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Background. Hypertension is an important risk factor of cardiovascular (CV) disease. An early diagnosis of target organ damage could prevent major CV events. Electrocardiography (ECG) is a valuable clinical technique, with wide availability and high specificity, used in evaluation of hypertensive patients. However, the use of ECG as a predictor tool is controversial given its low sensitivity. This study aims to characterise ECG features in a hypertensive population and identify ECG abnormalities that could predict CV events. Methods. We studied 175 hypertensive patients without previous CV events during a follow-up mean of 4.0 ± 2.20 years. ECGs and pulse wave velocity were performed in all patients. Clinical characteristics and ECG abnormalities were evaluated and compared between the patients as they presented CV events. Results. Considering the 175 patients (53.14% male), the median age was 62 years. Median systolic blood pressure was 140  mmHg and diastolic blood pressure was 78 mmHg. Median PWV was 9.8 m/s. Of the patients, 39.4% were diabetic, 78.3% had hyperlipidaemia, and 16.0% had smoking habits. ECG identified left ventricular (LV) hypertrophy in 29.71% of the patients, and a LV strain pattern was present in 9.7% of the patients. Twenty-nine patients (16.57%) had a CV event. Comparative analyses showed statistical significance for the presence of a LV strain pattern in patients with CV events ( p = 0.01 ). Univariate and multivariate analysis confirmed that a LV strain pattern was an independent predictor of CV event (HR 2.66, 95% IC 1.01–7.00). In the survival analysis, the Kaplan–Meier curve showed a worse prognosis for CV events in patients with a LV strain pattern ( p = 0.014 ). Conclusion. ECG is a useful daily method to identify end-organ damage in hypertensive patients. In our study, we also observed that it may be a valuable tool for the prediction of CV events.

The nodular primary localized cutaneous amyloidosis is rare and characterized by skin deposition of amyloid substance. There are cases of progression to invasive disease. The type of amyloid substance is not specific to this disease, also being found in primary systemic amyloidosis or systemic amyloidosis associated with multiple myeloma. The authors describe two cases of nodular primary localized cutaneous amyloidosis. A 70-year-old man underwent excision of papule on the mouth left commissure, and a 39-year-old woman with a vulva's labia majora swelling that was excised, in which the histology revealed a nodular amyloidosis, both without systemic involvement. Although the prognosis is benign, the follow-up of the patient is required for early detection of a possible evolution to systemic disease, or exclusion of an underlying systemic amyloidosis.

We present the case of a 55-year-old man with a self-limiting febrile condition associated with polyserositis with an inconclusive investigation. Bilateral pleural and pericardial effusions resolved. The peritoneal fluid loculated and was compatible with an exudate. The patient remained clinically asymptomatic. However, 2 years later, examination revealed a palpable and painless abdominal mass, which imaging suggested a cystic lesion. Surgical resection was performed and histological examination identified a mesenteric pseudocyst. Mesenteric pseudocysts are rare intra-abdominal cystic masses which are mostly benign and do not cause specific symptoms. Although imaging tests are useful for their differential diagnosis, histology is mandatory. LEARNING POINTS• Mesenteric pseudocysts are rare intra-abdominal cystic masses with a clinical presentation that sometimes is a diagnostic challenge.• Abdominal imaging used to investigate a concomitant systemic illness may reveal a fluid lesion which may delay the diagnosis.• Ultrasound, computed tomography and magnetic resonance imaging can be used for pre-operative diagnosis, but exact differentiation is only achieved through histopathological examination. KEYWORDSMesenteric pseudocyst, peritoneal fluid, abdominal cyst. CASE REPORTThe authors describe the case of a 55-year-old man, a smoker (15 pack-years) with no other previous relevant diseases who presented with a 3-week history of dyspnoea, orthopnoea and dry cough. Examination showed low grade fever (37.8°C) and bilateral decreased breath sounds. Thoracic radiography showed blunting of both costophrenic angles, and a discrete infiltrate in the inferior right pulmonary lobe. Thoracentesis revealed an effusion with exudate characteristics and with 240/mm 3 predominantly mononuclear cells. Microbiological cultures and also direct examination and cultures for tuberculosis were negative. The patient was admitted under the diagnostic hypothesis of pneumonia, and amoxicillin/clavulanic acid and azithromycin were initiated. Further echocardiographic investigation showed a discrete pericardial effusion with no other alterations. Abdominal ultrasound revealed perihepatic and perisplenic fluid. Blood tests revealed high levels of inflammatory markers but no other relevant findings. The patient was afebrile on the second day of admission and became asymptomatic with full symptomatic recovery.