Ventilator Support and Oxygen Therapy in Palliative and End-of-Life Care in the Elderly.

Elderly patients suffering from chronic cardio-pulmonary diseases commonly experience acute respiratory failure. As in younger patients, a well-known therapeutic approach of noninvasive mechanical ventilation is able to prevent orotracheal intubation in a large number of severe scenarios in elderly patients. In addition, this type of ventilation is frequently applied in elderly patients who refuse intubation for invasive mechanical ventilation. The rate of failure of noninvasive ventilation may be reduced by means of the integration of new technological devices (i.e., high-flow nasal cannula, extracorporeal CO2 removal, cough assistance and high-frequency chest wall oscillation, and fiberoptic bronchoscopy). Ethical issues with end-of-life decisions and the choice of the environment are not clearly defined in the treatment of elderly with acute respiratory insufficiency.

Pleural effusion as first extra-medullary clinical presentation of an occult multiple myeloma: The role of medical thoracoscopy.

Multiple myeloma is a malignant neoplasm of plasma cells that usually invades the bone marrow replacing normal bone marrow and producing large amounts of light chains of immunoglobulins (Ig) [1]. Clinical manifestations are related to the accumulation of these proteins in vital organs such as kidney and heart. Pleural effusion may be a sign of chest involvement that occurs in approximately 6% of patients with Known multiple myeloma [2,3]. We present the case of an 80-year- old man with pleural effusion as first extra-medullary clinical presentation of an occult multiple myeloma.

Occult malignancy underlying a case of "hyperacute" onset of severe pulmonary hypertension.

Investigations in a patient with new-onset pulmonary hypertension should include screening for undiagnosed malignancy http://bit.ly/2mrLmGM.

[Asthma attacks at school in Italian adolescents]. / Attacchi di asma a scuola negli adolescenti italiani.

We evaluated the occurrence of asthma attacks at school in a sample of 13,266 adolescents (13-14 year old) from 12 centers across Italy (SIDRIA-2 study). 23.8% of asthmatic subjects reported at least one wheezing attack at school in the previous 12 months. The attacks occurred in the gymnasium (55.4%), in the classroom (42.6%), outside (28.7%), in the bathroom (4.5%) and in other school environments (4%). During the attacks, self-administration of a bronchodilator was reported by 66% of the subjects. Educational programs and specific guidelines to deal with asthmatic schoolchildren are warranted.