Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over the cornea, over a joint surface (as seen in rheumatoid arthritis), or on a prosthetic heart valve. Pannus may grow in a tumor-like fashion, as in joints where it may erode articular cartilage and bone. In common usage, the term pannus is often used to refer to a panniculus (a hanging flap of tissue). Pannus in rheumatoid arthritis
The term "pannus" is derived from the Latin for "tablecloth". Inflammation and exuberant proliferation of the synovium leads to formation of pannus and destruction of cartilage, bone, tendons, ligaments, and blood vessels. Basically, the hypertrophied synovium is called pannus. Pannus tissue is composed of aggressive macrophage- and fibroblast-like mesenchymal cells, macrophage-like cells and other inflammatory cells that release collagenolytic enzymes. In people suffering from rheumatoid arthritis, pannus tissue eventually forms in the joint affected by the disease, causing loss of bone and cartilage. From Autoimmunity and Disease by Harley Y. Tse and Michail K. Shaw:Chronic stages of the disease typically coincide with the formation of a structure known as a pannus. A pannus is a membrane of granulation tissue composed of mesenchyme- and bone marrow-derived cells. Formation of the pannus stimulates the release of IL-1, platelet-derived growth factor, prostaglandins, and substance P by macrophages, which ultimately cause cartilage destruction and bone erosion. Pannus in ophthalmology
In ophthalmology, pannus refers to the growth of blood vessels into the peripheral cornea. In normal individuals, the cornea is avascular.
in several papers the involvement of the cranial nerve nuclei and central gray matter on MRI, is very specific to WE in the appropriate clinical setting. Non-recovery upon supplementation with thiamine is inconclusive.The sensitivity of MR was 53% and the specificity was 93%. The reversible cytotoxic edema was considered the most characteristic lesion of WE. The location of the lesions were more frequently atypical among people who drank appropriate amounts of alcohol, while typical contrast enhancement in the thalamus and the mammillary bodies was observed frequently associated with alcohol misuse. These abnormalities may include:
Dorsomedial thalami, periaqueductal gray matter, mamillary bodies, tectal plate and brainstem nuclei are commonly affected. Involvement is always bilateral and symmetric. Value of DWI in the diagnosis of WE is minimal. Axial FLAIR MRI images represent the best diagnostic MRI sequence. Contrast material may highlight involvement of the mamillary bodies.There appears to be very little value for CT scans.Thiamine can be measured using an erythrocyte transketolase activity assay, or by activation by measurement of in vitro thiamine diphosphate levels. Normal thiamine levels do not necessarily rule out the presence of WE, as this may be a patient with difficulties in intracellular transport. Prevention
There are hospital protocols for prevention, supplementing with thiamine in the presence of: history of alcohol misuse or related seizures, requirement for IV glucose, signs of malnutrition, poor diet, recent diarrhea or vomiting, peripheral neuropathy, intercurrent illness, delirium tremens or treatment for DTs, and others.