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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3925_Библиотеки_им_академика_М_И_Перельмана
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Figure 8.1 Dramatic clinical examples of aortic destruction, likely at least in part at the
hands of excess lytic activity of matrix metalloproteinase. Clockwise, from upper left hand
corner: (A) An ascending aorta rendered so thin that the markings on a ruler can be read
right through the aortic wall. (B) Severe annulo-aortic ectasia. Note aneurysm partially
hiding under right ventricular outflow tract. (C) Descending aortic aneurysm, with
penetrating ulcer, appearing “ready to burst.” (D) Massive descending aortic penetrating
ulcer/saccular aneurysm- precarious in appearance. (E) Ascending aortic dissection, with
descending aortic intramural hematoma. (F) Massive ascending aortic aneurysm on com-
puted tomography scan. (G) Massive ascending aortic aneurysm at operation. (Head of
patient is to right and below).
Figure 8.3 Matrix metalloproteinases were discovered when it was noticed that a piece
of tadpole tail digested the collagen on a laboratory plate. Source: From Ref. 24.
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Figure 9.3 Stain for leukocytes in aortic wall (by immunohistochemistry using an anti-
body to the pan-leukocyte marker CD-45). Note relative paucity of leukocytes in normal
aorta and “bland” ascending aortic aneurysm. Note marked leukocytic infiltration in
“inflammatory” aneurysm. Arrows denote leukocytes. Arrowhead indicated border between
media and adventitia.
Figure 9.4 Demonstration of destruction of matrix proteins, progressively more severe in
bland and then in inflammatory aneurysms. These figures depict the media of the aorta of
the indicated categories. Sirius red is used to stain collagen. Alcian blue is used to label
ground substance. EVG (black) is used to label elastin. Note marked degradation of
collagen, ground substance, and elastin in inflammatory aneurysms. Abbreviation: EVG,
Elasfica-van Gieson.
Figure 9.1 Histology of aortic wall, emphasizing the three layers of the aortic wall
(intima, media, adventitia). Not the depiction of the vascular associated lymphoid tissue
and vascular smooth muscle cells, which are so important in the inflammatory and lytic
processes underlying the pathophysiology of aneurysm development. Note the lamellar
architecture of the media (collagen and elastin) and the matrix.
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Figure 12.A Artist’s schematic of variant forms of aortic dissection: typical dissection,
penetrating ulcer, and intramural hematoma.
Figure 11.2 Proposed schema for the occurence of an acute aortic condition at one particu-
lar moment in time. Abbreviation: MMPs, matrix metalloproteinases.
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Figure 12.B Excised aortic
specimen bearing penetrating
ulcer of aorta. Note similarity in
appearance to duodenal ulcer, for
which this photo could easily be
mistaken.
0
5
10
15
20
25
Number of Patients
80706050403020
Ages
Type B Dissection
Intramural Hematoma
Penetrating Ulcer
Figure 12.C Age distribution of vari-
ant forms of aortic dissection, compared
to typical descending dissection. Note
that intramural hematoma and penetrat-
ing ulcer are diseases of advanced age.
Figure 12.G A large thoracoabdominal aortic aneurysm. The head is to the top and the
feet to the bottom of the picture. The chest and abdomen have been opened widely, reveal-
ing a large, extensive aneurysm of the thoracoabdominal aorta. A soda can is about 6 cm in
diameter. If a patient’s aorta is approaching this dimension, the aorta should be extirpated
surgically to prevent rupture or dissection.
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Figure 19.1 Future prospects in care of aneurysm disease.
Figure 19.2 RNA “Signature” analysis allows effective discrimination (in three-dimensional
space) of aneurysm patients (“cases”) from controls, on the basis of examination of peripheral
blood alone.
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