Atypical ischemic lower extremity ulcerations: a differential diagnosis

Dean, Steven M.

doi:10.1177/1358863x07084729

Cited by 20 publications

(17 citation statements)

References 37 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study from a tertiary referral center in Switzerland showed that 16 (52%) of 31 hypertensive ischemic leg ulcers were referred with a suspected diagnosis of PG [55]. However, there is a paucity of data in the literature pertaining to the differential diagnosis between PPG and parastomal ischemia-related skin ulcers, probably due to the fact that the abdominal wall is an uncommon location for ischemic changes [56]. …”

Section: Diagnosis and Differential Diagnosismentioning

confidence: 99%

Diagnosis and management of parastomal pyoderma gangrenosum

Shen

2013

Gastroenterology Report

View full text Add to dashboard Cite

Parastomal pyoderma gangrenosum (PPG) is an unusual neutrophilic dermatosis characterized by painful, necrotic ulcerations occurring in the area surrounding an abdominal stoma. It typically affects young to middle-aged adults, with a slight female predominance. The underlying etiology for PPG remains enigmatic but aberrant immune response to injury may play a pivotal role. The reported risk factors for the development of PPG include the presence of extra-intestinal manifestations, autoimmune disorders and obesity, along with local factors, such as the presence of parastomal hernia or pressure ulcer. PPG can develop at any time after the stoma construction. The histopathological features of PPG are not pathognomonic and its diagnosis is mainly based on clinical features. The management of PPG often requires a multidisciplinary approach, with a combination of local wound care and systemic medications.

show abstract

Section: Diagnosis and Differential Diagnosismentioning

confidence: 99%

Diagnosis and management of parastomal pyoderma gangrenosum

Shen

2013

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…Calciphylaxis occurs mainly in patients with kidney disease, and biopsy shows calcium deposition within arterioles and venules and subcutaneous tissues. 32 In diabetic ulcers, mediasclerosis can be demonstrated in about 30% of patients. 33 Of the 40 patients described by Schnier et al, only 35% did not have signs of arteriosclerosis or CVI.…”

Section: Differential Diagnosismentioning

confidence: 99%

Arteriolosclerotic ulcer of Martorell

Vuerstaek¹,

Reeder

Henquet

et al. 2010

Acad Dermatol Venereol

View full text Add to dashboard Cite

In 1945, Martorell described ischaemic leg ulcers in patients with hypertension. He suggested that the ischaemic necrosis was secondary to a hypertensive arteriolar disease and referred to them as 'hypertensive ischaemic ulcers'. In recent years, the specific entity of these ulcers has been questioned. Others claim they have a much higher incidence, but presume the diagnosis is frequently missed. Almost 900 cases of Martorell's ulcers have been reported in literature since the first description. A systematic review and comprehensive search of literature (evidence-based) was needed to characterize this type of ulcer. Based on aetiology and histopathology, it seems to be justified to maintain the name 'arteriolosclerotic ulcer of Martorell'. We conclude that the arteriolosclerotic ulcer of Martorell is a specific entity with its own clinical and histological diagnostic keys, wound management and preventive measures. We introduce a set of criteria that may be used to facilitate diagnosing arteriolosclerotic ulcer of Martorell as well as a flowchart that includes diagnosis, treatment and prevention of this particular type of vascular leg ulcer.

show abstract

“…It has long been understood that the development of nonatherosclerotic PVD, with its implicit failure of appropriate matching of blood perfusion to meet requisite metabolic demand, is associated with a severely compromised ability of the skeletal muscle to maintain performance (i.e., developed tension levels) (19,44). However, with the use of the OZR model of the metabolic syndrome, it has been clearly demonstrated that blood-perfused skeletal muscle rates of fatigue are increased as compared with LZR and that this compromised performance is not simply a function of global ischemia (25).…”

Section: Discussionmentioning

confidence: 99%

“…Although underrepresented to date, this is an exceedingly important area of investigation, since a growing body of evidence suggests that an increasing number of human subjects are afflicted with the symptomology of PVD in the absence of overt plaque/lesion development (12,19,31,44,45).…”

mentioning

confidence: 99%

Blunted temporal activity of microvascular perfusion heterogeneity in metabolic syndrome: a new attractor for peripheral vascular disease?

Butcher

Goodwill

Stanley

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Butcher JT, Goodwill AG, Stanley SC, Frisbee JC. Blunted temporal activity of microvascular perfusion heterogeneity in metabolic syndrome: a new attractor for peripheral vascular disease? Am J Physiol Heart Circ Physiol 304: H547-H558, 2013. First published December 21, 2012 doi:10.1152/ajpheart.00805.2012.-A key clinical outcome for peripheral vascular disease (PVD) in patients is a progressive decay in skeletal muscle performance and its ability to resist fatigue with elevated metabolic demand. We have demonstrated that PVD in obese Zucker rats (OZR) is partially due to increased perfusion distribution heterogeneity at successive microvascular bifurcations within skeletal muscle. As this increased heterogeneity (␥) is longitudinally present in the network, its cumulative impact is a more heterogeneous distribution of perfusion between terminal arterioles than normal, causing greater regional tissue ischemia. To minimize this negative outcome, a likely compensatory mechanism against an increased ␥ should be an increased temporal switching at arteriolar bifurcations to minimize downstream perfusion deficits. Using in situ cremaster muscle, we determined that temporal activity (the cumulative sum of absolute differences between successive values of ␥, taken every 20 s) was lower in OZR than in control animals, and this difference was present in both proximal (1A-2A) and distal (3A-4A) arteriolar bifurcations. Although adrenoreceptor blockade (phentolamine) improved temporal activity in 1A-2A arteriolar bifurcations in OZR, this was without impact in the distal microcirculation, where only interventions against oxidant stress (Tempol) and thromboxane A2 activity (SQ-29548) were effective. Analysis of the attractor for ␥ indicated that it was not only elevated in OZR but also exhibited severe reductions in range, suggesting that the ability of the microcirculation to respond to any challenge is highly restricted and may represent the major contributor to the manifestation of poor muscle performance at this age in OZR. rodent models of obesity; microcirculation; skeletal muscle blood flow regulation; models of peripheral vascular disease; blood flow heterogeneity; vascular dysfunction WITH ONGOING STUDY, THERE is increasing appreciation that the transition from healthy physiology to disease states represents a change in the overall system of control from an existing normal structure (46). It is also generally unclear whether this transition represents a failure of the healthy system or evolving compensations to attempt to optimize the most critical biological outcomes despite progression of a challenged environment (38, 57). For this reason, a detailed understanding of which major contributing processes to an outcome are altered with pathology and the extent for which these are compensated is critical for developing appropriate therapeutic interventions. Failure to elucidate both the key sites of impairment and the compensatory mechanisms, as well as how these impact functional outcomes, has resulted in poorly targ...

show abstract

Atypical ischemic lower extremity ulcerations: a differential diagnosis

Cited by 20 publications

References 37 publications

Diagnosis and management of parastomal pyoderma gangrenosum

Diagnosis and management of parastomal pyoderma gangrenosum

Arteriolosclerotic ulcer of Martorell

Blunted temporal activity of microvascular perfusion heterogeneity in metabolic syndrome: a new attractor for peripheral vascular disease?

Contact Info

Product

Resources

About