Journal des rapports de cas cliniques

Background: Various biomaterials have been employed along with Coronally advanced flap (CAF) in root coverage procedures. The combined efficacy of bioactive glass and Platelet rich fibrin in management of gingival recession needs to be evaluated.
Aim: The aim of the present study was to clinically evaluate the efficacy of bioactive glass putty, platelet rich fibrin (PRF) and a combination of both in management of maxillary gingival recession defects.
Materials and methods: 31 patients with 60 Millers class I/II recession defects were treated with one of the following interventions; GROUP I: CAF alone, GROUP II, III and IV: CAF+Bioactive glass, CAF+PRF,CAF+ Bioactive glass+PRF respectively Clinical parameters such as recession height (RH), recession width (RW), probing pocket depth (PPD), clinical attachment level (CAL), width of attached gingiva (WAG),keratinized tissue height (KTH) were evaluated at baseline for 6 months. Mean root coverage (RC%), changes in biotype, RES and VAS aesthetic scores evaluated at the end of 6 months intervals.
Results: RH and RW showed statistically significant reduction from baseline to 6 months in all the groups (p ≤ 0.05). At the end of 6 months, the mean RC% was 61.0% ± 34.3%, 75.5% ± 25.9%, 67.2% ± 32.8% and 81.7% ± 28.6% in Group I, II, III and IV respectively. Intergroup analysis showed no statistically significant difference of parameters between groups at any time point.
Conclusion: All the therapeutic interventions were effective in management of gingival recession defects. Though, group IV showed greater mRC% when compared to other groups, intergroup analysis failed to show any statistical significance.

Objectives: To study factors and clinical scenarios possibly related to the development of endometrial micropolyps, hence chronic endometritis.
Materials and methods: 197 patients with abnormal uterine bleeding, infertility or recurrent miscarriages were studied by early follicular phase transvaginal ultrasound scan examinations and hysteroscopy. Presence of endometrial micropolyps was assessed in relation to sexual intercourse frequency, regular vaginal washing, parity, previous pelvic infection and previous uterine surgery. The likelihood of patients to use vaginal washing was examined against the other four factors. Furthermore, the association of micropolyps with other uterine pathologies was examined. Cross tabulation with chi square test, binary logistic regression analysis and odds ratio was used as appropriate to examine the data.
Results: Hysteroscopic examination revealed 81 cases with micropolyps not diagnosed previously by transvaginal ultrasound scan examinations. 56 of them (69.14%) presented with abnormal uterine bleeding, 13 with infertility (16.04%) and 12 with repeated miscarriages (14.81%), p=0.012. Cross tabulation and chi square test showed micropolyps were significantly associated to parity, sexual intercourse frequency, previous pelvic infection and regular vaginal washing, but not previous uterine surgery. Furthermore, binary logistic regression analysis showed vaginal washing was the most significant factor in this group. It also showed that micropolyps were significantly associated to the presence of endometrial polyps (p=0.022) and symptomatic patients with negative ultrasound findings (p=0.049). Patients who had more frequent sexual intercourse showed high odds ratio to use regular vaginal washing, but not the other three groups.
Conclusion: Women should be advised against vaginal washing, especially those at risk of chronic endometritis. Micropolyps might be precursors to endometrial polyps because of the close association between the two. Chronic endometritis might trigger clonal rearrangements and translocations between the four stromal chromosomes already suspected of initiating endometrial polyps’ development.

Background: Brown-Sequard Syndrome (BSS) is a kind of rare neurological condition characterized by incomplete spinal cord lesion which results in ipsilateral loss of motor function due to corticospinal tract compression on one side of the body, and contralateral loss of pain and temperature sensitivity as a result of spinothalamic tract dysfunction on the opposite side. The possible causes of Brown-Sequard Syndrome have been frequently observed in patients with spinal traumatic injuries and extramedullary spinal tumors. However, cervical disc herniation is an exceptional cause of this syndrome.

Case presentation: A 42-year-old man presented with a one-day history of neck pain and activity limitation of right arm and leg after neck massage. The Computed Tomography (CT) scan of head indicated no abnormal sign. The cervical Magnetic Resonance imaging (MRI) showed a large right-side C4/5 disc herniation which caused rightside compression of spinal cord. The patient received subtotal vertebrectomy of C5 and reconstruction with titanium mesh cage through anterior approach. The muscle strength of patient was improved the contralateral sensory disorder of pain and temperature was alleviated after the surgery.

Conclusion: The case demonstrated that a prompt diagnose followed by decompression of cervical spinal cord is essential for the prognosis of the patients who diagnosed as BSS.

Male breast cancer is relatively uncommon, representing less than 1% of all breast cancer with a peak incidence at 70 years. The principles of management are like that for female patients, including surgery (more mastectomy in men), radiotherapy and systemic treatment. The prognosis is stage dependent and it is generally worse than female breast cancer due to late presentation. The choroid is a relatively common site for metastasis due to rich blood supply and the most common primaries are the breast and the lung. We are presenting a case of a male patient with locally advanced breast cancer, who had mastectomy and radiotherapy in 2015 and who presented three years later with blurred vision in the left eye and was found to have choroidal metastasis. He had urgent palliative radiotherapy to the left eye. Further investigation followed showing widespread metastatic disease and he demised shortly thereafter.

Objective: To evaluate macular vascular circulation in patient with perifoveal vasculitis secondary to Behcet’s
disease by using (Retinal Flow) swept source optical coherence tomography angiography map.
Case report: We retrospectively review a 39-year-old female patient, with history of Behcet’s disease, presented with history of sudden unexplained central loss of vision which was more significant on the right eye with best corrected vision (BCVA=0.1) and less on the left eye with best corrected visual acuity (BCVA=0.7). The clinical ophthalmic examination of both anterior and posterior segments for the both eyes were normal with no any signs of uveitis. Imaging with DRI Triton Swept Source (SS- OCTA) (Topcon, Japan) was performed for evaluation of both superficial and deep capillary plexus of macular area. Fluorescein angiography (FA) was used also for assessing foveal avascular zone features.
Results: The SS-OCTA Retinal Flow map was more sensitive than FA in marking out hypoperfusion in both superficial capillary plexus (SCP), and deep capillary plexus (DCP), especially in the right eye which had the positive correlation with visual acuity. SS-OCTA Retinal Flow map was also sensitive in showing improvement of macular hypoperfusion after treatment of Behcet’s Perifoveal Vasculitis.
Conclusion: OCTA is a noninvasive imaging modality that can be used to evaluate macular vascular changes in Bechet’s perifoveal vasculitis and can explain acute visual loss in Behcet.

Metastases to the brain and spinal cord meninges concern 4-15% of patients with solid tumors. The most frequently occur intracranial in the course of hematological malignancies, lung and breast cancers and predict poor prognosis. Leptomeningeal metastases (LM) are usually a late complication of malignancy occurring from six months to three years after diagnosis of primary tumor. The median survival time of patients with dissemination into meninges is approximately two months; that period is the longest in the patients with breast cancer (79 days).

Objectives: To test the accuracy of 2D and 3D saline infusion sonohysterography in the diagnosis of endometrial polyps, submucous fibroids, intrauterine adhesions and depth of septae in comparison to hysteroscopic findings.

Materials and methods: 197 women with abnormal uterine bleeding, infertility or recurrent miscarriages were included in the study. A provisional diagnosis was made after 2D saline infusion sonohysterography. This was followed be 3D volume acquisition and manipulation of the 3D images to make a final diagnosis. All patients had hysteroscopy during the early follicular phase. Findings during 2D and 3D saline infusion were compared to each other and to those obtained during hysteroscopy.

Results: There was no difference regarding the primary diagnosis between the two SIS techniques in relation to the presence or absence of polyps, fibroids, intrauterine adhesions or septae. However, 3D SIS gave better visual impression and clearer documentation of the extent of the intrauterine pathology. This was especially so for the number and distribution of endometrial polyps as well as the extent and distribution of intrauterine adhesions and the depth of septae. These were useful preoperative findings for planning and facilitation of surgery. However, there were no differences between the two ultrasound techniques regarding the number or location of submucous fibroids.

Conclusion: 3D saline infusion sonohysterography when available, could add useful information especially for mapping and documenting the extent of intrauterine pathology. This information could be of great help in counselling patients and facilitating hysteroscopic surgery. However, both SIS techniques failed in diagnosing endometrial micropolyps which were seen only during hysteroscopy.

A 56-year-old man was referred to our department for recurrent postoperative cholangitis. In 2009 he had undergone a Roux-en-Y hepaticojejunal anastomosis for chronic pancreatitis. Six years later he began experiencing recurrent episodes of cholangitis. Radiographic cholangiography showed no signs of the stenosis of hepaticojejunal anastomosis. After a series of examinations and multidisciplinary discussions, we concluded that the recurrent infections were being caused by reflux through the hepaticojejunal anastomosis, which was occurring because of the short length of the Roux limb. The Roux limb was surgically lengthened from 15 cm to 30 cm. After the procedure no further attacks of cholangitis occurred.

Introduction: Hydatid disease in humans occurs as result of infection by the larval stages (hydatid cysts) of taeniid cestodes of the genus Echinococcus. The growth of the hydatid cysts in the internal organs (mainly liver and lungs) of humans may affect the health and lead to appearance of the disease manifestations.

Introduction: Hydatid disease in humans occurs as result of infection by the larval stages (hydatid cysts) of taeniid cestodes of the genus Echinococcus. The growth of the hydatid cysts in the internal organs (mainly liver and lungs) of humans may affect the health and lead to appearance of the disease manifestations.

Results: Imaging investigations demonstrated a cystic lesion within right lobe of the liver extending to adjacent part of the left lobe. A hydatid cyst was diagnosed. The patient underwent radical excision of the cyst with total removal. She also received pre and postoperative oral albendazole.

Conclusion: Hydatid disease cases of the liver may remain silent and become symptomatic and are usually diagnosed in adult patients because of the slowly growing nature of the cyst. The diagnosis needs careful history taking, examination and imaging investigations.