Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy.

BACKGROUND: Percutaneous endoscopic gastrostomies (PEG) maintain nutrition in the short or long term. A PEG is a feeding tube, placed surgically through the anterior abdominal wall, which delivers a liquid diet, or medication, via a clean or sterile delivery system. Those undergoing PEG placement are often vulnerable to infection because of age, compromised nutritional intake, immunosuppression and underlying disease processes such as malignancy and diabetes mellitus. The increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) contributes both an additional risk to the placement procedure, and also to the debate surrounding antibiotic prophylaxis for PEG placement. The aim of surgical antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patients serum and tissues, via a brief course of an appropriate agent, by the time of PEG placement. OBJECTIVES: The review seeks to establish whether prophylactic use of systemic antimicrobials reduces the risk of peristomal infection in people undergoing placement of percutaneous endoscopic gastrostomies. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals relevant conference proceedings, and bibliographies of relevant publications identified by these strategies for further studies; and contacted manufacturers and distributors of PEG products. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the use of prophylactic antimicrobials for PEG placement, with no restrictions for language, date or publication status. DATA COLLECTION AND ANALYSIS: Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. MAIN RESULTS: We identified 10 eligible RCTs evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome, and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22 to 0.44). AUTHORS' CONCLUSIONS: Administration of systemic prophylactic antibiotics for PEG placement reduces peristomal infection.

[Malignant centro-facial granuloma. Clinical contribution]. / Granuloma maligno centro-facciale. Contributo clinico.

The mid-face malignant granuloma represents an exceptionally rare disease. Its etiology is unknown and the prognosis is dismal. Characteristics pathological features are represented by granulomatous, ulcerative and lesions, with a destroying tendency. The AA., in reporting a recently observed case of the disease, stress the difficulties encountered in the diagnosis and analyze its clinical course typically showing relapsing episodes. Therapeutic strategies adopted in the various phases of the disease are discussed.

[Clinical, etiopathogenetic and anatomopathological considerations in primary cheilitis]. / Considerazioni cliniche, etiopatogenetiche ed anatomopatologiche sulle cheliti primitive.

Among the wide range of stomatitis and mucositis there are lesions, defined as primary cheilitis, affecting mainly the lips. Specific topographic and structural features of the involved area determine their appearance. The Authors revient contact-related cheilitis, actinic-related cheilitis, glandular and suppurative cheilitis, granulomatous and exfoliative cheilitis. They point out the principle clinical, etiopathogenetic and histopathologic features. From their overview it arises, that in modern literature, funy detailed contributions are definitively lacking. Symptomatic medical treatments are a clear reflection of many etiological doubis. Surgical therapy is advised only in chronic actinic-related cheilitis and in deep-rooted glandular cheilitis. In granulomatous cheilitis surgical treatment is indicated once a permanent lip deformity occurs.

[Benign neoplasms of the soft tissues of the oral cavity]. / Le neoformazioni benigne dei tessuti molli del cavo orale.

The Authors, starting from a statistical study of Gennari et al., point out the frequency of the benign neoformations in the soft tissue of the oral cavity. They describe then the most frequently findable histological forms and the problems posed to the clinic and the surgeon by some histological forms such as the mixed tumours of the minor salivary glands and the fibropapillomatosis of the vestibular fornices. The Authors conclude stating that they not always are harmless neoformations and easily surgically excisable.