Medicina-buenos Aires最新文献

Phlegmonous gastritis in an uncommon bacterial infection of the gastric wall, predominantly affects immunocompromised patients, with high mortality rates despite appropriate treatment. Various risk factors compromising gastric mucosal integrity have been described. Symptoms are typically nonspecific and may manifest as acute abdomen, therefore, imaging studies gain special value. Proper treatment requires appropriate antibiotic therapy and surgical intervention may be considered in some cases. Available literature on patients with oncohematological diseases or undergoing chemotherapy who develop phlegmonous gastritis, is limited. We present the case of a female patient with relapsed acute lymphoblastic leukemia who developed phlegmonous gastritis during the neutropenic period following chemotherapy.

External cardiac rupture with the development of a pseudoaneurysm is an uncommon complication of acute myocardial infarction (AMI) and do not always have typical presentations and can be challenging to diagnose. We present the case of a 59-year-old woman with no relevant cardiovascular history whose disease course was unusual. She initially presented with chest pain, dyspnea, and fever, and was diagnosed and treated for community-acquired pneumonia. Due to persistent symptoms, she went to the hospital where an electrocardiogram showed signs of an infarction. An echocardiogram revealed apical akinesia with a severely depressed ejection fraction and an associated thrombus. An AMI with differential diagnoses of an apical aneurysm versus a pseudoaneurysm was considered, and she was transferred to our center for further evaluation. The coronary angiography revealed an occlusion in the mid-left anterior descending artery, with no other significant lesions. The magnetic resonance imaging and the computed tomography scans showed severe left ventricular dysfunction, subacute infarction, and an apical pseudoaneurysm with a fragmented thrombus. A surgical resolution was considered, but the computed tomography scans revealed severe emphysema, and the pulmonary function tests showed severe obstructive ventilatory impairment. Any type of intervention was considered high risk, and it was decided to continue with medical treatment. Nine months later, the patient is still alive and asymptomatic.

Bone hemangiomas are slow-growing benign tumors, with rib involvement being exceptionally rare. Thoracic outlet syndrome caused by a bone neoplasm of the first rib is even more uncommon, with only a few cases documented in the literature. We present the case of a patient with a clinical diagnosis of neurogenic thoracic outlet syndrome secondary to a bone tumor of the first rib, treated using a combined approach of video-assisted thoracoscopy and posterior access for resection. To our knowledge, this is the second reported case in the literature of a young man with thoracic outlet syndrome secondary to a cavernous hemangioma of the first rib.

Introduction: The CheckMate 816 study, a global phase III randomized trial, demonstrated that neoadjuvant treatment with nivolumab plus chemotherapy significantly improves event-free survival in patients with resectable non-small cell lung cancer (NSCLC). Additionally, the treatment significantly increases the rate of complete pathological response. We present the results of CheckMate 816 in an Argentine subpopulation to evaluate the efficacy and safety of the neoadjuvant treatment.

Materials and methods: A retrospective observational and descriptive study was conducted at a high-volume single center in Argentina from January 2023 to March 2024. Patients received 360 mg of nivolumab plus chemotherapy and a platinum doublet every three weeks for three cycles before undergoing definitive surgery. The results were compared with the international trial and the Japanese population subgroup.

Results: Nine patients received neoadjuvant therapy, of whom eight underwent definitive surgery. All patients achieved complete (R0) resection, and in three cases, a complete pathological response was observed. Currently, all are alive and disease-free.

Discussion: The results obtained in the Argentine subpopulation were consistent with those observed in the global population and the Japanese subgroup. A high proportion of patients achieved a complete pathological response, an early indicator of therapeutic efficacy. Neoadjuvant therapy with nivolumab plus chemotherapy could be considered an effective treatment option for Argentine patients with resectable NSCLC.

The clinical reasoning process for decision-making in medicine is complex and involves multiple factors, including diagnostic probabilities, study characteristics, costs, and patient preferences. This article highlights the role of pre-test probability in calculating the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests and also likelihood ratios. It also discusses concepts such as sensitivity, specificity, and predictive values, and their relationship with pre-test and post-test probabilities in various clinical contexts. The notion of treatment and diagnostic thresholds is introduced, emphasizing their impact on medical decision-making. Finally, it underscores that diagnostic tests should only be requested if their results can change clinical management, promoting a rational and cost-effective approach to medical practice.

Rare encephalopathies are here described in order to summarize practical tools that should be considered in the anamnesis, as well as in the physical examination. The way in which the clinical picture was established was the primary point for structuring the review; subsequently, the encephalopathies were subclassified etiologically. Focal symptoms, headaches, abdominal pain, fever or extrapyramidalism, added to the findings in the magnetic resonance imaging, especially if damage to the gray or white matter is observed, and if the lesions are bilateral or not, can be helpful when hypothesizing the etiology of the encephalopathy.

Introduction: The prevalence of polycystic ovary syndrome (PCOS) in transgender and non-binary genders assigned female at birth (TMNBG) men is controversial. Our objectives were to investigate the prevalence, phenotypic characteristics of PCOS, and cardiometabolic risk of TMNBG with and without PCOS prior to hormone therapy.

Materials and methods: This was a retrospective study of 346 TMNBG adults presenting to our service for gender-affirming hormone therapy. PCOS was diagnosed according to the evidence-based international guideline for the evaluation and treatment of PCOS 2018 and the Rotterdam consensus of 2003.

Results: The described transgender population had a prevalence of PCOS of 23.8%. Phenotype B was the most common one (39.1%), followed by phenotype A (33.7%). Transgender people with PCOS had statistically higher body mass index (BMI), systolic and diastolic blood pressure, plasma insulin levels, HOMA-IR, and HOMA-B than those who did not meet PCOS criteria. However, blood pressure and markers of insulin resistance were similar for both groups after controlling for BMI.

Discussion: PCOS appears to be prevalent among TMNBG. Transgender people with PCOS may exhibit an unfavorable cardiometabolic risk profile compared to those without PCOS, especially due to a higher BMI. It is necessary to evaluate the specific components of PCOS before starting hormonal therapy due to the long-term implications it could have.