OBJECTIVE: Determination of fetal fibronectin (fFN) levels in a patient at risk of preterm delivery and having premature rupture of the membranes. PATIENT AND METHODS: The present case report concerns a pregnant woman with premature rupture of the membranes at 16 weeks of gestation who was submitted to repeated therapeutic transabdominal amnioinfusions and had a spontaneous resolution of the rupture at 32 weeks of gestation. RESULTS: A good pregnancy outcome was observed. High cervicovaginal fFN levels were observed during the period of membrane rupture with following drop of fFN levels during this period and spontaneous reseal of the membranes. CONCLUSIONS: Active expectant management, using repeated amnioinfusions, probably played a useful role in the therapeutic success of this pregnancy. Further, fFN was a reliable marker of the rupture of membranes. The possible role of fFN in the clinical management of high-risk pregnancies is confirmed.

Adult↗

PubMedDate not supplied

Uterine myomectomy in pregnant women.

OBJECTIVE: To determine whether myomectomy during pregnancy in selected patients improves outcome. METHODS: Retrospective analysis of 18 patients who underwent myomectomy between the 6th and 24th week of gestational age. Surgical management of tumors was required on the basis of the characteristics of the myomas and symptoms. The dimensions and site of myomas, symptoms of the patients, time and mode of delivery, and pregnancy outcome were analyzed. RESULTS: One woman was lost to follow-up, and one suffered a miscarriage. The remaining 16 patients delivered healthy babies between the 36th and 41st week; 14 delivered by cesarean section, and 2 vaginally. CONCLUSION: We suggest that myomectomy during pregnancy may be considered safe in selected patients. Moreover, it permits good pregnancy outcome with healthy babies delivered at term.

Abortion, Spontaneous↗

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Poor pregnancy outcome and anticardiolipin antibodies.

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

Abortion, Habitual↗

PubMedDate not supplied

The use of prostaglandin E2 for cervical ripening in patients requiring induction of labour.

A total of 290 women who required induction of labour for medical or obstetric reasons were given single or multiple doses of prostaglandin E2 gel (0.5 mg) to induce cervical ripening. Onset of labour occurred in 185 (63.8%) of the women treated with the gel, without any further treatment. The overall Caesarean section rate was 27.2% (79/290) and was significantly higher among those with an initially low Bishop score than in those with a higher initial score (34.7% versus 22.1%; P = 0.025). Prostaglandin E2 gel appears to be of considerable clinical benefit, especially where no other options are available except Caesarean section or a very long, difficult labour that may result in significant fetal distress.

Adult↗

PubMedDate not supplied

[Gabexate mesilate vs gabexate mesilate combined with octreotide in the prevention of postoperative complications of pancreatic surgery: preliminary results].

To date, gabexate mesilate, a synthetic protease inhibitor, has been used in the prophylaxis and treatment of acute pancreatitis, but has yet to be tested in preventing the postoperative complications of pancreatic surgery. For this purpose we planned a pilot study based on two treatment groups, each numbering 25 patients, submitted to high-risk pancreatic resection. In the first group, all patients received a continuous infusion of gabexate mesilate 1 g/day up to postoperative day 4; the second group of patients received the same treatment plus octreotide 0.1 mg every 8 hours for 5 days after surgery. All patients were followed until discharge with clinical and instrumental investigations to detect the onset of postoperative complications. The overall incidences of an uneventful course were 40% (10/25) and 32% (8/25), respectively. We found 12 complications closely related to pancreatic surgery in the former and 8 in the latter group. In the combined treatment group therefore we observe a 33% reduction in the incidence of related abdominal complications (12 vs 8). This favourable trend, however, needs to be confirmed in a larger multicentre trial.

Adolescent↗

PubMedDate not supplied

[Gentamicin, a broad spectrum antibiotic, in bacterial diseases of the respiratory system in children].

Explore the source record for details and available documents.

Bacterial Infections↗

PubMedDate not supplied

[Anastomotic complications in the surgical treatment of rectal neoplasms].

The authors review the problems relating to the healing of colorectal anastomotic complications following anterior resection. They report on their own experience with 328 anastomoses, 281 of which constructed manually and 47 using a mechanical suturing gun. Following manual anastomosis, the reported incidence of clinical dehiscence was 1%, as against a 10.3% incidence of radiologically detectable dehiscence. In the cases of mechanically produced anastomoses the incidence of clinical dehiscence was 6.4%. In 2 cases stenosis developed as a result of the clinically manifest dehiscence following manual anastomosis. In the patients undergoing mechanical anastomosis, occlusion occurred in one case and stenosis in another, without any concomitant peri-anastomotic inflammatory processes; these complications were caused by a membrane extending between the margins of the anastomosis. The authors ascribe the greater incidence of clinically important dehiscence following mechanical anastomosis to a greater sensitivity of the mechanical suture to colonic contamination compared to the manual suture. According to the authors, the stenosis is attributable to inflammatory processes resulting from the dehiscence in the manual anastomosis cases and from the anastomotic structure in the mechanical-suture case.

Anastomosis, Surgical↗

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[Surgical risk in the elderly].

In our Country 16% of population is over 65 years old and on 2010 a quarter of people will be over 70 years old. More over the percentage of patients over 70 years admitted in surgical departments is triple than 10 years ago and the percentage of octgenarian patients is ten times. In the last years new methods of diagnosis and care have been introduced to reduce morbility and mortality; the preoperative evaluation to define the risk factors is complex. The surgeon should respect some primary points: the patient interest, true surgical treatments, multimodal management, valid pain therapy, discharge as soon as possible, ambulatory or day hospital management, expecting and quality of life.

Adult↗

PubMedDate not supplied

[Intestinal infarction in the elderly].

The bowel infarction is till affected by high mortality in spite of new diagnostic methods and therapy. In our experience was observed about 45 patients with bowel infarction by different etiology; fast diagnosis and therapy are necessary for a good prognosis. The arteriography, at the light of this experience, is the gold standard but it is still performed in a low number of patients. The laparoscopy, in the advanced pathologies, is able to avoid an ineffectual laparotomy and permits a better diagnosis in borderline cases.

Age Factors↗

PubMedDate not supplied

[Septic shock: surgical and medical problems in the elderly].

The sepsis is a bacterial invasion of the organism producing many manifestations which are able to amplify themselves. In the United States of America there are 100,000 death per year and the incidence is among 300,000-500,000 cases. The major surgery in the elder (especially if it is in emergency) has a great percental of risk because the preoperative study isn't often complete. Fever, agitation, panting, bullation, abdominal splinting, enteroplegia, are signals of evolving inflammatory situation. Moreover there are disorders of biochemical values: leukocytosis, thrombocytopenia, increased levels of VES, PCR, amylase and biliribinaemia. The more common radiological examinations are the straight radiography of abdomen and horax, abdomen ultrasonography, CT or MRI. In the last years pro-calcitonin, interleukin-6 , C-reactive protein, and nitric oxide from endothelial and muscularis cells have been evaluated as prognostic factors in the septic shock.

Aged↗