Left Calf
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2021 ◽  
Sachin Gautam ◽  
Govind Mawari ◽  
Mradul Kumar Daga ◽  
Naresh Kumar

Abstract Ever since the WHO's declaration of the SARS-CoV-2 pandemic, the medical literature has been focusing upon the patterns of association of SARS-CoV-2 with different diseases. Patients with Osler-Weber-Rendu Syndrome, also known as, Hereditary hemorrhagic telangiectasia (HHT), presents with recurrent epistaxis, nostril manipulations, incidental detection of multiple AVMs (Arterio-Venous Malformations), and telangiectasias over mucocutaneous tissues and internal organs. In addition, these AVMs are prone to bleed or act as a nidus for thrombus formation apart from other serious complications like chronic hypoxemia, anemia, pulmonary artery hypertension, heart failure, and cerebrovascular disease accidents. Here, we provide a case report of such a patient who was diagnosed with HHT as per 'Curaçao criteria'; having a history of multiple episodes of epistaxis, radiological evidence of AVMs over left calf, pulmonary and hepatic region, multiple telangiectasias in the splenic region and uterine vascular malformations. Upon acquiring severe COVID-19 infection, the patient developed complications like anemia, pulmonary artery hypertension, sepsis, acute kidney injury, and post COVID-19 persistence of type1 respiratory failure. Moreover, the risk-benefit ratio of anticoagulation therapy in such patients with COVID-19 infection is tricky and challenging; however, our patient was prophylactically anti-coagulated with enoxaparin for 12 days with an uneventful outcome. Keywords: Osler-Weber-Rendu Syndrome, Hereditary hemorrhagic telangiectasia, HHT, Prophylactic Anticoagulation, Covid-19, SARS-CoV-2.

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 ◽  
pp. 1-9
Brian T. McGirr ◽  
Jake L. Martin ◽  
Chris E. Colborn ◽  
Alex C.S. Shefflette ◽  
Steve R. Soltysiak ◽  

BACKGROUND: Ultrasound is an important tool to diagnose many clinical conditions. Yet hand-held devices may be prone to more data variability in part from the greater likelihood of human error. OBJECTIVE: Quantify intra-rater reliability of subcutaneous skin fold thickness from a hand-held ultrasound device. PARTICIPANTS: College-age subjects (18 men, 14 women) submitted to two sets of ultrasound subcutaneous skin fold measurements spaced (mean + sem) 10.6 + 2.2 days apart. Per measurement, they stood relaxed as ultrasound measured the subcutaneous skin fold thickness that covered their left leg’s calf muscle group. Measurements occurred with a hand-held device (BodyMetrix Pro System BX2000; Livermore, CA) used in accordance with the manufacturer’s guidelines. Four subcutaneous measurements were made 90∘ apart (anterior, medial, posterior, lateral) at the portion of the left calf with the largest circumference. To assess intra-rater reliability, we used intraclass correlation coefficients, limits of agreement, coefficient of variation and the smallest real difference. RESULTS: Intra-rater reliability was high for most of our statistical tests. CONCLUSION: Despite the relatively long period between measurements, our hand-held ultrasound device exhibited a high degree of intra-rater reliability. Given our results, ultrasound measurements may be a useful tool to quantify skin fold thickness.

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 725
Horatiu Moldovan ◽  
Andra-Madalina Sibisan ◽  
Robert Tiganasu ◽  
Elena Nechifor ◽  
Daniela Gheorghita ◽  

We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.

2021 ◽  
Vol 24 (2) ◽  
pp. 118-123
Maria-Andrada Corodeanu ◽  
Sorina Vasile ◽  
Anca-Cristiana Oprea ◽  

A 53 year old male diagnosed with HIV, SARS-CoV-2 and Kaposi sarcoma developed a purple-brown maculopapular rash on the left calf approximately 6 months before hospitalization and was diagnosed with venous ulcer. The lesions grew in size, spread on the whole body and also appeared on the palate. During this time the patient did not ask for a second opinion and was not monitored by a medical specialist. In December 2020, he developed a severe form of COVID-19 with acute respiratory failure and was admitted to the hospital. He was simultaneously diagnosed with HIV and severe immunosuppression. The skin biopsy confirmed Kaposi sarcoma in the nodular stage. Antiretroviral therapy (ART) was initiated and the patient later received liposomal doxorubicin chemotherapy. The patient slowly recovered whilst showing improvement of his clinical condition and immunological status.

Miodrag Vranjes ◽  
Tanja Lakić

<p class="abstract">Compartment syndrome occurs when the pressure within a defined compartmental space increases above a critical pressure threshold. Lung cancer is one of the world's most frequently diagnosed cancer whose metastases are rare cause of compartment syndrome. We present a 50 year old male patient who was admitted to our emergency department due to painful left lower leg, swelling and paresthesia of the medial side of the foot that lasted about 2 months back. The diagnosis of metastatic lung adenocarcinoma was set 9 months earlier. Physical examination revealed an ill-defined, tense, and tender swelling left calf and X-ray images confirmed periosteal reaction on all four cortices of both bones without osteolytic lesions. After an adequate laboratory analyses and preoperative preparation, debridement with biopsy and fasciotomy was performed. Histopathological evaluation showed necrotic tumor tissue that morphologically and immunohistochemically corresponds to lung cancer. We performed an above knee amputation and the next day, the patient was discharged home, due to his personal request.</p>

2021 ◽  
Vol 14 (3) ◽  
pp. e240217
Jasmine Crane ◽  
Kevin Seebah ◽  
Darren Morrow ◽  
Atanu Pal

We present a 71-year-old man who developed left calf pain after an elective laparoscopic assisted anterior resection. A clinical picture with a raised creatine kinase and negative Doppler ultrasound was suggestive of compartment syndrome. Successful surgical management was performed with two incisional fasciotomies to release all four compartments of the left leg. The patient recovered well postoperatively. The lateral incision was closed primarily while the medial incision required vacuum-assisted closure dressings and healed by secondary intention. Neither wound required skin grafts. The patient recovered well but had an extended hospital stay due to extensive physiotherapy requirements and mild foot drop. This report is intended as a guide for clinicians when considering differentials in calf pain following surgery and to keep in mind the small risk of developing compartment syndrome after pelvic surgery.

2021 ◽  
Vol 7 (1) ◽  
Yuri Fujimoto ◽  
Ryosuke Hamachi ◽  
Yoshimasa Motoyama ◽  
Etsuko Kanna ◽  
Masako Murakami ◽  

Abstract Background Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. Case presentation A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. Conclusions Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

2020 ◽  
Vol 6 (1) ◽  
pp. 26
Firman Ardiansyah Ekoanindiyo ◽  
Antoni Yohanes ◽  
Endro Prihastono

Based on calculations by the Directorate General of Food Plants (Ditjen TP), Ministry of Agriculture. Corn production in the last 5 years has increased by an average of 12.49% per year. According to the Secretary of the Directorate General of Food Crops of the Ministry of Agriculture (Kementan) Maman Suherman in 2019 maize production is estimated to reach 33 million tonnes of dry shell (PK) in an interview with Republika on January 6, 2019. Cepiring sub-district, Kendal district, apart from being planted with rice in the rainy season, rice fields also planted with maize. After harvesting, the corn that has been plucked is separated from the cob using a corn sheller. The shelling machine is used using diesel fuel and electricity, with workers standing for long periods of time, causing fatigue in the arms, waist, thighs and back. The data processing of the nordic body map questionnaire was carried out to determine the complaints on the skeleton and muscles of the workers. From the results of the questionnaire above, most Sido Rejo farmers feel complaints on their right shoulder, left upper arm, back, right upper arm, back, waist, left elbow, right elbow, left forearm, right forearm, left wrist, wrist right, left hand, right hand, left thigh, right thigh, left calf, right calf, left leg to right leg. With anthropometric measurements, the dimensions of the body used are the height of the sitting shoulders and the data used are the average data or the 50th percentile. With this solar sheller, it can save fuel and be environmentally friendly and reduce the complaints of the frame and muscles of farmers

2020 ◽  
Vol 7 (12) ◽  
pp. 4172
Jasmine J. Mui ◽  
Martin Jones

Necrobiotic xanthogranuloma (NXG) is a rare skin disorder characterized by the development of large violaceous plaques all over the body. Rarely, these plaques become infected and require surgical debridement. The current literature is lacking on outcomes of surgical intervention in this patient population. Hence this case report aims to describe surgical management for a patient with NXG presenting to The Shoalhaven District Memorial Hospital and review the literature on the pathophysiology and current treatment modalities for this condition. A 61-year-old man presented to The Shoalhaven District Memorial Hospital with an infected NXG plaque on his left calf unresponsive to intravenous antibiotics. He has had a previously infected lesion on his right shin debrided by our surgical team in 2015, with plaque recurrence on the superior-medial aspect. His current infection was managed with surgical excision of the necrotic core of the NXG plaque while sparing the healthy surrounding plaque tissue. This is in accordance to the current literature which demonstrates poor cosmetic outcomes with complete surgical resection of healthy plaques, with a 42% recurrence with increased size and nodularity.1, 2 NXG appears to be related to autoimmune monoclonal paraproteinemia and associated with hematological malignancy. Therefore, management is primarily medical with surgical resection only indicated in cases of severe infection. NXG presents a rare challenge to the general surgeon given the lack of evidence for surgical debridement. Understanding the underlying pathophysiology, treatment options and healing patterns in this disorder will allow the surgeon to assess and manage infected lesions with minimal cosmetic disfigurement

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