Medical Reports最新文献

We present a case of breast sarcoidosis with a distinctive radiological presentation. The patient, a 47-year-old asymptomatic woman, underwent a routine screening mammogram that identified a small, slightly denser mass in the right upper quadrants of the breast, not seen in previous exams. Ultrasonography did not detect a breast mass; however, suspicious lymph nodes were noted in the ipsilateral axillary cavity. A fine-needle aspiration (US-FNA) was performed on one of these lymph nodes. Subsequently, digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-VAB) was conducted on the mammographic finding, confirming the diagnosis of sarcoidosis.

Introduction

Leukocyte adhesion deficiency (LAD) is a rare autosomal recessive disorder characterized by improper primary immune response due to absent or decreased adhesion molecules, leading to impaired neutrophil migration into surrounding tissues. LAD is divided into four subtypes: LAD-I, LAD-II, LAD-III, and LAD-IV, based on the underlying mutations. Clinical presentation typically includes recurrent infections and neutrophilia, and it is confirmed through flow cytometry and genetic testing. However, these diagnostic methods may not be available during wartime. Here, we present a case of LAD in a Syrian infant.

Case presentation

A 2-month-old infant born to consanguineous parents presented with recurrent skin lesions in the groin and axillary region, accompanied by fever, night sweats, anorexia, and milky vomits twice a day. Clinical examination revealed a 3×4 cm umbilical hernia, multiple ulcerated skin lesions with a base of yellow necrotic tissue in the groin, and a 2.5 cm ulcer in the axilla. The laboratory tests confirm the presence of neutrophilia (WBC: 64.07 ×10⁹/L; Neutrophils: 79 %), raising suspicion for LAD. However, confirmation through flow cytometry and genetic testing was not possible due to unavailability. Antibiotics were administered, but the patient was discharged against medical advice.

Conclusion

The scarcity of documented LAD cases from Syria, coupled with the lack of resources to confirm the diagnoses of LAD using flow cytometry, highlights the need for a structured approach to such cases based on clinical presentation and available laboratory findings. This approach is crucial for ensuring timely diagnosis and appropriate management, especially in resource-constrained settings affected by conflict.

Dental implants are long-term successful when the osteointegration is maintained with little yearly loss of crestal bone. The current study assesses the crestal bone loss surrounding Osseo integrated implants by adding a concentrated growth factor as an extra factor to maintain the crestal bone levels. The research comprised single patient with a single edentulous location. Along with the implant, concentrated growth factor is inserted. Three and nine months after the implant was implanted, assessments of soft tissue characteristics such as the sulcus bleeding index and plaque index were conducted. Hard tissue metrics, such as volume and bone density, were measured using cone-beam computed tomography both nine months after implant implantation and immediately following implant placement. baseline and nine-month markers were compared, several hard and soft tissue parameters indicated a significant change at nine months. By elevating the density and volume of bone surrounding dental implants, concentrated growth factor can be used as a breakthrough in customized medicine to promote quicker healing and osseous regeneration.

Background

Fusobacterium necrophorum is an anaerobic gram-negative rod commonly found in humans' gastrointestinal and respiratory tracts. While classically associated with Lemierre's syndrome, F. necrophorum can cause pharyngitis, sinusitis, and otitis, especially in young adults. On rare occasions, it can progress to lifethreatening complications including meningitis, intracranial abscess, and sinus thrombosis.

Case Report

Case Report-An adolescent presented multiple times in one week for persistent right ear pain. Despite treatment, the patient continued to worsen and presented to the emergency department after developing fever, lethargy, and vomiting. Lumbar puncture confirmed meningitis with over 250 white blood cells x10∼3/UL. The patient was transferred to a children's hospital, where cavernous sinus thrombosis was also identified. The patient underwent mastoidectomy and started on heparin intravenously. Upon discharge, he transitioned to enoxaparin and later rivaroxaban for three months. Why should an emergency physician be aware of this? Fusobacterium necrophorum is a rare cause of otitis and meningitis but can be deadly if not treated appropriately. As a gram-negative anaerobe, standard meningitis treatment does not adequately treat this organism. Significant morbidity and mortality are associated with this disease.

A dentigerous cyst is a developmental odontogenic cyst which develops from the reduced enamel epithelium in an impacted permanent tooth and is rarely associated with supernumerary teeth. The purpose of this article was to report the case of an 27-year-old male pateint with a dentigerous cyst associated with an impacted supernumerary tooth and its diagnostic dilemma. There was root stump irt 46 which showed periapical pathology beneath which the impacted supernumerary tooth was present. The root stump and supernumerary teeth both was extracted and healing was satisfactory. Later the specimen was histo-pathologically proved to be dentigerous cyst. This case shows how to arrive at a radiographic diagnosis in such conditions.

Key clinical message

Distal renal tubular acidosis, first described in 1946, holds significant clinical importance, particularly in paediatric populations, due to its long-term impact on bone density and growth, as well as effects on the kidneys [3,6]. Early recognition and appropriate management of RTA in paediatric patients is essential to mitigating long term complications and optimising patient outcomes [3].

We report a case of a 13-year-old female child who presented with unusual symptoms of distal RTA, namely bilateral lower limb weakness. Undiagnosed renal tubular acidosis predisposes patients to an array of complications and 25 % of patients may experience a metabolic emergency at some point [3]. The patient was treated with electrolyte-balancing agents and vitamin D. The patient responded to treatment and was discharged, followed by regular-follow ups in the outpatient department.

An insect born disease termed as leishmaniasis is a type of parasitic disease which is becoming a great threat for social as well as medical team of more than 99 countries and its cases are increasing in Pakistan. The present study was conducted in Pakistan and its purpose was to demonstrate the geographical distribution as well as clinical features and risk factors of cutaneous leishmaniasis. Total (n=26590) were identified with cutaneous leishmaniasis from the four provinces of Pakistan from which 43.88 %(n=11670) of cases reported from Khyber Pakhtunkhwa which is highest among all the provinces whereas 33.31 %(n=8858) of cases reported from Balochistan. Additionally, 9.91 % of cases reported from province Sindh meanwhile 7.06 %(n=1878) of cases reported from Azad and jamu Kashmir and 5.82 % (n=1548) percent cases were reported from punjab which is among the lowest. Khyber Pakhtunkhwa is in a moderate season, and it favors protozoan’s parasite to spread the disease. The infected patients’ skin scraps were collected for microscopic examination and blood samples were taken for PCR. Most of the infected patients are from rural areas where the chances of biting sand fly were greater in these areas. The purpose of this study was to report the infected areas as well as to spread awareness about the spread of this disease.

Mesenteric panniculitis (MP) is an inflammatory condition affecting the mesenteric adipose tissue, characterized by idiopathic inflammatory and fibrotic changes. We present a case of a 66-year-old woman initially diagnosed with MP, followed by the diagnosis of follicular lymphoma six months later. Despite several proposed hypotheses, the etiology of MP remains poorly understood, with potential associations including abdominopelvic surgery, infections, autoimmune conditions and various malignancies including lymphoma. Several studies have not consistently demonstrated an association with lymphoma. Further research is needed to delineate the exact mechanisms underlying MP and its potential associations with lymphoma, warranting careful evaluation and follow-up in clinical practice.

Double-J (DJ) stents are often used in urological procedures, mostly to treat symptoms of ureteral blockage. Long-term stent placement can result in major issues such as hydronephrosis and the production of stones. We describe a 49-year-old female patient with chief complaints of dysuria and right flank pain. The patient had a history of DJ stent insertion 3 years ago. From the kidney–ureter–bladder x-ray we found a DJ stent in the right paravertebral space, with its proximal tip at the level of the second lumbar vertebra, and a ureteral stone and the distal stent tip in the bladder and surrounded by stones. A ureterolithotomy and vesicolithotripsy were performed, as well as a DJ stent extraction. The patient was discharged home on the third postoperative day and was in good condition at the follow-up 10 days after surgery. In conclusion, a DJ stent is a foreign body that can be a place for stone formation, so the installation of DJ stents in patients needs to be considered as well as possible and need close monitoring.

Purpose of research

Calcifying epithelial odontogenic tumor (CEOT), a benign, infrequent, odontogenic epithelial neoplasm, is mostly intraosseous, with occasional peripheral presentations. Although rare, the malignant transformation potential of CEOT has been reported. Herein, we elucidate four CEOT cases, involving female subjects, with emphasis on relevant clinical-radiological-histopathological and immunohistochemical diagnostic features.

Principal results

The CEOT cases presented here showed diverse clinical, radiological and histopathological spectrum, with one of the cases showing pronounced features of malignancy.IHC staining showed marked p53 positivity whereas Ki67 expression was less in the presented malignant case of this series.

Conclusion

Differentiation between extremely benign, locally aggressive CEOTs and its malignant counterparts remain an enigma. IHC staining is instrumental in depicting malignant nature of CEOT.

Scientific elucidation regarding more instances of malignant or recurrent variants of CEOTs is needed, to clearly understand their biology, aggression and behavior, through advanced molecular assays.