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Wang M, Cao H, Dai J, Chen S, Xu L, Li S. Jejunal Dieulafoy lesion with intraintestinal calcification on computerized tomography: A case report. Medicine (Baltimore) 2021; 100:e26229. [PMID: 34160386 PMCID: PMC8238262 DOI: 10.1097/md.0000000000026229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A Dieulafoy lesion is a rare cause of gastrointestinal (GI) bleeding, especially in the jejunum, and the presence of calcifications on CT might be suspicious of the diagnosis. PATIENT CONCERNS We describe a 72-year-old woman with anemia and melena. Hemoglobin was 6.0 g/dL, and the stools were positive for occult blood (4+). Blood pressure was 116/54 mm Hg. Physical examination showed pale face and pitting edema in both lower limbs. Abdominal computerized tomography showed calcification in the small intestine of the left lower abdomen. Capsule endoscopy showed a blood clot. DIAGNOSES Dieulafoy lesion. INTERVENTIONS Single balloon endoscopy was performed via the oral approach and showed a blood clot on the suspected submucosal tumor of jejunum. A hemostatic clip was placed at the base of the lesion to allow the surgeon to locate it during the operation. Laparoscopy was performed, and the lesion was resected. OUTCOMES The postoperative pathology showed a Dieulafoy lesion. The lower extremity edema subsided. GI bleeding did not recur over 1 year of follow-up, and hemoglobin was 12.2 g/dL. A Dieulafoy lesion is a rare cause of GI bleeding, and it is even rarer in the jejunum. LESSONS A Dieulafoy lesion does not have special imaging features, but the presence of calcifications in the small intestine on computerized tomography might be suspicious of the diagnosis. When endoscopic treatment is difficult, surgical treatment could be considered.
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Affiliation(s)
- Mudan Wang
- Department of Emergency and Trauma Center
| | - Haijun Cao
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinfeng Dai
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanshan Chen
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Xu
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shangao Li
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Karaahmet F, Kılıncalp S, Coskun Y, Hamamci M, Akinci H, Ustun Y, Simsek Z, Erarslan E, Coban S, Yuksel I. The efficiency of endoclips in maintaining the gastrointestinal bleeding-related Dieulafoy's lesion. Wien Klin Wochenschr 2016; 128:700-705. [PMID: 25854908 DOI: 10.1007/s00508-015-0739-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dieulafoy's lesion (DL) is a relatively uncommon medical condition characterized by a large tortuous arteriole in the submucosa of any part of gastrointestinal (GI) tract wall that bleeds via erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Compared with other endoscopic hemostatic techniques, clipping alone for DL is limited. AIMS The aim of the present case series study is to identify common clinical and endoscopic features, rates of occurrence, to review the outcome of endoscopic management of upper GI tract DL, and to illustrate the use and the efficiency of endoclips in maintaining the GI bleeding due to DL. PATIENTS AND METHODS This case series was conducted at Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital. The patients who were admitted to the emergency department of Dıskapı Yıldırım Beyazıt Educational and Research Hospital underwent gastrointestinal system (GIS) endoscopy between 2008 and 2013 and were assessed retrospectively. Five cases of GI bleeding related to DL were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS The median number of endoscopic hemoclips application in first endoscopy was 4 (2-9). Rebleeding developed in all patients who had hemoclips applied. Re-endoscopy was performed in three of these patients, which controlled the bleeding. Two patients were transferred to surgery. CONCLUSIONS Combination of endoscopic injection and mechanical therapies seems a suitable method for maintaining upper GIS bleeding due to DL. Also, further studies are needed to better define the best endoscopic approach for the treatment of DL.
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Affiliation(s)
- Fatih Karaahmet
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey.
| | - Serta Kılıncalp
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Yusuf Coskun
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Mevlut Hamamci
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Hakan Akinci
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Yusuf Ustun
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Zahide Simsek
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Elife Erarslan
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Sahin Coban
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
| | - Ilhami Yuksel
- Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey
- Department of Gastroenterology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Simonsen TG, Gaustad JV, Leinaas MN, Rofstad EK. High interstitial fluid pressure is associated with tumor-line specific vascular abnormalities in human melanoma xenografts. PLoS One 2012; 7:e40006. [PMID: 22768196 PMCID: PMC3386940 DOI: 10.1371/journal.pone.0040006] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 05/30/2012] [Indexed: 12/22/2022] Open
Abstract
Purpose Interstitial fluid pressure (IFP) is highly elevated in many solid tumors. High IFP has been associated with low radiocurability and high metastatic frequency in human melanoma xenografts and with poor survival after radiation therapy in cervical cancer patients. Abnormalities in tumor vascular networks have been identified as an important cause of elevated tumor IFP. The aim of this study was to investigate the relationship between tumor IFP and the functional and morphological properties of tumor vascular networks. Materials and Methods A-07-GFP and R-18-GFP human melanomas growing in dorsal window chambers in BALB/c nu/nu mice were used as preclinical tumor models. Functional and morphological parameters of the vascular network were assessed from first-pass imaging movies and vascular maps recorded after intravenous bolus injection of 155-kDa tetramethylrhodamine isothiocyanate-labeled dextran. IFP was measured in the center of the tumors using a Millar catheter. Angiogenic profiles of A-07-GFP and R-18-GFP cells were obtained with a quantitative PCR array. Results High IFP was associated with low growth rate and low vascular density in A-07-GFP tumors, and with high growth rate and high vascular density in R-18-GFP tumors. A-07-GFP tumors showed chaotic and highly disorganized vascular networks, while R-18-GFP tumors showed more organized vascular networks with supplying arterioles in the tumor center and draining venules in the tumor periphery. Furthermore, A-07-GFP and R-18-GFP cells differed substantially in angiogenic profiles. A-07-GFP tumors with high IFP showed high geometric resistance to blood flow due to high vessel tortuosity. R-18-GFP tumors with high IFP showed high geometric resistance to blood flow due to a large number of narrow tumor capillaries. Conclusions High IFP in A-07-GFP and R-18-GFP human melanoma xenografts was primarily a consequence of high blood flow resistance caused by tumor-line specific vascular abnormalities.
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Affiliation(s)
- Trude G Simonsen
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
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4
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Oster SF, McLeod DS, Otsuji T, Goldberg MF, Lutty GA. Preliminary ocular histopathological observations on heterozygous NEMO-deficient mice. Exp Eye Res 2008; 88:613-6. [PMID: 19068214 DOI: 10.1016/j.exer.2008.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 10/29/2008] [Accepted: 10/29/2008] [Indexed: 11/18/2022]
Abstract
The majority of patients with incontinentia pigmenti (IP) have a mutation in the nuclear factor-kappa-beta essential modulator (NEMO) gene, and mice with a targeted deletion of NEMO exhibit skin pathology remarkably similar to the human disease. This study characterizes the retinal vascular abnormalities of NEMO-deficient mice, and compares this phenotype to known features of human IP. Nineteen heterozygous NEMO-deficient female mice, ages ranging from post-natal day 8 (P-8) through 6.5 months of life, were studied. Eyes were sectioned and stained either whole or as retinal flat mounts after incubation for enzyme histochemical demonstration of ADPase, which labels the vasculature. With maturation, retinal arteriolar abnormalities became evident at 3 months of age. Global assessment of the retinal vasculature with ADPase staining showed increased vascular tortuosity. Microscopic examination of sections of ADPase-incubated retinas revealed arteriolar luminal narrowing due to endothelial cell hypertrophy and increased basement membrane deposition. Venous morphology was normal. This study characterized the histological retinal phenotype of heterozygous NEMO-deficient female mice. Most striking were retinal arteriolar abnormalities, including luminal narrowing, endothelial cell hypertrophy, and basement membrane thickening. Retinal flat mounts revealed arteriolar tortuosity without evidence of vaso-occlusion or neo-vascularization.
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Affiliation(s)
- Stephen F Oster
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287-9115, USA
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5
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Heller M, Karen JK, Fangman W. Acroangiodermatitis. Dermatol Online J 2007; 13:2. [PMID: 17511935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
A 26-year-old man with a history of chronic primary lymphedema of the left lower extremity presented with elephantiasis, confluent, violaceous, mascerated plaques, and ulcers on the dorsal aspects of the toes of the left foot. Histopathologic examination showed a proliferation of small blood vessels associated with extravasated erythrocytes and hemosiderin deposits consistent with the diagnosis of acroangiodermatitis. Treatment of the focal ulcers includes compression therapy, local wound care, and surgical elimination of the shunt if there is an associated arteriovenous malformation.
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6
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Agrawal P, Kirkpatrick N. Repetitive preretinal haemorrhages caused by physical exertion. ACTA ACUST UNITED AC 2006; 84:709-10. [PMID: 16965508 DOI: 10.1111/j.1600-0420.2006.00689.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pavi Agrawal
- Department of Ophthalmology, Cheltenham General Hospital, Cheltenham, UK.
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7
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Nakata M, Yuzawa M, Kawamura A, Shimada H. Combining surgical ablation of retinal inflow and outflow vessels with photodynamic therapy for retinal angiomatous proliferation. Am J Ophthalmol 2006; 141:968-70. [PMID: 16678525 DOI: 10.1016/j.ajo.2005.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 12/14/2005] [Accepted: 12/16/2005] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate short-term efficacy of combining surgical ablation of retinal inflow and outflow vessels and photodynamic therapy (PDT) for stage 3 retinal angiomatous proliferation (RAP). DESIGN Prospective interventional case series. METHODS Five eyes (five patients) underwent surgical ablation of inflow and outflow vessels and PDT for stage 3 RAP. RESULTS Inflow and outflow vessels were ablated in four eyes, and only inflow was ablated in one eye. In four eyes starting PDT within six weeks of surgical ablation, choroidal neovascularization (CNV) disappeared or shrank after one PDT session (three months follow-up). However, CNV enlarged again in three of the four (final follow-up) because of reperfusion from newly formed inflow vessels. In one eye starting PDT seven months after ablation, a new retinal inflow vessel feeding the CNV appeared by the time of the first PDT session. The CNV continued to expand, despite two PDT sessions. CONCLUSIONS Combining surgical ablation and PDT was not useful on account of a high frequency of reperfusion from retinal inflow vessels.
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Affiliation(s)
- Mitsunori Nakata
- Department of Ophthalmology, Surugadai Hospital, Nihon University, 1-8-13 Surugadai, Kanda, Chiyoda-ku, Tokyo 101-8317, Japan
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8
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Katsinelos P, Paroutoglou G, Pilpilidis I, Tsolkas P, Papagiannis A, Kapelidis P, Trakateli C, Iliadis A, Georgiadou E, Kamperis E, Dimiropoulos S, Vasiliadis I. Double Dieulafoy-like lesion in the stomach. Surg Endosc 2003; 17:1324. [PMID: 12799880 DOI: 10.1007/s00464-003-4200-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 01/23/2003] [Indexed: 12/31/2022]
Abstract
Dieulafoy's lesion is an uncommon cause of major gastrointestinal bleeding and may be difficult to recognize. It consists of an arteriole that protrudes through a tiny mucosal defect usually within 6 cm of the gastroesophageal junction on the lesser curve of the stomach. Despite widespread awareness of this entity, it remains a diagnostic challenge for gastroenterologists because of its small size and hidden location. Emergency endoscopy is the most effective method of diagnosing the disease. We report a patient, with double Dieulafoy-like lesion, who was successfully treated endoscopically using hemostatic clip application. The characteristics of the Dieulafoy's lesion, its current diagnosis, and its treatment are discussed.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, General Hospital George Gennimatas, Thessaloniki, Greece.
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9
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Vahedi K, Massin P, Guichard JP, Miocque S, Polivka M, Goutières F, Dress D, Chapon F, Ruchoux MM, Riant F, Joutel A, Gaudric A, Bousser MG, Tournier-Lasserve E. Hereditary infantile hemiparesis, retinal arteriolar tortuosity, and leukoencephalopathy. Neurology 2003; 60:57-63. [PMID: 12525718 DOI: 10.1212/wnl.60.1.57] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The main hereditary vascular conditions involving both retinal and cerebral vessels include cerebroretinal vasculopathy, HERNS (hereditary endotheliopathy with retinopathy, nephropathy, and stroke), and hereditary vascular retinopathy; all are linked to the same locus on chromosome 3p21. Hereditary retinal arteriolar tortuosity is a distinct, autosomal dominant condition characterized by retinal arteriolar tortuosity and recurrent retinal hemorrhages. This condition is known to affect only retinal vessels. METHODS Clinical and brain MRI investigations of eight members of a three-generation family and extensive biological and systemic vascular investigations within one affected family member were conducted. RESULTS Six of eight family members were clinically symptomatic; disorders included infantile hemiparesis (2), migraine with aura (3), and retinal hemorrhage (1). Five individuals had retinal arteriolar tortuosities. A diffuse leukoencephalopathy in association with dilated perivascular spaces was observed in six individuals. Two family members had silent, deep cerebral infarcts as demonstrated on MRI. Genetic linkage analysis strongly suggests that this disorder is not linked to the 3p21 hereditary vascular retinopathy/cerebroretinal vasculopathy/HERNS locus. CONCLUSIONS The authors describe a novel hereditary autosomal dominant condition affecting both retinal and cerebral vessels and characterized by infantile hemiparesis, migraine with aura, retinal hemorrhage, retinal arterial tortuosity, and leukoencephalopathy with dilatation of perivascular spaces and microbleeds on brain MRI. Investigation of additional families should help to map the gene and to better categorize the spectrum of hereditary cerebroretinal small vessel diseases.
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MESH Headings
- Adolescent
- Adult
- Aged
- Arterioles/abnormalities
- Cerebrovascular Disorders/diagnosis
- Cerebrovascular Disorders/epidemiology
- Cerebrovascular Disorders/genetics
- Chromosome Disorders
- Chromosomes, Human, Pair 19/genetics
- Chromosomes, Human, Pair 3/genetics
- Comorbidity
- Female
- Fluorescein Angiography
- Genes, Dominant
- Genetic Linkage
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/genetics
- Magnetic Resonance Angiography
- Magnetic Resonance Imaging
- Male
- Migraine with Aura/diagnosis
- Migraine with Aura/epidemiology
- Migraine with Aura/genetics
- Neoplasms/epidemiology
- Paresis/diagnosis
- Paresis/epidemiology
- Paresis/genetics
- Pedigree
- Proto-Oncogene Proteins/genetics
- Receptor, Notch4
- Receptors, Cell Surface
- Receptors, Notch
- Retinal Artery/abnormalities
- Retinal Diseases/diagnosis
- Retinal Diseases/epidemiology
- Retinal Diseases/genetics
- Retinal Hemorrhage/diagnosis
- Retinal Hemorrhage/epidemiology
- Retinal Hemorrhage/genetics
- Ultrasonography, Doppler, Transcranial
- White People/genetics
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Affiliation(s)
- K Vahedi
- Service de Neurologie, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Paris, France.
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10
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Anstrom JA, Brown WR, Moody DM, Thore CR, Challa VR, Block SM. Anatomical analysis of the developing cerebral vasculature in premature neonates: absence of precapillary arteriole-to-venous shunts. Pediatr Res 2002; 52:554-60. [PMID: 12357050 DOI: 10.1203/00006450-200210000-00015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) commonly affects premature neonates. The gravity of the consequences associated with GMH-IVH makes it a major concern in their care. GMH-IVH begins in the germinal matrix tissue and is, most commonly, the result of venous rupture. Arteriole-to-venous precapillary shunts in the cerebrum of premature neonates could, if present, lead to elevated venous pressure in the germinal matrix and, thus, would be an important etiological factor. We report an autopsy study, involving 33 cases of premature neonates, designed to determine whether precapillary arteriole-to-venous shunts are present in the cerebral vasculature. Brain tissue was embedded in celloidin, sectioned into 100- micro m-thick slices and stained using alkaline phosphatase enzyme histochemistry, a method that distinguishes afferent from efferent vessels. Our sections, which are ideal for tracing vessels over long distances and for displaying patterns of branching and connections with other vessels, indicate that precapillary arteriole-to-venous shunts are not a major influence on cerebral blood flow in babies born at 23 wk gestation or later. The cerebral vasculature in one baby, who died at 24 wk postconception, included shunt-like connections, whereas in 34 babies shunts were not identified. We conclude that precapillary arteriole-to-venous shunts are not a significant factor leading to GMH.
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Affiliation(s)
- John A Anstrom
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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11
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Stalmans I, Ng YS, Rohan R, Fruttiger M, Bouché A, Yuce A, Fujisawa H, Hermans B, Shani M, Jansen S, Hicklin D, Anderson DJ, Gardiner T, Hammes HP, Moons L, Dewerchin M, Collen D, Carmeliet P, D'Amore PA. Arteriolar and venular patterning in retinas of mice selectively expressing VEGF isoforms. J Clin Invest 2002; 109:327-36. [PMID: 11827992 PMCID: PMC150858 DOI: 10.1172/jci14362] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The murine VEGF gene is alternatively transcribed to yield the VEGF(120), VEGF(164), and VEGF(188) isoforms, which differ in their potential to bind to heparan sulfate and neuropilin-1 and to stimulate endothelial growth. Here, their role in retinal vascular development was studied in mice selectively expressing single isoforms. VEGF(164/164) mice were normal, healthy, and had normal retinal angiogenesis. In contrast, VEGF(120/120) mice exhibited severe defects in vascular outgrowth and patterning, whereas VEGF(188/188) mice displayed normal venular outgrowth but impaired arterial development. It is noteworthy that neuropilin-1, a receptor for VEGF(164), was predominantly expressed in retinal arterioles. These findings reveal distinct roles of the various VEGF isoforms in vascular patterning and arterial development in the retina.
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Affiliation(s)
- Ingeborg Stalmans
- The Center for Transgene Technology and Gene Therapy, Flanders Interuniversity Institute for Biotechnology, Catholic University Leuven, Leuven, Belgium
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12
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Zadok D, Levi Y, Zehavi H, Rahimi-Levene N, Nemet P, Kornberg A. Factor VII deficiency in a patient with retinal arteriolar tortuosity syndrome. Eye (Lond) 2000; 14 Pt 5:721-3. [PMID: 11116692 DOI: 10.1038/eye.2000.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report a pedigree with hereditary retinal arteriolar tortuosity with macular haemorrhage and abnormality of the coagulation system. METHODS Case report and literature review. RESULTS A 49-year-old woman was referred due to macular haemorrhage in both eyes. Her 16-year-old son had recurrent retinal haemorrhages which presented at age 16 years and had mild retinal arteriolar tortuosity. Coagulation studies in the son revealed normal activated partial thromboplastin time (APTT), prolonged prothrombin time (PT) and 30% activity of factor VII. CONCLUSIONS Factor VII deficiency may aggravate the haemorrhages in retinal arteriolar tortuosity syndrome. We therefore suggest conducting routine coagulation studies (PT, APTT) in all patients with retinal arteriolar tortuosity syndrome. Determination of factor VII activity is warranted only in patients with normal APTT and prolonged PT.
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Affiliation(s)
- D Zadok
- Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel
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13
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Abstract
Although arteriovenous malformations (AVMs) have been known to have direct communications between arteries and veins without interposing capillaries, the exact location of arterial and venous junctions have not been defined. Utilizing microscopic and endoscopic observations, Yamada and associates identified shunting arterioles (50 mu-250 mu) directly connected to the AVM core vessels. While dissecting the AVMs in functional areas of the brain, shunting arterioles were sectioned to interrupt the arterial blood supply. This technique allowed cleavage formation between the core vessels and surrounding brain, thus avoiding brain tissue removal and preserving microcirculation to functionally critical brain. We demonstrate histologically for the first time by scanning electron microscopy shunting arterioles and communicating venules (20 mu-200 mu).
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Affiliation(s)
- S Yamada
- Department of Neurosurgery and Pathology, Loma Linda University School of Medicine, CA 92354, USA
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15
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Tanaka K, Inagaki S, Doi K. Preretinal arteriolar loops in rats. Lab Anim Sci 1994; 44:71-2. [PMID: 8007666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- K Tanaka
- Development Research Laboratories, Banyu Pharmaceutical Co., Ltd, Saitama, Japan
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16
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Affiliation(s)
- P A Gill
- New South Wales Agriculture, Regional Veterinary Laboratory, Wollongbar
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17
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Abstract
We investigated the presence of twin vessels in two patients and in four of their relatives at risk from one family with autosomal-dominant hereditary cavernous hemangioma of the retina associated with central nervous system involvement. Twin vessels were detected in four of the six patients examined. The proband had bilateral retinal vascular hamartomas with central nervous system involvement but no twin vessels. The proband's mother had vascular hamartomas of the retina and brain with twin vessels. In the other three family members, twin vessels were associated either with retinal cavernous hemangiomas (one patient) or with normal fundi (two patients). Because twin vessels may be an ocular manifestation of von Hippel-Lindau disease, their presence in one of our two patients and in the otherwise healthy three family members suggests that twin vessels may be associated with different retinal vascular hamartomas, including capillary and cavernous hemangiomas.
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Affiliation(s)
- F Bottoni
- Eye Clinic, S. Paolo Hospital, University of Milan, Italy
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18
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Cater G, Thibeault DW, Beatty EC, Kilbride HW, Huntrakoon M. Misalignment of lung vessels and alveolar capillary dysplasia: a cause of persistent pulmonary hypertension. J Pediatr 1989; 114:293-300. [PMID: 2915290 DOI: 10.1016/s0022-3476(89)80800-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two infants with fatal persistent pulmonary hypertension are described. Morphologically there was misalignment of the lung vessels, with the veins and the arterioles anomalously related, often sharing the same adventitial sheet. The capillaries did not make contact with the alveolar epithelium. The arterioles had increased medial muscle, and there was extension of the arteriolar muscularization to the precapillary level. The fraction of the parenchyma that was septal and connective tissue was increased. The acini had a decreased complexity, with immature alveoli and with a decreased radial alveolar count. The cause appeared to be related to abnormal capillary and venous plexus formation and migration. This syndrome seems to be identical with that described in three previous reports and probably represents a specific cause of persistent pulmonary hypertension.
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Affiliation(s)
- G Cater
- University of Missouri-Kansas City, School of Medicine
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19
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Abstract
Tortuosity of the retinal arterioles complicated by spontaneous retinal hemorrhages is inherited as an autosomal dominant trait. Even when hemorrhages involve the fovea, spontaneous clearing with recovery of normal vision is the rule. We have studied members of three families in which arteriolar tortuosity increases with age. Tortuosity increases most dramatically during adolescence and affects small arterioles in the macular area. Retinal hemorrhages in children from two pedigrees led to extensive laboratory investigation because arteriolar tortuosity, later unmistakeable, was not recognized initially. Inherited retinal arteriolar tortuosity may be overlooked easily, particularly in children. Patients with spontaneous retinal hemorrhages and their relatives should be examined for retinal arteriolar tortuosity before being subjected to cardiovascular or hematologic studies.
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20
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Lee J, Wattie J. Balloon angioplasty of a superior mesenteric artery occlusion in a patient with angiodysplasia of the caecum. Australas Radiol 1984; 28:240-3. [PMID: 6240257 DOI: 10.1111/j.1440-1673.1984.tb02513.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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21
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Soulages X, Géraud G, Delisle MB, Bès A, Bouissou H. [Recurrent cerebral ischaemic attacks in young subjects. Arteriolar dysplasia or early atheroma?]. Presse Med 1983; 12:1659-61. [PMID: 6224150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The case of a 33-year old woman with recurrent cerebral and peripheral ischaemic attacks is reported and the difficult nosological problem of juvenile ischaemia is discussed. Thromboangiitis obliterans (Buerger's disease) was excluded by morphological studies of finger tips, temporal artery and dermis, which demonstrated arteriolar dysplasia and premature aging of the connective tissue. A diagnosis of "juvenile atheroma" may be considered in view of the dyslipidaemia and increase in skin cholesterol and apoprotein B concentrations observed. A review of the literature, together with the biochemical and histological findings in this patient, suggests that ischaemic attacks, dysplasia of small vessels and serum dyslipidaemia reflected in the dermis are all manifestations of early atheroma.
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22
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Kayazawa F, Machida T. Retinal arteriolar tortuosity with macular hemorrhage. Ann Ophthalmol 1983; 15:42-43. [PMID: 6830095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A 58-year-old Japanese woman showed bilateral retinal arteriolar tortuosity with macular hemorrhage. Ophthalmoscopically, the retinal vein was normal, and other arteriosclerotic and hypertensive arteriolar changes were slight. The medical examination and laboratory tests did not reveal any significant etiologic factors. The hemorrhage absorbed rapidly, and visual outcome was excellent. To our knowledge, this case is the first reported in an Oriental.
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23
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Litvin B, Russo R. [A case of angiodysplasia of the colon]. J Belge Radiol 1983; 66:117-120. [PMID: 6630142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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24
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Abstract
Retinal arteriolar tortuosity with retinal haemorrhages was first described in 1958. In the present article, a case of recurring retinal haemorrhages combined with retinal arteriolar tortuosity is reported. The medical examination and laboratory tests did not reveal pathology except for a slightly increased bleeding time. There were no similar cases in the family. The cause of the haemorrhages is still unknown.
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