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Synchronous Lung Adenocarcinoma and Papillary Thyroid Carcinoma The Metastases at the Centre of the Discussion
Get PDFSynchronous tumours are defined as two or more independent primary neoplasms of different origins diagnosed at the same time in 1 individual. Although rare, its incidence is increasing and the proper diagnosis and staging of each tumour is crucial in defining the patient prognosis and the best therapeutic choice. We present a case of a 56-year-old woman presenting with a lung adenocarcinoma and pulmonary metastases initially diagnosed as stage IV and who was started on a tyrosine kinase inhibitor (erlotinib). In the meantime, she was also diagnosed with papillary thyroid carcinoma and was submitted to complete thyroidectomy. After 6 cycles of erlotinib, thoracic CT showed a decrease in the dimensions of the primary pulmonary tumour, but an increase in the size and number of pulmonary metastases while blood tests showed elevated thyroglobulin. This therefore raised the possibility that the metastases could have originated from the thyroid carcinoma. Anatomo-pathological examination of the lung metastases confirmed this hypothesis. In conclusion, it is important to confirm the origin of metastases in synchronous tumours given this can lead to a re-staging of tumours and a different prognosis, along with other therapeutic options. A multidisciplinary team meeting is crucial to define management and therapeutic approaches for these patients
Persistent Antiphospholipid Antibodies, Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Post-COVID Syndrome: 1 Year On
Get PDFThis is the first case report of a patient with post-COVID-19 postural orthostatic tachycardia syndrome (POTS) with multiple persistent antiphospholipid antibody (aPL)-positivity more than a year after illness onset who also meets Global Consensus-2 criteria for mast cell activation syndrome (MCAS), suggesting pathological activation of the acquired and innate immune systems by SARS-CoV-2. While the patient continues to meet criteria for POTS 1 year on, her functional ability has improved significantly with therapy directed at MCAS, POTS and aPL-positivity
Sudden Death Due to Thrombosis Associated with Implantable Cardioverter-Defibrillator Electrodes
Get PDFThrombosis associated with pacemaker leads is extremely rare, although the literature on this subject is scarce. A clinical case is reported, describing this condition and its clinical presentation, the complementary tests for establishing the diagnosis and the available therapeutic options
Gemfibrozil-Induced Polyuria
Get PDFGemfibrozil is a lipid-regulating agent used mainly to treat patients with hypertriglyceridaemia, especially those at risk for acute pancreatitis. Like any other pharmacological agent, gemfibrozil has known adverse effects, mainly gastrointestinal, such as cholelithiasis, gallstones, elevated transaminase, and other non-specific symptoms including dyspepsia, nausea and vomiting. Other reported adverse reactions are dizziness and vertigo, myopathy and rhabdomyolysis, angioedema, urticaria and rash. As far as we knew, gemfibrozil does not have urinary tract adverse reactions. In this report, we present a case of polyuria secondary to gemfibrozil with a score of 9 on the Naranjo scale, and a literature review
COVID-19-related Multisystem Inflammatory Syndrome in a Young Adult
Get PDFIntroduction: A condition called multisystem inflammatory syndrome in children (MIS-C), related to past SARS-CoV-2 infection, has been described in a series of cases. There is a growing body of evidence suggesting a similar entity in adults (MIS-A). We report a case of a young adult with a hyperinflammatory systemic syndrome with end-organ lesions and a recent SARS-CoV-2 infection. Methods and Procedures: The patient developed end-organ lesions in the respiratory, cardiovascular, digestive, haematological and mucocutaneous systems. A wide diagnostic work-up did not find any specific aetiology (autoimmunity, neoplastic or infectious). There was evidence of past SARS-CoV-2 infection with positive autoimmune titres (positive IgG). A presumptive diagnosis of MIS-A was made and treatment with corticosteroids was introduced with improvement.Discussion: COVID-19-related multisystem inflammatory syndrome in adults is still an unknown entity with no diagnostic criteria or treatment guidelines. Much of what is known is inferred from what we already know about MIS-C. There have been several reported cases with severity ranging from mild to severe. The mechanisms behind this condition are still largely unknown. More evidence is needed to establish diagnosis and treatment
Investigating Febrile Polyserositis: An Unusual Case of Idiopathic Hypereosinophilic Syndrome
Get PDFHypereosinophilic syndrome (HES) is a heterogenous group of diseases characterized by abnormal accumulation of eosinophils in the blood or peripheral tissues. It can affect all organs and therefore clinical manifestations are highly variable. We describe the case of a 38-yearold man admitted for febrile polyserositis. He developed cardiac tamponade requiring pericardiocentesis complicated by left ventricle perforation which was successfully repaired. He presented mild peripheral eosinophilia. Bronchoalveolar lavage evidenced eosinophilic alveolitis, and pleural and pericardium histopathology revealed the presence of abundant eosinophils. All other causes of tissue eosinophilia were excluded and the diagnosis of idiopathic HES was made. The patient was started on glucocorticoids with resolution of symptoms. This case report describes a rare but potentially fatal presentation of HES and demonstrates the difficulty and delay in diagnosis when peripheral hypereosinophilia is absent
Volgarizzamenti e fenomeni sintattico-testuali
Get PDFThe article provides a state of the art on studies and commentaries devoted to
the syntax of “volgarizzamenti” in the Italian area, with special focus on translations from Latin language. The object of research is defined by distinguishing
the notions of syntax, textuality, translation techniques and style, which
sometimes appear to be confused. Based on the available works, the question
arises as to whether and to what extent it is possible to speak of a syntax of
“volgarizzamenti”, in the same way as one speaks of a translation lexicon. Particular attention is given to the notion of “variante di traduzione”, given the
great heuristic potential it has; it is noted, however, that this potential can only
be exploited if a distinction is made between the many linguistic and extralinguistic planes at the origin of the variation
Geoetica: un'etica per la relazione tra gli esseri umani e la Terra
Get PDFGli esseri umani vivono in una società globalizzata, smaterializzata nella sua spazialità e temporalità,
tecnologizzata, sempre più omogeneizzata nelle forme culturali e nelle strutture economiche, con accresciute disuguaglianze nel riconoscimento dei diritti umani e nelle
possibilità di autodeterminazione e di accesso alle risorse naturali. La pandemia da SARS-CoV-2 ha evidenziato criticità e potenzialità della società globalizzata. I cambiamenti
ambientali antropogenici, che modificano le caratteristiche fisico-chimico-biologiche del sistema Terra, costituiscono una minaccia analoga se non più grave per l'abitabilità
del pianeta da parte dell'umanità e di molte altre specie viventi. Affrontare urgentemente tali cambiamenti richiede una forte cooperazione internazionale tra gli Stati. Allo stesso tempo è necessario che le comunità umane condividano principi e valori su cui fondare nuove forme di relazione tra esseri umani e natura. In tale prospettiva, la geoetica
si propone come etica globale di un mondo complesso, fondata sui principi di dignità, libertà e responsabilità
Why do we need randomized controlled trials? Medical scandals and the evolution of drug regulation
Get PDFPerché abbiamo bisogno degli studi randomizzati e controllati (RCT)? Finora, le risposte a questa domanda si sono concentrate principalmente sulle loro virtù metdologiche. In breve, abbiamo bisogno degli RCT perché questi sono il modo migliore per valutare la sicurezza e l'efficacia dei farmaci. Ma questa risposta è solo parzialmente soddisfacente, non spiega infatti perché mai vogliamo testare i farmaci prima che possano essere commercializzati e perché vogliamo farlo in modo così rigoroso. In questo articolo analizzo le ragioni che hanno portato gli RCT a diventare il 'gold standard' della
ricerca clinica. Tali ragioni sono il risultato dell'interazione di preoccupazioni storiche, organizzative
e socio-politiche. Concentrandomi sulla storia della regolamentazione dei farmaci negli Stati Uniti, sostengo che i cambiamenti e le riforme sono stati attuati in risposta a grandi scandali farmaceutici, e non solo in risposta alle reali esigenze epistemiche emerse con gli sviluppi della ricerca farmaceutica. Nello specifico, mostro che gli
scandali hanno giocato un ruolo cruciale nell'innescare una serie di riforme della regolamentazione dei farmaci, e quindi nel plasmare la metodologia della ricerca clinica
contemporanea
Misdiagnosis of Rectus Abdominis Abscess Owing to Delayed Contrast-Enhanced Computed Tomography
Get PDFA 77-year-old man, who was on anticoagulation, presented with a painful lump on the right abdominal wall. Laboratory tests showed slight anaemia and elevated inflammatory markers. Abdominal plain computed tomography (CT) revealed a mass in the right rectus abdominis muscle. He was admitted with a diagnosis of primary rectus abdominis haematoma. However, on the next day, the diagnosis was corrected to primary rectus abdominis abscess, following contrast-enhanced CT of the abdomen. This case illustrates the importance of considering primary rectus abdominis abscess in patients with suspected primary rectus abdominis haematoma, and contrast should be used when performing CT