Response to letter to the Editor regarding physical restraint in psychiatric setting.

The following letter addresses the issues of the applicability of physical restriction, with particular attention to the therapeutic regime and its meaning as a therapeutic or restrictive provision, while considering possible alternative measures in the context of Italian jurisprudence. The letter, in response to the questions posed by Cioffi and Tomassini, examines the possible legal implications for doctors and suggests that the integration of jurisprudence and psychiatry seems to be mandatory to define the operational protocols for the management of physical restraint. La seguente lettera affronta il problema relativo all'applicabilità della contenzione fisica, con particolare riferimento al regime terapeutico, nonché la sua valenza giuridica quale misura terapeutica o restrittiva, considerando eventuali approcci alternativi. La lettera, in risposta alle domande poste da Cioffi e Tomassini, esamina le possibili implicazioni legali cui possono incorrere i medici nell'applicare la contenzione fisica, suggerendo la necessità di un'integrazione tra le norme giurisprudenziale e la scienza psichiatrica, al fine di definire i protocolli operativi di gestione della contenzione fisica.

[Preoperative embolization in the treatment protocol for rhinopharyngeal angiofibroma: comparison of the effectiveness of various materials]. / L'embolizzazione pre-operatoria nel protocollo di trattamento dell'angiofibroma rinofaringeo: valutazione comparativa sull'efficacia dei vari materiali.

The authors examine the effectiveness of preoperative embolization in the treatment of rhinopharyngeal angiofibroma. In addition, they evaluate the effect various embolizing substances have in the aim of establishing what is the ideal time interval between embolization and surgery. Thirteen patients with rhinopharyngeal angiofibroma (3 were recurrences) were submitted to preoperative embolization. Of these, 4 were treated with a reabsorbable microparticulate substance (Gelfoam) while the remaining 8 were treated with non reabsorbable microparticulate substances (Ivalon, ITC contour, Terbal). The time interval between embolization and surgery ranged from a minimum of 1 day with a maximum of 4 days. The authors conclude that embolization markedly reduces blood loss during surgery, so much so that the available blood supply was not required. As regards the various embolizing substances and the time lapse between embolization and surgery, the authors feel that when using reabsorbable materials the interval should not exceed 48 hours so that the supply artery can quickly be recanalized. On the other hand, for the materials which are not reabsorbed, the time interval can exceed 48 hours but must be less than 4 days because collateral circulation can arise.