Marjolin's Ulcer of the Leg Secondary to Nonhealing Chronic Venous Stasis Ulcer

We report on a 79-year-old man with a chronic venous stasis ulceration of >20 years' duration in the left medial leg presenting to our clinic after admission for bleeding and suspected infection of his ulceration. This lesion had been biopsied in 1999 and was found to be a benign, chronic venous insufficiency ulceration. Plain film radiographs as well as a bone scan did not identify osteomyelitis. Because of the hypertrophic, nodular appearance of this ulceration, it was the clinicians' discretion to perform a repeat biopsy of the lesion. Biopsy revealed invasive, well-differentiated squamous cell carcinoma. A computed tomography scan subsequently identified a suspicious inguinal lymph node, and an ultrasound-guided needle aspiration revealed metastatic squamous cell carcinoma of the biopsied lymph node. Above-knee amputation was indicated at this time and was performed in conjunction with local superficial inguinal lymph node resection, after which the patient was discharged from our service.     

Swimming-induced pulmonary oedema an uncommon condition diagnosed with POCUS ultrasound

Swimming Induced Pulmonary Edema, or SIPE, is an emerging condition occurring in otherwise healthy individuals during surface swimming or diving that is characterized by cough, dyspnea, hemoptysis, and hypoxemia. It is typically found in those who spend time in cold water exercise with heavy swimming and surface swimming, such as civilian training for iron Man, triathalon, and military training. We report the case of a highly trained young female swimmer in excellent cardiopulmonary health, who developed acute alveolar pulmonary oedema in an open water swimming training diagnosed in the emergency department using POCUS ultrasound.     

Long-Term Outcomes of Endovascular Interventions in More than 500 patients with Budd–Chiari Syndrome

PurposeTo assess and compare the long-term outcomes of various endovascular interventions in patients with Budd-Chiari syndrome (BCS).Materials and MethodsIn this single-center retrospective study, 510 consecutive patients with BCS who had undergone a total of 618 endovascular procedures from January 2001 to December 2019 were included. Details of the type of endovascular intervention, technical success, clinical success, patency rate, complications, and survival outcomes were analyzed.ResultsThe overall technical success rate was 96% (593 of 618 procedures; 500 in treatment-naïve patients and 93 repeat interventions for recurrent disease). Endovascular procedures included recanalization procedures (angioplasty and stent placement) in 355 patients (71%) and transjugular intrahepatic portosystemic shunt (TIPS) creation in 145 (29%). Major postprocedure complications occurred in 14 patients (2.8%). Vascular/stent restenosis occurred in 95 patients (19%), and successful repeat intervention was performed in 82 of those 95 (86.3%). An additional 11 of these 82 (13.4%) underwent a third intervention for restenosis. In the recanalization and TIPS groups, the 1- and 5-y cumulative patency rates were 87% and 74% and 95% and 68%, respectively. The 1- and 5-y survival rates were 96% and 89% and 90% and 76%, respectively.ConclusionsEndovascular interventions for BCS are feasible and safe in the majority of patients, with excellent short- and long-term patency and survival rates.     

Pouteria campechiana leaf extract and its bioactive compound myricitrin are mosquitocidal against Aedes aegypti and Culex quinquefasciatus

Objective: To test the mosquitocidal potential of leaf extracts of Pouteria campechiana prepared with different solvents and elucidate the structure of an isolated mosquitocidal compound. Methods: The leaf extracts of Pouteria campechiana prepared with three solvents(petroleum benzene, ethyl acetate and acetone) and potential bioactive fractions were tested against various stages of Aedes aegypti and Culex quinquefasciatus by using the WHO protocols, and the chemical profile and its functional groups were identified by GC-MS and Fourier transmissioninfrared spectroscopy(FT-IR). The structure of bioactive compound was characterized by nuclear magnetic resonance(NMR) spectral technique. Results: The preliminary phytochemical results revealed the presence of alkaloids, amino acids, flavonoids, quinones, saponins, steroids, tannins, and terpenoids in the acetone extract. A significant toxic potential was observed in the acetone extract against both Aedes aegypti and Culex quinquefasciatus mosquitoes. The acetone extract exhibits remarkable larvicidal(LC_(50): 12.232 μg/mL and LC_(90): 63.970 μg/mL), pupicidal(LC_(50): 18.949 μg/mL and LC_(90): 167.669 μg/m L) and adulticidal(LC_(50): 20.689 μg/mL and LC_(90): 72.881 μg/mL) effects against Aedes aegypti. Furthermore, the same extract was subjected to isolation of bioactive compound by GCMS and FT-IR analysis. GC-MS results showed the presence of 5 major compounds, and octacosane(18.440%) was detected as the predominant compound. The FT-IR result of acetone extract demonstrated the presence of various functional groups like alkanes/alkynes, ester, aromatic and amides. The NMR spectrum results of isolated compound were well matched to glycoside linked flavonoids. Based on the chromatography and spectral techniques the isolate molecule was identified as myricitrin by FT-IR and nuclear magnetic resonance spectral data. Conclusion: The isolated compound myricitrin possesses a significant toxic effect in all stages of Aedes aegypti and Culex quinquefasciatus mosquito's with lowest LC_(50) and LC_(90) values.     

Lower limb nerve blocks

Peripheral nerve blocks are increasingly used for a wide range of surgical procedures involving the lower limb. A number of techniques can be used to provide anaesthesia and highly effective postoperative analgesia, offering an alternative to general anaesthesia in some cases, minimizing the requirement for strong opiates and improving the quality of recovery following surgery. Ultrasound-guided nerve localization offers several potential advantages when performing femoral, sciatic and ankle blocks; however, neurostimulation remains a useful and widely used aid to lower limb regional anaesthesia practice.