No abstract

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Looking to the duration of the disease, Q fever may be divided into acute and chronic forms. In humans, acute C. burnetii is often asymptomatic or mistaken for an influenza-like illness or atypical pneumonia. On the other hand, chronic Q fever is characterized by a spontaneous evolution lasting for > 6 months and a high level of IgG antibodies titre, generally determined by the indirect fluorescence antibody (IFA). However, other clinical manifestations may be observed, including hepatic, neurologic, dermatologic, and cardiac disturbs. Teha last one includes pericarditis, which has been observed in 1% of patients affected by C. burnetii infection. However, this incidence is probably underestimated. In fact, over 80% of acute as well as recurrent pericarditis remains aetiologically unexplained.We describe a case of a 36-year-old man reporting progressive onset of dyspnea, chest pain and dysthermia sensation. Ambulatory treatment was unsatisfactory developing a severe respiratory failure recquiring his admission in the Critical Care Department. Blood test showed discrete leukocytosis with left deviation and increased reactive protein C levels. Thoracic computed tomography (CT) showed a 22mm pericardial effusion with a bilateral pleural effusion more marked in the left lung area. Microbiological as well as serological studies showed positive IgM titers to C. Burnetii. Doxycycline treatment was initiated with postive results.

The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after aspiration of a foreign body, followed by severe respiratory distress and subcutaneous emphysema. Chest radiography revealed hyperinflation data, pneumothorax, and subcutaneous emphysema data. The flexible bronchoscope examination showed the presence of an inorganic foreign body impacted on the carina with tracheal lesions and laryngeal edema. It was necessary to perform a tracheostomy for its definitive extraction. The gold standard in the treatment of foreign body aspiration is bronchoscopy; although, in children, the technique adopted continues to be controversial, flexible bronchoscopy can be effective and very useful.

Spontaneous rupture of the spleen is a rare clinical condition that usually presents as a complication of a background pathology and can become a life-threatening condition if it is not diagnosed in time. We present the case of a 15-year-old girl with abdominal pain and clinical data of hypovolemic shock. The simple tomographic study revealed deformation of the splenic architecture and hemoperitoneum. Surgery demonstrated splenic rupture with ptosis spleen and intraperitoneal free blood. The anatomopathological examination showed the presence of splenomegaly and findings suggestive of peliosis. It also highlights the known causes related to spontaneous splenic rupture.

No abstract

The purpose of this review is to summarize the management of upper gastrointestinal bleeding (UGIB). This entity has an annual incidence of 48 to 160 cases per 100,000 adults, with a mortality rate of 10% to 14%. Classically, UGIB is divided in non-variceal hemorrhage and variceal hemorrhage, being more frequently observed the first one (80%-90%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of nonsteroidal anti-inflammatory drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, endoscopy, alcohol intake, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding. To stratify these patients, risk scores including Blatchford score and Rockall score are developed.Diagnosis is realized through endscopy, which allows definitive treatment. This treatment is improved providing pre-endoscopy as well as post-endoscopy therapy, including proton pump inhibitor (PPI) therapy. In variceal hemorrhage, if endoscopy therapy fails, balloon tamponade or transjugular intrahepatic portosystemic shunt (TIPSS) are indicated.The purpose of this review is to summarize the initial management of acute UGIB, especially in the Emergency Department.

Focal nodular hyperplasia (FNH) is considered the second most frequent benign liver tumor with a low prevalence, with a broad predominance in the female population. Most cases are asymptomatic and are often discovered incidentally. Diagnostic imaging through MRI, CT, and ultrasound can be achieved in up to 80% of cases. In some cases, a histopathological study may be necessary, especially in view of the diagnostic uncertainty and suspicion of malignancy. To date, the management of these lesions remains controversial, conservative management is recommended for asymptomatic or small lesions, relegating surgical treatment only in cases of symptomatic lesions or uncertain behavior.

The purpose of this mini-review is to summarize the management of Lower Gastrointestinal Bleeding (LGIB). This entity represents approximately 20% of all cases of gastrointestinal bleeds. The annual incidence is estimated to be between 20 and 27 cases per 100,000 populations, but this data is observed to be increased 200-fold in the elderly. This pathology is mainly self-limited and has a relatively low mortality rate (2-4%). The initial management includes investigate about the form of presentation, color and characteristics of the hemorrhage, the age of the patient, presence of coagulopathy, disease or cardiovascular risk factors, use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), antiaggregants or anticoagulants, previous episodes of hemorrhage, pelvic radiotherapy, endoscopy, polypectomy or previous surgery, change of the recent intestinal rhythm, etc. However, this process must not delay the initiation of hemodynamic resuscitation in patients with patients with ongoing bleeding.Diagnosis is realized through endscopy, which has diagnostic rates of 74% to 100%, or radiographic imaging techniques. The last one includes Computed Tomographic [CT] angiography and radionuclide technetium-99m-labeled red-cell scintigraphy. Both techniques allow definitive treatment. In fact, CT angiography is highly accurate at localizing the site of bleeding (nearly 100%), and can be used immediately before angiography treatment.Definitive treatment may be realized during the diagnosis via endoscopic therapies as well as angiography. If both of them fail, surgical treatment is indicated preferring segmental resections compared to subtotal colectomy.