Clinics and Practice

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Open AccessCase Report

Budd-Chiari Syndrome: An Unusual Presentation of Multisystemic Sarcoidosis

by Rym Ennaifer, Dhouha Bacha, Hayfa Romdhane, Myriam Cheikh, Houda Ben Nejma and Najet BelHadj

Clin. Pract. 2015, 5(3), 768; https://doi.org/10.4081/cp.2015.768 - 21 Dec 2015

Cited by 7 | Viewed by 417

Sarcoidosis is a multisystem granulomatous disease of unknown origin. All organs may be affected. Liver involvement is common but it is rarely symptomatic. Only a few cases of Budd- Chiari syndrome (BCS) secondary to a hepatic sarcoidosis have been described so far. We [...] Read more.

Sarcoidosis is a multisystem granulomatous disease of unknown origin. All organs may be affected. Liver involvement is common but it is rarely symptomatic. Only a few cases of Budd- Chiari syndrome (BCS) secondary to a hepatic sarcoidosis have been described so far. We describe a case of multisystemic sarcoidosis presenting with BCS. A 42-year old female was referred to our department for chronic and anicteric cholestasis. Laboratory and imaging investigations disclosed features of chronic BCS associated with multisystemic sarcoidosis. The positive diagnosis was based on microscopic features, which showed hepatic, gastric and cutaneous non-caseating granulomas. Screening for an underlying thrombophilic disorder was negative. The diagnosis of BCS complicating hepatic sarcoidosis was the most likely. She was put on corticosteroids and anticoagulation therapy. To our knowledge, few cases of sarcoidosis-related BCS have been reported in the literature. In addition to being an uncommon presentation of sarcoidosis, this case illustrates the importance of recognizing an unusual cause of BCS and its therapeutic difficulties. Full article

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Open AccessCase Report

Carotid Artery Stent Continued Expansion Days after Deployment, without Post Stent Deployment Angioplasty

by Umair Qazi, Tammam Obeid, Isibor Arhuidese and Mahmoud Malas

Clin. Pract. 2015, 5(3), 767; https://doi.org/10.4081/cp.2015.767 - 13 Oct 2015

Cited by 9 | Viewed by 404

Abstract

This is a carotid artery stent (CAS) case report, which avoids post-stent deployment angioplasty (Post-SDA), with duplex confirmed continued stent expansion at 1, 3 and 30-day post deployment. This report confirms that self-expanding nitinol stents in the carotid artery may not require Post-SDA. [...] Read more.

This is a carotid artery stent (CAS) case report, which avoids post-stent deployment angioplasty (Post-SDA), with duplex confirmed continued stent expansion at 1, 3 and 30-day post deployment. This report confirms that self-expanding nitinol stents in the carotid artery may not require Post-SDA. We believe CAS can be performed without Post-SDA, which helps reduce the occurrence of intraoperative hemodynamic depression. Full article

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Open AccessCase Report

Gastric Schwannoma: A Benign Tumor Often Misdiagnosed as Gastrointestinal Stromal Tumor

by Apurva S. Shah, Pravin M. Rathi, Vaibhav S. Somani and Astha M. Mulani

Clin. Pract. 2015, 5(3), 775; https://doi.org/10.4081/cp.2015.775 - 12 Oct 2015

Cited by 14 | Viewed by 466

Abstract

Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare [...] Read more.

Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma. Full article

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Open AccessCase Report

Left Atrial Appendage Thrombosis during Therapy with Rivaroxaban in Elective Cardioversion for Permanent Atrial Fibrillation

by Walter Serra, Mauro Li Calzi and Paolo Coruzzi

Clin. Pract. 2015, 5(3), 788; https://doi.org/10.4081/cp.2015.788 - 28 Sep 2015

Cited by 21 | Viewed by 784

Abstract

Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of thromboembolic events (TE). The use of transesophageal echocardiography (TEE) to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in [...] Read more.

Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of thromboembolic events (TE). The use of transesophageal echocardiography (TEE) to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC) is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA₂DS₂-VASc score; however, only few data are currently available about safety of shortterm anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine. Full article

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Open AccessCase Report

Can Break-Dance Break Your Neck? C1/C2 Luxation with a Combined Dens Fracture without Neurological Deficits in an 11-Year Old Boy after a Break-Dance Performance

by Athanasios K. Petridis, Adrian Kinzel, Klaus Blaeser, Joost Thissen, Homajoun Maslehaty and Martin Scholz

Clin. Pract. 2015, 5(3), 781; https://doi.org/10.4081/cp.2015.781 - 28 Sep 2015

Cited by 6 | Viewed by 476

Abstract

Atlantoaxial dislocation in children is a very rare condition. We present the case of a dislocation happened during a break-dance maneuver. The purpose of this report is describing dangers of break-dancing and discussing the treatment we chose. The patient was followed up until [...] Read more.

Atlantoaxial dislocation in children is a very rare condition. We present the case of a dislocation happened during a break-dance maneuver. The purpose of this report is describing dangers of break-dancing and discussing the treatment we chose. The patient was followed up until 12 months after surgery. Magnetic resonance imaging and computed tomography of the cervical spine were evaluated. Translaminar fixation of C1/C2 had been performed after manual reposition under X-ray illumination. After a 12-month follow-up, the patient shows a stable condition without neurological dysfunction. He is not allowed to perform any extreme sports. Full article

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Open AccessCase Report

Cognitive Impairment and Electroconvulsive Therapy in Geriatric Depression, What Could Be the Role of Rivastigmine? A Case Series

by Audrey Monica van Schaik, Didi Rhebergen, Marieke Jantien Henstra, Daniel J. Kadouch, Eric van Exel and Maximilianus Lourentius Stek

Clin. Pract. 2015, 5(3), 780; https://doi.org/10.4081/cp.2015.780 - 28 Sep 2015

Cited by 8 | Viewed by 525

Abstract

Electroconvulsive therapy (ECT), albeit highly effective in treating depression, is frequently associated with cognitive impairment, either temporary or more persistent. Especially in older patients, who generally respond even better, serious cognitive impairment during the course of ECT may lead to premature termination of [...] Read more.

Electroconvulsive therapy (ECT), albeit highly effective in treating depression, is frequently associated with cognitive impairment, either temporary or more persistent. Especially in older patients, who generally respond even better, serious cognitive impairment during the course of ECT may lead to premature termination of ECT. Treatment of this cognitive impairment is of utmost importance. In this case series report, we present the effect of rivastigmine, an acetylcholinesterase inhibitor, on cognitive impairment in three older, severely depressed patients during or after a course of ECT. An improvement of cognitive functioning, in particular a decline of confusional symptoms, was observed in two patients with structural brain alterations associated with aging. In the other patient, who suffered primarily from amnesia, no effect of rivastigmine was observed. These preliminary results emphasize the need for detailed profiling of cognitive impairment when developing a research design to study the potential benefits of rivastigmine in the prevention or treatment of cognitive impairment in severely depressed patients treated with ECT. Full article

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Open AccessCase Report

Comparison of Diagnostic Ability of Storage Phosphor Plate in Detecting Proximal Caries with Direct Measurement by Stereomicroscope: A Pilot Study

by Velayudhannair Vivek, Sunila Thomas, Bindu J. Nair, Alex Daniel Vineet, Jincy Thomas, Prasanna Ranimol and Aswathy K. Vijayan

Clin. Pract. 2015, 5(3), 763; https://doi.org/10.4081/cp.2015.763 - 28 Sep 2015

Cited by 3 | Viewed by 431

Abstract

Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of photo stimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries. Hundred proximal surfaces of 50 extracted human posterior teeth were [...] Read more.

Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of photo stimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries. Hundred proximal surfaces of 50 extracted human posterior teeth were radiographed with dental X-ray unit. The image receptors used was storage phosphor plate Vista scan (size 2), (time of exposure 0.4 s). Radiographs were interpreted and caries lesions were classified on a 4-point scale suggested by Abesi et al. The teeth were sectioned with diamond disc and were examined under a stereomicroscope with 20x magnification. Diagnostic accuracy of digital image is similar to that observed with stereomicroscope. The PSP plate digital X ray system can effectively be employed for detecting proximal caries as compared to direct observation by stereomicroscope. Further study with more number of observer/evaluator and large sample size is recommended. Full article

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Clin. Pract., Volume 5, Issue 3 (September 2015) – 7 articles

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