Acute lymphocitic leukaemia and AIDS.

Patients with AIDS have become more and more prevalent. Therefore, the onset of diseases that coexist with this condition must be studied in order to establish proper diagnosis and treatment. We report a case of a patient who reported with loss of strength in the lower limbs and a progressive worsening in his clinical picture. He was diagnosed with acute lymphocytic leukaemia, an unusual form of association with the AIDS condition. Despite the diagnosis, he evolved into pulmonary sepsis and so staging and chemotherapy treatment could not be performed.

Fever of unknown origin and the role of Plasmodium vivax in Sao Paulo.

Malaria is a disease that hits the northern part of Brazil in an endemic form. Recorded cases outside this region are unusual and, in most cases, limited to travellers. The southeast of Brazil has an extensive wilderness area with a type of vegetation similar to the one found in the equatorial rainforest. We present the case of a patient living in the southeast, with no reported travel history, who evolved to periodic fever, associated with myalgia and chills. With the positive test result for Plasmodium, the treatment for malaria was started. This case enabled the study in the Anopheles mosquito affected area, where the patient reported infection, outside the Amazon region.

Coronary stent stenosis in acute myocardial infarction.

Acute myocardial infarction (AMI) represents one of the major mortality causes in the world. Treatment of AMI is widely known; however, in developing countries some medications are not so easily available yet. We present a case of a 49-year-old black male patient who suffered an AMI and 2 weeks after stent angioplasty evolved to a new ischaemic episode with a stent thrombosis. The patient did not use the prescribed medications.

Acute myocardial infarction and heart block: a challenge to emergency physicians.

We present the case of a patient who underwent an acute ST-elevation myocardial infarction of the inferior wall and transitory total heart block in the first hours of his clinical presentation. There was no haemodynamic instability before the thrombolytic therapy was performed 8 h after the onset of pain. There was no block recurrence. The current case shows a possible complication during the thrombolytic therapy and the urge for a quick decision by the emergency physician. Pacemaker implantation should be considered in the event of the patient's haemodynamic worsening once the success of the therapy is a reflex of the arrhythmia reversion most of the times.

Stroke and myocardial infarction: a terrible association.

In the USA coronary heart diseases and cerebral vascular accidents together are the major causes of death regardless of race or sex. More specifically, the acute myocardial infarction and the encephalic vascular accident, as final events of atherosclerosis, correspond to a large part of death cases. Such cases could be potentially prevented with a proper follow-up and the identification of the risk factors. We present a case of a 65-year-old black man, diabetic and hypertensive, with ischaemic stroke diagnosis that progressed to acute ST elevation myocardial infarction. Thrombolysis or platelets antiaggregation were not possible due to the fact that the patient was in the acute phase of his ischaemic stroke. This case shows the association of the two major causes of death in this country, stroke and myocardial infarction, and the challenge for their treatment.