Calcification of the internal elastic membrane in temporal arteries: its relation to age and gender

OBJECTIVE: To investigate the age and sex distribution of calcifications of the internal elastic membrane (IEM) in temporal arteries. METHODS: Calcifications of the IEM were assessed light-microscopically in temporal arteries from 40 women and 21 men, aged 51 or more, who were known not to have giant cell arteritis (GCA). Their relation to age and the difference between women and men were tested statistically. RESULTS: The IEM calcifications differed morphologically from the calcifications in M?nckeberg's mediosclerosis and atherosclerosis. They increased significantly with age and were 2.62 times more common in women than men. CONCLUSION: Previous morphological studies indicate that the inflammatory process in GCA is initiated by a foreign-body, giant-cell attack on calcifications of the IEM. The present study showed that IEM calcifications in non-GCA controls show an age and sex distribution similar to that of GCA morbidity. The results may indicate that the presence of IEM calcifications in the general population influences the age and sex distribution of GCA. Furthermore, the findings support the hypothesis that the calcifications, although not disease specific, may play a pathogenetic role in the latter.     

Color duplex ultrasonography of temporal arteries: role in diagnosis and follow-up of suspected cases of temporal arteritis

The objectives of this study are to study the diagnostic value of color duplex ultrasonography (CDU) compared with the clinical results and temporal artery biopsy (TAB) in patients with suspected temporal arteritis (TA) and evaluate the prognostic value of CDU in follow-up of patients of sure diagnosis of TA under treatment in correlation to clinical response. The study included 32 consecutive patients of clinically suspected TA, and 30 age- and gender-matched control subjects. Baseline clinical characteristics and bilateral CDU of temporal arteries were performed to all subjects. CDU aimed to assess presence of a dark halo around the arterial lumen (a halo sign) or presence of stenoses and occlusions of temporal arteries. Unilateral TAB was performed then in all patients but not in control subjects. Subsequent CDU examinations were performed at 2, 4, 8, and 12 weeks after onset of treatment in patients with abnormal CDU. A halo sign at baseline CDU was evident in 13 TA patients (81%) and in 2 non-TA patients (12%) but none in control subjects. The presence of a halo sign in total yielded 81% sensitivity and 88% specificity whereas the presence of bilateral halo sign yielded 37% sensitivity and 100% specificity. Subsequent CDU examinations of TA patients showed disappearance of a halo sign in nine patients at 2 weeks and in four patients at 4 weeks with a mean of disappearance of 21 days after initiation of treatment. CDU is non-invasive, easy, and inexpensive method for diagnosis of TA. It is of higher sensitivity and specificity. It can be used in combination with clinical and laboratory tools for diagnosis of TA. It can effectively predict which patient will need TAB. In patients with bilateral halo sign, TAB is not necessary.     

Magnetic resonance imaging of the pulmonary arteries and their systemic connections in pulmonary atresia: comparison with angiographic and surgical findings

Patients with pulmonary atresia require several investigations and operations. The role of magnetic resonance imaging in assessing the anatomy of the central pulmonary arteries, the origin and course of systemic collateral arteries, and the patency of surgical shunts has been studied with the aim of reducing the need for invasive angiography. Transverse, coronal, and sagittal images were obtained in ten adult patients and assessed without knowledge of surgical and angiographic data. Central pulmonary artery anatomy varied from full development to complete absence. Transverse slices showed hypoplastic arteries particularly well and the findings accorded with surgical and angiographic data in all patients. The origin and proximal course of 15 large collaterals were identified on the magnetic resonance images and 18 were identified by surgical and angiographic data. Magnetic resonance imaging did not show their distal connections; if such information is required angiography will be needed. Five surgical shunts were shown to be patent and two occluded at surgery and angiography, and this was confirmed on the magnetic resonance images. The patency of a further four shunts was uncertain, but they were not seen by magnetic resonance and were presumed to be occluded.     

Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion

A 28 yr-old male presented with chest pain and acute ST elevation following ingestion of pseudoephedrine. The pain and electrocardiographic changes disappeared after the administration of sublingual Nitroglycerin. Myocardial enzymes did show some evidence for myocardial necrosis. A subsequent coronary arteriogram showed no occlusive lesions. Pseudoephedrine, a sympathomimetic agent, may be implicated in the initiation of coronary spasm and myocardial infarction in some patients.     

Giant cell inflammation compared with amyloidosis of the internal elastic lamina in temporal arteries

Close examination of a series of temporal artery biopsy specimens provided histologic and statistical evidence that any association between the occurrence of giant cell arteritis and senile amyloidosis of the temporal artery internal elastic lamina is not direct, but is associated incidentally with old age. Substantial demographic differences between the 2 conditions were found; the prevalence of giant cell arteritis first waxed and then waned with increasing age, while rates for senile amyloidosis of the temporal artery progressed steadily toward 100% in the ninth decade of life.     

Evidence that the pituitary-adrenal axis does not cross-adapt to stressors: comparison to other physiological variables

The effects of previous chronic immobilization stress on the physiological responses of male rats to a novel chronic stressor (shock) were studied. Previous chronic exposure to immobilization reduced adrenocorticotropin (ACTH) and lactate responses to acute immobilization stress without altering the response to a novel acute stressor (tail shock). When subjected to chronic tail shock, body weight inhibition caused by chronic shock was greater in the rats not previously exposed to chronic immobilization, which suggests that there is cross-adaptation between different stressors. However, adrenocorticotropin adaptation to chronic shock was impaired by previous chronic immobilization. These data indicate that the existence of cross-adaptation to stressors might depend on the variable measured, the central nervous system pathways controlling the pituitary-adrenal axis being, apparently, resistant to cross-adaptation. This lack of cross-adaptation at certain levels can assure the maintenance of an adequate response to unknown environmental stimuli.     

Magnetic resonance imaging of the pulmonary arteries and their systemic connections in pulmonary atresia: comparison with angiographic and surgical findings.

Patients with pulmonary atresia require several investigations and operations. The role of magnetic resonance imaging in assessing the anatomy of the central pulmonary arteries, the origin and course of systemic collateral arteries, and the patency of surgical shunts has been studied with the aim of reducing the need for invasive angiography. Transverse, coronal, and sagittal images were obtained in ten adult patients and assessed without knowledge of surgical and angiographic data. Central pulmonary artery anatomy varied from full development to complete absence. Transverse slices showed hypoplastic arteries particularly well and the findings accorded with surgical and angiographic data in all patients. The origin and proximal course of 15 large collaterals were identified on the magnetic resonance images and 18 were identified by surgical and angiographic data. Magnetic resonance imaging did not show their distal connections; if such information is required angiography will be needed. Five surgical shunts were shown to be patent and two occluded at surgery and angiography, and this was confirmed on the magnetic resonance images. The patency of a further four shunts was uncertain, but they were not seen by magnetic resonance and were presumed to be occluded.     

Dietary habits of colorectal neoplasia patients in comparison to their first-degree relatives

AIM:To compare the dietary habits between colorectal neoplasia patients,their first-degree relatives,and unrelated controls.METHODS:From July 2008 to April 2011,we collected epidemiological data relevant to colorectal cancer from patients with colorectal neoplasias,their first-degree relatives,and also from a control group consisting of people referred for colonoscopy with a negative family history of colorectal cancer and without evidence of neoplasia after colonoscopic examination.The first-degree relatives were divided into two groups following the colonoscopic examination:(1)patients with neoplasia or(2)patients without neoplasia.Dietary habits of all groups were compared.Aχ2 test was used to assess the association between two dichotomous categorical variables.RESULTS:The study groups consisted of 242 patients with colorectal neoplasias(143 men,99 women;mean age:64±12 years)and 160 first-degree relatives(66men,94 women;mean age:48±11 years).Fifty-five of the first-degree relatives were found to have a neoplastic lesion upon colonoscopy,while the remaining105 were without neoplasia.The control group contained 123 individuals with a negative family history for neoplastic lesions(66 men,57 women;mean age:54±12 years).Two hypotheses were tested.In the first,the dietary habits of first-degree relatives with neoplasia were more similar to those of patients with neoplasia,while the dietary habits of first-degree relatives without neoplasia were similar to those of the control group.In the second,no sex-related differences in dietary habits were expected between the particular groups.Indeed,no significant differences were observed in the dietary habits between the groups of patients,controls and first-degree relatives with/without neoplastic lesions.Nevertheless,statistically significant sex-related differences were observed in all groups,wherein women had healthier dietary habits than men.CONCLUSION:In all groups examined,women had healthier dietary habits than men.Modification of screening guidelines according to sex may improve the efficiency of screening programs.     

Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries.

OBJECTIVE: To determine the incidence of temporal arteritis (TA) in patients with polymyalgia rheumatica (PMR) using colour Doppler ultrasonography of the temporal arteries. METHODS: Ultrasonography was performed in all 127 consecutive patients with newly diagnosed, active PMR seen between 1994 and 2000 and in 127 age- and sex-matched controls. RESULTS: Of 102 patients with "pure" PMR, 8% had ultrasonographic findings arousing suspicion of concomitant active TA (specific halo sign and/or positive histology in 7%; histologically proven TA in 4%). Twenty-five patients had clinical signs of both PMR and TA. Histology and sonography were negative in three of these patients. Of the controls, none had a halo sign and four had stenoses. CONCLUSION: Ultrasonography of the temporal arteries is a new, non-invasive method of diagnosing concomitant TA in patients with PMR.     

Gut in diseases： Physiological elements and their clinical significance

The intestinal barrier function of GI tract is very important in the body except for the function of digestion and absorption. The functional status of gut barrier basically reflects the stress severity when body suffers from trauma and various stimulations. Many harmful factors such as drugs, illnesses, trauma and burns can damage the gut barrier, which can lead to the barrier dysfunction and bacterial/endotoxin translocation. The paper discusses and reviews the concepts, anatomy, pathophysiology of gut barrier and its clinical relations.