Oral ondansetron and intravenous dexamethasone in the prevention of cisplatin-induced emesis. A phase II trial in women.

Fifty-eight previously untreated patients with gynecological cancer, assigned to cisplatin-based chemotherapy (40-80 mg/m2), received the following antiemetic treatment: day 0, oral ondansetron 8 mg 3 times/day + intravenous dexamethasone 16 mg; days 1-7, oral ondansetron 8 mg twice/day. In cycle 1 complete or major control (0-2 emetic episodes) was achieved in 94.6% of the patients in the acute phase (day 0) and in 89.2% in the delayed phase (day 1-7). In the subgroup receiving cisplatin > or = 75 mg/m2 the effect on acute and delayed emesis decreased significantly with subsequent courses. Reversible side effects were observed in 8.9% of the cases. Oral ondansetron was efficacious, well tolerated and is worth testing further in randomized trials with intravenous therapy.

Infectious morbidity in gynecologic oncologic surgery. A clinical and economic evaluation.

In the Department of Obstetrics and Gynecology, Faculty of Medicine, Varese, between March 1991 and February 1992, 70 consecutive patients undergoing elective oncologic surgery were evaluated for rationalizing the use of antibiotics in order to reduce the cost of infectious complications. We divided our patients into two groups: a high infection risk group and a low infection risk group. Our findings show that: the HIR group shows a higher antibiotic cost than LIR one; our selection criteria for HIR patients are probably correct; in the LIR group 46.6% of patients were not submitted to any antibiotic therapy.

Cesarean section: an economic appraisal of infectious complications.

From March 1991 to April 1992, in the Dept. of Obstetrics and Gynecology, University of Pavia-Varese, 107 out of 115 consecutive patients submitted to cesarean section were evaluated for the clinical and economic evaluation of infectious complications. On the grounds of our previous experience we distinguished two groups: a high infection risk group (50 pts), because of labor and/or rupture of membranes, HIV+, diabetes; and a low infection risk group (57 pts). Our findings support the choice of these selective criteria both for the infectious event or for the use, and thence for the costs, of antibiotic treatment. In fact, based on this experience we believe that in cesarean sections with high infection risk AP is always recommended whereas in the low risk ones AP should not exceed L. 10.095 to be cost-effective.

[HELLP syndrome. Discussion of a case]. / HELLP syndrome. Discussione di un caso.

The HELLP syndrome is the most severe variant of pre-eclampsia. A case is reported in a primigravida patient at 25 weeks of gestation. The lack of response to medical treatment and the deterioration of maternal indices necessitated a Cesarean section with intensive neonatal care at a very premature stage. The physiopathological grounds and the various methods of treating this syndrome are discussed and the paper concludes that rapid birth is the only solution capable of preventing severe maternal complications.

[Infections in obstetric-gynecologic surgery: chemo-antibiotic prophylaxis and therapy. A bibliographic review]. / Le infezioni in chirurgia ostetrico-ginecologica: chemioantibioticoprofilassi e terapia. Rassegna bibliografica.

The Authors review, on the basis of their experience, the literature data concerning chemo-antibiotic prophylaxis in gynaecological surgery. Prophylaxis is widely employed although some important aspects are still under evaluation: bacterial selection and resistance, benefit in case of abdominal hysterectomy or elective Cesarean section, risk of pseudomembranous colitis. The most effective drugs are Piperacillin/Mezlocillin given in a single dose preoperatively. The same drugs are useful in the treatment of postsurgical infections.

Diagnostic alternatives to second look in ovarian cancer.

The accuracy of the markers CA 125, CA 15-3, CA 50 serum levels and the CT findings as alternative monitoring techniques to second look has been evaluated in 25 patients. The negative predictive value for the CA 125 was of 55% and its sensibility seems not to be increased by the association of the other markers. For the CT findings we report a diagnostic accuracy of 76%.