Buerger’s disease-like arteritis associated with Crohn’s disease. A case of ‘vas-colitis’?

Crohn’s disease and ulcerative colitis are classified as inflammatory bowel diseases (IBD) [1]. Crohn’s disease is characterized by the involvement of the intestinal wall, which leads to the formation of ulcers, fistulas and strictures of the intestine. The disease is more frequently found among Caucasians. Parenteral manifestations are possible in the course of IBD, including osteoarticular and ocular manifestations, affecting the skin or the blood vessels. Only a few cases of the coexistence of Takayasu’s disease and IBD have been reported so far [2–5]. Takayasu’s disease is a chronic inflammation of the large-diameter vessels, which was described for the first time nearly two hundred years ago [6]. The incidence of Takayasu’s disease in the U.S. is estimated at about 2.6 cases per million. This condition, in contrast to IBD, is most common among young women of the Asian origin [7]. In this paper we discuss the case of the co-existence of Crohn’s disease and vasculitis, with symptoms and some angiographic features similar to Buerger’s disease, that was classified as vasculitis associated with systemic disease. So far, the available literature lacks descriptions of similar cases of Crohn’s disease associated with vasculitis mimicking Buerger’s disease

Ankle-Brachial Index as the Best Predictor of First Acute Coronary Syndrome in Patients with Treated Systemic Hypertension

Objective. The objective of our study was to evaluate the incidence of target organ damages (TOD) in patients with arterial hypertension and the first ever episode of myocardial infarction (N-STEMI or STEMI) and to determine which of the analyzed kinds of TOD had the highest predictive value for the assessment of the likelihood of acute coronary syndrome (ACS). Material and Methods. The study group consisted of 51 patients with treated systemic hypertension, suffering from the first episode of myocardial infarction (N-STEMI or STEMI), confirmed by coronary angiography and elevation of troponin. The control group consisted of 30 subjects with treated hypertension and no history of myocardial ischaemia. In all subjects’ measurements of blood lipids, hsCRP and eGFR were measured. TOD, such as intima-media thickness (IMT), presence of atherosclerotic plaques, ankle-brachial index (ABI), and left ventricular hypertrophy, were assessed. Results. Age, BMI, blood pressure, and time since diagnosis of hypertension did not differ between the study groups. There were no differences regarding blood lipids and eGFR, while hsCRP was significantly increased in the study group. The left ventricular mass index was similar in both groups. Patients with myocardial infarction had significantly increased IMT and decreased ABI. The statistical analysis revealed that only ABI was the most significant predictor of ACS in the study group. Conclusion. Among several TOD, ABI seems to be the most valuable parameter in the prediction of ACS

Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry

Objective. The objective of the study was to compare polygraphic parameters and selected laboratory parameters in patients with obstructive sleep apnoea (OSA) who develop various types of left ventricular (LV) geometry. Material and Methods. The research covered 122 patients with obstructive sleep apnoea and coexisting effectively treated systemic hypertension (95 men, 27 women, average age: 54±10.63). Overnight polygraphy, echocardiography, carotid artery ultrasonography, and laboratory measurements were performed. The patients were classified into four groups, depending on LV geometry. Group 1 comprised patients with normal LV geometry, group 2 included those with LV concentric remodelling. Group 3 and group 4 were patients with LV hypertrophy, concentric or eccentric, respectively. Results. The most frequent type of LV geometry in the examined population was eccentric hypertrophy (36%). The highest average values of BMI and T-Ch were observed in the group of patients with concentric remodelling (group 2). The most severe respiratory disorders were found in the group of patients developing LV concentric hypertrophy (group 3); however, these differences were not statistically significant in comparison to other groups. Patients with LV eccentric hypertrophy had significantly decreased LV ejection fraction (p=0.0008). Conclusions. LV eccentric hypertrophy is the most frequent type of LV geometry in OSA patients. Patients with severe sleep-disordered breathing are more likely to develop concentric hypertrophy, while concentric remodelling occurs more frequently among OSA patients with other coexisting conditions, such as obesity or lipid-related disorders