Yellow Nail Syndrome: Report of Two Cases and a Brief Review of the Current Literature

Yellow Nail Syndrome (YNS) is a rare, and probably misdiagnosed, condition. It must be considered in middle-aged patients with unexplained chronic respiratory manifestations, lymphedema and nail abnormalities. We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion.

Use of Poppers (Amyl Nitrite): Unpleasant Side Effects in a Brothel

Introduction: Various agents can lead to an acquired methaemoglobinaemia (MHB) with potentially fatal consequences. There is a lack of literature on the formation of methaemoglobin (MH) in the blood after the intake of poppers (amyl nitrite). Poppers are a popular aphrodisiac agent. Case description: A 56-year-old diabetic called an ambulance after using poppers in a brothel with subsequent associated acrocyanosis, confusion and headache. The paramedics reported tachycardia and blood glucose of 3.8 mmol/l. The arterial blood gas analysis in the Emergency Department (ED) revealed a MHB of 23.1%. MH levels decreased rapidly without antidotal therapy. The patient was discharged the next day free of symptoms. Discussion: This case illustrates the potential risks of taking poppers. A wide spectrum of symptoms were present in our patient. For the differential diagnosis of acquired MHB, poppers should be considered.

Prepuce-sparing plasty and simple running suture for phimosis

Aim. Circumcision is the most common procedure for phimosis. In recent years, the value of foreskin properties as well as aesthetic reasons determined to other operations preserving the foreskin. We report 5-years experience with a technique that preserve the physical foreskin appearance intact. Patients and methods. Fifty-two patients, eligible to undergo phimosis surgery, underwent prepuce-sparing plasty and simple running suture. Evaluation of results was made with photos comparative and verified by using presence/absence of recurrence, scarring evaluation, and VAS for patient satisfaction. Results. Forty-eight patients reported no complications. There were no cases of bleeding, infection, pathological scarring, phimosis recurrence. The scar showed a good pliability and a thin thickness. Patient satisfaction was high. Conclusions. The association of prepuce-sparing plasty and simple running suture highlighted an effective and easy method for the correction of acquired phimosis in adult patients, with excellent functional and cosmetic results.

Pantoprazole-related Symptomatic Hyponatremia

Hyponatremia is the most common electrolyte balance disorder, especially in the elderly and polymedicated population. The authors report the case of an 83-year-old man with symptomatic severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) related to pantoprazole. Pantoprazole was discontinued and serum sodium levels reached normal values in two months. To the authors’ knowledge, this is the second reported case of pantoprazole-related hyponatremia and, while most patients with hyponatremia related to proton pump inhibitors have mild symptoms, this patient had severe manifestations.

Gastric and Peritoneal Involvement of Human Herpes Virus 8 Related Kaposi Sarcoma in a Patient with Acquired Immunodeficiency Syndrome

Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases in patients infected with human immunodeficiency virus (HIV). The authors report the case of a 40-year-old male with ascites, peripheral edema and peritoneal carcinomatosis secondary to a gastric KS related to human herpes virus type 8 (HHV-8). The patient had severe immunodeficiency, with a TCD4+ count of 86 cells/µl and newly diagnosed acquired immunodeficiency syndrome. His clinical condition rapidly deteriorated, with multiorgan failure, and he died without the possibility of initiating antiretroviral therapy or chemotherapy. To the authors’ knowledge, carcinomatosis is a rare feature in KS.

The Consequences of Not Looking at the Eosinophil Count: Pulmonary Infiltrates and Eosinophilia Syndrome (PIE) Probably Caused by Ciprofloxacin

Objectives: To describe a case of pulmonary infiltrates and eosinophilia (PIE syndrome) probably caused by ciprofloxacin. Materials and methods: A 64-year-old woman was admitted to our department with suspected hospital-acquired pneumonia and treated with antibiotics. She had no symptoms but had peripheral eosinophilia. She had recently been given ciprofloxacin for a urinary tract infection. Results: The patient spontaneously improved after exhaustive negative investigations. Conclusion: We concluded that this patient had PIE syndrome probably caused by ciprofloxacin.