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PubMed1983

[Anatomopathological aspects of arterial angiodysplasias].

Arterial angiodysplasias constitute an ill-defined entity comprising conditions of apparently very variable natures. Apart from arterial fibrodysplasia, the clinical features of which, if not the etiology, are well established, there exists a number of different arterial abnormalities, stenotic or aneurysmal, the significance of which remains unclear (dolicho-arteries, the Moya-Moya syndrome, etc.). However, the role of genetic factors and metabolic abnormalities in these conditions is uncontestable. They demonstrate both the authenticity of this group of diseases and the importance of metabolic disorders of the interstitial tissues in the majority of these vascular abnormalities.

Arterial Occlusive Diseases↗
PubMed1998

Unusual coronary artery ectasia and stenosis in a patient with systemic lupus erythematosus and acute myocardial infarction.

Acute myocardial infarction is an important and sometimes fatal complication of systemic lupus erythematosus (SLE). We describe a case of acute myocardial infarction in a 23-year-old woman with SLE. Angiography revealed coronary ectasia in the left main and proximal circumflex coronary arteries, as well as a stenotic lesion in the left anterior descending artery. The possible pathophysiology is discussed.

Adult↗
PubMed1997

The relationship between disturbed transit and dilated bowel, and manometric findings of dilated bowel in patients with duodenal atresia and stenosis.

To determine whether dilated bowel proximal to obstruction associated with duodenal atresia and stenosis is related to feeding problems after a surgical correction of obstruction, the authors reviewed retrospectively the degree of bowel dilatation and disturbed transit as well as other clinical features in 18 duodenal atresia and 12 duodenal stenosis patients. A multivariate analysis was conducted to determine the possible correlation among them. The authors also evaluated the physiological function of the dilated bowel in duodenal atresia and stenosis patients (n = 8) by manometry of dilated bowel. The results were as follows. (1) In multivariate analysis, using the degree of disturbed transit as a dependent variable and using other clinical features as independent variables, the presence of postoperative complication and the existence of bowel dilatation 2 weeks after the operation were risk factors for disturbed transit. (2) One or two episodes of phase 3 were found in six of eight measured patients during the recorded period. The most distinctive manometric finding was the low contraction amplitude of both phase 2 and phase 3. These results indicate that dilated bowel was related to disturbed transit during the postoperative period, and that the low contraction amplitude of the dilated bowel was the main pathophysiological feature. The tapering or plication of dilated bowel might be indicated in patients with a markedly dilated bowel.

Constriction, Pathologic↗
PubMed2000

Pathologic changes in the common bile duct of an experimental model with pancreaticobiliary maljunction without biliary dilatation.

Pancreaticobiliary maljunction (PBM), a congenital anomaly, causes regurgitation of pancreatic juice into the biliary tract, where it exerts a hazardous influence. However, changes in the common bile duct (CBD) remain obscure due to a lack of suitable experimental models. Using cats, we have developed an experimental model of PBM without bile-duct dilatation that allows the pure effects of PBM to be studied. Histologic and cellular kinetic changes in the CBD were analyzed in 6 controls and 9 experimental animals that survived for more than 6 months. CBD sections were stained with hematoxylin and eosin and a monoclonal antibody to the proliferating cell nuclear antigen (PCNA). Invaginations of the bile-duct epithelium or parietal sacculi increased, and peribiliary glands were well-developed. PCNA-positive cells significantly increased in the CBD, especially in the parietal sacculi and glands. It is concluded that PBM increases the cell cycle in CBD epithelium and subsequently developed peribiliary glands. These developed glands may be associated with the formation of protein plugs, often seen in patients with PBM.

Animals↗
PubMed1989

Right ventricular concentric hypertrophy and left ventricular dilatation by ductal constriction in fetal rats.

Fetal cardiac changes due to ductal constriction by maternal ingestion of nonsteroidal anti-inflammatory drugs were studied morphologically in near-term rats as an animal model, and results were compared with values of control 1 (C1, twenty-first day) and control 2 (C2, twenty-second day). The fetal ductus was constricted (-70%) (p less than 0.05) by maternal administration of 10 mg/kg indomethacin. Dilatation of the right ventricle and evidence of congestive heart failure including increased pericardial effusion (+200%) (p less than 0.05) and an increase in water content in the abdominal wall were present at 1, 4, and 8 hours after drug administration. At 24 hours after drug administration, concentric right ventricular hypertrophy was shown by a diminished right ventricular cavity (-36% vs. C2) (p less than 0.05), increased right ventricular wall thickness (+70% vs. C2) (p less than 0.05), and increased right ventricular mass (+31% vs. C1) (p less than 0.05). Left ventricular dilatation was indicated by an increased cavity volume (+87% vs. C2) (p less than 0.05) and increased muscle mass (+29% vs. C1 [p less than 0.05] or +9% vs. C2 [p greater than 0.05]). Both the wet and dry weights of the ventricles were increased. In conclusion, fetal ductal constriction caused right ventricular hypertrophy, diminished right ventricular cavity, and left ventricular dilatation and hypertrophy at 24 hours after drug administration in rats after initial congestive failure.

Animals↗
PubMed1996

[A surgical treatment for congenital bile duct dilatation with intrahepatic calculi].

A total of 141 cases of congenital bile duct dilatation (excluding those with cancer) were treated at the Department of gastroenterological Surgery of Tokyo Women's Medical College in the past 27 years. The lesion was morphologically classified as Todani type I in 93 patients, type II in 1, type III in 2, type IV-A in 42, and type V or multiple dilatation of the peripheral bile ducts in 3. Cholangiectasis was accompanied by intrahepatic stones in 1 type I patient, 18 type IVA patients, and 2 type V patients. None of type II and type III patients had intrahepatic stones. Of the 21 patients with intrahepatic stones, only 2 (both type IVA) had no history of surgery. In these patients, a common bile duct stone was considered to be the cause of intrahepatic stone formation. Nineteen patients had undergone surgery, comprising cholecystectomy in 2 type V patients, bypass surgery in 5 type IVA patients, and excision of the extrahepatic bile ducts with biliary tract reconstruction in 1 type I and 11 type IVA patients. Of the 12 patients who underwent excision of the extrahepatic bile ducts with biliary tract reconstruction, intrahepatic stone formation was considered to be ascribable to stenosis at the choledocho-jejunostomy site in 3 and to insufficient excision of the extrahepatic bile ducts in 4. Therefore, when performing excision of the extrahepatic bile ducts and biliary tract reconstruction in patients with congenital cholangiectasis, we now take care to achieve thorough excision of the extrahepatic bile ducts and not leave any stenotic region in the porta hepatis. For choledocho-jejunostomy, we join the left and right hepatic ducts as necessary or incise the hepatic duct axialy so as to make the anastomotic orifice large enough. In the 5 remaining patients, intrahepatic stone formation was considered to be due to persistence of intrahepatic bile duct dilatation or stenosis, although there were no technical problem with excision of the extrahepatic ducts and biliary tract reconstruction. In 4 of the 5 patients, partial hepatectomy was performed to remove the intrahepatic stones, but new stones formed again in 2 of them. When intrahepatic bile duct dilatation or stenosis is localized at the periphery of lobule, hepatectomy is indicated. However, when intrahepatic bile duct dilatation or stenosis is extensive in both lobes, no curative technique is available and bile duct dilatation or stenosis wil persist in the liver after surgery. In such cases, the disease may become further complicated by cholangitis and intrahepatic stone formation, making it very difficult to control. Therefore, patients with extensive intrahepatic bile duct dilatation or stenosis should be monitored very carefully even after surgery.

Bile Ducts↗
PubMed1982

Assessment of heart neurons in dilated (congestive) cardiomyopathy.

Pathological studies in seven hearts from patients with dilated cardiomyopathy have shown that the number of neurons is significantly reduced in these compared with five hearts from normal subjects. The number of ganglion cells was counted in a strip of right atrial wall between the venae cavae and sectioned serially. The mechanism responsible for the neuronal depopulation in this type of cardiomyopathy could not be determined. Previous viral infection may be causally related. Three hearts of patients suffering from chronic Chagas's heart disease were also studied. Depopulation of neurons was most severe in the hearts with Chagas's disease and less severe in those with dilated cardiomyopathy, though neurons were still significantly reduced in number in the latter compared with normal controls. Despite the lack of a specific, definite cause for the depopulation of neurons, physiological evidence of parasympathetic impairment in patients with dilated cardiomyopathy is in agreement with the pathological findings. It is suggested that on the basis of our findings neuronal depopulation in some patients with dilated cardiomyopathy may be of aetiological significance.

Adult↗
PubMed2000

Late onset X-linked hydrocephalus with normal cerebrospinal fluid pressure.

A family with X-linked hydrocephalus with normal cerebrospinal fluid (CSF) pressure and in which three brothers and a grandson of case 1, a proband, were affected is reported. The symptoms at onset were epileptic attacks that started in adulthood in the three brothers and at the age of 6 years in the grandson. In the three brothers, from 10 to 27 years after the onset of epileptic episodes, disorganization of intelligence and psychiatric deterioration were gradually noticed by their families. At the same time, they showed occasional urinary incontinence. Brain computed tomography (CT) scans revealed dilatation of the ventricular systems. Based on the results of the measurement of CSF pressure and radioactive-iodinated human serum albumin (RISA)-cysternography, two of the brothers were diagnosed as having normal pressure hydrocephalus (NPH), and they were treated neurosurgically. However, no obvious improvement in clinical symptoms was observed. Although the grandson had shown normal psychomotor development during his early childhood, temporal epilepsy and temper tantrums started at the age of 6 years. Computed tomography-scanning revealed dilatation of the ventricular system similar to the other three cases at the age of 8 years. With the diagnosis of NPH, the patient underwent a shunt operation, which resulted in no obvious effects. As it is reasonable to surmise that the pathological gene would have been transferred via the daughter of the proband to the grandson, it is suggested that the inheritance manner might be X-linked recessive. The cases presented here are different from the cases of hydrocephalus due to stenosis of the aqueduct Sylvius (HSAS) and other types of X-linked hydrocephalus reported previously in terms of the age of onset, course, symptoms, and CT findings. Thus, it is suggested that the present cases might be a new type of X-linked hydrocephalus.

Adolescent↗
PubMedDate not supplied

[Characteristics of microcirculatory changes in various forms of rheumatoid arthritis in children].

Using the method of biomicroscopy of bulbar conjunctiva with application of vessel gaging the authors made observation of 125 patients: 110--with RA and 15--with reactive arthritis. Marked vascular and intravascular changes in combination with dilatation of the capacitive vessels and narrowing of the resistive ones in vasculo-visceral form of RA correlated with the increase of immunological indices of the blood. In patients with vascular form of RA less marked changes of the vessels in dilatation of the capacitive part correlated with immunological indices of the synovial fluid.

Adolescent↗
PubMed1996

Coronary recanalization by elective angioplasty prevents ventricular dilation after anterior myocardial infarction.

OBJECTIVES: In a prospective study we evaluated whether late recanalization of the left anterior descending coronary artery (LAD) affects ventricular volume and function after anterior myocardial infarction. BACKGROUND: Persistent coronary occlusion after anterior myocardial infarction leads to ventricular dilation and heart failure. METHODS: We studied 73 consecutive patients with acute anterior myocardial infarction as a first cardiac event; all had an isolated lesion or occlusion of the proximal LAD. Six patients died before hospital discharge. The 67 survivors were classified into two groups: group I (patent LAD and good distal flow, n = 40) and group II (LAD occlusion or subocclusion, n = 27). The 20 patients in group I who had significant residual stenosis and all patients in group II underwent elective percutaneous transluminal coronary angioplasty (PTCA) within 18 days of myocardial infarction. The procedure was successful in 17 patients in group I (group IB) and in 16 patients in group II (group IIA): in the remaining 11 patients of group II, patency could not be reestablished (group IIB). Left ventricular volumes, ejection fraction and a dysfunction score were measured by echocardiography on admission, before PTCA, at discharge and after 3 and 6 months. RESULTS: Although cumulative ST segment elevation was similar in groups I and II, ejection fraction and dysfunction score were significantly worse in group II. However, ventricular function and volumes progressively improved in group IIA, whereas group IIB exhibited progressive deterioration of function (dysfunction score [mean +/- SD] increased from 21 +/- 6 to 25 +/- 8, p < 0.05; ejection fraction decreased from 43 +/- 10% to 37 +/- 11%, p < 0.05); and end-systolic volume increased from 34 +/- 10 to 72 +/- 28 ml/m2, p < 0.05). Patients in group IIB also had worse effort tolerance, higher heart rate at rest, lower blood pressure and significantly greater prevalence of chronic heart failure. CONCLUSIONS: Delayed PTCA of an occluded LAD can frequently restore vessel patency. Success appears to be associated with better ventricular function and a lack of chronic dilation. Large randomized studies are warranted to evaluate the effect of delayed PTCA on late mortality.

Adult↗
PubMed1999

Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis.

PURPOSE: To assess the usefulness of magnetic resonance (MR) cholangiopancreatography (MRCP) in the evaluation of disease in patients with acute or chronic pancreatitis. MATERIALS AND METHODS: MR imaging was performed at 1.5 T in 39 patients with chronic (n = 30) or acute (n = 9) pancreatitis. The patients underwent a pancreas MR imaging protocol that included an MRCP sequence. Comparison was made with findings at endoscopic retrograde cholangiopancreatography (ERCP), performed within 30 days. Three blinded readers used a scoring system to evaluate nine segments of the pancreatic and biliary ducts as depicted on the ERCP and MRCP images. MRCP image quality was also evaluated. RESULTS: Of 196 segments analyzed, 17 were not seen at MRCP (sensitivity, 91%). Of the segments visualized at MRCP, 14 were incorrectly characterized (accuracy, 92%). At MRCP, segments not detected or mischaracterized were either normal, slightly dilated, or narrowed. At ERCP, 42 segments in 19 patients were not visualized. MRCP findings were considered useful in all those cases. MRCP image quality was not interpretable in two cases due to artifacts. CONCLUSION: Very good correlation between ERCP and MRCP findings was demonstrated. Both modalities failed to depict pathologic conditions depicted by the alternative method. MRCP may obviate ERCP, particularly in patients who cannot undergo ERCP or in whom ERCP has been unsuccessful.

Acute Disease↗
PubMed1980

Estrogen-induced zonal changes in rat liver sinusoids.

Estrogen-containing oral contraceptives have been associated with changes in hepatic sinusoids in women. This association has not been studied systematically. To define, quantitate, and locate the estrogen-induced changes within the zones of the hepatic acinus. a morphometric analysis of sinusoids was performed in rat liver. Female rats received oral ethynyl estradiol, dissolved in corn oil, in doses of 0.125 mg/100 g body wt per day for either 2 or 6 wk. Control groups received corn oil in volumes equal to the ethynyl estradiol group or were untreated. After 2 or 6 wk, livers were fixed by perfusion with glutaraldehyde, and 5-microns sections were prepared and analyzed in an automatic image analyzer (Quantimet 720). The ratio of the volume fraction of the sinusoids in zone 1 to that in zone 3 was 2.04 +/- 0.15 (SE) after 2 wk of ethynyl estradiol administration, as compared with 0.87 +/- 0.5 (SE) in rats given corn oil and 0.76 +/- 0.3 (SE) in untreated controls. The differences between the two control groups and the ethynyl estradiol group were significant (P < 0.005). This greater zone 1/zone 3 ratio after ethynyl estradiol was due both to an increased volume fraction of sinusoids in zone 1 as well as to a decreased volume fraction of sinusoids in acinar zone 3, as compared with controls (P < 0.005). The surface to volume ratio of sinusoids, one of the parameters determining the probability of solute-sinusoidal wall interaction, was smaller in zone 1 (P < 0.005) and larger in zone 3 (P < 0.005) in animals treated with ethynyl estradiol than in controls. After 6 wk of ethynyl estradiol administration, the changes in volume fraction persisted. These results indicated that ethynyl estradiol, a synthetic estrogen contained in many oral contraceptives, induced selective zonal changes in rat liver sinusoids. These alterations resulted in the persistent dilatation of sinusoids of acinar zone 1, the acinar inlet, and in the sustained constriction of sinusoids of zone 3, the acinar outlet.

Animals↗
PubMed1993

Does the Whitaker test add to antegrade pyelography in the investigation of collecting system dilatation in renal allografts?

Significant pelvicalyceal dilatation in renal allografts is currently investigated by antegrade pyelography. However, the clinical significance of a radiologically demonstrated narrowing of the ureter is unclear. Over a 21-month period 26 of 155 renal allografts with pelvicalyceal dilatation were investigated by antegrade pyelography. In eight allografts no ureteric stenosis could be identified. Two grafts were shown to have ureteric necrosis and required surgical intervention and 16 of the other grafts appeared to have a ureteric stenosis. 15 of the 16 allografts with radiological ureteric stenosis underwent a concurrent pressure flow study to assess the functional relevance of the ureteric narrowing. As shown by a pressure rise of > 7 mmHg at a perfusion rate of 10 ml min-1, 11 of the 15 grafts were functionally obstructed and were treated by a nephrostomy catheter followed by antegrade insertion of a ureteric stent. The four grafts with a negative pressure flow study were subsequently shown on biopsy to have rejection. The diagnosis of allograft rejection was also confirmed by biopsy in seven of the eight allografts without a radiological ureteric stenosis. The last of the eight allografts was found to be cyclosporin toxic. Pelvicalyceal dilatation of renal allografts is appropriately investigated by antegrade pyelography in combination with a pressure flow study which identifies those grafts with mechanical obstruction.

Adult↗