Category Archives: Case Report

Complex Multitrauma Patient: Head, Thorax, Abdomen and Limbs

Gomotîrceanu F1, Ghiga Dana2, Petrişor M3, Haifa B3, Băţagă T1

1 County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Department of Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Multiple trauma represents the main cause of death in 40–50 years old patients. It requires a rigorous management of the critical patient to ensure a correct order in the performed maneuvers and a maximum efficiency.
Case report: We report a case of a 27 year-old patient with multiple trauma, victim of a train accident. The patient arrives with the presumptive diagnosis of multiple trauma due to train accident, open acute craniocerebral trauma, suspicion of acute subdural hematoma. After the evaluation in the emergency service, the patient was transferred to the Tîrgu Mureş Surgery Clinic, where an emergency intervention was performed. Any of the lesions presented (abdomen, thorax, extremities and head lesions) were able to produce the patient’s death by themselves.
Conclusions: The survival chances of multiple trauma patients increase due to a rigorous management and the application of a standardized evaluation protocol.

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Livedoid and Gangrenous Dermatitis (Nicolau Syndrome)

Fekete GyL1, Fekete Júlia Edit2

1 Department of Dermatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Public Health Center, Tîrgu Mureş, Romania

Livedoid and gangrenous dermatitis is a rare posttherapeutic accident, produced by intravenous, intramuscular or intra-arterial drug injection under an oily or suspension form. It was first described by Stefan G. Nicolau in 1925 after injections of bismuth. The progression of the disease is favorable most cases are cured after 6–8 weeks. We present a clinical case of a patient aged 74 years.

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Multifocal Sarcomatoid Carcinoma of the Small Intestine

Fülöp Emőke1, Marcu Simona Tünde1, Loghin Andrada1, Fülöp EF2, Mocan Simona3

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Sarcomatoid carcinomas (SCs) or carcinosarcomas are rare, biphasic tumors, with poor prognosis, only rarely located in the small and large intestine. The first treatment option of these tumors is surgical approach, adjuvant therapy showing no important role in the treatment protocol. We present the case of a 63 years old male patient, hospitalized in the Surgical Department II of the County Emergency Clinical Hospital Tîrgu Mureş with the diagnosis of small intestine tumor with jejunal localization. Microscopically, in hematoxylin-eosin (HE) staining, the tumor was consisting of two components, an epithelial and a mesenchymal one. From immunohistochemical point of view, tumor cells were strongly positive for cytokeratin AE1/AE3 as well as for vimentin. They were negative for epithelial membrane antigen (EMA), CD117, CD34, S100, chromogranin-A and synaptophisin. Based on the macroscopic and microscopic appearance, respectively the immunohistochemical feature of the tumor, the patient was diagnosed with multifocal sarcomatoid carcinoma of the small intestine.

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Particular Clinical-Therapeutic Aspects of Rhinophyma — Atypical Case Report

Andrei Liliana1, Bordeianu I2, Iordache IV2, Bratu I3

1 Hypocrate Medical Center, Tulcea, Romania
2 Faculty of Medicine, Ovidius University, Constanța, Romania
3 Faculty of Pharmacy, Ovidius University, Constanța, Romania

The authors present a case of pseudotumoral rhinophyma with some specific and rare clinical, evolutional and therapeutic aspects. Therapeutic indication was put on functional rather than cosmetic reasons, and surgery led to good functional and cosmetic results, accompanied by a fast spontaneous-directed epithelialization.

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Alternative Therapeutic Strategy in Peripheral Arterial Disease of Lower Limbs

Popa Setalia1, Aursulesei Viviana2,5, Baroi Genoveva3,5, Ivanov Anca4,5, Miron Ingrith4,5, Datcu DM2,5

1 PhD student, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
2 Department of Cardiology, Ist Internal Medicine Clinic, “Sf. Spiridon” Hospital, Iași, Romania
3 Vascular surgery Clinic, “Sf. Spiridon” Hospital, Iași, Romania
4 Haemato-Oncology Clinic, “Sf. Maria” Hospital, Iași, Romania
5 “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania

Background: Treatment in peripheral artery disease consists mostly in symptoms management and measures to stop the progression of atherosclerosis. New therapeutic opportunities are opened by current research; they are based on angiogenesis induced by stem cell therapy and growth factor administration. Bone marrow is a rich tissue in cells and growth factors, and it was observed that in bone fracture hematoma, the angiogenesis is induced currently as a vascular response to injury.
Case report: A 42 year-old male patient with peripheral artery disease. The diagnosis was confirmed through angiography, and the surgeon confirmed the impossibility of revascularization. In consequence, the patient was proposed for vasodilatation treatment with prostaglandins. After one month with no improvement, the patient insisted to find a new possibility of treatment, thus we decided to use adult self stem cells from bone marrow. Sixty ml bone marrow aspirate was taken under local anesthesia from the iliac crest and injected intramuscular in the middle outer part of the thigh and gastrocnemian area in 38 injection sites. The patient was followed up for 6 months and we observed an improvement of clinical symptoms, walking perimeter and ankle brachial index.
Conclusion: This is the first case where we tried an innovative therapeutic strategy in a young patient with no other revascularization opportunity, with a benefic result.

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Atrophoderma Vermiculata – Case Report

Fekete GyL1, Fekete Júlia Edit2

1 Department of Dermatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Public Health Center, Tîrgu Mureş, Romania

Atrophoderma vermiculata is a rare genodermatosis probably inherited in an autosomal recessive pattern, characterized by follicular inflammation and atrophy. Together with keratosis pilaris atrophicans facies and keratosis follicularis spinulosa decalvans it belongs to a group of closely related conditions, characterized by keratosis pilaris and atrophy of the skin. Clinical manifestations with reticular atrophy of the skin in a honeycomb appearance are characteristic. The course is generally slow, with progressive worsening. We report a clinical case of a 59 year-old woman who presented a symmetric reticular atrophy of the face, which appeared when she was 18 years old, with progressive worsening in the last 3 years. The lesions were located on the forehead and cheeks, without any clinical symptoms. The disease is considered rare, the true incidence is unknown.

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Chondrodermatitis Nodularis Helicis

Fekete GyL1, Fekete Júlia Edit2

1 Department of Dermatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Public Health Center, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0013

Chondrodermatitis nodularis helicis is a rare and well defined clinical condition, characterized by the appearance of painful nodule or nodules located on the helix. Affects mainly white men, aged 50 and more. The pathogenesis of the disease is unclear. The used treatments gives excellent results, but the disease tends to relapse. We present a clinical case of a young man of 38 years of age with a painful nodule located on the left ear.

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Two Cases of Dorsal Urethral Duplication

Gozar H, Prișcă RA, Derzsi Z

Department of Pediatric Surgery and Orthopedics, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0012

Urethral duplication is a rare congenital anomaly. In addition to a normally urethra, there is an accessory urethra arising from the bladder or the proximal urethra which may open anywhere on the penis or even on the perineum. Many patients with this malformation are asymptomatic. Some patients may complain of intermittent discharge from the accessory urethra, incontinence, infection, double streams or stricture. The duplicated urethra may be complete or incomplete, may be located dorsal, ventral or in Y-type. The treatment of urethral duplication is individualized, depending on the type of malformation. We report two cases of dorsal urethral duplication discovered in two boys.

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Possibilities and Difficulties of Treatment in the Case of a Pregnant Patient with Primary Mediastinal Large B-cell Lymphoma

Benedek Lázár Erzsébet1*, Köpeczi Judit Beáta1,2*, Tunyogi Aliz Beáta1,2, Kakucs Enikő1,2, Cătană Alina3, Benedek I1,4

1 Clinical Hematology and BMT Unit, Tîrgu Mureş, Romania
2 PhD candidate, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 County Emergency Clinical Hospital, Sibiu, Romania
4 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
* Authors have equal contributions

DOI: 10.2478/amma-2013-0011

Background: There are several histologic variants and clinical subtypes of diffuse large B cell lymphoma, which includes the primary mediastinal large B cell lymphoma (PMBL). In the last 10 years the incidence of diffuse large lymphomas grew significantly.
Case report: We present the case and evolution of an aggressive life-threatening mediastinal B cell lymphoma with respiratory insufficiency, diagnosed in the 27th week of pregnancy. After 4 courses of R-CHOP the clinical status has somewhat improved, but the dyspnea, the facial and neck oedema and the trouble of speech persisted. After the patient was admitted to our hospital, she received DHAP regimen followed by mobilization with G-CSF. Before transplantation we administered another 3 courses of DHAP chemotherapy with spectacular results. We performed autologous hematopoietic stem cell transplantation preceded by BEAM chemotherapy. At present, 5 years post-transplant the patient is well, with no metabolically active disease on the PET-CT performed 3 months ago.
Conclusion: We can conclude that even in very complicated DLBCL cases, with a very good, efficient medical-team work we can salvage lives, in our case both of the mother and the child’s. Even in partially chemo-refractory cases like in the presented one, salvage chemotherapy followed by autologous transplantation can lead to a successful treatment.

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Ulcerative Colitis associated with Sclerosing Cholangitis and Autoimmune Hepatitis

Hoduț A, Simedrea I, Sabău I, Belei Oana, Babi Ionela

First Pediatric Clinic, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania

DOI: 10.2478/amma-2013-0028

Introduction: Ulcerative colitis is a chronic intestinal inflammation, part of inflammatory bowel disease, which also includes Crohn’s disease. Both have extraintestinal manifestations, but those that tend to occur more commonly with ulcerative colitis include chronic active hepatitis, pyoderma gangrenosum and ankylosing spondylitis. Many individuals present with overlapping non-diagnostic features of more than one of these conditions that is referred to in the literature as autoimmune overlap syndrome. Sclerosing cholangitis associated with IBD is often referred to as overlap syndrome.
Material and methods: We present the case of a 15-year-old female, with an association between ulcerative colitis, primitive sclerosing cholalangitis and autoimmune hepatitis. She was admitted for: diarrheic bloody stools, abdominal pain, diminished appetite, headache and aphthous stomatitis. Blood sample analysis revealed: hypochromic anemia, iron deficiency, high levels of transaminase, abnormal protein electrophoresis, positive anti-neutrophil cytoplasmic antibodies and anti–smooth muscle antibodies, high level of faecal calprotectin, modified biliary tract on imaging of digestive system and suggestive modifications of colic mucosa for ulcerative colitis. We administered treatment with Arginine Chloride 5%, Sorbitol 10%, Aspartic acid, Vitamin B6, Ursodeoxycholic acid, 5-aminosalicylic acid.
Results: With the administered therapy the evolution was good, macroscopic blood disappeared from stools, and tests for blood trace in stool were also negative.
Conclusions: The patient had simultaneous onset of diarrhea with bloody stools and extraintestinal manifestations. Immunological markers didn’t fully match any of the associated diseases, so we concluded that there was an overlap syndrome. Budesonide was effective on both hepatic and intestinal disease.

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