Comparison of unilateral and bilateral spinal anesthesia with 2% hyperbaric prilocaine in day-case inguinal herniorrhaphy: a randomized controlled trial.

BACKGROUND: Hyperbaric 2% prilocaine produces a faster onset and shorter duration of spinal anesthesia than a plain solution. The anesthetic profile could be improved by restricting the block to the operative side. We compared unilateral versus conventional bilateral spinal anesthesia with hyperbaric 2% prilocaine in day-case patients undergoing unilateral inguinal herniorrhaphy. METHODS: Eighty patients were randomly assigned to receive either conventional bilateral (N.=40) or unilateral (N.=40) spinal anesthesia with 50 mg hyperbaric prilocaine 2%. In the unilateral group, lateral decubitus was maintained for 10 minutes. Sensory and motor block courses, time to first micturition, and side effects were recorded. RESULTS: On the operated side, the highest sensory block was T8 (T12-T2) in the unilateral and T9 (T11-T4) in the bilateral group (P=0.0328); the time to motor (115 ± 26 min in the unilateral and 108 ± 24 min in the bilateral groups, P=0.2350) and sensory (156 ± 30 min in the unilateral and 158 ± 26 min in the bilateral groups, P=0.7550) block resolution was similar in both groups. On the non-operated side, the unilateral group had a faster motor (64 ± 48, P<0.001) and sensory (120 ± 47, P<0.001) time to block resolution than the conventional group. Restricted unilateral motor and sensory block was achieved in 30% and 12.5% of patients, respectively. Time to voiding was shorter in the unilateral than in the conventional group (220 ± 47 vs. 249 ± 51 min, respectively, P=0.0104). There were no significant differences in adequacy for surgery and side effects between the groups. CONCLUSION: In day-case inguinal herniorrhaphy, attempting unilateral spinal anesthesia with 50 mg hyperbaric 2% prilocaine produced faster time to voiding.

Glyphosate degradation in water employing the H2O2/UVC process.

Glyphosate is the organophosphate herbicide most widely used in the world. Any form of spill or discharge, even if unintentional, can be transferred to the water due to its high solubility. The combination of hydrogen peroxide and UV radiation could be a suitable option to decrease glyphosate concentration to acceptable limits. In this work, the effects of initial pH, hydrogen peroxide initial concentration, and incident radiation in glyphosate degradation were studied. The experimental device was a cylinder irradiated with two tubular, germicidal lamps. Conversion of glyphosate increases significantly from pH = 3-7. From this value on, the increase becomes much less noticeable. The reaction rate depends on the initial herbicide concentration and has an optimum plateau of a hydrogen peroxide to glyphosate molar concentration ratio between 7 and 19. The expected non linear dependence on the irradiation rate was observed. The identification of critical reaction intermediaries, and the quantification of the main end products were possible and it led to propose a plausible degradation path. The achieved quantification of the mineralization extent is a positive indicator for the possible application of a rather simple technology for an in situ solution for some of the problems derived from the intensive use of glyphosate.

Transobturator tape in the management of female stress incontinence: clinical outcomes at medium term follow-up.

OBJECTIVE: To assess the efficacy of transobturator tape (TOT) in the management of stress urinary incontinence at a medium term follow-up. METHODS: TOT is a polypropylene tape positioned through the obturator foramen. 70 patients with type II urinary stress incontinence were treated with TOT between June 2003 and May 2006. Patients were prospectively studied by physical examination, quality of life questionnaire (I-QOL), visual analog scale, global impression (dry, improved, same, worse), preoperative urodynamic study, and pre- and postoperative flowmetry. Statistical analysis (t test) of the difference in I-QOL scores and flowmetry was made by StatSoft V. 5.1. RESULTS: The average follow-up was 32 (range 12-48) months. The I-QOL score increased statistically significantly by 40 points. The average percent improvement was 80%. 90% (63/70) of the patients were dry and 5% (4/70) were improved. The pre- and postoperative uroflowmetry studies were not statistically different. Vaginal erosion occurred in 4 patients. CONCLUSION: TOT is a safe procedure with a good efficacy at 32-month follow-up.

[Management of oropharyngeal dysphagia: outcomes in a group of 81 adult patients]. / La gestione della disfagia orofaringea (outcomes in un gruppo di 81 pazienti adulti).

BACKGROUND: Aim of the study is to assess outcomes in the management of 81 patients with diagnosis of oropharyngeal dysphagia. DESIGN: retrospective study on the outcome of logopedic treatment. SETTING: patients have been assessed and treated as in- and out-patients of the Azienda Ospedaliera "S. Giovanni Battista" of Turin. PATIENTS: 81 patients, 37 female and 44 male, mean age of 61,3 years, with diagnosis of oropharyngeal dysphagia. INTERVENTION: phoniatric and logopedic assessment and management including: food consistency change, compensatory head posture, oropharyngeal muscle strengthen and pharyngeal sensibility stimulation. SURVEY: tube feeding, dietary adjustments, presence of aspiration or penetration and postural techniques utilization were used as outcome measures. RESULTS: The number of patients on tube feeding changed from 50 out of 81 before treatment to 36 out of 81 at discharge time. Subjects who couldn't take anything by mouth decreased from 55 to 9. The number of patients with aspiration or penetration changed respectively from 47 and 8 to 20 and 4. Postural techniques were used in 15 cases. CONCLUSIONS: The data suggest that outcomes of oropharyngeal dysphagia rehabilitation are promising. The role of tube feeding and of food consistencies is of key importance in the management of deglutition disorders. All clinicians dealing with dysphagic patients should know the importance of food rheologic characteristics, the consequences of alimentation by nasogastric tube and percutaneous endoscopic gastrostomy.

Aetiopathogenesis and treatment of idiopathic retroperitoneal fibrosis.

Idiopathic retroperitoneal fibrosis (IRF) is a rare urological disease, for which many pathogenic theories have been proposed. The authors report a series of 13 cases of IRF in order to evaluate the clinical, diagnostic, laboratory, therapeutic and prognostic aspects. They also report a rare case (the ninth case reported in the literature) of multifocal fibrosclerosis. A possible genetic predisposition was studied by testing for the presence of immunophenotype HLA-B27; this test was positive in 44% of cases. A study of the immunological profile and lymphocyte populations revealed the typical features of chronic immune disease. Experience with medical and surgical treatment is reported, comparing various procedures: ureterolysis followed by application of a vascularized omental flap over the ureter (without subsequent corticosteroid therapy) gave the best results, with complete resolution of the symptoms and long-term successful alleviation of ureteric obstruction in 100% of patients, with a mean follow-up of 58 months.

Coexistence of orbital and retroperitoneal involvement in multifocal fibrosclerosis: case report.

OBJECTIVE: To report a rare case of multifocal fibrosclerosis involving the retrobulbar tissue and the retroperitoneum. METHODS: A 59-year-old man presented with bilateral exophthalmos, more serious in the right eye. Right orbital biopsy showed fibrous tissue with inflammatory cells. After the failure of the radiation therapy, a right orbital exenteration was required. Radiological examinations demonstrated a retroperitoneal mass involving the perirenal fat, the aorta, the presacral and the perivesical tissue. Renal function impaired. A left inferior calycoureterostomy and a surgically placement of a right JJ stent were performed. Histological examination of the retroperitoneal biopsies revealed fibrous connective tissue. RESULTS: After 9 years of follow up, there was no change in left visual or renal function (last creatinine: 1.3 mg/dl), and no symptoms or signs of recurrences. CONCLUSION: This case is the ninth to document the association of orbital pseudotumor and retroperitoneal fibrosis. It is important that both the ophthalmologist and the urologist are aware of the existence of this association, so that suitable treatment can be initiated without delay.

[Tracheal intubation with fiberscope in traumatology of the cervical spine. Our clinical experience]. / Intubazione tracheale con fibroscopio nella traumatologia del rachide cervicale. Nostra esperienza clinica.

Cervical spine lesions require early stabilisation. The fibroscope was used in order to avoid irreversible damage to the medulla during intubation. Twenty-five patients aged between 18 and 70 years old were treated. Pre-medication and local anesthesia of the nostril, rhinopharynx and oropharynx was performed. Local anesthesia of the hypopharynx was omitted to avoid the tussigenic reflex which is dangerous in this pathology. The patient was then deeply sedated maintaining respiratory activity. The tracheal tube was then introduced into the nostril and the fibroscope was then positioned using this as a guide. Following the insertion of the fibroscope in the trachea, the latter was then used to slide the tracheal tube down. The authors consider this technique to be useful in this pathology since it is risk free if used as described above.