1/16. Transesophageal echocardiography diagnosis of intramural hematoma of the ascending aorta: A word of caution.The diagnosis of intramural hematoma by echocardiography classically requires the presence of an echolucent, crescentic region in the wall of the aorta. Recently we have encountered 2 patients in whom intramural hematoma was characterized only by thickening of the aortic wall, which was circumferential in one patient, thus making the diagnosis difficult to distinguish from common atherosclerotic thickening of the aorta. In one case, computed tomography showed more clearly the abnormal tissue signature of the intramural blood. In summary, absence of an echolucent zone does not exclude the diagnosis of intramural hematoma. Alternative imaging procedures such as computed tomography and magnetic resonance imaging may enhance the diagnostic accuracy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/16. Unstable angina associated with coronary arterial calcification in a thalassemia intermedia patient with a pseudoxanthoma elasticum-like syndrome.The coexistence of a pseudoxanthoma elasticum (PXE)-like syndrome in beta-thalassemia and other hemoglobinopathies is a recently established clinical entity that has been observed with a significant frequency and related to some severe, even life-threatening complications. We present here a thalassemia intermedia patient who developed unstable angina in a setting of severe anemia and PXE-related coronary arterial calcification. Besides the clinical significance of this PXE-like syndrome, its acquired nature may introduce some new thoughts regarding the pathogenesis of atherosclerosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/16. Immunologic considerations in renovascular hypertension.For decases certain diseases, such as glomerulonephritis, polyarteritis nodosa, scleroderma and serum sickness, have been linked with autoimmune pathogenesis. During recent years a host of additional diseases traditionally thought to have some genetic predisposition but with obscure etiology have been suspected of being autoimmune in nature. Rheumatoid arthritis, diabetes, myasthenia gravis and thyroiditis are diseases of widely divergent organ systems, yet may well have common pathways of pathology via immune complexing mechanisms. Herein we present evidence supporting the concept that renal artery stenosis (occurring primarily in association with the middle aortic syndrome or after renal transplantation) is of immune etiology. Although the specific antigenic agent is still to be defined there is growing acceptance of the theory that medium and large vessels are subject to autoimmune vasculitis in many aspects similar to the autoimmune affections of small vessels. Several cases are presented. Some of these suggest an immune reaction by the natural history but without evidence of immunochemical reactants in the involved vessels, presumably because active disease was arrested at the time to study. In other cases immunofluorescent preparations demonstrate reactants in the walls of the vessels to document the hypothesis more convincingly.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/16. atherosclerosis and unstable angina in bernard-soulier syndrome.Platelets and von willebrand factor play pathogenetic roles in atherosclerosis and acute coronary artery ischemic syndromes. patients with bernard-soulier syndrome are deficient in several platelet membrane glycoproteins, including glycoprotein Ib (GpIb). Glycoprotein Ib is the primary platelet receptor for von Willebrand factor and plays a critical role in the initiation of thrombus formation. Glycoprotein Ib, but also GpIIb/IIIa, mediates the adhesion of platelets to damaged endothelium, particularly at the high shear stresses found in small or diseased arteries. A patient with bernard-soulier syndrome is described who developed coronary artery atherosclerosis and unstable angina requiring coronary artery bypass grafting. The implications of this experiment in nature on the contribution of platelets and platelet GpIb and GpIIb/IIIa receptors to the development of atherosclerosis and unstable angina are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/16. Extracranial tumor vascularity: determination by dynamic CT scanning. Part II: The unit approach.Twenty-eight patients had combined conventional drip infusion CT scans. The information about the anatomic location of the lesion, its configuration, its cross-sectional appearance, its vascularity (as determined by dynamic signature curves), and its clinical presentation were considered as a single overall unit. This diagnostic approach allowed a diagnosis to be made on virtually all of these enhancing lesions without resorting to either a digital venous imaging study or angiographic procedure. In 17 of these cases, such an invasive second procedure was performed either to confirm the CT impression as part of this study or as part of a therapeutic embolization procedure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/16. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations.Clinically, penetrating atheromatous ulceration of the aortic wall may be confused with either symptomatic thoracic aneurysm or classic spontaneous aortic dissection. aortography and computed tomographic (CT) scanning of the thoracic aorta provide specific diagnostic information which permits one to distinguish this lesion from atherosclerotic aneurysm and classic dissection. Hallmarks of findings on aortography and CT scan include the presence of the ulcer and an intramural hematoma. Since the findings may be disarmingly subtle, the potentially progressive and serious nature of this condition may remain unappreciated. Recognition of the penetrating atheromatous ulcer and distinguishing it from aortic dissection arising just distal to the origin of the left subclavian artery is mandatory. Resection of only a conservative segment of the proximal descending aorta suffices for classic dissection in the upper descending thoracic aorta, but the penetrating aortic ulcer requires graft replacement in the area of the ulcer and intramural hematoma.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/16. Idiopathic infantile arterial calcification in siblings: radiologic diagnosis and successful treatment.Idiopathic infantile arterial calcification is a disorder of unknown etiology manifested by widespread arterial calcification. This usually leads to early death from coronary artery occlusion. In 12 of the 75 cases in the literature, radiographs were taken and it was possible to make the diagnosis in them all. We present two patients, siblings, in whom the diagnosis was established radiologically. The nature of the calcium deposits was studied in one of the infants and proved to be calcium hydroxyapatite. Therapy with diphosphonate was apparently successful in the other child.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/16. Capsular infarcts: the underlying vascular lesions.In ten patients, 11 infarcts involving mainly the internal capsule have been examined pathologically. Serial sections of the involved basal ganglia were studied in ten infarcts and only a gross dissection was made in the other. The implicated penetrating arteries were traced throughout their length and obstructive vascular lesions were found in nine instances. In two of the nine there was an atheromatous plaque with a superimposed thrombus, in four an atheromatous plaque had caused severe stenosis, in one a destructive arterial process lipohyalinosis had occurred, in one case the nature of the obstruction remained "uncertained," and in one the penetrating arteries were obstructed at their orifices by an atheroma in the superior division of the middle cerebral artery. In two cases the vessels were patent, suggesting embolism. The atheromas consisted almost exclusively of a conglomerate of fat-filled macrophages. The clinical correlate was a pure motor hemiplegia or hemiparesis involving the face, arm, and leg without sensory deficit, homonymous hemianopia, receptive aphasia, or apractognosia. confusion was prominent in one patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/16. Leptomeningeal artery atherosclerosis visualized by angiography: clinical correlates.Circumscribed atherosclerotic involvement of secondary and tertiary branches of major cerebral arteries is a common angiographic finding whose nature is rarely in question. However, widespread and severe changes are unusual, and radiologic interpretation may be more difficult. We recently cared for a patient whose angiogram demonstrated extensive involvement of leptomeningeal vessels and were prompted to review the clinical courses and autopsy findings of a number of other patients with similar angiographic findings. Our observations suggest that the radiological appearance of leptomeningeal artery atherosclerosis can be confused with that of an arteritis. atherosclerosis of leptomeningeal arteries is strongly associated with a history of arterial hypertension and seems to parallel arterial lesions thought responsible for lacunar infarction and intraparenchymal hemorrhage.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/16. Basophilic degeneration of skeletal muscle in hypothyroid myopathy. Histochemical and ultrastructural studies.Morphologic and histochemical studies of basophilic degeneration (BD) of skeletal muscle were performed on a 64-year-old woman with hypothyroid myopathy. The BD had staining characteristics of polysaccharide and similarity to the deposits described in cardiac muscle in five of six muscle groups studied and was absent in the diaphragm. The frequent occurrence of BD at the myotendinous junction suggested the necessity of including this area in muscle biopsy specimens of suspected hypothyroid myopathy. review of the literature indicated a need for more detailed examination of muscle specimens of these patients to determine the clinical implication and biochemical nature of the BD. To my knowledge, the demonstration of a close association of BD and leptomeres and the presence of crystalline structures within the BD have not been described previously.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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