Pharmacological interventions on critical limb ischemia in diabetic patients.

Peripheral arterial disease is highly prevalent in patients with diabetes mellitus. Critical limb ischemia is an important component of this disease entity. Early diagnosis, identification of risk factors, and appropriate therapeutic management strategies are needed to aggresively treat this disease. This paper reviews risk factors for critical limb ischemia and discusses updates on pharmacologic therapies with a specific focus on the diabetic population.

Transluminal endovascular stent grafting of aortic dissections and aneurysms: a concise review of the major trials.

Transluminal endovascular repair of the vascular system is rapidly emerging as a leading therapeutic modality for aortic dissections and aneurysms. The use of transluminal endovascular stent grafting has been used to intervene successfully on the aorta and its major branch vessels. There have been several studies examining transluminal endovascular stent grafting of thoracic aortic aneurysms, dissections, and abdominal aortic aneurysms. This paper reviews some of the major trials of transluminal endovascular stent grafting as well as its major limitation, endoleak.

Aortic arch (pseudo) aneurysm complicating cardiac catheterization.

The development of an infected aortic (pseudo)aneurysm which occurred after placement of a coronary artery stent is reported. Complications of cardiac catheterization and coronary artery stent placement are infrequent and this complication has not yet been reported in the literature.

Zoonotic diseases: health aspects of Canadian geese.

OBJECTIVE: Review zoonotic diseases associated with Canadian geese. STUDY DESIGN: Review article: A review of the multiple physical, microbiologic and safety concerns, and methods used in controlling this potential problem. RESULTS: Over the last decade the Canadian goose population (protected by international treaties and protection acts) has increased rapidly such that in many cities they have become a pest rather than an admired wild bird. Their increasing numbers have caused a number of potential healthcare concerns including: physical, bacterial, parasitic, allergic and viral potential problems. The Canadian goose fecal droppings of one per minute have caused falls and the flying geese have caused air traffic accidents. Bacterial concerns, including botulism, salmonella and E. coli have all been reviewed and presented concerns. The viral Newcastle disease may be detected with hemagglutination studies and the Giardia psittaci parasites have been repeatedly found in their droppings. The Cryptosporidium parvum oocytes have been present on stool study. CONCLUSIONS: Definite links to human infectious diseases have been difficult to prove. Revision of the current laws and new control programs must be developed.

Coronary artery stent infection.

This paper aimed to examine the literature for cases of coronary artery stent infection in order to provide comprehensive data to clinicians regarding its prevalence, clinical presentations, and possible treatments. Coronary artery stenting was initially reported in 1987. Stenting of the coronary arteries is now used in 40-60% of all interventional coronary artery procedures. The understanding of the pathophysiology of coronary artery disease is evolving. It has been suggested that atherosclerosis may be a complication of an infectious etiology. By using a stent to treat coronary artery disease, a foreign body is directly juxtaposed with an area of inflammation. The first reported case of an infected coronary artery stent was in 1993. Although this is an exceedingly rare event, the associated mortality is alarmingly high. Analysis of the literature reveals a total of four reported cases of coronary artery stent infection. Symptoms of stent infection present days to weeks after the initial coronary intervention. All four patients developed fevers and at least two patients developed postintervention angina. In patients who have had a coronary artery stented, the presence of angina and fevers should make the clinician suspicious for a stent-related infection. Two of the patients had infection with Pseudomonas aeruginosa, which seems to be an unusual organism for a catheter-related infection. Surgical removal of the infected stent and artery complex was performed on nearly all cases. Despite aggressive measures, the majority of patients died. Few data are available on the long-term risk for coronary artery stent infection. In a patient who has undergone coronary artery stent placement, the clinician must be very sensitive to fever, return of angina, and bacteremia. The complication rate at the present time does not warrant the use of prophylactic antibiotics prior to high-risk procedures (e.g., dental procedures). Furthermore, the low infection rate of coronary artery stents may be a result of the inflammatory nature of atherosclerosis, which may provide a protective benefit against bacterial infection of the stent.

Enterotherapy associated T-cell lymphoma: a case report and literature review.

UNLABELLED: T-cell lymphoma of the intestine is a form of extranodal, non-Hodgkins lymphoma. Enteropathy associated T-cell lymphoma (EATCL) is a unique form of T-cell lymphoma involving the gastrointestinal tract. This disorder is rare and there is no consensus on guidelines for diagnosis or treatment. CASE: This 47 year old patient presented to the hospital with increasing abdominal girth and swelling of the lower extremities over the four days prior to admission. He complained of dyspnea on exertion, anorexia, nausea and vomiting, 40 pound weight loss over half a year, accompanied by intermittent diarrhea. On physical examination, the patient was found to have anasarca, an abdominal fluid wave with shifting dullness, mild abdominal tenderness, marked pitting edema of the extremities, and necrotic toes. A small bowel follow through revealed an abnormality in the mid-jejunum and a colonoscopy revealed two erythematous lesions near the cecum. Subsequent esophagoduodenoscopy and enteroscopy identified multiple white patchy lesions in the proximal jejunum. Biopsies were consistent with a T-cell lymphoma. The patient underwent a partial small bowel resection. Biopsies of the jejunum had ulceration and necrosis with a lymphomatous infiltrate. The lymphocytes were found to be a monoclonal CD2 positive T-cell population. A bone marrow biopsy was unremarkable. Enteropathy associated T-cell lymphoma is a rare, and this may be the first reported case of EATCL presenting as anasarca. DISCUSSION: The etiology and pathophysiology of intestinal lymphomas, particularly enteropathy associated T-cell lymphoma, is reviewed. CONCLUSION: EATCL is a rare and unique form of lymphoma without an exact treatment regimen which carries a high mortality rate.

Sudden cardiac death in a patient taking an over-the-counter diet pill.

The case of an otherwise healthy woman with a history of palpitations who survived sudden cardiac death from a ventricular arrhythmia is presented. Her only medications at the time of the event were alprazolan prn and over-the-counter diet pills. The relation between ventricular arrhythmias and over-the-counter diet pills is explored. Basic electrophysiologic principles are discussed as well as an overview for the work-up and long term management of sudden cardiac death.

Sterile pyuria: a differential diagnosis.

Sterile pyuria is not an uncommon laboratory finding. This article explores the major causes of sterile pyuria, including infectious, systemic, structural and physiologic, and drug-related causes. It also discusses the differential diagnosis of eosinophiluria and the basic workup of sterile pyuria.

Trans-Antarctic expedition: the second 100 days.

On July 27, 1989, six men and 39 sled dogs embarked on the first trans-Antarctic dog, sled, and ski crossing. Data sheets were developed and a review of their day-by-day reports was carried out. The period of time covered is November 3, 1989, to February 10, 1990. Miles traveled were recorded for each day and varied from no progress to 31 miles for a single day. A running account of the total miles traveled was also maintained in relationship to the number of days traveled. Radio contact was maintained when conditions permitted. They were able to make calls home and as far away as Paris, France. The time traveled was summarized where recorded and weather conditions particularly were reviewed and maintained. Land conditions, visibility, and cloud formations were discussed. The average temperature varied from -8 degrees C to -48 degrees C (-54 degrees F). Wind conditions and land locations were recorded, as were difficulties encountered on each day. High-calorie foods were eaten. One dog ate as many as 12,000 calories per day. Following a review of appropriate topics, a summary of the conditions is given.