[АRTERIAL PRESSURE ON THE FIRST TOE AS A PROGNOSIS CRITERION OF THE COMPLICATION OCCURRENCE IN THE DIABETIC FOOT SYNDROME ON BACKGROUND OF MENKEBERG'S SCLEROSIS].

In the patients, suffering diabetes mellitus type ІІ, treated in 2015 - 2016 yrs for complicated diabetic foot syndrome, a systolic arterial pressure (SAP) on level of the first toe was determined, and roentgenography of the foot in two projections done. The SAP value from 120 to 200 mm Hg and higher have had witness the presence of Menkeberg?s sclerosis stages III - V. Prognostically favorable is a SAP value of 80 mm Hg and higher, and unfavorable data ­ the SAP value lowering lesser than 80 mm Hg. The SAP value lower than 30 mm Hg have had witness the vessel obliteration and thrombosis occurrence.

Management of microanastomosis in patients affected by vessel diseases.

OBJECTIVE: In the last 10 years with the advances in microsurgery of techniques and materials the indications for free tissue transfer have considerably been increased. But, there are still some limitations and drawbacks. Among risk factors associated with flap failure, atherosclerosis can affect both the flap and the recipient vessels of free microvascular tissue transfers. The purpose of this paper is to discuss about the pathogenesis of Monckeberg's sclerosis, and the topics that must be taken into consideration when performing microsurgery in these patients. METHODS: PubMed database was searched using Mesh. The following terms was added to the search builder: Monckeberg's sclerosis, free flap. The Boolean operator "AND" was selected. All the selectable Mesh headings for "Monckeberg's sclerosis" and "free flap" were included. RESULTS: Almost all the literature works about microsurgery in Monckeberg's sclerosis patient show the importance of an accurate preoperative and postoperative evaluation and of a proper surgical technique. CONCLUSIONS: When adequate preoperative evaluation, surgical technique and postoperative monitoring are performed, even severe atherosclerosis should not be considered an absolute contraindication for microvascular surgery.

[Mönckeberg's sclerosis -- crystal-induced angiopathy]. / Mönckeberg-sclerosis -- kristály indukálta angiopathia.

INTRODUCTION: Mönckeberg's sclerosis is a special form of arteriosclerosis characterized by calcification and ossification of the media of medium size arteries mainly of lower extremities. AIMS: The aim of the authors was to examine medium size arteries with Mönckeberg's sclerosis in 22 amputated lower legs of 16 patients in order to demonstrate different crystals in the wall of blood vessels. METHODS: The methodology was based on previous findings of the authors indicating that in different metabolic disorders many crystals remain demonstrable in unstained histological sections unlike in haematoxylin-eosin stained sections. RESULTS: In unstained sections the authors observed rhomboid or prismatic calcium pyrophosphate dihydrate and clusters of elongated narrow hydroxyapatite crystals in the wall of medium size arteries of all examined cases. Both types of crystals showed axis parallel positive birefringence under polarized light. The intensity of birefringence of hydroxyapatite crystals was weaker in comparison with that of calcium pyrophosphate dihydrate crystals. Occasionally, other crystals which were different in shape from both calcium pyrophosphate dihydrate and hydroxyapatite crystals were also observed. CONCLUSIONS: It seems likely that similarly to crystal deposition induced arthropathy, calcium pyrophosphate dihydrate, hydroxyapatite and other crystals cause fibrosis and intimal proliferation, which may contribute to progressive occlusion of blood vessels resulting in ischemic symptoms. Based on this observation Mönckeberg's sclerosis may be defined as a crystal-induced angiopathy.

Medial artery calcification as an indicator of diabetic peripheral vascular disease.

BACKGROUND: Mönckeberg sclerosis or medial artery calcification (MAC) is a well-known phenomenon associated with diabetic and other arterial disease. However, its consequence within the foot, and specifically the first dorsal metatarsal artery, has not previously been studied. MATERIALS AND METHODS: Nearly 1,000 foot x-rays were studied over a 9-month period in a busy hospital to identify the prevalence of first dorsal metatarsal artery calcification. The electronic medical notes for all the patients were reviewed to confirm which patients were known to be diabetic. The patients with positive findings were then identified and their HbA1c, creatinine, and previous foot interventions recorded. RESULTS: Of the population studied, 1.4% had medial artery calcification of the 1st dorsal metatarsal artery: 93% were known diabetics and 100% had impaired glucose tolerance (a glucose plasma concentration of greater than 7.8 mmol/l 2-hours post-glucose loading). Seventy-nine percent had required previous podiatric care for foot ulceration and 64% had required surgical intervention for their diabetic feet. MAC has a high positive predictive value (92.9% (95% CI 69.2 to 98.7)) for diabetes, with a good specificity (99.9% (95%CI 99.4 to 100)) and low false positive rate (0.1% (05%CI 0.0 to 0.6)). CONCLUSION: Medial artery calcification in the first dorsal metatarsal artery is characteristic of impaired glucose metabolism, and if seen on routine x-ray should be an indication for screening of the patient. It should also be considered as a foot-at-risk sign in the established diabetic due to the high incidence of foot ulceration and need for surgical intervention in this group.

Arteriosclerose de Monckeberg como causa de isquemia crítica de membros inferiores: relato de caso / Monckeberg's arteriosclerosis as a cause of lower limb critical ischemia: case report

A arteriosclerose de Monckeberg pode ser uma causa rara de isquemia grave dos membros inferiores. Relatamos o caso de um paciente com isquemia crítica do membro inferior, sem condições de revascularização, que evoluiu para amputação. O paciente não apresentava os fatores de risco clássicos para aterosclerose. O diagnóstico anatomopatológico foi de arteriosclerose por calcificação da média de Monckeberg.