Search

In recent years, clinically significant advances have been made in the management of giant cell arteritis and Takayasu arteritis. This concise review article highlights important aspects of the diagnostic workup and imaging-based treatment surveillance of the large vessel vasculitides.Die Bestimmung der Prätestwahrscheinlichkeit auf Basis standardisierter Scoring-Systeme kann die Testgüte bildgebender Verfahren in der Diagnostik der Riesenzellarteriitis erhöhen.Die hochauflösende Sonografie der Gefäßwand ist das Erstlinienverfahren in der Riesenzellarteriitis-Diagnostik, falsch positive Befunde können jedoch bei kardiovaskulärem Risikoprofil, insbesondere bei Männern jenseits des 70. Lebensjahres, vorkommen.In der Therapiekontrolle ist Bildgebung unverzichtbar. Die PET-CT ist hier am besten untersucht, jedoch verbleiben Unklarheiten bezüglich der Befundinterpretation. Eine wertvolle alternative bzw. ergänzende Methode stellt die Kontrastmittelsonografie dar.

The SARS-CoV-2 pandemic has rapidly spread around the world and has led to a substantial morbidity and mortality in many countries. Although Corona Virus Disease 19 (COVID-19) is primarily a respiratory tract infection, there is growing evidence that other organs including the cardiovascular system are affected by COVID-19. In this review, we summarize the association of myocardial injury with in-hospital mortality of COVID-19 patients. Furthermore, we discuss potential mechanisms of myocardial injury including myocarditis and vascular thrombosis. Last, we review the current evidence on drugs which have been evaluated or are currently tested for the treatment of COVID-19 patients.

The SARS-CoV-2 pandemic has rapidly spread around the world and has led to a substantial morbidity and mortality in many countries. Although Corona Virus Disease 19 (COVID-19) is primarily a respiratory tract infection, there is growing evidence that other organs including the cardiovascular system are affected by COVID-19. In this review, we summarize the association of myocardial injury with in-hospital mortality of COVID-19 patients. Furthermore, we discuss potential mechanisms of myocardial injury including myocarditis and vascular thrombosis. Last, we review the current evidence on drugs which have been evaluated or are currently tested for the treatment of COVID-19 patients.

Small vessel vasculitis is a potentially life-threatening disease that affects almost every organ system. In contrast to other inflammatory rheumatic diseases, mortality has been reduced in vasculitis in the last decade, but not the number of disability pensions and days off. Central issues today are infections, cardiovascular events, fatigue and reactive depression. Conclusive rehabilitation concepts have not been implemented as consistently as with other inflammatory rheumatic diseases. The rehabilitation of patients should be done in specialized centers. For a socio-medical assessment, a structured ICF-oriented approach is crucial.

Autoimmune diseases are of considerable importance in dog breeding. An increased risk of diseases with genetic predisposition is present especially in breeds with a limited genetic diversity. Strict breeding regulations and a high degree of self responsibility of the breeders are essential to prevent these diseases. There are only a few DNA tests available for detecting carriers of genes predisposing for autoimmune diseases. In this review, we describe the special situation in the Nova Scotia Duck Tolling Retriever, who has a special predisposition for Systemic Lupus Erythematosus (SLE) and for Immune-mediated Rheumatoid Disease (IMRD), as well as for Steroid-Responsive Meningitis Arteritis (SRMA) and Juvenile Addison's Disease (JADD). In addition a short overview on the pathogenesis of autoimmune disease is presented.Autoimmunkrankheiten sind in der Hundezucht von erheblicher bzw. zunehmender Bedeutung. Speziell Hunderassen mit relativ schmaler Zuchtbasis und damit verbundener limitierter genetischer Diversität sind dafür prädisponiert. Durch verantwortungsvolle Züchtung unter Ausschluss von Tieren mit besonderer Prädisposition wird versucht, die Verbreitung von Autoimmunkrankheiten bei Rassehunden unter Kontrolle zu halten. Es werden zur Zeit bereits einzelne DNA-Tests angeboten, welche es ermöglichen, Genträger zu identifizieren. In der vorliegenden Übersichtsarbeit wird die besondere Prädisposition des Nova Scotia Duck Tolling Retrievers für den Systemischen Lupus Erythematosus (SLE) und die Immunbedingte Rheumatische Krankheit (IMRD), die Steroid-Responsive Meningitis Arteritis (SRMA) und die Juvenile Addison’s Disease (JADD) beschrieben. Zuvor wird die Pathogenese von Autoimmunkrankheiten dargestellt bzw. rekapituliert.Les maladies auto-immunes ont une signification de plus en plus importante et croissante dans l’élevage de chiens. Les races spéciales avec une base d’élevage étroite et une diversité génétique associée limitée sont prédisposées. Un élevage responsable, visant à exclure des animaux particulièrement prédisposés, permet de contrôler la recrudescence des maladies auto-immunes chez les chiens de race. Actuellement, des tests ADN individuels sont proposés, permettant d’identifier les porteurs de gènes. Cette revue systématique décrit la prédisposition particulière du Retriever de la Nouvelle-Écosse pour le lupus érythémateux disséminé et le rhumatisme à médiation immunitaire, la méningite-artérite sensible aux stéroïdes et le syndrome juvénile d’Addison. Mais avant cela, la pathogenèse des maaladies auto-immunes est présentée resp. récapitulée.Le malattie autoimmuni nell’allevamento dei cani sono di notevole e crescente importanza. Certe razze di cani con una base riproduttiva ristretta e una limitata diversità genetica sono particolarmente predisposte. Tramite un allevamento responsabile si punta ad un controllo della diffusione di malattie autoimmuni nei cani di razza, escludendo gli animali con una particolare predisposizione. Attualmente sono disponibili test del DNA che permettono di identificare i portatori dei geni. In questa recensione si descrive la particolare predisposizione dei Nova Scotia Duck Tolling Retriever per il Lupus eritematoso sistemico (LES), le malattie reumatiche immuno-mediate (IMRD), la meningite arterite sensibile agli steroidi (SRMA) e la malattia giovanile di Addison (JADD). Innanzitutto verrà presentata e descritta la patogenesi delle malattie autoimmuni.

The aim of our study was to determine the prevalence of NA-AION patients younger than 50 years among all our NA-AION patients and to compare clinical findings between young and elderly NA-AION patients.This was a retrospective review of complete ophthalmic examinations, including fluorescein angiography and visual field testing, performed on all patients with the first attack of acute NA-AION admitted to our department during the period of ten years (2004 to 2013). Of 120 NA-AION patients, 10 (8.3 %) were under 50 years of age.The majority of these were men: 8 of 10 (80 %). The average best corrected visual acuity on admission was 0.34 (fingers counted up to 1.0) and on discharge 0.53 (fingers counted up to 1.0). Of 10 eyes, 6 were emmetropic and 4 hyperopic, from + 0.50 D to + 2.0 D. Aside from the clinical picture of AION, other ophthalmological findings were normal. In fluorescein angiography, typical changes for ischaemic optic neuropathy were observed in all patients. In a majority of patients, an inferior altitudinal visual field defect was found. As regards systemic risk factors, hyperlipidaemia was observed in 7, arterial hypertension in 3, diabetes mellitus without diabetic retinopathy in 3, and ischaemic heart disease in 1 of 10 patients. One patient was treated for rheumatoid arthritis without signs of vasculitis. In 3 patients, more than one systemic risk factor was observed. Two of our patients had no systemic risk factors except moderate hyperopia. Bilateral manifestation was observed only in one patient 8 months after the first attack. None of the patients experienced recurrent attacks.The prevalence of younger patients in our study was lower than in previous studies. The reason could be the better medical prevention in our region. Our study confirmed that even in young NA-AION patients, moderate hyperopia could be a predisposing factor. Our study did not confirm the differences between young and elderly NA-AION patients as observed in previous studies. During a period of 10 years, we did not observe recurrences, high risk of other eye involvement or severe vision loss in our young patients compared to the elderly.

The case of a 35-year-old pregnant patient is described who presented with acute bilateral visual loss. As the reason for this a retinal arteritis could be demonstrated. The patient also suffered from acute unilateral hearing loss in combination with cerebral changes detectable by MRI. After exclusion of other causes the diagnosis of Susac syndrome (retinocochleocerebral microangiopathy) was made and appropriate therapy was initiated.

The aim of the study was to evaluate the glucose ratio (glucose level in the cerebrospinal fluid [CSF]/blood glucose level) as a quickly available marker for detecting bacterial meningoencephalomyelitis (BM).Blood and CSF samples of 328 dogs were reviewed and evaluated retrospectively. Following the neurological diagnosis, the dogs were assigned to seven different groups: steroid-responsive meningitis-arteritis (SRMA), intervertebral disc disease (IVDD), neoplasia of the central nervous system (N), idiopathic epilepsy (IE), bacterial meningoencephalomyelitis (BM), meningoencephalomyelitis of other origin (ME) and healthy dogs.The median of the CSF-glucose level (mmol/l) and the median of the glucose ratio in the SRMA group displayed the lowest values and differed significantly from the CSF-glucose levels of dogs in the groups IVDD, N, IE and healthy dogs (CSF-glucose level: p0.01; glucose ratio: p0.05). In the BM group, both parameters did not differ significant- ly from other groups, but displayed similar low levels as in the SRMA group. There was a negative correlation between the CSF cell count and the CSF-glucose ratio (Spearman correlation coefficient -0.322, p=0.01, R²=0.108).The CSF-glucose concentration cannot be used as a distinct marker to differentiate BM from other inflammatory CNS-diseases, especially from SRMA usually accompanied by severe pleocytosis. Low CSF-glucose levels appear to be caused by elevated CSF cell counts rather than by bacterial metabolism.For a definitive diagnosis of bacterial meningoencephalomyelitis in dogs, the detection of microorganisms remains necessary.

The results of conservative treatment for central retinal artery occlusion (CRAO) vary considerably and although local intraarterial fibrinolysis (LIF) is a promising treatment, outcomes have not been compared in randomized trials. The prospective randomized multicenter study by the European Assessment Group for Lysis in the Eye (EAGLE) is the first clinical trial to compare treatment outcomes of conservative standard treatment (CST) and LIF for acute non-arteritic CRAO. Patients (age 18-75 years) with CRAO present for less than 20 h and best-corrected visual acuity (BCVA)0.5 logMAR were randomized to either CST or LIF group. Primary endpoint was BCVA after 1 month and secondary endpoint was safety. Mean BCVA (logMAR) improved significantly in both groups and did not differ between the groups. Because of similar efficacy and the higher rate of adverse events in the LIF group the study was halted after the first interim analysis. Due to the similar outcomes of the two therapies and the higher rate of adverse reactions associated with LIF superselective lysis cannot be recommended for the management of acute CRAO.

The causes of non-arteritic retinal artery occlusions rarely originate from the eye itself but are mostly the result of thrombo-embolic events which often develop due to atherosclerotic vascular changes, which in turn are often a consequence of internal diseases. In this article the most important internal medical examinations to identify related risk conditions are highlighted, which ensure that appropriate therapy can be initiated to reduce further possible vascular events. Additionally, a critical assessment is made concerning the implementation of thrombophilia diagnostics.

Leprosy is usually well-controlled by multidrug therapy (MDT). However, in case of noncompliance or leprosy reactions, it may present a therapeutically challenge. A 33-year-old Brazilian woman with lepromatous leprosy was treated with MDT for one year, but then discontinued therapy because she wanted to have children. Eight weeks after stopping her medications, she developed a severe and recalcitrant erythema (nodosum) leprosum (ENL) which presented histologically with thrombosed small veins and neutrophilic inflammation in fat septa, but without arteritis. During her pregnancy and ensuing lactation period, glucocorticoids were the only suitable drug. With the use of the shortened WHO/MDT regimen (one year vs. two years of treatment), ENL will probably be seen more often after the end of leprosy therapy. It needs to be rapidly recognized and treated to avoid damage to eyes or kidneys.

Large vessel vasculitis is characterized by local inflammation of the vessel wall of the aorta and its first and second degree branches. Giant cells are found regularly. The process leads to stenoses and occlusions as well as to aneurysmatic dilatation. Recent progress in vascular imaging (colour Doppler ultrasound, MRI and PET) allows to detect Takayasu arteritis at an earlier stage and to reveal the involvement of larger arteries in temporal arteritis (giant cell arteritis, GCA). With increasing frequency, a subtype of predominantly female and less aged GCA patients without cranial symptoms is noticed in whom obstructions are prevailing in the proximal arm vessels or in the aorta. The latter may be affected exclusively. Initial therapy is based on corticosteroids. In GCA, methotrexate hitherto is the only other immunosuppressive drug that has proved to be helpful. Disease activity has to be controlled both by laboratory parameters and vascular imaging.

The aim of this study was to review the refractive errors of non-arteritic anterior ischaemic optic neuropathy (NAION) patients, especially with regard to hyperopia as an additional risk for NAION.The medical records of detailed ophthalmic examinations of 45 patients with acute NAION who were admitted to our department between January 1, 2002 and January 1, 2007 were reviewed retrospectively. Refractive errors were measured with an autorefractometer. The spherical equivalent (sum of sphere and cylinder) was used as a measure of refractive error.The majority of eyes (32 of 45) were hyperopic (71.1 %) The average degree of hyperopia was + 1.86 D. Six of 45 patients (13.3 %) were myopic. The average degree of myopia was -0.87 D.Our results suggest that hyperopia could be a predisposing factor for NAION. Since there is no reliable and effective treatment for NAION, measures to avoid ischaemic optic neuropathy have priority. Patients with moderate hyperopia should receive a detailed eye examination with emphasis placed on recognition and management of other possible risk factors to minimise the risk for NAION. Prevention of possible risk factors is the only way to avoid this severe complication and to prevent the involvement of the fellow eye.

The potential impact of coagulation abnormalities on non-arteritic ischaemic optic neuropathy (NAION), individually and in combination with cardiovascular risk factors, remains unclear.In a prospective case-control study a cohort of 26 NAION patients60 years at the time of the NAION or a previous thromboembolic event and 50 subjects matched for age and sex were prospectively screened for thrombophilic risk factors.Overall, thrombophilic defects were found to be present in 12 of 26 patients (46.2 %) and in 9 of 50 (18 %) controls (p = 0.01). The most frequent coagulation disorders were high levels of factor VIII (p = 0.04) and lipoprotein (a) (p = 0.03). Moreover, we identified two patients with homozygous resistance to activated protein C, which is the first description of this coagulation disorder associated with NAION. Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (p = 0.038).Our results indicate that thrombophilic disorders are associated with the development of non-arteriitic ischaemic optic neuropathy in patients60 years of age at the time of a first thromboembolic event. Selective screening of young patients and patients without cardiovascular risk factors may be helpful in identifying NAION patients with thrombophilic defects.

A case of two non-atherosclerotic aneurysms localised in the ascending aorta and in the pulmonary trunk is presented. Histopathologically, a severe granulomatous inflammation affecting the whole aneurysms wall was documented. To the best of our knowledge it is the second ever documented case of simultaneous occurrence of aneurysms in the aorta and the pulmonary artery.

Steroid-responsive meningitis-arteriitis (SRMA) is a disease of dogs familiar in small animal practice for decades. A combined evaluation of IgA in serum and cerebrospinal fluid (CSF) is an important diagnostic tool. It is suspected that immunpathological mechanisms are involved in the pathogenesis of SRMA because of the marked response to steroids. Excessive production of IgA seems to play a central role and might be caused by an immune reaction to self-antigens of the central nervous system (CNS). To test this hypothesis, we analyzed CSF samples from 55 dogs with SRMA using the western blot method. After blotting canine brain tissue, IgA, IgM and IgG of the CSF samples were tested for their binding to CNS antigens. We also evaluated CSF samples from 45 dogs with other brain diseases, including different encephalitides and intracranial tumors, and from healthy dogs as controls. Positive reactions (mostly IgA) were observed in the CSF samples from dogs with SRMA, different encephalitides and brain tumors (a total of 8% positive samples). The occurrence of autoantibodies against CNS structures was significantly higher in the control group "other brain diseases" than in the SRMA group (p = 0.0135). There was no significant difference in the number of positive samples between dogs with SRMA and the negative control group (healthy dogs, p = 0.1535). Despite the small number of positive samples, only dogs with abnormal findings in the CSF analysis also had autoantibodies in the CSF. There was no significant correlation between the occurrence of autoantibodies and levels of IgA, protein content and cell counts in the cerebrospinal fluid. However, there was a certain trend toward positive reactions in CSF samples with high protein content. The occurrence of autoantibodies in dogs with SRMA thus seems to be an epiphenomenona rather than the cause of the disease.

Segmental mediolytic arteriopathy (SMA) is defined as non-inflammatory arteriopathy with mediolysis due to segmental loss of media and consecutive formation of vascular gaps. Up to now, less than 40 cases of visceral and cerebral SMA and, to our knowledge, only one case of pulmonary SMA have been reported. We present the history of a 21 year old female patient, admitted to hospital with hemoptysis, but without other symptoms. Apart from two lesions in the sixth and tenth pulmonary segment, documented by CT and interpreted as colliquations, there were no other clinical and laboratory findings. Repeated bronchoscopy supplied no further information. Histomorphology of the resected lesion revealed SMA without evidence of vasculitis. Wegener's disease could be excluded. The aetiology of the disease is still unknown. Acute vasospasm (due to inappropriate reactions to catecholamine or endothelial dysfunction), as well as SMA as a precursor or subtype of fibromuscular dysplasia, are two theories still under discussion.

Atherogenesis is characterized by a chronic process, which commences years before diabetes mellitus becomes overt. Each step of the pathogenetic cascade is accompanied by inflammation. The degree of inflammation is a key determinant for the process of atherogenesis. C-reactive protein is elevated by inflammatory processes, correlates with the atherosclerotic prognosis and is therefore an important marker of inflammation. It denotes early cardiovascular damages and is elevated in acute coronary syndromes. Cardiovascular risk is excessively elevated in diabetic patients and inflammatory mechanisms are predominant in this group. Preventive interventions and therapeutic strategies based on pathophysiological processes are necessary. The importance of treatment of inflammation increases. Glitazones have been demonstrated to act via antiinflammatory effects. They do not only improve glucose utilisation, but also have pleiotropic effects, which target the increased cardiovascular risks in diabetic patients.

In patients with early manifestation of peripheral arterial occlusive disease (PAOD) and a less classical atherosclerotic risk profile, vasculitis is presumed to be the underlying disease. We performed a prospective study of the importance of determination of autoantibodies used for the diagnosis of vasculitis and collagen diseases in patients with symptomatic PAOD.698 consecutive patients (mean age +/- SD: 68 +/- 10 years) were included who were referred from 1998 to 1999 for interventional treatment of PAOD. In 121 PAOD-patients (61 +/- 12 years) with a less pronounced atherosclerotic risk profile, or rarefied distal arteries without sclerosis of the media, or elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) independent from the stage IV of PAOD, the following autoantibodies were investigated: antinuclear antibodies (ANA), antibodies against extractable nuclear antigens (ENA): SCL 70, RNP, SS-A, SS-B, Jo-1, SM), double-stranded DNA antibodies (ds-DNA), antineutrophil cytoplasmatic antibodies (c- and p-ANCA), antiphospholipid antibodies [phosphatidylserine (APSA) and beta(2)-glycoprotein], smooth (SMA) and striated muscle (StrMA). ANA, SMA and StrMA were estimated by indirect immunofluorescence technique, ENA by Western-blot and the others by enzyme linked immunoassay.38 PAOD-patients (35%) had increased autoantibody concentrations. The rate of different PAOD stages and localization did not differ between the group of patients with increased autoantibody concentrations and the group of patients without. But the group of patients with increased autoantibody concentrations had higher rates of elevated ESR [p-value of 0.0043, odds ratio of 7.1 (95% CI: 1.49-33.81)]. ANA were the most frequent autoantibodies detected in 17 (14%) of the 121 patients followed by APSA and autoantibodies directed against beta(2)-glycoprotein. During follow-up of 24 +/- 6 months no vasculitis or collagen diseases associated with the elevated autoantibody concentrations became clinically manifest in the 38 patients. Two patients died due to coronary heart disease. Four patients had a worsening of their PAOD but no amputation was performed. Out of the 83 patients without elevated concentrations of autoantibodies, eight patients died and three amputations were carried out.All in all, increased autoantibody concentrations in patients suffering from peripheral atherosclerosis are not a rare finding. A systematic determination of autoantibodies, especially in patients with a low atherosclerotic risk profile, does not increase the number of manifest or developing vasculitis of collagen disease.

Cardiovascular disease, the most common cause of death in the Western world, results mainly from atherosclerotic remodeling of the arterial system. Atherosclerosis defines a disease in which the arterial wall becomes thickened and loses elasticity. This is clearly not a static condition. Instead, atherogenesis reflects a continuous development over time, ranging from macroscopically intact arteries to ruptured sclerotic plaques. Different stages at different sites can be present simultaneously within one individual. The pathophysiology of atherogenesis comprises various important steps, including enhanced endothelial permeability, expression of adhesion molecules, monocyte adhesion and immigration, foam cell formation, fatty streaks, smooth muscle cell migration and plaque formation, and, finally, plaque rupture and thrombus formation. In recent years, atherosclerosis is more and more being recognized as a chronic inflammatory process. The hypothesis of a chronic inflammation in atherosclerosis is supported by the following findings: atherosclerosis is associated with enhanced serum levels of inflammation parameters, including in particular C-reactive protein (CRP, Table 1); the atherosclerotic artery produces different hydrolytic enzymes, adhesion molecules, cytokines, and growth factors as seen in chronic inflammation; cells found in early atherosclerotic lesions are typically inflammatory cells (monocytes/ macrophages and T-lymphocytes); and, there is convincing clinical and experimental evidence that formation of reactive oxygen species (ROS) is augmented during this chronic inflammatory process due to an imbalance between synthesis of ROS and neutralizing antioxidative defense mechanisms. Studies in the general population could clearly show that markers of inflammation, in particular CRP, predict the cardiovascular risk. It is the aim of this review to discuss the role of inflammatory processes for the development of atherosclerosis and cardiovascular disease. Pro-inflammatory substances contributing to oxidative stress are listed in Table 2, and particular emphasis is placed on pathophysiologic effects induced by oxidized LDL and angiotensin II. Figure 1 summarizes important reaction steps of oxidative stress reactions, based on formation of superoxide anion (O(2)(-)). Finally, therapeutic options are presented, although it has to be emphasized that treatment with antibiotics proved to be essentially ineffective, and treatment options with antioxidants are not sufficiently evaluated to allow a final statement. Meanwhile, however, there is accumulating evidence that established treatment regimens with statins or renin-angiotensin system inhibitors possess profound anti-inflammatory and antioxidative properties which may support their beneficial effects on cardiovascular disease.

Case-reports from two female patients with an occlusion of the right external iliac artery and femoral artery are presented due to a large-vessel vasculitis. Both patients suffered from systemic lupus erythematosus This rare manifestation occurred within the first few years of the disease and was important for prognosis and further treatment. Other manifestations of the disease were general symptoms and polyarthritis. In one case the vasculitis was confirmed by histology. A fibrous thickening of the intima and a vasculitis of small vessels within the adventitia were the prominent feature. This observation supports the idea of small vessel vasculitis as the characteristic manifestation in lupus erythematosus.

Primary bacterial infection of an artery is difficult to diagnose, especially at the beginning of the illness. Most of the patients come for emergency treatment in the phase of rupture.The course of illness in four patients serves as background for discussion of the problems of diagnosis and therapy.Bacterial infection of arteries shows a high rate of complications and, for the aorta, high mortality.If fever of uncertain origin is combined with pain of the stomach or of the back, or with a painful reddish swelling on a limb, this rare disease should be considered in the differential diagnosis.

Steroid responsive meningitis-arthritis in the dog is a frequently occurring disease in small animal practice. However, the etiology and pathogenesis are unknown. Immunopathologic events are suspected, since IgA seems to play a central role in pathogenesis. The influence of an infectious agent is possible. To classify the nature of such an agent, we tried to find in this study an oligoclonal T-cell proliferation using Southern blot technique. This could give a hint for an infection with a superantigen. In a first step a proliferation assay was performed, proving that staphylococcus enterotoxins A and B induce a strong lymphocyte proliferation in the dog in vitro. In one out of six dogs with steroid responsive meningitis-arthritis T-cell receptor rearrangement was detected after digestion of genomic DNA with two different restriction enzymes. Therefore a superantigen influence in this specific disease seems to be possible, but could not be proven finally using Southern blot techniques.

Two Case Reports and Literature Review: Adventitial cystic disease of the popliteal artery is an unusual but important cause of intermittent claudication. Two cases of adventitial cystic disease were diagnosed by ultrasound investigation. The changing size of the cysts is correlated with the clinical symptoms of the patient. One patient was treated by resection with interposition of saphenous vein; the other by ultrasound guided needle aspiration of the fluid.

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.

Clinical and histopathological features of cutaneous vasculitis are presented by means of 14 case reports. Proof of vasculitis in skin biopsy consecutively demands for a search of a cause and of the extension of the vasculitic process in the sense of a systemic disease. The most frequent form of cutaneous vasculitis is hypersensitivity angiitis, a disease in which always an exogenous (drugs, infections) or an endogenous (malignant neoplasia, connective tissue disease) trigger should be sought if cutaneous vasculitis persists after removal or treatment of the suspected cause. Then, antihistaminic or--particularly in cases with systemic involvement--immunosuppressive drugs (corticosteroids or cyclophosphamide) should be considered.

Three cases of abortions were diagnosed as caused by Equine Arteritis Virus (EAV) by isolation and typing of this virus from the respective fetuses. All 3 abortions were single cases, one occurring on a stud with Iceland Ponies, one with Warmbloods, one with Lipizzaner horses. On each stud horses of the respective breed were kept exclusively, therefore there existed no epidemiologic link. By means of seroneutralization tests performed on in contact horses it could be shown, that EAV had only been introduced recently into the stud with the Iceland Ponies. An extraneous mare stabled temporarily for covering by the stud's stallion could be incriminated for introducing EAV. By means of post-abortion serology it could be demonstrated that the Warmblood stud had been harbouring EAV for a longer period of time. Likewise, the Lipizzaner stud could be shown to have been persistently infected, this time on pre-abortion serums stored frozen at our Institute. On both these studs preexisting neutralizing antibodies accounted for the single case of abortion and prevented serial abortions. By investigating frozen serums taken in earlier years we could show that the Lipizzaner stallions had reacted positively to EAV for several years already. However, the gestation period of the aborting mare allowed to exclude EAV-positive semen transmitted on copulation as cause of its abortion. Both the Iceland Pony stallion as well as the Warmblood stallion could be excluded as sources of infection for the respective aborting mares as both repeatedly were seronegative.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute ocular toxoplasmosis is characterized by a focal retinochoroidal infiltrate, often appearing in the immediate vicinity of an old retinochoroidal scar (satellite lesion). There are atypical forms of ocular toxoplasmosis, including retinal granulomas, intraretinal and subretinal neovascularization, preretinal gliosis and retinal detachment. In rare instances, associated immunological phenomena, i.e. concomitant vasculitis and perivasculitis, have been described. We report on a 28-year-old male patient presenting with signs of congenital toxoplasmosis with intracerebral calcifications and internal hydrocephalus (Whytt's disease). Ocular manifestations included an acute retinochoroidal infiltrate adjacent to a retinochoroidal scar and segmental retinal periarteritis. All arterioles were involved, but there was no inflammation of the venules. Fluorescein angiography revealed filling irregularities of the vessel segments involved. Like a tubercular patient with segmental periarteritis reported on as long ago as 1939, our patient had undergone treatment for active tuberculosis of the lung 6 years earlier. Considering the fact that segmental periarteritis without concomitant periphlebitis is very rarely seen, the coincidence of acute toxoplasmosis and previous tuberculosis suggests a complex immunological etiology of retinal vasculitis. This assumption may be supported by the fact that a combined systemic treatment with pyrimethamine, trimethoprim, sulfamethoxazole and prednisolone reduced the retinochoroidal inflammation and periarterial infiltrates.

944 serum samples of horses, collected in 1988 and 1989, were examined for the occurrence of antibodies against equine arteritis virus by a microneutralizations test. In 10.9% of all sera reactors could be found. The distribution of seropositive horses varied from 4.6% (Salzburg) to 15.7% (Lower Austria). From Tyrol and Vorarlberg no samples could be obtained. It was not possible, to correlate clinical symptoms (infertility, respiratory symptoms, fever and edema) with the infection. It is assumed, that the disease appears in Austria only in a clinical inapparent form.

In the third year of life of a girl vaccinated neonatally against tuberculosis an abscess of the associated lymph nodes appeared which contained acid-fast bacilli. After extirpation of the lymph nodes weeks later an intestinal BCG-dissemination was observed which seemed to be cured under a brief tuberculostatic therapy. At the age of 22 years a left sided hemiplegia due to aneurysms and thrombosis of 2 cerebral arteries was seen. At autopsy in the adventitia of the arteria basilaris macrophages were discovered which showed intracellular acid-fast bacilli. A paralysis of the oculomotor nerve appearing later was also caused by this brain lesion. Towards the end of a pregnancy a serious BCG-dissemination in the intestines relapsed. A healthy premature child was born. Massive tuberculostatic therapy was inefficient. The woman died in her 27th year of life. A defective function of the macrophages is suggested for the immunological abnormality.

Case report of a young man suffering from seropositive juvenile arthritis who succumbed to the consequences of cerebral vasculitis. Postmortem generalised arteritis was found affecting mainly brain and kidneys. There were no laboratory signs of an inflammatory process during the months before his death nor hypergammaglobinaemia or decrease of complement. The generalised arteritis manifested itself solely as mononeuritis multiplex with eosinophilia. Thus even with discrete signs such as these severe vasculitis ought to be considered for appropriate treatment to be instituted.

Equine viral arteritis (EVA) caused by the equine arteritis virus, member of the genus arterivirus within the family of Togaviridae was recently isolated from the seminal plasma of two stallions indicating that the virus infection is also prevalent in the Federal Republic of Germany despite the apparent lack of acute clinical symptoms in the horse population. These findings are further supported by data from serological screenings. Out of 739 horse sera, 28 (3.8%) were found to have EVA virus-specific antibodies with titers greater than or equal to 4. It is important to note that the percentage of sero-positive horses was found to be increased from 1.8% in 1987-1988 to 6.8% in 1989. A voluntary prophylactic programme based on virological and serological tests is proposed to prevent further spread of the EVA virus infection. The pathogenesis, clinical symptoms and diagnosis of EVA are also reviewed.

Vascular insufficiency may complicate chronic digital infection. The reasons for this are twofold: firstly the oedema associated with chronic inflammation causes venous obstruction and this may lead to arterial occlusion. This report has also shown that a second cause of vascular insufficiency may result from direct damage to the vessel walls by the invading organisms, which leads to infectious thrombosis, particularly of the venous structures.

Three patients with supravalvular aortic stenosis are described. One was a typical, sporadic-type supravalvular aortic stenosis, another a predominant aortic valve stenosis as part a complex heart lesion and the third inflammatory shrinking of the anulus fibrosus with an inflammatory aortic valve stenosis. The means of diagnosis are discussed. Angiocardiography and aortography are essential in order to demonstrate the pathology, haemodynamics, relation to the coronary arteries and the sinus of Valsalva, and in order to show other abnormalities. The aetiology and pathogenesis of various types of supravalvular aortic stenosis are discussed.