Volume 68, Number 3, 2022
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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
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.
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Computed tomography evaluation of diaphragm alterations in 20 critically ill COVID-19 positive patients
DOI: 10.2478/amma-2022-0014
Objective: Diaphragmatic dysfunctions are multiple and critical illnesses often lead to the muscular atrophy that affects respiratory and peripheral muscles. The primary objective was to investigate diaphragm thickness in hospitalized patients. Secondary objectives were to assess clinical evolution and outcome. Methods: In a mean time period of 7.9 days, two different chest computed tomographies were used in order to examine diaphragm alterations of right and left diaphragm in 20 critically ill patients tested Real-Time Polymerase Chain Reaction positive to Severe Acute Respiratory Syndrome Coronavirus-2. Patients were divided in two groups (one group <5% decrease in diaphragm thickness and another group ≥5% decrease in diaphragm thickness).
Results: Results showed that patients presented low 10 years predicted survival rate (Charlson Comorbidity Index > 7.7±3.08), marked inflammatory status (C-Reactive Protein = 98.22±73.35, Interleukine-6 = 168.31±255.28), high physiologic stress level (Neutrophil/Lymphocyte Ratio = 31.27±30.45), respectively altered acid-base equilibrium. Half of the investigated patients had decrease in diaphragm thickness by at least 5% (right diaphragm = -7.83%±11.11%, left diaphragm = -5.57%±10.63%). There were no statistically significant differences between those with decrease of diaphragm thickness and those without diaphragm thickness, regarding length of stay in Intensive Care Unit and in hospital, inflammatory markers, and acid-base disorders.
Conclusions: Patients were admitted in Intensive Care Unit for acute respiratory failure and half of the investigated patients displayed diaphragm alterations at CT scan.
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Volume 68, Number 2, 2022
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Non syndromic congenital agenesis of multiple permanent teeth: Case series and recent literature review
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.
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Comparative analysis of mandibular changes after orthodontic treatment with and without extraction of four premolars – A digital cephalometric study
DOI: 10.2478/amma-2022-0012
Objective: To compare and evaluate the cephalometric hard and soft tissue changes of mandible after orthodontic treatment with and without extraction of four first premolar.
Methodology: 60 individuals with Class I skeletal pattern were selected as per inclusion criteria. They were divided into two groups: 30 in the extraction group and 30 in the non-extraction group. Each group consists of 15 males and 15 females. Pre-treatment and post-treatment lateral cephalograms of the selected subjects were obtained, analysed and compared to assess the changes might have occurred. Descriptive statistics of the explanatory and outcome variables were calculated by mean and standard deviation for quantitative variables. Paired t test was applied to check the statistical difference of pre-treatment and post-treatment cephalometric parameters within the group (Extraction and non-extraction). Unpaired t test was used to check the statistical difference between extraction and non-extraction groups. The level of significance is set at 5%.
Results: B point moved backward with lower incisor retraction. N-A-Pog shows a statistically significant decrease in the extraction group (P=0.003). B-NP shows a statistically significant decrease in extraction group (P=0.001). N- A’-Pog’ shows a statistically significant increase in non-extraction group (P=0.046). Soft tissue thickness in chin increases in extraction group and decreases in non-extraction group.
Conclusion: The results indicate that premolar extraction will have a flattening effect on the midface. With proper diagnosis and treatment planning, premolar extractions have high potential to improve the facial profile.
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Use of the continuous glucose monitoring system in the management of hypoglicemia in insulin autoimmune syndrome
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 autoantibodies, insulin autoimune syndrome, Hirata’s disease, continuous monitoring system
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Abdominal wall metastases due to a squamous cell carcinoma of the lung: Case report and literature review
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.
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Prosthetic management of acquired dentate maxillectomy defects: A clinical case series
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: surgical obturator, interim obturator, definitive obturator, dentate maxillectomy, obturator
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Ethanolic extract of Edamame (Glycine max L. merril) enhance second degree burn wound healing trough modulating of hydroxiproline levels and increasing epithelial thickness
DOI: 10.2478/amma-2022-0007
Objective: Burns has become a global health problem because it causes about 180.000 deaths worldwide every year. In developing countries, silver sulfadiazine cream is usually used as drug management for second-degree burns, but it is expensive, so several herbal treatments have developed recently. The seed of edamame has genistein compounds that can increase collagen synthesis. The antioxidant component also enhances the burn wound healing process. The study aims to prove the effectiveness of ethanolic extract of edamame’s seed in the second-degree burn wound healing process.
Methods: Burn wound was made by applying hot aluminum (70 °C) coin on the skin rat. The negative control group (C-) was given Na-CMC 0.5%, the positive control group (C+) was given cream silver sulfadiazine, the treatment groups T1, T2, T3, and T4 were given an ethanolic extract of edamame with the concentration of 20%, 40%, 60%, and 80% for 15 days. Hydroxyproline levels were evaluated by hydroxyproline biochemistry assay, the epithelial thickness was observed on histopathological preparations with HE staining.
Results: The results showed that the hydroxyproline levels on the 16th were modulated, while epithelial thickness was higher in the treatment group than in the control group (P<0.05).
Conclusions: We conclude that the certain concentration of ethanolic extract of edamame (Glycine max L. Merril) was effectively enhanced the second-degree burn wound healing by modulating hydroxyproline levels and increasing epithelial thickness.
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