Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial.

BACKGROUND: The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy. METHODS: One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend. RESULTS: Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture. CONCLUSIONS: The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.

[Umbilical endometriosis: report of a case and review of the literature]. / Endometriosi ombelicale: presentazione di un caso e revisione della letteratura.

The authors present a clinical of umbilical endometriosis in a young woman. This patient never underwent any operation or diagnostic abdominal procedures. The case is very interesting because of problems concerning differential diagnosis with other umbilical and periumbilical diseases and pathogenetic theories. In this study the authors suggest a hypothesis to explain the localization of ectopic endometrium in this site. We review the literature, with some comments on therapeutic options; finally we compare the medical and the surgical approach and we suggest an advisable therapy.

[Etiopathogenic, diagnostic and therapeutic problems apropos of 2 observations of acute acalculous cholecystitis]. / Problematiche eziopatogenetiche, diagnostiche e terapeutiche a proposito di due osservazioni di colecistite acuta alitiasica.

The acute acalculous cholecystitis (A.A.C.) is a disease with high rates of morbidity and mortality and risk and promoting factors are very important. Pathogenesis has not completely explained, diagnosis is difficult, and there is no agreement on the more effective therapy. The authors present two cases of A.A.C. and one case of not true A.A.C., discuss them and conclude: 1. Parietal ischemia of gallbladder is the most important factor in the pathogenesis. 2. No many diagnostic procedures are necessary if one stress patient's history and clinical findings. 3. The emergency cholecystectomy is the best effective therapeutic procedure and only in selected cases the not invasive procedures are usefull.

Vascular deaths in elderly neurological patients with leukoaraiosis.

OBJECTIVES: The prognostic significance of leukoaraiosis is still not completely elucidated. The objective was to examine survival and causes of death among elderly neurological patients with leukoaraiosis. METHODS: From 1 January 1994, vital status and causes of death were drawn from municipality lists and death certificates of 216 patients (mean age (SD) 70.6 (8.3) years) admitted to a geriatric unit who underwent cranial CT between 1 January 1984 and 31 December 1986 (mean observation period (SD) 8.4 (0.8) years). These patients had been enrolled for a study of clinical predictors of leukoaraiosis. Based on the presence of leukoaraiosis on CT, this group had been divided into two subgroups of patients, with and without leukoaraiosis. The difference in survival and causes of death between these groups formed the objective of the study. RESULTS: Survival time was shorter among the 90 patients with leukoaraiosis than among the 126 patients without (median survival time 4.07 v 7.78 years, log rank test P < 0.001). After controlling for age and other major death predictors, the risk of death remained significantly increased (relative risk (RR) = 1.64, 95% confidence interval (95% CI) 1.15-2.34) among patients with leukoaraiosis. Moreover, patients with leukoaraiosis had an almost threefold higher risk of dying from vascular causes than patients without (RR = 2.81, 95% CI 1.74-4.53). CONCLUSION: Leukoaraiosis is a predictor of vascular deaths in elderly neurological patients. Careful diagnostic evaluation and attention to preventive measures are required in patients with leukoaraiosis.