Panminerva medica
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Review Case Reports
Munchausen's syndrome. A case of factitious hemoptysis.
Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and detailed literature review, the authors report the case of a 22-year-old working-woman, with a history of asthma, Mediterranean anaemia and recurrent hemoptysis, who was admitted several times to the cardiovascular and Respiratory Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthmatic attack and wheeziness at rest. During the admissions the patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, tuberculin test, cold agglutinins and pneumotropic virus tests) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, bronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when she was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.
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Clinical Trial
Evaluation of effect and distribution of heparin administered in vascular reconstructive surgery.
The aim of this study was to find out whether intravenously administered heparin is distributed equally not only proximal but also distal to the arterial occlusion level in vascular reconstructive surgery. ⋯ In vascular reconstructive surgery which requires temporary arterial occlusion for as long as 80 minutes, the effect of heparin is excellent and equal throughout the body by collateral vessels, and the metabolic influence due to blockade of the blood flow is not so critical as to lead to cellular damage although anaerobic glycolysis is promoted distally due to hypoxia.
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Randomized Controlled Trial Clinical Trial
Many factors can affect the prevalence of hypertension in obese patients: role of cuff size and type of obesity.
To determine to what extent methodological errors, including measurements taken with inappropriate cuffs and/or inaccuracies in patient enrollment, can contribute to overestimating the prevalence of hypertension in overweight or obese women. ⋯ A comparison of different reports on the prevalence of hypertension in obesity reveals considerable differences, due mainly to age, sex, race and income level. Nevertheless, our data seem to indicate that even after adjusting for the above-mentioned variables, two significant confounding factors, cuff hypertension and the prevalence of android obesity in the obese study population, could be responsible for over-estimating the prevalence of hypertension. It should be noted that for certain groups of overweight and obese women, the prevalence of hypertension becomes similar to the rate found among the general population, as reported in many large epidemiological surveys.
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Paraplegia is a severe and disastrous complication of operations on the thoracic aorta. For preventing this complication, we employed evoked spinal cord potentials elicited by direct stimulation of the cord (ESPs-dsc) during operations on 83 patients with various aortic lesions (37 dissecting and 46 cases of nondissecting aneurysms, 35 descending and 48 thoracoabdominal aortic aneurysms). ⋯ During operation, four types of ESPs-dsc response pattern were observed: (1) no change (n = 57), (2) change with return (n = 15), (3) change with inconsistent return (n = 6), (4) change without return (n = 5). "Delayed" paraplegia occurred in two patients with "no change" and "change with return" response (3%), "immediate" paralysis occurred in three and "delayed" paraplegia occurred in one of those with "change with inconsistent return" response (67%), and all of those with "change with inconsistent return" response (67%), and all of those with "change without return" response developed "immediate" paraplegia (100%). We conclude that intraoperative monitoring of spinal cord function utilizing ESPs-dsc is a good indicator of spinal cord ischemia and we can improve the outcome according to its changes.
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Case Reports
Pulmonary edema and acute hypercapnic respiratory failure treated with bi-level nasal-CPAP: case report.
Noninvasive mechanical ventilation has been suggested for the treatment of patients with respiratory failure. We describe the case of a patient affected by bilateral cystic bronchiectasis and acute hypercapnic respiratory failure, due to a cardiogenic pulmonary edema, successfully treated with bi-level nasal-CPAP. This report suggests that in some cases noninvasive ventilatory support may mean avoiding tracheal intubation, even with critically ill patients.