Zygomatic implant guided rehabilitation based on inverted support technique: a pilot study.

OBJECTIVE: Zygomatic implant insertion surgery is a challenging operation. The primary aim of this pilot study was to assess the accuracy of EZgoma® "Inverted Support Technique" for the zygomatic implant-guided surgery. Secondly, any factors which may affect the surgical protocol results, such as implant-prosthetic virtual plan, surgical model matching, intra or post-operative complications, time rate between surgical procedure and prosthetic loading, zygomatic implant survival rate and implant success rate were analyzed. PATIENTS AND METHODS: A total of 20 zygomatic implants were placed in atrophic maxillae of 5 patients. The final position of zygomatic implants after surgery was compared with the pre-operative digitally planned position.  The analyzed parameters were zygomatic implants apex and base mean linear distance and zygomatic implants axis mean angular deviation. RESULTS: The comparison was provided by a tridimensional imaging elaboration platform, provided by Geomagic, which allows the overlay of virtual plan STL data with post-operative control CT scan DICOM data. As a result, all the mean values regarding the 20 placed zygomatic implants respected the universally agreed values in guided zygomatic implant surgery: the mean linear distance of the implant platform and of the implant apex were 1.59 mm and 1.62 mm respectively, while the mean angular deviation of the implant axis was equal to 1.74°. One of the patients had mucositis as a post-operative complication. In one patient the anterior wall of the maxillary sinus fractured, and in one zygomatic implant primary stabilization was not achieved. No other complications occurred. CONCLUSIONS: As a conclusion, data obtained from this study suggested that guided zygomatic implant rehabilitation may represent a reliable, efficient, rapid, ergonomic, and safe surgical protocol, however further investigations are needed.

Oral rehabilitation of oncology patients with dental implants after reconstruction surgery with autogenous flaps.

OBJECTIVE: Reconstruction after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate oral rehabilitation with autogenous flaps and dental implants for maxillofacial reconstruction in oncologic patients after implant insertions. MATERIALS AND METHODS: The study consisted of 19 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with autogenous flaps (free fibular flap, antero-lateral thigh flap, radial forearm flap, or rotational pedicled temporal muscle flap). Implants were inserted on the average 32.03±19.51 months after reconstructive operations. A total of 82 implants were inserted. Mean follow-up after maxillo-facial surgery was 7.2 years (mean 86.56±22.04 months). Mean follow-up after implant insertions was 4.5 years (mean 54.6±21.82). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications. RESULTS: There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. There was one implant failure. Overall implant survival rate was 98.8%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type. CONCLUSIONS: According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes.

Gastric metastasis from cervix carcer: a case report.

Gastric metastasis by solid tumor cancer is a rare event. Concomitant metastases to other organs are frequent, so that this condition is often associated to a poor prognosis. Upper gastrointestinal bleeding and anemia are the most common presenting symptoms. We present the case of a 81 years old women previously treated for cervix carcinoma showing later a stomach metastasis. The patient is alive and disease free 39 months after salvage gastrectomy. A radical surgery in selected patients could be useful for symptom palliation and prolonged survival.

Laparoscopic colorectal resections with transvaginal specimen extraction for severe endometriosis.

INTRODUCTION: Bowel resection is now considered the "gold standard" treatment for severe endometriosis infiltrating the bowel. Laparoscopic colorectal resection can be considered a safe option in order to reduce surgical trauma and complications as well as to improve cosmetics. Transvaginal approach, used for several years to remove large specimens, can be an interesting approach also in case of colorectal resections. AIM OF THE STUDY: To present our experience on laparoscopic colorectal resection and transvaginal specimen extraction as treatment of severe endometriosis. RESULTS: Eleven patients (mean age 45+/-12 years) have been operated by a combined team of gynecologist and colorectal surgeons. There were no intra- or post-operative complications. In all cases, the transvaginal route was used to remove the specimen and prepare the bowel for anastomosis. Patients were allowed to free light diet on post-operative day 3+/-1 and discharged on day 5+/-2. The mean follow-up was 4+/-2 months and all patients are well with normal bowel function and symptoms free. CONCLUSIONS: Our preliminary experience demonstrates such approach is safe and feasible with excellent results in term of post-operative course.

Recurrence of ovarian endometriosis and anatomical location of the primary lesion.

OBJECTIVE: To investigate whether the risk of endometriosis recurrence and pregnancy rate are related to the side of the pelvis on which the primary lesion is found. DESIGN: Cross-sectional study. SETTING: Tertiary institutional hospital. PATIENT(S): One hundred and twenty-one patients with advanced-stage pelvic endometriosis. INTERVENTION(S): Conservative laparoscopic treatment. MAIN OUTCOME MEASURE(S): Endometriosis recurrence and pregnancy rate. RESULT(S): Endometriosis was localized on the left hemipelvis, right hemipelvis, and bilaterally in 47.9%, 33.9%, and 18.2% of patients, respectively. The overall rate of disease recurrence was 17.3%. The recurrence rate was higher when the left ovary was involved than when it was not (29% vs. 7.3%; P<.05). The overall rate of spontaneous pregnancy was 48.1%. The median interval between surgery and occurrence of pregnancy was shorter in patients with endometriosis limited to the right hemipelvis than in those with disease limited to the left side (21 months [range, 12-48 months] vs. 9 months [range, 6-12 months]; P<.01). CONCLUSION(S): The likelihood of disease recurrence is lower when endometriosis is located only on the right side of the pelvis than when the left side is involved. In patients who try to conceive, the time between surgery and occurrence of pregnancy seems to be shorter when the endometriosis is localized in the right hemipelvis.

Microlaparoscopy: a new approach to the reassessment of ovarian cancer patients.

BACKGROUND: The purpose of the work was to determine the feasibility and accuracy of microlaparoscopy as diagnostic method for the reassessment of ovarian cancer patients. METHODS: Eight patients scheduled for second-look laparoscopy who had undergone primary surgery for ovarian cancer followed by 6 cycles of chemotherapy were included in the study. Microlaparoscopy was performed using a 2.8 mm laparoscope followed by conventional 10-mm laparoscopy. Three additional 5-mm ancillary trocars were inserted to perform intraabdominal biopsies. Pelvic washings were performed in all cases. RESULTS: Microlaparoscopy was feasible in all cases and as accurate as conventional laparoscopy in seven cases. In one case the procedure was terminated before conventional laparoscopy because of positive biopsies at frozen section examination. There were no intra-operative complications related to microlaparoscopy. The median time from skin incision to the removal of the microlaparoscope was 47 minutes (range 30-70). CONCLUSION: Microlaparoscopy seems to be a safe, accurate, minimally invasive method and therefore we suggest its use as primary approach to the reassessment of ovarian cancer patients.

Estroprogestin vs. gonadotrophin agonists plus estroprogestin in the treatment of endometriosis-related pelvic pain: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi.

OBJECTIVE: This is a randomized clinical trial comparing estroprogestin (E/P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E/P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. METHODS: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3-12 months after diagnosis. Eligible women were randomly assigned to treatment with E/P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E/P pill for 8 months (55 patients). RESULTS: At baseline, dysmenorrhea was reported in 46 women allocated to E/P pill only (97.9%), and in all the 55 women allocated to GNRHa+E/P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa+E/P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E/P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa+E/P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E/P only and 2 and 6 in the GNRHa+E/P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. CONCLUSIONS: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.

Endometrial thickness in tamoxifen-treated patients: an independent predictor of endometrial disease.

OBJECTIVE: To assess the independent contribution of transvaginal ultrasound in identifying women at risk for endometrial disorders, and determine whether a cutoff value identifies women who need endometrial histologic assessment. METHODS: Postmenopausal women with breast cancer who were receiving tamoxifen, with ultrasonographic endometrial thickness greater than 4 mm or vaginal bleeding, had hysteroscopy with selective endometrial biopsies. Endometrial thickness, duration of tamoxifen therapy, and endometrial histology were studied. Parametric and nonparametric tests and logistic regression and receiver operating characteristic curves were used for statistical analysis. RESULTS: The study population consisted of 163 women, 46 with vaginal bleeding. The proportion of women with abnormal histologic findings was greater among those with endometrial thicknesses exceeding 9 mm compared with those with endometrial thicknesses 9 mm or less (60% versus 6.1%, P < .001) and among women who received tamoxifen for more than 27 months than those who received it for less time (46% versus 16%, P < .005). Logistic regression showed that endometrial thickness greater than 9 mm and vaginal bleeding were independent predictors of abnormal findings at hysteroscopy. CONCLUSION: In women taking tamoxifen, sonographic endometrial thickness exceeding 9 mm and the presence of vaginal bleeding are independent predictors of endometrial disease. If either exists, hysteroscopy and biopsy should be done.

Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation.

OBJECTIVE: To assess the efficacy of two laparoscopic methods for the management of endometriomas with regard to pain relief, pregnancy rate, and disease recurrence. DESIGN: Prospective, randomized clinical trial. SETTING: Tertiary care hospital. PATIENT(S): Sixty-four patients with advanced stages of endometriosis. INTERVENTION(S): Patients were randomly allocated at the time of laparoscopy to undergo either cystectomy of the endometrioma (group 1) or drainage of the endometrioma and bipolar coagulation of the inner lining (group 2). MAIN OUTCOME MEASURE(S): Pain relief and pregnancy rate. RESULT(S): Thirty-two patients were enrolled in each group. The 24-month cumulative recurrence rates of dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain were lower in group 1 than in group 2 (dysmenorrhea: 15.8% versus 52.9%; deep dyspareunia: 20% versus 75%; nonmenstrual pelvic pain: 10% versus 52.9%). The median interval between the operation and the recurrence of moderate to severe pelvic pain was longer in group 1 than in group 2 (19 months [range, 13.5-24 months] versus 9.5 months [range, 3-20 months]). The 24-month cumulative pregnancy rate was higher in group 1 than in group 2 (66.7% versus 23.5%). CONCLUSION(S): For the treatment of ovarian endometriomas, a better outcome with a similar rate of complications is achieved with laparoscopic cystectomy than with drainage and coagulation.

A randomized clinical trial of two surgical techniques for cesarean section.

The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section. A randomized trial was designed to compare intra- and postoperative morbidity between the two techniques. Women to undergo a cesarean section were randomly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open (group 1) or to have the Pfannenstiel incision with both peritoneal layers sutured (group 2). The myometrium was closed with 1-0 polyglactin 910 suture using a continuous single-layer nonlocking technique. Patients in group 2 had the peritoneum approximated with 2-0 polyglactin 910 suture. The fascia was sutured with continuous 1-0 polyglactin 910 suture in all cases. Opening time was defined as the interval from skin incision to the opening of the uterine cavity. Febrile morbidity was defined as a temperature > or =38 degrees C on two occasions 4 hours (hr) apart excluding the first postoperative day. Endometritis was defined as postpartum temperature > or =38 degrees C on two occasions 4 hr apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine and 150 patients were allocated to group 1 and to group 2, respectively. A shorter median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range) operative time [30 min (10-65) vs. 40 min (20-110), respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative complications, proportion of patients who required transfusion, endometritis, sepsis, febrile morbidity, and urinary tract infections. A higher rate of wound infections was found in group 2 than in group 1 [14 of 150 (9.3%) vs. 2 of 149 (1.3%), respectively, p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization. This was accomplished with a reduction of wound infections.

Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study.

OBJECTIVE: To compare closure and nonclosure of the peritoneum at radical abdominal hysterectomy and pelvic node dissection with respect to postoperative morbidity. METHODS: Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned randomly to have a standard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed. Adjuvant radiotherapy was given to patients with risk factors. The postoperative incidence of lymphocysts (within 8 weeks from the operation and after 1 year) and infection-related and non-infection-related complications were analyzed. RESULTS: One hundred twenty subjects were enrolled, of whom 59 had peritoneal closure and 61 did not. Both groups were similar with regard to age, weight, nodes removed, nodal metastases, operative time, type of surgery, need for transfusion, and incidence of postoperative radiotherapy. The median follow-up was 36 months (range 11-72). Eleven patients died, four because of treatment-related complications. The amount of drainage was significantly higher in the closed group than in the unclosed group (median 740 mL, range 50-5980 versus median 340 mL, range 40-4000; P < .005). The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks (17 of 59 versus 15 of 6, respectively), at 8 weeks (eight of 56 versus ten of 61, respectively), and after 1 year (one of 21 versus four of 22, respectively). No difference was found between closed and open groups in terms of symptomatic lymphocysts (one of 59 versus two of 61, respectively), wound and pelvic infection (seven of 59 versus 11 of 61, respectively), febrile morbidity (two of 59 versus 11 of 61, respectively), and obstruction (zero of 59 versus one of 61, respectively). CONCLUSION: Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications.

Effect of lossy data compression on quantitative coronary measurements.

With the accepted use of (lossy) data compression at low compression factors (2, 3 and 4 on the Philips DCI), the question was posed whether higher lossy compression ratios can also be used without statistically affecting the results of quantitative coronary arteriography. In this study the influence of two data compression schemes (LOT and JPEG) at three different compression factors (5, 8 and 12) on coronary measurements was assessed with the Automated Coronary Analysis (ACA) package. A series of 30 original acquired digital images were compressed and decompressed at the different factors, and together with the original non-compressed images processed using the ACA package. In these images a total of 37 obstructed coronary segments were analyzed twice to assess the intra-observer variabilities in the obstruction and reference diameters and in the percent diameter stenosis. The results of the first and second measurements in each image were averaged, and from the differences in corresponding images with different compression ratios, the inter-compression variability was obtained. The results show that the intra-observer systematic errors in the absolute diameters are all small (< 0.07 mm), and statistically not significantly different. The intra-observer random errors for the compressed/decompressed series, however, were all larger (up to 0.21 mm) than for the original series (< 0.13 mm). Statistically significant differences in the intra-observer random errors were found for the JPEG compression scheme at a compression ratio of 5 and for the LOT scheme at a compression ratio of 12. The inter-compression systematic errors in the absolute diameter measurements were also small (< 0.07 mm) and not significant, while the random errors were found to be high in the range between 0.23 mm and 0.31 mm. Given the higher intra-observer variabilities for the compressed/decompressed image series as compared to original images, and the fact that all inter-compression variabilities were found to be so high, we must conclude that the higher compression ratios affect the results of QCA in a negative sense. In conclusion, the use of lossy data compression with JPEG or LOT compression schemes at ratios 5, 8 and 12 must be discouraged for QCA.

Clinical evaluation of AK 100 ULTRA for predilution HF with on-line prepared bicarbonate substitution fluid. Comparison with HD and acetate postdilution HF.

Convective transport across dialysis membranes has been known for a long time to be a good alternative to diffusion. Predilution hemofiltration (HF) offers a better clearance of small molecules and overcomes the blood viscosity problems related to conventional postdilution HF treatment. Three patients have performed a total of 293 predilution HF treatments with AK 100 ULTRA. The bicarbonate substitution fluid has been prepared on-line by the machine. The treatments have been well tolerated and no adverse patients reactions related to the quality of the substitution fluid or the predilution HF treatment have been observed. There is a drop in creatinine for all patients indicating an improved creatinine clearance. Bicarbonate predilution HF has been shown to be a safe and efficient treatment modality, it offers the possibility to improve the cardiovascular stability of patients having problems with other treatment modalities an it offers an improved intertreatment well-being for the patients.

Hemodialysis using a constant potassium gradient: rationale of a multicenter study.

The aim of this study is to evaluate the relationship between two different procedures for potassium removal during hemodialysis (HD) and cardiac arrhythmias. Cell excitability and the transmission of impulses may be influenced by variations of resting membrane potential (RMP). The rapid decrease of plasma potassium during the first two hours of standard HD causes a membrane hyperpolarization. A different K+ kinetic, with a gradual and constant elimination of K+ during HD, may reduce this further unphysiological aspect and its clinical consequences. This can be obtained keeping blood-dialysate K+ gradient as constant as possible with the use of a dialysate K+ concentration (Kd) decreasing during HD. Our experimental studies on various K+ intradialytic gradients seem to indicate as optimal to this purpose K+ gradients of 1.5 mEq/l at the beginning of dialysis, esponentially decreasing during treatment to Kd values of 2.5 mEq/l at the end of dialysis (variable Kd). Patients included in the trial will be submitted to two different methods of treatment with Kd 2 mEq/l and variable Kd, and to a 24 hours ECG the day of dialysis. We will compare the number of intra and interdialytic premature ventricular complexes to evaluate the impact of two different models of potassium removal on arrhythmias.

Diagnosis of pelvic masses with transabdominal color Doppler, CA 125 and ultrasonography.

BACKGROUND: The objective of this study was to test the accuracy of transabdominal color Doppler imaging in the prediction of malignancy of adnexal tumors when integrated in combination with CA 125 levels and two-dimensional ultrasound. METHODS: We considered 129 consecutive patients with a suspected adnexal mass at clinical examination and transabdominal and transvaginal two-dimensional ultrasound. Serum CA 125 was measured in all cases. All the patients underwent color Doppler imaging to measure the Resistance index of the tumor associated blood flow profile and then surgery and histologic diagnosis. RESULTS: The median age of the patients was 44 years (range 12-91), 64.3% were premenopausal and the prevalence of malignancy was 28.7%. The sensitivity of color Doppler mapping was 75.7%, specificity 71.7%, positive predictive value 68.3% and negative predictive value 93.0%, compared with 75.7%, 68.5%, 49.1% and 87.5% for CA 125 and 83.8%, 83.7%, 67.4% and 92.8% for two-dimensional ultrasound. Blood flow was undetectable by color Doppler imaging in 17 of the 129 cases (13.2%). In 55 patients with three concordant tests, the positive and negative predictive values were 100%. When CA 125 values and two dimensional ultrasound results were discordant (35 patients), the color Doppler diagnosis was correct in 88.6% of the cases (93% in premenopausal women). CONCLUSION: Color Doppler imaging alone is not better than two-dimensional ultrasound in predicting malignancy of pelvic masses. Its use together with CA 125 and two-dimensional ultrasound may improve the accuracy of predictions when the three tests are concordant or when the other two are discordant.

Management of adnexal masses by operative laparoscopy.

STUDY OBJECTIVE: To assess the efficacy of operative laparoscopy to confirm the diagnosis of benign adnexal masses, and treat the lesions. DESIGN: Consecutive patients evaluated for this indication between January 1989 and December 1993, who met the inclusion criteria. SETTING: The Jan Palfijn General Hospital, Antwerp, Belgium, and the Department of Obstetrics and Gynecology, University of Varese, Varese, Italy. PATIENTS: One hundred twenty-one women with a clinical, biochemical, and ultrasound diagnosis of benign adnexal mass. INTERVENTIONS: Operative videolaparoscopy was carried out in all patients using the carbon dioxide or argon laser, electrical, or mechanical means. MEASUREMENTS AND MAIN RESULTS: Depending on the patient's age and the appearance of the adnexal mass aspirate, biopsy, cystectomy, or adnexectomy was performed. The conversion rate to laparotomy was 2.4%. A pathologic diagnosis was made in all cases. In this series no malignancy was encountered. CONCLUSION: Operative laparoscopy is safe and effective for treating adnexal masses provided that the preoperative diagnosis indicates that the lesions are benign.

Comparison Between Abdominal and Laparoscopic Lymphadenectomy

In cervical cancer the pathologic stage is determined for two reasons: choice of treatment (surgical-radiotherapy-medical) and prognostic evaluation. In early cervical carcinoma the evaluation of pelvic lymph nodes is important. The clinical noninvasive approach using ultrasound, CT, MRI, and lymphography is of limited use because of low accuracy. Therefore, the clinical evaluation has to be performed surgically. This is required in FIGO I and FIGO IIa carcinoma with circumference < 4 cm. If the pelvic nodes are negative a radical hysterectomy is indicated; but if the nodes are positive, this procedure could be avoided and the treatment of choice is pelvic radiotherapy. In some cases radical hysterectomy is performed when the pathology of the lymph nodes is not yet known and subsequent pelvic radiotherapy is performed when the nodes are positive. This sequence of events is a major cause of complications (fistula of the intestinal or the urinary tract, ileus and lymphocysts). Laparoscopic lymphadenectomy may be the method of choice to stage these tumors with minimal discomfort for the patients. This study demonstrates that laparoscopic lymphadenectomy is comparable to open lymphadenectomy in the clinical staging of cervical cancer.

Bag Surgery as Part of a Protocol to Treat Ovarian Masses by Laparoscopy

In a protocol to treat all ovarian masses endoscopically the major objection is that there are reports that even if the preoperative examinations are favorable there is still a chance as high as 2 to 6% of encountering a malignant proliferation within the cyst, necessitating a conversion to laparotomy within the same operating session. Using the following selection criteria: Premenopausal patients less than 45 years; uni-locular cysts on ultrasound or slightly septated; size of the cyst between 4 and 10 cm; benign characteristics on ultrasound; normal biochemistry, including CA 125, ESR, liver enzymes; and cysts resistant to therapy at least for 6 weeks, we have used the bags whenever the macroscopic aspect of the cyst appeared suspicious for malignancy to the surgeon. The tumor was first fully inserted in the Endo pouch (Autosuture-US Surgical) and then transected from its pedicle. We used bipolar coagulation and scissors. The bag was then brought to the abdominal wall and a minilaparotomy of 5 cm on average was performed. The bag was brought into the opening, the sac opened with scissors, the plastic spread on the skin and only then the tumor was treated inside the bag. Using this technique we did not experience any spread in the abdomen as the laparoscope remained in place and the bag prevented the pneumoperitoneum from deflating.

[Infectious complications in oncologic-gynecologic surgery: clinical and economic evaluation]. / Morbosità infettiva in chirurgia oncologico-ginecologica: valutazione clinica ed economica.

In the Department of Obstetric and Gynecology, Faculty of Medicine-Varese, between March 1991 and June 1992, 74 consecutive patients undergoing elective oncologic surgery were evaluated in order to rationalize the use of antibiotics to decrease the costs of infectious complications. We divided the patients into two groups: a high infection risk group (in which every patient was submitted to antibiotic prophylaxis) and a low infection risk group (in which we didn't use any antibiotic prophylaxis). Our findings indicate that selection criteria for HIR patients are probably correct and in this group AP is necessary. In the LIR group, 45.5% of patients was not submitted to any antibiotic therapy. It's necessary to test the real efficacy of an AP in LIR patients in whom we had not a important incidence of infectious complications. In the LIR group AP should not exceed Lit. 23,251 per patient to be cost-effective.