RESUMEN
Diabetic foot infections (DFI) expanding to bones and joints are associated with a poor prognosis of limb salvage. The bactericidal epoxide fosfomycin accumulates in inflamed soft and bone tissue, and may represent a potential treatment option for targeting severe DFI. Fifty-two patients (35 men, 17 women, mean age 62.9 +/- SD 9.2 years) with limb-threatening DFI (that is, Wagner grade 3 and higher) were enrolled in a multi-center compassionate use program of fosfomycin. Twenty-two patients (42.4%) had unsuccessfully been pretreated with other antimicrobials. Besides standard treatment (topical wound care and surgical debridement), eligible subjects received a combination of 8 to 24 g fosfomycin daily, and a conventional antibiotic agent, usually a beta-lactam compound. Treatment duration averaged 14.4 +/- 8.3 days. Limb-sparing surgery was possible in 48 patients (92.3%, 95% confidence interval 81.5-97.9%). Only four participants faced mild drug-related side effects (nausea, rash). Logistic regression analysis showed a trend towards better results with prolonged treatment, whereas a dose increase above 12 g daily did not affect outcomes. In DFI being resistant to conventional antibiotic agents, intravenous fosfomycin offers an effective treatment choice that may increase the likelihood of limb preservation. The present data warrant a larger comparative trial to stabilize effect estimates.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Pie Diabético/tratamiento farmacológico , Pie Diabético/microbiología , Fosfomicina/uso terapéutico , Anciano , Infecciones Bacterianas/etiología , Desbridamiento , Femenino , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
We reviewed the clinical and pathological features of eight patients (seven females, one male), who underwent surgery for sarcomas of the breast, to evaluate the effect of the margins of resection and histological tumor type on survival. Patients with carcinosarcoma, cystosarcoma phyllodes or dermatofibrosarcoma protuberans were excluded. Tumor size ranged between 4.5 and 26 cm (median 12.8 cm); there were three grade 3, four grade 2 and one grade 1 lesions. Of the five patients treated by radical resection margins, two with large grade 3 sarcomas died of distant metastasis 3 and 10 months later. One patient out of the five radical resected patients developed a local recurrence 96 months later. The recurrence was resected radically, radiotherapy was administered, and the patient is still alive at 168 months. The remaining four radical resected patients are free of disease until now. One of three patients, treated by wide or marginal resection, received adjuvant radiotherapy. This patient developed local recurrence and solitary distant metastasis at 26 and 49 months, respectively, and died of multiple distant metastasis at 54 months. Regional axillary lymph node metastasis was not observed in five patients in whom lymph node dissection was performed, with a median of 14.2 dissected lymph nodes. Two of eight patients received preoperative chemo- or radiotherapy because of large tumor size; five of eight received postoperative radiotherapy. Local tumor control was achieved in six of eight patients. The median follow-up time was 53.9 months (3-168 months), of all survivors median 72.2 months. Recurrence and disease-free survival rates were analysed according to histologic grade, tumor size, stage, surgical and adjuvant treatment.
Asunto(s)
Neoplasias de la Mama/cirugía , Sarcoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/secundario , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/secundario , Metástasis Linfática , Masculino , Mastectomía Radical Modificada , Mastectomía Radical , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Sarcoma/mortalidad , Sarcoma/patología , Sarcoma/secundario , Tasa de SupervivenciaRESUMEN
AIM: Spinal cord stimulation (SCS) is available as an alternative therapy for patients suffering from inoperable critical limb ischemia (CLI). Selection of patients is essential to achieve the best treatment effect. For this purpose transcutaneous oxygen (TcpO(2)) measurements have frequently been applied. So far, it is unclear which TcpO(2) parameters serve this purpose best. METHODS: Studies in which inoperable CLI patients were treated with conservative treatment with or without SCS, and in whom various TcpO(2) measurements were performed before and during treatment were pooled to investigate which TcpO(2) parameter(s) were best to detect patients who benefit most from SCS treatment as to limb salvage. RESULTS: TcpO(2) in the supine position increased significantly (p<0.001) in patients after a short period of SCS treatment (from 9 to 22 mmHg), but not in those treated conservatively (from 7 to 7 mmHg). Baseline supine TcpO(2) (using a cut-off value of 10 mmHg), the baseline sitting-supine TcpO(2) difference (cut-off value: 17 mmHg), and the difference in TcpO(2) before and after test stimulation (cut-off value: 4 mmHg) were related to a significantly increased limb salvage. SCS patients with a sitting-supine TcpO(2) difference of >17 mmHg had a 1-year limb salvage of 83% vs 68% in the whole SCS-treated group irrespective of TcpO(2) selection. CONCLUSION: The TcpO(2) parameters mentioned above are capable of detecting the effect of SCS treatment. Selection using (a combination of) TcpO(2) measurements substantially improves limb salvage of patients treated with SCS for inoperable CLI.
Asunto(s)
Monitoreo de Gas Sanguíneo Transcutáneo , Terapia por Estimulación Eléctrica , Isquemia/terapia , Pierna/irrigación sanguínea , Recuperación del Miembro , Médula Espinal , Anciano , Enfermedad Crítica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
Over a period of 5 years 81 vascular complications after 15,460 catheterizations of the femoral artery for diagnostic (n = 11,883) or therapeutic (n = 3577) procedures were registered. The following complications were observed in declining frequency: 1. False aneurysm (n = 65), 2. arterial occlusion (dissection, embolia, thrombosis) (n = 8), 3. vascular lesion causing profuse bleeding (n = 7), 4. AV-fistula (n = 1). The total complication rate was 0.52%. The complication rate was significantly higher in therapeutical procedures (1,03%) than in diagnostic investigations (0.37%). Pseudoaneurysms were complicated by thrombosis of the femoral vein (n = 3), lymphatic fistula (n = 3) and deep wound infection (n = 9); secondary complication rate 18.5%. Risk factors for local vascular complications are old age, female gender, high grade arteriosclerosis at the puncture site, overweight, manifest arterial hypertension and medication with cumarin, acetylsalicylic acid or heparin. Further complicating factors are connected with technical risks such as duration of the procedure. French size of the catheter, the catheter sheath and multiple punctures. Vascular repair was performed by simple angiography in most cases, but in 14.8% more extensive surgical procedures were required. In patients with signs of occlusive vascular disease the external iliac artery was replaced by a PTFE-vascular access graft in 4 cases and an arterioplasty of the deep femoral artery was performed in 2 patients. 36% of the operations were undertaken as emergencies. Reintervention was necessary for a postoperative bleeding complication in 1 case (surgical complication rate 1.2%). A female patient suffering from aortic valve stenosis died during emergency operation due to massive retroperitoneal hemorrhage after cardiac catheterization (mortality rate 1.2%). Over a median follow-up period of 37 months no late complications of the intervention were recorded, nor recurrences of peripheral arterial occlusive disease.
Asunto(s)
Aneurisma Falso/etiología , Angiografía/instrumentación , Angioplastia/instrumentación , Arteriopatías Oclusivas/etiología , Fístula Arteriovenosa/etiología , Cateterismo Cardíaco/instrumentación , Arteria Femoral/lesiones , Hemorragia/etiología , Punciones/instrumentación , Anciano , Aneurisma Falso/cirugía , Arteriopatías Oclusivas/cirugía , Fístula Arteriovenosa/cirugía , Prótesis Vascular , Diseño de Equipo , Femenino , Arteria Femoral/cirugía , Hemorragia/cirugía , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Reoperación , Factores de RiesgoRESUMEN
Congenital anomalies of the caval vein are often associated with other abnormalities such as heart defects, situs inversus or a polysplenia-asplenia-syndrome. An isolated, congenital malformation like aplasia of the inferior vena cava is a rare finding. A review of the embryology and abnormalities, diagnostics, clinical signs and treatment is given together with the histories of two patients having thrombosis of the lower extremities and pelvic veins, caused by aplasia of the inferior vena cava. After thrombotic complications caused by vena cava aplasia there is high risk of recurrence. Those patients should be anticoagulated for lifetime.
Asunto(s)
Tromboflebitis/etiología , Vena Cava Inferior/anomalías , Adulto , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Recurrencia , Factores de RiesgoRESUMEN
The implantation of covered stents or stentgrafts has increased greatly in the last few years for the endovascular reconstruction of arterial aneurysms. We report of three patients experiencing severe septic complications after stentgraft implantation. Endovascular stentgraft infection is a serious complication with high morbidity and mortality. General antibiotic prophylaxis seems to be indicated when implanting stentgrafts.
Asunto(s)
Aneurisma de la Aorta Abdominal/terapia , Arteriopatías Oclusivas/terapia , Materiales Biocompatibles Revestidos , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Stents , Anciano , Angiografía , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagen , Terapia Combinada , Humanos , Masculino , Infecciones Relacionadas con Prótesis/terapia , Tomografía Computarizada por Rayos XRESUMEN
We report about a patient with a thoracic aneurysm caused by an acute type-B dissection. Due to the concomitant affections the risk of surgery was distinctly increased, the reconstruction was performed endo vascular by stentgraft implantation (Talent, World Medical Systems, Sunrise FL) after transposition of the left subclavian artery to create a sufficient neck for the proximal stent placement. Endoluminal treatment seems to be a promising, less invasive alternative method in the treatment of acute aortic dissections.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Stents , Arteria Subclavia/trasplante , Enfermedad Aguda , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aortografía , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Común/cirugía , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Primary bacterial infection of an artery is difficult to diagnose, especially at the beginning of the illness. Most of the patients come for emergency treatment in the phase of rupture. METHODS: The course of illness in four patients serves as background for discussion of the problems of diagnosis and therapy. RESULTS: Bacterial infection of arteries shows a high rate of complications and, for the aorta, high mortality. CONCLUSION: If fever of uncertain origin is combined with pain of the stomach or of the back, or with a painful reddish swelling on a limb, this rare disease should be considered in the differential diagnosis.
Asunto(s)
Aortitis/cirugía , Arteritis/cirugía , Infecciones Bacterianas/cirugía , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/mortalidad , Aneurisma Infectado/cirugía , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/mortalidad , Aneurisma Roto/cirugía , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/mortalidad , Rotura de la Aorta/cirugía , Aortitis/diagnóstico , Aortitis/mortalidad , Arteritis/diagnóstico , Arteritis/mortalidad , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/mortalidad , Implantación de Prótesis Vascular , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Fiebre de Origen Desconocido/etiología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factores de RiesgoRESUMEN
Between September 1996 and February 2000 five female and 62 male patients with an abdominal aortic aneurysm, requiring therapy, underwent endoluminal treatment. Their age ranged from 51 to 81 years (mean 72 years). Preoperative evaluation was done with spiral computed tomography (CT) and angiography. All procedures were performed under general anesthesia in a radiologically adapted operating room. Postoperative complications occurred in 28.4%. The total conversion rate was 13.4%, the 30-day lethality rate was 1.4%. During the mean follow-up of 15.1 months 19 secondary interventions were necessary in 13 patients. The results presented in this study do not justify the wide use of this method and indicate a stricter form of patient selection.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Endoscopía/métodos , Stents , Anciano , Anciano de 80 o más Años , Angiografía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Endoscopía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
The case of a 20-year old female patient who developed an isolated thrombosis of the pelvic vein after a marathon run, is presented. After surgical treatment and anticoagulation for one year, complete restitution was seen. The possible relation between marathon running and venous thrombosis without other risk factors is discussed.
Asunto(s)
Vena Ilíaca , Carrera/fisiología , Trombosis/etiología , Adulto , Derivación Arteriovenosa Quirúrgica , Femenino , Humanos , Vena Ilíaca/fisiopatología , Vena Ilíaca/cirugía , Trombectomía , Trombosis/fisiopatología , Trombosis/cirugíaAsunto(s)
Hipertensión/fisiopatología , Receptores Adrenérgicos alfa/fisiología , Resistencia Vascular , Vasoconstricción , Epinefrina/sangre , Humanos , Nitroprusiato/farmacología , Prazosina/farmacología , Sinapsis , Resistencia Vascular/efectos de los fármacos , Vasoconstricción/efectos de los fármacos , Yohimbina/farmacologíaRESUMEN
A woman is reported, in whom acne appeared after pregnancy. There are similar conditions in postcontraceptive acne and in acne after pregnancy. For acne after pregnancy the term "postgestative acne" is proposed.
Asunto(s)
Acné Vulgar/diagnóstico , Trastornos Puerperales/diagnóstico , Acné Vulgar/etiología , Femenino , Hormonas Esteroides Gonadales/fisiología , Humanos , Embarazo , Terminología como AsuntoRESUMEN
Primary bacterial aortitis represents a rare disease with a high lethality. From June 1997 to April 1999 5 patients with an abdominal aortic infection were treated by resection of the infected aorta and in-situ reconstruction or by extra-anatomic bypass. There was no treatment in one case because of the infaust prognosis. 3 patients survived, one with a paraparesis as a result of spinal ischemia. On the basis of our patients the pathogenesis, clinical symptoms with diagnosis and the therapeutic options are discussed.
Asunto(s)
Aortitis/cirugía , Infecciones por Proteus/complicaciones , Proteus mirabilis , Infecciones por Pseudomonas/complicaciones , Infecciones Estafilocócicas/complicaciones , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Aortitis/diagnóstico , Aortitis/etiología , Implantación de Prótesis Vascular , Diagnóstico Diferencial , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tereftalatos Polietilenos , Infecciones por Proteus/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológico , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológico , Factores de TiempoRESUMEN
Confirming earlier studies with a lower number of patients, the Gusto IIb Angioplasty Substudy has shown that in the treatment of acute myocardial infarction emergency PTCA is superior to thrombolysis in reducing the combined clinical endpoints of death, reinfarction and cerebrovascular infarction. The aim of this study was to assess whether, in the Swiss study population of Gusto IIb, emergency PTCA was associated with higher procedural costs than thrombolysis over a median follow-up of 16 months. Therefore, we compared the costs of the initial and the follow-up hospitalisations. There were no differences in clinical characteristics in the Swiss subpopulation compared to the total study population. In a total of 46 patients, PTCA was performed in 22 and thrombolysis with rtPA in 24. During follow-up, 4 patients died, one in the PTCA group and 3 in the thrombolysis group (p = ns). The median total costs of the initial hospitalisation were somewhat higher in the PTCA group than in the group with thrombolysis. During follow-up only 38% of the patients in the PTCA group had to be rehospitalised, compared to 50% in the thrombolysis group. Median total costs within 16 months, therefore, were similar in the two therapeutic groups, but mean total costs per patient were somewhat lower for the PTCA versus the thrombolysis group (p = ns). Based on this comparison of Swiss procedural costs, emergency PTCA should not, in hospitals with the necessary infrastructure, be withheld in the treatment of acute myocardial infarction on the grounds of initially higher procedural costs, especially as the invasive strategy is associated with a more favourable long-term outcome.
Asunto(s)
Angioplastia Coronaria con Balón/economía , Fibrinolíticos/economía , Infarto del Miocardio/economía , Infarto del Miocardio/terapia , Terapia Trombolítica/economía , Activador de Tejido Plasminógeno/economía , Costos y Análisis de Costo , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Hospitalización/economía , Humanos , Proteínas Recombinantes/economía , Proteínas Recombinantes/uso terapéutico , Suiza , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
We report on a posttraumatic aneurysm of the brachiocephalic trunk, something which is rather rare. The injury was caused by blunt chest trauma following a car accident. Computed tomography could not find the brachiocephalic lesion. In patients with fractures of the upper ribs after blunt chest trauma, angiography should be done to exclude severe injuries of the aorta and brachiocephalic vessels.
Asunto(s)
Aneurisma/cirugía , Tronco Braquiocefálico/lesiones , Traumatismos Torácicos/cirugía , Heridas no Penetrantes/cirugía , Adulto , Aneurisma/diagnóstico por imagen , Implantación de Prótesis Vascular , Femenino , Humanos , Tereftalatos Polietilenos , Radiografía , Traumatismos Torácicos/diagnóstico por imagen , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
OBJECTIVE: To determine the effect of spinal cord stimulation (SCS) on limb survival in patients with non-reconstructable critical leg ischaemia, and the value of patient selection on the basis of transcutaneous oxygen pressure (TcpO2) measurements and trial screening. DESIGN: A prospective, controlled, European multicentre study. METHODS: Non-reconstructable patients with stable critical leg ischaemia were divided into three groups. The SCS-Match group comprised patients with a baseline forefoot TcpO2 of < 30 mmHg and both sufficient pain relief and sufficient paraesthesia coverage (> 75%) after a test stimulation period of at least 72 h. If baseline TcpO2 was < 10 mmHg, the TcpO2 should have exceeded 20 mmHg after test stimulation. The SCS-Match group was compared with patients not meeting these criteria, who were treated either with SCS (SCS-No-Match) or without SCS (No-SCS). RESULTS: At baseline, the mean (+/- SD) supine TcpO2 was 14.9 +/- 8.3 mmHg in the SCS-Match group (n = 41), 11.3 +/- 13.3 mmHg in the SCS-No-Match group (n = 32) and 15.3 +/- 17.1 mmHg in the No-SCS group (n = 39). In the SCS-Match group a significant improvement in pain relief (p < 0.005) and TcpO2 (p < 0.001) was seen. After 12 months, cumulative limb survival of patients treated with SCS was significantly better than that of patients not treated with SCS (p < 0.03), and limb survival in the SCS-Match group was significantly higher (p < 0.03) than that in the SCS-No-Match and No-SCS groups (78, 55 and 45%, respectively). CONCLUSION: SCS treatment of non-reconstructable critical leg ischaemia provides a significantly better limb survival rate compared with conservative treatment. Patient selection based on TcpO2 and the results of trial screening further increase the probability of limb survival after SCS therapy.
Asunto(s)
Terapia por Estimulación Eléctrica , Isquemia/terapia , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Monitoreo de Gas Sanguíneo Transcutáneo , Enfermedad Crítica , Terapia por Estimulación Eléctrica/métodos , Femenino , Humanos , Isquemia/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Médula EspinalRESUMEN
PURPOSE: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms. METHODS: Three patients with proximal aortic anastomotic pseudoaneurysms 8--15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n = 1), bifurcated graft (n = 1)]. In one patient an uniiliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed. RESULTS: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft. CONCLUSION: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.
Asunto(s)
Aneurisma Falso/cirugía , Angioscopía , Aorta Abdominal , Aneurisma de la Aorta Abdominal/cirugía , Prótesis Vascular/efectos adversos , Anciano , Anastomosis Quirúrgica , Aneurisma Falso/etiología , Aneurisma de la Aorta Abdominal/etiología , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos VascularesRESUMEN
BACKGROUND: Standard treatment of acute thoracic aortic dissection type B is the medical therapy used for most patients, according to Stanford. Surgical therapy involves a high mortality rate and is reserved for patients with complicated dissections. We report from four patients with acute thoracic aortic dissection, treated endoluminally by stent-graft implantation. METHODS: Four patients with complicated acute thoracic aortic dissections type B were treated endoluminally by transfemoral stent-graft implantation. Preoperative evaluation was performed with spiral-computed tomography and calibrated aortography. The Talent stent-graft system (Metronic) was used in all patients. RESULTS: The primary entry tear could be sealed successfully and complete thrombosis of the false thoracic aortic lumen was obtained in all cases. In one patient, transposition of the left subclavian artery was performed, in two patients the stent-grafts had to be placed across the origin of the left subclavian artery. No severe intra- or postoperative complications occurred. CONCLUSION: Endoluminal treatment of acute thoracic aortic dissection seems to be a less invasive and effective therapy. Long-term results for this method are necessary.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Stents , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aortografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
We measured amount, course and duration of different parameters in order to assess metabolic-endocrine changes in patients with multiple trauma and the final outcome. Injures were initially quantified according to the Injury Severity Score. Serum levels of lactate, creatinine, bilirubin, somatomedin and thyroid hormons were measured in 51 patients (39 survivors, 12 deceased patients) for six days following the injury. In addition, neopterin levels were measured in 26 patients (19 survivors, 7 deceased patients). The patients were devided into two groups (survivors vs non-survivors). Global Index Scores and Septic Severity Scores were significantly different at the 1% and 5% level (p less than 0.05 to p less than 0.01). The same statistical differences were shown for lactate, somatomedin, neopterin and thyroid hormones.
Asunto(s)
Traumatismo Múltiple/sangre , Biomarcadores , Biopterinas/análogos & derivados , Biopterinas/sangre , Humanos , Lactatos/sangre , Ácido Láctico , Neopterin , Estudios Retrospectivos , Somatomedinas/sangre , Tiroglobulina/sangre , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangreRESUMEN
BACKGROUND: Of all upper extremity emboli, up to twenty percent arise from an arterial, not a cardiac source. METHOD: We report about a patient with recurrent embolism, caused by an axillary crutch-induced aneurysm of the axillary artery. RESULT: After revascularisation by embolectomy and axillo-brachial vein graft bypass, the patient was free of symptoms. CONCLUSION: Angiography and duplex scanning were necessary for the correct diagnosis.