[Mönckeberg's sclerosis -- crystal-induced angiopathy]. / Mönckeberg-sclerosis -- kristály indukálta angiopathia.

INTRODUCTION: Mönckeberg's sclerosis is a special form of arteriosclerosis characterized by calcification and ossification of the media of medium size arteries mainly of lower extremities. AIMS: The aim of the authors was to examine medium size arteries with Mönckeberg's sclerosis in 22 amputated lower legs of 16 patients in order to demonstrate different crystals in the wall of blood vessels. METHODS: The methodology was based on previous findings of the authors indicating that in different metabolic disorders many crystals remain demonstrable in unstained histological sections unlike in haematoxylin-eosin stained sections. RESULTS: In unstained sections the authors observed rhomboid or prismatic calcium pyrophosphate dihydrate and clusters of elongated narrow hydroxyapatite crystals in the wall of medium size arteries of all examined cases. Both types of crystals showed axis parallel positive birefringence under polarized light. The intensity of birefringence of hydroxyapatite crystals was weaker in comparison with that of calcium pyrophosphate dihydrate crystals. Occasionally, other crystals which were different in shape from both calcium pyrophosphate dihydrate and hydroxyapatite crystals were also observed. CONCLUSIONS: It seems likely that similarly to crystal deposition induced arthropathy, calcium pyrophosphate dihydrate, hydroxyapatite and other crystals cause fibrosis and intimal proliferation, which may contribute to progressive occlusion of blood vessels resulting in ischemic symptoms. Based on this observation Mönckeberg's sclerosis may be defined as a crystal-induced angiopathy.

Contribution of digit joint aspiration to the diagnosis of rheumatic diseases.

OBJECTIVES: To assess the diagnostic usefulness of digit joint aspiration in patients with involvement of one or more digit joints. PATIENTS AND METHODS: All patients who underwent digit joint aspiration during a rheumatology outpatient visit between 1994 and 1998 were included. Fine needles (25 or 28 G) were used, and the aspirate was immediately examined under the microscope to determine the leukocyte count and to look for crystals under polarized light. RESULTS: Digit aspiration yielded a diagnosis of crystal deposition arthropathy in 20 (29%) of the 71 patients (gout, N = 14; calcium pyrophosphate dihydrate crystal deposition disease, N = 6). In 28 patients, the amount of fluid was too small to allow analysis. The leukocyte count indicated inflammatory disease in eight of the remaining 23 patients and mechanical disease in 15. CONCLUSION: Fine-needle aspiration of symptomatic digit joints provided the diagnosis in two-thirds of patients.

[Study on identification of a calcium pyrophosphate dihydrate crystal using electron diffraction technique].

Electron diffraction technique was used to identify a single crystal in synovial fluid and tissue obtained from patients with pseudogout. One hundred and ten kinds of reciprocal lattice planes of the triclinic calcium pyrophosphate dihydrate (CPPD) crystal were made from its crystallographical data. Electron diffraction patterns obtained from synthesized crystal closely fitted to the reciprocal lattice planes. Synovial fluid of ten patients who had chondrocalcinosis in the knee joint were examined. Diffraction patterns of a single rhomboid-shaped crystal fitted to the reciprocal lattice planes and these kinds of crystals were identified as triclinic CPPD crystals. A single triclinic crystal in the calcified meniscus prepared for transmission electron microscopy was identified in the same way as above. On the other hand, there weren't enough crystallographical data on the monoclinic CPPD crystal to construct the reciprocal lattice planes. Instead of comparing diffraction patterns with the reciprocal lattice planes, diffraction patterns of a single rod-like crystal were compared with those of a synthesized monoclinic CPPD crystal. This comparison combined with energy dispersive elemental analysis made it possible to identify a single rod-like crystal as a monoclinic CPPD crystal.

Pseudogout associated with meniscal cysts - report of two patients.

Two patients with pseudogout developed large meniscal cysts at the knee. In the first case the diagnosis of meniscal cyst was confirmed surically. In the second case, the cyst resolved following thorough aspiration. Polarized microscopy of repeated aspirated from cyst in this case as well as of fluids from the knees of both patients consistently showed positively birefringent rhomboid crystals. X-ray diffraction of fluids from the knee of the second patient identified the crystals as calcium pyrophosphate dihydrate.