Introduction: This case describes a brachial artery mycotic aneurysm (BAMA) secondary to infective endocarditis caused by Enterococcus faecalis. BAMAs are rare and potentially limb or life threatening. A literature review revealed 61 cases since 1950, primarily caused by intravenous drug use, with Staphylococcus aureus being the most common causative bacteria. Report: A 71 year old man with known infective endocarditis presented with pulsatile swelling in his right antecubital fossa. A BAMA was confirmed on duplex scan. The patient underwent prompt extra-anatomic bypass with an ipsilateral cephalic vein graft. Discussion: Bacterial endocarditis should be acknowledged as a cause of BAMA. Prompt diagnosis and intervention are essential.
We enjoyed the recent editorial by Nestor et al. [1] and were particularly struck by the comment that "the use of off-label or unlicensed drugs. . .is rife in our specialty." This comment reflects the high incidence of the practice of mixing remifentanil with propofol, especially in paediatric practice by 38% of survey respondents [2], although this survey has not been without criticism. The same editorial argues that "safety is usually only regarded as proven once a drug or
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