1/6. Successful treatment of a pseudoaneurysm of the cystic artery with microcoil embolization.Pseudoaneurysms of visceral arteries are uncommon but well-characterized vascular abnormalities, usually provoked by intraabdominal inflammatory processes such as pancreatitis or cholecystitis, or by surgical trauma. However, pseudoaneurysms of the cystic artery are rare. They complicate cholecystitis or cholecystectomy, and manifest as hemobilia as they rupture into the biliary tree. The advent of transcatheter embolization techniques has begun to allow minimally invasive treatment of these life-threatening complications. Transcatheter embolization can be performed using several types of material, such as synthetic occlusive emulsions, gelatin sponges or other particles, or metallic microcoils. Microcoils are small metallic helical particles, made of stainless-steel, platinum, or tungsten. Super-selective catheterization of an artery and release of microcoils causes the vessel to thrombose and allows control of bleeding.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. arteriovenous fistula after arthroscopic synovectomy in a patient with haemophilia.arteriovenous fistula is a rare complication of arthroscopy. We report a human immunodeficiency virus-positive person with haemophilia who 19 months after an arthroscopic synovectomy of the knee presented with increasingly frequent haemarthroses and a palpable thrill over the knee. angiography confirmed an arteriovenous fistula. The patient was successfully treated by surgical ligation of the communicating vessels. The literature regarding vascular injuries after arthroscopy of the knee is reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/6. A case of symptomatic primary HIV infection.A 30-year-old homosexual Japanese man had fourteen days of fever, malaise, appetite loss, sore throat, and four days of diarrhea and slightly congested eyes before he developed a skin eruption. He presented with measles-like exanthems on his face, trunk, and extremities. Deep red enanthems were seen on his left buccal mucosa opposite the premolar teeth, and whitish enanthems were seen on the buccal and gingival mucosa. HIV rna was detected at the high concentration of 5.8 x 10(6) copies /ml in his serum. cerebrospinal fluid examination revealed aseptic meningitis with 5,488 copies /ml of HIV rna. Anti-HIV 1 antibodies against Gp160 and p24 tested by Western blot assay showed seroconversion on day 5 of his admission, seven days after he developed the skin eruptions. The fever lasted for three weeks from the initial onset, and the skin eruptions lasted for twelve days. Histopathologically, a mononuclear cell infiltration was seen mainly in the upper dermis surrounding small vessels and sweat ducts, with CD8 cytotoxic T lymphocytes predominant. Additionally, CD1a putative interdigitating dendritic cells had also infiltrated perivascularly, and were surrounded by CD8 and CD4 T cells. in situ hybridization study failed to detect HIV products in skin biopsy specimens. Our findings suggested that CD8 T cells and their interaction with CD1a dendritic cells in the skin may be important in inducing skin manifestations in acute hiv infections.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/6. Involvement of anterior chamber angle structures in disseminated histoplasmosis: report of three cases.This study describes the involvement of anterior chamber (AC) angle structures in patients with disseminated histoplasmosis. The postmortem eyes from three patients (aged 33, 41, and 42 years, respectively) with disseminated histoplasmosis, two of whom had acquired immunodeficiency syndrome, were examined by light microscopy using hematoxylin-eosin, periodic acid-Schiff (PAS), and Gomori's methenamide silver (GMS) stains. Electron microscopy studies of the choroid were performed in one eye. Significant numbers of budding yeast forms of histoplasma capsulatum measuring 2-5 microns in diameter were observed within the trabecular meshwork, Schlemm's canal and in the deep intrascleral plexuses. All eyes showed massive involvement of the choroidal vasculature, including the choriocapillaris. The organisms were observed freely as well as in small clusters within the cytoplasm of circulating monocytes. The vessels of the limbal conjunctiva (two eyes) and ciliary body (three eyes) contained many histoplasma organisms. In one eye, several budding yeast were noted in an iris vessel and in occasional histiocytes within the ciliary muscle. Blood smears containing histoplasma organisms were observed in two cases. None of the patients had an ophthalmologic examination prior to death. Involvement of the intravascular structures of the eye as well as the AC angle was observed in three patients with disseminated histoplasmosis. The fungus most likely reached the AC angle structures by direct hematogenous dissemination or via the aqueous humor by migration from vessels in the ciliary body and iris. An abnormal retrograde blood flow into the AC angle structures may have also played an important role. We suggested that the intraocular pressure be monitored in cases of suspected disseminated histoplasmosis to detect functional alterations indicative of a blockage in the outflow channels.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/6. Fine needle aspiration diagnosis of intramuscular bacillary angiomatosis. A case report.BACKGROUND: Bacillary angiomatosis (BA) is a localized infectious process that affects primarily patients with the acquired immunodeficiency syndrome. The microorganisms implicated in the pathogenesis of this disease belong to the rickettsiaceae family. CASE: A 43-year-old, human immunodeficiency syndrome-positive male presented with diffuse swelling in the right deltoid area. A neoplastic process was considered in the differential diagnosis. Fine needle aspiration biopsy showed proliferation of blood vessels lined with plump endothelial cells, and the interstitial space was occupied by neutrophilic infiltrate, leukocytoclastic debris and clumps of characteristic amphophilic, granular material. Warthin-Starry stain demonstrated clusters of bacilli diagnostic of bacillary angiomatosis. CONCLUSION: The diagnosis of this entity, made by fine needle aspiration cytology (as the only diagnostic procedure), was instrumental in preventing further surgical manipulation and in initiating appropriate and immediate antibiotic therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/6. Profound cerebrospinal fluid pleocytosis and Froin's Syndrome secondary to widespread necrotizing vasculitis in an HIV-positive patient with varicella zoster virus encephalomyelitis.Demonstration of the direct involvement of cranial blood vessels by varicella zoster virus (VZV) is facilitated by immunohistochemistry (IHC), in situ hybridization (ISH) and polymerase chain reaction (PCR) techniques. The extent to which an inflammatory vasculitis serves as the pathogenic mechanism for VZV encephalomyelitis (VZVE) is still, however, debated. Most VZVE patients are immunocompromised and show little inflammation, either pre-mortem in cerebrospinal fluid (CSF) or at autopsy. We describe an HIV-positive patient with a moderately depressed CD4 count (304) who presented with massively elevated CSF protein (1800 mg/dl), bloody CSF and pleocytosis (1300 white blood cells (WBC)/mm3). His CSF was positive for VZV dna by PCR. He was treated with acyclovir and foscarnet, but died. At autopsy, an unusually widespread, inflammatory, transmural vasculitis caused by VZV affected meningeal vessels at virtually all brain stem and spinal cord levels, causing multiple subpial hemorrhages and necrosis. Virus dna in multiple areas of brain, brainstem and spinal cord was readily revealed by PCR, but not by the presence of viral inclusions, IHC or ISH. This case, with a clinically confusing presentation for VZVE, illustrates the extensive, albeit infrequent, degree of necrotizing vasculitis and CSF abnormalities that VZV is capable of producing. Antiviral therapy may have inhibited VZV genome replication and subsequent antigen production, resulting in negative ISH and IHC studies, but generated increased VZV genomic fragments that were detectable by the more sensitive PCR technique.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |