Unexpected or Nonsuspected?: A Rare Cause of Recovered Left Ventricular Ejection Fraction After ECMO.

Acute heart failure represents a challenge, especially in infrequent etiologies. We present the clinical case of a young woman diagnosed with acute heart failure and cardiogenic shock. Pheocromocytoma was identified as a reversible etiology. The surgical treatment led to a complete recovery of cardiac function. (Level of Difficulty: Beginner.).

Caracterización de los pacientes con sospecha de aspergilosis invasiva estudiados con prueba Platelia Aspergillus® / Characterization of patients with suspected invasive aspergillosis studied by Platelia test

Objetivo: describir las características de los pacientes en los que se realizó prueba Platelia Aspergillus® por sospecha de AI, y los resultados de la prueba según las categorías diagnósticas. Metodología: se revisaron retrospectivamente las historias clínicas de pacientes con sospecha de AI atendidos en instituciones de salud de Medellín a quienes se les realizó la prueba Platelia Aspergillus®. Se colectaron y analizaron de manera descriptiva los datos clínicos, imaginológicos, microbiológicos y los resultados de la prueba Platelia Aspergillus®. Resultados: se incluyeron 78 pacientes atendidos entre 2006- 2008. Se diagnosticó AI en 21 (26.9%) pacientes, colonización en ocho (10.3%) pacientes. La forma pulmonar invasiva aguda se encontró en 17 (81.0%), forma diseminada en tres (14.3%). La fiebre y la disnea fueron la principal manifestación. En la tomografía de pulmón se observaron más frecuentemente nódulos pulmonares. La prueba fue positiva en 31 (39.7%) pacientes, en 50% de los pacientes colonizados. En 17 (47.2%) de los 36 pacientes recibieron antibióticos betalactámicos, la prueba fue positivo. Conclusiones: la AI puede encontrarse hasta en la tercera parte de pacientes con sospecha clínica; sin embargo, el diagnóstico es difícil debido al cuadro clínico inespecífico, además de las dificultades para obtener muestras clínicas y al pobre rendimientode las pruebas diagnósticas.

Objective: to describe the characteristics of patients with suspected IA, who were studied with the platelia test as well as theresults according to different diagnostic categories. Methods: the medical records of patients with suspected IA treated at health facilities in Medellin who were tested with platelia were retrospectively reviewed. Clinical data, imaging, microbiology and the platelia test results were collected and descriptively analyzed. Results: we included 78 patients treated from 2006 to 2008. IA was diagnosed in 21 (26.9%) patients and colonization was found in 8 (10.3%) patients. The acute invasive pulmonary form was found in 17 (81.0%), disseminated form in three (14.3%). Fever and dyspnea were the principal manifestation. Nodules were found more frequently in lung tomography. The tests were positive in 31 (39.7%) patients and in 50% of colonized patients. In 17 (47.2%) of 36 patients who received beta-lactamantibiotics, the test showed a positive result. Conclusions: IA can be found in up to one third of patients with clinical suspicion, but diagnosis remains difficult because of the nonspecific clinical picture, coupled with the difficulty for obtaining clinical samples and the poor performance of diagnostic tests.

Expression of hMLH1 and hMSH2 proteins in pleomorphic adenoma of minor salivary glands: relationship with clinical and histologic findings.

OBJECTIVE: The aim was to examine the relationship between clinicopathological features and immunoexpression of hMLH1 and hMSH2 proteins in pleomorphic adenoma (PA) of minor salivary glands. STUDY DESIGN: Paraffin-embedded samples of typically benign PA lesions (n = 35) were prepared for histologic and immunohistochemical assessment. Based on the clinicopathologic features, the samples were categorized into low- and high-risk subtypes for their estimated potential for malignant transformation. RESULTS: Immunohistochemical analysis revealed strong correlations regarding the expression estimation and staining-intensity distribution (SID) scores between the two proteins. Although there was no relationship between marker immunoexpression and SID scores regarding clinical parameters, statistically significant variations for these parameters were evident regarding some histologic criteria or for risk stratification subtypes. CONCLUSION: The findings of this study could suggest the relationship of a DNA mismatch repair deficiency with high-risk subtypes of PA and the implication of its role in the origin and progression of these subtypes.