Clin. Pract., Volume 9, Issue 1 (January 2019) – 10 articles

At 22 days after intrauterine insemination with ovulation induction using clomiphene citrate at a previous hospital, a 30-year-old woman was admitted to our hospital owing to right lower quadrant abdominal pain. We diagnosed threatened abortion because of a gestational sac in the uterus on transvaginal ultrasonography. The next day, she complained of increased abdominal pain. Transvaginal ultrasonography revealed a gestational sac-like structure in the echo free space. She was diagnosed with heterotopic pregnancy due to a ruptured right tubal pregnancy, underwent laparoscopic right salpingectomy. Rupture of a gestational age of 5 weeks is extremely rare. If this was a case of a heterotopic pregnancy due to superfetation, it could be explained as this clinical course. When a pregnant woman develops abdominal pain, heterotopic pregnancies should not be excluded from the differential diagnosis, and the possibility of superfetation should be taken into consideration. Full article

One of the most common disorders of the salivary glands is sialolithiasis. A history of pain or/and swelling in the salivary glands, especially during meal suggests this diagnosis. For small and accessible stones conservative therapies like milking of ducts with palliative therapy can produce satisfactory results. Surgical management should be considered when the stone/stones are inaccessible or large in size as conservative therapies turned out to be unsatisfactory. In this paper, we present three cases of sialolithiasis in the submandibular gland along with a review of existing literature. The purpose of this paper is to add three more cases to the literature and review the theories of etiology, clinical features, available diagnostic and treatment procedures. Full article

It is a known fact that a disabled person is a greater burden to society than a dead person. Krukenberg operation, first described by German army surgeon in 1917, Hermann Krukenberg, converts a forearm stump into a pincer, so as to retain some dexterity of the hand rather than it being reduced to a mere stump. We report this case of Krukenberg operation performed in a tertiary care setup, wherein an amputated forearm stump was converted into a functional pincer that can result in huge advantage for poor amputee patients in developing countries who rely heavily on the functionality of their hands to earn their everyday meal and are unable to bear the expense of costly prosthesis. One such patient, a 25-year-old male hailing from a very poor background who came to us with traumatic amputation of his dominant hand. Full article

There are various causes for residual alveolar ridge defects, most common being the collapse of the cortical plate during extraction. Localized defects of alveolar ridge affect prosthetic restoration due to poor emergence profile of the pontic. Various soft tissue augmentation procedures have been recommended for the correction of these defects. Abrams’s roll technique has been widely used for soft tissue ridge augmentation in the maxillary anterior region where aesthetics is a prime concern. The original Abrams’s roll technique has been modified and revisited by many authors to overcome the limitations. The present clinical case report discusses the modified roll technique as an option to treat alveolar ridge deformity. The current procedure resulted in expectable ridge augmentation, uneventful healing, and good aesthetic outcome. Hence this modified technique can be selected for the treatment of mild to moderate Seibert class I ridge defects in the aesthetic zone. Full article

The gut microbiota plays the important role to support the immunological tolerance. To study a metabolic activity of the intestinal microflora the 44 patients suffering from bronchial asthma and 17 healthy volunteers were tested. The short-chain fatty acids (SCFA) spectrum was determined using the method of gas-liquid chromatographic analysis. We have detected a significant decrease the total content of the fatty acids in the feces (P<0.001), the absolute concentrations of the individual acids (acetate, propionate, butyrate; P<0.001) and the total content of isoacids (P<0.001) for all of the patients with bronchial asthma in the study, regardless of the phenotype. The anaerobic type of the SCFA spectrum was detected for the majority (83%) of the patients tested. The aerobic type of the SCFA metabolic profile was detected for another part (17%) of the patients tested. Being detected the parameters change could play the principal role as for the bronchial asthma course as to support the organism sensibilisation. Full article

The aim of this article is to describe a large mandibular cyst treated with decompression followed by surgical enucleation. Furthermore, we described the utility of cyst volume measurements by using a 3D reconstruction on Cone Beam Computed Tomography (CBCT). The dentigerous cyst is the most common cyst type of epithelial origin, arising from remnants of odontogenic epithelium, asymptomatic and associated with the crown of an unerupted or partially or completely impacted tooth. However, after a long duration and extension of the cyst volume it may provoke significant bone resorption, cortical expansion, tooth displacement and the vitality of neighboring teeth may be affected. The regular treatment of this lesion is enucleation and extraction of the involved tooth. Marsupialization and decompression are proposed when the volume of the cyst is well developed to release the cystic pressure and allow the bone cavity to progressively decrease in volume with the gradual apposition of bone. This report presents a large dentigerous cyst related to impacted mandibular third molar of a 21-year-old male patient. The cyst was treated successfully by decompression and later by surgical enucleation with surgical extraction of the related molar. In conclusion, the combination of decompression and surgical approach showed on the three-dimensional CBCT investigation a significant correlation between the treatment and volume reduction of the cyst. The clinical case described allows us to observe bone formation after decompression and surgical enucleation was performed with less risk on vital anatomic elements. Full article

In adults, intestinal malrotation is an oligosymptomatic entity that is occasionally discovered during the course of diagnostic studies for other causes. In the case described herein, intestinal malrotation was discovered during investigation for cholelithiasis and acute cholecystitis. Malrotation may occur due to alterations in the asymmetric cellular dynamics of the mesentery responsible for intestinal shortening and unilateral retraction, this may occur as a secondary event following alterations in the expression of homeodomain transcription factors. The incidental finding of asymptomatic intestinal malrotation in adults does not preclude its surgical treatment. However, when intestinal malrotation is associated with cholecystitis, due to cholelithiasis, it is advisable, to first treat the cholecystitis conservatively, in our case, and then perform partial adhesiolysis of the Ladd bands that hinder access to the cystic area and carry out cholecystectomy by elective laparoscopy. Full article

Foreign body impactions in the tooth are common findings in the oral cavity of children because of their frequent habits of placing various objects in their mouth. The present case describes an 11-year-old boy with a foreign object in the maxillary left first molar tooth of which he was unaware. Foreign objects can not only be a source of infection but also be aspirated or ingested by the child. The discovery of foreign objects in the teeth is usually accidental. A detailed case history, consisting of a history of the ordinary placement of the object and clinical and radiographic examinations is necessary to determine the nature, size, and location of the foreign body, as well as the difficulty involved in its retrieval. The foreign object may sometimes fracture inside the tooth during exploration by the parent or child. Such an object may act as a potential source of infection and lead to complications. Full article

Direct oral anticoagulants have become increasingly used for atrial fibrillation and venothromboembolic disease. Thus far, there have been a few published cases of pericardial effusion associated with rivaroxban. However, there has been little published regarding the effects of concurrent medications and their effect on the cytochrome enzyme systems involved in rivaroxaban metabolism. We present a case of a 76-year-old female who develops a spontaneous haemopericardium after initiating rivaroxaban. After thorough medical reconciliation, we offer pharmacokinetic mechanisms that may have contributed to the haemopericardium. This case demonstrates the importance of reviewing patients medication lists and utilizing basic pharmacokinetics to prevent adverse events. Full article

Maxillary lateral incisors are most common teeth to be found missing. They also are the most common teeth that need esthetic replacement. A 23-year-old female patient with missing maxillary lateral incisors was treated orthodontically: laterals were replaced with implants. Challenges while doing this case are discussed in the following case report. Full article