Objective To summarize the clinical characteristics of polyarteritis nodosa which begin with pulmonary lesions, so as to make early diagnosis and treatment possible. Methods Clinical data of three patients of polyarteritis nodosawhich began with pulmonary lesions were summarized includingmode of onset, evolvement of symptom and sign, data of laboratory test. The results of vascular ultrasound and histopathology examination were analyzed for their diagnostic value.Results Cough, sputum productive cough, and irregular high fever were present in the earlier period. Increases of C-reactive protein ( CRP) , erythrocyte sedimentation rate ( ERS) , white blood cell count ( WBC) , and anemia were main laboratory findings. Computed tomography revealed scattered infiltration in the lung. Anti-infective treatment was ineffective. Involvement of skin, kidney, gastrointestinal tract, nerve and muscle was present in sequence. Two of the three cases were confirmed by pathological biopsy. The symptoms were improved by the treatment with glucocorticoid. Conclusions Polyarteritis nodosa which begin with pulmonary lesions is easy to misdiagnose due to atypical symptoms. It is important for diagnosis of polyarteritis nodosa to collect evidence of systematic involvement through taking careful history and physical examination. Further angiography and biopsy can confirm the diagnosis. Cytotoxic drugs and/ or glucocorticoid are effective for the treatment of polyarteritis nodosa.
目的 总结盐酸沙格雷酯治疗周围动脉炎性疾病的初步疗效。方法 2009年10月至2012年3月期间我院共收治32例周围动脉炎性疾病患者，其中血栓闭塞性脉管炎（TAO） 18例，雷诺综合征14例，经患者知情同意的情况下给予盐酸沙格雷酯治疗，给予西络他唑100mg/d以及必须的强的松治疗后加服盐酸沙格雷酯100mg，3次/d口服，治疗后3个月观察疗效。结果 18例TAO患者中有10例服用了盐酸沙格雷酯，治疗后其间歇性跛行距离〔（362±127） m〕较治疗前 〔（224±86） m〕延长；8例静息痛患者中7例症状消失，1例改善；4例溃疡患者中3例愈合，1例未愈合。8例未加服盐酸沙格雷酯患者，有6例间歇性跛行消失，2例改善；5例静息痛患者中3例症状消失，2例改善；2例溃疡患者中1例愈合，1例未愈合。14例雷诺综合征患者中8例加服盐酸沙格雷酯，雷诺症状7例消失，1例改善；3例溃疡患者完全愈合。6例未加服盐酸沙格雷酯患者雷诺症状4例消失，2例改善；1例溃疡患者未愈合。结论 从本组有限病例资料看，盐酸沙格雷酯对于治疗周围动脉炎性疾病是有效的。
目的 探讨大动脉炎所致肾动脉上腹主动脉闭塞的手术治疗方法。方法 回顾性分析1例肾动脉上腹主动脉闭塞行腹主动脉-双股动脉人工血管搭桥手术治疗的患者的临床资料,并进行文献复习。结果 术后患者头痛明显好转，血压由术前的220/110 mm Hg(1 mm Hg=0.133 kPa)降至160/100 mm Hg,双下肢踝肱指数由0.50升至1.19。术后2周复查CTA示人工血管通畅，术后3个月复查彩超示人工血管通畅，血压在(140～150)/(80～95) mm Hg间波动，双眼视力1.0左右，已恢复正常生活。结论 大动脉炎所致肾动脉上腹主动脉闭塞常会影响多个重要脏器的供血，病变复杂，手术时机及方法的正确选择及长期抗炎治疗可以提高患者的治疗效果。
Takayasu arteritis (TA) is a chronic nonspecific inflammation that commonly occurs in the aorta and its main branches. Most patients with TA are lack of clinical manifestations, leading to misdiagnosis. When the TA is correctly diagnosed, the patients may already have stenosis or occlusion in the involved arteries, resulting in arterial ischemia and hypoxia symptoms, and in severe cases it will be life-threatening. Contrast-enhanced ultrasonography (CEUS) is an emerging method for assessing TA, but the assessment relies heavily on experiences of radiologists performing manual and qualitative analyses, so the diagnostic results are often not accurate. To overcome this limitation, this paper presents a computer-assisted quantitative analysis of TA carotid artery lesions based on CEUS. First, the TA lesion was outlined on the carotid wall, and one homogeneous rectangle and one polygon were selected as two reference regions in the carotid lumen. The temporal and spatial features of the lesion region and the reference regions were then calculated. Furthermore, the difference and ratio of the features between the lesion and the reference regions were computed as new features (to eliminate interference factors). Finally, the correlation was analyzed between the CEUS features and inflammation biomarkers consisting of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The data in this paper were collected from 34 TA patients in Zhongshan Hospital undergoing CEUS examination with a total of thirty-seven carotid lesions, where two patients were with two lesions before and after treatment and one patient was with left and right bilateral lesions. Among these patients, 13 were untreated primary patients with a total of 14 lesions, where one patient was with bilateral lesions. The results showed that for all patients, the neovascularization area ratio in the 1/3 inner region of a lesion (ARi1/3) achieved a correlation coefficient (r) of 0.56 (P=0.001) with CRP, and for the primary patients, the neovascularization area ratio in the 1/2 inner region of a lesion (ARi1/2) had an r-value of 0.76 (P=0.001) with CRP. This study indicates that the proposed computer-assisted method can objectively and semi-automatically extract quantitative features from CEUS images, so as to reduce the effect on diagnosis due to subjective experiences of the radiologists, and thus it is expected to be used for clinical diagnosis and severity evaluation of TA carotid lesions.
Objective To observe the peripapillary choroidal thicknesses (pCT) and subfoveal choroidal thicknesses (SFCT) of nonarteritic anterior ischemic optic neuropathy (NAION). Methods Forty-four Chinese patients with unilateral NAION were recruited and compared with 60 eyes of 60 normal age and refractive-error matched control subjects. pCT and SFCT were measured by enhanced depth imaging optical coherence tomography. Choroidal thicknesses of eyes with NAION and unaffected fellow eyes were compared with normal controls. Choroidal thicknesses of NAION eyes with or without optic disc edema were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and the mean deviation (MD) of Humphrey static perimetry in NAION eyes were analyzed. Results The pCT at the nasal, nasal inferior and temporal inferior quadrants in NAION eyes with optic disc edema were significantly thicker than that of normal subjects (t=3.152, 3.166, 2.808; P＜0.05). There was no significant difference in the choroidal thicknesses between the unaffected fellow eyes of NAION patients and normal eyes of healthy controls; or between the NAION eyes with resolved optic disc edema and normal eyes (P＞0.05). No significant correlation between choroidal thickness (r=－0.220, －0.140, 0.110), SFCT (r=0.096, －0.148, －0.131) and logMAR BCVA, perimetry MD and RNFL was found in eyes affected by NAION (P＞0.05). Conclusions The peripapillary choroidal thicknesses increase in some quadrants in NAION eyes with optic disc edema. However, the choroidal thickness of NAION eyes is the same in age and refractive error-matched normal subjects.