Category Archives: Case Report

Ulnar-basilic arteriovenous fistula with multilocular gigantic aneurysmal dilatation: a case report

Emil-Marian Arbănași1, Eliza Russu1,2, Adrian Vasile Mureșan1,2, Eliza-Mihaela Arbănași3, Reka Kaller1

1. Clinic of Vascular Surgery, Emergency County Hospital, Târgu-Mureș, Romania
2. First Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0035

Introduction: Arteriovenous fistula dysfunction has been associated with a range of problems such as thrombosis, stenosis, dilatation, and infection.
Case presentation: We present the case of a 64-year-old patient with chronic kidney disease on hemodialysis and with aneurysmal dilatation of the ulnar-basilic arteriovenous fistula, having an increased risk of rupture. A temporary dialysis catheter is placed in the left femoral vein, an aneurysmal basilic vein is ligated at the anastomosis, aneurysmal dilatation is emptied by compression, and a right radiocephalic arteriovenous fistula is performed. The patient undergoes hemodialysis on the second day and subsequently three times a week for six weeks until the new arteriovenous fistula develops. He returns for aneurysmal sac resection.
Conclusion: The purpose of this paper is the presentation and management of a 15-year-old ulnar-basilic arteriovenous fistula with multilocular aneurysmal development and an imminent rupture.

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Prosthodontic Management of Dentate Maxillectomy Patient: A Clinical Case Report

Vineet Sharma, Jyoti Paliwal, Kamal Kumar Meena, Ramjee Lal Raigar

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

DOI: 10.2478/amma-2021-0038

Patients with minor defects of the alveolar ridge and hard palate can easily be treated by surgical closure, while patients with larger defects are more amenable to prosthetic restoration. The case report describes the rehabilitation of a dentate maxillectomy patient with a definitive closed hollow bulb cast partial obturator. A tripod retainer design was chosen for direct retention in the case. The tripod design consisted of a T-bar clasp placed on the left first central incisor and two embrasure clasps with buccal retention and palatal bracing components between the right first & second premolar and right first & second molar. A complete palate major connector was designed to ensure uniform distribution of functional load across tissues. The remaining teeth, the palate, and the rest provided support for the prosthesis. Prosthetic rehabilitation of the defect with a definitive obturator thus seals tissue openings in the palate, improves deglutition, speech, mastication, aesthetics, and significantly improves quality of life.

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Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

Tiberiu-Bogdan Szekely1, Cornelia Toganel1,2, Zoltan Kadar1,2, Alexandra Daniela Sava1, Tivadar Bara Jr.3, Daniela Roman1, Simona Gurzu4,5

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

DOI: 10.2478/amma-2021-0025

Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports.
Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT).
Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.

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Life Endangerment – A Paramount Condition in Forensic and Judicial Practice

Carmen Corina Radu, Timur Hogea, Dana Doroftei, Cosmin Carașca

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0026

Life-threatening injuries represent those types of lesions that certainly lead to the victim’s death if no qualified medical care is applied in due time. We hold important the aspect of imminent danger, and that the lesion, in its natural way of evolution, will determine the person’s death, his life being saved only by a qualified medical intervention. The juridical correspondent is represented in article 194: bodily harm – The new criminal code and the new criminal procedure code. The authors review and comment on the main particular aspects of life-threatening traumas, based on topography, anatomical aspects and forensic interpretation, in order to offer arguments to be incorporated from a medico-legal point of view, reported to the criteria of life-threatening conditions. We shall illustrate the subject by 6 case reports.

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Para-Infectious Acute Transverse Myelitis Following Sars-Cov2 Infection: A Case Report

Oana Mosora1, Valentin Moroșanu1, Adina Stoian1,2, Rodica Bălașa1,2

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

DOI: 10.2478/amma-2021-0024

Introduction: The new pandemic has highlighted new ways of clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) including a possible link to central nervous system (CNS) manifestation.
Case report: We present a case of acute transverse myelitis following a SARS-CoV 2 infection in a 34-year-old man who presented with bilateral lower-extremity weakness and acute urinary retention. Cervical magnetic resonance imaging showed a T2 hyperintense signal abnormality at C3-C6 and D3-D7 levels consistent with acute myelitis.
Conclusion: SARS-CoV 2 can cause myelitis by immune-mediated mechanisms, therefore it is extremely important for the clinicians to recognise the signs and promptly treat this neurological complication.

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Management of late onset recurrent ventricular tachycardia following circumflex artery injury during minimally invasive mitral valve replacement surgery – Clinical case report

Timea Magdolna Szabo1,2, Mihaela Ispas1, Ayman Elkahlout1

1. Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
2. Pharmaceutical biochemistry and the chemistry of environmental factors, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0013

Introduction: A rare complication of mitral valve surgery is the injury of the circumflex artery due to their close anatomical proximity resulting in a perioperative myocardial infarction and subsequent fibrosis with increased risk of developing ventricular arrhythmias.
Case presentation: We hereby describe the case of a 74-year-old male patient who underwent minimally invasive mitral valve replacement surgery for severe mitral regurgitation two weeks prior to presenting to the emergency department with dyspnea, palpitations and slight thoracic discomfort. He was diagnosed with recurrent sustained monomorphic ventricular tachycardia due to inferior wall myocardial infarction. Angioplasty of the culprit lesion was attempted, but the procedure failed due to the elastic recoil of the vessel. Our patient received antiarrhythmic therapy and an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death, with no further recorded episodes of ventricular tachycardia.
Conclusion: Although injury of the circumflex coronary artery during mitral valve surgery is described as rare, we strongly believe that increasing awareness of the potential risks involved can further prevent fatal complications.

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Metatypical Carcinoma – A Continuous Challenge for the Clinician

Oana Mirela Tiucă1, Andreea Cătălina Tinca2, Sabin Turdean3, Ovidiu Simion Cotoi4, Silviu Horia Morariu5

1. Dermatology Clinic, Mures Clinical County Hospital, Targu Mures, Romania
2. Pathology Service, Mures Clinical County Hospital, Targu Mures, Romania
3. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0026

Introduction: Non-melanocytic skin cancers represent the most frequent type of cutaneous carcinomas. Also called basosquamous cell carcinoma and considered by some authors as a clinical form of basal cell carcinoma, metatypical carcinoma represents a controversial clinical entity.
Case presentation: This paper aims to present the case of a 42-year-old female patient who presented to the doctor’s office for the appearance of a painful cutaneous tumor located in the left submandibular region. Excisional biopsy was performed. The microscopic features were consistent with the diagnosis of metatypical carcinoma with the predominance of the squamous type.
Conclusions: Taking into consideration its aggressive behavior, careful follow-up of patients diagnosed with this rare type of cutaneous tumor is mandatory for precocious identification of possible metastases and improvement of long and short term prognosis.

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Prenatal Diagnosis of Binder Phenotype, Naso-Maxillar Hypoplasia

Lucian Gheorghe Pop1, Ioan Dumitru Suciu2, Nicolae Bacalbasa3, Oana Daniela Toader1,3

1. National Institute of Mother and Child Care Alessandrescu-Rusescu, Bucharest, Romania
2. Floreasca Emergency Hospital, General Surgery Department, Bucharest, Romania
3. University of Medicine and Pharmacy-Carol Davila-, Bucharest, Romania
4. University of Medicine and Pharmacy -Carol Davila-, Bucharest, Romania

DOI: 10.2478/amma-2020-0032

Facial dysmorphism is a common diagnosis which represents a broad spectrum of aetiologies with different outcomes spreading from normal outcome to foetal demise or new-borns with multiple malformations. Prenatal diagnosis can be difficult, making counseling a challenging task even in experienced hands. This paper aims to present an unusual case of facial dysmorphism (Binder phenotype) which resulted in a normal pregnancy. However, throughout the pregnancy, future parents experienced excruciating anxiety, which required multiple prenatal counseling appointments. We believe that in case of a Binder phenotype, genetic testing, multiple scanning appointments and extensive discussion with future parents are vital in the prevention of an unneeded ending of a pregnancy.

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Genitourinary Bacterial Infection: a Cause of Infertility in Men? A Cases Series and Short Review of Literature

Răzvan Lucian Coșeriu1, Camelia Vintilă1, Bianca Irina Kosovski2, Anca Delia Mare3, Cristina Nicoleta Ciurea3

1. Department of Immunology, Mures County Clinical Hospital – Infectious Diseases Laboratory, Targu Mures, Romania
2. Department of Physiopathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0024

Introduction: The role of bacterial infections on the onset and the development of male infertility is still highly controversial, as the clinical cases have different outcomes and the practitioners have no guidelines that will help them select the cases that could better benefit from antibiotic treatment.
Case presentation: Four case reports are presented in order to emphasize the possible clinical implications of genitourinary bacterial infections on male infertility. The first patient had two bacterial strains isolated from the semen culture, Escherichia coli, and then Enterococcus faecalis. The antibiotic treatment was not effective. The second patient had a semen culture positive with Enterococcus faecalis. The treatment was successful: the bacteria were eradicated and the patient was able to conceive a baby. Enterococcus faecalis was also identified in the third and the fourth case. These patients were able to conceive, despite the different clinical management strategies of the cases.
Conclusion: Bacterial prostatitis might play a role in male infertility, but the clinical cases are still highly unpredictable. Every case presents a different viewpoint and raises awareness of the complexity of the problem.

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Ovarian Endometriosis and Malignant Transformation in Clear Cell Carcinoma

Ioana Maria Maier1, Adrian Cornel Maier2

1. Doctoral school, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Urology, Faculty of Medicine, University “Dunarea de Jos” Galati, Romania

DOI: 10.2478/amma-2020-0023

Atypical endometriosis is considered to be precursors for malignancy. Coexistence of atypical endometriosis and ovarian neoplasm has been found in some studies. We describe the case of a 48-year old women diagnosed with clear cell carcinoma of ovary. The review of histological slide confirms the presence of benign endometriosis in both ovaries, the atypical endometriosis and clear cell carcinoma in the right ovary and the presence of uterine leiomyoma.

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