The "Eternal Recurrence" of Arteritis. Suggesting Autoimmunity Underlining Friedrich Nietzsche's Challenging Clinical Case.

Friedrich Wilhelm Nietzsche (Röcken 1844 -Weimar 1900), the philosopher who theorized the concept of "eternal recurrence", suffered a lifelong multifaceted chronic illness that started in pediatric age with severe headaches and ended up with stroke at the age of 56. Even though many hypothetical diagnosis have been proposed in recent years, they all failed to explain the totality of clinical conditions that co-occurred in the philosopher's extremely challenging case, and debate on the matter is still open. In this report, we suggest an autoimmune condition, specifically Takayasu's arteritis, as a possible etiology of the philosopher's illness, which could not only potentially fit all available clinical data but also be the medical counterpart of Nietzsche's philosophical thought: could eternal recurrence of arteritis explain Zarathustra's destiny? If so, could a vascular surgeon, at this time in future, be so superhuman to change it?

[To centenary of Takayasu's presentation of nonspecific aortoarteritis case].

Literature review is dedicated to the 100th anniversary of the first case presentation for nonspecific aortoarteritis. The review covers the history of the disease concept development, current knowledge on its etiology and pathogenesis, unresolved problems of management strategy for patients with this pathology.

Takayasu disease on the centenary of its discovery.

Takayasu disease was first reported in 1908 by Mikito Takayasu as "a case of peculiar changes in the central retinal vessels." Because in these patients the pulse of the radial artery is impalpable, investigations focusing on the ischemic symptoms of the upper body were conducted. In 1948, Shimizu and Sano named this pathological condition "pulseless disease." Since then, the lesions of Takayasu disease have been detected not only in the aortic arch and its main branches but also in various vessels, including the abdominal aorta and renal arteries. The ocular symptoms of Takayasu disease are considered to be due to ischemia in the retina and choroid. The typical wreath-like arteriovenous anastomosis around the disc reported by Takayasu is observed at a relatively late stage of the disease. The characteristic fundus findings of Takayasu disease include tortuosity and dilatation of the central retinal artery and vein, retinal arteriovenous anastomosis, prominent retinal vasculature, microaneurysms in the capillaries, occlusion of retinal arterioles, soft exudate, choked disc, and optic atrophy. Fluorescein angiography reveals retinal microaneurysms, sludging, slower blood flow, dilatation of retinal vessels, leakage of fluorescence dye due to increased vascular permeability, and arteriovenous anastomosis. Arteriovenous anastomosis initially appears in the periphery at the early stage, and in the arteriovenous crossing at the advanced stage. Systemic administration of corticosteroids is required to prevent vascular stenosis during the early stages of Takayasu disease. Reconstruction of the carotid artery may improve subjective symptoms and fundus findings.

[Takayasu disease--pulseless disease].

In 1908, Takayasu, an ophthalmologist, reported "a case of strange changes in the central retinal vessels" without mentioning the other physical changes. In 1948, Shimizu and Sano examined 6 cases (5 women and one man) of the disease and found that the disease was actually a chronic type of arteritis that affects mainly the aortic arch and its branches and often the pulmonary arteries. They named the disease "Pulseless Disease." They called the following three signs as the Triad of the disease: (1) absence of radial pulsation, (2) signs and symptoms referable to the hyperactive carotid sinus reflex, (3) hypotensive opthalmoangiopathia as reported by Takayasu. Sano and Saito found that the sera of the patients contained immune interferon, and that the sera also contained such gamma globulin that reacted specifically with the affected arterial wall components such as vasa vasorum and the surrounding tissues and the media etc-an autoimmune disease.

Perspectiva histórica de la clasificación de las vasculitis / Historical perspective on the classification of vasculitis

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Nosology of primary vasculitis.

PURPOSE OF REVIEW: Recent developments in the nosology of primary systemic vasculitis are placed in the context of an historical overview. The ongoing attempts to develop criteria for classification and diagnosis are discussed. RECENT FINDINGS: Giant cell arteritis has supplanted temporal arteritis as the preferred term for chronic granulomatous arteritis in older adults. A new classification system for childhood vasculitis has been proposed by a European collaborative group. A study of idiopathic polyarteritis nodosa demonstrates greater similarity to microscopic polyangiitis in relapse rate than previously reported. Controversy has arisen over the eponym Wegener's granulomatosis because of alleged involvement of Friedrich Wegener in the Nazi regime during World War II. Diagnostic criteria for Kawasaki disease are problematic because many patients with coronary artery involvement do not fulfill current criteria at the time of presentation. Classification of antineutrophil cytoplasm autoantibody-associated small vessel vasculitis based on antineutrophil cytoplasm autoantibody specificity has been complicated by the finding that different ethnic groups may have very different clinical features relative to antigen specificity; for example, most patients with Wegener's granulomatosis in China have myeloperoxidase-antineutrophil cytoplasm autoantibodies rather than proteinase 3-antineutrophil cytoplasm autoantibodies. SUMMARY: Within the past year, new classification systems for primary vasculitis have been proposed, new classification criteria have been developed, and the appropriateness of a longstanding eponym has been challenged.

[Takayasu's arteritis. A concise review and some observations on a putative case reported by Giovanni Battista Morgagni (1761)]. / L'arterite di Takayasu. Una breve sintesi della letteratura e qualche riflessione sopra un possibile caso descritto da Giovanni Battista Morgagni (1761).

The discovery of Takayasu's arteritis is likely to date back as far as 1830, owing to the first description of the Japanese Rokushu Yamamoto. Thereafter, several authors from certain geographical areas and in various historical periods described such a vascular disorder, by introducing a quantity of definitions. At present, it is defined as an eponymic disease, namely Takayasu's arteritis, since Makito Takayasu, a Japanese ophtalmologist, reported in 1908 the clinical history of a woman showing some particular retinal anastomotic shunts of arterioles and venules. In the present study the description of an about 40 year-old woman suffering from a pulseless disease, as reported by Giovanni Battista Morgagni in 1761, is summarized. Such a description could be the first case report of Takayasu's arteritis, according to some previous literature data and our critical analysis.

[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.

Takayasu arteritis--five doctors in the history of Takayasu arteritis.

Takayasu arteritis is a chronic vasculitis mainly involving the aorta, its main branches, pulmonary and coronary arteries. Recent international survey has made clear different sex ratio, different involvement and different clinical manifestations among countries. At the same time, ethnic distribution of this morbid condition has focused on the role of genetic factors and the mechanisms inducing vasculitis. In this paper, five doctors who contributed in history to the elucidation of Takayasu arteritis were introduced as an aid in understanding recent studies on this morbid condition.

A case of Takayasu's disease occurred over two hundred years ago.

The author refers to a case described in 1761 by G.B. Morgagni, in which there were all the clinico-pathological features of aspecific aorto-arteritis, as it was pointed out in this century by some Japanese authors. Morgagni's case was a woman 40 years old, whose radial pulses were never perceived for many years before her death; the necroscopic examination showed severe aortic alterations, characterized by ectasias, aneurysms and stenosis, with subclavian obstruction at the origin. The radial arteries, on the contrary, were found unaffected. This case, as well as another reported by Savory in 1856, demonstrates that an obstructive disease of the aorta and its branches had been already noted and described long before in the European Countries in spite of the rarity of this sickness.