11 research outputs found
Management of traumatic wounds in the Emergency Department: Position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES)
No full textTraumatic wounds are one of the most common problems leading people to the Emergency Department (ED), accounting for approximately 5,4 % of all the visits, and up to 24 % of all the medical lawsuits. In order to provide a standardized method for wound management in the ED, we have organized a workshop, involving several Italian and European experts. Later, all the discussed statements have been submitted for external validation to a multidisciplinary expert team, based on the so called Delphi method. Eight main statements have been established, each of them comprising different issues, covering the fields of wound classification, infectious risk stratification, tetanus and rabies prophylaxis, wound cleansing, pain management, and suture. Here we present the results of this work, shared by the Academy of Emergency Medicine and Care (AcEMC), and the World Society of Emergency Surgery (WSES)
Colorectal metastases to the liver: present status of management.
No full textI.F. 1.133
surgical resection for liver metastases from colorectal cancer, while for unresectable patients different types of locoregional treatment have been attempted. One hundred seventy-one patients with hepatic metastases from colorectal cancer were treated by us over a period of 15 years. Sixty-four underwent hepatic resection, and 107 underwent various forms of locoregional treatment. Our experience confirms the opinion that hepatic resection can be performed with a "curative" aim in patients with colorectal liver metastases: a 5-year survival rate can be achieved in about 30% of resectable cases. Adjuvant chemotherapy after hepatic resection should be tested in prospective randomized trials. Patients with diffuse liver metastases can benefit from locoregional infusion chemotherapy. Symptoms improve in most patients and objective responses are higher than those reported for systemic chemotherapy. Survival benefit with respect to untreated patients, has not yet been demonstrated by prospective randomized studies. Future improvements may be achieved by using new treatment modalities, such as new drug combinations, repeat arterial ischemia, and local tumor destruction. As these types of treatment are still experimental they should be employed only in prospective clinical trials
Distribution of human recombinant interferon-alpha 2 in rat plasma, liver, and experimental liver metastases
No full textIt has been ascertained that one of several possible reasons for negligible interferon activity in solid tumors, namely, hepatic metastases induced in rats after intraportal injection of Walker carcinoma 256 cells, is the significantly lower levels of interferon in the interstitial fluid of metastases in comparison to normal liver and plasma
Vascularization of experimental liver metastases 3-the effect of hepatic artery ligation on blood flow
No full textCognitive strategies: a method to reduce diagnostic errors in ER
No full textI wonder why sometimes we are able to rapidly recognize patterns of disease presentation, formulate a speedy diagnostic closure, and go on with a treatment plan. On the other hand sometimes we proceed studing in deep our patient in an analytic, slow and rational way of decison making. Why decisions sometimes can be intuitive, while sometimes we have to proceed in a rigorous way? What is the “back ground noise” and the “signal to noise ratio” of presenting sintoms? What is the risk in premature labeling or “closure” of a patient? When is it useful the “cook-book” approach in clinical decision making? The Emergency Department is a natural laboratory for the study of error” stated an author. Many studies have focused on the occurrence of errors in medicine, and in hospital practice, but the ED with his unique operating characteristics seems to be a uniquely errorprone environment. That's why it is useful to understand the underlying pattern of thinking that can lead us to misdiagnosis. The general knowledge of thought processes gives the psysician awareness an the ability to apply different tecniques in clinical decision making and to recognize and avoid pitfalls
Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons
No full textDelirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication or drug withdrawal. The most important risk factors are advanced age and dementia whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different setting of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices) it often remains under-recognised, poorly understood and not adequately managed then there exists a clear need for improved understanding to overcome cultural stereotypes and for the development and dissemination of a comprehensive model of implementation of general good practice points. A network of Italian national scientific societies was thus convened (1) to develop a collaborative multidisciplinary initiative report on delirium in the elderly hospitalized patients, (2) to focus the attention of health care personnel on prevention, diagnosis and therapy of patients suffering from delirium, and (3) to make the health services research community and policy-makers more aware of the potential risks of this condition providing a reference for training activities and data collection
