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Peripheral pulmonary arterial disease sometimes associated with immature filariae (larvae) was found in 5 dogs in which infestations of D. immitis were considered to be relatively recent. Gross and histological arterial lesions were similar to the endarteritis described in association with adult filariae. No adult filariae were associated with these peripheral lesions.
This report describes the lesions seen in an extremely weak and emaciated adult male loggerhead turtle (Caretta caretta) found stranded near Perth, Western Australia. Blood collected from a dorsal cervical sinus immediately prior to euthanasia demonstrated severe anaemia, markedly elevated plasma concentrations of creatinine kinase (2263 U/L), alkaline phosphatase (58 U/L), urea (18.1 mmol/L) and hypoglycaemia (glucose 0.7 mmol/L). Necropsy examination demonstrated a severe chronic osteoarthritis of the right shoulder joint with marked remodelling of the glenoid fossa, coracoid, scapula and humerus. There was marked synovial effusion and periarticular fibrosis. Cytological examination and culture of synovial fluid failed to demonstrate an infectious agent. Other findings were low numbers of trypanorhynch cysts present on the surface of the liver and numerous spirorchid eggs in the attached mesentery. Several large and small spirorchid flukes were present in the heart and there was a localised endarteritis in the left aortic arch associated with this infection. Numerous nematode eggs and at least three species of spirorchid eggs were seen microscopically in faeces collected from the terminal colon. The pathogenesis and significance of these lesions is discussed.
Eight hundred and four patients with persistence of the ductus arteriosus were seen in Edinburgh between 1940 and 1979. Thirty-seven of them reached the age of 50 years, and in 32 the shunt was exclusively from left to right. Fifteen of the 32 were subsequently treated surgically. None of the 32 was lost to follow-up. Duration of clinical observation averaged 17 years and extended to over 30 years in eight patients. Their features have been correlated with those from reports of 48 comparable patients in an attempt to clarify the management of the persistent ductus in the older patient. Impairment of left ventricular function is shown as the major risk, even when the ductus is small. Bacterial endarteritis is infrequent. Surgical treatment carries greater risk than in childhood and early adult life but usually reduces heart size and restores exercise tolerance. Left ventricular dysfunction, however, occasionally vitiates the benefits; symptoms are then incompletely relieved and death from heart failure may occur months or years after operation. Experience in older patients thus emphasises the value of elective operation in childhood, however well the child, however trivial the shunt. It is concluded that in older patients, the presence or the development of symptoms or cardiac enlargement are almost always indications for surgical treatment. As age increases, especially by the eighth decade, medical treatment may be preferable. Continued follow-up of symptomless patients without cardiomegaly is important because increase in heart size usually precedes further deterioration which can then be prevented by timely surgical treatment.
Pulmonary venous atrial stenosis developed after a modified Senning procedure in an infant with transposition of the great arteries. The pulmonary venous atrium was surgically revised, but the obstruction recurred. The stenosis was then enlarged by percutaneous balloon catheter dilatation. There was an immediate haemodynamic and echocardiographic improvement. Clinical and echocardiographic improvement persisted nine months after dilatation. The procedure was complicated by staphylococcal endarteritis.
A lesion of the lumbo sacral plexus may result from an inadvertent intra-arterial injection of vasotoxic drugs into one of the gluteal arteries. Symptoms and follow-up of three cases are reported. The neuropathy is attributed to a toxic endarteritis with retrograde propagation of spasm and thrombosis. Swelling an bluish discoloration of the buttocks ("embolia cutis medicamentosa") as well as an impaired circulation in the homolateral leg are associated with the neurological syndrome in fully developed cases and makes possible a correct diagnosis.
A 48-year-old man presented with a vertical gaze palsy associated with secondary syphilis. It is suggested that the eye movement disorder is due to syphilitic endarteritis in the mesodiencephalic region.
We present a case of a female patient with monosomy of X chromosome in peripheral lymphocytes and skin fibroblasts, normal ovarian function and associated multiple congenital abnormalities of the aorta: bicuspid aortic valve, dilatation of the ascending aorta and multiple cystic structures of the aortic wall, complicated by endarteritis. We review the literature on fertile women with 45,X karyotype and the possible pathogenetic mechanisms of the aortic defects described as 'cystic medial necrosis of the aorta'.
A man aged 31 presented to hospital with acute onset of weakness in the legs, sensory loss, and disturbance of bladder and bowel function. Incomplete Brown-Séquard syndrome secondary to meningovascular syphilis of the spinal cord was diagnosed after serological tests for syphilis gave positive results. His condition was probably caused by endarteritis of the arteria radicularis magna of Adamkiewicz. He was treated with procaine penicillin 1.8 MIU intramuscularly once a day and probenecid 0.5 g by mouth three times a day for 21 days followed by physiotherapy and rehabilitation. Considerable neurological recovery was expected. To our knowledge this association has not been reported previously in detail in an English publication.
A patient in whom asthma preceded the development of multiple pulmonary and systemic artery aneurisms died after dissection of the aorta. At necropsy he was found to have widespread arteritis of unknown aetiology affecting many large and medium-sized pulmonary and systemic vessels as well as a few microscopic ones. Endarteritis obliterans was present in some of the vasa vasorum. The clinical and histopathological findings are discussed in relationship to other known causes of arteritis, and it is concluded that this condition has not previously been described.
Vascular complications of neurocysticercosis are common, but frequently not recognized. Mostly these are in the form of an endarteritis involving the smaller basal vessels due to basal exudates. Large vessel territory infarction has been clearly documented in not more than 10 cases. All these cases had either a chronic meningeal state or close proximity of cysts to the vessel wall explaining the vasculitis. We report a case that developed anterior as well as segmental middle cerebral artery territory infarction in the acute encephalitic state of neurocysticercosis. MR angiography showed constriction in the proximal segment of the right anterior cerebral artery. There was no biochemical or imaging evidence of a meningeal reaction. In vivo MR spectroscopy over the infarction showed absent N-acetyl-aspartate, low creatine and high lactate. This is the first case showing a large vessel territory infarction in the encephalitic state of neurocysticercosis, with no meningeal reaction. Focal arteritis due to an adjacent brain parenchymal reaction could be a possible mechanism for the vasculitis. MR spectroscopy may have a potential role in assessing tissue viability and therapeutic modalities in such infective vasculitis.
Prosthetic grafts have become an acceptable alternative to the autogenous arteriovenous dialysis fistula. The major drawback in their use for the dialysis patient is infection. We present a case of infected polytetrafluoroethylene arteriovenous fistula (endarteritis) with signs of unilateral splinter hemorrhage, Janeway lesions in the affected limb and septic venous embolization to the lungs. The graft eventually ruptured requiring emergency surgery. Staphylococcus aureus is by far the most common implicated organism. An otherwise non-threatening infection at a fistula site can lead to more serious complications such as infective endocarditis.
Four children aged 6 months to 9 years received fully HLA-mismatched ABO identical small intestinal allografts. In order to monitor the rejection process and to study epithelial changes induced by intestinal T cells activated by an allogeneic reaction, iterative biopsies were performed through the ileal enterostomy and processed for histology and immunohistochemistry. Episodes of acute histological reaction were observed in all 4 patients between day 10 and 160. It was preceded by appearance of pericryptic CD3+CD4+ or CD8+ T cells of recipient origin, increasing numbers of which expressed CD25. Simultaneously, early epithelial changes were noted: increased HLA-DR expression by enterocytes and decreased mitotic rate as shown by decreased numbers of KI67+ cells in crypts. During acute histological rejection, massive infiltration of mucosa by CD25+CD3+ T-cells and activated macrophages (KIM6+CD25+), was associated with crypt necrosis and then, destruction of surface epithelium. Successful treatment of graft rejection episodes with antilymphocytic serum (2), anti-CD3 monoclonal antibody (2), anti-CD25 monoclonal antibody (1) resulted in a rapid decrease of CD3+ cells, a more progressive decrease of CD25+ and KIM6+ macrophages, reappearance of KI67+ cells in crypts followed after a variable delay by recovery of villous architecture. Chronic histological rejection was observed in 1 patient after 7 months. It was characterized by total villous atrophy, fibrosis, endarteritis, infiltration of lamina propria and epithelium by CD3+CD8+ cells, a small number of which CD25+, strong HLA-DR expression by crypt and surface epithelium, increased numbers of KI67 enterocytes. Altogether these data suggested that activated T cells can induce two types of villous atrophy.(ABSTRACT TRUNCATED AT 250 WORDS)
Three patients with cysticercosis developed a cerebral infarct secondary to the occlusion of the middle cerebral artery or its major branches. Histopathologic examination revealed a large subarachnoid cysticercus surrounding the occluded arteries in two patients and diffuse thickening of the leptomeninges in one. Blood vessels around the parasite showed inflammatory changes that caused either occlusive endarteritis or thrombosis due to disruption of the endothelium. Cysticercosis should be considered as a cause of occlusion of the major intracranial vessels, particularly in young patients living in areas where this disease is endemic.
Six patients with subacute cor pulmonale due to tumor embolization to the lungs were reported from China. Five of the 6 patients suffered from progressive unrelenting dyspnea; 4 had completely normal cardiopulmonary findings on physical examination. Four of the 5 patients who had chest roentgenograms showed diffuse bilateral mottling of the lungs with no evidence of cardiomegaly. At autopsy right ventricular hypertrophy was present in all. The pathologic findings in the lungs consisted of multiple microscopic tumor emboli distributed diffusely in the pulmonary arterioles and/or perivascular lymphatics; the lumen of these vessels was obliterated with or without hyperplastic endarteritis. Although the outcome of this not uncommon clinicopathologic entity is generally fatal, early diagnosis followed by prompt effective therapy for the underlying primary neoplasm has been reported to prolong survival.
Eighteen patients had free jejunal reconstruction of the pharynx and cervical esophagus following pharyngoesophagectomy for malignant tumors. Four patients had no radiation therapy, four had postoperative radiotherapy, and ten had preoperative radiotherapy. Comparison of complication rates indicated no increased risk of complication in patients receiving 6,100 to 6,400 rad of postoperative radiotherapy. Patients having preoperative radiotherapy had a higher incidence of graft failure due to vessel thrombosis, suggesting that radiation endarteritis may increase the risk of graft failure.
Recombinant human interleukin-4 (rhuIL-4) is a candidate for the treatment of refractory cancer based on its potential to enhance the function of the immune system. Total daily dosages of 0 (placebo control), 1, 5, or 25 micrograms/kg of rhuIL-4 were given as divided (b.i.d.) subcutaneous dosages to male and female cynomolgus monkeys (5/sex/group) for 1 month followed by a 2-week recovery. Histomorphologic evaluation of 3/sex/group at 1 month revealed vascular lesions, granulocytic hyperplasia, and seminiferous tubular atrophy attributed to treatment with rhuIL-4. Dosage-dependent proliferative and inflammatory vascular lesions with eosinophil infiltration affected principally the arterial tree. After 2 weeks of recovery, these lesions, including chronic endarteritis and chronic and/or obliterative arteritis, occurred with an overall lower incidence, and were not observed for monkeys from the 1.0 micrograms/kg/day group. Granulocytic hyperplasia in bone marrow observed for monkeys from all groups given rhuIL-4 at 1 month was not present after 2 weeks of recovery. Seminiferous tubular atrophy was observed for monkeys from the 5 and 25 micrograms/kg/day groups at 1 month and after 2 weeks of recovery.
Eleven cats with spontaneous dirofilariasis were necropsied; ten were domestic shorthairs and one was a Persian. The cats ranged in age from 1 to 10 years, and 6/11 cats were male. One to three heartworms were present in the right ventricle and pulmonary arteries of each of the 11 cats. Patchy areas of rugose thickening of the intima of the pulmonary trunk and marked villous endarteritis of lobar and medium-sized pulmonary arteries were observed. Affected larger vessels were partially occluded by large villous intimal proliferations that were lined by hyperplastic endothelial cells supported by connective tissue stroma. Moderate to marked infiltration of eosinophils and mononuclear inflammatory cells was consistently observed in the intima of affected larger pulmonary arteries. Thrombosis of pulmonary arteries was seen in five cats. Medial hypertrophy, mild intimal proliferative changes, and focal infiltrations of leukocytes were seen in small pulmonary arteries. Lesions indicative of right-sided heart failure consisting of right ventricular dilation and chronic passive congestion of the liver were observed in four cats.
In three cases of cerebral amyloid angiopathy there was also a chronic cerebral vasculitis characterized by segmental fibrinoid necrosis, chronic adventitial inflammatory infiltrates, obliterative "endarteritis" and hyaline arteriolar change, resembling rheumatoid vasculitis. Two of these cases had rheumatoid arthritis, and one had unspecified "arthritis" at the onset of dementia. Both vasculitis and amyloidosis involved the leptomeningeal and cerebral cortical vessels. In the two autopsy-verified cases, the vascular disease was limited to the brain. In the third case, only a brain biopsy was available. Amyloid-containing neuritic plaques were present in the cerebral cortex in all three cases, but they were abundant only in one, which also showed numerous Alzheimer tangles.