Acta bio-medica : Atenei Parmensis
-
Castleman's Disease is a rare tumour involving lymph node tissues; a case of benign localized disease and a case of rapid progressive multicentric disease are reported. Case report 1: A 19-year-old man presented with four months of hypogastric and left iliac pain. Castleman's Disease was suspected after CT-scan. ⋯ The diagnosis was Castleman's Disease in both sites. In course of steroid therapy retroperitoneal multiple nodes appeared associated with fast-progressive mechanic jaundice and liver failure. Progressive multi-organ failure arose within 1 week, with irreversible clinical worsening to death.
-
Ventilator associated pneumonia (VAP) is the most common nosocomial infection at ICUs, with high mortality and morbidity. The diagnostic method for VAP is based on the combination of clinical, radiological, and microbiological criteria. Lower respiratory tract culture results are useful to confirm the etiology of VAP and adjusted antibiotics. Endotracheal aspiration (EA) is the simplest noninvasive technique for performing lower respiratory tract culture, with high sensitivity and moderately high specificity. The aim of this survey was to evaluate the quantitative cultures of endotracheal aspirates in VAP patients and the sensitivity patterns of microorganisms through E-test. ⋯ Tracheal aspirates in combination with clinical findings show important roles in the management of VAP and decrease inappropriate antimicrobial therapy. S. aureus is the main agent leading to VAP in the TICU of the Loghman Hakim Hospital.
-
High energy trauma is often responsible for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. ⋯ The final consequence of a mayor bleeding is hypovolaemic shock. The reduced oxygen tension of the tissue may be responsible for heart attack, arrhythmia, stroke, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications.
-
Case Reports
Caesarean delivery through deliberate posterior hysterotomy in irreducible uterine torsion: case report.
Gravid uterus rotation is a normal finding in the third trimester of pregnancy. However, a rotation greater than 45 degrees around the longitudinal axis of the uterus--uterine torsion--is a rare pathological condition in the obstetrical practice. We reporte the case of 180 degrees torsion of a myomatous uterus at preterm in which the foetus, in breech presentation, was delivered through a deliberate posterior hysterotomy. ⋯ Uterine torsion treatment depends on when the torsion occurs during the pregnancy. However, laparotomy is imperative in all cases. When derotation of the uterus is not possible, a transverse incision in the lower posterior uterine segment, if feasible, is a safe choice.
-
The increasing proportions of older persons accounting for global populations, and the implications for increasing rates of chronic diseases such as type 2 diabetes mellitus, continue to be a cause of concern for clinicians. Considering that older persons are a very heterogeneous group of individuals, the management of type 2 diabetes is particularly challenging. Once type 2 diabetes is diagnosed, the principles of it's management are similar to those in younger patients, but with special considerations linked to the increased prevalence ofcomorbidities and relative inability to tolerate adverse effects of medication and hypoglycemia. ⋯ Available anti-diabetic oral drugs include insulin secretagogues (meglitinides and sulfonylureas), biguanides (metformin), alpha-glucosidase inhibitors, thiazolidinediones (TZDs) and newly introduced glucagon-like peptide-1 (GLP-1) analogues and inhibitors of GLP-1 degrading enzyme dipeptidyl peptidase-4 (DPP-4). Unfortunately, as type 2 diabetes progresses in older persons, polypharmacy intensification is required to reach adequate metabolic control with the risk of adverse effects due to age-related changes in drug metabolism. The present review discusses the European Diabetes Working Party guidelines for type 2 diabetes in older persons with and without frailty and their importance on preventing or at least slowing down diverse aspects of disability.