The purpose of this study is to discuss the surgical treatment for ovarian torsion in children and adolescents with a focus on the procedures of adnexal conservation surgery and its frequency in the literature of the last 10 years. We retrospectively reviewed the medical charts of 127 operative ovarian lesions including 30 ovarian torsions (23.6%) treated in two pediatric centers over a 10-year period. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathological findings were analyzed. Mean age was 13.7 years. Conservative surgery has been performed in 46.7% of the cases and laparoscopic approach in 40%. Ovarian torsion occurred in 56.7% on ovaries with functional lesion, in 23.3% on normal adnexa and in 20% on ovaries with benign neoplasm. The article includes a literature review (2000-2010) and a statistical analysis which shows a slow increase in conservative surgery from 28 to 45%. Laparoscopic surgery accounts for 23.5%. Literature review shows 40.5% normal adnexa, 33.2% non-neoplastic lesions, 25.3% benign neoplasms and 1% malignant neoplasms. The surgical treatment of children and adolescents presenting adnexal torsion should be practiced as an emergency and it should be more conservative as possible in order to maximize the future reproductive potential.
In this study the skin permeation and the topical anti-inflammatory properties of ginger extracts were investigated. A commercial ginger dry extract (DE) and a gingerols-enriched dry extract (EDE) were evaluated for their in vivo topical anti-inflammatory activity by inhibition of Croton oil-induced ear oedema in mice. Furthermore, the feasibility of an anti-inflammatory plaster containing DE or EDE was evaluated. Since the in vivo activity was evaluated in mice, the ex vivo skin permeation study was performed by using mouse skin or human epidermis. The DE from the acetonic solution exerted a dose-dependent topical anti-inflammatory activity (ID (50) = 142 microg/cm (2)), not far from that of the potent reference substance indomethacin (ID (50) = 93 microg/cm (2)). Similarly, the EDE induced a dose-dependent oedema reduction though its potency (ID (50) = 181 microg/cm (2)) was slightly lower than that of DE. Increase of the 6-gingerol concentration in the extract did not improve the anti-inflammatory activity. The medicated plasters, containing 1 mg/cm (2) of the commercial DE or EDE, had good technological characteristics and exerted a significant antiphlogistic effect, too. By using the plaster containing EDE, the 6-gingerol amount that permeated through human epidermis was 6.9 microg/cm (2) while the amount that passed through mouse skin was 22.1 microg/cm (2). Nevertheless, the amounts of 6-gingerol permeated through human epidermis and mouse skin in the early period (8h) were comparable (p > 0.3). This preliminary result suggests that the anti-inflammatory effect observed in mice could also be exerted in humans.
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