Clinics and Practice

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Open AccessCase Report

Kikuchi-Fujimoto Disease: Unusual Presentation of Rare Disease

by Duy Vu, Srini Reddy, Lynn Day, Nail Aydin and Subhasis Misra

Clin. Pract. 2016, 6(1), 828; https://doi.org/10.4081/cp.2016.828 - 19 Apr 2016

Cited by 2 | Viewed by 464

Kikuchi-Fujimoto disease (KFD) is a rare, benign disorder that typically follows a selflimiting natural course and was initially described in young females of Asian descent. Its clinical presentation may mimic lymphoproliferative disorders, connective tissue disorders, and chronic infections. This often leads to misdiagnosis [...] Read more.

Kikuchi-Fujimoto disease (KFD) is a rare, benign disorder that typically follows a selflimiting natural course and was initially described in young females of Asian descent. Its clinical presentation may mimic lymphoproliferative disorders, connective tissue disorders, and chronic infections. This often leads to misdiagnosis and inappropriate treatment. The exact cause of this condition remains unknown although autoimmune processes and certain infectious agents have been associated with the disease. The diagnosis of KFD is made histopathologically. Treatment is supportive and long-term follow-up is recommended due to increased risk of future development of systemic lupus erythematosus. Here we are presenting a case of a patient with an unusual presentation of KFD. Full article

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Open AccessCase Report

Spontaneous Hematoma of Posterior Mediastinum with an Uncommon Cause: A Case Report and Review of the Literature

by Xiaowei Li, Leilei Liu, Dianbo Cao and Yutian Sun

Clin. Pract. 2016, 6(1), 838; https://doi.org/10.4081/cp.2016.838 - 11 Apr 2016

Cited by 2 | Viewed by 469

Abstract

Spontaneous mediastinal hematoma is exceedingly rare. We described such a case of a 61-year-old male with a posterior mediastinal hematoma from ruptured small aneurysm, which was ascertained via contrast-enhanced computed tomography examination. Subsequent super-selective angiography of left gastric artery revealed a ruptured aneurysm [...] Read more.

Spontaneous mediastinal hematoma is exceedingly rare. We described such a case of a 61-year-old male with a posterior mediastinal hematoma from ruptured small aneurysm, which was ascertained via contrast-enhanced computed tomography examination. Subsequent super-selective angiography of left gastric artery revealed a ruptured aneurysm with contrast medium leakage, feeding vessels respectively from caudal and cranial artery. The left gastric artery branch caudally feeding aneurysm was successfully occluded, while cranially feeding artery from the branch of left bronchial artery failed to embolize due to complex anatomic factor. Our management still yields to a satisfactory outcome. Full article

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Open AccessBrief Report

Could Spinal Canal Compression Be a Cause of Polyneuropathy?

by Richard Bostelmann, Samis Zella, Hans Jakob Steiger and Athanasios K. Petridis

Clin. Pract. 2016, 6(1), 816; https://doi.org/10.4081/cp.2016.816 - 11 Apr 2016

Cited by 2 | Viewed by 624

Abstract

Causality between spinal cord compression and polyneuropathy is difficult to define, especially under the circumstances that polyneuropathy can have many causes. Seven patients with spinal cord compression and electrophysiological signs of polyneuropathy were treated surgically on decompression of their spinal canal stenosis in [...] Read more.

Causality between spinal cord compression and polyneuropathy is difficult to define, especially under the circumstances that polyneuropathy can have many causes. Seven patients with spinal cord compression and electrophysiological signs of polyneuropathy were treated surgically on decompression of their spinal canal stenosis in the time from April 2010 to January 2013. Median follow up time was 9 months (2-23 months). Causes of polyneuropathy were: 1 patient with methotrexate-induced polyneuropathy, 1 endocrine-dysfunction-induced, 2 with diabetic- polyneuropathy, and 3 patients had unknown reasons. The localization of the spinal canal stenosis was also varying: 2 patients suffered of cervical spinal canal stenosis and 5 of lumbar. Decompressive surgery led to pain relieve in all patients initially. Surprisingly, also symptoms of polyneuropathy seemed to regress in all 7 patients for the first 5 months after surgery, and in 5 patients for the time of 9 months after surgery. There are two points we would like to emphasize in this short report. Since 5/7 patients with polyneuropathy and spinal canal stenosis improved clinically after surgery, surgery has a place in the treatment of such a combined pathology. Since it seems to be a possible causality between polyneuropathy of unknown origin and spinal cord stenosis, decompression of the spinal canal could also be a therapeutic step in a specific kind of polyneuropathy. Which patients could possibly have a spinal canal stenosis induced polyneuropathy remains a subject of further studies. Full article

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Open AccessCase Report

Simple Partial Status Epilepticus Manifested as Homonymous Hemianopsia: A Rare Intracranial Recording

by Anna Siatouni, Stylianos Gatzonis, Andreas Alexopoulos, Nikos Georgakoulias, Mathildi Papathanassiou, Stefanos Korfias, Vaso Zisimopoulou and Damianos Sakas

Clin. Pract. 2016, 6(1), 840; https://doi.org/10.4081/cp.2016.840 - 31 Mar 2016

Cited by 4 | Viewed by 439

Abstract

A 30-year-old woman with intractable seizures evaluated as surgical candidate. During presurgical evaluation an invasive electroencephalogram was recommended to define the location and extent of epileptogenic zone and relationship to epileptogenic lesion. On third monitoring night the patient complained of persistent homonymous hemianopsia [...] Read more.

A 30-year-old woman with intractable seizures evaluated as surgical candidate. During presurgical evaluation an invasive electroencephalogram was recommended to define the location and extent of epileptogenic zone and relationship to epileptogenic lesion. On third monitoring night the patient complained of persistent homonymous hemianopsia following a habitual seizure. Concurrently, persistent epileptic activity was evident in a small, restricted area around the right calcarine fissure. The ictal discharges persisted for the next 30 h despite high-dose administration of intravenous antiepileptic drugs, until patient was taken to operating room. Simple partial status epilepticus presenting with pure visual symptoms is rare and difficult to diagnose, even more so when presenting with negative visual phenomena. Epileptic etiology of unexplained, paroxysmal negative visual symptoms should be considered in the differential diagnosis in patients with pre-existing epilepsy, as well as patients with no prior history of epilepsy. Full article

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Open AccessCase Report

Rare Bone Marrow Biopsy Complication: A Challenging Case of Sacroiliitis and Staphilococcus aureus Sepsis

by Alessandro Morotti, Maria Consiglio Barozzino and Angelo Guerrasio

Clin. Pract. 2016, 6(1), 823; https://doi.org/10.4081/cp.2016.823 - 31 Mar 2016

Cited by 5 | Viewed by 465

Abstract

Bone marrow biopsy is a mandatory procedure to diagnose several hematological disorders. This invasive analysis is generally safe and the procedure-related risks are rare and include bleeding at the site of puncture and, very occasionally, local infections. Here, we describe a case of [...] Read more.

Bone marrow biopsy is a mandatory procedure to diagnose several hematological disorders. This invasive analysis is generally safe and the procedure-related risks are rare and include bleeding at the site of puncture and, very occasionally, local infections. Here, we describe a case of sacroiliitis that occurred as a consequence of bone marrow biopsy. Full article

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Open AccessCase Report

Diffuse Spinal Leptomeningeal Spread of a Pilocytic Astrocytoma in a 3-Year-Old Child

by Ameer Alyeldien, Sarah Teuber-Hanselmann, Azad Cheko, Tanja Höll, Martin Scholz and Athanasios K. Petridis

Clin. Pract. 2016, 6(1), 813; https://doi.org/10.4081/cp.2016.813 - 31 Mar 2016

Cited by 2 | Viewed by 380

Abstract

Pilocytic astrocytomas correspond to lowgrade gliomas and therefore metastasize exceedingly rare. However, pilocytic astrocytomas are able to and leptomeningeal dissemination may be seen. What are the treatment options of these cases? We present a case report of a 3-year-old child with a pilocytic [...] Read more.

Pilocytic astrocytomas correspond to lowgrade gliomas and therefore metastasize exceedingly rare. However, pilocytic astrocytomas are able to and leptomeningeal dissemination may be seen. What are the treatment options of these cases? We present a case report of a 3-year-old child with a pilocytic astrocytoma of the optic chiasm with leptomeningeal dissemination of the spinal meninges. Partial resection of the cerebral tumor has been performed. Since the leptomeningeal dissemination was seen all over the spinal meninges, the child did not undergo further surgical treatment. A wait and watch strategy were followed. Chemotherapy was initiated, if a 25% tumor growth was seen. Leptomeningeal dissemination of a pilocytic astrocytoma is seen so infrequently that no standard therapy is established. Since these metastases may occur even up to 2 decades after primary tumor resection, long-term follow- up is indicated. In case of spinal metastases, surgical treatment should be performed if feasible. Otherwise observation should be possessed and/or chemotherapy should be initiated. Full article

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Open AccessCase Report

Granulomatous Lithiasic Cholecystitis in Sarcoidosis

by Adriana Handra-Luca

Clin. Pract. 2016, 6(1), 811; https://doi.org/10.4081/cp.2016.811 - 31 Mar 2016

Cited by 3 | Viewed by 471

Abstract

Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis [...] Read more.

Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis diagnosed more than 20-years previously. 2-years previously the patient showed renal lithiasis, hypercalcemia and, increased angiotensin converting enzyme. The imaging features suggested thoraco-abdominal sarcoidosis. Prednisone was given at 1.2 mg/kg/day initially, than decreased, being at 2.5 mg/day at present. The ultrasound examination showed gallbladder lithiasis. A cholecystectomy was performed. Microscopy showed subacute and chronic cholecystitis with several epithelioid and giant cell granulomas some of them perineural. In conclusion, we report a case of granulomatous cholecystitis occurring in the course of treated sarcoidosis. The perineural location of granulomas may give further insights into the pathogenesis of gallbladder dysmotility. Full article

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Open AccessCase Report

Two Cases of the Laryngeal Cystic Lesions

by Takeshi Kusunoki, Ryo Wada, Hirotomo Homma, Yoshinobu Kidokoro, Aya Yanai and Katsuhisa Ikeda

Clin. Pract. 2016, 6(1), 822; https://doi.org/10.4081/cp.2016.822 - 25 Mar 2016

Cited by 2 | Viewed by 392

Abstract

We experienced two rare cases with laryngeal cystic lesions (laryngocele and laryngeal cyst). In the first case, the laryngocele case was removed by laryngomicrosurgery using an oral approach under general anesthesia. In the second case, the magnetic resonance imaging demonstrated a dumbbell-type cyst [...] Read more.

We experienced two rare cases with laryngeal cystic lesions (laryngocele and laryngeal cyst). In the first case, the laryngocele case was removed by laryngomicrosurgery using an oral approach under general anesthesia. In the second case, the magnetic resonance imaging demonstrated a dumbbell-type cyst with mucus widely extending from the laryngeal lumen to the neck through the thyroid cartilage. The patient had undergone chemotherapy for renal carcinoma with multiple lung and bone metastases. Therefore, we performed only fine needle aspiration rather than aggressive surgery for extirpation of the cyst using an external approach. This fine needle aspiration could improve the quality of life by decreasing both the left laryngeal swelling and the resulting pain, which were the chief complaints. Full article

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Open AccessCase Report

A Case of a Very Elongated Styloid Process 8 cm in Length with Frequent Throat Pain for 10 Years

by Takeshi Kusunoki, Hirotomo Homma, Yoshinobu Kidokoro, Aya Yanai, Mitsuhisa Fujimaki and Katsuhisa Ikeda

Clin. Pract. 2016, 6(1), 820; https://doi.org/10.4081/cp.2016.820 - 25 Mar 2016

Cited by 5 | Viewed by 391

Abstract

We experienced a case of an elongated styloid process that was 8 cm in length. The patient was a 68-year-old Japanese man with frequent episodes of left-sided throat pain for 10 years. The elongated styloid process could be diagnosed by 3D-computed tomography (left [...] Read more.

We experienced a case of an elongated styloid process that was 8 cm in length. The patient was a 68-year-old Japanese man with frequent episodes of left-sided throat pain for 10 years. The elongated styloid process could be diagnosed by 3D-computed tomography (left and right length: 7.8 cm and 8.0 cm, respectively) and successfully treated with surgery, since the anatomic relationships could be fully visualized. Surgical methods for shortening an elongated styloid process involve an intraoral or external approach. The external approach to the styloid process involves a trans-cervical approach to the parapharyngeal space, which enables wider visualization in the operative field than an intraoral approach. In the present case, the styloid process reached the parapharyngal space. Therefore, we selected the external approach and shortened only the left-sided styloid process (the same side as the throat pain). The chief complaint disappeared immediately after the operation. Full article

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Clin. Pract., Volume 6, Issue 1 (March 2016) – 9 articles

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