Postobstructive pulmonary edema (POPE) after laparoscopic appendecectomy: a case report

Presentamos el caso de un hombre joven y deportista ingresado por apendicitis aguda. A las pocas horas tras apendicectomía laparoscópica, el paciente comienza con disnea súbita en contexto de edema pulmonar postobstructivo, siendo preciso el ingreso urgente en la unidad de críticos. Debido a la presentación aguda, inesperada y potencialmente fatal de esta patología, realizamos una revisión de la misma.A case report of a young, athletic man admitted for acute appendicitis is presented. A few hours after laparoscopic appendectomy, the patient presented sudden dyspnea in the context of post-obstructive pulmonary edema, requiring urgent admission to the critical care unit. Due to the acute, unexpected and potentially fatal presentation of this pathology, we performed a review focused on it

Linfadenopatía relacionada con enfermedad por IgG4

We present the case of a 49 year old man without previous diseases but toxic habits, who consulted to our Inter- nal Medicine Outpatient department due to the presence of mild fever and painfull axillar lymphadenopathies lasting for 7 months, with no other accompanying symptoms. Image tests (echography and body-scan) con- firmed the presence of multiple pathologic size axillary and inguinal lymphadenopathies, being transferred to surgery to proceed with lymphadenectomy. Anatomopathological lymphadenopathy study showed plasmatic cells with predominance of IgG4, with a IgG4/IgG ratio > 0.4. Analytic study was unremarkable, except for a mild IgG4 elevated value. Corticosteroid therapy is started, achieving complete resolution.Hombre de 49 años que acudió a consulta de Medicina Interna por febrícula y adenopatías axilares dolorosas de 7 meses de evolución sin otra sintomatología asociada. No antecedentes personales de interés ni hábitos tóxicos. Analíticamente sin datos patológicos. En distintas pruebas de imagen (ecografía, tomografía axial computarizada de tórax-abdomen-pélvis), se confirmó la presencia de múltiples adenopatías de tamaño no despreciable axilares e inguinales, por lo que se derivó a Cirugía para extirpación de las mismas. El resultado de la anatomía patológica indicó células plasmáticas de predominio IgG4, presentándose cociente IgG4/IgG > 0,4. El resultado analítico fue normal, a excepción de una elevación leve de IgG4. Se inició tratamiento corticoideo, desapareciendo las mismas

Vogt-Koyanagi-Harada disease, a rare entity in Spain: the challenge of worldwide immigration and globalization

Vogt–Koyanagi–Harada disease is rare, mediated by autoimmune melanocyte inflammation and facilitated by genetic predisposition[1-3]. The main clinical features include uveitis, meningitis, tinnitus and sensorineural deafness, and skin and hair depigmentation. It usually develops in four consecutive stages: prodromal, acute uveitic, convalescent, and chronic or recurrent[4]. In view of the first two stages, the differential diagnosis takes into account uveo-meningeal syndromes. Treatment is based on high dose corticosteroids. We present the case of a 14-year-old girl admitted to hospital with fever, progressive uveo-meningeal symptoms, and sensorineural hearing loss. After work-up, the final diagnosis of Vogt–Koyanagi–Harada disease was made

Abordaje de la insuficiencia cardiaca amiloidótica desde la pluripatología

A 88-year-old patient with personal clinical record of heart failure with left ventricular hypertrophy preserved ejection fraction and paroxysmal atrial flutter, is admitted due to a right heart failure, being diagnosed of natural transthyretin cardial amyloidosis. We approach the diagnostic process and its implications under the view of pluripathology which allows us to maintain the balance between nihilism and obstinacy upon the advances of the disease.  Paciente de 88 años con antecedentes de insuficiencia cardíaca, hipertrofia ventricular izquierda con fracción de eyección preservada y flutter auricular paroxístico. Ingresó por insuficiencia cardíaca de predominio derecho, siendo diagnosticada finalmente de amiloidosis cardíaca por transtiretina natural. Abordamos el proceso diagnóstico y las implicaciones del mismo desde una visión global e integradora que nos permite mantener el equilibrio entre el nihilismo y la obstinación ante los avances que se están produciendo en esta enfermedad

Demyelinating encephalomyelitis in a patient with renal insufficiency associated with anti-tnf therapy: adalilumab

Ante el importante uso de los tratamientos biológicos en enfermedades reumatológicas/sistémicas en los últimos años, actualmente se están diagnosticando alteraciones secundarias a los mismos sobre el sistema nervioso principalmente de carácter inflamatorio que pueden ser confundidos con una esclerosis múltiple (EM) puesto que cursan tanto a nivel clínico como en imagen muy similares. En el presente artículo presentamos un caso clínico de un hombre de 44 años que presenta signos y síntomas compatibles con enfermedad desmielinizante cerebral en relación con un Anti TNF-α denominado Adalimumab en el contexto de una espondilitis anquilosante resistente a infliximab tras 4 años de tratamiento biológico.Given the important use of biological treatments in rheumatologic / systemic diseases in recent years, secondary alterations to them on the nervous system are currently being diagnosed mainly of an inflammatory nature that can be confused with multiple sclerosis since they are both level clinical as in very similar image. In this article we present a clinical case of a 44-year-old man who shows signs and symptoms compatible with cerebral demyelinating disease in relation to an Anti TNF-a called Adalimumab in the context of an ankylosing spondylitis resistant to infliximab after 4 years of biological treatment

"White bile" as a result of a malignant bile obstruction.

An 87-year-old female was admitted for endoscopic retrograde cholangiopancreatography (ERCP) due to obstructive jaundice. On admission, total bilirubin was 15 mg/dl at the expense of direct bilirubin, GOT 356 U/l mg/dl, GPT 174 U/l, FA 2,358 U/l and GGT 1,089 U/l. The ERCP showed a prominent, irregular, non-cannulable papilla, so a fistulotomy was performed, emitting a clear, non-mucous fluid. Biliary localization was verified after inserting the guidewire. Cholangiography showed dilatation of the intra-extra hepatic bile duct (common bile duct 18-20 mm). An uncoated metal prosthesis was implanted and a biopsy was performed, confirming papillary adenocarcinoma