Recenti progressi in medicina
-
Comparative Study
[Transthoracic echocardiography in the diagnosis of pulmonary embolism].
Transthoracic echocardiography is advocated by some as a useful diagnostic test for patients with suspected pulmonary embolism (PE), but its diagnostic accuracy is unknown. Recently, the sensitivity and specificity of transthoracic echocardiography in the diagnosis of PE was determined prospectively in unselected patients using pulmonary angiography as a reference diagnostic standard. ⋯ These echocardiographic diagnostic criteria for PE yielded a sensitivity of 56% and a specificity of 90%. Because of its inherent poor sensitivity, transthoracic echocardiography should not be used as a routine test to screen patients for suspected PE.
-
We describe the case of an aged patient, presenting an acute onset of flaccid paralysis of the limbs and bulbar weakness, complicated by ab ingestis pneumonia. These neurological findings were the first signs of a thyrotoxic crisis and showed a progressive regression together with the healing of the hyperthyroidism obtained, within two months, utilizing thyroid inhibitors. ⋯ The hypokalaemia was corrected after many infusions of KCl i.v., without obtaining significant modifications of the neurological picture. Taking into consideration the evolution and the results of the instrumental procedures (EMG, MRI) we believe this a rare case of thyrotoxic acute myopathy, with bulbar involvement, casually associated to hypokalaemia.
-
Clinical studies have shown that noninvasive positive pressure ventilation (NPPV) have significant advantages in the treatment of respiratory failure due to COPD. Reduced intubation need, decreased complications and mortality and less hospitalization in intensive care unit are recognized benefits of NPPV. ⋯ The contrasting results were obtained from studies with small patients number, short time observation and different patient's selection. Therefore randomized and controlled studies with a great number of patients are essential to evaluate the effects of NPPV in stable COPD patients with chronic retention of CO2, not only in survival but also in quality of life.