[Surgery for acute arterial emboli to the arm]

During a 5-year period (1987-1992) we removed under local anesthesia 20 emboli and 2 thrombi from the arms of 18 patients aged 60-90 using a Fogarty catheter. 18 of the emboli (90%) were of cardiac origin. 1 patient had thrombosis of the axillary artery (2 episodes). The occlusions were brachial in 14 (70%), axillary in 5 (25%), and radial in 1. From 1.5 hours to 1 week elapsed between onset of symptoms and operation. 9 patients underwent arteriography. Surgery was successful in 19 (95%). Limb necrosis developed in a patient operated on 1 week after onset of symptoms. Necrosis progressed despite a palpable radial pulse. 33 patients (15%) died of causes unrelated to the operation: 2 had terminal cardiac disease and the third concomitant occlusion of the superior mesenteric artery. Early surgical exploration is advocated for acute arterial embolism of the upper extremity. Ischemic changes may be reversible even later than 24 hours from onset of symptoms. Routine arteriography is not needed before surgical exploration of these cases.

Balloon catheter dilatation of focal colonic strictures following necrotizing enterocolitis

Two infants with severe colonic strictures secondary to necrotizing enterocolitis (NEC) were successfully dilated with balloon catheters. The procedures were performed under mild sedation, with fluoroscopic guidance. Results were sustained for more than 4 years follow-up. This procedure proved to be a safe and effective alternative to operative repair.

Buerger's disease presenting as acute small bowel ischemia

The case of a young man with an unusual presentation of thromboangiitis obliterans with ischemia of the small bowel, 2 years before peripheral vascular disease of the extremities was clinically expressed, is reported.

Renal artery stenosis secondary to neurofibromatosis in children: detection by Doppler ultrasound

Renal artery stenosis was diagnosed in two adolescents with neurofibromatosis using Doppler ultrasound. The diagnosis was confirmed by angiography. The renal vascular lesion in neurofibromatosis usually affects the proximal segment of the artery, which is the part most optimally visualized by ultrasound. We suggest that Doppler ultrasound of the renal arteries may be a useful technique in the investigation of hypertensive children with neurofibromatosis.

Use of percutaneous nephrostomy in hydronephrosis of pregnancy

Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.

Percutaneous drainage of postappendectomy abscesses complicated by enteric communication

Four patients with postappendectomy abscesses complicated by enteric fistulae were treated by percutaneous drainage. Sinograms, obtained at the time of the initial drainage, demonstrated communication to the cecum in 3 patients and to the small bowel in 1 patient. Complete cure was attained in 3 patients by percutaneous drainage. In the fourth patient, surgery was performed after 7 days of catheter drainage. Percutaneous drainage of abscesses with enteric communication requires a modified technique, which includes longer-term drainage than for simple noncommunicating abscesses.

Haemoptysis as the sole presenting symptom of dissection of the aorta

A 75 year old man who had had haemoptysis for 24 hours was found to have his left lower lobe compressed by a dissection of the aorta, which was otherwise symptomless.

Transcatheter occlusion of inferior mesenteric arteriovenous fistula: a case report

Transcatheter embolization of the inferior mesenteric artery with steel coils was performed for the control of massive lower gastrointestinal bleeding and sepsis. The bleeding and sepsis was caused by a very large arteriovenous fistula of the inferior mesenteric vessels. This iatrogenic lesion developed and became symptomatic just 5 weeks after an anterior resection of the rectum was performed. Following embolization, the patient made a speedy recovery from the sepsis and no recurrent bleeding was noted.

Percutaneous transluminal recanalization of common iliac artery occlusions

Percutaneous transluminal recanalization of occluded iliac arteries was attempted in 25 patients (26 limbs). In 22, successful recanalization was achieved, although 4 patients required additional surgical thrombectomy. The remaining 4 patients had surgical bypass procedures. The early and late results of percutaneous recanalization are presented as well as the technique used. We conclude that percutaneous recanalization of iliac occlusion is an effective procedure in the majority of cases. The option of surgical treatment remains viable when the percutaneous approach is unsuccessful.

Solitary eosinophilic granuloma of sternum: case report with review of the literature

A solitary lesion in the distal sternum in a 30-year-old woman caused by eosinophilic granuloma (EG) is reported. Bone scan with 99Tcm was negative. Laboratory tests were completely normal. Although EG bone lesions have been discussed extensively in the literature only one similar case of solitary EG of the sternum has been published to date. A comprehensive summary of the literature is presented.

A simple operation for correction of chronic lateral instability of the ankle

Twenty-two patients underwent a simple operation for correction of chronic lateral instability of the ankle. During the procedure the function of the peroneus brevis was preserved and the anterior talofibular ligament was reconstructed. At follow-up only one patient reported that the ankle still felt unstable.