Sticky platelet syndrome: an unusual presentation of arterial ischemia.

A 48-year-old woman presented with bilateral lower extremity critical limb ischemia. In addition to this, her work-up revealed multiple other thromboembolic insults including cerebral and visceral emboli. Initial laboratory findings were significant for an indeterminate platelet count, secondary to platelet clumping. After appropriate emergent surgical treatment including bilateral lower extremity embolectomy, the patient was empirically anticoagulated with a direct thrombin inhibitor. Further embolic work-up discovered bilateral renal and splenic infarctions as well as a large mobile mitral vegetation. Finally, an upper extremity duplex revealed left axillary, left subclavian, and right internal jugular acute deep vein thromboses. Mitral valve replacement was performed to remove the septic source. A series of hypercoagulability studies was done, and results were positive for lupus anticoagulants. Months after her recovery, the patient was tested and found to be positive for sticky platelet syndrome.

Surgical management of chronic mesenteric venous thrombosis--a case report.

Although mesenteric venous thrombosis is an uncommon disease, it is a diagnostic dilemma and if left untreated results in significant morbidity and mortality. The clinical presentation of mesenteric venous thrombosis (MVT) is varied and depends on the etiology. Prompt recognition and treatment is important as this may limit the progression of thrombosis. Even though medical management is the current mainstay of therapy, there have been reported cases of clinical improvement with operative management. The authors describe an improved outcome following mesenteric-systemic shunting in a symptomatic patient with acute-on-chronic MVT affecting the proximal superior mesenteric vein.

Endothelial nitric oxide synthase protein expression, localization, and activity in the penis of the alloxan-induced diabetic rat.

PURPOSE: To explore the possible relevance of endothelial nitric oxide synthase (eNOS) in the pathophysiology of erectile dysfunction (ED) associated with diabetes mellitus, we compared the catalytic activity, protein expression, and cellular localization of eNOS with those of neuronal nitric oxide synthase (nNOS) in the penis of rats with alloxan-induced diabetes. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were given alloxan or vehicle only and monitored weekly by Dextrostix for confirmation of glucosuria. Tail-flick immersion and penile reflex testing were used to evaluate sensory neuropathy and ED, respectively. At 4 to 5 weeks (early) and 10 to 11 weeks (late), animals were sacrificed, and their penes were subjected to nNOS and eNOS catalytic activity assay, Western immunoblotting, and immunohistochemistry examination. Masson's trichrome staining of penile tissue and serum testosterone measurements were performed for light microscopy and sex steroidogenic analysis, respectively. RESULTS: Confirmed diabetic rats showed significant reductions in penile nNOS expression and eNOS activity and expression early, prior to observed ED, and nNOS and eNOS activities and expressions late, synchronous with ED. Decreased intensities of both nNOS staining, localized to the dorsal and cavernosal nerves distributing to the penis, and eNOS staining, localized to penile vascular and sinusoidal endothelium, were assessed in diabetic animals. Penile vascular and cavernosal tissue appeared intact in diabetic rats. Testosterone levels were equivalent in nondiabetic and diabetic rats. CONCLUSIONS: In the penis of the alloxan-induced diabetic rat, eNOS protein expression and synthetic activity were reduced compared with the normal rat penis, independent of testosterone influence and in the absence of significant erectile tissue degenerative changes. These eNOS effects apparently preceded nNOS effects. Full elucidation of the possible mechanisms affecting eNOS function in the diabetic rat penis requires further investigation.