Non-puerperal uterine inversion due to huge submucosal uterine myoma: a case report

Uterine inversion is a rare clinical entity with challenging diagnosis and management. Reports of successfully managed cases contribute to knowledge and aid future management of cases among practitioners. We report a case of a 46 year old para-3 with protrusion of a mass from her vagina and vaginal bleeding of 7 days duration. She was managed as a case of chronic uterine inversion. She was resuscitated and had vaginal myomectomy, Haultin’s procedure and subsequently total abdominal hysterectomy due to ischaemic necrosis of parts of the uterus.

VENOUS GANGRENE - AN INSTITUTIONAL EXPERIENCE

Venous gangrene represents the most severe manifestation following deep venous thrombosis (DVT), and presents as acral ischaemic necrosis. The pathophysiology is driven by an acquired coagulopathic state leading to microvascular thrombosis outcomes are generally poor. This study was aimed at analysing the outcomes in these rare group of patients who presented with venous gangrene at a single institution during a two year period.

Recurrent hypoglycaemia and dilated cardiomyopathy: delayed presentation of Sheehan’s syndrome

Sheehan’s syndrome (SS) is ischaemic necrosis of the pituitary gland due to massive postpartum haemorrhage. The clinical manifestations may vary from subtle to life-threatening and may present immediately after delivery or many years later. We present a case history of a 58-year-old non-diabetic woman who had undetected SS and presented with two unusual manifestations, including recurrent hypoglycaemia and dilated cardiomyopathy 34 years after delivery. The dilated cardiomyopathy reversed partially after treatment.

Ischaemic Necrosis of Pinnae in a Dachshund Dog – A Report

Ischaemic necrosis or thrombo-vascular necrosis of pinnae or pinnal margin vasculopathy is a slowly progressive idiopathic syndrome characterized by wedge-shaped devitalization and necrosis of the distal pinnae. It may occur either in unilateral or bilateral forms, bilateral affection being more common. Initially, an erythematous swelling and discoloration may be noted in the center of the medial aspect towards the apex of pinnae. Later, a necrotic ulcer may be seen in the center of the lesion, progressing to exudation and hemorrhage. In chronic cases, the areas of ulceration undergo complete necrosis resulting in deformity. Although there is no age, sex, and breed predisposition, certain breeds like Dachshunds and Chihuahuas are commonly affected (Morris et al., 2013; Nuttall et al., 2005). This communication reports a case of ischaemic necrosis of pinnae in a Dachshund dog with its successful clinical management.

Compartment Syndrome in the Lower Limb

Acute compartment syndrome of the limb is characterised by ischaemia of the soft tissues in association with raised tissue pressures within unyielding osseofascial compartments. It is a surgical emergency as the sustained high levels of pressure compromise capillary perfusion lead to hypoxia-induced tissue necrosis. Compartment syndrome may occur following initial injury or following revascularisation of an ischaemic limb; sometimes it is associated with a crush injury. Irreversible muscle and nerve damage occur when hypoxic levels are sustained and the period beyond which the damage becomes permanent depends on the type of tissue and pressure levels. Consequently, prompt diagnosis and decompression may rescue threatened tissues. A missed diagnosis is associated with significant morbidity arising from the ischaemic necrosis and, sometimes, putrefaction of tissues within the compartment. Late decompression may lead to myoglobinuria, renal failure and death after reperfusion of dead tissue. The principles described in the foregoing account apply to the upper and lower limb except for the hand and foot.

Radioulnar Ischaemic Necrosis in a Dog with Concurrent Osteomyelitis and Bone Sequestration

An 11-month-old intact female Golden Retriever presented for a 3- to 4-week history of right thoracic limb lameness. Computed tomography of the limb showed a sequestrum with a periosteal and endosteal reaction at the level of the nutrient foramen of the radius. Septic osteomyelitis was suspected based on cytology. Repeat examination and imaging revealed improvement in the lesion and resolution of the lameness. This lesion is similar to reports of radioulnar ischaemic necrosis, but is the first report with concurrent osteomyelitis and sequestration.

Vascular surgery

This chapter on vascular surgery covers diseases of the arterial, venous, and lymphatic systems. The chapter is well structured, describing conditions seen commonly in clinic, in the emergency department, and in theatre. It includes a list of cases to see such as limb ischaemia and varicose veins. It reviews the diagnosis and management of a stable and leaking abdominal aortic aneurysm including repair. It includes a section on amputation which is pertinent to injuries seen due to ischaemic necrosis or malignancy. It reviews the classification of arterial disease and provides pictorial guidance for students. This chapter includes guidance for exam questions on history taking and examination. It is written for both those looking to apply for medicine, and those in medical school.