Comparison between the high-definition 3D exoscope and the operating microscope in head and neck reconstruction.

The purpose of this study was to compare the three-dimensional (3D) operating exoscope (OE) with the conventional operating microscope (OM) in head and neck reconstruction. A retrospective cohort study was performed including 50 consecutive patients with no history of previous surgery or irradiation (32 male, 18 female; mean age 59.2 ± 13.3 years), who underwent free flap head and neck reconstruction using a 3D OE (n = 25; OE group) or conventional OM (n = 25; OM group). The mean total operative time was 8.0 ± 1.53 h in the OE group and 7.6 ± 1.52 h in the OM group (P = 0.86). The median (interquartile range) anastomosis time was 78.0 (63.0-91.5) minutes in the OE group and 90.0 (75.5-115.0) minutes in the OM group (P = 0.06). The final free flap survival rate was 100%. Only seven patients experienced a free flap reconstruction-related complication, and they were similarly distributed between the two groups (four in the OE group, three in the OM group; P = 0.68). Secondary outcomes (length of hospital stay, tracheostomy dependence, feeding tube dependence) were comparable in the two groups (P > 0.05). The 3D OE is a viable alternative to the conventional OM for performing standard head and neck free flap reconstructive procedures.

Premature ovarian failure. Clinical evaluation of 32 cases.

AIM: Premature menopause, also termed premature ovarian failure (POF), is characterized by cessation of menstruation before the age of 40 years. Pathogenetic mechanisms are not so clear, particularly genetic implications of cellular apoptosis. Diagnostic approach is multifactorial and therapy depends on the pregnancy wish. METHODS: Eight hundred and thirty patients approached the Menopausal Center of the University Department of Gynaecological, Obstetrical and Reproductive Sciences of the Second University of Naples between October 1998 and October 2002. All patients were clinically investigated and selected on the basis of menopausal age, pregnancy wish and menopausal syndrome. RESULTS: Menopausal mean age was 48.31+/-4.62 years and 32 patients (4%) were affected by premature ovarian failure because of menopausal appearance before the age of 40. Three of these patients were treated to have a pregnancy; the remaining 29 required medical treatment to reduce menopausal symptoms. The osteoporosis risk for premature menopause patients was similar to the other women. The cardiovascular risk was increased because of an increase in risk factors in premature ovarian failure patients. No breast or endometrial pathology was revealed and therapy compliance was satisfactory without any drop-out. CONCLUSION: Premature ovarian failure has a varied etiology, pathogenetic aspects, clinical evolution and therapeutical approach. Adequate treatment of premature menopause women presents good compliance, resolution of infertility when required and a successful resolution of menopausal symptoms.

Methotrexate treatment for tubal pregnancy. Criteria for medical approach.

AIM: The purpose of this retrospective study is to underline the indications for the use of systemic methotrexate (MTX) in tubal pregnancies. METHODS: One hundred and four (n=104) consecutive women were treated in our Department for tubal pregnancy. The database analysis showed that after careful respect for inclusion criteria, the treatment chosen was the intravenous administration of MTX in 68 patients, whereas laparoscopy constituted the primary treatment in 36 patients. A single dose of MTX was intravenously administered, diluted in saline solution, with a dosage of 50 mg/m2 of body surface. Close serum beta-hCG monitoring was performed, and in the case of a short fall, a 2nd dose of methotrexate was submitted. RESULTS: The overall success rate of MTX treatment was 91%; the 2nd dose of MTX was used in 12% of patients, whereas in only 6 out of 68 patients included in the medical treatment group a surgical approach for suspected tubal rupture was necessary. CONCLUSION: Treatment with methotrexate is effective and safe in the presence of these criteria: patient hemodynamically stable, absence of tubal rupture sign and hemoperitoneum, an adnexal mass with a diameter < or = 5 cm, an amenorrhea < or = 6 weeks and HCG levels < or = 10,000 mIU/ml. Laparoscopy is indicated in diagnostic uncertainty, when MTX is not suggested, when adnexal mass is > 5 cm, or in patients in which beta-hCG levels was > 10,000 mIU/ml.

Developing a free supportive care program for cancer patients within an integrative medicine clinic.

The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.

[Indications for hormone replacement therapy]. / Indicazioni alla terapia ormonale sostitutiva.

BACKGROUND: The purpose of the present study is to evaluate indications and contraindications, advisability and compliance of hormone replacement therapy (HRT) in women in the climacteric who, owing to the cessation of ovarian activity, face loss of the state of present and future wellbeing. METHODS: A series of 602 women who have attended the Menopause Centre of the II Division of the Department of Gynaecology and Obstetrics of the Second University of Naples in the period from 1/12/1998 to 10/4/2001. The diagnostic methodology adopted is outlined and the reasons for the prescription of HRT indicated. Patients who do not present contraindications were assessed in relation to the gravity of the climacteric syndrome and the likelihood of a future pathology bound up with the lack of estrogens. The intensity of the symptomatology was assessed on the basis of Kuppermann's nomogram. RESULTS: The cessation of ovarian activity occurred between the ages of 40 and 45 in 16.9% of cases while the percentage was 5.9% prior to the age of 40. Cases in which a climacteric syndrome was present numbered 147, or 24.2%. Women who present a cardiovascular risk represent a noteworthy percentage (27.1%). A high number of women are at osteoporotic risk: 223, or 37.0%. Although it has a great number of indications, HRT is only prescribed in about half the patients. Stress is laid on the caution exercised by physicians in prescribing HRT and the diffidence of women in accepting it. Of the well-known contraindications to HRT the most common are those relative to the mammary risk. CONCLUSIONS: HRT was only prescribed for about half the women who came to our attention both as a result of the caution of the physicians who consider even relative contraindications peremptory, and because of the diffidence of a percentage of women with regard to such therapy. Alternative therapies to HRT are in fact a second valid choice, especially in the prevention of osteoporosis.

[Pelvic actinomycosis and sub-acute abdomen]. / Actinomicosi pelvica ed addome sub-acuto.

An interesting case of pelvic actinomycosis with paculiar clinical manifestation is presented. A 42 years-old patient came to our emergency service for an abdominal pelvic pain and fever. Past history showed IUD in situ for over 15 years. The patient was submitted to a ultrasonographic scan and a complete hematological screening was performed. The diagnosis was of subacute abdomen, and an exploratory laparotomy was carried out. During laparotomy an atypical reactive tissue and a suppurative cavity were found. The histological finding of tissue biopsy showed pelvic actinomycosis. On the basis of these findings the conclusion is drawn that a better prevention of pelvic actinomycosis is necessary of its diffusion in the last years due to sexual habit changes.

Trisomy 13 in a case of myelofibrosis with myeloid metaplasia with early blastic transformation.

We describe a case of early myeloid blastic transformation in a 64-year-old man suffering from myelofibrosis with myeloid metaplasia. Both chronic and blastic phase cytogenetic analysis showed trisomy 13 to be the sole chromosome aberration. A potential role for this rare abnormality in determining such an unusually poor clinical outcome is discussed.

A malformed girl with a de novo proximal 6q deletion.

An additional case of interstitial deletion of chromosome 6, the first with breakpoints in q12 and q14, is reported. The female infant was the malformed first child of young, healthy parents. A review of proximal 6q deletions is made.

Multiple skeletal familial abnormalities associated with balanced reciprocal translocation 2;8(q32;p13).

A father and three of his offspring had skeletal abnormalities consisting of a short forearm, cubitus valgus, fusion of first and second cervical vertebrae, and cleft of L5 and S1. All four had a reciprocal, apparently balanced, translocation 2;8(q32;p13). Normal sibs had normal chromosomes. We conclude that this may be a rare instance of an autosomal dominant condition associated with a balanced chromosome translocation.

Clinical features of monosomy 10qter.

The authors report a 10qter deletion in a 16-month-old boy. The patient's phenotype includes: low birth weight, mental and growth retardation, triangular facies, hypertelorism, prominent nasal bridge, malformed and low set ears, cryptorchidism. The karyotype was 46,XY,del(10)(q26.1 leads to qter). Cytogenetic analysis of both parents, including a search for the fragile site in the 10q25 region, were normal. The assignment of the human GOT structural gene to the 10q25.3 band is suggested.