Major Lower Limb Amputation for Chronic Limb-Threatening Ischemia Is Associated with Poor Long-Term Survival: 4-Year Follow-Up of a Single-Center Experience.

Despite advances in medicine, 30% of patients with chronic limb-threatening ischemia (CLTI) require major lower limb amputation (MLLA). The long-term outcome of this cohort is poorly described. In all, 154 patients undergoing MLLA for CLTI during 2018-2020 were analyzed for short-term and long-term outcomes and prosthesis use.

The undergraduate virtual grand teaching ward round: Perceptions from the subcontinent.

Background Grand ward rounds are an integral component of undergraduate medical education. Covid-19 prevented the conduct of conventional grand ward rounds (CWRs) prompting a 'virtual' grand ward round (VWR). With restrictions lifted should future grand ward rounds remain virtual? Undergraduate perceptions on the two formats were sought to explore the feasibility of the VWR as a teaching ward round for medical students.

Enhancing Equity in a Widening Participation Scheme for School Students.

Objectives: The Royal College of Surgeons (RCS) Diversity Review 2021 found that premedical school students from ethnic minority backgrounds were dissuaded from pursuing a surgical career. Gloucestershire is in the bottom 20% of disadvantaged counties; there is no widening participation (WP) scheme in the county. We implemented a fully inclusive WP scheme in Gloucester, with means of accessing virtual and face-to-face work experience, to enhance the equity of work experience.

Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of gastro-oesophageal junctional adenocarcinomas: A 10-year cohort study.

Background: Gastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative study, we analyzed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced GOJ adenocarcinomas.

A Case of Common Carotid Artery Occlusion: A Unique Pattern of Occlusion and Lessons Learned.

Common carotid artery occlusion (CCAO) is a rare cause of cerebrovascular events. For patients with neurological deficits due to emboli from an occluded common carotid artery, ligation of the ipsilateral internal carotid may appear as a simple therapeutic option, provided there is adequate collateral circulation. Here, we describe a patient with an unusual pattern of CCAO, who underwent ligation of the internal carotid artery after a successful test occlusion with a hypotensive challenge.

Infected Aortic Aneurysm with Infective Spondylitis in a Patient with Pre-Aortic Confluence of the Iliac Veins: An Unusual Triple Combination.

It is uncommon for infective spondylitis to coexist with an infected aneurysm of the adjacent abdominal aorta. Also, pre-aortic confluence of the iliac veins or marsupial vena cava is a rare anatomical variant, which increases the potential for venous injury and hemorrhage during an emergency operation. Herein, we report the case of a 57-year-old male with these three pathologies, who was successfully treated with emergency open surgery.

Mycotic aortic aneurysm in a debilitated patient with compromised immunity; beware of Candida!

Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa.

An epithelioid haemangioma of the ulnar artery masquerading as an aneurysm.

Epithelioid haemangiomas are rare benign vascular tumors that usually present as subcutaneous nodules in the head and neck area. Occasionally these tumors can arise in a peripheral artery. When it does so, it is often confused with an aneurysmal dilatation of the respective vessel.

Pulsatile varicose veins: an uncommon presentation of a common condition.

Varicose veins of the lower limbs are common. However, pulsatile varicose veins are unusual. They could be an indicator of a sinister underlying pathology, such as severe cardiac dysfunction.

Iatrogenic Deep Femoral Artery Pseudoaneurysm Causing Quadriceps Paralysis: An Indication for Open Surgery in an Endovascular Era.

Contemporary management of iatrogenic pseudoaneurysms is mostly performed using non-surgical techniques. Herein, we present a rare case of deep femoral artery (DFA) pseudoaneurysm with compression neuropathy, which required open repair. A 67-year-old female patient presented with increasing pain in the right groin, sensory neuropathy of the anteromedial thigh and upper leg, and quadriceps paralysis 4 days after coronary angiography via femoral puncture.

Spontaneous Transection of the Superficial Femoral Artery with Devastating Outcomes: A Case Report.

Non-traumatic, simultaneous pseudoaneurysms of the bilateral superficial femoral arteries (SFAs) are extremely rare. Spontaneous transection of the SFA is another unique pathology. Here, we present a patient with end stage kidney disease who was diagnosed with bilateral, simultaneous SFA pseudoaneurysms.

Severe leg swelling following removal of a temporary femoral venous hemodialysis catheter.

Temporary central venous catheters are commonly used for patients who require emergency hemodialysis (HD). An arteriovenous fistula (AVF) is a rare complication of this procedure. In this case report, we present a patient who was diagnosed with an iatrogenic femoral AVF after cannulation of the right femoral vein with a temporary HD catheter.

Aortoenteric Fistula after Endovascular Aneurysm Repair.

Aortoenteric fistula is a rare complication following endovascular abdominal aortic aneurysm repair. However, there is a significant morbidity and mortality associated with this complication. Patients can present with gastrointestinal hemorrhage, fever, or nonspecific features of chronic infection.

Clinical Outcomes Following Lower Extremity Vein Bypass for Chronic Limb Threatening Ischaemia (CLTI) at the University of Colombo, Sri Lanka.

Objective: Although high quality epidemiological data are lacking, the global increase in chronic limb threatening ischaemia may be disproportionately affecting low and LMICs. All available data for outcomes from bypass for limb salvage are from high income countries, with none from LMIC settings where the challenge is greatest. This study aimed to assess the clinical outcomes following vein lower extremity bypass for chronic limb threatening ischaemia at the University of Colombo, Sri Lanka, and to compare patients and outcomes with those described in the Society for Vascular Surgery (SVS) Objective Performance Goals (OPG) and United States National Surgical Quality Improvement Program (NSQIP).

A learning health systems approach to improving the quality of care for patients in South Asia.

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (LMICs). Improving the quality of healthcare is complex, and requires an interdisciplinary team equipped with the skills to design, implement and analyse setting-relevant improvement interventions. Such capacity is limited in many LMICs.

A cross-sectional study on peripheral arterial disease in a district of Sri Lanka: prevalence and associated factors.

Background: Peripheral arterial disease (PAD), a slowly progressive atherosclerotic disease affecting vital organs of the body, is increasingly recognized as a health burden worldwide. Epidemiological information on peripheral arterial disease is scarce in Sri Lanka. The present study intended to estimate the prevalence and associated factors of PAD among adults aged 40-74 years in Gampaha district, Sri Lanka.

A case of a mycotic aneurysm of the superficial femoral artery infected by mixed bacterial species.

A 65-year-old woman, recently diagnosed with diabetes, presented with fever and a warm, pulsatile, tender mass over the medial aspect of her left thigh. She gave a history of diarrhea two weeks earlier. All lower limb pulses were present.

Open repair of infra renal abdominal aortic aneurysms: a single center experience from the developing world.

Introduction: In the absence of endovascular aneurysm repair due to financial constraints, Abdominal Aortic Aneurysm (AAA) in Sri Lanka is managed exclusively by open surgery. We report our experience with open AAA repair with emphasis on peri-operative morbidity and mortality.

Methods: Seventy nine consecutive open AAA repairs were carried out between April 2004 and March 2010.

Larvivorous potential of the guppy, Poecilia reticulata, in anopheline mosquito control in riverbed pools below the Kotmale dam, Sri Lanka.

The larvivorous potential of Poecilia reticulata was studied in the laboratory and in the field. In the laboratory, the number of anopheline larvae consumed per fish per day and the number of larvae in fecal matter per fish were determined. In the field study, 29 of 60 selected riverbed pools in Kotmale oya, below the Kotmale dam, were stocked with P reticulata, whereas the rest served as controls.

Costs and effectiveness of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river basins below the major dams of Sri Lanka.

In this study we examined the costs and effectiveness of using larvivorous fish, Poecilia reticulata, and a chemical larvicide, temephos, in anopheline mosquito control in the riverbeds below the major dams in Sri Lanka. Five riverbeds below the dams, namely Laxapana, Kotmale 1, Kotmale 2, Nilambe, Rantembe and Victoria, were selected. Riverbed pools in Laxapana and Kotmale 1 were treated with P.

Anopheline breeding in river bed pools below major dams in Sri Lanka.

Anopheline mosquito larval surveys were carried out from September 2000 to August 2002 in Mahaweli and Kelani river beds, below five major dams in the wet and intermediate zones of Sri Lanka, to study the prevalence of anopheline species in these areas. In each study site, all permanent and semi-permanent pools were surveyed fortnightly by dipping at 6 dips/m(2) surface area of water. Larvae were collected in separate containers, staged and identified at their third and fourth stages.

Larvivorous potential of fish species found in river bed pools below the major dams in Sri Lanka.

Malaria in Sri Lanka is closely associated with the river systems in the country. Construction of major dams across rivers has resulted in year-round pooling and anopheline mosquito breeding in river beds below the dams. This study was carried out to determine the larvivorous activity of fish found in river bed pools below the dams to identify the potential fish species for anopheline larval control in these areas.