The significance of perivascular inflammation in the absence of arteritis in temporal artery biopsy specimens.
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We retrospectively compared 81 temporal artery biopsy specimens demonstrating perivascular inflammation without evidence of temporal arteritis and 76 specimens demonstrating no inflammation. Patients with perivascular inflammation included 43 women (mean age, 71.2 years). Nineteen patients met the 1990 American College of Rheumatology (ACR) criteria for the diagnosis of temporal arteritis. All patients demonstrated chronic perivascular inflammation consisting primarily of lymphocytes. Granulomas were noted in 4 specimens. Internal elastic lamina disruption, intimal fibroplasia, and dystrophic calcification were noted in 86 arteries examined. Fibrosis or scarring of the vessel walls was observed in 10 specimens. Corticosteroid therapy was beneficial to 33 of 56 patients. In patients with no evidence of inflammation (50 women; mean age, 66.6 years), 21 met ACR criteria for temporal arteritis. Histologically, disruption of the elastic lamina was noted in 75 of 81 arteries biopsied, intimal fibroplasia in 66, microcalcifications in 5, and fibrosis or scarring in 5. In this group, 47 patients received corticosteroid therapy; clinical improvement was noted in 28. Patients with chronic perivascular inflammation but no arteritis seem no more likely to have temporal arteritis on clinical grounds than similar patients without inflammation on biopsy. (+info)
Verminous arteritis in a 3-month-old thoroughbred foal.
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Strongylus vulgaris migration and cranial mesenteric arterial thrombus formation resulted in fatal colic in a 3-month-old Thoroughbred foal. Vascular damage associated with S. vulgaris occurs early in the course of infection and, despite widespread use of broad-spectrum anthelmintics, appropriate management is still essential to minimize exposure of young animals to this parasite. (+info)
Stoke in the young: a four-year study, 1968 to 1972.
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Twenty-six patients under 20 years of age having cerebrovascular disease were studied from 1968 to 1972. Common risk factors such as hypertension, diabetes mellitus, hyperlipidemia and heart disease were not present. Angiographical study showed a variety of abnormalities. No consistent defect was present. There was a high incidence of pyrexia and convulsions in the early stages of stroke and it appears possible that some form of arteritis might have been important in the production of the cerebral infarction. (+info)
Non-atherosclerotic aorto-arterial thrombosis: A study of 30 cases at autopsy.
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BACKGROUND: Aorto-arterial thrombosis is very often associated with atherosclerotic and/or aneurysmal changes. Thrombosis, unrelated to these changes is infrequent. AIMS: To evaluate the clinical presentation and aetiopathogenesis of aorto-arterial thrombosis, unrelated to atherosclerosis and aneurysms. SUBJECTS AND METHODS: A retrospective study of 30 autopsied cases of non-atherosclerotic and non-aneurysmal aorto-arterial thrombosis collected over a period of 14 years was carried out. RESULTS: There were 23 males and seven females and majority presented in the third to fourth decades of life with clinical features of acute abdomen or lower limb gangrene. Abdominal aorta as the site of thrombosis was observed in 46.5% cases. The causes were attributed to hypercoagulable states and changes in the aortic wall. No aetiology could be identified in 5 patients (16.6%. Associated tuberculosis was seen in six cases. CONCLUSIONS: Non-atherosclerotic aortic thrombosis is a heterogeneous group of disorders. Young and even elderly patients with symptoms related to abdominal ischaemia or peripheral vascular disease should be investigated thoroughly for hypercoagulable states and aortic pathology. (+info)
The significance of antineutrophil cytoplasmic antibody in microscopic polyangitis and classic polyarteritis nodosa.
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AIMS: To describe the distribution and features of classic polyarteritis nodosa (PAN) and microscopic polyarteritis (MPA) and the importance of antineutrophil cytoplasmic antibody (ANCA) in childhood PAN. METHODS: Classic PAN was diagnosed in 15 patients based on the presence of aneurysms on angiography in 10 patients and of necrotising vasculitis in medium sized arteries in five. MPA was diagnosed in 10 patients, based on characteristic findings at renal biopsy in six and by the presence of small sized necrotising arteritis in four. Serum ANCA was detected initially by indirect immunofluorescence (IIF) followed by an immunoassay for myeloperoxidase (MPO) in each case. RESULTS: The median age of the patients with classic PAN and MPA was 12 (range 8-17) and 9.5 (range 5-14) respectively. None of the patients with classic PAN had renal failure. Six of the patients with MPA presented with renal failure; four progressed to chronic renal failure. Clinically evident pulmonary-renal syndrome was present in three of the 10 patients with MPA. IIF for ANCA in classic PAN was negative in nine, showed mild staining patterns in six, and in one MPO-ELISA was mildly increased. IIF for ANCA in MPA revealed very strong perinuclear ANCA staining in nine and atypical staining in one. In MPA, median MPO-ELISA level was 42.5 EU/ml (range 20-250). Treatment of childhood PAN was satisfactory with effective treatment; however relapses did occur. CONCLUSION: ANCA is useful in the diagnosis and follow up of MPA. (+info)
Inclusion of the E3 region in an adenoviral vector decreases inflammation and neointima formation after arterial gene transfer.
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Adenoviral vectors are promising agents for vascular gene transfer. Their use, however, is limited by inflammatory host responses, neointima formation, and brevity of transgene expression. Inclusion of the immunomodulatory adenoviral E3 genes in a vector might prevent inflammation and neointima formation and prolong transgene expression. We compared 2 adenoviral vectors in a model of in vivo gene transfer to rabbit arteries. Both vectors expressed a luciferase reporter gene. One vector (AdE3Luc) contained the adenovirus early 3 (E3) region and the other (AdRSVLuc) lacked E3. Expression of E3 genes by AdE3Luc was confirmed in vitro and in vivo. Arteries transduced with AdE3Luc had substantially and significantly less inflammation (fewer T cells and lower levels of vascular cell adhesion molecule-1 and intercellular adhesion molecule 1 expression) and decreased neointima formation 14 days after gene transfer. Luciferase expression from the 2 vectors was equivalent, however, at both 3 and 14 days after gene transfer. Expression of E3 had no systemic immunosuppressive effects, as measured by peripheral blood counts and by assays for serum antibodies to adenovirus. We conclude that expression of E3 significantly decreases adenovirus-induced arterial wall inflammation and neointima formation. Because inflammation and neointima formation are major barriers to the clinical application of adenoviral vectors, use of E3-containing vectors improves the promise of adenovirus-mediated arterial gene transfer. (+info)
Acute renal allograft rejection with intimal arteritis: histologic predictors of response to therapy and graft survival.
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BACKGROUND: Acute renal allograft rejection with intimal arteritis is designated by the widely used Banff 97 classification as type 2A or 2B depending on the extent of arteritis, without regard to interstitial inflammation or tubulitis. We examined whether the distinction between type 2A and 2B is relevant to short- and long-term clinical outcomes, and if outcomes in this subset of acute rejection also are affected by tubulitis, interstitial inflammation, and several additional histologic and clinical parameters. METHODS: Pathology records were searched to identify cases of acute renal allograft rejection with intimal arteritis diagnosed between January 1985 and September 2000. For each case, the patient's chart was reviewed to determine the response of the rejection episode to therapy, type(s) of therapy given, and length of graft survival. All biopsies were reviewed and Banff acute and chronic indices recorded by a pathologist blinded to these data. Biopsies not showing type 2A or 2B rejection were excluded, as were repeat biopsies from the same patient and cases with recurrent glomerular disease, viral infection, donor-specific antibodies, or more than mild chronic change. RESULTS: The initial response to anti-rejection therapy was significantly worse in patients with type 2B acute rejection (N = 29) than in those with type 2A (N = 102) by univariate and multivariate analyses, despite more aggressive treatment of type 2B rejection. In a Cox proportional hazards model the hazard ratio for graft failure for 2B versus 2A was 1.9 (P = 0.05), but this was not significant when adjusted for the initial response to therapy. Cases with minimal or mild tubulitis responded better to therapy than those with moderate or severe tubulitis, although graft survival was not significantly affected by the tubulitis score. CONCLUSIONS: The distinction between types 2A and 2B acute rejection in the Banff 97 classification has significant prognostic value with regard to both short- and long-term clinical outcomes, although the difference in long-term graft survival is mainly related to the initial response to therapy. Reports of biopsies showing type 2A or 2B rejection also should specify the degree of tubulitis present, as the latter may significantly influence the initial response to therapy. (+info)
A case of polyarteritis is reported in an 18-year old woman, occurring 2 years after an allogeneic bone marrow transplant. The clinical manifestations were similar to those of polyarteritis nodosa (PAN) with a wide range of organs involved including life-threatening cardiac and mesenteric problems requiring plasmapheresis and intravenous immunoglobulin (IgIV). (+info)