1/14. Severe potential consequences of delayed diagnosis in patients with hip claudication.delayed diagnosis in patients with hip claudication can lead to severe consequences. We report on patients with ischaemic hip claudication which had primarily been attributed to coxarthrosis. One patient went through a variety of treatments including hip arthroplasty. The second patient had a life-threatening abdominal aortic aneurysm (AAA) which remained undiagnosed. Orthopaedic surgeons should maintain a high degree of suspicion for vascular disease. Moreover, we strongly advocate that all men over 60 years old who seek medical advice for whatever reason should be screened once for AAA by ultrasonography.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/14. Living with peripheral vascular disease: a review of the literature.Peripheral vascular disease is a debilitating condition that can significantly reduce a patient's quality of life. It affects mainly older people and causes severe chronic pain that can make even simple activities of daily living impossible. This paper reviews the literature on the management of PVD, with specific emphasis on the patient experience of living with the condition.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
3/14. Neurogenic pain and abnormal movements contralateral to an anterior parietal artery stroke.BACKGROUND: Unlike delayed pain syndrome, acute central pain is a very rare symptom in acute stroke. In addition, the incidence of hemiballismus in acute cerebrovascular diseases is less than 1%. To our knowledge, the association of these 2 clinical conditions has not been previously described. PATIENT AND methods: After observing one patient with hemiballismus accompanied by ipsilateral acute limb pain at stroke onset, we retrospectively examined more than 4000 patients in the Lausanne stroke Registry for hemiballismus-hemichorea occurring together with acute ipsilateral pain. RESULTS: Of the 29 subjects with hemiballismus-hemichorea, the observed patient was the only one to have acute pain at the onset of stroke. magnetic resonance imaging showed acute infarction in the territory of the right anterior parietal artery, whereas the basal ganglia, thalamus, and subthalamic region were intact. CONCLUSIONS: The syndrome of acute limb pain associated with hemiballismus may result from disconnection of the parietal lobe from deeper structures. In contrast with isolated hemiballismus, we suggest that the simultaneous occurrence of this movement disorder with ipsilateral pain is specific for an anterior parietal artery stroke.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/14. Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.OBJECTIVE: Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. CASE REPORT: We report a case in which failure of nerve stimulation to locate the sciatic nerve at the popliteal fossa in a patient with underlying neuropathy was overcome by ultrasound guidance, which allowed quick and easy catheter placement. After failure of the stimulation technique, ultrasound permitted us to observe advancement of the needle, placement of the catheter, and spread of local anesthetic around the nerve. CONCLUSION: Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
5/14. breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease.Two patients with collagen vascular disease (rheumatoid arthritis and scleroderma) had extremely poor cosmetic results after breast radiation therapy (RT). The patient with rheumatoid arthritis received 5251 cGy at 210 cGy per day, followed by a 1600 cGy iridium-192 implant boost. Between 8 and 11 months post-RT she had severe breast fibrosis, retraction, and pain that required a mastectomy for relief. The patient with scleroderma received 5040 cGy at 180 cGy per day without a boost. Between 1 and 4 months post-RT the systemic symptoms of scleroderma progressed and the breast became hard and retracted. Both rheumatoid arthritis and scleroderma are chronic systemic diseases characterized by severe inflammation and an autoimmune component. The presence of scleroderma at or before treatment should be considered a contraindication to breast RT, whereas the presence of active rheumatoid arthritis should be considered a relative contraindication. An autoimmune mechanism will be presented to explain both the fibrosis and the systemic progression of collagen vascular disease that was observed.- - - - - - - - - - ranking = 6keywords = vascular disease (Clic here for more details about this article) |
6/14. Thoracic endovascular stent graft placement: a case report.Endovascular stent grafting (EVSG) is a minimally invasive alternative to open repair of thoracic aortic aneurysms. It is useful in the treatment of thoracic aneurysms, dissections, and ruptures. Currently, the incidence of thoracic aortic aneurysms is 6:100,000 people. Comorbidities often include hypertension, coronary artery disease, chronic obstructive pulmonary disease, peripheral vascular disease, and cerebrovascular disease, and there often is a history of smoking. Without surgical intervention, a high risk of mortality exists, primarily due to aneurysm rupture. Due to the complexity of performing open surgical repair of the thoracic aorta and its associated morbidities such as paraplegia, renal failure, stroke, and prolonged ventilator support, new approaches to thoracic aneurysm repair are being investigated. When compared with open repair, stent grafting is a palliative rather than a curative treatment, and the risk of aneurysmal rupture still exists. This article describes a patient who underwent EVSG who had a history of abdominal aortic aneurysm repair and a known bovine arch.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
7/14. Continuous lumbar sympathetic block.A 74-year-old woman with peripheral vascular disease suffered from rest pain in the right big toe and intermittent claudication. Because of concomitant venous congestion, a chemical lumbar sympathectomy was considered to carry an increased risk of leg edema. A continuous lumbar sympathetic block with local anesthetic abolished the pain in the toe without side effects. After this reversible block, a chemical lumbar sympathectomy was performed producing pain relief for 4 weeks when the patient was last seen.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/14. Clinical application of infrared thermography in diagnosis and therapeutic assessment of vascular ischemic pain.Temperature is a very important and useful manifestation of various disease entities. The importance of body temperature as an indicator of disease has been known for centuries but in recent years attention has also been paid to how to conveniently and effectively make use of skin temperature as a diagnostic tool. skin temperature can be measured with thermocouples, electronic thermistor-thermometers, electronic integrators, liquid crystal thermography, and infrared thermography. The temperature of extremities is largely dependent on the blood flow through peripheral vessels, and in the study of vascular diseases thermography has been, therefore, found to be useful. Blood flow can be assessed by many methods including washout techniques or laser Doppler flowmetry. Of these, infrared thermography has the advantages of being noninvasive, remote from the patient when in use, and capable of producing multiple recordings at short time intervals. Here we present a case of vascular ischemic pain which was diagnosed and therapeutically assessed by thermography.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/14. The eosinophilia-myalgia syndrome with neuritis associated with L-tryptophan use.Causes of the eosinophilia-myalgia syndrome other than L-tryptophan include parasitic myositis (that is, trichinosis), acute tropical myositis, sarcoidosis, granulomatous myositis, polymyositis, collagen vascular diseases, neoplastic myositis, and eosinophilic myositis. Some of these can be excluded by the absence of associated findings, that is, sarcoidosis, collagen vascular disease, neoplastic myositis; or on epidemiologic grounds, for example, acute tropical myositis. A muscle biopsy is diagnostic for trichinosis and for granulomatous, neoplastic, and eosinophilic myositis. A normal erythrocyte sedimentation rate militates against but does not rule out neoplastic or collagen vascular disease-associated myositis. The erythrocyte sedimentation rate may be elevated in most of these disorders although trichinosis is characterized by a very low rate. Most conditions associated with eosinophilia are characterized by both blood and local tissue eosinophilia.- - - - - - - - - - ranking = 3keywords = vascular disease (Clic here for more details about this article) |
10/14. abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia.DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical decision making was requested.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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