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A patient with peripheral vascular disease, annular erythema and Sjögren's syndrome is described. A selective IgA deficiency, which was not apparent on routine serum protein electrophoresis, and mixed cryoglobulinaemia were additional features of her autoimmune disease. [ABSTRACT FROM AUTHOR]

Evaluates the level of zinc in the aorta of patients with peripheral vascular disease. Benefits of patients from zinc sulfate therapy; Zinc composition in the arterial wall; Detection of subendothelial accumulation of cholesterol esters, triglycerides and phospholipids in atherosclerotic plaques.

The article describes a new technique for the atraumatic local labeling of digital skin with Xenon 133. Tourniquet studies show that the clearance curves obtained are blood flow dependent. This technique has the advantages of being simple to use, non-instrusive in application, safe for both patient and examiner and readily reproducible. It provides a means of directly assessing the effective or nutritional flow through the digital skin.

Presents comparative studies of digital plethysmography and infrared thermography in peripheral vascular disease by researchers from Newark, New Jersey. Examination of patients who had diseases of the peripheral vasculature; Demonstration on the importance of pulse wave contours in the detection of peripheral arterial disease; Independence of the correlation between qualitative wave form and angiography with the volume flow quantitative determination.

Presents synopses of the scientific sessions at the tenth annual meeting of the International College of Angiology in Geneva, Switzerland, on July 23-28, 1968. Vascular surgery; Peripheral vascular diseases; Trends in angiology; Trends in organ preservation and transplantation.

The phrase "peripheral vascular disease" is one of the most misleading designations in medical terminology. The classification is not restricted to diseases of the blood vessels of the extremities but encompasses all vessels distal to the heart. Although the unfortunate choice of this term has led to much confusion and misunderstanding, diseases affecting all peripheral vessels are often manifested by changes in the skin of the extremities and these changes can he detected by careful observation, The development of abnormal color changes, often with associated lesions, is perhaps second only to pain among the reasons for the patient's coming to the physician, hut the physician often is not aware of the normal and abnormal variations of the color of the skin or of the significance of warmth and coldness of the skin. The purpose of this paper is to emphasize the prudent interpretation of color changes in the extremities as they relate to peripheral vascular disease and which may be manifestations of abnormal local circulatory disease as well as of diffuse underlying systemic disease. Peripheral vascular diseases are not limited to occlusive, embolic or inflammatory conditions in the vessels of the extremity only. This discussion is not intended to be a comprehensive review of all conditions hut rather it gives selective examples to emphasize the variety arid scope of diseases that are properly classified as peripheral vascular diseases and to stress the importance of color changes of the skin of the extremities. [ABSTRACT FROM AUTHOR]

Thrombophlebitis may be listed as one of the most common conditions in peripheral vascular disorders. The basic and contributory causes have been discussed. The possibility of even a trivial injury producing thrombophlebitis, which not infrequently involves medio-legal suits, has been emphasized. The management of thrombophlebitis has been outlined, in more or less detail. Hospitalization is recommended for all cases. It is difficult to foretell whether a mild or a severe case of thrombophlebitis may develop into pulmonary infarction or fatal pulmonary embolism. Furthermore, the advisability of intensive care of early cases is the best preventive measure against the development of the post-thrombotic syndrome. Supervision should be continued after discharge from the hospital. The regime outlined has given the most satisfactory results in the author's experience. [ABSTRACT FROM AUTHOR]

It has been pointed out that since the ballistocardiogram records the combined hemodynamic response of the force of the heart and peripheral vascular resistance, it is particularly suitable for measuring the response of an agent which acts on both the myocardium and the peripheral blood vessels. This type of measurement is also significant in view of the fact that the efficacy of agents for angina pectoris is thought to be due, in part, to decreased peripheral resistance.4 The ballistocardiographic response to 0.6 mg clonitrate administered sublingually indicates that this agent has an onset of action within 3 minutes and that this activity is sustained for at least a 4-hour period. More importantly this longer duration of effect is also noted when the drug is used therapeutically for the treatment and prophylaxis of angina pectoris.5,7 We have observed in several of our patients that drug requirements were halved or less when they were switched from nitroglycerin to clonitrate. The dual characteristics of rapid onset of action and sustained response should make clonitrate a particularly useful agent in the control of angina pectoris. [ABSTRACT FROM AUTHOR]

Discusses the therapeutic effects of cyclandelate (Cyclopasmol) in peripheral circulatory diseases. Analysis on the proper use of Cyclopasmol; Underlying mechanism of action; Safety profile in terms of general adverse events.

1. Objective measurement of blood flow contributes to the assessment of the presence and distribution of peripheral arterial disease. Strain gauge plethysmography is technically simple, allows distinction between muscle and skin flows and enables frequent measurements of rapidly varying flows. 2. Reactive hyperemia flows are considered to give the best index of the ‘functional capacity’ of the circulation. 3. The ranges of peak flows in a group of normal subjects and in a group of patients with gross arterial disease were quite distinct so that the test can be used in the diagnosis of the presence of disease. 4. The magnitude of the peak flow was not related to the major symptom in patients with disease, indicating that the manifestations of disease are as much dependent on its distribution as on the degree of impairment of flow. 5. The time at which peak flow occurred during reactive hyperemia was related to the site of disease, being almost immediate with diffuse small vessel disease and considerably delayed with major vessel occlusion. 6. The delay in peak flow with major vessel occlusion is considered to be a manifestation of the initial preferential supply from collaterals to the proximal relatively undiseased vascular bed; and the period of this delay is thus considered to enable assessment of the severity of small vessel disease in patients with major arterial occlusion. This may be of assistance in predicting the likely results of arterial reconstruction. [ABSTRACT FROM AUTHOR]

The subject of direct and retrograde arteriography is discussed and reviewed. Aortography, both by the translumbar needle method and by the method of retrograde catheterization of the aorta has in our experience been a practical, safe, dependable and often useful procedure. But because retrograde catheterization is not as simple and innocuous as direct aortography, we do not believe that it should ever become a routine diagnostic procedure. It has unquestionably great use in vascular lesions involving the aorta and its branches where correct indications and a correct planning for the operation need a diagnosis that among other things contains a detailed anatomic investigation of the vascular anomaly in question. Except for visualization of the renal arteries, or due to inability to needle the small aorta in children, retrograde abdominal aortography offers no advantages over the translumbar method, and there are definite practical disadvantages. In visualizing the thoracic aorta, however, the direct approach has been far less popular or successful than the retrograde route. Because of difficulties in positioning the tip of the catheter, poor visualization, or incidence of serious cerebral complications when the contrast medium is introduced into the arteries of the upper extremity or the common carotid artery, we feel that the percutaneous femoral artery catheterization method is better suited for thoracic angiography. By passing the catheter through the femoral artery and placing the tip of the catheter at various levels in the aorta, it is possible with small amounts of relatively weak solutions of contrast media to obtain clear and detailed arteriograms of any portion of the aorta, including the aortic arch and its branches, the proximal aorta, the coronary arteries, the aortic valves and the left ventricle. Although retrograde arteriography is not universally practiced at present, the growing importance of this study in the more accurate diagnosis of arterial lesions encourages its more widespread employment; in some cases the examination may save the patient from an unnecessary thoracotomy or laparotomy. At the same time the procedure is not without danger; for this reason the report of five untoward reactions is cited, and in addition the various complications both local and systemic following arteriography are discussed. The methods of direct and retrograde arteriography are compared. It is concluded that translumbar needle aortography is simpler and less hazardous and should be the method of choice in all suitable cases. Retrograde arteriography should be restricted to those patients in whom it is difficult or impossible to introduce the radiopaque substance into the artery proximal to the lesion. Emphasis is placed on the complications which may result from the use of this method. [ABSTRACT FROM AUTHOR]

This attempt at treating peripheral vascular deficiencies In the early stages seems to have some merit especially as it is generally accepted that in the advanced arteriosclerotic stage with poor run-off, amputation must be the end result. The leg became warmer and cramps were reduced in the affected leg. Tins must be the result of the newly formed capillaries (130 by 109). This series is too small to warrant general conclusions. It is hoped that institutions with a larger peripheral vascular disease population will attempt to better evaluate this method of creating new-vessels and that these will remain functional thereby saving a vascular bankrupt extremity. [ABSTRACT FROM AUTHOR]

Investigates the effect of hyalurodinase in the treatment of various type of ulceration in the lower limbs. Description of the enzyme hyalurodinase; Administration of the medication to subject; Changes in the appearance noted in the lesion after the treatment.

1. The medical management of peripheral vascular diseases has kept up with the other fields of medicine and surgery. 2. Many new agents have been developed for specific therapy and many agents used for other diseases have been found to be beneficial in peripheral vascular disorders. These agents consist of intravascular fibrinolysins, sulfonyl-ureas with fibrinolytic activity, ‘desludging’ agents, vasodilators and cortisone compounds. 3. Graduated exercises have been found beneficial for several reasons. Exercise has been found to be of value not only for the mechanical effect of muscle contractions upon the blood vessels but (a) au increased fibrinolytic activity of the blood, (b) inhibition of sludging, (c) development of a collateral circulation and (d) reduction of atherosclerosis in cholesterol fed animals. [ABSTRACT FROM AUTHOR]

Chromaffin-reacting cells were stained by the modified Sevki method in digital skin of 7 patients with various peripheral vascular disorders, and 15 control patients without vascular or skin diseases. Then- was a wide range of variation as to numbers of these cells, and no significant difference could be detected in the histologic features of the chromaffin-reacting cells in the digital skin from the control group, and from the patients with peripheral vascular diseases. No differences were observed in the appearance or the number of chromaffin positive granules in these cells. The chromaffin granules of digital skin may be the source of humoral agents affecting the circulation in the extremities, but elucidation of their role will be facilitated by more quantitative histochemical methods. [ABSTRACT FROM AUTHOR]

Studies the value of skin thermometry in peripheral vascular disease of the lower extremities. Advantages and disadvantages of skin thermometry; Investigation on whether skin thermometry combined with sympathetic blockade can be used as indication for the desirability of sympathectomy; Restricted value of skin-thermometry for the determination of the site and the extent of the vascular disease; Value of the method in predicting the results of sympathectomy.

Clinical results have been reported on 183 vascular graft and shunt procedures performed during recent years on 178 patients at the University Hospital and the Minneapolis General Hospital. There were 92 femoral-popliteal shunts with 62 successful operations (67.4 per cent success), 7 aorta-iliac shunts with 5 successful operations (71.4 per cent success), 18 iliac-femoral shunts with 12 successful operations (66.6 per cent success), and 25 aorta-femoral shunts with 21 successful operations (84 per cent success). In patients with aorta-iliac and aorta-femoral shunts we have had 95 per cent success with the use of nylon grafts. The results of shunt procedures from the iliac to the femoral artery have been virtually identical between autogenous vein grafts and nylon grafts, with 83.3 per cent success for the autogenous vein cases and 80 per cent success for the nylon cases. Forty patients have been operated upon for Leriche syndrome and in those with nylon reconstitutions we have had an 80 per cent success rate. When Ivalon has been used to reconstitute flow results have been good in 77.7 per cent of patients; with the use of homografts the success rate has been 68.7 per cent. Patients with femoral-popliteal shunts constitute the largest single group in our series with 92 operations performed and an over-all success rate of 67.4 per cent. At this time the best results have been obtained with autogenous venous grafts (84.3 per cent success), and the Edwards-Tapp nylon grafts have been somewhat less successful (53 per cent success). Endarterectomy for specific segmental occlusions in the lower aorta, common iliac arteries and external iliac arteries has been highly successful. We believe this procedure is of considerable benefit in many of the shunt and graft procedures when used to prepare the host arteries for receipt of the graft. Our experience with shunt procedures in diabetic patients has been rather small, but the problem of poor tissue healing and high susceptibility to infection makes surgery in these patients more difficult than in nondiabetics. Considering the advanced age of patients requiring vascular reconstitutive surgery, it is important that we continue our efforts to provide readily available prosthetic materials for grafts and shunts that will not leak copious quantities of blood upon reconstitution of flow. Continued research efforts along this line will be particularly rewarding. [ABSTRACT FROM AUTHOR]

Discusses various medical management of peripheral vascular diseases. Effect of diet on atherosclerosis; Contraindication of the use of tobacco in thromboangiitis obliterans; Identification of drugs that can be taken to relieve night pain and cramps.

Discusses the vasodilatation and regional heparinization by arterial catheterization in peripheral vascular disorders. Objectives on the use of intra-arterial route; Mechanism of the action of intra-arterial injections; Introduction of catheter in the aorta.

Reports on a research about the sympathectomies in peripheral vascular diseases. Conduction of cervical sympathectomies in the Raynaud's disease group; Surgical procedures used; Effect of sympathectomy on the patients.

1. A survey of 2300 case records was made, showing the incidence of the various disorders which one may expect to find in the average course of practice, in clinics or in hospitals. Among the arterial disorders, the most commonly met conditions are arteriosclerosis obliterans, diabetic atheromatosis, and thrombosis of the arteries due to various causes. It may be noted that thromboangiitis obliterans, although frequently mentioned among the vascular disorders, is not as common as might be expected. We have not fully computed the number of our cases where the abdominal aorta shows some pathologic changes. This is not uncommon, and will be discussed in another presentation. Arteriospasm was commonly found among our patients with circulatory disturbances. Among the venous disorders, thrombophlebitis is a condition which is commonly found and the incidence seems to be increasing. 2. The method of evaluating the effects of treatment and the rules that were formulated to score the results of therapy into three groups (good results, moderate improvement and failures) were discussed. 3. The methods of treatment were briefly outlined, as were the various procedures used in the arterial cases and in the thrombophlebitis group. 4. The results of treatment showed that of the 1000 cases that were treated, the arterial group showed 381 good results (54.9 per cent); 259 were cases of moderate improvement (37.4 per cent); and 53 failures (7.7 per cent). Of the venous series, 254 cases showed good results (76.1 per cent), 73 (21.8 per cent) showed a moderate improvement, and 7 (2.1 per cent) were failures. Of the lymphatic series, 2 of the 9 cases showed good results, 4 were moderately improved, and 3 were unimproved. 5. Attention may be focused chiefly on the occlusive vascular group, because it is, particularly, for this type of patient that surgery is being advocated. In view of our very satisfactory results in improving these cases and preventing the development of gangrene, the question is raised whether surgery for these patients is justifiable at the present time. 6. Under medical treatment, patients have been carried along for 5 to 10 years or even longer, with comfort and were able to continue their activities. The incidence of gangrene in patients with thrombosis, excluding thromboangiitis obliterans and diabetes, is minimal. 7. Furthermore, it is quite possible that in the near future, further advances in biochemistry and the study of hormones may eventually not only contain the progressiveness of thrombosis, but may be helpful in inducing a regression of this pathologic condition. [ABSTRACT FROM AUTHOR]

Using Burch's plethysmograph and venous occlusive pressure, 706 blood flow determinations and 849 min. of continuous slow recording have been obtained in the fingers and toes of 40 normal subjects and patients with various types of cardiac and/or peripheral vascular disease.4 A new method of obtaining and measuring blood flow has been described. This involves the accurate timing within the pulse cycle of both the standardization and the venous occlusive pressure. It has been suggested that this point within the cycle should be at the junction of the catacrotic and the following anacrotic limb of the pulse curve. In addition, ‘systolic’ and ‘cycle’ flows have been determined in every case. It is felt that with this new method, definitely narrower ranges of normals for various age groups could be set up, and that more accurate and more easily duplicated flow figures are obtained. The older age group will have a wider range of values depending on collateral circulation. The younger age group should be sedated if organic disease is suspected. The need for rigidly controlled conditions is again emphasized. With this method for the determination of blood flow of the fingers, the cuff artifact is, in the vast majority of subjects, insignificant. However, in the case of the toes, one should routinely determine the cuff artifact by proximal arterial occlusion before applying venous occlusion. In any study of blood flows, note should be made not only of actual flow figures but also of the pulse volume, the α and β waves, the total volume increase, and the time required to attain this volume increase. [ABSTRACT FROM AUTHOR]

1. Three thousand consecutive cases of diabetes mellitus are reviewed and analyzed for peripheral vascular complications. This group was further classified into potential, threatened, and obvious cases of gangrene. 2. The incidence of circulatory disturbances among diabetic patients has increased from 17.3 per cent in the first 1000 cases (1920–1930) to 50.7 per cent in the last series (1942–1951). The incidence of potential and threatened cases of gangrene followed this trend, but the incidence of frank cases of gangrene showed a relative decrease, although remaining the same numerically. 3. Clinical, contributory, and etiological factors concerned with the high incidence of vascular changes in diabetic patients are discussed. 4. The most current group of 1000 cases, observed from 1942 to 1951, is more specifically studied and tabulated in relation to age at the time of appearance of the vascular disorder, age incidence, sex, duration of the diabetes mellitus, and severity of the diabetic state. The results reached in this paper do not emphasize either the duration or the severity of the diabetes. The explanation of increased incidence of peripheral vascular disorders occurring among diabetic patients will have to be sought along other lines of investigation. 5. The practical application of this discussion poses the question of preventing gangrene. The problem of the future is to lower the incidence of the potential cases of gangrene. This will be accomplished by continued biochemical research, particularly in the fields of lipoprotein and polysaccharide metabolism. In this manner, it may be possible to avoid the early and basic influences which produce the changes in the smaller vessels and eventually involve the larger arterial system. [ABSTRACT FROM AUTHOR]

The study was undertaken to attempt to evaluate the influence of a cerebrovascular lesion on the peripheral vascular system. A relationship being present, what part did the altered circulatory physiology contribute to the hand and shoulder deformities seem in Rehabilitation Units? The radioisotope of sodium, used as a tracer, was injected intravonously, and by the use of surface counters, the amount of activity, which is a function of vascular efficiency, was measured in the capillaries and tissues of the dorsum of the hands. Comparisons were made of the measured activity of the involved hemiplegic hand as against the opposite non-involved hand and the hands of a normal control group. A Circulatory Index was determined, from the experimental data, and statistical analysis made of these results in the various neurological groups. A total of 43 individuals with hemiplogia and 9 normal persons (controls) were investigated. All were given a thorough neurological survey, and the hemiplegies classified as to age; duration since onset of cerebrovascular accident; site of the corebrovascular lesion, right or left; presence of spasticity or flaccidity, and bilateral or diffuse cerebral damage. Results of the investigations to date reveal definite statistical significant results in the clinical groups of flaccidity, diffuse cerebral involvement, and patients over 55 years of age. It is pointed out that the results which have been obtained, could be possible from either a change in cerebral reflex control of the peripheral circulation, or a local phenomenon, or a combination of both mechanisms. Further studies are planned in the use of another tracer substance, iodinated albumin, and other clinical groups in order to gain more insight into this altered physiology. [ABSTRACT FROM AUTHOR]

Focuses on the case history of patients with peripheral vascular disease who undergo amputation. Mortality in amputation cases; Prevention of the occurrence of gangrene; Dismemberment of the putrid part of the body; Diagnosis of the physicians.

1. It was proven experimentally that benzazoline HCl (Priscoline®) will penetrate the human skin under the positive pole of galvanic current applied by the customary ion transfer technique. 2. Empirically, a 10 per cent concentration both in aqueous and ointment form was found the most suitable. 3. Therapeutic trials in cases of indolent ulcers were rather encouraging. [ABSTRACT FROM AUTHOR]

Various plethysmographic procedures useful for the examination of patients with peripheral vascular disease are described. The vasodilating procedures of most importance are the posterior tibial nerve block, body heating with or without alcohol and reactive hyperemia. These procedures used in combination may serve to identify: (1) The neurogenic functional element controlling vasomotor tone, (2) the amount of myogenic or humoral factor controlling vasomotor tone, and (3) the presence or absence of organic arterial disease. Normal values for the volume pulsation and the relative blood flow of the digit, the systolic blood pressures of the extremities, and the maximum and potential blood flows are given. The importance of considering these measurements as ratios is discussed. [ABSTRACT FROM AUTHOR]

Focuses on the application of intraarterial therapy on peripheral vascular diseases. Characteristics of an ideal intraarterial vasodilator; Increase in blood flow in the main arterial channels; Evidence of vasodilatation in the limb.

1. The dihydrogenated alkaloids of ergot in equimixture known as CCK 179, consisting of dihydroergocornine, dihydroergocristine and dihydroergocristine, have been found to be adjuncts in the treatment of chronic peripheral vascular disease. 2. Statistically significant improvement was noted in over 60 per cent of the cases followed for approximately 2 years. Organic occlusive arterial diseases showed the greatest improvement. Improvement noted was primarily an increase in surface temperatures in extremities, increased cold protection as manifested by easier and quicker warming of the previously cold extremities which remained warmer longer; increase in walking distance, improvement in healing of ulcers, partial relief of paresthesias, rest pains and nocturnal cramps. Vasospastic disorders were rarely benefited. Edemas, due chiefly to thrombophlebitis, post traumatic causalgia and venous obstruction were benefited. Phantom limb pain was benefited in one case. 3. Toxic or uncomfortable side reactions were rare, 4. Dosage required individual attention with increasing and decreasing oral administration combined with parenteral therapy for maximum effectiveness. 5. In over 25 per cent of the older age group, CCK 179, proved to be a nonspecific geriatrics drug manifested primarily by an improved sense of well being. [ABSTRACT FROM AUTHOR]

1) The hydrogenated alkaloids of ergot, i.e., dihydroergocornine (DHO 180), dihydroergocristine (DCS 90), and dihydroergokryptine (DHK 135) act centrally by lowering the tone of the vascular system and peripherally by adrenergic blockade. They may inhibit or suppress vasoconstrictive sympathetic vascular impulses induced by cold or adrenalin. 2) These therapeutically important vascular effects are most regularly achieved with a combination CCK 179 which contains the three hydrogenated alkaloids (DHO 180, DCS 90 and DHK 135) in equal amounts. CCK 179 is better tolerated than its single components. 3) The therapeutic results in 118 cases of functional and organic peripheral vascular diseases show that the CCK 179 is an effective drug for the treatment of disturbances of the peripheral circulation. [ABSTRACT FROM AUTHOR]

Within a two-year period, five otherwise healthy young or middle aged adult males were evaluated for lower extremity ischemia secondary to isolated popliteal artery occlusion. Two patients had also previously developed asymptomatic occlusion in the opposite popliteal artery. The development of adequate collateral arterial circulation was monitored by ultrasound, plethysmography and exercise testing. Four patients developed excellent functional rehabilitation without the need for arterial reconstruction, and the fifth had a satisfactory result from a femoropopliteal bypass vein graft. [ABSTRACT FROM AUTHOR]

Evaluates lumbar sympathectomy as an operative method for the treatment of obliterative peripheral vascular disease. Number of case records of patients studied in whom unilateral or bilateral lumbar sympathectomy was the only operative procedure performed; Criteria presented by patients with severe peripheral occlusive arterial disease; Results of sympathectomy in diabetic patients.

This article focuses on the effect of peripheral lymphocytes from patients with inflammatory joint disease on human target cells in vitro. In the connective tissue diseases an aggressive role for lymphocytes has been suggested. Some researchers have used tissue culture methods to test this hypothesis. They found that cultures of human foetal target cells were damaged by the addition of mononuclear cells from patients with connective tissue diseases. In this article the use of this method for assessment of a possible abnormal effect of peripheral blood lymphocytes from patients with connective tissue diseases on cultured target cells has been described.

Focuses on a study which investigated the peripheral physiology in patients with systemic amyloidosis. Assessment of forearm blood flow response; Case histories on the medical condition; Results of forearm vascular dynamics.

Assesses the peripheral vascular manifestations of systemic lupus erythematosus. Peripheral arterial occlusion; Chronic ulcers of the leg; Thrombophlebitis; Raynaud's phenomenon.

Focuses on endotoxin shock or a state of peripheral vascular collapse induced by a lipoprotein-carbohydrate complex liberated from the cell wall of gram-negative bacilli. Age, sex and outcome of patients with shock and renal failure; Experimental canine endotoxin shock; Significance of microcirculation in endotoxin shock.

Describes a practical laboratory approach to the study of peripheral vascular functions as aid in the diagnosis and treatment of the peripheral vascular diseases. Vasolidating procedures; Routine measurements; Differentiation of functional iron from organic occlusive arterial disease.

Review of the pharmacology of vasodilating drugs would indicate that the most effective agents would be those acting directly on the smooth muscle of the blood vessels. This is so because such action is spasmolytic in character and in therapeutic doses does not block reflex vasomotor activity. Theoretically, such drugs should be free of any vascular side effects. A 5-year experience with cyclandelate (Cyclospasmol) bears this out. Of 137 patients with peripheral vascular disease treated with this drug, 80 per cent or 104 patients obtained good to moderate relief of their peripheral arterial insufficiency. Three women with Raynaud's disease had good to moderate response, and three out of four patients with thromboangiitis obliterans had a similar reaction. The dose used for 132 patients was 800 mg per day in divided dose. Our experience would indicate that patients who do not respond to 1600 mg per day will not react to larger doses. In no instances were any untoward effects of the drug noted even after 5 years. Treatment failure was most frequent in the oldest age group and in those patients with the longest history of vascular insufficiency. This would indicate that successful drug therapy is possible only when there are sufficient vessels capable of responding. [ABSTRACT FROM AUTHOR]

Cyclandelate is a useful general vasodilator for the treatment of peripheral diseases, with remarkable lack of the side effects. It is beneficial in arteriosclerosis obliterans and in thromboangitis obliterans, especially where concomitant coronary or cerebral disease or peptic ulcer is present. The drug does not appear to be as potent as other drugs for vasospastic diseases, but it is definitely useful because of its unusual lack of contraindications. [ABSTRACT FROM AUTHOR]

1. Nocturnal leg cramps are painful complaints encountered fairly often in clinical practice. They occur more frequently in older patients and, while usually not serious, may be severe enough to interfere with the patient's rest. 2. Twenty women and seven men with nocturnal leg cramps were included in the present study. The majority were in the age group of 40 to 80 years. The underlying cause of the cramps included thrombophlebitis and other vascular disorders, pregnancy, profound diuresis after the administration of Mercuhydrin, and a miscellaneous category. Seven patients had cramps of unknown origin. 3. Of the 24 patients who received the active drug, the therapeutic benefits reported by 19 were described as excellent, and 5 were satisfactory. There were no failures in this group. The 3 patients who received placebos and the 3 patients who were alternated between placebos and active drug, had no diminution in the frequency or severity of night cramps while on placebos. Those patients who improved while taking the active drug had a return of symptoms when the drug was discontinued. 4. The benefits of therapy with methocarbamol are comparable to those of quinidine with the added advantage that methocarbamol is nontoxic in the dosages used and has no deleterious effect on normal muscle tone. [ABSTRACT FROM AUTHOR]

With strictly a clinical office approach, isoxsuprine was used in the treatment of 100 patients with peripheral vascular disorders. Definite clinical improvement was obtained in 89 per cent of these patients. In our hands, isoxsuprine was found to be easy to administer, devoid of side effects in recommended doses, and well tolerated. Our clinical findings are in agreement with those of other investigators who have used more finite measurements of evaluation. We believe that isoxsuprine is a very useful drug and an extremely good addition to presently used vascular therapy, although not a replacement, and that further clinical trials in peripheral vascular disorders are recommended. [ABSTRACT FROM AUTHOR]

Examines the applicability of sympathectomy for peripheral vascular sclerosis patients. Clinical evidence that muscular vasoconstriction is under sympathetic control; Basis for the selection of patients for the procedure; Increase in collateral circulation after the operation.

1. A systolic murmur arising in the lower abdominal aorta is frequently heard in the presence of clinical symptoms of peripheral vascular occlusive arterial disease of the lower extremities. 2. The exact mode of production is not clear. Pressure is not applied to the aorta. The murmur is produced either (a) by a stenosis of the lumen brought on by calcified plaques and elevated atheromatous lesions sufficient to interfere with blood flow or (b) by a combination of atherosclerosis of the lower abdominal aorta with additional atherosclerosis distally as in the femorals. The stenosis in the latter instance, is insufficient to produce an interference with the blood flow intense enough to produce a murmur. When combined with an obstruction further on as in the femorals, the flow is altered enough to produce the murmur. In these cases, a systolic murmur is frequently heard also over the femorals. 3. In a consecutive series of 35 patients suffering from peripheral vascular disease, the murmur was heard in 22. There were 20 cases of arteriosclerosis obliterans and 2 of thromboangiitis obliterans. In a similar group of 35 patients suffering from other illnesses, the murmur was not found. 4. X-ray evidence of calcification of varying degrees of the abdominal aorta was present in every case of arteriosclerosis obliterans. [ABSTRACT FROM AUTHOR]

The effect of tolbutamide in the treatment of symptomatic chronic occlusive arterial disease was studied in a double-blind design to neutralize the influence of the placebo effect. The constant speed treadmill was utilized to give a more accurate measure of the time elapsed before the appearance of intermittent claudication. No beneficial results were observed in 13 patients completing a 6-week period of therapy and a similar period of treatment with a placebo. [ABSTRACT FROM AUTHOR]

The routine palpation of all pedal pulses should be a part of every industrial pre-employment physical examination for workers over 40. In routine pre-employment examinations the incidence of peripheral vascular disease in healthy laborers between the ages of 40 to 60 is 1 per cent. The dorsalis pedis pulse normally is not palpable in about 15 per cent of healthy laborers. But, the absence of both the dorsalis pedis and posterior pulse in an extremity is such an important sign of impending vascular disease that a waiver should be obtained before a worker is employed. [ABSTRACT FROM AUTHOR]

Focuses on the treatment of the patients suffering from peripheral vascular disorder. Increase on the risks of arterial disease; Awareness on the symptoms of the disease; Description on the physical condition of the patients.

The article focuses on the infections in peripheral vascular disease. Peripheral vascular conditions seem to be the blind spot of many physicians,basically because the subject is not well covered in medical schools. A typical case will illustrate common errors and highlight basic principles of good management. One month after starting therapy, sharp localization of the lesion occurred. After another month, two previous black areas sloughed out and granulations formed. By the next month, there was epithelial growth.