The Eastern European experience on occupational skin diseases. Make underreporting an issue?

BACKGROUND: While legislation in most of the Eastern European countries is nowadays widely harmonized with the legal safety and health provisions of Western countries, there is still a sustained resistance to the notification of occupational skin diseases (OSD). OBJECTIVE: The aim of the study was to identify the main barriers in notification and recognition of OSD in 22 Eastern European countries. METHODS: An online survey was administered to key persons in the field of occupational safety and health in 22 Eastern European countries. Multiple variables of the notification system were studied, including clinical, organizational and educational issues. RESULTS: The main causes of underreporting OSD are ineffective enforcement of occupational safety and health legislation, contractual relationship employer-employee, long duration of the notifying process, restrictions of the notification systems in terms of who is entitled to notify an OSD, ineffective regulations in regards to the pre-employment and periodical medical examination, ineffective compensation schemes, restraints and hesitations, mainly from the doctors, inappropriate mentalities - fear of losing the jobs, fining of the employers by the authorities, stigmatization of the workers with OSD, additional costs for employers, stakeholders' lack of interest in notifying, lack of guidelines and protocols and lack of preventive programmes. CONCLUSIONS: The most valuable method for a proper recognition of OSD is to increase the awareness of physicians involved in the management of OSD (occupational physicians, GPs, dermatologists), as well as employers and workers. There is an urgent need to improve national legislation, to develop and promote adequate preventive programmes, emphasizing ethical, legal, economical and psychological aspects in order to achieve an increased recognition and a real reporting of OSD, and to enforce an international action plan for Eastern Europe in order to improve the notification of OSD.

Anatomo-clinical analysis of 14 consecutive cases of primary cystic mesenterico-epiploic tumors.

BACKGROUND: The aim of this study is an anatomo-clinical evaluation of the primary cystic mesenterico-epiploic tumors,based on a single-center's 15 year experience. MATERIAL AND METHOD: We performed a retrospective study of a series of 14 primary cystic mesenterico-epiploic tumors that were operated in the Surgical Department 4 UMPh Targu-Mures, Romania, between 01.01.1997 and 01.01.2012. Data about the clinical complaints, imagistic aspects, associated lesions, surgical approach, hospitalization, pathology, and immediate and late postoperative course were recorded and analysed using the Microsoft Excel software. RESULTS: In all cases we performed a complete and intact surgical excision, using an open approach in 13 cases and laparoscopy in 1 case, with no mortality and no significant surgical-related morbidity; we have encountered a single recurrence at 1.5 years after surgery. We had no preoperative pathological diagnosis; the exact preoperative anatomic location of the tumor was possible only in one case. Pathologic examination showed the following types: inclusion cysts - 4 cases, enteral duplication cysts - 2 cases, simple mesothelialcysts - 6 cases, cystic lymphangioma - 1 case and simple lymphatic cyst - 1 case. We have systematized 3 clinicoimagistic patterns according to the dimension of the tumor,with no relationship to the histologic origin of the tumor. CONCLUSIONS: Primary cystic mesenterico-epiploic tumors aredifficult to diagnose preoperatively. Complete excision is usually possible, even for large tumors. These relatively rare tumors must be considered in the differential diagnosis of cystic abdominal masses.