Misha Witz

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.

Renal Vein Occlusion: A Review

PURPOSE The different etiologies of renal occlusion are reviewed. A special category, division of the left renal vein in abdominal aortic surgery, is also discussed in the review. MATERIALS AND METHODS The various diagnostic modalities used in cases of renal vein occlusion include excretory urography, ultrasound, nuclear scan, angiography, venography, computerized tomography and magnetic resonance imaging. The main goals of therapy in this condition should be conserve renal parenchyma and to protect renal function. RESULTS The principal mode of treatment is medical and includes correction fluid and eletrocyte imbalance, dialysis, antihypertensive drugs, anticoagulation and in certain cases thrombolysis. CONCLUSIONS Renal vein occlusion in adults is usually a result of the vein thrombosis which is frequently associated with the nephrotic syndrome. The anatomy of renal vascularization is of primary importance in understanding its pathophysiological responses and the clinical and diagnostic presentation of patients with this condition. The reaction of the kidney to its vein occlusion is determined by the balance between the acuteness of the disease, extent of the development of collateral circulation, involvement of 1 or both kidneys and the origin of the underlying disease. Renal vein occlusion is generally a complication of some other condition but may also be a primary disease.

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.

Inflammatory fibroid polyp of sigmoid colon

SummaryA case of inflammatory fibroid polyp of the sigmoid colon is presented. This is the eighth case of this type of polyp in the colon and, to the best of our knowledge, the first one involving the sigmoid and producing intussusception.Symptomatology of the inflamed fibroid polyp in this part of the gut closely simulates gastrointestinal malignancy. The treatment is surgical excision of the polyp, or colonoscopic resection when it is possible. Intraoperative colonoscopy helps the surgeon to localize the lesion and to rule out the existence of other lesions.

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.

Revascularisation for a Poorly Functioning Solitary Kidney

Renovascular disease in a solitary kidney is a difficult and challenging problem. In six patients, with a mean age of 62 years, revascularisation was undertaken. In four of them, one to three attempts at PTA were made before the operation but all were unsuccessful. The preoperative mean serum creatine (Cr) was 3.52 mg% (range 2.5-5.5). The stenoses were caused by atherosclerosis in five cases and fibromuscular dysplasia (FMD) in one. Two methods of revascularisation were used: aortorenal bypass with saphenous vein (three patients) or PTFE (two patients), and transaortic renal endarterectomy with a venous patch (one patient). One patient with an aortic aneurysm underwent simultaneous aortic repair with a PTFE graft. There was no mortality or major complications in our series and no patient suffered acute tubular necrosis (ATN) after surgery. The mean follow-up period was 51 months (15-84 months). Postoperative Cr and blood pressure improved in all patients. Four patients no longer required any medication and the other two only needed reduced doses of antihypertensive drugs. Based on our experience of patients with poor single kidney function, we do not recommend PTA in this specific group of patients and suggest an aggressive surgical approach, which can effectively improve solitary kidney function, thus eliminating further haemodialysis.

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.

The use of the venous stripper for graft removal in arterial reoperations

A simple technique for removal of synthetic grafts using a standard venous stripper inside the graft is described. The method permits the simultaneous placement of a drainage tube in the canal after graft removal in cases where the graft is infected.