Hereditary angio-oedema: its pathogenesis and management

Hereditary angio-oedema is a genetically-determined disease. Usually the disease is due to a deficiency of C1-inhibitor or less commonly to the production of a functionally inactive molecule. The pathogenesis and clinical features of the disease are reviewed, and discussed in relation to the homeostatic role of C1 inhibitor. Finally the therapeutic approach to the disease is described and the scientific bases for the newer therapeutic discussed.

[Cerebral manifestations in angioneurotic edema (author's transl)]

Two patients with hereditary angioneurotic edema are described. A female patient, born in 1929, showed an infarction in the area of the right posterior cerebral artery, verified by computer tomography. The son of this patient, aged 20 years, suffered from a transitory ischemic attack and a prolonged reversible ischemic neurological deficit, both in the territory of the left middle cerebral artery. Etiology, symptomatology, therapy, and differential diagnosis of cerebral manifestations in angioneurotic edema are discussed in view of previously described cases.

Diagnostic and therapeutic problems associated with hereditary deficiency of the C1 esterase inhibitor

Six patients in a family with a history of hereditary angioedema reported swelling of the extremities and recurrent abdominal pain occurring spontaneously or after trauma. Attacks of oedema involving the airways, the greatest danger with this disorder, were present only in one case. This autosomal dominant disease is due to deficient activity of the inhibitor of the first component of complement. Low levels of C4, and absence of C1 esterase inhibitor confirm the diagnosis. Two asymptomatic cases with the appropriate biochemical abnormality are reported in this study. For short term prophylaxis of attacks (before surgery expecially), fresh frozen plasma is used, or better still, C1 esterase inhibitor. For long term prophylaxis of attacks antifibrinolytic and hormonal drugs are used: in two cases, the authors obtained good results with methyltestosterone after failure of tranexamic acid.

Hereditary angioneurotic oedema: an unusual cause of recurring abdominal pain

Two patients with hereditary angioneurotic oedema, a condition characterized by repeated episodes of abdominal pain and oedema, and by an absence of complement-1 esterase inhibitor activity in the plasma are presented in detail. Both underwent multiple surgical procedures before the diagnosis was established. Abdominal pain is often the presenting complaint, and although a complete history will usually lead to the proper diagnosis, cases in which the family history is not clear can present a diagnostic dilemma. Characteristic radiological demonstration of localized intestinal oedema will only be obtained if studies are performed early during the acute attack.