Arteriopatía periférica asociada a marihuana / Marijuana-associated peripheral arteriopathy

La arteriopatía por marihuana debe ser considerada en pacientes jóvenes con arteriopatía periférica sin factores de riesgo para ateroesclerosis. Se ha descrito por primera vez en 1960 y existen más de 100 casos en la literatura. Si bien se tiende a considerar como una entidad independiente de la tromboangeítis obliterante o enfermedad de Leo Buerger, debido a los hallazgos la consideramos dentro del espectro de esta última. Presentamos dos casos de pacientes jóvenes con enfermedad vascular periférica asociada al consumo de marihuana, luego de excluir otras enfermedades. El tratamiento es el cese del consumo. Es indispensable valorar el uso de drogas en pacientes jóvenes que se presentan con arteriopatía periférica.

The marijuana arteriopathy should be considered in young patients with peripheral arterial disease with no risk factors for atherosclerosis. It was described for the first time in 1960 and since then there have been about 100 cases published in the literature. Although it tends to be considered as an independent entity of thromboangiitis obliterans or Leo Buerger´s disease, in the light of the last findings it is possible to consider it within the spectrum of the latter. We present two cases of young patients with peripheral vascular disease associated with marijuana use where other associated illnesses had been excluded and where the mainstay of treatment has been the cessation of marijuana consumption. It is essential to assess drug use in young patients presenting with peripheral arterial disease.

Base eletrônica de dados clínicos e cirúrgicos em isquemia cronica de membros inferiores / Electronic clinical and surgical database in chronic lower limb ischemia

CONTEXTO: Um sistema eletrônico de protocolo seria capaz de armazenar dados clínicos e possibilitar futuras pesquisas, visando a rapidez, eficiência de cruzamentos e análise de tais dados. OBJETIVO: a) criar uma base de dados clínicos cirúrgicos em doenças vasculares e, a partir desta, uma base em Isquemia Crônica de Membros Inferiores; b) informatizar essa base sob forma de um protocolo eletrônico; c) incorporar ao SINPE(c) (Sistema Integrado de Protocolos Eletrônicos); d) realizar um projeto piloto. MÉTODOS: Criou-se uma base teórica de dados clínicos sobre as doenças vasculares. O protocolo específico foi criado considerando-se as características individuais das doenças causadoras de Isquemia Crônica de Membros Inferiores. Após seu término, essa base eletrônica e informatizada seria incorporada ao SINPE(c). RESULTADOS: O usuário, previamente cadastrado, realizará o cadastro do paciente e selecionará, dentro do protocolo mestre, o protocolo específico em Isquemia Crônica de Membros Inferiores, para acesso aos seus respectivos dados clínicos. Orientado pelas alternativas diretas de preenchimento, o usuário seleciona apenas os dados pertencentes ao seu paciente. Estes podem ser resgatados para pesquisa, mostrando o número de coletas que satisfazem os parâmetros escolhidos e informações estatísticas sobre a mesma. CONCLUSÃO: a) a criação da base teórica de dados clínicos e cirúrgicos em doenças vasculares e, a partir desta, em Isquemia Crônica de Membros Inferiores, foi factível; b) a informatização da base teórica sob forma de protocolo eletrônico foi exequível; c) o protocolo eletrônico mestre e específico poderá ser incorporado ao SINPE(c), d) o projeto piloto foi criado ...

BACKGROUND: Electronic medical record systems may optimize future studies by improving speed, as well as data comparison and analysis. OBJECTIVE: (a) To create a general database of clinical and surgical vascular diseases and select data from it to create a specific database of chronic lower limb ischemia; b) to store this database in the form of an electronic system; c) to incorporate this database into the Brazilian integrated electronic medical record system (SINPE(c)); and (d) to conduct a pilot study to test the system. METHODS: A general database of clinical vascular disease was created, and a specific system was developed to record the individual characteristics of the diseases that cause chronic ischemia of lower limbs. When completed, the database was incorporated into SINPE(c). RESULTS: For data collection, an authorized user enters patient data and creates a medical record for that patient. After that, chronic ischemia of lower limbs is selected in the master system to access clinical data. Aided by the autofill tool, the user selects only the data for that specific patient. Data may be retrieved for studies, to find out the number of entries that meet the chosen parameters, and to provide statistical information about them. CONCLUSION: (a) The theoretical database of clinical and surgical vascular diseases and the derived database of chronic lower limb ischemia were created; (b) the theoretical electronic database was created; c) the electronic medical records in both the master and the specific database were incorporated into SINPE(c), (d) the pilot study was successfully created and tested using the parser module of SINPE(c). .

Arteriopatía periférica crónica inducida por cocaína / Chronic peripheral arterial disease induced by cocaine

La trombosis periférica aguda inducida por cocaína ha sido descripta en la literatura, siendo una complicación poco común. Si bien existen comunicaciones que reflejan los efectos crónicos de la cocaína sobre el sistema arterial periférico, no hay casos publicados de tal complicación en ausencia de otros factores de riesgo. Se presenta el caso de una mujer de 22 años de edad con antecedentes de consumo de cocaína intranasal de 3 gramos por semana durante un año, que consultó por claudicación intermitente a los 200 metros asociada a dolor y parestesias en miembro inferior izquierdo de 2 meses de evolución. El ecodoppler arterial evidenció una estenosis mayor del 70% en la arteria femoral superficial izquierda. Se realizaron estudios complementarios descartando otras etiologías probables. Se inició tratamiento con ácido acetilsalicílico, cilostazol y ejercicio reglado, asociado a terapia de apoyo para mantenimiento del cese del consumo de cocaína, con buena respuesta. Se destaca la importancia de la difusión de información a los pacientes, dado que la mayoría de la población desconoce las complicaciones cardiovasculares de dicha adicción. Es indispensable indagar sobre el consumo de cocaína en pacientes jóvenes con arteriopatía sin factores de riesgo aparentes.

Cocaine induced acute peripheral thrombosis, though a rare complication, has been described in the literature. Although there are reports describing the chronic effects of cocaine on the peripheral arterial system, there are no published cases of this complication when other risk factors are lacking. We report on a 22 year old female patient, with intranasal consumption of 3 grams of cocaine per week for a year, who consulted for intermittent claudication at 200 meters, associated to left lower limb pain and paresthesiae for the last two months. Arterial Doppler ultrasonography showed a stenosis greater than 70% in the superficial left femoral artery. Other probable etiologies were excluded. Treatment was initiated with acetylsalicylic acid, cilostazol and graded physical exercise, associated to support therapy in order to maintain cocaine consumption avoidance, with good response. This case emphasizes the relevance of patients information, as most people ignore the cardiovascular complication of this addiction. It is also essential to inquire about cocaine consumption in young patients with peripheral arteriopathy and no apparent risk factors.

A Guinea Pig Model of Cochlear Ischemia / 听力学及言语疾病杂志

Objective To explore a new method for establishing an animal model of cochlear ischemia.Methods Thirty guinea pigs were randomized into three groups:normal group,operation group,ischemia group.Anterior inferior cerebellar artery(AICA)was exposed surgically via a skull base approach.In ischemia group,a small piece of filter paper containing FeCl3 was placed upon the AICA to induce thrombus formation.In operation group,AICA was only exposed.In normal group,nothing was done to animal.The blood flow of cochlea(CoBF)was continuously monitored with laser Doppler flowmeter.The thresholds of auditory brainstem response(ABR)were measured before,after each experiment,and one week after operation.The AICAs of ischemia group and operation group were resected and pathological sections were perfomed for observation of the details.Results After the administration of FeCl3,the CoBF decreased to 50% of the base level at 30 min.In the AICA pathological sections of ischemia group,white thrombus composed of cellulose,blood platelets and erythrocytes could be seen.The threshold of ABR in ischemia group increased significantly.Conclusion The method provides a relatively ideal model for ischemis of the inner ear and this model may be helpful in studying the mechanisms of hearing loss caused by chronic microcirculatory disorders.

Experimental Model of Bilateral Carotid Artery Occlusion: a Serial Study of the Optic Nerve in the Rat

PURPOSE: This study was performed to examine the serial alteration of the optic nerve in chronic ischemia-induced brain injury of albino rat, which might be an experimental model of ischemia-induced optic nerve disease and vasogenic glaucoma in human. METHODS: We ligated bilateral common carotid arteries so that the brain and optic nerve had permanent ischemic injuries. Serial alteration of the optic nerve was studied on postoperative 1 day, 3 day, 5 day, 1 week, 2 week, 4 week and 9 week. After fixing the brain by perfusing formaline through the left ventiricle, we dissected the brain and optic nerve and then made specimen for Hematoxilin-Eosin (HE) stain to observe the histopathology of the optic nerve. Kluiver-Barrera (KB) stain was performed to qualify the myelin injury and optic nerve injury status. RESULTS: The HE stain specimen showed increased spaces in the nerve fiber layer and increased number of vacuoles three days after the operation. The optic neve injury became augmented with time. The KB stain showed better-defined configuration of HE stain. CONCLUSIONS: We were able to notice that optic nerve injury was induced by the bilateral common carotid ligation in this chronic ischemic experimental model, which might be an help to the studies of ischemic optic nerve disease, neurodefensive mechanism, and the hemodynamic mechanism of glaucoma in human.

Surgical Treatment of Chronic Ischemia of Lower Extremities

Between Jan. 1993 and Dec. 1995, thirty five patients (male : 30, female : 5) with chronic ischemia of lower extremities had underwent vascular surgery. The main cause of ischemia was atherosclerosis. Hypertension, diabetes and valvular heart disease were associated with these patients. The most common chief complaint was coldness and claudication. The procedures of operation included femoro-femoral crossover(14), axillo-bifemoral(7), aorto-bifemoral(6), femoro-popliteal(4), femoro-peroneal(2), femoral angioplasty(2). Pstoperative complications were wound infection(10), Bleeding(6), Compartment syndrome(4) and so on. Various anticoagulant therapy were maintained for at least 6 months. The 1 year, 2 year, 3 year, 4 year patency rates of postoperation were 78.2%, 75.1%, 71.4%, and 62.8% respectively

A Case of Ocular Ischemic Syndrome

Ocular ischemic syndrome is an uncommon ocular condition occurring secondary to marked carotid arterial obstruction. It generally develops in older patients, in conjunction with entities associated with systemic artherosclerosis. We have currently encountered a case of monocular visual loss in a 65 year old patient who had a recent attack of cerebrovascular accident. Ocular examination revealed characteristic findings of chronic ischemia, including corneal edema, rubeosis, anterior uveitis, progressing cataract, retinal arterial narrowing, venous irregular dilatation and scattered retinal hemorrhages. Diagnosis was made by the fluorescein angiographic findings of prolonged retinal circulation time and diffuse capillary non perfusion as well as by carotid MR-Angiographic finding of complete obstruction of internal caratid artery.