Rev Esp Enferm Dig
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Epstein-Barr virus, a member of the Herpesviridae family, is responsible for the infectious mononucleosis clinical syndrome, which mainly includes the pharyngitis, fever, and lymphadenopathy triad after incubation for 30-50 days. The liver is involved in 80-90% of patients in a self-limiting transient manner, with jaundice being much more uncommon (5%). ⋯ After exclusion of other etiologies, and given the clinical suspicion of the above association, which was later confirmed by lab tests, empiric therapy was initiated with antiviral agents (aciclovir + valganciclovir) and corticoids, which resulted in a progressive clinical improvement until complete remission. Therefore, we believe that this case report will reinforce the clinical evidence in support of the above combined therapy for serious infectious mononucleosis as a step prior to liver transplantation.
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Primary intestinal lymphangiectasia or Waldmann's disease is an uncommon cause of protein losing enteropathy with an unknown etiology and is usually diagnosed during childhood. It is characterized by dilation and leakage of intestinal lymph vessels leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia. Differential diagnosis should include erosive and non-erosive gastrointestinal disorders, conditions involving mesenteric lymphatic obstruction and cardiovascular disorders that increase central venous pressure. ⋯ After the diagnosis of a protein losing enteropathy, the patient underwent an enteroscopy and biopsies were taken, whose histological examination confirmed dilated intestinal lymphatics with broadened villi of the small bowel. Secondary causes of intestinal lymphangiectasia were excluded and the diagnosis of Waldmann's disease was recorded. The patient was put on a high-protein and low-fat diet with medium-chain triglyceride supplementation with improvement.
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Case Reports
Paraesophageal hernia and gastric volvulus: an uncommon etiology of vomiting and upper gastrointestinal bleeding.
The authors report the case of a 75 year-old woman admitted to the emergency room with abdominal pain and coffee ground vomiting. Marked epigastric distension with tenderness and signs of severe dehydration were present. Upper GI endoscopy showed a black esophagus covered by a large amount of dark fluid, diffuse hyperaemia and superficial erosions. ⋯ The patient was discharged without further complications. Acute gastric volvulus is a rare entity that may manifest with vomiting due to gastric outlet obstruction and gastrointestinal bleeding associated with mucosal ischemia and sloughing. Emergency surgery wass required to resolve symptoms and prevent complications.
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Illicit drug trafficking within the body ("body packers") represents a medical-legal problem currently on the rise. Endoscopic removal of drug packets is not generally recommended because of the risk of packet rupture and subsequent overdose on the spilled substance. A 40-year-old male presented with abdominal pain and diaphoresis following the ingestion of 30 g of hashish as a means of illegal trafficking, remaining in police custody during his hospital stay.
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Propofol sedation is increasingly used for standard and advanced endoscopies due to its advantages over traditional sedation based on benzodiazepines and/or opioids. These include a better sedation, greater patient cooperation, and higher patient satisfaction for most endoscopic procedures; it also decreases time to sedation and decreases recovery and discharge times. As anesthesiologists have typically provided propofol-based sedation, the increase in its use is limited by anesthesiologists' availability and cost. ⋯ This Editorial puts into perspective discussions that have recently taken place in Spain about the safety of non-anesthesiologist administration of propofol. It aims at refocusing the debate on facts, with the hope that an agreement between anesthesiologists, endoscopists and nurses will be achieved. Anesthesiologists' support is essential to ensure that the transition that endoscopists are making from traditional to propofol sedation is safe.