La Clinica terapeutica
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La Clinica terapeutica · May 2006
ReviewRenoprotective effect of renin-angiotensin system block: what has happened?
The Renin Angiotensin System block achieved by current available therapy (angiotensin II antagonism), despite undoubted beneficial effects, is associated to a persistent cardiovascular and renal mortality. During this angiotensin II antagonism, Renin Angiotensin System block is incomplete and angiotensin II break through. The Author analyses possible etiopathogenetic factors. Renin inhibition and Angiotensin-Converting Enzyme type 2 modulation are indicated and discussed as opportunities of Renin Angiotensin System block other than Angiotensin-Converting Enzyme inhibitors and Angiotensin Receptor Blockers, that may render the Renin Angiotensin System block more quiescient.
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La Clinica terapeutica · Mar 2006
Review[Home mechanical ventilation in chronic obstructive pulmonary disease].
Due to the its great morbidity and mortality, home mechanical ventilation via tracheotomy is reserved, as a mandatory support, just to the patients with chronic obstructive pulmonary disease (COPD), who, after an episode of acute respiratory failure, cannot acquire a full ventilatory autonomy. During the last two decades the potential benefits of non-invasive ventilation (NIV) as a domiciliary treatment of severe COPD with CO2 retention have been investigated. Patho-physiologic basis of its employ are resting of respiratory muscles and/or resetting of respiratory centres. ⋯ As the results of the few available controlled studies obtained with the latter ventilatory technique aren't very enthusiastic and univocal, it's not possible to draw clear guidelines about the domiciliary use of NIV in COPD. In conclusion, the author suggests that, in order to avoid useless waste of resources, the application of NIV to stable COPD should be reserved to very selected cases (significant hypercapnia, frequent nocturnal desaturations and/or sleep disordered breathing and/ or hospital admissions) with demonstrated effectiveness and adequate compliance to the treatment. With the aim of better define the real field of application of home NIV in stable COPD, further and larger studies are needed having as end-points not only the crude survival and the lung functional data but also the quality of life of the patient and the impact upon the health expenses.
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Latent autoimmune diabetes in adults (LADA) is a disorder with onset after age 30, insulin independence for at least 6 months after diagnosis, and the presence of circulating pancreatic islet autoantibodies. The prevalence of LADA varies substantially across ethnic groups and ranges approximately from 1% to 10% among patients with type 2 diabetes. In this review we discuss the nomenclature, diagnostic criteria, immunologic and genetic markers, metabolic alterations and therapy of this form of diabetes.
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La Clinica terapeutica · Jan 2006
Editorial[Artificial nutrition in the patient with hyperglycemia].
The stress of critical illness evokes insulin resistance and hyperglycemia. Artificial nutrition is commonly considered one of the main causes of hyperglycemia in hospitalized patients. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia Intensive insulin treatment to normalize blood glucose during feeding has been shown to improve morbidity and mortality in patients in intensive care. Insulin glargine may contribute to improving the glycemic values in patients receiving artificial nutrition with hyperglycemia.
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La Clinica terapeutica · Sep 2005
Comparative Study[Breast cancer: HER2 changes one's cards on the table].
Recently, preliminary results of several randomized studies using trastuzumab in the adjuvant or neoadjuvant treatment of HER2-positive breast cancer have been reported. In the neoadjuvant setting, patients have been randomized to receive either chemotherapy alone (Group I), 4 cycles of paclitaxel followed by FEC (fluorouracil, epirubicin, cyclophosphamide) fo 4 cycles, or the same chemotherapy with concomitant weekly trastuzumab for 24 weeks (Group II). Pathologic complete responses were 25% in Group I and 66.7% in Group II, showing a significant superiority of treatment including trastuzumab. ⋯ Treatment has been generally well tolerated with acceptable cardiotoxic effects (< 4%). However, the short follow-up precludes any information about long-term side-effects. Overall, although the risk/benefit ratio is in favor of trastuzumab including regimens, the use of this monoclonal antibody in the neoadjuvant or adjuvant treatment of HER2-positive breast cancer, should be carefully discussed with the patient.