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This study, a collaborative effort among the Local Health Authority 2 of Perugia, Italy, the National Coordination of Worker's Safety Representatives for University and Research Institutions and the National Coordination for Protection and Prevention Services for Universities and Research Institutions, describes the results of a method used to evaluate work-related stress. Personnel from four Italian universities, which we call University I, II, III and IV geographically distributed in nord (1), center (2) and south (1) of Italy, responded to a questionnaire regarding risk evaluation of work-related stress in response to the Italian Law 81/2008. The methodology includes a preliminary analysis of the physical/technological and organizational/relational aspects of the company in order to determine a risk factor of work-related stress. This is followed by an evaluation by agencies competent in the areas of prevention and protection, (Administrative personnel of the company, Medical support persons, heads of the Prevention and Protection Service, employee representatives, and others) that apply a specific algorithm and by the employees through the completion of a questionnaire. The employees, mostly men, of the various universities, completed 510 questionnaires. Based on the results of the questionnaires and on a comparison between the expectations of the administration and the employees, the preventative measures that need to be adopted were identified. The results of this study show that there is not complete agreement between the administration and the employees regarding the work-related expectations. This difference in viewpoints could be a source of work-related stress. Some aspects of the study were shown to be of common concern in the various universities, while for other aspects, there were significantly different perceptions between male and female employees. An immediate response is needed with respect to some aspects in the work context and to plan further investigations where the results are not clear. The method used provides an adequate response to the legislative requirements and labor principles, in evaluating the risk of work related stress. In addition the method allows employees to contribute directly to the evaluation process.

Background: Severe acute pancreatitis are still dangerous, as can be seen from the high mortality rate (around 30%). It's commonly known that in the last years diagnostic ability, precise stadiation and control over the disease development were increased. Surgical therapy is directed mainly to achieve the control over septic evolution, and in biliary pancreatitis to resolve hypertension and infection inside the biliary tree (now widely accepted as the real cause of this disease). Recently, some authors demonstrated that the prognosis of a pancreatitis can be greatly improved by stopping the evolution toward a severe phase with necrosis and multiple organ failure without any surgical operation. They believe that's possible to achieve this result performing an early endoscopic sphincterotomy in all biliary pancreatitis (recognised by means of echography and CT scan), before the development of necrosis., Methods: In our department, following this address, very good results have been obtained: that's why a multicentric trial has been carried out to appraise the results obtained by endoscopic sphincterotomy within 48 hours from the disease onset. Answers from 114 hospitals were received, with a total survey of more than 10,000 pancreatitis. Endoscopic sphincterotomy was performed in 55% of billiary pancreatitis, which were estimated at the onset, on second or third degree of Balthazar classification., Results: In 86% of patients, endoscopic sphincterotomy was performed within 48 hours from symptoms onset. Complications related to this treatment are reported in less than 4% of patients., Conclusions: The procedure, avoiding the evolution toward necrosis and sepsis, allowed the reduction of surgical operations to 6.7%, and of the mortality amongst all cases gathered to 2.5%.

The authors report on a multicentric trial performed on early endoscopic sphincterotomy in severe pancreatitis. A large figure (7.764) of biliary pancreatitis was collected and 4.285 sphincterotomies were carried out. The results have been highly satisfactory: removal of hypertension and infection in biliary tree, stopped the trend toward necrosis and infection in almost all cases precociously treated. However, answering to the many doubts raised by some colleagues about the danger of this method, the authors examined all the complications that were reported. Hemorrhages and perforations of the biliary tree were the most common one. There were 120 (2.8%) hemorrhages, most frequently treated by medical means; in 20 cases a surgical hemostasis (1 death) had to be performed. Perforations, 24 (0.56%) were treated by medical therapy in 18 cases; 6 patients underwent surgical approach, with no deaths. Other complications (cholangitis, stent ruptures), less frequent, were treated successfully without surgical operations. The authors believe the main cause of this complications to be lack of experience and delay of endoscopic procedure (papillary oedema, fragility). What they suggest, is that endoscopic sphincterotomy has to be performed by an expert endoscopist, and within 48-72 hours from disease onset. Observing also that contrast introduced in the biliary tree could be harmful, they suggest to practice cholangiography at low pressure, and always leaving a nose-biliary drain. Endoscopic sphincterotomy, therefore, if correctly performed, reduces the necessity of surgery in severe pancreatitis. In this way, operations have to be carried out only in those patients with septic complications, with encouraging results and a sharp reduction of mortality.

The authors exopound three cases of women affected by endometrial carcinoma in which the ascithis has represented the first clinic manifestation in absence of metrorrhage (first two cases); in the third case, instead, the ascithis has appeared four years after the surgical operation of total laparohysterectomy with bilateral annexiectomy and telecobaltotherapy. The association of the malign ascithis with endometrial adenocarcinoma is of rare observation. The Authors think very likely that the intraperitoneal semination in the cases they examined, is due to the infiltration of the myometry, of the regional and iuxtaregional lymphonoids with formation of ascithis.