1,721,053 research outputs found
A West Nile Virus infection expressed as unilateral limb paralysis and complicated by Parsonage–Turner syndrome: a case report
Full text linkBackgroundWest Nile Virus is a single-stranded Ribonucleic Acid arbovirus of the Flaviviridae family that is transmitted to humans by Culex species mosquitoes. West Nile Virus infection is asymptomatic in the majority of affected people. Of those who develop symptoms, the usual manifestation is a febrile syndrome, while only 1% develop neurological symptoms due to a neuroinvasive form of infection, including encephalitis, meningitis, asymmetrical flaccid paralysis, or a combination of all these features. Parsonage-Turner syndrome is a rare disorder characterized by sudden painful symptoms and subsequent paralysis, involving a shoulder or one of the upper limbs due to post-infective brachial plexopathy. The etiology is unknown, although it can be considered a multifactorial process: a predisposing factor, such as viral infection or strenuous upper-extremity exercise, can trigger an immune-mediated process localized in the brachial plexus.Clinical presentationIn late summer, a 79-year-old male Italian patient was admitted to the emergency department for acute right upper limb weakness and high fever, without any mental status impairment, pain, sensory alterations, or signs of meningeal irritation. Laboratory tests confirmed acute West Nile Virus infection, expressed as a unilateral upper limb flaccid paralysis. After a few days, the patient reported an acute pain in the right upper limb scarcely responsive to nonsteroidal anti-inflammatory drug therapy and a subsequent wider distribution of flaccid paralysis. After multiple examinations, Parsonage-Turner syndrome could be suspected. Patient was treated with steroids and reported an improvement of clinical condition after 2 months, with complete pain remission but partial strength recovery in the affected limb.ConclusionsWest Nile Virus disease has a broad spectrum of neurological manifestations, among which the most common are signs of meningeal irritation or cognitive impairment. We report an unusual presentation of neuroinvasive West Nile Virus infection with arm weakness as expression of unilateral viral neuritis, followed by a post-infective brachial plexopathy consistent with Parsonage-Turner syndrome diagnosis. We diagnosed Parsonage-Turner syndrome after excluding the most common causes of atraumatic acute upper limb pain, through a challenging differential diagnosis in a patient with several comorbidities
The non-invasive mechanical ventilation: the experience of the department of Internal Medicine and Critical Area of the Polyclinic Hospital of Modena
Full text linkAcute respiratory failure (ARF) is a deficiency of the respiratory system that causes an alteration of normal levels of oxygen and/or carbon dioxide in the blood.
ARF may be due to alterations in gaseous diffusion in alveolar-capillary level (type “1” acute respiratory failure), or to alterations in the functioning of the respiratory pump (type “2” acute respiratory failure) or to an association of the above causes.
ARF specific etiological treatment must be associated to oxygen administration, through ventilation, which may be spontaneous or mechanical (non-invasive or invasive).
The actual study describes experience about non-invasive mechanical ventilation in the department of Internal Medicine and Critical Area of the Polyclinic Hospital of Modena, from 2010 to 2014, examining clinical parameters and outcomes.
Respiratory failure is a condition in which the respiratory system is not able to adequately carry out its gas exchange functions, such as oxygenation of the arterial blood and/or elimination of carbon dioxide from the venous blood.
Conventionally, (1),(2),(3) respiratory failure is defined in case of:
Partial pressure of arterial oxygen (PaO2) <60 mmHg;
Partial pressure of carbon dioxide in the arterial blood (PCO2)> 45 mmHg;
Association of both previous.
You can distinguish two types of acute respiratory failure(4)(ARF):
ARF type “1”, with gas exchange impairment and hypoxemia (associated with hypo/normocapnia). The pathophysiological mechanism behind is an important intrapulmonary shunt with changes in ventilation/perfusion ratio.
Generally diseases responsible for this condition are acute pulmonary edema, ARDS, severe pneumonia and pulmonary embolism.
ARF type “2”, with hypoventilation and hypercapnia.
It is caused by a reduction of the ventilation volume/minute or by an increase of physiologic dead space. Among the most common diseases there are neuromuscular diseases, myopathies, chronic obstructive pulmonary disease (COPD), bronchial asthma and restrictive lung disease.
The two types of respiratory failure are closely connected and can evolve into one another.
The ARF therapy can be divided into:
Etiological therapy: it is directed to the treatment of the specific cause that induced ARF, it can be delivered with inotropic agents, antibiotics, bronchodilators, steroids etc.
Supportive therapy (or symptomatic): aimed at correcting hypoxemia and respiratory acidosis, is indicated in all respiratory insufficiencies and it is based on the administration of O2 and postural therapy.
Ventilation can be spontaneous (delivered by low or high flow systems) or mechanical.
Mechanical ventilation is classifiable under invasive ventilation (IMV) or non-invasive (NIV).
The IMV provides the invasion of the patient’s airways to put them in communication with the respiratory system. It can be through tracheal intubation or tracheotomy and it’s a relevant method adopted by resuscitation intensive departments and partly by respiratory diseases departments. The NIV despite is a method that requires training and experience to be used optimally, it has the advantage to be used in emergency medicine departments and in other departments from specialists who are not resuscitators or pulmonologists. Moreover, compared to the IMV, the NIV offers the following advantages: reduction in the respiratory work, absence of complications related to prosthesis, possibility of avoiding sedation required for the IMV, conservation of laryngeal functions and cost reduction.(5)
The NIV techniques most used in emergency medicine departments are CPAP (Continuous positive airway pressure) and BiPAP (or BiLevel - BiLevel positive airway pressure) CPAP provides a predetermined positive pressure, greater than atmospheric, which is maintained constant throughout the respiratory cycle, and it improves oxygenation by increasing the functional residual capacity, favouring the recruitment and the patency of the alveoli excluded from the ventilation and improving the relationship between ventilation and perfusion.
The main indications for CPAP are acute cardiogenic pulmonary edema (ACPE), hypoxic and not hypercapnic ARF, obstructive sleep apnea syndrome (OSAS); atelectasis. (8),(9),(10)
BiPAP provides two different levels of positive pressure, which are an inspiratory positive airway pressure (IPAP) and an expiratory positive airway pressure (EPAP).
BiPAP facilitates the removal of air exhaled and prevents cases of re-breathing of CO2. It also reduces the patient's work of breathing. The main indications to BiPAP are hypercapnic ARF, chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, neuromuscular disorders, dysfunction of the respiratory center (sedation/intoxication), shock (cardiovascular/septic). (11), (12)Acute respiratory failure (ARF) is a deficiency of the respiratory system that causes an alteration of normal levels of oxygen and/or carbon dioxide in the blood.
ARF may be due to alterations in gaseous diffusion in alveolar-capillary level (type “1” acute respiratory failure), or to alterations in the functioning of the respiratory pump (type “2” acute respiratory failure) or to an association of the above causes.
ARF specific etiological treatment must be associated to oxygen administration, through ventilation, which may be spontaneous or mechanical (non-invasive or invasive).
The actual study describes experience about non-invasive mechanical ventilation in the department of Internal Medicine and Critical Area of the Polyclinic Hospital of Modena, from 2010 to 2014, examining clinical parameters and outcomes.
Respiratory failure is a condition in which the respiratory system is not able to adequately carry out its gas exchange functions, such as oxygenation of the arterial blood and/or elimination of carbon dioxide from the venous blood.
Conventionally, (1),(2),(3) respiratory failure is defined in case of:
Partial pressure of arterial oxygen (PaO2) <60 mmHg;
Partial pressure of carbon dioxide in the arterial blood (PCO2)> 45 mmHg;
Association of both previous.
You can distinguish two types of acute respiratory failure(4)(ARF):
ARF type “1”, with gas exchange impairment and hypoxemia (associated with hypo/normocapnia). The pathophysiological mechanism behind is an important intrapulmonary shunt with changes in ventilation/perfusion ratio.
Generally diseases responsible for this condition are acute pulmonary edema, ARDS, severe pneumonia and pulmonary embolism.
ARF type “2”, with hypoventilation and hypercapnia.
It is caused by a reduction of the ventilation volume/minute or by an increase of physiologic dead space. Among the most common diseases there are neuromuscular diseases, myopathies, chronic obstructive pulmonary disease (COPD), bronchial asthma and restrictive lung disease.
The two types of respiratory failure are closely connected and can evolve into one another.
The ARF therapy can be divided into:
Etiological therapy: it is directed to the treatment of the specific cause that induced ARF, it can be delivered with inotropic agents, antibiotics, bronchodilators, steroids etc.
Supportive therapy (or symptomatic): aimed at correcting hypoxemia and respiratory acidosis, is indicated in all respiratory insufficiencies and it is based on the administration of O2 and postural therapy.
Ventilation can be spontaneous (delivered by low or high flow systems) or mechanical.
Mechanical ventilation is classifiable under invasive ventilation (IMV) or non-invasive (NIV).
The IMV provides the invasion of the patient’s airways to put them in communication with the respiratory system. It can be through tracheal intubation or tracheotomy and it’s a relevant method adopted by resuscitation intensive departments and partly by respiratory diseases departments. The NIV despite is a method that requires training and experience to be used optimally, it has the advantage to be used in emergency medicine departments and in other departments from specialists who are not resuscitators or pulmonologists. Moreover, compared to the IMV, the NIV offers the following advantages: reduction in the respiratory work, absence of complications related to prosthesis, possibility of avoiding sedation required for the IMV, conservation of laryngeal functions and cost reduction.(5)
The NIV techniques most used in emergency medicine departments are CPAP (Continuous positive airway pressure) and BiPAP (or BiLevel - BiLevel positive airway pressure) CPAP provides a predetermined positive pressure, greater than atmospheric, which is maintained constant throughout the respiratory cycle, and it improves oxygenation by increasing the functional residual capacity, favouring the recruitment and the patency of the alveoli excluded from the ventilation and improving the relationship between ventilation and perfusion.
The main indications for CPAP are acute cardiogenic pulmonary edema (ACPE), hypoxic and not hypercapnic ARF, obstructive sleep apnea syndrome (OSAS); atelectasis. (8),(9),(10)
BiPAP provides two different levels of positive pressure, which are an inspiratory positive airway pressure (IPAP) and an expiratory positive airway pressure (EPAP).
BiPAP facilitates the removal of air exhaled and prevents cases of re-breathing of CO2. It also reduces the patient's work of breathing. The main indications to BiPAP are hypercapnic ARF, chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, neuromuscular disorders, dysfunction of the respiratory center (sedation/intoxication), shock (cardiovascular/septic). (11), (12
CANCER OCCURRENCE IN THE FOLLOW-UP OF 25 FAMILIES WITH HEREDITARY NONPOLYPOSIS COLORECTAL-CANCER (HNPCC)
No full textnot availabl
GENETIC EPIDEMIOLOGY OF HEREDITARY NONPOLYPOSIS COLORECTAL-CANCER
No full textLynch syndrome or Hereditary non-polyposis colorectal cancer (HNPCC) has recently received considerable attention either for its clinical implication or for the characterization of the molecular basis. HNPCC is an autosomal dominant disorder featured by the development of early onset colorectal malignancies frequently localized in the proximal colon, synchronous and metachronous lesions of the large bowel, and association with tumors of other organs, especially endometrium, stomach and urinary tract. In typical cases the clinical diagnosis may be relatively easy, but in many other instancies small size of families, possible low penetrance, variable expressivity, and frequency of phenocopies may render the identification of Lynch syndrome extremely complex. Molecular biology will be of considerable help in diagnosis HNPCC, since at least four genes have recently been identified whose mutations are closely associated with the development of this phenotype. Various studies in different races and continents seem to indicate that the frequency of Lynch syndrome is in the order of 1 to 5% of all colorectal malignancies. In most of these investigations the clinical guideline for the definition of HNPCC were the so-called ''Amsterdam Criteria'', proposed by the International Collaborative group on HNPCC. In some of these series, gene mutation were found in 50-70% of the families. However, the problem is much more complex owing to the existence - in a given population - of ''suspected'' HNPCC families and juvenile cases that might represent possible first mutations of a HNPCC kindred. Molecular studies should make clear how many of these families are true HNPCC and how many represent spurious aggregates of cancer. Finally, segregation analysis repetedly showed that the autosomal dominant model was the most plausible type of transmission in HNPCC families, though more complex models (i.e., codominant) cannot be excluded and deserve further investigations
IDENTIFICATION OF HEREDITARY NONPOLYPOSIS COLORECTAL-CANCER IN THE GENERAL-POPULATION - THE 6-YEAR EXPERIENCE OF A POPULATION-BASED REGISTRY
No full textBackground. Hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome) is an autosomal dominant disease characterized by early-onset intestinal neoplasms, localization of tumors in the proximal colon, and frequent association with cancers at other sites, especially the endometrium, skin, and stomach. The identification of HNPCC is often difficult, owing to the lack of biomarkers and the extreme frequency of sporadic colorectal cancer in the Western World. Methods. The authors reviewed the clinical data and the family trees of all patients (n = 817) with colorectal malignancies registered in the local health district between 1984-1989 with the following objectives: (1) to identify families with HNPCC and (2) to establish the frequency of the syndrome in northern Italy. Six clinical criteria were defined (vertical transmission, familial aggregation, early age at onset, right colon localization, multiple tumors, and mucinous carcinoma), all indicative of an increased possibility of HNPCC. Results. The registered families were divided into various subgroups according to the presence (in the nuclear pedigree) of four or more criteria (41 families, 5.0% of total), three criteria (58 families, 7%), two criteria (73, 8.9%), or less than two criteria (203 families, 24.8%). The remaining 380 case families did not show criteria suggesting a genetic component. One hundred thirty-three genealogic trees were extended further to gather information on second-degree and third-degree relatives. The expanded pedigrees were further analyzed to ascertain if they met the recently proposed requisites for HNPCC. Nineteen of 37 (51%) families with four criteria met the minimum requisites and could therefore be considered HNPCC. Similarly, HNPCC was diagnosed in six extended pedigrees of the three-criteria (16.6%) and in three families (8.5%) of the two-criteria subgroups. The difference in the detection of HNPCC among various subgroups was statistically significant (P < 0.001). From the observed findings, the frequency of HNPCC in this population can be estimated to be between 3.4-4.5% of all cases of colorectal cancer. Conclusions. HNPCC can be identified in the general population through the data of a colorectal cancer registry if the nuclear pedigrees of all incident cases are traced and a proportion of them selectively expanded. The observed frequency of HNPCC was rather consistent with previous estimates in other populations
Inheritance and susceptibility to tumours of the large bowel: A new classification of colorectal malignancies
No full textnon c'e
In response. Adjuvant chemotherapy in colorectal cancer patients with microsatellite instability.
No full textTo the Editor: In a recent issue of Clinical Cancer Research (1), we read Benatti et al.'s article with interest, therein they showed significantly better survival in microsatellite instability high (MSI-H) patients than microsatellite stable patients, and concluded that the type of genomic instability could influence the prognosis of colorectal cancer, in particular, in stages II and III. Furthermore, in relation to adjuvant treatment, they concluded that fluorouracil-based chemotherapy does not seem to improve survival among MSI-H patients. Although Benatti et al. introduced our results, our research on the similar topic came to a different conclusion (2). There are major issues to be discussed as to how Benatti et al. drew their conclusions. The first point is the total number of MSI-H patients who received chemotherapy. In Benatti et al.'s study, only 65 MSI-H patients received fluorouracil-based chemotherapy; among these 65 patients, 31 patients had stage IV disease. Considering that most of the patients who had stage IV disease would have received postoperative chemotherapy, the total number of MSI-H patients, in stages II and III, who received chemotherapy seems to be much fewer than 65. The second point is how they examined the survival rate. Benatti et al. examined the survival in stage II and stage III patients separately. Therefore, the number of MSI-H patients who received chemotherapy in either stage II or III should be 20 at most. This number of patients seems to be too small to find any difference in survival. In fact, MSI-H patients who underwent chemotherapy showed higher survival rates than those who did not, although it did not reach statistical significance. Furthermore, according to the survival curve of stage II cancers, there seems to be no cancer-related death in MSI-H patients who had undergone chemotherapy. Considering all these points, the small number of MSI-H patients who underwent chemotherapy seems to be the main reason why they could not find significant differences in survival between MSI-H patients who did or did not undergo chemotherapy. All of these points are also true in an analysis of MSI-H patients in stage III. In Benatti et al.'s study, the number of MSI-H patients with chemotherapy in stage II or III seems to be too small to draw any conclusion. In our previous study, we examined 73 MSI-H patients who received chemotherapy and showed a significant difference in survival between MSI-H patients and microsatellite stable patients (2). Taken together, Benatti et al.'s study may potentially bias the significance of MSI-H as a predictor of survival in patients with adjuvant-treated colon cancer
Clinical features of colorectal cancer patients in advanced age: a population-based approach
No full textIn the immediate future, the number of geriatric patients will continue to rise; consequently we should expect an increase of colorectal cancer, a disease of the elderly population. Through the data of a Cancer Registry, we examined (a) the effect of ageing on the main features of colorectal cancer; (b) changes in management, especially for individuals older than 80 years; and (c) changes in prognosis and survival in subgroups of patients with different age. The Registry provided information on colorectal cancer up to 2010 (27 years). A total of 5293 patients were registered; these were divided into three groups: A (0â64 years), B (65â79) and C (80 or more). Three periods of observation were chosen: 1 (1984â1992), 2 (1993â2001) and 3 (2001â2010). Group A included 1571 patients (29 %), Group B 2539 (48 %) and Group C 1183 (22.3 %). The fraction of old individuals increased during the 27 years of the investigation. In these patients, tumours were predominantly localized to the right colon (42.6 %). The rate of surgery and ratio between curative and palliative approaches were similar among the three groups (p 
Familial aggregation of tumors and detection of hereditary non-polyposis colorectal cancer in 3-year experience of 2 population-based colorectal-cancer registries
No full textThe clinical data of 2 population-based registries, located in areas with different incidence rates of colorectal cancer, were used in order to assess the role of familial factors in the pathogenesis of these tumors. The occurrence of tumors in family members was investigated in 389 subjects with colorectal cancer registered in Modena (Northern Italy, an area characterized by a high incidence of colorectal malignancies) between 1984 and 1986; similar information was obtained in 213 patients with tumors of the large bowel registered in Ragusa (Sicily, Southern Italy, an area of similar magnitude acid with low incidence rates for these tumors) in the 3-year period 1988 to 1990. In both series, colorectal cancer occurred significantly more often among relatives of patients. Controls were patients of the same sex and age (+/- 5 years) hospitalized during the study periods, but not for gastrointestinal or neoplastic diseases. There were 89 cancer cases (3.1%) among 2,851 relatives of patients in Modena, vs. 17 cases among 1,744 relatives (1.0%) in Ragusa (p < 0.01). Apart from colorectal cancer, there was no excess of other types of tumors in patients ́ families (in both series). During the 3 years of registration, 17 cases of hereditary non-polyposis colorectal cancer (HNPCC, or Lynch syndrome) were diagnosed in Modena; in contrast, this syndrome was more rare in Ragusa (one case only during 3 years of observation). Similarly, many more families with clinical suspicion of HNPCC were recorded in Northern regions (44 vs. 10). Although incidence rates of colorectal cancer are appreciably higher in Northern than in Southern Italian regions, the excess of this cancer type among close relatives is similar. However, full-blown HNPCC or suspected Lynch syndrome were significantly more frequent in Northern Italy
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