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The authors report a case of severe ischaemia following an injection of sclerosant for varicose veins in the legs and discuss the pathophysiology of this accident. It seems that such an accident requires the immediate injection of a massive dose of cortisone; an intravenous infusion containing 400 mg of hydrocortisone hemisuccinate, 400 mg of heparin, 400 mg of Praxilene and 4 ampoules of injectable Tranxene 50; admission to a competent unit, i.e. with experience of this type of accident and the techniques of haemodilution combined with steroid therapy and the use of calcium inhibitors, for example Aldalate, as peripheral antispasmodics. Finally, the authors discuss the precautions which need to be taken in order to avoid such accidents, even in the hands of experts.

Stress phlebitis of the upper extremity is in fact due to compression of the subclavian vein in the costo-clavicular space during certain movements, the effort being only a fortuitous component. Clinically, it evolves in two stages: at the stage of intermittent compression, the functional symptoms are related to certain positions of the upper extremity; the compression is identified clinically and with additional tests. Treatment includes physical therapy; however, persistence of the symptoms may result in having to consider the resection of the first rib. At the stage of organized phlebitis, the diagnosis is obvious although sometimes unrecognized, and the current consensus is to use anticoagulants: heparin followed by anti-vitamin K. From a medico-legal standpoint, stress phlebitis of the upper extremity is not considered a professional disease, but if it is possible to attribute it to a type of work requiring frequent upward positioning of the arms, there is an obligation for these patients to be rehabilitated professionally.

The frequency with which pulmonary embolism remains unrecognized clinically is well known and explains the value of pulmonary scintigraphy when there is the slightest suspicion of pulmonary embolism or in cases of unexplained dyspnoea of effort after a standard cardiac and pleuro-pulmonary examination. The practical value of a regular pre-operative electrocardiogram and of anticoagulant treatment during the acute phase of myocardial infarction are emphasized. Certain precautions to be observed during the use of antivitamins K in cases of heart failure are outlined.