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Vasculitides throughout history and their clinical treatment today. Curr Rheumatol Rep 2011; 13:465-72. [PMID: 21904885 DOI: 10.1007/s11926-011-0210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Therapeutic management of the vasculitides is closely linked to modern rheumatologic advances, particularly as it relates to the discovery and first clinical use of glucocorticoids. These compounds were introduced in the late-1940s for the treatment of rheumatoid arthritis, but soon after, clinicians in Europe and the United States realized that they could have a significant positive impact in systemic vasculitides. However, once it was realized that glucocorticoid use was associated with a high degree of morbidity, the search for better immunosuppressive agents with similar efficacy but improved safety profiles was on. During the past several years, several agents have been utilized for the therapeutic management of systemic vasculitides, and the list keeps growing with the development of newer compounds that have retained efficacy but with a better safety profile.
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Abstract
INTRODUCTION Orbital floor fractures are usually the result of mechanical trauma. Orbital emphysema tends to develop in fractures affecting the paranasal sinuses and walls of the orbit. CLINICAL CASE We report the case of a 35-year-old male who suffered an orbital floor fracture with associated orbital emphysema as a result of nose blowing. DISCUSSION Only one other similar case has been found in the literature.
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Affiliation(s)
- G E Murty
- ENT Department, Freeman Hospital, Newcastle upon Tyne, UK
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Robin JB, Schanzlin DJ, Meisler DM, deLuise VP, Clough JD. Ocular involvement in the respiratory vasculitides. Surv Ophthalmol 1985; 30:127-40. [PMID: 3906973 DOI: 10.1016/0039-6257(85)90081-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The respiratory vasculitides are idiopathic inflammatory syndromes, characteristically involving the pulmonary vasculature as well as that of several other organ systems. The inflammatory response in these diseases is uniformly granulomatous. There are three distinct, recognized respiratory vasculitides: Wegener's granulomatosis, Churg-Strauss syndrome (allergic granulomatosis and angiitis), and lymphomatoid granulomatosis. Each of these entities may have ophthalmic manifestations, and ocular involvement may, in fact, be the presenting sign. The systemic and ocular manifestations, as well as the differential diagnosis and management of each of these entities are discussed.
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Bullen CL, Liesegang TJ, McDonald TJ, DeRemee RA. Ocular complications of Wegener's granulomatosis. Ophthalmology 1983; 90:279-90. [PMID: 6602963 DOI: 10.1016/s0161-6420(83)34574-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
140 patients with biopsy-proven Wegener's granulomatosis were examined during a 16-year period at the Mayo Clinic. Forty patients had diverse and explosive ophthalmic involvement, including conjunctivitis, episcleritis, scleritis, corneal ulceration, uveitis, retinal vasculitis, optic neuropathy, orbital mass, orbital cellulitis, and obstruction of the nasolacrimal duct. The multiple ophthalmic and systemic complications in these 40 patients and the importance of establishing the pathologic diagnosis are discussed. Treatment with corticosteroids and immunosuppressive agents has dramatically improved the prognosis, although substantial mortality (four patients died of Wegener's granulomatosis) and ocular morbidity (three eyes were enucleated) are still associated with this disease.
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Appel GB, Gee B, Kashgarian M, Hayslett JP. Wegener's granulomatosis - clinical-pathologic correlations and long-term course. Am J Kidney Dis 1981; 1:27-37. [PMID: 7332000 DOI: 10.1016/s0272-6386(81)80008-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although Wegener's granulomatosis is a relatively well defined clinical-pathologic entity, there are few long-term reports of large numbers of patients followed at a single institution. This has hindered appreciation of the diagnosis, management, and course of the syndrome. We report an analysis of 18 patients followed at one medical center. Delay in treatment can be obviated by awareness of this potential diagnosis in any patient with combined respiratory and renal manifestations. Biopsy of involved respiratory tissue yields a high probability of establishing a specific diagnosis, while biopsy of renal tissue often provides confirmatory evidence of a vasculitic disease process. The initial degree of renal involvement as manifested by serum creatinine, proteinuria, and light microscopic morphology correlates well with eventual prognosis. The availability of modern immunosuppressive therapy and of modalities to treat end-stage renal disease appears to have greatly influenced the course of the disease.
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Cupps TR, Silverman GJ, Fauci AS. Herpes zoster in patients with treated Wegener's granulomatosis. A possible role for cyclophosphamide. Am J Med 1980; 69:881-5. [PMID: 7446553 DOI: 10.1016/s0002-9343(80)80014-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In review of the ongoing protocol for the treatment of Wegener's granulomatosis with cyclophosphamide at te National Institutes of Health, an increased incidence of herpes zoster infection was noted. There were a total of nine episodes in seven of a total of 65 patients with a 255 patient year follow-up. The infections occurred while the patients were in complete clinical remission during immunosuppressive therapy. Cutaneous dissemination was noted in two episodes, but no visceral or central nervous system involvement was noted despite continuation of immunosuppressive therapy. The major causal factor of the increased incidence of herpes zoster appeared to be the cyclophosphamide therapy.
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Abstract
Wegener's granulomatosis is characterized by a necrotizing granulomatous vasculitis which can be found in both the upper and lower respiratory tracts and with either focal or proliferative glomerulonephritis. However, any organ system can be affected by the disease. Over the past 17 years, 47 patients with histologically proven Wegener's granulomatosis have been treated at the National Institute of Allergy and Infectious Disease. Since 1972, patients with head and neck manifestations have been managed in collaboration with the Department of Otolaryngology, National Naval Medical Center. Experiences with these patients have shown that all have had some degree of respiratory tract involvement, with 42/47 having disease in the nose or paranasal sinuses. An effective therapeutic regimen is possible with immunosuppressants (particularly cyclophosphamide) and locally supportive measures. As a result of such therapy, more than 80% of the patients treated have experienced long-term remissions. The clinical implications of this therapy are discussed, and a protocol for patient management presented.
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Haynes BF, Fishman ML, Fauci AS, Wolff SM. The ocular manifestations of Wegener's granulomatosis. Fifteen years experience and review of the literature. Am J Med 1977; 63:131-41. [PMID: 327802 DOI: 10.1016/0002-9343(77)90125-5] [Citation(s) in RCA: 248] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Ocular manifestations of Wegener's granulomatosis may occur secondary to contiguous granulomatous sinusitis or as a result of focal vasculitis. Contiguous granulomatous sinus disease causes nasolacrimal duct obstruction, proptosis and ocular muscle or optic nerve involvement. Focal vasculitis unrelated to contiguous upper respiratory tract disease is manifested by conjunctivitis, episcleritis, scleritis, corneoscleral ulceration, uveitis, and granulomatous vasculitis of the retina and optic nerve. A review of 29 cases of Wegener's granulomatosis and three cases of lymphomatoid granulomatosis studied over the past 15 years at the National Institute of Allergy and Infectious Diseases (NIAID) disclosed single or multiple ocular manifestations of disease in 15 patients (47 per cent). The pattern of ocular disease, its relationship to systemic involvement, diagnostic methods and the response to therapy are discussed.
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Keczkes K. Wegener's granulomatosis. Combined therapy with low-dosage systemic corticosteroids, azathioprine and cyclophosphamide in three patients. Br J Dermatol 1976; 94:391-9. [PMID: 1268053 DOI: 10.1111/j.1365-2133.1976.tb06116.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Three patients with Wegener's granulomatosis are reported. All three had skin, nose, sinus, mouth and pulmonary lesions; one had severe renal involvement as well. In two patients combined treatment with low-dosage systemic corticosteroids, azathioprine, and cyclophosphamide resulted in rapid clinical improvement and complete disappearance of the skin, mouth, nasal, sinus and pulmonary lesions. In one of these two patients who had severe renal involvement, proteinuria greatly diminished and arrest of progression of renal insufficiency was observed. In the third patient combined treatment with azathioprine and cyclophosphamide resulted in complete remission of skin, mucous membrane, lung and sinus lesions. The patient with severe renal involvement is alive and ambulant 4 years after the onset of the disease, the other two are completely symptom-free and well 2 1/2 years and 1 year after the onset of their illnesses, respectively. These results confirm previous reports about the effectiveness of immunosuppressive and cytotoxic agents in Wegener's granulomatosis, the use of which seems to have improved the prognosis significantly in a disease previously considered to be fatal within 5 months.
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Abstract
This paper reviews studies previously conducted on the effect of anticancer drugs on immune function in man. It provides new data reporting on the effect of short intensive courses of cytotoxic drug therapy on B-lymphocyte and T-lymphocyte number in cancer patients. Both types of lymphocyte were found in this investigation to be equally sensitive to cytotoxic drugs. The degree of absolute cell number reduction and rate of recovery were similar for T-lymphocytes and B-lymphocytes. Other workers have demonstrated, however, that with prolonged administration of cytotoxic drugs B-lymphocyte number and function are more adversely affected than are T-lymphocyte number and function. Immune function which had been suppressed by continuous programs of chemotherapy for periods of up to 2-3 years will, in certain groups of patients, recover to normal or almost normal levels of function. Short courses of combination drug chemotherapy may be followed by "rebound-overshoot" recovery of immune function. This has been associated with a more favorable clinical course than in situations where it does not occur. Chemotherapy and chemoimmunotherapy programs in clinical oncology ought ideally to be initially evaluated for the effect that they have on immune function. This will permit the development of drug dose and time schedules which allow for recovery of immune function and may possibly lead to augmented antitumor responses.
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Marshall R. Pharmacological and pathological responses of the human pulmonary circulation to drugs. PHARMACOLOGY & THERAPEUTICS. PART B: GENERAL & SYSTEMATIC PHARMACOLOGY 1976; 2:289-312. [PMID: 785491 DOI: 10.1016/s0306-039x(76)80010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lundström B, Lindqvist B, Söderbergh H, Wentzel T, Hallmans G. Nephroangiography in Wegener's granulumatosis. A comparison with panarteritis nodosa. ACTA RADIOLOGICA: DIAGNOSIS 1975; 16:641-53. [PMID: 3092 DOI: 10.1177/028418517501600612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Three cases of Wegener's granulomatosis with a classical course are described, 2 of which with fatal outcome in spite of immuno-suppressive therapy. Nephroangiography was performed during the oliguric or anuric phase. The appearances were similar to those encountered in glomerulonephritis and were compared with those in three cases of panarteritis nodosa. Two of these represented the classical form with intrarenal arterial aneurysms; the third was a case of the microscopic type presenting blurred intrarenal arteries with lumen variations and occlusions. These observations support the opinion that Wegener's granulomatosis nodosa are different diseases. Nephroangiography seems to be of value in their differentiation.
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Abstract
A case of Wegener's granulomatosis is presented with control of lung lesions by corticosteriods and renal lesions by azathioprine. It supports previous experience of antimitotic therapy in this condition.
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Dale DC, Fauci AS, Wolff SM. The effect of cyclophosphamide on leukocyte kinetics and susceptibility to infection in patients with Wegener's granulomatosis. ARTHRITIS AND RHEUMATISM 1973; 16:657-64. [PMID: 4742843 DOI: 10.1002/art.1780160510] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Scott J, Finch LD. Wegener's granulomatosis presenting as gingivitis. Review of the clinical and pathologic features and report of a case. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1972; 34:920-33. [PMID: 4565579 DOI: 10.1016/0030-4220(72)90230-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Davis RW, Fetter BF, Young WG. Wegener's granulomatosis. Two patients presenting with solitary pulmonary lesions and review of eleven other cases. Ann Thorac Surg 1972; 13:427-34. [PMID: 4537125 DOI: 10.1016/s0003-4975(10)65154-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Fauci AS, Wolff SM, Johnson JS. Effect of cyclophosphamide upon the immune response in Wegener's granulomatosis. N Engl J Med 1971; 285:1493-6. [PMID: 5127139 DOI: 10.1056/nejm197112302852701] [Citation(s) in RCA: 112] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Froud PJ, Henderson AH. The treatment of Wegener's granulomatosis with immunosuppressive-cytotoxic drugs. J Laryngol Otol 1971; 85:703-10. [PMID: 5090114 DOI: 10.1017/s0022215100073965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Previous reports of 18 patients with Wegener's Granulomatosis treated with immunosuppressive and cytotoxic drugs are reviewed, and 4 new cases are reported. The prognosis in these patients is shown to be significantly better than that found in previous series where such drugs were not used
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Barland P. The use of chemotherapeutic agents in the treatment of non-neoplastic diseases. JOURNAL OF CHRONIC DISEASES 1971; 23:829-42. [PMID: 4934683 DOI: 10.1016/0021-9681(71)90013-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cabot RC, Castleman B, McNeely BU, Kaufman SD, Keller AR. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 16-1971. N Engl J Med 1971; 284:899-910. [PMID: 5549833 DOI: 10.1056/nejm197104222841609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Cooper K, Stafford J, Turner-Warwick M. Wegener's granuloma complicating pregnancy. THE JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF THE BRITISH COMMONWEALTH 1970; 77:1028-30. [PMID: 5496137 DOI: 10.1111/j.1471-0528.1970.tb03452.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Teisberg P, Enger E. Immunosuppressive therapy in Wegener's granulomatosis. ACTA MEDICA SCANDINAVICA 1970; 187:7-9. [PMID: 5423209 DOI: 10.1111/j.0954-6820.1970.tb02899.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Peermohamed AR, Shafar J. Sustained azathioprine-induced remission in Wegener's granulomatosis. BRITISH MEDICAL JOURNAL 1969; 4:600-1. [PMID: 5356550 PMCID: PMC1630081 DOI: 10.1136/bmj.4.5683.600] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Byrd LJ, Shearn MA, Tu WH. Relationship of lethal midline granuloma to Wegener's granulomatosis. ARTHRITIS AND RHEUMATISM 1969; 12:247-53. [PMID: 5787235 DOI: 10.1002/art.1780120313] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Hansotia P, Peters H, Bennett M, Brown R. Chelation therapy in Wegener's granulomatosis. Treatment with EDTA. Ann Otol Rhinol Laryngol 1969; 78:388-402. [PMID: 4975577 DOI: 10.1177/000348946907800216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sams WM, Harville DD, Winkelmann RK. Necrotising vasculitis associated with lethal reticuloendothelial diseases. Br J Dermatol 1968; 80:555-60. [PMID: 5695563 DOI: 10.1111/j.1365-2133.1968.tb12353.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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