Jonathan Lehmann

Acute brachial artery thrombosis as the initial manifestation of human immunodeficiency virus infection

Thrombosis of upper extremity arteries is most commonly due to atherosclerosis of the proximal subclavian artery, trauma, or catheter‐related injury. In the absence of an identifiable cause, a search for a hypercoagulable state is indicated. Hematologic manifestations of human immunodeficiency virus (HIV) infection and AIDS are frequent occurrences (Coyle TE. Med Clin N Am 1997;81:449–476). The most important of these are cytopenias (anemia, neutropenia, and thrombocytopenia). The incidence and severity of cytopenia are generally correlated to the stage of the HIV infection. In addition, various coagulation abnormalities have been reported in HIV‐infected patients. Apart from thrombocytopenia, these have included a prolonged APTT due to the presence of lupus anticoagulant, an increased prevalence of protein S and heparin cofactor II deficiency, and hypoalbuminemia‐related fibrin polymerization defects (Toulon P. Ann Bio Clin (Paris) 1998;56:153–160). HIV infection has also been associated with endothelial dysfunction. Although for the most part asymptomatic, elevated d‐dimer levels have been found in HIV‐infected patients, suggesting the existence of a prethrombotic state. In fact, clinical thrombosis eventuates in 2% of these patients (Toulon, 1988). Documented thromboses have involved both veins and arteries. We hereby present a patient who developed an acute thrombosis of his brachial artery as the initial manifestation of HIV infection. Am. J. Hematol. 64:137–139, 2000.

Isolated complete popliteal artery rupture associated with knee dislocation

Complete dislocation of the knee is a rare injury, and is frequently associated with injuries to other structures in the popliteal fossa. Prompt recognition of associated popliteal artery disruption and early revascularization is paramount for successful and functional results. The necessity for emergency vascular reconstruction markedly complicates an already difficult orthopaedic problem. Arteriography is recommended in all cases of complete dislocation of the knee.

Delayed carotid artery rupture in advanced cervical cancer--a dilemma in emergency management.

Abstract Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5–36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.

Endovascular treatment of an open cervical fracture with carotid artery tear

The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report.