Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments.

117 women with severe pelvic organ prolapse (POP; stage > 2) were enrolled to elucidate a 24-month outcome of POP surgery, using conventional or mesh repair with 3 techniques. 59 patients underwent conventional repair and 58 underwent mesh repair. Two types of mesh were used: a trocar-guided transobturator polypropylene (Avaulta, Bard Inc.) and a porcine dermis mesh (Pelvisoft, Bard Inc.). Women with recurrences, who underwent previous unsuccessful conventional repair, were randomised. Primary outcome was the evaluation of anatomic failures (prolapse stage > 1) in treated and untreated compartments. Anatomic failure was observed in 11 of 58 patients (19%; CI 8.9-29) in the mesh group and in 16 of 59 patients (27.1%; p value = 0.3) in the conventional group. 9 of 11 failures in the mesh group (15.5%; CI 6.2-24.8) were observed in the untreated compartment (de novo recurrences), 14.3% in Pelvisoft and 16.7% in Avaulta arm, while only 1 recurrence in the untreated compartment (1.7%) was observed in the conventional group (odds ratio 10.6, p = 0.03).

[Cesarean section, techniques and skin suture materials]. / Taglio cesareo, tecniche e materiali di sutura della cute.

AIM: The aim of the study was to compare the outcome, complications and costs of three skin suture techniques after Caesarean section. METHODS: The study sample was 310 women who underwent caesarean section between 2003 and 2007. The sample was divided into three groups: an intradermal suture with non-reabsorbable thread was applied in 98; metallic clips were placed in 90; 2-octyl-cyanoacrylate (2-OCA) glue was used for wound closure in 112. The sutures were checked at 4 days and 2 months after the operation to determine cosmetic outcome, patient compliance, strength of incision closure, allergic reactions, suture infection, and total cost of each technique. RESULTS: No substantial differences in strength of incision closure or cosmetic outcome between the techniques were found. Compliance was better in the group that received 2-OCA, while the total cost of suture alone was lower in the group that received the non-reabsorbable intradermal suture. CONCLUSION: The results suggests that following Caesarean section according to Stark, skin suture with 2-OCA glue has the advantage of greater patient compliance, while intradermal thread suture is less costly with a cosmetic outcome comparable to that of the other two techniques.

[Ultrasonographic evaluation of timing in emergency cervical cerclage]. / Valutazione ecografica del timing nel cerchiaggio cervicale d'emergenza.

The aim of the present paper is to utilise endovaginal ultrasonography as an instrument for establishing the most appropriate moment for carrying out cervical cerclage after interrupting uterine contractions in a situation of near miscarriage. A patient at 20 weeks and 4 days of gestation, with contractions, integral membranes and complete dilatation, was laid in the Trendelemburg position, keeping the bladder moderately full, and given tocolytic therapy. After 14 days cerclage was carried out on a reconstituted neck. At 37 weeks and 1 day, the patient delivered a female newborn weighing 3.100 g. The Trendelemburg position, the moderately full bladder and tocolytic therapy with endovaginal ultrasonographic monitoring can move the timing of surgery forward so as to render it safer and more useful for prognostic purposes.

Gastric carcinoma detected by cervical cytology.

This paper is a report on a case of gastric carcinoma of diffuse type in a young female patient aged 38. The patient was still asymptomatic at hospital admission, her only pathological sign being the finding of malignant cells of indeterminate origin at a routine Pap-test examination. Subsequent investigations showed the presence of a poorly differentiated gastric carcinoma, with metastatic diffusion to uterus, ovaries and peritoneum. Only a few cases of gastric carcinomas without cervical localization, detected by Pap-test, are reported in literature. A few other cases with cervical localization have been described. The aim of this work is to point out that a Pap-test smear may reveal the presence of extragenital tumors still unappreciated.

[Endometriosis of the ileum and colon complicated by intestinal obstruction. Report of two cases]. / Endometriosi dell'ileo e del colon complicata da occlusione intestinale. Due casi clinici.

The authors report two cases of intestinal occlusion, one ileal and the other colic, caused by endometriosis. Both patients underwent surgery. Following a review of data in the literature regarding the frequency, pathogenesis, diagnosis and management, the authors conclude that pre- and intraoperative diagnosis is often impossible in these cases and must be postponed to histological analysis. Full remission was achieved after surgery.

[Cloacal exstrophy, ultrasonic diagnosis]. / Estrofia della cloaca, diagnosi ecografica.

This study aims to underline the importance of transvaginal ultrasonography in the first three months of pregnancy. The authors report a case which was referred to their attention for preliminary tests performed prior to amniocentesis, recommended by the general physician because of the mother's age. The primapara woman and father of the fetus were healthy and the family history excluded hereditary diseases or congenital pathologies. Transvaginal ultrasonography permitted the diagnosis at the start of the fourth month of pregnancy of a polymalformed fetus with cloacal exstrophy, sacral myelomeningocele, clubfoot, single umbilical artery. In this case, the mother decided to undergo eugenic abortion in view of the severity of the pathology.

Physiology as the antechamber to metaphysics: the young William James's hope for a philosophical psychology.

In the 5 years before 1878, when his career in psychology was becoming established, William James wrote a series of notes and reviews assessing the work of many of the pioneers in the new field. Adopting a public and confident voice, even while he was privately still uncertain and searching, James criticized the dogmatism of positivist and idealist claims to the study of the human brain and mind. In his short writings of 1873-1877, James started to formulate his own middle path. His first steps on that path show that he did not reject either scientific or philosophic inquiry; instead, he viewed scientific knowledge as a way to understand philosophical questions more deeply. Saving his sharpest critiques for positivism, James endorsed scientific investigation without materialist assmptions. While his career in psychology was still only a hope, James treated science as a means toward humanist insight.

[Selective episiotomy. Comparison of two suture technics]. / Episiotomia selettiva. Due tecniche di sutura a confronto.

AIMS: The study aimed to highlight any differences between the sequelae of episiorrhaphy performed using the Blair-Donatti and Guilmen-Pontonnier techniques. METHODS: A total of 202 pregnant women were recruited in the Obstetrics Ward of Codogno Civic Hospital in 1994 and 1995. Subjects were randomly divided into two groups matched for socioeconomic status, age and parity (group A: Guilmen-Pontonnier suture, group B: Blair-Donatti suture). The following parameters were evaluated: pain twenty-four hours, sixty-six hours and one, two and three months after labour, pain during sexual relations, the onset of infection, hematoma, dehiscence of the wound, and lastly the cosmetic results. RESULTS: No significant differences were found between the parameters examined in both groups, barring the improved cosmetic result in group A.

[A clinical study of the use of a combination of glucomannan with lactulose in the constipation of pregnancy]. / Studio clinico dell'impiego di una associazione di glucomannano con lattulosio nella stipsi gravidica.

RATIONALE: Constipation is a problem frequently encountered during pregnancy as is excessive weight gain. Treatments of common use to control constipation are endowed with some drawbacks and they are not active in controlling weight increase. A preparation of lactulose and glucomannan in previous studies proved very effective and well tolerated in patients affected by stypsis and evidentiated also activity both in controlling excessive food intake and in correcting some metabolic imbalances regarding lipids and urea. MATERIAL AND METHODS: 50 pregnant females affected by constipation were treated with sachets containing a preparation of glucomannan (1.45 g) and lactulose (4.2 g) in a posology of 2 (1-4) sachets a day for 1-3 months. RESULTS: Treatment induced a return to normal frequency of weekly number of evacuations (4.9-5.8/week) and a parallel control of weight gain (within 20% of initial body weight). The latter finding seems to be related to hunger control induced by glucomannan at the gastric level which prevents an excessive food intake.

The four postulates of Robert Koch.

A critical revision of the "Four postulates of Koch". The erroneousness of the 3rd and 4th postulates are justified in an historical perspective. Koch could not foresee the future progress of medicine and microbiology, but he could have imagined it; imagination is an endowment of scientific thinking. Koch considered science as a static and incontrovertible activity, but did not foresee the future development of that technological progress that soon after allowed to "see" the viruses and greatly widened the concept of infection.

[Hydronephrosis in pregnancy. Ultrasonographic study]. / Idronefrosi della gravidanza. Studio ecografico.

Hydronephrosis is a common pathology during pregnancy and according to some authors affects between 80 and 90% of women in the third trimester. The right side is most frequently affected. Moreover, there appears to be no relation between parity and hydronephrosis or between previous infections of the urinary tract and hydronephrosis; however its presence, especially if severe, is associated with urinary infections with a frequency which is significantly greater than in patients with a urinary tract within normal limits. There are two pathogenetic hypotheses: one identifies the inhibitory effect of progesterone and prostaglandins on muscular tone and the peristalsis of smooth ureteral muscle, with consequent dilatation and anfractuosity of the excretory tract above the pelvic brim; the other is the mechanical hypothesis based on the possible compression of the ureter caused by the pregnant womb at the level of the pelvic brim at the intersection with the ilial and ovarian vessels. One hypothesis does not exclude the other, but on the contrary they complement each other and give added plausibility to a multifactorial pathogenesis. The study of hydronephrosis in pregnancy has made considerable progress since the introduction of echotomography in image diagnosis, a low-cost method which is easy to use and does not harm the product of conception. Echographs with 3.5 MHz probes were used to carry out a prospective study by examining the kidneys and excretory tract in 370 asymptomatic pregnant women during the first, second and third trimesters of gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intestinal volvulus in pregnancy]. / Volvolo intestinale in gravidanza.

Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.

[Gynecomastia]. / La ginecomastia.

Gynecomastia is a benign pathology due to the increased volume of the mammary glands. The various etiological factors lead to an imbalanced estrogen/androgen ratio or to a greater local receptivity to the former with consequent hypertrophy of the mammary stromal gland components. Although the majority of cases are benign and/or transient, gynecomastia must be carefully examined using thorough anamnesis, hormone assays and instrumental tests in order to exclude local or further removed pathology. At present, medical or surgical therapy is reserved for those cases in which this condition is painful and/or psychologically damaging. In this study, following a review of the literature, the Authors focus on the etiological, diagnostic and therapeutic aspects of gynecomastia and illustrate the cases they have observed.

[Ultrasonography and ultrasound-guided biopsy in lymphomas]. / Ecografia e biopsia ecoguidata nei linfomi.

The authors have reviewed the literature on imaging techniques for the diagnosis of lymphoma. Lymphography, axial computerized tomography (CT) and echotomography have been compared as to their sensitivity and specificity. Lymphography allows diagnosis of the disease even in lymph nodes of less than 0.5 cm diameter, but this technique cannot be applied to all lymphatic station. Echotomography and CT are equivalent as to the accuracy of diagnosis and are both helpful for guided needle biopsy. In view of its low cost, echotomography is considered by most workers the first-line approach to the evaluation of lymphoma patients. In spite of its advantages over other methods, echotomography must, nevertheless, be integrated by CT, lymphography, and nuclear magnetic resonance.

Synthesis and inhibiting properties toward trypsin like proteases of N alpha-(N,N-dimethylcarbamoyl)-alpha-azaornitine and alpha-azalysine esters.

N alpha-(N,N-dimethylcarbamoyl)-alpha-azaornitine and N alpha-(N,N-dimethylcarbamoyl)-alpha-azalysine phenyl and p-nitrophenyl esters (7-10) were synthesized and tested as inhibitors of trypsin, chymotrypsin and thrombin. The N,N-dimethylcarbamoyl group was chosen to decrease the tendency of acylcarbazates to cyclization into 1,3,4-oxadiazol-2(3H)-ones. Only the p-nitrophenyl alpha-azaornithine derivative 8 was inactivated rapidly by intramolecular acylation of the terminal amino group, rather than by cyclization to oxadiazolone, in aqueous solution at pH 8. The corresponding alpha-azalysine derivative 10 is completely unaffected under the same conditions. Rapid inactivation of thrombin and trypsin only was observed for all alpha-azapeptide esters 7-10 at 0.5 mM inhibitor concentration. No proteolytic activity was restored after 24 h following 2,000 fold dilution of the inhibitor concentration suggesting formation of very stable acylenzymes.

[Echography in the diagnosis of breast cancer]. / L'ecografia nella diagnosi del cancro mammario.

Fifty-one patients with clinically palpable breast cancer were examined using small-parts echotomography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of overall diagnosis were assessed in the two groups of patients: T1 (diameter less than 2 cm) and T2-T3-T4 (diameter greater than 2 cm). The frequency of the main echographic signs associated with breast cancer was also investigated. Diagnostic accuracy was found to be high in the T2-T3-T4 group (93%), but very low in the T1 group (71%). The study confirms the importance of ultrasound as an additional test in the study of breast cancer. However, this method becomes increasingly less sensitive and specific as the size of the tumour decreases.

[Risk factors for cystic kidney disease in hemodialysis patients]. / Fattori di rischio nella malattia cistica renale dell'emodializzato.

Acquired bilateral cystic transformation of kidneys in patients on chronic dialysis has been increasingly noted by morphological and clinical studies. Our study aims to identify a group of high-risk patients for incidence and extent of such disease. We studied with ultrasonography 87 patients on maintenance hemodialysis (60 men and 27 women), median age 58 years (range 18 to 81), mean duration of hemodialysis 75 months (range 2-256). The presence of cysts was divided into five grades from 0 no cysts to 4 more than 15 cysts detected for each kidney. 74 patients 85% of our dialytic population had acquired cystic disease; cysts varied in size from 0.5 to 4.5 cm in diameter. The cysts were found in 97% of patients dialyzed for more than 8 years and in 73% of patients on hemodialysis for less than 3 years. The incidence of cystic disease was highly and significantly correlated with the duration of dialysis, the grade correlated with duration of chronic renal failure and hemodialysis. The extent of disease appears to be increased in males. Because of high incidence of disease in long term dialysis patients ultrasonography monitoring is recommended for patients on dialysis for more than 3 years with more attention for males.