Shoshin syndrome: report of a treatable disaster

Shoshin syndrome is a rare fulminating heart failure caused by thiamine deficiency. In Japanese “sho” means acute damage and “shin” means heart. It consists of a rare and hyperacute manifestation of beriberi that was first described in polished white rice-eating communities in various locations across Asia including China, Japan and Indonesia. In a totally different context, ‘Shoshin’ is a word from Zen Buddhism meaning “beginner’s mind”, which is considered the necessary attitude to approach the Zen practice. This case report is a prime example of clinical manifestations of thiamine deficiency for the presence of both cardiological and neurological disorders, for hyperacute onset of cardiac failure (shoshin syndrome), for the simultaneous involvement of peripheral and central nervous system, and for the dramatic global recovery after thiamine replacement therapy. We therefore explain why the physician should adopt a beginner’s mind in clinical practice

A case of refractary epilepsy and related pain due to dysmenorrhea solved with lacosamide. Clinical and neurophysiological correlates

In most cases, the etiology of epilepsy is unknown, although some individuals may develop epilepsy as a result of certain brain injuries, following a stroke, a brain tumor or because of drugs and alcohol. Even some rare genetic mutations may be related to the onset of the condition. Seizures are the result of excessive and abnormal activity of neurons in the cerebral cortex. In this case report we show a clinical case of refractory epilepsy due to pain related to uncontrolled dysmenorrhea. The patient, 43 yrs old, had a history of epilepsy of 20 years and ovarian cancer. She was treated with lamotrigine, clonazepam and levomepromazina maleato. At admission the patient shew seizures due to pain related to dysmenorrhea. In emergency we treated with verapamil hydrochloride 10 mg ev, subsequently verapamil hydrochloride 20 mg in 250 ml of saline solution as maintenance dose. Then we decided to administer a loading dose of 100 mg cpr of Lacosamide to stop the treatment with verapamil hydrochloride. With Lacosamide we solved the seizures in 24 hours

A providential pneumonia

The statines rappresent the main therapy for the control of lipid disorders. They have proved to be extremely safe in most percentage of the patients who use it, however are not totally free by side effects and as all drugs should be used appropiately and it is better consider risk factors of patients before starting treatment with statins and use first the minimal effective doses

A strange onset of pulmonary thromboembolism in a young woman

Frequently pulmonary embolism diagnosis is difficult especially when clinical findings are unusual and was correctly diagnosed too late to begin an effective therapy. Young women without genetic predisposition who are healthy and active are considered to be a low risk population for deep vein thrombosis and pulmonary embolism. We present the case of a young woman who developed a pulmonary embolism with a unusual onset

HRV and BIA in healthy young vegetarian people

.The Western diet is one of the leading causes of the increased prevalence of metabolic syndrome and intractable diseases. For these reasons, there has been increased interest in vegetarian diets. A number of studies have been conducted on long-term vegetarian dietary habits, and several studies have reported that a long-term vegetarian diet reduces death rate, helps regulate diabetes, and reduces the incidence and mortality associated with vascular disease. The term “vegetarian diet” is rather generic, because it actually refers to four types of diet: semi-vegetarian which excludes meat intake; lacto-ovo-vegetarian excludes meat and seafood; lacto-vegetarian excludes meat, seafood, and eggs, except milk and dairy products; and vegan excludes all foods of animal origin. Thus, vegan diet is probably the “true” vegetarian diet. vegetarian diets may play a beneficial role in promoting health and preventing obesity. However, there are conflicting results in the literature on HRV and body composition in people taking an omnivorous diet and those who take a vegetarian diet. The aim of our study is to evaluate the HRV with linear and non linear methods and the body composition analyzed by bioimpedentiometric method (BIA). We enrolled 17 young man: 9 on free diet (age 27±0.85 years) and 8 vegetarian/vegan (age 30±1.53 years) who have been following this diet for a minimum of six months. We did not include people with the following conditions: Body mass index (BMI) >25 kg/m2; smokers, systolic and or diastolic blood pressure >140/90 mmHg (at rest); cardiac diseases; sportsman. Data collection was performed, between 11 and 14 AM, at a room temperature between 21°C and 25°C. Volunteers were instructed not to ingest alcohol and caffeine for 24 h prior to evaluation. Protocol: After 10 rest minutes we recorded a ECG for 5 minutes. Using dedicated software (Cardiolab – Xai Medica) we analysed the HRV indexes in the time and frequency domain; with the Kubios software we analysed the non linear indexes (Poincaré plot and Detrended Fluctuation analysis – DFA). The second step was the measurement of body composition with bioimpedentiometry (Akern). Standard statistical methods. We used the T-test. Differences was considered significant when the probability of a Type I error was less than 5% (P < 0.05). We used the software SigmaStat 3.5. Data are expressed as mean ± ESM. Results: We reported only the data in which there is a significant difference between the control and the vegetarian group. HRV: LF (nu) 53.23 ± 5.36 vs 69.91 ± 5.47; HF 46.71 ± 5.35 vs 26.44 ± 4.82; LF/HF 1.46 ± 0.38 vs 5.02 ± 2.12; Poincarè Plot: SD2/SD1 1.84 ± 0.14 vs 2.38 ± 0.39; DFA: α1 1.00 ± 0.06 vs α1 1.21 ± 0.10. BIA: ICW 57.60 ± 0.73 vs 54.98 ± 0.54; ECW 42.44 ± 0.73 vs 45.06 ± 0.55; BCM 57.38 ± 0.82 vs 54.60 ± 0.57. In the frequency domain our data shows that there is a significant difference in the LF/HF in vegetarians when compared to control subjects. This fact is due to both a significant increase in LF and a significant decrease in HF oscillatory components. These data indicate an increase of sympathetic modulation to sinus node confirmed also by the non linear analysis of HRV. In fact the Poincarè plot SD2/SD1 ratio is significantly higher, and a significant increase of alpha1 index, using the DFA in the vegetarian people was noticed. That condition is a charming feedback in the data of the bioimpedentiometry. In vegetarian subjects we observed a significant ECW increase and concomitant significant ICW decrease, confirmed by the BCM (body cell mass), higher in the control group. We propose to measure the inflammatory cytokines involved in the pathogenesis of cardiovascular diseases like reactive C protein, IL-6, TNF-alfa, IL-1 beta, IL17beta. These cytokines will be measured on frozen serum, withdrawn from enrolled subjects in this study

Malignant Insulinoma with Multiple Liver Metastases and Hypercalcitoninemia in a Patient with Type 2 Diabetes Mellitus Presenting as Recurrent Episodes of Diaphoresis due to Severe Hypoglycemia

Insulinoma is an insulin-producing pancreatic neuroendocrine tumor that can be malignant in about 10% of cases. Locoregional invasion, lymph node metastases, or remote metastases are the main criteria of malignant insulinoma. Its incidence in patients with pre-existing diabetes mellitus (DM) is exceptionally rare. In this report, we describe a 66-year-old man with long-standing type 2 DM who presented with recurrent episodes of diaphoresis due to severe hypoglycemia despite the withdrawal of insulin therapy, hypercalcitoninemia, and biochemical and radiological findings suggestive of metastatic malignant insulinoma. Unfortunately, after few days of diazoxide treatment, edema, hypotension, oliguria, and water retention were observed, patient’s clinical status deteriorated rapidly, and he died in our department from acute renal failure