bluuebunny/crossref_metadata_2025 huggingface dataset:
Telemedicine: a new frontier for effective healthcare services
Authors: Scalvini S. , Vitacca M. , Paletta L. , Giordano A. , Balbi B.
Published: July 2016

Telemedicine can be defined as the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities. Such a wide definition includes many health care activities and a large number of applications have been tried, with variable degrees of interaction between all the players in the health care system. This review, starting from the need and opportunity that we are now facing to capitalize the great technological improvements in the field of information and communication technologies to improve also our health services, will illustrate the history, classification and main field of application of Telemedicine. Lastly, the available data on the application of Telemedicine for patients with respiratory diseases will be reviewed.
The treatment of Sleep Apnea Syndrome: looking for new answers for old problems
Authors: Fanfulla F. , Braghiroli A.
Published: July 2016

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Randomized trial of paroxetine in end-stage COPD
Authors: Lacasse Y. , Beaudoin L. , Rousseau L. , Maltais F.
Published: July 2016

Background: Although the underlying pathology is initially confined to the lungs, the associated emotional responses to chronic obstructive pulmonary disease (COPD) contribute greatly to the resulting morbidity. The objective of this study was to examine the effect of an antidepressant drug on disease-specific quality of life in patients with end-stage COPD who present significant depressive symptoms. Methods: We conducted a 12-week, randomized double- blind placebo-controlled trial of Paroxetine in which quality of life measured by the Chronic Respiratory Questionnaire (CRQ), an evaluative COPD-specific quality-oflife questionnaire, was the primary outcome. Results: 23 patients were randomized and 15 completed the trial (8 on Paroxetine; 7 on placebo). In the per-protocol analysis, we observed statistically and clinically significant improvements favoring the active treatment in 2 of the 4 domains of the CRQ: emotional function (adjusted mean difference: 1.1; 95% confidence interval [CI]: 0.0 - 2.2) and mastery (difference: 1.1; CI: 0.4 - 1.8). Dyspnea and fatigue improved, but to an extent that did not reach statistical significance. In the intention-to-treat analysis, none of the differences in CRQ scores was significant. Paroxetine was not associated to any worsening of respiratory symptoms. Conclusions: The results of this small randomized trial indicated that patients with end-stage COPD may benefit from antidepressant drug therapy when significant depressive symptoms are present. This study underlined the difficulties in conducting experimental studies in frail and elderly patients with COPD.
On the matter of fluorescence bronchoscopy
Authors: Patelli M. , Paioli D. , Trisolini R.
Published: July 2016

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Inspiratory muscle workload due to dynamic intrinsic PEEP in stable COPD patients: effects of two different settings of non-invasive pressure-support ventilation
Authors: Vitacca M. , Lanini B. , Nava S. , Barbano L. , Porta R. , Clini E. , Ambrosino N.
Published: July 2016

Background: In severe stable hypercapnic COPD patients the amount of pressure time product (PTP) spent to counterbalance their dynamic intrinsic positive end expiratory pressure (PEEPi,dyn) is high: no data are available on the best setting of non invasive pressure support ventilation (NPSV) to reduce the inspiratory muscle workload due to PEEPi,dyn. Methods: The objectives of this randomised controlled physiological study were: 1. To measure the inspiratory muscle workload due to PEEPi,dyn 2. To measure the effects on this parameter of two settings of NPSV in stable COPD patients with chronic hypercapnia admitted in a Pulmonary Division of two Rehabilitation Centers. Twenty- three stable COPD patients with chronic hypercapnia on domiciliary nocturnal NPSV for 30±20 months were submitted to an evaluation of breathing pattern, PEEPi,dyn, inspiratory muscle workload and its partitioning during both assisted and unassisted ventilation. Two settings of NPSV were randomly applied for 30 minutes each: i- “at patient’s comfort” (C): Inspiratory pressure support (IPS) was the maximal tolerated pressure able to reduce awake PaCO2 with the addition of a pre-set level of external PEEP (PEEPe); ii- “physiological setting” (PH): the level of IPS able to achieve a > 40% and < 90% decrease in transdiaphragmatic pressure in comparison to spontaneous breathing (SB). A PEEPe level able to reduce PEEPi,dyn by at least 50% was added. Results: During SB the tidal diaphragmatic pressuretime product (PTPdi/b) was 17.62±7.22 cmH2O*sec, the component due to PEEPi,dyn (PTPdiPEEPi,dyn) being 38 ± 17% (range: 16-65%). Compared to SB, PTPdiPEEPi,dyn was reduced significantly with both settings, the reduction being greater with PH compared to C. Conclusions: In conclusion in severe COPD patients with chronic hypercapnia the inspiratory muscle workload due to PEEPidyn is high and is reduced by NPSV at a greater extent when ventilator setting is tailored to patient’s mechanics.
Fibrosing mediastinitis causing rapidly progressive dyspnea, pulmonary edema and death in a 16 yr old male
Authors: Malagari K. , Papiris S.
Published: July 2016

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.
Difficult diagnosis of Infliximab-related miliary tuberculosis
Authors: Contini S. , Raimondi G. , Graziano P. , Saltini C. , Bocchino M.
Published: July 2016

The use of Infliximab in the treatment of patients with rheumatoid diseases unresponsive to conventional therapies has been reported to be complicated by opportunistic infections. We report the case of a 56-yr old female rheumatoid arthritis patient complaining of fever and respiratory symptoms 9 months after commencing Infliximab, who received no ethiologic diagnosis for the six months before admission. Tuberculosis was suspected upon chest radiographic pictures and empirical treatment for miliary tuberculosis instated in the wake of microbiological confirmation. The case typifies the difficulties of diagnosing miliary tuberculosis in the immunocompromised as well as in the immunocompetent patient.
Pulmonary tuberculosis with multifocal skeletal involvement
Authors: Kaya A. , Topu Z. , Fitoz S. , Numanoglu N.
Published: July 2016

Skeletal tuberculosis accounts for 1-5% of all tuberculosis infections. Of these infections, 50% involve the vertebral column and only 0-5% involve ribs. Rib tuberculosis is seen in only 0.1% of all tuberculosis infections. Skeletal tuberculosis is localised to a single site in 90-95% of reported cases. Multifocal involvement is uncommon and is usually associated with disseminated disease. We present a case of pulmonary tuberculosis associated with multifocal skeletal involvement.
Favourable effects of cardiovascular rehabilitation on funcional capacity and autonomic balance in elderly patients with heart failure
Authors: Malfatto Gabriella , Branzi Giovanna , Bizzi Caterina , Valli Paola , Facchini Mario
Published: July 2016

In 42 patients with chronic heart failure we evaluated left ventricular function, exercise capability and autonomic control before and 3 months after a program of cardiovascular rehabilitation. The results were analyzed separately for younger (Group 1, n=18, age 51±6 years) and older patients (Group 2, n=24, age 68±4 years), with comparable clinical characteristics and therapy. Before rehabilitation, compared to younger patients, Group 2 patients showed a lower exercise capability, a comparable left ventricular ejection fraction and similar high sympathetic activity at rest, with no response to regular breathing (= stimulation of cardiopulmonary receptors, i.e. parasympathetic challenge) and active standing (= sympathetic stimulation). After rehabilitation, in both groups a 20% improvement of exercise tolerance and aerobic performance was observed, as well as a slightly increase of left ventricular ejection fraction (about 10%), and a recovery in vagal and sympathetic responsiveness. Thus, in heart failure patients age does not hinder the favorable clinical and autonomic modulation induced by cardiovascular rehabilitation.
La telecardiologia come strumento di integrazione tra ospedale e territorio
Authors: VV AA
Published: July 2016

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PIANO NAZIONALE DELLA PREVENZIONE 2005-2007
Authors: Chieffo Carmine
Published: July 2016

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More than a scientific journal for cardiac rehabilitation and prevention
Authors: Tramarin Roberto
Published: July 2016

In early 2002, a brave and far-sighted decision of the Executive Board of the Italian Working Group of Cardiac Rehabilitation and Prevention (GICR) gave birth to this journal which, with the new Cardiac Section of Monaldi Archives for Chest Disease, has become the official organ of the Group. We feel honoured by the recent decision of the current GICR Executive Board to entrust us with the Editorship of the Cardiac Series of the journal for the next three years. The excellent work done and important results achieved by Raffaele Griffo and the Editorial Board that collaborated with him in the first two years of the journal’s life, constitute a heritage that we will find difficult to match. At the same time we trust that our personal commitment and enthusiastic determination that we have shown from the outset, since 2001, as promoter of “Archives operation”, will enable us, together with the support of the Executive, of the new Editorial Board and of all those who give us the privilege of their active collaboration, to preserve and consolidate the legacy that we have inherited. The role of cardiac rehabilitation within the medical panorama is now recognised for its consistency in terms of facilities, hospital beds, specialized personnel, patients, clients, workflow. But over and above these figures, its importance also in terms of scientific production cannot be denied, as well as its vitality and integration, in concrete, organizational terms, within the cardiology network. At the same time the dynamics of complex systems – of which the health systems of developed countries constitute a typical example – inevitably pose for health professionals and the various players concerned a series of problems and issues specific to cardiac rehabilitation that need to be evaluated, debated, and subject to experimentation and innovation. It is our task to orient the editorial policy of the journal to take up these challenges facing cardiac rehabilitation today, e.g. the relationship with other domains of rehabilitation, with the field of cardiovascular prevention, the pressure to de-hospitalization and the need to develop and evaluate new effective and sustainable processes of care. In forming the new Editorial Board of the Cardiac Series of Monaldi Archives we have taken the above aspects into account. We hope they will serve as the basis for an organic development of the journal’s editorial policy.
Diet prescription in obese patients
Authors: Lesi Carlo , Giaquinto Ester , Valeriani Luca , Zoni Luisa
Published: July 2016

Diet is a cornerstone in the treatment of obese patients with or without metabolic complications. To optimize outcome, diet treatment should always take into account factors such as the Body Mass Index, the timeframe for reaching the recommended weight loss, comorbidities (e.g. arterial hypertension, diabetes mellitus, renal disease, lipid abnormalities, hyperuricemia) and, finally, individual patient characteristics (e.g. habits, preferences, adherence capacity). Hypocaloric diets need to be adequately balanced in terms of glucides, lipids and proteins, vitamins and minerals. For these reasons the diet prescription for obese patients, particularly those with comorbidities or cardiovascular disease, should be under the guidance of expert nutrition professionals who are aware of the risks of an unbalanced diet.
Obesity and metabolic syndrome: clinical and therapeutic review
Authors: Cuppini Andrea , Matteini Paola
Published: July 2016

The recent ATP III classification defines metabolic syndrome as including ≥3 of the following characteristics: abdominal adiposity, atherogenic dyslipidemia, high blood pressure, and insulin resistance. In these patients the visceral fat may produce inflammatory cytochines that may account for an enhanced cardiovascular risk. The treatment of obese patients is complex and often ineffective: patients may initially reduce weight but subsequently regain or even increase it, according to the socalled “yo-yo syndrome”. Given the difficulties of treatment of patients with incresed BMI, visceral adiposity, or metabolic syndrome, a multidisciplinary approach to these patients may yield more frequent positive results. The different strategies that may be applied, in varying mix targeted to the individual patient, include diet, drugs, educational and psychological support and, in few selected cases, surgery.
News and advertising on foods, diet and obesity
Authors: Di Diodoro Danilo
Published: July 2016

In recent decades a new ideal of beauty has evolved characterised by slim women and muscular men; obesity, which in past centuries was considered healthy and attractive, is now “out of fashion”. The news media devote ample space, especially during spring and summer, to diet and fitness programs, and many diets and devices, without any scientific evidence, are presented as miracle cures. The business of diets and “natural” products generates intensive campaigns developed to promote foods, nutritional programs, and specific tools for losing weight as rapidly and effortlessly as possible. In this context, general practitioners and specialists have a fundamental role to play in correcting the often distorted messages that the general public receives, through educational programs designed to promote a correct understanding of the cardiovascular risks of obesity and healty methods and treatments for losing weight and safely achieving real health objectives.
Large mediastinal mass of heterotopic thyroid tissue: a case report and review of literature
Authors: Corsini Fabrizio , Cioffi Angela , Costabile Fausta , Corigliano Marco , Cirenza Giacinto , Torella Roberto , Salvatore Teresa
Published: July 2016

Salvatore. Incidental detection of a mediastinal mass in a asymptomatic patient poses a not easy diagnostic problem. For solid masses or cysts, histology or cytology is often necessary. Although substernal extension of a cervical goiter is common, totally intrathoracic primary thyroidal mass is unusual. We describe a rare case of heterotopic accessory mediastinal thyroid in a patient completely asymptomatic both for signs of thyroid dysfunction and mechanical compression. Radiological and hormonal 6 and 12 months follow-up is reported.
Inhaled foreign bodies in adolescents and adults
Authors: Tariq S.M. , George J. , Srinivasan S.
Published: July 2016

Background. Accidental foreign body inhalation is not uncommon. The incidence is high in children, especially the very young ones. We evaluated the management of inhaled foreign bodies in an adult respiratory medical unit, highlighting circumstances leading to inhalation, associated complications and difficulties encountered at bronchoscopic retrieval. Methods. We reviewed all cases of inhaled foreign bodies presenting over a period of 12 years (1991-2003). Results. 5 of 8 cases were teenagers whereas 3 were aged over 55 years. The older patients had co-morbidities and had aspirated food particles. In 2 cases, a bronchoscopy was performed primarily to exclude lung cancer, and the discovery of a foreign body was a surprise. Pulmonary complications related to foreign body inhalation were common among this group. All 5 teenage patients presented after inhalation of small objects. 4 patients from the teenage group had general anaesthesia; in 2 of them a laryngeal mask airway was employed, whilst 2 had endotracheal intubation. Only one patient was given a rigid bronchoscopy following failure of the fiberoptic instrument. Difficulties at retrieval of foreign body were frequently encountered. Conclusions. In the adolescent and adult patients, most inhaled foreign bodies are retrievable by flexible bronchoscopy. However, facilities for rigid bronchoscopy should be available as a back-up. Pulmonary complications are common after foreign body inhalation especially in the older patients. Difficulties at bronchoscopic removal may occur due to late presentation or to the site and/or position of the foreign body within the tracheobronchial tree.
Impact of children’s respiratory allergies on caregivers
Authors: Majani G. , Baiardini I. , Giardini A. , Pasquali M. , Tiozzo M. , Tosca M. , Cosentino C. , La Grutta S. , Marseglia G.L. , Canonica G.W.
Published: July 2016

Background. Despite the great attention that has been paid to HRQoL in children with respiratory allergy, few studies have addressed this aspect in relation to caregivers. The aim of our study was to evaluate the impact of childhood respiratory allergies on caregivers by means of a new method. Methods. 119 parents of children suffering from allergies (75 suffering from asthma and 44 suffering from rhinitis) were recruited from three Italian Allergy Units. Parents were asked to complete the Disease Impact On Caregiver (DIOC), a new non disease specific questionnaire, validated on the Italian population. The questionnaire consists of 31 items grouped in four factors (Performance, Personal gratification, Psychophysical endurance, Socio-emotional domain) and covers the life aspects that could be affected by the assistance duties towards an ill family member. Results. Child’s asthma resulted to have a worse impact on many aspects of a parents’ life than rhinitis. Differences resulted to be statistically significant in 19 aspects out of the 31 assessed. The worse impact of asthma versus rhinitis was confirmed in the following domains: Performance (24.0±18.2 vs 11.5±17.8), Personal gratification (26.3±20.5 vs 12.1±16.5) and Psychophysical endurance (35.0±24.8 vs 18.8±21.7). In the Socio-emotional domain no difference emerged. Conclusions. Compared to parents of rhinitics, parents of asthmatic children appear to be more compromised in their resistance to stress, mood, emotional stability, amount of spare time and leisure activities. Our results suggest the need of giving the due attention to these problems both in clinical practice and in research, in order to avoid possible interferences of the caregiver’s distress in the optimization of treatment outcome.
Ectopic thymoma simulating a pericardial cyst
Authors: Caramori G. , Calia N. , Pasquini C. , Arar O. , Ravenna F. , Guzzinati I. , Boniotti A. , Cavazzini L. , Ciaccia A. , Cavallesco G. , Papi A.
Published: July 2016

We present a case of a 53 year old man with a thymoma near the pericardium, a rare ectopic localisation of thymoma. A round radiodensity found at the right cardiophrenic angle was initially suspected at the echocardiography to be a pericardial cyst. The diagnosis of thymoma was made only after histopathological examination of the surgically re-sected lesion.
Lung and respiratory muscle function at discharge from a respiratory intensive care unit
Authors: Vitacca M. , Bianchi L. , Barbano L. , Ambrosino N.
Published: July 2016

Background. The purpose of this prospective observational study was to describe lung and respiratory muscle function at Respiratory Intensive Care Unit (RICU) discharge after a severe exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Methods. The study was conducted in 42 consecutive COPD patients in whom arterial blood gases, dynamic and static lung volumes, maximal inspiratory pressure (MIP) were assessed at discharge from the RICU and compared with values measured 6 months previously when they were in a stable state. The same measurements were performed at 6-month interval in 42 comparable stable COPD patients not requiring any hospitalisation for at least 6 months used as controls. Results. 24% of patients in the study group were discharged with hypercapnia whereas they were normocapnic before the acute episode. Compared to prior to exacerbation, patients of study group showed a significant worsening in mean values of PaCO2 (p=0.005), MIP (p=0.005) and FEV1 (p=0.041). Predefined criteria of worsening in PaCO2, MIP and FEV1 were observed in 47%, 33% and 28% of patients in study respectively. Neither lung nor respiratory muscle function in last stable state did predict post RICU functional worsening. In a period of 6 months controls showed no change in the studied parameters. Conclusions. After a severe acute exacerbation requiring admission to a RICU and immediately before discharge 1) a large proportion of COPD patients still show preserved lung and respiratory muscle function 2) more than one third of them would require further care and rehabilitative attempts to restore functional derangements.
Successful management of ARDS with bronchopleural fistula secondary to miliary tuberculosis using a conventional ventilator
Authors: Malhotra P. , Agarwal R. , Gupta D. , Aggarwal A.N.
Published: July 2016

Most institutions in India and other developing countries do not have facilities for high frequency ventilation in adults. We report the successful management of a case of ARDS with bronchopleural fistula secondary to miliary tuberculosis using a conventional ventilator and early empiric anti-tubercular therapy.
Liposarcoma of the pleural cavity. An exceptional tumour
Authors: Minniti A. , Montaundon M. , Jougon J. , Hourneau M. , Begueret H. , Laurent F. , Velly J-F.
Published: July 2016

Primitive liposarcomas of the pleura are exceptional tumours.We report a new case of primitive liposarcoma of the pleura revealed by chest pains in a 50 year old man. Computed tomography showed a large fat density mass in the left pleural cavity. Surgical resection was performed, completed with adjuvant radiotherapy. Few reports are available in the literary world. We present our case, review previously reported cases and discuss treatment.
Primary pulmonary nodular Amyloidosis
Authors: Agresta F. , Marin A. , Della Libera D. , Romanzi F. , Ciardo L.F. , Bittesini L. , Nardini S. , Bedin N.
Published: July 2016

Primary nodular amyloidosis of the lung is an uncommon manifestation. The disease runs a benign course, but offers diagnostic problems due to non-specific radiological features entering the big field of the solitary nodule. We describe the case of a 60 year old man with multiple nodules on the left lung operated on diagnostic and therapeutic video-assisted thoracoscopy and discuss the possibilities, if any, of suspecting such a disease through radiologic characteristics along with findings from the patient’s history, physical examination and laboratory tests.
Smoked Marijuana as a Cause of Lung Injury
Authors: Tashkin D.P.
Published: July 2016

P. Tashkin. In many societies, marijuana is the second most commonly smoked substance after tobacco. While Δ9-tetrahydrocannabinol (THC) is unique to marijuana and nicotine to tobacco, the smoke of marijuana, like that of tobacco, consists of a toxic mixture of gases and particulates, many of which are known to be harmful to the lung. Although far fewer marijuana than tobacco cigarettes are generally smoked on a daily basis, the pulmonary consequences of marijuana smoking may be magnified by the greater deposition of smoke particulates in the lung due to the differing manner in which marijuana is smoked. Whereas THC causes modest short-term bronchodilation, regular marijuana smoking produces a number of long-term pulmonary consequences, including chronic cough and sputum, histopathologic evidence of widespread airway inflammation and injury and immunohistochemical evidence of dysregulated growth of respiratory epithelial cells, that may be precursors to lung cancer. The THC in marijuana could contribute to some of these injurious changes through its ability to augment oxidative stress, cause mitochondrial dysfunction, and inhibit apoptosis. On the other hand, physiologic, clinical or epidemiologic evidence that marijuana smoking may lead to chronic obstructive pulmonary disease or respiratory cancer is limited and inconsistent. Habitual use of marijuana is also associated with abnormalities in the structure and function of alveolar macrophages, including impairment in microbial phagocytosis and killing that is associated with defective production of immunostimulatory cytokines and nitric oxide, thereby potentially predisposing to pulmonary infection. In view of the growing interest in medicinal marijuana, further epidemiologic studies are needed to clarify the true risks of regular marijuana smoking on respiratory health.
The relation of the pleural thickening in tuberculosis pleurisy with the activity of adenosine deaminase
Authors: Uskul B. , Turker H. , Ulman C. , Ertugrul M. , Selvi A. , Kant A. , Arslan S. , Ozgel M.
Published: July 2016

Selvi, A. Kant, S. Arslan, M. Ozgel. Background: Residual pleural thickening (RPT) still occurs in most patients with tuberculosis pleurisy despite advances in the treatment of tuberculosis. The aim of this study was to evaluate the significance of RPT in tuberculosis pleurisy with the patients clinical findings, biochemical and microbiological properties of pleural effusion and with the total adenosine deaminase (ADA) and isoenzymes levels. Methods: 121 tuberculosis pleurisy patients were evaluated retrospectively. According to posteroanterior chest x-rays, the 63 (52%) cases with the thickness 2 mm or more in lower lateral hemithorax were grouped as I and the 58 (48%) cases without pleural thickness were grouped as II. The amount of pleural effusion was classified into small, medium or massive according to their chest x-rays. In both groups; sex, age, symptoms score, bacteriological and biochemical tests and ADA levels were recorded. Results: 81 (67%) male and 40 (33%) female, overall 121 patients were enrolled into the study. RPT was found higher in males (p=0.014) and the increase ran parallel with the amount of cigarette smoking (p=0.014). RPT was found to be lower in small effusions (p=0.001). The group with RPT, the serum albumin was found lower (p=0.002), pleural fluid total protein (p=0.047) and the ratio of pleural fluid protein to serum protein (p=0.002) were found higher. In group I, total ADA: 69.5±38.9 IU/L and ADA2: 41.3±31.6 IU/L were higher than the cases without RPT (p=0.032, p=0.017, respectively). Conclusions: We suggest that the immunological mechanisms are effective in the development of pleural thickening.
Obstructive Granulomatous Bronchiolitis Obliterans due to Mycobacterium tuberculosis
Authors: Agarwal R. , Kumar V. , Jindal S.K.
Published: July 2016

Bronchiolitis obliterans is an uncommon cause of obstructive airway disease in adults characterised by progressive irreversible airway obstruction. Granulomatous bronchiolitis is a rare entity and tuberculosis presenting as bronchiolitis is distinctly uncommon. The authors present a case of tubercular granulomatous bronchiolitis obliterans, confirmed on histopathology, who responded completely to anti-tubercular chemotherapy.
Pulmonary involvement in systemic sclerosis due to therapy and as a complication
Authors: Chiappini F. , Zoli A. , Maugeri L.
Published: July 2016

(SS), similar to other connective tissue diseases. Sometimes lung disease may be a side effect of antirheumathic drugs. We report a case of a patient affected by SS, with isolated pulmonary hypertension, who developed bronchiolitis secondary to penicillamine. The latter was treated by withdraw of the drug without increasing the steroids. After one month, the patient’s clinical conditions appeared improved.
Mediastinal Images Resembling Thymus Following 131-I Treatment for Thyroid Cancer
Authors: Montella L. , Caraglia M. , Abbruzzese A. , Soricelli A. , Caputi M. , Squame G. , Salvatore M. , Del Prete S. , Palmieri G.
Published: July 2016

The follow-up of Differentiated Thyroid Cancer conventionally includes serum thyroglobulin and periodic Whole Body Scans. The uptake of 131-I in normal and pathological tissues different from metastatic thyroid cancer sites is a cause of false-positive scans. Among them, mediastinal uptake caused by thymic hyperplasia can be observed. The aim of the present study was to review a series of 573 patients with differentiated thyroid cancer treated with 131-I after surgery between 1992 and 2003 looking above all for those with mediastinal images resembling thymus. This evaluation is presented together with some hypotheses on the relationships between thymus and thyroid. Moreover, some considerations are made on the differential diagnosis between thymus and mediastinal tumour thyroid residues.
Risk factors for tuberculosis
Authors: Davies P.D.O.
Published: July 2016

The risk of developing tuberculosis is dependent on both the risk of being infected and the risk of infection leading on to active disease. The former will depend on the incidence of tuberculosis in the community where the individual lives or works. The latter will depend on many factors impinging on the individual both genetic and environmental. The greatest single risk factor for developing tuberculosis from infection is concurrent HIV infection. Where these two infections are prevalent tuberculosis case rates have risen dramatically and will continue to do so unless either infection can be curtailed.
Bronchiolitis Obliterans Organising Pneumonia (BOOP) in a lung cancer patient after lobectomy
Authors: Yan S.W. , Wong C.F. , Wong P.C. , Cheung C.F.
Published: July 2016

A 79 year-old patient with lung cancer underwent a standard thoracotomy and lobectomy. Postoperatively, he developed low-grade fever and dyspnoea. Chest X-rays showed progressive lung infiltrates, which was subsequently diagnosed to be Bronchiolitis Obliterans Organizing Pneumonia (BOOP) by transbronchial lung biopsy. He responded well to corticosteroid therapy. The case report is followed by a brief discussion on BOOP in association with lung cancer and thoracotomy.
Anxiety and Depression Short Scale: norms for its use in rehabilitation
Authors: Moroni L. , Bettinardi O. , Vidotto G. , Balestroni G. , Bruletti G. , Giorgi I. , Bertolotti G.
Published: July 2016

In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individualâ€™s problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index.
Cardiovascular complications of obesity
Authors: Cascella Teresa , Giallauria Francesco , Tafuri Domenico , Lombardi Gaetano , Colao Annamaria , Vigorito Carlo , Orio Francesco
Published: July 2016

Obesity is one of the major coronary risk factor representing an increasingly important worldwide health problem. The increased prevalence of obesity among younger population is likely to have long-term implications for cardiovascular disease (CVD). Obesity plays a central role in the insulin resistance syndrome and contributes to increase the risk of atherosclerotic CVD. The present review will examine the relationships among cardiovascular risk factors during the childhood-adolescence-adulthood transition. In fact, the relationship between obesity (especially visceral obesity) and CVD appears to develop at a relatively young age. The foremost physical consequence of obesity is atherosclerotic cardiovascular disease and polycystic ovary syndrome represents an intriguing example of obesity-related cardiovascular complications affecting young women.
Ãˆ tempo di consuntivi
Authors: Pirelli Salvatore
Published: July 2016

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8Â° Congresso Nazionale GICR
Authors: Pirelli Salvatore
Published: July 2016

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Cynical hostility and the metabolic syndrome: A case-control study
Authors: Gremigni Paola
Published: July 2016

Background: Evidence suggests that metabolic syndrome and hostility are independent risk factors for the development of coronary heart disease. Recently, the combined effect of metabolic syndrome and hostility has shown to predict the incidence of myocardial infarction. This study tested whether cynical hostility was associated with the metabolic syndrome in a sample of Italian adults. Methods: 992 subjects participated in the study. Among them, 546 participants were classified as having metabolic syndrome and 446 as controls, not having any of the risk factors that constitute the metabolic syndrome. Cynicism, the cognitive component of hostility, was measured with a self-report questionnaire derived from the Cookâ€“Medley Hostility Scale. Metabolic syndrome was based on having the following risk factors: obesity, hyperinsulinemia, dyslipidemia, and elevated arterial blood pressure. Results: The cross-sectional association of cynical hostility with metabolic syndrome was statistically significant (p <0.0001). Hostility was also associated with age (p <0.0001) and educational level (p <0.02). Predictors of having metabolic syndrome were higher cynicism (O.R. 1.12), older age (O.R. 1.39), and lower educational level (O.R. 1.05). Conclusions: The results highlight the potential importance of intervention on psychological factors (i.e. hostility) to prevent coronary heart disease.
Le risorse della Cardiologia Riabilitativa
Authors: Scardi Sabino
Published: July 2016

Le UnitÃ  Operative di riabilitazione sono al momento attuale le strutture che possiedono le migliori potenzialitÃ  per garantire la continuitÃ  della cura dei cardiopatici nel territorio, perchÃ© il cardiologo riabilitatore ha la cultura del cronico. Tuttavia lâ€™esiguitÃ  delle strutture, le scarse potenzialitÃ , lâ€™insufficienza del personale, il numero crescente di utenti che necessitano di continuitÃ  assistenziale (ad esempio anziani) limitano la potenzialitÃ  dellâ€™intervento riabilitativo a lungo termine. In alternativa la costituzione di organici Centri Cardiologici Territoriali, dotati di personale e attrezzature adeguati, in stretta collaborazione con lâ€™ospedale e il medico di medicina generale, sarebbero in grado di raccordare la cura acuta con quella a lungo termine, avviando programmi di continuitÃ  assistenziale per assicurare il follow-up dei malati.
Timing e modalitÃ dei controlli dopo sindrome coronarica acuta trattata con rivascolarizzazione: alcune riflessioni
Authors: Menegato Alessandra , Galli Michele
Published: July 2016

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Sono condivisibili e implementabili nel mondo reale i percorsi suggeriti? Quali sono i veri ostacoli allo sviluppo della riabilitazione-prevenzione e come superarli?
Authors: Tavazzi L. , Iacono A.
Published: July 2016

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Trend in Cardiologia Riabilitativa
Authors: Giannuzzi Pantaleo
Published: July 2016

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Interventional Strategies in early Atherosclerosis
Authors: Gattone Marinella , Giannuzzi Pantaleo
Published: July 2016

Atherosclerosis remains clinically mute for a long time and frequently manifests itself with an acute cardiovascular event; therefore, the possibility to detect the disease in a subclinical phase and to reduce or reverse its progression is an issue of relevance. Non-invasive diagnostic procedures such as B-mode ultrasonography of carotid intima-media thickness (CIMT), electron beam computed tomography (EBCT) and magnetic resonance angiography (MRA) allow to identify atherosclerotic disease in its early phases, to evaluate the disease progression and monitor the effects of interventions. In recent years, several therapeutic strategies have been adopted over time to slow early atherosclerosis in asymptomatic individuals at intermediate/high cardiovascular risk. Prospective trials employing multifactorial non-pharmacological interventions (diet, exercise, smoking cessation) have demonstrated a favorable effect on progression of atherosclerosis. Hence lifestyle modification may be an effective therapeutic strategy to be adopted as a first step and a highly cost-effective intervention in a preclinical setting involving a large number of individuals. Drugs should be considered as a second step or should be associated to further reduce the risk in individuals at high probability of future events, who require more intensive interventions. Reducing low-density lipoprotein levels, blood pressure and platelet aggregation seems to be the most effective intervention in these subjects, whereas the treatment of emerging coronary risk factors, e.g. oxidative stress, inflammatory activation and infections has not produced the expected protective effect.
Questionnaires for asthma in children: written or video?
Authors: Sestini P.
Published: July 2016

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Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren
Authors: Mavale-Manuel S. , Joaquim O. , Nunes E. , Pedro A. , Bandeira S. , Eduardo E. , Macome C. , Almeida L. , Cossa A. , Malichocho J. , Maciel L. , Constance E. , Marques S. , Tembe A. , De Blic J. , Annesi-Maesano I.
Published: July 2016

Background. The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. Methods. 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). Results. According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p<.001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p<.001). â€œSevere attacks of asthmaâ€ was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p<.05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. Conclusions. In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.
Non-invasive mechanical ventilation: a practice not for all seasons
Authors: Bianchi L. , Vitacca M.
Published: July 2016

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Exacerbations and associated healthcare cost in patients with COPD in general practice
Authors: Schermer T.R.J. , Saris C.G.J. , Van den Bosch W.J.H.M. , Chavannes N.H. , Van Schayck C.P. , Dekhuijzen P.N.R. , Van Weel C.
Published: July 2016

Background. Acute exacerbations are a characteristic clinical expression of chronic obstructive pulmonary disease (COPD). The objective of this study was to investigate the occurrence rate, management, and healthcare costs of exacerbations in patients with COPD in Dutch general practice. Methods. Baseline data set from the COPD on Primary Care Treatment (COOPT) trial was used. Details on the occurrence and management of exacerbations were collected by systematic medical record review for the 2-year period preceding trial inclusion. Results. The mean age of the 286 study subjects involved was 59.2 (SD 9.6) years, postbronchodilator FEV1 67.1% (SD 16.2) of predicted. Following ERS criteria, subjects suffered from: no (26%); mild (19%); moderate (40%); or severe (15%) airflow obstruction. The overall mean and median annual exacerbation rates were 0.88 (SD 0.79) and 0.5 (IQR 1.0), respectively. Exacerbation rate was not related to severity of airflow obstruction (p=0.628). Mean annual exacerbation costs per subject were â‚¬ 40, â‚¬ 53, â‚¬ 61 and â‚¬ 92 for the respective severity subgroups (p=0.012). The increase of costs in the more severe subgroups was mainly attributable to more physician consultations, diagnostic procedures, and prescription of reliever medication (e.g., bronchodilators, cough preparations). Conclusions. Occurrence of exacerbations did not depend on the severity of airflow obstruction, whereas the healthcare cost associated with exacerbations increased along with the severity of the disease.
Clearance of technetium-99m-DTPA in pulmonary sarcoidosis
Authors: Antoniou K.M. , Tzanakis N. , Malagari K. , Symvoulakis K.E. , Perisinakis K. , Karkavitsas N. , Siafakas N.M. , Bouros D.E.
Published: July 2016

Background. The aim of this study was to explore the possible association of the lung clearance of 99mTc- DTPA scan with HRCT lung abnormalities and with the pulmonary function tests [PFTs] in patients with sarcoidosis. Methods. We studied prospectively 15 patients [5 males, 10 females] of median age 46yr [range 27-67] with histologically proved sarcoidosis. HRCT scoring included the sum of the severity and extent of lymph node enlargement and parenchymal involvement. Results. The mean DTPA clearance half-time [Ï„ 1/2 <40 min] was found [mean [SD]] 38.3+4.5min. The lymph node enlargement was found 34% and the parenchymal involvement 12%. DTPA clearance was negatively correlated with the parenchymal involvement [r= -0.651, p=0.009]. The HRCT parenchymal abnormalities were found significantly correlated with PFTs [FVC [r= -0.65, p=0.008] and TLCO [r= -0.76, p=0.02]. Conclusions. Our data suggest a moderate association between 99mTc-DTPA scan and HRCT in pulmonary sarcoidosis. However, further studies in large scale of sarcoid patients are needed to clarify the role of this novel methodology in the evaluation and follow-up of this disorder.
Pedunculated solitary fibrous tumours arising from the pleura
Authors: Poyraz A. , Kilic D. , Hatipoglu A. , Bakirci T. , Bilezikci B.
Published: July 2016

Solitary fibrous tumour (SFT) is one of the rare tumours which arise from visceral pleura. Klemperer and Rabin first described SFT as a distinct clinical entity among primary pleural tumoUrs in 1931. Approximately 820 cases have been reported in literature to date. The management of patients with SFT is complete resection of the tumour and follow up of the patient to detect any possible late recurrence. In the present paper, we report two cases of pedunculated solitary fibrous tumours of the pleura that appeared as a wandering chest nodule to which surgical resection undertaken at our hospital. The aim is to summarise our experience in the management of solitary fibrous tumour.
A survey on hospitalised communityacquired pneumonia in Italy
Authors: Migliorati P.L. , Boccoli E. , Bracci L.S. , Sestini P. , Melani A.S.
Published: July 2016

Background and aim. Community Acquired Pneumonia (CAP) remains a major cause of disease and death. We evaluated the levels of care, the outcome and the characteristics of hospitalised patients with CAP in a primary hospital in Italy. We also investigated the value of both the Pneumonia Severity Index (PSI) and the modified Appropriateness Evaluation Protocol (AEP) for recognising both the outcome and the unnecessary admissions and stay of hospitalised patients with CAP. Methods. A retrospective review of all the charts of adult patients with CAP at Manerbio, Brescia, Italy between January 2001 and December 2002 was performed. Results. We evaluated 148 patients; their mean age (Â±SD) was 70 (Â±17) years; 34% were female. Most patients (87%) had at least a concomitant co-morbid disease. The overall survival rate at 30 days was 88%. All but one death occurred in the high-risk group of patients according to the PSI. On the contrary, the death rate of patients with inappropriate hospital admission according to the AEP was high. Patients with high PSI score had a significantly longer hospital length of stay than the low-risk group. However, a substantial part of the hospital stay did not show any justification into the charts. Conclusions. The PSI, but not the AEP, upon hospital admission, was useful for evaluating the outcome of patients with CAP. The PSI score and the modified AEP can be useful for assessing the appropriateness of hospitalisation for patients with CAP. There is the need for a practical and validated tool to support physicians in their decision making regarding the early and safe discharge of hospitalised patients with CAP.
Airway inflammation in patients affected by obstructive sleep apnea
Authors: Sabato R. , Guido P. , Salerno F.G. , Resta O. , Spanevello A. , Foschino Barbaro M.P.
Published: July 2016

Obstructive sleep apnea (OSA) is characterised by repetitive episodes of upper airway occlusion during sleep. OSA has been shown to be associated with a variable degree of nasal inflammation, uvula mucosal congestion and airway hyperreactivity. The upper airway inflammation, whose clinical importance is uncertain, is characterised by leukocytes infiltration and interstitial oedema. In addition, recent data has shown the presence of neutrophilic inflammation in the lower airways. The current opinion is that airway inflammation is caused by the local, repeated mechanical trauma related to the intermittent airway occlusion typical of the disease. Another potential mechanism involves the intermittent nocturnal hypoxemia that through the phenomenon of the ischemia- reperfusion injury may induce the production of oxygen free radicals and therefore cause local and systemic inflammation. Finally, a state of low-grade systemic inflammation may be related to obesity per se with the pro-inflammatory mediators synthesised in the visceral adipose cells. Several authors stress the role of circulating and local inflammatory mediators, such as proinflammatory cytokines, exhaled nitric oxide, pentane and 8-isoprostane as the determinants of inflammation in OSA.