Sample records for aortitis

  1. Infectious Aortitis. (United States)

    Ramirez, F Daniel; Jamison, Bruce M; Hibbert, Benjamin


    Aortitis is broadly divided into infectious and non-infectious etiologies, each with distinct treatment implications. We present the case of a patient who sustained a type A aortic dissection during urgent coronary angiography for acute coronary syndrome. Clinical findings and events during the procedure raised suspicion for an underlying vascular disorder; however, the diagnosis of staphylococcal aortitis was not made until pathological examination of resected tissue. Clues to the diagnosis of infectious aortitis noted throughout the patient's clinical course are detailed as are potential consequences of diagnostic delays and treatment decisions, underscoring the difficulties in recognizing and managing the condition. In addition, we describe a previously unreported complication of cardiac catheterization in the setting of an infectious aortopathy.

  2. [Aortitis: report of three cases]. (United States)

    Wurmann, Pamela; Sabugo, Francisca; Cruz, Julio; Díaz, Gonzalo; Sánchez, Felipe; Pino, Sandra; Pezo, Ninette; Díaz, Juan Carlos; Fernández, Cristina


    Aortitis is a nonspecific term that describes an inflammation of the aortic wall caused by inflammatory, infectious, paraneoplastic and idiopathic diseases. The symptoms are variable and nonspecific; therefore a high level of clinical suspicion is required to diagnose it. It is often an incidental finding while looking for other diagnoses and it is confirmed mainly through imaging studies. We report three cases of aortitis: A 29-year-old woman presenting with alopecia, oral and nasal ulcers and positive antinuclear antibodies. A CAT scan showed a segmental thickening of thoracic aorta, with dilated and stenotic areas. She was successfully treated with steroids, hydroxychloroquine, cyclophosphamide and azathioprine. A 41-year-old male presenting with dorsal pain and cough. The CAT scan showed an extra-intimal thickening of the descending aorta and stenosis of the celiac artery. The final diagnosis was a polyangiitis and was treated with steroids, cyclophosphamide and azathioprine. A 28-year-old woman presenting with pain in the left upper abdomen. Imaging studies showed a thickening of the aortic arch and subclavian artery. The final diagnosis was sarcoidosis and the patient was treated with prednisone.

  3. Syphilitic aortitis: Rearing of the ugly head

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    Vaideeswar Pradeep


    Full Text Available Context: Syphilitic aortitis has been relegated to the category of rare cardiovascular disease or a "medical curiosity" in the west. The same situation may not exist in developing countries due to the stigmata that continue to remain attached to sexually-transmitted diseases in general. Aims: To study the prevalence of syphilitic aortitis among autopsied non-atherosclerotic aortic diseases encountered in a span of 15 years. Settings and Design: Retrospective, autopsy-based study. Materials and Methods: Among 187 cases of non-atherosclerotic diseases of the aorta, 44 had been diagnosed as syphilitic aortitis on the basis of the pathological features and serology. The demographic details and modes of clinical presentation were retrieved from the health records. Depending on the presence of complicating lesions, the cases were classified as uncomplicated or complicated aortitis. Results: The 44 cases of syphilitic aortitis formed 23.5 % of the non-atherosclerotic aortic diseases. They were predominantly seen in males in the fifth decade, who often presented with valvular regurgitation, aneurysmal disease or myocardial ischemia; 13.6 % of patients were asymptomatic. Blood VDRL results were available in 19 patients; 84.2 % were positive. Concomitant involvement of the ascending, transverse and descending thoracic was seen in 45.5 % of cases. None had uncomplicated aortitis. Complications in the form of aortic regurgitation (72.7 %, coronary ostial stenosis (59 % and aneurysms (59 % frequently coexisted. Thirty-five aneurysms were present in 59 %, chiefly involving the aorta. Conclusions: We found syphilitic aortitis to be a common cause of aortitis at autopsy. Diagnosis should be made with the help of characteristic pathological features correlated to the clinical context and appropriate serological tests.

  4. Aortitis with antiphospholipid antibodies: CT and MR findings

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    Seror, O.; Dordea, M.; Ghenassia, C.; Coderc, E.; Sellier, N. [Department of Radiology, Centre Hospitalo-Universitaire Paris XIII, Bondy (France); Fain, O. [Department of Medicine, Centre Hospitalo-Universitaire Paris XIII, Bondy (France)


    Two cases of aortitis associated with the presence of antiphospholipid antibodies (APAs) are reported. Only CT and MR imaging were able to show these unusual form of aortitis preferentially affecting the outer aortic tunics. We conclude that aortitis could be a new manifestation of primary antiphospholipid syndrome (APS) and the initial pathological process before the development of aortic thrombosis, reported as a classical complication of APS. (orig.) (orig.) With 2 figs., 6 refs.

  5. Aortitis in patients with psoriatic arthropathy: report of two cases and review of the literature

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    Gleb Slobodin


    Full Text Available Aortitis, which is well described in patients with other spondyloarthritides, has been rarely cited in relation to psoriatic arthropathy (PsA. Two patients with known PsA, who developed aortitis, are reported herein. The PubMed database was searched using the following keywords: aortitis, Takaysu arteritis, PsA, ankylosing spondylitis, reactive arthritis, inflammatory bowel disease. The relevant articles were critically reviewed and pertinent data organized. Analysis of 5 cases of aortitis in patients with PsA, including the 2 cases reported herein, revealed no specific pattern of PsA joint involvement in the patients who developed aortitis. All aortic segments can be involved and complications, such as insufficiency of the aortic valve and stenosis of the major aortic branches, have been described. The genetic association involving the IL12B locus may be involved in the clinical association of aortitis and spondyloarthritis.

  6. Aortitis requiring aortic repair associated with glaucoma, thyroiditis, glaucoma, and neuropathy: case report

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    Bayer Günther


    Full Text Available Abstract Aortitis may be due to infectious and non-infectious causes. We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman. Despite antibiotic therapy, inflammatory signs persisted and resolved only after initiation of glucocorticoid therapy. Increasing aortic ectasia necessitated resection of the ascending aorta and implantation of a Vascutek 30 mm prosthesis. Histologically a granulomatous aortitis was diagnosed. Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

  7. Gonococcal ascending aortitis with penetrating ulcers and intraluminal thrombus. (United States)

    Woo, J Susie; Rabkin, David G; Mokadam, Nahush A; Rendi, Mara H; Aldea, Gabriel S


    Neisseria gonorrhoeae is an uncommon pathogen causing bacterial aortitis. We describe a patient with a bicuspid aortic valve and known ascending aortic aneurysm who presented with fever and chest pain. Imaging demonstrated complex penetrating ulcers in the proximal ascending aorta. The patient underwent a modified Bentall procedure, resection of the ulcers, and ascending aortic reconstruction. Pathologic examination and culture of the aortic specimens revealed the infectious cause.

  8. Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome complicated by aneurysmal aortitis. (United States)

    Ng, Chin Soon; Hogan, Patrick; McKenzie, Scott; Gibbs, Harry; Strutton, Geoff; Wong, Richard


    "MAGIC syndrome" (Mouth And Genital ulcers with Inflamed Cartilage) has been proposed to describe patients with clinical features of both relapsing polychondritis and Behcet disease. A total of 18 cases have been reported with only 1 case associated with aneurysmal aortitis described in 1997. Herein, we describe a patient with MAGIC syndrome complicated by aneurysmal aortitis requiring cardiothoracic surgery and intensive immunosuppression. Monitoring for the possible development of inflammatory aortic aneurysms should thus be considered in patients with MAGIC syndrome who have persistently elevated serum inflammatory markers. If an aortic aneurysm is detected, cardiothoracic surgical referral is necessary, close monitoring for enlargement is mandatory, and intensification of immunosuppressive therapy should be considered.

  9. ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis

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    Predescu L.M.


    Full Text Available Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions.

  10. Assessment of aortitis by semiquantitative analysis of 180-min {sup 18}F-FDG PET/CT acquisition images

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    Martinez-Rodriguez, Isabel [University of Cantabria, Department of Nuclear Medicine, Marques de Valdecilla University Hospital, Santander (Spain); Hospital Universitario Marques de Valdecilla, S. Medicina Nuclear, Santander (Spain); Martinez-Amador, N.; Banzo, I.; Quirce, R.; Jimenez-Bonilla, J.; Arcocha-Torres, M. de; Ibanez-Bravo, S.; Lavado-Perez, C.; Bravo-Ferrer, Z.; Carril, J.M. [University of Cantabria, Department of Nuclear Medicine, Marques de Valdecilla University Hospital, Santander (Spain); Blanco, R.; Gonzalez-Gay, M.A. [University of Cantabria, Department of Rheumatology, Marques de Valdecilla University Hospital, Santander (Spain)


    The aim of this study was to evaluate the contribution of semiquantitative analysis of 180-min {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images for the assessment of aortitis in cases of suspected large vessel vasculitis (LVV) and to establish a threshold index for application in the clinical setting. This prospective study included 43 patients (mean age 67.5 ± 12.9 years) with suspicion of LVV (25 with a final diagnosis of aortitis). {sup 18}F-FDG PET/CT scan was acquired 180 min after injection of 7 MBq/kg of {sup 18}F-FDG. A semiquantitative analysis was performed calculating the aortic wall maximum standardized uptake value (SUV{sub max}) (T), the lumen SUV{sub max} (B) and the target to background ratio (TBR). These results were also compared with those obtained in a control population. The mean aortic wall SUV{sub max} was 2.00 ± 0.62 for patients with aortitis and 1.45 ± 0.31 for patients without aortitis (p < 0.0001). The TBR was 1.66 ± 0.26 for patients with aortitis and 1.24 ± 0.08 for patients without aortitis (p < 0.0001). The differences were also statistically significant when the patients with aortitis and controls were compared. Receiver-operating characteristic (ROC) analysis revealed that the area under the curve was greater for the TBR than for the aortic wall SUV{sub max} (0.997 vs 0.871). The highest sensitivity and specificity was obtained for a TBR of 1.34 (sensitivity 100 %, specificity 94.4 %). Semiquantitative analysis of PET/CT images acquired 180 min after {sup 18}F-FDG injection and the TBR index of 1.34 show very high accuracy and, therefore, are strongly recommended for the diagnosis of aortitis in the clinical setting. (orig.)

  11. Successful Endovascular Repair of a Penetrating Aortic Ulcer in Bacterial Aortitis. (United States)

    Mezzetto, Luca; Veraldi, Gian Franco; Engelberger, Stephan; Giovannacci, Luca; Van den Berg, Josua; Rosso, Raffaele


    Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta. Unfit for surgery due to severe comorbidities, he was treated by means of a tubular endograft and long-term antibiotic therapy. A rapid improvement of clinical conditions was observed during the subsequent hospital stay. Complete regression of aortic involvement was demonstrated after 1 year. In conclusion, for selected patients affected by IA and PAU an endovascular approach associated to long-term antibiotic therapy may be safe and effective.

  12. Refractory PMR with aortitis: life-saving treatment with anti-IL6 monoclonal antibody (tocilizumab) and surgical reconstruction of the ascending aorta. (United States)

    Ashraf, Fahd Adeeb Mohamed; Anjum, Shakeel; Hussaini, Abid; Fraser, Alexander


    Aortitis is uncommon but well described in patients with polymyalgia rheumatica (PMR). While glucocorticoid remains the mainstay therapy for large-vessel vasculitis, there have been cases where tocilizumab therapy led to clinical and serological improvement in patients with relapsing or refractory disease. We report a case of life-threatening PMR with aortitis in the absence of manifestations related to giant cell arteritis, which, having failed to respond to corticosteroid therapy, was successfully treated with tocilizumab and emergency reconstruction of the ascending aorta. This case adds to the literature supporting the potential value of interleukin-6 inhibition in rare rheumatological conditions such as inflammatory aortitis.

  13. ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis. (United States)

    Predescu, L M; Zarma, L; Platon, P; Postu, M; Bucsa, A; Croitoru, M; Prodan, B; Chioncel, O; Deleanu, D


    Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.

  14. Value of F-18 FDG hybrid camera PET and MRI in early takayasu aortitis

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    Meller, J.; Becker, W. [Department of Nuclear Medicine, Georg August University, Robert Koch Strasse 40, 37075 Goettingen (Germany); Grabbe, E.; Vosshenrich, R. [Department of Radiology, Georg August University, Robert Koch Strasse 40, 37075 Goettingen (Germany)


    Takayasu aortitis (TA) is a chronic inflammatory and fibrotic vasculitis of large- and medium-sized arteries. Early stages of the disease show a panarteritis and inflammatory wall thickening of the aorta and its branches, whereas advanced (fibrotic) stages comprise stenosis, aneurismatic transformation and occlusion. Magnetic resonance imaging visualises early-stage disease with high accuracy and is considered to be the method of choice in the diagnosis of TA. The aim of this article is the detailed comparison of FDG-PET performed with a hybrid camera and MR imaging in five patients with early TA. Five patients (median age 60 years) were enrolled during an ongoing prospective study on [18F]2'-deoxy-2-fluoro-D-glucose (FDG) hybrid camera PET in patients with fever of unknown origin (FUO). These patients underwent MR imaging after establishing the diagnosis of TA. Abnormal FDG uptake in the wall of the aorta was noted in all patients. The bracheocephalic artery and the common carotid arteries were visualized in 3 cases. Increased uptake of the subclavian artery was found in 3 patients and in 4 patients pathological uptake was noted in the ilio-femoral vessels. Of 34 vascular regions studied, 26 (76%) showed elevated FDG uptake. On transversal MR images vessel wall thickening and contrast enhancement of the thoracic aorta was found in 4 patients (ascending aorta/aortic arch: n=2; descending aorta: n=3; abdominal aorta: n=1). Additionally, vessel wall pathologies of the subclavian and the common carotid arteries could be shown in 1 patient and in another patient in the ilio-femoral arteries. No abnormalities were found using contrast-enhanced MR angiography. Of 28 vascular regions studied, 9 (32%) showed vasculitis on MRI. The FDG-PET is a suitable whole-body screening method in the primary diagnosis of early TA, especially in those cases with early disease that present with uncharacteristic symptoms such as FUO. Both MRI and MRA remain indispensable in the exact

  15. Early diagnosis and follow-up of aortitis with [{sup 18}F]FDG PET and MRI

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    Meller, J.; Siefker, U.; Sahlmann, C.O.; Lehmann, K.; Conrad, M. [Department of Nuclear Medicine, Georg August University, Robert Koch-Strasse 40, 37075, Goettingen (Germany); Strutz, F.; Scheel, A. [Department of Nephrology and Rheumatology, Georg August University, Goettingen (Germany); Vosshenrich, R. [Department of Radiology, Georg August University, Goettingen (Germany)


    The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([{sup 18}F]FDG) positron emission tomography (PET) with magnetic resonance imaging (MRI) in patients with early aortitis, at the time of initial diagnosis and during immunosuppressive therapy. The study population consisted of 15 patients (nine females and six males; median age 62 years, range 26-76 years) who presented with fever of unknown origin or an elevated erythrocyte sedimentation rate or elevated C-reactive protein and who showed pathological aortic [{sup 18}F]FDG uptake. Fourteen of these patients had features of early giant cell arteritis (GCA), while one had features of early Takayasu arteritis. During follow-up, seven PET scans were performed in six patients with GCA 4-30 months (median 19 months) after starting immunosuppressive medication. The results of [{sup 18}F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [{sup 18}F]FDG uptake was present in 59/104 (56%) of the vascular regions studied in 15 patients. Seven follow-up PET studies were performed in six patients. Of 30 regions with initial pathological uptake in these patients, 24 (80%) showed normalisation of uptake during follow-up. Normalisation of [{sup 18}F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [{sup 18}F]FDG uptake were investigated with MRI and MRA. Thirteen of these 14 patients showed inflammation in at least one vascular region. Of 76 vascular regions studied, 41 (53%) showed vasculitis on MRI. Of 76 vascular regions studied with both PET and MRI, 47 were concordantly positive or negative on both modalities, 11 were positive on MRI only and 18 were positive on PET only. MRI was performed during follow-up in six patients: of 17 regions with inflammatory changes, 15 regions remained unchanged and two

  16. Coronary bilateral ostial enlargement using the saphenous vein in a patient with syphilitic aortitis

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    Ulisses A. Croti


    Full Text Available A patient with tertiary syphilis presenting with bilateral coronary ostial lesions and aortic regurgitation underwent surgical reconstruction of the coronary ostia by the anterior approach with autogenous saphenous vein grafting and substitution of the aortic valve with a bovine bioprosthesis. The procedure was easily performed and had good outcomes both early and late. The rarity of the association of a lesion in both coronary ostia with aortic regurgitation in syphilis and the surgical technique employed are discussed.

  17. 大动脉炎综合征的影像表现特点%Imaging features of aortitis syndrome

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    杨之晖; 许建荣; 沈加林; 殷炎; 凌林华; 李磊


    目的讨论多发性大动脉影像表现特点.方法 46例大动脉炎综合征病例,经普通血管造影7例,DSA造影23例,MR检查8例,DSA和MR检查4例,DSA和CT检查4例.结果大动脉炎综合征病变以狭窄-阻塞型最常见( 73.9%),按Lupi-Herrea分型以Ⅲ型多见(43.5%),最常受累的血管为左锁骨下动脉(69.6%)及左颈总动脉(60.9%).结论大动脉炎综合征多部位血管受累多见,以狭窄-阻塞型常见,MR及CT可观察血大动脉炎病变血管壁病理改变.

  18. Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 2

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    Ichiro SAKAMOTO; Kuniaki HAYASHI; Naofumi MATSUNAGA; Kazuto ASHIZAWA; Yohjiro MATSUOKA; Masataka UETANI


    In part 1 of this article, clinical features and imaging findings of Takayasu arteritis (also known as aortitis syndrome) were described in detail. In part 2, treatment of Takayasu arteritis will be first described and discussed. This will be followed by description of clinical features and imaging findings of other systemic vasculitis. Comments on interventional radiology for systemic vasculitis will also be made.

  19. Vessel involvement in giant cell arteritis : an imaging approach

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    Holm, Pieter W; Sandovici, Maria; Slart, Riemer H.; Glaudemans, Andor W; Rutgers, Abraham; Brouwer, Elisabeth


    Vasculitis is classified based on the size of the involved vessels. The two major forms are small vessel vasculitis (SVV) and large vessel vasculitis (LVV). Main forms of LVV are Takayasu Arteritis (TA), Giant Cell Arteritis (GCA), Isolated Aortitis (IA) and Chronic Periaortitis (PC). This manuscrip

  20. Thoracic vasculitis presenting as surgical problems.

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    Jansen, Michael


    We present four patients with vasculitis manifesting with unusual clinical or pathological features, generating surgical problems. Two cases presented with pulmonary hypertension, with investigations and radiological evidence prompting clinical suspicion of pulmonary thrombo-embolic disease. First case, with an antecedant history of Wegener\\'s granulomatosis (WG), demonstrated following "embolectomy", WG involving the large pulmonary elastic arteries. The second case of inoperable "pulmonary thrombo-embolic disease" was subsequently found at limited post mortem to have giant cell arteritis, which affected widespread small peripheral pulmonary arterial vessels. The other two cases were of aortitis occurring in the background of immune-mediated disease, which had been treated with aggressive immunosuppression regimens. The first of these was a case of Cogan\\'s syndrome complicated by descending aortitis, a rarely reported phenomenon, with co-existent acute endocarditis of the aortic valve leaflets. Most cases of endocarditis in this context occur secondary to and in continuity with ascending aortitis. That this case, and a case of ascending aortitis occurring in the context of relapsing polychondritis occurred in the face of aggressive immunosuppression with an apparent clinical response, underscores the need to not accept a clinical picture at face value. This has implications for clinical management, particularly in the follow-up of surgical prosthetic devices such as grafts which may be used in these cases. All four cases emphasise the continued importance of histology and the post-mortem examination in elucidating previously undetected or unsuspected disease.

  1. Abdominal aortic aneurysm in a premature neonate with disseminated candidiasis: Ultrasound and angiography

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    Khoss, A.E.; Ponhold, W.; Pollak, A.; Schlemmer, M.; Weninger, M.


    When using ultrasound for detection of kidney enlargement, we found an acute abdominal aortic aneurysm secondary to aortitis arising from umbilical artery catheterisation in a premature neonate with systemic candidiasis. Aortography was performed to provide vascular details such as involvement of celiac, renal, iliac and femoral arteries.

  2. Severe reversible dilated cardiomyopathy associated with a large left ventricular thrombus in a young child with middle aortic syndrome. (United States)

    Ponniah, U; Overholt, E


    We report a case of a seven-year girl who presented with severe dilated cardiomyopathy (DCM) associated with a large thrombus in the left ventricle (LV). She had a long segment stenosis of the lower thoracic descending aorta, possibly due to non-specific aortitis and underwent successful stent angioplasty. The LV thrombus resolved after heparin without sequelae.

  3. Severe reversible dilated cardiomyopathy associated with a large left ventricular thrombus in a young child with middle aortic syndrome


    Ponniah, U; Overholt, E


    this article reports a case of a seven-year girl who presented with severe dilated cardiomyopathy (DCM) associated with a large thrombus in the left ventricle (LV). She had a long segment stenosis of the lower thoracic descending aorta, possibly due to non-specific aortitis and underwent successful stent angioplasty. The LV thrombus resolved after heparin without sequelae.

  4. Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 1

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    Kuniaki HAYASHI; Ichiro SAKAMOTO; Naofumi MATSUNAGA; Kazuto ASHIZAWA; Masataka UETANI


    This is a review article describing some new and interesting aspects in the diagnosis and treatment in systemic vasculitis and demonstrating several cases that we have encountered. Particular emphasis will be put on Takayasu arteritis (also known as aortitis syndrome) most commonly observed in Japan and other oriental countries. CT and MRI better demonstrate the vessel wall abnormality of Takayasu arteritis than angiography. Importance of plain chest radiograph should also be kept in mind; it could provide a clue in the diagnosis of Takayasu arteritis in its early stage.

  5. CT of thoracic aortic aneurysms. (United States)

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E


    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  6. Cardiac Involvement in Ankylosing Spondylitis (United States)

    Ozkan, Yasemin


    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  7. Survey of 200 cases of the abdominal aortography

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    Kim, Ki Jeung; Choi, Doo Suk; Hah, Hae Koo [National Medical Center, Seoul (Korea, Republic of)


    From 1962 to 1970 about 200 abdominal aortographies were performed in Department of Radiology of National Medical Center, Seoul, Korea, with percutaneous retrograde seldinger catheterization technique. The 200 cases of the abdominal aortography were analyzed as followings. 1) The sex ratio of all patients was 105 (52.5%) males to 95 (47.5%) females. And high incidence was noted in middle age group. (46 patients were from 30 years to 40 years of age) 2) Radiological findings were grouped as 62 (31%) vascular lesion, 113 (56.5%) visceral or other expanding lesions and 29 (14.5%) angiographically nonspecific findings. Total is over 200 due to double lesions in 4 patients. 3) The 62 vascular lesions were composed of 40 aortitis, 28 renal hypertension etc. a) The 40 aortitis was divided into 25 artherosclerotic and 15 nonspecific. The 15 nonspecific aortitis revealed segmental narrowing (2-4 cm) with collaterals. b) In 28 renal hypertension, 17 cases were combined with aortitis, but not in 11 cases (Pure renal hypertension), and 19 cases were unilateral. 4) The highest incidence in 113 (56.5%) visceral or other expanding lesions, was renal lesions (88 cases), and other lesions, such as 12 retroperitoneal masses, 9 liver and pancreatic masses were also noted. The 88 renal lesions were composed of 37 renal tbc, 17 hydronephrosis (excluding tbc hydro), Tumors, 10 cyst etc. a) The most significant findings of renal tuberculosis in renal arteriogrpahy was rarefaction of contrast staining in involved area which was noted in 32 cases (87%) out of 37 renal Tuberculosis. b) All 12 hypernephroma, 1 wilm's tumor, metastaic tumor from fibromyomata uteri revealed pathological vessels and tumor stainings, however these findings were not noted in 2 ureteral carcinoma involving renal pelvis. 5) No permanent complications arose after abdominal aortography. (Percutaneous retrograde seldinger catheterization technique) 6) Abdominal aortography and selective visceral injections gave

  8. [Some aspects of pathogenesis of ankylosing spondylitis]. (United States)

    Erdes, Sh


    Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease of the spine (spondylitis) and sacroiliac joints (sacroileitis) associated in many cases with inflammatory affection of the peripheral joints (arthritis), entesises (entesitis), eyes (uveitis), intestine (enteritis) and aortic root (aortitis). AS is considered now as a prototype of diseases from the group of seronegative spondyloarthritis. AS is a hereditary disease. Predisposition to AS (90%) is associated with genetic factors the key gene of which is HLA-B27. As pathogenesis of AS is not still verified, three hypotheses are considered basing on HLA-B27 biology. The role of environmental factors involved in AS development (tension in enteses and infection) are discussed.

  9. Determinants of Vessel Targeting in Vasculitis

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    Gary S. Hoffman


    Full Text Available Studies of autoimmune diseases have not yet elucidated why certain organs or vessels become the objects of injury while others are spared. This paper will explore the hypothesis that important differences exist in regions of the aorta that determine vulnerability to diseases, such as atherosclerosis, aortitis, giant cell arteritis and Takayasu's disease. The reader is invited to reassess; (1 whether the aorta is indeed a single homogeneous structure, and (2 whether the initial stage of aortitis (and indeed other diseases considered “autoimmune” may be primarily due to acquired alterations of substrate, that influence unique immune profiles, which by themselves may not be pathogenic. Disease susceptibility and patterns are influenced by many factors that are inborn and acquired. Examples include genetic background, gender, ethnicity, aging, prior and concomitant illnesses, habits, diet, toxin and environmental exposures. Studies of vascular diseases must assess how such variables may affect regional differences in endothelial cells, subendothelial matrix, vascular smooth muscle and the response of each to a variety of stimuli.

  10. MRI evaluation of the aortic disease; Zastosowanie tomografii rezonansu magnetycznego w rozpoznawaniu chorob aorty

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    Kapuscinski, O.; Polkowski, J. [Zaklad Radiologii, Inst. Kardiologii, Warsaw-Anin (Poland); Zaleska, T. [Oddzial Kardiologii, CSK, Warsaw-Miedzylesie (Poland); Walecki, J.; Biesiadko, M. [Zaklad Diagnostyki Obrazowej, CMKP and CSK, Warsaw-Miedzylesie (Poland)


    The goal of our study was to establish the value of MRI in diagnosing aortic disease. During 3 years period 46 patients were examined (12 women aged from 6 to 62 years and 34 men aged from 8 to 72 years). In 28 cases the thoracic aorta was examined, in 6 cases the abdominal aorta and in 12 - both the thoracic and the abdominal aorta. MR images were performed on MRT 50 A Toshiba unit 0.5 T. MR images demonstrated aortic aneurysm (caused by atherosclerosis or trauma), aortic dissections, aortic anomalies (i.e. in Turner syndrome) and non-specific aortitis and vasculitis. We regard MRI as preferable noninvasive imaging technique in diagnosing aortic disease. (author) 13 refs, 3 figs

  11. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) associated with acute aortic dissection: a study of two cases (United States)

    Strecker, Thomas; Bertz, Simone; Wachter, David Lukas; Weyand, Michael; Agaimy, Abbas


    Acute aortic dissection is a life-threatening condition mainly caused by hypertension, atherosclerotic disease and other degenerative diseases of the connective tissue of the aortic wall. Mesothelial/monocytic incidental cardiac excrescences (cardiac MICE) is a rare benign reactive tumor-like lesion composed of admixture of histiocytes, mesothelial cells, and inflammatory cells set within a fibrinous meshwork without a vascular network or supporting stroma. Cardiac MICE occurring in association with aortic dissection is exceptionally rare (only one such case reported to date). We herein report on the surgical repair of two Stanford type A aortic dissections caused by idiopathic giant cell aortitis in a 66-year-old-woman and by atherosclerotic disease in a 58-year-old-man, respectively. In both cases, the dissections could be visualized via computed tomography. Histopathology showed cardiac incidental MICE within the external aortic wall near the pericardial surface which was confirmed by immunohistochemistry. PMID:26097568

  12. Disección de aorta en 2 pacientes con prótesis valvulares aórticas


    Diana Otero Norza; Bayardo Robelo Pentzke; Rodrigo Chamorro Castro; Elliot Garita Jiménez; Carlos Salazar Vargas


    La disección aórtica es una verdadera catástrofe vascular que puede ocurrir espontáneamente en enfermos con padecimientos propios de la pared del vaso o bien asociada a condiciones tales como embarazo, hipertensión, aortitis o trauma. Ocasionalmente vemos pacientes que presentan disección después de cirugía cardiaca, particularmente después de reemplazo de la válvula aórtica. El diagnóstico puede ser obvio o muy difícil y el eco trans-esofágico, la tomografía axial del tórax y la resonancia m...

  13. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

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    Marcelo A. Nakazone


    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  14. A Model of Left Ventricular Dysfunction Complicated by CAWS Arteritis in DBA/2 Mice

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    Naoto Hirata


    Full Text Available It was reported previously that a Candida albicans water-soluble fraction (CAWS, including a mannoprotein and β-glucan complex, has strong potency in inducing fatal necrotizing arteritis in DBA/2 mice. In this study, histopathological changes and cardiac function were investigated in this system. One mg/day of CAWS was given to DBA/2 mice via peritoneal injection for five days. The CAWS-treated DBA/2 mice were induced aortitis and died at an incidence of 100% within several weeks. Histological findings included stenosis in the left ventricular outflow tract (LVOT and severe inflammatory changes of the aortic valve with fibrinoid necrosis. Cardiomegaly was observed and heart weight increased 1.62 fold (<0.01. Echocardiography revealed a severe reduction in contractility and dilatation of the cavity in the left ventricle (LV: LV fractional shortening (LVFS decreased from 71% to 38% (<0.01, and the LV end-diastolic diameter (LVDd increased from 2.21 mm to 3.26 mm (<0.01. The titer of BNP mRNA increased in the CAWS-treated group. Severe inflammatory changes resulting from CAWS brought about lethal LV dysfunction by aortic valve deformation with LVOT stenosis. This system is proposed as an easy and useful experimental model of heart failure because CAWS arteritis can be induced by CAWS injection alone.

  15. Revisiting the role of environmental and climate factors on the epidemiology of Kawasaki disease. (United States)

    Rodó, Xavier; Ballester, Joan; Curcoll, Roger; Boyard-Micheau, Joseph; Borràs, Sílvia; Morguí, Josep-Anton


    Can environmental factors, such as air-transported preformed toxins, be of key relevance to the health outcomes of poorly understood human ailments (e.g., rheumatic diseases such as vasculitides, some inflammatory diseases, or even severe childhood acquired heart diseases)? Can the physical, chemical, or biological features of air masses be linked to the emergence of diseases such as Kawasaki disease (KD), Henoch-Schönlein purpura, Takayasu's aortitis, and ANCA-associated vasculitis? These diseases surprisingly share some common epidemiological features. For example, they tend to appear as clusters of cases grouped geographically and temporarily progress in nonrandom sequences that repeat every year in a similar way. They also show concurrent trend changes within regions in countries and among different world regions. In this paper, we revisit transdisciplinary research on the role of environmental and climate factors in the epidemiology of KD as a paradigmatic example of this group of diseases. Early-warning systems based on environmental alerts, if successful, could be implemented as a way to better inform patients who are predisposed to, or at risk for, developing KD. Further research on the etiology of KD could facilitate the development of vaccines and specific medical therapies.

  16. Aortopathy in pregnancy. (United States)

    Smok, Dorothy A


    Up to half of all aortic dissections and ruptures in women younger than 40 years are associated with pregnancy. In pregnancy, women with aortic disease such as arteritis and aortitis are at significant risk of aneurysmal formation and dissection with potential for catastrophic outcomes. Pregnancy places predisposed women at an increased risk of dissection due to physiological and hormonal changes that occur, particularly those with connective tissue disorders, genetic syndromes, congenital heart disease, and other heritable and acquired conditions involving the aorta. Thus, preconception counseling and preparation are advised to determine which patients may cautiously pursue pregnancy, to optimize medical management prior to conception (antihypertensive medications and anticoagulants in the setting of mechanical valves), to identify women in whom aortic root repair should occur prior to pregnancy, and lastly, those in whom pregnancy is contraindicated. Additionally, discussion of the heritable nature of many aortic conditions and associated syndromes is indicated. Preconception and genetic counseling, management by a multidisciplinary team, along with close echocardiographic surveillance and medical management, are recommended if precursors of dissection are identified.


    Baer, Alan N.; Gourin, Christine; Westra, William H.; Cox, Darren; Greenspan, John; Daniels, Troy E.


    IgG4-related disease has been recently defined as a distinct clinic-pathologic entity, characterized by dense IgG-4 plasmacytic infiltration of diverse organs, fibrosis, and tumefactive lesions. Salivary and lacrimal glands are a target of this disease and, when affected, may clinically resemble Küttner tumor, Mikulicz disease, or orbital inflammatory pseudotumor. In some patients, the disease is systemic, with metachronous involvement of multiple organs, including the pancreas, aorta, kidneys, and biliary tract. We report a 66-year old man who presented with salivary gland enlargement and severe salivary hypofunction and was diagnosed with IgG4-related disease on the basis of a labial salivary gland biopsy. Additional features of his illness included a marked peripheral eosinophilia, obstructive pulmonary disease, and lymphoplasmacytic aortitis. He was evaluated in the context of a research registry for Sjögren syndrome and was the only one of 2594 registrants with minor salivary gland histopathologic findings supportive of this diagnosis. PMID:23146570

  18. Usefulness of {sup 18}F FDG PET/CT in evaluating disease activity at different times in a patient with chronic periaortitis

    Energy Technology Data Exchange (ETDEWEB)

    Treglia, Giorgio; Stefanelli, Antonella; Mattoli, Maria Vittoria; Leccisotti, Lucia; Muoio, Barbara [Catholic Univ. of the Sacred Heart, Rome (Italy); Bertagna, Francesco [Univ. of Brescia, Brescia (Italy)


    We report the case of a 53 year old man with a chronic periaortitis (CP) in whom Fluorine 18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been useful in assessing the disease extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease activity during follow up. This case highlights the usefulness of FDG PET/CT at different times in patients with CP. CP is a rare inflammatory disorder that affects the abdominal aorta and the retroperitoneum. Imaging procedures are essential to diagnose and monitor the disease course. Ultrasonography may be used as first line screening test, and is particularly useful to monitor patients with hydronephrosis and aortic aneurysms. However, CT or magnetic resonance imaging (MRI) of the abdomen are currently considered the investigations of choice to diagnose CP. In active CP, the periaortic mass usually enhances on CT and MRI. Both these methods can be used to monitor the disease course of CP and to evaluate response to treatment. A note of caution: signs of vasculitis seen on MRI and CT may persist for some time, despite achievement of clinical remission. A further limitation of abdominal CT and MRI is that neither technique can detect vasculitis in vessels other than the abdominal aorta, which has been described in 43% of patients with CP. FDG PET/CT has been proposed as useful tool in inflammatory diseases, such as aortitis, because metabolic changes assessed by FDG PET/CT usually precede morphological changes assessed by conventional imaging methods. Our case highlights the usefulness of FDG PET/CT at different times in patients with CP. This method may be useful in assessing disease activity and extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease during follow up.

  19. Three Presentations of Takayasu’s Arteritis in Hispanic Patients

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    Ramy Magdy Hanna


    Full Text Available Takayasu’s arteritis (TA is a medium and large vessel vasculitis, defined as a nonspecific aortitis that usually involves the aorta and its branches Kobayashi and Numano (2002. Its etiology remains unclear, and its complications are diverse and severe, including stenosis of the thoracic and abdominal aorta, aortic valve damage and regurgitation, and stenosis of the branches of the aorta. Carotid stenosis, coronary artery aneurysms, and renal artery stenosis resulting in renovascular hypertension are also reported sequellae of TA Kobayashi and Numano (2002. The disease was first described in Japan, but has also been diagnosed in India and Mexico Johnston (2002. Its incidence in the United States has been quoted as 2.6 patients per 1,000,000 people/year Johnston (2002. In Japan, its incidence is 3.6 patients per 1,000,000 patients/year and prevalence is 7.85 patients per 100,000 per year Morita et al. (1996. The natural history of this disease, which is commonly present in Asian populations, has only recently been studied in Hispanic patients despite the notable incidence and prevalence of TA in Mexican, South American, and Indian populations (Johnston 2002, Gamarra et al. 2010 . We present three cases of Hispanic patients who presented with TA at Olive-View-UCLA Medical Center (OVMC. We review their clinical and radiographic presentations. Finally, we review the literature to compare the clinical features of our three patients with data regarding the presentation of TA in more traditional Asian populations.

  20. {sup 18}F-FDG hybrid PET in patients with suspected spondylitis

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    Gratz, S.; Behr, T.M.; Behe, M. [Department of Nuclear Medicine, Philipps University of Marburg (Germany); Department of Nuclear Medicine, Georg August University of Goettingen (Germany); Doerner, J. [Department of Orthopedics, Georg August University of Goettingen (Germany); Fischer, U.; Grabbe, E. [Department of Radiology, Georg August University of Goettingen (Germany); Altenvoerde, G.; Meller, J.; Becker, W. [Department of Nuclear Medicine, Georg August University of Goettingen (Germany)


    This study investigated the value of fluorine-18 2'-deoxy-2-fluoro-D-glucose (FDG) imaging with a double-headed gamma camera operated in coincidence (hybrid PET) detection mode in patients with suspected spondylitis. Comparison was made with conventional nuclear medicine imaging modalities and magnetic resonance imaging (MRI). Sixteen patients with suspected spondylitis (nine male, seven female, mean age 59 years) prospectively underwent FDG hybrid PET (296 MBq) and MRI. For intra-individual comparison, the patients were also imaged with technetium-99m methylene diphosphonate (MDP) (555 MBq) (n=13) and/or gallium-67 citrate (185 MBq) (n=11). For FDG hybrid PET, two or three transverse scans were performed. Ratios of infected (target) to non-infected (background) (T/B) vertebral bodies were calculated. MR images were obtained of the region of interest. Patients found positive for spondylitis with MRI and/or FDG hybrid PET underwent surgical intervention and histological grading of the individual infected foci. Twelve out of 16 patients were found to be positive for spondylitis. Independent of the grade of infection and the location in the spine, all known infected vertebrae (n=23, 9 thoracic, 12 lumbar, 2 sacral) were detected by FDG hybrid PET. T/B ratios higher than 1.45{+-}0.05 (at 1 h p.i.) were indicative of infectious disease, whereas ratios below this value were found in cases of degenerative change. FDG hybrid PET was superior to MRI in patients who had a history of surgery and suffered from a high-grade infection in combination with paravertebral abscess formation (n=2; further computed tomography was needed) and in those with low-grade spondylitis (n=2, no oedema) or discitis (n=2, mild oedema). False-positive {sup 67}Ga citrate images (n=5: 2 spondylodiscitis, 1 aortitis, 1 pleuritis, 1 pulmonary tuberculosis) and {sup 99m}Tc-MDP SPET (n=4: 1 osteoporosis, 2 spondylodiscitis, 1 fracture) were equally well detected by FDG hybrid PET and MRI. No

  1. Sobre a nefrosclerose maligna

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    Hilde Adler


    Full Text Available 1º - Das aus den oeffentlichen Krankenhäusern von Rio de Janeiro stammende Sektionsmaterial umfasst einen beträchtlichen Prozentzatz von Individuen schwarzer und gemischter Rasse. Es besteht durchweg aus Angehörigen der sozial und oekonomisch niedersten Bevölkerungsschichten der Stadt und ihrer Vororte, die gemessen am Standard der Gesamtbevölkerung unter den dürftigsten hygienischen Bedingungen leben. So fanden sich unter 212 Autopsien aus dem Anfall der Pathologisch-Anatomischen Abteilung des Institutes Oswaldo Cruz im Jahr 1920 bei 111 Fällen schwarze oder Mischlinsfarbe protokolliert, (52,3%. Unter 349 Sektionen der gleichen Abteilung im Jahr 1938 waren 184 (= 52,7% von Individuen von schwarzer oder gemischter Rasse. Ein derartiges Material bietet guenstige Bedingungen fuer die Untersuchung der Bedeutung der Rassenzugehoerigkeit als aetiologischem und pathogenem Faktor fuer bestimmte Affektionen, bei welchen sie in der Literatu in diesem Sinn angeführt worden ist. 2º - Unter 1080 Sektionen von Indiduen männlichen Geschlechts jeder Altersstufe aus dem Material der gleichen Abteilung der Jahre 1918-1926 fanden sich bei 214 Faellen syphilitische Befunde protokolliert. (19,8% der Faelle. 129 (12% wiesen eine Aortitis oder Arteritis syphilitica auf. 3º - Das histologische Material einer Serie von 528 Autopsien von Individuen im Alter unter 40 Jahren wurde auf das Vorkommen der fuer Nephrosclerose maligna (FAHR typisch erachteten pathologischen Veraenderungen untersucht. Es wurden 4 Faelle festgestellt, die das Bild dieser Nephropathie zeigten. Unter den 528 Individuen dieser Gruppe waren 244 Weisse, (46,2% 274 Schwarze oder Mischlinge (51,8% Bei 10 war die Rassenzugehoerigkeit nicht ersichtlich. 4º - Unter Heranziehung von 6 weiteren Faellen aus anderen Serien von Sektionen der letzten 4 Jahre beläuft sich die Gesamtzahl der mikroskopisch festegestellen Faelle von Nephrosclerose maligna unter dem Material der Pathologisch

  2. Elastólise pós-inflamatória e cutis laxa (doença de James Marshall: estudo de casos Post-inflammatory elastolysis and cutis laxa (James Marshall disease: case study

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    Claudemir Roberto Aguilar


    onset of the disease is usually up to the age of four years (93%, and it is more common in African Americans (8:1, females (4:1 and in tropical climate (9:1. Other features include alpha-1-antitrypsin deficiency (7%, aortitis (7%, related skin conditions (62%, premature facial ageing (97% and stable atrophic phase during childhood after months or years with inflammatory lesions (97%. Biopsies of recent lesions showed a more intense inflammatory infiltrate and less elastolysis than those obtained from older lesions. Reconstructive surgery yielded good results during atrophic phase and 0.05% topical tretinoin was ineffective. CONCLUSIONS: In 62% of patients the acute phase of post-inflammatory elastolysis and cutis laxa is associated with different elastolysis-promoting inflammatoy dermatoses. The correct management of these conditions may reduce severity of atrophic lesions, which can also be treated by reconstructive surgery. Alpha-1-antitrypsin deficiency should be investigated.

  3. Smoking and severity of coronary stenosis%吸烟与冠状动脉的狭窄程度

    Institute of Scientific and Technical Information of China (English)

    盛晓东; 贾恩志; 杨志健; 袁彪; 朱铁兵; 王连生; 陈波; 曹克将; 马文珠


    吸烟量和Gensini's评分、人体测量、白细胞计数的Spearman相关分析结果.结果:①吸烟组患者外周血中白细胞总数、中性粒细胞计数、单核细胞计数水平与Gensini's评分明显高于非吸烟组患者(P<0.05~0.01).②Spearman相关分析结果显示吸烟组患者的吸烟总数、外周血中白细胞总数、中性粒细胞计数、单核细胞计数水平与Gensini's评分显著相关(r=0.109,0.100,0.135,0.139,P<0.05~0.01).结论:吸烟与冠状动脉粥样硬化程度显著相关,并且炎症反应可能是这种相关关系的机制之一.%BACKGROUND: Smoking is an important cause of cardiovascular disease, its definite mechanism in inducing cardiovascular disease is still unclear, and whether there is linear correlation between the amount of cigarette smoking and cardiovascular risk still needs to be investigated.OBJECTIVE: To analyze the association between cigarette smoking and the severity of coronary atherosclerosis.DESIGN: A retrospective investigation and comparative study.SETTING: The First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 500 consecutive patients, who underwent coronary angiography for suspected or known coronary atherosclerosis, were selected from the First Affiliated Hospital of Nanjing Medical University from April 2004 to April 2005. The inclusive criteria included patients with history of chest pain and/or ischemic changes of electrocardiography (ECG), and those with suspected or known coronary artery disease by coronary angiography. Patients with spastic angina pectoris (acetylcholine-positive) were excluded. Patients with infectious processes within 2 weeks before catheterization, heart failure (Killip Class≥ 2 after acute myocardial infarction), hepatic dysfunction, vascular disease (aortitis should be treated with prednisolone), familial hypercholesterolemia, thyroid dysfunction, or adrenal dysfunction were also excluded. There were 370 males aged 42