Leg Swelling Research Articles

Peritoneal carcinomatosis presenting as a mimic for DVT.

Unilateral leg swelling poses a diagnostic challenge with a myriad of potential differential diagnosis, including deep vein thrombosis (DVT), Baker's cyst, and cellulitis. As some of these causes can be benign and easily treatable, other causes may be more severe and even life threatening. This article highlights the critical need for healthcare professionals to expand their differential diagnosis when common causes have been excluded, recognizing that some rare etiologies may signify severe underlying conditions. We present the case of a 55-year-old female with a two-month history of right leg swelling, initially attributed to erysipelas due to negative DVT findings. Upon closer examination, an abdomino-pelvic CT scan revealed diffuse peritoneal carcinomatosis, obstructing the right external iliac vein and elucidating the unilateral lower limb edema. This case focuses the importance of considering atypical causes, especially in patients with a history of cancer, and the potential life-threatening nature of rare etiologies. The article emphasizes the significance of a multidisciplinary approach, comprehensive laboratory assessments, and advanced imaging techniques in achieving accurate and timely diagnoses, ultimately guiding effective patient management.

Apixaban failure in a post-bariatric surgery female patient with thoracic aortic thrombus secondary to COVID-19

A floating thrombus in the thoracic aorta represents a rare vascular condition frequently associated with morbidity and mortality. There is no standardised management approach, but options potentially include anticoagulation therapy, surgical intervention or a combination of these. Clinicians are increasingly selecting direct oral anticoagulants (DOACs) due to predictable pharmacokinetics. Here, we present a 37-year-old female with a history of Roux-en-Y gastric bypass surgery for obesity, who was found to have an incidental floating thrombus in the thoracic aorta during evaluation for generalised weakness and altered mentation following a recent COVID-19 infection. The patient was initially treated with intravenous heparin and subsequently transitioned to apixaban. Despite medication adherence, she presented two weeks later with worsening mental status and bilateral leg swelling. Repeat imaging revealed rupture of the thrombus, leading to right renal and bowel infarctions. The failure of anticoagulation was attributed to malabsorption secondary to her bariatric surgery. Despite aggressive interventions, the patient ultimately developed multisystem organ failure and succumbed to her illness. Literature suggests that DOACs may be less effective in post-bariatric patients due to altered pharmacokinetics. Due to the absence of clinical guidelines for post-bariatric patients, we recommend full-dose anticoagulation with warfarin, a vitamin K antagonist, to enable therapeutic international normalised ratio (INR) monitoring and necessary dose adjustments. DOACs are less effective in this population, particularly in hypercoagulable states, and the lack of monitoring increases the risk of treatment failure and subsequent life-threatening complications. This case report is of apixaban treatment failure in a female patient with a Roux-en-Y gastric bypass.

Synopsis and Pregnancy Outcome of Decompensated Heart Failure in Pregnancy at a Tertiary Health Care Centre in South-Eastern Nigeria: A Retrospective Study.

Heart failure during pregnancy is rare, potentially serious, and complicates approximately 1% of all pregnancies. However, there is a global dearth of data on heart failure in pregnancy, and no data from southeastern Nigeria. To determine the prevalence, clinical profile, and outcomes of pregnancy in women presenting with heart failure during pregnancy at the University of Nigeria, Enugu. A hospital-based, retrospective study covering 9 years between 2013 and 2021, using data from the medical records of patients seen at the cardiology and obstetrics/gynecology units. Information on the clinical profile, echocardiographic reports, and pregnancy outcomes were obtained and analyzed. Of 9749 new pregnant women, 26 (0.3%) had heart failure during pregnancy, with a prevalence rate of 0.3% and a mean age of 33.27 years. Among 26 women, peripartum cardiomyopathy (46%) was the most common cause of heart failure. The most common presenting symptoms were breathlessness (84.62%), bilateral leg swelling (69.24%), and paroxysmal nocturnal dyspnoea (65.39%). The majority presented with New York Heart Association classes III (57.7%) and IV (26.9%). The most affected age group and mode of delivery were 31-40 years (82%) and cesarean section (50%), respectively. Pregnancy outcomes showed high maternal (11.5%) and fetal/neonatal (15.4%) mortality rates. There was a significant association between the etiology and severity of heart failure (P = 0.009), and the trimester of pregnancy at presentation (P = 0.009). heart failure in pregnancy is associated with high maternal and fetal mortality. The most common cause of heart failure in South Eastern Nigeria was peripartum cardiomyopathy.

Venous thrombosis related to duplicated inferior vena cava: A case report and systematic review.

Swollen legs are commonly observed in clinical practice, and deep vein thrombosis (DVT) is 1 of the causes. Duplicated IVC (DIVC) is a relatively rare anomaly that results in DVT. A 52-year-old male patient presented to the emergency department because of right leg swelling, pain, and redness for 3 days. His right leg was swollen from the sole to the thigh, with mild tenderness and local heat, without pitting edema. Laboratory tests showed mild elevated C-reactive protein (CRP) 3.82 mg/dL (reference value: 0-0.79 mg/dL), and notably high levels of D-dimer (25,700 ng/mL; reference value: 0-653). Lower limb computed tomography angiography showed duplication of the IVC (DIVC) and was highly suspicious for venous thrombosis involving the right popliteal vein, superficial femoral vein, common femoral vein, external iliac vein, internal iliac vein, common iliac vein, and inferior vena cava (IVC). Enoxaparin (80 mg) was administered subcutaneously, twice daily. After admission, catheter-directed thrombolysis and thrombectomy via the right superficial femoral and popliteal veins were performed. The congestion in the right lower leg improved, and the patient was discharged with rivaroxaban 15 mg twice daily 3 days later. A systematic review using the keywords "duplication IVC," "thrombosis" and "case report" was performed on PubMed until May 2023. Males accounted for 55.2% (16 of 29) of the cohort. The mean ± standard deviation age of the patients was 48.9 ± 17.9 years old. Pulmonary embolism was documented in 27.6% (8 29) of the cases. Regarding treatments, we found that 21 patients (72.4%) used anticoagulants, 20 patients (69.0%) received IVC filter placement, and 7 cases (24.1%) were treated by catheter-directed thrombolysis. Women had a higher proportion of popliteal vein and calf vein thrombosis, with a statistically significant difference (25% vs 61.5%, P = .047 < .05), (12.5% vs 53.8%, P = .017 < .05). The incidence of DIVC is around 0.3% to 0.7% with male predominance. A DIVC is a risk factor for DVT, especially in young people.

Unilateral Leg Swelling and Liver Enzyme Elevation in an Adolescent.

A previously healthy 15-year-old female developed sudden onset right lower extremity swelling, pain, and erythematous linear streaking from the ankle to mid-thigh. Duplex venous ultrasound revealed multiple superficial and deep venous thrombi in the right lower extremity. Incidentally, the patient was also noted to have elevated transaminases and a microcytic anemia with significant iron deficiency. Additional evaluation ultimately led to the diagnosis of 2 distinct but interconnected chronic conditions, one of which progressed to requiring liver transplantation.

IDIOPATHIC PULMONARY HYPERTENSION – CASE PRESENTATION

&amp;lt;p class=&amp;quot;p1&amp;quot;&amp;gt;Pulmonary hypertension (PH) is a hemodynamic condition characterized by a mean pulmonary artery pressure (mPAP) &amp;amp;ge; 25 mmHg at rest, pulmonary arterial wedge pressure (PAWP) &amp;amp;le; 15 mmHg, and pulmonary vascular resistance (PVR) &amp;amp;gt; 240 dyn&amp;amp;middot;s&amp;amp;middot;cm&amp;lt;span class=&amp;quot;s1&amp;quot;&amp;gt;⁻&amp;lt;/span&amp;gt;⁵. The annual incidence of pulmonary arterial hypertension (PAH) is approximately 3&amp;amp;ndash;10 new cases per million adults. It is estimated that the prevalence of pulmonary hypertension in individuals over 65 years of age is around 10%.The aim of this study is to present the case of a female patient with progressive dyspnea in whom PAH remained undiagnosed for a prolonged period.A 74-year-old female patient, M.P., was hospitalized in the Coronary Care Unit of the Clinical Center in Kosovska Mitrovica due to symptoms of shortness of breath, choking, fatigue, leg swelling, and weakness. The admission ECG revealed: sinus rhythm, normal axis, high R wave in V2, ST depression, and negative T waves in leads II, III, aVF, and V4&amp;amp;ndash;V5. Echocardiography findings showed right ventricular enlargement (2.9 cm), pulmonary artery dilation (3.3 cm), 1&amp;amp;ndash;2+ pulmonary regurgitation, and 3+ tricuspid regurgitation, with a systolic pulmonary artery pressure (SPAP) of up to 126 mmHg. The right ventricle measured 5.3 cm in the 4Ch view, with a TAPSE of 1.8 cm. Right heart catheterization revealed the following pressures: PA 78/34/57 mmHg, RV 74/8/10 mmHg, RA 6/6/7 mmHg, CO 4.3 l/min, and LV 99/10/8 mmHg. Although primary pulmonary hypertension is predominantly a disease of younger individuals, it should also be considered in older patients presenting with progressive dyspnea in the absence of structural heart disease.&amp;lt;/p&amp;gt;

A Challenging Case of Eosinophilic Fasciitis Without Classic Histopathological Findings.

Eosinophilic fasciitis (EF) is a rare dermatologic disease with clinical similarities to localized scleroderma and systemic sclerosis (SSc). Diagnosing EF is challenging due to overlapping clinical features among these conditions. Differentiating EF from localized scleroderma and SSc can be aided by laboratory tests, histopathological examination, and imaging studies. The diagnosis of EF specifically requires the exclusion of SSc and typically requires magnetic resonance imaging or en bloc fascial biopsy of affected areas. Here, the authors present a 75-year-old woman with a painful, violaceous rash on the legs and abdomen, leg swelling, and tightness around her upper abdomen. Review of systems revealed decreased appetite, unintentional weight loss, and shortness of breath on exertion. Physical examination showed a faint violaceous rash on the abdomen and legs as well as abdominal distention. The patient's clinical picture was complicated by worsening of the rash, development of chronic cough, continued unintentional weight loss, decreased appetite, early satiety, dry eyes, and dry mouth. An autoimmune process was considered, and the patient was seen by rheumatology, where an appropriate workup excluded localized scleroderma and SSc. EF was suspected and supported by magnetic resonance imaging findings showing fascial edema. En bloc fascial biopsy of the right thigh did not reveal classic EF findings.

Rapid degradation of left ventricular function after permanent right ventricular pacing in patients with high-grade atrioventricular block

Background: Permanent right ventricular (RV) pacing is a standard for high-grade atrioventricular (AV) block treatment. However, it may result in left ventricular (LV) dilatation, systolic dysfunction, and heart failure (HF) as a consequence of ventricular dyssynchrony and an abnormal myocardial contraction pattern. Pacing-induced cardiomyopathy (PICM) can develop months or years after implantation of a permanent pacemaker (PPM) in patients who have long-term and high-burden RVP. Case Illustration: We reported a case of a 56 years old Asian female having a record of PPM on VVIR mode implantation due to a high grade AV block presented with shortness of breath and bilateral leg swelling. Conclusion: Echocardiography showed a significant decrease in LV systolic function less than two years after PPM implantation. Coronary angiography showed widely patent vessels; subsequently, His-Bundle Pacing (HBP) was scheduled on the patient. Keywords: Atrioventricular Block, Right Ventricular Pacing, Pacing-induced Cardiomyopathy

Case Report, A 74-year-old female with cellulitis ET causa abscess (Cruris, Dorsum, And Tarsal) dextra

Cellulitis is an inflammation of the subcutaneous tissue often caused by infection with Staphylococcus aureus and Streptococcus bacteria A 74-year-old woman with complaints of pain and swelling of the right leg, accompanied by weakness and rapid breathing (Kussmaul), was diagnosed with cellulitis cruris, dorsum, and tarsal dextra. The patient had a history of uncontrolled type 2 diabetes mellitus, as well as complications such as acute kidney injury and hypokalemia. Physical examination showed edema, redness, tenderness, and warmth in the affected area. Laboratory examination indicated severe infection, iron deficiency anemia, and kidney damage. Management included debridement to remove necrotic tissue, combined antibiotic therapy (ampicillin and metronidazole) and postoperative care. This report highlights the association of diabetes mellitus with increased risk and severity of cellulitis, and the importance of a collaborative approach in managing comorbidities.

Recovery process of patients with iliac vein compression syndrome after stenting: a grounded theory study

BackgroundIliac vein compression syndrome (IVCS) impedes venous blood return from the lower extremities due to iliac vein compression, manifesting as leg swelling, varicose veins, and thrombosis. These symptoms significantly degrade quality of life. Although iliac vein stenting provides symptomatic relief, the recovery process is protracted and fraught with challenges such as in-stent restenosis and psychological distress. This study aims to deepen our understanding of patient coping strategies by exploring the entire journey from diagnosis through stenting to recovery in individuals affected by IVCS.MethodsThis qualitative study employed a grounded theory approach, conducting in-depth, semi-structured interviews with 16 patients who had undergone stenting for IVCS. Participants were recruited from a teaching hospital in Taiwan and interviewed between August 2022 and July 2023.ResultsThe recovery process for the patients involved five stages and 11 subcategories, which outlined a journey toward a new direction of health. The stages were (1) exacerbation—worsening symptoms that disrupt daily life, compelling the patient to finally address the issue; (2) seeking help—medical professional help sought; (3) despondency—ongoing pain and recurring symptoms after surgery; (4) adjustment—self-directed health promotion with support systems aiding in recovery; and (5) health preservation—suitable health care and beneficial exercise habit development.ConclusionsThe recovery process was depicted in a linear diagram of living with a new direction for health. Careful attention should be paid to the importance of clarifying patient expectations after stenting, addressing post-treatment physical discomfort and emotional anxiety issues, and enabling patients to confidently undergo follow-up and rehabilitation to achieve their recovery goals.Clinical trial numberNot applicable.

An iliac arteriovenous fistula associated with leg swelling 2 years after the removal of a hemodialysis catheter: A case report.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis. In rare instances, this procedure can result in a very serious complication known as arteriovenous fistula (AVF). Although some cases of femoral arteriovenous fistula have been reported previously in the literature; however, the incidence of iliac AVF precipitated by a hemodialysis catheter is exceedingly uncommon. The purpose of this study is to report a case in which a hemodialysis catheter caused a femoral arteriovenous fistula and to describe the successful treatment, thereby providing a reference for the diagnosis and treatment of such conditions in the future. Herein, we report the case of a patient with diabetes and end-stage kidney disease (ESKD) who presented with an iliac arteriovenous fistula as a complication of hemodialysis catheter insertion into the right femoral vein. Two years after hemodialysis catheter removal, the patient was admitted to our institution with swelling of the right lower limb and calf pain. The patient was subsequently diagnosed with an iliac arteriovenous fistula by computed tomography angiography and angiography. The patient was transferred to the Vascular Surgery Department for surgical treatment. The patient's leg swelling improved after surgery. After 1 year of follow-up, there was no occurrence of swelling in the patient's right leg. If the patient has a history of femoral venous catheter placement and develops limb swelling, in addition to considering the presence of a femoral arteriovenous fistula, it is important to consider the possibility of an iliac AVF. Iliac AVF are rare disorders. The primary goal for treatment of IAVF is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective for the treatment of iliac AVF. Iliac AVFs are rare disorders. The primary goal of treatment for iliac AVFs is to relieve associated symptoms. Based on the results of this study, the endovascular approach is safe and effective in the treatment of iliac AVFs.

Comparing different timings of tourniquet application in total knee arthroplasty: effects on postoperative pain and bone cement interface

ObjectiveThis study aims to elucidate the impact of varying tourniquet application timings on postoperative pain and the bone cement interface following TKA.MethodPatients who underwent TKA in our department between March 2021 and July 2023 were included in this study. They were randomly assigned to three groups: Group 1 used tourniquets throughout the operation, Group 2 applied tourniquets before the osteotomy, and Group 3 applied tourniquets after completing the osteotomy. The general epidemiological data, tourniquet pressure and duration, postoperative VAS scores, osteotomy surface preparation, blood loss, transfusion rate, KSS scores, knee flexion deformity, knee and thigh circumference differences, and perioperative complications were analyzed and compared among the three groups.ResultThere was no significant difference in the general epidemiological data among the three groups. At different times after the operation, VAS scores for the surgical site and tourniquet site were significantly different among the three groups. The three groups had similar osteotomy surface preparation before prosthesis installation. At two weeks, they differed significantly in knee flexion deformity. While the differences in knee circumference were not significant, Group 1 had a significantly larger thigh circumference difference than the other two groups at 24 h. The incidence of skin complications and DVT in Group 1 was significantly higher than that in Group 3.ConclusionThe use of tourniquets after osteotomy can lead to a good bone cement interface and reduce postoperative leg pain, swelling, and complication rates.

Leg Ulcer and Venous Symptoms Related to Lower Extremity Arteriovenous Access for Hemodialysis: A Retrospective Review with Emphasis on Wound Complications.

Lower extremity arteriovenous (AV) access serves as a crucial alternative for hemodialysis when upper extremity options are no longer viable. While there are numerous reports on functional patency, limited information exists regarding complications related to venous insufficiency and postoperative quality of life. This study aims to assess the actual incidence of such complications and provide evidence-based insights for clinical decision-making. We retrospectively analyzed 121 end-stage renal disease patients who underwent lower extremity AV access at Maharaj Nakorn Chiang Mai Hospital from 2006 to 2023. Among them, 105 patients (86.8%) had lower extremity AV grafts, while 16 patients (13.2%) had lower extremity AVF. Primary and secondary patency rate were 69.4% and 81.8% at one year, respectively. The mortality probability was 50.4% with a mean follow-up of 58 months. Mortality predictors included age (P = .001), aspirin use (P = .022) and statin use (P = .005). Primary failure occurred in 8 patients (6.6%) and vascular graft infection is the primary cause. There were no occurrences of venous leg ulcers developed, suggesting that the risk of this complication may be lower than previously thought in the short to medium term. However, 13.3% of patients experienced leg swelling and 21.7% had hyperpigmentation. The mean revised venous clinical severity score was 1.22 and the average EQ-5D-5L quality of life score was 0.99. Our findings suggest that the risk of venous leg ulcers in patients with lower extremity AV access may be lower than previously thought, at least in the short to medium term. This should encourage surgeons to consider this technique when upper extremity options are exhausted, while maintaining vigilance for early signs of venous insufficiency. Continued research into the detrimental effects of the hyper-dynamic blood flow rate on AV access and preventive strategies will enhance the benefit of lower extremity AV access in the future.

Central Catheter Complicated with Fatal Pulmonary Embolism in a Patient under Chronic Hemodialysis: A Case Report

Introduction: The use of central venous catheter is a common practice in hemodialysis in Mali. Its use exposes to risks such as infection, stenosis, thrombosis among others. Pulmonary embolism is a rare but serious complication. The aim of our work was to offer advice on the diagnosis, risk factors, treatment and prevention of deep vein thrombosis following the placement of a central catheter. Observation: This was a 56-year-old woman, a housewife living in the city of Bamako. She had been on chronic hemodialysis for 6 months due to nephroangiosclerosis, at a rate of two four-hour sessions per week through a right femoral catheter. Before her hospitalization, she had a fever, physical asthenia, anorexia, a feeling of heavy leg on the right and abdominal pain. The clinical examination found a conscious patient, with little color and normal parameters, a swelling of the right leg with pain and redness. The biological assessment revealed hypochromic microcytic anemia, Procalcitonin at 2.75ng/l. The Doppler of the right lower limb confirmed deep vein thrombosis. The pulsed cardiac Doppler and the ECG confirmed the diagnosis of pulmonary embolism. Curative treatment of venous thrombosis was started. The immediate aftermath was marked by respiratory problems requiring oxygen therapy, acute circulatory failure syndrome with coldness of the extremities. The outcome was unfavorable with the death of the patient. Conclusion: The use of central venous catheter for hemodialysis as first-line treatment remains frequent in Mali. Patients should benefit from increased monitoring and prophylactic treatment to prevent the occurrence of thromboembolic events.

Hematologic profile in a Persian cat with osteosarcoma

A three-year-old Persian cat presented to the West Java Provincial Veterinary Hospital with swelling in the left front leg and was diagnosed with osteosarcoma. This study aimed to evaluate the impact of osteosarcoma on the haematological profiles of cats. Humerus amputation is the standard treatment. A detailed haematological assessment was performed, including red blood cell count, white blood cells count, lymphocytes, monocytes, immature cells, mid-sized cells, granulocytes, haemoglobin, haematocrit, MCV, MCH, MCHC, and platelets. The findings revealed leukocytosis, granulocytosis, hypochromic macrocytic anaemia, and thrombocytopenia, indicating that osteosarcoma may disrupt the normal blood component production.

Prevalence of Feet Problems and Protective Measures among Diabetic Pilgrims During AL-Arba'een of Imam Al-Hussain

Background: Pilgrims with diabetes are at high risk for foot problems due to decreased immunity, neuropathies, and peripheral vascular disease. This study was done to assess the prevalence of foot problems and protective measures adopted by diabetic pilgrims to prevent foot problems during AL-Arba'een of Imam Al-Hussain. Methods: A descriptive study was conduct at a mobile clinic in Holy Kerbala during AL-Arba'een of Imam Al-Hussian from the period of 5th October 2019 to 10th July, 2024 in order to accomplish the early listed objectives. A purposive sampling consists of 186 pilgrims who were diagnosed previously as diabetic patients. The data were collected used a constructed questionnaire and therefore analyze used the statistical package for social science (SPSS) version 24 through the application of descriptive statistical analysis (frequencies, percentage, and mean of score). Results: the most prevalent foot problems are foot blisters 52.6%, foot redness 55.9%, 73.1% and 89.7% have foot/legs pain and numb respectively. Most diabetes pilgrims complain from foot, toes, or leg swelling; 86.5%, and 91.9% of them their foot is sensitive to touch, and complains from feet hurt when walking; also 69.8% of pilgrims have muscle cramps in legs or foot. Most of diabetic pilgrims were washed their feet frequently, 44% of them are examined the water temperature before putting their feet in it, 39.7% of diabetic pilgrims are inspected the soles of their feet while walking, 38.1% of them are changed their socks at least one time a day, and 52.1% of diabetic pilgrims are inspected their shoes for a foreign body or torn linings before wearing. Conclusions: Foot blisters, redness, foot/legs pain or numb; foot, toes, or legs swelling; foot sensitive to touch; foot hurt when walking; also, muscle cramps in legs or foot are the most common foot problems among diabetic pilgrims. The most important preventive measures that were done by diabetic pilgrims to prevent foot problems are washed their feet every day, examined water temperature before putting their foot in it, inspect the soles of their foot while walking, and inspect their shoes for foreign objects or torn linings before wearing.

Chronic Venous Insufficiency: An Updated Review for Nursing

Background: Chronic venous disease (CVD) is a prevalent condition characterized by structural and functional abnormalities of the venous system, primarily affecting the lower extremities. It manifests through symptoms such as leg heaviness, swelling, varicose veins, and venous ulcers, significantly impacting patients' quality of life and imposing substantial economic burdens on healthcare systems. The pathophysiology involves venous hypertension, inflammation, and valve incompetence, with risk factors including age, obesity, pregnancy, and genetic predisposition. Aim: This review aims to provide an updated overview of CVD, focusing on its etiology, epidemiology, pathophysiology, clinical evaluation, and management strategies. It emphasizes the role of nursing interventions and the importance of an interprofessional approach to optimize patient outcomes. Methods: The review synthesizes current literature on CVD, including diagnostic criteria, treatment modalities, and nursing protocols. It highlights evidence-based practices such as compression therapy, wound care, lifestyle modifications, and minimally invasive procedures like sclerotherapy and endovenous ablation. The role of the CEAP classification and Venous Clinical Severity Score (VCSS) in guiding treatment decisions is also discussed. Results: CVD management requires a multidisciplinary approach, with compression therapy and lifestyle modifications forming the foundation of treatment. Minimally invasive procedures and surgical interventions are effective for advanced cases. Nursing interventions, including patient education, wound care, and pain management, play a critical role in improving outcomes. Early diagnosis and adherence to treatment plans are essential to prevent complications such as venous ulcers, deep vein thrombosis, and cellulitis. Conclusion: Effective management of CVD relies on a combination of conservative measures, advanced therapies, and patient education. An interprofessional team approach, including nurses, physicians, and specialists, is crucial for optimizing care and reducing the burden of this chronic condition.

Xanthogranulomatous osteomyelitis: multimodality imaging of a rare case involving tibial diaphysis with review of literature.

The case report discusses xanthogranulomatous osteomyelitis, a rare inflammatory bone condition that can resemble malignancy on imaging studies. The report details a case of a 42-year-old woman with left leg pain, swelling, and redness lasting 4months. Imaging revealed a lytic lesion in the left tibia with endosteal erosion, and MRI showed extraosseous soft tissue extension. An open biopsy confirmed xanthogranulomatous osteomyelitis. Following surgical curettage and bone grafting, the patient recovered well at subsequent follow-ups until 1year after surgery. The article emphasizes the importance of distinguishing xanthogranulomatous osteomyelitis from other malignancies and discusses its epidemiology, clinical presentation, diagnostic techniques, and relevant imaging features, highlighting the potential for misdiagnosis based on overlapping characteristics with conditions like lymphoma and Ewing sarcoma.

Prediction of Lower Leg Swelling in Driving Posture

This study focused on lower leg swelling as a typical physical load in prolonged sitting postures such as driving. We obtained prediction equations for lower leg swelling (ratio of the inverse of the measured impedance to the initial impedance and lower leg swelling assessment value, BI [%]) from thigh pressure distribution, participants’ physical characteristics, and sitting time. A total of 22 participants (11 males and 11 females) were recruited. The impedance in the lower leg and thigh pressure distribution were measured over 90 min in a sitting posture at three tilt angles (8°, 0°, and −8° from the horizontal plane). Multiple regression analysis was performed to construct prediction equations for lower leg swelling in the males, the females, and all the participants. Bioelectrical impedance was selected as the dependent variable, with height, body fat percentage, thigh pressure distribution, and sitting time as the independent variables. The validity of all constructed prediction equations for the males, the females, and all the participants was confirmed by an adjusted R2. These findings can be used to develop a device to prevent lower leg swelling (the main problem resulting from a prolonged sitting posture) and can be applied to automobile seats, aircraft seats, and office chairs.

First isolation of Aerococcus viridans from clinical specimens collected on a pig farm in Poland.

Successful retrieval of Aerococcus viridans from porcine clinical specimens has been rarely described, and data has only been obtained from a few swine-producing countries. Therefore, the aim of this study was the isolation of A. viridans recovered from a specimen originating from a commercial pig farm located in Poland. Seven dead 12-week-old pigs weighing 24-26 kg with joint swelling of the hind legs were selected on a modern farrow-to-nursery farm in Poland in October 2023. The research material was joint swabs from one affected limb amputated through the proximal part of the femur. Bacteria were isolated using matrix-assisted laser desorption/ionisation-time-of-flight mass spectrometry. Antimicrobial susceptibility testing of isolates of Staphylococcus aureus, A. viridans and Trueperella pyogenes was performed by disc diffusion and also by minimal inhibitory concentration evaluation in the case of A. viridans. Two pooled samples were screened by PCR for Streptococcus suis, Actinobacillus pleuropneumoniae, Actinobacillus suis, Mycoplasma hyorhinis, M. hyosynoviae and Glaesserella parasuis. Five samples were positive for bacteria by culture and five isolates were recovered. Staphylococcus aureus was identified in three samples and T. pyogenes and A. viridans in one each. Pooled samples were G. parasuis-, M. hyorhinis-, M. hyosynoviae-, Actinobacillus pleuropneumoniae-, Actinobacillus suis- and S. suis-negative in the PCR. The A. viridans isolated was susceptible to beta-lactams and gentamicin. Ten representative nucleotide contigs from the 500 obtained showed similarity as high as 97.5% to GenBank reference strains. To the best of our knowledge, this is the first identification of A. viridans in clinically affected Polish pigs. It elevates the importance of uncommon pathogens, including A. viridans, in the development of lameness in pigs. This research emphasises the role of modern diagnostic tools for accurate identification of swine pathogens. Further research would prove beneficial to elucidate the mechanisms of A. viridans infection, its prevalence, pathogenicity and virulence factors.