Percutaneous transvenous retrieval of intracardiac port-a-cath catheter fragment: a case report.

A female patient, 36 years of age, with a metastasised left breast cancer received several courses of chemotherapy for aggressive local tumour growth and multiple metastatic activity. In the current patient, surgical ablation of the left breast was carried out. Also loco-regional radio-therapy was conducted. To facilitate the administration of chemotherapy courses and prevent thrombophlebitis a vascular access port (port-a-cath) was surgically inserted via the right subclavian vein. After a few successful administrations of chemotherapeutic drugs the vascular port stopped functioning. It was demonstrated that a detached catheter fragment had dislodged into the right ventricle. Successful percutaneous, transvenous removal of the entrapped catheter fragment by the Gooseneck retrieval loop snare from the right ventricle was performed via the right femoral vein access. The procedure was uncomplicated and the patient tolerated the procedure well.

[Pulmonary hemorrhage with respiratory insufficiency in Henoch- Schoenlein purpura]. / Longbloedingen met respiratoire insufficiëntie bij Henoch-Schönlein-purpura.

A 20-year-old woman presented with abdominal pain, purpura on the extremities, and arthralgia. The diagnosis of Henoch-Schönlein purpura was made based on granular IgA deposits in the vessels in a skin biopsy. Three weeks after onset of these symptoms, she developed glomerulonephritis and diffuse alveolar haemorrhage; she developed respiratory failure and needed mechanical ventilation. She recovered upon treatment with corticosteroids. Diffuse alveolar bleeding has occasionally been reported in adults with Henoch-Schönlein purpura; this is the first report from the Netherlands.

Ibopamine-induced reversible leukopenia during treatment for congestive heart failure.

Reversible leukopenia was documented in an 81-year-old woman treated with adjunctive ibopamine 100 mg t.i.d. for chronic congestive heart failure. Her antecedent medical history included stable, mild renal function impairment, mitral regurgitation, atrial fibrillation, recurrent transient ischaemic attacks and cholelithiasis. The drugs concomitantly used were digoxin, isosorbide dinitrate, frusemide, urapidil and chlorthalidone in conjunction with oral potassium substitution. Upon withdrawal of ibopamine but continuation of all other drugs, the patient recovered from the blood dyscrasia within 5 days and showed resolution of symptoms. Measurements of protected isolation and selective intestinal decontamination were taken. No complications resulting from secondary infection occurred. After withdrawal of ibopamine and under continuation of all other concomitant medications her body weight continued to decrease during the following few days, her symptoms were alleviated and she was discharge to a nursing home.