Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
-
Monaldi Arch Chest Dis · Mar 2010
Review Case ReportsTuberculous pericarditis: three cases and brief review.
Tuberculous pericarditis is a form of extrapulmonary tuberculosis that is considered unusual in western coun-tries. Diagnosis is often challenging, while proper treatment has a major impact on prognosis. We present three interesting cases, with complicated or unusual manifestations of tuberculous pericarditis: a patient with cardiac tamponade as the initial manifestation of tuberculosis; a patient progressing to constriction despite adequate treatment; and a patient receiving anti-TNFalpha, who developed pericarditis in the context of immune reconstitution inflammatory syndrome. ⋯ In conclusion, tuberculous pericarditis remains an active thread in the western world. A high index of suspicion combined with the use of all available diagnostic techniques are important to increase diagnostic yield. Prompt and effective treatment is essential to reduce morbidity and mortality.
-
Monaldi Arch Chest Dis · Mar 2010
ReviewLong-term oxygen therapy in COPD: evidences and open questions of current indications.
Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO2 < 55 mmHg (7.3 kPa) or PaO2 ranging from 56 to 59 mmHg (7.4-7.8 kPa) in presence of signs of Cor Pulmonale, hematocrit > 55%. ⋯ The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.
-
Monaldi Arch Chest Dis · Sep 2007
ReviewThe patients with severe chronic obstructive pulmonary disease and chronic respiratory insufficiency.
Caring for patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure is difficult independent of whether the target is survival or quality of life (QOL). The role of inhaled drug therapy in this specific set of very severe COPD patients has not previously been assessed. The only drug able to prolong survival in these patients is long term oxygen therapy, whereas there is little evidence to indicate long-term domiciliary mechanical ventilation in the routine management of stable hypercapnic patients. ⋯ Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Lung Volume Reduction Surgery may improve mortality, exercise capacity, and QOL in selected patients, but is associated with significant morbidity and an early mortality rate in the most severe patients. Lung transplantation is a final step in end-stage patients, but short- and long-term outcomes remain significantly inferior in relation to other "solid" organs recipients.
-
Monaldi Arch Chest Dis · Mar 2007
ReviewAssessment and monitoring of ventilatory function and cough efficacy in patients with amyotrophic lateral sclerosis.
Assessing and monitoring respiratory muscle function is crucial in patients with Amyotrophic Lateral Sclerosis, since impaired function can lead to either ventilatory failure or respiratory tract infection. Spirometry, diffusing capacity of the lung, breathing pattern, sleep study, blood gas analysis and respiratory muscle strength tests, as well as cough peak flow and cough expiratory volume measurements can provide relevant information on ventilatory function and cough efficacy. ⋯ So far, the current literature has not highlighted any gold standard which stipulates when to commence ventilation and cough support in patients with Amyotrophic Lateral Sclerosis. A composite set of clinical and functional parameters is required for treatment scheduling to monitor lung involvement and follow-up in these patients.
-
Monaldi Arch Chest Dis · Dec 2006
Review[Hyperhomocysteinemia in pediatric age and nutritional aspects of folates: an early cardiovascular risk factor].
During the last decade, scientific evidence is mounting that elevated plasma levels of homocysteine are associated with an increased risk of atherosclerosis and cardiovascular ischemic events. Despite this evidence, however, there are still concerns about the mechanisms(s) by which homocysteine exerts its pro-atherogenic effect, and it is unclear whether the decreased plasma levels of homocysteine through diet or drugs may be paralleled by a reduction in cardiovascular risk. ⋯ Exercise training reduces plasma levels of homocysteine and improves endothelial function, however without evidence of a better outcome. Larger studies are needed in order to demonstrate that the reduction of plasma levels of homocysteine by oral supplementation with folates and vitamins B6 and B12 translates into a decreased incidence of ischemic events, in particular in patients with documented coronary artery disease and ischemic encephalopathy.