Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulati...Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.展开更多
BACKGROUND: Cholesterol crystal embolism (CCE) from atherosclerotic arterial disease leading to perforation of the gallbladder is rare. We describe our experience of managing a patient with perforation of gallbladder ...BACKGROUND: Cholesterol crystal embolism (CCE) from atherosclerotic arterial disease leading to perforation of the gallbladder is rare. We describe our experience of managing a patient with perforation of gallbladder caused by CCE. METHODS: A 64-year-old man was admitted to this hospital because of acute abdominal pain with clinical features suggestive of peritonitis. He was known to suffer from atherosclerotic peripheral arterial disease and had undergone aortobifemoral bypass 17 years ago. A CT scan showed a collection of peri-hepatic fluid. The gallbladder was normal in appearance but contained multiple calculi. At laparotomy, free bile was observed in the peritoneal cavity, leaking from a pin-hole size peroration of the fundus of the gallbladder. Hence cholecystectomy was performed. RESULTS: The patient made an uneventful recovery. Histological study of the gallbladder showed chronic cholecystitis and obliteration of the lumen of the mural arteries with cholesterol crystals within, indicating CCE. CONCLUSIONS: Although perforation of the gallbladder following CCE of its mural arteries is rare, the diagnosis should be considered in patients with abdominal pain and known atherosclerotic arterial disease. Management should include an early recognition of this condition, prompt institution of treatment, prevention of further insults by discontinuing or avoiding predisposing factors, and modification of cardiovascular risk factors.展开更多
Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or ...Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.展开更多
BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE acc...BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins.CASE SUMMARY A 76-year-old man complained of coldness,numbness and purple color change in his left foot for 7 d.He had a feeling of fatigue,constipation,foamy urine,poor appetite and sleep.He had a lacunar infarction for 5 years and hypertension for 9 mo.Laboratory results showed elevated eosinophils,cholesterol,uric acid,serum creatinine,urea and 24 h urine analysis revealed proteinuria.A renal biopsy revealed atheroembolic renal disease.Taken together,these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease.CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE,and early treatment with corticosteroids is effective but requires further investigation.展开更多
Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. Howeve...Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. However, no cases of cholesterol crystal involvement in cutaneous cancer have been reported. We report four cases of basal cell carcinoma with cholesterol crystal deposition, and discuss the mechanism(s) of the condition. Disease duration, anatomical site, histopathological features, and serum lipid profiles were investigated. The median disease duration was 3.5 years, and the sites of the lesions were the scrotum (one patient) and the nose (three patients). Histopathologically, there was necrotized tissue around the clefts. In addition, we detected frequent apoptotic cells around the cholesterol clefts in two of the patients by using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Serum lipid levels were slightly elevated in two of the patients. In conclusion, cholesterol crystal deposition in basal cell carcinoma was considered to relate to a long disease duration with a tumor in a region that was subject to external irritation. Histopathologically, apoptotic cells around the cholesterol clefts indicated that lipids from the tumor cell membranes were one of the causes of cholesterol crystal deposition.展开更多
Background:Cholesterol crystallization is an essential step toward gallstone formation.Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cho...Background:Cholesterol crystallization is an essential step toward gallstone formation.Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization,this has not been investigated in human bile.Methods:Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol(n紏10)or pigment(n紏3)stones.Small cholesterol gallstones were collected from another two patients.Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals.Weight of the added stones was evaluated before and after 21 days of bile incubation.Results:In unfiltered bile,the presence of stones was associated with a trend towards less anhydrous cholesterol crystals,but significantly more aggregated cholesterol monohydrate crystals.In ultrafiltered bile,the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both platelike and aggregated cholesterol monohydrate crystals.After 21 days of the incubation,stone weight was decreased in both unfiltered(–4.561.6%,P紏0.046)and ultrafiltered bile(–6.561.5%,P紏0.002).Bile from pigment-stone patients was clear in the absence of stones,but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added.Conclusions:The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways.Whereas cholesterol monohydrate crystals increase,anhydrous cholesterol crystals tend to be inhibited.Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.展开更多
Cholesterol crystal embolism （CCE） is a serious complication after mechanical manipulation of the aorta during angiography or cardiac vascular surgery1.2. Methods Retrospective analysis of the medical ma- terials of...Cholesterol crystal embolism （CCE） is a serious complication after mechanical manipulation of the aorta during angiography or cardiac vascular surgery1.2. Methods Retrospective analysis of the medical ma- terials of 2 cases of CCE in our hospital and review of some literature were conducted. Results Two cases of CCE had blue toes and renal failure, but cholesterol emboli were found in one patients＇ skin biopsy. Strengthen statins were administered and none received corticosteroids. The renal function in both cases was recovered, and the livedo reticularis was disappeared. Conclusions Since there is currently no established treatment other than supportive therapy to CCE, prevention is very important, and we should avoid aortic manipulating procedures in severely atherosclerotic patients. It＇ s crucial early diagnosis for patients to prevent further development of choles- terol embolism. Our study indicated that statins therapy seems to be a more reasonable and effective therapy.展开更多
A novel liquid crystal compound with a carboxyl group at one end, cholest-5-en-3-ol- (3β) hydrogen decanedioate (1) was successfuly prepared by the reaction of cholesterol with sebacoyl chloride. Its chemical struc...A novel liquid crystal compound with a carboxyl group at one end, cholest-5-en-3-ol- (3β) hydrogen decanedioate (1) was successfuly prepared by the reaction of cholesterol with sebacoyl chloride. Its chemical structure and liquid crystalline properties were characterized by FTIR, CNMR, 1HNMR, POM and DSC. The compound with an active carboxyl group shows 13 themortropic liquid crystalline behaviour.展开更多
基金Support was provided in part from Michigan State UniversityThe Jean P.Schultz Biomedical Research Endowment+3 种基金Clinical and Translational Sciencelnstitute at Michigan State UniversitySeed Funds from the Department of Medicine,College of Human MedicineGraduate Medical Education,Inc.East Lansing,MichiganEdward W.Sparrow Hospital,Lansing, Michigan
文摘Cholesterol crystal embolic （CCE） syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.
文摘BACKGROUND: Cholesterol crystal embolism (CCE) from atherosclerotic arterial disease leading to perforation of the gallbladder is rare. We describe our experience of managing a patient with perforation of gallbladder caused by CCE. METHODS: A 64-year-old man was admitted to this hospital because of acute abdominal pain with clinical features suggestive of peritonitis. He was known to suffer from atherosclerotic peripheral arterial disease and had undergone aortobifemoral bypass 17 years ago. A CT scan showed a collection of peri-hepatic fluid. The gallbladder was normal in appearance but contained multiple calculi. At laparotomy, free bile was observed in the peritoneal cavity, leaking from a pin-hole size peroration of the fundus of the gallbladder. Hence cholecystectomy was performed. RESULTS: The patient made an uneventful recovery. Histological study of the gallbladder showed chronic cholecystitis and obliteration of the lumen of the mural arteries with cholesterol crystals within, indicating CCE. CONCLUSIONS: Although perforation of the gallbladder following CCE of its mural arteries is rare, the diagnosis should be considered in patients with abdominal pain and known atherosclerotic arterial disease. Management should include an early recognition of this condition, prompt institution of treatment, prevention of further insults by discontinuing or avoiding predisposing factors, and modification of cardiovascular risk factors.
文摘Cholesterol crystal embolization(CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.
文摘BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins.CASE SUMMARY A 76-year-old man complained of coldness,numbness and purple color change in his left foot for 7 d.He had a feeling of fatigue,constipation,foamy urine,poor appetite and sleep.He had a lacunar infarction for 5 years and hypertension for 9 mo.Laboratory results showed elevated eosinophils,cholesterol,uric acid,serum creatinine,urea and 24 h urine analysis revealed proteinuria.A renal biopsy revealed atheroembolic renal disease.Taken together,these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease.CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE,and early treatment with corticosteroids is effective but requires further investigation.
文摘Cholesterol crystals are a primary cause of cholesterol embolism if they appear in vessels. Various papers have reported the involvement of cholesterol crystal deposition in cutaneous diseases such as xanthoma. However, no cases of cholesterol crystal involvement in cutaneous cancer have been reported. We report four cases of basal cell carcinoma with cholesterol crystal deposition, and discuss the mechanism(s) of the condition. Disease duration, anatomical site, histopathological features, and serum lipid profiles were investigated. The median disease duration was 3.5 years, and the sites of the lesions were the scrotum (one patient) and the nose (three patients). Histopathologically, there was necrotized tissue around the clefts. In addition, we detected frequent apoptotic cells around the cholesterol clefts in two of the patients by using the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Serum lipid levels were slightly elevated in two of the patients. In conclusion, cholesterol crystal deposition in basal cell carcinoma was considered to relate to a long disease duration with a tumor in a region that was subject to external irritation. Histopathologically, apoptotic cells around the cholesterol clefts indicated that lipids from the tumor cell membranes were one of the causes of cholesterol crystal deposition.
基金The present chapter is written in the context of the project FOIE GRAS,which has received funding from the European Union’s Horizon 2020 Research and Innovation program under the Marie Sklodowska-Curie Grant Agreement No.722619.
文摘Background:Cholesterol crystallization is an essential step toward gallstone formation.Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization,this has not been investigated in human bile.Methods:Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol(n紏10)or pigment(n紏3)stones.Small cholesterol gallstones were collected from another two patients.Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals.Weight of the added stones was evaluated before and after 21 days of bile incubation.Results:In unfiltered bile,the presence of stones was associated with a trend towards less anhydrous cholesterol crystals,but significantly more aggregated cholesterol monohydrate crystals.In ultrafiltered bile,the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both platelike and aggregated cholesterol monohydrate crystals.After 21 days of the incubation,stone weight was decreased in both unfiltered(–4.561.6%,P紏0.046)and ultrafiltered bile(–6.561.5%,P紏0.002).Bile from pigment-stone patients was clear in the absence of stones,but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added.Conclusions:The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways.Whereas cholesterol monohydrate crystals increase,anhydrous cholesterol crystals tend to be inhibited.Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.
文摘Cholesterol crystal embolism （CCE） is a serious complication after mechanical manipulation of the aorta during angiography or cardiac vascular surgery1.2. Methods Retrospective analysis of the medical ma- terials of 2 cases of CCE in our hospital and review of some literature were conducted. Results Two cases of CCE had blue toes and renal failure, but cholesterol emboli were found in one patients＇ skin biopsy. Strengthen statins were administered and none received corticosteroids. The renal function in both cases was recovered, and the livedo reticularis was disappeared. Conclusions Since there is currently no established treatment other than supportive therapy to CCE, prevention is very important, and we should avoid aortic manipulating procedures in severely atherosclerotic patients. It＇ s crucial early diagnosis for patients to prevent further development of choles- terol embolism. Our study indicated that statins therapy seems to be a more reasonable and effective therapy.
基金support by the National Natural Science Foundation of China(Grant No.29925411)the Key Laboratory of Cellulose and Lingnocellulosics Chemistry(LCLC-2003-142)are gratefully appreciated.
文摘A novel liquid crystal compound with a carboxyl group at one end, cholest-5-en-3-ol- (3β) hydrogen decanedioate (1) was successfuly prepared by the reaction of cholesterol with sebacoyl chloride. Its chemical structure and liquid crystalline properties were characterized by FTIR, CNMR, 1HNMR, POM and DSC. The compound with an active carboxyl group shows 13 themortropic liquid crystalline behaviour.
