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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a 65-year-old man livedo reticularis occurred in the lower half of the body two days after beginning lysis with streptokinase. This was followed by skin and toe necrosis as well as acute renal failure. Autopsy showed a severe ulcerative atherosclerosis of the aorta with cholesterol crystal embolisation in numerous organs, particularly in both kidneys. The coincidence in time leads one to assume that the streptokinase treatment encouraged acute diffuse embolisation by dissolving the protective thrombi over the ulcerative atheromatous plaques.
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PMID:[Acute renal failure due to diffuse cholesterol crystal embolisation during streptokinase treatment (author's transl)]. 48 51

Sneddon's syndrome refers to the rare association of extensive livedo reticularis with multiple ischaemic cerebrovascular episodes. Endarteritis obliterans is the most common cutaneous pathology. It is likely that several pathogenic mechanisms may give rise to Sneddon's syndrome, as the condition is associated with a high incidence of generalised atherosclerosis, hypertension, valvular heart disease and the presence of antiphospholipid antibodies.
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PMID:Sneddon's syndrome. 145 2

Cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute fibrinous pericarditis and pericardial effusion. Echocardiography has demonstrated an increased incidence of pericardial effusion, even in those who have minimal symptoms. Chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely. While myocarditis is commonly noted at autopsy, it is often silent clinically. Diagnosis during life can be confirmed only by endomyocardial biopsy. Electrocardiographic changes are often nonspecific. Endocarditis with superimposed nonbacterial verrucous vegetations (Libman-Sacks) is noted in more than 40% of hearts at autopsy, but is rarely diagnosed during life. Valve dysfunctions, such as aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency, occasionally manifest during life and rarely may necessitate surgery. Atrial and ventricular arrhythmias, first degree AV block, and acquired CHB occur in association with pericarditis, myocarditis, vasculitis, and myocardial fibrosis, respectively. CCHB developing in newborns of mothers with SLE, particularly those who have an antibody to soluble tissue ribonuclear protein RO(SS-A), is increasingly being appreciated by both pediatric cardiologists and rheumatologists. Recently, severe coronary atherosclerosis resulting in angina pectoris and/or myocardial infarction in young adults has been noted, particularly in those who had developed risk factors such as hypertension and hyperlipidemia while receiving prolonged corticosteroid therapy. Rarely, coronary arteritis may produce similar symptoms. Congestive heart failure of either single or multiple etiologies carries an ominous prognosis. It remains a cause of high morbidity and mortality unless recognized early and treated properly. Extracardiac vascular manifestations of SLE include telangiectasia, vasculitis, livedo reticularis, Raynaud's phenomena, and thrombophlebitis, all of which may occur either alone or in different combinations. Evidence is now slowly accumulating that substantiates that immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for the majority of the cardiovascular manifestations of SLE, for example, pericarditis, myocarditis, endocarditis, coronary arteritis, coronary atherosclerosis, and systemic and pulmonary vasculitis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cardiovascular manifestations of systemic lupus erythematosus: current perspective. 286 Jun 99

This paper presents 3 cases of generalized livedo racemosa and cerebral infarction in female patients ages 27, 39, and 42 years. Livedo racemosa is characterized by a broken, irregular pattern on the skin. It is probably caused by patchy impairment of cutaneous arteriolar circulation, resulting in reflectory venous dilation and stasis of blood. Livedo may accompany diseases such as atherosclerosis, diseases with intravascular occlusion, and collagen disorders, indicating a need for a careful search for an underlying condition. These 3 patients demonstrated several risk factors for atherosclerosis: hypertension (1 patient), oral contraceptive use (2 patients), and smoking (2 patients). The clinical findings in these 3 cases provide support to the theory that a chronic endarteritis obliterans of the small and medium-sized arteries is the underlying cause for the skin and neurologic manifestations in livedo racemosa associated with stroke.
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PMID:Livedo racemosa generalisata and stroke. 402 92

Multiple cholesterol emboli syndrome (MCES) after angiography has been reported infrequently. Seven patients (from five reports) who developed MCES after angiography are reviewed. An eighth case is described. All patients had evidence of extensive atherosclerosis. Following angiography of the eight patients, six demonstrated livedo reticularis below the umbilicus; technical difficulties were reported in four; four became febrile and/or hypertensive; and only one survived. Since therapy has been unsuccessful, careful angiographic technique is essential to prevent this syndrome.
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PMID:Multiple cholesterol emboli syndrome after angiography. 646 95

Renal cholesterol embolization can occur spontaneously or as a complication of aortic surgery or major vessel angiography in patients with diffuse atherosclerosis. The demonstration of characteristic cholesterol crystals in tissue biopsy specimens is a pathognomonic finding. However, renal cholesterol embolism may be clinically diagnosed when renal failure develops after known inciting factors or together with systemic manifestations of atheromatous embolization such as lower extremity livedo reticularis, focal digital ischemia or retinal embolism. Previous investigators have emphasized the progressive nature of renal insufficiency due to cholesterol embolism, its poor prognostic significance and almost uniformly fatal outcome. In this report, we describe five additional patients with renal cholesterol embolization. In three of them only moderate renal insufficiency developed, and kidney function subsequently improved in all. In two patients the condition progressed to end-stage renal disease; one died with chronic renal failure whereas the other patient required four months of hemodialysis before kidney function eventually improved. Thus, cholesterol embolization may produce a spectrum of renal functional impairment. In some patients there is only a moderate loss of renal function with subsequent improvement; in others renal failure ensues. In this latter group, eventual return of kidney function can occur even after a prolonged period of renal insufficiency.
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PMID:The clinical spectrum of renal cholesterol embolization. 724 79

ELISA was used to investigate concentrations of Willebrand's factor antigen (WF III Ag) in 131 patients with various forms of systemic vasculitis (SV) and 93 patients with cardiovascular diseases. Compared to donors, a mean WF III Ag level proved significantly higher in all nosological variants of SV except periarteritis nodosa. Skin livedo vasculitis did not produce noticeable deviations in WF III Ag levels versus those in donors, whereas atherosclerosis obliterans showed these levels to be significantly elevated. Essential hypertension patients had low values of WF III Ag. The highest mean level of the antigen was found in rheumatoid vasculitis and Wegener's granulomatosis in which the antigen content rose to the highest for vascular affections levels (p < 0.05-0.01). High WF III Ag in Wegener's granulomatosis, periarteritis nodosa, leukocytoclastic vasculitis were indicative of renal involvement. Moreover, there was a tendency to an increase in the antigen quantities in Wegener's granulomatosis patients with intercurrent infections versus such without them. In other SV forms and atherosclerosis obliterans concentrations of the antigen were not related to clinical features of the disease.
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PMID:[The von Willebrand factor antigen in systemic vasculitis]. 803 87

We evaluated two patients with systemic cholesterol embolization (SCE) associated with the development of pleural effusions. These two patients had evidence of atherosclerosis and presented with livedo reticularis, renal insufficiency, and gangrenous cutaneous changes as manifestations of their SCE. In both cases, closed pleural biopsies demonstrated acute inflammation of the parietal pleura. Our experience with these individuals and a review of the medical literature suggest that pleural injury from atheromatous embolization may occur. Physicians caring for patients with SCE should be aware of the possible association of pleural reactions with this process.
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PMID:Pleural effusion in patients with systemic cholesterol embolization. 844 70

In patients with an acute arterial occlusion, identification of the type of mechanism is important, because both prognosis and treatment differ for each type. The aorta is the most frequent source of arterial atheromatous emboli. Aortic arch plaques are therefore recognized as an independent risk factor for stroke, and plaques located on the thoracoabdominal aorta embolize in the visceral arteries or limb circulation. The treatment of risk factors seems the most effective preventive treatment. When atherosclerosis is patent, an anti-platelet drug such as aspirin or ticlopidine is useful. When the embolus actually occurs, heparin avoids extension of thrombus and prevents its recurrence. Surgical treatment is logical but has not been supported by any randomized trial. Cholesterol cristal embolization evolves in 3 clinical forms: 1-the paucisymptomatic form, not diagnosed during subject's lifetime and only recognized in autopsy studies; 2-a benign form such as the blue toe syndrome or cutaneous livedo, with a spontaneous mild prognosis, and 3-a diffuse multisystemic form with a very poor prognosis. More than 80% of patients with the diffuse form die. When there is renal involvement, only 25% are still alive, with renal function after 6 months of follow up. Vascular surgery is limited to patients with aneurysms, which in themselves constitute a surgical indication. For all other patients, surgery is rarely indicated because 1-the source of cholesterol cristal embolization is not certain, 2-patients are usually too weak for a major surgical intervention, and 3-the necessary aortic clamping during surgery would induce a major risk of recurrence. Prevention is the most effective treatment because in 30% of patients, embolization is due to one of the following: anticoagulant drug, recent fibrinolysis, percutaneous angioplasty, vascular surgery, diagnosis angiography and/or coronarography. The medical treatment is mostly symptomatic: rest, warm conditions, appropriate dressing, antiplatelet drugs, hydration, and organ supply when necessary, principally to ensure renal function. In diffuse and multi-visceral embolization, either colchicine or corticosteroids adjuvant therapy might be useful Prostanoid drugs are also a possible adjuvant treatment.
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PMID:[Atheromatous embolisms and cholesterol embolisms: medical treatment]. 871 78

This article is meant to increase the interest in an often forgotten clinical entity. Cholesterol emboli are in the majority of cases only diagnosed at post-mortem examination. Even though the triad livedo reticularis, renal failure and eosinophilia constitutes its most prominent feature, the variable clinical manifestations of this disorder with multiorgan involvement ("pseudovasculitis") make the search for cholesterol crystals particularly exciting. The discovery of 10 cases of cholesterol emboli over 2 years in a regional hospital's internal medicine department demonstrates that this occurrence is not rarely and that its accurate identification can be particularly relevant. It is important to recognize this disease since it is often iatrogenic, affects elderly people with atherosclerosis of the large vessels and causes high morbidity and mortality.
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PMID:[Cholesterol crystal embolisms: an exciting search for "pearls"]. 921 14


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