The classification of benign stenosis of Vater's ampulla is explained and reference is made to 5 years' experience in this field. The preoperative diagnosis of this condition is discussed and an account is given of the results obtained and the postoperative course. Attention is drawn to the very low incidence of postoperative pancreatitis with respect to the surgical methods employed. This incidence is evaluated in the conclusions reached.

Adolescent↗

PubMedDate not supplied

[Acute emphysematous cholecystitis].

A case of acute cholecystitis in a patient of 66 is reported. The aetiopathogenetic aspects are examined with particular regard to the microbiology of such forms, the particular radiological and anatomo-pathological findings and the medical and surgical implications, in the light of a review of the question.

Acute Disease↗

PubMedDate not supplied

[Vaccinal coverage for measles and pertussis: a study in 7 regions of Italy].

During the year 1993 a series of surveys aimed to estimate the immunization coverage against measles and pertussis have been carried out in seven Italian regions and two large towns (Milan and Naples). Mothers of children aged between 12 and 23 months, randomly selected from the list of newborns, by using the EPI cluster sampling, have been interviewed in order to determine the reasons for absent or incomplete vaccinations. The observed coverage for pertussis ranges between 8% in the Molise region and 71% in the town of Milan; coverage for measles ranges between 9% in the town of Naples and 52% in the region Lombardy. The most commonly reported reason for not-vaccinating for pertussis has been the negative advise given by the caring physician. Immunization against measles has often not been administered because of relative contraindications and the negative advise by the physicians. The coverage for the two non-compulsory vaccinations are low compared to compulsory vaccinations and to the immunization level reported for most European countries, pointing out that further health education is needed for improving the up-take of such voluntary vaccinations.

Adult↗

PubMedDate not supplied

Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS Study Group.

OBJECTIVE: To investigate potential risk factors for surgical wound infections in clean surgery. STUDY DESIGN: Multicenter prospective study in eight general surgical wards and one thoracic surgical ward. METHODS: All patients undergoing clean operations in the nine wards were included in the study. The following data were collected for each study participant: demographic characteristics, underlying disease, predisposing factors, type of surgery, length of operation, preoperative shaving, type and duration of surgical drains, and length of hospital stay. After surgery, patients were visited daily by an intern surgeon in order to detect infections. Infections occurring after discharge were not actively surveyed. A multiple logistic regression was performed to obtain an adjusted estimate of the odds ratios and to identify which factors were independently associated with surgical infection. RESULTS: 2,262 patients were included in the study: eighty three patients (3.7%) developed a surgical infection. The highest infection rates were observed following vascular surgery, thoracic surgery and herniorraphy. Seven factors appeared to be significantly and independently associated with an increased risk of SWIs in a logistic regression model; age greater than 85 years, obesity, patients undergoing high risk operations or more than one operation during stay, length of operation greater than 120, preoperative shaving, open surgical drains lasting more than three days. CONCLUSIONS: The high incidence of infection observed in our study population indicates potential problems in quality of care. In order to prevent SWIs in patients undergoing clean operations, more efforts should be placed on the prevention of the risk associated with two modifiable risk factors, that is preoperative shaving and use of open surgical drains.

Adult↗

PubMedDate not supplied

[The effect of changing some patient care practices on the incidence of surgical wound infections following "clean" interventions. PRINOS group of study].

OBJECTIVES: To evaluate the changes in patient care practices following an intervention program in general surgery and their impact on surgical wound infections (SWI) associated with clean operations. STUDY DESIGN: A "before-after" study design was used. Active surveillance was implemented in each ward; the intervention consisted of an educational program, whose effectiveness was evaluated comparing SWI rates before and after its implementation. RESULTS: A total of 799 patients undergoing clean operations from three general surgical wards were included in the study: 606 before and 193 after the intervention program. The observed reduction in the SWI incidence was 79.2%; the most striking change in patient care practices observed after the intervention was the substitution of open surgical drains with closed drains. High risk operations (RR 8.4), length of operation greater than 2 hours (RR 11.2), and open surgical drains lasting more than three days (RR 5.1) significantly increased the risk of SWIs in the preintervention phase, according to the logistic regression analysis. Of the observed pre-intervention SWIs, 46.2% was attributable to exposure to open drains. CONCLUSIONS: Many postoperative infections can be prevented in environments where patient care practices fall well below the accepted standards. More efforts should be placed on the prevention of the risk associated with modifiable risk factors, such as open surgical drains.

Adult↗

PubMedDate not supplied

Serum uric acid and insulin secretion in diabetes mellitus.

In order to define the relationship, if any, between serum uric acid and insulin pattern in different types of diabetes mellitus, 4 groups of subjects (controls, and affected by type 1 and type 2 diabetes mellitus, with and without obesity) were considered. In each group, successively cleared of the long-term and complicated diabetic patients, serum and urinary uric acid and insulin secretion (serum C-peptide values) were determined. Serum uric acid and C-peptide values were higher in type 2 obese diabetic subjects vs the other groups of patients and controls (p < 0.001). No difference was found, on the contrary, between creatinine clearance and urinary excretion of uric acid among the groups. Moreover, serum uric acid values were in positive correlation (p < 0.02) with serum C-peptide values considering, among the diabetic subjects, only those with duration of diabetes less than 5 years and without micro-macrovascular complications. In conclusion, these data lead to presume that diabetic patients with short duration of disease and without complications show a different serum uric acid pattern, strictly related to beta-cellular secretion.

Adult↗

PubMedDate not supplied

[Salmonellosis caused by unusual vehicles in Molise].

Explore the source record for details and available documents.

Adolescent↗