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1.
Vasc Health Risk Manag ; 15: 317-353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31616151

RESUMO

One of the challenges of thromboangiitis obliterans (TAO) management is in the patients whose other vascular beds are involved and it remains a challenge to know whether to pursue invasive procedures or to continue medical treatment for such TAO patients. The aim of this review was to investigate reports of the involvement of the visceral vessels in TAO and the related clinical manifestations, management approaches and outcomes. According to our systematic review, the frequency of published articles, the organs most commonly involved were the gastrointestinal tract, the heart, the central nervous system, the eye, the kidneys, the urogenital system, the mucocutaneous zones, joints, lymphohematopoietic system and the ear. Notably, reports of the involvement of almost all organs have been made in relation to TAO. There were several reports of TAO presentation in other organs before disease diagnosis, in which the involvement of the extremities presented after visceral involvement. The characteristics of the visceral arteries looked like the arteries of the extremities according to angiography or aortography. Also, in autopsies of TAO patients, the vascular involvement of multiple organs has been noted. Moreover, systemic medical treatment could lead to the recovery of the patient from the onset of visceral TAO. This study reveals that TAO may be a systemic disease and patients should be aware of the possible involvement of other organs along with the attendant warning signs. Also, early systemic medical treatment of such patients may lead to better outcomes and reduce the overall mortality rate.


Assuntos
Artérias , Tromboangiite Obliterante/terapia , Vísceras/irrigação sanguínea , Adulto , Artérias/diagnóstico por imagem , Artérias/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Fumar/mortalidade , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/mortalidade , Tromboangiite Obliterante/patologia , Adulto Jovem
3.
PLoS One ; 13(10): e0205305, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30300407

RESUMO

We aimed to compare the clinical outcomes between endovascular treatment and inframalleolar bypass surgery for critical limb ischemia (CLI) in patients with thromboangiitis obliterans (TAO) and to assess the role of bypass surgery in the era of innovative endovascular treatment. Between January 2007 and December 2017, a total of 33 consecutive patients with the diagnosis of TAO presenting with CLI who underwent endovascular treatment (endovascular group, n = 22) or bypass surgery to the pedal or plantar vessels (bypass group, n = 11) were included and analyzed retrospectively. The primary endpoint was defined as a major amputation of the index limb, and the secondary endpoint was defined as graft occlusion, regardless of the number of subsequent procedures. In the bypass group, six patients (55%) had undergone previous failed endovascular procedures and/or arterial bypass surgery to the index limb before inframalleolar bypass, and two patients (18%) received microvascular flap reconstruction after bypass surgery. During the median follow-up period of 32 months (range 1-115 months), there were no significant differences in primary and secondary endpoints between the two groups although the bypass group had a higher Rutherford class than the endovascular group. Kaplan-Meier survival analysis showed that there were similar limb salvage (P = 0.95) and graft patency rates (P = 0.39). In conclusion, endovascular treatment is a valid strategy leading to an acceptable limb salvage rate for TAO patients, and surgical bypass to distal target vessels could play a vital role in cases of previous failed endovascular treatment or extensive soft tissue loss of the foot.


Assuntos
Procedimentos Endovasculares/métodos , Isquemia/cirurgia , Veia Safena/cirurgia , Tromboangiite Obliterante/cirurgia , Enxerto Vascular/métodos , Adulto , Idoso , Amputação/mortalidade , Amputação/estatística & dados numéricos , Procedimentos Endovasculares/mortalidade , Feminino , Oclusão de Enxerto Vascular/mortalidade , Oclusão de Enxerto Vascular/patologia , Humanos , Isquemia/mortalidade , Isquemia/patologia , Salvamento de Membro/mortalidade , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/patologia , Análise de Sobrevida , Tromboangiite Obliterante/mortalidade , Tromboangiite Obliterante/patologia , Enxerto Vascular/mortalidade
4.
Stem Cell Res Ther ; 9(1): 150, 2018 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848379

RESUMO

Thromboangiitis obliterans (TAO), also known as Buerger's Disease, is an occlusive vasculitis linked with high morbidity and amputation risk. To date, TAO is deemed incurable due to the lack of a definitive treatment. The immune system and inflammation are proposed to play a central role in TAO pathogenesis. Due to their immunomodulatory effects, mesenchymal stromal cells (MSCs) are the subject of intense research for the treatment of a wide range of immune-mediated diseases. Thus far, local intramuscular injections of autologous or allogeneic MSCs have shown promising results in TAO. However, sequential intravenous allogeneic MSC administration has not yet been explored, which we hypothesized could exert a systemic anti-inflammatory effect in the vasculature and modulate the immune response. Here, we report the first case of a TAO patient at amputation risk treated with four sequential intravenous infusions of bone marrow-derived allogeneic MSCs from a healthy donor. Following administration, there was significant regression of foot skin ulcers and improvements in rest pain, Walking Impairment Questionnaire scores, and quality of life. Sixteen months after the infusion, the patient had not required any further amputations. This report highlights the potential of sequential allogeneic MSC infusions as an effective treatment for TAO, warranting further studies to compare this approach with the more conventionally used intramuscular MSC administration and other cell-based therapies.


Assuntos
Transplante de Células-Tronco Mesenquimais/métodos , Tromboangiite Obliterante/terapia , Transplante Homólogo/métodos , Administração Intravenosa , Adulto , Humanos , Masculino , Células-Tronco Mesenquimais , Tromboangiite Obliterante/patologia , Resultado do Tratamento
6.
Stem Cell Res Ther ; 9(1): 43, 2018 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-29471870

RESUMO

BACKGROUND: For patients with thromboangiitis obliterans (TAO), revascularization with bypass or angioplasty is frequently not feasible due to the poor outflow of the distal small vessels. We evaluated the long-term results of our experience treating patients with TAO with autologous bone marrow-derived mononuclear cells (ABMMNCs) to determine the safety and efficacy of ABMMNC therapy in patients with critical limb ischemia due to TAO. METHODS: This was a retrospective chart review from a single university hospital vascular surgery center between January 2005 and July 2006. Patients were treated with smoking cessation and either aspirin (100 mg/day) alone or aspirin and ABMMNC injection according to patient preference. Groups were compared for demographics, clinical characteristics, and short-term and long-term results. RESULTS: Of 59 patients with TAO who were treated, 19 patients elected aspirin alone and 40 patients elected aspirin and ABMMNC injection. No patients suffered perioperative complications and 49 (83%) patients remained smoke-free for 10 years. The 10-year amputation-free survival was 85.3% (29/34) in patients treated with ABMMNCs compared to 40% (6/15) in patients treated with aspirin alone (p = 0.0019). Ulcer area (p < 0.0001), toe-brachial index (TBI; p < 0.0001), transcutaneous oxygen pressure (TcPO2; p < 0.0001), and pain score (p < 0.0001) were also significantly improved with ABMMNC treatment, although there was no difference in mean ankle-brachial index (ABI; p = 0.806). CONCLUSIONS: In patients with critical limb ischemia due to TAO, ABMMNC treatment was safe and effective. ABMMNC treatment significantly improved amputation-free survival, ulcer healing, and pain, although there is no difference in ABI compared to treatment with aspirin alone.


Assuntos
Aspirina/administração & dosagem , Células da Medula Óssea , Transplante de Medula Óssea , Isquemia , Leucócitos Mononucleares/transplante , Tromboangiite Obliterante , Adulto , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Isquemia/mortalidade , Isquemia/patologia , Isquemia/terapia , Masculino , Taxa de Sobrevida , Tromboangiite Obliterante/mortalidade , Tromboangiite Obliterante/patologia , Tromboangiite Obliterante/terapia
8.
Stem Cells Transl Med ; 6(3): 689-699, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28297569

RESUMO

Critical limb ischemia (CLI) due to Buerger's disease is a major unmet medical need with a high incidence of morbidity. This phase II, prospective, nonrandomized, open-label, multicentric, dose-ranging study was conducted to assess the efficacy and safety of i.m. injection of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (BMMSC) in CLI due to Buerger's disease. Patients were allocated to three groups: 1 and 2 million cells/kg body weight (36 patients each) and standard of care (SOC) (18 patients). BMMSCs were administered as 40-60 injections in the calf muscle and locally, around the ulcer. Most patients were young (age range, 38-42 years) and ex-smokers, and all patients had at least one ulcer. Both the primary endpoints-reduction in rest pain (0.3 units per month [SE, 0.13]) and healing of ulcers (11% decrease in size per month [SE, 0.05])-were significantly better in the group receiving 2 million cells/kg body weight than in the SOC arm. Improvement in secondary endpoints, such as ankle brachial pressure index (0.03 [SE, 0.01] unit increase per month) and total walking distance (1.03 [SE, 0.02] times higher per month), were also significant in the group receiving 2 million cells/kg as compared with the SOC arm. Adverse events reported were remotely related or unrelated to BMMSCs. In conclusion, i.m. administration of BMMSC at a dose of 2 million cells/kg showed clinical benefit and may be the best regimen in patients with CLI due to Buerger's disease. However, further randomized controlled trials are required to confirm the most appropriate dose. Stem Cells Translational Medicine 2017;6:689-699.


Assuntos
Células da Medula Óssea/citologia , Extremidades/irrigação sanguínea , Isquemia/terapia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Tromboangiite Obliterante/terapia , Adolescente , Adulto , Animais , Células Cultivadas , Extremidades/patologia , Feminino , Humanos , Injeções Intramusculares , Isquemia/patologia , Angiografia por Ressonância Magnética , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais/metabolismo , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Tromboangiite Obliterante/patologia , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
9.
Int Angiol ; 36(5): 410-416, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26344511

RESUMO

BACKGROUND: Rickettsia was suggested as a possible etiology of Buerger's disease (BD) in the 1980s but this suggestion was never ruled out or proven. Recently, we found evidence of Rickettsia by polymerase chain reaction in 3 out of 25 biopsy samples from the amputated limb of a young man diagnosed with BD. The aim of this paper was to investigate the presence of anti-rickettsial antibodies in the sera of BD patients. METHODS: To detect the IgG class antibody against Rickettsia rickettsii, which has cross reactions with the spotted fever group (RSFG), and Rickettsia typhi, which has cross reactions with typhus fever group, the sera of patients and controls were diluted to 1:64 and analyzed by indirect micro fluorescence immunoassay (MIF). RESULTS: The MIF study showed that 26 of the 28 patients were positive for Rickettsia rickettsii antibodies and MIF had the same appearance as the positive control, which was provided with the kit. In all members of the healthy control group, Rickettsia rickettsii was negative and had the appearance of the negative control. Rickettsia typhi was negative for all patients and members of the control group. CONCLUSIONS: A species of Rickettsia associated with the RSFG, which might not be pathogenic for the entire population, may induce BD in the context of a specific genetic or environmental background. RSFG infection could explain key questions about BD, including its gender and geographical distribution, clinical manifestation, angiography pattern, and pathological findings. Evaluating antibodies against RSFG in BD patients from different countries is now highly recommended.


Assuntos
Anticorpos Antibacterianos/sangue , Imunoglobulina G/sangue , Infecções por Rickettsia/patologia , Tromboangiite Obliterante/patologia , Adulto , Estudos de Casos e Controles , Reações Cruzadas , Diagnóstico Diferencial , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Rickettsia rickettsii , Tromboangiite Obliterante/sangue , Tromboangiite Obliterante/microbiologia
11.
Orv Hetil ; 157(30): 1207-11, 2016 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-27452071

RESUMO

Thromboangiits obliterans (Buerger's disease) is a non-atherosclerotic, segmental inflammatory and obliterative disease affecting small and medium sized arteries and veins. The etiology is still unknown, but it is in close relationship with tobacco use. Symptoms begin under the age of 45 years and the undulating course is typical. Patients usually present with acute and chronic ischemic or infectious acral lesions. Diagnosis is usually based on clinical and angiographic criteria and it is important to exclude autoimmune disease, thrombophilia, diabetes, and proximal embolic sources. Even though Buerger's disease most commonly involves the arteries of the extremities, the pathologic findings sometimes affect the cerebral, coronary and internal thoracic, renal and mesenteric arteries as well. The authors present the history of a patient with known Buerger's disease and acute ischemic stroke. Brain imaging detected acute and chronic ischemic lesions caused by middle cerebral non-atherosclerotic arteriopathy on the symptomatic side. Other etiology was excluded by detailed investigations. Orv. Hetil., 2016, 157(30), 1207-1211.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Artérias Cerebrais/patologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/patologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia
12.
Rinsho Shinkeigaku ; 56(5): 323-7, 2016 05 31.
Artigo em Japonês | MEDLINE | ID: mdl-27098901

RESUMO

A 78-year-old man presented complaining of tingling and pain. Neurological examination revealed dysesthesia and hypothermesthesia below both knees and areflexia in the lower extremities. Laboratory data revealed elevated serum levels of immunoglobulin IgG4 and para-aortic, and mesenteric lymphadenopathy was evident on plain computed tomography of the abdomen. Microscopic findings of a bone marrow biopsy specimen showed occlusion of blood vessels with IgG4-positive plasma cells. IgG4-related disease was diagnosed because the bone marrow biopsy exhibited > 10 IgG4-positive plasma cells per high-power field. Treatment was initiated with prednisolone starting at 30 mg/day, but no improvement in neurological symptoms was achieved. Sural nerve biopsy demonstrated obstructive thromboangiitis with severe loss of myelin and axons. Further investigations are needed to elucidate the relationship between obstructive thromboangiitis and steroid-resistant IgG4-related peripheral neuropathy.


Assuntos
Axônios/patologia , Imunoglobulina G/análise , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Idoso , Biomarcadores/análise , Biomarcadores/sangue , Medula Óssea/irrigação sanguínea , Medula Óssea/patologia , Humanos , Imunoglobulina G/sangue , Masculino , Doenças do Sistema Nervoso Periférico/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Nervo Sural/patologia , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/patologia , Tomografia Computadorizada por Raios X
13.
Harefuah ; 155(1): 41-4, 67, 66, 2016 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-27012074

RESUMO

INTRODUCTION: Thromboangiitis obliterans is an inflammatory occlusive vascular disease of young smokers that commonly involves the small and medium sized arteries and veins of the extremities. An important differential diagnosis of thromboangiitis obliterans is atherosclerotic arterial disease. An atypical presentation of thromboangiitis obliterans by involvement of mesenteric arteries has been described sporadically. CASE PRESENTATION: We report the case of a patient presenting with Raynaud's phenomenon, ischemia of the upper and lower extremities, as well as mesenteric ischemia. The dramatic course of the disease advanced to gangrene of the calves and intestinal infarction. In this patient, angiographic and histologic features were consistent with thromboangiitis obliterans associated with atherosclerotic arteriopathy. DISCUSSION: A review of the literature revealed 31 reported cases of mesenteric artery involvement by thromboangiitis obliterans. The overlap between thromboangiitis obliterans and atherosclerotic arteriopathy is rare but has recently focused attention in the literature. CONCLUSION: In the differential diagnosis of mesenteric ischemia, thromboangiitis obliterans is a rare but important diagnosis that should be considered. In view of shared features of thromboangiitis obliterans and peripheral artery disease, awareness of their possible coexistence is needed in order to make the right diagnosis and offer proper treatment.


Assuntos
Arteriosclerose/diagnóstico , Oclusão Vascular Mesentérica/diagnóstico , Tromboangiite Obliterante/diagnóstico , Arteriosclerose/patologia , Diagnóstico Diferencial , Gangrena/patologia , Humanos , Isquemia/etiologia , Isquemia/patologia , Masculino , Artérias Mesentéricas/patologia , Oclusão Vascular Mesentérica/etiologia , Oclusão Vascular Mesentérica/patologia , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/patologia , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/patologia
14.
Genet Mol Res ; 14(2): 6715-22, 2015 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-26125880

RESUMO

We investigated the expression and effects of hypoxia-inducible factor-1α (HIF-1α) in rat thromboangiitis obliterans (TO). Rats were divided into sham and model groups. The model group was further divided into groups based on observation duration. Lauric acid was injected below an artery clamp to simulate TO in the model group; saline was used in the sham group. Clamps were removed 15 min after injection in both groups, and physiological changes were observed at different times (gross observation and hematoxylin and eosin staining). The animals were killed at various times following the operation and serum and muscle tissues were sampled. For the sham group: the endometrium was relatively intact; medial membrane and epineurium lesions were absent; and blood vessels and surrounding tissues had no inflammatory cell infiltration. For the model group: all subgroups displayed inflammation; large numbers of inflammatory cells were gathered; muscle tissue lost its normal texture and structure; and the internal elastic membrane was integrated. Compared with the preoperative status, HIF-1α expression increased significantly in all subgroups (P < 0.05); there was no change in the sham group. HIF-1α expression in each subgroup was different (F = 14.267, P < 0.05). Femoral artery injection of lauric acid can be used as a rat TO model owing to its simple application and success rate. HIF-1α expression increased in the early stage of TO and gradually decreased with the extension of ischemia time; it may play a leading role in TO development and can be used for diagnosis and cure evaluation.


Assuntos
Artéria Femoral/patologia , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Tromboangiite Obliterante/genética , Tromboangiite Obliterante/patologia , Animais , Modelos Animais de Doenças , Progressão da Doença , Amarelo de Eosina-(YS) , Expressão Gênica , Hematoxilina , Histocitoquímica , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Injeções Intra-Arteriais , Ácidos Láuricos , Masculino , Ratos , Ratos Sprague-Dawley , Tromboangiite Obliterante/sangue , Tromboangiite Obliterante/induzido quimicamente
15.
Chirurgia (Bucur) ; 110(2): 183-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26011844

RESUMO

Thromboangiitis obliterans (Buerger'€™s disease) represents an inflammatory disease of limbs'€™ small arteries and veins causing vascular thrombosis, and partial or total obstruction. It affects mostly male gender aged 40 years old. The peculiarity of our case is underlined by presenting a 62 years, chronic tobacco user and not compliant female patient known with thromb oangiitisobliterans for almost 15 years. The arteriographic and clinical features with concomitant and sever affected upper and lower limbs are highly suggestive, emphasizing the possibility of Buerger'€™s disease development even in female patients.


Assuntos
Dedos/irrigação sanguínea , Plexo Lombossacral/cirurgia , Fumar/efeitos adversos , Tromboangiite Obliterante/patologia , Tromboangiite Obliterante/cirurgia , Dedos do Pé/irrigação sanguínea , Dedos do Pé/cirurgia , Amputação , Diagnóstico Diferencial , Progressão da Doença , Feminino , Dedos/patologia , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Simpatectomia/métodos , Tromboangiite Obliterante/etiologia , Dedos do Pé/patologia , Resultado do Tratamento
16.
J Tradit Chin Med ; 35(1): 41-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25842727

RESUMO

METHODS: Ninety lower-limb stage II or worse TAO patients were randomly divided into three groups: group A (30 cases) treated by intervention and oral administration of Chinese medicine; group B (30 cases) treated by intervention alone; and group C (30 cases) treated only with oral administration of Chinese medicine. Therapeutic effects were observed, including the cure rate; the recurrence rate after one month, three months, six months, nine months, and one year; the ankle brachial indexes; the incidence of complications; and the level of C-reactive protein and erythrocyte sedimentation rate. RESULTS: Group A had significantly better clinically curative effects, related indexes, and outcomes during the long-term follow-up survey, than that of groups B and C. CONCLUSION: Integrated treatment is more effective for treating lower-limb stage II or worse TAO. OBJECTIVE: To observe if integrated treatment is better than other therapies for lower-limb stage II thromboangiitis obliterans (TAO).


Assuntos
Aspirina/administração & dosagem , Medicamentos de Ervas Chinesas/administração & dosagem , Tromboangiite Obliterante/tratamento farmacológico , Administração Oral , Idoso , Proteína C-Reativa/metabolismo , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboangiite Obliterante/metabolismo , Tromboangiite Obliterante/patologia
17.
Circ J ; 78(12): 2819-26, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25298073

RESUMO

Buerger's disease (thromboangiitis obliterans) is considered to be a nonatherosclerotic, inflammatory, and vaso-occlusive disease, although the details of the mechanisms of pathogenesis remain unknown. The occurrence of the disease is strongly related to tobacco abuse and its progression is closely linked to continued smoking. The purpose of this review article is to demonstrate the pathological characteristics of arteries affected with Buerger's disease from a possible immunoreactive point of view. In addition, we present the mechanisms for preserving the architecture of the arterial wall in affected vasculatures. Thereafter, we discuss the possibility that the pathogenesis of Buerger's disease is a type of endarteritis obliterans, deeply connected to the Notch pathway, distinct from arteriosclerosis obliterans and other vasculitides.


Assuntos
Endarterite/complicações , Tromboangiite Obliterante/etiologia , Artérias/imunologia , Artérias/patologia , Progressão da Doença , Endarterite/patologia , Endarterite/fisiopatologia , Matriz Extracelular/patologia , Humanos , Imunoglobulinas/análise , Subpopulações de Linfócitos/imunologia , Macrófagos/imunologia , Metaloproteinase 3 da Matriz/fisiologia , Infiltração de Neutrófilos , Receptores Notch/fisiologia , Estudos Retrospectivos , Fatores de Risco , Transdução de Sinais/fisiologia , Fumar/efeitos adversos , Fumar/fisiopatologia , Tromboangiite Obliterante/imunologia , Tromboangiite Obliterante/patologia , Túnica Íntima/imunologia , Túnica Íntima/patologia , Ativador de Plasminogênio Tipo Uroquinase/fisiologia
18.
Expert Rev Cardiovasc Ther ; 12(10): 1145-56, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25190335

RESUMO

Therapeutic angiogenesis for the treatment of ischemic disease can be attained through the delivery of recombinant growth factor proteins, through gene transfer or cell transplantation. Gene transfer associated with adenovirus or naked plasmid DNAs has been extensively studied in clinical trials. An investigational product, beperminogene perplasmid, is the naked plasmid DNA encoding the cDNA of human HGF, which has potent angiogenic activity. In several clinical trials, beperminogene perplasmid showed favorable safety and efficacy profile in the treatment of critical limb ischemia. This article reviews the results of pre-clinical and clinical studies of beperminogene perplasmid in the treatment of critical limb ischemia caused by peripheral arterial disease and Buerger's disease.


Assuntos
Terapia Genética/métodos , Doença Arterial Periférica/terapia , Tromboangiite Obliterante/terapia , Animais , DNA/administração & dosagem , Humanos , Isquemia/patologia , Isquemia/terapia , Neovascularização Fisiológica/genética , Doença Arterial Periférica/patologia , Plasmídeos/administração & dosagem , Tromboangiite Obliterante/patologia
19.
Isr Med Assoc J ; 16(7): 449-53, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25167694

RESUMO

Smoking is a risk factor for thromboangiitis obliterans (TAO, Buerger's disease) and arteriosclerosis, but there are few cases of coronary heart disease (CAD)-associated Buerger's disease. A literature search for articles in English, Spanish and French published between 1966 and 2012 on patients with coronary involvement and TAO revealed 12 patients. We describe an additional case with involvement of the central nervous system, myocardium and large-diameter proximal arteries. The main clinical manifestations in these 13 cases were lower limb claudication and acute thoracic pain. The histologic findings showed thrombosis with unbroken internal elastic lamina and intimal clusters of granulocytes; coronary angiography revealed predominant involvement of the left anterior descending and right coronary artery. Treatment included coronary bypass procedures, coronary angiopiasty, smoking cessation, and anticoagulant therapy. A complete therapeutic response was observed in half the patients. This review of all published cases of TAO patients with coronary symptoms, together with our patient, demonstrates the rarity of this clinical association. Patients under age 40 with CAD but no prominent cardiovascular risk factors besides smoking should be evaluated for the presence of Buerger's disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/diagnóstico , Doença da Artéria Coronariana/patologia , Diagnóstico por Imagem , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/efeitos adversos , Tromboangiite Obliterante/patologia
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