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At least 109 records · Page 6Linked to original sources
PubMed1991

Hospitalisation of prostatic cancer patients undergoing orchiectomy.

We report our experience with 100 orchiectomies for advanced prostatic cancer in hospitalised patients. Approximately 60% of the patients required hospitalisation for additional treatment and investigation of complications due to their disease at the time of orchiectomy. In 51 cases the orchiectomy was combined with transurethral resection of the prostate (TURP); 37 patients had pathological levels of serum creatinine and 17 had pathological dilatation of the upper urinary tract, 6 of whom required a nephrostomy catheter. Because of anaemia on admission, 21 patients received a peri-operative blood transfusion. Two patients had significant post-operative bleeding, 2 developed a wound infection and 1 had a deep thrombophlebitis. The patients' mean age was 76.4 years and the period of hospitalisation ranged from 3 to 150 days with peaks at 3 and 8 days. The most important reason for prolonged hospitalisation was social problems. It was concluded that many patients who were hospitalised as a direct consequence of their prostatic carcinoma would have been in hospital for a similar period regardless of the method of hormonal manipulation used. Because so many patients have other reasons for hospitalisation, or require additional surgical procedures such as TURP, the true average cost of orchiectomy for advanced prostatic cancer is difficult to determine.

Aged↗
PubMed1985

Oesophageal intramural pseudodiverticulosis.

Twelve cases of oesophageal intramural pseudodiverticulosis are described and the findings in 85 previously reported cases are reviewed. The condition occurs in all age groups, predominantly in the sixth and seventh decades, with a slight predilection for males. The characteristic radiographic appearance is of multiple flask shaped outpouchings of 1-4 mm with narrow necks communicating with the oesophageal lumen. The source of the pseudodiverticula has been shown to be pathologically dilated excretory ducts of the submucous glands due to chronic submucosal inflammation. The distribution was segmental in 57 cases (59%) and diffuse in 40 (41%). Dysphagia is the main symptom and was found in 85 cases (88%); 88 cases out of 97 had radiological narrowing of the oesophagus; of these, 39 (44%) were in the upper oesophagus, 20 (23%) in the middle oesophagus, and 29 (33%) in the lower oesophagus. Treatment is directed towards management of the associated disorder, as the diverticula themselves rarely cause problems.

Adult↗
PubMed1979

Ultrasonography of the brachiocephalic arteries.

Sixteen patients with various lesions involving the brachiocephalic arteries were studied ultrasonographically. The examination was very useful in diagnosing aneurysms of the peripheral arteries and in differentiating an aneurysm from other causes of palpable pulsatile masses, such as a tortuous artery and tumor beneath an artery. The ultrasound technique used for evaluation of these lesions is described.

Adult↗
PubMed1992

US measurement of the subarachnoid space in infants: normal values.

The subarachnoid space was examined with real-time ultrasonography (US) in 89 healthy infants. US of the brain in all infants revealed no abnormalities. Three variables were measured in the coronal plane at the level of the foramen of Monro: the sinocortical width (SCW) ranged from 0.4 to 3.3 mm, the craniocortical width (CCW) from 0.3 to 6.3 mm, and the interhemispheric width (IHW) from 0.5 to 8.2 mm. All variables can be used routinely, as the SCW could be demonstrated in all infants, and the CCW and IHW were demonstrated in 96% (85 of 89). Correlation of sonographic measurements with the independent variables age, head circumference, body weight, and body length was poor. To differentiate normal from pathologically dilated subarachnoid spaces, the following upper limits are proposed on the basis of the 95th percentile: 3 mm for SCW, 4 mm for CCW, and 6 mm for IHW.

Female↗
PubMed1992

Pancreatic duct obstruction treated with percutaneous antegrade insertion of a metal stent: report of two cases.

Expanding metal stents were used to treat symptomatic pancreatic duct obstruction in two patients with chronic pancreatitis. Both patients initially underwent percutaneous external pancreatic duct drainage and then had metal stents inserted for internal drainage. Both patients remained asymptomatic, and the stents were patent during short-term follow-up periods of 6 and 9 months, respectively. Percutaneous insertion of metal stents, which can be performed to treat pancreatic duct obstruction after a trial of external drainage has been shown to relieve the patient's symptoms, should be considered as an alternative to endoscopic stent placement or surgical drainage.

Aged↗
PubMed1996

Contractile activity and passive stretch regulate tubulin mRNA and protein content in cardiac myocytes.

Accumulation of tubulin protein and an increased array of microtubules have been associated with contractile dysfunction in cardiac myocytes after pressure overload in vivo. Experiments were performed to assess the ability of mechanical stimuli experienced by ventricular cardiac myocytes during the progression of hypertrophic and dilated pathology to increase beta-tubulin production in cultured neonatal rat cardiac myocytes. Results indicate that both contractile activity and load due to passive stretch increase beta-tubulin protein content in neonatal rat cardiac myocytes through accumulation of beta-tubulin mRNA, which occurs without increased beta-tubulin gene transcription. Western blot analysis demonstrated that contraction resulted in the accumulation of beta-tubulin in neonatal rat cardiac myocytes above increases observed in the content of total cellular protein. Northern blot analysis indicated that beta-tubulin mRNA content increased in response to both stretch and contraction. alpha-Adrenergic agonists that lead to pathophysiological growth in cardiac myocytes also stimulated an increase in beta-tubulin mRNA content. Treatment of contracting neonatal cardiac myocytes with angiotensin II (ANG II) further increased beta-tubulin mRNA content, whereas ANG II treatment in arrested neonatal cardiac myocytes failed to increase beta-tubulin mRNA. Nuclear run-on experiments indicate that contraction stimulates beta-tubulin mRNA accumulation without an increase in beta-tubulin gene transcription. These results imply that tubulin production in cultured cardiac myocytes can be regulated directly by mechanical forces. In mechanically challenged hearts, the accumulation of beta-tubulin and the development of contractile dysfunction may be directly related to the mechanical forces imposed on the myocardium during the onset and progression of cardiovascular disease.

Animals↗
PubMed1980

Ureteral stasis in cervicoprostatic obstructions.

A urodynamic study of patients with prostatic adenoma or other types of cervicoprostatic obstructions demonstrate that ureteral stasis is not a consequence of a direct compression of the intramural ureter by the adenoma but is secondary to dynamic disturbances.

Constriction, Pathologic↗
PubMed2003

Sustained decrease in superoxide dismutase activity underlies constrictive remodeling after balloon injury in rabbits.

OBJECTIVE: The redox pathophysiology of vascular repair is incompletely understood. We assessed the role of vascular superoxide dismutase (SOD) activity in oxidative/nitrative stress and caliber loss postinjury (PI). METHODS AND RESULTS: Rabbits submitted to iliac artery balloon overdistension were followed for 14 days PI. Significant decrease in vascular SOD activity occurred at 7 and 14 days PI (by 45% and 34%, respectively, versus control, 96+/-1 U/mg, P<0.05). Separation in concanavalin-A column showed that both extracellular SOD (ecSOD) and CuZn SOD activities were reduced, whereas Western analysis showed normal or augmented protein expression. Immunoreactivity to nitrotyrosine, neuronal NO synthase (NOS), and inducible NOS (iNOS) increased in media and neointima PI; iNOS mRNA also augmented. Administration of ecSOD from days 7 to 14 PI corrected the SOD activity decrease and minimized caliber loss by 59% (P=0.007) despite unaltered neointima. Nitrate levels markedly increased with ecSOD in injured artery homogenates (26+/-5 versus 4+/-0.3 micromol/L per mg, P=0.001). Such increase was 70% inhibited by specific iNOS antagonist 1400w. Nitrotyrosine and neuronal NOS expression decreased after ecSOD. CONCLUSIONS: Sustained low vascular SOD activity has a key role in constrictive remodeling after injury, promoting oxidative/nitrative stress and impairment of iNOS-derived NO bioavailability. SOD function may critically determine whether iNOS induction is beneficial or deleterious in vivo.

Animals↗
PubMed1989

The effects of deep inhalation on maximal expiratory flow during intensive treatment of spontaneous asthmatic episodes.

Asthmatic patients who came to hospital for treatment of severe attacks were assessed for level of obstruction and the effects of a deep inhalation (DI) on degree of obstruction at various stages of their treatment and after recovery over several days. The more severe the obstruction, the greater was the constrictor effect of a DI; as lung function improved with intensive treatment, including corticosteroids, the constrictor effect diminished. Thus, we believe the constrictor effects of a DI relate to the degree of inflammation in the obstructive process. These longitudinal data relating severity to the effects of a DI were nearly identical to previously published cross-sectional data in a group of patients with spontaneous asthma with widely different levels of lung function. It is possible that the response to a DI in a given asthmatic subject serves as a functional marker for the predominant mechanism for obstruction.

Adult↗
PubMed1991

Ultrastructural evidence of a merocrine secretion in the human endolymphatic sac.

The results of a light and transmission electron microscopic analysis of an endolymphatic sac (ES) from a patient suffering from episodic vertigo, tinnitus, and hearing loss are presented. A biopsy of the intraosseous portion of the ES was obtained during a translabyrinthine approach to section the vestibular nerve in the internal acoustic meatus. The material consisted mainly of tubular epithelial structures filled with heavily stained material. Pathologically dilated and degranulated rough endoplasmic reticuli and disaggregation of polyribosomes with accumulation of solitary ribosomes in the cytosol and endoplasmic reticulum suggested a disturbed epithelial cell protein synthesis. Ultrastructural evidence of an increased merocrine secretion of glycoprotein conjugates into the ES was noted. This made it possible to analyze the presumed intracellular secretory pathways. An increased number of intraepithelial lymphocytes and monocytes was observed. Since the inner ear had been subjected to surgical intervention before the vestibular nerve section, no conclusions can be drawn as to whether the patient's symptoms were related to the disturbed protein metabolism and hypersecretion of glycoprotein conjugates into the ES. The findings support earlier experimental results that indicate that the ES has not only a resorptive function but also a secretory one.

Adult↗
PubMed2005

Role of endothelins and nitric oxide in the pulmonary circulation of perinatal lambs during hyperoxia and hypoxia.

Endothelins (ET) have opposite vascular effects mediated through different receptors: ET(A) receptors mediating vasoconstriction and ET(B) receptors mediating vasoconstriction as well as vasodilation. The role of ET in acute hypoxic pulmonary vasoconstriction (HPV) was studied after dual ET receptor blockade with bosentan and nitric oxide (NO) synthase inhibition with nitro-L-arginine (L-NA). We started from the hypothesis that ET antagonism may inhibit HPV but, if not, would do so after NO synthase inhibition. HPV was evaluated in anesthetized lambs, with an intact pulmonary circulation, by the increase in the mean pulmonary artery pressure (Ppa) minus occluded Ppa (Ppao) gradient in response to hypoxia (inspiratory oxygen fraction of 0.1) at different levels of pulmonary flow (multipoint pressure/flow relationships). ET receptor antagonism decreased pulmonary and systemic vascular tone both in hyperoxia and hypoxia. ET antagonism had no effect on HPV. NO synthase inhibition increased pulmonary vascular tone more in hypoxia than in hyperoxia so that HPV was enhanced. After L-NA, bosentan still decreased pulmonary vascular tone in hypoxia but did not affect the magnitude of HPV. The present results suggest that ET and NO are involved in the regulation of basal pulmonary vascular tone. Furthermore, the vasodilator effect of bosentan persisted in the presence of NO synthase inhibition, suggesting a non NO-dependent vasodilator mechanism. The results from these experiments are in agreement with the idea that ET do not play a major role in HPV in the perinatal lamb, even when it is enhanced by NO synthase inhibition.

Animals↗
PubMed1979

Orthopaedic features in the presentation of syringomyelia.

The orthopaedic surgeon is often the first consultant to whom a patient with syringomyelia is referred. The disease is not as rare as he may suppose, but its early presenting features are very variable; if he relies solely on such familiar features as pes cavus and scoliosis, he may well miss the diagnosis. The commonest presenting symptom is pain in the head, neck, trunk or limbs; headache or neckache made worse by straining is particularly significant. A history of birth injury also may suggest the possibility of syringomyelia, especially if any spasticity subsequently worsens. Neurological features which may be diagnostic include nystagmus, dissociated sensory loss, muscle wasting, spasticity of the lower limbs or Charcot's joints. Radiographic features include erosion of the bodies of cervical vertebrae and widening of the spinal canal; if, at C5, the size of the canal exceeds that of the body by 6 millimetres in the adult, pathological dilatation is present. The presence of basilar invagination or other abnormalities of the foramen magnum, of spina bifida occulta and of scoliosis are further pointers. Thermography is a useful way of showing asymmetrical sympathetic involvement in early cases. A greater awareness of the prevalence of syringomyelia may lead to earlier diagnosis and to early operation, which appears to hold out the best hope of arresting what is all too commonly a severely disabling and progressive condition.

Adolescent↗
PubMed1994

Compression of the left main bronchus between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.

A man with chronic obstructive lung disease presented to the hospital with respiratory failure and a chest x-ray indicated complete radiopacity of the left hemithorax. An endobronchial malignancy was suspected, but unexpectedly left-main bronchial occlusion was found secondary to compression between a descending thoracic aortic aneurysm and an enlarged right pulmonary artery.

Aged↗
PubMed1992

Mechanisms and consequences of portal hypertension.

Portal hypertension is characterised by alterations in the splanchnic and systemic circulation resulting in the development of portosystemic collateral channels, the most important of which are found in the lower oesophagus and stomach. The major clinical complication of gastro-oesophageal varices is bleeding and over the last decade there has been considerable interest in the pharmacological management of this complication. The factors currently implicated in the development of gastro-oesophageal varices in patients with cirrhosis include a) increased portal vascular resistance, b) splanchnic and systemic vasodilatation and c) changes in the lower oesophageal venous anatomy [palisade and perforating venous zones]. In a patient with gastrointestinal bleeding, endoscopic examination of the upper gastrointestinal tract will confirm the diagnosis of portal hypertension by confirming the presence of gastro-oesophageal varices. Cirrhosis is the most common aetiological factor for gastro-oesophageal varices, but imaging techniques, including Doppler ultrasound, computerised tomography and venous phase angiography, may be required to exclude extrahepatic portal venous obstruction from the differential diagnosis. Although the pathogenesis of variceal rupture remains unclear, several risk factors for variceal haemorrhage have been identified, including a) increased size, b) high intravariceal-portal pressure, c) increased varix wall tension characterised by the presence of red spots observed at endoscopy (particularly in large varices since wall tension is related to variceal size), and d) poor liver function. Although oesophagitis may be observed at endoscopy, an erosive mechanism is no longer considered to be of pathogenic significance. A high portal pressure in the immediate postbleeding period is now recognised as predictive of rebleeding. Periodic elevations in intravariceal pressure, associated with the release of enhanced endogenous vasoactive compounds, or beta-adrenergic-mediated stress-related increases in portal pressure, may contribute to the rupture mechanism. Consequently, portal hypertension is now being more widely considered as a multiorgan disorder associated with changes in blood flow within both systemic and splanchnic vascular beds. This article reviews the factors currently implicated in the development of portal hypertension and the approach to diagnosis. The pathogenesis of variceal bleeding will also be considered.

Constriction, Pathologic↗
PubMed2005

Prevalence of asymptomatic microbleeds in patients with moyamoya disease.

Basal moyamoya vessels are a potential source of hemorrhage in patients with moyamoya disease, but the etiology remains unclear. Symptomatic hemorrhage resulting from long-standing hemodynamic effects on pathologically dilated, fragile moyamoya vessels may be preceded by asymptomatic microbleeding in adult moyamoya disease patients, regardless of hemorrhagic or ischemic onset. T2*-weighted magnetic resonance (MR) imaging was used to investigate the presence of microbleeds in 27 adult patients with angiographically confirmed moyamoya disease, 21 females and six males aged 18-70 years (mean 40.8 +/- 15.7 years). Clinical diagnosis was intracranial bleeding in six patients, transient ischemic attack or cerebral infarction in 18, and asymptomatic in three. Asymptomatic microbleeds were detected in four of the 27 patients, two of six who initially presented with hemorrhagic events and two of 18 with ischemic onset. These microbleeds were located in the paraventricular white matter, temporal subcortex, and basal ganglia. The presence of microbleeds had no correlation with either patient age or duration from disease onset or diagnosis of disease. A large cohort study is needed to explore the significance of asymptomatic microbleeds in moyamoya disease.

Adolescent↗
PubMed2004

MDCT cholangiography with volume rendering for the assessment of patients with biliary obstruction.

OBJECTIVE: We sought to evaluate the diagnostic utility of MDCT cholangiography with volume rendering in the evaluation of patients with suspected biliary tree obstruction. SUBJECTS AND METHODS: MDCT was performed in 34 patients who were thought to have biliary obstruction. Portal venous phase scanning was initiated 70 sec after the IV infusion of 150 mL of contrast agent, and no cholangiographic contrast agent was administered. Three-dimensional MDCT cholangiographic images were produced using volume rendering. ERCP was performed in 26 patients, and percutaneous transhepatic cholangiography (PTC) was performed in five patients; 17 patients underwent biopsy or surgery. The findings on MDCT cholangiography were compared with those of ERCP, PTC, biopsy, or surgery. RESULTS: The correct diagnosis was made on MDCT cholangiography for 14 (93%) of the 15 patients with a biliary stone and in 16 (94%) of the 17 patients with malignant biliary obstruction. Microlithiasis in one patient could not be detected on MDCT cholangiography. One patient with polypoid adenocarcinoma and one patient with normal findings were incorrectly diagnosed with a biliary stone on the basis of MDCT cholangiography. In one of the two patients with a benign stricture, the stricture was incorrectly diagnosed as malignant. For the diagnosis of biliary stone, sensitivity and specificity of MDCT cholangiography were 93% and 89%, respectively. For the diagnosis of malignant obstruction, sensitivity and specificity were both 94%. The accuracy of the technique for the diagnosis of the cause of biliary obstruction was 83.3%. CONCLUSION: MDCT cholangiography with volume rendering is a noninvasive and fast imaging technique with high sensitivity and specificity for the diagnosis of the cause of biliary tree obstruction. It is a promising diagnostic tool for the assessment of patients with bile duct obstructions.

Adult↗