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PubMed1985

Subendocardial infarction in retrospect: pathologic, cardiographic, and ancillary features.

Fifty-three patients with subendocardial infarction (SEMI) were studied at autopsy; all were elderly and the group was equally divided by sex. About half had more than one SEMI; the recurrences or extensions often involved superjacent, but not infrequently adjacent, areas. Six showed fibrinous pericarditis. This larger study showed more widespread and severe coronary narrowing than an earlier report. Six patients had thrombi in the right coronary artery. Six showed electrocardiographic evidence of concomitant anteroseptal and inferior (Roesler-Dressler) infarction, and 12 had intraventricular block generally preceding higher-grade block or arrhythmias. At some time during their terminal hospitalization, 27 patients, or half, developed distinctive protracted RS-T depression or T wave inversion. Twenty-four of the SEMIs were diagnosed on accepted criteria as transmural infarct; that diagnosis was sustained in only four. Thus neither the presence of changes in RS-T segment or T wave nor the absence of QRS changes are mandatory for the diagnosis of SEMI; this invalidates the common assumption that the diagnosis is not justified unless these conditions are met.

Aged↗

PubMed1979

[Pathology of sudden extra-hospital death. 1. Obstructive lesions of the coronary arteries and myocardial scars].

The coronary arteries and myocardium were examined morphologically by special unified methods in 127 cases of prehospital sudden coronary death among Kaunas male population from 45 to 65 years of age. Obstruction of at least one of four major coronary arteries was severe (75% or more) in 90% of patients and moderate (50--75%) in the remaining 10%. In most cases one or two coronary arteries had severe obstruction (77% of cases) located predominantly in the proximal and middle segments of the left anterior descending and right coronary arteries. Post-infarction scars and small foci of myocardial sclerosis were found in 72% of hearts any may be considered as special "morphological catamnesis" of past acute coronary events. In 85% of cases the heart mass was more than 400 g. The data presented indicate the undoubted role of coronarogenic factors in the development of an acute terminal episode such as sudden death, the unexpectedness of which is only imaginary.

Aged↗

PubMedDate not supplied

Combined vascular and neurogenic claudication.

Eight patients with combined vascular and neurogenic claudication were presented. In the adult with coexistent neurospinal and vascular disease, a careful history and examination often suggested the pathology more productive of symptomatology. Among patients presenting with predominately vascular claudication, six of six patients had calf pain as part of the pain pattern, and in three of six patients the pain was crampy. Five of six patients had a consistent exercise tolerance pain pattern and obtained relief of symptoms by resting the leg. Among patients presenting with mainly neurogenic claudication. Only four of eight patients had associated calf pain, and none experienced crampy pain. Five of eight patients had a variable exercise tolerance pain pattern and obtained complete relief of symptoms only by assuming the recumbent position. Doppler testing was very helpful as the initial step in the evaluation of the significance of an arterial lesion and in the follow-up assessment of these patients after vascular surgery. Lumbosacral-spine, cardiovascular, and neurologic examination was similar in the two groups of patients.

Aged↗

PubMed2006

[Choanal stenosis: a rare complication of radiotherapy for nasopharyngeal carcinoma].

Choanal stenosis is usually a congenital anomaly in children. Acquired choanal stenosis after radiotherapy for nasopharyngeal carcinoma is a very rare pathology; only two publications report seven cases in the literature. We describe the clinical history, preoperative evaluation, surgical treatment and outcome of a case of acquired choanal stenosis after radiotherapy. The patient, a 56-year-old woman, presented with a history of nasopharyngeal carcinoma (T2- NO-MO) one year before that had been successful treated with radiotherapy (68 Gy). At the end of radiotherapy, she complained of complete nasal obstruction, anosmia and hearing loss due to a bilateral serous otitis media. Bilateral complete choanal stenosis was confirmed by endoscopy and CT scan. Functional endoscopic surgery was performed, and nasal stents were left in place for 3 weeks. One year after, the patient have good airflow, and a patent nasopharynx without choanal stenosis. In conclusion, choanal stenosis is an unusual complication of radiotherapy that can be successfully treated with transnasal endoscopic resection.

Carcinoma↗

PubMed2004

Major venous sinus resection in the surgical treatment of recurrent aggressive dural based tumors.

BACKGROUND: Despite gross total resection, aggressive dural based tumors invading major venous sinuses have high recurrence rates with poor long-term survivability. Options for aggressive surgical management of dural sinus invasion may be limited by the inherently high risk of morbidity and mortality. METHODS: Between July 1996 and July 2002, 5 cases of recurrent aggressive dural based tumors were operated on. Gross total resection had been previously performed in 4 cases, and near total resection in 1 case. Tumor pathology included 2 malignant meningiomas, 1 hemangiopericytoma, 1 atypical meningioma, and 1 benign meningioma with atypical features. All tumors recurred within 3 to 47 months and occluded a major venous sinus (four superior sagittal and one dominant right transverse sinus). Gross total resection of tumor and involved venous sinus was accomplished in each case. RESULTS: Three patients had no signs of clinical or radiographic recurrence at 10, 18, and 53 months of follow up. One patient who developed a fatal pulmonary embolism 10 months postoperatively had evidence of tumor progression on autopsy. One patient had tumor recurrence at 10 months, but is alive at 38 months and receiving adjunctive therapy. CONCLUSION: For aggressive dural based tumors that recur with invasion of a major venous sinus, radical resection of tumor and occluded sinus can be performed safely and may improve long-term survival.

Adult↗

PubMed1997

Postoperative ischemic jejunal stenosis treated with balloon catheter dilation and Wallstent implantation.

Ischemic stenosis of the jejunum is rare. For technical, anatomical, and pathological reasons, ischemic stenosis of the jejunal segment used for the replacement of the esophagus or the stomach, or both, represents a special entity. The present study reports a case of balloon catheter dilation of ischemic strictures of the jejunal segment, used for substitution after gastrectomy. In this patient, an occlusion of the blood vessels supplying the affected segment was observed at its aortic origin, and a Wallstent was implanted. A rare late complication, aortoesophageal fistula, appeared one year after placement of the Wallstent. The case presented in this study suggests that using balloon catheters and implanting a Wallstent may be a useful approach to the management of postoperative ischemic strictures of the jejunum in selected cases. The minimally invasive technique with special indications used here has not previously been described. The rare complication mentioned, however, requires special attention.

Aged↗

PubMed1989

[Female infertility due to tubal obstruction--management and clinicopathologic study of 66 cases].

Sixty-six cases of female infertility due to obstruction of fallopian tubes from December 1984 to June 1988 were analysed. A discrepancy of 28.8% existed between hysterosalpingography and operative findings, e. g. X-ray revealed blocked tubes, but during operation the tubes were found to be patent. The abnormal and marked tortuosity giving rise to resistance to the passage of oil at the ampullar portion of tubes in the majority of cases may be the explanation. Pathological examination of 48 specimens revealed the chief cause of obstruction was nonspecific infection (50.0%). The next tuberculous infection (31.3%). The third isthmic nodular salpingitis (6.25%) and the fourth endometriosis (4.2%). Operative procedures were done for the purpose of ovum pick-up and to treat the diseased tubes. Three cases of clinical pregnancy as the result of intra-operative ovum pick-up in a program of IVF/ET occurred after 1987 when our IVF technology gradually improved. This result suggests that operation on the tubes did not jeopardize the process of implantation. Among the 14 cases followed up for more than one year 3 cases became pregnant. Operations to relax and straighten up the tortuous part of the tubes or instillation of fluid into the tubes and transplantation of the healthy tube into the single horn uterus were effective. To do an anastomosis on the chronically inflamed and thickened tubes was not helpful.

Adult↗

PubMed2003

Iliac artery stenosis proximal to a kidney transplant: clinical findings, duplex-sonographic criteria, treatment, and outcome.

BACKGROUND: Stenosis of the iliac segment proximal to the transplant renal artery (Prox-TRAS) is an uncommon cause of graft dysfunction and hypertension. We assessed the role of duplex sonography (DS) in regard to clinical and angiographic findings and followed the patients after percutaneous transluminal angioplasty (PTA), PTA stenting (PTAS), or surgery. METHODS: From January 1988 to August 2001, 97 of 1,064 kidney recipients underwent angiography for clinical or Doppler-sonographic suspicion of vascular problems. Kidney function, blood pressure, medication, and DS findings after renal transplantation (RTx) at the time of diagnosis of Prox-TRAS and after treatment were evaluated. RESULTS: Prox-TRAS was diagnosed in 16 patients (1.5%) (49.6+/-6.9 years). Four patients demonstrated early presentation of Prox-TRAS 1 to 7 days after RTx (group A), leading to acute renal failure but without hypertension. In all patients, DS revealed pulsus parvus et tardus, low pulsatility index (PI) (<1.0), and a pathologic flow profile in the iliac artery proximal and distal to the graft. After treatment (surgery in two patients, PTA in one patient, PTAS in one patient), all patients developed good renal function (creatinine 1.7+/-0.9 mg/dL). PI increased from 0.9+/-0.1 to 1.2+/-0.1 (P=0.04), and flow profile within the iliac artery distal to the graft normalized. Late presentation (3-209 months after RTx) of Prox-TRAS was observed in 12 patients (group B), causing an increase of creatinine in 11 patients (two patients receiving dialysis treatments), impairment of blood pressure (141+/-15 and 80.7+/-7 to 160+/-18 and 85+/-7 mm Hg, P=0.009), and an increase in antihypertensive drugs (2.1+/-1.1 and 4.3+/-1, P=0.003) in all patients. The PI was decreased when compared with values early after RTx (1.6+/-0.4 to 1.2+/-0.3, P=0.007), and flow profile in the iliac artery was pathologic. All patients except one were managed by surgery (n=6), PTA (n=1), or PTAS (n=4). Creatinine (2.7+/-1.4 to 1.8+/-0.4 mg/dL, P=0.02) and blood pressure (160+/-18/85+/-7 mm Hg to 138+/-7/82+/-9, P=0.018) improved. Antihypertensive drugs were reduced to 2.8+/-0.8 (P=0.01). PI increased from 1.2+/-0.3 to 1.9+/-0.5 (P=0.01). Flow profile within the iliac artery distal to the graft anastomosis normalized. Kidney function, blood pressure, and PI remained unchanged during follow-up (82+/-69.9 months) in both groups. CONCLUSIONS: Prox-TRAS is rare. Because clinical symptoms are similar to those of transplant renal artery stenosis, DS is a valuable tool for diagnosis and follow-up for this type of vascular lesion. Selective treatment with PTA, PTAS, or surgery improves kidney function and hypertension.

Adult↗

PubMed1982

Mechanism of acquired right ventricular outflow tract obstruction in patients with ventricular septal defect: an angiocardiographic study.

Right ventricular outflow tract obstruction can complicate the natural history of patients with isolated ventricular septal defect. Although numerous pathologic mechanisms may be responsible for this phenomenon, it is less clear what the frequency is of each of these mechanisms in any cohort of patients studied in a single institution. We identified 20 patients with isolated ventricular septal defect from 1970 to 1981 who acquired a right ventricular outflow tract gradient of 25 mm Hg or more. They ranged in age at the initial catheterization investigation from 4 days to 23 months and at the subsequent study from 13 months to 8 years. Angiographically, 2 mechanisms were implicated in the 20 patients. Hypertrophy of right ventricular anomalous muscle bundles was identified in 19 of the 20 while hypertrophy of a malaligned infundibular septum (that is, classic tetralogy type) was identified in only 1 patient. These data indicate that acquired right ventricular outflow tract obstruction is rarely of the classic tetralogy type.

Aortic Valve↗

PubMedDate not supplied

[Pregnancy after hysterosalpingography and laparoscopy].

Pregnancies following hysterosalpingography (HSG) and laparoscopy (LPSK) are described. HSG was performed in 463 and laparoscopy in 255 patients if they did not conceive within 6 months following HSG. Group I included patients with bilaterally occluded tubes, group II patients with pathological changes in the tubes with one or both unobstructed tubes, and group III patients with normal HSG and LPSK findings. Group I included 79 patients, group II 163 and group III 221 patients after HSG, and group I 42, group II 118 and group III 95 patients after LPSK. After the application of both methods, pregnancy was to be expected only in patients from group II and III. During the year following HSG, out of 384 patients from groups II and III, 55 (14.3%) conceived, and following LPSK, out of 213 patients from groups II and III, 28 (13.1%) conceived. Following the applications of both methods, 83 (27.4%) patients from groups II and III conceived. The number of spontaneous pregnancies after HSG and LPSK is almost equal. It may therefore be assumed that it is only the mechanical activity of the perfusion liquid that has a therapeutic effect.

Adult↗

PubMed2001

Apoptosis in atherosclerosis: pathological and pharmacological implications.

Normal embryonic development, tissue differentiation and repair in the eukaryote requires a tightly regulated apoptosis, or programmed cell death. Apoptosis also plays an essential role in different pathological processes including atherosclerosis, in which it affects all cell types in the atherosclerotic lesion, including endothelial cells, vascular smooth muscle cells, and macrophages. During atherosclerosis progression, pro- and anti-apoptotic signals abound in the evolving lesion. Apoptosis limits the number of a particular cell type that accumulates in the lesion and slows down the overall progression of the lesion. On the other hand, it contributes to the production of unstable plaques. Many pharmacological agents used to treat cardiovascular and lipid disorders have pro- or/and anti-apoptotic effects. Pharmaceuticals that modulate apoptosis in specific types of cell can potentially serve as anti-atherogenic agents. However, to develop agents for clinical use requires a thorough knowledge of the pathophysiology of apoptosis in atheromatous lesions, a highly cell-specific process. Here we review our current understanding of the process to provide a background for future pharmacological research in the area.

Animals↗

PubMedDate not supplied

Overestimating the size of hepatic malignancy on helical CT during arterial portography: equilibrium phase CT and pathology.

PURPOSE: Overestimating the size of hepatic malignancy with helical CT during arterial portography (CTAP) can be a potential pitfall in determining liver resection area. We evaluated the prevalence and extent of overestimation of hepatic malignancy on CTAP in correlation with helical equilibrium phase CT (EPCT) and pathologic findings. METHOD: CTAP and EPCT in 47 histologically proven malignant hepatic tumors [33 hepatocellular carcinomas (HCCs) and 14 metastases] in 39 patients were retrospectively studied. Nineteen tumors were resected and pathologically evaluated. RESULTS: The size overestimation ratios (CTAP/EPCT) ranged from 1.02 to 1.56 (mean +/- SD 1.24 +/- 0.16) in HCC and from 1.00 to 2.48 (1.34 +/- 0.42) in metastasis. In 19 surgical specimens, the overestimation ratios (CTAP/specimen) ranged from 1.05 to 1.45 (1.20 +/- 0.13) in HCC and from 1.10 to 1.38 (1.22 +/- 0.10) in metastasis. Histopathologically, flattening of parenchymal structures (100%), atrophy of hepatic cords (95%), sinusoidal congestions (95%), fibrosis and ductular proliferation (58%), and no tumor were seen in peritumoral parenchyma corresponding to perilesional perfusion defects with CTAP. CONCLUSION: CTAP frequently and significantly overestimates the size of malignant hepatic tumors. This phenomenon is attributable to either benign histopathological changes in the perilesional liver parenchyma caused by parenchymal compression or portal venous obstruction by malignant liver tumors or to a siphoning effect by hypervascular neoplasms.

Adenocarcinoma↗

PubMedDate not supplied

MR sialography: initial experience using a T2-weighted fast SE sequence.

PURPOSE: The aim of this study was to evaluate an MR technique optimized for imaging of the parotid gland ductal system. METHOD: The pulse sequence was optimized in 10 volunteers to depict static or nearly static fluid in the parotid ductal system. A heavily T2-weighted fast SE sequence (TR 3,600 ms/TE 800 ms) with a slice thickness of 30-40 mm using an 8 cm surface coil allowed depiction of the fluid-filled parotid duct. Thirteen patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 2), sialadenosis (n = 3), Heerfordt syndrome (n = 1), pleomorphic adenoma (n = 2), parotid carcinoma (n = 1), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 2), and non-Hodgkin lymphoma (n = 1). RESULTS: The heavily T2-weighted projection image yielded good quality sialographic images. The main duct and primary branching ducts were clearly depicted in all normal cases. The main duct was visualized in all patients. Intra- and extraglandular duct widening and ductal strictures were well depicted. Sialolithiasis with a calculus in the main duct was correctly demonstrated in one case. CONCLUSION: MR sialography is noninvasive and does not depend on duct cannulation or contrast agent injection. Initial experience with a thick slice projection technique indicates that MR sialography can be successfully applied to image the parotid gland ductal system.

Adenolymphoma↗

PubMed1989

[True and false popliteal artery entrapment in sportsmen].

Popliteal artery entrapment and its various anatomical type I, II, III and IV has been perfectly described in previous studies. The only test that diagnoses true entrapment due to an anatomical abnormality in the course of the popliteal artery, where it is tied by an embryonic anomaly, is passive dorsiflexion of the foot on the extended leg the deviation then observed at ultrasonography and angiography and the disappearance of downstream signal at doppler examination are pathognomonic. Ultrasonography, computerized tomography (CT) and, more recently, nuclear magnetic resonance (NMR) provide detailed information on the abnormality: separation of the artery from the vein by a muscular bridge is the hallmark of true popliteal entrapment. On the other hand, there is a functional pathology due to dynamic compression of the popliteal artery by the medial gastrocnemius muscle, which raises difficult diagnostic and therapeutic problems, especially in high-level sportsmen for whom the leg muscle activity is very important. In these subjects with a developed muscular mass the medial gastrocnemius muscle crushes the popliteal artery against the femoral condyle without deviation of the artery, particularly in active dorsiflexion and activity hyperextension of the foot on the extended leg. In such case, the popliteal artery and vein remain close to each other, as demonstrated by ultrasounds, CT and NMR. True popliteal artery entrapment can be cured by surgery with subsequent resumption of sporting activities, but whether false entrapment must be operated is difficult to decide. Surgery has been performed with success in some cases of highly disabling false entrapment due to compression of the artery by the medical gastrocnemius muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Pathological features of Crohn's disease determining perforation.

Even if Crohn's disease (CD) stenoses are related to perforating complications, such as abscess or fistula, it remains unclear why only some stenoses lead to such complications. We have studied the surgical specimens in 94 cases of CD to characterize the anatomical features of stenosis. We found no differences between group A (patients with perforation) and group B (noncomplicated patients) as far as extent of lesion, number of stenoses, and the caliber of the stenotic bowel. In CD of the ileum, the wall thickness of the stenoses was significantly different: 12.0 +/- 3.4 mm in group A and 7.6 +/- 3.1 mm in group B (p less than 0.001). In colonic CD, the length of stenosis was significantly greater in patients with perforation. Duration of symptoms, age at surgery, and sex did not correlate with the increased thickness or with perforating complications. These observations suggest that the fibrotic gastrointestinal tract, poorly distensible, may increase the intraluminal pressure above the stenosis and in this way squeeze bowel content through mucosal fissures of the inflamed bowel. Evaluation and monitoring of wall thickness may help in prompting surgery before the disease is complicated by perforation.

Adult↗

PubMed2004

The role of ultrasonography in recognizing the cause of fetal cerebral ventriculomegaly.

Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign common to several pathological entities carrying different prognoses. The main causes of fetal ventriculomegaly are aqueductal stenosis, Chiari II malformation, Dandy-Walker complex and agenesis of the corpus callosum. Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of mild forms of ventricular dilatation and is used as a screening method for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. To this end, the evaluation of the posterior fossa in association with the visualization of the corpus callosum is a useful landmark. Research into the cause of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated anomalies. In this article the role of prenatal sonography in recognizing the cause of ventriculomegaly and the prognostic value of the prenatal sonographic findings are discussed.

Agenesis of Corpus Callosum↗

PubMedDate not supplied

[Specificity and sensitivity of ERCP in pancreatic pathology].

Fifty-three patients were examined by endoscopic retrograde cholangiopancreatography (ERCP). Operative and/or instrumental-clinical findings indicated that 38 patients had pancreatic disease, consisting of 17 cases of neoplasia, 10 of chronic pancreatitis with benign stenosis, and 11 of chronic pancreatitis without stenosis. An analysis of Wirsung's duct and of the secondary ducts was carried out employing, in the latter case, linear discriminate analysis (Nix and Schmitz method). With this method, 16 of 17 patients (94%) were correctly assigned to group A (pancreatic neoplasia), thus indicating high sensitivity; 7 of 8 patients (88%) were assigned to group B (chronic pancreatitis with benign stenosis), and finally 7 of 10 patients (70%) were placed in group C (chronic pancreatitis without stenosis). Detection of a sample sign such as sharp and/or irregular stenosis of Wirsung's duct enabled a correct diagnosis of neoplasia in the cases examined; this criterion, however, is very specific but poorly sensitive. When it is absent, analysis of the secondary ducts is determinant. If the two criteria are applied together, an exact diagnosis of all forms of neoplasia is obtained.

Acute Disease↗

PubMed1987

Computed tomography of aortoiliac atherosclerosis.

Twenty-three patients with atherosclerotic peripheral vascular disease underwent angiography and CT of the aortoiliac segment within a 72-hour interval. Examinations were evaluated for depiction of disease in the aortic and iliac segments in five categories: stenosis, plaque morphology, vascular ectasia, calcification, and other pathologic conditions. Angiography and CT were equally accurate in their depiction of the degree of aortic stenosis or occlusion and in identification of aortic ectasia. Angiography proved superior to CT in the display of plaque morphology in 57% of aortic lesions and 74% of iliac abnormalities. Angiography also showed clear superiority over CT in quantification of iliac stenosis in 75% of patients with abnormalities, as well as in identification of iliac ectasia. CT detected both intimal calcification and incidental disease or congenital abnormalities better than angiography, including an unsuspected chronic contained aortic rupture. Overall, CT compared favorably with angiography in the identification of all types of aortic disease but major disadvantages of CT were evident in the iliac segment because of vessel tortuosity or heavy calcification. CT cannot replace arteriography in detecting atherosclerotic disease of the aortoiliac segment but can help to clarify angiographic findings in selected groups of patients.

Angiography↗