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PubMed1994

[A case of ruptured left ventricular aneurysm due to syphilitic myocarditis].

This case involved a 20-year-old male who on May, 14, 1992, lost consciousness while working and went into a state of shock. He was taken to a hospital, where cardiac tamponade was diagnosed. He was later transferred to this hospital. Based on the results of echocardiography, coronary arteriography and left ventriculography, a ruptured ventricular aneurysm was diagnosed. The patient underwent emergency surgery. Serologic tests for syphilis performed at admission were definitely positive. Histopathological examination of the wall of the ventricular aneurysm disclosed fibrous myocarditis and peripheral coronary endarteritis accompanied by infiltration of plasma cells and lymphocytes. Immunohistological study revealed treponeme in the histiocytes of the aneurysmal wall. The diagnosis was a ruptured ventricular aneurysm caused by syphilitic myocarditis. Since the advent of penicillin therapy, cardiovascular syphilis, particularly syphilitic myocarditis, has become a rare disease. The chief interest of this case is that treponeme was detected in the lesion of myocarditis.

Adult↗

PubMed1993

Pulmonary tumor embolism to arterial vessels and carcinomatous lymphangitis. A comparative clinicopathological study.

A prospective study of 222 consecutive autopsies of cancer cases was undertaken to investigate whether carcinomatous lymphangitis and pure arterial tumor embolism of the lungs are different clinicopathological entities. The lungs were removed as a block and 15 sections (three from each lobe) were analyzed. A protocol containing clinical (ie, dyspnea, cyanosis, right ventricular failure, engorgement of jugular veins, and peripheral edema as main cause of death) and morphological (ie, right ventricle thickness and dilatation, vascular sclerosis, pulmonary infarct) data were carefully recorded in each case. Arterial tumor embolism was detected in 19 cases (8.5%) and carcinomatous lymphangitis in 44 cases (19.8%). We found no differences in relation to signs and symptoms of arterial tumor embolism and carcinomatous lymphangitis, but respiratory distress as the main cause of death was significantly more frequent in the cases with arterial involvement by tumor emboli. Morphologically, however, right ventricular hypertrophy-dilatation, histological signs of pulmonary hypertension, and hemorrhagic infarcts were more prevalent in the cases with arterial tumor embolism. This study permits us to conclude that although arterial tumor embolism and carcinomatous lymphangitis are clinically similar diseases, they are morphologically different entities. Our results suggest that the most probable pathogenesis of pulmonary endarteritis and subsequent pulmonary hypertension is the injury to the vascular endothelium caused by the arrest of tumor emboli.

Carcinoma↗

PubMed1993

[The 150th birthday of Otto Heubner 21 January 1993].

Otto Heubner can be counted among the fathers of pediatry. Beginning as an autodidact, he became pediatrist by chance, holding the first university chair in Germany (1884) exclusively devoted to pediatry; he needed no Dr. med. habil. thesis. Observing the little patients was his primary interest; for the infants treated in the hospital he introduced "aseptic environments". Heubners main scientific achievements were the treatment of infectious and stomach-intestinal diseases. He described "Endarteritis syphilitica" and found Meningococci in the cerebrospinal fluid. "Serious deficiency of digestion" (Coeliac disease) became known through his work. Together with his friend M. Rubner he created the notion of EQ (Nutrition Quotient). Also, he realized the functional effects of orthotic albuminuria. Heubners centers of activity were Leipzig and Berlin, where he had a large community of followers; his successor, recommended by him, was A. Czerny.

Germany↗

PubMed1996

Radiation proctitis: a review.

Radiation therapy of cancers in the pelvic region may lead to radiation proctitis. Radiation injury to the rectal wall eventually causes connective tissue fibrosis and obliterative endarteritis with subsequent local tissue ischemia. Patients with radiation proctitis may be minimally ill and heal spontaneously. However, symptoms of proctitis may persist, and the disease progresses to chronic bleeding and/or stricture and fistula formation. Medical therapy is often unsuccessful, and surgery is eventually required. Because of numerous postoperative complications and no guarantee of success, surgery should only be done as a last resort.

Female↗

PubMed1996

[Stimulation of tissue lymphatic drainage in the treatment of patients with arterial diseases].

The results of treatment of 17 patients with endarteritis obliteran and 44 patients with atherosclerosis obliteran of the lower limbs were analysed. The complex of therapeutic measures included direct and indirect stimulation of lymphatic drainage in the tissues. The effect of lymphostimulation on regional hemodynamics, microcirculation, and metabolism in the tissues of the ischemic lower limb are appraised. Changes in the lymphatic system resorption capacity, in microcirculation, in the composition and properties of the peripheral lymph in the limb in stimulation of lymphatic drainage of tissues are analysed. Indirect lymphostimulation contributed to the improvement of the indices under study in patients with IIb and IIIa stages of ischemia. Direct stimulation of lymphatic drainage caused a more pronounced effect in cases of stage IIIa ischemia of the limb and may be applied in preoperative and postoperative management of patients with stage IIIb ischemia.

Adult↗

PubMedDate not supplied

[The percutaneous closure of patent ductus arteriosus with the Rashkind technic. The initial experience of the Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil].

The authors report their experience with the percutaneous closure of the patent ductus arteriosus with the Rashkind technique. They performed 42 procedures with a success of 97.6% and one embolization episode. The mean age was 8.7 +/- 6.7 years, the mean weight was 25.0 +/- 15.8 Kg and the minimum diameter of the ductus was 4.0 +/- 1.3 mm. The immediate overall prevalence of residual shunt was 48.8% falling to 21% in a mean follow-up of 17 +/- 13 months in 29 cases. Two patients underwent late reocclusion: one with a new umbrella and the other with a coil. Another patient had an immediate severe residual shunt and it was reoccluded in the same procedure with a coil. The anatomical type and minimum internal diameter of the ductus, age and weight, size of the umbrella and the rotation of the umbrella were not predictors of residual shunt. There were no deaths, hemolysis, endarteritis or fracture of the umbrella's arms. One patient remained with a slight gradient in the left pulmonary artery. The authors conclude that the Rashkind technique is safe and efficient and has good long term results. It should be considered as the first line therapeutic modality in the treatment of selected patients with persistent ductus arteriosus.

Academies and Institutes↗

PubMed1997

[A rare cause of Pierre Marie hypertrophic osteoarthropathy: subacute infectious endocarditis].

Secondary hypertrophic osteoarthropathy occurred in a patient with subacute endocarditis. Chest x-ray in this smoker with ethylic cirrhosis showed a pulmonary opacity. Clinical signs of osteoarthropathic inflammation resolved with antibiotics before surgical cure of the aortic insufficiency. The diagnosis was retained on the basis of outcome after antibiotic therapy and the absence of any other etiology, notably bronchogenic cancer. Endocarditis or infectious endarteritis should be entertained in case of hypertrophic osteoarthropathy in patients with an infectious syndrome. Pathogenic hypotheses are discussed. In congenital cardiopathies, intrapulmonary shunts, megacaryocytes and activation of the vascular-platelet endothelium unit may be involved. Bacterial factors and platelet aggregation could play a role in initiating hypertrophic osteoarthropathy in patients with infectious endocarditis.

Blood Platelets↗

PubMed1996

[Surgical treatment of difficult patent ductus arteriosus and related operative complications].

Sixty-nine patients with difficult patent ductus arteriosus (PDA) were retrospectively studied. The PDA included window type (9 patients), aneurysms of the ductus arteriosus(13), large ductus(15), false aneurysms(3), calcified(3), recurrence of ductal patency(5), endarteritis(5) and severe pulmonary hypertension(16). Surgical procedures included ligation of PDA in 51 patients, ligation with Dacron pledget or ribbon in 9, division of PDA under temporary cardiopulmonary bypass in 5. Ruptures of PDA or aorta in 4 patients were repaired respectively with Dacron patch(2) and conduit (2). There were 2 early deaths (2.9%). The mean follow-up was 119 months clinically. All surviors were free from symptoms andcardiac murmur. We conclude that satisfied surgical results rely mainly on proper operative techniques according to different situations of difficult PDA. Surgical correction with Dacron patch or conduit seems to be a simple, safte and reliable method in dealing with the rupture of PDA or aorta.

Adult↗

PubMed1976

Coarctation of the aorta in adults.

Thirty-six patients, 19 men and 17 women, presented at age 18 or older between 1952 and 1974 with coarctation of the aorta. Of the 14 (39%) who had associated cardiovascular disease, 12 had aortic stenosis or insufficiency or both. Three patients had infections-two, endocarditis (aortic valve) and one, endarteritis. Three of the seven patients who did not undergo an operation are alive, two at more than 50 years of age. Five patients had myocardial infarctions, two at 35 years of age. Twenty-nine (80%) had operations; in eight instances the patient was over age 40. All 18 patients undergoing repair of isolated coarctation survived, while only 7 of the 11 patients with associated cardiovascular lesions who underwent repair recovered. Aortic valvular disease and myocardial infarction are serious complicating factors in coarctation of the aorta.

Adolescent↗

PubMed1998

Recurrent Salmonella sepsis and aortitis in a patient with hepatocellular carcinoma.

A 62 years old man was admitted to hospital because of fever; a small superficial hepatic nodule was showed by ultrasonography. Blood cultures grew Salmonella enteritidis. Cefotaxime was administered for ten days. Fever promptly disappeared but one week later recurred with abdominal and back pain. Cultures grew again Salmonella enteritidis. Biopsy of the hepatic nodule showed hepatocarcinoma. Computed abdominal tomography showed a paraaortic mass. Angiography demonstrated hematoma communicating with the aortic lumen. The patient underwent revascularization of the involved aortic tract and resection of the hepatic nodule. Histology showed suppurative aortic endarteritis and a well-differentiated hepatocellular carcinoma with a large area of suppurative necrosis. The recovery of Salmonella species as of any uncommon bacteria from blood should warrant a through research of underlying disease, especially cancer.

Aortitis↗

PubMed1999

Hyperbaric oxygen therapy for radiation induced hemorrhagic cystitis.

PURPOSE: Radiation therapy has been used successfully to treat pelvic malignancy but morbidity from hemorrhagic cystitis remains a major long-term sequela in 1 to 2% of patients. Obliterative endarteritis secondary to ionizing radiation leads to tissue hypoxia and poor healing. Hyperbaric oxygen therapy has been demonstrated to improve angiogenesis and promote healing in radiation injured tissue, including the bladder. We describe the treatment and long-term followup of a cohort of patients treated with hyperbaric oxygen for hemorrhagic cystitis. MATERIALS AND METHODS: A total of 17 patients (mean age 62 years) with hemorrhagic cystitis received hyperbaric oxygen following failure of standard treatment modalities. Hyperbaric oxygen was administered on a once daily schedule (mean number of treatments 14) until hematuria resolved. Followup ranged from 9 to 60 months (mean 21). RESULTS: Hematuria resolved completely in 11 of 17 patients (64%), 2 had only residual microscopic hematuria, 2 had improvement but died of complications relating to cancer shortly after completion of treatment and 2 had recurrence of gross hematuria. Early application of hyperbaric oxygen was associated with earlier resolution of hemorrhagic cystitis. CONCLUSIONS: Radiation induced hemorrhagic cystitis that does not respond to standard regimens can be successfully treated with hyperbaric oxygen. This modality is well tolerated even in patients debilitated by advanced cancer and blood loss. Long-term remission can be achieved in the majority of patients.

Aged↗

PubMed1952