Present Case Research Articles

Modeling the impact of coincidence loss on count rate statistics and noise performance in counting detectors for imaging applications

Coincidence loss can have detrimental effects on the image quality provided by pixelated counting detectors, especially in dose-sensitive applications like cryoEM where the information extracted from the recorded signal needs to be maximized. In this work, we investigate the impact of coincidence loss phenomena on the recorded statistics in counting detectors producing sparse binary images. First, we derive exact analytical expressions for the mean and the variance of the recorded counts as a function of the incoming event rate. Second, we address the problem of the mean and variance of the recorded events (i.e., pixel clusters identified as individual incoming events), which also acts as a function of the incoming event rate. In this frame, we review previous studies from different disciplines on approximated two-dimensional models, and we critically reinterpret them in our context and evaluate the suitability of their adoption in the present case. The knowledge of the first two momenta of the recorded statistics allows inferring about the signal-to-noise ratio (SNR) and the detective quantum efficiency at zero frequency (DQE0). Analytical results are validated through comparison with numerical data obtained with a custom-made Monte Carlo code. We chose a realistic case study for cryoEM application consisting of a 25-µm-thick MAPS detector featuring a pixel size of 10 µm and illuminated with electrons of 300 keV energy over a wide range of incoming rate.

Reconstruction of Chronic Monteggia Fracture with Radial Head Excision: A Case Report

Introduction: Chronic Monteggia fracture is a rare and clinically challenging condition, characterized by a non-union fracture of the proximal ulna with dislocation of the radial head. This case report presents the case of a 42-year-old woman with a chronic Monteggia fracture diagnosed 21 years after the initial injury, highlighting the importance of a careful patient history and radiographic investigation. Case presentation: A 42-year-old woman presented with left elbow pain and a history of significant trauma 21 years previously. Physical examination revealed limited range of motion and radiographic examination revealed a nonfused fracture of the proximal ulna with dislocation of the radial head. The patient underwent open reduction and internal fixation (ORIF) reconstruction of the ulna and excision of the radial head. Conclusion: Successful surgical reconstruction of chronic Monteggia fractures results in significant improvements in the patient's function and quality of life. This case report emphasizes the importance of early diagnosis and timely surgical intervention to prevent long-term complications and achieve optimal functional outcomes.

Challenges of Anesthetic Management in Pediatric Patients with Hernia Inguinalis Lateralis Dextra Reponibilis: A Case Report

Introduction: Hernia inguinalis lateralis dextra reponibilis (HILD repr.) is a common condition in infants and children, but anesthetic management in these pediatric patients requires special attention. Children's unique physiological and pharmacological characteristics, potential comorbidities, and risk of postoperative pain demand a careful and integrated approach. Case presentation: This case report presents comprehensive anesthetic management of a 6-month-old male infant who underwent elective herniorrhaphy for HILD repr. The anesthesia procedure involved induction with sevoflurane and fentanyl, maintenance of anesthesia with sevoflurane, and multimodal pain management with paracetamol and bupivacaine. The surgery was successful without complications, and the patient recovered well. Conclusion: This case highlights the importance of implementing modern anesthetic practices in pediatric patients with HILD repr., including selection of appropriate anesthetic agents, close monitoring, and multimodal pain management. Specific challenges such as unique airway anatomy, variability in drug pharmacokinetics, and risk of perioperative complications are also highlighted. The successful anesthetic management of this case highlights the importance of an individualized approach and close monitoring to optimize clinical outcomes and minimize complications in pediatric patients with HILD repr.

Obinutuzumab in Difficult to Treat Phospholipase A2 Receptor Positive Membranous Nephropathy: Our Experience at a Tertiary Care Center in North India

Obinutuzumab is a glycoengineered type II anti-CD20 monoclonal antibody with superior B cell cytotoxicity compared to rituximab. Various case reports suggest that in refractory phospholipase A2 receptor (PLA2R) positive membranous nephropathy (MN) patients, Obinutuzumab led to immunologic remission and improvement in proteinuria. In the present case series, we present six cases of difficult-to-treat PLA2R-associated MN refractory to prednisolone, calcineurin inhibitor (CNI), cyclophosphamide, and rituximab but subsequently responded to Obinutuzumab. Five out of six cases showed partial /complete clinical remission and immunological remission (IR) with normalization of serum albumin and stable renal function. Though this drug’s long-term efficacy and impact remain unclear, it is being increasingly considered for PLA2R-associated MN resistant to standard therapy.

Implementation Of Optical Diagnostics For Study Of A Non-Canonical Hypersonic Geometry

The study of shock/boundary-layer interactions on a non-canonical hypersonic geometry involves physical complexities not found on the canonical investigations that dominate the literature. The present case examines a cone-slice-ramp, which combines an upstream asymmetric flow expansion with a downstream three-dimensional compression ramp. Optical diagnostics of the off-body flowfield are a necessary complement to surface instrumentation including high-frequency pressure sensors and Temperature Sensitive Paint (TSP). Focused Laser Differential Interferometry (FLDI) measured the flowfield distribution of second-mode instability waves responsible for transition. Filtered Rayleigh Scattering (FRS) was used for flow visualization of the separation region and unsteady shear layer. Velocimetry through the separation shear layer was provided by Femtosecond Laser Electronic Excitation Tagging (FLEET) whereas Coherent Anti-Stokes Raman Scattering (CARS) measured the thermal profiles through multiple flow features generated by the interaction. These flowfield diagnostics detail the alterations in the shock/boundary-layer interaction as the flow state moves from laminar to transitional to turbulent conditions, revealing behaviors absent from canonical flows.

Non-Invasive Paraclinical Diagnosis of Hepatocutaneous Syndrome in a Dog

A 14-year-old, female spayed Bichon Maltese with no other known previous pathologies was presented for dermatological examination after being referred from a private clinic with the suspicion of generalized, treatment-resistant demodicosis. Upon presentation and clinical examination, multiple deep skin scrapings were performed, returning negative parasitological results. Complete blood count and serum biochemistry revealed mild hepatic damage. Abdominal ultrasound revealed an abnormal echostructure of the liver displaying a honeycomb or Swiss cheese-like pattern, reported as pathognomonic for hepatocutaneous syndrome. The owner declined any further paraclinical examination, including skin biopsy and histopathological examination, requesting a treatment protocol that could be pursued at home, considering the age of the dog and its reactive behavior during the examination. The present case report highlights a non-invasive method of diagnosing the hepatocutaneous syndrome in a dog by clinical examination, routine blood testing, and ultrasound assessment of the abdomen, in the absence of the possibility of doing a histopathological diagnosis.

Full Digital Workflow for Aesthetic Rehabilitation of the Upper Teeth: A Case Report

The present case report presents a digital workflow for designing an aesthetic rehabilitation of the upper anterior teeth in an adult male. The patient suffered from a gummy smile resulting from an unfavorable ratio between upper lip length and gingiva/tooth display. In addition, the tooth shapes, color, and position were not accepted by the patient. The treatment planning included gingivectomy based on a digitally designed PMMA guide performed using a soft tissue SOGA laser (Shenzhen Soga Technology Co., Ltd., Shenzhen, China). The preparation was guided by the plastic guides for preparation control created digitally in Exocad software (Rijeka 3.1. Darmstadt, Germany) and printed in three-dimensional plastic. Next, both arches and maximum intercuspation were scanned. The milled lithium disilicate veneers were manufactured using CAD-computer-aided manufacturing (CAM) equipment. The restorations were cemented using a translucent light-cure resin cement (RelyX Universal, 3M ESPE, St. Paul, MN, USA). Next, occlusion adjustment and polishing were executed. Based on the present case report, it can be assumed that the application of digital techniques allows us to achieve an aesthetic and functional result with reduced work time and errors. Emphasizing the clinical impact, these methods enhance patient satisfaction and treatment accuracy in intricate aesthetic rehabilitations.

Non-Invasive Paraclinical Diagnosis of Hepatocutaneous Syndrome in a Dog

A 14-year-old, female spayed Bichon Maltese with no other known previous pathologies was presented for dermatological examination after being referred from a private clinic with the suspicion of generalized, treatment-resistant demodicosis. Upon presentation and clinical examination, multiple deep skin scrapings were performed, returning negative parasitological results. Complete blood count and serum biochemistry revealed mild hepatic damage. Abdominal ultrasound revealed an abnormal echostructure of the liver displaying a honeycomb or Swiss cheese-like pattern, reported as pathognomonic for hepatocutaneous syndrome. The owner declined any further paraclinical examination, including skin biopsy and histopathological examination, requesting a treatment protocol that could be pursued at home, considering the age of the dog and its reactive behavior during the examination. The present case report highlights a non-invasive method of diagnosing the hepatocutaneous syndrome in a dog by clinical examination, routine blood testing, and ultrasound assessment of the abdomen, in the absence of the possibility of doing a histopathological diagnosis.

Full Digital Workflow for Aesthetic Rehabilitation of the Upper Teeth: A Case Report

The present case report presents a digital workflow for designing an aesthetic rehabilitation of the upper anterior teeth in an adult male. The patient suffered from a gummy smile resulting from an unfavorable ratio between upper lip length and gingiva/tooth display. In addition, the tooth shapes, color, and position were not accepted by the patient. The treatment planning included gingivectomy based on a digitally designed PMMA guide performed using a soft tissue SOGA laser (Shenzhen Soga Technology Co., Ltd., Shenzhen, China). The preparation was guided by the plastic guides for preparation control created digitally in Exocad software (Rijeka 3.1. Darmstadt, Germany) and printed in three-dimensional plastic. Next, both arches and maximum intercuspation were scanned. The milled lithium disilicate veneers were manufactured using CAD-computer-aided manufacturing (CAM) equipment. The restorations were cemented using a translucent light-cure resin cement (RelyX Universal, 3M ESPE, St. Paul, MN, USA). Next, occlusion adjustment and polishing were executed. Based on the present case report, it can be assumed that the application of digital techniques allows us to achieve an aesthetic and functional result with reduced work time and errors. Emphasizing the clinical impact, these methods enhance patient satisfaction and treatment accuracy in intricate aesthetic rehabilitations.

Clinical approach to a rare case of hydrallantois in bitch

AbstractThe present case describes the clinical, sonographic and histopathological findings of hydrallantois in bitch. After 55 days of the first mating, nulliparous Golden Retriever bitch was presented with a primary complaint of perceptible abdominal distension and dyspnoea for the last 3‒4 days. Ultrasonography revealed marked uterine distension with well appreciable anechoic to hypoechoic allantoic regions along with fetal stress. During caesarean section, a cumulative 2.75 L of placental fluid was recovered from allantoic portion with an altered electrolyte profile in comparison to maternal plasma. The histopathology examination of one fetal kidney corroborated tubular degeneration, suggesting nephrosis to be the concomitant aetiology. In conclusion, the clinical examination and ultrasonography provided provisional diagnosis of the condition; caesarean section proved to be an ideal option in order to prevent the dystocia or any other complication during whelping in a bitch even if none of the puppies survived. This approach, with supportive therapy ensures comprehensive care post‐treatment.

Clinical approach to a rare case of hydrallantois in bitch

AbstractThe present case describes the clinical, sonographic and histopathological findings of hydrallantois in bitch. After 55 days of the first mating, nulliparous Golden Retriever bitch was presented with a primary complaint of perceptible abdominal distension and dyspnoea for the last 3‒4 days. Ultrasonography revealed marked uterine distension with well appreciable anechoic to hypoechoic allantoic regions along with fetal stress. During caesarean section, a cumulative 2.75 L of placental fluid was recovered from allantoic portion with an altered electrolyte profile in comparison to maternal plasma. The histopathology examination of one fetal kidney corroborated tubular degeneration, suggesting nephrosis to be the concomitant aetiology. In conclusion, the clinical examination and ultrasonography provided provisional diagnosis of the condition; caesarean section proved to be an ideal option in order to prevent the dystocia or any other complication during whelping in a bitch even if none of the puppies survived. This approach, with supportive therapy ensures comprehensive care post‐treatment.

Management of patient with Fusobacterim nucletum related pleural empyema: intrapleural antibiotic therapy can be considered for salvage therapy

Pleural empyema can lead to significant morbidity and mortality despite chest drainage and antibiotic treatment, necessitating novel and minimally invasive interventions. Fusobacterium nucleatum is an obligate anaerobe found in the human oral and gut microbiota. Advances in sequencing and puncture techniques have made it common to detect anaerobic bacteria in empyema cases. In this report, we describe the case of a 65-year-old man with hypertension who presented with a left-sided encapsulated pleural effusion. Initial fluid analysis using metagenomic next-generation sequencing (mNGS) revealed the presence of Fusobacterium nucleatum and Aspergillus chevalieri. Unfortunately, the patient experienced worsening pleural effusion despite drainage and antimicrobial therapy. Ultimately, successful treatment was achieved through intrapleural metronidazole therapy in conjunction with systemic antibiotics. The present case showed that intrapleural antibiotic therapy is a promising measure for pleural empyema.

Surgical Treatment Option in a Recurrent Giant Sacrococcygeal and Gluteal Squamous Cell Carcinoma - Case Presentation

Surgical Treatment Option in a Recurrent Giant Sacrococcygeal and Gluteal Squamous Cell Carcinoma - Case Presentation

Case Report of a Dog Heavily Infected With Hepatozoonosis

Canine hepatozoonosis is a widespread tick-borne protozoan disease and generally affects domestic dogs. Diagnosis can be made via PCR, serology, and direct observation of the gamonts of the parasite on stained blood smears. In the present case, a four-year-old female crossbred hunting dog presented to Balikesir University Veterinary Faculty clinics of internal medicine with a history of exercise intolerance, and weight loss for ten days. The dog was highly infected and showed anemia, thrombocytopenia, and neutrophilia. In radiographic analysis, unilateral pulmonary pathology was determined. This case report can be important for clinicians who live in Turkey to recognize the parasite.

COMPLETE REVERSAL OF TRANS-TENTORIAL AND SUB-FALCINE BRAIN HERNIATION WITH CRANIECTOMY: A SUCCESSFUL CASE REPORT

Introduction: Brain herniation, or brain code, is a critical condition caused by elevated intracranial pressure, leading to abnormal brain tissue protrusion. Chronic herniations may be linked to developmental defects and remain asymptomatic, while acute herniations are life-threatening, especially after neurosurgery. Case Presentation: A 25-year-old female with Glioblastoma multiforme presented with facial weakness. Initially suspected as Bell’s Palsy, her condition rapidly worsened, leading to coma and signs of raised intracranial pressure. A CT scan revealed a brain tumor with associated edema, hemorrhage, and multiple herniations. Emergency craniectomy and subsequent medical management showed initial improvement, but she later developed ischemia and infarction, resulting in her death. Discussion: Timely diagnosis and intervention are crucial in managing brain herniation. Clinical signs and cranial nerve assessments are vital for diagnosis. Management focuses on reducing intracranial pressure through medical and surgical means. Early intervention is key to better outcomes, though the prognosis can be poor due to underlying conditions like Glioblastoma multiforme. Conclusion: Effective management of brain herniation requires timely surgical and medical intervention. This case illustrates the rapid progression and complexity of brain herniation, emphasizing the importance of early and comprehensive treatment.

Central dentinogenic ghost cell tumor of the maxilla: a case report with new imaging findings and review of the literature.

A dentinogenic ghost cell tumor (DGCT) is a rare benign odontogenic tumor that commonly shows characteristics of solid proliferation and has a relatively high risk of recurrence after surgical treatment. We herein report a case of a central DGCT that occurred in the maxilla and resulted in bone expansion. This study highlights new imaging findings (particularly magnetic resonance imaging) along with histopathological observations. In addition, we conducted a review of the existing literature on this rare tumor. A 37-year-old man developed swelling around the right cheek. A benign odontogenic tumor such as ameloblastoma was suspected based on the imaging examination findings (including bone expansion and the internal characteristics of the tumor) on panoramic imaging, computed tomography, and magnetic resonance imaging. The lesion was surgically excised from the right maxilla. Postoperative histopathological examination led to a definitive diagnosis of central DGCT. The tumor comprised epithelial neoplastic islands, resembling ameloblastoma, inside tight fibroconnective tissue; masses of ghost cells and formation of dentin were also observed. We had suspected that the minute high-density region around the molars on the imaging examinations represented alveolar bone change; however, it represented dentin formation. This led to difficulty diagnosing the lesion. Although DGCT may present characteristic findings on imaging examinations, its occurrence is infrequent, and in some cases, the findings may include the presence or absence of an impacted tooth without obvious calcification. The present case suggests that we should consider the possibility of an odontogenic tumor with calcification when high-density structures are observed inside the lesion.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background: Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries. Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies. Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation: A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and who was a heavy smoker, was admitted to our hospital with symptoms of long time with bilateral claudication and became leg rest pain. He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access. Aortoiliac occlusive disease (TASC II Type D Class) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received optimal medical treatment, and was educated about smoking cessation. Conclusion: Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.

Gut microbiota shifts from onset to remission in immune checkpoint inhibitor-induced enterocolitis: a case report

BackgroundImmune checkpoint inhibitors (ICIs) are crucial in cancer treatment; however, they carry the risk of immune-related adverse events (irAEs), such as enteritis. Case presentation: This study investigated the role of the gut microbiota during the onset and remission of irAE enteritis in a patient with stage IV melanoma undergoing anti-PD-1 and anti-CTLA-4 therapy. Following commencement of ICI treatment, the patient developed severe diarrhea and was diagnosed with grade 3 irAE enteritis. Steroid and probiotic treatments provided swift symptom relief and remission, as confirmed by reduced fecal calprotectin levels and gastrointestinal imaging. Microbiota diversity analysis conducted via 16S rRNA gene sequencing identified a decrease in Streptococcus prevalence with improvement in enteritis symptoms. Conversely, genera Fusobacterium, Faecalibacterium, Bacteroides, Prevotella, and Bifidobacterium showed increased representation after remission. These genera are associated with anti-inflammatory properties and fibrous substrate degradation, aiding gut health. Immunological assessment demonstrated fluctuations in cytokine expression and the modulation of costimulatory molecules, aligning with therapeutic interventions and microbiota alterations.ConclusionsOur findings indicate a significant correlation between gut microbiota and immune responses in irAE enteritis. This underscores the potential utility of microbiome profiling in predicting irAE occurrence and in providing treatment strategies, thereby promoting a more comprehensive approach to managing the adverse effects of ICIs.

Acute cerebral venous sinus thrombosis presenting in papilloedema: a case report

Background: Papilloedema has several aetiologies, including brain tumours, central nervous system inflammation, cerebral venous thrombosis, cerebral venous sinus thrombosis (CVST), and idiopathic intracranial hypertension. CVST is a rare condition and a form of stroke with an incidence of 5:1,000,000/year. Case presentation: A 23-year-old female developed impaired vision in her left eye, accompanied by headache, nausea, and vomiting, 5 weeks prior to hospitalization. Visual acuity in the left eye (OS) was 6/12, which improved to 6/9 on pinhole examination, and to 6/6 with S-0.50 and C-0.50 on the 180° axis. OS intraocular pressure (IOP) was 14 mmHg. Bilateral funduscopic examination revealed papilloedema, peripapillary venous tortuosity, and macular exudate. Both computerised tomography scan and magnetic resonance angiography examination detected superior sagittal sinus thrombosis. Conclusion: Acute CVST is a rare condition. A good prognosis depends on early diagnosis and prompt treatment.

Diagnostic and therapeutic delays in lung cancer during the COVID-19 pandemic: a single center experience at a German Cancer center

BackgroundThe COVID-19 pandemic has had negative drawbacks on the healthcare system worldwide and on individuals other than those directly affected by the virus. Delays in cancer therapy and diagnosis have been reported in the literature. We hypothesized similar effects on patients with lung cancer at our center.MethodsWe retrospectively analyzed data of patients referred to our center with newly diagnosed lung cancer from 2018 to 2022. We considered distribution of UICC Stages and time from case presentation in our multidisciplinary tumor board or from therapeutic indication from treating physician to therapy initiation (surgery, systemic therapies and radiation) to define delays in diagnosis and treatment.Results1020 patients with newly diagnosed lung cancer were referred to our center from 2018 to 2022, with a median of 206 cases yearly (range: 200–208). Cases with Stage IV in 2020–2022 were significantly higher than in 2018–2019 (57% vs. 46%, p = 0,001). 228 operative resections took place between 2018 and 2022, 100 from January 2018 to February 2020 and 128 from March 2020 to December 2022. Median time from presentation in our tumor board to resection was also significantly longer after the beginning of the pandemic than before (22 days vs. 15,5 days, p = 0,013). No significant delays were observed for administration of systemic treatment and initiation of radiation.ConclusionsDuring the pandemic higher disease stages were reported for patients with lung cancer, yet there were no clinically relevant delays in treatment. In the context of the post-covid era new diagnostic strategies are necessary to facilitate early diagnosis of lung cancer. Despite the pandemic, for patients with suspicious symptoms prompt access to healthcare facilities is essential for early diagnosis.