Introduction Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under‐appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work‐up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized. Objectives To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases. Methods Twenty‐three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2‐3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV1/FVC<0.7, significant abnormalities in chest CT or echocardiography, and/or an established diagnosis of neuromuscular disease were among the exclusion criteria. Results and Conclusion Patients presented with reduced aerobic capacity (peak V̇O2: 79 ± 26 vs 116 ± 21 %predicted), a tachypneic breathing pattern (peak breathing frequency/tidal volume = 38.4 ± 22.7 vs 21.7 ± 14.2 breaths/min/L) and exercise‐induced inspiratory capacity reduction (‐0.17 ± 0.33 vs 0.10 ± 0.30 L) (all P < .05) compared to controls. In addition, higher ventilatory response (ΔV̇E/ΔV̇CO2 = 34.1 ± 6.7 vs 27.0 ± 2.3 L/L) and symptomatic burden (dyspnea and leg discomfort) to the imposed workload were observed in patients. Of note, pulse oximetry was similar between groups. Reduced aerobic capacity in the context of a tachypneic breathing pattern, inspiratory capacity reduction and preserved oxygen exchange during progressive exercise should raise the suspicion of inspiratory muscle weakness in subjects with otherwise unexplained breathlessness.

Malignant melanoma is the 19th leading cause of cancer worldwide. It is an aggressive neoplastic disease in which pathophysiological understanding and management has been in constant evolution in recent decades. The primary site is the skin, uvea and mucous membranes and has the capacity to metastasize to any organ. There are few reports of primary or secondary involvement of the biliary tract. We present the case of a 73-year-old woman with a bile duct lesion suggestive of cholangiocarcinoma and a final diagnosis of a single melanoma metastasis. Surgical treatment was performed due to oligometastatic stage IV melanoma with possibility of R0 resection followed by immune checkpoint therapy.

Complex reconstructions of the abdominal wall, necessary after resection of neoplasms, infection or trauma, are a challenge for the surgical team. Although ovarian carcinoma is commonly presented with peritoneal carcinomatosis and invasion of adjacent organs, it rarely can invade the abdominal wall. Invasion of the abdominal wall was documented on ultrasound and abdominal computed tomography. Surgery was discussed and performed in a multidisciplinary team and consisted of wide en bloc excision and reconstruction with open intraperitoneal onlay mesh with inorganic polypropylene-coated mesh (Bard/BD Sepramesh), a midweight macroporous mesh and abdominoplasty. Postoperative course was uneventful and the patient showed good evolution 1 year after the procedure. Our report highlights the main objectives in complex reconstructions, the importance of a multidisciplinary team and discusses the characteristics that the mesh must have in order to achieve the desired goal.