1/4. Risk-factor profile in severe, generalized, obliterating vascular disease.A 74-year-old woman had a history over 25 years of endarterectomy of both renal arteries, iliac venous thrombosis, pulmonary embolism, left internal carotid artery endarterectomy, coronary angioplasty, aortocoronary bypass grafting, occlusion of the right axillary artery, lower-limb claudication due to common iliac artery aneurysm, external iliac artery stenosis, multiple femoral artery stenoses, bifurcational stent grafting, occlusion of the left brachial artery and the right external iliac artery, and stroke. Assessment of the risk-factor profile revealed an absence of classic risk factors but the presence of the factor v Leiden mutation, the methylenetetrahydrofolate reductase AI298C mutation, the HFE C282Y mutation, plasminogen activator inhibitor-1 gene mutation, the -455 G/A fibrinogen gene polymorphism, the epsilon3/epsilon4 apolipoprotein E -675 4G gene polymorphism, and hyperhomocysteinemia. This case shows that severe, generalized, occlusive vascular disease may be due to the combination of various genetic risk factors for atherosclerosis and venous thromboembolism.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/4. Digital angiography using hand-operated table movement for vascular disease of the pelvis and lower extremities.We developed a new technique using hand-operated table movement during digital angiography (DA) for the study of vascular disease of the pelvis and lower extremities. Digital video memory (DVM) is used in this technique to digitize, record, and display fluorographic images without subtraction in real time. This allows free table movement and the imaging of a large area with a single injection of contrast medium. Forty-five examinations for vascular disease of the pelvis and lower extremities were performed by this DA technique. Good images of an extensive area from the lower abdomen to the lower leg were obtained in a single study.- - - - - - - - - - ranking = 1.2keywords = vascular disease (Clic here for more details about this article) |
3/4. thrombocytopenia and lupus-like anticoagulant in a patient with peripheral vascular disease: response to infusion of prostacyclin.A 46 year old man with intermittent claudication due to severe peripheral vascular disease had a circulating lupus like anticoagulant (LLAC), thrombocytopenia (79 X 109/1), markedly reduced platelet survival and a normal bone marrow. He was treated with intravenous prostacyclin (PGI2) infusions which resulted in improvement of the patient's exercise tolerance and normalisation of his platelet count (300 X 109/1) and platelet aggregation could then be assessed. The platelets were markedly hyperaggregable and generated supranormal quantities of thromboxane a2. A diagnosis of consumptive thrombocytopenia secondary to peripheral vascular disease and platelet hyperaggregability was made. Despite therapy with aspirin and dipyridamole, gradual and progressive reduction in platelet count followed and his exercise tolerance declined over the next three months. Immunoglobulin prepared from the patient's serum did not inhibit vascular PGI2 synthesis in vitro. To our knowledge this is the first reported case of consumptive thrombocytopenia due to severe peripheral vascular disease and platelet hyperaggregability. PGI2 administration caused a transient resolution of these features which was not sustained by aspirin and dipyridamole.- - - - - - - - - - ranking = 1.4keywords = vascular disease (Clic here for more details about this article) |
4/4. Patient assessment and examples of a method of treatment. Use of the circulator boot in peripheral vascular disease.Effective peripheral blood flow is positively related to cardiac output and gravity (part dependent) and inversely related to gravity (part elevated), venous pressure, interstitial fluid pressure, degree of peripheral neuropathy, arteriosclerotic and thrombotic arterial obstructions, and infection. These factors are considered in the operation of the end-diastolic pneumatic boot in the treatment of illustrative patients with lymphedema, venous stasis disease, peripheral arteriosclerosis obliterans, peripheral neuropathy, cellulitis, and osteomyelitis and the failing heart. A method of treatment that includes the use of the boot and the injection of local antibiotics is described.- - - - - - - - - - ranking = 0.8keywords = vascular disease (Clic here for more details about this article) |