Craving for menthol sweets: a case report. / Craving por mentolados: a propósito de un caso.

We describe a case of craving for menthol sweets in a 53-year-old woman with excessive consumption of menthol sweets (100 units/day). She was admitted with a history of rheumatoid arthritis, obesity, anxiety associated with onychophagia and pinching of the skin. Organic disorders were ruled out with paraclinical tests and in-hospital treatment was administered. At discharge, the patient's condition was stable, but because of exacerbated pain due to the rheumatological disease, she presented depressive symptoms, requiring her medication to be adjusted. CONCLUSIONS: The "food craving" and anxiety present pathophysiological similarities. Mints have different mechanisms or ways in which they can counteract or control these symptoms, including an increase in serotonin, binding to GABA-A receptors and stimulation of the nicotinic receptor in nerve cells.

Craving por mentolados: a propósito de un caso

Se describe un caso de craving por dulces mentolados, una paciente de 53 arios con cuadro de consumo excesivo de dulces mentolados (100 unidades/día). Ingresó con el antecedente de artritis reumatoide, con obesidad, en estado de ansiedad asociado con onicofagia y pellizcos de la piel. Se descartó la organicidad mediante paraclínicos y se le dio asistencia hospitalaria. Al alta, la paciente estaba estable; sin embargo, por progresión del dolor por la enfermedad reumática, ha sufrido síntomas depresivos, por lo que ha requerido ajuste de la medicación. Conclusiones: El food craving y la ansiedad presentan similitudes fisiopatológicas. Las mentas tienen distintos mecanismos o modos en que pueden contrarrestar o controlar estos síntomas, entre los que está el aumento de serotonina, la unión a receptores GABA-A y la estimulación del receptor nicotínico en las células nerviosas.

We describe a case of craving for menthol sweets in a 53-year-old woman with excessive consumption of menthol sweets (100 units/day). She was admitted with a history of rheumatoid arthritis, obesity, anxiety associated with onychophagia and pinching of the skin. Organic disorders were ruled out with paraclinical tests and in-hospital treatment was administered. At discharge, the patient's condition was stable, but because of exacerbated pain due to the rheumatological disease, she presented depressive symptoms, requiring her medication to be adjusted. Conclusions: The "food craving" and anxiety present pathophysiological similarities. Mints have different mechanisms or ways in which they can counteract or control these symptoms, including an increase in serotonin, binding to GABA-A receptors and stimulation of the nicotinic receptor in nerve cells.

Síndrome de Leriche / Leriche's syndrome

Resumen El síndrome de Leriche es una vasculopatía oclusiva que afecta de manera progresiva la aorta abdominal, las iliacas comunes o ambas. Se comunica el caso de una paciente con distintos factores de riesgo vascular, quien manifestó de manera aguda un cuadro clínico compatible con oclusión vascular (claudicación). Se confirmaron mediante estudio imagenológico las características de un síndrome de Leriche. La paciente finalmente falleció. La incidencia y prevalencia de este síndrome se desconocen, los casos en mujeres se asocian principalmente con enfermedades autoinmunitarias. Para el diagnóstico se requiere la realización de una adecuada historia clínica y se confirma mediante estudios imagenológicos. El tratamiento está dirigido a prevenir el avance de la enfermedad. Como parte del manejo farmacológico se encuentran algunos vasodilatadores, antiagregantes plaquetarios y las estatinas. El manejo quirúrgico puede ser cirugía a cielo abierto o endovascular, la primera demuestra mayor beneficio, a pesar de los riesgos que conlleva.

Abstract Leriche's syndrome is an occlusive vasculopathy that progressively affects the abdominal aorta and the common iliacs. This paper reports the case of a female patient with various vascular risk factors, which presented a clinical picture compatible with vascular occlusion (claudication). The characteristics of a Leriche's syndrome were confirmed by imaging. The patient finally died. Incidence and prevalence of Leriche's syndrome are unknown, cases in the female gender are the main ones in autoimmune diseases. For the diagnosis, an adequate clinical history is required and confirmed by imaging studies. The treatment is aimed at preventing the progress of the disease. Within the pharmacological management are some vasodilators, antiplatelet agents and statins. Surgical management can be an open or endovascular surgery, the first one offers the greatest benefit, despite the risks involved.

Aspergiloma pulmonar en paciente con síndrome de sobreposición: Reporte de caso / Pulmonary aspergiloma in patient with overposition syndrome: Case ́s report / Aspergiloma pulmonar em paciente com síndrome de sobreposição: Relato de caso

Introducción. La infección por Aspergillus spp. representa un reto diagnóstico y terapéutico para el clínico, puesto que existe un número aproximado de 180 especies. El pulmón es el principal órgano afectado por el Aspergillus debido a la alta capacidad esporulativa de este hongo y a que sus conidias son lo suficientemente pequeñas para poder alcanzar el alveolo. Caso. Mujer de 41 años de edad con antecedente de lupus eritematoso sistémico, ingresó con un cuadro de disfagia, en el cual se confirmó la presencia de síndrome de sobreposición mediante perfil inmunológico. Posteriormente, mediante estudio imagenológico, realizado por tener tos y disnea, se encontró la presencia de una masa ovoidea en hemitórax derecho y al realizar una fibrobroncoscopia se evidenció que dicha lesión era compatible con un aspergiloma, por lo que se dio manejo antifún-gico con una evolución clínica adecuada.Conclusión. El aspergiloma se presenta como una masa voluminosa constituida por filamentos mi-celiales, la cual se puede confundir con múltiples patologías principalmente de tipo tumoral, por lo que es necesario realizar biopsia de la misma

Introduction. For clinicians, Aspergillus spp. infection represents a diagnostic and therapeutic cha-llenge, since there are around of 180 species. Lung is the main affected organ by Aspergillus infection due to the high sporulative capacity of this fungus, and because its conidia are small, enough to reach the alveolus. Case. A 41-years-old patient with a history of systemic lupus erythematosus, was admitted with dysphagia, and an immunological pool confirmed the presence of an overlap syndrome. Later, due to symptoms of cough and dyspnea, an ovoid mass was found by imaging and fibrobronchoscopy, which showed that this lesion was compatible with aspergilloma, so antifungal therapy was given with an adequate clinical progression. Conclusions. Aspergilloma is a voluminous mass constituted by mycelial filaments, which can be confused with multiple pathologies, mainly of the tumor type, which is why it is necessary to perform a biopsy of it.

Introdução. As infecções causadas pelo fungo Aspergillus spp. representam um desafio diagnóstico e terapêutico para o clínico, uma vez que existe um número aproximado de 180 espécies. O pulmão é o principal órgão afetado por Aspergillus devido à alta capacidade esporulativa deste fungo, pois seus conídios são pequenos o suficiente para atingir o alvéolo.Caso. Mulher de 41 anos com história de lúpus eritematoso sistêmico, foi admitida com disfagia, a presença da síndrome de sobreposição foi confirmada pelo perfil imunológico. Posteriormente, por meio de um estudo de imagem, realizado devido à tosse e dispnéia, foi encontrada presença de massa ovóide no hemitórax direito e, ao realizar uma fibrobroncoscopia, foi demonstrado que a lesão era compatível com um aspergiloma, de modo que o manejo antifúngico foi dado com uma evolução clínica adequada.Conclusão. O aspergiloma é apresentado como uma massa volumosa constituída por filamentos mi-celiais, que podem ser confundidos com múltiples patologias principalmente do tipo tumoral, sendo necessária a realização de uma biópsia do mesmo

Embolia pulmonar por metilmetacrilato / Pulmonary embolism due to methyl acrylate

Resumen La vertebroplastia es un procedimiento terapéutico que se usa para reparar lesiones vertebrales. Por su parte, el metilmetacrilato, es un cemento óseo que se inyecta en el hueso esponjoso del cuerpo vertebral durante dicho procedimiento. Se expone el caso de una paciente de sexo femenino de 59 años, con antecedente de artrodesis lumbar, quien consultó por lumbalgia tipo punzada, posterior a caída desde su propia altura. Al examen físico se refirió dolor en región torácica sin signos clínicos de radiculopatía e imposibilidad para la movilización. Los estudios imagenológicos reportaron fractura por acuñamiento de cuerpos vertebrales T12-L1. Se hizo cambio de material de artrodesis que requirió uso adicional de metilmetacrilato para fijación de tornillos canulados. Dos horas posteriores al procedimiento quirúrgico refirió dolor torácico, disnea y taquipnea por lo cual se solicitaron estudios adicionales. Por hallazgos en la radiografía de tórax, se sospechó embolia pulmonar secundaria a metilmetacrilato y por tanto se solicitó tomografía computarizada de tórax. Fue trasladada a la unidad de cuidados intensivos; luego de 72 horas de estancia allí, se hizo ecocardiograma que mostró cavidades derechas dilatadas, hipoquinesia del ventrículo derecho con deterioro de la sístole, insuficiencia tricúspide e hipertensión pulmonar moderada. Se indicó tromboprofilaxis por tres meses y seguimiento por servicios de Medicina interna y Neurocirugía.

Abstract Vertebroplasty is a therapeutic procedure that is used to repair spinal lesions. For its part, methyl acrylate is a bone cement that is injected into the spongy bone of the vertebral body during this procedure. The case is presented of a 59 year-old woman with a history of a lumbar arthrodesis, who consulted due stabbing-type lower back pain, after a fall from her own height. On physical examination, she had pain in the thoracic region with no clinical signs of radiculopathy, and impossibility for movement. The imaging studies reported a fracture due to wedging of vertebral bodies T12-L1. A change was made in the arthrodesis material, which required the additional use of methyl acrylate to fix the cannulated screws. Two hours after the surgical procedure, she referred to chest pain, dyspnoea and tachypnoea, for which further studies were requested. Due to the findings in the chest x-ray, a pulmonary embolism induced by methyl acrylate was suspected, for which a computed tomography scan of the chest was requested. She was transferred to the Intensive Care Unit. After 72 hours of admission there, an echocardiogram was performed that showed dilated right cavities, hypokinesis of the right ventricle with systolic dysfunction, tricuspid insufficiency, and moderate pulmonary hypertension. Thromboprophylaxis was prescribed for three months and follow-up by the Internal Medicine and Neurosurgery departments.