Sustained classic clinical spectrum of thromboangiitis obliterans (Buerger's disease).

Thromboangiitis obliterans (TAO) has been reported to become less common in general population but more common in women, and in elderly patients. The authors looked at the clinical characteristics of TAO in Poland where there was no significant decrease of smoking and the extent of aging of the general population is less profound. They retrospectively reviewed the records of 377 patients with the diagnosis of TAO hospitalized in their institution from 1970 to 1995. If young smoking males demonstrated distal-extremity ischemia with no bruits audible over major arteries, upper limbs involvement, or superficial thrombophlebitis, the diagnosis of TAO was considered certain. When at least one of those criteria was missed, and in men older than 35 years, but in all females, typical arteriographic findings were required for the diagnosis of TAO. Connective-tissue disease, hyperlipidemia, diabetes, and hypercoagulable state were excluded. Three hundred forty-two men (91%), and 35 (9%) women had a mean age of 29.5 years at the onset of the disease (the oldest patient was 50 years old). The prevalence of TAO in southwest Poland is 8.1/100,000 and the incidence of the disease steadily declines; there was no increase of TAO in women. Three hundred thirty-seven (89%) experienced rest pain, 321 (85%) had ischemic necrosis, and 233 (62%) thrombophlebitis at some (continued on next page) time in the course of the disease. Raynaud's phenomenon occurred in only 39 patients (10%). Those patients who had quit smoking had a 50% decrease of the disease recurrences compared to their smoking period. Because the cause of declining incidence of TAO is obscure, the authors critically evaluated previously used explanations of this phenomenon. They did not confirm the observation of a change in the TAO clinical spectrum: occurrence in women did not increase, the aging of the TAO population was not observed. In Poland TAO is still a disease affecting the peripheral circulation of young smoking males with recurrent episodes of superficial thrombophlebitis and common involvement of the upper extremities; Raynaud's phenomenon is rather infrequent. Smoking cessation ameliorates the course of the disease but does not invariably stop further exacerbations.

Buerger's disease in two brothers: iliac artery occlusion by thromboangiitis obliterans--case reports.

Several characteristics of thromboangiitis obliterans are unique and confirm the existence of the disease as a distinct pathological entity. Its predilection for young smoking males, peripheral type of vascular involvement, recurrences of superficial thrombophlebites, and typical histolopathology form the principals of the disease although the etiology remains unknown. The authors report the unusual finding of Buerger's disease occurring in two brothers, one of whom had occlusion of the left external iliac and femoral arteries. All other clinical characteristics of these two cases were typical for thromboangiitis obliterans. Presentation of some peculiarities of the disease, particularly the lack of familial association, may help to unravel the pathogenesis of thromboangiitis obliterans.

[Raynaud's syndrome during the course of polymyalgia rheumatica]. / Zespól raynaud'a w przebiegu polimialgii reumatycznej.

A case is described of polymyalgia rheumatica in which Raynaud's sign appeared at the beginning of the disease parallel with changes of rheumatoid arthritis type without other features of arterial system involvement in particular without clinical features of the involvement of the subclavian or axillary artery. The sign of temporal artery involvement appeared only after 18 months of disease duration. Steroid-therapy produced complete regression of both articular muscular and vascular changes.

[Crural amputation in the course of systemic lupus erythematosis]. / Amputacja podudzia w przebiegu tocznia rumieniowatego ukladowego.

A case is presented of a 22-year-old woman in whom, in the course of unrecognised systemic lupus erythematosus, spontaneous abortion, thrombosis of the femoral artery, and inflammatory changes of the crural vessels developed. The administered treatment with steroids failed to prevent crural amputation.

[Prostaglandin E1 in the treatment of chronic ischemia of the extremities]. / Prostaglandyna E1 w leczeniu przewleklego niedokrwienia konczyn.

The authors observed the effect of prostaglandin E1 (Prostavasine) on the blood flow in the lower extremities in 25 patients with chronic ischemia caused by thrombo-angitis obliterans and arteriosclerosis obliterans (clinical stage III and IV). The blood flow in the lower extremities and the effects of prostaglandin E1 were assessed by means of rheo-angiographic and Doppler-testing investigations. The parameters A (amplitude), S (area) and WOT (index) of rheo-angiographic curves showed significant increased. No significant changes were found in the determined Doppler's indexes. The observed differences of values the parameters of rheo-angiographic curves suggests that prostaglandin E1 evident improvement the tissue blood flow in patients with critical ischemia of the lower extremities. The authors found that prostaglandin E1 was without any significant effect dilating the great vessels, but an evident improvement was observed in rheo-angiographic records which reflect rather the blood flow values in the small vessels.

[Vascular complications in systemic lupus erythematosus]. / Powiklania naczyniowe w przebiegu ukladowego tocznia rumieniowatego.

A 41-year-old woman is reported who had been observed and treated for 15 years for arterial and venous thrombotic episodes and in whom only in the 9th year of the disease systemic lupus erythematosus was diagnosed. During these 9 years the case was not meeting the diagnostic criteria of this disease. The possibility of transition of inactive collagen disease manifesting itself as thrombo-obliterative vasculitis into its active form is discussed.