Clinics and Practice

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Open AccessCase Report

Septic Arthritis of the Temporomandibular Joint in an Infant

by Raymond Chuk, John Arvier, Barbara Laing and David Coman

Clin. Pract. 2015, 5(2), 736; https://doi.org/10.4081/cp.2015.736 - 03 Jul 2015

Cited by 7 | Viewed by 419

Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in [...] Read more.

Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in a neonate and an infant; as such a high degree of clinical suspicion is required. We present the case of an eleven-month-old boy who has made a full recovery from an acute temporomandibular joint septic arthritis and review the relevant literature. Full article

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Open AccessCase Report

Ovarian Cancer during Pregnancy: A Case Report and Literature Review

by Moawia E. Hummeida, Kamal Hamad, Abdel Fatah Abdel Gadir and AbdelAziem A. Ali

Clin. Pract. 2015, 5(2), 727; https://doi.org/10.4081/cp.2015.727 - 29 Jun 2015

Cited by 5 | Viewed by 660

Abstract

Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of prospective randomized trials and cohort studies. In this paper the authors reported a rare case of small cells ovarian cancer, diagnosed at [...] Read more.

Ovarian cancer during pregnancy is a rare event. Little is known about the treatment of this condition due to lack of prospective randomized trials and cohort studies. In this paper the authors reported a rare case of small cells ovarian cancer, diagnosed at 16 weeks of gestation, treated with conservative surgery at 18 weeks and chemotherapy. At week 38, the patient underwent caesarean section and delivered a healthy baby girl. Staging surgery was then carried out followed by adjuvant chemotherapy. Thus the findings from this case concluded that prognosis and quality of the patient’s life should be a priority, chemotherapy during the second trimester seems to be safe however, potential risks of this interventions still has to be considered. Full article

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Open AccessCase Report

Computed Tomography-Guided Cryoablation of Local Recurrence after Primary Resection of Pancreatic Adenocarcinoma

by Claudio Pusceddu, Luca Melis, Barbara Sotgia, Alessandro Fancellu and Giovanni Battista Meloni

Clin. Pract. 2015, 5(2), 741; https://doi.org/10.4081/cp.2015.741 - 23 Jun 2015

Cited by 7 | Viewed by 400

Abstract

The optimal management of local recurrences after primary resection of pancreatic cancer still remains to be clarified. A 58-year old woman developed an isolated recurrence of pancreatic cancer six year after distal pancreatectomy. Re-resection was attempted but the lesion was deemed unresectable at [...] Read more.

The optimal management of local recurrences after primary resection of pancreatic cancer still remains to be clarified. A 58-year old woman developed an isolated recurrence of pancreatic cancer six year after distal pancreatectomy. Re-resection was attempted but the lesion was deemed unresectable at surgery. Then chemotherapy was administrated without obtaining a reduction of the tumor size nor an improvement of the patient’s symptoms. Thus the patient underwent percutaneous cryoablation under computed tomography (CT)-guidance obtaining tumor necrosis and a significant improvement in the quality of life. A CT scan one month later showed a stable lesion with no contrast enhancement. While the use of percutaneous cryoblation has widened its applications in patients with unresectable pancreatic cancer, it has never been described for the treatment of local pancreatic cancer recurrence after primary resection. Percutaneous cryoablation deserves further studies in the multimodality treatment of local recurrence after primary pancreatic surgery. Full article

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Open AccessCase Report

Surgical Removal of an Unrecognized Tapestry Needle from the Urethra

by Mustafa Zafer Temiz, Emrah Yuruk, Kutlu Teberik and Engin Kandirali

Clin. Pract. 2015, 5(2), 740; https://doi.org/10.4081/cp.2015.740 - 23 Jun 2015

Cited by 1 | Viewed by 341

Abstract

The variety of intraurethral foreign bodies has been reported in literature. Most of them tend to be self-inserted because of sexual or erotic reasons. We report a 23-year old male patient who had tapestry needle into his urethra, which was not self-inserted. The [...] Read more.

The variety of intraurethral foreign bodies has been reported in literature. Most of them tend to be self-inserted because of sexual or erotic reasons. We report a 23-year old male patient who had tapestry needle into his urethra, which was not self-inserted. The patient was referred to our institution with dysuria and hematuria. There was microscopic hematuria in urine analysis and no pathologic sign in sonography. The needle was detected in proximal urethra in pelvic X-ray and endoscopic visualization revealed that it was trapped in mucosa. The needle was successfully removed by open surgery. Main treatment for the removal of urethral foreign bodies is usually endoscopic but open surgery may be required in some cases especially cutting foreign bodies. Full article

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Open AccessCase Report

Use of Recombinant Factor VIIa in Symptomatic Intracerebral Hemorrhage Following Intravenous Thrombolysis

by Shadi Yaghi, Aya Haggiagi, Ayesha Sherzai, Randolph S. Marshall and Sachin Agarwal

Clin. Pract. 2015, 5(2), 756; https://doi.org/10.4081/cp.2015.756 - 18 Jun 2015

Cited by 6 | Viewed by 647

Abstract

Symptomatic intracerebral hemorrhage (sICH) occurs in up to 7% of stroke patients treated with thrombolytic therapy. There are limited data on the effectiveness of the reversal agents used for intravenous tissue plasminogen activator related intracranial bleeds. We report a patient with sICH following [...] Read more.

Symptomatic intracerebral hemorrhage (sICH) occurs in up to 7% of stroke patients treated with thrombolytic therapy. There are limited data on the effectiveness of the reversal agents used for intravenous tissue plasminogen activator related intracranial bleeds. We report a patient with sICH following intravenous thrombolysis whose intracerebral hemorrhage continued to expand despite treatment with platelets and cryoprecipitate, needing recombinant factor VIIa use for stabilization before surgical evacuation. Factor VIIa along with routine reversal agents following intravenous thrombolysis related sICH may further enhance clot stability and reduce the risk of hematoma expansion. It could be a bridge to definitive surgical management in those patients. Full article

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Open AccessCase Report

Rare Presentation of Gall Bladder Tuberculosis in a Non Immuno-Compromised Patient

by Pawan Kumar, Priya Hazrah, Anil Taneja, Arvind Ahuja and Deborshi Sharma

Clin. Pract. 2015, 5(2), 754; https://doi.org/10.4081/cp.2015.754 - 17 Jun 2015

Cited by 3 | Viewed by 460

Abstract

The gall bladder is least common intraabdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting [...] Read more.

The gall bladder is least common intraabdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery. Full article

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Open AccessCase Report

Recurrent Thymoma in the Retroperitoneal Space: A Rare Case Report

by Jun Yang, Qin-qing Li, Ying-ying Ding and Cheng-de Liao

Clin. Pract. 2015, 5(2), 746; https://doi.org/10.4081/cp.2015.746 - 17 Jun 2015

Cited by 3 | Viewed by 470

Abstract

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and recurrences of thymoma generally are locally, and retroperitoneal recurrence is considered to be rare. A 46-year old Asian woman with invasive thymoma had undergone thymectomy 10 years [...] Read more.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and recurrences of thymoma generally are locally, and retroperitoneal recurrence is considered to be rare. A 46-year old Asian woman with invasive thymoma had undergone thymectomy 10 years ago. Computed tomography demonstrated a wellcircumscribed mass in the left retroperitoneal space. The patient had not any symptom including myasthenia gravis. Because on the anterior mediastinum area shows no sign of tumor recurrence and the mass adjacent to the vertebral body, neurogenic tumor was suspected. Surgical resection was performed using a retroperitoneal approach, which revealed the tumor adhering neighboring diaphragm. The tumor was histologically diagnosed to be type B1 thymoma according to the World Health Organization classification. The retroperitoneal mass was an unusual local recurrence after thymectomy. The patients whose had under invasive thymectomy should be evaluated carefully when finding retroperitoneal mass during follow-up. Full article

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Open AccessCase Report

Vertebrobasilar Dolichoectasia Induced Hydrocephalus: The Water-Hammer Effect

by Vaso Zisimopoulou, Aikaterini Ntouniadaki, Panagiotis Aggelidakis, Anna Siatouni, Stylianos Gatzonis and Antonios Tavernarakis

Clin. Pract. 2015, 5(2), 749; https://doi.org/10.4081/cp.2015.749 - 27 May 2015

Cited by 8 | Viewed by 486

Abstract

Vertebrobasilar dolichoectasia is a clinical entity associated rarely with obstructive hydrocephalus. We present a 48-year old male with a profound dilatation of the ventricular system due to a dolichoectatic basilar artery, as appeared in imaging studies. The patient suffered from longstanding hydrocephalus and [...] Read more.

Vertebrobasilar dolichoectasia is a clinical entity associated rarely with obstructive hydrocephalus. We present a 48-year old male with a profound dilatation of the ventricular system due to a dolichoectatic basilar artery, as appeared in imaging studies. The patient suffered from longstanding hydrocephalus and presenile dementia. The underlying mechanism for obstructive hydrocephalus due to vertebrobasilar dolichoectasia is considered to be both a water-hammer effect and a direct compression of adjacent structures. We suggest prompt surgical intervention upon diagnosis as a first choice treatment in order to avoid further complications. Full article

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Open AccessCase Report

Anterior Sacral Meningocele Masquerading as an Ovarian Cyst: A Rare Clinical Presentation Associated with Marfan Syndrome

by Neslin Sahin, Mine Genc, Esin Kasap, Aynur Solak, Berrin Korkut and Erkan Yilmaz

Clin. Pract. 2015, 5(2), 752; https://doi.org/10.4081/cp.2015.752 - 24 Apr 2015

Cited by 12 | Viewed by 580

Abstract

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian [...] Read more.

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions. Full article

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Open AccessCase Report

Treatment of Costal Osteochondroma Causing Spinal Cord Compression by Costotransversectomy: Case Report and Review of the Literature

by Marcus D. Mazur, Michael L. Mumert and Meic H. Schmidt

Clin. Pract. 2015, 5(2), 734; https://doi.org/10.4081/cp.2015.734 - 24 Apr 2015

Cited by 2 | Viewed by 376

Abstract

In laminectomies for costal osteochondroma causing spinal cord compression, visualization of the extraforaminal part of the tumor is limited. The authors describe using a costotransversectomy to resolve spinal cord compression by a costal osteochondroma invading through the neural foramen. A 21-year-old woman with [...] Read more.

In laminectomies for costal osteochondroma causing spinal cord compression, visualization of the extraforaminal part of the tumor is limited. The authors describe using a costotransversectomy to resolve spinal cord compression by a costal osteochondroma invading through the neural foramen. A 21-year-old woman with hereditary multiple exostoses presented with hand numbness and progressive neck and upper back pain. Plain radiographs identified a large lesion of the T2 and T3 pedicles, with encroachment on the T2-3 neural foramen causing ~50% spinal canal stenosis. Costotransversectomy was performed to resect the cartilaginous portions of the osteochondroma, debulk the mass, and decompress the spinal canal. A mass of mature bone was left, but no appreciable cartilaginous tumor. At five-year follow- up, the patient had improvement of neck pain, no new neurological deficits. a stable residual mass, and no new osteochondromas, indicating that appropriate surgical management can yield good results and no evidence of recurrence. Full article

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Open AccessCase Report

Paraspinal Arterio-Venous Fistula in Children: Two More Cases of an Exceptional Malformation

by Nesrine Farhat, Brigitte Desprechins, Bernard Otto, Vincent Ramaekers and Marie-Christine Seghaye

Clin. Pract. 2015, 5(2), 707; https://doi.org/10.4081/cp.2015.707 - 24 Apr 2015

Cited by 5 | Viewed by 391

Abstract

We report on the case of two toddlers who presented in the last 2 years with heart and vascular murmur, respectively, and in whom the diagnosis of paraspinal arterio-venous fistula was made. Paraspinal arterio-venous fistulae in children are extremely rare congenital or post-traumatic [...] Read more.

We report on the case of two toddlers who presented in the last 2 years with heart and vascular murmur, respectively, and in whom the diagnosis of paraspinal arterio-venous fistula was made. Paraspinal arterio-venous fistulae in children are extremely rare congenital or post-traumatic vascular malformations. In the rare case of connection with the spinal venous system, they might affect spinal vascularization due to potential venous congestion. Interventional embolization rather than surgery is the treatment of choice for such lesions. Up to now, there is no consensus about the indication of prophylactic closure of asymptomatic fistulae. However, close clinical follow-up with repeated spinal magnetic resonance imaging to exclude venous congestion is mandatory for young asymptomatic patients until treatment. Full article

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Clin. Pract., Volume 5, Issue 2 (April 2015) – 11 articles

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