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Uncommon late presentation of platypnea-orthodeoxia syndrome

Journal of Geriatric Cardiology 2015年第6期12卷 687-689页

作者： laura Toffetti Marco Centola laura massironi Cristina Pipia Fabiano Di Marco Alessandro Colombo Emanuela Piccaluga Division of Cardiology Ospedale San Paolo University of Milan Italy Divison of Internal Medicine Ospedale San Paolo Italy Division of Respiratory Medicine University of Milan Italy Division of Cardiology Azienda Ospedaliera 'Luigi Sacco ' Milan Italy

A 79-year-old man presented with progressive dyspnea,gradually worsening over a period of several weeks. His past medical history included hypertension, chronic hepatitis C without cirrhosis, ischemic stroke occurred at the age of 68 and chronic obstructive pulmonary disease (COPD) caused by long-term cigarette smoking. The patient was alert and oriented and not in acute distress. The physical examination of the chest revealed decreased breath sounds at the bases of the lungs, without crackles or wheezes. Heart sounds were regular without murmurs. The respiration rate was normal. Extremities had no cyanosis, clubbing or oedema. The 12-lead electrocardiogram showed sinus rhythm with normal heart rate and non-specific T wave changes in D1, D2 and V5-V6. The chest radiograph revealed bilateral hilar prominence. Baseline peripheral capillary oxygen saturation (SpO_2) measured by standard pulse oximetry was 89%. A face mask was placed, delivering oxygen at 6 L/min. The subsequent arterial blood gas analysis provided information on the following parameters: pH 7.41, PaCO_2 34 mmHg, PaO_2 64 mmHg, SaO_2 91%. The full blood examination was normal, except for elevated C-reactive protein(50 mL/L, normal range < 10 mg/L) and D-dimer (782 ng/mL, normal range ≤ 270 ng/mL). A pulmonary embolism was suspected and a computed tomography pulmonary angiogram was then performed. No filling defects within the lumen of the pulmonary arterial branches were detected,neither were pleural effusion or pulmonary inflammatory infiltrates. A transthoracic echocardiogram (TTE) showed normal left ventricular ejection fraction, grade I diastolic dysfunction, normal heart valves, normal pulmonary pressure(systolic pulmonary artery pressure of 27 mmHg) and moderate enlargement of the ascending aorta (sinuses of Valsalva diameter of 49 mm). The patient was treated with a standard therapy for the acute exacerbation of COPD. Serum inflammatory markers progressively decreased. Nevertheless,episodes of dy

关键词：慢性阻塞性肺病综合征慢性阻塞性肺疾病晚期血症低氧呼吸困难丙型肝炎

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Clinical challenge for gastroenterologists–Gastrointestinal manifestations of systemic mastocytosis:A comprehensive review

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World Journal of Gastroenterology 2022年第29期28卷 3767-3779页

作者： Alessandra Elvevi Elena Maria Elli Martina Luca Miki Scaravaglio Fabio Pagni Stefano Ceola laura Ratti Pietro Invernizzi Sara massironi Gastroenterology Division San Gerardo HospitalUniversity of Milano-Bicocca School of MedicineMonza 20900Italy Hematology Division and Bone Marrow Transplant Unit San Gerardo HospitalMonza 20900Italy Department of Medicine and Surgery Section of PathologySan Gerardo HospitalUniversity of Milano-Bicocca School of MedicineMonza 20900Italy

Mastocytosis is a rare and heterogeneous disease characterized by various clinical and biological features that affect different prognoses and *** disease is usually divided into 2 principal categories:cutaneous and systemic disease(SM).Clinical features can be related to mast cell(MC)mediator release or pathological MC *** is a disease often hard to identify,and the diagnosis is based on clinical,biological,histological,and molecular criteria with different specialists involved in the patient’s clinical *** all manifestations of the disease,gastrointestinal(GI)symptoms are common,being present in 14%-85% of patients,and can significantly impair the quality of *** we review the data regarding GI involvement in SM,in terms of clinical presentations,histological and endoscopic features,the pathogenesis of GI symptoms,and their treatment.

关键词： Systemic mastocytosis Gastrointestinal involvement Gastrointestinal symptoms

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Acute mesenteric ischemia and small bowel imaging findings in COVID-19:A comprehensive review of the literature

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World Journal of Gastrointestinal Surgery 2021年第7期13卷 702-716页

作者： Lorena Pirola Andrea Palermo Giacomo Mulinacci laura Ratti Maria Fichera Pietro Invernizzi Chiara Viganò Sara massironi Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryUniversity of Milano-BicoccaMonza 20900Italy European Reference Network on Hepatological Diseases San Gerardo HospitalMonza 20900Italy

BACKGROUND Coronavirus disease 2019(COVID-19),an infectious condition caused by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2),has rapidly spread worldwide since its first description in Wuhan in December *** though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality,extrapulmonary involvement has progressively gained *** particular,gastrointestinal(GI)signs and symptoms,reported in up to two-thirds of patients with COVID-19,might represent the first and,in some cases,the only disease *** presence has been associated in some studies with an increased risk of a severe disease *** pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 *** not typical of SARS-Co V-2 infection,several small bowel manifestations have been described in infected patients who underwent any form of abdominal *** radiological findings were mainly reported in patients with abdominal symptoms,among which abdominal pain was the most *** To discuss small bowel radiological manifestations of SARS-Co V-2 infection in abdominal imaging *** Bibliographical searches were performed in Pub Med,using the following keywords:"COVID-19"AND"imaging"AND"gastrointestinal"OR"abdominal"OR"small bowel".RESULTS Of 62 patients with described radiologic small bowel alterations,mesenteric ischemia was diagnosed in 31 cases(50%),small bowel wall thickening in 10 cases(16%),pneumatosis in nine cases(15%),intussusception in eight cases(13%),pneumoperitoneum in two cases(3%)and paralytic ileus in two cases(3%).We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young *** So far it is difficult to establish whether

关键词： COVID-19 SARS-CoV-2 Radiology Small intestine Abdomen

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