Takayasu's arteritis and Crohn's disease: an unusual association. Report on two cases.

Two cases of Takayasu's arteritis associated with Crohn's disease of the colon are described, both of which occurring in young female patients. In the first case, the vasculitic process was widespread, involving the aortic arch, the abdominal aorta, the renal arteries and the left iliac artery, similar to the angiographic "Indian" pattern. The second case presented a typical "Japanese" aortic arch involvement. In the first patient, Crohn's disease appeared to have been present prior to Takayasu's arteritis, vice versa in the second case; steroid treatment, assigned for both diseases might, however, have modified their natural evolution. The association is rare. Moreover, the coexistence of two immune-mediated diseases in the same subject is unusual as they are generally considered to be independent. Hypotheses concerning their possible inter-relationship are advanced.

[Takayasu's arteritis]. / L'arterite di Takayasu.

A brief review of Takayasu's Arteritis (TA), a chronic granulomatous arteritis that mainly affects the aorta and its major branches, is made. The various ethiopathogenetic mechanisms which may give origin to the vascular damage and its pathologic pattern are described. TA is a more widespread disease than previously stated, it is not exclusive of young women of Japanese origin but it is actually present worldwide irrespective of age and with variegated patterns of clinical and angiographic presentation. However, two main forms may be identified: the Japanese form in which prevails the aortic arch involvement and the Indian form in which vasculitis is present in abdominal aorta and its branches (above all the renal arteries) with an upright extension to the thoracic aorta and a protean clinical picture with a more systemic spectrum. The new clinical and angiographic criteria for TA definition are reviewed and stressed.

Effect of felodipine on arterial blood flow and venous function at rest in patients with mild essential hypertension.

Felodipine is a second-generation dihydropyridine calcium antagonist used to treat mild to moderate arterial hypertension. The authors used venous occlusion plethysmography to study the effect of this drug on lower limb arterial inflow and venous outflow in 10 at rest patients with mild essential hypertension. They also sought correlations between changes in district blood flow and blood pressure. Plethysmography was carried out at 8 AM and 4, 8, and 24 hours later at baseline (after washout), on the first day of treatment with a single daily administration of 10 mg felodipine ER, and after 7 and 30 days of treatment. The drug was given after the 8 AM evaluation. The authors determined rest flow, maximal venous incremental volume (MVIV) at 40 mmHg and 60 mmHg, and gradient of venous volume between 60 and 40 mmHg divided by the pressure difference (DV/DP) as index of venous distensibility. On the days of plethysmographic evaluation, arterial blood pressure and heart rate were measured continuously over 24 hours by the ABPM (Ambulatory Blood Pressure Monitoring). The results were analyzed by ANOVA. Rest flow, MVIV, and DV/DP were stable at the baseline evaluation. On days 1, 7, and 30 of treatment the rest flow after 4 and 8 hours was significantly greater than at 8 AM but had always returned to normal after 24 hours. No other plethysmographic parameters changed significantly; in particular venous outflow remained unchanged. Mean arterial, systolic, and diastolic blood pressure were significantly reduced, compared with baseline, following treatment on the first day and after 7 and 30 days' treatment. There was no effect on heart rate. The authors conclude that felodipine is useful for the treatment of mild essential hypertension, since it reduces arterial resistance without altering venous capacitance or distensibility.

[The evaluation of the effect of venodilatation in 2 different systems of transdermal nitroglycerin release]. / Valutazione dell'effetto di venodilatazione di due diversi sistemi di rilascio transdermico di nitroglicerina.

The aim of our study was to compare the activity of two different nitroglycerin controlled release systems (active matrix versus polyptychial matrix) on venous lower limbs circulation evaluated with strain-gauge plethysmography. Ten patients with stable coronary heart disease (M 5, F 5, mean age 65.1 +/- 4.6) were recruited and randomized to receive transdermal placebo and 5 or 10 mg of nitroglycerin carried by polyptychial or active matrix in a sequential and variable order. Five transdermal delivery systems were used with different content: placebo, nitroglycerin 5 or 10 mg on two different matrices (active matrix or polyptychial matrix). Venous strain-gauge plethysmography was performed in basal conditions and after 30, 60, 90, 120, 180, 240, 480, 1440 minutes, to evaluate the following parameters: maximal venous incremental volume at 40 and 60 mmHg (MVIV40 and MVIV60); time of maximal venous incremental volume at 60 mmHg (tMVIV60); maximal volume of outflow (MVO); time of maximal volume of outflow (tMVO); index of venous distensibility (dV/dP); index of venous tone (dP/dP); venous pressure (PV). Statistical data analysis was performed by one-way A.NO.VA and two-tailed Student's t test. The results of our study have shown that both transdermal systems, active and polyptychial matrix, are able to induce a venodilatation, but venodilatation induced by active matrix carried transdermal nitroglycerin along 24 hours is more stable and higher than that induced by polyptychial matrix carried transdermal nitroglycerin.