Category Archives: Case Report

Particular Aspects of a Pancreatic Insulinoma Case

Motoc R1,2, Albu C2, Munteanu Irina2, Dirtu Oana2, Motoc Crina2, Tilea I3,2

1 Internal Medicine Clinic III, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Tirgu Mures Emergency Clinical County Hospital, Tirgu Mures, Romania
3 Family Medicine, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0130

With a very low incidence (1-4 cases per 1 million per year), characterized by insulin hypersecretion, independent of the glycemia control system, insulinoma is a rare endocrine tumor, clinical with accentuated neuropsychological symptoms that hampers clinical diagnosis. We present a case of a 33 years old patient with no notable personal history, active lifestyle, non-smoker, a work environment that doesn’t involve professional toxicity; a remarkable family history of a brother with type 1 diabetes mellitus and grandmother with liver adenocarcinoma was noticed; in this particular case Whipple triad was strongly suggestive, gastrointestinal upper-ultrasonography endoscopy with tissue puncture as a tumor diagnostic tool was used and laparotomy was used successfully for removing the tumor, with favorable follow-up.

Keywords: , , ,
Full text: PDF

Coronary Artery Dissection in the Left Main Treated with Stenting in a Patient with Multiple Re-infarction – Case Report

Nyulas Tiberiu1, Blendea Ciprian1,2, Barcan Andreea1, Bajka Balazs1,2, Korodi Szilamer1, Rat Nora1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0129

Introduction: In complex cases of multiple coronary artery stenosis, revascularization strategy could be essential for improving the life expectancy andqualityof life. However, major complications are sometimes encountered during interventions, such as rupture of the atheromatous plaque with consequent dissection of the coronary artery, causing an acute coronary syndrome which requires immediate intervention from the operator. In the absence of an experienced interventional cardiologist a complication like this can be fatal. Case presentation: We present the case of a 67-years old patient, male, with a known history of cardiovascular disease, who presented in our service complaining of chest pain with tightening character, irradiation in the shoulder and left arm, respectively shortness of breath and fatigue. The patient presented a history of multiple infarctions, intervention and stenting on RCA and circumflex artery. Computed Tomographic Coronary Angiography provided detailed information on the location of the target lesions and was followed by a revascularization procedure. However, despite the complex pre-interventional assessment, while trying to engage the guide in the emergence ofthe circumflex artery, atherosclerotic plaque rupture occurred, causing a dissection of the coronary wall which extended retrogradely into the left main, requiring a rapid response from the operator. A coronary stent was implanted into the left coronary artery trunk, treating the dissection. Conclusions: Coronary artery dissection is a very serious complication that can occur during a complex revascularization procedure, requiring immediate intervention in order to save the patient’s life.

Keywords: , ,
Full text: PDF

Inferior Vena Cava Hypoplasia Associated with Deep Vein Thrombosis – Case Presentation

Nyulas Tiberiu1, Blendea Ciprian1,2, Rat Nora1, Barcan Andreea1, Korodi Szilamer1, Bajka Balazs1,2

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0128

Introduction: We present the case of a patient suffering from inferior vena cava hypoplasia complicated with Phlegmasia cerulean dolens. Imaging techniques allow precise diagnosis of inferior vena cava hypoplasia, providing essential structural details on the degree of damage of the vena cava and for the other branches. Case presentation: A 58 years old, obese and diabetic male patient presented with intense pain in the lower limbs, with the onset 24h before presentation. The patient presented generalized edema, cyanosis and functional impotence. Angio CT examination revealed hypoplasia of the inferior vena cava, with extensive DVT (deep vein thrombosis). In emergency conditions, with the agreement of the patient, we initiated the thrombolytic therapy (streptokinase for 72h) associated with anticoagulants (heparin). The evolution was favorable: a significant reduction in leg circumference was recorded, together with pain relief and reduction of local inflammation in the lower limbs. Conclusion: Severe cases of inferior vena cava hypoplasia complicated with deep vein thrombosis can present a good prognosis if appropriate treatment with anticoagulants and thrombolytics is initiated in time.

Keywords: , , ,
Full text: PDF

Intersphincteric Resection for Low Rectal Cancer – Case Report

Russu Cristian1, Molnar Călin1*, Copotoiu Sanda Maria2, Sărăcuț Claudiu1, Gherghinescu Mircea1, Molnar Varlam Claudiu3, Copotoiu Constantin1

1 Surgical Clinic 1 of the Emergency County Hospital and the University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Anesthesia and Intensive Care Clinic 1 of the Emergency County Hospital and the University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Obstetric-Gynecology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0118

Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome.
Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions) followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up.
Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

Keywords: , , ,
Full text: PDF

Multiparasitic Infection (Hydatid Cyst of the Spleen and Ascaris Lumbricoides Infestation) Mimicking an Acute Surgical Abdomen – Case Report

Molnar Călin1, Vizitiu Alexandru1*, Deak Karoly1, Russu Cristian1, Tudor Adrian1, Suciu Bogdan1, Stolnicu Simona2, Hulub Marius3, Molnar Claudiu4

1 Surgical Clinic No. I, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Anathomo-Pathology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania
3 University of Medicine and Pharmacy Tirgu Mures, Romania
4 Obstetric-Gynecology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0117

Hydatid cyst involving the spleen is a rare clinical condition (0.5-4%). We report a case of multi-parasitic infection in a 62 year old female (hydatid cyst and ascaris lumbricoides infestation), confirmed during surgery. The purpose of the paper is to emphasize on the rare association of the two parasitic infections, affecting two different organs (spleen and jejunum). The combined symptomatology of the two parasites could mimic an acute surgical abdomen.

Keywords: , ,
Full text: PDF

Percutaneous Revascularization in a Case of Vasospastic Angina Associated with Polymorphic Ventricular Tachycardia

Rudzik Roxana, Şuş Ioana *, Hadadi László, Şerban Răzvan Constantin, Dobreanu Dan

University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0106

Introduction: Coronary vasospasm is a possible cause of ventricular tachyarrhythmias and is frequently associated with atherosclerotic lesions. The revascularization of mild to moderate coronary artery stenosis which causes symptoms only due to associated vasospasm is still a matter of debate, as the standard treatment of Prinzmetal angina is represented by the long term administration of calcium-channel blockers.
Case presentation: We present the case of a 46 year old woman with an intermediate severity coronary artery stenosis complicated by vasospastic angina and subsequent polymorphic ventricular tachycardia. Although the functional significance of the fixed coronary artery lesion was equivocal at invasive fractional flow reserve measurement, a combined pharmacologic and interventional treatment strategy was chosen with stent implantation and long acting calcium channel blocker administration with a symptom-free, good clinical outcome.
Conclusion: Patients with vasospastic angina and intermediate severity atherosclerotic coronary artery stenoses are at risk of malignant ventricular arrhythmias, therefore myocardial revascularization should be considered in addition to the standard medical treatment.

Keywords: , , ,
Full text: PDF

Combined Myocardial Infarction in a Young Patient with Anomalous Coronary Artery Anatomy: A Case Report

Hadadi László1,2*, Lakatos Éva Katalin1,2, Țăruși Mariana2, Dobreanu Dan1,2

1 Univeristy of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Emergency Institute for Cardiovascular Diseases and Transplantation of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0102

Introduction: combined myocardial infarction (MI) is defined as the simultaneous ischemic injury of two different myocardial territories, raising the possibility of multiple culprit lesions. The anomalous origin of a coronary artery could represent an important challenge during percutaneous coronary intervention (PCI).
Case presentation: A 46 year old, smoker Caucasian male presented to a territorial hospital four hours after the onset of severe angina. Consecutive electrocardiograms showed complete atrioventricular block and inferior ST segment elevation (STE), later PQ prolongation with right bundle branch block plus STE in leads V4-V6. After administration of thrombolytic treatment, the patient was transferred to the regional PCI center. Emergent coronary angiography revealed acute occlusion of the left anterior descending artery (LAD) and a thrombus containing, severe stenosis of the anomalously originated right coronary artery (RCA). Rescue PCI with stent implantation in the LAD and RCA was performed nine hours after pain onset. At the 1 year follow-up visit the patient had no angina or heart failure symptoms.
Conclusion: this is the first report of a combined MI caused by acute, sequentially occurring thrombotic occlusion of two coronary arteries, one of them with anomalous origin, in a patient treated by rescue PCI following partially successful thrombolysis.

Keywords: , , ,
Full text: PDF

Recurrent Incisional Hernia Associated with Interferon Treatment for Virus C Hepatitis: Case Report

Gherghinescu Mircea1, Molnar Călin1*, Popa Daniel1, Russu Cristian1, Lazăr Alexandra1, Copotoiu Constantin1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0101

Background: Hepatitis C prevalence in Romania is 3.5 %. Nowadays, the treatment of this condition comprise of interferon. One of the interferon’s side effects is the reduction of collagen synthesis, substance that is necessary in the process of abdominal wall healing.
Case report: We report the case of a 56 years old female patient, admitted in our Clinic for a giant, recurrent incisional hernia. The patient’s history was eventful: a hysterectomy for uterine fibroma in 2009, incisional hernia repair in 2010, the treatment with Interferon in 2011 and 2012 for viral hepatitis C. A well represented subcutaneous tissue is observed intraoperator, a wall defect of 15 cm in diameter with a 5 mm thick muscle aponeurosis lay. We performed abdominal wall plasty by components separation technique, reinforced with a polypropylene mesh disposed on lay. Postoperative analgesia was provided by inserting a wound catheter through which Ropivacaine 0,5 % was continuously injected for 72 hours. The postoperative evolution was uneventful, the patient being discharged 7 days after the surgical intervention.
Conclusions: The treatment with Interferon of hepatitis C can favor the recurrence of an incisional hernia. The Oscar Ramirez procedure seemed to be the best choice for surgical treatment of this giant incisional hernia. Postoperative analgesia can be accomplished by a wound catheter through which Ropivacaine 5% is continuously infiltrated.

Keywords: , , , ,
Full text: PDF

Viability Changes in Leucocytes in a Critical Trauma Patient: Monocyte, Lymphocyte, Granulocyte Response to the Acute Phase: Case Report

Benedek Orsolya1, Dobreanu Minodora2*, Azamfirei Leonard3, Veres Mihaly4, Copotoiu Sanda-Maria1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Anesthesia and Intensive Care 1
2 University of Medicine and Pharmacy of Tîrgu Mureş, Laboratory Medicine
3 University of Medicine and Pharmacy, Tîrgu Mureş, Anesthesia and Intensive Care 2 and Emergency Medicine
4 Emergency Clinical County Hospital Tîrgu Mureş, Anesthesia and Intensive Care Clinic

DOI: 10.1515/amma-2015-0099

Trauma affects the activity of the innate immune system. The objective of this case report is to present the case that prompted us to analyse all the peripheral white blood cell lines. A 19 year old male patient was admitted to the Intensive Care Clinic with severe head trauma. The final diagnosis was set to be severe cerebral trauma with subarachnoid hemorrhage, right frontal and temporal cerebral contusions, diffuse cerebral edema, left parietal and temporal fracture, sphenoid hemosinus and right sided lung contusions.
Material and Method: Whole blood was immediatly analyzed by flow cytometry for leukocytes. Apoptosis was detected with Annexin V, necrotic cells were stained with propidium iodide. Samples were drawn three consecutive days.
Results: Lymphocytes, monocytes and granulocytes all showed marked increase in viability and decrease in necrosis during the biological monitoring in correlation with a positive clinical outcome. The most important changes were noted in the monocyte population. Discussion: Although we started out monitoring neutrophil viability and death, this particular case prompted us not to overlook other leucocyte populations.
Conclusion: The apparent positive relationship between this patient’s positive clinical outcome and cellular viability and death changes is promising but they warrant further study.

Keywords: , , , ,
Full text: PDF

Graham Little-Lassueur Syndrome with Hypertrophic Lichen Planus in a Patient with Chronic Hepatitis C

Badea Mihail Alexandru1, Buicu Florin2*, Ţilea Anton Mihai3, Badea Iudita Maria4, Chiotoroiu Andreea Luciana5, Mureșan Vasile Adrian5, Morariu Silviu Horia6

1 Dermatology Clinic, County Hospital of Tîrgu Mureș, Romania,
2 Department of Public Health and Medicines Management, Tîrgu Mureș,
3 Dermatology Clinic, Emergency Military Hospital, Bucharest, Romania
4 Anesthesiology and Intensive Care medicine Clinic, Emergency County Hospital of Tîrgu Mureș
5 University of Medicine and Pharmacy Tîrgu Mureș, Romania
6 Department of Dermatology, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0089

Graham Little-Lassueur Syndrome (GLLS) is considered a form of lichen planopilaris which associates follicular lichen planus, cicatricial alopecia of the scalp and noncicatricial alopecia of the axillary and/or pubic regions. We present the case of a 47 years old female patient, known for 5 years with chronic hepatitis C and a poor therapeutic control of the disease due to Interferon intolerance. She presented to our clinic for the occurrence on the shins of some well-defined, intensely pruritic erythematous plaques, covered with thick scales, with a verrucous appearance, accompanied by excoriations. The skin biopsy reveal hypertrophic lichen planus on the shins and lichen planopilaris on the scalp. The patient was treated with systemic antihystamines, topical corticosteroids and salicylic acid under occlusion, emollients, phototherapy UVB narrow band 4 sessions/week for 3 weeks, cryotherapy. From our knowledge this is the first case of GLLS associated with chronic viral hepatis C.

Keywords: , ,
Full text: PDF