The Inferior Alveolar Nerve of the Horse: Course and Anatomical Relationship with Mandibular Cheek Teeth.

The precise location of neurovascular structures within the relatively long mandibular canal of the horse is of paramount importance in surgical procedures of the area. The inferior alveolar nerve (IAN) enters the mandibular canal on the medial (lingual) surface of the mandible and innervates all the mandibular teeth. During its course, the nerve moves laterally, crossing the roots of the inferior cheek teeth. However, the exact anatomical relationships occurring between the IAN and the roots of the equine mandibular cheek teeth have not been described in detail. In this study, the mandibles of 40 horses were examined with CT scans and then used for bilateral detailed anatomical dissection, to assess the path of the IAN and its relationship to the roots of the lower cheek teeth. The data obtained show that the equine IAN is located ventral to the apices of the molar teeth (311/411, 310/410, 309/409 according to the Triadan numerical system). At the level of PM(4) (308/408), the IAN is located on the lingual side of the roots and coronally to its apices. At the level of PM(3) (307/407), the IAN is then found on the lingual side of the roots but in proximity to the apices. In 2 of 40 horses (=5%), the IAN moves towards the lingual side between the mesial and the distal root of PM(4). Our observations are valuable for planning a surgical approach to the ventral side of the mandible in the horse and to avoid potential post-operative complications.

Decreased adrenergic tone in acromegaly: evidence from direct recording of muscle sympathetic nerve activity.

OBJECTIVE: Sympathovagal imbalance has been shown in acromegaly by indirect measurements of adrenergic tone. Data regarding direct measurement of sympathetic activity are lacking as yet. Aim of this study was to assess the adrenergic tone through direct recording of muscle sympathetic nerve activity (MSNA) in acromegalic patients. DESIGN: Fifteen patients (age 26-66 years, eight women) with newly diagnosed active acromegaly without hyperprolactinaemia, pituitary hormone deficiencies, obstructive sleep apnoea and cardiac hypertrophy, and 15 healthy subjects matched for age, sex and body mass index were recruited. After evaluating anthropometric and echocardiographic parameters, anterior pituitary function, glucose and lipid metabolism, and measuring plasma leptin, direct recording of sympathetic outflow via the microneurographic technique was performed. RESULTS: For similar anthropometric and metabolic parameters in patients and controls, HOMA index was significantly increased in the former (4·2 ± 2·39 vs 1·6 ± 0·19, P < 0·001). Surprisingly, this finding of insulin resistance was accompanied by a marked sympathetic inhibition (MSNA 18·3 ± 8·10 vs 37·3 ± 6·48 bursts/min, P < 0·0001, respectively in patients and controls). A reduction in plasma leptin (1·6 ± 1·04 vs 6·5 ± 2·01 µg/l, P < 0·0001) was also recorded in the patients. MSNA was positively correlated with leptin (P < 0·0001). CONCLUSIONS: Newly diagnosed acromegalic patients without cardiac hypertrophy display a decreased sympathetic outflow in spite of insulin resistance. This finding might be related to hypoleptinaemia.

[Laparoscopic surgery for endometrial cancer in overweight women]. / Utilizzo della laparoscopia nel trattamento chirurgico delle sovrappese affette da cancro dell' endometrio.

AIM: The aim of this study was to investigate the feasibility and safety of laparoscopic staging of overweight women with endometrial cancer and to compare the surgical outcomes among these patients with those managed by laparotomy. METHODS: This was a retrospective analysis (Canadian Task-force Classification II-3). We reviewed operative and hospital records of 70 patients with a body mass index >25 kg/m2 who underwent surgical treatment for endometrial cancer between 2001 and 2008. Thirty-five patients treated laparoscopically were compared to an equivalent group of patients treated by laparotomy. Operative and postoperative variables were afterwards assessed. RESULTS: Women in laparoscopic group had a significantly lower blood loss (median, 25th-75th percentiles: 1.2, 0.8-2.0 in laparoscopic versus 1.8, 1.0-2.8 in laparotomic group, P<0.05). No differences between both group in terms of operative time (median, 25th-75th percentiles: 165 min, 130-183 in laparoscopic versus 135 min, 110-170 in laparotomic; P>0.05) and mean number of pelvic and para-aortic lymph nodes removed (22 ± 8.4 versus 24 ± 6.2 and 9.2 ± 2.5 versus 9.3 ± 5 respectively; P>0.05). Length of urethral catheter and hospital stay were statistically higher in laparotomic group (two days versus three days; four days versus seven days respectively; P<0.05). CONCLUSION: Laparoscopic surgery in overweight women with endometrial cancer had equivalent surgical staging than women operated by laparotomy. With regard to postsurgical variables, overweight women who underwent laparoscopic surgery had better results than those treated by laparotomy.

One-Step Laparoscopic Management of a Female Adnexal Tumor of Wolffian Origin.

We report a case of female adnexal tumor of Wolffian origin (FATWO), a rare neoplasm arising from the mesonephric ducts. A 48-year-old woman came first to our center for a recent discovery of a pelvic mass. Transvaginal ultrasonographic findings suggested a solid right para-ovarian mass suspected to be malignant. After thorough counseling, the patient underwent operative laparoscopy for excision of the para-ovarian mass with frozen section (FS) examination resulting in the diagnosis of a poorly differentiated adenocarcinoma. In this case, FS results allowed performing a comprehensive oncological staging, through a totally laparoscopic extrafascial hysterectomy, bilateral adnexectomy, total omentectomy, pelvic wall peritonectomy, and pelvic, parasacral and para-aortic lymphadenectomy. Final pathological and immunohistochemical results confirmed the diagnosis of FATWO. To our knowledge, this is the first case of FATWO managed entirely by a minimally invasive laparoscopic approach in a single surgical session.

Controversies in surgical staging of endometrial cancer.

Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and benefits in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratification can guide to the appropriate type of surgery by selecting patients who benefit of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and robotic-assisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional benefits as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life.

[Assessment of the association of Kava-Kava extract and hormone replacement therapy in the treatment of postmenopause anxiety]. / Valutazione dell'associazione di estratto di Kava-Kava e terapia ormonale sostitutiva nel trattamento d'ansia in postmenopausa.

BACKGROUND: Anxiety is one of the main symptoms in menopause. The aim of this study was to evaluate the efficacy of the association of Kava-Kava extracts with hormone replacement therapy (HRT) and to compare it with HRT alone in the treatment of postmenopausal anxiety. METHODS: Forty women in physiological or surgical menopause for the past 1 to 12 years were enrolled in the study. Patients in physiological menopause were randomly assigned to one of the following protocols: TTS natural estrogens 50 micrograms/day with progestin and Kava-Kava extract at a dose of 100 mg (HRT + K, no. = 13); TTS natural estrogens 50 micrograms/day with progestin and a placebo product (HRT, no. = 9). Patients in surgical menopause were randomly assigned to one of the following protocols: TTS natural estrogens 50 micrograms/day and Kava-Kava extract at a dose of 100 mg (ERT + K, no. = 11); TTS natural estrogens 50 micrograms/day and a placebo product (ERT, no. = 7). Each treatment cycle lasted for 6 months. The outcome of the study was to evaluate changes in the HAMA score. RESULTS: A significant reduction in the HAMA score was observed after 3 and 6 months' treatment in all four groups of women studied. The groups treated with the therapeutic association (HRT + K, ERT + K) showed a greater reduction in the HAMA score compared to patients in the groups treated with hormones alone. CONCLUSIONS: The results of this study show that the association of HRT and Kava-Kava extract may represent an excellent therapeutic tool for the treatment of women in stabilized menopause, in particular those suffering from anxiety and depression, given that Kava-Kava therapy accelerates the resolution of psychological symptoms without diminishing the therapeutic action of estrogens on organic disease, such as osteoporosis and cardiovascular disease.

[Combination of beta-interferon and laser-CO2 therapy in female HPV genitalis]. / Associazione del beta-interferone alla terapia con laser-CO2 nell'HPV genitalis femminile.

230 women affected by HPV genital infection diagnosed by macroscopic examination, colposcopy and Pap test, were divided into two groups, of 95 and 135 people respectively, homogeneous for lesion localization and extension. The first group was treated with laser CO2 and the second group was treated with laser CO2 and intramuscular beta-interferon. We evaluated the side effects, the clinical results and the incidence of recurrences after 1, 6 and 12 months after the complete destruction of the lesions. At the first control, in both groups, we found no persistence of the lesions. At the second control after 6 months recurrences were present in 19 patients of the first group and in 7 patients of the second group. 51 recurrences were present after 12 months in the first group and 14 in the second group. The difference, evaluated with the chi 2 test, was found to be statistically significant (p < 0.01 after 6 months and p < 0.001 after 12 months).

Leiomyoma of the ovary. Case report.

The leiomyoma of the ovary is a very rare form of ovarian neoplasia, while its uterine localization is very common and diffused. It occurs prevalently in post-menopausal women usually causing abdominal swelling and pain. Such a case occurred in our observation and we report it here.

[Incidence of HBeAg in hemodialysis patients: preliminary data (author's transl)]. / Dati preliminari sull'incidenza dell'HBeAg in pazienti sottoposti ad emodialisi.

The incidence of HBeAg in HBsAg positive hemodialysis patients in reported. 21.2% of hemodialysis patients have been resulted positive for serum HBsAg. 63.6% of HBsAg positive patients resulted to have HBeAg in their serum. Anti-HBe antibody was never found. The Authors emphasize the importance of HBeAg in hemodialysis patients to evaluate their infectivity.

[Surgical treatment of peritonitis caused by diverticulitis of the sigmoid. Apropos of 12 cases]. / Sul trattamento chirurgico delle peritoniti da diverticolite del sigma. A proposito di 12 osservazioni.

Twelve cases of peritonitis due to sigmoid diverticulitis managed by minimal surgery are reported. Morbidity involved two cases of stenosing sigmoiditis on which sigmoid resection was successfully carried out. Although it is considered that radical surgery is the optimal solution, it is also recalled that the prime objective is to cure the peritonitis, so each case must be assessed carefully on its own merits since the condition is a complication of a benign disease and the risk of emergency sigmoid resections is by no means negligible.

[Epidemiological and clinical aspects of voluntary interruption of pregnancy 2 years after passing of Law 194]. / Aspetti epidemiologici e clinici della interruzione volontaria di gravidanza a due anni dall'approvazione della Legge 194.

PIP: Abortion has been legal in Italy since June 1978. At the Obstetrical and Gynecological Clinic of the University of Siena a doctor is assisted by a psychologist and by a social worker, who deal mostly with adolescents; all patients are given a brochure with information on the procedure and with detailed instructions for the postabortum period. Abortion is commonly carried out by vacuum aspiration and under total anesthesia in 98% of cases. 2171 abortions were done from June 1978 to June 1980; the 1st year there were 1138 abortions and 1107 live births; the second year there were 1133 abortions and 1190 live births. 30% of patients came from districts outside of the Siena region, 32.2% of patients were housewives and 15.29% students. Most abortions were done between the 9-10th gestational week because of the shortage of medical personnel at the clinic. All ages were more or less equally represented, with a slight majority of patients in the age group 25-35; minors were only 2.67% of all patients in the 1st year, but the percentage doubled in the 2nd year. In 86.87% of cases hospitalization was only 1 day. 10.78% of patients had had previous abortions; 68.17% of patients were married. 65.45% of women did not use any type of contraception, and 23.44% used coitus interruptus, or 88.89% of women without effective contraception. There were 35 cases of complications, or a rate of 1.61%, 2 requiring laparotomy and 1 requiring hysterectomy. From these data it seems obvious to conclude that many women use abortion as a fertility control method and information on birth control methods and family planning education are sorely lacking.^ieng