Topiramate for self-mutilation in a patient with borderline personality disorder.
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Biomedical subjects
Publications and source records attributed to G Battistini.
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Between February 1993 and December 1994, 875 adults underwent tuberculin screening by the Public Health Service of Parma. The adults were randomly assigned to a multipuncture test, Tine or Mono, and contemporarily, as a reference test, received the intradermal Mantoux (IM) in the opposite arm. The tests were then read 72 hours later by two different trained nurses. The error quota due to IM was estimated by repeating both the tests done initially in patients with discordant results. The Mono test revealed a sensitivity of 95%, which was the same as that observed for the Mantoux test. As an 'operative index' of the screening, the number of false positives subsequently tested for every 10 correctly identified was used. The authors retain that the results obtained indicate the validity of the Mono test for screening in the adult population with a prevalence of tuberculous infection above 10%.
The authors describe their technique and their experience of ambulatory surgical-cryotherapeutic combined, treatment of anal fissure. The data were observed in 35 patients (medium age 37.5); in 16 cases, previous treatments gave no benefit. The surgical treatment was the lateral internal close sphincterotomy according to Notaras, with local anesthesia (personal technique), followed by a fissure curettage with a N protosside cryosound. The results confirm the well known effectiveness of lateral internal sphincterotomy and the validity of ambulatory treatment and of cryotherapy.
The paper outlines the indications for the use of Kehr's tube in the surgical management of extra-hepatic biliary lithiasis by reporting the authors' personal experience relating to the period 1988-1992. In line with data reported in the literature the paper emphasizes the value of Kehr's tube not only in those cases where it is necessary to prevent choledochotomy and radiological control, but above all were the postoperative possibility of removing any residual calculi using litholytic, endoscopic or lithotripsic methods, is of prime importance.
The paper analyses the authors' initial experience of video laparoscopic cholecystectomy, outing the difficulties and incidence of morbidity in the preliminary group of 38 patients. The details of complications and their pathogenesis are also reported.
The authors report a series of 111 cases of non-palpable breast tumours. Radiological examinations showed the following mammographic patterns: microcalcification (63%); irregular opacity and/or denseness (26%); opacity and low density microcalcifications (12%), to which 3 progressive risk rates were assigned (high, medium, low). Histological controls of the tumours showed a positive predictive value of 73% for mammographic patterns defined as "high-risk". Localisation using a metal probe proved to be a simple and efficacious method which was well tolerated by patients.
The paper reports two rare cases of adrenal myelolipoma which were referred to the authors' attention. This is a functionally inactive benign tumour made up of fatty tissue and foci of hemopoietic cells. It is often diagnosed due to the compression disorders caused to adjacent structures, whereas at other times it is identified by chance during the course of diagnostic tests carried out for other pathologies.
Following a brief review of the main method of prosthetic repair used for inguinal hernia: Lichtenstein, Stoppa, Rives, etc, the authors propose an original technique consisting in the placement of a marlex patch below the trasversalis fascia, in a pre-peritoneal site, using a classical inguinal access route. The prosthesis is fitted round the spermatic funicle and fixed with a single stitch to the pubis and with a few others, in resorbable material, to the posterior face of the trasversalis fascia. Above it, plastic surgery is performed to bring the triple stratum closer to the reflexio of the inguinal ligament. The prosthesis is kept in place by positive abdominal pressure. The method outlined here has been used in 71 cases of primary or recurrent inguinal hernia. Follow-up lasted for 1-24 months and showed the low morbidity (4.5%) due to sepsis of the surgical wound, which did not require reoperation, and only 1 case of recurrent hernia which was probably caused by the incorrect positioning of the prosthesis.
Myelolipoma is a rare, benign tumour composed of fat and hematopoietic cells. Abdominal pain is often the only symptom and the result of compression by the tumour of contiguous organs. A personal case is reported after a review of the literature.
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Sixty patients with stage IIIA and IIIB breast cancer have been treated with a combined modality approach including induction chemotherapy, surgery and adjuvant chemotherapy: 74.5% of patients achieved an objective response after 3 cycles of induction chemotherapy, and 98.3% of patients were rendered disease-free after induction chemotherapy and surgery or radiotherapy; at 4 years, actuarial survival and disease-free survival are 71.5% and 43%, respectively. These results are significantly better than our historical control, and locally advanced breast cancer must now be considered a curable disease when treated with an aggressive multimodal approach.
Using conjunctival capillaroscopy, the authors studied 40 diabetic patients during glycemic decompensation. The capillaroscopic test, after all metabolic control tests, was repeated 1 and 3 months later and demonstrated improved microcirculation in 10 patients, and proved that therapeutic control is possible during the progression of diabetic microangiopathy.
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Estrogen (ER) and progesterone (PgR) receptors were evaluated in the tumor tissue (T) and in the mammary gland far from malignancy (D) in 36 breast cancers. Results were correlated with the pathological grading of the tumor and the axillary nodal status. It is suggested that a lower cancer malignancy with negative nodes and lower values of pathological grading (G1-G2) may be associated with a high level of ER in the mammary parenchyma far from the tumor (D).
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The authors review the epidemiologic and etiopathogenetic aspects of AIDS, in agreement with data published in december by the Center for Disease Control and by the WHO for the States, Europe and Italy. In their experience twenty-one patients, with clinical clues of AIDS, undergoing lymph node biopsy, have been analysed (18 LAS-ARC and 3 AIDS) and the role of prophylaxis for the surgical approach to the patient with aids or related syndrome has been underlined.
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