ABSTRACT
Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.
Subject(s)
Humans , Biopsy , Calciphylaxis , Cardiovascular Diseases , Hyperparathyroidism, Secondary , Ischemia , Kidney Failure, Chronic , Lower Extremity , Necrosis , Peritoneal Dialysis , Skin Ulcer , Skin , Ulcer , WarfarinABSTRACT
Allogeneic hematopoietic stem cell transplantation is the only option for chemotherapy-refractory chronic myeloid leukemia (CML). Extramedullary relapse after transplantation is rare and usually accompanies marrow relapse. Generally, the prognosis of extramedullary relapse is poor. Here, we report a man with extramedullary relapsed CML after stem cell transplantation that presented as an isolated cardiac mass, which has shown an indolent course for more than 2 years, without evolving to medullary relapse during that period. This case implies that the CML clone might contribute to the development of quiescent extramedullary relapse with a benign course.
Subject(s)
Bone Marrow , Clone Cells , Heart Neoplasms , Hematopoietic Stem Cell Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Prognosis , Recurrence , Sarcoma, Myeloid , Stem Cell TransplantationABSTRACT
Recently, the use of extracorporeal membrane oxygenation has evolved rapidly and there is potential for expanding its use. There are many complications associated with extracorporeal membrane oxygenation, but the fracture of a guidewire has been reported to be very rare during extracorporeal membrane oxygenation insertion. We describe our experience of successfully removing a fractured 0.038-inch guidewire using a catheter wedge with balloon inflation following a fracture that occurred during insertion of extracorporeal membrane oxygenation through the left femoral vein.