Introduction: The exponential growth of SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on most health systems around the world. The complications derived from the novel coronavirus disease (COVID-19) vary due to comorbidities, sex and age, with more than 50% of the patients requiring some level of intensive care developing acute respiratory distress syndrome (ARDS). The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological, and radiological presentation as well as the current treatment strategies. Areas covered: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The new treatment strategies are updated, and the analysis of the physiopathology is included in this review. Expert opinion: ARDS is one of the most frequent complications in patients with COVID-19. Information regarding the etiology and physiopathology are still unfolding and for the prevention and amelioration, good clinical management, adequate ventilatory support and the use of systemic corticoids seem to be the most efficient way to reduce mortality and to reduce hospital lengths.
Introduction: The exponential growth of the SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on health systems worldwide. The complications derived from the novel coronavirus disease (COVID-19) vary in due to comorbidities, sex and age, with more than 50% of the patients who require some level of intensive care developing acute respiratory distress syndrome (ARDS). Areas covered: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological and radiological presentation as well as the current treatment strategies. Expert Opinion Elevation of inflammatory biomarkers is a common trend among seriously ill patients. The information available strongly suggests that in COVID-19 patients, their altered immune response, including a massive cytokine storm, is responsible for the further damage evidenced among ARDS patients. The increasingly high number of scientific articles and evidence available can only suggest that the individualization of each case is the norm, not all patients with acute respiratory failure due to COVID-19 meet the Berlin definition and therefore ARDS should be considered as a heterogeneous disease, with a wide range in the expression of its severity and clinical manifestations.
ResumenLos insulinomas son los tumores neuroendocrinos pancreáticos más frecuentes y típicamente son benignos y pequeños. Los insulinomas gigantes de páncreas son tumores raros. Reportamos el caso de un paciente varón de 67 años, quien presentaba síntomas y signos de hipoglicemia. Subsecuentes estudios de laboratorio y radiológicos establecieron el diagnóstico de un insulinoma de 13,5 cm. Fue sometido a pancreaticoduodenectomía. A pesar del tamaño, en la evaluación patológica no se identificó invasión local ni metástasis. Además de la descripción de la presentación clínica y los hallazgos operatorios, se realiza una revisión de las opciones para la localización y manejo de los insulinomas. Palabras clave. Insulinoma, Gigante; Páncreas, Neoplasias; Tumores Neuroendocrinos. Abstract Insulinomas are the most common pancreatic neuroendocrine tumors and are typically small and benign. Giant pancreatic insulinomas are rare pancreatic tumors. We report a 67 year old man who presented with signs and symptoms of hypoglycemia. Subsequent laboratory and radiologic studies established the diagnosis of a 13.5 cm insulinoma. The patient underwent a pancreatoduodenectomy. Despite the size, neither local invasion nor metastatic disease was identified on pathological evaluation. In addition to describing the clinical presentation and operative findings, localization and management options of insulinomas are reviewed. Los tumores neuroendocrinos de páncreas (TNEP) tienen una incidencia estimada en 1 por 100 000 habitantes (1,2) y se dividen en dos grupos: aquellos asociados con un síndrome funcional debido a la secreción ectó-pica de una sustancia activa biológica (tumores funcionantes) y aquellos que no están asociados con un síndrome funcional (usualmente llamados no funcionantes) (1,2) . Los TNEP funcionantes incluyen a los insulinomas, gastrinomas, VIPomas, somatostatinomas, glucagonomas, TNEP que causan liberación de la hormona de crecimiento y un grupo menos común de TNEP que secretan ACTH (ACTHomas) y causan síndrome de Cushing, TNEP que causan síndrome carcinoide, TNEP que causan hipercalcemia y muy raramente TNEP ectópicos que secretan hormona luteinizante, renina o eritropoyetina. Los TNEP (funcionantes y no funcionantes) secretan también otras sustancias (cromogranina, sinaptofisina, enolasa neuronal específica, subunidades de la gonadotropina coriónica humana, neurotensina, grhelina), sin embargo, estas no causan un síndrome hormonal especifico (2,3) . Los insulinomas son los TNEP funcionantes más frecuentes, con una incidencia reportada de 4 casos por millón de habitantes por año, con un pico de incidencia específica en la quinta década de la vida y con una leve predilección por el sexo femenino (4) .Más del 90% de los insulinomas son tumores pequeños y únicos; aproximadamente 10% son múltiples, menos del 10% son malignos (clásicamente determinada por la evidencia de invasión local o metástasis) y del 5% al 10% están asociados con la neoplasia endocrina múltiple tipo 1 (NEM -1) (4-6) o síndrome de Wermer, desorden au...
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