VASA. Zeitschrift für Gefässkrankheiten
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Systemic thrombolytic therapy for pulmonary embolism (PAE) is an established and common procedure. Due to increased risk, however, it is not much used in pulmonary embolism combined with thrombotic mass in the right ventricle. ⋯ Twelve hours after thrombolytic treatment, helix lung CT scan showed a reduction in the size of the pulmonary embolism and no thrombotic masses in the right ventricle. In this patient with a small cardiac thrombus and rather peripheral pulmonary emboli, a systemic thrombolytic therapy proved to be effective and safe.
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Ischemia/reperfusion-injury of skeletal muscle--pathophysiology and clinical implications. Ischemia and reperfusion of skeletal muscle occurs in acute vascular occlusion and revascularisation, in elective vascular surgery, in orthopedic surgery by means of a tourniquet, and in transplantation of muscle-containing cutaneous flaps. The ischemia sets up a cascade of events, which fully develops not prior to the moment of reperfusion. ⋯ The present review discusses the main mechanisms of ischemia/reperfusion-injury in terms of cellular metabolism, endothelial function, cytokine release, and leucocyte function. Release of toxic oxygen radicals by activated leucocytes plays the pivotal role in this reaction. In addition, the clinical manifestations of ischemia/reperfusion will be reviewed as well as some of the means proposed to control this harmful reaction.
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The authors report a case of vibration white finger syndrome in a 51-year old male, pneumatic drill worker. The patient complained of severe pain in the I, II, III and IV right fingers related to acral ischemic lesions. Dried skin with desquamation, tingling, paraesthesia and loss of sensation were present in both hands. ⋯ Under local anaesthesia an epidural spinal cord cervical electrode was implanted to control pain and ameliorate local microcirculatory conditions. The clinical result was excellent with the disappearance of symptoms and healing of acral lesions in a few weeks. Epidural spinal cord electrical stimulation represents an excellent technique for treatment in secondary Raynaud phenomenon related to vibration white finger syndrome.