Koch’s Bacillus bovis (Mycobacterium bovis) was made avirulent by special culture conditions, i.e., 230 passages on medium containing potatoes treated with bile salts. It has been used mainly to prevent tuberculosis. The vaccine was named after the bacteriologist Albert Calmette and the veterinarian Camille Guérin, i.e., Bacillus Calmette-Guérin (BCG). These researchers worked at the Pasteur Institute in Lille and launched the vaccine in 1921.Recently, BCG was used also for its non-specific immunostimulant action. Intravesical administration of BCG is an adjunctive therapy for the treatment of bladder cancer, which does not invade the muscle wall.We will discuss the clinical case of a patient who had fever of unknown origin for about 2 months and was resistant to treatment with multiple lines of antibiotics.

A psychodynamic profile at the origin of anorexia was described. In order to provide reliability to the considerations presented, the work made use of a sample of anorexic and depressed patients compared with controls, to whom a series of statistically processed personality tests were administered. This methodology brought to light that anorexic profile originated in childhood (adverse attitudes enacted by the personality of parental figures), interpreted by the child as a refusal of her own (fat) corporeity and the tendency to process information, express emotions and affections, react and act accordingly. These traits characterize the nascent personality and become apparent in adolescence (disesteem, insecurity, immaturity, social isolation, and sexual issues). Therefore, clinical work on the personality and anorexic behavior should aim at understanding the meanings attributed to the food and the body to initiate a correction and change. Such an intervention would tend to facilitate a gradual change in the original feeling and thinking of these dimensions in anorexia.

Peritonitis is the most frequent complication of peritoneal dialysis (PD) and 3–6% of episodes have fungal origin. Candida guilliermondii is an uncommon species of Candida with invasive behavior in patients affected by severe underlying disorders or using indwelling vascular devices.Here we report the case of an 84-year-old woman undergoing outpatient PD for 4 years who had fever, chills, and diffuse increasing abdominal pain. After empiric antimicrobial therapy, based on teicoplanin in the dialytic circuit plus oral ciprofloxacin plus fluconazole, the patient was hospitalized. Afterwards, the culture from the peritoneal fluid showed the presence of C. guilliermondii.PD-related fungal peritonitis is an infrequent event, but the morbidity and mortality rates are significant. In this scenario, appropriate prevention strategies including antifungal prophylaxis during antibiotic treated bacterial peritonitis should be evaluated.

Common variable immunodeficiency (CVID) is a rare disorder characterized by primary antibody deficiency leading to hypogammaglobulinemia and increased risk of infections. Pulmonary hypertension (PH) is an unusual complication of CVID and may be associated with chronic hypoxemic respiratory failure.We described the case of a 47-year-old female patient hospitalized with worsening dyspnea, which had emerged about 10 days before and was associated with productive cough. 26 years before, she was diagnosed with common variable hypogammaglobulinemia, that was treated with intravenous immunoglobulin infusions for at least 20 years. She had suffered from recurrent secondary infections of the respiratory tract with inveterate bronchiectasis, pulmonary hypertension, and chronic respiratory failure.This case suggests that Internal Medicine wards, due to their global vision of the patient, are well suited to manage subjects with serious, complex, and genetically determined pathologies.

The psychopathological diagnosis, which is crucial in the psychological-psychiatric work, is performed through tests and interviews aimed at evaluating the cognitive processes and the patients’ behavior. Feeling-thinking-communicating-acting process is particularly important, as it characterizes patients’ evolutionary phases and allows to move closer to the diagnosis.In this study, three patients with different psychological-psychiatric pathologies are described. For each case, verbal and non-verbal communication and psycho-emotional and cognitive sequence are analyzed. After this description, psychodiagnostic test results are discussed in order to highlight signs and symptoms of considered subjects.The described method allows to “explore” psychodynamic spaces hidden by psychic defenses that prevent a clear understanding of the psychic functioning and the operative plot at the intra- and inter-personal level of the subject.

Baclofen is commonly used to treat muscular spasticity and other conditions such as pain, alcohol withdrawal, and myoclonus. It is contraindicated in chronic kidney disease. As it is eliminated predominantly by the kidneys, acute kidney injury can lead to acute baclofen overdose with central nervous system affection due to drug accumulation. Currently, there is no consensus about the treatment of baclofen intoxication.A 67-year-old woman was admitted with altered mental status and vomiting. Initially, she was unresponsive/lethargic and kept the intermittent ability of nonverbal communication gradually sliding into a comatose state with apneas. Initial neurologic and radiologic examinations ruled out a structural lesion of the central nervous system. Laboratory data showed acute kidney injury and suspected urinary tract infection with extremely high inflammation parameters. The patient had a history of multiple sclerosis and received daily oral baclofen. Baclofen-induced coma secondary to baclofen overdose caused by renal insufficiency was suspected and renal dialysis started within 24 hours. Cystoscopy and implantation of a ureteric stent were necessary because of obstructive nephropathy. During hemodialysis, the patient’s mental status steadily improved. The patient woke up and was oriented and cooperative. Both clinical and laboratory data were widely normalized within days.Diagnosis of baclofen overdose can be challenging, but adequate supportive therapy, including hemodialysis, should be considered to reduce the length of comatose state and the risk of aspiration pneumonia.

Cecal volvulus is a surgical emergency which is associated with the risk for bowel ischemia and perforation. Occasionally, volvulus can be caused by an internal hernia.We report the case of a 73-year-old woman with no prior surgical history who had abrupt onset abdominal pain, distension, bilious emesis, and obstipation. Computed tomographic imaging showed a twisted, dilated cecum within the lesser sac with the base of the volvulus at the foramen of Winslow and mass effect against a decompressed stomach. In the operating room, the patient underwent exploratory laparotomy, reduction of the cecal volvulus through the lesser sac, and right hemicolectomy with primary ileocolic anastomosis.Given the substantial morbidity and mortality risk if a closed loop obstruction is left untreated, it is of paramount importance to consider internal hernias as a potential cause to allow an early diagnosis and an urgent surgical treatment.