The purpose of this study was to review the positive angiographic findings in patients with polyarteritis nodosa (PAN). The authors reviewed the angiograms of 56 consecutive patients (25 women and 31 men; age range, 18-81 years; mean age, 55 years) with PAN and arterial abnormalities consistent with necrotizing vasculitis. Aneurysms were present in 27 patients and segments of ectasia were present in seven patients, for a total of 34 (61%) of 56 patients with aneurysmal lesions. The remaining 22 (39%) patients had arterial lesions that were occlusive: luminal irregularity, stenosis, or occlusion. All but one of the patients with an aneurysm also had occlusive lesions. Therefore, 55 (98%) of the 56 patients were found to have occlusive lesions. Skeletal muscle arteries were affected in 18 patients, nine in the extremities. The most frequent finding in patients with PAN was occlusive arterial lesions. Although the presence of aneurysms increases specificity for the diagnosis of PAN, many patients have only occlusive lesions. Involvement of skeletal muscle arteries was common.

Polyarteritis nodosa: spectrum of angiographic findings.

The use of intra-articular injections of high molecular weight elastoviscous solutions of hyaluronan or hylans (cross-linked derivatives of hyaluronan) to treat arthritis is termed viscosupplementation. The function of viscosupplementation is to restore the rheologic properties of synovial fluid. Although anecdotal data exist, no long-term studies regarding the use of viscosupplementation in the ankle have been published to date. The goal of this clinical trial was to compare pain reduction following ankle arthroscopy versus that following ankle arthroscopy combined with weekly intra-articular instillation of hylan G-F 20 during the first 3 postoperative weeks. In the series of patients described in this report, we found that both treatment groups experienced statistically significantly decreased pain following the intervention (P = .002 and P = .0009 for the arthroscopy alone and arthroscopy plus hylan groups, respectively), and that those who received 3 intra-articular injections of hylan G-F 20 following ankle arthroscopy improved statistically significantly (P = .0014) more than did those who underwent arthroscopy as a sole therapy. These preliminary results suggest that viscosupplementation combined with arthroscopy may be more beneficial than arthroscopy alone, and provide further insight into the role of viscosupplementation in the treatment of ankle osteoarthritis. Level of Clinical Evidence: 4

The Role of Viscosupplementation in the Ankle Using Hylan G-F 20

Summary

Four cases of extraperitoneal haemorrhage occurring in the setting of anticoagulation or coagulopathy are presented. Treatment of this condition has traditionally consisted of reversal of anticoagulation and supportive therapy. Diagnosis was made on contrast-enhanced computed tomography. The finding of active contrast extravasation was found to be a factor predictive of failure of conservative therapy and, therefore, an indication for angiography and embolization. In all four cases presented in the present paper, the bleeding vessel(s) were identified and significant active bleeding arrested by transcatheter embolization.

Spontaneous extraperitoneal haemorrhage: Computed tomography diagnosis and treatment by selective arterial embolization

Purpose of review Numerous therapeutic options have been suggested for the treatment of central retinal artery occlusion (CRAO) such as ocular massage, anterior chamber paracentesis, physical exercise, and medication-induced reduction of intraocular pressure. Because of the lack of a proven effective treatment for CRAO, there has been a strong effort to develop alternative therapies. Recently, thrombolytic therapy has been suggested as a viable therapy for CRAO. The aim of this review is to provide an update on the progress of thrombolytic therapy for CRAO. Recent findings Although there is no consensus on a standardized treatment regimen for CRAO, emerging evidence suggests that thrombolytic therapy may be effective if administered promptly. Despite the benefit of thrombolytic therapy, on the basis of the results of case reports and case series, randomized controlled studies are necessary to ultimately prove the effectiveness of the treatment. Summary Thrombolytic therapy has yet to be validated as an effective treatment of CRAO. The execution of randomized, controlled trials is greatly needed to establish whether thrombolytic therapy can be considered standard of care therapy for CRAO.

Thrombolytic therapy in central retinal artery occlusion: cutting edge therapy, standard of care therapy, or impractical therapy?

Hémorragie digestive par rupture d'un anévrisme des artères viscérales. Présentation de quatre observations

We describe a patient with polyarteritis nodosa who developed a large retroperitoneal hemorrhage from a ruptured suprarenal capsule artery aneurysm. Platinum coils were embolized selectively during arteriography and successfully controlled the aneurysmal bleeding. The vasculitis was controlled ten weeks later but our patient developed anemia and computerized tomography scan revealed a large retrogastric hemorrhage. A further arteriograstric confirmed the presence of a ruptured gastric coronary artery aneurysm. A second embolization was performed with complete success

Embolization of two bleeding aneurysms with platinum coils in a patient with polyarteritis nodosa

Resume Introduction Pres de 50 % des patients atteints de granulomatose de Wegener (GW) presentent des manifestations ophtalmologiques. Une cecite survient dans 8 % des cas. La survenue d'une occlusion de l'artere centrale de la retine (OACR) a cependant ete exceptionnellement rapportee. Exegese Nous rapportons deux patients avec OACR et GW, diagnostiques selon les criteres de classification de l'American College of Rheumatology. A notre connaissance, l'association d'une OACR et d'une GW n'a ete rapportee que chez 15 patients. Nous analysons la presentation clinique de ces 17 cas, leur pronostic visuel et general, et leur traitement. Conclusion L'OACR est une manifestation rare de la granulomatose de Wegener. Elle est associee a des formes vasculitiques severes de la GW. Son diagnostic precoce pourrait permettre une amelioration du pronostic general et fonctionnel, par l'utilisation rapide d'un traitement immunosuppresseur.

Occlusion de l'artère centrale de la rétine au cours de la granulomatose de Wegener

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Embolization of two bleeding aneurysms with platinum coils in a patient with polyarteritis nodosa

Occlusion de l'artère centrale de la rétine au cours de la granulomatose de Wegener