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The aim of this work was to study the prevalence of hypocalcemia in cancer patients based on ionized calcium and, as a secondary aim, the influence that hypocalcemia may have on survival. For this retrospective study, a representative sample of all the records of low and normal ionized calcium measured in 2014 was studied. Patients under 18 years and patients from the bone marrow transplantation service were excluded. The number of patients included in this study was 471. The median patient age was 63 years (18 to 91), and 247 (52%) were female. The most represented cancers were thyroid, colorectal, and breast. Ionized calcium was in the normal range in 331 (70%) patients and low in 140 (30%). In a univariable analysis, there were no significant differences in survival at 4 years between normal (47%) and low-level (42%) ionized calcium (p = 0.192), but there were differences in gender, age, the primary site, the number of metastatic sites, and the level of albumin. In the multivariable analysis, only the primary cancer, the number of metastatic sites, and the albumin levels were associated with survival. In a multivariable analysis excluding thyroid cancer, hypocalcemia remained not associated with survival. Hypocalcemia occurs in a variety of cancer types, and it does not have an influence on survival.

Tracheobronchomalacia is defined as loss of the structural integrity of airway wall cartilaginous structures with hyperdynamic airway collapse during respiration. It is a common finding in chronic obstructive pulmonary disease (COPD) but is not always symptomatic, especially if airway narrowing is mild. Symptoms and signs develop as the severity of airway narrowing progresses. When a patient is symptomatic, a prompt study with computerized tomography and flexible bronchoscopy is mandatory for future management. We present a case of tracheobronchomalacia in a patient with COPD whose diagnosis and treatment were challenging. LEARNING POINTS Tracheobroncomalacia is a common finding in chronic obstructive pulmonary disease patients; management of the obstructive disorder is the first treatment step. When patients remain symptomatic, non-invasive positive pressure ventilation can be applied; if there is no response, a stent trial or surgical procedure should be considered. It is a challenge to identify which patients should undergo invasive intervention or surgical management.

Paget-Schröetter Syndrome, or effort thrombosis of the subclavian vein, is an uncommon condition that affects young, active, healthy individuals. It's a type of Thoracic Outlet Syndrome (TOS), consequence of compression and repetitive injury of the subclavian vein, between the first rib and the clavicle. This paper reports the case of a 27 year-old female presenting with an acutely swollen right upper limb, with no history of trauma or repeated movement of right arm, taking oral contraceptive pills and no history of venous thromboembolic disease. Duplex ultrasound evaluation confirmed right subclavian venous thrombosis with no evidence of cervical rib or other structural abnormalities, diagnosing Paget-Schröetter Syndrome. Following anticoagulation, catheter directed thrombolysis and balloon angioplasty were performed, with no success due to external compression. Therefore, after the correction of the external compression through first rib resection, the luminal flow was restored and the venous obstruction symptoms disappeared. In these case, a prompt treatment was critical for the achievement of the best results.A Síndrome de Paget-Schröetter, ou trombose de esforço da veia subclávia, é uma entidade rara que surge em indivíduos jovens e saudáveis. É enquadrado na Síndrome do Desfiladeiro Torácico: sinais e sintomas resultantes da compressão e lesão repetida da veia subclávia, entre a primeira costela e a clavícula. Relata-se o caso clínico de uma jovem de 27 anos de idade com edema agudo do membro superior direito, sem história de trauma ou movimentos repetidos do braço direito, sem antecedentes de patologia tromboembólica venosa e medicada com contraceptivo oral. O ecodoppler revelou trombose da veia subclávia direita, sem evidência de costela cervical ou outras anomalias estruturais. Após o início de hipocoagulação, foi realizada venografia, com fibrinólise fármaco-mecânica e angioplastia com balão sem sucesso, devido a compressão extrínseca. Posteriormente, foi submetida a remoção trans-axilar da primeira costela, o que permitiu restabelecimento do fluxo venoso e desaparecimento dos sintomas de compressão venosa. Neste caso, um tratamento atempado foi crucial para o sucesso terapêutico.

Light-chain deposition disease (LCDD) is a rare monoclonal gammopathy that involves the deposition of light chains (LC) in multiple organs, leading to progressive dysfunction. The kidney is usually the most affected organ and responsible for the initial clinical manifestations. We present the case of a patient with LCDD with prominent liver involvement (marked cholestasis, hepatomegaly and portal hypertension) but with no evidence of coexisting lymphoproliferative disorder. LEARNING POINTS Light-chain deposition disease (LCDD) is rare, and diagnosis can be challenging, especially in the absence of a coexistent lymphoproliferative disorder. The presence of light chains in blood or urine can be intermittent, and immunohistochemistry results of biopsy can be difficult to interpret. Hence, there is a need for a high level of suspicion in this diagnosis. Although renal involvement is the most classic presentation, LCDD should be suspected when there is multiple organ involvement, as in this case, even when renal manifestations do not dominate the clinical picture. Prognosis depends on the affected organs, and treatment should be started as rapidly as possible to suppress production of the clonal light-chain and halt organ damage.