[Necrotic toes in a female patient using interferon]. / Een interferongebruikster met necrose aan de tenen.

BACKGROUND: Interferon has an important role in treatment of viral hepatitis, multiple sclerosis and solid and non-solid tumours. Ischaemia and necrosis of the extremities are relatively little-known adverse effects of treatment with interferon. CASE DESCRIPTION: A 44-year-old woman was treated with interferon-beta for relapsing-remitting multiple sclerosis. She developed ischaemia and necrosis of the right lower extremity. Extensive laboratory and imaging investigations offered no clear diagnosis, leading to suspicion of a connexion with interferon-beta treatment. Discontinuation of interferon lead to rapid healing, clearly suggesting a relationship between interferon and the vascular complications. CONCLUSION: Vascular complications during treatment with interferon seem to arise fairly frequently, and can even occur many years after commencing therapy. When vascular symptoms similar to Raynaud's syndrome develop, careful monitoring of the disease course and treatment with vasodilators if required is important. If this is insufficiently effective, interferon should be discontinued. Prompt recognition can prevent significant morbidity in these patients.

Reconstruction of the supra-aortic trunks.

OBJECTIVE: To review our 10-year experience of reconstruction of the supra-aortic trunks. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 47 patients who required reconstruction of the supra-aortic trunks for stenotic or occlusive disease between April 1987 and May 1997. INTERVENTIONS: Right-sided bifurcation graft through a sternotomy (n = 25), left-sided thoracotomy (n = 1), and extra-anatomic bypass (n = 21). MAIN OUTCOME MEASURES: Morbidity, mortality, and long term patency. RESULTS: 3 patients died (6%); 7 (15%) developed major complications (leak from the brachiocephalic stump, n = 2, and acute occlusion of the bypass graft, n = 5) all of which were successfully treated by immediate reoperation; and 9 (19%) developed minor complications, all of which resolved within 3 months. The median follow up was 36 months (range 1-108), and the 3-year patency rate was 80%. No patient died during the follow up period, but a further 3 were lost to follow up. The remaining 41 were all assessed by duplex scanning or angiography, and 3 required further operation for recurrent symptoms; 33 remained completely free of symptoms. CONCLUSION: Symptomatic stenotic or occlusive lesions of the supra-aortic trunks can be treated with acceptable morbidity and mortality, giving long term benefit to patients.

Catheter for percutaneous thrombectomy: first clinical experience.

The authors evaluated a double-lumen thrombectomy catheter that functions by way of the Venturi effect in seven consecutive patients with thrombus in the superficial femoral artery. The estimated age of the thrombotic material was between 3 days and 9 weeks. Thrombectomy was successful in all patients, and mean time required was less than 20 minutes. In five patients, diagnosis, thrombectomy, and therapeutic intervention were successfully performed in one session.