Skin diseases of the elderly
Robert A. Norman in Geriatric Dermatology, 2020
Cutaneous cholesterol embolism appears in patients with severe arteriosclerosis (Figure 17). The atheroembolism results from cholesterol crystals, which become detached from ameromatous plaques; it may occur spontaneously or complicate intravascular studies and surgical procedures. The microemboli affect small arteries and arterioles of the viscera — gastrointestinal tract, kidney — and the central nervous system and retina. The cutaneous manifestations are paroxysmal painful ischemia of the feet and legs, livedo reticularis, gangrene (i.e. ‘warfarin’ toes) and ulcers. The differential diagnosis includes the coagulopathy syndromes and periarteritis nodosa.
Results of renal artery revascularization in the post-ASTRAL era with 4 years mean follow-up
Published in Blood Pressure, 2020
Karin Zachrisson, Ferid Krupic, Mikael Svensson, Ann Wigelius, Andreas Jonsson, Angeliki Dimopoulou, Anna Stenborg, Gert Jensen, Hans Herlitz, Anders Gottsäter, Mårten Falkenberg
In four patients with bilateral RAS, revascularization was possible in only one renal artery. All other revascularizations (256 of 260, 98%) were successful. There were four major complications (1.8%). Two patients had cholesterol embolism with rapid renal impairment, and one suffered from thrombo-embolism to the lower extremities and to a kidney. Puncture site occlusion of an atherosclerotic common femoral artery in one patient was treated with thromboendarterectomy. Minor complications occurred in 24 patients (10.71%). They were mainly small puncture site haematomas, 14 in the groyne and 2 after puncture of the brachial artery. Three patients with haematomas adjacent to the revascularized kidney were treated conservatively and their haematomas resolved spontaneously. Two patients had minor allergic reactions to the contrast medium, and two suffered from transient pain associated with the procedure.
Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis
Published in Renal Failure, 2022
Kiyokazu Tsuji, Mineaki Kitamura, Ko Chiba, Kumiko Muta, Kazuaki Yokota, Narihiro Okazaki, Makoto Osaki, Hiroshi Mukae, Tomoya Nishino
There were several statistically significant differences in the patient background characteristics among the three groups (CKD stage 4, 5, and 5 D) and between the two groups (CKD stage 4–5 and 5 D). For example, activated vitamin D analogs were prescribed more commonly in the CKD stage 5 D group (80%) than in the CKD stage 4–5 group (24%). Additionally, hemoglobin concentration, serum albumin concentration, and body mass index were lower, while serum creatinine and phosphorus concentrations were higher in the CKD stage 5 D group than in the CKD stage 4 group (both p < 0.017). However, of those differences, only serum creatinine differed between the CKD stage 5 D and CKD stage 5 group (p < 0.017). There were no statistically significant differences in phosphate binders or bisphosphonate use among the groups. Furthermore, serum calcium, intact PTH, and TRACP-5b concentrations did not differ among the groups. Two patients were prescribed corticosteroids: one because of cholesterol embolism (CKD stage 4) and one because of anti-glomerular basement membrane disease (CKD stage 5 D). DXA aBMDs were lower in the CKD stage 5 D group than in the CKD stage 4 group (total hip, p < 0.01) and in the CKD stage 5 group (total hip, p < 0.01). DXA lumbar spinal aBMD did not differ between the CKD stage 4 group and the CKD stage 5 D group (p = 0.05).
Related Knowledge Centers
- Embolism
- Kidney Failure
- Livedo Reticularis
- Atheroma
- Blood Vessel
- Embolus
- Cholesterol
- Gangrene
- Cholesterol Crystal
- Kidney