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PubMed1984

[Acute bilharzial cor pulmonale due to Schistosoma mansoni].

The authors report a cause of acute cor pulmonale caused by Schistosoma mansoni bilharziosis. The clinical feature was a collapse with right ventricular failure following a delivery. The hemodynamic exploration showed a pre-capillary and supra-systemic pulmonary hypertension. The histopathologic study in post-mortem showed pulmonary lesions of fibrosis endarteritis with granulomatosis reaction round many eggs of Schistosoma mansoni. The authors discuss the frequency of various anatomic lesions (20, 30%), hemodynamic (20%) and clinical (2,5%) of the pulmonary bilharziosis. They recall the anatomical and histological mechanisms of the pulmonary artery hypertension in this disease. They emphasize the originality of this observation which is due to its super acute character and its Schistosoma mansoni bilharziosis etiology whereas pulmonary demonstrations are usually due to Schistosoma haematobium.

Acute Disease↗
PubMedDate not supplied

Reversible renal failure secondary to severe compensated aortic regurgitation.

Severe renal failure associated with proteinuria occurred in a 21-year patient, who had massive rheumatic aortic regurgitation. There was no sign of congestive heart failure or extra-cellular dehydration. Subacute bacterial endocarditis was ruled out by appropriate laboratory investigations. Prosthetic aortic valve replacement resulted in normalization of the renal function and marked reduction of proteinuria. Renal histology showed severe sclerotic endarteritis involving predominantly the large arteries, and membrano-proliferative-like glomerulopathy without immune deposits. The role of the massive aortic regurgitation in the production of renal failure and histologic alterations is suggested.

Acute Kidney Injury↗
PubMedDate not supplied

[Antenatal cerebral artery occlusions (4 new cases)].

Cerebral arterial occlusion, occurring during monozygotic twin pregnancies, is a well known entity, specially when one twin is stillborn or macerated. Most of the authors consider that the aetiology is either embolization from the dead fetus or intravascular coagulation causing embolization in the surviving co-twin via placental vascular connections. Some data suggest an infectious endarteritis on the basis of angiographic and histological findings. Clinical features may appear several weeks after birth. CT scan and pathological findings depend on the date of the arterial occlusion. Four recent cases are described, two of them concerning monozygotic twin pregnancies. Pathological, CI scan, clinical features and pathogenesis are discussed taking account of the others data in the literature.

Arterial Occlusive Diseases↗
PubMed1984

[66% glucose, a safe sclerosant. Experimental study].

Although accidents due to the intra-arterial injection of detergent sclerosant are very rarely observed, they are dramatic in their effects and often result in amputations, a risk accepted with difficulty for a treatment with a functional aim. To avoid these incidents, which may occur even when treatment is applied by the most experienced surgeons, the authors have used 66% glucose solution without accident since 1948. To confirm efficacy of the method, an experimental study compared 66% glucose (66 G) with a very commonly used product, 1% sodium tetradecyl sulfate (STD), in the rabbit. Except when enormous doses of 66 G are employed, the only effect noted was eosinophilic necrosis of the vessel wall without clinical symptoms, whereas doses eight times lower of STD produced an irreversible ischemia from obliterating endarteritis of the branches of the vascular tree injected. The 66% glucose solution appears to be a very safe, gently acting sclerosant, and the product of choice for peri- and post-operative sclerosis, particularly in regions where accidental arterial puncture is anatomically possible.

Animals↗
PubMed1981

Hyperbaric oxygen therapy with subtotal extirpation surgery in the management of radionecrosis of the mandible.

Radiation-induced obliterative endarteritis causes ischemia and hypoxia in tissue wounds, making them prone to dehiscence, infection and delayed healing. The successful use of hyperbaric oxygen as an adjunct to intensive antibiotic and surgical therapy in the treatment of radionecrosis of the mandible is well established. This report details our experience in four cases of radionecrosis of the mandible of long duration, prior to acceptance of the patients into our hyperbaric oxygen protocol.

Aged↗
PubMed1982

Use of the bulbocavernosus muscle (Martius procedure) for repair of radiation-induced rectovaginal fistulas.

Radiation-induced fistulas of the vagina are rare, occurring in only 1 of 3% of patients treated for cancer of the uterine cervix. Primary surgical repair of these fistulas is usually unsuccessful because the defect is a result of devascularization. This type of radiation injury results from endarteritis obliterans, and successful repair requires an accessory blood supply. From 1971 to 1980, the authors performed 14 Martius procedures on 12 patients with radiation-induced rectovaginal fistulas. Eleven patients had successful closure of their fistulas using this procedure, and no operative complications occurred. The Martius procedure is effective for most radiation-induced vaginal fistulas, and the operation is well tolerated by most patients.

Adult↗
PubMed1980

[Clinical variants of chronic ischemic syndrome of the lower extremities].

Analysis is made of 1,014 cases with occlusive lesion of the bifurcation of the aorta and iliofemoral segment in patients with chronic ischemic syndrome of the lower limbs. The cause of high arterial occlusion with atherosclerosis in 95.5% of patients and nonspecific aortitis in 12 cases. A group of 20 patients with selective lesion of the femoral segment, which is distinguished from atherosclerosis obliterans, endarteritis with ascending thrombosis, and nonspecific aortitis by its clinico-angiographic and morphological manifestations, was analyzed in detail. This form of arterial occlusion is called "segmental thromboarteritis". The results of reconstructive operations in most patients with "segmental thromboarteritis" proved unfavourable.

Adult↗
PubMedDate not supplied

Fatal primary pulmonary hypertension in mixed connective tissue disease.

The clinical history and autopsy findings are reported of a 23 year old woman who had symptoms of mixed connective tissue disease (MCTD) for 4 years, and who died suddenly from pulmonary hypertension due to proliferative endarteritis of the lung vessels. These arterial lesions resembled those in progressive systemic sclerosis. Children and adolescents with MCTD appear to have an increased risk for getting this complication. The fatal outcome of pulmonary hypertension in MCTD as shown in this and other cases seems to warrant treatment with immunosuppressive drugs.

Adult↗
PubMed1981

[Giant-cell vasculitis (arteritis and phlebitis)].

Vasculitis was detected in 5 patients although not in the temporal artery but in vessels of other localizations: subcutaneous veins of the lower extremities (an adolescent of 17 and a man of 41), cardiac and renal arteries (a man of 32), gall bladder artery (a woman of 72), veins of the spermatic cord (a man of 28). Giant cells formed in granulomatous reaction, most frequently in the intima of the vessel or close to it in such nosological forms as endarteritis, periarteritis nodosa, obliterating thromboangiitis (Buerger's disease). A hypothesis is suggested concerning the etiological role in the development of giant cell vasculitis of chemical haptens (xenobiotics), protozoa, possibly bacteria and viruses.

Adolescent↗
PubMed1995

Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings.

PURPOSE: To evaluate and describe the neuroimaging findings of patients with neurosyphilis. METHODS: The neuroimaging studies of 35 patients with documented neurosyphilis were reviewed. Diagnosis was established in 34 patients with cerebrospinal fluid for a Venereal Disease Research Laboratory test, complemented by autopsy in 1 and brain biopsy in 1. All patients had reactive fluorescent treponemal antibody tests with absorption in their sera. Imaging studies included plain and contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, MR angiography, and conventional angiography. Imaging findings were also correlated with the relevant pathologic findings at autopsy in three additional patients with neurosyphilis who did not have brain imaging studies. RESULTS: Of the 35 patients with imaging studies, 32 tested human immunodeficiency virus (HIV)-seropositive, and 3 were HIV-seronegative. Eleven (31%) of 35 patients had normal radiographic findings. Cerebral infarctions were seen in 8 (23%) of 35 patients, and nonspecific white matter lesions in 7 (20%) of 35. Cerebral gummas and extraaxial enhancement indicating meningitis were noted in 2 (6%) of 35 patients, respectively. Arteritis was demonstrated in 2 (50%) of 4 patients who underwent either MR angiography or conventional angiography. The 3 subjects who had autopsy but not imaging studies were found to have manifestations of meningovascular syphilis, including syphilitic leptomeningitis and an obliterative endarteritis. CONCLUSION: We conclude that findings of vascular occlusive disease manifested as infarction or arteritis, enhancing cortical lesions with or without adjacent meningeal enhancement, focal or diffuse extraaxial enhancement, and white matter disease, although nonspecific, in the proper clinical setting should prompt appropriate testing for neurosyphilis, a treatable disease, in patients with and without HIV infection.

AIDS Dementia Complex↗
PubMed1994

[Sneddon syndrome].

Sneddon's syndrome is a rare disease characterised by cerebrovascular ischaemic attacks and generalised livedo. Since previous observations, other symptoms were described: involvement of heart, of kidney, arterial hypertension, complicated obstetric or gynaecologic history in women. Prognosis is highly variable, depending on extent and speed of progression of cerebrovascular changes, which can lead to severe permanent mental deterioration. In livedo, histopathology shows pathological changes of small to medium-sized dermal arteries in a distinct time sequence: an early phase localized in endothelium followed by a late fibrotic phase. No specific laboratory findings are found. Recently some cases were reported in association with antiphospholipids antibodies. The etiopathogeny of Sneddon's syndrome is still unknown and could result from different processes: progression to an autoimmune disease such as lupus erythematosus, primitive endarteritis obliterans, or a new clinical expression of the antiphospholipid antibodies syndrome. At present, none of the therapeutic modalities provides significant improvement.

Cerebrovascular Disorders↗
PubMed1976

[The role of thrombosis in renal allograft rejection (author's transl)].

Platelets and intravascular coagulation are involed in the pathogenesis of renal allotransplant rejection phenomena: fibrin deposition is a prominent feature of hyperacute rejection; arteriolar microthromboses when they are present, worsen the prognosis of an acute reversible rejection; the organisation of platelets and fibrin deposits on the intima may lead to the "endarteritis obilterans" of chronic bascular rejection. The interactions between endothelium, platelets, coagulation, fibrinolysis and cellular or humoral effectors of the immune respone were studied and special reference was made to their role in vascular rejection. The poor prognosis in vasuclar lesions justifies therapeutic trials with drugs inhibiting the early events of thrombogenesis.

Acute Disease↗
PubMed1994

[Inflammatory abdominal aortic aneurysm].

Inflammatory abdominal aortic aneurysm (IAAA) is a distinct clinicopathological entity, characterized by: (1) clinical presentation, such as back pain, weight loss, and increased ESR, (2) patchy and/or diffuse lymphoplasmacytic infiltration, and (3) marked periaortic fibrosis resulting in thickening of the aneurysmal wall and occasional retroperitoneal fibrosis. Its pathogenesis is unknown, but some authors support the theory that IAAA is a subtype of atherosclerotic abdominal aortic aneurysm because of close relationship between IAAA and atherosclerotic change. In this article, we describe clinical and histological features of IAAA on the basis of the literature and our review of 6 cases of IAAA, emphasizing the similarity and difference between IAAA and atherosclerotic abdominal aortic aneurysm. Our review supports that marked lamellar fibrosis completely replacing the media and adventitia, patchy lymphocytic infiltration (mostly B cells) and endarteritis obliterans are characteristic features of IAAA.

Aorta, Abdominal↗
PubMed1994

A case of radiation-induced rectal cancer developing after a long-term follow-up.

A case of radiation-induced rectal cancer is presented. In November, 1971, a 58-year-old woman had a stage II squamous cell carcinoma in the uterine cervix. She underwent a hysterectomy and postoperative radiotherapy. External pelvic irradiation of 10 MV x-ray was carried out in 15 fractions of 2 Gy daily, with a total dose of 30 Gy, and intracavitary radium insertion with a total dose of 960 mg hours (20 mg x 48 hours). She had been followed-up in our department since 1972, when rectal bleeding occurred. Proctoscopy and periodical biopsies were performed when the patient visited our hospital. There was no evidence of malignant tumor cells nor of recurrent cervical cancer from 1973 to 1989. In August, 1990, a biopsy specimen taken from a rectal ulcer revealed a malignant mucinous adenocarcinoma. The time interval between the radiotherapy and the development of the rectal cancer was 19 years. Microscopically, the main lesion was situated in the granulation tissue covered with the regenerating mucosal epithelium, and histologically was found to be a mucinous adenocarcinoma. Other radiation damage was additionally found including colitis, endarteritis and intestinal wall fibrosis. The evidence strongly suggested the present case to be one of radiation-induced rectal cancer.

Adenocarcinoma, Mucinous↗
PubMed1994

[Post-radiation duodenal ulceration treated with hyperbaric oxygen].

Radiation enteric disorders are rare and difficult to treat. A case of radiation duodenitis treated by hyperbaric oxygen is reported. A sixty-year-old man underwent right nephroureterectomy, chemotherapy (platin and 5 fluorouracil) and radiation therapy (54 Gy) for excretory urinary carcinoma. Six months later, even though he was under omeprazole therapy for reflux oesophagitis, he experienced antroduodenitis, duodenal ulceration, and duodenal telangiectasia. Symptoms and duodenal ulcer disappeared 2 months later with hyperbaric oxygen (10 one hour sessions at 2 ATA). Most likely, hyperbaric oxygen can reduce the consequences of obliterative endarteritis due to irradiation, responsible for ischaemia and fibrosis later on.

Aged↗
PubMed1994

[Ileal perforation in 3 cases of Behçet disease].

Digestive manifestations are uncommon in Behçet's disease. The authors reported 3 male patients between 20 and 30 years with Behçet's disease who developed surgical abdomen. Emergency surgical intervention found perfored ileal ulceration. Histological study of resection piece showed mainly intestinal angitis with periphlebitis, venous thrombosis and obliterant endarteritis.

Acute Disease↗
PubMed1993

[Neonatal thrombosis of the aortic arch].

The authors report a case of aortic arch thrombosis in a neonate probably related to perinatal placental emboli. However the finding of a fibroblastic endarteritis raised the possibility of a primitive lesion of the aortic wall. The evolution was complicated by cerebral ischemia. A surgical thrombectomy was performed. The outcome was favourable with persistence of a moderate right motor deficiency at 9 months. The authors advise the addition of an enlargement patch and the use of anticoagulation therapy in case of intimal lesion or very adherent thrombus.

Aorta, Thoracic↗