1/21. 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) |
2/21. One pair must last a lifetime. Foot care and vascular disease.This is the second in a series of articles on foot care relating to various clinical conditions.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
3/21. Digital necrosis related to carboplatin and gemcitabine therapy in systemic sclerosis.We present a woman with scleroderma who developed multiple ischemic digits after chemotherapy for lung cancer. The ischemia started during treatment with carboplatin and gemcitabine and required amputation of the affected digits. A review of the literature shows that thrombotic episodes coinciding with chemotherapy are not uncommon, though venous thrombosis occurs more frequently than arterial. Scleroderma patients are at particular risk for digital infarction because of their underlying vascular disease and associated Raynaud's phenomenon. This case illustrates the risk of severe digital ischemia and digital loss in patients with scleroderma during chemotherapy with carboplatin and gemcitabine.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/21. Marked reduction in serum high-density lipoprotein cholesterol concentrations in a woman with acute inflammation due to diabetic gangrene.BACKGROUND: c-reactive protein (CRP) is a well-established, sensitive marker of systemic inflammation and the risk of cardiovascular disease. High-density lipoprotein (HDL) is an anti-atherogenic lipoprotein known to be regulated by genetic and acquired factors. methods: The patient was a 77-year-old Japanese woman, who was diagnosed with type 2 diabetes mellitus (DM), with a body height of 152 cm and a weight of 65 kg (body mass index 28.1 kg/m2). She suffered from diabetic foot gangrene in her right foot with high-grade fever when she visited our hospital. Her plasma glucose (PG) concentration and serum CRP were markedly elevated being 21.6 mmol/l and 370 mg/l, respectively, while her serum HDL-C concentrations were markedly low being 0.13 mmol/l. She was immediately admitted to our hospital and received intensive insulin treatment, along with intravenous-administration of antibiotics. Her general conditions were gradually improved and the high-grade fever disappeared, with concentrations of plasma PG and serum CRP being reduced, and concurrent reciprocal increase in her serum HDL-C concentrations. RESULTS: To determine the potential causative factors responsible for the drastic change in serum HDL-C concentrations, we investigated the relationship of serum HDL-C to serum CRP, serum total protein (TP) and PG. serum CRP and PG showed inverse relationships with serum HDL-C, while serum TP concentrations showed a positive association with HDL-C. After multivariate analyses with CRP, TP and PG as independent variables and serum HDL-C as dependent variable, CRP maintained its independent association with serum HDL-C. CRP also showed inverse correlations with lipoprotein lipase (LPL) mass and cholesteryl ester transfer protein mass. CONCLUSIONS: In acute inflammation and poorly controlled diabetes, CRP is suggested to be inversely associated with serum HDL-C, independent of PG and TP.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/21. Thrombotic microangiopathy and digital necrosis: two unrecognized toxicities of gemcitabine.We report one new case of hemolytic-uremic syndrome (HUS) and one case of digital necrosis after treatment with gemcitabine (Gemzar). Case 1, a 34-year-old man, was given first-line metastatic treatment with gemcitabine for a adenocarcinoma of the pancreas. After a cumulative dose of 10 000 mg/m2 gemcitabine, the onset of subacute renal failure associated with hemolytic anemia of mechanical origin was observed. A diagnosis of probable gemcitabine-induced thrombotic microangiopathy was arrived at. Symptoms resolved after stopping the chemotherapy, in spite of the progression of the disease. Case 2, a 61-year-old man, was administered a combination of gemcitabine and a platinum salt as first-line metastatic treatment for carcinoma of the bladder urothelium. Following a cumulative dose of 10 000 mg/m2 of gemcitabine, the patient suffered from bilateral peripheral vascular disease of somewhat acute onset with hemorrhagic lesions of the finger pads that became necrotic. The work-up was negative and a causal relationship was attributed to gemcitabine. The patient made good progress when given an i.v. infusion of Ilomedine (iloprost trometamol) and chemotherapy was withdrawn. We conclude that gemcitabine must be added to the list of drugs that cause HUS and necrotizing vasculitis.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/21. Complete gangrene of penis in patient with arterial vascular disease.We present a clinical case of distal penile gangrene in a patient with peripheral vaso-occlusive disease that did not correlate with the extension of the intraoperative finding and required total penectomy. Surgical intervention at the onset of wet gangrene avoids the complication of sepsis.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
7/21. Trench foot following a collapse: assessment of the feet is essential in the elderly.Elderly patients commonly present to hospital following a collapse and period of distressing immobilisation on the floor. We present a case of bilateral trench foot in such a patient with no prior peripheral vascular disease. Examination of the feet is mandatory for early detection of this rare condition in the collapsed elderly patient.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/21. Treatment of peripheral gangrene due to systemic sclerosis with intravenous pentoxifylline.Vascular problems are very common in systemic sclerosis with 95% of patients suffering with Raynaud's phenomenon at some stage in their illness. Acute ischaemic lesions are much less common, but when they occur are a serious complication, and are often difficult to treat. Many drugs have been used in this situation, including both oral and intravenous vaso-dilators and low molecular weight dextran, each with varying degrees of success. The phospho-diesterase inhibitor, pentoxifylline, is reported to be useful in peripheral vascular disease, and in Raynaud's phenomenon, and the intravenous form is indicated for acute peripheral ischaemia, though its use in the context of connective tissue disease has not so far been reported. We now report the use of intravenous pentoxifylline in two patients with acute peripheral gangrene due to systemic sclerosis.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/21. Recognition and treatment of arterial insufficiency from cafergot.Cafergot is a combination of ergotamine tartrate and caffeine and may cause symptoms of peripheral vascular insufficiency. Iatrogenic ergotism should be suspected in any patient exhibiting ischemic symptoms while receiving this medication. Progression to fulminant necrosis and gangrene can occur. Two cases are presented and the management reviewed. This effect of ergotamine tartrate and caffeine may be an idiosyncratic hypersensitivity reaction with therapeutic doses or may result from excessive medication. Iatrogenic ergotism occurs most often in women in their mid-thirties with migraine syndrome. By alpha-adrenergic agonism, as well as by possible interactions with prostaglandins, calcium, and serotonin, ergotamine causes vasoconstriction of both arteries and veins. The angiographic pattern of spasm, collateral formation, and intravascular thrombi is typical. Treatment of ergotism depends on the severity of the symptoms and the possibility of gangrene. Discontinuation of ergotamine, cigarette smoking, and caffeine may be all that is necessary in most patients. nitroprusside is the drug of choice in the treatment of acute vascular insufficiency from ergotism, but in a less urgent situation, prazosin has also been effective. Intra-arterial balloon dilatation has also been helpful. Other forms of therapy have been supportive and the results inconsistent. Cafergot should be used with extreme caution in patients with renal or hepatic failure, peripheral vascular disease, or pregnancy. Relative contraindications include hypertension, ischemic heart disease, and Raynaud's phenomenon.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/21. Prostacyclin in severe peripheral vascular disease.Prostacyclin (prostaglandin I2, epoprostenol sodium) arrested the progress of gangrene in the feet of a 6 year old boy with familial but otherwise unexplained peripheral vascular disease. Toe regrowth is now occurring at the line of demarcation.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
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