Chronic Ischemia Presenting as Muscular Groin Pain

A 66-year-old man was admitted to a hospital rehabilitation unit for the management of chronic groin pain. Since the groin pain began, he had been unable to bear weight on his right foot. During a podiatric examination, the patient reported sharp pain at the apex of his right hallux. A full podiatric assessment was undertaken to evaluate his vascular, neurologic, and biomechanical status. The patient’s ankle-brachial index was found to be 0.34 in the right lower limb and 0.68 in the left lower limb. After vascular assessment, the patient was diagnosed as having chronic ischemia of the right leg. He underwent left-to-right femoral-to-femoral bypass graft surgery to salvage the right lower leg and foot. (J Am Podiatr Med Assoc 97(5): 402–404, 2007)

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O17 CHRONIC GROIN PAIN DUE TO OR DESPITE THE HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab396.016 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Fernando Ruiz Jasbon ◽

Kristina Ticehurst ◽

Lovisa Kroon ◽

Jukka Ahonen ◽

Jonny Norrby

Keyword(s):

Inguinal Hernia ◽

Patient Reported Outcomes ◽

Groin Hernia ◽

Groin Pain ◽

Chronic Groin Pain ◽

Hernia Surgery ◽

Observation Study ◽

Post Operative Pain ◽

Patient Reported ◽

Groin Hernia Surgery

Abstract Aim There is a discrepancy between the high frequency of chronic post-operative pain reported in questionnaire-based studies after groin hernia surgery and the clinical experience of many surgeons in which it is infrequent that patients return after surgery because of chronic post-operative pain. This is supported by the Swedish Hernia Registry, where the proportion of patients who are re-operated for chronic post-operative pain is 0.02-0.03% for open methods and less than 0,01% for laparo-endoscopic methods. The aim of this study is to find the incidence of non-surgical causes of chronic groin pain and other patient-reported outcomes after inguinal hernia surgery. Material and Methods Prospective cohort observation study of patients evaluated for suspected inguinal hernia-related symptoms at a hernia clinic in Sweden during 1 year. Patients completed validated pain forms before surgery and 6 and 12 months after surgery. Patients were assessed preoperatively about the possible causes of groin pain according to a checklist. For this purpose, a questionnaire of inguinal hernia-related symptoms was used. Patients with moderate or severe chronic groin pain after surgery were offered to participate in a clinical examination where the pain was evaluated for probable cause according to a checklist. Results 574 patients were included in the study, of which 372 were operated on and answered the post-operative questionnaires. Preliminary results on surgical and non-surgical causes of chronic groin pain after hernioplasty and other patient-reported outcomes will be presented at Hernia 2021 EHS-AHS Joint Congress. Conclusions Proportion of patients with chronic groin pain related to groin hernia surgery and other non-surgical pathologies will be reported.

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Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

VASA ◽

10.1024/0301-1526/a000203 ◽

2012 ◽

Vol 41 (4) ◽

pp. 275-281 ◽

Cited By ~ 3

Author(s):

da Rocha Chehuen ◽

G. Cucato ◽

P. dos Anjos Souza Barbosa ◽

A. R. Costa ◽

M. Ritti-Dias ◽

...

Keyword(s):

Blood Flow ◽

Oxygen Uptake ◽

Intermittent Claudication ◽

Lower Limb ◽

Ventilatory Threshold ◽

Reactive Hyperemia ◽

Ankle Brachial Index ◽

Metabolic Parameters ◽

Walking Distance ◽

The Relationship

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

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Faculty Opinions recommendation of Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725953073.793533330 ◽

2017 ◽

Author(s):

Darin Correll

Keyword(s):

Hernia Repair ◽

Physical Disability ◽

Mesh Repair ◽

Groin Hernia ◽

Groin Pain ◽

Chronic Groin Pain ◽

Groin Hernia Repair ◽

Recurrent Groin

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Sacral plexus disorder caused by a wooden toothpick in the rectum

BMJ Case Reports ◽

10.1136/bcr-2020-238690 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238690

Author(s):

Takuro Endo ◽

Taku Sugawara ◽

Naoki Higashiyama

Keyword(s):

Lower Limb ◽

Spinal Nerve ◽

Leg Pain ◽

Sacral Plexus ◽

Lateral Recess ◽

Lateral Recess Stenosis ◽

Preoperative Ct ◽

History Of ◽

History Of Pain ◽

The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

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950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital

British Journal of Surgery ◽

10.1093/bjs/znab134.592 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

Z Hashmi ◽

R Ahmed ◽

T Zafar ◽

M Ahmed ◽

N Yousaf ◽

...

Keyword(s):

Local Anaesthesia ◽

Groin Pain ◽

Clinical Judgement ◽

Chronic Groin Pain ◽

Day Case ◽

Post Operative Pain ◽

The Mean ◽

Mesh Hernioplasty ◽

Operating Surgeon

Abstract Objective To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case. Method All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters. Results From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up. Conclusions Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

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Aortic dissection during transoesophageal echocardiography: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa333 ◽

2020 ◽

Author(s):

Rin Hoshina ◽

Hideyuki Kishima ◽

Takanao Mine ◽

Masaharu Ishihara

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Aortic Dissection ◽

Right Coronary Artery ◽

Bypass Graft ◽

Transoesophageal Echocardiography ◽

Ascending Aorta ◽

Maximum Diameter ◽

Abnormal Finding ◽

The Right

Abstract Background Transoesophageal echocardiography (TOE) is a safe and useful tool. In our case, we are presenting a rare case of a patient with aortic dissection during TOE procedure. Case summary A 79-year-old woman was referred to our hospital for recurrent paroxysmal atrial fibrillation (AF) with palpitation. Pre-procedural cardiac computed tomography (CT) showed slight dilated ascending aorta (maximum diameter: 40 mm). We decided to perform catheter ablation (CA) for AF, and recommended TOE before the CA because she had a CHADS2 score of 4. On the day before the CA, TOE was performed. Her physical examinations at the time of TOE procedure were unremarkable. At 3 min after probe insertion, there was no abnormal finding of the ascending aorta. At 5 min after the insertion, TOE showed ascending aortic dissection without pericardial effusion. After waking, she had severe back pain and underwent a contrast-enhanced CT. Computed tomography demonstrated Stanford type A aortic dissection extending from the aortic root to the bifurcation of common iliac arteries, and tight stenosis in the right coronary artery (maximum diameter; 49 mm). The patient underwent a replacement of the ascending aorta, and a coronary artery bypass graft surgery for the right coronary artery. Discussion Transoesophageal echocardiography would have to be performed under sufficient sedation with continuous blood pressure monitoring in patients who have risk factors of aortic dissection. The risk–benefit of TOE must be considered before a decision is made. Depending on the situation, another modality instead of TOE might be required.

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Early outcomes of novel Temren atherectomy device combined with drug-coated balloon angioplasty for treatment of femoropopliteal lesions

Vascular ◽

10.1177/17085381211029819 ◽

2021 ◽

pp. 170853812110298

Author(s):

Görkem Yiğit

Keyword(s):

Critical Limb Ischemia ◽

Bypass Graft ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Rotational Atherectomy ◽

Total Occlusion ◽

The Mean ◽

Knee Pathology ◽

Drug Coated Balloon

Objectives In this study, perioperative properties and early outcomes of patients who underwent combined Temren rotational atherectomy (RA) and drug-coated balloon (DCB) angioplasty treatment for complex femoropopliteal lesions in a single center were reported. Methods Between June 2019 and February 2020, 40 patients who underwent combined Temren RA and DCB treatment due to critical lower limb ischemia or claudication-limiting daily living activities were retrospectively evaluated. Results The mean age of patients was 73.2 ± 7.8 years and the majority of the patients were male (65%). Of the patients, 17 had critical limb ischemia and 23 had lifestyle-limiting claudication. Pathologies were total occlusion in 33 limbs and critical stenosis in seven limbs. Nine patients previously underwent endovascular intervention or surgery. The mean total occlusion length was 140.9 ± 100.9 (range, 20–360) mm in patients with chronic total occlusion. There was an additional iliac artery pathology in 5 and below the knee pathology in 8 patients. Rotational atherectomy was possible in all cases. Flow-limiting dissection was seen in six patients (15%). Provisional stent was performed to these patients. Following Temren RA, all patients underwent DCB. Adequate vascular lumen (less than 30% stenosis) was provided in all patients and the symptoms regressed. No distal embolization was encountered. Access site complications (17.5%) were small hematoma in four patients, ecchymosis in two patients, and pseudoaneurysm of the femoral artery in one patient. The mean follow-up was 13.55 ± 4.2 (range, 1–18) months. Re-occlusion was seen in three patients (7.5%) ( n = 2 at 2 months and n = 1 at 4 months). Of these patients, two had required open revascularization via femoropopliteal bypass graft with common, superficial femoral, and popliteal artery endarterectomy and one had required femoro-posterior tibial artery bypass. Four minor toe amputations (10%) were performed to reach complete wound healing in the critical limb ischemia patients. A below-knee amputation was performed in a 94-year-old patient with long segment stenosis at the end of a 1-month follow-up period. There was no mortality after follow-ups. The Kaplan–Meier estimator estimated the rate of freedom from target lesion revascularization (TLR) which was 92.3%. The decrease in the Rutherford levels after the procedure was found to be statistically significant in 36 patients ( p < 0.001). The increase in the ankle–brachial index after the procedure was found to be statistically significant in 36 patients ( p < 0.001). Conclusions Combined use of Temren RA with adjunctive DCB is safe and effective method with high rates of primary patency and freedom from TLR and low rates of complication in the treatment of femoropopliteal lesions.

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Esthetic and Functional Improvement of Asymmetric Lower Limb Overgrowth in a Proteus Syndrome Patient: a Combined Surgical Technique

Indian Journal of Surgery ◽

10.1007/s12262-021-02773-7 ◽

2021 ◽

Author(s):

Francesca Riccardi ◽

Simone Catapano ◽

Giuseppe Cottone ◽

Dino Zilio ◽

Luca Vaienti

Keyword(s):

Adipose Tissue ◽

Lower Limb ◽

Vascular Malformations ◽

Functional Improvement ◽

Proteus Syndrome ◽

Phosphatase And Tensin Homolog ◽

Tensin Homolog ◽

Genetic Mosaicism ◽

Phosphoinositide 3 Kinase ◽

The Right

AbstractProteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results.

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US-guided percutaneous microwave ablation (MWA) of submandibular gland: A new minimal invasive and effective treatment for refractory sialorrhea and treatment response evaluation with contrast-enhanced imaging techniques

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211115 ◽

2021 ◽

pp. 1-12

Author(s):

Hui-Li Zhang ◽

Jing-E Zhu ◽

Jia-Xin Li ◽

Xiao-Long Li ◽

Li-Ping Sun ◽

...

Keyword(s):

Effective Treatment ◽

Submandibular Gland ◽

Microwave Ablation ◽

Imaging Techniques ◽

Symptom Relief ◽

Minimal Invasive ◽

Whole Saliva ◽

Patient Reported ◽

The Right ◽

Percutaneous Microwave Ablation

A 33 years’ old male complained of excessive salivation with frequent swallowing and spitting, which resulted in communication disturbance, reduced quality of life, and social embarrassment for 19 years. He had been diagnosed as sialorrhea and submandibular gland hyperfunction by stomatologist, then had unilateral submandibular gland resection 13 years ago, but the symptom relief was not satisfactory. After that, he had been treated with glycopyrrolate for less than a year, which was withdrawn because of the short duration of symptomatic control after each tablet take-in and intolerable side effects. With the wish to receive a new treatment with long term effectiveness, low re-operation risk and normal preserved saliva secretion function, the patient was subject to MWA for the right submandibular gland. After systematic clinical evaluation, US-guided percutaneous MWA was successfully performed with an uneventful post-operative course. The volume of the right submandibular gland and ablated area were measured precisely by an ablation planning software system with automatic volume measurement function based on three-dimensional reconstruction of the pre-operative and post-operative enhanced magnetic resonance imaging (MRI) raw data. Finally, the ablated volume was calculated as 62.2% of the whole right submandibular gland. The patient was discharged 1 day after the operation, with symptoms relieved significantly, the mean value of whole saliva flow rate (SFR) decreased from 11 ml to 7.5 ml per 15 minutes. During the follow up by phone three months after operation, the patient reported that the treatment effect was satisfactory, whereas the SFR value became stable as 7 ml per 15 minutes, drooling frequency and drooling severity (DFDS) score decreased from 6 to 5, drooling impact scale (DIS) score decreased from 43 to 26. US-guided percutaneous MWA of submandibular gland seems to be an alternative, minimal invasive, and effective treatment for refractory sialorrhea. We described a patient with refractory sialorrhea treated successfully with ultrasound (US) guided percutaneous microwave ablation (MWA).

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