Clinics and Practice

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Open AccessCase Report

Median Raphe Cyst: A Clinically Challenging Diagnosis

by Chadi Hajar, Ibrahim R. Hajjali, Laura Oscar and Daniel C. Mayes

Clin. Pract. 2019, 9(3), 1176; https://doi.org/10.4081/cp.2019.1176 - 27 Sep 2019

Cited by 1 | Viewed by 770

Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. Only a few hundred cases have been published in the English literature and the lack of awareness of this entity can lead to confusion [...] Read more.

Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. Only a few hundred cases have been published in the English literature and the lack of awareness of this entity can lead to confusion and misdiagnosis. We report here a case of median raphe cyst located in the midline of the anterior scrotum of a 35-year-old man. Clinically, the patient presented with a scrotal mass increasing substantially in size over two days associated with tenderness, skin erythema, and scrotal pain. Radiologic interpretation of a sonogram and computed tomography scan suggested a thrombosed vessel. The patient was diagnosed with septic thrombophlebitis associated with overlying cellulitis. Despite conservative therapy with antibiotics, the patient developed pyrexia, tachycardia, and leukocytosis prompting surgical excision of the lesion. Histopathologic examination revealed an infected median raphe cyst. The cyst wall was lined by a stratified epithelium that included numerous Alcian blue positive goblet cells. The epithelial cells showed reactive changes with infiltration by numerous neutrophils. Our objective is to bring attention to and thereby facilitate the diagnosis of this unusual entity. Full article

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Open AccessCase Report

Treatment of Non-Atopic Dermatitis with Polarized UV-Free Polychromatic Light: A Case Report

by Alberto Leguina-Ruzzi, Kishan Rajnikant Raichura, Sarah Karis Tonks, Semira Kwabi and Claudia Leitner

Clin. Pract. 2019, 9(3), 1161; https://doi.org/10.4081/cp.2019.1161 - 23 Sep 2019

Cited by 2 | Viewed by 691

Abstract

Non-atopic dermatitis is a common inflammatory condition, which is potentially debilitating and can compromise life quality. Polarized ultraviolet-free polychromatic light is used as therapeutic option for the treatment of wound healing and dermatological conditions. It has not yet been tested in the management [...] Read more.

Non-atopic dermatitis is a common inflammatory condition, which is potentially debilitating and can compromise life quality. Polarized ultraviolet-free polychromatic light is used as therapeutic option for the treatment of wound healing and dermatological conditions. It has not yet been tested in the management of non-atopic dermatitis. In this case report, we present a 67-year-old female patient who had suffered with moderate non-atopic dermatitis for the past 20 years, and had undergone multiple treatments during that time without significant improvement or relief from her symptoms. She was treated for six weeks only with daily light therapy applications (10 minutes/area). Our results showed that light therapy offered a significant reduction in erythema of the affected zones with a concomitant reduction in pruritus and dehydration of the skin, without side effects or discomfort. Full article

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Open AccessCase Report

Clinical and Functional Outcome of Modified Quad Surgery in Adult Obstetric Brachial Plexus Injury Patients: Case Reports

by Rahul K. Nath, Divya Goel and Chandra Somasundaram

Clin. Pract. 2019, 9(3), 1140; https://doi.org/10.4081/cp.2019.1140 - 23 Sep 2019

Cited by 4 | Viewed by 675

Abstract

Untreated adult obstetric brachial plexus injury (OBPI) patients, in general, use compensatory strategies to achieve their lost upper extremity functions; they cause some adverse effects. Our present study is a case series of 3 female adult OBPI patients, aged 46, 23 and 21 [...] Read more.

Untreated adult obstetric brachial plexus injury (OBPI) patients, in general, use compensatory strategies to achieve their lost upper extremity functions; they cause some adverse effects. Our present study is a case series of 3 female adult OBPI patients, aged 46, 23 and 21 years old. They all had a modified Quad surgical procedure. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized upper extremity movements using the modified Mallet scale. The average postoperative follow-up was 4.3 months (1 to 9 months). Total Mallet score significantly improved from 15 and 18 to 21 in two patients. Supination angle measured from active movement of these 3 patients improved from 40°, 0° and -60° to 80°, 40° and -40°, respectively. The modified Quad surgical procedure significantly improves active abduction and other shoulder functions not only in young pediatric and adolescent patients, as we have previously reported, but also in adult patients with muscle imbalance secondary to brachial plexus injury sustained at birth. Full article

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Open AccessCase Report

Ewing’s Sarcoma with Distant Metastasis: A Brief Note on Management and Emerging Therapies

by Girish Gulab Meshram, Neeraj Kaur and Kanwaljeet Singh Hura

Clin. Pract. 2019, 9(3), 1111; https://doi.org/10.4081/cp.2019.1111 - 17 Sep 2019

Cited by 3 | Viewed by 780

Abstract

Ewing’s sarcoma is an aggressive fatal malignancy of bones and soft-tissue. It predominantly affects the young population, with a worldwide incidence of three cases per million. The pelvis, extremities, and ribs are the most common sites. We present a case of massive Ewing’s [...] Read more.

Ewing’s sarcoma is an aggressive fatal malignancy of bones and soft-tissue. It predominantly affects the young population, with a worldwide incidence of three cases per million. The pelvis, extremities, and ribs are the most common sites. We present a case of massive Ewing’s sarcoma of the right femur with metastasis to bones and lungs. The patient was treated with chemotherapy. However, he succumbed to his illness before completion of therapy. In conclusion, Ewing’s sarcoma with distant metastasis is a high risk case with poor prognosis. Integrating novel molecular targets with conventional chemotherapeutic agents holds a promise for high-risk Ewing’s sarcoma patients. Full article

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Open AccessCase Report

Acute Eosinophilic Appendicitis after Generalized Skin Reaction Due to Unknown Cause in a Child: Case Report and Literature Review

by Maria Aggelidou, Katerina Kambouri, Maria Kouroupi, Dimitrios Cassimos, Soultana Foutzitzi and Savas Deftereos

Clin. Pract. 2019, 9(3), 1177; https://doi.org/10.4081/cp.2019.1177 - 16 Sep 2019

Cited by 3 | Viewed by 777

Abstract

Acute eosinophilic appendicitis (AEA) is a rare variant of appendix inflammation possibly linked to allergy. Histopathological evidence of eosinophilic infiltration of the muscularis propria and edema separating the muscle fibers is the gold standard for the diagnosis. Here, we report a case of [...] Read more.

Acute eosinophilic appendicitis (AEA) is a rare variant of appendix inflammation possibly linked to allergy. Histopathological evidence of eosinophilic infiltration of the muscularis propria and edema separating the muscle fibers is the gold standard for the diagnosis. Here, we report a case of a young boy with AEA following a skin reaction of possible allergic origin. A 6-year-old male was presented to the emergency department with a two-day diffuse abdominal pain and tenderness in the right lower quadrant. A possible allergic reaction had occurred five days before as a pruritic rash. There was no history of allergy and the stool examination was negative for parasites. The initial diagnosis was acute appendicitis, and appendectomy was performed. The histopathological diagnosis was AEA. Further studies on the proper diagnostic and treatment approach of AEA before surgery are required. Full article

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Open AccessCase Report

Mycoplasma pneumoniae-Associated Transverse Myelitis Presenting as Asymmetric Flaccid Paralysis

by Shafee Salloum, Ajay Goenka and Elizabeth Ey

Clin. Pract. 2019, 9(3), 1142; https://doi.org/10.4081/cp.2019.1142 - 12 Sep 2019

Cited by 4 | Viewed by 1873

Abstract

Acute transverse myelitis is a rare spinal cord inflammatory disorder that manifests as sudden onset of motor, sensory, and autonomic dysfunctions. Here, we report a case of acute transverse myelitis in a 13-year-old boy secondary to Mycoplasma pneumoniae infection. He presented with left [...] Read more.

Acute transverse myelitis is a rare spinal cord inflammatory disorder that manifests as sudden onset of motor, sensory, and autonomic dysfunctions. Here, we report a case of acute transverse myelitis in a 13-year-old boy secondary to Mycoplasma pneumoniae infection. He presented with left facial palsy and contralateral upper extremity weakness without sensory or autonomic changes. The patient was diagnosed with transverse myelitis based on his magnetic resonance imaging findings, although his presentation was mainly motor dysfunction, which is more consistent with acute flaccid paralysis. Full article

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Open AccessCase Report

Diode Laser Assisted Excision of a Gingival Pyogenic Granuloma: A Case Report

by Dimitrios Andreadis, Ioanna Lazaridi, Eleftherios Anagnostou, Athanasios Poulopoulos, Prashanth Panta and Shankargouda Patil

Clin. Pract. 2019, 9(3), 1179; https://doi.org/10.4081/cp.2019.1179 - 27 Aug 2019

Cited by 7 | Viewed by 1530

Abstract

Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a [...] Read more.

Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser. Full article

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Open AccessCase Report

An Unusual Infection in an Immunocompetent Male from a Non-Endemic Area: Lessons from a Vacation

by Ritesh Neupane, Munish Sharma, Divakar Sharma, Rajeev Thachil, Mahesh Krishnamurthy and Gerald Lowman

Clin. Pract. 2019, 9(3), 1141; https://doi.org/10.4081/cp.2019.1141 - 09 Aug 2019

Cited by 1 | Viewed by 472

Abstract

Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys. It is not common in the East Coast of the United States, and is in fact, reportable [...] Read more.

Primary pulmonary histoplasmosis is found worldwide, and is particularly endemic in some areas of the North America, usually those surrounding the Ohio and Mississippi river valleys. It is not common in the East Coast of the United States, and is in fact, reportable in Pennsylvania. It has been rarely described in immunocompetent individuals residing in a non-endemic region. We present a case of a previously healthy middle-aged male, a Pennsylvania resident, who presented with mid-sternal chest discomfort, fatigue, chills and mild shortness of breath, and was diagnosed with primary pulmonary histoplasmosis. Full article

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Open AccessCase Report

Cardiac Papillary Fibroelastoma of a Bicuspid Aortic Valve in an Adolescent: A Case Report

by Sarah Dénes, Benoît Daron, Marie Behaeghe and Marie-Christine Seghaye

Clin. Pract. 2019, 9(3), 1135; https://doi.org/10.4081/cp.2019.1135 - 07 Aug 2019

Cited by 1 | Viewed by 575

Abstract

Cardiac papillary fibroelastomas (CPFE) are exceptional primary benign cardiac tumours affecting the heart valves. We report here the case of a 15-year-old boy in whom echocardiography performed for non-specific chest pain during follow-up for bicuspid aortic valve showed as accidental finding the presence [...] Read more.

Cardiac papillary fibroelastomas (CPFE) are exceptional primary benign cardiac tumours affecting the heart valves. We report here the case of a 15-year-old boy in whom echocardiography performed for non-specific chest pain during follow-up for bicuspid aortic valve showed as accidental finding the presence of a round mobile mass without stalk attached on the inferior side of the aortic valve. The mass did not cause any outflow tract obstruction or aortic insufficiency. Electrocardiogram-gated cardiac computed tomography and magnetic resonance imaging allowed to suspect CPFE. Although the patient was asymptomatic, open cardiac surgery with elective surgical resection of the tumour was performed to avoid systematic emboli. Histology confirmed the diagnosis of CPFE. This is an exceptional case of acquired CPFE in a young patient with bicuspid aortic valve. Due to the risk of systemic embolization, aortic or coronary ostium obstruction, elective excision of such lesions is recommended. Full article

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Open AccessCase Report

Giant Aggressive Forehead Tumor: A 15-Year Follow-Up

by Raymond Challita and Said Halabi

Clin. Pract. 2019, 9(3), 1172; https://doi.org/10.4081/cp.2019.1172 - 02 Aug 2019

Cited by 1 | Viewed by 510

Abstract

Proliferating trichilemmal tumors are rare tumors that originate from adnexal structures – specifically from the outer root sheaths of hair follicles. These tumors can be benign or malignant. We report a rare case of a giant aggressive forehead trichilemmal tumor that was paradoxically [...] Read more.

Proliferating trichilemmal tumors are rare tumors that originate from adnexal structures – specifically from the outer root sheaths of hair follicles. These tumors can be benign or malignant. We report a rare case of a giant aggressive forehead trichilemmal tumor that was paradoxically benign on pathology. It was surgically excised and followed-up for 15 years. Full article

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Clin. Pract., Volume 9, Issue 3 (August 2019) – 10 articles

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