Day-surgery, one-day surgery: the experience of an ENT unit in a 250 bed hospital.

The increasing trend in day-surgery procedures, resulting from continuous improvement in medical practice as well as cultural and economic factors, has profoundly changed the management of patient hospitalisation. Improvement in organizational and professional skills of health staff is essential for this procedure which allows mean hospitalisation time to be reduced. A retrospective study on personal experience of day-surgery procedures from 1st January 2002 to 31st December 2004 is herewith presented. The study comprises 1077 patients (74.2%) out of 1452 hospitalisations for programmed surgery in this period. Re-conversion rate of day-surgery hospitalisation reached 0.5%, while re-admissions within one month reached 2.5% and referred to late post-tonsillectomy haemorrhage in all 27 cases. The Authors highlight the importance of communication for an active and responsible involvement of the patients: the human factor is an indispensable quality for the good outcome of the procedure.

[Benign paroxysmal positional vertigo: follow-up of 165 cases treated by Semont's liberating maneuver]. / La vertigine parossistica posizionale benigna: follow-up di 165 pazienti trattati con manovra liberatoria di Semont.

The purpose of the present work has been to evaluate the effectiveness of the Semont's liberatory maneuver in treating benign paroxysmal positional vertigo (BPPV) stemming from lithiasis of the posterior semicircular canal. After taking an overview of the history, epidemiology and clinical manifestation of this pathology, the cases studied are presented: 165 cases of BPPV of the posterior semicircular canal diagnosed between September 1992 and December 1994 at the Audiology and E.N.T. Clinic of the Santo Spirito Hospital in Casale Monferrato, Italy. Diagnosis was based on careful examination of the case history and the finding of typical paroxysmal positional vertigo. Among the 1096 patients who came under observation for vertigo or instability, the incidence of BPPV was rather high: approximately 23%, predominantly females (64% of the cases). In 56% of the cases the right labyrinth was involved while the left labyrinth was involved in 39% (in 5% the form was bilateral). The average age of the patients was 60 years, with incidence being greatest in the 6th and 7th decades of life. In 10% of the cases the etiology was traumatic (cranial, cervical trauma or post otological or general surgery), in 5% it was of viral origin, in 1% of vascular origin; however, in the vast majority of cases (84%) it was idiopathic. All the patients were treated with the Semont's liberatory maneuver (repeated 1-3 times in subsequent sessions at 48 hour intervals). A full 62% of the patients treated were freed of the disorder after a single maneuver and 95.5% after 3 treatments. In 5% of the cases (3 very elderly patients), the disorder persisted even after rehabilitation with Brand Daroff's exercises. To evaluate the evolution in time, all the patients were sent a written questionnaire aimed at determining the progression of symptoms, any recurrences, the number of recurrences, and the length of time from the date of treatment. In the case of positive response, the patients were invited in for a clinical-instrumental check-up. This follow-up ranged from 6 to 30 months. At the end of May 1995 the case breakdown was as follows: 80.7% of the patients were still symptom free, most being quite satisfied with the results; 18% had had one or more recurrence of the paroxysmal positional vertigo which were successfully treated by one or more application of the Semont's maneuver.