Clinics and Practice

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Open AccessCase Report

Bifid Mandibular Canal: A Rare or Underestimated Entity?

by Ibrahim Nasseh and Georges Aoun

Clin. Pract. 2016, 6(3), 881; https://doi.org/10.4081/cp.2016.881 - 10 Oct 2016

Cited by 2 | Viewed by 505

One of the rare anatomical variations that can be of significant importance for the dentist is the bifid mandibular canal. Many complications can occur from this condition such as failure of anesthesia when performing inferior alveolar nerve block, difficulties during the surgical extraction [...] Read more.

One of the rare anatomical variations that can be of significant importance for the dentist is the bifid mandibular canal. Many complications can occur from this condition such as failure of anesthesia when performing inferior alveolar nerve block, difficulties during the surgical extraction of the third mandibular molar, and during implants placement. Therefore, good knowledge of this condition is essential. In this report, we describe the radiographic finding of a unilateral bifid mandibular canal. Full article

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Open AccessCase Report

Giant Adrenal Cavernous Hemangioma in a Patient with Familial Adenomatous Polyposis

by Dhouha Bacha, Abir Chaabane, Fatma Khanchel, Saloua Néchi, Hassen Touinsi and Emna Chelbi

Clin. Pract. 2016, 6(3), 878; https://doi.org/10.4081/cp.2016.878 - 10 Oct 2016

Cited by 3 | Viewed by 484

Abstract

Adrenal hemangioma is an uncommon benign vascular tumor that is often discovered incidentally. It has never been reported in association with familial adenomatous polyposis. We report a case of a 60-year old man with a history of familial adenomatous polyposis, in whom a [...] Read more.

Adrenal hemangioma is an uncommon benign vascular tumor that is often discovered incidentally. It has never been reported in association with familial adenomatous polyposis. We report a case of a 60-year old man with a history of familial adenomatous polyposis, in whom a huge retroperitoneal cyst of 18 × 17 cm was discovered during routine radiologic evaluation. Because of the impossibility of ruling out the presence of malignancy, surgical cystectomy was performed, associated to a scheduled total colectomy. Pathological examination revealed that the cyst corresponded to an adrenal cavernous hemangioma. Colonic adenomas did not show signs of degeneration. Screening for adenomatous polyposis coli (APC) gene mutation was not carried out. As familial adenomatous polyposis is known to involve a variety of extracolonic manifestations, this finding raises the suspicion of a possible variant of this syndrome including adrenal hemangioma. An extensive study based on a larger patient series with genetic exploration is necessary. Full article

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Open AccessCase Report

Oromandibular Dystonia: A Case Report of the Lateral Pterygoid Muscle Involvement and Treatment with Botulinum Toxin A

by Athanasia Alexoudi, Zoi Dalivigka, Anna Siatouni, Anastasia Verentzioti and Stylianos Gatzonis

Clin. Pract. 2016, 6(3), 862; https://doi.org/10.4081/cp.2016.862 - 10 Oct 2016

Cited by 3 | Viewed by 519

Abstract

The objective of the present case report is to punctuate the importance of individualized therapy procedures and the accurate diagnosis of the muscles involved in oromandibular dystonia and underline the role of electromyography (EMG). We report a woman who presented sustained jaw movement [...] Read more.

The objective of the present case report is to punctuate the importance of individualized therapy procedures and the accurate diagnosis of the muscles involved in oromandibular dystonia and underline the role of electromyography (EMG). We report a woman who presented sustained jaw movement towards the left, severe difficulty in jaw opening and jaw protrusion. The patient was treated with injections of botulinum A toxin in lateral pterygoid, masseter, platysma, sternoclidomastoid, temporalis muscles with EMG guidance. She experienced an 80% reduction of her symptoms after the first injection. In jaw deviation dystonia symptoms impressively respond to botulinum toxin treatment of the pterygoid muscle. Individualized therapy procedures are necessitated. Full article

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Open AccessCase Report

Multiple Esophageal Foreign Bodies in an Infant: A Rare Case of Serious Parental Neglect

by Arunabha Chakravarti, Sunil Garg and Rahul Bhargava

Clin. Pract. 2016, 6(3), 841; https://doi.org/10.4081/cp.2016.841 - 04 Oct 2016

Cited by 1 | Viewed by 365

Abstract

A case of multiple esophageal foreign bodies, which were retrieved successfully by rigid esophagoscopy in a 1-year old child is being reported. There are few cases of multiple esophageal foreign bodies in children reported in the literature; this case was unique in presentation [...] Read more.

A case of multiple esophageal foreign bodies, which were retrieved successfully by rigid esophagoscopy in a 1-year old child is being reported. There are few cases of multiple esophageal foreign bodies in children reported in the literature; this case was unique in presentation as there was no history of foreign body ingestion. This case also highlights the serious neglect present in our society towards children of lower socio-economic strata despite this child being the 1st child in the family. Full article

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Open AccessBrief Report

Midterm Results of Consecutive Periprosthetic Femoral Fractures Vancouver Type A and B

by Klemens Trieb, Rainer Fiala and Christian Briglauer

Clin. Pract. 2016, 6(3), 871; https://doi.org/10.4081/cp.2016.871 - 24 Aug 2016

Cited by 8 | Viewed by 366

Abstract

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2 ± 8.5 years, [...] Read more.

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2 ± 8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n = 5) or type B (n = 29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications. Full article

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Open AccessCase Report

Persistent Hyperinsulinism in Kabuki Syndrome 2: Case Report and Literature Review

by Hobia Gole, Raymond Chuk and David Coman

Clin. Pract. 2016, 6(3), 848; https://doi.org/10.4081/cp.2016.848 - 23 Aug 2016

Cited by 21 | Viewed by 661

Abstract

Kabuki syndrome is a clinically and genetically heterogeneous congenital malformation syndrome with protean clinical manifestations. This reflects the important epigenetic role in embryonic development of the two genes currently known to be associated with Kabuki syndrome i.e., KMT2D and KDM6A, which are [...] Read more.

Kabuki syndrome is a clinically and genetically heterogeneous congenital malformation syndrome with protean clinical manifestations. This reflects the important epigenetic role in embryonic development of the two genes currently known to be associated with Kabuki syndrome i.e., KMT2D and KDM6A, which are responsible for Kabuki syndrome 1 and Kabuki syndrome 2, respectively. Hypoglycemia is thought to be a rare manifestation of Kabuki syndrome; however it may be under diagnosed. Herein we describe the case of a 5-year-old girl with Kabuki syndrome 2 in whom persistent hyperinsulinism was diagnosed at 4 years of age. We postulate an epigenetic mechanism for hyperinsulinism where specific loss KDM6A demethylation of the H3K27me3/me2 mark may lead to deregulated pancreatic β-cell development. Full article

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Open AccessCase Report

Medication Error When Switching from Warfarin to Rivaroxaban Leading to Spontaneous Large Ecchymosis of the Abdominal and Chest Wall

by Flavio Egger, Federica Targa, Ivan Unterholzner, Russell P. Grant, Markus Herrmann and Christian J. Wiedermann

Clin. Pract. 2016, 6(3), 873; https://doi.org/10.4081/cp.2016.873 - 11 Aug 2016

Cited by 5 | Viewed by 593

Abstract

Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial [...] Read more.

Non-vitamin K oral anticoagulant (NOAC) therapy may be inappropriate if prescription was incorrect, the patient’s physiological parameters change, or interacting concomitant medications are erroneously added. The aim of this report was to illustrate inappropriate NOAC prescription in a 78-year-old woman with non-valvular atrial fibrillation and borderline renal dysfunction who was switched from warfarin to rivaroxaban and subsequently developed bruising with hemorrhagic shock and acute on chronic renal failure. Administration of 4-factor prothrombin complex concentrate effectively reversed coagulopathy and stopped bleeding. Retrospective determination of circulating plasma levels of rivaroxaban and warfarin confirmed that excessive anticoagulation was likely due to warfarin that the patient probably continued to take although rivaroxaban was initiated. Pharmacodynamic interaction between rivaroxaban and warfarin may not only be additive but synergistic. In patients at high risk of complications, judicious prescribing and dosing of NOACs, and regular monitoring of concomitant medications and renal function are highly recommended. Full article

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Open AccessCase Report

Cocaine Use and Splenic Rupture: A Rare Yet Serious Association

by Nishrutha Karthik and Karthik Gnanapandithan

Clin. Pract. 2016, 6(3), 868; https://doi.org/10.4081/cp.2016.868 - 11 Aug 2016

Cited by 2 | Viewed by 427

Abstract

Cocaine abuse is frequent in patients visiting the emergency department. The knowledge of the cardiovascular complications of cocaine is excellent among physicians. However the awareness regarding its abdominal complications, the most important of which include gastroduodenal perforation, bowel ischemia and splenic rupture is [...] Read more.

Cocaine abuse is frequent in patients visiting the emergency department. The knowledge of the cardiovascular complications of cocaine is excellent among physicians. However the awareness regarding its abdominal complications, the most important of which include gastroduodenal perforation, bowel ischemia and splenic rupture is less adequate. We report a 58-year-old with cocaine use who presents with upper abdominal pain and a rapidly worsening clinical status. He was found to have atraumatic splenic rupture causing a hemoperitoneum that was managed by intervention radiology guided splenic artery embolization. Splenic hemorrhage and rupture need timely recognition, as they are difficult to diagnose clinically and can be potentially fatal. In the encounter of patients with cocaine use who present with chest or upper abdominal pain, clinicians should consider imaging to look for splenic rupture as it is often masked or overlooked due to the complicated clinical picture. Full article

505 KiB

Open AccessCase Report

Genetic Counseling for a Prenatal Diagnosis of Structural Chromosomal Abnormality with High-Resolution Analysis Using a Single Nucleotide Polymorphism Microarray

by Akiko Takashima, Naoki Takeshita and Toshihiko Kinoshita

Clin. Pract. 2016, 6(3), 852; https://doi.org/10.4081/cp.2016.852 - 08 Aug 2016

Cited by 1 | Viewed by 383

Abstract

A 41-year old pregnant woman underwent amniocentesis to conduct a conventional karyotyping analysis; the analysis reported an abnormal karyotype: 46,XY,add(9)(p24). Chromosomal microarray analysis (CMA) is utilized in prenatal diagnoses. A single nucleotide polymorphism microarray revealed a male fetus with balanced chromosomal translocations on [...] Read more.

A 41-year old pregnant woman underwent amniocentesis to conduct a conventional karyotyping analysis; the analysis reported an abnormal karyotype: 46,XY,add(9)(p24). Chromosomal microarray analysis (CMA) is utilized in prenatal diagnoses. A single nucleotide polymorphism microarray revealed a male fetus with balanced chromosomal translocations on 9p and balanced chromosomal rearrangements, but another chromosomal abnormality was detected. The fetus had microduplication. The child was born as a phenotypically normal male. CMA is a simple and informative procedure for prenatal genetic diagnosis. CMA is the detection of chromosomal variants of unknown clinical significance; therefore, genetic counseling is important during prenatal genetic testing. Full article

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Clin. Pract., Volume 6, Issue 3 (August 2016) – 9 articles

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