[Isolated peripheral arterial ischaemia and medullary neurostimulation: case report].
Isolated peripheral arterial ischaemia (IPAI) is an unusual pathology of dialysis and peritoneal patients which represents the first sign of a complication of uraemia known as calciphylaxis. Recent studies have revealed an increased incidence of this complication. Risk factors are known but there is no consensus on them: elevated CaxP product, female gender, elevated serum parathormone. We present here the case of a 65-year-old man with 21-year history of dialysis, distal isolated ulceration and without any signs of severe vasculopathy. Our clinical diagnosis was calciphylaxis. In this case, the role of early PTX is not clear and the use of steroids is recommended only in non-ulcerating cases. The therapy gives good results but not in all patients. Electrical stimulation of the posterior roots of the spinal cord is an alternative approach to this case. We hypothesised that the electrical action, through cutaneous vasodilatation of afferent dorsal fibres and release of calcitonin gene-releasing protein, determines the release of prostaglandin E sub 2 that may positively affect the proliferation and activity of epidermal fibroblasts.
Servizio Ambulatoriale di Algologia e Terapia del dolore, Mariano Santo (CS), Italy.
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Amato
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Rizzuto
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Nicoletti
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Senatore
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Roberti
D000344:Afferent Pathways / Q000503:physiopathology; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002115:Calciphylaxis / Q000209:etiology* / Q000628:therapy; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000627:therapeutic use; D015232:Dinoprostone / Q000378:metabolism; D004599:Electric Stimulation Therapy; D005347:Fibroblasts / Q000473:pathology; D016523:Foot Ulcer / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008160:Lumbosacral Plexus; D008297:Male; D008959:Models, Neurological; D016491:Peripheral Vascular Diseases / Q000209:etiology* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects*; D012881:Skin Temperature; D013126:Spinal Nerve Roots; D014664:Vasodilation
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D015740:Calcitonin Gene-Related Peptide; D015232:Dinoprostone