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https://www.readbyqxmd.com/read/28028432/rhabdomyolysis-and-autoimmune-variant-stiff-person-syndrome
#1
Shreyas Gangadhara, Suhas Gangadhara, Chetan Gandhy, Derrick Robertson
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/28028431/oncocytic-pleomorphic-adenoma-of-palatal-salivary-gland-with-macrophages-and-giant-cells-associated-with-cholesterol-crystals
#2
Gargi S Sarode, Sachin C Sarode, Shankargouda Patil, Sukumaran Anil
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/28028430/a-child-with-debilitating-pruritus
#3
Nikhil Sonthalia, Samit S Jain, Vinay B Pawar, Vinay G Zanwar, Ravindra G Surude, Pravin M Rathi, Kshitij K Munde, Sandeep Bavdekar
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/28028429/gastric-schwannoma-a-case-report
#4
Hayfa Romdhane, Myriam Cheikh, Zeineb Mzoughi, Sana Ben Slama, Rym Ennaifer, Najet Belhadj
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27994842/diode-laser-versus-scalpel-in-the-treatment-of-hereditary-gingival-fibromatosis-in-a-6-year-old-boy
#5
Samia Aboujaoude, Antoine Cassia, Carla Moukarzel
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27994841/do-all-critical-aortic-stenosis-with-chest-pain-need-aortic-valve-replacement-a-case-report
#6
Munish Sharma, Daniel A N Mascarenhas
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27994840/intraspinal-lumbar-juxtaarticular-cyst-treatment-through-ct-guided-percutaneus-induced-rupture-results-in-a-favorable-patient-outcome
#7
Adisa Kursumovic, Richard Bostelmann, Maria Gollwitzer, Stefan Rath, Hans Jakob Steiger, Athanasios K Petridis
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...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777715/bifid-mandibular-canal-a-rare-or-underestimated-entity
#8
Ibrahim Nasseh, Georges Aoun
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.
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777714/giant-adrenal-cavernous-hemangioma-in-a-patient-with-familial-adenomatous-polyposis
#9
Dhouha Bacha, Abir Chaabane, Fatma Khanche, Saloua NĂ©chi, Hassen Touinsi, Emna Chelbi
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 18x17 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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777713/medication-error-when-switching-from-warfarin-to-rivaroxaban-leading-to-spontaneous-large-ecchymosis-of-the-abdominal-and-chest-wall
#10
Flavio Egger, Federica Targa, Ivan Unterholzner, Russell P Grant, Markus Herrmann, Christian J Wiedermann
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777712/midterm-results-of-consecutive-periprosthetic-femoral-fractures-vancouver-type-a-and-b
#11
Klemens Trieb, Rainer Fiala, Christian Briglauer
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777711/cocaine-use-and-splenic-rupture-a-rare-yet-serious-association
#12
Nishrutha Karthik, Karthik Gnanapandithan
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777710/oromandibular-dystonia-a-case-report-of-the-lateral-pterygoid-muscle-involvement-and-treatment-with-botulinum-toxin-a
#13
Athanasia Alexoudi, Zoi Dalivigka, Anna Siatouni, Anastasia Verentzioti, Stylianos Gatzonis
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777709/genetic-counseling-for-a-prenatal-diagnosis-of-structural-chromosomal-abnormality-with-high-resolution-analysis-using-a-single-nucleotide-polymorphism-microarray
#14
Akiko Takashima, Naoki Takeshita, Toshihiko Kinoshita
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777708/persistent-hyperinsulinism-in-kabuki-syndrome-2-case-report-and-literature-review
#15
Hobia Gole, Raymond Chuk, David Coman
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...
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27777707/multiple-esophageal-foreign-bodies-in-an-infant-a-rare-case-of-serious-parental-neglect
#16
Arunabha Chakravarti, Sunil Garg, Rahul Bhargava
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.
August 8, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27478586/ultrasound-guided-greater-auricular-nerve-block-as-sole-anesthetic-for-ear-surgery
#17
Michael K Ritchie, Colin A Wilson, Brian W Grose, Pavithra Ranganathan, Stephen M Howell, Matthew B Ellison
A greater auricular nerve (GAN) block was used as the sole anesthetic for facial surgery in an 80-year-old male patient with multiple comorbidities which would have made general anesthesia challenging. The GAN provides sensation to the ear, mastoid process, parotid gland, and angle of the mandible. In addition to anesthesia for operating room surgery, the GAN block can be used for outpatient or emergency department procedures without the need for a separate anesthesia team. Although this nerve block has been performed using landmark-based techniques, the ultrasound-guided version offers several potential advantages...
April 26, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27478585/further-effort-is-needed-to-improve-management-of-chronic-pain-in-primary-care-results-from-the-arkys-project
#18
Gaetano Piccinocchi, Roberto Piccinocchi
Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs) in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire...
April 26, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27478584/metastatic-clear-cell-renal-cell-carcinoma-presenting-with-a-gingival-metastasis
#19
Rusha A E Ali, Kamal E H Mohamed
Metastatic deposits to the oral cavity are exceptionally rare. The commonest tumor types metastasizing to the oral cavity include lung and breast carcinoma. Renal cell carcinoma is believed to be the third most common infra clavicular tumor to metastasize to the head and neck. We report a case where an oral cavity deposit was the initial presentation for an occult clear cell renal carcinoma. Additional therapeutic options, including immunotherapy, tyrosine kinase inhibitors, and participation in a clinical trial, should be discussed with the patient despite the poor overall prognosis...
April 26, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27478583/huge-aneurysm-of-the-proper-hepatic-artery
#20
Mohamed Amine Attaoui, Rached Bayar, Zeineb Mzoughi, Sahir Omrani, Lassaad Gharbi, Mohamed Taher Khalfallah
Hepatic artery aneurysms are rarely diagnosed. It is mainly because of non specific symptoms. They are generally an incidental findings during imaging studies. They are usually detected in the sixth decade, predominantly in men. We report herein a case of an 80 year-old man with a huge hepatic artery aneurysm revealed by abdominal pain and chronic anemia. It was treated by embolisation. Hepatic artery aneurysms are second among visceral aneurysms. They may cause abdominal pain, jaundice and hemorrhagic events...
April 26, 2016: Clinics and Practice
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