Recenti progressi in medicina
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Failing to define what is meant by euthanasia often complicates the ethical debate, and exacerbates the conflict between supporters of different views. The scientific and technological progress of modern medicine may lead to difficult dilemmas when available treatment can only prolong the process of dying, or achieve survival at the expenses of severe residual disability. As an example, the case of neonatal intensive care is discussed on the basis of the results provided by an international research project (EURONIC) aimed at investigating end-of-life decision-making in several European countries.
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The liver controls pulmonary vascular tone by releasing vasoactive substances. In severe liver failure, the imbalance between vasodilator and vasoconstrictive mediators may lead to alteration of the respiratory function, called as hepatopulmonary syndrome (HPS, when a significant decrease of the vascular pulmonary resistance occurs, with development of intrapulmonary vascular dilatations) and portopulmonarv hypertension (PPH, when the vasoconstrictive prevalence, with an increase of the pulmonary vascular resistances). ⋯ The alteration of pulmonary vascularization may be diagnosed by means of pulmonary angiography, contrast-enhanced echocardiography and perfusion lung nuclear scanning of the lungs. Both clinical syndromes respond poorly to medical treatment, the unique therapeutical possibilities being represented by orthotopic liver transplantation (or combined heart-lung-liver or lung-liver transplantation in patients with severe PPH).