Localized polyarteritis nodosa: cases involving the lower extremities and the breast

Summary Two patients with cutaneous polyarteritis nodosa with nodules in the lower extremities and another patient with an unusual presentation of polyarteritis nodosa involving only the arteries of the breast are reported.     

Trends in the clinical presentation of temporal arteritis in israel: Reflection of increased physician awareness

Summary We have noticed significant changes in the clinical presentation in patients diagnosed with temporal arteritis in Israel between 1980–1992 compared to patients diagnosed prior to 1977. At the time of diagnosis 57% of the patients were older than 75 years, compared to only 23% within this age group in the previous period. There was an increase in the number of nonspecific and unusual presenting symptoms such as weakness, respiratory and neurological symptomatology, and a decreased proportion of patients presenting with the classical manifestation such as headaches, temporal tenderness and visual symptoms. The time from presentation to diagnosis was shortened significantly. It is suggested that these changes are largely due to the increasing awareness among physicians to the various manifestations of this conditions.     

Takayasu''s aortitis with renovascular hypertension

We report a case of Takayasu's disease with severe renovascular hypertension in a girl from Eritrea. In the "burn-out" phase after the erythrocyte sedimentation rate had normalized, reconstructive vascular surgery was performed as further progression of the disease seemed unlikely. However, probably due to her growth, the graft rotated and a second operation was successfully performed.     

一例干燥综合征合并急性心肌梗死的病例分析

本文通过分析1例干燥综合征合并急性ST段抬高型心肌梗死患者的诊治过程,阐述了此类急性心肌梗死的用药选择和治疗时机,探讨了干燥综合征继发急性心肌梗死患者的病情演变,及此类患者发生急性心肌梗死的可能原因,为相同临床情况的患者治疗提供了治疗经验。     

孤立性巨细胞性肺动脉炎一例及文献复习

目的　了解孤立性巨细胞性肺动脉炎的临床及病理表现。方法　 1例右肺动脉完全堵塞患者 ,行右肺切除 ,标本取材后 ,石蜡包埋制片 ,苏木精 伊红及免疫组化染色。结合有关文献及本例患者的临床资料 ,对本病的临床及病理表现进行论述。结果　本病的病理表现主要为肺动脉管壁增厚、纤维组织及小血管增生 ,淋巴细胞 (主要为T淋巴细胞 )、浆细胞、组织细胞及少量多核巨细胞浸润 ,管腔血栓形成及机化 ,肺出血性梗死。结论　孤立性巨细胞性肺动脉炎是一种非常罕见的疾病 ,结合血管造影和病理检查可以确诊。     

Rapidly progressive dementia due to Mycobacterium neoaurum meningoencephalitis

Dementia developed in a patient with widespread neurologic manifestations; she died within 5 months. Pathologic findings showed granulomatous inflammation with caseation necrosis, foreign body-type giant cells, and proliferative endarteritis with vascular occlusions. Broad-range polymerase chain reaction identified Mycobacterium neoaurum as the possible pathogen. Central nervous system infection by M. neoaurum may result in rapidly progressive dementia.     

儿童多发性大动脉炎28例临床分析

目的分析儿童多发性大动脉炎临床特点及治疗转归,提高对此病的认识。方法研究对象为1990~2002年在北京协和医院住院并确诊为儿童多发性大动脉炎的患儿28例,对其临床表现、实验室及影像学检查、治疗转归进行回顾性分析。结果28例中男7例,女21例,男女比例1∶3,年龄1.5~18岁,确诊时病程15d至6年。常见的临床症状为血管杂音25例(89.3%),高血压14例(50.0%),无脉或脉弱19例(67.8%),头痛等19例(67.8%);动脉造影22例,其中I型(8例,36.4%)和Ⅴ型为主(6例,27.3%);炎症活动指标主要为血沉升高20例(71.4%),C反应蛋白升高12例(42.8%),WBC升高10例(35.7%)。28例中23例接受激素和(或)免疫抑制剂治疗,有效率91.3%,11例无病情活动但有严重并发症者行外科手术或介入治疗后好转。结论对于多系统、多脏器损害的疾病,应全面检查,尤其是四肢血压、脉搏及血管杂音,注意大动脉炎的可能,早期诊断是提高治疗效果的关键。