Pseudoaneurysm of the facial artery after the injection of local anesthetics

Generally, a true aneurysm is a dilatation of the vessel wall, whereas a pseudoaneurysm (PA) is a weakening or rent in a vessel wall, with contained rupture into the surrounding tissues. In the face, PAs of the facial artery are an extremely rare development after penetrating or blunt trauma. A 31-year-old woman presented with nontender, palpable, and firm lump that had been steadily increasing in size over a 4-week period. Examination confirmed a firm and spherical swelling in the left mandibular area, which was nonpulsatile. The patient presented with a mass on the upper part of her left chin 6 months after the injection of local anesthetics for dental treatment. After the procedure, a hematoma developed over the injection site, and it was treated with local ice. This case is unique in that the lesion seen using computed tomography and ultrasonography scanning had an unusual presentation. Ultrasonography revealed thrombi within the tumor, and color Doppler examination showed blood moving in the perivascular mass. During the operation via intraoral incision, a lesion was found as a dilation of the muscular branch of the facial artery. The facial artery was exposed, isolated, and tied off with a 2-0 white silk ligature. Histopathologic analysis determined that the content of the fragile cystic lesion was an organized thrombus and hematoma. As with any penetrating facial injury, local anesthetics can damage vessels and produce a PA. Therefore, we present a rare case of false facial artery aneurysm with no associated risk factors, which was nonpulsatile on presentation.     

Fusobacterium nucleatum GroEL induces risk factors of atherosclerosis in human microvascular endothelial cells and ApoE(-/-) mice

Infection and inflammation are risk factors in the initiation and progression of atherosclerosis. Periodontitis is one of the most prevalent chronic inflammations of the oral cavity, and has been reported to be associated with systemic disease. In this study, we evaluated whether the heat-shock protein GroEL of Fusobacterium nucleatum, one of the most prevalent bacteria in periodontitis, induces factors that predispose to atherosclerosis in human microvascular endothelial cells (HMEC-1) and apolipoprotein E-deficient (ApoE(-/-)) mice. GroEL induced the expression of chemokines such as monocyte chemoattractant protein-1 and interleukin-8 as well as cell adhesion molecules, such as intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and E-selectin. GroEL induced the activity of tissue factor and reduced the activity of the tissue factor pathway inhibitor. Foam cell formation was induced by GroEL. GroEL-injected ApoE(-/-) mice showed significant atherosclerotic lesion progression compared with control mice. Serum levels of risk factors for atherosclerosis such as interleukin-6, C-reactive protein, and low-density lipoprotein were increased in GroEL-injected ApoE(-/-) mice compared with control mice, whereas serum levels of high-density lipoprotein were decreased. We could detect significantly higher levels of anti-F. nucleatum GroEL antibody in serum and F. nucleatum DNA in gingival crevicular fluid from patients with periodontitis than in that from healthy subjects. Our results indicate that the host response to the GroEL of periodontal pathogens like F. nucleatum may be a mechanism involved in atherosclerosis, supporting the association of periodontitis and systemic infection.     

Serum uric acid: a marker of metabolic syndrome and subclinical atherosclerosis in Korean men

Serum uric acid (SUA) is a potential risk factor for atherosclerosis. We assessed the relationship between SUA and subclinical atherosclerosis in Korean men (n = 3010). Multidetector computed tomography (MDCT) and ultrasonographic measurements of coronary artery calcification (CAC) and carotid intima-media thickness (cIMT), respectively, are markers of subclinical atherosclerosis. Odds ratios (ORs) of CAC score and cIMT across SUA levels were 1.101 (P = .046) and 1.266 (P = .002), respectively, after adjustment for several variables. The independent association between CAC and cIMT was observed (OR = 1.231, P < .001). Serum uric acid was independently associated with metabolic syndrome (MetS) with an OR of 1.415 (P < .001). Metabolic syndrome was only independently associated with cIMT, with an OR of 2.103 (P = .003). High-sensitivity C-reactive protein was positively correlated with SUA (r = .125, P < .001). Serum uric acid level is independently associated with CAC, cIMT, and MetS in Korean men.     

Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center

Takayasu's arteritis (TA) is primary vasculitis. Cardiac involvements in TA is due to the consequences of the vascular lesions as well as the primary pathology of the heart. The disease activity of TA is known to influence the prognosis of TA. We hypothesized that the cardiovascular involvement of TA is related to the disease activity. We evaluated the cardiovascular manifestations of TA, and we assessed their relation to the disease activity of TA. Two hundred four patients were diagnosed with TA from September, 1994 to March, 2009 according to the diagnostic criteria of the 1990 American College of Rheumatology. Their clinical features and the laboratory, angiographic and echocardiographic findings were retrospectively reviewed. The group with active disease activity was defined as satisfying one of the following criteria: i) an elevated ESR or CRP level, ii) thickened arterial wall with mural enhancement on CT or MR angiography, and iii) carotidynia at the time of the initial diagnosis. One hundred thirty nine patients (69.2%) were classified as the active group. The cardiovascular signs and symptoms were not generally different between the active and inactive groups. The active TA patients had more frequent involvement of the ascending aorta and the aortic arch and its main branches than did the inactive group. The active group showed a higher incidence of significant aortic valve regurgitation and pulmonary hypertension, and a higher level of NT-proBNP. These findings suggest that disease activity plays an important role for the cardiovascular manifestations of TA. The TA patients with higher activity have more cardiovascular morbidity compared to the TA patients with low disease activity.