Spatz-Lindenberg disease: a rare cause of vascular dementia.
BACKGROUND: Isolated cerebral thromboangiitis obliterans (Spatz-Lindenberg disease) is not well recognized as a cause of vascular dementia. CASE DESCRIPTION: A 58-year-old woman presented with dementia and pyramidal signs. Neuroimaging showed multiple areas of white matter change. Brain biopsy showed intimal thickening of the walls of leptomeningeal and intraparenchymal arteries, almost to complete occlusion, with an intact internal elastic lamina and media and without inflammation or infiltration. The cortex showed only moderate gliosis. CONCLUSIONS: Spatz-Lindenberg disease should be considered in the differential diagnosis of vascular dementia. Additional studies of its pathogenesis are required to determine appropriate treatment. (+info)
Immunohistochemical analysis of arterial wall cellular infiltration in Buerger's disease (endarteritis obliterans).
PURPOSE: The diagnosis of Buerger's disease has depended on clinical symptoms and angiographic findings, whereas pathologic findings are considered to be of secondary importance. Arteries from patients with Buerger's tissue were analyzed histologically, including immunophenotyping of the infiltrating cells, to elucidate the nature of Buerger's disease as a vasculitis. METHODS: Thirty-three specimens from nine patients, in whom Buerger's disease was diagnosed on the basis of our clinical and angiographic criteria between 1980 and 1995 at Nagoya University Hospital, were studied. Immunohistochemical studies were performed on paraffin-embedded tissue with a labeled streptoavidin-biotin method. RESULTS: The general architecture of vessel walls was well preserved regardless of the stage of disease, and cell infiltration was observed mainly in the thrombus and the intima. Among infiltrating cells, CD3(+) T cells greatly outnumbered CD20(+) B cells. CD68(+) macrophages or S-100(+) dendritic cells were detected, especially in the intima during acute and subacute stages. All cases except one showed infiltration by the human leukocyte antigen-D region (HLA-DR) antigen-bearing macrophages and dendritic cells in the intima. Immunoglobulins G, A, and M (IgG, IgA, IgM) and complement factors 3d and 4c (C3d, C4c) were deposited along the internal elastic lamina. CONCLUSION: Buerger's disease is strictly an endarteritis that is introduced by T-cell mediated cellular immunity and by B-cell mediated humoral immunity associated with activation of macrophages or dendritic cells in the intima. (+info)
Implantable spinal cord stimulator to treat the ischemic manifestations of thromboangiitis obliterans (Buerger's disease).
Thromboangiitis obliterans (Buerger's disease) is a segmental inflammatory vasculitis that involves the small-sized and medium-sized arteries, veins, and nerves. It is causally related to tobacco use. The diagnosis is usually made on the basis of the presence of distal arterial disease in individuals who smoke and in whom other disease entities have been excluded. The most effective treatment for Buerger's disease is smoking cessation. Without strict adherence to tobacco avoidance, disease progression is likely. Methods to control ischemic pain include medications, sympathectomy, or surgical revascularization. The effect of sympathectomy is unpredictable, and the chances of a successful revascularization procedure are rare because distal target vessels often are extensively diseased. Herein, we describe a patient whose condition did not respond to the usual conservative therapy but did respond dramatically to the implantation of a permanent spinal cord stimulator. Although these devices have been used for more than 20 years in various other peripheral arterial diseases, their use in Buerger's disease has been limited. (+info)
Morphologic change of the internal elastic lamina in Buerger's disease.
Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease. (+info)
Association of thromboangiitis obliterans with cigarette and bidi smoking in Bangladesh: a case-control study.
BACKGROUND: In addition to cigarettes, bidi, made of unprocessed and low-grade tobacco, is being smoked widely in Bangladesh and in other south Asian countries. The cause-and-effect relationship is established between thromboangiitis obliterans (TAO) and smoking. However, type of smoking material(s) most strongly related to TAO is not yet determined. METHODS: We conducted a hospital-based case-control study in Rajshahi, Bangladesh, to examine the relationship of type of smoking materials (cigarette versus bidi) with TAO on 103 pairs of cases and controls matched by age and sex during the period 1995 to 1996. The inclusion criteria for cases were newly diagnosed TAO and current smoker, while those for controls were current smokers admitted to the hospital due to non-cardiovascular diseases. RESULTS: Among the cases 35.0% and 65.0% were cigarette and bidi smokers, while among the controls 69.9% and 30.1%, respectively. Using logistic regression approach, considering cigarette smoking approximately 10 per day as reference, bidi smoking >20 per day (odds ratio [OR] = 34.76, 95% CI: 6.11-197.67) and 11-20 per day (OR = 7.12, 95% CI: 2.35-21.63) had greater risk of TAO after adjusting confounding factors. Respective OR for bidi smoking approximately 10 per day, cigarette smoking 11-20 per day and cigarette smoking >20 per day, were 2.18 (95% CI: 0.64-7.51), 3.81 (95% CI: 1.37-10.57) and 6.88 (95% CI: 1.87-25.30). CONCLUSION: Within the limits inherent to case-control study, our findings suggest that bidi smoking may well play a more important role in causing TAO than cigarettes. It leads to the speculation that unprocessed and low-grade tobacco used for producing bidi might play a more potent role to initiate TAO than cigarettes. (+info)
Omentopexy for limb salvage in Buerger's disease: indications, technique and results.
Buerger's disease is a limb-threatening condition occurring in the young and productive age group and its management has always been a challenging problem. A large number of medical and surgical options have been suggested, but the quest for an ideal solution to this problem continues. Omentopexy for Buerger's disease is an attractive option, which is rapidly gaining popularity. We discuss the historical aspects, technical considerations and results of omental transfer for this limb-threatening condition. In doing so, the relevant literature on the subject has been extensively reviewed. In all published series, there has been marked improvement in intermittent claudication and rest pain. Ischaemic ulcers have healed and the progression of gangrene has stopped. If carried out with the complete understanding of the anatomy of the omental vascular arcade, the results of omentopexy are gratifying, thus avoiding amputation and conserving the limb. (+info)
Thrombus in the main pulmonary artery of a patient with thromboangiitis obliterans: observation by transthoracic echocardiography.
We describe a 45-year-old man with thromboangiitis obliterans. He had a large immobile wall-adherent thrombus located in the main pulmonary artery, which was detected by transthoracic echocardiography. The pulmonary arterial involvement in this patient may suggest that thromboangiitis obliterans is a generalized vascular disease. We conclude that pulmonary artery should be thoroughly examined for thrombi in thromboangiitis obliterans patients who present with signs and symptoms of right heart failure. Transthoracic echocardiography should be the initial mode of examination in these patients. (+info)
Plasma catecholamines in Buerger's disease: effects of cigarette smoking and surgical sympathectomy.
OBJECTIVES: to study the influence of tobacco exposure and sympathectomy on basal sympathoadrenal function of patients with Buerger's disease. DESIGN: plasma catecholamines were measured before and after smoking, in patients with Buerger's disease (n=13), in patients with Buerger's disease submitted to surgical bilateral lumbar sympathectomy (n=13), and in healthy volunteers (n=16). MATERIALS AND METHODS: venous blood samples were collected before and 2h after smoking one cigarette (0.9mg nicotine). Plasma concentrations (pg/ml) of dihydroxiphenylalanine (pL-DOPA), noradrenalin (pNA), adrenalin (pAD) and 3,4-dihydroxiphenylacetic acid (pDOPAC) were determined. RESULTS: Buerger's patients have low basal plasma catecholamines compared to volunteers: pNA (501 (196-927) vs 1858 (968-3663)) and pAD (71 (31-109) vs 193 (116-334)). Sympathectomy increased pL-DOPA, pAD and pDOPAC, but not pNA. After smoking, pNA only decreased in volunteers (1858 (968-3663) vs 1064 (535-2393)). In Buerger+sympathectomy group, smoking lowered pAD (700 (58-3379) vs 278 (54-429)). CONCLUSIONS: in Buerger's disease there is an impairment of sympathoadrenal function with an altered peripheral adrenergic response to cigarette smoking. Patients submitted to sympathectomy have high pAD, but this benefit is reversed after smoking. This might be clinically relevant given the association between cigarette smoking and the manifestations of Buerger's disease and the controversy on the effectiveness of sympathectomy in the management of the disease. (+info)