Mashiah A, Yeguna Y, Pasik S, Hod I
Vascular Surgery Unit, Kaplan Hospital, Rehovot, Israel.
J Cardiovasc Surg (Torino). 1987 Nov-Dec;28(6):706-10.
Forty-five consecutive patients (32 women and 13 men) underwent biopsy of the temporal artery because of suspected giant cell arteritis. Their ages ranged from 38 to 84 years, mean 68.1 years. Five patients (11.1%) four of them women, were found to be affected by the disease. Their ages ranged from 54 to 80 years, mean 69 years. Clinical and laboratory findings included elevated erythrocyte sedimentation rate, prolonged fever, continuous headache, sudden onset of unilateral blindness, intermittent mandibular claudication, severe anemia and myalgia. None of these, whether present in isolation or in various combinations, were of significant diagnostic value. All biopsies were examined both by light microscopy and by scanning electron microscopy. The former examination took about 5-7 days to complete, and the latter about 3 hours. Light microscopy studies showed that 46.6% of the arterial biopsies were normal, 42.3% were arteriosclerotic and 11.1% (5 specimens) were characteristic of giant cell arteritis. Scanning electron microscopy revealed that the biopsies obtained from all five patients found to have temporal arteritis displayed the "occlusive" pattern: the three-laminar appearance of the artery was markedly distorted or lost, the internal elastic lamina was barely detectable, and the densely hypertrophied media and intima filled the arterial lumen, virtually obliterating it. We conclude that scanning electron microscopy is a quick and accurate procedure for diagnosis of temporal arteritis and that positive findings may be taken as an indication for immediate steroid treatment.
45例连续患者（32名女性和13名男性）因疑似巨细胞动脉炎接受了颞动脉活检。他们的年龄在38岁至84岁之间，平均年龄为68.1岁。5例患者（11.1%），其中4例为女性，被发现患有该病。他们的年龄在54岁至80岁之间，平均年龄为69岁。临床和实验室检查结果包括红细胞沉降率升高、长期发热、持续性头痛、单侧突然失明、间歇性下颌跛行、严重贫血和肌痛。这些症状无论是单独出现还是以各种组合出现，均无显著诊断价值。所有活检标本均进行了光镜检查和扫描电子显微镜检查。前者检查大约需要5 - 7天完成，后者大约需要3小时。光镜研究表明，46.6%的动脉活检标本正常，42.3%为动脉硬化，11.1%（5个标本）具有巨细胞动脉炎的特征。扫描电子显微镜显示，从所有5例被发现患有颞动脉炎的患者身上获取的活检标本呈现出“闭塞”模式：动脉的三层结构明显扭曲或消失，内弹性膜几乎无法检测到，密集肥厚的中膜和内膜充满动脉腔，几乎将其闭塞。我们得出结论，扫描电子显微镜是诊断颞动脉炎的一种快速且准确的方法，阳性结果可作为立即进行类固醇治疗的指征。
