Intermittent claudication of cauda equina with central lumbar disc protrusion. A case report.
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Twenty male claudicant patients and nine age-matched controls were exercised on a treadmill. Blood and urine samples were taken before and after exercise. Total antioxidant concentration was measured using an enhanced chemiluminescent assay and microalbuminuria determined by radioimmunoassay. Claudicants had increased microalbuminuria after exercise. Mean (s.e.m.) antioxidant concentrations were similar for patients and controls at rest: 479(28) and 438(23) mumol/l respectively. Claudicants showed a significant decrease in antioxidant concentration 1 min after exercise to 428(27) mumol/l; this returned to 470(30) mumol/l by 10 min. A correlation was found between the decrease in antioxidant concentration and the increase in microalbuminuria (rs = -0.496, P < 0.05). This study supports the concept of ischaemia-reperfusion injury in claudicant patients and has implications for treatment.
The mainstay of treatment for claudication is reversal of risk factors, especially smoking, and the use of antiplatelet drugs and possibly pentoxifylline. A major factor in the long term management is atherosclerotic involvement in other parts of the circulation resulting in a shortened life span. Treatment should be directed at the disease in general, rather than in the legs alone. Patients disabled by claudication may gain symptomatic relief with relatively low risk using balloon angioplasty or vascular reconstructive procedures.
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