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At least 991 records · Page 55Linked to original sources
PubMed1996

Demographic characteristics of patients undergoing aortic valve replacement for stenosis: relation to valve morphology.

OBJECTIVE: To determine the relative importance of the different causes of isolated aortic valve stenosis in a surgical series, and to relate these to patient characteristics including the rate of insertion of bypass grafts for coronary artery disease. DESIGN: Survey of the clinical and pathological data on patients undergoing aortic valve replacement for isolated stenosis. SETTING: Tertiary care cardiothoracic surgical unit. PATIENTS AND METHODS: 465 adult patients undergoing aortic valve replacement representing a consecutive series in one surgical unit. Retrospective review of patients records and classification of cause of aortic stenosis based on pathological examination of excised valve cusps. RESULTS: 63.7% patients had calcific bicuspid valves, 26.9% tricuspid calcific valves, and 5.4% rheumatic, 2.6% mixed pathology and 1.5% unicommissural valves. The ratio of males to females for bicuspid valves was 1.85:1 and for tricuspid calcific valves 0.76:1. The mean age of patients with bicuspid valves was 64.9 years compared with 73.4 years for those with tricuspid valves. Some 22.3% of patients with bicuspid valves and 44.8% of those with tricuspid valves had sufficient coronary artery disease to necessitate insertion of coronary bypass grafts. The differential rate of insertion of coronary bypass grafts was independent of age. CONCLUSIONS: Bicuspid calcified aortic valves are the predominant cause of isolated aortic valve stenosis followed by tricuspid calcified aortic valves. The sex and age distribution of bicuspid and tricuspid calcific aortic valve stenosis is different. The higher rate of insertion of vascular grafts in tricuspid calcific aortic valves may indicate that risk factors for atherosclerosis enhance cusp calcification in these patients.

Adult↗
PubMed1994

Cytokine expression in radiation-induced delayed cerebral injury.

Radiation-induced delayed brain injury is a well-documented complication of both standard external beam radiation (teletherapy) and interstitial brachytherapy; however, the cause of this damage has not been determined. Cytokines and growth factors are important regulatory proteins controlling the growth and differentiation of normal and malignant glial cells, which have been implicated in the tissue response to radiation injury. Six snap-frozen brain biopsies showing radiation injury were obtained from four patients harboring malignant gliomas who underwent either postoperative external beam and/or stereotactic interstitial brachytherapy at standard dosages. The specimens showed variable amounts of gliosis, tissue necrosis, calcification, inflammation, and vascular proliferation and hyalinization. Frozen tissue sections were examined for the presence of infiltrating lymphocytes, macrophages, cytokines, and other immunoregulatory molecules by the use of a panel of specific monoclonal and polyclonal antibodies. All specimens showed diffuse T cell infiltration with both CD4+ and CD8+ cells. Infiltrating activated macrophages (CD11c+, HLA-DR+) were prominent in five of six cases. Tumor necrosis factor-alpha and interleukin-6 immunoreactivity was prominent in four of six cases and was predominately localized to macrophages. Transforming growth factor-beta astrocytic and macrophage immunoreactivity was present at moderate levels in all cases. This study suggests that in radiation necrosis, interleukin-1 alpha, tumor necrosis factor-alpha, and interleukin-6 are expressed, predominately by infiltrating macrophages.

Adult↗
PubMed2006

Long-term outcomes in patients with calciphylaxis from hyperparathyroidism.

BACKGROUND: Calciphylaxis is a rare condition associated with chronic renal failure and entails a very poor prognosis. Pathogenesis is poorly understood but involves abnormalities in calcium and phosphorus metabolism that lead to vascular and extravascular calcification. Patients present with painful ulcerating plaques that progress to gangrenous wounds. Parathyroidectomy has been advanced as a life-saving intervention in these patients, but long-term results with wound healing and survival after parathyroidectomy are not well described. METHODS: Between January 1987 and October 2003, 15 patients with biopsy-confirmed calciphylaxis were treated at the University of Wisconsin. Of these 15 patients, 9 were treated with medical therapy (bisphosphonates and phosphate binders), whereas 6 underwent parathyroidectomy. The medical records were reviewed, and patients or relatives were interviewed. Survival was determined by Kaplan-Meier analysis. RESULTS: Four patients underwent subtotal parathyroidectomy, and two patients underwent total parathyroidectomy. All had reductions in the intact parathyroid hormone level (mean +/- SD, 25.2 +/- 4.5 pg/mL). Whereas all six patients treated with parathyroidectomy had partial/complete wound healing, only two of nine in the medical group had any improvements in the skin lesions (P = .006). With up to 80 months of follow-up, patients who underwent parathyroidectomy had a longer median survival compared with those who did not have surgery (39 vs. 3 months; P = .017). CONCLUSIONS: On the basis of our long-term follow-up of this patient population, subtotal or total parathyroidectomy was associated with long-term survival and was more likely to promote healing if performed earlier in the course of disease. Therefore, patients with calciphylaxis from secondary hyperparathyroidism should be referred promptly for potential parathyroidectomy.

Adult↗
PubMed2003

[Critical appraisal of sevelamer for the treatment of hyperphosphatemia in patients with chronic renal failure].

OBJECTIVE: To evaluate in patients with chronic renal failure (CRF) the effectiveness and the costs of sevelamer, a cationic polymer calcium- and aluminum-free, that is a new gastrointestinal phosphate binder. METHODS: Literature review and critical appraisal of six clinical trials about the effectiveness and two economic studies of sevelamer in CRF patients. RESULTS: Sevelamer is an effective phosphate binder (used in a mean daily dose of 3.5 g three times per day with meals) and with similar effect as that obtained with calcium salts, without the adverse manifestations of the latter (elevation of calcium x phosphorus product, hypercalcemia, vascular and cardiac calcifications, etc.). Moreover, sevelamer reduced serum LDL cholesterol in around 30%. Despite the greater direct costs of sevelamer compared with calcium salts, the total costs may be lower due to the reduction of costs with clinical complications and hospitalizations. CONCLUSIONS: Sevelamer has important therapeutic value in CRF patients with hyperphosphatemia. Economic analyses should be performed in our setting to define the cost-effectiveness relationship of sevelamer.

Calcium↗
PubMed1983

Histological and biochemical characterization of murine sarcomas.

A mouse fibrosarcoma and rat osteosarcoma were examined histologically and biochemically with regard to collagen content. The fibrosarcoma was composed of undifferentiated mesenchymal cells without distinct fibroblastic characteristics. Collagen production and deposition were consistent with those observed in cultured fibroblasts. Type I and type III collagens were evident as determined by immunofluorescence staining and biochemical analysis. The osteosarcoma appeared similar to bone with regard to a high content of type I collagen, limited calcification and poor vascularization. While these sarcomas do not histologically resemble their non-transformed counterparts, analysis of their macromolecular composition confirmed the identity of their presumed cell of origin. Similar methodology could be readily applied for identification and classification of human malignant sarcomas.

Amino Acid Sequence↗
PubMedDate not supplied

Cortical dysgenesis in a variant of phenylketonuria (dihydropteridine reductase deficiency).

The neuropathology of a 2 1/2-year-old patient with dihydropteridine reductase deficiency showed diffuse demyelination throughout white matter and spongy vacuolation in the long tracts of the brain stem. These changes are characteristic neuropathologic observations in untreated phenylketonuria. In addition, extensive neuronal loss, calcification and abnormal vascular proliferation were noted in the cerebral cortex, white matter, basal ganglia, and thalamus. Golgi studies demonstrated an abnormal orientation of neurons together with abnormalities of dendrites and dendritic spines. The pathogenesis of the vascular abnormalities in this condition is unknown, although folate deficiency may be involved. The secondary deficiency of serotonin and dopamine occurring during neuronal growth and differentiation may also affect the terminal stages of neuronal maturation.

Cerebral Cortex↗
PubMed1999

Myxoid synovial sarcoma: an underappreciated morphologic subset.

Focal myxoid change is a well-recognized feature of synovial sarcoma, but the presence of a predominantly myxoid stroma is rare. We describe seven cases of myxoid synovial sarcoma in which marked myxoid change initially obscured the diagnosis, leading to confusion (principally with malignant peripheral nerve sheath tumor). The median age (20 yr) and tumor location (four lower extremity, two upper extremity, and one head and neck region) were similar to those found in typical synovial sarcoma. Histologically, five cases were monophasic spindle cell lesions with a lacy appearance in areas with a prominent Alcian blue-positive myxoid stroma. Each case had foci with more typical features of synovial sarcoma, including a fascicular growth pattern with a variably collagenized stroma, stromal mast cells, a hemangiopericytoma-like vascular pattern, and calcification. Two cases showed small foci of glandular (biphasic) differentiation. Immunohistochemically, all of the seven cases were positive for epithelial membrane antigen, four of six were positive for pan-keratin, three of six were positive for S-100, two of four were positive for CD99, and six of six were negative for desmin. Clinical follow-up in six cases ranged from 8 to 48 months (median, 21 mo). Local recurrence developed in three patients at 9, 20, and 24 months, respectively. In one of these three patients, lung metastases developed at 13 months, and the patient died of disseminated disease at 23 months. In another of the three patients, lung metastases developed at 27 months. Three patients had no evidence of disease at 8, 15, and 15 months. Our data are too limited to indicate any clinical differences between myxoid synovial sarcoma and conventional synovial sarcoma Recognition of this rare histologic variant of synovial sarcoma is important because it can easily be mistaken for other myxoid spindle cell neoplasms, potentially resulting in suboptimal therapy.

Adolescent↗
PubMed1975

Idiopathic arterial calcification of infancy: a clinicopathologic study.

The clinical and pathologic features of a group of 62 infants dying of idiopathic calcific arterial disease were reviewed. The disease most commonly occurs in infants less than 6 months of age. Pathologically, it is characterized by calcific deposits along the internal elastic membrane of arteries accompanied by fibrous thickening of the intima which causes luminal narrowing. The arterial lesions are widespread but the resultant luminal narrowing invariably promotes myocardial ischemia, causing the infants' deaths. A definite tendency of the disease to occur in siblings has been noted, but additional patterns of inheritance are not yet apparent. Clinical diagnosis is feasible with radiologic study of arteries of the head, neck, and extremities. There is a similarity of idiopathic calcific arterial disease of infancy to the arterial lesions of metastatic calcification in severe renal disease, calcific arterial lesions noted in conjunction with certain cardiovascular anomalies, and hypervitaminosis D. Certain experimental situations and toxic states can also produce calcific and proliferative vascular lesions.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Morphological aspects of peritoneal sclerosis.

The term peritoneal sclerosis simply means the presence of sclerotic tissue in the peritoneum. Qualitative and quantitative morphological aspects indicate that there are two nosological entities: simple sclerosis and sclerosing peritonitis. Simple sclerosis is a thin (<40-50 microm) layer of submesothelial sclerotic tissue often limited to certain peritoneal areas, with monotonous histology. It is a component of the slight anatomical alterations constantly detectable in peritoneal dialysis patients. Sclerosing peritonitis is characterized by very thick (1,0004,000 microm) sclerotic tissue involving the whole peritoneal wall, often with inflammatory infiltrates, microabscesses, giant cells of macrophagic origin, calcifications and severe vascular alterations. Intermediate stages between simple sclerosis and sclerosing peritonitis have rarely been detected. Simple sclerosis and sclerosing peritonitis also seem to be distinct with respect to frequency, etiology, reproducibility in animal models and clinical manifestations.

Animals↗
PubMed2005

The sonographic features of papillary thyroid carcinomas: pictorial essay.

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy in children and adults, with an incidence of 22,000 cases per year in the United States. Differentiating PTC from more frequently occurring benign thyroid nodules has proved challenging as there may be significant overlap in their clinical presentation and sonographic appearance. That said, high-resolution ultrasound provides a safe and affordable way of identifying and characterizing thyroid nodules and guiding percutaneous biopsies. Although no single sonographic feature is pathognomonic for PTC, certain features should raise suspicion and the combination of several features may be even more suggestive. In this pictorial essay, we describe the high-resolution sonographic features of pathologically proven PTCs. The nodule number, echo texture, internal architecture, calcifications, margins, contours, vascularity, and lymph nodes are considered. While the classic sonographic description of PTC is a solitary, hypoechoic solid nodule with microcalcifications and intrinsic vascularity, in practice, PTC may manifest with a myriad of sonographic appearances making biopsy necessary for a definitive diagnosis.

Biopsy, Fine-Needle↗
PubMedDate not supplied

[NMR of phakomatoses].

23 patients affected by phakomatoses were studied with NMR, including tuberous sclerosis (11 cases), Sturge-Weber's disease and Von Recklinghausen's neurofibromatosis (6 cases). SE sequence was used performing T1-WIs with TR = 350-750 ms and TE = 20-30 ms and T2-WIs with TR = 1500-2100 ms and TE = 50-100 ms. Tuberous sclerosis was characterized in each case by the presence of hiperintense areas in T2-WIOs, associated in 9 cases to subependimal microcalcifications. Sturge-Weber-disease showed: cerebral or lobar emiatrophia, abnormal vascularization and cortical calcifications. Cerebral neurofibromatosis was characterized by extra-assial tumors, associated in 4 cases to gliomas of the optical pathways. The AA. conclude that NMR is the choice examination in the evaluation of phakomatoses.

Adolescent↗
PubMed1988

[Papillary nephrocarcinoma: radiographic and echographic aspects].

Between 1976 and 1987, 395 patients with kidney tumors were studied with radiological techniques and sonography. In 37 cases (9.4%) histopathology diagnosed pure papillary renal cell carcinoma. Analyzing the radiographic patterns of these neoplasms, the authors observed constantly diminished vascularity (100%), frequent calcifications (35.1%) and necrotic areas (51.3%). Such X-ray features are not specific: nevertheless, their coexistence is strongly suggestive of papillary renal cell cancer. No consistent US pattern was found; however, necrotic areas were easily demonstrated in most cases. It must be stressed how patients with papillary carcinoma experienced a longer postoperative survival; it has not yet been established whether such favorable behavior is due to low biological aggressiveness or to earlier diagnosis.

Adult↗
PubMed1979

[Doppler-sonographic findings in media sclerosis of the extremities, verified by radiography].

23 patients were examined who in the ultrasound-Doppler-pressure measurement were evident by too large peripheral systolic measuring values. On the X-ray pictures of the soft tissues of these patients more or less expressed linear and longitudinal calcifications of the vascular wall in the sense of a Mönckeberg sclerosis of the media were to be proved. Though these changes of the arteries which are to be established in most cases in diabetics of older age do not cause, as a rule, any disturbances of the peripheral blood supply, they are of clinical interest, since they falsify the results of indirect measurements of the pressure (pseudohypertension). An arterial obstructive disease which is simultaneously present may possibly been overseen and the false diagnosis of a therapy-resistant arterial hypertension may be made.

Adult↗
PubMed1984

Renal osteodystrophy in CAPD patients.

To assess the influence of continuous ambulatory peritoneal dialysis (CAPD) on the evolution of renal osteodystrophy, we studied 36 adult patients with end-stage renal failure before starting dialysis and after 7-30 months. 17 patients (12 males and 5 females) were treated by CAPD as first treatment and 19 (14 males and 5 females) received maintenance hemodialysis. The two groups were age- and sex-matched and no patient received vitamin D. All patients had adequate clinical and metabolic follow-up with a radiological survey and quantitative bone histology at the start of dialysis and at the end of the study. Serum phosphate concentrations were much easier to control in CAPD than in hemodialysis patients. There was no difference in the evolutive pattern of vascular and periarticular calcifications in the two groups. The 25-hydroxyvitamin D3 levels were frequently lower in CAPD than in hemodialysis patients. In some CAPD patients, there was a significant loss of trabecular bone volume at the end of the study. The radiological and histological appearances of secondary hyperparathyroidism improved or seemed to worsen to a lesser degree in CAPD compared to hemodialysis patients.

Adult↗
PubMed1983

[Structure of the mineral deposits in major arterial walls in calcinosis (based on scanning electron microscopic data)].

The results of morphological studies on the structure of mineral deposits in the walls of major arteries in atherosclerosis are presented. Calcium deposits looking like petrificates and microgranular deposits were found. The petrificates consisted of microgranular, microcrystalline and macrocrystalline deposits of calcium salts. In the arterial wall, the crystals consisted of calcium phosphate and calcium carbonate. The relationship between the destruction of elastic fibers and elastic membranes and calcification of the vascular wall was confirmed.

Aged↗
PubMed1984

Arteriographic findings of claudication patients.

The purpose of this work was to study what kind of types of arteriographic changes occur in patients with claudication, whether the patients can be divided into different groups on the basis of the morphology of the arteriographic findings, whether there are any correlations between the arteriographic findings and the patient's age, sex, occupation, bodyweight, smoking habits, diabetes, hypertonia and the arteriosclerosis of the cerebral and coronary arteries. The series consisted of 490 patients subjected to arteriography of the lower extremities because of claudication. There were 399 males and 91 females. The following changes were seen in the arteries of claudication patients: --tortuosity of the distal aorta and the iliac arteries --arteriosclerotic wall changes varying from intimal thickenings to complete occlusions --collaterals --calcific deposits on vascular walls --aneurysms of the distal aorta. The vessels located proximally to the inguinal ligament were tortuous in 63,1% of the patients and extremely tortuous in 11,2%. Single wall changes were seen rarely; 69% of the patients had more than 6 separate plaques. Smooth and flat plaques were also few. 78% of the patients had wall changes of mixed shapes, and 81% had wall changes with irregular contour. A complete occlusion of a vessel was detected in 67%. Symmetric ASO changes were seen in the extremities of 5,3% of the patients. On the basis of the location and extent of the arteriographically diagnosed wall changes, the series was divided into three main groups. The first main group was further divided into three subgroups and the latter two into two subgroups each. Slightly more than half of the patients belonged to the largest group I A, where arteriosclerotic changes were detected in all segments. Gangrenous changes were most frequent in this group. The patients in group III A, which consisted of diffuse changes of the femoro-popliteal region, had the highest (31,8%) frequency of concomitant diabetes and the second highest (30,3%) frequency of concomitant hypertonia. Hypertension was most frequent as a concomitant disease (42,9%) in group I B, which consisted of the patients with aneurysms of the distal aorta. Single arteriosclerotic changes in the femoropopliteal region were few (1,2%). Vascular tortuosity increased with age. The older age groups had more arteriosclerotic changes particularly in the distal aorta, the deep femoral artery, the superficial femoral artery and the popliteal artery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗