Cardiorespiratory comorbidity: a new challenge for physical and rehabilitation medicine specialist.

BACKGROUND: The cardiorespiratory comorbidity can reduce the participation in the rehabilitation project of patients with motor disorders. AIM: The first aim of the study was to assess the frequency of cardiopulmonary comorbidity in inpatient rehabilitation units in Italy. The second aim was to evaluate the influence of cardiorespiratory comorbidity on some process and outcome indicators. DESIGN: Data collection with a questionnaire sent to Physical and Rehabilitation Medicine specialists. SETTING: Inpatient Rehabilitation Units. POPULATION: Patients admitted to Rehabilitation Units with neurological and orthopedic disability. METHODS: A questionnaire was sent to 33 Rehabilitation Units in Italy. OUTCOME: Length of stay in hospital (LOS), percentage of transfer to acute wards, level of satisfaction of the Physicians related to the degree of functional recovery of patients with cardiopulmonary comorbidity. In a subgroup of patients with and without cardiopulmonary comorbidity indicators were also used to retrospectively assess functional recovery during the hospitalization. RESULTS: Analysis were made on 16 complete responses received. Data of 909 subjects were evaluated. The mean incidence of cardiovascular and respiratory diseases is high: 61.50%. The length of hospitalization (LOS) in patients with cardiac and respiratory comorbidity is significantly longer than in subjects without associated disease (46.55, SD 21.00 days vs. 37.26, SD 18.97; P<0.05). The number of transfers to acute wards is significantly higher in subjects with cardiorespiratory comorbidity (8.62% vs. 2.44%; P<0.05). Eleven out of 16 medical doctors (69%) said they were "quite satisfied" for the degree of functional recovery of patients with comorbidity. A group of patients with neurological disabilities associated with cardiorespiratory disease had significantly lower Functional Independence Measure (FIM) score at admission (55.36, SD 20.62, vs. 73.72, SD 22.15; P<0.05) than these without comorbidity. At discharge the subjects of the two groups assessed, independently from the presence of cardiorespiratory comorbidity, present no statistically significant difference of FIM scale values. CONCLUSION: The high frequency of cardiorespiratory comorbidity in patients with motor disorders negatively influenced the LOS and percentage of transfer to acute wards but not necessarily the functional results. It is, therefore, necessary to train the medical doctor who specializes in physical and rehabilitation medicine also in the clinical management of complex patients. CLINICAL REHABILITATION IMPACT: The results of the survey suggest that rehabilitation is useful even in patients with motor disorders and cardiorespiratory comordibity.

[Oxygen therapy via Ventimask. Personal cases]. / Ossigenoterapia con Ventimask. Casistica personale.

Eleven patients suffering from seriously hypoxaemic chronic respiratory insufficiency with slight hypercapnia have been assessed. A comparison between the results obtained with continuous oxygen therapy carried out with a Ventury mask and that done with the Ventimask was made in the case of each patient. Distribution of O2 with the Ventimask made it possible to obtain higher average pO2 levels than with the Ventury mask.

[Morphine combined with marcaine in long-term epidural analgesia in patients with Pancoast's syndrome caused by bronchogenic carcinoma of the apex of the lung]. / Morfina associata a marcaina nell'analgesia epidurale a lungo termine del paziente con sindrome di Pancoast da carcinoma broncogeno dell'apice polmonare.

The long-term, epidural administration of morphine and marcaine (bupivacaine) in 12 patients suffering from bronchogenic carcinoma of the pulmonary apex and consequent Pancoast's syndrome has been examined. In 75% of cases the technique provided satisfactory results and the administration system was well tolerated by the patient.

[Goodpasture's syndrome. Clinical case and diagnostic problems]. / Sindrome di Goodpasture. Caso clinico e problemi diagnostici.

Goodpasture's syndrome is characterised clinically by the association of haemoptysis and haematuria and is therefore the expression of lesions localised in two different apparatus, the respiratory and the renal, with an autoimmune type mechanism (production of circulating antibodies against the glomerular and alveolar basal membrane). A case of Goodpasture's syndrome in a male of 28 is reported in which the two basic clinical signs were not in evidence, making differential diagnosis more complicated.

[An association of acute pancreatitis and intestinal infarct due to superior mesenteric artery occlusion]. / Associazione di pancreatite acuta ed infarto intestinale da occlusione dell'arteria mesenterica superiore.

The clinical case of a 67-year-old woman admitted for abdominal pain whose interpretation created difficulties but which corresponded substantially to the pain encountered in intestinal occlusion associated with diabetes mellitus and increase in amylasemia is reported. After decrease, 48 hours after hospitalization, necropsy revealed extensive acute pancreatitis associated with infarction of the small bowel to occlusion of the superior mesenteric artery.

[Allergic bronchial asthma: an evaluation of immunofluorescence technics on bronchial biopsies]. / Asma bronchiale allergico: valutazione delle tecniche di immunofluorescenza su biopsia bronchiale.

Although the immunofluorescence technique has mostly been applied to renal diseases, it may be of use in the examination of lung tissue. Immunofluorescence tests on bronchial bioptic samples can show: 1) presence of IgE, IgA, IgM, IgG and complement factors; 2) their location on the bronchial mucosa; 3) their relationships with epithelioid cells, mast cells and plasma cells. Patients with atopic asthma were examined. Bioptic samples were taken from the main bronchi and treated by immunofluorescence. Cellular positivity was found for IgE, IgA, IgM and complement components.

[Therapeutic efficacy of the principal antitubercular drugs: an evaluation by antibiogram]. / Efficacia terapeutica dei principali farmaci antitubercolari: valutazione mediante antibiogramma.

Pulmonary and extrapulmonary tuberculosis is still encountered in clinical practice, sometimes in forms that are difficult to categorize nosographically. In this study, the therapeutic efficacy of the 6 main antitubercular drugs (rifampicin, streptomycin, isoniazide, ethambutol, kanamycin, para-aminosalicylic acid) in 20 patients with early TB of the lungs was assessed on the basis of antibiogram findings. Para-aminosalicylic acid was found to be the least effective; isoniazide, rifampicin and streptomycin were reasonably so; both kanamycin and ethambutol were extremely effective.

[Echography in the study of thoracic pathology. II-- Guided biopsy]. / L'ecografia nello studio della patologia toracica. Nota II--Guida alla biopsia.

The usefulness of ultrasonic studies for guiding the needle during biopsy of solid lesions or evacuation of saccate effusions and empyemas. Is a explained possible diagnostic protocol is then proposed which includes the ultrasonic examination in the diagnostic approach to parietal, mediastinic or diaphragmatic lesions.

[Percutaneous needle aspiration biopsy in the diagnosis of pulmonary neoplasms]. / L'agobiopsia percutanea aspirativa nella diagnosi delle neoplasie polmonari.

The diagnostic efficacy of percutaneous needle biopsy (PNB) was assessed in 220 lung tumour patients. The results obtained prove this diagnostic technique to be extremely sensitive even though personal experience suggests that slight complications (pneumothorax, homophthoe) may occur.

[Transthoracic needle aspiration in infectious pathology]. / L'agoaspirazione transtoracica nella patologia infettiva.

A study was conducted on 20 patients with isolated or multiple patches of doubtful significance in the framework of neoplastic or infectious pathologies or in the presence of probably infectious diffuse or localised pulmonary infiltrations in immunodepressed patients or those in whom broad spectrum antibiotic treatment had failed. Percutaneous needle aspiration and sterile brushing was performed for the purpose of bacteriological examination in all patients. The result showed the clear superiority of needle aspiration (75% positive) over sterile brushing (25%). The first method is therefore recommended for use in the diagnosis of so-called "difficult" lung pathologies.

[Antibacterial and antifungal activity of isoflurane and common anesthetic gases]. / Attività antibatterica ed antifungina dell'isofluorano e dei comuni vapori anestetici.

An in vitro analysis was conducted to investigate the hypothetical antibacterial and antimycotic activity of the common anesthetic gases (halothane, enflurane, isoflurane, methoxyflurane) in view of the clinical absence of bronchopulmonary pathology after inhalation narcosis despite the many risk factors involved. For this purpose scalar dilutions of the four gases were prepared on cultures of Klebsiella pneumoniae and Candida albicans and the antibacterial action of the gases was tested in vitro. Even with the weaker concentrations used, halothane and methoxyflurane totally inhibited both microorganisms. Enflurane had less effect on Klebsiella p. and almost none on Candida. Isoflurane, a new halogen ether anesthetic was found to have an excellent inhibitory effect. In conclusion it is hypothesised that the anesthetic gases considered might have an in vivo antibacterial activity considering the experimental results obtained in vitro.

[Isolated endobronchial metastases]. / Metastasi endobronchiali isolate.

Endobronchial metastases account for about 5% of autoptic findings in patients with multiple secondary locations. Five cases are reported of patients with malignant neoplasms in various organs with metastases to the trachea and the large bronchi without involvement of the pulmonary parenchyma and therefore with negative radiographic and CT scan findings.