Medicina
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The use of positive airway pressure is the treatment of choice for obstructive sleep apnea. Since the beginning of SARS-CoV-2 virus pandemic the recommendations were to avoid the administration of this therapy in the sleep laboratory and to start treatment with autoadjustable continuous positive airway pressure devices. The objective was to evaluate access to these devices in the current epidemiological context. ⋯ The delay between the beginning of the procedure to access the device and the start of treatment was 31 ± 21 in patients who had medical insurance and 65 ± 35.2 in those who did not (p = 0.008). Access to auto-adjustable therapies during the COVID-19 pandemic was below our former experience and that described in other studies with fixed therapies. It is worth considering whether this decrease is a product of the pandemic and independent of the type of therapy or is directly related to the higher costs of self-adjustable devices or to a lack of coverage from the healthcare providers.
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Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. ⋯ A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.
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The aim of this study was to describe the long term prognosis of 34 patients with Takayasu arteritis and the results of surgical and endovascular treatment. A total of 5 central surgeries and 53 endovascular procedures were performed including 18 bypass surgeries (33.8%) and 35 angioplasties (66.2%). The median follow-up was 7.5 years, interquartile range [IQR] 2.6-12.5. ⋯ Surgery had higher mortality in patients with aortic and ascending aortic valve disease, combined coronary artery disease and carotid disease. In long term follow up Takayasu arteritis frequently requires revascularization and restenosis or new lesions are common. Surgical treatment had better results with less restenosis than angioplasty.
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Clear cell "sugar" tumor of the lung is a rare benign tumor arising from perivascular epithelioid cells (PECs). They belong to a group of mesenchymal neoplasms called PEComas. ⋯ We report the case of a 66-year-old man in whom a solitary pulmonary nodule was discovered during oncological staging for an adenocarcinoma of the prostate who underwent an anatomical pulmonary segmentectomy. The final pathology result was a perivascular epithelioid cell tumor (pulmonary PEComa or clear "sugar" cell tumor).
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Case Reports
[Vibrio vulnificus infection of the skin and soft parts. Communication of a case diagnosed in Argentina].
Vibrio vulnificus is one of the most virulent Vibrio species known. It is a bacterium with universal distribution. The first case registered in Uruguay occurred in 2001 and, since then, several infections have occurred per year. ⋯ We present the case of a severe skin and soft tissue infection by V. vulnificus from an open wound in a patient in contact with a marine aquatic environment on the coast of the River Plate, in Uruguay. Isolation of vibrios from wound specimens can cause rapidly progressing tissue damage, particularly V. vulnificus which has a high mortality rate without early and appropriate intervention. In our case, the rapid identification of the microorganism allowed us to support the empirical treatment used, which a good clinical evolution.