scholarly journals Acute Digital Ischemia After Arterial Injection of Crushed Zolpidem Tablets: Role of Microcrystalline Cellulose? A Case Report

2020 ◽  
Vol 11 ◽  
Author(s):  
Grégoire Détriché ◽  
Guillaume Goudot ◽  
Lina Khider ◽  
Alexandre Galloula ◽  
Matthieu Guillet ◽  
...  
Keyword(s):  
Case Report ◽  
Microcrystalline Cellulose ◽  
Clinical Severity ◽  
Acute Ischemia ◽  
Palmar Arch ◽  
Vasodilator Therapy ◽  
Tissue Ischemia ◽  
Left Hand ◽  
Digital Ischemia ◽  
Run Off

Literature is scarce on acute ischemia after intra-arterial injection of crushed tablets and no effective medical treatment against the progression of lesions is reported. The only factor able to modify the outcome is the delay between injection and management by a specialized vascular team. Moreover the risk of necrosis seems higher after benzodiazepine intra-arterial injection than with other drugs. We tried to find out mechanistic explanations. We report on the case of a 31-year-old drug addict woman who self-injected into her left brachial artery crushed tablets of zolpidem. She developed an acute ischemia of the left hand, with necrosis of the intermediate and distal phalanges of fingers II, III, and IV. Angiogram of the left upper arm confirmed the distal arterial occlusions with no run-off after the palmar arch in the necrotic fingers. Once she was admitted into our vascular unit, intravenous vasodilator therapy by iloprost, heparin and local protective care were rapidly introduced. After delineation between living and necrotic tissues, she required distal amputations of the affected fingers. The clinical severity of arterial injections of benzodiazepine tablets is linked to the association of several pathophysiological mechanisms. Rather than related benzodiazepine pharmacologic effects with tissue ischemia, by the inhibition of phosphodiesterase, a vasodilator intermediate, or through the peripheral benzodiazepine-type receptor, the predominant mechanism is more likely in relation with microcrystalline cellulose, one component of zolpidem tablets, known as potential embolic agents. They are insoluble and resistant to degradation in water. These properties are probably prominent in the case we described here. Through this case report we want to drag attention of physicians in charge of a patient with acute ischemia after crushed tablet accidental intra-arterial injection, not only to look at the drug injected but also the other components of the tablet and especially to microcrystalline cellulose.

scholarly journals Envenomation by neotropical Opisthoglyphous colubrid Thamnodynastes cf. pallidus Linné, 1758 (Serpentes:Colubridae) in Venezuela

2004 ◽  
Vol 46 (5) ◽  
pp. 287-290 ◽  
Author(s):  
Fresnel Diaz ◽  
Luis F. Navarrete ◽  
Jaime Pefaur ◽  
Alexis Rodriguez-Acosta
Keyword(s):  
Case Report ◽  
Marked Improvement ◽  
Middle Finger ◽  
Snake Bite ◽  
Venomous Snake ◽  
Left Hand ◽  
At Home

This is a case report of a "non-venomous" snake bite in a herpetologist observed at the Sciences Faculty of the Universidad de los Andes (Mérida, Venezuela). The patient was bitten on the middle finger of the left hand, and shows signs of pronounced local manifestations of envenomation such as bleeding from the tooth imprint, swelling and warmth. He was treated with local care, analgesics, and steroids. He was dismissed from the hospital and observed at home during five days with marked improvement of envenomation. The snake was brought to the medical consult and identified as a Thamnodynastes cf. pallidus specimen. This report represents the first T. pallidus accident described in a human.

scholarly journals Excellent Functionality Despite Clinico-Radiological Deformity in Osteomyelitis Variolosa - A Case Report

2015 ◽  
Vol 9 (1) ◽  
pp. 114-119
Author(s):  
Aakash Mugalur ◽  
Sunil M Shahane ◽  
Ashwin Samant ◽  
Aditya C Pathak ◽  
Rajeev Reddy
Keyword(s):  
Case Report ◽  
Elbow Joint ◽  
Cortical Thickening ◽  
Diagnostic Challenge ◽  
Left Hand ◽  
Articular Surfaces ◽  
The World ◽  
Radiological Abnormality ◽  
Endemic Areas ◽  
The Right

Despite the eradication of smallpox from the world in 1980 the osteo-articular sequelae of smallpox are still occasionally noticed in previously endemic areas. The sequelae of osteomyelitis variolosa may raise a diagnostic challenge to the untrained eyes of the surgeon. We present a case of “osteomyelitis variolosa” in a 70 years old patient. The patient had bilateral dislocation of the elbow joint with multidirectional instability. There was distortion of the articular surfaces and ankylosis of the bilateral proximal radio-ulnar joint. Hypoplasia of the right ulna with short fourth and fifth metacarpals of the left hand and hypoplasia of right fourth metacarpal with cortical thickening was noted radiologically. The patient had minimal disability of his elbows despite the striking radiological abnormality and was functionally independent.

scholarly journals Acute right upper extremity ischemia resulting from true aneurysmof right brachial artery: A case report

2020 ◽  
Vol 12 (4) ◽  
pp. 337-340
Author(s):  
Niki Tadayon ◽  
Sina Zarrintan ◽  
Seyed Mohammad Reza Kalantar-Motamedi
Keyword(s):  
Case Report ◽  
Upper Extremity ◽  
Ct Angiography ◽  
Brachial Artery ◽  
Artery Aneurysm ◽  
True Aneurysm ◽  
Postoperative Course ◽  
Run Off ◽  
The Right ◽  
Extremity Ischemia

We report a case of 66-year-old woman with true aneurysm of the right brachial artery. She presented with acute upper extremity ischemia. The hand was cold and parenthesized and distal pulses were absent. CT angiography (CTA) revealed a 20*25 mm true brachial artery aneurysm. The aneurysm was thrombosed without distal run-off. We excised the aneurysm and reestablished the arterial flow by a reverse saphenous interposition graft. The postoperative course was uneventful.

scholarly journals Digital Ischemia in Patients with Solid Tumors: a Case Report and Review of the Literature

2011 ◽  
Vol 02 (02) ◽  
pp. 281-284 ◽  
Author(s):  
Lucia Raimondo ◽  
Chiara Alessandra Cella ◽  
Roberto Moretto ◽  
Elide Matano ◽  
Chiara Carlomagno
Keyword(s):  
Case Report ◽  
Solid Tumors ◽  
Review Of The Literature ◽  
Digital Ischemia

Bilateral Opponens Replacement in Post Polio Thenar Paralysis, Using Different Techniques. A Case Report.

HAND ◽  
1983 ◽  
Vol os-15 (2) ◽  
pp. 221-222 ◽  
Author(s):  
J. G. Andersen ◽  
J. W. Brandsma
Keyword(s):  
Case Report ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Left Hand ◽  
Right Hand ◽  
Abductor Digiti Minimi ◽  
The Right ◽  
Flexor Digitorum

A patient is presented with bilateral thenar paralysis, due to poliomyelitis. On the right hand a successful abductor digiti minimi transfer was performed. On the left hand weakness of the hypothenar muscles prevented a good result. Subsequently an opponens replacement, using flexor digitorum superficialis from the ring finger, yielded a good result.

Acute Ischemia of the Lower Extremity During Renal Transplantation – Case Report

2014 ◽  
Vol 86 (8) ◽  
Author(s):  
Radosław Krupiński ◽  
Andrzej Wolski ◽  
Jacek Bicki ◽  
Sławomir Rudzki
Keyword(s):  
Case Report ◽  
Renal Transplantation ◽  
Lower Extremity ◽  
Acute Ischemia

scholarly journals ABSENCE OF SUPERFICIAL PALMAR ARCH WITH PERSISTENT MEDIAN ARTERY - A CASE REPORT

2014 ◽  
Vol 04 (03) ◽  
pp. 109-111
Author(s):  
Kavitha K. ◽  
Prima D'Souza ◽  
Vishal Kumar ◽  
Keyword(s):  
Case Report ◽  
Ulnar Artery ◽  
Anatomical Variations ◽  
Arterial Supply ◽  
Vascular Pattern ◽  
Superficial Palmar Arch ◽  
Undergraduate Medical Students ◽  
Palmar Arch ◽  
Surgical Emergencies ◽  
Median Artery

AbstractThe anatomical variations in the arterial supply of the palm are frequently reported. One such variation reported during routine dissection for undergraduate medical students in our college is the absence of superficial palmar arch and presence of persistent median artery. The arterial supply to the palm is in the form of superficial and deep palmar arches. In the present case the median artery and ulnar artery supplies the palm without forming an arch on the left extremity. Awareness of variations in the vascular pattern of the palm is clinically important in case of angiographic procedures and surgical emergencies.

scholarly journals Penetrating wound of the heart manifested with periphery embolism: Case report

2012 ◽  
Vol 69 (9) ◽  
pp. 803-805 ◽  
Author(s):  
Milos Velinovic ◽  
Mile Vranes ◽  
Biljana Obrenovic-Kircanski ◽  
Svetozar Putnik ◽  
Aleksandar Mikic ◽  
...  
Keyword(s):  
Case Report ◽  
Atrial Septal Defect ◽  
Femoral Artery ◽  
Septal Defect ◽  
Common Femoral Artery ◽  
Acute Ischemia ◽  
Rare Type ◽  
Penetrating Wound ◽  
Event Reconstruction ◽  
The Right

Introduction. Heart injuries can be classified as penetrating and non-penetrating (blunt). Penetrating wounds are usually caused by stabbing with a piercing object, weapon or projectiles - missiles. The right atrium is damaged in most cases, because of its anatomical position - making the most of the anterior side of the heart. Morbidity caused by stabbing injuries to the heart is 20%-30%, while piercing wounds cause 30%-60% of deaths. Case report. A 28-year-old patient was admitted to our clinic with acute ischemia of the extremities. Angiography revealed a bullet in the right common femoral artery, occluding it. The patient denied having any piercing or shooting wound to his leg, but he said that four years before he had been shot to his chest. Echocardiography revealed an atrial septal defect of secondary type. An event reconstruction revealed that, four years after shooting, the bullet was displaced from the heart to the right common femoral artery. Conclusion. This case report is unique because of the rare type of injury, time that passed from the injury, the way bullet entered the artery (via atrial septal defect) and especially the success of both surgical procedures (embolectomy and repair of atrial septal defect).

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