Medicina
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We present the case of a patient with venous thromboembolic disease and contraindication to anticoagulation, where the incidental finding of a duplication of the inferior vena cava was made. This observation determined the need to implant two embolic protection filters. Although this vascular anomaly is rarely present, it is important to keep this possibility in mind to ensure that proper protection is provided when inferior vena cava filters are implanted.
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We present the case of a patient who consulted for cough, showing a mass in the lower lobe of the right lung on imaging studies. Bronchoscopy revealed an irregular, whitish endobronchial formation, from which whitish membranes were aspirated. Biopsies were taken from the aspirated material and sent for analysis Based on the cyto and histopathological study, pulmonary hydatid disease coexisting with a sarcoma was diagnosed. ⋯ The usual complication is the rupture of the cyst with the eventual seeding and its infection. In this case, the coexistence of hydatid disease with a pulmonary sarcoma was revealed, a fact of which we only know of one report, more than fifty years ago. The publication is motivated by the extremely infrequent nature of this association, highlighting the importance of carrying out histopathological studies even when clinical and imaging suspicion points to hydatid disease.
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Light chain amyloidosis (AL) is a rare and underdiagnosed disease. The best treatment available is autologous bone marrow transplantation (BMT). Cardiac involvement is the main prognostic determinant in this pathology and sometimes an impediment to receive BMT. ⋯ After diagnosis, specific chemotherapy treatment with Cyclophosphamide, Bortezomib and Dexamethasone (CYBORD scheme) and Daratumumab was started. He evolved with refractory HF so it was decided to admit him to the cardiac transplantation list, receiving the same soon after, with good evolution. This allowed the patient to restart the chemotherapy regimen and finally receive BMT, with good evolution.
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Immune-mediated gastritis is a rare adverse effect in patients treated with immune checkpoint inhibitors. We present a patient with a diagnosis of cervical carcinoma under treatment with pembrolizumab who was admitted with nausea, vomiting and weight loss; an endoscopy revealed a ulcerated lesion covered by mucus in the antrum and gastric body. The biopsy revealed extensive denudation of the gastric mucosa with fibrin leukocyte reaction. ⋯ Immunohistochemistry confirmed positivity for PDL1 (clone SP2630) and combined positive score of 35%, with a relative contribution of epithelial cells of 25% and inflammatory cells of 10%. After three weeks with 30 mg meprednisone, a new endoscopy revealed a stomach with clear mucus content; fundus and body without lesions, and an antrum with congestive mucosa and multiple superficial ulcers covered by fibrin. Diagnostic and therapeutic aspects of immune-mediated gastritis are described.
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Case Reports
[Benefit of surgery in a case of negative motor focal epileptic seizures secondary to parietal cortical dysplasia].
Focal atonic seizures are recognized rarely as ictal phenomena, they can correspond to both generalized epilepsy and focal epilepsy. The areas of the brain involved in the management of this type of seizure are: the negative motor area and the primary motor and primary somatosensory cortices, although the neurophysiology that generates them is still unclear. ⋯ A scalp Video EEG and then a Stereo EEG was performed, defining the epileptogenic area and its relationship with eloquent areas. Surgical resection of the lesion was performed, achieving complete seizure control.