what is the diagnosis?

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what is the diagnosis?

Post  Ahmed Al-Kaisy on Wed Dec 19, 2007 11:08 am

A 41-years old male, a smoker, referred to your clinic for the evaluation of claudication. this began several months ago and has steadily progressed since that time. additional questioning reveals symptoms of cold induced vasospasm. he has no history of diabetes or hypertension. on examination the patient is found to be thin and in no acute distress. his BP is 140/80 and his pulse is 68. his chest is clear and cardiac examination is unremarkable. his abdomen is soft and nontender without masses or bruit. his extremities are warm but with diminished radial, dorsalis pedis, snd posterior tibial pulses. which of the followings is the most effective treatment for this condition?

a- atenolol 50mg qd.
b- diltiazem 30 mg qid.
c- assessment of ankle-brachial indices.
d-smoking cessation.
e- surgical revascularization.

Ahmed Al-Kaisy

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HI

Post  besma on Sat Dec 22, 2007 9:47 am

i dont know but i think smoking cessation is the safest thing to do since he is normotensive and with no cardiac manifestation i dont think he need atenolol or diltiazem. i dont know Question

besma

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Re: what is the diagnosis?

Post  Ahmed Al-Kaisy on Sun Dec 23, 2007 11:58 pm

ur thinking is again right....

the diagnosis is thromboangiitis obliterans, also known as buergers disease, is a vasculitis of the small and medium sized arteries and veins of the upper an lower extremities. cerebral, visceral and coronary vessels may also be involved. young male smokers less than 45 years of age are most commonly affected. patient with buerger disease frequently presents with a tried of claudication, raynaud phnomenon and migratory superficial thrombophlebitis. physical examination typically reveals reduced or absent distal pulses, trophic nail changes, digital ulcerations, and digital gangrene. the etiology is unknown, but there appears to be a definite relationship to ciggarette somking and an increased incidence of HLA-B5 and HLA-A9 antigens in patients with that disease. there is no specific treatment. smoking cessation appears to be moderately effective in halting disease progression. surgical reconstruction is of limited applicability due to the distal nature of the disease. in severe cases, amputation may be required.......

Ahmed Al-Kaisy

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Re: what is the diagnosis?

Post  sufyan on Wed Dec 26, 2007 8:15 pm

it is smoking cessation, and your answer ahmed is more than enough
good job

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