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Biomedical subjects

R Dische

Publications and source records attributed to R Dische.

At least 19 recordsLinked to original sources
PubMed1994

Acute biological response to laser balloon angioplasty in the atherosclerotic rabbit.

Laser balloon angioplasty with Nd:YAG energy has been proposed as a method to seal intimal dissection and prevent elastic recoil after balloon angioplasty. To better define the vessel response to laser balloon angioplasty, its effects on luminal diameter, Indium-111 labelled platelet deposition, and histology were studied in 10 atherosclerotic rabbits. Balloon angioplasty was performed in both iliac arteries and was followed by laser balloon angioplasty in only one iliac artery. The nonlased artery served as a control. Single (15-35 W for 20 sec) or repetitive laser pulses (12-25 W for 20 sec x 3) were used. Platelet deposition was quantified 2 hr after the intervention. Lumen diameter (mm) increased following balloon angioplasty from 0.99 +/- 0.47 (mean +/- SD) to 1.92 +/- 0.43 and 0.89 +/- 0.46 to 1.99 +/- 0.57 in the balloon and laser-treated arteries, respectively (P < 0.001 for both groups for comparisons to baseline, P = NS for between groups comparison). Laser balloon angioplasty resulted in a further increase in luminal diameter to 2.42 +/- 0.53 (P < 0.02) when compared to the post balloon angioplasty diameter. Platelet deposition (10(6)/cm vessel) was higher following laser balloon angioplasty (26.9, 10.2-189; median range) than after balloon angioplasty (10.6, 3.4-30), P < 0.001. Histologic evidence of laser "sealing" was present in only one artery. Thus although laser balloon angioplasty results in an improved lumen diameter, it is accompanied by increased platelet deposition. In the atherosclerotic rabbit model, abolition of vascular recoil rather than "sealing" seems to be the most important advantage of laser balloon angioplasty over conventional balloon angioplasty.

Angiography↗
PubMed1993

Prenatal detection of monosomy 21 mosaicism.

We report a case of chromosomal mosaicism for monosomy 21 revealed in amniotic fluid cell culture. Ultrasound examination at 19 weeks' gestation showed in utero growth retardation and a complex cardiac malformation. A repeated amniocentesis confirmed the presence of monosomy 21 mosaicism. In view of the sonographically detected fetal abnormalities, termination of pregnancy was elected.

Abnormalities, Multiple↗
PubMed1992

Zidovudine pharmacokinetics during pregnancy.

As the indications for zidovudine (ZDV) treatment in human immunodeficiency virus-infected individuals expand, we anticipate an increased use of this drug during pregnancy. We report pharmacokinetics data from a patient studied both in the third trimester and intrapartum. ZDV peak-plasma levels and serum half-lives were comparable to nonpregnant adults. High concentrations of ZDV and its glucuronide metabolite were found in umbilical cord blood and in amniotic fluid.

Adult↗
PubMed1991

Salmonella typhimurium appendicitis.

A child with signs and symptoms of acute gastroenteritis developed localization of her pain to the right lower quadrant. A clinical diagnosis of appendicitis was made and an inflamed appendix was found at surgery. The postoperative period was marked by high spiking fevers and profuse nonbloody diarrhea. Cultures of the appendix and the stool revealed Salmonella typhimurium. Nontyphoidal Salmonella organisms are a rare cause of acute suppurative appendicitis. Intraoperative cultures of the appendix and peritoneal fluid as well as postoperative cultures of the diarrheal fluid were crucial in elucidating the cause of this patient's unusual course.

Adolescent↗
PubMed1991

Coronary laser thermal angioplasty in the swine: reduced complications with shorter laser delivery time.

Although laser thermal angioplasty (LTA) with a laser heated metal probe has been tolerated in diseased human coronary arteries, definition of a safety threshold is lacking. Determination of safer operation parameters for coronary LTA using a new "over the wire" 1.3-mm laser probe catheter was attempted in seven normal pigs in which platelets were labeled with indium-111. Argon laser power of 10 watts was used for 1, 2, 3, and 5 seconds. Macroscopic findings, platelet deposition and histologic changes were compared between the laser treated coronary segments and controls, the nonheated laser probe, and the wire alone segments. After 1-second LTA, there was no vessel perforation or occlusive thrombi and only infrequent nonocclusive thrombi; platelet deposition was minimal; and histologic alterations rare and superficial. These findings were comparable to controls, the nonheated laser probe, and the wire alone segments. In contrast, vessels treated for 2, 3, and 5 seconds had more frequent perforation, and occlusive and nonocclusive thrombi that was accompanied by platelet deposition significantly greater than vessels treated with LTA for 1 second. A deep histologic injury was present in most of these segments. Additionally, the safety of laser delivery of 1 second repeated for five times was tested in two additional pigs. On macroscopic and histologic analysis the incidence of vessel perforation, occlusive and nonocclusive thrombi appeared slightly less when compared to the 2-, 3-, and 5-second LTA groups, and more than the 1-second LTA group.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Laser↗
PubMed1990

Brush cells in the human fetal trachea.

We performed a morphologic examination of human fetal lung tissue, using scanning and transmission electron microscopy, in order to establish the presence of brush cells in extrapulmonary and intrapulmonary airways, and developing acinar epithelium. Brush cells, characterized by a border of regular straight microvilli containing a filamentous core, were observed within the tracheal epithelium of a 19-20 week gestational age fetus. These cells constituted 0.5% of the total epithelial cell population. Brush cells were not seen within the bronchial, bronchiolar or developing acinar epithelium. Our study shows that brush cells occur infrequently but normally in the developing tracheal epithelium of the second trimester fetus.

Fetus↗
PubMed1989

Fixed subaortic stenosis: an acquired secondary obstruction? A twenty-seven year experience with 168 patients.

168 patients with fixed subaortic stenosis (fixed SAS) were studied between 1959 and 1987. For assessment of the long term prognosis, the hemodynamic results of the catheterizations were compared with the angiograms. The obstructive lesions were divided into 4 basic types: 1) thin fibrous ridge subjacent to the valve, 2) funnel shaped, 3) irregular fibromuscular, 4) tunnel shaped. Operative reports were used in all and 2D-echocardiography in so far 67 patients to distinguish between pure fibrous and fibromuscular types. The average age at initial diagnosis was 7.8 years (5 weeks to 23 years). Only 4 of 168 patients had significant obstruction in early infancy. All 4 had Shone's complex. Progression of the disease was documented in 30 of 34 patients (80%) by serial catheterization; regrowth was noted in only 4. In 10 patients fixed SAS was not detected by the 1st catheterization but was present subsequently. 22 patients had additional dynamic obstruction, proved in 19 during the second decade of life. Among 132 operated patients, there were 11 early (8%) and 3 late (2%) deaths. Twenty underwent reoperation for residual obstruction. The mean postoperative gradient across the left ventricular (LV) outflow tract of 89 patients recatheterized after conventional operation was as follows: Type (1) 16 +/- 17, (2) 19 +/- 16, (3) 51 +/- 41, and type (4) 79 +/- 24 mmHg. Complete assessment confirmed that only 33% of the operations led to satisfactory hemodynamic results. Our data show that the pure fibrous forms have a better prognosis than the fibromuscular forms and are better differentiated by 2D-echocardiography than by angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1989

High density lipoprotein plasma fractions inhibit aortic fatty streaks in cholesterol-fed rabbits.

The effects of in vivo administration of high density lipoprotein-very high density lipoprotein (HDL-VHDL) on the development of aortic fatty streaks were studied in cholesterol-fed rabbits. The rabbits received a 0.5% cholesterol-rich diet for 8 weeks. During this period, the HDL-VHDL group was intravenously administered with 50 mg/week of homologous HDL-VHDL protein; the control group received normal saline (0.9% NaCl). HDL-VHDL fraction was obtained at density range 1.063 to 1.25 gm/ml by ultracentrifugation of normal rabbit plasma. Along the study, plasma lipid levels followed a similar profile in both groups. At the completion of the study, atherosclerotic-like lipid-rich lesions covered 37.9 +/- 6% (X +/- SEM) of the intimal aortic surface in the control group, and 14.9 +/- 2.1% in the treated group (p less than 0.001). The values of total and free cholesterol, esterified cholesterol, and phospholipids deposited within vessel wall were significantly lower in the aortas of the HDL-VHDL treated group than those in the control group. Cholesterol accumulation in the livers was also significantly lower (p less than 0.01) in the treated group than in the control. We concluded that administration of homologous HDL-VHDL lipoprotein fraction to cholesterol-fed rabbits, dramatically inhibited the extent of aortic fatty streaks and lowered lipid deposition in the arterial wall and liver without modification of the plasma lipid levels.

Animals↗
PubMed1988

Alveolar brush cells in an infant with desquamative interstitial pneumonitis.

A full-term infant developed bilateral pneumothoraces and respiratory distress shortly after birth, despite initially good Apgar scores. Persistent tachypnea, hypoxemia, and a chest X-ray remarkable for diffuse alveolar and interstitial infiltrates prompted a lung biopsy at 4 months of age. The biopsy revealed desquamative interstitial pneumonitis with the unique demonstration by electron microscopy of numerous alveolar brush cells. Respiratory brush cells occur normally in the trachea and bronchi of humans and mammals. Although identical cells have been noted in the alveoli of rats, they have never been reported in the alveoli of humans. We present the first electron microscopical demonstration of the alveolar brush cell in humans.

Basement Membrane↗
PubMed1988

Subdiaphragmatic bronchogenic cyst with communication to the stomach: a case report.

A case of an infradiaphragmatic bronchogenic cyst in an adult patient presenting with nausea, vomiting, and epigastric discomfort is reported. An upper gastrointestinal series showed a multiloculated cyst communicating with the stomach via a patent fistulous tract. At laparotomy the cyst was found to be connected to and communicating with the posterolateral portion of the stomach. The cyst was completely below the diaphragm and received its blood supply from a branch of the abdominal aorta. Histologically, the cyst was composed of smooth muscle, respiratory epithelium, cartilage, and submucous glands. A review of the literature reveals that this case of bronchogenic cyst was unique in that it was located entirely beneath the diaphragm, was not associated with a diaphragmatic hernia or other congenital anomaly, and maintained a patent communication with a portion of the gastrointestinal tract, ie, the stomach, reminiscent of its embryological development.

Bronchogenic Cyst↗
PubMed1988

Fulminant herpes simplex hepatitis in a patient with ulcerative colitis.

A 16 year old girl with ulcerative colitis developed hepatitis with a high fever, leukopenia and a marked rise in serum transaminases without jaundice. There were no skin, oral, or genital lesions. Liver biopsy was precluded by abnormalities in coagulation. Postmortem examination of the liver by light and electron microscopy, culture, immunoperoxidase and immunofluorescent staining confirmed the diagnosis of hepatitis due to type 1 herpes simplex virus. Despite the rarity, this viral aetiology should be included in the differential diagnosis of all patients with severe hepatitis. The absence of mucocutaneous lesions should not exclude the diagnosis, especially when other clinical features are compatible.

Adolescent↗
PubMed1986

Esophageal cryptosporidiosis in a child with acquired immune deficiency syndrome.

Oral Candida and Candida esophagitis are common findings in patients with the acquired immune deficiency syndrome. The intestinal protozoan, Cryptosporidium, is known to cause gastrointestinal symptoms in these patients. We report a 2-yr-old child with acquired immune deficiency syndrome, who had oral candidiasis, dysphagia, and vomiting. Upper gastrointestinal endoscopy and esophageal biopsy led to a diagnosis of esophageal cryptosporidiosis. We recommend upper gastrointestinal endoscopy as a diagnostic tool in selected patients with acquired immune deficiency syndrome. This is in contradistinction to a previous report that concludes that endoscopy is not necessary in this setting.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Percutaneous intracardiac direct-current shocks in dogs: arrhythmogenic potential and pathological changes.

In 12 dogs, a total of 65 direct-current (DC) shocks of 100-300 J were delivered through a standard USCI6F tripolar electrode catheter to selected sites in the heart. Severe arrhythmias were more frequent after electric shocks of high energy to the ventricles and AV-nodal or His-bundle region than after comparable shocks to the left or right atria. There was a direct relationship between the strength of the electric shocks, and the extent and severity of the injury. Application of 300 J shocks led to massive necrosis and damage to all components of the myocardium including the walls of small blood vessels. However, perforation of the atrial and ventricular walls or septum did not occur in any of the animals (mean follow-up period 97 days: range 8 to 167 days). Percutaneous DC shocks up to 250 J proved to be a safe technique for closed-chest ablation of conduction tissue in dogs. These might be of value for patients with arrhythmias requiring electrical ablation of accessory pathways or foci situated in various sites in the heart.

Animals↗
PubMed1979

Congenital absence of the pulmonary valve associated with imperforate membrane type of tricuspid atresia, right ventricular tensor apparatus and intact ventricular septum: a curious developmental complex.

We have presented the unique clinical and morphological features of 3 patients with an imperforate tricuspid valve and right ventricular tensor apparatus. Thus, despite valve tissue and apparatus, there was not a perforate atrioventricular connection. This most uncommon type of tricuspid atresia' was associated in all 3 cases with a congenitally absent pulmonary valve, an underdeveloped right ventricle, and a curious distortion of the ventricular septum. Indeed, 2 of these patients demonstrated severe disproportionate ventricular septal thickening, although histopathologic examination did not substantiate those features usually associated with a hypertrophic cardiomyopathy. Rather, microscopic examination revealed a sinusoidal malformation consisting of normal myocardial cells separated by branching ethothelial-lined channels which communicated with the right ventricular cavity. In addition, gross examination of these 3 specimens revealed an abnormally persistent right venous valve in 2, which subdivided the right atrium. Finally, these cases provide further evidence that the term 'tricuspid atresia' oversimplifies the observed morphological features.

Abnormalities, Multiple↗
PubMed1978

The straddling mitral valve: morphological observations and clinical implications.

The morphological features of 23 patients with straddling or overriding mitral valve are presented. Levocardia was present in 20 of 23; visceroatrial situs solitisu in 20 of 23, with 3 patients, 2 with asplenia and 1 with polysplenia, having visceral heterotaxia. A concordant D-ventricular loop was present in the 20 patients with visceroatrial situs solitus. Six of these had double outlet right ventricle; 2 had asplenia syndrome; 1 had D-transposition of the great arteries, ventricular defect and pulmonary atresia; 1 with tricuspid atresia and double outlet-outlet chamber; 1 with polysplenia syndrome; and 12 had endocardial cushion defect with marked underdevelopment of the left ventricle, and normally related great arteries. Left ventricular size was related to the amount of mitral valve (or left-sided component of a common atrioventricular valve) connected to it. In those patients in whom little effective mitral orifice was connected to the left ventricle, the left ventricle was diminutive. Endocardial fibroelastosis of the left ventricle was noted in only a single patient. Six of the 7 patients with double outlet right ventricle (including one with double outlet bulbus) had subpulmonary obstruction, and in one of these, this was related in part to the straddling mitral valve. In 1 patient with double outlet right ventricle, there was a double orifice mitral valve, and it was the accessory mitral orifice that straddled. The diagnosis of overriding mitral valve should be suspected in any patient with significant conotruncal anomalies and underdeveloped left ventricle, especially the patient with double outlet right ventricle, and in the patient with endocardial cushion defect, hypoplasia of the left ventricle, and obstructive anomalies of the aortic arch. In certain patients, selective left atriography, left ventriculography, and single and two dimensional echocardiography may be diagnostic of this condition.

Abnormalities, Multiple↗
PubMed1977

Ventricular septal defect in interruption of aortic arch.

A necroscopy study of 34 patients with interruption of the aortic arch was carried out to characterize more fully the ventricular septal defect and the anatomic basis of subaortic obstruction. In 21 patients (61.8 percent) the site of interruption was between the left common carotid artery and the left subclavian artery; in 13 (38.2 percent) it was distal to the left subclavian artery; no case of interruption just distal to the innominate artery was found. A ventricular septal defect was present in all but two patients, both with large aortopulmonary fenestrations. All patients had visceroatrial situs solitus and D-ventricular loop. The great arteries were normally related in 33 patients and D-transposition was found in one patient. Twenty-one patients had a ventricular septal defect involving the conal septum. Conoventricular malalignment resulted in a typical subpulmonary ventricular defect. The malignant was characteristically in a leftward direction allowing for potential muscular narrowing of the left ventricular outflow tract. In some patients, the conal ventricular septal defect was characterized by a deficiency of a the conal septum without malalignment. In 4 of 21 patients with a ventricular septal defect involving the conal septum, the defect was immediately adjacent to the pulmonary.value. Typical infracristal membranous ventricular defects five patients), cushion defects (3 patients) and muscular defects (3 patients), were also found. The potential for subaortic narrowing was present in some of these patients as well. No relation between position of ventricular septal defect and type of arch interruption could be discerned. The presence or absence of subaortic obstruction was not predictive of a specific type of interruption. Similarly, although deformity of the aortic valve was not uncommon in this series, it was not associated with any specific type of interruption.

Aorta↗