Swelling in the leg

Swelling in the leg

1. Anatomy

   • bones
   • muscles
   • femoral artery
   • femoral vein
   • adductor canal
   • popliteal fossa

2. Possible causes of leg pain & swelling

   • diabetic muscle infarction
   • boil
   • thigh strain/ injury
   • superficial thrombophlebitis
   • tumors (bone tumors)
     • most common bone tumors in children
       • 2) Ewing's sarcoma
         • children 10-15
         • male>female
         • site=diaphysis of long bones
         • radiologically
         • microscopically
       • 1) Osteosarcoma
         • male> female
         • site:metaphysics of long bones
         • histopathology
           • 1) pleomorphism & mitotic figures
           • 2) pink glassy homogenous osteoid formation
           • 3) fibroblastic and chondroblastic formation
           • biopsy
             • types
               • needle
               • open
         • radiologically
           • neo-osteogenesis
             • in subperiosteal layer
               • codman's triangle
             • from the central mass
               • sun burst appearance
         • types
           • primary
             • children 12-14
             • genetic mutation in p53 or retinoblastoma
           • secondary
             • adults >40
             • post irradiation
         • clinical picture
           • pain, pathological fracture
           • progressively growing mass
         • stages of osteosarcoma
         • investigations
           • WBC count
             • to rule out inflammation and infection
           • hemoglobin test
             • test for anaemia caused by cancer
           • ESR
             • to check for inflammation associated with cancer
         • Management of osteosarcoma
           • chemotherapy
             • methotrexate
               • folic acid analog
                 • inhibits dihydrofolate reductase
                   • thus inhibits DNA synthesis for replication of cells
             • doxorubicin
               • anticancer antibiotic
                 • several mechanisms of action
                   • causes DNA strand scission
                   • generate free radicals
                   • membrane disruption
             • cisplatin
               • acts like an alkylating agent
                 • cross links bases
                   • DNA strand breakage
           • surgery
             • amputation
             • limb savage surgery
               • autografts
               • allografts
               • rotatioplasty
               • prosthetic implants
         • Complications
           • movement problems
           • loss of a limb
           • metastastis
             • hematogenous spread
               • liver
               • lung
               • brain
               • bone
           • chemotherapy side effects
             • allopecia
             • sterility
             • GI complications
           • Prognosis
             • depends on
               • age and general health
               • location and size of tumor
               • response to treatment
     • benign
     • melignant

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