Occlusion of the common femoral artery by cement after total hip arthroplasty: a case report

The incidence of vascular injuries after total hip arthroplasty is extremely low. In this report we describe an unusual injury to the common femoral artery. A 59-year-old Caucasian woman presented with rest pain, numbness and cramps in the operated limb after hip replacement. Cement leakage under the transverse ligament had caused occlusion of the common femoral artery necessitating vascular reconstruction. She had a good functional recovery at follow-up. To the best of our knowledge, this is the first well-documented case reporting this pathomechanism of vascular lesion to the femoral artery. This case report highlights the potential risk of such a limb-threatening complication, and awareness should lead to prevention by meticulous surgical technique (correct technique of pressurization) or to early detection of the lesio

A rare case of arterial avulsion presenting with occult blood loss following total hip arthroplasty: a case report

INTRODUCTION: Iatrogenic arterial damage during total hip replacement is a rare but potentially life- or limb-threatening complication. To the best of our knowledge, this is the first reported case of an avulsion injury to a posterior branch of the profunda femoral artery during primary hip arthroplasty. CASE PRESENTATION: We describe the case of a 55-year-old Caucasian man who underwent a total hip replacement. The patient's hemoglobin levels dropped postoperatively, but there was no obvious bleeding, hemodynamic instability, pulsatile mass, or limb ischemia. The patient's hemoglobin levels continued to drop despite nine units of transfused blood. Three days after surgery, the patient underwent an angiography that showed an avulsion injury to a posterior branch of the profunda femoral artery. The avulsion was ligated and the hematoma was evacuated. CONCLUSION: Vascular damage may present in many ways including obvious bleeding, haemodynamic instability, a pulsatile mass, limb ischemia, and occult blood loss. Any of these signs in isolation or in combination could represent a vascular injury and an urgent angiogram should be considered

Autoimmune encephalomyelitis in NOD mice is not initially a progressive multiple sclerosis model.

OBJECTIVE: Despite progress in treating relapsing multiple sclerosis (MS), effective inhibition of nonrelapsing progressive MS is an urgent, unmet, clinical need. Animal models of MS, such as experimental autoimmune encephalomyelitis (EAE), provide valuable tools to examine the mechanisms contributing to disease and may be important for developing rational therapeutic approaches for treatment of progressive MS. It has been suggested that myelin oligodendrocyte glycoprotein (MOG) peptide residues 35-55 (MOG35-55 )-induced EAE in nonobese diabetic (NOD) mice resembles secondary progressive MS. The objective was to determine whether the published data merits such claims. METHODS: Induction and monitoring of EAE in NOD mice and literature review. RESULTS: It is evident that the NOD mouse model lacks validity as a progressive MS model as the individual course seems to be an asynchronous, relapsing-remitting neurodegenerative disease, characterized by increasingly poor recovery from relapse. The seemingly progressive course seen in group means of clinical score is an artifact of data handling and interpretation. INTERPRETATION: Although MOG35-55 -induced EAE in NOD mice may provide some clues about approaches to block neurodegeneration associated with the inflammatory penumbra as lesions form, it should not be used to justify trials in people with nonactive, progressive MS. This adds further support to the view that drug studies in animals should universally adopt transparent raw data deposition as part of the publication process, such that claims can adequately be interrogated. This transparency is important if animal-based science is to remain a credible part of translational research in MS.Stichting MS ResearchWellcome TrustMedical Research CouncilNational Multiple Sclerosis Society. Grant Number: RG4132A5/

Spinal cord stimulation for unreconstructible chronic limb ischaemia

There is still a lack of prospective randomised studies; at the present we know of only one by Jivegard et al. on a relatively small number of 51 patients. Their results are encouraging, tissue loss being reduced significantly and a trend towards increased limb salvage. The results of ongoing Dutch and American studies are awaited. It has however been shown in convincing microcirculatory studies by Jacobs et al. and others that SCS has a positive effect. Wide clinical experience has also substantiated this; were this not the case it would be hard to understand why elaborate studies by Augustinsson, Meyerson and the prolific work of Linderoth should ever have been designed. Recent communications by Lo Gerfo and others have shown that it is important to visualise the arterial tree all the way down to the foot by selective angiography before pronouncing a leg as non-reconstructible. The 3- and 5-year patency results of femoro- and popliteo-pedal bypass surgery presented by Lo Gerfo are so extraordinary--albeit probably unreproducible by all vascular surgeons--that SCS must be restricted to the truly unoperable or unreconstructable cases of CLI. SCS therefore is definitely not meant to be an alternative to reconstructive techniques!(ABSTRACT TRUNCATED AT 250 WORDS