RESUMEN
Background Most of the patients in our Indian setting present with grade 4 lymphedema in which no other surgical option is available and in these debilitating cases the nodovenous shunt followed by reduction surgery provides acceptable outcomes. We would like to describe the surgical technique used for the nodovenous shunt procedure and debulking surgery done in post-filarial lymphedema and share our experience with clinical outcomes. Materials and Methods This was a descriptive study. The study period was from 2010 to 2019. Patient records were reviewed retrospectively, and the data was analyzed. All patients with post-filarial lymphedema, operated by two surgeons, were studied. The surgical technique was described. Results In the study period, 16 patients with lymphedema were treated surgically. The number of procedures done was 32. In 14 of them nodovenous shunt followed by debulking surgery was done. Two of the patients with post-filarial lymphedema had multiple nodules following secondary skin changes and in them sculpting surgery was done following the nodovenous shunt. Most of the patients presented with grade 4 lymphedema. In all the patients there was significant (>5 cm) reduction in limb circumference postoperatively. Conclusion Nodovenous shunt followed by reduction surgery for lymphedema is a reliable surgical option to reduce disease morbidity in patients with post-filarial lymphedema.
RESUMEN
We report a 30-year-old male patient with persistent fever, history of stroke, and a left atrial mass. He was diagnosed as miliary pulmonary tuberculosis radiologically and had fever despite 2 months of antitubercular treatment. The mass was excised and fever resolved. Acid fast bacilli (AFB) were demonstrable on Ziehl Neelsen stain and routine histopathology. To the best of our knowledge, the visualization of AFB from an intracardiac lesion on ZN staining has not been reported earlier and tuberculosis must be considered in the differential diagnosis of left atrial masses.