Does timing of initiation influence acceptance and adherence to NIV in patients with ALS?

BACKGROUND: The role of nocturnal non invasive ventilation (NIV) to prolong tracheostomy-free survival, is still controversial in amyotrophic lateral sclerosis (ALS) patients and the best timing to initiate NIV is unclear. OBJECTIVE: As NIV acceptance and adherence can be influenced by many factors, we aimed to compare immediate acceptance and short-term NIV adherence between NIV initiated very early and NIV initiated later. METHODS: This is a post hoc analysis of our previous cohort retrospective study of 88 ALS patients: 53 under later NIV (late group - LG) (forced vital capacity [FVC]<80% pred. at NIV prescription) and 35 under very early NIV (very early group - VEG) (FVC>80%). We compared hours of NIV use as immediate acceptance of NIV (use ≥4h/night) and dherence at 4 months post-initiation (defined as use ≥4h/night or 120h/month). RESULTS: No differences were found between VEG and LG in use of NIV (>5h/night in both groups), immediate acceptance (85.7% vs. 85.0%, p=0.927) and short-term adherence (81.3% vs. 87.2%, p=0.469); 39.7% of patients increased their NIV use (35% by >60min/night). A decline in adherence was observed in 12.5% of patients irrespective of group affiliation. CONCLUSIONS: In ALS patients, initiation of very early NIV does not reduce its immediate acceptance or the short-term adherence. However, at least 1 in 10 patients may be at risk of reducing their adherence irrespective of early or late NIV prescription. As still under debate and not conclusive, further literature on early NIV benefit is welcomed.

Impact of an early respiratory care programme with non-invasive ventilation adaptation in patients with amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: Forced vital capacity (FVC) <80% is one of the key indications for starting non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS). It was hypothesized that a very early start of NIV could lengthen the free interval before death compared to later-start NIV; as a secondary outcome, the survival rate of patients on NIV without tracheotomy was also evaluated. METHODS: This retrospective study was conducted on 194 ALS patients, divided into a later group (LG) with FVC <80% at NIV prescription (n = 129) and a very early group (VEG) with FVC ≥80% at NIV prescription (n = 65). Clinical and respiratory functional data and time free to death between groups over a 3-year follow-up were compared. RESULT: At 36 months from diagnosis, mortality was 35% for the VEG versus 52.7% for the LG (P = 0.022). Kaplan-Meier survival curves adjusted for tracheotomy showed a lower probability of death (P = 0.001) for the VEG as a whole (P = 0.001) and for the non-bulbar (NB) subgroup (P = 0.007). Very early NIV was protective of survival for all patients [hazard ratio (HR) 0.45; 95% confidence interval (CI) 0.28-0.74; P = 0.001] and for the NB subgroup (HR 0.43; 95% CI 0.23-0.79; P = 0.007), whilst a tracheotomy was protective for all patients (HR 0.27; 95% CI 0.15-0.50; P = 0.000) and both NB (HR 0.26; 95% CI 0.12-0.56; P = 0.001) and bulbar subgroups (HR 0.29; 95% CI 0.11-0.77; P = 0.013). Survival in VEG patients on NIV without tracheotomy was three times that for the LG (43.1% vs. 14.7%). CONCLUSION: Very early NIV prescription prolongs the free time from diagnosis to death in NB ALS patients whilst tracheotomy reduces the mortality risk in all patients.

[Behavior of the lithium excretion fraction in hypertensive patients during variations of sodium intake]. / Comportamento della frazione di escrezione del litio nel paziente iperteso durante variazioni dell'introito sodico.

Fractional excretion of lithium (FeLi) is a marker of proximal tubular sodium reabsorption. During different sodium intakes (normal = 120 mEq/day, low = 40 mEq/day and high = 240 mEq/day) fractional lithium excretion was evaluated in essential hypertensive patients (n. 19) and control subjects (n. 5). Our data showed that FeLi was higher in hypertensives than in controls. Dividing hypertensives on the basis of blood-pressure sensitivity, salt resistant patients showed lower FeLi levels as compared to salt sensitive ones. Our findings indicate that proximal tubular sodium reabsorption is decreased in essential hypertension; this behavior is particularly evident in salt sensitive patients, suggesting that factors affecting proximal tubular function are activated in these patients in order to reduce the impairment of renal excretory capability.

[Prostatic pathology and correlated urethral stenosis. 10 cases treated with transluminal urethroplasty]. / Patologia prostatica e stenosi uretrali correlate. Dieci casi trattati con uretroplastica transluminale.

Our study was intended to verify the efficacy and the side effects of intraluminal dilatation of the distal urinary tract with vascular balloon catheter in a group of patients with urethral stenosis. In 6 out of 10 patients, there was a significant increase in urethral diameter (by 70% to 150%). In 4 patients, the stenosis was only slightly improved (increase in urethral diameter by 10% to 20%). Only 5 patients, all belonging to the group in which dilatation was anatomically effective, have been having normal micturition and have been asymptomatic. According to data in our possession, transurethral dilatation does not seem to be very effective, since it restores adequate micturition in only 50% of cases. In view of the absence of severe side effects, however, this technique may be indicated in patients with medical problems that preclude surgery.

[Intradiploic dermoid cyst of the skull: report of a case]. / Cisto dermóide craniano intradiplóico: registro de um caso.

A case of intradiploic dermoid cyst of the skull in a female child with seizures is reported. The authors emphasize diagnostic aspects and the surgical procedure. The characteristics of the tumor were cleared at the surgical procedure, and its nature was confirmed by histological examination. The importance of the skull biopsy when radiological aspects are not definite and the benign characteristics of the process are discussed. Good results of surgical treatment and the infrequency of the tumor justify the report.

Cisto dermoide craniano intradiploico. Registro de um caso. / Intradiploic dermoid cyst of the skull. Report of a case

Relato de caso de cisto dermoide craniano intradiploico.E ressaltado o aspecto diagnostico e o procedimento cirurgico que permitiu caracterizar a natureza do tumor.Destacando a benignidade do processo, a apresentacao do caso e justificada pela respectiva raridade