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Query: UMLS:C0344329 (collapse)
 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary systemic amyloidosis is a rare cause of vertebral collapse. We describe a patient with extensive systemic involvement who developed collapse of vertebral bodies L1 and L3 in quick succession. Primary amyloid was found on biopsy of L1, but plain radiography, isotope bone scan and magnetic resonance imaging showed no specific features.
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PMID:Vertebral body collapse due to primary amyloidosis. 208 51

This study reviews the utility of specimen angiography in identifying colonic lesions clinically thought to represent angiodysplasia. Four elderly patients presented with acute rectal bleeding. The diagnosis of angiodysplasia was made preoperatively in 3 patients by colonoscopy or angiography, or both. These specimens were injected with silicon rubber compound, xerographed, cleared with methyl salicylate, and examined with transillumination before histologic sampling. Although this technique was not used in the fourth case, fortuitous random sampling of the ascending colon revealed vascular changes indicative of angiodysplasia that correlated with a preoperative bleeding scan. Associated lesions in 1 patient were carcinoma of the colon and primary amyloidosis, the concurrence of which has not been described previously. With the injection technique the lesions of angiodysplasia appear grossly as spiderlike, dilated blood vessels. Microscopically, dilated veins, venules, and capillaries are found in the submucosa only or in the mucosa and submucosa. The importance of the postoperative injection is that it prevents the collapse of the blood vessels and enables the pathologist to identify the lesions grossly. As these lesions are usually small, this is important for proper sampling and histologic documentation.
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PMID:Utility of specimen angiography in angiodysplasia of the colon. 373 71

The nephrotic crisis, a grave complication of the nephrotic syndrome (NS) with a possible progress to the hypovolemic shock, was observed in 62 (6.2%) out of 1000 patients with the NS of different etiology (chronic glomerulonephritis, lupus nephritis, amyloidosis and other nephropathies). The main clinical symptoms of different stages of the nephrotic crisis are described, namely of the abdominal painful crisis, migrating erysipelas-like erythemas and the hypovolemic shock (collapse). The spectrum of diseases requiring the differential diagnosis with the nephrotic crisis is established. The complex of measures for the prophylaxis and treatment of the nephrotic crisis is proposed.
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PMID:[Clinical picture and differential diagnosis of the nephrotic crisis]. 407 12

Fibrillary renal deposits and nephritis. The authors have studied 8 patients whose glomeruli contain abundant fibrils in their mesangial matrix and basement membranes. Although the location of these fibrils is very similar to that of amyloid, they are about twice the size of amyloid fibrils, averaging 20 nm in width, and fail to react as amyloid does with special stains. Immunofluorescence-microscopic studies are usually positive with antiserums to IgG, often IgM, and in some cases IgA, and also kappa and lambda light chains, C3, and C4. The fibrils are associated with diffuse mesangial widening and increased mesangial matrix strands. Although peripheral glomerular capillary walls appear to be spared initially, their eventual involvement leads to glomerular capillary collapse and glomerular obsolescence. Crescent formation occurred in 5 cases, focally in 3 and diffusely in 2. Tubular basement membrane involvement was seen in 1 case. These patients exhibit hematuria, and proteinuria, and often hypertension and renal insufficiency. Proteinuria was in the nephrotic range in 3 patients in whom involvement of glomerular capillary basement membranes was extensive. Unless electron microscopy is applied to renal biopsies, these cases may be considered to represent mesangiocapillary or rapidly progressive glomerulonephritis, or amyloidosis. The nature of these fibrils is as yet not determined. It is likely that they have been called "atypical amyloidosis" in the past.
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PMID:Fibrillary renal deposits and nephritis. 635 91

A few cases of improvement in secondary renal amyloidosis following surgery (in particular, removal of the amylogenic foci) have been published, but cases of aggravation are much more numerous. The authors report on three patients whose renal function deteriorated dramatically after extra-renal surgery (pneumonectomy, aortic valve replacement, mitral valve replacement). None of the usual precipitating factors, such as DIC, cardiovascular collapse, sepsis or renal vein thrombosis, could be detected, but two patients had been under extracorporeal circulation. Such accidents appear to be unpredictable and irreversible. They can be seen in primary or secondary amyloidosis and whether or not surgery involves an amylogenic focus. Indeed, in two of their patients the diagnosis of amyloidosis was unknown before the operation. This suggests that in patients with suspected amyloidosis no major surgical operation should be undertaken without prior renal biopsy.
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PMID:[Dramatic aggravation of renal amyloidosis after surgery. Three cases (author's transl)]. 730 69

We reviewed 546 operative cases in haemodialysis patients during the past 8 years between June 1990 and May 1998. The average age of the 257 male and the 289 female patients was 57.1 years. The average period of haemodialysis was 14 years and 4 months. We discussed the etiology, pathological focus, frequency, symptoms, problems and operative indications. Carpal tunnel syndrome occurred most frequently, occupying 289 cases. Short-term postoperative results were positive in the initial case within 6 months after the occurrence of the first symptoms. Because no effective method preventing recurrence existed, synovectomy was used as much as possible in the initial operation. Surgical treatment was used for amyloid arthropathy in 15 shoulders. It was effective in cases resistant to any conservative treatment. For the knee joint, the arthroscopic synovectomy was performed in 8 cases, and total knee replacement in 6 cases. The results of the total knee replacement cases were good. However, recurrences were observed in 40% of the synovectomy cases. In the hip joint, the curettage and bone grafting were performed in 7 hips of 6 patients. All bone grafts were consolidated and there was no case of postoperative pathological fracture. In some cases with destructive spondyloarthropathy, the vertebrae involved spontaneously fused without severe kyphotic deformity. A case with mild pain and without neurological deficit can be treated conservatively. A case with severe pain, instability, and myelopathy indicates operative measures must be taken. Attention must be paid for a possible collapse of the grafted bone after the cervical level two anterior fusion. Haemodialysis patients are vulnerable to infection. This diagnosis is difficult to distinguish due to the weakened state of the immune system. Rigorous attention is required to prevent and detect infection in cases using artificial joints or instrumentation. The treatment of bone and joint disturbances from dialysis-related amyloidosis has become surgical due to the advancement of dialysis control. However, it remains one of the more conservative treatments. Determining the cause and establishing a method of treatment are desired as early as possible.
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PMID:Surgical treatments for orthopaedic complications in long-term haemodialysis patients--a review of 546 cases over the last 8 years. 979 33

A 67-year-old man presented with localized tracheobronchial amyloidosis involving the distal trachea and the right-sided airways. The disease caused right middle lobe collapse and threatened the right upper and lower lobes. A variety of bronchoscopic methods, including Nd:YAG laser resection, dilation, and stenting, were used as temporizing methods. External beam radiation therapy, considered because of disease progression, caused a measurable local response. Radiation therapy should be considered as a treatment option for localized tracheobronchial amyloidosis causing airway obstruction.
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PMID:Radiation therapy for tracheobronchial amyloidosis. 982 38

We evaluated the safety and histological results of percutaneous transpedicular biopsy in patients undergoing vertebroplasty for vertebral collapse. Over a 6 year period, we carried out biopsies in 46 patients who underwent percutaneous injection of acrylic surgical cement for 57 collapsed vertebrae, because the diagnosis was not clearly established on clinical or imaging grounds. All procedures were performed under fluoroscopic guidance via a coaxial bitranspedicular approach used for vertebroplasty. We performed a clinical examination and CT after every procedure and approximately 6 months thereafter. Biopsies contributed to in 55 (96.5%) of the 57 vertebral lesions. Biopsy material was inadequate in one case (1.7%) and one biopsy was a false-negative (1.7%). The accuracy of the histological results was 98.2%, allowing a correct diagnosis in 55 of the 56 procedures. Of the 37 lesions in 28 patients with a history of a tumour, the final diagnosis was osteoporotic collapse in 25 (67.6%), metastasis in nine (24.3%), and myeloma in three (8.1%). The final diagnosis in the 19 lesions in 17 patients without a known tumour was osteoporotic collapse in 12 (63.2%), metastasis in five (26.3%), and amyloidosis in two (10.5%), the latter in one patient. No complications were observed.
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PMID:Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty. 1139 48

Destructive spondyloarthropathy has recently been described in patients who undergo maintenance hemodialysis for chronic renal disease. The condition most frequently involves the lower segment of the cervical spine, although the craniocervical junction also may be affected. Although the pathogenesis of destructive spondyloarthropathy remains unclear, the disorder is thought to relate to a hemodialysis-associated amyloidosis. It appears that the disease correlates with the duration of hemodialysis, although it has been reported in patients with chronic renal insufficiency not associated with hemodialysis. Radiographic features simulate those of an infectious process, encompassing a range of abnormalities from superficial erosions to large bony defects. Computed tomography (CT) images reveal osteolytic areas, with bone sclerosis of adjacent vertebral endplates, and minimal osteophytosis. The intervertebral spaces appear narrow or obliterated. On magnetic resonance imaging (MRI), the disorder may show the imaging characteristics of spondylodiskitis. The absence of high signal intensity on T2-weighted images generally helps to eliminate the diagnosis of an infection. With progression of the disease, collapse of a vertebral body and spinal instability may occur. Severe complications of destructive spondyloarthropathy in long-term dialysis patients may include spinal cord compromise, necessitating surgical decompression, with or without spinal stabilization.
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PMID:Imaging in dialysis spondyloarthropathy. 1219 Oct 28

The N-terminal portion of apolipoprotein A-I corresponding to the first 93 residues has been identified as the main component of apolipoprotein A-I fibrils in a form of systemic amyloidosis. We have been able to characterize the process of conformational switching and fibrillogenesis in this fragment of apolipoprotein A-I purified directly from ex vivo amyloid material. The peptide exists in an unstructured form in aqueous solution at neutral pH. The acidification of the solution provokes a collapse into a more compact, intermediate state and the transient appearance of a helical conformation that rapidly converts to a stable, mainly beta-structure in the fibrils. The transition from helical to sheet structure occurs concomitantly with peptide self-aggregation, and fibrils are detected after 72 h. The alpha-helical conformation is induced by the addition of trifluoroethanol and phospholipids. Interaction of the amyloidogenic polypeptide with phospholipids prevents the switching from helical to beta-sheet form and inhibits fibril formation. The secondary structure propensity of the apolipoprotein A-I fragment appears poised between helix and the beta-sheet. These findings reinforce the idea of a delicate balance between natively stabilizing interactions and fatally stabilizing interactions and stress the importance of cellular localization and environment in the maintenance of protein conformation.
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PMID:Conformational switching and fibrillogenesis in the amyloidogenic fragment of apolipoprotein a-I. 1242 24


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