SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors report a case of Cockett's syndrome discovered by ilio--cava angiography at a patient who was operated on a bilateral retro-iliac ureter which occasioned an important renal insufficiency. After a review of the literature, it appears it is the first case published with such a pathologic association mentioned.
Surgical correction of the severely stenosed or atretic external canal still remains a difficult surgical challenge. As more and more techniques are described, it is apparent that the main thrust and emphasis is to prevent late cicatrization or stenosis. The essential principles are to create a wide canal and cover as much raw surface as possible with skin, preferably full-thickness and with an intact blood supply. The following technique, using dual flaps, has been used successfully in 10 consecutive problem ears with unusual underlying pathologies. With follow-up ranging from seven months to four years, there have been no cases of restenosis to date.
Common bile duct stenosis associated with pancreatitis and hypereosinophilia is described in two children. Ultrasonography and CT showed slight increase in the size of the pancreas and bile duct dilatation. Percutaneous cholangiography (PTC) demonstrated extrinsic stenosis of the bile duct at the level of the pancreas. Spontaneous resolution of the clinical and radiological findings was observed. Knowledge of this rare pathological association with favourable evolution can avoid an unnecessary surgical procedure.
Preoperative diagnosis of hilar carcinoma (Klatskin tumor) is usually done according to the only clinical and imaging findings. However, in 5-15% of patients operated with this diagnosis, hilar stenosis is an inflammatory pseudo-tumoral benign one. We reported the case of a patient who underwent resection of common bile duct for suspicion of hilar carcinoma in whom, despite clinical and imaging findings highly suggestive of malignancy, pathologic examination revealed aspecific cholangitis. After a review of the literature, we conclude that resection of common bile duct is mandatory to exclude malignancy and allows excellent biliary drainage. Associated major hepatectomy should ideally be indicated, due to its higher risks, after pathological confirmation of cholangiocarcinoma, if necessary by frozen section.
A 28-year-old, previously healthy man was referred to our hospital three months after the appearance of lumbago, leg pains and fever. Routine examinations were normal. Phlebography demonstrated occlusion of the common femoral veins by thrombosis. Inferior vena cavography and magnetic resonance image showed that the inferior vena cava (IVC) became gradually narrower from the level of 11th thoracic vertebra. An intravascular endoscopic study gave the same morphological findings; the endothelial surface was found to be intact. We concluded that the stenosis of the IVC was the primary lesion and was the essential pathological condition. The massive thrombosis appeared to have occurred secondarily.
OBJECTIVES: Endoscopic resection of the frontal sinus floor is a minimally invasive and functional surgical procedure designed for the treatment of inflammatory sinus diseases, which avoids the side-effects of external osteoplastic obliteration. The aim of the study was to evaluate long term results and to determine computed tomographic criteria predictive of success. PATIENTS AND METHODS: Our study reports the results of 20 patients operated for nasofrontal stenosis associated or not with osteitis or secondary mucocele. RESULTS: A successful result was obtained in 90% with a mean follow-up of 3.5 years. Failures (2) were attributed to insufficient resection and to frontal sinus osteogenesis. CONCLUSION: Endoscopic frontal sinusotomy is a safe and effective procedure for large sinuses with large distance between nasion and cribriform plate, but not in case of osteogenesis and multiple mucoceles. In case of unfavourable anatomy, or for the aforementioned pathologies, the obliteration procedure should be preferred.
Nine patients with persistent coronary artery aneurysms 1.7-14.0 years after an episode of Kawasaki disease underwent progressive bicycle ergometry with expiratory gas analysis. Two of the patients had aneurysms complicated by angiographically documented coronary artery stenosis. Results of the exercise tests were compared to those obtained from a group of age- and gender-matched normal control subjects. The Kawasaki disease patients did not differ significantly from the control subjects with regard to peak oxygen consumption (81 +/- 7% versus 79 +/- 12% predicted), peak workload (75 +/- 13% versus 77 +/- 9% predicted), anaerobic threshold (21.9 +/- 6.5 versus 18.9 +/- 4.0 ml/kg per minute) or oxygen pulse (96 +/- 7% versus 90 +/- 14% predicted). None of the patients developed significant ST segment changes or rhythm disturbances during exercise. The exercise function of the patients with coronary artery stenosis did not differ from that of patients without stenosis. It was concluded that the aerobic exercise function of patients with persistent coronary artery aneurysms after an episode of Kawasaki disease appears to be well preserved. Kawasaki disease patients with significant coronary artery pathology are not accurately identified by a single assessment of aerobic exercise function.
TIPSS was successfully performed in a 10-year-old female cystic fibrosis (CF) patient with bleeding gastric varices due to portal hypertension; precipitation of portosystemic encephalopathy later unveiled the presence of a latent colonic stricture associated with high potency pancreatic enzymes. The unusual sequence of events resulting from the co-existence of two CF pathologies are described, and the implications of treatment discussed.
Monostotic fibrous dysplasia, an unusual disease that can involve the temporal bone, will frequently cause an acquired stenosis of the external auditory canal. Three patients with this disorder who presented with occluded canals are described. Two individuals developed external canal cholesteatomas medial to the obstruction, one of whom eventually developed a postauricular abscess and infected draining sinus. The third patient presented with a restenosis nine months following canalplasty. The cases reported illustrate three surgical criteria necessary to manage these unusual cases successfully: removal of sufficient diseased bone to create a patulous canal; resurfacing denuded bony areas with thin split-thickness skin grafts to prevent soft tissue contractions; an adequate meatoplasty. Postoperatively, the reconstructed canals have remained patent and stable during follow-up periods ranging from one to four years. Clinical, radiographic, and pathologic features of fibrous dysplasia are discussed, the differential diagnosis is presented, and the relevant literature is reviewed.
Malrotation of the gut is a congenital anomaly of the gastrointestinal tract and usually present with obstruction in early childhood. Late presentation may come into light for associated pathology. We report a case that had developed obstruction due to tuberculous stricture and not due to the anomaly itself.
The sudden unexpected deaths of two young people and the findings in their hearts at autopsy are described. The striking feature was marked narrowing of the sinus node arteries by fibromuscular dysplasia. There were no other histological abnormalities present elsewhere. The observations suggest that pathological changes of the sinus node arteries might lead to a terminal cardiac arrhythmia acting as the mechanism of death.
Measurement of recirculation and intradialytic venous line pressures may aid in the detection of hemodialysis vascular access stenoses. The authors screened 29 consecutive asymptomatic patients for recirculation values exceeding 15% or venous pressures greater than 150 mmHg. All 13 patients requiring and agreeing to angiography on the basis of the screening protocol proved to have high-grade stenoses of their vascular access outflow or inflow. Asymptomatic vascular access pathology is common. High-risk asymptomatic populations may be detected by simple screening procedures.
Explore the source record for details and available documents.
Transcranial color-coded duplex ultrasonography is a new diagnostic procedure allowing the visualization of major intracranial vessels. The purpose of this report is to describe this method and to evaluate its practical potential in the routine examination of basal cerebral arteries. The results from the examination of 96 patients are presented. By means of color coding of Doppler frequencies, the major intracranial vessels were identified by nature of their anatomic location with respect to the echogenic brainstem structures in all subjects. The average maximal systolic velocity was, in the middle cerebral artery, 108 +/- 15 cm/s; in the anterior cerebral artery, 96 +/- 15; in the posterior cerebral artery, 76 +/- 16; and in the basilar artery, 59 +/- 17 cm/s. The determination of the angle between the ultrasonic beam and the examined vessel improved the accuracy of flow velocity measurements in comparison with conventional transcranial Doppler ultrasonography. The exact measurement of blood flow velocity in several segments of the visualized vessel proved helpful in the assessment of pathologic findings, especially in differentiation between a stenosis of the intracranial vessel and a vasospasm.
The aim of the work was to assess the frequency, localization and degree of pathological changes in the extracranial segment of carotid arteries in patients in different stages of hypertension by using ultrasonic diagnosis. The authors examined 115 hypertonic patients stage I and II and 95 hypertonic patients stage III according to the WHO classification. They compared the results with a group of 20 subjects, healthy from the clinical and biochemical aspect. The examinations were made by means of an Exhoflow II apparatus of Diagnostic Electronic Corporation, using the method described by Traubner (16). The findings in the control group were normal. In the hypertonic patients stage I and II in 15 (13%) mild, haemodynamically insignificant changes were recorded. In the hypertonics stage III 31 (32.6%) had a pathological finding, incl. 16 patients (16.8%) who had severe stenotic changes, serious from the haemodynamic aspect.
A 10-year review of our experience with all patients with symptoms of colonic narrowing (n = 61) revealed 14 patients who were treated endoscopically. The site of narrowing was the sigmoid colon in 12 patients and the rectum in two patients. The strictures occurred after anastomosis in seven patients, with carcinoma in four patients, and with inflammatory disease, external compression, and idiopathy in one patient each. Although combinations of endoscopic techniques were occasionally used, the predominant method responsible for successful management of the narrowing was bouginage in four patients, endoscopy with a prototype dilating endoscope in four patients, balloon dilatation in three patients, and electrocautery and laser surgery in one patient each. There were no perforations or bleeding complications. Repeated treatments were usually needed. As less invasive methods evolve to treat colonic narrowing, appropriate matching of available techniques with the underlying disease becomes easier. We have found that dilation with a bougie, balloon, or a prototype dilating endoscope can provide especially beneficial results when used on patients with strictures resulting from inflammatory disease or external compression. Cutting and ablating tools such as the electrocautery and laser tools are more suited for management of strictures that result from carcinoma and anastomotic webs. Appropriate matching of endoscopic technique to underlying colonic pathology will allow increasingly successful and safer management of colonic narrowing without operation.
In an attempt to determine the cause of pathological changes in saphenous vein grafts arising months or years after coronary artery bypass surgery, we studied 13 patients who underwent reoperation 7 months to 12 years after the first surgery. Four of 17 grafts occluded early in the postoperative period. In these four cases, only thrombosis was observed in the graft lumen, and there were no marked changes in the graft wall. The 13 grafts occluded in late postoperative period exhibited two significant pathological changes. One was fibrointimal proliferation, which was found to some extent in all 13 grafts. However, it was thought to be the cause of occlusion in only one case. This fibrointimal proliferation was interpreted as a remodeling process associated with arterialization of the vein graft and occasionally causing graft occlusion. The other long-term pathological change, observed in 11 grafts, was atherosclerosis. Atherosclerotic changes significantly contributed to the development of occlusive and stenotic lesions and are suspected to be a major cause of late saphenous vein graft deterioration. In conclusion, fibrointimal proliferation and atherosclerosis are different pathological process, and it is important to distinguish between them in the evaluation of saphenous vein graft disease.
PURPOSE: Optic disc photographs of 750 patients attending a glaucoma practice were examined to identify focal peripapillary arteriolar narrowing. METHODS: A subgroup of 110 of these patients' photographs, who had also had finger circulation tested for vasospasm to cold, were divided into patients with peripapillary focal narrowing and a control group without such a narrowing. These groups were compared with regard to their clinical status, optic disc morphology, and visual field characteristics. RESULTS: Patients with focal arteriolar narrowing were statistically significantly older (p < 0.0001) and had greater cup/disc ratio (p < 0.0001), suggesting more glaucomatous damage than those without focal narrowing. Focal narrowing was statistically significantly more common in patients with glaucoma than in patients with ocular hypertension (p < 0.0001) and were significantly more common when peripapillary atrophy was present (p < 0.0012). The location of the focal narrowing correlated with the presence of a visual field defect in the corresponding hemifield (p < 0.0001 for both upper and lower hemifields). There was no association between focal arteriolar narrowing and digital vasospasm to cold in our study. Peripapillary focal arteriolar narrowings appear to be related to the severity of glaucoma, although the effects of age were not excluded. A patient is presented in whom the narrowing disappeared within a few months suggesting focal vasoconstriction in her. CONCLUSION: Focal narrowing may be indicative of more widespread vascular pathology in the same region; however, we do not know whether these changes precede glaucomatous damage or occur secondarily to glaucomatous damage.