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Results for “Constriction, Pathologic”

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PubMed1984

[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↗

PubMed1984

Cerebral hyperperfusion after carotid endarterectomy: a cause of cerebral hemorrhage.

Correction of a very high grade carotid stenosis by endarterectomy in a normotensive man was followed by the development of severe unilateral head, eye, and face pain, seizures, and on the 6th day a fatal intracerebral hemorrhage. Autopsy revealed changes in the cerebral hemisphere ipsilateral to the endarterectomy that resembled the changes seen in malignant hypertension, whereas the opposite hemisphere was normal. These changes included hypercellularity and edema of arterial and arteriolar walls, with necrosis, extravasation of erythrocytes, and exudation of fibrin. We propose that the clinical and pathological features in this case were due to relative hyperperfusion of a cerebral hemisphere in which autoregulation had been impaired because of preoperative chronic hypoperfusion with chronic maximal dilatation of its blood vessels. This state of relative hyperperfusion is probably similar to the normal perfusion pressure breakthrough that occasionally occurs after the resection of cerebral arteriovenous malformations. It is similar to the breakthrough perfusion that occurs in severely hypertensive patients and results in hypertensive encephalopathy.

Arterioles↗

PubMed1986

Clinicopathologic correlation in postendarterectomy recurrent stenosis. A case report and bibliographic review.

The case history of a 60-year-old man with symptomatic recurrent stenosis of the left carotid artery 20 years after carotid endarterectomy is presented. At reoperation (repeat endarterectomy and venous patch angioplasty) the lumen was found to be reduced by 60% and histopathologic study revealed atheromatosis with organizing mural thrombus. The case is discussed in the context of the recent literature concerning restenosis, the reported frequency of which varies depending on the size of the population studied and the method of follow-up, with noninvasive studies revealing that restenosis is more commonly asymptomatic than symptomatic. Early simple fibrous restenosis differs histologically from the more complex, frankly atherosclerotic late restenosis and appears to reproduce the original pathologic condition of the carotid bifurcation; as in the original lesions hemodynamic conditions probably play a major etiologic role in the formation of the restenoses. The most important clinical factor in restenosis is continued cigarette smoking. In the majority of the studies reviewed, more than half of the patients with recurrent disease presented with symptoms referable to the site of the original operation. An argument in favor of routine vein patching during the primary procedure to attempt to prevent restenosis is presented.

Adult↗

PubMed1995

Dorsal spinal venous occlusion in the rat.

Occlusion of the major components of the spinal venous system is usually associated with spinal arteriovenous malformations or systemic thrombophlebitis. Although spinal venous system dysfunction has been implicated in compressive cord syndromes, myelopathies from decompression sickness, and spinal cord trauma, its pathophysiology remains unclear. To characterize disorders associated with spinal venous occlusion, we developed a model in the rat produced by focally coagulating the dorsal spinal vein transdurally at the T7 and T10 vertebral levels. Following such occlusion, venous stasis, sludging and perivascular hemorrhages in the small venous branches were observed. By 1 week postocclusion, animals developed hindlimb paralysis from which they partially recovered over time. Histologic examination in the acute phase disclosed tissue necrosis, edema, and hemorrhages predominantly in the dorsal aspect of the spinal cord. This was gradually replaced by an intense macrophagic infiltration and the partial formation of a cystic cavity by 1 month. These findings indicate that dorsal spinal vein occlusion in the rat causes significant neurologic and pathologic alterations. We conclude that this procedure produces a relevant animal model for the study of the pathophysiology of spinal venous occlusion, and it allows the characterization of its effects on spinal cord blood flow, the blood-spinal cord barrier, and the development of edema independent of cord compression. Our findings in this model provide an insight into one of the mechanisms of injury extension in spinal cord trauma and other disorders associated with spinal venous dysfunction.

Animals↗

PubMed1993

Acute pancreatitis is not a cause of chronic pancreatitis in the absence of residual duct strictures.

It has been shown that intraductal injections of bile salts into the bile-pancreatic ducts of dogs or rats were immediately followed by acute hemorrhagic pancreatitis and, some months later, by persisting chronic pancreatitis. The study described in this article was designed to test the assumption that these chronic lesions were due to ductal strictures secondary to the toxic effect of bile salts. The bile-pancreatic ducts of 100 rats were injected with 0.2 ml of a solution containing 4 microM Na taurodeoxycholate and 0.2 microM trypsin. The 66 survivors were killed at intervals from 1 day to 2 months following the induction of acute pancreatitis. Four to six sections were done in the first series, and serial 15-micron sections of the entire pancreas were taken from rats surviving 2 months. These showed that from the sixth day on, the largest ducts draining pathological areas were obstructed by fibrosis. Distal to this obstruction, intralobular ducts were dilated and their epithelia flattened or atrophied. Acini were atrophied and replaced by peri- and intralobular fibrosis. Lesions were limited to areas drained by obstructed ducts, with the rest of the parenchyma being normal. We conclude that in experimental animals, as in human beings, chronic lesions that persist after acute pancreatitis are due to duct obstruction, not to acinar necrosis.

Acute Disease↗

PubMed1988

[Treatment of hydronephrosis caused by obstruction of the pyeloureteral junction diagnosed before birth].

From 1981 to 1987, the authors observed 69 patients with ureteropelvic junction obstruction diagnosed by antenatal ultrasound, representing a total of 77 pathological renal units. Seventy renal units were treated by ureteropelvic resection, one renal unit returned to normal without treatment. There were 3 primary nephrectomies and 3 secondary nephrectomies for non-improvement after percutaneous nephrostomy. An early antenatal surgical management of ureteropelvic obstruction after antenatal ultrasound diagnosis does not seem to give better results than when diagnosis is made at a later stage. The interest of the antenatal diagnosis is not as important as for other uropathies such as urecterocele, mega-ureter or posterior urethral valves.

Constriction, Pathologic↗

PubMedDate not supplied

[Hypophysis compression syndrome in the sella turcica: mechanisms of development, pathology].

Intrasellar hypertension--a phenomenon of the hypophysis compression in the sella turcica-was described 13 years ago. It develops under stressor conditions and is probably one of the causes of frequent in critical situations (shock, collapse, coma, etc.) episodes of acute hypophyseo-adrenal failure. Intrasellar hypertension morphologically manifests by the volume unbalance between a suddenly increasing, 1.5-2 times, hypophysis (due to adenocyte hypertrophy, hyperemia, colloid retention) on the one hand, and its rigid capsule and sella turcica, on the other. Extrahypophyseal factors (high liquid and venous pressure) may take part in developing of this phenomenon due to hypophysis squeezing from outside.

Blood Pressure↗

PubMed1994

The cleavage plane in semi-closed endarterectomy of the superficial femoral artery: a histologic study.

PURPOSE: The purpose of this study was to determine the cleavage plane in semiclosed endarterectomy of the superficial femoral artery, a histologic study of endarterectomy cores of 10 consecutive patients was performed. Superficial femoral artery occlusive disease consisted of multiple stenoses in one and an occlusion in the other cases. METHODS: Microscopic paraffin cross-sections were made every half centimeter of the endarterectomy core. The sections were stained with hematoxylin-eosin and with elastica van Gieson. Microscopic studies were conducted of a total of 484 sections. Intima, internal elastic membrane, media, external elastic membrane, and adventitia were identified, if present. RESULTS: When the procedure of separating the diseased intima from the remainder of the arterial wall was commenced, the cleavage plane was located between the internal elastic membrane and the media in most cases. In two cases the cleavage plane was located inside the intima, and in one case parts of the media were removed as well. During passage of the ring stripper through the artery, the location of the cleavage plane changes and extends into the media. In one patient a residual stenosis was located in the segment of the core in which only the intima and internal elastic membrane were removed. In two patients the endarterectomy core contained parts of the external plastic membrane as well. During passage of the ring stripper through the artery, the location of the cleavage plane changes. In some segments the media is left intact, whereas in other segments the media is partially or totally removed. The reason for the variability of the cleavage plane rests in the nature of the pathologic behavior of the atheroma. The tissue necrosis that is part of the atheromatous complex frequently dips beyond the internal elastic membrane into the media and even into the external elastic membrane and adventitia. CONCLUSIONS: The question remains as to whether the location of the cleavage plane has an influence on the long-term results of endarterectomy. Long-term follow-up studies are required to supply us with the answer.

Aged↗

PubMed1980

Pancreatic B-cell function and abnormal urinary peptides in a boy with lipoatrophic diabetes and stenosis of the aqueduct of Sylvius.

A boy with the classical clinical manifestations of acquired lipoatrophic diabetes has been studied for 5 years from the onset of diabetes at age 13. At the age of 15 a ventriculo-cisternal shunt operation was performed because of stenosis of the aqueduct of Sylvius, followed by a dramatic improvement in his diabetic state with a decrease of the 24 hr insulin requirement from 130 to 32 units. After 12 months there was a relapse with increased insulin requirement up to the preoperative level. Pimozide treatment was given for 7 months with no effect on the metabolic derangements. Extremely high basal levels of serum C-peptide and pro-insulin were found throughout the period of observation. A further increase occurred after i.v. arginine infusion tests, indicating hyperfunctioning B-cells. Repeated screenings of peptides in the urine by sephadex chromatography revealed pathological patterns similar to those observed in patients with other hypothalamic disorders, but different from that found in the urine of patients with congenital generalized lipodystrophy. Injection into mice of peptides extracted from the preoperative urine produced an acute hyperglycemia. The mechanisms behind this hypothalamic syndrome are unknown, but it is postulated that the abnormal urinary polypeptides originate from disorganized hypothalamic centres and that these peptides may be responsible for the disturbed carbohydrate and lipid metabolism.

Adolescent↗

PubMed1994

Obstructive azoospermia of unknown origin: sites of obstruction and surgical outcomes.

Although the majority of patients with obstructive azoospermia have medical histories or signs related to seminal tract obstruction, the pathogenesis of the obstruction is unknown in some patients. Of 38 patients with obstructive azoospermia treated at our hospital preoperative data did not indicate causes or sites of obstruction in 6. Operative and pathological findings showed obstruction at the proximal convoluted vas deferens or between the most distal portion of the cauda epididymis and the vas deferens in 8 of 11 blocked seminal tracts. Microsurgical epididymovasostomy resulted in a patent anastomosis in all 6 patients and pregnancy in 2. In patients with obstructive azoospermia of obscure preoperative causes, it is highly probable that the obstruction sites are in the convoluted vas deferens or the transitional region between the cauda epididymis and vas deferens, and that fertility may be restored by microsurgical epididymovasostomy.

Adult↗

PubMed1995

Endoscopic, radiographic, and manometric findings in dysphagia associated with sarcoid due to extrinsic esophageal compression from subcarinal lymphadenopathy.

Esophageal dysphagia associated with sarcoid has been attributed to dysmotility from neuropathy, dysmotility from myopathy, mechanical obstruction from esophageal mural involvement, and mechanical obstruction from extrinsic compression by subcarinal lymphadenopathy. The relative importance of these etiologies has not been evaluated because of variable and nonstandardized analysis. In particular, manometry has not been performed to exclude esophageal dysmotility in dysphagia attributed solely to extrinsic compression. A 42-yr-old male with chronic sarcoid for 20 yr presented with mild dysphagia to solids. An upper gastrointestinal series revealed smooth narrowing of the esophageal lumen and transient hang-up of the barium column and a 1.3-cm diameter radiopaque pill at the level of the carina. Chest computerized tomography revealed esophageal narrowing at the level of the carina and splaying of the two mainstem bronchi from compression by subcarinal lymphadenopathy. Esophagogastroduodenoscopy revealed elliptical esophageal narrowing due to multiple, smooth, and nodular deformities at 29-32 cm from the incisors. Pathological examination of deep biopsies of the nodules revealed normal mucosa and submucosa without granulomas. Esophageal manometry revealed a highly localized high pressure zone of 39.8 +/- 6.1 mm Hg at 29-31 cm from the incisors (lab normal about -5 mm Hg). Esophageal muscle contractions were peristaltic and of normal amplitude above, within, and below this high pressure zone. This case report demonstrates that extrinsic compression from subcarinal lymphadenopathy is a sufficient mechanism for dysphagia with sarcoid, but it does not exclude a role for other mechanisms, such as nerve injury, in some cases.

Adult↗

PubMed1977

[5 adult cases of cerebral aqueduct stenosis caused by ependymitis granularis].

In the present report five autopsy cases of adult aqueductal stenosis arising from granular ependymitis have been reported. In all cases the aqueduct was obstructed or markedly stenosed by subependymal gliosis mainly consisting of fibrillary astroglia. Islands and tubules of ependymal cells were embedded in a dense bed of subependymal glia with the loss of ependyma. The walls of all ventricles showed the same pathologic findings with the aqueduct, although the degree was not so marked. Such findings support the view that some type of chronic infection produces the aqueductal stenosis, because it is impossible to produce such diffuse ependymal changes by congenital anomaly. It is of particular importance in this report that all cases were adults. In comparison with the microscopical findings in cases of aqueductal stenosis of infants and children arising from granular ependymitis, which have been reported in the literature, there were no principle differences between infants, children and adults.

Adult↗

PubMed1986

Radiology of colonic interposition and its associated complications.

A retrospective review of the medical records, pathology reports, and radiographic studies of 81 patients who had undergone colonic interposition was undertaken, with special attention to postoperative complications. Both early (within 30 days postoperatively, 81 patients) and late (later than 30 days postoperatively, 57 patients) complications were reviewed. Early findings included anastomotic narrowing (18 patients), anastomotic leak (13), aspiration (11), and ischemic necrosis of the colon (3). Late findings included aspiration (9 patients), anastomotic strictures (8), gastric stasis (6), redundancy and tortuosity of the colon (5), anastomotic ulcers (4), gastrocolic reflux (3), and gastroesophageal reflux into the residual esophagus (2).

Colon↗

PubMed1988

Angioplasty techniques for stenoses involving coronary artery bifurcations.

Branch occlusion during coronary angioplasty is an infrequent but potentially serious complication. The overall incidence of branch occlusion during dilatation of a primary vessel is 5%. Branch vessels most jeopardized by dilatation generally have a complex plaque that not only involves the target vessel but also extends into the origin of the branch vessel. Branches free of pathology at their origin generally have an exceedingly low incidence of occlusion during adjacent balloon dilatation. Side branches at risk for occlusion should be "protected" if the branch vessel is of an important size that could be dilated with a conventional dilatation catheter. The advent of lower profile dilatation catheters and guidewires has provided an opportunity to introduce several pieces of dilatation hardware into the coronary system through a single guiding catheter. Several techniques are described for both "protecting" and dilating side branches, either simultaneously or secondarily, after balloon dilatation of a primary vessel.

Angioplasty, Balloon↗

PubMed1992

[Incidence of local complications after heart catheter studies and their imaging with intravenous digital subtraction angiography: a retro- and prospective study].

Frequency of local complications following punction of the femoral artery aimed to cardiac catheterisation has been checked with 1051 patients retrospectively as well as 300 patients prospectively. Intravenous DSA was carried out when symptoms like stenotic murmurs, pulsations, hematoma, swelling or resistance within the concerned inguinal region appeared with suspicion diagnose of pseudoaneurysm, arteriovenous fistula or any other complications of vessels. The retrospective study reviewed a rate of complications of 1.62% and the prospective study a rate of 2.7%. The study reviewed that by using of DSA-checkings during a time period of 4 up to 10 month later no rest aneurysm or AV-fistula could be proved. That means a spontaneous thrombose took place with patients without operation indication. Significant connections were found between clinical pathological findings next to the position of punction and the occurrence of local complications. The single symptoms like stenotic murmurs or large hematoma are statistically proved indications to a complication of vessel. There is no connection between findings like pseudoaneurysm or AV-fistula and small hematomas next to the punction position. The intravenous DSA has been proved as easy and proof method with a small quantity of complications for the inclusion and differentiation of local complications following punction of the artery femoral.

Adult↗

PubMedDate not supplied

A pelvic scoring system for infertility surgery.

A pelvic scoring system for infertility surgery was devised in which pelvic pathology is assessed for comparative and prognostic purposes. Pelvic pathology was divided into three areas: adhesions (ADH), salpingitis (SPG), and tubal occlusion (TOC). The extent of pathology was scored as mild (1), moderate (2), severe (3), or extensive (4). The maximum scores for adhesions, salpingitis, and tubal occlusion were 48, 24, and 28, respectively--various weightings were applied and subareas accounted for. The pelvic score (PLV#) was simply the sum of the adhesions (ADH#), salpingitis (SPG#), and tubal occlusion (TOC#) scores. The stage of pelvic pathology was arbitrarily assigned as stage 0, I, II, III, and IV with PVL#'s of 0, 1-25, 26-50, 51-75, and 76-100, respectively. A close correlation (r = .960-.990) of PLV# was noted between different observers using this system. Poorer reproductive potential was observed in the patients with higher scores and stages. This scoring system properly reflects clinical experience and can be relied on for patient counseling via prediction of prognosis. This system can be utilized to compare objectively the results of infertility surgery between surgeons as well as among institutions.

Constriction, Pathologic↗

PubMed1998

MR imaging of symptomatic osteochondromas with pathological correlation.

OBJECTIVE: To demonstrate the value of MR imaging in the diagnosis and differentiation of the various symptomatic complications of osteochondromas, providing pathological correlation with emphasis on the usefulness of MR imaging as a single imaging modality in these patients. DESIGN: We retrospectively reviewed all MR examinations of clinically symptomatic osteochondromas (30 patients) performed at our institution between March 1990 and October 1997. PATIENTS: Thirty patients had clinically symptomatic osteochondromas during the study period. Twenty patients were male and 10 were female. There were five cases of multiple osteochondromatosis. Pathological correlation was available in 24 patients. RESULTS AND CONCLUSION: Symptomatic complications included fracture (7%), osseous deformity limiting range of motion (23%), vascular injury (7%), neurological compromise (10%), bursa formation (27%) and malignant transformation (27%). MR imaging was able to diagnose or suggest the etiology for the clinical symptomatology in all cases, demonstrating that it is an ideal imaging modality in the diagnostic evaluation of symptomatic complications of osteochondromas and often avoids the need for further imaging.

Adolescent↗

PubMed1989

[Diagnosis and therapy of benign stenoses of Vater's papilla].

Experience obtained from operations on 2,458 patients for benign stenosis of Vater's papilla provided a background against which a classification was made of this pathological pattern. Preoperative and intraoperative diagnostic methods and surgical techniques are discussed and are critically appraised. Endoscopic papillospincterotomy had been introduced to clinical practice in 1979 and has ever since been the optional surgical approach to Vater's papilla. Differentiated attitudes to various possible corrections of benign stenosis together with high technical standards in surgery proper have so far yielded good long-term results for 89 per cent of patients.

Adolescent↗