Ischemic ulcers

Vasculitis ischemic ulcers, skin lesions, leukocytoclastic vasculitis... 

Atherosclerosis can result in ischemia of peripheral muscles just as coronary artery disease causes cardiac ischemia. Pain (claudication) occurs in skeletal muscles, especially in the legs, during exercise and disappears with rest. Although claudication is not immediately life-threatening, peripheral artery disease is associated with increased mortality, can severely limit exercise tolerance, and may be associated with chronic ischemic ulcers and susceptibility to infection. 

Nizankowski R, Krolikowski W, Bielatowicz J, Szczeklik A. Prostacyclin for ischemic ulcers in peripheral arterial disease. A random assignment, placebo controlled study. Thromb Res 1985 37(l) 21-8. 

A number of studies have investigated the use of PGE and PGI2 compounds in Raynaud s phenomenon and peripheral atherosclerosis. In the latter case, prolonged infusions have been used to permit remodeling of the vessel wall and to enhance regression of ischemic ulcers. 

Intermittent claudication is a clinical diagnosis. Usually lower extremity ischemia is caused by flow-limiting atherosclerotic plaques. Intermittent claudication is the presenting symptomatology in half of the patients with chronic lower extremity ischemia. The other one-third to half of patients with documented peripheral arterial occlusive disease are asymptomatic or silent (8). Other symptoms and physical findings indicating more severe ischemia are pain at rest, pale and cold extremity(s), ischemic ulcers, peripheral cyanosis, and gangrene (12). 

Unfortunately, there have been no randomized controlled studies to date that evaluate the efficacy of sympathectomy in treating advanced arterial occlusive disease. There have been several uncontrolled studies (51,54-57) that demonstrate relief of rest pain and healing of ischemic ulcers in 28 to 73 % of patients and acute limb salvage rates of 60 to 94%. The wide range of these results and lack of a randomized and controlled setting brings into question the effect of placebo as well concomitant medical therapies and conditions. 

Arterial ulcers, also known as ischemic ulcers, normally present in the lower extremities as a result of vascular disease. Vasoconstriction leading to reduced blood flow can instigate tissue necrosis when cell nutrients and oxygen are reduced. Ischemic ulcers can be associated with diabetes. 

Prior to this work, dietary fiber, of which ceUulose is oae of the more important constituents, was considered important primarily as a means of preventing or overcoming constipation. Otherwise, dietary fiber was considered to be a metaboHcally iaert substance. A large variety of diseases such as appendicitis, hiatus hernia, gallstones, ischemic heart disease, diabetes, obesity, dental caries, and duodenal ulcers are now suspected to be associated with the consumption of a highly refined diet (42). 

While the role of PHD inhibitors in the treatment of anemia is now validated, therapeutic validation is less certain in other HIF-associated pathologies such as wound healing, ulcerative colitis, therapeutic angiogenesis, and treatment of acute ischemic events such as myocardial ischemia and stroke. All of these indications are supported by a compelling array of in vitro and in vivo preclinical studies but their utility in the clinical setting remains to be evaluated and represents exciting possibilities for the future of small-molecule inhibitors of PHD enzymes. 

Colitis Ulcerative and hemorrhagic/ischemic colitis, sometimes fatal, has been observed within 12 weeks of starting alpha interferon treatment. Abdominal pain, bloody diarrhea, and fever are the typical manifestations of colitis. 

Acetaminophen is similar to salicylates in that it is a useful analgesic for mild to moderate pain, with equal efficacy to aspirin, and like aspirin, it is antipyretic. However, acetaminophen exerts little if any effects on platelet aggregation and is not antiinflammatory. Thus, it is not useful for patients with arthritis or other inflammatory diseases. It is also not useful as an antithrombotic agent in the prevention of myocardial infarction or transient ischemic attacks. Acetaminophen does not produce the gastric ulceration that can occur with aspirin and is useful in patients who are salicylate sensitive or who have a history of ulcers or other gastric ulcerations. 

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