Recenti progressi in medicina
-
Cardiotoxicity is the most important side effect of the highly effective chemotherapeutic drugs anthracyclines. The total dose that must not be surpassed to avoid cardiotoxicity is specific for each anthracycline. For doxorubicin the maximal dose is 450-550 mg/mq. ⋯ Endomyocardiac biopsy is highly effective for the diagnosis, but is indicated only for selected cases. The therapy of anthracycline cardiomyopathy is directed mainly to the control of congestive heart failure. In the initial phase the treatment is based on the use of digitalis and diuretics, that are substituted in the following maintaining phase by ACE inhibitors.
-
Review Comparative Study
[Levels of scientific evidence and strength of clinical recommendations. From trials to guidelines. The Italian Group on Medicine Based on Evidence--(GIMBE)].
Evidence-based medicine is a new paradigm of clinical practice that promotes the collection, interpretation and integration of valid, important and applicable to patients research-derived evidence, and it can improve the efficiency and the effectiveness of health care. Nevertheless research often fails to get in clinical practice, also because the traditional tools used by physicians to solve clinical problems are less reliable as the volume/complexity of medical information and biomedical technology have grown exponentially. New tools are emerging to help physicians: the systematic reviews of randomized controlled trials and the clinical practice guidelines that summarize a great volume of medical knowledge to improve health care. ⋯ These combine the strength and heterogeneity of the primary studies with magnitude and precision of the treatment effects as it relates to the minimal clinical benefit. The recommendation may suggest therapeutic intervention when the baseline risk is high or otherwise when the baseline risk is low. The Authors discuss principles of evidence-based medicine, measures of treatment effectiveness, systematic reviews and methods used by experts to graduate the strength of clinical recommendations in producing practice guidelines.
-
The study about the adhesion molecules pointed out their pathogenetic role in a lot of diseases within cardiological, nephrological, oncological precincts and in a lot of infectious diseases. Their role was in fact pointed out in the ischemic heart disease and in the reperfusion damage, in the glomerulonephritis, in the tumoural metastatic processes, in the infectious and inflammatory chronic processes. The Authors considered the recent literature and emphasized the therapeutic possibilities that such an experimental approach seems to suggest.
-
Multiple organ system failure (MOSF) is a severe clinical process that causes progressive renal and liver failure. Acute pancreatitis (AP) can cause MOSF. Several series document high mortality rate from necrotizing forms is associated with MOSF. ⋯ So it is important to provide prophylactic use of antibiotics that are effective against expected bacteria and also achieve a therapeutic concentration in pancreatic tissue and juice. Fluid replacement, nutritional support and other therapeutic strategies must be employed to prevent MOSF. When the MOSF is clearly developed, medical and surgical measures are unuseful and the mortality rate is very high also in an intensive care unit.