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Central Mesh Failure (CMF) after abdominal wall repair (AWR) is uncommon but should be considered in case of recurrence. The mechanism is unclear and different theories are actually proposed, as the action of opposite forces acting in the abdominal wall on the prosthesis, and the characteristics of the device to be implanted. The use of lightweight meshes in some cases could be inadequate to withstand the bursting strenght of the abdominal wall. Three cases of incisional hernia recurrence due to central mesh failure are here reported. KEY WORDS: Abdominal wall repair (AWR), Central mesh failure (CMF), Hernia recurrence, Lightweight mesh.La rottura della protesi usata per la riparazione dei difetti della parete addominale è un evento poco comune che andrebbe, tuttavia, considerato tra le cause di recidiva. I meccanismi alla base di tale evento, che si verifica solitamente nella parte centrale della protesi, sono ancora poco chiari. Sono state proposte diverse teorie che considerano le forze antitetiche che agiscono sulla protesi impiantata nella parete addominale e le caratteristiche strutturali dei materiali impiantati. Protesi “leggere”, potrebbero essere insufficienti, in alcuni casi, a resistere alla tensione che si sviluppa a livello della parete addominale. In questo lavoro vengono presentati tre casi di ernia incisionale recidiva causata da una rottura centrale di protesi.

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is characterized by telangiectasic vascular malformations of the skin and of the digestive and respiratory mucosa. Epistaxis is the most common otorhinolaryngologic manifestation, with potential complications as septal perforations and, in cases of serious bleeding, anemia. Given that some therapeutic approaches are burdened by failure, whereas others are invasive and painful, the possibility of using simple and effective approaches to manage recurrent epistaxis, especially in outpatients, is needed and useful. Recently, the use of Surgiflo, (OMRIX biopharmaceuticals Ltd.MDA Blood Bank, Ramar-GanPOB, Kiryat Ono, Israel) a gelatin-thrombin matrix, currently used as an alternative to the nasal packing, has been proposed. We evaluated the effectiveness of Surgiflo in the treatment of recurrent epistaxis in outpatients with HHT. The present investigation reports the case of 3 patients with recurrent HHT-related epistaxis treated with Surgiflo. We also review the literature discussing available treatment options. Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a rare systemic fibrovascular dysplasia with autosomal-dominant inheritance. It is characterized by a spectrum of telangiectasic vascular malformations occurring in the skin and in the digestive and respiratory mucosa. Other manifestations of HHT occur in the lungs, liver, or central nervous system [1] and [2]. Otorhinolaryngologic manifestations are frequent, and epistaxis caused by spontaneous bleeding of nasal mucosa telangiectasis is the most common. The potential complications of epistaxis are septal perforations and, in cases of serious bleeding, anemia [3]. Treatment of HHT is aimed at controlling symptoms. For instance, it is possible to stop nose bleeding by applying direct pressure to the nose or performing anterior and/or posterior packing [4] and [5]. If these measures are insufficient and the frequency and duration of episodes impair the patient's quality of life, surgical cauterization, photocoagulation laser, or septal mucosal dermoplasty may be recommended [1] and [6]. To prevent the onset of chronic anemia resulting from severe epistaxis, the endovascular treatment with microembolization could be performed. Chemical cauterization should always be avoided because it may harm nasal structures [1]. Although brachytherapy and fibrin glue injection in the nasal septum and inferior turbinates submucosa are efficacious, they bring about only temporary symptom improvement [3]. Given that some therapeutic approaches are burdened by failure and some others are invasive and painful, the possibility of using simple and effective approaches to manage recurrent epistaxis, especially in hematology units and in outpatients, is needed and useful. Recently, the use of Surgiflo, a gelatin-thrombin matrix, currently used in neurosurgery and in thoracic and vascular surgery, has been proposed as an alternative to the nasal packing after functional endoscopic sinus surgery. In addition, some authors have evaluated the use of Surgiflo in the management of recurrent epistaxis [4] and [7]. Therefore, we evaluated the effectiveness of Surgiflo in the treatment of recurrent epistaxis in patients with HHT. The present investigation reports 3 cases of outpatients with recurrent HHT-related epistaxis treated with Surgiflo. We also review the literature discussing available treatment options. Surgiflo is a dehydrated gelatin-thrombin matrix in a syringe. For intranasal use, its gelatinous consistency must be maintained to remain in the nasal cavity (reconstitution with up to 3.5 to 4 mL of sterile water). A 16-cm-long applicator is put through the nasal vestibule to the rhinopharynx. The rhinopharynx and the nasal cavity are filled in with Surgiflo from back to front. A.V., female, 63 years old, had been complaining of mild recurrent epistaxis for 20 years, with worsening in the 6 months before treatment. She did not use salicylate-based drugs. The patient underwent cauterization of varices of the base of the tongue 7 years before and of the nasal septum 1 year before, with many anterior packings, followed by immediate epistaxis after each packing removal. The patient was transferred to ENT consultation in April 2011; nasal endoscopy showed crusts and hematic points spread throughout nasal septal mucosa. Blood test showed hemoglobin (Hb) levels of 10.50 g/dL and iron levels of 29 μg/dL. Surgiflo was applied inside both nasal cavities through nasal endoscopy without anesthesia, and the patient left the hospital after 2 hours of monitoring without recurrence of bleeding. No epistaxis has recurred until now. G.C., male, 49 years old with HHT, had been complaining of a right anterior epistaxis for 5 years. He underwent repeated right anterior packings that were effective, but bleeding recurrences were immediate after each packing removal. Nasal endoscopy showed hematic points throughout the right nasal cavity. Blood tests showed Hb levels of 10.90 g/dL and iron levels 33 μg/dL. In September 2011, he was treated with Surgiflo without anesthesia. The patient left the hospital after 2 hours of monitoring without bleeding. No epistaxis has recurred until now. G.E., male, 62 years old, was affected by HHT; he had been complaining of epistaxis for 7 years, treated by repeated anterior packings followed by immediate bleeding recurrences. During his physical examination at ENT Unit, we noticed hematic points spread throughout nasal septum. Blood tests showed Hb levels of 10.30 g/dL and iron levels 30 μg/dL. We applied Surgiflo in July 2012 inside his nasal mucosa through nasal endoscopy without anesthesia. The patient left the hospital after 2 hours of monitoring without bleeding. No epistaxis has recurred until now. Epistaxis is the earliest and the most common symptom of HHT. Ninety-five percent of individuals with HHT experience recurrent epistaxis, with a mean frequency of 18 episodes per month [1]. Although the nasal packing allows stopping most of bleedings, the disadvantages of local infections, septic complications, pain, mucosal traumatism, and bleeding recurrence still remain. An alternative to the traditional packing could be the use of absorbable packing such as Surgicel (ETHICON, LLC San Lorenzo, Puerto Rico) (oxidized cellulose polymer) or Gelfoam (Pharmacia and Upjohn Company, Kalamazoo, MI, USA) (absorbable gelatin sponge), whose placement is, anyhow, painful in outpatients and less effective for posterior bleeding [4]. For instance, some authors have evaluated the use of the gelatin-thrombin matrix after functional endoscopic sinus surgery with encouraging outcomes, reporting the prevention of bleeding after surgery in 96.7% of cases [7]. Furthermore, Buiret et al [4] report the cases of 2 patients, one with thrombocytopenia and the other with thrombopathy, hospitalized for recurrent epistaxis and, after repeated failed treatments, successfully treated with local application of Surgiflo. In the present study, we report 3 cases of patients with recurrent HHT-related epistaxis treated with Surgiflo. Our preliminary encouraging findings suggest that the use of local application of gelatin-thrombin matrix could be an effective alternative to the traditional anterior/posterior nasal packing, especially in outpatients at higher risk for bleeding, in which often the bleeding occurs again after the removal of nasal packing. Moreover, this technique is not invasive or potentially dangerous for outpatients. Surgiflo is effective, repeatable over time, and easy to apply, even without anesthesia. In addition, it could avoid the use of surgical procedures such as cauterization. In our opinion, Surgiflo can represent a valid tool for the management recurrent epistaxis in HHT, particularly in outpatients, because it is free of disadvantages related to the anterior packing or surgical procedures, effective, and reabsorbable. Furthermore, the cost of this device is widely offset by the reduction of hospitalization [4].

Il trattamento della restenosi intrastent recidivante rappresenta una sfida per il cardiologo interventista1. L’imaging intracoronarico con tomografia a coerenza ottica (OCT) permette di caratterizzare la restenosi intrastent e può guidare la scelta terapeutica2.

Lupus nephritis (LN) seldom recurs in a grafted kidney. By contrast, primary membranoproliferative glomerulonephritis (MPGN), which has been included, along with hemolytic uremic syndrome and age-related maculopathy, among the complement dysregulation diseases, has a high recurrence rate and is considered a contraindication to living-donor kidney transplant because of the poor prognosis. We report the case of a young girl with LN-related chronic renal failure who underwent a living donor transplant from her mother. After four months she had a recurrence that did not match the criteria for LN. Graft biopsies and revision of the clinical course pointed to type II MPGN on the basis of a lack of ARA criteria, persistent isolated low C3 levels, and response to plasma therapy. If confirmed by genetic analysis, the patient might benefit from treatment with the monoclonal antibody against the C5-C9 complex, eculizumab.

This study explores the possibility that the celiac disease (CD) may be correlated with the insurgence of some oral signs, as based on a systematic review of the literature. Should this correlation be proven, any dentistry's screening would then be important to diagnose early celiac sprue pathogenesis. A literature survey was accomplished by using the Medline database (Entrez PubMed). The survey, which covered the period from the year 1972 to 2009, provided 382 published articles. Of these, 29 articles were selected according to inclusionary/exclusionary criteria, and consequently qualified for the final review analysis. Manual searching through the reference lists of the selected articles allowed the obtainment of others 17 articles. Findings gathered through this literature's review corroborate the significance of a causal relationship between some oral signs and CD. There are enough evidence making the correlation between CD and oral defects scientifically sustainable. This recognition should lead dentists to play more significant roles in screening for CD, as otherwise, if not properly diagnosed and not treated with a gluten-free diet, may eventually cause some malignancies.

Phlebostatic sore of the lower limbs is a typical chronic venous insufficiency complication and is still a widely controversial issue in its treatment. The common therapies, in fact, are not yet standardized and they not show complete efficacy. Since 2005 to 2007 a multicentric clinical trial was conducted at the Plastic and Reconstructive Surgery of "Sapienza" University of Rome and at the Plastic and Reconstructive Surgery Department, University of Perugia, in order to evaluate the efficacy of the Idrastin lymph-draining cream in patients with phlebostatic sores of the lower limbs. This study enrolled on 80 patients, split into 2 homogeneous groups of 40 patients: group A was treated by only elastocompressive therapy, group B by elastocompressive therapy and Idrastin. Multicentric analysis has considered the following parameters: local pain, perilesional flogosis , granulation tissue, perilesional tissue tropism healing time. In the group B results highlighted: reduction of the local pain, stopped in 72 hours; flogosis decrease disappeared in one week; tissue granulation growth in one week; lesion healing in 4 weeks. These results pointed out statistically significance of the variables considered. In our opinion Idrastin compounds such as phytoessence of hops and Hedera helix, had contributed to analgesia; Aesculus hippocastanum, and Vitis vinifera and Ruscus aculeatus phytoessence showed anti-flogistic action; allantoin and Centella asiatica and jaluronic acid aided to sore healing. Idrastin gives an effective support to the treatment of the phlebostatic sores warrants a faster and more effective healing process, than to the wounds treated by only the elastocompressive therapy.

We describe the case of a young man who suffered from relapsing infections of a cranial prosthesis implanted in 1982 after a serious accident. The presence of a bacterial infection was diagnosed by microbiological assays performed on purulent drainage from the surgical wound, removed prosthetic material and bone biopsies obtained intraoperatively. The first prosthesis infection was sustained by two nosocomial pathogens, Enterobacter cloacae and methicillin-resistant Staphylococcus aureus (MRSA); it was treated for eight weeks with parenteral antibiotic therapy, including teicoplanin and piperacillin/tazobactam, in association with surgical debridement and prosthesis removal. The following relapse, sustained by Enterobacter cloacae, was treated with a prolonged course of parenteral antibiotic therapy and prosthesis substitution. A third infection was diagnosed two months after the last cranioplasty: cultures of purulent drainage grew MRSA and Staphylococcus gallinarum. In addition to radical debridement, oral antibiotic treatment including linezolid was introduced. Antibiotic therapy was stopped after 10 weeks; at a follow-up visit performed after three years no signs or symptoms of relapse were evident. This case shows the difficulty in eradicating prosthesis infections, and demonstrates the central role of radical surgical debridement and the need of appropriate antibiotic treatment in dosing and duration.

Nosocomial pneumonia is the second most frequent nosocomial infection and represents the leading cause of death due to hospital acquired infections. In recent years, evidence has accumulated that initial inappropriate antibiotic treatment is an important and independent mortality risk factor for patients with nosocomial pneumonia. On this point, several authors have found that delaying the administration of appropriate antibacterial treatment is associated with an excess in hospital mortality. In this scenario, various strategies have been proposed, such as de-escalation therapy, that attempt to balance the need to provide appropriate initial treatment with limiting the emergence of antibacterial resistance. Another relevant point is the duration of antibiotic therapy: international guidelines suggest that it should be based upon the clinical response, with a standard duration of 14-21 days, but several authors have shown that a shorter course could lead to the same clinical results, and significantly reduce both antimicrobial consumption and the emergence of resistant pathogens. The present review deals with the clinical importance of early, shorter antibiotic therapy.

We report a case of eosinophilic cystitis (EC) in a 65-year-old man with urethral stricture disease from blunt pelvic traumatic event. EC is a rare condition characterized by eosinophilic infiltration of the bladder wall, that usually presents with irritative voiding symptoms, suprapubic pain and hematuria. Etiology is still not clear although a review of the literature suggests that pathogenetic mechanisms probably engage an altered immune response in the bladder, with the inflammatory reaction caused by factors such as exogenous allergens and previous bladder injury or surgery to the bladder or the prostate. The diagnosis of EC has to be confirmed by biopsy, since in some cases it may manifest as other inflammatory and malignant bladder disorders. A conservative medical management is indicated initially, since this disease may be self-limited, with a benign course especially in children and young patients. In adults EC is more often a chronic recurrent condition that requires close follow-up since it may lead to serious progressive bladder and/or upper urinary tract disease. More invasive therapies (including transurethral resection, partial or total cystectomy) may also be required when conservative therapy fails.

Indications, procedures, complications, pharmacokinetics and outcomes of renal transplantation are different in children and in adults. Subjects18 yrs old, are often included in a unique list as in Italy, benefiting from donors15 yrs old, and the waiting time is reduced to12 months in 71% of cases. The risk of thrombosis limits the use of donors2 yrs and trans-plantation in infants1 yr. The age at kidney transplantation is5 yrs in 20-30% of children. In Italy living-related trans-plantation (LRT) is performed in 7% of cases, while in the USA it is more common (57%) and is often pre-emptive before entering dialysis (24%). Current therapy tends to reduce steroid treatment doses and, optimizing induction therapy with IL-2R inhibitors, using tacrolimus or mycophenolate or sirolimus. Transplanted patient survival is better in children than in adults (94-98% at 5 yrs). Infections, cardiovascular diseases and neoplasia induce 34, 15 and 12% of deaths, respectively, at 10 yrs; morbidity for infections and lymphoproliferative disease is increasing. Acute rejections declined from 70% in 1987 to 31% in 2002 in cadaveric transplantation (CT) and renal survival at 3 yrs increased from 50% in 1985 to 82% for CT and up to 92% in LRT. In adolescents (11-17 yrs old) renal survival is lower than in infants and in adults65 yrs old. Renal losses are due to chronic transplant nephropathy (32%), vascular thrombosis (13%) and the recurrence of the original nephropathy (focal glomerulosclerosis up to 50%, membrano-proliferative glomerulonephritis up to 30%, and primary hyperoxaluria up to 90% if combined kidney-liver transplantation is not performed). Growth improves after transplantation particularly in children5 yrs, while it is not completely satisfactory in adolescents. Overall, results indicate that kidney transplantation in children has very much improved and will offer in the near future even more favorable outcomes.

Antibodies capable to recognize antigen expressed on cancer cells represents the ideal approach for targeted anti neoplastic therapies. The CD33 antigen is present on 90% of acute myeloid leukemia blasts and is shared on normal hemopoietic cells only on the non stem dillerentiating fraction. Gemtuzumab Ozogamicin (GO) is an engineered humanized antibody anti-CD33 conjugated with a potent intercalating agent, named calicheamicin, which is release only at intracellular level (lower pH), following a selective binding to CD33-positive cells, thus representing a promising approach for target anti-leukemia therapy. GO was approved conditionally by the Federal Drug Administration in May 2000 as a single therapy for first recurrence of Acute Myeloid Leukemia (AML) in a subset of older patients. Since 2000, treatment trials and pilot studies have revealed potential expanded applications along with potential limitations. Phase II trials have confirmed the activity and the efficacy of GO as single agent in the treatment of relapsed AML. More recently, clinical trials on induction and post-remission treatment of adult AML have shown efficacy of GO in combination chemotherapy. The strong and homogeneous CD33 expression in Acute Promyelocytic Leukemia (APL), have resulted in an effective treatment of this disease with GO used as salvage treatment, as well as innovative approach for molecular relapsed patients. However, the incidence of veno-occlusive disease, better defined as sinusoidal occlusive syndrome (SOS), must be taken into account as potential complication associated with the GO administration, especially in patients treated with ablative regimens. In conclusion, the extension of the approval in Italy to AML CD33+ in relapsed, regardless age limitation, along with the ongoing evaluation by the European EMEA, represent the basis for a large clinical application of GO in myeloid malignancies potentially extended to paediatric patients with AML and to ALL CD33+.

Epileptic seizures occur more frequently in multiple sclerosis (MS) patients than in the general population. We evaluated clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) findings, as well as EEG-MRI correlations and the response to antiepileptic drugs (AEDs) in 270 consecutive patients with definite MS referred to our Department from 1995 to 2002. Thirteen (4.8%) subjects experienced epileptic seizures. In four cases, seizures manifested within 1-2 years ("early-onset"), and in six cases within 8-23 years ("late-onset") of MS diagnosis. Seizures were usually partial with secondary generalization. Thus, acute symptomatic seizures occurred in three cases. Epilepsy usually appeared late in the course of disease, although a single episode or a cluster of seizures can represent the onset symptom or a relapse of MS. Prognosis of epilepsy during the course of MS is usually good but the choice of AEDs remains a matter of debate.

The treatment of Crohn's disease is still a debatable issue especially as regards the integrated implementation of medical and surgical therapy, the timing of surgery and the choice of surgical technique. Prognostic factors seem to be important in the choice and planning of therapeutic procedures. The authors retrospectively review 81 patients, 31 of whom submitted to surgery. The parameters observed were the presenting symptoms, the time from onset of symptoms to surgery, previous medical treatment, disease location, and complications. Bowel resection and the treatment of fistulas and abscesses were carried out. Emergency resections were performed in 14 patients (45%): 11 for bowel obstruction, 2 for perforation and 1 for bleeding. The mean follow-up (which included laboratory tests and endoscopy) was 132 months (range: 6 months to 32 years). In-hospital mortality was 2.3% and morbidity 12.9%. Long-term mortality amounted to 3 patients, only 1 of whom died of complications related to recurrence of the disease. Statistical analysis showed that the recurrence rate was 51.3% at 5 years after the first surgical treatment, 65.4% at 10 years and 88.1% at 20 years. Recurrences requiring surgery amounted to 15.3%, 20.5% and 42.5%, respectively. No statistically significant correlations were observed between recurrence rate and time of onset of the disease (p = 0.5601), time of the first surgical treatment, disease location, or specific medical therapy, (p = n.s.). Recurrence requiring surgical treatment was observed in 33.3% of patients when the disease was located only in the ileum, in 33.3% when it was located in both the ileum and colon, and in 28.6% when only the colon was involved (p = 0.9767). The quality of life was good in 66.6% of patients, fair in 26.6%, and poor in 6.6%. The authors conclude that the treatment of Crohn's disease must be multidisciplinary and surgery must be limited to complications. When surgery is indicated, it must be performed promptly, because, in these cases, persisting with medical treatment increases the postoperative morbidity. Short resections must be performed in order to preserve the bowel as much as possible. As far as risk factors are concerned, the most important are the location and the aggressiveness of the disease, whilst biological and laboratory parameters do not seem to influence the results.

Objectives: To assess, by magnetic resonance imaging, the volumes and magnetization transfer ratio (MTR) values of optic nerves (ONs) from patients with multiple sclerosis (MS) who had incomplete or no visual recovery after optic neuritis; and to compare these quantities with those derived from ONs from patients with MS who showed a marked clinical recovery after optic neuritis, ONs from healthy volunteers, and ONs from patients with Leber hereditary optic neuropathy (LHON). Methods: Conventional and magnetization transfer magnetic resonance images of the ONs were obtained from 30 patients with MS, 18 healthy volunteers, and 10 patients with LHON. The ON from patients with MS were classified as clinically unaffected (n=18); clinically affected with recovery (n=20; visual acuity20/25 at least 6 months after optic neuritis); and clinically affected with incomplete or no recovery (n=22; visual acuity 20/25 at least 6 months after optic neuritis). The ON volumes and MTR values were measured. Results: Volumes (P=.002) and MTR values (P.001) of the ONs from patients with MS and incomplete or no recovery were both lower than those of the ONs from patients with MS and recovery, but not different from those of the ONs from patients with LHON. Volumes and MTR values of the affected ONs from patients with MS and recovery did not differ from those of clinically unaffected ONs, which were similar to those of healthy volunteers. Conclusion: These findings suggest that, in patients with MS, neurodegeneration is associated with persistent functional deficits secondary to incomplete recovery from relapses.

The aim of this retrospective study was to identify and evaluate the clinical characteristics and incidence of recidivation in a series of 40 cases of keratocyst consisting of 31 primary lesions, 7 cases of primary recidivation (17.5%) and 2 cases of secondary recidivation (5%). All the lesions were large sized and were treated using surgery. All patients underwent an annual clinical control for a minimum follow-up of seven years.The authors present a series of 40 odontogenic keratocysts treated between 1985 and 1996 by the Division of Maxillofacial Surgery at Turin University. The series consisted of 40 keratocysts including 31 primary lesions, 7 cases of primary recidivation (17.5%) and 2 cases of secondary recidivation (5%); 12 patients were female (38.7%) and 19 were male (61.3%). The mean age of patients was 42 years old. The clinical records and enclosed X-ray documentation (OPT X-ray, head X-ray, face X-ray) were examined for each patient, together with histological findings. Each case then underwent an annual follow-up.The review of clinical data and the examination of X-ray documentation showed that 28 lesions developed in the mandible and only 3 cases in the upper jaw. From a therapeutic point of view, keratocysts localised in a mandibular site were managed using cystectomy in 19 cases and in 18 cases this was followed by marsupialisation. Caldwell-Luc's operation was used in 2 cases of intrasinusal maxillary development, whereas the single case of extrasinusal development underwent cystectomy. Recidivation always involved the mandible and occurred in 22% of cases within 5 years of surgery. Of the 19 cases undergoing simple cystectomy, 8 cases (42%) revealed recidivation. Only one (5.5%) of 18 cases treated using cystectomy and marsupialisation showed recurrence.On the basis of their experience and in view of the specific characteristics of keratocysts, in particular the tendency to undergo recidivation, the authors affirm that annual clinical and radiological controls are indispensable and important, including biopsy where necessary, in order to diagnose new lesions promptly irrespective of the surgical technique used.

Anal fistulas are frequent events which often recur after an inadequate surgical treatment. Nevertheless their evolution into malignant diseases is infrequently observed. The authors report one case of mucinous adenocarcinoma arising out of a recurrent, long-lasting fistula-in-ano. As reported, abdomino-perineal resection combined with radiotherapy can be the choice treatment. The difficulty is to obtain a reliable differential diagnosis. No imaging technique nor histologic examination can establish a definitive reliable diagnosis; nevertheless, as the risk of adenocarcinoma developing from a long-lasting recurrent fistula-in-ano, although small, is real, authors believe that operative exploration and biopsy of recurrent abscesses and fistulas should be recommended.

Today, surgery is the treatment of choice for nasal sinus polyposis. Nevertheless, although meticulous surgery does "per se" reduce the percentage of recurrences, there are cases where even the most painstaking removal of the entire pathology cannot prevent recurrence. Therefore recurrences do not appear linked to the type of surgery; rather onset appears linked to intrinsic, only partially recognizable factors responsible for the primary and secondary polypogenesis. In order to identify negative prognostic factors which might be implicated in recurrences, the present study extrapolated the data from forms on 181 patients who had undergone surgery for nasal sinus polyposis and subjected it to multivariance analysis. These patients were recruited during the course of a multicenter study with the participation of 12 ENT Centers in Piemont and Liguria. The recurrence rate was 13%. In analyzing unfavorable factors prognosticating recurrence, thirteen parameters were examined. Nine of these (age, sex, severe deviation of the septum causing restriction, severe turbinate hypertrophy, surgery or repeat surgery for recurrence, type of macro-micro endoscopic surgery, allergy to seasonal inhalants, allergy to perennial inhalants, mixed allergies) did not prove to have any significance in recurrences. The presence of bilateral involvement of the sinus system presented a negative trend as regards recurrences while involvement of more than one subsite (anterior ethmoid, posterior ethmoid, maxillary sinus, sphenoid), ASA and NSAID intolerance and abundant eosinophilic infiltration in the mucous chorion proved statistically significant (p0.05 for all three parameters) for recurrence. Post-operative topic prophylactic treatment with steroids (beclomethasone) or anti-H1 drugs (azelastin, HCl) did not appear to affect the onset of recurrence although it did have a positive effect on subjective symptoms.

We report the results of our experience with venography in patients with postoperative recurrent varicocele. The study was carried out to detect the causes of this condition.Forty-four patients with postoperative recurrent varicocele, examined in our department from June, 1993, to June, 1996, were submitted to selective spermatic venography after clinical examination and color Doppler sonography. Thirty-six patients had been treated with high surgical ligation of the spermatic vein and 8 with inguinal ligation. Thirty-two patients were treated percutaneously, after diagnostic angiography, with coils and/or sclerotizing agents.In our study, the persistence of patent collateral veins, missed at surgical ligation, was the main cause of recurrence (68%): this was due either to a double or triple spermatic vein, mostly in the pelvic tract (50%), venous bridges crossing the surgical ligation (11%), or to retroperitoneal anastomoses (7%). A smaller group of patients showed ineffective ligation of the vein (27%); in the remaining 5% of cases incompetence of the extrafunicular plexus was detected.Our experience, supported by a literature review, demonstrates that the anatomic variants, not detected preoperatively because phlebography had not been performed, were the most frequent causes of recurrence. Spermatic venography is the most accurate imaging modality for vascular mapping in postoperative recurrences; it often allows to treat the patients simultaneously by a percutaneous approach.