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Clinics and Practice
Volume 1
Issue 1
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Clinics and Practice is published by MDPI from Volume 11 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with PAGEPress.

Clin. Pract., Volume 1, Issue 1 (March 2011) – 20 articles

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83 KiB  
Case Report
Urinary Tract Infection Mimicking Acute Mesenteric Ischaemia in an Immunocompromised Patient
by Thomas Hanna, James Powys-Lybbe and Jacob A. Akoh
Clin. Pract. 2011, 1(1), e19; https://doi.org/10.4081/cp.2011.e19 - 15 Apr 2011
Cited by 1
Abstract
Bowel infarction due to acute mesenteric ischaemia (AMI) is an abdominal emergency with a high mortality rate. We report a case of exaggerated septic response to a urinary tract infection mimicking AMI in an immunosuppressed diabetic patient. A 56-year-old female was found collapsed [...] Read more.
Bowel infarction due to acute mesenteric ischaemia (AMI) is an abdominal emergency with a high mortality rate. We report a case of exaggerated septic response to a urinary tract infection mimicking AMI in an immunosuppressed diabetic patient. A 56-year-old female was found collapsed at home with a 24 hour history of diarrhoea, a central abdominal pain and a complex past medical history. Examination showed her to be pyrexial, drowsy, profoundly dehydrated with evidence of cardiovascular collapse. She had a tender distended abdomen, raised inflammatory markers, raised lactate of 9.1 u/L and urinalysis was positive for leucocytes and nitrites. An abdominal computed tomography (CT) scan was reported to show small bowel ischaemia. She underwent a negative laparotomy and recovered following management in the intensive therapy unit. The negative laparotomy rate can be reduced by having abdominal CT performed and reported by an experienced radiologist or by the use of diagnostic laparoscopy. Full article
677 KiB  
Case Report
Recurrent Hypothermia and Hypoglycemia as the Initial Presentation of Hepatitis C
by Viplove Senadhi
Clin. Pract. 2011, 1(1), e18; https://doi.org/10.4081/cp.2011.e18 - 15 Apr 2011
Cited by 2
Abstract
Hepatitis C most commonly manifests with asymptomatic elevations in transaminase levels or in advanced stages, may present with hepatic encephalopathy or ascites. We report the first case in the literature, in which the initial manifestation of hepatitis C induced chronic liver disease was [...] Read more.
Hepatitis C most commonly manifests with asymptomatic elevations in transaminase levels or in advanced stages, may present with hepatic encephalopathy or ascites. We report the first case in the literature, in which the initial manifestation of hepatitis C induced chronic liver disease was recurrent hypoglycemia and hypothermia. In our case, the hypoglycemia was induced by glycogen depletion from hepatitis C induced chronic liver disease. In chronic liver disease, glycogen stores are depleted from extensive fibrosis and it has been shown that glycogen depletion may herald hepatic encephalopathy, which later manifested in our patient. Full article
185 KiB  
Case Report
Massively Dilated Right Atrium Masquerading as a Mediastinal Tumor
by Thomas Schroeter, Nicolas Doll, Sreekumar Subramanian, Friedrich W. Mohr and Michael A. Borger
Clin. Pract. 2011, 1(1), e20; https://doi.org/10.4081/cp.2011.e20 - 14 Apr 2011
Abstract
Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. [...] Read more.
Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. The enormously dilated atrium compressed the right lung, resulting in a radiographic appearance of a mediastinal tumor. Tricuspid valve repair and reduction of the right atrium was performed. Follow up examination revealed improvement of liver function, reduced peripheral edema and improved New York Heart Association (NYHA) class. The reduction of the atrial size and repair of the tricuspid valve resulted in a restoration of the conduit and reservoir function of the right atrium. Given the chronicity of the disease process and the long-standing atrial fibrillation, there is no impact of this operation on right atrial contraction. In combination with the reconstruction of the tricuspid valve, the reduction atrioplasty will reduce the risk of thrombembolic events and preserve the right ventricular function. Full article
452 KiB  
Case Report
An Inside Story of a Thrombosed Pile
by Yashwant Kumar and Alka Bhatia
Clin. Pract. 2011, 1(1), e16; https://doi.org/10.4081/cp.2011.e16 - 14 Apr 2011
Abstract
We report a case of extremely rare variant of ano-rectum malignant tumor. The tumor is often misdiagnosed as either hemorrhoids or rectal polyp, which are benign diseases. On histology also this variant may be confused with other more commonly occurring spindle cell lesions [...] Read more.
We report a case of extremely rare variant of ano-rectum malignant tumor. The tumor is often misdiagnosed as either hemorrhoids or rectal polyp, which are benign diseases. On histology also this variant may be confused with other more commonly occurring spindle cell lesions in this area; its recognition is therefore important as it normally has a poor prognosis. Full article
132 KiB  
Article
Acute Promyelocytic Leukemia, Hypogranular Variant: A Rare Presentation
by Kafil Akhtar, Shamshad Ahmad and Rana K. Sherwani
Clin. Pract. 2011, 1(1), e11; https://doi.org/10.4081/cp.2011.e11 - 12 Apr 2011
Cited by 3
Abstract
Early diagnosis of acute promyelocytic leukemia (APL) is essential because of its associated life threatening coagulopathy and unique response to all trans-retinoic acid (ATRA) therapy. The characteristic cell morphology supplemented by cytochemistry offers the most rapid means for diagnosis. Here we describe a [...] Read more.
Early diagnosis of acute promyelocytic leukemia (APL) is essential because of its associated life threatening coagulopathy and unique response to all trans-retinoic acid (ATRA) therapy. The characteristic cell morphology supplemented by cytochemistry offers the most rapid means for diagnosis. Here we describe a rare case of acute promyelocytic leukemia-hypogranular variant that poses particular diagnostic challenge. Full article
1100 KiB  
Case Report
Peritoneal Carcinomatosis Mimicking a Perforated Diverticulitis
by Olivier Facy, Nicolas Lagoutte, Brice Paquette, Patrick Rat and Pablo Ortega Deballon
Clin. Pract. 2011, 1(1), e14; https://doi.org/10.4081/cp.2011.e14 - 11 Apr 2011
Abstract
We report the case of a patient with a pelvic abscess and a malignant pancreatic tumor. The management of this complicated diverticulitis included radiological drainage and surgery. This abscess was due to a peritoneal carcinomatosis originating from the pancreas, which is an extremely [...] Read more.
We report the case of a patient with a pelvic abscess and a malignant pancreatic tumor. The management of this complicated diverticulitis included radiological drainage and surgery. This abscess was due to a peritoneal carcinomatosis originating from the pancreas, which is an extremely rare cause of intestinal perforation. Full article
1070 KiB  
Case Report
Cholestatic Hepatitis due to Salmonella typhi
by Ayse Albayrak, Sibel Seda Gunbey and Ferda Aktas
Clin. Pract. 2011, 1(1), e13; https://doi.org/10.4081/cp.2011.e13 - 11 Apr 2011
Cited by 2
Abstract
Salmonella infection occurs worldwide and is still an important public health problem in many developing countries. The infection can affect almost all major organs including the liver. Severe hepatic involvement with a clinical feature of acute hepatitis is a rare complication. In this [...] Read more.
Salmonella infection occurs worldwide and is still an important public health problem in many developing countries. The infection can affect almost all major organs including the liver. Severe hepatic involvement with a clinical feature of acute hepatitis is a rare complication. In this paper, a 39-year-old male with acute cholestatic typhoid hepatitis is presented. The case had a tender hepatomegaly and elevated serum alanine and aspartate transaminase, alkaline phosphatase, and gamma glutamyl transferase levels; these features cannot been distinguished from those of acute viral hepatitis. Serological and viral markers of acute viral hepatitis were negative. No pathology could be determined in abdomen Ultrasonography (USG) or Magnetic Reso - nance (MR) Cholangiography. As enteric fever is a common infection, the recognition of salmonella hepatitis is of clinical importance. When patients from an endemic or outbreak area present acute febrile hepatitis, typhoid fever should be a consideration. Full article
109 KiB  
Case Report
Completely Extruded Talus without Soft Tissue Attachments
by Young Rak Choi, Jae Jung Jeong, Ho Seong Lee, Sang Woo Kim and Jin-Soo Suh
Clin. Pract. 2011, 1(1), e12; https://doi.org/10.4081/cp.2011.e12 - 11 Apr 2011
Cited by 8
Abstract
A completely extruded talus without any remaining soft tissue attachments is extremely rare. The present report describes treatment of a 45-year-old man who sustained a completely extruded talus injury following a rockclimbing fall. Upon admission, the extruded talus was deep-frozen in our bone [...] Read more.
A completely extruded talus without any remaining soft tissue attachments is extremely rare. The present report describes treatment of a 45-year-old man who sustained a completely extruded talus injury following a rockclimbing fall. Upon admission, the extruded talus was deep-frozen in our bone bank. The open ankle joint underwent massive wound debridement and irrigation for 3 days. Four days later we performed a primary subtalar fusion between the extruded talus and the calcaneus, anticipating revascularization from the calcaneus. However, aseptic loosening and osteolysis developed around the screw and talus. At 12 months post-trauma we performed a tibiocalcaneal ankle fusion with a femoral head allograft to fill the talar defect. Follow-up at 24 months post-trauma showed the patient had midfoot motion, tibio-talar-calcaneal fusion, and was able partake in 4-hour physical activity twice per week. Full article
214 KiB  
Case Report
Congenital Melanocytic Nevus of the Oral Mucosa: Report of a Rare Pigmented Lesion and Review of the Literature
by Melanie Louise Gilbert, Weddad Hanna, Danny Ghazarian, Dean Dover and Hagen Benjamin Edward Klieb
Clin. Pract. 2011, 1(1), e17; https://doi.org/10.4081/cp.2011.e17 - 07 Apr 2011
Cited by 5
Abstract
Oral pigmented lesions are uncommon and congenital melanocytic nevi are especially rare. We report a case of a patient with multiple congenital melanocytic nevi including a palatal lesion. This is reported to add to the scant literature that exists on this subject. Prognosis [...] Read more.
Oral pigmented lesions are uncommon and congenital melanocytic nevi are especially rare. We report a case of a patient with multiple congenital melanocytic nevi including a palatal lesion. This is reported to add to the scant literature that exists on this subject. Prognosis and management are discussed. Full article
996 KiB  
Case Report
Spontaneous Resolution of Obstructive Hydrocephalus from Blood in the Cerebral Aqueduct
by Shadi Yaghi and Archana Hinduja
Clin. Pract. 2011, 1(1), e15; https://doi.org/10.4081/cp.2011.e15 - 07 Apr 2011
Cited by 4
Abstract
Obstructive hydrocephalus is a neurological emergency that needs to be immediately identified and treated. It very rarely resolves without treatment. We report about an 86-year-old man with right frontal stroke who developed obstructive hydrocephalus caused by blood in the cerebral aqueduct. The patient [...] Read more.
Obstructive hydrocephalus is a neurological emergency that needs to be immediately identified and treated. It very rarely resolves without treatment. We report about an 86-year-old man with right frontal stroke who developed obstructive hydrocephalus caused by blood in the cerebral aqueduct. The patient had sudden and immediate clinical improvement and a repeated head computed tomography (CT) scan showing spontaneous resolution of hydrocephalus. Spontaneous resolution of obstructive hydrocephalus is possible when the cause is minimal blood in the cerebral aqueduct without any blood in the fourth ventricle. Full article
60 KiB  
Case Report
Supplemental Root in a Mandibular First Molar: A Rarity
by Poonam Mahajan and Ajay Mahajan
Clin. Pract. 2011, 1(1), e10; https://doi.org/10.4081/cp.2011.e10 - 05 Apr 2011
Abstract
Anatomic variations are common in human dentition. A clear understanding of these variations is very important for success of endodontic treatment. A dentist should be aware of these anatomic variations as this can affect the treatment outcome. A case of endodontic therapy is [...] Read more.
Anatomic variations are common in human dentition. A clear understanding of these variations is very important for success of endodontic treatment. A dentist should be aware of these anatomic variations as this can affect the treatment outcome. A case of endodontic therapy is presented in which inability to locate an anatomically rare supplemental canal of a three rooted mandibular first molar resulted in treatment failure. A 21-year-old female reported with pain and swelling in relation to lower right first molar. An intra oral periapical radiograph revealed 3 roots; the first canal of the mesial root and a canal of one of the distal roots were found to be treated endodontically, which were infraobturated but the canal of the 2nd distal root had not been treated. The radiograph revealed periapical radiolucency and widening of periodontal space. Prior to starting the endodontic treatment the clinician must be aware of the anatomic variations in tooth pulp morphology and also the importance of preoperative radiographs cannot be underscored. Full article
1285 KiB  
Case Report
Group B Streptococcus Endocarditis Associated with Multiple Pulmonary Septic Emboli
by Carlos G. Teran, Ariel O. Antezana, Jerome Salvani and Deborah Abaitey
Clin. Pract. 2011, 1(1), e7; https://doi.org/10.4081/cp.2011.e7 - 04 Apr 2011
Cited by 5
Abstract
Endocarditis is a rare presentation of group B streptococcal infection. Its association with pulmonary septic embolism was only barely studied and limited data is available up to date. Multiple septic emboli is a common complication of bacterial endocarditis, but only a few cases [...] Read more.
Endocarditis is a rare presentation of group B streptococcal infection. Its association with pulmonary septic embolism was only barely studied and limited data is available up to date. Multiple septic emboli is a common complication of bacterial endocarditis, but only a few cases have been documented in relation to group B streptococcus. We present the case of an 87 year old female patient with multiple underlying conditions that predisposed the development of bacterial endocarditis secondary to group B streptococcus and subsequently multiple pulmonary septic emboli. The patient was treated with ceftriaxone and azythromycin with good response and complete recovery without any further complications. In the event of a diagnosed case of group B streptococcus endocarditis, there should be a low threshold for the suspicion of septic pulmonary emboli especially in cases with right valves involvement. Full article
118 KiB  
Case Report
Sister Mary Joseph’s Nodule: A Rare Cytologic Presentation
by Kafil Akhtar, Sufian Zaheer, Shamshad Ahmad and Rana K. Sherwani
Clin. Pract. 2011, 1(1), e6; https://doi.org/10.4081/cp.2011.e6 - 04 Apr 2011
Cited by 2
Abstract
Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph’s nodule. It indicates neoplasm of inner organs mostly located in the gastrointestinal tract or the pelvis. However, in approximately 15–30% the [...] Read more.
Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph’s nodule. It indicates neoplasm of inner organs mostly located in the gastrointestinal tract or the pelvis. However, in approximately 15–30% the primary tumor remains occult. In most cases, Sister Mary Joseph’s nodule appears as an early and sometimes the only symptom of the malignancy. Here we report a rare fine needle aspiration (FNA) cytologic diagnosis of umbilical metastasis of an ovarian carcinoma. Full article
112 KiB  
Case Report
A Rare Case of Coin Impaction in Larynx in an Adult
by Gautam B. Singh, Anil K Rai, Hukum Singh and Anubha Varun
Clin. Pract. 2011, 1(1), e3; https://doi.org/10.4081/cp.2011.e3 - 04 Apr 2011
Cited by 4
Abstract
Impaction of foreign body in larynx is reported exclusively in paediatric population only. Moreover impaction of coin in larynx has never been reported previously. With this background, we report a rare case of coin impaction in larynx in a healthy adult. Full article
137 KiB  
Case Report
Pure Red Cell Aplasia and Associated Thymoma
by Cristian Rosu, Sandra Cohen, Caroline Meunier, Denise Ouellette, Gilles Beauchamp and George Rakovich
Clin. Pract. 2011, 1(1), e1; https://doi.org/10.4081/cp.2011.e1 - 01 Apr 2011
Cited by 5
Abstract
Pure red cell aplasia is a rare cause of anemia, caused by an absence of red blood cell precursors in the bone marrow. It is usually a paraneoplastic syndrome, associated most commonly with large-cell granular lymphocyte leukemia but also thymoma. For patients who [...] Read more.
Pure red cell aplasia is a rare cause of anemia, caused by an absence of red blood cell precursors in the bone marrow. It is usually a paraneoplastic syndrome, associated most commonly with large-cell granular lymphocyte leukemia but also thymoma. For patients who present both pure red cell aplasia and thymoma, thymectomy leads to an initial remission of the aplasia in 30% of cases. However, sustained remission may require the addition of medications such as corticosteroids, cyclospo­rine, or cyclophosphamide. We present a case of pure red cell aplasia associated with a thymoma in an otherwise healthy 80 year-old woman. Full article
78 KiB  
Case Report
Incidence of Dehydration Encephalopathy among Patients with Disturbed Consciousness at a Hospital Emergency Unit
by Emina Ogawa, Ryuji Sakakibara, Kei Endo, Fuyuki Tateno, Yasuo Matsuzawa, Nobuo Hosoe, Masahiko Kishi and Kohji Shirai
Clin. Pract. 2011, 1(1), e9; https://doi.org/10.4081/cp.2011.e9 - 31 Mar 2011
Cited by 2
Abstract
Systemic dehydration and diffuse central nervous system signs without any other illness is referred to as dehydration encephalopathy (DE). However, the incidence of DE at emergency units remains uncertain. We investigated the incidence of DE among persons with disturbed consciousness who visited the [...] Read more.
Systemic dehydration and diffuse central nervous system signs without any other illness is referred to as dehydration encephalopathy (DE). However, the incidence of DE at emergency units remains uncertain. We investigated the incidence of DE among persons with disturbed consciousness who visited the emergency unit. We reviewed the medical case records of the emergency unit at our university hospital during a 6-month period. Among them, 132 patients presented with disturbed consciousness as the sole initial manifestation on arrival. They were 75 men, 47 women; mean age 68 years (16-95 years). After carefully excluding other etiologies, the incidence of DE was 2% among all persons in the emergency unit and 4% among persons older than 68 years.In conclusion, the incidence of DE in our emergency unit was not common. Nevertheless, recognition of DE is extremely important in order to avoid unnecessary medication in elderly subjects. Full article
601 KiB  
Case Report
Polysubstance Abuse Related Subacute Urinary Retention and Hutch Diverticulum of Urinary Bladder
by Sarwan Kumar, Deepak Gupta and Shiva S. Rau
Clin. Pract. 2011, 1(1), e8; https://doi.org/10.4081/cp.2011.e8 - 31 Mar 2011
Cited by 1
Abstract
The present case highlights the presentation and management of hyperkalemia and acute renal failure secondary to polysubstance abuse related subacute urinary retention due to α-adrenergic and µ-receptor activation in a patient with Hutch diverticulum. Full article
136 KiB  
Case Report
Resistant Thrombocytopenia in an HIV and Hepatitis C Patient: Treatment Response with Novel Agent Eltrombopag
by Rajakrishnan Vijayakrishnan, Sourbha Dani, Aparna Ramasubramanian, Rekha Nair and Tony M. Samaha
Clin. Pract. 2011, 1(1), e5; https://doi.org/10.4081/cp.2011.e5 - 29 Mar 2011
Abstract
HIV-associated thrombocytopenia is a dis- ease which can be recurrent to standard therapy which includes highly active antiretroviral therapy (HAART) therapy, steroids and immunoglobulin. We report a patient with HIV and hepatitis C who presented with resistant thrombocytopenia. Treatment with Eltrombopag – a [...] Read more.
HIV-associated thrombocytopenia is a dis- ease which can be recurrent to standard therapy which includes highly active antiretroviral therapy (HAART) therapy, steroids and immunoglobulin. We report a patient with HIV and hepatitis C who presented with resistant thrombocytopenia. Treatment with Eltrombopag – a thrombopoeitin receptor agonist showed initial good response with recurrence of thrombocytopenia. This novel agent could be considered as a treatment option prior to splenectomy and may be useful as a tempo- rizing measure. Full article
601 KiB  
Case Report
It Can’t Be December Already: A Real Life Simile to Jeffery Archer’ Short Story
by Sarwan Kumar, Deepak Gupta and Shiva S. Rau
Clin. Pract. 2011, 1(1), e4; https://doi.org/10.4081/cp.2011.e4 - 29 Mar 2011
Abstract
This case reflects the difficulties arising out of the patients autonomy to choose the type, timing, and extent of the medical management even though in some clinical scenarios, like the case presented, the patient was not able to communicate his physiological needs for [...] Read more.
This case reflects the difficulties arising out of the patients autonomy to choose the type, timing, and extent of the medical management even though in some clinical scenarios, like the case presented, the patient was not able to communicate his physiological needs for a safe and protected shelter from the extreme weather, and was unable to follow up with the medical plan offered at the emergency room during each of his prior visits before the catastrophic event of unwitnessed hypoglycemic seizure and severe hypothermia. Full article
1859 KiB  
Case Report
Giant Epidermoid Cyst over the Male Breast
by Vipul D. Yagnik
Clin. Pract. 2011, 1(1), e2; https://doi.org/10.4081/cp.2011.e2 - 29 Mar 2011
Cited by 1
Abstract
Epidermoid cyst is commonly known as sebaceous cyst. It is the most commonly encountered cyst of the skin. Epidermoid cyst over the breast is uncommon. Punctum is the hallmark for clinical diagnosis. Local excision with primary closure is the treatment of choice. Biopsy [...] Read more.
Epidermoid cyst is commonly known as sebaceous cyst. It is the most commonly encountered cyst of the skin. Epidermoid cyst over the breast is uncommon. Punctum is the hallmark for clinical diagnosis. Local excision with primary closure is the treatment of choice. Biopsy is mandatory in giant cyst to exclude malignancy. Full article
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