Recenti progressi in medicina
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Acute respiratory failure (ARF) is one of the most common and severe urgencies of the modern medicine which may require the application of mechanical ventilation and a careful monitoring of the patient's conditions. With the popularity of non-invasive ventilation and the interest of the pulmonologist for the care of the respiratory critical patient, in Italy there has been the spreading of Respiratory Intensive Care Units (RICU), which are as intermediate specialist structures in terms of intensity of care between the General Intensive Care Unit and the ordinary ward. In this article, the author analysed the cultural, scientific and organizational aspects of the central role played by the pulmonologist who's working in the RICU in the complex intra-hospital multi-disciplinary management of ARF.
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Home parenteral nutrition is the primary treatment for intestinal failure. Intestinal transplantation is indicated when home parenteral nutrition fails or when there is a risk of death because of underlying disease. Survival after transplantation is related to the appropriateness of the indication and the timing of listing for transplantation.
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Hemp (Cannabis sativa L.) has been used since remotes ages as a herbal remedy. Only recently the medical community highlighted the pharmacological scientific bases of its effects. The most important active principle, Delta-9-tetrahydrocannabinol, was identified in the second half of the last century, and subsequently two receptors were identified and cloned: CB1 that is primarily present in the central nervous system, and CB2 that is present on the cells of the immune system. ⋯ Furthermore, parallels exist between opioid and cannabinoid receptors, and evidence is accumulating that the two systems sometimes may operate synergistically. The interest of the pharmaceutical companies led to the production of various drugs, whether synthetic or natural derived. The good ratio between the polyunsatured fatty acids omega-3 and omega-6 of the oil of Cannabis seeds led to reduction of the phlogosis and an improvement of the pain symptoms in patients with chronic musculo-skeletal inflammation.
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In a context in which there is doubt as to the efficacy and safety of cancer drugs recently put on the market, the off-label use of these drugs complicates the situation. The Italian government, unlike some others, has opted to lay down strict rules regarding off-label use, in order to ensure greater efficacy and safety for patients.
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Multicenter Study
[Effects of transdermal buprenorphine in cancer patients. Results from the Cancer Pain Outcome Research (CPOR) Study Group].
Pain still afflicts most cancer patients, mainly in the metastatic phases, and undertreatment is well documented. Transdermal delivery systems (TDS) could potentially have advantages over oral and parental routes, but evidence from comparative trials are scanty. In the framework of a wider initiative, an Outcome Research Study was carried out in Italy in 2006 to evaluate the effects of various analgesic options, particularly TDS Buprenorphine. Despite the limitations due to the observational design, these findings may be useful to clinicians to better judge the value of the drug under evaluation and to help researchers to design further comparative studies.