scholarly journals Dermatologic Conundrum: A Cardiac Condition Masqueraded as a Dermatologic Distraction

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
George Degheim ◽  
Evan Hiner ◽  
Abeer Berry ◽  
Nathan Foster
Keyword(s):  
Lower Extremity ◽  
Signs And Symptoms ◽  
Subacute Bacterial Endocarditis ◽  
Left Lower Extremity ◽  
Streptococcus Oralis ◽  
Pain Medications ◽  
Clinical Presentations ◽  
Cardiac Condition ◽  
Sternal Border ◽  
Diastolic Murmur

A 38-year-old male presented to the emergency department (ED) complaining of extreme pain and a petechial rash on the left ankle for two weeks associated with generalized fatigue, intermittent fevers, and weight loss. He was discharged home from the ED on pain medications. He returned a few days later with a progressive rash that involved the entire left lower extremity to the level of the knee. He was diagnosed with herpes zoster (shingles) and was prescribed acyclovir and steroids. After several days, the patient presented for the third time to the ED. He developed a right lower extremity discomfort this time. The pain in bilateral lower extremities had become unbearable. His cardiac examination revealed a systolic murmur at the apex and a faint diastolic murmur at the left sternal border. Ultimately, he had an echocardiogram that demonstrated both a bicuspid aortic valve and large vegetation on the anterior leaflet of the mitral valve, and his blood culture grew Streptococcus mitis and Streptococcus oralis. The patient was subsequently diagnosed with subacute bacterial endocarditis thought to be sourced from his poor dentition. The diagnosis of infective endocarditis is often delayed due to its nonspecific clinical presentations. Our case displays an unusual skin manifestation of IE that may be present in the absence of other signs and symptoms of the disease.

scholarly journals External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Kiyokazu Fukui ◽  
Ayumi Kaneuji ◽  
Norio Kawahara
Keyword(s):  
Lower Extremity ◽  
Femoral Vein ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Needle Aspiration ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
External Iliac Vein ◽  
Iliac Vein Compression ◽  
Deep Vein

Abstract Background A hip joint ganglion is a rare cause of lower-extremity swelling. Case presentation We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. Conclusions Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.

scholarly journals Full circumference lower extremity degloving injury treated with hydrosurgical debridement and negative-pressure wound therapy with gauze wound filler for fixation of avulsed flap skin grafts

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Tae Nagama ◽  
Natsuko Kakudo ◽  
Atsuyuki Kuro ◽  
Yujiro Ozaki ◽  
Yasuko Shirasawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Traumatic Injury ◽  
Skin Grafts ◽  
Wound Therapy ◽  
Left Lower Extremity ◽  
Degloving Injury ◽  
Severe Traumatic Injury ◽  
Degloving Injuries

Abstract Degloving, a skin and subcutis avulsion, is a severe traumatic injury sometimes caused by rolling wheels or machines. Although avulsed flaps are often readapted to its original site, most of these tissues become necrotic. Due to the extensive skin and soft tissue deficiency caused by necrosis, treatment becomes difficult. Skin grafts harvested from avulsed flaps may be used to treat degloving injuries, while negative pressure wound therapy (NPWT) is used to secure the grafts. Commonly used porous polyurethane foam wound fillers are difficult to set in circumferential extremity degloving injuries; gauze-based wound fillers are easier to use and cause less pain during dressing changes. We present a case of an extensive, full-circumference left lower-extremity degloving injury, treated using NPWT with gauze-based wound fillers for fixation of skin grafts harvested from avulsed flaps after hydrosurgical debridement. For complex wound geometries, gauze-based wound fillers can be easily applied for skin graft immobilization.

Acute Generalized Exanthematous Pustulosis With Multiple Organ Dysfunction Syndrome

2013 ◽  
Vol 22 (3) ◽  
pp. 270-273 ◽  
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Manar Al Asad ◽  
Lindsay Scratchko ◽  
Ghulam Khaleeq
Keyword(s):  
Lower Extremity ◽  
Rare Condition ◽  
Skin Condition ◽  
Multiple Organ ◽  
Drug Induced ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Left Lower Extremity ◽  
Causative Drug ◽  
Diffuse Erythema ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.

Dynamic and Static Assessment of Single-Leg Postural Control in Female Soccer Players

2020 ◽  
Vol 29 (2) ◽  
pp. 174-178
Author(s):  
Kelly M. Meiners ◽  
Janice K. Loudon
Keyword(s):  
Lower Extremity ◽  
Postural Stability ◽  
Postural Sway ◽  
Center Of Pressure ◽  
Force Plate ◽  
Soccer Players ◽  
Balance Test ◽  
Left Lower Extremity ◽  
Static Assessment ◽  
Dynamic Postural Stability

Purpose/Background: Various methods are available for assessment of static and dynamic postural stability. The primary purpose of this study was to investigate the relationship between dynamic postural stability as measured by the Star Excursion Balance Test (SEBT) and static postural sway assessment as measured by the TechnoBody™ Pro-Kin in female soccer players. A secondary purpose was to determine side-to-side symmetry in this cohort. Methods: A total of 18 female soccer players completed testing on the SEBT and Technobody™ Pro-Kin balance device. Outcome measures were anterior, posterior medial, and posterior lateral reaches from the SEBT and center of pressure in the x- and y-axes as well as SD of movement in the forward/backward and medial/lateral directions from the force plate on left and right legs. Bivariate correlations were determined between the 8 measures. In addition, paired Wilcoxon signed-rank tests were performed to determine similarity between limb scores. Results: All measures on both the SEBT and postural sway assessment were significantly correlated when comparing dominant with nondominant lower-extremities with the exception of SD of movement in both x- and y-axes. When correlating results of the SEBT with postural sway assessment, a significant correlation was found between the SEBT right lower-extremity posterior lateral reach (r = .567, P < .05) and summed SEBT (r = .486, P < .05) and the center of pressure in the y-axis. A significant correlation was also found on the left lower-extremity, with SD of forward/backward movement and SEBT posterior medial reach (r = −.511, P < .05). Conclusions: Dynamic postural tests and static postural tests provide different information to the overall assessment of balance in female soccer players. Relationship between variables differed based on the subject’s lower-extremity dominance.

Clinical correlation of anatomical location of non-thrombotic iliac vein lesion

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 359-363 ◽  
Author(s):  
Afsha Aurshina ◽  
Borislav Kheyson ◽  
Justin Eisenberg ◽  
Anil Hingorani ◽  
Arkady Ganelin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Intravascular Ultrasound ◽  
Iliac Vein ◽  
Clinical Findings ◽  
Common Iliac Vein ◽  
Anatomical Location ◽  
Clinical Correlation ◽  
Common Site ◽  
External Iliac Vein ◽  
Left Lower Extremity

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

Substernal goitre presenting with upper and lower extremity oedema

2021 ◽  
Vol 14 (11) ◽  
pp. e245036
Author(s):  
Rebekah LeAnn Bennett Daggett ◽  
Daniel Farishta ◽  
Hugo Cuellar ◽  
Cherie-Ann O Nathan
Keyword(s):  
Lower Extremity ◽  
Initial Assessment ◽  
Uneventful Recovery ◽  
Surgical Removal ◽  
Extensive Literature ◽  
Rare Presentation ◽  
Clinical Presentations ◽  
Left Innominate Vein ◽  
Home Placement ◽  
Work Up

Substernal goitre is characterised by compressive symptoms of the airway and oesophagus. Chronic, progressive symptoms usually result in surgical removal. We report a rare presentation of substernal goitre in a male in his early 70s who suffered from severe bilateral lower extremity (LE) lymphoedema, resulting in immobility and nursing home placement, and left upper extremity lymphoedema. Our initial assessment led to a filariasis work-up, which was negative, due to the patient’s prior 2-year residence in India and service overseas. Chest CT scan revealed an incidental substernal goitre extending posterior to the left innominate vein and aortic arch to the level of the left mainstem bronchus. The patient underwent a left hemithyroidectomy via cervical excision and sternotomy and had an uneventful recovery with resolution of lymphoedema and mobility. Despite extensive literature regarding clinical presentations of substernal goitre, severe lymphoedema of the LE is not a well-established association.

Breast and endocrine surgery

2014 ◽  
Author(s):  
Asmaa Al-Alaak
Keyword(s):  
Treatment Options ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Breast Disease ◽  
Endocrine Surgery ◽  
Endocrine Disease ◽  
Surgical Disease ◽  
Clinical Presentations ◽  
Basic Facts ◽  
Clinical Signs And Symptoms

One of the main ‘complaints’ about breast disease is that ‘it is all so similar’ and that there are lots of treatment options which can seem confusing at first. The key to understanding breast disease and preparing for questions about it is to keep the basic facts about breast anatomy and pathology to the forefront, learn to recognize key patterns of clinical signs and symptoms, and then match them to the clinical scenario. The EMQs are particularly useful at practising fitting questions into clinical patterns and rehearsing the patterns. Endocrine disease poses its own challenges. Even for a surgeon it is important to understand and recognize the underlying biochemistry and how this affects the clinical presentations. Endocrine surgical disease is much less about anatomy or surgical procedures themselves as it is about understanding how treatment is matched to the pathophysiology of the conditions.

scholarly journals Bumbling, Stumbling, Fumbling: Weakness, Steppage Gait, and Facial Droop in a 3-Year-Old Male

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986585
Author(s):  
Aviva J. Whelan ◽  
Abdullah Tolaymat ◽  
Shane C. Rainey
Keyword(s):  
Lower Extremity ◽  
Respiratory Illness ◽  
Gait Disturbance ◽  
Western World ◽  
Diagnostic Challenge ◽  
Left Lower Extremity ◽  
Peripheral Facial Palsy ◽  
Cranial Nerve Palsies ◽  
The Central Nervous System ◽  
Gait Disturbances

A previously healthy, unimmunized, 3-year-old Caucasian boy presented to the emergency department with right-sided facial droop, clumsiness, and intermittent bilateral hip pain. Two weeks ago, he had 24 hours of self-resolving rhinorrhea and fever. Examination was significant for right facial nerve palsy, lower extremity pain, areflexia of his right lower extremity, and diminished reflexes of his left lower extremity. He was admitted for urgent magnetic resonance imaging of the brain. Cerebrospinal fluid (CSF) protein was 85 mg/dL with elevated albumin and immunoglobulin, and CSF white blood cell was 3 cells/mm3. Serum Mycoplasma immunoglobulin (Ig) M and IgG were elevated. There was concern for Guillain-Barré syndrome (GBS). He was started on intravenous IG (IVIG) and was treated for presumed Mycoplasma infection. Weakness and gait disturbances in a child can present the clinician with a diagnostic challenge. Gait disturbance may indicate a neurological lesion anywhere from the central nervous system to the peripheral nerves, neuromuscular junction, or muscle. In the present case, the combination of peripheral facial palsy, presumed neuropathic pain, gait difficulties, and areflexia in the setting of an antecedent respiratory illness were suggestive of GBS. The cornerstone treatments involve hospitalization to facilitate continuous monitoring for serious sequelae, such as acute respiratory failure and cardiac dysrhythmia, followed by immunotherapy with IVIG or plasma exchange. Gait disturbance and weakness in a child is a diagnostic challenge. GBS is the most common cause of acute paralysis in the Western world and should remain high on the clinician’s differential diagnosis. However, patients with GBS may also present nonclassically with extremity pain and cranial nerve palsies.

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