Present Case Report Research Articles

Metastatic Malignant Melanoma Clinically Presenting as Parotid Mass - A Case Report of an Unusual Clinical Presentation

Malignant melanoma has been considered as one of the most common tumor of the skin despite its occurrence in other organs. Being fatal in nature, timely detection and subsequent treatment is essential to avoid poor prognosis. The current case occurred in a 73-year-old male patient, with a melanoma presented as metastasis in parotid lymph node. The article discusses and focuses on the distinct clinic-pathologic presentation of this case, emphasizing the necessity to identify and report such cases for understanding of its molecular pathology role and impact. However, these rare lesions may present themselves in an un-common way which needs to be identified and reported to understand their biologic behavior. The current case report aims to fulfill the understanding criteria of such incidents.

How to start an awake spine program: Protocol and illustrative cases.

Surgical techniques and technology are steadily improving, thereby expanding the pool of patients amenable for spine surgery. The growing and aging population in the United States further contributes to the increase in spine surgery cases. Traditionally, spine surgery is performed under general anesthesia. However, awake spinal surgery has recently gained traction due to evidence of decreased perioperative risks, postoperative opioid consumption, and costs, specifically in lumbar spine procedures. Despite the potential for improving outcomes, awake spine surgery has received resistance and has yet to become adopted at many healthcare systems. We aim to provide the fundamental steps in facilitating the initiation of awake spine surgery programs. We also present case reports of two patients who underwent awake spine surgery and reported improved clinical outcomes.

A Paracolic location of the Appendix Vermiformis with lymphoid Hypoplasia

The present case report from the dissection room shows a rare and unique paracolic position of the vermiform appendix reaching almost up to the liver in a white European man. The appearance of the gut associated lymphoepithelial tissue was hypoplastic.

Phlegmasia Cerulea Dolens as the Initial Sign of COVID-19 Infection

A 56-year-old woman with asthma, diabetes, hypertension, hyperlipidemia, and obesity presented with acute ischemic venous thrombosis (phlegmasia cerulean dolens) of the left calf and popliteal veins due to asymptomatic COVID-19 infection. We believe that this is the first case report of this distinct clinical presentation and should alert clinicians that the hypercoagulability associated with COVID-19 infection may occur in the absence of respiratory symptoms.

Xanthogranulomatous Oophoritis in the Setting of Post-IVF Twin Pregnancy with History of Endometriosis: A Rare Case Report with Review of Literature

AbstractXanthogranulomatous inflammation is an uncommon, nonneoplastic, chronic process in which the affected organ is destroyed by massive cellular infiltration of foamy histiocytes admixed with multinucleated giant cells, plasma cells, fibroblasts, neutrophils, and foci of necrosis. The organs most commonly affected by this entity are kidney and gallbladder. Only a few cases involving the ovary have been reported. The etiology of this entity is unknown, but the associated risk factors are infection, inappropriate antibiotic therapy, use of intrauterine contraceptive device, abnormalities in lipid metabolism, endometriosis, leiomyoma, and recurrent pelvic inflammatory disease. The current case was a 31-year-old female with post-in vitro fertilization (post-IVF) twin pregnancy, who presented with pain in the abdomen, provisionally diagnosed as ovarian mass with suspicion of malignancy. Patient was treated with antibiotics and an elective lower segment cesarean section was planned, due to lower abdominal pain and the presentation of both fetuses being breech. Patient underwent exploratory laparotomy with right oophorectomy and left double-J stenting, in view of left hydronephrosis. Diagnosis of xanthogranulomatous oophoritis was established on histopathological examination. There is only a single case; previously documented from India, in the setting of primary infertility. The present case report stresses that the condition may affect women of any age group and may be encountered in pregnancy, as has been observed in this case. Hence, thinking about this differential diagnosis in the cases presenting with similar complaints, would be of great value to avoid misdiagnosing them.

082 Prenatal ovarian torsion: A case report

Objective: The present case report stresses how intriguing the prenatal diagnosis and management of fetal ovarian cyst may be, mainly with concern for ovarian torsion and its sequelae. Study design: we present a case of fetal ovarian cyst diagnosed at 33 weeks during routine prenatal ultrasound and complicated by in utero ovarian torsion; imaging findings on prenatal and postnatal ultrasound and postnatal MRI are shown. Discussion: Ovarian cysts are the most common cystic abdominal mass in female fetus and new-born babies [1].

The impact of covid-19 on a patient with a severely compromised permanent maxillary central incisor.

Abstract The SARS-CoV-2 pandemic situation led to public health measures that forced patients to remain isolated and take steps to prevent the dissemination of the virus. Many of these patients were unable to attend to the dental services or delayed seeking dental care due to a lack of private services and concerns about the SARS-CoV-2 outbreak, which in many cases complicated their situation. This case report describes the long-term clinical outcome of an endo-periodontal periapical lesion with associated bone defect of a maxillary central incisor in an esthetically demanding, systemically healthy patient, who neglected dental treatment during the pandemic outbreak. Treatment procedures included primary endodontic treatment of the periapical lesion and cause-related therapy aimed to control the infection in the rest of the mouth. Clinical examination at the 1-year recall revealed clinical attachment gain with shallow residual probing pocket depths and a slight increase in gingival recession. The esthetic appearance of the treated tooth was improved via a zirconia-ceramic crown. The present case report suggests that successful periodontal and esthetic results can be accomplished and maintained for at least 2 years after treatment of an apparently hopeless tooth with extremely compromised endoperiodontal conditions.

Atypical Unilateral SARS-CoV-2 Pneumonia in a Single Lung Re-Transplanted Patient: A Case Report

BackgroundSince December 2019, the SARS-CoV-2 pandemic significantly has impacted the medical community. When infected with SARS-CoV-2, most of the patients developed bilateral pneumonia. We have herein presented the atypical case of a patient who developed unilateral SARS-CoV-2 pneumonia, affecting only the second lung allograft re-transplanted (re-LTX).Case PresentationA SARS-CoV-2 infection occurred in a 2-dose vaccinated patient with LTx with a history of second unilateral lung transplantation performed after an end-stage bronchiolitis obliterans syndrome. The first symptoms started with a flu-like syndrome, and the patient's clinical condition worsened with nonsevere acute respiratory failure requiring conventional oxygen therapy. Treatment consisted in administrating specific anti-SARS-CoV-2 monoclonal antibodies along with probabilistic antibiotherapy, anticoagulation, and steroids. On day 7, the patient was discharged from hospital. We aimed to assess this atypical unilateral pneumonia based on different explorations. A ventilation scintigraphy showed a severe ventilation decrease owing to end-stage bronchiolitis obliterans syndrome within the left first allograft, which may be associated with asymmetrical virus diffusion between the 2 lungs. We did not identify any other relevant differences with respect to the 2 donors’ clinical characteristics. Using specific immunohistochemistry staining against angiotensin converting enzyme-2 receptor, the main known receptor for SARS-CoV-2 binding on airway epithelial cells, no staining difference was observed between the 2 lung biopsies that were collected at re-LTx from each lung.ConclusionsWith the present case report, we aimed to highlight how this kind of unusual presentation may be caused by the difference of ventilation between the 2 lungs.

Maxillary Sinus Osteoma as a Support for Dental Implant Associated to Sinus Augmentation Procedure: A Case Report and Literature Review

Background: Maxillary sinus augmentation is a method extensively used to restore sufficient bone volume in the posterior maxilla to allow for the placement of fixtures. The purpose of the present case report was to describe a rare case of sinus osteoma used for implant support and to review the relevant literature. Materials and Methods: A 58-year-old man with a radiopaque intrasinusal lesion was referred for rehabilitation of the maxilla. The lesion was probably an osteoma and involved the nasal wall of the maxillary sinus. After discussing the options with the patient, he agreed to maintain the lesion and a sinus augmentation with a bone graft. A part of the osteoma was partially removed for histological analysis while avoiding perforation or tearing of the schneiderian membrane. After six months, 6 implants (Bone System Implant, Milano, Italy) were placed in the maxilla, two of which were inserted in the osteoma. Results: The two implants placed in the osteoma were perfectly osseointegrated. The graft material appeared well-integrated with no local signs of inflammation. No postoperative events or symptoms were reported after the surgery stages and at a 6-month follow-up. Regarding the two implants placed in the osteoma: article selection identified 9 case reports, 2 case series, and 1 retrospective study for a total of 58 subjects, 35 males and 25 females. The patients’ ages were heterogeneous and ranged between 12 and 79 years old. Conclusions: In the present case, we decided to leave the osteoma because it was asymptomatic and used as dental implant support. The effectiveness of the present investigation can provide useful guidance for surgeons and dentists in the management of similar clinical situations.

Digital Implantology full mouth reconstruction by complete 3D virtual workflow

The present case report demonstrates a fully integrated digital protocol for pretreatment surgical & restorative implant planning and execution of a hopeless dentition. A 56-year-old female patient presented with a periodontally compromised failing dentition. Preclinical Protocol Aesthetic analysis was done in EXOCAD using DSLR photographs and a face scan (DOF). Further to that IOS (3shape Trios) STL file & CBCT Dicom file were integrated into the EXOPLAN software for virtual implant planning. A fully guided surgical stent was printed on the 3D printer (BEGO) and PMMA temporaries were milled for immediate loading. Clinical Protocol: Following full mouth extraction the surgical guide was placed with fixation pins. Seven active implants in the upper jaw & six in the lower jaw were placed and subsequently loaded with milled PMMA temporaries using multi-unit abutments. Upon healing, after 4 months intraoral scanning was done using a multi-unit scan body; function was restored using a customized milled titanium bar with Zirconia framework. We observed advantages such as simplification of clinical steps with accurate reproduction of proposed planning done prior with complete digital workflow. The entire process provided us extreme precision in delivering the temporary and final prosthesis as planned prior to the surgery. The patient was extremely satisfied with the treatment and the situation remained stable at follow-up. Fully digital implant workflow is restoratively driven and provides predictable aesthetic and functional treatment outcomes. The procedure requires additional training for the implantologist and has a learning curve.

A CASE STUDY OF GINGIVAL ACTINOMYCOSIS REPORTED TO KCD PESHAWAR

Background: Actinomycosis caused by saprophytic Actinomycess species123 is an infectious disease that frequentlycauses chronic granulomatous and suppurative lesions. Although the most common type of Actinomycosis is cervicalfascial, intraoral, and periodontal types rarely occur in a localized fashion4. Early and adequate differential diagnosisof Actinomycosis before therapeutic attempts and management steps are of great importance due to the opportunisticcharacteristic of actinomycotic infection.The present case report is about a patient with chronic periodontitis and a diffuse and atypical actinomycotic lesion,which was limited to the gingival region. The diagnosis was based on histopathological examination, the case’s history,and the lesion’s clinical nature.The patient responded to daily administration of Amoxicycllin 500mg TDS and Chlorhexidine mouthwash 0.2%rinse (following toothbrushing) performed with oral hygiene reinforcement and periodontal debridement monthly. Completeimprovement of the lesion was observed after 5 months.Study Design: A Case Reprot StudyDuration And Place Of Study: department at Khyber College of Dentistry Peshawar in March 2014 with achief complaint of burning mouth, pain in eating, ulceration, and bleeding.Keywords: Gingival actinomycosis, Actinomyces species, sulfur granules, antibiotic therapy, oral hygiene, periodontitis,KCD Peshawar

Latex bag contrast system for the diagnosis of oesophageal and rectal strictures in two cats

AbstractA common problem we often encounter during traditional contrast radiography is that contrast media are not adequately retained in the target region, especially during oesophagography and proctography. Patients with oesophageal disorders often have dysphagia or regurgitation, which increase the risk of aspiration pneumonia. Stercoroma in patients with rectal disease often prevents clinicians from obtaining good‐quality proctography for diagnosis. In the present case report, we introduce a novel contrast diagnostic system that has been used to diagnose oesophageal and rectal strictures. Latex bags (commercial latex condoms) are thin with good elasticity, producing a delicate interface for contrast filling, thereby providing better image quality. The watertight design of the latex bag system facilitates the retrieval of contrast media after radiographic examination. Furthermore, it significantly decreases the risk of aspiration pneumonia during the diagnostic process.

An unusual presentation of oral malignant melanoma: Disguising as a periapical granuloma

The present case report comprises of an unusual presentation of oral malignant melanoma which occurred in the furcation area of maxillary right first molar. A clinician may not suspect a malignant neoplasm and the histopathological examination of the tissue may be missed out in such cases. Without any obvious clinical or radiological features, the lesion mimicked a periapical granuloma. The diagnosis was achieved after a thorough histopathological examination and extensive immunohistochemistry panel to rule out other similar histopathological entities.

Successful Systemic Heparinization for Treatment of Acute Arterial Occlusion of Tibial Artery and Aortic Mural Thrombi in a Patient With COVID-19 Infection: A Case Report

The present case report described a 60-year-old woman who developed multiple isolated acute arterial occlusions of the left anterior tibial artery, peroneal artery, and posterior tibial artery with aortic mural thrombi in the infrarenal aorta during treatment of COVID-19 pneumonia. The patient underwent conservative treatment by systemic heparinization and switched to low molecular weight heparin. She experienced clinical improvement within hours of medical treatment and complete resolution of the tibial artery thrombosis after two weeks of treatment. The aortic mural thrombi was evaluated by computed tomography angiography (CTA) abdomen and lower extremities and resolved after six weeks of anticoagulant administration. Keywords: Acute limb ischemia; Aortic mural thrombi; Thrombosis; COVID-19

A case report of fatal feline babesiosis caused by Babesia canis in north western Spain

BackgroundIn Europe, Babesia infections in cats are sporadic and only partial knowledge is currently available since the number of described cases including both the clinical presentation and the molecular identification of the Babesia species involved is limited. In the present case report, the clinical signs, the epidemiological data and the molecular results suggest that this is the first reported fatal case of feline babesiosis caused by Babesia canis.Case presentationA six month old female European shorthair cat from north-western Spain died after being hospitalized for two days. This animal was pregnant and showed anorexia, lethargy, weakness, jaundice and fever with increased respiratory and heart rates. Haematological analysis revealed haemolytic regenerative anaemia, thrombocytopenia and leukocytosis. The presence of piroplasms was assessed using a PCR targeting the 18S rRNA gene of Babesia spp. and Theileria spp.; the sample resulted positive and B. canis was identified by DNA sequence analysis. The possible existence of co-infections with other vector-borne pathogens such as Anaplasma spp., Bartonella spp., Borrelia burgdorferi s.l., Cytauxzoon spp., Ehrlichia spp., Hepatozoon canis, Mycoplasma spp. or Rickettsia spp. was excluded by qPCR.ConclusionsOur results together with previous reports on Babesia infections in cats from Europe suggest that feline babesiosis should be included in the differential diagnosis of animals with anaemia, thrombocytopenia, anorexia and lethargy, especially in young or immunocompromised animals from endemic areas for canine babesiosis.

Transinusal Pathway Removal of an Impacted Third Molar with an Unusual Approach: A Case Report and a Systematic Review of the Literature.

Background: The purpose of the present case report was to investigate a very rare ectopic third molar removal by a trans-sinusal approach and report the study findings through a systematic review of the literature on this topic. Case presentation: A 38-year-old female patient was visited for pain at the level of the right maxillary region. No relevant medical history was reported. The CBCT tomography assessment revealed an impacted third tooth at the level of the postero-lateral maxilla. Review Methods: An electronic search was performed through Boolean indicators query on Pubmed/Medline, EMBASE, Cochrane Library databases. The clinical reports were identified and selected in order to perform a descriptive analysis. The surgical approach concerned a trans-sinusal access to the site for the ectopic tooth removal with a lateral antrostomy. No evident inflammatory alteration was associated to the ectopic tooth and a non-relevant post-operative sequelae was reported at the follow up. Results: A total of 34 scientific papers were retrieved from the database search. Only two cases reported a wait-and-see radiographical follow-up approach, while the most common treatment was surgical removal, also for asymptomatic cases. Conclusion: The third-molar ectopic tooth into the maxillary sinus is an uncommon occurrence that is beast treated by an in-chair intraoral tran-sinusal approach, with a consistent reduction of the invasivity, a mild morbidity and a successful functional outcome.

RAF-1 Mutation Associated with a Risk for Ventricular Arrhythmias in a Child with Noonan Syndrome and Cardiovascular Pathology.

IntroductionNoonan syndrome (NS) is a dominant autosomal disease, caused by mutations in genes involved in cell differentiation, growth and senescence, one of them being RAF1 mutation. Congenital heart disease may influence the prognosis of the disease.Case presentationWe report a case of an 18 month-old female patient who presented to our institute at the age of 2 months when she was diagnosed with obstructive hypertrophic cardiomyopathy, pulmonary infundibular and pulmonary valve stenosis, a small atrial septal defect and extrasystolic arrhythmia. She was born from healthy parents, a non-consanguineous marriage. Due to suggestive phenotype for NS molecular genetic testing for RASopathies was performed in a center abroad, establishing the presence of RAF-1 mutation. Following rapid progression of cardiac abnormalities, the surgical correction was performed at 14 months of age. In the early postoperative period, the patient developed episodes of sustained ventricular tachycardia with hemodynamic instability, for which associated treatment was instituted with successful conversion to sinus rhythm. At 3-month follow-up, the patient was hemodynamically stable in sinus rhythm.ConclusionsThe presented case report certifies the importance of recognizing the genetic mutation in patients with NS, which allows predicting the severity of cardiac abnormalities and therefore establishing a proper therapeutic management of these patients.

EEG Abnormalities During Delirium as a Prodromal Feature of Dementia with Lewy Bodies: A Case Report

Background:A 79-year-old woman was admitted to the Neurology Clinic of the University of Chieti-Pescara for a syncope. At admission, the occurrence of an acute stroke was ruled out. Her cognitive status was unimpaired. After three days from the hospitalization, the patient experienced an episode of mixed delirium.Objective:The present case report shows a case of delirium-onset dementia with Lewy bodies (DLB) with a specific electroencephalographic (EEG) pattern from its prodromal stage.Methods:Delirium was assessed by 4AT test. During the hospitalization, the patient underwent a quantitative EEG (QEEG) with spectral analysis. At six months from the episode of delirium, she was tested by neuropsychological evaluation, QEEG, and 18F-fluorodeoxyglucose PET/CT to assess the onset of a possible cognitive decline.Results:At baseline, the QEEG exam showed a dominant frequency (DF) in the pre-alpha band (7.5 Hz) with a dominant frequency variability (DFV) of 2 Hz. This pattern is typical of DLB at early stage. After six months, she reported attention deficits in association with cognitive fluctuation and REM sleep behavior disorder. The neurological examination revealed signs of parkinsonism. Cognitive status resulted to be impaired (MoCA = 15/30). QEEG recording confirmed the presence of a DLB-typical pattern (DF = 7.5 Hz, DFV = 2.5 Hz). The 18F-FDG-PET/CT showed a moderate bilateral posterior hypometabolism (occipital and temporal cortex), with relative sparing of the posterior cingulate cortex compared to cuneus/precuneus (Cingulate Island sign), and mild bilateral hypometabolism in frontal regions (suggestive of a DLB diagnosis).Conclusion:EEGs may represent supportive and validated biomarkers for delirium-onset prodromal DLB.

Amaurosis as Opening Diagnosis of Secondary Systemic Hypertension and CKD of Nontraditional Causes

Tubulointerstitial diseases are some of the causes of chronic kidney disease. The main focus of this presented case report is an example of Chronic Interstitial Nephritis (CIN). The case is about a 43-year-old male patient from Monterrey.

Case Report of a Peculiar Presentation of Hereditary Complement-Mediated Thrombotic Microangiopathy

Case Report of a Peculiar Presentation of Hereditary Complement-Mediated Thrombotic Microangiopathy