11/432. Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease).thromboangiitis obliterans (Buerger's disease) is a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. It is causally related to tobacco use. The diagnosis is usually made on the basis of the presence of distal arterial disease in individuals who smoke and in whom other disease entities have been excluded. The most effective treatment for Buerger's disease is smoking cessation. Without strict adherence to tobacco avoidance, disease progression is likely. methods to control ischemic pain include medications, sympathectomy, or surgical revascularization. The effect of sympathectomy is unpredictable, and the chances of a successful revascularization procedure are rare because distal target vessels often are extensively diseased. Herein, we describe a patient whose condition did not respond to the usual conservative therapy but did respond dramatically to the implantation of a permanent spinal cord stimulator. Although these devices have been used for more than 20 years in various other peripheral arterial diseases, their use in Buerger's disease has been limited.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
12/432. The hemodynamics of steal syndrome and its treatment.A 61-year-old man developed steal syndrome after creation of a transposed basilic vein arteriovenous fistula (AVF) resulting in rest pain and ischemic ulcers in the fingertips. Our initial surgically created stenosis reduced the diameter by 32% and the area by 56%, and increased the radial artery pressure from 52 to 78 mmHg, with relief of symptoms. Within 3 weeks his symptoms reappeared. Repeat measurements did not explain his return of symptoms. A second area of stenosis was created in the AVF, with a diameter reduction of 75%, and an area reduction of 94%. His symptoms resolved, and his ulcers healed. The hemodynamics of the AVF and the steal syndrome were evaluated by duplex imaging and Doppler pressure assessment. A greater stenosis increased the radial artery pressure from 78 to 140 mmHg while maintaining flow through the AVF. Rather than increasing the degree of stenosis at the first site, we created a second area of stenosis. Hemodynamically, this would be additive to the first without the risk of creating a high-grade stenosis that could thrombose the AVF. Increasing the resistance in the AVF will decrease flow in the AVF and, ultimately, increase flow to the hand.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
13/432. Fibroblast growth factor as therapy for critical limb ischemia: a case report.In an attempt to avert impending, primary amputation, an 85-year-old woman with chronic critical leg ischemia was enrolled in an experimental protocol to induce therapeutic angiogenesis. Treatment consisted of six consecutive, weekly intravenous infusions of recombinant basic fibroblast growth factor (bFGF). Angiographic evaluation was performed before and after therapy. The patient's clinical response was monitored through serial measurements of the ankle/brachial index and by repetitive assessment of limb flow by mercury strain-gauge plethysmography. A beneficial clinical response was detectable by week 4 of therapy, which was characterized by an improved walking distance, relief of ischemic pain, a marked reduction in analgesic consumption, and healing of persistent, unresponsive, painful inflammation of the hallux. The clinical improvement was sustained throughout the remaining weeks of therapy and follow-up evaluation. plethysmography documented improved blood flow; specifically, the augmentation of digital flow was sustained and correlated with the marked improvement in the patient's clinical status.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
14/432. ergotamine-induced intermittent claudication.We report about a female patient with intermittent claudication caused by ergotamine. She used ergotamine as a treatment for migraine headaches for more than 4 years. The claudication began 7 month before admission. Colour Doppler sonography and angiography showed severe stenosis of the left external iliac and superficial femoral artery. The patient was treated with phenprocoumon for one year after withdrawal of ergotamine. After that the superficial femoral stenosis disappeared completely, but the external iliac stenosis was still present and was consequently successfully treated by atherectomy. The histology showed a fibrosis of the intima and a hypertrophy of the media.- - - - - - - - - - ranking = 0.049771439528613keywords = headache (Clic here for more details about this article) |
15/432. Type I acute aortic dissection accompanied by ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery.We report a case of acute type I aortic dissection with ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. The patient was a 52-year-old man who visited the hospital with major complaints of sudden low back pain and melena. Mesenteric ischemia was suspected, and angiography revealed type I aortic dissection with accompanying blood flow insufficiency in the superior mesenteric artery. Because catheterization during angiography improved the blood flow disorder and prevented intestinal necrosis, it was possible to replace the ascending aorta with a prosthetic graft. Arterial pulsation in the mesentery was recovered by the operation and the patient's life was saved without bowel resection. This case demonstrates that prompt surgical or percutaneous relief of ischemia in major organs is important to save lives in the cases of acute aortic dissection with ischemic complications.- - - - - - - - - - ranking = 1.0080558931822keywords = pain, back (Clic here for more details about this article) |
16/432. Opioids for chronic nonmalignant pain. Choosing suitable candidates for long-term therapy.Opioid maintenance analgesia for chronic nonmalignant pain can be successful in selected cases, but it is not a panacea for all pain, and management of patients using opioids can be an arduous process. A consistent and principle-based approach is recommended. Passion and chauvinism exist on both sides of the controversy and should be discouraged.- - - - - - - - - - ranking = 6keywords = pain (Clic here for more details about this article) |
17/432. Intraoperative SSEP detection of ulnar nerve compression or ischemia in an obese patient: a unique complication associated with a specialized spinal retraction system.OBJECTIVE: To report a case of peripheral nerve compression caused by a specialized spinal retraction system, the Thompson-Farley retractor system, that most likely would not have been detected without intraoperative monitoring of the ulnar nerve. DESIGN: Bilateral median and peroneal nerve somatosensory evoked potentials (SSEPs) were monitored continuously during a C5 corpectomy, as was core body temperature. RESULTS: Within minutes after cervical soft-tissue retraction, the left ulnar nerve SSEP began to decline in amplitude. peroneal nerve SSEPs were normal throughout the surgery; core body temperature remained at 36 degrees /- 0.2 degrees C. After much effort to reposition the patient, the SSEPs returned to baseline and the Thompson-Farley system was replaced by a self-retracting system. CONCLUSIONS: To our knowledge, this is the first report of peripheral nerve compression caused by the Thompson-Farley retractor system. Even with careful positioning on the operating table, obese patients may be particularly at risk for upper arm compression. Continuous monitoring of SSEPs is suggested to prevent postoperative morbidity.- - - - - - - - - - ranking = 0.21365247791601keywords = upper (Clic here for more details about this article) |
18/432. rhabdomyolysis as the presenting manifestation of calciphylaxis.A 43-year-old woman was admitted with progressive leg pains and weakness and was found to have rhabdomyolysis. Prior to this admission the patient had hypercalcemia, but this returned to normal following treatment with calcitonin. During the hospitalization, she developed the syndrome of calciphylaxis consisting of necrotic skin and muscle associated with vascular calcification. This is the first case report of rhabdomyolysis caused by calciphylaxis in a patient without chronic renal failure.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
19/432. Successful partial ear replantation after prolonged ischaemia time.We present the case of a 34-year-old male patient who had successful replantation of upper pole of pinna 33 h after amputation. As no vein was anastomosed, systemic heparinisation and subcutaneous injection of heparin to the replanted ear were used to encourage outflow. Complications included arterial spasm and bleeding. Management of similar cases as planned urgent cases rather than emergency cases is discussed.- - - - - - - - - - ranking = 0.21365247791601keywords = upper (Clic here for more details about this article) |
20/432. Isolated infarction of the cecum: CT findings in two patients.Colonic ischemia isolated to the cecum is a rare entity. The authors evaluated two patients who underwent computed tomography (CT) because appendicitis was suspected at clinical examination. CT findings were suggestive of isolated cecal ischemia or infarction. Surgical-histopathologic findings helped confirm the presumptive CT diagnoses. Isolated cecal infarction should be included in the differential diagnosis of acute right lower quadrant pain.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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