Medicina
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Stroke (CVA) in young adults comprises approximately 10% of all cerebrovascular events. The information available on the recurrence of a new event in this population and particularly in Latin America is limited. Our objective was to examine the presence of stroke recurrence after having presented a stroke. ⋯ The recurrence of neurovascular events occurs predominantly in patients with a history of previous stroke/TIA, probably secondary to diseases that are difficult to diagnose.
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Pediatric melanomas are rare and some of them may arise on giant congenital melanocytic nevi. The risk of developing melanoma on a medium-sized nevus is not clear but is thought to be very rare. Proliferative cellular nodules which mimic malignant melanoma may pose significant diagnostic challenges. We report the case of a 9-year-old patient who developed a melanoma on a medium-sized congenital melanocytic nevus on the tip of the nose, requiring a complex surgery with excellent aesthetic results.
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We present the case of a 46-year-old woman with a history of Roux-en-Y gastric bypass one year prior, who presented to the emergency room with vomiting and oliguria lasting 10 days. Initial evaluation revealed acute kidney injury with serum creatinine 14.9 mg/dL (normal range 0.5-0.9), serum urea 240 mg/dL (normal range 17-49), proteinuria 0.10 g/day and a glomerular filtration rate less than 10 ml/min per 1.73 m2. Urine sediment showed 15-20 leukocytes and 25 red blood cells per field, with no cylinders or crystals observed. ⋯ Despite the administration of intravenous sodium bicarbonate, red blood cell transfusions and high doses of loop diuretics, renal failure persisted, as evidenced by the presence of oliguria, serum creatinine 13.5 mg/dL, serum urea 220 mg/dL and serum phosphate 8 mg/dL (normal range 2.5-4.5), and hemodialysis therapy was initiated 3 days after admission to the hospital until the present time. Increased oxalate absorption secondary to fat malabsorption due to bypass gastric causes hyperoxaluria, crystal deposition and oxalate nephropathy. The aim of this report is to highlight the strong correlation between oxalate nephropathy and bariatric surgery, with their implications.
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Esophageal adenoid cystic carcinoma (EACC) is an exceedingly rare malignant tumor constituting only 0.2% of all esophageal tumors. The tumor exhibits aggressive behavior, composed histologically of ductal and modified myoepithelial cells. We report a case of a 69-year-old female with a diagnosis of an EACC by preoperative endoscopic biopsy. ⋯ EACC presents diagnostic and therapeutic challenges due to its rarity and aggressive nature. Prognostic considerations remain unclear, emphasizing the need for further research and accumulated cases to delineate optimal treatment. The presented case demonstrates a 1-year survival with systemic palliative care, contributing to the evolving knowledge surrounding EACC.
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Dengue virus is an endemic virus in Argentina that, although it was initially considered to be non-neurotropic, it is currently recognized to be neuroinvasive; thus conditioning a prevalence of neurological manifestations of up to 15% among patients. Even being considered severe symptoms, there is underdiagnoses of dengue encephalitis due to its varied clinical presentation. ⋯ Regarding neuroimaging methods, the findings are usually varied and nonspecific, and can even be normal in up to 40-50% of cases. We present three cases of dengue encephalitis diagnosed in a university hospital in Buenos Aires, Argentina, where the clinical presentation varied from temporal-spatial disorientation to refractory convulsive status with different presentations in the cerebrospinal fluid but all with positive PCR for dengue in it and with normal neuroimaging.