Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical trial.

PURPOSE: The aim of this study was to evaluate if the combination of micronized purified flavonoid fraction with short-term routine antibiotic and anti-inflammatory therapy was better at reducing the intensity of postoperative symptoms and wound bleeding after a Milligan-Morgan's open hemorrhoidectomy than antibiotic and anti-inflammatory treatment alone. METHODS: Fifty patients were randomly assigned to receive routine antibiotic and anti-inflammatory treatment alone (control patients) or a combination of micronized purified flavonoid fraction with identical antibiotic and anti-inflammatory treatment (micronized purified flavonoid fraction patients). The evolution of symptoms (pain, tenesmus, pruritus, and bleeding) during the postoperative period was assessed by means of patients' self-questionnaires. Each symptom was scored on a graded severity scale from 0 to 3, daily during the first three days of the immediate postoperative period, then at regular intervals (about every 14 days) until postoperative day 60. A global score for evaluation of each postoperative symptom and bleeding was used. The global score for each symptom was the sum of scores for each patient over the study period. The global score for each symptom was compared between the two groups with the Mann-Whitney U test. RESULTS: No significant differences in age, gender distribution, and stage of disease between the two groups were noticed at baseline. Posthemorrhoidectomy symptoms were relieved more rapidly in the micronized purified flavonoid fraction group; during the first three postoperative days, the global score for each symptom was significantly more reduced in the micronized purified flavonoid fraction group. The global scores for each symptom are as follows: pain after 3 days, 6.16 (SD = 1.9) in the control group vs. 3.48 (SD = 1.8) in the micronized purified flavonoid fraction group (P < 0.0001); tenesmus, 5.36 (SD = 1.8) in the control group vs. 1.48 (SD = 1.5) in the micronized purified flavonoid fraction group (P < 0.0001); pruritus, 4.04 (SD = 1.9) in the control group vs. 1.84 (SD = 1.4) in the micronized purified flavonoid fraction group (P < 0.0001); bleeding, 4.4 (SD = 2.1) in the control group vs. 2.0 (SD = 1.3) in the micronized purified flavonoid fraction group (P < 0.0001). A significant difference (P < 0.0001) between groups was also shown in favor of micronized purified flavonoid fraction patients when global scores were calculated over the entire study period (60 days). CONCLUSION: Micronized purified flavonoid fraction used in combination with short-term antibiotic and anti-inflammatory treatment can reduce both the duration and extent of postoperative symptoms and wound bleeding following hemorrhoidectomy.

[Non-Hodgkin's lymphoma in multiple places and uterine involvement]. / Linfoma non-Hodgkin a localizzazioni multiple con interessamento uterino.

Multiple locations of non-Hodgkin lymphoma, in cases of recurrence of disease, may affect all the lymph node stations. The case reported, sited in the uterus, constitutes a very rare event and whenever it occurs the preoperative diagnosis may present serious difficulties. Surgery, which must be prompt and radical, is mandatory for histopathological staging of the disease and for the implementation of an appropriate chemotherapy protocol. In the case reported here the diagnostic work-up enabled us to achieve correct preoperative staging.

Amikacin gel administration in the treatment of peristomal dermatitis.

Ten colostomized patients (six males, four females) and six ileostomized patients (three males, three females), presenting moderate (10 cases) or severe (6 cases) peristomal dermatitis, were treated for up to 28 days with a local daily application of amikacin sulphate 5% gel. All cases with moderate dermatitis and two patients with severe dermatitis recovered within 7 days of treatment. Two cases of severe dermatitis recovered in 14 days and the last two cases recovered in 28 days. No signs of intolerance to amikacin gel were shown by the patients. We conclude that amikacin sulphate 5% gel is a useful tool in the topical care of peristomal dermatitis in ostomate patients.

[Surgical rehabilitation of stomal disease]. / La riabilitazione chirurgica delle patologie stomali.

The Authors report their experience in the surgical rehabilitation of patients with complicated ileo- or colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed. The results of a surgical protocol in the treatment of stomal diseases observed in 63 patients are herein reported. In 14 patients the surgical treatment was performed in general anaesthesia, while in 49 local anaesthesia was used. The latter was better tolerated by the patients. In conclusion, surgery should play a major role in this rehabilitation protocol, either in terms of prevention or definitive treatment.

[Bizarre gastric leiomyoblastoma. A case report and review of the literature]. / Leiomioblastoma gastrico bizzarro. Analisi di un caso e revisione della letteratura.

Gastric leiomyoblastoma of Martin's myoid tumour or Stout's smooth muscle cell bizarre tumour is a rare benign mesenchymal neoplasia, that may become malignant. A personal clinical case is reported and the most important clinical and anatomopathological aspects are reviewed, stress being laid on the importance of identifying the macroscopic and histological features that can point with certainty to malignity and so influence the choice of surgery.

[Septic ascites: a rare post-operative complication]. / L'ascite settica: una rara complicanza post-operatoria.

Spontaneous bacterial peritonitis in patients with chronic hepatitis represents a very controversial matter in terms of frequency, pathology and treatment. This unusual complication mainly due to decreased immunological defences and ascitic fluid opsonic activity is not accepted by all the Authors as a rare event. However, there is agreement as far as management is concerned: cultural examination of the ascitic fluid and the relative antibiogram are the best tools in guiding the approach to an adequate antibiotic therapy.

[Use of human fibrin glue (Tissucol) in the treatment of recurrent fistulas]. / Impiego della colla di fibrina umana (Tissucol) nel trattamento delle fistole recidive.

In this study, the treatment of either primitive or secondary abdominal relapsed fistulas with Human Fibrin Glue (Tissucol) is reported. Twelve patients with different types of fistulas were treated in day hospital with the above mentioned procedure. Apart from two patients, the good percentage of success obtained in a short period of time is stressed. Results show that such a technique may be favourably adopted, nevertheless a correct first surgical procedure is recommended.