[Combined vaginal and laparoscopic surgical treatment of genito-urinary prolapse]. / Trattamento chirurgico combinato vaginale e laparoscopico del prolasso genito-urinario.

BACKGROUND: A new combined technique for vaginal prolapse and cystocele using minimal access surgery is presented and evaluated. METHODS: Thirty-five patients (mean age 57.1) with genitourinary prolapse (II-IV degree Baden-Walker) without urinary incontinence underwent surgery between January 98 and December 99 with 4-24 months of follow-up (mean 14.6 months). The surgical stages include total vaginal hysterectomy with bilateral adnexectomy, wide opening of the vagina without excessive removal of the vaginal mucosa; the bladder is loosened and the polypropylene mesh (PPM) is lightly fixed to the bladder and stitched to the anterior and posterior vaginal wall. The PPM is introduced into the abdomen and laparoscopically fixed to the sacral promontory with titanium spirals having checked vaginally the right tension of the mesh. Accurately laparoscopic peritonization of the PPM ends the surgical procedure. RESULTS: The operation time was 90'-140' (mean 112') followed by 3-7 days of hospitalization (mean 4.3). Vaginal prolapse and cystocele were corrected in all cases. No surgical complications, de novo urinary incontinence, prolapse recurrence or inconvenience to sexual activity have been observed. There was one erosion of the vaginal wall by the PPM 45 days after the operation. CONCLUSIONS: Initial studies suggest that laparoscopic sacrocolpopexy and cystocele repair with PPM is an effective treatment for genitourinary prolapse. If subsequent studies will confirm these findings, the development of minimal access techniques for genitourinary prolapse will represent a significant surgical advance.

A rare complication due to sulfuric acid ingestion.

The authors present a case of pyloric and duodenal obstruction in an 8-year-old child, resulting from accidental ingestion of sulfuric acid. A marked pyloric and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is seen infrequently, especially in pediatric age. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. This dynamic pathophysiologic event imposes postponement of surgical intervention because of various time length between ingestion of acid and onset of gastric outlet obstruction (17 days to 5 years). Clinical features included postprandial epigastric distress, repeated non-bilious vomiting, and marked weight loss. The authors also discuss the various surgical procedures that were employed to relieve the obstruction. Notwithstanding a potential risk of malignant evolution, a gastro-jejunostomy is the treatment of choice because of the age of the patient, and good postoperative results are confirmed by barium studies.

[A multicenter epidemiological study of burns of the head in childhood in the period of 1986-1990]. / Studio epidemiologico multicentrico delle ustioni nell'estremo cefalico in età pediatrica nel periodo 1986-1990.

A retrospective study was performed over the children admitted to three regional pediatric burn units, over a 5-year period (1986-1990). Out of 695 pediatric patients, 270 (38.8%) were admitted with burns of the head and neck. This whole childhood age group (up to 14 years of age) was examined epidemiologically. The age group presenting the highest incidence was within 0-3 years (71%); scalds were involved in high percentage (68%) and many injuries occurred at home (93%). Epidemiological aspects of the report are discussed with particular consideration of preventive programs.

[A case of lateral cleft lip. Embryology and surgical technic]. / Un caso di schisi laterale del labbro. Embriologia e tecnica chirurgica.

Lateral labial cleft is exceptionally rare. This malformation gives the opportunity to evaluate its origin (following the embryology of facial segments) and its association with other deformities. Surgical treatment must reconstruct an anatomic and functional situation which must give a good aestetic result.

[Use of vancomycin in the treatment of severe Staphylococcus aureus infection. Description of 3 cases]. / Impiego della Vancomicina nel trattamento di sepsi gravi da Staphylococcus aureus. Descrizione di 3 casi.

In recent years, the diffusion of antibiotic multiresistant staphylococcus strains in hospitals (especially aureus and epidermis) has created serious drawbacks as regards the treatment of severe septic forms and the systemic spread of these bacteria. The results of endovenous vancomycin treatment in three cases of sepsis with secondary localisations (endocarditis, osteomyelitis, pneumonia) caused by gram positive staphylococcus aureus are examined. The pharmaceutical was found to be effective in all cases and free from significant side effects.

[Use of pentoxifylline in diabetes with intermittent claudication]. / L'uso della pentossifillina nei diabetici con claudicatio intermittens.

The authors have investigated the effect of pentoxifylline administration (400 mg in three doses) in diabetic subjects with lower limb vasculopathy. The results have shown a marked improvement in clinical symptoms and VRBC and a slight improvement in fibrinogen and blood lipid levels.