Marked arteriosclerosis of the descending aorta in a teenager with interruption of the aorta

Marked arteriosclerosis localized to the descending thoracic and abdominal aorta was observed in a 19-year-old girl with interruption of the aorta (type A) and a ventricular septal defect. She died from rupture of saccular aneurysm of the pulmonary trunk. The descending thoracic and abdominal aorta showed marked thrombogenic, lamellar thickening of the intima. In contrast, no significant arteriosclerosis was detected in the ascending aorta. Several factors including diffuse sludging of blood, mural thrombosis and hemodynamic changes, in close association with polycythemia, are hypothesized to be causative factors in the development of this lesion.

Granule-laden perivascular cells observed in rabbits with experimental cerebral atherosclerosis

Granule-laden perivascular cells distributed around the fine vessels in brain of hypertensive rabbits fed a cholesterol diet were examined by electron microscopy. Perivenule granule-laden cells contained secondary lysosomes, residual bodies, Golgi vesicles, fusion vesicles, and vacuoles. In periarteriole granule-laden cells, secondary lysosomes and vacuoles were not prominent. Findings indicated that the granule-laden cell may be a histiocyte that appears during the vascular reaction to hypertension and hypercholesterolemia. This vascular reaction may occur more strongly in the veins than the arteries.

Emerin deficiency at the nuclear membrane in patients with Emery-Dreifuss muscular dystrophy

Mutations in the STA gene at the Xq28 locus have been found in patients with X-linked Emery-Dreifuss muscular dystrophy (EDMD). This gene encodes a hitherto unknown protein named 'emerin'. To elucidate the subcellular localization of emerin, we raised two antisera against synthetic peptide fragments predicted from emerin cDNA. Using both antisera, we found positive nuclear membrane staining in skeletal, cardiac and smooth muscles in the normal controls and in patients with neuromuscular diseases other than EDMD. In contrast, a deficiency in immunofluorescent staining of skeletal and cardiac muscle from EDMD patients was observed. A 34 kD protein is immunoreactive with the antisera--the protein is equivalent to that predicted for emerin. Together, our findings suggest the specific deficiency of emerin in the nuclear membrane of muscle cells in patients with EDMD.

[Clinicopathological analysis of rheumatic heart disease]

Autopsy cases of rheumatic heart disease which took natural courses without surgery were clinicopathologically analyzed. The patients had pancarditis (2 patients), mitral stenosis (MS; 12), mitral regurgitation (MR; 8), aortic stenosis and regurgitation (ASR; 5) and combined valvular disease (CVD; 30). The patients with pancarditis (mean age 15 years) showed high rheumatic activity, short clinical course, enlargement of the heart, edematous swelling and inflammation of the valves, myocardium and pericardium with multiple Aschoff nodules. Patients with MS (mean age 42 years) showed low rheumatic activity, enlarged left atrium and right ventricle, thickening and calcification of the valve edge which was categorized into oval shape and slit shape ostial narrowing, and fibromuscular thickening of the small coronary artery wall. Patients with MR (mean age 32 years) showed moderate rheumatic activity, enlarged left ventricle, left atrium and right ventricle, diffuse thickening of the valve, contraction of the posterior leaflet and healing Aschoff nodules. Patients with ASR (mean age 36 years) showed moderate rheumatic activity, elongated enlargement of the left ventricle, adhesion of the commissures, thickening with contraction and calcification of the cusps, hypertrophy and fibrosis of the myocardium. Patients with CVD were divided into the left-sided double stenosis group (CVD-S; 16 patients) and double regurgitation or triple valve disease group (CVD-R; 14). The CVD-S group (mean age 51 years) showed low rheumatic activity, female predominance and similar morphology to MS. The CVD-R group (mean age 32 years) showed moderate rheumatic activity, relatively short clinical course, male predominance and similar pathology to pancarditis and/or MR. The valvular pathology in rheumatic fever was modified by connective tissue matrix of the valves, especially of acid-mucopolysaccharides.

[Surgical pathology of infective endocarditis]

Underlying pathologic disorders of infected valves were analyzed in 36 consecutive patients with infective endocarditis (from April 1987 to May 1995) of 18 aortic, 11 mitral and 8 prosthetic valves. Among 29 cases of native valve endocarditis, 27 had known organic changes [aortic valve prolapse 8, bicuspid aortic valve 4, annuloaortic ectasia 1, mitral valve prolapse 9 (including 2 cases associated with hypertrophic cardiomyopathy), looping chordae 1, rheumatic heart disease 4]. However, the remaining two cases had unknown etiology. Histological examination of these two aortic valves revealed proliferation of small vessels and remnants of vascular smooth muscle cells, suggesting postinflammatory valve prolapse. Five cases with definite pathology had no clinical signs of infection. The preponderance of surgically resected valves with infective endocarditis in Japan is non-rheumatic in origin.

Multicore myopathy associated with multiple pterygium syndrome and hypertrophic cardiomyopathy

A boy with multicore myopathy associated with multiple pterygium syndrome and hypertrophic cardiomyopathy is described. Light microscopy of biopsy samples from the skeletal muscle and myocardium revealed multiple cores in the muscle fibers in the former but their absence in the latter. These results suggest that the pathogenesis of the histologic changes might differ between skeletal muscle and myocardium, and that further electron microscopic examination be done on both types of specimen. The prognosis of multicore myopathy is not usually good when cardiac involvement is present.

[Late coronary artery aneurysm formation following directional coronary atherectomy]

The most important factor to reduce late restenosis following directional coronary atherectomy is the technical provision of the largest luminal diameter as possible. However, the safety of deep arterial resection and the resulting arterial perforation or late aneurysm formation is questionable. This study examined the frequency of coronary artery aneurysm formation in patients treated by directional coronary atherectomy. Ninety-eight patients with 123 lesions were analyzed by quantitative angiographic and histologic data. Coronary aneurysms (ratio of dilated vessel segment to the adjacent reference segment > 1.2:1) occurred in seven patients (seven lesions: 5.7%). Specimens were categorized by the deepest layer retrieved. Forty lesions (32.5%) were treated by resection of the intima alone, 65 (52.8%) by resection of the medial tissues and 18 (14.6%) received resections of the adventitial tissues including fatty tissues in three lesions. Late coronary aneurysms occurred often in lesions with resection of adventitial tissue (38.9%) and occurred in all three lesions with resections of fatty tissues. Six coronary aneurysms occurred in the left anterior descending artery (six in segs. 6, 7), and one aneurysm in the left circumflex artery. Among the target lesions in which coronary artery aneurysms were formed, six lesions were primary lesions and one lesion was a restenotic lesion after percutaneous transluminal coronary angioplasty. Statistically, patients with coronary artery aneurysms frequently have associated hypertension (p = 0.02) but rarely diabetes mellitus (p = 0.05). Lesions with late aneurysms had significantly high specimen weight (p = 0.01) and a trend to lower postprocedure % diameter (p = 0.20). There was no significant preprocedural angiographic predictor of aneurysms such as minimal lumen diameter or reference vessel diameter.

Morphological study of vagal innervation in human semilunar valves using a histochemical method

To determine the innervation of human semilunar valves, we examined the pulmonary and aortic valves of the normal autopsied hearts of 3 men (53 to 71 years old). Whole valve tissues with the aorta or pulmonary trunk were stained for acetylcholinesterase by a histochemical method. Acetylcholinesterase-positive nerve fibers with a diameter of 2 to 20 mm were located on the ventricular side of the semilunar valves. Innervation of the semilunar valves was extremely sparse compared with that of the atrioventricular valves and that of the aortic or pulmonary arterial wall. The nerves originated from the subendocardium of the ventricles and the adventitia of the arterial walls. The nerves were more distributed in the basal site than in the marginal site of the semilunar valve. The nerve fibers formed a network in basal two-thirds of the leaflet. Thick nerves ramified in the thin nerve plexus. The thick nerves had a varicose-like structure. Thin nerves had a dot- and brush-like ending. The nerves in human semilunar valves may play a role in valve motion.

Local treatment with antithrombotic drugs can prevent thrombus formation: an angioscopic and angiographic study

OBJECTIVES

This study was designed to evaluate the efficacy of local versus systemic treatment of thrombosis with various antithrombotic drugs.

BACKGROUND

Local use of low dose antithrombotic drugs has been proposed as being effective and safe.

METHODS

Heparin (30 U/kg), an antithrombin agent (argatroban, 0.05 mg/kg body weight) or a defibrinogenating drug (batroxobin, 0.05 U/kg) was locally infused into one side of the canine iliac artery after injury by balloon inflation. The other side was injured as a control. The efficacy of systemic delivery of high dose (heparin [300 U/kg] and argatroban [0.5 mg/kg]) and low dose drugs was also assessed.

RESULTS

Sixty minutes after local treatment in 22 dogs, no thrombotic stenosis was observed by angiography in locally treated arteries (p < 0.005 vs. mean thrombotic stenosis of 27% in control segments for heparin, 25.3% in control segments for argatroban and 32% in control segments for batroxobin). Angioscopy demonstrated the same trend. In locally treated arteries, thrombus weight was significantly lower in the treated than control side. In the systemic high dose group (n = 10), angiographic thrombotic stenosis was < 5% after high dose drug delivery (p < 0.05 vs. control segments, 37.4% for heparin, 43% for argatroban). In another 10 dogs, low dose systemic delivery was not effective in inhibiting thrombus formation. Activated partial thromboplastin time and fibrinogen levels did not change with local treatment.

CONCLUSIONS

Compared with systemic administration of antithrombotic drugs, local treatment is a safer and more effective method of preventing thrombosis.

[Immunohistochemical study of the endomyocardial biopsy of systemic lupus erythematosus]

The mechanisms of cardiac involvement in systemic lupus erythematosus (SLE) were studied using immunohistochemical staining of endomyocardial biopsy specimens from 14 patients with SLE and normal coronary arteriograms. All 14 specimens showed mild interstitial edema, 11 showed mild cardiac fibrosis, and another two cases showed moderate cardiac fibrosis with myocardial derangements. Four specimens showed moderate cell infiltration in the interstitium. Area of fibrosis, diameter of myocardium and area of interstitial edema were increased in the SLE patients compared to the control cases. Immunofluorescence showed IgG and fibrinogen deposition in the membrane of cardiac myocytes and in the interstitium. Immunohistochemistry found no B lymphocytes in any of the seven SLE cases. T lymphocytes were observed in all seven SLE cases, and OKT 8 lymphocytes were increased significantly in the interstitial tissue as compared with OKT 4 lymphocytes. At endomyocardial biopsy, all 14 patients were receiving corticosteroid therapy and had low activity disease. The results suggest that cardiac tissue damage was associated with immunological abnormalities and might progress silently under conditions in which the disease activity was suppressed by corticosteroid therapy.