[Severe Raynaud's syndrome treated by lumbar sympathectomy]. / Svært Raynauds syndrom behandlet med lumbal sympatektomi.

Avoiding exposure of extremities to cold combined with pharmacologic treatment usually suffice in the attempt to suppress the related symptoms of Raynaud's syndrome. This case report describes a severe case of Raynaud's syndrome affecting the lower extremities of a 16-year-old female. She was referred to a centre of vascular surgery with severe vasospasms of the feet. After failed attempts of pharmacologic treatment, a laparoscopic lumbar sympathectomy was performed with no complications and a slight reduction of symptoms three years post-surgically.

Excess mortality during the first year after arterial trauma.

INTRODUCTION: Extant studies on arterial trauma originate from outside Denmark and their findings may therefore not apply to a Danish setting. The aim of the present study was to investigate the long-term mortality and clinical characteristics of patients with arterial trauma treated in Odense University Hospital (OUH). METHODS: This study was based on a historical cohort comprising all arterial traumas treated at OUH between 1990 and 2012. The Personal Identification Numbers were drawn and cross-referenced between The Danish Vascular Registry and the Accident Analysis Group. Mortality was compared with the expected mortality from the entire Danish population, matched to age, sex and date of trauma. RESULTS: A total of 231 patients were analysed. The median follow-up period was 6.9 years (range: 0-22.47). Traffic was the most common cause of arterial trauma, violence the least common. Patients were mainly men (69%) with a median age of 32 years. Women had a median age of 46 years. The mortality rate ratios were as follows: overall in the first year 15.34 (95% confidence interval (CI): 10.34-21.93). Overall mortality rate ratios for year 1-5 was 1.66 (95% CI: 0.82-2.98); but when stratified, the effect was only significant in the reconstructed subgroup (2.22 (95% CI: 1.01-4.24). CONCLUSION: Excess mortality was observed in patients with arterial traumas in the first year. However, patients receiving reconstructive arterial surgery after traumas had an excess mortality, even after adjustment for the effect of the first year. Whether the observed mortality is due to surgery itself, patients' risk behaviour or other factors remains unclear. Further national investigation is needed. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. The study was approved by the Danish Data Protection Agency on 14 June 2013.