Poster 213: Relationships of Risk factors For Peripheral Arterial Disease to Calf Muscle Oxygenation Responses During Calf Exercise (original) (raw)
Related papers
Progression of neuropathy in peripheral arterial disease
Muscle & Nerve, 1995
Atherosclerotic peripheral arterial disease (PAD) can cause muscle denervation, but whether it is associated with more severe peripheral nerve disease is not clear. Equally unclear is the effect of exercise training on the neuromuscular aspects of this disease. We performed serial electrophysiologic studies (nerve conduction studies and quantitative electromyography) and muscle strength assessment on 16 patients with moderately severe PAD. Seven of the patients were assigned to a natural history (control) group and 9 to an exercise training group. Over study periods ranging from 3 to 23 months, 6 of 7 patients in the control group and 8 of 9 patients in the exercise training group showed progression of multifocal neuropathic disease in their ischemic legs. For equivalent lengths of time, the degree of neuropathic progression was not significantly different between the control and exercise training groups. There was a significant decline in muscle strength for the control group but not for the exercise training group. These results demonstrate that PAD can be associated with the development of a multifocal predominantly motor neuropathy, which is most likely ischemic in etiology. Furthermore, exercise training does not pose an additional risk for the development of neuropathy in patients with moderately severe PAD.
Archives of Physical Medicine and Rehabilitation, 2007
The patient had a cadaveric renal transplant performed after having end-stage renal disease from uncontrolled diabetes and hypertension. After 1 month of immunosuppressive therapy, he presented with mental status changes and falls. A noncontrast computed tomography of the brain was normal; however, his cerebrospinal fluid contained Cryptococcus neoformans and fluconazole was started. Assessment/Results: After his cryptococcal infection, the patient had functional and cognitive decline. He required comprehensive inpatient rehabilitation and had improved. 10 months post-transplant, he was readmitted for seizure disorder and found with imaging to have a superior right frontal lobe cystic lesion. He underwent a craniotomy and abscess removal. Pathology confirmed Nocardia farcinica infection and trimethoprim-sulfamethoxazole was started. Within 1 week, the patient had another seizure episode, and his antibiotic was changed for presumed resistance. Nonetheless, follow-up imaging noted a growing left parietal lesion requiring another craniotomy. Following each craniotomy, he participated in physical therapy and was able to be discharged with an improvement in his functional status. Discussion: Nocardiosis is a rare gram-positive aerobic bacterial opportunistic infection affecting 500 to 1000 patients per year in the United States. One third of infections affect the central nervous system, and few involve renal transplant recipients. Of the several known species, Farcinica is less often implicated but is more likely to show resistance to usual antibiotic regimens. Despite repeated infections and surgeries, this patient was able to maintain a high level of function because of rehabilitation. Conclusions: Functional decline may initially occur in the immunosuppressed patient with neurologic infection. However, this case demonstrates that with aggressive antibiotic therapy, surgery, and a comprehensive rehabilitation program, a satisfactory outcome was achieved in this complex and medically challenging patient.
Muscle fiber characteristics in patients with peripheral arterial disease
Medicine & Science in Sports & Exercise, 2001
Purpose: There have been conflicting reports of muscle fiber type changes in patients with peripheral arterial disease (PAD). The purpose of this study was to examine the myosin heavy chain (MHC) expression as well as histochemical changes in the gastrocnemius muscle in patients with symptomatic PAD. Methods: Needle biopsy specimens were obtained from the medial gastrocnemius of 14 subjects with PAD (mean age (Ϯ SD), 69.7 Ϯ 4.8 yr) and eight activity-matched control subjects (mean age, 65.1 Ϯ 6.6 yr). Ankle-brachial index was assessed using Doppler ultrasound to determine the hemodynamic status of the patients, and maximal walking performance was determined during a graded treadmill test. Expression of MHC isoforms was determined by SDS-PAGE. Results: The proportion of MHC I was significantly smaller in PAD than in the controls (45.6 Ϯ 9.1% vs 58.8 Ϯ 15.0%). The proportion of MHC IIx was also larger in the subjects with PAD compared with the controls (22.9 Ϯ 9.1% vs 16.0 Ϯ 11.3%). In addition, there was a significant decrease in the cross-sectional area of the type I and type IIA fibers in the subjects with PAD as well as enhanced capillary density. Conclusion: This study showed a significant modification in the expression of MHC isoforms and muscle fiber type in the gastrocnemius in patients with symptomatic PAD. These results suggest that muscle ischemia resulting from PAD is an important factor in causing the adaptations in the contractile apparatus of the muscle.
Therapeutic Advances in Cardiovascular Disease, 2019
Background: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. Methods: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than −15 mmHg. Results: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. Conclusion: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.
POEMS Syndrome Diagnosed 10 Years after Disabling Peripheral Neuropathy
Case reports in medicine, 2011
Peripheral neuropathy is characterized as a generalized, relatively homogeneous process affecting many peripheral nerves and predominantly affecting distal nerves. The epidemiology of peripheral neuropathy is limited since the disease presents with varying etiology, pathology, and severity. Toxic, inflammatory, hereditary, and infectious factors can cause damage to the peripheral nerves resulting in peripheral neuropathy. Peripheral neuropathy is most commonly caused by diabetes, alcohol, HIV infection, and malignancy. We report a case of a 42-year-old female with 10-year history of progressively worsening peripheral neuropathy, hypothyroidism, and skin changes who presents with dyspnea secondary to recurrent pleural and pericardial effusions. Prior to her arrival, her peripheral neuropathy was believed to be secondary to chronic demyelinating inflammatory polyneuropathy (CDIP) given elevated protein in the cerebral spinal fluid (CSF) which was treated with intravenous immunoglobuli...
Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease
European Journal of Internal Medicine, 2009
Objectives: To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). Design: Cross sectional, observational study conducted at 96 internal medicine services. Materials and methods: 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) b 0.9. Results: Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. Conclusions: Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-toaction to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
Circulation, 2008
Background— This study assessed functional performance, calf muscle characteristics, peripheral nerve function, and quality of life in asymptomatic persons with peripheral arterial disease (PAD). Methods and Results— PAD participants (n=465) had an ankle brachial index <0.90. Non-PAD participants (n=292) had an ankle brachial index of 0.90 to 1.30. PAD participants were categorized into leg symptom groups including intermittent claudication (n=215) and always asymptomatic (participants who never experienced exertional leg pain, even during the 6-minute walk; n=72). Calf muscle was measured with computed tomography. Analyses were adjusted for age, sex, race, ankle brachial index, comorbidities, and other confounders. Compared with participants with intermittent claudication, always asymptomatic PAD participants had smaller calf muscle area (4935 versus 5592 mm 2 ; P <0.001), higher calf muscle percent fat (16.10% versus 9.45%; P <0.001), poorer 6-minute walk performance (966...
Annals of vascular surgery, 2018
Impaired microcirculation is associated with poor walking capacity in symptomatic peripheral artery disease (PAD) patients during treadmill test, however, this test does not simulate the efforts of daily walking of these patients. Thus, the aim of the study was to describe the microcirculation responses during six-minute walk test (6MWT) and to analyze the relationship between microcirculation indicators and walking impairment in symptomatic PAD patients. Thirty-four patients were included (mean age = 67.6 ± 11.2). The clinical characteristics were collected and they performed a 6MWT in which initial claudication distance (ICD) and total walking distance (TWD) were recorded. During and after the 6MWT, calf muscle oxygen saturation (StO) parameters were monitored continuously to measure microcirculation behavior. The association between calf muscle StO parameters and walking impairment was analyzed by Pearson or Spearman correlations. Walking impairment was not associated with any St...