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Fazeli B, Masoudian M. SMOKING AND BUERGER’S DISEASE: FROM HYPOTHESES TO EVIDENCE SYNTHESIS. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2022. [DOI: 10.47316/cajmhe.2022.3.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Early after the definition of thromboangiitis obliterans (TAO), it was noticed that TAO patients are almost always tobacco smokers. Later on, the relationship between continued smoking and TAO prognosis was documented. Consequently, smoking came to be considered as the main cause of TAO. However, it is still unknown why, amongst millions of smokers, only a small number develop TAO. It also remains unknown why, of the TAO patients who continue smoking, only half of them show aggravation and undergo amputations. The aims of this review are to investigate evidence in support of or against the relationship between TAO and smoking, according to the TAO-related literature published from 1908 to January 2022, and to discover the possible role of smoking in TAO pathophysiology. Taken together, it appears that smoking predisposes TAO patients toward the potential harmful effects of the main aetiology and helps the main aetiology to develop vascular lesions. Therefore, smoking cessation would almost always be helpful for improving the prognosis of TAO patients and reducing disease manifestation. However, concluding that smoking is not the main aetiology of TAO would open a new door to finding the true main aetiology of TAO and to discovering the appropriate treatment and medical management of patients who fail to stop smoking.
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The Management of Ischemic Limb in Thromboangiitis Obliterans (Buerger’s Disease). Indian J Surg 2021. [DOI: 10.1007/s12262-021-02748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Berti A, Bond M, Volpe A, Felicetti M, Bortolotti R, Paolazzi G. Practical approach to vasculitides in adults: an overview of clinical conditions that can mimic vasculitides closely. ACTA ACUST UNITED AC 2020. [DOI: 10.4081/br.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary systemic vasculitides are rare diseases affecting blood vessel walls. The type and patterns of distribution of the organs affected usually reflect the size of the vessels predominantly involved, and the patterns of clinical manifestations are generally useful to reach a specific diagnosis. However, presenting symptoms may lack adequate specificity for a prompt diagnosis, leading to a diagnostic (and therapeutic) delay, often causing irreversible damage to the affected organs. Due to their rarity and variable clinical presentation, the diagnosis of primary vasculitides could be challenging for physicians. Vasculitis mimickers, i.e. the clinical conditions that could be likely mistaken for vasculitides, need to be carefully ruled out, especially before starting the immunosuppressive therapy. We present here a practical approach to the diagnosis of primary systemic vasculitides involving large, medium and small size vessels, and reviewed most of the conditions that could mimic primary systemic vasculitides.
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Tsimbalist N, Suftin B, Kriuchkova A, Chupyatova E, Babichenko I. Case report: morphological aspects of Buerger's disease. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Buerger's disease is a rather rare pathology characterized by nonatherogenic vascular lesion associated with the inflammation in the intima of the vessel and the thrombus formation. Most often the pathological process affects small and medium caliber arteries. Vascular occlusion can lead to tissue ischemia and the trophic ulcers, and cause the extremity amputation. The disorder pathogenesis has not been fully explored. Literature data indicate that the disease development may be associated with autoimmune processes. The paper presents the results of immunohistochemical study of the material obtained after amputation of the lower extremity in a patient diagnosed with Buerger's disease. The patient had a 15-year tobacco smoking experience. In the inflammatory cell infiltrates around the affected vessels, lymphocytes with CD4, CD8 antigens and IgG immunoglobulin deposits were found, which could be considered as the evidence of the autoimmune mechanisms’ involvment. Immunohistochemical reactions with markers of NK cells CD56 and the central component of the C3d complement system were negative. The results of the study suggest that the key role is played by helper and suppressor T lymphocytes, as well as by humoral antibodies of the IgG class.
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Affiliation(s)
| | - B.A. Suftin
- Central Military Clinical Hospital of the National Guard Troops of the Russian Federation, Balashikha, Russia
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Firat A, Igus B. Endovascular Recanalization of Thromboangiitis Obliterans (Buerger’s Disease) in Twenty-Eight Consecutive Patients and Combined Antegrade–Retrograde Intervention in Eight Patients. Cardiovasc Intervent Radiol 2019; 42:820-828. [DOI: 10.1007/s00270-019-02193-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/21/2019] [Indexed: 12/24/2022]
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Papillophlebitis in a young male patient with Buerger's disease. ACTA ACUST UNITED AC 2018; 93:354-356. [PMID: 29398225 DOI: 10.1016/j.oftal.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/24/2022]
Abstract
CLINICAL CASE A 27-year-old male with sudden visual loss of OD. He had a past history of heavy smoking, as well as a chronic ischaemia of his left lower limb of one-year onset. This led to a diagnosis of Buerger's disease, which is an inflammatory thrombotic disorder that affects small and medium vessels. The visual acuity (VA) of OD was 0.9, and in the funduscopy a very congestive papilla was observed, along with venous tortuosity, scattered retinal haemorrhages, but without macular oedema. He progressed favourably, with a complete recovery of VA. DISCUSSION Papillophlebitis may be an ocular complication of Buerger's disease.
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Yamashita M, Eguchi K, Ogawa M, Takahashi K, Nagai M, Shimpo M, Misawa Y, Kario K. A Case of Left Atrial Myxoma Whose Initial Symptom Was Finger Ischemic Symptom. Int Heart J 2018; 59:233-236. [PMID: 29375114 DOI: 10.1536/ihj.16-394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We experienced a 45-year-old Japanese man who was transferred to our hospital complaining of acute onset of pain and pallor in the right lower limb. Two years earlier, he had complained of repetitive pain at rest and pallor in the left third and fourth fingers. The physical exam and angiography demonstrated occlusion of finger arteries, however we could not reach final diagnosis. Acute arterial occlusive disease in the right lower limb was suspected. Transthoracic echocardiography demonstrated a gross tumor in the left atrium, which suggested left atrial myxoma. An emergency tumorectomy was successfully conducted. Pathologically, the fragile tumor and resultant thrombosis could have caused the patient's peripheral circulatory failure at least two years prior to this episode. A rigorous systemic survey is important even when the ischemic symptom is localized in peripheral circulation.
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Affiliation(s)
- Maho Yamashita
- Department of Medicine, Jichi Medical University School of Medicine
| | - Kazuo Eguchi
- Divison of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Masaya Ogawa
- Department of Medicine, Jichi Medical University School of Medicine
| | - Kan Takahashi
- Department of Medicine, Jichi Medical University School of Medicine
| | - Michiaki Nagai
- Divison of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Masahisa Shimpo
- Divison of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Yoshio Misawa
- Divison of Cardiovascular Surgery, Department of Surgery, Jichi Medical University School of Medicine
| | - Kazuomi Kario
- Divison of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
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Ra JC, Jeong EC, Kang SK, Lee SJ, Choi KH. A Prospective, Nonrandomized, no Placebo-Controlled, Phase I/II Clinical Trial Assessing the Safety and Efficacy of Intramuscular Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells in Patients With Severe Buerger's Disease. CELL MEDICINE 2016; 9:87-102. [PMID: 28713639 DOI: 10.3727/215517916x693069] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Buerger's disease is a rare and severe disease affecting the blood vessels of the limbs. Adipose tissue-derived mesenchymal stem cells (ADSCs) have the potential to cure Buerger's disease when developed as a stem cell drug. In the present study, we conducted a prospective, nonrandomized, no placebo-controlled, phase I/II clinical trial with a 2-year follow-up questionnaire survey. A total of 17 patients were intramuscularly administered autologous ADSCs at a dose of 5 million cells/kg. The incidence of adverse events (AEs), adverse drug reaction (ADR), and serious adverse events (SAEs) was monitored. No ADRs and SAEs related to stem cell treatment occurred during the 6-month follow-up. In terms of efficacy, the primary endpoint was increase in total walking distance (TWD). The secondary endpoint was improvement in rest pain, increase in pain-free walking distance (PFWD), toe-brachial pressure index (TBPI), transcutaneous oxygen pressure (TcPO2), and arterial brachial pressure index (ABPI). ADSCs demonstrated significant functional improvement results including increased TWD, PFWD, and rest pain reduction. No amputations were reported during the 6-month clinical trial period and in the follow-up questionnaire survey more than 2 years after the ADSC injection. In conclusion, intramuscular injection of ADSCs is very safe and is shown to prompt functional improvement in patients with severe Buerger's disease at a dosage of 300 million cells per 60 kg of body weight. However, the confirmatory therapeutic efficacy and angiogenesis need further study.
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Affiliation(s)
- Jeong Chan Ra
- Biostar Stem Cell Research Institute, R Bio Co. Ltd., Seoul, Republic of Korea
| | - Euicheol C Jeong
- †Department of Plastic Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.,‡Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sung Keun Kang
- Biostar Stem Cell Research Institute, R Bio Co. Ltd., Seoul, Republic of Korea
| | - Seog Ju Lee
- Biostar Stem Cell Research Institute, R Bio Co. Ltd., Seoul, Republic of Korea
| | - Kyoung Ho Choi
- Biostar Stem Cell Research Institute, R Bio Co. Ltd., Seoul, Republic of Korea
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Lockwood SJ, Bresler SC, Granter SR. Politics, culture, and the legitimacy of disease: the case of Buerger's disease. Clin Rheumatol 2016; 35:2145-9. [PMID: 27188859 DOI: 10.1007/s10067-016-3310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 11/25/2022]
Abstract
Thromboangiitis obliterans (TAO) or Buerger's disease is a rare form of vasculitis with distinctive clinical and pathological features that carries significant morbidity, often leading to amputation, and is strongly associated with tobacco smoking. Despite its distinctive clinicopathological characteristics, the existence of TAO as an entity sui generis was challenged for many years as it languished in relative obscurity. Then, as societal attitudes towards smoking changed, TAO not only became accepted as a disease entity, it quite literally became a poster child to illustrate the ills of smoking. Herein, we examine the history of TAO to illustrate the power of societal attitudes and politics in shaping medicine.
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Affiliation(s)
- Stephen J Lockwood
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Scott C Bresler
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Scott R Granter
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
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Rivera-Chavarría IJ, Brenes-Gutiérrez JD. Thromboangiitis obliterans (Buerger's disease). Ann Med Surg (Lond) 2016; 7:79-82. [PMID: 27144003 PMCID: PMC4840397 DOI: 10.1016/j.amsu.2016.03.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/21/2016] [Accepted: 03/25/2016] [Indexed: 12/18/2022] Open
Abstract
Thromboangiitis Obliterans is a non-atherosclerotic inflammatory disease of unknown etiology, which has a strong association with tobacco. We present current concepts on the pathophysiology and diagnosis, as well as a review in treatments. Current concepts on the pathophysiology and diagnosis of Thromboangiitis Obliterans. Importance of complete abstinence of tobacco. Actual Treatments of Thromboangiitis Obliterans.
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Affiliation(s)
- Ignacio J Rivera-Chavarría
- Division of Vascular Surgery, Rafael Ángel Calderón Guardia Hospital, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - José D Brenes-Gutiérrez
- Division of Vascular Surgery, Rafael Ángel Calderón Guardia Hospital, Caja Costarricense del Seguro Social, San José, Costa Rica
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