Degeneration Of Elastic Tissue Research Articles

Preoperative Intralesional Bevacizumab Injection in Primary Pterygium in Tunisian Patients: A Randomized Controlled Prospective Study.

To assess the efficacy and safety of a single preoperative intralesional bevacizumab injection as an adjuvant treatment before primary pterygium surgery. We conducted a randomized controlled interventional study from January 2019 to December 2020. The study included a total of 60 patients (60 eyes) with primary pterygium. We defined two groups of 30 patients each. Group A received an intralesional injection of bevacizumab (Avastin), 1 month before surgery (lesion excision and conjunctival autograft). Group B (control) had only the surgical treatment. Patients were followed up 7 days (D7), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. Pre-, per-, and postoperatively, photographs of the lesions were taken, as well as a histopathological examination. The main outcome measures were the change in functional discomfort following intralesional bevacizumab injection and pterygium recurrence. Recurrence was defined as fibrovascular tissue growth invading the cornea. Therapeutic success was defined as the absence of pterygium recurrence in M6. The mean age of the 60 patients was 54.17 ± 10.53. After bevacizumab injection, the preoperative functional discomfort score decreased significantly (P = 0.048). There was a significant improvement in grade and color intensity (P = 0.001). We noted no local nor systemic complications after intralesional injection of bevacizumab. After pterygium excision, the success rate was statistically higher in Group A (P = 0.047). There was no significant difference in either final best-corrected spectral visual acuity or astigmatism between the two groups. We noted a statistically significant association between recurrence and color intensity (P = 0.046), vascular density (P = 0.049), and the degree of elastic tissue degeneration (P = 0.040). A single preoperative subconjunctival injection of bevacizumab 1 month before surgery decreases the vascularity of newly formed blood vessels and hence may reduce the recurrence rate.

Genetics of Thoracic and Abdominal Aortic Diseases.

Dissections or ruptures of aortic aneurysms remain a leading cause of death in the developed world, with the majority of deaths being preventable if individuals at risk are identified and properly managed. Genetic variants predispose individuals to these aortic diseases. In the case of thoracic aortic aneurysm and dissections (thoracic aortic disease), genetic data can be used to identify some at-risk individuals and dictate management of the associated vascular disease. For abdominal aortic aneurysms, genetic associations have been identified, which provide insight on the molecular pathogenesis but cannot be used clinically yet to identify individuals at risk for abdominal aortic aneurysms. This compendium will discuss our current understanding of the genetic basis of thoracic aortic disease and abdominal aortic aneurysm disease. Although both diseases share several pathogenic similarities, including proteolytic elastic tissue degeneration and smooth muscle dysfunction, they also have several distinct differences, including population prevalence and modes of inheritance.

Type I Aortic Dissection on Pregnant Woman

Acute aortic dissection is rare in young women. Half of the dissections in women younger than 40 years old occur during pregnancy, typically in third trimester and in postpartum period. The reasons for increased rate of aortic dissection in pregnancy are known to be increased sex hormones, degeneration of elastic tissue in aorta, and pressure of the uterus on aorta and distal iliac arteries causing pathological alterations in the artery walls by increasing the resistance to distal flow. Aortic dissection is a condition that can be presented with different symptoms and can be fatal for both mother and the fetus if the diagnosis is missed or late. Despite the diagnosis tools like computerized tomography, echocardiography, magnetic resonance imaging or aortography, suspicion of aortic dissection is still the basis of diagnosis. Treatment objective is to provide the security of the mother and the fetus. In this case presentation, approach to pregnancy-induced aortic dissection was discussed by presenting a case in which a 41-year-old woman in 34th week presented with swelling in the legs, pain in the epigastric region and blurry vision complaints, developed type A aortic dissection and died during the follow-up. J Med Cases. 2016;7(3):105-108 doi: http://dx.doi.org/10.14740/jmc2437w

Type I Aortic Dissection on Pregnant Woman

Acute aortic dissection is rare in young women. Half of the dissections in women younger than 40 years old occur during pregnancy, typically in third trimester and in postpartum period. The reasons for increased rate of aortic dissection in pregnancy are known to be increased sex hormones, degeneration of elastic tissue in aorta, and pressure of the uterus on aorta and distal iliac arteries causing pathological alterations in the artery walls by increasing the resistance to distal flow. Aortic dissection is a condition that can be presented with different symptoms and can be fatal for both mother and the fetus if the diagnosis is missed or late. Despite the diagnosis tools like computerized tomography, echocardiography, magnetic resonance imaging or aortography, suspicion of aortic dissection is still the basis of diagnosis. Treatment objective is to provide the security of the mother and the fetus. In this case presentation, approach to pregnancy-induced aortic dissection was discussed by presenting a case in which a 41-year-old woman in 34th week presented with swelling in the legs, pain in the epigastric region and blurry vision complaints, developed type A aortic dissection and died during the follow-up. J Med Cases. 2016;7(3):105-108 doi: http://dx.doi.org/10.14740/jmc2437w

New optical coherence tomography fundus findings in a case of beta-thalassemia

Patients with beta-thalassemia may present with an acquired diffuse elastic tissue defect due to degeneration of elastic tissue along with vaso-occlusive findings in the retinal microvasculature. Here we report the case of a patient with granular-like accumulation presenting as black sunburst lesions detected by optical coherence tomography (OCT). A 38-year-old man with beta-thalassemia intermedia associated with angioid streaks complained of deterioration of vision in both eyes. Funduscopic examination revealed small, round, hyperpigmented lesions bilaterally. During the early and late phases of fluorescein angiography, granular hyperfluoresence was present, associated with pigment decompensation and mottled-like hypofluorescence. The main OCT finding was the presence of granuloid-like accumulations at the retinal pigment epithelium level. Granule penetration was also noticed at the photoreceptor layer, while isolated granuloid-like accumulations were found in the inner layers of the macula and choroid. In this case, the new OCT finding was the granular-like hyperpigmented accumulations in the macula located at the level of the retinal pigment epithelium. To the best of our knowledge, our OCT findings show for the first time granuloid-like accumulations representing black sunburst lesions.

Peau et ménopause

Important changes related to declining level of several hormones occur during menopause: vasomotor instability, bone loss, anxiety, sexual dysfunction, skin aging... Our objective was a review of the literature concerning the histological and clinical changes seen in post menopausal skin, and also an analysis of the effect of hormonal replacement therapy in slowing down the aging process. Decline in progesterone increases the impact of androgen on the sebaceous glands and hair. Decreased estrogen slows down mitotic activity in the epidermal basal layer, reduces the synthesis of collagen and contributes to thickening of the dermo-epidermal junction. This hypoestrogenemia may be spontaneously attenuated by local synthesis of oestradiol in peripheral target tissues according to the intracrine process. This new hormonal pattern is associated with skin atrophy, hyperseborrhea, increased pilosity on the cheeks and upper lip, loss of scalp hair, increase in degeneration of elastic tissue, atrophy and dryness of the vaginal mucosa. Estrogen treatment in post menopausal women has been shown to increase collagen content, dermal thickness and elasticity. Biophysical properties are also significantly improved for the parameters reflecting hydration and sebum secretion. However, numerous side effects such as increased incidence of cancer and cardiovascular morbidity limit the use of this treatment. So non hormonal alternatives are proposed. Laser and lifting remain the most important options.

Pseudoxanthome élastique de survenue précoce avec atteinte cardiovasculaire sévère

Pseudoxanthoma elasticum is a rare inherited connective disorder, characterized by elastic tIssue degeneration. The onset of the symptoms usually occurs within the second decade of life. We describe the case of a 15 year-old boy, born to consanguin parents, who presented characteristic cutaneous signs of pseudoxanthoma elasticum. The patient had also presented with severe cardiovascular involvement of early onset, at the age of 6 months. The latter included episodes of ischemic stroke, arterial hypertension, thrombosis of the left iliac and carotid arteries and cardiomegaly. His sister suffered from isolated cutaneous involvement. Diagnosis of pseudoxanthoma elasticum was confirmed on the histology of the skin and molecular analysis in our patient and in his sister revealed the same homozygote mutation. The organs most commonly affected by pseudoxanthoma elasticum are the skin, eyes and vascular system. The cutaneous lesions are characteristic and usually appear around the age of 13. Ophthalmological involvement is frequent. Angioid bands are the most typical lesions; the occur between the ages of 14 and 25. Survival depends on the vascular damage. Conversely to our case report, it usually appears later in life, during the third decade. Arterial hypertension and intestinal bleeding have also been described. The cardiac involvement in our patient is rare. This boy and his sister presented with the same homozygote mutation. Such a major intra-familial clinical variability emphasizes the hypothesis of the absence of any genotype-phenotype relationship in pseudoxanthoma elasticum.

Dissecting aneurysm of the intracranial vertebral artery associated with proximal focal degeneration of the elastica: A comparative pathological study of the vertebral artery in patients with and without aneurysms

Background The pathogenesis underlying intracranial dissecting aneurysms remains unclear. We performed a detailed study using vertebral artery specimens obtained at autopsy from patients with and without aneurysms to identify the primary abnormality resulting in weakness of the elastica. We compared our observations with those made in specimens manifesting the normal atherosclerotic process. Methods Using histologic methods, we examined intracranial vertebral artery specimens from two autopsied aneurysm patients and 13 autopsied control cases to compare the state of atherosclerosis and the weakness of the elastica at this aneurysm predilection site. Results Case 1: A 54-year-old woman with 2 dissecting aneurysms of the bilateral vertebral arteries (VA) who died from recurrent subarachnoid hemorrhage (SAH). Case 2: A 53-year-old woman who died from SAH. Microscopically, all 3 vertebral aneurysms were typical transmural dissecting aneurysms. They manifested areas of focal, se-vere degeneration of the elastic lamina and calcification at VA sites proximal to the aneurysms. These lesions could be differentiated from secondary changes attributable to the aneurysms because of their separate location only proximal to the site of aneurysmal rupture. Atherosclerotic changes were minimal in both cases. In the controls, the degenerative state of the elastic lamina of the VA reflected an atherosclerotic process. Conclusions We postulate that focal degeneration of elastic tissue not involved in the atherosclerotic process was the vasculopathy resulting in aneurysm formation in our SAH cases.

VISUAL LOSS ASSOCIATED WITH PSEUDOXANTHOMA ELASTICUM

An 18-year-old woman with pseudoxanthoma elasticum had sudden profound bilateral visual loss, presumably as a result of optic nerve infarction caused by anemia and hypotension from massive gastrointestinal bleeding. Her central visual acuity largely recovered in her right eye, but her left eye had only hand motions acuity. During the subsequent 24 years, she underwent three separate surgical procedures for gastrointestinal bleeding. Abdominal arterial angiography showed numerous aneurysms of the gastric arteries. A subtotal gastrectomy was done, and histopathologic examination found advanced degenerative changes of the elastic lamina of the gastric arteries. At age 42 years, the patient lost residual vision in her right eye. This was caused by an extrafoveal subretinal choroidal neovascular membrane, which was obliterated with laser photocoagulation. Degeneration of elastic tissue, the primary defect in this syndrome, may cause cardiovascular complications and formation of breaks in the Bruch membrane, which are visible as angioid streaks. Ingrowth of fibrovascular tissue through angioid streaks may cause disturbances of macular function. The optic nerve ischemia and infarction associated with the profound visual loss in this patient reminds the ophthalmologist of the systemic nature of this disorder and the possibility that systemic vascular complications with massive blood loss may occur.

Spontaneous Aortic Lesions in Fallow Deer (Dama Dama L)

In 19 out of 22 aortas from fallow deer, 15 months to 5½ years, aortic lesions were found. Three types of lesions were observed, fatty streaks were seen in 2, fibrous plaques in 15 and fibrous plaques with complicated lesions (calcification and acid mucopolysaccharides) in 2 of the aortas. Elastic tissue degeneration of the inner two thirds of the tunica media was frequently found in the aorta of the animals > 3½–5½ years of age. There was no statistical evidence for a correlation between age and frequency (P ~ 0.10) but a trend towards age dependence was seen. The percentage of involved surface was found to significantly increase (0.05 > P > 0.01) with age. Lesions were found to start in the abdominal aorta in young animals and to extend cranially to the thoracic aorta with age. The percentage of involved surface in different affected regions, comprising all age groups were, in the posterior abdominal portion, 10.5 %, in the anterior abdominal portion, 4.3 % and in the posterior thoracic portion, 1.04 %. The influence of hemodynamic flow upon the localization of the aortic lesions, the endothelial cell population density and the endothelial nuclear patterns were discussed.

Spontaneous Aortic Lesions in Moose (Alces Alces L)

In 17 out of 22 aortas from moose, 6 months to more than 18 years, aortic lesions were found. Five different types of lesions were observed, fatty streaks were seen in 1, fibrous plaques in 7, fatty streaks with complicated lesions (calcification and acid mucopolysaccharides) in 3, fibrous plaques with complicated lesions in 2 and fibrous plaques with complicated lesions and fat droplets in 4 of the aortas. Elastic tissue degeneration of the inner two thirds of the tunica media was principally found in the aorta of the animals beyond 4 year of age. There was no statistical evidence for a correlation between age and frequency but a trend towards age dependence was seen. The percentage of involved surface was found to increase significantly (0.05 > P > 0.02) with age. There was no significant difference between affected male and female animals in the different age groups. The frequency of involved surface in different affected regions, comprising all age groups were, in the posterior abdominal portion, 13.0 %, in the anterior abdominal portion, 3.0 %, in the posterior thoracic portion 5.2 %, in the anterior thoracic portion, 0.1 % and in the aortic arch, 0.1 %. Proliferating endothelial cells and the source of smooth muscle cells were discussed.

Spontaneous Aortic Lesions in Roe Deer (Capreolus Capreolus L)

In 34 out of 60 aortas from roe deer, aged from 6 months to more than 8 years, aortic lesions were found. The frequency of affected regions involved were, in the posterior abdominal portion 53.3 %, in the aortic arch 18.3 %, in the anterior abdominal portion 16.7 %, in the posterior thoracic portion 8.33 % and in the anterior thoracic portion 3.3 %. Of the observed lesions, fatty streaks were seen in 3, fatty streaks and fibrous plaques in 3, fatty streaks with complicated lesions (calcification and acid mucopolysaccharides) in 14 and fibrous plaques with complicated lesions in 14 of the aortas. Elastic tissue degeneration of the inner two thirds of the tunica media was principally found in the aorta of the animals beyond 4 years of age. The lesions significantly (P < 0.001) increased in number and severity with age and appeared to be more progressive in pregnant animals. There was, however, no significant difference between affected male and female animals in the different age groups.

Spontaneous Aortic Lesions in Reindeer (Rangifer Tarandus L)

Aortas of 20 reindeer, aged from 1.5 to 8.5 years, were studied. Fatty streaks were seen in 9, a fibrous plaque in 1, and elastic tissue degeneration in the tunica media in 4 of the aortas.

Proliferation and degeneration of elastic tissue in aortic explants from normo-, and hypercholesterolemic rabbits: An ultrastructural study

Ultrastructural differences exist between the processes of elastogenesis and degeneration of elastic tissue in explants from normal aorta and in those from atherosclerotic lesions of rabbits maintained in culture for 10 days. In aortic explants from normal rabbits de novo formation was observed early and proceeded through the characteristic structural units which fused with each other and gave rise to larger elastic tissue elements—all having a typical filamentous appearance. Degeneration affected first the large lamellae and consisted of rarefaction of the interior and the surface with subsequent ingrowth of collagen fibrils. The structural integrity of the “young” elements was maintained to the end of the observation time. In the explants from lesions the newly formed units of elastic tissue showed subtle ultrastructural changes: there was an excess or paucity of the constituent microfibrils in relation to the homogeneous component. In either case the units were ill-defined and most of the larger elements lacked the filamentous inner structure. Degeneration largely proceeded through the gradual deposition in a segmental or islet-like pattern of finely crystalline substance (calcium compounds?) in the matrix of all, including the smallest elastic tissue elements. Ultimate disintegration of the tissues gave rise to round or oval, single or fused “shells” (tissue ghosts) with radially arranged crystalline substance. Whereas these changes have no known structural counterparts in the non-explanted aortic lesions or any other tissues, their basis may be inherent in the atherosclerotic process that becomes “unmasked” in the in vitro conditions of the present study.

Diseases of the optic nerve, tracts, and visual cortex: an annual review of the ophthalmic literature.

The ophthalmic literature dealing with diseases of the optic nerve, tracts, and visual cortex was reviewed for the period September 1973 to November 1974. Eighteen papers dealing with topics of interest to optometrists have been abstracted. Principal subjects include: relation of central serous retinopathy to pregnancy, a stimulating discussion of the role of elastic tissue degeneration in formation of angioid streaks, methods of assessing internal carotid artery disease, ophthalmoscopy versus tangent screen evaluation, stereoacuity as a useful tool in detecting monocular problems, advances in head X-ray, and, lastly, developments in objective assessment of the nerve head and central retinal artery.

Senile (Solar) Comedones

The microbial flora of senile was evaluated quantitatively. Corynebacterium acnes and Gram-positive cocci were recovered in equivalent amounts. Staphylococcus type II (S II) was the predominant coccus. Pityrosporum species were regularly present. Histopathologic study indicated that senile were large, noninflammatory, open comedones surrounded by extreme degeneration of elastic tissue. Because of the apparent influence of sunlight in pathogenesis, it is proposed that these comedones might be more appropriately called solar comedones.

Morphology of cerebral arteries in Marfan's syndrome and medianecrosis idiopathica (author's transl)

Degenerative processes of the tunica media are reported with increasing frequency among the causes of a dissecting aneurysm in the wall of large arteries. The underlying process is supposed to be a necrosis or degeneration of elastic tissue and smooth muscle cells, occurring either in idiopathic necrosis of the media (Gsell-Erdheim) or in systemic disorders as Marfan's syndrome, pseudoxanthoma elasticum, Ehlers-Danlos-syndrome and homocystinuria. Neurological symptoms in these conditions are attributed to disturbances of general circulation but not to involvement of cerebral arteries.

Idiopathic infantile arterial calcification—A misnomer?

An autopsy case of idiopathic arterial disease in an infant was studied in detail. Pathologic features included intimal fibrous proliferation in elastic and muscular arteries, elastic tissue degeneration and scant calcification, and focal round cell infiltration at the junction of intima and media in arteries with intimal proliferation. These changes were widespread but patchy or segmental in distribution. They were associated with evidence of vascular insufficiency in several organs and with the presence of thrombi in many affected arteries. Intimai proliferation appeared to be quantitatively and physiologically the most critical of the pathologic changes. The case is believed to represent an example of so-called idiopathic arterial calcification of infancy. Review of the literature and consideration of this case suggest 2 possibilities: (1) calcification has been overemphasized as a feature of this condition, since it represents only a secondary (and often insignificant) phenomenon, with the intimal proliferation being the fundamental pathologic alteration; or (2) descriptions of this condition include 2 diseases, 1 characterized principally by vascular calcification, and the other by intimal proliferation. It is suggested that the former hypothesis is more tenable. The designation “idiopathic arterial calcification” appears to be misleading, and the condition should be called “occlusive infantile arteriopathy” until its origin can be definitely established.

PSEUDOXANTHOMA ELASTICUM WITH GASTRIC HEMORRHAGE.

Pseudoxanthoma elasticum (PXE) is a rare, heritable, systemic disorder of elastic tissue and is primarily manifested by abnormalities of the skin, ocular fundus, and cardiovascular system. 1 Gastrointestinal hemorrhage, frequently recurrent, has been reported in association with PXE and may constitute the major hazard to life. Although peptic ulcers, esophageal varices, and ulcerative colitis have been present in some cases, the source of bleeding is most commonly undetermined. 2-15 Involvement of the visceral vessels with elastic tissue degeneration has been postulated as the most likely cause of unexplained bleeding. However, in only five previously reported cases has histologic examination of visceral vessels been performed to substantiate this theory. 16-19 This report describes the clinical, radiological, and pathological findings in a 37-year-old white male with previously undiagnosed PXE who underwent subtotal gastrectomy for persistent gastric hemorrhage. Report of Case A 37-year-old, single, white male clerk was admitted to Strong Memorial Hospital

Elastic Tissue Degeneration in Sickle-Cell Disease

Elastic Tissue Degeneration in Sickle-Cell Disease