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Results for “Dilatation, Pathologic”

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PubMed1993

A role of fatty acid oxidation in cardiac hypertrophy.

Following a myocardial infarction the patient with a dilated heart is at greater risk for arrhythmias, congestive failure and sudden death. Studies of myocardial infarction in experimental animals have shown that, with infarcts involving up to 20% of the left ventricle, hypertrophy of surviving myocytes occurs and there are minimal hemodynamic changes. Infarctions greater than 20% induce little additional hypertrophy, and develop increased left ventricular filling pressures and cardiac dilatation. It has been suggested that inadequate hypertrophy of residual myocardium may be a reason for the progressive left ventricular dilatation which occurs after large myocardial infarcts. There are data in humans and animals suggesting that the mass of the left ventricle following a myocardial infarction correlates with improvement in systolic function. Studies from our laboratories have previously shown that 2-tetradecylglycidic acid, an inhibitor of carnitine palmitoyl transferase I, inhibits mitochondrial long-chain fatty acid oxidation and causes myocardial hypertrophy when given to rats by mouth for 7-28 days. We carried out studies to see whether induction of additional myocardial hypertrophy by means of feeding tetradecylglycidic acid might prevent pathologic dilation following a large (50%) infarct in rats. Treatment of control and infarcted rats with tetradecylglycidic acid for 10 days resulted in myocardial hypertrophy in both groups. The rats with myocardial infarction treated with tetradecylglycidic acid had an increase in peak developed left ventricular pressure during abrupt aortic occlusion and lower left ventricular end-diastolic volumes, when compared to untreated rats with myocardial infarction, while the stroke volume was maintained. Thus induction of myocardial hypertrophy with an inhibitor of long-chain fatty acid oxidation retarded the process of left ventricular dilatation and had beneficial effects on systolic function following a large myocardial infarction.

Animals↗

PubMed2006

Cardiac myosin missense mutations cause dilated cardiomyopathy in mouse models and depress molecular motor function.

Dilated cardiomyopathy (DCM) leads to heart failure, a leading cause of death in industrialized nations. Approximately 30% of DCM cases are genetic in origin, with some resulting from point mutations in cardiac myosin, the molecular motor of the heart. The effects of these mutations on myosin's molecular mechanics have not been determined. We have engineered two murine models characterizing the physiological, cellular, and molecular effects of DCM-causing missense mutations (S532P and F764L) in the alpha-cardiac myosin heavy chain and compared them with WT mice. Mutant mice developed morphological and functional characteristics of DCM consistent with the human phenotypes. Contractile function of isolated myocytes was depressed and preceded left ventricular dilation and reduced fractional shortening. In an in vitro motility assay, both mutant cardiac myosins exhibited a reduced ability to translocate actin (V(actin)) but had similar force-generating capacities. Actin-activated ATPase activities were also reduced. Single-molecule laser trap experiments revealed that the lower V(actin) in the S532P mutant was due to a reduced ability of the motor to generate a step displacement and an alteration of the kinetics of its chemomechanical cycle. These results suggest that the depressed molecular function in cardiac myosin may initiate the events that cause the heart to remodel and become pathologically dilated.

Actins↗

PubMed1991

Ejaculatory duct obstruction in subfertile males: analysis of 87 patients.

OBJECTIVE: To study the causes, presentation, and treatment of ejaculatory duct obstruction in subfertile males. DESIGN: Collaborative retrospective study of clinical experience collected by two urologists over a 15-year period. SETTING: National Health Service and Private Care Hospitals. PATIENTS, PARTICIPANTS: Subfertile males with azoospermia (n = 67), very severe oligozoospermia (n = 17), oligozoospermia (n = 1), or normal sperm concentration (n = 2) in small volume ejaculates with acid pH and little or no fructose. INTERVENTIONS: Exploration of scrotum with vasogram and testicular biopsy, plus reconstruction if possible. MAIN OUTCOME MEASURES: Follow-up seminal analysis and occurrence of pregnancy in female partners. RESULTS: The causes were: müllerian duct cyst (n = 17); wolffian duct malformation (n = 19); previous surgical trauma (e.g., imperforate anus) (n = 15); previous genital infection (n = 19); tuberculosis (n = 8); megavesicles (pathological dilatation of vesicles and ampullae of unknown cause) (n = 8); and carcinoma of prostate (n = 1). After incision of Mullerian duct cysts, five pregnancies were produced. Five pregnancies occurred in the other groups using a variety of surgical techniques. CONCLUSIONS: Routine vasography has shown that ejaculatory duct obstruction is not as rare as previously thought. The diagnosis should not be missed because the condition is simple to correct surgically in certain cases.

Constriction, Pathologic↗

PubMed1994

Left ventricular dysfunction in ischemic heart disease: fundamental importance of the fibrous matrix.

The contractile function of the myocardium is coordinated by a fibrous matrix of exquisite organization and complexity. In the normal heart, and apparently in physiological hypertrophy, this matrix is submicroscopic. In pathological states changes are frequent, and usually progressive. Thickening of the many elements of the fine structure is due to an increased synthesis of Type I collagen, This change, which affects the myocardium in a global manner, can be observed by light microscopy using special techniques. Perivascular fibrosis, with an increase in vascular smooth muscle, is accompanied by development of fibrous septa, with a decrease in diastolic compliance. These structural changes are believed to be due to increased activation of the renin-angiotensin-aldosterone system, and to be independent of the processes of myocyte hypertrophy. Reparative or replacement fibrosis is a separate process by means of which small and large areas of necrosis heal, with the development of coarse collagen structures, which lack a specific organizational pattern. Regarding ischemic heart disease, an increase in tissue collagenase is found in experimental myocardial "stunning" and in the very early phase of acute infarction. Absence of elements of the fibrous matrix allow for myocyte slippage, and--if the affected area is large--cardiac dilatation. If, subsequently, the necrosis becomes transmural, there is further disturbance of collagen due to both mechanical strain and continued autolysis, During healing collagen synthesis increases greatly to allow for reparative scarring in the available tissue matrix. In cases of infarction with moderate or severe initial dilatation, pathological hypertrophy of the spared myocardium is progressive, accounting for late heart failure and poor survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Normal diameter of the thoracic aorta in adults: a magnetic resonance imaging study.

To determine the evolution of the diameter of the thoracic aorta with age in order to detect dilatation more reliably by imaging, we performed a retrospective analysis of the MRI examinations of the normal thoracic aorta of 66 subjects aged 44.1+/-19.1 years (range 19.1-82.4 years) obtained between 1991 and 2000 on a Magnetom SP 42 1T apparatus (Siemens) using T1-weighted spin echo sequences with electrocardiographic synchronization. Sixteen measurements were made in the axial plane, the oblique sagittal plane in the axis of the aortic arch, and the oblique frontal plane perpendicular to the latter at the level of the ascending aorta, the arch and the descending thoracic aorta. We found an increase in the thoracic aorta diameter and a significant relationship between this diameter and the age of our subjects, wherever the measure was performed. However, there was no systematic correlation between aortic diameter and age. The aortic diameter evolved with age and a marked difference seemed to exist in measurements made in groups younger and older than 40 years. This study, conducted on a small population of 66 patients, thus helps to define a normal aortic diameter, thereby making the diagnosis of pathological dilatation of the aorta more reliable.

Adult↗

PubMed1996

Desmin gene expression in cardiac myocytes is responsive to contractile activity and stretch.

Experiments were performed to assess the ability of mechanical stimuli, experienced by ventricular cardiac myocytes during the progression of hypertrophic and dilated pathology, to increase the expression of desmin in cultured neonatal rat cardiac myocytes. Results indicate that both contractile activity and load due to passive stretch increase desmin content in neonatal rat cardiac myocytes through increased desmin gene transcription. Western blot analysis demonstrated that contraction induced a selective increase in desmin protein content in neonatal rat cardiac myocytes above increases observed in the content of total cellular protein. Northern blot analysis indicated that desmin mRNA content increased in response to contraction as well as to alpha-adrenergic stimulation. Desmin mRNA content also increased in cultured neonatal myocytes in response to stretch. Angiotensin II (ANG II) treatment of contracting neonatal cardiac myocytes further increased desmin mRNA content, whereas similar treatment in arrested neonatal cardiac myocytes further increased desmin mRNA content, whereas similar treatment in arrested neonatal cardiac myocytes failed to increase desmin mRNA. This contraction-dependent responsiveness to ANG II is not a function of increases in the density or relative subtype composition of ANG II receptors. Treatment of contracting neonatal rat cardiac myocytes with actinomycin D prevented increases in desmin mRNA content, suggesting regulation of transcription of the desmin gene by contraction. Nuclear run-on experiments indicate that contraction. Nuclear run-on experiments indicate that contraction increases transcription of the desmin gene in cardiac myocytes. These results are consistent with the modulation of desmin gene expression secondarily to changes in the mechanical environment that occur in cardiac tissue undergoing dilation or hypertrophy.

Angiotensin II↗

PubMedDate not supplied

Sonographic estimates of vein size in the lower extremities: subjective assessment compared with direct measurement.

PURPOSE: We studied whether subjective impression of vein size is a valid means of assessment during sonographic evaluation for deep vein thrombosis. METHODS: Diameter was assessed at 5 predetermined venous segments on 975 legs of 721 patients referred for evaluation for lower extremity deep vein thrombosis. The sonographer recorded a subjective assessment of whether the venous segment was enlarged, normal, or narrowed based on a visual impression of sonographic images obtained without compression. This subjective impression was then compared with the absolute measurements of vein diameter and vein diameter:artery diameter ratio at each segment. RESULTS: A significant correlation was found between the subjective characterization of vein size as enlarged, normal, and narrowed and both the absolute vein diameter and the vein:artery ratio at all 5 segments. CONCLUSIONS: Vein size can be reliably categorized by the subjective impression of experienced sonographers. Therefore, actual measurement of the vein diameter is not necessary in the evaluation for deep vein thrombosis in the majority of patients.

Analysis of Variance↗

PubMed1995

Infundibulopelvic stenosis, multicystic kidney, and calyectasis in a kindred: clinical observations and genetic analysis.

Congenital obstructive anomalies of the urinary tract usually occur sporadically. We describe inheritance in a three-generation kindred of a spectrum of kidney anomalies consistent with an autosomal-dominant mode of transmission, with incomplete penetrance, calyectasis (maternal grandmother), infundibulopelvic stenosis (uncle), and multicystic kidney (male proband, age 4 years). The proband's mother, father and half sister had normal renal imaging studies. Inheritance of informative polymorphic markers (3'-HVR, GGG1, GGG9, SM-7, KG8, and CW3) mapping close to the adult polycystic kidney disease type 1 (PKD-1) and tuberous sclerosis (TSC-2) loci on chromosome 16p was evaluated by Southern blot studies and by PCR-based, fluorescent genotyping for linkage to phenotype. The 3 affected individuals, as well as the unaffected mother (obligate carrier) and unaffected half-sister, inherit a common chromosome haplotype linked to the PKD1 locus. Our findings support the hypothesis that these anomalies may be part of a spectrum of obstructive renal dysplasia which are inherited as a simple Mendelian trait exhibiting an autosomal-dominant mode of transmission with variable expression and incomplete penetrance.

Adult↗

PubMed1994

Primary common bile duct anastomosis in the rat using microsurgical techniques.

In a rat model, we attempted to describe the natural healing course of the common bile duct (CBD) after primary microsurgical repair. Fifty-three rats were divided into experimental groups with CBD microsurgical anastomoses and control groups with CBD mobilization and ligation. Examination of three experimental groups at 1 week, 1 month, and 3 months showed evolving inflammation and stricture changes with eventual patent, healed ducts in 92% of animals at the end of 3 months following transection and repair. There were no histologic abnormalities in the livers. There were fibrotic ducts and hepatic stasis and cirrhosis changes in the control group with CBD ligation. This study demonstrates that microsurgical techniques can achieve successful primary biliary repair in the rat.

Anastomosis, Surgical↗

PubMed1980

Trigeminal neuralgia due to dolichoectasia: angiographic and CT findings in a patient with the EEC syndrome.

Ectrodactyly (lobster claw deformity), ectodermal dysplasia and clefting of the lip or palate, the EEC syndrome, is a rare genetic disorder involving both mesodermal and ectodermal derivatives. Cerebral arterial dolichoectasia, a pathological dilatation and elongation of intracranial vessels, was found in a patient with the EEC syndrome. Her hypertensive cardiovascular disease, mild dementia and trigeminal neuralgia were all related to her dolichoectasia. Although the association of dolichoectasia has not been previously observed with the EEC syndrome, it may be more frequent than currently recognized. Cerebral arterial dolichoectasia and its attendant sequelae could account for some of the unexplained abnormalities described in other case reports of patients with the EEC syndrome.

Abnormalities, Multiple↗

PubMed1978

Angiographic, operative, and histologic findings after embolization of craniofacial angiomas.

After pre- or intraoperative angiography and Gelfoam embolization in patients with deforming vascular malformations in the craniofacial region, the angiographic findings and the results of embolization were controlled by operation and histology. In arteriovenous hemangiomas the disfigurations of the craniofacial region originate from the shunt vessels themselves, in capillary hemangiomas exclusively from neoplastic, pathologically dilated and convoluted veins which could be demonstrated only by percutaneous punctures. Lymphatic hemangiomas also could be radiologically shown only after direct punctures and without any feeding or draining vessels. During operation vast necrosis of the fatty tissue in the region of embolization and massive phlebolithiasis in the draining veins were found. Histologically, arterial obliterations could be shown in the former shunt area. The reconstructive operations could be done in bloodless surgical regions and always showed good cosmetic results, which were regarded as constant because of the embolization of the shunt area.

Adolescent↗

PubMed1978

[Comparative studies of various suture techniques in transthoracic esophagogastric anastomoses in dogs (author's transl)].

In 27 dogs esophagogastric anastomoses were performed in a single-layered end-on, a three-layered end-on and a double-layered inverting technique. The anastomoses were reinvestigated on the 2., 4., 7., 15. and 30. postoperative day. Suture line leakages were not observed. The inverted suture resulted in considerable anastomotic stenosis, ulceration of the mucosa, disordered and initially incomplete revascularisation, and widespread granulomatous inflammatory reaction. In contrast, the end-on technique led to almost no stenosis, ordered revascularisation, and narrow and delicate scar tissue formation while maintaining a normally layered structure. The single-layered methode was superior to the three-layered one. The best results were obtained by the extramucous technique.

Animals↗

PubMed1991

Percutaneous transhepatic manometry of sphincter of Oddi.

A nonoperative examination of the function of the sphincter of Oddi, involving percutaneous transhepatic manometry via the percutaneous transhepatic biliary drainage tract, was developed and clinically applied in 23 patients with biliary disease. Long-term recording of sphincter of Oddi motility, which was impossible using conventional intraoperative or endoscopic manometry, was made possible by means of this method and revealed various changes of sphincter of Oddi motility. The mean recording time was 131.33 +/- 9.77 min. The frequency of contractions of the sphincter of Oddi in basal fasting conditions varied from 0 to 13/min and high-frequency contractions (frequency 9.49 +/- 0.35/min, duration 5.77 +/- 0.54 min) were observed in 12 patients on a total of 19 occasions. In five patients, high-frequency contractions were observed twice during one session of continuous recording and the interval between burst contractions was 85.4 +/- 13.3 min. Long-term continuous recording is advantageous for the evaluation of the function of the sphincter of Oddi and short-term manometry may not be representative of overall sphincter of Oddi motility.

Adult↗

PubMed1986

Hepatolithiasis in East Asia. Retrospective study.

Hepatolithiasis is a major disease in Asia but differences in operative incidence between countries have not been examined. A retrospective study was conducted in Taiwan, Hong Kong, and Singapore, and the results were compared with those in Japan with the aim of defining factors involved in the etiology of the condition. In order to ensure uniformity of the data collected, the same form was used throughout the study and was completed by the same personnel after reviewing the patient's record and radiographs in each case. The years 1976-1980 were chosen for the study, since the newer methods of diagnosis such as ultrasound, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography became available during that period. The most significant finding was the difference in the relative prevalence of hepatolithiasis as a proportion of all gallstone cases in Taiwan, Hong Kong, and Singapore, where the majority of the population consisted of patients of Chinese descent. The highest prevalence, 53.5%, was found in Taiwan, while in Hong Kong it was 3.1% and in Singapore 1.7%. Environmental rather than ethnic factors are implicated in the cause of hepatolithiasis.

Adult↗

PubMed1999

The saphenous venous compartments.

The relationships between the connective framework of the lower extremity hypodermis and the saphenous veins was studied by dissection, stereomicroscopy, ultrasonography and histology in 64 lower limbs. A fibroelastic lamina was evidenced in the hypodermis of the medial aspect of the thigh and leg and in the back face of the leg. This lamina, together with the underlying muscular fascia, fixed the boundaries of two compartments occupied by the saphenous veins and nerves. The adventitia of the saphenous veins was connected to the compartment walls by thick connective strands. The saphenous veins ran deeply in the hypodermis, closely ensheathed by a fibroelastic sleeve. As a consequence, they could no longer be considered as a truly superficial vein. This term seems to be appropriate only for their tributaries, which ran in a more superficial plane just below the dermis. The role of the saphenous vessels in blood return from the lower limbs may be greater than classically accepted. In fact, due to their close fascial ensheathing and adventitial anchoring, muscular contractions may enhance blood flow within these vessels as occurs in the intermuscular veins. Finally, dilative pathology of the saphenous vein may be resisted by the membranous lamina as a sort of a fibroelastic shield.

Adult↗

PubMed2001

Pancreatic complications in choledochal cyst and their surgical outcomes.

Follow-up results were analyzed to evaluate the surgical managements of pancreatic complications such as pancreatitis and protein plug formation in patients with choledochal cysts. Sixty-two patients with choledochal cysts treated between 1976 and 1999 were reviewed. Twenty-four were children and 38 were adults. Fifty-four patients showed primary cases. Cyst excision and hepaticoenterostomy were finally performed in 56 patients. Surgical sphincteroplasty or endoscopic sphincterotomy was performed to prevent recurrent protein plugs in six patients. The follow-up period was 8.1 +/- 6.1 years. Acute pancreatitis and protein plug formation was observed in 18 (33.3%) and 11 (20.4%) of 54 patients showing primary cases, respectively. Both acute pancreatitis and protein plug formation were observed more frequently in children from 1 to 15 years of age (70.6% and 41.2%, respectively) than in adults (18.6% and 12.5%, respectively). Acute pancreatitis and/or protein plug formation developed in four (57.1%) of seven patients who underwent cystenterostomy. Protein plug formation in the residual cyst after cyst excision was observed in two patients, one of whom had undergone sphincteroplasty. Diabetes mellitus due to chronic pancreatitis developed in one patient who was diagnosed late. No other pancreatitis or protein plug recurred postoperatively in this series. Our results suggested that cystenterostomy did not resolve pancreatic complications of choledochal cysts, and that surgical sphincteroplasty was ineffective in preventing the recurrent protein plug formation in the residual duct. In conclusion, complete cyst excision and an early diagnosis are necessary to prevent the development of chronic or recurrent pancreatitis after surgery.

Acute Disease↗

PubMed2004

Small bowel obstruction caused by a congenital intestinal web with an enteric bezoar in an adult: report of a case.

An intestinal web is a rare congenital anomaly, typically reported in childhood, but often remaining asymptomatic throughout the entire life span of the individual. We report the case of a symptomatic intestinal web associated with an enteric bezoar in an adult, which to the best of our knowledge has never been documented before. A 25-year-old man presented with acute small bowel obstruction, and laparotomy revealed a stenotic area of the ileum as well as impaction of an enteric bezoar. We resected this segment of ileum and an intestinal web was subsequently found in the stenotic area. The patient recovered well and has remained asymptomatic for 3 years. Although rare, a congenital intestinal web may be a cause of adult small bowel obstruction requiring surgical resection.

Adult↗

PubMed2006

Unexplained hematuria during pregnancy: right-sided nutcracker phenomenon.

We report a case of hematuria in a pregnant patient caused by right renal vein hypertension, as a result of compression of right renal, the inferior caval and the right gonadal veins because of posterior displacement of the pancreas caused by the presence of the gravid uterus. Hematuria resolved after a cesarean delivery. This condition has not been, to our knowledge, previously described.

Adult↗