OCR Text |
Show DISEASES ()F T1115 Bl.(.)()1) VESHELS. TA 1111: IV. ATumioMA or 1'1111'1‘111xs 11.1: 1111: Aom‘A Axn OTHER Au'rtiutAt, Tut'sz. Fig.1 represents the interior surl'aee 111' 111 121111121. opened posteriorly. The whole length 111' th .2 Vessel is eoVere1111y 11 Vast 111111111er111' eretaeeous yellowish and whitish plarlttes. some 11111 111;; 21Ii‘ees11r1'aee..s111ue e11\ere1l with 21 Very thiu 1111-111111‘ane: in the eayity ot' the aortie sinus. where tlte eor- 11na1'y arteries originate. 1111 the semi-lunar ValVes ( 1'. N. 1'. N"). there are great quantities ot' inerustations ot' phos- plt211e111'1itne; the V211Ves are slightly Verted: the internal tissue is 11or111211.211111iseontiuuous with that 111 the initral ValVes ('1'. .11.. 1'. .1/.). the oritieesol' the lel'tinnon1iuate. eonnnou earotid 211111 the stthelayiau arteries 11). 1.. I}. C. 1). .11. (C. 1). ‘11.. N. (C). The seetion 111' the artery was made in sueh 21 way 21s to show. 111 its whole extent. 2111 the 2111euris111111tun1ors ordilatations111arl<e11 1.1. The 111terual eoat 111' the Vessel remained intact. \\ hilst the 11111111111 211111 external eoats were perl'orated 11y the 111111111" \Vhieh 1-111111ge, or with >1‘1t'1‘11s‘is‘ 211111 atherotna, The 1111111 deposit talx'es plaee 111t11eatherotnatous111 s1-1er11ti1- parts 111'1111- tissue ol the 111- net 1.1111111111111111 eoats, and often plates 21111.11.1y111111ersot' litue are thtts torined, l'ortions 111' large or 1niddle~size11 arteriti-s are eonVerted into solid tttlles 11y this proeess. .\s 21 rule. the n1useul21r 111211 is thus altered. 111 heteroplastie1111‘11111111111 111'11111 eentral nerVous system the eapillaries are found to haVe undergone ealeareons 1-112111ge. The Veins are more rarely 2111'1-11te1l 1111111 the arteries, 11111 in the Variees: they otten form the inner portiouol'the destruetiVe 111'111'(‘S301'111e 1111'11111111. [HAIL/11111111111111 411'1/11‘1111111111'1ss1'1x. 111‘/11'1'1'11'111/1111 [711111111112 There are two prineipal 1'111'111s- 111' 1111‘11'11111 21lteratit:1ns. pr1'1111112ed 11y intlannnatory processes 111 the Vaseular walls. One is the 111111 1:11;- ingplaee in eVery111111111111121111111 111' 1111.111111111y 11>s111.*<,\\'111'111111'Vets- eular V'alls become more pernieahle and the 11111111111 exehange 111' the material 1111111111111 1111- 111111111 211111 the tissuesis essentiallyaltered. The other is: the strietly angiopathie ehange ol' the wall alone, 111 1'1'1nse1ittenee (11' the preseuee 111' foreign 11111lies, (the 1111‘111111111s) in the vessels. \Vliieh 1‘2111a to formation 01' granular and eieatt'ieial tissue 1111 the, inner surt'aee 111' the artery 11r Vein. This latter l'ortn may 1.11t designated 21511111s‘1/14111111111111111'111/'//f/1/11111111'11 111'/1.1111'111111111'11'.1_ There are. besides. 21 1111111111212 111' forms 111' 1111111111111at11111 going on 111 the Vascular walls. whieh leaVe 111-1111111 greater or lesser alterations ot' a temporary or permanent eharaeter, in the whole wall, 11r in parts 111' it. 1'111‘11111111 111-11‘1'1'1'1131 takes plaee 111t).\1 frequently 111 suppurating wounds 01'11111ers. The arteries undergo 21 suppuratiVe proeess 111111 11eeay. The startol' the 1nor111d 11111111111111 eoines l'roin .supptu‘ating tissue, 211111 11egius in the outer 1211111111111 gradually p2 s 'es through theother coats. The Vaseular wall 111 purulent arteriitis 1111s 21 yellowish or grayish white eolor, 211111 is thieltened, \Very otteu the (mats 111-e21k1111‘01tgh.an11haetnorrhage takes plaee 111 21 greater 11rless ex- tent, for instanee. 111 secondary 11111111111‘1'1121ges 111' wounds. 111 111ee1‘- ate1'llungs in phthisis, 111eeratiVe eareinoina. ete. Para/rat 111'/1111111111(1/111101'tlle1111111111111112111'11111 new-horn l1al1es 111'- ten preduees t'atal h2en1orrhages. '1'1111111V11s11111111'11111'1'1111t‘gunistns 1111011 \1'11111111 seetns 111 111,1 the. most frequent eause 111' sueh arteriit Now and 1111-11 11,11111y 111;. 111-111111111111 11y phlogogenie s1111st11u1.-es: eir1111211111}; in the Vessels, when the J1111‘11113111.tln'on111i aredtw'eloped 111 uleerated surlaees 111'the intestinal traet‘. and 1111111 tltel't‘ earried into the Vetne p111‘12el1ythe eapillaries. (1)ysentery), (leeasioually they originate in suppurating wounds. 11y thepassage 111' the 1111'1111111otie masses into the 111111111-11111'1‘11111. pyzeniia 211111 l'ortnation 111' 111etastatie 2111scesses are 11rought. :11111111. [1(1/1111'1111/s11'1' 111'/11‘1'1'11'm‘. 1112/1/11 ftt11‘11'1/N1s1111111112111111111111t‘y 1111111-1-ss‘.iti1'111‘111211111121111sttlttetts ees siu1ilarto1111/11111111111112211111111/11111111111111. 11111111 11111211111111 portions the surl'aee looks [11111111 111111 sot'teued. or there are 111 it g1 ;1_V1sh trans- lttt'etltpatches,11l‘11111et‘exerest‘eltees or ti|1riuotts 1111111111. Very 111111111 like those seen 111 endoearditis, 111 the external 1111111 there are gray» ish red 111111. generally but little pereeplihle 11y the 1111111-11 eye. 111111111 the'11111'1'11seope, in the alleeted portions. :111 the eoats 111' the Vessel are 111111111 to he inVolVed. The Vasa V11s111‘uu1 are turgid, with round eells and granular 11r 11111'11111us inasses. Newrolo'ol/e 111‘/11'1'1'11's 1nay |1e eause11 11y iui'eetious 1111111111] When the 111112111111111111111 111111 the gangrene pass. into the adjaeent tissues. al.1s1-ess‘es are l'ornied there. The pits 1111t‘puseles 1-1111121111111111 the Vaseular wall originate in the Vasa Vas11r11111,orin t11e111li11nnng 111111111 \‘L‘S‘t‘lS. ['111'111111111111111111131 is found under s11111121reirettn1stanees. and the 11111111111appearanee 111' these 111111.11 Vessels- i< 1111111112 like 1112111111111arteries, \Very 1'1'1'11111'1111)"1111*11‘t'tt\'1ilt-st‘t1111:tilll'I't‘sll or purttor1n 111111111111. Coagulation ot' the 111111111 111 the Veins either pt'et'etles 111‘ t'ollows 111112111111111111111 111' 1111- wall. Heeasioually the phlehitis pro- [S'ize'rtox IV protrttded upon the ottter {surface 111' the Vessel: the inter- 11211 1211111 had undergone repair 111 those plaees where 11s- suresoriginallyexisted.2111111111'11ughwhiehthe111111.11lpassed into. 11etween 211111 outside 111'the Vaseular tuuies. Nos. 2.1'1eorrespoudto the projeetions 1'111'111e11 ttpou the external surl'aee 111' the Vessel. .\'o. 5 designates 21 clot situated at the oritiee 111'tl1e inl'erior Inesenterie artery. .\11iueision into the superior ineseuterie artery (.1. A11. 5.) shows the 1'1'ee11111n 111' the '~21Vity 1'1'11111 elots. 1111.. (lowuto 111 1aneuris1nalenlargement. Most 111'11111111'2111ehes11t'tl1is Vessel were oeeludedhy (lots at their origins. 211111 eollat' eral eireulation est'2111lis11e11. Fig 2 indieates 21 spheroidal aneuristn 111' the right Vert1-11ral artery (.1. 11. 1'.) at the anterior pyrainids. Fig. 31 shows the stratified eonteuts 111' the opened sae. .l'ig. 1 represents the anterior surface 111' the 1111111111111 1111longata 1'1111si11eral11y111.1presse1111ythettunor: the eolor 111' the pyramid is ehaug'ed into 21 yellow ish 111‘11w11. and parth 111'1ght yellow. showing the existence 111' 1'111‘1111-1‘ 1111-1111111- 1'11ages into the 111‘11111. 111111 111' the detritus 111' the altered tissue. and rel'or111ati1111ol'eon111-1-11Ve tissue from 11111‘1111121sts takes plaee. (Nos/11' 1‘11111111/1111s1'11ts 11111111I1'11rift/N. 11"1'1. 1\'11'111/I11111tt'. 11'11‘1111‘1‘111‘.f/1'. .11'1‘11/1'1‘ 111‘ 111/1151111. norm. 1\". [1111111111 15'1"}. 211/111, 1'1'1'1'111111'111'1‘11.'1‘s).1'o1,. 111'. 1.1111- the 1111121111111211111'y proeesses going on in the heart audits 11111111111'aues, there may he periarteriitis, 111es11arteriitis and endoar- teriitis. All three 11121y 1211(1‘ 111111111211 thesainetitne in the Vessel. \\'hen the eu1loarterial 111112111111121111:1u 11111111tnes ehronie. there is l'111'1netlin the internal 11111111111'1111e 21 quantity (11'1'111111111-111‘1‘1tissue. whieh presentsa111111111111'111' more 111‘ less regularly arranged protni111-111'1'1s11p1111 its internal surl'aee. whieh 111'te11 1111111111y 21 great part 111 the interiorot the Vessel. The1111\1'1yl'11r1ne1l tissueis sotnetitnes Very .s'111111.2111111111111111111t11111s11111o11 Vessels Sometimes it is sot't 2111111111l1l1y. 111 either ease the 11111'111111 ti site 111' the 1111111121 is 11e- stroyeIl. This (11111111111111 111' hyperplasia is ealled 111'/1111'11-111‘11 ens-1's. 11 may exist 111 stnaller 21s well 21s 111 larger Vessels, and generally leads to 11e1-lusion 111' the eaVity. 1t 1111>tllet'el'ot'e1111*11211111‘(11'1I1'111‘I'1 ' 11/1/1'1‘11'1111s- 11111le11 to the 11111.1Ve. th-nerally. when ehronie arteriitis 1121s 11111-11 set 111.1111111 return at ditlerent iuterVals. and then there will 111.1 1111-1111111 new deposits, and the 11111 will iuerease 111 Volume. )11.-so111't1_-riitis is generally 11 soeiated with endoarteriitis. The inns1-111211' tissue 11111111111es 11111111-1‘111ed 211111 is replaeed 11y lil1r11us strttetnre. The alterations in this lesion are 11eVer so exteusiVe 21s in the 1111'1111-r. l'eriarteriiti.s leads toeondensation 211111 thiekeuiug 111' theexternal eoat. 1.7111111 arteries 11ut 11111s11y in111e11de11 in tissue. there are l'or1111-11 large knots 111' 11111‘ous strings. (l'eriarteriitis11111111sa.) TheVeiusundergo111112111111121111ryreaetious111theirseVet‘111tunies similar to tlteartet'ies; onlythat the1111121111111111111usare.sel1l11111e1111s lined to the Vessels alone. 211111 the inner eoat 51111111111 11ee11111es thick» 11111111111sueh an extent 21s111e211't'eries, tienerally the 11_\'perpl11s1a is produeed 1.1y 1111'11111111 111 t‘l1e Vessels 211111 the 111112111111111111111 iu the adjoining tissues. tly'uxxuu/H/ 111111 A111 11' 1‘. 111'111s1'111s .11'1'111‘1111‘ 1111/. 111/111;.) Alitiology ol' the hyperplastie 1-11111121rter1itis. lilte that 111' endoearditis,1s11111111111111. WhateVer is likely to produee a lesion in any serous. lil1rous,or innseular tissue 111 any portion 111' thel1111ly. is e21112111111otgiVingrise11:1intlannnation 111 the \‘asettlarwalls. 111 t'aet7 the Vessels. 21s theyeonstautlyeoutain 111111111, whieh 1-211'1‘11-s21111;1111l.s5 111' 1111ptn'1ties 111111 1111111 111' the l1o1ly, 211111 are111-s11les exposedy 11121 greater or lesserdegree. to 111eehanieal injuries. they are 111111111 111 111tlatne 11l'teuer than the heart and its 1111-111111'1111es. There are two ehiel'eauses\1‘1111-11.al1oVe any other. giVe rise to 1‘111‘111111‘ intlannnatilll]I11'1111'\'1‘>'>t'1<2>I\‘1111111>;llltl11111121'1‘11111>1>1 11121111111-1' was the lirst 111 thoroughly study syphilitie arteriitis. whieh he eonsiders 21 Very 1'1'1-11111-111 111'1‘111'1‘121111‘, The Vessels are 2111'eete11, either alone or 111 eons 'innetiou with sypliilitieJ1111‘1,-111211y1111111111sdiseases. \V2ts1'ttl2tt‘ 2111'eetions alone show grayish or whitish thiekened spots 111' 1lill'ereut1 sizes 111 the itniereoat. or thiel<, tttl11-rettlons inasses or strings on the outer 1-11111. llistologieally they do not 111111-1' 1'1'11111 ordinary hyper- plastie 1-111111eetiVe tissue. The 1'111‘111 111' 111111112 arteriitis111-eurriug 111 111111111 inllauitttatory 111-111111. shows the Vessels surrounded 11y Very eopious eellular intiltrations. gnnnnatou. granulatious or eieatrieial 11111'11tts' .strueture: here all 1'11ats are inVolVed. The peeuliar eharaeterot syphilitie artei'iitis is the 11121111111111 histologieal ehaug ‘going on 111 the Vessel. 1'1112111-y111111 any 111111111 111 ordinary arteriit .. 211111 whieh Very frequently lead to 111-elusi1111 111' the Vaseular1*21Vityg111'1111lit1-rati1111 11t'its walls. The Veins are as 11211111t1111e1'11111e the seat 111' gttininatons syphilitie 111112111111111111 as the arteries, 11111111‘1‘1111211 diagnosis 111' syphilitie 111111 non-syphih 11111 arteriitis ean only he 111211112 11y thorough examination ot'all parts 111' the 1711111" and 21seert21111111g the 111-111211 presenee_1_11" syphil- 1111' 111/11111111111els1-\\'111'1‘1* 1It‘>1llt‘~ the 11111 Where 2tt'1t-t'tltls 12.\1s‘1s‘. (1111111111/111'11111'. 171'1'1‘1111/1'All't'ltl'l'. Lani/11111111" ‘11'1'111'1'lttti'1‘11'11._1[///.) 111111111111121111111 111' the Vasettlar walls is a V1-1'y1-111111non oeenrrenee in tul.1ereulous tissue. There may he 1'111'1111211 111 the wall 11t'a Vessel dueesathrotnl1us. \Vhieh,ui1der the inllueueeot i11t'eetious sul1stans Ittl1t-I't‘112s ees'111‘11111'1‘111‘111‘1'1. undergoes purulent neerohiosis. and the gangrenous sttl1st11uees intensit'y'the inllaintnatory proeess still inore. 511111 l'111'11111tions |1ee11111e 1-as1-1111s. the Vessels will also 1.11-1-11111e lll\'111\'t'11. The 1111'111211-11 arteries may then 11111111 111111 more 111' less eepiotts' 11212111111'1'1121'1'11 will 111111111; 11111-111111 Veins 1nay earry 1111- pro1lu1-ts ot' their 11 -11se1l walls into thegeneral 1211'1-11111111111211111 1111-tast11tie 21111-ess oreosmus 1311-1 will 1.11-1'111‘1111'I1\\'111-]'11~111‘11 11etrittts1s deposit1111211111 1'1111111111s. ' The tula-reulous proeess may <'\'(' rise 111111111111111shyperplasia111'111111111111' 111 11111111" walls 111' Vessels. Very 11xtettsiyd hyperplasia may pro-1111111 1111st1u111111ns 111 the Vaseular 1111'111111.1titit'111112111111121111111s111'tlie\‘eilisitt'etd'telt1111'111111111-}_1ttt‘1211 eireulatiou, I1‘1lt‘t‘XIt‘t'llttl1‘11111‘111111'511111111'21111111211111lllt'slll‘l‘UUIltl- in: walls a great inanV nodules. 111 the 111111111 111211 the Vasa Va.sor111n are also iuliltra'tml 1111111‘21111111's1nall1-rin size, The same is: the ease with the 1111111111. (EiaVe 11111'11se aortitis is. 11s 21 r1111 1211111. in lighter 1"111'111s. the 1111121111111211111'y stage passes into the liypet'plas- tie. 'There is 21 new 1'111'11121111111et t‘11llli1't'ii\'1'tissttetllltl1‘1111111211'lt's' 111 the partly destroyed tissue. in Very light inllaniatitni, absorp- 111' 111111'1- 1.1ill'tts1' 1111121111l1111111t'y ['1'111'[>>t‘>', "1111211 1111‘ eaVities. espeeiallt when the walls eontain 11111111-11111111' granulation. The \'t‘::t1£ltlzt)' 111; closed up altogether 1.1y 111111111111. |