Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study.

The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.

The Anatomage Table: A Promising Alternative in Anatomy Education.

Anatomy is one of medical and nursing education's most prominent and crucial keynotes. For ages, conventional lectures and the analysis of actual human corpses were employed as predominant teaching techniques. However, the sphere of healthcare pedagogy has been greatly altered by the developing passion for technology over the past few years. Anatomage offers a life-size digital representation of the human body, allowing the visualization, manipulation, and virtual dissection of complex anatomical structures, using detailed 3D (three-dimensional) models. Academic institutions utilize Anatomage as a means to enhance and contemporize the acquisition of anatomy knowledge. This systematic review aims to present the educational role of Anatomage in anatomy and whether it can replace the use of cadaveric material in medical education entirely in the future.  A detailed search on PubMed, SCOPUS, Wiley Online Library, and Google Scholar databases was performed. The criteria for the selection were the English language and the year of publication between 2018 and 2023. We rejected publications that were irrelevant to the topic. Before applying the filters, we found 198 publications, from which 24 were finally chosen for the purpose of this review.  The results of this systematic review indicate that most students agree on the beneficial role of Anatomage in the thorough comprehension of anatomical knowledge, and they prefer it over traditional learning methods, such as the use of cadaveric material. Anatomage not only offers a deeper insight into the relations between inner formations, since it is a particularly easy-to-use and pleasant teaching tool, but also contributes to the improvement of learning outcomes in the classroom, which is proved by higher grades in the anatomy course. However, it can be an effective teaching method if it is used in addition to the classic method of cadaver training, rather than being the only educational practice.  Integrating the Anatomage Table (AT) into undergraduate courses is paramount to the comprehensive learning and application of human anatomy in students' future health careers. Learners who have utilized the table note it to be a beneficial and effective tool in preparing them to enter into the healthcare profession.

Larsen Syndrome and Associated Spinal Deformities.

Larsen syndrome is a rare genetic disorder that affects the connective tissue within the body. The present narrative review aims to examine the genetic basis of Larsen syndrome, clarify its symptoms, and define all the existing therapeutic approaches. A comprehensive search was performed in the PubMed database. Inclusion criteria considered molecular and clinical studies, management and surgical treatment of related deformities, case reports of patients with the syndrome, reviews of the associated anomalies, articles whose full text is available in PubMed, and articles published in the English language. Larsen syndrome is caused by mutations in the FLNB gene, which encodes the cytoskeletal protein filamin B, crucial in the development of the skeleton. Symptoms include joint dislocations, characteristic facial features and anomalies of the spine. Larsen syndrome may be conservatively treated initially, although surgical intervention is usually required. Various surgical techniques, including posterior spinal fusion, anterior decompression, circumferential arthrodesis, and single-stage 360° fixation, have been proposed along with growth-sparing procedures. Preoperative and postoperative care and education ensure optimal results. Further research is needed to identify novel therapeutic modalities for this condition.

Correlation between Bovine Arch and Thoracic Aortic Disease: A Literature Review.

The bovine artery is considered the most frequent aortic arch branching variation. Despite being considered a normal variation of the aortic arch branching, still it has been linked with various issues regarding the thoracic aorta. The aim of this study is to highlight the prevalence of bovine artery among specific vascular pathologies throughout the literature and to provide information to clinicians about the importance of identifying this variation. For this specific review, we acquired potentially relevant studies for inclusion from the electronic database of PubMed. We limited our investigation to papers published within the last decade (from 2011 to 2021). Single case reports, papers with language restrictions, letters to the editor, conference abstracts, studies that were non-human centered and studies with unextractable and incomplete data were not included. Searching the PubMed database, it was evident that there is a close relationship between bovine arch and thoracic aortic arch pathology. In the defined period 2011-2021 that our research was focused, we selected eight studies tackling this issue. The majority of the studies in this review (except one) provided concerning data about the prevalence of this aortic arch variant among patients with aortic aneurysmal dilatation and aortic dissection. Following our results, we strongly believe that bovine arch should no longer being considered as a normal variation with no clinical significance, but rather as a potential risk factor for thoracic aortic arch morbidities.

The Impact of COVID-19 Pandemic in Orthopaedic Surgery Hospital Admissions and Workload in a Major Trauma Center.

The coronavirus disease 2019 (COVID-19) pandemic has led to important restrictions in social life of civilians worldwide and there were lower admission rates mainly in surgical departments in many hospitals. This study presents how COVID-19 pandemic affected admissions at the orthopaedic and trauma surgery department of a major trauma center. A retrospective study was conducted that recorded all patients examined at the outpatient orthopaedic clinic and the emergency orthopaedic department, as well as patients admitted to the orthopaedic surgery clinic and patients that underwent operative procedures between March 23 and May 4, 2020 (first lockdown period) and between March 23 and May 4, 2019 (control period). In addition, all patients with hip fractures that required hospitalization and underwent hip surgery were identified during the same time periods. During lockdown period 1 compared with the lock-down period 2 were observed: 70% and 61% decrease in the number of patients examined at the outpatient clinic and the emergency orthopaedic department respectively. The number of patients admitted to the orthopaedic surgery clinic declined by 41%, whereas operative procedures decreased by 22%. Regarding hip fractures timing to surgery during the first period was significantly less compared with second lockdown period, however, hospitalization days remained almost unchanged over the two time lockdown periods. Restrictions during the first lockdown period due to COVID-19 pandemic caused an important decrease in the number of patients and theaters in all orthopaedic departments in one of the major trauma centers in Athens. However, the incidence of hip fractures in elderly was not significantly decreased. Further similar studies are needed to identify variations and patterns of these parameters in other trauma centers.

Anatomy and Pathogenesis of Vascular Thoracic Outlet Syndrome.

The current literature review article describes the anatomy and pathogenesis of the vascular nature of thoracic outlet syndrome (TOS), as well as gathers the latest and most important information concerning its diagnostic methods and treatment. This syndrome's subcategory includes the venous and the arterial. Data for this review was accumulated through the PubMed database in which only scientific studies published in the last decade (2012-2022) were searched. PubMed offered 347 results, of which 23 were judged suitable and used. Non-invasive methods both for the diagnosis and the treatment of vascular TOS are gaining ground. Medicine, at this point, finds itself on the verge of slowly putting aside the previous invasive gold-standard methods, to be used only in the most urgent situations. The vascular thoracic outlet condition is a rare form of TOS but is also the most trouble-causing one and the deadliest. Fortunately, it can be more efficiently managed because of the current medical innovations. However, further research is needed to establish their already confirmed effectiveness, so they can be even more widely trusted and used.

Oncology Clinical Trials in Greece: Progress in the Past Decade.

Cancer is established as a major contributor to global burden as millions of deaths are reported every year. Advances in molecular, epidemiologic and clinical research have led to significant improvements in prevention, screening and treatment of tumors. The purpose of the study is to describe the progress of oncology clinical trials performed in Greece during the past decade and the obstacles that still need to be addressed in cancer research. A search was conducted in the public database EU Clinical Trials Register using the algorithm 'cancer AND Greece'. Results included relevant trials approved between 2010 and 2020. A total of 480 trials were approved for conduct in Greece from 2010 to 2020. The majority are multinational, phase III trials, exploring the efficacy and safety of agents in the management of lung cancer and multiple myeloma. A variety of small-molecules and monoclonal antibodies has and is being tested against key binding targets. Based on their promising effects on patients' responses and outcomes, many have been marketed for the treatment of several cancer types and are considered milestones in cancer discovery. It goes without saying that oncology research has made tremendous steps towards the development of potent and tolerable anticancer agents, with Greece having an active role. Current efforts focus on the use of alternative designs and tools aiming at further improving patients' survival and quality of life, while globalization of clinical research is also a matter of high importance.

The Distal Oblique Bundle in the Distal Forearm: From Anatomical Features to Clinical Implementation.

Background and objective The distal oblique bundle (DOB) is nowadays recognized as the thickest component of the distal interosseous membrane (DIOM). It is neither thought to be a clear-cut ligament, and nor does it follow the typical configuration of the rest of the DIOM. It is not always present and some studies have raised disputes about its prevalence and a few anatomical features. In this study, we aimed to provide data on the prevalence and anatomical features of the DOB, which are of great importance at this early stage of research into the topic. Our findings have been correlated with current knowledge and are expected to contribute to clinical implementation. Materials and methods Twenty-eight fresh-frozen forearms were utilized for measurements. Specifically, mean length, width, distance from the middle of the bundle's insertion to the ulna to the tip of the styloid process of the ulna, as well as the distance from the midpoint of its insertion to the radius to the tip of the radiuses' styloid process were calculated. The prevalence was described with a cutoff thickness point of 0.5 mm. Early results based on three cases of DOB reconstruction with the "Riggenbach" technique due to distal radioulnar joint (DRUJ) instability were documented. Results Eleven DOBs were reported out of the 28 specimens, suggesting a prevalence of 39.3%. The mean thickness was 0.88 mm (range: 0.6-1.3 mm), the mean width was 5.22 mm (range: 2.2-8.4 mm), and the mean length was 25.68 mm (range: 22.7-29.2 mm). Proximally, the mean distance from the bundle's ulnar insertion to the tip of the styloid process of the ulna was 51.02 mm (range: 45.5-55.6 mm) while distally, the mean distance from the bundle's insertion to the radius to the tip of the styloid process of the radius was 34.5 mm (range: 31.3-37.7 mm). After a follow-up of at least six months, improvement was evident in all measured areas in the three patients who underwent surgery. Additionally, they reported satisfaction and accomplishment of their preoperative goals. Conclusions Discrepancies in measurements in some anatomic features between studies are probably due to variations in specimen types, measurement methods, and sites. Efforts must continue to be made on a more extensive scale and in a more standardized manner for more factual results and conclusions. "Reconstruction-recreation" or "original construction-creation" procedures yield promising results in a fast, simple, and less invasive manner than traditional methods of DRUJ stabilization.

Wunderlich Syndrome: Spontaneous Cystic Rupture on Account of Acquired Kidney Atrophy.

Wunderlich syndrome is an uncommon condition of spontaneous subcapsular and perirenal hemorrhage of atraumatic etiology in the kidney, with the potential to spread to the retroperitoneal region beyond the perirenal fascias. Its clinical manifestations usually include Lenk's triad, namely, acute flank pain, flank mass, and hemodynamic instability, which vary depending on the causative underlying renal pathology. Tumor bleeding of benign and malignant renal neoplasms is the most common cause of this syndrome, followed by vascular disorders and renal cystic diseases. Here, we report the case of a unilateral subcapsular renal hematoma on account of a left atrophic kidney with parapelvic cystic formations and variant hypoplastic vasculature which was successfully managed via radical nephrectomy after initial conservative treatment. Spontaneous cystic rupture contributed to the emergence of the syndrome, and its mechanisms are being addressed.

The Story Retold: The Kocher Manoeuvre.

The Kocher manoeuvre is used for mobilization of the duodenum and head of the pancreas and bears the name of Theodor Kocher, who published it in 1903. We describe the embryology of the duodenum and pancreas, relating it to surgical anatomy applied during the procedure. Finally, we present the key points of the procedure, providing more insights into the anatomical structures that are mainly involved.

Duplication of the Artery to the Cystic Duct: A Case Report of a Rare Anatomical Variation with Surgical Significance.

Anatomical variations of the cystic artery are frequently documented, but variations of the artery to the cystic duct are extremely uncommon. We report a rare duplication of the artery to the cystic duct, revealed during laparoscopic cholecystectomy on an 18-year-old Caucasian female treated for gallstone disease. Both arterial branches were meticulously and carefully retracted and cauterized to avoid bleeding and subsequent postoperative complications. To our knowledge, this is the first reported case of an artery to the cystic duct duplication. The presence of congenital variations of the artery to the cystic duct encumbers surgical maneuvers and increases the potentiality of intraoperative injury and hemorrhage.

Is CT-A Always Reliable in Detecting Active Bleeding in Closed Pelvic Fractures? Management of a Case with Multiple Closed Pelvic Fratures and Internal Iliac Artery Bleeding.

One of the most important complications of pelvic injuries is hemorrhage which can be attributed to the venus plexus of the pelvis, the damaged bone on the fracture site, or in 15% of cases to arterial cause. In the last case mortality could reach 70%. Clinical case presentation, a 77-year-old man, presented in the emergency department of our hospital hemodynamically unstable due to fall from height (3 meters) with comminuted bilateral fractures of the pubic rami, right sacral and iliac wing fracture, right acetabular fracture, fractures of transverse processes of the first, second, and fifth lumbar spine vertebrae and a periprothetic fracture of the right femur. Advanced trauma life support (ATLS) protocol was followed throughout. Computed tomography (CT) scans and CT angiography performed, showed the above mentioned pelvic fractures that did not require stabilization, without further injuries, and a well described retroperitoneal hematoma without any evidence of active bleeding. During the resuscitation process the patient developed cardiac arrest and cardiopulmonary resuscitation (CPR) protocol was followed. The patient was intubated and retained his cardiac rhythm. However, he remained unstable and an angiography was then performed that revealed internal iliac artery bleeding and embolism of the internal iliac artery was performed. The patient was stabilized and was transferred to the intensive care unit for further management. Arterial hemorrhage due to pelvic injury is less common, however presents with high rates of mortality. CT angiography may in some cases not reveal existing active bleeding, misleading the clinician. Therefore, in patients with high clinical suspicion of arterial pelvic hemorrhage who remain unstable during the initial resuscitation and do not present with other primary source of bleeding, an angiography and embolism should be performed as soon as possible.

Surgical Removal of Bone Bridge and Interposition of the Extensor Digitorum Brevis in the Treatment of Calcaneonavicular Coalition in Pediatric Patients: A Case Series, Short Review, and Commentary.

This study retrospectively presents a single-clinic case series of pediatric patients with calcaneonavicular coalition treated by surgical removal of the bone bridge and interposition of the extensor digitorum brevis. This technique is currently the most cited and utilized protocol in operative treatment. Clinical, functional, and radiological results are analyzed and compared with related research. This is a single-clinic retrospective study, conducted for a period of 15 years. One independent investigator reviewed medical records and conducted a de-identified preoperative, inpatient, and postoperative assessment focused on demographic data, history and clinical evaluation, imaging assessment, American Orthopedic Foot and Ankle Society (AOFAS) scoring, and complication analysis. Of 34 patients, 13 met the inclusion criteria. Mean patient age was 11.2 years; 10 were males and 3 were females. Pathology concerned the right lower limb in eight cases and the left in five. Mean time between diagnosis and surgical intervention was 4.3 months and mean postoperative follow-up was 27.2 months. Thorough overview of reported symptoms, identified signs, imaging evaluation, functional outcomes, and adverse effects was performed. Bone bridge removal and interposition of the extensor digitorum brevis is an effective method of treating the condition. Despite drawbacks, results are comparable or even, to some degree, superior to other techniques.

Variations of Ulnar Nerve in the Forearm and Hand: A Review of the Literature and Clinical Significance.

The ulnar nerve originates from the anterior division of the lower trunk of the brachial plexus which continues as the medial cord and gives off branches to the forearm and the hand with motor and sensory fibers. The objective of the current study is to assemble the recognized anatomical variations of the ulnar nerve (UN) and underline their clinical impact. A literature search was undertaken via PubMed database, using the term: "ulnar nerve AND variations." Classical anatomical textbooks were also used for the normal anatomy of the UN. A total of 23 articles met the inclusion criteria, 16 of which are included in this review. Fifty-four additional articles provided useful information according to the aim of this review. Of great interest is the communication between the UN and the radial nerve (RN) in the forearm, as well as the communication between the UN and the median nerve (MN) in both forearm and hand. Furthermore, variations of the UN were observed in the hand and the classification of the UN compression was also described according to the point of the neuropathy. These collecting data are categorized into five tables. Additional aberrations were also included in this review. According to literature, the UN is characterized by numerous variations of its course and branches. Therefore, good knowledge of the normal anatomy is essential. Moreover, the anomalies are of particular importance due to their significant clinical implications and should be taken into consideration by the surgeons during surgical procedures in this region.

Cervical Diffuse Idiopathic Skeletal Hyperostosis: Rare Cause of Emergency Tracheostomy.

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare and potentially life-threatening syndrome. We present the case of a patient complaining about severe dyspnoea and diagnosed with vocal cord paresis. An emergency tracheotomy was performed to restore his breathing. Diagnostic imaging revealed large mass-occupying cervical osteophytes compressing the larynx. The osteophytes were removed via an anterior cervical approach, and vital signs were normalized. However, postoperatively, a fistula was discovered between the upper part of the oesophagus and the trachea. As a result, a gastrostomy tube had to be placed indefinitely. Literature review confirms the rare frequency of emergency tracheostomy due to DISH syndrome. The aim of the present study is to expand on our knowledge of a rare pathological entity that can frequently be misdiagnosed.

Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece.

Introduction The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. Materials The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns born between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. Results In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing centre for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. Conclusion In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centred approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. To run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL.

Fusobacterium Nucleatum Causing Necrotizing Fasciitis of the Neck, Thorax, and Upper Limb: A Lemierre's-Like Case Presentation.

Necrotizing fasciitis (NF) is a rare "flesh-eating" entity with a high mortality rate due to late diagnosis. More specifically, this disease is deemed to be a subset of the aggressive skin and soft tissue infections (SSTIs) resulting in necrosis of the muscle fascia and subcutaneous tissues. It is usually caused by Gram-positive cocci specifically strains of Staphylococcus aureus and Streptococci or the combination of Gram-negative and anaerobic bacteria. If septic thrombophlebitis complicates a parapharyngeal abscess the clinical condition is referred to as Lemierre's syndrome (LS), which is also a rare entity and can result in necrotizing fasciitis of the neck and is usually caused by Fusobacterium necrophorum or Fusobacterium nucleatum. In our study, a rare case of a 61-year-old male patient who presented with progressed necrotizing fasciitis of his neck, chest, as well as his upper arm and a history of a bacterial throat infection in our emergency department is discussed. Despite treatment involving iv antibiotics and urgent radical surgical debridement, the patient unfortunately succumbed to his disease due to sepsis and secondary multiorgan failure.

The Facts and Myths for the Use of Lasers in Orthopedic Surgery.

For the past three decades, laser use has been investigated, mainly on implant applications, as well as hard and soft tissue processing on orthopedics. However, despite significant technological advances and achievements in Biophotonics, lasers have yet to emerge as a successful tool for hard-tissue manipulation (e.g., osseous tissue). Indeed, a careful search in relevant literature reveals a limited number of laser-based clinical applications in orthopedics, except for the low-level laser therapy applications. In this review article, we give a brief overview of the biophysical mechanisms of bone tissue and biocompatible implants laser surgery and, in parallel, we summarize some specific pre-clinical and clinical laser applications in orthopedics. Taking into consideration the complexity of laser-based applications in inhomogeneous musculoskeletal biostructures and/or implants, it is justified to state that applying laser radiation is still an open field of multidisciplinary research before performing interventions in clinical praxis. The evidence from this study indicates the need for more experimental and theoretical studies regarding light transport on soft and hard tissues, in order to further enhance safe and efficient laser applications in orthopedics. This undoubtedly implies the need for developing modern light delivery devices for laser surgery, by means of implementing robotic guidance, specialized for medical procedures on various anatomic structures. The aforementioned studies could eventually revolutionize the clinical applications of laser technology in orthopedics.

Distraction Osteogenesis Technique for the Management of a Gustillo Type I Tibial Shaft Fracture Initially Managed with an Intramedullary Nail Device.

Fractures of the tibia shaft are the most common long bone fractures, especially in young male adults. Due to specific anatomical features, these fractures are more common than any other long-bone fracture. This is one of the main reasons they are associated with twice the incidences of deep infection compared with any other bone and can be combined with the presence of segmental bone defect. Many reconstruction techniques have been used to manage such cases, including Ilizarov technique, Masquelet technique, vascularized fibula transfer, and the monolateral external fixator. We present a case of a 21-year-old male patient who was admitted to our hospital for a Gustillo type I tibial shaft fracture which was initially treated by an intramedullary nail device. Two months postsurgery the patient presented with clinical signs of infection in the area of the fracture site, confirmed by an osteolytic lesion revealed radiographically. A surgical operation was performed that included a tibial osteotomy proximal to the defected bone, bone excision, and application of a LRS external fixation device. Antibiotic therapy was administrated based grown cultures, and regular follow-up X-ray revaluation was performed. After six months, the bone was radiologically united, the frame was removed, and the leg was protected in a walking boot while the patient used only partial weight bearing. The treatment of segmental bone defects associated with infection and soft tissue loss presents a great challenge, and the choice of the appropriate method requires further study.

Primary Extranodal Skeletal-Muscle Non-Hodgkin B Cell Lymphoma: Clinical Presentation and Diagnostic Approach.

Primary extranodal non-Hodgkin lymphomas that involve skeletal muscles (PSML) are infrequent with non- specific features or symptoms. Therefore, their diagnosis can be immensely convoluted since they mimic other soft tissue tumors and diseases (34). In this study, the case of a 61-year-old male patient, who presented with a history of a 6-week left thigh oedema and concomitant pain in our Emergency Department, is discussed. The patient was initially reviewed in another institution; the results of imaging studies (ultrasound scan) were consistent with deep vein thrombosis (DVT).Despite treatment, the patient's pain and swelling was exacerbating, which forced him to visit our hospital. Magnetic resonance imaging (MRI) revealed a diffused mass in his right thigh, while fine needle aspiration cytology (FNAC) yielded a diagnosis of B-cell lymphoid hyperplasia. The patient was then referred to a tertiary cancer treatment center for further management.