VASA. Zeitschrift für Gefässkrankheiten
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A 39 year old male comes to the emergency room because of rapidly increasing pain in his left leg one hour after the injection of Flunitrazepam into a groin vessel. There is a history of drug abuse for more than 15 years. The left leg is cool and shows intense patchy cyanosis. ⋯ The accidental injection of drugs into the femoral artery may result in the clinical picture of acute limb ischemia without occlusion of the big vessels of the leg. This obviously occurs most often with benzodiazepines, especially when crushed tablets soluted in water are injected. Color-coded duplex sonography is able to show open vessels within minutes and prevents ineffective surgical interventions.
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The unilateral distal arterial lesions still give problems in classification and differential diagnosis specially in younger patients. We report on a 45 years old male patient with an aneurysm of the distal ulnar artery and superficial palmar arch. The chronic occupational trauma of the artery led to the clinical picture of hypothenar hammer syndrome.
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False aneurysms of the internal mammary artery are extremely rare. A case of false aneurysm of a branch of the right internal mammary artery after median sternotomy is reported. ⋯ A false aneurysm was suspected on CT-scan and confirmed by angiography. In the same setting percutaneous embolization was performed.
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Objective evaluation of the management of patients with ruptured infrarenal aortic aneurysm in emergency situations has been described rarely. ⋯ Ruptured aortic aneurysm demands surgical intervention. Clinical outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient's prognosis can be approximated using APACHE II score. Treatment results of heterogeneous patient groups can be compared.
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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.