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R Scala

Publications and source records attributed to R Scala.

31 records · Page 2Linked to original sources
PubMed1993

[Cystic lymphangioma of the retroperitoneum. A case report].

Cystic lymphangioma of the retroperitoneum is a primary mesodermal derived benign neoplasm, arising from retroperitoneal lymphatics. The Authors report a case of cystic lymphangioma of the retroperitoneum recently observed, and a review of the international literature registering 181 cases from 1958 up to nowadays. Retroperitoneal localization, sub-clinic evolution and the impossibility to preoperatively define the histological type of the tumour, in spite of the modern diagnostic techniques, explain the difficulties to reach a correct differential diagnosis. The authors conclude that surgery only allows to exactly localize the tumour, yet the definition of cystic lymphangioma is an histological goal.

Female↗
PubMed1993

[Significance of prognostic parameters in acute pancreatitis].

The diagnostic and therapeutic approach to Acute Pancreatitis (A.P.) is directly related to the clinical presentation. The Authors reviewed the data of 66 patients, hospitalized between October 1989 and December 1991, to verify the effectiveness of the prognostic criteria suggested by Ranson (1974), Mercadier (1977) and Imrie (1978). A.P. was of biliary origin in the majority of the patients (63.5%); five patients (7.5%) had an acute alcoholic pancreatitis, while the aetiology was traumatic or unknown in the remaining cases. A complicated clinical course was defined by the development of pseudocyst, pancreatic abscess, digestive haemorrhage, death or prolonged hospitalization (more than 20 days). The 28.8% of the patients developed complications during hospitalization. There were seven pancreatic pseudocysts, six pulmonary complications, three renal insufficiencies, two vascular complications, two sepsies and a gastrointestinal haemorrhage. The mean hospitalization period was 15.1 days (range 1-112). The Authors conclude that the three different prognostic criteria are equally useful to test the severity of A.P. attacks allowing to identify patients with the higher risk to develop complications during hospitalization.

Acute Disease↗
PubMedDate not supplied

Bi-level home ventilators for non invasive positive pressure ventilation.

With the widespread use of non-invasive positive pressure mechanical ventilation, great efforts have been made to produce machines, the bi-level home ventilators, which are less sophisticated, cheaper and able to better compensate air leaks with respect to the domiciliary volume-target machines and the traditional ventilators used in intensive care unit. As consequence of quick technologic evolution, bi-level home ventilators may be nowadays successfully applied for both the non-invasive ventilatory domiciliary treatment of chronic respiratory failure and the management of acute respiratory failure especially outside the intensive care setting. In this paper, the author describes the technical aspects, the individual characteristics and the clinical applications of the most common used bi-level ventilators.

Equipment Design↗
PubMedDate not supplied

Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: clinical experience of a respiratory ward.

BACKGROUND: Although a controlled trial demonstrated that non-invasive positive pressure ventilation (NIV) can be successfully applied to a respiratory ward (RW) for selected cases of acute hypercapnic respiratory failure (AHRF), clinical practice data about NIV use in this setting are limited. The aim of this observational study is to assess the feasibility and efficacy of NIV applied to AHRF in a RW in everyday practice. METHODS: Twenty-two percent (216/984) of patients consecutively admitted for AHRF to our RW in Arezzo (years: 1996-2003) received NIV in addition to standard therapy, according to pre-defined routinely used criteria. Tolerance, effects upon arterial blood gases (ABG), success rate (avoidance a priori criteria for intubation) and predictors of failure of NIV were analysed. RESULTS: Nine patients (4.2%) were found to be intolerant to NIV, while the remaining 207 (M: 157, F: 50; mean (SD) age: 73.2 (8.9) yrs; COPD: 71.5%) were ventilated for >1 hour. ABG significantly improved after two hours of NIV (pH: 7.32 (0.06) versus median (Interquartiles) 7.28 (7.24-7.31), p<0.0001; PaCO2: 71.9 (13.5) mmHg versus 80.0 (15.2) mmHg, p<0.0001; PaO2/FiO2: 212 (66) versus 184 (150-221), p<0.0001). NIV succeeded in avoiding intubation in 169/207 patients (81.6%) with hospital mortality of 15.5%. NIV failure was independently predicted by Activity of Daily Living score, pneumonia as cause of AHRF and Acute Physiology and Chronic Health Evaluation III score. CONCLUSIONS: In clinical practice NIV is feasible, effective in improving ABG and useful in avoiding intubation in most AHRF episodes that do not respond to the standard therapy managed in an RW adequately trained in NIV.

Aged↗
PubMedDate not supplied

[Hormonal therapy in oncologic treatment: pathogenic hypotheses and interactions between thyroid and breast pathologies].

INTRODUCTION: The aim to individuate the eventual correlation between the two pathologies has justified deeper studies to achieve new prospective approaches for both disease. BACKGROUND: We have selected 4 groups of patients who presented an association between the two pathologies: a) malignant breast pathology associated to a malignant thyroid pathology, b) patients with breast carcinoma who presented association with some thyroid alterations, c) patients with thyroid carcinoma who presented association with some breast alterations, d) patients who presented some associations between benign breast pathology and benign thyroid pathology. MATERIALS AND METHODS: We have excluded all patients with a clear physiological or surgical menopausal status, and we've so considered only patients with a regular menstrual cycle. We've so selected a group of 120 patients and we've performed in all these patients during the early follicular phase the following exams: breast echographic evaluation and thyroid echographic-structure and volume determination and finally hormonal determinations we have so obtained two breast subgroups: 32 patients with hyperestrogenic integrative hormonal characteristics, 28 patients subjected to adjuvant hormonal therapy with hypoestregenic hormonal status and finally two thyroid subgroups, 22 patients showing clinical or subclinical hypothyroidism, 38 patients showing clinical or subclinical hyperthyroidism. We've compared these data to a random age-matched health control women group of 25 patients. RESULTS: The first group of patient showed a thyroid hormonal pattern of subclinical hypothyroidism or at least free T3 and free T4 mean value currently under and TSH and TPO Ab levels curve currently over the mean values of the control group. The second group showed the TSH suppressed with free T3 and free T4 curves currently over the mean value of the control group. The third group showed slight elevations in serum PRL levels curve. The fourth group showed increased estrogen levels-curve, often over the mean value of the control group. CONCLUSION: How much is it allowed to perform an hormonal therapy, specially for a benign pathology if we're not yet able to understand the deep and unknown interaction between breast and thyroid?

Adult↗
PubMedDate not supplied

[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.

Algorithms↗
PubMedDate not supplied

[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. Due to its poor tolerability, negative pressure NIV has been taken over by positive pressure technique. 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.

Home Care Services, Hospital-Based↗
PubMedDate not supplied

[Muscular fatigue in chronic respiratory insufficiency. Physiopathologic considerations and therapeutic strategies].

The Authors has performed a careful exam of the pattern of chronic airways insufficiency in children. They dwell on the reasons which determinate the increase of the inspiratory muscular load and of difficulty of inspiratory muscles. Continuing that exam, the chronic anoxia of muscular cells (a bioptic study) is correlated with functional troubles of muscular fibre. In addition to that the Authors subdivide several different illness of lung in children according to the different mechanism of respiratory insufficiency. They conclude with the exam of strategy to use to obtain the diminution of the muscular load and of respiratory insufficiency.

Child↗
PubMedDate not supplied

[Relationship between symptomatology of acute ischemic heart disease and glucose metabolism balance].

Diabetes mellitus is one of the most important cardiovascular risk factors. An increased prevalence of silent or paucisymptomatic myocardial ischaemia has been described in diabetic patients. The authors examined the relationship between glucose metabolism balance and acute ischemic heart disease symptoms in 174 patients: 46 diabetics and 128 non diabetics. Diagnosis of diabetes mellitus was made during admission to hospital in four patients. No differences of strength, length, type, site and radiation of pain between 46 diabetic patients and 128 non diabetics were found. As regards the other symptoms, the authors found that only dyspnoea and palpitations were prevalent in diabetic patients with ten-year or more-disease length. On the other hand, the prevalence of these two symptoms was not different between non diabetics and diabetics with less than ten-year-disease length.

Adult↗
PubMedDate not supplied

[Non-invasive nasal ventilation in a a case of hypercapnic coma].

Noninvasive positive pressure ventilation (NPPV) via nasal mask is well known to be effective in the treatment of acute respiratory failure (ARF) secondary to chronic obstructive pulmonary disease (COPD). A case of ARF with hypercapnic coma due to exacerbation of COPD is described. Six hours of conservative therapy with oxygen and medical treatment did not show any result. As endotracheal intubation (ET) was avoided on the basis of advanced age, poor life expectancy of the patient and family wish, NPPV was set up using a pressure triggered ventilator. After 61 hours of uninterrupted NPPV, the acid-base alteration and the lethargic status was fully reversed. The conclusions is drawn that NPPV may be useful also in the treatment of patients affected by severe decompensated hypercapnic respiratory failure in whom ET is not indicated.

Aged↗