Hepatopathy secondary to infiltration by malignant melanoma: diagnostic value of liver biopsy.

We present the case of a 61-year-old male with no relevant history of interest who was admitted to hospital due to constitutional syndrome and discomfort in the right hypochondrium. On admission, abdominal ultrasound was performed with findings of chronic liver disease and innumerable well-defined hypoechogenic lesions of small size. Although the study was extended with other imaging tests, they did not provide more information than what was available at the time. Subsequently, an ultrasound-guided liver biopsy was performed with pathological anatomy compatible with infiltration by malignant melanoma. Subsequently, a search for the primary origin of the melanoma was performed and it was found in the right thigh. Hepatic involvement by melanoma is infrequent and both the symptoms and the findings in the complementary tests are non-specific, characteristics that make diagnosis difficult. Therefore, in these cases liver biopsy plays a fundamental role in the diagnosis.

Gastric leiomyoma as an atypical cause of upper gastrointestinal bleeding.

We introduce the case of a 40-year-old male with no medical history of interest who was admitted in the Digestive System unit due to upper gastrointestinal bleeding, and a large protruding lesion located in gastric antrum was detected during oral endoscopy, but biopsies were negative for malignancy. Therefore, endoscopic ultrasound was performed, confirming the submucosal origin of the lesion, puncturing it, and obtaining histological results compatible with leiomyoma. Gastric leiomyomas are rare mesenchymal tumors that are usually asymptomatic and are detected by performing a procedure for another reason. The definitive diagnosis is histological, being sometimes difficult to obtain samples given the submucosal origin of these lesions. The main treatment is surgery, although endoscopic resection is accepted in certain cases.

Gastrointestinal bleeding due to Heyde's syndrome resolved by transcatheter aortic valve implantation (TAVI).

We introduce the case of an 82-year-old woman with Heyde's syndrome (HS) whose gastrointestinal bleeding was refractory to medical and endoscopic therapy, for which a percutaneous aortic valve implantation (TAVI) was performed. The outcome after TAVI was good, gastrointestinal bleeding ceased and Hb remained stable during follow-up in the following 3 months. Currently, although SH is not an indication for TAVI, it could be an indication for TAVI in patients with recurrent gastrointestinal bleeding or refractory anemia to other therapies, using the percutaneous route in those with high surgical risk.

Upper gastrointestinal bleeding secondary to toxicity by anthracyclines, cytarabine and methotrexate in a patient with acute lymphoblastic leukemia.

A 60-year-old male patient with no medical history but acute lymphoblastic leukemia was admitted in the hematology ward for chemotherapy treatment (methotrexate, cytarabine, fludarabine and idarubicin). Approximately six days after finishing this chemotherapy, the patient began with symptoms of upper gastrointestinal bleeding (hematemesis and melena). Gastroscopy revealed erosive esophagitis, gastritis and duodenitis, as well as Forrest III ulcers in the duodenal bulb and multiple Forrest IIb ulcers in the second portion of the duodenum. Given the multiplicity of lesions, medical treatment with high doses of folinic acid, intravenous omeprazole, and transfusion of blood products was decided, with favorable evolution of the gastrointestinal bleeding. However, the patient died of respiratory infection.

A Real-World Data Observational Analysis of the Impact of Liposomal Amphotericin B on Renal Function Using Machine Learning in Critically Ill Patients.

BACKGROUND: Liposomal amphotericin B (L-AmB) has become the mainstay of treatment for severe invasive fungal infections. However, the potential for renal toxicity must be considered. AIMS: To evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more than 48 h. METHODS: Retrospective, observational, single-center study. Clinical, demographic and laboratory variables were obtained automatically from the electronic medical record. AKI incidence was analyzed in the entire population and in patients with a "low" or "high" risk of AKI based on their creatinine levels at the outset of the study. Factors associated with the development of AKI were studied using random forest models. RESULTS: Finally, 67 patients with a median age of 61 (53-71) years, 67% male, a median SOFA of 4 (3-6.5) and a crude mortality of 34.3% were included. No variations in serum creatinine were observed during the observation period, except for a decrease in the high-risk subgroup. A total of 26.8% (total population), 25% (low risk) and 13% (high risk) of patients developed AKI. Norepinephrine, the SOFA score, furosemide (general model), potassium, C-reactive protein and procalcitonin (low-risk subgroup) were the variables identified by the random forest models as important contributing factors to the development of AKI other than L-AmB administration. CONCLUSIONS: The development of AKI is multifactorial and the administration of L-AmB appears to be safe in this group of patients.

"Omental Cake" in a Patient With Asbestosis Leading to the Diagnosis of Malignant Peritoneal Mesothelioma.

We report a case of a 68-year-old man with medical history of pleural asbestosis and diagnosed with malignant peritoneal mesothelioma. This neoplasm is rare, has a poor prognosis, and is associated with asbestosis in many cases. It manifests clinically insidiously and in relation to the intra-abdominal locoregional effect. Radiological findings are variable, although the finding of "omental cake" by CT scan is characteristic but not pathognomonic, as seen in our case. A biopsy is required for the diagnosis, which can be guided by radiology or surgery. Treatment options available are cytoreductive surgery with intraperitoneal hyperthermic chemotherapy or systemic chemotherapy. However, new therapeutic options are emerging, which are still under development and research.