La Clinica terapeutica
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La Clinica terapeutica · Jan 2009
Percutaneous endoscopic gastrostomy (PEG) in critically ill patients performed at bed in Intensive Care Unit: report of our experience.
Patients with severe brain injures and severe neurological diseases frequently require prolonged nutritional support during their hospitalization as well as during their rehabilitation period. Since 1980, the percutaneous endoscopic gastrostomy (PEG) has become the method of choice for long term feeding. The aim of the present study was to present our experience concerning the placement of PEG in critically ill patients, recovered in Intensive Care Unit (ICU). ⋯ Our experience underlines that PEG, in selected critically ill patients, is a safe technique easy to perform even in ICU.
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La Clinica terapeutica · Jan 2009
[Our experience in the chemical spinal neuromodulation in chronic pain from spinal collapse due to osteoporosis.].
Osteoporosis is a metabolic disease of the bone characterized by reduced bone mass and microstructural deterioration of bone tissue with a consequent increase in bone fragility and risk of vertebral collapse. Treatment of osteoporosis with the new molecule is effective in improving the density and quality of bone but does not provide an analgesic effect for patients with vertebral collapse. The treatment of chronic pain from vertebral collapse is difficult and may require the use of opioids, but for some patients the intake of these drugs is burdened with systemic side effects. The aim of our study is to use the way in reducing intrathecal opioid dosage and at the same time have good pain control without significant side-effects. We report our experience in the use of continuous infusion pump for intrathecal morphine in patients with chronic pain from osteoporotic vertebral collapse that can not tolerate therapy with systemic opioids because of severe side effects. ⋯ This study demonstrates that intrathecal-morphine therapy offers patients relief from pain and a good quality of life. Continuous intrathecal infusion of morphine is a valuable therapy and is particularly suitable for those patients who show side effects with the administration of systemic opioids.
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Born more than one century ago as a technique for the treatment of the respiratory emergencies due to foreign bodies inhalations, bronchoscopy plays nowadays a crucial and well-defined role in the management of the respiratory critical patient admitted in an intensive hospital setting thanks to its numerous applications both in the diagnostic and in the therapeutic fields. Despite the wide use of the bronchoscopy, especially of fibreoptic technique, it has never to be forgotten the importance of the operator's expertise specifically in this peculiar field of application in order to avoid usefulness risks and to prevent life-threatening consequences for the critical patient. The expert Pulmonologist represents the leader actor for the Clinical Governance of this branch of the Respiratory Intensive Care Medicine. In this review, the Authors examined the aspects connected with the choice of the instrument, the most clinical practice common indications, the risks and the consequences of the use of the bronchoscopy in respiratory intensive care.
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La Clinica terapeutica · Jan 2009
[Triage in the emergency department. Practical and ethical issues].
Triage is a complex and dynamic decisional process composed of sequential actions and necessary evaluations in order to establish the priority of access to medical attention in emergency care. In the Triage not only medical-biological knowledge is important but also the methods that together are inspired by ethical models. Following the historical considerations and after having brought out the methods and practice used in various countries and also having underlined the personal experience of the Emergency Department of the Emergency Department of the University Policlinic of the "Sapienza" University of Rome (Italy), the biggest hospital in Europe, the authors emphasized the nursing care in the "triage" and support the necessity of an adequate training period not only to acquired the technical knowledge required but also the psychological and social interaction as well as moral and practical competence. By "practical" we intend it to be explicitly a dimension in which moral competence has been acquired in using concrete first person action in a virtuous way towards the betterment of the sick person using the best modes of justice.
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La Clinica terapeutica · Jan 2009
Our experience on pain palliation of bone metastasis with Sr-89 or Sm-153 in cancer patients resistant to a conventional analgesic therapy. A retrospective study.
These retrospective study is aimed to evaluate the efficacy of therapy with Stronthium-chloride 89 (89SrCl) and Samarium 153 conjugated with ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP) in the palliation of bone pain due to metastatic malignancy. ⋯ Radionuclide therapy with bone-seeker agents 89Sr and 153Sm in the palliation of painful bone metastases allows a partial/total relief of pain with an improvement of quality of life. No tumoricid effect was found. Haematological toxicity was limited and reversible. Patients with prostate cancer seem to have a higher response rate.