¿Quién describió la claudicación intermitente? Sir Benjamin Collins Brodie / Who described intermittent claudication? Sir Benjamin Collins Brodie

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[The history of intermittent claudication due to arterial disease]. / Histoire de la claudication intermittente d'origine artérielle.

The clinical description of intermittent claudication due to arterial occlusive disease was made by two French precursors: a veterinary surgeon, Jean-François Bouley, and a neurologist, Jean-Martin Charcot. The subsequent works clarified the aetiology, the investigations and the treatment of this trouble but did not add anything to the initial description.

The "galloping" history of intermittent claudication.

Intermittent claudication (IC) due to arterial occlusive disease was first diagnosed by the French veterinary surgeon Jean-François Bouley jeune in a horse drawing a cabriolet in the streets of Paris as early as 1831. The animal was repeatedly exercised and always started to limp with the hind legs at similar work loads. Autopsy revealed partially thrombosed aneurysm of the abdominal aorta and occlusions of both femoral arteries which were correctly identified as the cause of IC. In 1858 the famous neurologist Jean-Martin Charcot working at the Salpêtrière in Paris first discovered the condition in a patient, who was wounded by a bullet during the conquest of Algery and developed iliac artery aneurysm obliterated by a thrombus. He was aware of the first description in veterinary medicine. In Germany IC was also first mentioned in horses (Rademacher, 1838). 13 reports of patients were contributed by the neurologist Heinrich Erb in 1898 and 1904. Some interesting features of the phenomenon of IC like the amount of exercise necessary to provoke it, localization, social relevance, prolongation of the Achilles tendon reflex, decrease of maximal plantar flexion force of the foot and production of "Lewis factor p" are summarized. In human patients arteriosclerosis is the well recognized principal cause of arterial obstructions, in horses, however, the lesions are due to infection by the roundworm Strongylus vulgaris. In the fascinating life cycle the larvae migrate into the intima of small and large arteries and provoke aneurysms and intravascular thrombosis.

Jean-François Bouley (Bouley jeune). Pioneer investigator in intermittent claudication.

Reports of pathologic investigations as to the cause of intermittent claudication in horses were made in France in October, 1831, by veterinarian Jean-François Bouley. Obstructive clots in the femoral arteries were found to be responsible for the muscular changes causing limping. Bouley's work in the horse was used by Charcot in 1858 to understand the mechanism of claudication in the case of a soldier with gunshot wound in whom a traumatic aneurysm, clotting, and ischemia of the legs developed. This was not, however, the first medically reported case of human claudication from vascular occlusive disease; the one reported by Barth in 1835 seems to be the first. According to Dejerine in 1911, the disease in the horse appeared to be due to invasion of the vessels by a parasitic round worm; earlier he had ascribed some cases of human claudication to impaired circulation of the spinal cord. It was not until 1949, however, that Verbiest elaborated the concept of spinal stenosis to explain one type of human claudication.

[20 years pentoxifylline: a part of recent angiology history]. / 20 Jahre Pentoxifyllin: ein Stück jüngerer Angiologiegeschichte.

Pentoxifylline was first registered (in Germany) 20 years ago. Then its main action seemed to be vasodilatation. Later hemorheological effect, in particular on red cell deformability, were found. Independent of its pharmacological effects, the clinical effectiveness in peripheral and cerebral arterial disease is well established. More recently its action on leucocytes has gained interest. Both rheological and biochemical changes have been reported. This new knowledge will create new indications for pentoxifylline within the near future which possibly will go beyond angiology.

Cauda equina pseudoclaudication syndrome.

Intermittent claudication is known as a specific symptom in patients with chronic occlusive arterial lesions. Clinically it is important that neurogenic intermittent pseudo-claudication should be differentiated from true intermittent claudication. Nevertheless confusion still exists in differential diagnosis between these two entities. This paper deals with general review of intermittent pseudo-claudication and a particular emphasis is placed on the different concepts of the pathophysiology and the differential diagnosis from the standpoint of vascular surgery. Recently one case of the neurogenic intermittent pseudo-claudication was encountered and presented in this paper.