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   2015| October-December  | Volume 2 | Issue 4  
    Online since April 13, 2016

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Risk Factors and Saphenofemoral Junction in Varicose Veins
Kshitij Manerikar, Arjinder Pal Singh Bawa, Abhilash Kumar Pithwa, Gurjit Singh, Harshwardhan Shrotri, Somnath Gooptu
October-December 2015, 2(4):134-138
Introduction: Varicose veins (VVs) are dilated, tortuous, subcutaneous veins. It is common condition causing substantial morbidity. Prevalence of VVs ranges between 5% and 30% in the adult population. Surgery is one of the common modality of its treatment. A complete knowledge about anatomical variation at saphenofemoral junction (SFJ) and variations in tributaries of great saphenous vein (GSV) is important while dealing with such patients effectively. It will help in reducing chances of recurrences and complications. Methods: A prospective non-randomized study of fifty patients was carried out in our hospital between May 2014 and May 2015. Diagnosis was established by clinical examination and supplemented with venous duplex ultrasound study. Patients were subjected to trendelenburg's operation, stripping of GSV with hook phlebectomy of affected perforators. Results: A total of fifty patients were studied in this study, in which tobacco chewing was the most common associated risk factor with primary VVs, and it was observed in 46% of patients. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m 2 . Location of SFJ was a mean of 2.24 ± 0.55 cm inferior and 3.77 ± 0.61 cm lateral to the pubic tubercle on duplex ultrasound and 2.35 ± 0.42 cm inferior and 3.73 ± 0.58 cm lateral intraoperatively, both of which had nonsignificant P value. The number of tributaries varied from 2 to 6 at the first 5 cm from SFJ. There were two and six tributaries in one patient each whereas three tributaries were observed in 42% patients. The most frequent consistent branch was a superficial inferior epigastric vein, seen in 98% of patients. The least frequent branch was posterior accessory saphenous vein, seen only in 2% of patients. The external pudendal artery was crossing SFJ anteriorly in 38% and posteriorly in 56%, and it was not identified in remaining 4% patients. Conclusion: Our study showed the nonsignificant difference in Duplex ultrasound and intraoperative finding of SFJ location with respect to pubic tubercle; hence, one can plan a precise incision with the help of duplex ultrasound marking preoperatively. One must look for all tributaries for ligation which will prevent recurrence of varicose vein as variation in numbers and location of tributaries was remarkable in our study.
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Early Intervention is an Important Factor in Reducing Mortality and Morbidity After Embolectomy/thrombectomy for Acute Limb Ischemia
Vikas Deep Goyal
October-December 2015, 2(4):148-151
Background: Retrospective analysis of risk factors associated with acute limb ischemia, the role of early intervention and patient selection in reducing mortality and morbidity after embolectomy and results of surgical treatment. Patients and Methods: From December 2011 to November 2013, 10 patients underwent embolectomy for acute limb ischemia at Dr. Rajendra Prasad Government Medical College Kangra at Tanda (H.P). Their mean age, sex, symptomatology, associated diseases, surgical technique, operative mortality, amputation, and incidence of renal dysfunction have been evaluated. Results: Ten patients underwent embolectomy for acute limb ischemia. The mean age of the patients in the study was 51.4 ± 8.8 years and mean hospital stay was 10.5 ± 7.78 days. There was no operative mortality and one patient required amputation. Three patients had renal dysfunction, but they recovered with conservative management. Conclusion: This study highlights that early intervention and patient selection are very important factors in minimizing mortality and morbidity after embolectomy. Right femoral and popliteal arteries are the most common peripheral sites of embolus arising from the heart and great vessels.
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Oral Anticoagulation-induced Iliacus Hematoma and Femoral Neuropathy!
Sunil Joshi, Mario Newton, Deep Shikha Kerketta
October-December 2015, 2(4):163-165
Oral anticoagulation is very effective in the management of thrombotic disorders. However, it can be associated with significant bleeding complication as its side effects. Iliacus hematoma presenting as a femoral neuropathy is a rare clinical scenario. Patients on anticoagulation with iliacus hematoma and neurological dysfunction should be taken up for decompression to avoid permanent disability. We, hereby, we report an interesting case of progressive femoral neuropathy due to iliacus hematoma which was decompressed successfully with prompt recovery of neurological dysfunction.
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Nutcracker Syndrome in an 8-year-old Boy: A Rare Encounter
Ashish Avinash Baviskar, Chaitanya Raut, Chandan Kumar Ray Mohapatra, Prashant Mishra
October-December 2015, 2(4):160-162
The nutcracker syndrome is the clinical equivalent of nutcracker phenomenon characterized by compression of the left renal vein (LRV), most commonly between the aorta and the superior mesenteric artery, with impaired blood outflow often accompanied by distention of the distal portion of the vein. It is manifested by pain, hematuria, varicocele or lower or pelvic urinary symptoms. We present a case of an 8-year-old boy who presented with painless hematuria for 2 months. Multislice computed tomography angiography revealed obstruction, ectasia, and increased blood flow at the LRV level. After undergoing surgical treatment (LRV transposition), the patient is asymptomatic with complete resolution of his symptom.
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The Adventitial Angioproliferation in Human Immunodeficiency Virus Associated Large Artery Vasculopathy is Not a Manifestation of Kaposi Sarcoma
Balasoobramanien Pillay, Pratistadevi Kanaye Ramdial, Amsha Ramburan, Kievershen Nargan, Datshana P Naidoo
October-December 2015, 2(4):139-145
Introduction: Human immunodeficiency virus-associated large artery vasculopathy (HIV-vasculopathy) is characterized by distinctive transmural microanatomical alterations, including adventitial angioproliferation, similar to that described in early cutaneous Kaposi sarcoma (KS). Human herpesvirus-8 (HHV8), the etiological agent of KS, is identifiable in tissue sections. The aim of this study was to investigate, based on HHV8-latent nuclear antigen-1 (HHV8-LNA-1) immunohistochemical and HHV8 polymerase chain reaction (PCR) testing, whether KS is the cause of the angioproliferation. Materials and Methods: Sections from 20 large arteries, ten each with HIV-associated occlusive and aneurysmal vasculopathy and ten biopsies with early cutaneous KS from 30 anti-retroviral therapy naive patients were appraised microscopically and subjected to HHV8-LNA-1 immunostaining. Arterial sections were also subjected to HHV8 PCR investigation with appropriate positive and negative controls. Results: The microscopic large arterial adventitial alterations included a dissecting proliferation of capillary-caliber vasculature, surrounded by mixed inflammation, microhemorrhages, hemosiderin and vasa vasorum intimomedial fibrosis, and hypertrophy. Ten vessels also demonstrated adventitial leukocytoclastic and lymphocytic vasculitis. Immunohistochemical and PCR detection of HHV8 was consistently negative. Skin biopsies of KS shared the vascular adventitial alterations, but vasculitis and thrombosis were absent. Endothelial and dermal spindle cells were immunopositive for HHV8. Conclusion: The adventitial angioproliferation in large arteries with HIV-vasculopathy is not a manifestation of KS. The exact roles of HIV, including interaction with co-infective agents and cellular and subcellular responses in the induction of vasculopathic and vasa vasorum abnormalities, including adventitial angioinflammatory alterations, require accelerated investigation for improved disease understanding and patient management.
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Internuclear Ophthalmoplegia in Pontomesencephalic Stroke as the First Manifestation of Takayasu Arteritis
Chetana Sen, Krishnarpan Chatterjee
October-December 2015, 2(4):156-159
Takayasu arteritis (TA) is a chronic inflammatory disease affecting the aorta and its main branches. Patients generally present with symptoms such as fever, myalgia, limb claudication, carotid vessel tenderness, hypertension, and asymmetric pulses. Neurological manifestations are present in a small percentage of patients, with stroke occurring in about 10% of cases. Stroke, occurring as the very first presentation of the disease, is however unusual. We present an atypical case of unilateral internuclear ophthalmoplegia (INO) due to acute pontomesencephalic stroke in the absence of cerebral angiographic abnormality, in a 36-year-old woman as the initial presenting feature of TA. The patient had angiographic evidence of bilateral subclavian artery stenosis but no abnormality in the cerebral vessels, thus pointing toward a possible embolic origin from inflamed vessels. Though other unusual neurological manifestations have been reported, INO as the first manifestation has not been found in medical literature so far.
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Persistent Asymptomatic Left-sided Sciatic Artery: A Rare Case Report with Review of Literature
Amit Mahajan, Anil Luther, Premjith Chandran
October-December 2015, 2(4):154-155
Persistent sciatic artery is a very uncommon embryologic vascular anomaly, with a prevalence of 0.05% based on reported studies. Although the majority of these patients are asymptomatic, it continues to be one of the risk factors for vascular compromise to lower extremity due to the rare complications associated with it such as aneurysmal dilatation, thrombosis or embolic phenomena, and arteriovenous malformations. We present a rare case of a 45-year-old woman with severe narrowing of bilateral superficial femoral arteries, and the left inferior gluteal artery continuing as the popliteal artery.
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Human Immunodeficiency Virus Vasculopathy: A Mystery Wrapped in an Enigma
Anshul Kumar Gupta, Ramesh K Tripathi
October-December 2015, 2(4):146-147
  1,180 57 -
Symmetrical Peripheral Gangrene Complicating Vivax Malaria
Krishnarpan Chatterjee, Chetana Sen
October-December 2015, 2(4):166-167
We present a case of Plasmodium vivax malaria who presented with distal lower limb gangrene. Large vessels of the lower limb were normal. After ruling out other causes, a diagnosis of symmetrical peripheral gangrene was made. The dry gangrene was treated conservatively, and amputation planned after the line of demarcation was seen.
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From the Editor-in-Chief's Desk
Ramesh K Tripathi
October-December 2015, 2(4):133-133
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Confronting the Reality: Acute Limb Ischemia in India - An Editorial Point de Vue
Himanshu Verma, Ramesh K Tripathi
October-December 2015, 2(4):152-153
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