Hemodynamic assessment in patients with lower limb varicose veins should be performed with the patient standing, the limb examined in a non-weight-bearing position, and reflux elicited by appropriate provocative maneuvers. Duplex ultrasound is used to identify reflux and localize the anatomical reflux pathways, with attention to pelvic and nonsaphenous venous pathways. Quantitative parameters, including peak reflux velocity, reflux volume or volume flow, ambulatory venous pressure, venous filling index, and ejection fraction, help assess reflux burden, calf muscle pump function, and venous hypertension. The Cure Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA) is a hemodynamic, vein sparing strategy for the outpatient treatment of lower limb varicose veins. It achieves hemodynamic correction by interrupting reflux entry points, preserving or remodeling re-entry points, and maintaining the saphenous trunk. Short-, mid-term, and long-term outcomes of CHIVA are not inferior to, and may in some settings be better than, those of conventional stripping or endovenous thermal ablation. Postoperative pain and ecchymosis are less pronounced, and the need for adjunctive sclerotherapy is lower. In selected patients with limited disease and only mild truncal change, ambulatory selective varices ablation under local anesthesia may be considered. Follow up and outcome assessment should move beyond closure alone. Imaging and functional endpoints should be evaluated together. A standardized postoperative surveillance strategy that integrates hemodynamic parameters with varicose veins scales may help reduce recurrence and improve quality of life.

Background/Objective: Peripheral arterial disease (PAD) is a widespread but underdiagnosed manifestation of systemic atherosclerosis, associated with high morbidity and mortality. Traditional diagnostic methods such as the ankle-brachial index (ABI) have limited sensitivity in certain populations, highlighting the need for reliable blood-based biomarkers. Fatty Acid Binding Protein 3 (FABP3) has emerged as a robust biomarker with diagnostic utility in PAD. To evaluate the diagnostic performance of FABP3 when used in combination with traditional clinical risk factors for PAD in patients presenting to vascular surgery clinics. Methods: A retrospective analysis was conducted on 657 patients presenting to ambulatory vascular surgery clinics at St. Michael's Hospital. Two logistic regression models were compared: (1) Model A: Included standard clinical risk factors (calf pain, age, smoking, diabetes, hypertension, hypercholesterolemia, coronary artery disease, and signs of chronic limb-threatening ischemia); and (2) Model B: Included the same factors as Model A, plus FABP3 levels. Diagnostic metrics including area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed. Results: Among 657 patients, 423 had PAD and 234 did not. Model B (FABP3-integrated model) outperformed Model A, with a higher AUC (0.86 vs. 0.82), sensitivity (96% vs. 81%), specificity (84% vs. 67%), PPV (92% vs. 81%), NPV (94% vs. 65%), and diagnostic accuracy (93% vs. 76%). FABP3 also improved detection in asymptomatic PAD patients (84% detected vs. 0%). Conclusions: Integrating FABP3 with standard clinical risk factors significantly improves PAD diagnosis, especially in asymptomatic and borderline cases. These findings support the potential role of FABP3 in routine PAD screening, warranting further prospective studies for validation.

Rosai-Dorfman disease (RDD) is a rare, benign, non-neoplastic histiocytic proliferative disorder. Involvement of the distal femur with intra-articular extension is uncommon and can pose diagnostic challenges. Physiotherapy plays a critical role in postoperative recovery; however, structured rehabilitation guidelines for such cases remain limited in the literature. This case report describes a rare presentation of intraosseous RDD and highlights the clinical outcomes of a phased, impairment-based physiotherapy protocol following surgical excision and bone grafting. The patient presented with gradually progressive left-sided knee pain that worsened over several months. Radiographic evaluation demonstrated a mixed lytic-sclerotic lesion in the distal femur with intra-articular extension. The patient underwent intra-articular curettage with allograft bone grafting; biopsy confirmed intraosseous RDD. She was referred for physiotherapy five weeks after immobilization. Postoperatively, she presented with restricted knee flexion range of motion (ROM) to 70°, extensor lag, fear of falling, swelling in the patellar region, a healed surgical scar, quadriceps and calf muscle atrophy, altered gait, pelvic drop during stance, reduced quadriceps, hamstring, and hip abductor strength (manual muscle testing (MMT) 3-), and impaired proprioception of the knee joint. A structured, phase-wise physiotherapy program was initiated with the goals of protecting the graft, gradually restoring knee mobility, improving muscle strength, facilitating gait re-education, and enhancing proprioception. The patient demonstrated progressive improvement in knee range of motion, muscle strength, gait symmetry, and functional independence without complications. This case underscores the importance of early, goal-oriented, phase-based physiotherapy following surgical management of intraosseous RDD of the distal femur. A structured rehabilitation protocol complemented surgical treatment, facilitating the recovery of mobility and function and helping to prevent long-term disability. This report contributes clinically relevant guidance to the limited literature on postoperative physiotherapy management in rare cases of RDD.

Diabetic myonecrosis, also referred to as diabetic muscle infarction, is a rare complication of uncontrolled diabetes that is characterized by spontaneous ischemia of muscle tissues, which can lead to severe pain. This condition can occur in type 1 and type 2 diabetics, most often involving the thigh or calf muscles, with the majority of literature being case reports with a few systematic reviews due to its rarity. We present a case of a 41-year-old male with severely uncontrolled type 2 diabetes and three weeks of worsening left calf pain, elevated inflammatory markers, and myonecrosis on MRI, who was found to have probable diabetic myonecrosis and was treated with rest, pain control, and aspirin with significant clinical improvement. As diabetic myonecrosis is a rare condition and is not often considered in the differential, there is potential for misdiagnosis or underdiagnosis of this condition. Our case report will add to the body of literature regarding this rare condition, which could increase clinician awareness of the condition, provide guidance for work-up and treatment, and contribute to future research.

Computed coronary tomography angiography (CCTA) is an important diagnostic tool in patients with suspected acute coronary syndromes (ACS). We present a case of vasculitis and coronary involvement, in which CCTA provided critical insights for both diagnosis and management.

Calciphylaxis is a rare syndrome of microvascular calcification and skin infarction, occurring most commonly in patients with kidney failure. Calciphylaxis carries a poor prognosis, and current treatment involves mitigating risk factors, wound care, and medical therapies such as intravenous sodium thiosulfate for calcium chelation. We present an innovative treatment approach of topical sodium thiosulfate soaked gauze successfully used to treat calciphylaxis of a 58-year-old female with renal transplant. She presented with a tender bruise over the posterior right calf, in the context of good graft function (serum creatinine 88 μmol/L), warfarin use for metallic mitral valve, and total parathyroidectomy. Ultrasound imaging highlighted extensive subcutaneous tissue calcification. A punch biopsy of the lesion confirmed calciphylaxis and revealed acute deep ulceration within necrotic debris and calcium deposits along dermal blood vessels. She was managed with cessation of calcitriol and warfarin (switch to enoxaparin with anti-factor Xa level monitoring), replacement of vitamin K2, analgesia, and diligent wound care and debridement. She had twice-weekly intravenous sodium thiosulfate without any improvement and was suspended at 16 weeks after developing central line bacteraemia. On routine deep tissue debridement, small hard calcium deposits resembling calcinosis were noted to superficialise. The decision was made to commence thrice-weekly applications of topical sodium thiosulfate, prepared as gauze soaked in sodium thiosulfate 25% 15 mL applied for approximately 15 min. The ulcer completely healed, pain resolved, and topical treatment was suspended after a total of 20 weeks. This case demonstrates successful treatment of calciphylaxis using topical gauze soaked in sodium thiosulfate without concurrent intravenous sodium thiosulfate.

Background/Objectives: This aim of this study was to describe the demographic, clinical, and laboratory characteristics of hospitalized children with benign acute childhood myositis (BACM) and to evaluate seasonal patterns, including changes observed during the COVID-19 pandemic. Methods: We conducted a retrospective single-center review of pediatric patients hospitalized with a diagnosis of BACM between January 2016 and December 2024. Clinical, laboratory, and epidemiological data were analyzed, including seasonal distribution before and after the COVID-19 pandemic. Results: We identified 47 cases of BACM, with a male predominance (66%) and a median age of 7 years. Most cases (72%) occurred during autumn and spring. The most common prodromal symptoms were fever, cough and rhinorrhea. Bilateral calf pain was the most frequent presenting symptom. The median creatine phosphokinase (CPK) level was 4986 U/L, with higher values in boys (p = 0.040). Higher CPK levels were associated with longer hospital stays in our cohort (p = 0.030). Influenza B was the most frequently identified pathogen (63%). No BACM cases were recorded during the COVID-19 pandemic period (2020-2022), followed by an increase in 2024. All patients fully recovered, with a median hospital stay of 3.2 days. Conclusions: BACM is a self-limiting condition with a characteristic clinical and laboratory profile. The absence of cases during the COVID-19 pandemic suggests a possible association between reduced viral circulation and BACM incidence. Awareness of its typical presentation may support early diagnosis, reduce unnecessary investigations, and facilitate appropriate clinical management.