Category Archives: Case Report

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

Manu Rathee, Santhanam Divakar, Prachi Jain, Sandeep Singh, Sujata Chahal, Sarthak Singh Tomar

Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

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.

Keywords: direct metal laser sintering, fixed dental prosthesis, non-rigid connectors, 3D printing, pier abutment

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Single-plaque psoriasis: a single-clue diagnostic challenge

Luminita Emilia Decean¹, Roxana Flavia Ilies², Andreea Sasu³, Iulia Barsan⁴, Adriana Mihai¹

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
3. First Psychiatric Clinic, Targu Mures County Hospital, Romania.
4. Elitemed Anatomical Pathology Laboratory, Targu Mures, Romania

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.

Keywords: single plaque, unilateral, psoriasis, histopathology

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

Preethesh Shetty¹, Raksha Bhat¹, Arjun Kini²

1. Nitte (Deemed to be University), AB Shetty Memorial Institute Of Dental Sciences (ABSMIDS), Department of Conservative Dentistry and Endodontics,
Mangalore, India
2. New York University College of Dentistry, New York, NY, USA.

DOI: 10.2478/amma-2022-0027

Keywords: endodontics, tooth fractures, incisors, esthetics, trauma

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

Rebeca Chiciudean¹, Ioan Jung², Tivadar Bara³, Simona Gurzu^1,2,4

1. Department of Pathology, Clinical County Emergency Hospital, Targu-Mures, Romania
2. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu-Mures, Romania
3. Department of Surgery, Clinical County Emergency Hospital, Targu-Mures, Romania
4. Research Center of Oncopathology and Translational Medicine (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania

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.

Keywords: adrenal hyperplasia, pheochromocytoma, metanephrine

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

Adrienn Nemeth^1,2, Puiu Popescu²

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Emergency Department, Emergency County Hospital, Targu Mures, Romania

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.

Keywords: acute pancreatitis, postpartum, abdominal pain, hypertriglyceridemia

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

Andrei-Cristian Fülöp¹, Zeno Opriș¹, Eugen-Francisc Fülöp², Ioana-Geanina Ghilință³, Rita Szodorai⁴, Attila Kövecsi⁴

1. Department of Radiology, Emergency County Hospital, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Paediatric Cardiology, Emergency County Hospital, Targu Mures, Romania
4. Department of Pathology, Emergency County Hospital, Targu Mures, Romania

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.

Keywords: astrocytoma, magnetic resonance imaging, stroke, glioblastoma

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Non syndromic congenital agenesis of multiple permanent teeth: Case series and recent literature review

Sowmya Sridhar¹, Savil R Uchil¹, Anupama P Nayak¹, Ravikiran Ongole², Suprabha BS¹, Ashwin Rao¹, Karuna YM¹

1. Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2. Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI: 10.2478/amma-2022-0013

Introduction: Hypodontia refers to the congenital absence of less than six teeth. This absence may be unilateral or bilateral. Though the congenital agenesis of bilateral mandibular/ maxillary incisors has often been reported in literature, however, the congenital absence of bilateral mandibular and maxillary incisors, as well as the mandibular second molar- giving rise to a total of six missing permanent teeth in an apparently healthy individual has not been reported earlier.
Case presentation: This case series presents two cases of a 10- and 11-year-old children with presence of retained deciduous anterior in both arches with absence of permanent successors and also aims to review the literature regarding etiology, clinical implications and management in such cases.
Conclusions: It is essential that practitioners monitor the developing dentition with establishment of a proper review schedule. Non-eruption of the permanent tooth more than one year later than expected, or even after six months following the emergence of the contralateral tooth, warrants a high degree of suspicion. A multidisciplinary team, including pediatric, restorative and orthodontic specialists, is advised. In addition, prior to formulation of any treatment plan, due consideration to the general issues such as the patient’s systemic and oral health, motivation and expectations should be given.

Keywords: congenital agenesis, hypodontia, permanent teeth

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Use of the continuous glucose monitoring system in the management of hypoglicemia in insulin autoimmune syndrome

Andrada Raluca Pop¹, Claudia Emanuela Ruscanu², Gabriela Roman¹, Ionela Maria Pascanu²

1. Diabetes Center, Emergency County Hospital Cluj Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
2. Endocrinology Center, Emergency County Hospital Targu Mures, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0011

Background: Insulin autoimune syndrome (IAS), also known as Hirata’s disease, is a rare cause of spontaneous hyperinsulinemic hypoglicemia characterised by the presence of autoantibodies directed against human insulin (IAA).
Case Report: A 48-year-old Caucasian female patient with IAS was studied in two different periods, for 7 days each, using a continuous monitoring system (CGM) under various treatment regimens, i.e diet modification and corticosteroids therapy.
Discussions: The use of CGM in autoimmune hypoglycemia is encouraged and must be taken into consideration in order to prevent episodes of hypoglicemia. Including of IAS and quantification of IAA in differential diagnosis in patients with hypoglicemia episodes and negative imaging results can prevent patients from going through unnecessary procedures.

Keywords: insulin autoimune syndrome, Hirata’s disease, continuous monitoring system, insulin autoantibodies

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Abdominal wall metastases due to a squamous cell carcinoma of the lung: Case report and literature review

Corina Florica Ioniță¹, Ioana Iulia Cojocaru², Adriana Gomotîrceanu¹, Bogdan Andrei Suciu³, Doina Milutin², Alexandru Ilie Butilcă⁴, Călin Dragoș Molnar³, Ioana Halmaciu³

1. Topmed Medical Center, Târgu Mureș, Romania
2. County Emergency Clinical Hospital Targu Mures, Romania
3. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Recovery Clinic Hospital, Cluj Napoca, Romania

DOI: 10.2478/amma-2022-0010

Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.
Case presentation: A 67-year-old patient came to our service reporting the existence of a tumor 5 cm in diameter, located at the level of the abdominal wall, without other clinical symptoms. Surgical excision of the tumor was performed. The postoperative evolution was favorable, with the patient discharged on the third postoperative day. Histological examination of the resected specimen revealed metastasis of squamous cell carcinoma of the lung.
Conclusions: The appearance of a tumor in the abdominal wall of patients with NSCLC may raise the suspicion of metastasis at this level.

Keywords: lung cancer, abdominal wall, metastases

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Prosthetic management of acquired dentate maxillectomy defects: A clinical case series

Vineet Sharma, Jyoti Paliwal, Balwant Singh Gurjar, Kamal Kumar Meena

Department of Prosthodontics and Crown and Bridge, RUHS College of Dental Sciences, Jaipur, India

DOI: 10.2478/amma-2022-0009

Acquired maxillectomy defects produce hypernasal speech, food, and liquid regurgitation into the nasal cavity, impaired deglutition and mastication, and cosmetic deformity. Furthermore, patients with acquired maxillary defects face psychosocial stigma, which has a negative impact on their quality of life. Prosthetic rehabilitation of such defects is required for stomatognathic system restoration and oroantral communication obturation. This case series discusses the fabrication of surgical, interim, and definitive obturator prostheses to restore the acquired dentate maxillectomy defects of three cancer patients. All patients had their treatment in the prosthodontics department of the RUHS College of Dental Sciences. The surgical obturator prosthesis was made before surgery, whereas the interim and definitive obturators were made one month and six months after surgery, respectively. The surgical obturator formed a shield between the surgical pack and the oral cavity. After the surgical obturator and packing were removed, an interim obturator was inserted for three to six months to allow the surgical site to heal. After the surgical site had healed, the fabrication of the definitive obturator began. Prosthetic rehabilitation with obturator prostheses sealed the acquired tissue defects of the palate and restored swallowing, speaking, chewing capacity, and cosmetic value, as well as significantly improved the quality of life of these patients.

Keywords: obturator, surgical obturator, interim obturator, definitive obturator, dentate maxillectomy

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