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Clin. Pract., Volume 11, Issue 2 (June 2021) – 8 articles

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Open AccessCase Report
Inappropriate Sinus Tachycardia Following Viral Illness
Clin. Pract. 2021, 11(2), 219-222; https://doi.org/10.3390/clinpract11020032 - 09 Apr 2021
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Abstract
A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. [...] Read more.
A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion. Full article
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Open AccessCase Report
Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis
Clin. Pract. 2021, 11(2), 216-218; https://doi.org/10.3390/clinpract11020031 - 06 Apr 2021
Viewed by 240
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the [...] Read more.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication. Full article
Open AccessReview
Malignant Phyllodes Tumor of the Breast: A Practice Review
Clin. Pract. 2021, 11(2), 205-215; https://doi.org/10.3390/clinpract11020030 - 06 Apr 2021
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Abstract
Introduction: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Objective: Our objective was to provide [...] Read more.
Introduction: Phyllodes tumor (PT) of the breast, particularly malignant phyllodes tumor (mPT), is a rare fibroepithelial neoplasm. A complex diagnosis is based on pathologic, radiologic, and clinical findings, with controversies about what is the best therapeutic strategy. Objective: Our objective was to provide an overview of the clinical, pathologic, and therapeutic aspects of this rare tumor. Conclusions: mPT is a rare presentation of breast cancer and a challenge in clinical practice. A multidisciplinary approach should take into account some aspects like pathogenic mutations and hereditary syndromes. Oncologic surgery is the fundamental approach, and the use of adjuvant therapies is still controversial due to the lack of clinical trials. Treatment recommendations should be individualized according to patient risk and preferences. Prospective studies are fundamental to clarifying the best treatment for these tumors. Full article
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Open AccessCase Report
Ruptured Emphysematous Liver Abscess: An Unusual Presentation in Kochs
Clin. Pract. 2021, 11(2), 200-204; https://doi.org/10.3390/clinpract11020029 - 02 Apr 2021
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Abstract
Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed [...] Read more.
Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed in the background of a tuberculous liver abscess is rare. We present a case of ruptured GFLA with underlying tuberculous pathology in a normoglycemic patient. The abscess was managed by image guided intervention. A brief case report along with review of literature is presented. Full article
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Open AccessArticle
Laying Open and Curettage under Local Anesthesia to Treat Pilonidal Sinus: Long-Term Follow-Up in 111 Consecutively Operated Patients
Clin. Pract. 2021, 11(2), 193-199; https://doi.org/10.3390/clinpract11020028 - 01 Apr 2021
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Abstract
(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this [...] Read more.
(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this study, the long-term follow-up in a large series was analyzed. (2) Methods: The laying open approach was performed for all types of consecutive PSD patients—simple, complicated, and abscess. The primary outcome parameter of the study was the healing rate. The secondary outcome parameters were operating time, hospital stay, time to resumption of normal work, and healing time. (3) Results: 111 (M/F–92/19, mean age-22.9 ± 5.7 years) consecutive patients were operated on and followed for 38 months (6–111 months). Of these, 24 had pilonidal abscesses, 87 had chronic pilonidal disease, while 22 had recurrent disease. Operating time and hospital stay were 24 ± 7 min and 66 ± 23 min, respectively. On average, patients could resume normal work in 3.6 ± 2.9 days and the healing time was 43.8 ± 7.4 days. Three patients were lost to follow-up. Complete resolution of the disease occurred in 104/108 (96.3%) patients, while 4 (3.7%) had a recurrence. One recurrence was due to a missed tract, while three recurrences presented after complete healing had occurred. Two patients with recurrence were operated on again with the same procedure, and both healed completely. Thus, the overall success rate of this procedure was 98.1% (106/108) with a recurrence rate after first surgery of 3.7% over a median follow-up of 38 months. (4) Conclusions: Pilonidal disease managed by laying open (deroofing) with curettage under local anesthesia is associated with a high cure rate. This procedure is effective in treating all kinds of pilonidal disease (simple, complicated, and abscess). Full article
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Open AccessCase Report
Synergistic Effects of Dexamethasone and Dexmedetomidine in Extending the Effects of Pectoral I and Pectoral II Blocks for Postoperative Analgesia Following Total Mastectomy with Lymph Node Dissection
Clin. Pract. 2021, 11(2), 190-192; https://doi.org/10.3390/clinpract11020027 - 30 Mar 2021
Viewed by 239
Abstract
Regional anesthesia is an important aspect of the overall anesthetic plan for patients. It has the potential to offer superior benefits compared to opioid-based treatment and is an important component of Enhanced Recovery after Surgery (ERAS) protocols. The use of the pectoral type [...] Read more.
Regional anesthesia is an important aspect of the overall anesthetic plan for patients. It has the potential to offer superior benefits compared to opioid-based treatment and is an important component of Enhanced Recovery after Surgery (ERAS) protocols. The use of the pectoral type I (PECS I) and pectoral type II blocks (PECS II) has been shown to reduce postoperative pain and opioid consumption in patients undergoing complete mastectomy and breast surgery. We describe the use of dexamethasone and dexmedetomidine to prolong the analgesic effects of these regional blocks in a patient undergoing total mastectomy with lymph node dissection. Full article
Open AccessCase Report
Esophagitis Dissecans Superficialis (EDS) Secondary to Hair Dye Ingestion: Case Report and Literature Review
Clin. Pract. 2021, 11(2), 185-189; https://doi.org/10.3390/clinpract11020026 - 29 Mar 2021
Viewed by 262
Abstract
Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and [...] Read more.
Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and distal thirds of the esophagus. When present, EDS is best treated by discontinuing the offending agent and initiating pharmacologic therapy with proton pump inhibitors. Steroids may also be effective if the etiology is autoimmune in nature. Our case highlights a 65-year-old female diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and para-phenylenediamine (PPD). Full article
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Open AccessBrief Report
A Prospective Study Comparing Laparoscopic vs. Conventional Stomach Pull Up in Total Pharyngo-Laryngo-Esophagectomy for Post Cricoid Cancer
Clin. Pract. 2021, 11(2), 178-184; https://doi.org/10.3390/clinpract11020025 - 29 Mar 2021
Viewed by 261
Abstract
The aim of this study is to compare laparoscopic and conventional techniques following Total Pharyngo-laryngo-esophagectomy (TPLE) with respect to perioperative morbidity and mortality and postoperative recovery in post cricoid cancer patients. This is a prospective study, which was undertaken in Gujrat Cancer Research [...] Read more.
The aim of this study is to compare laparoscopic and conventional techniques following Total Pharyngo-laryngo-esophagectomy (TPLE) with respect to perioperative morbidity and mortality and postoperative recovery in post cricoid cancer patients. This is a prospective study, which was undertaken in Gujrat Cancer Research Institute (GCRI) in the period of July 2007 to March 2010. Fifteen consecutive patients who underwent laparoscopic TPLE were compared to that of 18 consecutive patients who underwent open TPLE. Laparoscopic and open TPLE procedure were compared with respect to patient characteristics, intra operative and complications present. The average duration was observed to be 3.5 h in the MIS (Minimally Invasive Group) group and was 5.3 h in the open group. The average blood loss was 300 mL in the MIS group and 500 mL in the open group. Average duration of the hospital stay in the MIS group was 13 days and 16 days in the open group. In the MIS group, one patient (6.7%) had a pneumonic complication and two patients (13%) had wound complications. In the open group, six patients (33%) had pneumonic consolidation and four patients (22%) had wound infections. In both groups, one patient each suffered mortality. Laparoscopic TPLE has been found to be much safer with less morbidity as compared with open surgery. Full article
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