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Thromboangiitis obliterans (Buerger disease) is an occlusive, nonatherosclerotic, inflammatory vasculitis that causes ischemia in small and medium vessels. Buerger's disease or Thromboangiitis obliterans is a type of vasculitis in young, mostly One hundred years after the original description by Leo Buerger, the . Available from URL: bestthing.info (accessed 1 August ). Reny JL, Champion K, Emmerich J, et al. Maladie de Buerger. HISTORICAL PERSPECTIVE Leo Buerger ( –) Revisited Friedrich C. Luft, MD Key Indexing Download PDF Maladie de Leo Buerger et toxiques.
Buerger's disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities.
These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger's disease, for which there is no treatment known to be effective.
Diseases with which Buerger's disease may be confused include atherosclerosis build-up of cholesterol plaques in the arteries , endocarditis an infection of the lining of the heart , other types of vasculitis, severe Raynaud's phenomenon associated with connective tissue disorders e.
In the proper clinical setting, certain angiographic findings are diagnostic of Buerger's. Collateral circulation gives "tree root" or "spider leg" appearance.
Distal plethysmography also yields useful information about circulatory status in digits. To rule out other forms of vasculitis by excluding involvement of vascular regions atypical for Buerger's , it is sometimes necessary to perform angiograms of other body regions e. Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.
Further information: Thrombosis prophylaxis The cause of the disease is thought to be autoimmune in nature and heavily linked to tobacco use in patients with Buerger's as primary disease. In acute cases, drugs and procedures which cause vasodilation are effective in reducing pain experienced by patient.
For example, prostaglandins like Limaprost  are vasodilators and give relief of pain, but do not help in changing the course of disease.
Epidural anesthesia and hyperbaric oxygen therapy also have vasodilator effect. It aids in healing and giving relief from pain of ischemic ulcers. Use of vascular growth factor and stem cell injections have been showing promise in clinical studies.
Debridement is done in necrotic ulcers. Even more remarkable is the fact that in the 27 year-old Buerger began developing an improved cystoscope; the development was published in Tilden Brown, the Friedrich C. It is a great achievement and something we, on this side of the Atlantic, all have reason to be proud of.
[Leo Buerger disease, subsequent to cannabis intoxication].
In , Buerger was appointed Professor of Urologic Surgery at the New York Polyclinic and authored papers on various subjects including infectious diseases, shock, osteogenic sarcoma, and early transfusion experiences.
Nonetheless, Buerger was extremely unpopular, particularly amongst colleagues.
Perhaps his over-reaching success in such numerous disciplines contributed. Kaplan describes Buerger as a short, dapper, immaculately groomed man. His talents at music also exceeded the amateur ranks. In , Buerger was divorced from his first wife.
The aftermath of financial difficulties appears to have played a role. Buerger did not ingratiate himself with his colleagues when at a dinner at the Alexandria Hotel he publicly announced that he had come to Los Angeles to teach the local urologists how to practice urology. Furthermore, his penchant for fast cars and assorted accoutrements probably did not impress John Allen Burden — , the Seventh-day Adventist minister, administrator, and medical missionary instrumental in founding Loma Linda University.
The internal elastic lamina remains intact. These findings are consistent with multiple etiologies, including various inactive vasculitides or thromboembolic disease. The temporal progression of the TO lesion has 2 important implications. First, in most cases, biopsies are not helpful in the diagnosis of TO, since once the patient seeks clinical attention for ischemia, digital necrosis has already occurred and the patient is no longer in the acute thrombotic phase of the disease.
In this patient, biopsy results of the temporal artery revealed distinguishing features consistent with the acute phase lesion of TO. Although this location is more typical of involvement with GCA, a main distinguishing feature is that, unlike in the acute phase of TO, GCA does not have an occluding thrombus.
In GCA, luminal occlusion occurs due to transmural inflammation and intimal hyperplasia, not in situ thrombus formation. Furthermore, in GCA, the internal elastic lamina is generally disrupted, and multinucleated giant cells are found throughout the intima and media, not at the junction of the thrombus and vessel wall as is seen in TO 9.
The general pathologic impression in GCA is one of intense vessel wall inflammation inducing narrowing and occlusion of the lumen, instead of an inflammatory occlusive thrombus inducing secondary vessel wall changes as seen in TO. TO involvement of the temporal artery is rare and cited only once previously in the literature.
MALADIE DE LEO BUERGER PDF
Lie and Michet describe a series of 3 cases of TO diagnosed by temporal artery biopsy All cases were heavy cigarette smokers, and all received a temporal artery biopsy due to localized swelling.
Two patients went on to develop digital ischemic lesions characteristic of TO. In summary, confirmation of the diagnosis of TO via temporal artery biopsy is extremely uncommon, with only 3 previous cases noted in the literature. In patients suspected of having TO, the temporal artery should be carefully examined; if it is clinically involved, a biopsy can potentially result in a pathologic diagnosis.
Since TO is commonly a diagnosis of exclusion following multiple invasive procedures, a careful physical examination including assessment of the temporal arteries should be emphasized, and if positive, a biopsy should be considered given its relative accessibility for definitive diagnosis. Law had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study conception and design.Sympaticectomy was unsuccessfully tried. Fiessinger JN, Schafer M.
Leo Buerger (1879-1943) Revisited
Scar lesions with substance loss of the second and fourth right fingers. In this patient, biopsy results of the temporal artery revealed distinguishing features consistent with the acute phase lesion of TO.
The intensity of this pain often contrasts with the apparently limited, almost benign appearance of the ischaemic trophic lesions Fig.
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