La Clinica terapeutica
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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 · Jul 2005
Review[Therapeutic advances in neoplastic hematology: target therapy anti-CD33].
Antibodies capable to recognize antigen expressed on cancer cells represents the ideal approach for targeted anti neoplastic therapies. The CD33 antigen is present on 90% of acute myeloid leukemia blasts and is shared on normal hemopoietic cells only on the non stem dillerentiating fraction. Gemtuzumab Ozogamicin (GO) is an engineered humanized antibody anti-CD33 conjugated with a potent intercalating agent, named calicheamicin, which is release only at intracellular level (lower pH), following a selective binding to CD33-positive cells, thus representing a promising approach for target anti-leukemia therapy. ⋯ The strong and homogeneous CD33 expression in Acute Promyelocytic Leukemia (APL), have resulted in an effective treatment of this disease with GO used as salvage treatment, as well as innovative approach for molecular relapsed patients. However, the incidence of veno-occlusive disease, better defined as sinusoidal occlusive syndrome (SOS), must be taken into account as potential complication associated with the GO administration, especially in patients treated with ablative regimens. In conclusion, the extension of the approval in Italy to AML CD33+ in relapsed, regardless age limitation, along with the ongoing evaluation by the European EMEA, represent the basis for a large clinical application of GO in myeloid malignancies potentially extended to paediatric patients with AML and to ALL CD33+.
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Rheumatoid Arthritis (RA) is a chronic inflammatory disease resulting in diarthrodial joints inflammation (particularly joints of hands, wrists, feet, knees, cubitus, ankles, shoulder, etc.) that is manifested by swelling and functional impairment. The associated complications, osteoporosis and cardiovascular disease, make RA important in public health terms. During the active phase of disease, elevated plasma concentrations of inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and acute-phase proteins, lead to reduction of fat free body mass (FFM) with a loss mean of 15% of cell body mass (CM) and consequent reduction of muscle strength. ⋯ Proper antioxidant nutrients (Vitamin A, Vitamin C, selenium) may provide an important defence against the increased oxidant stress and a supplementation of folate and vitamin B12, in patients treated with methotrexate (MTX), reduce the incidence of side effects and offset the elevation in plasma homocysteine frequent in these patients. Calcium and vitamin D, in patients treated with corticosteroids, reduce the bone loss, while a supplementation with iron may prevent anaemia. Finally, elimination diets may be feasible therapy only in patients with positive skin prick test.
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La Clinica terapeutica · Jul 2004
Review[Community acquired pneumonia of hospitalised patient in the ordinary ward].
Despite the evolution of the respiratory diagnostic methods and of the microbiological techniques and despite the introduction of new and effective antimicrobial drugs, community-acquired pneumonia (CAP) still remains a common and potentially lethal disease, as it represents the sixth general cause of death and the first cause of death concerning the infective diseases. The prolonged survival of patients affected by chronic respiratory and non-respiratory disorders and the worrying problem of antibacterial resistance showed by several pathogen agents constitute the possible causes of the epidemiological importance of CAP which still carries on significantly affecting health costs. In this review the author describes the epidemiological, etiological, microbiological, diagnostic and therapeutic aspects of CAP which requires hospitalisation in a non-intensive care setting.