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Thrombosis of the aorta and coronary arteries, with special reference to the “fibrinoid” lesions
126
THE
AMER,ICAN
Collens, William S., and Wilensky, ripheral Vascular Obstruction.
HEART
JOURNAL
Nathan D.: Two Quantitative Am. J. Surg. 34: 71, 1936.
Tests
of
Pe-
The authors believe that previous tests offer no information regarding degrees of vascular obstruction and are of no use in following the progression of vascularity in an extremity under treatment. They have devised two tests: (1) the venous filling time and (2) claudication time. Changes in these times indicate changes in rate of blood flow. H. M.
Lazarus, Joseph A.: Nesenteric Vascular Occlusion. Report of a Case of Complete Occlusion of Superior Mesenteric Artery With Involvement of Entire Small Intestine. Am. J. Surg. 33: 129, 1936. The case was that of a diabetic woman. There was complete closure of the main stem of the superior mesenteric artery by a thrombus and involvement of the entire small intestine, ceoum, and ascending colon. An autopsy report is included. AUTHOR. Jirka, M.
Frank
J., and Scuderi, Carlo S.:
A. 107:
201,
Glomus Tumor.
Report of a Case. J. A.
1936.
This case, one of seventy in the literature, and includes photographs of the histological was on the inner aspect of the arm, of the size sized bluish area which was exquisitely painful
is briefly but adequately slides. In this instance of a split pea, and with when touched
presented, the tumor a pinheadH. M.
Clark,
Eugene,
Graef,
Coronary Arteries, Path.
22:
183,
Irving,
and
Chasis,
Herbert:
Thrombosis
With Special Reference to the ‘ ‘Fibrinoid’
of the Aorta and ’ Lesions. Arch.
1936.
Homogeneous masses which exhibited the tinctorial properties of fibrin were frequently encountered on the surface and within the ,superficiai fibrous regions of intimal aortie plaques of atherosclerosis and syphilitic aortitis. In the lipoid zones of aortic plaques material which stained like fibrin frequently occurred in a fibrillar or homogeneous form. This material was commoner in ulcerated or eroded plaques, but it was present also in sections of plaques which appeared intact. Homogeneous masses staining like fibrin were observed forming a layer between the formed elements of the thrombi and the plaques in eight of nine cases of In many instances identical masses were encountered parietal aortic thrombosis. within the fibrous or lipoid zones of the underlying plaques. The evidence reviewed leads us to the belief that the homogeneous fibrin-staining (‘ ‘iibrinoid”) masses, occurring on the surface of fibrous plaques or the fibrous covering on atheromns, represent compressed and hyalinized blood elements and that are the remnants of an orthe subsurface ‘( fibrinoid ” masses in most instances ganizing surface deposit. The “fibrinoid layer ” beneath aortie thrombi represents laminated surface deposits of blood elements which have undergone a variable degree of organization. It is suggested also that in other instances in which there is ulceration of the plaque or a loss of endothelial lining and a loosening and separation of the super-;he subsurface fibrin-staining masses may represent ficial collagenous fibers, coagulated blood plasma which has penetrated the plaque from the lumen of the
vessel.
SELECTED
127
ABSTRACTS
As a result of repeated deposition of blood elements on the surface of the pla,ques and progressive organization of such hyalinized elements, the plaques of . syphilitic aortrtrs and atherosclerosis may undergo a progressive increase in size. A thrombus of formed elements and orthodox configuration may frequently supervene on such laminated, hyalinized and partially organized surface deposits. No differences could be discerned between the tinctorial behavior of these ‘ ‘fibrinoid” masses and that of the fibrinous eomponent of thrombi. It is believed that these masses owe their tinctorial properties to their fibrinous component. There is no evidence at present to support the view that the deposits of homogeneous fibrin-staining material in the mtimal aortic plaques of atherosclerosis or syphilitic aortitis represent altered or necrotic collagenous fibers. Study of serial sections of eleven thrombosed coronary art.eries has revealed differences in the character of the intimal plaque at the site of initial thrombosis. In some a fresh break in the inner collagenous lining of the atheroma was demonstrated; in others the fibrous lining was thinned out, and the collagen fibers were widely separated. In the presence of congestive heart failure the thrombi were deposited on intimal plaques which were apparently intact. In one ease a fresh thrombus was deposited on a plaque containing partially organized surface deposits of blood elements. We could find no evidence to support the view that the fibrin-staining material in the plaques of coronary arteries represents altered or necrotic fibrous tissue. As in the plaques of atherosclerotic and syphilitic aortas, such fibrin-staining masses either represent the remnants of an organizing surface deposit of fibrin or are due to the penetration into the plaque of blood elements. AUrEuXL. Paterson, J. C.: Vascularization Coronary Arteries. Arch.
Path.
and Hemorrhage 22: 313, 1936.
of the
Intims
of Arteriosclerotic
Vascularization of the intima of coronary arteries by discrete capillaries which arise from their lumens is a common finding in association with atherosclerosis. It is particularly marked in thrombosed coronary arteries. It has not been found in normal coronary arteries or in those affected by early nodular endarteritis. Hemorrhagic lesions within the intima, which had occurred into atheromatous foci, have been observed in a number of arteriosclerotic coronary arteries, including those from nine consecutive patients with recent coronary thrombosis. When the hemorrhage was recent, capillary channels were found in the inner layers of the intima in close proximity to the extravasated blood. The sequence of events in the production of intimal hemorrhage appears to be (1) endarteritis with vaseularization of the intima, (2) atheroma with resultant softening of the intercapillary stroma, and (3) capillary rupture. Because discrete intimal capillaries, atheroma, and intimal hemorrhage have been found in practically every coronary artery showing recent thrombosis in this series, it is suggested that these factors represent a chain of events which lead to thrombosis, the immediate cause being damage to the endothelium by the extravasation of blood into the intima. AUTHOR. Yabter, Wallace M.: Demonstration Dioxide Arteriography. South. Report anlourysmal an~eurysm is implied.
of a Ruptured M. J. 29: 973,
Popliteal 1936.
Aneurysm
of a case in which simple arterial and venous punctures, puncture, were used to demonstrate an aneurysm radiographically. was well visualized. No danger in the use of direct aneurysmal
by
Thorium
instead
of The puncture
H.
M.
THE
AMER,ICAN
Collens, William S., and Wilensky, ripheral Vascular Obstruction.
HEART
JOURNAL
Nathan D.: Two Quantitative Am. J. Surg. 34: 71, 1936.
Tests
of
Pe-
The authors believe that previous tests offer no information regarding degrees of vascular obstruction and are of no use in following the progression of vascularity in an extremity under treatment. They have devised two tests: (1) the venous filling time and (2) claudication time. Changes in these times indicate changes in rate of blood flow. H. M.
Lazarus, Joseph A.: Nesenteric Vascular Occlusion. Report of a Case of Complete Occlusion of Superior Mesenteric Artery With Involvement of Entire Small Intestine. Am. J. Surg. 33: 129, 1936. The case was that of a diabetic woman. There was complete closure of the main stem of the superior mesenteric artery by a thrombus and involvement of the entire small intestine, ceoum, and ascending colon. An autopsy report is included. AUTHOR. Jirka, M.
Frank
J., and Scuderi, Carlo S.:
A. 107:
201,
Glomus Tumor.
Report of a Case. J. A.
1936.
This case, one of seventy in the literature, and includes photographs of the histological was on the inner aspect of the arm, of the size sized bluish area which was exquisitely painful
is briefly but adequately slides. In this instance of a split pea, and with when touched
presented, the tumor a pinheadH. M.
Clark,
Eugene,
Graef,
Coronary Arteries, Path.
22:
183,
Irving,
and
Chasis,
Herbert:
Thrombosis
With Special Reference to the ‘ ‘Fibrinoid’
of the Aorta and ’ Lesions. Arch.
1936.
Homogeneous masses which exhibited the tinctorial properties of fibrin were frequently encountered on the surface and within the ,superficiai fibrous regions of intimal aortie plaques of atherosclerosis and syphilitic aortitis. In the lipoid zones of aortic plaques material which stained like fibrin frequently occurred in a fibrillar or homogeneous form. This material was commoner in ulcerated or eroded plaques, but it was present also in sections of plaques which appeared intact. Homogeneous masses staining like fibrin were observed forming a layer between the formed elements of the thrombi and the plaques in eight of nine cases of In many instances identical masses were encountered parietal aortic thrombosis. within the fibrous or lipoid zones of the underlying plaques. The evidence reviewed leads us to the belief that the homogeneous fibrin-staining (‘ ‘iibrinoid”) masses, occurring on the surface of fibrous plaques or the fibrous covering on atheromns, represent compressed and hyalinized blood elements and that are the remnants of an orthe subsurface ‘( fibrinoid ” masses in most instances ganizing surface deposit. The “fibrinoid layer ” beneath aortie thrombi represents laminated surface deposits of blood elements which have undergone a variable degree of organization. It is suggested also that in other instances in which there is ulceration of the plaque or a loss of endothelial lining and a loosening and separation of the super-;he subsurface fibrin-staining masses may represent ficial collagenous fibers, coagulated blood plasma which has penetrated the plaque from the lumen of the
vessel.
SELECTED
127
ABSTRACTS
As a result of repeated deposition of blood elements on the surface of the pla,ques and progressive organization of such hyalinized elements, the plaques of . syphilitic aortrtrs and atherosclerosis may undergo a progressive increase in size. A thrombus of formed elements and orthodox configuration may frequently supervene on such laminated, hyalinized and partially organized surface deposits. No differences could be discerned between the tinctorial behavior of these ‘ ‘fibrinoid” masses and that of the fibrinous eomponent of thrombi. It is believed that these masses owe their tinctorial properties to their fibrinous component. There is no evidence at present to support the view that the deposits of homogeneous fibrin-staining material in the mtimal aortic plaques of atherosclerosis or syphilitic aortitis represent altered or necrotic collagenous fibers. Study of serial sections of eleven thrombosed coronary art.eries has revealed differences in the character of the intimal plaque at the site of initial thrombosis. In some a fresh break in the inner collagenous lining of the atheroma was demonstrated; in others the fibrous lining was thinned out, and the collagen fibers were widely separated. In the presence of congestive heart failure the thrombi were deposited on intimal plaques which were apparently intact. In one ease a fresh thrombus was deposited on a plaque containing partially organized surface deposits of blood elements. We could find no evidence to support the view that the fibrin-staining material in the plaques of coronary arteries represents altered or necrotic fibrous tissue. As in the plaques of atherosclerotic and syphilitic aortas, such fibrin-staining masses either represent the remnants of an organizing surface deposit of fibrin or are due to the penetration into the plaque of blood elements. AUrEuXL. Paterson, J. C.: Vascularization Coronary Arteries. Arch.
Path.
and Hemorrhage 22: 313, 1936.
of the
Intims
of Arteriosclerotic
Vascularization of the intima of coronary arteries by discrete capillaries which arise from their lumens is a common finding in association with atherosclerosis. It is particularly marked in thrombosed coronary arteries. It has not been found in normal coronary arteries or in those affected by early nodular endarteritis. Hemorrhagic lesions within the intima, which had occurred into atheromatous foci, have been observed in a number of arteriosclerotic coronary arteries, including those from nine consecutive patients with recent coronary thrombosis. When the hemorrhage was recent, capillary channels were found in the inner layers of the intima in close proximity to the extravasated blood. The sequence of events in the production of intimal hemorrhage appears to be (1) endarteritis with vaseularization of the intima, (2) atheroma with resultant softening of the intercapillary stroma, and (3) capillary rupture. Because discrete intimal capillaries, atheroma, and intimal hemorrhage have been found in practically every coronary artery showing recent thrombosis in this series, it is suggested that these factors represent a chain of events which lead to thrombosis, the immediate cause being damage to the endothelium by the extravasation of blood into the intima. AUTHOR. Yabter, Wallace M.: Demonstration Dioxide Arteriography. South. Report anlourysmal an~eurysm is implied.
of a Ruptured M. J. 29: 973,
Popliteal 1936.
Aneurysm
of a case in which simple arterial and venous punctures, puncture, were used to demonstrate an aneurysm radiographically. was well visualized. No danger in the use of direct aneurysmal
by
Thorium
instead
of The puncture
H.
M.