Effect of Trendelenburg's Operation With Subfascial Ligation of Perforators in Clinical Improvement and Quality of Life Among Patients With Varicose Veins.

Background Assessing patients' quality of life has received increasing attention, mainly because questions have been raised regarding the direct benefits of the treatment provided. Hence, clinical outcomes and quality of life must be measured after chronic venous disease treatment. The primary objective of the study was to assess the improvement in clinical outcome and improvement in quality of life using the revised venous clinical severity score and chronic venous insufficiency questionnaire-14, respectively, in patients with varicose veins undergoing Trendelenburg's surgery and subfascial ligation of perforators. The secondary objective was to identify the relationship between the revised venous clinical severity score and the chronic venous insufficiency questionnaire-14 score. Method The present study is a single-center, prospective cohort study to assess the clinical improvement and quality of life in patients with varicose veins undergoing Trendelenburg surgery and subfascial ligation of perforators. All the study participants were evaluated preoperatively with the clinical, etiological, anatomical, and pathophysiological stage of the disease, revised venous clinical severity score for the clinical severity, and the chronic venous insufficiency questionnaire-14 questionnaire for the quality of life. The study participants were reviewed 90 days after surgery and reassessed for clinical severity and quality of life, both scores. Results Of the 87 screened varicose vein patients, 52 were included in the study. However, one patient was lost to follow-up. There were 38 (74.5%) males and 13 (25.5%) females. There was a significant difference in the preoperative and postoperative mean revised venous clinical severity score of the C3, C4, and C6 stages of the disease (p-value = <0.01). There was a significant difference in the mean preoperative and postoperative chronic venous insufficiency questionnaire-14 score in C3, C4, and C6 (p-value = <0.01). There was a significant difference in the median preoperative and postoperative revised venous clinical severity score (p-value = <0.01). There was a considerable difference in the mean preoperative and postoperative chronic venous insufficiency questionnaire-14 score (p-value = <0.01). The correlation coefficient between the preoperative chronic venous insufficiency questionnaire-14 score and the revised venous clinical severity score was 0.26 (p-value = 0.58), and the correlation coefficient between the postoperative chronic venous insufficiency questionnaire-14 score and the revised venous clinical severity score was 0.42 (p-value = <0.01).  Conclusion Patients undergoing Trendelenburg's surgery and subfascial ligation of perforators for varicose veins significantly improved the clinical severity and quality of life. There was significant improvement among the overall revised venous clinical severity score and chronic venous insufficiency questionnaire-14 score after surgery among the different clinical classes. There was no preoperative correlation between the revised venous clinical severity score and the chronic venous insufficiency questionnaire-14 score. However, there was a significant correlation between the postoperative revised venous clinical severity score and chronic venous insufficiency questionnaire-14 score.

A Rare Case of Kissing Gastric Ulcers Secondary to Non-steroidal Anti-inflammatory Drug (NSAID) Intake.

Peptic ulcer disease is a heterogeneous disease caused by the imbalance between mucosal protective and aggressive factors. Such ulcers are common in the anterior wall of the duodenum and gastric antrum. Kissing ulcers, although commonly reported in the duodenum, are rarely seen in the stomach. We present a rare case of an 85-year-old lady who had an index presentation of sudden onset hematemesis following ibuprofen intake. Endoscopy revealed kissing gastric ulcers, which are extremely rare secondary to non-steroidal anti-inflammatory drugs. She had complete healing after treatment with proton pump inhibitors.

A Rare Occurrence of Cutaneous Recurrence in a Patient of Post Modified Radical Mastectomy.

Carcinoma breast is the second most common malignancy in females. Due to the recent awareness and medical advances, most of the cases are diagnosed and treated at an early stage. Cutaneous recurrence without other distant metastasis post-surgery in carcinoma breast is usually uncommon. We report a 52-year-old lady who presented to us with cutaneous recurrence of carcinoma right breast, post neoadjuvant chemotherapy and modified radical mastectomy. The diagnosis was confirmed on histopathology after the biopsy from the cutaneous nodule. The patient was discussed in the tumor board and planned for palliative chemotherapy considering extensive cutaneous metastasis.

Strangulated Epigastric Hernia: A Rare Occurrence.

An epigastric hernia is a rare type of abdominal hernia, described in the literature mostly as small, containing only preperitoneal fat. A large true epigastric hernia with herniation of the abdominal viscera is even rarer. Only a few case reports have given an account of strangulation in such an epigastric hernia. This case report describes a middle-aged, morbidly obese man with a big epigastric hernia presenting with incarceration and acute abdominal pain. Emergency surgical exploration revealed a 7 cm midline defect in the rectus sheath and a 30 cm segment of the jejunum and a 6 cm segment of the transverse colon were gangrenous. The gangrenous bowel segments were resected, and an end-to-end jejuno-jejunal and colo-colic anastomosis were done. The patient had an uneventful postoperative recovery.

Gastric Carcinoma: An Unexpected Complication of Loop Gastro-Jejunostomy Done in Childhood.

Gastric adenocarcinoma is the fifth most common cancer worldwide and the third leading cause of death. The major risk factors include Helicobacter pylori infection, genetic factors, environmental factors, and atrophic gastritis. Gastric remnant cancer is gastric carcinoma that develops in the remnant stomach more than five years after distal gastrectomy for benign disease, incidence ranging from 1% to 8%. However, gastric carcinoma after loop gastro-jejunostomy without gastric resection for benign etiology is rare. We report a case of a 45-year-old lady with gastro-jejunostomy without gastric resection done in childhood, presenting with adenocarcinoma at the anastomotic site after 35 years.

A Rare Case of Spontaneous Splenic Rupture as the Index Presentation of Chronic Myeloid Leukemia.

Splenic injury is usually caused by blunt trauma to the abdomen. Very rarely, spontaneous rupture can occur in patients with splenomegaly due to various underlying pathological conditions such as hematological, neoplastic, inflammatory, and infectious diseases. Here, we report the case of a 48-year-old gentleman who presented to the emergency department with sudden-onset pain in the abdomen and hypotension. Blood investigation revealed anemia and leukocytosis with blast cells on peripheral smear, suggestive of chronic myeloid leukemia (CML) in the chronic phase. Contrast-enhanced computed tomography revealed splenomegaly with grade three splenic laceration and a subcapsular hematoma with hemoperitoneum. Because of persistent hemodynamic instability, despite resuscitation, he underwent emergency splenectomy. The postoperative period was uneventful. Bone marrow biopsy revealed CML in the chronic phase with World Health Organization grade I reticulin fibrosis. Subsequently, he was started on hydroxyurea and discharged for further follow-up with medical oncology.

Lymphoedema praecox in a young woman: a rare disease.

Primary lymphoedema is a rare disorder. Often presents at a young age with asymptomatic limb oedema with gradual progression. We present a 16-year-old woman who presented with a history of swelling of the left lower limb for 6 years. There was the presence of isolated left lower limb oedema, which was a non-pitting type. The patient underwent imaging studies and was diagnosed to have primary lymphoedema. The patient was managed conservatively as the patient did not have any other problems other than the left lower limb oedema.

A Rare Case of Large Bowel Obstruction Secondary to Bone Grafting.

Anterior abdominal wall incisional hernias can occasionally present as acute intestinal obstruction. Incisional hernias occurring at uncommon sites or after uncommon surgeries may contribute to diagnostic dilemmas. Herein, we report the case of a 53-year-old lady who presented with obstructed incisional hernia following autologous iliac bone grafting. We report this as a rare case of obstructed incisional hernia following an orthopedic procedure.