Menkeberg's syndrome
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Description:
Menkeberg's sclerosis (synonym: the kaltsifitsiruyushchy sclerosis of Menkeberg) a sclerosis a sclerosis — the macrovascular disease developing preferential against the background of a diabetes mellitus and consisting in not atherosclerotic damage of average and large arteries of the lower extremities is more rare – visceral vessels (renal, coronary, etc.).
Calcification of walls of arteries of the lower extremities can be found in people with normal carbohydrate metabolism, and with age its frequency increases, and 45 years in 5% of cases, from 45 to 60 years – at 16% are found in persons more young, and at elderly 60 years – at 37% are aged more senior.
However at patients with a diabetes mellitus calcification of arteries of the lower extremities in all age groups comes to light, on average, 3 times more often: respectively at 15%, 53% and 100%. So, at the women sick with a diabetes mellitus, Menkeberg's sclerosis manages to be established by 4,5 times, and at men - by 1,8 times more often than at the persons of the corresponding age and a floor which do not have diabetes. At the same time at men Menkeberg's sclerosis proceeds much heavier and leads to serious complications – up to gangrene. The most expressed changes are found in men 80 years lasting diabetes mellitus more than 10 years are more senior. At patients with gangrene of the lower extremity against the background of a diabetes mellitus Menkeberg's sclerosis comes to light practically always.
The type of a diabetes mellitus has no significant effect on formation of a sclerosis of Menkeberg.
Symptoms of the Syndrome of Menkeberg:
At patients with manifestations of diabetic foot it is not possible to establish existence of a sclerosis of Menkeberg on the basis of only clinical signs. At poll of patients the known symptomatology of a diabetic macrovascular disease comes to light. Complaints to onychalgias, paresthesias, a burning sensation or a chill, increased fatigue are characteristic when walking, spasms in gastrocnemius muscles, the alternating lameness. Constancy and expressiveness of these signs depend on a sclerosis stage.
Most often Menkeberg's sclerosis is diagnosed for patients with the started stages of diabetic foot – in the presence of trophic ulcers, gangrene, an aseptic necrosis, dislocations, incomplete dislocations, spontaneous changes owing to osteoporosis.
Comparative survey of preferential affected and relatively less affected extremities allows to reveal changes of coloring of skin, initial forms of an atrophy of hypodermic cellulose and muscles, dystrophy of nails, a hair loss on skin of extremities, cracks, ulcers, necrotic changes. Inspection of extremities is recommended to be performed in position of the patient lying and standing since at arterial insufficiency the postural change is followed by change of coloring of skin.
Determine by Palpatorno a pulsation of arteries: subnodal – in the depth of a popliteal space, back tibial – behind an internal anklebone of a tibial bone and an artery of the back of foot – between I and II plusnevy bones. Pulse is investigated at the same time on symmetric points of both extremities and it is consecutive throughout vessels – at their different levels.
Reasons of the Syndrome of Menkeberg:
The mechanism of formation of a sclerosis of Menkeberg is rather difficult. Refer the sorbitol accumulation causing swelling of a wall of an artery, focal hypertensia, a lipidemia and a hypoxia to the factors damaging a vascular endothelium at a diabetes mellitus. The hypoxia at noncompensated diabetes has the mixed character as transport of oxygen is broken at all stages – respiratory, gemichesky, microcirculator and probably at the level of utilization in fabrics (in connection with an excess glycosylation of hemoglobin of erythrocytes in the conditions of a chronic hyperglycemia).
It is considered to be that as a result of any structural or functional damage of an endothelium cellular elements of blood (in particular, thrombocytes and monocytes / macrophages) enter on the site of destruction of a vessel pathological interaction with plasma components (first of all, with lipoproteids) that leads to migration of smooth muscle cells from an average cover of an artery (mussel) in internal (intima) and to their subsequent proliferation. In the course of proliferation of myocytes of a mussel in her and in an intima of vessels new connective tissue components are formed, inside - and vnekletochno in excess quantity lipids, and also calcium salts collect.
Treatment of the Syndrome of Menkeberg:
Treatment is carried out by the general rules of maintaining patients with a syndrome of diabetic foot. It includes a complex of general and recreational actions, physiotherapeutic procedures and the combined continuous drug treatment (vitamin therapy, reception of lipotropic and hypolipidemic means, purpose of plasma substituting solutions, vasoprotectives, vasodilating drugs, inhibitors of an aldozoreduktaza, antioxidants / antigipoksant, anabolic steroids, a geparinoterapiya). Use of these or those drugs, their combination and the sequence of reception are defined by the attending physician on the basis of localization and a stage of calcification. Besides, the patient has to keep to a diet; normalization of the ABP, body weight, compensation of a diabetes mellitus, treatment of diabetic neuropathy, correction of a lipidemia, decrease in exercise stresses are necessary. Smoking is strictly forbidden. At an obliteration of vessels treatment can be operational (reconstructive operations). Amputation of an extremity concerning gangrene, as a rule, does not lead to process stabilization, and within the next year gangrene of other extremity develops.
Achievement of permanent compensation of a diabetes mellitus and carrying out repeated courses of complex therapy 2-3 times a year remains the main condition of success of treatment.
