La Clinica terapeutica
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La Clinica terapeutica · Nov 2012
Case ReportsSpinal arteriovenous malformation presenting with prolapsed intervertebral disc: a diagnostic dilemma.
The availability of multiple investigating modalities should be utilized to arrive at the correct diagnosis of the spinal arteriovenous malformation (AVM). We hereby report the case of a 21-year-old, obese female, who presented with paraplegia and impaired bowel control two years after an episode of the fall. ⋯ A diagnosis of a spinal arterio-venous fistula was confirmed after a spinal angiogram. The dilemma of treating the right pathology for the clinical signs and symptoms are being discussed.
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La Clinica terapeutica · Nov 2012
Unusual innervation pattern of pectoralis minor muscle-anatomical description and clinical implications.
The highlight of the current case study is unique branching pattern of the medial pectoral nerve in relation to the pectoralis minor muscle. In addition, the third thoracic spinal nerve also was observed to penetrate the muscle. The lateral pectoral nerve did not innervate the muscle. ⋯ The possible clinical consequence of much an anomaly could be motor and sensory loss associated with accidental injury of these multiple nerves penetrating the substance of pectoralis minor while performing axillary lymphadenectomy. In accordance to the above case description, the surgeon should be cautioned of these possible neural branches while performing axillary dissection in mastectomy. Additionally, iatrogenic sensory or motor losses may be prevented by appropriate knowledge of these variations.
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La Clinica terapeutica · Jul 2012
Review[Atheroembolism renal disease: diagnosis and etiologic factors].
Atheromatous renal disease is the major cause of renal insufficiency in the elderly, and cholesterol embolism is a manifestation of this disease. Cholesterol embolism occurs in patients suffering from diffuse erosive atherosclerosis, usually after triggering causes, such as aortic surgery, arterial invasive procedures (angiography, left heart catheterization and coronary angioplasty) and anticoagulant or thrombolytic therapy. It is characterized by occlusion of small arteries with cholesterol emboli deriving from eroded atheromatous plaques of the aorta or large feeder arteries. ⋯ Skin and renal biopsy specimens are the best sample for histologic diagnosis. There is, at present, no pharmacological treatments shown to be effective in altering the course of the disease. Management is limited to supportive therapy and avoidance of anticoagulation; aortic procedures should be postponed.
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La Clinica terapeutica · Jan 2012
ReviewRole of noninvasive ventilation in elderly patients with hypercapnic respiratory failure.
The effectiveness of non-invasive ventilation (NIV) in treating patients with acute respiratory failure (ARF) is showed by its ability to diminish the recurrence to endotracheal intubation (ETI), the occurrence of ETI-associated lung infections as well as related mortality. A specific issue is the outcome of NIV in patients referring to Emergency Department for ARF who receive a do-not-intubate (DNI) order because of too critical conditions or advanced age. ⋯ The positive outcome was confirmed by a subsequent 3-year observation, that demonstrated an overall survival rate of 54%. These findings clearly suggest to treat by NIV elderly patients also in presence of a DNI order.
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La Clinica terapeutica · Jan 2012
Information needs of family members of critically ill patients in intensive care unit of a tertiary hospital.
BACKGROUND AND AIMS. The experience in intensive care unit (ICU) has created an intense emotional situation both to patients and their family members. The aim of this study was to determine the family members information needs of critically ill patients in ICU. ⋯ The results suggest that family members perceived support and proximity as the most crucial need. Comfort need was viewed as least important. Although this study was conducted in a tertiary hospital, the findings could still provide insight for nurses to improve the delivery of care to patients and family members.