高频超声检测大动脉炎患者血管内皮依赖性舒张功能的研究

目的利用高分辨力超声技术对大动脉炎（头臂动脉型）患者的血管内皮依赖性舒张功能进行研究和分析.方法采用高频超声测量61例大动脉炎患者和36例正常对照组血管内皮舒张功能（EDD%）,并进行对比分析.测量其血浆中一氧化氮（NO）、内皮素（ET）等血管活性物质的浓度变化.结果大动脉炎组较正常对照组EDD%明显减低;血浆NO水平明显降低;ET水平明显升高（P＜0.01）.结论大动脉炎患者存在一定程度的血管内皮依赖性舒张功能受损,超声检测血管内皮依赖性舒张功能可作为监测早期大动脉炎的客观指标.     

Bayard Horton's clinicopathological description of giant cell (temporal) arteritis

The author set out to review the thought processes of Bayard Horton as he was clinicopathologically describing the first cases of temporal arteritis. The Mayo Clinic records of the original temporal arteritis patients were examined. Horton obtained the first biopsies of the temporal arteries in temporal arteritis and was the first to describe the histopathology. Horton initially thought his first two patients had actinomycosis of the temporal arteries, but later abandoned this diagnosis. He reported these two patients in 1932 as 'an undescribed form of arteritis of the temporal vessels'. He was the first to describe jaw claudication. He saw a patient with blindness and symptoms suggestive of temporal arteritis before this complication was described in the literature, but initially felt the patient had some other disease. The sedimentation rate was elevated in his first patient. He cared for the first temporal arteritis patient ever treated with cortisone.     

Angiotensin-converting enzyme in patients with temporal arteritis

It is well documented in the literature that patients with active sarcoidosis exhibit elevated serum ACE activity. Since both temporal arteritis and sarcoidosis represent granulomatous inflammatory conditions, this study was undertaken to determine serum ACE activity in patients with temporal arteritis as well as in a control group. The serum ACE levels in patients with temporal arteritis were significantly lower than in the controls. Hence, granulomatous inflammation in temporal arteritis seems to differ radically from the granulomatous inflammation present in sarcoidosis. Serum ACE activity was increasing during cortisone treatment of patients with temporal arteritis, but dropped again as soon as cortisone therapy was discontinued.     

多发性大动脉炎中颈总动脉炎损害的彩色多普勒显像研究

目的：应用彩色多普勒诊断技术分析多发性大动脉炎中的颈总动脉炎声像图特征，从定性与定量方面提高对本病认识。方法：分析43例64条病变颈总动脉的二维及彩色多普勒声像图指标。结果：64条病变血管参数无论是在二维声像图的形态结构方面，还是在彩色血流分布及频谱形态变化方面均有显著性异常，管腔狭窄、管壁增厚。收缩期最大血流速度(Vmax)、阻力指数(RI)、收缩期加速度(Acc)及收缩期加速时间(Tacc)均增加。结论：彩色多普勒血流显像是诊断多发性大动脉炎中的颈总动脉炎损害的有效方法之一。     

彩色多普勒超声诊断大动脉炎外周血管病变的价值

目的 探讨大动脉炎外周血管病变的彩色多普勒超声表现。方法 采用美国惠普公司生产的8500彩色多普勒超声检测仪,探头频率7．5MHz,对50例大动脉炎患者外周血管进行二维超声、彩色及脉冲多普勒超声检测。结果 大动脉炎侵及血管分布：头臂动脉为主38例,其中锁骨下动脉6例;主肾动脉12例,合并血栓形成3例。表现为病变动脉血管管壁增厚,管腔狭窄、闭塞,出现盗血。结论 彩色多普勒超声诊断大动脉炎有确切的价值,应作为临床诊断大动脉炎的首选方法。     

Polymyalgia rheumatica and temporal arteritis

Polymyalgia rheumatica and temporal arteritis are a clinical syndrome and clinicopathologic entity, respectively. Polymyalgia rheumatica occurs more commonly than temporal arteritis, with approximately half of all patients with temporal arteritis having the polymyalgia rheumatica syndrome. Both conditions are found in the population over 50 years of age and are associated with an elevated ESR. The etiology of both is unclear, although genetic, and potentially, environmental factors may play significant roles. Both conditions respond to corticosteroid therapy, but patients with temporal arteritis require significantly higher doses to control symptoms and to prevent blindness.     

Focal hypertrophic pachymeningitis in association with temporal arteritis

We present an extremely rare case of a patient with focal hypertrophic pachymeningitis in association with histologically proven temporal arteritis (giant cell arteritis). It is proposed that focal hypertrophic pachymeningitis in itself is the contributing factor to severe headache rather than temporal arteritis alone.     

Do temporal arteritis lesions contain bacterial DNA?

BACKGROUND: Temporal arteritis is a primary vascular inflammatory disease. The aetiology of temporal arteritis is unknown, but the influence of environmental factors such as infections has been suggested. MATERIALS AND METHODS: We used broad-range PCR, targeting conserved regions of the gene encoding for ribosomal RNA, to detect bacterial DNA in 27 temporal artery biopsies. Five uninvolved temporal arteries were also included. A lung sample of confirmed bacterial pneumonia served as a positive control. Inflammation was examined by histochemistry and light microscopy. RESULTS: The sensitivity of the broad-range PCR assay was 5.0 fg of DNA. Bacterial DNA sequences were neither detected in 27 temporal arteritis specimens nor in the normal temporal artery samples. However, bacterial DNA was successfully amplified from the lung sample of a subject with pneumonia. In addition, human DNA was amplified by primers for human beta-actin from all clinical specimens, suggesting lack of significant inhibitors of the molecular amplification reaction. Histochemistry showed signs of strong inflammation in the arteritis samples. CONCLUSIONS: The lack of detectable amounts of bacterial DNA suggests that viable bacteria do not have a role in chronic stages of temporal arteritis. However, these findings do not rule out the possibility of bacterial degradation products as stimulants of chronic inflammation, or of viable microbes as triggering factors of acute temporal arteritis.     

Polymyalgia rheumatica and temporal arthritis

Polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions that affect different cellular targets in genetically predisposed persons. Compared with temporal arteritis, polymyalgla rheumatica is much more common, affecting one in 200 persons older than 50 years. Temporal arteritis, however, is more dangerous and can lead to sudden blindness. The diagnosis of polymyalgia rheumatica is based on the presence of a clinical syndrome consisting of fever, nonspecific somatic complaints, pain and stiffness in the shoulder and pelvic girdles, and an elevated erythrocyte sedimentation rate. Temporal arteritis typically presents with many of the same findings as polymyalgia rheumatica, but patients also have headaches and tenderness to palpation over the involved artery. Arterial biopsy usually confirms the diagnosis of temporal arteritis. Early diagnosis and treatment of polymyalgia rheumatica or temporal arteritis can dramatically improve patients' lives and return them to previous functional status. Corticosteroid therapy provides rapid and dramatic improvement of the clinical features of both conditions. Therapy is generally continued for six to 24 months. Throughout treatment, clinical condition is assessed periodically. Patients are instructed to see their physician immediately if symptoms recur or they develop new headache, jaw claudication or visual problems.     

Nephrotic syndrome in temporal arteritis

Renal abnormalities are highly unusual in temporal arteritis. The association of temporal arteritis with nephrotic syndrome has been reported previously in only one patient. This report describes another case.     

全身动脉血管磁共振血管成像对多发性大动脉炎的诊断价值

目的：探讨全身动脉血管增强磁共振血管成像（MRA）在多发性大动脉炎临床诊断中的应用价值。方法：对临床拟诊断为多发性大动脉炎的27例患者进行全身动脉血管MRA检查,在病变处再行SE序列T1加权像（T1 WI）、T2加权像（T2 WI）加脂肪抑制技术横断位或冠状位平扫,以显示受累血管的部位、范围及程度。结果：27例全身动脉血管MRA成像共显示血管狭窄、闭塞74段,假性动脉瘤5个,其中头臂动脉型12例,胸、腹主动脉型7例,广泛型8例。在T1 WI横断位或冠状位均可见到受累动脉的血管壁有不同程度增厚、有或无强化,管腔闭塞或向心性狭窄,部分病例伴狭窄后扩张。T2 WI扫描则清晰显示大多数的受累血管壁表现为多环状影,纤维化或者钙化的血管中膜,其中有一部分血管处于外层的环形低信号影比较厚,有一部分厚薄表现不均匀。最外层的受累血管壁则显示为环状高信号影,外膜显著增厚。结论：全身动脉增强MRA有助于显示多发性大动脉炎累及血管的部位、范围及程度,可以作为该病首选的检查方法。     

Takayasu's arteritis. Carotid duplex sonographic appearance, including color Doppler imaging

Takayasu's arteritis (also known as pulseless disease, aortoarteritis, and aortic arch syndrome) is a chronic inflammatory arteriopathy that affects the aorta and its main branches as well as the pulmonary arteries. We report the carotid duplex sonographic findings of Takayasu's arteritis in three patients. Takayasu's arteritis can be suspected by noting a long segment of diffuse, homogeneous, circumferential vessel wall thickening in the proximal common carotid artery, resulting in narrowing of the lumen. The internal and external carotid arteries are normal.     

妊娠并发多发性大动脉炎麻醉探讨（附3例报告）

目的探讨妊娠并发多发性大动脉炎病人的麻醉方法。方法对3例妊娠并发多发性大动脉炎行剖宫产手术的病人的麻醉过程进行回顾性分析。3例病人均实施硬膜外麻醉及术后硬膜外镇痛。结果硬膜外麻醉及术后硬膜外镇痛麻醉效果好，生命体征平稳，手术顺利，3例病人均安全度过围手术期。结论硬膜外麻醉及术后硬膜外镇痛对妊娠并发多发性大动脉炎病人行剖宫产手术是较为安全合理的麻醉方法。     

大动脉炎累及冠状动脉12例临床分析

目的探讨多发性大动脉炎累及冠状动脉的临床特点。方法对多发性大动脉炎累及冠状动脉患者的症状、体征、实验室检查及治疗方法进行分析。结果12例患者在具有外周血管病变的同时，存在心肌缺血或心肌梗死的症状，心电图、超声心动图及冠状动脉造影均可提示缺血或梗死存在；治疗主张积极进行血运重建。结论多发性大动脉炎可累及冠状动脉，并可导致严重的冠状动脉病变，应予以积极治疗。     

Differential diagnosis of nonspecific aortic arteritis

The article presents diagnostic criteria for nonspecific aortic arteritis proposed by K. Ishikawa (1988), American Rheumatology Society (1990), algorithm of differential diagnosis with giant cell arteritis, obliterating thrombotic angiitis, Marfan's syndrome, atherosclerosis of major vessels, etc.     

The pathogenesis of experimental arteritis induced by Candida alkali-extract in mice

The pathogenesis of experimental arteritis induced by Candida alkali-extract in mice was studied from the immunological, pharmacological and chemical points of view. The following results were obtained. 1) The incidence of arteritis increased in parallel with IgE antibody level of Candida, as shown by the PCA method. 2) Candida polysaccharide showed cardiotonic, coronary vasodilatatory and vasoconstrictive activities on Langendorff's and spiral preparation of rats. 3) Candida polysaccharide was shown to contain digitoxose by gas-mass spectrometry. From these results, it is suspected that this extract reacts on experimental animals by the toxic and immunological mechanisms, and that these mechanisms may be related to the occurrence of arteritis.     

Erythrocyte sedimentation rate in temporal arteritis

Some authors have reported that the erythrocyte sedimentation rate (ESR) is elevated in almost all patients with biopsy-proven temporal arteritis, while others believe it may be normal in up to 30% of such patients. We studied 62 patients with biopsy-proven temporal arteritis, and found that all of the 54 untreated patients and six of the eight treated patients had an elevated ESR; thus, when the ESR is normal, a diagnosis of temporal arteritis must be suspect.     

Headache and Intermittent Claudication of the Jaw In Temporal Arteritis

SYNOPSIS-ABSTRACT
THE PHYSICIAN should beware of headache in the senior citizen. It may forebode, among many things, the insidious onset of temporal arteritis, a disease that can be easily overlooked in its early stages. Temporal arteritis occurs exclusively in older persons. The average age of the first 105 patients carefully studied at the Mayo Clinic was 69.1 years. Danger lurking behind the headache of temporal arteritis is of far greater magnitude than that in any other type of headache. Loss of vision can occur at any time during the course of the illness, and has occurred in a high percentage of cases. Loss of vision, if it occurs, is always permanent. A high degree of suspicion on the part of the physician will lead to an early diagnosis, and thus, if treatment is promptly instituted, to the prevention of blindness. To the medical profession, the real challenge of temporal arteritis is to fide the patient through the illness without the loss of vision.     

Temporal arteritis and Guillain-Barré syndrome

The association of temporal arteritis and Guillain-Barré syndrome has rarely been reported. We describe a patient who sequentially suffered from both disorders. An 81-year-old woman presented with headache and loss of appetite. Analysis showed anemia and an erythrocyte sedimentation rate of 94 mm/hr. Temporal artery biopsy disclosed giant cell arteritis. Upon treatment with prednisone, all symptoms improved. A few weeks later, the patient began having low back pain, paresthesias, ascending weakness, and unexplained intermittent hypotension. Examination showed absent tendon reflexes in the knees. Cerebrospinal fluid contained one mononuclear cell/dL, and a protein level of 81 mg/dL. An electrophysiologic study revealed reduced nerve conduction velocities. Intravenous immunoglobulin therapy was instituted, and all symptoms slowly disappeared. This is the third reported case of Guillain-Barré syndrome in association with temporal arteritis. The other two patients recovered. Although the association of Guillain-Barré syndrome and temporal arteritis in these three patients could be coincidental, a common immunologic mechanism is also a possibility.