic tests. Borrelia serology was negative. Our observation of SMP differed from previously described cases, since it mimicked localized lipoatrophy. Our observation highlights the wide spectrum of clinical presentations of localized scleroderma. The latter should be considered in the presence of lipoatrophy-like lesions for proper workup and therapy.

[1966-2006: from occupational medicine to occupational health in agriculture]. / 1966-2006: de la médecine du travail a la santé au travail en agriculture.

Occupational medicine in agriculture was established in 1966 in a different and specific way as compared to occupational medicine in the commerce and industry social security scheme. The long preliminary debates resulted in the establishment of an occupational medicine for all farm employees and voluntary operators. This mission was entrusted to the Mutualité sociale agricole (MSA), a French welfare agency, which directly hires specifically trained occupational physicians. In parallel, preventive medicine examinations have been implemented for those insured by the MSA. The order adopted on May 11th, 1982, a reference regulation regarding occupational medicine in agriculture, was amended by the reform adopted in 2004. Occupational health in agriculture is now codified in the rural law.

[The French National Institute for Agricultural Medicine (INMA)]. / Institut national de médecine agricole (INMA), Tours.

Since 1958, the French National institute for agricultural medicine (INMA) has been studying the determinant health factors (non-exclusively medical) in the agricultural and rural environment. To reach this objective, the INMA organizes various types of training (degree in agricultural medicine, training for the physicians from the Mutualité Sociale Agricole--a French social security agency--, continuing education, seminars and symposiums etc.) designed for various health and safety professionals (occupational physicians, consultant physicians, general practitioners, especially from rural areas, members of safety committees etc.). This agricultural and rural specificity of the INMA is also one of the characteristics of its oldest training (2,500 physicians trained to date): the degree in agricultural medicine, which, following one or two years of courses, allows trainees to carry on occupational medicine in the agricultural sector. Through its holdings, the INMA website (www.inma.fr) provides physicians with a lot of answers to their questions regarding the health issue in agriculture.

[Agricultural occupational health and social security]. / Fonctionnement de la Santé-Sécurité au travail en agriculture.

The Mutualité Sociale Agricole (MSA) is the French social security agency for all agricultural wage earners and non-wage earners. It is the second French social security scheme after the general scheme, providing coverage for wage earners in commerce and industry. The MSA covers the whole spectrum of benefits (recovery, illness, family, retirement, occupational injury and disease) within a unique business window. The management of the MSA is overseen by elected representatives, thus creating a unique social democracy in the world of social security. Among the services managed by the MSA, occupational health and safety hold an original position: the MSA is indeed the only social security agency dealing with occupational health. 350 occupational physicians and 250 prevention consultants work in a multidisciplinary environment for the benefit of agricultural wage earners, as well as farmers, since the MSA implemented in 2002 an occupational risk prevention scheme for farmers.