Extremity Discomfort Research Articles

Spinal hydatid disease-A case report: An uncommon differential diagnosis in LMICs

Background and Importance: With a 0.2–1% incidence, spinal hydatid disease is a very uncommon diagnosis. While it is uncommon in affluent nations, it should be taken into account when making a differential diagnosis for spinal cord compression syndrome, particularly in regions where it is prevalent. Case Presentation: We report a case of hydatid illness of the spine. A 52-year-old man presented with lower extremity discomfort and spastic paraparesis, trouble urinating, and back pain and edema. He had at the level of the 12th thoracic to third lumbar vertebrae (Th12-L3) with paraspinal extension. The patient was treated with four months of antiparasitic therapy and two surgical resections performed by general surgeons. Histological analysis showed pieces of fibrous tissue exhibiting granulomatous inflammation; however, no evidence of acid-resistant bacteria or PAS-positive chitin membrane was found. The existence of bacteria following therapy has not been confirmed by the parasitological investigation of the lesions. Clinical discussion: Primary spinal hydrodatidosis is a rare condition that affects about 0.2–1% of the population. Conclusion: Due to rarity of this disease, early discovery and timely treatment are critical, and this diagnosis should be considered when generating a differential diagnosis for spinal cord compression syndrome.

Unveiling a foreign body masquerading as periarticular calcification: a case report

IntroductionEvaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.Case presentationWe present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.DiscussionThis case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient’s subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.ConclusionOur findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

Spontaneous Iliac Artery Dissection in a 66-Year Old Male Complicated By Hemorrhage, GI Bleeding, and Bilateral DVT/PE

Spontaneous iliac artery dissection (IAD) is a rare medical condition with only a few cases being reported in the medical literature. Dissections typically involve the aorta and are not localized to the iliac arteries. Patients with spontaneous IAD typically present with symptoms that resemble peripheral artery disease, and cases are typically associated with connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome or high-risk states such as pregnancy and extreme athletics. There are some case reports that showed an association with hyperlipidemia, hypertension, and tobacco use. The most frequent complication of spontaneous IAD is rupture, and cases are typically treated endovascularly but may be treated with classical surgery such as in the case of rupture. Some cases have reportedly been treated with conservative management alone. In this case, we discuss a 66-year-old male with a past medical history of hyperlipidemia, hypertension, and tobacco use with no known diagnosis of connective tissue disease, and not in a high-risk state, who was found to have a spontaneous iliac artery dissection. He initially presented with sudden onset back pain that he described as a shooting pain that radiated into his head. He was also having right lower extremity discomfort. Initial vital signs were significant for tachycardia and hypertension, and physical exam was significant for tachycardia and diminished right posterior tibial and dorsalis pedis pulses. Laboratory workup was significant for a leukocytosis of 10.06 and creatinine of 1.52, consistent with acute kidney injury. Labs were otherwise unremarkable. Computed tomography angiogram (CTA) of the head and neck was negative for acute pathology, but CTA chest/abdomen/pelvis demonstrated arterial dissection that began at the origin of the right common iliac artery extending down to the right common femoral artery and also demonstrated a left renal infarct. A bare metal stent was placed by Interventional Radiology and the patient was started on dual antiplatelet therapy (DAPT) with a heparin drip and clopidogrel. Connective tissue disease workup was later performed including antinuclear antibody, rheumatoid factor, cyclic citrullinated peptide, and extractable nuclear antigen antibodies panel, which were all negative. Hospital stay was complicated by development of subarachnoid hemorrhage, intraventricular hemorrhage, subdural hematoma, and intradural hematoma that required laminoplasty and evacuation by Neurosurgery. DAPT was discontinued and the patient was later restarted on aspirin only. The patient then developed a cecal bleed that required clipping by Gastroenterology. Aspirin was discontinued and he then developed bilateral lower extremity deep venous thromboses and pulmonary emboli. He was started on enoxaparin with the assistance of Hematology and was later transitioned to apixaban with no complications. This case supports comorbidities as risk factors for spontaneous IAD and raises the need for formal screening and surveillance guidelines for these patients, as there are currently no guidelines in place. This case also demonstrates the complications that can occur with DAPT and anticoagulants and provides a manner in which to cautiously initiate anticoagulation in patients with high risk of bleeding while also preventing the development of further thrombi.

Factors associated with health-related quality of life in gynaecologic cancer survivors with lower limb lymphedema: a cross-sectional study in Taiwan

BackgroundsGynaecological cancer survivors may develop lower limb lymphoedema after surgery, which negatively impacts quality of life. The purposes of this study were (1) to assess the levels of symptom distress, depression, body image, and health-related quality of life (HRQoL); (2) to recognize factors associated with HRQoL related in gynaecologic cancer survivors with lower limb lymphoedema.MethodsA cross-sectional study was conducted with convenience sampling of gynaecologic cancer survivors with lower limb lymphoedema. Gynaecologic cancer survivors were assessed for symptom distress, depression, body image, and HRQoL. Multiple regression analysis was conducted to recognize the factors associated with HRQoL. Independent-samples t-test was used to compare symptom distress, depression, body image, and HRQoL by grade of lymphoedema.ResultsThe most common distressing symptoms of lower limb lymphoedema were lower extremity oedema, lower extremity tightness, and lower extremity stiffness. Worse HRQoL was associated with more symptom distress, less satisfaction with body image, a high grade of lymphoedema, and a longer duration of lower limb lymphoedema. These factors explained 76.5% of the variance in HRQoL. Gynaecologic cancer survivors with late grade lymphoedema experienced lower HRQoL and higher levels of symptom distress, depression, and greater dissatisfaction with body image than those who had early grade lymphoedema.ConclusionsSymptom distress had the strongest association with overall HRQoL and with all individual domains of HRQoL, except mental function. These results suggest that educating gynaecologic cancer survivors to assess lower limb lymphoedema-related problems, providing symptom management, and guiding survivors in physical activity to relieve lower extremity discomfort can improve HRQoL.

BREAST CANCER-RELATED LYMPHEDEMA: RISK FACTORS, DIAGNOSIS, MANAGEMENT, PREVENTION

Breast cancer-related lymphedema (BCRL) is a negative outcome of breast cancer or its treatment, which affects 1 of every 5 patients. Disruption of the lymph flow results in its accumulation in the tissues with resulting edema. Diagnosis is based on the presence of symptoms such as progressive upper extremity swelling, limb pain and discomfort, skin changes, restricted range of motion, and the measurement of the extremity girth. First-line treatment is nonivasive, which includes compressions or physiotherapy. Prevention strategy focuses on compres­sion therapy or exercises, however, limiting the extent of lymph node removal is the only measure shown to reduce the incidence of BCRL.

Reliability of 3D Depth Motion Sensors for Capturing Upper Body Motions and Assessing the Quality of Wheelchair Transfers.

Wheelchair users must use proper technique when performing sitting-pivot-transfers (SPTs) to prevent upper extremity pain and discomfort. Current methods to analyze the quality of SPTs include the TransKinect, a combination of machine learning (ML) models, and the Transfer Assessment Instrument (TAI), to automatically score the quality of a transfer using Microsoft Kinect V2. With the discontinuation of the V2, there is a necessity to determine the compatibility of other commercial sensors. The Intel RealSense D435 and the Microsoft Kinect Azure were compared against the V2 for inter- and intra-sensor reliability. A secondary analysis with the Azure was also performed to analyze its performance with the existing ML models used to predict transfer quality. The intra- and inter-sensor reliability was higher for the Azure and V2 (n = 7; ICC = 0.63 to 0.92) than the RealSense and V2 (n = 30; ICC = 0.13 to 0.7) for four key features. Additionally, the V2 and the Azure both showed high agreement with each other on the ML outcomes but not against a ground truth. Therefore, the ML models may need to be retrained ideally with the Azure, as it was found to be a more reliable and robust sensor for tracking wheelchair transfers in comparison to the V2.

First-generation therapy for varicose veins: medication, compression, sclerotherapy, and stripping

Background: Improving the understanding varicose veins (VV) is increasing due to life extension and concerns regarding quality of life. Recently, endovascular treatment has become more common, even in mild cases. Excessive procedures are often performed before conservative and non-surgical treatments. We aimed to explain the efficacy of medication, compression, sclerotherapy, and stripping of treatments and to consider the appropriate indications for many treatment methods, including endovascular procedures.Current Concepts: Venoactive drugs can be used as first-line agents for symptoms, such as edema, at all stages of varicose vein. These are effective adjuvant agents and can help achieve compression before and after procedures. Compression therapy is effective for skin change and ulcers and is excellent for the improvement of symptoms. Sclerotherapy has been widely used as an adjuvant treatment, but recently, its indications have been expanded for non-invasive causes. Traditional high ligation and stripping is still the recommended treatment option for recurrent or complicated varicose veins.Discussion and Conclusion: The patients’ symptoms should be evaluated more critically than assessing only the venous reflux using ultrasound. Additionally, objective evaluation of various causes of lower extremity discomfort should be considered. Treatment according to appropriate indications, such as medication, compression, sclerotherapy, stripping, and endovascular therapy, can improve the patients’ quality of life and prevent complications.

An Overview of Indian Vegetable: Production Trends and Related Health Hazards

Agriculture has been regarded as one of the most drudgery-prone occupations in the unorganized sector. In vegetable production system both men and women play important role in the entire process from land preparation to harvesting of crops. Vegetable cultivators actively participate in various farm operations such as a ploughing, uprooting, sowing, transplanting, weeding, hoeing,harvesting. They are exposed to number of health hazards the most prevalent of which are musculoskeletal issued like a like strains, low back pain, lower and upper extremity discomfort and so on. It was observed that farmworker generally adopt awkward posture during various activity of vegetable production system. In order to minimize the adverse effect of these postural discomfort and hazard an ergonomic evaluation of farm activity need to be conducted. Ergonomic measures were accomplished by making modification on the task/tool used or by workers moreover training and extension activities will also improve their work productivity and efficiency.

Correlation between Restless Leg Syndrome and Superficial Venous Reflux.

Restless leg syndrome (RLS) is a common cause of lower extremity discomfort. We hypothesized that patients with RLS symptoms have higher rates of deep and superficial venous reflux (SVR). Retrospective review of patients ≥18 years of age evaluated in a venous center from December 2018 to February 2019. Differences in rates of RLS symptoms, demographics, comorbidities, and clinical and radiologic presence of venous disease were analyzed. Overall, 207 patients were analyzed; 140 (67.6%) reported RLS symptoms ( n = 25 with prior RLS diagnosis). RLS symptoms were more common with superficial or combined superficial and deep venous reflux (DVR) compared with those without reflux ( p < 0.001). Patients with RLS symptoms as opposed to those without had similar demographics and comorbidities (all p > 0.05) but increased rates of venous pain, phlebitis, family history of venous disease, lower extremity swelling and SVR, and combined SVR and DVR (all p < 0.05). Our multivariable logistic regression found presence of SVR, and family history of venous reflux was associated with RLS symptomatology (all p < 0.001). Ninety-nine patients with RLS underwent ablation; of them, 93 had duplex-proven reflux resolution of which 81 (87%) reported RLS symptom improvement. This included 13 of 16 (81.3%) with prior RLS diagnosis. SVR is associated with increased rates of RLS symptoms in a vein center population. Therefore, RLS symptoms should trigger a targeted venous evaluation. Our results suggest that venous ablation may lead to resolution of RLS symptoms in patients with SVR, but randomized prospective trials with strict RLS definition criteria are warranted to confirm these outcomes.

Neck and Upper Extremity Discomfort and Its Relationship with Extent of Computer Usage among University Students

Introduction: Technology has played a crucial role in transforming the lives of an individual. The use oftechnology has increased steeply among students. With an abrupt increase in the computer users in a periodof two decades, the musculoskeletal discomfort has risen sharply.Methods: The present study was observational one comprising 107 students in the age group of 20-35years. After taking informed consent, a self structured questionnaire along with Neck disability index andthe disabilities of arm, shoulder and hand scale were used to conduct the study. The data was analyzed usingMicrosoft excel 2007 percentile and coefficient of correlation with significant value p&lt;0.05.Result: The prevalence of neck and upper extremity discomfort was 89.71% among the computer users.Out of this 88.78% subjects complained shoulder discomfort, 14.95% had elbow discomfort and 28.97%had hand/wrist discomfort. Statistically there was no significant relationship of neck disability with hours ofworking per day (r = 0.01, p = 0.89), hours of work last week on typical day (r = -0.08, p = 0.35) and breaktime (r = 0.14, p = 0.13). A statistically non significant relationship was observed for DASH with hours ofworking per day (r = 0.03, p = 0.69), hours of work last week on typical day (r = -0.11, p = 0.25) and breaktime (r =-0.07, p = 0.42).Conclusion: Prevalence of shoulder discomfort was seen more than elbow and hand/wrist among students.

Prevalence of mobile device-related lower extremity discomfort: a systematic review

Mobile device users often experience musculoskeletal discomfort due to the intensive use of these devices in static body postures. Prolonged sitting and standing at work and in free time are risk factors for various diseases and all-cause mortality. Prolonged static postures are the main cause of lower extremity discomfort. A systematic search of the articles was conducted in four different electronic databases. All selected papers were appraised using a critical appraisal tool. Fourteen studies were selected for the review. The prevalence of musculoskeletal complaints ranged from 0.4 to 72.9%. Mobile device-related lower extremity discomfort ranged from 0.4 to 9.6%. The most common body posture among mobile device users in the selected studies was sitting. There is some evidence for the association between lower extremity pain and mobile device use. Experts should take this review as a basis to provide appropriate and effective ergonomic measures, especially for working mobile device users.

A Case Report of Combined Treatment Including Bee Venom Injection for Restless Leg Syndrome Patient with Lower Extremity Discomfort

Objectives The purpose of this study is to report the effect of Bee venom acupuncture for managing Restless leg syndrome(RLS) and therefore improving the quality of life and symptoms. Methods The 64-years old male patient who has been suffered by Restless leg syndrome was treated by bee venom acupuncture on ST36 and ST37 and herbal medicine. The patient was observed during 7days, and the treatment was executed during 7 days, once a day. Symptoms were measured by Korean International Restless Legs Scale(K-IRLS), Korean Restless Legs Quality of Life Questionnaire(K-RLSQoL), and Numeral Rating Scale(NRS). Results After bee venom acupuncture, International Restless Legs Scale was alleviated from 16 to 11. Restless Legs Quality of Life Qeustionnaire score was improved from 51 to 61. Discomfort measured by NRS also decreased. Conclusions Bee venom injection can be suggested for RLS patients by improving the quality of life and symptoms.

Ophthalmic Manifestations of Rathke’s Cleft Cyst and Its Association to Radiological Characteristics

ABSTRACT Purpose To evaluate the ophthalmic features of Rathke’s cleft cyst (RCC) and its association with radiological characteristics. Methods In this retrospective single-center study, patients who showed typical findings suggestive of RCC on magnetic resonance imaging (MRI) and underwent relevant ophthalmic examination were recruited retrospectively. Patients were stratified into two groups according to the presence or absence of ophthalmic symptoms related to RCC. We reviewed patients’ demographic information, initial symptoms, endocrinological status, ophthalmic features, and characteristics of MRI. Height, size and location of RCC, as well as the optic chiasm displacement assessed from MRI. Results Thirty-three patients (20 women and 13 men) were included in this study from among 335 patients with RCC on MRI. Fifteen patients had ophthalmic manifestation related to the cyst (Ophthalmic group), whereas 18 patients were not (Non-ophthalmic group). Headache was the most common initial symptom (15 patients, 45.5%), followed by visual disturbance (7, 21.2%), diplopia (1, 3.0%), retro-orbital pain (1, 3.0%), galactorrhea (1, 3.0%), and peripheral extremity discomfort (1, 3.0%). In seven asymptomatic patients (21.2%), the lesion was an incidental finding during a regular medical examination. Ophthalmic manifestation included visual field defect (14 patients, 93.3%) and diplopia (1 patient, 6.7%). The height, volume, and the coronal and sagittal displacements were larger in the ophthalmic group (P < .001, all). Eleven patients who manifested ophthalmic symptoms underwent excision surgeries and nine of them (81.8%) experienced visual function improvement. Conclusion Appropriate ophthalmic examinations are warranted in patients with RCC, and treatment should be actively considered in patients with ophthalmic manifestations.

A framework for studying risk factors for lower extremity musculoskeletal discomfort in nurses

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index

Lower Extremity Discomfort in Registered Nurses: Links to Nursing Unit Layout

This study reports objective measurements of lower extremity activity (amount of walking, standing, sitting) in nurses working in medical/surgical (M/S) and intensive care units (ICU), and explores nurses’ perceptions of nursing unit design impact on workload, lower extremity activity, and musculoskeletal discomfort. Nursing units are expanding in size, leading to nurses spending more time on their feet. Though limited in number, studies consistently report elevated prevalence of lower extremity discomfort/injury in nurses. This was a mixed method approach using physical activity measurement and semi-structured interviews of M/S and ICU nurses. Lower extremity discomfort was prevalent in the study participants. Time on feet and step counts differed between nursing units with different layouts. Average hours on feet ranged from 7.3 to 9.5 across units over 12-hour shifts. Nurses’ comments explained ways in which walking and standing activities were influenced by unit layout design and culture. Nurse leaders must advocate for unit designs that maximize patient safety, promote a culture of team spirit, and provide a physically safe working environment for staff. This study reports objective measurements of lower extremity activity (amount of walking, standing, sitting) in nurses working in medical/surgical (M/S) and intensive care units (ICU), and explores nurses’ perceptions of nursing unit design impact on workload, lower extremity activity, and musculoskeletal discomfort. Nursing units are expanding in size, leading to nurses spending more time on their feet. Though limited in number, studies consistently report elevated prevalence of lower extremity discomfort/injury in nurses. This was a mixed method approach using physical activity measurement and semi-structured interviews of M/S and ICU nurses. Lower extremity discomfort was prevalent in the study participants. Time on feet and step counts differed between nursing units with different layouts. Average hours on feet ranged from 7.3 to 9.5 across units over 12-hour shifts. Nurses’ comments explained ways in which walking and standing activities were influenced by unit layout design and culture. Nurse leaders must advocate for unit designs that maximize patient safety, promote a culture of team spirit, and provide a physically safe working environment for staff. Jing Li, PhD is a former graduate research associate at the College of Engineering, The Ohio State University, in Columbus, Ohio. Carolyn Sommerich, PhD, CPE, is associate professor at the College of Engineering and School of Health and Rehabilitation Sciences, The Ohio State University. Esther Chipps PhD, RN, NEA-BC, is clinical nurse scientist, associate professor of clinical nursing, at The Ohio State University Wexner Medical Center and The Ohio State University College of Nursing. She can be reached at [email protected]

Footrest intervention: Association between prolonged standing and perceived exertion in the body parts among industrial workers using Borg's scale questionnaire

Posture involves complex interactions between bones, joints, connective tissue, skeletal muscles and nervous system. The complexity of these interactions is compounded when one considers the near infinitesimal variety of human balance (Timothy and Michelle, 2015). Poor posture can lead to excessive strain on our postural muscles (Dariusz et al., 2018). In industrial workplaces, prolonged standing has been identified as one of the risk factors which associated with occupational injuries (Halim et al., 2012). Many workers are required to stand for a long time period in performing their task without sit or walk during work shift (Waters and Dick, 2015). Prolonged standing involves in occupational aspect especially in service and manufacturing sector (Messing et al., 2008). Static work postures particularly prolonged standing and trunk and neck flexion have been identified as tasks at high risk for causing acute and chronic MSD (Reid et al., 2010). Hence, occupational related to prolonged standing has become rising issue and concern in the aspect of ergonomic such as by providing footrest encourages proper posture as it gives support to the lower back and increases circulation to the leg of the user (Halim and Omar, 2011). Various studies which have been conducted indicate prolonged standing is associated with development of musculoskeletal disorders including lower back pain, lower extremity discomfort and varicose (Nelson-Wong et al., 2008). Based on previous study by Lin et al. (2012), the result of analytical indicated that leg discomfort is significantly affected by prolonged standing especially in the first 2 h.

Untreated primary hypothyroidism with simultaneous rhabdomyolysis, pericardial effusion, and sudden sensorineural hearing loss: a case report

BackgroundHypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss.Case presentationA 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient’s severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered.ConclusionsEarly recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.

Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review.

Chronic venous disease (CVD), although affecting up to 40% of the US population, is often underdiagnosed by healthcare professionals due to an incomplete understanding of the presenting symptoms. CVD is a common cause of lower extremity pain and discomfort, including aching, cramping, tingling, burning, swelling, heaviness, restlessness, and fatigue, and may lead to significant morbidity if left untreated. The negative impact of CVD on quality of life is well established and the optimization of management strategies is an important area of evolving research. Management of CVD has rapidly evolved over the last two decades with the development of minimally invasive endovenous ablative techniques, now the mainstay of treatment. We discuss the data supporting various methods of CVD treatment with an emphasis on the impact on patient comfort and quality of life. Both radiofrequency ablation (RFA) and endovenous laser therapy (EVLA) are excellent options for treatment of lower extremity venous disease, but RFA is associated with less post-procedure discomfort. Ultrasound-guided foam therapy is best reserved for the adjuvant setting or for patients ineligible for RFA or EVLA.

May‐Thurner syndrome and thrombosis: A systematic review of antithrombotic use after endovascular stent placement

BackgroundMay‐Thurner Syndrome (MTS) is caused by compression of the left common iliac vein between the right common iliac artery and the pelvis. It likely predisposes an individual to lower extremity deep vein thrombosis (DVT) as well as symptoms of unilateral lower extremity swelling and discomfort in the absence of a known history of thrombosis. In the case of MTS‐associated acute thrombosis, there is low‐quality evidence to suggest that endovascular intervention including thrombolysis and endovascular stent placement reduces the risk of recurrent thrombosis. However, the optimal type and duration of antithrombotic therapy after stent placement for left iliofemoral vein stenosis is not known. MethodsA systematic literature search including studies that evaluated the outcome of endovascular stent occlusion and systemic anticoagulant use in patients with MTS associated DVT was performed. The primary outcome of interest was 12‐month risk of endovascular stent occlusion or recurrent DVT. ResultsA total of five studies encompassing 61 patients were included in our study. All studies were retrospective without a comparator group. A variety of anticoagulants and durations were prescribed. Of the 55 patients evaluable, the 12‐month rate of endovascular stent occlusion or recurrent DVT ranged from 0% to 40%. The 12‐month stent patency rate ranged from 60% to 100%. ConclusionsThe published evidence regarding antithrombotic treatment for patients with MTS who have undergone stent placement for a DVT is limited. Further high‐quality, prospective studies are needed in this setting to inform clinical decision making.

Effect of Using a Sit-Stand Desk on Ratings of Discomfort, Fatigue, and Sleepiness Across a Simulated Workday in Overweight and Obese Adults.

Limited research examines the influence of sit-stand desks on ratings of discomfort, sleepiness, and fatigue. This study evaluated the time course of these outcomes over 1 day. Adults (N = 25) completed a randomized cross-over study in a laboratory with two 8-hour workday conditions: (1)prolonged sitting (SIT) and (2)alternating sitting and standing every 30 minutes (SIT-STAND). Sleepiness was assessed hourly. Discomfort, physical fatigue, and mental fatigue were measured every other hour. Linear mixed models evaluated whether these measures differed across conditions and the workday. Effect sizes were calculated using Cohen's d. Participants were primarily white (84%) males (64%), with mean (SD) body mass index of 31.9 (5.0)kg/m2 and age 42 (12) years. SIT-STAND resulted in decreased odds of discomfort (OR = 0.37, P = .01) and lower overall discomfort (β = -0.19, P < .001, d = 0.42) versus SIT. Discomfort during SIT-STAND was lower in the lower and upper back, but higher in the legs (all Ps< .01, d = 0.26-0.42). Sleepiness (β = -0.09, P = .01, d = 0.15) and physical fatigue (β = -0.34, P = .002, d = 0.34) were significantly lower in SIT-STAND. Mental fatigue was similar across conditions. Sit-stand desks may reduce acute levels of sleepiness, physical fatigue, and both overall and back discomfort. However, levels of lower extremity discomfort may be increased with acute exposure.