Reoperation for a patient with starr-edwards aortic valve malfunction due to pannus formation twenty-nine years after implantation

We report a re-do case of severe aortic valve stenosis due to pannus formation 29 years after an aortic Starr-Edwards caged-ball valve implantation. A huge shelf of calcified and thick pannus tissue below the valve had reduced the already small orifice by at least a third in surface area. The explanted Starr-Edwards valve revealed no mechanical or structural failure. Early detection and treatment of pannus outgrowth is essential in order to prevent life-threatening prosthetic valve malfunctions.     

An immunohistochemical and immunoelectron microscopic study of adhesion molecules in synovial pannus formation in rheumatoid arthritis

To investigate the mechanism of synovial pannus formation in rheumatoid arthritis, immunohistochemical and immunoelectron microscopic studies with monoclonal antibodies against the adhesion molecules, CD54 (ICAM-1), CD 11a (LFA-1), CDw49a (VLA-1), CDw49b (VLA-2), CDw49c (VLA-3), Cdw49d (VLA-4) and CDw49e (VLA-5), were carried out to determine the pattern of distribution of these molecules at the rheumatoid synovial cartilage junction. Treatment with anti-ICAM-1 resulted in membrane staining of most of the macrophages and fibroblasts infiltrating the synovial tissue and bordering the pannus-cartilage junction, suggesting the possibility that ICAM-1 may function to facilitate the adhesion of synovial type A cells bearing ICAM-1 to type B cells of the pannus. ICAM-1-positive macrophages and fibroblasts were often found to be in contact with lymphoid cells, suggesting also that a cellular immune reaction occurs in the formation of the pannus. In addition, VLA-3, VLA-4 and, particularly, VLA-5 were the predominant1 integrins expressed by rheumatoid synovial pannus. Since these three integrins all function as fibronectin receptors, it is possible that the fibronectin-rich environment of the rheumatoid cartilage surface effectively traps pannus cells expressing high levels of these molecules. The VLA-5 molecule was found in a pericellular and interterritorial matrix distribution in the present study, strongly suggesting that a recepfor-ligand interaction between VLA-5 and cartilage matrix may occur at the early stage of pannus formation. Furthermore, an increase in1 integrin may be necessary for the growth of the pannus and also for the upregulation of the VLA molecules, leading secondarily to increased attachment.     

Recurrent infarctions due to a dome-shaped pannus above the mitral valve prosthesis

This report describes a unique case of a 56-year-old female who suffered from recurrent stroke after double mechanical valve replacement. During the four years after the surgery, she remained in normal sinus rhythm, received adequate anticoagulation therapy, and no apparent left atrial thrombus was detected. She underwent redo surgery to prevent further stroke after fourth instance of cerebral infarction. Intraoperative findings revealed a ‘dome-shaped’ pannus formation covering the sewing ring of the mitral prosthesis circumferentially, probably leading to clot formation and repeated infarctions. She has been stroke free for three years after pannus resection.     

Immunolocalization of membrane-type 1 MMP in human rheumatoid synovium tissues

Membrane-type 1 matrix metalloproteinase (MT1-MMP, also known as MMP14), the best characterized membrane-anchored MMP, is an important matrix-degrading proteinase that could digest a broad spectrum of extracellular matrix proteins and accelerate angiogenesis. We have previously reported that some MMPs involved in the angiogenesis and the pannus formation within the joint, leading to the erosion of articular cartilage and bone in the pathological process of rheumatoid arthritis (RA). In the present study, we used immunohistochemistry assay and con-focal scanning technique to study the detailed immunolocalization of MT1-MMP in human RA synovium tissues as well as the infiltrating immune cell subsets. Our results showed that the positive MT1-MMP immunostaining could be found in synoviocytes, vascular endothelial cells, infiltrating macrophages and monocytes in RA synovium tissues, while weak or negative immunostaining could be found in infiltrating T cells, B cells and NK cells, respectively. Moreover, the Ki-67⁺ highly proliferating synoviocytes also showed higher MT1-MMP expression in RA synoviocytes. Thus, the aberrant expression of MT1-MMP in RA synoviocytes as well as infiltrating immune cells may contribute to the proliferation of the synoviocytes, and the angiogenesis and the pannus formation in RA pathological progression.     

自噬在类风湿关节炎中的作用及中药干预研究进展

类风湿关节炎(RA)目前临床上多使用糖皮质激素或免疫抑制剂进行治疗,但长期使用具有明显的毒副作用,且免疫抑制剂价格昂贵,一定程度限制其广泛的应用。中药治疗RA历史悠久,且毒副作用小,但其具体作用机制不甚明确。自噬的过程是细胞自身在受到外界的刺激,通过细胞内信号转导,触发的一系列细胞维持内环境稳定的一种主动的生物学过程,其异常参与多种疾病的发生。目前研究表明自噬异常与RA的发生发展过程关系密切,可以干预RA血管翳生成、滑膜炎症和骨破坏等关键病理环节,从而影响RA的进展和预后。近年来很多研究发现中药复方及其活性成分可以通过调节自噬过程,发挥治疗RA的作用。本文对中药调控自噬进而干预RA的相关文献进行调研,以期为中药治疗RA重要作用机制、新药开发及临床治疗提供新思路。     

Reoperation for a Starr-Edwards aortic valve implanted 28 years earlier

A 56-year-old man admitted with dyspnea had undergone aortic valve replacement using a Starr-Edwards ball valve to treat aortic regurgitation 28 years earlier. Chest radiography showed moderate cardiomegaly, moderate pulmonary edema, and mild pleural effusion. Echocardiographic examination showed severe mitral regurgitation. The mitral valve was replaced using a St. Jude Medical prosthesis, and the Starr-Edwards aortic valve was replaced using a CarboMedics prosthetic valve. The cloth covering on the Starr-Edwards valve had worn away and pannus had formed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 35.     

眼红斑痤疮临床表现及治疗分析

目的研究眼红斑痤疮临床表现、并发症情况及相关治疗。方法对眼红斑痤疮患者先用肉眼观察,然后用裂隙灯显微镜检查眼部,用其弥散光线观察面部皮肤细微改变,尤其是血管异常。结果 88例中男性58例(66%),女性30例(44%)。就诊年龄最小3岁,最大84岁,平均55.8岁,40岁以上71例(80.7%)。睑缘结膜炎84例(95.5%),结膜炎4例(睑缘正常)(4.5%)。下方角膜血管翳13例(14.8%)16只眼(双眼3例);结节性结膜炎及表层点状角膜炎(双眼)各2例(各占2.3%)。角膜基质深层血管增生、丝状角膜炎、肉芽肿性结膜炎(双眼)、结膜瘢痕、无菌性角膜溃疡、双上睑皮炎各1例(各占1.1%)。结膜下出血4例(4.5%);霰粒肿3例,内麦粒肿2例。面部包括睑缘附近皮肤均有不同程度血管增生或红斑,其中肥大性酒糟鼻3例(3.4%)。结论眼红斑痤疮侵犯眼表及眼前节某些组织,面部及眼表血管异常是基本依据,结合其他重要所见则明确诊断。     

Pannus and enthesitis in the atlanto‐axial region in ankylosing spondylitis

A 30‐year‐old man with ankylosing spondylitis (AS) of 7 years duration consulted us for intractable neck pain of 2 months duration. Magnetic resonance imaging cervical spine showed inflammatory pannus around the dens and computed tomography scan showed fluffy periostitis at the attachment of the alar ligament. Cervical spine involvement in AS is reviewed.