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Clinics and Practice is published by MDPI from Volume 11 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with PAGEPress.

Clin. Pract., Volume 6, Issue 2 (April 2016) – 10 articles

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520 KiB  
Case Report
A Rare Association of Hepatitis a Virus Infection with Type-1 Diabetes
by Mohammed Hasosah, Alaa Bokhari, Ashraf Alsahafi, Ghassan Sukkar and Abdullah Alzaben
Clin. Pract. 2016, 6(2), 844; https://doi.org/10.4081/cp.2016.844 - 4 Jul 2016
Cited by 1 | Viewed by 622
Abstract
Patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases, which includes fatty liver, steatohepatitis and cirrhosis. The association of hepatitis A infection with type-1 diabetes is extremely rare. To the best of our knowledge, our case is the first [...] Read more.
Patients with type-1 diabetes are predisposed to develop a spectrum of liver diseases, which includes fatty liver, steatohepatitis and cirrhosis. The association of hepatitis A infection with type-1 diabetes is extremely rare. To the best of our knowledge, our case is the first case report in children. We described a nine year-old girl who had type-1 diabetes and developed hepatitis A virus infection without complications. A review of the literature is also provided. Full article
539 KiB  
Case Report
Acute, Severe Cryptosporidiosis in an Immunocompetent Pediatric Patient
by Caitlin Tallant, Patrick Huddleston, Asim Alshanberri and Subhasis Misra
Clin. Pract. 2016, 6(2), 837; https://doi.org/10.4081/cp.2016.837 - 4 Jul 2016
Cited by 9 | Viewed by 695
Abstract
Severe diarrheal illness in children can be attributed to a number of different microbiological agents. Without appropriate microbiological testing of stool samples, patients who present with multiple days of severe diarrhea might have a delay in proper diagnosis and treatment. Here, we report [...] Read more.
Severe diarrheal illness in children can be attributed to a number of different microbiological agents. Without appropriate microbiological testing of stool samples, patients who present with multiple days of severe diarrhea might have a delay in proper diagnosis and treatment. Here, we report a case of an immunocompetent pediatric patient presenting with acute cryptosporidiosis. Humans and bovine species are known hosts of cryptosporidium and several studies have evaluated the zoonotic transmission of cryptosporidium from cattle to humans. Adding diagnostic tests for cryptosporidium like Ziehl-Neelsen staining of stool or fecal rapid antigen detection techniques should be considered in the workup of patients presenting with undifferentiated, severe diarrheal illness, especially in those who have close contact with livestock. Full article
1027 KiB  
Brief Report
Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery
by Verena Heymanns, Abidemi W. Oseni, Ameer Alyeldien, Homajoun Maslehaty, Richard Parvin, Martin Scholz and Athanasios K. Petridis
Clin. Pract. 2016, 6(2), 824; https://doi.org/10.4081/cp.2016.824 - 4 Jul 2016
Cited by 5 | Viewed by 720
Abstract
Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to [...] Read more.
Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature. Full article
570 KiB  
Case Report
Transient Superficial Peroneal Nerve Palsy after Anterior Cruciate Ligament Reconstruction
by Majed Alrowaili
Clin. Pract. 2016, 6(2), 832; https://doi.org/10.4081/cp.2016.832 - 29 Jun 2016
Cited by 1 | Viewed by 776
Abstract
A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the [...] Read more.
A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status. Full article
151 KiB  
Case Report
Triorchidism: Presenting as Undescended Testis in a Case of Indirect Inguinal Hernia
by Ajay H. Bhandarwar, Saurabh S. Gandhi, Chintan B. Patel, Amol N. Wagh, Virendra Gawli and Nimesh A. Jain
Clin. Pract. 2016, 6(2), 786; https://doi.org/10.4081/cp.2016.786 - 23 Jun 2016
Cited by 3 | Viewed by 782
Abstract
Triorchidism is the commonest variety of polyorchidism, an entity with more than two testis is an extremely rare congenital anomaly of the testis. Although excision of the abnormal testis is a safer alternative proposed, recent literature suggests more conservative approach in normal testes [...] Read more.
Triorchidism is the commonest variety of polyorchidism, an entity with more than two testis is an extremely rare congenital anomaly of the testis. Although excision of the abnormal testis is a safer alternative proposed, recent literature suggests more conservative approach in normal testes with watchful regular follow up to screen for malignancy. This case presented as a left inguinal swelling diagnosed as indirect left inguinal hernia. The left side testis was of smaller size (about half) with normal sperm count, morphology and motility. Intraoperatively indirect inguinal hernia was noted with supernumerary testis at deep ring in addition to normal left testis in left scrotal sac. The ectopic testis were small (2.5×2.5×1 cm) lacking epididymis and with short vas deferens. An evident normal semen analysis and varied anatomy, the decision for orchidectomy of ectopic testis was taken. The histopathological finding was consistent with arrest in germ cell development. Full article
677 KiB  
Article
Further Effort Is Needed to Improve Management of Chronic Pain in Primary Care. Results from the Arkys Project
by Gaetano Piccinocchi and Roberto Piccinocchi
Clin. Pract. 2016, 6(2), 855; https://doi.org/10.4081/cp.2016.855 - 21 Jun 2016
Cited by 1 | Viewed by 836
Abstract
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 [...] Read more.
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. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years) had mostly chronic non-cancer pain (87.7%). In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%). Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%). NSAID prescription decreased (12.8%), while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation. Full article
563 KiB  
Case Report
Huge Aneurysm of the Proper Hepatic Artery
by Mohamed Amine Attaoui, Rached Bayar, Zeineb Mzoughi, Sahir Omrani, Lassaad Gharbi and Mohamed Taher Khalfallah
Clin. Pract. 2016, 6(2), 846; https://doi.org/10.4081/cp.2016.846 - 17 Jun 2016
Cited by 1 | Viewed by 549
Abstract
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 [...] Read more.
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. Full article
651 KiB  
Case Report
Metastatic Clear Cell Renal Cell Carcinoma Presenting with a Gingival Metastasis
by Rusha A.E. Ali and Kamal E.H. Mohamed
Clin. Pract. 2016, 6(2), 847; https://doi.org/10.4081/cp.2016.847 - 10 Jun 2016
Cited by 6 | Viewed by 620
Abstract
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 [...] Read more.
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. Full article
586 KiB  
Case Report
Ultrasound-Guided Greater Auricular Nerve Block as Sole Anesthetic for Ear Surgery
by Michael K. Ritchie, Colin A. Wilson, Brian W. Grose, Pavithra Ranganathan, Stephen M. Howell and Matthew B. Ellison
Clin. Pract. 2016, 6(2), 856; https://doi.org/10.4081/cp.2016.856 - 23 May 2016
Cited by 10 | Viewed by 1000
Abstract
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 [...] Read more.
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 ultrasoundguided version offers several potential advantages. These advantages include increased reliability of the nerve block, as well as prevention of inadvertent vascular puncture or blockade of the phrenic nerve, brachial plexus, or deep cervical plexus. The increasing access to ultrasound technology for medical care providers outside the operating room makes this ultrasound guided block an increasingly viable alternative. Full article
628 KiB  
Case Report
Exercise-Triggered Chest Pain as an Isolated Symptom of Myocarditis in Children
by Prisca Tshimanga, Benoît Daron, Nesrine Farhat, Brigitte Desprechins, Marc Gewillig and Marie-Christine Seghaye
Clin. Pract. 2016, 6(2), 843; https://doi.org/10.4081/cp.2016.843 - 26 Apr 2016
Cited by 2 | Viewed by 636
Abstract
In childhood, chest pain occurring at exercise is a common complaint. A cardiac etiology for it is exceptionally found, explaining that most children do not undergo systematic cardiological investigation. However, chest pain at exercise may manifest as the unique symptom of a viral [...] Read more.
In childhood, chest pain occurring at exercise is a common complaint. A cardiac etiology for it is exceptionally found, explaining that most children do not undergo systematic cardiological investigation. However, chest pain at exercise may manifest as the unique symptom of a viral myocarditis. Recognizing this form of myocardial injury, however, might help to avoid clinical deterioration by providing adequate care. In this paper, we report on two children presenting with the unique clinical symptom of chest pain related to physical activity and in whom laboratory and cardiac investigations suggested transient myocardial damage related to myocarditis. Full article
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