case of limb gangrene secondary to accidental intra-arterial (I.A.) diazepam injection in an infant is described. Hazards of I.A. diazepam injection, the possible mechanisms leading to this injury, the preventive measures and the therapeutic modalities are discussed.

We present an elbow disarticulation due to accidental intra-arterial injection of diazepam. Considering the risk of inadvertent and accidental intra-arterial injection of diazepam and its subsequent severe sequelae that are reported in the literature, we emphasize that intravenous diazepam should be administered with more hesitancy and care.

Introduction: Cutaneous Mucormycosis is a rare opportunistic infection caused by Zygomycetes class of fungi that is often fatal, requiring aggressive local control as well as systemic therapy. Few cases of mucormycosis were described in patients with liver cirrhosis, mostly rhino-orbital. To our knowledge, only two cases of upper extremity involvement was reported in cirrhosis while a few cases were reported in the post-transplant setting. We report herein the third case of upper extremity mucor infection in the setting of liver cirrhosis.Case Presentation: We described a rare case of forearm infection originating in a traumatic intravenous access portal in a 25 year-old woman with liver cirrhosis secondary to autoimmune hepatitis.Discussion: She developed acute on chronic liver failure during the last trimester of pregnancy, which was terminated. Painful, erythematous lesion was noted on her right forearm in the area of intravenous access, which later became necrotic. Extensive debridement was done and histopathological examination confirmed the diagnosis of mucormycosis. The patient started on Amphotericin B. Her condition continued to deteriorate and ended up with above elbow amputation followed by right shoulder disarticulation. She died two days later due to multi-organ failure. In conclusion, forearm mucromycosis in liver cirrhosis can be fatal.

INTRODUCTION: Subclavian artery thrombosis is a condition in which the blood flow through the vessel is suddenly obstructed. In fact, occlusion occurs in one of subclavian arteries, especially in the left subclavian artery. A patient with an acute occlusion presents with a cold, painful, cyanosis, pulseless upper extremity. CASE REPORT: A 48 years old lady admitted to Imam Khomeyni hospital (Sari, Iran) with a history of acute left upper limb pain. On examination, her left hand was cold, blue and painful on active and passive movements. Her left axilliary pulse was detected with no brachial or ulnar pulses. Left subclavian angiography showed a large thrombus in the proximal part of her left subclavian artery, the other sites of artery were normal. She had an elbow amputation in Tehran later.CONCLUSION: Therapeutic intervention is indicated in any symptomatic patient. Rapid diagnosis and treatment of thrombosis of subclavian artery prevent ischemia and gangrene of upper extremity. Subclavian artery thrombosis is uncommon cause of acute upper extremity ischemia, but should always regard to it. A true history and physical exam could be established rapid diagnosis and prevented side effects such as gangrene and amputation of upper extremity.

Objectives: Multiple limb amputations are an uncommon complication from inotrope-induced peripheral gangrene. Case Presentation: A 20-year-old lady with valvular heart disease had septic shock secondary to infective endocarditis and required prolonged cardiopulmonary resuscitation. Despite aggressive fluid resuscitation, the patient had triple strength intravenous noradrenaline to maintain hemodynamic stability. On day 5 of post-shock, dry gangrene occurred in distal parts of all limbs, and inotrope was stopped. Although the gangrenous changes were non-progressive, she required a significant degree of assistance with mobility and daily function performance. The patient was counseled for multiple limb amputations to promote walking and hand function through prosthetic restoration. Five months after the event, she had a right transtibial amputation, left Chopart amputation, left wrist disarticulation, and right second, third, fourth, and fifth fingers amputation. Three specific goals for inpatient rehabilitation were independent short-distance ambulation with prostheses, performing basic activities of daily living with adaptive devices, and independent wheelchair propulsion for long-distance mobility using a right-sided transtibial prosthesis, left-sided Syme's prosthesis with Kingsley's foot, right-sided silicone-based cosmetic glove and left-sided body-powered transradial prosthesis. Discussion: Although an uncommon complication, inotrope may lead to multiple limb amputations secondary to peripheral gangrene. Following amputation, the ultimate rehabilitative goal is to restore the mobility and capacity to perform daily functions through prosthetic restoration, whether walking for lower amputees or functioning hand for upper limb amputees. Prescribing prosthesis in a single limb loss is relatively straightforward, but restoring multiple limb amputations bears many challenges toward successful recovery of walking and functions.