Category Archives: Case Report

The importance of early diagnosis and surveillance in Peutz-Jeghers Syndrome: A case report

DOI: 10.2478/amma-2023-0017

Introduction: Peutz-Jeghers syndrome is a rare autosomal dominant inherited disorder characterized by hamartomatous intestinal polyps and mucocutaneous pigmentation. Most cases appear to be linked to the mutation of the STK11 gene. Patients are at a lifetime risk of gastrointestinal and non-gastrointestinal cancers.
Case Presentation: The present study offers the case of this rare disorder in a young woman revealed by jejunal obstruction caused by intussusception. A 32-year-old woman was referred to the surgical department with symptoms suggestive of an obstructive syndrome. On examination, there were multiple perioral pigmented lesions. An urgent exploratory laparotomy revealed bowel obstruction caused by an intussusception with a large polyp. The patient suffered another similar episode 4 years before leading to the diagnosis of Peutz-Jeghers Syndrome, however she was under no surveillance. Patients with pigmented lesions and a family member suffering from the mentioned syndrome should perform endoscopy and genetic tests to diagnose early and avoid complications.
Conclusion: Peutz-Jeghers Syndrome is difficult to treat due to its nonspecific symptomatology and late diagnosis. Life-threatening complications such as intussusception and various types of cancer are unanticipated. It is vital to diagnose and perform routine screening, which will make it possible to prolong the survival of many patients.

Full text: PDF

Air guns: An underestimated danger – case presentation, literature review and legal interpretation

DOI: 10.2478/amma-2023-0013

Introduction: The compressed air weapon is a type of arm to which the projectile is propelled due to the compression of air in a sealed chamber. These types of weapons belong to the category of non-lethal weapons and ammunition subject to authorization. However, accidental fatal cases, suicides or even deaths with intention attributed to these types of weapons are described in the literature.
Case presentation: We are discussing the case of a 5-year-old boy who, at a picnic with several families, is shot and killed with a compressed air rifle, left unattended. The medical crew arrived at the scene could not save the boy’s life. Necroptic examination revealed a gunshot wound through the heart, with the projectile stuck in the lateral-internal wall of the right ventricle. The projectile identified was a metal type projectile (lead), with a length of 8.5 mm and a diameter of 4.5 mm.
Conclusions: Compressed air weapons, although considered non-lethal, have proven over time their extremely dangerous potential through the fatal injuries produced. Raising public awareness, limiting use and enforcing strict legislation could prevent tragic events.

Full text: PDF

Post maxillectomy definitive rehabilitation in post-covid mucormycosis patients using conventional and 3D printed obturator: A twin case report

DOI: 10.2478/amma-2022-0032

Maxillectomy is the surgical removal or resection of the maxilla or upper jaw bone. Maxillectomy may be total or partial. It is performed during surgical treatment of cancer and infections (bacterial. fungal) of the oral cavity, nasal cavity and maxillary sinuses. Patient affected from post-Covid mucormycosis require local debridement or surgical resection resulting in maxillectomy. After surgery, patient has difficulty in mastication, speech, and swallowing because of communication between oral and nasal cavity. This may also give rise to psychological challenges and social exclusion. The prosthodontic rehabilitation of such patient using obturator provide a separation between oral and nasal cavity and improve the quality of life of the patient. There are various techniques and materials used for fabrication of definitive obturator. This article discusses the prosthodontic rehabilitation after maxillectomy in post-covid mucormycosis patients using obturator by conventional and 3D printed techniques.

Full text: PDF

Non-surgical approach to a paediatric pilocytic astrocytoma with MRI follow-up. Case report and brief literature review

DOI: 10.2478/amma-2022-0022

Introduction: Pilocytic astrocytoma is a common tumour in paediatric patients. A low-grade glioma, it is most commonly treated by surgery, with various post-surgical side effects. New methods of treatment and follow-up are constantly evolving to offer alternative options to paediatric patients whose nerve structures are developing.
Case presentation: A 9-year-old patient diagnosed with a pilocytic astrocytoma by MRI and histopathological examination underwent a biopsy and evacuation procedure of the cystic component after which the patient’s condition improved significantly. The ‘wait-and-see’ approach using MRI instead of total surgical excision of the tumour was preferred, and the patient had favourable results on control imaging.
Conclusions: Paediatric patients suffering from pilocytic astrocytoma with favourable imaging and histopathological features may consider MRI follow-up instead of surgical excision until the character of the tumour changes or until the brain has reached full development.

Full text: PDF

Digitally designed fixed dental prosthesis with stress breaking effect using non-rigid connector for pier abutment: A case report

DOI: 10.2478/amma-2022-0033

Rigid connectors between pontic and retainer are preferred way of fabricating fixed partial dentures for many decades as they provide desirable strength, retention and stability to the prosthesis. However, it is not ideal for cases such as lone-standing abutments (pier abutment), maligned teeth where occlusal stress can extrude the restoration. This may lead to marginal leakage and secondary caries on the abutment teeth. Conversely, it is recommended to use non-rigid connectors which act as a stress breaker, where the tensile stresses are concentrated on the surrounding bone and not on the connectors. With advancement in digital technology in dentistry, the non-rigid connectors can be fabricated using additive manufacturing technology. The present case report discusses the Direct Metal Laser Sintering (DMLS) designed fixed dental prosthesis with key and keyway (Tenon and Mortise) non-rigid connector for rehabilitation of pier abutment in maxillary posterior region.

Full text: PDF

Single-plaque psoriasis: a single-clue diagnostic challenge

DOI: 10.2478/amma-2022-0019

Introduction: Psoriasis is a chronic, common immune inflammatory condition of the skin, affecting 2-3% of the population, with regional variability. Classically, psoriasis presents as one of the following types: plaque, guttate, inverse, pustular or erythrodermic psoriasis. Typically, the patient will present with several symmetric psoriatic plaques on typical areas of the body, leading the clinician towards the diagnosis of psoriasis.
Case report: The present case report series focuses on an atypical presentation of psoriasis noted in 2 patients who presented to our office with a single large, erythematous plaque located on the lower leg. Due to poor response to previous treatment, a biopsy was performed and upon analysis, revealed a diagnosis of psoriasis. The lesions showed significant improvement under local therapy.
Conclusion: In spite of significant research on such a common and seemingly well-understood dermatosis, the present case reports plead for further study with regards to atypical presentations of psoriasis.

Full text: PDF

Reattachment of coronal tooth fragments: Aesthetic management of a complicated anterior maxillary crown fracture

DOI: 10.2478/amma-2022-0027

The trauma of anterior teeth is a frequent occurrence in young patients. Reattachment of fractured fragments is one of the various treatment modalities proposed in anterior tooth coronal fractures. The reattachment of fractured fragments grants the advantage of immediate aesthetic rehabilitation and restoration of function, which is a relatively rapid and less arduous procedure. The manuscript presents a case report depicting the management of a complicated crown root fracture of anterior maxillary teeth first treated endodontically, followed by reattachment of the same fragment with a cast post-reinforcement. Reattachment of fractured coronal tooth fragments is a feasible restorative option, rapidly restoring the function and aesthetics of the tooth by a conservative and inexpensive approach.

Full text: PDF

Unusual case of infrarenal pheochromocytoma developed on ectopic adrenal tissue: An autopsy case report

DOI: 10.2478/amma-2022-0025

Introduction: Pheochromocytomas are catecholamine-secreting tumors arising from the chromaffin cells of the adrenal medulla. We describe an unusual case of pheochromocytoma located in the infrarenal area and associated with bilateral adrenal hyperplasia.
Case presentation: A 70-year-old patient was admitted for syncope, diaphoresis, and high blood pressure. Computed tomography showed a 73x70x72 mm retroperitoneal mass of the left infrarenal area. High levels of metanephrine and noradrenaline were found in the urine. A tumor resection was performed. A few days after surgery, the blood pressure suddenly decreased and could not be restored, resulting in the death of the patient. Histopathological examination of the surgical specimen revealed a proliferation of monotonous cells, with eosinophilic cytoplasm, round nuclei with prominent nucleoli arranged in clusters, and capsular and vascular invasion. The tumor cells expressed synaptophysin and chromogranin, without positivity for inhibin A or S100 protein. At the autopsy, both adrenal glands showed hyperplasia but unrelated to the tumor mass. The histological aspect, location, and immunophenotype indicated an ectopic infrarenal pheochromocytoma.
Conclusions: In patients with pheochromocytoma developed on ectopic adrenal tissue, clinical management might be difficult, and diagnosis can be sometimes established only based on post-mortem histopathological examination. Autopsy can be extremely useful in such cases with unexplained evolution.

Full text: PDF

Postpartum pancreatitis in young female – a rare case in the Emergency Department

DOI: 10.2478/amma-2022-0018

Introduction: Acute pancreatitis is a condition that leads to multiple organ failure syndromes if not diagnosed and treated correctly. The most frequent causes of acute pancreatitis are gallstones, alcohol consumption, and elevated triglyceride serum level.
Case Presentation: A 21-year-old female presented to the emergency department with epigastric pain, nausea, vomiting, and diaphoresis. The patient had a non-complicated vaginal birth four months prior, had no personal history of illness, reported no alcohol consumption, and had a slender body constitution. Laboratory tests outlined a white blood cell count of 22.000/µL, elevated neutrophil count, lactate dehydrogenase 294 U/L, and lipemic serum sample reported for chemistry laboratory test. In addition, the contrast-enhanced computed tomography scan revealed severe pancreatitis, with an intraabdominal fluid collection.
Conclusions: This case report highlights the importance of correct early diagnosis in the postpartum and late postpartum period and raises awareness concerning the possibility of acute pancreatitis in a postpartum woman even if she does not have the two most common risk factors: gallstones or alcohol consumption.

Full text: PDF

Development of a low-grade glioma in an ischemic brain territory that evolved into a glioblastoma. A case report and brief literature review

DOI: 10.2478/amma-2022-0015

Introduction: Glioblastoma is one of the most common and aggressive brain tumours with a very high mortality rate. It often evolves from a late or misdiagnosed astrocytoma. Stroke is one of the most common pathologies of the brain, affecting approximately 1.1 million Europeans each year. This article presents the sequential development of a low-grade astrocytoma in an ischemic brain territory into a high-grade glioblastoma.
Case presentation: A 59-year-old patient presented to our hospital with severe headache and transient loss of balance and vision. Clinical findings and control imaging revealed the presence of an ischemic brain area in the left temporal lobe of the brain. Monthly brain magnetic resonance imaging (MRI) follow-up revealed the development of a low-grade astrocytoma in the ischemic territory, which later evolved into a glioblastoma.
Conclusions: Patients who suffer from a stroke should be closely monitored via MRI to prevent the rare development of tumour pathology in the affected territory.

Full text: PDF