1/6. Multiple spontaneous small bowel perforations due to systemic cholesterol atheromatous embolism.A-65-year-old man was admitted for coronary and peripheral angiography to evaluate angina pectoris and peripheral vascular disease. Following angiography, he suffered from blue toes, livedo reticularis and progressive renal failure. The patient's condition continued to deteriorate, including the development of malnutrition. Four months later he suddenly developed panperitonitis, went into shock and died. The autopsy verified multiple perforations of the small bowel with disseminated cholesterol atheromatous embolism. The other organs including kidney were also invaded by atheroembolism. This was a rare case of multiple spontaneous perforations of small bowel due to systemic cholesterol atheromatous embolism.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/6. Renal cholesterol embolism in patients with carotid stenosis: a severe and underdiagnosed complication following cerebrovascular procedures.Here, we report two cases with rapidly progressive renal failure, caused by cholesterol crystal embolism (CCE), after an angiography for carotid artery stenosis. The diagnosis was determined by histological examination and from clinical symptoms, including livedo reticularis and eosinophilia. Neurologists and neuroradiologists tend to underdiagnose CCE, which results from the same atherosclerotic risk factors as cerebrovascular disease. We need to understand more about CCE and identify its unique clinical symptoms to enable an early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/6. cholesterol emboli presenting as acute allograft dysfunction after renal transplantation.cholesterol emboli are a common complication of atherosclerotic vascular disease. A 40-yr-old renal transplant recipient who developed acute allograft dysfunction 1 day after the initiation of cyclosporine therapy and 6 days after transplantation is described. A renal allograft biopsy revealed cholesterol emboli in interlobular arteries and in glomeruli. Four previously reported cases of cholesterol emboli in renal allografts are described, and the cause and pathogenesis of atheroembolic disease are reviewed. Atheroemboli causing injury to the renal allograft may arise from either donor or recipient vessels. Vigilance for the occurrence of these emboli needs to be maintained when donor or recipient vessels demonstrate evidence of significant atherosclerotic vascular disease.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
4/6. Splenic infarct presenting as sterile peritonitis with peripheral embolic phenomena.Two patients with end-stage renal disease from diabetes mellitus on peritoneal dialysis for 2 or more years developed sterile peritonitis secondary to splenic infarcts with associated peripheral embolic phenomena. The dialysate had WBC counts > 200/microL, of which 70% or more were polymorphonuclear cells, and RBC counts of 60/microL or less, although transient hemoperitoneum occurred in both patients. Extensive atherosclerotic vascular disease as well as hematologic abnormalities were also present in both patients. One patient had polycythemia due to decreased plasma volume. The other patient had evidence of dysfibrinogenemia. The patients responded well to anticoagulation with warfarin. When the warfarin was discontinued, recurrent emboli occurred in both patients. Splenic infarct should be included in the differential diagnosis of diabetic patients with atherosclerotic disease who present with sterile peritonitis that does not respond to antibiotic therapy, especially if hemoperitoneum occurs even transiently. The diagnosis can be confirmed with CT scan of the abdomen. warfarin therapy is effective in preventing recurrent embolic phenomena, but may need to be continued indefinitely.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/6. Reversal of gangrenous lesions in the blue toe syndrome with lovastatin--a case report.A seventy-six-year-old man with ischemic heart disease, peripheral vascular disease, and chronic renal failure developed bilateral cyanotic toes, which upon muscle biopsy, were shown to be caused by atheromatous emboli. The probable source was atheromatosis of the abdominal aorta. The toes became gangrenous, but surgical therapy was deferred because the patient was considered a high risk. With lovastatin therapy there was complete healing and except for transient cyanosis related to temporary cessation of therapy, there has been no recurrence for the past thirty months. The possible role of lovastatin in the conservative treatment of this disorder is discussed.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/6. Nephrotic-range proteinuria in renal atheroembolic disease: report of four cases.The protean clinical manifestations of atheroembolic disease (AED) mimic systemic disorders with kidney involvement. Acute or chronic renal failure develops spontaneously or more frequently after an inciting event in patients with AED. Significant proteinuria and nephrotic syndrome, however, constitute uncommon findings. We present four patients with AED documented histopathologically who developed nephrotic-range proteinuria. The mechanisms of proteinuria are discussed, and it is suggested that AED be considered in the differential diagnosis of nephrotic syndrome in elderly patients with serious vascular disease.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |