The rehabilitation of severely burned patients: prevention and treatment of scarring

A detailed description, based on direct personal experience with burn patients, is provided of techniques for the prevention of scar contractures in various parts of the body.

[Improvement of endoscopic resection procedures in relation to the volume of prostatic adenoma]

First choice therapy of obstructive prostatic hyperplasia is still represented by endoscopic transurethral resection of the prostate, despite new techniques for tissue ablation have being proposed. The issue aims to answer to the questions arising about indications of this procedure, and introduces to the knowledge of physical laws which regulate irrigation during and after operation and to the different techniques of irrigating flow derivation whose application reduced morbidity depending on tissue volume and "resection time". Moreover, the new technique of continuous resection with simultaneous suprapubic evacuation of tissue chips (Turbo-TUR) will be illustrated in details, as it permitted to extend indications and advantages of endoscopic surgery to bulky adenomas, electively submitted to open surgery up to now.

Elevation of plasma carbamazepine concentrations by ketoconazole in patients with epilepsy

The effect of ketoconazole (200 mg/d orally for 10 days) on the plasma concentrations of carbamazepine (CBZ) and its active metabolite carbamazepine-10,11-epoxide (CBZ-E) was assessed in eight patients with epilepsy stabilized on CBZ therapy. Administration of ketoconazole was associated with a significant increase in plasma CBZ concentrations (from 5.6 +/- 1.9 to 7.2 +/- 2.9 micrograms/ml on day 10 [means +/- SD, P < 0.02]), whereas plasma concentrations of CBZ-E were unchanged. After ketoconazole was discontinued, plasma CBZ levels decreased to pretreatment values. This interaction was probably mediated by an inhibiting action of ketoconazole on cytochrome CYP3A4, the main enzyme responsible for CBZ metabolism.

ESWL Monotherapy

Between February 1988 and December 1995, 1563 consecutive patients who had never previously been treated for ureteral stones were admitted to our hospital: 1535 (98%) underwent primary ESWL (with Lithostar plus) with fractioned doses and 28 (2%) needed primary endosurgery. At present 1327 (87%) patients can be evaluated. Up to 6,000 SW were given to 733 (55%) patients: 93% achieved complete clearance. Of the 594 (45%) patients who completed treatment, 195 (33%) achieved complete clearance with first treatment, 27 (5%) required endosurgery and 372 (62%) were treated again, of whom 279 (75%) were made stone-free. Overall 877 (66%) were stone-free following first treatment; 1156 (87%) following second treatment and 171 (13%) were failures. Lumbar (9% failure) and ≤0.6 cm (6% failure) stones gave higher success rates. Auxiliary pre-ESWL manoeuvres were reduced from 112/352 (32%) prior to 1990 to 75/975 (8%) after 1990, without affecting outcome (failures were 11 and 13.6% respectively). In-situ ESWL is a safe therapy for ureteral stones and in our experience capable of rendering 87% of patients stone-free.

[Initial experiences in the treatment of benign prostatic hypertrophy with laser (side firing)]

After a short literature review about the topic, the AA. present a 6 months follow up of 15 patients treated with prolase II fiber (cytocare) for BPH. In 80% we got good results about the symptom score and urinary flow, but at the endoscopic control in some cases we found an irregularity in the prostatic urethral as there was some prostatic residual tissue. 20% of the patients were submitted to TURP to relieve the symptoms.

[Endoscopic surgery of bladder diverticula]

The most frequent method utilized in the treatment of bladder diverticula is by open surgery using the extravesical, transvesical or combined approach. The endoscopic techniques consisting of electrocoagulation of the diverticular mucosa alone (Orandi) or opening the diverticular neck by electroresection (Post-Vitale) constitute a therapeutic alternative not widely used to date. We have attempted to combine both techniques and, since 1985, we have treated 21 patients with bladder diverticula via the transurethral approach using the following technique: 1. The diverticular neck is opened wide by incision or electroresection. 2. Complete electrocoagulation of the diverticular mucosa. 3. Resolution of cervico-urethral obstruction by cervico-prostatic incision or electroresection of the prostate. We have achieved good results and no complications have been observed. Reduction of the diverticulum was not achieved in only one case. In our view, failure was due to the fact that treatment of the diverticulum had not been combined with prostate resection which the patient refused. The technique is described and the indications and possible complications are discussed. The results achieved by the authors indicate that this technique should be used more widely.

[Conservative endoscopic treatment of urothelial cystic dysplasia of the upper urinary tract]

We highlight the importance of the new diagnostic possibilities afforded by ureterorenoscopy and nephroscopy in the differential diagnosis of single or multiple cystic dysplasia of the upper excretory tract. Moreover, endoscopic treatment was performed in the two cases reported herein. In the first case the biopsy procedure was also therapeutic and in the second case cyst removal resolved the ureteral obstruction. Because the disease is detected infrequently and because treatment may be required even less frequently, several technical solutions have been applied to assess efficacy and reliability. Diathermy coagulation has proved to be the safest, fastest and the most effective. Follow-up has documented the absence of recurrence and good reepithelialization of the ureteral wall without progression to stricture. In those cases with single cyst, one-stage diathermy loop resection permits obtaining biopsy material and radical removal of the neoformation.

Treatment of hirsutism related to micropolycystic ovary syndrome (MPCO) with two low-dose oestrogen oral contraceptives: a comparative randomized evaluation

In order to evaluate the clinical and endocrinological efficacy of two low-dose oral contraceptives (OC) containing 30 micrograms Ethinylestradiol (EE) and 150 micrograms Desogestrel (DG) and 75 micrograms Gestodene (GD), respectively, an open randomized study was carried out in 34 young hirsute women, matched for body mass index and age. All of them met endocrine and ultrasonic criteria for Micropolycystic Ovary Syndrome (MPCO). The participants were randomly assigned to one of two pill groups (each of 17). The serum values for Total Testosterone (TT), Free Testosterone (FT), Androstenedione (A), Dehydroepiandrosterone (DHEA), Dehydroepiandrosterone Sulphate (DHEAS), 17-Hydroxyprogesterone (17Pg), Sex Hormone Binding Globulin (SHBG), Ceruloplasmin (CP), as well as Ferriman-Gallwey Index (FGI) and Free Androgen Index (FAI) were evaluated prior to and after EE-DG and EE-GD 6 cycle treatment. A significant decrease in TT, FT, A, 17Pg, DHEA, DHEAS, FGI, FAI was observed, SHRG and CP increased significantly. There were no significant differences between the two OC. Our results seem to indicate that both OC are equipotent as far as their pharmacological profile and residual androgenic activity are concerned. Therefore, these OC may represent a highly effective and suitable alternative to the treatment of hyperandrogenism related to MPCO.

Short-term treatment of hirsutism related to micropolycystic ovary syndrome with a combination type oral contraceptive containing desogestrel

The antiandrogen effects of an oral contraceptive containing 0.03 mg. Ethinyl Oestradiol and 0.15 mg. Desogestrel have been evaluated in 17 non-obese hirsute women, with normal serum LH and FSH values and their ratio, and evidence for Micropolycystic Ovary Syndrome (MPCO) on ultrasound examination. At the completion of 5 cycles (21 days) of treatment, a statistically significant decrease in serum Total Testosterone, Free Testosterone, Androstenedione levels was observed. Similarly, serum values for Dehydroepiandrosterone Sulphate and 17-OH-Progesterone showed a marked fall. The Sex Hormone Binding Globulin (SHBG) values rose about four-fold, so that the Free Androgen Index was suppressed. The clinical score, evaluated according to the method of Ferriman and Gallwey, was found sharply reduced. Therefore, the well defined improvement of biochemical and clinical parameters, along with the absence of discernible side effects, are undoubtedly confirming the effectiveness of the treatment in hyperandrogenism of women with MPCO.