Chronic venous insufficiency - a potential trigger for localized scleroderma.Ludwig RJ, Werner RJ, Winker W, Boehncke WH, Wolter M, Kaufmann R.
Department of Dermatology, Klinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany. email@example.com
Localized scleroderma is a cutaneous disease that is characterized by an initial inflammatory response, followed by sclerosis of the skin. The cause of localized scleroderma has not yet been determined. Seifarth et al. reported two cases of localized scleroderma at sites of chronic venous insufficiency. We document here three more patients in whom localized scleroderma was located at insufficient veins. Treatment of underlying chronic venous insufficiency (CVI) leads to a substantial clinical improvement of scleroderma at the site of insufficient veins, but not elsewhere. Experimental data support the concept of chronic venous insufficiency creating a microenvironment, which may lead to localized scleroderma. Local hypoxaemia, which is present in CVI, induces the release of endothelium-derived cytokines, such as IL-1. Subsequently, expression of endothelial adhesion molecules and consequently leucocyte extravasation are induced. Infiltrating leucocytes secrete a number of inflammatory mediators, including transforming growth factor beta, which is a potent stimulus for collagen synthesis. Therefore, it may well be that CVI is a potential trigger factor for localized scleroderma. In addition, localized scleroderma may only develop if a certain amount of trigger factors are present - and resolves if one or more of the contributing factors (i.e. CVI) can be treated
Scleroderma (systemic sclerosis): Fast Facts
--Scleroderma is a chronic autoimmune disease, in which the body’s immune system mistakenly targets healthy cells for destruction.
--The hallmark feature of scleroderma is hardening of the skin.
--Scleroderma can range from a localized disease that primarily affects the skin to a more serious illness, known as systemic sclerosis, that causes damage to multiple parts of the body, including the joints, digestive tract, lungs and kidneys.
--Like many other autoimmune diseases, scleroderma occurs much more frequently in women than men, with about four times as many women as men developing the disease.
--Although the cause of scleroderma is unknown, genetic and environmental factors are thought to play a role in the disease. Scleroderma does not often run in families, but there may be certain gene variants that increase likelihood of the disease.
Paolo Zamboni, University of Ferrara, Italy, presented the rationale and preliminary results of an endovascular treatment for multiple sclerosis on the third day of the CX Symposium.
Zamboni explained that, though multiple sclerosis is an inflammatory neurodegenerative disease of the central nervous system of unknown origin - widely considered to be autoimmune in nature - it is strongly associated with chronic cerebrospinal venous insufficiency.
This link was supported by Zamboni’s recent study of 65 patients affected by clinically defined multiple sclerosis, along with 235 "healthy" control subjects. Though this study left open the question as to whether venous stenoses are the cause or product of multiple sclerosis.
"I cannot answer this at the moment," Zamboni told CX Daily News. "The interesting thing, though, is that when you can treat the stenosis, you have, in time, an improvement in those patients. Especially in the first phase."
Zamboni’s current, ongoing study is exploring the effects of endovascular treatment for stenosed jugular and azygous veins in a cohort of 100 multiple sclerosis patients, with follow-up to one year.
"I think that this is really promising," he said. "I have good cooperation with the neurologists in my country. And I think that this could be promising if neurologists and vascular people work back to back on this."
if it makes you uncomfortable....
A venogram is an X-ray test that takes pictures of blood flow through the veins in a certain area of the body.
During a venogram, a special dye (contrast material) is put into your veins so they can be seen clearly on an X-ray picture. A venogram looks at the condition of your veins and the valves in your veins.
A venogram can show the veins in your legs, pelvis, or arm; the veins leading to the heart; or the veins leaving your kidneys. Venography also may be done to find a blood clot (deep vein thrombosis, or DVT). Blood clots in the deep veins can be serious because the clot or part of it can break off and move through the blood vessels. A clot that blocks an artery in your lung (pulmonary embolus) can be life-threatening.
CureOrBust wrote:It also appears to have gone quiet in regard to the centre in the US? or is it really just an "outpost" for his centre in italy?
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