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PubMed1984

A case of Wegener's granulomatosis presenting with jaw claudication.

The major manifestations of Wegener's granulomatosis have been well described. Jaw claudication has not been recognized as one of the symptoms associated with this disease. We report the first case of Wegener's granulomatosis presenting with jaw claudication. Documentation of different histological types of vasculitis producing similar symptoms broadens our concepts of systemic vasculitis and emphasizes the need for tissue biopsy for diagnosis.

Diagnosis, Differential↗
PubMedDate not supplied

[Neurogenic intermittent claudication].

In the period 1971-1981 operations were carried out in 1114 cases of discopathy or lumbar spondylosis. Three patients in this group had pains of the type of intermittent claudication as the main symptoms. In all these cases narrowing of the vertebral canal was found in the lumbar part caused in two cases by degenerative changes and herniation of the intervertebral discs, and in a third case it was due to an extensive connective tissue scar at the site of previously done laminectomy. The nerve roots of the cauda were relieved from pressure surgically and in all cases pains disappeared. The authors discuss factors contributing to the development of neurogenic intermittent claudication.

Adult↗
PubMed1978

[The effect of oxyfedrine and intervall training in intermittent claudication (author's transl)].

In 23 patients suffering from intermittent claudication due to chronic occlusions of the femoral artery proved on angiography, a double-blind study was performed to compare the effects of treatment with oxyfedrine and interval-training and of interval-training alone. The claudication distance, physical work capacity and physical work intensity were measured on the treadmill before, during and after 10-weeks training period in each case. After training, the walking ability improved in both groups, however, quantitatively being more pronounced in the oxyfedrine group. In the placebo group, the increase in physical work intensity was mainly caused by the improvement of walking ability in patients with higher levels of performance at the beginning of the training. In the oxyfedrine group, on the other hand, a continuous and regular increase in physical work intensity was found at all levels of performance and during the whole training period. For the differences found, blood supply lowering mechanisms after physical training and improvement of collaterals after combination oxyfedrine and physical training are discussed. The possibility of additive action of the pharmacologic treatment and physical training are pointed out.

Aged↗
PubMed1978

Effects of physical training in intermittent claudication.

Mechanisms for increased claudication distance following physical training were studied in ten patients with peripheral arterial insufficiency. The exercise capacity on a bicycle ergometer increased by an average of 26% after 3--4 months of training (P less than 0.05). Neither maximum lower leg blood flow during the exercise test nor oxygen uptake at exhaustion changed significantly after training (-8% and +5%, respectively), whereas popliteal-venous O2-saturation was lower at exhaustion after the training than before (8.5 +/- 3.2 and 11.4 +/- 4.6, respectively, P less than 0.05). Anaerobic glycolysis, as evidenced by the lactate release, was also lowered after the training (P less than 0.05). In conclusion, the present study shows that the increased exercise capacity following physical training in claudicants is associated with an increased local aerobic working capacity despite a virtually unchanged blood flow. This increased aerobic exercise capacity might partly be explained by an increased O2 extraction in the lower leg during exercise.

Aged↗
PubMed1983

Neurogenic claudication due to pseudospondylolisthesis.

Pseudospondylolisthesis is a subluxation of the lumbar vertebrae due to incompetent facet joints. The resulting stenosis of the lumbar spinal canal may impinge on the nerve roots of the cauda equina and induce neurogenic claudication. This syndrome is difficult to distinguish clinically from lower extremity claudication of vascular etiology. Accurate diagnosis requires radiographic examination of the spine.

Diagnosis, Differential↗
PubMed1984

Intramuscular pressure, blood flow, and skeletal muscle metabolism in patients with venous claudication.

Nine patients with chronic iliac vein obstruction and venous claudication were investigated. Intramuscular pressure was measured in the anterior tibial and the deep posterior compartments in both legs at rest and during exercise. The pressures were significantly higher in the leg with iliac vein obstruction (39 +/- 10 mm Hg) than in the contralateral leg (26 +/- 12 mm Hg) at rest as well as during exercise (60 +/- 16 mm Hg and 41 +/- 15 mm Hg, respectively) in the deep posterior compartment. Similar changes were observed in the anterior tibial compartment. Muscle water content was higher (P less than 0.01) in the obstructed leg and contributes to the explanation for the high intramuscular pressure in this leg. Muscle blood flow, adenosine triphosphate, phosphocreatine, and lactate were determined in the gastrocnemius muscles at rest and at exercise. Muscle blood flow, measured with the 133xenon clearance technique, was lower in the obstructed leg (17.5 ml/min, 100 gm) than in the control leg (28.1 ml/min, 100 gm) during exercise. Lactate increased more (P less than 0.05) in the obstructed leg. It is suggested that pain in venous claudication is caused by the high intramuscular pressure, and therefore fasciotomy may be useful in the treatment of this disorder.

Adenosine Triphosphate↗
PubMed1982

Lactate and pyruvate changes during treadmill exercise in patients with intermittent claudication.

Exercise and post-exercise metabolism was studied in the legs of 6 healthy individuals without arterial occlusive disease and in 34 patients with intermittent claudication. Venous blood from the popliteal vein was taken intermittently by regional catheterization during and after an exhaustive constant load exercise on a treadmill. Change of lactate and pyruvate was studied in arterial and popliteal venous blood. The mean arterial concentration of pyruvate during exercise was increased less in patients and controls as compared to the lactate concentration in both groups. There was a continuous rise of the arterial pyruvate concentration after exercise in patients in contrast to the controls. During exercise, the difference between the arterio-popliteal venous blood samples in lactate concentrations was significantly higher in patients than in the controls. In general, patients had a significantly higher lactatepyruvate ratio in the popliteal venous blood than in the arterial blood. It is concluded that the onset and degree of anaerobic work is best studied by the regional catheterization technique. This new technique permits to study the spontaneous and reactive metabolic changes in the legs during and after treadmill exercise in patients with intermittent claudication.

Adult↗
PubMed1978

Physical training of patients with intermittent claudication: indications, methods, and results.

Supervised dynamic physical training for 4 to 6 months as a treatment of intermittent claudication was studied in 148 patients who had clearcut symptoms for more than 6 months. Nineteen patients could not complete the planned training program because of cardiac complications, rapid progress of the disease, intercurrent disease, or social reasons. Before the training was started, walking tolerance and calf blood flow were determined. The intensity of each training session (three times per week) was adjusted to the patient's cardiac tolerance as predicted by the cardiac tolerance test. The walking ability increased in 88% of the patients and the average increase was 234%, while the calf blood flow remained unchanged. After the training period, more than 40% of the patients could walk 1,000 m or more. The increase in walking ability was independent of the location of the atherosclerotic lesion or the presence of diabetes. It is concluded that physical training is a good alternative to reconstructive surgery in the treatment of patients with intermittent claudication. It does not interfere with the surgical possibility if operation becomes necessary in the immediate or later course of the disease.

Adult↗
PubMed1981

Home-training of patients with intermittent claudication.

Fifteen patients with intermittent claudication but without angina pectoris underwent a training programme consisting of three months of home-training followed by three months of supervised in-hospital training. Detailed information and instruction preceded the start of the training. There was a significant increase in maximal walking distance and also in physical activity during the home-training period. There was no difference in the increase in walking distance between this group and an earlier, comparable, group that had undergone a similar period of supervised in-hospital training. A further significant increase in maximal walking distance was obtained after three months of supervised in-hospital training. The physical activity during leisure time was, however, not further increased. Smoking habits were affected. After one year, one out of twelve smokers had stopped smoking and eight had reduced their consumption by 30-75%. Home-training after a careful instruction and with control of results is an alternative to supervised in-hospital training for a large group of patients with intermittent claudication but without angina pectoris.

Activities of Daily Living↗
PubMedDate not supplied

[An unusual case of intermittent venous claudications].

The authors report on a case of intermittent venous claudications in a 76-year-old man, who three months previously suffered a sudden acute attack of phlebitis in the right upper limb. The Doppler exam showed post-phlebitic failure of the humeral valve and diminished permeability of the axillobrachial axis of the vein, with sub-clavicular obstruction. The discussion provides an opportunity for reviewing the various anatomo-pathological definitions and explanations of the mechanism of intermittent venous claudications.

Aged↗
PubMedDate not supplied

[Philosophy of the treatment of intermittent claudication].

Everything points to the prime importance of good health habits and the prevention of risk factors. Long-term medication has only a limited and still questionable impact. Surgery will never be proposed straight off, but only if the claudication is persistent and troublesome in an active individual. Lumbar sympathectomy always provides a degree of improvement and entails a minimal risk. There is no secondary deterioration. Yet in cases of associated phlebites, it can aggravate trophic skin problems. Reconstructive surgery gives far better immediate results but at the price of increased risk and a secondary deterioration that makes difficult repeat operations necessary. It is thus necessary to be very careful in using surgery to deal with intermittent claudications.

Humans↗
PubMed1980

[Results of the physiotherapy of arterial disease at the stage of intermittent claudication by programmed efforts training (author's transl)].

The results of treatment of intermittent claudication by a physical training programmed during 30 to 45 days in a rehabilitation center, are assessed on 148 patients of whom 105 have followed a full program at first (32 cases) or after surgery (73 cases). Ankle pressures are not altered. Irrigraphy shows a significant increase of 10 to 14% of the proximal indexes. Walking distance is greatly increased. 13 patients had a walking distance of about 900 m at the beginning and 31 patients at the end of the course ("functional remission"). Out of 105 patients, 98 showed improvement, 4 remained unchanged and 3 slightly worsened. The appreciation of his own progress is a strong psychological stimulation for the patient, this helping him to accent his illness, and to fight the corrigible risk factors of atherosclerosis, all significantly reduced. The interpretation of the results is discussed and shows the importance of non-hemodynamic factors in the achieved progress. The programmed exercise training is one of the best non surgical symptomatic treatments of intermittent claudication.

Adult↗
PubMed1995

Micro- and macrocirculatory, and biohumoral changes after a month of physical exercise in patients with intermittent claudication.

We studied 15 subjects with intermittent claudication, classed as stage II according to Leriche-Fontaine. The patients were subjected to laser Doppler flowmetry, strain gauge plethysmography, Doppler velocimetry, and blood sampling, in basal conditions and after one month of physical training. Symptom-free walking distance at the end of the training period showed a significant increase, while there was no major change in maximal walking distance or the Windsor index. Laser Doppler flowmetry showed no significant change in cutaneous blood flow at rest, after the month of physical training. On the other hand, strain gauge plethysmography showed a significant decrease in rest flow at the end of the training period, while peak flow of postischemic hyperemia did not change appreciably. Biohumoral evaluations showed a significant decrease of white blood cell count, triglycerides and uric acid. Platelet count, prothrombin time, aPTT and plasminogen were unchanged. On the other hand, we recorded a small, but significant, rise of fibrinogen. Our study confirmed the importance of scheduled physical activity in the patient with intermittent claudication, showing that clinical improvement is not accompanied by an increase in the circulatory reserve. The unchanged levels of plasminogen suggest that the fibrinolytic activity does not vary significantly after a course of physical exercise.

Aged↗
PubMed1994

Treatment of intermittent claudication with defibrotide or mesoglycan. A double blind study.

Forty-four patients with intermittent claudication were included and randomised in two groups respectively treated with oral defibrotide (one 400 mg tablet bid) or oral mesoglycan (one 24 mg tablet bid) for 6 months. Twenty-two subjects completed the study in the defibrotide group and 20 in the mesoglycan group. The two treatments were well tolerated and the two drop outs in the mesoglycan group were not due to medical causes. In the defibrotide group, after 1 month the pain-free walking distance (PFWD) increased from 473 +/- 96 m to 586 +/- 84 (p < 0.05). The walking distance (WD) increased from 767 +/- 125 m to 898 +/- 109 (p < 0.05). After 6 months the posterior tibial pressure (PTP) at the end of the treadmill exercise test also increased from 40 +/- 19 to 63 +/- 12 (p < 0.05). No variations in PFWD, WD and PTP were observed in the mesoglycan group. The improvement in walking was possibly due to the action of defibrotide increasing local fibrinolysis and decreasing the distal vasospasm present in subjects with peripheral vascular disease and intermittent claudication.

Double-Blind Method↗
PubMed1994

Intermittent medullary claudication: postmortem spinal angiographic findings in two cases and in six controls.

Postmortem thoracolumbar aortography with solidifying contrast medium to visualize the arteries of the lower part of the spinal cord was performed in two patients with a long history of intermittent neurogenic claudication and degenerative spinal stenosis, as well as in six controls. One of the patients proved to have advanced atheromatous lesions in the aorta, several obliterated intercostal and lumbar arteries, and a blocked caudal portion of the anterior spinal artery. The other had an arterious malformation in the spinal cord at the thoracolumbal junction. The angiographic findings for these patients differed remarkably from those of six age-matched controls, indicating that disturbed blood flow in the lower part of the cord probably contributed to the symptom complex in the patients with claudication. The potential combination of local compression and vascular disease of the cord may explain why decompressive procedures sometimes fail to eliminate a patient's symptoms.

Aged↗
PubMed1994

[Electromagnetic therapy for patients with intermittent claudication--is it effective?].

A treatment based on electromagnetic principles (Elmedistraal) has been tested on 12 patients with intermittent claudication. What initiated this investigation was the publicity in the media around this treatment and its supposedly positive effect on peripheral circulation. 12 patients received ten placebo and ten active treatments. The patients were thus their own control. We looked for changes in clinical signs, ankle/arm pressure index (ultrasound Doppler) and maximal walking distance (treadmill). The patients reported changes in symptoms by means of a visual analog scale. In this study neither subjective nor objective effects of treatment with Elmedistraal could be documented in patients with claudication.

Aged↗
PubMed1994

[Padma-28, a herbal preparation, increases walking distance in patients with intermittent claudication].

Thirty-six patients with stable intermittent claudication were randomized in a doubleblind study either to treatment with two tablets of Padma-28 twice daily (containing 340 mg dried herbal mixture composed according to an ancient lamaistic prescription) or placebo for four months. Effect of treatment was quantified by measurements of systemic and peripheral systolic blood pressures, and pain-free and maximal walking distances on a tread-mill. The actively treated group attained a significant increase in pain-free walking distance from 115 m (72-218) to 227 m (73- >1000, p < 0.05). The placebo group did not show significant changes in either pain-free or maximal walking distance. Significant changes in systemic or peripheral blood pressures could not be demonstrated in any of the groups. In conclusion, our study has shown that treatment with Padma-28 over a four month period significantly increases the walking distance in patients with stable intermittent claudication of long duration.

Aged↗