Open Access Case Study

Fibrotic Sarcoidosis Mimics Non-specific Interstitial Pneumonia: A Case Report

Tomoo Kishaba, Junya Fukuoka, Yuichiro Nei, Hiroaki Nagano, Shin Yamashiro, Fumihito Kunishima

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2017/33805

Aims: Fibrotic sarcoidosis is not common presentation and it is not easy to diagnose for many differential diagnosis. We herein report an interesting fibrotic sarcoidosis who shows atypical presentation such as progressive dyspnea with fibrotic imaging findings.

Presentation of Case: A 75-year-old Japanese lady visited our hospital with fifteen months duration of non-productive cough and one month exertional dyspnea. Physical examination revealed bilateral fine crackles and squawk at left lung base. Laboratory findings showed elevation of lactate dehydrogenase (LDH) and Krebs von den Lungen-6 (KL-6). Chest high-resolution computed tomography (HRCT) showed mediastinal lymphadenopathy, left lower lung field dominant reticular shadow and traction bronchiectasis. In terms of pulmonary function test (PFT), percent predicted vital capacity (%VC), forced vital capacity (FVC) and percent predicted forced vital capacity (%FVC) were 71.2%, 1.12L and 52.8%, respectively. Based on clinical course, laboratory findings and chest imaging, we considered possibility of fibrotic non-specific interstitial pneumonia (f-NSIP).She undertook video-assisted thoracoscopic surgery (VATS). Specimens were taken from left upper lobe and lower lobe. Pathological findings showed well-formed peri-lymphatic granuloma, architectural destruction with dense fibrosis and microscopic honeycombing. According to the clinical-radiological-pathological discussion, we diagnosed this case as fibrotic sarcoidosis. We commenced oral prednisolone 30 mg/day, treatment response was good including clinical symptoms, laboratory biomarker and chest imaging findings. She is well on prednisolone 2.5 mg/day now.

Discussion: This case show similar presentation of f-NSIP both clinically and radiologically. Multidisciplinary discussion was useful for decide to commence adequate management.

Conclusion: We present a fibrotic sarcoidosis patient who mimics f-NSIP.

Open Access Case Study

Spontaneous Regression of an Oral Manifestation of Plasmablastic Lymphoma: Literature Review and Commentary about the Phenomena

Natália Batista Daroit, Viviane Palmeira da Silva, Bruna Jalfim Maraschin, Fernanda Visioli, Pedro Bandeira Aleixo, Márcia Gaiger de Oliveira, Pantelis Varvaki Rados

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/33683

Plasmablastic Lymphoma (PBL) is a hematolymphoid malignant disease that has a predilection for the oral cavity and jaw. The aim of this paper is report a total resolution of oral manifestation of PBL without any oncological treatment; this process is extremely rare and we discuss the mechanism which can occur. We present a case of PBL in left maxilla and oral mucosa in a woman HIV-positive patient. After an incisional biopsy an unusual outcome of spontaneous regression of the disease occurred, we reported the diagnostic process, the management and the follow up of case. We revised the similar cases reported in the literature and we will discuss the hypotheses how the phenomenon can occur. Although the PBLs are aggressive lesions, with questionable prognosis, the spontaneous regression can occur and the patient should be monitored for the risk of metastases and possible recurrence of the disease.

Open Access Case Study

Multiple Variations in Carotid Arteries: Lower Common Carotid Bifurcation, Hypoplastic and Tortuous Internal Carotid Artery

Oguz Kadir Egilmez, Lokman Uzun, M. Tayyar Kalcioglu, Muhammet Tekin

Journal of Advances in Medicine and Medical Research, Page 1-4
DOI: 10.9734/BJMMR/2017/33449


Aim: During the neck surgery, vascular complications could be encountered in the cases with vascular anomalies. To reduce the complication rates and minimize operative morbidity and mortality, it is important to know the normal vascular anatomy of the neck and its related anomalies.

Presentation of Case: In this report, a 60-year-old male patient diagnosed with laryngeal carcinoma was presented. Total laryngectomy and bilateral functional neck dissection was performed to the patient with the diagnosis of squamous cell carcinoma of the larynx. During the neck dissection, bifurcation of right common carotid artery was detected lower than the usual localization, hypoplastic as well as tortuous internal carotid artery was seen on the same side. Multiple fusiform dilatation with narrowing of the right internal jugular vein (IJV) was also detected.

Discussion: Previously, there are several reported anomalies in the literature. The bifurcation of the common carotid arteries may be lower or higher than the normal levels. Also tortuous arteries can be seen during surgery and it may be asymptomatic if it is mild otherwise may lead to ischaemia of the organs if it is severe. The cause could be genetic, or may be thickening of the arteries.

Conclusion: We wanted to emphasize the importance of the knowledge of normal anatomy and also anomalies of vessels of the head and neck region and implications of these anomalies were discussed under the light of literature.

Open Access Minireview Article

Identical Twins Rhinoplasty; Twice the Challenge

Sultan Alanazy, Turki Aldriweesh

Journal of Advances in Medicine and Medical Research, Page 1-3
DOI: 10.9734/BJMMR/2017/33672

In identical twins, they have strong special environmental, psychological and social relationships. Rhinoplasty is one of the most popular procedure and in this group of the population carries distinct consideration regarding the evaluation of the behavior of each of them, dysmorphia, expectations, motivation, operative timing, phenotype identities, and result. The rhinoplasty surgeon deals with them as a two-part unit. The aim of this review is to elaborate the difficulty of rhinoplasty in identical twins from the first visit until post-operative period.

Open Access Minireview Article

The Regulation of Proprotein Convertase Subtilisin/ Kexin Type 9 and Its Liver Involvement

R. G. Mihăilă

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2017/33548

Introduction: Anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies have been very effective to lower low-density lipoprotein (LDL)-cholesterol. They attracted the attention on PCSK9 enzyme role in multiple pathways and underlined the complex correlations between lipid metabolism and various other liver or extrahepatic diseases, that are insufficiently known. Hepatocyte nuclear factor 1, sterol regulatory element-binding protein (SREBP) 1c and SREBP2 are the main modulators of liver PCSK9 gene and protein expression, processes that can also be influenced by some natural and synthetic compounds (as berberine, or bortezomib and rosuvastatin, respectively), endoplasmic reticulum stress, metabolic status and the diurnal pattern.

Aim: This minireview is an analysis of PCSK9 involvement in liver pathology.

Results and Conclusion: PCSK9 is a key enzyme which increases LDL-receptor degradation. Hepatitis C virus (HCV) enters into hepatocytes in combination with lipoproteins through LDL-receptors and negatively modulates the PCSK9 expression to reduce LDL-receptor degradation and increase HCV entry into hepatocyte. PCSK9 modulates the hepatic CD81 - a mediator of post-attachment process. The greater the liver lipid accumulation the higher the plasma levels of PCSK9, which were observed in non-alcoholic fatty liver disease. A decreased expression of PCSK9 and an increased expression of LDL-receptor were shown in liver samples from patients with hepatocellular carcinoma, a fact that suggests that these cancer cells are able to modulate their local microenvironment to obtain a higher amount of cellular cholesterol. With better understanding of the role of this enzyme, PCSK9 and the factors involved in its regulation can become targets for the treatment of different liver pathologies.

Open Access Minireview Article

Surgical and Prosthetic Approach for Oral Rehabilitation of Patient with Excessive Gingival Display and Gummy Smile

Romeu Felipe Elias Calixto, Frederico Bordini Chaves Faleiros, Eugênio Carlos Marangoni, Flávia Regina Machado de Medeiros, Amanda Fucci Wady, André Gustavo Paleari

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2017/33979

Aims: The aim of this study is to describe the surgical and prosthetic approaches of oral rehabilitation of a partially edentulous patient with a vertical maxillary excess with excessive gingival display when smiling.

Presentation of Case: A 40-year-old female patient complaining of cosmetic dental problems reported to the School of Dentistry at Franca University (UNIFRAN). After a clinical examination and radiographic imaging, it was determined that the patient was partially edentulous with vertical maxillary excess with excessive gingival display when smiling. A diagnostic wax-up was performed to determine the ideal position of the anterior teeth in relation to proper oral posture at rest, to the smile line, and to the bone level. In light of the ideal position of the anterior teeth for reducing gingival display when smiling, it was decided to remove the remaining teeth and perform a maxillary ostectomy. After performing the pre-prosthetic surgery, six implants were installed in the remaining maxillary bone, and a provisional conventional complete denture was installed and left in position until the osseointegration period. Later, a complete arch fixed implant-supported prosthesis was manufactured, since the prosthesis–tissue junction was above to the high smile line.

Discussion and Conclusion: Pre-prosthetic ostectomy and treatment by means of a complete arch fixed implant-supported prosthesis produced an effective and predictable outcome, resulting in a very favorable esthetic and functional outcome for the patient.

Open Access Original Research Article

Tolerability of The Copper- T Intrauterine Device by Acceptors at Jos University Teaching Hospital, Jos, North-Central Nigeria

A. G. Ohihoin, J. T. Mutihir, I. A. O. Ujah, E. N. Ohihoin, E. C. Herbertson, O. C. Ezechi

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/BJMMR/2017/31897

Background: The Copper-T (Cu-T) Intrauterine device (IUD) is one of the oldest and most reliable forms of contraception. Its widespread use has been limited by side effects, such as heavy menstrual flow and pain on insertion. Findings suggest that the intrauterine device acts more as a contraceptive than an abortifacient, thus improving its acceptability.

Objectives: To determine the proportion of women using Cu-T IUD, who will develop side effects during the study period; Outline experienced side effects of Cu-T; and ascertain the discontinuation rate and reasons for removal.

Methods: The intrauterine device used for this study is Copper T380A.

A descriptive cohort study, of women using Cu-T IUD at the Jos University Teaching Hospital, North Central Nigeria. A structured proforma was used to extract data from family planning records. Study duration was one year. (Jan-Dec 2007).

Results: A total of 103 women participated in the study. The average age of the respondents was 30.75 ± 5.90 years, with a range of 20-47 years. Only a few (17.5%) of the respondents had side effects or complications, The commonest side effect was vaginal discharge and abnormal cessation of menstrual flow (5.8%) respectively. Other side effects documented were painful period (2.9%) and abdominal pain (1%). Only 5.8% (n=6) discontinued the Cu-T IUD, due to side effects. The commonest reason for discontinuation was abdominal pain, 1.97% (n=2), although only one client had initially reported abdominal pain as an adverse effect. There was a significant relationship between development of side effects and discontinuation. (p <0.01).

Conclusion: Only a few of the women using Cu-T IUD developed side effects, and discontinuation rate was quite low. Patients who discontinued usage did so because of side effects and husband’s request. Limitations of this study include the short duration of follow up.

Public health education should be done to enlighten Nigerian women on this method of contraception which seems quite tolerable and reliable, with the aim of increasing its uptake.