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ObjectiveTo evaluate the changes in ventilatory mechanics and hemodynamics that occur in patients dependent on mechanical ventilation who are subjected to a standard respiratory therapy protocol.MethodsThis experimental and prospective study was performed in two intensive care units, in which patients dependent on mechanical ventilation for more than 48 hours were consecutively enrolled and subjected to an established respiratory physiotherapy protocol. Ventilatory variables (dynamic lung compliance, respiratory system resistance, tidal volume, peak inspiratory pressure, respiratory rate, and oxygen saturation) and hemodynamic variables (heart rate) were measured one hour before (T-1), immediately after (T0) and one hour after (T+1) applying the respiratory physiotherapy protocol.ResultsDuring the period of data collection, 104 patients were included in the study. Regarding the ventilatory variables, an increase in dynamic lung compliance (T-1 = 52.3 ± 16.1mL/cmH2O versus T0 = 65.1 ± 19.1mL/cmH2O; p < 0.001), tidal volume (T-1 = 550 ± 134mL versus T0 = 698 ± 155mL; p < 0.001), and peripheral oxygen saturation (T-1 = 96.5 ± 2.29% versus T0 = 98.2 ± 1.62%; p < 0.001) were observed, in addition to a reduction of respiratory system resistance (T-1 = 14.2 ± 4.63cmH2O/L/s versus T0 = 11.0 ± 3.43cmH2O/L/s; p < 0.001), after applying the respiratory physiotherapy protocol. All changes were present in the assessment performed one hour (T+1) after the application of the respiratory physiotherapy protocol. Regarding the hemodynamic variables, an immediate increase in the heart rate after application of the protocol was observed, but that increase was not maintained (T-1 = 88.9 ± 18.7 bpm versus T0 = 93.7 ± 19.2bpm versus T+1 = 88.5 ± 17.1bpm; p < 0.001).ConclusionRespiratory therapy leads to immediate changes in the lung mechanics and hemodynamics of mechanical ventilation-dependent patients, and ventilatory changes are likely to remain for at least one hour.

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Their clinical features, pathological characteristics, base line IPI score, stage at presentation, type of treatment and outcome were analyzed. Results: Median age was 41.5 years (range 20-77yrs). B-symptoms were present in 42 (60%) patients and 35 (50%) patients were presented with poor performance status (ECOG 3/4). According to Ann Arbor staging, 49 patients (70%) were in stage I, 14 (20%) stage II, 02 (2.8%) stage III and 05 (7%) in stage IV. IPI risk categorizations, low risk 30%, low intermediate risk 20%, high intermediate risk 20% and high risk 30%. Sixty three cases (90%) were non germinal center/Activated B cell type (ABC). Twenty eight patients were treated with CHOP, 27 patients with R (Rituximab) þCHOP and rest were treated with CVP þ/-R. Radiation therapy (RT) was received as consolidative treatment in 50% of cases. Complete remission (CR) was observed in 75% of cases. Median event free (EFS) and overall survival (OS) was 72% and 58% with median follow up period of 42 months. Helicobacter pylori (HP) antibody testing was positive in 14 cases (20%) and all patients received anti-HP treatment. HP associated PGDLBCL were associated with less B symptoms, low IPI, better CR rate (P Conclusion: PGDLBCL consists 60% of all gastric lymphoma at our centre. Around half of them are presented with B symptoms and poor performance status. H. Pylori positivity is seen in 20% of cases and associated with low risk IPI with good survival. Addition of rituximab to CHOP has a statistical significant survival impact in patients with PGDLBCL. RT may be omitted in selective cases of PGDLBCL, where RCHOP/ RCVP (rituximab based chemotherapy) is being considered, to avoid radiation induced side effect with same survival. Chemotherapy may be omitted in some selected cases of HP associated PGDLBCL.

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

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