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Biomedical subjects

H J Leu

Publications and source records attributed to H J Leu.

At least 19 recordsLinked to original sources
PubMed1996

Varicose veins combined with mucoid degeneration of the venous wall.

We report on a 56-year-old woman with bilateral chronic venous insufficiency, a cavernous hemangioma at the right thigh and an aneurysm of the left femoral vein, without bone or soft tissue hypertrophy. Histopathology revealed a mucoid degeneration of the media musculature of the venous wall. Such a finding has not yet been described in the world literature. The differential diagnosis must consider a secondary hitherto unknown alteration of varicose veins, a variety of a vascular malformation not yet described, and a primary degeneration of the smooth muscles of the vascular wall followed by the development of varicose veins.

Aneurysm↗
PubMed1996

Discography with manometry and discographic CT: their value in patient selection for percutaneous lumbar nucleotomy.

In minimally invasive spinal surgery and percutaneous disc surgery the exact preoperative structural analysis of the disc herniation becomes a prerequisite in patient selection. Discography including discal manometry and discographic CT (in addition to CT and MRI) are used to review the anatomy of disc herniations prior to surgery. The analysis of the findings of discography in 360 lumbar discs examined from 1988 to 1994 are presented. In 68 discs operated with hemilaminectomy, later intraoperative findings were available for comparison with preoperative discographic findings. The diagnostic accuracy of determining the exact anatomical location of the herniation with discography alone was 75%. The diagnostic accuracy increased to 99.55% with the use of CT discography. The authors conclude that CT discography is an accurate and useful diagnostic aid.

Diskectomy, Percutaneous↗
PubMed1995

[Thrombosis and phlebitis of superficial veins. Differential histopathologic diagnosis].

Primary thrombosis and phlebitis with secondary thrombosis of superficial veins are frequent. A biopsy may be performed if the clinician suspects an underlying systemic disease. The pathologist must be aware of the different types and their etiology because the further diagnostic and therapeutic procedures depend on his evaluation. The different types of primary thrombotic and primary phlebitic disorders are described and their possible etiology is discussed.

Diagnosis, Differential↗
PubMed1995

Microvascular changes in chronic venous insufficiency--a review.

Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial spaces). Through the latter an increased extravasation can be observed, leading to an enlarged pericapillary space, oedema in the interstitial tissue and to the clinical finding of swelling. Haemoglobin from extravasated erythrocytes and erythrocyte fragments in the pericapillary space is degraded to haemosiderin which is responsible for hyperpigmentation. Microthrombosis in the capillaries causes microinfarction and micronecrosis. Skin areas with severe microangiopathy have reduced numbers of perfused nutritional capillaries and are characterized by a low transcutaneous (tc) PO2. The increased blood flow in the deeper skin layers does not contribute to nutrition of the superficial skin layers. The microvascular ischaemia is patchy and appears to be the main factor determining trophic changes and venous ulceration. The process of microinfarction and micronecrosis is followed by the formation of a granulation tissue, proliferation of capillaries and fibroblasts and finally wound healing by formation of scar tissue destroying the microlymphatic network. Clinically this process leads to lipodermatosclerosis, atrophy and in its most extreme form to ulceration where the compensating mechanisms are no longer able to repair the damage.

Capillary Permeability↗
PubMed1995

Classification of vasculitides. A survey.

Many proposals for the classification of vasculitides have been presented but none have been universally recognized. This survey deals critically with the recently proposed nomenclatures and shows up their advantages and disadvantages. Finally a new trial is presented which includes also phlebitic and lymphangitic disease entities and tries to consider all known vasculitic disease entities.

Diagnosis, Differential↗
PubMed1994

[True aneurysm of the ascending aorta in HIV disease].

A 31-year-old male who presented with a true aneurysm of the ascending aorta had for 5 years been seropositive for HIV-1 following intravenous drug abuse. Elective aneurysmectomy was refused. Controls by computerized tomography and echocardiography gave evidence of a progressive dilatation during the following 8 months. In February 1992 a further increase of the aneurysm with severe thoracic pain necessitated an emergency graft implantation. Histopathology of the resected aorta revealed a granulomatous giant cell mesaortitis. The postoperative course was uneventful and the patient remained free of cardiovascular symptoms, but died 25 months later due to multiple HIV-associated opportunistic infections. The differential diagnosis (Marfan's syndrome, vasculitis due to tuberculosis, syphilis and other infectious agents, rheumatological diseases, HIV-associated vasculitis) and the etiopathological considerations are discussed.

Adult↗
PubMed1994

Phlebitides--a survey.

Classification of phlebitides is difficult and none of the suggestions made so far has been internationally recognized. Already the definition of "primary" and "secondary" presents difficulties. For practical purposes the phlebitides are classified in this survey according to their importance as disease entities and their etiology. The role of phlebitis saltans as an idiopathic disease or as an indicator of underlying disorders is emphasized and the differential diagnosis between symptomatic skipping phlebitis and paraneoplastic thrombosis with secondary inflammation is outlined.

Diagnosis, Differential↗
PubMed1994

[The current concept of the pathogenesis of trophic skin lesions in chronic venous insufficiency from the morphologic viewpoint].

Disturbances of the venous macrocirculation are the main cause of trophic skin lesions in primary and secondary chronic venous insufficiency. The microcirculatory process initiates with functional and organic endothelial alterations in the cutaneous and subcutaneous capillaries, followed by increased permeability for blood plasma and erythrocytes, and later by edema and micronecroses in the interstitial tissue. Subsequently a reactive chronic inflammation develops. A vicious circle consisting of repeated tissue necrosis alternating with repair processes and later with tissue fibrosis may develop. This injury and repair process is non-specific and characteristic for all types of tissue necrosis. Intensity and duration of the process depend on degree and persistence of the underlying disorder.

Capillary Permeability↗
PubMed1994

[Micromorphologic changes in the skin in primary and secondary (post-thrombotic) chronic venous insufficiency].

The micromorphological alterations in chronic venous insufficiency are characterized by a patchlike distribution. At least in the initial stages, normal skin areas may alternate with regions containing severe alterations. The capillaries may be rarified, or elongated and dilated with formation of glomerulus-like clusters, or they may show proliferation within a granulomatous repair tissue. Pericapillary accumulation of fibrin may be observed only within necrotic tissue surrounding an ulcer. The pericapillary space which is enlarged and edematous in chronic venous insufficiency, cannot be anatomically defined. The interstitial tissue may contain a secondary chronic inflammation with repair function. Finally a hyaline scar tissue with so-called "avascular" fields and dystrophic calcification/ossification may result.

Capillaries↗
PubMed1994

Systemic phlebitis of visceral veins with intramural giant cell granulomas--a new entity?

We report a case of granulomatous giant cell poly-phlebitis of the mesenteric veins in a 38-year-old man, resulting in a segmental infarction of the ileum. Multiple epithelioid granulomas with giant cells of the Langhans type were situated in media/adventitia of small and middle-sized mesenteric veins with subsequent thrombotic occlusions. No involvement of arterial vessels could be detected. The etiology of the disease remains unknown. Any known type of vasculitis could be excluded. An immunology-related vasculopathy is assumed, but could not be definitely proved. This is the first case of a granulomatous giant cell poly-phlebitis of visceral veins reported in the world literature.

Adult↗
PubMed1994

Cerebrovascular accidents resulting from segmental mediolytic arteriopathy of the cerebral arteries in young adults.

Five cases of cerebrovascular accident or transient ischaemia in young adults resulting from segmental mediolytic arteriopathy are reported. The aetiology of segmental mediolytic arteriopathy is unknown but the disorder is characterized by focal, non-inflammatory mucoid degeneration of the media of muscular, non-arteriosclerotic arteries, frequently involving cerebral intracranial or extracranial vessels. It is similar to Erdheim-Gsell's medionecrosis of the aorta and may occur in any muscular artery. The consequences are mostly fatal in cerebral arteries. Histological analysis of each case is described. Clinicians should be aware of the possibility of intramural haemorrhage and dissecting aneurysm as a result of mucoid degeneration of the arterial media in young adults with cerebrovascular accident.

Adult↗
PubMed1993

Primary granulomatous giant cell polyphlebitis of visceral veins.

A case of granulomatous giant cell phlebitis occurred in the mesenteric veins of a 38-year-old man, resulting in segmental infarction of the ileum. Multiple epithelioid granulomas with giant cells of the Langhans type were situated in media/adventitia of small and middle-sized mesenteric veins with subsequent thrombotic venous occlusions. No involvement of arterial vessels could be detected. The aetiology of the disease remains unknown. Known types of vasculitis were excluded. It was assumed that this is an example of in immunological vasculopathy but this could not be proved.

Adult↗
PubMed1993

[Biopsy in systemic vasculitis: guidelines and risks].

Biopsy examinations may be of great importance for the diagnosis of systemic vasculitides if they are correctly performed and some general pitfalls are avoided. Apart from technical mistakes (insufficient or too superficially excised material, necrotic tissue material without intact border areas, bad or retarded fixation), the following points should be kept in mind: Immunohistochemical and electron microscopic examinations are practically worthless for diagnostic reasons. The surgical access to the biopsy area and the tolerability of the intervention should be carefully evaluated. Biopsies without sufficient information to the pathologist about the clinical findings and the laboratory results are often responsible for insufficient pathology reports. Biopsies during or immediately after a corticosteroid treatment provide faulty results. Skin biopsies in systemic vasculitides usually present non-specific alterations. Polymyalgia does not cause a temporal arteritis and no conclusive findings within the striated musculature. A "blind" temporal artery biopsy has only a limited chance to provide findings of diagnostic value. The sites which offer the best possibilities for biopsy in various systemic vasculitides are enumerated and the possible histology findings at these sites are discussed.

Arteries↗