The use of Bucrylate in emergency sclerotherapy achieved results in bleeding gastric varices on a par with those obtained in esophageal varices in cases of alcoholic and posthepatitis cirrhosis. The group of patients with portal hypertension due to prehepatic block (splenoportal thrombosis) showed no benefit from sclerotherapy in terms of obliteration of gastric varices, but benefited from elective surgery. The choice of the obliterating treatment indicated may be facilitated by classifying gastric varices into distinct groups on the basis of anatomicotopographic criteria.

From the analysis of the literature and our experience, it is evident that, when AAA and CRC are coexistent with preoperative diagnosis of both diseases, single-stage intervention, when feasible for patient in general and local conditions, has to be preferred due to the lower morbidity. Single-stage treatment avoids a second surgical and anesthesiologic trauma and eliminates the risks joined with the non-treated lesion, increasing, however, the magnitude of the operation. Endovascular therapy, for its less invasiveness, appears to be an adequate solution for one-stage treatment of the two diseases but its role is still subject of ongoing discussions.

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Background: Third-and fourth-degree perineal tears are associated with significant discomfort and impact on women's quality of life after labor. We reviewed the literature on risk factors for obstetric anal sphincter injuries (OASIS), focusing on modifiable risk factors for OASIS to help obstetricians prevent them. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus using key search terms. We selected clinical studies, systematic reviews, and meta-analyses in English investigating antepartum and intrapartum factors associated with OASIS. Three researchers independently selected studies and documented outcomes. Results: We identified forty-two relevant articles for inclusion. Among antepartum factors, primiparity, neonatal birth weight, and ethnicity were associated with a higher risk of OASIS. Instrumental delivery, midline episiotomy, duration of the second stage of labor, persistent occiput posterior position, and labor augmentation were those intrapartum factors reported associated with OASIS. Conclusions: Multiple anteand intrapartum factors are associated with a higher risk of OASIS. The actual modifiable factor is episiotomy during the second stage of labor. However, literature reporting episiotomy associated with a reduction in OASIS prevalence during instrumental delivery is limited. These results may help obstetricians recognize women at higher risk of developing severe perineal tears and recommend further investigation on the role of episiotomy in an operative delivery.