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Clinics and Practice
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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 2 (April 2011) – 21 articles

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655 KiB  
Case Report
Primary Pineal Malignant Melanoma
by Oderay Mabel Cedeño Díaz, Roberto Garcia Leal and Cesar La Cruz Pelea
Clin. Pract. 2011, 1(2), e31; https://doi.org/10.4081/cp.2011.e31 - 21 Jun 2011
Cited by 5
Abstract
Primary pineal malignant melanoma is a rare entity, with only thirteen cases reported in the world literature to date. We report a case of a 70-year-old man, who consulted with gait disturbance of six months duration, associated in the last month with dizziness, [...] Read more.
Primary pineal malignant melanoma is a rare entity, with only thirteen cases reported in the world literature to date. We report a case of a 70-year-old man, who consulted with gait disturbance of six months duration, associated in the last month with dizziness, visual abnormalities and diplopia. No other additional melanocytic lesions were found elsewhere. The magnetic resonance showed a 25 mm expansive mass in the pineal gland that was associated with hydrocephaly, ventricular and transependimary oedema. The lesion was partially excised by a supracerebellar infratentorial approach. The histological examination revealed a melanoma. The patient received radiation therapy, but died of disease 16 weeks later. We herein review the literature on this rare tumour and comment on its clinical, radiological and histopathological features and differential diagnosis. Full article
266 KiB  
Case Report
Diffuse Pulmonary Infiltrates in an Old Man with Chronic Lymphocytic Leukemia
by Alireza Hosseinnezhad, Joseph M. Seguel and Andrew G Villanueva
Clin. Pract. 2011, 1(2), e41; https://doi.org/10.4081/cp.2011.e41 - 31 May 2011
Cited by 1
Abstract
An 82-year-old man known case of chronic lymphocytic leukemia (CLL) presented with fever and weakness. He had never received any treatment for his CLL in the past. On admission he was found to be in mild respiratory distress with bilateral crackles and had [...] Read more.
An 82-year-old man known case of chronic lymphocytic leukemia (CLL) presented with fever and weakness. He had never received any treatment for his CLL in the past. On admission he was found to be in mild respiratory distress with bilateral crackles and had markedly elevated white blood count (WBC) (137 K/uL with 93% lymphocytes). His respiratory status deteriorated necessitating noninvasive ventilatory support. Chest computed tomography (CT) scan revealed bilateral diffuse ground glass opacities, so broad spectrum antibiotic therapy was initiated. Despite that, he remained febrile and cultures were all negative. Chest x-rays showed progressive worsening of diffuse alveolar opacities. Bronchoalveolar lavage (BAL) was negative for infectious etiologies, however flow cytometry of the fluid was consistent with CLL. Chemotherapy with chlorambucil was started. Although most of the pulmonary infiltrates in CLL patients are due to infectious causes, leukemic cells infiltration should be considered as well in CLL patients with respiratory symptoms who do not respond appropriately to standard antimicrobial regimen. Full article
1098 KiB  
Case Report
Caecal Carcinoma: A Review of 3 Cases in a Private Hospital in Lagos
by John Adi Ashindoitiang
Clin. Pract. 2011, 1(2), e42; https://doi.org/10.4081/cp.2011.e42 - 30 May 2011
Cited by 2
Abstract
Colorectal tumors are rare in the developing countries but common in the civilized world. With the event of westernization of the diet, the incidence is increasing in the developing countries such as Nigeria. Caecal tumors present late because of the anatomical features of [...] Read more.
Colorectal tumors are rare in the developing countries but common in the civilized world. With the event of westernization of the diet, the incidence is increasing in the developing countries such as Nigeria. Caecal tumors present late because of the anatomical features of this part of colon. The tumors in the caecum are insidious in onset and often attend large size. Barium enema and colonoscopy have limitation in accessing this region. Computed tomography (CT) scan is expensive and not readily affordable in the developing world. High index of suspicion is therefore necessary to the diagnosed carcinoma of the caecum as it is a curable disease if diagnosed early and treated. We present 3 cases of caecal tumors seen over a 5-year period that were treated with good outcome. Full article
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Case Report
Intracameral Bevacizumab Administered for Non-Small Cell Lung Cancer Metastasis to Iris
by Jonathan C. Schell, Steven B. Koenig, Kenneth Bastin and William J. Wirostko
Clin. Pract. 2011, 1(2), e39; https://doi.org/10.4081/cp.2011.e39 - 30 May 2011
Cited by 5
Abstract
Ocular iris metastasis from lung cancer is uncommon. We report a patient with metastatic non-small cell lung cancer who was found to have a metastatic lesion to the iris. Local therapy for pain control and vision loss was administered with intracameral bevacizumab. Complete [...] Read more.
Ocular iris metastasis from lung cancer is uncommon. We report a patient with metastatic non-small cell lung cancer who was found to have a metastatic lesion to the iris. Local therapy for pain control and vision loss was administered with intracameral bevacizumab. Complete resolution of pain, improvement in vision, and near complete resolution of iris tumor were seen within two months. No ocular toxicity to anterior segment structures was detectable on corneal pachymetry and corneal specular microscopy. This is the first case report demonstrating safety and efficacy of intracameral bevacizumab for iris metastasis from non-small cell lung cancer. Full article
127 KiB  
Case Report
Survival Post Surgery for Malignant Pericardial Effusion
by Olivier Nguyen and Denise Ouellette
Clin. Pract. 2011, 1(2), e38; https://doi.org/10.4081/cp.2011.e38 - 30 May 2011
Cited by 5
Abstract
The study reviews the survival of patients with malignant pericardial effusion treated with a subxiphoid pericardial window. The medical records of 60 consecutive patients diagnosed with a malignant pericardial effusion and treated with a subxiphoid pericardial window between 1994 and 2008 were reviewed. [...] Read more.
The study reviews the survival of patients with malignant pericardial effusion treated with a subxiphoid pericardial window. The medical records of 60 consecutive patients diagnosed with a malignant pericardial effusion and treated with a subxiphoid pericardial window between 1994 and 2008 were reviewed. 72% had lung cancer. Overall 30-day mortality was 31%. Survival rates at 3 months, 6 months, 1 year, and 2 years were 45%, 28%, 17%, and 9%, respectively. Overall median survival was 2.6 months. Patients with malignant pericardial effusion, especially those with primary lung cancer have poor survival rates. In advanced malignancy, the subxiphoid pericardial window procedure provides only short-term palliation of symptoms, and has no effect on long-term survival. The use of any surgical procedure in patients with malignant advanced pericardial effusion should be considered along with nonsurgical options on a case-by-case basis depending on symptoms, general status, and expected survival. Full article
648 KiB  
Case Report
Apyretic Gastrointestinal Disorders Due to Giardiasis Contracted in Morocco
by Yann A. Meunier and Michael K. Hole
Clin. Pract. 2011, 1(2), e40; https://doi.org/10.4081/cp.2011.e40 - 18 May 2011
Cited by 2
Abstract
We present the case of a 32-year-old French man who presented with morning nausea, bloating, frequent flatulence, burping, occasional pyrosis, and alternating diarrhea and constipation two weeks after a trip to Morocco. The diagnosis was established by a parasitological stool exam that revealed [...] Read more.
We present the case of a 32-year-old French man who presented with morning nausea, bloating, frequent flatulence, burping, occasional pyrosis, and alternating diarrhea and constipation two weeks after a trip to Morocco. The diagnosis was established by a parasitological stool exam that revealed cysts of Giardia lamblia. He was successfully treated with tinidazole. Full article
439 KiB  
Case Report
Central Ossifying Fibroma, Periapical Cemento-Osseous Dysplasia and Complex Odontoma Cccurring in the Same Jaw
by Farzaneh Agha Hosseini and Elham Moslemi
Clin. Pract. 2011, 1(2), e36; https://doi.org/10.4081/cp.2011.e36 - 17 May 2011
Cited by 3
Abstract
Central ossifying fibroma is a rare, benign fibro-osseous lesion that arises from the periodontal ligament. Periapical cemento-osseous dysplasia is another variant of fibro-osseous lesion which occurs in the anterior region of the mandible of females. Odontoma is a benign odontogenic tumor that contains [...] Read more.
Central ossifying fibroma is a rare, benign fibro-osseous lesion that arises from the periodontal ligament. Periapical cemento-osseous dysplasia is another variant of fibro-osseous lesion which occurs in the anterior region of the mandible of females. Odontoma is a benign odontogenic tumor that contains enamel, dentine cement and pulp tissue. A 46-year-old woman was referred to the Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, with two nonpainful swellings on both sides of the mandible, which had been slowly growing over a period of one year. Our differential diagnosis was florid cemento-osseous dysplasia, focal cemento-osseous dysplasia for the right side, complex odontoma for the left side and periapical cement-osseous dysplasia for the anterior side. The historical feature revealed ossifying fibroma, complex odontoma and periapical cemento-osseous dysplasia. The occurrence of these three lesions in the same jaw has been rarely reported in the literature. The relationship between the occurrence of these three lesions is not obvious it could be coincidental. It seems that more case reports are needed to establish the relationship between them. Full article
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Case Report
Acute Renal Failure, Thrombocytopenia, and Elevated Liver Enzymes after Concurrent Abuse of Alcohol and Cocaine
by Alireza Hosseinnezhad, Rajakrishnan Vijayakrishnan and Mary Jo S. Farmer
Clin. Pract. 2011, 1(2), e35; https://doi.org/10.4081/cp.2011.e35 - 16 May 2011
Cited by 5
Abstract
Cocaine has been associated with known adverse effects on cardiac, cerebrovascular and pulmonary systems. However, the effect of cocaine on other organs has not been extensively reported. A middle age man presented with abdominal pain and nausea after inhalation of crack cocaine. On [...] Read more.
Cocaine has been associated with known adverse effects on cardiac, cerebrovascular and pulmonary systems. However, the effect of cocaine on other organs has not been extensively reported. A middle age man presented with abdominal pain and nausea after inhalation of crack cocaine. On admission, he was found to be hypertensive and tachycardic. Physical examination revealed mild abdominal tenderness without rebound. Laboratory investigations were significant for acute kidney failure with elevated serum creatinine (3.72 mg/dL), thrombocytopenia (platelet count 74,000/UL), elevated alanine and aspartate transaminases (ALT 331 U/L; AST 462 U/L) and elevated creatine phosphokinase (CPK 5885 U/L). Urine toxicology screening solely revealed cocaine. A clinical diagnosis of cocaine toxicity was made and patient was admitted to the intensive care unit because of multi organ failure. Despite downward trending of liver enzymes during the hospital course, he continued to have residual renal insufficiency and a low platelet count at the time of discharge. In a patient with history of recent cocaine use presenting with these manifestations, cocaine itself should be considered as a likely cause. Full article
1071 KiB  
Case Report
Fulminating Septic Shock from Clostridium Perfringens in an Early Breast Cancer Patient with Severe Myalgia after Docetaxel Treatment
by Alessandro Marco Minisini, Jessica Menis, Alessandro Follador, Claudio Avellini and Gianpiero Fasola
Clin. Pract. 2011, 1(2), e33; https://doi.org/10.4081/cp.2011.e33 - 12 May 2011
Cited by 1
Abstract
Anaerobic bacteraemia could be a lifethreatening condition in neutropenic patients receiving chemotherapy. Taxane therapy is associated with necrotising inflammation of the caecum (named also typhlitis) that could be a potential source for bacteraemia. We report the case of a sudden onset of septic [...] Read more.
Anaerobic bacteraemia could be a lifethreatening condition in neutropenic patients receiving chemotherapy. Taxane therapy is associated with necrotising inflammation of the caecum (named also typhlitis) that could be a potential source for bacteraemia. We report the case of a sudden onset of septic shock by Clostridium perfringens in a young patient treated with docetaxel as adjuvant chemotherapy for early breast cancer. A minireview of the literature has been performed. Full article
1048 KiB  
Case Report
Coexistence of Behçet’s Disease with Ankylosing Spondylitis and Familial Mediterranean Fever: A Rare Occurrence
by Makram Frigui, Manel Kechaou, Moez Jallouli, Neila Kaddour, Habiba Bouhamed Chaabouni and Zouhir Bahloul
Clin. Pract. 2011, 1(2), e34; https://doi.org/10.4081/cp.2011.e34 - 06 May 2011
Cited by 5
Abstract
Behçet's disease (BD) and familial Mediterranean fever (FMF), which are two separate diseases sharing some clinical features, may also coexist in the same patient. Further investigations are needed to understand whether this coexistence is due to either chance or geographical distribution patterns of [...] Read more.
Behçet's disease (BD) and familial Mediterranean fever (FMF), which are two separate diseases sharing some clinical features, may also coexist in the same patient. Further investigations are needed to understand whether this coexistence is due to either chance or geographical distribution patterns of these diseases or to common etiopathogenetic characteristics. Spondylarthritis as part of the clinical picture in these two diseases has been questioned and probably it is not a prominent characteristic of any of them. We report a 35- year-old Tunisian man who had an association of BD, FMF and Human Leukocyte Antigen (HLA) B27 positive ankylosing spondylitis. Although that spondylarthritis is an infrequent joint involvement of FMF and BD, it must be looked for in case of association of these diseases. Full article
96 KiB  
Case Report
Bilateral Tuberculate Supernumerary Teeth
by Joycelyn Odegua Eigbobo and Babatope Bamidele Osagbemiro
Clin. Pract. 2011, 1(2), e30; https://doi.org/10.4081/cp.2011.e30 - 06 May 2011
Abstract
Supernumerary teeth are teeth in excess of the normal series occurring in any region of the dental arch. They are located mostly in the anterior maxillary region and are classified according to their location and morphology. The tuberculate type of supernumerary tooth possesses [...] Read more.
Supernumerary teeth are teeth in excess of the normal series occurring in any region of the dental arch. They are located mostly in the anterior maxillary region and are classified according to their location and morphology. The tuberculate type of supernumerary tooth possesses more than one cusp or tubercle (barrel shaped). It is rare to find bilateral tuberculate supernumerary teeth in the premaxillary region and when found they rarely erupt. This report describes a 13-year-old boy with erupted palatally placed bilateral tuberculate supernumerary teeth. The presence of these supernumerary teeth led to the labial displacement and rotations of the anterior maxillary teeth. The treatment involved extraction of the supernumerary teeth and a referral for orthodontic management of the crowding, displacement and rotations. The occurrence of erupted palatally placed tuberculate anterior teeth in this case is a rare experience. However, the associated orthodontic problems are within familiar spectrum. Full article
328 KiB  
Article
A Case of Idiopathic Encephalomeningocele
by Athanasios K. Petridis, Alexandros Doukas and Hubertus M. Mehdorn
Clin. Pract. 2011, 1(2), e29; https://doi.org/10.4081/cp.2011.e29 - 06 May 2011
Cited by 2
Abstract
In the present case we report about an encephalomeningocele in an adult female. Since the cause of this medical entity is a congenital fusion defect of the neural tube of the cranial base, most of the encephaloceles occurs in children leading to facial [...] Read more.
In the present case we report about an encephalomeningocele in an adult female. Since the cause of this medical entity is a congenital fusion defect of the neural tube of the cranial base, most of the encephaloceles occurs in children leading to facial disfigurement. In the rare cases described in adults, rhinorrhea is usually present. Here we present a case of temporobasal encephalomeningocele in a 72-year-old female patient suffering from headaches in the last 4–5 years. No rhinorrhea or other significant neurological symptoms were noticed. No congenital cause was apparent. After diagnostic steps including brain magnetic resonance imaging (MRI), cranial computed tomography (CT) and MR cisternography, an encephalomeningocele was diagnosed. Through a pterional approach this was completely removed. The only symptom the patient complaint about, headache, was eliminated after surgery. Full article
100 KiB  
Case Report
Neuroradiological Findings of an Adolescent with Early Treated Phenylketonuria: Is Phenylalanine Restriction Enough?
by Mayara Thays Beckhauser, Mirella Maccarini Peruchi, Gisele Rozone de Luca, Katia Lin, Sofia Esteves, Laura Vilarinho and Jaime Lin
Clin. Pract. 2011, 1(2), e25; https://doi.org/10.4081/cp.2011.e25 - 03 May 2011
Abstract
Phenylketonuria is caused by mutations in the enzyme phenylalanine hydroxylase gene, that can result in abnormal concentrations of phenylalanine on blood, resulting in metabolites that can cause brain damage. The treatment is based on dietary restriction of phenylalanine, and noncompliance with treatment may [...] Read more.
Phenylketonuria is caused by mutations in the enzyme phenylalanine hydroxylase gene, that can result in abnormal concentrations of phenylalanine on blood, resulting in metabolites that can cause brain damage. The treatment is based on dietary restriction of phenylalanine, and noncompliance with treatment may result in damage of the brain function. Brain abnormalities can be seen on magnetic resonance imaging of these individuals. Studies indicate that the appearance of abnormalities in white matter reflects high levels of phenylalanine on the blood. This case will show the clinical and neuroradiological aspects of a teenager with constant control of phenylalanine levels. Despite the continuous monitoring and early treatment, the magnetic resonance imaging identified impressive abnormalities in the white matter. This leads us to one question: is the restriction of phenylalanine sufficient to prevent changes in the white matter in patients with phenylketonuria? Full article
118 KiB  
Conference Report
Cerebellopontine Angle Facial Schwannoma Relapsing Towards Middle Cranial Fossa
by Takafumi Nishizaki, Norio Ikeda, Shigeki Nakano, Takanori Sakakura, Masaru Abiko and Tomomi Okamura
Clin. Pract. 2011, 1(2), e32; https://doi.org/10.4081/cp.2011.e32 - 02 May 2011
Cited by 2
Abstract
Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of [...] Read more.
Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve. Full article
84 KiB  
Case Report
Early Viral Kinetics and Response to Treatment in a Hepatitis C Virus Genotype 5 Infected Patient
by Emanuele Durante-Mangoni, Domenico Iossa and Umberto Malgeri
Clin. Pract. 2011, 1(2), e28; https://doi.org/10.4081/cp.2011.e28 - 29 Apr 2011
Abstract
Genotype 5 hepatitis C has been poorly studied despite its worldwide spread. We have analyzed the early kinetics of genotype 5 hepatitis C virus RNA during pegylated interferon/ribavirin treatment in a 59-year-old man with active liver necroinflammatory changes and advanced liver fibrosis. The [...] Read more.
Genotype 5 hepatitis C has been poorly studied despite its worldwide spread. We have analyzed the early kinetics of genotype 5 hepatitis C virus RNA during pegylated interferon/ribavirin treatment in a 59-year-old man with active liver necroinflammatory changes and advanced liver fibrosis. The patient had a high viral load but a small serum level of hepatitis C core antigen. On combination antiviral treatment with pegylated-interferon alpha 2a, 180 μg/week, and ribavirin, 1200 mg/day, the patient experienced an impressive reduction in serum HCV RNA as early as day 2 of treatment and eventually became a sustained virological responder. Our viral kinetics data support previous clinical studies showing HCV genotype 5 could be as intrinsically sensitive to interferon as HCV genotypes 2 and 3. Full article
500 KiB  
Case Report
Kawasaki Disease: Giant Aneurysm with a Large Thrombus of the Left Coronary Artery
by Alakananda Ghosh and Brojendra N. Agarwala
Clin. Pract. 2011, 1(2), e23; https://doi.org/10.4081/cp.2011.e23 - 28 Apr 2011
Cited by 1
Abstract
We report a six-month-old febrile infant presenting with stridor. Later on, he developed typical Kawasaki disease with giant aneurysm of the coronary artery with thrombosis that resolved with an aggressive anticoagulation therapy. The giant aneurysm still persisted a year later. Respiratory illness with [...] Read more.
We report a six-month-old febrile infant presenting with stridor. Later on, he developed typical Kawasaki disease with giant aneurysm of the coronary artery with thrombosis that resolved with an aggressive anticoagulation therapy. The giant aneurysm still persisted a year later. Respiratory illness with stridor is an unusual presentation of Kawasaki disease. Full article
928 KiB  
Case Report
Kala-Azar in a Brazilian Child
by Yann A. Meunier and Michael K. Hole
Clin. Pract. 2011, 1(2), e27; https://doi.org/10.4081/cp.2011.e27 - 26 Apr 2011
Abstract
We report the case of a six-year-old Brazilian girl referred for splenomegaly who first presented with fever, asthenia, and weight loss. Geographical location, clinical exam, and blood laboratories suggested kalaazar. Serology confirmed kala-azar diagnosis, but direct evidence of the parasites was not made. [...] Read more.
We report the case of a six-year-old Brazilian girl referred for splenomegaly who first presented with fever, asthenia, and weight loss. Geographical location, clinical exam, and blood laboratories suggested kalaazar. Serology confirmed kala-azar diagnosis, but direct evidence of the parasites was not made. A treatment by meglumine antimoniate is given under hospital surveillance for two weeks. Thereupon, the patient is asymptomatic and all tests are normal. Full article
1026 KiB  
Case Report
Association of Aortic and Main Left Coronary Aneurysms with Severe Aortic Insufficiency in Takayasu’s Arteritis
by Marcelo Derbli Schafranski, Marcelo Ferraz de Freitas and Marcelo Valladão de Carvalho
Clin. Pract. 2011, 1(2), e26; https://doi.org/10.4081/cp.2011.e26 - 22 Apr 2011
Abstract
Takayasu’s arteritis is a granulomatous vasculitis of unknown etiology that affects mainly the aorta and its branches. As a result of intimal fibroproliferation, segmental stenosis, occlusion, dilatation, and aneurysmal formation of the involved vessels may develop. It is an uncommon disease and usually [...] Read more.
Takayasu’s arteritis is a granulomatous vasculitis of unknown etiology that affects mainly the aorta and its branches. As a result of intimal fibroproliferation, segmental stenosis, occlusion, dilatation, and aneurysmal formation of the involved vessels may develop. It is an uncommon disease and usually affects young Asian female patients during the second and third decades of life. Coronary arteries are exceptionally affected and coronary aneurysm formation is a very rare finding. We describe a case of a previously healthy 26-year-old Caucasian female whose Takayasu’s arteritis presented as a previously undescribed association of aortic and main left coronary aneurysms with severe aortic insufficiency. Full article
96 KiB  
Case Report
Amyand Hernia with Appendicitis
by Vipul D. Yagnik
Clin. Pract. 2011, 1(2), e24; https://doi.org/10.4081/cp.2011.e24 - 22 Apr 2011
Cited by 12
Abstract
The term Amyand hernia refers to presence of appendix within inguinal hernia. The incidence of having a normal appendix within inguinal hernia is about 1%, whereas the finding of appendicitis in the inguinal hernia is only 0.1%. Full article
288 KiB  
Case Report
Significant Stenoses of Twin Circumflex Arteries Accompanied by Heart Failure: A Rare Coronary Artery Anomaly
by Davran Cicek, Seher Gokay, Halil Olcay Eldem and Haldun Muderrisoglu
Clin. Pract. 2011, 1(2), e22; https://doi.org/10.4081/cp.2011.e22 - 19 Apr 2011
Cited by 1
Abstract
Although coronary artery anomalies may cause some clinical symptoms, most are incidentally discovered as benign findings on coronary angiograms. A circumflex coronary artery anomalously originating from the right sinus of Valsalva is the most common coronary anomaly. However, a double circumflex coronary artery, [...] Read more.
Although coronary artery anomalies may cause some clinical symptoms, most are incidentally discovered as benign findings on coronary angiograms. A circumflex coronary artery anomalously originating from the right sinus of Valsalva is the most common coronary anomaly. However, a double circumflex coronary artery, both stenotic in their mid portions, resulting in symptomatic heart failure is a rare clinical and angiographic condition. In this case, we present a 71-year-old male patient admitted to our clinic with the diagnosis of acute heart failure. Angiography revealed stenotic double circumflex arteries, arising from the left and right sinus of Valsalva, and the patient was treated by percutaneous coronary intervention. Full article
214 KiB  
Case Report
Supratherapeutic International Normalized Ratio: An Indicator of Chronic Malnutrition Due to Severely Debilitating Gastrointestinal Disease
by Sarwan Kumar, Deepak Gupta and Shiva S. Rau
Clin. Pract. 2011, 1(2), e21; https://doi.org/10.4081/cp.2011.e21 - 19 Apr 2011
Abstract
This case highlights the fact that Supratherapeutic INRs direct the attention of the treating physicians’ team to the underlying severely debilitating gastrointestinal diseases. Prolonged fasting or starvation reduces vitamin K levels. Such patients are more sensitive to treatment with Vitamin K antagonist-based anticoagulants. [...] Read more.
This case highlights the fact that Supratherapeutic INRs direct the attention of the treating physicians’ team to the underlying severely debilitating gastrointestinal diseases. Prolonged fasting or starvation reduces vitamin K levels. Such patients are more sensitive to treatment with Vitamin K antagonist-based anticoagulants. Hence, the Supratherapeutic INR can be an objective indicator of chronic loss of appetite with poor nutritional status of the patient and therefore acts as a warning sign for diagnosis of severe debilitating primary gastrointestinal disease. Full article
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