Medicina
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A case of a 20-year-old man with multilevel non-contiguous tuberculous spondylitis (cervical, dorsal 6, dorsal 10 and lumbar) is presented. In the context of disseminated tuberculosis in an HIV-negative patient with serious compromise of his general condition and multiple locations of the disease, some of these with fistulas that secreted caseum. The acute paraplegia led, considering the sensory level at dorsal 6, to a first urgent decompression surgery via the posterior approach. ⋯ Subsequently, dislocation of dorsal level 6 was evidenced backwards, compressing the spinal cord and, given the mechanical instability, a third surgical stage was indicated by posterior approach, which included reduction, decompression and fixation, resolving the three levels by posterior approach with bars and screws. The surgical, medical and physiotherapy treatment of this rare form of Pott's disease was successful, with recovery of his mechanical stability and progressive recovery of his neurological status. The surgical, medical and physiotherapy treatment of this rare form of Pott's disease was successful, with recovery of his mechanical stability and progressive recovery of his neurological status.
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We repor a case of acute ST elevation myocardial infarction in a 22-year-old patient with SLE, hypertension and nephropathy who underwent successful coronary angioplasty to a middle third of the left anterior descending artery. She evolved without signs of heart failure however, due to the delay in diagnosis, she presented severe deterioration of ventricular function. ST segment elevation myocardial infarction is a very rare event in young premenopausal women, but compared to the general population, patients with lupus have at least a 50% higher risk of suffering it regardless their age. ⋯ In the context of lupus, conditions such as the presence of nephritis have been described as favoring the appearance of myocardial infarction, constituting subgroups of higher risk. The increased risk of AMI in patients with SLE must be taken into account and must be suspected as a differential diagnosis of precordial pain in young women, even those under 25 years of age, a population categorized as having low CV risk according to traditional scores. This would avoid delays in diagnosis and treatment with adverse consequences such as extensive myocardial necrosis and its impact on ventricular systolic function, as occurred in this patient.
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Bone healing after a fracture has many intercalated steps that depend on the host, type of injury, and often the orthopedist. The diamond concept since 2007 has outlined 4 main facets that have to be considered as a model by the treating surgeon at the time of injury and when nonunion develops: osteogenic cells, osteoconductive scaffolds, osteoinduction, and the biomechanical environment. All of these foment fracture healing in optimal circumstances. ⋯ The mindset of the orthopedist must thoroughly analyze all these facets and many more when dealing with nonunion. This work presents, probably the most significant ones, parting from the original 4-corner diamond model and expanding it to a more representative hexagon integrated model. Metaphorically, just like the strongest inorganic constituent of the bone: hydroxyapatite.
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Lung ultrasound (LUS) has shown to be a useful tool to detect the degree of pulmonary involvement in patients with pneumonia and acute respiratory distress syndrome. The present study evaluates the association of the 12-region lung ultrasound score and the requirements of intensive care unit, in patients with COVID-19 infection who were admitted to intermediate care in a specialized hospital; 115 patients with a diagnosis of pneumonia confirmed by chest radiography secondary to SARS-CoV-2 were included, LUS was performed together with the laboratory evaluation that included the measurement of inflammatory biomarkers (lymphocytes, C-reactive protein, D-dimer, procalcitonin, ferritin, lactate dehydrogenase, and pro B-type natriuretic peptide). ⋯ In the univariate analysis, an association was observed between the lung ultrasound score, elevated levels of procalcitonin and brain natriuretic peptide, and the admission to intensive care. In the multivariate analysis, only the lung ultrasound score was an independent predictor of need for intensive therapy.
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Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. ⋯ A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.