[Thrombosis of the subclavian vein after conservative treatment of a clavicular fracture: A rare complication]. / Thrombose der V. subclavia bei konservativ therapierter Klavikulaschaftfraktur: Eine seltene Komplikation.

We report the case of a 16-year-old male patient who presented with a clavicular fracture that was conservatively treated with a redressment bandage. After a few days the patient developed deep vein thrombosis of the subclavian, axillary and brachial veins, which was successfully treated with nadroparin. Conservative treatment of clavicular fractures is a common procedure in modern traumatology. Continuous, close monitoring and knowledge of rare but severe complications are necessary to avoid further complications.

Catheter-directed thrombolysis with percutaneous rheolytic thrombectomy versus thrombolysis alone in upper and lower extremity deep vein thrombosis.

PURPOSE: To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT). METHODS: A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT. RESULTS: Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 +/- 27.1 hr compared with 26.3 +/- 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 +/- 5.3 million units compared with 2.7 +/- 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT. CONCLUSION: Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.

[Paradoxic occurrence of symptoms of rheumatic fever after thrombolytic therapy with streptokinase--a case of delayed hypersensitivity?]. / Paradoxes Auftreten von Symptomen des rheumatischen Fiebers nach einer Lysetherapie mit Streptokinase--eine allergische Spätreaktion?

We report the case of a 51-year-old patient with a Paget von Schrötter-Syndrome of the right arm who underwent a successful lysis therapy with 9 x 10(6) IU streptokinase (Streptase) i.v. over 3 days. 36 h after ending the lysis therapy he developed a generalized eczema, which was interpreted as a drug-induced allergic reaction of the arthus type (Coombs III). He received methylprednisolone p.o. with an initial dose of 40 mg, tapered to 0 over 5 days. One day after the efflorent rash the patient developed fever for 12 h (with 38.8 degrees C maximum) and a gonarthritis of the left knee, and 24 h later of both knees. An echocardiogram showed a small pericardial effusion without hemodynamic influence. On the following 2 days a minimal proteinuria of 0.28 and 0.22 g/l was found. Subsequently and after a follow-up of 2 years, the patient was totally free of pathologic clinical and laboratory findings. We interpret this unusual case as a delayed hypersensitivity reaction to streptokinase with a paradoxical occurrence of clinical symptoms formally fulfilling the diagnostic criteria of "rheumatic fever".

[Occurrence of atypical histamine H2 receptors in the wall of the frog subclavian vein]. / O sushchestvovanii atipichnykh H2-gistaminovykh retseptorov v stenke podkliuchichnoi veny liagushki.

Selective H2-histamine agonist dimaprit was shown to produce relaxation of the isolated frog subclavian vein, with it persisting under the effect of selective H2-histamine antagonist cimetidine. Possible nonspecific mechanisms of relaxation produced by histamine are discussed. The data presented do not exclude that there are atypical H2-histamine receptors in subclavian vein of frogs, the activation of which initiates the attenuation of the active tension.