1/5. diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica.BACKGROUND AND PURPOSE: The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. CASE DESCRIPTION: This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. OUTCOMES: She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a "high-grade circumferential stenosis of the distal-most aorta at its bifurcation." DISCUSSION: This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Human pythiosis in Srinagarind Hospital: one year's experience.We have reported four cases of human pythiosis arteritis from Srinagarind Hospital, Khon Kaen, thailand. This unusual human infection occurring perhaps exclusively in thalassemia and hemoglobinopathy patients, should be noted by physicians, who work in areas with a high incidence of hemoglobinopathy, and for patients who present with unexplained arterial insufficiency. As our reported cases occurred within only one year, this condition may be more common than originally suspected and found more frequently if actively searched for.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Laser-enhanced angioplasty.We have successfully used a balloon-guided laser to ablate arteriosclerotic plaque, thus permitting use of standard angioplasty to treat seven patients with severe peripheral artery obstruction. The device (Lastac System, marketed by G.V. Medical, Inc, and approved by FDA in December 1988) is designed to reduce the incidence of vessel perforation by using the balloon to center an argon laser between the vessel walls. A control monitor allows the physician to determine the amount and duration of energy applied. A lens on the laser tip further reduces risk of damage by narrowing the laser beam's angle of delivery, and an infusion pump cools tissue receiving laser energy and clears blood from the beam's field. Each of the seven patients treated with the Lastac System continues to be free of claudication; one patient experienced clinically insignificant vessel perforation. Although this series of patients is quite small, we believe increased use of the system will further demonstrate its effectiveness in eliminating plaque and probably will reduce the occurrence of restenosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Concurrent musculoskeletal pain in a patient with symptomatic lower extremity arterial insufficiency.The etiology of back and lower extremity pain can, at times, be difficult to differentiate. This is especially true in cases where two pain-producing conditions coexist. Such difficulties have been reported in cases of coexisting vascular and neurogenic claudication. We report the case of a 66-year-old woman with concurrent musculoskeletal pain and hip claudication. Her arterial insufficiency was initially masked by her diffuse pain complaints and only became apparent to us after successful treatment of her soft tissue problems. We caution physicians to be aware of coexisting musculoskeletal pain that may mask significant underlying pathology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Venous claudication successfully treated by distal superficial femoral-to-greater saphenous venous bypass.Chronic venous disease of the lower extremities is a clinical entity that is commonly encountered by practicing physicians. The problem is usually a direct consequence of a previous episode of deep venous thrombosis. patients so afflicted suffer from a distinct series of symptoms that are grouped under the term "postthrombotic" or "postphlebitic" syndrome. These consist of leg edema, stasis dermatitis, ulceration, and sometimes claudication. The causative pathophysiologic features consist of either valvular incompetence and/or main channel obstruction. This report offers a new method of relieving symptoms caused by a superficial femoral vein obstruction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |