Cases reported "Ischemia"

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1/12. Management of iatrogenic lower limb ischaemia in children.

    An acutely ischaemic lower limb following femoral artery cannulation in children is a problem infrequently encountered by plastic surgeons in the UK. When such a case presented to us, we performed a search of published literature to guide us to the optimum treatment. This included methods for extraperitoneal exposure of the common iliac artery and vein. We describe the surgical technique that we used to salvage an acutely ischaemic lower limb following femoral puncture and a review of the literature.
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keywords = puncture
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2/12. Penile strangulation treated with the modified string method.

    Penile strangulation by a nonmetallic or thin metallic ring is easily overcome by severing the object, but a heavy metal ring causing penile strangulation is very difficult to sever. Here we report 2 cases of penile strangulation by metal rings, involving a 38-year-old man and a 44-year-old man, both of whom were treated with the modified string method and glandular puncture.
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ranking = 1
keywords = puncture
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3/12. Vascular complications of the intra-aortic balloon counterpulsation.

    From September 1994 to December 2002, 6,274 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital, Hradec Kralove, czech republic. Intra-aortic balloon counterpulsation (IABP) was applied in 192 cases (3.1%). From this group of 192 counterpulsated patients 103 were successfully treated (53.6%); 89 counterpulsated patients (46.4%) died from the surgical procedure (30-day mortality rate). In 5 cases (2.6%) from the group of 192, the IABP was introduced before the operation. Ischemic changes of the limb were observed in 11 cases (5.7%). Significant bleeding occurred at the site of puncture in 6 cases (3.1%). dissection of the femoral and iliac arteries was found in 2 patients (1.0%), perforation of the iliac artery in 1 case (0.5%). In 2 cases (1.0%) the balloon was led into the venous system. In case report No. 1 an introduction of the balloon under a sclerotic plaque of the descending aorta and iliac artery is described. In case report No. 2 a placement of the balloon in the venous bloodstream is reported.
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keywords = puncture
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4/12. Lower limb ischemic complications after the use of arterial puncture closure devices.

    We report three cases of lower limb ischemia occurring after the use of arterial puncture closure devices (APCDs). In two patients, who have undergone percutaneous angioplasty of lower limb arteries, the Angio-Seal APCD led to thrombosis of the common femoral artery. In another patient who has undergone coronary angiography, this device has led to dissection of the common femoral artery. Since these observations seem to not be merely sporadic, radiologists and cardiologists as well as vascular surgeons should be aware of their possible occurrence in order to avoid these complications and to provide promptly an adequate treatment.
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ranking = 5
keywords = puncture
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5/12. Intervertebral disk space infection following translumbar aortography.

    After 1,748 translumbar aortograms three cases of intervertebral disk space infection were observed over a five-year period, for an incidence of 0.15%. Cultures suggested that the intervertebral disk had been inoculated with digestive tract organisms by the needle used to puncture the aorta. diagnosis of this complication can be made early by retrieval of the responsible organisms from the intervertebral disk under CT control. Treatment consists of prolonged immobilization associated with appropriate antibiotic therapy for at least three months.
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ranking = 1
keywords = puncture
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6/12. Management of supracondylar fracture with brachial artery thrombosis in a child: case report and literature review.

    brachial artery thrombosis following prompt reduction of a supracondylar fracture of the humerus in a 7-year old is described. Persisting absence of the distal pulses in a viable extremity may herald the insidious development of Volkmann's ischemia. pulse volume recordings provide a safe, objective means of evaluation. Arteriography by direct open technique avoids the hazards of percutaneous puncture in children.
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ranking = 1
keywords = puncture
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7/12. brachial artery puncture: a definite risk to the hand.

    We have described a patient who had an acutely ischemic hand after brachial artery puncture in the antecubital fossa. Because of the anatomy of the forearm, hematoma formation and compression of the brachial artery and median nerve are poorly tolerated and predispose to irreversible ischemia or neuropathy. We recommend that brachial artery puncture in the antecubital fossa be avoided.
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ranking = 6
keywords = puncture
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8/12. phentolamine reversal of epinephrine-induced digital vasospasm. How to save an ischemic finger.

    A 17-year-old girl accidently injected her thumb with an adult autoinjector epinephrine syringe, resulting in rapid digital ischemia. Local infiltration of 0.5% phentolamine mesylate injected at the puncture site immediately resolved the ischemia and resulted in no long-term sequelae. Similar cases of epinephrine-induced digital ischemia are reviewed herein, revealing phentolamine to be the drug of choice for reversal of this type of ischemia. Alternative attempts to restore blood flow included warm water immersion, amyl nitrite inhalations, metacarpal nerve block, and application of topical nitroglycerin paste; each was found to be ineffective. We conclude that digital ischemia secondary to accidental injection of epinephrine can be quickly and safely reversed with the use of 0.5% phentolamine locally infiltrated in the region of accidental injection.
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ranking = 1
keywords = puncture
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9/12. Retroperitoneal haemorrhage: a dangerous complication of common femoral arterial puncture.

    Three cases of retroperitoneal haemorrhage resulting from femoral artery catheterizations are reported. The blood tracked up the femoral sheath and was not accompanied by local clinical signs. Two of the patients died. A high index of suspicion, and an early recourse to ultrasound examination and surgical intervention, might have saved the lives of those patients who died.
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ranking = 4
keywords = puncture
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10/12. The use of intra-arterial urokinase in the management of hand ischemia secondary to palmar and digital arterial occlusion.

    Impending gangrene of the hand or digits secondary to palmar or digital artery occlusion can be a devastating complication of upper extremity thromboembolic or atheroembolic disease. Over the past 7 years, 9 patients with severe unilateral hand ischemia and impending tissue loss secondary to distal forearm, palmar arch, and digital artery occlusion were managed with intra-arterial urokinase (UK) infusion. The etiology of the ischemia was thromboembolism in 3 patients, atheroembolism in 2, and traumatic ulnar artery occlusion ("hypothenar hammer syndrome") in the remaining 4 patients. Initial high-dose UK was administered in 3 patients (240,000 U per hour for 2 hours) and all 9 patients were maintained on 80,000 to 120,000 U per hour until clot lysis occurred or until a minimum dose of 600,000 U had been given without clinical improvement. Following UK therapy, the 3 patients with thromboemboli had angiographic demonstration of clot lysis as well as complete resolution of ischemia. The 2 patients with atheroemboli showed no angiographic or clinical improvement, and both required surgical intervention. Angiographic improvement was demonstrated in only 1 patient with traumatic ulnar artery occlusion, although 3 of the 4 patients were clinically improved. A pericatheter thrombosis due to insufficient heparinization and a subcutaneous abscess at the femoral artery puncture site were the only complications of UK infusion. No hemorrhagic complications occurred and no adverse effects of lytic therapy were documented in patients who subsequently required surgery. UK is an effective treatment for recent thromboembolism, because it lyses unorganized thrombi. It is ineffective for treatment of organized thrombi or atheroemboli. Because the etiology of acute hand ischemia is not always obvious at the time of presentation, a trial of UK infusion is warranted, because it is relatively safe and its use may obviate the need for complex microsurgical reconstruction.
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ranking = 1
keywords = puncture
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