Left Lower Limb
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2021 ◽  
pp. 634-655
Hosna Elshony ◽  
Abdelrahman Idris ◽  
Alaa Ahmed ◽  
Murouj Almaghrabi ◽  
Walaa Ahmed ◽  

Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl’s eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.

2021 ◽  
Vol 8 (10) ◽  
pp. 3093
Atul Tandon

Background: Varicose veins are a widespread medical condition found in at least 10 percent of the general population. Symptoms of varicose veins range from asymptomatic varicose veins to more extreme symptoms such as ulceration and bleeding.Methods: Fifty-six cases of varicose veins of lower limb were evaluated by taking detailed history and by carrying out thorough clinical examination. Patients with features of varicose veins and its complications were included in the study while patients with secondary varicose veins due to deep vein thrombosis, recurrent varicose veins, pregnancy, and venous flow obstruction were excluded from the study.Results: It was more common in left lower limb then compared to right one, 26 (46.4%) patients developed in left and 23 (41.1%) patients in right lower limb. In the present study, right limb involvement of 41.1% and left limb involvement of 46.4%. In the present study bilateral involvement is seen in four patients (12.5%).Conclusions: Distributions of varicose veins of lower limbs is greater common in center age organization of 30 to 50 years (58.9%) with male predominance, career and own family history are the opposite contributory factors.

Kofi Tawiah Mensah

Introduction: Mangled extremity injuries in civilian settings are challenging conditions for the accident and emergency units of low-resource settings where salvage therapies may not be feasible or affordable for the patients. Case Report: We have described a successful case of initial conservative limb salvage management for a mangled distal left lower limb in a four-year-old male who sustained the injury when a vehicle ran over his extremity as he played by the road. The treatment approach was in contrast to the radical completion of amputation with its attendant revisions, which are associated with similar injuries with the mangled extremity severity scores of ≥ 7. Conclusions: The benefits and challenges of the limb salvage intervention were discussed based on the literature in this regard, and a recommendation was proposed while considering an initial conservative limb salvage approach in well-resuscitated children presenting early with a mangled extremity injury.

2021 ◽  
Chandrasekaran Kaliaperumal

Abstract This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed.A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine at thoracic T2/3 level with ASIA impairment score (AIS) score D with an incomplete spinal cord affecting his left lower limb with complete paralysis and right lower limb paresis with impaired sensation below T6 level to L5. Neuroimaging confirmed a penetrating knife injury traversing the T2/3 level causing hemi-section of the spinal cord confirmed intraoperatively. He underwent an urgent exploratory surgery of his spine and a T2/3 laminectomy was performed to aid removal of the knife. The dura was noted to be contused and severed spinal cord was noted to be severed with associated cord oedema. A microsurgical repair of the severed cord was performed with duroplasty followed by intense neuro-rehabilitation. On a three month follow up his AIS score is E with lower limb power is 5/5 bilaterally and he is able to mobilise independently up to 8-10 steps without any supportive aid and with crutches he is independently functional and mobile.This is the first documented case of microsurgical repair of severed thoracic spinal cord secondary to traumatic knife injury. In the management of such scenario, apart from the removal of foreign body, repair of the cord with duroplasty should be carefully considered. The role of spinal neuroplasticity in healing following timely repair of the spinal cord along with intense rehabilitation remains the key. This had resulted in a good clinical and functional outcome with in a 12 month period.

Wan Nuraisyah Azzahrah Wan Zuki

Phlegmasia cerulea dolens (PCD) is a rare syndrome caused by venous thrombosis and characterised by a triad of limb oedema, cyanosis and pain. It requires early recognition as delay of treatment can cause gangrene, limb amputation and in extreme cases, death. A 67- year-old Chinese lady, with underlying hypertension, diabetes mellitus and dyslipidaemia presented to the emergency department with a 2 days history of pain, oedema and bluish discoloration over the entire left leg. She had a history of fall 6 months prior and since then she used a walking stick for mobilization. This patient underwent ultrasound doppler left lower limb , which showed features suggestive of long-segment left lower limb deep vein thrombosis. A diagnosis of PCD was made. Subsequently, she went for a CT angiogram and venography of the left lower limb which confirmed thrombosis of the left calf vein extending to the long segment of the left common iliac vein. She was commenced on intravenous heparin infusion and then underwent inferior vena cava filter insertion and catheter directed thrombolysis. Repeat venogram showed successful catheter directed thrombolysis of the left lower limb deep venous thrombosis (DVT). Treatment should be initiated as soon as the diagnosis of PCD is suspected. Currently, guidelines for treatment are lacking however 3 therapeutic options are advocated alone or in combination: anticoagulants, thrombolytic therapy, and venous thrombectomy. An early recognition of PCD and appropriate decision regarding the treatment is essential to preserve the limb.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S16

2021 ◽  
Vol 6 (4) ◽  
pp. 38-43
P. V. Hryhorieva ◽  

Defining quantitative growth parameters of individual skeletal bones, namely the right and left femurs, is practically important for determining the age of the fetus. Lack of data on changes in the length of the femur in 4-10 months’ fetuses, as well as the dependence of its morphometric parameters on the length of the lower limb and the age of the fetus, prompted us to conduct this study. The purpose of the study was to determine the morphometric parameters of the length of the right and left femurs during the fetal period of human ontogenesis, which could form the base of normal indicators. Materials and methods. Morphometric study was performed on the lower extremities specimens of 40 human fetuses of an 81.0-375.0 mm parietal-coccygeal length. Results and discussion. As a result of the study, the dynamics of changes in the length of the right and left femurs and lower extremities in 4-10 months’ human fetuses was established. Direct correlations were found in the studied fetal groups, and only in 5-month-old fetuses a direct medium-strength reliable correlation between the lengths of the right and left femurs was found. A weak correlation between the length of the left lower limb and the length of the left femur was found in 7-month-old fetuses. In other cases, direct significant strong correlations were found between the analyzed indicators. The results obtained regarding the change in the length of the right and left femurs, as well as the Pearson correlation coefficient between the morphometric parameters of the length of the right and left femurs and the length of the lower extremities and parietal-coccygeal length of human fetuses 4-10 months are important both theoretically and practically for fetal anatomy. Conclusion. During the fetal period of human ontogenesis, where there is a relatively uniform increase in the length of the right and left femurs, no significant differences in their length were detected. Between the 4th and the 10th month of fetal development, the length of the right femur increases by 5.59 times (from 13.18 ± 2.56 mm to 73.66 ± 2.19 mm), and the length of the left femur increases by 5.44 times: from 13.54 ± 2.35 mm to 73.73 ± 2.12 mm, respectively. In the fetal period the right and left lower extremities also grow equally, no significant differences in their length have been established

2021 ◽  
Vol 15 (1) ◽  
Franck Katembo Sikakulya ◽  
Walufu Ivan Egesa ◽  
Sonye Magugu Kiyaka ◽  
Philip Anyama

Abstract Background Klippel–Trénaunay syndrome is a rare congenital capillary–lymphatic–venous condition characterized by the clinical triad of capillary malformations (port wine stains), varicose veins with or without venous malformations, and bony and/or soft-tissue hypertrophy. It has a very low incidence of about 1:100,000. Case presentation We report the case of 21-day-old neonate Black African female (born in Uganda) with Klippel–Trénaunay syndrome who presented with macrodactyly and ectrodactyly on the left foot, as well as numerous port wine stains on the left thoracoabdominal region and anteroposterior left lower limb. Color Doppler ultrasound examination of the left lower limb and abdomen revealed varicose veins without signs of arteriovenous fistula. Conclusion The report presents the case of a neonate with a rare congenital vascular disorder type Klippel–Trénaunay syndrome.

2021 ◽  
Ahmed Shabhay ◽  
Jaffu O. Chilongola ◽  
Stephen Mshana ◽  
Zarina Shabhay ◽  
Jeff Van Baal ◽  

Abstract Background Antimicrobial resistance to current novel antibiotics is posing a major threat to both human and zoonotic life. This poses a serious potential of rolling back to pre-antibiotic era clinical settings. Antimicrobial discovery pipeline has dried up as major pharmaceutical brands have shifted to long term chronic illness drugs production. In the absence of new novel antibiotics molecules, clinicians have resorted into a desperate last resort to review and re-introduce prior discarded antibiotics as their new weaponry in the fight against multi-resistant Gram-negative bacteria. Case presentation: We report a case of a 77 years old bed ridden diabetic and hypertensive with renal impairment diagnosed with bilateral lower limbs wet gangrene. She underwent transfemoral on her right and transtibial amputation on her left lower limb. She developed Surgical site infection on her right stump and wet gangrene on her left stump. Surgical toilet, debridement and stump revision was done on her right stump and a transfemoral amputation on her left lower limb. Pus swab on her right stump revealed carbapenem resistant strains of Pseudomonas aeruginosa. She was instituted on parenteral colistin and showed no bacterial growth 7 days post treatment. She suffered an ischaemic cerebral vaso-occlusive stroke during her hospital stay. CT angiography revealed distal infra-renal abdominal aorta multiple calcified plaques, multiple calcified plaques and completely obstructing thrombus both on common and external iliac arteries, seen downstream to both superficial femoral arteries with multiple collaterals in both thighs. The included portion of the lower lung fields showed a large filling defect in the right main pulmonary artery extending to the lower lobe branches suggestive of right-sided pulmonary embolism. She developed hypostatic pneumonia, bed sores and her condition deteriorated and she unfortunately succumbed from her comorbidities. Despite our patient succumbing to her multiple co-morbidities we report this case to highlight the isolation of carbapenem resistant strains of Pseudomonas aeruginosa and the efficacy and safety of colistin as a salvage antibiotic in renal impaired patients. Conclusions Colistin can be safely used as a last reserve antibiotic for multi-resistant strains of Pseudomonas aeruginosa infection even in patients with renal impairment.

2021 ◽  
Vol 14 (9) ◽  
pp. e245353
Sri Hari Priya Vemulakonda ◽  
Naveen Kumar Gaur ◽  
Oseen Hajilal Shaikh ◽  
Uday Shamrao Kumbhar

Primary lymphoedema is a rare disorder. Often presents at a young age with asymptomatic limb oedema with gradual progression. We present a 16-year-old woman who presented with a history of swelling of the left lower limb for 6 years. There was the presence of isolated left lower limb oedema, which was a non-pitting type. The patient underwent imaging studies and was diagnosed to have primary lymphoedema. The patient was managed conservatively as the patient did not have any other problems other than the left lower limb oedema.

2021 ◽  
Vol 13 (3) ◽  
pp. 187-189
Christy Vijay ◽  
Medini Lakshmeswar ◽  
SK Manjula

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