Pathophysiology of superficial femoral artery in-stent restenosis

Peripheral artery disease (PAD) is an emerging problem especially with aging population and increase in the incidence of diabetes and metabolic syndrome. The disease is histologically characterized by the presence of moderate to severe calcification and fibrous plaques as compared to coronary and carotid atherosclerotic disease, which are richer in necrotic core. Endovascular therapy for the superficial femoral artery (SFA), at least in the United States, has been largely limited to balloon angioplasty and stenting and these are considered safe and relatively effective therapies. However, the patency rates remain low even at one year and restenosis is a growing and challenging problem. Recently the development of newer devices, i.e., drug-eluting stent, and drug coated balloon are showing greater efficacy and are being adopted into daily practice. In this review, we will present the morphologic characteristics of the underlying SFA atherosclerotic disease and discuss in-stent restenosis and the mechanisms that may be involved in the induction of excessive smooth muscle cell proliferation and deposition of proteoglycans and collagen, that lead to restenosis.

Unusual complication of sternotomy: bone fragment induced right ventricular rupture after mitral valve replacement surgery

Major surgical complications following open cardiac procedures via median sternotomy are infrequent but potentially devastating events. We report on a unique, fatal complication of median sternotomy. A 44-year-old woman underwent mitral valve replacement for endocarditis related to intravenous drug abuse. Twenty days after the surgery, she presented to the emergency department in acute distress, and died of cardiac tamponade soon after admission. Postmortem examination revealed a defect in the right ventricular wall caused by a bone fragment resulting from the median sternotomy.

Histoplasma capsulatum in the eye

The ocular pathologic findings in an immunosuppressed patient who died of disseminated histoplasmosis are described. Histoplasma capsulatum was found in large numbers within the endothelial cells of the choroid, in one area each of the ciliary body and trabecular meshwork. There was a minimal inflammatory response. No granulomas were noted. Previously reported cases of ocular histoplasmosis in immunosuppressed patients are similar in that, with one exception, granulomatous inflammation was not demonstrated. Thirteen eyes in which histoplasma organisms have been found in the eye are reviewed.