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Results for “Constriction, Pathologic”

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PubMed1994

[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↗

PubMed1997

[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↗

PubMedDate not supplied

Unusual causes of benign biliary strictures with cholangiographic features of cholangiocarcinoma.

Focal strictures occurring at the hepatic duct confluence, or within the common hepatic duct or common bile duct in patients without a history of prior surgery in that region or stone disease, are usually thought to represent cholangiocarcinoma until proved otherwise. However, not uncommonly, patients undergo surgical exploration for a preoperative diagnosis of cholangiocarcinoma, based on the cholangiographic appearance of the lesion, only to find histologically that the stricture was benign in nature. Despite sophisticated radiographic, endoscopic, and histologic studies, it is often impossible before laparotomy to distinguish malignant from benign strictures when they have the characteristic radiographic appearance of cholangiocarcinoma. Even at the risk of overtreating some benign cases, most agree that aggressive surgical resection is the treatment of choice, given the serious consequences resulting from a failure to diagnose and adequately treat cholangiocarcinoma. Four patients who presented to our institution between February 1991 and June 2000 underwent laparotomy for a preoperative diagnosis of biliary tract malignancy based on clinical presentation and cholangiographic findings. The final pathology report in all patients showed marked fibrosis and inflammation of the biliary duct without evidence of malignancy. A review of the patient data and the relevant literature identified benign causes of focal extrahepatic biliary strictures associated with concomitant disease processes in two of the four patients. We present these cases and discuss the benign etiologies with emphasis on the role of surgery in both diagnosis and treatment.

Aged↗

PubMed2002

Fetal therapy for giant hepatic cysts.

Cystic mesenchymal hamartoma is an extremely rare, benign tumor. Rapid growth to a giant size can pose a threat not only in early childhood but also during fetal life. The experience with 2 antenatally diagnosed giant hepatic cysts with widely disparate approaches to management, treatment, and outcome is presented. A giant hepatic cyst was diagnosed on routine screening ultrasound scan. Because of its extremely massive size, the cyst was treated in utero with repeated aspirations, primarily for obstetric considerations. The infant did well, and the lesion was excised laparoscopically during the neonatal period. A second fetus with a giant hepatic cyst was not treated in utero, and the pregnancy continued to term. Nonimmune hydrops fetalis developed, and the fetus was delivered prematurely at 34 weeks. At birth, the infant was noted to have diffuse neurologic injury and no urine output despite normal-appearing kidneys. The lesion was excised during the neonatal period by open laparotomy. Observations at the time of surgery and pathologic studies of the placenta showed aneurysmal dilatation of the placental veins suggesting in utero compression of the fetal intraabdominal umbilical vein. The infant died shortly after birth. The experience with these 2 cases suggests the possibility that giant mesenchymal hamartoma diagnosed in utero may cause umbilical venous obstruction leading to ischemia during fetal life. Decompression of giant hepatic cysts may reverse this phenomenon and allow normal fetal development.

Constriction, Pathologic↗

PubMed2001

Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography.

BACKGROUND: Monitoring contrast medium wash-in kinetics in hyperemic myocardium by magnetic resonance (MR) allows for the detection of stenosed coronary arteries. In this prospective study, the quality of a multislice MR approach with respect to the detection and sizing of compromised myocardium was determined and compared with positron emission tomography (PET) and quantitative coronary angiography. METHODS AND RESULTS: A total of 48 patients and healthy subjects were studied by MR using a multislice hybrid echo-planar pulse sequence for monitoring the myocardial first pass kinetics of gadolinium-diethylenetriamine pentaacetic acid bismethylamide (Omniscan; 0.1 mmol/kg injected at 3 mL/s IV) during hyperemia (dipyridamole 0.56 mg/kg). Signal intensity upslope as a measure of myocardial perfusion was calculated in 32 sectors per heart from pixelwise parametric maps in the subendocardial layer and for full wall thickness. Before coronary angiography, coronary flow reserve (hyperemia induced by dipyridamole 0.56 mg/kg) was determined in corresponding sectors by (13)N-ammonia PET. Receiver-operator characteristic analysis of subendocardial upslope data revealed a sensitivity and specificity of 91% and 94%, respectively, for the detection of coronary artery disease as defined by PET (mean coronary flow reserve minus 2SD of controls) and a sensitivity and specificity of 87% and 85%, respectively, in comparison with quantitative coronary angiography (diameter stenosis >/=50%). The number of pathological sectors per patient on PET and MR studies correlated linearly (slope, 0.94; r=0.76; P<0.0001). CONCLUSIONS: The presented MR approach reliably identifies patients with coronary artery stenoses and provides information on the amount of compromised myocardium, even when perfusion abnormalities are confined to the subendocardial layer. This modality may qualify for its clinical application in the management of coronary artery disease.

Adult↗

PubMed1990

[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↗

PubMedDate not supplied

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↗

PubMed1986

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↗

PubMed1989

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↗

PubMed1987

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↗

PubMed1996

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↗

PubMed1998

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↗

PubMed1985

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↗

PubMed1980

[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↗

PubMed1981

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↗

PubMed2001

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children.

OBJECTIVES: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Bronchi↗

PubMed1997

[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↗

PubMed1981

[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↗