Category Archives: Case Report

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.

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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.

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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.

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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.

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Considerations Upon a Case of Hepatocellular Carcinoma Treated with Magnetic Resonance Imaging – Guided Percutaneous Cryotherapy Guidance

Colțescu Camelia¹, Habersetzer F.¹, Oltean G.², Bățagă Simona², Georgescu D.², Garnon J.³

1 Department of Hepatology and Gastroenterology, University Hospital Strasbourg
2 Department of Internal Medicine, 1st Medical Clinic, Faculty of Medicine, the University of Medicine and Pharmacy (UMPh) Targu Mures
3 Department of Radiology, University Hospital Strasbourg

Hepatocellular carcinoma represents 5 % of the cases of death in the world. The recent epidemiological data show a major increase of its incidence in the western countries and USA, the explanation being through the growth in the incidence of viral hepatopathies, especially with hepatitis C virus. Of the patients diagnosed with hepatocarcinoma, 70 % benefit from palliative treatment only. The curative treatment in the case of hepatocarcinoma includes surgical resection, liver transplant, radiofrequency. Magnetic Resonance Imaging-guided percutaneous cryotherapy, the method in progress of evaluation, seems to give spectacular results in the case of small size, non resectable situated very close to the hepatic hylum. The evolution of a patient with viral cyrrhosis C complicated with a hepatocarcinoma and the problems related to hepatocarcinoma treatment while waiting for liver transplantation was the object of an analysis that allowed the emphasis of the lack of tumoral progress and the reduction of tumoral volume until its disappearing from an imagistic point of view.

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Erythrodermia Associated to Lung Cancer

Simu Lia-Maria1, Morariu S.H.1, Turcu M.2, Podeanu Maria-Daniela3, Şincu Nina4, Marian D.5

1 Department of Dermatology and Venereology, University of Medicine and Pharmacy Tg. Mureş
2 Department of Pathology, University of Medicine and Pharmacy Tg. Mureş
3 Department of Radiology and Imaging, University of Medicine and Pharmacy Tg. Mureş
4 Department of Infectious Diseases, University of Medicine and Pharmacy Tg. Mureş
5 Department of Surgery, University of Medicine and Pharmacy Tg. Mureş

There are a few skin lesions which are conected with internal malignancies, being important especially if they appear prior to neoplasia.
We are presenting the case of a patient who had desquamative erythrodermia associated to lung carcinoma. The patient was also diagnosed with a cerebral metastasis. The appearance of skin lesions suggested the presence of a subacute immune vasculitis, this was confirmed by immunohystochemical examinations, which revealed a leukocytoclastic vasculitis. Given the fact that previous erythematous lesions improved during the treatment of cerebral metastasis, the reccurence of erythrodermia suggests the evolution of metastasis. On the other hand, we can not rule out the possible role of the received chemotherapy in the development of the vasculitic process. The observation that these events do not occur in all cancer patients leads to the conclusion that the triggering mechanisms responsible for these paraneoplastic syndromes are individually conditioned.

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T-cell/Histiocyte-rich B-cell Lymphoma

Turcu M.1, Horvath Emoke2, Chira Liliana3, Cotoi O.S.4

1 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
2 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
3 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
4 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures

Background: T-cell/histiocyterich B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of diffuse large B-cell lymphoma (DLBCL), representing less than 10% of all DLBCL cases. T/HRBCL has attracted considerable attention as a result of the difficult task of distinguishing it from similar entities, such as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), classic Hodgkin lymphoma and peripheral T/cell lymphoma, nonspecific.
Case report: We present the case of a 70-year-old female patient addressing her primary care physician for headaches, nausea and a large, painful tumor in her left axilla. The paraclinical examinations revealed minimal deviations of hematological tests, but showed elevated LDH values. Surgery was performed and a specimen, composed of 13 lymph nodes, (the largest one having the surface diameter of 130 mm) was removed and examined histologically. On microscopic evaluation, the HE stain showed portions of lymph node completely effaced and replaced by a vaguely nodular lymphoid proliferation composed of scattered, large cells, with abundant cytoplasm, multilobated vesicular nuclei and proeminent nucleoli, consistent with lymphocytes and histiocytes. The immunohistochemical study proved the proliferative mass to be constituted of a limited number of large, CD20 positive B-cells, with proeminent nucleolus, in a background of CD3 positive T-cells, together with a variable number of histiocytes, highlighted with CD68. The large B-cells were scattered and did not form any clusters or strips. A diagnosis of T/HRBCL was made.
Conclusion: T/HRBCL is a rare variant of DLBCL, with an aggressive clinical outcome. In such cases immunohistochemical analyses are mandatory to reach correct diagnosis.

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Successful Treatment with Infliximab in a Case of Crohn’s Disease with Peripheral Arthropathyes

Hodut A, Sabau I, Simedrea I, Belei Oana, Militaru Andrea

First Pediatric Clinic, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania

Introduction: Crohn disease is an inflammatory bowel disease that involves any region of the alimentary tract from the mouth to the anus and it is transmural. Children with early onset are more likely to have colonic involvement. Infliximab constitutes today one of major therapeutic approaches at cases of Crohn’s disease.
Material and methods: We present the case of a 15-year-old female who was admitted in our department presenting pain of the large joints (exacerbated by movement), abdominal pain (epigastric and hypogastric), vomiting, diarrhea. In order to induce remission of the disease, we chose the step-up therapy (the only one accepted in Romania for children with Crohn disease). The initial response to immunosupressant therapy was moderate: no digestive symptoms were present, but extradigestive (articular) symptoms were still present and remission was not obtained (inflammation markers were still present and PCDAI was still above 15). We decided to try to induce remission with Infliximab.
Results: We obtained only temporary improvement of symptoms with “classical” therapy. We had a good response to Infliximab (remission was obtained), but treatment discontinuation without medical advise led to relapse after 9 months.
Conclusions: Infliximab was effective as therapy in Crohn’s disease with peripheral arthropathy, but too soon discontinuation of treatment due to patient’s non compliance determined relapse of the disease.

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The von Meyenburg Complexes

Turdean S1, Turcu M3, Varga AF1, Unguraş Dana1, Moldovan C4, Sin Anca2

1 “Gheorghe Marinescu” Municipal Hospital, Târnăveni
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Cellular and Molecular Biology
3 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Pathology
4 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Histology

Background: Biliary duct hamartomas (the von Meyenburg complexes) is a rare malformation of the hepatic ductal plates usually discovered incidentally during surgery or autopsy.
Case presentation: We present the case of a 66 year-old man who presented symptoms suggestive of a biliary colic. Following an open surgical biopsy from the liver, the sample obtained underwent classic Hematoxylin-Eosin, as well as histochemical and immunohistochemical stains, which allowed establishing the diagnosis of biliary duct hamartoma, using macro- and microscopical criteria (well-defined, subcapsular hepatic lesions and no nuclear atypia).
Conclusion: The recognition of this particular lesion is important due to its macroscopic and microscopic resemblance to multiple liver metastases and other types of multicentric subcapsular hepatic lesions. The mandatory technique in order to diagnose this rare type of hepato-biliary lesion remains the histopathological examination.

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Giant Abdominal and Penoscrotal Idiopathic Lymphedema

Hintea A1, Botan A2, Coros MF1, Nagy S1, Cozma D1, Kazay Z2

1 County Emergency Clinical Hospital Tîrgu Mureș, Surgical Clinic I
2 County Emergency Clinical Hospital Tîrgu Mureș, Department of Plastic and Reparatory Surgery

The lymphatic system produces and transports fluids, immune cells and fats throughout the body. Abnormal transport and accumulation of lymph fluid may cause swelling (lymphedema).
Lymphedema, occurring quite frequently in the medical practice, may appear in a variety of pathologies such as: allergic reactions, infectious diseases, localized infections, radiotherapy, insect bites, as post-surgery reaction, etc. In all cases, it represents a subsequent effect of the main illness [1].
There is very small number of cases where lymphedema occurs as sole affection, the so-called ”primary or idiopathic lymphedema”. It is considered a genetic disease resulting in agenesis or the insufficient development of the lymphatic system [2].
The FLT4 gene provides instructions for producing a protein called vascular endothelial growth factor receptor 3 (VEGFR-3), which regulates the development and maintenance of the lymphatic system. Mutations in the FLT4 gene interfere with the growth, movement, and survival of lymphatic cells. These mutations lead to the development of small or absent lymphatic vessels. If lymph fluid is not properly transported, it builds up in the body’s tissues and causes lymphedema. It is not known how mutations in the FLT4 gene lead to the other features of this disorder, but many of these patients do not have a FLT 4 gene mutation. In these cases the cause of the swelling is unknown [1,3].[More]

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