rss_2.0Open Access Macedonian Journal of Medical Sciences FeedSciendo RSS Feed for Open Access Macedonian Journal of Medical Sciences Access Macedonian Journal of Medical Sciences Feed Malaria in a Pregnant Woman with Beta Thalassemia Minor: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Malaria is an infectious disease that is caused by plasmodium parasites. Malaria is commonly spread by female anopheles mosquitoes carrying the plasmodium parasite, although it can also be transferred through blood transfusion. In the developing world, malaria frequently affects the most vulnerable, including small children and pregnant women, resulting in severe morbidity and mortality.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>This case report presents a primigravida with beta-thalassemia who developed malaria during her pregnancy despite never having visited a malaria-endemic region. A 22-year-old primigravida in her 29th week of pregnancy presented to an outpatient clinic with a 1-week history of fever. Blood smears, both thick and thin, revealed <italic>Plasmodium malariae</italic> trophozoites, schizonts, and gametocytes. She was diagnosed with a mild form of beta-thalassemia and required monthly blood transfusions. We think the patient got malaria from a blood transfusion because she has never been to or lived where malaria is common. Infections transferred through blood transfusions should be prevented in thalassemia patients who require regular transfusions, particularly in vulnerable groups such as pregnant women.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Transfusion-transmitted diseases can be prevented by screening donors who have a history of malaria and have traveled to endemic areas.</p> </sec> </abstract>ARTICLEtrue Clinical Manifestation of Infective Endocarditis in Children: A Case Series<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Infective endocarditis (IE) was a significant cause of morbidity and mortality, particularly in children with congenital heart disease (CHD). Infective endocarditis could occur in all ages with higher in children below 1-year-old, including neonates. Various clinical manifestations of IE in children make it difficult to make a prompt diagnosis and appropriate management. Finding in echocardiography could help clinicians determine the diagnosis of IE. Systemic embolization could cause many complications that may present as chief complaint underlying patient hospitalization.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>We present case series of diverse manifestation of IE in children in Bandung, West Java, Indonesia. Two cases had a history of structural heart disease, while one case with no history of any structural heart disease before.</p> </sec> <sec><title style='display:none'>CONCLUSION:</title> <p>Wide range of symptoms that could occur in children with IE, made it challenging to make a proper diagnosis</p> </sec> </abstract>ARTICLEtrue Cause of Leg Edema after Femoropopliteal Bypass Procedure in Patient with Previously Unrecognized Arteriovenous Fistulas: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Arteriovenous fistulas (AVFs) are pathological, congenital, or acquired communications between the arterial and venous vascular bed. Asymptomatic AVFs do not require surgical or endovascular treatment; however, if they are symptomatic, they must be treated to relieve the patient of symptoms and cardiovascular disorders.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>Our patient had an undiagnosed AVF that became symptomatic after femoropopliteal bypass surgery. We successfully treated these complications with four cover stents.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>The presence of AVFs should be kept in mind in the case of rapidly developing leg edema after revascularization. Endovascular treatment of symptomatic AVF is a safe and effective treatment modality. Treatment of symptomatic AVFs is not only recommended for improving impaired arterial or venous blood flow, but also for preventing recurrent PE.</p> </sec> </abstract>ARTICLEtrue Case Mild Symptoms COVID-19 in Rural Central Java Area: Case Report of an Indonesian Patient<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>SARS-CoV-2 virus infection is a pandemic that began to emerge in December 2019 in various countries with high death rates of 4–9% until now. In March 2020, Indonesia found its first case where the condition of the infection kept spreading to various regions in Indonesia. Different regional conditions in Indonesia make it difficult to manage this virus infection. The capability of the regional hospitals to detect this virus infection with their facilities and infrastructure is required.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>A 17-year-old man came to the Ajibarang Regional Hospital with complaints of coughs and colds felt for 4 days and fever for 2 days. Physical examination found a good general condition, moderate pain, the temperature of 38.8°C, pharyngeal hyperemia, and minimal lung crackles sound. Laboratory tests showed normal leukocytes, platelet, and hemoglobin levels. Chest radiograph was suggestive of bronchitis. The patient was hospitalized for approximately 4 days until the fever resolved and was discharged. Five days after the patient was discharged from the hospital, the results of the viral load examination using real-time polymerase chain reaction confirmed positive for Coronavirus Disease 2019 (COVID-19).</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>This case showed unusual conditions of a mild clinical COVID-19 infection, laboratory results that did not support viral infections, as well as radiology examination of only bronchitis. The viral load test was found to be positive. Therefore, the diagnosis of the COVID-19 infection requires a comprehensive interpretation of complete history taking, clinical examination, laboratory, and radiology examinations for clinicians working with limited hospital facilities and infrastructures.</p> </sec> </abstract>ARTICLEtrue Case of 21-hydroxylase Deficiency with Massive Bilateral Adrenal Masses<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Congenital adrenal hyperplasia (CAH) can lead to bilateral adrenal tumors. Excess adrenocorticotropic hormone is thought to play a role in the development of adrenal nodules. Here, we present a patient with a simple virilizing form of 21-hydroxylase deficiency, a married man, bilateral adrenal tumors, and 46-XX chromosomes.</p> </sec> <sec><title style='display:none'>CASE REPORT</title> <p>A 39-year-old man suffered from abdominal pain and tension. Abdominal tomography showed macronodular hyperplasia in both adrenal glands, with the largest nodule reaching 4.2 cm on the left side. The patient’s old records showed that CAH had been diagnosed at the age of 11 years, but the patient was not taking any medication. The patient was treated with glucocorticoid. Despite irregular use of the treatment, the size of the nodules remained stable for 3 years, and then a significant reduction in nodule size was observed.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>In patients with bilateral adrenal masses and incidentaloma, CAH should be considered to avoid unnecessary surgery or biopsy. A 17-hydroxyprogesterone test in a suspicious patient is a useful tool for diagnosis.</p> </sec> </abstract>ARTICLEtrue Elasticum: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with autosomal recessive inheritance caused by mutations in the ABCC6 gene. The lack of functional ABCC6 protein leads to ectopic mineralization that is most apparent in the elastic tissues of the skin, eyes, and blood vessels. Dermatologic manifestations consist of small yellow papules on the nape and sides of the neck and in flexural areas that coalesce into reticulated plaques resembling the cobblestone aspect, and then the skin becomes loose and wrinkled. Histopathologic findings provide characteristic clues such as short, fragmented, clumped, and calcified mid-dermal elastic fibers.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>A 27-year-old Albanian female was referred to the dermatology clinic with skin complaints for approximately 17 years. On physical examination, we observed “cobblestone pattern” lesion located in the anterior, lateral, and posterior aspects of the neck, bilateral axillary, inguinal, antecubital, and popliteal regions, and periumbilical area. A biopsy was performed and the histopathology confirmed the typical changes in the dermis because of ectopic mineralization. The funduscopy revealed the “peau d’orange” aspect, bilateral angioid streaks but no neovascularization. Carotid echography showed minimal intimate thickening with flow acceleration but without significant stenosis of the right common carotid artery (ACC). Different laboratory exams were conducted that resulted within the normal range.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>There is no specific treatment, and therapeutical management is based on prevention, tracking, and follow-ups to increase surveillance of clinical complications through a multidisciplinary team. The dermatologist is usually the first who faces Pseudoxanthoma elasticum manifestations. Therefore, the dermatologist should provide the patient with the best therapeutical and preventive approaches.</p> </sec> </abstract>ARTICLEtrue Findings of the Case Child Murder: Is It Infanticide or Child Homicide? The Indonesian Perspective: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Infanticide and child homicide are common but not the same cases of homicide. According to Indonesian criminal law, infanticide means murder committed by the mother him/herself, while child homicide means murder that can be committed by anyone. Signs of care for the baby became a very significant differentiating factor for these two types of homicide.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>It was reported a case of finding an unidentified baby with an unrecognizable face and incomplete body parts by residents in the Sanehan River, Silih Nara District, Central Aceh, in a state not wrapped in anything. In the identification of the baby, it is estimated that the age based on gestational age is 38−40 weeks with a body length ranging from 44 to 46 cm. On external examination, a sharp trauma was found on the back of the neck, both arms and both thighs were cut off, an open wound in the lower abdomen. Autopsy results showed blunt trauma to the back of the head and facial bones appeared to be crushed. The pulmonary flotation test showed that the baby was born alive.</p> </sec> <sec><title style='display:none'>CONCLUSIONS</title> <p>The cause of death of the victim was a sharp and blunt force on the head and limbs and a blunt force on the stomach. Estimated time of death of the victim ranged from 6 to 8 days before the examination. It is necessary to determine whether this homicide case is a case of infanticide or child homicide. From the analysis and deepening of the data by the forensic medicine team, it is most likely that the baby in this case is an infanticide case, where the baby has received the affection of the baby’s parents is not possible.</p> </sec> </abstract>ARTICLEtrue Effect of Aromatherapy on Hemodialysis-Related Nausea: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>After hemodialysis, complications may occur and one of them that problematic is hemodialysis-related nausea. Information is still unclear about aromatherapy concerning nausea-related to hemodialysis. This study aimed to describe the effect of aromatherapy on nausea after hemodialysis procedures.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>A 51-year-old female, undergoing routine hemodialysis, experienced severe hemodialysis-related nausea. Her nausea occurred a day after dialysis and existed for 3–4 days and this repeated as a cycle that affected her appetite, food intake, and general condition. The daily measurements of nausea used the visual analog scale and the nausea severity scale before and after the intervention. In addition, a manual book with a packet containing nausea education, protocol of intervention, and monitoring sheets, was provided. For two weeks, the application of two drops of lavender aromatherapy was given on a humid cotton swab and inhaled for 5 min. In addition, education explained oral hygiene using warm water when waking up in the morning and before eating food. There was a decrease in the intensity of nausea from severe to none based on daily measurements and from severe nausea (score: 21) to moderate nausea (score: 10) after the 2-weeks intervention. Thus, the patient could enjoy eating without any uncomfortable feeling of nausea.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Lavender aromatherapy was demonstrated as a complementary therapy in overcoming nausea after dialysis among CKD patients. This report could provide a novel therapeutic modality for hemodialysis patients suffering hemodialysis-related nausea.</p> </sec> </abstract>ARTICLEtrue Assessing the Justification in Seeking Compensation for Sports Injury<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>This paper shows the role of occupational medicine in assessing the justification for seeking compensation for a sports injury.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>A 23-year-old female candidate applied for admission to the Police. Starting in 2022, the Academy tightened the admission criteria and started testing candidates by professional selection. The candidate was injured at the “Marine” training ground, breaking both lower leg bones. She is now seeking compensation from the Ministry of the Interior. Like for other jobs with special working condition, it is known that before hiring future police officers, they have to pass the preliminary occupational medicine examination. The same applies to enrolment in sports clubs, for practicing sports and before entering competitions. The candidate asks whether she should have had a medical examination before applying for training as a police officer, that is, before psychophysical testing. Only candidates who pass the tests can be admitted to the Police Academy at the Ministry of Internal Affairs, which are followed by a medical examination and the signing of an employment contract. The state cannot be expected to pay trainers for potential candidates and their training, for only about a quarter of candidates pass the selection.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>The candidates themselves must be aware of their psychophysical capabilities, and it is to be expected that sportswomen, even amateurs, skilled and at least moderately fit, will apply for the above mentioned position of policewoman, bearing in mind the complexity of the future profession.</p> </sec> </abstract>ARTICLEtrue Closure of Postauricular Defect Using Type-1 Keystone Perforator Island Flap: An Alternative Facial Reconstruction Technique<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>The use of local flaps is a common and effective method for reconstructing various post-surgical defects. Some advantages of local flaps compared to other methods such as skin grafts are the relatively high success rate and lower complication rates such as infections and wound dehiscence. There are various methods of flaps available and choosing the proper method is based on various factors such as the size of the defect, anatomical location of the defect, and operator capabilities. Therefore, an effective but simple local flap method with a high success rate is needed especially when dealing with defects located on prominent cosmetic areas such as the face.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>We report the successful use of the keystone perforator island flap for closure of a facial defect caused by basal cell carcinoma removal in a 76-year-old female patient.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Although not commonly used for facial reconstruction, this paper reports successful use of this relatively simple and effective method prompting the potential for increased usage in treating small-moderate sized defects on the face.</p> </sec> </abstract>ARTICLEtrue Bleeding Management in Patient with Blunt Abdominal Trauma at Rural Hospital: A Case Report of 40-Year-Old Male with Spleen Rupture<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Abdominal injury caused by blunt trauma is a common presentation in the emergency room. Especially in developing countries like Indonesia, the number of motor vehicle accident in public roads is still high. Eighty percentages of traumatic injury are blunt injury with the majority of deaths which are caused by hypovolemic shock.</p> </sec> <sec><title style='display:none'>CASE DESCRIPTION</title> <p>A 43-year-old man arrived at the emergency room after motorcycle accident 2 h before. AMPLE and primary survey was conducted: clear airway, spontaneous breathing, BP 70/palpation mmHg, HR 123 times/min, and altered consciousness, in which showed the patient was undergoing hemorrhagic shock. The patient was hemodynamically stable after being given 1 L of normal saline through two intravenous lines. FAST was conducted and intraperitoneal free fluid was seen in Morison’s pouch, left hemithorax, and pouch of Douglass. Chest X-ray showed fracture of ribs 7, 8, and 9 left lateral aspect with minimal hemothorax. After a supporting examination was performed, the patient’s BP dropped to 60/40 mmHg, showing the patient was a “transient responder,” indicating the patient should undergo laparotomy. The patient was given 500 mL colloid with a systolic target of 80–90 mmHg in accordance to permissive hypotension theory ± 1500 mL blood was found inside the abdomen during operation, a splenic rupture grade V was the cause. In the 5<sup>th</sup> day after surgery, the patient was discharged.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Since blunt abdominal trauma could cause intraperitoneal bleeding that leads to hemorrhagic shock; therefore, immediate diagnosis is needed. Multiple trauma management at rural hospital should be concordant to ATLS and Schwartz’s Principles of Surgery.</p> </sec> </abstract>ARTICLEtrue in Managing AUB-C in Adolescence with Acute Lymphoblastic Leukemia in North Sumatera, Indonesia: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Abnormal uterine bleeding is a common problem not only cause health disturbance but also affect the physical, social, emotional status, and quality of life of a women. The most common symptom is abnormally heavy or prolonged uterus bleeding. FIGO introduces nine categories cause of abnormal uterine bleeding, which are known as “PALM-COEIN.” In general, components in “PALM” are components of structural abnormality, which can be diagnosed by imaging and/or histopathological examination, while “COEIN” includes non-structural abnormality.</p> </sec> <sec><title style='display:none'>CASE REPORT</title> <p>A 17-year-old female without a history of sexual intercourse came to the gynecology polyclinic of the University Of North Sumatra hospital with a chief complaint of irregular menstruation that had been experienced by the patient since 5 months ago. The patient claimed to have had menstruation for 10−14 days, 4−5 times changing pads. Gynecology examination was within normal limits. Blood analysis has been done 3 times and the results came up with a significant decrease of platelet counts and hemoglobin levels.</p> <p>Transabdomen ultrasonography was done and showed no abnormality found. The patient was diagnosed with AUB-C in acute lymphoblastic leukemia.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Abnormal uterine bleeding (AUB) is a common finding in women during their reproductive years. There are steps on how to diagnose an abnormal uterine bleeding disorder (AUB) based on comprehensive history taking, followed by a physical and additional workup.</p> </sec> </abstract>ARTICLEtrue Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Neglected femoral neck fractures in young adults (age &lt;60) pose a major challenge in terms of appropriate treatments for each specific condition.</p> </sec> <sec><title style='display:none'>AIM</title> <p>The objective of this case report is to explain the presentation of neglected femoral neck fractures and its clinical consequences and to discuss the management of the disease.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>This case presents a 14-year-old male with neglected displaced fracture of femoral neck, which was successfully managed by closed reduction and internal fixation with two cannulated screws and nonvascularized fibular strut graft.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Femoral neck fractures in young adults are considered as a rare fracture case, eventually it was associated with serious complications. The management of this type of fractures in children is challenging, particularly that of a neglected fracture. Fibular strut graft with two cannulated hip screws for neglected femoral neck fractures in children considered to be cost-effective and technically less demanding as well as associated with good outcomes.</p> </sec> </abstract>ARTICLEtrue Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations.</p> </sec> <sec><title style='display:none'>CASE REPORT</title> <p>A nulliparous 29-year-old woman in her 21<sup>st</sup> week of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.</p> </sec> </abstract>ARTICLEtrue Sub-aortic Gerbode Defect Following Tricuspid, Aortic, and Mitral Valve Endocarditis<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Communication between the left ventricle and right atrium, termed a Gerbode ventricular septal defect (VSD), was first described in 1838 and later explained with varying etiologies, including congenital and acquired forms. Most of the acquired LV-RA shunts are of either a postoperative or of infective etiology. Among these etiologies, infective endocarditis is a rare cause, and echocardiography is a mainstay of its diagnosis and clinical management.</p> </sec> <sec><title style='display:none'>CASE REPORT</title> <p>Here, we describe the case of a patient with bacterial endocarditis as a cause of a left ventricle to right atrium shunt, with subsequent intraoperative diagnosis and surgical repair. A 38-year-old man with a history of fever in the past 2 weeks was diagnosed with bacterial endocarditis involving the tricuspid, aortic, and mitral valve. Pre-operative transesophageal echocardiography revealed a severe aortic regurgitation with large vegetations on the right and non-coronary cusps sizing about 1 cm2. The mitral valve had mild regurgitation and some filiform vegetations on the ventricular side of the anterior leaflet. The examination showed advanced tricuspid regurgitation with vegetations on the anterior and septal leaflets. The cardiologists also measured severe pulmonary hypertension up to 90 mmHg. During surgery, after careful observation, a communication between the left ventricle and the right atrium was discovered in the area under the junction between the right and non-coronary cusps of the aortic valve. The patient underwent aortic valve replacement with a 25-mm Regent mechanical valve (St. Jude Medical, St. Paul, MN), primary closure of a 5 mm ×5 mm septal defect using polyester 2.0 pledgeted sutures, replacement of the tricuspid valve with 31-mm Epic bio-prosthesis, and curettage of the ventricular side of the anterior mitral valve leaflet. The patient’s postoperative course was uneventful and he was transferred at the infective hospital on the 10th post-operative day. After 4 weeks of parenteral antibiotic therapy, the patient was discharged in good conditions.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>To the best of our knowledge, this is a unique case reported with triple valve endocarditis and Gerbode defect treated with surgery. We encourage meticulous examination of patients with endocarditis to find abnormal communications.</p> </sec> </abstract>ARTICLEtrue Repigmentation of Halo Nevus Following Excision: A Case Report<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Halo nevus is a benign condition characterized by symmetrical oval-shaped and well-defined hypopigmented patch surrounding melanocytic lesions. Their sizes varies from a few millimeters to centimeters. A “wait and see” approach is usually preferred in most cases of halo nevus. However, the condition can cause severe psychological impact and impair patient’s quality of life, especially when it emerges on prominent areas such as the face. Surgical option can be utilized for removal of melanocytic lesions and accelerate regression of the halo.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>We report a case of a 25-year-old woman with white patches around two moles on her face who was diagnosed as halo nevus. Surgical excision was performed and a 12-week follow-up showed reduction in diameter of the halo nevus.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Large halo nevus can cause significant esthetic burden that may affect patient’s quality of life. A more invasive approach such as excision of underlying nevus may be used to achieve more rapid results.</p> </sec> </abstract>ARTICLEtrue Diagnosis of Testicular Lymphoma in Young Male Patient: Incidental Finding in Ultrasonography<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Ultrasonography is a common diagnostic procedure in patients with testicular abnormalities. Primary testicular lymphoma (PTL) is rarely discovered and is more common among elderly populations.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>This case describes a young male patient with a history of painless testicular enlargement. Ultrasonography reveals an incidental finding of hypoechoic echo structural mass and increased vascularity using color Doppler ultrasonography. The further pathological examination discovered the findings indicative of a non-Hodgkin, diffuse, and large B-cell lymphoma. These distinctive features should be helpful in suggesting a diagnosis of PTL on imaging.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>PTL is a rare and aggressive extranodal NHL. Despite its low incidence, it is an extremely rare testicular cancer at a young age. Careful ultrasound imaging examination should be applied in patients with testicular enlargement. The presence of hypoechoic echostructural and an increase in vascularity should be considered for the possibility of a diagnosis of primary testicular tumor.</p> </sec> </abstract>ARTICLEtrue Radicularis Magna Maxillae: A Case Report and 5-Year Follow-Up<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>An odontogenic cyst is a pathological, epithelial-lined cavity containing fluid or semi-fluid which arises from the epithelial remnants of tooth formation. These cysts may become increasingly obvious clinically as they increase in size, initially creating a bony hard swelling. As this gradually and slowly enlarges, the bony covering becomes increasingly thin, which clinically may be demonstrated on palpation. Management of jaw cysts as a pathology requires a serious and thorough approach, and it begins at the first examination of the patient. The most important starting point is to analyze and find out the cause of the change, the duration of development, and the presence or absence of clinical symptoms. The use of 3D CBCT analysis of the jawbones provides an answer for the modality of surgical treatment, the proximity to certain anatomical structures, and the way to resolve postoperative bone defects.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>Twenty-three-year-old male, came with swelling on the left anterior side of the face, and above tooth 22. The swelling began 7 days earlier, and the patient had no other medical conditions and diseases. The radiographic examination shows radiopaque mass between and above the root of tooth 22 in the anterior maxilla, confluent with other large radiopaque mass to the other teeth of this zone. A radical surgical approach was considered for cyst removal, and bone regeneration techniques for replenishment of the bony defect.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>A radical surgical approach is the only treatment in most cases of large radicular cysts. It should be noted that the preoperative 3D analysis is also a key factor that dictates this radical approach. Bone augmentation techniques are a reliable and predictable method for filling in bone defects, and should always be combined and included in this treatment.</p> </sec> </abstract>ARTICLEtrue Unusually Long Appendix: A Case Report and Literature Review<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>BACKGROUND</title> <p>Acute appendicitis is one of the most common conditions in emergency surgery and appendectomy is the most frequently performed surgical procedure. The complexity of this pathology is reflected in the numerous congenital malformations and anatomical variations of the vermiform appendix. Anatomical variations are mainly related to its length and position. The average length of the appendix was found to be 9.5 cm in the male and 8.7 cm in the female, but different length has been reported, from 1 cm to even a 33 cm on the cadaver.</p> </sec> <sec><title style='display:none'>CASE PRESENTATION</title> <p>A 34-year-old man was admitted to the general surgery department due to symptoms that began the previous day. The patient complained of lumbar pain which later migrated to the periumbilical region and the right lower quadrant (RLQ) of the abdomen followed by fever, nausea, and vomiting. On clinical examination, he had a tenderness in RLQ with abdominal guarding. Laboratory analyzes showed leukocytosis and high markers of inflammation. Urinalysis and abdominal ultrasound were normal. Taking into consideration the clinical presentation and laboratory parameters, a decision was made to proceed for an open appendectomy. Intraoperatively, the appendix was inflamed, very long, partly retrocaecal, and partly paracolic in position, with two coils, extending upward. After dividing the mesoappendix, it measured 20 cm in length. The appendectomy was performed. Post-operative recovery was without complications. The patient was discharged from the hospital on the 3<sup>rd</sup> post-operative day.</p> </sec> <sec><title style='display:none'>CONCLUSION</title> <p>Although acute appendicitis is very frequent condition in emergency surgery, making the diagnosis could be challenging due to numerous differential diagnostic dilemmas. The position of the appendix and direction of its extension could lead to misdiagnosis. The synthesis of clinical examination, laboratory analyzes, and diagnostic procedures should lead clinicians to the right diagnosis and surgical treatment, avoiding possible complications and additional costs.</p> </sec> </abstract>ARTICLEtrue B-cell Lymphoma Presenting as a Pituitary Mass<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>INTRODUCTION</title> <p>The authors describe the case of a pituitary mass considered from the radiological point of view as a non-secretory adenoma.</p> </sec> <sec><title style='display:none'>CASE REPORT</title> <p>The patient, a 31-year-old male, presented with an intense headache, non-responsive to antalgics, right eye Mydriasis, and semiptosis. An endoscopic transnasal surgery caused important but temporary relief to the patient, who some days later complained of tumefactions in both axillar regions. Pathological diagnosis was of a non-Hodgkin B-cell lymphoma.</p> </sec> <sec><title style='display:none'>CONCLUSIONS</title> <p>Although pituitary involvement is rare in the case of systemic lymphomas, and even rarer among primary central nervous system malignancies, this possibility must become part of differential diagnosis when approaching pituitary masses.</p> </sec> </abstract>ARTICLEtrue