Clinical Case Presentation Research Articles

Understanding oral malignancies: 2 case reports

The clinical presentation, diagnosis, and management of several squamous cell carcinoma cases are covered thoroughly. Roughly 94% of all mouth malignancies are squamous cell carcinomas. Race, gender, and age group differences exist in annual incidence and mortality rates. This percentage is 7.7 per 100,000 in the US. Like other carcinomas, intraoral carcinoma is more common in older adults, especially in men. Individuals with oral SCC have often known about an abnormality in that area for four to eight months prior to seeking professional medical attention. Early growth is characterized by little discomfort, which may account for the delay in seeking professional assistance. The clinical manifestations of oral SCC include exophytic, endophytic, leukoplakic, and erythroplakic, all of which exhibit apparent surface alterations.Tobacco usage, excessive alcohol consumption, HPV infection, eating little fruits and vegetables, prolonged sun exposure, and having a compromised immune system are risk factors. Improving outcomes requires early discovery and treatment, which may include chemotherapy, radiation therapy, surgery, or a combination of these. In order to improve the prognosis for oral cancer, early identification and intervention are crucial. Survival risk from squamous cell carcinoma is often low. This article emphasis on the clinical presentation of oral malignancies.

Problems of prescribing immunosupressive therapy to a rheumatological patient with chronic viral infection. Clinical case presentation

In rheumatological practice, overlap syndrome (“overlap-syndrome”) is often encountered, which is manifested by the presence of diagnostic signs of more than one of the six classic systemic autoimmune diseases. The presence of chronic viral infections significantly complicates drug therapy. The article presents the history of the disease of a 46-year-old patient who was diagnosed with an overlap syndrome in the form of a combination of idiopathic polymyositis with antisynthetase syndrome and rheumatoid arthritis. The complexity of treating the patient was determined by the identification of active chronic viral hepatitis C. A multidisciplinary approach to the management of the patient in compliance with the principles of rational pharmacotherapy is described.

Periodic Bleeding from a Cesarean Section Scar Fistula.

We present the case of a 36-year-old woman who presented to our clinic for a second opinion. After multiple previous surgeries, she presented with an abdominal wound infection, which was initially treated conservatively. In the further course, catamenial bleeding occurred as an unusual symptom, and the suspicion of a fistula formation was postulated. Subsequent surgical repair and consecutive histopathological diagnosis revealed evidence of a fistula with endometriosis genitalis externa and thus gave an explanation for this striking clinical case presentation.

Anti-LAN Antibodies: Clinical Implications and Case Presentation

Abstract Introduction/Objective The LAN system, originating from the 901 Series of High Incidence antigens, transitioned to a recognized System in 2012. The LAN antigen, situated on ABCB6, a multipass membrane protein associated with porphyrin transport, plays a crucial role in heme synthesis. Functionally, LAN acts as an ATP-binding cassette transporter on the red blood cell membrane. Comprising a single antigen, LAN exhibits elevated expression in various tissues including the heart, skeletal muscles, fetal liver, mitochondrial membrane, eye, and Golgi apparatus. Notably, LAN shows no specific association with any particular geographic or ethnic group. Resistant to Ficin/Papain, Trypsin, α-Chymotrypsin, and 0.2M DTT, LAN antibodies primarily consist of IgG and necessitate IAT for detection. While Anti-LAN has been implicated in Hemolytic Transfusion Reactions (HTRs), its involvement in Hemolytic Disease of the Fetus and Newborn (HDFN) remains infrequent. LAN-negative blood is exceedingly rare, often requiring Monocyte Monolayer Assay Testing (MMA) for clinical assessment. Methods/Case Report Case Presentation: An 81-year-old female with a medical history including seizure disorder, hypertension (HTN), hyperlipidemia (HLD), gastroesophageal reflux disease (GERD), small bowel obstruction, and high-grade de-differentiated metastatic retroperitoneal liposarcoma presented for preoperative evaluation. A type and screen ordered as part of outpatient preoperative assessments revealed a positive antibody screen. Further investigation traced the origin of the anti-LAN antibody to an external facility since 2017. Antibody identification indicated the reactivity of the patient’s plasma with all cells (1+ AHG in PEG), excluding the auto control. Utilizing rare frozen antisera anti-LAN, the patient was phenotyped for LAN, yielding a LAN-negative status. Subsequent testing with three rare frozen LAN-negative group O cells aimed to exclude clinically significant antibodies. Differential adsorption, employing a comprehensive baseline RBC phenotype record obtained from the external facility, ruled out anti-E, anti-K, and anti-Fyb, thereby confirming Anti-LAN specificity. Results (if a Case Study enter NA) NA Conclusion The exceptional rarity of LAN-negative blood underscores the high prevalence of reactivity to Anti-LAN antibodies, exceeding 99% in most populations. In select cases, autologous transfusion may emerge as a viable management strategy. Consequently, the patient’s surgical procedure has been deferred, with no immediate requirement for blood products.

Cellulite Treatment With Electrotherapeutic Combinations: Cryolipolysis, Microcurrents, LED And Ultrasound N

Cellulite is a multifactorial condition present in 80% to 90% of post-pubertal women and is one of the most intolerable aesthetic imperfections. It is a morphological alteration of the integumentary tissue, directly interfering with self-esteem. There are several theories about the pathophysiology of cellulite, and several different therapeutic regimens have been developed, from topical treatments to mechanical or electrotherapybased devices. In this brief review, we summarize the scientific scenario to determine the clinical evidence regarding the safety and efficacy of cellulite treatment options. Clinical protocols and the author's experience using a combination of external procedures are also discussed. Therapies such as ultrasound and shock waves have shown improvements in cellulite and a good safety profile, but the combination therapy red LED, microcurrent, plate cryolipolysis and 40 kHz ultrasound have demonstrated the most beneficial results in cellulite reduction. Although there is a lack of scientific evidence for treatments that improve cellulite, future emerging options and their combination may pave the way to eradicating this aesthetic concern, Objective: The objective of this work was to review the literature on cellulite and the main electrotherapeutic resources used, to demonstrate the effectiveness of the technique that associates red LED before the cryolipolysis technique in a mobile handle and association with microcurrents and finishing with low frequency ultrasound in the licus system in the treatment of cellulite, reducing edema, inflammation and decreasing adipose tissue in addition to toning the dermis with the presentation of clinical cases. Materials and Methods: In this study, we performed a comprehensive review of all scientific articles available and indexed in PubMed and Web of Science in the last 20 years about this technology and its effects on cellulite. We discussed the scientific evidence available in clinical studies and analyzed the effects and possible mechanisms of action of LED, cryolipolysis, microcurrents and the use of 40 kHz ultrasound in cellulite. The treatments were performed with LED at 4 joulles per cm2, cryolipolysis technique with mobile plate and associated microcurrents, with intervals for reperfusion. We used 4 series of 5 minutes of freezing and in the intervals 3 minutes for return of circulation, that is, reperfusion without injury, and finished with 40 kHz ultrasound at 0.3 watts/cm2 for 2 minutes per cm2. We demonstrated the result after 4 sessions. Conclusion: In the author's opinion, a combined approach where combined approaches are used strategically and in a staggered manner to produce synergistic results has the best clinical outcome. For example, the use of red LEDs prior to the combination of microcurrents simultaneously with cryolipolysis and finishing with 40 kHz ultrasound in a weekly LICUS system can result in improvements in severe cellulite in approximately 2 months. More large-scale studies, particularly regarding combined approaches, need to be conducted to evaluate the long-term results of cellulite therapies in terms of safety, efficacy, and patient satisfaction. improve the appearance of cellulite, sometimes to a satisfactory degree, but never eradicate cellulite, as this involves extensive remodeling of the tissue. potential to be effective in lysing subdermal collagen, such as that seen in the dermal septa (the underlying cause of cellulite). References Despite multiple therapeutic approaches attempting to treat cellulite, no procedure has proven to be successful in the long term, requiring weekly or biweekly maintenance of treatment

Urinary tract infections with Burkholderia cepacia. A narrative review.

Burkholderia cepacia is an opportunistic Gram-negative bacillus that is found naturally in soil and water and usually causes respiratory infections in patients with cystic pulmonary fibrosis. Few cases of urinary tract infections with B. cepacia have been described in the literature, all of them clinical case presentations or case series. Therefore, we have compiled the data from the literature on this topic in a review to gain a better understanding of the etiopathogenesis, diagnosis and treatment methods of this disease. B. cepacia can lead to multidrug-resistant urinary tract infections in hospitals when surfaces and medical equipment are contaminated. The diagnosis is made after the onset of postoperative febrile syndrome or prolonged hospitalization in the intensive care unit. The evolution can be unfavorable, with the occurrence of sepsis and increased mortality.

Neuropsychiatric Symptoms in Rhombencephalosynapsis: A Clinical Report.

Rhombencephalosynapsis (RES) is a hindbrain malformation characterized by a missing cerebellar vermis with apposition or fusion of the cerebellar hemispheres. The present clinical case report provides a comprehensive, longitudinal overview of cognitive and affective manifestations in a 22-year-old patient with RES. The patient shows clinical signs of emotional reactivity and dysregulation, impulsivity, and impairments in executive functioning since early childhood. These features fit the constellation of neuropsychiatric symptoms observed in patients with congenital and acquired abnormalities of the posterior vermis. It is proposed that patients with RES may show affective and cognitive difficulties which increase their vulnerability to psychological stress and risk of developing mental health issues.

The Transformative Therapeutic Relationship: A Challenge and Opportunity.

The transformative therapeutic relationship is a unique interpersonal and intrapsychic phenomenon between analyst and patient. It occurs within the therapeutic framework, and is characterized by specific boundaries of time, place, and verbal and behavioral interactions. Collectively, these interactions may facilitate mutual trust, caring, respect, and affection between analyst and patient. The shared experience of the transformative therapeutic relationship can result in significant intrapsychic and interpersonal changes for both patient and analyst. Clinical case presentations are provided.

11 cases of peritoneal dialysis catheter penetrating into the intestinal cavity: case series.

The penetration of a peritoneal dialysis catheter into the intestinal cavity is a clinically rare complication. In the present retrospective clinical case series, 11 patients with uraemia who received continuous ambulatory peritoneal dialysis and attended hospital between 2019 and 2023 are described. The median patient age was 61.91 ± 11.33 years. All patients had previously experienced peritoneal dialysis-related peritonitis and were clinically cured by infusing sensitive antibiotics into the abdominal cavity. Colonoscopy was utilised to locate the penetrating catheter and close the perforation with a titanium clip once the catheter had been removed via an external approach. Following a 2-4-week fast, the perforations healed in all 11 patients. The present authors' experience illustrates that directly removing the catheter and clamping the perforation opening under the guidance of colonoscopy is simple to operate with few complications compared with traditional open surgery.

Basal Cell Carcinoma: Comprehensive Review with Emphasis on Scar Tissue Manifestation and Post-Vaccination Incidence.

Basal cell carcinoma (BCC) arising within scar tissue is a rare but clinically significant phenomenon. This comprehensive review aims to provide a succinct overview of the current state of knowledge regarding the etiological factors, pathogenesis, clinical presentation, and management of BCC. This study constitutes a literature review pertaining to BCC, with a particular emphasis on BCC developing within scar tissue. It also provides a clinical case presentation of a patient who had developed BCC in a BCG post-vaccination scar and a review of analogous findings available in the existing literature. Despite the fact that an array of mechanisms play a role in injury-related BCC growth, the main mechanism remains ambiguous and yet to be elucidated. The review also includes a detailed description of the various therapeutic options available for BCC, ranging from surgical interventions to novel pharmacological treatments. By examining these intersections, the review seeks to elucidate the potential mechanisms, identify risk factors, and suggest considerations for clinical practice. The findings underscore the importance of vigilant dermatological assessment in patients with scar tissue and those recently vaccinated, aiming to improve early detection and optimize management strategies for BCC.

Making decisions regarding language reconstruction Review of the topic and clinical case presentation

Making decisions regarding language reconstruction Review of the topic and clinical case presentation

Onset of Rheumatoid Arthritis with eye manifestations (clinical case report)

Objective. Rheumatoid Arthritis may onset with ocular manifestations. The purpose of our work was presentation of clinical case of the onset of rheumatoid arthritis with an eye lesion.Materials and methods. A clinical case of rheumatoid arthritis with an atypical onset was analyzed. As well, a search and review of relevant literature was performed.Results. Patient with rheumatoid arthritis got bilateral ulcerous keratitis, refractory to conventional treatment and complicated by bilateral corneal perforation with iris prolapse. Due to the atypical clinical course of ophthalmic lesions being insusceptible of medical treatment, the patient was examined further. Laboratory immunological workup revealed positive rheumatoid factor, anti-CCP and anti-MCV antibodies. The typical symmetric presentation of arthritis developed 8 months after the onset of ophthalmic disorders. Baseline therapy of rheumatoid arthritis has demonstrated efficacy both in controlling the joint manifestations and preventing relapse of keratitis.Conclusion. The development of eye syndrome may precede articular manifestation of rheumatoid arthritis. While managing patients with recurrent bilateral keratitis, rheumatologic pathology should be suspected.

Experience in treating multifocal alopecia areata in a child with Jak kinase inhibitors

Alopecia Areata is an autoimmune disease characterized by hair loss mediated by CD8 + T cells. There are no proven effective treatments for alopecia. Recent research on the immunology of hair follicles and recent developments in the field of immunopatogenesis, as well as common ways of developing the disease with other autoimmune disorders have led to research on new treatments, targeted at specific immunological pathways. The so-called JAK-STAT pathway is responsible for transmitting signal from different cytokines to the nucleus of the cell, suggesting that blocking this pathway may be effective in the treatment of alopecia.Study purpose. Presentation of Clinical Case of Multi-focal Alopecia Treatment in Child Oral Tofacitinib.Materials and methods. The study was conducted on the basis of the dermatology department with the laser surgery group of the Center for Pediatric Dermatology and Laboratory of Skin Pathology in children FGAU «National Medical Research Center for Children’s Health» of the Ministry of Health of Russia from April 2021 to November 2022. Severity Alopecia Tool (SALT) was used to determine the severity of the disease in participants. The SALT scale takes into account the percentage of affected hair and divides it into 6 subclasses (S 0 %, S1 <25 %, S2 25–49 %, S3 50–74 %, S4 75–99 % and C5100 %).Results. When oral tofacitinib was administered for 6 months in a 9-year-old patient, full recovery of hair growth on the scalp was observed. No significant abnormalities based on clinical and biochemical blood results were found for the period of treatment and for a year after withdrawal. There was no recurrence of hair loss after the withdrawal of the drug for 12 months.Conclusion. JAK inhibitors can be effective new treatments for alopecia in children. Additional data from randomized controlled trials are required for safe use of JAK inhibitors.

Presence of an included mesiodens. Report of a case

Introduction: Supernumerary teeth are additional teeth to the normal formula, in turn these can be retained; that is to say that they are prevented from erupting due to anomalies of position or situation. Objective: The objective of this work is to report the clinical case of an included mesiodens, its affectations in the oral cavity and the surgical treatment. Case report: A 20 year old male patient presented several dental malpositions; in addition to the radiographic examination (panoramic x-ray) the presence of a supernumerary tooth compatible with a mesiodens was observed, which due to its location was affecting the roots of the teeth and caused the partial extrusion of tooth 2.1 and the widening of its periodontal ligament. An occlusal radiograph was requested to establish the best approach. After the radiological diagnosis of the supernumerary tooth, surgical treatment was performed. Conlusion: In the present clinical case, the presence of impacted teeth is observed, indicating that some teeth have failed to fully emerge into the oral cavity. These impacted teeth may be causing dental misalignment, malposition and possible bite problems. Detailed radiographic evaluation and clinical analysis suggest the need to consider treatment options, such as extraction or surgical intervention, to allow proper eruption and restore optimal dental function and esthetics

A Rare Case of Adrenal Gland Metastasis from Parotid Adenocarcinoma: Unveiling the Potential Augmented Utility of FAPI PET/CT

Conventional imaging techniques, while essential, occasionally fall short in identifying elusive metastatic lesions, leading to delayed diagnoses and compromised patient outcomes. Gallium-68 fibroblast activating protein inhibitor (68Ga-FAPI) positron emission tomography/computed tomography (PET/CT), leveraging the distinct affinity of fibroblast activation protein for cancer-associated fibroblasts, emerges as a promising solution to bridge this diagnostic gap. Parotid gland adenocarcinoma is a relatively rare malignancy with metastasis typically occurring in regional lymph nodes and distant sites such as the lungs and bones. However, there have been limited reported cases of rare metastatic sites such as the adrenal gland. This exceptional case report details the clinical presentation, diagnostic workup, and management steps of a rare case of a 47-year-old female patient diagnosed with parotid gland adenocarcinoma with confusing metastasis to the ipsilateral adrenal gland which was confirmed later with a follow-up 68Ga-FAPI PET/CT scan. We aim to highlight FAPI unique ability to illuminate metastatic foci in challenging anatomical locations.

A retrospective observational study on disseminated herpes zoster in immunocompetent patients

IntroductionDisseminated herpes zoster (DHZ) is a severe infection associated with high incidences and mortality rates in immunocompromised patients. Although studies have shown its occurrence in immunocompetent patients, its epidemiology, clinical presentation, and treatment outcomes in this cohort remain unknown. Thus, this study aimed to examine the clinical presentation, treatment, complications, and outcomes of DHZ in immunocompetent patients and compare these findings with previous studies. MethodsWe included 20 immunocompetent patients of DHZ at our institution and reviewed 42 previously published cases. We then investigated the clinical features, predisposing factors, laboratory findings, treatment, and outcomes of all cases including in-hospital mortality, neurological dysfunction at discharge, and postherpetic neuralgia. We compared DHZ-immunocompetent patients to DHZ-immunocompromised patients. ResultsPatients had a median age of 71.5 years and were predominantly male. The trigeminal area was the most common site of initial rash, with a mean dissemination time of 6.5 days. Pain was the most common symptom, followed by fever (approximately 40 % of cases); acyclovir was the most used treatment. Additionally, the in-hospital mortality was 0 %, neuropathy at discharge was observed in approximately 10 % of patients, and postherpetic neuralgia was present in approximately 40 % of patients. In the immunocompromised cases, the mortality rate was 12 %, which was higher than in our cases; however, the rates of neuropathy and postherpetic neuralgia were lower. ConclusionsThis study provides new insights into the clinical presentation, treatment, and outcomes of DHZ cases in immunocompetent patients, highlighting its tendency for residual neurological damage despite having low mortality rates.

Clinical features, case presentation and prognostic variables in horses with partial and full thickness oesophageal perforation

Clinical features, case presentation and prognostic variables in horses with partial and full thickness oesophageal perforation

An unusual case of nodular fasciitis presenting as an intra-tendinous mass.

Nodular fasciitis is a benign soft tissue pseudotumour typically occurring in the upper extremities, head and neck, thigh and trunk. It is most commonly seen in subcutaneous locations but also can be present in intramuscular and intermuscular (fascial) locations. Its occurrence in the hand is rare, and while it can occur in close proximity to tendons, its presentation as an intra-tendinous mass has not been previously described. We present a unique and rare case of nodular fasciitis arising within the flexor digitorum profundus (FDP) tendon of the hand in a 16-year-old female. The patient presented with a painful swelling in the volar aspect of the base of her left middle finger, with progressive flexion deformity of the finger. Ultrasound and magnetic resonance imaging revealed a mass within the FDP tendon of the middle finger. An ultrasound-guided biopsy revealed a diagnosis of nodular fasciitis. Given the self-limiting nature of the condition, she was managed conservatively with close clinical and imaging follow-up. This case highlights the importance of considering nodular fasciitis in the differential diagnosis of an intra-tendinous lesion in the hand, even though it is a rare occurrence in this location. The clinical presentation, diagnostic workup, and management of this unique case are discussed, emphasising the potential for its misdiagnosis as a malignancy which can have important implications in management.

Impacted mandibular 3 molar- An enigma in diagnosis

The clinical presentation of third molar impaction cases differs from patient to patient. The different clinical aspects of mandibular third molar impactions include pain at the site or radiating pain in the jaw, trismus, cheek bite, difficulty in mastication abscess formation requiring incision and drainage. A significant number of cases are asymptomatic and are detected only on routine radiographic examination. A few cases also show unusual symptoms and clinical presentation. Hence the present case is intended to publish the unusual or the incomplete presentation, creating a diagnostic enigma.

Respiratory Syncytial Virus in Adult Patients at a Tertiary Care Hospital in Germany: Clinical Features and Molecular Epidemiology of the Fusion Protein in the Severe Respiratory Season of 2022/2023.

Following an interseasonal rise in mainly pediatric respiratory syncytial virus (RSV) cases in Germany in 2021, an exceptionally high number of adult cases was observed in the subsequent respiratory season of 2022/2023. The aim of this study was to compare the clinical presentation of RSV infections in the pre- and post-SARS-CoV-2 pandemic periods. Additionally, the local epidemiology of the RSV fusion protein was analyzed at a molecular genetic and amino acid level. RSV detections in adults peaked in calendar week 1 of 2023, 8 weeks earlier than the earliest peak observed in the three pre-pandemic seasons. Although the median age of the adult patients was not different (66.5 vs. 65 years), subtle differences between both periods regarding comorbidities and the clinical presentation of RSV cases were noted. High rates of comorbidities prevailed; however, significantly lower numbers of patients with a history of lung transplantation (p = 0.009), chronic kidney disease (p = 0.013), and immunosuppression (p = 0.038) were observed in the 2022/2023 season. In contrast, significantly more lower respiratory tract infections (p < 0.001), in particular in the form of pneumonia (p = 0.015) and exacerbations of obstructive lung diseases (p = 0.008), were detected. An ICU admission was noted for 23.7% of all patients throughout the study period. Sequence analysis of the fusion protein gene revealed a close phylogenetic relatedness, regardless of the season of origin. However, especially for RSV-B, an accumulation of amino acid point substitutions was noted, including in antigenic site Ø. The SARS-CoV-2 pandemic had a tremendous impact on the seasonality of RSV, and the introduction of new vaccination and immunization strategies against RSV warrants further epidemiologic studies of this important pathogen.