Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S64 Abstracts Abstracts inflammation of the submandibular gland. A CBCT procedure was performed and it confirmed the presence of radiopaque object at the above-mentioned location. The treatment consisted of a surgical sto- ne removal, performed under local anesthesia. Conclusions: On the basis of the case described, it can be concluded that a considerable salivary stone in the duct of submandibular gland may cause no symptoms for the patient, thereby the dentist is likely to be unaware of its presence. As a result it may lead to a misinterpretation of RTG image taken during everyday dental practices. 05 Surgical Removal Of Inverted Impacted Maxillary Premolar: Case Report Paulina Sosnowska Department of Dental Surgery, Medical University of Warsaw Background: The eruption process is a very complex phenomenon in which multiple factors act synchronously to achieve a normal tooth position. However the process might be altered by genetic, molecu- lar, cellular or tissue causes. An impacted tooth is prevented from its normal path of eruption in the dental arch due to lack of space in the arch or obstruction in the eruptive pathway of the tooth. The teeth most commonly impacted are the mandibular third permanent mo- lar, maxillary permanent canine and occasionally the premolars. This impaction can be horizontal, vertical, mesioangular, distoangular or inverted of which inversion is very rare. Inversion is defined as "the malposition of a tooth in which the tooth has reversed and is posi- tioned upside down". In most cases inverted teeth have been found to be erupted into nasal cavity or found in maxillary sinus. Inversion of the premolar is very rare with few cases reported in the literature. Case: 46-year-old patient has been referred to the Department of Dental Surgery, Medical University of Warsaw. The panoramic radio- graph revealed abnormal position of right maxillary second premolar. Tooth was rotated 180 degrees to the horizontal axis. In clinical exa- mination the tip of the root was visible in the oral cavity. The patient reported prior attempt of removing the tooth by the dentist who considered it as residual root fragment. The patient was qualified for surgical removal of the 15 tooth. Under local anaesthesia, the tooth was removed as a whole, as well as adjacent cyst. Distally in the re- sultant osseous defect, the undamaged Schneiderian membrane was visible. Two pieces of absorbable haemostatic gelatin sponge was applied and the wound was sutured. Conclusions: This is a rare case of inverted impaction of the premolar. Some of the etiological factors that may result in an inverted impaction are systemic conditions like nutritional or endocrine disorders, previous trauma or stimulation to the affected site during tooth growth, abnormal location of tooth bud during initiation or follicular tooth sac inflammation. Systemic conditions or trauma that could result in inversion of a tooth was not reported by the patient. The most probable reason for the condition in this case is abnormal location of the tooth bud, but as the patient had never been diagnosed by radiograph, the condition was not treated at an early stage. This shows the importance of radiological examination before every treatment. 06 Non-Surgical Management Of A Large Periapical Lesion (Case Report) Yuriy Riznyk, Yaryna Havryshkevych, Mateusz Wykretowicz Danylo Halytsky Lviv National Medical University Therapeutic Dentistry Department Background: Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis. Apical periodon- titis is an inflammatory disorder of periradicular tissues caused by the etiological agents of endodontic origin. Persistent apical perio- dontitis can occur when a root canal treatment of apical periodontitis has: inadequate antimicrobial control, inappropriate access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Based on current approaches all inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. However, treating a tooth with periapical radiolucency of a considerable size is always a question of success. The objective of our present case report was INTERNATIONAL JOURNAL of MEDICAL STUDENTS to evaluate the periapical pathology of posterior teeth clinically and radiographically, and to treat these teeth using the orthograde way and avoid traumatic surgical exploration. Case: A 21-year-old male patient with a non-contributory medical history was presented to our department with complaints on persistent acute pain in the UR6, increasing on biting. After the evaluation of main complaints, the clinical testing and radiographic analysis were performed. The pe- riradicular lesion in the area of teeth UR6-UR8 was revealed. The diagnosis: symptomatic apical periodontitis of UR6, asymptomatic apical periodontitis of UR7, UR8. The endodontic treatments of UR6 and UR8 were carried out in single visit method. The endodontic re- treatment of UR7 was carried out in two sessions, with crown-down instrumentation, irrigation with 6% sodium hypochlorite, 17% EDTA, 2% chlorhexidine and intracanal medication with calcium hydroxide paste. After 14 days, the root canals were filled with gutta-percha and AH-plus sealer by the lateral condensation technique and MTA. In a year the clinical and radiographic examination revealed almost a complete repair. Conclusions: Understanding the causes of endodon- tic treatment failure is of primary importance for a proper manage- ment of this condition. Teeth with a post-treatment apical periodon- titis can be managed by either nonsurgical endodontic retreatment or periradicular surgery. This case shows the capacity of the body to heal when the etiological factors are removed by a nonsurgical endodontic retreatment. An appropriate treatment of the infected ca- nals allowed a complete repair of these large radiolucent periapical lesions without any surgical intervention. Internal Case Report 07 Rapidly Progressive Glomerulonephritis Associated With Sys- temic Lupus Erythematosus: A Case Report Jastrzębska K, Gozdowska J, Perkowska-Ptasińska A, Durlik M. Departments of Transplantation Medicine and Nephrology, Medical University of Warsaw, Poland Background: Lupus nephritis is a frequent manifestation of a mul- tisystem autoimmune disease-systemic lupus erythematosus (SLE) and an important cause of both acute renal injury and end stage renal disease. Renal involvement is observed in approximately 60% of patients with SLE. Case: We report the case of crescentic glomeru- lonephritis in a previously healthy 21-year-old man who experienced a nasal injury in February 2011. Within a brief period the patient with insidious symptoms such as mild edema of lower limbs and face developed such clinical features as fever, nausea, vomiting, headache, loin pain, hematuria, oliguria, and hypertension. Based on the clinical history, laboratory test of renal function and ultra- sonography, acute kidney injury (AKI) was diagnosed and treated symptomatically. Rapidly worsening renal function became an im- portant determinant of renal failure therefore initially treatment was changed to hemodialysis therapy. Conducted immunological tests demonstrated elevated levels of antinuclear antibodies (ANA) and antibodies to dsDNA as well as low complement (C3 and C4) levels. The diagnosis of rapidly progressive glomerulonephritis (RPGN) in the background of diffuse mesangial proliferative glomerulonephritis with crescent formation was confirmed by the presence of patholo- gical features in renal biopsy. In addition to hemodialysis, treatment with steroid (methylprednisolone) and immunosuppressive agents (cyclophosphamide) was applied. The therapy resulted in clinical and histological improvement. After two months of treatment, there was recovery of renal function and the patient became dialysis in- dependent. Maintenance therapy (low doses of steroids and myco- phenolate mophetil) has been continued for about 4 years. Serum creatinine level is about 1.2 mg/dL, without proteinuria. Conclusions: Crescentic glomerulonephritis in the course of SLE is associated with unfavorable prognosis therefore must be treated promptly to pre- vent irreversible kidney injury. This case illustrates the potential of long-term high-dose immunotherapy in the treatment of RPGN in the course of SLE. Therapy the RPGN among patient with SLE can be challenging, considering the lack of current treatment guidelines and www.ijms.info • 2015 Vol 3 Suppl 1 published research. 08 49-Year-Old Patient With Nephrolithiasis, Haematuria, High Level Of Creatinine And Sepsis-Are You Sure It Is Acute Kid- ney Failure? Karolina Borowska, Katarzyna Ożga Jagiellonian University Medical College Background: Acute kidney failure (AKI) is a very complex condition, which symptoms depend on cause of this disorder. Regardless of a cause we can observe general malaise, loss of appetite, nausea, vomiting and eventually oliguria or even anuria. Renal function exa- cerbates rapidly. There are a lot of causes of AKI, we can divide into three groups: prerenal, intrinsic and postrenal. Possible reasons of AKI are haemorrhage, tumour or systemic autoimmune disease. The complications such as hypertension, anaemia and infections may occur. Case: The patient, a 49-year-old man was admitted to the Department of Allergy and Immunology of JUMC with oliguria and fever. He was previously treated because of Staphylococcus sepsis. Nephrolithiasis and infection were considered as a cause of AKI. Pa- tient had fever (38,50C) and his blood pressure was elevated to 140/90 mmHg. The physical examination disclosed basal crackles. The chest X-ray confirmed pulmonary oedema. The laboratory tests showed significant elevation of kidney function markers (cretinine- 560μmol/L, urine-17,3mmol/L), hypoalbuminaemia, anaemia and high level of acute-phase proteins-CRP-179,5 mg/L. Furthermore, haematuria was observed. Haemodialysis treatment was essential. Urine culture revealed presence of Klebsiella pneumoniae, so the appropriate, targeted antibiotic was administered intravenously. The result of immunological test for presence of anti-glomerular base- ment membrane (anti-GBM) antibodies was positive, while tests for ANCA and ANA were negative. All symptoms and test results indica- ted on Anti-GMB disease. Methylprednisolone was introduced. The patient was transferred to Intensive Care Unit to perform plasma- pheresis therapy. Kidney biopsy confirmed advanced glomerulopathy with signs of glomeruli basement membranes inflammatory changes regression. Then the patient received first intravenous pulse of cyclo- phosphamide. Although general condition of the patient significantly improved, he still required haemodialysis. After 42 days of hospita- lization he was discharged and advised to return to check-up and next cyclophosphamide dosage in two weeks. Conclusions: AKI can be caused by many different diseases or iatrogenic actions. Although systemic vasculitis are not so common disturbances, they should be taken into consideration in the differential diagnosis of kidney fai- lure. This case proves that rare diseases exist not only in textbooks but they are around us. 09 Incidental Tumor-Related Left Ventricular Hypertrophy Coe- xisting With Sarcoidosis Piotr Sypień, Martyna Zaleska Warsaw Medical University, Department of Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw Background: Cardiac tumors are uncommon group of disorders, es- timated in population as 0,0017-0,33% [1]. Most of them are metas- tasis, only 5% are primary. Usually they are benign, most frequently we find myxomas(50%), fibromas (6,9%) and sarcomas (6,4%). They are generally localized in left heart. They present with non-specific symptoms. During diagnostic process transthoracic echocardiogra- phy (TTE) plays an important role. Once a patient comes in with suspicion of cardiac tumor, echocardiography does not fully define diagnosis, cardiac magnetic resonance (CMR) may be of some help. Case: We present a case of 70-years old patient suffering from paro- xysmal atrial fibrillation, hypertension and goitre, who was admitted with suspicion of cardiac hypertrophy due to lung cancer. Follow up with TTE brought unspecific wall hypertrophy of about 40 mm localized in posterior wall and CMR brought unspecific oval mass sized 63x41 mm localised in back wall. Mediastinoscopy with biopsy of lymphoid nodes done as a part of lung cancer follow up gave an unexpected diagnosis of sarcoidosis. Due to supposing diagnosis www.ijms.info • 2015 Vol 3 Suppl 1 open by the biopsy, CMR of heart was performed. Final diagnosis of oval mass sized 63 x 41 mm suspection of fibroma or rhabdomyoma was done. Conclusions: Cardiac tumors are uncommon and most frequent they are metastatic. Even though in a patient with suspec- ted lung cancer, oval mass in the heart may end up as coexists lung sarcoidosis and fibroma. 10 Tacrolimus-Associated Central Pontine Myelinolysis After Liver Transplantation Artur Kośnik Liver and Internal Medicine Unit of Medical University of Warsaw, Warsaw, Poland Background: Central pontine myelinolysis (CMP) is a detrimental neurologic complication after liver transplantation, representing a source of early mortality. The etiology of CMP is unclear, although a marked variation of perioperative serum sodium remains the main risk factor. The last studies indicate the role of immunosuppressants on its development and emphasise the neurotoxicity of calcineuri- ne inhibitors, mainly tacrolimus. We present the first Polish case of tacrolimus-associated central pontine myelinolysis after orthotopic liver transplantation. Case: A 46-year-old man who underwent or- thotopic liver transplantation (OLT) developed dysarthria followed by disorders of consciousness and dysphagia. Magnetic resonance imaging (MRI) findings confirmed the diagnosis of central pontine myelinolysis (CMP). Since no perioperative disorders of fluid and electrolyte balance was observed, the hypothesis of tacrolimus neu- rotoxicity was established. The immunosuppression regimen was modified by switching from tacrolimus to everolimus. The patient experienced significant neurologic recovery. Regression of MRI ab- normalities was observed four months later. Conclusions: Tacrolimus may precipitate central pontine myelinolysis and its cessation from immunosuppressive therapy in early post-operative course may have benefits for patients who present with devastating neurological symptoms. In the setting of central pontine myelinolysis everolimus (and other mTOR inhibitors) should be considered as safe and effec- tive immunosuppressants. 11 Cold-Induced Angina And St-Segment Depressions In 22 Years Old Female With Pericardial Effusion. Coronary Artery Spasm And Raynaud's Phenomenon As Systemic Vasospasm Disorder Sylwia Gajda Medical University of Warsaw Background: Typical angina pain lasting more than 20 minutes and ST segment changes on ECG are not always due to atherosclero- sis.If the patient is young with no risk factors for coronary artery disease (CAD), the diagnosis is more challenging.Pericarditis and myocarditis can mimic myocardial infarction.Coronary artery spasm (CAS) and cardiac syndrome X should be considered too. What makes the diagnoses more difficult, is that they may overlap, which can lead to a variety of clinical presentations. Case: A 22-year-old fema- le presented with 4 episodes of crushing chest pain while running in cold weather.The patient also complained of fatigue and palpi- tations whenever walking up stairs during previous 2 months.She has never smoked, BMI = 18.4, blood pressure = 90/60 and a normal cholesterol level. Last winter she started to suffer from Raynaud's phenomenon and had cold intolerance for years. In the past she had blood tests positive for ANA, low platelet count and a decrease in C3 complement.She was scheduled for a treadmill stress test, but befo- re the test she got a Raynaud's attack, chest pain and an ECG tracing showing ST-segment depressions up to 2 mm in lateral and inferior leads. Blood tests, including cardiac enzymes, were normal.She was sent home with cardiac syndrome X as a possible diagnosis. The next day she had similar angina pain at rest along with ECG changes and was admitted to the hospital. During hospitalisation she complained of similar symptoms. Each time cardiac enzymes were negative.Echo- cardiography showed 4 mm of fluid in pericardial sac.Myocarditis and CAS were suspected and she was treated with diltiazem and ibuprophen.After 4 days she was discharged, however 3 days later INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC S65