Klippel-Trenaunay syndrome is a rare disorder consisting of the triad of vascular and/or lymphatic malformations, capillary malformations, and soft tissue or bony hypertrophy. Symptom control is the mainstay of treatment for these patients, with many of the symptoms never fully being relieved. In this case report, we present the case of a 46-year-old man with chronic lower extremity ulcerations unresponsive to wound care therapy. Owing to the chronic nature of his wounds and associated pain, reconstruction of his iliac vein was performed using polytetrafluoroethylene graft and an arteriovenous fistula.
A 65-year-old woman presented to our institution with 4 months of severe pain on the plantar aspect of her foot. She had chronic foot pain secondary to Morton's neuroma and had recently undergone neurectomy. She was found to have a large pseudoaneurysm on the plantar aspect of her foot. She was taken to the operating room for an open repair from a plantar approach. We obtained the patient's consent to publish this case.
portal access. athenahealth, a cloud-based EHR, was selected based on the study selection criteria.
RESULTS: Net profit increased 12% in the first year of introduction of implementation Days in Accounts Receivable decreased by 10.97% Patient visits increased by 2.93% No show rate decreased 16.22% overall Automated, easily accessible quality data gathering demonstrated by improved care coordination with other IPA members.CONCLUSION: This small study demonstrates the use of a low-cost EHR to improve financial outcomes and care coordination for an independent practice in a rural setting. The results of this study merit further investigation to determine how small practices can meet the needs of a 21st century patient population.
We present a case of a 60-year-old woman with chronic lower abdominal pain and green urine. Further workup revealed a cholecystovesicular fistula (CVF), a newly coined term to indicate a fistula between the gallbladder and the urinary bladder. The CVF was treated surgically. The pathophysiology of CVF is thought to result from gallbladder perforation into the liver. Over time, a tract forms inferiorly until it meets another organ, in this case, the urinary bladder. This later complication of the gallbladder disease joins the broader spectrum of cholecystic fistulas. To our knowledge, a CVF has never been reported in the literature.
An 81-year-old woman presented to our institution with a contained ruptured mycotic aortic aneurysm involving the takeoff of the celiac artery that required ligation of the celiac trunk, resulting in foregut ischemia and the need for revascularization. The technique of aortic reconstruction with delayed hepatic artery revascularization by a common iliac artery to hepatic artery bypass is described.
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