Present Case Report Research Articles

Seizures and prolonged recovery from general anaesthesia in a horse with guttural pouch mycosis undergoing bilateral arterial coil embolisation

AbstractAn 11‐year‐old Holstein mare was referred after profuse bilateral epistaxis due to fungal plaques. Clinical evaluation was unremarkable except for mild tachycardia. General anaesthesia was induced for coil embolisation of the left internal carotid artery, right external carotid and maxillary arteries. Under anaesthesia, cardiorespiratory stability was ensured, and six coils were deployed under fluoroscopy, whereas three previously deployed coils were found. During recovery from anaesthesia, generalised seizures, fast horizontal nystagmus and a breath‐holding breathing pattern were evident. Diazepam and medetomidine were administered, but the seizures resumed shortly after. After the administration of hypertonic saline solution and hydrocortisone, the seizures ceased. However, the horse remained unresponsive for 3 hours despite supportive care consisting of oxygen, glucose, fluid therapy and warming. Although a poor prognosis was presumed, the horse recovered after one attempt, 180 minutes after isoflurane cessation. The present case report highlights the importance of adequate support during recovery from anaesthesia.

Delayed hepatothorax: An unusual presentation case report.

Introduction and importanceWe are reporting a case of a delayed hepatothorax due to a right-sided diaphragmatic rupture 13 years after a blunt trauma due to a motor vehicle accident, who presented as isolated gastritis without any type of respiratory symptomatology.Case presentationPatient refers that his symptoms remained refractory to medical treatment and had gotten worse over time. Chest wall inspection showed asymmetric thoracic expansion and a decreased movement of right hemithorax when compared to the left. Cardiorespiratory auscultation was significant for growling sounds on the right second intercostal space and reduction of breath sounds on the right lower lobe region of the lung when compared to the left side.Clinical discussionThoracotomy was indicated since patient presented late. Meanwhile, laparotomy would have been appropriate if the patient had presented immediately after trauma. After the procedure, the patient presented in great condition and all the gastrointestinal symptoms associated with the traumatic diaphragmatic hernia had resolved. We propose that the absence of respiratory symptoms in our patient could be due to the progressive adaptation of small, cumulative changes in decreasing breathing capacity through time.ConclusionA case like ours has not been reported in the literature and clinicians should take this case report into consideration when suspecting a possible diagnosis of a delayed traumatic diaphragmatic hernia that may be complicated by a hepatothorax. We recommend maintaining a high index of clinical suspicion for hepatothorax due to delayed traumatic diaphragmatic hernia for all patients with a history of trauma.

Reduced corneal endothelial cell density after toxic anterior segment syndrome (TASS) caused by inadvertent intraocular ointment migration: A case report.

Introduction and importanceToxic anterior segment syndrome (TASS) is an acute sterile inflammation of the anterior segment which may occur after surgery. This case presents endothelial cell density (ECD) loss due to months of TASS caused by intraocular migration of ocular ointment. The chronicity of this case and the clinical consequences are rare in the literature.Case presentationA Colombian 71-year-old man developed TASS secondary to intraocular ointment migration after uneventful cataract surgery with phacoemulsification and intraocular lens placement in the capsular bag. The main complaint for the patient was a chronic red eye, no pain or visual disturbance were reported, rheumatologic diseases were discarded. It was documented the presence of intraocular ointment in the anterior chamber, over the iris and in the anterior chamber angle. The ECD was reduced secondary to TASS and the long-term presence of ointment moving in the anterior chamber, so it had to be removed.Clinical discussionIt is important to avoid using ocular ointment after intraocular surgeries to avoid the risk of ointment migration into the anterior chamber. Intraocular ointments should be removed promptly to reduce ECD loss as documented in the present case report in which after ointment elimination ECD remains stable for 7 years.ConclusionTopical ointments should not be used after routine cataract surgery because of the risk of intraocular ointment migration and subsequent risk of developing TASS and reduced ECD.

Rare case of 4 times ectopic pregnancy on the same site

In the present case report we discuss the factors that contribute to the recurrence of ectopic pregnancy in the interstitial area of the uterus. Interstitial pregnancies account for 2-6% of all ectopic pregnancies and carry a 2-5% mortality rate due to their potential to cause a life-threatening haemorrhage. Identification of early signs and symptoms of ectopic pregnancy is of paramount importance for the optimal management of these women.

Desmoplastic ameloblastoma of maxilla - A case report

Desmoplastic ameloblastoma is an unusual type of ameloblastoma which varies substantially from other variants of ameloblastoma. This case report describes a case of desmoplastic ameloblastoma in a 40-year-old male patient who presented with a swelling in the right maxillary anterior region which was painless in nature. The patient was apprehensive about the asymmetry caused by the massive tumor. Initially, conventional computed tomography was done, and the diagnosis was confirmed by histopathology. Surgical resection of the tumor was done, and a prefabricated prosthetic splint was given postoperatively. The surgical site healed completely, and there was no recurrence at 6-month follow up. The present case report emphasizes the specific histological features of the tumor. Due to its invasive nature, early intervention is needed to reduce the disfigurement, functional hindrance, and other complications caused by the tumor.

The Presence of Atypical Auditory Brainstem Response Waveforms in a Child with Normal Hearing

Auditory brainstem response (ABR) is an objective test typically carried out to estimate behavioral hearing thresholds among difficult-to-test children. The latencies of ABR waveforms are commonly used for hearing diagnosis. The available ABR normative data are utilized as guidelines by clinicians to identify the prominent peaks of ABR. In this paper, atypical ABR waveforms of a normal child were reported. Several useful points were highlighted from the present case report to guide clinicians to appropriately interpret the ABR results.

Oculocerebrorenal syndrome of Lowe: Oral findings

Lowe syndrome is characterized by abnormalities of the eyes, central nervous system and kidneys, caused by a mutation of the oculocerebrorenal gene on the X-chromosome. Oral features associated with this syndrome include enamel hypoplasia , chronic gingivitis and mobile teeth, with few studies focusing on these features. The present case report describes the oral and dental findings of a 10-year-old boy with Lowe syndrome, who was followed for 4 years. In spite of several treatment sessions and oral hygiene appointments, the chronic gingivitis with anterior fibrotic gingiva has increased over time, as well as the mobility of the anterior permanent teeth.

Clinical manifestations of exuberant leishmaniasis mucocutaneous: case report

Cutaneous mucosal leishmaniasis (LM) is a chronic infection that affects the upper respiratory tract and/or buccal mucosa and is caused by Leishmania protozoan parasites. A 71-year-old male smoker received dental care at the Stomatology Service of the Hospital Metropolitano Odilon Behrens (HMOB), after various appointments with medical specialists. He presented granulomatous and erythematous lesions on the skin of the nose, on upper lip mucosa, and along the entire soft palate and uvula, as well as the destruction of the nasal septum. Due to the suspicion of leishmaniasis, an incisional biopsy was performed. Histopathological examination was performed; however, polymerase chain reaction (PCR) and immunofluorescence were necessary to confirm the diagnosis of LM. The patient was treated with 27 doses of liposomal amphotericin B 20mg / Sbv / kg / day. Due to the lack of improvement, the patient was again hospitalized, and the medication was repeated adding Fluconazol 150mg, to which the patient showed significant improvement. The present case report shows an infectious lesion that is unusual in dental practice and its approach. The description of the characteristics and management, together with the pathological process, were presented.

Treatment of dentin hypersensitivity by association of chemical desensitizing agents: a case report

Background: Dentin hypersensitivity is an increasingly common complaint, especially among young people. It manifests as painful symptoms in areas of exposed dentinal tubules and is related to the patients' lifestyle. Aim: The present work aimed to address a protocol with chemical desensitizing agents in treatment of Dentin Hypersensitivity. Case report: The treatment was performed in a 22-year-old female patient who presented as the main complaint a moderate to intense degree sensitivity in anterior and posterior teeth. In the 1st and 2nd week, a neural action desensitizer based on potassium nitrate (Ultra EZ™ - Ultradent Products Inc) was used, while in the 3rd and 4th week, a desensitizer with an obliterating action based on calcium phosphates (Nano P™ - FGM Dental Products) was chosen. In the 5th week, another chemical occlusal desensitizer agent was applied, the 5% sodium fluoride varnish (Enamelast™ - Ultradent Products Inc). Results: The patient was successfully treated by the associative technique through neural and blocker desensitizers obtaining effective pain control in a18-month follow-up. Conclusion: The associative technique of different chemical desensitizers has shown extremely satisfactory results, which can be confirmed in the present case report.

Voriconazole injection may induce delayed methotrexate excretion: a case report and experimental study

BackgroundWe report a case of delayed excretion of methotrexate (MTX) in a pediatric patient on high-dose MTX therapy in response to a change in the concomitant dosage of voriconazole from oral to intravenous. As the intravenous, but not the oral formulation of voriconazole includes sulfobutylether-β-cyclodextrin (SBECD), which has an anionic residue, we hypothesized that SBECD inhibits the renal excretion of anionic compounds.MethodsWe evaluated the inhibitory effects of SBECD on renal excretion of phenolsulfonphthalein (PSP), which is eliminated in urine via organic anion transport systems. PSP was administered intravenously to rats at 2.5 and 25 mg/kg with or without SBECD pretreatment (320 mg/kg).ResultsThe plasma concentration of PSP at the dosage of 2.5 mg/kg were comparable between control and SBECD groups. On the other hand, at 25 mg/kg the elimination of PSP was delayed. The clearance of PSP at the dosage of 25 mg/kg was 9.71 ± 1.65 and 4.13 ± 0.76 mL/min/kg in control and SBECD groups, respectively (p < 0.05). This suggested that SBECD partly inhibits the renal excretion of anionic drugs.ConclusionThe present case report discusses the delayed elimination of MTX in high dose therapy and possible mechanism involving SBECD as an excipient in concomitant drugs. It seems better to avoid choosing injection containing SBECD for patients undergoing HD-MTX treatment. Further studies are needed to confirm the inhibitory effects of SBECD on the renal excretion of MTX, especially in high-dose regimens.

Large cystic-solid pulmonary hamartoma: A case report

BACKGROUNDIt now seems that all pulmonary hamartomas (PHs) are large cystic-solid lesions that are difficult to diagnose. However, few cases of large cystic-solid PHs have been reported. The present case report presents a large cystic-solid PH and provides a literature review of the imaging features, formation mechanism and histopathological basis of PHs.CASE SUMMARYA 53-year-old woman with no clinical symptoms underwent a chest computed tomography (CT) examination at our hospital. Nonenhanced CT images revealed a large, flat tumor with multiple air-containing cysts in the left thoracic cavity and a cystic part confined to the medial side of the tumor; the solid part of the tumor showed abundant fat and lamellar soft tissue components. Multiple small blood vessels were detected in the solid part of the tumor on contrast-enhanced CT images. Given the large size of the lesion, the patient elected to undergo surgery. Histological examination revealed PH. A detailed review of the patient’s CT imaging showed that the lesion had a small vascular pedicle to the left lower lobe, which was a clue to its lung tissue histological origin. According to immunohistochemical staining, the confined multiple air-containing cysts were caused by the entrapment of respiratory/alveolar epithelium.CONCLUSIONThis case shows the imaging manifestations of a large PH. Heightened awareness of its formation mechanism and histopathological basis may alert radiologists to consider this diagnosis in their daily workflow.

Haemophilia B- A coagulation disorder

Haemophilia is a group of inherited blood disorders in which blood does not clot properly. Bleeding disorders are due to defect in blood vessels, the coagulation mechanism or the blood platelets. When the coagulation factors are deficient, the blood does not clot properly and bleeding continues. Haemophilia is a X-linked recessive disorder that affects males, while the females are protected by normal gene on X-chromosome. Haemophilia-A is the most common genetic defect due to deficiency of Factor VIII while Haemophilia-B is the second most common genetic defect due to deficiency of Factor IX also called as Christmas disease.The present case report is of a 18-year-old male boy admitted in emergency wing of Government Medical College and Hospital, Jammu, who developed iliopsoas haematoma which after complete investigations revealed deficiency of clotting Factor IX.A report of presentation of a case of haemophilia-B.The present case report was done to demonstrate the sign and symptoms of haemophilia-B, complete haematological, bleeding and clotting test done for diagnosis and its treatment.The case of haemophilia-B presented with sudden inability to walk demonstrating right iliopsoas haematoma on ultrasonography. The patient was anaemic with haemoglobin – 7 gm%, TLC – 7000 mm and platelets 2.5 lakh/μl. The prothrombin time was decreased (10 seconds), activated partial thromboplastin time was increased (45 seconds), Factor VIII levels were within norrmal range, while Factor IX was decreased. Finally, a diagnosis of haemophilia-B was made.

Periosteum as Barrier Membrane: A Case Report

Introduction: The quest for finding a regenerative material for periodontal defects is everlasting. Numerous resorbable, nonresorbable, synthetic, and autogenous materials have been tried and tested in this regard. The periosteum has gained popularity in this field as it has exhibited osteogenic properties. The harvest of the periosteum is hassle-free and does not cause additional surgical sites. Case Presentation: The present case report demonstrates the successful use of the periosteum as a barrier membrane in the treatment of an intrabony defect. A 25-year-old female patient reported a complaint of food lodgement and bleeding gums. Clinical and radiographic examinations suggested an intrabony defect concerning the maxillary molar. The periosteum pedicle as a barrier membrane, along with bone graft, was used to treat the defect. Conclusions: The outcome was favorable in defect filling and soft tissue thickness.

Fracture of an unossified medial epicondyle: a case report of an unusual presentation diagnosed utilizing ultrasonography

Fracture of an unossified medial epicondyle: a case report of an unusual presentation diagnosed utilizing ultrasonography

A Novel Case of Sole Constitutional Nonhomologous Robertsonian Translocation rob(14;15) (q10:q10) in B-Cell Acute Lymphoblastic Leukemia

Robertsonian translocation is one of the major chromosomal rearrangements with an incidence rate of 0.1% of the general population. The current study presents a novel case of 18 years old male with complaint of high-grade fever was admitted at The Gujarat Cancer &amp; Research Institute, Ahmedabad, India for treatment. Molecular cytogenetic study revealed sole constitutional nonhomologous Robertsonian translocation rob (14; 15) (q10:q10) in a B-cell Acute Lymphoblastic Leukemia. The constitutional translocation might be associated with a degree of genetic instability within the probability of somatic cytogenetic changes leading to hematopoietic disorders and neoplasia. Thus, present case report therefore support the hypothesis of increased susceptibility of rob (14; 15) carriers to leukemia. However prognostic significance of constitutional cytogenetic abnormalities in Acute Lymphoblastic Leukemia has remained a matter of debate.

Dentigerous cyst in anterior maxilla- A case report

Dentigerous cyst is an odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. It is one of the most prevalent types of odontogenic cysts associated with an erupted, developing or impacted tooth, particularly the mandibular 3rd molars,the other teeth that are commonly affected are maxillary canines and third molars. The present case report describes an infected dentigerous cyst associated with impacted permanant maxillary canine managed with enucleation and surgical removal of the tooth.

Case Report: Medicolegal evaluation in a case of fatal scald where a child fell into a cauldron in rural Nepal

Thermal injuries in young children involving the buttocks, perineum, and lower limbs raise suspicion of child abuse. Determining the manner of death and ruling out homicide in a fatal case of scalding remains a challenge for forensic practitioners. One such issue is reported in the present case report, where a medicolegal evaluation of a fatal scald in a two-year-old girl child is discussed. Young children sustaining serious injuries from scalds is a grave social concern. Such young lives need to be protected from scald injuries whether accidental or purposeful. Differences in injury patterns on the basis of their distribution and their characteristics are important to determine manner of death in such cases.

Fibromuscular dysplasia of splenic artery – A case report of unusual clinical presentation

Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries. The disease typically affects the renal and extracranial carotid arteries, but it has been noted in most medium-sized arteries throughout the body, most commonly the mesenteric, external iliac and brachial arteries. Splenic artery aneurysms are uncommon, and their rupture is rare. Aneurysm of splenic artery associated with FMD is even rarer and only four cases of rupture of such aneurysms are identified in the literature, two of which were diagnosed postmortem, while all the cases presented acutely with haemodynamic shock.

Knee disarticulation following oncologic total knee arthroplasty: A 5-year follow-up case report

BackgroundThe present case report describes the 5-year follow-up results of an atypical knee disarticulation of a man previously treated with an oncologic total knee arthroplasty due to an Ewing sarcoma. MethodsThe patient presented an aseptic loosened tibial component of a tumor prosthesis system and requested final amputation, as he had previously suffered from five revision surgeries. To encourage the most functional outcome regarding an exoskeletal prosthesis, we decided to disarticulate the knee joint while retaining the currently fixed femoral component to create a full end-bearing stump. FindingsThe patient could be mobilized as a functional knee disarticulated amputee. Seven months after amputation, he showed a slightly less symmetrical gait compared to the preoperative status (preoperative mean Symmetry Index: 0.984 for kinematics and 0.940 for kinetics, 7-month postoperative Symmetry Index: 0.858 and 0.915). At the 5-year follow-up, the femoral component is still stably fixated and shows no loosening signs. In addition, the Symmetry Index increased to 0.908 and 0.949. InterpretationEven after 5 years, the presented amputation appears to be consistent with “conventional” knee disarticulation. The femoral component still withstands the altered loads and the patient shows a further improved gait pattern.

Expedited Digital‐Analog Hybrid Method to Fabricate a 3D‐Printed Implant Overdenture

The present case report describes a technique to convert an interim mandibular complete dental prosthesis into a digitally designed and additively manufactured implant overdenture prosthesis. A patient had two dental implants placed, an interim complete denture, and a soft reline procedure completed. After implant osseointegration, existing healing abutments were removed, a functionally generated reline impression with polyvinyl siloxane impression material was made. Using an intraoral scanner, a 360-degree optical scan was obtained of the relined interim prosthesis. A new prosthesis was digitally designed using the optical scan, additively manufactured, and housings picked-up intraorally to create an implant-retained overdenture.