Background/Objective: The National Kidney Foundation Kidney disease outcomes quality initiative guidelines suggest that the creation of more native arteriovenous fistulas (AVFs) would improve the quality of life of end stage renal failure patients. However, the ability to comply with this suggestion is affected by the failure rate of AVFs mainly due to thrombosis. Heparin is a well-accepted treatment to prevent thrombosis in general but has not been suggested in arteriovenous fistula. This study was conducted to investigate the effect of intraoperative systemic heparin on the thrombosis rate and associated morbidities over a duration of six weeks.

Primary lymphomas of the heart are extremely rare, accounting for 2% of all primary cardiac tumors. Due to the rare presentation, there is no proper consensus available on treatment strategy. Preoperative confirmation of the pathology is fundamental in guiding an early treatment plan, which allows for improved prognosis. Unfortunately, in most cases, primary cardiac lymphoma is only identified on postoperative histopathological analyses, which affect the treatment plan and outcome. Here, we report a unique case of primary cardiac lymphoma presented with dyspnea and reduced effort tolerance. Young age, rapid onset of symptom, and absence of cardiac risk factors prompted us towards further imaging and emergency resection. The patient received a course of postoperative chemotherapy and was disease-free on six months of follow-up.

Intravascular tumour extension can occur in many different types of cancer. Those with the highest tendency include renal cell carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma. Inferior vena cava (IVC) tumour thrombus in gynaecological malignancy is rarely reported. We present a report on a female patient with extensive IVC tumour thrombus (intravenous leiomyomatosis) with concurrent intrauterine leiomyomatosis. She underwent a single-stage procedure, involving laparotomy and a sternotomy to remove her pelvic tumour, as well as the intracaval and intracardiac thrombus. The clinical presentation and management of this rare tumour will be detailed in this case report.

BACKGROUND: Acute arterial thromboembolism among the novel coronavirus 2019 (COVID-19) patients is worrying as it can result in significant thrombotic events. AIM: The research aimed to determine the clinical results of COVID-19 infected patients who had ALI (acute limb ischaemia) during the COVID-19 epidemic. METHODS: ALI patients who had a positive COVID-19 were included in the observational cohort study, which was conducted at a single centre. The primary outcomes were 30 days mortality, limb salvage, and successful revascularization. RESULTS: From May to October 2021, data from 21 ALI subjects who had positive COVID-19 were analysed. Of the 21 included subjects, 10 were males (48%). Their mean age was 65±5 years. In nine subjects (42%), revascularization was done. Four (19%) of the 21 persons died while they were hospitalized. Twelve patients underwent major amputation and among them, one patient died after a month of hospitalization for COVID-19-related pneumonia.  Among the 12 patients that underwent amputation, 10 of them presented with ALI during the first week of COVID-19 illness. Only one patient developed acute limb ischaemia despite being on heparin thromboprophylaxis. CONCLUSION: Despite attempts at revascularization, ALI-associated with COVID-19 has high mortality and high rates of limb loss. In our experience, major amputation is required in up to a third of patients. This poor result appears to confirm that these infected individuals have a marked hypercoagulable condition. However, adhering to the treatment protocol of heparin thromboprophylaxis confers a benefit in this patient group.

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Extraosseous Ewing's sarcoma is a rare entity that involves the lower extremities, paravertebral regions of the spine, retroperitoneum, pelvis, and the chest wall. Involvement of mesentery as this case has been only reported five times in English literature. An eleven-year-old girl was planned for gynaecological surgery for suspected ovarian dysgerminoma. Intraoperatively she was referred to the surgical team since tumor arising from mesentery of the terminal ileum. Complete resection of the tumor with a right hemicolectomy was done. Histopathological assessment of the tumor revealed features of small blue round cell tumor which after an expert immunohistochemical staining reported as extraosseous Ewing sarcoma. She underwent a course of adjuvant chemotherapy and currently well during follow up. Due to the rarity of this tumor, a proper consensus on management has not been outlined. However, complete resection and adjuvant chemotherapy remain a standard therapy which showed an excellent post-operative outcome.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. The incidence of post-cardiac surgery gastrointestinal emergencies ranges between 0.4-2.9% and are often of varying diagnoses. Although acute mesenteric ischemia is infrequent, it represents 10-67% of these complications and carries an overall mortality rate of almost 95% of non-surgically treated patients compared to approximately 57% of surgically treated patients. The high number of mortalities is mainly due to its protean clinical presentations resulting in a delay in diagnosis. Case Report: We report a case of acute mesenteric ischemia in a patient who had undergone coronary artery bypass graft (CABG) with concomitant aortic valve surgery. Progressive abdominal distention and rising lactate level were the features pointed towards diagnosis of mesenteric ischemia in this patient. Based on a literature search and review, we discuss on the pearls and pitfalls in the management of this case; with aim to improve the outcome of such similar case in future. Conclusion:Gastrointestinal complications post cardiac surgery should be treated aggressively. Routine utilization of risk assessment tools such as GICS scoring model; timely intervention such as lower the threshold for diagnostic laparoscopy and selective mesenteric angiography may improve the outcome of this group of patients.