Background: Late-delayed complications after radiotherapy (RT) results from an imbalance between cell lesions and the protective capacities of the CNS. Temozolomide (TMZ) after RT may represent a potent radiosensitizing regimen. Although radionecrosis (RN) of the anterior visual pathway has been documented, in our opinion this is the first report of reversible visual field loss associated with occipital lobe radionecrosis. Case observation: We report a patient who suffered a left lateral homonymous hemianopia one year after radiochemotherapy (RCT) for an infiltrative low grade fibrillary astrocytoma. The visual field deficit was completely reversible after one month. Visual field defects have been described after the use of conventional external beam therapy for lesions near the anterior visual pathway. The cortex is relatively spared after RT. Conclusions: Given the new scientific data, we suppose that neuroplasticity may play a role in the reversibility of visual field deficit. At this time there is no proven treatment of radionecrosis. Homonymous hemianopia caused by occipital lesions are attributable to vascular disease and tumors, but take into account radiation effects. The risk of neurogenic visual loss must be factored into the decision to irradiate the whole brain.
Benzodiazepine overdose has various clinical manifestation, mainly regarding the central nervous system (CNS), cardiac and respiratory side effects, but rarely results in significant morbidity and mortality. Acute benzodiazepine poisoning results in dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, bradycardia, hypotension, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Anyway, deep nonresponsive coma should be investigated for additional etiologies. On the other hand, human transmissible prion disease has a fatal outcome with no specific treatment.
Benzodiazepine overdose has various clinical manifestation, mainly regarding the central nervous system (CNS), cardiac and respiratory side effects, but rarely results in significant morbidity and mortality. Acute benzodiazepine poisoning results in dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, bradycardia, hypotension, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Anyway, deep nonresponsive coma should be investigated for additional etiologies. On the other hand, human transmissible prion disease has a fatal outcome with no specific treatment.
Single ventricle heart (SVH) is a very rare congenital heart disease. However, since the introduction of Fontan's intervention, the survival rate of patients with SVH has been significantly improved, increasing the number of women who may become pregnant in this condition. It has been already reported, in isolated case presentations or in some series of patients, that the pregnacy in the context of SVH and Fontan circulation carries a very high risk for first trimester miscarriage, maternal cardiovascular or obstetric complications and for an increased rate of pre-term birth. Therefore, it is an open field of debate weather or not to allow pregnancy in this category of patients. We are presenting the case of a 22 years old patient who underwent two surgeries for SVH: a Glenn procedure when she was 2 years old and the implantation of a Fontan circuit at the age of 16 years. Since the last surgery she was under permanent internal cardiac stimulation. During the pregnancy the patient was hemodynamically stable, with a normal resting oxygen saturation and a good ejection fraction of the single ventricle. However, the evolution of this patient has become even more challenging due to an aberrant praevia placental lobe. This condition brought her to hospital for several episodes of metrorrhagia and uterine contractions. She delivered at 33 weeks of gestation by emergency Caesarian section with a good evolution until discharge, for mother and the newborn. This case is supporting the opinion that pregnancy can be tolerated without important cardiovascular events in patients with SVH and Fontan circulation, unless heart failure or cardiac arrythmia are associated. Nevertheless, the obstetrical complications remain an important problem in pregnancy overcome of patients with Fontan circulation for SVH that can be superimposed with other unfavorable conditions, like aberrant praevia placental lobe in this case. During the management of such particular clinical settings difficult decisions must be taken, including those addressing the antithrombotic therapy that will be covered in the presentation of this case.
Cogan syndrome is a rare disease characterized by the concomitance of non-syphilitic interstitial keratitis with Meniere-like vestibulo-auditory symptoms. There are criteria for the diagnosis of both typical and atypical Cogan syndrome. We present the case of a 40 years old woman with sudden onset of hearing loss, tinnitus, intense vertigo, instability associated with kerato-conjunctivitis. The concomitance of the symptoms, the onset, and the evolution under treatment are consistent with the diagnosis of atypical Cogan syndrome.
Fat embolism is a rare complication of high or medium intensity trauma. It is caused by the formation of fat particles in the territories of small terminal circulation, especially at pulmonary, tegumentary and cerebral levels. The mechanism underlying the fat embolism is described by several different theories in literature. In legal medicine, fat embolism raises many controversies upon the diagnostic certainty of the thanatogenerator mechanism leading to death. The occurrence of fat embolism syndrome followed by death must be properly explained so that the fatality can be adequately framed from a legal point of view. In this paper the authors present three cases in which victims of trauma died due to clinically undiagnosed fat embolism, the diagnosis being established only by postmortem histopathological examination. The authors underline the fact that the diagnosis of fat embolism syndrome, although it is a clinical one, it is often established only during autopsy.
Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding. The most common clinical presentation of GAVE is chronic occult bleeding that leads to symptomatic iron deficiency anemia, but some cases could present with acute massive bleeding. Frequently, patients are dependent by iron suplimentation, or in severe cases even blood transfusions. Endoscopic therapy is frequently necessary in acute or chronic blood loss. Over the past several years, treatment for GAVE has continued to evolve as the number of available effective therapeutic interventions has increased. These included: YAG laser, argon plasma coagulation (APC), endoscopic band ligation, cryotherapy and surgical anterectomy. Argon plasma coagulation is the most commonly used technique, but has been associated with several complications like sepsis, post-APC bleeding, gastric outlet obstruction and increased incidence of hyperplastic polyps. Endoscopic band ligation (EBL), a mechanical procedure, has been reported in the past years as an effective salvage therapy for GAVE that is refractory to other approaches, or even as the first line treatment. We present a case of nodular GAVE treated succesfully with endoscopic band ligation after unsuccesufull sessions with argon plasma coagulation.
Introduction: Matrix metalloproteinases (MMPs) are key enzymes involved in degradation of extracellular colagen matrix during periodontal disease progression. The aim of our work was to study the levels of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10 in saliva of patients with chronic periodontitis. Materials and methods: The study included 22 patients with chronic periodontal disease and 15 controls. We collect unstimulated whole saliva from all volunteers included in the study. Salivary levels of mentioned MMPs were analyzed using magnetic bead-based multiplex assays and Luminex technology. Results: MMP-1, MMP-7, MMP-9 and MMP-10 present statistically increased salivary levels at patients with periodontal disease versus the control group (p<0.05). Salivary level of MMP-2 at patients with chronic periodontitis was increased but statistically insignificant compared with healthy subjects (p=0.1). Conclusions. The increased level of these enzymes in patients diagnosed with periodontal disease reflects their implication in periodontal tissue degradation. Saliva is an excellent fluid useful in monitoring the severity of this oral disease that affects about half of the adult population around the world.
Pregnancy-specific dermatoses are a heterogeneous group of inflammatory dermatoses associated exclusively with pregnancy. Although these dermatoses are rare, it raises problems in medical practice because of their appearance, being difficult to diagnose, treat and the possibility of the fetus being affected. Pemphigoid Gestationis (PG) is a rare, autoimmune, strongly pruritic, vesiculobullous dermatosis with a strong impact on the patient. Polymorphic Eruption of Pregnancy (PEP) is a benign, self-limited inflammatory skin disorder that usually affects first pregnancy in the third trimester or immediately in the postpartum period. Other dermatoses associated with pregnancy include: Intrahepatic Cholestasis of Pregnancy (ICP), Atopic Eruption of Pregnancy (AEP) and Pruritic Folliculitis of Pregnancy (PFP). We will extensively present PG and PEP, to draw attention to the importance of correct diagnosis and the implications of treatment during pregnancy.
