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PubMed1987

Congenital internal mammary artery-to-pulmonary artery fistulas: a case report.

A case of congenital internal mammary artery-to-pulmonary artery fistulas is reported. The patient was a 7-year-old boy in whom this condition was suspected from an abnormal shadow in the left upper lung field upon chest X-ray examination and continuous murmur. A definite diagnosis was made by selective angiography of the internal mammary artery. This condition is extremely rare. Our patient is the youngest among the 16 cases which have been reported so far in the English literature. Surgical treatment may be indicated because there is a risk of rupture of the fistula, endarteritis, and congestive heart failure.

Angiography↗
PubMed1977

Roentgen manifestations of radiation injury to the gastrointestinal tract.

Radiation injury of the gastrointestinal tract requires a minimum dose of 4200 to 4500 rads. The symptoms and signs of radiation injury usually appear within 6 to 24 months following therapy. The radiation induced changes include mucosal atrophy and ulceration associated with an obliterative endarteritis in the supportive vasculo-connective tissue. The roentgen manifestations are those of an ischemic process but may also mimic those of recurrent malignant disease. Obstruction, hemorrhage, and fistula formation are common complications. Surgery is frequently required. The morbidity and mortality is considerable.

Colon↗
PubMed2001

Clinical, cerebrospinal fluid and pathological findings and outcomes in HIV-positive and HIV-negative patients with tuberculous meningitis.

BACKGROUND: The early diagnosis of tuberculous (TB) meningitis remains difficult. In South Africa, the HIV epidemic has shifted the spectrum of meningitis towards chronic infections (mainly tuberculosis [TB] and cryptococcosis). This study aimed to analyze clinical, cerebrospinal fluid (CSF) and pathological findings and outcomes in TB meningitis to evaluate whether HIV infection significantly influences the characteristic findings. PATIENTS AND METHODS: 40 consecutive patients with TB meningitis presenting at the Pretoria Academic Hospital were evaluated clinically and chest X-rays (CXR), computerized tomography (CT) brain scans, CSF profiles, HIV and routine blood tests were analyzed. Postmortem examinations (PM) were performed in seven patients and outcomes were assessed after treatment. RESULTS: 20 patients were HIV-positive and 17 were negative (three not tested). History and clinical findings were similar in both groups. The mean Glasgow Coma Scale (GCS) value on admission was 13 in both groups, while CXR showed abnormalities consistent with TB in 9/17 with HIV and 7/15 without, with abnormal CT brain scans in 15/19 patients with HIV and 12/16 without. Dilated ventricles and infarcts occurred more commonly in HIV-positive patients. The CSF results showed similar results in both groups. PM in three HIV-positive patients showed weakly formed granulomas and extensive endarteritis and infarcts. Outcomes were similar in the two groups, but a low GCS value on admission was a better prognostic indicator than the CD4-count in HIV-positive patients. CONCLUSION: HIV infection does not significantly alter clinical and CSF findings in TB meningitis in South Africa, but ventricular dilatation and infarcts are more frequent in HIV-positive patients. The GCS gives a better indicator of prognosis than the CD4-count.

AIDS-Related Opportunistic Infections↗
PubMed1975

Internal mammary arteriovenous malformation with communication to the pulmonary vessels.

A 25 year old asymptomatic man with a past history of pulmonary tuberculosis presented with a continuous murmur. Selective arteriography revealed a left internal mammary arteriovenous malformation in communication with vessels in the left upper pulmonary lobe. No significant hemodynamic abnormalities were detected. This is the 26th reported case of internal mammary arteriovenous fistula and the 6th with a pulmonary communication. Review of the data in previous cases suggests that surgical indications are limited to symptomatic relief, heart failure during infancy or the possible risk of endarteritis, proximal arterial degeneration or rupture.

Adult↗
PubMed1988

Catheter occlusion of the persistently patent ductus arteriosus.

Catheter occlusion of a persistently patent ductus arteriosus was attempted in 40 patients (11 men and 29 women, mean age 7.2 +/- 8.3 years, range 244 days to 40 years), using a transvenously placed Rashkind umbrella occluder (USCI). Thirty-one 12-mm and six 17-mm diameter devices were successfully placed in the ductus (internal diameter average 3.9 mm, range 2 to 9 mm). One procedure was abandoned when fluoroscopy failed to visualize the device. There were 2 immediate embolizations subjected to surgical recovery. A residual shunt was present on the immediate postocclusion ventriculogram in 12 of 37 procedures (32%). Twenty-eight patients (75%) have had at least a follow-up at 3 months with Doppler study and 6 (21%) continued to have shunting into the pulmonary artery. Three of 4 patients have undergone successful placement of a second device and 1 patient's shunting spontaneously resolved at 1 year postimplant, leaving only 2 patients (7%) with persistent shunts. There has been 1 episode of probable prosthetic endarteritis and 1 patient has developed mild narrowing of the left pulmonary artery related to device placement. Catheter occlusion of the patent ductus arteriosus using the Rashkind umbrella appears to be a safe and effective method of non-surgical management.

Adult↗
PubMed1981

Spread of rectal cancer within veins. Histologic features and clinical significance.

Histologic evidence of venous invasion was demonstrated in 52 percent of 703 cases of rectal carcinoma. Quantitation of venous invasion and follow-up study showed that invasion of extramural veins was associated with a low 5 year survival rate (33 percent), whereas invasion limited to intramural veins was not. Spread into thick-walled extramural veins carries a very poor prognosis (15 of 91 patients survived 5 years). The corrected 5 year survival rate for stage C patients with invasion of thick-walled extramural veins was only 8 percent. Host reactions in and around the walls of invaded veins increase the survival rate; inflammatory damage to the vein walls and endarteritis obliterans are particularly important in this respect.

Adenocarcinoma↗
PubMed1993

Abdominal radiotherapy is a cause for chronic pancreatitis.

We report a series of five patients with nonalcoholic chronic pancreatitis who underwent abdominal radiotherapy for Hodgkin's disease (n = 4) or seminoma (n = 1) at doses ranging from 3600 to 4050 rads, 6 to 20 years (median, 7 years) before the onset of pancreatitis. Patients were in complete remission for their malignant disease. Other causes of chronic pancreatitis were excluded. The manifestations of chronic pancreatitis (median follow-up after the diagnosis of pancreatitis, 5 years) were pancreatic pain (n = 5), acute pancreatitis (n = 3), pseudocysts (n = 3), common bile duct stenosis (n = 2), duodenal stenosis (n = 1), splenic vein obstruction (n = 1), diabetes mellitus (n = 4), steatorrhea (n = 4), and pancreatic calcifications (n = 1). Other abdominal radiation injuries were severe chronic ulcer of the genu superius (n = 1), stenosis at the junction of the right and left hepatic ducts (n = 1), and splenic and left renal atrophy (n = 1). In one patient, pathological examination of the pancreas showed signs of chronic pancreatitis, severe fibrous endarteritis, and lack of inflammation. Abdominal radiotherapy should be added to the list of causes of chronic pancreatitis. We suggest that the physiopathology of postradiotherapy chronic pancreatitis is a vascular process.

Abdomen↗
PubMed1980

Dental management of patients with surgically corrected cardiac and vascular disease.

This article deals with the dental management of patients with surgically corrected cardiac and vascular disease. The emphasis of the report is on the susceptibility of these patients to bacterial endocarditis or endarteritis and the prevention of these diseases in the susceptible patient receiving dental treatment. The author would strongly encourage the medical and dental professions to work together in the management of these patients. The dentist must seek medical consultation prior to rendering dental care, and the physician is encouraged to seek dental consultation and treatment for the patient who is going to receive a prosthetic heart valve or is a candidate for heart transplantation.

Arteries↗
PubMed1985

Livedo racemosa generalisata and stroke.

The authors describe three young female patients with generalized livedo racemosa and cerebral infarction. The radiologic and biopsy findings point to a widespread vasculopathy, involving small and mid-sized arteries. The histologic examination of the temporal artery biopsy in two patients gives additional evidence for a chronic endarteritis as possible underlying cause of this disease entity.

Adult↗
PubMed2006

Buerger's disease: What has the last decade taught us?

Thrombangiitis obliterans (TAO), or Buerger's disease, is most likely an endarteritis that is introduced by T-cell-mediated cellular immunity and B-cell-mediated humoral immunity associated with the activation of macrophages or dendritic cells in the intima. There is no specific marker of the disease, and the diagnosis is based on clinical and angiographic criteria. The disease spontaneously leads to tissue loss and major amputations and is self-limiting in the 5th to 6th decades of life. Patients should quit smoking and be offered treatment with prostaglandin or prostacyclin, modern wound management, and pain-relieving drugs. Surgical revascularization may be indicated in elective patients, and amputation should only be the last option. It has been suggested that environmental factors may play a major role in the modification of the disease process. TAO is a typical lower class disease, the social and psychological components of which are widely unexplored. Unfortunately, the last decade has not taught us anything to enable us to improve the treatment of TAO patients.

Journal Article↗
PubMed2004

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. Patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.

Angina Pectoris↗
PubMed2005

Cardiovascular lesions in pigs naturally or experimentally infected with porcine circovirus type 2.

Abundant intracytoplasmic porcine circovirus type 2 (PCV2) was associated with myocardiocyte swelling or necrosis, or myocardial fibrosis (or both) in three naturally infected pigs aged 4-7 weeks from three different farms. One 6 week old pig from a fourth farm had severe diffuse segmental to circumferential lymphohistiocytic and plasmacytic periarteritis and endarteritis in several organs, PCV2 antigen was demonstrated in endothelial cells, and inflammatory cells in the arterial walls. In three pigs experimentally infected with PCV2, viral antigen was also associated with obliterated blood vessels in areas of granulomatous and necrotizing lymphadenitis. Together these findings suggest that the cardiovascular system in general and endothelial cells in particular play an important role in the pathogenesis of PCV2-associated diseases.

Animals↗
PubMed2005

[Syphilitic aortitis. Experience of an internal medicine unit].

INTRODUCTION: Infectious aortitis remains a rare disease. It is characterized by an endarteritis of infectious origin generally followed by the development of a so called mycotic aneurysm. Those infectious aneurysms account for 0.5 to 1.3% of all aortic aneurysms. Of the infectious agents, Treponema pallidum has a particular place. Cardiovascular syphilitic infection was very common at the beginning of the XX(th) century with a prevalence of 6.9% of all autopsies. In 1950-1960, the prevalence had decreased to less than 1%. Since 1990, syphilis was considered as disappeared. EXEGESIS: we report syphilitic aortitis in four patients. Diagnosis, treatment, and prognosis are detailed. CONCLUSION: A syphilitic infection of the aorta should be looked for in every patient suffering from an inflammatory or infectious disease of aorta.

Adult↗
PubMed1994

Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention.

Postoperative adhesions occur in 60% to 90% of patients undergoing major gynecologic surgery and represent one of the most common causes of intestinal obstruction in the industrialized world. The incidence of adhesion-related intestinal obstruction after gynecologic surgery for benign conditions without hysterectomy is approximately 0.3%, increasing to 2% to 3% among patients who undergo hysterectomy, and is as high as 5% if a radical hysterectomy is performed. Other adhesion-related complications include chronic pelvic pain, ureteral obstruction, and voiding dysfunction. Intraperitoneal adhesions also can limit the effectiveness of intraperitoneal therapeutic agents used in cancer treatment. Postoperative adhesions are sequelae of impaired fibrinolysis of the fibrin and cellular exudate after peritoneal injury. Adequate blood supply is essential for normal fibrinolysis. Therefore factors that increase ischemia and potentiate adhesion formation include thermal injury, infection, presence of a foreign body, and radiation-induced endarteritis. Only recently, appropriate animal models have been developed to study the process of adhesion formation and prevention. Until clinical confirmation of findings from these investigations exists, only a meticulous surgical technique can be advocated to minimize these untoward effects of surgery.

Animals↗
PubMed1982

Multiple mycotic aneurysms and transverse myelopathy complicating repair of aortic coarctation.

The case of an 18-year-old man with coarctation of the aorta discovered on routine physical examination and subsequently surgically repaired is reported. Four months postoperatively, aneurysms developed at the repair site and thrombosis of both femoral arteries was noted. Following an attempt to repair the aneurysm and remove the thrombi, the patient became paraplegic; Aspergillus fumigatus was found infecting the aorta and femoral vessels. After additional operations and a course of amphotericin B to control the fungal infection, the patient died of intrathoracic bleeding originating from infected, aneurysmally dilated intercostal vessels in the area of the original coarctation repair. The complicating fungal infection of the operative site and the paraplegia are discussed. This report is among the first to present a patient with fungal endarteritis complicating operation for coarctation of the aorta.

Adolescent↗
PubMed1979

Rupture of postcoarctation mycotic aneurysms of the aorta.

Sudden and usually fatal rupture is a common complication of postcoarctation mycotic aneurysms. Prompt operative treatment is always indicated, and can be performed using one of three techniques depending on the adequacy of the collateral circulation and the presence or absence of active bacterial infection. Renal dysfunction commonly is associated with bacterial endarteritis and is secondary to an immune-complex glomerulonephritis. The patient reported here was treated successfully by the placement of an emergency axillofemoral bypass graft, removal of the infected portion of the descending thoracic aorta, and delayed intrathoracic reconstruction.

Adolescent↗
PubMed1987

Renal parenchymal involvement in essential hypertension.

This article has reviewed the involvement of the kidney as a target organ of essential hypertension. Since Bright first made the association of renal disease and hypertension in 1836, the nature of this relationship has been debated. Although there is evidence implicating abnormalities of renal function in the pathogenesis of essential hypertension, hypertension frequently precedes histologic evidence of alterations in renal structure. Nephrosclerosis, or hardening of the kidney, is the term used to describe the histologic changes occurring in the kidney as the result of hypertension. It can be though of as an acceleration of the normal aging process of the renal vasculature. Glomerular and tubular changes have been traditionally thought to be ischemic in origin. Experimental evidence supports the notion that, as renal function is lost, intraglomerular hypertension develops and may be responsible for additional nephron loss in hypertension. This idea may have therapeutic implications for hypertensive patients with renal insufficiency in that agents that reduce both systemic and intraglomerular pressure may be preferable. Hemodynamically, early hypertension is often characterized by normal peripheral and renal vascular resistance and an increased cardiac output. In established hypertension, cardiac output is usually normal, and peripheral and renal vascular resistances are increased. Renal blood flow is reduced, glomerular filtration rate is maintained, and the filtration fraction rises. In the absence of an accelerated malignant phase, renal failure is uncommon in essential hypertension. Males and blacks are most sensitive to the vascular damage of essential hypertension. Essential hypertension remains an important cause of end-stage renal disease, especially in blacks. Atherosclerotic obstruction of the renal arteries may be a more common cause of renal failure in patients with essential hypertension than has been previously recognized. There are few sensitive markers of early renal involvement in essential hypertension. Several studies of sensitive markers are promising and may detect patients who are prone to renal injury and deserve more aggressive treatment. Malignant hypertension is characterized pathologically by vascular changes of proliferative endarteritis and fibrinoid necrosis. Fortunately, its frequency is decreasing because of early identification and effective treatment of essential hypertension. Effective treatment of severe and malignant hypertension clearly leads to stabilization (and occasionally improvement) of renal function.(ABSTRACT TRUNCATED AT 400 WORDS)

Hemodynamics↗
PubMed1991

Surgical management of radiation enteropathy.

Acute radiation enteropathy is usually self-limited and rarely requires surgical intervention. Chronic radiation enteropathy may occur months, years, or decades after treatment. Patients may present with crampy abdominal pain, diarrhea, or cachexia or may present acutely with bowel obstruction or fistula. The bowel and its mesentery are shortened, and mucosal ulceration and submucosal fibrosis are present. The vasculature of the bowel is markedly compromised by progressive endarteritis. Ideally, nutritional support should be given and surgery performed electively. Regardless of presentation, both large and small bowel must be evaluated for concurrent problems. At surgery, resection and restoration of continuity of the gastrointestinal tract is optimal management. Recurrent obstruction and fistulae are real risks, and optimal management is resection of bowel damaged by radiation and anastomosis using bowel spared from irradiation. However, if the patient is unstable or necessary dissection and mobilization of the bowel judged too morbid, bypass of the affected loop is acceptable. Occasionally, only diversion of the bowel by enterostomy is possible.

Acute Disease↗