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Results for “Constriction, Pathologic”

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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↗

PubMed2005

Metallic ureteral stents versus endoureterotomy as a therapeutic approach for experimental ureteral stricture.

PURPOSE: To determine if the deployment of metallic ureteral stents in benign ureteral stricture is more effective than endoureterotomy. MATERIALS AND METHODS: Twenty pigs were randomly divided in two groups to be treated with endoureterotomy or metallic stents. The internal ureteral diameter 2 cm distal to the ureteropelvic junction, histopathologic changes, ultrasonographic and fluoroscopic studies, urine culture, and serum urea and creatinine levels were analyzed during the phases of the study. The study was divided into three phases. The first included premodel documentation of normal urinary tract and laparoscopic ureteral stricture induction. In the second phase 1 month later, diagnosis and endoureteral treatment were carried out. Twelve weeks after stricture treatment, follow-up imaging studies and postmortem evaluation of all animals were performed. RESULTS: The success rates were 80% for endoureterotomy and 70% for metallic stent implantation. In all animals in the latter group, a ureteral hyperplasic reaction took place that affected the zone of stent implantation. One difference between the groups was the presence of urinary infection in 30% of animals in the endoureterotomy group and in no animals treated with metallic stents. Statistically significant differences in ureteral diameter between the first and second study phases were found within both groups (P < .0001), but not between groups (P = .021). Results from pathologic analysis revealed statistically significant differences between groups (P = .0029). CONCLUSIONS: The interaction among the distal end of the metallic stent, the urothelium, and peristalsis might be the origin of the failure of these devices. Although the deployment of metallic stents is attractive compared with other endourologic techniques like endoureterotomy in cases of benign strictures, certain problems must be resolved to prevent hyperplasia. Until then, this technique will not be a fully reliable therapeutic option for ureteral disorders.

Animals↗

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↗

PubMed2003

Unsuspected ileal stenosis causing obscure GI bleeding in patients with previous abdominal surgery--diagnosis by capsule endoscopy: a report of two cases.

Peri-anastomotic ulcerations may occur in patients with previous abdominal surgery. They may present only with obscure GI bleeding. We report two cases in whom capsule endoscopy identified postsurgical stenoses with ulcers as the cause of obscure GI bleeding. Case 1. A 57-year-old male operated on in 1970 for a post-traumatic diaphragm hernia followed by displacement of the caecum in the upper left abdominal quadrant. Case 2. A 32-year-old female with a salpingectomy for tuberculosis (1978) followed by segmental ileal resection for intestinal obstruction. Both patients had undergone extensive work-up including bidirectional endoscopies and enteroclysis with negative results. Capsule endoscopy with the GIVEN diagnostic system was done. Ileal stenoses with mucosal ulcers in dilated prestenotic loops were observed in both cases. The capsule was retained at the stenosis site, requiring ileal resection and anastomosis. Pathology reports showed mucosal ulcers. In case 2, tuberculosis was ruled out by tissue and faecal polymerase chain reaction and culture. Ileal stenoses with prestenotic ulcerations causing GI bleeding may occur in patients with previous abdominal surgery. Capsule endoscopy may clarify the diagnosis and shorten the diagnostic work-up. However, these patients should be warned that capsule retention requiring surgery might occur.

Adult↗

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↗

PubMed1999

The impact of urinary extravasation after radical retropubic prostatectomy on urinary incontinence and anastomotic strictures.

OBJECTIVE: The aim of this study was to determine the relevance of urinary extravasation as proven by cystogram 18 days after radical retropubic prostatectomy for the degree of postoperative urinary incontinence and the incidence of anastomotic strictures. PATIENTS AND METHODS: A total of 225 patients underwent radical retropubic prostatectomy at our institution during a 30-month period, 215 of whom received a cystogram a mean 18 days following surgery. Three and 6 months after surgery these 215 patients were evaluated regarding the degree of urinary incontinence and the presence of anastomotic strictures. RESULTS: The cystogram demonstrated a watertight anastomosis in 89% (n = 195; group I), the remaining 11% (n = 24; group II) showed urine extravasation. Groups I and II were comparable with respect to age, preoperative serum levels of prostate-specific antigen (PSA), tumor grade and pathological staging. Six months after surgery, there was no statistically significant (p > 0.05) difference between both groups regarding the degree of urinary incontinence and the presence of anastomotic strictures. CONCLUSIONS: The presence of urine extravasation 18 days after radical retropubic prostatectomy has no impact on postoperative urinary incontinence and the incidence of anastomotic strictures. Based on these data it is not indicated to leave the catheter in situ beyond that point of time.

Aged↗

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↗

PubMed2003

[Vascular manifestation of von Recklinghausen neurofibromatosis: case report of venous dysplasia].

We present the case report of a patient with neurofibromatosis and regional dysmorphism in the superficial femoral vein. Colour coded duplex sonography revealed an incidental finding: thickening of a short portion of the vein wall with calcification. This unusual finding strongly suggests a causal relationship. Pathological processes in the arteries have often been described in patients with von Recklinghausen's disease (neurofibromatosis). Dysplastic and hyperplastic reactions of the intramural nerve tissues and the smooth muscle elements in the vascular wall have been observed. This leads to the formation of aneurysms and arteriovenous fistulas and to stenosing processes in the peripheral, visceral and cerebral arteries. However, involvement of the veins in type 1 von Recklinghausen's neurofibromatosis has only been reported in old histopathological studies of medium-sized and small vessels.

Arteriovenous Malformations↗

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↗

PubMed2000

Miniprobe ultrasonography and gastrointestinal tract stenosis.

OBJECTIVE: Malignant and nonmalignant stenosis of the gastrointestinal tract are a significant diagnostic and therapeutic challenge. Malignant stenosis is difficult to stage because the endosonographic catheter cannot be passed through the stricture. The objective of this study was to stage tumoral stenosis using a miniprobe. METHODS: We evaluated 30 patients (20 men, 10 women, average age 65 years). There were 9 nonmalignant cases and 21 malignant cases of stenosis of the gastrointestinal tract. Of the malignant cases, two were caused by extradigestive neoformations that infiltrated the wall of the digestive tract. Twelve of the remaining 19 cases were treated by surgery (63%). Echoendoscopy was done with a miniprobe through the working channel of the videoendoscope. The TNM classification was used to diagnose extension. The pathology study was used to confirm the final diagnosis after surgery for malignant lesions. Nonmalignant stenosis was confirmed in clinical follow-up. RESULTS: Sensitivity of the miniprobe in determining stage T and stage N were 83% and 64% respectively. CONCLUSIONS: Miniprobes provide valuable additional information in the study of stenosis of the digestive tract. Sensitivity is good in classifying tumoral T stage, and acceptable for classifying N stage, and may be improved by using low-frequency miniprobes.

Aged↗

PubMed2006

Apertura pyriformis stenosis in the newborn.

Apertura pyriformis stenosis in the newborn. Respiratory distress in the newborn can have a variety of aetiologies, the best known of which are cardiac and pulmonary diseases. Major nasal airway obstruction is probably often overlooked when acute desaturation of the neonate requires reanimation procedures, although it is well established that the baby is an obligate nose breather at birth. Nasal airway stenosis or atresia could account for a number of unexplained deaths in the delivery room. In the differential diagnosis of major nasal airway obstruction in the newborn, choanal atresia is by far the most common aetiology. However, a few cases of pyriform aperture stenosis have been reported. One child presenting this pathology was recently treated at the Brussels University Children's Hospital. Unexpectedly, the baby survived until 3 months without any medical support but had severe feeding problems. The diagnosis was confirmed by naso-sinusal CT scan. Surgery was performed at 4 months through an unusual endonasal approach which seems to be less traumatic than the classical sublabial approach. The post-operative course was satisfactory. The 9-month-old patient does not now show residual breathing problems. The presentation will focus on this unusual case.

Choanal Atresia↗