Ultrasonography in the quantification of arterial involvement in Takayasu's arteritis.

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) in the detection and quantification of arterial involvement in Takayasu's arteritis (TA). METHODS: The common carotid and subclavian arteries, and the abdominal aorta of 15 patients with TA were studied by Color Doppler (CD) US and Doppler spectral analysis and compared with angiography. RESULTS: The mean difference (+/-SD) between the percent luminal stenoses measured at angiography and by CD US was 2.0+/-10.3% for the common carotid artery, 4.0+/-23.6% for the subclavian artery and -1.3+/-16.8% for the abdominal aorta. The differences were not statistically significant. However, the agreement of the methods was less than satisfactory as shown by the wide standard deviations. CONCLUSIONS: More efforts are needed to improve the less than optimal agreement of US with angiography regarding the severity of individual stenoses. The technique performs best in the study of carotid arteries.

Arterial wall thickness measurements by B mode ultrasonography in patients with Takayasu's arteritis.

OBJECTIVE: To assess the feasibility and potential diagnostic usefulness of arterial ultrasonography in Takayasu's arteritis. METHODS: The total wall, intimal + medial, and adventitial thickness of the common carotid, subclavian and common femoral arteries, and of the abdominal aorta, were examined by B mode ultrasonography in 16 patients with Takayasu's arteritis and 16 healthy control subjects. RESULTS: The mean total wall and intimal + medial thickness of all arteries other than the common femoral were significantly increased in Takayasu's arteritis. Long segments of homogeneous circumferential wall thickening in multiple vessels were characteristic. When the common carotid and subclavian arteries and the abdominal aorta were examined, each individual with Takayasu's arteritis had at least one artery with total wall thickness exceeding the reference range in controls. CONCLUSIONS: B mode ultrasonography is able to expose the widespread arterial wall thickening characteristic of Takayasu's arteritis and may provide a useful tool for the detection and follow up of this disease.

Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa.

During a 10-year period, intraparenchymal aneurysms were found in 38 of 748 patients at selective abdominal angiography with magnification technique. According to strict criteria, 17 patients were classified as suffering from necrotizing vasculitis of the polyarteritis nodosa group (PAN), 7 from severe arterial hypertension, and 3 from rheumatoid arthritis. The diagnoses of 5 patients remained to be confirmed, and each of the remaining 6 patients suffered from various other diseases. PAN was diagnosed histopathologically in 2 patients without angiographic aneurysms. Based on the 156 patients in whom the indication for angiography was suspicion of arteritis, the angiographic diagnosis of PAN had a sensitivity of 89 percent and a specificity of 90 percent, a positive predictive value of 55 percent and a negative predictive value of 98 percent. The mean number of both renal and hepatic aneurysms was higher in patients with PAN than in the other patients (p less than 0.01 and p less than 0.05, respectively). Five PAN patients had numerous and large aneurysms, whereas the aneurysms of the other 12 PAN patients did not differ from those of patients with other diseases. Patients with PAN had renal infarcts more often than the other patients (p less than 0.05). Our findings suggest that visceral angiography is useful in establishing the diagnosis of PAN, but the angiographic finding of aneurysms is not pathognomonic.

Effects of alcohol on systemic and pulmonary hemodynamics in normal humans.

Even at low doses, alcohol has been reported to impair left ventricular pump function. To characterize further the effects of alcohol on the normal cardiovascular system, using the Swan-Ganz thermodilution catheter, we studied 6 healthy physicians, aged 27-36 years, while they were lightly intoxicated. Within a period of 30 min the subjects ingested 0.5 g/kg of ethanol diluted to 15% (w/v) in fruit juice. Hemodynamic measurements were obtained before the first ingestion and every half-hour thereafter for 2 hours. A peak blood ethanol concentration (mean +/- SE) of 13.3 +/- 1.6 mmol/l (0.61 mg/dl) was recorded at 60 min. Unexpectedly, pulmonary artery pressure rose during the early part of the increasing blood ethanol phase, probably due to pulmonary vascular constriction. At 30 min, the systolic pulmonary artery pressure had increased by 10% (p less than 0.05) and the diastolic pressure by 14% (p less than 0.001); both returned to baseline levels by the end of the experiment. Calculated pulmonary vascular resistance rose from a baseline value of 0.50 +/- 0.30 to 0.85 +/- 0.34 units (p less than 0.01) at 30 min. Left ventricular preload decreased significantly during the declining blood ethanol phase: mean pulmonary capillary wedge pressure decreased from 12 +/- 3 to 10 +/- 2 mmHg (p less than 0.01), and mean right atrial pressure decreased significantly. This study suggests that alcohol causes changes in cardiac function by altering its loading conditions. The combined diuretic and systemic venodilatory actions of alcohol provide the most probable explanation for the decrease in preload.

Treatment of Takayasu's arteritis: an analysis of 29 operated patients.

Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.059). The material of the graft, or postoperative warfarin or platelet-inhibitor drug treatment administered for at least 3 postoperative months had less bearing on graft patency. Ten out of the 11 graft occlusions occurred within the first 2 postoperative years. In operations due to lesions of the brachiocephalic arteries (20 patients), bypass procedures appeared to be superior to thromboendarterectomies; 67% (20/30) of the grafts and 17% (1/6) of the thromboendarterectomies remained patent. Five hypertensive patients underwent surgery because of renal artery stenosis. Hypertension was cured in one patient and in another the antihypertensive regimens could be reduced. There were 2 operative deaths, one due to myocardial infarction after aortic valve replacement and the other due to cerebral hemorrhage, probably because of excessive blood flow resulting from the insertion of an aorto-bicarotid bifurcation bypass graft. Four of the 7 late deaths occurring nine months to 15.7 years postoperatively were considered to be related to Takayasu's arteritis.

The mortality predictive power of discharge electrocardiogram after first acute myocardial infarction.

The prognostic value of discharge ECG was studied in 457 patients after their first acute myocardial infarction. Thirteen different ECG variables were studied on the discharge ECG. When cumulative 4-year survival rates were calculated by standard life-table method for each variable individually, the following variables had statistically significant prognostic power: PTF (P terminal force), PTFA (P terminal frontal axis), AF (atrial fibrillation), ST depression, ST elevation, QRS duration, and the combination block (LBBB/RBBB + LAHB/LPHB). The variables with no statistically significant predictive power were: QTc, LBBB or RBBB, LAHB or LPHB, AV block, T wave angle, T negativity, and sigma R. The relative risks for the most important variables in the discrete life-table model were: PTF 3.4, QRS duration 3.3, ST depression 2.6, PTFA 2.5, and ST elevation 2.2. In further analysis a model with only three ECG variables (PTF, ST depression, and ST elevation) was developed which stratified the study population in categories with 1.9% to 75.5% estimated 4-year survival rates.

Renal complications of polyarteritis nodosa: CT findings.

Three patients with multiple renal complications of polyarteritis nodosa are described. The arteriographic findings in these patients were multiple arterial aneurysms and tissue infarctions, with the development of spontaneous intrarenal, subcapsular, and perirenal hemorrhagic complications. Computed tomography showed the hemorrhages and multiple renal infarcts; acute and late forms could be differentiated on the basis of contrast medium enhancement and scar formation.

Bilateral renal artery dissections: unusual complication of polyarteritis nodosa.

A case of polyarteritis nodosa with the acute complications of multiple bilateral real artery dissection, perirenal haemorrhage and kidney infarction is described. The diagnosis of polyarteritis nodosa was established on the basis of angiographical and clinical findings. Follow-up arteriograms and CT-findings after prednisone therapy are discussed.