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Biomedical subjects

S Sharma

Publications and source records attributed to S Sharma.

At least 739 records · Page 41Linked to original sources
PubMed1996

Treatment of obstructive sleep apnea with a self-titrating continuous positive airway pressure (CPAP) system.

Conventional manually adjusted continuous positive airway pressure (CPAP) is an effective therapy for sleep-disordered breathing. We prospectively investigated the efficacy of a self-titrating nasal CPAP system in the acute treatment of obstructive sleep apnea (OSA) syndrome. Twenty patients with moderately severe OSA [apnea hypopnea index (AHI) > 15/hour] were enrolled in a randomized, controlled, prospective clinical trial. An initial diagnostic sleep study was performed, followed by randomization to a manually adjusted CPAP titration on one night and self titrating CPAP on the other night. On the conventional CPAP night, the CPAP was manually adjusted until abolition of all apneas and electroencephalographic (EEG) arousals, whereas the self-titrating CPAP was set in automatic mode at lights out. The self-titrating CPAP system utilized an algorithm based on airway vibration patterns to detect airway stability. The AHI decreased from 50.8 +/- 28.8/hour [mean +/- standard deviation (SD)] at baseline to 3.8 +/- 3.1/hour (p < 0.005) during manually adjusted and 6.1 +/- 5.3/hour (p < 0.005) during self-titrating CPAP. The arousal index (Ar-I) decreased from 34.1 +/- 23.1/hour (baseline) to 11.2 +/- 5.0/hour on manual adjustment (p < 0.005) and 11.3 +/- 0.3/hour on self titration (p < 0.005), whereas total sleep time was unchanged. No significant differences in any measure of oxygenation or sleep architecture were observed between the manually adjusted and self-titrating CPAP nights except that the lowest arterial oxygen saturation (SaO2) was higher with manual titration (84.4 +/- 4.2% vs. 79.9 +/- 9.7%, p < 0.05). The maximum pressure required for abolition of apneas and arousals was significantly lower (p < 0.05) during the self-titrating study (10.1 +/- 3.8 cmH2O) as compared to manually adjusted CPAP (12.3 +/- 3.9 cmH2O). Failure to increase pressure and failure to maintain minimum pressure occurred in 7 of the 20 subjects during the self-titrating study. This required manual resetting of the system in five subjects, but the system self-corrected in two subjects. An unsupervised study would have resulted in undertreatment of OSA. Based on a single-night laboratory study, self-titrating CPAP was well tolerated and improved OSA and sleep architecture comparable to manually adjusted CPAP. The future modifications of this prototype will require further research to assess its efficacy and safety in the laboratory and home environments before its recommendation for general long-term use.

Adult↗
PubMed1996

Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy.

Laparoscopy approach to cholecystectomy has shortened the recovery period, reducing discharge times from 1 to 3 days to same-day discharge. We hypothesize that the use of more than one modality to prevent postoperative pain may be more efficacious than single modality. Patients were randomized to a treatment (n = 24) or control (n = 25) group and studied using a prospective, double-blind design. Preoperatively, at 45 min before induction of anesthesia, the treatment group received an intramuscular (IM) bolus injection of meperidine 0.6 mg/kg and ketorolac 0.5 mg/kg. The control group received two bolus IM injections of placebo (normal saline). Ten minutes before incision, local anesthesia (treatment group) or saline (control group) was infiltrated into the skin of each patient. Anesthetic management, postoperative pain, and nausea treatment were standardized. Pain and nausea assessment were done 1 h preoperatively, 0, 0.5, 1, 2, 3, and 4 h postoperatively, at discharge, and 10, 24, and 48 h postoperatively. Patients were discharged by scoring criteria. Postoperatively, significantly more patients in the treatment group were without pain on arrival in the postanesthesia care unit (PACU), 12/21 (57.1%) vs 1/24 (4.2%) in the control group (P < 0.001). Similarly, the severity of pain was sixfold less in the treatment group than in the control group. The incidence of nausea in the PACU was significantly less in the treatment group; 4.7% vs 29.5% in the control group (P < 0.05). Patients from the treatment group satisfied Postanesthesia Discharge Score significantly earlier than those in the control group (281 +/- 12 min vs 375 +/- 19 min; P < 005). The concomitant use of local anesthetic and nonsteroidal antiinflammatory and opioid drugs proved to be highly effective in our patients, resulting in faster recovery and discharge.

Adult↗
PubMed1996

Computed tomographic analysis of airway dimensions after carotid endarterectomy.

Airway obstruction is a rare but serious postoperative complication of carotid endarterectomy. We prospectively studied airway dimensions between the hyoid bone and cricoid cartilage in patients undergoing carotid endarterectomy using preoperative and postoperative computed tomographic (CT) scans of the neck. CT scans showed soft tissue swelling in all 19 patients. Five patients with clinical evidence of airway obstruction and a hematoma present on CT scan were intubated postoperatively. The three-dimensional reconstruction of the neck from the CT scans showed a reduction in the volume of the airway in all patients. This reduction was greater in the intubated (62% +/- 9%) compared to the nonintubated (32% +/- 7%) patients (P < 0.01). The anterior-posterior and transverse diameters of the airway were reduced, while retropharyngeal edema was increased after carotid endarterectomy. This change was greater for the upper airway at the level of the hyoid compared to the arytenoids and cricoid, and was significantly greater in the intubated than the nonintubated patients. Tracheal deviation was greater in the intubated than in the nonintubated patients. These results demonstrate significant soft tissue edema of the neck after carotid endarterectomy that reduces airway volume and can result in airway obstruction.

Aged↗
PubMed1996

Sensitivity and predictability of vitreous cytology, biopsy, and membrane filter culture in endophthalmitis.

PURPOSE: Forty-seven consecutive patients with endophthalmitis were prospectively studied to: 1) compare the undiluted vitreous biopsy culture and membrane filter culture of vitrectomy cassette fluid; 2) determine the sensitivity and specificity of initial smear examinations in relation to final culture; and 3) characterize vitreous cytology in culture positive and negative endophthalmitis. METHODS: Examinations included smears (Gram stains, Diff Quik [Bacto Laboratories Pvt. Ltd., Liverpool, Australia] and unstained) and aerobic/anaerobic culture of undiluted vitreous biopsy specimens and diluted vitreous collected in the cassette. The cassette fluid was passed through 5-microns polycarbonate filter for cytology and a 0.22-microns polyvinylidene difluoride millipore filter for culture. RESULTS: By either method culture results were positive in 27 (57.4%) patients. Culture positive of the vitreous biopsy alone was 44.6% and cassette fluid alone was 49% (P > 0.05). In the initial smear examination the sensitivity and specificity of the Gram stain were 66.6% and 84.2%, respectively. comparatively, Diff Quik provided lower sensitivity and specificity at 40.7% and 80.9% respectively. Examination of wet film of vitreous samples did not provide any useful information. Although polymorphs were seen in large numbers in all cultures that yielded positive results on examination, they also were seen in 80% of the sterile samples. There was no significant difference in the quantity of macrophages observed in infected and noninfected samples. CONCLUSIONS: Initial smear examination and cytology have limited roles in the diagnosis of infectious endophthalmitis. Obtaining cultures of both an undiluted vitreous biopsy sample and the vitrectomy cassette fluid has a significant advantage compared with culture of only one sample.

Adolescent↗
PubMed1996

Adult-type colloid milium of hands and face successfully treated with dermabrasion.

Colloid milium is an unusual cutaneous disorder characterized by multiple cystic papules. The adult form develops in sun-exposed parts of the body in patients who have actinic-damaged skin. We describe the case of a patient with the classic clinical and histologic features of this disorder. The patient was successfully treated by dermabrasion to the hands and affected facial regions and, 10 months later, has not shown any signs of recurrence.

Amyloid↗
PubMed1996

Changes in plasma adrenocorticotropin, corticosterone, corticosteroid-binding globulin, and hippocampal glucocorticoid receptor occupancy/translocation in rat pups in response to stress.

Pituitary-adrenal responses to stress in the neonatal rat have been reported to be substantially reduced compared to older animals (i.e. a stress hyporesponsive period). This supposed period of endocrine quiescence is characterized by reduced stress-induced increases in both plasma ACTH and corticosterone. At the same time a number of authors have noted the decreased plasma corticosteroid-binding globulin (CBG) levels of the neonate, and there is evidence for an increased percentage of free corticosterone as well as age-related changes in the volume of distribution for corticosterone. These findings suggest that the reduced CBG levels might enhance the biological significance of existing glucocorticoid levels, beyond that assumed on the basis of plasma total corticosterone levels. We examined this question by estimating hippocampal glucocorticoid receptor occupancy and 'translocation' in Day 6, Day 15, and adult animals under basal and stressful conditions. The results showed that: 1) plasma ACTH levels were elevated in Day 6 animals in response to acute exposure to ether, maternal separation, and maternal separation + ether, however, ACTH responses were substantially lower than in Day 15 or adult animals; 2) Plasma total corticosterone levels followed a similar pattern; most noteworthy was the potent glucocorticoid response in Day 15 animals to the combination of maternal separation + ether; 3) Plasma CBG levels in Day 6 animals were extremely low (< 3% adult values); by Day 15 CBG levels were about 25% of adult levels. Interestingly, maternal separation was associated with a substantial decrease in plasma CBG levels; 4) Hippocampal glucocorticoid receptor occupancy/translocation was similar at all ages under both basal and stress conditions. The only notable exception occurred during maternal separation in Day 15 animals, where the percentage of hippocampal glucocorticoid receptor occupancy/translocation was higher than that observed at any time in either Day 6 or adult animals. This finding is likely related to the decrease in plasma CBG that occurs following separation of Day 15 pups from the dam. Thus, despite the higher corticosterone level in the adult, the increase in glucocorticoid receptor occupancy/translocation was generally comparable across all ages either under basal conditions, or following stress. These receptor data underscore the importance of developmental changes in plasma CBG levels.

Adrenalectomy↗
PubMed1996

Oxygen-dependent and -independent mechanisms of renal injury in experimental ascending pyelonephritis.

Pyelonephritis is the most common urinary tract infection affecting females of all age groups. Despite concerted efforts the mechanism of renal injury in pyelonephritis is not clearly understood. In the present study we have made an attempt to characterise the mediators of inflammatory insult in an experimental model of ascending pyelonephritis. Mice infected with Escherichia coli O6:K13:H1 were sacrificed at 2, 7 and 14 days post-infection. Luminol-dependent chemiluminescence response, NADPH oxidase, acid phosphatase, beta-glucuronidase and N-acetyl-beta-D-glucosaminidase activities were monitored in circulating as well as renal phagocytic cells in order to determine the role of reactive oxygen species and lysosomal enzymes in genesis of renal injury. We have demonstrated that reactive oxygen species are generated at the initiation of infection and the levels increase progressively during the course of infection. While intracellular release of lysosomal enzymes was seen in all groups, extracellular release was primarily observed at 7 and 14 days post-infection only. The results indicate that while reactive oxygen species play a significant role in tissue injury during all stages of infection, lysosomal enzyme release in extracellular milieu augments tissue destruction at later stages only.

Acetylglucosaminidase↗
PubMed1996

Haemophilus influenzae adherent to contact lenses associated with production of acute ocular inflammation.

Ten episodes of adverse responses to contact lens wear, including contact lens-induced acute red eye (CLARE), in which Haemophilus influenzae was isolated from contact lenses and/or from one of the external ocular sites at the time of the event, are described. All episodes occurred in patients wearing disposable hydrogel lenses on a 6-night extended-wear schedule. Two of the patients had recurrent episodes. H. influenzae was usually isolated in large numbers, and other bacteria or fungi colonizing the contact lens or the external ocular surface were usually present in low numbers. Those patients who were colonized with H. influenzae were more than 100 times as likely to have had a CLARE or infiltrative response than those subjects who were not colonized with this bacterium. H. influenzae colonization of the contact lens and eye may be subsequent to colonization of the nasopharynx because four of the seven patients presented with fever at the time of the event, with concurrent upper respiratory tract infection. Contact lens wearers should be made aware of the potential risk of CLARE associated with the wearing of contact lenses for extended periods during and subsequent to upper respiratory tract infection.

Acute Disease↗
PubMed1996

Early environmental regulation of forebrain glucocorticoid receptor gene expression: implications for adrenocortical responses to stress.

The adrenal glucocorticoids and catecholamines comprise a frontline of defense for mammalian species under conditions which threaten homeostasis (conditions commonly referred to as stress). Glucocorticoids represent the end product of the hypothalamic-pituitary-adrenal (HPA) axis and along with the catecholamines serve to mobilize the production and distribution of energy substrates during stress. The increased secretion of pituitary-adrenal hormones in response to stress is stimulated by the release of corticotropin-releasing hormone (CRH) and/or arginine vasopressin (AVP) from neurons in the nucleus paraventricularis. In this way, a neural signal associated with the stressor is transduced into a set of endocrine and sympathetic responses. The development of the HPA response to stressful stimuli is altered by early environmental events. Animals exposed to short periods of infantile stimulation or handling show decreased HPA responsivity to stress, whereas maternal separation, physical trauma and endotoxin administration enhance HPA responsivity to stress. In all cases, these effects persist throughout the life of the animal and are accompanied by increased hypothalamic levels of the mRNAs for CRH and often AVP. The inhibitory regulation of the synthesis for these ACTH releasing factors is achieved, in part, through a negative feedback loop whereby circulating glucocorticoids act at various neural sites to decrease CRH and AVP gene expression. Such inhibitory effects are initiated via an interaction between the adrenal steroid and an intracellular receptor (either the mineralocorticoid or glucocorticoid receptor). We have found that these early environmental manipulations regulate glucocorticoid receptor gene expression in the hippocampus and frontal cortex, regions that have been strongly implicated as sites for negative-feedback regulation of CRH and AVP synthesis. When the differences in glucocorticoid receptor density are transiently reversed, so too are those in HPA responses to stress. Taken together, our findings indicate that the early postnatal environment alters the differentiation of hippocampal neurons. This effect involves an altered rate of glucocorticoid receptor gene expression, resulting in changes in the sensitivity of the system to the inhibitory effects of glucocorticoids on the synthesis of CRH and AVP in hypothalamic neurons. Changes in CRH and AVP levels, in turn, determine the responsivity of the axis to subsequent stressors; increased releasing factor production is associated with increased HPA responses to stress. Thus, the early environment can contribute substantially to the development of stable individual differences in HPA responsivity to stressful stimuli. These data provide examples of early environmental programming of neural systems. One major objective of our research is to understand how such programming occurs within the brain.

Adrenal Cortex↗
PubMed1996

Hippocampal and hypothalamic type I corticosteroid receptor affinities are reduced in adult rats born by a caesarean procedure with or without an added period of anoxia.

Brief periods of hypoxia during labour and birth are a frequent occurrence. Within the CNS, the hippocampus is known to be particularly vulnerable to the damaging effects of hypoxia/ischaemia in both adult and immature animals. The hippocampus also contains the highest concentration of corticosteroid receptors of any brain region and both mineralocorticoid (type I) receptors and glucocorticoid (type II) receptors in the hippocampus play a role in the regulation of basal diurnal and stress-induced glucocorticoid secretion. Given this background, the aim of this study was to test whether an acute period of anoxia during the birth process may have lasting effects on CNS corticosteroid receptor levels and/or pituitary-adrenocortical function. Type I and type II corticosteroid receptor binding sites in the hippocampus and hypothalamus were compared in adult rats that had been born vaginally, born by a Caesarean procedure or born by a Caesarean procedure with 5, 10 or 15 min of added anoxia. Using 14 nM [3H]corticosterone as radioligand, mineralocorticoid receptor binding was reduced by approximately 50% in the hippocampus and hypothalamus of adult rats that had been born by the Caesarean procedure either with or without an added period of anoxia, in comparison to vaginally born controls. Saturation analysis revealed that these reductions resulted from decreases in affinity of the mineralocorticoid receptor for [3H]corticosterone, with no change in numbers of receptors. Birth condition had no effect on glucocorticoid receptor binding capacities in the hippocampus or hypothalamus. A small increase in basal corticosterone secretion during the diurnal trough was observed in adult animals that had been born by Caesarean section with 5 or 15 min of added anoxia. The plasma corticosterone response to a 20-min restraint stress was reduced in adult animals born by Caesarean section with or without an added period of anoxia, in comparison to vaginally born controls. However the adrenocorticotropin response to stress was largely unaffected by birth condition. The results indicate that an acute birth insult is sufficient to produce long-lasting alterations in hippocampal and hypothalamic mineralocorticoid receptor sites, accompanied by changes in basal and stress-induced glucocorticoid secretion.

Adrenocorticotropic Hormone↗
PubMed1996

Escherichia coli-macrophage interactions modulate mesangial cell proliferation and matrix synthesis.

Patients with chronic renal interstitital diseases often develop glomerular lesions (focal segmental glomerular sclerosis). Because mesangial expansion (enhanced mesangial cell (MC) growth and matrix accumulation) has been demonstrated to precede the development of focal segmental glomerulosclerosis, we studied the effect of the interaction between bacteria such as Escherichia coli and macrophages on MC proliferation and matrix synthesis. We determined the effect of control media (CM), E. coli supernatant (ESP), serum-free macrophage supernatant (MSP), and E. coli-treated macrophage supernatants (HB101-MSP, H10-MSP) on the proliferation of MCs and synthesis of laminin (a component of mesangial matrix). ESP did not alter MC growth, whereas E. coli MSP increased the mean MC number by 5- to 6-fold when compared to cells treated with CM. Both HB101-MSP and H10-MSP stimulated greater (p < 0.05) incorporation of [3H]thymidine when compared with MSP (HB101-MSP 3.1 +/- 0.4, H10-MSP 2.7 +/- 0.3 vs. MSP 1.6 +/- 0.2 x 10(6) cpm/micrograms protein). When MC proliferation was judged by incorporation of bromodeoxyuridine, both HB101-MSP- and H10-MSP-treated cells showed a greater (p < 0.01) number of proliferating cells compared with cells treated with either MSP or CM. MC treated with H10-MSP grew in a specific pattern and showed a tendency to form hillocks (foci of cell proliferation and matrix aggregation). Both HB101-MSP and H10-MSP enhanced (p < 0.01) synthesis of laminin compared with CM. HB101-MSP-induced enhanced laminin synthesis was attenuated when MCs were treated with anti-transforming growth factor (TGF)-beta antibodies. HB101-MSP also increased mRNA expression of TGF-beta by MCs. These results indicate that E. coli-macrophage interaction has the potential to cause mesangial expansion.

Animals↗
PubMed1996

Computed tomography and magnetic resonance findings in long-standing patent ductus. Case reports.

Two adult patients with patent ductus arteriosus (PDA), resulting in Eisenmenger's syndrome, were evaluated by computed tomography and Magnetic Resonance imaging of the chest, which clearly demonstrated the patent arterial duct as well as the morphologic features of long-standing pulmonary arterial hypertension. Massively dilatated, calcified pulmonary arteries were seen, and the arterial duct was identified as a vascular channel between the distal aortic arch and the main pulmonary artery.

Ductus Arteriosus, Patent↗
PubMed1996

Distribution of aromatase P450 transcripts and adipose fibroblasts in the human breast.

The fibroblast component of adipose tissue is the primary extraglandular site of aromatase P450 (P450arom) expression, which is responsible for the conversion of C19 steroids to estrogens. Previously, we have shown positive correlations between the level of P450arom transcripts and the ratio of fibroblasts to mature adipocytes in adipose tissue samples proximal to breast tumors. The present study was conducted to determine the distribution of P450arom messenger ribonucleic acid (RNA) levels and fibroblast to adipocyte ratios in disease-free breasts of premenopausal women. Adipose tissue samples were collected from 3 regions (outer, upper, and inner) of both breasts of 13 women undergoing reduction mammoplasty. The histological composition of adipose tissue (n = 12) was determined by morphometry using a computerized image analysis program. We used a competitive RT-PCR method employing rat P450arom complementary RNA as an internal standard to quantify adipose P450arom transcripts in tissue total RNA samples (n = 11). Overall, 67% of the highest fibroblast to adipocyte ratios and 64% of the highest P450arom transcript levels were detected in an outer breast region, whereas in only 1 patient were the highest values detected in an inner region. Parametric ANOVA showed significant differences between the fibroblast content of the regions [p(F) = 0.037]. This distribution pattern directly correlates with the most common or the least common sites of carcinoma in the breast, the outer and inner regions, respectively. Moreover, a direct relationship was demonstrated between adipose fibroblasts and P450arom transcripts within the breast, in that regions with the highest fibroblast to adipocyte ratios contained the highest P450arom transcript levels (by ANOVA of contrast variables, P = 0.0009). These results suggest that, similar to our previous findings in the breast bearing a tumor, adipose tissue aromatase expression in the disease-free breast is determined by the local ratio of fibroblasts to adipocytes.

Adipose Tissue↗
PubMed1996

Biodistribution and clearance of 99mTc-labeled Arg-Gly-Asp (RGD) peptide in rats with ischemic acute renal failure.

Based on the previous demonstration of a renoprotective effect of arginine-glycine-aspartic acid (RGD) peptides in acute renal failure, experiments were designed to test the distribution and renal accumulation of the peptide. To accomplish this goal, in this study, RGD peptide was radiolabeled and its biodistribution and renal accumulation was determined in rats with ischemic acute renal failure (ARF). 99mTc-RGD with or without 111In-DTPA were injected intravenously in control and ARF rats. Various organs were dissected at different times after injection and subjected to gamma-scintillation counting and autoradiography (ARG). Blood clearance of 99mTc-RGD was rapid, with t1/2 < 10 min, and unchanged in ARF compared with control rats. Kidneys retained the largest portion of the injected dose in both control and ARF rats, as detected using scintillation counting and whole-body ARG (10.56 +/- 1.05% and 10.12 +/- 3.16% injected dose/g wet weight, respectively). Renal ARG revealed a significant increase in binding to the cortex in ARF kidneys, compared with that of control kidneys. Given the differences in renal blood flow and GFR in control and postischemic kidneys, the next series of experiments was performed with two radiopharmaceuticals, 99mTc-RGD and 111In-DTPA. The ratio of 99mTc-RGD:111In-DTPA was increased more than three-fold in ARF kidneys compared with control kidneys (2.7 +/- 0.15 versus 0.8 +/- 0.19, respectively). The results indicate that (1) RGD peptide undergoes a rapid clearance predominantly via the renal route; (2) despite a significant reduction in the renal perfusion, 99mTc-RGD peptide accumulates in the postischemic kidney; (3) this is consistent with the hypothesis on the involvement of RGD-recognizing integrins in the development of tubular obstruction in renal ischemia.

Acute Kidney Injury↗
PubMed1996

Renovascular hypertension resulting from nonspecific aortoarteritis in children: midterm results of percutaneous transluminal renal angioplasty and predictors of restenosis.

OBJECTIVE: Nonspecific aortoarteritis is a major cause of renovascular hypertension in children. Stenosis of the renal artery is usually long and begins at the origin of that artery. We retrospectively studied the midterm results of angioplasty during treatment and defined the predictors of restenosis in 40 stenoses in 24 children. MATERIALS AND METHODS: All patients had clinically inactive disease and hemodynamically significant stenosis causing hypertension. Midterm results were analyzed by the life table method. The effect of clinical, angiographic, and technical factors on the restenosis rate was tested by the Kaplan-Meir survival method. RESULTS: Technical success was obtained without complications in 38 (95%) of the lesions in 22 (92%) of the patients. The stenosis decreased from 89 +/- 7% to 11 +/- 12%, the pressure gradient fell from 97 +/- 27 to 10 +/- 10 mm Hg, and blood pressure decreased from 174 +/- 14/112 +/- 11 to 141 +/- 13/88 +/- 11 mm Hg (p < .001). Clinical benefit was seen in all patients with technically successful angioplasty. During the follow-up period (33 +/- 22 months), restenosis was seen in eight lesions (20%). The predicted cumulative patency rate at 5 years was 71%. Adverse effects on the rate of restenosis were associated with male sex (p = .04), stenosis beginning at the origin of the renal artery (p = .01), and more than 20% residual stenosis after angioplasty (p = .02). CONCLUSION: Our results show that hypertension in children with renal artery stenosis caused by nonspecific aortoateritis can be safely treated by renal angioplasty with excellent midterm results. A long stenosis beginning at the origin of the artery predisposes to restenosis, but repeat dilatation often produces lasting benefit.

Adolescent↗
PubMed1996

Morphologic mural changes in the aorta revealed by CT in patients with nonspecific aortoarteritis (Takayasu's arteritis).

OBJECTIVE: Nonspecific aortoarteritis is a panarteritis of unknown cause that primarily involves vessel walls. The imaging morphology of changes caused by nonspecific aortoarteritis has been infrequently studied. SUBJECTS AND METHODS: We analyzed this morphology by axial CT in 24 patients (group 1) and compared these images with those of healthy subjects (n = 12, group 2) and subjects with atherosclerosis (n = 12, group 3), aortic aneurysm (n = 9, group 4), and aortic dissection (n = 5, group 5). Ten-millimeter contiguous sections were obtained before and after enhancement with contrast material. RESULTS: Distinctive wall changes were seen in group 1 and included thickening in 20 patients, crescents in 19, indistinct outline in 10, and low-attenuation ring in eight. Calcification and thrombus were seen in 13 and seven patients, respectively. Angiograms showed skip areas of involvement. CT scans showed wall changes even in skipped areas that were normal at angiography. In group 2, the aortic wall was imperceptible or less than 1 mm thick and showed no abnormality. In group 3, calcification was seen in all patients and wall abnormality in none. In group 4, changes, including thrombus in all patients, calcification in nine, and low-attenuation ring in one patient, were seen within the aneurysm. In group 5, changes included calcification and the intimal flap in all patients and thrombus in three. CONCLUSION: CT shows distinctive changes in the aortic wall in patients with non-specific aortoarteritis that are peculiar to this disease. Detecting these changes may improve our understanding of the disease pathogenesis. Our findings suggest that this disease involves a contiguous length of the aorta, producing wall and luminal diameter changes in some areas and only wall changes in the intervening segments.

Adolescent↗