لومړى فصل دويني او لمف رګونه

دشريانو ناروغي د وريدونو ناروغي دلمفاوي رګونونو ناروغي

١ • ٢ • ٣ •

(arteries)

Tunica itima (tunica adventitia) (tunica media)

vasculitis arteritis arteriosclerosis aneurysms

Arteriosclerosis

1 لومړى فصل دويني او لمف رګونه

Senile arteriosclerosis I

Hypertensive arteriosclerosis II

Medial calcific sclerosis Monckeberg’s arteriosclerosis III

Atherosclerosis – IV

atherosclerosis arteriosclerosis

Senile arteriosclerosis tunica media tunica intima

Fibroblastosis

internal elastic lamina

Hypertensive Arteriolosclerosis hypertension

arteriolosclerosis

2 لومړى فصل دويني او لمف رګونه

arterioles necrotizing Hyperplastic arteriolosclerosis Hyaline arteriolosclerosis arteriolitis

Hyaline arteriolosclerosis

nephrosclerosis

eosinophilic A

Arteriolosclerosis

Pathogenesis

3 لومړى فصل دويني او لمف رګونه

i

stress

ii

iii

Hyperplastic Arteriolosclerosis arteriolosclerosis toxaemia scleroderma Haemolytic-uraemic syndrome

interlobular intima

intima

hyperplastim intima onion i (BM) (onion) B

(ground intima intima mucinous ii proteoglycans substances)

fibrous iii

Pathogenesis

4 لومړى فصل دويني او لمف رګونه

hyperplastic intimal endothelial

Necrotizing arteriolitis

fibrinoid necrosis arteriolitis C adventitia

Pathogenesis necrotisisng arteriolitis

Monckeberg’s arteriosclerosis monckeberg’s tunica media genital arteriosclerosis dystrophic calcification degeneration idiopathic pseudoxanthoma elasticum calcification

5 لومړى فصل دويني او لمف رګونه

x-rays Medial calcification

atherosclerosis

Pathogenesis

degeneration

Atherosclerosis

Monckeberg’s arteriosclerosis

arteriosclerosis Atherosclerosis fibrofatty plaques atheroma athero atherosclerosis sclerosis atherosclerosis plaque

6 لومړى فصل دويني او لمف رګونه

transient cerebral strocke heart attacks atheroma atheroma ischemia (aneurysm) mesenteric ischaemic encephalopathy

atherosclerosis atherosclerosis atheroma IHD(ischaemic heart disease)

atherosclerosis

atherosclerosis

١-١ جدول : د atherosclerosis لپاره د خطر فکتورونه .

I. MAJOR RISK FACTORS II. EMERGING RISK FACTORS

A) Modifiable 1. Environmental influences

1. Dyslipidaemia 2. Obesity

2. Hypertension 3. Hormones:oestrogen deficiency, oral contraceptives

3. Diabetes mellitus 4. Physical inactivity

4. Smoking 5. Stressful life

B) Constitutional 6. Homocystinuria

1. Age 7. Role of alcohol

2. Sex 8. Prothrombotic factors

3. Genetic factors 9. Infections (C.pneumoniae, Herpesvirus, CMV)

4. Familial and racial factors 10. High CRP

7 لومړى فصل دويني او لمف رګونه

major risk factors I

A dyslipidaemias smoking diabetes mellitus hypertension

B

II

atherosclerosis atherosclerosis

hypertension lipid disorders diabetes mellitus

Dyslipidaemias

atherosclerotic lesion Virchow atherosclerosis atherosclerosis lipoproteins

atherosclerosis Hypercholestraemia

8 لومړى فصل دويني او لمف رګونه

atherosclerotic plaques i lipoproteins

ii atherosclerosis

IHD atherosclerosis hypercholesterolaemia iii

IHD hypercholesterolaemia iv IHD

lipoproteinis

very-low chylomicrons (suspend) High density Low-density lipoproteins(LDL) density lipoproteins (VLDL) lipoproteins (HDL) (carrier proteins) apoproteins apoproteins D C B A apoproteins lipoproteins IHD atherosclerosis

١-٢ جدول :په سيرم کي د lipoproteins د موجوديت اهميت او مربوطه ستونځي.

Classes Sites of Synthesis Normal Serum Levels Role in Atherosclerosis

1. HDL cholesterol Liver, intestine > 60 mg/dl Protective

2. LDL cholesterol Liver < 130 mg/dl Maximum

3. VLDL triglycerides Intestine, liver < 160 mg/dl Less marked

4. Chylomicrons Liver, intestine, macrophage — Indirect

9 لومړى فصل دويني او لمف رګونه

140-200mg/dl Total cholesterol i 240 mg/dl 260 mg/dl

IHD

Triglycerides ii

160 mg/dl

LDL 130 mg/dl LDL iii atherosclerosis

VLDL iv LDL VLDL

60 mg /dl HDL HDL v atherosclerosis

trans polyunsaturated

atherosclerosis omega-3

10 لومړى فصل دويني او لمف رګونه

LDL

LDL total cholesterols dyslipidaemia HDL nicotinic acid statin hyperlipidaemia exercise LDL dyslipidaemia HDL

Hypertension

atherosclerosis diastolic 160 mmHg systolic pressure IHD 95 mmHg pressure

Smoking

atherosclerosis atherosclerotic IHD IHD HDL atherosclerosis coagulation hypoxia carboxyhaemoglobin atherosclerosis

11 لومړى فصل دويني او لمف رګونه

Diabetes Mellitus

atherosclerosis II type I atherosclerosis type II cerebrovascular IHD diabetic dyslipidaemia (diabetic atherosclerosis foot) HDL LDL platelets

atherosclerosis

atherosclerosis atherosclerosis atherosclerosis

atherosclerosis menopause atherosclerosis HDL

Genetic factors

atherogenesis

atherosclerosis

12 لومړى فصل دويني او لمف رګونه

hyperlipoproteinaemia atherosclerosis

Emerging risk factors atherosclerosis

atherosclerosis atherosclerosis

atherosclerosis (obesity)

stroke MI menopause

exercise

type A stressful life style B-type atherosclerosis

HDL atherosclerosis

thrombi fibrinogen prothrombotic factors atherosclerosis

13 لومړى فصل دويني او لمف رګونه

cytomegalovirus chlamydia pneumonia atherosclerosis

acute phase CRP(c-reactive proteins) atherosclerosis reactant

Pathogenesis atherosclerosis pathogenesis

athrosclerosis Insudation hypothesis  intima

Encrustation hypothesis  platelets encrustation thrombi encrustation atherogenesis hypothesis

Atherosclerosis dyslipidaemia

atherosclerosis

Reaction-to-injury hypothesis

monoclonal theory

14 لومړى فصل دويني او لمف رګونه

reaction-to-injury hypothesis

 atheroma

 lipoprotein

foam cells

atherosclerosis pathogenesis platelets B A reaction-to-injury C 15 لومړى فصل دويني او لمف رګونه

atherosclerosis i

atherosclerosis

dyslipidaemia CO

stress dyslipidaemia

intimal ii

platelets

(ECM) platelets TNF-α IL-1 plaque

fibroblast growth factor(FGF) Platelete-derived growth factor(PDGF)  intima media migration T interferon(IF-ɣ) Transforming growth factor-β(TGF-β) 

Nitric oxide endothelin

16 لومړى فصل دويني او لمف رګونه

proteoglycans

iii

LDL foam cell intima oxidation LDL LDL

LDL  scavenger LDL foam oxidized LDL  ( apoptosis) foam cells plaque

dyslipidaemia iv

endothelial dyslipidaemia hypercholesterolaemia LDL atheroma HDL (foamy cells)

Thrombosis - V platelets atheromatous plaque foamy atheromatous plaque fibrin

17 لومړى فصل دويني او لمف رګونه

Monoclonal hypothesis

monoclonal

leiomyoma atheromatous plaque glucose-6-phosphate dehydrogenase(G6PD)

monoclonal

foam cell atherosclerosis

Mutation lipoproteins

herpes virus chicken

intima atherosclerosis

atheroma

18 لومړى فصل دويني او لمف رګونه

1mm

foam

proteoglycans

atheromatous plaques

atherosclerosis ground substances

atheromatous plaques

atherosclerotic

19 لومړى فصل دويني او لمف رګونه

fatty streaks atheroma fibrofatty plaque

atherosclerosis descending

Carotid Femoral iliac cerebral coronary

Atheromatous plaques

fibrous cap 

foam cells fibrous cap 

fibrin  foam fibrous cap  foam

20 لومړى فصل دويني او لمف رګونه

atheromatous abdominal oarta atheroma

atherosclerosis plaques

atheromatous plaques atherosclerosis aneurysm plaque

Calcification i

atheromatous plaque

monckeberg’s tunica media

Ulceration ii

emboli atheroma

21 لومړى فصل دويني او لمف رګونه

atheroma

coronary artery thromboembolic occlusion atheromatous plaque

plaque thrombosis iii emboli thrombi

(adventitia) Haemorrhage iv haematoma

atherosclerosis Aneurysm formation v adventitia

fibrosis adventitia atrophy

aneurysm

22 لومړى فصل دويني او لمف رګونه

coronary atheromatous plaque dystrophic calcification

atherosclerosis

ischaemia

necrosis infarction

emboli thrombi

aneurysm carotid mesenteric cerebral coronaries small

23 لومړى فصل دويني او لمف رګونه

embolization thrombosis i

ischaemic MI ii

cerebral infarction ischaemic brain iii

infarction ischaemic iv

claudication v

atherosclerosis

symptomatic atherosclerotic

24 لومړى فصل دويني او لمف رګونه

Arteritis vasculitis angiitis Arteritis

arteritis

١-٣ جدول :د vasculitis طبقه بندي.

I. INFECTIOUS ARTERITIS II. NON-INFECTIOUS ARTERITIS

1. Endarteritis obliterans 1. Polyarteritis nodosa (PAN)

2. Non-syphilitic infective arteritis 2. Hypersensitivity (allergic, leucocytoclastic) vasculitis

3. Syphilitic arteritis 3. Wegener’s granulomatosis 4. Temporal (giant cell) arteritis 5. Takayasu’s arteritis (pulseless disease)

6. Kawasaki’s disease

7. Buerger’s disease (thromboangiitis obliterans)

8. Miscellaneous vasculitis arteritis I

abcesses pneumonia Tuberculosis endocarditis septicaemia

Endarteritis Obliterans

TB lesion peptic ulcer arteritis menintitis

25 لومړى فصل دويني او لمف رګونه

fibrous –itis

Non-symphilitic intective Arteritis non-syphilitic infective arteritis

ischaemic necrosis thrombi

Syphilitic Arteritis tertiary vasculitis syphilitic periarteritis syphilitic endarteritis cerebral arteries

Syphilitic Aortitis

ascending mediastinal descending treponema diaphragm

26 لومړى فصل دويني او لمف رګونه mediastimum

atheromatous plaques fibrous

periarteritis vasa vasorum  military  gummas 

periarteritis endartertis vasa vasorum syphilictic aortitis

27 لومړى فصل دويني او لمف رګونه

syphilitic aortitis

aortic aneurysm a

(incompetence) valve b rheumatic

syphilitic (stenosis) coronary ostia c aortic atheroma aortitis

١-٤ جدول :د aortic atheroma او syphilitic aortitis پرتلوي څيړنه .

Feature Syphilitic Aortitis Aortic Atheroma

1. Sites Ascending aorta, aortic arch; Progressive increase from the arch to abdominal

absent below diaphragm aorta, more often at the bifurcation

2. Macroscopy Pearly-white intimal lesions resembling Yellowish-white intimal plaques with fat in the core;

tree-bark without fat in the core; ulceration ulceration and calcification in plaques common

and calcification often not found

3. Microscopy Endarteritis and periarteritis of vasa Fibrous cap with deeper core containing foam

vasorum, perivascular infiltrate of plasma cells, cholesterol clefts and soft lipid

cells and lymphocytes

4. Effects Thoracic aortic aneurysm, incompetence Abdominal aortic aneurysm, aortic valve stenosis,

of the aortic valve, stenosis of coronary ostia stenosis of abdominal branches Heubner’s arteritis cerebral syphilitic arteritis

cerebrum tertiary syphilis syphilitic meningitis

cerebral

syphilitic oartitis fibrosis (periarteritis , endarteritis) ischaemic

28 لومړى فصل دويني او لمف رګونه

Non-infectious arteritis II

arteriols vasculitis small vessel vasculitis vasculitis

anti-neutrophil sytoplasmic antibodies(ANCAs) immunologic vasculitis ANCAs immunofluorescence ANCAs

proteinase-3(PR-3) Cytoplasmic ANCA(c-ANCA)  Wegener’s granulomatosis

myeloperoxidase Perinuclear ANCA(p-ANCA)  microscopic polyarteritis nodosa

Kawasaki SLE anti-endothelial cell antibodies(AECAs) Buerger’s disease immune immunologic vasculitis Pauci-immune vasculitis complex pauci-immune vasculitis complex

Polyarteritis Nodosa

29 لومړى فصل دويني او لمف رګونه

necrotizing vasculitis PAN polyarteritis

PAN

Haematuria albuminuria immune complex neuritis melaena

PAN

PAN

fibrinoid fibrinoid necrosis i necrose (periarteritis) aneurysm thrombi

fibroblast ii

(healed) iii fibrosis thrombus

30 لومړى فصل دويني او لمف رګونه

Hypersensitivity Vasculitis leucocytoclastic vasculitis PAN

influenza virus HBV mycobavteria staphylococci streptococci CMC mixed Henoch-Schonein purpura sickness hypersensitivity vasculits SLE vasculitis cryoglobulinaemia

fibrinoid necrosis Leucocytoclastic vasculitis i

immune complex

lymphocytic vasculitis ii

Wegener’s Granulomatosis necrotizing vasculitis

acute necrotizing granulomas i

necrotizing vasculitis ii

diffuse necrotizing glomerulonephritis iii

31 لومړى فصل دويني او لمف رګونه

Wegener’s granulomatosis PAN sinuses nasopharynx nasophyngeal sinusitis pneumonitis ulceration

complex

c-ANCA

granulomatous Wegener’s granulomatosis necrotizing vasculitis

epithelioid fibrinoid necrosis  fibrosblasts necrotizing vasculitis 

glomerulonephritis 

Temporal (Giant Cell) Arteritis granulomatous temporal mesenteric femoral brachial axillary C.carotid

32 لومړى فصل دويني او لمف رګونه

gait cell arterits

ophthalmic

T-cell lamina biopsy

lamina i

Langhan’s foreing body Giant cells ii

internal elastic lamina iii

iv

eosinophils v

Takayasu’s Artertis (pulseless disease)

granulomatous vasculitis Aortic arch syndrome

ischaemia

33 لومړى فصل دويني او لمف رګونه

(CHF) congestive MI Takayasu’s autoimmune

aorta

i

vasa vasorum adventitia ii

Langhan’s iii

fibrosis iv

Kawasaki’s Disease mucocutaneus lymph node syndrome subacute conjunctiva lymphadenopathy aneuryms conronary autopsy

pancreatic Hepatic mesenteric

34 لومړى فصل دويني او لمف رګونه

PAN panarteritis Kawasaki’s disease PAN

Buerger’s Disease( thromboangiitis Obliterans) (obliterans)

ischaemia

Etiopathogenesis

 thrombosis AECAs hypercoagulability HLA HLA  HLA-B5 HLA-A9

fibrous Mural thrombi

i mural thrombosis

35 لومړى فصل دويني او لمف رګونه

microabscesses thrombi

atherosclerosis

epithelioid ii Langhans’ gaint cells fibrosis

thrombus panarteritis Buerger’s disease microabscesses vasculitis

SLE ankylosing spondylitis Rheumatoid artheritis vasculitis Henoch-Schonlein pupura Rheumatic fever

Raynaud’s Phenomenon Raynaud’s Disease

Raynaud’s Disease (vasculitis) arterioles

36 لومړى فصل دويني او لمف رګونه

(cyanosis) Hyperaemia venostasis ischaimia

ischaemia autonomic

Raynaud’s phenomenon atherosclerosis Raynaud’s disease multiple myeloma Buerger’s SLE scleroderma RD ergot pulmonary hypertension RP RD fibroid necrosis

Aneurysms aneurysm

aneurysm thromboembolism thrombosis

aneurysm

37 لومړى فصل دويني او لمف رګونه

A

aneurysm : aneurysm

fibrous aneurysm

aneurysm B

Saccular aneurysm

spindl Fusiform aneurysm

Cylindrical aneurysm

aneurysm varicose serpentine

ciroid Racemose

C

Atherosclerotic aneurysm

tertiary Syphilitic aneurysms

dissecting haematoma Dissecting aneurysm

Mycotic aneurysms

circle Willis Berry aneurysms atherosclerotic aneurysms dissecting syphilitic

38 لومړى فصل دويني او لمف رګونه

aneurysm

Atherosclerotic Aneurysms atherosclerotic aneuryms

cylindrical Fusiform aneurysm Saccular iliac arteris

aneurysms

Pathogenesis degeneration media atherosclerotic lesion

mural thrombus Fusiform

adventitia aneurysm fibrous mural thrombus atheromatous plaques intima

39 لومړى فصل دويني او لمف رګونه

atherosclerotic aneurysms

aneurysm AA aneurysm

peritoneum aneurysm retroperitoneum

aneurysm Compression

mesenteric A. aneurysm collateral thrombosis thromboembolism ischaemia circulation aneurysm

Syphilitic aneurysms syphilitic aortitis arteritis tertiary aneurysm syphilitic aortitis

aortic valve syphilitic heart disease

Pathogenesis

40 لومړى فصل دويني او لمف رګونه

syphilitic aneurysms syphilitic aortitis vasa vasorum

ischaemic endartertis obliterans scar

ascending arch aneurysms 3-5 cm saccular valve Bovinum hypertrophy

fibrous adventitia scar mural thrombus spirochaetes aneurysm

effects

syphilitic aneurysm atherosclertic aneurysm

pleural cavity syphilitic aneurysm (rupture)

compression dyspnoea trachea hoarseness laryngeal nerve dysphagia

41 لومړى فصل دويني او لمف رګونه

aortic valve

Cystic medial necrosis Dissecting Aneurysms

dissecting haematoma Dissecting aneurysm (dissected)

–

Pathogenesis pathogenesis DA DA aorta

DA i dissection degeneration

Non-hypertensive cases ii

fibrillin autosomal Marfan’s syndrome a elastic fibrillin

Erdheim necrosis cystic medial necrosis b

coronary bypass catheterization c

d

42 لومړى فصل دويني او لمف رګونه

necrosis dissecting aneurysm vasa vasorum

aneurysm SA AA DA Dissecting Haematoma arch DA

dissection coronary dissection

intramural haematoma

DA aortic dissection DeBakey I

ascending DA Type-I

Ascending DA Type-II

Subclavian dissection 20 % Type-III

43 لومړى فصل دويني او لمف رګونه

Ascending DA C DA B (type-I) Dissecting aneurysm A aorta

Stanford Dissection

44 لومړى فصل دويني او لمف رګونه

Stanford II

II type-I (proximal dissection) Type-A

descending aorta ( Distal dissection) Type-B DeBakey type III

necrosis aneurysm

fibromuscular  

 fibrous 

Dissection aneurysm

retroperitoneum pericardium

coronaries MI

ischaemia Ischaemia spinal cord cerebral renal

45 لومړى فصل دويني او لمف رګونه

Fibromuscular dysplasia atherosclerotic renal artery medial fibroplasis adventitia

renal fibomuscular dysplasia

(Veins)

lamina adventitia media tunica intima vena iliac vavae

Varicosities

(oesophageal varices) (varicocele) sparmatic cord (Haemorrhoids)

46 لومړى فصل دويني او لمف رګونه

Varicose Veins varicose vein saphenous vein

Ethiopathogenesis

varicose vein

i

ii

intravascular thrombosis iliac iii

vi

v

vi

varicose

fibromuscular hypertrophy degeneration hyalinised mural thrombosis

47 لومړى فصل دويني او لمف رګونه

varicose veins cellulitis dermatitis stasis varicose ulcers

Thromboptlebitis Phlebothrombosis

phlebothrombosis thrombophlebitis

Ethiopathogenesis thrombophlebitis

thrombophlebitis phebothrombosis deep vein thrombosis ( DVT)

salpingitis [eritonitis appendicitis

mural thrombus

fibroblasts fibrosis

48 لومړى فصل دويني او لمف رګونه

thrombophlebitis phlebothrombosis

tenderness

pulmonary embolic septic thromboembolism embolization

Phlebothrombosis

phlebothrombosis

thrombophlebitis Migrans

trousseau’s syndrome thrombophlebitis thrombi

GIT breast thrombotic endocarditis

Phlegmasia alba dolens

iliofemoral iliofemoral

49 لومړى فصل دويني او لمف رګونه

Phlegmasia Cerulea Dolens

iliofemoral

Superior vena caval syndrome

SVS superior vena cava

tuberculous mediastinitis syphilitic aortic aneurysm

inferior vena Caval syndrome

IVS Inferior vena cava iliofemoral

(Lymphatics)

50 لومړى فصل دويني او لمف رګونه

Lymphangitis lymphangitis

β- Acute lymphangitis staphylococci haemolytic streptococci lymphadenitis

exudate

Chronic lymphangitis TB lymphangitis actinomycosis

fibrosis

lymphoedema Lymphoedema lymphoedema

51 لومړى فصل دويني او لمف رګونه

primary lymphoedema I

non- Milrory’s disease lymphoedema familial

lymphaodema familial Milroy’s disease i autosomal eyelids dominant

fibrosis

lymphoedema non-familial ii Milroy’s turner’s syndrome disease

Lymohoedema Praecox

lymphoedema

non-pitting

Secondary Lymphoedema II

lymphoedema

i

radical mastectomy ii

52 لومړى فصل دويني او لمف رګونه

iraradiation fibrosis iii

elephantiasis filariasis iv

ymphangitis v

collateral lymphoedema

scaring fibrosis

chyle chylothorax pleural cavity chyloperitoneum chyluria chylopericardium

hamartoma hamartomas

hamartomas

١-٥ جدول :د ويني او لمفاوي رګونو ټيومورونه او ټيومور ته ورته ليژنونه .

A. Benign Tumours and Hamartomas B. Intermediate Grade Tumours

1. Haemangioma Haemangioendothelioma

2. Lymphangioma C. Malignant Tumours

3. Glomus tumour (glomangioma) 1. Haemangiopericytoma

4. Arteriovenous malformations 2. Angiosarcoma

5. Bacillary angiomatosis 3. Kaposi’s sarcoma

53 لومړى فصل دويني او لمف رګونه

A

Haemangioma

Haemangioma

strawberry

haemangiomas

pericytes stroma

haemangioma stroma

54 لومړى فصل دويني او لمف رګونه

Cavernous Haemangioma

cavernous haemangiomas

stroma

cavernous haemangioma

Granuloma Pyogenicum haemangioma granulation granulation granuloma granuloma pyogenicum

haemangioma Lymphangioma granulation

55 لومړى فصل دويني او لمف رګونه

angiomas cystic hygroma cavernous

lymphangioma Capillary lymphangioma

lymphangioma

Cavernous lymphangioma

cystic hygroma

lymphangioma

Glomus Tumour (Glomangioma) glomus dermis arteriovenous shunts

56 لومړى فصل دويني او لمف رګونه

glomus

cystic cavernous lymphangioma

Glomus tumour

57 لومړى فصل دويني او لمف رګونه

peliosis hepatis

papule

epitheliod lobules

B

Haemangioendothelioma haemangiosarcoma haemangioma

haemangioblastoma

A Haemangioendothelioma

reticulin B

58 لومړى فصل دويني او لمف رګونه

C

Haemangiopericytoma pericytes pericytes

BM pericytes

Angiosarcoma haemangioendothelioma haemangiosarcoma

hepatic angiosarcomas radioactive arsenical pesticide polyvinyl chloride

well-differentiated

angiosarcoma Lymphangiosarcoma lymphedema

C B A angiosarcoma CD34 59 لومړى فصل دويني او لمف رګونه

Kaposi’s Sarcoma Kaposi HIV/ AIDS

KS

Kaposi Kaposi’s sarcoma

Kaposi’s Sarcoma

% Kaposi’s sarcoma homosexuals

transplant Kapos’s sarcoma immunosuppressive

Pathogenesis KS

HIV Epidemiological 

60 لومړى فصل دويني او لمف رګونه

HIV-1  bFF GM-CSF TNF-α IL-6

Kaposi’s sarcoma

Early patch stage  interstitial haemosiderin Late nodular stage  spindls

Kaposi’s sarcoma Late nodular

61 لومړى فصل دويني او لمف رګونه

Atherosclerosis (special issue): Arch Pathol Lab Med 1112, 1988. Berlinder JA, Watson AD: A role for oxidised phospholipids in atherosclerosis. New Engl J Med 353:9, 2005. Gimbrone MA Jr et al: Endothelial dysfunction, haemodynamic forces and atherogenesis. Ann N Y Acad Sci 902: 230, 2000. Goldschmidt-Clermont PJ et al: Atherosclerosis 2005: Recent discoveries and novel hypotheses. Circulation 112:3348, 2005. Grundy SM, Theroux P: Pathophysiology of coronary artery disease. Circulation 111:3481, 2005. Parmus DV: The arteritides. Histopathology 25: 1, 1995. Rose R: The pathogenesis of atherosclerosis: a perspective for 1990s. Nature 362: 801, 1993. Rose R: The pathogenesis of atherosclerosis—an inflammatory disease. N Engl J Med 340: 115, 1999. Silver MD: Cardiovascular Pathology, 2nd ed. London, Churchill Livingstone, 1991.

62