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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review examines the pathology, clinical effects and physiological disturbances produced by vascular disease and autonomic neuropathy in the lower limb in diabetic subjects. Atherosclerosis is a major factor in causing foot lesions in diabetics. The distribution of the disease frequently makes vascular reconstructive surgery difficult or impossible but an aggressive approach to reconstruction is justified because the results of major amputations are bad. Arterial calcification probably has no significant effect on the blood supply to the foot. There is some evidence that disease of arteries in the foot may be associated with the development of ulcers or gangrene. Disease of the arterioles and capillaries is frequent, but there is little evidence that this microangiopathy causes lesions. Autonomic neuropathy affecting the limb is also common, and although there are several mechanisms by which this might predispose to ulcers or gangrene, there is little evidence of such a direct relationship. In a patient presenting with ulceration or gangrene of the foot it is often impossible to determine the relative roles of vascular disease, affecting large or small vessels, and neuropathy, either somatic or autonomic, in the development of the lesion. Further progress depends on the development of more direct methods for assessing microvascular and autonomic nervous function.
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PMID:Vascular disease and vascular function in the lower limb in diabetes. 652 89

Authors review 1360 lower limb amputations for ischemic gangrene. The incidence of postoperative malignant edema of the stump was found to be 0.2 to 0.4%, and the distribution was favourable to encourage amputating surgeons to choose possibly distal levels even in case of vascular disease.
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PMID:The risk of malignant edema following lower limb amputation for ischemic gangrene. 663 12

A total of 160 consecutive diabetic patients were examined for hand and foot ulcers. We found 6 patients with ulcers of the hand. Antecedent trauma, all trivial, was noted in all the patients with ulcers. Five patients with foot ulcers had peripheral neuropathy and 1 patient had occlusive vascular disease. Only 3 of the 10 diabetic foot cases had a history of trauma. The mean age of the patients with hand and foot ulcers was 43 years and 56 years respectively. Staphylococcus was the commonest isolate. Digital gangrene was a more common complication in hand ulcers compared with the foot.
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PMID:Hand and foot ulcers in Nigerian diabetics - a comparative study. 667 Jan 19

The long-term complications of diabetes mellitus occur despite insulin therapy. One of these complications is gangrene of an extremity which is a prime cause of morbidity and mortality in diabetic patients. Peripheral occlusive vascular disease frequently underlies the gangrene and this challenges the surgeon to revascularize the limb and to limit the amputation to the gangrenous tissue. The author describes six diabetic patients with gangrene of an extremity treated at the Riverside Hospital in Ottawa to illustrate how this condition may be managed by revascularization with no amputation or with conservative amputation and debridement. Major amputation was avoided in all six patients.
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PMID:Management of gangrene in diabetic extremities. 674 48

We reviewed diabetic gangrene in 104 American blacks and found that the clinical features were similar to those reported for the general diabetic population. We observed, however, that there was a significant association of hypertension with above-knee and bilateral amputations in our patients (P less than .001 and .01, respectively), and that the mean blood pressure of the bilateral amputees (124.5 +/- 3.8 mm Hg) (SEM) was significantly higher (P less than .005) than that of the unilateral amputees (114.4 +/- 1.7 mm Hg). There results suggest a strong association of hypertension with far-advanced occlusive vascular disease of the lower limbs. Moderately severe anemia (hematocrit 20% to 30%) was associated significantly with primary above-knee amputation and mortality (P less than .02 and .05, respectively). Mortality resulted mostly from mixed causes (cardiopulmonary failure, uremia, sepsis, diabetic coma). The dead patients had significantly increased prevalence of cardiac disease (P less than .02), higher frequency of above-knee amputation (P less than .01), and a duration of diabetes (17.4 +/- 2.8 years) significantly longer (P less than .025) than that of the surviving patients (12.0 +/- 1.0 years).
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PMID:Diabetic gangrene in black patients. 706 2

In summary, definitive answers to the many questions regarding femoropopliteal and femorodistal bypass grafting are not available. The results vary widely for many reasons. Although many aspects of vascular surgery do not lend themselves to scientific investigation by randomized, controlled, prospective studies, some of these questions can be answered by such studies. Since large numbers of patients may be required for prolonged follow-up, multicentre cooperative studies can provide meaningful data. There is also a need for standardization of follow-up techniques. The classification of vascular disease by symptoms and presentation such as claudication, rest pain, ischemic ulcers pregangrene and gangrene is inadequate and highly subjective. A more objective classification is essential, perhaps using the current techniques of the vascular laboratory or newer techniques that are sure to be developed. The national and regional vascular societies must be the leaders in these efforts. A start has already been made and it is hoped that progress will be rapid.
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PMID:Vascular surgery: the unanswered questions. 709 29

Twenty-six cases of carcinoid-related mesenteric angiopathy and intestinal infarction (three from our institution and 23 previously reported cases) were reviewed. Twenty patients presented with acute abdominal findings, including peritonitis (13 cases), intestinal obstruction (five cases), and bleeding per rectum (two cases). Fifteen patients (75%) experienced antecedent symptoms of abdominal pain and/or diarrhea, averaging 2.5 years in duration. Twelve patients (46%) exhibited symptoms of carcinoid syndrome. Mesenteric angiography in three cases demonstrated encasement and segmental branch narrowing or occlusion of major mesenteric vessels. Eleven patients underwent resection and primary bowel anastomosis with an early survival rate of 91%. Four additional patients who underwent lesser surgical procedures and five patients who did not undergo operation all died. Elastic vascular sclerosis (EVS) was identified in 19 of 22 cases with available histologic material (86%). These changes were observed in proximity to as well as distant to the primary tumor. In general, the severity of EVS did not correlate with the likelihood of gut ischemia. Although not the sole cause of intestinal gangrene in patients with midgut carcinoids, EVS may contribute significantly to the evolution of these ischemic changes.
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PMID:Mesenteric angiopathy, intestinal gangrene, and midgut carcinoids. 728 Oct 10

Upper gastrointestinal manifestations of collagen vascular diseases have been well described. Recently our attention has been focused on the colonic complications: fibrosis and stricture resulting in obstruction, severe obstipation and recurrent fecal impactions secondary to pseudo-obstruction, progressive colonic dilatation resulting in gangrene of the colon, and sigmoid volvulus and diverticulitis in the presence of both wide- and narrow-mouth pseudodiverticula. Patients with these colonic manifestations of collagen vascular disease are disabled, if not severely ill. Recognition of the problem enables the surgeon to plan definitive surgical intervention ranging from segmental resection to total colectomy and ileoproctostomy to restore satisfactory large bowel function.
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PMID:Colonic manifestations of collagen vascular diseases. 743 49

Blackfoot disease (BFD) is an endemic peripheral vascular disorder resulting in gangrene of the lower extremities, especially the feet, among residents in a limited area on the southwest coast of Taiwan. In the present study, the concentrations of zinc, cadmium, lead, and copper in urine of BFD patients with matched normal controls are investigated by differential pulse anodic stripping voltammetry (DPASV) on a hanging mercury drop electrode (HMDE). The analytical results indicate that urinary copper, cadmium, and lead of the BFD patients are significantly higher than those of the controls. In addition, the patients showed a significantly lower concentration of zinc in the urine than the normal controls. The possible connection of these elements with the etiology of the disease is discussed.
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PMID:Simultaneous determination of Zn, Cd, Pb, and Cu in urine of patients with blackfoot disease using anodic stripping voltammetry. 750 41

Epidural spinal cord stimulation (ESCS) has been suggested to improve microcirculatory blood flow and reduce amputation rates in patients with severe peripheral arterial occlusive disease (PAOD). Pain relief, limb salvage, and skin circulation were studied in 177 patients with ischemic pain caused by nonreconstructible PAOD who were receiving ESCS. Medical or surgical therapy had failed and vascular reconstruction was impossible in all cases. Clinical status was classified as Fontaine's stage III (chronic ischemic rest pain) in 114 patients and Fontaine's stage IV (ischemic pain and ulcers or dry gangrene) in 63 patients. PAOD was essentially due to arteriosclerosis, but 36 patients also had diabetic vascular disease. After a mean follow-up of 35.6 months, significant pain relief (> 75%) with limb salvage was achieved in 110 patients. In 11 patients with limb salvage, pain alleviation was determined to be between 50% and 70%. ESCS was ineffective in reducing pain, leading to major amputation in 56 patients. The cumulative limb salvage rate was 66% at 4 years. The systolic ankle/brachial blood pressure index did not change under stimulation. TcPO2 was assessed on the dorsum of the foot. Clinical improvement was associated with increased TcPO2, with limb salvage improving from 24.2 to 48.1 mm Hg in stage III (p < 0.02) and from 16.4 to 37.2 mm Hg in stage IV (p < 0.03) disease. A TcPO2 increase of more than 50% within the first 3 months after implantation was predictive of success. TcPO2 changes are correlated with the presence of adequate paresthesias in the painful area during the trial period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease. 781 84


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