バージャー病

PURPOSE: To report the short-term outcomes of lumbar sympathetic radiofrequency ablation (LSRA) in patients with peripheral arterial disease (PAD) who were refractory to conservative management or unsuitable for revascularization, and to generate preliminary evidence to inform the design of future prospective investigations. PATIENTS AND METHODS: A retrospective, self-controlled analysis was conducted on consecutive patients with PAD who underwent LSRA at our institution between July 2025 and March 2026. Pain intensity (Faces Pain Scale-Revised, FPS-R), toe skin temperature, and perfusion index (PI) were measured preoperatively and on postoperative day 7. Complications were documented. Normality of between-condition differences was assessed using the Shapiro-Wilk test. Wilcoxon signed-rank tests were used as the primary analysis for non-normally distributed variables, with paired t-tests as sensitivity analysis. Effect sizes (Cohen's d for paired samples) with 95% confidence intervals were calculated. RESULTS: Sixteen patients were included, comprising 14 cases of atherosclerotic occlusive disease and 2 cases of thromboangiitis obliterans. At postoperative day 7, FPS-R scores decreased from 5.88±1.36 to 3.75±1.24 (V=91, p=0.001; Hedges' g=1.48, 95% CI 0.77-2.17, large effect), toe skin temperature increased from 35.06±1.04 °C to 35.95±0.78 °C (t=-5.06, p=0.00014; Hedges' g=-1.20, 95% CI -1.82 to -0.56, large effect), and PI increased from 2.92±1.71 to 3.94±1.71 (V=0, p=0.0005; Hedges' g=-2.02, 95% CI -2.87 to -1.16, large effect). One patient (6.25%) experienced lumbar artery injury requiring embolization, with successful resolution; no other major complications were observed. CONCLUSION: In this preliminary, short-term, retrospective pilot study of carefully selected PAD patients, LSRA was associated with improvements in pain, toe skin temperature, and perfusion index at postoperative day 7. These findings require validation in prospective, controlled trials with longer follow-up.

BACKGROUND: To compare segment-specific lower-extremity arterial intima-media thickness (IMT) between patients with thromboangiitis obliterans (TAO) and smoking-comparable controls using B-mode ultrasonography, and to assess associations with inflammatory parameters. METHODS: This prospective case-control study included 22 male patients with angiographically confirmed, intervention-treated TAO and 22 healthy male volunteers with comparable age and cumulative smoking exposure. IMT was measured at the popliteal artery, anterior tibial artery (ATA), and posterior tibial artery (PTA). Hemogram-derived indices, C-reactive protein, and erythrocyte sedimentation rate were recorded. Intra- and inter-observer reproducibility were assessed. Primary IMT comparisons were adjusted for age and cumulative smoking exposure, with Holm correction applied separately to the IMT and inflammatory-marker comparisons; Benjamini-Hochberg correction was used for Spearman analyses. RESULTS: ATA and PTA IMT were greater in patients with TAO and remained significant after adjustment for age and cumulative smoking exposure and correction for multiple comparisons (both Holm-adjusted p < 0.001). Popliteal IMT did not differ (p = 0.625). CRP and ESR remained higher after correction, whereas NLR did not (adjusted p = 0.066). CONCLUSION: Clinically stable TAO was associated with greater distal crural IMT without significant popliteal IMT difference. Distal crural B-mode IMT measurement may provide complementary structural information in TAO.

OVERVIEW OF WOUND CARE: This report describes two cases of patients with TAO who developed CLTI with subsequent wounds. Both patients had a 30-year smoking history. The first case was a 47-year-old man. In addition to complaints of numbness and pain in his left foot for the past year, he also had a wound in the middle of his left foot. He developed CLTI due to TAO. Wound irrigation, serial debridements, moist wound care, and interventions to increase granulation were best practices in Case 1. However, amputation was performed on the second toe due to demarcated necrosis. The second case was a 43-year-old man diagnosed with TAO three years ago. One month after these complaints, wounds developed on the first and fifth toes of his left foot. The fifth toe was subsequently amputated. Hyperbaric oxygen therapy was administered after the amputation. The wound on the first toe recurred, and an additional wound developed at the stump site on the fifth toe approximately 4 years later. In both cases, interventions were performed in accordance with wound care best practices. The wound on the fifth toe had closed on the day 5, and then the first toe had also begun to granulate on the day 26. DISCUSSION: In patients with TAO, best practice wound care and smoking cessation are key practices for wound management and limb salvage.

Corydalis Herba is a traditional Tibetan medicine clinically applied to treat vasculitis and related conditions. Although many kinds of compounds have been isolated and identified from Corydalis Herba, there is no systematic mass spectrometry(MS) research on it, and its effective substances and mechanisms for treating thromboangiitis obliterans remain unknown. Therefore, one of the origins of Corydalis Herba, i.e., the dried herb of Corydalis hendersonii(CH), was used in this study, and ultra high performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry(UHPLC-Q-TOF-MS/MS), network pharmacology, and molecular docking methods were used to investigate its chemical constituents as well as its effective substances and mechanisms for treating thromboangiitis obliterans. A total of 107 chemical constituents of CH were identified, and 17 of them were unequivocally identified by comparison with reference compounds. The 107 compounds comprise 74 alkaloids, 10 flavonoids, 14 organic acids, 7 amides, and 2 amines, and 89 of them were new constituents of Corydalis Herba, including 8 potential new compounds. In addition, the electrospray ionization(ESI) MS fragmentation patterns of different types of benzyltetrahydroisoquinoline alkaloids were proposed. Finally, 16 core targets(SERPINE1, ICAM1, MMP9, VCAM1, SELE, F3, MPO, etc.), 85 active ingredients, 26 effective substances, and 10 key effective substances(protopine, naringenin, berberine, tetrahydropalmatine, kaempferol, higenamine, apigenin, luteolin, quercetin, and tetrahydrocoptisine) of CH in the treatment of thromboangiitis obliterans were determined by network pharmacology, molecular docking analyses, and literature retrieval. The results lay a solid foundation for further research on the quality control, pharmacological effects, mechanisms, and in vivo process of Corydalis Herba.

Buerger's disease, or thromboangiitis obliterans, is a rare vascular disorder closely linked to smoking. It can cause severe ischemic pain, trophic disorders, and a high risk of amputation. Its management requires a specialized, multidisciplinary, and patient-centered approach. Drawing on the testimony of Nicolas Robin, a patient receiving vascular care, this article highlights the clinical, functional, psychological, and social consequences of this condition, as well as the challenges involved in the care pathway.