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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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Coronary Arteritis in IgG4-Related Disease.

lun, 10/06/2019 - 06:36
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Coronary Arteritis in IgG4-Related Disease.

N Engl J Med. 2019 May 30;380(22):2156

Authors: de la Fuente J, Bird J

PMID: 31141636 [PubMed - indexed for MEDLINE]

Emphysematous Aortitis by Clostridium septicum: A Rare and Lethal Complication of Right Colon Cancer.

lun, 10/06/2019 - 06:36
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Emphysematous Aortitis by Clostridium septicum: A Rare and Lethal Complication of Right Colon Cancer.

Eur J Vasc Endovasc Surg. 2019 04;57(4):509

Authors: Curtis-Martínez C, Sánchez-Guillén L

PMID: 30852054 [PubMed - indexed for MEDLINE]

Levamisole-induced vasculopathy: A systematic review.

ven, 07/06/2019 - 06:31
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Levamisole-induced vasculopathy: A systematic review.

Semin Arthritis Rheum. 2019 04;48(5):921-926

Authors: Dartevel A, Chaigne B, Moachon L, Grenier F, Dupin N, Guillevin L, Bouillet L, Mouthon L

Abstract
OBJECTIVE: To characterize levamisole-induced vasculopathy.
METHODS: We performed a systematic review searching MEDLINE for articles published from 1972 to 2016.
RESULTS: We retrieved 357 references and abstracts and selected 111 articles. Levamisole-induced vasculopathy was reported in 192 patients, with a female predominance (n = 122, 63.5%). Median [interquartile range] age was 44 [38-50]. Skin was the most frequently involved organ (n = 182, 94.8%). Cutaneous lesions were mostly on the face (n = 136, 70.8%), especially the ears. Purpura (n = 131, 68.2%) was the most reported cutaneous lesion. Organ involvement included acute renal failure (n = 24, 12.5%), and pulmonary involvement (n = 20, 10.4%). Anti-neutrophil cytoplasmic antibodies (ANCAs) were found in 167/178 patients (93.8%), with both anti-myeloperoxydase and anti-proteinase 3 specificity reported in 51/118 patients (43.2%). Anti-phospholipid (APL) antibodies were found in 93/137 patients (67.9%). Leukopenia was detected in 69/138 patients (50%). Skin biopsies identified vasculitis and thrombotic vasculopathy in 73/148 (49.3%) and 62/148 (41.9%) patients, respectively. The outcome was favourable in 116/134 patients (86.6%), but relapses were reported in 33 (28.4%), mainly on levamisole re-exposure.
CONCLUSION: Levamisole-induced vasculopathy is characterized by a female predominance, skin involvement, ANCA and/or APL antibody positivity, leukopenia, vasculitis or vascular thrombotic histological lesions, and despite possible systemic involvement, a favourable outcome with levamisole interruption.

PMID: 30166200 [PubMed - indexed for MEDLINE]

Juvenile temporal arteritis: A clinicopathological multicentric experience.

mar, 04/06/2019 - 04:40
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Juvenile temporal arteritis: A clinicopathological multicentric experience.

Autoimmun Rev. 2019 May;18(5):476-483

Authors: Journeau L, Pistorius MA, Michon-Pasturel U, Lambert M, Lapébie FX, Bura-Riviere A, de Faucal P, Jego P, Didier Q, Durant C, Urbanski G, Hervier B, Toquet C, Agard C, Espitia O, Groupe d'Étude Français des Artérites des gros Vaisseaux

Abstract
INTRODUCTION: Juvenile temporal arteritis (JTA) is a recently-described and little-known inflammatory disease and its etiology is undetermined. Less than forty cases have been published. This paper is aimed at reporting the largest JTA series and to compare it to literature data to better evaluate its characteristics at diagnosis, its evolution and treatment options.
MATERIAL AND METHODS: We conducted a retrospective and descriptive multicentric study in France by identifying adult patients under the age of 50 which had a pathological temporal artery biopsy owing to the presence of a temporal arteritis. Patients with temporal arteritis as a manifestation of systemic vasculitis were excluded.
RESULTS: We included 12 patients and the literature review identified 32 cases described in 27 articles, thus a total of 44 patients - 34 men and 10 women - with a median age of 30 and a maximum of 44. All patients presented either a lump in the temporal region or prominent temporal arteries, and 47.7% of patients suffered from headaches. Only 11.4% of patients presented general symptoms and 6.8% a biological inflammatory syndrome; 34.1% had peripheral blood eosinophilia; 83.7% presented a single episode and complete excision without further treatment was documented for 72.7%. Pathology analysis revealed infiltrate of inflammatory cells in the arterial wall in 97.6% of patients but also sparse giant cells for 25% and granuloma for 22.9%, perivascular extension of the inflammation for 82.6%, and presence of lymphoid follicles or germinal centres for 60%. Clinical relapses were present in 16.3% of cases.
CONCLUSION: JTA is a rare, localized and benign disease. The majority of cases have only one episode which is cured by local surgery.

PMID: 30844551 [PubMed - indexed for MEDLINE]

Ocular involvement in granulomatosis with polyangiitis: A single-center cohort study on 63 patients.

mar, 04/06/2019 - 04:40
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Ocular involvement in granulomatosis with polyangiitis: A single-center cohort study on 63 patients.

Autoimmun Rev. 2019 May;18(5):493-500

Authors: Pérez-Jacoiste Asín MA, Charles P, Rothschild PR, Terrier B, Brézin A, Mouthon L, Guillevin L, Puéchal X

Abstract
OBJECTIVE: To analyse the ocular manifestations of patients with GPA, their treatment and outcome.
METHODS: Retrospective cohort study performed at the National Referral Center for Vasculitis, Cochin Hospital, Paris (France), from January 2005 to December 2015. Among 308 patients with a new diagnosis of GPA in accordance with the American College of Rheumatology classification criteria and/or revised Chapel Hill nomenclature definitions, we identified those with ocular involvement and a subsequent follow up in our center.
RESULTS: The prevalence of ocular involvement in our GPA series was 38.6%; 63 patients were analysed with a median follow-up of 50.5 months (IQR: 17.8-82.8). Scleritis (18 patients, 28.6%) and episcleritis (18 patients, 28.6%) were the most common ophthalmologic manifestations, followed by orbital disease (13 patients, 20.6%). Bilateral involvement and visual acuity loss was seen in 29.1% and 16.7% of patients, respectively. Ocular involvement was the first GPA manifestation in 9 patients (14.3%), concomitant with systemic manifestation in 36 (57.1%), and occurred only during follow-up in 18 (28.6%). The indication for GPA treatment was suggested by ocular involvement in 12 patients (19.0%), by systemic features in 40 (63.5%) and by both ocular and systemic involvement in 11 (17.5%). Remission of ocular involvement was achieved in 51 patients (80.9%). In the remaining 12 (19.1%), symptoms persisted or even worsened, finally leading to rituximab (RTX) therapy in 8 of them (66.7%). Altogether, when used as first line or for refractory disease, ocular remission was achieved in 11 of the 12 cases (91.7%) treated with RTX versus 34 of the 47 cases (72.3%) treated with CYC (P = .260). Eye disease relapsed in 14 patients (22.2%). RTX allowed achievement of remission in 8 of them (57.1%). In the remaining six, other immunosuppressive drugs were used.
CONCLUSIONS: Scleritis and episcleritis are the most common ocular manifestations in GPA, most of the time associated with other systemic manifestations. In >40% of cases, ocular manifestations were refractory to initial treatment or recurrent and led to RTX prescription, which appeared to be useful in these situations.

PMID: 30844550 [PubMed - indexed for MEDLINE]

Rituximab therapy for primary central nervous system vasculitis: A 6 patient experience and review of the literature.

mar, 04/06/2019 - 04:40
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Rituximab therapy for primary central nervous system vasculitis: A 6 patient experience and review of the literature.

Autoimmun Rev. 2019 04;18(4):399-405

Authors: Salvarani C, Brown RD, Muratore F, Christianson TJH, Galli E, Pipitone N, Cassone G, Huston J, Giannini C, Warrington K, Hunder GG

Abstract
OBJECTIVES: To assess the efficacy and safety of Rituximab (RTX) in adult primary central nervous system vasculitis (PCNSV).
METHODS: We retrospectively assessed the effect of RTX in 6 patients with PCNSV. Five of the 6 were refractory to high dose glucocorticoids (GCs) and/or conventional immunosuppressants (IS). The sixth was newly diagnosed and received RTX in combination with GCs. Clinical evaluation, laboratory tests, and imaging modalities were performed at initial RTX administration and during the follow-up. Treatment response was assessed using the treating physician's global opinion regarding response and the degree of disability using the modified Rankin scale (mRS). We also performed a literature review for previous use of RTX in PCNSV using PubMed, Ovid Medline, and the Cochrane library.
RESULTS: The six patients (3 females) had a median age at diagnosis of 50.5 years (range 17-68 years). All had active disease when RTX was started. In 4 patients, RTX administration was associated with a marked reduction in the number of flares (from 18 before starting RTX to 3 after). One patient, after an initial improvement, had 2 flares when B cells were depleted and he was not able to reduce prednisone below 20 mg/day. A 6th patient had a flare when B cells recovered and retreatment with RTX re-induced and maintained remission. The median mRS score at last visit (median: 2; range 0-4) was lower than that prior to treatment (median 3; range 1-5). The median prednisone daily dose before RTX administration was significantly higher than that at last follow-up (p = .006). In the literature review, we identified 5 papers describing 7 patients treated with RTX. Six patients responded to RTX with clinical and MRI improvement with no reported flares after RTX treatment.
CONCLUSIONS: Our data support a potential role for RTX treatment in selected patients with PCNSV.

PMID: 30743080 [PubMed - indexed for MEDLINE]

Further observations on a bilateral IRVAN syndrome case.

mar, 04/06/2019 - 04:40
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Further observations on a bilateral IRVAN syndrome case.

Int Ophthalmol. 2019 May;39(5):1179-1186

Authors: Rodríguez Á, Carpio-Rosso W, Rodríguez FJ

Abstract
PURPOSE: Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging.
METHODS: This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation.
RESULTS: A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography.
CONCLUSIONS: A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.

PMID: 29948501 [PubMed - indexed for MEDLINE]

A case report dysregulated neutrophil extracellular traps in a patient with propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated vasculitis.

sam, 01/06/2019 - 01:41
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A case report dysregulated neutrophil extracellular traps in a patient with propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated vasculitis.

Medicine (Baltimore). 2019 Apr;98(17):e15328

Authors: Watanabe-Kusunoki K, Abe N, Nakazawa D, Karino K, Hattanda F, Fujieda Y, Nishio S, Yasuda S, Ishizu A, Atsumi T

Abstract
RATIONALE: Neutrophil extracellular traps (NETs) are immune defence systems that release extracellular chromatin and myeloid granules including myeloperoxidase (MPO) to kill pathogens. An experimental animal study recently demonstrated that disordered NETs induced by propylthiouracil (PTU) could contribute to the production of MPO anti-neutrophil cytoplasmic antibody (ANCA) and the development of ANCA-associated vasculitis (AAV). However, the role of dysregulated NETs in the pathogenesis of human AAV remains unclear.
PATIENT CONCERNS: We report a 19-year-old woman with Graves' disease on PTU presented fever, polyarthralgia, and lung hemorrhage with high titer of MPO-ANCA. This patient had a variety of atypical ANCAs and disordered NETs in vitro.
DIAGNOSES: A diagnosis of PTU-induced AAV (PTU-AAV).
INTERVENTIONS: The PTU was discontinued and she was treated with immunosuppressants and plasmapheresis for reducing pathogenic autoantibodies.
OUTCOMES: Clinical manifestations including fever, polyarthralgia, and lung hemorrhage were on remission with a decrease of dysregulated NETs.
LESSONS: The clinical course of this PTU-AAV case indicated that dysregulated NETs would play a role in the development of ANCA and the pathogenesis of AAV.

PMID: 31027105 [PubMed - indexed for MEDLINE]

Comparisons of clinical manifestations and prognosis between giant cell arteritis patients with or without sensorineural hearing loss: A retrospective study of Chinese patients.

sam, 01/06/2019 - 01:41
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Comparisons of clinical manifestations and prognosis between giant cell arteritis patients with or without sensorineural hearing loss: A retrospective study of Chinese patients.

Medicine (Baltimore). 2019 Apr;98(17):e15286

Authors: Chu X, Wang D, Zhang Y, Yin Y, Cao Y, Han X, Shen M, Jiang H, Zeng X

Abstract
Auditory manifestations has rarely been mentioned in studies concerning giant cell arteritis (GCA). This study explores the proportion of hearing loss (HL) in Chinese GCA patients and investigates the differences in clinical features between GCA patients with and without HL.The study retrospectively reviewed the clinical records of 91 patients diagnosed with GCA at Peking Union Medical College Hospital (PUMCH) from November 1998 to October 2017. GCA diagnoses were reconfirmed according to the American College of Rheumatology 1990 criteria. Diagnosis of HL was made based on a patient's symptoms combined with physical examination or ear-nose-throat (ENT) audiometry tests. Subgroup analysis was conducted according to the occurrence of HL.Totally 23 patients (25.3%) had HL. A higher percentage of males (65.2% vs 38.2%, p = 0.025) was seen in HL group. Symptoms such as headache (91.3% vs 61.2%, p = 0.011), visual loss (56.5% vs 32.4%, p = 0.039) and CNS symptoms (39.1% vs 17.6%, p = 0.035) were more frequent in HL group. Moreover, they were more likely to have smoking history (p = 0.019), lower lymphocyte count (p = 0.049), positive ANA or APL (p = 0.047, p = 0.017) or negative biopsy results (p = 0.015). Symptom like myalgia (26.1% vs 66.2%, p = 0.001) as well as comorbid disease like coronary artery disease (p = 0.037) and hypertension (p = 0.040) was more frequent in patients without HL. Either C-reactive protein (90.91 ± 65.86 vs 76.05 ± 61.15 mg/L, p = 0.347) or erythrocyte sedition rate (83.04 ± 29.61 vs 93.69 ± 26.78 mm/h, p = 0.136) was high in both groups but the differences were not significant. Meanwhile, no significant differences were found in age, disease course, vascular involvement or prognosis between the two groups. Unilateral HL tended to happen at the same side with unilateral headache, visual loss, scalp tenderness or jaw claudication.HL is probably not rare in GCA patients and is more frequently to be seen in patients presented with headache, visual loss or CNS symptoms. Differentiation of HL is necessary for specialists and GCA should be considered as a potential diagnosis especially in HL patients with high inflammatory markers. Auditory assessment should be conducted in GCA management.

PMID: 31027087 [PubMed - indexed for MEDLINE]

Measurement of Contrast Sensitivity in Patients with Behçet's Disease without Ocular Involvement.

sam, 01/06/2019 - 01:41
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Measurement of Contrast Sensitivity in Patients with Behçet's Disease without Ocular Involvement.

Korean J Ophthalmol. 2019 Apr;33(2):167-172

Authors: Ozsoy E, Cankaya C, Ozturk E, Gunduz A, Ulucan PB

Abstract
PURPOSE: To evaluate contrast sensitivity in patients with Behçet's disease (BD) without ocular involvement.
METHODS: The study group was composed of 47 BD patients (20 to 50 years of age) who did not have ocular involvement. The control group was composed of 47 normal volunteers who were similar to the study group in terms of age and gender. No participants in this study had any ocular or systemic pathologies except for BD. The contrast sensitivity measurements were performed using the Functional Acuity Contrast Test under photopic conditions, and the results were compared between the two groups.
RESULTS: The mean age of the BD patients and control subjects was 34.5 ± 9.7 and 33.2 ± 7.6 years, respectively. The mean disease duration of the BD patients was 5.5 ± 6.4 years. There was a statistically significant decrease at five spatial frequencies (A, 1.5; B, 3; C, 6; D, 2; and E, 18 cycles per degree) in patients with BD compared with control subjects (p < 0.001, p = 0.004, p = 0.002, p < 0.001, and p = 0.001, respectively).
CONCLUSIONS: The contrast sensitivity of BD patients without ocular involvement was lower than that of the control group. Further studies seem mandatory to confirm our results.

PMID: 30977326 [PubMed - indexed for MEDLINE]

Diffuse inflammatory aneurysmal aortitis secondary to Scedosporium apiospermum complex in an immunocompetent individual.

sam, 01/06/2019 - 01:41
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Diffuse inflammatory aneurysmal aortitis secondary to Scedosporium apiospermum complex in an immunocompetent individual.

Pathology. 2019 04;51(3):316-318

Authors: Klinken EM, Stevenson BR, Kwok CHR, Hockley JA, Lucas M

PMID: 30819537 [PubMed - indexed for MEDLINE]

Incidence, severity and risk factors of peripheral intravenous cannula-induced complications: An observational prospective study.

sam, 01/06/2019 - 01:41
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Incidence, severity and risk factors of peripheral intravenous cannula-induced complications: An observational prospective study.

J Clin Nurs. 2019 May;28(9-10):1585-1599

Authors: Simin D, Milutinović D, Turkulov V, Brkić S

Abstract
AIMS AND OBJECTIVES: To determine the incidence, severity and risk factors of peripheral intravenous cannula-induced complications.
BACKGROUND: Peripheral venous cannulation in hospitalised patients may cause complications such as phlebitis, infiltration, occlusion and dislodgement. A review of the literature reveals the discrepancy in their incidence and identification of a wide range of risk factors, whereas the data on the occurrence and degree of severity are insufficient.
DESIGN: An observational prospective study.
METHODS: The study observed 1,428 peripheral intravenous cannula insertion among 368 adult patients hospitalised at the tertiary healthcare clinics. The data collection and analysis included patients' medical data and the data related to each cannula (including placement, monitoring and the reasons for removal), as well as the data on the type of administered medications and solutions. Reporting of this research adheres to the STROBE guidelines.
RESULTS: Phlebitis ranked first among complications with occurrence of 44%, followed by infiltration of 16.3%, while the incidence of occlusion and catheter dislodgement was 7.6% and 5.6%, respectively. In assessing the occurrence of phlebitis, multivariate analysis highlighted the presence of comorbidity, current infection, catheter size, time in situ and the number of administrations of infusion solutions associated with risk, whereas 20-gauge catheter, two or more attempts at cannulation and administration of a high-risk solutions during the first day have been singled out with regard to infiltration. As for the severity, the most common was medium stage of phlebitis, whereas grade 2 was most commonly observed for infiltration.
CONCLUSION: The incidence of infiltration, occlusion and dislodgment is almost congruent with the average incidence of previous studies. However, the incidence and degree of severity associated with the occurrence of phlebitis were significantly higher.
RELEVANCE TO CLINICAL PRACTICE: The results of the study draw attention to vulnerable groups of patients, cannula-specific and pharmacological risk factors for the development of peripheral intravenous cannula-induced complications.

PMID: 30589945 [PubMed - indexed for MEDLINE]

Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study.

sam, 01/06/2019 - 01:41
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Impact of subcutaneous tunnels on peripherally inserted catheter placement: a multicenter retrospective study.

Eur Radiol. 2019 May;29(5):2716-2723

Authors: Kim IJ, Shim DJ, Lee JH, Kim ET, Byeon JH, Lee HJ, Cho SG

Abstract
OBJECTIVE: To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line-associated bloodstream infections (CLABSIs).
METHODS: Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models.
RESULTS: Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149-0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI.
CONCLUSIONS: Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI.
KEY POINTS: • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.

PMID: 30560363 [PubMed - indexed for MEDLINE]

Sudden unexpected death due to coronary thrombosis associated with isolated necrotizing vasculitis in the coronary arteries of a young adult.

sam, 25/05/2019 - 20:49
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Sudden unexpected death due to coronary thrombosis associated with isolated necrotizing vasculitis in the coronary arteries of a young adult.

Forensic Sci Med Pathol. 2019 Jun;15(2):252-257

Authors: Sakai K, Asakura K, Saito K, Fukunaga T

Abstract
Coronary arteritis is an uncommon cause of sudden death in non-atherosclerotic coronary diseases, and is mostly associated with systemic vasculitis or systemic autoimmune diseases; therefore, sudden death due to isolated coronary arteritis rarely occurs. The case described in this report is that of a 34-year-old man with no significant personal medical history who died suddenly after presenting with nausea. Postmortem examination revealed a significant infiltration of lymphocytes predominantly on the adventitia and periadventitial tissues of the coronary arteries in the epicardium. The lymphocytic infiltrate partially extended to the thickened intima with fibrosis, destructing the media and internal elastic lamina, and the lumen was occluded by a thrombus in the left main stem and left anterior descending branch. The arterial walls exhibited focal fibrinoid necrosis with regression in the intima and fibrous scars with angiogenesis in the media and adventitia. Focal myocardial infarction was detected in the left ventricle as a fibrotic change of the myocardium. No findings associated with vasculitis were discerned in the aorta, other peripheral arteries, or major organs. Laboratory tests of postmortem blood samples returned negative results for antinuclear antibodies, cryoglobulin, immunoglobulin G4, and cytoplasmic anti-neutrophil cytoplasmic antibodies for myeloperoxidase and proteinase 3. These autopsy findings suggest that the sudden death was caused by isolated necrotizing vasculitis that is assumed to be polyarteritis nodosa localized at the coronary arteries. However, pathological characteristics may not be exactly the same between isolated necrotizing vasculitis in the coronary arteries and polyarteritis nodosa.

PMID: 30810977 [PubMed - indexed for MEDLINE]

What is the role of diffusion tensor imaging (DTI) in detecting subclinical pyramidal tract dysfunction in Behçet's and neuro-Behçet's cases?

sam, 25/05/2019 - 20:49
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What is the role of diffusion tensor imaging (DTI) in detecting subclinical pyramidal tract dysfunction in Behçet's and neuro-Behçet's cases?

Neurol Sci. 2019 Apr;40(4):753-758

Authors: Aykac SC, Gökcay F, Calli C

Abstract
The aim of this study is to investigate the pyramidal tract integrity with DTI in Behçet's and neuro-Behçet's cases. We performed this technique in two subgroups of neuro-Behçet's patients (parenchymal and vascular), and Behçet's cases without neurological involvement and control group. Totally, 28 patients were investigated. The control group was composed of 14 healthy people. Cranial MR and DTI were performed in three patient groups and the control group. At DTI, circular regions of interest (ROI) were symmetrically drawn on axial slices on the left and right sides along the pyramidal tract pathway at two levels: middle one third of the cerebral peduncle and posterior limb of the internal capsule. Fractional anisotropy (FA) values for each ROI were obtained by averaging all voxels within the ROI. Calculated FA values on both sides (left and right) of the posterior limb of the internal capsule and cerebral peduncle are significantly lower in all three patient groups when compared to the control group. But there is no any difference of FA values in the selected brain regions of three patient groups. FA values on the posterior limb of the internal capsule and cerebral peduncle do not show a statistically significant difference in parenchymal neuro-Behçet's cases. Our study demonstrates that DTI can detect subclinical pyramidal tract dysfunction in neuro-Behçet's and Behçet's patients. Detection of subclinical nervous system involvement is crucial for morbidity in Behçet's disease. For this reason, studies based on DTI, which include a large number of patients and explore different brain regions, are needed to guide clinicians.

PMID: 30661157 [PubMed - indexed for MEDLINE]

Hypereosinophilic vasculitis: A case report.

mer, 22/05/2019 - 20:20
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Hypereosinophilic vasculitis: A case report.

Medicine (Baltimore). 2019 Apr;98(17):e15392

Authors: Alzayer H, Hasan MA

Abstract
INTRODUCTION: The Revised International Chapel Hill Consensus Conference 2012 subdivides vasculitides based on combinations of features that separate different forms of vasculitis into definable categories. Hypereosinophilic vasculitis with sparing of the respiratory tract and renal system is a rare presentation that is yet to be described in the Revised International Chapel Hill Consensus Conference 2012 report that addresses nomenclature of vasculitides. This is a condition that involves a vascular injury due to either a primary eosinophilic vasculitis or an underlying connective tissue disease and it predisposes patients to a prothrombotic state.
PATIENT CONCERNS: A 39-year-old patient presented with left hand digital ischemia, preceded by Raynaud phenomenon, and vasculitic rash. For 3 months, he was having digital ischemia affecting the left 2nd and 3rd digits in the form of pallor and gangrenous discoloration with a preceding history of a pinpoint pruritic rash affecting his lower limbs that extended to involve the trunk and upper limbs over a short period of time and responded to only a tapering dose of oral steroids. Examination revealed a delayed capillary refill in all left-hand digits and a weak left radial pulse but no bruit. The rest of his peripheral vascular examination was unremarkable.
DIAGNOSIS: Investigations revealed an absolute eosinophilic count of 4.34 K/μL and erythrocyte sedimentation rate of 44 mm/h. A magnetic resonance angiogram showed a beaded appearance of the left ulnar artery distally and the radial artery branches in the left hand and subsequently was diagnosed with hypereosinophilic vasculitis.
INTERVENTIONS: He was started on oral prednisone of 1 mg/kg daily orally tapering done as well as azathioprine for maintenance.
OUTCOMES: Two weeks postdischarge, the patient was seen in the outpatient department where his ischemic symptoms improved, and his skin rash healed. Noticed improvement in his splinter hemorrhages was also detected. He continued to do well on 2 years follow-up CONCLUSION:: This case reflects the importance of frequent reevaluation for vasculitic diseases criteria and nomenclature. Hypereosinophilic vasculitis with absent respiratory and renal involvement is a rare presentation with scarce evidence to guide treatment.

PMID: 31027135 [PubMed - indexed for MEDLINE]

An Autopsy Case with Cerebral Hemorrhaging due to disseminated Aspergillosis During Glucocorticoid Therapy for Overlap Syndrome of Systemic Lupus Erythematosus and Systemic Sclerosis.

mer, 22/05/2019 - 20:20
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An Autopsy Case with Cerebral Hemorrhaging due to disseminated Aspergillosis During Glucocorticoid Therapy for Overlap Syndrome of Systemic Lupus Erythematosus and Systemic Sclerosis.

Intern Med. 2019 Apr 01;58(7):1023-1027

Authors: Ueno M, Nakano K, Yoshinari H, Nakayamada S, Iwata S, Kubo S, Miyagawa I, Tanaka Y

Abstract
We encountered a 60-year-old female patient who died of cerebral hemorrhage caused by disseminated aspergillosis during massive steroid therapy for overlap syndrome of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) and performed autopsy. Histologically, necrotizing vasculitis accompanied by Aspergillus hyphae was noted in the arterial wall of the region with cerebral hemorrhage and an abscess containing Aspergillus clumps was present in the lung, therefor we considered the cerebral hemorrhage caused by disseminated aspergillosis. For immunocompromised patients, it is desirable to perform treatment taking the possibility of deep mycosis into consideration, and when it is suspected, early therapeutic intervention may be useful.

PMID: 30568120 [PubMed - indexed for MEDLINE]

Seventy-one-year-old woman followed with CMR during the course of systemic vasculitis.

ven, 10/05/2019 - 14:31
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Seventy-one-year-old woman followed with CMR during the course of systemic vasculitis.

Heart. 2019 04;105(7):515-530

Authors: Gastl M, Faruque Osmany DM, Manka R

PMID: 30442742 [PubMed - indexed for MEDLINE]

To Replace or Not to Replace? Replacing Short Peripheral Catheters Based on Clinical Indication.

mar, 07/05/2019 - 13:29
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To Replace or Not to Replace? Replacing Short Peripheral Catheters Based on Clinical Indication.

J Infus Nurs. 2019 May/Jun;42(3):143-148

Authors: Maier D

Abstract
Short peripheral catheters (SPCs) are the most frequently used medical devices in hospital settings. Many hospital policies state that SPCs be replaced at 96 hours, which can be unnecessary and costly. A pre-post quality improvement initiative was implemented following complications surrounding removal of timed SPC catheters compared with those removed by clinical indication, using the Visual Infusion Phlebitis (VIP) scale. Data collected included patient demographics, SPC characteristics, nursing time, and product use. SPCs replaced based on clinical indication remained intact longer and had fewer complications than those in the group with routinely replaced SPCs. Decreasing SPC replacements by use of clinical indication resulted in cost savings of $7263.60/unit/month.

PMID: 30985563 [PubMed - indexed for MEDLINE]

An Atypical Case of Non-asthmatic Eosinophilic Granulomatosis with Polyangiitis Finally Diagnosed by Tissue Biopsy.

mar, 07/05/2019 - 13:29
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An Atypical Case of Non-asthmatic Eosinophilic Granulomatosis with Polyangiitis Finally Diagnosed by Tissue Biopsy.

Intern Med. 2019 Mar 15;58(6):871-875

Authors: Kobayashi T, Kanno K, Kikuchi Y, Kakimoto M, Kawahara A, Kimura K, Ishida R, Miyamori D, Otani Y, Kishikawa N, Tazuma S

Abstract
A 78-year-old woman with fever of unknown origin that had persisted for 3 months, systemic edema, and cervical lymphadenopathy was admitted to our hospital. Skin purpura and jaw claudication were subsequently observed. Histopathological examinations of the lymph nodes, skin, and temporal artery revealed findings characteristic of eosinophilic granulomatosis with polyangiitis (EGPA). However, she had no past medical history of asthma with modest eosinophilia. Although EGPA is a systemic vasculitis characterized by asthma and eosinophilia, various limited forms have been described. This was therefore considered to be an atypical form of non-asthmatic EGPA complicating with temporal arteritis (TA) diagnosed by tissue biopsy.

PMID: 30449779 [PubMed - indexed for MEDLINE]

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