Lesser saphenous vein thrombophlebitis: its natural history and implications for management.

Little attention has been given to superficial thrombophlebitis and particularly to lesser saphenous vein thrombophlebitis (LSVT) by vascular surgeons. A prospective nonrandomized study was conducted to assess LSVT's potential association with deep venous thrombosis (DVT) as well as its natural history. Between January 1994 and December 1995, the authors reviewed 33 cases of LSVT detected by duplex scanning in 32 patients at their institution's vascular laboratory. Combined LSVT/DVT was treated with heparin and warfarin. LSVT alone or LSVT plus greater saphenous vein thrombophlebitis (GSVT) were treated with local warm compresses and nonsteroidal antiinflammatory drugs. Follow-up scans were obtained in 23 of the 32 patients and ranged from 2 weeks to 18 months after diagnosis of LSVT. Thirty-one patients had unilateral LSVT and 1 patient had bilateral LSVT. Isolated LSVT was found in 9 patients (28%), LSVT combined with DVT occurred in 21 patients (65.6%), and 2 patients had LSVT/GSVT. LSVT was contiguous with DVT in 15 patients, and in 5 patients it was noncontiguous. Within 3 months, 9 of 16 patients (56%) with LSVT/DVT had complete or partial resolution of their LSVT, and 1 (14%) of the 7 patients with LSVT and LSVT/GSVT had improved. Within 18 months, 13 of 16 patients (81%) with LSVT/DVT had complete resolution of their thrombus while only 3 of 7 patients (43%) with LSVT and LSVT/GSVT had resolved. These data show that LSVT is more often associated with DVT (65.6%) than previously believed. While most LSVT will improve in 18 months, those associated with DVT will resolve sooner. Whether anticoagulation accounted for this difference remains to be proven.

The changing face of Canadian home parenteral therapy.

This article describes the Calgary Health Region Home Parenteral Therapy Program (HPTP), which has successfully shifted infusion therapies such as anti-infectives, analgesics, hydration, vasodilators, glucocorticoids, and iron-chelating agents from the hospital to patients' homes. Particular attention is given to the parenteral administration of anti-infectives, which currently accounts for more than 95% of program adult therapy days.

Functional improvement with digital prosthesis use after multiple digit amputations.

PURPOSE: Patients who sustain traumatic amputation of multiple fingers suffer both a functional and psychologic loss. Previous studies of prosthesis use for finger amputees have focused primarily on the psychologic benefits. Clinically our group noticed a functional improvement on hand function tests when patients with multiple digit amputations used a prosthesis. Given the expense of multiple finger prostheses we sought to determine if they led to a consistent functional improvement in these patients. METHODS: Ten consecutive patients performed a battery of hand function tests and rated their ability to perform a variety of activities of daily living both with and without their prosthesis using the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: Our results show a significant improvement in 3-finger-pinch strength and grip strength and a trend of improvement of tip-pinch, lateral-pinch, and grip strength in dynamometer positions 1, 2, 3, and 4 in these patients when tested with and without their prostheses. Function in activities of daily living, as assessed by the Disabilities of the Arm, Shoulder, and Hand questionnaire, was improved globally with prosthesis use. In addition, significant improvement was noted in several specific activities including opening a jar, writing, and turning a key, among others. CONCLUSIONS: These results show that prosthesis use provides a functional benefit to these patients in multiple activities.

Acute lower extremity ischemia in a 7-year-old boy: an unusual case of popliteal entrapment syndrome.

Popliteal artery entrapment syndrome is a rare cause of acute limb ischemia that most commonly is seen in young adults. The most significant complications associated with popliteal entrapment include aneurysm formation and acute thrombosis. This case presents the youngest patient ever reported with this syndrome and highlights the advantages of multimodal treatment including thrombolysis, popliteal aneurysm resection, and revascularization. Although a significant body of literature exists on popliteal entrapment syndrome in teenagers and young adults, it has not been reported previously in a patient younger than 11 years. Limb salvage was achieved in this patient with a combination of endovascular and surgical techniques.