La Diagnosi Infermieristica: II. La Formulazione della Diagnosi Infermieristica

La diagnosi infermieristica, seconda fase del processo infermieristico, è un giudizio clinico riguardante le risposte della persona, della famiglia o della comunità a problemi di salute/processi vitali attuali o potenziali. Essa costituisce la base sulla quale scegliere gli interventi infermieristici volti a raggiungere dei risultati di cui l'infermiere è responsabile. La diagnosi infermieristica esprime il giudizio professionale sulle condizioni del paziente, sulle sue risposte ai trattamenti ricevuti e sulle necessità di assistenza infermieristica. La NANDA propone tre modelli di diagnosi: reali, di rischio, di benessere. La struttura della diagnosi infermieristica si compone di tre elementi utili essenzialmente per l'adozione di un linguaggio infermieristico condiviso. Per questo motivo è usata una terminologia specifica per diagnosticare in modo infermieristico. Gli elementi componenti sono tre: titolo, caratteristiche definenti, fattori correlati. Il titolo deve "qualifcare" la tipologia del problema; le caratteristiche definenti sono l'equivalente dei segni e dei sintomi soggettivi ed oggettivi presenti in relazione ad una determinata diagnosi; i fattori correlati sono in pratica le cause, i fattori eziologici che determinano una certa situazione; si possono raggruppare in quattro categorie: fisiopatologici, situazionali, fasi maturative, trattamenti. Il caso clinico suggerito prevede l'individuazione delle diagnosi infermieristiche evidenziate dai dati raccolti, sempre secondo la metodologia di Carpenito

On hyperbolicity of SU(2)-equivariant, punctured disc bundles over the complex affine quadric

Given a holomorphic line bundle over the complex affine quadric $Q^2$, we investigate its Stein, SU(2)-equivariant disc bundles. Up to equivariant biholomorphism, these are all contained in a maximal one, say $\Omega_{max}$. By removing the zero section to $\Omega_{max}$ one obtains the unique Stein, SU(2)-equivariant, punctured disc bundle over $Q^2$ which contains entire curves. All other such punctured disc bundles are shown to be Kobayashi hyperbolic.Comment: 15 pages, v2: minor changes, to appear in Transformation Group

Systemic perfusion: a method of enhancing relative tumor uptake of radiolabeled monoclonal antibodies

We evaluated the feasibility of systemic vascular perfusion with saline (mimicking plasmapheresis) as a method to enhance tumor-specific monoclonal antibody (MoAb) tumor/background ratios. Initially, groups of rats were injected intravenously (i.v.) with 131I-5G6.4 MoAb (murine IgG2aK reactive with ovarian carcinoma). These animal's radioactivity levels were determined by dose calibrator and they were imaged before and after perfusion which was conducted at 4 or 24 h post-antibody injection. Animals were sacrificed after perfusion, as were controls, and normal organ radioactivity levels determined. In addition, nude mice bearing HTB77 ovarian cancers subcutaneously were injected i.v. with 131I-5G6.4 MoAb and were imaged before and after systemic perfusion with saline 24 h post-5G6.4 injection. Perfusion in rats dropped whole-body 5G6.4 levels significantly at both perfusion times (P P P < 0.05). These studies show that (1) much background antibody radioactivity can be removed using whole-body perfusion with saline, (2) that the decline in whole body activity is larger with 4 than 24 h perfusion and (3) tumor imaging can be enhanced by this approach. This and similar approaches that increase relative tumor antibody uptake such as plasmapheresis may be useful in imaging and therapy with radiolabeled antibodies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27583/1/0000627.pd

Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases

Background:This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin-and irinotecan-based systemic chemotherapy regimens.Methods:Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2).Results:Of 50 eligible patients, 38 (76%) had received 654 lines of chemotherapy. Most presented with synchronous disease (72%), <4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (<48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at 60 days respectively. By intention-to-treat analysis using Response Evaluation Criteria in Solid Tumours, 1 patient (2%) had a complete response, 11 (22%) partial response, 12 (24%) stable disease, 22 (44%) progressive disease; 4 (8%) were non-evaluable. Median overall survival was 12.6 months (95% CI, 7.0-18.3); 2-year survival was 19.6%.Conclusion: Radioembolisation produced meaningful response and disease stabilisation in patients with advanced, unresectable and chemorefractory mCRC. \ua9 2010 Cancer Research UK All rights reserved

131I-metaiodobenzylguanidine (131I-MIBG) therapy for residual neuroblastoma: a mono-institutional experience with 43 patients

Incomplete response to therapy may compromise the outcome of children with advanced neuroblastoma. In an attempt to improve tumour response we incorporated 131I-metaiodobenzylguanidine (131I-MIBG) in the treatment regimens of selected stage 3 and stage 4 patients. Between 1986 and 1997, 43 neuroblastoma patients older than 1 year at diagnosis, 13 with stage 3 (group A) and 30 with stage 4 disease (group B) who had completed the first-line protocol without achieving complete response entered in this study. 131I-MIBG dose/course ranged from 2.5 to 5.5 Gbq (median, 3.7). The number of courses ranged from 1 to 5 (median 3) depending on the tumour response and toxicity. The most common acute side-effect was thrombocytopenia. Later side-effects included severe interstitial pneumonia in one patient, acute myeloid leukaemia in two, reduced thyroid reserve in 21. Complete response was documented in one stage 4 patient, partial response in 12 (two stage 3, 10 stage 4), mixed or no response in 25 (ten stage 3, 15 stage 4) and disease progression in five (one stage 3, four stage 4) Twenty-four patients (12/13 stage 3, 12/30 stage 4) are alive at 22–153 months (median, 59) from diagnosis. 131I-MIBG therapy may increase the cure rate of stage 3 and improve the response of stage 4 neuroblastoma patients with residual disease after first-line therapy. A larger number of patients should be treated to confirm these results but logistic problems hamper prospective and coordinated studies. Long-term toxicity can be severe. © 1999 Cancer Research Campaig

A remark on the orbit structure of the complexification of a semisimple symmetric space

We consider the action of a real semisimple Lie group G on the complexification G(C)/H-C of a semisimple symmetric space G/H and we present a refinement of Matsuki's results (Matsuki, 1997 [1]) in this case. We exhibit a finite set of points in G(C)/H-C, sitting on closed G-orbits of locally minimal dimension, whose slice representation determines the G-orbit structure of G(C)/H-C. Every such point (p) over bar lies on a compact torus and occurs at specific values of the restricted roots of the symmetric pair (g. h). The slice representation at (p) over bar is equivalent to the isotropy representation of a real reductive symmetric space, namely Z(G)(p(4))/G((p) over bar). In principle, this gives the possibility to explicitly parametrize all G-orbits in G(C)/H-C. (C) 2012 Elsevier B.V. All rights reserved