Subject(s)
Anal Canal/surgery , Colposcopy/methods , Pelvic Floor/injuries , Pelvic Floor/surgery , Adult , Female , Humans , Vagina/surgeryABSTRACT
BACKGROUND: Reductions in mortality were reported with negative pressure wound therapy for laparostomy. However, some authors have voiced concern over an increased risk of enteroatmospheric fistulae. In this retrospective study, we hypothesized that surgical and metabolic derangements could increase the incidence of enteroatmospheric fistulae. We aimed to assess our experience and report long-term outcomes. METHODS: A multicentre review of all patients with a laparostomy managed with negative pressure wound therapy between 2005 and 2015 was undertaken. Features associated with enteroatmospheric fistulae were included in multivariate logistic regression. RESULTS: Fifty-seven patients were treated according to uniform protocol. Fourteen per cent (8/57) presented enteroatmospheric fistulae. Mesenteric ischaemia and preoperative arterial serum lactate >3.5 mmol/L were associated with a significantly increased risk of enteroatmospheric fistulae. Preoperative arterial serum lactate >3.5 mmol/L was an independent predictor of enteroatmospheric fistulae with an odds ratio of 12.41 (95% CI 1.54-99.99). All mesenteric ischaemia patients with anastomosis (5/15) presented enteroatmospheric fistulae. In-hospital mortality was 26.3% (15/57). One-year mortality was 33.3% (19/57). Incisional hernia rate was 5.2% (2/38) after 14.2 (2.4-56.3) months of follow-up. DISCUSSION: Mesenteric ischaemia increases the risk of enteroatmospheric fistulae. Anastomosis should only be created in revascularized patients. When mesenteric vascularization is not restored, diversion is advised.
Subject(s)
Abdominal Wound Closure Techniques/adverse effects , Intestinal Fistula/etiology , Negative-Pressure Wound Therapy/adverse effects , Postoperative Complications/etiology , Aged , Female , Follow-Up Studies , Humans , Incidence , Intestinal Fistula/diagnosis , Intestinal Fistula/epidemiology , Logistic Models , Male , Middle Aged , Outcome Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Peri-rectal tumors are rare and their management is challenging, especially when presenting with local recurrence. The aim of the current study was to report a multicenter series of peri-rectal tumors, focusing on the risk of recurrence. MATERIAL AND METHODS: From 1994 to 2014, patients with peri-rectal tumors from three different centers were retrospectively analyzed. Sixty-two patients were identified and divided into two groups; Group 1: patients who presented with local recurrence at follow-up (n = 9, recurrence rate: 14.5%), and Group 2: patients without recurrence (n = 53). RESULTS: In Group 1, there were initially more patients with symptoms of a perineal mass (44.4% vs. 12.2%; p = 0.04), more malignant tumors (55.6% vs. 15.1%; p = 0.02), and larger lesions (+2.6 cm; p = 0.004). Incomplete resection was also more frequent in Group 1 (44.4% vs. 3.8%; p = 0.003). Eight patients with recurrence had further surgery, whilst one patient had radiological recurrence and was treated medically. Among the eight re-resections, five patients remain disease-free; two have had further recurrences and have had palliative treatment, whilst another has had a further resection and remains disease-free. CONCLUSIONS: Peri-rectal tumors are uncommon and there is no consensus on best management. Based on this large multicenter series, several risk factors seem to be associated with local recurrence, namely patient- (discovery of a perineal mass), tumor- (malignant and large lesion), and surgery-related (incomplete resection). Clinical follow-up should be adapted according to these factors.
Subject(s)
Neoplasm Recurrence, Local/diagnosis , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/prevention & control , Rectal Neoplasms/complications , Retrospective Studies , RiskABSTRACT
OBJECTIVE: Even if the safety of the polyurethane prosthesis has been the subject of many studies and professional and public controversies. Nowadays, polyurethane covered implants are very popular in plastic surgery for the treatment of capsular contracture. MATERIALS AND METHODS: We have identified 41 papers (1 is a communication of the FDA) by using search browsers such as Pubmed, Medline, and eMedicine. Eleven manuscripts have been used for an introduction, and the remaining thirty have been subdivided into three tables whose results have been summarized in three main chapters: (1) capsular formation and contracture, (2) complications, (3) biodegradation and cancer risk. RESULTS: (1) The polyurethanic capsule is a well defined foreign body reaction characterized by synovial metaplasia, a thin layer of disarranged collagen fibers and a high vascularization. These features make possible a "young" capsule and a low occurrence of capsular contracture even over a long period (10 years); (2) the polyurethane implants may be difficult to remove but there is no evidence that they cause an increase in the other complications; (3) there is no evidence of polyurethane related cancer in long-term studies (after 5 years). CONCLUSIONS: Polyurethane foam covered breast implants remain a valid choice for the treatment of capsular contracture even if it would be very useful to verify the ease of removal of the prosthesis and to continue investigations on biodegradation products.
Subject(s)
Breast Implantation/adverse effects , Breast Implants/classification , Polyurethanes , Animals , Breast Implants/adverse effects , Contracture/epidemiology , Female , Foreign-Body Reaction/epidemiology , Humans , Polyurethanes/adverse effects , Postoperative Complications/epidemiologySubject(s)
Anti-Inflammatory Agents/therapeutic use , Betamethasone/therapeutic use , Calcitriol/analogs & derivatives , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Salicylates/therapeutic use , Administration, Topical , Adult , Aged , Calcitriol/therapeutic use , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids , Humans , Male , Middle Aged , Patient Compliance , Salicylic Acid , Treatment OutcomeABSTRACT
Lyme borreliosis is a cutaneous-systemic infection that is generally transmitted by a hard-bodied tick and caused by some species of Borrelia, Borrelia burgdorferi (sensu stricto), B. garini, and B. afzelii. Lyme borreliosis is a widespread disease, present in all continents. It can be divided into an early disease, corresponding to the primary stage, and a late disease, including the secondary and tertiary stages. The typical cutaneous lesions are erythema (chronicum) migrans, lymphadenosis benigna cutis, and acrodermatitis chronica atrophicans. The course of Lyme borreliosis depends on the timeliness of both diagnosis and antibiotic treatment.
Subject(s)
Lyme Disease , Skin Diseases, Bacterial , Acrodermatitis/microbiology , Acrodermatitis/pathology , Adult , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/microbiology , Arthritis, Infectious/pathology , Child , Erythema Chronicum Migrans/pathology , Female , Humans , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Lyme Disease/pathology , Lyme Disease/transmission , Lymphatic Diseases/microbiology , Lymphatic Diseases/pathology , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/drug therapy , Skin Diseases, Bacterial/pathology , Tropical ClimateSubject(s)
Betamethasone/analogs & derivatives , Calcitriol/analogs & derivatives , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Salicylates/administration & dosage , Administration, Topical , Anti-Inflammatory Agents/therapeutic use , Betamethasone/administration & dosage , Calcitriol/therapeutic use , Drug Therapy, Combination , Glucocorticoids , Humans , Salicylic AcidABSTRACT
Between 1987 and 1991, the authors made patch-tests on 1,427 patients, 389 male and 1,038 female, of mean age 36 years (6-70 years) and mostly suffering from eczema. The standard tests of Italian Group for Research into Contact Dermatitis and the Environment (GIRDCA) were used, following the best data of recent years. Nickel sulphate, thiomersal, "Fragrance mix", cobalt sulphate and potassium bichromate were the allergens varied with age: nickel and thiomersal were most frequently positive between 20 and 30 years. In contrast, the highest frequency of positivity to fragrance mix was seen between 40 and 60 years. Positivity to a simple allergen had a tendancy to reduce with age.
Subject(s)
Dermatitis, Allergic Contact/epidemiology , Adolescent , Adult , Age Factors , Aged , Allergens/adverse effects , Child , Dermatitis, Allergic Contact/etiology , Eczema/epidemiology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Patch Tests , Skin TestsABSTRACT
We present the first cases of Lyme disease found in Italy. The diagnosis was based on clinical and laboratory data. The antigen used for indirect immunofluorescence (I.I.F.) was kindly supplied to us by Prof. R. Ackermann (Köln). Reciprocal titer was 64 in five patients, 128 in six, 256 in three and 512 in one. The patients came either from the Eastern Ligurian Coast or the Trieste Karst: these are consequently the first two Italian areas where Lyme disease has been recognized up to the present.
