RESUMEN
We report a case of pulley rupture following repeated local corticosteroid injections for trigger digit. The treatment involved exploration, tenolysis, and reconstruction using the palmaris longus tendon.
Asunto(s)
Antiinflamatorios/efectos adversos , Traumatismos de los Tendones/inducido químicamente , Tendones/efectos de los fármacos , Triamcinolona Acetonida/efectos adversos , Trastorno del Dedo en Gatillo/tratamiento farmacológico , Adulto , Antiinflamatorios/administración & dosificación , Contractura/inducido químicamente , Contractura/cirugía , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Imagen por Resonancia Magnética , Rotura Espontánea/inducido químicamente , Rotura Espontánea/cirugía , Traumatismos de los Tendones/cirugía , Tendones/patología , Tendones/trasplante , Triamcinolona Acetonida/administración & dosificaciónRESUMEN
This study extends earlier trials indicating that atherosclerosis risk factors are underdetected and undertreated in peripheral arterial disease (PAD) patients. Recognition and treatment of hyperlipidemia and hypertension in PAD patients is suboptimal. Diabetes appears to be detected more frequently although glycemic control is still suboptimal. The use of antiplatelet therapy is particularly underutilized. Additionally, despite the demonstrated efficacy of regular exercise in PAD patients, almost half of the study sample was sedentary. Approximately one third of the current study sample was overweight and nearly one third was obese by ATP-III guidelines. Only 31% of subjects were taking dietary measures to improve their cardiovascular health, and even fewer were physically active. To rectify suboptimal management of risk factors, there is a need for increased public awareness of PAD, reimbursement and implementation of screening programs and more aggressive treatment. Future studies are needed to examine innovative interventions for identification and management of cardiovascular risk factors in patients with PAD.
Asunto(s)
Claudicación Intermitente/epidemiología , Claudicación Intermitente/terapia , Estilo de Vida , Enfermedades Vasculares Periféricas/epidemiología , Enfermedades Vasculares Periféricas/terapia , Distribución por Edad , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Estudios de Cohortes , Terapia Combinada , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/epidemiología , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/tratamiento farmacológico , Angiopatías Diabéticas/epidemiología , Femenino , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/tratamiento farmacológico , Hiperlipidemias/epidemiología , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipolipemiantes/uso terapéutico , Incidencia , Claudicación Intermitente/diagnóstico , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/diagnóstico , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Fumar/efectos adversos , Fumar/epidemiología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Cardiovascular risk factors are associated with impaired endothelium dependent vasodilation and reduced vascular compliance. In this study, the correlation with cardiovascular risk factor score of two common techniques for assessing vascular function was compared. Risk factors and vascular function were evaluated in a study population of 122 people with peripheral arterial disease (PAD) or with risk factors for PAD (73 men and 49 women; mean age 69 years). A risk factor score was determined using Framingham criteria. Vascular compliance was assessed by pulse waveform analysis and simultaneous blood pressure measurement. Flow-mediated vasodilation of the brachial artery was measured using duplex ultrasonography. Participants with a high risk factor score had significantly reduced vascular compliance of large and small vessels. By contrast, the difference in flow-mediated vasodilation between those with a high or low risk factor score did not reach statistical significance. There was a significant negative correlation between vascular compliance and risk factor score. There was a similar trend between flow-mediated vasodilation and risk factor score, but this did not reach statistical significance. A measure of vascular compliance was more significantly correlated with cardiovascular risk factor score than was a measure of flow-mediated vasodilation in the study population. Neither technique provided values that were highly correlated with risk factor burden. Although flow-mediated vasodilation is a preferred research tool for assessing vascular function, technical limitations and biological variability may reduce its clinical application in assessing individual cardiovascular risk.
