RESUMO
Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most isolated endarteritis biopsy samples. We investigated if isolated endarteritis responds to rejection treatment and affects kidney transplant survival. We retrospectively enrolled recipients of kidney transplant who underwent biopsies between 1999 and 2011 at seven American and Canadian centers. Exclusion criteria were recipients were blood group-incompatible or crossmatch-positive or had C4d-positive biopsy samples. After biopsy confirmation, patients were divided into three groups: isolated endarteritis (n=103), positive controls (type I acute T cell-mediated rejection with endarteritis; n=101), and negative controls (no diagnostic rejection; n=103). Primary end points were improved kidney function after rejection treatment and transplant failure. Mean decrease in serum creatinine from biopsy to 1 month after rejection treatment was 132.6 µmol/L (95% confidence interval [95% CI], 78.7 to 186.5) in patients with isolated endarteritis, 96.4 µmol/L (95% CI, 48.6 to 143.2) in positive controls (P=0.32), and 18.6 µmol/L (95% CI, 1.8 to 35.4) in untreated negative controls (P<0.001). Functional improvement after rejection treatment occurred in 80% of patients with isolated endarteritis and 81% of positive controls (P=0.72). Over the median 3.2-year follow-up period, kidney transplant survival rates were 79% in patients with isolated endarteritis, 79% in positive controls, and 91% in negative controls (P=0.01). In multivariate analysis, isolated endarteritis was associated with an adjusted 3.51-fold (95% CI, 1.16 to 10.67; P=0.03) risk for transplant failure. These data indicate that isolated endarteritis is an independent risk factor for kidney transplant failure.
Assuntos
Endarterite/etiologia , Transplante de Rim/efeitos adversos , Adulto , Biópsia , Endarterite/patologia , Endarterite/terapia , Feminino , Rejeição de Enxerto/terapia , Sobrevivência de Enxerto , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.
Assuntos
Arteriosclerose Obliterante/cirurgia , Endarterite/cirurgia , Doença de Raynaud/cirurgia , Simpatectomia , Toracoscopia/métodos , Arteriosclerose Obliterante/diagnóstico , Arteriosclerose Obliterante/etiologia , Arteriosclerose Obliterante/fisiopatologia , Endarterite/diagnóstico , Endarterite/etiologia , Endarterite/fisiopatologia , Extremidades/irrigação sanguínea , Ganglionectomia/efeitos adversos , Ganglionectomia/normas , Humanos , Doença de Raynaud/diagnóstico , Doença de Raynaud/fisiopatologia , Fatores de Risco , Prevenção Secundária , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Simpatectomia/normas , Nervos Torácicos/cirurgia , Tempo , Estimulação Elétrica Nervosa Transcutânea , Resultado do TratamentoRESUMO
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.
Assuntos
Arteriosclerose Obliterante , Angiopatias Diabéticas , Endarterite , Isquemia , Perna (Membro)/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose Obliterante/complicações , Arteriosclerose Obliterante/etiologia , Arteriosclerose Obliterante/fisiopatologia , Doença Crônica , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/fisiopatologia , Endarterite/complicações , Endarterite/etiologia , Endarterite/fisiopatologia , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Isquemia/terapia , Terapia a Laser , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , VasoconstriçãoRESUMO
An 11-year-old boy presented with Staphylococcus aureus infective endarteritis and mycotic pseudoaneurysms within the context of a previously undiagnosed aortic coarctation. He had an urgent resection of the pseudoaneurysm and coarctation repair. Nuances to his initial diagnosis and key learning points related to the complication of pseudoaneurysm are discussed.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma da Aorta Torácica/etiologia , Coartação Aórtica/complicações , Endarterite/etiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Falso Aneurisma/diagnóstico , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/microbiologia , Coartação Aórtica/diagnóstico , Criança , Diagnóstico Diferencial , Endarterite/diagnóstico , Endarterite/microbiologia , Humanos , Imageamento Tridimensional , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios XAssuntos
Encefalopatias/tratamento farmacológico , Transtornos da Consciência/tratamento farmacológico , Infecções por Coronavirus/terapia , Endarterite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Metilprednisolona/administração & dosagem , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório/terapia , Betacoronavirus , Encefalopatias/líquido cefalorraquidiano , Encefalopatias/diagnóstico por imagem , Encefalopatias/etiologia , COVID-19 , Angiografia Cerebral , Transtornos da Consciência/etiologia , Infecções por Coronavirus/complicações , Endarterite/líquido cefalorraquidiano , Endarterite/diagnóstico por imagem , Endarterite/etiologia , Endotélio Vascular/diagnóstico por imagem , Escala de Coma de Glasgow , Humanos , Inflamação/diagnóstico por imagem , Inflamação/tratamento farmacológico , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Bandas Oligoclonais/líquido cefalorraquidiano , Pandemias , Pneumonia Viral/complicações , Recuperação de Função Fisiológica , Respiração Artificial , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , Infarto/diagnóstico , Mucosa Intestinal/metabolismo , Intestino Delgado/irrigação sanguínea , Isquemia Mesentérica/diagnóstico , Pneumonia Viral/diagnóstico , Betacoronavirus/metabolismo , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Endarterite/etiologia , Endarterite/patologia , Evolução Fatal , Humanos , Infarto/etiologia , Infarto/patologia , Infarto/cirurgia , Mucosa Intestinal/virologia , Intestino Delgado/metabolismo , Intestino Delgado/cirurgia , Masculino , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/patologia , Isquemia Mesentérica/cirurgia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/patologia , RNA Mensageiro/metabolismo , SARS-CoV-2 , Choque Séptico/etiologia , Glicoproteína da Espícula de Coronavírus/genética , Trombose/etiologia , Trombose/patologia , Tomografia Computadorizada por Raios XRESUMO
Infective endocarditis has been a subtle and very often lethal complication of hemodialysis. Thirty-five episodes have been described to date. Antecedent infections, particularly those involving the access site, access manipulation, and dental work appear to predispose to IE. Once IE is acquired, factors associated with mortality are involvement of two or more valves, infection caused by enterococci, antecedent infection, steroid therapy, infection in the first year post-access insertion and patient age over 46. The incidence of access infection with the arteriovenous fistula is significantly less than that associated with the arteriovenous cannula. Staphylococci are the most common organisms in access infections and in IE. Gram-negative bacilli and particularly Pseudomonas aeruginosa are a frequent cause of access infection but an unusual cause of IE. Access removal may be madatory in the successful management of IE in patients on hemodialysis.
Assuntos
Infecções Bacterianas/etiologia , Endocardite Bacteriana/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Antibacterianos/uso terapêutico , Valva Aórtica , Derivação Arteriovenosa Cirúrgica , Endarterite/etiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Trombose/etiologiaAssuntos
Permeabilidade do Canal Arterial/diagnóstico , Endarterite/diagnóstico , Infecções Respiratórias/diagnóstico , Meios de Contraste , Diagnóstico Diferencial , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/terapia , Ecocardiografia Doppler , Endarterite/etiologia , Endarterite/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Respiratórias/etiologia , Infecções Respiratórias/terapia , Tomografia Computadorizada por Raios XRESUMO
The clinical and pathologic findings in 32 patients with central nervous system (CNS) coccidioidomycosis were studied. Seventeen patients had received more than 1.5 g of amphotericin B (AMB), chiefly intravenously, during treatment periods of up to eight years. Eight patients had received 246 mg to 1.3 g of AMB, and three patients had received only brief treatment (one to three days; total dose, no more than 100 mg). Fifteen patients had not received AMB. Significant clinical differences between the patients treated with and without AMB were longer survival time following diagnosis of illness (P less than 0.05) and more frequent cranial nerve signs in the treated patients (P = 0.089). The wide spectrum of macroscopic and microscopic lesions in the CNS included meningitis, ventriculitis, hydrocephalus, and cerebritis. Long-standing infections were associated with disseminated discrete foci of gliosis and infarcts in the brain, particularly in the basal ganglia and deep white matter, related to endarteritis obliterans in basilar meninges. In contrast to patients with CNS and systemic mycoses treated with amphotericin B methyl ester (J Infect Dis 146:125, 1982), no diffuse lesions of white matter were found in patients treated with or without AMB. Histopathologic patterns observed in this study included leptomeningitis alone, leptomeningitis with cerebritis, leptomeningitis with cerebritis and infarcts, and the unusual pattern of disseminated miliary granulomas. The frequency and extent of CNS lesions in the groups treated with and without AMB were not significantly different. It is concluded that AMB therapy, while prolonging survival, does not alter the spectrum of pathologic findings in CNS coccidioidomycosis infection.
Assuntos
Anfotericina B/uso terapêutico , Doenças do Sistema Nervoso Central/tratamento farmacológico , Coccidioidomicose/tratamento farmacológico , Adolescente , Adulto , Idoso , Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/fisiopatologia , Pré-Escolar , Coccidioidomicose/complicações , Coccidioidomicose/patologia , Coccidioidomicose/fisiopatologia , Endarterite/etiologia , Feminino , Humanos , Hidrocefalia/etiologia , Masculino , Meningite/etiologia , Pessoa de Meia-IdadeRESUMO
A case of septic endarteritis leading to septic arthritis and septic emboli occurred after percutaneous transluminal angioplasty. To our knowledge, this is the first reported instance of arterial wall infection potentially caused by percutaneous transluminal angioplasty. Treatment consisted of long-term intravenous antibiotics and drainage of the septic joint.
Assuntos
Angioplastia com Balão/efeitos adversos , Artrite Infecciosa/etiologia , Endarterite/etiologia , Infecções Estafilocócicas , Arteriopatias Oclusivas/terapia , Embolia/etiologia , Humanos , Artéria Ilíaca , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/etiologiaRESUMO
Infection of the femoral artery (endarteritis) complicating intraaortic balloon pumping has not been reported. Most reports of complications with this pump have not emphasized wound infection. Whether the balloon is inserted by open or percutaneous technique, infection remains a problem. During the past 7 years, 32 of 50 patients (64 percent) who had intraaortic balloon pump insertion survived balloon removal. In four patients, wound infection of the groin developed with involvement of the femoral artery. Sepsis was due to P. aeruginosa in three patients and E. cloacae in one. All patients required variable degrees of resection of the infected femoral artery wall. One had successful arterial reconstruction with vein patch angioplasty alone after debridement of the vessel wall. In a second patient, resection of the common femoral artery with interposition of a saphenous vein that had been reconstructed to enhance its diameter to that of the femoral artery was accomplished. Dehiscence of a vein patch angioplasty occurred in the remaining two patients with resultant hemorrhage. Further resection of the femoral artery was required with femoro-femoral saphenous vein grafting in one patient and iliofemoral vein grafting in another. Tissue coverage of the reconstructed vessel was best accomplished using a tensor fascis lata myocutaneous flap. All patients survived the infection without amputation.
Assuntos
Circulação Assistida , Endarterite/cirurgia , Infecções por Enterobacteriaceae/cirurgia , Artéria Femoral/cirurgia , Balão Intra-Aórtico , Infecções por Pseudomonas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Endarterite/etiologia , Enterobacter , Infecções por Enterobacteriaceae/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/etiologia , Infecção da Ferida Cirúrgica/cirurgiaRESUMO
A 17-year-old girl developed infective endarteritis, caused by Staphylococcus aureus, at the site of a previously undiagnosed aortic coarctation. Transoesophageal echocardiography revealed a clinically unsuspected false aneurysm. Foreknowledge of the presence of the aneurysm proved to be life saving when an acute deterioration required emergency surgery.
Assuntos
Coartação Aórtica/complicações , Aneurisma Coronário/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Endarterite/etiologia , Infecções Estafilocócicas/etiologia , Adolescente , Feminino , HumanosRESUMO
Infectious complications following percutaneous coronary interventions are extremely unusual, with a reported frequency of less than 1%. This report describes a patient who developed septic endarteritis as a complication of percutaneous coronary intervention and reviews the literature of this complication.
Assuntos
Endarterite/etiologia , Artéria Femoral , Infecções Estafilocócicas/etiologia , Cateterismo Cardíaco , Angiografia Coronária , Doença das Coronárias/terapia , Endarterite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , StentsRESUMO
The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocardiography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previously reported only in a few cases. In brief, our case not only shows the importance of echocardiography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.
Assuntos
Permeabilidade do Canal Arterial/complicações , Endarterite/etiologia , Artéria Pulmonar , Embolia Pulmonar/etiologia , Criança , Diagnóstico Diferencial , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Doppler , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Estreptococos Viridans/isolamento & purificaçãoRESUMO
A 35-year-old man with long-standing lepromatous leprosy and history of recurrent, severe type 2 lepra reaction was found to have pterygium unguis and destruction of the fingernails. We propose that the obliterative angiitis and endarteritis due to severe type 2 lepra reaction were responsible for these nail changes.
Assuntos
Hanseníase Virchowiana/patologia , Doenças da Unha/patologia , Adulto , Biópsia , Endarterite/etiologia , Humanos , Masculino , Doenças da Unha/etiologia , Recidiva , Vasculite/etiologiaRESUMO
This is a case report of a femoral artery infection with fatal outcome after using a percutaneous suture mediated closure device: A 77-year old patient underwent diagnostic angiography of his thoracic and abdominal aortic aneurysm, the puncture site was closed with the Perclose system. He developed a staphylococcal femoral artery infection with groin abscess, requiring surgical intervention with debridement and removal of the Perclose suture. After stent graft exclusion of the thoracic and abdominal aortic aneurysm a staphylococcal sepsis occurred and the patient died of aneurysm rupture months later despite long term antibiotic therapy. Since the use of the Perclose device carries an increased risk of femoral artery infection with septic endarteritis and bacteremia, it should not be used in routine diagnostic angiography.
Assuntos
Endarterite/etiologia , Endarterite/patologia , Artéria Femoral/patologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/patologia , Suturas/efeitos adversos , Idoso , Angiografia/efeitos adversos , Angiografia/métodos , Evolução Fatal , Humanos , Masculino , Punções/efeitos adversos , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/terapiaRESUMO
Two cases of sclerosing cholangitis after oily arterial chemoembolization are reported. In one patient angiocholitis with liver abscesses, in the other patient gradual cholestasis were the main clinical features. In both cases, endoscopic retrograde cholangiogram showed a stricture of the common hepatic bile duct and, in one case, irregularities of intrahepatic biliary tree. Histologic examination of the liver in the two patients pointed out the involvement of small bile ducts and arteriolar endarteritis obliterans. Ischaemia is likely to be the main mechanism of these two cases of sclerosing cholangitis as well as in those described after FUDR intra-arterial chemotherapy. The prevalence of sclerosing cholangitis after arterial oily chemoembolization is probably underestimated because of a non specific clinical presentation and need to be precise by further study.
Assuntos
Colangite Esclerosante/etiologia , Embolização Terapêutica/efeitos adversos , Óleo Iodado/efeitos adversos , Carcinoma Hepatocelular/terapia , Colangiopancreatografia Retrógrada Endoscópica , Colangite Esclerosante/diagnóstico por imagem , Colangite Esclerosante/patologia , Endarterite/etiologia , Endarterite/patologia , Evolução Fatal , Feminino , Ducto Hepático Comum/diagnóstico por imagem , Humanos , Neoplasias do Íleo/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
A 24-year-old man presented clinically confirmed Behcet's disease. He developed thoracic pain accompanied by hemoptyses as a result of thromboses and aneurysm formation in the pulmonary artery. The presence of these aneurysms was suggested by perihilar images on standard radiography, and confirmed by pulmonary arteriography findings and results of histological examination of the operative specimen. Radiological and anatomical evidence of the presence of bronchial endarteritis lesions was also obtained.