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PubMed1988

Intestinal ischemia: comparison of plain radiographic and computed tomographic findings.

This article illustrates the radiographic and CT findings in 14 patients with proved intestinal ischemia or infarction. Gaseous bowel distention, thumbprinting and pneumatosis were the most frequent radiographic findings; intestinal distention, thickening of the bowel wall, engorgement of mesenteric vessels, and pneumatosis, the most frequent CT findings. The authors conclude that CT offers major advantages for evaluating patients suspected of having intestinal ischemia or infarction.

Adult↗

PubMed2002

Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience.

PURPOSE: To evaluate the utility of curved planar reformations compared with standard transverse images in the assessment of pancreatic tumors. MATERIALS AND METHODS: Forty-three patients suspected of having pancreatic tumors underwent contrast material-enhanced biphasic multi-detector row computed tomography (CT). Curved planar reformations were generated along the pancreatic duct, common bile duct, and major mesenteric vessels. Three blinded independent readers assessed the curved planar reformations and transverse images separately for the presence of tumor, resectability, and vascular involvement. The results were compared with those of a consensus panel who evaluated the curved planar reformations and transverse images together along with clinical data and surgical findings. RESULTS: Of 43 patients, 20 had pancreatic malignancies as judged by the consensus panel and proven at biopsy and/or clinical follow-up. For tumor detection, transverse images and curved planar reformations had an average sensitivity of 95.0% and 98.4% (P >.05), respectively, and an average specificity of 90.9% and 91.3% (P >.05), respectively. For tumor resectability, transverse images and curved planar reformations had an average sensitivity of 85.7% and 71.4% (P >.05), respectively, and an average specificity of 85.2% and 84.3% (P >.05), respectively. Average interpretation time was 6.4 minutes with transverse images and 4.1 minutes with curved planar reformations. CONCLUSION: Curved planar reformations are equivalent to transverse images in the detection of pancreatic tumors and determination of surgical resectability.

Adenocarcinoma↗

PubMed2003

Segmental misty mesentery: analysis of CT features and primary causes.

PURPOSE: To review the computed tomographic (CT) features of segmental misty mesentery (SMM) in 29 patients and assess the primary causes of this CT finding. MATERIALS AND METHODS: The authors analyzed the medical records and CT features of SMM in 29 patients. CT images were evaluated for the site, thickness, and vascular changes of the involved mesentery; bowel wall changes; lymphadenopathy; and the fat ring sign. The primary cause of SMM in five patients was determined at histopathologic examination, that in three patients was determined at surgical observation of the mesentery, and that in nine patients was determined on the basis of follow-up CT and clinical data. The primary cause of SMM in 12 patients was unknown. RESULTS: Twenty-five of the 29 patients had various underlying diseases. Fourteen (48%) patients had a malignancy: 11 had intraabdominal cancer and three had extraabdominal cancer. Jejunal mesentery was more commonly involved than was ileal mesentery (P <.05). The mean thickness of the SMM was 4.0 cm. Mesenteric vessels were dilated in 27 patients (93%): 19 with venous dilatation and eight with either arterial dilatation only or both arterial and venous dilatation. At CT, seven (24%) patients had a thickened bowel wall; nine (31%) patients, lymphadenopathy; and two (7%) patients, the fat ring sign. The primary cause of SMM was edema in eight, malignant neoplasm in four, inflammation and/or fibrosis in five, and idiopathic in 12 patients. CONCLUSION: At CT, SMM appears as a result of malignant neoplasms, inflammation, or vascular disorders.

Adolescent↗

PubMed1982

Percutaneous drainage of abscesses and fluid collections: technique, results, and applications.

A combination of computed tomography, ultrasonography, and fluoroscopy was utilized to guide percutaneous catheter drainage of 58 abscesses and fluid collections in 51 patients. Cavities were evacuated in 53 cases, with surgery avoided in 44 of these. There were two failures and six recurrences. The mean duration of catheter drainage was seven days. Five complications occurred, including a small bowel fistula and a lacerated mesenteric vessel. Based on this experience, guidelines for drainage are presented, as well as principles for the critical step of access route planning. Double-lumen sump drainage catheters and the irrigation procedure have simplified and improved drainage. Causes and solutions for unsatisfactory results are defined.

Abdomen↗

PubMed1986

The left-sided pancreas.

Ultrasonography (US) performed in nine patients (two with pancreatic carcinoma, one with hepatomegaly, six with no relevant abdominal disease) showed the pancreas to lie wholly to the left of the aorta. This not uncommon location may give rise to difficulty in demonstrating the pancreas on real-time US scans. The superior mesenteric vessels and splenic vein remain useful landmarks for locating the head of the pancreas in this position.

Aged↗

PubMed1991

Renal peripelvic lymphangiectasia: appearance at CT.

In a patient who had undergone emergency nephrectomy during exploratory surgery, a pathologic diagnosis of peripelvic lymphangiectasia was made. Subsequent computed tomographic examination of the remaining kidney showed large multilocular renal sinus cysts, renal capsular cysts, and regions of fluid attenuation surrounding the mesenteric vessels, findings consistent with peripelvic lymphangiectasia. A brief discussion of cystic disease of the renal sinus is presented.

Adult↗

PubMed1999

Mesenteric, omental, and retroperitoneal edema in cirrhosis: frequency and spectrum of CT findings.

PURPOSE: To determine the frequency and CT imaging spectrum of mesenteric, omental, and retroperitoneal edema in patients with cirrhosis. MATERIALS AND METHODS: Eighty patients were identified with liver cirrhosis and no other cause of edema. Five radiologists jointly reviewed the abdominal CT scans of these patients to assess, by majority decision, the presence, severity, distribution, and configuration of mesenteric edema and the presence of omental and retroperitoneal edema. Subcutaneous edema, ascites, pleural effusion, splenomegaly, varices, portal venous thrombosis, and serum albumin levels were also documented. RESULTS: Mesenteric edema was present in 69 (86%) patients. Mesenteric edema occurred alone in 26 (38%) and with omental or retroperitoneal edema in 40 (58%) of the 69 patients with edema. No patient had omental or retroperitoneal edema alone. Mesenteric edema was mild in 51 (74%) and moderate to severe in 18 (26%), patchy in 47 (68%) and diffuse in 22 (32%), purely infiltrative in 60 (87%) and infiltrative with superimposed masslike nodules in nine (13%) patients. These parameters had significant associations among themselves and with ascites, pleural effusions, subcutaneous edema, and low mean serum albumin levels but not with splenomegaly or varices. CONCLUSION: Mesenteric, omental, and retroperitoneal edema occur commonly in patients with cirrhosis. The appearance of mesenteric edema varies from a mild infiltrative haze to a severe masslike sheath that engulfs the mesenteric vessels.

Adult↗

PubMed2001

Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria.

PURPOSE: To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis. MATERIALS AND METHODS: Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images. RESULTS: CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients. CONCLUSION: Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.

Adult↗

PubMed2002

Mechanisms of decreased leukocyte localization in the developing host.

Delays in leukocyte localization likely contribute to diminished host defense in neonates. Understanding the processes that may be affected has been hampered by the lack of suitable developmental models. Using intravital microscopy, we directly examine leukocyte recruitment in a rabbit pup model. In response to intraperitoneal interleukin (IL)-1beta, there were one-third as many leukocytes that arrested in pup mesenteric vessels and emigrated compared with adult vessels, although leukocyte flux was not different. Leukocyte rolling velocity in pups was one-half that in adults. In response to surgical trauma alone, the number of arrested pup cells was 15% that of adult cells, although again leukocyte flux was not different. An anti-L-selectin antibody inhibited rolling significantly by 60 min for both pups and adults. The effect on arrest and emigration occurred at significantly earlier times, although the effect was less in rabbit pups. A primary defect in leukocyte emigration in the rabbit pup appears to be a failure of the cell to transition efficiently from rolling to arrest. L-selectin-dependent adhesion and emigration are decreased, rolling is not, suggesting that at least part of the defect is due to events downstream of the initial tether.

Age Factors↗

PubMed1985

Effect of phosphate depletion on blood pressure and vascular reactivity to norepinephrine and angiotensin II in the rat.

Phosphate depletion (PD) adversely affects myocardial function but its influence on blood pressure is not well elucidated. In this study we evaluated whether PD influences blood pressure and/or affects its hormonal regulation or the peripheral vascular response to pressor agonists. Mean arterial pressure (MAP) in PD rats was lower than in normal animals, whereas heart rate was not significantly different between the two groups. Cardiac index (CI) in PD rats was lower and systemic vascular resistance (SVR) was higher than in controls. Plasma norepinephrine (NE) in the resting state and during the stress of immobilization was significantly greater in PD rats than in controls. Base-line plasma renin activity was also significantly higher in PD rats and increased similarly in the two groups of rats after administration of isoproterenol. Bolus injections of NE or angiotensin II produced a smaller rise in MAP in PD rats than in controls. Reduced responsiveness to NE was also demonstrated in isolated hind-limb preparation from PD rats. When NE was infused to achieve a rise in MAP of 30 mmHg, the dose required in PD was higher than in controls. Treatment with indomethacin did not affect the response in MAP to NE. The content and affinity of both alpha- and beta-receptors in PD hearts were not different from those of control hearts. The contents of PiATP, and AMP in the mesenteric vessels of PD rats were significantly lower than in control animals. These data show that PD leads to reductions in MAP, arteriolar response to pressor agents, and CI with appropriate compensatory rise in NE but with inadequate compensatory increase in SVR.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiotensin II↗

PubMed2006

Benzoquinone ansamycin heat shock protein 90 inhibitors modulate multiple functions required for tumor angiogenesis.

Heat shock protein 90 (Hsp90) is a molecular chaperone involved in maintaining the correct conformation and stability of its client proteins. This study investigated the effects of Hsp90 inhibitors on client protein expression and key cellular functions required for tumor angiogenesis. The benzoquinone ansamycin Hsp90 inhibitors geldanamycin and/or its derivatives 17-allylamino-17-demethoxygeldanamycin (17-AAG) and 17-(dimethylaminoethylamino)-17-demethoxygeldanamycin inhibited production of vascular endothelial growth factor (VEGF)-A by tumor cells and blocked proliferative responses of human endothelial cells at nanomolar concentrations. 17-AAG also significantly reduced endothelial cell migration, tubular differentiation, invasion through Matrigel, and secretion of urokinase-type plasminogen activator at concentrations at or below those that inhibited proliferation. 17-AAG significantly reduced expression of VEGF receptor (VEGFR)-2 and established Hsp90 client proteins in human endothelial cells in vitro as well as in mouse vena cava, mesenteric vessels, and blood vessels within human tumor xenografts in vivo; this was associated with decreased tumor microvessel density. Finally, we showed for the first time that Hsp90 inhibitors also reduce expression of VEGFR-1 on human vascular endothelial cells, VEGFR-3 on lymphatic endothelial cells in vitro, and all three VEGFRs on mouse vasculature in vivo. Thus, we identify Hsp90 inhibitors as important regulators of many aspects of tumor angiogenesis (and potentially lymphangiogenesis) and suggest that they may provide therapeutic benefit not only via direct effects on tumor cells but also indirectly by inhibiting the production of angiogenic cytokines and responses of activated endothelial cells that contribute to tumor progression and metastasis.

Antineoplastic Agents↗

PubMedDate not supplied

An experimental animal model of intestinal obstruction to simulate in utero therapy for jejunoileal atresia.

OBJECTIVE: To obtain 'intestinal atresia-like' conditions in the fetal lamb model to subsequently allow in utero surgical repair. METHODS: Six time-dated pregnant sheep underwent general anesthesia at 75 days of gestation (term 145 +/- 5 days). After maternal laparotomy and hysterotomy, the fetal abdomen was opened. Once the jejunoileal intestinal loop was identified, the mesenteric vessels were isolated, ligated, and sectioned in 2 fetuses, and in the remaining 5 fetuses the bowel loop was ligated. Two further fetuses were used as controls and underwent sole laparotomy. Of the group of 7 fetuses 2 were reoperated at 100-105 days of gestational age and underwent intestinal recanalization. Eight fetuses were delivered at term by cesarean section and the remaining 1 by spontaneous delivery. One newborn underwent neonatal entero-enteric anastomosis. RESULTS: 4 out of 6 fetuses survived, in utero intestinal or vascular ligation having provoked an 'intestinal atresia-like' picture. The animal operated at birth died. The 2 control fetuses and the 2 fetuses with in utero intestinal recanalization survived until term. CONCLUSION: The present study shows that in utero treatment of intestinal obstruction is possible in an experimental model.

Animals↗

PubMed2002

Benign inflammatory pancreatic mucinous cystadenomas mimicking locally advanced cystadenocarcinomas. Presentation of 3 cases.

We report 3 cases of benign mucinous cystadenoma of the pancreas mimicking, both clinically and on imaging findings, locally advanced cystadenocarcinoma spreading to neighbouring organs (stomach, splenic and mesenteric vessels, and diaphragm). Surgical resection was performed in light of the suspicion of invasive carcinoma in all 3 cases. Histological examination of the resected specimens showed entirely benign mucinous cystadenomas associated with marked peri-tumoural inflammation that accounted for the pre-operative misdiagnoses. All 3 patients are alive 40, 47 and 54 months after surgery without evidence of tumour relapse. These cases indicate that surgery must be considered in patients with cystic tumour of the pancreas suggesting locally advanced cystadenocarcinoma, even when pre-operative imaging findings suggest tumour extension into neighbouring organs.

Adult↗

PubMed2005

Chronic mild hyperhomocysteinemia induces aortic endothelial dysfunction but does not elevate arterial pressure in rats.

Mild hyperhomocysteinemia is prevalent in the general population and has been linked to endothelial dysfunction and high arterial pressure (AP) in clinical studies. The present study was designed to determine whether a rise in AP was induced by mild hyperhomocysteinemia and whether the potential rise in AP is secondary or prior to endothelial dysfunction. Experiments were performed in a rat model of mild hyperhomocysteinemia induced by oral administration of homocysteine for 1-4 months. Aortic endothelial dysfunction was observed 2 months after homocysteine treatment while endothelium-independent vasodilation was normal. In parallel, homocysteine treatment increased phenylephrine-induced contraction in aortas with endothelium, but did not modify the contraction in aortas without endothelium, suggesting a decrease of basal NO production. In conscious unrestrained rats, AP was not significantly different 1, 2, 3 and 4 months after homocysteine treatment. In correlation, endothelial function of a resistance vessel (mesenteric artery), mainly non-NO nonprostanoid factor mediated, was preserved, indicating that homocysteine treatment only affected the NO pathway. In conclusion, mild hyperhomocysteinemia alone is not sufficient to elevate arterial blood pressure, at least in the rat model. Aortic endothelial dysfunction produced by mild hyperhomocysteinemia is independent of hemodynamic factors.

Animals↗

PubMed1994

Utility of an excluded and everted segment of small intestine placed under the skin of the abdominal wall as an adrenal transplant site in rats.

The feasibility of excluded and everted small intestine segments as reservoirs for adrenal tissue transplantation was compared between biadrenalectomized adult rats with isogenic transplants of adrenal quarters or allogenic transplants of neonatal adrenal glands. Small clusters of adrenocortical cells, located between the adipocytes and the mesenteric vessels of the segments' lumen, were observed following isogenic transplantation. Several large regenerated adrenocortical nodules, surrounded by a connective capsule, were present in each of the rats transplanted with neonatal adrenal glands. Medullary tissue did not regenerate. It was concluded that the excluded and everted segments of small intestine were optimal sites for adrenal tissue transplantation and that the regeneration process of the adrenocortical tissue takes place more quickly after the transplantation of neonatal adrenal glands than after the transplantation of adrenal quarters.

Abdominal Muscles↗

PubMed1980

Ultrastructural studies on the pancreatic polypeptide cell of the rat with special reference to pancreatic regional differences and changes induced by alloxan diabetes.

Rat pancreatic tissues were fixed with our modification of Dalton's fixative and the islets from various pancreatic regions were examined by electron microscopy. In addition, the effect of the alloxan-diabetic state on the pancreatic polypeptide cell was examined at the ultrastructural level. The results are as follows. (1) The islets of the rat contain four types of glandular cells: A, B, D and PP cells. (2) The PP cell is characterized by approximately 170-millimicron-sized secretory granules with a rather ill-defined core. The ultrastructure of this type cell is described in some detail. (3) In the pancreatic portion which hooks around posterior to the superior mesenteric vessels, PP cells are abundant and some of them are markedly degranulated. Their cell organelles, such as the nucleolus, granular endoplasmic reticulum and Golgi apparatus are well developed. (4) In alloxan-diabetic rats, B and PP cells show disappearance and numerical increase, respectively. In the PP cells, hypertrophy of the Golgi apparatus and appearance of extremely electron-translucent secretory granules are noted.

Animals↗

PubMed1997

Regression of a distal bile duct carcinoma after treatment with octreotide for 6 months.

We report the case of a 66-year-old male who was admitted for obstructive jaundice presenting with an enlargement of the pancreatic head on CT scan. During exploratory laparotomy an invasion of the retropancreatic mesenteric vessels was found. Subsequently, the patient was included in a multi-center trial of subcutaneous high-dose octreotide in irresectable pancreatic cancer. After 6 months there was no tumour detectable on routine CT follow-up. One year after commencing octreotide treatment the patient underwent Whipple resection; the specimen showing a small T1N0M0 distal bile duct carcinoma. Taking into account that somatostatin receptors have been found on bile duct cancer cells our observation might warrant a controlled clinical trial.

Adenocarcinoma↗

PubMed1997

Endothelial dysfunction and cardiorenal injury in experimental salt-sensitive hypertension: effects of antihypertensive therapy.

BACKGROUND: Pharmacological control of hypertension has contributed to a significant decrease in cardiovascular morbidity and mortality, although the beneficial effect on cardiac and renal diseases has been far more modest than the reduction in stroke. The endothelium plays a crucial homeostatic role in the regulation of vascular tone thrombogenesis and vascular remodeling. We studied the relationship between endothelial dysfunction and cardiorenal injury in hypertensive rats and evaluated the effects of two classes of antihypertensive agents commonly used in the clinical setting, a diuretic (DIU) and an ACE inhibitor (CEI). METHODS AND RESULTS: Dahl salt-sensitive rats (DS) given high dietary salt (4% NaCl) developed hypertension (systolic blood pressure [SBP], 218+/-9 versus 147+/-3 mm Hg in DS given 0.5% NaCl; P<.001), which was associated with impaired endothelium-dependent relaxations (EDRs) in aortic rings (ED50, 5.44+/-.18 versus 7.51+/-.10; P<.05) and mesenteric vessels (area under the curve, 299+/-11 versus 217+/-11 arbitrary units; P<.05). Hypertensive DS also demonstrated depressed nitric oxide synthase activity in the aorta (0.76+/-.15 versus 2.83+/-.17 nmol x min(-1) x g protein(-1); P<.05), left ventricular hypertrophy (0.43+/-.02 versus 0.29+/-.02 g ventricular weight/100 g body weight; P<.05), glomerular injury (histological injury score: 151+/-8 versus 11+/-2; P<.05), and increased urinary protein excretion (95+/-21 versus 25+/-5 mg/24 hours; P<.05). Treatment of DS rats with the CEI perindopril (4.56 mg x kg(-1) x d(-1)) did not affect SBP (225+/-6 mm Hg) but modestly improved EDR (ED50: 6.07+/-.37; P<.05 versus hypertensive DS) as well as proteinuria and glomerular histology. Addition of the DIU indapamide (1.44 mg x kg(-1) x d(-1)) normalized SBP (151+/-2 mm Hg; P<.05), EDR (ED50, 7.33+/-.08; P<.05), left ventricular hypertrophy (0.27+/-.01 g/100 g body weight; P<.05), and proteinuria (31+/-4 mg/24 hours; P<.05) and prevented glomerular injury (injury score: 30+/-2; P<.05). Monotherapy with DIU reduced SBP (175+/-3 mm Hg; P<.05) and normalized EDR and left ventricular hypertrophy but did not provide effective renal protection. In hypertensive DS, impaired EDR and left ventricular hypertrophy were positively correlated with SBP. In addition, we found a significant correlation between cardiac hypertrophy and endothelial dysfunction. Indeed, a hierarchical regression analysis revealed that impaired aortic EDR, and therefore decreased aortic compliance, positively contributed to left ventricular hypertrophy in addition to but independently of SBP [F(2,37)=6.29; P=.004]. CONCLUSIONS: These studies suggest a dissociation of the endothelial, cardiac, and renal effects of antihypertensive therapy in hypertension and may explain the variable success of antihypertensive regimens in treating hypertension while preventing cardiac and renal damage.

Acetylcholine↗