Acute dyspnea in Emergency Department: point of care ultrasound in the diagnosis of atrial sarcoma

We describe a rare case of a 65-year-old patient presented to Emergency Department for acute dyspnea. Traditional diagnostic work-up was done and the emergency physician promptly performed a bedside point-of-care ultrasound. A giant mass in the left atrium was detected with impairing of mitral valve function. The patient was then sent to cardiac surgery department with a final diagnosis of high-grade cardiac sarcoma

Uncommon case of pericardial effusion

We present the case of a 59-year-old patient with severe aortic stenosis, asymptomatic mild to moderate pericardial effusion and no major risk factors for poor prognosis. He underwent four-week course of non-steroidal anti-inflammatory drugs (ibuprofen 600 mg TID) with no improvement of the effusion. After complete diagnostic work-up and examination, we discovered that he had a prostate cancer with bone metastasis. On the bone scintigraphy, there was particular involvement of ribs and sternum. We decided to treat our patient with an association of docetaxel and hormone therapy, after six months we observed a reduction in the pericardial effusion. Even in the presence of a patient without risk factor of poor prognosis, pericardial effusion can be the first sign of occult neoplasia

Electrocardiographic features of hyperkalemia during acute kidney injury in a patient with pacemaker

We describe a case of a 79-year-old man with pacemaker who presented to the Emergency Department due to asthenia and acute confusional state. He had a history of atrial fibrillation, anemia and colostomy and he was on treatment with diuretics. The electrocardiogram (ECG) showed pacemaker-induced ventricular activity, QRS complexes excessively wide with sine-wave appearance, tall and peaked T waves, without electrically evident atrial activity. Potassium concentration on arterial blood gas analysis was 8.8 mmol/L. ECG abnormalities disappeared after therapy with calcium chloride and spontaneous cardiac activity reappeared

A challenging diagnosis of dyspnea: A case report of contralateral reexpansion pulmonary edema

Reexpansion pulmonary edema (RPE) is an uncommon complication of thoracentesis or chest drainage. It occurs in the ipsilateral or contralateral lung. Causes, pathogenesis and therapy are not well understood especially for contralateral RPE. We describe a case of fatal contralateral RPE in a 59-years-old woman with right lung cancer underwent ultrasound-guided thoracentesis for massive pleural effusion and severe dyspnea. Pathogenesis of contralateral RPE is probably multifactorial and in this case is mostly due to the overperfusion of the healthy lung and consequent capillary damage. The right therapy for this condition is not known

Unattended Automated Office Blood Pressure Measurement and Cardiac Target Organ Damage, A Pilot Study

The ESC-2018 guidelines suggest the use of Unattended automated office blood pressure (UAOBP) to avoid or at least reduce the white coat effect, even if do not support its use as preferred method

PEG Intron in Essential Thrombocythemia: Two Years Treatment in 90 Patients.

In Essential Thrombocythemia (ET) the optimized pharmacokinetics of the weekly-administered pegilated Interferons a (IFN) may increase the patient compliance to a long-lasting IFN treatment. This phase II study has been designed to evaluate in ET patients efficacy, safety and tolerability of a two years treatment with PEG Interferon a - 2b (PEG Intron, Schering-Plough). In 16 Hematological Institutions of the Gruppo Italiano Malattie Mieloproliferative Croniche (GIMMC) the PEG Intron treatment has been started in 90 ET patients, 30 Males and 60 Females, median age 45 years (18-72), previously treated with Alkylating agents (14%), Hydroxyurea (64%), IFN a (31%), Anagrelide (7%) and Antiplatelet drugs (91%). The patients showed: age over 60 (19%), previous thrombosis (4%), disease related symptoms (40%), thrombotic general risk factors (57%), platelet count > 1000 x109/L (81%), peripheral granulocyte precursors (8%), splenomegaly (22%), mean platelet count 1093 x 109/L. In the first year (Part I of the study) the very low initial dose of PEG Intron (25 mg/week) was increased to 50, 75 and 100 mg/week in the patients not reaching the Hematological Response (HR=PLT <500 x109/L) at weeks 13, 26 and 39, respectively. The HR was obtained in 17%, 55%, 79% and 79% of cases after 13, 26, 39 and 52 weeks of treatment, respectively. The PEG Intron toxicity, never of WHO grade IV and only in two cases of grade III, was cause of dose reduction, transitory interruption and drug withdrawal in 7%, 17% and 7% of cases, respectively. Ten patients showed laboratory signs of thyroid dysfunction. Neither thrombotic nor hemorrhagic events were observed. In the second year (Part 2 of the study) 76 responding patients continued PEG Intron treatment at progressively decreasing dose in order to maintain the HR. In detail, the mean PEG Intron dose (mg/week) from the baseline level of 52 was reduced to the values of 33, 34, 30 and 29 at weeks 13, 26, 39 and 52, respectively. In the patients still on PEG Intron treatment at weeks 13, 26, 39 and 52 the rate of the HR was 94.2%, 83.2%, 81.5% and 84.9%, respectively. A withdrawal of PEG Intron was registered after 8-44 weeks (median 23.5) in 10 patients, in 8 of them as consequence of drug related toxicity. The reduction of the PEG Intron dose allowed at week 52 to a significant decrease of the toxicity, respect the baseline. These preliminary data show that PEG Intron at relatively low dose is able to induce and to maintain the HR in the majority of ET patients, with acceptable safety and toxicity