The Sequence of Events in the Development of Bilateral Renal Cortical Necrosis Accompanying the Generalized Shwartzman Reaction

The generalized Shwartzman reaction, or Shwartzman-like conditions, were induced in a variety of experimental mammalian species by systemic injections of disintegrated cells of Gram negative bacteria, live Salmonella cholerae-suis or Liquoid. A comparative study of the renal lesions showed that the initial step in the development of bilateral cortical necrosis is stagnation and disintegration of red cells in glomerular capillaries. The glomerular “microthrombi” consist mainly of erythrocytic debris, which frequently has staining properties akin to those of fibrin; even wide-spread glomerular “thrombosis” is not accompanied by obvious destruction of renal parenchyma. A second step is necrotic mural lesions in afferent arteries, with ensuing thrombosis. These vascular lesions lead to the formation of individual infarcts which fuse to form total bilateral cortical necrosis in fulminant cases of the generalized Shwartzman reaction.     

Mural Dissections of Brain-Supplying Arteries in a Chimpanzee (Pan troglodytes)

We describe the pathologic features of mural arterial dissection involving brain-supplying arteries in a 31-y-old female chimpanzee (Pan troglodytes). Several hours after examination for a possible respiratory tract infection, the chimpanzee became unresponsive, developed seizures, and died within 18 h. At necropsy, the occipital cortex of the brain had a small area of congestion, and the cerebellar cortex contained a small necrotic area. Histologic evaluation confirmed the cortical lesions and revealed an additional necrotic area in the medulla oblongata characterized by mural dissection of the brain-supplying vertebral and basilar arteries and subsequent branches. Lesions in the cortices and medulla were within areas supplied by the vertebrobasilar system. Dissection of brain-supplying arteries has been described in humans but not previously in chimpanzees (or any other NHP), suggesting that these species might be useful in understanding this condition in humans. In addition, the lesion should be added to the NHP clinician''s and pathologist''s differential diagnosis list for similar presentations in this species.Mural dissection of brain-supplying arteries is a well-recognized clinical problem in humans.² In fact, these dissections are a common lesion of these arteries, second only to atherosclerotic changes. Dissections of these arteries can cause pain and lead to tissue ischemia and infarction (stroke).²In our experience, the blood supply to the brain is similar between chimpanzees and humans. However, mural dissection of brain-supplying arteries in NHP species had not been described previously, and the apparent absence of information on this topic might reflect a low rate of occurrence for the condition or indicate that the condition has gone unrecognized. Regardless of the cause, similar vascular mural dissection in NHP might be expected to cause significant clinical problems for the affected animal, as well as diagnostic and management challenges for veterinary clinicians and pathologists.Here we describe the first documented occurrence of mural arterial dissection involving brain-supplying arteries in an adult chimpanzee. The objectives of this report are to make the laboratory animal community aware of this condition and to suggest that chimpanzees might help to increase our understanding of this condition in humans.     

Age-related non-neoplastic lesions in the heart and kidneys of Syrian hamsters of the APA strain

Spontaneous cardiac and renal lesions in APA hamsters were examined histopathologically. Myocardial degeneration, valvular thickening, coronary arterial degeneration and increase in heart weight were common in old hamsters. These changes, which suggest cardiac failure, seem to be related to cardiac thrombosis which predominantly affected the left atrium and was found in over 40% of each sex over 16 months of age. Neither glomerular amyloidosis nor arteriolar nephrosclerosis was detected. In general the histopathology of renal lesions in APA hamsters resembled that of the condition known as glomerulonephrosis in rats. Renal lesions occurred more frequently and more severely and developed more rapidly in females than in males. There was no apparent correlation between cardiac thrombosis and renal disease.     

Preliminary observations, at the ultrastructural level, on the reactivity of cerebral arteries from New Zealand rabbits to combined atherogenic stimuli (hypercholesterol diet and hypertension)

Both in monkeys (Rhesus and Cynomolgus) and in New Zealand rabbits fed an atherogenic diet, a marked delay in the appearance of atherosclerotic lesions of the cerebral arteries in comparison with other arterial districts has been observed. This appearance has been described in monkeys as relatively earlier if hypertension is added to the atherogenic diet. Preliminary observations on a little group of rabbits on a 3 months hypercholesterolic diet, subjected to Goldblatt aortic coarctation, have shown an increase of blood pressure and a severe gross atherosclerotic involvement of aorta, resembling the one obtainable after 6 months of atherogenic diet. Histologically, the aorta predominantly shows lesions of the fatty streaks type with necrotic areas in the deep; the carotid lesions show some lipid in smooth muscle cells disseminated in a sub-endothelial "edematous" space (rich in protein). The cerebral arteries do not show any lesion. At TEM, the aortic lesions look sometimes as advanced plaques with an initial fibrosis at the surface; the carotid lesions are characterized by a granular deposit in the sub-endothelial space in which some smooth muscle cells (with lipid in the cytoplasm) are present; in the cerebral arteries only the presence of collagen fibers among the smooth muscle cells of the media, never observed in the animals fed the atherogenic diet alone, has sometimes been noted.     

Carbon Monoxide-Induced Early Thrombolysis Contributes to Heme Oxygenase-1-Mediated Inhibition of Neointimal Growth after Vascular Injury in Hypercholesterolemic Mice

Arterial thrombosis is a critical event in the pathogenesis of lesion development. In this study, we evaluated the effect of heme oxygenase-1 (HO-1), a stress-inducible enzyme with vasoprotective functions, on arterial thrombosis following vascular mechanical injury. The carotid arteries of apoE-deficient mice were subjected to angioplasty with a modified beaded-needle. Arterial thrombosis occurred at 12 h after injury. Treatment of the injured vessels with an adenovirus bearing HO-1 gene (Adv-HO-1) (1× 10⁸ pfu), but not saline or empty adenovirus (Adv), immediately after angioplasty resulted in earlier thrombolysis and restoration of blood flow detected at 24 h. Immunohistochemistry revealed that the arterial plasminogen activator inhibitor-1 (PAI-1) expression was markedly reduced in Adv-HO-1-treated injured arteries as compared to control counterparts. The thrombolytic effect was also observed by exposing animals with existing arterial thrombosis to carbon monoxide (CO) (250 ppm, 2 h), a byproduct derived from heme degradation by HO-1. In parallel with less fibrin(ogen) deposition, the macrophage infiltration, monocyte chemoattractant protein-1 expression and neointimal formation assessed at 2 weeks after angioplasty were substantially reduced in injured arteries treated with Adv-HO-1. These results support a role of early thrombolysis induced by CO in HO-1-mediated protection against intimal hyperplasia after vascular injury.     

Spatial distribution of osteoblast-specific transcription factor Cbfa1 and bone formation in atherosclerotic arteries

The mechanisms of ectopic bone formation in arteries are poorly understood. Osteoblasts might originate either from stem cells that penetrate atherosclerotic plaques from the blood stream or from pluripotent mesenchymal cells that have remained in the arterial wall from embryonic stages of the development. We have examined the frequency of the expression and spatial distribution of osteoblast-specific factor-2/core binding factor-1 (Osf2/Cbfa1) in carotid and coronary arteries. Cbfa1-expressing cells were rarely observed but were found in all tissue specimens in the deep portions of atherosclerotic plaques under the necrotic cores. The deep portions of atherosclerotic plaques under the necrotic cores were characterized by the lack of capillaries of neovascularization. In contrast, plaque shoulders, which were enriched by plexuses of neovascularization, lacked Cbfa1-expressing cells. No bone formation was found in any of the 21 carotid plaques examined and ectopic bone was observed in only two of 12 coronary plaques. We speculate that the sparse invasion of sprouts of neovascularization into areas underlying the necrotic cores, where Cbfa1-expressing cells reside, might explain the rarity of events of ectopic bone formation in the arterial wall. This study has also revealed that Cbfa1-expressing cells contain alpha-smooth muscle actin and myofilaments, indicating their relationship with arterial smooth muscle cells.     

Plexiform-like lesions and increased tissue factor expression in a rat model of severe pulmonary arterial hypertension

Severe pulmonary arterial hypertension (PAH) occurs in idiopathic form and in association with diverse diseases. The pathological hallmarks are distal smooth muscle hypertrophy, obliteration of small pulmonary arteriole lumens, and disorganized cellular proliferation in plexiform lesions. In situ thrombosis is also observed. A detailed understanding of the disease progression has been hampered by the absence of an animal model bearing all the pathological features of human disease. To create a model with these characteristics, we gave young (200-g) rats monocrotaline 1 wk following left pneumonectomy; controls with vehicle treatment or sham operation were also studied. In experimental rats, pulmonary arteries had distal smooth muscle hypertrophy and proliferative perivascular lesions. The lesions had a plexiform appearance, occurred early in disease development, and were composed of cells expressing endothelial antigens. Three-dimensional microangiography revealed severe vascular pruning and disorganized vascular networks. We found that expression of tissue factor (TF), the membrane glycoprotein that initiates coagulation, facilitates angiogenesis, and mediates arterial injury in the systemic circulation, was increased in the pulmonary arterioles and plexiform-like lesions of the rats. TF was also heavily expressed in the vessels and plexiform lesions of humans with pulmonary arterial hypertension. We conclude that plexiform-like lesions can be reproduced in rats, and this model will facilitate experiments to address controversies about the role of these lesions in PAH. Increased TF expression may contribute to the prothrombotic diathesis and vascular cell proliferation typical of human disease.     

长期高饱和、高不饱和脂肪酸饮食诱导胰岛素抵抗大鼠肾动脉舒张和收缩功能的变化

本文旨在探讨长期高饱和、高不饱和脂肪酸饮食诱导胰岛素抵抗（insulin resistance,IR）大鼠。肾动脉舒张和收缩功能的变化。成年Wistar大鼠随机分为对照组、高饱和脂肪酸组和高不饱和脂肪酸组,每组14只。喂养6个月后,用高胰岛素正常葡萄糖钳夹技术的葡萄糖输注率（glucose infusion rate,GIR）评价IR;用尾套法测定大鼠血压,同时比较三组大鼠的体重、血清甘油三酯、游离脂肪酸、胰岛素、空腹血糖和NO代谢产物NO2-／NO3-。大鼠处死后,取肾动脉放入生理盐溶液中,观察血管对各种因子的舒、缩反应。结果显示,喂养6个月后,与对照组大鼠比较,高饱和脂肪酸组和高不饱和脂肪酸组大鼠均出现血压升高、血清甘油三酯升高和胰岛素敏感性降低;体重、空腹血糖、胰岛素和游离脂肪酸均升高（P〈0．01）：而两高脂组间体重、空腹血糖、胰岛素和游离脂肪酸无显著性差异。高饱和脂肪酸组大鼠肾动脉对ACh的内皮依赖性最大舒张反应（Rmax）最低,其次为高不饱和脂肪酸组和对照组：对照组与两高脂组有显著性差异（P〈0．01）,而两高脂组间无显著性差异。血管经L-Arg孵育后,两高脂组肾动脉对ACh的内皮依赖性Rmax均比孵育前增加,经N^ω-吐硝基-L-精氨酸（N^ω-nitro-L-arginine,L-NNA）及美蓝（methyleneblue,MB）孵育后,两高脂组Rmax均比孵育前降低（P〈0．05,P〈0．01）;对照组各孵育液之间无显著性差异（P：〈0．05）。肾动脉对硝普钠的非内皮依赖性Rmax及对去甲肾上腺素的收缩反应,三组间无显著性差异（P〈0．05）。相关分析结果显示,肾动脉对ACh的内皮依赖性Rmax与收缩压、甘油三酯呈明显负相关,与NO2-／NO3-和GIR呈明显正相关,游离脂肪酸与N02-／NO3-呈明显负相关。结果提示,高饱和及高不饱和脂肪酸饮食均可引起高血压及与之密切相关的内皮依赖性血管舒张功能减弱、高脂血症和IR,高脂诱导内皮依赖性血管舒张功能减弱与L-Arg-NO-cGMP通路受损有关。     

The Relationship Between Genito-Urinary Hæmorrhage and Diseases of the Vascular System: (Section of Urology)

The diseases of the vascular system which cause h?morrhage from the genito-urinary tract are:-(1) Those in which changes are noted in the blood and capillary endothelium, and(2) Those in which alterations of a pathological nature are taking place in the walls of both large and small blood-vessels, but in which there is no change in the blood itself.In the first group are the purpuras; in the second arteriosclerosis, hyperpiesis and atheroma.This paper is confined to a discussion of the latter group of diseases in relation to genito-urinary h?morrhage.Little attention has been paid to sudden loss of blood from the kidney, bladder, or genitalia in support of a diagnosis of a vascular lesion, other than angioma. H?morrhage in these cases may be purely renal, vesical, or penile.Investigations consist of examination of the superficial arteries, estimation of the blood-pressure, examination of the blood and cystoscopy. Surgical lesions must be excluded by the usual well-known methods.A careful record has been kept of fifteen cases of arteriosclerosis in which h?morrhage from the genito-urinary tract has been the predominant manifestation of the disease. Details are given of nine patients with renal, one with vesical and three with urethral h?morrhage. Two cases of thrombosis of the penis are also included.From a study of the literature here the cases of urethral h?morrhage and thrombosis of the penis, recorded as due to arterial disease, appear to be unique.     

The use of Doppler ultrasound of the renal arteries for the diagnosis of vasorenal hypertension at the outpatient stage]

Ultrasonic dopplerography of the renal arteries was used to improve the differential diagnosis of arterial hypertension before hospitalization. Dopplerograms of the renal arteries of normal subjects were characterized by almost symmetrical parameters of the blood stream. In patients with vasorenal hypertension a marked asymmetry of the blood stream was seen with its reduction and qualitative changes in the dopplerogram on the side of the stenosed renal artery, that was confirmed by angiographic findings. Chronic pyelonephritis was dopplerographically characterized by hemodynamically insignificant asymmetry of the blood stream in the renal arteries with its reduction on the side of the involved kidney. In essential hypertension the type of asymmetry of blood stream parameters in the renal artery seemed similar to that in normal subjects.     

Ultrasonographic study of blood flow in the renal arteries of patients with arterial hypertension

Vascular duplex ultrasound duplex with simultaneous ECG registration was made to estimate the quantitative and time parameters of blood flow in the renal arteries with grade 1-2 arterial hypertension. There were increases in vascular resistance indices and acceleration phase index and a reduction in systolic phase index. There were correlations of the time parameters of blood flow in the renal arteries with age and lipidogram values.     

Pattern of arteries in the hindlimbs of hybrid mice

The pattern of the arterial system has been studied in the hindlimbs of adult male and female mice in a hybrid strain. A technique was developed to inspect the distribution pattern after the vessels were injected with a blue polymer, the bone was stained with alizarin red S, and the soft tissue was cleared to transparency. Substantial variations were identified in the point of origin of 6 of 41 arterial branches; extra vessels and absence of vessels were uncommon. The types of arterial differences identified in normal adult mice were different from those identified in mice with absence of the tibia, which have absence of major arteries, including the popliteal and posterior tibial arteries.     

Cryogenic effect on the coronary arteries in animal experiments

The present study was designed to examine both acute and chronic effects of cryothermia on the coronary arteries in the experimental model. Microscopic examination has revealed coronary intimal hyperplasia in the majority of coronary arteries at the site of cryogenic lesion. In some cases cryothermia was complicated by arterial thrombosis.     

Elaeophorosis in white-tailed deer: pathology of the natural disease and its relation to oral food impactions

The lesions of naturally occurring elaeophorosis in white-tailed deer (Odocoileus virginianus) were studied. Arterial changes caused by adult Elaeophora schneideri occurred mainly in cephalic arteries and were characterized by circumferential intimal thickening, disruption of the internal elastic lamina, and verminous thrombosis. Microfilariae caused focal necrosis and fibrosis in the myocardium, but produced only minor changes in other tissues. Radiographic studies indicated that E. schneideri can cause impairment of the cephalic arterial circulation in white-tailed deer. Eleven of 14 (78%) infected deer had oral food impactions, with sublingual impactions being most common. Seven deer with impactions had other oral pathologic conditions, such as gingivitis, loose or absent premolar and/or molar teeth, and remodeling and/or lysis of mandibular bone. The evidence indicates a relation between food impactions and infection by E. schneideri in white-tailed deer, but no definitive connection was established.     

Brain and Spinal Cord Lesions in Encephalitozoonosis in Mink

Central nervous system lesions were studied by light microscopy in 43 farmed mink, aged 5 months to 2 1/2 years, with spontaneous encephalitozoonosis and showing cataractous eye changes. Lesions were found in the brain and spinal cord of all animals examined but were generally mild and chronic. The lesions were consistent with those previously described in spontaneous encephalitozoonosis in other carnivores. Parasites in parasitophorous vacuoles and free or phagocytosed in necrotic and granulomatous lesions were demonstrated in animals aged 5 months to 1 year. The occurrence of arterial lesions of the polyarteritis nodosa type found in the youngest animals probably indicates fetal infection. In animals aged 1 1/2 and 2 1/2 years active lesions were usually lacking and the changes were characterized by arterial sclerosis, sometimes with aneurysmal formations, small perivascular lympho-plasmacytic cuffings and focal gliosis.     

超声对早期糖尿病肾病的诊断价值及肾动脉血流阻力指数与血清hs-CRP、VEGF的关系分析

目的:研究彩色多普勒超声对早期糖尿病肾病的诊断价值及肾动脉血流阻力指数与血清超敏C反应蛋白(hs-CRP)、血管内皮生长因子(VEGF)的关系。方法:选取从2017年2月～2018年2月兰州大学第二医院收治的早期糖尿病肾病患者50例记为病变组,另取同期于该院进行体检的健康人员50例记为对照组。分别对两组人员进行彩色多普勒超声检查,比较肾血流参数。采用酶联免疫吸附法检测两组人员血清hs-CRP、VEGF水平,并作指标间的相关性分析。结果:病变组肾主动脉、肾锥体两侧叶间动脉、肾段动脉的收缩期峰值速度、舒张期最低速度较对照组降低,病变组肾主动脉、肾锥体两侧叶间动脉、肾段动脉的阻力指数较对照组升高(均P0.05)。病变组血清hs-CRP、VEGF水平较对照组升高(均P0.05)。经Pearson相关性分析显示:早期糖尿病肾病患者肾主动脉、肾锥体两侧叶间动脉、肾段动脉的血流阻力指数与血清hs-CRP、VEGF均呈正相关关系(均P0.05)。结论:彩色多普勒超声应用于早期糖尿病肾病的诊断价值较高,且肾动脉血流阻力指数与血清hs-CRP、VEGF密切相关,临床工作中通过联合检测血清hs-CRP、VEGF,从而有助于早期糖尿病肾病的诊断。     

The legacy of Capt. Gino Pieri: a forgotten Italian contribution to the study of cutaneous blood supply during World War I

Among the many scientists who studied the cutaneous blood supply, Gino Pieri, an Italian Army surgeon operating during World War I, deserves attention. During those times, amputations were frequent, and flaps used to cover stumps were often inadequately designed and became necrotic, because of poor knowledge of the skin's blood supply. Pieri solved the problem after drawing a perforator map of human body skin, injecting the main arteries with methylene blue dye. His flaps were mainly designed along the course of what Ian Taylor would call "source" arteries, to capture the greatest perforators.     

Ultrasound studies in varicocele

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.     

The Cutting Balloon--a new technology?

The Cutting Balloon consists of a standard balloon dilatation catheter with four microtome-sharp blades that incise the plaque and minimize arterial wall trauma. It was used in 31 patients; nine had calcified arteries, ten had non-compliant lesions, three had in-stent restenosis and nine had aorto-ostial lesions. Seventeen lesions were predilated, 28 were post-dilated and 18 required stent implantation. The procedure was very effective in aorto-ostial lesions, non-compliant lesions that were not responsive to high-pressure balloon dilatation, and was partially successful in calcified arteries. It has a very specific niche in selected lesions.     

Renal angiography and age in various cardiovascular diseases (morphometric analysis)

Two hundred and fifty-eight angiograms have been analysed, 78 of them are from persons without any renal and cardio-vascular pathology, 184--from patients with vasorenal hypertension. Total area of transversal sections of the arteries is stated (characterizing the arterial bed capacity of the kidney) and its relation to the transversal section area of the renal projection (arterio-renal index). These parameters decrease with age, and are especially noticeable when vasorenal hypertension is present. Stenosis of renal arteries (up to 30%) of various etiology do not practically change the capacity of the renal arterial bed, and when the degree of stenosis increases up to 80%, an essential decrease both in the arterial bed capacity and in the arterio-renal index takes place.