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Introduction: Conventional methods of critical leg ischaemia treatment are of limited efficacy. Amputation, as an ultimate solution, is not so rare. The results of marrow stem cell therapy as a potential novel approach to peripheral artery disease management were presented in 2002 by Tateishi-Yuyamy., Aim: To assess efficacy and safety of critical lower limb ischaemia treatment with marrow stem cell autotransplantation., Methods: Ten patients suffering from chronic leg ischaemia in Fontaine IV stadium were involved in the study. They did not require emergency amputation and had previously been unsuccessfully treated with conventional therapy. Autologic marrow stem cells were condensated by a separator from bone marrow samples taken from the iliac crest. The cells were delivered intramuscularly by repeated injections into the pedal and tibial regions. The number of CD34 and AC133 positive mononuclear cells in each sample was evaluated by flow cytometry. After two weeks and one, two, three and twelve months the following parameters were measured: Laser Doppler Flux (LDF), percutaneous oxygen partial pressure, ankle-brachial index (ABI), visual analgesic scale (VAS), analgesic therapy requirement and ulceration area. Also, lower leg angiography and scintigraphy were performed., Results: An improvement of the peripheral blood flow assessed by Laser Doppler Flux and percutaneous oxygen partial pressure was found. Pain severity decreased in the majority of patients. Amputation was required in three patients in whom the therapy failed. No side effects of the therapy were observed. The clinical effect of the treatment did not correlate with the amount of cells injected., Conclusion: Marrow stem cell autotransplantation into the ischaemic lower limb seems to be a potentially effective method of peripheral perfusion enhancement. Further studies are needed to clarify the underlying mechanisms of such improvement.

We describe a 50 years old man with multiple symmetric lipomatosis (Madelung disease) and two years history of intermittent claudication who was hospitalized because of persistent ulcer of left foot. Lipomata were located on the neck, shoulders and chest; they enlarged gradually over a few years, becoming huge in size. Ulceration of the foot appeared a few weeks before hospitalization and its ischaemic origin was uncertain because of atypical character (painless, ankle/brachial index > 0.5). After angiographic examination patient was assigned for conservative treatment. Intravenous infusions of alprostadil were given with poor effect. Because of gradual enlargement of the ulceration, pain intensification and relatively favourable angiographic picture aorto-bifemoral prosthesis implantation was performed with satisfactory short-therm effect. In addition, patient required vitamin B12 supplementation due to megalocytic anemia.

Unlabelled: The purpose of this study was to investigate the foot skin microcirculation in type 1-diabetic patients. The study group comprised 67 patients divided into four subgroups: 13 women and 11 men healthy and had no family history of diabetes; 19 women and 24 men had type 1-diabetes. The studied measurements included 7 parameters determined during rest and post occlusive hyperaemia. They were performed with laser Doppler fluxmetry using surface probe localised in distal part of the lower limbs. The most significant data localised the probe in thumb. The maximum of hyperaemic response (MAX) was significantly lower in the diabetic patients as compared to the healthy subjects (p < 0.01). The time of peak flow (TM) was higher (p < 0.01) in diabetic patients as compared to the control subjects. The half time of hyperaemia (TH) was significant longer (p < 0.05) for diabetic groups., Conclusion: The laser Doppler method is helpful to identify patients with risk development diabetic complications. The most valuable data is MAX, TM and TH, the best localisation of the probe seems to be the most distal point of thumb.

Unlabelled: Recognition of early microcirculatory disturbances in feet of diabetics may facilitate the pathogenic interpretation of the diabetic foot syndrome, selection of the patients at risk of developing clinical problems and serve as the base for designing the preventive measures. This could be particularly true in diabetics with peripheral neuropathy. Therefore the study aimed at the assessment of functional parameters of the foot microcirculation in IDDM patients presenting signs of peripheral neuropathy but without any symptoms of the diabetic foot syndrome was undertaken. For comparison 20 IDDM subjects with the signs of peripheral neuropathy and 10 IDDM subjects without this complication were studied both clinically and metabolically. All of them underwent the examination of microcirculation of the feet with the use of Laser Doppler Flowmeter. The parameters measured were: resting blood flow, post-occlusive, hyperemic response, flow change after heating to 44 degrees C and the flow on dependency. In IDDM subjects with peripheral neuropathy the following functional microcirculatory abnormalities were found: delay and decrease in post-occlusive, hyperemic response (4.5 +/- 1.8 s in neuropathic vs 0.5 +/- 2.4 s in non-neuropathic IDDM patients), decrease of the peak flow (36 +/- 7.0 PU in non neuropathic vs 18 +/- 5.0 PU in neuropathic IDDM patients) and also impairment of the response of the skin flow to focal heating peak flow at 44 degrees C (48 +/- 7.0 PU vs 12 +/- 3.0 PU in non neuropathic IDDM patients). Also the venoarteriolar reflex measured as the ratio of resting to standing flow in the feet skin was significantly decreased (80% in non-neuropathic versus 35% in neuropathic IDDM patients)., Conclusion: Laser Doppler Flowmetry discovers the very early functional abnormalities in the microcirculation of the skin in the feet of IDDM with peripheral neuropathy, when none of the typical symptoms of the diabetic foot syndrome is present. It points to the significance of the relation between neuropathic and microcirculatory disturbances in the early pathogenesis of diabetic foot syndrome.

Blood flow pattern (maximum moment velocity, mean velocity, artery diameter and minute flow) in the superficial femoral artery and in the foot artery was evaluated in 30 patients, subjected to laser biostimulation for symptoms of atherosclerotic ischemia of the lower limbs. The blood flow examination was performed before the treatment and immediately afterwards (20 procedures) and 6 months following the therapy. It was found that laser biostimulation had a favorable effect on the blood flow pattern, particularly in the initial stage of ischemia (Io), and may be a useful method of medical treatment in atherosclerotic ischemia of the lower limbs.