Peripheral vascular disease in Behcet's syndrome

We describe a patient with Behcet's syndrome who had peripheral vascular disease involving the left subclavian artery for which angioplasty with stent placement was performed and reangioplasty done for in-stent restenosis. She presented with recurrence one year after stent placement; angiography revealed diffuse disease of the axillary and radial arteries with mild to moderate restenosis at the site of stent placement.     

An unusual vascular involvement in a patient with Behcet's disease: renal artery stenosis

Behcet's disease (BD) is a rare multisystem inflammatory disorder characterized by recurrent ulcers affecting the mouth and genitals, various skin lesions, relapsing iritis, and vasculitis. Vascular events may dominate the clinical presentation in some patients with BD. Hitherto three forms of vascular disease such as venous occlusions, arterial aneurysms, and arterial occlusions have been reported in BD. Renal vascular involvement has reported in less than 1% of the patients with vascular BD. A case of BD with renovascular hypertension is reported. To our knowledge, a case of BD with renovascular hypertension treated with angioplasty and stent implantation has not been reported previously.     

Behcet's disease: cardiac and pulmonary involvement

A patient with Behçet's disease who had pulmonary andcardiac involvement is described. The cardiac lesion was endocarditisin the right ventricle and a thrombus on this lesion which causedpulmonary emboli. The thrombus was excised completely and hemoptysisstopped. Pulmonary defects shown by pulmonary scintigraphy didnot disappear with the therapies given to the patient. Theseabnormalities in Behçet's disease very rare, echocardiographicexamination can be useful in detecting them.     

Cardiovascular involvement in celiac disease

Celiac disease(CD) is an autoimmune response to ingestion of gluten protein, which is found in wheat, rye, and barley grains, and results in both small intestinal manifestations, including villous atrophy, as well as systemic manifestations. The main treatment for the disease is a gluten-free diet(GFD), which typically results in the restoration of the small intestinal villi, and restoration of other affected organ systems, to their normal functioning. In an increasing number of recently published studies, there has been great interest in the occurrence of alterations in the cardiovascular system in untreated CD. Herein, published studies in which CD and cardiovascular terms appear in the title of the study were reviewed. The publications were categorized into one of several types:(1) articles(including cohort and case-control studies);(2) reviews and meta-analyses;(3) case studies(one to three patient reports);(4) letters;(5) editorials; and(6) abstracts(used when no full-length work had been published). The studies were subdivided as either heart or vascular studies, and were further characterized by the particular condition that was evident in conjunction with CD. Publication information was determined using the Google Scholar search tool. For each publication, its type and year of publication were tabulated. Salient information from each article was then compiled. It was determined that there has been a sharp increase in the number of CD-cardiovascular studies since 2000. Most of the publications are either of the type "article" or "case study". The largest number of documents published concerned CD in conjunction with cardiomyopathy(33 studies), and there have also been substantial numbers of studies published on CD and thrombosis(27), cardiovascular risk(17), atherosclerosis(13), stroke(12), arterial function(11), and ischemic heart disease(11). Based on the published research, it can be concluded that many types of cardiovascular issues can occur in untreated CD patients, but that most tend to resolve on a GFD, often in conjunction with the healing of small intestinal villous atrophy. However, in some cases the alterations are irreversible, underscoring the need for CD screening and treatment when cardiovascular issues arise of unknown etiology.     

A case of Behcet's disease with intestinal involvement due to Crohn's disease

A 15-yr-old, Arabic male presented with painful, recurrent, self-resolving oral and genital ulcers, erythema nodosum and uveitis. Behcet's disease was diagnosed. A few months later, he experienced anorexia, abdominal pain, diarrhea, and weight loss. Although all routine laboratory and radiologic investigations were negative, colonoscopy revealed the presence of serpiginous ulcers with pseudopolyps and inflamed intervening mucosa in the proximal half of the colon. Therapy with oral steroids was helpful, but the disease exacerbated a few months after prednisone was discontinued. Repeat evaluation showed similar endoscopic findings and, on colonic biopsy, noncaseating granulomas compatible with Crohn's disease were seen. Again, the patient responded well to oral steroids and sulfasalazine. We believe that gastrointestinal involvement in our patient is compatible with Crohn's disease and that screening tests to rule out chronic inflammatory bowel disease should be performed in the presence of gastrointestinal involvement in Behcet's disease. Behcet's disease may be a part of the spectrum of chronic inflammatory bowel disease.     

Cardiovascular complications of collagen vascular disease

Opinion statement  

白塞病心脏受累的超声表现

目的:加深对白塞病心脏损害的认识.方法:回顾性分析69例住院白寒病病人的超声心动图表现.结果:超声心动图正常33例,异常36例,异常检出率为52.2%,在异常病例中,瓣膜关闭不全(61.1%)、心包积液(41.7%)、肺动脉高压(38.8%)和心腔扩大(36.1%)的发生比例较高,主动脉病变、心肌病变、陈旧性心肌梗死、室壁瘤和心腔内血栓均可见.结论:确诊白塞病的患者应行超声心动图的检查,及时诊断心脏白塞病对病人的治疗和预后判断有重要临床意义.有主动脉瓣关闭不全者,进行超声心动图检查时除注意瓣膜关闭不全程度外,应明确有无瓣膜穿孔、撕裂及瓣环穿孔、主动脉扩张和主动脉夹层动脉瘤形成,对于有以上超声表现的年轻病人应警惕白塞病的存在.肺动脉压力的升高往往伴有白塞病的肺部受累.经食管超声心动图可以作为经胸超声心动图的重要补充.     

Cardiovascular involvement in inflammatory bowel disease: dangerous liaisons

Increasing evidence of a link between inflammatory bowel disease(IBD) and adverse cardiovascular events has emerged during the last decade.In 2014,an important number of meta-analyses and cohort studies clarified the subtle dangerous liaisons between gut inflammation and cardiovascular pathology.The evidence suggests that patients with IBD have a significantly increased risk of myocardial infarction,stroke,and cardiovascular mortality,especially during periods of IBD activity.Some populations(e.g.,women,young patients) may have an even greater risk.Current effective treatment of IBD is aimed at disease remission and seems to reduce cardiovascular risk in these patients.A beneficial effect was demonstrated for salicylates,but not for steroids or azathioprine.tumor necrosis factor-α antagonists,which are highly effective in the reduction of inflammation and in the restoration of the digestive mucosa,lead to conflicting cardiovascular effects,as they seem to reduce the risk for ischemic heart disease but increase the rate of cerebrovascular events.Future supplemental treatment strategies that may reduce the atherothrombotic risk during periods of IBD activity should be explored.     

Cardiovascular involvement in Behçet’s disease

Behçet’s disease is a chronic relapsing systemic vasculitis that can involve almost every organ and systems in the body with extremely different diverse manifestations. Cardiovascular involvement is one of these manifestations, the involvement of which might present in various patterns in itself. Cardiovascular involvement is relatively uncommon in Behçet’s disease; however, Behçet’s disease is relatively rather common in certain parts of the world. Therefore, especially in these locations recognizing such miscellaneous presentations are of critical importance, since cardiovascular involvements exceed other presentation in mortality and morbidity rates. Based on these facts, in this review, we summarized the cardiovascular involvements and its different manifestations in Behçet’s disease.     

Perioperative and long-term prognostic value of intravenous dipyridamole thallium scintigraphy in patients with peripheral vascular disease

The prognostic value of long-term risk stratification of patients with peripheral vascular disease who undergo intravenous dipyridamole thallium scintigraphy has not been well studied. We screened 131 patients with peripheral vascular disease who underwent intravenous dipyridamole thallium testing to determine cardiac event rates over an average follow-up of 18 +/- 10 months. Of the 131 patients, 111 subsequently had peripheral vascular surgery. The patients with abnormal thallium scans after dipyridamole had a significantly higher risk of death or myocardial infarction, both in the perioperative phase (7% versus 0%; p less than 0.001) and at late follow-up (17% versus 6%; p less than 0.01). The risk of a cardiac event was two-fold greater when a reversible as compared to a fixed thallium defect was present. Multivariate analysis selected the number of thallium segments with perfusion defects, prior history of angina pectoris, and chest pain during dipyridamole testing as perioperative predictors of a cardiac event. A reversible thallium defect was the only predictor of death or nonfatal myocardial infarction during late follow-up. Thus intravenous dipyridamole thallium scintigraphy is a useful noninvasive test for risk stratification of patients before peripheral vascular surgery and provides prognostic information as to the risk of a cardiac event in the 2-year period after the test. A reversible thallium defect is associated with a significant increased risk and would indicate that coronary angiography should be considered and preoperative coronary revascularization.     

Cardiovascular ultrasound: expanding frontiers in vascular disease

Advances in cardiovascular ultrasound have included development of instrumentation providing outstanding images, as well as color spectral Doppler hemodynamic information. The increasing utilization of cardiovascular ultrasound has led to its increasing diagnostic application and accuracy in the evaluation of the patient with known or suspected cerebrovascular and peripheral vascular disease. The sensitivity of duplex ultrasound to detect carotid disease varies from 87% to 94% with a specificity of 88% to 93%. The accuracy of duplex examination for detection of peripheral venous disease, when compared to contrast venography, is high. A sensitivity of nearly 93% with a specificity of 98% has been noted. Cardiovascular ultrasound is a noninvasive technology with no known biological hazard that can be applied to the broad spectrum of patients including those who are critically ill. It is a relatively low-cost procedure when compared to other diagnostic procedures and can be performed on a serial basis. Since it provides anatomical and functional hemodynamic information, it is rapidly becoming the procedure of choice not only for diagnosis, but also for management.