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PERITONEAL LESIONS – REGARDING A CASE OF PRIMARY PERITONEAL SEROUS PAPILLARY ADENOCARCINOMA (PPSPA)
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 Conclusion: Gender-related pathophysiological, behavioural and clinical factors underlying the differences in HF epidemiology and outcomes should be incorporated in preventive and treatment strategies. HAND, FOOT AND MOUTH SYNDROME IN AN IMMUNOCOMPETENT ADULT: ON PURPOSE OF A CASE REPORT Bárbara Flor de Lima, João Silva, Maria João Oliveira, Ana Grilo, Nuno Riso. Department of Auto-immunity, Hospital Curry Cabral, Lisbon Introduction: Hand-foot-mouth syndrome (HFMS) is characterized by fever, oral vesicles on the oral mucosa and tongue, and peripherally distributed small, tender cutaneous lesions on the hands, feet and buttocks. This syndrome is rarely seen in adults, and when present, the majority of them have Common Immunodeficiency Variable. The group A Coxsackie viruses are recovered most often from this patients. Case Report: N.O.M., 35 years, male sex, caucasian and works as an ambient technitian. Has a personal history of multiples acute faringitis, hypertension, hypercholesterolemia and occasional abdominal pain. He refers poliarthralgia affecting knees and fists, odynophagia, followed by fever (38°C) and aftous lesions on oral mucosa, vesicles on the palms of hands and feet. On April 2011, 3 weeks later of the described presentation, he is admitted to the emergency room with oppressive retrosternal pain, with slighty downwards of ST segment at inferior leads on ECG and Troponin I 0,15ng/mL and MB fraction of Creatine kinase 0,5ng/mL. From the evaluation during in-hospital stay, he has serologies positive for Coxsackie A9 and Echovirus (1/160), positive IgA anti-transglutaminase (25,3U/mL) and IgA and IgG anti-gliadine (77,8 U/ mL) antibodies, with normal immunoglobulins, antinuclear antibody double strand DNA, and being HIV negative. Conclusion: It is described a case of HFMS caused by Coxsackie A9 infection complicated by acute myopericarditits rarely seen in an immunocompetent adult. Keywords: Hand-foot-mouth syndrome, myopericarditis, Coxsackie A9 SUBCLINICAL ATHEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS Cristina Florea1, Elena Ardeleanu2, Alexandru Caraba1. 1The IVth Internal Medicine Clinique, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; 2Head of Discipline of Family Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania Background: Systemic lupus erythematosus (SLE) is associated with an increased risk of accelerated atherosclerosis. The aim of this study is represented by the assessment of the subclinical atherosclerosis by common carotid ultrasonography, and the characterization of factors implied in its appearance. Methods: The study was done on 30 women, divided into two groups: SLE group (15 patients with SLE, without renal involvement) and control group (15 healthy age). Carotid ultrasonography was done in all subjects, assessing intima-media thickness (IMT) and the presence of atherosclerotic plaques. Total cholesterol, triglycerides, antinuclear antibodies, anti dsDNA antibodies, C3, circulating immune complexes, blood pressure were determined in all patients. SLE was characterized by means of SLEDAI and SLICC/ACR. The statistical analysis was done using Pearson’s test and Student’s t – test, p < 0,05 was considered statistically significant. Results: IMT and the incidence of atherosclerotic plaques were higher in patients with SLE (p < 0,05). In these patients, IMT was strong correlated with SLICC/ACR (r = 0,9046, p < 0,001), duration of disease evolution (r = 0,8986, p < 0,001), systolic blood pressure (r = 0,7695, p < 0,01). Moderate correlations were established between IMT and diastolic blood pressure (r = 0,66, p < 0,01), the number of lupus flares (r = 0,6099, p < 0,01), total cholesterol (r = 0,5149, p < 0,05). Conclusion: The patients with SLE present a high incidence of subclinical atherosclerosis. The principal factors which contribute to its appearance are: dyslipidemia, arterial hypertension, smoking, and SLE related factors. PERITONEAL LESIONS – REGARDING A CASE OF PRIMARY PERITONEAL SEROUS PAPILLARY ADENOCARCINOMA (PPSPA) Margarida Fonseca1, Bruno Gonçalves2, Adelina Ferreira3, Teresa Macedo4, Rui Nabiço4. 1Resident of Internal Medicine, Hospital de Braga, Braga, Portugal; 2 Resident of Gastroenterology, Hospital de Braga, Braga, Portugal; 3Department of Internal Medicine, Hospital de Braga, Braga, Portugal; 4Department of Oncology, Hospital de Braga, Braga, Portugal Background: Most of peritoneal adenocarcinomas comes from malignant neoplasms of the ovaries and fallopian tubes, and as such it is imperative a
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gynecologic investigation during the study of peritoneal carcinomatosis and / or a serous ascites. In 10-15% of cases there is no evidence of pathology in the ovaries or fallopian tubes, so the hypothesis of PPSPA should be considered. Methods: The authors present the case of a 76-year-old woman with ascites and constitucional syndrome since 3 months. Results: She had an elevated serum CA-125. An adnexial mass and “omental cake” was found on CT Scan. Paracentesis of the ascitic fluid resulted in a positive cytologic for malignant cells. With the conclusion of peritoneal carcinomatosis from ovarian cancer, she underwent chemotherapy and cytoreductive surgery. The histologic and immunohistochemical study of peritoneal and ovarian biopsies specimens revealed the absence of ovarian neoplasias, resulting in the diagnosis of PPSPA. Conclusion: PPSPA is a rare clinical entity. The authors make a review of its diagnostic criteria, highlighting the importance of histology in the distinction between ovarian cancer and primary carcinoma of the peritoneum. AN UNUSUAL PRESENTATION OF AN ABDOMINAL INFECTION IN THE ELDERLY PATIENT David Fortes1, Luís Mieiro1,2, Alda Jordão1, J.P. Gorjão-Clara2. 1Internal Medicine Department, Pulido Valente Hospital, Lisbon University, Lisbon, Portugal; 2 Universitary Unit of Geriatrics, Pulido Valente Hospital, Lisbon University, Lisbon, Portugal Background: Pyogenic hepatic abscesses are relatively rare. Although high, mortality has been reduced since the use of percutaneous drainage. Clinical presentation in the elderly is often scarce or atypical and aggressive treatment can be harmful. Case description: We report the case of a 93-year-old woman admitted for fever, cough, dyspnoea, and without gastrointestinal signs or symptoms like nausea, vomiting, abdominal pain, jaundice or hepatomegaly. Laboratorial tests showing high inflammatory parameters, and the thoracic radiography showing a pleural effusion. Degradation of the general state has conduced to computerized tomography, where a voluminous subcapsular hepatic abscess was found. Percutaneous drainage was performed and Escherichia coli sensitive to amoxicillin with clavulanate was isolated. A 2-month control computerized tomography shows no evidence of the abscess and the patient regained her functional status. (Barthel Index 90). Conclusion: Most complications of this treatment are related to long admissions in inpatient departments. In this case, frequent follow-up as an outpatient was conducted and this may have contributed to the excellent result and restored functionality of the patient, avoiding bed rest and loss of physical condition commonly seen in long-term stays. More than the rarity of this clinical situation it is relevant the paucity of abdominal and gastroenterology symptoms and the particularly presentation of an acute abdominal infection as a pulmonary disease. This case is the evidence that elderly patients can have not common symptomatic presentation and that geriatrician must be always aware of this possibility. CORRELATION BETWEEN CLINICAL ASPECTS, ULTRASONOGRAPHY AND HISTOPATHOLOGICAL CHANGES IN PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY Mircea Catalin Fortofoiu1,2, Maria Fortofoiu1,2, Florin Petrescu1,2, Liviu Constantin Iovanescu1,2, Violeta Comanescu2, Mihai Relu Stanescu1, Florin Bogdan1. 1University Of Medicine And Pharmacy of Craiova, Dolj, Romania; 2 Emergency Clinical County Hospital, Craiova, Dolj, Romania Background: The stages that an initially cronic cardiovasculary affection goes through untill the onset of cardiac insufficiency are marked, usually by intermediate modifications at the myocard’s level, these modifications usually being along the lines of hypertrophia or overload. Methods: The clinical study was made through processing the data from the medical documents of 185 subjects. Histological and immunohistochemical study include collection of samples from the necropsy, histological preparations, staining with Hematoxilin-Eosin, light green and imunolabeling with specific antibodies. Microscopic examination of samples and relevant image acquisition was made with a microscope connected to a computer that has specific software necessary for the morphometric study. Morphometric study of the samples are processed using a special software that determines quantitative estimate of the size of miocardiocytes and the degree of myocardial fibrosis.
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gynecologic investigation during the study of peritoneal carcinomatosis and / or a serous ascites. In 10-15% of cases there is no evidence of pathology in the ovaries or fallopian tubes, so the hypothesis of PPSPA should be considered. Methods: The authors present the case of a 76-year-old woman with ascites and constitucional syndrome since 3 months. Results: She had an elevated serum CA-125. An adnexial mass and “omental cake” was found on CT Scan. Paracentesis of the ascitic fluid resulted in a positive cytologic for malignant cells. With the conclusion of peritoneal carcinomatosis from ovarian cancer, she underwent chemotherapy and cytoreductive surgery. The histologic and immunohistochemical study of peritoneal and ovarian biopsies specimens revealed the absence of ovarian neoplasias, resulting in the diagnosis of PPSPA. Conclusion: PPSPA is a rare clinical entity. The authors make a review of its diagnostic criteria, highlighting the importance of histology in the distinction between ovarian cancer and primary carcinoma of the peritoneum. AN UNUSUAL PRESENTATION OF AN ABDOMINAL INFECTION IN THE ELDERLY PATIENT David Fortes1, Luís Mieiro1,2, Alda Jordão1, J.P. Gorjão-Clara2. 1Internal Medicine Department, Pulido Valente Hospital, Lisbon University, Lisbon, Portugal; 2 Universitary Unit of Geriatrics, Pulido Valente Hospital, Lisbon University, Lisbon, Portugal Background: Pyogenic hepatic abscesses are relatively rare. Although high, mortality has been reduced since the use of percutaneous drainage. Clinical presentation in the elderly is often scarce or atypical and aggressive treatment can be harmful. Case description: We report the case of a 93-year-old woman admitted for fever, cough, dyspnoea, and without gastrointestinal signs or symptoms like nausea, vomiting, abdominal pain, jaundice or hepatomegaly. Laboratorial tests showing high inflammatory parameters, and the thoracic radiography showing a pleural effusion. Degradation of the general state has conduced to computerized tomography, where a voluminous subcapsular hepatic abscess was found. Percutaneous drainage was performed and Escherichia coli sensitive to amoxicillin with clavulanate was isolated. A 2-month control computerized tomography shows no evidence of the abscess and the patient regained her functional status. (Barthel Index 90). Conclusion: Most complications of this treatment are related to long admissions in inpatient departments. In this case, frequent follow-up as an outpatient was conducted and this may have contributed to the excellent result and restored functionality of the patient, avoiding bed rest and loss of physical condition commonly seen in long-term stays. More than the rarity of this clinical situation it is relevant the paucity of abdominal and gastroenterology symptoms and the particularly presentation of an acute abdominal infection as a pulmonary disease. This case is the evidence that elderly patients can have not common symptomatic presentation and that geriatrician must be always aware of this possibility. CORRELATION BETWEEN CLINICAL ASPECTS, ULTRASONOGRAPHY AND HISTOPATHOLOGICAL CHANGES IN PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY Mircea Catalin Fortofoiu1,2, Maria Fortofoiu1,2, Florin Petrescu1,2, Liviu Constantin Iovanescu1,2, Violeta Comanescu2, Mihai Relu Stanescu1, Florin Bogdan1. 1University Of Medicine And Pharmacy of Craiova, Dolj, Romania; 2 Emergency Clinical County Hospital, Craiova, Dolj, Romania Background: The stages that an initially cronic cardiovasculary affection goes through untill the onset of cardiac insufficiency are marked, usually by intermediate modifications at the myocard’s level, these modifications usually being along the lines of hypertrophia or overload. Methods: The clinical study was made through processing the data from the medical documents of 185 subjects. Histological and immunohistochemical study include collection of samples from the necropsy, histological preparations, staining with Hematoxilin-Eosin, light green and imunolabeling with specific antibodies. Microscopic examination of samples and relevant image acquisition was made with a microscope connected to a computer that has specific software necessary for the morphometric study. Morphometric study of the samples are processed using a special software that determines quantitative estimate of the size of miocardiocytes and the degree of myocardial fibrosis.