La Clinica terapeutica
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La Clinica terapeutica · Jan 2009
[Our experience in the chemical spinal neuromodulation in chronic pain from spinal collapse due to osteoporosis.].
Osteoporosis is a metabolic disease of the bone characterized by reduced bone mass and microstructural deterioration of bone tissue with a consequent increase in bone fragility and risk of vertebral collapse. Treatment of osteoporosis with the new molecule is effective in improving the density and quality of bone but does not provide an analgesic effect for patients with vertebral collapse. The treatment of chronic pain from vertebral collapse is difficult and may require the use of opioids, but for some patients the intake of these drugs is burdened with systemic side effects. The aim of our study is to use the way in reducing intrathecal opioid dosage and at the same time have good pain control without significant side-effects. We report our experience in the use of continuous infusion pump for intrathecal morphine in patients with chronic pain from osteoporotic vertebral collapse that can not tolerate therapy with systemic opioids because of severe side effects. ⋯ This study demonstrates that intrathecal-morphine therapy offers patients relief from pain and a good quality of life. Continuous intrathecal infusion of morphine is a valuable therapy and is particularly suitable for those patients who show side effects with the administration of systemic opioids.
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La Clinica terapeutica · Jan 2009
[Triage in the emergency department. Practical and ethical issues].
Triage is a complex and dynamic decisional process composed of sequential actions and necessary evaluations in order to establish the priority of access to medical attention in emergency care. In the Triage not only medical-biological knowledge is important but also the methods that together are inspired by ethical models. Following the historical considerations and after having brought out the methods and practice used in various countries and also having underlined the personal experience of the Emergency Department of the Emergency Department of the University Policlinic of the "Sapienza" University of Rome (Italy), the biggest hospital in Europe, the authors emphasized the nursing care in the "triage" and support the necessity of an adequate training period not only to acquired the technical knowledge required but also the psychological and social interaction as well as moral and practical competence. By "practical" we intend it to be explicitly a dimension in which moral competence has been acquired in using concrete first person action in a virtuous way towards the betterment of the sick person using the best modes of justice.
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La Clinica terapeutica · Jan 2009
Our experience on pain palliation of bone metastasis with Sr-89 or Sm-153 in cancer patients resistant to a conventional analgesic therapy. A retrospective study.
These retrospective study is aimed to evaluate the efficacy of therapy with Stronthium-chloride 89 (89SrCl) and Samarium 153 conjugated with ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP) in the palliation of bone pain due to metastatic malignancy. ⋯ Radionuclide therapy with bone-seeker agents 89Sr and 153Sm in the palliation of painful bone metastases allows a partial/total relief of pain with an improvement of quality of life. No tumoricid effect was found. Haematological toxicity was limited and reversible. Patients with prostate cancer seem to have a higher response rate.
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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.
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La Clinica terapeutica · Nov 2008
ReviewAntioxidant properties of anesthetics: the biochemist, the surgeon and the anesthetist.
General anesthesia can impair immunological defense mechanisms while inducing an inflammatory reaction. Generalized inflammatory reactions involve leucocytes which in turn release inflammatory mediators and free oxygen radicals. ⋯ Similarly, other anesthetics show antioxidant and protective roles but this mechanism is to be related to their ability to induce antioxidant enzyme (i.e., heme oxygenase-1). The aim of the present review is to evaluate the antioxidant properties of anesthetics in various experimental models and if they may be considered efficient therapeutic tools in counteracting oxidative stress during general anesthesia and sedation in ICU.