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Displaying 1-5 out of 5 published

13 July 2007

The man's name was René Fontaine (1889-1979), not Fontain. The original work was entitled Die chirurgische Behandlung der peripheren Durchblutungsstörungen by R. Fontaine, M. Kim & R. Kieny, Helv Chir Acta 1954; 21: 499-533 [The surgical treatment of the peripheral blood perfusion disturbances].

Today, the Fontaine classification of non-diabetic patients with chronic peripheral arterial occlusive disease (PAOD) is as follows:

Stage I: Clinically asymptomatic arterial occlusion

Stage II: Intermittent claudication (functional ischaemia)

Stage III: Ischaemic rest pain (critical ischaemia)

Stage IV: Ulceration or gangrene

Some clinicians find it convenient to divide Stage II into A and B: IIA: Simple claudication IIB: Moderate to severe claudication Claudication is subjective, so a separator of 200 m is arbitrary.

Further, Stage III may be divided into A: segmental systolic ankle blood pressure > 50 mm Hg, and B: ABP < 50 mm Hg. Stage IV A is sometimes used to designate limited ulceration or gangrene of for example a toe, and IV B for more extensive gangrene. These differentiations are not useful and can be neglected.

In clinical practice, the Fontaine classification, so easy to remember, has proven helpful as a convenient frame of reference for treatment and referral.

Competing interests: None declared

Competing interests: None declared

William P. Paaske, Professor

Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark

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Dear Sir, In this article the authors state that spinal claudication manifests as weakness and not as pain. This is definitely not the case: spinal claudication is typical only in its protean manifestations which can vary between weakness and numbness of any part of the limb to pain and cramping that completely mimics the symptoms of vascular claudication. In my own practice, most of my patients are passed on from my vascular colleagues and have pain. In my own case I get episodes of typical calf cramping coming on when I rush associated with neither pain, weakness nor parasthesiae and no other pain.

Competing interests: None declared

Competing interests: None declared

Mark Pickin, Consultant Orthpaedic Physician

Doncaster DN2 5LT

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Dear Editor,

We come across a lot of patients with Takayasu's disease who are young females,present with claudication of extremities,especially affecting the upper limbs.Therefore it is important to keep in mind this important condition in mind as claudication can be the presenting feature of this disease.

Competing interests: None declared

Competing interests: None declared

PRASANTA PADHAN, MD,POST DOCTORAL FELLOW

DEPARTMENT OF CLINICAL IMMUNOLOGY AND RHEUMATOLOGY,CHRISTIAN MEDICAL COLLEGE ,VELLORE,INDIA.632004

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Dear Sir,

The authors state that spinal claudication presents predominantly with weakness, rather than pain. However in my experience, spinal claudication does often present with pain and paraesthesias in the legs after a certain distance, and not always soon after standing up. For our Dutch citizens a useful question to differentiate intermittent (vascular) claudication is that spinal claudication patients have no problems cycling (i.e. bending). It even has a Dutch eponymous syndrome; the syndrome of Verbiest (who claimed to be the first to describe this in 1951).Furthermore their pain does not disappear on standing still; they do have to bend or sit. At medical school, we were even taught a sixth P, for perishing cold (a bit of a stretch to list under P, but a useful symptom and/or sign. In older patients with co-morbidity one often has to consider both spinal and intermittent claudication being present simultaneously.

Yours, Jan coebergh

Verbiest, H. [Further reports on primary stenosis of the lumbar spinal canal in adults.] Ned Tijdschr Geneeskd. 1951 Jul 7;95(27):1965-70

Competing interests: None declared

Competing interests: None declared

jan a coebergh, neurology trainee

2566 MJ

hagaziekenhuis, the hague

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Unfortunately a typing error occurred in this article. Pain occurring before 200 m does not reflects Fontaine stage Ia peripheral arterial disease (PAD), instead it is classified as Fontain stage IIb. Stage I describes asymptomatic PAD.

Competing interests: None declared

Competing interests: None declared

Stephan Imfeld, Angiology Department

4054 Basel

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