Search results for “Case Report”

Acquired Haemophilia: A Case Report and Literature Review

Acquired haemophilia (AHA) is a rare coagulation disorder secondary to autoantibodies against coagulation factor, most commonly factor VIII with potential for life threatening bleeding episodes. We report a case of an 88-year-old female presenting with frank haematuria three weeks after catheter insertion. Her background was of Alzheimer’s Dementia, Asthma and Bullous Pemphigoid for which she was on low dose maintenance prednisolone (5mg). Laboratory tests showed haemoglobin 98g/dl and partial thromboplastin time (PTT) of 60s, with corrected prothrombin time 52s. Fibrinogen 5.39. As such coagulation factors were tested which revealed factor VIII of 0%. Her case was complicated by urinary tract sepsis, as such she was treated with oral prednisolone 60mg without immunosuppressive agent usage. A pan-CT scan revealed likely mesothelioma for which she declined further investigation. This case report will describe a rare presentation of AHA associated with bullous pemphigoid and mesothelioma, complicated by infection and frailty.

Transmural Migration of a Retained Surgical Sponge; A Case Report

Introduction A retained surgical towel in the abdomen is a serious postoperative complication and the most avoidable. Known as “gossypiboma”, it may migrate into adjoining cavities like the stomach, small bowel, colon, vagina, urinary bladder, pericardium, and urethra. Case Report A 32-year-old male presented with complaints of abdominal pain, 4 months after a laparotomy for complicated appendicitis. Initial history and presentation gave an impression of a lower urinary tract obstruction. However, symptoms progressed with signs of bowel obstruction and investigations pointed to a possible retained foreign body. This was confirmed on laparotomy with indications of a transmural migration during the period of evaluation. The report discusses the pathophysiology and manifestations of a migratory surgical gossypiboma. Conclusions A rare case of gossypiboma displaying transmural migration is reported. This showed an initially peritoneally placed sponge that migrated into the intestinal lumen with the sudden presentation of obstructive symptoms. Routine practice of the World Health Organization Surgical Safety Checklist can significantly prevent these incidents.

Conjunctival Resection for Mooren's Ulcer Refractory to Medical Therapy: A Case Report

Purpose To report a rare case of Mooren’s ulcer in a healthy young male without systemic autoimmune disease, and to highlight the effectiveness of conjunctival resection as therapy for cases unresponsive to medical management. Case report A 34-year-old immunocompetent male presented with progressive peripheral corneal ulceration in the left eye. Extensive systemic and infectious evaluations, including rheumatologic, immunologic, and microbiological testing, were unremarkable. Human leukocyte antigen genotyping was DR17(03)-negative and DQ2-positive. Rheumatological evaluation yielded no definitive systemic diagnosis. Despite immunosuppressive therapy with adjuvant medications, the epithelial defect and stromal inflammation persisted. The patient underwent conjunctival resection, resulting in marked reduction in inflammation, rapid re-epithelialization, and structural stabilization of the cornea. Histopathology of excised conjunctiva showed nonspecific inflammation without granulomatous changes, vasculitis, or neoplastic features. During follow-up, patient remained in remission with visual acuity preserved at 6/6 bilaterally and no recurrence. Conclusion Mooren’s ulcer is rare but vision-threatening. Early recognition, comprehensive evaluation, and timely surgical intervention can be vision-saving. This case highlights the role of a multidisciplinary approach and supports conjunctival resection as a useful adjunct in refractory disease. Long-term follow-up is essential.

Effectiveness of The Luo Yuan Technique in Patients with Hyperuricemia, Case Report

Significance This case report describes the alternative management of hyperuricemia through acupuncture using the Luo Yuan technique. Case presentation A 53-year-old Mexican man was diagnosed with secondary hyperuricemia. The patient began to experience arthralgia in the metatarsophalangeal joint of the first toe on his left foot after consuming a high amount of purine-rich foods, with a 10-year history. The symptoms were sporadically controlled with the use of colchicine and indarzone. In a six-element blood chemistry test, serum uric acid was 8.7 mg/dL before acupuncture treatment and 8.3 mg/dL at the end of treatment, without applying dietary restrictions on purine consumption. Conclusions and relevance This report demonstrates the potential efficacy of acupuncture at the Luo and Yuan points of the Spleen and Stomach meridians in reducing elevated blood uric acid levels. This suggests its potential as an alternative treatment for patients with hyperuricemia and other metabolic disorders.

Antibiotic-Resistant Urinary Tract Infection in a Bahamian Woman: A Case Report

Bacterial resistance to antibiotics is becoming a major public health challenge in the Bahamas. Indiscriminate use of antibiotics by medical practitioners is a major contributor to this problem. We describe a 53-year-old woman who presented with symptoms of a urinary tract infection. Empiric treatment with first- and second-line antibiotics, namely trimethoprim-sulfamethoxazole and ciprofloxacin, respectively, were ineffective in clearing the infection. After culture and sensitivity testing via minimum inhibitory concentration analysis, nitrofurantoin proved to be the only effective oral antibiotic.

Leflunomide-Induced Cystoid Macular Edema: A Rare Case Report

Introduction Cystoid macular edema (CME) is a sight-threatening condition caused by fluid accumulation in the macula due to blood-retinal barrier disruption. Various factors, including drug reactions, can lead to retinal fluid leakage. Leflunomide, a disease-modifying anti-rheumatic drug, marked significant progress in managing rheumatoid arthritis. Although effective, Leflunomide has rarely been linked to CME. This report presents a unique case of Leflunomide-induced CME, adding to the limited literature on this subject. Methods We report the case of a 75-year-old female with rheumatoid arthritis treated with Leflunomide, presenting with bilateral CME and reduced visual acuity (VA). Comprehensive ophthalmic evaluations, including VA tests, fundus examination, and optical coherence tomography, were conducted. Results The patient presented with CME and decreased VA in both eyes for several months. She had undergone cataract surgery 20 years prior and was using topical nepafenac, dorzolamide, and dexamethasone. Initial VA was OD 20/50 and OS 20/40. VA improved with treatment, but CME recurred upon discontinuation. The patient had been on Leflunomide for one year. After consulting with the Rheumatology department and considering a previous case of bilateral Leflunomide-induced CME, the drug was discontinued. CME resolved without recurrence or the need for topical treatment. At her final visit, VA was OU 20/25. Conclusion This case highlights Leflunomide as a potential, though rare, cause of CME. It emphasizes considering systemic medications in CME diagnosis. Timely discontinuation of Leflunomide may resolve CME and prevent further visual impairment. Further studies are needed to understand this rare side effect comprehensively.

Investigating The Connection Between X-Linked Dominant Hypophosphatemic Rickets Syndrome and Endodontic Periapical Lesions: A Case Report

Vitamin D deficiency is known to affect bone healing 1. In this case report, the potential link between vitamin D, calcium, and phosphorus deficiency and periapical lesions is explored, offering fresh insights into the complex relationship between systemic health and dental pathology. This pathology is caused by a mutation in the PHEX gene on chromosome X, which encodes a protein necessary for vitamin D synthesis and phosphate reabsorption, which are essential for the mineralization of bone and teeth 23. A 25-year-old man with rickets and vitamin D deficiency presented to our clinic with recurrent abscesses in multiple teeth. Radiographic imaging revealed periapical lesions on multiple teeth with advanced endo-perio lesions on teeth 26 and 16, and a negative cold test on all his teeth. Despite successful endodontic treatment, the patient’s compromised metabolic healing raised concerns about the prognosis. This case report highlights the intricate interplay between vitamin and mineral deficiencies and dental health, emphasizing the need for cautious management and long-term follow-up.

Acute Hypomagnesemia-Induced Cerebellar Down-Beat Nystagmus Syndrome Due to Benign Paroxysmal Positional Vertigo: A Case Report

Magnesium is essential for the proper functioning of all human cells and is involved in the regulation of neurotransmitter function and neurological function. Acute and chronic hypomagnesemia cause severe neurological symptoms such as neuromuscular irritability, myoclonus, stridor, dysphagia, mainly postural tremor and movement disorders along with vertical downbeat nystagmus. Here we report a case of cerebellar downbeat nystagmus syndrome induced by acute hypomagnesemia (HICS) due to very frequent vomiting in a 75-year-old woman with benign paroxysmal positional vertigo (BPPV). The clinical condition improved with daily intravenous and then oral magnesium supplementation. To our knowledge, this is the first described case of HICS induced by acute hypomagnesemia due to vomiting triggered by a benign peripheral pathology such as BPPV which was then successfully treated once the central syndrome was resolved.

Ebstein's Anomaly With Right Atrial Thrombus in 23 Years Old Man at Reference National Teaching Hospital of Ndjamena: A Case Report.

Ebstein’s anomaly is a rare congenital heart disease. It is usually associated with other congenital defects, particularly atrial septal defect/patent foramen ovale (PFO). We report here the case of Ebstein's disease revealed in a 23-year-old adult admitted for palpitations and exertional dyspnoea. He was in heart failure. The EKG showed atrial flutter . Cardiomegaly was present with a cardiothoracic index of 0.7. On echocardiography, the apical displacement of the tricuspid septal leaflet was 15 mm/m2 , the Celermajer index was Grade 3.  There was a large thrombus floating in the right atrium. While awaiting surgical management, the patient was being treated with diuretics, digitalis and anticoagulants.

Hemangioma of the Buccal Mucosa of the Cheek Presenting as a Dermoid Cyst: A Case Report

This case report presents a 73-year old Asian female with a presumed dermoid cyst in the buccal mucosa of the left cheek that was visible and embarrassing to her. Histopathology revealed the mass to be consistent with a cavernous hemangioma. Hemangiomas are benign vascular tumors of mesenchymal origin. It is usually present at birth but can develop later in life. It commonly occurs in the head and neck region, but rarely in the oral cavity.

A 5 years old female child recovered from Moyamoya Disease with Unani formulation: A Case Report

Moyamoya disease is a very rare chronic circulatory occlusive disorder of the blood vessels of the brain, in which patients complain of headache, seizure, weakness, and sometimes paralysis. A 5 years old female child with a complaint of headache and seizure was admitted elsewhere and during the treatment, she was diagnosed with Moyamoya disease. Further, she went to AIIMS Patna, where the neurosurgeon advised Digital Subtraction Angiography (DSA) and after the final diagnosis, they suggest the surgical intervention of the brain. During the search for an alternative treatment, they consulted my center for Unani treatment. We advised a semiliquid Unani polyherbal formulation containing Gule Banafsha (Viola odorata), Ustukhuddoos(Lavandula stoechas), and Nilofer (Nymphaea alba Linn) for three months. After the completion of the treatment schedule, she went for DSA again in Patna AIIMS and they find that there is no sign of occlusion in the blood vessels of the brain. The patient has no complaints and the report also showed that she gets improved. 

Delayed Vision Loss Post Assault-Induced Zygomatic Fracture Repair in a Patient with an Ipsilateral Anterior Clinoid Process Pneumatization, A Case Report

A 27-year-old male presented one week after surgical repair of his fractured left zygomatic arch, 5 weeks post-assault, complaining of persistent blurred vision in the left eye and worsening migraine headaches. Magnetic resonance images (MRI) revealed no intra-orbital pathologies or optic neuropathy but demonstrated a clearly delineated air-filled space of the left anterior clinoid process (ACP). No vision threatening pathologies were identified and surgical treatment was not recommended. His blurred vision remained at 6-month follow up. We report a case of delayed vision loss and headache post zygomatic fracture repair surgery in patient with a confirmed ipsilateral ACP pneumatization.

Non-Specific Steroid Cell Tumor of The Ovary: Case Report And Review of The Literature

Steroid cell tumors of the ovary are particularly rare, secreting sex hormones, characterized by steroid cell proliferation and represent only 0.1% of all ovarian tumors. They are classified into three subtypes according to their cell of origin: stromal luteoma, Leydig cell tumors and a third subtype of unknown lineage corresponds to a not specified steroid cell tumor (SCT-NOS). This third subtype accounts for 60% of steroid cell tumors. The clinical manifestations of SCT-NOS can take many forms, including pain, abdominal distension, but perhaps the most visible presentations are those related to hormonal activity and virilization of the tumor. We present a rare case of a 48-year-old woman with vaginal bleeding and a history of trunk obesity, hirsutism for 2 years and hypothyroidism with hormone replacement therapy. Clinical examination revealed a characteristic of obesity, virilization. Serum testosterone was 3.62 µg / L and CA-125 was 40.67. Magnetic resonance imaging identified a left ovarian solid mass and histopathology confirmed a steroid cell tumor not specific. The patient underwent exploratory laparotomy and left salpingoophorectomy. Macroscopically, the mass is well circumscribed, solid, homogeneous and yellowish. Microscopically, the tumor is mainly composed of eosinophilic or vacuolar granular cytoplasm. Immunohistochemistry showed that the tumor cells were strongly positive for inhibin. The postoperative period was uneventful. Through this rare observation, we will discuss the aspects that characterize this type of tumor and present some guidelines to be used in the differential diagnosis, as well as the difficulties encountered in the clinical, radiological and therapeutic fields.

Cutaneous Myiasis Caused by Tumbu Fly Larvae Infestation in an Infant: A Case Report

Myiasis is a parasitic infestation of the body of a mammal caused by Cordylobia Anthropophaga (Tumbu fly) larvae. The infestation is prevalent in Sub-Saharan Africa, South-East Mexico and Central America. It is usually seen among rural dwellers and has no age or sex predilection. We report a case of Tumbu fly myiasis seen in a 7month-old male living in Port Harcourt, Nigeria who was erroneously thought to have bullous impetigo.

Post-Covid-19 Acute Disseminated Encephalomyelitis (ADEM) in a 27-year-old girl: Case Report

Acute disseminated encephalomyelitis (ADEM) is a monophasic, multifocal, demyelinating, autoimmune disease that affects the central nervous system (CNS). It usually occurs after a systemic infection, usually viral, including certain coronavirus infections. A 27-year-old girl presented with complaints of left interscapular pain, paresthesias and weakness in the ipsilateral upper limb. These symptoms followed paresthesias on the fingertips of her right hand the day before her admission. she was treated two weeks earlier for pneumonia with COVID-19. Her clinical pattern resulted in a moderate weakness of the left limbs associated with tactil and algic hypoesthesia in the lower left limb ascending until the C4 level in the left side. Magnetic resonance imaging (MRI) of the brain and spinal cord showed diffuse spontaneous hypersignals on fluid-attenuated inversion recovery (FLAIR) images at the cerebral level and on T2-weighted images at the spinal level. These imaging lesions coupled with the medical history of a recent COVID-19 infection led to the diagnosis of acute disseminated encephalomyelitis (ADEM) post covid-19. The clinical condition improved rapidly with intravenous (IV) corticosteroid therapy and IV immunoglobulin combined with physiotherapy. ADEM is a demyelinating autoimmune disease which is increasingly reported during this current corona virus pandemic.

Variant Trifurcation of the Ulnar Nerve in Guyon’s Canal of the Human Wrist: Case report

During routine dissection of the right hand of a 52-year-old Asian descent male cadaver in the Department of Anatomy at Jazan University-Faculty of Medicine, we observed an anatomical variation of the ulnar nerve (UN). There was a trifurcation of the nerve in the ulnar tunnel proximal to the pisiform bone. An awareness of such variation may be of great clinical importance despite the presence of trifurcation of the ulnar nerve, which does not usually cause symptoms but becomes important in the evaluation of entrapment neuropathy and during surgical and orthopedic interventions

Clinical Case of Bilateral Mandibular Auto Transplantation for Missing Bilateral First Molars: Case Report and Review of Literature

Auto transplantation is a fast and economical option when a suitable donor tooth is available for replacement of a tooth considered impossible to treat. The purpose of this case report is to describe methods used for autotransplantation and its advantages for cases with a missing bilateral mandibular firstmolar, as compared with a dental implant, removable partial denture, and other methods of prosthesis. In the present patient who underwent auto transplantation, clinical and radiographic outcomes were considered satisfactory at one and two years postoperatively. Bone healing was observed around the roots of transplanted teeth, which showed good function. In autotransplantation cases, even when the donor tooth has complete root formation, a high success rate can be achieved when the patient is properly selected and treated. Although the chance of root resorption remains because of necrotic pulp and periodontal irritation during manipulation, auto transplantation should be considered as a good treatment modality in feasible cases. Based on the present findings, even though autotransplantation is not common in general dental practice, we consider that it offers a clinically and economically viable alternative as compared to other more complicated prosthetic and dental implant treatments. The purpose of this report is to show that auto transplantation is a superior treatment method for single molar defects as compared to other prosthetic methods, as the periodontal ligament of the patient can be used and cutting adjacent teeth is avoided. In addition, it is a treatment method that can effectively utilize a wisdom tooth.

Yasmin Induced Pulmonary Embolism: a Case Report

We evaluate a case report of Yasmin induced pulmonary embolism in order to provide reference for safety use of oral contraceptives.

Lennert Lymphoma (lymphoepithelioid lymphoma) with Extensive Necrosis: A Case Report

Lennert lymphoma (lymphoepitheloid lymphoma) is an extremely rare variant of peripheral T-cell lymphoma, not otherwise specified. Here we report a case of Lennert lymphoma diagnosed in a 57-year-old woman. She had a three-year history of waxing and waning lymphadenopathy with a rapid increase in size in the past four months before presentation. A needle biopsy and a fine needle aspiration were non-diagnostic due to extensive necrosis. The patient underwent a right neck lymph node excisional biopsy which showed the lymph node architecture was effaced by numerous and sometimes confluent clusters of epithelioid histiocytes and infiltration of small lymphocytes. Extensive necrosis was present. Immunohistochemical stains revealed a mixed population of B- and T-cells with the T-cells showing diminished T-cell markers CD3, CD5, and CD7. Flow cytometric analysis detected a small population (7% of total lymphocytes) of CD4-positive T-lymphocytes with loss of CD3, CD5, and CD7 expressions. PCR-based T-cell receptor gene rearrangement studies showed positive results (clonal peaks) in both gamma and beta genes. Stains for microorganisms were negative. The overall findings indicate Lennert lymphoma. To our knowledge, this is the first reported case of Lennert lymphoma with extensive necrosis. The patient is undergoing chemotherapy. The diagnosis of Lennert lymphoma can be challenging, particularly in cases with extensive necrosis. Our case highlights that adequate sampling is important in the investigation of patients with suspected Lennert lymphoma. A careful pathologic examination with ancillary studies including flow cytometry, immunohistochmistry, and cytogenetic and molecular studies leads to the accurate diagnosis.  

Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a recently recognized type of T-cell lymphoma that can develop following breast implants, with morphologic and immunophenotypic features indistinguishable from those of ALK-negative ALCL. Here we report a case of a 58-year-old woman with a history of subglandular silicone implants placed for bilateral breast augmentation 25 years ago, who presented with bilateral breast pain and was found to have bilateral Baker Grade III capsular contracture, and heterogenous fluid collection centered near the left third costochondral articulation, a suspicious left chest wall lesion, and left axillary lymphadenopathy on imaging. A left axillary lymph node core biopsy and an aspiration of the fluid were performed, and no malignant cells were identified. The patient underwent bilateral removal of breast implants and total capsulectomies. Microscopic examination of the capsule surrounding the left breast implant revealed large pleomorphic tumor cells in a fibrinous exudate. By immunohistochemistry, the tumor cells were found to be positive for CD3 (subset), CD4, CD7, CD30 (strong and uniform), and CD43, and negative for CD2, CD5, CD8, and ALK1, supporting the diagnosis of breast implant-associated ALCL. No lymphoma cells were identified in the right breast capsule, confirmed by CD30 stain. Breast implant-associated ALCL is a very rare disease that can develop many years after breast implant placement. Proper evaluation with breast imaging and pathologic workup is essential to confirm the diagnosis in suspected cases. Our case highlights that adequate sampling is important in the investigation of patients with suspected breast implant-associated ALCL.

A Case Report on Challenging Management of Multiple Neoplasms in Elderly

Multiple primary malignancies especially in the head and neck region is no longer a rare occurrence and the prevalence is increasing. They were described as synchronous when the malignancies present within 6 months of another or metachronous tumors if the subsequent malignancy presents 6 months later. Many etiologies had been hypothesised including similar carcinogens exposure, genetic susceptibility and mutation, immunodeficiency or treatment of the index tumor. Among the hypotheses, the most accepted theory was field cancerisation in which the occurrence of multiple primaries in the aerodigestive tract was due to persistent exposure of similar carcinogens through inhalation or oral intake . However the co-incidence of thyroid and aerodigestive malignancies is relatively low. Hereby we would like to report a case of a 74 years old lady with known esophageal squamous cell carcinoma presented with metachronous laryngeal squamous cell carcinoma and papillary micro carcinoma of thyroid.

Sudden Death Due to Spontaneous Rupture of the Urinary Bladder following Acute Alcohol Inebriation- A Case report and Review of Literature

Spontaneous rupture of the urinary bladder (SRUB) is a rare clinical condition. Prompt diagnosis is often difficult both clinically and radiologically and necessitates a high index of suspicion as the patients present with non-specific abdominal pain and may not offer a clear history. The depressant effect of alcohol further complicates the diagnosis. We report a case of a young male who was unable to seek medical support and was found dead within 12 hours of the onset of abdominal discomfort following acute alcohol intoxication. At autopsy, rupture of the urinary bladder with blood and blood clots was found in the pelvic cavity with no any corresponding external injury. Spontaneous rupture of the urinary bladder is a rare cause of death in acute alcohol intoxication. In order to further understand this rare condition, the review of related literature has been done.

Use of Fluoride and Silver Ion Compounds in Three International School Based Oral Health Programs – A Case Report

Untreated dental caries in children is one of the most common diseases and largest public health problems in the world. A novel caries management program, using 50% silver nitrate, 38% silver diamine fluoride, and 5% sodium fluoride varnish, was developed at Shoreview Dental, LLC, a private dental practice in Oregon USA, and then introduced into schools in Ecuador, Ghana, and Bolivia. Cavitated carious lesions were treated with 50% silver nitrate, followed by covering with 5% sodium fluoride varnish, three times over two weeks for 165 children in Ecuador at initial assessment, 3 months, and 6 months. This protocol was repeated for 271 children in Ghana at initial assessment and 12 months. In Bolivia, 130 children were treated with 38% silver diamine fluoride, followed by covering with 5% sodium fluoride varnish, once per visit at initial assessment, 6, 12, 18, 24, 30, and 36 months. The percentage of children with active cavitated carious lesions at initial evaluation was 92.7% (Ecuador), 55.4% (Ghana), and 92.3% (Bolivia). The final arrest rate of treated surfaces was 98.8% (Ecuador), 67.6% (Ghana), and 90.2% (Bolivia). Effectiveness of cavitated caries lesion arrest is increased when it is thoroughly cleaned and dried before the treatment protocol. Further optimization is obtained when this protocol is repeated multiple times.

Glandular and Cystic Bladder Cystitis: Case Report and Review of the Literature

Glandular-cystic bladder cystitis is a rare, benign non-tumor condition, preferentially located on the area of the bladder trigone and can simulate a malignant tumor. It is a benign reactive metaplasia of the bladder submucosa, characterized by hyperplasia of the islets of Von Brunn and cystic. It is classified among reactive epithelial anomalies of the urothelium, such as islet hyperplasia of Von Brünn, cystitis, glandular cystitis, nephrogenic metaplasia and epidermoid metaplasia. It presents a clinical diagnostic challenge having the expression of a simple recurrent cystitis and misleading the radiological diagnosis evoking a malignant tumor of the bladder. Its certainty diagnosis is histological. We report the case of a 38-year-old young man who consulted for recurrent cystitis. The CT scan showed a vegetative tissue structure of the middle and left medial vesical floor, sawtooth 3 cm long axis suspecting a tumor of the bladder. The patient underwent transurethral resection of the bladder lesion. The histological and immunohistochemical examination concluded with glandular and cystic cystitis (minor form). In the light of this observation, we will discuss the diagnostic difficulties, the pathophysiological mechanisms, the radiological aspects, the anatomopathological, therapeutic features and the prognosis of this rare condition. The literature regarding this entity has been reviewed and the differential diagnosis was discussed.

Management of Plastıc Bronchıtıs in Chıldren: A Case Report and Lıterature Revıew

Plastic bronchitis (PB) is a rare disease characterized by the presence of mucofibrinous plugs which may occlude and conform the shape of tracheobronchial tree. These casts are exteremely cohesive. Most common presenting symptoms include cough, fever and dyspnea and if the cohesive casts occlude the airway totally life-threatening complications and even death may occur. The aim of treatment is to remove the casts and adress the symptoms. In this study a 6-year-old boy with PB is presented. In addition to medical treatment obstructing casts were removed via rigid bronchoscope. It is aimed to review the clinical and radiographic features and choices of treatment in this disease.

Ramsay Hunt Syndrome. A Case Report

This case report describes facial nerve palsy due to Ramsay Hunt syndrome, highlighting otic vesicles, audiovestibular symptoms, and imaging considerations. Management with antivirals, corticosteroids, and supportive care is summarized. Early recognition can improve outcomes and limit sequelae.

Pure Small Cell Carcinoma of Prostate in a Patient Presenting with Acute Urinary Retention: A Rare Case Report

Small cell carcinoma of the prostate is a rare and highly aggressive subtype of prostate cancers. In this case report, we evaluated a patient applied our outpatient clinic with acute urinary retention, whose pathology reported as pure small cell carcinoma of the prostate. A 73-year-old male patient was admitted to our outpatient clinic with acute urinary retention. Digital rectal examination was normal. The PSA value was 1.81 ng/dl. Prostate size was 101 cc. Open prostatectomy was performed. The pathology of the patient was reported as pure small cell prostate carcinoma. Four cycles of etoposide and cisplatin chemotherapy were administered to the patient. The patient died 13 months later after the first diagnosis. We evaluated the pathological and clinical findings of small cell carcinoma of the prostate.

Sustained Clinical Response of Pseudotumoral Lesion of the Central Nervous System in Behcet's Disease After Treatment with Infliximab. Case Report.

This case documents a pseudotumoral CNS lesion in Behcet's disease with sustained response to infliximab therapy. Clinical evolution, neuroimaging changes, and rationale for TNF‑alpha inhibition are detailed. The report supports considering biologic therapy for refractory neuro‑Behcet manifestations under specialist guidance.

Bilateral Radial Club Hands at the Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Case Report.

Radial Club Hand (RCH) is a rare and complex congenital disorder of the pre-axial border of the upper extremity. It is a congenital longitudinal radial ray deficiency which presents as radial deviation of the hand and distal forearm in the shape of a golf club 12. Radial ray deficiency (the most common type of longitudinal failure of formation) is a spectrum of malformations affecting the structures of the radial side of the forearm, including hypoplasia of the bones, joints, muscles, tendons, ligaments, nerves and blood vessels. The thumb dysfunction, wrist instability and short upper extremity that accompany this condition can cause significant functional impairment particularly in patients with bilateral involvement. Thus, the performance of activities of daily living such as accomplishing personal hygiene, fastening buttons and zippers becomes challenging 3.

Severe Infantile Blount’s Disease in Kumasi, Ghana: A Case Report

Blount’s disease, also known as tibia vara, is a developmental disorder involving the posteromedial proximal tibial physis resulting in progressive varus, procurvatum and internal torsion of the affected tibia 1. The condition was first published by Blount in 1973 2. The aetiology of this disease is unkown. However, associations exist between blount’s disease and the Afro-Caribbean race, early age of walking and obesity 34. Furthermore, genetic predisposition has been postulated as well as mechanical loading of the physis 456. Affected children are usually overweight and start walking early. It is bilateral in 80% of cases 7.

A Case Report of Inverting Papilloma of Lacrimal Sac

Purpose To report a rare case of Inverting Papilloma originating from the Lacrimal Sac in Tertiary Hospital. Method Case report. Results Inverting papilloma is uncommon in lacrimal sac. More often presents in Maxillary sinus, Ethmoid sinus and lateral wall of nasal cavity. This case of 69 years old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Other ophthalmologic examinations were unremarkable at that time of examination. Orbital CT-scan revealed: Heterogenously enhancing mass extending to ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed Inverting papilloma. Combined surgical management of anterior Maxillectomy via lateral Rhinotomy approach and Dacryocystectomy was done. Intraoperatively, there was note of adhesions to bone in the area of the Lacrimal Sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement. Conclusions This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via Lateral Rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the Lacrimal Sac area was confirmed by intraoperative findings which correlated with CT- scan findings.

A Meningeal Syndrome Revealing A Tetanus in A Togolese: Case Report and Review of the Literature

Although it is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa. Because of its rarity, this disease poses two problems for doctors of the 21st century: to make early diagnosis in order to refer patients to appropriate care structures, and to continue to ensure correct prevention of an affection that few current doctors have met. In it generalized form, the diagnosis of tetanus is easy, but when the beginning is localized, tetanus can be change with other diseases leading to a diagnostic wandering and a delay of adequate management. We report a case of tetanus in an 18-year-old male, who was received for neck pain and stiffness of the neck with a positive Kernig sign associated to fever since 48 hours. Initially treated for meningitis, the patient will develop at day 3 of hospitalization, the signs of generalized tetanus which led to evoked the diagnosis of tetanus. This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. After using tetanus serum and vaccination with antibiotics (Metronidazole and Penicillin) and Diazepam in association with stripping of the wound under the foot, the patient was improved. This case illustrates that any neurological sign with the first trismus must evoke until proof of the contrary, a tetanus especially in case of association with a wound even if the immunization schedule is up to date.

An Inherited Balanced Translocation Between Chromosomes 4 and 6 in Recurrent Pregnancy Loss: A Case Report

Recurrent pregnancy loss is an important reproductive issue with a heterogeneous etiology where two or more consecutive abortions occur before 20 weeks of gestation. Approximately 15% of all clinically recognized pregnancies result in miscarriage with an incidence of 1 in 300 cases. Couples, who experience repeated pregnancy loss before three months of gestation, mostly have fetuses with chromosomal aneuploids. A non-consanguineous couple with a married life of 4 years was referred to the Institute with a clinical history of three first trimester abortions. Karyotype analysis revealed a balanced autosomal translocation between chromosomes 4 and 6 with 46, XX, t (4;6)(q35; q22) karyotype in the female and normal 46, XY in the male partner. Therefore, the siblings and the couple were suggested for extended genetic counseling. Interestingly, similar translocation was seen in her father and three sisters, whereas her mother and elder sister showed a normal chromosomal constitution, indicating the paternal inheritance.

Lenalidomide-Induced High Grade Fever in a Patient with Multiple Myeloma: A Case Report

Lenalidomide is a second generation immunomodulatory agent and a potent analogue of thalidomide that is FDA approved mainly for the treatment of multiple myeloma (MM) and transfusion-dependent anemia due to low or intermediate-1- risk myelodysplastic syndromes (MDS) associated with 5q deletion among other indications. Through its action on the immune system, lenalidomide alters the production of different cytokines ultimately resulting in immune activation against tumors. This immune activation may lead to collateral immune toxicities like fever, angioedema, Stevens-Johnson syndrome, tumor flare and others. Here we report a case of lenalidomide-induced high grade fever in a patient with MM and we summarize the literature about the physiology of such reaction and how to mitigate this adverse event.

Reduction of Side Effects by Segmented Electrodes in Case of Subthalamic Nucleus Deep Brain Stimulation in Parkinson Disease: A Case Report.

Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.

Implant Anchorage in Orthodontic Retrusion: A Case Report

Mini screws represent a new treatment modality in orthodontic biomechanics. They provide absolute anchorage, no secondary movements and reduced orthodontic treatment time. Futhermore, the surgical procedure for mini implants placement is quite simple and this type of treatment requires no patient compliance. We selected a clinical case in order to emphasize one of the most important indications of the mini implants: retrusion of the upper incisors for a incresed overjet case in a young patient. Two mini implants were placed in order to obtain the correction of the overjet and the retrusion of the anterior teeth. The retrusion was obtained in a reduced period of time using retraction devices on crimpable hooks.

Melanoma of the Breast with Smoothened (SMO) Mutation: Case Report and review of the Literature

We report the case of a 75 year-old female with past history of ampullary adenocarcinoma presenting with a rapidly enlarging breast mass, initially misclassified on fine needle aspiration as a probable sarcoma, which was ultimately diagnosed as melanoma on resection in the absence of a known cutaneous primary lesion. Next-generation sequencing (NGS) of the tumor revealed a mutation in the Smoothened oncogene (SMO) of unknown significance and wild-type BRAF. To our knowledge, SMO mutation in melanoma of any site has not been previously reported, though the effectiveness of SMO inhibitors has been studied in both in vivo and in vitro models of melanoma. Currently, these inhibitors have not been studied in SMO mutant melanoma. The patient declined further therapy after resection due to multiple comorbidities. She expired two years after presenting with the breast mass from complications of high grade urothelial carcinoma.

A Rare Variant of the Stafne Bone Cavity Localized to the Subcondylar Region of the Mandible: A Case Report with Review of the Literature

An anatomical variant of the Stafne bone cavity (SBC) located in the right subcondylar region of the mandible is presented. Such an occurrence of the SBC in this region near the parotid gland is considered rare and poses a diagnostic challenge for the dentist and radiologist. Knowledge of head and neck clinical anatomy and imaging studies such as plain film panoramic radiographs and cone beam CT scans can assist the clinician in arriving at a correct definitive diagnosis without surgical intervention.

Treatment of a Severe Pediatric Lyell Syndrome with Amniotic Membrane: Case Report and Histological Findings

Background: Lyell Syndrome (TEN, Toxic epidermal necrolysis) represents a medical emergency particularly in pediatric patients in whom the massive skin damage can quickly lead to multi-organ dysfunction and death. Prompt restoration of the physiologic mucosal/cutaneous barrier is mandatory. The use of amniotic membranes has been described in the treatment of ophthalmic Lyell Syndrome, but its use has not yet been adopted for the management of larger cutaneous wounds. Study Hypothesis: Here we report the use of amniotic membranes in a pediatric case of severe Lyell Syndrome with complete skin surface, ocular and mucosal involvement with life threating presentation. Methods: A 7-year old female was admitted to our Burn Centre for severe cutaneous/mucosal exfoliation (100% Total body surface area, TBSA) as a result of an adverse reaction to ibuprofen administration. Supportive fluid administration, cardiac-pulmonary assistance and pain management were complemented by serial grafting of amniotic membranes on all affected areas to provide coverage of the exfoliated skin/mucosa. Biopsies were obtained to monitor histological skin changes. Results: The patient showed an excellent response to amniotic membrane treatment, with rapid restoration of mucosal and cutaneous layers in the grafted areas. This resulted in a decreased need for dressing changes, avoidance of additional surgeries and a reduced dependence on supportive therapy. Lower pain levels than usually expected led to a reduced need for narcotic pain medications and allowed for early physical rehabilitation and a short hospital stay. Histology confirmed evidence of topical immune-modulation in treated areas (reduction of inflammatory infiltrate). Conclusion: As we tested in numerously TEN and burn pediatric injuries Amniotic membranes with their regenerative and immune-modulatory effects may represent an life saving treatment even in the worst cases of pediatric Lyell syndrome.

Intestinal Malrotation in a Suspected Celiac Disease Patient: A Case Report

Intestinal malrotation is the incomplete rotation of the midgut during embryogenesis. The reported prevalence is 1 in 500 live births, however some studies report a prevalence as high as 1% of the population1, 2. Traditionally it is though as a disease of the pediatric population presenting as bilious emesis during the first year of life but can present with different symptoms even in adulthood. Presentation in older populations tends to be atypical, chronic abdominal pain, nausea and diarrhea being the most commonly reported symptoms 3. However, as these symptoms accompany almost all-gastrointestinal pathology it is difficult to determine if abnormalities of rotation and fixation of the intestine are the cause for the symptoms in a given patient given its relative rarity. It therefore is important to have a high index of suspicion in patients with non-specific gastrointestinal symptoms. We report laparoscopic management of a patient with abnormal rotation/fixation who was treated for many years as celiac disease (CD). Celiac disease is an immune mediated systemic disorder elicited by gluten in genetically susceptible individuals4. It can present as chronic abdominal pain, chronic diarrhea, failure to thrive, weight loss, stunted growth, distention and fatigue. His symptoms immediately resolved after surgery.

Management of Arthrofibrosis of the Knee after an Arthroscopic Meniscectomy with Paralytic Shellfish Poisoning Toxin. Case Report.

Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.

Multidisciplinary Dentistry - Ceramic Laminate Veneers for Orthodontic Finalization - Clinical Case Report

Currently, patients seeking dental treatment are increasingly concerned with the esthetics. Accordingly, the professional must be able to indicate treatment approaches that often include more than one specialty. This concept of integrated dentistry allows achieving excellence in results, which may not be reached one single Dentistry specialty. In addition, the multidisciplinary dentistry enables the solution of cases more conservatively, especially cases where aesthetics is a relevant factor. This study aimed to report a clinical case showing esthetic disharmony of the anterior teeth even after the ending of the orthodontic treatment, causing dissatisfaction for both the patient and the dentist. From a functional point of view, the occlusion was adequate. However, the esthetics prevented a satisfactory outcome. To solve this issue, the case was treated through minimally-invasive ceramic laminates, then reaching the expected result.

Metabolic Correction Therapy as Adjuvant Treatment for Breast Cancer Patients: A Case Report

Breast cancer is the most common cancer in women worldwide. In the United States, is the second leading cause of cancer deaths in women. In Puerto Rico between 2008 and 2012, breast cancer was the most diagnosed type of cancer and the leading cause of cancer deaths among women. This is a case of 54 years old female diagnosed with stage IV right breast carcinoma. The patient complaints were weakness and a right breast ulcer. She started a metabolic correction therapy, which consisted of high intravenous vitamin C infusions, a nutritional supplementation plan, and Paleolithic diet. During treatment, both Glycohemoglobin and Carcinoembryonic Antigen levels decreased significantly, the right breast ulcer decreased in size, and the patient’s quality of life improved. Over the years, vitamin C studies have demonstrated a cytotoxic action against malignant cells. Based on the results from this case, we advocate continue studying possible adjuvant treatments for cancer patients, involving IV infusions of vitamin C and metabolic correction plans.

Giant Ileal Conduit Stone: Feasibility of Endoscopic Lithotripsy: A Case Report and Review of Literature

Ileal conduit has been considered the urinary diversion of choice following radical cystectomy although orthotopic bladder substitution is gaining popularity. Urinary diversions are associated with complications including stone formation in up to 54%. We report the management of the largest ileal conduit stone reported in the literature.

Pericentric Inversion in Chromosome 10 in a Girl, Inherited from a Phenotypically Normal Mother: Case Report and Literature Review

Pericentric inversions in chromosome 10 are regarded as both common and rare conditions, based on breakage and rearrangement within each specific segment. We present phenotypic and cytogenetic characterizations of a rare recombinant chromosome 10, namely inv(10)(p11q26), in a 13-month-old flabby girl associated with a maternal pericentric inversion. A review of the literature on the different aspects of this condition is also provided.

Delayed Diagnosis of Glioblastoma due to Recent Ruptured Aneurysm. A Case Report.

Rupture of an intracranial aneurysm may cover for a long time clinical and radiological signs of a coexistent tumor. We report the delayed diagnosis of glioblastoma in a 65-years old female with recent history of subarachnoid hemorrhage. In the literature are described few similar cases: we briefly discuss the management in the rare occurrence of a double neurosurgical disease.

Live Pregnancy in Non Communicating Horn of Unicornuate Uterus with Placenta Percreta: A Case Report and Review

Objective: Mullerian anomalies of the female genital tract are rare and unicornuate uterus is one such variant: it may present with a rudimentary horn with or without a communication. Pregnancy is rare in a non communicating horn and majority of them end up in rupture during first trimester. The ones which progress to fetal viability are around 10 % and may end up in catastrophic hemorrhage with fetal loss at any time. Case report: We hereby report a rare case of unruptured rudimentary horn pregnancy associated with placenta accreta and delivery of a live born fetus at 34 weeks period of gestation. Around ten cases of such an association have been reported in the past. Conclusion: Diagnosis of pregnancy in a non communicating horn of a unicornuate uterus is challenging especially at term. High index of suspicion and timely delivery of a live fetus has major role in achieving best maternal and neonatal outcome.

Myasthenia and Antisynthetase Antibody Syndrome: A Case Report in Togo

Myasthenia is a rare neurological condition with risk of death in case of inappropriate management. The outcome of this pathology is very bad in developing countries with inadequate technical Platform. We underlined the main difficulties of diagnostic and the management of Myasthenie and antisynthetase antibody syndrome in a 44 years-old Togolese man.

Atypical Patterns of Constrictive Pericarditis after Heart Transplantation: A Case Report

Constrictive pericarditis (CP) represents a rare complication after heart transplantation (HTx), resulting from various postoperative events such as mediastinitis, pericardial effusion, or allograft rejection. We describe our recent experience with managing an HTx recipient who developed atypical patterns of CP predominantly involving the right ventricle. A 52-year-old male who had received heart transplantation 2.5 years before was admitted to our institution because of progressive symptoms of heart failure. The patient had experienced acute rejection twice post-HTx, both with International Society for Heart and Lung Transplantation grade 1R, undergoing an additional endomyocardial biopsy other than those performed during regular check-ups. On admission, echocardiography revealed paradoxical septal motion and a large cystic-like mass with a thick capsule in front of the right ventricle. Right heart catheterization revealed elevation of right atrial pressure, with severely reduced cardiac index. Magnetic resonance imaging revealed both seroma and a thick cystic-like capsule tightly adhered to the right ventricle. CP was suspected despite the atypical patterns of presentation. Seroma was removed through exploratory lateral thoracotomy, without improvement in symptoms, which was only achieved via subsequent pericardiectomy involving resection of the thickened parietal pericardium, removal of effusion fluid, and further excision of diffusely thickened visceral pericardium and epicardium. The patient is currently recovering uneventfully. The possibility of CP after HTx should be considered despite the rarity of this condition and HTx recipients should be closely monitored using various imaging modalities because CP typically demonstrates non-specific symptoms and physical findings of heart failure, with high mortality.

Non-Syndromic Multiple Keratocystic Odontogenic Tumor: A Case Report

A Keratocystic Odontogenic Tumor (KCOT) is a benign odontogenic lesion that is well-known for its histopathological features and invasive clinical behaviors. KCOTs may be non-syndromic or syndromic, and the syndromic type presents a higher risk of recurrence and invasive behaviors. Non-syndromic KCOTs are uncommon and account for only 5% of the cases. The purpose of the present case report is to conduct clinical, radiographic and pathologic evaluations and treat a 37-year-old man with non-syndromic nevoid basal cell carcinoma. Syndromic and non-syndromic keratocysts present more invasive behaviors than the solitary type. The initial symptoms of syndromic keratocysts appear as multiple keratocysts of the mandible and maxilla that are diagnosed by a dentist; as a result, the diagnosis and treatment of the disease is very crucial.

Flapless Root Resection of Both Maxillary First Molars’ Distobuccal Root: Case Report

Background: Furcation involvement is characterized by periodontal disease invading furcation regions of multi-rooted teeth. Treatment modalities are scaling and root planning and surgical management such as osteoplasty or ostectomy, odontoplasty, bicuspidization, root resection and hemisection. Periodontally compromised maxillary molars generally have poor prognosis because of inter radicular loss of attachment, and difficulty in access and treatment. Root resection is procedure by which one or more of the roots of a tooth are removed at level of furcation while leaving crown and the remaining roots in function. Case: A 58 year-old female patient applied to Periodontology clinic with complaints of sensibility and gingival recession in teeth number 16 and 26. Both teeth were completely exposed due to severe attachment loss in distobuccal root. There was also second degree mobility on the right molar and third degree mobility on the left molar teeth. Flapless root resection were planned after root canal therapy. After local anesthesia, distobucal roots were resected by high speed rotary motor with adequate irrigation at the level of the furcation roof. A small cavity was prepared and retrograded with glass ionomer cement. A platelet-rich fibrin membrane was obtained from patient’s blood and stitched to the distal surface of right first molar. Left first molar area was left uncovered. Recovery was followed on 2nd, 8th week and 6th month. When healing was compared between left and right sides, no mobility was observed and a slight redness and swelling was observed on the right side at 2nd week. At 8th week, there was no difference in clinical appearance. At 6th month, all complaints of the patient were gone and prognosis of the teeth was good.

Hearing Loss Induced for Pesticides in a Rural Worker: A Case Report

The use of pesticides by agricultural workers without protection can damage the hearing. This report describes the characteristics of work with pesticides, and compares the results of high-frequency audiometry over 36 months.

Surgical Managment of Intracranial Invasive Aspergillosis in Immunocompetent Patients: Results from 3 Case Reports

Cerebral aspergillosis is a severe disease most commonly suspected in immunodeficient patients. The objective of this study is to determine the role of surgery in management of intracranial aspergillosis. We report three cases of immunocompetent patients presenting: posteriror fossa aspergillosis, sphenoidal extended to sellar region aspergillosis and post operative aspergillosis without extracerebral involvement. Microbiology and histological examination were carried out to provide the diagnosis. The patients underwent surgical procedure associated with medical treatment or not. In one case, surgical treatment was efficient. The outcome was good in two cases. Conclusion: Rapid diagnosis of invasive aspergillosis applying radiological and surgical procedures and immediate ignition of antifungal can be life saving.

Immune Thrombocytopenia after Allogeneic Stem Cell Transplantation: Case Report and Brief Overview of Treatment Strategies

Immune thrombocytopenia (ITP) is a rare but well-recognized post-allogeneic hematopoietic stem cell transplant (HSCT) autoimmune complication for which a standard treatment approach is lacking. Herein we report on an adult patient affected by high-risk acute myeloid leukemia (AML) who developed a post-HSCT ITP. Due to the refractoriness to first-line therapies the patient underwent the thrombopoietin (TPO) mimetic Eltrombopag obtaining the ITP resolution. We also discuss the clinical course of ITP in post-HSCT setting and pros and cons of different therapeutic strategies, focusing on the emerging role of TPO mimetics.

Peripheral Cemento Ossifying Fibroma – A Case Report

Introduction: Cemento-ossifying fibroma is is a reactive lesion arising from the soft tissues (gingiva). Case report: A 13-year-old boy presented with the complaint of lump in mandibular right posterior region on the lingual side since a month. The patient presented no symptoms and had no medical history of interest. The lesion was excised and submitted for histopathological evaluation, which gave a diagnosis of peripheral cemento-ossifying fibroma. Discussion: Periheral Cemento-ossifying fibromas are slow-growing lesions, and are more frequent in women between the second and third decades of life. Although the underlying cause is not known, there have been reports of the lesion developing after irritation/ trauma in the concerned area. Due to the good delimitation of the tumor, surgical removal and curettage is the treatment of choice.

Oral Ellis-Van Creveld Syndrome: A Brief Review of Literature and A Case Report

EVC syndrome is a rare autosomal recessive genetic syndrome which its exact prevalence is unknown. The main manifestations of EVC include condro-ectodermal dysplasia, polydactyly, congenital heart defects and tooth and nail hypoplasia, and the survival rate of patients depends on the heart disease. EVC should be differentiated from other chondrodystrophia such as Achondroplasia and Jeune syndrome. Few cases of this syndrome have been reported in dental literature. This article is a brief review about the main orofacial features of EVC and reported all Prosthodontics and Restorative treatment of a 7-year-old girl that was born in prone family to EVC and presenting typical features of this syndrome.

Broken Endodontic Instrument Caused Inferior Alveolar Nerve Paraesthesia: A Case Report.

A healthy 55-year-old man was referred to the Department of Endodontics, Oral and Dental Healthy Hospital, Eskişehir suffering from pain and paraesthesia in the left lower lip and chin.A panoramic radiograph revealed the presence of broken endodontic instrument beyond the apex of the mandibular left third molar. A cone beam computed tomography (CBCT) examination was undertaken, which revealed that the broken instrument was inside the mandibular canal. Damage to the inferior alveolar nerve (IAN) secondary to extrusion of a broken endodontic instrument was diagnosed. Extraction of the tooth was decided and the patient was prescribed with 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone. The complete resolution of the paraesthesia and the control of pain achieved in the present case suggest that surgical removal of broken endodontic instrument extruded into the mandibular canal with the use of prednisone and pregabalin is a good option in the management of inferior alveolar nerve injury.

Reversible Cerebral Lession and Irreversible Cerebral Necrosis After Cardiorespiratory Arrest: A Case Report

This case contrasts reversible cerebral lesions with areas of irreversible necrosis following cardiorespiratory arrest. The authors discuss imaging evolution, mechanisms of hypoxic–ischemic injury, and implications for prognostication and rehabilitation.

Multiple Cerebral, Calcified and Infected Hydatid Cysts Case Report and Literature Review

Calcified and Infected Hydatid Cysts Case Report and Literature Review

Reconstruction of Severely Atrophic Pre-Maxilla Using Rhbmp-2 and Titanium Mesh for Dental Implants: A Case Report.

This case report details reconstruction of a severely atrophic pre‑maxilla using rhBMP‑2 and a titanium mesh framework. Surgical technique, graft outcomes, and implant rehabilitation are described, with notes on indications and complications.

Bullous Pemphigoid Triggered by Artificial Hip Made of Titanium Alloy: A Case Report and Review of Triggers for Bullous Pemphigoid

Bullous pemphigoid (BP) is one of the most common autoimmune blistering diseases. Here, we report an old woman presented with a 2-month history of bullous lesions located just over the skin of the right thigh and buttock where the orthopedics operation was performed using artificial hip made of titanium alloy and a twenty days history of similar lesions involving the rest of the body gradually.

Pregnancy with Maternal Caroli’s Disease - Case Report

A maternal case of Caroli’s disease in pregnancy is described, with attention to diagnostic imaging, obstetric management, and maternal–fetal risks.

Syndrome of inappropriate antidiuretic hormone secretion in a patient with a Nodular Lymphocyte-Predominant Hodgkin Lymphoma. A case report and review of literature

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a known side effect of several oncology drugs, but it is rarely seen secondary to vinblastine with only a few cases reported worldwide. Herein we present a patient with nodular lymphocyte-predominant Hodgkin disease that developed a severe acute hyponatremia seven days after her first cycle of chemotherapy with R-ABVD. After fluid restriction, symptoms and concentration of blood sodium were restored. After a comprehensive review of the literature vinblastine was thought to be the cause and avoided in the second infusion of chemotherapy without recurrence of the SIADH.

RETRACTED: In-Stent Thrombosis in the Middle Cerebral Artery (MCA): A Case Report

This article has been retracted on November 20, 2015. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2470-5020.jnrt-25-5846) In-stent thrombosis (IST) is a complication of angioplasty and stenting, especially in the vessels with smaller diameter. We present a case of subacute IST after stenting treatment of an isolated higher stenosis of the right middle cerebral artery (MCA). Analysis of clinical features and emergent brain image helped to indicate the pathophysiological mechanism underlining the symptoms of this patient. Emergent Transcranial Doppler (TCD) helped to evaluate the compensatory collateral circulation and provided good supporting evidence in deducing the mechanism of IST. Slightly larger size of the implanted stent that caused dissection or vascular endothelium injury was presumed in this patient. Persistent evidence of inflammatory factors might also contribute to IST in this patient.

Retraction Note: In-Stent Thrombosis in the Middle Cerebral Artery (MCA): A Case Report

Unusual cutaneous toxicity after prolonged use of Hydroxyurea in polycythemia vera: a case report

Hydroxyurea (HU) is commonly used for the long-term treatment of patients with chronic myeloproliferative neoplasms. The drug is usually well tolerated in the large majority of subjects, although systemic and/or localized toxicities have seldom been reported. Here we report a case of unusual cutaneous toxicity due long-term use of HU in a patient with polycythemia vera.

An Extremely Rare Case of Thoracic Intramedullary Melanocytoma: Case Report and Review of Literature

Melanocytoma is a rare benign lesion arising from leptomeningeal melanocytes. Meningeal melanocytomas are commonly seen in the thoracic region of the spinal canal and may also arise in the cervical or lumbar region, most often located in the intradural extramedullary compartment 1. To our knowledge, only 21 cases of intramedullary melanocytomas have been reported in the literature to date. The authors present a rare case of thoracic intramedullary melanocytoma and the review of the literature pointing out the role of diagnosis, surgical treatment and follow-up.

Sotos Syndrome, Isolated Left Ventricular Non Compaction Cardiomyopathy and Ventricular Pre Excitation: A Case Report.

We report the case of a 22 year-old-male patient affected by Sotos syndrome was preoperatively and urgently evaluated for tracheal stent implantation due to respiratory insufficiency caused by idiopathic tracheal stenosis. Rest electrocardiogram detected a ventricular pre excitation; a transthoracic echocardiography showed a classic pattern fulfilling criteria for isolated left ventricular non compaction. At the best of our knowledge this is the first report of a patient suffering from Sotos syndrome and simultaneously affected by isolated left ventricular non compaction and ventricular pre excitation.

Rhabdomyolysis in a HIV-infected Patient Following the Addition of Raltegravir, A Case Report with Review of the Literature

Antiretrovirals have traditionally been associated with much toxicity. Newer antiretrovirals are considered much less toxic relative to older antiretrovirals. Upon its FDA-approval in 2009, raltegravir’s adverse drug reaction profile was found to be similar to placebo. However, recently there have been reports of increased creatine kinase and rhabdomyolysis following the initiation of raltegravir. We describe a 52-year-old, African-American man who developed rhabdomyolysis after starting raltegravir for HIV. Rhabdomyolysis resolved upon discontinuation of raltegravir. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6). Although raltegravir is a well-tolerated antiretroviral, clinicians should be aware of the possibility of rhabdomyolysis when prescribing this medication.

Apical Hypertrophic Cardiomyopathy and Multiple Coronary Artery-Left Ventricular Fistulas: A Case Report.

We describe a rare case of multiple coronary artery-left ventricular fistulas associated with apical hypertrophic cardiomyopathy in a 62 year asymptomatic old male admitted to our department for a perioperative evaluation of non cardiac surgery, already diagnosed for multiple coronary artery-left fistulae. He underwent transthoracic echocardiography and then to accelerated dipiridamole stress-echo.

Histologic and Histomorphometric Evaluation of Implant Osseointegration of a Dental Implant Three Years in Function Removed Due to Abutment Fracture

For the edentulous patient, dental implant therapy is the accepted treatment to replace one or more missing teeth as implant survival rates are greater than 90%. Unfortunately, surgical removal of dental implants occurs for a variety of reasons. As human studies are limited, this case report provides an opportunity to evaluate the peri-implant characteristics in a dental implant removed from a patient using histology. In our patient, the implant was removed three years after completion of the prosthetic phase due to fracture of the abutment that could not be removed from the implant. Histological examination of the implant revealed mature lamellar bone in direct contact with the implant surface. Histomorphometric evaluation revealed a bone-to-implant contact (BIC) of 73.6%.

Systematic Review of Spinal Cord Injuries in Equestrian Athletes: Incidence, Risk Factors, and Outcomes

Objective The goal of this systematic review is to identify common themes amongst acute spinal cord injuries (SCI) in equestrian athletes. Design A systematic review was performed using PubMed, CINAHL Plus with Full Text (EBSCO), Cochrane Library, and Scopus with pre-determined MESH terms. The initial search returned 354 studies. Following PRISMA guidelines, 13 articles were included. Exclusion criteria included injuries to the horse only, non-English language, cauda equina, and case reports. Data extraction was completed, and common findings were evaluated narratively due to heterogeneity of data. Results Seven manuscripts listed specific horse-related activities that caused SCI, with fall from horse as the highest percentage of injury. Nine articles identified the injury region, with large variations and no clear dominant area of injury. Five articles identified the length of hospital stay with ranges from 1 to 82 days. Four articles looked at the association of professional vs non-professional riders. Only two articles evaluated helmet use at time of injury, with one article showing 81% of those with SCI used helmets, and the other showing only 35.6% utilized this safety measure. Conclusion SCI in equestrian athletes can have a wide presentation, with large variation on location of injury, length of stay, and other factors. However, non-professional riders are at greater risk of SCI and individuals are more likely to sustain injury from a fall from a horse rather than a kick or another modality of injury. Future study can elicit presenting symptoms, types of surgical intervention used, and long-term outcomes and recovery.

Gastric Pneumatosis: the tale of two late preterm infants with Necrotizing Enterocolitis

Gastric pneumatosis though rare, when seen is cause for concern. It has been associated with fulminant necrotizing enterocolitis (NEC) and gastric outlet obstruction, although other associations have been identified. It is not to be confused with pneumoperitoneum and can be managed conservatively as it is not always a harbinger of intestinal perforation. This case report highlights gastric pneumatosis which occurred in association with necrotizing enterocolitis in two late preterm infants. NEC accounts for 5.4% of our Neonatal Intensive Care Unit admissions, however these are the first two cases of gastric pneumatosis seen in the history of our unit. It is crucial for clinical staff to be cognizant of this pathognomonic sign so that cases are not missed, and for the feeding policy that governs the management of late preterm infants to be revisited. That which specifically predisposes a baby with NEC to developing gastric pneumatosis remains unknown and warrants further research.

RET 898-901Del mutant, a variant of unknown significance, has a durable response to Pralsetinib in a Medullary Thyroid Carcinoma patient

Background Patients with distant metastatic Medullary Thyroid Carcinoma (MTC) have an estimated 40% ten-year survival rate. Gain of function mutations in the REarranged during Transfection or RET gene in MTC can result in an aggressive phenotype resistant to traditional therapy. In this case report, we describe the treatment of an MTC patient with a unique RET kinase deletion mutation. Case presentation Since diagnosis, 21 years ago, this patient has had chronically elevated calcitonin levels (>40,000 pg/mL) that was unable to be controlled by conventual therapy and clinical trials. As result of uncontrolled MTC, metastatic disease was found in the spine, liver, and lungs. Circulating tumor DNA (ctDNA) analysis identified a RET 898-901Del mutation, reported as a variant of unknown significance. The treating physician identified that the deletion was in the activation loop of RET kinase and considered that the mutation was constitutively activating RET kinase. The patient was prescribed Pralsetinib, a small molecule inhibitor targeting the ATP binding site of RET. Pralsetinib treatment achieved a durable response and was able to significantly decrease serum calcitonin levels (<200 pg/mL) and tumor size. Conclusion This RET deletion mutation is a pathogenic mutation with comparable enzymatic activity to the more common RET M918T mutation. The case report highlights the versatility of structural biologic approaches to guide therapeutic decisions.

Primary Leiomyosarcoma of the Thyroid; a Case Report and a Review of Recent Literature

A case report of primary thyroid leiomyosarcoma with literature review. It discusses diagnostic pitfalls, histologic criteria, and management options.

Spontaneous Subgaleal Hemorrhage in a Child with Autism

Severe ascorbic acid (Vitamin C) deficiency, commonly known as “scurvy,” continues to be a problem in malnourished populations across the world but is relatively rare in the United States. Early features of this condition include general weakness, fatigue, and aching limbs. An extremely rare and late feature of this condition is subgaleal hemorrhage. Scurvy has such a low prevalence in First World countries that it is often misdiagnosed or not diagnosed at all. The subject in this case report presented acutely and is one of few to involve a subgaleal hemorrhage to be documented in medical literature to date. Laboratory studies and clinical improvement through treatment established the diagnosis. Ascorbic acid deficiency should be considered when evaluating children with poor nutrition despite socioeconomic status, living conditions, or access to health care. This case also reminds us that neurodivergent children are a vulnerable population and more research will need to be conducted to determine just how detrimental the pandemic has been to patients with ongoing problems who were lost to follow up.

An Uncommon Complication of Multiple Myeloma in a Post Bone Marrow Transplant patient–Plasma Cell Pleocytosis

This case report describes plasma cell pleocytosis occurring after bone marrow transplantation for multiple myeloma. The authors outline clinical presentation, cerebrospinal fluid findings, and differential diagnosis, emphasizing the need to consider hematologic relapse or CNS involvement in post‑transplant patients with neurologic symptoms. Management considerations and follow‑up strategies are discussed.

Pericardiocentesis Procedure: Anatomical Structures and Approaches

Knowledge of accurate surface anatomy is essential for safe clinical practice. Different views and opinions for clinically important surface markings exist between clinicians. Pericardiocentesis is performed as an emergency procedure in conditions aggravating cardiac tamponade. The approach of pericardiocentesis should be held by the hands of an experienced operator because of the surrounding relations. Nowadays, the introduction of imaging-guided procedures, especially echo-guided procedures, has significantly improved the safety and feasibility of pericardiocentesis and has provided the possibility of choosing the best anatomical approach among the apical, subcostal and parasternal approaches. This case report also emphasizes the importance of instillation of agitated saline as a supplementary technique while performing echo-guided pericardiocentesis in order to reduce the likelihood of cardiac chamber perforations.

Two Implant Mandibular Overdentures: Clinical and Laboratory Procedures

Edentulism is considered a poor health outcome and may compromise quality of life. Implant-supported overdentures provide a good opportunity for dentists to improve the quality of life and oral health. Atrophic mandible poses a significant challenge to successful oral rehabilitation with dental implants. The aim of this case report is to demonstrate the concept of immediate functional loading in the mandible using unsplinted implants to support a locator attachment supported overdenture.

Urticaria as the First Presentation of COVID-19 Infection

A case report describes urticaria as an initial manifestation of COVID‑19. It outlines clinical course, differential diagnosis, and implications for testing and isolation.

A Case of an Orbitocranial Injury with an Unusual Foreign Object

Introduction Large impaled object in the orbital region causes severe visual impact and requires specialized care within the shortest time possible. Objectives In this case report, we discussed the approach and management of a patient that presented with a penetrating orbitocranial injury, from management at the emergency unit, diagnostic imaging, referral to other subspecialty, surgical and medical intervention, and post-operative care. Discussion A 36-year old male had an impaled toilet brush on the supero-nasal aspect of the right orbit, with visual acuity of 6/60 and lacerated upper eyelid. The globe had minimal movement on all gazes, but pupil was reactive to light with no afferent defect. On plain cranial and orbital CT-scan, the foreign body entered the anterior and medial aspects of the right orbit penetrating the right superior orbital wall, right medial lamina papyracea, and the lateral and inferior border of the right frontal sinus with its distal tip at the intracranial region at the right frontal lobe compressing the medial rectus along its tract. Two hours after injury, patient underwent wound exploration, removal of foreign body, repair of eyelid laceration, right craniotomy, frontal contussectomy, duraplasty, and JP-drain insertion under general anesthesia. Intraoperatively, there was note of transected canaliculus and avulsed conjunctiva. The medial rectus was intact and attached. The frontal lobe was contused with embedded fragments of right posterior orbital bone with 3cm opening on the dura.  Post-operatively, Fluconazole was added to the medications after culture results of the toilet brush tip tested positive for fungal elements. Patient was discharged after 21 days with visual acuity of 6/6 on both eyes and improved ocular movement.  Conclusion These types of injury warrants thorough and systematic history taking and physical examination, acquiring pertinent imaging modalities to better visualize the extent of injury, and execute surgical and medical intervention that is multidisciplinary.

Digital Planning for Mini-Implant Supported Palatal Expander in Open-Bite Treatment

Open bite malocclusion, due to it’s multifactorial etiology, has always been considered a difficult problem to treat. Often associated with transverse maxillary deficiency, this is a real challenge in the field of orthodontics. The traditional approach, for this type of anomaly, in adult patients, is orthognathic surgery and RME (rapid maxillary expansion). There are several approaches to the treatment of adult patients using digital technology. Mini-implant supported palatal expander limits the side effects of the conventional RME and is less invasive compared to orthognathic surgery. Precise and predictable mini-implant insertion, using a customized surgical guide, provides a safe therapeutic approach. This case report combines Cone-beam computed tomography (CBCT), laser scan superimposition, computer-aided design (CAD) and 3D printing in order to design and print a customized surgical guide for orthodontic mini-implant insertion. A CBCT scan was performed to determine the optimal site for mini-implants’ placement. Using the 3Shape Trios Intraoral Scanner the maxilla and the mandible were laser-scanned. Blue Sky Plan 4 software was used to design the surgical guide, and RayWare software was used for printing it. 4 mini-implants were inserted using a safe and predictable technique. The 3D technology represents the future of orthodontics, reducing the risks, chair-side time while providing the best treatment plan for the patient.

Aneurysm of the Common Iliac Artery Revealing a Behcet's Disease

A case report of a common iliac artery aneurysm revealing underlying Behçet’s disease. It reviews diagnostic clues, vascular complications, and multidisciplinary management.

A Rare Cause of Acute Renal Failure: Retroperitoneal Fibrosis

Idiopathic retroperitoneal fibrosis also known as Ormonds disease is a rare disorder characterized by the development of fibrotic tissue in the retroperitoneum. The fibrotic tissue may compress ureters, leading to obstructive nephrouropathy and renal failure. A 58-year-old man with fatigue, loss of appetite and unable to urinate was admitted to our clinic. Because of the serum creatinine value of 5.3 mg/dl, urinary ultrasonography was performed and bilateral grade 3 hydronephrosis with moderate level urine in bladder was detected. Hydronephrosis did not regress by transurethral foley catheter and suspicious appearance in the retroperitoneal area was found in abdominal magnetic resonance imaging. Tru-cut biopsy result of the current lesion was finally reported as a connective tissue. Bilateral double j catheter insertion was performed and started to immunosuppression therapy with corticosteroid. Two months later, double j catheters were removed and hydronephrosis was not detected in follow-up. In this case report, we tried to explain that, retroperitoneal fibrosis should be considered in the differential diagnosis of postrenal acute renal failure, even in patients without a classic symptom such as pain. In addition, early surgical intervention should be avoided in such patients.

Possibility to Influence Treatment of Open Tibial Fracture by Negative Pressure Wound Therapy

Modern medicine gives treatment options even in cases, where this has not been possible in the past. We want to present how negative pressure wound therapy (NPWT) helps in limb salvage. The case report brings our insight and experience on how to be successful with NPWT. We present a high-energy injury with an open tibial fracture IIIB according to Gustillo-Anderson classification 11. NPWT is an excellent option to treat extensive soft tissue injury. NPWT is also beneficial in the application of the dermoepidermal graft as we have found. We can confirm that this therapy contributed to a faster healing of soft tissues compared to classical wound healing.

Socket Shield Technique - A New Approach of Immediate Implant Articles Review

Dental implant restoration is challenging procedure when it involve the esthetics zone, and since implant dentistry is prosthodontically driven procedure, care were practice in restoration of missing teeth in esthetics area which will fulfill the objective. Extraction of teeth leave buccal plate bone unsupported and decrease the blood supply and since this plate is very thin resorption will be expected. Different attempt was done in order to prevent this sequence and create natural emergence profile around dental implant prosthesis. Socket preservation procedures were introduced, however in case of ridge deficiencies, hard and soft tissue augmentation procedures are indicated. Socket shield technique meets the demands of minimal invasion, tissue preservation, and no need of bone substitute materials. And can be applied not only for maintaining buccal contour of an edentulous ridge but also for keeping the inter-implant soft and hard tissue In this review paper we present different articles and case report using socket shield technique as treatment protocols and try to explore different protocol are practice in order to achieve high treatment out come with optimal success.

Dissociative Amnesia – A Challenge to Therapy  

The psychiatric disease of dissociative amnesia is described and illustrated with case reports. It is emphasized that dissociative amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.

Non-Hodgkin Lymphoma of External Auditory Canal – Uncommon Location and Related Risk Factors

Objective: Presentation of rare case report of primary non-Hodgkin Lymphoma of temporal bone secondary to immunodeficiency after prolonged steroid administration in a diabetic patient. Then review the literature of similar case reports. Method: 49 years old female presented with hearing loss, facial paralysis and otalgia. Biopsy revealed high grade non Hodgkin’s B-lymphoma. She underwent chemotherapy and had remarkable response. Result: Rapidly progressive deafness, facial paralysis and otalgia are common presentations of external canal Non-Hodgkin lymphoma. The disease is common in middle age, females and has a fair response to chemotherapy, good to radiotherapy. Surgery is an alternative method in isolated lesions or recurrent cases. Conclusion: High dose steroid and type II diabetes are potential risks for acquired immunodeficiency. External Auditory canal lymphoma is uncommon sequel. Chemotherapy is very effective in treatment of isolated cases without B symptoms

Association of Non Epileptic Seizures and Epilepsy:2 Cases Reports of Masturbation Seizures

Introduction: Non epileptic seizures (NES) are little reported in our country. Case report: We report 2 observations of 4 years old girls, with normal psychomotor development, and frequent paroxystic seizures, characterized by stereotyped movements of the members, occurring during sleep onset or deep sleep. Electroencephalogram Sleep records showed brief discharges of spikes and spikes-waves. Magnetic Resonance Imaging was normal. Suspicion of NES associated with epilepsy was based on the following arguments: mild regression of the seizures frequency after using antiepileptic drug video records of the seizures strongly suggestive of masturbation seizures, masturbation seizures are triggered by the girls and stopped on order, best regression of the seizures frequency after adjunction of trihexiphenidyl. Moreover, the authors make a review of literature on the NES. Conclusion: The early diagnosis of the NES allows to avoid the inadequate treatments and an improvement of the prognosis.

Autism Spectrum Disorders and Gluten/Casein Free Diet Treatment: A Systematic Review (1990-2016)

Background: High number of patients suffering from autism spectrum disorders utilize dietary intervention methods, especially gluten-free/casein-free diet. In contrast with its’ extensive usage no sufficient and consistent data exist to support its’ efficiency and safety. Objective: The main aim of this systematic review is to provide a general look to the efficiency and safety of gluten-free/casein-free diet treatment for autism spectrum disorders. Method: Studies used in this systematic review are gathered from 3 online databases (PubMed, Embase and the Cochrane Library). Inclusion criteria are established for study selection. Articles published in a peer-reviewed article between 1990 and 2016 in English about our topic of interest and conducted with patients under the age of eighteen (18) are selected and further analyzed (“Level of Evidence” and “Grade of Recommendation” criteria are utilized). Results: Even though some studies with high values of “Level of Evidence” claim that gluten-free/casein-free diet is beneficial for patients suffering from autism spectrum disorders, studies with lower risk of bias demonstrate otherwise. Since studies such as case reports and cohort studies may contain bias associated with small sample size, absence of clear assessment methods, lack of randomization and short treatment period we suggest that there is no sufficient data to support gluten-free/casein-free diet treatment. Conclusion: Due to controversial outcomes from studies that have different “Level of Evidence” we speculate that efficiency of gluten-free/casein-free diet might be related to individual genetic differences. Therefore, studies conducted with large study groups could not provide statistically significant data to support this treatment option. Further studies should be conducted, especially in the field of genetics, in order to test our hypothesis.

Left Brachiocephalic Vessel Venous Tumor Thrombus in a Laryngeal Cancer Patient Detected with PET-CT Imaging

Accurate diagnosis of tumor thrombus and distinguishing benign thrombus from tumor thrombus avoid unnecessary anticoagulant treatment of oncological patients and it is important for patient management. In this case report, the role of FDG PET/CT in the presentation of a suspicious tumor thrombus in the left brachiocephalic vein of a patient with known laryngeal carcinoma and leiomyosarcoma diagnosis is presented.

Dental Sinus Infections- Why are we Still Missing the Well Documented Diagnosis?

Background: Dental infections, salivary gland lesions, neoplasms and developmental abnormalities can cause oral cutaneous fistulae, fistulae of the neck and intraoral fistulae. Published case reports deliver the same message; that these lesions are misdiagnosed and treated late and ineffectively and this remains a significant on-going problem. Aim: It is important to reiterate the management and diagnosis of this condition, despite the fact that it is already well documented in the current literature as patients are still being subjected to unnecessary treatment. Design and Setting: We performed a retrospective review of 5 consecutive dental sinus infections between June 2013 and January 2014 that were misdiagnosed initially. Information was extracted from the medical case notes of 2 male and 3 female patients with an age range from 12-87 years. Method: The medical records of all 5 patients were analyzed, medical photography was taken and the patients were followed up regularly in our clinic. Results: Each patient presented with a non-healing lesion and all were treated with either oral or topical antibiotics. Patients were eventually referred to the craniofacial department where they all received an orthopantomogram and underwent dental extraction, which led to complete healing. Conclusion: Cutaneous facial sinus tracts of odontogenic origin are often initially misdiagnosed which leads to prolonged and inappropriate treatment. Correct diagnosis and treatment will result in predictable and rapid healing and thus it is essential to record these case series, to ensure that medical professionals are aware of the presenting symptoms, which can often be very subtle.

Anterior Open Bite Closure Using Ortodontic Mini-Implants

This case report describes the treatment of a dento-alveolar protrusion with anterior open bite. The 21-year old patient had a convex profile , class I dental malocclusion , anterior open bite of 4 mm and presented tongue thrust. The treatment plan was to insert two mini-implants for premolar intrusion along with the straight –wire fixed appliances. Tongue therapy was performed by myofunctional exercises. Using the absolute anchorage we were able to achieve our goals in a predictable manner without the use of orthognathic surgery or patient compliance . After the tongue thrust habit was removed we are confident that this is a stable result .

A Successful Vancomycin Treatment of Multidrug-Resistant MRSA-Associated Canine Pyoderma

Case Report This report describes a case of diffuse pyoderma in a 10-year-old female dog with hypothyroidism. A previous treatment, without an early diagnosis, including cephalosporin associated with prednisolon resulted to be unsuccessfully. After clinical and microbiological examination in our laboratories, a diagnosis of methicillinresistant Staphylococcus aureus (MRSA)-associated pyoderma was made. The antimicrobial susceptibility testing evidenced many resistances and susceptibility of the strain only to vancomycin and linezolid. A new therapy against hypothyroidism and associated with an appropriate antimicrobial (vancomycin) treatment, improved and resolved the infection. Clinical Significance To our knowledge, this is the first case of canine pyoderma caused by a strain of MRSA with a such severe multiresistant profile. MRSA infections present a serious challenge because of the emergence of resistance to numerous conventional antibiotics and the risk factors associated with the transfer of the bacteria to humans, who have a contact with infected pets.

Maxillary Constriction with Skeletal Class II Malocclusion - A Comprehensive Treatment Approach.

This case report reiterates the fact that a bilateral posterior crossbite with severe skeletal class II malocclusion in the growth period could be effectively treated by a comprehensive approach with a rapid palatal expansion appliance followed by fixed appliance therapy. A 14-year-old boy presented with a severe skeletal Class II malocclusion with an orthognathic maxilla, retrognathic mandible and a high mandibular plane angle with an Angles’ Class II division 1 subdivision malocclusion with maxillary constriction, increased overjet, deep bite and severe crowding of maxillary and mandibular incisors. A banded rapid palatal expansion appliance was initially given to correct the bilateral posterior cross bite and subsequently maxillary and mandibular first premolars were extracted and Roths’ Pre adjusted edgewise appliance therapy (0.022 x 0.28-inch slot) was strapped up to correct the severe tooth size-arch length discrepancy. The patient’s soft tissue profile and dentofacial esthetics improved dramatically with increased self-confidence and enthused self-esteem.

Massive Splenic Rupture – An Unusual Presentation

A case report of massive splenic rupture with atypical presentation. It covers diagnostic work‑up, stabilization, and operative decision‑making.

Compound Heterozygous Hemoglobin SD Disease Presenting as Sickle Cell Crisis in Pregnancy

A case report of compound heterozygous hemoglobin SD disease presenting as sickle crisis during pregnancy. The discussion covers transfusion, pain control, and peripartum care.

Acute Bilateral Hydro Nephrosis after the Use of Dapagliflozin

Background Dapagliflozin; the new oral hypoglycemic agent; is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that acts by inhibiting glucose reabsorption in the proximal tubule of the nephron. Main reported side effects are osmotic diuresis, dehydration, urinary tract and genital infections. Here, we report a case of acute bilateral hydronephrosis after the introduction of dapagliflozin. Case Presentation A 52 year old nurse lady, with 15 year history of type2 diabetes mellitus (T2 DM) complicated by type4-renal tubular acidosis, hypertension, proteinuria, and hyperlipidemia. Patient had two episodes of UTI’s in 2011 required full urologic work up, were successfully treated with simple courses of oral antibiotics. CT pyelography done in 2011 was normal. Dapagliflozin was added to her therapeutic regimen in March 2015. Results Within 48 hours after starting dapagliflozin, she reported increased urine output. Ten days later; she developed severe bilateral loin and lower back pain, followed by suprapubic pain, dysuria and fever. Urine analysis and cultures confirmed E. coli urosepsis. Renal US revealed echogenic kidneys with 12 mm bilateral hydronephrosis, normal ureters and urinary bladder. Discontinuation of dapagliflozin in April 2015 resulted in resolution of symptoms. Repeat CT of the abdomen in July 2015 revealed no hydro nephrosis. Conclusions This is the first case report of reversible bilateral hydronephrosis after the use of dapagliflozin. The cause of hydronephrosis, could be explained by over-diuresis and/or by the unmasking of underlying subclinical obstruction in both uretero-pelvic junctions (UPJ).

The Daughter of Time: Late Development of Waldenstrom’s Macroglobulinemiain a Patient with Immunotactoid Glomerulopathy.

Immunotactoid glomerulopathy (ITG) is a rare cause of chronic kidney disease (CKD) and end-stage-renal-disease (ESRD). It is often associated with monoclonal gammopathy and/or hematologic malignancy. We report a patient originally diagnosed with ITG in 1998. He presented with nephrotic-range proteinuria, hypertension, and a gradual decline in glomerular filtration rate. A published case report of this patient at the time the disease was originally diagnosed described only a small peak of IgM paraprotein without lymphoma or plasma cell dyscrasia. He was diagnosed with monoclonal gammopathy of unknown significance. He later developed ESRD and initiated hemodialysis in 2004. Fourteen years after the diagnosis of ITG and MGUS was made he developed headache, lymphadenopathy, borderline splenomegaly, thrombocytopenia, and coagulopathy. Workup revealed a very high level of monoclonal IgM-kappa (4390 mg/dL),and low grade B-cell lymphoma, consistent with lymphoplasmacytic lymphoma, leading to a diagnosis of Waldenstrom’s macroglobulinemia (WM). He died shortly thereafter of complicated gram-negative sepsis. To our knowledge this is the first report of WM associated with ITG. The patient's course illustrates that plasma cell dyscrasia and lymphoma can present many years after the original diagnosis of ITG is made and that continued vigilance for these conditions is warranted.

Report of a False Positive Rapid HIV Test Due to Hepatitis A in a U.S. Army Soldier

A 25 year old, single, active duty soldier presented to a clinic in Afghanistan complaining of malaise, fatigue, acholic stools, and mild jaundice over a 5- to 7-day period. He had significantly elevated liver transaminase levels approaching 5000 U/L and a positive rapid human immunodeficiency (HIV) 1 antibody test. Ultimately, the patient was found to have a false positive rapid HIV-1 antibody test due to acute hepatitis A virus infection. This case report describes his evaluation and outcome, in addition to exploring possible causes of false positive HIV screening.