Left Lower Limb Research Articles

A case of Chronic Thromboembolic Pulmonary Hypertension in association with Deep Vein Thrombosis and Pulmonary Embolism: A case report of a young female in Bangladesh

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as Group 4 Pulmonary Hypertension (PH) in current categorization by WHO. The initial suspicion with clinical presentation, then screening with imaging and confirmation with Right heart catheterization (RHC) are the steps of diagnostic algorithm for CTEPH. We report the case of a 35 years old female presented with progressive swelling of left lower limb for 2 months and shortness of breath for 1 and half months. Examination revealed respiratory rate 28 breaths/min, pitting edema of left leg, left parasternal heave and palpable P2. Doppler study of both lower limbs and Computed tomography pulmonary angiography (CTPA ) confirmed the diagnosis of deep vein thrombosis of left leg (DVT) and pulmonary embolism (PE), respectively. The echocardiography suggested presence of pulmonary hypertension. We approached the patient with conservative management and discharged her home, once she improved, with advice of life-long anticoagulation. Bangladesh Heart Journal 2023; 38(2): 143-147

Attempted Suicide with a Self-Inflicted Penetrating Stab Wound to the Medulla Oblongata Caused by a Pair of Scissors: Case Illustration

A 78-year-old male patient with a history of psychotic depression was found in the bathroom of his apartment with a pair of scissors driven deeply into the back of his neck. He presented with tetraparesis with residual control over the left lower limb movement. Immediate skull radiograph and brain computed tomography scans revealed the tip of the scissors passing into the foramen magnum. Emergent surgery with midline suboccipital craniectomy and resection of the posterior arch of C1 was performed. The scissors were spontaneously dislocated in the course of surgery. Thereafter, debridement, placement of external ventricular drain and primary closure of the dura and skin were achieved. Post-operatively, the patient was not able to follow any instructions. On the 22nd post-operative day, the patient passed away in palliation. To our knowledge, this is the first reported case of a suicide attempt involving the use of scissors reaching the medulla oblongata.

Lower limb balance, ankle dorsiflexion, orofacial tissue pressure, and occlusal force of rugby players

This cross-sectional study examined the lower limb balance, ankle dorsiflexion, orofacial tissue pressure, and occlusal strength of rugby players. Twenty-six participants were divided into groups: rugby players (n ​= ​13) and healthy sedentary adults (n ​= ​13). Participants underwent an analysis of lower limb balance using a composite score (Y-Balance Test). Ankle dorsiflexion was measured using the Lunge Test. The Iowa Oral Performance Instrument was employed to measure orofacial tissue pressure. Bite force was measured with a dynamometer, and T-Scan assessed occlusal contact distribution. Data were analyzed using the t-test (p ​< ​0.05) and ANCOVA with age and weight as covariates, where it is possible to verify that these factors did not influence the results obtained. Significant differences were observed in the balance of the right (p ​= ​0.07) and left (p ​= ​0.02) lower limbs, where rugby players had lower composite scores. There were significant differences in the right (p ​= ​0.005) and left (p ​= ​0.004) lunges, with rugby players showing lower values, as well as lower tongue pressure (p ​= ​0.01) and higher lip pressure (p ​= ​0.03), with significant differences to sedentary participants. There was no significant difference in molar bite force and distribution occlusal contacts between groups. Rugby seems to reduce lower limb displacement, cause ankle hypomobility, lead to changes in orofacial tissues, particularly the tongue and lips. This study is significant for identifying significant differences between rugby players and sedentary individuals, providing new insights into the impact of rugby on health and performance, which can benefit sports training and injury prevention.

Coronavirus disease 2019 (COVID-19)-associated brain abscesses caused by Pseudomonas aeruginosa and Aspergillus fumigatus: two case and a review of the literature

BackgroundBacterial and fungal superinfections are commonly reported in patients with coronavirus disease 2019.Case presentationWe report the first case of brain and intramedullary abscesses caused by Pseudomonas aeruginosa and a rare case of brain abscesses caused by Aspergillus fumigatus in two post-coronavirus disease 2019 patients. The first patient—34-year-old Iranian woman—presented with weakness of the left upper limb, headaches, and lower limb paresthesia. She had a history of undiagnosed diabetes and had received corticosteroid therapy. The second patient—45-year-old Iranian man—presented with right-sided weakness and had a history of intensive care unit admission. Both patients passed away despite appropriate medical therapy.ConclusionThe immune dysregulation induced by coronavirus disease 2019 and its’ treatments can predispose patients, especially immunosuppressed ones, to bacterial and fungal infections with unusual and opportunistic pathogens in the central nervous system. Pseudomonas aeruginosa and Aspergillus fumigatus should be considered as potential causes of brain infection in any coronavirus disease 2019 patient presenting with neurological symptoms and evidence of brain abscess in imaging, regardless of sinonasal involvement. These patients should get started on appropriate antimicrobial therapy as soon as possible, as any delay in diagnosis or treatment can be associated with adverse outcomes.

A Rare Case of Fatal Necrotizing Fasciitis In An ASA Grade I Young Patient.

Abstract This case report presents a young adult who tragically died within 24 hours of his presentation due to severe necrotising fasciitis. The patient, initially healthy, sought medical advice from his GP for a sore throat and was prescribed amoxicillin. However, three days later, they ended up in the emergency department, critically unwell, with disseminated intravascular coagulopathy and painful left thigh with mild crepitus on examination. A CT scan of the abdomen and pelvis with contrast revealed extensive necrotizing fasciitis in the left psoas muscle, left thigh, and left leg. Urgent surgical intervention, including left lower limb fasciotomy, laparotomy, and left above knee amputation, were performed in one session. The patient was then admitted to the intensive care unit, despite this immediate management, he succumbed to this rapidly progressive disease, experiencing sepsis and multiorgan failure. This case highlights the importance of recognizing the symptoms of necrotising fasciitis early, even in young patients without comorbidities.

Rotura del implante protésico tras artroplastia total de cadera: una complicación infrecuente. A propósito de un caso y revisión de la literatura.

Femoral stem breakage is a rare complication after total hip arthroplasty, occurring in 0.23% of cases. Due to its infrequency, we present the case report of a 64-year-old man with bilateral hip prosthesis and breakage of the femoralneck in the left lower limb.

Postural Analysis Using Rasterstereography and Inertial Measurement Units in Volleyball Players: Different Roles as Indicators of Injury Predisposition.

Background and Objectives: Acute and chronic injuries are frequent in volleyball. Biomechanics of sport-specific tasks can influence the risk of injury, which is also related to specific court positions. We investigated posture at raster-stereography, balance, and dynamic tasks using inertial motion units to find differences between roles, which can be predictive of a higher risk of injury. Materials and Methods: We cross-sectionally evaluated amateur volleyball athletes. Participants were divided into roles as outside hitters, setters, middle blockers, and opposite hitters. We excluded the "libero" position from our analysis. Results: Sixteen players were included in the analysis. A statistically significant difference was found in left lower limb stiffness among the outside hitter and setter groups. Conclusions: Differences in stiffness might be related to the different training and the different abilities among the two groups. Raster-stereography is extending its indications and should be implemented for non-invasive postural analysis. The use of inertial motion units provides objective measurements of variables that could go unrecognized within a clinical evaluation; its use should be considered in injury preventive programs.

Management of post-traumatic genu valgus deformity in adolescent by proximal tibial corticotomy with bone lengthening by Ilizarov method: a case report

Introduction: Genu Valgus and Varus are the most common lower limb deformities at knee level, seen in childhood. Genu valgus is more common about 10%, where knee/knees turn inward, causing the appearance of the knees to be touching each other while the ankles remain apart. Genu Valgus is a normal physiological process in children’s; it may be pathological due to various causes. Physiological genu valgus is greatest at the age of 3-4 years and spontaneously resolves by the age of 7 years. When valgus deformity is persistent or worsening after 7 years of age is called pathological genu valgus. Cosmetic abnormality is common complaint. Abnormal circumduction gait, knees touching on medial aspect and LLD found on examination. Plan x-ray A/P view in standing position of full both lower limbs with pelvis provides diagnosis and treatment plan information. Case presentation: A 15 years old girl came with the complaints of abnormal walking due to right knee bending inwards, also during standing position. She was perceived pain in right knee during walking and longtime standing position. She has H/O- fractured proximal tibia (Rt.) more than 6 months ago due to trauma and treated by plaster. Plaster removed after 3 months. One month later she developed pain in knee joint during walking and right knee gradually bend inwards. O/E- Bil genu valgus right &gt; left. Clinically, right knee -300 and left knee -100 There was 1.5 cm shortening of right lower limb than left. Both right and left lower limb with pelvis full radiograph was done. In x-ray both femurs and knee joints were normal. In radiograph, the medial and lateral surface of right tibia with fibula bends medially. Left tibial surfaces and fibula appears almost normal. The right tibia at the point of 14 cm from upper end there was maximum angulation point. The degree of genu valgus was evaluated by CORA method and treatment plan set accordingly. There was 300 medial bending of right tibial shaft and about 100 of left tibial shaft. The patient was diagnosed as post traumatic unilateral right tibial genu valgus following proximal tibia fracture. The patient was treated by proximal tibial corticotomy with Ilizarov frame. Aim: The aim of the treatment is restoration of normal mechanical axis. Objective: To assess the effectiveness and outcomes of the treatment method. Result: After complete union and consolidation, substantial evidence was checked and confirmed by both clinical and radiological. There was no abnormal gait and pain during walking. Mechanical axis of right lower limb was restored as normal. The final outcome is excellent. Conclusion: Genu valgus is common in children and observation is the first line of treatment. Physiological variant treated conservatively. Pathological genu valgus needs management according the cause. When surgical correction is indicated, corrective osteotomy usually done but there is so many complications and needed repeated surgery. In post-traumatic proximal tibial genu valgus effectively corrected by Ilizarov with corticotomy, which minimize complications, Due to early mobilization and decrease hospital stay time, resulting cost effective and found excellent final outcome.

Painless nondiabetic lumbosacral radiculoplexus neuropathy with complete recovery: a case report

BackgroundLumbosacral radiculoplexus neuropathy, also known as amyotrophy, is an uncommon monophasic disorder characterized by inflammation of the lumbosacral nerve roots and plexuses. Lumbosacral radiculoplexus neuropathy is usually associated with diabetes mellitus, is typically painful at presentation, and often associated with long-term residual neurologic deficits. We report a case of painless, nondiabetic lumbosacral radiculoplexus neuropathy in a young Chinese woman, who made a full recovery after treatment with intravenous immunoglobulin, adding an atypical case to the scarce literature on lumbosacral radiculoplexus neuropathy.Case presentationA 35-year-old Chinese woman presented to our emergency department with 1-week history of painless left lower limb weakness and numbness. Examination revealed weakness confined to the left lower limb but spanning various nerves and myotomes, with abnormal sensation. Clinical localization to the lumbosacral plexus was supported by neurodiagnostic tests, and magnetic resonance imaging of the lumbosacral plexus showed that the nerve roots were also involved. After treatment with intravenous immunoglobulin for nondiabetic lumbosacral radiculoplexus neuropathy, the patient had a full recovery.ConclusionOur patient’s case highlights that lumbosacral radiculoplexus neuropathy, an already rare disorder, can occur in the absence of diabetes mellitus and pain, making it even harder to recognize. A systematic and meticulous clinical approach, supported by intelligent selection of adjunctive tests, is required for localization and diagnosis. With an accurate diagnosis, our case also demonstrates that appropriate and prompt treatment can lead to complete recovery, despite previous reports suggesting a high prevalence of long-term residual deficits after lumbosacral radiculoplexus neuropathy.

Subacute combined degeneration: When neuroimaging complements the clinic—A case report

Introduction: Low serum B vitamin levels are potentially causally related to these prevalent mental symptoms. Because of this, cobalamin—vitamin B12—is crucial for producing myelin and neurotransmitters. Additionally, subacute combined degeneration (SCD) is one of the consequences of B12 deficiency. Symptomatology often is paraplegia, spasticity, and contractures which are typically progressive. In addition, as the disease advances, they experience a distal sensorimotor loss that ascends proximally and causes spastic quadriparesis and generalized hypoesthesia. Case Report: Male, 33 years old, with a history of a fall in December 2015, when pain and discomfort started in the left lower limb. A year ago, she evolved with paraparesis, loss of sphincter control, sensory changes in the extremities of the limbs and sensory level at T10, in addition to a report of visual disturbance in the left eye. At that time, the dosage of vitamin B12 was very low—50 pg/mL (reference above 300 pg/mL). On physical examination: extrapyramidal syndrome with hypoesthesia at the distal level. Bilateral Hoffmann’s sign, spastic paraparesis, hyperreflexia in the lower limbs, clonus in the feet, and loss of sphincter control. Sensitive level at T10. Magnetic resonance imaging (MRI) showed cervical dorsal lumbar spinal cord and cone with hypersignal focus on the lateral and posterior cords and skull hypersignal focus in the topography of the corticospinal tracts, suggestive of combined subacute degeneration. Conclusion: Vitamin B12 deficiency, in addition to other pathologies, is also found in SCD. When treated early, these alterations found in the imaging exam can be resolved without signs of atrophy. Thus, neuroimaging plays a relevant role in the diagnosis, complementing the clinic.

SURG-46. PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE

Abstract Few studies have documented the occurrences of melanomas in the cervical spine. one percent of all malignant melanoma cases are primary melanoma of the central nervous system, which is extremely uncommon and nonspecific. We aimed to report a case of uncommon presentation of primary melanoma in the cervical spine. This a 59-year-old, male who presented with a 2-year history of anterior neck swelling, severe pain and tingling sensation in the left shoulder and arm which worsened in the previous 6 months. He developed weakness and paresthesia in the left upper arm and progressive gait disturbance of the left lower limb. Physical examination revealed masses in the left cervical and right submandibular region. There was left upper and lower extremities hemiparesis and hemi hypoesthesia. MRI showed hyperintense lesion on T1WI and hypointense on T2WI originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed malignant melanoma. This case is presented in order to highlight the significance of and challenges associated with making a preoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1 weighted images and hypo intensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.

Osteoporosis and body composition in old patients with amputated lower limbs

The study aim was to investigate bone mineral density (BMD) and body composition in old patients with amputated lower limbs.Materials and methods. This work is a cross-sectional study, which enrolled 31 patients, who underwent amputation of one of the lower extremities. The mean age of the study patients was 73.4±9.0 years, ranging from 60 to 101 years. The majority of study patients were men (77.4%). 41.4% of patients underwent amputation of the left lower limb, 58.6% – right. The time from amputation to enrollment in the study ranged from 4 to 444 months, with a median of 30 months. Bone mineral density in the lumbar spine and proximal femurs was analyzed by dual energy x-ray absorptiometry.Results. Osteoporosis in the proximal part of the left femur was registered in 51.7% of patients, osteopenia – in 17.2%, normal BMD – in 31.1% of cases. Osteoporosis in the proximal part of the right femur was observed in 64.0% of patients. In the lumbar spine, osteoporosis was found only in 6.9% of patients. The mean T-score in the lumbar spine reached +0.38 SD, in the proximal left femur – -1.5 SD, in the left femur neck – -2.1 SD, in the proximal right femur – -2.0 SD, in the right femur neck – -2.1 SD. In the case of amputation of the left lower limb, the left femur BMD averaged 710.8±239 mg/cm3, the left femur T-score – -2.6±1.6SD, the T-score in the left femur neck – –3.0±1.3 SD, with the intact left leg – 980.1±194 mg/cm3,–0.8±1.5SD,–1.5±1.2SD, respectively (p=0.002, p=0.005 and p=0.006). In case of amputation of the right lower limb, the right femur BMD reached 743.8±268 mg/cm3, right femur T-score – -2.4±1.7SD, the T-score in the right femur neck – -2.4±1.7SD, with the intact right leg – 909.9±211.0 mg/cm3, -1.2±1.5SD, -1.5±1.5SD, respectively (p=0.09, p=0.06 and p=0.1). The likelihood of developing osteoporosis in the left femur with amputation of the left leg increased by 9.8 times, compared with patients who had a preserved left lower limb (odds ratio=9.8; 95% CI=1.1–93.5; p=0.02). In patients with amputation of the left leg, inverse correlation was registered between bone mineral density and the time from the moment of amputation to inclusion in the study (r= -0.65, p=0.03).Conclusion. Preliminary results of this study demonstrate a decrease in bone mineral density in the proximal femur of the amputated limb. Further studies are needed to study BMD in amputees and to elucidate the pathogenetic basis of the relationship between BMD and other clinical and laboratory parameters in this group of patients.

Sustained pain and macrophage infiltration in a mouse muscle contusion model.

Prior studies have emphasized the role of inflammation in the response to injury and muscle regeneration, but little emphasis has been placed on characterizing the relationship between innate inflammation, pain, and functional impairment. The aim of our study was to determine the contribution of innate immunity to prolonged pain following muscle contusion. We developed a closed-impact mouse model of muscle contusion and a macrophage-targeted near-infrared fluorescent nanoemulsion. Closed-impact contusions were delivered to the lower left limb. Pain sensitivity, gait dysfunction, and inflammation were assessed in the days and weeks post-contusion. Macrophage accumulation was imaged in vivo by injecting i.v. near-infrared nanoemulsion. Despite hindpaw hypersensitivity persisting for several weeks, disruptions to gait and grip strength typically resolved within 10 days of injury. Using non-invasive imaging and immunohistochemistry, we show that macrophage density peaks in and around the affected muscle 3 day post-injury and quickly subsides. However, macrophage density in the ipsilateral sciatic nerve and dorsal root ganglia (DRG) increases more gradually and persists for at least 14 days. In this study, we demonstrate pain sensitivity is influenced by the degree of lower muscle contusion, without significant changes to gait and grip strength. This may be due to modulation of pain signaling by macrophage proliferation in the sciatic nerve, upstream from the site of injury. Our work suggests chronic pain developing from muscle contusion is driven by macrophage-derived neuroinflammation in the peripheral nervous system.

Ayurvedic Management along with Hypnotherapy in Functional Neurological Symptom Disorder (Conversion Disorder)

Functional neurological symptom disorder (FND)/Conversion disorder may be broadly defined as the presence of neurologic symptoms in the absence of a neurologic diagnosis, or when a neurologic diagnosis exists, it does not fully account for all of the patient’s symptoms. The cardinal symptom is limited solely to neurological symptoms. The diagnosis is made on the basis of the positive findings of the examination demonstrating preserved neurological function. Yoshapasmara, described in Madhava nidana, is comparable to FND where gathi / samvedhana (motor or sensory functions) are lost in the absence of underlying neurological conditions.&#x0D; A 29-year female was admitted with C/o Weakness and numbness in the left lower limb for 6 months. She had severe stress factors due to family conflicts. One day after a conflict with her mother-in-law, she felt difficulty walking on her left leg. They consulted a neurologist and done imaging, which was normal. On detailed clinical examination, the diagnosis was FND. She was managed with Internal medications and Udwartana, Abyanga, and Vyathyasa chikitsa (Dry and unctuous therapies alternatively). Hypnotherapy was administered in addition to Ayurvedic management to address stress factors. There were noticeable changes in the Perceived Stress Scale (PSS), muscle strength, and could walk without assistance with some difficulty after treatment. The neuropsychiatric perspective incorporating biopsychosocial aspects at the individual level, including consideration of Psychological and Spiritual aspects wherever relevant, is crucial for better outcomes in such cases.

THE EFFECTIVENESS OF 120-140 J/CM ENERGY DENSITY FOR THE ENDOVENOUS LASER ABLATION IN PATIENTS WITH DIABETES MELLITUS

The aim of this study is to analyze the impact of the 120-140 J/cm energy for EVLA in patients with diabetes. Material and methods. The outcomes of 40 patients with varicose disease and diabetes mellitus as a comorbid condition were analyzed. Forty patients with varicose disease and diabetes mellitus were enrolled in the investigation. There were 27 women (67.5%) and 13 men (32.5%). The average age of the patients was 59.5±1.18 years, ranging from 44 to 74 years. The blood glucose level was 184.5±11.6 mmol/l, and the concentration of glycohemoglobin was equal to 8.5±0.25%. The average duration of the diabetes history was 10.6±0.91 years. Biolitec ELVeS Radial 2 Ring Fiber diode device and laser with 1470 nm wavelength and 120 – 140 J/cm energy were used for EVLA. VCSS results and recurrence rates were subjected to analysis in 1 week, 1 month, 6 months, and 1 year following the treatment. Results. The outcomes of the EVLA with high power energy for the treatment of varicose disease in patients with diabetes were not enough highlighted. The total VCSS score was for the right lower extremity: 4.75±0.725 - 1 week after EVLA; 1.93±0.547 - 1 month later; 0.79±0.306 - 6 months after; 0.36±0.151 - 1 year after; respectively for the left lower limb 5.37±0.806 - 1 week; 2.6±0.643 - after 1 month; 1.06±0.351 - after 6 months; 0.62±0.034 - after 1 year. 1 week after EVLA, there was an intense decrease in the pain index in the right lower limb, and after 1 month, almost 90% of the patients had no pain at all. In the 6-month and 1-year follow-ups, the pain had completely disappeared, and only 1 person reported having episodic pain. This trend is also reflected in the left leg. The intensity of pain in the left leg decreased significantly after 1 week of EVLA. During all observations, the intensity of pain was statistically significantly less than in the previous examinations (p&lt;0.05). In the short term after EVLA the rapid reduction of the intensity of pain and oedema, and the disappearance of chronic venous insufficiency symptoms ensured earlier rehabilitation of patients. The recurrence was observed in 1 case (2.5%). Conclusion. 120-140 J/cm of energy was approved as an optimal density for the EVLA in patients with varicose and diabetes mellitus.

Clinical Characterization of Patients with Venous Thromboembolic Disease in 2 Reference Centers in El Salvador

Introduction. During the last decade, venous thromboembolic disease (VTE) has become increasingly important due to its high impact on morbidity and mortality in patients. Suspicion scores together with the diversification of diagnostic methods have allowed rapid and timely diagnosis. Although the annual incidence of VTE is estimated to be approximately 1 in 1,000 people, the risk in certain groups is significantly higher. For the United States, the statistics do not vary significantly. It is estimated that DVT and PE affect between 350,000 and 600,000 people a year, causing between 100,000 and 300,000 deaths. For El Salvador, there are no clinical data related to risk and development factors. Aim. To describe the clinical characteristics of patients with venous thromboembolic disease in 2 reference centers of the Salvadoran Social Security Institute in 2020. Methods. This study is retrospective, observational, cross-sectional and descriptive. All patients with a first-time or recurrent diagnosis that were documented by venous Doppler of the lower and/or upper limbs, computed tomography angiography, magnetic resonance imaging and/or venography at the General Hospital, Medical Surgical and Oncological Hospital of Social Security were included. diagnosed in the internal medicine hospitalization area and in outpatient consultation for the first time in the Hematology Service during the period established between January and December 2020. Results. Of the total of 138 registered patients, the final study population that met all the inclusion criteria was 88, of which the majority corresponded to the female gender in 56.8% (n=50), with a mean age for all of them. the cases of 55 years (range 23 to 88 years). Regarding the associated comorbidities, the 2 main ones were arterial hypertension 52.3% (n=46) and diabetes mellitus 25% (n=22), the most prevalent risk factor being the use of OACs with 9.1% (n=8 ). The most frequent anatomical location was the left lower limb with 45.2% (n=46) of the cases and at the time of diagnosis the initial treatment of all patients with thrombosis was with low molecular weight heparins in 51.1% (n=45). ). VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. Conclusions. VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. The main anatomical location of thrombosis is in the lower limbs, mainly on the left side, and in the lungs in main branches. Regardless of the location, mortality is similar in deep vein thrombosis and pulmonary embolism.

Case Report on Challenging Deep Vein Thrombosis

In pregnancy, venous thromboembolism (VTE) remains a leading cause of direct maternal mortality. It is approximatelyfive times more common in pregnant women, with an incidence of 0.5-2 in 1000. The highest risk of deep venous thrombosis(DVT) leading to pulmonary embolism (PE) is during the postnatal period, especially after a cesarean section. A clinician who doesnot treat pregnant women regularly may not routinely identify pregnancy-specific risk factors for VTE. In patients with DVT,treatment with anticoagulation is associated with a high risk of bleeding during the immediate postpartum state, and patients dowell with monitored anticoagulation and proper supportive treatment, as described in this case report. We are reporting a caseof a 20-year-old primigravida who presented with labor pains at 39 (+6) weeks of gestation at Sree Balaji Medical College andHospital, Chrompet, Chennai. The patient had no comorbidities and did not report any past or family history of VTE. An emergencycesarean section was performed due to fetal distress, and on the first postoperative day, she developed swelling pain andtenderness in the left lower limb. Color Doppler ultrasound showed left anterior tibial vein thrombosis, following whichanticoagulant therapy was started with low molecular weight heparin. The patient was closely monitored for signs of bleeding orPE and was eventually discharged on oral anticoagulation. In conclusion, all women should be assessed for the risk factors of DVTduring the antenatal period, and early ambulation in the postoperative period is crucial to prevent such deadly complications.

High Origin of Profunda Femoris Artery - A Case Report

Profunda Femoris Artery arises from lateral aspect of femoral artery 3.5cm distal to inguinal ligament. Profunda femoris Artery gives lateral circumflex and medial circumflex femoral arteries from lateral and medial aspect of femoral artery respectively. Following variation was reported in left lower limb of a 62-year male cadaver, during routine dissection of Rachana Shareera dissection class. Profunda Femoris Artery arises from lateral aspect of femoral artery 1.5 cm distal to inguinal ligament, runs laterally and down words parallel to femoral artery, the profunda femoris passed beneath rectus femoris, sartorius and vastus medialis successively in its course, later pierced adductor magnus, 5.5 cm above knee joint.

The effect of Ayurvedic management in Vranshopha w.s.r. to Cellulitis – A Case Study

Cellulitis is a spreading inflammation of the skin and subcutaneous tissue that is usually caused by a bacterial infection.[1] Streptococci, Staphylococci, or Clostridium organisms are typically the culprits. Additionally, it can be brought on by snake and insect bites. Cellulitis is associated with Vranshopha in Ayurveda, and Ekadesa Upakrama is recommended as a course of treatment. Modern medicine says that depending on the symptoms, it is treated with antibiotics, anti-inflammatory, antipyretic, and analgesic medications. However, these medications have a number of negative effects and require recovery time. A 48 year old male patient arrived with the main complaints of 15 days of left lower limb pain, swelling, burning sensation, itching, and redness; and was treated with Jalaukavacharana, Kwatha Parisheka and Lepa. The symptoms have significantly improved after the treatment.

Surgical Treatment for Branched Endograft Thrombosis of the Abdominal Aorta

Introduction. Endovascular intervention was firstly introduced for repairing aortic aneurysms in the early 1990s. The greatest advantage of endovascular aneurysm repair (EVAR) is its minimally-invasive character, thus implying shorter post-operative period. The operative mortality rate comprises 3.3 % (95 % CI 2.9–3.6); however, according to recent studies, the rate has declined to 1.4 % due to a rapid improvement in outcomes. According to the DREAM-trial, the incidence of a branched endograft thrombosis accounts for 6.4% within the first 30 days. The EVAR trial reports an incidence of 2.6% after the first year of follow-up. Stent bending and small distal aortic diameters (less than 20 mm) are believed to be the most common causes of endograft thrombosis.Aim. To identify the causes of complications following the abdominal aortic stent-graft repair and to determine the optimal treatment strategy.Materials and methods. The paper presents a case of 71-year-old patient with late complication after endovascular abdominal aortic repair of an infrarenal aortic aneurysm. The patient was admitted to the hospital on January 05, 2020 as an emergency due to the pain in the left lower limb. On December 03, 2019 the patient underwent endovascular abdominal aortic repair. Angiography of January 06, 2020 revealed thrombosis of the left branch of the stent graft. Thrombectomy of the brunched left stent graft, left iliac artery and balloon dilatation of the brunched left stent-graft were performed.Results and discussion. Endovascular abdominal aortic repair stands as the first choice for patients with appropriate aortic anatomy and those with significant comorbidity. Despite the significant progress in endovascular abdominal aortic repairing, the EVAR procedure is followed by a nearly fivefold increase in the 30-day reintervention rate as compared to open surgery which comprises 9.8 % according to the EVAR-I, and 18 %, according to the EVAR-II trials.Conclusion. Our multidisciplinary team consisted of vascular and endovascular surgeons managed to perform hybrid surgery, thus eliminating the EVAR-associated complication together with its cause.