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Digital gangrene

Ashok Kumar, Anshul Goel, Mehul Lapsiwala
Polyarteritis nodosa is a medium artery vasculitis that can cause fatal complications. It commonly follows an acute monophasic course that may remit after treatment or cause serious morbidity or death. A 24-year-old patient described here had many vasculitic episodes in the past 16 years causing infarction of different organs. The last episode was most serious which caused mononeuritis multiplex, digital gangrene, bowel gangrene and subsequent perforations. There was strong clinical suspicion of this disease right from the beginning...
October 2016: Oxford Medical Case Reports
Mohammed Shabrawishi, Abdurahman Albeity, Hani Almoallim
Raynaud's phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud's phenomenon (PRP) or secondary Raynaud's phenomenon (SRP) to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene...
2016: Case Reports in Rheumatology
Fay Crawford, Karen Welch, Alina Andras, Francesca M Chappell
BACKGROUND: Peripheral arterial disease (PAD) of the lower limb is common, with prevalence of both symptomatic and asymptomatic disease estimated at 13% in the over 50 age group. Symptomatic PAD affects about 5% of individuals in Western populations between the ages of 55 and 74 years. The most common initial symptom of PAD is muscle pain on exercise that is relieved by rest and is attributed to reduced lower limb blood flow due to atherosclerotic disease (intermittent claudication). The ankle brachial index (ABI) is widely used by a variety of healthcare professionals, including specialist nurses, physicians, surgeons and podiatrists working in primary and secondary care settings, to assess signs and symptoms of PAD...
September 14, 2016: Cochrane Database of Systematic Reviews
Murray Baron, Janet Pope, David Robinson, Niall Jones, Nader Khalidi, Peter Docherty, Elzbieta Kaminska, Ariel Masetto, Evelyn Sutton, Jean-Pierre Mathieu, Sophie Ligier, Tamara Grodzicky, Sharon LeClercq, Carter Thorne, Geneviève Gyger, Douglas Smith, Paul R Fortin, Maggie Larché, Maysan Abu-Hakima, Tatiana S Rodriguez-Reyna, Antonio R Cabral-Castaneda, Marvin J Fritzler, Mianbo Wang, Marie Hudson
OBJECTIVE: To determine if ischaemia is a causal factor in the development of calcinosis in SSc. METHODS: Patients with SSc were assessed yearly. Physicians reported the presence of calcinosis, digital ischaemia (digital ulcers, digital necrosis/gangrene, loss of digital pulp on any digits and/or auto- or surgical digital amputation) and nailfold capillary dropout assessed using a dermatoscope. The number of digits with digital ischaemia was used as an assessment of the severity of digital ischaemia...
September 4, 2016: Rheumatology
Carlson-Babila Sama
BACKGROUND: Following digital surgical procedures, the ensuing post-operative course may be complicated by the presence of underlying ischaemic or vasospastic process. In the presence of such conditions, post-operative ischaemic changes may be further exacerbated with the use of local anaesthetics in combination with epinephrine. CASE DETAILS: We report a 21 year-old female who presented with an amputated fifth digit due to a rapidly spreading gangrene which started immediately after the surgical repair of a traumatic laceration which was infiltrated with a pre-mixed solution of lignocaine and epinephrine 3 hours earlier...
July 2016: Ethiopian Journal of Health Sciences
Varut Lohsiriwat
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer...
July 14, 2016: World Journal of Gastroenterology: WJG
Vinod Warrier, Ali Ahmad, Yaqoub Alshatti, Ali Jafar
BACKGROUND: Digital necrosis is a rare phenomenon of paraneoplastic syndrome associated with squamous cell carcinoma of the tonsil. Since 1965, more than 70 cases have been reported worldwide in the literature. CASE REPORT: A 54-year-old male smoker presented with Raynaud's phenomenon, proceeding to frank gangrene of the fingers. Working up the case finally pointed toward carcinoma of the tonsil as the underlying cause - a rare paraneoplastic manifestation. CONCLUSION: No definite etiology has been found to be the cause of Raynaud's phenomenon in this case of the squamous cell carcinoma of the tonsil...
2016: International Medical Case Reports Journal
Zsuzsanna H McMahan, Fredrick M Wigley, Livia Casciola-Rosen
OBJECTIVE: We sought to evaluate whether scleroderma patients who are double-positive for anti-interferon inducible protein 16 (IFI-16) antibodies and anti-centromere (CENP) antibodies are at increased risk for significant digital vascular events relative to patients positive for anti-CENP antibodies alone. METHODS: Sera from 165 scleroderma patients who tested positive for anti-CENP antibodies upon clinical evaluation were re-assayed for both anti-CENP and anti-IFI-16 antibodies by ELISA...
July 7, 2016: Arthritis Care & Research
Yen-Yi Juo, Lisbi Rivas Ramirez, Garry Ruben
BACKGROUND: Atherosclerotic lesions of the supra-aortic trunk vessels, including the innominate artery, subclavian artery, or the common carotid artery, tend to present either as low-flow state distal to the lesion or as embolic events. The risk of embolic cerebrovascular event complicates the management of this condition via a pure endovascular approach. A combined operative-endovascular intervention may be a valuable approach in order to reduce the risk of intraoperative stroke and prevent future embolic events...
August 2016: Vascular and Endovascular Surgery
Georges Ephrem, Sireesha Garikipati, Ivan D Hanson
INTRODUCTION: Percutaneous endovascular revascularization requires the use of fluoroscopic guidance and radiopaque contrast. We present a successful intervention without the use of iodinated contrast. CASE: A 92-year-old man with dry gangrene involving the second and fourth left toes had acute on chronic kidney injury. Arterial duplex showed severe stenosis in bilateral superficial femoral arteries (SFAs). Fluoroscopic and ultrasound guidance and intravascular imaging were used to avoid iodinated contrast...
September 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Katherine K Temprano
Raynaud's phenomenon is a relatively common but often unrecognized clinical syndrome causing characteristic color changes in the digits as a result of vasospasm. This may occur after exposure to a cold environment, emotional stress, or from other physical or medication exposures. Differentiating between primary and secondary Raynaud's is important as secondary Raynaud's can be complicated by digital ischemia and gangrene whereas primary Raynaud's is generally a benign condition. Referral to a rheumatologist is recommended to help evaluate for an underlying rheumatologic condition and to guide future therapy...
March 2016: Missouri Medicine
Amgad Said, Justin Keasberry
BACKGROUND: Venous gangrene complicating deep vein thrombosis in the context of anticoagulation use in patients with gynecologic malignancy is rarely reported. We report an unusual presentation of venous gangrene of the lower limbs associated with warfarin therapy in a 53-year-old woman from the Cook Islands with an occult ovarian cancer. CASE PRESENTATION: A 53-year-old woman of Cook Islands origin presented with exertional dyspnea, rapid atrial fibrillation, bilateral lower limb edema, and painful digital ischemia of her hallux...
2016: Journal of Medical Case Reports
Tatsuya Shiraki, Osamu Iida, Kotaro Suemitsu, Yoriko Tsuji, Masaaki Uematsu
We here report a successful angioplasty for tibial artery occlusion using direct tibial puncture and subsequent retrograde approach under surgical cutdown technique. An 82-year-old man with ulcer/gangrene in first and second digits was referred to our hospital for endovascular therapy (EVT) of lower extremity ischemia. Diagnostic angiogram revealed anterior tibial artery (ATA) occlusion with severe calcification. Subintimal angioplasty was attempted using a 0.014-inch hydrophilic guidewire but was unsuccessful...
May 2016: Vascular and Endovascular Surgery
K P Sathe, A Ohri, A Mishra, U Ali
No abstract text is available yet for this article.
May 2016: Indian Journal of Nephrology
Siba Prasad Dalai, Lalit Kumar Meher, Samir Kumar Behera, Sachidananda Nayak, Sujit Kumar Tripathy
Cryoglobulins are monoclonal or polyclonal immunoglobulins that undergo reversible precipitation at low temperatures. Cryoglobulinemia is associated with HCV infection in more than 90% cases, the remaining 10% being called as Essential Cryoglobulinemia which is generally associated with a severe course and suboptimal response to conventional therapies. As the digital vessels are more prone to colder temperatures, hyperviscosity in those vessels can initiate local thrombosis and may manifest as ischemic ulceration and gangrene...
April 2016: Journal of Clinical and Diagnostic Research: JCDR
Yuk Law, Yiu Che Chan, Stephen Wing-Keung Cheng
Due to the relatively low metabolic demand and extensive collaterals of the upper limb, peripheral arterial disease seldom leads to tissue loss, except in patients with end-stage renal failure (ESRF), rheumatologic diseases, Raynaud's disease, frostbites, or distal emboli. We report a case of a 51-year-old lady with ESRF who presented to our tertiary referral vascular center with infected gangrene of her right ring finger. Duplex ultrasound showed that her forearm arteries were severely diseased. Digital subtraction angiogram showed severe multilevel stenoses/occlusions in her forearm radial and ulnar arteries...
2016: International Journal of Nephrology and Renovascular Disease
Julie J Paik, Ram Hirpara, Jennifer A Heller, Laura K Hummers, Fredrick M Wigley, Ami A Shah
OBJECTIVE: To demonstrate potential thrombotic complications after radial arterial line placement in patients with scleroderma. METHODS: This is a retrospective case series of 4 patients with scleroderma who were hospitalized in the intensive care unit (ICU) requiring invasive hemodynamic monitoring and developed severe complications after radial arterial line placement. We reviewed their medical records to assess their laboratory findings and clinical presentations...
October 2016: Seminars in Arthritis and Rheumatism
Khanh N Pham, Mitchell H Sokoloff, Charles A Steiger
We report an interesting case of Buerger's disease that manifested at the glans penis in a 56 year-old former smoker. Penile involvement in Buerger's disease is rare. Our patient had no prior extremity or digit amputations in his 4-year history of Buerger's disease. However, our patient did suffer from recurrent penile ulcers over an 8-week timeframe that ultimately progressed to a gangrenous, unsalvageable glans penis. He underwent a partial penectomy and urethral reconstruction with excellent post-operative results...
2016: American Journal of Clinical and Experimental Urology
Saranya Khunkhet, Ploysyne Rattanakaemakorn, Natta Rajatanavin
No abstract text is available yet for this article.
November 2015: JAAD Case Reports
A Ikpeme, A Akintomide, O Ukweh, S Effanga
BACKGROUND: Peripheral limb vascular diseases form one of the most common diseases that affect the middle-aged and the elderly. Duplex ultrasound has revolutionized medicare and is an important modality for investigating them. Unfortunately, this modality is still not popular in our environment and in Calabar was used for the 1st time 4 years ago. This work is, therefore, to report our findings and hopefully increase the awareness of its benefits thereby improving and hastening the diagnosis of vascular pathologies in our environment...
May 2016: Nigerian Journal of Clinical Practice
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