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Coronary artery disease (CAD) is a common problem amongst diabetic foot syndrome (DFS) patients, associated with peripheral arterial disease. This analytic cross‐sectional study investigates the diagnostic efficacy of the Toe Brachial Index (TBI) in the detection of CAD in 62 DFS patients. The presence of CAD was assessed by longitudinal strain echocardiography, a sensitive method that provides a more accurate measure of intrinsic left ventricular contractility than left ventricular ejection fraction, especially in diabetic patients. Univariate and multivariate logistic regression identified CAD‐associated factors. Receiver operating characteristic curve evaluated TBI and toe pressure's diagnostic performance for CAD. p‐Values < 0.05 were considered significant. There was a significant association between TBI and CAD, with each 0.01 increase in TBI associated with a 15% decrease in the odds of CAD development (odds ratio = 0.85, 95% CI: 0.72–0.99, p = 0.039). TBI demonstrated an area under the curve of 0.854, a sensitivity of 80.0% and a specificity of 66.7% at a cut‐off of 0.69. Additionally, toe pressure exhibited an area under the curve of 0.845, sensitivity of 74.0% and specificity of 75.0% at a cut‐off of 68.0 mmHg. Overall accuracy for TBI and toe pressure was 77.4% and 74.2%, respectively, indicating their potential for CAD risk stratification in the DFS population. This study highlights a significant association between low TBI and the presence of CAD in DFS patients. Consequently, TBI emerges as a valuable screening tool for identifying CAD within this population. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Giant pedunculated hepatic hemangiomas, mostly seen in women, are considered a rare type of giant hepatic hemangioma, with challenging diagnosis. Unlike other types of liver hemangiomas, they can manifest different kinds of symptoms, and are prone to life‐threatening manifestations like rupture or torsion. Hemangioma is the most common benign liver primary tumor. Hepatic hemangioma >4 cm (some studies suggest >10 cm) is referred to as a giant hemangioma. Although hepatic hemangioma does not manifest symptoms in most cases, a giant hepatic hemangioma can manifest different kinds of symptoms. Giant pedunculated hepatic hemangiomas are considered a rare type of giant hepatic hemangioma, with challenging diagnosis, as the thin pedicle could be hard to be detected on imaging. A 41‐year‐old woman was admitted to our hospital, with dull discomfort of the right upper quadrant and epigastric region and early satiety for the past 7 months, with the history of taking oral contraceptive (OCP) for 10 years. Ultrasound and computed tomography revealed a 130 × 124 × 76 mm solid mass, with central cystic lesion, located in the midline of the epigastric region, attaching to the inferior surface of the third segment of the left lobe of the liver. Due to the potential risk for torsion, and rupture of the hemangioma, the management of the patient proceeded to surgical excision. Pathological examination of the specimen confirmed the diagnosis of hepatic hemangioma. Giant pedunculated hepatic hemangioma is a rare benign tumor. It demonstrates higher incidence rate in women, as some hemangiomas have estrogen receptors, and estrogen can lead to endothelial cell proliferation and organization in vascular structure. Most hemangiomas do not express any symptoms; therefore, no treatment is needed except for the patients who manifest symptoms, or in giant pedunculated hemangiomas, as they are prone to rupture or torsion. In this review most cases were female, and most of them presented with abdominal pain, in most cases the tumor located in the left lobe of the liver. Almost all the reviewed cases underwent surgery. Giant hepatic hemangioma is a differential diagnosis of palpable mass, or other symptoms of the right upper quadrant, and epigastric region specially in women taking OCP. Imaging is needed to rule out these tumors, and most often, pedunculated hemangioma is harder to be defined on imaging. It requires surgery because of the risk of acute problems, such as torsion and rupture. [ABSTRACT FROM AUTHOR]

We decided to evaluate the effect of treatment of diabetic foot ulcers in improving heart function by strain echocardiography than conventional transthoracic echocardiography. This prospective cross-sectional study included patients with diabetic foot ulcer (DFU). Conventional and two-dimensional strain echocardiography performed before and after three months diabetic foot treatment. Then, we compared the echocardiographic parameters including left ventricular ejection fraction (LV-EF), left ventricular global longitudinal strain (LV-GLS). Multivariate and univariate logistic regression analysis were performed to find which variable was mainly associated with LV-GLS changes. 62 patients with DFU were conducted. After echocardiography, all patients underwent surgical or non-surgical treatments. Three months after the treatment, LV-EF was not significantly different with its' primary values (P = 0.250), but LV-GLS became significantly different (P<0.05). In the multivariate logistic regression analysis, with the increase in the grade of ulcer, LV-GLS improved by 6.3 times. Not only the treatment of DFU helps to control adverse outcomes like infection, limb loss and morbidity but also it enhances cardiac function. Of note, strain echocardiography found to be a better indicator of myocardial dysfunction than LV-EF. These findings make a strong reason for the routine assessment of cardiac function in patients with DFU. [ABSTRACT FROM AUTHOR]

Appendiceal diverticulitis is an infrequent disease that can mimic other diseases' symptoms or cause different symptoms because of its various complications. However, one of the most frequent complications of this disease is a perforation that can lead to other serious problems such as peritonitis. This complication can threaten a patient's health condition. In this article, a male patient presented with abdominal pain and was admitted to the surgical ward with suspicion of a perforated peptic ulcer. However, more investigation showed a simultaneous occurrence of peptic ulcer and perforated appendiceal diverticulitis that cause peritonitis symptoms. [ABSTRACT FROM AUTHOR]

Blunt neck trauma is an uncommon, life-threatening injury that may result in tracheoesophageal transection. The manifestations of these traumas are rather vague and nonspecific; therefore, the injury may be missed, if a careful attention is not paid. A 23-year-old young man presented with complete transection of the trachea and concurrent esophageal injury, caused by clothesline-type blunt neck trauma, while riding a motorcycle. On early examination, the patient was hemodynamically stable; however, after a few minutes, he manifested respiratory distress and progressive subcutaneous emphysema. The airway immediately was secured by inserting an endotracheal tube in distal part of the transected trachea. Afterward, the patient underwent primary repair of transected trachea and esophagus, and tracheostomy. The post-operative period was uneventful. The blunt traumas to neck, which lead to complete transection of the trachea and the esophagus, are rare injuries. Clothesline-type injuries are the principal reasons for cricotracheal separation and further esophageal injuries. In most cases, subcutaneous emphysema is a sign of significant trauma to the aerodigestive tract. After securing the patient's airway, early surgical repair of the transected trachea and esophagus reduces the risk of further complications. This report discusses a rare, life-threatening presentation of blunt neck trauma called clothesline-type injury, that led to complete transection of the trachea and concurrent esophageal rupture. Establishing a secure airway for those patients with tracheal injuries is required. Repairing the injured trachea and esophagus primarily at the earliest possible time can improve the patient prognosis and prevent further complications. • Blunt neck trauma is an uncommon, life-threatening injury that may lead to tracheoesophageal transection • Progressive subcutaneous emphysema is a prominent sign, that indicates significant trauma to the aerodigestive tract • Establishing a secure airway in patient with blunt trauma to neck would be life-saving • Repairing the injured trachea and esophagus primarily at the earliest possible time can improve the patient prognosis and prevent further complications [ABSTRACT FROM AUTHOR]

Struma ovarii is a highly specialized form of mature ovarian teratoma in which contains greater than 50% thyroid tissue and absence of uniform diagnostic criteria combined with the rarity of the tumor contributes to the large discrepancy in the reported frequency. When the characteristic features of thyroid carcinoma are present, the lesion is termed malignant struma ovarii. An 11-year-old girl presented with palpitation and right lower pain that was diagnosed with right ovarian mass and was ultimately treated by right abdominal salpingo-oophorectomy. Postoperatively, she was diagnosed with a malignant struma ovarii. The patient was subsequently treated with thyroidectomy and is currently disease free. Malignant struma ovarii is a medical rarity and previous studies have reported cases with struma ovarii in adults and to our best knowledge this is the first describing struma ovarii in a girl before puberty. Conclusion according to results, Struma ovarii should be considered in the differential diagnosis of female presenting with hyperthyroidism and without clear etiology; and radioactive uptake and scan and thyroglobulin levels can be useful diagnostic tools. [ABSTRACT FROM AUTHOR]