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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Monaldi Arch Chest Dis · Apr 2004
Case ReportsFibrosing mediastinitis causing rapidly progressive dyspnea, pulmonary edema and death in a 16 yr old male.
Idiopathic fibrosing mediastinitis is a rare entity involving more severely the more compliant structures within the mediastinum. In this report a rare case of simultaneous involvement of both the superior vena cava (SVC) and pulmonary veins is described in a 16--year old male with progressive dyspnea on exertion, cough and a three months' history of blood--tinged sputum. Physical examination and imaging studies revealed signs of pulmonary venous hypertension (PVH) and SVC stenosis. Fibrosing mediastinitis was confirmed by multiple biopsy samples.
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Monaldi Arch Chest Dis · Apr 2004
Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: clinical experience of a respiratory ward.
Although a controlled trial demonstrated that non-invasive positive pressure ventilation (NIV) can be successfully applied to a respiratory ward (RW) for selected cases of acute hypercapnic respiratory failure (AHRF), clinical practice data about NIV use in this setting are limited. The aim of this observational study is to assess the feasibility and efficacy of NIV applied to AHRF in a RW in everyday practice. ⋯ In clinical practice NIV is feasible, effective in improving ABG and useful in avoiding intubation in most AHRF episodes that do not respond to the standard therapy managed in an RW adequately trained in NIV.
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Monaldi Arch Chest Dis · Mar 2004
Review[Cardiologic assessment in candidates for non-cardiac surgery].
Cardiovascular complications are important causes of morbidity and mortality with major non cardiac procedures. The aim of preoperative cardiac evaluation is more appropriately the initiation of a process of communication between Cardiologist, Surgeon and Anesthesiologist, with the purpose of performing an evaluation of patient's clinical risk profile and of providing the more cost-effective strategy to reduce risk of cardiac complications. There is general agreement that an accurate clinical evaluation is necessary and often sufficient for preoperative cardiac risk assessment. ⋯ According to the integrated valuation of these four parameters we can identify the patients who need additional noninvasive testing from those who can directly undergo noncardiac surgery. Preoperative testing should be limited to circumstances in which the results will affect patient management and outcomes. Coronary angiography and following revascularization have the same indications as if performed in the non-operative setting.
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Monaldi Arch Chest Dis · Jan 2004
Quality of generated diagnosis related groups in Italian Respiratory Intermediate Care Units.
To date we lack official data on tipology of Diagnosis Related Groups (DRGs) and their quality in Italian Respiratory Intermediate Care Units (RICUs). ⋯ Severe pulmonary diseases determined the case mix of patients cared for in the Italian RICUs during the observed period. The Italian RICUs offer high quality assistance and are characterised by high mean weight per treated patient. However, the activity has been under-estimated due to the low sensitivity of the ICD9 classification system used in the recognition of the real disease and in the correct generation of relative DRG. The ICD9 classification system penalised the recognition of respiratory failure in particular.
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Monaldi Arch Chest Dis · Jan 2004
ReviewRespiration during sleep in neuromuscular and thoracic cage disorders.
Many of the neuromuscular and thoracic cage disorders are associated with disorders of breathing during sleep. The abnormal mechanics of the chest wall impairs respiratory muscle function and this is compounded if there is underlying muscle weakness. Respiratory abnormalities appear during REM sleep before NREM or wakefulness. ⋯ Arousals from sleep return the blood gases towards normal, but cause fragmentation of sleep, leading to daytime sleepiness. Ventilatory failure occurs particularly if the vital capacity is less than 1.0-1.5 litres or if the maximal inspiratory mouth pressure is less than 20-25cmH2O. Non invasive ventilation effectively prevents both central and obstructive apnoeas and improves the sleep architecture and daytime blood gases.