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Introduction: Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin. The Park’s classification describes four different types of anal fistulas depending on their links with the sphincter apparatus. In this paper, we report an interesting case of post-traumatic complex trans-sphincteric fistula treated with VAAFT procedure. Case Presentation: A 60-year-old-male patient, from an accidental fall, developed a gluteal abscess with a high trans-sphincteric anal fistula and a secondary tract leading to a large second abscess located in the right ischiorectal fossa. An abscess incision was done, and a draining seton was placed in another Institution. The patient came to our Hospital and underwent surgery using Video Assisted Anal Fistula Treatment (VAAFT) procedure. Conclusions: VAAFT is an effective and safe procedure for complex anal fistula, even when they have a post-traumatic origin.

Riassunto Obiettivi Esaminare le principali cause di infezioni odontogene di frequente riscontro nella pratica clinica quotidiana, la loro evoluzione e le eventuali complicanze. Materiali e metodi Il corso mira ad aiutare il clinico nel compiere correttamente l’esame obiettivo del paziente, raccogliere un’ampia ed esaustiva anamnesi patologica remota e prossima, nonche nel richiedere o eseguire esami di secondo livello, qualora necessari. Vengono illustrati e spiegati i flussi decisionali per eseguire correttamente le diagnosi differenziali delle infezioni odontogene vs altre patologie del cavo orale. Vengono poi definite le principali cause potenzialmente scatenanti le infezioni odontogene, con particolare attenzione all’eziologia. Risultati e conclusioni Qualora non riconosciute o trattate adeguatamente, le infezioni a eziologia odontogena possono compromettere gravemente la salute del paziente. Il giusto inquadramento diagnostico e la stesura di un piano terapeutico mirato ed efficace sono le chiavi di volta per permettere al clinico di evitare l’instaurarsi di antibioticoresistenze, in grado di aumentare la morbilita e la mortalita e di portare a un possibile fallimento della terapia.

Riassunto Obiettivi Fornire un aggiornamento, in base alle raccomandazioni della comunita scientifica, sulla corretta terapia farmacologica da adottare nelle infezioni odontogene di principale riscontro nell’attivita clinica quotidiana. Materiali e metodi Il corso intende aiutare il clinico nella quotidianita della prescrizione antibiotica per il trattamento delle diverse infezioni di origine odontogena, con particolare attenzione ai pazienti “special needs” o con specifiche comorbilita. Risultati e conclusioni Se mal diagnosticate o non trattate correttamente, le infezioni odontogene possono compromettere notevolmente la salute del paziente, rendendo necessario il ricovero ospedaliero. E fondamentale che l’inquadramento diagnostico sia corretto e che, successivamente, il trattamento impostato sia appropriato per il singolo paziente, cosi da raggiungere un successo terapeutico ed evitare l’instaurarsi di antibiotico-resistente. Queste, infatti, sono in grado di influenzare negativamente lo stato di morbilita e mortalita del paziente stesso.

A case of splenic abscess in a diabetic, cardiopathic and arteriopathic 49-year-old man is reported. The abscess developed on a previous splenic infarction caused by an embolus coming from an intraventricular thrombus. The angiographic procedure was the source of bacterial contamination (Staphylococcus aureus). The patient was successfully treated with splenectomy.

The authors review 561 patients suffering from odontogenic abscesses and phlegmons which were large enough to merit hospitalisation in the Division of Maxillo-Facial Surgery of the Odontostomatological Clinic at the University of Turin during the period from 1972 to 1990. The main features of these septic processes are evaluated: site, size, mode of growth and evolution, tooth responsible. Special attention is paid to the treatment performed: this was essentially based on antibiotic therapy and/or drainage of the abscess via a transcutaneous, transmucous or transdental route. The need to combine medical therapy with surgical drainage of purulent material was noted in the treatment of large infections; in many cases medical therapy alone was unable to guarantee the resolution of the pathology; on the other hand, surgical drainage alone in some cases led to the patient's recovery.

Pancreatic abscess is a major cause of death from acute pancreatitis; its reported frequency is between 1.7 and 25 per cent of all patients presenting with acute pancreatitis. The mortality varies between 13 and 54 per cent. Despite apparently adequate initial surgical treatment, the recurrence rate is about 30 per cent. The key to survival in pancreatic abscess is adequate drainage of cavity. Proponents of open treatment claim that it allows better drainage of the viscid content of the pancreatic abscess which often cannot easily pass down a drain. In the present case, following laparotomy for severe intra-abdominal sepsis due to pancreatic abscess, the abdominal cavity was left open to heal by granulation. The procedure permitted early resolution of the septic process. Total parenteral nutritional support resulted in definitive wound healing. We regard laparostomy as a valuable technique in the management of pancreatic abscess; the successful of this technique hinges on expert nursing care and the capability of maintaining complication-free long term parenteral nutrition.

The authors describe their experience in the utilisation of vessel dilators provided with coaxial sheath to insert, with a single puncture two drainage catheters of stated caliber in abscessual cavities.

The study of soft tissues has greatly improved since the introduction of ultrasonography (US) and computed tomography (CT). In order to define the role of instrumental investigations, 51 patients affected by non glandular superficial soft tissue masses underwent US and 9 were also examined with CT. US proved to be accurate to define the size, the structure of the mass (93%), the benign or malignant nature (91%). US was also useful for percutaneous biopsy. However, US cannot be considered the only investigation because it does not give enough data about bony and articular structures: a conventional X-ray film must be performed in order to define the relation of the mass with the adjacent bone and to clarify the possible presence of fatty tissue in a solid mass shown at US. CT has a role in case of large masses, surrounding a bone diaphysis, when the malignant nature is suspected and to define the relationship with vessels and muscles.

Differential diagnosis problems are caused by the increased, at time occasional, detection of benign and malignant spleen focal lesions in routine superior abdomen ultrasound (US). The following pathologic conditions were reported in 29 patients with focal lesions (excepted systemic diseases): 6 plain cysts, 1 cystic lymphangioma, 3 echinococcus cysts, 3 abscesses, 7 hematomas and 9 metastases. US examination and clinical data together have permitted the differentiation of cysts from solid nodules but has limits in the characterisation of lesions and in the diagnosis of abscesses. Metastases did non present specific US or CT aspects and have been correctly characterized only with aid of anamnestical data and for the coexistence of hepatic lesions. CT has proven superior specificity, compared to US, only in the diagnosis of abscesses and should thus be utilized only in selected cases.