Minerva medica
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Extracorporeal membrane oxygenation (ECMO) technology has undergone significant advancement in the last several years. These changes have led to more compact circuits that are increasingly efficient at gas exchange while decreasing the complication rates often associated with its use. The ability to remove carbon dioxide at relatively low flows has broadened the application of ECMO in the management of respiratory failure. As this technology continues to evolve, there is great promise of a portable lung replacement therapy, an artificial lung, which would have far-reaching implications in the approach to both acute and chronic respiratory failure.
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Cervical radiculopathy is a mixed pain syndrome characterized by neuropathic, skeletal and myofascial pain. This condition is frequently found in developed countries and is a significant source of disability and a reason for frequent medical consultation. In our Pain Therapy Centre, cervical radiculopathy is initially treated with bi-weekly cycles of mesotherapy coupled, at least 15 days later, with physiotherapy to reach the complete mobilization of cervical spine. Cervical radiculopathy is a localized neuro-pathic pain and in agreement with international guidelines, we checked if patients treated topically with 5% lidocaine medicated plaster may benefit in improving pain management and in reducing the time necessary to start physiotherapy. ⋯ For all analyzed parameters, both treatments were effective, but patients treated with 5% lidocaine medicated plaster showed faster control of the painful symptoms, an essential condition for an earlier rehabilitative treatment.
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Since the early 1960s, several authors reported on the use of some experimental artificial liver devices in order to support patients with either acute liver failure (ALF) or end-stage chronic liver disease. In the 1980s, liver transplantation became an established real treatment replacing the whole liver with a major survival benefit. In the 1990s, the concept of albumin dialysis appeared as a new revolution in the concept of dialysis with the great capacity of removal of toxins, drugs and molecules strongly bound to albumin. ⋯ The performance of these systems would need further improvement. Large randomized trials are still needed in both patients with ALF and ACLF to establish the indications, the timing and the real place of liver support therapies. Meanwhile, early use of these devices in patients with ALF and ACLF could be considered as an additional tool among others in the management of these patients in specialized liver units.
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Acute pain of mild to moderate intensity is one of the problems most frequently encountered in primary care and emergency medicine and is a major reason of request for visit by patients. In recent years the focus has been more on the treatment of chronic pain, perhaps ignoring the negative impact of acute pain on quality of life and functional status of the patient, despite a growing number of evidence indicating the need to treat optimally also acute pain to avoid it prolongs in time. The remarkable progress achieved in the understanding of the physiological mechanisms of the nociceptive stimulus, as well as those common to biochemical inflammation and acute pain, highlighted the active and complex role of central nervous system in the genesis and maintenance of pain that from acute, if not promptly and adequately treated, can become chronic. ⋯ Pharmacokinetic parameters and pharmacodynamic studies are outlined, as well as the latest acquisitions in terms of metabolism of this drug and the risks related to its misuse. Are also discussed the recommendations issued by scientific societies and recent articles that indicate paracetamol as the drug of first choice for mild to moderate pain in various clinical settings, such as post-operative pain, post-traumatic and osteoarticular diseases, alone or in association with weak opioids, in particular with codeine. Most recent findings about metabolism and analgesic effect of codeine and its metabolites are highlighted, and how, in combination with acetaminophen, there is an increase in analgesic efficacy without increasing side effects, offering the chance of obtaining a better pain control.
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Mild, temporary hepatic failure (MTHF) may be completely asymptomatic or cause minimal signs and symptoms. This common clinical problem is very diffuse and, in case of repeated episodes may cause a chronic impairment in liver function. The aim of this registry was to evaluate the evolution of MTHF in subjects using Liverubin (a new standardized Silymarin preparation) over a 4-week period. ⋯ In conclusion, data from this pilot, registry study indicate a significant activity of Liverubin associated with a very good safety profile, in patients with temporary hepatic failure. The recovery of hepatic function is faster and more effective with Liverubin compared to the best "standard" management.