Category Archives: Case Report

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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A Case of Plasmacytoid Dendritic Cell Leukemia

Köpeczi Judit Beáta1, Benedek I1,2, Benedek Erzsébet1, Kakucs Enikő1, Tunyogi Aliz1, Istrati Monica1, Kurtus Aranka1

1 Clinical hematology and Bone Marrow Transplantation Clinic, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0027

Introduction: Plasmacytoid dendritic cell leukemia is a rare subtype of acute leukemia, which has recently been established as a distinct pathologic entity that typically follows a highly aggressive clinical course in adults. The aim of this report is to present a case of plasmacytoid dendritic cell leukemia due to its rarity and difficulty to recognize and diagnose it.
Case report: We present a case of a 67 year-old man who presented multiple subcutaneous lesions on his face, neck, chest and upper extremities with reddish-brown, brown colour. In the bone marrow aspirate 83% of the blast cells were found. Immunophenotypically the blasts were positive for CD4, CD56, CD123 (high intensity), CD36, CD22, CD10 (10.42%), CD33, HLA-DR, CD7 (9.24%), CD38 (34.8%) and negative for CD13, CD64, CD14, CD16, CD15, CD11b, CD11c, CD3, CD5, CD2, CD8, CD19, CD20, CD34. The skin biopsy showed lymphohistiocytoid infiltration in the dermis. The patient was diagnosed with acute plasmacytoid dendritic cell leukemia and received polychemotherapy with rapid response of skin lesions and blastic infiltration of the bone marrow. After 3 courses of polychemotherapy the cutaneous lesions reappeared and multiplied. The blast infiltration in the bone marrow increased to 70%. A more aggressive polychemotherapy regimen was administered, but the patient presented serious complications (febrile neutropenia) and died in septic shock 8 months after the initiation of treatment.
Conclusions: Immunophenotyping of blasts cells is indispensable in the diagnosis of plasmacytoid dendritic cell leukemia. The CD4+, CD56+, lin-, CD123 ++high, CD11c-, CD36+, HLA-DR+, CD34-, CD45+ low profile is highly suggestive for pDCL. The outcome of plasmacytoid dendritic cell leukemia is poor. Despite the high rate of initial response to treatment, early relapses occur and the patients die of disease progression.

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Tattoo-Associated Skin Reactions — Clinical Cases

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-2013-0041

Tatooing has been practiced for thousands of years. It has become a common practice for people of Western countries in the last 10–20 years, where approximately 3–5% of the population has at least one tattoo. Various pigmented substances introduced into the skin may cause the occurrence of adverse irritative, immunological, infectious or other reactions of the skin. We present three clinical cases with adverse reactions after tattooing.

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Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy — a Clinical Case Report

Molnar C1, Tîlvescu C1, Neagoe VI1, Butiurca VO1, Molnar CV2, Copotoiu C1

1 Surgery Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Obstetrics-Gynecology Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0055

Introduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal flank are rare, but possible complications of laparoscopic cholecystectomy.
Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013 – 30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively.
Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development.

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Cor Triatriatum Dexter, a Very Rare Congenital Anomaly Presented in a Complex Pathological Context – Case Presentation

Gozar Liliana, Blesneac Cristina, Toganel Rodica

University of Medicine and Pharmacy Tirgu Mures

 

DOI: 10.2478/amma-2014-0035

Background: Cor triatriatum dexter is an extremely rare congenital anomaly, and in most cases, without hemodynamic significance. Congenital cytomegalovirus infection is the most common viral infection, the majority of infected infants being asymptomatic and only 5-15% being symptomatic in the neonatal period.
Case report: We present the case of a female infant, aged 3 months. Clinical examination reveals cranial and facial anomalies. The karyotype was normal. Laboratory tests revealed the presence of anti-CMV antibodies in urine. Imaging studies showed cerebral and renal anomalies. Echocardiographic exam revealed a congenital anatomical feature without hemodynamic significance – cor triatriatum dexter.
Conclusions: although cytomegalovirus infection is mostly asymptomatic, it can present as a complex pathological association, in which a congenital cardiac anatomical feature without hemodynamic significance, considered by some authors as an anatomical variant, can appear.

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