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In order to guarantee urinary and fecal continence as well as correct pelvic statics, the perfect neuroanatomical integrity of the pelvic floor muscles is mandatory. As Dickinson stated: "There is no considerable muscle in the body whose form and function are more difficult to understand than those of the levator ani, and about which such nebulous impressions prevail". Clinical implications of pelvic floor anatomy and nerve supply are evident: a denervation of this muscle group and the consequent muscle dysfunction could result in urinary and/or fecal incontinence, as well as pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

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In the light of the most recent acquisitions published in the international literature, this review analyzes the pharmacologic features and modes of use of tramadol, one of the most widely used, on a worldwide scale, analgesic agents in acute and chronic pain of moderate to severe intensity. The action of the 2 enantiomers of tramadol--which exert different pharmacologic effects--and of metabolite M1, is differentiated. The global activity of tramadol results from the sum of their specific actions. Data of kinetics show a very high oral bioavailability and the sustained-release (SR) formulations assure a 24-h coverage through the constant blood levels. Data reported in the relevant literature show that tramadol is effective in the treatment of arthrosic and neuropathic pain, with a value of Number Needed to Treat (NNT) of 3.4, and in the mixed nociceptive-neuropathic pain, especially in persistent or chronic pain. Moreover, tramadol maintains a good tolerability profile in the elderly subjects and a good analgesic efficacy in the long-term treatments with reduced pharmacological interactions and a low incidence of constipation. These global features assured its inclusion into the most recent guidelines on the management of chronic pain. Furthermore, data from literature showed that tramadol is devoid of immunosuppressive activity, has a poor tendency to tolerance and a minimum risk of addiction and abuse.

This article offers the reader two letters from Tommaso Frosini to Francesco Redi of 10 and 21 may 1681 in which important chapters of Giovanni Alfonso Borelli's masterpiece, De Motu Animalium are summarized. The commentary indicates the early circulation of Borelli's work in Florence and the special stress that Francesco Redi laid on it.

Effort rhabdomyolysis is a syndrome which takes the form of a pathology with different etiopathogenetic stages. General anesthesia may trigger off acute muscular cytolysis which is probably influenced by the inflammatory surgical pathology itself. The observation of two cases of post-anesthetic rhabdomyolysis following muscular stress suggest that the exhaustion of muscle energy reserves and the consequent alteration of the ATP/ADP ratio may act as a trigger mechanism for this syndrome. Its close relationship with malignant hyperthermia makes a precise anamnesis vitally important, especially in relation to recent intense physical effort in patients undergoing emergency surgery for acute pathologies.

The effects of interscalene block were studied on 109 patients undergoing upper extremity elective orthopaedic surgery. Blocks were performed in a non-randomized manner with three different techniques, the site where anaesthetic solution was injected being the main distinguishing mark. The anaesthetic solution was injected into the interscalenic compartment both in the case of patients where classic technique had been carried out and in the group where the nerve stimulator had been used. In the "double needle" technique group, on the contrary, the anaesthetic solution was injected close to the vertebral column. The spread of analgesia involves the caudal portion of the cervical plexus and the cranial portion of the brachial plexus, but with the cervical plexus is almost certain to be involved, the brachial is not. Block outcome was related to the surgical procedure (surgery or orthopaedic manipulation), the site of surgery, paraesthesia elicitation, prolonged surgery and height, weight, age and sex of patients. Results also different according to the technique used. When the anaesthetic solution was injected close to the vertebral column analgesic cover was more widespread and lesser amounts of anaesthetic needed. When the block was performed within the interscalenic compartment, the analgesic cover was usually restricted to the area supplied by the primary superior trunk of the brachial plexus. The different results were explained by the presence of fibrous sheaths within the interscalenic compartment limiting spread of the anaesthetic, which are absent close to the vertebral column. Therefore two types of interscalene block were postulated: an intrascalene or troncular block within the interscalenic compartment and a radicular or paravertebral block close the vertebral column.

Nine infants with haematoma of the SCM muscle were evaluated. A review of previous reports and a comparison of the clinical features of this group of patients to ones considered in other reports is reported and a simple therapeutic program is outlined: during the first year of life, postures and simple exercises performed by the mother under the pediatrician's supervision are suggested. In the eight cases in which the therapeutic program was followed, the long-term outcome was satisfactory from both cosmetic and functional point of view. Therefore this method should be preferred during the first year of life, also taking into account the lack of negative influence on the mother-infant relationship and on the infant's neurological development.

Ten subjects with peripheral arterial occlusive disease were treated with buflomedil, analysing the effect of every single intravenous administration of the drug, and the effect of the administration repeated for a period of 5 days. This controlled study was aimed at evaluating the state of the peripheral blood flow, not just relating to the flowmetric parameters, but also to those more directly connected to the metabolic and functional conditions of the microcirculation. During every single administration, blood flow, skin and muscular temperatures were recorded. As concerned the drug's chronic effect, endurance limit, skin and muscular temperatures, whole blood viscosity, plasma viscosity and red cell filterability were recorded before beginning the treatment and after 15 days. The results of this study show that during a single buflomedil infusion no modifications have been observed in blood flow and muscular temperature, whereas skin temperature showed a slight increase. On the contrary, after a 15 days treatment, muscular temperature and endurance limit significantly increased, without flowmetric changes. A significant decrease in values of blood viscosity at high shear-rate was recorded too. The overall results seem to indicate that after treatment with buflomedil there is an improvement of the metabolic muscular conditions, probably due to a stimulant effect of the drug on microcirculatory blood flow.

Precurarisation with 1 mg/15 kg d-tubocurarine was given before 1.5 mg/kg succinylcholine to obtain muscle relaxation for tracheal intubation in 100 patients, whereas 1 mg/kg succinylcholine only was administered to 100 controls. Serious postoperative myalgia fell from 8% to 0%, and forms of average intensity from 21% to 8% in the curarised group. Muscle resolution was regarded as satisfactory in 96% (98% in the controls). The effectiveness and degree of safety of this combination are discussed, together with the indications and contraindications for the employment of the technique in the prevention of myalgia induced by succinylcholine.

Reference to personal experience covering 2035 appendicectomies is referred to in an account of the technique of transvaginal laparotomy of the rectus muscle. Here the sheath of the rectus and the peritoneum are incised at different levels and in different directions. The outside border of the sheath is not touched and the muscle is displaced medially, without section or displacement of the muscle fibres. If required, the operation can be extended upwards or downwards into a pararectal incision without departing from the context of the sheath. The technique is easy and gives ample vision. Closure is simple, rapid and cosmetically satisfying. The resulting solidity of the wall means that laparocele does not occur.