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RISS 인기검색어
- 검색키워드
- 저자 : ( Armando Braz ) (검색결과 4 건)
- 무료
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( Armando Lopes Braz ),( Tiago Mascarenhas ),( Conceicao Quadrado ),( Jose Braz Nogueira ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
The clinical case is about a 44 years old male patient who was transferred to our hospital due to vasculitis. He was living in Angola for 8 years, being healthy until 2 weeks before being transferred. He started to feel abdominal cramps, muscular and joint pain over a period of 3 days. He was admitted in a clinic suspecting of malaria, starting antimalarial medication. On the 3rd day, the blood results for infectious diseases and maliaria were negative. He stooped the treatment and was discharged. After 4 days the patient started to complain of the same symptoms aggravated with asthenia, tiredness and diarrhea. He was readmitted and treated with antibiotics. Three days later some petequial lesions appeared in the lower limbs, getting spread arms and ears. These lesions got bigger over the next 2 days becoming macules and then changed to penfi - goid lesions with central necroses. The lesions covered the all lower limbs and part of the upper limbs, spearing the trunk. Corticosteroids were added to the treatment but he got worse, being later transferred to our hospital. The fi rst evaluation revealed a severe lower limbs edema, hypoalbuminemia and renal failure. All the treatment was stooped apart of pain killers and done some skin biopsies. The result was positive for leukocytoclastic vasculitis. Because of the GIT symptoms an endoscopy and colonoscopy was performed. The gut was covered with extense ulcerative lesions and was identifi ed inside them CMV. The body CT and Abdominal ultrasound were normal. The patient started the treatment with Valaciclovir during 15 days, followed with 6 weeks of Ganciclovir. This case still covered in dough, because it`s impossible to know if the hypersensibility reaction to the anti-malary drugs started the vasculites, triggering the CMV infection or the CMV developed the vasculitis.
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Poster Session:PS 0569 ; Oncology : Pancreatic Cancer Causing Heart Failure
( Armando Lopes Braz ),( Tiago Mascarenhas ),( Conceicao Quadrado ),( Jose Braz Nogueira ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 67-year-old patient was sent to the internal medicine consultation due to dyspnea, orthopnea and lower limb edemas for 6 month, which got worse in the past 2 weeks, with diffi cult stabilization and control, even with intense therapy for heart failure. The therapy was improved and an echocardiogram was requested. One month later she was reevaluated showing no clinical improvement, so she was admitted in the internal medicine ward. The echocardiogram showed an ejection fraction of 21%, increased right chambers, severe pulmonary hypertension and left ventricle dilatation with depressed cardiac function. The therapy for heart failure was optimized and a ventilation-perfusion scyntigraphy was performed to evaluate the respiratory system. It revealed areas of pulmonary collapse and pulmonary embolism. On the ward she suffered a sudden episode of dyspnea and left leg edema and experienced severe pain. An ultrasound of the lower limbs proved the existence of bilateral severe deep venous thrombosis. For a further investigation the patient did a body CT-scan and cancer markers were searched. The CA19.9 was 253679 and there were several metastatic lesions on the liver and an infracentrimetic mass on the pancreatic tail on the CTScan. She started anticoagulation for prevention of other pulmonary embolism, while waiting for a pancreatic biopsy. The patient died 3 month after the diagnosis due to a sudden Myocardial infarction. The symptoms of heart failure dominated the whole clinical picture, being the DVT the wind of change to establish the diagnosis of pancreatic cancer, a scary disease that was silent for so long. This case shows the importance of the paraneoplastic symptoms such the bilateral DVT which was the important milestone for a further investigation and the fi nal diagnose.
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Poster Session : PS 0383 ; Infectious Disease ; From a Thoracic Pain to a Cervical Spondilolyscitis
( Armando Braz ),( Marta Rosario ),( Conceicao Quadrado ),( Jose Braz Nogueira ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 68-year-old patient with atrial fibrillation, sleep apnea doing nocturnal Cpap, hypertension and ischemic heart failure, went to the emergency department with complaints of chest pain radiating to the neck for 3 days. In the emergency room he couldn`t take a deep breath despite being medicated with painkillers. On the blood work there was an increase of the infi ammatory parameters, but the cardiac enzymes, the EKG and the chest X-ray were normal. Nitrates were also administered but without improvement. The diagnosis of infective endocarditis was plausible due to the clinical and laboratorial fi ndings, but the echocardiogram showed a hypertrophic left ventricle but no vegetation. Without a defi nitive diagnosis, the patient was admitted in the internal medicine department. Blood cultures were taken and started the empirical treatment for infective endocarditis with penicillin and fi ucloxaciline. After 3 days, a MSSA was isolated, sensitive to fi ucloxaciline and clindamicine, but the patient became hemodynamicaly instable and got worse. The symptoms also changed, having intense neck pain, dysphagia and odynophagia. A neck and thorax CT-scan was performed showing a large retropharyngeal abscess extending to the posterior mediastinum. Due to kidney failure, the patient needed to start doing hemodialysis, where he had a cardiac arrest. Upon stabilization, a surgical drainage of the abscess was performed and he was transferred to the intensive care unit where he stayed for 97 days due to cervical spondylodiscitis. There were several problems including: thoracic empyema, right brachial plexus damage due to destruction of the c3-c6 vertebrae and more. He returned to the ward, starting intense physiotherapy with a quick and full recovery. This is a success story of a patient who was discharged after a serious condition, walking by his own feet, but the origins of the abscess still a mystery.
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( Ardavazd Vartikyan ),( Armando Lopes Braz ),( Tiago Mascarenhas ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Biphosphonates are potent drugs that inibit bone resorption, and are widely used in the treatment of many diseases, such as osteoporosis, Paget disease, and many cancer situations with bone metastases. Osteonecrosis of the jaw (ONJ) can occur as a complication of this therapy and there are known risk factors such as bad dental hygiene, history of dental extraction, chemotherapy, corticosteroids and radiation therapy of the head and neck. The authors describe a case of ONJ in a 75 year old patient with Prostate cancer and bone metastatic disease who started therapy with Zoledronic Acid in 2007. In 2014 he developed pain and numbness in the mandible region with subsequent diagnosis of ONJ. The patient was submitted to segmentar mandibulectomy in July of 2014 and is presently assintomatic. Physicians should be aware of this potential complication of biphosphonate therapy. ONJ can affect the quality of life in cancer patients and an early diagnosis may reduce or avoid the consequences of such disease.
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