Annals of surgery
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Ten patients with pregangrenous and gangrenous changes of the toes in the presence of normal peripheral pulses are described. In the absence of diabetes this is an uncommon condition and is only rarely reported upon in the literature. Four patients had non occlusive arteriosclerotic changes in large arteries; three suffered from thrombocytosis and one from polycythemia vera; one patient had a monoclonal gamopathy and one was exposed to cold three months before the onset of gangrene. ⋯ In two patients anti-platelet aggregation agents provided relief. Toe amputation should be conservative and performed when definite demarcation appears between necrotic and viable tissue. This condition has a benign prognosis.
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Traumatic hemobilia is an uncommon complication of blunt or penetrating liver injury and is characterized by jaundice, biliary colic, gastrointestinal hemorrhage, and a recent history of abdominal trauma. The clinical diagnosis of hemobilia is confirmed by endoscopy and selective arteriography. Selective hepatic artery angiography will locate the site of bleeding, and determine the extent of liver injury. ⋯ The treatment of massive or persistent hemobilia is surgical drainage of hematoma and ligation of bleeding sites. Non-massive hemobilia may be treated conservatively with liver healing documented by serial selective arteriograms. The nonoperative treatment of a case of non-massive hemobilia with a good result is presented.