Recenti progressi in medicina
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In Italian Territory Medicine there is no consolidated habitude, by Family General Practicioners and Paediatricians, to use Guidelines for diagnosis and management of diseases. Therefore, 19 General Practicioners, organized in a cooperative group, have identified a guideline on COPD, a disease often underdiagnosed and inappropriately treated, and verified, over 3 years of application, if it is possible, in clinical practice, to modify diagnostic-therapeutic habitudes. The results - even inferior to expectations for most of the indicators used - showed an increase in the number of cases diagnosed as COPD, possibly linked to a greater use of spirometry and chest Rx.
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Editorial
[Reflections on the use of non-invasive mechanical ventilation in acute respiratory failure].
Given its prevalence into the clinical practice, non-invasive ventilation (NIV) can be included among the cornerstones of medicine. Just think of the acute applications of NIV which are in constant expansion, from COPD exacerbation to severe de novo hypoxemia, from postoperative distress to extra-hospital use in acute pulmonary edema, from ongoing support of interventional procedures to delicate strategies for end of life in terminally ill oncologic and non-oncologic patients. The thought should be focused on how, by whom, where and to whom is delivered this mode of artificial ventilation to avoid the risk of trivialization and flattening.
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Acute mesenteric ischemia/infarction is a complex and often misdiagnosed syndrome. The availability of new imaging methods, namely multislice computed tomography, has enabled early recognition of signs and symptoms of acute mesenteric ischemia, resulting in timely therapeutic intervention.
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Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. ⋯ The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.
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The aim of this study was to assess diagnostic accuracy of multislice CT in restaging patients with N2 non-small cell lung carcinoma after neoadjuvant chemotherapy, using a multiparametric approach as compared with traditional size-based radiological criteria. All patients staged as N2 at histologic examination after neoadjuvant chemotherapy were correctly staged with multislice CT (sensitivity, specificity, positive and negative predictive value, and accuracy were 100%, 80%, 85%, 100% and 93,7% respectively, vs 34%, 60%, 34%, 60% and 50% using size-based criteria), suggesting that a multiparametric approach results in improved diagnostic accuracy.