Case Report
Type III Takayasu's Arteritis in a Pediatric Patient. Case Report and Review of the Literature
Arteritis de Takayasu tipo III en un paciente pediátrico. Reporte de caso y revisión de la literatura
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Case report and review of the literature" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1308 "Ancho" => 2979 "Tamanyo" => 270332 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A y B) Angioplastia. Colocación de 2 <span class="elsevierStyleItalic">stents</span> largos, que cubren la zona de estenosis severa. Gradiente posquirúrgico: ninguno. Gradiente en la zona de estenosis renal: 10<span class="elsevierStyleHsp" style=""></span>mmHg. 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Case Report and Review of the Literature" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "216" "paginaFinal" => "219" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Karla Mendiola Ramírez, Astrid Cristina Portillo Rivera, Abraham Galicia Reyes, José Antonio García Montes, María del Rocío Maldonado Velázquez, Enrique Faugier Fuentes" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Karla" "apellidos" => "Mendiola Ramírez" "email" => array:1 [ 0 => "karlamendiola@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Astrid Cristina" "apellidos" => "Portillo Rivera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Abraham" "apellidos" => "Galicia Reyes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "José Antonio" "apellidos" => "García Montes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "María del Rocío" "apellidos" => "Maldonado Velázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Enrique" "apellidos" => "Faugier Fuentes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología y Hemodinamia, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Arteritis de Takayasu tipo III en un paciente pediátrico. Reporte de caso y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1312 "Ancho" => 2986 "Tamanyo" => 253985 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) and (B) Angioplasty. Placement of 2 long stents, covering the area of severe stenosis. Postoperative gradient: none. Gradient of the renal stenosis: 10<span class="elsevierStyleHsp" style=""></span>mmHg. There was no procedure on the left subclavian or the renal arteries.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Takayasu's arteritis (TA) is the third most common vasculitis in childhood after Henoch Schönlein and Kawasaki's<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> disease. Its cause is unknown but it is known to be mediated by T cells and antibodies which are not organ-specific, although antiaorta and antiendothelium antiannexin V antibodies have been occasionally reported.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is a possible intervention of tuberculosis as a cause, with granulomas and Langhan's giant cells found, whose morphology resembles tuberculous lesions in patients with TA. There is a high incidence of positive intradermal tuberculin.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The average age of presentation is 11.4 years, 20% of cases were diagnosed before age 19 and 2% before age 10. There is a delay in diagnosis of 19 months.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In childhood, the clinical picture is nonspecific, with possible fever, malaise, anorexia, myalgia, joint pain, abdominal pain, hypertension, hypertensive retinopathy, heart failure, headache and seizures. The presence of murmurs and absence of pulses are present in the ischemic stage of the disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The course of the TA is variable, despite the use of corticosteroids, which reduce by 50% the progression of the lesions; immunosuppressive therapy (methotrexate/azathioprine/mycophenolate mofetil) leads to a better control of the disease and prevents restenosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Stenosis is not reversible and early angioplasty is required in patients with renovascular hypertension, severe claudication, stroke, myocardial infarction, renal artery stenosis, moderate regurgitation of the aortic valve and the presence of more than 3 stenotic<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> sites. Early diagnosis and appropriate treatment prevents complications related to the disease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Report</span><p id="par0035" class="elsevierStylePara elsevierViewall">The case is a female patient, 7 years and 7 months old, previously healthy, from the State of Mexico. She began her current illness a month earlier, with malaise, myalgia, vomiting, claudication, headache, tinnitus, fosfenus, tinnitus, abdominal and chest pain. She was admitted to a second level hospital for hypertension and heart failure and was sent to a third level hospital due to absence of pulses and left ventricular hypertrophy. She was admitted due to hypertension, absence of pulses (left brachial and lower limbs), an aortic pansystolic grade II/VI murmur, hepatomegaly and claudication. Her study protocol can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A computed tomography scan revealed hypoplasia of the right vertebral artery (V4), left subclavian stenosis and narrowing of the descending aorta with arteritis data on the wall, yuxtadiafragmática and transverse diameters of 4.5–5.0<span class="elsevierStyleHsp" style=""></span>mm. Were also stenosis in the origin of the superior mesenteric artery (3.3<span class="elsevierStyleHsp" style=""></span>mm) and significant stenosis in the origin of the right renal artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnosis of TA III was based on the following: decreased peripheral arterial pulses and limb claudication, pressure difference greater than 10<span class="elsevierStyleHsp" style=""></span>mmHg, murmur over the aorta, arterial hypertension and angiographic abnormalities (thoracic ascending and abdominal aorta and renal arteries).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Glucocorticoids and methotrexate were initiated. Cardiac catheterization was performed due to the presence of more than 3 sites of stenosis. We documented diastolic dysfunction, mild mitral regurgitation; severe stenosis of the thoracoabdominal aorta with a gradient of 50<span class="elsevierStyleHsp" style=""></span>mmHg and nonsevere renal artery stenosis (10<span class="elsevierStyleHsp" style=""></span>mmHg gradient) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). Angioplasty was performed in which two stents were placed in the stenotic area, with a postsurgical gradient of 0 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). She is currently asymptomatic with no residual gradient. She no longer receives glucocorticoids but is receiving methotrexate, folic acid, vitamins A, C and D, aspirin, furosemide, spironolactone, and captopril.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">TA represents 1.5% of vasculitidies in childhood, with 2% of cases diagnosed before age 10. Their course is variable, depending on the degree of activity, time of diagnosis, presentation and associated symptoms and the effect on other organs. They may have multiple relapses despite treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The inflammatory process causes thrombosis in the affected arteries, progressive appearance of stenosis, dilation and aneurysms. Antiplatelet therapy with low dose aspirin reduces the frequency of ischemic events.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment is based on the use of glucocorticoids and immunosuppressive therapy. The use of ACE inhibitors is controversial due to their renal effects, but can be considered for use in patients with normal renal function. Surgical correction with angioplasty techniques is effective, increasing 5 years survival to 80%–95%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Restenosis occurs in 31.7% during the first year. The risk decreases by 50% with the use of corticosteroids and immunosuppressants. Follow-up angiography should be performed every 12 months.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The experience in our country has been described by Lupi-Herrera in a series of 107 patients with TA, whose ages ranged from 11 to 30 years, with a mean age 26 years.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The major clinical manifestations were asthenia, weight loss, headache, claudication, and hypertension. Stenosis occurred in the thoracic aorta (25% upper/lower 67%), subclavian (85%) and renal (62%) arteries. A higher morbidity was associated with the Mexican phenotype, severity of disease expression and variations depending on the medical and surgical treatment employed.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Worldwide experience is very similar, but with few cases reported in the pediatric literature. The studies conclude that it is a condition that must be actively suspected in order to initiate early treatment to decrease mortality. In our country, there are few publications and experience regarding treatment. In this case report, a good clinical history with an appropriate semiology made it possible to steer towards an accurate diagnosis, providing an opportunity for the patient to receive adequate medical and surgical treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres125807" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec113095" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres125806" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec113094" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interest" ] 8 => array:2 [ "identificador" => "xack38114" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-15" "fechaAceptado" => "2011-11-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec113095" "palabras" => array:3 [ 0 => "Takayasu arteritis" 1 => "Angioplasty" 2 => "Immunosuppressive treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec113094" "palabras" => array:3 [ 0 => "Arteritis de Takayasu" 1 => "Angioplastia" 2 => "Tratamiento inmunosupresor" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takayasu's arteritis (TA), also known as “pulseless disease”, is the third most common vasculitis in childhood. It is a chronic, idiopathic, granulomatous vasculitis that involves large vessels. It occurs most commonly in females with a 4:1 ratio over males; the average age of appearance is 26 years. Its cause is unknown.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Here we report the case of a 7-year-old girl, with type III TA according to the Numano classification, in the ischemic phase, treated with corticosteroids and immunosuppressive agents and early angioplasty due to the severity of the disease. The outcome was satisfactory.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The diagnosis of TA in children under 10 years of age is made only in 2% of them. The delay in diagnosis reaches a mean of 19 months. The course of the disease is variable despite surgical and immunosuppressive treatment.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La arteritis de Takayasu (AT) o «enfermedad sin pulsos» es la tercera vasculitis más frecuente en la infancia. Es crónica, idiopática, granulomatosa y afecta a vasos grandes. Afecta a las mujeres, con una relación 4:1; con una edad promedio de 26 años. Su causa es desconocida.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una niña de 7 años y 7 meses de edad, con AT tipo III de la clasificación de Numano, en fase isquémica, a la que se le inició tratamiento con glucocorticoides e inmunosupresores, así como angioplastia temprana, por la severidad del cuadro clínico. Tuvo una evolución satisfactoria.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El diagnóstico de AT antes de los 10 años se realiza en el 2% de los pacientes; el retraso en el diagnóstico es en promedio de 19 meses; el curso de la enfermedad es variable a pesar del tratamiento inmunosupresor y quirúrgico.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Mendiola Ramírez K, et al. Arteritis de Takayasu tipo III en un paciente pediátrico. Reporte de caso y revisión de la literatura. Reumatol Clin. 2012;8:216–9.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1730 "Ancho" => 3165 "Tamanyo" => 605602 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">CT angiography. Stenosis at the left subclavian artery, thoracic aorta, abdominal aorta and renal arteries.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 3181 "Tamanyo" => 285239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">(A) and (B) Cardiac catheterization showing severe stenosis of the thoraco-abdominal aorta. Pressure gradient of 50<span class="elsevierStyleHsp" style=""></span>mmHg. Stenosis below the renal arteries is not severe.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1312 "Ancho" => 2986 "Tamanyo" => 253985 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) and (B) Angioplasty. Placement of 2 long stents, covering the area of severe stenosis. Postoperative gradient: none. Gradient of the renal stenosis: 10<span class="elsevierStyleHsp" style=""></span>mmHg. There was no procedure on the left subclavian or the renal arteries.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Result \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Reference Value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ophthalmic examination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No evidence of vasculitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No evidence of vasculitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastric bacilloscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Echocardiogram \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduced cardiac motility; dilatation of left cavities, moderate mitral insufficiency, trivalve aorta with normal coronary pattern, left aortic arch.EF 40%, AF 19%, LV mass index 165<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LV Mass Index 64<span class="elsevierStyleHsp" style=""></span>g/m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>s \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electrocardiogram \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sinus rhythm, HR 140 beats per minute, aP +50, aQRS +45, PR 0.12, QRS 0.04, QTc 0.4, Left ventricle hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean HR 109–169QRS +60Interval +20 to + 120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest X-ray \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Situs solitus, levocardia, ICT 0.61, normal pulmonary flow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CTI 0.6–0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laboratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Blood count:</span>Hb 11.8<span class="elsevierStyleHsp" style=""></span>g/dl, Hto 35.8%, platelets 405<span class="elsevierStyleHsp" style=""></span>000, leucocytes 11<span class="elsevierStyleHsp" style=""></span>700/m<span class="elsevierStyleSup">3</span>, neutrophils 9240/m<span class="elsevierStyleSup">3</span>, lymphocytes 2460/m<span class="elsevierStyleSup">3</span><span class="elsevierStyleBold">Acute phase reactants:</span>ESR 10<span class="elsevierStyleHsp" style=""></span>mm/h, CRP 0.302<span class="elsevierStyleHsp" style=""></span>mg/dl, procalcitonin 0.51<span class="elsevierStyleHsp" style=""></span>ng/ml<span class="elsevierStyleBold">Renal function tests:</span>BUN 6<span class="elsevierStyleHsp" style=""></span>mg/dl, Cr 0.6<span class="elsevierStyleHsp" style=""></span>mg/dl<span class="elsevierStyleBold">Other:</span> renin 4.6<span class="elsevierStyleHsp" style=""></span>ng/ml/h, C3 135<span class="elsevierStyleHsp" style=""></span>mg/dl, C4 18.3<span class="elsevierStyleHsp" style=""></span>mg/dl, RF negative, IgA 409<span class="elsevierStyleHsp" style=""></span>mg/dl, IgG 1260<span class="elsevierStyleHsp" style=""></span>mg/dl, IgM 262<span class="elsevierStyleHsp" style=""></span>mg/dl, ANA and anti-DNA negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Blood count:</span>Hb: 12–18<span class="elsevierStyleHsp" style=""></span>g/dl, Hto: 37%–47%, platelets: 145<span class="elsevierStyleHsp" style=""></span>000–450<span class="elsevierStyleHsp" style=""></span>000 leucocytes: 4000–11<span class="elsevierStyleHsp" style=""></span>000, neutrophils:4500–7500, lymphocytes: 1000–4800.<span class="elsevierStyleBold">Acute phase reactants:</span>ESR: 0–10<span class="elsevierStyleHsp" style=""></span>mm/h, CRP: 0–0.300<span class="elsevierStyleHsp" style=""></span>mg/dl, procalcitonin: 2.0<span class="elsevierStyleHsp" style=""></span>ng/dl<span class="elsevierStyleBold">Renal function tests:</span> BUN: 2–23<span class="elsevierStyleHsp" style=""></span>mg/dl, Cr: 0.4<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>mg/dl<span class="elsevierStyleBold">Other:</span> renin: 0.5–5.7<span class="elsevierStyleHsp" style=""></span>ng/ml/h, C3: 75–135<span class="elsevierStyleHsp" style=""></span>mg/dl, C4: 12–75<span class="elsevierStyleHsp" style=""></span>mg/dl, RF negative, IgA: 124–170<span class="elsevierStyleHsp" style=""></span>mg/dl, Ig G: 923–1.110<span class="elsevierStyleHsp" style=""></span>mg/dl, IgM: 65–90<span class="elsevierStyleHsp" style=""></span>mg/dl, ANA and anti-DNA negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right kidney: 83<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>46<span class="elsevierStyleHsp" style=""></span>mm, left 82<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>39<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>mmDoppler with adequate vascular permeability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right kidney: 85<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>47<span class="elsevierStyleHsp" style=""></span>mm, left 81<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab212312.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagnostic Approach to the Patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takayasu Arteritis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Al Abrawi" 1 => "M. Fuillet" 2 => "L. David" 3 => "X. Barral" 4 => "P. Cochat" 5 => "R. Cimaz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ped Rheum" "fecha" => "2008" "volumen" => "6" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arteritis de Takayasu" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Lupi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cardiología Pediátrica, diagnóstico y tratamiento" "paginaInicial" => "431" "paginaFinal" => "443" "serieFecha" => "2001" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takayasu¿s arteritis progression on anti-TNF biologics: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Osman" 1 => "S. Aaron" 2 => "M. Noga" 3 => "E. 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Lakhoua" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ped Rheum" "fecha" => "2010" "volumen" => "8" "paginaInicial" => "1" "paginaFinal" => "4" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiplatelet therapy for prevention of arterial ischemic events in Takayasu arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.A.S. De Souza" 1 => "P.N. Machado" 2 => "M.V. Pereira" 3 => "D.A.E. Arrae" 4 => "E.T. Ries Neto" 5 => "A.H. Mariz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "1236" "paginaFinal" => "1241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20467149" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antiplatelet therapy in the treatment of Takayasu arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "U. Masafumi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "1079" "paginaFinal" => "1080" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20472963" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-interventional immunosuppressive treatment and vascular restenosis in Takayasu¿s arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.C. Park" 1 => "W.S. Lee" 2 => "B.Y. Park" 3 => "K.S. Lee" 4 => "D. Choi" 5 => "H.W. Shim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/rheumatology/kei245" "Revista" => array:6 [ "tituloSerie" => "Rheumatology" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "600" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16352637" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of Takayasu's arteritis in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Reddy" 1 => "V.J. Robbs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiovasc J Africa" "fecha" => "2007" "volumen" => "18" "paginaInicial" => "393" "paginaFinal" => "397" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limitations of therapy and guarded prognosis in an American Cohort of Takayasu Arteritis Patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.K. McKinnon" 1 => "M.T. Clark" 2 => "S.G. Hoffman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "1000" "paginaFinal" => "1009" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack38114" "titulo" => "Acknowledgement" "texto" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The authors of this article would like to thank Dr. Jose Agustin Ramirez Barreto for his help in translating this article.</p>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000800000004/v1_201305061641/S2173574312000512/v1_201305061641/en/main.assets" "Apartado" => array:4 [ "identificador" => "17376" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000800000004/v1_201305061641/S2173574312000512/v1_201305061641/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574312000512?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 16 | 35 |
| 2024 October | 91 | 58 | 149 |
| 2024 September | 120 | 41 | 161 |
| 2024 August | 119 | 52 | 171 |
| 2024 July | 127 | 64 | 191 |
| 2024 June | 128 | 54 | 182 |
| 2024 May | 174 | 70 | 244 |
| 2024 April | 107 | 47 | 154 |
| 2024 March | 93 | 55 | 148 |
| 2024 February | 92 | 31 | 123 |
| 2024 January | 78 | 44 | 122 |
| 2023 December | 52 | 36 | 88 |
| 2023 November | 74 | 57 | 131 |
| 2023 October | 72 | 45 | 117 |
| 2023 September | 103 | 59 | 162 |
| 2023 August | 58 | 36 | 94 |
| 2023 July | 61 | 33 | 94 |
| 2023 June | 38 | 37 | 75 |
| 2023 May | 62 | 35 | 97 |
| 2023 April | 55 | 40 | 95 |
| 2023 March | 85 | 32 | 117 |
| 2023 February | 67 | 40 | 107 |
| 2023 January | 59 | 21 | 80 |
| 2022 December | 100 | 43 | 143 |
| 2022 November | 120 | 41 | 161 |
| 2022 October | 401 | 55 | 456 |
| 2022 September | 91 | 42 | 133 |
| 2022 August | 110 | 60 | 170 |
| 2022 July | 87 | 54 | 141 |
| 2022 June | 66 | 44 | 110 |
| 2022 May | 71 | 46 | 117 |
| 2022 April | 69 | 55 | 124 |
| 2022 March | 52 | 67 | 119 |
| 2022 February | 74 | 53 | 127 |
| 2022 January | 87 | 50 | 137 |
| 2021 December | 72 | 58 | 130 |
| 2021 November | 56 | 74 | 130 |
| 2021 October | 87 | 71 | 158 |
| 2021 September | 85 | 57 | 142 |
| 2021 August | 82 | 70 | 152 |
| 2021 July | 77 | 46 | 123 |
| 2021 June | 90 | 51 | 141 |
| 2021 May | 82 | 63 | 145 |
| 2021 April | 127 | 104 | 231 |
| 2021 March | 147 | 57 | 204 |
| 2021 February | 95 | 43 | 138 |
| 2021 January | 72 | 41 | 113 |
| 2020 December | 75 | 31 | 106 |
| 2020 November | 154 | 40 | 194 |
| 2020 October | 50 | 14 | 64 |
| 2020 September | 78 | 49 | 127 |
| 2020 August | 69 | 24 | 93 |
| 2020 July | 54 | 33 | 87 |
| 2020 June | 63 | 32 | 95 |
| 2020 May | 59 | 31 | 90 |
| 2020 April | 51 | 28 | 79 |
| 2020 March | 23 | 11 | 34 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 1 | 0 | 1 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 7 | 1 | 8 |
| 2018 April | 71 | 12 | 83 |
| 2018 March | 77 | 20 | 97 |
| 2018 February | 47 | 3 | 50 |
| 2018 January | 40 | 10 | 50 |
| 2017 December | 54 | 10 | 64 |
| 2017 November | 67 | 5 | 72 |
| 2017 October | 41 | 6 | 47 |
| 2017 September | 71 | 15 | 86 |
| 2017 August | 69 | 12 | 81 |
| 2017 July | 72 | 13 | 85 |
| 2017 June | 98 | 25 | 123 |
| 2017 May | 103 | 19 | 122 |
| 2017 April | 73 | 12 | 85 |
| 2017 March | 77 | 12 | 89 |
| 2017 February | 72 | 8 | 80 |
| 2017 January | 65 | 18 | 83 |
| 2016 December | 91 | 22 | 113 |
| 2016 November | 68 | 19 | 87 |
| 2016 October | 109 | 9 | 118 |
| 2016 September | 114 | 11 | 125 |
| 2016 August | 104 | 10 | 114 |
| 2016 July | 72 | 23 | 95 |
| 2016 April | 1 | 0 | 1 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 4 | 0 | 4 |
| 2015 August | 8 | 0 | 8 |
| 2015 July | 24 | 6 | 30 |
| 2015 June | 50 | 18 | 68 |
| 2015 May | 80 | 28 | 108 |
| 2015 April | 62 | 35 | 97 |
| 2015 March | 63 | 17 | 80 |
| 2015 February | 53 | 21 | 74 |
| 2015 January | 36 | 20 | 56 |
| 2014 December | 62 | 24 | 86 |
| 2014 November | 39 | 11 | 50 |
| 2014 October | 46 | 16 | 62 |
| 2014 September | 44 | 11 | 55 |
| 2014 August | 55 | 27 | 82 |
| 2014 July | 67 | 20 | 87 |
| 2014 June | 75 | 29 | 104 |
| 2014 May | 82 | 22 | 104 |
| 2014 April | 67 | 20 | 87 |
| 2014 March | 67 | 32 | 99 |
| 2014 February | 68 | 19 | 87 |
| 2014 January | 61 | 13 | 74 |
| 2013 December | 60 | 15 | 75 |
| 2013 November | 46 | 23 | 69 |
| 2013 October | 65 | 20 | 85 |
| 2013 September | 62 | 19 | 81 |
| 2013 August | 68 | 25 | 93 |
| 2013 July | 64 | 27 | 91 |
| 2013 June | 68 | 37 | 105 |
| 2013 May | 64 | 26 | 90 |
| 2013 April | 60 | 34 | 94 |
| 2013 March | 59 | 29 | 88 |
| 2013 February | 44 | 37 | 81 |
| 2013 January | 54 | 40 | 94 |
| 2012 December | 41 | 25 | 66 |
| 2012 November | 43 | 17 | 60 |
| 2012 October | 44 | 25 | 69 |
| 2012 September | 32 | 12 | 44 |
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