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PubMed2000

[An autopsy case of pulmonary mucormycosis with fatal hemoptysis from a rupture of the thoracic descending aorta during remission from acute myelocytic leukemia].

A 16-year-old girl was hospitalized because of anemia and thrombocytopenia in April 1998, and was diagnosed as having AML (FAB:M2). After failure of initial remission induction therapy, she was successfully treated with the MEC regimen as a second-line chemotherapy. On June 22, the first consolidation therapy was started. One week later, the patient developed a high fever with backache. Chest computed tomography (CT) on July 8 showed a 3cm mass lesion adjacent to the thoracic descending aorta in the left upper lobe. She was given fluconazole and antibiotics, and remained in remission. On July 24, the mass lesion changed to a cavitary lesion on chest CT, suggesting a fungal infection, probably aspergillosis. With recovery from neutropenia, the patient became asymptomatic, and fluconazole was changed to itraconazole. On July 27, she suffered sudden, massive hemoptysis and died. Autopsy revealed a localized adhesion between the cavitary lesion and the thoracic descending aorta, and the aortic wall was ruptured at this site. Microscopic examination revealed invasion of mucormycotic hyphae into the wall of the aorta with infiltration of inflammatory cells. The vasa vasorum were occluded by thrombi, in which mucormycotic hyphae were detected.

Adolescent↗
PubMed1975

Restitution of aortic wall after sustained necrotizing transmural ligation injury. Role of blood cells and artery cells.

Partial ligation of the rabbit abdominal aorta with fine silk suture for 48 hours produced a circular band of transmural necrosis. On release of the ligature, blood cells from the lumen and from adventitial vasa vasorum, as well as cells derived by mitosis from the adjacent surviving endothelium and media, participated in the restitution of a continuous endothelial lining and an intact media containing well-differentiated smooth muscle cells within normal medial lamellar units. Initial deposition of a layer of blood platelets on the fibrillar material coating the denuded lumenal surface was followed by ingress from the lumen of polymorphonuclear granulocytes and mononuclear cells. These changes preceded the appearance of mitoses in surviving endothelial and medial smooth muscle cells at the margin of injury. By 24 hours, poorly differentiated cells had accumulated in the central portion of the intima and inner media. Similar cells formed a more extensive, nearly complete lumenal layer which was eventually continuous with and indistinguishable from the adjacent uninjured endothelium. By 7 days, smooth muscle cells repopulated the media, and a collection of less differentiated cells persisted between the restored endothelium and media. By 28 days, the only deviation from normal arterial structure was the persistence at the point of ligature of intimal thickening, consisting of smooth muscle cells and collagen and elastin fibers. Though still present at 6 weeks, this zone became increasingly compact and layered. There was no evidence that fibrin thrombus formation was a consistent feature of the initial reaction or that it played a role in the healing process or in the formation of the intimal lesion. Despite complete circumferential necrosis at the site of ligature, there was no evidence of medial rupture or intramural hemorrhage.

Animals↗
PubMedDate not supplied

[Mechanisms of development of diabetic macroangiopathy].

Pieces of the aorta and heart coronary arteries taken at autopsy of 100 patients who had died of insulin-dependent and non-insulin-dependent diabetes mellitus were studied histologically and immunohistologically. Atherosclerosis was more pronounced in diabetes mellitus patients than in patients with normal glycemic indices. Atherosclerosis was most severe in non-insulin-dependent diabetes. Diabetic microangiopathy of the vasa vasorum of large arteries promotes development of atherosclerosis.

Adolescent↗
PubMed2001

Intracranial infective aneurysms: angiographic evaluation with treatment.

Infective intracranial aneurysms are relatively uncommon. They develop due to septic embolisation of the vasa vasorum or lumen of the artery, with resultant focal arteritis and necrosis, leading to aneurysm formation. They are an important cause for intracranial haemorrhage. Six cases of infective aneurysms are described. A focus of infection could be detected in all the patients. Surgery was done in three cases, out of which two patients made significant recovery, while one patient died in the immediate postoperative period. Out of the three cases, treated conservatively with antibiotic therapy, there was total resolution on follow up angiogram in two, while one patient was lost to follow up.

Adolescent↗
PubMedDate not supplied

Pathogenesis of Takayasu's arteritis.

Takayasu's arteritis is an inflammatory disease of the arteries that involves large vessels. The inflammatory lesions in Takayasu's arteritis originate in the vasa vasorum and are followed by cellular infiltration, mainly composed of T cells (gammadelta lymphocytes, cytotoxic T lymphocytes, T helper cells), but also of natural killer cells, dendritic cells, monocytes and granulocytes, invading the outer layer of the media and/or its neighbouring adventitia. At this stage, positive production of inflammatory cytokines and/or adhesion molecules around these areas is remarkable. According to data available--in Takayasu's arteritis--interleukin-6, interleukin-1 and RANTES are released in large amounts by infiltrating inflammatory cells within damaged tissue, as well as by circulating inflammatory cells, and very likely help maintain the aberrant immune activation, by promoting endothelial cells activation and by inducing lymphocyte infiltration. Although the nature of the antigen that triggers the auto-immune process is still unknown, the infiltrating T lymphocytes may recognize one or a few self-antigens processed and presented in association with HLA. A considerable percentage of patients with Takayasu's arteritis have immune complexes in sera; moreover, on peripheral blood lymphocyte, Fc receptors and antibodies reactive against human endothelial cells (AECA) have been detected. This observation raised the possibility that AECA might have a role in endothelial cell activation and expression of adhesion molecules, which will facilitate leukocyte traffic.

Antibodies↗
PubMedDate not supplied

Acute spontaneous aortic pathologies associated with intramural hematoma: can a differential diagnosis be made by imaging techniques?

Acute intramural aortic hematoma may result from ruptured vasa vasorum without intimal disruption (IMH hereafter) but can also be found in association with processes in which an intimal lesion is present, such as aortic dissections (AD), where the hematoma represents the acute thrombosis of the false lumen, or in penetrating atherosclerotic ulcers (PAU), where blood collects beyond the disrupted internal elastic lamina. As the clinical presentation of these conditions is very similar, imaging techniques should aim both to diagnose the hematoma and to characterize the underlying pathology. This review critically analyzes the diagnostic potential of several imaging methods based on personal experience and literature reports. Although intramural hematoma can be easily diagnosed unrespective of the tomographic imaging modality, it is usually difficult to distinguish between IMH and hematomas associated either to AD or to PAU. Indeed, only PAU related hematomas can be consistently diagnosed due to the high probability of unveiling the causative wall ulceration; conversely, the differential diagnosis between IMH and AD - associated hematomas is still matter of controversy. According to the literature, the two conditions cannot be differentiated by transesophageal echocardiography, though some reports state that a distinction might be made by MR imaging. As regards CT, only a small percentage of AD - associated hematomas exhibit clear evidence of a typical intimal flap, allowing for a safe diagnosis to be made: often, unfortunately, the intimal lesion subsequently found at surgery cannot be detected, yielding a picture of IMH. Therefore, the radiological report should give the same diagnostic probability to both conditions.

Aortic Dissection↗
PubMed1975

[False aneurysm due to mycotic angitis-case report (author's transl)].

Cerebral mycotic angitis takes place as a secondary disease to inflammation which is precipitated on the arterial wall to the artery, most frequently the vasa vasorum, as a result of settlement of infectious embolus into there, and it is usually seen in the patient with cardiac disease. The middle cerebral artery is a major region where the lesion takes place in multitude, and it is only rarely seen in the patient having infection in the brain or dura mater. We have recently experienced a very rare case in which false aneurysm was induced in the internal carotid artery by angitis due to Aspergillus, and this report deals with case. A 26-year-old office-man: He was attacked by loss of consciousness, aphesia, right hemiparesis during work in his office. As left CAG demonstrated evidence of arteriovenous malformation, redical operation was performed. He took a favorable course postoperatively, but developed meningitis on 10th day, when massive antibiotic therapy was started. During treatment, however, his consciousness rapidly decreased, and it was found on left CAG that there was false aneurysm in the cisternal segment of the left internal carotid artery which has previously been completely healthy. Operation was practiced once again to reinforce the wall of the left internal carotid artery, but the patient died of aggravated meningitis. Autopsy demonstrated a very fragile left internal carotidartery associated with perporation which was surrounded byprominent coagula. Histological examinations indicated that the perforation of the vascular wall had been caused by angitis due to Aspergillus infection.

Adult↗
PubMed2003

Comparison between color duplex ultrasonography and histology of the temporal artery in cranial arteritis (giant cell arteritis).

BACKGROUND: Duplex sonography of the temporal artery may be helpful in the diagnosis of cranial arteritis. PATIENTS AND METHODS: The superficial temporal arteries of 36 patients with cranial arteritis or suspected arteritis were examined using both duplex ultrasonography (US) and biopsy. The data of these patients were divided into two groups. Group A consisted of 24 patients (66.7%) with definite positive results using duplex (US) and Group B of 12 patients (33.3%) who showed a suspicious or negative ultrasonographic result. RESULT: In all patients of Group A, the histological findings corresponded with the ultrasonographic changes in the inflamed artery. - The characteristic ultrasonographic sign was a dark halo around the lumen of the temporal arteries. There was a high correlation between a bilateral halo found by US with an ocular involvement. Ten out of 14 patients with a bilateral halo (71.4%) showed a distinct involvement of the optic nerve or retina. - The characteristic histological signs were infiltration of the vessel wall by inflammatory cells, mainly lymphocytes. Group B: The biopsies of the superficial temporal arteries were positive in 8 patients (66.7 %), negative in 4 other patients (33.3%). CONCLUSION: Patients with a distinct halo, demonstrated by US, also showed corresponding pronounced inflammatory cell infiltration of the vessel wall. Patients with no ultrasonographic changes presented histological signs of initial inflammation such as isolated inflammatory cells around the vasa vasorum and/or in the adventitial layer.

Aged↗
PubMedDate not supplied

[Mathematical modeling of non-stationary spatial gradients of nitric oxide in the muscle wall of blood vessels].

A mathematical description of the diffusion of low-mass uncharged molecules in homogenous biological medium was considered. The distribution of nitric oxide in vascular smooth muscles was taken as an example. The model makes it possible to describe the spatial-temporal gradient of NO near the surface of endothelium in terms of one-dimensional diffusion. In the case of the constant rate of nitric oxide production in endothelium, an analytical expression of nonstationary distribution of NO concentration was obtained. It was found that, if the diameter of blood vessel exceeds 800 microns, the concentration of nitric oxide on the outer border of vascular smooth muscle layer is less than the equilibrium dissociation constant (0.25 microM) of soluble guanylyl cyclase. Thus, the diffusion of nitric oxide produced in endothelium is insufficient to cause a relaxation of vascular smooth muscles in medium- and large-size blood vessels. In this case, the role of nitric oxide synthesized in vasa vasorum acquires a special significance for the regulation of vessel tone.

Algorithms↗
PubMedDate not supplied

Functional morphology of ductus venosus in human fetus.

OBJECTIVES: The morphology of region umbilical vein, umbilical sinus and ductus venosus of human fetuses have been investigated. MATERIAL AND METHODS: 26 human fetuses between 20 and 40 weeks' gestation were examined by morphological methods. The umbilical vein, DV and the portal vein were obtained after termination of gestation. Tissue samples have been fixed in phormaldehyde solution (pH 7,2) and were embedded in paraffin. The paraffin sections (5-7 micro k) were stained with hematoxylin and eosin, silver impregnation by Bilchovski, orcein, pikrofuchsin. Measurement of the angle between ductus venosus and the portal vein was obtained with alidade. RESULTS: Anatomical scheme of the region of umbilical vein, umbilical sinus and DV indicating two different patterns. The first: DV has situated into line with umbilical vein (22 cases). The second: umbilical vein has rotated before umbilical sinus, forming the turn in right (4 cases). The double-layer wall of ductus venosus (DV) contained the elastic, collagen and argyrophilic fibers. Around isthmus region of DV vasa vasorum and nervi vasorum have been found. The specific anatomical finding of the ductal isthmus was an accumulation of smooth muscle cells as intimal pillow, which were protruded into the vascular lumen. The double-layer wall of portal sinus (intima and adventitia) have been as the internal elastic membrane. The smooth muscle cells have been revealed in the walls, were not formed the tunica media at term 20-40 weeks of gestation. By the contrast the umbilical vein showed multiple, circularly running smooth muscle bundles. In this study, the ductal thickness was consistently bigger in the inlet than in the outlet. The tunica adventitia was greatest in the junction with the portal sinus and the inferior vena cava compared with the part arranged in the liver parenchyma. The wall thickness of the portal sinus and of the umbilical vein was significantly higher than of the duclal wall. CONCLUSION: The vascular muscle-elastic cells of intimal hyperplasia ("intimal pillow") in wall of DV, probably, executes the role of the fortification of resistant behaviours of vessel wall in connection with DV and portal sinus with high hemodynamics load in this area. The maximum thickness of adventicia in the field of joints also witnesses an hemodynamic in favour of particularities. The angle between DV and left branches of portal vein in dominate cases was sharp and right that reflects the general regularity of architectonics of the vascular riverbed.

Adult↗
PubMedDate not supplied

Dendritic cells co-localize with activated CD4+ T cells in giant cell arteritis.

OBJECTIVE: Giant cell arteritis (GCA) is a vasculitis predominantly affecting medium- and large-sized arteries. Recent data show the co-localization of dendritic cells and Chlamydia pneumoniae in vascular biopsies from GCA patients. Here we define the topographical relation of dendritic cells and these activated T-cells to determine the antigen presenting cell in GCA, and to examine several auxiliary biochemical and genetic aspects relating to the role of bacteria such as C. pneumoniae in eliciting GCA. METHODS: 18 paraffin-embedded temporal artery biopsy specimens from 14 patients with GCA that were PCR-positive for C. pneumoniae were examined by two-color immunohistochemistry for the topographical relationship between dendritic cells and activated T-cells. In addition the presence of GTP-binding proteins. Tumor necrosis factor alpha (TNF alpha), and Toll-like receptor 4 (TLR4) was investigated. 15 temporal artery specimens from 10 patients without GCA served as controls. RESULTS: In all GCA specimens, dendritic cells co-localized in the immediate vicinity of activated CD4+ Talin-expressing T cells, and these were predominantly found in granulomatous infiltrates. Confocal microscopy confirmed the cell-cell contact of dendritic cells with activated T cells. Results further showed that RhoA and Rac1 were predominantly present in the region of granulomatous infiltrates. TNF alpha production and expression was found in dendritic cells and macrophages, predominantly in granulomatous infiltrates and in endothelial cells of the vasa vasorum dispersed in the adventitial and medial layers of the temporal artery. No control specimens showed TNF alpha expression. More than 95% of dendritic cells were positive for TLR4; macrophages and endothelial cells localized in the adventitia showed TLR4 production. CONCLUSIONS: The immediate co-localization of dendritic cells and activated T cells indicate a high probability that the former represent the antigen presenting cells in GCA. In addition, because of the presence of Rho A and Rac1 in the granulomatous infiltrates, we speculate that they provide the right environment for cell-cell contact and adhesion, and that they may promote the internalization of bacteria. TNF alpha is expressed at high levels in the granulomatous infiltrates of temporal artery specimens from patients with GCA. Since TLR4 is produced in the same cell types, and predominantly in the adventitial layer of the temporal artery, we suggest that these receptors are coupled to signal transduction pathways that control TNF alpha expression.

Aged↗
PubMed2003

[Usefulness of semi-skeletonized right gastroepiploic artery].

The right gastroepiploic artery (RGEA) could be harvested easily and safely by using an ultrasonic scalpel. It is easier and faster not to remove a satellite vein from RGEA than to skeletonize it fully. And blood flow of the vein is important, because it is the flow of vasa vasorum of RGEA. Among 70 patients who have bypassed to right coronary arteries (RCA), 25 patients were treated with semi-skeletonized RGEA (SSK-RGEA), the other 45 patients were operated with pedicled RGEA or (if pedicled RGEA was short and small) with the other grafts. An availability of SSK-RGEA for RCA was 100%. And that of pedicled RGEA was 47% (p < 0.001). Twenty-eight patients were operated without a pump. Twenty-three of them (82%) were bypassed with RGEA. In the on-pump cases (42 patients), RGEA were used for 13 (31%) cases (p < 0.05). Early post-operative angiographies revealed 1 occlusion. But the site of occlusion was the origin of RGEA branch from a gastro-duodenal artery, and the anastomotic site was patent. This graft was supposed to be occluded post-operatively by arteriosclerosis. Flow competition occurred in two grafts. In conclusion, the SSK-RGEA was useful for RCA bypass grafting. The reliability of RGEA should increase the indication of off-pump coronary artery bypass grafting.

Cardiopulmonary Bypass↗
PubMed2003

Pedicled or skeletonized? A review of the internal thoracic artery graft.

The internal thoracic artery is the gold-standard conduit for coronary artery bypass surgery. Until recently, it was used almost exclusively as a pedicle, with construction of 1 distal anastomosis. Skeletonization of the internal thoracic artery has recently been advocated in order to increase the number of arterial anastomoses and decrease the occurrence of sternal wound infections. When skeletonized, the vessel loses its "milieu" which raises the question of whether this technique sacrifices the superior longevity of the conduit. The current status of research on the effects of skeletonization (depriving the internal thoracic artery of vasa vasorum, innervation, and lymphatic and venous drainage, together with creating an imbalance between vasoconstricting and vasodilating substances) appears to support the superiority of the pedicled graft. Long-term patency studies of the skeletonized ITA, with meticulous follow-up and confirmation by angiography, are not currently available. Theoretically, skeletonization of the ITA might adversely affect its long-term resistance to atherosclerosis. More data are needed before this technique can be universally recommended. If the skeletonized ITA has decreased long-term patency, bypass surgery may be at a disadvantage when compared with the new generation of drug-eluting stents.

Coronary Artery Bypass↗
PubMed1992

Capillary and venule proliferation in the healing process of Dacron venous grafts in rats.

A woven, noncrimped graft (made of Dacron and coated with an elastomer) that was 1.5 mm in diameter and 15 mm long was capable of replacing the vena cava in rats. The elastomer mixture consisting mainly of silicone rubber was necessary to bond the woven Dacron fibrils of the woven graft to prevent fraying at the anastomoses and bleeding through the interstices of the lightly woven, fairly high porosity (500) conduit. Sequential histologic studies showed that patency was associated with the ingrowth of small venules and the spreading of endothelial cells from each anastomosis toward the center. Small venules appeared in loose connective tissue, forming a pseudointima 12 days after grafting. This process occurred in the midportion of the graft before pannus endothelial growth covered the endothelial surface. Various thicknesses of the external polymer coat were studied for their influence on healing. None of the grafts developed a thrombus in these latter studies, and regardless of the thickness of the external elastomer, endothelial resurfacing was complete at 30 days. However, the graft with the thinnest external elastomer coating had the best-formed vasa vasorum, and the intima at both the anastomoses and midportions of the graft was significantly thinner than intima found in grafts of other composition. We conclude that this woven Dacron polygraft provides a surface resistant to early thrombosis; that healing occurs mainly by pannus ingrowth, but external and interstitial factors are also important; and that properties inherent in the polygraft wall determine the size of the residual lumen.

Animals↗
PubMedDate not supplied

Angiogenesis in atherosclerosis.

This article reviews studies on the structure, complications and pathogenesis of angiogenesis in atherosclerotic plaques. Although important, this topic has not been studied extensively; the authors present a review of the important information available in the literature. Since angiogenesis has profound clinical complications, the focus is on data which provided information to understand the nature of the vascular structures involved and the sequence of events which led to the initiation and growth of these small vessels in the plaque. This review indicates that it is most likely that the capillaries that first form arise from the vasa vasorum. Since the cell biology literature suggests that angiogenesis is regulated by angiogenic factors which stimulate vascular cell migration and proliferation, the known role of several growth factors and inhibitors is reviewed. It is likely that a complex interaction in the atherosclerotic vessel wall results in angiogenesis, and that further study with purified growth factors and other substances is needed to clarify the pathogenesis of this important biological process.

Animals↗
PubMed1992

The innervation of the great saphenous vein: an immunohistochemical study with special regard to regulatory peptides.

The human great saphenous vein is often used in by-pass surgery. In spite of its importance little is known about the neuronal regulation and innervation of this vessel. On the other hand, therapeutic phlebectomy of the saphenous vein provides a good basis for investigations on the nervous supply of human veins. In former studies the human great saphenous vein has been proved to be a richly innervated portion of the low pressure vascular system. We studied the innervation of the proximal femoral saphenous vein by immunohistochemical methods and with special regard to regulatory neuropeptides. A peptidergic innervation mainly localized along the vasa vasorum and associated with immunoreactivity of substance P and CGRP was found which yields evidence for a mechanosensory innervation of this vascular segment.

Calcitonin Gene-Related Peptide↗
PubMed2003

Temporal arteritis associated with systemic necrotizing vasculitis.

OBJECTIVE: To evaluate the clinical and laboratory characteristics of patients with systemic vasculitis associated with temporal artery involvement. METHODS: From a cohort of 120 patients fulfilling American College of Rheumatology criteria for temporal arteritis, we retrospectively identified 7 patients with systemic necrotizing vasculitis associated with histological temporal arteritis. RESULTS: Among the 7 patients, 2 had classic polyarteritis nodosa, one had unclassified systemic vasculitis, one had Wegener's granulomatosis (WG), and 3 had microscopic polyangiitis. The mean age of the patients was 70.2 years, and cranial symptoms revealed the disease in all but one patient. Temporal arteritis was generally associated with extracephalic manifestations suggestive of systemic vasculitis. Antineutrophilic cytoplasmic antibodies were positive in 3 of the 4 patients with small vessel vasculitis. Pathologically, the main temporal artery was involved in all but one patient, with inflammatory infiltrate of vasa vasorum and adventitia associated in 5 with small tributary involvement. Fibrinoid necrosis was rare, observed in 2 specimens; 2 patients with unclassified systemic vasculitis and WG had a classic giant cell arteritis (GCA) histologic pattern. Only one patient had exclusive involvement of small vessels, surrounding the spared main temporal artery. Muscle biopsies showed histopathological evidence of vasculitis in 2 patients, skin biopsy in one, and vein biopsy in the other. CONCLUSION: Temporal artery involvement in systemic necrotizing vasculitis was generally associated with extracranial clinical features suggestive of systemic vasculitis. Temporal artery biopsy is a simple tool for diagnosis of vasculitis, but the histopathological findings do not always discriminate between necrotizing vasculitis and classic GCA.

Aged↗
PubMed1992

Mycotic aneurysm of the tibioperoneal trunk: case report and review of the literature.

Peripheral mycotic aneurysms can occur when septic emboli lodge in either the lumen or the vasa vasorum of a peripheral vessel. Such aneurysms have become rare after the widespread use of aggressive antibiotic treatment for bacterial endocarditis. We report the case of a large mycotic aneurysm of the tibioperoneal trunk 18 months after an episode of Streptococcus viridans bacterial endocarditis. Treatment included complete resection of the aneurysmal sac with restoration of circulation to the posterior tibial artery with a reversed saphenous vein graft. To our knowledge, this is the first case of a mycotic aneurysm of the tibioperoneal trunk reported in the English literature. It also represents the first case in which a mycotic aneurysm of an infrapopliteal vessel was managed successfully with restoration of circulation.

Aneurysm, Infected↗