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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Clinical Case
Get PDFDiffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary condition characterized by diffuse proliferation of neuroendocrine cells in the epithelium of the bronchial wall. DIPNECH may be easily missed in daily clinical practice and diagnosis is often delayed, which may impair prognosis since this condition is considered a pre-invasive lesion for lung carcinoid tumours. We report a clinical case of DIPNECH in order to discuss the diagnostic and therapeutic approach for this entity, the management of which is not yet well established in the literature
Complexities of Diagnosing and Treating a Mesenteric Cyst in a Chronic Myeloid Leukaemia Patient
Get PDFMesenteric cysts are a rare nosologic entity, the diagnosis of which is complex due to their nonspecific presentation. They may emerge from any part of the mesentery and grow to any size, thus conditioning a wide range of clinical manifestations that renders them easily mistaken for different gastrointestinal pathologies. Diagnosis encompasses a mixture of clinical suspicion, imaging techniques and sometimes surgery, and curative treatment is based on complete surgical resection of the cyst. We hereby present a case of a mesenteric cyst that developed on the anterior abdominal wall of a 59-year-old man awaiting allogeneic bone marrow transplantation after being diagnosed with chronic myeloid leukaemia. He was admitted to the emergency room with complaints of an increased abdominal perimeter and increased weight, not associated with alterations to his dietary or physical exercise habits. Suspecting ascites in the context of leukaemic progression, the patient was admitted to the medical ward; however, subsequent study identified a mesenteric cyst as the most probable diagnosis and the patient was proposed to undergo surgery. He underwent laparotomic cyst excision without complications and the histological evaluation of the surgical specimen confirmed the diagnosis
Pericardial Effusion as an Initial Presentation of Panhypopituitarism
Get PDFPericardial effusion has a broad spectrum of clinical presentation, ranging from an incidental finding on imaging to a potentially fatal emergency such as pericardial tamponade, the most severe presentation. The authors present a case of a middle-aged male hospitalized due to shortness of breath. Initial work-up was positive for massive pericardial effusion with haemodynamic compromise. Additional study revealed panhypopituitarism. The acromegalic phenotype was suggestive of acromegaly secondary to pituitary adenoma, which had probably evolved to apoplexy. Hormone replacement was started with clinical improvement. At the 3-year follow-up, there was no evidence of recurrence of pericardial effusion. Panhypopituitarism is a relatively rare entity, but can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure. Pericardial effusion is an extremely rare manifestation of secondary hypothyroidism
Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome
Get PDFCannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain
Personnalité, caractère et tempérament : une source explicative d’une posture victimaire des femmes sous emprise conjugale?
Get PDFL’étude vise à questionner la pertinence d’une conception causale des traits de personnalité dans le renforcement d’une posture victimaire chez des femmes sous emprise conjugale. Les déterminants individuels de trente-quatre victimes sont explorés à travers le modèle psychobiologique de la personnalité de Cloninger (TCI). L’analyse factorielle identifie des cohérences internes marquées : un style d’attachement émotionnel empreint d’une anxiété abandonnique, un besoin d’attention, un manque d’autonomie, un rapport de dépendance, une instabilité des relations interpersonnelles, une insécurité affective, un manque de confiance en soi et une image négative de soi. La sentiment d’abandon, l’instabilité émotionnelle cumulées au besoin de dépendance et de surprotection peuvent influer davantage sur des relations conjugales ambivalentes, chaotiques ou conflictuelles. Les résultats de cette étude ne peuvent être généralisables à d’autres échantillons de participantes Le concept même de « personnalité » est reconsidéré sur la base des travaux s’inscrivant dans l’approche socio-cognitive du comportement. L’étude se conclut par une lecture victimologique autour du rôle modérateur des traits de personnalité dont les fondements sont remis en question
Un approccio intersezionale all’integrazione delle sopravvissute alla tratta in Europa. Dalla paura alla fiducia
Get PDFIl presente articolo prende in esame alcuni dei più significativi ostacoli all’integrazione delle sopravvissute alla tratta secondo l’approccio intersezionale al processo d’integrazione in Europa, sviluppato attraverso il progetto di ricerca INTAP cofinanziato dalla Commissione europea per rendere più efficaci gli attuali sistemi di integrazione, in linea con la direttiva UE sulla tratta degli esseri umani (direttiva 2011/36/UE). I risultati chiave di questo studio sono individuati nel ruolo della paura che rappresenta il principale ostacolo all'integrazione delle sopravvissute e il ruolo della persona di fiducia che rappresenta la principale opportunità. In particolare, il saggio approfondisce il tema dell’ansia e della paura che caratterizza le vittime, il ruolo della comunità etnica di appartenenza e della spiritualità, il problema del permesso di soggiorno, il fattore discriminazione e gli effetti della tratta sulla psiche.
Vengono quindi analizzate alcune buone prassi e proposte di azioni che favoriscano la protezione e l’inclusione delle sopravvissute alla tratta nella società europea, sia dal punto di vista degli operatori ed ONG specializzate sia dal punto di vista delle politiche in materia d’asilo e per il contrasto di discriminazione razziale e di genere
Fatal Ischaemic Stroke During COVID-19 and Acute Lung Injury
Get PDFSevere COVID-19 may predispose to both venous and arterial thrombosis. We describe a patient with acute ischaemic stroke while suffering from COVID-19 and respiratory failure, necessitating mechanical ventilation. Deep sedation may delay diagnosis
Immune Thrombocytopenic Purpura in Patients with COVID-19
Get PDFWe described three COVID-19-infected patients with profound immune thrombocytopenia causing haemorrhagic mucocutaneous complications. We conclude that an immune mechanism was responsible as common causes were excluded. Since corticoids were considered harmful in the circumstances, the patients were successfully treated with intravenous immunoglobulins without later relapse
COVID-19 Precipitating Euglycaemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use
Get PDFObjective: To describe a patient who developed euglycaemic diabetic ketoacidosis (DKA) in the setting of SGLT2 inhibitor use precipitated by COVID-19.Patient and methods: A 52-year-old male with type II diabetes on empagliflozin and no history of DKA presented with symptoms of COVID-19 as well as laboratory findings consistent with euglycaemic DKA. His hospital course was complicated by recurrent episodes of euglycaemic DKA as well as hyperglycaemic DKA. Conclusion: SGLT2 inhibitors should be held as early as possible in COVID-19 cases due to the risk of euglycaemic DKA. These patients should also have more intense glucose monitoring
Leucocytosis and Stroke in a Lung Cancer Patient
Get PDFSignificant leucocytosis in the setting of an underlying malignancy may be attributed to several causes and is not uncommon; however, extreme leucocytosis (>50×109 cells/l) and hypereosinophilia is less common and may represent a paraneoplastic syndrome. The underlying mechanism is thought to be bone marrow stimulation by tumour-produced cytokines, most notably interleukin-5 (IL-5) and granulocyte-macrophage colony-stimulating factor (GM-CSF). This paraneoplastic syndrome is likely reflective of extensive disease and dissemination, and options for treatment are limited but include tumour resection, corticosteroids and hydroxyurea. In this report, we discuss an unusual case of known stage III lung adenocarcinoma presenting with an ischaemic stroke and extreme leucocytosis and hypereosinophilia