Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Over the past few decades, the progressive aging of the population combined with the resulting increase in cardiovascular disease and the marked improvement of technologies applied to surgery justify the marked increase of the elderly patients requiring cardiovascular surgery. This claims a highly skilled perioperative management, which should be aimed at treating cardiac disease without increasing risk of hospitalization-related harmful events. Current preoperative assessment for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II (EUROSCORE II) and the Society of Thoracic Surgeons (STS) risk score, are limited in their ability to predict perioperative outcomes in older patients. This is because patients' chronological age should not be considered as the only tool to identify the surgical risk. ⋯ Therefore, further research is needed in order not only to identify a unique, fast and easy to use tool aimed to recognize frailty syndrome, but chiefly resulting able to give us information about the effectiveness of focused preoperative interventions. Finally, we need to have scientific data on the role that surgical, percutaneous and transcatheter procedures have on outcome in elderly patients in terms of perioperative mortality, postoperative quality of life and regarding the possible reversibility of frailty. Cardiovascular surgery is to date a "moving target", due to changing face of patients and changing face of technical requirements and perioperative management should reflect such changes.
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Monaldi Arch Chest Dis · Jul 2017
Case ReportsGradually worsening dyspnea and dry cough in an elderly patient.
Primary tracheal chondrosarcomas are an extremely rare condition that affect adult of all ages, 24% being more that 70 years old. The progression may be slow, with symptoms that may continue up to 72 months before diagnosis is made. The clinical manifestations, that include a combination of nonproductive cough, wheezing, and dyspnea without hemoptysis often leads to misdiagnosis of asthma or chronic obstructive pulmonary disease. We report a case of an 87-year-old male, a Medical Doctor, with such a history, in whom a diagnosis of a tracheal chondrosarcoma was finally performed, 12 months after the first manifestation of the disease.
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Monaldi Arch Chest Dis · Jul 2017
Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam.
Endobronchial Ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is usually performed under general anesthesia or deep sedation with drugs such as Propofol that, at least in Italy, can be administered only by an anesthesiologist. Aim of the study was to assess conscious sedation feasibility, safety and tolerability using Meperidine and Midazolam as administered by Pulmonologist and relevant impact on the efficiency of the sampling procedures. All patients undergoing EBUS-TBNA from February 2013 to July 2014 were examined retrospectively. ⋯ A 27% cost reduction was calculated. EBUS-TBNA under conscious sedation using Meperidine and Midazolam prescribed and administered by pulmonologist without the Anesthesiologist assistance, revealed to be a safe, well tolerated and cost saving procedure. The efficiency of sampling was good, apart from a relatively low diagnostic yield due to different expertise of operators.
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Monaldi Arch Chest Dis · May 2017
Observational StudyAssociation of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome.
Clinical judgement and suspicion of influenza based on signs and symptoms of influenza-like illness and severe acute respiratory illness are critical for better patient outcome. Whether clinical characteristics of patients are associated with the development of acute respiratory distress syndrome and PCR positivity of samples was the aim of this study. We included all patients (n=37) presenting with influenza like illness (ILI) or severe acute respiratory illness (SARI) to a tertiary care hospital in northwest Pakistan during December 2015 until the end of January 2016. ⋯ The presence of Influenza type A/H1N1pdm09 strains was confirmed in 7/11 patients. However no significant difference was observed in the clinical features and complications of PCR positive and negative patients. Clinical signs and symptoms of influenza-like illness or severe acute respiratory illness significantly predict the development of complications irrespective of the positivity or negativity of laboratory qPCR reports.
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Monaldi Arch Chest Dis · Oct 2016
Advances in exercise rehabilitation for patients with Lower Extremity Peripheral Artery Disease.
Patients with Lower Extremity Peripheral Artery Disease (LEPAD) have been recently identified as target groups for structured Cardiac Prevention and Rehabilitation (CPR) programs, whose core components and intervention goals are now well recognized. Historically, exercise training (ET) programs have been employed for the treatment of LEPAD with typical intermittent claudication, and several meta-analysis documented improvements in walking distances of enrolled patients. Both in American and European guidelines, a frequency of at least 3 sessions per week and program duration of 12 weeks were judged as optimal, while recommended sessions lengths were 30-45 minutes and 30-60 minutes respectively. Among emerging aspects in the field of LEPAD rehabilitation, 1) the extended role of CPR programs in stages other than that of intermittent claudication, 2) an updated identification of predictors of poor outcome after ET, 3) the attributable effect of exercise on global cardio-respiratory fitness in LEPAD, 4) the combination of ET and invasive measures for advanced stages of LEPAD, and 5) the role of community walking programs have been discussed.