Polyserositis as a Post-Covid-19 Complication.

INTRODUCTION: Polyserositis is described as inflammation with effusion of more than one serous membrane. There is very little published literature linking it to COVID-19 as a late complication. OBJECTIVE: Present and describe a case of post-COVID-19 polyserositis. METHODS: Data were collected from the medical record of a female patient admitted for fainting spells and marked weakness. The patient underwent a clinical evaluation, additional hematology, imaging and histopathology tests, and a surgical procedure. The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor. RESULTS: We present the case of a 57-year-old female patient admitted to hospital for fainting spells and marked weakness, four months after COVID-19 infection. She also had a history of obesity, asthma, type 2 diabetes mellitus and a cholecystectomy in December 1992 for gallstones. Clinical assessment revealed pericardial effusion and bilateral pleural effusion, in addition to a tumor-like lesion outside the pericardium, proximal to the right ventricular wall. A surgical procedure and findings from additional tests led to diagnoses of thymic remnants and polyserositis. CONCLUSIONS: This is a case of polyserositis in a post-COVID-19 patient. After other causes of polyserositis were ruled out, and since there is a likely physiological and pathogenic mechanism operating between the two diseases, the polyserositis was determined to be a late complication of COVID-19. To date, it is the second case reported in the world and the first reported in Cuba.

Tratamiento endovascular de malformaciones arteriovenosas intracerebrales con n-butil cianoacrilato. Métodos de trabajo y experiencia en 58 casos / Endovascular treatment of intracranial arteriovenous malformation with n-butyl cyanoacrylate. Working methods and experience in 58 cases

INTRODUCCIÓN Y OBJETIVOS: Las malformaciones arteriovenosas (MAV) constituyen malformaciones vasculares del sistema nervioso central, responsables de una morbimortalidad significativa. La embolización con n-butil cianoacrilato es una modalidad de tratamiento bien establecida que se combina con la cirugía o la radiocirugía. Nuestro objetivo, en este trabajo, fue caracterizar la serie de MAV tratadas por vía endovascular con n-butil cianoacrilato en la población cubana y evaluar los resultados postembolización. MATERIAL Y MÉTODO: Un total de 58pacientes con MAV cerebrales fueron embolizados con n-butil cianoacrilato en la unidad de terapia endovascular del Centro de Investigaciones Médico Quirúrgicas (CIMEQ) en la Habana (Cuba) en el quinquenio comprendido entre febrero de 2006 y febrero de 2011. Se realizaron un total de 91sesiones que comprendieron embolizaciones intranidales y desvascularizaciones predominantemente parciales, de un 25-30% por sesión, y cierre de 123 pedículos arteriales. Se establecieron tiempos de seguridad para la inyección del n-butil cianoacrilato mediante el cálculo de su tiempo de polimerización, utilizando sistemáticamente la hipotensión postembolización y la realización de test superselectivo con propofol para la determinación de elocuencia cerebral. RESULTADOS: El 68,8% de los casos empezaron con manifestaciones hemorrágicas, el 24,1% con crisis epilépticas y el 1,7% con ictus isquémico. El 93,2% de las MAV fueron supratentoriales y el 6,8%, infratentoriales; según la clasificación de Spetzler y Martin, el 13,8% eran de grado ii, el 56,9% de grado III, el 22,4% de grado IV y el 6,8% de grado V. Se realizaron 128 tests superselectivos con propofol, 118 (92,2%) negativos y 10 (7,8%) positivos. Predominaron las desvascularizaciones parciales del 20-30%; en el 17,2% de los pacientes se logró oclusión total, y en el 27,5%, del 70-99%. Se establecieron tiempos de seguridad para la inyección de Histoacryl(R), y se estableció la utilización de la hipotensión posprocedimiento. Se registró una morbilidad del 17,2%, con un 6,9% de complicaciones hemorrágicas y una mortalidad del 3,4%. CONCLUSIONES: Las tasas de oclusión total y de morbimortalidad se encuentran en los rangos descritos internacionalmente. La implementación de cierres intranidales con desvascularizaciones del 20-30% por sesión y la utilización de la hipotensión posprocedimiento después de las complicaciones hemorrágicas descritas se tradujo en ausencia de complicaciones hemorrágicas

BACKGROUND AND PURPOSE: Arteriovenous malformations (AVMs) constitute malformative lesions of the central nervous system vasculature and cause significant morbidity and mortality. Endovascular embolization with n-butyl cyanoacrylate is a well established modality of AVM treatment, usually combined with surgery or radiosurgery. The purpose of this study was to characterise the AVMs that were treated endovascularly with n-butyl cyanoacrylate and to evaluate the post-embolization results in the Cuban population. MATERIALS AND METHODS: From February 2006 to February 2011, a group of 58 consecutive patients with brain AVMs were embolized using n-butyl cyanoacrylate in the endovascular therapy unit of the Medical Surgical Research Centre in Havana (Cuba). In all, 91sessions were carried out with intranidal embolization and mainly partial devascularization, 25-30% per session, and closing 123 arterial pedicles. Safety times for n-butyl cyanoacrylate injection were established by calculating the polymerisation times for different dilutions, using post-embolisation hypotension systematically, as well as a superselective test with propofol to determine cerebral eloquence. RESULTS: Haemorrhagic signs were the initial presentation in 68.8% of the patients, 24.1% presented with epileptic episodes and 1.7% with ischemic stroke. Of the AVMs, 93.2% were supratentorial; according to the Spetzler and Martin classification, 13.8% were grade II, 56.9% were grade III, 22.4% were grade IV and 6.8%, grade V. One hundred and twenty-eight selective tests with propofol were performed and 118 (92.2%) of those were negative. Partial devascularization (20-30%) prevailed; complete obliteration was achieved in 17.2% of the patients and 70%-99% in 27.5% of the patients. Safety times for n-butyl cyanoacrylate injection were established and the use of post-procedure hypotension was settled. Morbidity of 17.2%, with 6.9% haemorrhagic complications and mortality of 3.4% were registered in the whole series. CONCLUSIONS: The rates of total occlusion and of morbidity and mortality in the series are in the internationally described ranges. The implementation of intranidal closings with 20-30% devascularization per session and the use of post-embolization hypotension after the haemorrhage complications described resulted in the total absence of haemorrhagic complications

[Endovascular treatment of intracranial arteriovenous malformation with n-butyl cyanoacrylate. Working methods and experience in 58 cases]. / Tratamiento endovascular de malformaciones arteriovenosas intracerebrales con n-butil cianoacrilato. Métodos de trabajo y experiencia en 58 casos.

BACKGROUND AND PURPOSE: Arteriovenous malformations (AVMs) constitute malformative lesions of the central nervous system vasculature and cause significant morbidity and mortality. Endovascular embolization with n-butyl cyanoacrylate is a well established modality of AVM treatment, usually combined with surgery or radiosurgery. The purpose of this study was to characterise the AVMs that were treated endovascularly with n-butyl cyanoacrylate and to evaluate the post-embolization results in the Cuban population. MATERIALS AND METHODS: From February 2006 to February 2011, a group of 58 consecutive patients with brain AVMs were embolized using n-butyl cyanoacrylate in the endovascular therapy unit of the Medical Surgical Research Centre in Havana (Cuba). In all, 91sessions were carried out with intranidal embolization and mainly partial devascularization, 25-30% per session, and closing 123 arterial pedicles. Safety times for n-butyl cyanoacrylate injection were established by calculating the polymerisation times for different dilutions, using post-embolisation hypotension systematically, as well as a superselective test with propofol to determine cerebral eloquence. RESULTS: Haemorrhagic signs were the initial presentation in 68.8% of the patients, 24.1% presented with epileptic episodes and 1.7% with ischemic stroke. Of the AVMs, 93.2% were supratentorial; according to the Spetzler and Martin classification, 13.8% were grade II, 56.9% were grade III, 22.4% were grade IV and 6.8%, grade V. One hundred and twenty-eight selective tests with propofol were performed and 118 (92.2%) of those were negative. Partial devascularization (20-30%) prevailed; complete obliteration was achieved in 17.2% of the patients and 70%-99% in 27.5% of the patients. Safety times for n-butyl cyanoacrylate injection were established and the use of post-procedure hypotension was settled. Morbidity of 17.2%, with 6.9% haemorrhagic complications and mortality of 3.4% were registered in the whole series. CONCLUSIONS: The rates of total occlusion and of morbidity and mortality in the series are in the internationally described ranges. The implementation of intranidal closings with 20-30% devascularization per session and the use of post-embolization hypotension after the haemorrhage complications described resulted in the total absence of haemorrhagic complications.