Fungal prosthetic aortic valve endocarditis and endarteritis: An unusual cause of aortic root vegetations.

Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non-specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33-year-old patient who presented with fevers and acute lower limb ischemia requiring a 4-compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.

Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers.

BACKGROUND: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of "arteriolosclerosis." The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. METHODS: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. RESULTS: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p &x#3c; 0.0001). CONCLUSION: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

Endarteritis obliterans in the pathogenesis of Buerger's disease from the pathological and immunohistochemical points of view.

Buerger's disease (thromboangiitis obliterans) is considered to be a nonatherosclerotic, inflammatory, and vaso-occlusive disease, although the details of the mechanisms of pathogenesis remain unknown. The occurrence of the disease is strongly related to tobacco abuse and its progression is closely linked to continued smoking. The purpose of this review article is to demonstrate the pathological characteristics of arteries affected with Buerger's disease from a possible immunoreactive point of view. In addition, we present the mechanisms for preserving the architecture of the arterial wall in affected vasculatures. Thereafter, we discuss the possibility that the pathogenesis of Buerger's disease is a type of endarteritis obliterans, deeply connected to the Notch pathway, distinct from arteriosclerosis obliterans and other vasculitides.

Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease.

OBJECTIVE: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis.

BACKGROUND: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS: Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.

Multisite infective endocarditis/endarteritis in a young peripartum patient with patent ductus arteriosus and rheumatic heart valve disease: a case report.

Infective endocarditis (IE) is rarely seen in pregnancy and puerperal period, and generally occurs in patients with preexisting heart disease or intravenous drug abuse. In this report, we describe a case of a 27-year-old patient with missed diagnosis of rheumatic heart disease and a moderate size patent ductus arteriosus, in whom multisite culture-negative IE/pulmonary endarteritis developed after uncomplicated vaginal delivery.

[Chronic angiospastic arterial ischemia of limbs in the patients of elderly and senile age].

The experience of examination and treatment of about 3000 patients having chronic arterial ischemia of extremities allowed to determine that such a clinical presentation appears as a result of functional organic diseases of arteries of extremities: arterial vasoconstriction and obliterating disease of arteries (obliterating atherosclerosis, obliterating endoarteritis, diabetic angiopathy). Chronic ischemia of extremities develops from arterial vasoconstriction of central genesis and then obliterating disease of arteries joins the process. The paper is devoted to the first phase of development of chronic arterial ischemia of extremities: vertebragenous angiospastic disease of arteries of extremities and its treatment for patients of middle and old age.

Persistence of pulmonary endarteritis in canine heartworm infection 10 months after the eradication of adult parasites of Dirofilaria immitis.

Pulmonary endarteritis caused by Dirofilaria immitis and pulmonary hypertension (PH) are closely linked and the determination of PH could be validated to assess the severity and chronicity of the vascular damage, i.e. by the use of the Right Pulmonary Artery Distensibility (RPAD) Index. The aim was to evaluate the RPAD Index in dogs 10 months after the last dose of adulticide. The study included 23 client-owned dogs with heartworm brought for adulticide treatment. Echocardiographic exam was carried out to estimate worm burden, RPAD Index as well as other routine echocardiographic values on day 0 (diagnosis), day 120 (discharge), and 10 months after the last dose of adulticide. No significant differences were observed in the RPAD Index over time, neither when microfilaremic status and parasite burden were evaluated. An RPAD Index <29% was found in 52.2% of the dogs on day 0, day 120, and 10 months after the last dose of adulticide. Regarding other echocardiographic parameters, only significant differences were observed on tricuspid annular plane systolic excursion (TAPSE) values between day 0:day 120 (p = 0.008), and day 0:end of the study (p = 0.037). There was not significant improvement in pulmonary damage 10 months after the elimination of the parasites (p = 0.296), suggesting that, once the endarteritis has developed, the vascular changes are chronic and may not be reversible. The modifications of the TAPSE value suggest an improvement in the systolic function of the right ventricle after the disappearance of the worms, independently of the presence of PH. The endarteritis causes a decrease in the elasticity in the pulmonary vasculature and an increase in the resistance that, chronically, and depending on the severity, will cause the development of PH and later right heart failure. This complication of the disease is one of the most damaging and frequent, so it is necessary to adequately monitor PH in dogs undergoing adulticide treatment. Furthermore, knowing the pulmonary status could provide valuable information to help provide an objective prognosis and help assess the need to add additional treatments, once the worms have been eliminated.

Metaischemic (post-Goldblatt) hypertensive vascular disease in rats.

Malignant hypertension was induced in rats by aortic ligation above the left renal artery. After 7- and 28-day periods of hypertension, the characteristics of the vascular disease were studied and the kidney below the aortic ligation was removed. The blood pressure and the vascular disease were reexamined at the end of the first and fourth weeks after nephrectomy. The evolution of the vascular disease was assessed in the contralateral kidney, in the heart, and in the superior mesentery. The results obtained allowed the following conclusions: 1) when the predominant lesions are of fibrinoid necrosis and moderate intimal hyperplasia without fibromucoid changes (initial phase), the hypertension and the hypertensive vascular disease are completely reversible after the nephrectomy; 2) when the predominant lesions are proliferative endarteritis with fibromucoid changes (chronic phase), neither the hypertension nor the vascular disease are reversible after the left nephrectomy and during the period of follow-up. Therefore, the type of vascular lesion seems to be one important determinant of the reversibility of the hypertensive process after nephrectomy.

Endarteritis and false aneurysm complicating aortic coarctation.

We report a tricky case of endocarditis because of the localization, aortic coarctation, and the pathogenic bacteria Actinobacillus actinomycetemcomitans. Furthermore, we underline the leading role of transesophageal echocardiography in the diagnosis of aortic endarteritis. First, aortitis was treated with antibiotics and, second, successfully operated on.

Vascular ulcers in scleroderma.

Seven patients with scleroderma and either livedo reticularis or atrophie blanche lesions had ulcers of the lower extremity. Livedoid vasculitis, periarteritis nodosa, or endarteritis obliterans lesions were associated with the ulcers. Five patients had livedoid vasculitis, one patient had associated lupus panniculitis, and one patient had rheumatoid arthritis. Four patients had elevated ESRs, four had positive antinuclear antibody tests, and two had positive tests for rheumatoid factor. Patients with scleroderma and livedoid vasculitis or livedo reticularis and ulcers should be examined to rule out underlying vascular disease or endarteritis obliterans.

Endarteritis of the aortic arch in Turner's syndrome with cystic degeneration of the aorta.

We present a case of a 36-year-old 45 XO Turner syndrome with bicuspid aortic valve, dilatation of the ascending aorta and of the major branches of the aortic arch and multiple cysts of the aortic wall. This was complicated by endarteritis of the base of the aortic arch and production of an intraluminal structure (intra-aortic debris). She also presented reactive pleural effusion and involvement of the pulmonary artery which was complicated by pulmonary embolism. Possible aetiological mechanisms are discussed.

Congestive heart failure due to aortic incompetence with intestinal infarction due to endarteritis obliterans.

A 27-year-old man with congestive heart failure due to aortic incompetence and subsequent intestinal infarction was found at laparotomy to have extensive necrosis of the bowel due to proliferative endarteritis. Symptoms resolved following treatment with prednisolone and cyclophosphamide, and replacement of the aortic valve. The sub-total occlusion produced by endarteritis obliterans may lead to acute end-organ infarction if cardiac output is reduced.

Meningovascular neurosyphilis in human immunodeficiency virus infection as a differential diagnosis of focal CNS lesions: a clinicopathological study.

The acquired immunodeficiency syndrome (AIDS) appears to alter the course of syphilis and particularly neurosyphilis. We report the case of an HIV-positive patient with two CNS lesions due to vascular complications of neurosyphilis of the meningovascular type, 18 months after he had developed a penile chancre. On admission, CT scans were inconsistent with cerebral toxoplasmosis or CNS lymphoma. At necropsy, histopathological examination showed typical Heubner's endarteritis of the basilar and posterior cerebral arteries. In AIDS patients, superadded meningovascular syphilis must be suspected, especially when CT scanning reveals the presence of multi-focal, low density lesions with the particular characteristics of infarction.

Non-thrombotic changes of fetal placental vessels in stillbirths. A qualitative and quantitative study.

A qualitative and quantitative microscopical examination of fetal stem vessels was performed in 50 placentas of stillborn infants and 50 normal controls. The vascular changes were morphologically similar in both groups, differences being only of quantitative nature. Subendothelial edema was more frequent in control placentas suggesting that it is not pathological. Subendothelial proliferation of smooth muscle cells prevailed in control and fresh stillbirths and could be due to arterial growth. Subendothelial proliferation of undifferentiated cells or fibrous and muscular tissues was more common in stillbirths. It occurred in most placentas of macerated stillbirths, but in fresh stillbirths the frequency was lower, though significantly higher than in controls. This thickening could represent the only reaction of placental vessels to fetal or maternal disease or cessation of fetal blood flow. Occlusion of the vascular lumen by fibrous and muscular tissues and vascular lumen divided by septa were present in the majority of the placentas of macerated stillbirths and rarely in fresh stillbirths, suggesting that in the macerated ones these changes were secondary to placental retention. The progressive collagenization of the media was the alteration most closely related to time of placental retention.

Magnetocardiographic patterns in complicated and uncomplicated pregnancies.

Magnetocardiographic (MCG) patterns, produced by the electrical activity of the heart, were investigated in 38 full term pregnant women (17 pre-eclamptic and 21 with uncomplicated pregnancies), by means of a superconducting quantum interference device (SQUID). The most important difference was noted in the waveform amplitudes of the MCG recordings; these were appreciably lower in women with pre-eclampsia compared to those in the normal control series, although in both groups the emitted magnetic fields ranged at approximately the same frequency band. Electrocardiographic (ECG) QRS complexes were represented clearly only in the low MCG waveform amplitudes, and these were related to the presence of widespread obliterative endarteritis in the fetal vasculature of the placentae. The above MCG findings are consistent with an increased contractibility of the myocardium in pregnant women with hypertensive disease secondary to the increased peripheral resistance.

Occlusion of the digital arteries -- A model for pathogenesis of navicular disease.

The digital arteries of 10 horses suffering from navicular disease, and 7 horses from a control group, were examined angiographically. The horses from the disease group showed complete or partial occlusion of the digital arteries in all cases. In the control group of 7 healthy horses, isolated vessel obstructions were also found but these were limited to narrowing of part of an artery only. Histological investigations showed that total occlusion of a vessel involved an organised thrombus but that partial occlusion generally involved changes to the vascular wall, similar to those caused by endarteritis obliterans. The vessel changes are discussed, with particular reference to their possible significance as a cause of navicular disease.