1/69. 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 = 1keywords = vascular disease (Clic here for more details about this article) |
2/69. Pulmonary hypertension associated with pulmonary occlusive vasculopathy after allogeneic bone marrow transplantation.BACKGROUND: Pulmonary vasculature abnormalities, including pulmonary veno-occlusive disease, have been demonstrated in marrow allograft recipients. However, it is often difficult to make a correct diagnosis of pulmonary lesions. methods: An open lung biopsy was performed on a patient who developed severe pulmonary hypertension after bone marrow transplantation for T-cell lymphoma. RESULTS: An open lung biopsy specimen demonstrated pulmonary arterial occlusion due to intimal fibrosis and veno-occlusion. The most striking alteration was partial to complete occlusion of the small arteries by fibrous proliferation of the intima. CONCLUSION: High-dose preparative chemotherapy and radiation before transplantation are thought to have contributed to the development of vasculopathy in this patient, because arterial occlusion by intimal fibrosis and atypical veno-occlusion are often associated with lung injury due to chemoradiation. An open lung biopsy is essential for diagnosing pulmonary vascular disease presenting signs compatible with posttransplantation pulmonary hypertension.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
3/69. Dramatic worsening of vascular calcifications after kidney transplantation in spite of early parathyroidectomy.vascular calcification is a common feature in chronic dialysis patients, but their clinical significance is debated and the role of kidney transplantation (TP) in the natural history of their development has received scanty attention. We will describe a case of dramatic worsening of vascular calcifications during TP in a young patient in spite of early and successful parathyroidectomy (PTX), and will discuss other causes which might be putatively linked to vascular damage during the time of TP. A 37-year-old man on regular dialytic treatment (RDT) for 11 years, received his first cadaveric transplantation in January 1993. He underwent PTX 6 months after TP because of the lack of decreasing in parathyroid hormone values despite normal graft function. Although PTX was effective, a dramatic worsening was evident in large as well as in medium and small-sized arteries during the following three years of TP. In February 1997, few months after starting dialysis again because of the recurrence of his primary membranoproliferative glomerulonephritis (MPGN), the patient experienced myocardial infarction followed by aorto-coronary bypass (right coronary artery and anterior descending coronary artery) and leg "claudicatio". Though a role for parathyroid hormone in vascular disease has been commonly accepted, the case here reported clearly shows that blunting parathyroid gland activity may be unable to avoid the worsening of a process of vascular disease during the time of TP. Many other factors--linked to the time of TP--may be involved in vascular diseases, such as nephrotic syndrome, dyslipidemia, hypertension and drugs. In the case of our patient, a clear cut risk factor for his progressive atherosclerosis can be designated hyperlipidema and other disturbancies secondary to a nephrotic syndrome due to relapse of MPGN, together with persistent hypertension. This is the first case report in the English literature which clearly demonstrates that TP may add fuel to the fire of vascular disease also in young people and even in the absence of parathyroid hyperactivity, perhaps on the basis of a favorable genetic background. Furthermore, the history of our patient demonstrates that vascular calcifcation heralds major cardiovascular diseases.- - - - - - - - - - ranking = 0.71428571428571keywords = vascular disease (Clic here for more details about this article) |
4/69. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity.Various surgical options for internal carotid or subclavian artery pseudoaneurysm repair have been reported; however, in general they have resulted in poor outcomes with high morbidity and mortality rates. Recently, these open surgical procedures have been partly replaced by percutaneous transluminal placement of endovascular devices. We evaluated the potential for using flexible self-expanding uncovered stents with or without coiling to treat extracranial internal carotid, subclavian and other peripheral artery posttraumatic pseudoaneurysm. Three patients with posttraumatic pseudoaneurysm were treated by stent deployment and coiling (two cases) of the aneurysm cavity. In one case, a 5.0 x 47 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 5 mm size pseudoaneurysm (left internal carotid artery) and deployed. angiography demonstrated complete occlusion of the pseudoaneurysm without coiling. In the second patient, a 5.0 x 31 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 7 mm size pseudoaneurysm (right internal carotid artery) and deployed. A total of six coils (Guglielmi Detachable Coils, boston Scientific) were deployed into the pseudoaneurysm cavity until it was completely obliterated. In the third case, an 8.0 x 80 mm SMART (Cordis) stent was advanced over the wire, positioned to span the neck of the 10 x 7 mm size pseudoaneurysm of the left subclavian artery, and deployed. Fourteen 40 x 0.5 mm Trufill (Cordis) pushable coils were deployed into the pseudoaneurysm cavity until it was completely obliterated. At long-term follow-up (6-9 months), all patients were asymptomatic without flow into the aneurysm cavity by Duplex ultrasound. We conclude that uncovered endovascular flexible self-expanding stent placement with transstent coil embolization of the pseudoaneurysm cavity is a promising new technique to treat posttraumatic pseudoaneurysm vascular disease by minimally invasive methods, while preserving the patency of the vessel and side branches.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
5/69. Concepts and data model for a co-operative neurovascular database.BACKGROUND: Problems of clinical management of neurovascular diseases are very complex. This is caused by the chronic character of the diseases, a long history of symptoms and diverse treatments. If patients are to benefit from treatment, then treatment decisions have to rely on reliable and accurate knowledge of the natural history of the disease and the various treatments. methods: Recent developments in statistical methodology and experience from electronic patient records are used to establish an information infrastructure based on a centralized register. RESULTS: A protocol to collect data on neurovascular diseases with technical as well as logistical aspects of implementing a database for neurovascular diseases are described. The database is designed as a co-operative tool of audit and research available to co-operating centres. CONCLUSION: When a database is linked to a systematic patient follow-up, it can be used to study prognosis. Careful analysis of patient outcome is valuable for decision-making.- - - - - - - - - - ranking = 0.42857142857143keywords = vascular disease (Clic here for more details about this article) |
6/69. tuberculosis or systemic lupus erythematosus? A diagnostic and therapeutic dilemma.The diagnosis of patients with fever of unknown origin (FUO) is often problematic because the range of possible differential diagnoses is broad. We report on a case in which a patient presented with FUO and was subsequently found to have both a collagen vascular disease and an intercurrent infection. Treatment for the collagen vascular disease with corticosteroids exacerbated the intercurrent infection. The problems in the diagnosis and management of such cases are discussed.- - - - - - - - - - ranking = 0.28571428571429keywords = vascular disease (Clic here for more details about this article) |
7/69. Vascular manifestations of Behcet's disease. Eighteen cases among 140 patients.OBJECTIVES: To describe the features, prognosis, and treatment of vascular involvement in Behcet's disease (BD). patients: Among 140 patients with BD seen at the Hotel-Dieu Hospital in Beirut between 1980 and 2000, 18 (13%) had vascular involvement and were included in this retrospective study. All these patients fulfilled International Study Group criteria for BD. RESULTS: Men with BD were more likely to have vascular involvement (13/77, 17%) than women (5/63, 8%) (P = 0.12) and were younger at diagnosis of vascular disease (32 /- 7 vs. 36 /- 7.5 years; P < 0.01). Many patients had vascular disease at more than one site: 17 had thrombophlebitis, 10 had arterial thromboses, and one had an aneurysm. thrombophlebitis was more common in men (82% vs. 18%; P < 0.03) and arterial occlusion in women (70% vs. 30%; P > 0.05). Caval thrombosis and arterial occlusions were the most serious complications. Combined treatment with glucocorticoids, anticoagulants, and immunosuppressants was effective in superior vena cava syndrome and extracranial arterial occlusion. CONCLUSION: Vascular manifestations of BD are common in lebanon, particularly venous lesions. Aneurysms are seen less often than arterial occlusions. Medical treatment may be sufficient in superior vena cava syndrome and arterial occlusion.- - - - - - - - - - ranking = 0.28571428571429keywords = vascular disease (Clic here for more details about this article) |
8/69. Deterioration in renal function associated with angiotensin converting enzyme inhibitor therapy is not always reversible.Fifteen patients presented between January 1986 and January 1991 with deterioration in renal function coincident with the introduction of angiotensin converting enzyme inhibitors. There was evidence of extrarenal vascular disease in 12 patients and preexisting renal impairment in 13. Four patients remained dialysis-dependent and died within 4 weeks of presentation. Five patients required short-term dialysis. serum creatinine remained above pre-treatment values in seven patients. Conventional explanations of the decline in renal function with ACE inhibition do not account for irreversible decrements in renal function. Possible mechanisms for this observation and clinical guidelines to identify patients at risk are suggested. We conclude that these agents should be used with great care in patients in whom atherosclerotic vascular disease is likely.- - - - - - - - - - ranking = 0.28571428571429keywords = vascular disease (Clic here for more details about this article) |
9/69. Vertebrobasilar occlusive disorders presenting as sudden sensorineural hearing loss.BACKGROUND: Isolated sudden sensorineural hearing loss (SSHL) has been rarely related to vertebrobasilar occlusive disorders (VBOD). This is an important issue for both neurologists and otolaryngologists, since the management and prognosis of this type of hearing loss widely differs from that of hearing loss from other causes. OBJECTIVES: To describe the clinical characteristics and report the incidence of SSHL related to VBOD. methods: Retrospective analysis of clinical charts from 333 patients admitted for SSHL in a large ear, nose, and throat emergency tertiary care center from 1999 to 2002. RESULTS: Four cases (1.2%) of VBOD as the unique cause of SSHL were diagnosed among 333 patients. The most typical features of these cases were the presence of one of the following characteristics: (1) bilateral SSHL, (2) associated occipital or posterior nuchal pain, and (3) the occurrence of delayed neurologic deficits. The underlying vascular disease affected the vertebral arteries: dissection in two cases and atherosclerosis in two other cases. The audiometric features of hearing loss were endocochlear in one case, of both types in one case, and unknown in two cases. Hearing recovered partially or completely. CONCLUSIONS: Our results confirm the low incidence of SSHL related to VBOD and show that the observation of endocochlear audiometric features cannot preclude a central cause in SSHL. The clinical presentation of our cases related to VBOD emphasize that a careful follow-up of any patient with SSHL is warranted and that the presence of nuchal pain suggestive of arterial dissection in younger subjects, a past history of atherosclerosis or embolism in older patients, or the occurrence of delayed associated neurologic symptoms should be considered with particular caution in this situation.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
10/69. Intra-abdominal hemorrhage caused by segmental arterial mediolysis of the inferior mesenteric artery: report of a case.PURPOSE: This article reports a patient with acute intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis methods: The patient was a 56-year-old female who presented with severe acute abdominal pain. An abdominal and pelvic computed tomogram demonstrated suggestion of an intra-abdominal hemorrhage. Visceral angiography illustrated aneurysms in the branches of the inferior mesenteric artery. The patient underwent a left hemicolectomy with resection of the diseased artery. RESULTS: The angiographic and histologic findings were consistent with a diagnosis of segmental arterial mediolysis involving only the inferior mesenteric artery. CONCLUSIONS: This is the first known reported case of intra-abdominal hemorrhage related to segmental arterial mediolysis requiring emergent hemicolectomy.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
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