Medium Caliber Arteries Research Articles

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

Type 1 kyphoscoliotic Ehlers–Danlos syndrome caused by mutations of the PLOD1 gene: analysis of own observations

Kyphoscoliotic type of Ehlers–Danlo syndrome occurs in the practice of doctors of different specialties. The main manifestations of the disease are congenital muscular hypotonia, progressive kyphoscoliosis, generalized joint hypermobility, dislocation/subluxation of the joints. In recent years, special attention has been paid to the fragility of blood vessels characteristic of patients, which usually has serious consequences. Purpose: the study aims at clarifying the clinical characteristics of type 1 kyphoscoliotic Ehlers–Danlo syndrome based on the analysis of the clinical findings observed in 2 patients with severe vascular disorders. Data from clinical and molecular genetic examination of 2 children (girl and boy) 17 and 13 years old from unrelated families are presented. The diagnosis of type 1 kyphoscoliotic Ehlers–Danlo syndrome was established in accordance with the diagnostic criteria according to the International Classification 2017. Children showed severe vascular disorders in the neonatal period, ruptures of medium-caliber arteries in adolescence. Genomic sequencing in both patients revealed a pathogenic nucleotide variant in the PLOD1 gene — duplication of the 11959421–11968422 chromosome 1 region in the homozygous state. The results of literature analysis and own observations of 2 patients with type 1 kyphoscoliotic Ehlers–Danlo syndrome indicate the severity and rather high incidence of vascular disorders, which should be considered when developing recommendations for the medical management of patients.

Cerebral hemodynamic disorders in patients with schizophrenia with concomitant metabolic syndrome

To identify the differences or comparability of parameters of cerebral hemodynamics between patients with schizophrenia with or without concomitant metabolic syndrome (MS). The study included 94 patients with schizophrenia (48 men and 46 women). A control group consisted of 40 mentally and somatically healthy individuals (17 men and 23 women) comparable in sex and age to the main group of patients. The diagnosis of metabolic syndrome was carried out according to the criteria of the International Diabetes Federation (IDF). Assessment of cerebral hemodynamics was carried out by 4 - channel rheoencephalography (REG) at rest with closed eyes. Data analysis was carried out using the Kraskel-Wallis ANOVA criterion with the procedure of automatic a posteriori pairwise comparison, the χ2 criterion and Spearman correlation analysis. According to the IDF criteria, 37 (39.4%) patients were diagnosed with MS. REG results revealed significantly (p<0.05) lower indicators of blood filling in the carotid basin, elasticity of the wall of the main arteries, the tone of small-caliber arteries and arterioles, as well as higher values of the tone of medium-caliber arteries in the carotid and vertebrobasilar basins, in both groups of patients with schizophrenia compared with the control group. In patients with schizophrenia with MS, compared with patients without MS, there were lower indicators of blood filling (p=0.044 and p=0.016) and elasticity of the wall of the main arteries (p=0.044 and p=0.028) in the carotid basin on the left and right sides. The presence of MS in patients with schizophrenia was accompanied by more pronounced disorders of cerebral blood flow in the form of a decrease in blood filling and elasticity of the wall of the main arteries in the carotid basin. The results indicate that patients with schizophrenia with MS should be considered as a group at increased risk of cerebrovascular diseases.

The role of immune aging in Giant Cell Arteritis

Giant cell arteritis (GCA) is a granulomatous vasculitis with a predilection for medium and large calibre arteries. The most significant risk factor for its development is advancing age, with a peak incidence in the seventh and eighth decades of life. Despite this, until recently, the role of aging in disease pathogenesis has been largely overlooked. Advancing age is associated with numerous alterations in both the innate and adaptive immune system. Indeed, there is significant overlap in the cellular and molecular pathways involved in immune aging and those observed in the pathogenesis of GCA. In this review we explore these similarities and further expand the discussion on the postulated role of accelerated immune ageing in the pathogenesis of GCA. With the dramatic increase in lifespan in recent decades, elucidating the potential role of early immune aging in disease pathogenesis is extremely pertinent, with the potential to offer a new therapeutic avenue not only for those with GCA, but all immune mediated rheumatic diseases.

E45 Kawasaki syndrome-related heart disease before and during the COVID-19 pandemic

Abstract Introduction Kawasaki disease (kDa) is an acute febrile systemic panvascularitis that affects medium-caliber arteries with a strong predilection for the coronary arteries. It is the leading cause of acquired heart disease in children under 5 years of age. However, after the COVID-19 pandemic, we see a change in the profile of cardiac involvement. Objective To describe the clinical, paraclinical, and evolutionary characteristics of cardiac damage in children managed for Kawasaki or Kawasaki-Like syndrome before and during the Covid19 pandemic. Materials and Methods This is a retrospective, descriptive study conducted over a period of five years (1st January 2017 to 31st December 2021). Result We collected 30 cases of patients hospitalized with Kawasaki disease, between January 2017 and December 2021: 11 cases with Kawasaki syndrome before COVID-19; and 19 cases with Kawasaki syndrome after COVID-19. The mean age and standard deviation (SD) at diagnosis was 42 (±37.8) months before the pandemic vs 81 (±34.7) months after the pandemic. The sex ratio was 0.5 (4 girls and 7 boys) before the pandemic vs 0.7 (8 girls and 11 boys) after the pandemic. Heart damage was found in 2 cases before the pandemic (coronary aneurysm type) vs 3 cases after the pandemic, mainly cardiogenic shock. The mean time from the first transthoracic ultrasound to fever was 11.3 days before the pandemic, vs 5.8 days after the pandemic. Transthoracic ultrasound showed 2 cases of coronary aneurysm before the pandemic, with a Z score exceeding 2.5SD; vs 7 cases of heart failure after the pandemic with a decrease in left ventricular ejection fraction. The ASAI score (a score that assesses the risk of coronary artery disease) was &amp;gt;6 in 1 case before the pandemic vs in 0 cases after the pandemic. The average predictive score for cardiac involvement was 4.2 (±1.4) before the pandemic, vs 3.5 (±1.5) after the pandemic. The outcome was favorable in all cases despite a more severe picture after the COVID-19 pandemic. Conclusion The change in the pattern of cardiac involvement in Kawasaki disease following the emergence of COVID-19 must be taken into account in order to manage an influx of patients with severe Kawasaki disease.

Pathological Aspects and Immunohistochemical Evaluation of Troponin C in the Cardiovascular System of Dogs With Pheochromocytoma

Functional pheochromocytomas secrete catecholamines and have been associated with cardiovascular lesions in dogs. This study aimed to describe the postmortem pathological findings in the cardiovascular system of dogs with pheochromocytoma and to evaluate the expression of cardiac troponin C in these dogs using immunohistochemical analysis. Twelve cases were identified, with a mean age of 10.6 years. The heart of all dogs was enlarged and with concentric hypertrophy of the left ventricular myocardium. Histological analysis showed cardiomyocyte necrosis and degeneration in the myocardium, with frequent bands of contraction, fibrosis, inflammation, and thickening of the medium-caliber arteries in the myocardium. There was a marked decrease or absence of immunolabeling in necrotic cardiomyocytes. We conclude that IHC for troponin C can be a useful tool for detecting myocardial necrosis in dogs with pheochromocytomas, including early cases of necrosis with only incipient cardiac changes where overt histologic abnormalities are not immediately apparent in the cardiomyocytes.

PECULIARITIES OF THE STRUCTURAL AND FUNCTIONAL REARRANGEMENT OF THE PARENCHYMA OF THE TESTES OF RATS WITH DOSED STENOSIS OF THE AORTO-ILIAC SEGMENT

Relevance. Abdominal ischemic disease is a general term that characterizes various clinical syndromes of damage to the organs of the digestive system when blood flow is disturbed in the abdominal part of the aorta and its branches, as a result of which there is a disparity of the blood supply of internal organs to their energy needs with the subsequent development of chronic ischemia and necrosis of cells and tissue.&#x0D; Objective. To establish the characteristic features of the dynamics of the remodeling of the blood vessel of the testicles of rats with dosed stenosis of the aorto-iliac segment.&#x0D; Materials and methods. The experiment was conducted on 48 white outbred sexually mature male rats with an average age of 3 months and a weight of 180-200 g. All animals were divided into two groups: experimental group consisted of 36 animals with simulated dosage stenosis of the aorto-iliac segment and control group (12 subjects). All operative manipulations were performed in compliance with the rules of asepsis and antisepsis. Preliminary anesthetization of the animals was carried out with the intramuscular injections of ketamine (50 mg/ml) in terms of 0.083 mg/g of body weight. After performing a laparotomy through a midsection along the white line of the abdominal wall, the abdominal aorta was isolated and compressed by 1/3 of its diameter by applying a silk ligature. The degree of narrowing was controlled using a metal probe with a cone-shaped tip according to the already known method. On the 1st, 3rd, 7th, and 14th day, the animals were taken out of the experiment and an organometric assessment of the condition of the testicles was carried out with the determination of the following parameters: the weight of the organ was determined using a torsion weight VT-500, the length and width were measured using a caliper. After that, pieces of testicular tissue were taken and fixed in a 10% solution of neutral formalin and 96% ethyl alcohol. The obtained paraffin sections with a thickness of 5-7 μm were stained with hematoxylin and eosin, and microscopic examination of a series of histological sections was carried out.&#x0D; Results. A day after the simulation of experimental stenosis of the aorto-iliac segment, a microscopic examination of the structures of the testicle revealed significant swelling of the stroma of the organ. The interstitial tissue was unevenly located between the tortuous seminiferous tubules, the lumen between which was slightly expanded. At the same time, the internal structure of the tubules remained preserved, layers of spermatogenic cells at different stages of maturation were clearly differentiated in them.&#x0D; On the third day of observation, previously identified signs of disorders of organ blood circulation in the testicles continued to increase. The swelling of the testicular interstitial tissue slightly decreased, but it was accompanied by changes in the structure of the cells of the spermatogenic epithelium, the manifestation of which was the detachment of spermatogonia from the basal membrane of the tubules and the expansion of the spaces between the rows of spermatogenic cells. The walls of the small arteries and arterioles were still significantly thickened.&#x0D; On the 7th day of observation, against the background of a significant decrease in the swelling of the space between the tortuous seminiferous tubules, dystrophic changes in the testicular tissue began to increase.&#x0D; On the 14th day of observation, even more expressed signs of organ hemodynamics violation were observed, and as a result, deviations of the trophism of testicles of experimental animals. Manifestation of such changes were prominent arterial and venous plethora. Large-caliber arteries were significantly filled with blood, and as a result, small and medium-caliber arteries, especially arterioles, had thickened walls and a markedly narrowed lumen.&#x0D; Conclusion. With dosed stenosis of the aorto-iliac segment, significant disorders of central hemodynamics occur, which are characteristic of occlusive diseases of the aorta and its branches.&#x0D; As a result, in the testes of sexually mature male rats, dystrophic changes in the cells of the spermatogenic epithelium occur and the functional activity of the organ decreases, which can form the basis for the development of infertility.

Infantile Periarteritis Nodosa (About 5 Cases and Review of the Literature)

PAN is an inflammatory and necrotizing vasculitis affecting small and medium caliber arteries of the body, rarely described in children. Its pathophysiology is complex and remains poorly elucidated, involving the deposition of circulating immune complexes in the vascular wall, neutrophil anti-cytoplasmic antibodies, the role of cytotoxic lymphocytes, cytokines, environmental factors (infections), as well as genetic susceptibility (mutations in ADA 2 and the MEFV gene). There are two main forms: a classic systemic form with visceral involvement (60% of cases) and a cutaneous form with lesions limited to the skin and muscles (30%), which usually evolve less severely. Positive diagnosis is based on the Eular/Printo/Pres criteria. The treatment depends on the form of PAN, and relies essentially on NSAIDs, colchicine, corticotherapy and immunosuppressants: azathioprine and cyclophosphamide. Our work is a retrospective study of 5 cases of PAN, collected at the IV pediatric department and the pediatric rheumatology consultation of the children's hospital of Rabat between 2009 and 2014: The diagnosis was retained on the criteria of Eular/Printo/Pres. The clinical picture was dominated by skin and joint involvement. One of our patients presented an atypical picture of PAN associated with infective endocarditis and large vessel involvement. All of our patients received corticosteroid therapy, and one of our patients benefited́ in addition to colchicine.

60 Childhood Behçet disease: clinical features, management and outcome of 13 cases

BackgroundBehçet disease is a rare vasculitis that involves medium and small calibre arteries. Multisystem involvement is possible. Few are the papers that provide information about its clinical course, and outcome in the pediatric population. Also, the management is mainly based on adult guidelines.ObjectivesTo shed light on the clinical course and outcome of juvenile Behçet disease.MethodsA single center retrospective descriptive study of 13 children with Bechet disease. The mean follow-up period was for 3 years.ResultsWe had 8 boys and 5 girls. Four of our patients were consanguineous. The mean age was 9 years. The mean interval between onset and diagnosis was 3 months. All of our patients had recurrent aphthous stomatitis with a median of 6 episodes per year. The other symptoms at diagnosis were concomitant genital ulcers in 4 cases, pseudo-folliculitis in 7 cases, urticarial rush in 4 cases, severe headache in 2 patients, stroke in one patient, prolonged and/or recurrent fever in 9 patients, uveitis in 4 cases, episcleritis in one case, arthritis in 5 cases, pulmonary hemorrhage in one case, and pyoderma gangrenosum in one case. The pathergy test was performed in all the patients, and was positive in 3 of them. Diagnosis was based on the International Criteria for Behcet's Disease. Acute phase reactants (ESR and CRP) were high in all patients. Meanwhile, granulocytosis was found in 10 patients. HLA 51 was positive in 8 patients, from whom three were siblings. All our patients were on steroids, five had colchicine, seven had azathioprine, two had methotrexate, two had cyclophosphamide, three had etanercept and one had tocilizumab. Complete remission was obtained in 8 cases in a mean time of 15 months, while five children had partial remission, and one boy lost sight of his left eye after a severe retinitis.ConclusionBehcet’s disease can cause severe sequalae if not diagnosed and treated on time. More studies are needed to establish management guidelines for pediatric population.

46 Evaluating Clinical Outcomes in Temporal Artery Biopsy: A Retrospective Observational Study

Abstract Aim Giant cell arteritis (GCA) is an inflammatory vasculopathy affecting large and medium calibre arteries, with temporal artery biopsy (TAB) constituting an important diagnostic component. The aim of this study was to analyse local practice in TAB and assess clinical outcomes with reference to current guidelines. Method All patients undergoing TAB in our institution between April 2018 and March 2021 were retrospectively studied and the American College of Rheumatology (ACR) score recorded. Results 124 patients were included in the study. The female to male ratio was 2.2:1 and average age was 71±10 years. 95 patients presented with temporal artery signs and headache respectively. The mean time from steroid commencement to TAB was 6 days (range 0–36 days). 23 biopsies were positive (median ACR score of 4, range 2–4, excluding pathology result) – these patients were treated with steroids. 98 biopsies were negative or non-specific; most stopped steroid treatment, however 30 patients were clinically GCA and continued therapy (median ACR score of 3, range 2–4). Three patients were never prescribed steroids (median ACR score of 2). Conclusions GCA is a clinical diagnosis guided by symptoms and signs, inflammatory biochemical markers, and medium artery biopsy. The provisional ACR scoring is highly suggestive of the outcome of TAB.

Vasculitis Associated with Parrot Bornavirus 4 Infection in a Rose-Crowned Parakeet (Pyrrhurarhodocephala)

A 3-month-old, female rose-crowned parakeet (Pyrrhura rhodocephala) was found dead after a 24-hcourse of lethargy and passing blood-tinged faeces. Fine white streaks were seen in the pectoral muscles on necropsy. Microscopic examination revealed typical lesions of avian ganglioneuritis and vascular necrosis in the pectoral muscles, myocardium, kidneys, air sacs, adrenal glands, pancreas and thyroid gland. These lesions were characterized by mural fibrinoid necrosis of small and medium-calibre arteries and arterioles, associated with lymphoplasmacytic inflammation, necrosis, atrophy and fibrosis of the surrounding tissues. Parrot bornavirus (PaBV) nucleoprotein was demonstrated by immunohistochemistry in smooth muscle and endothelial cells of many vessels. An avian bornavirus was isolated from kidney tissue and its identity confirmed as PaBV-4 by sequencing and phylogenetic analysis. We postulate that the vascular lesions could have been immune-mediated and that PaBV-4 may have played a role in its pathogenesis.

Cardiac Fibromuscular Dysplasia of Small to Medium Caliber Arteries: An Elusive Spot Diagnosis.

Cardiac Fibromuscular Dysplasia of Small to Medium Caliber Arteries: An Elusive Spot Diagnosis.

P087 Polyarteritis nodosa: a case report

Abstract Background Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral. Material and results We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose. Conclusion The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.

Doença de Kawasaki com acometimento hepático: relato de caso de um paciente com síndrome colestática

Kawasaki disease (KD) is characterized by vasculitis in medium-caliber arteries, mainly in children under 5-years-old. The diagnosis should be made by clinical criteria, since there is no specific laboratory test. However, some laboratory and histopathological findings may help to corroborate the diagnosis, especially in inconclusive cases. The objective of this study is to report a case of a patient with a classic DK, who developed cholestatic syndrome and lymphadenopathy, requiring laboratory and pathological investigations (lymph node and hepatic biopsies) to rule out other etiologies. The clinical case described in this study exemplifies how complementary investigation can be used to rule out other etiologies and contribute to the early diagnosis and treatment of KD, which may prevent the disease from developing with complications and severe sequelae, such as coronary aneurysms.

Типы и стадии сосудистого ремоделирования при контрактуре Дюпюитрена (анализ 506 артерий в операционном материале 111 пациентов)

Purpose Analysis of the severity and staging of pathomorphological changes in the arteries of palmar aponeurosis in patients with Dupuytren's contracture of different age groups Materials and methods Analysis of case records of patients younger than 50 years old (n = 19, group 1), from 50 to 65 years old (n = 60, group 2) and over 65 years old (n = 32, group 3). Light microscopy of paraffin sections of palmar aponeurosis fragments resected in partial fasciectomy and histomorphometry of palmar aponeurosis arteries of three calibers: small (outer diameter less than 150 microns), medium (150–300 microns), large (more than 300 microns). Control samples – fragments of the aponeurosis of three patients younger than 50 years old with hand injuries. Results Groups 1–3 arecomparable in terms of fibromatosis duration, frequency of lesions in both hands, and the number of fingers with impaired function, but in group 3 the frequency of contractures in advanced stages and cardiovascular diseases was higher (p less 0.05). In arteries of small caliber, obliterating lesions and signs of expansive remodeling were also encountered; in arteries of medium caliber, expansive remodeling prevailed; in arteries of large caliber, constrictive remodeling was expressed. Discussion The types of remodeling identified were found in all age groups. Based on the results of the study and the data obtained earlier, 6 stages of pathomorphological changes in the vessels of the palmar aponeurosis were identified in Dupuytren's contracture. Conclusion Dupuytren's contracture refers to diseases mediated by vascular remodeling, affecting mainly the arterial bed, the severity and staging of which does not depend on the age of a patient

Relationship of Cerebral Hemodynamics and Cerebral Bioelectrical Activity in Patients with Cervical Osteochondrosis

Introduction . Osteochondrosis of the cervical spine is a very common disease that causes a significant decrease in the quality of life of patients. In the case of pronounced changes in the cervical spine with osteochondrosis, there is a violation of blood circulation in the cerebral cortex, which leads to pronounced clinical symptoms. The aim of this study was to identify a correlation between bioelectrical activity and cerebral hemodynamics in patients with osteochondrosis of the cervical spine. Materials and methods . The examination involved 25 patients of the neurosurgical department who received conservative treatment for exacerbation of osteochondrosis of the cervical spine, and 25 volunteers without a history of diseases of the spine and joints. The cerebral bioelectrical activity and blood flow indicators were recorded in the pool of the common carotid and vertebral arteries. Results . In the main group and the clinical comparison group, the rheographic index and the peripheral vascular resistance index were studied, which characterize both the volume pulse blood filling of the vascular bed and the tone of small and medium caliber arteries. At the same time, the EEG rhythm indices were analyzed: а -, в -, S-, and в -waves. An analysis of the intersystem interaction of bloodflow indices and the biopotentials of the cortical rhythm of the brain in the main group showed a mismatch in the intra-system connections, which corresponds to the period of the general stress of the body. An analysis of the correlation between the indicators of electroencephalography and rheoencepha-lography in the control group revealed a stable system of correlation between the indicators, showing intersystem and intrasystem consistency and reflecting a high level of reserve capacity of the body and the state of steady adaptation to adverse factors. Conclusion . The use of simultaneous recording of cerebral hemodynamics and brain biopotentials in patients with osteochondrosis of the cervical spine will allow clinicians to correctly assess the functional state of the central nervous system and to prescribe adequate treatment in a timely manner.

Case report: morphological aspects of Buerger's disease

Buerger's disease is a rather rare pathology characterized by nonatherogenic vascular lesion associated with the inflammation in the intima of the vessel and the thrombus formation. Most often the pathological process affects small and medium caliber arteries. Vascular occlusion can lead to tissue ischemia and the trophic ulcers, and cause the extremity amputation. The disorder pathogenesis has not been fully explored. Literature data indicate that the disease development may be associated with autoimmune processes. The paper presents the results of immunohistochemical study of the material obtained after amputation of the lower extremity in a patient diagnosed with Buerger's disease. The patient had a 15-year tobacco smoking experience. In the inflammatory cell infiltrates around the affected vessels, lymphocytes with CD4, CD8 antigens and IgG immunoglobulin deposits were found, which could be considered as the evidence of the autoimmune mechanisms’ involvment. Immunohistochemical reactions with markers of NK cells CD56 and the central component of the C3d complement system were negative. The results of the study suggest that the key role is played by helper and suppressor T lymphocytes, as well as by humoral antibodies of the IgG class.

Fibromuscular dysplasia and its neurological manifestations

The authors present the current data on the classification, epidemiology, etiology, neurological manifestations, prognosis, diagnosis, and treatment of patients with fibromuscular dysplasia (FMD). The review is based on the selection of publications by searching PubMed for keywords from the first sources until March 2019. FMD is a segmental non-atherosclerotic and non-inflammatory disease of large- and medium-caliber arteries leading to their stenosis. The disease occurs mostly in women (90%), and manifests itself in the 5th decade of life. In the cerebrovascular form of FMD, the extracranial internal carotid artery and the vertebral artery are usually affected. Diagnosis is based on the identification of alternation of narrowing and dilation of arteries using angiography (the string of beads sign (multifocal form)). Neurological manifestations include headache, tinnitus, and ischemic stroke, usually due to the dissection or stenosis, rarely, intracerebral or subarachnoid hemorrhages. The prognosis in most cases is favorable, relapses of strokes are rare. Treatment includes antiplatelet agents, if they are ineffective to prevent recurrence of ischemic stroke, endovascular treatment is carried out. Approaches to the treatment of intracranial aneurysms do not differ from those in patients without FMD.

Arteritis de células gigantes

The Giant Cell Arteritis is considered one of the most prevalent autoimmune vasculitis syndromes, which affects arteries of medium and large caliber, being the most feared complication, anterior ischemic optic neuropathy that can evolve to an irreversible loss of vision. The symptoms are caused by local ischemia due to endovascular damage accompanied by systemic damage mediated by cytokines. In recent years, doppler ultrasound, Magnetic Resonance Imaging (MRI) and PET scans have become important in the search for tools that can confirm or exclude the diagnosis of GCA. However, the Temporal Artery Biopsy (BAT) continues to be the gold standard test for the diagnosis of this disease.

Giant Cell Arteritis in Ophthalmology Practice: a Case Report

Introduction. Giant cell (temporal) arteritis refers to a group of chronic and acute systemic vasculitis mainly affecting the extracranial and intracranial arteries of large and medium caliber. Loss of vision due to anterior ischemic optic neuropathy (AION) or occlusion of the central retinal artery is one of the most severe and most common complications of giant cell arteritis. This case report describes a patient with giant cell arteritis, the outcome of it was a total vision loss in the right eye. The patient repeatedly visited the ophthalmologists in the outpatient clinics with complaints of intermittent episodes of vision loss.Purpose. To present methods of diagnosis and treatment, through which the doctor at the initial reception will be able to suspect the disease and start treatment timely.Conclusions. The anamnestic criteria for the GCA diagnosis in the practice of ophthalmologist are: female, age over 50 years, headaches with paresthesia, intermittent lameness of the mandible, short-term episodes of vision loss. The necessary laboratory methods of research include: clinical blood test with determination of erythrocyte sedimentation rate, determination of C-reactive protein level.