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Biomedical subjects

J T Lie

Publications and source records attributed to J T Lie.

At least 55 records · Page 3Linked to original sources
PubMed1995

Giant cell arteritis involving the facial artery.

Jaw claudication in giant cell (temporal) arteritis (GCA) is believed to be due to vasculitic obstruction or stenosis of the arteries supplying the muscles of mastication, notably the facial and internal maxillary arteries and their branches. However, histologic documentation of this is rarely available because GCA is usually diagnosed by temporal artery biopsies. We describe a patient with jaw claudication and other clinical features of GCA in whom a facial artery biopsy confirmed involvement by GCA.

Aged↗
PubMed1995

Bilateral lower limb gangrene and stroke as initial manifestations of systemic giant cell arteritis in an African-American.

Giant cell arteritis (GCA) is a systemic disease of the elderly that occurs infrequently in blacks and seldom has peripheral vascular disease and stroke as its presenting major complications. The occurrence of bilateral lower limb gangrene and a fatal stroke as manifestations of occult systemic GCA in an African-American is such a unique combination of rare occurrences that it warrants documentation in the literature.

Black or African American↗
PubMed1995

Simultaneous clinical manifestations of malignancy and giant cell temporal arteritis in a young woman.

The rare instance of adenocarcinoma of the lung that appeared concurrently with a biopsy proven giant cell temporal arteritis in a 45-year-old woman is described. The lung cancer (without lymph node metastases) was resected, and the temporal arteritis treated with prednisone in the standard dosage regimen. At 36 months followup, she was well with no signs of recurrence or metastases of the lung cancer, nor any recrudescence of temporal arteritis or polymyalgia rheumatica symptoms. This unusual association of lung cancer and temporal arteritis in a young woman, most probably a chance occurrence, has not been previously reported.

Adenocarcinoma↗
PubMed1995

Bilateral juvenile temporal arteritis.

Juvenile temporal arteritis (JTA) is an uncommon nongiant cell arteritis of the superficial temporal artery occurring exclusively in older children and young adults without a history of trauma or evidence of systemic disease or localized symptoms. Of the 6 cases reported to date, there has been no recurrence after a simple surgical excision of the nodular artery for cosmetic reasons. We describe the first known case of bilateral JTA in a 21-year-old man and differential diagnoses are discussed to distinguish JTA from the classic giant cell (temporal) arteritis of the elderly, which requires corticosteroid drug treatment.

Adult↗
PubMed1995

Histopathologic specificity of systemic vasculitis.

A definitive diagnosis of vasculitis almost always requires histologic documentation of a true inflammatory disease of the blood vessels. Although each major type of systemic vasculitis may have its own characteristic and unique features, variability and overlaps still exist, and histopathologic specificity is rarely an absolute discriminator. The correct interpretation of biopsy specimens for the diagnosis of vasculitis remains more an art than a science; it is subject to such variables as the examining pathologist's interest and expertise, tissue selection and sample size, the age of the disease from onset to the time of biopsy, and whether there was drug treatment prior to the biopsy.

Churg-Strauss Syndrome↗
PubMed1995

Systemic and cerebral vasculitis coexisting with disseminated coagulopathy in systemic lupus erythematosus associated with antiphospholipid syndrome.

Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are closely related, but each has it own characteristic vasculopathy: vasculitis in SLE and thrombosis in APS, and either may be a serious or life threatening complication. When a patient has SLE associated with APS, systemic and cerebral vasculitis may coexist with disseminated coagulopathy. We report this complication in a 60-year-old woman who died from stroke and myocardial infarction, an occurrence seldom documented in the literature.

Antiphospholipid Syndrome↗
PubMed1995

Non-giant cell arteritis of the temporal artery presenting as the polymyalgia rheumatica-temporal arteritis syndrome.

We describe a heterogeneous group of 4 elderly patients with atypical vasculitis of the temporal artery who presented clinically with the polymyalgia rheumatica-temporal arteritis syndrome. The first had apparently isolated eosinophilic necrotizing vasculitis without peripheral blood eosinophilia, history of asthma, or pulmonary vasculitis (so called limited form of Churg-Strauss syndrome). Temporal artery biopsy in the 2nd patient revealed small vessel necrotizing vasculitis in the fragment of skeletal muscle surrounding a normal temporal artery (i.e., negative for giant cell arteritis, GCA). This patient subsequently developed rheumatoid polysynovitis. The temporal artery biopsies in the remaining 2 patients showed vasa vasorum vasculitis, without GCA, associated with malignancy in Patient 3 and as an unexpected and apparently isolated finding in Patient 4. All 4 patients responded to the standard corticosteroid therapy for giant cell temporal arteritis. Unusual temporal artery biopsies such as these should be interpreted in relation to clinical findings.

Adrenal Cortex Hormones↗
PubMed1994

How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis?

OBJECTIVE: To determine the effect of previous corticosteroid treatment on the results of temporal artery biopsy. DESIGN: Consecutive case series. SETTING: Tertiary care center. PATIENTS: A consecutive cohort of 535 patients who had temporal artery biopsies at Mayo Clinic, Rochester, Minnesota, between 1 January 1988 and 31 December 1991. MEASUREMENTS AND RESULTS: The dose and duration of corticosteroid treatment received before temporal artery biopsy and detailed clinical and laboratory data were obtained from the patients' medical records. All temporal artery biopsy slides were re-evaluated by a pathologist blinded to clinical data, previous corticosteroid treatment information, and the original pathologic diagnosis. Biopsy specimens were classified as negative for arteritis, positive for typical temporal arteritis, or positive for atypical temporal arteritis. Biopsy results were positive for 31% of patients (89 of 286) who did not receive corticosteroids before biopsy and for 35% of those (86 of 249) who did receive corticosteroids before biopsy (P = 0.4; 95% confidence interval for the difference, -4.7% to 11.5%). Patients who received corticosteroids before biopsy tended to have clinical features more suggestive of arteritis. A multiple logistic regression analysis model, controlling for these differences in clinical and laboratory features, showed that the biopsy positivity rate was unrelated to previous corticosteroid treatment. CONCLUSIONS: Although these results do not prove that histologic features are unaffected by corticosteroids, they show that, in this large, consecutive sample, the positivity rates of temporal artery biopsy were similar in untreated and corticosteroid-treated patients. Temporal artery biopsy may show arteritis even after more than 14 days of corticosteroid therapy in the presence of clinical indications of active disease.

Adrenal Cortex Hormones↗
PubMed1994

Giant cell arteritis in Iceland. An epidemiologic and histopathologic analysis.

OBJECTIVE: To investigate the incidence and clinical and histopathologic features of giant cell (temporal) arteritis (GCA) in the Caucasian population of Iceland. METHODS: All patients diagnosed between 1984 and 1990 were included. Case ascertainment for the study was done in 2 ways: 1) a computerized search from all hospitals and primary care clinics for the diagnosis of GCA, and 2) a review of all temporal artery biopsies performed during the 7-year period. RESULTS: One hundred thirty-three patients with GCA were identified. All fulfilled the 1990 American College of Rheumatology criteria for the classification of GCA. The incidence rate for the population 50 years and older was 27/100,000 (36/100,000 and 18/100,000 for women and men, respectively). Clinical findings included the following: mean age at diagnosis 72.5 years for women and 70.3 years for men, new headache 63.2%, abnormal temporal artery on palpation 43.6%, mean erythrocyte sedimentation rate 88 mm/hour, symptoms of polymyalgia rheumatica 48.1%, and visual disturbances 14.3%. A total of 744 patients underwent temporal artery biopsy during the 7-year period; 16.8% had a positive biopsy result. All 133 patients with the diagnosis of GCA underwent a temporal artery biopsy; 94% had a positive result. Histopathologic findings from the positive biopsies included a fragmented internal elastic lamina in 99.2%, giant cells in 65.6%, and fibrinoid necrosis in 12%. CONCLUSION: Compared with previous epidemiologic surveys, this study shows a high incidence of biopsy-proven GCA in Iceland.

Aged↗
PubMed1994

Choroidal infiltrates as the initial manifestation of lymphoma in rheumatoid arthritis after treatment with low-dose methotrexate.

OBJECTIVE: To report the third known and documented occurrence of malignant disease as a complication of immunosuppression associated with low-dose methotrexate therapy for rheumatoid arthritis. MATERIAL AND METHODS: We present a case report of a 64-year-old woman with rheumatoid arthritis who had received low-dose methotrexate therapy for 16 months in whom blurred vision occurred. An ophthalmologic examination was performed, and prednisone was administered. Subsequently, she complained of sore throat, weakness, and fever. An axillary lymph node biopsy and immunologic studies were done. RESULTS: Funduscopic examination revealed severe bilateral choroidal thickening. Findings on the biopsy disclosed a large cell, B-cell phenotype non-Hodgkin's lymphoma. Immunologic studies performed on frozen and paraffin-embedded tissue samples showed that the neoplastic cells were positive for CD20 and CD22 and without definite immunoglobulin light chain expression. CONCLUSION: Although the occurrence of lymphoma may be associated with autoimmune diseases, low-dose methotrexate therapy has also been implicated. Because of the increasing use of low-dose methotrexate therapy for classic and juvenile rheumatoid arthritis, an increased risk of lymphoproliferative disease is possible.

Antigens, CD↗
PubMed1994

Juvenile temporal arteritis revisited.

We describe a case of arteritis involving the superficial temporal artery in an 8-year-old boy. After a 2-week prodrome of headache in the right temporal region, a painful pulsatile 6-mm nodule developed. No history of trauma or systemic disease was noted. The differential diagnosis included vasculitis or thrombosis of a vascular malformation of the temporal artery. The lesion was surgically excised for both diagnostic and cosmetic reasons. Histologic features of the nodule were diagnostic of juvenile temporal arteritis and characterized by non-giant cell granulomatous inflammation of the temporal artery, occlusive fibrous intimal proliferation, and microaneurysmal disruption of the media. At 12-month follow-up, the patient was well; no recurrent lesions or systemic disease was noted. Although rare, this disease should be recognized as arteritis that affects the external carotid circulation and should not be confused with classic giant cell temporal arteritis. If physicians are aware of this benign inflammatory disease of the temporal artery in children and young adults, unnecessary treatment will not be administered.

Child↗
PubMed1994

Mesenteric inflammatory veno-occlusive disease. A seldom recognized cause of intestinal ischemia.

We describe seven patients (three men, four women; ages 27-78) who presented with signs of intestinal ischemia requiring surgical intervention. In each case, the resected colon, small bowel, or both showed striking phlebitis and venulitis affecting veins of the bowel and mesentery and resulting in ischemic injury of the bowel. In each case, this vasculopathy was the only demonstrable cause of ischemia. Arteritis involving the bowel or the mesentery was not found in any patient, and none had clinical evidence or a history of extraintestinal vasculitis. The composition of the inflammatory infiltrate was variable; in four patients, it was predominantly lymphocytic, in two necrotizing and in one lymphocytic/granulomatous. In addition, three patients also had myointimal hyperplasia of the affected mesenteric veins. Six of seven patients recovered uneventfully after surgery, suggesting a self-limited or indolent process, and the seventh died of an unknown cause. We propose the name mesenteric inflammatory veno-occlusive disease (MIVOD) to describe this unusual and previously unrecognized cause of intestinal ischemia. Its etiology is unknown, and MIVOD may represent a precursor of the recently described idiopathic myointimal hyperplasia of mesenteric veins.

Adult↗
PubMed1994

Systemic therapy with fibrinolytic agents and heparin for recalcitrant nonhealing cutaneous ulcer in the antiphospholipid syndrome.

Skin ulceration is a cutaneous manifestation of the antiphospholipid syndrome (APS) and is associated with thrombosis of small dermal vessels. Numerous therapeutic agents have been used but are often ineffective. We describe the efficacy of heparin and fibrinolytic agents [urokinase and tissue plasminogen activator (tPA)] in the treatment of longstanding nonhealing cutaneous ulcers. In one patient, heparin plus low dose tPA resulted in healing. In another patient, treatment first with urokinase and heparin, and subsequently with tPA alone, resulted in healing. When the ulcer recurred secondary to severe peripheral edema, tPA plus heparin led to complete resolution of the ulcer. This suggests that fibrinolytic therapy and/or heparin may be useful in other recurrent thrombotic manifestations of the APS as well. However, it must be emphatically stressed that since life threatening adverse reactions can occur secondary to hemorrhage, this treatment should be undertaken only after extensive evaluation and close monitoring of the coagulation status.

Antiphospholipid Syndrome↗