Arterial lesions in Behçet's disease.

BACKGROUND: Arterial involvement is a rare but serious condition in the course of Behçet's disease. We aimed to assess the results of therapeutic approaches in our patients with arterial lesions caused by Behçet's disease. PATIENTS AND METHODS: The records of 534 patients with Behçet's disease between 1987 and 2002 were retrospectively evaluated for the presence of arterial lesions. All patients were followed up regularly at 3 to 6 months intervals. RESULTS: Arterial lesions were diagnosed in 21 (3.9%) patients. Eight of these patients had pulmonary artery aneurysms (PAA), and the other 13 patients had non-pulmonary arterial lesions. Urgent surgical intervention was performed in three patients with PAA leading to death in all three. In addition, three other patients died due to massive haemoptysis at home despite to immunosuppressive therapy. Only two out of eight patients with PAA are still alive who were treated with cyclophophamide and corticosteroids. Thirteen operations were performed in 7 out of 13 patients having non-pulmonary arterial lesions. Although ten of the operations were primary operations, three reoperations had to be performed. A stent-graft was applied for the management of an iliac artery aneurysm in one patient. Only one patient died 8 years after the first non-pulmonary arterial involvement following a type IV thoracoabdominal aortic aneurysm repair. Five patients with arterial occlusive lesions were successfully treated by corticosteroids. CONCLUSIONS: Pulmonary artery aneurysms in Behçet's disease patients have a poor prognosis despite any form of therapy. High dose corticosteroids alone can be successfully used for isolated non-pulmonary arterial occlusive lesions, unless disabling symptoms occur. Surgery or stent-graft insertion is indicated for non-pulmonary arterial aneurysms because these aneurysms entail high risk of complications.

Venous lesions in Behçet's disease.

OBJECTIVES: Review of venous lesions in Behçet's disease (BD). DESIGN: Retrospective study. SETTING: University Hospital, Turkey. MATERIALS AND METHODS: One hundred and twenty nine patients with BD diagnosed and treated in our hospital during the last 10 years were reviewed. Fifty-two patients with 54 vascular lesions of Behçet's disease were identified. MAIN RESULTS: The incidence of isolated venous lesions in BD was 26%. Venous lesions developed after the initial diagnosis of BD in all patients within 10 years. Thirty-four (63%) of the 54 vascular lesions were venous and 15 (28%) were arterial. In 5 (9%) patients, both arterial and venous lesions were present. Deep vein thrombosis was the most frequent lesion (76%), followed by superficial thrombophlebitis (10%), superior vena cava thrombosis (10%) and inferior vena cava thrombosis (2%) and varicose veins (2%). CONCLUSIONS: Venous lesions are not rare and affect the prognosis of BD. For this reason, venous lesions of BD should always be sought at follow-up of patients with BD.

Vascular injury during lumbar disc surgery. Report of two cases; a review of the literature.

Iatrogenic vascular injuries are unusual complications of lumbar disc surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma. Diagnosis is suspected when early signs of retroperitoneal haemorrhage appear, but may often be delayed for weeks or years due to formation of a pseudoaneurysm or an arteriovenous fistula which may be of gradual onset and produce initially only a few symptoms. Prompt diagnosis and aggressive treatment can improve the current mortality rate of more than 50%. Two cases are described that illustrate the full spectrum of acute and chronic manifestations of such injuries. One case of acute haemorrhage due to arterial trauma was immediately detected and the other case with arteriovenous fistula was recognized several years post-operatively.

Giant lymphoid hamartoma of mediastinum (Castleman's disease).

The giant lymphoid hamartoma is known as a rare, benign, large, solitary, encapsulated mass of lymphoid tissue. It frequently involves mediastinum or pulmonary hilum. It may also occur in other various locations. Few of the patients may have general symptoms. The disease has been divided into two variants according to microscopic structure. These are hyaline vascular type and plasma-cell type. The hyaline vascular type is benign but the plasma-cell type meets malignancy criteria, so that the plasma-cell type has been subject to discussion whether it is suited to chemotherapy or not. Our case was a 55-year-old male with persistent cough. There was a mass having a size of 6 centimeters on left pulmonary hilum on chest radiograph. Left thoracotomy was performed and a hilar lymphoid mass removed. The biopsy finding was "hyaline vascular type giant lymphoid hamartoma". No other therapy was done. Patient is well six months after the operation.