RESUMO
Pachydermoperiostosis or the Touraine-Soulente-Golé syndrome is a rare monogenetic disorder characterized by pachydermia, periostosis and digital clubbing accounts for approximately 3â¼5% of all patients with hypertrophic osteoarthropathy. Missense mutations in SLCO2A1 and HPGD genes could plausibly underlie the pathogenesis of pachydermoperiostosis. Patients have usually a favorable outcome with very few cases associated with cancer. Herein, we report the first case of a patient with pachydermoperiostosis associated with bladder cancer.
Assuntos
Osteoartropatia Hipertrófica Primária/complicações , Neoplasias da Bexiga Urinária/complicações , Adulto , Humanos , Masculino , Osteoartropatia Hipertrófica Primária/diagnóstico por imagem , RadiografiaAssuntos
Lúpus Eritematoso Sistêmico/complicações , Peritonite/etiologia , Adulto , Ascite/etiologia , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Recidiva , Indução de Remissão , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoAssuntos
Fármacos Gastrointestinais/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Octreotida/uso terapêutico , Doença de von Willebrand Tipo 2/tratamento farmacológico , Idoso , Angiodisplasia/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Hemorragia Gastrointestinal/tratamento farmacológico , Humanos , Masculino , Síndrome , Doença de von Willebrand Tipo 2/diagnósticoAssuntos
Cardiomegalia/diagnóstico por imagem , Aneurisma Coronário/etiologia , Lúpus Eritematoso Sistêmico/complicações , Tuberculose Pulmonar/complicações , Adulto , Fatores de Confusão Epidemiológicos , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/terapiaRESUMO
A 71-year-old woman on warfarin (2.5 mg daily) developed severe low back pain with reduced touch sensation and weakness of the lower limbs that progressed to complete paralysis within 28 to 30 hours. Imaging revealed bleeding at the D4 through D11 level, however the patient refused emergency laminectomy. No recovery was observed and the patient was discharged to a rehabilitation facility. Only few other cases of hematomyelia linked to anticoagulant therapy have been reported. Early diagnosis, appropriate management and immediate intervention are needed to prevent irreversible neurological sequelae. The elusive clinical features at presentation may cause an important diagnostic delay.
Assuntos
Anticoagulantes/efeitos adversos , Diagnóstico Tardio , Paralisia/etiologia , Doenças Vasculares da Medula Espinal/induzido quimicamente , Doenças Vasculares da Medula Espinal/diagnóstico , Varfarina/efeitos adversos , Idoso , Antifibrinolíticos/uso terapêutico , Feminino , Humanos , Dor Lombar/etiologia , Paralisia/reabilitação , Plasma , Doenças Vasculares da Medula Espinal/complicações , Vitamina K/uso terapêuticoRESUMO
INTRODUCTION: This article deals with the description and diagnosis of a new nosographic syndrome, which received the eponym of "Cugini's syndrome" by the name of the Author who discovered its clinical picture. This syndrome is characterized by the binomial: "minimal target organ damage associated to monitoring prehypertension". CLINICAL HISTORY AND DIAGNOSIS: Between the years 1997 and 2002, the Author published a series of investigations regarding some office normotensives who inexplicably showed incipient signs of target organ damage (TOD). Investigated via ambulatory (A) blood (B) pressure (P) monitoring (M), these subjects were surprisingly found not to be hypertensive. Neverthless, the office normotensives with TOD exibited the daily mean level of their systolic (S) and diastolic (D) BP (DMLSBP/DBP) significantly more elevated as compared to true normotensives. Because of these ABPM findings, the Author realized that the investigated subjects were false normotensives whose TOD was associated with a monitoring prehypertension (ABPM-diagnosable prehypertension alias monitoring prehypertension alias masked prehypertension). The year after the last Cugini's investigation, the INC-7 Reports introduced the term: "prehypertension" in its classification of arterial hypertension, as an office sphygmomanometric condition in between office normotension and office hypertension. The ABPM cut-off upper limits for a differential diagnosis between monitoring normotension, prehypertension and hypertension are reported, as calculated by the Author in its collection of ABPMs. The eponym of "Cugini's syndrome" was assigned in 2007 and confirmed in 2009. CONCLUSIVE REMARKS: The monitoring prehypertension is a further condition of discrepancy between office sphygmomanometry and ABPM, as per a masked prehypertension, whose diagnosis has to be immediately diagnosed, for preventing the onset of a TOD. There are reported the present investigations dealing with the possible need for an early antihypertensive treatment of prehypertension. A pharmacological treatment seems to be especially justified in the presence of a Cugini's syndrome.
Assuntos
Hipertensão/diagnóstico , Hipertensão/história , Monitorização Ambulatorial da Pressão Arterial , História do Século XX , Humanos , Hipertensão/terapia , ItáliaRESUMO
INTRODUCTION: Proton pump inhibitors (PPIs) have been linked to clinically symptomatic hypomagnesemia. AREAS COVERED: We searched Medline database in all languages using 'proton-pump inhibitors, magnesium, hypomagnesemia and hypomagnesemic hypoparathyroidism' as search terms and other articles were identified through searches of the files of the authors and reference lists from relevant articles. All patients presented with hypomagnesemic hypoparathyroidism, however, they rarely had life-threatening conditions such as malignant ventricular arrhythmias associated with prolonged QT interval, tetany and generalized seizures. Hypomagnesemia was seen with different PPIs, which could suggest a class effect, and was refractory to Mg replacement until PPIs were stopped. Hypomagnesemia may recur after re-challenge with the same or a different PPI and is not clearly dose-related. Mechanisms are poorly understood but PPI-induced hypochlorhydria does not seem involved. Carriers of TRPM6/7 mutations could be at risk. EXPERT OPINION: Although mechanism and incidence rate remain unclear, there seems little doubt that PPIs may cause hypomagnesemia. We should obtain blood Mg levels prior to initiation of PPIs when patients are expected to be on treatment for long period of time and in those with other potential causes of hypomagnesemia. Use of H2-blockers may be an appropriate alternative.
Assuntos
Hipercalciúria/induzido quimicamente , Deficiência de Magnésio/induzido quimicamente , Nefrocalcinose/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Erros Inatos do Transporte Tubular Renal/induzido quimicamente , Humanos , Hipercalciúria/sangue , Magnésio/sangue , Deficiência de Magnésio/sangue , Nefrocalcinose/sangue , Erros Inatos do Transporte Tubular Renal/sangueAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Toxidermias/etiologia , Eosinofilia/induzido quimicamente , Espondilartrite/tratamento farmacológico , Sulfassalazina/efeitos adversos , Toxidermias/diagnóstico , Eosinofilia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de DoençaAssuntos
Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Pancreatite/induzido quimicamente , Doença Aguda , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/efeitos adversos , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Humanos , Liraglutida , MasculinoAssuntos
Ácidos Heptanoicos/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Miosite/induzido quimicamente , Pirróis/efeitos adversos , Músculo Quadríceps/efeitos dos fármacos , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Atorvastatina , Biópsia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Imageamento por Ressonância Magnética , Fadiga Muscular/efeitos dos fármacos , Força Muscular/efeitos dos fármacos , Miosite/tratamento farmacológico , Miosite/imunologia , Miosite/patologia , Miosite/fisiopatologia , Necrose , Prednisona/administração & dosagem , Músculo Quadríceps/imunologia , Músculo Quadríceps/patologia , Músculo Quadríceps/fisiopatologia , Resultado do Tratamento , Extremidade SuperiorAssuntos
2-Piridinilmetilsulfinilbenzimidazóis/efeitos adversos , Hipoparatireoidismo/induzido quimicamente , Deficiência de Magnésio/induzido quimicamente , Omeprazol/efeitos adversos , Inibidores da Bomba de Prótons/efeitos adversos , Tetania/etiologia , Biomarcadores/sangue , Feminino , Humanos , Hipoparatireoidismo/complicações , Hipoparatireoidismo/diagnóstico , Magnésio/sangue , Deficiência de Magnésio/sangue , Deficiência de Magnésio/complicações , Deficiência de Magnésio/diagnóstico , Pessoa de Meia-Idade , PantoprazolAssuntos
Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Síndrome Hepatorrenal/induzido quimicamente , Pirazóis/efeitos adversos , Sulfonamidas/efeitos adversos , Idoso , Celecoxib , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/fisiopatologia , Feminino , Seguimentos , Síndrome Hepatorrenal/fisiopatologia , HumanosRESUMO
BACKGROUND: Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cellmediated response to cornstarch from surgical glove powder in susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique. METHODS: We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management was conservative, and no relapse was observed after over 1-y of follow-up. DISCUSSION: We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported. CONCLUSION: We should be aware of this rare cause of peritonitis in the surgical setting.