Eur Rev Med Pharmaco
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Eur Rev Med Pharmaco · Nov 2008
ReviewConservative and radical oncoplastic approches in the surgical treatment of breast cancer.
In the attempt to optimise the balance between the risk of local recurrence and the cosmetic outcomes in breast surgery, new surgical procedures, so-called oncoplastic techniques, have been introduced in recent years. The term oncoplastic surgery refers to surgery on the basis of oncological principles during which the techniques of plastic surgery are used, mostly for reconstructive and cosmetic reasons. The advantage of the oncoplastic surgery for breast cancer is the possibility of performing a wider excision of the tumour with a good cosmetic result. ⋯ Careful patient selection and preoperative planning are key components for the success of any oncoplastic operation for breast cancer. Accurate preoperative evaluation of the clinical and biological features of the tumour as well as of the morphological aspects of the breast allow the surgeon to make a decision if a conservative or radical approach is preferable and select the most effective oncoplastic surgical technique. In this review we summarise the indications, advantages and limitations of several oncoplastic procedures.
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Eur Rev Med Pharmaco · Aug 2008
ReviewNew approaches to the treatment of opioid-induced constipation.
Opiates are indispensable for the treatment of moderate to severe pain. The gastrointestinal tract is one of the major victims of the undesired effects of opiates, because the enteric nervous system expresses all major subtypes of opioid receptors. As a result, propulsive motility and secretory processes in the gut are inhibited by opioid analgesics, and the ensuing constipation is one of the most frequent and troublesome adverse reactions. ⋯ Postoperative ileus associated with opioid-induced postsurgical pain control is likewise ameliorated by the compounds. With this proof of concept, several phase III studies are under way to define optimal dosage, dosing regimen as well as long-term efficacy and safety of methylnaltrexone and alvimopan. In addition, there is preliminary evidence that these peripherally restricted opioid receptor antagonists may act as prokinetic drugs in their own right.
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Eur Rev Med Pharmaco · Jan 2008
ReviewPathogenesis, diagnosis, and management of disseminated intravascular coagulation: a literature review.
Disseminated Intravascular Coagulation (DIC) is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the circulation, occurring in the course of severe diseases. ⋯ Recent research on DIC, resulted in the development of diagnostic algorithms for the diagnosis of the syndrome and better supportive therapeutic strategies.
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Eur Rev Med Pharmaco · Sep 2007
ReviewUpdate in the treatment of locally advanced breast cancer: a multidisciplinary approach.
Locally advanced breast cancer represents a wide variety of neoplasms and constitutes approximately 10%-20% of the newly diagnosed breast cancers. These cancers may have widely different clinical and biological characteristics. ⋯ The clinical treatment of locally advanced breast cancer is complex and should be tailored to the individual patient. In this paper we discuss the options of management of locally advanced breast cancer, focusing on a multidisciplinary approach through a combined-modality care involving surgery, radiotherapy and systemic therapy.
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Eur Rev Med Pharmaco · May 2007
Review Comparative StudyThe use of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema.
The patient with acute heart failure may present with acute cardiogenic pulmonary edema (ACPE), a condition accompanied by severe respiratory distress, with crackles over the lung and orthopnea, and an O2 saturation usually < 90% on room air, prior to treatment. Non-invasive ventilation is the delivery of assisted ventilation without the need for endotracheal intubation and an invasive artificial airway. Two techniques are used for ventilatory support: continuous positive airway pressure (CPAP) and non-invasive positive-pressure ventilation (NPPV). ⋯ Recent literature showed that CPAP and NPPV both significantly decrease the need for endotracheal intubation, and CPAP significantly decreases mortality when compared to standard medical treatment. These techniques resulted safe and there is no evidence of increased risk of acute myocardial infarction (AMI) with either of them. Although both CPAP and NPPV present similar efficacy, CPAP has been shown to be cheaper and easier to implement in clinical practice and it could be considered the preferred intervention in patients with ACPE especially in the Emergency Department setting.