Left Limb Research Articles

A Symptomatic Calcified Chronic Subdural Hematoma in an Elderly Patient: A Case Report

Calcified chronic subdural hematomas are rare forms of chronic subdural hematoma, accounting for 0.3-2.7%. Surgery is adequate for most chronic subdural hematomas, but its effectiveness is uncertain for calcified chronic subdural hematomas. In this case report, we illustrate a case of a 70-year-old male presenting with a motor function deficit in his left limbs over two months and neurological deterioration. A substantial calcified subdural collection was seen on computed tomography in the right parietal hemisphere. This was surgically removed with success and completeness. A chronic subdural hematoma has minimal possibility of becoming calcified. Because of the patient's condition's severity, surgery was the only remaining choice. J Shaheed Suhrawardy Med Coll 2023; 15(1): 83-86

Age related differences in whole body and body part angular momentum in the frontal plane during walking

The contribution of body part angular momentum (BPAM) to whole body angular momentum (WBAM) in the frontal plane during walking differs across age groups. We investigated age related differences in BPAM and WBAM during walking. We used marker coordinate data from a publicly available database for 54 individuals aged 20–30 years and 78 aged 60–70 years. Angular momentum in the frontal plane was calculated as the sum of the translational component and the rotational component for each segment. The angular momentum of each segment was categorized into five BPAM: right and left lower limbs (foot, shank, and thigh), right and left arms (hand, forearm, and upper arm), and torso (head, thorax, and pelvis). BPAM at WBAM peak frames during stride cycles was compared between older and younger adults. The peak WBAM, angular momentum of the stance-and swing side upper limbs, and torso in older adults was significantly larger than that in younger adults, with increases of 74.6% in the stance-side upper limb, 127.5% in the swing-side upper limb, and 30.9% in the torso. These results suggest that interventions aimed at improving torso control could decrease the amplitude of WBAM in the frontal plane in older adults.

The Development and Reliability of a Surface Electromyography-Based Index for Quantifying Knee Muscle Coactivation During the Lower Quarter Y-Balance Test

This study aimed to develop and evaluate the reliability of a surface electromyography-based (sEMG) index to quantify knee muscle coactivation in healthy recreational athletes during the Lower Quarter Y-Balance Test (YBT-LQ). A prospective observational repeated measures design was used to assess both intra- and inter-rater reliability. Forty males completed three trials, with two raters independently conducting assessments. sEMG signals from the vastus medialis, vastus lateralis, biceps femoris, and semitendinosus muscles were collected to calculate four coactivation indices (CoAIs) for different muscle pairs. The reliability evaluation of these CoAIs was based on intraclass correlation coefficients. The results revealed that the reliability of the CoAIs varied depending on the muscle pair, direction, and limb examined. The highest intra- and inter-rater reliability was noted for the left lower limb in the posterolateral direction. The lowest reliability was found for the right lower limb in the anterior direction. Statistical analyses indicated significant differences in specific CoAIs across different YBT-LQ directions. These findings highlight the potential of sEMG-based CoAIs for assessing knee muscle activity during the YBT-LQ in healthy male recreational athletes. However, choosing CoAIs is critical for reliable clinical and research assessments of knee stability and neuromuscular control.

A case report on the choice of venous access after ectopic peripherally inserted central catheter in an upper limb of a patient with a second recurrence of right-side breast cancer.

Intravenous catheter placement in the healthy upper extremity is preferred for chemotherapy in patients with breast cancer. Common venous accesses are peripherally inserted central catheters (PICCs) and totally implantable intravenous port catheters (TIVPs). In this case, a patient with breast cancer had a history of infusion port placement through the left internal jugular vein, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. This case can assist PICC catheterization nurses in developing optimal venous access strategies tailored to the specific situations of patients in similar situations. Through adequate evaluations and optimal selection of venous access, the success rate of disposable catheterization can be improved, and the risk of complications reduced. A 53-year-old female with breast cancer had a history of infusion port, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. An axial computed tomography (CT) image before totally implantable venous access port (TIVP) placement and An axial CT 103 days after TIVP placement shows diffuse stenosis of the left innominate vein, associated with infusion port placement through the left internal jugular vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. The patient's lower limb PICC was left in place for 201 days with no complications, completing the full treatment cycle. This case presents a rare and insightful clinical scenario. For patients with a history of infusion port placement, particularly via the left internal jugular vein, careful analysis of the innominate vena cava and examination of chest wall vein exposure are essential to determining the optimal vascular access strategy.

Successfully intravenous thrombolytic therapy in systemic lupus erythematosus-related ischemic stroke: A case report.

Stroke is a relatively frequent complication occurring in patients with systemic lupus erythematosus (SLE). The increasing number of patients with Ischemic Stroke secondary to SLE aroused the clinician's concern. SLE thrombosis markers, diagnostic high-resolution magnetic resonance image (HR-MRI), and therapeutic interventions for acute ischemic stroke were recently coming into focus perspectives from the field. A 42-year-old female with slurred speech and numbness in her left limb was admitted to our hospital. Magnetic resonance imaging (MRI) revealed right thalamic infarction with diffusion-weighted lesions. Prior to admission, the patient had a National Institute of Health Stroke Scale (NIHSS) score of 3. In light of the clinical manifestation, the American Heart Association/American Stroke Association (AHA/ASA) Guidelines for Intravenous Thrombolysis in Acute Ischemic Stroke (2019) should be referred to. The patient was treated with thrombolytic alteplase (rt-PA). The patient was hospitalized for 2 weeks and discharged after his symptoms improved. After thrombolysis, the NIHSS score of the patient decreased to zero. The computed tomography scan was reexamined 24 hours later, and no acute changes or hemorrhage were identified in the infarcted area. Subsequent imaging and serological analyses indicated that HR-MRI of the responsible vessel was negative, but the infarction in this patient was still regarded as being caused by vasculitis of the right posterior cerebral artery in the region supplying the thalamus. This is the first case of successful intravenous thrombolytic therapy with rt-PA in a patient with SLE secondary to stroke with an NIHSS score of 3. This provides further evidence for expanding the reference of indications with rt-PA intravenous thrombolysis.

A rare occurrence of enchondroma with pathological fracture of proximal femur in an adult female: A case report

Enchondroma occurrence in the proximal femur is a very uncommon condition. We report a 40-year-old female with a history of accidental slip and fall, sustained injury to her left lower limb, and was unable to bear weight on the injured leg since the fall. Anteroposterior radiograph of the pelvis with bilateral hips shows a well-defined lytic lesion in the neck of the femur with some calcified matrix and no periosteal reaction with the left femoral subtrochanteric fracture. Magnetic resonance imaging scan revealed hypointense signals on T1 and hyperintense signals on T2 sequence over the proximal femur as well as left subtrochanteric femur fracture. After preanesthetic evaluation, bone curettage with excision biopsy with open reduction and internal fixation with long proximal femoral nail and bolts and iliac crest bone graft was done. A biopsy sample sent for histopathological examination reveals enchondroma. Complete weight bearing was started after four months. No recurrence was noted on follow up.

Piperacillin-tazobactam fixed dose combination induced skin reaction in a patient with split thickness skin grafting: a case report

Piperacillin is a semi-synthetic ureido-penicillin. It has a broad spectrum against gram negative bacilli particularly P. aeruginosa. It is one of the most broadly active of the currently available penicillin with regard to other bacterial species like proteus, klebsiella, H. influenzae and gonococci. Tazobactam is β-lactamase inhibitor and combined with piperacillin to increase spectrum of the drug. Patient was 25 years old female, admitted in orthopaedic department for treatment of traumatic leg injury of left limb. Leg was amputated in the accident, so after 1-month split thickness skin grafting was done at plastic surgery department. For prophylaxis piperacillin-tazobactam IV 4.5 gm 8 hourly given, on 2nd post operative day patient reported rashes on neck, trunk, both upper and lower extremities, sparing the mucous membrane. Patient was prescribed anti pruritic and anti-allergic medication for ADR management. It is necessary to use such kind of drugs cautiously in patients whose health is deteriorated by this medication.

Cinesioterapia para recuperação da osteocondrite dissecante em ombro de cadela da raça Bernese

Osteochondritis dissecans is characterized by the detachment of a cartilaginous flap as a result of Osteochondrosis, resulting in a slowdown in ossification and thickening of the cartilage. The majority of affected animals are large or giant breed dogs, demonstrating clinical signs at an approximate age of between 4 and 8 months of age, with late manifestations possible. The main symptom is lameness, which intensifies, in most cases, after exercise. This work reports the case of a 7-month-old Bernese dog, with a history of lameness of the left thoracic limb, mainly after exercise.

Anterior circulation acute ischemic stroke due to vertebral artery ostial stenosis in a patient with congenital internal carotid artery agenesis: a case report

BackgroundCongenital agenesis of internal carotid artery (ICA) is a rare cerebrovascular variation entity. Most cases of congenital ICA agenesis are asymptomatic and discovered incidentally. Congenital ICA agenesis presenting as ischemic stroke is even rare.Case presentationAn 80-year-old male patient was admitted to our hospital due to sudden dysarthria and left limb weakness for 3.5 h. Based on emergency physical examination and head computed tomography (CT) scan results, acute ischemic stroke (AIS) of right cerebral hemisphere was suspected. Following intravenous thrombolysis with recombinant tissue plasminogen activator, right congenital agenesis of ICA was confirmed by CT and digital subtraction angiography. Additionally, there was a severe right vertebral artery ostial (VAO) stenosis. After ruling out common causes of AIS such as haematological diseases, arterial dissection, organic heart disease, immunological abnormality and underlying possible malignancies, we hypothesize that the severe stenosis of the right VAO may have contributed to the development of AIS in this case.ConclusionsWe present a case of right congenital ICA agenesis in which severe stenosis of the right VAO may have played a role in the development of AIS. This case underscores a rare scenario where a lesion in the posterior circulation leads to an infarction in the anterior circulation in the setting of congenital ICA agenesis.

Unani Integrative Approach for the Management of Sciatica, Employing Pharmacotherapy with Regimenal Therapy: A Case Report

Sciatica, a subtype of low back pain (LBP) is one of the most common clinical complaints in primary care which is characterized by pain that originates in the lower back or buttocks and radiates down one or both legs along the distribution of the sciatic nerve. It commonly results due to nerve root compression by a prolapsed lumbar disc. Sciatica affects both genders equally and has an annual incidence of 1-5%, most common in 30-65 years of age. The management of sciatica includes non-pharmacological, pharmacological and surgical approaches. Combining these management techniques can help in pain reduction and thereby can lead to an overall wellbeing of the individual. In this case report we present the case of a 52 year old male patient with lower back pain radiating to left lower limb who came to Department of Regimenal therapies, National Institute of Unani Medicine, Bengaluru. The patient had taken NSAIDs and other measures for pain management from last 6 months. Despite taking exhaustive measures, no significant improvement was seen. The symptoms have gotten worse over the past two months. After complete clinical examination and diagnosis, the patient underwent treatment for 4 weeks using integrative approach in the form of unani pharmacotherapy, coupled with regimenal therapy. Many objective parameters were used to evaluate the patient both before and after the intervention. The assessment parameters after the intervention reported a significant amelioration of the symptoms. Our study suggested that, management of sciatica with an integrative strategy can be considered. Keywords: Sciatica, LBP, lumbar disc, Integrative therapy, NSAIDs, Regimenal therapy.

Spinocerebellar Ataxia Type 27B (SCA27B): A Hereditary Ataxia in Portugal.

Spinocerebellar ataxia type 27B (SCA27B) is a recently discovered hereditary disease caused by (GAA)≥250 repeat expansion in the fibroblast growth factor 14 (FGF14) gene, and multiple studies have recognized it as one of the most common causes of autosomal dominant ataxia in the European population. We present the case of a 62-year-old Portuguese patient who developed a slowly progressive gait impairment associated with wide-base ataxic gait, dysarthria, left upper limb dysmetria, and dysdiadochokinesia. This pure cerebellar phenotype had an episodic worsening induced by intense physical activity and alcohol intake. The patient had an older brother with a late-onset cerebellar ataxia of unknown cause. Genetic testing detected a heterozygotic intronic FGF14 repeat expansion with complete penetrance (> 360 repeats), confirming the diagnosis of SCA27B. To our knowledge, we present the first reported case of SCA27B in the Portuguese population.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) Technique: A Case Report Demonstrating Its Cost-Effectiveness in a Resource-Limited Setting

Wide-Awake Local Anesthesia No Tourniquet (WALANT) offers a cost-effective alternative to general anesthesia (GA) for wound debridement, improving patient safety, surgical accessibility, and cost-efficiency. This study explores WALANT’s cost-effectiveness and patient outcomes in a resource-limited setting. The patient, E.M., a 27-year-old woman, presented with left upper limb swelling, which began a week after Implanon device removal at another facility. Upon admission, she displayed severe sepsis symptoms, including a blood pressure of 100/58 mmHg, a heart rate of 144 beats per minute, a respiratory rate of 24 breaths per minute, and a temperature of 39.2℃. Her left upper limb showed swelling, redness, and shininess, leading to a diagnosis of necrotizing fasciitis with septic shock. Initially, wound debridement was conducted under GA. However, the patient’ s choice to undergo WALANT for her second debridement saved her 89.1% of the cost of performing debridement under GA. This cost reduction significantly benefited the uninsured patient, alleviating the financial burden and also achieved a favorable patient outcome within the constraints of a resource-limited setting.

Surgical management of traumatic spondyloptosis: a case series

BackgroundTraumatic spondyloptosis is a rare and severe spinal injury characterized by complete anterior translation of one vertebra over another, often resulting in debilitating neurological deficits.Case presentationWe present two cases of traumatic spondyloptosis and elaborate on the clinical presentation, management, and follow-up improvement. The first case is a 30-year-old Nepalese man who sustained traumatic spondyloptosis following a blunt force injury to his back while engaged in tree-cutting activities. The patient presented with severe back pain, left lower limb paralysis, and neurological deficits (consistent with American Spinal Injury Association grade C). Radiographic evaluation revealed total anterior dislocation of the L4 vertebral body over L5, accompanied by fractures of the superior endplates of both vertebrae. The second case is a 35-year-old Nepalese female who presented with back pain and lower limb paralysis following a fall from a 300-m cliff, exhibiting tenderness and ecchymosis in the mid-back region. Radiological examination revealed D12 vertebra translation over L1 with fracture, categorized as American Spinal Injury Association grade A. Both cases were surgically managed and stabilized.ConclusionThese cases emphasize the importance of a comprehensive approach to trauma management as well as prompt recognition, and early surgical management in optimizing outcomes for patients with traumatic spondyloptosis.

Migration of cervical spine screws to the sacral canal: a case report

Cervical open door laminoplasty is widely used in multilevel decompression, which is a motion-sparing decompression treatment option for multilevel cervical myelopathy. Implant distance migration in cervical laminoplasty has not been reported. A 61-year-old woman underwent cervical laminoplasty, three months postoperatively, she experienced left shoulder pain and left upper limb pain, and underwent cervical magnetic resonance imaging, which showed no abnormalities. She gradually developed dizziness, headache, unstable walking, incomplete urinary incontinence, and fluctuating neck lumps. The X-ray showed that the screws of the C7 lateral mass had disappeared and migrated to the sacral canal. The patient underwent cerebrospinal leakage repair and removal of the screws in the spinal canal. Displacement of fixators implanted into the spinal canal after cervical laminoplasty is a rare complication that can cause permanent neurological injury.

Acute Limb Ischemia as a Complication of Early Infectious Endocarditis Following Surgical Closure of an Atrial Septal Defect: Case Analysis and Literature Review

Background: This study reports the case of a 47-year-old woman who presented with acute pain and coldness in the left lower limb, occurring 5 months after a surgical closure of an atrial septal defect (ASD). Initial examination suggested acute limb ischemia. Methods: Doppler ultrasound and computed tomography (CT) angiography of the lower extremity arteries confirmed the presence of an occlusion in the left popliteal artery. Echocardiography revealed vegetation on the surgical patch used for the ASD closure. Blood cultures were positive for Staphylococcus aureus. Treatment: The patient was treated with antibiotics for 6 weeks and underwent replacement of the surgical patch. Conclusion: This case underscores the importance of screening for endocarditis in patients with systemic embolism and a history of ASD patch closure, even though endocarditis is a rare complication. In cases of systemic emboli and large vegetations, a therapeutic approach often requires surgical removal and replacement of the closure patch.

Complete Recovery After Thoracic Endovascular Aortic Repair for Type a Aortic Dissection With Cerebral Malperfusion: A Case Report.

A 52-year-old woman presented with chest pain, shortness of breath and loss of sensation in her left limbs. Computed tomography angiography revealed an type A aortic dissection involving the brachiocephalic trunk and right common carotid artery. Endovascular therapy successfully managed the condition by reconstructing the artery and occluding the false lumen.

Gas gangrene with Clostridium septicum in a neutropenic patient.

Gas gangrene is a rare presentation of a necrotizing fasciitis, caused by Clostridium perfringens, C. septicum and other clostridial species. With its rapid progression it is a potentially life-threatening infection, that poses as a challenge in the clinical management requiring an interdisciplinary approach.Here we present a 62-year-old woman, who developed neutropenic fever while undergoing chemotherapy for triple negative breast cancer. She presented with a high fever, reporting little pain in her left thigh accompanied by redness and induration locally. Subsequently the patient developed pain and redness of the back of the left hand. The initial findings suggested cellulitis and immediate empiric treatment with intravenous meropenem was started. Despite the antibiotic treatment the patient rapidly developed septic shock along with progression of the local infection. Emergency surgical debridement revealed extensive necrosis of the soft tissues including extensive myonecrosis of the thigh. On the left hand an extensive debridement was performed, the left lower limb could not be preserved and exarticulation of the left hip was required. Microbiologically C. septicum was isolated in different samples, confirming gas gangrene. As there was no local entry portal on the skin, hematogenous seeding from intestinal translocation in this neutropenic patient was suspected. The empiric antibiotic treatment was tailored to intravenous penicillin and complemented with clindamycin for toxin inhibition. Following radical debridement and antibiotic treatment, the patient could be stabilized. After repetitive debridement wound closure was achieved and the patient was discharged for rehabilitation. Antibiotic treatment was continued for four weeks.This rare case of gas gangrene in a neutropenic patient shows the complexity in the diagnostic and therapeutic management of necrotizing soft tissue infections in immunocompromised patients. It particularly highlights the importance of an interdisciplinary management with fast recognition of the disease and rapid, if needed radical, surgical debridement as well as tailored antibiotic treatment for a successful outcome.

A novel bailout technique using myocardial biopsy forceps to grasp a dislodged angio-seal collagen with footplate

BackgroundHemostatic devices are now frequently used in femoral artery punctures, and the Angio-Seal (Terumo, Tokyo, Japan) is one of the most commonly used devices for closure of the femoral artery because it provides rapid hemostasis. Although device failure rarely occurs, if the collagen falls into the femoral artery, it may lead to severe limb ischemia. Herein, we describe a case of a novel endovascular technique for the treatment of Angio-Seal arterial closure device failure.Case presentationThe patient in Case 1 was a 75-year-old man with severe left limb claudication. We used a contralateral antegrade approach and used the Angio-Seal for hemostasis. However, the Angio-Seal collagen and footplate dropped and stopped at the bifurcation of the superficial femoral artery and deep femoral artery. The collagen with the footplate was caught with myocardial biotome forceps (MBF) and pulled into the external iliac artery (EIA). The distal common femoral artery (CFA) was punctured, and we delivered a 10.0- × 80-mm stent (SMART®; Cordis, USA) to the EIA from the ipsilateral sheath. The stent was deployed at the EIA and crushed the collagen. The patient in Case 2 was an 88-year-old man with rest pain in the right limb. The right CFA was punctured using an ipsilateral approach and the Angio-Seal was used for hemostasis. The Angio-Seal collagen with the footplate dropped into the bifurcation of the deep femoral artery. The collagen and footplate were caught with MBF and pulled up to the EIA. The right CFA was punctured and a 10.0- × 60-mm stent (SMART®; Cordis) was delivered from the ipsilateral sheath. The stent was deployed at the EIA and crushed the collagen with the footplate.ConclusionsMBF were used to grasp the dislodged collagen with the anchor and cover it with a stent at the iliac artery. This may be a useful bailout technique for Angio-Seal dislodgement.

Lower limb salvage in an interesting case of recurrent calf cellulitis

Cellulitis of the lower limb is a complex pathologic entity which might progress to life-threatening complications, such as sepsis, without a prompt and appropriate treatment. Therefore, a delayed diagnosis often requires life-saving amputations. This paper outlines the therapeutic approach in such situations by describing a patient who had already undergone amputation of the right lower limb and where the rapid institution of targeted therapy saved the left lower limb affected by cellulitis. The conclusion of this research is that in extensive infections of the extremities, the institution of triple antibiotic therapy in combination with staged surgical treatment may avoid limb amputation and save the lives of these patients.

Comprehensive technical analysis of a kickboxing fight in K1 format based on observation

Introduction: Observation and specialized analysis of confrontations in combat sports are fundamental for introducing corrections in training programs and for modifying the individual technical-tactical profiles of athletes in these types of activities. These actions comprehensively assess the progress of sports activities, ultimately inspiring and guiding the direction of training in sports clubs. The aim of this study was to analyze and assess the level of the offensive structure of Kickboxing sport fights in the K1 format, in terms of global simulated sparring, in selected thematic sets. Materials and Methods: The research material consisted of a multimedia recording of 10 simulated K1 sparring sessions, in which 20 professional athletes of this discipline participated (age: 24.5 ± 4.6 years; body height: 179.1 ± 4.6 cm; body weight: 81.7 ± 9.9 kg; BMI: 25.5 ± 3.7; training experience: 6.9 ± 1.3 years). To assess the offensive structure of the fight, a retrospective analysis of the recorded empirical material was conducted in terms of the quantity of attacks made, and then specialized technical-tactical preparation (PTT) indicators were calculated, in the global context of sparring, for thematic sets (total; punches vs kicks; right vs left limb attacks; type of techniques; direction of attack). Results: The analysis revealed a significantly higher technical-tactical efficiency regarding hand strikes, left hand, and direction of strikes to the opponent's head in terms of activity (p < 0.001), effectiveness (p < 0.001), and efficiency (p = 0.008–0.408) of attack. In isolated analysis of kicking techniques, a significant advantage in efficiency was registered for selected attacks directed at the lower parts of the opponent's body, i.e., torso, legs (p =< 0.001–0.043). The most effective and exploited techniques were: left straight (Aa x̃=36.8; Sa x̃=23.9), and for kicks, right low kick (Aa x̃=14.9; Sa x̃=5.6). The highest attack efficiency was noted for the right middle kick (Ea x̃=54.18). Several selected comparative sets (inter-limb symmetry, type of attack, direction of attack) for technical-tactical efficiency, were characterized by significant statistical differentiation (p=<0.001–0.048). Conclusions: Kickboxing is an asymmetrical combat sport, which necessitates the application of targeted training on individual body segments of the athlete, and compensatory actions in the prevention of injuries. The study results allow for detailed diagnosis and interpretation of the technical-tactical profile along with the key manifestation of offensive competencies in Kickboxing profession in the K1 format, favoring the optimization of the quality of coaching control.