Anticoagulation therapy for postoperative deep vein thrombosis coupled with pulmonary embolism: a potential trigger for delayed popliteal artery injury presentation after total knee arthroplasty.

OBJECTIVES: A case of delayed popliteal artery injury (PA-INJ) onset after total knee arthroplasty (TKA) in a patient under postoperative anticoagulation therapy is reported. The role of anticoagulation both in late PA-INJ presentation and in PA-INJ management is discussed. REPORT: An obese 76-year-old woman was presented with a common femoral vein thrombosis coupled with pulmonary embolism five days after TKA. She was immediately placed under anticoagulation therapy. Four days later, during physiotherapy-supervised mobilization, she developed a calf haematoma and large retro-articular pseudoaneurysm. Angiography revealed a minor PA-INJ successively treated with a covered stent-graft. CONCLUSIONS: In cases of initially undetected and staunched TKA-related PA-INJs, postoperative anticoagulation therapy may act as a potential trigger for final arterial rupture during mobilization exercises, followed by acute bleeding; in these cases, endovascular management represents an excellent treatment option. Close clinical and instrumental monitoring is strongly recommended after TKA, in patients who imperatively require full-dose anticoagulation therapy.

Basilar artery thrombosis: imaging and endovascular therapy.

PURPOSE: Basilar artery thrombosis represents a rare type of ischaemic stroke with a mortality rate of 80%-90% if not promptly treated. The aim of our study was to review our experience with computed tomography angiography (CTA) in the diagnosis of basilar artery thrombosis and its treatment with endovascular procedures. MATERIALS AND METHODS: Our retrospective study is based upon 59 nontrauma patients with episodes of sudden loss of consciousness. Patients were investigated using unenhanced brain CT followed by intracranial CTA (16-slice CT) when no parenchymal haemorrhage was detected. Patients with a CTA diagnosis of basilar artery thrombosis were considered for endovascular treatment. CTA accuracy was evaluated by considering the 12 patients who underwent endovascular angiography (the gold standard). The success of endovascular therapy was evaluated by considering the degree of microcirculatory reperfusion. RESULTS: After the exclusion of 33 patients affected by parenchymal or subarachnoid haemorrhage, the final study consisted of 26 patients who underwent CTA. Basilar artery thrombosis was diagnosed in 15 of them, and 12 were treated at our institution. The comparison between CTA and endovascular angiography showed 100% agreement in evaluating occlusion site and extension. Seven patients underwent intra-arterial lysis, and five underwent mechanical clot removal. CONCLUSIONS: CTA, with its wide availability and rapid execution times, is the most indicated examination in the case of suspected basilar artery thrombosis. Although there is a lack of randomised controlled prospective studies suggesting the most appropriate therapeutic approach to basilar artery thrombosis, our study lends weight to the role of interventional neuroradiology in the treatment of this condition.

Histamine in wine. Bronchoconstriction after a double-blind placebo-controlled red wine provocation test.

A 38-year-old woman with a history of seasonal rhinoconjunctivitis reported repeated attacks of wheezing after drinking various alcoholic beverages. Two consecutive histamine provocations using two identical samples of red wine containing 200 micrograms histamine/l and 3,700 micrograms/l, respectively, were performed in a double-blind placebo-controlled fashion to assess a possible histamine-induced bronchoconstriction. Lung function, plasma histamine, skin temperature, pulse rate and symptoms were assessed. In 3 male controls, four consecutive wine tests were performed in a randomised double-blind placebo-controlled fashion. Drinking wine with 3,700 micrograms histamine/l caused coughing and wheezing with a decrease in lung function. Plasma histamine showed an increase at 10 and 20 min and decreased at 30 min both after histamine-rich as well as histamine-poor wine, reaching the peak increase after histamine-rich wine. Controls did not react and plasma histamine levels did not increase. Bronchoconstriction after wine or food rich in histamine seems to be caused by diminished histamine degradation on the basis of reduced activity of diamine oxidase. Histamine in wine may induce bronchoconstriction in patients suffering from histamine intolerance.

Anaphylaxis after dental treatment with a formaldehyde-containing tooth-filling material.

A 67-year-old patient developed systemic reactions after application of a formaldehyde-containing tooth filling. She had a clearly positive RAST result for formaldehyde, whereas skin prick testing and patch tests were negative. Sensitization to formaldehyde appears to have occurred 1 year previously. Induction of formaldehyde allergy may represent a major complication during dental treatment, and assessment of specific IgE should be considered in patients at risk.