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Kejiou H, Rizziki A, Ouhmich M, Benzirare A, Mahi OE. [Case report : Rare case of a spontaneous pseudoaneurysm of the superficial femoral artery revealing Behçet's disease in a young patient]. Ann Cardiol Angeiol (Paris) 2024; 73:101707. [PMID: 38262254 DOI: 10.1016/j.ancard.2023.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 01/25/2024]
Abstract
Behçet's disease is a chronic inflammatory vascular disorder that can affect arteries and veins of various sizes. Arterial involvement, which plays a significant prognostic role, requires a treatment approach involving corticosteroids, immunosuppressants, and potentially surgical or endovascular procedures. This article presents the case of a young man diagnosed with Behçet's disease, manifested by a spontaneous pseudoaneurysm in the superficial femoral artery. The patient underwent surgical intervention to remove the pseudoaneurysm and restore circulation using a venous graft. This case underscores the importance of considering Behçet's disease in vascular manifestations.
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Affiliation(s)
- Houssam Kejiou
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc.
| | - Abdellah Rizziki
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Mohamed Ouhmich
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Adnane Benzirare
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
| | - Omar El Mahi
- Département de Chirurgie Vasculaire, Centre Hospitalier Universitaire Mohamed 6 d'Oujda au Maroc Faculté de Médecine, Université Mohamed 5, Oujda, Maroc
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Mezzetti E, Costantino A, Leoni M, Pieretti R, Di Paolo M, Frati P, Maiese A, Fineschi V. Autoimmune Heart Disease: A Comprehensive Summary for Forensic Practice. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1364. [PMID: 37629654 PMCID: PMC10456745 DOI: 10.3390/medicina59081364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
Autoimmune heart disease is a non-random condition characterised by immune system-mediated aggression against cardiac tissue. Cardiac changes often exhibit nonspecific features and, if unrecognised, can result in fatal outcomes even among seemingly healthy young individuals. In the absence of reliable medical history, the primary challenge lies in differentiating between the various cardiopathies. Numerous immunohistochemical and genetic studies have endeavoured to characterise distinct types of cardiopathies, facilitating their differentiation during autopsy examinations. However, the presence of a standardised protocol that forensic pathologists can employ to guide their investigations would be beneficial. Hence, this summary aims to present the spectrum of autoimmune cardiopathies, including emerging insights such as SARS-CoV-2-induced cardiopathies, and proposes the utilisation of practical tools, such as blood markers, to aid forensic pathologists in their routine practice.
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Affiliation(s)
- Eleonora Mezzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Andrea Costantino
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Matteo Leoni
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Rebecca Pieretti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Marco Di Paolo
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (P.F.); (V.F.)
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy; (E.M.); (A.C.); (M.L.); (R.P.); (M.D.P.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (P.F.); (V.F.)
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Ismail MA, Mounir O, Sedky A, Algahlan HA, Abda EA, Radwan AR, Abozaid HS. Exists a role for serum irisin in Egyptian Behcet's patients with subclinical atherosclerosis? Clin Rheumatol 2023; 42:179-186. [PMID: 36112245 PMCID: PMC9823020 DOI: 10.1007/s10067-022-06368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To examine the serum irisin level in a group of Behcet's disease patients, its association with illness parameters, and its utility in diagnosing subclinical atherosclerosis. METHODS This randomized case-control study included 50 patients and 50 age- and sex-matched controls. Carotid Doppler ultrasound for the measurement of the carotid artery intima-media thickness (CIMT) and ankle-brachial pressure index (ABPI) were performed. A clinical evaluation, lipogram, and serum irisin were also performed. RESULTS Between the patients and the control group, there was a significant difference in CIMT, S. irisin level, and ankle-brachial pressure index; however, gender and BMI did not significantly affect CIMT, ABPI, or S. irisin level. CIMT demonstrated a substantial negative correlation with both S. irisin and ABPI (r = - 0.62, P 0.0001). With a sensitivity of up to 94.30% and a specificity of 93.30%, the ROC analysis revealed that a decrease in S. irisin level in Behcet's patients was indicative of subclinical atherosclerosis. The drop in the ABPI level demonstrated a sensitivity of up to 94.30% and a specificity of 100%. CONCLUSION Subclinical atherosclerosis is prevalent among Egyptian Behcet's patients, and S. irisin can be employed as a biomarker for diagnosing subclinical atherosclerosis in Behcet's illness. Key Points • Serum irisin has been studied in numerous autoimmune disorders as a marker for subclinical atherosclerosis, although its importance in Behcet's disease remains unclear (BD). • We examined the change in serum irisin levels in Behcet's disease patients and healthy controls. In addition, its association with carotid artery intima-media thickness (CIMT) and ankle-brachial pressure index was investigated (ABPI). • Changes in serum irisin levels are significant in BD, and a decrease in irisin level indicates subclinical atherosclerosis.
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Affiliation(s)
- Mohamed A Ismail
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Ola Mounir
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Ahmed Sedky
- Department of Clinical Pathology, Sohag University, Sohag, Egypt
| | | | - Esam A Abda
- Department of Rheumatology and Rehabilitation, Assuit University, Asyut, Egypt
| | - Ahmed R Radwan
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt
| | - Hanan Sayed Abozaid
- Department of Rheumatology and Rehabilitation, Sohag University Hospital, 82524, Sohag, Egypt.
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Ghembaza A, Boussouar S, Saadoun D. [Thoracic manifestations of Behcet's disease]. Rev Mal Respir 2022; 39:523-533. [PMID: 35659162 DOI: 10.1016/j.rmr.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).
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Affiliation(s)
- A Ghembaza
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France
| | - S Boussouar
- Cardiovascular and Thoracic Imaging Unit, hôpital Pitié Salpêtrière, AP-HP, Paris, France; Inserm, laboratoire d'imagerie biomédicale, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - D Saadoun
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France.
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An Abdominal Aortic Pseudoaneurysm Revealing Behçet’s Disease. Case Rep Vasc Med 2022; 2022:8286579. [PMID: 35127194 PMCID: PMC8813256 DOI: 10.1155/2022/8286579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
Behçet's disease (BD) is a vasculitis with multisystemic manifestations. Articular involvement is frequent and benign whereas vascular complications are rare but serious and can form the onset of the disease. The assessment of the thickness of the common femoral vein wall is a new tool for the diagnosis of BD with good sensitivity and specificity. We report the case of a 52-year-old man diagnosed with BD revealed by an abdominal aortic pseudoaneurysm and a chronic monoarthritis. The first flare-up of BD can occur in men over 50 years of age. In a context of a multisystemic disease, lumbar pain should lead to the search of abdominal aortic aneurysm. The assessment of the thickness of the common femoral vein wall is accessible and should be used especially in challenging cases.
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Ruptured abdominal aortic aneurysm reveals Behçet's disease. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Ahmed AA, Tharwat S, Batouty NM, El Bahy A, Tawfik AM, Shahin DA. Cardiac magnetic resonance imaging in patients with Behçet's disease. Adv Rheumatol 2021; 61:74. [PMID: 34876236 DOI: 10.1186/s42358-021-00230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behçet's disease (BD) is a multisystemic vasculitis that may affect the heart. However, the incidence and nature of cardiac involvement in BD have not been clearly documented yet. The aim of this study was to delineate the cardiac magnetic resonance imaging (MRI) appearances of cardiac involvement in BD patients. METHODS This cross-sectional observational study was carried out 30 BD patients without known cardiac disease. Patients were subjected to history taking, physical examination, echocardiography and cardiac MRI. RESULTS At least one abnormality on cardiac MRI was observed in 20/30 patients (66.67%). Myocardial oedema was observed in 3 patients (10%) and late gadolinium enhancement in 1 patient (3.3%). Pericardial effusion was found in 3 patients (10.0%), global hypokinesia in 6 patients (20.0%) and intra-cardiac thrombosis in only 1 patient (3.3%). Pulmonary artery was dilated in 4 patients (13.3%). Left ventricular (LV) and right ventricular (RV) end diastolic volume were altered in 4 patients (13.3%) and 7 patients (23.3%) respectively. LV and RV end systolic volume were abnormal in 7 patients (23.3%) and 5 patients (16.7%) respectively. There was aortic valve regurge in 2 patients (6.7%), tricuspid valve regurge in 9 patients (30%), and mitral valve regurge in 9 patients (30%). Dilated left main coronary artery was found in 2 patients (6.7%) and arrhythmogenic right ventricular dysplasia in only one patient 1 patient (3.3%). On logistic regression analysis, BD activity index score was a significant predictor of cardiac abnormalities. CONCLUSION BD may cause cardiac abnormalities without clinical manifestations and cardiac MRI may represent a tool for early detection of these subtle abnormalities. Higher BD activity index scores are strongly linked to cardiac problems.
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Affiliation(s)
- Ali A Ahmed
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt.
| | - Nihal M Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed El Bahy
- Mansoura University Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Ahmed M Tawfik
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
| | - Dina A Shahin
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University Hospital, Mansoura University, El Gomhouria St, Mansoura, Dakahlia Governorate, Egypt
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8
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Demirbaş A, Elmas ÖF, Demirbaş GU, Atasoy M, Türsen Ü, Lotti T. Potential Utility of Oral Mucosal Capillaroscopy as an Indicator of Microvascular Damage in Behçet Disease: A Preliminary Study. Dermatol Pract Concept 2021; 11:e2021116. [PMID: 34631265 DOI: 10.5826/dpc.1104a116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Behçet disease (BD) is an auto-inflammatory condition characterized by multisystemic vasculitis. Oral mucosal capillaroscopy is an easy-to-use, repeatable, non-invasive method for evaluating mucosal microvasculature, contributing to the differential diagnosis and prognosis of various acute and chronic inflammatory diseases. Objectives This study aims to characterize and describe the oral labial mucosal capillary findings in patients with BD using handheld dermatoscopy and to investigate the relationship between the capillary findings and the severity of the disease. Methods This cross-sectional study included patients with BD and healthy subjects. Capillaroscopic examination of the oral labial mucosa in each subject was performed by a handheld dermatoscope using polarized light. The clinical severity of BD was evaluated using Krause's Clinical Severity Scoring for BD. Results Sixty patients with BD and 60 healthy subjects were enrolled in the study. The frequencies of irregular capillaries, microhemorrhages, glomerular vessels, megacapillaries, and tortuous vessels were statistically significantly higher in the patient group when compared to the healthy individuals. In addition, a correlation was detected between the oral mucosal capillaroscopic findings and disease duration, severity, and vascular complications. Conclusions Our study is the first to explore the potential role of oral mucosal capillaroscopic examination in patients with BD. Data obtained from this study indicated that oral mucosal capillaroscopy may be a useful tool to demonstrate microvascular damage in patients with BD.
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Affiliation(s)
| | - Ömer Faruk Elmas
- Department of Dermatology, Kırıkkale University Kırıkkale, Turkey
| | - Gözde Ulutaş Demirbaş
- Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Mustafa Atasoy
- Health Science University, Kayseri City Hospital, Department of Dermatology, Kayseri, Turkey
| | - Ümit Türsen
- Mersin University, Department of Dermatology, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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Daoud F, Rachdi I, Somai M, Zaouak A, Hammami H, Ouederni M, Maamouri R, Zoubeidi H, Tougorti M, Ksouri J, Dhaou BB, Aydi Z, Fenniche S, Cheour M, Boussema F. Epidemiological, clinical, and therapeutic characteristics of Behçet's disease: a monocentric study in Tunisia. Pan Afr Med J 2021; 40:13. [PMID: 34733381 PMCID: PMC8531968 DOI: 10.11604/pamj.2021.40.13.19146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/23/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION to describe the epidemiological, clinical, therapeutic and evolving characteristics of Behçet´s disease and identify prognostic factors. METHODS we have realized a retrospective, single-center study, conducted over a period of 26 years and including 130 patients presenting Behçet´s disease and hospitalized in an Internal Medicine Department. RESULTS the mean age of the Behçet´s disease at onset was 30.3 ±8.8 years and that at diagnosis was 34.6 ±9.4 years. The sex ratio (male/female) was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months. Conclusion: improving the prognosis of Behçet´s disease requires a shortening of the time to diagnosis, multidisciplinary collaboration, intensive treatment of functional threats, regular monitoring, and patient adherence.
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Affiliation(s)
- Fatma Daoud
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Imène Rachdi
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mehdi Somai
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Anissa Zaouak
- Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Meriem Ouederni
- Ophthalmology Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rym Maamouri
- Ophthalmology Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Hana Zoubeidi
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Molka Tougorti
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Jihène Ksouri
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Besma Ben Dhaou
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Zohra Aydi
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Monia Cheour
- Ophthalmology Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Fatma Boussema
- Internal Medicine Department, Habib Thameur Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Sunbul M, Midi IG, Agackiran SK, Engin E, Ucem S, Alibaz-Oner F, Sayar N, Direskeneli H, Sadıc BO. Myocardial involvement in Behçet's disease may be higher in patients with Neuro-Behçet's disease: a speckle tracking echocardiographic study. Acta Cardiol 2021; 77:515-523. [PMID: 34392811 DOI: 10.1080/00015385.2021.1965354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Behcet's disease (BD) may present with life threating complications including neurological and cardiovascular involvement. Neuro-Behcet's disease (NBD) is one of the most important causes of morbidity and mortality in patients with BD. The aim of the present study is to investigate whether patients with NBD are different than BD patients with other manifestations in terms of subclinical myocardial dysfunction. METHODS Forty patients with NBD (23 female, mean age: 42.4 ± 9.4 years), 40 patients with BD (9 female, mean age: 39.7 ± 9.0 years) and 40 controls (20 male, mean age: 41.8 ± 6.5 years) were consecutively included in the study. All subjects underwent a transthoracic echocardiography for evaluation of left ventricular (LV) and atrial (LA) functions with two-dimensional (2D) speckle tracking echocardiography (STE). RESULTS Baseline characteristics, clinical data, LV dimensions, systolic and diastolic functions were all in normal range among the groups. LV global longitudinal strain (LV-GLS) was significantly lower in patients with NBD and BD patients without neurologic involvement compared to controls. LA conduit strain was significantly lower in patients with NBD compared to controls. Patients with both parenchymal NBD and vascular NBD manifestations had significantly lower LV-GLS and LA conduit strain compared to controls. Linear regression analysis demonstrated that among cardiovascular risk factors only presence of NBD was the independent predictor of LV-GLS. CONCLUSIONS BD is associated with impaired LV and LA functions. LV-GLS and LA conduit strains of the patients with NBD were lower. NBD was an independent predictor of LV-GLS, suggesting a link between neurological manifestations and cardiac dysfunction in BD patients.
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Affiliation(s)
- Murat Sunbul
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ipek Gursoy Midi
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Seda Kutlug Agackiran
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Esin Engin
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Selen Ucem
- Marmara University School of Medicine, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beste Ozben Sadıc
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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Elgengehy FT, Gamal SM, Sobhy N, Siam I, Soliman AM, Elhady GW, Gheita TA. Vasculitis damage index in Behçet's disease. Adv Rheumatol 2021; 61:33. [PMID: 34108037 DOI: 10.1186/s42358-021-00193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasculitis damage index (VDI) is a validated damage index for systemic vasculitis, and as Behçet's disease is considered one of systemic vascular disease we aimed to study the relationship of the vasculitis damage index to clinical manifestations and comorbidity in patients with Behçet's disease (BD) to determine if VDI could be used to assess damage in patients with BD. METHODS A total of 109 patients with BD were recruited from the Rheumatology Department (outpatient and inpatient clinic), Cairo University Hospitals. All patients were subjected to full history taking, clinical examination, and routine laboratory investigations. Disease activity was assessed by the BD current activity form, and the VDI was calculated in all patients. The relationship of the VDI to the disease clinical manifestations was studied. Mann-Whitney and Kruskal Wallis tests were used to estimate differences in quantitative variables. Spearman correlation test was used to test for correlation between quantitative variables. RESULTS In the current study, the VDI ranged from 1 to 10, with a mean of 3.5 ± 1.8. It was significantly associated with total thrombosis (P = 0.022); total neurological manifestations (P = 0.000), especially stroke and cranial nerve affection; uveitis (P = 0.005); avascular necrosis (AVN) (P = 0.015); osteoporosis (P = 0.01); impaired vision (P < 0.0001); cataract (P < 0.0001); and diabetes (P = 0.012). Generally, immunosuppressive treatment was significantly associated with VDI (P = 0.039), especially cyclophosphamide (P < 0.0001), biological agent (P = 0.008), chlorambucil (P = 0.003), and anticoagulant (P = 0.02). VDI was also significantly correlated with age (P = 0.033), disease duration (P = 0.029), and duration of eye involvement (P = 0.003). CONCLUSION VDI is significantly associated with most disease parameters of BD, except for parameters such as mucocutaneous manifestations and uncomplicated venous thrombosis; however, further studies may be needed to establish BD-specific damage index.
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Affiliation(s)
- Fatema T Elgengehy
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt.
| | - Sherif M Gamal
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
| | - Nesreen Sobhy
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
| | - Ibrahem Siam
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Ahmed M Soliman
- Dermatology and venereology Department, National Research Center, Cairo, Egypt
| | - Ghada W Elhady
- Public Health Department, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
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Xie WX, Jiang HT, Shi GQ, Yang LN, Wang H. Behcet’s disease manifesting as esophageal variceal bleeding: A case report. World J Clin Cases 2021; 9:2854-2861. [PMID: 33969069 PMCID: PMC8058672 DOI: 10.12998/wjcc.v9.i12.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Behcet’s disease (BD) is a chronic disease characterized by oral and vulvar ulcers as well as eye and skin damage and involves multiple systems. It presents as an alternating process of repeated attacks and remissions. Esophageal venous rupture and bleeding caused by BD is rarely reported at home and abroad. This paper reports a case of bleeding from oesophageal varices caused by BD, aiming to provide an additional dimension for considering the cause of bleeding from esophageal varices in the future.
CASE SUMMARY A 38-year-old female patient was admitted due to a gradual increase in shortness of breath and chest tightness after the activity, and was admitted to our hospital for treatment. After admission, relevant examinations showed that the patient had multiple blood clots. Four days after admission, she suddenly experienced massive hematemesis. Emergency esophagogastroduodenoscopy revealed bleeding from esophageal and gastric varices. The patient had no history of viral hepatitis or drinking habits, and no history of special genetic diseases or congenital vascular diseases. There is no obvious abnormality in liver function. After reviewing the medical history, it was found that the patient had recurred oral ulcers since childhood, ulcers were visible in the perineum during menstruation, and there was an intermittent red nodular rash and uveitis. The current skin acupuncture reaction is positive, combined with the evaluation of the external hospital and our hospital, the main diagnosis is BD. She received methylprednisolone, cyclophosphamide, immunomodulation, acid suppression, gastric protection, and anticoagulation and anti-infection treatments, and was discharged from the hospital. During the 1-year follow-up period, the patient did not vomit blood again.
CONCLUSION This case highlights bleeding from esophageal varices caused by BD, aiming to provide an additional dimension concerning the cause of bleeding from esophageal varices in the future.
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Affiliation(s)
- Wen-Xing Xie
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hai-Tao Jiang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Guo-Qing Shi
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Li-Na Yang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hong Wang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Hammami AS, Jellazi M, Arfa S, Daada S, Ben Hamda K, Achour A, Ouali S. Getting to the <em>heart</em> of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series. Reumatismo 2021; 73:32-43. [PMID: 33874645 DOI: 10.4081/reumatismo.2021.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.
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Affiliation(s)
- A S Hammami
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
| | - M Jellazi
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Arfa
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Daada
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - K Ben Hamda
- Department of Cardiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - A Achour
- Department of Radiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Ouali
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
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14
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Bounssir A, Bakkali T, Mouhani S, Elkhaloufi S, Sefiani Y, El Mesnaoui A, Lekehal B. [Unusual complication of Behcet's disease]. Ann Cardiol Angeiol (Paris) 2021; 70:119-121. [PMID: 33032787 DOI: 10.1016/j.ancard.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
Arterial involvement in Behcet's disease is rare and the tibioperoneal trunk localisation is exceptional. We report the case of a young men with Behcet's disease and in whom the evolution to angiobehcet was unusual. The medical treatment and the therapeutic abstention were decided according to a bundle of argument.
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Affiliation(s)
- A Bounssir
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - S Mouhani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - S Elkhaloufi
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - A El Mesnaoui
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina de Rabat, 10104 Souissi Rabat, Maroc; Université Mohammed V de Rabat, avenue des Nations Unies, Agdal Rabat, Maroc
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15
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Aghoutane N, Zoulati M, Bakkali T, Lahlou N, Lyazidi Y, Chtata H, Taberkant M. Hepatic artery aneurysm revealing Behçet's disease. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:344-346. [PMID: 33248537 DOI: 10.1016/j.jdmv.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- N Aghoutane
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco.
| | - M Zoulati
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
| | - T Bakkali
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
| | - N Lahlou
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
| | - Y Lyazidi
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
| | - H Chtata
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
| | - M Taberkant
- Department of vascular surgery, military hospital Mohammed V, Hay-Riad, Rabat, Morocco
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16
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Ha-ou-nou F, Essaadouni L. Fréquence et facteurs prédictifs de thrombose veineuse au cours de la maladie de Behçet. Rev Med Interne 2020; 41:578-582. [DOI: 10.1016/j.revmed.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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17
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Naouli H, Bouarhroum A, Jiber H. A ruptured abdominal aortic aneurysm in Behçet's disease: A case report. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:300-302. [PMID: 32862990 DOI: 10.1016/j.jdmv.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco.
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Boite Postale 1893, KM 2.200 Route Sidi Harazem, Fès 30070, Morocco
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18
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Xia S, Song C, Zhang L, Hu W, Li H, Shen Y, Lu Q. Endovascular treatment with in-vitro fenestration and sac filling technique for ruptured thoracoabdominal aortic aneurysm with Behcet's disease. J Cardiothorac Surg 2020; 15:221. [PMID: 32807210 PMCID: PMC7430017 DOI: 10.1186/s13019-020-01252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose We provided an endovascular strategy of treating ruptured aortic aneurysm with Behcet’s Disease. Case report A 25-year-old man was diagnosed ruptured thoracoabdominal aortic aneurysm with Behcet’s Disease according to his eye damage history, high level of ESR and C-reactive protein and the imaging result. We used in-vitro fenestration of the stent-graft combined with in-stent technique to occlude the ruptured aortic aneurysm and preserve the blood supply from the aorta for visceral arteries in emergency. Sac filling technique was used to treat the endoleak to quickly prevent bleeding. The patient kept post-operative immunotherapy for 1 year. Conclusion The patient had a good prognosis in the reduction of the cavity of aortic aneurysm to the normal size without any complications in a year follow-up.
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Affiliation(s)
- Shibo Xia
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Wenping Hu
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Haiyan Li
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Yu Shen
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, The Second (Navy) Military Medical University, CPLA, 168 Changhai Road, Shanghai, 200433, China.
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19
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Association between serum homocysteine and arterial stiffness in patients with Behçet’s disease. EGYPTIAN RHEUMATOLOGIST 2020. [DOI: 10.1016/j.ejr.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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20
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El Bhali H, Zahdi O, Bakkali T, Hormat-Allah M, Sefiani Y, Lekehal B, El Mesnaoui A, Bensaid Y. [False aneurysm of the abdominal aorta revealing Behçet's disease]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:344-349. [PMID: 31474346 DOI: 10.1016/j.jdmv.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis diagnosed on the basis of clinical criteria established by the International Study Group for Behçet's. Vascular involvement is common, affecting both arteries and veins. Aortic localizations are rare and severe and can be life-threatening in case of rupture. Thrombosis is observed but aneurysm or false aneurysm are more common. Computed tomographic angiography is essential for diagnosis and study of the characteristics of aneurysms and false aneurysms. Treatment relies on corticosteroids and immunosuppressive drugs in severe forms supplemented by open or endovascular repair. This latter approach represents a safe and efficient alternative to open surgery, it induces fewer pseudoaneurysms and increases the survival rate especially in association with immunosuppressors. We report a case of Behçet disease revealed by a false aneurysm of the abdominal aorta treated by deployment of a covered stent.
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Affiliation(s)
- H El Bhali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - O Zahdi
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - A El Mesnaoui
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
| | - Y Bensaid
- Service de chirurgie vasculaire, centre hospitalo-universitaire Ibn Sina, université Mohamed V de Rabat, 10104 Souissi, Rabat, Maroc
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21
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[Spontaneous aortic isthmus aneurysm: Exceptional revelation of Behçet's disease]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:340-343. [PMID: 31474345 DOI: 10.1016/j.jdmv.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/30/2019] [Indexed: 11/23/2022]
Abstract
Arterial involvement in Behçet's disease is rare. The exceptional aortic isthmus location is difficult to treat. We report the case of a young man in whom an aortic isthmus aneurysm revealed Behçet's disease. In this exceptional situation, we opted for classical open surgical repair despite current preference for endovascular treatment.
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22
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Ahn HS, Lee D, Lee SY, Kim YH, Lee JH, Yu DS, Han KD, Park YG, Lee YB. Increased Cardiovascular Risk and All-cause Death in Patients with Behçet Disease: A Korean Nationwide Population-based Dynamic Cohort Study. J Rheumatol 2019; 47:903-908. [PMID: 31371649 DOI: 10.3899/jrheum.190408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behçet disease (BD) is a chronic inflammatory multiorgan disease. An increased risk of cardiovascular disease (CVD) and heightened death rate with BD have been suggested, but to our knowledge, a nationwide large-scale study has not been conducted to date. This study aimed to determine the overall CV risk and death rate in patients with BD versus controls using the Korean National Health Insurance Service claim database. METHODS Patients with BD (n = 5576) with no previous history of CVD were selected from 2010 to 2014. An age- and sex-matched control population of individuals without BD (n = 27,880) was randomly sampled at a ratio of 5:1. Both cohorts were followed for incident CVD or all-cause death until 2015. RESULTS The risks of myocardial infarction (HR 1.72, 95% CI 1.01-2.73) and stroke (HR 1.65, 95% CI 1.09-2.50) were significantly higher in patients with BD than in controls. Patients with BD also had a significantly higher risk of all-cause death (HR 1.82, 95% CI 1.40-2.37) compared to controls. CONCLUSION Korean patients with BD had a higher overall risk of CVD than did those without BD. Therefore, patients with BD must be carefully monitored for the potential development of CVD to ensure that appropriate early treatments are delivered.
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Affiliation(s)
- Hyo-Suk Ahn
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dongjae Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Soo Young Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yeong Ho Kim
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ji Hyun Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dong Soo Yu
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kyung-Do Han
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yong Gyu Park
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
| | - Young Bok Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
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Martin C, Au Duong J, Tissot B, Minville V, Ferré F. Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report. A A Pract 2019; 12:196-198. [PMID: 30169381 DOI: 10.1213/xaa.0000000000000882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Venous complications in Behcet disease (BD) affect nearly 40% of patients. We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. Methotrexate was withheld 15 days before surgery and restarted on postoperative day 2. Immunosuppressive therapy, such as methotrexate, appears to be the most effective prophylactic treatment for venous thrombosis in patients with BD, whereas prophylaxis with low-molecular-weight heparin may be ineffective, as was the situation in our patient. Therefore, continuation of methotrexate perioperatively should be considered in patients with BD. Systematically performing preoperative deep vein thrombosis screening should be also considered. The patient also had diabetes mellitus treated with metformin and sitagliptin preoperatively.
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Affiliation(s)
- Charlotte Martin
- From the Department of Anesthesia and Critical Care Medicine, Hôpital Pierre-Paul Riquet, Purpan, Toulouse, France
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Hamza N, Ben Sassi S, Nabli F, Nagi S, Mahmoud M, Ben Abdelaziz I, Hentati F. Stroke revealing Neuro-Behçet's disease with parenchymal and extensive vascular involvement. J Neurol Sci 2019; 398:131-134. [DOI: 10.1016/j.jns.2019.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/25/2019] [Indexed: 01/15/2023]
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Tracy A, Subramanian A, Adderley NJ, Cockwell P, Ferro C, Ball S, Harper L, Nirantharakumar K. Cardiovascular, thromboembolic and renal outcomes in IgA vasculitis (Henoch-Schönlein purpura): a retrospective cohort study using routinely collected primary care data. Ann Rheum Dis 2018; 78:261-269. [PMID: 30487151 DOI: 10.1136/annrheumdis-2018-214142] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND IgA vasculitis (IgAV, Henoch-Schönlein purpura) is a small-vessel vasculitis most common in children but also occurring in adults. Case series have suggested that IgAV may be associated with cardiovascular disease and venous thromboembolism, but this has not been evaluated in population-based studies. Renal disease and hypertension are possible complications of the disease with unknown incidence. METHODS Using a large UK primary care database, we conducted an open retrospective matched cohort study of cardiovascular, venous thrombotic and renal outcomes in adult-onset and childhood-onset IgAV. Control participants were selected at a 2:1 ratio, matched for age and sex. Adjusted HRs (aHRs) were calculated using Cox proportional hazards models. RESULTS 2828 patients with adult-onset IgAV and 10 405 patients with childhood-onset IgAV were compared with age-matched and sex-matched controls. There was significantly increased risk of hypertension (adult-onset aHR 1.42, 95% CI 1.19 to 1.70, p < 0.001; childhood-onset aHR 1.52, 95% CI 1.22 to 1.89, p < 0.001) and stage G3-G5 chronic kidney disease (adult-onset aHR 1.54, 95% CI 1.23 to 1.93, p < 0.001; childhood-onset aHR 1.89, 95% CI 1.16 to 3.07, p=0.010). There was no evidence of association with ischaemic heart disease, cerebrovascular disease or venous thromboembolism. All-cause mortality was increased in the adult-onset IgAV cohort compared with controls (aHR 1.27, 95% CI 1.07 to 1.50, p=0.006). CONCLUSIONS Patients with IgAV are at increased risk of hypertension and chronic kidney disease (CKD) compared with individuals without IgAV; analysis restricted to adult-onset IgAV patients showed increased mortality. Appropriate surveillance and risk factor modification could improve long-term outcomes in these patients.
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Affiliation(s)
- Alexander Tracy
- Centre for Translational Inflammation Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Charles Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Simon Ball
- Department of Renal Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Lorraine Harper
- Centre for Translational Inflammation Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Emergent Endovascular Treatment of Thoracoabdominal Aortic Rupture in Behcet's Disease. Ann Vasc Surg 2018; 47:282.e7-282.e11. [DOI: 10.1016/j.avsg.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
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Clinical characteristics of conduction disturbance in patients with Behcet's disease. Clin Rheumatol 2017; 37:1921-1925. [PMID: 29177984 DOI: 10.1007/s10067-017-3920-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
To summarized clinical features of Behcet's patients with conduction disturbances and explore the underlying risk factors. A retrospective case-control study was conducted in Anzhen Hospital, Capital Medical University. Demographic data, clinical features, laboratory results, treatments, and fatality rate during hospital stay were analyzed. We found 23.1% of Behcet's disease had conduction disturbances and 84.0% had aortic valvular insufficiency. The male percentage of the Behcet's disease patients with conduction disturbances was significantly higher than controls (88.9 vs. 61.7%, P = 0.03). The echocardiography showed left ventricular end-diastolic diameter [64.00 (18) vs. 48.00 (15) mm, P = 0.000]; left ventricular end-contraction diameter [47.50 (11) vs. 30 (13) mm, P = 0.000]; left atrial diameter [47 (17) vs. 34 (14) mm, P = 0.001]; and left ventricular ejection fraction [60 (10) vs. 63 (13) mm, P = 0.023] were significantly different between two groups. Aortic valvular insufficiency was an independent risk factor for Behcet's disease with conduction disturbances (OR = 17.830; 95% CI 2.106, 150.981; P = 0.008). Conduction disturbance in Behcet's disease deserved attention. The diagnosis of BD and evaluation of conduction disturbance should be kept in mind when accepting patients with valvular regurgitation.
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Cure E, Icli A, Ugur Uslu A, Aydoğan Baykara R, Sakiz D, Ozucan M, Yavuz F, Arslan S, Cumhur Cure M, Kucuk A. Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease. Z Rheumatol 2017; 76:259-266. [PMID: 27431747 DOI: 10.1007/s00393-016-0141-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients. PATIENTS AND METHODS A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated. RESULTS cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients. CONCLUSION Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.
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Affiliation(s)
- E Cure
- Recep Tayyip Erdogan University, Rize, Turkey.
| | - A Icli
- Necmettin Erbakan University, Konya, Turkey
| | - A Ugur Uslu
- Eskisehir Military Hospital, Eskisehir, Turkey
| | | | - D Sakiz
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - M Ozucan
- Necmettin Erbakan University, Konya, Turkey
| | - F Yavuz
- Dogubeyazit Docent Dr Yasar Eryilmaz State Hospital, Agri, Turkey
| | - S Arslan
- Necmettin Erbakan University, Konya, Turkey
| | | | - A Kucuk
- Malatya State Hospital, Malatya, Turkey
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Cure E, Icli A, Ugur Uslu A, Aydoğan Baykara R, Sakiz D, Ozucan M, Yavuz F, Arslan S, Cumhur Cure M, Kucuk A. Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease. Z Rheumatol 2016. [PMID: 27431747 DOI: 10.1007/s00393-016-0141-z.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients. PATIENTS AND METHODS A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated. RESULTS cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients. CONCLUSION Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.
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Affiliation(s)
- E Cure
- Recep Tayyip Erdogan University, Rize, Turkey.
| | - A Icli
- Necmettin Erbakan University, Konya, Turkey
| | - A Ugur Uslu
- Eskisehir Military Hospital, Eskisehir, Turkey
| | | | - D Sakiz
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - M Ozucan
- Necmettin Erbakan University, Konya, Turkey
| | - F Yavuz
- Dogubeyazit Docent Dr Yasar Eryilmaz State Hospital, Agri, Turkey
| | - S Arslan
- Necmettin Erbakan University, Konya, Turkey
| | | | - A Kucuk
- Malatya State Hospital, Malatya, Turkey
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Dehaene A, Jacquier A, Falque C, Gorincour G, Gaubert JY. Imaging of acquired coronary diseases: From children to adults. Diagn Interv Imaging 2016; 97:571-80. [PMID: 27130480 DOI: 10.1016/j.diii.2016.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 02/09/2023]
Abstract
Acquired coronary diseases include aneurysms, fistulae, dissections, and stenosis. Aneurysms may occur secondarily to Kawasaki disease, a childhood vasculitis, the prognosis of which depends on the coronary involvement, or they may be degenerative, infectious, inflammatory, or traumatic in origin. Fistulae develop between the coronary arterial system and a pulmonary or bronchial artery, or cardiac cavity. Dissections may occur spontaneously or may be post-traumatic. These coronary abnormalities may be found incidentally or may present as complications, infarction or rupture. The goals of this article are to understand acquired childhood and adult coronary diseases and their usual means of presentation, the ways of investigating them, and the principles of their treatment.
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Affiliation(s)
- A Dehaene
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France.
| | - A Jacquier
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
| | - C Falque
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
| | - G Gorincour
- Department of pediatric radiology, La Timone Hospital, AP-HM, Marseille, France
| | - J Y Gaubert
- Department of adult radiology, La Timone Hospital, AP-HM, Marseille, France
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Zeidan MJ, Saadoun D, Garrido M, Klatzmann D, Six A, Cacoub P. Behçet's disease physiopathology: a contemporary review. AUTOIMMUNITY HIGHLIGHTS 2016; 7:4. [PMID: 26868128 PMCID: PMC4751097 DOI: 10.1007/s13317-016-0074-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022]
Abstract
Behçet’s disease, also known as the Silk Road Disease, is a rare systemic vasculitis disorder of unknown etiology. Recurrent attacks of acute inflammation characterize Behçet’s disease. Frequent oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions are the most common manifestations. Inflammation is typically self-limiting in time and relapsing episodes of clinical manifestations represent a hallmark of Behçet’s disease. Other less frequent yet severe manifestations that have a major prognostic impact involve the eyes, the central nervous system, the main large vessels and the gastrointestinal tract. Behçet’s disease has a heterogeneous onset and is associated with significant morbidity and premature mortality. This study presents a current immunological review of the disease and provides a synopsis of clinical aspects and treatment options.
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Affiliation(s)
- Mohamad J Zeidan
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - David Saadoun
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Marlene Garrido
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - David Klatzmann
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - Adrien Six
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - Patrice Cacoub
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France.
- INSERM, UMR_S 959, 75013, Paris, France.
- CNRS, FRE3632, 75005, Paris, France.
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013, Paris, France.
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Merashli M, Ster IC, Ames PRJ. Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis. Semin Arthritis Rheum 2016; 45:502-10. [DOI: 10.1016/j.semarthrit.2015.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/23/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
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Gaudric J, Dennery M, Jouhannet C, Kagan N, Saadoun D, Chiche L, Koskas F. [Aortitis and surgery]. Rev Med Interne 2016; 37:284-91. [PMID: 26797187 DOI: 10.1016/j.revmed.2015.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/21/2015] [Indexed: 01/29/2023]
Abstract
Non-infectious aortitis are usually due to giant cell arteritis (temporal arteritis), Takayasu and Behçet's diseases. Aortitis should be suspected in the presence of aortic wall thickening or of aneurysm or occlusion of the aorta and its branches in the absence of characteristic cardiovascular risk factors. Surgery is required in case of severe damage. But the quiescence of the inflammatory disease must be obtained before endovascular or surgical treatment to prevent complications such as anastomotic false aneurysm or stent thrombosis, especially common in this disease. The frequency of aortic aneurysms (in particular of ascending aorta) in giant cell arteritis encourages its systematic screening, as well as regular monitoring of the entire aorta during the follow-up. Behçet's and Takayasu diseases require the greatest control of inflammation and the knowledge of some surgical tricks to avoid the risk of recurrence. The literature review shows that endovascular treatment could reduce perioperative morbidity but did not allow reducing long-term complications.
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Affiliation(s)
- J Gaudric
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - M Dennery
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Jouhannet
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - N Kagan
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Saadoun
- Service de médecine interne et immunologie clinique, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Chiche
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Koskas
- Service de chirurgie vasculaire, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Lyazidi Y, Abissegue Y, Chtata H, Taberkant M. Une maladie de Behçet révélée par un anévrisme aortique et fémoral. ACTA ACUST UNITED AC 2015; 40:399-401. [DOI: 10.1016/j.jmv.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/09/2015] [Indexed: 10/22/2022]
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Chetoui A, El Malki H, Bahous M, Rhissassi J, Sayah R, Laaroussi M. [Aneurysm of the ascending aorta associated with massive aortic regurgitation: rare and serious complication of Behçet disease]. Pan Afr Med J 2015; 21:85. [PMID: 26491528 PMCID: PMC4594973 DOI: 10.11604/pamj.2015.21.85.6076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/10/2015] [Indexed: 11/18/2022] Open
Abstract
L'atteinte artérielle au cours de la maladie de Behçet survient chez 2 à 12% des patients et se traduit par des lésions oblitérantes et/ou anévrysmales prédominant sur les gros troncs. Les complications cardiaques sont plus rares (1 à 6%) touchant les trois tuniques. En revanche, les anévrysmes de l'aorte ascendante associés à une insuffisance aortique restent une complication très rare de la maladie de Behçet. Nous rapportons l'observation d'un jeune patient de 35ans suivie pour une maladie de Behçet compliquée d'un anévrysme de l'aorte ascendante associé à une régurgitation aortique massive. Le diagnostic a été posé sur les données cliniques radiologiques de l’échocardiographie et de la tomodensitométrie puis confirmé à l'examen histologique de la pièce. Le traitement était chirurgical et a consisté en un remplacement total de la racine de l'aorte à cœur ouvert selon la technique de Bentall afin d’éviter le risque de rupture ou de dissection. L’évolution à 18 mois de l'intervention était favorable. Le traitement médical associant la corticothérapie et les immunosuppresseurs est la règle en postopératoire pour éviter les récidives.
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Affiliation(s)
| | - Hicham El Malki
- Service de Chirurgie Cardiovasculaire A, CHU Ibn Sina, Rabat, Maroc
| | | | - Jaafar Rhissassi
- Service de Chirurgie Cardiovasculaire A, CHU Ibn Sina, Rabat, Maroc
| | - Rochde Sayah
- Service de Chirurgie Cardiovasculaire A, CHU Ibn Sina, Rabat, Maroc
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Naouli H, Zrihni Y, Jiber H, Bouarhroum A. [An abdominal aortic aneurysm revealing Behçet's disease]. ACTA ACUST UNITED AC 2014; 39:434-8. [PMID: 25457357 DOI: 10.1016/j.jmv.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/28/2014] [Indexed: 11/26/2022]
Abstract
Behçet's disease is a vasculitis of unknown origin. Vascular lesions predominantly affect veins. Arterial involvement is rare but usually associated with poor prognosis. Aortic syndromes are usually aneurysmal and occasionally reveal Behçet's disease. We report the case of a 46-year-old man whose Behçet's disease was revealed by a sub-renal abdominal aortic aneurysm in pre-rupture state. The diagnosis of this disease was retained based on clinical, biological and radiological criteria. The surgical procedure consisted in the resection of the aneurysmal sac and the interposition of a prosthetic PTFE tube.
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Affiliation(s)
- H Naouli
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc.
| | - Y Zrihni
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
| | - H Jiber
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
| | - A Bouarhroum
- Service de chirurgie vasculaire périphérique F4, faculté de médecine et de pharmacie de Fès, CHU Hassan II, Fès, Maroc
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