Individuals with long history of smoking had been associated with intermittent inflammatory occlusion of arteries/veins of extremities, resulting in variable circulatory impairment of fingers & toes. The idea is to enlighten the importance of risks associated with smoking in any form.
In the study all active /passive smokers, under 40 years, male:female, ratio 20:1 had a genetic predisposition . An early evidence of superficial thrombophlebitis followed by intermittent burning/pricking pain of legs/arms, hands, diminished sensations, painful moments of limbs, fever, Impaired pulsation of ulnar, radial posterior tibial dorsalis pedis, in some painful indolent ulceration had been seen along the nail margins. Effected parts of extremities pale/cold, sometimes hot to touch from acute inflammatory changes. On elevation no changes in skin coloration when pale & on dependency markedly engorged when inflammed. There had been variable period of remissions /relapses, depending upon the frequency of smoking.In cases with advanced inflammatory changes of main vessels& collaterals coupled with infection& tissue necrosis, evidence of gangrene was seen. Biopsy /histopathology & arteriography had confirmed the nature of disease. Smoking cessation, good nursing care & appropriate antibiotic regimen had changed the outlook as following,
75-80% patients with effective smoking cessation, good peripheral circulation, nursing care, prompt follow up been associated with improvement with out proceeding to amputation.10-12%Patients with infection impaired circulation & evidence of tissue necrosis had been associated with prolonged hospitalized treatment/arterial bypass of the effected vessels, debridement etc.6-8% patients, with poor collateral circulation, evidence of occlusion of the main vessels, complicated infection, with poor prognosis resulted in inevitable amputation. as the last resort.
Smoking had been found to be directly proportional to the course of diseases i.e. a strong dose response relationship exists with the severity of disease & frequency/duration of smoking. Early notification for treatment, arteriography & appropriate antibiotic treatment/nursing care had been associated with good prognosis.
Glucocorticoids & anticoagulants found with no active role in the prognosis / course of the disease.
M. Ishaq, None.