1/21. methotrexate-induced papular eruption in patients with rheumatic diseases: a distinctive adverse cutaneous reaction produced by methotrexate in patients with collagen vascular diseases.BACKGROUND: In the past few years, low doses of methotrexate have been used for treatment of patients with rheumatoid arthritis and other collagen vascular diseases, mainly as an immunosuppressive and corticosteroid-sparing drug. Several cutaneous adverse reactions have been described in association with methotrexate therapy. OBJECTIVE: We describe the clinical and the histopathologic features of distinctive cutaneous lesions that appeared in 4 patients with acute bouts of collagen vascular diseases who were receiving methotrexate therapy. methods: We clinically and histopathologically evaluated cutaneous lesions caused by methotrexate therapy in 4 patients, 2 with systemic lupus erythematosus, 1 with rheumatoid arthritis, and 1 with Sharp syndrome. RESULTS: Clinically, lesions consisted of erythematous indurated papules most commonly located on proximal areas of the extremities. Histopathologic examination of these papules showed an inflammatory infiltrate mainly composed of histiocytes interstitially arranged between collagen bundles of the dermis, intermingled with few neutrophils. In some foci of deeper reticular dermis, small rosettes composed of clusters of histiocytes surrounding a thick central collagen bundle were seen. Cutaneous lesions showed a direct chronologic relationship with methotrexate therapy, and they disappeared when the drug was tapered or withdrawn and corticosteroids were increased. CONCLUSION: patients receiving low doses of methotrexate for acute bouts of collagen vascular diseases may experience characteristic cutaneous lesions with distinctive clinical and histopathologic findings shortly after methotrexate administration. We discuss the differential diagnosis with other dermatoses showing similar histopathologic findings that have been described in patients with collagen vascular diseases.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/21. collagen vascular diseases and radiation therapy: a critical review.PURPOSE: Although many oncologists have the impression that patients with collagen vascular disease tolerate radiotherapy less well than other patients, until now this was never described in a review article. methods AND RESULTS: The principal objective was to determine whether patients with collagen vascular diseases have a greater risk of severe radiation therapy complications, than those without a collagen vascular disease. However, most of the publications found on this topic are short anecdotal case reports of patients with increased toxicity after radiation. Consequently, the true incidence of these side effects is unknown. CONCLUSIONS: Unless further studies on this subject are reported, each radiation oncologist should be cautious in treating these patients.- - - - - - - - - - ranking = 0.875keywords = vascular disease (Clic here for more details about this article) |
3/21. factor v Leiden and prothrombin G20210A in relation to arterial and/or vein rethrombosis: two cases.The factor v Leiden (FV Leiden) and prothrombin G20210A mutations, are the most common established genetic risk factors for deep vein thrombosis (DVT). However, the relationship between these mutations and arterial thrombotic syndromes (coronary heart disease, myocardial infarction, stroke) has not been established. Some studies have suggested a relationship between them, but other authors have considered it unlikely that these anomalies are a major risk factor for arterial thrombosis. From the clinical point of view, a question arises concerning the risk of repeated thrombosis in patients carrying one of these two mutations. The question is whether the recurrence is attributable to the mutations or to the presence of additional circumstantial risk factors. As the risk of repeated thrombosis varies considerably from one patient to another, decisions about long-term treatment require weighing the persistence of risk factors for vascular disease (venous and arterial), especially in selected cases such as young patients or patients with thrombosis of unusual localization.- - - - - - - - - - ranking = 0.125keywords = vascular disease (Clic here for more details about this article) |
4/21. The medial gastrocnemius muscle flap in the treatment of wound complications following total knee arthroplasty.There is greater potential for wound healing complication in rheumatoids, diabetics, and other patients with peripheral vascular disease. Local wound care in areas of avascularity and skin necrosis has poor results, especially if an ulcer is greater than 2 cm in diameter. Gastrocnemius muscle flap coverage of persistent wounds and areas of skin necrosis following total knee arthroplasty should be considered early in the course of such a complication.- - - - - - - - - - ranking = 0.125keywords = vascular disease (Clic here for more details about this article) |
5/21. First report of supraventricular tachycardia after intravenous pulse methylprednisolone therapy, with a brief review of the literature.The occurrence of supraventricular tachycardia after high-dose intravenous methylprednisolone pulse therapy (HIVMPT) in a patient with active rheumatoid arthritis is described for the first time. This case report further expands the range of arrhythmias that can occur with HIVMPT. Other arrhythmias previously reported to occur after HIVMPT include atrial fibrillation, atrial flutter, junctional rhythm, and ventricular tachycardia. To the best of our knowledge, supraventricular tachycardia has not been reported previously, although severe bradycardia, hypotension, asystole, cardiovascular collapse, and sudden death have been documented. A review of the literature indicates that these case reports not withstanding, HIVMPT is generally safe, and cardiovascular toxicity is rare. However, close supervision with repeated measurements of blood pressure, electrocardiogram, and blood electrolytes is mandatory during and immediately after HIVMPT, especially for patients with pre-existing cardiovascular disease, and the lowest effective dose of methylprednisolone should be infused at a slow rate.- - - - - - - - - - ranking = 0.125keywords = vascular disease (Clic here for more details about this article) |
6/21. Necrotizing scleritis of scleral flaps after transscleral suture fixation of an intraocular lens.A 56-year-old woman with rheumatoid arthritis underwent intracapsular cataract extraction and sulcus fixation of an intraocular lens using transscleral fixation sutures buried under partial-thickness scleral flaps. Necrotizing scleritis confined to the area of the scleral flaps developed one month postoperatively, resulting in exposure and loosening of one fixation suture and lens implant decentration. The scleritis responded to systemic prednisone and cyclophosphamide treatment, with healing in two weeks. The final visual acuity was 20/30. Surgical trauma may stimulate local intravascular immune complex deposition and initiate the inflammatory process, thereby leading to necrotizing scleritis. This process should be considered when contemplating the use of scleral flaps in patients with collagen vascular disease and systemic vasculitis.- - - - - - - - - - ranking = 0.125keywords = vascular disease (Clic here for more details about this article) |
7/21. Reversing myocardial microvascular disease in a patient with rheumatoid arthritis.Rheumatoid arthritis (RA) is associated with increased cardiovascular mortality. This is regarded as being due to accelerated coronary atherosclerosis. We describe a 62-year-old man with seropositive erosive RA and extraarticular manifestations but no history of cardiovascular disease. Noninvasive assessment of myocardial blood flow by adenosine stressed thallium scanning showed reversible ischemia and diffusely poor myocardial perfusion. Repeat assessment after intensive immunosuppression for rheumatoid vasculitis revealed resolution of the ischemic changes and generally increased myocardial perfusion. coronary angiography revealed no significant atheroma, suggesting that myocardial microvascular disease was responsible for the ischemia. This may be an important determinant of cardiovascular outcome in RA, and this case indicated that it can be reversed with immunosuppression.- - - - - - - - - - ranking = 0.75keywords = vascular disease (Clic here for more details about this article) |
8/21. Development of calciphylaxis after long-term steroid and methotroxate use in a patient with rheumatoid arthritis.calciphylaxis may be considered a small vessel vasculopathy which is generaly associated with end-stage renal disease and hyperparathyroidism. The precise pathogenesis of the disease is not known. It needs sensitizers and challengers to occur. steroids and immunosuppressive drugs including methotrexate are among those challenger agents. calciphylaxis in collagen vascular diseases is rare. Only one case in rheumatoid arthritis was recently reported. Here we describe a case of calciphylaxis associated with active rheumatoid arthritis. This patient had active disease despite treatment of steroids and methotrexate for a long time. She died shortly after the diagnosis of calciphylaxis due to sepsis.- - - - - - - - - - ranking = 0.125keywords = vascular disease (Clic here for more details about this article) |
9/21. breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease.Two patients with collagen vascular disease (rheumatoid arthritis and scleroderma) had extremely poor cosmetic results after breast radiation therapy (RT). The patient with rheumatoid arthritis received 5251 cGy at 210 cGy per day, followed by a 1600 cGy iridium-192 implant boost. Between 8 and 11 months post-RT she had severe breast fibrosis, retraction, and pain that required a mastectomy for relief. The patient with scleroderma received 5040 cGy at 180 cGy per day without a boost. Between 1 and 4 months post-RT the systemic symptoms of scleroderma progressed and the breast became hard and retracted. Both rheumatoid arthritis and scleroderma are chronic systemic diseases characterized by severe inflammation and an autoimmune component. The presence of scleroderma at or before treatment should be considered a contraindication to breast RT, whereas the presence of active rheumatoid arthritis should be considered a relative contraindication. An autoimmune mechanism will be presented to explain both the fibrosis and the systemic progression of collagen vascular disease that was observed.- - - - - - - - - - ranking = 0.75keywords = vascular disease (Clic here for more details about this article) |
10/21. Sterile corneal ulceration after cataract extraction in patients with collagen vascular disease.We report the occurrence of sterile corneal ulceration in 11 eyes of eight patients with collagen vascular diseases and dry eyes after cataract extraction with intraocular lens implantation. Keratolysis occurred after both extracapsular and intracapsular cataract extraction and appeared unrelated to the type of intraocular lens. Despite aggressive lubrication and other medical treatment, including systemic immunosuppressive agents, penetrating keratoplasty was often required. Although all eyes were saved, visual outcome was usually poor. The histopathologic finding of polymorphonuclear leukocytes localized near the areas of corneal dissolution provides evidence for the role of polymorphonuclear leukocyte-derived collagenase as a contributing factor in the pathogenesis of sterile corneal ulceration in these patients.- - - - - - - - - - ranking = 0.625keywords = vascular disease (Clic here for more details about this article) |
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