Limbs
Keith Hopcroft, Vincent Forte in Symptom Sorter, 2020
SMALL PRINT: Duplex ultrasound. FBC, ESR/CRP, CRP, TSH, LFTs, U&E, fasting glucose or HbA1c and RA factor as a basic screen for systemic causes and background disease.Swabs for bacteriology are only useful if there is clinical evidence of viable tissue infection, e.g. cellulitis.Full cardiovascular assessment if any suspicion of arterial insufficiency.Ankle brachial pressure index (ABPI) in both legs by handheld Doppler. Sensitivity of up to 95%; if less than 0.8 assume arterial disease is present. Limited usefulness in patients with microvascular disease, e.g. RA, DM, systemic vasculitis; may cause spuriously high ABPI.Specialist: Duplex ultrasound is the investigation of choice to assess arterial and venous insufficiency.
Limbs
Keith Hopcroft, Vincent Forte in Symptom Sorter, 2020
SMALL PRINT: Duplex ultrasound. FBC, ESR/CRP, CRP, TSH, LFTs, U&E, fasting glucose or HbA1c and rheumatoid factor/anti-CCP antibodies as a basic screen for systemic causes and background disease.Swabs for bacteriology are only useful if there is clinical evidence of viable tissue infection, e.g. cellulitis.Full cardiovascular assessment if any suspicion of arterial insufficiency.Ankle brachial pressure index (ABPI) in both legs by handheld Doppler. Sensitivity of up to 95%; if less than 0.8 assume arterial disease is present. Limited usefulness in patients with microvascular disease, e.g. RA, DM, systemic vasculitis; calcified arteries may cause spuriously high ABPI.Specialist: Duplex ultrasound is the investigation of choice to assess arterial and venous insufficiency.
Compression therapy for venous ulceration
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Possible arterial insufficiency should also be assessed by physical examination or noninvasive studies prior to therapy beginning. Coexisting arterial insufficiency, especially if severe, is a recognized risk factor for the non-healing of venous ulceration.17 Compression therapy can be counterproductive in the presence of arterial insufficiency, given that the already diminished skin perfusion pressure can be further decreased, resulting in an overall pro-ulcerogenic effect, as well as an increased risk of critical limb ischemia.18 Compression therapy must be used with extreme caution in patients with arterial insufficiency and is essentially contraindicated in patients with an ankle brachial systolic blood pressure ratio of <0.5.
Rhodotorula minuta as a hypersensitivity pneumonitis causative agent in contaminated continuous positive airway pressure device: A case report
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Florence Côté, Marie-Eve Bédard
A 69-year-old ex-smoker was admitted to the hospital with fever, dyspnea and cough. He was previously known for diastolic heart failure, atrial fibrillation under anticoagulant, hypertension, dyslipidemia, type II diabetes, possible asthma with obstructive pattern on pulmonary function testing in 2009 and rheumatoid polyarthritis treated with Prednisone 10 mg per day. He had had a CPAP for an obstructive sleep apnea since 2007. He was also known for pleural plaques from previous asbestos exposure and a chronic unilateral pleural effusion. He had been hospitalized two months earlier for osteomyelitis of his fifth left toe complicated by Streptococcus hemolyticus lutetiensis bacteremia; he had been successfully treated with 42 days of antibiotics. His toe was considered healed on the day of his admission. Angiography later proved arterial insufficiency.
Absent or diminished pedal pulses and estimated GFR decline in patients with diabetic kidney disease
Published in Renal Failure, 2019
Nivetha Subramanian, Jennifer Xu, Laure Sayyed Kassem, Michael Simonson, Niraj Desai
Vascular disease reflects a combination of pathophysiologic processes that culminate in altered structure and function of vessels, leading to arterial insufficiency. Traditional risk factors for the development of these diseases include older age, diabetes, hypertension, hyperlipidemia, and smoking are also common in patients with chronic kidney disease (CKD) [1]. Moreover, a growing number of studies have shown a high prevalence of vascular disease in patients with CKD, particularly in those patients with albuminuria [2–7]. The excessive risk of these diseases in CKD is also associated with additional independent risk factors including inflammatory markers, oxidative stress, and sub-optimally controlled diabetes [2]. Chronic kidney disease itself may be a marker for mechanisms beyond shared cardiovascular risk factors that lead to vascular disease.
Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Vikram Sangani, Mytri Pokal, Mamtha Balla, Ganesh Prasad Merugu, Sreedhar Adapa, Srikanth Naramala, Venu Madhav Konala
Hospital course: Due to lower back pain and weakness in the lower extremities, he underwent computed tomography (CT) of the cervical, thoracic and lumbar spine which revealed multiple bony sclerotic lesions consistent with metastasis and multifocal lymphadenopathy. The patient received 10 mg of dexamethasone initially. Magnetic resonance imaging (MRI) was not done due to pacemaker placement 2 months ago. Neurosurgery recommended no indication for surgical decompression. With a history of Peripheral arterial disease and associated chronic skin discoloration in lower extremities, arterial ultrasound was ordered, which showed occlusion of left distal superficial femoral and left dorsalis pedis arteries with extensive plaque formation bilaterally. Vascular surgery was consulted who reviewed the ankle-brachial pressure index (ABPI), which is more specific for lower extremity ischemia, which was negative. They concluded that the weakness is unrelated to arterial insufficiency.