Clinics and Practice

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Open AccessCase Report

Retroperitoneal Abscess Due to Dropped Gallstones After Laparoscopic Cholecystectomy

by Farah Adel, Jose M Ramia, Roberto De la Plaza, Jose Quilñones, Vladimir Arteaga and Jorge Garcia-Parreño

Clin. Pract. 2012, 2(1), e20; https://doi.org/10.4081/cp.2012.e20 - 23 Feb 2012

Cited by 4 | Viewed by 1

Abstract

Complications of dropped gallstones after laparoscopic cholecystectomy are infrequent but retroperitoneal abscess is extremely rare. We present a new case, discuss causes, diagnostic methods, preventive measures and therapeutical options. Full article

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Open AccessCase Report

Breast Metastasis from Multiple Primary Rhabdomyosarcoma in Upper Extremity

by Ramesh Omranipour and Mohamad Reza Hadi

Clin. Pract. 2012, 2(1), e25; https://doi.org/10.4081/cp.2012.e25 - 21 Feb 2012

Cited by 3 | Viewed by 1

Abstract

We report a 16-year-old girl with a multiple primary rhabdomyosarcoma of right upper extremity who developed contralateral breast metastasis in her clinical course. She was diagnosed to have multiple primary rhabdomyosarcoma of the right upper extremity with lung metastasis one year prior to [...] Read more.

We report a 16-year-old girl with a multiple primary rhabdomyosarcoma of right upper extremity who developed contralateral breast metastasis in her clinical course. She was diagnosed to have multiple primary rhabdomyosarcoma of the right upper extremity with lung metastasis one year prior to finding a mass in her left breast. The excisional biopsy of the breast mass confirmed metastatic rhabdomyosarcoma. Despite aggressive chemotherapy and subcutaneous total mastectomy, she developed a widespread bone and lung metastasis in few months and expired. Metastatic rhabdomyosarcoma of the breast is very rare but it should be considered in adolescent females with primary alveolar rhabdomyosarcoma, specially located on an extremity. Full article

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Open AccessCase Report

Mucormycosis of the Hard Palate Masquerading As Carcinoma

by Bhari Sharanesha Manjunatha, Nagarajappa Das, Rakesh V. Sutariya and Tanveer Ahmed

Clin. Pract. 2012, 2(1), e28; https://doi.org/10.4081/cp.2012.e28 - 15 Feb 2012

Cited by 11 | Viewed by 1

Abstract

A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused [...] Read more.

A growing number of medically compromised patients are encountered by dentists in their practices. Opportunistic fungal infections such as mucormycosis usually occur in immunocompromised patients but can infect healthy individuals as well. Mucormycosis is an acute opportunistic, uncommon, frequently fatal fungal infection, caused by a saprophytic fungus that belongs to the class of phycomycetes. Among the clinical differential diagnosis we can consider squamous cell carcinoma. Such cases present as chronic ulcers with raised margins causing exposure of underlying bone. There is a close histopathological resemblance between mucormycosis and aspergillosis. Microscopically, aspergillosis has septate branching hyphae, which can be distinguished from mucormycotic hyphae by a smaller width and prominent acute angulations of branching hyphae. A definitive diagnosis of mucormycosis can be made by tissue biopsy that identifies the characteristic hyphae, by positive culture or both. The culture of diseased tissue may be negative and histopathologic examination is essential for early diagnosis. Mucormycosis was long regarded as a fatal infection with poor prognosis. However with early medical and surgical management survival rates are now thought to exceed 80%. In the present case, the fungus was identified by hematoxylin and eosin stain and confirmed by Grocott’s silver methenamine special staining technique. Removal of the necrotic bone, which acted as a nidus of infection, was done. Post-operatively patient was advised an obturator to prevent oronasal regurgitation. Since mucormycosis occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. Full article

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Open AccessCase Report

Anterior Mandibular Ameloblastoma

by Ajay H. Bhandarwar, Girish D. Bakhshi, Ashok D. Borisa, Amol Wagh, Rajat Kapoor and Channabasappa G. Kori

Clin. Pract. 2012, 2(1), e30; https://doi.org/10.4081/cp.2012.e30 - 14 Feb 2012

Cited by 3 | Viewed by 1

Abstract

Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis- [...] Read more.

Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis- menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis- menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented. Full article

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Open AccessCase Report

A Rare Case of Paratesticular Leiomyosarcoma

by James Moloney, John Drumm and Deirdre M. Fanning

Clin. Pract. 2012, 2(1), e29; https://doi.org/10.4081/cp.2012.e29 - 14 Feb 2012

Cited by 11 | Viewed by 1

Abstract

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. [...] Read more.

Soft-tissue sarcomas of the genitourinary tract account for only 1-2% of urological malignancies and 2.1% of soft-tissue sarcomas in general. A 69-year-old male complained of a 4 month history of a painless right groin swelling during routine urological review for prostate cancer follow-up. Clinical examination revealed a non-tender, firm right inguinoscrotal mass. There was no discernible cough impulse. Computed tomography of abdomen and pelvis showed a non-obstructed right inguinal hernia. During elective hernia repair a solid mass involving the spermatic cord and extending into the proximal scrotum was seen. The mass was widely resected and a right orchidectomy was performed. Pathology revealed a paratesticular sarcoma. He proceeded to receive adjuvant radiotherapy. Only around 110 cases of leiomyosarcoma of the spermatic cord have been described in the literature. They commonly present as painless swellings in the groin. The majority of diagnoses are made on histology. Full article

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Open AccessCase Report

Unusual Presentation of Eosinophilic Enteritis as Multiple Strictures of Small Intestine

by Sunil V. Jagtap, Dhiraj B. Nikumbh, Ashok Y. Kshirsagar and Neha Ahuja

Clin. Pract. 2012, 2(1), e24; https://doi.org/10.4081/cp.2012.e24 - 13 Feb 2012

Cited by 3 | Viewed by 1

Abstract

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index [...] Read more.

Eosinophilic enteritis is a rare disease of unknown etiology. It is characterized by eosinophilic infiltration of the bowel wall to a variable depth and symptoms associated with gastrointestinal tract depending upon the predominant layer involved. Diagnosis of eosinophilic enteritis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia. We report a case of unusual presentation of eosinophilic enteritis clinically presenting as intestinal obstruction due to multiple strictures of the small bowel in an adult male. Full article

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Open AccessCase Report

Pseudo-Tumoral Hepatic Tuberculosis Discovered After Surgical Resection

by Miloudi Nizar, Mzoughi Zeineb, Ben Abid Sadri, Sabbagh Safa, Marsaoui Lobna, Arfa Nafaa, Gharbi Lassaad and Khalfallah Mohamed Taher

Clin. Pract. 2012, 2(1), e27; https://doi.org/10.4081/cp.2012.e27 - 03 Feb 2012

Cited by 1

Abstract

Pseudo-tumoral hepatic tuberculosis is rare. It is characterized by non-specific symptoms and radiological polymorphism. Diagnosis is problematic. This article presents three cases, each clinically different from each other, that illustrate how difficult diagnosis can be. The definitive diagnosis of pseudo-tumoral hepatic tuberculosis was [...] Read more.

Pseudo-tumoral hepatic tuberculosis is rare. It is characterized by non-specific symptoms and radiological polymorphism. Diagnosis is problematic. This article presents three cases, each clinically different from each other, that illustrate how difficult diagnosis can be. The definitive diagnosis of pseudo-tumoral hepatic tuberculosis was reached on the basis of histological examination of surgical samples. Treatment of the disease based on appropriate anti-tubercular therapy generally gives a positive outcome. Full article

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Open AccessCase Report

Maxillary First Molar with Two Palatal Roots Located Under Dental Operating Microscope

by Prashant P. Shetty, Madhusudan S. Astekar, Ankit Jain and Mihir Pandya

Clin. Pract. 2012, 2(1), e26; https://doi.org/10.4081/cp.2012.e26 - 03 Feb 2012

Viewed by 1

Abstract

An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion [...] Read more.

An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion of endodontic treatment. This report points to the importance of looking for additional roots and canals with the help of operating microscope. Finding additional roots and canals would enable clinician to successfully treat a case that would otherwise not be successful. Full article

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Open AccessCase Report

Undiagnosed Xiphopagus Twins: A Perinatal Malady

by Gowri Dorairajan

Clin. Pract. 2012, 2(1), e23; https://doi.org/10.4081/cp.2012.e23 - 02 Feb 2012

Viewed by 1

Abstract

Conjoined twins are a very rare entity. It is associated with poor survival rate in the presence of vital organ sharing. The entity can be diagnosed as early as the first trimester. A conjoined twin diagnosed late in labor is a malady with [...] Read more.

Conjoined twins are a very rare entity. It is associated with poor survival rate in the presence of vital organ sharing. The entity can be diagnosed as early as the first trimester. A conjoined twin diagnosed late in labor is a malady with high perinatal mortality and maternal morbidity. We present one such case of xiphopagus twins. The management of a case diagnosed late in labor can be very challenging. Such obstetric challenges can be avoided by a meticulous early scan with a high index of suspicion, especially in the absence of separating membrane while scanning multiple pregnancies. Full article

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Open AccessCase Report

You Can’t Judge a Book by Its Cover or a Tumor by Its Expression Profile

by Steven M. Sorscher and Theodore Thomas

Clin. Pract. 2012, 2(1), e21; https://doi.org/10.4081/cp.2012.e21 - 31 Jan 2012

Viewed by 1

Abstract

Expression profiling has shown great promise in matching cancers of unknown primary to likely primary tumors of origin based on patterns of mRNA expression. However, it remains uncertain as to whether even well matched tumors will demonstrate the clinical features, such as rate [...] Read more.

Expression profiling has shown great promise in matching cancers of unknown primary to likely primary tumors of origin based on patterns of mRNA expression. However, it remains uncertain as to whether even well matched tumors will demonstrate the clinical features, such as rate of progression, of their matched counterparts. In this case report, we note that based on histology, immunohistochemistry and expression profile this patient’s poorly differentiated neuroendocrine tumor would have been expected to grow very rapidly on no therapy. Instead, this cancer was very indolent, with only very little radiographic progression over several years. We believe this report represents a remarkable case of a tumor where features, including expression profile, would not at all have accurately predicted the clinical course seen. While some series have suggested that matching by expression profiling predicts outcome, this case shows a dramatically different result. Full article

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Open AccessCase Report

Oral Alveolar Rhabdomyosarcoma: A Case Report with Immunohistochemical Analysis

by Madhusudan Astekar, Rashmi Metgud, Priyanka Sharma and Gayatri Ramesh

Clin. Pract. 2012, 2(1), e17; https://doi.org/10.4081/cp.2012.e17 - 30 Jan 2012

Cited by 5 | Viewed by 1

Abstract

Rhabdomyosarcomas are among the most common soft-tissue tumors in children. These tumors are derived from mesenchymal tissue with a tendency toward myogenic differentiation that probably originates from immature and highly invasive satellite cells associated with the embryogenesis of skeletal muscle. Some of these [...] Read more.

Rhabdomyosarcomas are among the most common soft-tissue tumors in children. These tumors are derived from mesenchymal tissue with a tendency toward myogenic differentiation that probably originates from immature and highly invasive satellite cells associated with the embryogenesis of skeletal muscle. Some of these tumors are associated with high rates of recurrence and metastasis. The diagnosis is made by microscopic analysis and auxiliary techniques such as immunohistochemistry, electron microscopy, cytogenetic analysis, and molecular biology. We report a case of 28- year-old man who presented with a painless progressive swelling of gingiva since 3 months, which was gradually increasing in size without any systemic symptoms or signs of any metastatic spread. An incisional biopsy was done and histopathology reported an alveolar variant of rhabdomyosarcoma. Immuno - histochemistry with panel of markers was done which showed positivity for CD99, vimentin and negative for desmin and myogenin. So the characteristic immunohistological expression was negative in present case. Hence we conclude that haematoxylin and eosin morphology and ultra structure are needed to classify rhabdomyosarcoma and immunohistochemistry act only as an auxiliary. Full article

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Open AccessCase Report

Treatment of Indolent, Nonencapsulated Cryptococcal Meningitis Associated with Hydrocephalus

by Sarah T. Garber and Paul L. Penar

Clin. Pract. 2012, 2(1), e22; https://doi.org/10.4081/cp.2012.e22 - 27 Jan 2012

Cited by 6 | Viewed by 1

Abstract

Infection with cryptococcal meningitis is uncommon in immunocompetent patients. The major virulence factor is the polysaccharide capsule, while nonencapsulated mutants are generally considered nonpathogenic. The authors present a case of hydrocephalus caused by meningitis from an indolent, nonencapsulated Cryptococcus sp. requiring placement and [...] Read more.

Infection with cryptococcal meningitis is uncommon in immunocompetent patients. The major virulence factor is the polysaccharide capsule, while nonencapsulated mutants are generally considered nonpathogenic. The authors present a case of hydrocephalus caused by meningitis from an indolent, nonencapsulated Cryptococcus sp. requiring placement and multiple revisions of a ventriculoperitoneal shunt (VPS). The patient presented with progressively worsening occipital headaches. Computed tomography and magnetic resonance imaging showed significant hydrocephalus with no apparent cause. Her symptoms initially resolved after placement of a VPS, but returned four months later. Cultures of the shunt tubing and cerebrospinal fluid (CSF) showed no bacterial infection. When the symptoms failed to resolve, CSF fungal culture revealed Cryptococcus-like yeast, although the organisms were nonencapsulated, and the cryptococcal antigen was negative. After antibiotic therapy, the symptoms resolved. The unusual clinical presentation delayed the diagnosis, highlighting the importance of understanding the detection, diagnosis, and treatment of meningeal infections caused by C. neoformans. Full article

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Open AccessCase Report

Compartment Syndrome Obscured by Post-Operative Epidural Analgesia

by Md Quamar Azam, Mir Sadat Ali, Majed Al Ruwaili and Hassan Noori Al Sayed

Clin. Pract. 2012, 2(1), e19; https://doi.org/10.4081/cp.2012.e19 - 27 Jan 2012

Cited by 8 | Viewed by 1

Abstract

Compartment syndrome is an orthopedic emergency that require early recognition and urgent intervention to avoid catastrophic complications. High index of suspicion is required for early diagnosis based on a constellation of signs and symptoms that include pain out of proportion and worsened by [...] Read more.

Compartment syndrome is an orthopedic emergency that require early recognition and urgent intervention to avoid catastrophic complications. High index of suspicion is required for early diagnosis based on a constellation of signs and symptoms that include pain out of proportion and worsened by passive stretching, altered sensorium and palpable tenseness. Any event thus, that masks pain, may lead to delay the diagnosis of compartment syndrome. We report here a case of polytrauma where post-operative analgesia was administered using epidural catheter, which obscured pain and lead to delay in recognition of compartment syndrome. Authors wish to share a lesson, learned at the expense of tragedy. Full article

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Open AccessBrief Report

The Clinical Response of West Nile Virus Neuroinvasive Disease to Intravenous Immunoglobulin Therapy

by Zvi Shimoni, Hanna Bin, Shlomo Bulvik, Mark Niven, Rawi Hazzan, Ella Mendelson and Paul Froom

Clin. Pract. 2012, 2(1), e18; https://doi.org/10.4081/cp.2012.e18 - 27 Jan 2012

Cited by 15 | Viewed by 1

Abstract

The aim of the study was to determine whether intravenous gamma globulin (IVIG) treatment is effective in patients with West Nile Virus (WNV) neuroinvasive disease. We contacted hospital based infectious disease experts in Israeli hospitals to identify patients with WNV neuroinvasive disease who [...] Read more.

The aim of the study was to determine whether intravenous gamma globulin (IVIG) treatment is effective in patients with West Nile Virus (WNV) neuroinvasive disease. We contacted hospital based infectious disease experts in Israeli hospitals to identify patients with WNV neuroinvasive disease who were treated with IVIG. The main outcome measure was neurological response after treatment. There were 12 patients who received IVIG and four improved within 48 h. Three patients died, 6 had partial recovery, and 3 recovered completely. Eleven of the 12 patients were infected with Israeli genotypes that are highly homologous to Europe/Africa viruses. The rapid response in some patients suggests that IVIG is effective, and might be used to treat patients with WNV neuroinvasive disease with IVIG. Full article

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Open AccessCase Report

Neuroendocrine Carcinoma Arising in a Wound of the Postoperative Maxillary Sinus

by Takeshi Kusunoki and Katsuhisa Ikeda

Clin. Pract. 2012, 2(1), e16; https://doi.org/10.4081/cp.2012.e16 - 24 Jan 2012

Cited by 1 | Viewed by 1

Abstract

We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and [...] Read more.

We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc’s method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc’s method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis. Full article

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Open AccessCase Report

Phaeochromocytoma in a 20-Year-Old Nigerian, Resolving the Dilemma of Benignity or Malignancy

by Fred O. Ugwumba, Okechukwu C. Okafor, Agharighom David Okoh and Obinna Virginus Ajuzieogu

Clin. Pract. 2012, 2(1), e15; https://doi.org/10.4081/cp.2012.e15 - 18 Jan 2012

Viewed by 1

Abstract

Pheochromocytomas are rare tumors that present a diagnostic challenge in developing countries. They occur in the adrenal gland and as paragangliomas along the sympathetic chain. Clinical features are usually those of sustained or paroxysmal hypertension and complications thereof. Surgical extirpation remains the mainstay [...] Read more.

Pheochromocytomas are rare tumors that present a diagnostic challenge in developing countries. They occur in the adrenal gland and as paragangliomas along the sympathetic chain. Clinical features are usually those of sustained or paroxysmal hypertension and complications thereof. Surgical extirpation remains the mainstay of treatment and is greatly facilitated by accurate pre-operative tumor localization. Pre-operative medical management with antihypertensive medication has led to significant reductions in peri-operative mortality. Determination of malignancy is difficult in the absence of obvious metastases. We present a case of left adrenal phechromocytoma that was stabilized. Adrenalectomy had a good outcome and the patient has so far been followed up for a year. Full article

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Open AccessCase Report

Emphysematous Pyelonephritis Treated with Elective Nephrectomy in a 75-Year-Old Diabetic Patient

by Yayi He, Bingyin Shi, Xiaoyan Wu, Peng Hou and Yi Wang

Clin. Pract. 2012, 2(1), e14; https://doi.org/10.4081/cp.2012.e14 - 18 Jan 2012

Viewed by 1

Abstract

We present a case of 75-year-old man with type 2 diabetes and emphysematous pyelonephritis (EPN). The patient presented with abdominal pain, fever of undetermined origin and progressive decrease in urine output. Computerized tomography scan revealed gas formation in the left renal parenchyma and [...] Read more.

We present a case of 75-year-old man with type 2 diabetes and emphysematous pyelonephritis (EPN). The patient presented with abdominal pain, fever of undetermined origin and progressive decrease in urine output. Computerized tomography scan revealed gas formation in the left renal parenchyma and capsule. A left nephrectomy was performed. He made a quick recovery. EPN should be taken into consideration in diabetic patients with symptoms of pyelonephritis who show a poor response to conventional treatment. Elective nephrectomy may be life saving in some patients.
Full article

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Open AccessBrief Report

Awareness about HIV Infection among the Paramedical Staff in a Tertiary Care Hospital in Delhi, India

by Nikhil Gupta, Binita Goswami, Bhawna Singh and Sandeep Ghosh

Clin. Pract. 2012, 2(1), e13; https://doi.org/10.4081/cp.2012.e13 - 18 Jan 2012

Cited by 1 | Viewed by 1

Abstract

In India, acquired immunodeficiency syndrome (AIDS) is a growing epidemic involving all sections of the society. Health care personnel are at increased risk of acquiring blood borne diseases like AIDS, hepatitis, etc. We aimed to assess the level of awareness of HIV infection [...] Read more.

In India, acquired immunodeficiency syndrome (AIDS) is a growing epidemic involving all sections of the society. Health care personnel are at increased risk of acquiring blood borne diseases like AIDS, hepatitis, etc. We aimed to assess the level of awareness of HIV infection among the paramedical staff working in a tertiary care hospital. A total number of 207 paramedical staff were asked to complete a questionnaire covering the various aspects of HIV and AIDS which was then critically reviewed. We observed that 57.54% of the staff was aware of the different aspects of HIV infection. Our results highlighted that awareness regarding the different facets of HIV varied among the nurses, lab technicians and support staff. Transmission of blood borne infections through needle stick injury is a harsh reality involving health care personnel. There is an urgent need to teach basic knowledge about HIV infection among high-risk populations. Full article

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Open AccessCase Report

An under Recognized Cause of Chest Pain

by Unnikrishnan Ponnamma Kunjan Pillai, Santosh G. John, Aparna Narayana Kurup, Joe Devasahayam and Alexandre Lacasse

Clin. Pract. 2012, 2(1), e12; https://doi.org/10.4081/cp.2012.e12 - 18 Jan 2012

Viewed by 1

Abstract

Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. With recent advances in imaging techniques, IMH is now increasingly [...] Read more.

Aortic intramural hematoma (IMH) is related to but is pathologically distinct from aortic dissection. In this potentially lethal entity, there is hemorrhage into the aortic media in the absence of an intimal tear. With recent advances in imaging techniques, IMH is now increasingly recognized. The limited data available suggest that the clinical course of IMH mimics that of acute aortic dissection, and mortality rates are similar. Physicians need to be cognizant regarding this entity when they are evaluating chest pain. Here we report a case of IMH, in a 63-year-old female, which was managed conservatively. Full article

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Open AccessCase Report

Hypochondriacal Delusion in an Elderly Woman Recovers Quickly with Electroconvulsive Therapy

by Annemieke Dols, Didi Rhebergen, Piet Eikelenboom and Max L. Stek

Clin. Pract. 2012, 2(1), e11; https://doi.org/10.4081/cp.2012.e11 - 18 Jan 2012

Cited by 2 | Viewed by 1

Abstract

A 72-year-old woman without any medical and psychiatric history, suffered from nausea, pain in the epigastria and constipation for over a year. She eventually lost 20 kilograms despite nightly drip-feeding. Extensive additional tests did not reveal any clues for her complaints. She remained [...] Read more.

A 72-year-old woman without any medical and psychiatric history, suffered from nausea, pain in the epigastria and constipation for over a year. She eventually lost 20 kilograms despite nightly drip-feeding. Extensive additional tests did not reveal any clues for her complaints. She remained convinced that her symptoms were a side-effect of anti-fungal medication she used. She was diagnosed with hypochondria. In the course of time her ideas about her somatic symptoms became delusional and she was diagnosed with a hypochondriacal delusion as part of melancholia, without depressed mood or loss of interest or pleasure as prominent features. It is important to recognize melancholia as soon as possible by continually evaluating other symptoms of depression. This may enable to avoid repetitive and exhaustive somatic examinations, which are not indicated, and to start effective treatment. In our patient electroconvulsive therapy resulted in a fast and complete recovery. Full article

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Open AccessCase Report

Sphenochoanal Polyps and the Optic Nerve

by Tolgar Lütfi Kumral, Güven Yildirim and Yavuz Uyar

Clin. Pract. 2012, 2(1), e10; https://doi.org/10.4081/cp.2012.e10 - 09 Jan 2012

Cited by 5 | Viewed by 1

Abstract

Isolated sphenoid pathology is uncommon. Nasal polyps that originate from the anterior wall of the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. The atypical location of sphenochoanal polyps leads to misdiagnosis, and surgery risks injuring the surrounding structures, such as [...] Read more.

Isolated sphenoid pathology is uncommon. Nasal polyps that originate from the anterior wall of the sphenoid sinus and reach the nasopharynx are called sphenochoanal polyps. The atypical location of sphenochoanal polyps leads to misdiagnosis, and surgery risks injuring the surrounding structures, such as the optic nerve, carotid artery, and brain. For the differential diagnosis of sphenochoanal polyps, nasal endoscopy and computed tomography are very important. We present the clinical and radiological features of a sphenochoanal polyp and review the status of the optic nerve during endoscopic surgery for a sphenochoanal polyp. Full article

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Open AccessCase Report

Abdominal Wall Metastasis in Scar after Open Resection of an Adrenocortical Carcinoma

by Nikhil Gupta, Umesh Bansal, Neha Mahajan and Maha Singh Yadav

Clin. Pract. 2012, 2(1), e9; https://doi.org/10.4081/cp.2012.e9 - 30 Dec 2011

Cited by 4 | Viewed by 1

Abstract

A 42-year-old man patient presented with progressively increasing, occasionally painful lump in the left upper and central abdomen. Investigations revealed well-defined capsulated left adrenocortical carcinoma. Tumor was resected successfully along with left kidney. Tumor recurred in the abdominal surgical scar 1.5 years after [...] Read more.

A 42-year-old man patient presented with progressively increasing, occasionally painful lump in the left upper and central abdomen. Investigations revealed well-defined capsulated left adrenocortical carcinoma. Tumor was resected successfully along with left kidney. Tumor recurred in the abdominal surgical scar 1.5 years after surgery. We are reporting this case because of rarity of metastatic recurrence of an adrenocortical carcinoma in the abdominal surgical scar 1.5 years after resection of primary tumor. Full article

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Open AccessCase Report

Additional Biological Therapies for Attention-Deficit Hyperactivity Disorder: Repetitive Transcranical Magnetic Stimulation of 1 Hz Helps to Reduce Methylphenidate

by Helmut Niederhofer

Clin. Pract. 2012, 2(1), e8; https://doi.org/10.4081/cp.2012.e8 - 30 Dec 2011

Cited by 4 | Viewed by 1

Abstract

Excessive hyperactivity, impulsiveness and attentional difficulties characterize attentiondeficit hyperactivity disorder (ADHD). The aim of this case report is to signal the possible therapeutic effectiveness of the repetitive transcranial magnetic stimulation (rTMS). Low frequency (1Hz, 1200 stim/die for five days) was applied on the [...] Read more.

Excessive hyperactivity, impulsiveness and attentional difficulties characterize attentiondeficit hyperactivity disorder (ADHD). The aim of this case report is to signal the possible therapeutic effectiveness of the repetitive transcranial magnetic stimulation (rTMS). Low frequency (1Hz, 1200 stim/die for five days) was applied on the impending scalp in the motor additional area of a patient suffering from combined type ADHD who received methylphenidate (MPH). We saw a significant improvement, especially according to criteria associated with hyperactivity. The improvement lasted for at least three weeks and suggested the final reduction in dosage of MPH.to 10 mg. Full article

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Open AccessCase Report

An Emerging Problem in Clinical Practice: How to Approach Acute Psychosis

by Sofia Markoula, Dimitrios Chatzistefanidis, Spyridon Konitsiotis and Athanassios P. Kyritsis

Clin. Pract. 2012, 2(1), e7; https://doi.org/10.4081/cp.2012.e7 - 30 Dec 2011

Viewed by 1

Abstract

Limbic encephalitis (LE) is rare, presents with memory impairment, seizures and behavioral disorder. We present a 44-year-old female with an agitation-depressive disorder associated with delusions and hallucinations, admitted to our hospital with the diagnosis of psychosis. A computed tomography (CT) scan of the [...] Read more.

Limbic encephalitis (LE) is rare, presents with memory impairment, seizures and behavioral disorder. We present a 44-year-old female with an agitation-depressive disorder associated with delusions and hallucinations, admitted to our hospital with the diagnosis of psychosis. A computed tomography (CT) scan of the brain and lumbar puncture on admission were normal. Because of clinical deterioration and addition of seizures in the clinical picture, further workup with serum and repeat cerebrospinal fluid studies, magnetic resonance imaging (MRI), and electroencephalogram disclosed a lesion in the left medial temporal lobe consistent with LE. The patient was treated symptomatically with antidepressive, antipsychotic and anticonvulsant drugs. Aggressive diagnostic tests for the presence of an occult cancer were negative. An 8-year follow up has not revealed a tumor to support a paraneoplasmatic origin of LE. This case, initially diagnosed and treated as psychosis, is a case of non-paraneoplasmatic, non-infective LE, probably caused by an autoimmune mechanism. Full article

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Open AccessArticle

Acute Interstitial Nephritis, a Rare Complication of Giardiasis

by Antonio De Pascalis and Erasmo Buongiorno

Clin. Pract. 2012, 2(1), e6; https://doi.org/10.4081/cp.2012.e6 - 30 Dec 2011

Cited by 2 | Viewed by 1

Abstract

Acute interstitial nephritis is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. Acute interstitial nephritis as a form of hypersensitivity reaction is an uncommon manifestation in the setting of human parasitic infections. We [...] Read more.

Acute interstitial nephritis is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. Acute interstitial nephritis as a form of hypersensitivity reaction is an uncommon manifestation in the setting of human parasitic infections. We present a case of acute interstitial nephritis in association with Giardia infection in a 54-year-old woman who developed an impairment of renal function after a prolonged period of slight fever and diarrhea. After an attempt to recover renal impairment by vigorous rehydratation, because of the unclear origin of the persisting renal failure, a percutaneous renal biopsy was performed and a diagnosis of severe acute interstitial nephritis was made. Steroid therapy was started and after six weeks, renal function had completely recovered. In cases of unexplained renal failure in patients affected by parasitic infections, interstitial nephritis should be considered and it is our opinion that a renal biopsy should be always performed. Full article

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Open AccessCase Report

A Mixed Neoplasm of Intraosseous Hemangioma with an Ameloblastoma: A Case of Collision Tumor or a Rare Variant?

by Harshvardhan S. Jois, Mohan Kumar K.P, Mandali Satish Kumar and Shefali Waghrey

Clin. Pract. 2012, 2(1), e5; https://doi.org/10.4081/cp.2012.e5 - 30 Dec 2011

Cited by 1 | Viewed by 1

Abstract

Hemangiomas of the head and neck are considered to be benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell proliferation, followed by gradual involution. Central hemangiomas are a rare occurrence and even rarer are the hybrid tumors [...] Read more.

Hemangiomas of the head and neck are considered to be benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell proliferation, followed by gradual involution. Central hemangiomas are a rare occurrence and even rarer are the hybrid tumors of central hemangiomas with odontogenic tumors such as ameloblastomas. This paper reports a case of one such hybrid tumor in a middle aged adult clinical presenting as a mandibular swelling with indistinct mixed radiographic presentation and histopathologically comprising of intimately associated hemangiomatous vascular channels and typical ameloblastic areas. To the authors’ knowledge this is the sixth case of such a hemangiomatous ameloblastoma which has been reported till date. Full article

280 KiB

Open AccessCase Report

Caecal Tumour Masquerading as an Appendicular Mass

by Martha Nixon, Jes Verwey and Jacob A. Akoh

Clin. Pract. 2012, 2(1), e4; https://doi.org/10.4081/cp.2012.e4 - 30 Dec 2011

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Abstract

Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe comorbidities and who later died from severe metastatic [...] Read more.

Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe comorbidities and who later died from severe metastatic disease. A 65-year-old lady presented with right iliac fossa pain and a mass. She was treated for an appendix mass initially and when the mass failed to resolve after four weeks, she was thoroughly investigated for the possibility of a tumour. Severe co-morbities had a significant impact on her management as definitive surgery was delayed. She represented 10 months after the initial admission with small bowel obstruction and died of metastatic caecal cancer. Management of appendix mass must entail a careful approach to investigating and treatment with emphasis on early intervention if the mass does not resolve promptly. This will avoid delayed diagnosis, treatment and a detrimental impact on prognosis. Full article

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Open AccessCase Report

Delayed Diagnosis of a Right-Sided Traumatic Diaphragmatic Rupture

by Alexandr Kučera, Michal Rygl, Jiří Šnajdauf, Lucie Kavalcová, Ondřej Petrů, Vlasta Ritchelová and Martin Kynčl

Clin. Pract. 2012, 2(1), e3; https://doi.org/10.4081/cp.2012.e3 - 30 Dec 2011

Cited by 1 | Viewed by 1

Abstract

Right-sided traumatic diaphragmatic rupture in childhood is a very rare injury. Diaphragmatic rupture often manifests itself later, after an organ progressively herniates into the pleural cavity. When the patient is tubed, the ventilation pressure does not allow herniation of an organ, which occurs [...] Read more.

Right-sided traumatic diaphragmatic rupture in childhood is a very rare injury. Diaphragmatic rupture often manifests itself later, after an organ progressively herniates into the pleural cavity. When the patient is tubed, the ventilation pressure does not allow herniation of an organ, which occurs when the patient is ex-tubed. We present a patient with a delayed diagnose of right sided diaphragmatic rupture with a complicated post-operation state. Full article

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Open AccessCase Report

Ingestion of a Foreign Body Unmasks an Asymptomatic Small Bowel Carcinoid Tumor

by Yi-Zarn Wang and Patrick Greiffenstein

Clin. Pract. 2012, 2(1), e2; https://doi.org/10.4081/cp.2012.e2 - 30 Dec 2011

Cited by 1 | Viewed by 1

Abstract

Bowel obstruction is a common surgical admission around the world. On the other hand, small intestinal tumors, such as midgut carcinoid, are uncommon neoplasms and an infrequent cause of intestinal obstruction leading to hospitalization. A foreign body is an extremely rare cause of [...] Read more.

Bowel obstruction is a common surgical admission around the world. On the other hand, small intestinal tumors, such as midgut carcinoid, are uncommon neoplasms and an infrequent cause of intestinal obstruction leading to hospitalization. A foreign body is an extremely rare cause of intestinal obstruction and when ingested, foreign bodies most often lodge in the narrowest portion of the gastrointestinal tract. Narrowing of the small bowel due to a neoplasm can prohibit the passage of an accidentally ingested foreign object and produce an obstruction that neither the neoplasm nor the foreign body could have produced alone. We hereby report a case in which an accidentally ingested piece of foreign material leads to the finding of a small, early stage, asymptomatic, midgut carcinoid cancer in the proximal ileum that would have otherwise eluded detection for several years. Full article

299 KiB

Open AccessCase Report

Mild Stroke Symptoms as the Initial Presentation of a Patient with Underlying Subacute Bacterial Endocarditis

by Ami Kamdar, Michael Debney, James Scott and Diane Ames

Clin. Pract. 2012, 2(1), e1; https://doi.org/10.4081/cp.2012.e1 - 16 Dec 2011

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Abstract

We describe a patient with sub-acute bacterial endocarditis, whose chief presenting feature was mild expressive dysphasia. Full article

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Clin. Pract., Volume 2, Issue 1 (February 2012) – 30 articles

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