Lymphatic malformation

Isolated lymphatic malformations are uncommon on the lateral side of the thigh. Completely excised.
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Aneurysm at the level of the renal arteries ( occlusion of the right renal artery and left renal artery arising from the aneurysm)-

Infra renal abdominal aortic aneurysms are common and relatively they are considered to be straight forward operations technically. But when the renal arteries are involved we need to do the addition planning to preserve the kidneys (at least one kidney) and repair the aneurysm. In the patients (see figure CT angio) there is occlusion of the right renal artery and left renal artery is arising from the aneurysm. The origin of the superior mesentric artery is abutting on the upper margin of  the aneurysm. In such a situation we need to plan to re-implant the left renal artery to the graft or auto transplant the kidney. Preservation of the right kidney is questionable when the artery is already for a very long time.

PEPFAR and AIDS future

Dear APVASCULAR.BLOGSPOT.COM,
Pinjala (pinjala@hotmail.com) has sent you an article from The Economist
online
Pinjala has also included the following message for you:
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This is important to know how the focus on the AIDS management is going to
change in the coming few years with the available funds from different
sources.
-----------------------------------------------------------------------

Well, I declare!
Jun 9th 2011
MORE money, probably. That was the bottom line of the declaration that came
out of the UN General Assembly's high-level meeting on AIDS, which closed
on June 10th. It was, however, accompanied by a promise of more money for
real by PEPFAR, the American President's Emergency Plan For AIDS Relief,
and a series of PEPFAR's allies.The UN "recognised", in the nuanced
argot of diplomacy, an estimate made by scientists at its agency, UNAIDS,
that the amount of money which needs to be spent on AIDS per year in poor and
middle-income countries should reach something between $22 billion and $24
billion by 2015. However that recognition was prefaced, in a phrase that bore
the hallmarks of arm-wrestling behind the scenes, by a commitment only to
reach a "significant level" of annual global expenditure on the
disease.Not quite a target, then, but perhaps the best that could be expected
in these stringent times.

AP BlackBerry Client: India health costs a crisis impoverishing millions

A story from AP BlackBerry Client has been shared with you.

India health costs a crisis impoverishing millions
http://m.apnews.com/ap/db_16052/contentdetail.htm?contentguid=0DbOrX25

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Superficial Femoral Artery (SFA) aneurysm - Ruptured

Isolated aneurysms of superficial artery are less common. When this happens in the rural villages these people get access to the vascular centers very late and there are some complications associated with it.  This is a case of SFA aneurysm which has ruptured and presented to us very late. We operated this patient under the Rajiv Aarogyasri scheme. A vein graft was interposed to repair the SFA (proximal saphenous vein). Post operative out come uneventful. Pulses were palpable and there were no aneurysms at the other sites. This patient received  two antiplatelet drugs in the post operative period and advised to continue them for 6 months. Some surgeons may be using only one antiplatelet drug such as Tablet Aspirin 75 mg or 150 mg once daily.

Tibial vessel injuries (3) - Repair of the posterior tibial artery!

Fig: Spiral CT and Intra -Operative photo

 

Tibial vessel injuries are generally managed conservatively as one of the three is usually is patent and supplies adequate blood to the distal leg and foot. Rarely we see all the three vessels are injured and distal foot is ischemic. In such situations we do consider repair of one of the tibial vessels to save the ischemic foot. In this case ( fig) posterior tibial artery was repaired ( resection and anastomosis) and the other occluded vessels are not repaired. Nerve injury is left for the secondary repair. At the end of the procedure the repaired posterior tibial artery is pulsting well beyond the anastomosis. 

 

 

Cattle as MRSA reservoir? Can MRSA get transmitted in Milk?

Penicillin binding protein 2a is encoded by the gene mecA. It imparts the resistance to the bacteria against antibiotics. The resistance of the staphylococci is due to the acquisition of one of the several SCCmec elements carrying the gene mecA. PCR test can detect the mecA gene. PBP2a is detected by the agglutination assay.

A novel mecA homologue, mecALGA251, associated with resistance to β-lactam antibiotics was present in clinical MRSA isolates from the UK and Denmark, and bovine milk samples from the UK. This is giving raise to an alarm that the cattle can be a reservoir for the MRSA which can get transferred to the humans. In the recent past there was lot discussion about the NDM1 betalactamase producing MRSA infections and their spread across the continents. Now we are hearing that the milk and probably milk products also associated with risk of carrying the MRSA infections. It is alarming to note the ability of staphylococcus to spread with the capabilities of antibiotic resistance across the continents and species too.

Ref: The Lancet Infectious Diseases, Early Online Publication, 3 June 2011