Panminerva medica
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Bronchoscopy is the most important tool in diagnosis of respiratory diseases, but also provides therapeutic options in various disorders. Besides hemoptysis, airway stenoses are a frequent indication for therapeutic bronchoscopy interventions. Thereby, a broad spectrum of endoscopic techniques including electrocautery, argon plasma coagulation, laser treatment, cryosurgery and stent implantation is available. In the last decade, development of new endoscopic modalities provides also treatment of patients with chronic obstructive pulmonary disease and uncontrolled asthma.
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Transthoracic ultrasonography (US) has become an essential modality for the evaluation of a wide range of thoracic pathologies by respiratory, emergency and critical care physicians. It can be performed with entry-level equipment and by personnel with minimal training. Its advantages include low cost, lack of radiation and immediate application at the point of care. ⋯ US-assisted fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes, lesions arising from the chest wall, pleura, peripheral lung and mediastinum are safe and have a high yield in the of hands of clinicians. US can potentially also guide aspiration and biopsy of diffuse pulmonary infiltrates, consolidations and lung abscesses. Transthoracic US may also be used for the detection of pulmonary embolism.
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Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of partial or complete upper airway collapse during sleep that is highlighted by a reduction in, or complete cessation of, airflow despite documented on going inspiratory efforts. Due to the lack of adequate alveolar ventilation that results from the upper airway narrowing, oxygen saturation may drop and partial pressure of CO2 may occasionally increase. The events are mostly terminated by arousals. ⋯ Obviously, epidemiological studies investigating the prevalence of OSAHS are all biased by the lack of a uniform definition. The prevalence of an AHI of >5 events · h-1 in a general population (without taking into account symptoms of sleepiness) has previously been estimated to be 24% in a male population. When symptoms of sleepiness were also taken into account, the prevalence decreased to 4% in males and 2% in females.
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Over the last 15 years, advances in acute ischemic stroke (AIS) management have led to a significant reduction in the morbidity and mortality related to this serious disease. This has resulted from progress in imaging technology, increased access to imaging procedures, enhanced coordination in stroke care from emergency departments to rehabilitation centers, development of organized inpatient stroke units, and to the widespread use of acute thrombolysis. Once the diagnosis of AIS is confirmed by neuroimaging, the etiological work up is conducted in parallel with therapeutic measures by stroke units. ⋯ Like myocardial infarction, ischemic stroke should be considered as a treatable emergency. Widespread public education regarding stroke symptoms, novel treatments, and time constraints for effective therapy should increase the number of patients that present within the first hours after stroke. Since "time is brain," early presentation is key to transforming trial results into effective stroke therapies.
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Pain is frequently reported following stroke, but seems to be an underemphasized phenomenon since it can importantly impact rehabilitation and long-term outcomes. Two major forms of pain have to be distinguished in patients with post-stroke pain: central, neuropathic pain, arising from the vascular lesion defined as central post-stroke pain (CPSP) and pain primarily triggered by peripheral mechanisms such as hemiplegic shoulder pain and spasticity-related pain. ⋯ This article aims at reviewing the pertinent evidence regarding clinical characteristics and mechanisms of post-stroke pain generation with a focus on CPSP. We discuss possible treatment options and highlight current pathophysiological concepts.