Full Text Available A 12-year-old boy with coarctation of aorta developed infective endarteritis and mycotic aneurysm at the site distal to coarctation. The computed tomography angiogram was very helpful in the diagnosis. Medical management and early surgical intervention was curative. Infective endarteritis in coarctation may be underdiagnosed.
Calegaro, J.U.M.; Turini, T.L.
This case shows endarteritis of left pulmonary artery in the angiographic study with absent perfusion of the left lung in the MAA 131 I scintigraphy. Considerations are made conderning the presumable diagnosis of infection by 'toxocara canis' larval form. The literature review don't point out a similar case. (author) [pt
Davydova, L.I.; Zajtsev, V.T.; Kononenko, E.I.; Gorbenko, L.V.; Karpovich, I.P.; Troyan, V.I.; Skripko, V.A.; Belousova, L.G.; Pavlova, T.S.
Effective renal blood flow (general and separate) as well as the secretory-evacuatory function of the canalicular system of kidneys in 39 patients with obliterating endarteritis and in 20 persons of a control group have been studied by means of hippuran 131 I. Considerable decrease in the effective renal blood flow has been revealed. The decrease in blood flow with the increase in the ischemia degree turned out to be insignificant. The total function of kidneys is reduced in the 2-5 stages of diseases. Indices of secretory - evacuatory function of canals were changed. Indices of the total function of kidneys and intrarenal hemodynamics are the most informative when studying the state of this organ
Full Text Available The interaction between blood-borne pathogens and fibrinolysis is one of the most important mechanisms that mediate invasion and the establishment of infectious agents in their hosts. However, overproduction of plasmin (final product of the route has been related in other contexts to proliferation and migration of the arterial wall cells and degradation of the extracellular matrix. We have recently identified fibrinolysis-activating antigens from Dirofilaria immitis, a blood-borne parasite whose key pathological event (proliferative endarteritis is produced by similar mechanisms to those indicated above. The objective of this work is to study how two of this antigens [actin (ACT and fructose-bisphosphate aldolase (FBAL] highly conserved in pathogens, activate fibrinolysis and to establish a relationship between this activation and the development of proliferative endarteritis during cardiopulmonary dirofilariasis. We demonstrate that both proteins bind plasminogen, enhance plasmin generation, stimulate the expression of the fibrinolytic activators tPA and uPA in endothelial cell cultures and are located on the surface of the worm in contact with the host's blood. ELISA, western blot and immunofluorescence techniques were employed for this purpose. Additionally, the implication of lysine residues in this interaction was analyzed by bioinformatics. The involvement of plasmin generated by the ACT/FBAL and plasminogen binding in cell proliferation and migration, and degradation of the extracellular matrix were shown in an "in vitro" model of endothelial and smooth muscle cells in culture. The obtained results indicate that ACT and FBAL from D. immitis activate fibrinolysis, which could be used by the parasite like a survival mechanism to avoid the clot formation. However, long-term overproduction of plasmin can trigger pathological events similar to those described in the emergence of proliferative endarteritis. Due to the high degree of
Full Text Available Abstract Background Ustekinumab (Stelara®, a human monoclonal antibody targeting the p40-subunit of interleukin (IL-12 and IL-23, is indicated for moderate to severe plaque psoriasis and psoriatic arthritis. In large multicenter, prospective trials assessing efficacy and safety of ustekinumab increased rates of severe infections have not been observed so far. Case presentation Here, we report the case of a 64-year old woman presenting with chills, pain and swelling of her right foot with dark maculae at the sole, and elevated inflammatory markers. She had received a third dose of ustekinumab due to psoriatic arthritis three days before admission. Blood cultures revealed growth of Staphylococcus aureus and imaging showed a thickening of the aortic wall ventral the bifurcation above the right internal iliac artery, resembling an acute bacterial endarteritis. Without the evidence of aneurysms and in absence of foreign bodies, the decision for conservative management was made. The patient received four weeks of antibiotic therapy with intravenous flucloxacillin, followed by an oral regime with levofloxacin and rifampicin for an additional four weeks. Inflammatory markers resolved promptly and the patient was discharged in good health. Conclusion To our knowledge, this is the first report of a severe S. aureus infection in a patient receiving ustekinumab. Albeit ustekinumab is generally regarded as a safe drug, severe bacterial infections should always be included in the differential diagnosis of elevated inflammatory markers in patients receiving biologicals as these might present with nonspecific symptoms and fever might be absent. Any effort to detect deep-seated or metastatic infections should be made to prevent complications and to secure appropriate treatment. Although other risk factors for an invasive staphylococcal infection like psoriasis, recent corticosteroid injection, or prior hospitalisations were present, and therefore a directive
González-Miguel, Javier; Morchón, Rodrigo; Carretón, Elena; Montoya-Alonso, José Alberto; Simón, Fernando
Proliferative endarteritis is one of the key pathological mechanisms of cardiopulmonary dirofilariosis, a cosmopolitan parasitosis caused by Dirofilaria immitis affecting dogs and cats around the world. It has been shown that the excretory/secretory antigens from D. immitis adult worms (DiES) bind plasminogen (PLG) and activate fibrinolysis, which can lead to a survival mechanism for the parasite in its intravascular environment. However, overproduction of plasmin (final product of the route) has been related to pathological processes similar to those described in proliferative endarteritis. The aim of this study is to relate the appearance of this pathological condition with the activation of the PLG/plasmin system of the host by DiES. Cell proliferation through the crystal violet technique, cell migration by wound healing assay and degradation of the extracellular matrix by measuring collagen degradation and levels of matrix metalloproteinases were studied in an "in vitro" model using canine vascular endothelial and smooth muscle cells. These cells were treated with a mixture of DiES + PLG. Untreated cells, cells only stimulated with DiES or with PLG, or with a mixture of DiES + PLG + εACA (an inhibitor of the PLG-plasmin conversion) were employed as controls. In addition, the effect of DiES on the expression of the fibrinolytic activators tPA and uPA, the inhibitor PAI-1 and the PLG receptor Annexin A2 was analyzed in both types of cultures by western blot. Plasmin generated by DiES + PLG binding produced a significant increase in the cell proliferation and migration of the endothelial and smooth muscle cells, as well as an increase in the destruction of the extracellular matrix based on a further degradation of Type I Collagen and an increased level of matrix metalloproteinase-2. DiES also induce an increase in the expression of tPA and uPA in endothelial cells in culture, as well as a decrease in the expression of PAI-1 in both types of cells
Abou-Haila, A; Hadjiisky, P; Roland, J; Orcel, L
The parietal reaction after placing a cuff of polyethylene around the femoral artery has been studied in 18 (2,5 - 3 months old) male rabbits by using histologic, histochemical (4 macromolecular substances) and histoenzymatic techniques (16 enzymatic activities). Studies were performed on the 1st, 3rd, 5th, 15th and 21st day, and every 15 days during the 3 months of the experiment. This process induced rapidly in each animal a parietal reaction with adventitial oedema (1st day), hypoxia of the media (1st -5th day), cytoenzymatic activation followed by a cellular transformation and proliferation of the intima-media, that forms a diffuse intimal thickening (adaptation). Most cells of the thickening were, by their enzymatic activities, quite comparable to immature smooth muscle cells, which probably emigrated from the media: intense LDH, NADH2 - TR; moderate G6P-DH, SDH, NADPH2 - TR, alpha-GP-DH, ATP/ase; weak ICHD, beta-HB-DH. Moreover, some reactions (accentuation of beta-Glu/ase, UDGP-DH, Glu-DH, 5'N/ase) besides suggested the active participation of the cells in the production of extracellular conjonctive constituents, because the histochemical studies revealed the presence of metachromatic glycosamino-glycanes and positive APS substances during the edification of the diffuse intimal thickening. In advanced thickening, an histoenzymatic duality was observed, that might prove the double origin of the thickening cells: some superficial cells had the enzymatic characteristics of endothelial cells (increased activity of aerobic oxydoreductases). At every stage of the study, the thickening cells differed from the atherocytes by a lack of lipids in their cytoplasm.
Marquez, Juan R; Martinez, Carlos E; Escobar, Jaime; Hormaza, Jose A; Sanchez, William
The Gangrene of Fournier (GF) it is one of the last stages and the most serious in the call perineal sepsis; it is defined like a synergic fascitis necrotizant of the genital area that produces thrombosis of the subcutaneous microvasculature for an endarteritis obliterative, secondary to a bacterial dissemination that produce the necrosis and it gangrenes of the underlying tissue. The paper includes etiology and image studies among other topics
Khattar, Nikhil; Guleria, Sandeep; Sharma, Sanjeev
Nonspecific aortoarteritis or Takayasu's disease (TD) is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu's arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.
Full Text Available Nonspecific aortoarteritis or Takayasu′s disease (TD is a chronic pan endarteritis of unknown origin involving the aorta and its major branches affecting young adults especially women. The disease is more common in eastern Asian countries. Hypertension in these patients generally reflects as renal artery stenosis, which is seen in 28-75% of patients. Surgical revascularization is occasionally needed in patients with failed medical management or endovascular interventions. We report two cases of Takayasu′s arteritis in young women where renal revascularization was done using free internal iliac artery hepatorenal bypass graft with excellent control of hypertension in the postoperative period.
Andersen, Ulla Vestergaard; Howe, Daniel K.; Dangoudoubiyam, Sriveny
Strongyle parasites are ubiquitous in grazing horses. Strongylus vulgaris, the most pathogenic of the large strongyles, is known for its extensive migration in the mesenteric arterial system. The lifecycle of S. vulgaris is characterised by a long prepatent period where the migrating larvae...... are virtually undetectable as there currently is no test available for diagnosing prepatent S. vulgaris infection. Presence of S. vulgaris larvae in the arterial system causes endarteritis and thrombosis with a risk of non-strangulating intestinal infarctions. Emergence of anthelmintic resistance among...... cyathostomins has led to recommendations of reduced treatment intensity by targeting horses that exceed a predetermined strongyle faecal egg count threshold. One study suggests an apparent increase in prevalence of S. vulgaris on farms where reduced anthelmintic treatment intensity has been implemented...
Prasad Krishnamurthy Narasimha
Full Text Available Takayasu′s arteritis (TA is rare, chronic progressive, pan-endarteritis involving the aorta and its main branches, with a specific predilection for young Asian women. Anaesthesia for TA patients is complicated by their severe uncontrolled hypertension, extreme arterial blood pressure differentials, aortic regurgitation (AR, end-organ dysfunction, stenosis/aneurysms of major blood vessels and difficulties encountered in monitoring arterial blood pressure. We present the usefulness of ultrasound during anaesthetic management of a 35-year-old woman posted for emergency caesarean section due to intra-uterine growth retardation, foetal tachycardia in active labour, who was already diagnosed to have TA along with moderate AR and uncontrolled hypertension, using epidural technique. The use of intra-operative doppler helped resolve the initial dilemma about the diagnosis and treatment of the differential blood pressure between the affected and the normal upper limb in the absence of prior arteriogram.
Gill, J K; Rohatgi, V K; Lahiri, B; Aggarwal, B M [S.N. Medical Coll., Agra (India)
Rectal biopsy was done in 39 follow-up cases of squamous cell carcinoma of cervix treated with radiotherapy who clinically presented as cases of radiation proctitis. On histological examination, definite evidence of radiation injury was found in 23 cases. In rectal mucosa, radiation ulcers, broken epithelial lining, glandular atrophy, inflammatory cell infiltration, and edema of stroma were seen. Muscularis mucosa was either intact or partially broken. In submucosa, blood vessels showed endarteritis, plasma cell infiltration, fibrinoid necrosis, and hyalinization of vessel wall. In a few cases, hyalinization, edema, and vacuolation of muscle fibres were seen in muscle layer. In one case, squamous cell carcinoma of rectum was diagnosed. During follow-up examinations no complication due to rectal biopsy was observed.
It is essential that emergency physicians understand ways to manage patients contaminated by radioactive materials and/or exposed to external radiation sources. Contamination accidents require careful surveys to identify the metabolic pathway of the radionuclides to guide prognosis and treatment. The level of treatment required will depend on careful surveys and meticulous decontamination. There is no specific therapy for the acute radiation syndrome. Prophylactic antibodies are desirable. For severely exposed patients treatment is similar to the supportive care given to patients undergoing organ transplantation. For high-dose extremity injury, no methods have been developed to reverse the fibrosing endarteritis that eventually leads to tissue death so frequently found with this type of injury. Although the Three Mile Island episode of March 1979 created tremendous public concern, there were no radiation injuries. The contamination outside the reactor building and the release of radioiodine were negligible. The accidental fuel element meltdown at Chernobyl, USSR, resulted in many cases of acute radiation syndrome. More than 100,000 people were exposed to high levels of radioactive fallout. The general principles outlined here are applicable to accidents of that degree of severity
Yazdani Abyaneh, Mohammad-Ali; Raghu, Preethi; Kircher, Kenneth; Kutzner, Heinz; Kortz, Alison; Carlson, John Andrew
Vasculitis associated with sarcoid granulomas is an uncommon phenomenon. A 72-year-old female presented with an expanding region of circumscribed alopecia and scalp atrophy of 2 months duration. Biopsy showed non-caseating granulomas, dermal thinning, loss of follicles, fibrosis and muscular vessels disrupted by mixed lymphocyte, macrophage and giant-cell infiltrates. Affected vessels had loss and fragmentation of the elastic lamina, fibrous replacement of their walls and luminal stenosis (endarteritis obliterans). Dermal and vascular advential intralymphatic granulomas and lymphangiectases were found by D2-40 expression, suggesting lymphatic obstruction and poor antigen clearance. No evidence of a post-zoster eruption, systemic sarcoidosis or systemic giant-cell arteritis was found. Two years later, prednisone had halted - but not reversed - progression of her alopecia. Review of the literature showed two types of vasculitis associated with sarcoid granulomas: (i) acute, self-limited leukocytoclastic vasculitis and (ii) chronic granulomatous vasculitis (GV). Persistence of non-degradable material or antigen contributes to the pathogenesis of granulomatous inflammation. In this case, lymphatic obstruction probably impeded clearance of nonimmunologic and/or immunologic stimuli permitting and sustaining the development of sarcoid granulomas and sarcoid GV, ultimately causing scarring alopecia and cutaneous atrophy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Nielsen, M K; Vidyashankar, A N; Gravatte, H S; Bellaw, J; Lyons, E T; Andersen, U V
Strongylus vulgaris is regarded as the most pathogenic helminth parasite infecting horses. Migrating larvae cause pronounced endarteritis and thrombosis in the cranial mesenteric artery and adjacent branches, and thromboembolism can lead to ischemia and infarction of large intestinal segments. A recently developed serum ELISA allows detection of S. vulgaris-specific antibodies during the six-month-long prepatent period. A population of horses has been maintained at the University of Kentucky without anthelmintic intervention since 1979, and S. vulgaris has been documented to be highly prevalent. In 2012, 12 foals were born in this population, and were studied during a 12-month period (March-March). Weekly serum samples were collected to monitor S. vulgaris specific antibodies with the ELISA. Nine colts underwent necropsy at different time points between 90 and 300 days of age. At necropsy, Strongylus spp. and Parascaris equorum were identified to species and stage and enumerated. Initial statistical findings indicate a significant interaction between foal age and ELISA results (pvulgaris-directed maternal antibodies transferred in the colostrum, but then remained ELISA negative during their first three months of life. Foals born in February and March became ELISA positive at about 12 weeks of age, while those born in April and May went positive at about 15 and 21 weeks, respectively. Foal date of birth was significantly associated with ELISA results (pvulgaris burdens (pvulgaris, S. edentatus, and P. equorum burdens (pvulgaris larvae leaving the bloodstream and migrating back to the intestine. Copyright © 2013 Elsevier B.V. All rights reserved.
Nielsen, Martin K; Vidyashankar, Anand N; Bellaw, Jennifer; Gravatte, Holli S; Cao, Xin; Rubinson, Emily F; Reinemeyer, Craig R
Strongylus vulgaris is the most pathogenic helminth parasite of horses, causing verminous endarteritis with thromboembolism and infarction. A serum enzyme-linked immunosorbent assay (ELISA) has been validated for detection of antibodies to an antigen produced by migrating larvae of this parasite. The aim was to evaluate ELISA responses to anthelmintic treatment in cohorts of naturally infected horses. Fifteen healthy horses harboring patent S. vulgaris infections were turned out for communal grazing in May 2013 (day 0). On day 55, horses were ranked according to ELISA titers and randomly allocated to the following three groups: no treatment followed by placebo pellets daily; ivermectin on day 60 followed by placebo pellets daily; or ivermectin on day 60 followed by daily pyrantel tartrate. Fecal and serum samples were collected at ∼28-day intervals until study termination on day 231. Increased ELISA values were observed for the first 53 days following ivermectin treatment. Titers were significantly reduced 80 days after ivermectin treatment. Horses receiving daily pyrantel tartrate maintained lower ELISA values from 137 days post ivermectin treatment until trial termination. These results illustrate that a positive ELISA result is indicative of either current or prior exposure to larval S. vulgaris infection within the previous 5 months.
Khourdaji, Iyad; Parke, Jacob; Burks, Frank
Radiation therapy (RT), external beam radiation therapy (EBRT), brachytherapy (BT), photon beam therapy (PBT), high intensity focused ultrasound (HIFU), and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU), urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures. PMID:26494994
Full Text Available Radiation therapy (RT, external beam radiation therapy (EBRT, brachytherapy (BT, photon beam therapy (PBT, high intensity focused ultrasound (HIFU, and cryotherapy are noninvasive treatment options for pelvic malignancies and prostate cancer. Though effective in treating cancer, urethral stricture disease is an underrecognized and poorly reported sequela of these treatment modalities. Studies estimate the incidence of stricture from BT to be 1.8%, EBRT 1.7%, combined EBRT and BT 5.2%, and cryotherapy 2.5%. Radiation effects on the genitourinary system can manifest early or months to years after treatment with the onus being on the clinician to investigate and rule-out stricture disease as an underlying etiology for lower urinary tract symptoms. Obliterative endarteritis resulting in ischemia and fibrosis of the irradiated tissue complicates treatment strategies, which include urethral dilation, direct-vision internal urethrotomy (DVIU, urethral stents, and urethroplasty. Failure rates for dilation and DVIU are exceedingly high with several studies indicating that urethroplasty is the most definitive and durable treatment modality for patients with radiation-induced stricture disease. However, a detailed discussion should be offered regarding development or worsening of incontinence after treatment with urethroplasty. Further studies are required to assess the nature and treatment of cryotherapy and HIFU-induced strictures.
Shirouzu, Kazuo; Isomoto, Hiroharu; Morodomi, Tatsuhisa; Ogata, Yutaka; Araki, Yasumi; Kakegawa, Teruo
A case of radiation-induced rectal cancer is presented. In November, 1971, a 58-year-old woman had a stage II squamous cell carcinoma in the uterine cervix. She underwent a hysterectomy and postoperative radiotherapy. External pelvic irradiation of 10 MV x-ray was carried out in 15 fractions of 2 Gy daily, with a total dose of 30 Gy, and intracavitary radium insertion with a total dose of 960 mg hours (20 mg x 48 hour). She had been followed-up in our department since 1972, when rectal bleeding occurred. Proctoscopy and periodical biopsies were performed when the patient visited our hospital. There was no evidence of malignant tumor cells nor of recurrent cervical cancer from 1973 to 1989. In August, 1990, a biopsy specimen taken from a rectal ulcer revealed a malignant mucinous adenocarcinoma. The time interval between the radiotherapy and the development of the rectal cancer was 19 years. Microscopically, the main lesion was situated in the granulation tissue covered with the regenerating mucosal epithelium, and histologically was found to be a mucinous adenocarcinoma. Other radiation damage was additionally found including colitis, endarteritis and intestinal wall fibrosis. The evidence strongly suggested the present case to be one of radiation-induced rectal cancer. (author)
Cross, M.J.; Frazee, R.C. (Department of General Surgery, Scott and White Memorial Hospital, Temple TX (United States))
Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.
Cross, M.J.; Frazee, R.C.
Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting
In the Soviet Union magnetic fields were first applied successfully for medical purposes in the treatment of various diseases in the forties. Clinical-experimental research has established that a constant magnetic field and a low-frequency alternating magnetic field posses analgesic, antiedematous and antifebril action, decrease dystrophic processes, and increase blood circulation. An alternating magnetic field at a frequency of 50 cycles per second has a rhythm close to that of muscle nerve currents in the normal bodily state. Thus, in applying a 50-cycle magnetic field to organs and tissues as a specific stimulus we normalize the frequency of the current. By normalizing the electrical state of the tissues it is possible to normalize the general state of the organism as well. It is assumed that the magnetic field, like a tape-recorder heat, erases the pathological recording which has distorted or replaced the normal information characteristic of the cells. The range of magnetotherapy's therapeutic action is very broad: it includes cardiovascular diseases, hypertension, skin diseases, obliterating endarteritis, disturbances of peripheral blood circulation, diseases of the digestive organs, diseases of the musculoskeletal apparatus, osteochondrosis, radiculitis, and many others.
Sharma, Mohit; Radhakrishnan, Raghu
Limited mouth opening (LMO) in oral submucous fibrosis (OSF) has been attributed to both the submucosal and muscle fibrosis (MF). While reflectory trismus was proposed before as an auxiliary mechanism by another group, the stretch-mediated muscle damage (MSD), histopathological changes in blood vessels (such as endothelial dysfunction, endothelial hypertrophy, and endarteritis obliterans), and upregulated anaerobic isoforms of lactate dehydrogenase (LDH) have been proposed by us as complementary events leading to MF. Additionally, the amount of hypoxia-mediated upregulation of anaerobic isoforms of LDH determines the extent of MF. Radiotherapy (RT)-mediated release of reactive oxygen species causes vascular damage thereby worsening hypoxia. While the alteration in LDH levels secondary to hypoxia enhances fibrosis, RT worsens it. Oral squamous cell carcinoma occurring in the background of OSF is an absolute contraindication for RT as it augurs unfavorable prognosis. An algorithm to demonstrate this with evidence is clearly depicted. The role of HIF-1α in the progression of OSF and its malignant transformation, and the consideration of hyperbaric oxygen therapy as a therapeutic remedy in OSF are underscored. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Bories-Azeau, A.; Dayan, L.
The irradiation of the pelvic abdominal cancers extends beyond the centre of the tumour and may induce actinic digestive lesions. The bowel and more rarely the small bowel -which is the subject-matter of our study- are concerned by those radiolesions that are favoured by therapeutic overdose, post-operative adhesions fastening the bows, radio-surgical or chemicostatic associations, and lastly by vascular or nutritive deficiencies. One may distinguish between two kinds of lesions, depending on the lapse of time before their coming out and on the symptoms. The early or acute types are characterized by a radio-mucitis and give an exsudative enteropathy with anorexia, vomiting, diarrhoea and loss of weight, of which the diagnosis is easy because it occurs during the irradiation and lessens at the end of the treatment. The late radiolesions of the small bowel are characterized by sclerosis and chronic endarteritis and, after a longlasting period of latency, give varied symptoms: disordered intestinal transit which sometimes is irreversible, perforation, fistula, syndrome of malabsorption, giving often rise to be mistaken for a recurrence of the cancer. The treatment varies whether the lesion is segmental or diffuse. In the first case, the failure of the medical means accounts for the surgical cutting away or the internal derivation; in the second case, the digestive mutilation which would result from an enlargement of the lesion commands to be more cautious and to call for the methods of parenteral feeding and digestive setting to rest [fr
Full Text Available Introduction. Damage of testicles is frequent in lepromatous leprosy worsen by the presence of erythema nodosum leprosum.
Objective. One patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with important testicular compromise.
Material and methods. A 28 year old man patient who had lepromatous leprosy since his 22 was studied. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles and did not respond to the conventional treatment. A left orchidectomy was practiced to treat the persistent pain.
Results. The extracted testis evidenced the following findings: tubular atrophy, remarkable fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient revealed azoospermy, normal total testosterone, discretely diminished free testosterone and elevated luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity. We reviewed general concepts about erythema nodosum leprosum and the pathologic changes produced by leprosy in the testis.
Conclusion. Lepromatous leprosy may lead to hypogonadism. This should be considered by the leprosy programs in order to avoid and treat the consequences of the possible hypogonadism.
Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nodoso leproso.
Objetivo. Presentar un paciente con lepra lepromatosa y eritema nodoso leproso con severo compromiso testicular.
Materiales y métodos. Estudiamos un hombre de 28 años con lepra lepromatosa desde los 22, que durante el tratamiento con poliquimioterapia para la lepra presentó eritema nodoso
In curative therapy of oral cavity and oropharyngeal carcinomas the osteoradionecrosis has to be accepted as a calculated risk with an incidence of 4-35%. It is the question of a radiation-induced bone death that comes about by progressive and irreversible morphological alterations at bones and at vessels: Loss of osteocytes, active osteoblasts and osteoclasts (hypocellularity), injury of normal bone metabolism, slackening of regeneration processes, extreme susceptibility to infections of the devitalized bone, radiation-induced obliterating endarteritis with hyalinization thrombosis and fibrosing of vessels, obliteration of the lumen and gradual reduction of blood supply at the level of tissue (hypovascularity and hypoxemia: Aseptic osteoradionecrosis, radio-osteonecrosis). If there is a secondary infection of dental, parodontal or traumatic origin additionally, the condition explodes as septic osteoradionecrosis with the symptoms and findings of radioosteomyelitis. The osteoradionecrosis begins more frequently in the mandibula than in the maxilla. The cumulative incidence is 30% after 6, 60% after 12, and more than 80% after 24 months. The duration of osteoradionecrosis follows an exponential curve with constant probability of necrosis termination at any moment after necrosis event in which the monthly probability of necrosis healing is nearly 0.06. Risk factors for formation of an osteoradionecrosis are tumor neighbourhood to bones and teeth, tumor and mandibula dosis, tumor stage, irradiation technique, status of teeth as well as moment and carrying out of tooth extractions. Tumors in neighbourhood of mandibula have a fivefold higher risk, with 80 Gy irradiated patients a 2.9-fold and toothed patients a 2.6-fold, altogether high-risk patients have a 17.7-fold higher necrosis risk than low-risk patients. Promoting factors are caries, parodontosis, a periapical pathology, a trauma, irritation by artificial teeth, elective tooth extraction before irradiation, tooth
Barrett, Mary M; Sangüeza, Martin; Werner, Betina; Kutzner, Heinz; Carlson, John A
Epstein-Barr virus (EBV) infection can rarely present as painful genital ulcers, mostly in young female adolescents. Typically diagnosed by clinical findings, EBV vulvar ulceration (EBVVU) is rarely biopsied. Herein, the authors report the histopathology in 8 biopsies from 7 EBVVU patients, all serologically confirmed for acute (4/7) or reactivated-chronic (3/7) EBV infection. The 7 women all presented with 1 or more painful, punched-out vulvar ulcers. Only patients with acute EBV infection showed other clinical findings: fever and/or atypical lymphocytosis affected 75% (3/4); lymphadenopathy in 50%; and malaise/fatigue, dysuria and/or hepatomegaly in 25%. All reactivated-chronic EBVVU had a solitary ulcer, and 2 had history of a similar episode of vulvar ulceration (aphthosis). Histopathologically, lymphocytic arteritis was identified in 88% (7/8); a submucosal scar was found in the eighth specimen. Other histopathologies included venulitis (62%), endarteritis obliterans (38%), thrombosis (25%), neutrophilic sebaceous adenitis (25%), and mucosal lymphoid hyperplasia (12%). Dense angiocentric CD3 CD4 T-cell lymphocyte-predominant infiltrates were found, regionally or diffusely. In 2 specimens, neutrophils compromised half of the infiltrate. Minor components of CD8, CD20, and CD30 lymphocytes, CD123 plasmacytoid monocytes, CD68 macrophages, and plasma cells were present. Small-vessel endothelium and smooth muscle adjacent to the ulcers faintly expressed cytoplasmic EBV latent membrane protein-1 (LMP1). In situ hybridization for early EBV mRNA (EBER) identified rare solitary or scattered clustered positive lymphocytes in 38%. Polymerase chain reaction for EBV DNA was positive in one EBER positive biopsy. EBV infection has been documented in muscular vessel vasculitis. Based on the aforementioned, EBVVU appears to be the consequence of localized lymphocytic arteritis.
Luiz Carlos Simões
Full Text Available OBJECTIVE - To report the results of percutaneous occlusion of persistent ductus arteriosus with the Amplatzer prosthesis in 2 Brazilian cardiological centers. METHODS - From May 1998 to July 2000, 33 patients with clinical and laboratory diagnosis of persistent ductus arteriosus underwent attempts at percutaneous implantation of the Amplatzer prosthesis. The median age was 36 months (from 6 months to 38 years, and the median weight was 14kg (from 6 to 92kg. Sixteen patients (48.5% were under 2 years of age at the time of the procedure. All patients were followed up with periodical clinical and echocardiographic evaluations to assess the presence and degree of residual shunt and possible complications, such as pseudocoarctation of the aorta and left pulmonary artery stenosis. RESULTS - The minimum diameter of the arterial ducts ranged from 2.5 to 7.0mm (mean of 4.0±1.0, median of 3.9. The rate of success for implantation of the prosthesis was 100%. Femoral pulse was lost in 1 patient. The echocardiogram revealed total closure prior to hospital discharge in 30 patients, and in the follow-up visit 3 months later in the 3 remaining patients. The mean follow-up duration was 6.4±3.4 months. All patients were clinically well, asymptomatic, and did not need medication. No patient had narrowing of the left pulmonary artery or of the aorta. No early or late embolic events occurred, nor did infectious endarteritis. A new hospital admission was not required for any patient. CONCLUSION - The Amplatzer prosthesis for persistent ductus arteriosus is safe and highly effective for occlusion of ductus arteriosus of varied diameters, including large ones in small symptomatic infants.
Khourdaji, Iyad; Burks, Frank; Killinger, Kim A.
Fournier’s gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier’s gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers. The nidus for the synergistic polymicrobial infection is usually located in the genitourinary tract, lower gastointestinal tract or skin. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The Laboratory Risk Indicator for Necrotizing Fasciitis score can be used to stratify patients into low, moderate or high risk and the Fournier’s Gangrene Severity Index (FGSI) can also be used to determine the severity and prognosis of Fournier’s gangrene. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for satisfactory functional and cosmetic results. PMID:26445600
Andersen, Ulla V; Howe, Daniel K; Dangoudoubiyam, Sriveny; Toft, Nils; Reinemeyer, Craig R; Lyons, Eugene T; Olsen, Susanne N; Monrad, Jesper; Nejsum, Peter; Nielsen, Martin K
Strongyle parasites are ubiquitous in grazing horses. Strongylus vulgaris, the most pathogenic of the large strongyles, is known for its extensive migration in the mesenteric arterial system. The lifecycle of S. vulgaris is characterised by a long prepatent period where the migrating larvae are virtually undetectable as there currently is no test available for diagnosing prepatent S. vulgaris infection. Presence of S. vulgaris larvae in the arterial system causes endarteritis and thrombosis with a risk of non-strangulating intestinal infarctions. Emergence of anthelmintic resistance among cyathostomins has led to recommendations of reduced treatment intensity by targeting horses that exceed a predetermined strongyle faecal egg count threshold. One study suggests an apparent increase in prevalence of S. vulgaris on farms where reduced anthelmintic treatment intensity has been implemented. These issues highlight the need for an accurate and reliable assay for diagnosing prepatent S. vulgaris infection. Immunoscreening of a larval S. vulgaris cDNA library using hyperimmune serum raised against S. vulgaris excretory/secretory antigens was performed to identify potential diagnostic antigens. Immunoreactive clones were sequenced, one potential antigen was characterised, expressed as a recombinant protein, initially evaluated by western blot (WB) analysis, the diagnostic potential of the IgG subclasses was evaluated by ELISA, and the diagnostic accuracy evaluated using serum from 102 horses with known S. vulgaris infection status. The clone expressing the potential antigen encoded a S. vulgaris SXP/RAL2 homologue. The recombinant protein, rSvSXP, was shown to be a potential diagnostic antigen by WB analysis, and a target of serum IgGa, IgG(T) and total IgG in naturally infected horses, with IgG(T) antibodies being the most reliable indicator of S. vulgaris infection in horses. Evaluation of diagnostic accuracy of the ELISA resulted in a sensitivity of 73.3%, a specificity
Carbonell, C.; Ogbac, R.V.
Full text: Gastritis is simply defined as inflammation of the gastric mucosa. In post-RAI patients, this is one of the most common complications that are encountered. Some patients may even require repetitive administration of high doses of radioactive iodine (I-131). Small doses of radiation (up to 1500 R) cause reversible mucosal damage, whereas higher radiation doses cause irreversible damage with atrophy and ischemic-related ulceration. Reversible changes consist of degenerative changes in epithelial cells and nonspecific chronic inflammatory infiltrate in the lamina propria. Higher amounts of radiation cause permanent mucosal damage, with atrophy of fundic glands, mucosal erosions, and capillary hemorrhage. Associated submucosal endarteritis results in mucosal ischemia and secondary ulcer development. Recurrent gastritis, if left untreated, may be a predisposing factor for gastric malignancy. Methods:A total of thirty post-RAI subjects were evaluated for signs and symptoms of gastritis and were divided into 3 groups which were given drugs for gastritis (H2-receptor antagonist, proton pump inhibitor, and sucralfate). Survey forms were distributed to evaluate the presence of nausea, vomiting, epigastric pain (graded according to severity of pain), and gastrointestinal bleeding. Results were tallied accordingly. Results and Discussion: In a total of 3 subjects who were given sucralfate, all of them did not experience any nausea and vomiting. One subject experienced mild epigastric discomfort and another subject was able to experience a non-specific symptom of abdominal bloatedness. (Note: Subjects are still for completion) In theory, radiation irritates the mucosa causing inflammation and mucosal damage which is further irritated by gastric acid secretion. The administration of H2-receptor blockers and proton pump inhibitors only inhibit gastric acid secretion while existing inflammation of mucosa due to high doses of radiation is left untreated. However
Relação entre a Classificação Clínica de White e a Histopatologia das Placentas de Gestantes Diabéticas The Relationship between White's Classification and the Histopathological Changes in the Placentas of Diabetic Pregnant Women
Iracema de Mattos Paranhos Calderon
as alterações histopatológicas e a elevada proporção de recém-nascidos pré-termo nas diabéticas clínicas, classes D a FRH, sugerem amadurecimento placentário precoce nas diabéticas clínicas com vasculopatia.Purpose: to analyze the relationship between White's classification and the histopathological, changes occurring in the placentas of diabetic pregnant women, performing a qualitative comparison of histopathological changes in the placentas of nondiabetic pregnant women with those in diabetic ones (classes A and A/B, clinical, short duration (classes B and C, and clinical with vasculopathy (classes D to FRH, studying the influence of the quality of glycemic control and of gestational age on placental changes in the three groups of diabetic pregnant women. Patients and methods: specimens of placentas were collected from all diabetic pregnant women seen between 1991 and 1996 in the Maternity Section of the Hospital das Clínicas, Faculdade de Medicina de Botucatu, stained using the hematoxylin-eosin technique, and submitted to a histopathological examination. The quality of glycemic control was analyzed by the glycemia average of gestation and classified as adequate or inadequate, with a limit of 120 mg/dl. Gestational age was individualized as term and preterm. Results: forty-two newborns (43.3% were born at term and the remaining were preterm (56.7%. The prematurity rate was higher for women with clinical diabetes (classes B and C; D to FRH. Some histopathological alterations were observed only in placentas from diabetic pregnant women: cystoid degeneration, chorial edema, intima edema, dysmaturity, Hofbauer cell hyperplasia, villitis, ghost cells, two vessels in the umbilical cord, and endarteritis. Conclusions: histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A/B, clinical, short duration (classes B and C, and clinical with vasculopathy (classes D to FRH were similar to those in the nondiabetic ones
Horácio M. Canelas
parvinodular calcifications. The CFT for cysticercosis in the cerebrospinal fluid, performed in 271 patients, was positive in 240 (88.6 percent. The same test in the blood was positive in 70.2 percent of the cases. The correlation between these data was not significant. Intracranial mottling calcifications were found in only 19.2 percent of the cases. Therefore, in 240 cases the diagnosis was based on cerebrospinal fluid findings, confirmed by surgery and/or autopsy in 58 patients. In 13 cases, despite a normal cerebrospinal fluid, the diagnosis was made by a positive CFT for cysticercosis in the blood, associated to the finding of intracranial parvinodular calcifications. In the remaining 23 cases the parasite was recovered during surgery and/or autopsy. Regarding to its clinical features, the disease was manifested under three separate forms: acute (meningoencephalitis, cerebral edema, ventricular obstruction, ischemic softening secondary to endarteritis, subacute and chronic (specially the purely convulsive clinical pictures. The symptoms had been present for less than 1 month in 40 cases, from 1 to 12 months in 116 cases, and for more than 1 year in 115 cases; in 5 cases this information was not ascertained. Our cases were classified, regarding to the clinical symptomatology, in hypertensive, convulsive, with focal or diffuse neurologic manifestations, and psychic. These forms were found as single manifestations in the following rates: 46.6 percent of the convulsive, 35.9 percent of the hypertensive, 24.5 percent of the cases with focal or diffuse neurologic symptoms, and none of the psychic. There was association of intracranial hypertension and convulsive seizures in 69 cases (25.0 percent. In 26 cases (9.4 percent there were, in addition, psychic symptoms. In 24 cases (8.7% focal or diffuse neurologic manifestations were associated to intracranial hypertension and convulsions. In general, the hypertensive forms were more common than the convulsive forms. Hypertensive