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NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
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Do elevated autoantibodies in patients with multiple sclerosis matter?

ven, 22/03/2019 - 10:39
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Do elevated autoantibodies in patients with multiple sclerosis matter?

Acta Neurol Scand. 2019 Mar;139(3):238-246

Authors: Dal-Bianco A, Wenhoda F, Rommer PS, Weber M, Altmann P, Kraus J, Leutmezer F, Salhofer-Polanyi S

Abstract
OBJECTIVES: The incidence and clinical impact of serum autoantibodies in patients with multiple sclerosis (MS) are controversially discussed. The aim of the study was to reassess the value of elevated serum autoantibodies in our MS study cohort.
MATERIAL & METHODS: In total, 176 MS patients were retrospectively analyzed for coexistence and clinical impact of increased serum autoantibody levels.
RESULTS: The 18.8% of the MS cohort showed elevated serum autoantibody levels, but only 10.2% of all MS patients were diagnosed with a further autoimmune disease (AI). Patients with elevated serum autoantibodies (AABS) were not significantly more often diagnosed with a clinical manifest AI as compared to patients with negative autoantibodies (P = 0.338). MS patients with disease duration of more than 10 years showed no significant increase of positive autoantibodies as compared to patients with a more recent disease onset (P = 1). MS patients with elevated serum autoantibodies did not exhibit a significantly worse disease course (P = 0.428).
CONCLUSIONS: According to our data, elevated serum autoantibodies do not have the potential to serve as a prognostic tool for disease severity in patients with MS Since MS patients with positive serum AABS did not significantly more often suffer from clinical manifest AIs than MS patients with negative serum AABS, the role of routine testing of serum AABS in MS patients should be critically called into question.

PMID: 30447159 [PubMed - indexed for MEDLINE]

Clinical and Pathological Characteristics of Elderly Japanese Patients with IgA Vasculitis with Nephritis: A Case Series.

ven, 22/03/2019 - 10:39
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Clinical and Pathological Characteristics of Elderly Japanese Patients with IgA Vasculitis with Nephritis: A Case Series.

Intern Med. 2019 Jan 01;58(1):31-38

Authors: Ueda H, Miyazaki Y, Tsuboi N, Hirano K, Yokote S, Kobayashi E, Ogura M, Kawamura T, Ryuzaki M, Yokoo T

Abstract
Objective This case series aimed to identify the clinical and pathological characteristics of elderly patients (≥60 years) with biopsy-proven IgA vasculitis with nephritis (IgAVN). Methods The clinical and pathological presentation and treatment outcomes were compared between two groups. Patients Patients with IgAVN who were ≥19 years old at the time of their renal biopsy were divided into elderly (≥60 years) and adult (19-59 years) groups. Results Of the 23 patients in our study, 13 were elderly. In the elderly group, the median age at the diagnosis was 68 years (range, 60-85 years), with a median follow-up period of 15 months (range, 3-80 months). Twelve elderly patients had comorbidities, including hypertension, diabetes mellitus, chronic kidney disease, cardiovascular disease, and malignancies. A decrease in the estimated glomerular filtration rate, as well as massive proteinuria and rapidly progressive nephritic syndrome, were more frequent in the elderly group than in the adult group. Furthermore, renal pathological changes, including cellular or fibrocellular crescents, interstitial fibrosis, tubular atrophy, and arteriosclerosis, were more severe among elderly patients than adult patients. All elderly patients were treated with glucocorticoids and had no incidence of end-stage renal disease at the final follow-up; in addition, nine elderly patients had reduced proteinuria with a preserved renal function. Adverse events, including infection, diabetes mellitus, and vascular disorders, were identified in nine patients. Three elderly patients died from severe infections. Conclusion IgAVN in elderly patients is characterized by severe renal involvement. Elderly patients are at higher risk than adults for treatment-related adverse events.

PMID: 30101942 [PubMed - indexed for MEDLINE]

Asymptomatic Histoplasma Pylephlebitis in an Orthotopic Liver Transplant Recipient: A Case Report and Literature Review.

ven, 22/03/2019 - 10:39
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Asymptomatic Histoplasma Pylephlebitis in an Orthotopic Liver Transplant Recipient: A Case Report and Literature Review.

Mycopathologia. 2019 Feb;184(1):177-180

Authors: Phoompoung P, Chayakulkeeree M, Ngamskulrungroj P, Pongpaibul A

Abstract
Histoplasma capsulatum is one of the most common pathogenic dimorphic fungi in Thailand. Its usual clinical syndrome is progressive disseminated histoplasmosis, whereas isolated hepatic histoplasmosis is extremely rare. Here, we report the world's first reported case of hepatic histoplasmosis with pylephlebitis in a 45-year-old Thai male who underwent orthotopic liver transplantation due to hepatitis B cirrhosis. Histopathology of the recipient's liver showed infiltration of fungal organisms in portal vein and hepatic granulomas. Serum H. capsulatum antibody was positive, and molecular identification from the liver revealed the DNA of H. capsulatum.

PMID: 29789991 [PubMed - indexed for MEDLINE]

Frequency of Behçet's disease among a group of visually impaired adults.

ven, 22/03/2019 - 10:39
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Frequency of Behçet's disease among a group of visually impaired adults.

Ir J Med Sci. 2019 Feb;188(1):333-336

Authors: Uyaroglu OA, Seyhoglu E, Erden A, Vahabov C, Babaoglu H, Armagan B, Sari A, Kilic L, Tatar O, Bilgen SA, Karadag O, Kalyoncu U

Abstract
BACKGROUND: Behçet's disease (BD) is one of the reasons of acquired visual impairment among young adults. Ocular involvement is a significant cause of disability in BD. The objective of this study is to assess the prevalence of BD among a group of adults who has visual impairment.
METHODS: Ankara Metropolitan Municipality Education and Technology Center is one of the official institutions which records and follows the demographic data of visually impaired people in Turkey. In November 2014, there were 675 visually impaired people recorded at this center. Medical history was taken from 294 adults by phone in November and December of 2014. Participants were asked if the visual impairment had been either acquired or congenital. If the patients had BD or suspicious BD, they were recalled for detailed investigation which would be carried out by an internist, a rheumatologist and an ophthalmologist.
RESULTS: Two hundred thirteen of 294 (72.4%) visually impaired adults were male. One hundred nine of 294 (37.1%) had acquired visual impairment. Six (5.5%) of those 109 patients had BD. Overall prevalence of BD among study group was 2.04%.The median age of people with BD was 35 years. The median age at BD diagnosis was 16.5 years and the median duration from diagnosis to visual loss was 2.5 years.
CONCLUSION: BD is still one of the causes of acquired visual impairment in Turkey. In this study, BD prevalence among a visually impaired adult group was 2.04%. BD accounted for 5.5% among adults who had acquired visual impairment. In a study of 1965, BD prevalence among people with acquired blindness was 12%. However, this study was conducted at pre-immunosuppressive period. Our prevalence is obviously lower than those studies. Extended population-based studies are needed for population estimations.

PMID: 29524101 [PubMed - indexed for MEDLINE]

Dual anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody-positive crescent glomerulonephritis in a patient with monoclonal gammopathy of undetermined significance: A case report.

sam, 16/03/2019 - 06:50
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Dual anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody-positive crescent glomerulonephritis in a patient with monoclonal gammopathy of undetermined significance: A case report.

Medicine (Baltimore). 2019 Feb;98(7):e14557

Authors: Li X, Hao Y, Xue R, Qi X, Ma Z

Abstract
RATIONALE: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and anti-glomerular basement membrane (GBM) antibody disease are both rare autoimmune diseases. Monoclonal gammopathy of undetermined significance (MGUS) is one of the most common causes of plasma cell dyscrasias (PCD). The three entities can cause renal lesions via different mechanisms and, however, they have not been reported in a single patient with renal lesion.
PATIENT CONCERNS: Here, we describe a patient with half-year fatigue and 40-day nausea and vomiting. Laboratory workup displayed increased serum creatinine, proteinuria, and mild microscopic hematuria. Serological tests were positive for anti-nuclear antibody (titer 1:100), anti-GBM antibodies (not quantified), and myeloperoxidase (MPO)-ANCA (228 RU/ml). Serum immunofixation electrophoresis found monoclonal immunoglobulin (MIg) G κ-light chain in the serum. Renal biopsy displayed crescentic formation in glomerule by microscopy and staining for liner IgG (+), sparse C3 (+-) and light chain (κ and λ) (+-) by immunofluorescence. The bone marrow examination indicated basically normal myelogram and sporadic plasma cells positive for CD38, CD138 staining, and κ light-chain restriction.
DIAGNOSIS: Crescentic glomerulonephritis and MGUS.
INTERVENTIONS: The patient was treated with plasmapheresis, pulse methylprednisolone therapy in combination with cyclophosphamide.
OUTCOMES: The patient still became hemodialysis-dependent.
LESSONS: The present study discusses, to the best of our knowledge, first case of crescentic glomerulonephritis seropositive for ANCA anti-GBM antibody in MGUS. The rare concurrence highlights it as a clinical concern.

PMID: 30762802 [PubMed - indexed for MEDLINE]

Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report.

sam, 16/03/2019 - 06:50
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Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report.

BMC Neurol. 2019 Feb 12;19(1):26

Authors: He D, Yu Y, Wu S, Tian S, Yu H, Xu S, Chu L

Abstract
BACKGROUND: Mixed cerebrovascular disease is a diagnostic entity that presents with hemorrhagic and ischemic stroke clinically and/or subclinically. Here, we report a patient with mixed vascular risk factors, who presented with multiple intracerebral hemorrhages and a simultaneously occurring cerebral infarction with hemorrhagic transformation.
CASE PRESENTATION: A 63-year-old male with no history of trauma or prior neurological disease presented with a sudden onset of weakness in his right limbs, followed by an episode of focal seizure without impaired awareness. The patient had a 4-year history of deep vein thrombosis in the lower limbs, and a 2-year history of Raynaud's phenomenon in the hands. He also had a family history of hypertension and thrombophilia. Head computed tomography plain scans showed two high densities in the bilateral parietal lobes and one mixed density in the left frontal lobe. The patient was diagnosed with mixed cerebrovascular disease. In this report, we make a systematic clinical reasoning regarding the etiological diagnosis, and discuss the possible pathogenic mechanisms leading to mixed cerebrovascular disease. We exclude coagulopathy, endocarditis, atrial fibrillation, patent foramen ovale, brain tumor, cerebral venous thrombosis, cerebral vascular malformation, cerebral amyloid angiopathy and vasculitis as causative factors. We identify hypertension, hereditary protein S deficiency, hypercholesteremia and hyperhomocysteinemia as contributing etiologies in this case.
CONCLUSION: This case presents complex underlying mechanisms of mixed cerebrovascular disease, in which hypertension and hyperhomocysteinemia are considered to play a central role.

PMID: 30755166 [PubMed - indexed for MEDLINE]

Diffuse large vessel giant cell arteritis found by 18Fluorodeoxyglucose PET/CT imaging.

sam, 16/03/2019 - 06:50
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Diffuse large vessel giant cell arteritis found by 18Fluorodeoxyglucose PET/CT imaging.

Lancet. 2019 01 26;393(10169):349

Authors: Power SP, O'Mahony D

PMID: 30696574 [PubMed - indexed for MEDLINE]

Lemierre's syndrome: One rare disease-Two case studies.

sam, 16/03/2019 - 06:50
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Lemierre's syndrome: One rare disease-Two case studies.

J Clin Pharm Ther. 2019 Feb;44(1):122-124

Authors: Le C, Gennaro D, Marshall D, Alaev O, Bryan A, Gelfman A, Wang Z

Abstract
WHAT IS KNOWN AND OBJECTIVE: Lemierre's syndrome is often misdiagnosed as a common cold or viral infection. Fusobacterium necrophorum is the most common causative organism. The recommended treatment regimen is 6 weeks of a beta-lactam antibiotic along with metronidazole.
CASE DESCRIPTION: We present two cases of Lemierre's syndrome with internal jugular vein thrombophlebitis and positive blood cultures for F. necrophorum. The first case was successfully treated with 6 weeks of a beta-lactam antibiotic and 4 weeks of metronidazole, while the second case was successfully treated with 4 weeks of a beta-lactam antibiotic and 2 weeks of metronidazole.
WHAT IS NEW AND CONCLUSION: Two cases of Lemierre's syndrome were treated successfully with only 2-4 weeks of metronidazole therapy. Shorter duration of metronidazole therapy should be explored in future studies.

PMID: 30484880 [PubMed - indexed for MEDLINE]

Clinical Features and Management of "Phlebitis-like Abnormal Reaction" After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins.

sam, 16/03/2019 - 06:50
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Clinical Features and Management of "Phlebitis-like Abnormal Reaction" After Cyanoacrylate Closure for the Treatment of Incompetent Saphenous Veins.

Ann Vasc Surg. 2019 Feb;55:239-245

Authors: Park I, Jeong MH, Park CJ, Park WI, Park DW, Joh JH

Abstract
BACKGROUND: Cyanoacrylate closure for the treatment of incompetent saphenous veins does not cause thermal damage and demonstrates satisfactory outcomes with rapid recovery. However, the characteristics of phlebitis-like abnormal reaction (PLAR), the most common adverse event after cyanoacrylate closure, have not been clarified. Moreover, it differs from typical phlebitis after thermal ablation. The objective of our study is to investigate the clinical features of PLAR after cyanoacrylate closure and to report its management.
METHODS: A total of 160 patients with 271 incompetent saphenous veins (great saphenous veins, 201; small saphenous veins, 70) underwent cyanoacrylate closure with the VenaSeal™ system. We defined PLAR as any unusual skin condition that develops suddenly, such as erythema, itching, swelling, and pain/tenderness, over the treated veins several days after cyanoacrylate closure. Oral antihistamines and intravenous dexamethasone were administered to manage PLAR.
RESULTS: Of the 271 treated veins, 69 experienced PLAR (25.4%). The mean time of occurrence was 13.6 ± 4.6 days after treatment. The rate of occurrence of erythema, itching, swelling, and pain/tenderness were 92.2%, 91.2%, 66.2%, and 48.5%, respectively. The occurrence of PLAR was significantly higher for great saphenous veins than for small saphenous veins (P < 0.001). Occurrences were more frequent in cases with a suprafascial great saphenous vein of length >10 cm than in cases with a subfascial great saphenous vein (P = 0.001). The proportion of patients who reported swelling decreased by more than half after the administration of oral antihistamine. The pain score on the 10th day also decreased significantly after the administration of antihistamine (P = 0.006).
CONCLUSIONS: PLAR must be distinguished from classic phlebitis. We believe that PLAR is a type IV hypersensitivity reaction due to a foreign body, and in our experience, antihistamines or steroids are effective for the prevention and management of PLAR.

PMID: 30217712 [PubMed - indexed for MEDLINE]

Strawberry gingivitis: a rare manifestation of granulomatosis with polyangiitis.

sam, 16/03/2019 - 06:50
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Strawberry gingivitis: a rare manifestation of granulomatosis with polyangiitis.

QJM. 2019 Jan 01;112(1):53

Authors: Kumar RR, Jha S, Sharma A

PMID: 30137535 [PubMed - indexed for MEDLINE]

A Unique Case Report on Hypersensitivity Vasculitis as an Allergic Reaction to the Herpes Zoster Vaccine.

sam, 16/03/2019 - 06:50
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A Unique Case Report on Hypersensitivity Vasculitis as an Allergic Reaction to the Herpes Zoster Vaccine.

Vasc Endovascular Surg. 2019 Jan;53(1):75-78

Authors: Puram V, Lyon D, Skeik N

Abstract
Hypersensitivity vasculitis (HV) or leukocytoclastic vasculitis is a rare small-vessel vasculitis that may occur as a manifestation of the body's extreme allergic reaction to a drug, infection, or other foreign substance. Characterized by the presence of inflammatory neutrophils in vessel walls, HV results in inflammation and damage to blood vessels, primarily in the skin. Histologically, when neutrophils undergo leukocytoclasia and release nuclear debris into the vasculature, vascular damage manifests as palpable purpura. The incidence of HV is unknown and its relationship and interaction with certain vaccinations is rare and poorly understood. Affected patients with HV generally have a good prognosis; however, fatality may occur if organs such as the central nervous system, heart, lungs, or kidneys are involved. We report a unique case of a 60-year-old man who presented with a serious case of HV after receiving the herpes zoster vaccine. A thorough literature review yielded only one similar case of vascular reaction to the varicella vaccine that was reported in the Annals of Internal Medicine in 1997; however, no other reported cases with regard to the herpes zoster vaccine have been found. Our case presents a rare glimpse into HV that may result from varicella vaccine administration.

PMID: 30122132 [PubMed - indexed for MEDLINE]

Spontaneous remission in large-vessel vasculitis: Takayasu arteritis and paraneoplastic disorder associated with thymic carcinoma.

sam, 16/03/2019 - 06:50
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Spontaneous remission in large-vessel vasculitis: Takayasu arteritis and paraneoplastic disorder associated with thymic carcinoma.

Scand J Rheumatol. 2019 01;48(1):79-81

Authors: Onishi A, Tanaka Y, Morinobu A

PMID: 29974801 [PubMed - indexed for MEDLINE]

Hematinic deficiencies and hyperhomocysteinemia in gastric parietal cell antibody-positive or gastric and thyroid autoantibodies-negative Behcet's disease patients.

sam, 16/03/2019 - 06:50
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Hematinic deficiencies and hyperhomocysteinemia in gastric parietal cell antibody-positive or gastric and thyroid autoantibodies-negative Behcet's disease patients.

J Formos Med Assoc. 2019 Jan;118(1 Pt 2):347-353

Authors: Chiang CP, Wu YH, Chang JY, Wang YP, Wu YC, Sun A

Abstract
BACKGROUND/PURPOSE: Our previous study found that 9 of 63 recurrent aphthous stomatitis (RAS)/Behcet's disease (BD) patients have serum gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA positivity or RAS/BD itself was a significant factor causing hematinic deficiencies and hyperhomocysteinemia in GPCA-positive RAS/BD (GPCA+RAS/BD) or gastric and thyroid autoantibodies-negative RAS/BD (Abs-RAS/BD) patients.
METHODS: The mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between any two of three groups of 9 GPCA+RAS/BD patients, 41 Abs-RAS/BD patients, and 126 healthy control subjects.
RESULTS: GPCA+RAS/BD patients had significantly lower mean blood Hb (for men only), iron (for men only), and vitamin B12 levels as well as a significantly higher mean serum homocysteine level than 126 healthy control subjects. Moreover, GPCA+RAS/BD patients had significantly greater frequencies of blood Hb, iron, and vitamin B12 deficiencies and of hyperhomocysteinemia than healthy control subjects. GPCA+RAS/BD patients did have a significantly lower mean serum vitamin B12 level and a significantly higher mean serum homocysteine level as well as significantly greater frequencies of vitamin B12 deficiency and of hyperhomocysteinemia than Abs-RAS/BD patients. Moreover, Abs-RAS/BD patients did have significantly lower mean blood Hb, iron, and folic acid levels and significantly greater frequencies of blood Hb and iron deficiencies than healthy control subjects.
CONCLUSION: The GPCA is a major factor causing vitamin B12 deficiency and hyperhomocyteinemia in GPCA+RAS/BD patients. RAS/BD itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+RAS/BD and Abs-RAS/BD patients.

PMID: 29898820 [PubMed - indexed for MEDLINE]

Multifocal vertebral sclerosing bone changes and soft tissue masses caused by Hodgkin's lymphoma in a patient with systemic lupus erythematosus: a case report.

sam, 16/03/2019 - 06:50
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Multifocal vertebral sclerosing bone changes and soft tissue masses caused by Hodgkin's lymphoma in a patient with systemic lupus erythematosus: a case report.

Scand J Rheumatol. 2019 01;48(1):77-78

Authors: Krabbe S, Helweg-Larsen J, Loft A, Jacobsen S

PMID: 29495920 [PubMed - indexed for MEDLINE]

Multiple Recurrent Pseudoaneurysms after Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Behçet's Disease.

sam, 16/03/2019 - 06:50
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Multiple Recurrent Pseudoaneurysms after Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Behçet's Disease.

Ann Thorac Cardiovasc Surg. 2018 Dec 20;24(6):315-319

Authors: Yamamoto Y, Inoue Y, Ichinose T, Nishizawa M, Igari K, Toyofuku T, Kudo T

Abstract
In Behçet's disease (BD) patients, endovascular repair is a reasonable alternative treatment for aortic aneurysms to avoid postoperative anastomotic pseudoaneurysms. However, there are some complications that may occur after endovascular repair. We herein report the case of a 40-year-old man with active BD developed recurrent aortic pseudoaneurysms at the proximal and distal margins of the stent graft and a femoral puncture site pseudoaneurysm 3 months after endovascular abdominal aortic aneurysm (AAA) repair. The aortic pseudoaneurysms were treated endovascularly, including the use of the chimney technique for the proximal pseudoaneurysm close to the renal arteries and the femoral pseudoaneurysm with surgical excision and reconstruction. Intensive immunosuppressive therapy was initiated immediately after the operation. The patient is in good condition without any complications at 8-month follow-up. This case suggests the utility of the chimney technique and postoperative immediate intensive immunosuppressive therapy in treating recurrent aortic pseudoaneurysms in emergency, active BD patients.

PMID: 29332924 [PubMed - indexed for MEDLINE]

Diffuse alveolar hemorrhage in a patient with ANCA-associated vasculitis after thyroidectomy: A case report.

mer, 13/03/2019 - 05:46
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Diffuse alveolar hemorrhage in a patient with ANCA-associated vasculitis after thyroidectomy: A case report.

Medicine (Baltimore). 2019 Feb;98(8):e14630

Authors: Wang KR, Zhou YF

Abstract
RATIONALE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune disease that mainly affects the lungs and kidneys. Limited reports of perioperative management of such patients were primarily concerned with airway stenosis. Here, we report a patient with AAV who developed diffuse alveolar hemorrhage (DAH) early after radical thyroidectomy.
PATIENT CONCERNS: A 57-year-old female developed wheezing and dyspnea approximately 30 minutes after radical thyroidectomy, with hemoptysis occurring the following day. The patient had a history of AAV and DAH and was maintained with prednisone.
DIAGNOSIS: A diagnosis of DAH was made on the basis of the history of AAV, dyspnea, hemoptysis, and chest computed tomography scan results that showed diffuse high-density shadows in the lungs.
INTERVENTIONS: The patient was administered high-dose glucocorticoids and cyclophosphamide immunosuppressive therapy. Non-invasive ventilation was needed for 2 days postoperatively due to dysfunction of oxygenation.
OUTCOMES: After high-dose glucocorticoids and cyclophosphamide immunosuppressive therapy, DAH improved approximately 2 weeks after the surgery, during which time kidney function was not significantly impaired.
LESSONS: Patients with AAV may develop DAH in the early postoperative period and this may be confused with surgical complications and general anesthetic residues. Therefore, it needs to be identified in an appropriate timeframe.

PMID: 30813199 [PubMed - indexed for MEDLINE]

Coronary Artery Dissection in a Patient with Buerger's Disease.

mer, 13/03/2019 - 05:46
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Coronary Artery Dissection in a Patient with Buerger's Disease.

Braz J Cardiovasc Surg. 2019 Jan-Feb;34(1):114-117

Authors: Tekin Aİ, Arslan Ü

Abstract
Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.

PMID: 30810686 [PubMed - indexed for MEDLINE]

Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report.

mer, 13/03/2019 - 05:46
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Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report.

Braz J Cardiovasc Surg. 2019 Jan-Feb;34(1):111-113

Authors: Barca LV, López-Menéndez J, Palacios AR, Stuart JR

Abstract
We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.

PMID: 30810685 [PubMed - indexed for MEDLINE]

A case of primary angiitis of the central nervous system presenting with diffuse cerebral microbleeds and recurrent intracranial hemorrhage.

mer, 13/03/2019 - 05:46
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A case of primary angiitis of the central nervous system presenting with diffuse cerebral microbleeds and recurrent intracranial hemorrhage.

Neurol Sci. 2019 Feb;40(2):417-419

Authors: Han X, Pang Z, Wang Z, Xu S, Lin Y

Abstract

PMID: 30284656 [PubMed - indexed for MEDLINE]

Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan: A multicenter study.

dim, 10/03/2019 - 05:40
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Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan: A multicenter study.

Medicine (Baltimore). 2019 Mar;98(9):e14668

Authors: Takeuchi M, Kanda T, Kaburaki T, Tanaka R, Namba K, Kamoi K, Maruyama K, Shibuya E, Mizuki N

Abstract
Noninfectious uveitis (NIU), which pathogenesis is often autoimmune nature, occurs as a symptom of systemic syndromes or only in the eye. The standard treatment of NIU is local, topical, and oral administration of corticosteroids (CS) in combination with immunomodulatory therapy (IMT). However, additional therapeutic strategies involving topical and systemic administration of CS or others to treat relapse or exacerbation of ocular inflammation in NIU which present as various ocular manifestations have not been established. The aim of this study was to investigate therapeutic strategies used for various ocular inflammations in relapse or exacerbation of NIU and to evaluate factors associated with the treatment pattern in Japan. The subjects were 198 eyes of 156 NIU patients with relapse or exacerbation of ocular inflammation at 6 university hospitals in Japan. The most frequent disease was sarcoidosis in 23.7% of the cases, followed by Behçet disease (BD) in 21.2%, Vogt-Koyanagi-Harada (VKH) disease in 13.6%, acute anterior uveitis (AAU) in 5.6%, tubulointerstitial nephritis and uveitis syndrome (TINU) in 4.0%, and juvenile idiopathic arthritis (JIA)-associated uveitis in 3.0%. Common ocular findings were worsened anterior inflammation (AI) in 67.2% of the cases, vitreous opacity (VO) in 46.5%, macular edema (ME) in 26.8%, retinal vasculitis (RV) in 23.7%, serous retinal detachment (SRD) in 9.1%, and optic perineuritis (OPN) in 4.0%. Reinforcement of betamethasone eye drop (ED) monotherapy for only AI in both unilateral and bilateral AI, sub-tenon injection of triamcinolone acetonide (STTA) for unilateral posterior inflammation including VO and ME, and systemic therapy using CS and/or IMT for bilateral anterior and posterior inflammation were significantly more frequent. Frequencies of exacerbated individual ocular findings in sarcoidosis and BD were similar, and severe ocular inflammation associated with panuveitis required both topical and systemic therapies. These results demonstrate that reinforcement of betamethasone EDs, topical administration of triamcinolone acetonide, and long-term administration of systemic corticosteroids are the major therapeutic strategies, and reinforcement of betamethasone EDs was used for exacerbated AI independently from its use for posterior inflammation. In addition, STTA was preferentially used for VO and ME associated with posterior inflammation.

PMID: 30817592 [PubMed - indexed for MEDLINE]

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