This is a descriptive study of chronic ischaemia of the lower limb caused by atherosclerotic disease in 588 patients. The study was performed over 34 years in a tertiary clinic in the central province of Sri Lanka. It was found that the pattern of occlusions were similar to that of other reports on western patients. However, critical ischaemia was seen in 57% of Sri Lankan patients, suggesting a more florid disease. Pioneering efforts of reconstructive surgery in 278 patients and in-hospital results are presented.
Although the ectopic thyroid in adults is rarely symptomatic, biochemistry and imaging workup are essential. Treatment modality of choice is dependent on patient factors, institution factors and surgeon factors. The mainstay treatment involves hormone suppression treatment with exogenous thyroid hormone. If medical management is unsuccessful, surgical excision requires an experienced team including an anaesthetist and otolaryngologist. Anaesthetic considerations are important because intubation may be a potentially difficult procedure secondary to potential serious obstruction of the upper airway. We present a case report and narrative review of the literature regarding lingual thyroid workup and management.
Even though the history of vascular surgery originates from 1900, laparoscopy assisted vascular procedures were only reported in 1993. Since then this minimally invasive approach has gained popularity for both occlusive and aneurysmal conditions with the advantages of less postoperative pain, early ambulation and reduced hospital stay. External iliac artery occlusion may be treated with angioplasty and stenting or by open bypass. Open bypass from the aorta or the common iliac artery to the femoral artery requires a substantial incision. Laparoscopic dissection allows exposure of the vessels with small port site incisions. The anastomosis may be done using intracorporeal suturing or a mini incision (1,2,3). We present a 44-year-old male who underwent a laparoscopy assisted ilio-femoral bypass. Case report A 44-year-old male smoker presented with rest pain and gangrene of the left 4th and 5th toes. He gave a history of intermittent claudication of ipsilateral thigh and calf. He had no history of ischaemic heart disease, cerebral ischaemia or mesenteric angina. On examination he had a weak left femoral pulse and an iliac bruit. His popliteal, posterior tibial and dorsalis pedis pulses were absent. His ankle-brachial pressure index (ABPI) was 0.3. Digital subtraction angiography (DSA) showed a narrowing of the left external iliac artery and occlusion of the left superficial femoral artery. There were multiple collaterals reforming the popliteal artery (Figure 1).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.