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PubMed2004

[Endoscopic, pathologic-anatomic and histologic findings in the bovine teat. 2. Changes in the area of Fürstenberg's rosette].

In the present study endoscopically diagnosed changes of the Fürstenberg's rosette were examined histologically. For this purpose the teats of 200 slaughtered cows were inspected. In 19 cases proliferations in the region of the Fürstenberg's rosette were found. Additionally, tissue samples were taken from the Fürstenberg's rosette of 26 cows which showed milk flow disorders due to stenoses of this part of the teat. Teats of slaughtered cows as well as biopsy specimens were fixed in 5% formaldehyde and embedded in paraffin and in plastic. All specimens were stained according to H.E., Giemsa and Turnbull, respectively. Histologically, the proliferations of the Fürstenberg's rosette consisted of fibrovascular tissue (granulation tissue) covered by keratinized squamous epithelium (teat canal epithelium) in eleven cases. In the other cases double-layered cuboid epithelium (cisternal epithelium) was found additionally. The formation of granulation tissue and deposition of blood pigment was observed exclusively in areas covered by stratified epithelium. Therefore a traumatic lesion of the teat canal was supposed to be the cause of the histological findings. In contrast to several reports in the literature, however, no indications of an inversion of the teat canal epithelium were found. On the basis of these findings, the hitherto assumed idea of pathogenesis of proliferations of the Fürstenberg's rosette was modified and a new pathogenesis pattern was developed.

Animals↗

PubMed1994

Endoscopic procedures through the foramen interventriculare of Monro under stereotactical conditions.

The foramen interventriculare of Monro is an anatomical narrowness for the endoscopic access to the third ventricle. The effective mechanical angle to pass the foramen interventriculare from a frontal bore hole depends on the diameter in the plane of entrance, the depth of the foramen, and the diameter of the endoscope. Under the pathological conditions of a hydrocephalus internus the foramen interventriculare is enlarged. By means of stereotactical guidance, it is possible to reach the third ventricle accurately without damaging anatomical structures around the foramen interventriculare. The endoscopic technique under stereotactical guidance using a rigid endoscope is sufficient and safe to perform ventriculostomies in cases of hydrocephalus occlusus. Best clinical results were obtained in patients with benign aqueduct stenosis or with a tumor in this region compressing the aqueduct. In all patients no further shunt operation was necessary. The path through the foramen interventriculare should be considered also for biopsies in the third ventricle. Calculation of the foramen interventriculare trajectory prevents perforation of the roof of the third ventricle containing the main deep veins. Lesions in the foramen interventriculare like colloid cysts can also be approached very accurately by means of stereotactical calculation. However the endoscopic technique with the at present obtainable instruments does not allow removal of the whole lesion. Even so a free passage to the third ventricle can be achieved by reducing the size of the cyst by means of coagulation and sucking off the colloid material.

Adolescent↗

PubMed1998

Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.

OBJECTIVE: The purpose of this study was to investigate the use of breath-hold single-shot fast spin-echo MR cholangiopancreatography in neoplastic pancreaticobiliary duct obstruction. MATERIALS AND METHODS: Breath-hold MR cholangiopancreatography was performed for preoperative examination of 32 consecutive patients with pathologically confirmed neoplastic obstruction of the biliary tract or pancreatic duct using a single-shot fast spin-echo sequence. Two observers, unaware of clinical or pathologic findings, independently reviewed the MR cholangiopancreatograms to assess level of obstruction and site of underlying tumor. Pathologic diagnoses, based on surgical or CT-guided biopsy specimens, were pancreatic tumor (n = 12), gallbladder cancer (n = 9), intrahepatic cancer (n = 9), and ampullary cancer (n = 2). RESULTS: On the basis of conventional cholangiography, CT, and surgical findings, 20 patients had isolated bile duct obstruction, 11 patients had combined pancreatic and bile duct obstruction, and one patient had isolated pancreatic duct obstruction. Isolated bile duct obstruction was classified as lobar (n = 5), hilar (n = 12), or distal (n = 3). These levels of obstruction were correctly identified in 27 (84%) and 28 (88%) of the 32 cases by the two observers. The site of the underlying tumor was identified in 27 (84%) and 29 (91%) cases by the two observers. Good interobserver agreement was reached for both level of obstruction (kappa = .70) and identification of tumor site (kappa = .75). CONCLUSION: Breath-hold single-shot fast spin-echo MR cholangiopancreatography is accurate in identifying the level of obstruction and the site of underlying tumor in neoplastic pancreaticobiliary duct obstruction, with good interobserver agreement.

Adult↗

PubMed1984

[Ultrasound and atheromatous disease : current contribution of Doppler spectrum analysis in carotid stenoses].

The carotid bifurcation plaque is a common pathology. Specific pathologic atheromatous findings have been studied in three hundred patients-carotid bifurcations. This study was carried with the Doppler technics and especially the spectral analysis of the Doppler. From that study it appeared that the most frequent disturbances could be classified according five grades, corresponding to the importance of the stenosis. The first grade corresponds to a stenosis responsible of an obstruction less than 40% of the vessel. The second one is a stenosis from 40% to 60% of the lumen. The third grade is the witness of a extended plaque and a stenosis between 60% to 75%. The fourth grade corresponds to a stenosis between 60% and 90%. The fifth grade is a stenosis superior to 90% of the surface of the artery, also called pre-occlusive grade. This ultrasonic method has been compared to the data provided by the angiography, the echotomography and the anatomopathology. The correlation is excellent in the three cases, and is of 95%. The authors emphasize that this method is the most accurate among the non invasive investigations and let hope that it might replace the traumatic ones in the future.

Arteriosclerosis↗

PubMed1995

Retrograde pancreatography. Technical tips and spectrum of pathology.

ERP is an important technique in the diagnosis of diseases involving the pancreatic ducts, in determining therapeutic strategy, and in assessing the results of surgical bypass procedures. ERP facilitates the diagnosis of the majority of pancreatic tumors at a stage when they normally present to the clinician. It assists the diagnosis of small tumors in the ampullary region at an early stage when other tests are negative. In cases of obscure recurrent pancreatitis, ERP may identify a mechanical cause (e.g., stone, stricture). ERP is useful in the diagnosis of CCP only in the precalcified stage. If histologic confirmation already has been obtained at surgery, ERCP is not required. Compared with noninvasive techniques, ERP provides additional information: It enables a concomitant examination of the gastroduodenal tract and opacification of the bile ducts; additional procedures may be performed, such as intraductal cytologic brushings, biochemical and cytologic analysis of pancreatic juice, endoscopic manometry, and pancreatoscopy. The diagnostic yield is increased if these procedures are performed during ERCP. Because ERP outlines the ductal anatomy, it is of great value in assessing therapeutic strategy. In cases of acute recurrent pancreatitis or chronic pancreatitis, ERP provides an important baseline for performing procedures such as ductal drainage and therefore reduces the inappropriate use of exploratory laparotomy. In cases of necrotic pancreatitis or pancreatic trauma, ERP enables accurate localization of a pancreatic fistula and facilitates any subsequent surgical procedure. Finally, ERP is the method of choice when assessing the patency of pancreatic-digestive anastomosis.

Acute Disease↗

PubMed2002

Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology.

BACKGROUND: Experience with Ultraflex expandable metallic stents (Micro-invasive, Boston Scientific, Watertown, MA) in the management of endobronchial pathologies leading to airway compromise is reported. METHODS: Between January 1999 and August 2000, twenty-eight expandable metallic stents were inserted into 25 patients (7 men and 18 women; median age, 65 years) who presented with respiratory distress. Each patient had comorbid medical conditions or end-stage malignancy that precluded formal surgical repair. Seventeen patients had intrinsic airway obstruction, 5 had extrinsic compression, 2 had a tracheal tear, and 1 had a tracheoesophageal fistula. Stents were inserted through a bronchoscope under direct vision. Eighteen patients received tracheal stents alone (1 of these patients received two tracheal stents), and 5 patients received bronchial stents only. Two patients received a tracheal and a bronchial stent. Twenty-one stents were covered and seven were uncovered. RESULTS: All patients had successful stents with restoration of airway patency and closure of tracheal defects. One patient developed a respiratory infection early after the operation. Follow-up bronchoscopy confirmed satisfactory stent position in each patient. Late complications included sputum retention, halitosis, and granulation tissue formation. CONCLUSIONS: Ultraflex expandable metallic stents should be considered in the management of airway compromise in selected patients for whom formal surgical repair is inappropriate or contraindicated.

Aged↗

PubMed1984

Identification of mechanical asphyxiation in cases of attempted masking of the homicide.

Five homicides are described that had remained unexplained as to the causes of death after gross pathology. Although general signs of asphyxiation were present, they were lacking injuries specific of strangulation or oro-nasal occlusion. The diagnoses of asphyxiation were established by microscopical investigation of the lung and confirmed by subsequent police inquiries. An oro-nasal occlusion was involved in three cases, a strangulation or an oro-nasal occlusion, in another case. The victims were young and healthy. Toxicological investigations remained negative in four cases; one victim was anaesthetized by bromazepam and ether and had a blood alcohol concentration of 80 mg/100 ml. Lung histology and electron microscopy revealed acute emphysema, the development of a haemorrhagic-dysoric syndrome and a microembolism syndrome. With regard to the haemorrhagic-dysoric syndrome, the development of alveolar-interstitial edema is particularly important. This finding may also be diagnosed by light microscopy in semi-thin sections. It is emphasized that the combined action of several pathomechanisms is responsible for the rapid manifestation of the pulmonary lesions. Especially, the haemorrhagic-dysoric syndrome is brought about by the combined action of inspiratory intrapulmonary vacuum and raised intracapillary pressure. The complex pattern allows to compile the diagnosis of mechanical asphyxia even if there is no corresponding injury.

Adolescent↗

PubMed2001

Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology?

OBJECTIVE: To describe the pathology-specific response to transurethral resection of ejaculatory ducts (TURED) in patients with complete or partial ejaculatory duct obstruction and to evaluate the role of TURED in light of powerful assisted reproductive technologies. DESIGN: Retrospective clinical study. SETTING: University hospital. PATIENT(S): Thirty-eight infertile men with obstruction of the ejaculatory ducts. INTERVENTION(S): Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED. MAIN OUTCOME MEASURE(S): Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery. RESULT(S): Improvement in semen variables was significantly better in patients with partial obstruction (94%) of ducts than in those with complete obstruction (59%) (P=.04). Cystic obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI. CONCLUSION(S): Ejaculatory duct obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.

Adult↗

PubMed2000

Pathological effects of extensive radiofrequency energy applications in the pulmonary veins in dogs.

INTRODUCTION: The long-term complications of catheter ablation within the pulmonary veins are unknown. The development of pulmonary vein stenosis has recently been described after catheter ablation to treat either chronic or paroxysmal atrial fibrillation. The purpose of this study was to examine the pathological and hemodynamic effects of radiofrequency (RF) energy application within the pulmonary veins. METHODS AND RESULTS: Right heart and transseptal catheterization were performed in 9 anesthetized mongrel dogs. The pulmonary vein ostia were cannulated and pulmonary venous pressure was measured before RF energy application in up to 4 separate pulmonary veins. Animals were euthanized at intervals of 2 to 4 weeks (n=3), 6 to 8 weeks (n=3), or 10 to 14 weeks (n=3) after ablation. Repeat catheterization before euthanasia demonstrated statistically significant differences in pulmonary capillary wedge pressure, cardiac output, pulmonary vascular resistance, and systemic vascular resistance (P<0.05) compared with the baseline. Luminal narrowing was observed in 22 of 33 pulmonary veins to which RF energy was applied. Of these, 7 were totally occluded, 7 had severe stenosis, and 8 were only minimally narrowed. Histological examination revealed intimal proliferation with organizing thrombus, necrotic myocardium in various stages of collagen replacement, endovascular contraction, and a proliferation of elastic lamina. CONCLUSIONS: Applications of RF current within the pulmonary veins may result in pulmonary vein narrowing or complete occlusion. These observations should be considered in treatment of arrhythmias originating within the pulmonary veins.

Animals↗

PubMedDate not supplied

[Diagnostic value of hysterosalpingography in examination of Fallopian tubes in infertile women].

UNLABELLED: Hysterosalpingography (HSG) is a radiographic examination of endocervical canals, uterine cavity and Fallopian tube with the use of a radiographic contrast medium [1]. This method is an integral part of gynaecological examination and its value has not been underestimated in the modern gynaecological practice. GOAL OF THE STUDY: The goal of the study was to evaluate the reliability of HSG in the diagnosis of Fallopian tube and to compare the obtained results with laparoscopic findings. METHODS: The study included 140 infertile women. HSG was performed in the first half of the cycle, usually on the ninth day, without anaesthesia. The instruments after Schultze were used; 15 mL of Telebrix-contrast was used. Three radiograms were done. Laparoscopic examination was carried out in general endotracheal anaesthesia. A Storz laparoscope was used. CO2 was used for artificial pneumoperitoneum and indigolipstick for tube passage. The obtained findings were elaborated statistically. Descriptive and analytic models were used. p < 0.05 and p < 0.01 were considered as a risk factor of statistical significance. RESULTS: An approximate time interval between the two procedures was 5.18 months. Normal findings of HSG examination were noted in 53 women (37.9%); tube occlusion in 67 women (47.9%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. A normal finding was found in 56 women (40.0%), tubal occlusion in 64 women (45.7%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. HSG and laparoscopic findings regarding normal tubes were in agreement in 32 women (22.9%), tubal occlusion in 35 women (25.0%) and peritabal adhesion with tubal passage in 5 (3.6%) patients. The best sensitivity of HSG was observed in detection of proximal tubal occlusion (78%), and the smallest in occlusion with the accompanying adhesion (2%). The best specificity of HSG was noted in the diagnosis of combined occlusions (96%) and the smallest in tubal passage with peritubal adhesion (25%). There were 15% of false negative findings and 17.1% of false positive findings. DISCUSSION: The time interval from one to the other procedure can be considered as an important factor in laparoscopic confirmation or negative HSG findings. With the continuation of the time interval the conditions are made for the aggravation of old and occurrence of new pathological processes in genital internal female organs. The possible causes of differential diagnosis of tubal occlusion between HSG and laparoscopic examination might be: 1) unequal anaesthesia during HSG and laparoscopic examination; 2) different properties of contrast media; 3) anatomic variations in the width of lumen tubes; 4) erroneous interpretation of the results. The sensitivity of HSG in this study was different in various types of tubal passage. In other studies the sensitivity of HSG was from 65% [10] to 96%[7]. The high specificity was found during detection of combined tubal occlusion (96%). The results of other authors were similar [7, 10]. This is a good contribution to the statement that HSG is a useful test of tubal obstruction. A rather high percent of false positive results of HSG was established in this study. The possible reasons might be tubal spasm and endometrial polyp in the area of the uterine opening of the tubes. CONCLUSION: On the basis of the obtained results, the following conclusions can be drawn: 1) HSG is a simple method for examination of female sterility; 2) HSG and laparoscopy are the complementary methods in the examination of tubal sterility; 3) HSG is inferior in relation to laparoscopy in the examination of peritubal adhesion.

Constriction, Pathologic↗

PubMedDate not supplied

[Diagnostic value of hysterosalpingography in examination of fallopian tubes in infertile women].

UNLABELLED: Hysterosalpingography (HSG) is a radiographic examination of endocervical canals, uterine cavity and Fallopian tube with the use of a radiographic contrast medium [1]. This method is an integral part of gynaecological examination and its value has not been underestimated in the modern gynaecological practice. GOAL OF THE STUDY: The goal of the study was to evaluate the reliability of HSG in the diagnosis of Fallopian tube and to compare the obtained results with laparoscopic findings. METHODS: The study included 140 infertile women. HSG was performed in the first half of the cycle, usually on the ninth day, without anaesthesia. The instruments after Schultze were used; 15 mL of Telebrix-contrast was used. Three radiograms were done. Laparoscopic examination was carried out in general endotracheal anaesthesia. A Storz laparoscope was used. CO2 was used for artificial pneumoperitoneum and indigolipstick for tube passage. The obtained findings were elaborated statistically. Descriptive and analytic models were used. p < 0.05 and p < 0.01 were considered as a risk factor of statistical significance. RESULTS: An approximate time interval between the two procedures was 5.18 months. Normal findings of HSG examination were noted in 53 women (37.9%); tube occlusion in 67 women (47.9%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. A normal finding was found in 56 women (40.0%), tubal occlusion in 64 women (45.7%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. HSG and laparoscopic findings regarding normal tubes were in agreement in 32 women (22.9%), tubal occlusion in 35 women (25.0%) and peritubal adhesion with tubal passage in 5 (3.6%) patients. The best sensitivity of HSG was observed in detection of proximal tubal occlusion (78%), and the smallest in occlusion with the accompanying adhesion (2%). The best specificity of HSG was noted in the diagnosis of combined occlusions (96%), and the smallest in tubal passage with peritubal adhesion (25%). There were 15% of false negative findings and 17.1% of false positive findings. DISCUSSION: The time interval from one to the other procedure can be considered as an important factor in laparoscopic confirmation or negative HSG findings. With the continuation of the same time interval the conditions are made for the aggravation of old and occurrence of new pathological processes in genital internal female organs. The possible causes of differential diagnosis of tubal occlusion between HSG and laparoscopic examination might be: 1) unequal anaesthesia during HSG and laparoscopic examination; 2) different properties of contrast media; 3) anatomic variations in the width of lumen tubes; 4) erroneous interpretation of the results. The sensitivity of HSG in this study was different in various types of tubal passage. In other studies the sensitivity of HSG was from 65% [10] to 96% [7]. The high specificity was found during detection of combined tubal occlusion (96%). The results of other authors were similar [7, 10]. This is a good contribution to the statement that HSG is a useful test of tubal obstruction. A rather high percent of false positive results of HSG was established in this study. The possible reasons might be tubal spasm and endometrial polyp in the area of the uterine opening of the tubes. CONCLUSION: On the basis of the obtained results, the following conclusions can be drawn: 1) HSG is a simple method for examination of female sterility; 2) HSG and laparoscopy are the complementary methods in the examination of tubal sterility; 3) HSG is inferior in relation to laparoscopy in the examination of peritubal adhesion.

Constriction, Pathologic↗

PubMed2004

Nonocclusive mesenteric ischemia after cardiopulmonary bypass.

Nonocclusive mesenteric ischemia (NOMI) is a rare abdominal pathology caused by mucosal hypoperfusion without actual obstruction to the mesenteric arteries. We present a case of NOMI after a cardiopulmonary bypass operation. The patient was a 79-year-old woman with a history of hypertension and diabetes mellitus. A coronary bypass operation was performed with stable hemodynamic conditions, and continuous venovenous hemodialysis was performed on the second postoperative day because of renal insufficiency. After 24 h of hemodialysis, the hematocrit level increased from 29.1% to 36.1%. The patient had some vague abdominal pain on the third postoperative day with abnormal laboratory values: leukocytes 17.10 x 10(3)/microl, creatine kinase 1085 U/l, glutamic-oxyloacetic transaminase 6188 U/l, and lactate dehydrogenase 8695 U/l. Selective angiography showed diffuse stenosis of the superior mesenteric artery (SMA) without any occlusive findings on the major branches; the patient was therefore diagnosed with NOMI. An infusion of urokinase and prostaglandin E1 was started; however, disseminated intravascular coagulopathy had developed and the patient died on the 21st postoperative day as a result of multiple organ failure. The autopsy demonstrated extensive necrosis and hemorrhage in the small intestine without any occlusive findings on the major branches of the SMA.

Aged↗

PubMed1999

An audit of gastroduodenal Crohn disease: clinicopathologic features and management.

BACKGROUND: This study was undertaken to assess the clinicopathologic features and management of gastroduodenal Crohn disease. METHODS: The medical records of 54 patients with gastroduodenal Crohn disease treated between 1958 and 1997 were reviewed. RESULTS: Gastroduodenal Crohn disease occurred in association with disease elsewhere in 52 patients (96%). The commonest pathology was stricture (n = 41), followed by ulceration (n = 4) and duodenocutaneous fistula (n = 2). Medical treatment was initially attempted in 31 patients, of whom 12 required no surgical treatment for gastroduodenal disease. Nineteen patients required surgery for gastroduodenal obstruction or fistula despite medical treatment. Overall, 33 patients (61%) required surgery; the indication was obstruction in 30, duodenocutaneous fistula in 2, and bleeding in 1. There was one postoperative death because of persistent bleeding and intraabdominal sepsis after oversewing of a bleeding ulcer. In obstructive disease 16 patients were treated by bypass surgery, 10 by strictureplasty, and 4 by gastrectomy. After surgery for obstructive disease anastomotic leak developed in three patients, and persistent gastric outlet obstruction was seen in six patients. In the long term 11 patients required reoperation for anastomotic obstruction (n = 9) or stomal ulceration (n = 2). For duodenocutaneous fistula one patient underwent simple closure of fistula, and the other patient duodenojejunostomy. Both of these patients developed an intra-abdominal abscess without evidence of leak. There has been no fistula recurrence. CONCLUSIONS: Gastroduodenal Crohn disease is a complex and difficult problem that is associated with serious complications and need for reoperation.

Adolescent↗

PubMed2005

[Study on inhibiting the intimal hyperplasia after rabbit artery injury by local transfection of tissue-type plasminogen activator gene].

AIM: To observe the effects of local transfection of tissue-type plasminogen activator(tPA) gene on intimal hyperplasia of right external iliac artery in rabbits after operation injury, and its possible mechanism. METHODS: Microsurgery injury was used to establish the intimal injury model of right external iliac artery in rabbits. 105 male New zealand rabbits were randomly divided into 3 groups (35 rabbits each group). Group A was normal saline control group, group B was pBudCE4.1-transfected group, and group C was pBudCE4.1/tPA-tansfected group. The normal saline, pBudCE4.1 and pBudCE4.1/tPA transfection solutions were injected into injured vessel walls. Each group was again divided into five subgroups (7 rabbits each subgroup) which were sacrificed at different time (2 d, 3 d, 7 d, 14 d and 28 d after operation). The injured vascular specimens were then harvested for pathologic examination, electron microscope observation, RT-PCR and immunohistochemical staining detection. RESULTS: The intimal thickness and area of vessel walls in group C at every time points after operation were significantly less than those in group A and group B (P<0.01). The stenosis rate of vessels in group C at 28 days after operation decreased by 51.5% and 54.2%, respectively, as compared with groups A and B. The expression of tPA mRNA in group C was significantly higher than that in groups A and B at every time points after operation (P<0.01), reaching the peak at 7 days. The scanning electron microscope examination showed that there were a few thrombocytes adhering to vessel walls in group C but no thrombus, whereas a lot of thrombocytes and thrombi on vessel walls in groups A and B. Immunohistochemical staining exhibited that platelet-derived growth factor (PDGF)-positive cells in the vessels of group C were significantly more than those in group A and B (P<0.01). CONCLUSION: Local transfection of tPA gene can inhibit hyperplasia of neo-intima and prevent restenosis, which is proof of concept for gene therapy of intimal hyperplasia.

Animals↗

PubMed2005

Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma.

BACKGROUND: Nontraumatic inflammatory hilar strictures are uncommon, but are known to mimic malignancy. This study examines the clinical and pathologic features of benign idiopathic strictures. STUDY DESIGN: Patients without a history of trauma or earlier biliary operation treated for benign strictures were identified. Clinical information was obtained from the medical record and all resected specimens were reexamined. RESULTS: From January 1992 to July 2003, 275 patients with proximal biliary strictures were referred. Among these, 22 patients had a final histologic diagnosis of benign stricture, despite a suspected preoperative diagnosis of malignancy. All 22 patients underwent resection of the extrahepatic biliary tree, which in 10 patients was combined with en bloc partial hepatectomy. Histologic reexamination identified five different benign processes: lymphoplasmacytic sclerosing pancreatitis and cholangitis, primary sclerosing cholangitis, granulomatous disease, nonspecific fibrosis/inflammation, and stone disease. Major postoperative morbidity occurred in 6 (26%) patients but none died. No preoperative clinical or radiographic features were identified that could reliably distinguish patients with benign strictures from those with cancer. CONCLUSIONS: "Malignant masquerade" of the proximal bile duct results from several different underlying conditions, and differentiating benign strictures from cancer remains problematic. The treatment approach should continue to be resection for presumed malignancy.

Adolescent↗

PubMed1988

[Magnetic resonance of the thoracic aorta].

Various pathological conditions of the thoracic aorta were studied by MR Imaging in 31 patients: 23 were aneurysms (branching and non-branching), 2 arterio-venous fistulae, 2 aortic prostheses, 2 Marfan's syndromes, 1 coronary sinus aneurysm, and 1 isthmic stenosis. MRI studies were always performed on patients who had been examined by other imaging procedures. A comparative study was carried out on the results of MRI, angiography, computerized tomography, and ultrasounds. The possibility of propedeutic protocol was explored. Our experience, in accordance with the literature on the subject, indicates MRI as the procedure of choice in the study of aneurysms of the thoracic aorta. The advantages offered by MRI--the high natural contrast between circulating blood and the supporting structures, the possibility of obtaining multiplanar images as well as data on intraluminal, parietal, and extraparietal conditions--make it a highly competitive procedure if compared to either CT or angiography. While awaiting further evidence, the use of a propedeutic protocol in non-aneurysmatic diseases is still not advisable, due to insufficient patient population, and to the lack of a consistent literature on the subject.

Adult↗

PubMedDate not supplied

The treatment of fistulae and ureteral stenosis after kidney transplantation.

INTRODUCTION: The incidence of urological complications after kidney transplantation varies from 3% to 14%, with a probable loss of the graft in 10% to 15% of cases and a mortality rate of up to 15%, despite improvements in prevention, diagnosis, and treatment as well as the use of new immunosuppressive therapies. Urinous fistulae, which are considered early complications of transplantation, are due to ischemic damage or necrosis generally occurring in the distal third of the ureter. Preservation of accessory arteries to the lower portion of the kidney is important, as they may constitute the blood supply of this segment of the collecting system or ureter. Their ligation may lead to necrosis and urinary fistulae. Ureteral stenosis, as late complication, is related to a pathology of the ureter itself, to infections, to abscesses, to fibrosis, and to ischemia. An early endoscopic approach permits resolution in 70% of cases. The aim of this retrospective study was to determine incidence and treatment of these complications. MATERIALS AND METHODS: From 1991 to 2004 we performed 453 kidney transplantations both from cadaveric and living donors. In 199 patients we performed a transvesical ureteroneocystostomy (UNCS), and in 260, an extravesical UNCS. RESULTS: The nine patients who showed fistulae (1.9%) underwent surgical treatment. In eight we used a direct ureteral reimplantation, and in one, a Boari flap technique. Nephrectomy was necessary in four patients, including two who died of septic complications. In all 26 cases of ureteral stenosis (5.6%), we used an endourological approach (anterograde or retrograde), with surgical treatment afterward in 11 patients (42%) nine direct reimplants, one anastomosis to the native ureter (transplantation from a living donor), and in one case a Boari flap technique four patients who underwent surgical treatment showed progressive damage to graft function. CONCLUSIONS: In all patients who showed fistulae we suggest surgical review: for patients with ureteral stenosis, we suggest first an endourological approach and only when it is not successful do we consider surgical treatment.

Constriction, Pathologic↗

PubMed2004

Fibrosis and stenosis of the long penetrating cerebral arteries: the cause of the white matter pathology in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

In cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) the vascular smooth muscle cells are destroyed and granular osmiophilic material is deposited followed by fibrosis of the arterial wall. To verify whether true stenosis of the fibrotic white matter arteries is a key pathogenic event in CADASIL, we analyzed the thickness of walls (expressed as sclerotic index) and luminal diameters of penetrating arterioles in both grey matter and white matter of four CADASIL patients due to the C475T (R133C) mutation in the Notch3 gene and in 9 age-matched controls. We also reconstructed 9 arterioles from 1000 serial sections in two CADASIL patients. The thickness of the arteriolar walls in both grey matter and white matter was significantly increased in the CADASIL patients compared with controls. Furthermore, in CADASIL patients the arteriolar walls were significantly thicker in the white matter than in the grey matter. The distribution curve of arteriolar internal diameters in CADASIL patients shifted towards smaller sizes. In serial sections, the marked increase in the thickness of the white matter penetrating arterioles or their branches did not occur until the internal diameters had decreased to about 20 to 30 pm and external diameters to about 100 to 130 microm. In conclusion, long penetrating arterioles and their branches supplying subcortical structures in CADASIL are stenosed and their walls are thickened. This conforms to the abundance of infarcts and primary ischemic damage in CADASIL patients' white matter.

Actins↗