A case report of endovascular stenting in Salmonella mycotic aneurysm: a successful procedure in an immunocompromised patient

<p><b>INTRODUCTION</b>Mycotic aneurysms are associated with high mortality rates and are managed in the local setting with extra-anatomical bypass followed by ligation, exclusion and debridement of the aneurysm. This is the first case of successful endovascular stenting in an immunocompromised patient with Salmonella mycotic aneurysm.</p><p><b>CLINICAL PICTURE</b>A middle-aged man who was HIV positive had Salmonella septicaemia. He developed abdominal pain 5 days after admission and a computed tomography (CT) scan of the abdomen revealed infrarenal aortitis. He developed a mycotic aneurysm 3 weeks later.</p><p><b>TREATMENT</b>He opted for endovascular stenting and after prolonged antibiotic therapy and negative blood cultures, he underwent the procedure using a Talent stent, with an iliac extension.</p><p><b>OUTCOME</b>He was discharged 1 week after stenting and maintained on oral bactrim based on sensitivity. At 1-year follow-up, he remains well symptomatically and CT scan showed no endoleak or collection.</p><p><b>CONCLUSION</b>Endovascular stenting, though a fairly new procedure, can be successfully deployed even in a mycotic aneurysm in the right setting.</p>

Complications relating to intravenous buprenorphine abuse: a single institution case series

<p><b>INTRODUCTION</b>We present a retrospective descriptive study of cases admitted to Tan Tock Seng Hospital from March 2005 to October 2005 with complications of Subutex abuse.</p><p><b>CLINICAL PICTURE</b>A total of 8 patients were studied. Of the 8, 7 were male and one was female. Their complications consist of the following: arterial pseudoaneurysm (2), arterial pseudoaneurysm with infective venous thrombus (1), infective venous thrombus (1), venous thrombus (2), end arterial spasms (1) and sympathetic dystrophy (1).</p><p><b>TREATMENT</b>For the patient who presented with buprenorphine-associated neuropathy, non-operative treatment with analgesics was given. Conservative medical therapy involving deep venous thrombosis treatment was instituted for the patient with deep venous thrombosis. Repair, restorative bypass and embolectomy surgery were performed for patients who had severe embolic/thrombotic complications. One of the patients who received the above surgery required amputation of his lower limb.</p><p><b>OUTCOME</b>Of the 8 patients, 4 were treated medically, 3 required surgery and 1 required amputation. Their recoveries were uneventful. Of the 8, 1 absconded and was not followed up with.</p><p><b>CONCLUSION</b>Parenteral injection of buprenorphine can cause a wide range of vascular complications from simple vascular irritation to severe infective thrombosis and pseudoaneurysms requiring limb amputations. Non-sterile preparation of an injected substance or non-sterile injection sites and the repeated punctures of major vessels are possible culprits in those who are seen to have acute infection of injection sites.</p>