The alternating lameness

Description:

The alternating lameness (claudicatio intermittens, claudicatio ischaemica) — the syndrome arising at the ischemia of the lower extremities caused by blood supply disturbances (most often an obliterating endarteritis or arteriosclerosis) and characterized by emergence during walking of pain or feeling of tension, weight, paresthesias in one or (more rare) in both shins (see an obliterating endarteritis). If the patient stops, pains pass, when walking renew. The disease develops more often at men of advanced and middle age, in young years meets seldom. Family cases of the alternating lameness are described.

Reasons перемежающаейся lamenesses:

Etiology: acute (typhus, flu) and chronic (syphilis) infections, intoxications (alcohol, especially smoking), cooling, physical and mental injuries, gout, diabetes etc. Some of the specified moments (infections, intoxications), apparently, are complicated by a disease of the endocrine and vegetative device.

Pathogeny:

The pathogeny comes down to the ischemic phenomena owing to a vasospasm. The last is caused by dysfunction of adrenal system of adrenal glands (the humoral theory) with which the sympathetic nervous system (the neurogenic theory) morpho-physiological is connected. It results in insufficiency of blood supply of nerves and muscles of extremities, especially at their activity (walking), and to defeat of nerve terminations that in turn strengthens a vasospasm. As a result of a pathological chain of all these factors dystrophic neurovascular process develops. The course of a disease is usually chronic, but also the acute current is described.

Symptoms перемежающаейся lamenesses:

Peripheral and spinal types of the alternating lameness are described. At the alternating lameness of peripheral type quite often before emergence of pains when walking patients feel exhaustion, weight or paresthesias in legs. The objective research opens easing or disappearance of pulse on foot, is more rare in a popliteal space, in old cases in a femoral artery. At a research of skin temperature of foot and fingers periodic, then permanent decrease it comes to light at first. Skin color changes. If the patient moves the affected leg, there is a pale, cyanotic coloring of skin of this leg and there are pains. The symptom of "a white spot" is characteristic. Pains gradually become frequent and amplify. Over time there can be trophic sores, a hypotrophy of muscles of a shin. In process of development of dystrophic and proliferative processes in vessels the picture of an obliterating endarteritis can develop. In this period at arteriography sometimes find changes of vascular walls, narrowing of their gleam. Staging of a course of the alternating lameness is noted. The spinal form the alternating lameness usually appears in a prodromal stage of chronic processes (a myelitis, syphilis) at defeat of the arterioles feeding gray matter of a spinal cord.

Diagnosis:

The alternating lameness is usually not difficult, in view of typicalness of emergence of onychalgias when walking, their termination at stops, easing or disappearance of pulse of the main arteries of a leg, and also subjective and objective temperature disturbances. Sometimes the alternating lameness should be differentiated with a polymiositis, an ischialgia, flat-footedness, a Raynaud's disease. The forecast adverse in cases of an obliteration of vessels of an extremity, however during a disease there can be remissions.

Treatment перемежающаейся lamenesses:

It is necessary to prohibit smoking, alcohol intake. It is impossible to wear close shoes, it is necessary to avoid humidity, cooling of legs, pulling of a leg with rubber. 5 — 10% NaCl solution on 10 ml of 10 — 15 injections, subcutaneously are intravenously recommended to 1% Pilocarpinum solution, insulin of 10 — 12 PIECES (No. 10), Padutinum, the depot Padutinum is better (No. 15 — 20) on 1 ampoule intramusculary, in 2 — 4 weeks to repeat, 1% niacin solution inside 1 table. l. within a month or intravenously 1% — 1 ml (No. 10 — 15), courses to repeat; Pachycarpinum on 0,1 g 3 times a day within 2 months, periodically to repeat. Favorable results are yielded by pararenal novocainic blockade. Sometimes with success apply intra arterial administration of stored blood in vessels of the affected extremity.
From physiotherapeutic methods — a diathermy, UVCh, mud cure, a steam pressure chamber, bathtubs hydrosulphuric, radonic, on 2 — 3 courses, alternating. At syphilis, atherosclerosis — the corresponding  treatment and a diet. From surgical methods are offered a periarterial sympathectomy (see), an epinefrektomiya; in a gangrenous phase — amputation.