La Clinica terapeutica
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General concepts and about medical disasters, public health and triage are outlined. Ethical values at stake are summarized. ⋯ Three attitudes are suggested: protection of human dignity, precaution, solidarity. A personalistic perspective is suggested to deepen solidarity as a pillar both of clinical and public health ethics.
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La Clinica terapeutica · Jan 2010
Review[Near Infrared Spectroscopy for cerebral monitoring during cardiovascular surgery].
Near-infrared spectroscopy (NIRS) is an optical imaging technique for medical applications, able to monitor the variation of hemoglobin saturation into the tissues. The NIR photon passes through the biological tissue following a path similar to a more or less complex split. The NIR absorption of photons is proportional to the concentration of chromophores (pigments that absorb the light in the spectral region of interest). ⋯ The NIRS may represent an added value in those patients. The NIRS is also applied during surgery performed with cardiopulmonary bypass, including aortic arch surgery with cardiocirculatory arrest. Continuous monitoring of any changes in cerebral rSO2 allows a rapid treatment in the aim to improve the psycho-neurological outcome of patients undergoing this type of surgery.
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La Clinica terapeutica · Jan 2010
Review Historical Article[The psychopathology of delirium. Evolution of the research from Jaspers to Kapur].
Delirium represents a symptom of a thought disorder in which a belief is strongly held in spite of invalidating evidence. Many varieties of delirium have been described and this symptom is common in psychotic disorders (schizophrenia, brief psychotic disorder, chronic delusional disorders, etc.), affective disorders (major depressive disorder, psychotic depression, melancholic depression, bipolar disorder, etc.), organic illnesses and psychotropic substance abuse. Delirium has been deeply studied by psychopathology. Our work offers an overview of the most relevant psychopathological descriptions of delirium in the last century, from Jaspers to Kapur.
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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 · Nov 2008
ReviewOptimal sequence of anthracyclines and taxanes as adjuvant breast cancer treatment.
Results from randomized trials evaluating taxane versus non-taxane containing regimens in adjuvant breast cancer treatment indicate an advantage in DFS and OS for the taxane-arms, but the best schedule of administration, in combination with anthracyclines or in sequence, is still a debated issue, even if the sequential strategy appears to be less toxic. Up to now, the majority of clinical trials employed the "standard" sequence, with anthracycline-based combinations fi rst, followed by taxanes. ⋯ An important issue to be considered is the hypothesized differences in the ability of the drugs to induce cross-resistance to each other, as suggested by data of a preclinical study, and from clinical study with a cross-over design; results of these trials suggest that the best strategy would be to administer a taxane prior to an anthracycline, also according to the Norton and Simon hypothesis. Moreover, trials evaluating the best sequence of anthracyclines and taxanes in adjuvant breast cancer setting are of small sample size, and an adequately powered randomized phase III trial is needed before definitive conclusions are reached.