Investor Presentaiton
IJMS
INTERNATIONAL JOURNAL of
MEDICAL STUDENTS
11th WIMC
Abstracts
Abstracts
11th WIMC
mofetil (MMF), and prednisone; serum level of TAC was within the
reference limits. The patient was discharged home in good condi-
tion. 5 weeks after LT the patient was admitted to the hospital due
to abdominal pain and diarrhea from 7 days. Hepatomegaly and
ascites were found during physical examination. Lab tests showed
increased serum level of liver enzymes and renal failure. The ab-
dominal angio-CT scan revealed significant hepatic perfusion defect
without any sign of liver vessels pathology. Moreover, there were no
typical symptoms for any common complications after LT, therefore
the VOD was suspected. Then, treatment strategy was changed: TAC
was stopped, MMF dose was decreased due to leukopenia and a
novel drug mammalian target of rapamycine inhibitor everolimus
was introduced. Unfortunately, liver biopsy was not performed due
to advanced ascites. The modification of the immunosuppressive
regimen caused disappearing of the pathological symptoms, and ab-
dominal CT-scan revealed significant improvement of the liver paren-
chyma. Great outcomes confirmed VOD as a diagnosis of the disease.
Conclusions: Discontinuation of TAC and introducing the novel immu-
nosuppressive agent caused complete recovery in described patient.
Rare complications should be included into differential diagnosis in
liver transplant recipients, especially when symptoms are not typical
for common complication, therefore appropriate treatment strategy
can be use and better outcomes can be gain.
Pediatric Case Report
32
Ectopic Thoracic Kidney In A Child
Aleksandra Księżopolska
Medical University of Warsaw/Department of Pediatrics and
Nephrology
Background: Renal ectopia is one of the most common congenital
abnormalities. It occurs in 1/1000 newborns and is found in 1/20 000
autopsies. Most often, ectopic kidney is placed in the minor pelvis
or medially upward. There is a tendency to appear more frequently
in males and at the left side of the body. Thoracic location of kidney
is extremely rare only about 5% of all renal ectopias. These patients
don't present any pathological signs for a long time and defect is
usually discovered accidentally during routine check-up, diagnosis
of dyspnea or suspicious mass in lungs. Case: We present the case
of a 1,5-month-old boy, who was referred to Department of Pedia-
tric Nephrology to diagnose the long-lasting newborns jaundice and
suspicion of left kidney agenesis. Physical examination was normal,
except jaundice. In laboratory tests function of the kidneys and uri-
nalysis were normal, too. The ultrasound of abdomen and thorax
revealed the ectopic left kidney located upwardly, in the thoracic
cavity. X-ray of the chest revealed left kidney above the diaphragm.
Renal scintigraphy (DMSA scan) confirmed ectopic thoracic kidney.
Voiding cystourethrography (VCUG) excluded vesicoureteral reflux.
The patient was in good general condition and didn't show any
concomitant abnormalities. Conclusions: In the event of suspicion
of the renal agenesis on ultrasonography, ectopic kidney should be
included in differential diagnosis. Ectopic kidney can be placed in
pelvis or thoracic cavity. A complete urological evaluation in patient
with ectopic kidney is necessary to exclude concomitant urological
anomalies.
33
Lower Limb Replantation Strategy After Traumatic Avulsion
Augustina Grigaitė, Justina Linauskaitė
Lithuanian University of Health Sciences
Background: 9 year old boy was admitted to Emergency Room due to
traumatic amputation of his left leg. He experienced avulsion trauma
after attempting to jump over tractor's cardan joint, his leg got stuck
into it and was forcibly detached from the rest of the body. Lower
part of the leg below the knee joint was completely avulsed from
the rest of the body. Case: It was decided to replant the detached
limb to salvage the knee joint which, if successful, would assure
better outcomes for boy's future mobility. Replantation was needed
to ensure revascularization of the knee joint. 14 days after the re-
S72 INTERNATIONAL JOURNAL of MEDICAL STUDENTS
plantation, necrosis of the feet occurred, as expected, because of
the severity of the trauma. Fortunately, knee joint revascularized
and remained viable. Leg amputation inferior to the knee joint was
performed by a plastic and reconstructive surgeon in assistance with
orthopedic surgeon. Skin flap was used to form the stump. 2 months
after the surgery leg stump healed completely, no necrosis or infec-
tion occurred. 6 months following the surgery, leg prosthesis was
fitted. A year after the trauma boy is able to walk without crutches
using calf prosthesis. Conclusions: Limb avulsion traumas are one of
the most severe ones. Leg amputation is a life changing condition,
especially for children. In this case the preservation of quality of life
through regained function is crucial. The goal of replantation was to
salvage the knee joint which is extremely important for leg mobility.
Replantation allowed viability of the knee joint, which showed good
outcomes after applying the prosthesis.
34
Isolated Cerebellitis As A Rare Manifestation Of Perinatal Hiv
Infection Case Report
Bartłomiej Piotr Gaweł, Joanna Kacperczyk
Student Scientific Club of Paediatric Anesthesiology and In-
tensive Care, Medical University of Warsaw
Background: Clinical manifestation of HIV infection in children differs
from that in adults. Most common involvement of CNS in perinatally
infected children is encephalopathy. Isolated cerebellar involvement
is rare and can have various aetiology. Most frequently it is asso-
ciated with lymphoma, less frequently with infections (toxoplas-
mosis, JC virus, CMV) and cerebrovascular disorders. Opportunistic
infections in children have a more fulminant course due to lack of
prior immunity. Case: 3 years old male patient was admitted to the
hospital for diagnosis of walking impairment. Patient had undergo-
ne an episode of cerebellitis previous year which responded well
to therapy. Death of 1,5 years old brother due to hydrocephaly of
unknown origin. Cerebellitis was diagnosed yet in spite of treatment
patient developed disruption of consciousness and respiratory fai-
lure and thereafter was intubated. He was transferred to another
hospitals' ICU in a critical state for further diagnosis of suspected
severe hereditary or metabolic disorder. Despite further treatment
and widest possible diagnostics no cause was found and patient
state worsened quickly. He had developed cardiovascular instability
and impaction due to rise of intracranial pressure. Next day patient
went into cardiac arrest and due to previous DNR instruction patient
was not resuscitated. Only post-mortem HIV infection was identified
as a cause of death. Conclusions: Perinatal HIV infection is rare in
developed countries so it is uncommon for paediatricians to consi-
der it in differential diagnosis. Moreover, HIV infection has different
symptoms in adult population than in children. When added these
two factors contribute to the failure of administering right treatment
and death of the patient. HIV should be considered in every child
with lymphadenopathy, fever of unknown origin, recurrent or oppor-
tunistic infections.
35
A De Novo Unbalanced Chromosomal Rearrangment Invol-
ving X And Y Chromosome In A Patient With Ambigous Geni-
talia - Clinical Findings And Cytogenetic Analyses
Małgorzata Dera, Aleksandra Pietrzyk, Zofia Litwińska
Pomeranian Medical University/Unit of cytogenetics
Background: Due to the coexisting submicroscopic chromosomal re-
arrangements it is very difficult to determine the primary cause of
the sex differentiation disorders which occurs in the patient. Case:
A male neonate with ambigous genitalia was born at 38 gestational
weeks (birth weight: 2570g, Apgar score 7/8/9) to young, healthy,
unrelated parents with no family history of congenital anomalies,
intellectual disability or miscarriage. Intrauterine hypotrophy and
neonatal hypoglicemia were remarkable in his medical history.
Upon physical examination penoscrotal hypospadias was noted with
testicles palpable in scotum. No dysmorphic features, congenital
defetcs and were found. High resolution karyotype of peripheral
blood lymphocytes revealed partial deletion of long arm of chromo-
some Y and was determined as 46, XY, del(Y)(q11.23). FISH analysis
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showed mosaic for 45,X in 30% of analysed nuclei. Microdeletions
Y molecular test was showed presence of investigated sequences of
short arm of chromosome Y, including SRY but none of those located
on long arm, such as AZFa, AZFb, AZFC. Further array CGH analysis
delineated chromosome Y deletion to be 34.92 Mb of size but also
showed undetected previously deletion in Xp22.33 (1.12 Mb) with
concurrent 20 Mb duplication in Xp22.33- Xp.22.11. Conclusions: Si-
milar chromosome X aberrations has been described as pathogenic
and have been reported in females with dysmorphic features and
ID. In so complex abnormalities phenotype- genotype correlation is
extremely difficult to perform.
36
12 Years Old Girl With Hiv-Related Thrombocytopenia
Agnieszka Cieniewicz
Students' Scientific Group, Department of Children's Infec-
tious Diseases, Medical University of Warsaw
Background: Over the past 30 years the number of children infected
with human immunodeficiency virus (HIV) has increased dramati-
cally. Haematological abnormalities of varying severity may be the
manifestation of this infection. They are believed to occur as a con-
sequence of changes in the microenvironment of bone marrow and
due to deficiency of growth factors. Thrombocytopenia is found in
40% of patients with HIV infection during the course of the disease.
I present a case of a girl with HIV associated thrombocytopenia,
misdiagnosed as idiopathic thrombocytopenic purpura. Case: Since
8th month of life the girl has been hospitalised several times due
to recurrent fever, episodes of haemoptysis, bacterial infections of
upper respiratory tract, laryngitis, candidiasis, erythematous papular
rash and petechiae. She had a history of easily bruising in areas of
accidental trauma. At the age of 5 she was admitted to Department
of Haematology. Physical examination revealed hepatomegaly and
lymphadenopathy. Dental caries was also observed. The lowest pla-
telet count observed in laboratory tests was 3×10^9/L. Bone marrow
aspiration showed an abundance of megakaryocytes. Other haema-
tological investigations were normal. She was diagnosed with idio-
pathic thrombocytopenic purpura. Treatment with IVIG was started
but low platelets count persisted. An improvement was observed
after introducing steroids but platelets count decreased on any at-
tempt of reducing the dose. After a year of unsuccessful treatment,
on further questioning the girl's father admitted he had been HIV po-
sitive for several years. This prompted the decision of performing HIV
test, which was positive (her mother also turned out to be infected).
At the age of 6, the girl was diagnosed with vertical HIV infection in
stadium B2 with thrombocytopenia. After initiating antiretroviral the-
rapy platelet count increased. Currently the patient is aged 12 and
is successfully treated. Conclusions: Thrombocytopenia can be the
presenting feature of HIV infection in childhood. Therefore HIV should
be considered in differential diagnosis in paediatrics in all cases of
unexplained thrombocytopenia or any other cytopenia.
37
Urinary Retention And Tumor In The Pelvis Severe Suspi-
cions And An Unexpected Solution
Aleksandra Rurarz, Bartosz Siewert
Students' Scientific Association of the Clinical Department of
Paediatrics, Medical Centre for Postgraduate Education at
the Bielanski Hospital, Warsaw
Background: Urinary retention is a medical emergency which may
result from a vast number of medical conditions. The most obvious
cause is the obstruction of urine flow resulting from urinary tract
pathology or oppression by adjacent organs or as a result of the
ongoing processes in the abdomen, especially in the pelvis. Case:
A girl at the age of 13 years 7 months was admitted to the Hospital
Emergency Department due to urinary retention. 6 days before the
admission she reported abdominal pain in the lower abdomen but
she did not have fever and reported no voiding symptoms. In the
PHC clinic she was initially diagnosed with cystitis but general urine
analysis did not confirm this diagnosis. Symptoms intensified and
three days before the admission the first episode of urinary reten-
tion occured. The girl was consulted in the Emergency Department
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2015 Vol 3 Suppl 1
where the bladder catheterization was performed, yielding 1200 ml
of urine. The diagnosis of cystitis was upheld and Furaginum and
No-spa were commissioned. Initially, an improvement was observed
but during the day of admission difficulties in urinating reappeared
despite strong urgency. On clinical examination the bladder was pal-
pable 3 cm above the symphysis pubis. General examination and
urine culture led to the exclusion of urinary tract infection. After
catheterization, 13000ml of urine was obtained. In the differential
diagnosis urolithiasis and proliferative processes were considered.
The executed abdominal ultrasonography revealed enlarged uterus
and vagina with fluid collections. The consulting gynecologist confir-
med vaginal atresia. The girl underwent the intervention of hymen
incision during which free flow of hemolized blood in the amount
of approx. 700ml was received. After surgery, the girl was in a good
condition and the symptoms disappeared. Conclusions: In the course
of history taking and physical examination, medical doctors should
avoid duplicating earlier diagnoses and their own differential diag-
nosis should be carried out every time. A very careful examination
of each patient, regardless of age, which includes consideration of
the urogenital organs is crucial as well. Otherwise, medical doctors
may cause a delay in the right diagnosis. Such examination should
obviously take place in conditions of comfort for the patient and
preserving their right to privacy.
38
Infective Endocarditis Complicated With Embolism Of The
Middle Cerebral Artery In 10-Month-Old Girl - Case Report
Agnieszka Pskit
Students' Scientific Association at Department of Pediatric
and Pediatric Cardiology, Medical University of Warsaw
Background: Infective endocarditis (IE) is a non-uniform disease with
various signs and symptoms. Valvular heart disease is a high-risk
factor increasing incidence of IE. The diagnosis, according to Duke
criteria, is based on the positive blood culture and an echocardio-
gram with evidence of endocardial involvement. The disease may re-
sult in complications like emboli, neurological events and valve des-
truction. Case: 2-month-old girl with an aortic stenosis was admitted
to hospital in order to continue the diagnosis and qualification for
an interventional treatment. During hospitalization echocardiogra-
phy showed pressure gradient through the aortic valve (PG) up to
73mmHg, mean 43mmHg. The patient was qualified for balloon aortic
valvuloplasty. Immediately after the procedure echocardiogram re-
vealed that PG decreased to a maximum of 22mmHg, mean 12mmHg
and mild aortic insufficiency (IAO). At the age of 3.5 months the pa-
tient was admitted to the local hospital due to pneumonia. When she
was 4 months old echocardiography showed a slight increase of IAo
up to modrete, which was considered as a typical sign after baloon
valvuloplasty during folow up. In the age of 9 months, she was refe-
red to the local hospital due to the sudden restriction of mobility and
muscle weakness in the left lower extremity. The angio-CT revealed
an ischemic stroke in the course of embolisation of the right middle
cerebral artery. In echocardiography further increase of IAo was diag-
nosed, even that infective endocarditis was not diagnosed. During a
planned visit in cardiological unit at 10 months, a girl was diagnosed
with severe IAO with an image of the oscillating intracardiac vegeta-
tions on both cusps of the aortic valve. Blood cultures were positive
for Staphylococcus epidermidis. Infective endocarditis was diagno-
sed and treated according to the guidelines. Conclusions: Patients
with aortic valve disease are at increased risk of developing infective
endocarditis than general population. Therefore in such cases it is
essential to remember during follow-up visits to pay attention to
the details from the interview and test results that may suggest this
disease. One of the earliest symptoms of infective endocarditis may
be ischemic stroke due to artery embolism caused by the torn piece
of valvular vegetation.
39
Side Effects Not Only Statistics
Bartosz Siewert, Aleksandra Rurarz
Paediatric Clinic, Bielański Hospital, Warsaw
Background: Every medical intervention, especially connected with
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