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( Igor Nunes ),( Tiago Santos ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Multiple myeloma is the second most frequent hematologic tumour and represents about 1% of all tumours, with a medium diagnosis age of 70 years. Usually, it presents as anaemia, bone pain, hyperkalemia e kidney failure. Infection susceptibility is most obvious about 2-3 months after the initial diagnosis and after chemotherapy, but it is rarely described as being a form of acute presentation. In this article, we present the clinical case of a patient with initial diagnosis of Streptoccus pneumoniae pneumonia, that then turned into a diagnosis of smoldering myeloma. It is important to consider the possibility of multiple myeloma in middle-aged patients, previously healthy, that present with acute bacterial infection, without an evident predisposing factor.
Igor Logetto Caetité Gomes,Diogo Turiani Hourneaux de Moura,Igor Braga Ribeiro,Sérgio Barbosa Marques,Alexandre de Sousa Carlos,Beanie Conceição Medeiros Nunes,Bruno Salomão Hirsch,Guilherme Henrique 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2
Background/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported. Methods: An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate. Conclusions: Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.
( Tiago Santos ),( Igor Nunes ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
The double anti-aggregation with aspirin and clopidogrel has been used as background therapy in most patients after coronary stent placement. However, isolated cases of thrombocytopenia induced by each of these drugs, only rarely have been described, particularly when associated with clopidogrel. Currently, there is no consensus on alternative therapeutic strategies in cases of patients who had to suspend this type of drug because of thrombocytopenia after coronary stent placement. According to studies on the effi cacy and safety of this drug, ticagrelor has recently been appointed as antiplatelet therapy with aspirin in cases of percutaneous coronary intervention, as it demonstrated faster and more effective early inhibition of platelet aggregation compared with clopidogrel. This is the case of thrombocytopenia induced by clopidogrel after coronary stent placement following an acute coronary syndrome with ST segment elevation. We also intend to discuss alternative therapy adopted, as well as analysis and comparison of the cases published on the same topic.