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[An MRI study of the cervical segment of the vertebral artery].

MRI appears to be a very valuable examination to study pathology of the vertebral artery. The examination must include T1 and T2 sequences and scans in three planes. The use of oblique scans allows the planes of section to be adjusted to the course of the artery. MRI can therefore demonstrate abnormalities of flow caused by intrinsic or compressive pathology.

Arterial Occlusive Diseases

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome is an uncommon cause of peripheral vascular disease in young fit individuals, presenting as progressive claudication or sudden limb ischaemia. It can also present later in life with insidious symptoms relating to popliteal thrombosis or aneurysm. As a local cause of atherosclerosis in the popliteal artery it is probably under-diagnosed, as clinical and radiological features are subtle and varied. Early diagnosis and surgical division of aberrant muscular relations result in an excellent clinical result. Late surgical treatment with vein grafting is less durable. The disease incidence, clinical features, pathology, investigations, treatment and prognosis are reviewed.

Adolescent

[Comparative study of the diagnostic value of hysterosalpingography and laparoscopy].

A total of 100 women had either hysterosalpingography with watersoluble Verografin or lipidsoluble Jodlipol for the assessment of tubal patency. Of these, all had laparoscopy. Laparoscopy have been shown to be the best test of tubal abnormalities. Hysterosalpingraphy with lipidsoluble contrast medium is poorly informative while the method of investigating the tubal pathology and cannot be used in clinical practice.

Adult

[Lassa fever associated with effusive constrictive pericarditis and bilateral atrioventricular annular constriction: a case report].

A case of Lassa fever associated with effusive constrictive pericarditis and bilateral atrioventricular annular constriction was reported. A 49-year-old man, who had been diagnosed by indirect fluorescent antibody test as the first case of Lassa fever in Japan, was referred to the Hiroo Hospital because of syncope, progressive hepatomegaly, ascites and pericardial effusion in spite of pericardiocentesis and corticosteroid therapy. On admission, his blood pressure was 92/60 mmHg and he had a paradoxical pulse. Two-dimensional echocardiography revealed a localized pericardial effusion adjacent to the right ventricular wall and behind the left ventricular posterior wall. Bilateral atrioventricular annular constriction was also present. On pulsed Doppler echocardiography, the peak inflow velocities of the right and left ventricles increased during atrial systole. Right heart catheterization revealed a mean diastolic pressure gradient of 8 mmHg across the tricuspid valve. After pericardiectomy, a diastolic dip and plateau pattern became evident in the right ventricular pressure tracing, suggesting the presence of residual constriction. However, the atrioventricular annular constriction was no longer evident on two-dimensional echocardiography. This is considered the first reported case of subacute effusive constrictive pericarditis caused by Lassa fever.

Cardiac Catheterization

Coronary arteriography in dogs following blunt cardiac trauma: a longitudinal assessment.

The purpose of the study was to examine the effects of blunt cardiac trauma on the epicardial coronary arteries of dogs by using sequential coronary arteriographic studies. A direct impact to the anterior surface of the heart at a velocity of 12 m/sec was delivered by an air pressurized impactor in eight of ten dogs with the chest open and the pericardium intact. Selective coronary arteriograms were performed percutaneously with the chest closed starting just before trauma and repeated afterward at intervals of 3 hours, 3 days, 2 weeks, and 5 weeks. Two of ten dogs were sham operated and did not undergo impact to the heart. The coronary arteries in these two dogs remained angiographically normal throughout the study period. In dogs that underwent impact and were maintained for the entire duration of the study (seven of eight dogs), injury to the epicardial coronary arteries occurred in every instance. Injury was limited mostly to branches of the left anterior descending and right coronary arteries. The left circumflex coronary artery, which was posterior to the site of impact, was always spared. The types of injury included complete branch occlusion, partial coronary obstruction, extravasation, and in one instance, an arteriovenous fistula. In nearly all instances, these injuries became evident angiographically between 3 hours and 3 days after impact and usually were completely resolved after 2 to 5 weeks. These observations indicate that the epicardial coronary arteries may be compromised by nonpenetrating cardiac impact. The resulting coronary pathology, however, resolved within a few weeks after injury.

Angiography

[Chronic pancreatitis and its treatment in diseases of terminal segment of the common bile duct].

Clinical observations embrace 77 cases of chronic pancreatitis combined with various pathologic changes of the choledochal terminal portion. The surgical correction of these changes was carried out upon 73 cases. The follow-up lasting from 2 to 6 years has shown the manifestation of chronic pancreatitis either disappear or subside dramatically in the most cases following the surgical correction of the pathologic changes in the choledochal terminal portion.

Biliary Tract Diseases

[Value of magnetic resonance imaging in 2 cases of annular constriction of the ventricles].

Chronic pericarditis can take the form of localised annular bands constricting the atrioventricular grooves, the pulmonary infundibulum and, rarely, the atria. The authors report two cases of pericardial bands surrounding the ventricles and involving the atrioventricular groove resulting in a biloculation of the left ventricle. One case was complicated by adiastole and one by mitral regurgitation due to involvement of the posterior mitral leaflet. Magnetic resonance imaging gave precise definition of these bands and of their extension into the myocardium. This investigation was a valuable complement before surgery of the localised constriction.

Calcinosis

Paraesophageal hiatus hernia in the aged.

A review of the records of Granada Hills Hospital revealed 4 documented cases of paraesophageal hiatus hernia. One of these geriatric patients presented with incarceration of the gastric fundus, and required an emergency thoracotomy for relief. Paraesophageal hiatus hernia, unlike sliding hiatal hernia, often gives rise to acute surgical problems secondary to incarceration, obstruction, gangrene, perforation or hemorrhage. The approach to the repair operation, may be either abdominal or thoracic, dependent upon the need to correct other associated gastrointestinal pathologic lesions. Unless severe debilitating medical diseases are present, operative intervention is recommended.

Age Factors

The embolic type of popliteal entrapment syndrome.

The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.

Adolescent

[Mechanical obstruction of the juncture between the eustachian tube and pharynx. Pathogenesis of ear diseases in cleft palate].

The universality of middle ear diseases in infants with cleft lip and palate is well known. Middle ear disease is causally related to an eustachian tube dysfunction due to anatomical variations of the tubal lumen or muscles. Endoscopy of the nasopharynx, microscopic examination and impedance measurement of the ear was performed in 53 children with cleft lip, alveolus and palate. Dynamic and static documentation was performed with a videocamera or a reflex camera. The pharyngeal port of the eustachian tube was mechanically obstructed by the lateral part of the cleft palate muscle in nearly all patients. The degree of the mechanical obstruction seemed to be related to the extent of the cleft. Furthermore there were less pathologic ear findings in patients with less obstructed pharyngeal ports of the eustachian tube.

Child

[Pathogenesis of stenosing ligamentitis].

On the basis of complex examination of women with stenosing ligamentitis, including investigations of hormonal background in accordance with the clinical criteria, hormonal smears, radioimmunological assay of the initial vegetative tonicity, blood circulation by means of rheography, it has been concluded that the stenosing ligamentitis is the local expression of general dystrophy of the connective tissue due to hormonal shift, pathology of the vegetative nervous system and the circulatory system.

Adult

Epidemiological studies of cerebro-and cardiovascular diseases in the northeast of Japan Part I. Pathological approach to the study in Akita Prefecture.

To define the etiologic factors of Japanese cerebrovascular diseases, a pathological research was conducted on autopsy cases of stroke in Akita Prefecture. In most cases of cerebral hemorrhages, especially in the middle age group (30-59 of age), arteriosclerotic deviations in basal berebral arteries of the circle of Willis and intracerebral small arteries are not found. The authors conclude that cerebral hemorrhage may occur without relationship to disturbances of lipid metabolism, biochemically, and to atherosclerosis, pathologically. Concerning cerebral infarction, especially in the old generation (over 60 years of age), severe arteriosclerotic deviations were recognized both in basal cerebral and intracerebral arteries. These changes were highly influenced by the grade and duration of hypertension, and rarely influenced by hypercholesterolemia. According to the above-mentioned facts, the results obtained from out epidemiological survey were confirmed by the pathological studies.

Adult

"Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters"--the future treatment of atherosclerotic coronary artery disease? A clinical-morphologic assessment.

Although various public health preventive efforts and prescribed pharmacologic treatment methods will have long-term benefits in the reduction of coronary artery atherosclerosis and subsequent cardiac events, the immediate and short-term future in the treatment of coronary artery disease will focus on several interventional devices designed to remodel or remove causes of acute and chronic coronary artery obstruction. Certain clinical-morphologic aspects of these interventional devices or techniques that result in remodeling of the coronary lumen shape (balloon angioplasty, thermal probes, intravascular stents) or removal of obstructing material (lasers, atherectomy devices) are reviewed. Two new areas in the pathology of atherosclerotic plaque (plaque fissures, eccentric plaque) and their clinical relevance in coronary heart disease are described.

Angioplasty, Balloon

Isolated stenosis of the pulmonary artery branches--an autopsy case with review of the literatures.

A necropsy of a 21-year-old male with isolated stenosis of the pulmonary artery was presented. The pulmonary artery branches showed various fibrous thickening including atheromata and mural thrombi. Those findings appeared mostly in elastic and large muscular pulmonary arteries as well as in medium sized arteries, while the small arteries and arterioles remained in slight changes. Systemic large elastic arteries seemed to be small and showed atheromatous lesions similar to those of the main pulmonary arteries. Moreover, eight autopsy cases with pulmonary artery stenosis from the literature were shortly reviewed and some pathological findings as an aid for angiographic cardiovascular studies were discussed.

Adolescent

Lumbar stenosis. An electromyographic evaluation.

Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilateral symptoms who actually has bilateral pathology. The importance of a bilateral electromyographic examination is emphasized and the rarity of bilateral or multiradicular findings in simple herniated nucleus pulposus.

Constriction, Pathologic