Transverse colon volvulus in a young patient with wandering liver.

We present the case of a 26-year-old male patient with no history of interest who consulted the emergency department due to occlusive symptoms. Urgent CT showed the presence of a transverse colonic volvulus in the context of a heterotopic liver, located in the left hypochondrium. There were no clinical or radiological signs of perforation or ischemia, so urgent endoscopic decompression was performed with subsequent elective surgery with a favorable resolution of the condition. Transverse colonic volvulus is rare (<1%) and wandering liver is an exceptional predisposing factor, with less than a hundred published cases. In these patients, endoscopic decompression carries a risk of perforation with high recurrence rates, and surgical treatment should be considered. However, in this case, in the absence of severity criteria, decompressive colonoscopy was considered an urgent treatment and subsequent elective surgery with favorable results.

Longitudinal analysis of antibody responses to the Pfizer BNT162b2 vaccine in Patients Undergoing Maintenance Hemodialysis

BackgroundHemodialyzed patients are at higher risk for COVID-19 and were prioritized in the Portuguese vaccination campaign MethodsWe performed a prospective, longitudinal, cohort analysis of 143 patients on hemodialysis and 143 age-matched controls along BTN162b2 vaccination. ELISA quantified anti-full-length Spike IgG, IgM and IgA levels prior to the first vaccine dose (t0); 3 weeks later (second dose, t1); and 3 weeks later (t2); 127 patients were re-evaluated140 (t3) and 180 days (t4) after the first dose. ResultsSeroconversion at t1 was remarkably low in patients, with positivity for anti-spike IgG, IgM and IgA antibodies of 29.4%, 12% and 41%, respectively, increasing to 90.9% (IgG) and 83.9% (IgA) in t2, (IgM remained unchanged). Below 70 years of age anti-spike IgG levels at t1 were significantly lower compared to age-matched controls and showed a profile similar to older individuals. Immunosuppression was associated with lower antibody responses (p=0.005 at t1; p=0.008 at t2). Previous unresponsiveness to hepatitis B vaccination (75/129, 58% of patients negative for anti-HBs antibodies) did not correlate with humoral unresponsiveness to BTN162b2. Anti-spike IgG, IgM and IgA positivity and antibody levels significantly decay at t3, with IgG levels showing further waning at t4. ConclusionsThe large majority of hemodialyzed patients showed IgG seroconversion upon BNT162b2 mRNA vaccination, albeit a sizable proportion of patients presented poor responses. Follow-up of antibody responses 180 days post vaccination unveiled significant decay of anti-spike antibodies and warrant close monitoring of COVID-19 infection and further studies on reinforced vaccination schedules in patients undergoing maintenance hemodialysis.

Extraocular Muscles Involvement as the Initial Presentation in Metastatic Breast Cancer / 한국유방암학회지

Orbital metastasis is a rare event, and metastatic disease affecting the extraocular muscles is an even less frequent complication of solid tumors. Herein, we report an unusual case of ptosis as the initial presentation of an invasive breast cancer. A 68-year-old woman presented with III and VI partial nerve paresis, secondary to a compressive retrobulbar mass. Magnetic resonance imaging revealed an infiltrative lesion involving the extraocular muscles. Tissue biopsy yielded a result compatible with metastasis to the orbit, with immunohistochemistry analysis suggesting breast as the primary organ. Mammography identified an area of architectural distortion; stereotactic wire-guided biopsy confirmed the result of the previous orbital biopsy. A positron emission tomography scan demonstrated disseminated disease. Palliative chemotherapy with bone-modulating agents and subsequent hormonal therapy was proposed. Unfortunately, the patient did not respond to therapy and died 38 months after diagnosis.

Evaluation of Nasal Obstruction in Various Sagittal Skeletal Deformity of Jaws.

Nasal obstruction (NO) is a common symptom present in 25% of the general population, which significantly interferes with the quality of life. The different facial profiles and malocclusion patterns could be associated with the degree of NO. In order to evaluate the nasal function in patients with different facial morphology patterns, the authors developed a prospective study in which 88 patients from a dentofacial deformities center were included. These patients were submitted to fibrorhinoscopy (Mashida, ENT PIII) with a 3.2-mm cannula under topical anesthesia to evaluate septal deviation, inferior and medium turbinates, and pharyngeal tonsils. The 88 patients included in the study were divided into 3 groups according to the classification of the facial profile, distributed as follows: 32 class I, 28 class II, and 28 class III; the data collected was statistically analyzed by analysis of variance and the results are shown. The patients included in this study presented similar prevalence of NO with the reduction of airway function efficiency. Although it was not a statistically different, the group II presented higher mean Nasal Obstruction Syndrome Evaluation scores.

IBD or strongyloidiasis?

Introduction: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. Case report: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patientclinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. Discussion: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic (AU)

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IBD or strongyloidiasis?

INTRODUCTION: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. CASE REPORT: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patient-clinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. DISCUSSION: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic.

Milky ascites and Listeria meningitis associated with systemic lupus erythematosus

The case of a woman with systemic lupus erythematosus and coexistent milky ascites and meningitis by Listeria monocytogenes is reported. The patient was under longstanding immunosuppressive treatment. Listeriosis is considered an uncommon condition in adults, which occurs as opportunistic infection in immunosuppressed hosts. Samples from ascites showed low triglyceride concentration. Opalescent ascites and Listeria meningitis are rarely reported inpatients with systemic lupus erythematosus.

Relata-se o caso de uma mulher com lúpus eritematoso sistêmico e ascite leitosa coexistente com meningite por Listeria monocytogenes. A paciente estava em tratamento imunossupressivo de longa duração. A listeriose é considerada doença incomum em adultos, que ocorre como infecção oportunista em hospedeiros imunossuprimidos. Amostras da ascite revelaram baixa concentração de triglicérides. Ascite opalecente e meningite por Listeria são raramente descritas em pacientes com lúpus eritematoso sistêmico.