Clinics and Practice

388 KiB

Open AccessCase Report

Multiple Doses of Cell Therapy and Neurorehabilitation in Amyotrophic Lateral Sclerosis: A Case Report

by Alok Sharma, Hemangi Sane, Amruta Paranjape, Radhika Pradhan, Rohit Das, Hema Biju, Nandini Gokulchandran and Prerna Badhe

Clin. Pract. 2020, 10(3), 1242; https://doi.org/10.4081/cp.2020.1242 - 28 Sep 2020

Cited by 3 | Viewed by 765

Abstract

Cell therapy, along with intensive rehabilitation has been shown to significantly improve outcomes in amyotrophic lateral sclerosis (ALS), in addition to standard therapy. We present a 40-years-old male ALS patient, suffering for the past four years, who underwent multiple doses of cell therapy [...] Read more.

Cell therapy, along with intensive rehabilitation has been shown to significantly improve outcomes in amyotrophic lateral sclerosis (ALS), in addition to standard therapy. We present a 40-years-old male ALS patient, suffering for the past four years, who underwent multiple doses of cell therapy at our institution. Along with riluzole treatment and lithium co-administration, his treatment involved multiple intrathecal transplants of autologous bone marrow-derived mononuclear cells, followed by multidisciplinary neurorehabilitation. The outcome measures of ALSFunctional Rating Scale Revised score remained stable, and importantly, Six Minute Walk Test distance improved from 475.2 m to 580.8 m, over a span of 16 months. Improved outcomes are indicative of slowing down of disease progression. Multiple doses of intrathecal autologous cell therapy along with rehabilitation and lithium, in addition to standard riluzole treatment is a novel approach for decelerating disease progression and qualitatively improving living conditions for ALS patients and their caregivers. Full article

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Open AccessCase Report

Multiple Extra-Splanchnic Venous Thromboses—An Unusual Vascular Complication of Acute Pancreatitis

by Junare Parmeshwar Ramesh, Chandnani Sanjay, Suhas Udgirkar, Nair Sujit, Debnath Prasanta, Modi Ammar, Debnath Partha, Jain Shubham, Ravi Thanage, Rathi Pravin and Contractor Qais

Clin. Pract. 2020, 10(3), 1226; https://doi.org/10.4081/cp.2020.1226 - 28 Sep 2020

Cited by 2 | Viewed by 753

Abstract

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable clinical presentations. Splanchnic venous thrombosis is a well-known vascular complication of AP and commonly present as thrombosis of the splanchnic venous system: splenic vein (SplV), portal vein (PV) and superior [...] Read more.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas with variable clinical presentations. Splanchnic venous thrombosis is a well-known vascular complication of AP and commonly present as thrombosis of the splanchnic venous system: splenic vein (SplV), portal vein (PV) and superior mesenteric vein (SMV), either separately or in combinations. Involvement of extra-splanchnic vessels is rare and associated with morbidity and mortality. Vascular complications are late phenomena and usually associated with local complications of AP, namely acute fluid collections, necrotizing pancreatitis and walled-off pancreatic necrosis. Pathogenesis of venous thrombosis is multifactorial in which pancreatic inflammation and systemic inflammatory response play a key role. At present, there are no consensus guidelines on treatment and use of anticoagulation for venous thrombosis in the setting of AP. Limited literature suggests the use of anticoagulation in presence of PV with or without SMV thrombosis and extrasplanchnic vessel involvement. Literature on extra-splanchnic vessels involvement in acute pancreatitis is sparse. Here we present two cases with multiple extra-splanchnic vessels involvement and their management. Full article

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Open AccessCase Report

Dental Prosthetic Rehabilitation of Papillon-Lefèvre Syndrome: A Case Report

by Shweta M. Patil, Suryakant B. Metkari, Shilpa Shetty, Savita Thakkannavar, Sachin C. Sarode, Gargi S. Sarode, Namrata Sengupta and Shankargouda Patil

Clin. Pract. 2020, 10(3), 1285; https://doi.org/10.4081/cp.2020.1285 - 21 Sep 2020

Cited by 3 | Viewed by 842

Abstract

Papillon-Lefèvre syndrome (PLS) is a rare disorder characterized by palmar plantar hyperkeratosis and rapidly progressive periodontitis with loss of deciduous and permanent dentition at an early age. It is reported to occur in 1 to 4 individuals per million people. This case report [...] Read more.

Papillon-Lefèvre syndrome (PLS) is a rare disorder characterized by palmar plantar hyperkeratosis and rapidly progressive periodontitis with loss of deciduous and permanent dentition at an early age. It is reported to occur in 1 to 4 individuals per million people. This case report presents highlighting features of the rare PLS in a 17-year old male who complained of discomfort while mastication and it was accompanied with symmetrical, sharply demarcated erythematous plaques involving the skin of the palms and soles, which extended to the finger joints, elbows, and knees. Along with the rough and dry skin, hyperhidrosis of lesion with a foul odor and transverse grooving of nails were noted. The past dental history revealed normal eruption of deciduous teeth followed by pre-mature mobility and shedding in 4-6 months. Permanent teeth also showed normal eruption and early shedding in the next 4-5 years. Complete edentulous maxillary and mandibular arches led to a decrease in alveolar bone and facial heights. There was no similar disorder in the patient’s family but family history revealed the consanguineous marriage of the patient’s parents. Full article

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Open AccessCase Report

Cerebral Cavernous Malformation in a Patient with Pontine Hemorrhage: A Case Study

by Myrto Palkopoulou, Eleni Bakola, Marina Foliadi, Petros Stefanidis and P. Teresa Acquaviva

Clin. Pract. 2020, 10(3), 1211; https://doi.org/10.4081/cp.2020.1211 - 21 Sep 2020

Cited by 3 | Viewed by 774

Abstract

The cerebral cavernous malformations are benign vascular hamartomas, with thin and dilated vascular walls and therefore constantly susceptible to hemorrhage. Clinically, they present with recurrent headaches, acute intracranial hemorrhage and focal neurological deficits. They are considered as angiographically occult vascular malformations and the [...] Read more.

The cerebral cavernous malformations are benign vascular hamartomas, with thin and dilated vascular walls and therefore constantly susceptible to hemorrhage. Clinically, they present with recurrent headaches, acute intracranial hemorrhage and focal neurological deficits. They are considered as angiographically occult vascular malformations and the imaging technique of choice for their diagnosis is magnetic resonance tomography. We present the case of a female patient with acute-onset symptomatology, congruent with a lesion in the basal pons. Her medical history included an intracranial hemorrhage due to a cavernoma, which was surgically removed. The magnetic resonance imaging of the brain revealed two new cavernomas, which were not identified in the imaging conducted in the past. In literature, the cases of de novo appearance of cavernomas are considered highly rare, especially in patients with no consistent family history or medical history of radiation therapy. Resultantly, they should be considered as dynamic lesions, regarding their number, size and behavior. Full article

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Open AccessBrief Report

Therapy Results of Pericallosal Aneurysms: A Retrospective Unicenter Study

by Cornelius Deuschl, Marvin Darkwah Oppong, Hanna Styczen, Lisa Markhardt, Karsten Wrede, Ramazan Jabbarli, Ulrich Sure, Alexander Radbruch, Michael Forsting, Isabel Wanke and Christoph Mönninghoff

Clin. Pract. 2020, 10(3), 1257; https://doi.org/10.4081/cp.2020.1257 - 18 Sep 2020

Cited by 3 | Viewed by 821

Abstract

This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 [...] Read more.

This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal hemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pre-treatment digital subtraction angiography. In addition, demographic, clinical and radiographic parameters of all patients were recorded. Outcome was measured based on the modified Rankin scale (mRS) at 6 months after admission (favorable mRS score, 0-2 vs unfavorable mRS score, 3-6). Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge 24 patients with SAH had a favorable outcome (mRS 0-2) and 16 patients an unfavorable outcome (mRS 3-6). Mortality rate of patients with SAH was 9.1% (4/44). Overall aneurysm recurrence was treated in 13 % of patients in the EVT cohort (6/46), whereas patients treated with NT had no recurrence. All patients with unruptured PAA had a favorable outcome. EVT and NT of PAA show comparable good results, although aneurysm recurrence occurs more often after EVT. Full article

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Open AccessCase Report

Self-Inflicted Finger Cold Injury Leading to Amputation: Report of a Case

by Alammar Alwaleed and Almadani Jamal

Clin. Pract. 2020, 10(3), 1217; https://doi.org/10.4081/cp.2020.1217 - 7 Sep 2020

Viewed by 1003

Abstract

A cold injury can result in devastating outcomes, leading to significant morbidity and loss of distal extremities. Amputations are common after severe frostbite injuries with delayed presentation, often mediated by post-injury arterial thrombosis. Ischemic injuries are managed according to the ischemia time. The [...] Read more.

A cold injury can result in devastating outcomes, leading to significant morbidity and loss of distal extremities. Amputations are common after severe frostbite injuries with delayed presentation, often mediated by post-injury arterial thrombosis. Ischemic injuries are managed according to the ischemia time. The most controversial aspect of treating a salvage injury is the time of surgical intervention, which used to be based on the previous management dogma freeze in January, amputate in July. Recently, the paradigm has shifted to early surgical management if the level of viability of the deep structure can be ascertained using 99mTc pertechnetate scintigraphy (99mTc bone scans). We present a case of a finger amputation resulting from a cold injury secondary to a crush injury. Full article

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Open AccessCase Report

Success of Dental Implant Osseointegration in a Florid Cemento-Osseous Dysplasia: A Case Report with 8-Year Follow-Up

by Rola Shadid and Omar Kujan

Clin. Pract. 2020, 10(3), 1281; https://doi.org/10.4081/cp.2020.1281 - 4 Sep 2020

Cited by 6 | Viewed by 1599

Abstract

Florid cemento-osseous dysplasia (FCOD) is a rare benign fibro-osseous lesion which affects multiple quadrants and predominantly the mandible. This case report presents a successful implant placement with 8-year of follow-up in a 44-yearold woman asking for a fixed restoration in mandibular right posterior [...] Read more.

Florid cemento-osseous dysplasia (FCOD) is a rare benign fibro-osseous lesion which affects multiple quadrants and predominantly the mandible. This case report presents a successful implant placement with 8-year of follow-up in a 44-yearold woman asking for a fixed restoration in mandibular right posterior edentulous area. Radiographic images showed lobular, irregularly shaped radiopacities and radiolucencies almost symmetrically observed in the premolar-molar area of the right and left regions of the mandible. The findings of Xray images were attributable to FCOD. Minimally invasive two-stage surgery with strict infection control was followed to place two implants in lower right posterior region. The implants demonstrated clinically rigid fixation and restored successfully after 6 months. A direct functional connection between dysplastic bone and the implant load bearing surface was evidenced by the lack of symptoms, and the lack of soft tissues inflammation or peri-implant bone loss up to 8 years follow-up. Full article

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Open AccessCase Report

Extensive Catastrophic Thromboses from Elevation of Factor VIII

by Jacqueline Kropf, Sarah Cheyney, Josselin Vachon, Philip Flaherty, Mai Vo and Steve J. Carlan

Clin. Pract. 2020, 10(3), 1265; https://doi.org/10.4081/cp.2020.1265 - 4 Sep 2020

Cited by 5 | Viewed by 744

Abstract

Catastrophic thrombotic syndrome, otherwise known as thrombotic storm (TS) is an extreme prothrombotic clinical syndrome that presents as rapid onset of multiple thromboembolic events affecting a large variety of vasculature. In recent studies, there has been a correlation of high plasma levels of [...] Read more.

Catastrophic thrombotic syndrome, otherwise known as thrombotic storm (TS) is an extreme prothrombotic clinical syndrome that presents as rapid onset of multiple thromboembolic events affecting a large variety of vasculature. In recent studies, there has been a correlation of high plasma levels of factor VIII with thrombotic events. We present the case of a young man who exhibited multi-organ failure due to thrombotic storm. A 38-year-old male presented to the emergency department for progressive dyspnea and was diagnosed to have pulmonary embolism. The patient developed respiratory distress requiring intubation and was diagnosed with both an ST-elevation myocardial infarction and right cerebral infarction during the hospital course. The patient expired and autopsy revealed the cause of death to be myocardial, cerebral and renal infarction from widespread vascular thrombosis. Autopsy revealed cause of death to be elevated factor VIII associated thrombotic coagulopathy. Factor VIII level upon autopsy was 375% (55-200%). Although TS is rare, it can be lifethreatening if not recognized early. Survival depends on the prompt initiation and duration of anticoagulation. Full article

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Open AccessBrief Report

Changes in Radiographic Parameters Following Chiropractic Treatment in 10 Patients with Adolescent Idiopathic Scoliosis: A Retrospective Chart Review

by Eric Chun Pu Chu, Diya Midhun Chakkaravarthy, Kevin Hsu Kai Huang, Vicky Wei Kye Ho, Fa-Sain Lo and Amiya Bhaumik

Clin. Pract. 2020, 10(3), 1258; https://doi.org/10.4081/cp.2020.1258 - 4 Sep 2020

Cited by 9 | Viewed by 2129

Abstract

This retrospective chart review was undertaken to investigate the role of chiropractic intervention for patients with adolescent idiopathic scoliosis (AIS). Ten cases of patients with AIS, mean age 13.3 years, undergoing chiropractic adjustment were retrospectively evaluated. Chart review was performed to extract age, [...] Read more.

This retrospective chart review was undertaken to investigate the role of chiropractic intervention for patients with adolescent idiopathic scoliosis (AIS). Ten cases of patients with AIS, mean age 13.3 years, undergoing chiropractic adjustment were retrospectively evaluated. Chart review was performed to extract age, medical history and treatment intervention. The magnitude of scoliosis was quantified using the Cobb method on standing radiographs. A comparison of the measurements from pre- and post-treatment radiographs revealed that Cobb angle reduced from average 29.7° down to average 23.4° (average 21.2% correction). Improvements in spinal morphologies were observed in most curves (64%, n=9/14) and curve stabilization in the rest (36%, n=5/14). A better correction was obtained in cases of mild and moderate AIS. In terms of stabilizing progression (≤5o curve progression) or correcting curvatures (≥6° reduction), radiological changes were observed in all patients. Full article

392 KiB

Open AccessCase Report

Pinna High Grade Trichoblastic Carcinoma, a Report

by Elie Yaacoub, Joseph El Borgi, Raymond Challita, Ziad Sleiman and George Ghanime

Clin. Pract. 2020, 10(3), 1204; https://doi.org/10.4081/cp.2020.1204 - 4 Sep 2020

Cited by 2 | Viewed by 661

Abstract

Trichoblastic carcinoma is a rare malignant hair follicle tumor. It resembles basal cell carcinoma clinically, but different studies emphasize on the importance of differentiating between these two cancers since they have different clinical course which may affect treatment options and follow up. Regardless [...] Read more.

Trichoblastic carcinoma is a rare malignant hair follicle tumor. It resembles basal cell carcinoma clinically, but different studies emphasize on the importance of differentiating between these two cancers since they have different clinical course which may affect treatment options and follow up. Regardless of its aggressive behavior, no consensus is present for the treatment of trichoblastic carcinoma. We presented the third case of pinna trichoblastic carcinoma, which was surgically excised and followed up for two years post-surgery. Full article

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Clin. Pract., Volume 10, Issue 3 (September 2020) – 10 articles

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