Clinics and Practice

671 KiB

Open AccessCase Report

The Importance of Surgery as Part of Multimodal Therapy in Rapid Progressive Primary Extraosseous Ewing Sarcoma of the Cervical Intra- and Epidural Space

by Richard Bostelmann, Mario Leimert, Hans Jakob Steiger, Kirstin Gierga and Athanasios K. Petridis

Clin. Pract. 2016, 6(4), 897; https://doi.org/10.4081/cp.2016.897 - 14 Dec 2016

Cited by 10 | Viewed by 577

Abstract

Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a [...] Read more.

Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma- like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression- free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear. Full article

867 KiB

Open AccessCase Report

Compound Dorsal Dislocation of Lunate with Trapezoid Fracture

by Bong-Sung Kim, Gerrit Grieb, Patrick Rhodius, Arne H. Böcker, Jan-Philipp Stromps, Nils Andreas Krämer and Norbert Pallua

Clin. Pract. 2016, 6(4), 879; https://doi.org/10.4081/cp.2016.879 - 13 Dec 2016

Cited by 3 | Viewed by 462

Abstract

We report about a dorsal dislocation of the lunate accompanied by a trapezoid fracture in a 41-year old male patient after a motorcycle accident. The lunate dislocation with no dorsal or volar intercalated segment instability (DISI, VISI) was diagnosed by x-ray whereas the [...] Read more.

We report about a dorsal dislocation of the lunate accompanied by a trapezoid fracture in a 41-year old male patient after a motorcycle accident. The lunate dislocation with no dorsal or volar intercalated segment instability (DISI, VISI) was diagnosed by x-ray whereas the trapezoid fracture was only diagnosable by computed tomography. A closed reduction and internal fixation of the lunate by two Kirschner wires was performed, the trapezoid fracture was conservatively treated. Surgery was followed by immobilization, intense physiotherapy and close follow-up. Even though complaints such as swelling and pain subsided during the course of rehabilitation, partial loss of strength and range of motion remained even after 16 months. In conclusion, a conservative treatment of trapezoid fractures seems to be sufficient in most cases. Closed reduction with Kwire fixation led to an overall satisfactory result in our case. For dorsal lunate dislocations in general, open reduction should be performed when close reduction is unsuccessful or DISI/VISI are observed in radiographs after attempted close reduction. Full article

602 KiB

Open AccessCase Report

Mesiodens within the Nasopalatine Canal: An Exceptional Entity

by Georges Aoun and Ibrahim Nasseh

Clin. Pract. 2016, 6(4), 903; https://doi.org/10.4081/cp.2016.903 - 07 Dec 2016

Cited by 8 | Viewed by 591

Abstract

A supernumerary tooth is one that is supplementary to the normal dentition. It can be found anywhere at the dental arch. A mesiodens is a supernumerary tooth located between the two maxillary central incisors usually palatally or within the alveolar process. Less frequently, [...] Read more.

A supernumerary tooth is one that is supplementary to the normal dentition. It can be found anywhere at the dental arch. A mesiodens is a supernumerary tooth located between the two maxillary central incisors usually palatally or within the alveolar process. Less frequently, the mesiodens is in relation with the nasal floor and the nasopalatine canal walls. This paper presents a very rare case of an impacted inverted mesiodens located inside the nasopalatine canal and found incidentally with a cone-beam computed tomography examination. Full article

757 KiB

Open AccessCase Report

Renal Angiomyolipoma in Pregnancy: Surgical Management with Fetal Preservation-Approach in a Developing Setting

by Fred O. Ugwumba, Emeka F. Nnakenyi, Okechukwu C. Okafor, Augustine C. Onuh, Paschalina C. Ezechukwu and Sunday Urube

Clin. Pract. 2016, 6(4), 893; https://doi.org/10.4081/cp.2016.893 - 07 Dec 2016

Cited by 1 | Viewed by 443

Abstract

Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes- torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique [...] Read more.

Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes- torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care. Full article

622 KiB

Open AccessCase Report

Pediatric Endobronchial Inflammatory Myofibroblastic Tumor: A Case Report and Review of the Literature

by Leilei Liu, Xianglei Kong, Xiaoqian Lu and Dianbo Cao

Clin. Pract. 2016, 6(4), 853; https://doi.org/10.4081/cp.2016.853 - 07 Dec 2016

Cited by 4 | Viewed by 459

Abstract

Inflammatory myofibroblastic tumor (IMT) belongs to the group of soft tissue tumor and could occur at any anatomical site from the central nervous system to gastrointestinal tract. The lung and abdomen are commonly affected sites, however, pulmonary IMT is predominantly located within the [...] Read more.

Inflammatory myofibroblastic tumor (IMT) belongs to the group of soft tissue tumor and could occur at any anatomical site from the central nervous system to gastrointestinal tract. The lung and abdomen are commonly affected sites, however, pulmonary IMT is predominantly located within the parenchyma rather than presenting as endobronchial lesion. IMTs may occur in any age group, but they are observed most commonly in children and adolescents. Here, we present a case of IMT arising from the left main stem bronchus in a 10-year-old girl. Full article

510 KiB

Open AccessCase Report

Rhabdomyolysis and Autoimmune Variant Stiff-Person Syndrome

by Shreyas Gangadhara, Suhas Gangadhara, Chetan Gandhy and Derrick Robertson

Clin. Pract. 2016, 6(4), 885; https://doi.org/10.4081/cp.2016.885 - 30 Nov 2016

Cited by 4 | Viewed by 467

Abstract

Stiff-person syndrome (SPS) is a rare neurologic disorder characterized by waxing and waning muscular rigidity, stiffness and spasms. Three subtypes have been described: paraneoplastic, autoimmune and idiopathic. Rhabdomyolysis has been described in the paraneoplastic variant, but to our knowledge no case has been [...] Read more.

Stiff-person syndrome (SPS) is a rare neurologic disorder characterized by waxing and waning muscular rigidity, stiffness and spasms. Three subtypes have been described: paraneoplastic, autoimmune and idiopathic. Rhabdomyolysis has been described in the paraneoplastic variant, but to our knowledge no case has been reported involving the autoimmune variant. We report a case report of a 50-year-old man with history of SPS who presented with recurrent episodes of severe limb and back spasms. He was hospitalized on two separate occasions for uncontrollable spasms associated with renal failure and creatinine phosphokinase elevations of 55,000 and 22,000 U/L respectively. Laboratory tests were otherwise unremarkable. The acute renal failure resolved during both admissions with supportive management. Rhabdomyolysis has the potential to be fatal and early diagnosis is essential. It should be considered in patients who have SPS and are experiencing an exacerbation of their neurologic condition. Full article

676 KiB

Open AccessCase Report

Gastric Schwannoma: A Case Report

by Hayfa Romdhane, Myriam Cheikh, Zeineb Mzoughi, Sana Ben Slama, Rym Ennaifer and Najet Belhadj

Clin. Pract. 2016, 6(4), 849; https://doi.org/10.4081/cp.2016.849 - 30 Nov 2016

Cited by 4 | Viewed by 465

Abstract

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation [...] Read more.

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign. Full article

669 KiB

Open AccessCase Report

Do All Critical Aortic Stenosis with Chest Pain Need Aortic Valve Replacement? A Case Report

by Munish Sharma and Daniel A. N. Mascarenhas

Clin. Pract. 2016, 6(4), 887; https://doi.org/10.4081/cp.2016.887 - 24 Nov 2016

Cited by 1 | Viewed by 379

Abstract

Aortic valve replacement (AVR) remains the cornerstone of treatment for symptomatic critical aortic stenosis (AS). It is a Class I indication that symptomatic patients with critical AS undergo either surgical or transcatheter aortic valve replacement (TAVR). We present a patient with critical AS [...] Read more.

Aortic valve replacement (AVR) remains the cornerstone of treatment for symptomatic critical aortic stenosis (AS). It is a Class I indication that symptomatic patients with critical AS undergo either surgical or transcatheter aortic valve replacement (TAVR). We present a patient with critical AS and new angina that was managed successfully with percutaneous coronary intervention (PCI) of the Right coronary artery. Physicians should consider that not all patients with critical AS and angina necessarily require AVR. Concomitant pathology leading to the symptoms should be carefully ruled out. This leads to a less invasive, cost effective care plan especially in patients with advanced age and comorbidities for which any type of surgical valvular intervention may pose high risk. Full article

670 KiB

Open AccessBrief Report

Intraspinal Lumbar Juxtaarticular Cyst Treatment through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome

by Adisa Kursumovic, Richard Bostelmann, Maria Gollwitzer, Stefan Rath, Hans Jakob Steiger and Athanasios K. Petridis

Clin. Pract. 2016, 6(4), 866; https://doi.org/10.4081/cp.2016.866 - 24 Nov 2016

Cited by 6 | Viewed by 605

Abstract

Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can [...] Read more.

Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010–2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks–5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CTscans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints. Full article

703 KiB

Open AccessCase Report

A Child with Debilitating Pruritus

by Nikhil Sonthalia, Sami S. Jain, Vinay B. Pawar, Vinay G. Zanwar, Ravindra G. Surude, Pravin M. Rathi, Kshitij K. Munde and Sandeep Bavdekar

Clin. Pract. 2016, 6(4), 865; https://doi.org/10.4081/cp.2016.865 - 24 Nov 2016

Cited by 1 | Viewed by 447

Abstract

We describe a case of two-year-old boy presenting with debilitating pruritus, patchy alopecia and jaundice since the age of 6 months. On evaluation he had intrahepatic cholestasis with persistently raised serum alkaline phosphatase, normal Gamma glutamyl transferase and raised serum bile acid levels. [...] Read more.

We describe a case of two-year-old boy presenting with debilitating pruritus, patchy alopecia and jaundice since the age of 6 months. On evaluation he had intrahepatic cholestasis with persistently raised serum alkaline phosphatase, normal Gamma glutamyl transferase and raised serum bile acid levels. His liver biopsy showed bland cholestasis and electron microscopy showed granular bile suggestive of progressive familial intrahepatic cholestasis type I. Medical therapy with ursodeoxycholic acid, cholestyramine, rifampicin with nutritional modification was successful in alleviating the symptoms and correcting the nutritional status. To our knowledge this is only the sixth case of progressive familial intrahepatic cholestasis type I reported from India. Herein we discuss the diagnostic and therapeutic hurdles that one encounters in managing progressive familial intrahepatic cholestasis and also review the literature regarding this rare disorder. Full article

646 KiB

Open AccessCase Report

Diode Laser Versus Scalpel in the Treatment of Hereditary Gingival Fibromatosis in a 6-Year Old Boy

by Samia Aboujaoude, Antoine Cassia and Carla Moukarzel

Clin. Pract. 2016, 6(4), 895; https://doi.org/10.4081/cp.2016.895 - 14 Nov 2016

Cited by 4 | Viewed by 548

Abstract

Hereditary gingival fibromatosis (HGF) is a rare disease characterized by a benign enlargement of the gingiva involving both the mandible and the maxilla. This case is about a 6-year-old child with non syndromic HGF showing a severe gingival enlargement covering almost all surfaces [...] Read more.

Hereditary gingival fibromatosis (HGF) is a rare disease characterized by a benign enlargement of the gingiva involving both the mandible and the maxilla. This case is about a 6-year-old child with non syndromic HGF showing a severe gingival enlargement covering almost all surfaces of the teeth, in both arches, hence causing major aesthetic, phonetic and masticatory problems. The aim of the present article is to compare the outcomes of two therapeutical approaches: (i) classical surgical removal with scalpel; and (ii) diode laser resection. Compared to the surgical approach, the clinical results show that the main advantages of the diode laser technique are a better visibility during the intervention, minimal postoperative discomfort combined to a better gingival recontouring. However, the time consumption and the high cost of the laser equipment remain the main disadvantages of the systematic use of this technique. Full article

650 KiB

Open AccessCase Report

Oncocytic Pleomorphic Adenoma of Palatal Salivary Gland with Macrophages and Giant Cells Associated with Cholesterol Crystals

by Gargi S. Sarode, Sachin C. Sarode, Shankargouda Patil and Sukumaran Anil

Clin. Pract. 2016, 6(4), 884; https://doi.org/10.4081/cp.2016.884 - 24 Oct 2016

Cited by 3 | Viewed by 475

Abstract

Pleomorphic adenoma (PA) is the most common salivary gland tumor characterized by histo-morphological diversity in the form of myxoid, hyalinized, chondroid, osseous, and squamous areas. In this paper, we report a rare case of predominantly oncocytic variant of PA in a 45-year-old male [...] Read more.

Pleomorphic adenoma (PA) is the most common salivary gland tumor characterized by histo-morphological diversity in the form of myxoid, hyalinized, chondroid, osseous, and squamous areas. In this paper, we report a rare case of predominantly oncocytic variant of PA in a 45-year-old male patient on the posterior palatal region. Microscopic examination showed homogenous eosinophilic cellular mass composed of epithelial components arranged in the form of tubular and solid patterns. The polygonal and oval cells showed abundant dark eosinophilic granular cytoplasm. The cell borders were distinct with a central nucleus showing prominent nucleoli. Interestingly at few places, cholesterol clefts were seen surrounded by macrophages and giant cells. The tumor was surgically excised with no evidence of recurrence after 2 years. Full article

Journal Menu

Journal Browser

Clin. Pract., Volume 6, Issue 4 (October 2016) – 12 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI