The role of EHP-30 as specific instrument to assess the quality of life of Italian women with endometriosis.

AIM: Our goals were to assess the psychometrical characteristics of EHP-30, to test its higher degree of appropriateness compared to the generic Quality of Life-assessment tools for Italian women suffering from endometriosis, and to determine its ability to identify the disease's effects on the patients' psychosocial condition, highlighting critical points that can be modified for future linguistic validation. METHODS: Participants to our study were 98 women between 19 and 51-year-old (M=34.4, SD=7.5), selected from patients of the Department of Obstetrics and Gynecology, ARNAS Civico Hospital, Palermo, Italy. All of them had a surgical diagnosis of endometriosis with histological confirmation. Quality of Life was assessed through generic (SF-36) and specific (EHP-30) instruments. RESULTS: Our study shows that the current Italian version of EHP-30 is affected by overall weaker construct validity than the English one; it seems that this has to be ascribed to the inadequacy of the EHP-30 translation into Italian. In particular, unsatisfactory reliability levels have been observed for social support and self-image scales. An incorrect order of response categories has been in addition found out for several items of the Italian version of EHP-30. Research results suggest solutions to adopt for a revision of the EHP-30 Italian version that can satisfy the requirements of validity and reliability. CONCLUSION: Although requiring a structural and linguistic revision, also the Italian version of a specific measurement instrument as EHP-30 is, appears to be more appropriate than generic tools to assess the quality of life of Italian women suffering for endometriosis.

[The laparoscopic treatment of common bile duct lithiasis]. / Trattamento laparoscopico della litiasi della via biliare principale.

Nowadays the laparoscopic cholecystectomy has become the main surgical therapy in the treatment of cholecysto-lithiasis. At the beginning the treatment of cholecysto-choledochal lithiasis was the sequential endoscopic-laparoscopic therapy. In fact, the endoscopic sphincterotomy allows transpapillary ablation of Common Bile Duct (CBD) stones, and the laparoscopic cholecystectomy completes the therapy. Recently we have brought the full-laparoscopic of CBD lithiasis. This has become possible on account of an improved intraoperative laparoscopic diagnostics and a better technical experience of the laparoscopic surgeon. Intraoperative examination of CBD requires suitable instruments: cholangiography is still a basic examination and now is easily performed in laparoscopy without a considerable increase of the surgical time; choledochoscopy allows an intraluminal inspection of completes the examination, supplying further detailed information. Afterwards the laparoscopic approach allows the transcystic ablation of stones, using a Dormia probe or through a choledochotomy, but is previously required for the surgeon a high-level operative and technical ability about laparoscopic surgery, in order to perform an excellent preparation of the CBD and precise stitches, making knots with extra corporeal or intra-abdominal technique. Clinical results in patients until now fully-laparoscopic treated are quite good and encourage the CBD lithiasis therapy by a mini-invasive approach, which has the advantage that's not requested the sacrifice of a sound papilla.

[Steroid anesthesia in microsurgery of the middle ear]. / L'anestesia steroidea nella micro-chirurgia dell'orecchio medio.

The essential requirements for correct anaesthesia in microsurgery of the middle ear are described and results obtained with an association of Althesin and NLA drugs in 52 stapedectomies, 27 tympanoplasties, and 14 myringoplasties are presented. Althesin was injected i.v. to induce anaesthesia. Maintenance was obtained by means of the continuous venous perfusion of a 10% solution. The usefulness of the association was apparent from the good cardiac stability noted throughout anaesthesia, during which adrenaline was routinely infiltrated via the external meatus. In addition, the manageability of Althesin enabled a modest degree of hypotension to be established during certain stages of the operation. This enabled the intraoperative bleeding that is one of the major snags in this type of surgery to be reduced in some cases. Other benefits related to the degree of postoperative sedation required and the low toxicity of the drugs employed.

[Clinical pharmacology aspects of althesin]. / Aspetti di farmacologia clinica dell'Althesin.

The main pharmacokinetic and pharmacodynamic features of althesin are described. Though relatively new, this steroid is now widely employed in anaesthesiological practice. From the pharmacological standpoint, the high therapeutic index of althesin, the fact that its metabolic fate is known, its rapid elimination, and the prompt, complete awakening of patients when it is used mean that it can be reliably employed in all forms of surgery and on all types of patient. The absolute contraindications coincide with those preventing the employment of general anaesthesia in any form, while the relative contraindications, i.e. those involving particular care in its administration, are linked to the presence of diseases interfering with its mechanism and elimination, the existence of allergy, or cardiovascular disorders of a fairly substantial nature. Althesin, in fact, while not responsible for frank cardiovascular changes, cannot be regarded as entirely innocuous. In other words, it is subject to the same limitations as the barbituric and non-barbituric drugs commonly employed in the i.v. induction of anaesthesia.