Leg Swelling Research Articles

Comparison of Janani Suraksha Yojana (JSY) and augmented Arogya Laxmi scheme (ALS) in improving maternal and child health outcomes in urban settlements of Hyderabad, South India

BackgroundIndia accounts for the largest number of global neonatal deaths with around 20 per 1000 live births. To improve the utilization of government services for institutional deliveries, Augmented Arogya Laxmi Scheme (ALS) was launched in Telangana state of southern India. This study assessed the effectiveness of the Janani Suraksha Yojana (JSY), which combines cash assistance with delivery and post-delivery care, in comparison to ALS in improving the outcomes related to antenatal, natal, and postnatal care in urban settlements of Hyderabad, Telangana, southern India.MethodsThis was a two-year cross-sectional study conducted in 14 urban settlements of Hyderabad city from September 2017- August 2019. All mothers delivered during the 18 months preceding the survey were enrolled after a written informed consent. Field investigators collected data on variables related to socio-demographic characteristics, awareness, and utilization of JSY and ALS programs. Variables related to antenatal history, antenatal care, complications during birth, delivery outcomes, newborn care, and postnatal care till 28 days were assessed. We used multivariable logistic regression model to examine the association between the different maternal, child, and socio-demographic characteristics of the two study groups.ResultsA total of 926 mothers were beneficiaries of Janani Suraksha Yojana (JSY) program while 933 mothers were beneficiaries of augmented Arogya Laxmi Scheme (ALS). Mothers in ALS group (AOR 1.71; 95% CI 1.21–2.43) were at increased odds of having more than eight antenatal care (ANC) visits compared to the mothers availing JSY. Mothers in ALS group were at decreased odds of having complications like severe pain in the abdomen (AOR 0.43; 95% CI 0.22–0.86), swelling of legs or feet (AOR 0.59; 95% CI 0.44–0.80) compared to mothers in JSY group. Children of mothers in the ALS group had increased odds of receiving breastfeeding within 30 minutes of birth (AOR 1.46; 95% CI 1.13–1.88) compared to children of mothers in JSY group.ConclusionsThe newly launched augmented ALS led to the increased utilization of the government health facilities and improved the maternal and child health outcomes.

Lessons from an elderly patient with pulmonary embolism caused by protein S deficiency: a case report

BackgroundLower limb deep vein thrombosis (DVT) concurrent with pulmonary embolism (PE) is perilous, particularly in the elderly, exhibiting heterogeneity with thrombophilia mutations. Tailored treatment is essential, yet sudden deaths complicate causative factor elucidation. This report emphasizes genetic testing necessity in PE patients with thrombophilia indicators, facilitating cause identification, personalized treatment guidance, and family education.Case presentationThis study details a 75-year-old Chinese woman with DVT and PE, where genetic testing identified thrombophilia, guiding personalized treatment decisions.ResultsUpon admission, the patient, after over 10 days of bed rest, presented chest tightness, shortness of breath, and unilateral leg swelling. Diagnostic measures revealed DVT and a substantial PE. Genetic testing identified a PROS1 gene C200A>C mutation, reducing protein S activity. Following 2 weeks of anticoagulation and inferior vena cava filter insertion, the patient, discharged, initiated lifelong anticoagulant therapy. A 1-year follow-up showed no recurrent thrombotic events. Family members carrying the mutation received informed and educational interventions.ConclusionGenetic testing for thrombophilic predisposition post-PE is crucial, elucidating etiology, guiding individualized treatment, and playing a pivotal role in family education.

Symptom assessment in cancer patients using the Memorial Symptom Assessment Scale

Objective: Cancer is a chronic disease characterized by the unregulated proliferation and abnormal spread of cells. Symptoms that occur after chemotherapy treatment, which is the most commonly used treatment in cancer, negatively affect morbidity, effectiveness of treatment and quality of life. This study aimed to determine symptoms in cancer patients undergoing chemotherapy using the Memorial Symptom Assessment Scale (MSAS) Material and Methods: A total of 273 cancer patients who applied to Ümraniye Training and Research Hospital emergency department as outpatients and were hospitalized in the internal medicine department were included in the study between 5/1/2014 and 6/4/2014. The study was conducted prospectively. Of the 273 participants, 41.3% were female (N = 112) and 58.7% were male (N = 159). The mean age of the participants was 62.46 ± 12.913 years (range, 32-92 years). Participants were divided into 6 groups based on diagnosis: Lung cancers, gastrointestinal cancers, cancers of the reproductive system, hematologic cancers, cancers of the urinary system and others. Each participant used the Memorial Symptom Assessment Scale (MSAS) containing 32 symptoms to rate whether they had experienced each symptom during the past week. Of these 32 items, 24 provide information on the intensity and frequency of symptoms, while 8 provide information on severity and distress. Results: The most common types of symptoms based on the Memorial Symptom Rating Scale were lack of energy (72.9%), pain (71.1%) and difficulty concentrating (60.8%), while the least common symptoms were feeling “I don’t look like myself” (4.4%), swelling of arms and legs and changes in skin (7.3%) and constipation (8.4%). Conclusion: Cancer patients have a lower quality of life due to the side effects of the treatments they receive or the impact of the cancer itself. The most common symptoms in the patients screened in this study were lack of energy and pain. In light of these data, determining the factors affecting the quality of life in cancer patients may be guiding in determining the symptomatic treatment for these patients and facilitating patient care.

Upaya Pemberdayaan Kader dan Ibu Hamil tentang Senam Hamil untuk Mengatasi Ketidaknyamanan Kehamilan pada Ibu Hamil di Posyandu Kinasih Banjarsari Surakarta

Pregnancy exercise is a form of structured exercise or exercise. Exercising on a regular basis will improve blood circulation, strengthen muscles and flex joints and can reduce common disorders during pregnancy such as aches, back pain, muscle stiffness, constipation, and reduce leg swelling. Doing pregnancy exercise regularly can reduce lower back pain, one of which is by kneeling, rotating the pelvic bones, bending the buttocks, bending the knees, chest. The purpose of this community service is that after receiving counseling it is hoped that pregnant women and Health Cadres members of Posyandu Kinasih, Banjarsari Subdistrict, Surakarta can apply and be able to provide education to pregnant women to carry out pregnancy exercise to overcome discomfort in pregnant women. The target of counseling activities about pregnancy exercise is all Health Cadres and pregnant women in the Banjarsari Village, Surakarta. The expected output of pregnancy exercise counseling activities for cadres and members of the Balita Kinasih Posyandu in Banjarsari Surakarta Village is an increase in knowledge and skills about pregnancy exercise for mothers and cadres. The results of community service are that after counseling cadres and pregnant women become more knowledgeable, understand about pregnancy exercise as evidenced in the results of the evaluation through the distribution of questionnaires, the average value of the level of knowledge is from 70% to 90%. Based on the implementation of community service, it can be concluded that there is an increase.

Semiquantitative 18F-FDG PET/CT in monitoring glucocorticoid response of immunoglobulin G4-related effusive constrictive pericarditis: a case report

BackgroundImmunoglobulin G4 (IgG4)-related effusive constrictive pericarditis (ECP) is a rare manifestation of IgG4-related disease (IgG4-RD). It can lead to persistent pericardial fibrosis, resulting in cardiac tamponade, diastolic dysfunction, and heart failure. Glucocorticoids are the primary treatment for effectively reducing inflammation and preventing fibrosis. However, guidelines for monitoring treatment response are lacking and tapering glucocorticoid therapy for specific target organs remains a challenge. Recent studies on IgG4-RD have demonstrated that semiquantitative measurements of fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in the main involved organs in positron emission tomography/computed tomography (PET/CT) scanning are correlated to disease activity. We present a case of IgG4-related ECP to demonstrate the usefulness of 18F-FDG PET/CT for diagnosing and treatment follow-up of IgG4-related ECP.Case presentationHerein, a 66-year-old woman diagnosed with IgG4-related ECP presented with breathlessness, leg swelling, rales, and fever. Laboratory tests revealed markedly elevated levels of C-reactive protein, and transthoracic echocardiography revealed constrictive physiology with effusion. High IgG4 levels suggested an immune-related pathogenesis, while viral and malignant causes were excluded. Subsequent pericardial biopsy revealed lymphocyte and plasma cell infiltration in the pericardium, confirming the diagnosis of IgG4-related ECP. 18F-FDG PET/CT revealed increased uptake of 18F-FDG in the pericardium, indicating isolated cardiac involvement of IgG4-RD. Treatment with prednisolone and colchicine led to a rapid improvement in the patient’s condition within a few weeks. Follow-up imaging with 18F-FDG PET/CT after 3 months revealed reduced inflammation and improved constrictive physiology on echocardiography, leading to successful tapering of the prednisolone dose and discontinuation of colchicine.ConclusionThe rarity of IgG4-related ECP and possibility of multiorgan involvement in IgG4-RD necessitates a comprehensive diagnostic approach and personalized management. This case report highlights the usefulness of 18F-FDG PET/CT in the diagnosis and treatment follow-up of isolated pericardial involvement in IgG4-RD.

Rescue From Permanent Kidney Injury in Acute Thrombosis of Both Renal Veins, the Inferior Vena Cava, and Both Iliofemoral Veins by Catheter-Based Thrombectomy.

A 33-year-old man with previously diagnosed lupus membranous nephropathy presented with painful swelling in both legs. Laboratory tests revealed acute kidney injury, and imaging studies by duplex ultrasound and computed tomography scan showed acute thrombosis of both renal veins, the infrahepatic inferior vena cava, and both iliofemoral venous segments. Initially, pharmacomechanical thrombolysis led to an insufficient morphological result. The therapeutic breakthrough was achieved by catheter-based mechanical thrombectomy of the infrarenal vena cava and both renal veins, which successfully cleared all affected venous segments from thrombus, paralleled by improvement of the patient's condition. However, after 1 week, the patient experienced recurrent thrombosis of the right renal vein with hemorrhagic infarction of the right kidney. After further optimization of immunomodulatory and antithrombotic therapy, a repeated catheter-based mechanical thrombectomy resulted in sustained clinical improvement and preservation of renal venous drainage and kidney function. Extensive acute thrombosis of both renal veins, the inferior vena cava, and both iliofemoral venous segments is a rare emergency potentially threatening kidney function. Immediate effective thrombus removal is essential to preserve kidney function and can be achieved by catheter-based mechanical thrombectomy embedded in a comprehensive immunomodulatory and antithrombotic therapeutic concept. This case demonstrated the efficacy of a catheter-based therapeutic approach in patients with extensive thrombosis of the venous system. A catheter-based approach must be embedded in a comprehensive medical therapeutic concept, which is essential to achieve a sustainable result.

Spontaneous femoral arterio-venous fistula in an 80-year-old female patient as an incidental finding

Spontaneous arteriovenous fistulas (AVF), in contrast to iatrogenic or post-traumatic ones, are extremely rare and only sporadically published in the literature. In the absence of exposure risk, the diagnosis of AVF can be challenging, especially if it is an incidental finding. An 80-year-old female patient presented to our vascular consultation because of swelling of the left leg due to varicosis. For years, she had also noticed that the right foot seemed to be cooler. Percutaneous catheter examinations via the groin had not been performed, and she could not remember any groin injuries. Truncal varicosis of the great saphenous vein confirmed clinically and sonographically. In addition, with peripheral pulses obtained, the right foot appeared slightly cooler but not discolored. On auscultation, a systolic-diastolic murmur accompanied by palpable buzzing was heard in the right groin. Color duplex sonography showed a coarse color mosaic pattern between the common femoral artery (AFC) and the anterior saphenous vein (VSAA) in the sense of aliasing ("confetti phenomenon"). A fistula channel between the AFC and VSAA could be visualized, in which very high systolic-diastolic flow velocities prevailed; pulsatile and turbulent flow was present in the region of the crosse-near femoral vein. Endovenous laser ablation was performed for symptomatic truncal varicosis of the left leg. Under ultrasound-guided compression of the afferent artery and fistula at the right groin, the fistula flow did not stop. The patient was reluctant to undergo a proposed interventional closure of the AVF. In follow-up over 4 years, no signs of cardiac insufficiency or critical limb ischemia developed. Spontaneous femoral AVF is a rarity. Characteristic clinical findings lead to a targeted use of color duplex sonography with correct interpretation of artifacts that can otherwise be easily missed.

A case of patient with decompensated Budd-Chiari syndrome treated with T-TIPS: A case report

A 46-years old man with a recent onset of painful hepatomegaly and abdominal swelling was referred to the emergency department and hospitalized in the internal medicine ward for a diagnostic hepatological work-up. He had no clinically significant previous medical history, except for a mild long-standing polycitemia. When admitted to hospital, he was febrile but hemodynamically stable (blood pressure 100/60 mmHg, pulse rate 90/min) and had a satisfactory blood oxygen saturation levels in room air. At clinical examination, he was slightly sub-icteric; a palpable but tender hepatomegaly together with a significant abdominal effusion and a mild leg swelling were noticed. In order to evaluate different possible causes of liver disease, alcoholic, viral, autoimmune, metabolic and congenital etiologies were excluded, mainly by biochemical tests.

Understanding the caring network of podoconiosis patients in Rwanda: a qualitative study

IntroductionGlobally, a total of almost 4 million people live with podoconiosis in 32 potentially endemic countries including Rwanda. Podoconiosis is a non-infectious geochemical disease that causes massive swelling of the lower leg and is caused by long-term exposure to red clay soil found in tropical highland areas. The disease is a disabling neglected tropical disease (NTD) and is associated with profound stigma, discrimination and comorbid mental health conditions. Treatment interventions are commonly known as morbidity management and disability prevention. Both biomedical and traditional treatments are used by affected people. However, understandings informed by the social sciences of care in the context of NTDs are largely unexplored. This study explored the perspectives and experiences of care among care receivers (podoconiosis patients) and caregivers (family members, traditional healers) in the district of Huye, Rwanda.MethodThe study used qualitative methods including seventeen InDepth Interviews (eleven patients, two traditional healers, two care professionals, and two family members) and participant observation in a health centre and patients’ houses.ResultA caring network was found amongst the podoconiosis patients, their family members, care professionals and traditional healers. Caring network is not only about the medical treatments, but also about the caring relationship amongst them.DiscussionUsing notions of ‘Network’ and ‘Collectives’, from the care ethics literature the study shows that in addition to care work requiring professional know-how, it is also about the relationships between patients, their families, traditional healers, and biomedical care professionals.

A Case Of Deep Vein Thrombosis With Pharmaco-Mechanical Catheter Directed Thrombolysis Therapy

Deep Vein Thrombosis (DVT) is a formation of blood clots condition in deep vein caused by multiple risk factor. The goals of acute phase of DVT management is prevent expansion of thrombus, limiting the progressivenes of leg swelling and also prevent venous dysfunction. In this case report, we present a case of DVT with Pharmaco-mechanical Catheter Directed Thrombolysis therapy which provides satisfactory outcomes during therapy and follow up.

A comparative study of altered hemodynamics in iliac vein compression syndrome.

Introduction: Iliac vein compression syndrome (IVCS) is present in over 20% of the population and is associated with left leg pain, swelling, and thrombosis. IVCS symptoms are thought to be induced by altered pelvic hemodynamics, however, there currently exists a knowledge gap on the hemodynamic differences between IVCS and healthy patients. To elucidate those differences, we carried out a patient-specific, computational modeling comparative study. Methods: Computed tomography and ultrasound velocity and area data were used to build and validate computational models for a cohort of IVCS (N = 4, Subject group) and control (N = 4, Control group) patients. Flow, cross-sectional area, and shear rate were compared between the right common iliac vein (RCIV) and left common iliac vein (LCIV) for each group and between the Subject and Control groups for the same vessel. Results: For the IVCS patients, LCIV mean shear rate was higher than RCIV mean shear rate (550 ± 103s-1 vs. 113 ± 48s-1, p = 0.0009). Furthermore, LCIV mean shear rate was higher in the Subject group than in the Control group (550 ± 103s-1 vs. 75 ± 37s-1, p = 0.0001). Lastly, the LCIV/RCIV shear rate ratio was 4.6 times greater in the Subject group than in the Control group (6.56 ± 0.9 vs. 1.43 ± 0.6, p = 0.00008). Discussion: Our analyses revealed that IVCS patients have elevated shear rates which may explain a higher thrombosis risk and suggest that their thrombus initiation process may share aspects of arterial thrombosis. We have identified hemodynamic metrics that revealed profound differences between IVCS patients and Controls, and between RCIV and LCIV in the IVCS patients. Based on these metrics, we propose that non-invasive measurement of shear rate may aid with stratification of patients with moderate compression in which treatment is highly variable. More investigation is needed to assess the prognostic value of shear rate and shear rate ratio as clinical metrics and to understand the mechanisms of thrombus formation in IVCS patients.

Remote Heart Failure Symptoms Assessment After Myocardial Infarction Identifies Patients at Risk for Death.

Heart failure is a common complication after myocardial infarction (MI) and is associated with increased mortality. Whether remote heart failure symptoms assessment after MI can improve risk stratification is unknown. The authors evaluated the association of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality after MI. Prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart center between June 2017 and September 2022 were used. Patients remotely completed the KCCQ 1 month after discharge. A total of 1135 (aged 64±12 years, 26.7% women) of 1721 eligible patients completed the KCCQ. Ranges of KCCQ scores revealed that 30 (2.6%), 114 (10.0%), 274 (24.1%), and 717 (63.2%) had scores <25, 25 to 49, 50 to 74, and ≥75, respectively. During a mean follow-up of 46 months (interquartile range, 29-61), 146 (12.9%) died. In a fully adjusted analysis, KCCQ scores <50 were independently associated with mortality (hazard ratio [HR], 6.05 for KCCQ <25, HR, 2.66 for KCCQ 25-49 versus KCCQ ≥50; both P<0.001). Adding the 30-day KCCQ to clinical risk factors improved risk stratification: change in area under the curve of 2.6 (95% CI, 0.3-5.0), Brier score of -0.6 (95% CI, -1.0 to -0.2), and net reclassification improvement of 0.71 (95% CI, 0.45-1.04). KCCQ items most strongly associated with mortality were walking impairment, leg swelling, and change in symptoms. Remote evaluation of heart failure symptoms using the KCCQ among patients recently discharged for MI identifies patients at risk for mortality. Whether closer follow-up and targeted therapy can reduce mortality in high-risk patients warrants further study.

Performance of an adjustable compression wrap in occupational leg swelling.

Edema in some subjects worsens over time and wraps help to reduce the leg volume. An adjustable compression wrap was tried on volunteers for 5 h and volumes measured in each limb before and after wrapping using a 3D surface scanner (HandySCAN 3D®) to estimate the volume of the leg. The contralateral leg was used as control. We observed a significant decrease in volume in the wrap legs and an increase in the control legs (p < .001), both in the lower part of leg (p = .001) and in the upper part (p = .001). Using the Readywrap® for 5hours significantly reduces the leg volume. This study enables Readywrap to be studied in a population that is easy to observe in the context of a research program. The Handyscan3D® was shown accurate and reproducible to assess leg volume in future studies.

Rare case of unileaflet mitral valve diagnosed by computed tomography

Introduction. Congenital malformations of the mitral valve encompass a broad spectrum of lesions, with an incidence of approximately 0.4% among patients with congenital heart diseases. Case Report. A 45-year-old female was admitted to our institution due to a confirmed mitral valve defect identified via echocardiographic examination. She presented with leg swelling and rapid fatigue. Her medical history includes systemic lupus erythematosus. Upon admission, she was in cardiopulmonary decompensation, with a systolic murmur detected in the mitral valve area, radiating towards the axilla. Transesophageal echocardiographic revealed severe mitral stenosis with moderate regurgitation, without clear visualization of the two cusps. Cardiac computed tomography confirmed a voluminous anterior mitral cusp and a hypoplastic posterior cusp, observed in diastole as a crescent-shaped, characteristic of a unicuspid mitral valve. Follow-up echocardiographic showed progression of mitral regurgitation with circumferential pericardial effusion, necessitating pericardiocentesis. Due to further hemodynamic instability, urgent surgical mitral valve replacement was indicated. The surgery proceeded without complications, but the immediate period was marked by exacerbation of renal impairment, requiring hemodiafiltration on several occasions. Following cardiological stabilization, the patient was transferred to the Nephrology Clinic for further management of renal insufficiency and systemic lupus. Conclusion. It is crucial to emphasize the significance of a multidisciplinary approach for each patient, with particular emphasis on detailed imaging diagnostics to definitively establish a congenital heart disease diagnosis.

Tuberculosis-induced osteomyelitis of the right distal tibia in a healthy male Saudi infant: a case report

Background: Tuberculosis (TB) is a challenging disease; however, it is preventable and curable in most cases. In 2022, TB was the second most common single infection leading to death worldwide after coronavirus disease. Almost 10 million people get infected with TB every year. TB manifests clinically in two types: pulmonary and extrapulmonary; the pulmonary type is the most common. Case presentation: A 17-month-old medically free male infant was referred to our institution with right distal leg pain, swelling and skin changes, started 1 month ago. Since then, both pain and swelling worsened and led to limping. The father denied any history of recent trauma, fever, cough, night sweating, infections, contact with sick patients, skin rashes in other body parts, or any other systematic changes. The baby was delivered at full term by cesarian-section due to placenta previa, with a birth weight of 3500 g, Prenatal and postnatal history is unremarkable. The patient was vitally stable and appeared healthy with no dysmorphic features. He was able to bear weight on his feet; however, his gait and walking abilities could not be assessed. Local examination showed swelling, erythema, and tenderness over the right distal tibia with an intact range of motion. The patient was admitted and initial investigations were done for him. After close observation and multiple investigations, a diagnosis of TB-induced right tibial osteomyelitis was made, and first-line management was initiated. Conclusion: This report highlights the importance of orthopedic surgeons in considering TB-induced osteomyelitis in the differential diagnosis of vague musculoskeletal symptoms.

Tuberculosis-induced osteomyelitis of the right distal tibia in a healthy male Saudi infant: a case report

Background: Tuberculosis (TB) is a challenging disease; however, it is preventable and curable in most cases. In 2022, TB was the second most common single infection leading to death worldwide after coronavirus disease. Almost 10 million people get infected with TB every year. TB manifests clinically in two types: pulmonary and extrapulmonary; the pulmonary type is the most common. Case presentation: A 17-month-old medically free male infant was referred to our institution with right distal leg pain, swelling and skin changes, started 1 month ago. Since then, both pain and swelling worsened and led to limping. The father denied any history of recent trauma, fever, cough, night sweating, infections, contact with sick patients, skin rashes in other body parts, or any other systematic changes. The baby was delivered at full term by cesarian-section due to placenta previa, with a birth weight of 3500 g, Prenatal and postnatal history is unremarkable. The patient was vitally stable and appeared healthy with no dysmorphic features. He was able to bear weight on his feet; however, his gait and walking abilities could not be assessed. Local examination showed swelling, erythema, and tenderness over the right distal tibia with an intact range of motion. The patient was admitted and initial investigations were done for him. After close observation and multiple investigations, a diagnosis of TB-induced right tibial osteomyelitis was made, and first-line management was initiated. Conclusion: This report highlights the importance of orthopedic surgeons in considering TB-induced osteomyelitis in the differential diagnosis of vague musculoskeletal symptoms.

Management of Recurrent Leg Swelling in an Elderly Patient with Invasive Urothelial Carcinoma: Examining the Challenges of Post-Lymphovenous Anastomosis in Treating Cancer-Related Lymphedema

Management of Recurrent Leg Swelling in an Elderly Patient with Invasive Urothelial Carcinoma: Examining the Challenges of Post-Lymphovenous Anastomosis in Treating Cancer-Related Lymphedema

Abdominal lymphocele following multi-level anterior lumbar interbody fusion (ALIF) managed with a laparoscopic peritoneal window: case report and review of the literature

PurposeLymphocele formation following anterior lumbar interbody fusion (ALIF) is not common, but it can pose diagnostic and treatment challenges. The purpose of this case is to report for the first time the treatment of a postoperative lymphocele following a multi-level ALIF using a peritoneal window made through a minimally invasive laparoscopic approach.MethodsCase report.ResultsA 74-year-old male with a history of prostatectomy and pelvic radiation underwent a staged L3–S1 ALIF (left paramedian approach) and T10-pelvis posterior instrumented with L1–5 decompression/posterior column osteotomies for degenerative scoliosis and neurogenic claudication. Three weeks after surgery, swelling of the left abdomen and entire left leg was reported. Computed tomography of the abdomen/pelvis demonstrated a large (19.2 × 12.0 × 15.4 cm) retroperitoneal fluid collection with compression of the left ureter and left common iliac vein. Fluid analysis (80% lymphocytes) was consistent with a lymphocele. Percutaneous drainage for 4 days was ineffective at clearing the lymphocele. For more definitive management, the patient underwent an uncomplicated laparoscopic creation of a peritoneal window to allow passive drainage of lymphatic fluid into the abdomen. Three years after surgery, he had no back or leg pain, had achieved spinal union, and had no abdominal swelling or left leg swelling. Advanced imaging also confirmed resolution of the lymphocele.ConclusionsIn this case report, creation of a peritoneal window minimally invasively via a laparoscope allowing passive drainage of lymphatic fluid into the abdomen was safe and effective for management of an abdominal lymphocele following a multi-level ALIF.

IMMUNOSTIMULANT ACTIVITY OF HANTAP (STERCULIA COCCINEA JACK) LEAVES EXTRACT ON NON-SPECIFIC AND SPESIFIC IMMUNE RESPONSES

Objective: This study aims to determine the immunostimulant effect and the effective dose of hantap leaf ethanolic extract against non-specific and specific immune responses.&#x0D; Methods: The immunostimulant activity of the extract was tested by the carbon clearance method (non-specific response). The effect of the extract on delay-type hypersensitivity/DTH (cellular-specific response) was determined by the paw edema method. The number of leukocyte cells and the percentage of leukocyte cell types were also calculated. The antibody titer (humoral-specific response) test was carried out by the hemagglutination method.&#x0D; Results: The results of the non-specific immune response demonstrated that three doses of hantap leaf extract, when compared to the negative control, could accelerate the rate of carbon elimination and increase the phagocytosis index. Hantap leaf extract can provide an immunomodulatory effect by increasing the delayed-type hypersensitivity response by showing a greater volume of leg swelling than the negative control received CMC Na 0.5%, which was significantly different (p&lt;0.05), increasing leukocyte count and leukocyte differential and increasing primary and secondary antibody titers. The effective dose of hantap leaves extract was 200 mg/kg body weight.&#x0D; Conclusion: This study proves that hantap leaf extract has an immunomodulatory effect that increases the immune system (immunostimulant)

Xanthogranulomatous Osteomyelitis: Two Rare Cases Report

INTRODUCTION: Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory lesion that is histologically characterized by the presence of foamy histiocytes and plasma cells (1-8). Radiologic and gross examinations can mimic malignancy (9), so carful workup and definitive diagnosis should be made by histopathologic evaluation. Case Report: There are two rare cases being reported here; the first one is a 21-year-old male who presented with chronic pain and swelling of upper leg for one year. He has history of healed traumatic fracture of fibula 7 years ago. Radiological examination revealed highly suspicious radio opaque lesions of upper fibula. The second case is a 30 years old female, presented with pain and swelling of wrist for six months with clinical suspicion of Ewing sarcoma. Radiological examination revealed highly suspicious radio opaque, lytic lesions of lower radius. Biopsy of both lesions were done. Microscopic examination showed marked chronic inflammatory cells infiltration mainly foamy histiocytes and lymphoid cells with many foreign body giant cells. No evidence of tuberculosis or malignancy. Conclusion: As these lesions were clinically highly suspicious of malignancy or associated with other diseases, so proper diagnostic roles in xanthogranulomatous osteomyelitis should include histopathological examination in order to rule out any malignant conditions of the bone.