Raymond J. Krause

Impending Gangrene of Four Extremities Secondary to Ergotism

TO encounter late at night a young nurse with impending gangrene of all four extremities secondary to ergotism is a frightening experience, and one that impresses the physician with the paucity of ...

Acute abdominal aorto-vena caval fistula. Report of 2 cases.

From the Department of Surgery and the Peripheral Vascular Laboratory, Good Samaritan Hospital, and the University of Cincinnati College of Medicine, Cincinnati, Ohio. The most common cause of abdominal aorto-vena caval fistula is trauma, in which case the communication may be small and unrecognized. The development of an aorto-caval fistula associated with an arteriosclerotic aneurysm is quite rare, as pointed out in a review of the literature by Beall.,, However, occasional case reports2-12 have appeared since the first successful surgical repair was performed by Cooley in 1954.4 These arteriovenous fistulas may be small and remain relatively asymptomatic until cardiac failure or complication of the associated abdominal aortic aneurysm occurs. In this event, rupture of the aneurysm may be the first manifestation of the two associated lesions. On the other hand, a sudden large perforation of the abdominal aortic aneurysm into the inferior vena cava may initiate an onset of catastrophic clinical symptoms and signs as to suggest vena caval involvement. The cases comprising this report are examples of the two different clinical situations described above.

Injury to the axillary artery following anterior dislocation of the shoulder

Abstract Two instances of injury to the axillary artery secondary to anterior dislocation of the shoulder are reported. In each case it was possible to restore arterial continuity. The possibility that this type of injury is more common than indicated by the paucity of case reports is suggested. Anesthetization of the stellate ganglion has little place in the treatment of acute arterial injuries of the upper extremity. Absence of a palpable pulse at the wrist following injury to the shoulder or arm indicates occlusion of the major artery and is a prime indication for immediate exploration of the artery at the site of injury.