Baroreflex sensitivity in patients with Takayasu's aortitis

Atypical giant cell arteritis presentations diagnosed with FDG-18 whole body PET imaging

Two male patients aged above 70 years were investigated for chronic non-specific symptoms and evidence of significant systemic inflammation, but without classic 'cranial symptoms' of giant cell arteritis (GCA). Each patient had multiple non-diagnostic investigations, but finally extensive large-vessel vasculitis was revealed by whole body positron emission tomography/CT imaging. Both cases were confirmed to have GCA on temporal artery biopsy and responded well to initial high-dose prednisolone therapy. The patients successfully completed 12 months of steroid-sparing therapy with tocilizumab and achieved remission of their condition.

Sudden Death Due to Unusual Complication of Takayasu Arteritis: An Autopsy Case

Takayasu arteritis is an uncommon inflammatory disease with usually a good prognosis. However, sometimes, the evolution can be fatal essentially by a coronary arteries involvement. We present a case of a 19-year-old woman who died suddenly from cardiogenic shock complicating an unknown Takayasu arteritis.At the autopsy, the aorta showed a significant thickening of the wall. The coronary arteries were slightly thickened and did not show any occlusion. Microscopic examination of the aorta showed an abundant granulomatous and a lymphoplasmacytic infiltrate. Microscopic sections of other internal organs showed signs of cardiac hypertrophy and an extensive edema of the lung. Death was attributed to acute heart failure complicating a supravalvular aortic stenosis secondary to unknown Takayasu arteritis.Takayasu arteritis can be life-threatening by an occlusion of the ascending aorta and its major branches, without any coronary arteries involvement.

[How to manage Takayasu arteritis?]

Thorough clinical and imaging assessment of the arterial tree when a diagnosis of Takayasu arteritis is established. Glucocorticoïd as intiation therapy. Immunosuppresive agent should be considered as adjunctive therapy if resistance or dependance to glucocorticoïd therapy. Supportive care, antihypertensive drugs, glucocorticoïd induced osteoporosis preventive therapy, tuberculosis screening should not be forgiven. Monitoring of therapy should be clinical and supported by biological markers and imaging. Reconstructive surgery should be performed in the quiescent phase of disease.

Takayasu's arteritis

The frequency of Takayasu's arteritis (TA) has been estimated to be 2.9 cases per 1 million people, with a female preponderance, although female-to-male ratio varies from different geographic areas. A high frequency of haplotype A24-B52-DR2 has been found in Japanese patients, without this association in other populations. TA has a striking predilection for the aortic arch and its branches. Evidence favors an autoimmune pathogenesis. Segmental inflammation (active and inactive lesions) may coexist. Due to its enhanced resolution, magnetic resonance imaging and magnetic resonance angiography eventually will replace catheterization angiography. Mortality reduction with glucocorticoid treatment has not been firmly established.

Takayasu's arteritis: low corticosteroid dosage and pregnancy--a case report

The authors describe a case of Takayasu's arteritis in a twenty-five-year-old Italian woman, characterized by nonspecific symptoms (weakness, arthralgias, fever) and elevated erythrocyte sedimentation rate early onset of these symptoms at the age of about twenty-three years early diagnosis, only eighteen months after the onset of symptomatology absence of progression of the disease under corticosteroid therapy with a follow-up of three years uneventful pregnancy ending in cesarean section and birth of a baby without maternal and neonatal complications.

Reconstructive surgery of the renal arteries in Takayasu's disease

Between 1977 and 1989, 24 patients (19 women and 5 men) with Takayasu's disease underwent renal artery restoration. Mean age was 32.9 years (range 15 to 60 years). All patients were hypertensive and three had moderate, chronic renal failure. Renal artery lesions were unilateral in two patients (8%), bilateral in 17 patients (71%), and unilateral in a solitary kidney in five (21%). Associated lesions of the thoracic or abdominal aorta or both were found in 22 patients (92%). Lesions of the visceral arteries found located in 21 patients (87%) and of the supraaortic trunks in 16 (67%). Initial revascularization of the supraaortic trunks was performed in four patients (17%). Renal artery revascularization was unilateral in 11 patients (46%) and bilateral in 13 (54%). Concomitant aortic reconstruction was performed in 21 patients (87%), visceral artery reconstruction in 17 patients (71%), and supraaortic surgery in seven (29%). One patient who underwent combined aortic and renal artery restoration, and in whom visceral artery involvement had been neglected, died postoperatively of heart failure and intestinal infarction. Three patients were lost to follow-up. Twenty patients have been followed for a mean of 61.3 months (range 4 to 124 months). One patient died at 89 months of intestinal infarction secondary to embolization originating from a false aortic aneurysm. Five repeat renal revascularizations were required in four patients. Hypertension is presently cured in 12 patients (63%), improved in six (31%), and unchanged in one (6%). Even though surgical treatment of arterial lesions in Takayasu's disease often includes complex and repeat revascularization procedures, satisfactory long-term results suggest the use of renal artery reconstruction in this affliction.

Baroreceptor reflex in a patient with coarctation of the aorta

We report the case of a 23-year-old man with coarctation of the aorta whose baroreceptor sensitivity was extremely reduced. Antihypertensive therapy was effectively performed after coarctectomy. Only one month after coarctectomy, baroreflex sensitivity had recovered. The present case is believed to be the first in which reduced baroreceptor sensitivity in coarctation of the aorta was reversible in the early phase after coarctectomy.

Takayasu's arteritis of the upper extremities. A case report and review of literature

Takayasu's Arteritis is an inflammatory process of the large arteries. It most commonly involves the aorta and its major branches. It is characterized by acute and chronic inflammation and fibrosis of the vessel wall with resultant constriction or occlusion of the vessel lumen. There are various histopathologic stages this disease evolves through which may complicate the diagnosis. In this study we present a case of Takayasu's Arteritis involving the right axillary artery, with a literature review.

Neurological complications of vasculitis

The vasculitides are a group of disorders that include the polyarteritis nodosa group of systemic necrotizing vasculitides, hypersensitivity vasculitis, Wegener's granulomatosis, lymphomatoid granulomatosis, giant cell arteritis, Behçet's disease, and isolated angiitis of the central nervous system. Classification is based on clinical, angiographic, and histological features. The frequency and distribution of neurological involvement vary with the underlying disorder and may provide the initial symptoms. Polyarteritis nodosa and Wegener's granulomatosis may affect both the central and peripheral nervous systems, whereas isolated angiitis of the central nervous system and Behçet's disease affect the central nervous system alone. Neurological dysfunction occurs in 80% of patients with polyarteritis nodosa and fewer than 10% of patients with hypersensitivity vasculitis. The mechanism of neurological dysfunction in the vasculitides is tissue ischemia. The clinical effects of ischemia vary, and symptoms may be transient or prolonged. Mononeuritis multiplex, polyneuropathy, and stroke are frequent complications, but encephalopathies, cranial neuropathies, and brachial plexopathies are seen as well. The occurrence of symptoms late in the course of a disease suggests ischemia resulting from healed, scarred vessels as well as from those that are acutely inflamed; this is the case in Takayasu's arteritis and possibly also in polyarteritis nodosa. Treatment is based on identifying and removing the sensitizing agent when possible. Wegener's granulomatosis requires therapy with cyclophosphamide; temporal arteritis, with corticosteroids. In other vasculitides a balance must be reached between the progression of the disease and the side effects of immunosuppression.

Occlusive thromboaortopathy (Takayasu's disease) and pregnancy. Clinical course and management of 33 pregnancies and deliveries

Twenty-seven Japanese patients with occlusive thromboaortopathy (Takayasu's disease) associated with 33 pregnancies and deliveries were followed up prospectively, from the prepregnant period. Inflammatory activity of the disease was apparently not enhanced by the pregnancy, but various cardiovascular-related events occurred in the perinatal period. During the intrapartum uterine contractions, marked elevation of systolic blood pressure was associated with 10 pregnancies, including 1 case of subsequent cerebral hemorrhage; this did not occur in 13 normal control gravidas. There were no maternal or neonatal deaths. The birth weight of 25 infants of 21 patients without complications or with a mild single complication of Takayasu's disease was 3,023 +/- 442 g (mean +/- standard deviation). The birth weight of 8 infants of 6 patients who had a severe single complication or multiple complications of the disease was 2,599 +/- 394 g (p less than 0.05). Of 83 pregnancies, the present 33 plus 50 other reported cases there were no un-toward events in two fifths. Three fifths had various problems, most of which were related to pressure elevation and heart failure, including intrapartum cerebral hemorrhage in 4. These data should assist in predicting the outcome of pregnancy and delivery in patients with Takayasu's disease.

Tooth extractions and aortitis syndrome (Takayasu's disease)

Several problems in tooth extraction in patients with aortitis syndrome are described and the following points are stressed. (1) The extractions of teeth should be done at nonactive period of the disease. (2) Patients who reveal hyper- or impaired sensitivity of the carotid sinus should be positioned in the most relaxed way with no pressure and no stretch of the carotid sinus region. (3) Since no pulsation is present at any extremity in many patients, these patients should be carefully monitored during treatment. (4) Antibiotics before tooth extraction are necessary. (5) Tooth extractions should not alter an already unbalanced hemodynamic state to a more severe stage.