Clinics and Practice

271 KiB

Open AccessCase Report

Post-Colonoscopy Appendicitis: A Rare Entity

by Vipul D. Yagnik and Bhargav D. Yagnik

Clin. Pract. 2012, 2(2), e55; https://doi.org/10.4081/cp.2012.e55 - 28 May 2012

Cited by 6 | Viewed by 1

A 35-year-old woman was admitted to the surgical ward complaining of right-sided lower abdominal pain. She had undergone colonoscopy a week previously. She was diagnosed with acute appendicitis following colonoscopy and laparoscopic appendectomy was performed via the 2-port technique. Post colonoscopy appendicitis is [...] Read more.

A 35-year-old woman was admitted to the surgical ward complaining of right-sided lower abdominal pain. She had undergone colonoscopy a week previously. She was diagnosed with acute appendicitis following colonoscopy and laparoscopic appendectomy was performed via the 2-port technique. Post colonoscopy appendicitis is very rare with 14 cases reported since 1988. Full article

315 KiB

Open AccessBrief Report

Anaesthetic Concerns for Large Intracranial Cyst Excision: Expect the Unexpected!

by Uma Hariharan Hariharan, Rakesh Garg, Alka Gupta, Seema Wasnik and Mridula Pawar

Clin. Pract. 2012, 2(2), e50; https://doi.org/10.4081/cp.2012.e50 - 28 May 2012

Cited by 1 | Viewed by 1

Abstract

Neurosurgical procedures in infants poses various challenges such as difficulty in venous cannulation, securing invasive vascular lines, difficult airway, controlling intra-cranial tension, managing large fluid shifts to positioning- related issues and temperature maintenance. We hereby present an case of a large intracranial space [...] Read more.

Neurosurgical procedures in infants poses various challenges such as difficulty in venous cannulation, securing invasive vascular lines, difficult airway, controlling intra-cranial tension, managing large fluid shifts to positioning- related issues and temperature maintenance. We hereby present an case of a large intracranial space occupying lesion, suspected to be a hydatid cyst, which later turned out to be an infected ventricular cyst and intraoperative problems. A thorough preparation prior to operation of infected cystic lesion of the brain is required including anticipation of massive blood loss and its management. A slow decompression of the large cystic lesion should be done. Full article

303 KiB

Open AccessCase Report

Retinal Vasculitis in Systemic Lupus Erythematosus: An Indication of Active Disease

by Umi Kalthum Md Noh, Aida Zairani A. Zahidin and Then Kong Yong

Clin. Pract. 2012, 2(2), e54; https://doi.org/10.4081/cp.2012.e54 - 15 May 2012

Cited by 11 | Viewed by 1

Abstract

A 26-year-old woman with a recent flare-up of systemic lupus erythematosus presented with peripheral retinal hemorrhages at a routine check-up. She is on a tapering dose of immunosuppressive agents. Her visual acuity was good. Fluorescein angiogram revealed vasculitic changes with capillary non-perfusion areas. [...] Read more.

A 26-year-old woman with a recent flare-up of systemic lupus erythematosus presented with peripheral retinal hemorrhages at a routine check-up. She is on a tapering dose of immunosuppressive agents. Her visual acuity was good. Fluorescein angiogram revealed vasculitic changes with capillary non-perfusion areas. A few weeks later, she developed cerebral lupus with advanced lupus nephritis. Immunosuppressive therapy was restarted and panretinal photocoagulation was delivered. Her visual acuity remained stable, despite development of a cataract from prednisolone therapy. Full article

436 KiB

Open AccessCase Report

Synchronous Ovarian Carcinoma with Colorectal Metastases: An Unusual Presentation

by Kafil Akhtar, Rana Sherwani and Afzaal Anees

Clin. Pract. 2012, 2(2), e53; https://doi.org/10.4081/cp.2012.e53 - 07 May 2012

Cited by 6 | Viewed by 1

Abstract

This report describes the case of a 50-yearold female patient who presented with bilateral adnexal lump and dysfunctional uterine bleeding with altered bowel habits. Computed tomography of the abdomen and pelvis revealed a bilateral adnexal lump situated in both the ovaries and a [...] Read more.

This report describes the case of a 50-yearold female patient who presented with bilateral adnexal lump and dysfunctional uterine bleeding with altered bowel habits. Computed tomography of the abdomen and pelvis revealed a bilateral adnexal lump situated in both the ovaries and a lobular mass of 8 cm in the rectum. Proctoscopy revealed an elevated irregular rectal lesion. The microscopic examination of the ovarian lump revealed a bilateral serous adenocarcinoma with a papillary pattern with psammomatous calcification. A left hemicolectomy with lymphadenectomy was also performed. Immunohistochemical staining was positive for cytokeratin 7 and negative for cytokeratin 20. The use of immunohistochemistry demonstrated the tumor to be of ovarian origin. We report this case of synchronous involvement of the ovary and the colorectum because of its rarity and unusual presentation. Full article

327 KiB

Open AccessCase Report

Imatinib Mesylate Treatment for Platelet-Derived Growth Factor Receptor Alfa-Positive Choroid Plexus Carcinoma

by Chihiro Kawakami, Akiko Inoue, Kimitaka Takitani, Motomu Tsuji, Kimiko Wakai and Hiroshi Tamai

Clin. Pract. 2012, 2(2), e49; https://doi.org/10.4081/cp.2012.e49 - 07 May 2012

Cited by 2 | Viewed by 1

Abstract

We herein report a female child with choroid plexus carcinoma treated with standard dose of imatinib at disease recurrence. This patient failed initial twice-surgical resections, central nervous system (CNS) irradiation, and adjuvant chemotherapies and high-dose thiotepa and melphalan with auto peripheral blood stem [...] Read more.

We herein report a female child with choroid plexus carcinoma treated with standard dose of imatinib at disease recurrence. This patient failed initial twice-surgical resections, central nervous system (CNS) irradiation, and adjuvant chemotherapies and high-dose thiotepa and melphalan with auto peripheral blood stem cell rescue. Finally, imatinib treatment was undergone as a palliative setting, however the tumor did not reduce and the patient died of tumor bleedings. We consider that the reasons for the failure are as follows: i) adequate CNS level of imatinib were not obtained because of the blood brain barrier, ii) the lack of plateletderived growth factor receptor beta expression in our case may have a crucial role. Full article

312 KiB

Open AccessCase Report

A Case of Retropharyngeal Abscess with Spondylitis Causing Tetraplegia

by Takeshi Kusunoki, Shin Ito, Takashi Iizuka, Noritsugu Ono and Katsuhisa Ikeda

Clin. Pract. 2012, 2(2), e52; https://doi.org/10.4081/cp.2012.e52 - 30 Apr 2012

Cited by 1 | Viewed by 1

Abstract

We report a case of retropharyngeal abscess with spondylitis causing tetraplegia. At a previous hospital, administration of antibiotics improved the inflammation findings. However, magnetic resonace imaging showed a remaining retropharyngeal abscess. This patient showed a disturbance of consciousness under this therapy. Therefore, he [...] Read more.

We report a case of retropharyngeal abscess with spondylitis causing tetraplegia. At a previous hospital, administration of antibiotics improved the inflammation findings. However, magnetic resonace imaging showed a remaining retropharyngeal abscess. This patient showed a disturbance of consciousness under this therapy. Therefore, he was admitted to our hospital and underwent a drainage operation. At 1 day after this operation, he recovered from the disturbance of consciousness. Full article

391 KiB

Open AccessBrief Report

The Slipping Slipper Sign: A Simple Test with High Specificity and Positive Predictive Value for Peripheral Neuropathy among Diabetic Patients

by Krystal A.T. Gayle, Marshall K. Tulloch-Reid, Rainford J. Wilks and Trevor S. Ferguson

Clin. Pract. 2012, 2(2), e51; https://doi.org/10.4081/cp.2012.e51 - 30 Apr 2012

Cited by 1 | Viewed by 1

Abstract

This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients [...] Read more.

This study evaluated the ability of the slipping slipper sign (defined as unknowingly losing a slipper while walking) to identify diabetic neuropathy in Jamaican patients. A single question was used to ascertain the presence of the slipping slipper sign (SSS) among 69 patients attending a diabetes clinic. Nurses assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. The sensitivity, specificity and positive predictive value for the SSS were calculated. Eight participants (men=5, women=3) reported positive SSS. The SSS had a sensitivity of 28.6%, specificity of 100% and positive predictive value (PPV) 100% for neuropathy on at least one of the three tests. These findings indicate that the SSS has high specificity and PPV for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional methods of screening for severe neuropathy Full article

368 KiB

Open AccessCase Report

Primary Hyperparathyroidism with Rare Presentation as Multiple Brown Tumours

by Smit Doshi, Arti Vadi, Amit Mahajan and Tapan Nagpal

Clin. Pract. 2012, 2(2), e48; https://doi.org/10.4081/cp.2012.e48 - 30 Apr 2012

Cited by 4 | Viewed by 1

Abstract

We present a case of primary hyperparathyroidism with an uncommon presentation as multiple brown tumours, which may easily be mistaken for a primary bone neoplasm. A brief literature review and its clinical and surgical management are also discussed here. Full article

762 KiB

Open AccessCase Report

Colonisation of Basal Cell Carcinoma and Actinic Keratosis by Malignant Melanoma In Situ in a Patient with Xeroderma Pigmentosum Variant

by Louise J. Smith and Ehab A. Husain

Clin. Pract. 2012, 2(2), e47; https://doi.org/10.4081/cp.2012.e47 - 16 Apr 2012

Cited by 3 | Viewed by 1

Abstract

Although malignant melanoma (MM) and both basal cell carcinoma (BCC) and actinic keratosis (AK) are sun-induced lesions, the coexistence of these entities at the same anatomical site (collision tumour) is exceedingly rare. We report the case of a 54-year-old woman with a known [...] Read more.

Although malignant melanoma (MM) and both basal cell carcinoma (BCC) and actinic keratosis (AK) are sun-induced lesions, the coexistence of these entities at the same anatomical site (collision tumour) is exceedingly rare. We report the case of a 54-year-old woman with a known history of xeroderma pigmentosum variant (XPV) who presented with 2 separate skin lesions over the middle and upper right forearm, respectively. The clinical impression was that of BCCs or squamous cell lesions. On histological examination, both specimens showed features of melanoma in situ (MIS). In the first lesion, MIS merged with and colonised a superficial and focally invasive BCC. In the second lesion, MIS merged with an AK. No separate invasive nests of malignant melanoma were seen in either specimen. The atypical melanocytes were highlighted by Melan-A and HMB-45 immunostaining, whereas the epithelial cells in both the BCC and AK stained with the pancytokeratin MNF-116. The patient had a previous history of multiple MMs and non-melanomatous skin cancers and finally developed widespread metastatic malignant melanoma, which proved fatal. The rare and interesting phenomenon of collision tumours may pose diagnostic difficulties. To our knowledge, this is the first reported simultaneous presentation of cytologically malignant collision tumours in a patient with XPV. Full article

349 KiB

Open AccessCase Report

Ectopic Enamel Pearl

by Vandana Rathva

Clin. Pract. 2012, 2(2), e46; https://doi.org/10.4081/cp.2012.e46 - 13 Apr 2012

Cited by 1

Abstract

Enamel pearls are one of a number of different enamel structures that can be found on the roots of deciduous and permanent teeth. They have a distinct predilection for the furcation areas of molar, particularly the maxillary third and second molars. However, they [...] Read more.

Enamel pearls are one of a number of different enamel structures that can be found on the roots of deciduous and permanent teeth. They have a distinct predilection for the furcation areas of molar, particularly the maxillary third and second molars. However, they have been found less commonly on the apical portions of the root. This report describes an unusual case of enamel pearl on apical third of mandibular molar teeth. Enamel pearl was confirmed as predisposing factor for the cause of localized periodontitis; it is very important to recognize their radiographic aspect to ensure proper treatment of involved teeth. Full article

438 KiB

Open AccessCase Report

Successful Staged Management of Simultaneous Abdominal Aortic Aneurysm and Renal Tumor: The Novel Minimally Invasive Treatment with Endovascular Aneurysm Repair and Retroperitoneal Laparoscopic Radical Nephrectomy in an Elderly and High-Risk Case

by Satoru Kira, Norifumi Sawada, Shouji Kudou, Hidenori Zakoji, Shigeaki Kaga, Masahiko Matsumoto and Masayuki Takeda

Clin. Pract. 2012, 2(2), e45; https://doi.org/10.4081/cp.2012.e45 - 12 Apr 2012

Cited by 5 | Viewed by 1

Abstract

The association between abdominal aortic aneurysm (AAA) and renal tumor is becoming more frequent, and the increasing incidence of this synchronous diseases raised questions about the procedures of treatment. In most of the previous cases, open nephrectomy and AAA surgery have been reported, [...] Read more.

The association between abdominal aortic aneurysm (AAA) and renal tumor is becoming more frequent, and the increasing incidence of this synchronous diseases raised questions about the procedures of treatment. In most of the previous cases, open nephrectomy and AAA surgery have been reported, however in high risk and elderly patients, the procedure is life threatening. We present a successful staged treatment of AAA and renal tumor using novel minimally invasive treatment with endovascular aneurysm repair and retroperitoneal laparoscopic radical nephrectomy in an elderly and high-risk case. Full article

276 KiB

Open AccessCase Report

Hypercalcemia in a Patient with Autoimmune Polyglandular Syndrome

by Svetlana Katsnelson, Jessica Cella, Heesuk Suh and Marina M. Charitou

Clin. Pract. 2012, 2(2), e39; https://doi.org/10.4081/cp.2012.e39 - 04 Apr 2012

Cited by 1 | Viewed by 1

Abstract

Hypercalcemia is a rare condition in patients with autoimmune polyglandular syndrome (APS-1), usually characterized by hypoparathyroidism and hypocalcemia, and it can develop due to simultaneous adrenal insufficiency. We present a case of severe hypercalcemia in a patient with APS-1, found to have adrenal [...] Read more.

Hypercalcemia is a rare condition in patients with autoimmune polyglandular syndrome (APS-1), usually characterized by hypoparathyroidism and hypocalcemia, and it can develop due to simultaneous adrenal insufficiency. We present a case of severe hypercalcemia in a patient with APS-1, found to have adrenal insufficiency secondary to steroid non-compliance. Full article

358 KiB

Open AccessCase Report

Tuberculous Spondylitis Presenting as Severe Chest Pain

by Martha A. Kaeser, Norman W. Kettner, Usama Albastaki, Hossam Ahmed Kotb, Ibrahim M.A. Eldesouky and Claude Pierre-Jerome

Clin. Pract. 2012, 2(2), e42; https://doi.org/10.4081/cp.2012.e42 - 03 Apr 2012

Cited by 2 | Viewed by 1

Abstract

This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in [...] Read more.

This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted. Full article

280 KiB

Open AccessCase Report

Haematuria in Association with Lynch Syndrome

by Marwan Ma'ayeh, Richard Power and Deirdre Mary Fanning

Clin. Pract. 2012, 2(2), e41; https://doi.org/10.4081/cp.2012.e41 - 02 Apr 2012

Viewed by 1

Abstract

A 40-year-old Caucasian male presented to the Emergency Department complaining of intermittent painless frank haematuria. Past medical history was significant for Hereditary Non-Polyposis Colon Cancer (HNPCC) and a prophylactic total colectomy. Computed tomography urogram showed thickening in the posterior wall of the bladder. [...] Read more.

A 40-year-old Caucasian male presented to the Emergency Department complaining of intermittent painless frank haematuria. Past medical history was significant for Hereditary Non-Polyposis Colon Cancer (HNPCC) and a prophylactic total colectomy. Computed tomography urogram showed thickening in the posterior wall of the bladder. Cystoscopy showed a small bladder mass. Histology showed a papillary urothelial neoplasm of low malignant potential. HNPCC, also known as Lynch Syndrome, is an autosomal dominant disorder responsible for 3-5% of colorectal cancers. There are certain cancers known to be associated with HNPCC; colorectal cancer, endometrial, ovarian, stomach, pancreas, biliary tract, small bowel, brain, renal pelvic and ureteric tumours, sebaceous gland adenomas and keratocanthomas. An association with bladder tumours is not well established. Full article

741 KiB

Open AccessCase Report

Dedifferentiated Liposarcoma of the Retroperitoneum with Osteosarcomatous Component

by Wenbin Sun, Xiaoyan Sun and Dianbo Cao

Clin. Pract. 2012, 2(2), e33; https://doi.org/10.4081/cp.2012.e33 - 02 Apr 2012

Cited by 1 | Viewed by 1

Abstract

Liposarcoma is one of the most common soft-tissue sarcomas and classified as five groups. Dedifferentiated liposarcoma includes multiple elements such as solid tissue, adipose tissue and calcified tissue, which is different from common liposarcoma in tissue constitue. Dedifferentiation to osteosarcoma is rarely described [...] Read more.

Liposarcoma is one of the most common soft-tissue sarcomas and classified as five groups. Dedifferentiated liposarcoma includes multiple elements such as solid tissue, adipose tissue and calcified tissue, which is different from common liposarcoma in tissue constitue. Dedifferentiation to osteosarcoma is rarely described in the literature. We reported the radiological and pathological findings in a case of dedifferentiated liposarcoma with osteo-sarcomatous dedifferentiation in the retroperitoneum and discussed the characteristic features of this specific tumor. Complete surgical resection of the neoplasm is the only curative means, but establishing a prognosis remains a challenge for long-term evaluation. Full article

385 KiB

Open AccessCase Report

Primary Renal Synovial Sarcoma

by Girish D. Bakhshi, Arshad S. Khan, Aftab S. Shaikh, Mohammad Ashraf A. Khan, Mohammad Adil A. Khan and Nilofar M. Jamadar

Clin. Pract. 2012, 2(2), e44; https://doi.org/10.4081/cp.2012.e44 - 30 Mar 2012

Cited by 8 | Viewed by 1

Abstract

Primary Renal Sarcoma is rare tumor comprising only 1% of all renal tumours. Synovial sarcomas are generally deep-seated tumors arising in the proximity of large joints of adolescents and young adults and account for 5-10% of all soft tissue tumours. Primary synovial sarcoma [...] Read more.

Primary Renal Sarcoma is rare tumor comprising only 1% of all renal tumours. Synovial sarcomas are generally deep-seated tumors arising in the proximity of large joints of adolescents and young adults and account for 5-10% of all soft tissue tumours. Primary synovial sarcoma of kidney is rare and has poor prognosis. It can only be diagnosed by immunohistochemistry. It should be considered as a differential in sarcomatoid and spindle cell tumours. We present a case of 33-year-old female, who underwent left sided radical nephrectomy for renal tumour. Histopathology and genetic analysis diagnosed it to be primary renal synovial sarcoma. Patient underwent radiation therapy and 2 years follow up is uneventful. A brief case report with review of literature is presented. Full article

440 KiB

Open AccessArticle

Hemiplegic Peripheral Neuropathy Accompanied with Multiple Cranial Nerve Palsy

by Hirohisa Okuma, Reiko Nagano and Shigeharu Takagi

Clin. Pract. 2012, 2(2), e40; https://doi.org/10.4081/cp.2012.e40 - 30 Mar 2012

Cited by 2 | Viewed by 1

Abstract

A 32-year-old man experienced double vision around January, 2010, followed by weakness of his left upper and lower extremities. Articulation disorders and loss of hearing in his left ear developed, and he was admitted to our hospital on February 14, 2010. Physical examination [...] Read more.

A 32-year-old man experienced double vision around January, 2010, followed by weakness of his left upper and lower extremities. Articulation disorders and loss of hearing in his left ear developed, and he was admitted to our hospital on February 14, 2010. Physical examination was normal, and neurological examination showed clear consciousness with no impairment of cognitive function, but with articulation disorders. Olfactory sensation was reduced. Left ptosis and left gaze palsy, complete left facial palsy, perceptive deafness of the left ear, and muscle weakness of the left trapezius muscle were observed. Paresis in the left upper and lower extremities was graded 4/5 through manual muscle testing. Sensory system evaluation revealed complete left-side palsy, including the face. Deep tendon reflexes were slightly diminished equally on both sides; no pathologic reflex was seen. No abnormality of the brain parenchyma, cerebral nerves or cervicothoracolumbar region was found on brain magnetic resonance imaging. On electroencephalogram, alpha waves in the main frequency band of 8 to 9 Hz were recorded, indicating normal findings. Brain single photon emission computed tomography (SPECT) scan showed reduced blood flow in the right inner frontal lobe and both occipital lobes. Nerve biopsy (left sural nerve) showed reduction of nerve density by 30%, with demyelination. The patient also showed manifestations of multiple cranial nerve disorder, i.e., of the trigeminal nerve, glossopharyngeal nerve, vagus nerve, and hypoglossal nerve. Whole-body examination was negative. Finally, based on ischemic brain SPECT images, spinal fluid findings and nerve biopsy results, peripheral neuropathy accompanied with multiple cranial nerve palsy was diagnosed. Full article

238 KiB

Open AccessCase Report

Post-Partum Anaphylaxis: Universal but Successful Management Protocol Should Not Deter Appreciation of Underlying Etio-Pathogenesis Plethora

by Deepak Gupta, Andrew Rubens and Milos Marjanovic

Clin. Pract. 2012, 2(2), e43; https://doi.org/10.4081/cp.2012.e43 - 29 Mar 2012

Viewed by 1

Abstract

Post-partum Anaphylaxis in mothers is extremely rare and has been reported secondary to initiation of the breast-feeding. However, we hereby report the occurrence of post-partum anaphylaxis in a post-partum patient in the absence of the initiated breast-feeding. Full article

410 KiB

Open AccessBrief Report

Traumatic Pseudoaneurysm of the Superficial Temporal Artery

by Suvy Manuel, Deepti Simon, Eldhose K. George and Raghava B. Naik

Clin. Pract. 2012, 2(2), e34; https://doi.org/10.4081/cp.2012.e34 - 28 Mar 2012

Cited by 2 | Viewed by 1

Abstract

Aneurysms of the superficial temporal artery are relatively rare vascular complications following trauma. Two cases of pseudoaneurysm of the anterior branch of the superficial temporal artery, subjected to blunt maxillofacial trauma are presented here. The first case was treated by surgical resection and [...] Read more.

Aneurysms of the superficial temporal artery are relatively rare vascular complications following trauma. Two cases of pseudoaneurysm of the anterior branch of the superficial temporal artery, subjected to blunt maxillofacial trauma are presented here. The first case was treated by surgical resection and the second was cured by application of continuous pressure. The review of the English literature has also been included. An awareness of these vascular injuries, despite their infrequency, is necessary to facilitate early diagnosis, proper investigation and prompt treatment. Full article

440 KiB

Open AccessCase Report

A Rare Massive Exophytic Gingival Growth

by Suvy Manuel, Surej L.K. Kumar and Bindu J. Nair

Clin. Pract. 2012, 2(2), e38; https://doi.org/10.4081/cp.2012.e38 - 05 Mar 2012

Viewed by 1

Abstract

Oral surgeons ought to be aware of variety of lesions that can present as focal exophytic gingival overgrowths. Most gingival lesions arise due to local irritating factors. The case presented share dramatic clinical pictures and findings of a long-standing fibrous gingival lesion. A [...] Read more.

Oral surgeons ought to be aware of variety of lesions that can present as focal exophytic gingival overgrowths. Most gingival lesions arise due to local irritating factors. The case presented share dramatic clinical pictures and findings of a long-standing fibrous gingival lesion. A massive growth of 6¥7 cm in size and 5 years duration from the maxillary left posterior gingival region in a 64-year-old female causing severe facial disfigurement is presented. Lesion was characterized by the central core of woven bone formation. The article discusses on the clinical findings of peripheral ossifying fibroma and stresses on the unrestricted growth potential of this interesting lesion. Full article

342 KiB

Open AccessCase Report

Medulloblastoma: Seeding of VP Shunt Tract and Peritoneum

by David Pettersson, Kelli R. Schmitz, Jeffrey M. Pollock and Katharine L. Hopkins

Clin. Pract. 2012, 2(2), e37; https://doi.org/10.4081/cp.2012.e37 - 05 Mar 2012

Cited by 11 | Viewed by 1

Abstract

We report on a 5-year-old boy with seeding of the peritoneum and a ventriculoperitoneal shunt tract by anaplastic medulloblastoma. The role of ventriculoperitoneal shunting in the spread of primary central nervous system tumors has been controversial. In the case reported here, the unique [...] Read more.

We report on a 5-year-old boy with seeding of the peritoneum and a ventriculoperitoneal shunt tract by anaplastic medulloblastoma. The role of ventriculoperitoneal shunting in the spread of primary central nervous system tumors has been controversial. In the case reported here, the unique distribution of tumor implants on ultrasound and multiplanar computed tomography gives further credence to the argument that ventriculoperitoneal shunting is a pathway for extraneural metastases of primary central nervous system tumors. Full article

365 KiB

Open AccessCase Report

Fever of Unknown Origin in a Swiss-Born Child: Don’t Miss Tuberculosis!

by Melanie Cegielski, Bernard Vaudaux, Katia Jaton, David Bervini and Marie-Helene Perez

Clin. Pract. 2012, 2(2), e36; https://doi.org/10.4081/cp.2012.e36 - 28 Feb 2012

Abstract

Tuberculosis incidence is low in Switzer land. We report here on a Swiss-born toddler. Tuberculosis manifested with a fever of unknown origin, mimicking an inflammatory or autoimmune disorder triggering a high dose of corticosteroid treatment. The disease went unrecognized for several weeks until [...] Read more.

Tuberculosis incidence is low in Switzer land. We report here on a Swiss-born toddler. Tuberculosis manifested with a fever of unknown origin, mimicking an inflammatory or autoimmune disorder triggering a high dose of corticosteroid treatment. The disease went unrecognized for several weeks until development of a miliary tuberculosis with advanced central nervous system involvement. This case highlights the difficulties encountered in diagnosing tuberculosis and in identifying the origin of this case. It reminds us that this disease must never be forgotten when facing a child with persistent fever who must be screened for, before starting immunosuppressive therapy. Full article

298 KiB

Open AccessCase Report

Intracranial Capillary Hemangioma Mimicking a Dissociative Disorder

by Santosh G. John, Unnikrishnan Pillai and Alexander Lacasse

Clin. Pract. 2012, 2(2), e35; https://doi.org/10.4081/cp.2012.e35 - 24 Feb 2012

Cited by 9 | Viewed by 1

Abstract

Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS). Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient [...] Read more.

Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS). Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser’s syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms. Full article

255 KiB

Open AccessCase Report

Potassium Permanganate Ingestion As a Suicide Attempt

by Sebnem Eren Cevik, Onur Yesil, Tuba Cimilli Ozturk and Ozlem Guneysel

Clin. Pract. 2012, 2(2), e32; https://doi.org/10.4081/cp.2012.e32 - 16 Feb 2012

Cited by 8 | Viewed by 1

Abstract

Potassium permanganate is a highly corrosive, water-soluble oxidizing antiseptic. A 68- year-old female patient was admitted to our Emergency Department after ingestion of 3 tablets of 250 mg potassium permanganate as a suicide attempt. The physical exam revealed brown stained lesions in the [...] Read more.

Potassium permanganate is a highly corrosive, water-soluble oxidizing antiseptic. A 68- year-old female patient was admitted to our Emergency Department after ingestion of 3 tablets of 250 mg potassium permanganate as a suicide attempt. The physical exam revealed brown stained lesions in the oropharynx. Emergency endoscopy was performed by the gastroenterologist after the third hour of ingestion. Emergency endoscopy revealed multiple superficial (Grade I-II) lesions on the esophagus and cardia, which were considered secondary to the caustic substance. The mainstay in the treatment of potassium permanganate is supportive and the immediate priority is to secure the airway. Emergency endoscopy is an important tool used to evaluate the location and severity of injury to the esophagus, stomach and duodenum after caustic ingestion. Patients with signs and symptoms of intentional ingestion should undergo endoscopy within 12 to 24 h to define the extent of the disease. Full article

297 KiB

Open AccessCase Report

Retinal Arterial plaques in Acquired Immunodeficiency Syndrome

by Pradeep Venkatesh, Harish Pathak and Satpal Garg

Clin. Pract. 2012, 2(2), e31; https://doi.org/10.4081/cp.2012.e31 - 15 Feb 2012

Viewed by 1

Abstract

The authors report the unusual observation discrete plaque like excrescencies along the retinal arterial wall in a young patient with acquired immunodeficiency syndrome. Though bilateral, in the right eye there was severe arteriolar narrowing and so these plaques were less identifiable. Fluorescein angiography [...] Read more.

The authors report the unusual observation discrete plaque like excrescencies along the retinal arterial wall in a young patient with acquired immunodeficiency syndrome. Though bilateral, in the right eye there was severe arteriolar narrowing and so these plaques were less identifiable. Fluorescein angiography did not reveal any arteriolar occlusion or areas of capillary occlusion in both eyes. There were no other signs of HIV associated microangiopathy and the patient did not have any concurrent cardiovascular or hematological abnormality. The cause of these plaques remains unexplained and we conjecture that they could represent macro immunecomplex deposition along the arteriolar walls. Full article

Journal Menu

Journal Browser

Clin. Pract., Volume 2, Issue 2 (May 2012) – 25 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI