Dardani 1, A. Cavazza 1, I. Iori 1, E. Negri 1. Introduction Systemic vasculitis are multi system diseases requiring detailed multidisciplinary assessment.
Two weeks previously he had first noticed arthralgia treated with Ketoprofene. He was subsequently evaluated for generalized palpable purpuric rash at Dermatology Clinic where hypersensitivity vasculitis was suspected. Two days later he developed abdominal pain and was hospitalized. At admission, lab tests showed just mildly elevated inflammatory markers. Skin biopsy was performed and "wait and see" strategy chosen. In few days the patient developed rectal bleeding and computed tomography CT and pan colonoscopy PC were performed: the CT showed a diffusely edematous and thickened gut while the PC detected severe petechiae throughout the intestinal wall.
Intestinal and Skin biopsy showed leukocytoclastic vasculitis while the control lab tests revealed new onset microscopic hematuria. Intravenous Methylprednisolone was started and transitioned to Prednisone tapering orally to complete six months therapy. There was marked improvement of abdominal pain and gastrointestinal bleeding while skin lesions gradually faded. Anyway, even in adults, HSP can present with arthralgia, abdominal pain and rectal bleeding, palpable purpura and hematuria which represent a pathognomonic clinical tetrad.
Major digestive bleeding secondary to chronic portal venous thrombosis as clinical onset of previously unknown hepatic cirrhosis complicated by hepatic carcinoma. Arioli1, F. Bassi1, F. Pileri2, M. Leone1, C.
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Trenti1, D. Galimber-ti1, L. Camellini1, E. Negri1, I. Iori1, A. Introduction Hepatocarcinoma HCC is a complication of hepatic cirrhosis HC generally detected in early stage due to Ultrasonographic US surveillance in hepatopathic patients.
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It can be treated effectively with well tolerated loco-regional treatment. In advanced stages of the disease, HCC may be complicated by portal vein thrombosis PVT that represents the limiting element of the treatment and, therefore, the more devastating prognostic element. In both cases the diagnostic role of Doppler US study is emphasized such as the importance of alpha fetoprotein requested in the correct scenario. In both cases patients underwent endoscopic variceal ligation VL regardless to the chance of etiologic treatment of HCC and anticoagulant therapy was attempted.
Just in the first case it was possible to begin Sorafenib due to the better Child Class present at the diagnosis A5 versus B8. In this scenario anticoagulant therapy can be considered just in case of preserved liver function and should be individualized. Unlike the anticoagulation, VL is codified therapy and shouldn't be denied to patients since it appears to significatively prolong surveillance. The patient had recently undergone surgical removal of a bone tumor in the left heel about 10 months before.
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X-rays performed in the ER revealed an area of bone resorption in the right hip, therefore the patient was admitted in the Internal Medicine ward. The patient provided the histological report of the previously removed tumor, that revealed a diagnosis of osteoclastoma. At admission, the patient was found to have hypercalcemia Furher X-rays showed multiple bone cysts localized in the right hip iliopubic branch and iliac crest and in both the scapulas.
Neck ultrasonography revealed a hypoechoic nodule of 3 cm in diameter adjacent to the lower pole of the left thyroid lobe, compatible with a parathyroid adenoma. Abdomen ultrasound showed a 6 mm stone in the right kidney. The patient underwent surgical removal of the abnormal gland, and the histological findings confirmed the diagnosis of parathyroid adenoma.
Post operative period was marked by persistent hypocalcemia, and the patient was managed consequently. The previously removed osteoclastoma was probably a first sign of the skeletal involvement in primary hyperparathyroidism. Therefore, when a diagnosis of osteoclastoma is made, it would be worth investigating mineral metabolism in order to exclude the presence of primary hyperparathyroidism.
Background and aim of the study A diagnostic and therapeutic challenge.
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Materials and methods We studied a 50 years old woman for persistent cough and fever with a history of prolonged juvenile pulmonary infection. At chest radiograph pleuric and pulmonary fibrotic outcomes at the right apex and a pulmonary infiltrate at the right upper lobe. The chest CT revealed a cavity with internal vegetation at the right apex and multiple right infiltrates.
Meaning of "normotensione" in the Italian dictionary
Not sure, but still suspecting TB, treatment with Isoniazid, Pyrazinamide, Rifampin and Ethambutol was started with slow improvement of symptoms, inflammation and radiographs. After 2 months treatment was tapered to Isoniazid and Rifampin, but the patient clinically relapsed despite a improvement on chest CT. Assuming drug resistance we restarted a 4 drugs regimen plus levofloxacin for 2 months with new slow improvement. The clinical course was complicated by polyneuropathy, attributed to levofloxacin; the drug was replaced with linezolid for 1 month and then the 4 drugs regimen was continued for 2 months.
Complete clinical and laboratoristic resolution was obtained with disappearance of all radiologic lesions. Asti1, M. Di Guglielmo1, G. Fertuso1, A. D'alessandro1, G. Perrone1, S. Nardi1, G. Maresca1, P. Objective examination shows treatable abdomen, reduced MV, hyperpyrexia and he reports sacrococcygeal pain, because of which he fails to maintain the sitting position. On examination, there aren't clinical signs of relief, except for sacrococcygeal pain patient-reported and hyperpyrexia. The microbiological investigations, such as the Widal Wright serodia-gnosis, throat swab and urine culture, result negative.
here Abdominal ultrasound shows a gross swelling of 8x6 cm, multilobed and multi-divided, in front inseparable from the rear wall of the rectum and in the back to the coccyx; this finding is confirmed by NMR. For this reason, the patient undergoes surgery of drainage of the retroperitoneal abscess by laparotomy, and bacteriological examination concludes for Staphylococcus Aureus etiology. Asti1, G. Fertuso2, M. Di Guglielmo2, A. D'alessandro2, G.
Perrone2, S. Nardi2, G. Maresca2, P. Maria di Loreto Nuovo" A. Senegalese patient, 34 years old, arrived to emergency room because of generalized asthenia for a few days, therefore he fails to maintain the upright position. He also complains severe pain in the sacral region. Routine investigations shows a severe lymphocytopenia and the signs of a possible degenerative process in action, as evidenced by high values of LDH and CPK. The patient underwent lumbosacral CT scan, which shows lysis of D with heterogeneous paravertebral tissue cold abscess seat left an-terolateral.
As a result of a CT lumbar scan, practiced after 6 months of therapy, the cold abscess is almost absorbed. Fertuso1, M.
Related Tromboembolia polmonare acuta (Italian Edition)
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