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[Arteriosclerotic changes in the carotid arteries in patients with hypersensitive carotid sinus reflex].

Thirty-seven patients (15 female, 22 male; aged 46-89 years, mean age 68.8 years) with III or IV grade carotid sinus reflex carotid arteries were investigated by sonography (B-scan and CW-Doppler). It was demonstrated that stenoses or arteriosclerotic plaques, localized in the region of the carotid bulb or bifurcation, were present on both sides in 27 patients and on one side only in four patients. Five patients did not show these changes and four of them had thickening of common carotid artery endothelium. Thus, vascular changes occurred in 35 patients. Occlusions and stenoses greater than 50% were visible in five patients. Primarily bilateral changes were shown as well as unilateral and bilateral pathologic reflex response; main localization was the posterior wall of the carotid bulb. Thus, arteriosclerotic changes seem to be important in the development of pathologic carotid sinus reflex. Cerebral complications (left-sided PRIND) occurred in one patient who did not have high degree carotid stenosis. In comparison to other authors who investigated only with CW-Doppler a much higher rate of arteriosclerotic wall changes and a greater occurrence of bilateral changes could be demonstrated by application of the highly sensitive B-scan sonography.

Aged

[Drug-induced stenosis of the small bowel. Value of enteroclysis].

The purpose of this study is to characterize radiographically drug-induced ulcerated stenosis of the small bowel and to determine the contribution of enteroclysis in the diagnosis of this rare entity. The clinical pathologic and radiographic findings of 12 patients with drug-induced stenosis (non steroidal anti-inflammatory drugs or potassium salts) evaluated by enteroclysis were reviewed. Three radiological features of strictures were differentiated: diaphragm like stricture, short stricture and stenotic ulceration with girdle aspect. All formulation of NSAIDS and potassium salts are capable of causing the same radiographic and pathologic patterns. Enteroclysis improves the detection of these lesions since intestinal overdistension and correct filling of the loops increase the visualization of small obstructive stenosis and the detection of superficial ulcers. Thus, any patient who has an abnormality of the small bowel should be asked about use of drugs, especially when diaphragm-like strictures are found.

Aged

[Interrelations of lysosomal enzymes of leukocytes in patients with cicatricial stenosis of the larynx].

Activities of acid and alkaline phosphatases, cathepsin B, leucine aminopeptidase, N-acetyl-beta-D-hexosaminidases, beta-D-galactosidase and beta-D-glucuronidase were studied in leukocytes of two groups of patients with normal and pathological healing of wounds after surgical treatment of scar stenosis of larynx. Analysis of the enzymatic activity, calculated by means of Student's test using the data of a single estimation of the activity in leukocytes before surgical treatment, did not exhibit any distinct differences in these two groups of patients. The study of interrelationship between the activities of individual enzymes by means of principles of regression analysis enabled to show that the enzymes studied were in the positive regressive relation. Pattern of enzymatic activity in leukocytes of patients with pathological wound healing was distinctly different from that of patients with normal healing in the shape of regression and, especially, in relaxation of the interrelations between phosphatases and other enzymes. The principle of regression enabled to evaluate the prognosis of postoperative development of wound healing using the preliminary estimation of enzymatic activity in leukocytes of patients with scar stenosis of larynx.

Acid Phosphatase

[New aspects in therapy of proximal tubal occlusion: hysteroscopic proximal tubal catheterization].

To date, the therapy of first choice in case of proximal tubal pathology is resection of the occluded segment and microsurgical reconstruction. Essential disadvantage of this rather successful method consists in the need of a laparotomy. According to the concept of minimal invasiveness a pilot study has been undertaken to evaluate hysteroscopic proximal tube catheterization (HPTC) and balloon dilatation for recanalization. This attempt has proven intraoperatively successful in more than 80% of the cases and the first pregnancy and birth following HPTC can yet be reported.

Adult

[Urogenital tuberculosis. Apropos of 40 cases].

The authors report a series of 40 cases of genitourinary tuberculosis diagnosed and treated in the department of urology "B" of Avicenne hospital over a 7-year period. The objective of this study is to define the various diagnostic and therapeutic aspects of this disease. The patients were predominantly males (62.5%) with a mean age of 40 years. 25% of cases reported a history of extra-urinary tuberculosis. The very polymorphous clinical presentation is dominated by signs of cystitis (45%). Intravenous urography is frequently suggestive of the diagnosis based on the appearance and multiplicity of the lesions. The radiological lesions most frequently encountered were silent kidney (19 cases) and small tuberculous bladder (11 cases). The definitive diagnosis was established by pathological examination in 38 cases (biopsies, operative specimens, prostatic resection chips) and/or by demonstration of AFB in 2 cases (urine, pus). Tuberculostatic treatment was administered to all patients, either alone (5 cases) or, more usually, in combination with surgical and/or endo-urological treatment (35 cases), reflecting the magnitude and severity of the destructive and scar lesions.

Adolescent

[Histologic characteristics of the pathologic processes in thromboangiitis obliterans (Buerger's disease)].

In order to elucidate histologic characteristics of the pathologic processes in thromboangiitis obliterans (Buerger's disease) a histopathologic study of amputated legs of 9 patients diagnosed as this disease was carried out. The ages of the patients ranged from 27 to 47 years, all male, and the duration of symptoms prior to amputation was between 3 and 11 years. All of the patients had no history of hypertension. The initial stage of the pathologic processes was characterized by contraction of small arteries of legs followed by intimal thickening with laminar elastosis, the subsequent stage by occlusion of arterial lumens by both thrombosis and following organization and recanalization which occurred in the small arteries, and the later stage by lymphocytic infiltration of the arterial walls, suggesting some immunological mechanisms involved in the pathogenesis. Accompanying venules demonstrated similar processes to those of small arteries, which enhanced the local circulatory disturbances.

Adult

Advances in head and neck surgery in children.

Advances in pediatric head and neck surgery in the past decade have been on broad fronts. The laser coupled with the microscope has become an invaluable tool in the management of laryngeal pathological entities such as papilloma, cysts, hemangiomas, and granulation tissue secondary to endotracheal tube damage. Its use in the management of choanal stenosis is increasing. Improvements in radiation and combination chemotherapy have spectacularly increased the survival rates in rhabdomyosarcoma. Newer surgical procedures for corrrection of drooling are obtaining good results. Reconstructions of extensive laryngotracheal stenosis in children are being performed with considerable success. Better techniques are available for revision surgery of defects remaining after primary palatoplasty.

Adolescent

Simultaneous endoscopic and radiologic examination of the colon.

The selective radiologic visualization of pathologic ileocolonoscopic findings using contrast medium offers various advantages over endoscopy or radiologic evaluation performed alone. It allows one to combine a macroscopic biopsy with the radiologic examination and documentation procedure. The technique proves useful to document benign and malignant stenoses and tumors of the colon, diverticular disease, and mucosal abnormalities in long-standing ulcerative colitis and Crohn's disease, and to visualize fistulae, the appendix, or terminal ileum. Up to now, 146 patients have been examined without complication.

Aged

Hysterosalpingography versus laparoscopy in tubal infertility: comparison based on findings at laparatomy.

One hundred ten infertile women underwent hysterography (HSG) and laparoscopy at the Obafemi Awolowo University, Nigeria. Both techniques showed normal tubal patency in 62 (56.4%) women and abnormal pelvic pathology in 48 (43.6%). All 48 women underwent laparotomy for tuboplasty. At laparotomy, HSG and laparoscopic assessments were compared. Both techniques were comparable in the diagnosis of intratubal and distal tubal occlusion. However, laparoscopy was superior in the diagnosis of non-tubal factors and proximal tubal occlusion (P less than 0.002). It is suggested that laparoscopy should be the first procedure in the investigation of tubal infertility and only followed by HSG if the results show some abnormality.

Adult

Axillary nerve entrapment in the quadrilateral space. Case report.

The quadrilateral space syndrome is a recently established entity with seemingly consistent pathological and radiographic features. An example of this syndrome is reported. In this patient, entrapment of the axillary nerve by fibrous bands in the quadrilateral space caused shoulder pain with paresthesias in the upper extremity. Subclavian angiography provided the diagnosis by demonstrating that the posterior humeral circumflex artery, which was normal when the arm was in a neutral position, was occluded when the arm was abducted and externally rotated. Axillary neurolysis through a posterior approach resulted in relief of symptoms.

Adult

Recurrent acute pancreatitis caused by afferent loop stricture after gastrectomy.

Afferent loop obstruction after gastrectomy and Billroth II gastrojejunostomy is only rarely diagnosed as the cause of recurrent acute pancreatitis. Three patients are described in whom afferent loop stricture after gastrectomy and Billroth II reconstruction manifested as recurrent pancreatitis 13 to 24 years after the initial procedure. Late onset, nonspecific symptoms, and other simultaneous gastrointestinal pathologic features promoted a chronic clinical course in all patients. Symptoms included acute abdominal pain, vomiting, jaundice, hyperamylasemia, weight loss, and anemia. A thorough history, barium examination, cholescintigraphy, and endoscopy were central in establishing the diagnosis. The pathogenesis of stricture formation is thought to be ischemic mucosal damage from intestinal crossclamping. Surgical decompression provided lasting relief of the symptoms. Afferent loop stricture should be considered in the different diagnosis in patients with recurrent acute pancreatitis and previous gastrectomy with Billroth II reconstruction.

Acute Disease

Failure of a gastrocnemius muscle flap due to an isolated high-grade stenosis of the sural artery.

The gastrocnemius muscle is highly reliable for flap coverage of defects of the knee or upper third of the leg. Pathology or injury to its dominant arterial pedicle is rare, so preoperative testing is usually not required when distal pulses are present. In this case, an unsuspected high-grade stenosis of the origin of the sural artery was the cause of failure of the flap and made it necessary to use a free flap for salvage. This case raises questions as to the need for preoperative or intraoperative assessment of patency and/or perfusion pressure of the flap vascular supply.

Arteries

Studies of pathologic vasoconstriction (vasospasm) in microvascular surgery.

Characterization and resolution of microvascular spasm were investigated in 170 studies with the use of tail or femoral arteries of the rat. Topical epinephrine reliably produced vasospasm and topical vasodilators which included 2% and 20% lidocaine (Xylocaine) and 0.75% bupivacaine (Marcaine) were applied to resolve the vasoconstriction. Extensive vessel dissection was necessary to obtain significant resolution of vasospasm, and adventitial stripping was associated with even more impressive results. Local anesthetics appear to have a concentration dependent ability to resolve vasospasm, and 20% Xylocaine is the most effective agent yet studied.

Anesthetics, Local

[Feasibility of ultrasonic dopplerography in determination of the pathogenesis of transient cerebral circulatory disorders].

For specifying the pathogenesis of transient cerebrovascular disorders and the importance of occlusive lesions in the major cerebral vessels in this form of cerebrovascular pathology a new simple and safe method--ultrasonic dopplerography--was used in 87 patients. Subsequent cerebral angiography showed that the comparative reliability of this method in occlusions of the carotid and vertebral arteries reached 92.3%, and in their stenoses 76.6%. This makes it possible to recommend the ultrasonic dopplerography method for broad use in the conditions of both polyclinics and hospitals for examining patients with signs of transient cerebrovascular insufficiency.

Adult

Umbilical circulation--physiology and pathology.

1. The umbilical circulation under physiological conditions is protected by the amniotic fluid. This protective mechanism of the amniotic fluid may be disturbed artificially or spontaneously by the rupture of the membranes. 2. Umbilical cord compression is of no harm to the fetus when it is mild, since the fetus possesses a circulatory buffer system when umbilical blood flow is in a physiological range. However, severe reduction of umbilical blood flow may lead to fetal hypoxia. 3. Chronic or repetitive acute fetal hypoxia leads to deterioration of fetal circulation and umbilical blood flow. This can be recognized by the obstetrician during labor based on fetal heart rate patterns.

Animals

[Intestinal stenosis during ulceronecrotizing enterocolitis].

BACKGROUND: Intestinal stenosis following necrotizing enterocolitis (NE) occurred both in surgically-treated neonates after perforation, distal to an enterostomy and in medically-treated patients developing symptoms of obstruction. It has been proposed to detect stenosis by contrast enema before refeeding in those medically-treated patients. The aim of this study was to compare delay, clinical and pathological characteristics of surgical and medical patients, both after occlusion and prospective contrast studies. PATIENTS AND METHODS: Fifteen patients out of 50 with NE observed from 1984 to 1994 developed one or several intestinal stenosis. Diagnosis of NE was based on usual clinical signs, X-ray pneumatosis (43 to 50) and/or perforation in 16 cases. Among these 16 surgical patients, 12 survived the initial perforation. Among the 34 medical patients, 11 were seen before 1989 and did not have contrast studies before refeeding; 23 seen after 1989 had a contrast enema before. RESULTS: One or several stenosis occurred in four out of 12 surgical patients, four out of 11 medical patients without prospective contrast studies (one of them died from sepsis) and seven out of the 23 of the prospective group. On the whole, 26 stenosis occurred in 15 neonates: ten to the right colon, five to the transverse and 11 to the left colon. One ileal stenosis followed enterostomy. Delay of stenosis development was comparable in the three groups (between 3 weeks and 3 months). Pathologic examination showed similar lesions in the three groups (fibrosis 15, edema nine to 15 and chronic inflammation 12 to 15). CONCLUSION: Among 46 neonates who survived the initial period, 15 developed stenosis, a 30% proportion similar in patients operated on for perforation or in medically-treated patients whose diagnosis was made after occlusion or after contrast enema as well. These results suggest that systematic stenosis detection by contrast enema may avoid complications and permit programmed one-stage surgery.

Constriction, Pathologic

[Examination of the extracranial carotid artery with a high resolution B scanner. A comparison with carotid angiography (author's transl)].

Patients with cerebro-vascular insufficiency in stages I to IV had their extracranial carotid arteries examined with a high resolution real time ultrasound scanner. In 227 cases, carotid angiograms were available for comparison. Provided good image quality was obtained, sonography was able to distinguish with certainty between a normal and a pathological narrowed vascular lumen. Mural changes could be shown down to 0.5 mm. Under suitable conditions it was possible to differentiate between smooth and irregular plaques. Occasionally, ulcers were visible. High resolutions real time sonography is the only noninvasive method which provides information on the appearance and movements of vascular walls and of changes within these. It is possible to detect atherosclerotic changes at an early stage without risk, and to observe their development.

Arteriosclerosis

[B-image sonography of carotid bifurcation].

The main purpose of noninvasive high-resolution B-mode sonography of the extracranial carotid artery is to detect clinically relevant arteriosclerotic lesions. That is the reason why reproducible parameters are needed for the description of normal and pathological echo patterns of the vascular lumen and the vascular wall. From an experimental evaluation of 100 carotid specimens examined with a high resolution real time scanner a list of definitions for sonomorphologic parameters is derived. These parameters refer to the clinical importance of luminal and intramural changes. Because of its high sensitivity for even minimal arteriosclerotic lesions, B-mode sonography is a useful method for clinical and epidemiological studies of extracranial carotid disease.

Brain Ischemia