[An unusual embolization of a projectile in the superficial femoral artery]. / Neobvyklá embolizace projektilu do povrchní stehenní tepny.

The authors present an account on a gunshot wound which penetrated into the lateral side of the distal chest on the right. They describe acute treatment of severe haemorrhagic shock by suture of a lacerated with liver segment and resection of the upper pole of the right kidney. The projectile was not searched for because of the patients general serious condition. After 30 days the patient was discharged in a good condition. Shortly after discharge, i.e. cca one month after the injury, the patient developed signs of chronic ischaemia of the left lower extremity-finally claudications after 150 meters. Based on peripheral arteriography, which revealed the projectile in the area of the beginning of the superficial femoral artery and an ample collateral circulation, surgery was initiated. The bullet was extracted from the lumen of the superficial femoral artery from longitudinal arteriotomy. The artery was then treated by thrombectomy and a venous patch. Peroperative arteriography indicates satisfactory passage into the periphery. The authors try to reconstruct the pathway of the shot and in particular how the projectile penetrated into the artery. They emphasize the necessity to look for the projectice at the site of the shot wound. The objective of the paper is to make readers familiar with a case of uncommon embolization of a projectile into the superficial femoral artery and mistakes which may occur during treatment of a gunshot wound. The result is that the patient is quite free from complaints, as was confirmed by repeated out-patient check-ups.

Case management of pregnant and parenting female crack and polydrug abusers.

The increasing use of crack-cocaine among addicted women and subsequent births of polydrug-exposed infants prompted the State of Florida to undertake initiatives to seek solutions to these problems. This study, focused on one of these initiatives, explored the relationship between service components of a comprehensive treatment program and substance-free time among 120 African American and Caucasian crack-cocaine addicted women. Findings from a multiple regression analysis indicated that aftercare management (p < .0001), vocational services (p < .02), and residential treatment (p < .03) were statistically significant services associated with substance-free time. Although these findings are not conclusive, they are supportive of a growing body of literature that suggests that crack-using and polydrug-using women can be responsive to treatment when it is tailored to their individual needs and includes long-term community support.