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INTRODUCTION: Cases of myocarditis after COVID-19 messenger RNA (mRNA) vaccines administration have been reported. Although the majority follow a mild course, fulminant presentations may occur. In these cases, cardiopulmonary support with venoarterial extracorporeal membrane oxygenation (V-A ECMO) may be needed. RESULTS: We present two cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-CoV2 vaccine. One of the cases was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab using the Seldinger technique. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Whereas an endomyocardial biopsy was performed in both, a definite microscopic diagnosis just could be reached in one of them. Treatment was the same, using 1000mg of methylprednisolone/day for three days. A cardiac magnetic resonance was performed ten days after admission, showing a significant improvement of the left ventricular ejection fraction and diffuse oedema and subepicardial contrast intake in different segments. Both cases were discharged fully recovered, with CPC 1. CONCLUSIONS: COVID-19 vaccine-associated fulminant myocarditis has a high morbidity and mortality but presents a high potential for recovery. V-A ECMO should be established in cases with refractory cardiogenic shock during the acute phase.
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BACKGROUND: Perforations of the hypopharynx and the cervical oesophagus are infrequent severe situations, which may even be life-threatening for patients. METHODS: We review seven cases of intraluminal perforations of the hypopharynx or cervical oesophagus treated at our department between 1999 and 2001. RESULTS: In this series of patients, foreign bodies were the main cause of perforation. In four cases, the treatment was surgical by means of a cervicotomy and/or thoracotomy and drainage; in the other three cases, conservative treatment was applied. In some cases, the morbidity was considerable but there were no mortalities. CONCLUSIONS: The treatment of perforations of the hypopharynx and the cervical oesophagus must be individualized and multidisciplinary. The early diagnosis of these perforations is an important factor for prognosis.
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Perfuração Esofágica/terapia , Hipofaringe/lesões , Adulto , Idoso , Perfuração Esofágica/etiologia , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , RupturaRESUMO
Annular elastolytic giant cell granuloma (AEGCG) is an uncommon entity clinically characterized by erythematous annular plaques with atrophic and hypopigmented center, that predominates in sun-exposed zones. The histology shows a granulomatous infiltrate without palisading image, made up of lymphocytes, histiocytes and giant cells, with phagocytosis of elastic fibers, without necrobiosis or mucin deposit. We present the case of a male patient with atypical clinical manifestation on the non-sun exposed skin and AEGCG characteristic histology.
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Granuloma Anular , Idoso , Granuloma Anular/diagnóstico , Granuloma Anular/patologia , Humanos , Masculino , Transtornos de Fotossensibilidade , Pele/patologia , Fatores de TempoRESUMO
In recent years, the demand for cosmetic interventions to augment soft tissue by injecting different substances has increased, due to their apparent innocuity. However, these procedures are not free from adverse reactions, such as the formation of foreign body granulomas, a phenomenon described in literature with most of the materials used. We report the case of a female patient with inflammatory lesions of the face, whose diagnosis was made after the histopathological study, which revealed a granuloma caused by liquid silicone.
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Técnicas Cosméticas/efeitos adversos , Granuloma de Corpo Estranho/induzido quimicamente , Silicones/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
En la actualidad, la inyección de materiales en el subcutáneo con fin estético es frecuente. Comunicamos el caso de una paciente con lesiones esclerodermiformesen ambas regiones pretibiales, en cuyo estudio histopatológico se observó un granuloma por silicona. Años atrás la paciente se había sometido ala inyección de un material de relleno en la región glútea. Se trata, por tanto, de un granuloma de cuerpo extraño por silicona que ha migrado a distanciadel lugar de la inoculación. El diagnóstico de este cuadro puede ser difícil. El tratamiento es complicado y, en general, no satisfactorio
Nowadays inoculation of materials for soft tissues augmentation is common. We report the case of a woman with sclerodermiform lessions in pretibialregions, characterized by a silicone granuloma. The histopathologic study in some years ago, she have seen inoculated of an unknown material in glutealregion. This case is a foreing body granuloma caused by silicone migrated from the inoculation site. Diagnosis of this conditions disease may bedifficult, and treatment is often unsatisfactory