Clinics and Practice 2019-07-22T22:36:36+02:00 Francesca Baccino Open Journal Systems <p><strong>Clinics and Practice</strong>&nbsp;[ISSN 2039-7283] is a peer-reviewed, Open Access, online-only journal that publishes both&nbsp;<em>brief reports</em>&nbsp;and&nbsp;<em>case reports</em>&nbsp;in all areas of clinical medicine. Our journal would welcome any interesting description of patients, procedures and treatment in any condition or disease disease that can contribute to develop scientifically rigorous and clinically meaningful practice methods. <br><strong>Clinics and Practice</strong> aims at creating an innovative, rapid and collaborative background intended to help healthcare professionals finding the latest advances to answer the most pressing questions coming from the medicine/patients relationship.</p> Ultrasonography: A step forward in temporomandibular joint imaging. A preliminary descriptive study 2019-07-22T22:35:23+02:00 Surej Kumar L.K. Georgie P. Zachariah Sumesh Chandran <p>Ultrasonography (USG) is a cost-effective and noninvasive imaging modality commonly employed for imaging the abdominal region and extremities. Currently, with the availability of higher frequency probes and higher resolution devices, USG imaging of the temporomandibular joint (TMJ) looks promising. The aim is to evaluate and demonstrate the role of USG as an imaging modality of TMJ by visualizing the static and dynamic relationship of the joint, assessment of joint space and eliciting reproducibility at both open and closed mouth positions. 30 volunteers were selected based on the inclusion criteria in line with the research diagnostic criteria/temporomandibular disorders guidelines. High-resolution USG (≥12 MHz) of the right TMJ (chosen for uniformity) was done in the left decubitus position on (n=30) volunteers. The joint disc movement was directly visualized during opening and closing motions. The vertical joint space was assessed using the firmware and accurate reproducibility was checked. At the closed mouth position, the measured values ranged from 0.2 mm to 0.7 mm with a median of 0.05 cm and a mean of 0.4±0.15 mm. At the position of maximal mouth opening, the measured values ranged from 0.9 mm to 1.5 mm with a median of 1.1 mm and a mean of 1.1±0.17 mm. USG enables visualization of the dynamic relationship between joint structures, with particular importance to the condyle and disc position. The articular disc appears on the USG as a thin layer of hyperechogenicity surrounded by a hypoechoic halo, located between 2 hyperechoic lines viz, the condyle and the articular eminence. We recommend ultrasonographic imaging as a noninvasive diagnostic technique with relatively high specificity for patients with temporomandibular disorders.</p> 2019-06-28T15:51:40+02:00 ##submission.copyrightStatement## Leukoerythroblastosis in castration-resistant prostate cancer: A clue to diffuse bone marrow carcinomatosis 2019-07-22T22:36:32+02:00 Frank Sheng Fan Chung-Fan Yang <p>A 66-year-old man with a previous history of advanced prostate cancer failing complete androgen blockade, docetaxel chemotherapy, denosumab, and abiraterone acetate as judged by persistent high serum levels of prostate specific antigen presented with exertional dyspnea, normocytic anemia, and thrombocytopenia. Leukoery - throblastosis was noted in his peripheral blood. Bone marrow examination disclosed diffuse bone marrow carcinomatosis from prostate cancer. Prolonged activated partial thromboplastin time, prothrombin time, and an extremely elevated serum level of D-dimer led to a diagnosis of disseminated intravascular coagulation. Magnetic resonance imaging of spine revealed extensive bone marrow involvement but bone scan showed only scanty bony metastasis. We like to call attention to the importance of prompt bone marrow examination once recognizing leukoerythroblastosis in patients with advanced prostate cancer. Survey of a possible coexistent disseminated intravascular coagulation is as well strongly recommended in this condition.</p> 2019-05-06T14:53:51+02:00 ##submission.copyrightStatement## Subcutaneous calcification as a supportive radiologic finding for diagnosis of rhinofacial entomophthoromycosis 2019-07-22T22:36:36+02:00 Navarat Vatcharayothin Pornthep Kasemsiri Cattleya Thongrong Chanticha Laohakittikul Surapol Suetrong Piti Ungarreevittaya Nipon Chaisuriya <p>Rhinofacial entomophthoromycosis is an uncommon chronic fungal infection of the head and neck. The diagnosis is usually based on clinical manifestations; however, diagnosis of this infection based on early manifestations is difficult and occasionally rhinofacial entomophthoromycosis is mistaken for other diseases. Therefore, computed tomography is introduced to support the diagnosis. Radiologic findings were nonspecific with swelling of the sinonasal mucosa and perinasal region. However, subcutaneous calcification, that was observed in all our cases, may be a supportive radiologic evidence for diagnosis. The diagnosis should be confirmed definitively using histopathology or fungal culture. Early diagnosis allows prompt and appropriate treatment that will achieve excellent outcomes. We suggest that subcutaneous calcification radiologic finding may guide the aware physician to an early diagnosis of rhinofacial entomophthoromycosis.</p> 2019-03-22T00:00:00+01:00 ##submission.copyrightStatement## Non-traumatic splenic rupture in amyloidosis as a rare evolution of multiple myeloma 2019-07-22T22:36:30+02:00 Lorenzo Perrone Lorenzo Gervaso Eugenia Bosco Francesco Serra Erica Quaquarini <p>We report the case of a 64-year-old man with a diagnosis of IgG lambda multiple myeloma (MM) symptomatic for bone lesions for which he received autologous stem cell transplant after induction treatment and high-dose melphalan, thalidomide and lenalidomide therapy. Twelve years after the diagnosis, he had an unexpected and acute onset of abdominal pain with signs of hypovolemic shock. A computed tomography scan was immediately performed and demonstrated a splenic rupture. A splenectomy was performed but, a week after, the patient developed an acute respiratory distress syndrome and died. After histological exam of the spleen, non-traumatic spleen rupture due to amyloidosis was our final diagnosis. This event is potentially fatal and rare in patients with MM; clinicians should be aware of this potential course of the disease and monitor patients also for amyloid induced organ damages.</p> 2019-05-07T09:42:26+02:00 ##submission.copyrightStatement## An unexpected surprise: Delayed gastric outlet obstruction from coin ingestion 2019-07-22T22:36:31+02:00 Eric Omar Then Febin John Carmine Catalano Michell Lopez Vinaya Gaduputi <p>Gastric outlet obstruction (GOO) is characterized by postprandial vomiting due to mechanical obstruction. Rarely it can occur due to ingestion of a foreign body. Most cases of foreign body ingestion are benign, with passage of the ingested object into the stool with no clinical sequelae. We describe a case of an 80-year-old woman with GOO occurring secondary to ingestion of two coins (American quarters). Rarely will such a small object cause a true gastric outlet obstruction. To our knowledge this makes the second such case reported in the medical literature.</p> 2019-05-07T00:00:00+02:00 ##submission.copyrightStatement## A rare case of acute kidney injury and anemia induced by hypercalcemia 2019-07-22T22:36:29+02:00 Suparpit von Bormann Sirilak Suksompong Benno von Bormann <p>Hypercalcemia may result in acute kidney injury (AKI) and arterial hypertension. Anemia as a consequence of this constellation is nowhere described. A female patient underwent total thyroidectomy in 2007, since then being under continuous daily medication with 100 μg thyroxin, 1.6 g calcium and 1.0 μg alfacalcidol. In 2017, after accidentally overdosing alfacalcidol fourfold for several weeks leading to massive hypercalcemia (plasma calcium level 16.7 mg/dL), the otherwise healthy patient developed symptoms of AKI, such as serum creatinine 2.48 mg/dL, plus severe hypertension and acute anemia (hemoglobin concentration 10.2 g/dL). After cessation of calcium and alfacalcidol medication for 9 days, hypercalcemia and AKI symptoms and anemia recovered within 14 and after 62 days, respectively. The patient is currently free of complaints and has been sufficiently treated with half of the yearslong pre-event calcium/alfacalcidol dose. In conclusion, hypercalcemia with consecutive AKI after vitamin D overdose can occur asymptomatically. The treatment does not compulsorily include washout by hyperhydration and diuretics. AKI may lead to anemia, possibly caused by the deterioration of the release of erythropoietin.</p> 2019-06-04T10:55:37+02:00 ##submission.copyrightStatement## Good’s syndrome, a rare form of acquired immunodeficiency associated with thymomas 2019-07-22T22:35:28+02:00 Antonio Tamburello Laura Castelnovo Paola Faggioli Daniela Bompane Bruno Brando Arianna Gatti Lucia Roncoroni Biancamaria Di Marco Antonino Mazzone <p>Good’s syndrome (GS) or thymomaassociated immunodeficiency is a rare clinical entity that should be ruled out in patients with thymoma who develop severe, recurrent bacterial infections and opportunistic viral and fungal infections. There are no treatment protocols established, hence, early recognition is imperative to avoid complications. We report the case of a 42-year-old female, known for a previous thymectomy for giant thymoma who has suffered for a long time from recurrent pulmonary and urinary tract infections and cold sores. In March 2016 she referred to our unit complaining of fever, cough, chest pain, and cold sores due to <em>Herpes simplex</em> virus (HSV), confirmed serologically as HSV-1. Chest X-ray showed left pneumonia due to <em>Streptococcus pneumoniae</em>. She started antibiotics (amoxicillin/clavulanic acid associated with azithromycin) with gradual improvement. Given her history she was studied for an underlying immunodeficiency: IgG, IgA, and IgM were significantly low or absent, as well as all IgG subclasses; blood and bone marrow aspirate leucocyte immunophenotyping showed complete absence of B lymphocytes and reduced CD4+ T cells. In light of: i) thymoma; ii) B lymphocyte deficit; iii) hypogammaglobulinemia; iv) recurrent infections, GS was diagnosed and pre-emptive immunoglobulin treatment, associated with HSV and <em>Pneumocystis jiroveci</em> prophylaxis (Acyclovir for HSV and Sulfamethoxazole- Trimethoprim for <em>P. jiroveci</em>) were started. Since then the patient has no longer presented any infectious episodes.</p> 2019-06-05T15:12:40+02:00 ##submission.copyrightStatement## Recurrent amelanotic melanoma of nasal cavity: Biological variability and unpredictable behavior of mucosal melanoma. A case report 2019-07-22T22:35:27+02:00 Damir Vučinić Dag Zahirović Dubravko Manestar Ingrid Belac-Lovasić Tamara Braut Leo Kovač Nives Jonjić Gordana Zamolo <p>The aim of this report is to present a case of a patient with a recurrent nasal cavity amelanotic melanoma (AM), with emphasis on diagnosis and therapy options of this clinical entity. A 65-year-old female patient presented with pain in the right cheek region and nasal obstruction. In 2013, she was diagnosed with mucosal melanoma (MM) of the left nasal cavity. After endoscopic surgery and radiotherapy, the patient was followed by the oncology team. Five years after the initial diagnosis, rhinoscopy showed a tumorous formation in the right nasal cavity. The tumor mass was without black discoloration and was the same color as the surrounding nasal mucosa. Microscopic examination after biopsy of the tumor confirmed amelanotic MM. The patient underwent an additional endoscopic surgery. A complete standard diagnostic workup for MM found metastases in head and neck lymph nodes, on both sides. MMs of head and neck are uncommon malignancies. Unique biology of MM cells causes a high rate of recurrences. This report presents an example of recurrent AM of the nasal cavity, in treatment with checkpoint inhibitor (pembrolizumab), which could provide a good therapy option for patients with MM.</p> 2019-06-11T10:14:32+02:00 ##submission.copyrightStatement## Reverse Koebnerization in a linear oral lichenoid lesion: A case report 2019-07-22T22:35:25+02:00 Prashanth Panta Archana Andhavarapu Sachin C. Sarode Gargi Sarode Shankargouda Patil <p>The spectacle of Koebner’s phenomenon (KP) is interesting in that trauma precipitates a subset of pathologically distinct conditions, indicating the subtle interplay between sensitization and dermato-mucosal integrity. KP is interesting because, if factors initiating it are controlled, then it may be possible to prevent these debilitating conditions through induction of reverse Koebnerization. Herein, we present a report of a patient with an erosive lesion, localized to the occlusal plane on buccal and lingual mucosa, that interestingly subsided following 1 week after a dental scaling procedure. This report analytically describes the role of dental calculus and cuspal trauma as important triggers surrounding the genesis of oral lichenoid lesion and oral lichen planus. An engaging discussion on these closely related enigmatic entities forms the central theme of this report.</p> 2019-06-24T11:52:05+02:00 ##submission.copyrightStatement##