[Livedoid paralytic syndrome secondary to intramuscular injection of benzathine-penicillin].
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This paper presents a 26-year-old woman with the characteristic features of Gardner-Diamond syndrome: recurrent painful bruises reproducible by intradermal injection of autologous red blood cells, and a "hysterical" personality pattern together with nonspecific multisystem complaints.
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During a meningococcal outbreak, 221 patients were studied. A skin rash was present in 78 (35.3%) patients. Twenty one (11.3%) patients had a frankly purpuric rash, involving mainly the extremities and the remaining had a generalised macular or petechial lesions. Extensive purpuric lesions, involving mainly the extremities were associated with disseminated intravascular coagulation (DIC), shock and a fatal outcome. This peripherally distributed rash may be used as a clinical substitute for the laboratory tests that confirm DIC.
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We report the intraarterial injection of a flunitrazepam tablet dissolved in water in a patient with intravenous drugs addiction. Several ecchymotic lesions were present at different sites of the arm. In order to achieve analgesia and the sympathetic blockade of the arm, we performed an axillary perivascular block of the brachial plexus by means of the intermittent injection through a catheter of 0.25% bupivacaine with a 1:200,000 epinephrine solution. In addition, an anticoagulant treatment with heparin was started as prophylaxis of the thrombosis of the vessel. There was a satisfactory clinical course even though a distal phalange had to be amputated on the 18th day. We propose the continuous perivascular block as the method of choice of this type of medical problem.
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A 79-year-old woman with primary biliary cirrhosis was admitted with esophageal variceal hemorrhage. She was initially managed with sclerosing of esophageal varices with no relief from the bleeding. Intravenous Vasopressin was started, but had to be discontinued because of cutaneous changes. A portocaval shunt was performed to control the variceal bleeding. Postoperatively she did poorly from sepsis and hepatic encephalopathy and died 46 days after admission to the hospital.