No abstract available.
Acute Kidney Injury* ; Cholesterol* ; Coronary Angiography* ; Embolism, Cholesterol*

Cholesterol crystal embolism caused by showers of cholesterol emboli from an atherosclerotic aorta is a multisystem disorder that affects many organs. Common signs and symptoms on presentation include skin findings and renal failure. However, myositis due to a cholesterol embolism is uncommon. We report a rare case of cholesterol crystal embolism that presented with features of focal and foot necrosis in an 83-year-old woman.
Aorta ; Cholesterol ; Embolism ; Embolism, Cholesterol ; Female ; Foot ; Humans ; Myositis ; Necrosis ; Renal Insufficiency ; Skin

Cholesterol embolization syndrome (CES) usually occurs after endovascular procedures, it may also occurs after using anticoagulants and thrombolytics. We report a case of 66-year-old man with sudden elevation of creatinine after using warfarin due to cortical infarction. Histologic examinations revealed a cholesterol cleft on the arcuate artery. We concluded it as warfarin induced atheroembolic renal disease. Careful observation of kidneys is necessary in the case of renal abnormalities after using anticoagulation, considering the possibility of cholesterol embolism due to anticoagulant therapy.
Aged ; Anticoagulants ; Arteries ; Cholesterol ; Creatinine ; Embolism ; Embolism, Cholesterol ; Endovascular Procedures ; Humans ; Infarction ; Kidney ; Warfarin

PURPOSE: Many articles have proposed that osteonecrosis of the femoral head (ONFH) is caused by fat embolism or intravascular coagulation linked to hyperlipidemia. To determine whether hyperlipidemia is an associated factor for ONFH, serum lipid levels were measured. MATERIALS AND METHODS: Nighty-eight patients presenting with ONFH and 110 controls were investigated. We compared the average value of serum lipid levels and the incidence of hyperlipidemia of the two groups. RESULTS: ONFH group showed generalized increase in lipid level and statistically significant difference in the average value of total cholesterol (P=0.0001), HDL-cholesterol (P=0.0261) and phospholipid (P=0.0465) compared with the control. The incidence of hyperlipidemia of the two groups showed statistically significant difference in HDL-cholesterol (P=0.019) and triglyceride (P=0.024). CONCLUSION: Hyperlipidemia seems to be associated with pathogenesis of ONFH. We speculated that hyperlipidemia might be a contributing factor of ONFH. Hyperlipidemia may play a role as a triggering factor in the pathogenetic process that results in osteonecrosis. However, it can not be ruled out that secondary hyperlipidemia might be a finding following ONFH.
Cholesterol ; Embolism, Fat ; Head* ; Humans ; Hyperlipidemias ; Incidence ; Osteonecrosis* ; Triglycerides

Cholesterol embolism is due to dislodgment of cholesterol crystals from the atheromatous aorta resulting in an occlusion of small arteries. Cholesterol emboli may occur spontaneously but usually develops as a complication of vascular procedures. The organs most frequently involved are the skin and the kidneys but any organ can be affected. Cutaneous manifestations include livedo reticularis, indurated firm violaceous painful plaques and noduli tending to show central necrosis and tender blue toes. We report two cases of cutaneous cholesterol embolization of lower extremities with the impairment of renal function after coronary angiography, proven by skin biopsy.
Aorta ; Arteries ; Biopsy* ; Cholesterol* ; Coronary Angiography* ; Embolism ; Embolism, Cholesterol* ; Kidney ; Livedo Reticularis ; Lower Extremity ; Necrosis ; Skin* ; Toes

PURPOSE:We investigated the incidence and predisposing factors of pulmonary embolism in minimal change nephrotic syndrome(MCNS). METHODS:Lung perfusion scan using 99mTC-MAA were done on 14 patients who were diagnosed to minimal change nephrotic syndrome. Group A; Five patients who had perfusion defects on scan, Group B; Nine patients who had no perfusion defect on scan. Between the two groups, the differences of platelet number, hematocrits, albumin, cholesterol, triglyceride, proteinuria were evaluated. RESULTS:Five patients were found to have perfusion defect consistent with pulmonary embolism(35.7%). However, there were minimal or no respiratory symptoms and signs. In our laboratory studies, the mean proteinuria on admissions was 676+/-31 mg/m2/hr in the group with pulmonary embolism, and 313+/-28 mg/m2/hr in the group without pulmonary embolism. There were more severe proteinuria in group with pulmonary embolism(P<0.05). The mean platelet count at early stage of remission after steroid treatment was 746,600+/-280,000/mm3 in the group with pulmonary embolism, 511,890+/-90,000/mm3 in the group without pulmonary embolism. There were significant difference of platelet count between the two groups(P<0.01). In patients with pulmonary embolism, there were more higher and sustained increasement of platelet count. All cases of pulmonary embolism were treated with dipyridamole(5 mg/kg). In 4 cases the perfusion defects were improved in two weeks, however, one case showed persistent perfusion defect after 1 month. CONCLUSION:Our study suggested that pulmonry embolism might be one of the major complications in childhood MCNS. The occurrence rate was correlated with severity of proteinuria before treatment and sustained increasement of platelet counts in early remission state after steroid treatment. Therefore, the scintigraphic pulmonary perfusion study is mandatory in childhood MCNS, especially in the high risk patients, such as the patients with severe proteinuria and sustained increasement of platelet count.
Causality ; Cholesterol ; Embolism ; Hematocrit ; Humans ; Incidence ; Nephrosis, Lipoid* ; Perfusion ; Platelet Count ; Proteinuria ; Pulmonary Embolism* ; Triglycerides

A cholesterol embolism is a systemic disease resulting from the occlusion of arteries by cholesterol crystals released from atheromatous plaques. It has been associated with inflammation, sheering forces from blood flow due to hypertension, aneurysm formation, infection, mechanical manipulation during surgery or vascular procedures, and anticoagulation. We report a case of a cutaneous cholesterol embolism in a 66-year old man who had purpuric skin lesions on both feet associated with diabetes mellitus, hypertension, and anticoagulation for a cerebral infarction.
Aneurysm ; Arteries ; Cerebral Infarction ; Cholesterol ; Diabetes Mellitus ; Embolism, Cholesterol ; Foot ; Hypertension ; Inflammation ; Plaque, Atherosclerotic ; Skin

The occlusion of arterioles by cholesterol microcrystals and subsequent ischemic change give rise to so called "cholesterol embolism". Usually cholesterol emboli are released from atheromatous plaque in great arteries by various provoking factors-by direct physical impacts during the cardiovascular interventions, such as CABG (coronary artery bypass graft) and CAG (coronary angiography), and by intricate biologic processes which weakens fibrous cap of atheromatous plaque, such as thrombolytic and anticoagulant therapy. Herein we report cholesterol embolism occurred in a 71-year old man who has underlying atherosclerosis after cardiovascular surgery and follow-up angiography, and concomitant anticoagulant therapy.
Aged ; Angiography ; Arteries ; Arterioles ; Atherosclerosis ; Cholesterol* ; Embolism, Cholesterol* ; Follow-Up Studies ; Humans

Cutaneous cholesterol embolism is a disease due to the embolism of cholesterol crystals from ulcerated atheromatous plaques to peripheral vessels of the skin. It has been associated with major vessel surgery, angiography, angioplasty, intra-aortic balloon pump placement, anticoagulation, thrombolytic therapy and cardiopulmonary resuscitation. In addition, it may occur spontaneously. In paraffin-fixed sections, the cholesterol crystals are dissolved and leave needle-like clefts within the lumina of arterioles. We report a case of cutaneous cholesterol embolism in a 72-year-old woman who had purplish gangrenous lesions on both her feet after coronary angiography and percutaneous transluminal coronary angioplasty.
Aged ; Angiography ; Angioplasty ; Angioplasty, Balloon, Coronary ; Arterioles ; Cardiopulmonary Resuscitation ; Cholesterol* ; Coronary Angiography ; Embolism ; Embolism, Cholesterol* ; Female ; Foot ; Humans ; Plaque, Atherosclerotic ; Skin ; Thrombolytic Therapy ; Ulcer

"Purple toe" syndrome is an extremely rare complication of warfarin therapy. The occurrence of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis in most of patients led to suggest that the mechanism was related to cholesterol emboli from the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli are commonly associated with irreversible organ dysfunction such as renal failure, distal gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of limb and occasional mortality has been reported. We report a case of purple toe syndrome associated with acute renal failure after warfarin therapy with a review of literatures.
Acute Kidney Injury* ; Atherosclerosis ; Cholesterol ; Embolism ; Embolism, Cholesterol ; Extremities ; Foot ; Gangrene ; Hemorrhage ; Humans ; Mortality ; Necrosis ; Pancreatitis ; Plaque, Atherosclerotic ; Renal Insufficiency ; Skin ; Toes* ; Warfarin*