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Reduced blood flow to the lower extremities causes peripheral arterial disease (PAD), which is caused by atherosclerotic plaque in the arterial wall. If this impairment is not treated, it will result in severe vascular diseases like ulceration and gangrene. Previous research has shown that while evaluating the pathology of the peripheral artery, the assumption of the model geometry significantly impacts the uncertainty of the stenosis area. However, more work needs to be done to understand the interaction between mechanical better and flow conditions in the peripheral artery using a separate computer model of the cardiovascular system. This paper reviews the numerical approach on pre- and post-treatment of hemodynamic behavior in peripheral arterial disease (PAD). The goal of this study was to thoroughly examine the most recent developments with the application of computational studies in PAD from 2017 to 2022. While FSI investigation highlights the behavior of both the fluid and structure domains (blood and artery) during the numerical analysis of blood flow, CFD simulations primarily focus on the fluid domain (blood) behavior. Out of 92 research publications, 19 were appropriate for this assignment. This thorough study divides the publications into the categories of CFD, and FSI approaches. The results were then reviewed in accordance with the wall characteristic, analytical method, geometry, viscosity models, and validation. This paper summarizes the parameters of geometrical construction, viscosity models, analysis methods, and wall characteristics taken into consideration by the researchers to identify and simulate the blood flood flow in the stenosis area. These parameters are summarised in this study. Additionally, it could offer systematic data to help future studies produce better computational analyses.

Ewing’s sarcoma is a highly malignant tumour of osseous or non-osseous origin, typically seen in the paediatric and adolescent age group. However, extraskeletal Ewing’s sarcoma is an uncommon tumour. It could arise from the soft tissue in the paravertebral area, chest wall, head and neck, and retroperitoneum. Retroperitoneal extraosseous Ewing’s sarcoma is even rarer, with only a few reported cases in the literature. We describe the radiologic findings of this rare retroperitoneal extraskeletal Ewing sarcoma manifested in an adult patient. Our patient is a 32-year-old gentleman who presented with abdominal pain and constitutional symptoms for two months. Imaging shows a retroperitoneal tumour with local infiltration. It was confirmed via histopathological analysis as retroperitoneal Ewing’s sarcoma. We discussed the diagnostic strategy as well as the literature review of this rare disease.

Extraskeletal Ewing Sarcoma is rarely reported. A fifteen-year-old girl presented with the right-sided pleuritic chest pain, shortness of breath, and productive cough with whitish sputum associated with poor oral intake. She subsequently underwent contrast-enhanced Computerized Tomography thorax, which showed lobulated heterogenous hypodensity occupying the entrance of the right superior pulmonary vein, extending to the left atrium.

Superior mesenteric artery (SMA) syndrome is rare with the common presentation of megaduodenum from entrapment of the third part of the duodenum (D3) by the SMA. We present a case report of a thin, fit 16-year-old boy, active smoker complaining of generalized colicky abdominal pain associated with persistent postprandial vomiting. Small bowel study demonstrated partial duodenal obstruction from compression of the third part of the duodenum by the SMA. Computed tomography of the abdomen shows an aorto-mesenteric angle of 13 degrees with aorto-mesenteric distance of 0.32 cm, indicating SMA syndrome. His symptoms resolved spontaneously with watchful waiting and nutritional care plan. The success was contributed to restoring the fat cushion around the SMA, hence, widening the aorto-mesenteric angle. In conclusion, watchful waiting with a nutritional care plan is a feasible initial strategy in the approach to SMA syndrome. However, should this strategy be unsuccessful, the choice of surgical treatment is duodenojejunostomy.

Arteriovenous fistula (AVF) is an abnormal direct communication between an artery and the venous drainage without a capillary component. Although renal AVF is rare, detecting the disease is important to assist in management and, thus, help reverse the sequelae of the disease such as hypertension and heart failure. The clinical presentation and radiological features are important parameters that can help in the diagnosis and decision of treatment. We would like to share our successful approach to a 52-year-old female with idiopathic high-flow left renal AVF with concomitant renal artery aneurysm using a single Amplatzer vascular plug in the limit of our setting.

Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators’ diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.

Wilms tumor is the most common primary malignant renal tumor of childhood which usually presents between 2 and 6 years of age. Its presentation in the neonatal period is extremely rare and presenting with intestinal obstruction is perhaps unknown. We report a 2-day-old baby girl who manifested features of acute upper gastrointestinal obstruction with frequent post-feeding vomiting and abdominal distension. The initial abdominal radiograph showed abnormally displayed small bowel loops to the right hemiabdomen. Subsequent ultrasound and computed tomography scan of the abdomen detected a massive left renal mass. Left-sided nephrectomy was performed, and histopathology demonstrated left-sided Wilms tumor with favorable histology. Post-treatment yearly follow-up for 5 years recorded a disease-free, normally thriving child.

Extranodal sinonasal natural killer/T-cell lymphoma is known for its locally destructive nature at the midface region. The initial presentations are related to the localized granulomatous-like lesion usually in the nasal cavity that may lead to symptoms of nasal obstruction, discharge, hyposmia and epistaxis. Advanced disease may present with a rapid dissemination of disease to the liver, spleen, skin, lymph nodes, and bone marrow hence poorer prognosis. We report a case of a young lady with rapid progression of extranodal sinonasal NK/T cell lymphoma with torrential tumour bleeding from the oral and nasal cavities compromising the upper airway patency, which warranted an emergency tracheostomy and arterial embolization.

Aortoilliac occlusive disease is occlusive atherosclerosis disease involving the distal aorta and bifurcation of iliac arteries and it is a subtype of peripheral arterial disease. Total occlusion of the abdominal aorta is a rare occurrence with an incidence of 3% -8.5% among the aortoiliac occlusive disease patients. We present a case of a 53 years old patient with a background history of hypertension and ex intravenous drug abuser with negative retroviral screening status, with no previous complaints who was brought to the Emergency Department with sudden onset of altered sensorium and 1 episode of seizure. Computed tomography angiogram of the brain showed a ruptured anterior communicating artery aneurysm. Diagnostic conventional angiogram of the brain was planned; however, difficulty was encountered during bilateral femoral artery cannulation with the abrupt termination of bilateral common iliac arteries. Computed tomography angiogram of the abdomen showed incidental finding of total occlusion of the abdominal aorta. As a conclusion, total occlusion of abdominal aorta secondary to aortoiliac occlusive disease with an associated intracranial aneurysm is never reported in the literature to date. This case highlights the possibility of association in between these two conditions which may benefit from further research.

Pulmonary underdevelopment is a rare congenital disease which manifests as persistent hemithorax opacification at chest radiography. We present three patients with different types of pulmonary underdevelopment, their imaging features and associated anomalies. Case 1 is a premature neonate with persistent respiratory distress. Further imaging confirmed right pulmonary hypoplasia, associated with a patent foramen ovale, patent ductus arteriosus and vertebral anomalies. Case 2 is a 6-year-old child with corrected anorectal malformation, and recurrent pneumonia. Further imaging confirmed left pulmonary aplasia, associated with an aberrant right subclavian artery and vertebral anomaly. Case 3 is a full term neonate who developed excessive drooling of saliva and respiratory distress. Further imaging confirmed right pulmonary agenesis, associated with an atrial septal defect, patent ductus arteriosus and tracheo-oesophageal fistula. Pulmonary underdevelopment is classified into three types: hypoplasia, aplasia and agenesis. The majority of them have associated anomalies. This condition should be considered a differential diagnosis in paediatric patients with an opaque hemithorax on chest radiography.

Sinonasal undifferentiated carcinoma is a rare and extremely aggressive sinonasal tract malignancy. It is a rapidly enlarging tumour and a highly destructive lesion. We hereby report a 71-year-old Malay male with progressive left proptosis for one month, associated with reduced vision in the left eye, intermittent diplopia and anosmia. He was later diagnosed as having sinonasal undifferentiated carcinoma. The patient subsequently underwent a series of radiotherapy and showed improvement following treatment. This case was reported to highlight the importance identifying this entity and emphasise that sinonasal undifferentiated carcinoma should be considered in an elderly patient with proptosis associated with nasal symptoms.

Objective: To evaluate the outcome of pregnant women with abnormal placentation who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy.Material and Methods: Descriptive retrospective study of patients with abnormal adherent placenta who underwent transient hypogastric artery balloon occlusion with cesarean hysterectomy between January 2014 and December 2016. Data were recorded and analyzed.Results: Fourteen pregnant women with abnormal placentation were included in our series. Most patients underwent cesarean hysterectomy at less than 37 weeks of gestational age. The sonograms of 7 cases overestimated the severity of placenta adherence compared with the pathological diagnosis. The median estimated blood loss was 4,350 milliliters (mL). The median estimated blood loss in placenta accrete, increta and percreta were 3,000 mL, 5,337 mL and 5,150 mL, respectively. One case had a procedure-related complication: perforation of the small branch of the anterior division of the right hypogastric artery from the guidewire.Conclusion: Intraoperative transient balloon occlusion of the hypogastric arteries was an effective method and safe treatment for controlling the massive intraoperative bleeding of cesarean hysterectomy. This technique can be an alternative option in combination with surgery in cases of abnormal placental adherence.

Currently, there is no effective therapy for non-alcoholic fatty liver disease (NAFLD), and although calorie restriction is recommended in guidelines, but adherence is an issue. The current study aimed to determine the effectiveness of eight weeks intermittent fasting (IF) strategy in the control of NAFLD activity and the adherence rate of such strategy. This was a randomized controlled trial with modified alternate-day calorie restriction (MACR), a form of IF, as the active intervention and usual habitual diet as control. The outcome measures included changes in body mass index (BMI), blood lipids (cholesterol, LDL, HDL and triglyceride), fasting blood sugar (FBS), liver enzymes (ALT and AST), and ultrasound measurements of liver steatosis and 2-dimensional shear wave elastography (SWE). Per-protocol (PP) analysis was performed with comparison within (post vs. pre-intervention) and between (MACR vs. control) groups and P 0.22). Both liver steatosis and fibrosis (SWE) scores were significantly reduced in MACR vs. controls (both P

Background Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. Case presentation We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. Conclusion Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.

Current methods of joint diagnosis depend on invasive, radiative methods, large set ups and requiring skilled operators, which are still not able to assess the joint during motion. Replacing these methods are acoustic methods, which are only able to diagnose joint health based on the characteristics sound emitted by a moving joint. This paper looks into informing the medical practitioner of the locations of joint damage instead, hence the feasibility of localizing upon the damaged part of the joint, which is represented by a playback of a recording of crepitus sounds emitted from a human joint in 2 dimensional settings. Three microphones, an earphone and a data acquisition device were used to implement the testing. Using the time-difference-of-arrival (TDOA) between the 3 sensors, the Angle-of-Arrival (AOA) method was used to attain the initial localization coordinates. These coordinates were then fed into a gradient descent algorithm to reduce the positioning error of the AOA method, yielding the final position results. Results show that the developed system is able to achieve localization errors of less than 1.0 cm.

Background/aim Even though advanced magnetic resonance imaging (MRI) can effectively differentiate between medulloblastoma and ependymoma, it is not readily available throughout the world. This study aimed to investigate the role of simple quantified basic MRI sequences in the differentiation between medulloblastoma and ependymoma in children. Patients and methods The institutional review board approved this prospective study. The brain MRI protocol, including sagittal T1-weighted, axial T2-weighted, coronal fluid-attenuated inversion recovery, and axial T1-weighted with contrast enhancement (T1WCE) sequences, was assessed in 26 patients divided into two groups: Medulloblastoma (n=22) and ependymoma (n=4). The quantified region of interest (ROI) values of tumors and their ratios to parenchyma were compared between the two groups. Multivariate logistic regression analysis was utilized to find significant factors influencing the differential diagnosis between the two groups. A generalized estimating equation (GEE) was used to create the predictive model for the discrimination of medulloblastoma from ependymoma. Results Multivariate logistic regression analysis showed that the T2- and T1WCE-ROI values of tumors and the ratios of T1WCE-ROI values to parenchyma were the most significant factors influencing the diagnosis between these two groups. GEE produced the model: y=exn/(1+exn) with predictor xn=-8.773+0.012x1 - 0.032x2 - 13.228x3, where x1 was the T2-weighted signal intensity (SI) of tumor, x2 the T1WCE SI of tumor, and x3 the T1WCE SI ratio of tumor to parenchyma. The sensitivity, specificity, and area under the curve of the GEE model were 77.3%, 100%, and 92%, respectively. Conclusion The GEE predictive model can discriminate between medulloblastoma and ependymoma clinically. Further research should be performed to validate these findings.

Purpose We sought to present our preliminary experience on the effectiveness and safety of magnetic resonance imaging (MRI)-guided, high-intensity focused ultrasound (HIFU) therapy using a volumetric ablation technique in the treatment of Association of Asian Nations (ASEAN) patients with symptomatic uterine leiomyomas. Methods This study included 33 women who underwent HIFU treatment. Tissue characteristics of leiomyomas were assessed based on T2- and T1-weighted MRI. The immediate nonperfused volume (NPV) ratio and the treatment effectiveness of MRI-guided HIFU on the basis of the degrees of volume reduction and improvement in transformed symptom severity score (SSS) were assessed. Results The median immediate NPV ratio was 89.8%. Additionally, the median acoustic sonication power and HIFU treatment durations were 150 W and 125 min, respectively. At six-month follow-up, the median leiomyoma volume had decreased from 139 mL at baseline to 84 mL and the median transformed SSS had decreased from 56.2 at baseline to 18.8. No major adverse events were observed. Conclusion The preliminary results demonstrated that volumetric MRI-guided HIFU therapy for the treatment of symptomatic leiomyomas in ASEAN patients appears to be clinically acceptable with regard to treatment effectiveness and safety.

Introduction: Unilateral vocal cord palsy is more common than the bilateral cases. The left side is more affected than the right side owing the longer course of the Left recurrent laryngeal nerve. Iatrogenic causes for example thyroidectomy or cardiac surgery predominate the etiology of its incidence. Methods: A review of medical case record . Results: A 68-year-old man presented with voice change for one month duration. It was associated with occasional shortness of breath. Examination showed unilateral Left vocal cord palsy. Further investigation revealed a huge anterior mediastinal mass. A CT-guided biopsy was performed and histopathologically confirmed as adenocarcinoma. Conclusion: Any lesion in the course of recurrent laryngeal nerve can lead to vocal cord palsy and change of voice. A metastatic lesion to mediastinal nodes even though very rare can be one of them. Mediastinal lymphoma is one of its differential diagnoses. Bangladesh Journal of Medical Science Vol.17(1) 2018 p.172-174

Introduction: Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes. Case presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy. Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality. Keywords: Foreign body, Aspiration, Chicken meat, Difficult ventilation

Highlights • Patients who are diagnosed with melioidosis pose significant challenges to the medical team involved because it involves a high rate of morbidity and mortality. • Managing cases of melioidosis is multidisciplinary as it may manifest under various clinical situations. • In endemic area, melioidosis can occur in immunocompetent youths with no recognisable risk factors., In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.

Malignant melanoma is cancer of the skin which commonly metastasises to the stomach. There have been no reported cases of emphysematous gastritis secondary to metastasis of malignant melanomas, to date. However, a 61-year-old woman with metastatic malignant melanoma of the left great toe presented to us with symptoms of severe left hypochondrium pain associated with high-grade fever, gross abdominal distension and recurrent vomiting. Two months earlier, metastasis was observed to have spread to the stomach and inguinal lymph nodes. At this stage, the patient opted for traditional medication instead of definitive surgery and chemotherapy. Radiological imaging revealed an emphysematous change to the stomach which was radiologically consistent with gastric malignant melanoma. Unfortunately, the patient succumbed to this rare condition.

Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.

Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI.

Highlights • Orbital abscess in infant requires prompt treatment. • MRSA is an increasingly common organism causing orbital abscess in infants. • Surgical drainage of orbital abscess is indicated when presence of persistent infection clinically or radiologically despite systemic antimicrobial therapy. • Image-guided endoscopic drainage of orbital abscess in infant provides a safer surgical technique., Introduction The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery. Presentation of case A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage. Discussion Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique. Conclusion Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.