ABSTRACT
INTRODUCTION: Chronic critical limb ischemia (CLI) is a severe condition of hypo-perfusion of lower limbs, which is associated with inflammation and a pro-coagulative state. It is a disease at high risk of amputation and cardiovascular death. Propionyl-L-carnitine (PLC) is efficacious in improving pain free walking distance in peripheral arterial disease with claudication; it also exerts favorable effects on the arterial wall and on endothelial function. The purpose of this study was to evaluate the effects of PLC on microcirculation, endothelial function and pain relief in patients affected by CLI not suitable for surgical intervention. PATIENTS AND METHODS: We enrolled 48 patients with CLI. Patients were randomized into two groups: the first group was treated with PLC, the second was treated with saline solution. All of them underwent the following tests: laser Doppler flowmetry at the forefoot at rest and after ischemia, trans cutaneous oxygen partial pressure and carbon dioxide partial pressure at the forefoot at rest and after ischemia, endothelium dependent dilation of the brachial artery. All tests were repeated after treatments. Pain was assessed by visual analog pain scale. RESULTS: Endothelium dependent dilation increased after PLC (9.5 ± 3.2 vs 4.9 ± 1.4 %; p < 0.05). Post-ischemic peak flow with laser-Doppler flow increased after PLC. TcPO2 increased, while TcPCO2 decreased after PLC; CO2 production decreased after PLC. VAS showed a significant reduction in pain perception after active treatment. CONCLUSIONS: In CLI patients, PLC can improve microcirculation (post ischemic hyperemia, TcPO2 and TcPCO2 production). PLC also enhances endothelium dependent dilation and reduces analgesic consumption and pain perception.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Carnitine/analogs & derivatives , Ischemia/drug therapy , Peripheral Arterial Disease/drug therapy , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Blood Gas Monitoring, Transcutaneous , Brachial Artery/physiology , Carnitine/pharmacology , Carnitine/therapeutic use , Endothelium, Vascular/drug effects , Endothelium, Vascular/physiopathology , Female , Humans , Ischemia/physiopathology , Laser-Doppler Flowmetry , Leg/blood supply , Male , Microcirculation/drug effects , Pain Management , Peripheral Arterial Disease/physiopathology , Regional Blood Flow/drug effects , Vasodilation/drug effectsABSTRACT
Incessant ventricular tachycardia is an arrhythmia refractory to conventional antiarrhythmic treatment. We describe the case of 55-year-old man who presented incessant ventricular tachycardia in the early post-acute phase of myocardial infarction. Optimal coronary revascularization was not effective, but radiofrequency catheter ablation was able to eliminate the anatomic substrate and clinical arrhythmic recurrence.
