1/25. Thermal biofeedback for claudication in diabetes: a literature review and case study.temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/25. A fatal case of craniofacial necrotizing fasciitis.A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occurred with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. streptococcus and staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/25. Two cases of penile necrosis in diabetics with end-stage renal failure.Distal penile necrosis associated with renal failure is a rare entity; only a few cases have been reported in the literature. Penile necrosis can frequently be a difficult management problem, the etiology of which is infectious, traumatic, or vascular. Physiological abnormalities are usually found in association with this condition, including diabetes, hyperparathyroidism, and peripheral vascular disease. Penile necrosis is a poor prognostic factor associated with high morbidity. We report two cases of this condition, presenting the clinical and pathophysiological background.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/25. Diabetes-associated cardiovascular risk factors.Cardiovascular disease is the biggest killer in the UK and diabetes puts people at increased risk of this disease. The role of nurses in reducing cardiovascular risk in diabetes is explored.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/25. Acute renal failure secondary to angiotensin ii receptor blockade in a patient with bilateral renal artery stenosis.A 54-year-old man with diabetes mellitus, peripheral vascular disease, and hypertension was admitted to the hospital for an acute exacerbation of chronic heart failure. Therapy with intravenous furosemide and oral losartan 100 mg twice/day was begun. Ten days later, the patient's blood urea nitrogen and serum creatinine levels rose and peaked at 110 and 6.0 mg/dl, respectively. His serum potassium level increased to 5.7 mg/dl, urine output dropped to 400 ml over 24 hours, and mental status changes occurred. magnetic resonance angiography revealed bilateral renal artery stenosis. After losartan was discontinued and hemodialysis was performed for 3 consecutive days, the patient's renal function returned to his baseline level. Reports in the medical literature reinforce the importance of recognizing that angiotensin-converting enzyme inhibitors should be used with caution in patients with bilateral renal artery stenosis. However, the literature is not as definitive about using of angiotensin ii receptor blockers (ARBs) in these patients. Our patient's experience suggests that ARBs should be used with caution in patients with bilateral renal artery stenosis. Clinicians should be aware that renal failure might occur when using ARBs in these patients.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/25. The medial gastrocnemius muscle flap in the treatment of wound complications following total knee arthroplasty.There is greater potential for wound healing complication in rheumatoids, diabetics, and other patients with peripheral vascular disease. Local wound care in areas of avascularity and skin necrosis has poor results, especially if an ulcer is greater than 2 cm in diameter. Gastrocnemius muscle flap coverage of persistent wounds and areas of skin necrosis following total knee arthroplasty should be considered early in the course of such a complication.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/25. hypertension, the endothelial cell, and the vascular complications of diabetes mellitus.hypertension is a major factor that contributes to the development of the vascular complications of diabetes mellitus, which primarily include atherosclerosis, nephropathy, and retinopathy. The mechanism of the pathophysiological effects of hypertension lies at the cellular level in the blood vessel wall, which intimately involves the function and interaction of the endothelial and vascular smooth muscle cells. Both hypertension and diabetes mellitus alter endothelial cell structure and function. In large and medium size vessels and in the kidney, endothelial dysfunction leads to enhanced growth and vasoconstriction of vascular smooth muscle cells and mesangial cells, respectively. These changes in the cells of smooth muscle lineage play a key role in the development of both atherosclerosis and glomerulosclerosis. In diabetic retinopathy, damage and altered growth of retinal capillary endothelial cells is the major pathophysiological insult leading to proliferative lesions of the retina. Thus, the endothelium emerges as a key target organ of damage in diabetes mellitus; this damage is enhanced in the presence of hypertension. An overall approach to the understanding and treatment of diabetes mellitus and its complications will be to elucidate the mechanisms of vascular disease and endothelial cell dysfunction that occur in the setting of hypertension and diabetes.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/25. Necrotizing fasciitis in irradiated tissue from diabetic women. A report of two cases.Two diabetic women with pelvic malignancies developed necrotizing fasciitis within the irradiation fields. Despite aggressive surgical and medical therapy, both died when their health became too unstable for them to tolerate further surgery to resect the residual infection. We attribute their poor outcome to several factors. First, postradiation tissue changes obscured the early clinical findings necessary for a prompt diagnosis and made the identification of adequate surgical margins difficult. Second, diabetic patients have increased susceptibility to this infection. Third, the cumulative effects of radiation, diabetes mellitus and other factors that are common in patients with gynecologic malignancy (advanced age, vascular disease, obesity) favor the development, progression and persistence of necrotizing fasciitis. Radiographic studies were helpful in defining the extent of the infection in one patient.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/25. risk factors and clinical manifestations of pathologically verified lacunar infarctions.review of 2,859 autopsy reports disclosed lacunar infarctions in 169 patients (6%). review of the charts of 167 of these patients revealed hypertension in 64%, diabetes in 34%, smoking in 46%, and no known risk factor for cerebrovascular disease in 18%. As many as 81% of the patients with lacunes were asymptomatic. Symptomatic lacunes presented most commonly as pure motor hemiparesis (31%), aphasia plus right hemiparesis (20%), or sensorimotor dysfunction (11%); none presented as pure sensory stroke. These results suggest that the spectrum of lacunar infarction is more heterogeneous than previously thought. Most lacunes are asymptomatic, and the majority of symptomatic patients do not present with "classical" lacunar syndromes.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/25. Orthostatic hypotension as a risk factor for symptomatic occlusive cerebrovascular disease.Thirteen patients presented with brief, repetitive, stereotyped transient ischemic attacks, large artery atherostenoses or occlusions with impaired collateral flow to a cortical perfusion borderzone, and orthostatic hypotension (OH). OH was caused by diabetes mellitus, aging, and treatments for ischemic heart disease and hypertension. Medical management of OH often eliminated the need for stroke prevention measures such as surgery or anticoagulation. Focal cerebral hypoperfusion from the combination of occlusive vascular disease and OH may be an underreported, treatable cause of TIA and stroke.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
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