[Neuroendocrine carcinoma of the skin]

Merkel cell carcinoma is an unusual neuroendocrine tumour that arises in the derm. The case reported seemed to deserve the author's attention because of the clinical features, pathological findings and natural history (local recurrence, regional lymph node metachronous metastases, distant metastases). The authors believe that a differential diagnosis between Merkel cell carcinoma and other tumours located in the subcutaneous tissue is mandatory, in order to perform specific immunohistochemical and ultrastructural study.

[Ambulatory surgery: current status and prospects]

Ambulatory Surgery (AS) was born some 20 years ago in USA pushed by economic requirements and rapidly spread over the European countries as one of the main factors of progress in health care. The Authors, after evaluating the actual situation of AS in the international literature, report their personal experience from January 1991 to December 1994. The series includes 810 surgical operations performed as outpatients procedures with immediate discharge. The following types of anaesthesia were used: local infiltration (86.6%), monolateral ultraselective spinal (10%), blended or general (3.4%). Hernias of the abdominal wall, varicose veins and anorectal diseases were the more frequent pathologies operated on. Results of surgery are satisfactory supporting the advantage of AS such as the absence of complications due to anaesthesia and hospital stay, the better relationship between patient and surgeon, the short return to working activities. AS proves its value on the clinical and socio-economic grounds provided that a well organised program and careful selection of patients are adopted. No extemporary organisation are advisable.

[Teicoplanin in the prevention of wound infections in major ambulatory surgery]

Wound infection is a frequent complication and is related to various parameters: type of surgery, patient's age, nutritional status, associated diseases, length of surgery and hospital stay, use of prosthesis and drainage and finally surgeon's ability. The frequency of wound infection is reported between 1.5%-5.1% after "clean surgery" and the greatest source of microbial contamination is due to GRAM positive cocci either aerobic or anaerobic. The Authors present their experience of ultra short-term prophylaxis with Teicoplanin in 375 patients undergoing major ambulatory surgery. Median age was 49 years (15-87 ys); patients over 65 years were 22%. Hernias of the abdominal wall and varicose veins represent the diseases most commonly operated on. In 30% of the cases the patients selected for major ambulatory surgery were in II and III classes according to the standards of the American Society of Anaesthesiologists (A.S.A.). The ultra short-term prophylaxis with Teicoplanin was administered as follows: 400 mg, i.v., thirty minutes pre-operatively. The operations were performed under local or loco-regional anaesthesia. The choice of Teicoplanin was based on the strong bactericidal activity on GRAM positive cocci, including the methicillin-resistant Staphylococcus aureus infections, and on the long activity of the drug. The results were considered according to the American College of Surgeons scheme: no wound infection was observed and excellent local and general drug's tolerance were noticed. Ultra short-term prophylaxis in ambulatory surgery was chosen for the following reasons: large use of prosthesis, major risk of sepsis in older patients and at last for a badly accepted infective complications in outpatient surgery.