Is the Arabin Pessary really useful in preventing preterm birth? A review of literature.

The aim of this review is to describe the state of the art in the use of Arabin Pessary for the prevention of spontaneous preterm birth (SPTB). We conducted a review of the literature in order to collect relevant studies concerning the efficacy of Arabin Pessary in preventing preterm birth, also considering it in addition or in comparison with other methods such as cervical cerclage or vaginal progesterone and in both singleton and twin pregnancy. Despite the large number of studies available there is not a clear consensus about the superiority of one of this methods over the others. In addition to this, although Arabin Pessary is widely used in clinical practice, no guidelines for management and use of cervical pessary during pregnancy have been assessed.

Wasted health care dollars. Routine cord blood type and Coombs' testing.

OBJECTIVE: To determine if selective newborn cord blood testing (NCBT) could contain costs without increasing morbidity of hemolytic disease of the newborn (HDN). DESIGN: A national telephone survey confirmed the common practice of routine blood type and Coombs' NCBT. Two 12-month study arms, retrospective and prospective, were conducted. Hemolytic disease of the newborn was studied retrospectively under an unrestricted NCBT policy. Then, HDN was studied after a policy change that restricted NCBT to patients in newborn intensive care units and normal newborns with clinical jaundice or Rh-negative mothers, and/or positive maternal antibody screenings, or unavailable maternal blood testing. PARTICIPANTS: All newborns (N = 8501) at the Metro-Health Medical Center, Cleveland, Ohio, were studied (retrospective arm, all 1989 admissions; prospective arm, all July 1990 to June 1991 admissions). OUTCOME MEASURES: Blood type and Coombs' NCBT, maternal blood type and antibody screening, Hobel risk scores for clinical severity of newborn hospitalization, duration of hospitalizations, and peak serum bilirubin levels. RESULTS: No quantitative or qualitative increases in morbidity from jaundice were detected by retrospective analysis with unrestricted NCBT, or prospectively after selective testing on 4498 newborns. Each study arm resulted in 15 readmissions for jaundice; these included two patients with ABO HDN. Furthermore, selective testing resulted in performance of NCBTs on only 390 infants in the "normal" nursery (24% of the original sample). Estimates projected on 1991 US births (4,111,000) showed that selective NCBT offers potential yearly savings above $30.8 million of patient charges, savings above $11.3 million of hospital costs, and the reassignment of more than 112 personnel full-time equivalents. CONCLUSION: Selective NCBT decreases the use of resources and costs without apparent additional patient morbidity from HDN.

[Transposition of the myocutaneous flap of the latissimus muscle of the back in reconstruction of the breast after radical mastectomy. Indications and technic studied in 2 operated cases]. / La trasposizione del lembo miocutaneo del latissimo del dorso nella ricostruzione della mammella dopo mastectomia radicale. Indicazioni e technica su due casi operati.

For repair of radical mastectomy defects the surgical approach with the latissimus dorsi myocutaneous flap is presented. The application of this flap and complication are described. In addition 2 cases are presented illustrating a personal modification of the technics.

[Microsurgical reconstruction of the mandible]. / Ricostruzione microchirurgica della mandibola.

The authors present two clinical cases of mandibular reconstruction using free vascularized bone grafts and dental osseointegrated implants. A wide discussion about the different techniques of reconstruction is reported. Several factors like the clinical history, age, general conditions of patient's health can influence the choices of the surgeon. The characteristics of the different donor sites are described, so the advantages and disadvantages of the different free microvascular flaps are analyzed. According to the authors not only the technical aspects of microsurgery but also a good choice of the right free flap plays an important role in a successful result. The influence of radiotherapy on microvascular reconstruction in the head and neck region is also discussed. The authors recommend the use of fibula and scapula as donor site for reconstruction of complex (i.e. interesting also the adjacent soft tissues, muscles, mucosa and skin) mandibular defects that require more than 6 cm of bone graft length. Corticotomies of bone ensure a perfect adaptation of the graft to the mandibular form with a good aesthetic result, while the use of dental osseointegrated implants allows total masticatory functional rehabilitation. It's important that these techniques must be utilized in well organized hospital centers by experienced surgeons who are able to resolve entirely the problems and needs of the patient.

[The role of autologous parietal bone graft in alveolar cleft]. / Interesse del trapianto autologo d'osso parietale nelle schisi alveolari.

Autologous bone grafting of alveolar clefts is a well recognized procedure. Calvarium represents an interesting donor site because of the absence of morbidity and the dimensional stability of this membranous bone compared with endochondral bone sources. The authors reponed their experiences with this type of grafting used in 17 patients. Referred to the parameters analized in an important Swedish study, the rate of success was about 80% agree with the results of other authors with the same type of graft. Aspects of general planning, timing, technique and failure are extensively discussed. Pre and post surgical orthodontic treatment is also very important for a good result. The pattern of maxillo-facial growth and the effect of the graft materials on facial development are mentioned. The study of literature indicates that the best grafting results are achieved when free autogenous mandibular symphyseal bone grafts were used. The only true disadvantage is the small quantity of bone tissue available. The authors conclude suggesting the use of chin bone grafting in situations where the technique provides sufficient bone and recommend the use of cranial vault as the alternative source of membranous bone graft, for example, in bilateral clefts, when anterior theeth are not erupted yet and in any other situation where the mandibular bone graft is not possible.

[The cancerous recurrence of a pleomorphic adenoma of the parotid. Comments on a case]. / La recidiva cancerizzata dell'adenoma pleomorfo della parotide. Considerazioni da un caso.

After taking the clinical case examined as a starting point and supporting the data obtained with a literature analysis of the cancerous relapse of a parotid pleomorphic adenoma, the Authors suggested a suitable surgical operation (total parotidectomy with conservation of the facial nerve) in the treatment of parotid pleomorphic adenoma. Doing so, it is possible to avoid a relapse of neoplasm and a possible transformation into malignancy. Furthermore it might prevent the formation of parotid carcinoma.

[The advantage of the autologous parietal bone graft in posttraumatic rhinoplasty]. / Interesse del trapianto autologo d'osso parietale nelle rinoplastiche post-traumatiche.

Popularized by Tessier in 1982, the calvarial bone graft has been used extensively in reconstructive techniques in the cranio-facial region. The authors present here their experience of nasal bone grafting using split skull grafts for post-traumatic reconstructions. Ten patients, with a total of 11 bone grafts harvested, were operated. Results are reported. The level of patient satisfaction has been high. We have had only 2 minor complications, 1 case of alopecia, corrected by a resection in local anesthesia, this inconvenient has never reported before in the literature, and another case of secondary displacement of the nasal bone graft, who required a second operation with a good result. Discussion is reported. Several methods have been used for nasal reconstruction as silicone implants and other bone donor site; but they have disadvantages like painful to the donor site, long hospitalizations, infections and extrusions, etc. The use of cranial graft has some advantages: first of all, it is less likely to resorb, because of its membranous origin, the donor site is in close proximity to the area to be grafted, there is almost no morbidity to the donor site. Recently two case reports describing major complications were published in the literature. A case of a superior sagittal sinus laceration reported by Cannella and Hopkins and a case of an intracerebral hematoma, reported by Leroy-Young. For these reasons it's important to follow strictly the surgical procedure described. We recommended this technique only to those surgeons who are experienced in cranio-facial surgery.

[Cervicofacial actinomycosis. A case study]. / L'actinomicosi cervico-facciale. Studio di un caso.

A case of cervicofacial actinomycosis, sited in the central hyoid region, is reported. The Authors have emphasized the difficulties of the diagnosis. It's very important hat the clinical diagnosis of actinomycotic infection be confirmed by a positive culture test. Actinomycosis can be suspected if multiple recurrent pustular swellings are present, associated with any trauma or teeth extractions.

[Postoperative treatment of alcohol withdrawal syndrome in a patient operated for oral cancer]. / Terapia della sindrome da astinenza da alcol nel postoperatorio in paziente trattato chirurgicamente per carcinoma orale.

A case of alcohol withdrawal occurred in a patient affected by cancer of the oral cavity is reported. The patient underwent resection of the floor of the oral cavity, partial glossectomy mandibulectomy and neck dissection; reconstruction was done using microsurgical forearm radial flap. The patient didn't refer his alcohol dependence before operation and withdrawal symptoms with agitation, tachycardia, tachypnea, tremors and vomiting appeared during his postoperative recovery in intensive care where the patient was unable to take any alcohol. A therapeutic plan to use in patients operated for oral cancer with alcohol withdrawal (92% association of oral cancer with alcohol dependence) is reported.

Free fat transplantation for facial tissue augmentation.

PURPOSE: This article reviews the lipofilling technique using a fat tissue suspension obtained by manual or vacuum machine-assisted suction. PATIENTS AND METHODS: Between 1989 and 1997 14 patients were treated by lipofilling. All patients were female; 6 were treated for cheek and zygomatic area augmentation for Romberg syndrome (2 cases) and bilateral facial lipodystrophy (4 cases); 4 were treated for nasolabial fold correction, 3 for lip augmentation, and 1 for correction of systemic lupus erythematosus (LES) scars. RESULTS: Good results were obtained in the treatment of the moderate Romberg syndrome case, with 3 stages of fat tissue transplantation from the abdominal area, in the severe Romberg syndrome case that was treated with 3 stages of lipofilling after a primary surgical procedure consisting of augmentation of the zygomatic region using a composite temporal flap of calvaria bone and temporal muscle, in the 4 cases of bilateral facial lipodystrophy, and in the 4 cases of nasolabial fold correction with 3 to 4 stages of lipofilling. Poor results were obtained in lip augmentation, and bad results were obtained in correction of the LES scars. CONCLUSIONS: Using the lipofilling technique with cannulas of 3 to 4 mm in diameter and low-power manual aspiration to preserve the integrity of the fat cells, good results were achieved in 10 of the 14 patients treated. The poor results occurred in areas of reduced vascularity and high motility.