Thromboangiitis obliterans (Buerger disease) in a female mild smoker treated with spinal cord stimulation.

The authors report the case of a 42-year-old female mild smoker admitted to the Hospital of Ferrara for the onset of asymptomatic necrotic ulcerations localized to the second, third, and fourth toes of left foot. Physical examination showed asphygmia of inferior limb distal peripheral pulses, with localized extremity marbleized and cyanotic skin at the level of the left foot, where necrotic ulcers were present at the second, third, and fourth toes. Doppler ultrasonography and angiography revealed a severe obliterating arteriopathy of bilateral distal arterial circulation. Both blood chemistry panel (including autoimmune and hypercoagulable profile) and diagnostic examination findings were normal. Thus, the patient met several criteria to be diagnosed with Buerger disease. After an attempt at medical therapy with the intravenous administration of the prostaglandin-analogue iloprost, given the young age and the lack of viable distal target vessels for bypass grafting, a spinal cord stimulator was implanted. More than 2 years later, the patient has a normal life.

Seasonal variation in the occurrence of deep vein thrombosis.

BACKGROUND: The occurrence of several adverse cardiovascular events, eg, myocardial infarction and stroke, is not randomly distributed over time, but shows definite seasonal patterns. The temporal pattern for pulmonary embolism (PE) is known, whereas the data concerning deep vein thrombosis (DVT) are not conclusive. The aim of our study was to investigate whether a seasonal variation exists also for DVT, together with the possible influence of different comorbid risk factors. MATERIAL/METHODS: We observed 1164 consecutive cases of DVT at the General Hospital of Ferrara, Italy, from 1998 to 2002. The total sample was divided into subgroups by gender, and by the most common comorbid conditions. For statistical analysis, the distribution of symptom onset was tested for uniformity by the chi 2 test for goodness of fit, and partial Fourier series were used to assess rhythmicity. RESULTS: Seasonal analysis showed a significantly reduced frequency of DVT events in summer and increased in winter, for the total population (p<0.0001), men (p=0.003), women (p=0.007), subjects with PE (p=0.001), and hypertension (p=0.001). Similarly, chronobiological analysis yielded a significant seasonal variation, with a peak in December for the total population (p<0.001), men and women (p<0.001 and p=0.02, respectively), PE (p=0.006), and hypertension (p=0.028). CONCLUSIONS: This study shows the existence of a highly significant seasonal pattern in the occurrence of DVT, characterized by a winter peak. Thus, colder months and relative hypercoagulability could be considered a supplementary high risk condition when prescribing an anticoagulant regimen.