Clinics and Practice

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Open AccessCase Report

Anesthetic Management of a Neonate with Congenital Diaphragmatic Hernia under High-Frequency Oscillatory Ventilation

by Ipek S. Edipoglu, Fatma Celik, Tutku Ozdogan, Serdar Comert and B. Haluk Guvenc

Clin. Pract. 2018, 8(2), 1057; https://doi.org/10.4081/cp.2018.1057 - 25 Jun 2018

Cited by 3 | Viewed by 890

Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitted to neonatal [...] Read more.

Perioperative management of a neonate with congenital diaphragmatic hernia (CDH) is challenging because of pulmonary hypoplasia, pulmonary hypertension, and respiratory insufficiency. In this report, we present our intra-operative experience in a 4-days old and 3070 grams CDH neonate. He was admitted to neonatal intensive care unit and intubated due to severe respiratory insufficiency. He showed signs of severe pulmonary hypoplasia and his echocardiography revealed a cardiac dextroversion. The patient was relatively stabilized after four days under combined high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO). A corrective surgical intervention was sustained with dopamine, dobutamine, fentanyl and midazolam infusions. Ventilator settings were: 9 cmH₂O MAP; 15-Hz frequency; 30 cmH₂O amplitude and 55% FiO₂. Venous-blood gas analysis indicated pH:7.38 pO₂:36.2, pCO₂:39.2 with SpO₂:98%. We believe that HFOV and iNO combination is an effective alternative for the anesthetic management of CDH cases as it provides better gas exchange and less volutrauma. Full article

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Open AccessCase Report

Bone Marrow Abnormalities Detected by Magnetic Resonance Imaging as Initial Sign of Hematologic Malignancies

by Ida Sofie Grønningsæter, Aymen Bushra Ahmed, Nils Vetti, Silje Johansen, Øystein Bruserud and Håkon Reikvam

Clin. Pract. 2018, 8(2), 1061; https://doi.org/10.4081/cp.2018.1061 - 7 Jun 2018

Cited by 7 | Viewed by 906

Abstract

The increasing use of radiological examination, especially magnetic resonance imaging (MRI), will probably increase the risk of unintended discovery of bone marrow abnormalities in patients where a hematologic disease would not be expected. In this paper we present four patients with different hematologic [...] Read more.

The increasing use of radiological examination, especially magnetic resonance imaging (MRI), will probably increase the risk of unintended discovery of bone marrow abnormalities in patients where a hematologic disease would not be expected. In this paper we present four patients with different hematologic malignancies of nonplasma cell types. In all patients the MRI bone marrow abnormalities represent an initial presentation of the disease. These case reports illustrate the importance of a careful diagnostic follow-up without delay of patients with MRI bone marrow abnormalities, because such abnormalities can represent the first sign of both acute promyelocytic leukemia as well as other variants of acute leukemia. Full article

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Open AccessCase Report

Revisiting Transthyretin Related Cardiac Amyloidosis: Case Report and Review of Literature

by Munish Sharma, Eduard Koman, Gary S. Ledley and Sung-Hae Cho

Clin. Pract. 2018, 8(2), 1054; https://doi.org/10.4081/cp.2018.1054 - 16 May 2018

Cited by 2 | Viewed by 515

Abstract

Amyloidosis is a complex group of disorders that can involve many organs and cause their dysfunction. Cardiac involvement indicates worse prognosis and influences treatment strategies. Cardiac amyloidosis is an under-diagnosed entity and high index of clinical suspicion and careful interpretation of basic diagnostic [...] Read more.

Amyloidosis is a complex group of disorders that can involve many organs and cause their dysfunction. Cardiac involvement indicates worse prognosis and influences treatment strategies. Cardiac amyloidosis is an under-diagnosed entity and high index of clinical suspicion and careful interpretation of basic diagnostic tools such as electrocardiogram and echocardiography is needed for early detection. Congestive heart failure due to restrictive pattern and/or conduction system abnormality, in absence of coronary artery disease should raise suspicion. We present a case of transthyretin related cardiac amyloidosis and discuss the key clinical and diagnostic findings along with review of existing literature regarding its management and outcomes. Full article

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Open AccessBrief Report

The Frequency of Clinical Manifestations of Hypophosphatemic Rickets in Patients with Therapeutic Strategies

by Leila Kanafi Vahed, Afshin Arianpur and Mohammad Esmaeili

Clin. Pract. 2018, 8(2), 1072; https://doi.org/10.4081/cp.2018.1072 - 10 May 2018

Viewed by 500

Abstract

The aim of this study was to evaluate the frequency of clinical manifestations of various types of rickets in patients could be effective in therapeutic strategies. A total of eleven child patients (7 females and 4 males) were included in the present study. [...] Read more.

The aim of this study was to evaluate the frequency of clinical manifestations of various types of rickets in patients could be effective in therapeutic strategies. A total of eleven child patients (7 females and 4 males) were included in the present study. The patients were admitted to the hospital with hypophosphatemic rickets. In our study, the age at the time of diagnosis ranged from 1 to15 years. Mean age of first presentations at final diagnosis was determined to be 5.5 an 2 years, respectively. Five patients out of 11 patients had showed significant history of vitamin D3 resistance. Family history of similar skeletal problems was reported to be positive in six patients. Furthermore, there were seven relative marriages in parents. Mean value of Gomez index has been revealed as 64%. Mean serum phosphate level was detected as 2.9 mg/dL, that this level in males (2.2 mg/dL) was significantly less than females (3.4 mg/dL) (P=0.5). Mean serum alkaline phosphatase activity was reached 913 IU/L. Alkaline phosphatase activity in women (1075 IU/L) was significantly lower than that of men (750 IU/L), (P=0.5). Definitive treatment with oral phosphate and vitamin D3 can prevent complications of the disease and the side effects of unconventional treatments. Full article

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Open AccessCase Report

Systemic Lupus Erythematosus Flare up as Acute Spinal Subarachnoid Hemorrhage with Bilateral Lower Limb Paralysis

by Xiang Yang, Seidu A. Richard, Jiagang Liu and Siqing Huang

Clin. Pract. 2018, 8(2), 1069; https://doi.org/10.4081/cp.2018.1069 - 10 May 2018

Cited by 2 | Viewed by 545

Abstract

Subarachnoid hemorrhage (SAH) is an uncommon complication of systemic lupus erythematosus (SLE). Solitary association of fatal spinal SAH as a complication of SLE, has not been encountered much in literature although coexisting acute cerebral and spinal SAH have been associated with SLE. We [...] Read more.

Subarachnoid hemorrhage (SAH) is an uncommon complication of systemic lupus erythematosus (SLE). Solitary association of fatal spinal SAH as a complication of SLE, has not been encountered much in literature although coexisting acute cerebral and spinal SAH have been associated with SLE. We present a 39-year old female with initial diagnosis of SLE eight years ago who suddenly developed a productive cough, acute abdomen and paralysis of the lower limbs. Magnetic resonance imaging of the spine revealed thoracic spinal SAH with varying degrees of thoracic spinal cord compression. The hemorrhage was total evacuated via surgery. She regained normal function of her lower limbers after the operation with no further neurological complications. One of the rare but fatal complications of SLE is solitary spinal SAH without cranial involvement. The best and most appropriate management of this kind of presentation is surgical decompression of the hematoma with total hemostasis. The cause of hemorrhage should be identified intra-operatively and treated appropriately. Full article

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Open AccessCase Report

A Case of Scarred Uterine Rupture at 11 Weeks of Gestation Having a Uterine Scar Places Induced by In Vitro Fertilization-Embryo Transfer

by Akiko Takashima, Naoki Takeshita and Toshihiko Kinoshita

Clin. Pract. 2018, 8(2), 1038; https://doi.org/10.4081/cp.2018.1038 - 10 May 2018

Cited by 6 | Viewed by 529

Abstract

Having a uterine scar places a woman at increased risk of complications, such as Cesarean scar pregnancy (CSP), uterine rupture, placenta previa, and placenta accreta, in subsequent pregnancies. We report a case of uterine rupture at 11 weeks of gestation in a woman [...] Read more.

Having a uterine scar places a woman at increased risk of complications, such as Cesarean scar pregnancy (CSP), uterine rupture, placenta previa, and placenta accreta, in subsequent pregnancies. We report a case of uterine rupture at 11 weeks of gestation in a woman with a previous Cesarean section. A 43-year-old woman with a history of abdominal myomectomy and Cesarean section had her pregnancy induced by in vitro fertilization with donor eggs. The exact location of the gestational sac was identified on her first day of hospitalization, and her pregnancy was suspected to be a CSP. The following day, the patient complained of sudden lower abdominal pain. A uterine scar rupture was diagnosed, and an emergency surgery was required. It may be that first-trimester screening could allow the early recognition of patients at risk for these perinatal complications. Full article

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Open AccessCase Report

Early Prenatal Diagnosis of Parapagus Conjoined Twins

by Ângela Melo, Rita Dinis, António Portugal, Ana Isabel Sousa and Isabel Cerveira

Clin. Pract. 2018, 8(2), 1039; https://doi.org/10.4081/cp.2018.1039 - 28 Mar 2018

Cited by 3 | Viewed by 663

Abstract

Conjoined twinning occurs in 1/100 of monozygotic twins, 1/50,000 gestations and 1/250,000 live births. It is the consequence of a division event at the primitive streak stage of the human embryonic development, about 13-14 days after fertilisation, in monochorionic monoamniotic gestations. A healthy [...] Read more.

Conjoined twinning occurs in 1/100 of monozygotic twins, 1/50,000 gestations and 1/250,000 live births. It is the consequence of a division event at the primitive streak stage of the human embryonic development, about 13-14 days after fertilisation, in monochorionic monoamniotic gestations. A healthy pregnant woman, Gravida 2 Para 1, was admitted into our Fetal Medicine Unit to perform the first trimester ultrasound. A diagnosis of conjoined parapagus twinning based on ultrasound features was made at 11 weeks of gestation, and the couple decided to terminate the pregnancy. The ultrasound showed two independent skulls and hearts, a shared spine below the thoracic level, and a shared stomach. The pathological findings were slightly different, showing two independent stomachs draining into a common duodenum. The karyotype was 46 XY. Early prenatal ultrasound may provide a window to counsel the family and to offer an early termination of pregnancy. Full article

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Open AccessCase Report

Rectal Leiomyoma, a Rare Entity

by Tagore Sunkara, Eric Omar Then, Andrea Culliford and Vinaya Gaduputi

Clin. Pract. 2018, 8(2), 1053; https://doi.org/10.4081/cp.2018.1053 - 21 Mar 2018

Cited by 7 | Viewed by 963

Abstract

Rectal tumors are often encountered as an incidental finding on screening colonoscopy. As per the World Health Organization, they are categorized according to their histologic appearance. These include epithelial tumors, mesenchymal tumors and lymphomas. Of interest, in our case, are mesenchymal tumors. These [...] Read more.

Rectal tumors are often encountered as an incidental finding on screening colonoscopy. As per the World Health Organization, they are categorized according to their histologic appearance. These include epithelial tumors, mesenchymal tumors and lymphomas. Of interest, in our case, are mesenchymal tumors. These are sub-classified into leiomyomas and gastrointestinal stromal tumors. Our case is a 33-year old male who was diagnosed with a rectal leiomyoma. The uncommon incidence and subsequent management of a rectal leiomyoma in a male, make this case worthy for literature review. Full article

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Open AccessCase Report

Misleading Hepatitis B Serology Following Rho (D) Immune Globulin (Human) Injection and Influenza Vaccine

by Xuanxuan Chen

Clin. Pract. 2018, 8(2), 1037; https://doi.org/10.4081/cp.2018.1037 - 21 Mar 2018

Cited by 1 | Viewed by 563

Abstract

Having a hepatitis B surface antibody (HBsAb) titre of more than 10 mIU/mL after hepatitis B vaccination is generally considered to confer immunity to hepatitis B. This case report discusses an unusual case of a false positive hepatitis B core total antibody (HBcAb) [...] Read more.

Having a hepatitis B surface antibody (HBsAb) titre of more than 10 mIU/mL after hepatitis B vaccination is generally considered to confer immunity to hepatitis B. This case report discusses an unusual case of a false positive hepatitis B core total antibody (HBcAb) following administration of either Rho (D) immune globulin (Human) injection or influenza vaccine in a patriuent who was previously immunised against hepatitis B. Full article

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Clin. Pract., Volume 8, Issue 2 (March 2018) – 9 articles

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