[Human cutaneous myiasis: a case report]

Myiasis is a self-limiting infestion of tissues by fly larvae commonly referred as maggots. A case of cutaneous myiasis in a 61 year old woman admitted to the Department of Emergency of S. Giovanni Hospital in Rome (Italy) is reported in the present note. The patient, a religious sister, returned to Rome from a mission trip of few weeks in Edea (Cameroon, Africa), was suffering from a subclavicular furuncular skin lesion; one maggot was surgically removed and submitted for parasitological examination. Based on the maggot shape and size, the travel history and the clinical presentation, a maggot of Cordylobia spp. has been identified (Calliphoridae, Diptera). This case calls for an awareness of its possibility as a cause of furuncular skin lesion, particularly in subjects returning from an endemic country for Cordylobia spp. (Africa).

[Bilateral aneurysms of the popliteal artery]

INTRODUCTION

Popliteal artery aneurysms are the most common of peripheral arterial aneurysms. Popliteal aneurysms are bilateral in 42% of patients. Atherosclerosis and bacterial invasion of the arterial wall are the predominant etiologic factors of popliteal artery aneurysms.

CLINICAL CASE

A male of 67 years old was referred to our institution for bilateral claudication and 150 m. free interval. The angiogram showed a partial occluded aneurysm of the right popliteal artery and a complete thrombosis of the left popliteal artery aneurysms. The left aneurysm was resected and a femoral popliteal by-pass was performed, using the inverted saphenous vein graft, associated with left lumbar sympathectomy. Six months later the contralateral aneurysm was excised and a Dacron femoro-popliteal by-pass graft was performed. Two years later Arteriographic and Doppler examination showed patent by-pass bilaterally.

CONCLUSION

Popliteal artery aneurysms can be a threaten for the lower limbs, because of thromboembolic phenomena and occasional rupture. Surgery is the best treatment before the appearance of an acute complication and a by-pass with an autogenous vein graft or a Dacron graft are the most common surgical procedures performed. Thrombolytic therapy offers good results where an acute complication appears.

[Treatment of traumatic lesions of the hepatic artery]

Injuries to the porta hepatis, which are difficult to diagnose and require variable treatment, are rare. The mortality for the vascular injuries is directly correlated to the uncontrolled intraabdominal hemorrhage and the treatment requires primarily bleeding control. This paper reports a case of a laceration of the left hepatic artery in a young multi traumatized patient (due to a car accident). The hepatic artery injury was successfully managed by primary closure. Even if the treatment of the extra hepatic injuries of the hepatic artery is still controversial, standardized therapy approaches have been proposed. The repair of the hepatic artery is an occasional option. The simple ligation is the most common option, in fact the oxygen extraction from the portal venous blood increases if the artery is ligated and this is sufficient for a adequate hepatocellular function in a healthy liver. In reality, in literature, damages to the liver due to artery ligatures are described even in the case of a good portal flow. Repairing hepatic artery injuries should always be taken into consideration after having made necessary evaluations on the general conditions of the patient because it is preferable to attempt to bring the patient back to the "status quo ante" and therefore avoid possible complications.

[Free microvascularized flaps in head and neck lesions: the technics of microsurgical reconstruction]

The authors report their experience of microsurgical reconstructive techniques using musculo-cutaneous free flaps after radical operations for head and neck neoplasms.

[Microsurgery in gynecology. 8 years' clinical activity]

A series of 110 patients given surgical treatment for "mechanical infertility of varying origin in 1980-88 is examined". The classification system proposed for the microsurgical procedures available is based both on personal experience and on the classification of the causes of mechanical infertility in women according to aetiopathogenesis. Clinical results are judged in terms of pregnancies achieved and suggest that while adhesiotomy, salpyngostomy, t-t tubal anastomosis and cornual reimplantation are all useful, fimbrioplasty is less likely to give good results, particularly in the long term. Finally the links between gynaecological microsurgery and F.I.V.E.T. and G.I.F.T. are analysed.