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PubMed1991

Pancreas transplant pathology. A morphologic, immunohistochemical, and electron microscopic comparison of allogeneic grafts with rejection, syngeneic grafts, and chronic pancreatitis.

In an effort to establish diagnostic criteria for rejection and recurrent disease in transplanted pancreas, a comparative study was performed based on clinical diagnosis. Clinical rejection was diagnosed in patients who had decreased urinary amylase or increased blood glucose; they were treated for rejection and improved. A clinical diagnosis of recurrent diabetes was made in syngeneic transplant recipients with islet dysfunction. In addition, two control groups were used--nontransplant, nondiabetic pancreatitis patients and pretransplant normal biopsies from patients in the study. Morphologically, tissues were assessed for acinar inflammation, ductal changes, islet and nerve inflammation, and vascular changes. Immunohistochemical staining for insulin and glucagon was also performed to quantitate differences between the groups. Vascular changes (endothelialitis, vasculitis, obliterative endarteritis) were specific for rejection. Also, rejection was characterized by a lymphocytic or mixed infiltrate that involved the ducts. Recurrent diabetes was characterized by selective loss of beta cells with isletitis. Leukocyte common antigen and UCHL1 staining was helpful in identifying islet inflammation. An insulin/glucagon ratio of less than 1.0 appears to be specific for recurrent disease and in the absence of isletitis is a reasonable method for detecting recurrent disease at an early stage.

Adolescent↗
PubMed1991

Significance of nail changes in leprosy: a clinical review of 357 cases.

Leprosy can cause many nail changes, which have been observed in up to 64% of infected patients. The manifestations of leprosy (clinical, bacteriologic, and histological) are profoundly affected by the patient's immunological status, which also determines the prognosis. Nail changes in leprosy can be caused by neuropathy and trauma, vascular impairment, infections, and miscellaneous changes. Often more than one factor will be important. Paradoxically, nail changes in tuberculoid and lepromatous patients are similar, despite wide differences in pathology. This may be because etiological factors common to both are implicated. Factors only associated with lepromatous disease are invasion of the bones of terminal phalanges by lepromatous granulomas and endarteritis occurring during type 2 lepra reactions. Otherwise, the only difference from tuberculoid leprosy is the time of onset and the symmetry of lesions. Lepromatous patients develop nail changes late in the course of disease. The presentation is usually bilaterally symmetrical. However, these changes are not specific to leprosy, and may be observed in other peripheral neuropathies.

Bacterial Infections↗
PubMed1990

[Intermediate and late changes in human cardiac graft].

Chronic rejection, the most serious complication in long-term survivors of cardiac transplantation, was studied in 5 cardiac grafts obtained at retransplantation and in 15 post-mortem studies of patients who had survived 3 months to 10 years after transplantation. The usual clinical presentation was cardiac failure. Coronary angiography was performed in several cases and showed narrowing and non-opacification of small arteries often accompanied by thrombosis. Histology showed three types of vascular rejection: the most characteristic one, usually observed after the 6th month, was a stenosing fibrous endarteritis; another type of rejection, occurring earlier, was associated with acute myocardial rejection and presented as an inflammatory arteritis; the third type of vascular rejection was accompanied by widespread atheromatous lesions. The significance and pathogenesis of these lesions are discussed with respect to the clinical context with electron microscopic and immuno-histochemical data.

Adult↗
PubMed1990

Healing in the irradiated wound.

Poor or nonhealing of irradiated wounds has been attributed to progressive obliterative endarteritis. Permanently damaged fibroblasts may also play an important part in poor healing. Regardless of the cause, the key to management of irradiated skin is careful attention to prevent its breakdown and conservative, but adequate, treatment when wounds are minor. When wounds become larger and are painful, complete excision of the wound or ulcer is called for and coverage should be provided by a well-vascularized nonparasitic distant flap.

Humans↗
PubMed1990

[Pathology of placenta from small for gestational age infants].

Pathologic study was carried out in 125 placentas, of which 25 were from cases of small for gestational age infants (SGA) and 100 from normal pregnancies. Ultrastructural study was done in 5 cases of each group. In the SGA group placenta circumvallata and velamentous insertion of cord were more frequently seen and the percentages of syncytial knots, cytotrophoblastic cells, and fibrinoid necrosis, stromal fibrosis and obliterative endarteritis of chorionic villi were also higher. Deficiency of vasculo-syncytial membranes and unduly thick trophoblastic basement membranes were common features of the SGA placentas. The most significant ultrastructural finding was the spasticity of capillaries of the villous stroma. It is believed that insufficient utero-placental blood flow may lead to the occurrence of SGA infants.

Chorionic Villi↗
PubMed1990

[2 familial cases of homocystinuria one of which revealed by fatal hypertensive encephalopathy].

Two cases in the same sibship are reported. The elder patient, who had posterior dislocation of the lens resulting in glaucoma and significant psychomotor retardation, died at the age of 13 with malignant arterial hypertension. Death was caused by thrombotic events (left carotid artery, coronary vessels, renal arteries and arterioles with fibrous endarteritis). The sister, aged 10, had psychomotor retardation and anomalies of both lenses. Chromatographic studies of serum and urine amino acids confirmed the diagnosis of homocystinuria. The form was pyridoxine-sensitive as shown by the results of therapy with pyridoxine and folates. We suggest that homocystinuria, although infrequent, should be routinely looked for in every child with a thrombotic event since a pyridoxine-folate combination is successful in half the cases, preventing the development of complications especially when initiated early.

Adolescent↗
PubMedDate not supplied

[The use of digital subtraction angiography in diseases of the arteries of the pelvis and lower limbs].

The diagnostic potentialities of digital subtraction angiography (DSA) in diseases of the pelvic arteries and lower limbs were studied. Intravenous (iv) and intraarterial (ia) DSA were performed in 613 patients, among them were patients with obliterating atherosclerosis and endarteritis, thromboembolism, aneurysms and arteriovenous fistulas. Iv DSA provided good information for the solution of therapeutic and tactical problems in pelvic, femoral and popliteal arterial lesions but in 16% of the cases it gave no opportunity to assess the status of the crural arteries. Ia DSA was shown to be no inferior to routine arteriography in the visualization of the lower limb arteries. This method is economical, well tolerated by patients, permits the intensification of examination of patients with acute and chronic arterial pathology. It can be employed under outpatient conditions and in the early postoperative period.

Angiography, Digital Subtraction↗
PubMed1989

[Autologous transfusion of UV-irradiated blood in the treatment of occlusive arterial diseases of the lower extremities].

Complex examination of 72 patients with obliterating atherosclerosis and 10 patients with obliterating endarteritis was performed. All the patients were given autotransfusion of UV-irradiated blood as conservative treatment, preoperative preparation and postoperative management. The course of AUVIB was followed by a decrease of the lactic acid level, increase of functional properties of hemoglobin, activation of humoral immunity, change of the blood hemostatic potential to the side of hypocoagulation. The AUVIB treatment was most effective in patients at initial stages and those with peripheral forms of the disease.

Acid-Base Equilibrium↗
PubMed1989

The woolly monkey (Lagothrix lagothricha): a possible model for human hypertension research.

The anatomical-pathological findings of 15 woolly monkeys were comparable with those described in man with essential benign or malignant hypertension. Kidneys revealed arterio- and arteriolosclerosis or an onion peel-like proliferation, in some cases necrotizing endarteritis. Obesity due to restricted physical activity, unnatural feeding, and psychical and physical stress could have contributed to the development of this condition. Further, high vulnerability of the genus woolly monkey is postulated. Thus, essential hypertension of woolly monkeys appears to be a multifactorial disease.

Animals↗
PubMed1978

Pathology of the heart in Kawasaki disease.

Pathologic studies were done on 20 hearts of patients who had typical clinical signs and symptoms of Kawasaki disease. The cardiac lesions were classified according to the duration of illness at the time of death. Stage I (zero to nine days) was characterized by acute perivasculitis and vasculitis of the microvessels (arterioles, capillaries, and venules) and small arteries, and acute perivasculitis and endarteritis of the three major coronary arteries (MCAs). Pericarditis, myocarditis, inflammation of the atrioventricular conduction system, and endocarditis with valvulitis were also present. Stage II (12 to 25 days) was characterized by panvasculitis of the MCAs and aneurysm with thrombus in the stems. Myocarditis, coagulation necrosis, lesion of the conduction system, pericarditis, and endocarditis with valvulitis were also present. In stage III (28 to 31 days), granulation of the MCAs and disappearance of inflammation in the microvessels were noted. Patients in stage IV (40 days to 4 years) had scarring with severe stenosis in the MCAs. Fibrosis of the myocardium, coagulation necrosis, lesions of the conduction system, and endocardial fibroelastosis were also present. The features observed revealed Kawasaki disease to be acute and inflammatory. The angiitis begins in the microvessels and fibrinoid necrosis of the media is rare. The disease is one with a pathologic pattern previously unknown.

Atrioventricular Node↗
PubMed1989

[Osteoradionecrosis. I. Etiology, pathogenesis, clinical aspects and risk factors].

In curative therapy of mouth-cavity and oropharyngeal carcinomas the osteoradionecrosis has to be accepted as a calculated risk with an incidence of 4-35%. It is the question of a radio-caused bone death that comes about by progressive and irreversible morphological alterations at bones and at vessels: Loss of osteocytes, active osteoblasts and osteoclasts (hypocellularity), injury of normal bone metabolism, slackening of regeneration process, extreme susceptibility to infections of the devitalized bone, radio-induced obliterating endarteritis with hyalinization, thrombosis and fibrosing of vessels, obliteration of the lumen and gradual reduction of blood-supply at the level of tissue (hypovascularity and hypoxemia: Aseptic osteoradionecrosis, radio-osteonecrosis). If there is a secondary infection of dental, periodontal or traumatic origin additionally, the condition explodes as septic osteoradionecrosis with the symptoms and findings of radio-osteomyelitis. The osteoradionecrosis begins more frequently in the mandibula than in the maxilla. The cumulative incidence is 30% after 6, 60% after 12, and more than 80% after 24 months. The duration of osteoradionecrosis follows an exponential curve with constant probability of necrosis termination at any moment after necrosis event in which the monthly probability of necrosis healing is nearly 0.06. Risk factors for formation of an osteoradionecrosis are tumor neighbourhood to bones and teeth, tumor and mandibula dosis, tumor stage, irradiation technique, status of teeth as well as moment and carrying out of tooth extractions. Tumors in neighbourhood of mandibula have a fivefold higher risk, with 80 Gy irradiated patients a 2.9-fold and toothed patients a 2.6-fold, altogether high-risk patients have a 17.7-fold higher necrosis risk than low-risk patients. Promoting factors are caries, parodontosis, a periapical pathology, a trauma, irritation by artificial teeth, elective tooth extraction before irradiation, tooth extraction after irradiation as well as jaw operations because of remains or recurrence of the tumor.

Humans↗
PubMed1989

[Pathogenesis of atherosclerosis: an update on the three main theories].

The causes and mechanisms of atherosclerosis remain incompletely understood. Almost all the present investigations are still connected with one of the main three historical theories of atherosclerosis: 1) the incrustation theory, as developed by von Rokitansky, has now led to the many studies on the roles of thrombosis and platelets; 2) the irritation theory, as opposed to the preceding one by Virchow and his school, is reviving through the rediscovery that leukocytes are present in the plaques, and that atherosclerosis (Virchow's endarteritis chronica deformans sive nodosa) has the features of a chronic inflammatory reaction; 3) the lipid infiltration theory, as initiated by the experiments of Anitschkov and Chalatov in rabbits fed a cholesterol enriched diet, motivates the huge mass of studies devoted to plasma lipids and their cellular metabolism. This article provides a brief update on each of these three complementary approaches of atherosclerosis.

Animals↗
PubMed1989

[Peptic ulcer in the elderly].

The Authors, after having reviewed all the literature on this topic, have studied all patients over 60 which were admitted with a diagnosis of peptic ulcer disease at the Institute of Surgical Pathology of the University of Pavia from January 1, 1974 until December 31, 1985. They noted, from their results, that this disease shows a predilection for adults, but is also frequently found in the elderly. In fact, in the latter, during this period of life, the complications which are most frequently observed (especially gastric) are hemorrhage and perforation; according to the Authors the former is due to arteriosclerosis which hinders vascular contraction, while the latter to a reduction of blood flow due to endarteritis, which causes necrosis of the ulcer's base, creating therefore a "locus minoris resistentiae". The Authors conclude that in the elderly, when drug therapy is inefficient, a surgical approach is necessary. In fact, with a well followed pre-operative care program the outcome of surgery is usually satisfactory and complications (mentioned above), which would render surgery and the post-operative period difficult, are prevented.

Age Factors↗
PubMed1989

[Chronic cor pulmonale due to granulomatous and obliterating pulmonary arteritis caused by schistosomiasis].

Among 3,125 autopsies undertaken at the Department of Pathology of the "Américo Boavida" Hospital in Luanda, from January 1976 to March 1987, we recorded four cases of children with schistosomiasis. Macroscopically, we observed Symmers type periportal fibrosis and chronic cor pulmonale secondary to schistosomiasis of liver and spleen. Histological examination of the lungs revealed granulomatous arteritis, obliterating segmental endarteritis and multiple schistosoma granulomas in the parenchyma. Pulmonary hypertension had caused secondary changes to arteries, such as subendothelial fibrosis and hypertrophy of the media.

Arteries↗
PubMed1985

[Anatomic and nosologic analysis of 100 cases of diffuse angiitis seen in rheumatology].

Diffuse inflammatory angiitis is seen in extremely varied aetiological and nosological situations. In some cases, the vascular disease represents the only sign of systemic disease. In other cases, it mays be associated with or complicated by diffuse systemic inflammatory conditions. This study analysed 100 cases of inflammatory angiitis with systemic manifestations seen over a period of 7 years in a rheumatology department. Patients with scleroderma, erythema nodosa, Behçet's syndrome and angiitis associated with microbial infectious diseases were excluded from this study. 24 cases in which the angiitis was clinically certain, but in which the vascular lesion was not confirmed histologically were also excluded. The type of histological lesion and the nosological distribution of these 100 cases are described in detail. The results of this analysis confirm the very great variety of the clinical and histological presentations. A number of rare syndromes were observed. Classical periarteritis nodosa only represented 14 per cent of the whole series and only 3 of the 14 cases had a demonstrable aetiology (2 HBs, 1: desensitisation to Candidin). The authors stress the histological diversity of inflammatory angiitis associated with rheumatoid arthritis and systemic lupus erythematosus. All sizes of vessels may be involved and all types of lesions can be observed in these two diseases. The authors also emphasise the lesser known clinical and histological features (stenosing endarteritis of the great vessels in systemic lupus erythematosus) and previously unreported cases (valvular lesions in 2 cases of Mac Duffie's syndrome, progression of 2 cases of delayed urticaria to pressure towards a clinical lupus with unusual laboratory findings).(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1977

Observations on vascular neuropathies.

A series of autopsy studies is presented of 13 cases of obliterative vascular disease of the vasa nervorum in a wide range of conditions, including polyarteritis nodosa, Wegener's granulomatosis, lymphomatoid granulomatosis, polymyositis and rheumatoid arthritis. In most cases, including 1 of rheumatoid neuropathy, the lesions were of the necrotising type. This supports the concept of polyarteritis nodosa as a pattern of reaction common to several diseases rather than that of a specific nosological entity. The remaining 4 cases of rheumatoid neuropathy, were associated with a bland endarteritis known as Bywater's arteritis. A comparison of these autopsy findings with clinical data and observations on sural nerve biopsies leads to the conclusion that all severe and most of the mild cases of rheumatoid neuropathy are due to occlusive vascular disease. Segmental demyelination independent of vascular lesions may be responsible for some of the mild cases and is frequently found in patients without clinical neurological manifestations.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Chronic rejection in human heart transplantation.

The more prevalent complication in patients with a long survival rate after heart transplantation is chronic rejection, which was studied in a series of 80 necropsies and five cardiac grafts surgically removed for retransplantation after chronic rejection. In the material obtained at necropsy, 11 of 14 patients with a survival rate of more than 6 months died from chronic rejection. Clinically, the usual manifestation was heart failure. Anatomic angiograms were performed in several cases. They demonstrated narrowing and nonopacification of small coronary arteries, often accompanied by thrombosis and ischemic complications. The histologic study detected three types of rejection. (1) The more typical rejection is observed after 6 months. It is characterized by a stenosing fibrous endarteritis. (2) Another type of rejection occurs earlier and is associated with acute rejection; its anatomic substratum is an inflammatory panarteritis. (3) This type of rejection is accompanied by large atheromatous deposits. The significance and pathogenesis of these lesions are discussed in correlation with their clinical context and with the electron microscopic observations.

Adult↗
PubMed1987

Osteonecrosis, fractures, and protrusio acetabuli secondary to x-irradiation therapy for prostatic carcinoma.

Two years after pelvic irradiation for prostatic cancer, bilateral protrusio acetabuli and collapse of the right femoral head requiring prosthetic arthroplasty developed in a 73-year-old man with chronic rheumatoid arthritis. There was no evidence of metastases. Histologic evaluation showed empty lacunae in the bone but no evidence of obliterative endarteritis. Osteonecrosis and pathologic fractures constitute a rare complication of high voltage irradiation.

Acetabulum↗