ABSTRACT
We describe the case of an 82-year-old man who had recently undergone cardiac surgery (quadruple coronary bypass), who consulted due to the appearance of a necrotic eschar on the thumb of the right index finger, together with paraesthesia and hypoaesthesia in the first 3 fingers of the same hand. An ultrasound scan of the right elbow was performed to rule out involvement of the median nerve and an anechoic, thick-walled mass was found, dependent on the wall of the proximal ulnar artery, compatible with a pseudoaneurysm of the same, compressing the nerve. Electromyography showed an acute lesion of the proximal median nerve and angio-CT confirmed the diagnosis of pseudoaneurysm of the proximal ulnar artery. Pseudoaneurysm is a dilatation by rupture of the arterial wall, which does not involve all three layers of the arterial wall and communicates with the vascular lumen. Its development after vascular manipulation is very rare, and it is uncommon for it to act by compressing a nerve structure. In our case, together with vascular surgery, treatment with intralesional thrombin was decided, with good evolution.
Se describe el caso de un varón de 82 arios intervenido recientemente de cirugía cardíaca (cuádruple bypass coronario), que consulta por aparición de una escara necrótica en el pulpejo del dedo índice derecho, junto a parestesias e hipoestesias en los tres primeros dedos de dicha mano. Se realiza una ecografía del codo derecho para descartar afectación del nervio mediano y se objetiva una masa anecoica, de paredes engrosadas, dependientes de la pared de la arteria cubital proximal, compatible con pseudoaneurisma de esta, que comprime dicho nervio. En la electromiografía se evidencia una lesión aguda del nervio mediano a nivel proximal y en el angio-TC se confirma el diagnóstico de pseudoaneurisma de la arteria cubital proximal. El pseudoaneurisma es una dilatación por rotura de la pared arterial, que no implica a las tres capas de esta y se comunica con la luz vascular. Su desarrollo tras una manipulación vascular es muy infrecuente y que actúe comprimiendo una estructura nerviosa es poco común. En nuestro caso, conjuntamente con cirugía vascular se decidió tratamiento con trombina intralesional, con buena evolución.
Subject(s)
Humans , Male , Aged, 80 and over , Cardiovascular System , Arteries , Vascular Diseases , Blood Vessels , Cardiovascular Diseases , Ulnar Artery , Aneurysm, False , Peripheral Nervous System , Median Nerve , Nervous SystemABSTRACT
INTRODUCTION AND OBJECTIVE: Belimumab is a monoclonal antibody targeting BLyS approved for Systemic Lupus Erythematosus (SLE), with recent indication for lupus nephritis (LN). To analyze effectiveness of Belimumab in LN patients. METHODS: Retrospective and cross-sectional study including SLE patients (SLICC/ACR 2012 criteria) with LN demonstrated by kidney biopsy, treated with Belimumab. A clinical history review was made and serological data, kidney function and urine sediment were collected. RESULTS: Eight patients with LN demonstrated by kidney biopsy were included. Median age was 37.56 (7.03) years, with 15.13 (8.71) years since SLE diagnosis was made and 4.61 (2.64) years since onset of belimumab. Proteinuria was reduced to normal values in 6 patients, and renal function was stable from the beginning of treatment in all cases. There was a reduction in the anti-DNA level and normalization of complement in those cases in which it was reduced. One patient presented an increase in anti-DNA titer, with normal complement. CONCLUSIONS: In clinical practice, belimumab can improve LN in terms of serological activity, kidney function and urine sediment.
Subject(s)
Lupus Erythematosus, Systemic , Lupus Nephritis , Adult , Antibodies, Antinuclear , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Cross-Sectional Studies , Humans , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Lupus Nephritis/drug therapy , Retrospective StudiesABSTRACT
We present the case of a 70 years old woman with infectious discitis which was detected using Fluorine fluodeoxiglucose positron emission tomography/computed tomography (18F-FDG PET/CT), after a negative magnetic resonance imaging. A Streptococuss gallolyticus (bovis gender bacteria) grow on culture. In addition 18F-FDG PET also demonstrated infectious endocarditis which was confirmed by transesophageal echocardiography and a colonic neoplasm. Here we have highlighted the potential role of 18F-FDG PET/CT study in patients with a clinical history suggestive of infectious discitis with a negative or indifferent magnetic resonance imaging.
