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Introduction. We report a case of stroke in a crack smoker with occlusion of the middle cerebral artery and a large thrombus in the carotid artery. Case Presentation. A 34-year-old female presented with left upper arm weakness, associated with paresthesia with onset of symptoms more than 24 hours before. Angio-RM sequences showed an area of ischemia, with occlusion of the M2 segment of the middle cerebral artery. Carotid ultrasound showed a soft plaque with distal end floating. Anticoagulant treatment was started, and seriated ultrasound evaluations showed its gradual dissolution. Conclusions. In atherothromboembolic stroke from carotid thrombosis, repeated ultrasound studies may be useful for either diagnosis and monitoring the efficacy of anticoagulant therapy.

Riassunto. Le dissecazioni delle arterie cervicali (DAC) sono una causa inusuale di ictus ma il loro tasso di prevalenza cresce fino al 20% nella fascia di età giovane-adulta. In molti casi le dissecazioni si associano a rare malattie connettivali come la sindrome di Ehlers-Danlos, di Marfan, la fibrodisplasia. I fattori di rischio esterni principali sono rappresentati da bruschi traumi cervicali come negli incidenti stradali o, meno frequentemente, da procedure meno cruente come la manipolazione e l'iperestensione prolungata del collo. Diversi casi di DAC sono presenti in letteratura dopo sedute chiropratiche, procedure odontoiatriche ed endoscopiche. Noi riportiamo un insolito caso di dissecazione della carotide interna di sinistra causata da iperestensione del collo occorsa dopo uno shampoo dal parrucchiere.

Background: Hepatocellular carcinoma (HCC) is among the world’s most common cancers. For over ten years, the only medical treatment for it has been the multikinase inhibitor Sorafenib. Currently, however, other first or second-line therapeutic options have also shown efficacy against HCC, such as multikinase inhibitors (Regorafenib, Lenvatinib, and Cabozantinib), a monoclonal antibody against the vascular endothelial growth factor receptor 2 (Ramucirumab), and immune-checkpoint inhibitors (Nivolumab, Pembrolizumab, Ipilimumab). Aim: The aim of this paper is to review the metabolic pathways of drugs that have been tested for the treatment of HCC and the potential influence of liver failure over those pathways. Methods: The Food and Drug Administration (FDA)’s and European Medicines Agency (EMA)’s datasheets, results from clinical trials and observational studies have been reviewed. Results: This review summarizes the current knowledge regarding targets, metabolic pathways, drug interactions, and adverse events of medical treatments for HCC in cirrhotic patients. Conclusions: The new scenario of systemic HCC therapy includes more active drugs with different metabolic pathways and different liver adverse events. Clinical and pharmacological studies providing more data on the safety of these molecules are urgently needed.

POEMS syndrome (P polyradiculoneuropathy, O organomegaly, E endocrinopathy, M clonal plasma cell disorder, and S skin changes) is a rare syndrome due to a plasma cell dyscrasia. It is characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes. Increased serum VEGF, sclerotic bone lesions, Castleman's disease, oedema, ascites, papilledema and thrombocytosis are other important clinical features. We report a case of POEMS syndrome in a 34-years old man with an unusual clinical presentation. Dyspnoea, organomegaly, and skin changes preceded the clinical manifestations of polyneuropathy. The variability of presentation of the POEMS should suggest to consider the diagnosis even in the lack of the signs of polyneuropathy.