Nail fold dermoscopy in collagen vascular disorders: A cross-sectional study

Background: The collagen vascular disorders, particularly systemic sclerosis, dermatomyositis, systemic lupus erythematosus and mixed connective tissue disorder, are often characterized by microangiopathic abnormalities of the nail folds. Nail fold dermoscopy is a well-established technique to assess these vascular changes. Aims: To evaluate finger nail capillary vascular abnormalities by dermoscopy and their correlation with cutaneous and systemic involvement in the patients of collagen vascular disorders. Methods: This was a cross-sectional study involving patients of collagen vascular disorders presenting to Government Medical College, Amritsar over a period of 2 years. Nail fold dermoscopy was done in these patients and correlated with cutaneous and systemic involvement. Statistical analysis was done using SPSS 17.0 version. Results: A total of 30 patients were enrolled in the study. Sixteen (53.3%), 11 (36.7%) and 3 (10%) patients of systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disorder, respectively were included for nail fold dermoscopy. The commonest change recorded in our study was dilated capillaries in 21 (70%) patients, followed by capillary dropouts in 17 (56.7%) patients and avascular areas in 16 (53.3%) patients. Of 17 patients presenting with sclerodactyly, active, early and late patterns were seen in 7 (41.2%), 2 (11.8%) and 7 (41.2%) patients, respectively. Out of 13 patients with respiratory involvement, active, early and late patterns were seen in 1, 1 and 7 (53.8%) patients, respectively (P value = 0.004). Limitations: Owing to lesser number of patients in our study, it is difficult to draw conclusive recommendations, and more studies with a larger sample size are required. Conclusion: Dermoscopy is a valuable tool not only to diagnose collagen vascular disorders but also for prognostication by correlating with systemic involvement.

The study of correlation between dyslipidemia and hypertension and its complications in 30-70 years age group.

Background: Dyslipidemia and hypertension were the two widely recognized independent key risk factors for development of coronary vascular disorders (CVD). Therefore, Dyslipidemia and hypertension can serve as an easy clinical approach to know persons at greater risk for the and timely interference directed to decrease CVD events. To this purpose, we studied the correlation between dyslipidemia and hypertension and its complications among 30-70 years age group in a tertiary care hospital in Andhra Pradesh. Materials and methods: The present work was a hospital based, analytical cross sectional study conducted in the department of General Medicine in a tertiary care hospital at Andhra Pradesh over the period of two years from October 2012 to September 2014. A total of 100 HTN patients and 50 non hypertensive controls were recruited for the study. The patients were in the range of 30-70 years age group. Both known hypertensive patients who were on treatment for a varying period of time and newly diagnosed hypertensive patients were included in the study. The hypertensive and healthy controls were selected in to the study by systematic random sampling. A structured and validated designed case report form (CRF) was used for data collection. The tool was validated by including the inputs from five experts in the subject area. The blood samples were drawn from all the patients after 10 to 12 hours of fasting. FBS, PPBS and Lipid profile values were obtained as per the prescribed T.V Murali Krishna, Vijaya Kumar Vasa, V A Deepika Ponnuru. The study of correlation between dyslipidemia and hypertension and its complications in 30-70 years age group . IAIM, 2016; 3(4): 84-90. Page 85 standards. Descriptive analysis of demographic and relevant clinical parameters was done. Various serum lipid levels were considered as primary outcome variables. Categorical variables were presented as frequencies and percentages. Results: There were 100 hypertension patients and 50 controls were included in the final analysis. Among the hypertension patients 86% of them were males and 14% were females. The HDL value was lower in hypertensive patients, compared to control group (39.78±6.37 Vs 54.5±4.2). Statistically significant difference was observed in total cholesterol, LDL cholesterol, TC/HDL ratio and LDL/HDL ratio between obese and non obese as well as in CVA, IHD among hypertensive patients relatively with healthy volunteers. Conclusion: Biochemically there was significant difference was observed in total cholesterol, LDL cholesterol, TC/HDL ratio and LDL/HDL ratio between obese and non obese hypertensive patients. The similar discrepancy was noticed in CVA, IHD patient population. The HDL value was low down in all hypertensive patients compared to control group

Delayed Diagnosis of Probable Radiation Induced Spinal Cord Vascular Disorders

Occasionally, unexpected neurological deficits occur after lumbar spinal surgery. We report a case of monoparesis after lumbar decompressive surgery. A 63-year-old man, who had undergone decompression of L4-5 for spinal stenosis 4 days previously in the other hospital, visted the emergency department with progressive weakness in the left leg and hypoesthesia below sensory level T7 on the right side. He had been cured of lung cancer with chemotherapy and radiation therapy 10 years previously, but detailed information of radiotherapy was not available. Whole spine magnetic resonance (MR) imaging showed fatty marrow change from T1 to T8, most likely due to previous irradiation. The T2-weighted MR image showed a high-signal T4-5 spinal cord lesion surrounded by a low signal rim, and the T1-weighted MR image showed focal high signal intensity with focal enhancement. The radiological diagnosis was vascular disorders with suspicious bleeding. Surgical removal was refused by the patient. With rehabilitation, the patient could walk independently without assistance 2 months later. Considering radiation induced change at thoracic vertebrae, vascular disorders may be induced by irradiation. If the spinal cord was previously irradiated, radiation induced vascular disorders needs to be considered.

Liver pathology in collagen vascular disorders highlighting the vascular changes within portal tracts.

Background: Collagen vascular disorders (CVDs) are autoimmune disorders with multisystem involvement. Clinical liver involvement is not a characteristic feature though histological involvement could be frequent. Liver disease in CVDs could be the consequence of various factors. Aim: The aim was to analyze the histological spectrum of liver in collagen vascular disorders (CVDs) at autopsy. Materials and Methods: Thirty-six autopsy livers negative for hepatitis B or C virus were studied in CVD cases with no known association with chronic liver disease or vascular thrombosis or hematological disorder. Cirrhotic and normal livers were used as controls. The paired t-test, one-way ANOVA, and two-sided Dunnett t-test were used for comparison (< 0.05). None of the control cases showed any abnormal vessels. Results: There were 21 systemic lupus erythematosus (SLE), 7 rheumatoid arthritis (RA), 5 systemic sclerosis (SSc), and 3 polyarteritis nodosa (PAN) cases (M:F = 11:25, age range 23-60 years). Histology: Diffuse nodular regenerative hyperplasia of liver (NRHL) was seen in 10 cases, and 6 (5 SLE and 1 RA) had numerous abnormal thin-walled vessels in intermediate- and small-sized portal tracts with no vascular occlusion or inflammation. Moderate sized portal tracts showed more interface and lobular inflammation. The main portal vein and its major branches were normal. None of these six cases had increased transmainases (P>0.05). Most SLE cases had increased transaminases (P<0.05). No evidence of portal hypertension was seen in all except in one RA. Septicemia is known to be associated with raised transaminases. Conclusion: A rare pathology of conglomerate of abnormal vessels in intermediate- and small-sized portal system was observed co-existing with NRHL in CVDs. Raised liver enzyme with interface hepatitis in CVD may not necessarily warrant an overlap, as a similar feature could be observed in septicemia.

Histologic and Immunohistochemical Study of Cutaneous Vascular Disorders

There is a wide array of designation for cutaneous vascular disorders based on clinical characteristics, histology, embryology, cellular biology, and hemodynamics. The cutaneous vascular disorders can be divided into hemangioma and vascular malformation according to the biologic classification based on cell kinetics i.e. endothelial hyperplasia. There are clinical and histologic differences between them. In this study, clinical, histologic and im-munohistochemical evaluations were attempted on 40 cases of cutaneous vascular disorders diagnosed the period between 1985 and 1993. The results are as follows: 1) Twenty-three out of forty cases were immunoreacive for proliferating cell nuclear antigen(PCNA). The lesions composed of capillary-sized blood vessels with endothelial hyperplasia were diffusely reactive, whereas those composed largely of dilated blood vessels with or without focal endothelial hyperplasia were only focally reactive. 2) Each groups of the classic classification contained both reactive and nonreactive cases except nevus flammeus and juvenfle hemangioma. 3) In contrast to the cases nonreactive for PCNA, those reactive for PCNA contained areas of proliferating small vessels, which showed reactivity for PCNA. In conclusion, the cutaneous vascular disorders diagnosed by the classic classification are heterogeneous in the pattern of the endothelial hyperplasia and the PCNA staining. Therefore it should be classified by the clinical and the histologic characteristics.

High resolution magnetic resonance angiography in evaluation of relationship between carotid arteriosclerosis and ischemic cerebral vascular disorders / 解放军医学杂志

Objective To evaluate the relationship between carotid arteriosclerosis and ischemic cerebral vascular disorders (ICVD). Method We examined 126 ICVD patients and 126 non-ICVD patients in the alterations of carotid dimension and intramembrane morphology with magnetic resonance angiography (MRA). Results Carotid plaques to various extent were detected in 82 cases of ICVD patients and 38 cases of non-ICVD patients. The incidence of carotid plaques was 68.3% and 35.7%, respectively in these two groups of patients. Furthermore, patients either with age over 60 years, hypertension, or hyperlipemia were found to be more susceptible to carotid arteriosclerosis. Conclusion MRA is very useful to detect early-stage carotid arteriosclerosis, and the occurrence in the carotid arteriosclerosis is closely related to ICVD.