Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC $74 Abstracts Abstracts ordering medicaments or other therapeutical products, may cause side effects. They are all listed in 'The Characteristic of a Medical Pro- duct' with ascribed frequency of occurrence. It is essential to remem- ber to be thoroughly acquainted with such a document before using a medical product. Case: A 13 year-old girl was admitted to hospital because of blurred vision and uncontrolled head movements to the back which had been preceded by gastroenteritis for two days. In the beginning a neuroinfection was considered, but after a thorough anamnesis it turned out that the patient was treated with Torecan. That led us to believe that the patients' symptoms were the side effects of the administered thiethylperazine and therefore treatment with Akineton (biperiden) was initiated. Our hypothesis was con- firmed as the treatment yielded very good results. On the second day of hospitalization dyskinesis reappeared, so the patient was administered one more dose of Akineton. Shortly after the initiation of treatment all symptoms disappeared, but the patient complai- ned about hallucinations which lasted for several hours. Observed side effects of both medications were described in 'Characteristic of Medical Product' as rare occurences. Conclusions: In the discussed case, side effects of medication used to stop diarrhea occurred. Such a procedure is not compatible with current guidelines concerning gastroenteritis treatment, but parents administered it without con- sulting a doctor. On the other hand, medication which was used to stop dyskinesis was administered properly but side effects of that drug also occurred. Every drug administration should be preceded by ensuring that benefits outweigh the potential side effects for the patient, which, despite being described as rare, can always occur. We should also pay special attention to educate patients (and their parents) about appropriate administration of drugs. 40 Acute Lymphoblastic Leukemia: Diagnostic Difficulties, Complications During Treatment And Patient's Death Due To Listeria Monocytogenes Infection Katarzyna Adamczewska Poznan University of Medical Sciences/ Pediatric Oncology and Hematology Background: ALL is the most common childhood cancer, which early recognition and proper treatment may turn problematic. This work is to highlight difficulties during making diagnosis of ALL, the ones connected with side effects of chemotherapy and atypical onset of opportunistic infections. Case: 15-year old boy was referred to Pedia- tric Oncology and Hematology Clinic with initial diagnosis of NHL with complaint of severe epistaxis, emesis and musculoskeletal pains. On clinical examination: lymphadenopathy, tachycardia. Chest X-ray and CT showed widened mediastinum, suggesting mediastinal mass and pleural effusion. Blood tests revealed leukocytosis, thrombo- cytopenia and hyperuricemia. Due to bone marrow myelogram and immunologic examination T-cell acute lymphoblastic leukemia was diagnosed. Patient was treated according to ALL IC BFM 2009 for IR risk group. On account of impaired coagulation, genetic examination was carried out with a result of factor V Leiden and heterozygo- tic C667T and A1298C mutations of MTHFR detection. Corticosteroid therapy resulted in insulin resistance. During diabetic diet sudden increase in bilirubin level occured with normal hepatic enzymes level at the same time. The suspicion of Gilbert's syndrome was confirmed. CT evaluating remission of mediastinal mass (Protocol la) revealed invasive pneumomycosis (Aspergillus fumigatus), despite lack of any clinical symptoms. Intensive treatment was immediately administered. After finishing Protocol II the rise in CRP was obser- ved with decreased number of WBC at the same time. Patient was feverish and complained of nonspecific abdominal pain and dysuria. USG detected fluid in right iliac fossa. 3 hours later boy's neurological state dramatically worsened (anisocoria, neck stiffness). CT reveled acute hydrocephalus which needed immediate drainage. Listeria mo- nocytogenes was isolated from CSF. Despite intensive antibiotic the- rapy, infection caused boy's death. Conclusions: Mediastinal mass, suggesting NHL, may occur during ALL, especially T-cell. During ALL treatment it must be remembered that multiple complications may cause deviation and delay in chemotherapy. Immunocompromised patients may be affected by opportunistic pathogens which results in life-threatening infection. Fluid in right iliac fossa is characteristic for listeriosis in ALL patients. 41 Burkitt Lymphoma In Untypical Localization Karol Ratajczak Students' Scientific Group, Department of Pediatric Otolaryn- gology, Medical University of Warsaw Background: Burkitt lymphoma is a malignant tumor of the lympha- tic system, arisen from B lymphocytes found in the germinal center. There are three clinical variants: the endemic variant, the sporadic type and immunodeficiency-associated type. The second and third type can be found all over the world, the endemic variant is associa- ted with EBV and most commonly occurs in children living in malaria endemic regions of the world. Burkitt's tumor usually develop in mandible, but may also concern intestines, nervous system, kidney, ovaries, or other organs. Case: A 6-year-old boy was admitted to the Department of Pediatric Otolaryngology due to sleep apnea and speech disorders ongoing for three days. A physical examination showed enlarged cervical nodes on the right side of the neck and enlarged right palatine tonsil. Other groups of lymph nodes were not palpable, organomegaly was not found. CT of the head and neck revealed abnormal mass in the site of right palatine tonsil. The size of the lesion was 39x37x33mm and it was almost closing the na- sopharynx. The mass also completely obstructed oropharynx and laryngopharynx. The lesion was removed under general anesthe- sia. Subsequently adenoidectomy was performed. Histopathological test of the mass revealed Burkitt lymphoma stage 2. Chemotherapy treatment was applied. Conclusions: Malignant tumors are uncom- mon in children, but they should be always considered in differential diagnosis, especially in case of one-sided sudden enlargement of palatine tonsil. The presented case demonstrates that Burkitt lym- phoma may develop in untypical localization and can be associated with unspecific symptoms leading to life-threatening consequences. 42 Recurrent Diaphragmatic Hernia In 2-Year-Old Male Patient - Case Report Natalia Bajorek, Matthew Olesiak, Wojciech Rogula, Miłosz Saryusz-Romiszewski, Dominika Korzeniowska Jagiellonian University Collegium Medicum/ Department of Pediatric Surgery Background: The authors present a 2-year-old male patient after a repair of a congenital diaphragmatic hernia who was admitted to the hospital with suspicion of bowel obstruction. Imaging studies showed a subsequent pathology classified as a recurrent diaphrag- matic hernia to be the most probable finding. Case: The patient presented to the hospital with the complaints of vomiting and no passage of stool for the prior three days. The patient underwent a left sided thoracoscopy for a congenital diaphragmatic hernia on day 2-post partum. The herniated bowel loops were reduced into the abdominal cavity. The diaphragmatic defect was repaired with interrupted non-absorbable sutures under considerably moderate tension. Until now, he suffered from recurrent episodes of bronchitis. Physical examination showed a distended abdomen with tenderness on palpation. X-ray scans were diagnostic for bowel obstruction and the suspicion of recurrent diaphragmatic hernia was raised. The pa- tient was qualified for laparotomy. Intra-operatively, the omentum and transverse colon strangulated with defects in the diaphragm was visualized. Segmental resection of necrotic bowel with anas- tomosis and diaphragm repair was performed. Pneumothorax with pleural empyema in left pleural cavity was cured with drainage. The postoperative period was complicated by the suspicion of sepsis. The patient was successfully treated and discharged home in good clinical condition. Conclusions: Recurrent diaphragmatic hernia may present as a life threatening complication 2 years after initial suc- cessful repair. 43 Salmonella Infection After Travelling To Tropics - Two Cases Report Joanna Ulan Students' Scientific Group, Department of Children's Infec- tious Diseases, Medical University of Warsaw Background: The number of children who travel internationally is increasing. Children face most of the same health risks as adults but consequences can be more serious. Diarrhoea is one of the most common diseases experienced by children who travel, especially to the developing countries. Case: Case 1: A 2-years old boy, who returned from Tanzania after a tourist stay, was admitted to the hospital because of fever. For few previous days he had been in worse condition, with decreased appetite and loose stools (2 per day). At admission the boy was febrile, apathetic and dehydrated. Lab tests showed normal leukocyte count, slightly elevated CRP level, hyponatremia and hypokalaemia. Test for mala- ria was negative. Supportive therapy with intravenous rehydration, antipyretics, natrium and kalium substitution was used. Fever per- sisted, vomits and diarrhoea occured. CRP level increased. Denga, rota- and adenoviral infection were excluded. Antimicrobial therapy with trimethoprim-sulfamethoxazole was administered and rapid cli- nical improvement was observed. Salmonella type B was cultured from stool sample. Case 2: A 2-years old girl was admitted to the hospital, after coming back from a 6-weeks stay in Thailand, with a day history of fever, one episode of vomiting and 2 loose stools. At admission she was in me- dium general condition, dehydrated. Physical examination revealed pharyngitis with no other abnormalities. Lab tests showed slightly elevated CRP level; leukocyte count and blood smear, electrolytes and glucose levels, urinalysis were normal. Intravenous rehydration and cefuroxime were used. General condition improved, the girl did not vomit and passed normal stools, but fever persisted. In the 3rd day of hospitalization lab tests revealed elevated procalcitonin level. Blood and stool were obtained for culture and antibiotic therapy was changed for ceftriaxone. Meningitis, malaria and denga were excluded. Stool culture was positive for Salmonella typhimurium, a strain resistant to third-generation cephalosporins and trimetho- prim-sulfamethoxazole, was cultured. The result of antibiogram was known, when clinical improvement was achieved with normalization of temperature, therefore antimicrobial therapy was not changed. Conclusions: Parents travelling with children to the developing coun- tries should realize health risks. Infection acquired abroad can cause serious morbidity and, additionally, may result in spread of less com- mon bacterial strains, including drug resistant ones. 44 Dysgerminoma In 9-Year Old Female - A Case Report Agnieszka Basiukajć Poznan University of Medical Sciences Background: Ovarian germ cell tumors are derived from primordial germ cells of the ovary. These neoplasms comprise approximately 20 percent of ovarian neoplasms overall, but account for only about 5 percent of all malignant ovarian neoplasms. Ovarian germ cell tu- mors arise primarily in young women between 10 and 30 years of age and represent 70 percent of ovarian neoplasms in this age group. Typical manifestation is abdominal pain and abdominal enlargement, precocious puberty and abnormal vaginal bleeding. The aim of the study is to present a case of dysgerminoma in 9-year old female. Case: A 9-year old female was admitted to Pediatric Oncology and Hematology Department with a suspicion of an abdominal tumor. She presented with a history of progressive abdominal enlargement for three weeks and non-specific abdominal pain for two years. Physical examination revealed distended abdomen and a large palpable mass in the mesogastric area. Abdominal ultrasonography and computed tomography showed a large heterogeneous mass 20x13x15cm and presence of fluid in peritoneum. Ovaries and uterus were not vi- sualized. Laboratory tests revealed elevated levels of lactate dehy- drogenase, alpha-fetoprotein and ẞ-human chorionic gonadotropin. Thus the ovarian germ cell tumor was suspected. The unilateral sal- pingo-oophorectomy was performed. Serum levels of tumor markers normalized after the surgery. The diagnosis of dysgerminoma was confirmed by histopathological examination. Cytological investiga- tion of peritoneal fluid revealed the presence of tumor cells. Further examinations showed enlarged mediastinal and retroperitoneal lym- ph nodes. The gynecological referral appeared normal however the ultrasound examination did not visualize the contralateral ovary. The patient was observed for gonadal dysgenesis although the karyotype investigation did not reveal any disorders. According to the protocole TGM-95, the patient was qualified for VIP (iphosphamide, etoposide, cisplatin) chemotherapy. Conclusions: The rarity of pediatric ovarian malignancies contributes to a low index of suspicion. In case of ab- dominal mass in female patients ovarian tumors should be taken into consideration at any age. 45 Liver Abscess In Amebiasis. A Case Report M. Fikri Safian, Bamdad Tavakolnia Medical University of Warsaw Background: Infection by Entamoeba histolytica occurs sporadically in non-endemic areas and it can present with extraintestinal mani- festations of which the most common is liver abscess. Case: In this case report the clinical course and treatment of a patient with liver abscess caused by Entamoeba histolytica admitted to our Clinic is presented and discussed. A 23 year-old man was referred from Infec- tious Diseases Hospital with suspicion of liver abscess by Entamoeba histolytica. CT and ultrasound examination were performed showing 120x80 mm abscess localized in right lobe of the liver. Patient was managed with percutaneous drainage under control of ultrasound. Pus obtained during the procedure was sent to bacteriological tests and histopathology investigations. An X-ray fistulography was per- formed 5 days later showing decrease in cyst size to 87x62 mm. The patient received antibiotic treatment with Ciprofloxacin and Metronidazole. Serological tests confirmed infection by Entamoeba histolytica. Bacteriological tests were negative. The patient was discharged in good condition and referred to Tropical and Parasitic Disease Ward for further pharmacological treatment. Conclusions: A differential diagnosis for liver abscess should take into account amoebic infection even though it is does not occur commonly in non-endemic areas. Standard treatment for Entamoeba histolytica abscess is chemotherapy. In cases where the size of an abscess exceeds 5 centimeters the drain placement is a treatment of choice accompanied by antibiotic therapy. 46 A Rare Case Report Of Xanthogranulomatous Osteomyelitis Of Right Tibia Dr. Mazharuddin Ali Khan, Dr.Chinnala Srujan Kumar, Dr. Da- vuluri Harish Kumar NTR University of Health Sciences/ Department of Orthopae- dics Background: Xanthogranulomatous osteomyelitis is a type of chro- nic inflammatory process which is rare bone infection and is diagno- sed histologically by fomy histiocytes, spindle cells and occasional osteoclastic gaint cells composition of immune cell aggregation Gross and radiological examination can mimic malignancy with variable densities, and differentiation should be confirmed by histopathologi- cal evaluation. Pathogenesis may be due to cell mediated immunity of delayed hypersensitivity type. Case: We describe the case of a 25-year-old female presenting with pain in left leg which aggrevated on walking and relieved by rest. Tenderness in left leg were detected following examination. Mild leukocytosis, elevated alkaline phospha- tase, and increased erythrocyte sedimentation rate with negative C-reactive protein (CRP) were revealed. X-ray imaging showed focal thickening of cortex in the mid shaft of tibia with no nidus. Com- puted tomography (CT) scan revealed lesions involving medulla and cortex, periosteal reaction with soft tissue component, and bone marrow infiltration in right humerus and left fibula. Magnetic reso- nance imaging (MRI) showed abnormal signal in medulla, of the left tibia associated with and diffuse hypersignal areas of soft tissue and cortical surface irregularity were demonstrated. Confirmation I was made by histological examination as xanthogranulomatous os- teomyelitis. Conclusions: This case is primarily presented due to its rarity and is the eighth case of Xanthogranulomatous osteomyelitis which is being reported in the literature to the best of our knowled- ge. The importance lies in the differential diagnoses of Xanthogra- nulomatous osteomyelitis which resembles tumour either benign or malignant based on gross and radiological examination and found INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S75