Functional popliteal artery entrapment is differentiated from anatomical entrapment by the absence of abnormal popliteal fossa anatomy. Although functional compression is a common entity in the general population, the precise etiology and natural history remains unknown. Magnetic resonance imaging clearly defines muscular variations within the popliteal fossa. In light of some of these variations, this article reviews embryological anatomy, diagnosis, classification, and treatment of the popliteal entrapment syndrome.

Objective: Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. Methods: Provocative tests were used to identify 58 nonoccluders and 16 occluders. Ten subjects from each group underwent magnetic resonance imaging evaluation of the popliteal fossa. The medial head of the gastrocnemius muscle attachment was assessed in the supracondylar, pericondylar, and intercondylar areas. Results: In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. Conclusion: The more extensive midline position of the medial head of the gastrocnemius in occluders is likely to be a normal embryological variation. Forceful contraction results in compression and occlusion of the adjacent popliteal artery. The clinical significance of these anatomic variations remains unclear. However, these new observations may provide insight for future analysis of the causes and natural history of functional compression and the potential progression to clinical entrapment. ( J Vasc Surg 2008;48:1189-96.)The classic syndrome of popliteal fossa entrapment is due to embryological anomalies between musculotendinous insertions within the popliteal fossa and neurovascular bundle. Functional entrapment occurs in the apparent absence of an anatomic abnormality. 1-3 This condition was first described in symptomatic military recruits and highly trained athletes 4,5 in whom calf muscle hypertrophy was believed to be the cause of the entrapment mechanism. However, provocative tests that cause gastrocnemius contraction (forceful plantar flexion) may compress and laterally displace the popliteal artery in up to 50% of normal, untrained individuals. 3,6 Apparent compression of the popliteal artery at various sites within the popliteal fossa has been noted on magnetic resonance imaging (MRI) during provocative testing. These sites are between plantaris and the medial head of gastrocnemius muscle (MHGM), between plantaris and popliteus, at the soleal sling, and between the MHGM and the lateral femoral condyle. 1,7 There is no clear explanation why compression occurs at these levels. It is possible, however, that these findings are due to the biased selection of muscular individuals 8 or to MRI artefacts created by different degrees of muscle contraction. The natural history and cause of functional entrapment therefore remains unknown.The normal attachment of the MHGM is to the popliteal surface of the femur just above the medial condyle, extending above the epiphyseal line. We hypothesize that an unrecognized variation in the attachment ...

The rapid spread of COVID-19 has resulted in a global pandemic. [1] By 10 July 2020, 22 million cases had been reported worldwide, resulting in 580 000 deaths. Governments around the world have implemented variable lockdown regulations to curb the rapid transmission of SAR-CoV-2. The first South African (SA) case of COVID-19 was reported on 5 March. [2] On 26 March, the SA government initiated a 21-day national level 5 lockdown. [3] The strict regulations included restriction of population mobility and interaction, international and domestic travel restrictions, restriction of commercial and business activity, cancellation of events and gatherings, and closure of schools and universities. Essential services such as security, health and food distribution were permitted. [4] The lockdown was eased off and downgraded to level 4 on 1 May and to level 3 on 1 June (Fig. 1). Many businesses were allowed to resume operations, and the regulations allowed for workers to resume work. By 1 July 2020, 159 333 cases of COVID-19 had been reported in SA, 45 944 (29%) in Gauteng Province. [5] Gauteng is the smallest province in SA, accounting for 1.5% of the land area, but it is the most densely populated province (accounting for 26% of the country's population) and is widely regarded as the country's economic and industrial powerhouse. [6] The progression and impact of SARS-CoV-2 are dependent on the demography of specific geographical regions. While mortality is higher in the older age group, relaxation of strict lockdown regulations may affect the working age group because of their increased mobility. Knowledge of age-specific infectivity may therefore provide insights into the impact and future trends of SARS-CoV-2 that may assist in developing mitigation strategies to counteract viral transmission. The effect of lockdown measures on SARS-CoV-2 infectivity is currently unknown in SA. In this article, we analyse the effects of the lockdown measures initiated on 26 March 2020 on SARS-CoV-2 attack rates (ARs) in Gauteng during the first 4 months of the epidemic in SA. We also studied the effects of geographical region, gender and age on the AR. MethodsIn this retrospective cohort study, we used a comprehensive database from an independent pathology laboratory in Johannesburg, This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Introduction: The aim of this study was to determine if any patterns of infection or bacterial resistance existed in critically ill polytrauma patients admitted to the intensive care unit (ICU) at the CM Johannesburg Academic Hospital (CMJAH). Methods: This was a prospective, single-center study of patient laboratory records of 73 critically injured polytrauma patients admitted to an ICU. The data collected from each patient, beginning with admission and extending until discharge from the ICU, included age, gender, admission hemoglobin levels, injury severity score, length of ICU stay, microbiological cultures and sensitivity (MCS), and types and numbers of surgical procedures. Results: Upon admission to the ICU, the injury severity score (ISS) was 40.86 (± 15.64). In total, 73.98% of the patients required the use of a ventilator during their ICU stay. The most prevalent organisms isolated from specimens were Pseudomonas aeruginosa (30.1%), Klebsiella species (25.7%), Acinetobacterbaumanni (16.4%), and Staphylococcus aureus (5.8%). Multi-drug resistance (MDR) was identified in 63% of patients, with Klebsiella (73.91%) and Pseudomonas (65.21%) occurring most frequently. Multivariate analysis showed MDR to be the only significant predictor associated with a higher risk for hospital mortality when age, gender, ventilation, duration of ICU stay, ISS score, and the number of surgeries undergone was taken into account. Conclusion: Critically ill polytrauma patients are at particularly high risk for Gram-negative sepsis.