TA CLASSIFICATION TYPES & CRITERIA

Reference: Ball, G.V. and S. Louis Bridges JR (Eds) (2002) Vasculitis. Oxford University

In Chapter 19 by Sharma and Jain they provide a classification of TA on page 283

"A new 5-type classification proposed by an International Cooperative Study on Takayasu's Arteritis is based on the location of the disease (Moriwaki et al, 1997)".

The Roman Numerals refer to Type.

The statement refers to Site of Involvement.

Type I - Branches of the aortic arch.

Type IIa - Ascending aorta, aortic arch and its branches.

Type IIb - Ascending aorta, aortic arch and its branches and thoracic descending aorta.

Type III - Thoracic descending aorta, abdominal aorta and/or renal arteries.

Type IV - Abdominal aorta and/or renal arteries.

Type V - Combination of Types IIb and IV.

--------

From: http://www.rheumatology.org/publications/classification/takayasu.asp?aud=mem


1990 criteria for the classification of Takayasu arteritis

1. Age at disease onset < 40 years
Development of symptoms or findings related to Takayasu arteritis at age 40 years

2. Claudication of extremities
Development and worsening of fatigue and discomfort in muscles of 1 or more extremity while in use, especially the upper extremities

3. Decreased brachial artery pulse
Decreased pulsation of 1 or both brachial arteries

4. BP difference >10 mm Hg
Difference of >10 mm Hg in systolic blood pressure between arms


5. Bruit over subclavian arteries or aorta
Bruit audible on auscultation over 1 or both subclavian arteries or abdominal aorta


6. Arteriogram abnormality
Arteriographic narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lowe extremities, not due to arteriosclerosis, fibromuscular dysplasia, or similar causes; changes usually focal or segmental

POSITIVE VIBRATIONS

QUOTE OF THE DAY

One of the most tragic things I know about human nature is that all of us tend to put off living. We are all dreaming of some magical rose garden over the horizon instead of enjoying the roses that are blooming outside our windows today. ~ Dale Carnegie

CASE REPORT: Descending Aorta to Carotid Bypass for Takayasu Arteritis as a Redo Operation

http://ats.ctsnetjournals.org/cgi/content/abstract/76/1/283

Case report

Descending aorta to carotid bypass for takayasu arteritis as a redo operation Norihiko Shiiya, MD, PhDa*, Kenji Matsuzaki, MDa, Tohru Watanabe, MDa, Satoshi Kuroda, MD, PhDb, Keishu Yasuda, MD, PhDa

a Department of Cardiovascular Surgery, Sapporo, Japan

b Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Accepted for publication January 7, 2003.

* Address reprint requests to Dr Shiiya, Department of Cardiovascular Surgery, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo 060-8648, Japane-mail: shiyanor@med.hokudai.ac.jp
'//-->

In Takayasu arteritis recurrent brain ischemia, due to bypass graft failure, is frequent. Redo bypass grafting from the ascending aorta may be at risk if a failing but patent graft that is critical for brain blood flow is present, because partial clamping the ascending aorta may disturb graft flow if the ascending aorta is short. We report such a patient who successfully underwent redo bypass grafting from the descending aorta. In type I Takayasu arteritis, this operation may be valuable because the descending aorta is usually disease free and brain blood flow is maintained during the operation.

Myocardial Thievery: The Coronary-Subclavian Steal Syndrome

http://ats.ctsnetjournals.org/cgi/content/abstract/81/1/386

Review

Myocardial Thievery: The Coronary-Subclavian Steal Syndrome

Thomas J. Takach, MD, George J. Reul, MD, Denton A. Cooley, MD * , J. Michael Duncan, MD, James J. Livesay, MD, David A. Ott, MD, Igor D. Gregoric, MD
Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas

* Address correspondence to Dr Cooley, Department of Cardiovascular Surgery, The Texas Heart Institute, PO Box 20345, Houston, TX 77225. (Email: dcooley@heart.thi.tmc.edu
'//-->).

Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated. We review the causes and background of coronary-subclavian steal; methods of preventing, diagnosing, and treating it; and the potential influence of various treatment regimens on long-term survival and the likelihood of late adverse events in patients with coronary-subclavian steal syndrome.

TODAY'S WORD

From Joel & Victoria Osteen

Brighter Days Ahead

Today's Scripture

“The way of the righteous is like the first gleam of dawn, which shines ever brighter until the full light of day” (Proverbs 4:18, NLT).

Today's Word from Joel and Victoria

Are you facing a situation that seems dark today? As a believer, God promises that your path will shine brighter and brighter as you seek His Truth and righteousness in every situation. What is righteousness? Righteousness is simply being in "right standing" with God. Being in "right standing" with God is about submitting your life to Him. It's about obeying His commands and seeking His plan for your life on a daily basis. God wants to be involved in every detail of your life. It pleases Him when you come to Him. It pleases Him when you study your Bible and talk to Him in prayer. And just as the increasing light of the sun helps you see better in the natural, the increasing light of God's Word will guide you in every decision you have to make. No matter what you may be facing today, take time to ask the Lord to shine His light on your thoughts. Ask Him to confirm His plan for your today. Ask Him to shine the light of His Word in your heart so that you can clearly see the next step to take. As you continue pursing His Truth and Righteousness, you will experience more of His blessings and live the life of abundance that He has in store for you!

A Prayer for Today

God, I know that You have a wonderful plan and purpose for me. I want to be in "right standing" with You today. Show me your ways and teach me to walk righteously before you. Shine your light in my heart and give me strength and wisdom to pursue the path You have in-store for me. In Jesus' Name. Amen.

THE POWER OF POSITIVE THINKING

From Dr. Val and the Voice of Reason Blog

http://www.revolutionhealth.com/blogs/valjonesmd?page=2

The Power of Positive Thinking
Posted on 07:49AM (EDT) on 2007-07-09

Norman Vincent Peale wrote a bestselling book in the 1950’s, “The Power of Positive Thinking.” I read it a few years ago and found it to be a tad simplistic but it had an undeniable point: a positive attitude is important in life.

In my last post I described the dangers of magical thinking – since it opens the door to pseudoscience-touting snake oil salesmen. But now we will turn our attention to positive thinking – a favorable psychological condition.

There is no doubt that there is a mind-body connection that affects health. “Type A personalities” are known to engage in behaviors that increase the risk for heart attack; anxiety and perceived stress can cause higher output of adrenaline and cortisol, and in turn contribute to inflammation, atherosclerosis, heart disease, sleep disturbances, and weight gain. Depressed individuals (for example) are more likely to suffer from pain syndromes, and may have impaired immune function.

Because our mind influences the health of our body, it is physically therapeutic to focus attention on peace of mind as a preventive health measure. And in so far as techniques are developed to reduce stress, decrease mental anguish, and improve psychological wellbeing – they are helpful in keeping the body in a healthier state.


Now, the temptation is to exaggerate the benefits of peace of mind – that one might be able to avoid cancer (for example) with the right attitude, which is blatantly false. So this is where positive thinking and magical thinking can be confused. Magical thinking ascribes excessive value to a treatment, while positive thinking understands the limitations of treatments and yet respects the reality of the mind-body connection.

Let’s consider back pain, for example. A magical thinker would look for the “secret cure” for their back pain, and turn over every stone – fully anticipating that he would discover a miracle solution that others don’t know about. He would read books promising the ultimate back treatment “that your doctor doesn’t want you to know about” and would spend a great deal of money on treatments that have been rumored to have some benefit in treating back pain (without any supporting evidence). The magical thinker is vulnerable to snake oil, and would rather risk thousands of dollars on experimental treatments than consider traditional modalities first.


A positive thinker, on the other hand, will realize that back pain is difficult to treat, has variable causes, and responds to different therapies based on an individual’s unique circumstances. A positive thinker would have a realistic view of recovery, would accept the limitations of therapeutic options, but would focus on his abilities rather than his disabilities and look for ways to make the best of his current circumstances. He would actively participate in physical activity, perhaps join a support group, get good rest and engage in a healthy lifestyle while working towards a brighter tomorrow one step at a time.

Definitions for clarity:

Snake oil is a treatment whose efficacy is knowingly exaggerated by those who wish to turn a profit on its sale. E.g. diet pills that will "miraculously correct morbid obesity in a matter of weeks."

A placebo is a treatment that has no known plausible mechanism for a physical effect - but may affect the individual through the mind-body connection. E.g. a sugar pill that is substituted for a pain killer may cause a patient to experience his pain differently, though there is no active ingredient in the pill.

An untested treatment is neither snake oil nor a placebo but could be used as either under certain circumstances. It is simply a proposed intervention of unclear clinical significance. There are many of these currently undergoing scientific review, and it takes patience to analyze their potential efficacy and safety.

A magical thinker is a person who is willing to accept snake oil as a valid treatment option for his condition despite a vast preponderance of evidence to the contrary. Magical thinking is belief-based, rather than evidence-based. Many very good and reasonable people are tempted to adopt magical thinking under duress.

A positive thinker is a person who choses to look for the positives in all circumstances, and approaches health with a can-do attitude. Realistic and yet optimistic, the positive thinker will focus on abilities rather than disabilities - and reach out for support as needed to optimize his psychological well being.

All of this is simply to say that a positive attitude, peace of mind, stress reduction techniques and a healthy lifestyle are an important foundation for good health. Placebos are most relevant for influencing psychological well being or pain perception (obviously they're not appropriate for treating infections, type 1 diabetes, and the like), and magical thinking and snake oil are dangerous hindrances to wellbeing. Stay positive and protect yourself from snake oil salesmen. Knowledge is power. There are voices of reason to guide you here at Revolution Health.


**Views expressed are my own and do not necessarily reflect the views of Revolution Health.**

ACCENTUATE THE POSITIVE

Durable Remission in Patients with Refractory Takayasu’s Arteritis Treated with Infliximab or Etanercept (Remicade)

Durable Remission in Patients with Refractory Takayasu’s Arteritis Treated with Infliximab or Etanercept

http://www.clevelandclinic.org/quality/outcomes/rheumaticAndImmunologic/takayasutreatment.htm

Eamonn S. Molloy, Carol A. Langford, Tiffany M. Clark, Carmen E. Gota, Leonard H. Calabrese, Gary S. Hoffman

While up to 20% of Takayasu’s arteritis (TAK) patients have a monophasic illness, most have a relapsing/remitting course, typically requiring prolonged treatment with glucocorticoids and additional immunosuppressive agents, such as methotrexate, azathioprine and, in severe cases, cyclophosphamide. More than one-third of patients are unable to achieve adequate disease control on these therapies. As tumor necrosis factor alpha (TNFa) is critical for granuloma homeostasis and granulomatous inflammation is the pathologic hallmark of TAK, TNFa is an attractive therapeutic target in TAK; anti-TNF therapy has been employed in TAK patients with encouraging results.

We sought to assess the efficacy of anti-TNF therapy in patients with TAK refractory to other therapies. Twenty-eight TAK patients were identified as having received anti-TNF therapy; 3 patients were excluded because of insufficient follow-up data. No patient was in remission at the time of initiation of anti-TNF therapy; 13 had not achieved remission at any time since initial diagnosis. Twenty-five patients were treated with anti-TNF therapy for up to 6.5 years. Twenty patients were treated with infliximab (INF) with a mean follow-up of 27 months (range 2-76). Nine patients were treated with etanercept (ETA) with a mean follow-up of 33 months (range 4-78). Four patients received both agents (all initially treated with ETA, later switched to INF). No patients were treated with adalimumab.

Of 25 patients, 22 were female; mean age was 35 years (range 15-63). Patients’ ethnicities were Caucasian, 20, Asian,3, Hispanic,1, and one unknown. Median disease duration was 108 months (range 31-336). All patients were previously treated with prednisone and a mean of 2 additional immunosuppressive agents (range 0-6) including 22 methotrexate, 10 cyclophosphamide, and 12 with a variety of other agents.

Overall, prednisone was discontinued in 15/25 patients (60%) and tapered below 10 mg/day in a further 7/25 (28%). Median prednisone dose before and after anti-TNF therapy was 19 mg (range 5-90) and 0 mg (range 0-30). Nine out of 18 patients were able to taper or discontinue additional immunosuppressive agents used concurrently with the anti-TNF agent. Six patients had definite new changes noted on MR imaging (3 INF, 3 ETA); 5 patients entered remission on higher dose anti-TNF therapy. Three patients who stopped ETA had disease flares within a median of 2 months (range 1-2); 6/7 patients that stopped INF had disease flare at a median interval of 6 months (range 2-12); 1 patient recommenced INF treatment and achieved sustained remission.

Conclusions
In this group of TAK patients refractory to other immunosuppressive therapies, anti-TNF therapy led to complete or partial remission in 79% of patients. Anti-TNF therapy allowed prednisone to be discontinued or tapered in 60% and 28%, respectively. Of those patients taking concurrent immunosuppressive drugs other than prednisone, anti-TNF therapy allowed reduction of the dose of these agents in 50%. These findings provide further support for the rationale for randomized controlled trials of anti-TNF therapy in TAK.

THINGS THAT I AM HAPPY ABOUT

1. Chilled Watermelon
2. Rubber inflatable swimming pools
3. Play n Bounce place
4. Good Book
5. Creative ideas

UNWRITTEN VIDEO - NATASHA BEDINGFIELD

UNWRITTEN
By Natasha Bedingfield

I am unwritten,
Can't read my mind
im undefined
im just begining
the pen is in my hand
ending unplanned

Staring at the blank page before you
Open up the dirty window
Let the sun illuminate the words
That you could not find
Reaching for something in the distance
So close you can almost taste it
Release your inner visions


Feel the rain on your skin
No one else can feel it for you
Only you can let it in
No one else, no one else
Can speak the words on your lips
drench yourself in words unspoken
Live your life with arms wide open
Today is where your book begins
The rest is still unwritten ,yeah

Oh, oh

I break tradition
Sometimes my tries
Are outside the lines, oh yeah
Within condition
To not make mistakes
But I can't live that way oh, oh

Staring at the blank page before you
Open up the dirty window
Let the sun illuminate the words
That you could not find
Reaching for something in the distance
So close you can almost taste it
Release your inner visions

Feel the rain on your skin
No one else can feel it for you
Only you can let it in
No one else, no one else
Can speak the words on your lips
drench yourself in words unspoken
Live your life with arms wide open
Today is where your book begins
The rest is still unwritten


Staring at the blank page before you
Open up the dirty window
Let the sun illuminate the words
That you could not find
Reaching for something in the distance
So close you can almost taste it
Release your inner visionnnnnnnnnns


Feel the rain on your skin
No one else can feel it for you
Only you can let it in
No one else, no one else
Can speak the words on your lips
drench yourself in words unspoken
Live your life with arms wide open
Today is where your book begins
The rest is still unwritten
The rest is still unwritten

AFFIRMATION OF THE DAY

WHAT A WONDERFUL WORLD - PAOLO NUTINI

FUNNY CARTOON OF THE DAY

TODAY'S WORD

Take Care of Yourself

Today's Scripture

“For God has bought you with a great price. So use every part of your body to give glory back to God because he owns it” 1 Corinthians 6:20 (TLB).

Today's Word from Joel and Victoria

There is no doubt that being in shape spiritually is the most important kind of fitness. But being in shape physically is very important as well. Some people know the Bible well - they pray often and they know what to do, but they don't have the physical energy to do anything at all. All three parts of your being - physical, emotional and spiritual - should be healthy and in sync for you to function most productively. Your body is the temple of the most high God, and you must honor Him with the care you take of it. Seek a balance, and try to be healthy and God-honoring in every part of life.

A Prayer for Today

God, thank You for giving me the ability to honor You with my body. Help me to take care of my body and make it a stronger and healthier temple for You. In Jesus' Name. Amen.

LIVING WELL WITH CHRONIC ILLNESS

Article by Dr. Jackie Black
http://EzineArticles.com/?expert=Dr._Jackie_Black

Living with chronic illness impacts one’s physical, psychological, emotional, and spiritual well-being. Living with chronic illness often causes one to feel helpless and hopeless, discouraged and isolated. It can devastate one’s career and financial security, friendships and love relationships, creativity, concentration, motivation, and one’s very peace of mind.

It is important now and useful long-term, to remain as active, social, and productive as possible. That means focus on what you can do and let go of what you can no longer do. Create priorities for your body, mind, heart, and soul.

Ancient philosophers and healers recognized that the body and the mind were one. Modern research confirms this body/mind connection. In the last 15 years, Western medicine has coined a term for what the ancients knew: psychoneuroimmunology. Harvard Medical School now publishes a professional journal called Mind/Body Medicine. Studies show that improved physical, emotional, and spiritual well-being stimulate an innate healing response in the body. It is possible to create a healthier lifestyle that will promote wellness. The key is to balance the physical, psychological, emotional, and spiritual aspects of your life.

Improving and maintaining physical well-being includes proper nutrition, rest, and exercise. It means carefully selecting the activities in which you participate and the people with whom you spend time to ensure that you are making good choices about expending energy and making the most of each day.

Paying attention to the psychological and emotional aspects of your life includes becoming a good observer of your thoughts, feelings, and how/what you feel in your body. This is a time to allow yourself to experience, examine, and express your thoughts and feelings in an honest and forthright way.

Accurately expressing yourself is one of the most important aspects of living with chronic illness. No one will know how you feel and what you can reasonably be expected to do or not do unless
you tell people directly. Value yourself and take ownership of your feelings, and thoughts, your resources and choices.

Honor and express your deepest truth and make what you say and how you say it match what you feel. Say your real “yes” and your real “no” and say what you feel without blaming or needing to please others. Don’t avoid saying what is in your heart or on your mind to say. Don’t hide your worries and concerns because you don’t want others to know you are not in control.

Accessing your spiritual nature can be as easy as watching the sunset or taking a walk through a beautiful garden. You might also consider meditation, yoga, chanting, or praying. Whether you call it God, the Universe, higher power, or “the force” a la Steven Spielberg, it is quite comforting and healing to experience the inner peace that is uniquely you.

Sitting in the quiet and allowing your attention to flow inward is very foreign to men and women in the Western world. It is, however, a fundamental practice if one is to develop and maintain health and well-being, inside and outside.

Human beings are resilient and adaptable. When faced with seemingly insurmountable tasks, we rise to the occasion. Chronic illness often motivates us to re-evaluate and reconsider every aspect of life; to review and change habits, goals, choices, and decisions.

This review includes everything from food choices, career/work, social relationships and recreational activities, to including naps and going to sleep earlier. Now is the time to create a more flexible schedule and intentionally pace yourself.

Determination and persistence will enable you to stay motivated through the tough times, and stay involved in activities that are meaningful and joyful. Maintaining your sense of humor is essential.

Invite people into your life who are kind, respectful, and compassionate. Stay away from well-meaning, well-intentioned people who have an agenda for you and can’t see you or hear you accurately.

This is the opportunity to create the changes in your life that will bring meaning to every day and cause you to choose and maintain a lifestyle that promotes and sustains your well-being: physical, psychological, emotional, and spiritual.

While chronic illness may close some doors, it will no doubt open others. Take good care! You’re worth it. Remember, only YOU can make it happen!

MUSIC VIDEO OF THE DAY