-
Orphanet Journal of Rare Diseases Dec 2006A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs... (Review)
Review
A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications.
Topics: Arterio-Arterial Fistula; Coronary Angiography; Coronary Disease; Coronary Vessel Anomalies; Humans
PubMed: 17184545
DOI: 10.1186/1750-1172-1-51 -
The Canadian Journal of Infectious... 2022Cerebral vascular comorbidities may occur in patients with schistosomiasis, as described in case reports. We have summarized general clinical and neurological features... (Review)
Review
INTRODUCTION
Cerebral vascular comorbidities may occur in patients with schistosomiasis, as described in case reports. We have summarized general clinical and neurological features in patients with stroke associated with schistosomiasis, through a review of case reports in the literature. A total of eight case reports were retrieved. The mean age of patients was 36.42 ± 16.7 (19 to 56 years), four females, three males, and one anonymous sex. Eosinophilia was the most frequent feature at presentation, followed by cardiac abnormalities, confusion, fever, ataxia, hemiplegia, headache, urticaria, dysphasia, and memory impairment. Patients usually present with watershed infarction or intracranial vasculitis. In one case, extracranial carotid arteries presented with inflammation and stenosis. The patient's serology was positive on admission in five cases. Full neurological recovery was reported in three cases, and partial improvement in another three. In two cases, information on neurological outcomes was incomplete. Stroke in schistosomiasis can be caused by haemodynamic impairment, direct lesion to the arterial wall, vasa vasorum obliterative endarteritis, contiguity with a focus of inflamed tissue, or inflammatory intimal damage. Schistosomiasis needs to be included in the differential diagnosis of stroke in people living or coming back from endemic areas.
CONCLUSIONS
Further studies addressing the noncommunicable comorbidity issues related to this condition are needed.
PubMed: 35923686
DOI: 10.1155/2022/3902570 -
Journal of the American Society of... May 2015Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most...
Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most isolated endarteritis biopsy samples. We investigated if isolated endarteritis responds to rejection treatment and affects kidney transplant survival. We retrospectively enrolled recipients of kidney transplant who underwent biopsies between 1999 and 2011 at seven American and Canadian centers. Exclusion criteria were recipients were blood group-incompatible or crossmatch-positive or had C4d-positive biopsy samples. After biopsy confirmation, patients were divided into three groups: isolated endarteritis (n=103), positive controls (type I acute T cell-mediated rejection with endarteritis; n=101), and negative controls (no diagnostic rejection; n=103). Primary end points were improved kidney function after rejection treatment and transplant failure. Mean decrease in serum creatinine from biopsy to 1 month after rejection treatment was 132.6 µmol/L (95% confidence interval [95% CI], 78.7 to 186.5) in patients with isolated endarteritis, 96.4 µmol/L (95% CI, 48.6 to 143.2) in positive controls (P=0.32), and 18.6 µmol/L (95% CI, 1.8 to 35.4) in untreated negative controls (P<0.001). Functional improvement after rejection treatment occurred in 80% of patients with isolated endarteritis and 81% of positive controls (P=0.72). Over the median 3.2-year follow-up period, kidney transplant survival rates were 79% in patients with isolated endarteritis, 79% in positive controls, and 91% in negative controls (P=0.01). In multivariate analysis, isolated endarteritis was associated with an adjusted 3.51-fold (95% CI, 1.16 to 10.67; P=0.03) risk for transplant failure. These data indicate that isolated endarteritis is an independent risk factor for kidney transplant failure.
Topics: Adult; Biopsy; Endarteritis; Female; Graft Rejection; Graft Survival; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Retrospective Studies
PubMed: 25381427
DOI: 10.1681/ASN.2014020157 -
Therapeutic Advances in Urology Aug 2015Fournier's gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing... (Review)
Review
Fournier's gangrene, an obliterative endarteritis of the subcutaneous arteries resulting in gangrene of the overlying skin, is a rare but severe infective necrotizing fasciitis of the external genitalia. Mainly associated with men and those over the age of 50, Fournier's gangrene has been shown to have a predilection for patients with diabetes as well as people who are long-term alcohol misusers. The nidus for the synergistic polymicrobial infection is usually located in the genitourinary tract, lower gastointestinal tract or skin. Early diagnosis remains imperative as rapid progression of the gangrene can lead to multiorgan failure and death. The diagnosis is often made clinically, although radiography can be helpful when the diagnosis or the extent of the disease is difficult to discern. The Laboratory Risk Indicator for Necrotizing Fasciitis score can be used to stratify patients into low, moderate or high risk and the Fournier's Gangrene Severity Index (FGSI) can also be used to determine the severity and prognosis of Fournier's gangrene. Mainstays of treatment include rapid and aggressive surgical debridement of necrotized tissue, hemodynamic support with urgent resuscitation with fluids, and broad-spectrum parental antibiotics. After initial radical debridement, open wounds are generally managed with sterile dressings and negative-pressure wound therapy. In cases of severe perineal involvement, colostomy has been used for fecal diversion or alternatively, the Flexi-Seal Fecal Management System can be utilized to prevent fecal contamination of the wound. After extensive debridement, many patients sustain significant defects of the skin and soft tissue, creating a need for reconstructive surgery for satisfactory functional and cosmetic results.
PubMed: 26445600
DOI: 10.1177/1756287215584740 -
American Journal of Transplantation :... Dec 2018The Banff classification of renal allograft pathology defines specific morphologic lesions that are used in the diagnosis of active (glomerulitis, peritubular... (Review)
Review
The Banff classification of renal allograft pathology defines specific morphologic lesions that are used in the diagnosis of active (glomerulitis, peritubular capillaritis, endarteritis) and chronic (transplant glomerulopathy, peritubular capillary basement membrane multilayering, transplant arteriopathy) antibody-mediated rejection (ABMR). However, none of these individual lesions are specific for ABMR, and for this reason Banff requires 1 or more additional findings, including C4d deposition in peritubular capillaries, presence of circulating donor-specific antibodies (DSAs), and/or expression in the tissue of transcripts strongly associated with ABMR, for a definitive diagnosis of ABMR to be made. In addition, while animal studies examining serial biopsies have established the progression of morphologic lesions of active to chronic ABMR as well as intermediate forms (chronic active ABMR) exhibiting features of both, clear documentation that lesions of chronic ABMR require the earlier presence of corresponding active and intermediate lesions is less well established in human renal allografts. This review examines temporal relationships between key morphologic lesions of active and chronic ABMR in biopsies of human grafts, likely intermediate forms, and findings for and possibly against direct and potentially interruptible progression from active to chronic lesions.
Topics: Graft Rejection; Humans; Isoantibodies; Kidney Transplantation; Prognosis; Tissue Donors
PubMed: 30133953
DOI: 10.1111/ajt.15088 -
BMC Infectious Diseases Mar 2020Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications. (Review)
Review
BACKGROUND
Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications.
CASE PRESENTATION
We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation.
CONCLUSIONS
Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.
Topics: Anti-Bacterial Agents; Echocardiography, Transesophageal; Endarteritis; Endocarditis, Bacterial; Humans; Male; Middle Aged; Pulmonary Embolism; Pulmonary Valve; Pulmonary Valve Stenosis; Sepsis; Tomography, X-Ray Computed
PubMed: 32164584
DOI: 10.1186/s12879-020-4925-z -
World Journal of Transplantation Dec 2015To describe the clinicopathologic features of concurrent polyomavirus nephropathy (PVN) and endarteritis due to rejection in renal allografts.
AIM
To describe the clinicopathologic features of concurrent polyomavirus nephropathy (PVN) and endarteritis due to rejection in renal allografts.
METHODS
We searched our electronic records database for cases with transplant kidney biopsies demonstrating features of both PVN and acute rejection (AR). PVN was defined by the presence of typical viral cytopathic effect on routine sections and positive polyomavirus SV40 large-T antigen immunohistochemistry. AR was identified by endarteritis (v1 by Banff criteria). All cases were subjected to chart review in order to determine clinical presentation, treatment course and outcomes. Outcomes were recorded with a length of follow-up of at least one year or time to nephrectomy.
RESULTS
Of 94 renal allograft recipients who developed PVN over an 11-year period at our institution, we identified 7 (7.4%) with viral cytopathic changes, SV40 large T antigen staining, and endarteritis in the same biopsy specimen, indicative of concurrent PVN and AR. Four arose after reduction of immunosuppression (IS) (for treatment of PVN in 3 and tuberculosis in 1), and 3 patients had no decrease of IS before developing simultaneous concurrent disease. Treatment consisted of reduced oral IS and leflunomide for PVN, and anti-rejection therapy. Three of 4 patients who developed endarteritis in the setting of reduced IS lost their grafts to rejection. All 3 patients with simultaneous PVN and endarteritis cleared viremia and were stable at 1 year of follow up. Patients with endarteritis and PVN arising in a background of reduced IS had more severe rejection and poorer outcome.
CONCLUSION
Concurrent PVN and endarteritis may be more frequent than is currently appreciated and may occur with or without prior reduction of IS.
PubMed: 26722657
DOI: 10.5500/wjt.v5.i4.292 -
Texas Medical Journal (Austin, Tex.) Aug 1897
PubMed: 36954086
DOI: No ID Found -
Journal of the American Society of... May 2015
Topics: Endarteritis; Endothelial Cells; Endothelium, Vascular; Female; Graft Rejection; Humans; Kidney Transplantation; Male
PubMed: 25381428
DOI: 10.1681/ASN.2014090932 -
Annals of Indian Academy of Neurology Jan 2008Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. (Review)
Review
BACKGROUND
Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions.
OBJECTIVE
To review the main infectious diseases associated with stroke.
DISCUSSION
Prevalence of stroke in HIV patients is around 1%. Pathogenic mechanisms include HIV vasculopathy, vasculitis, cardioembolism, acquired hypercoagulability, and the effect of opportunistic infections. Treatment with protease inhibitors has been associated with premature atherosclerotic vascular disease. Emerging viral infections that are associated with stroke include viral hemorrhagic fevers, Japanese encephalitis, dengue, and West Nile virus. Vasculitis involving perforating vessels of the brain is a cerebrovascular complication of tuberculous meningitis. Small, medium, and large arteries of the anterior circulation can be involved. A progressive intracranial arteriopathy afterLeptospira interrogansinfection has been described, which involves the large intracranial arteries. Cerebrovascular complications of mycosis are associated with large vessel vasculitis, direct vessel damage by invasion or embolization, and subarachnoid hemorrhage due to mycotic aneurysm rupture. Pathological findings of cerebral malaria include diffuse cerebral edema, perivascular ring hemorrhages, white matter necrosis, parenchyma petechial hemorrhages, occlusion of brain vessels, and sequestration of infected erythrocytes in cortical and perforating arteries. Stroke can occur in subarachnoid neurocysticercosis and the lesions in such cases consist mostly of deep lacunar infarctions resulting from endarteritis of small penetrating arteries. Cardiac arrhythmias, congestive heart failure, apical aneurysm, and mural thrombus are the conditions that predispose patients with American trypanosomiasis to cardioembolism. infestation is a cause of hemorrhagic stroke in Asia.
CONCLUSION
Infectious and tropical diseases should be included in the differential diagnoses of stroke.
PubMed: 35721447
DOI: No ID Found