Pericarditis at the Internal Disease Clinic of the Institute of Tuberculosis and Lung Diseases (1981-1987)

Causes, symptoms, clinical forms, and methods of diagnosis of pericarditis were analysed in a group of 30 patients. Chest pain, dyspnea, and tachycardia were prevailing clinical symptoms of the disease. Particularly useful diagnostic technique is ultrasound, being a method of choice in the diagnosis of the most frequent exudative pericarditis. The most frequent cause of cardiac tamponade was malignant pericarditis. Diagnostic problems with particular reference to tuberculous etiology of pericarditis have also been discussed.     

The isolation of carbon dioxide-requiring (carboxyphillic) type 19 pneumococcus (Streptococcus pneumoniae) from diseased guinea-pigs.

Type 19 pneumococcus was isolated only in anaerobic cultures from tissue fluids of guinea-pigs suffering from exudative pericarditis and pleuropneumonia. The organism was pathogenic to mice even after 40 subcultures. Further study showed it to be carboxyphilic rather than anaerobic. The necessity of specifying various atmospheric conditions in the diagnostic bacteriological isolation routine is emphasized.     

Digital vascular imaging and selective renin sampling in evaluation of vascular anatomy in renal transplant recipients.

Sixty-five renal transplant recipients underwent digital vascular imaging of the graft and simultaneous selective venous sampling for plasma renin activity. Renal artery stenosis was found in seven patients but did not appear to be functionally important. Diffuse intrarenal arterial attenuation was found in seven patients and was associated with impaired graft function and perfusion; it may indicate chronic rejection. Lower pole hypoperfusion was found in nine patients without impaired graft function or perfusion; its clinical relevance is uncertain. Aneurysmal dilatation of the main renal artery was found in two patients. Severe hypertension was common in patients with these three major abnormalities, but a causal association between the abnormality and hypertension could rarely be inferred. It may be the abnormalities on digital vascular imaging, especially diffuse intrarenal arterial attenuation and lower pole hypoperfusion, are secondary to severe hypertension. Digital vascular imaging with simultaneous selective venous sampling for plasma renin activity is useful in evaluating the vascular anatomy of the grafted kidney and in assessing any abnormality found. The combined procedure was well tolerated by all patients with no complications and no incidence of acute tubular dysfunction or proteinuria after the investigation.     

Ulceration of the hand secondary to a radial arteriovenous fistula: a model for varicose ulceration.

A patient in whom a radial arteriovenous fistula was constructed in preparation for haemodialysis subsequently developed ulceration on the dorsum of the hand. The lesion failed to heal despite antibiotic treatment, and so the fistula was closed. The lesion healed within three weeks. Subsequent construction of a fistula at the right wrist was followed 12 months later by the development of similar ulceration of the right hand. This complication of arteriovenous fistulas is similar to varicose ulceration of the leg and provides a unique opportunity to study the effects of sustained venous hypertension on the skin.     

Management of uraemic pericarditis.

Of 250 patients undergoing haemodialysis from 1967 to 1974 17 presented with uraemic pericarditis. Seven of these patients who had been transferred early enough to peritoneal dialysis treatment were cured without pericardiectomy (mean survival 18 months (range 6-36); no deaths). Only one patient was cured from his pericarditis by "aggressive haemodialysis." In seven out of 10 patients treated with haemodialysis, pericardiectomy finally had to be performed because of pericardial tamponade (postoperative survival 20 months (range 8-36); one death). Two patients died from pericardial tamponade before surgery. In patients with evidence of uraemic pericarditis frequent peritoneal dialysis with high fluid withdrawal is the treatment of choice, but in cardiac tamponade pericardiectomy should follow a preoperative pericardiocentesis with limited fluid aspiration. Of possible significance in the aetiology of pericarditis were the findings that 10 of the 17 patients had hypertension with cardiac enlargement and that 14 presented with evidence of underdialysis, possibly due to the reuse of dialysis components.     

Cellular events in alveolitis and the evolution of pulmonary fibrosis

"Alveolitis", as opposed to "pneumonia" sensu strictiori, is a term used to denote diffuse inflammatory changes of the pulmonary parenchyma, excluding those that result from local bacterial, fungal or other extracellular microbial growth. The various types of alveolitis are classified according to their histological characteristics and range from "luminal phagocytic" or "mural lymphoplasmacellular" and "exudative" to "fibrosing" alveolitis. In this overview, various exogenous and endogenous causes of different types of alveolitis, and the cellular events in their pathogenesis are briefly discussed to illustrate the complex mechanisms involved. Particular emphasis is placed on the possible transition from diffuse exudative to fibrosing alveolitis. It appears that pulmonary fibrosis, which is usually patchy rather than truly diffuse, does not have a uniform pathogenesis. Besides the possibility of a certain degree of a diffuse fibrosis three major pathways are evident: (1) granulation tissue budding into alveolar lumina (luminal fibrosis) (2) exudate incorporation into alveolar walls (mural fibrosis) and--at least equally important--(3) so-called collapse (atelectatic) induration (obliterative-interseptal fibrosis), a process that has largely been neglected so far.     

White cell accumulation in dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin

The mechanism by which chronic venous insufficiency and venous hypertension are associated with ulceration of the legs is not yet understood. To investigate this mechanism further accumulation of white cells in the dependent legs of normal volunteers, patients awaiting surgery for simple varicose veins, and patients with chronic venous insufficiency was studied. About 24% fewer white cells than in normal subjects left the dependent foot of patients with venous hypertension, and this trapping of white cells, was reversed when the foot was raised; similar changes were not observed in normal subjects or patients with varicose veins.The trophic skin changes typically seen in patients with venous hypertension may be aggravated by damage caused by the repeated accumulation of white cells in the microcirculation.     

Reconstructive vascular surgery for renovascular hypertension

Forty-six patients who underwent renal artery repair for presumptive renovascular hypertension are presented. Preoperative investigation included a rapid sequence IVP, a high quality angiogram and split function studies, as well as renin assays of renal venous blood in the more recent cases. Atherosclerosis was the causative pathological lesion in 60% of the patients, with fibromuscular dysplasia or miscellaneous causes of stenosis accounting for the remaining 40%.Surgical correction was usually obtained by bypass grafting (57%). Hypertension was cured or significantly improved in 36 patients (78%).Optimal results are dependent upon complete preoperative investigation and surgical repair of all the stenotic areas.     

留置中心静脉导管加尿激酶心包内灌洗治疗急性结核性心包炎的临床疗效观察

目的：观察留置中心静脉导管引流加尿激酶心包内灌洗治疗急性结核性心包炎的疗效。方法：自1996年1月～2009年5月对我院48例临床确诊为急性结核性心包炎伴中到大量积液的患者（病程均短于1月）,男28例,女20例,年龄14～72岁。随机分为两组,治疗组（常规抗结核、肾上腺糖皮质激素治疗的基础上给予留置中心静脉导管心包引流加心包内尿激酶灌洗治疗）或对照组（常规抗结核、肾上腺糖皮质激素治疗基础上给予留置中心静脉导管引流）。观察并比较两组穿刺并发症（心包内出血、心律失常及感染）,治疗前、后心包膜厚度的变化,拔管时心包积液的残留量,以及通过电话问询及心脏超声随访并发症,随访截止日期为2010年5月。随访期限为11～132个月。结果：治疗组与对照组比较,治疗组治疗1周及2周后心包膜厚度的变化、拔管时积液残留量及发生心包缩窄方面有明显差异（P〈0.05）,穿刺相关并发症方面无明显差异（P〉0.05）。全部治疗组患者给予尿激酶治疗后未见心包内出血及系统性出血并发症。随访期内无一例发生死亡,治疗组及对照组分别有1例（4.2%）及8例（33.3%）发生心包缩窄。结论：留置中心静脉导管加尿激酶灌洗治疗急性结核性心包炎安全、可行,心包积液引流彻底,拔管时间早,心包膜增厚程度显著减轻,心包粘连机会减少,能有效地预防患者心包缩窄的发生。     

Inflammatory pseudotumor of the liver. Report of the fine needle aspiration cytologic findings in a case initially misdiagnosed as malignant

The fine needle aspiration (FNA) cytologic features are described in a case of inflammatory pseudotumor of the liver (xanthogranuloma), a disease generally regarded as of unknown etiology. The initial FNA findings were those of an acute exudative process, with atypical biliary duct epithelium and hepatocytes. These were interpreted as verifying the radiologic impression of a malignancy. Histologic study of subsequently resected nodules revealed the true nature of the case. As the lesion evolved, granulomatous inflammation supervened, characterized by numerous foamy histiocytes and lesser populations of plasma cells and lymphocytes. Numerous gram-positive cocci were readily demonstrated, suggesting that the lesion was an unusual tissue response to an intrahepatic bacterial infection. The lesion eventually resolved with prolonged antibiotic therapy.     

Endogenous platelet-activating factor and anti-platelet-activating factor in patients with renovascular hypertension

Renovascular hypertension is relieved by percutaneous transluminal renal angioplasty. In four patients with renovascular hypertension, platelet-activating factor (PAF) was found to be released into the ipsilateral renal venous blood after percutaneous transluminal renal angioplasty, but was not found in the contralateral renal venous blood following this procedure. Anti-platelet-activating factor with a lipid-like property was also found, and its polarity was slightly lower than that of PAF judging by its behavior on thin layer chromatography. Anti-platelet-activating factor completely blocked the aggregation of rabbit platelets induced by PAF, ADP or arachidonic acid. These results indicate that PAF and anti-platelet-activating factor are released into renal venous blood following percutaneous transluminal renal angioplasty in patients with renovascular hypertension.     

Role of acute elevation of portal venous pressure by exogenous glucagon on gastric mucosal injury in rats with portal hypertension

Time-course studies revealed the increased susceptibility of the gastric mucosa to noxious injury in portal hypertension correlates with the level of elevated portal venous pressure and hyperglucagonemia. Whether acute elevation of portal venous pressure by exogenous glucagon aggravates such injury is not known. We tested the hypothesis that glucagon in a dose sufficient to acutely elevate portal venous pressure aggravates noxious injury of the gastric mucosa in rats with portal hypertension. Infusion of a portal hypotensive dose of somatostatin should reverse these changes. In anesthetized rats with portal vein ligation, glucagon, somatostatin or the combination was administered intravenously in a randomized, coded fashion. Acidified ethanol-induced gastric mucosal injury was determined. Portal venous pressure and gastric mucosal perfusion and oxygenation (reflectance spectrophotometry) were monitored to confirm the effects of the respective intravenous treatments. Exogenous glucagon exacerbated acidified ethanol-induced gastric mucosal injury. The exacerbation was attenuated by somatostatin. These changes paralleled the portal hypertensive and hypotensive effects of glucagon and somatostatin, respectively. Our data suggest that a unique mechanism is triggered with the onset of portal hypertension. In an antagonistic manner, glucagon and somatostatin modulate this novel mechanism that controls portal venous pressure and susceptibility of the gastric mucosa to noxious injury.     

Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib

Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.     

The significance of electron dense deposits in mild lupus nephritis.

In patients with lupus nephritis, progression from a mild lesion to a diffuse proliferative glomerulonephritis has been reported in one to 35 percent of patients. Because of the wide variation in the rate of progression, this study was undertaken to determine those factors which would identify the patients most likely to progress. Of 21 patients with a mild lupus nephritis by light microscopy, progression to a diffuse proliferative lesion was seen in only those patients who had subendothelial deposits. While not all patients with subendothelial deposits had a deteriorating course, the persistence of such deposits on subsequent biopsies indicated a poor prognosis.     

Recovery process of arthritis induced by 6-sulfanilamidoindazole (6SAI) in rats

6-Sulfanilamidoindazole (6SAI) is known to induce not only an acute arthritis but also serositis and arteritis which resemble those induced by some vasodilators in rats. In this study, the recovery process of ankle lesions was examined histopathologically for up to 12 weeks of recovery period in rats bearing arthritis induced by administration of 6SAI (500 mg/kg) for 2 weeks. At 2 weeks of 6SAI-treatment, exudative synovitis and exudative/edematous periarthritis with marked formation of granulation tissues and periosteal reactive bone formation were noted in the ankles, but no remarkable neutrophil infiltration was detected in those lesions. The ankle swelling induced by 6SAI diminished by 4 weeks of recovery period, and the elevated plasma fibrinogen levels were normalized by 2 weeks of recovery period. Although fibrosis and newly-formed periosteal bone were still observed after 2 weeks of recovery period, no inflammatory lesion was detected at that point. At 4 or 12 weeks of recovery periods, the ankles showed an almost normal appearance. These results indicate that 6SAI-induced arthritis is reversible in nature and does not develop into chronic phase.     

Pathomechanism of chronic venous insufficiency and leg ulcer

Uniform view of chronic venous diseases has been formed in the last 3 decades. Chronic venous insufficiency (CVI) is a functional disorder of the venous system of the lower limb. The basis of the pathology is always the venous hypertension caused by valvular insufficiency and reflux with or without venous outflow obstruction. Epifascial, subfascial and transfascial forms of CVI can be distinguished. In the practice these forms are almost always combined. The consistent venous hypertension is the initiating factor in alterations in the microcirculation which leads to skin changes and venous ulceration. The precise mechanism of the development of venous leg ulcer is still uncertain. A recent hypothesis suggests that leukocytes are trapped in the capillaries and attaching to the endothel they become activated and release proteolytic enzymes, free radicals which have destructive effects on lipid membranes, proteins as well as on many connective tissue compounds. The endothelium plays active role in the complex mechanism. Increased expression of tissue metalloproteinases has been observed in the periulcer skin. The presence of perivascular leukocyte infiltration and fibrin cuff is a reflexion of an inflammatory process. The clinical stages of CVI are likely to be the results of a systemic inflammatory response to a period of venous hypertension.     

Peripheral venous hypertension after the creation of arteriovenous fistula for haemodialysis

The function of an arteriovenous (av) fistula for haemodialysis may be complicated by manifestation of peripheral venous hypertension, which results from the arterial blood flow through the venous system into the periphery of the upper extremity. Its development is most typically caused by a proximal forearm av-fistula, as, in addition to the desirable arterialisation of the subcutaneous venous system of the arm, arterialisation of the venous system of the forearm and the hand may occur and possibly promote the development of venous hypertension, which may in the extreme result in gangrene of the fingers. Awareness of these problems as well as of the necessity of their surgical solution is essential for doctors dealing with haemodialysis.     

Renal vein plasma adenosine 3',5'-cyclic monophosphate in renovascular hypertension.

The concentration of plasma adenosine 3'',5''-cyclic monophosphate (cyclic AMP) and plasma renin activity (PRA) were measured concomitantly in blood from both renal veins and in arterial blood in 22 hypertensive patients. In the nine patients with true renovascular hypertension the concentration of plasma cyclic AMP was greater in the venous effluent of the kidney affected by the renal artery stenosis than in that of the unaffected or less affected kidney. The arteriovenous difference in cyclic AMP concentration was less on the affected side in all but one patient. The arteriovenous differences in PRA identified the affected kidney as the source of hyper-reninemia and showed that renin release from the other kidney was suppressed. In the 13 patients with hypertension associated with but unrelated to renal artery stenosis there were no consistent patterns of cyclic AMP concentration or PRA in the venous effluent of the kidneys or of their arteriovenous differences. In renovascular hypertension the venous effluent of the kidney affected by renal artery stenosis contains not only more renin but also more cyclic AMP, owing to either increased cyclic AMP production or decreased excretion or extraction of cyclic AMP by the affected kidney. This unilateral increase in cyclic AMP concentration may become a complementary diagnostic feature of true renovascular hypertension.     

Conservative and surgical treatment of pericarditis--our experience

Methods and results of both conservative and invasive therapy of pericarditis were analysed in the group of 30 patients. An emphasis was on successful treatment of mild (idiopathic) pericarditis and efficiency of the early started, combined pharmacotherapy (tuberculostatics + corticosteroids) of pericarditis of tuberculous etiology. A stress is on marked immediate efficacy of surgery in case of cardiac tamponade, independent on its etiology, with simultaneous recommendation of ultrasound-guided pericardial sac paracentesis. Survival rate in patients with malignant pericarditis is relatively low.     

Identification and quantification of prosthetic mitral regurgitation by flow convergence method using transthoracic approach

Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.