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PubMed2006

Severe acute gastric dilatation causing respiratory failure.

Severe acute gastric dilatation occurring in the absence of bowel obstruction is uncommon. We report acute gastric dilatation developing postoperatively in a 79-year-old man, culminating in respiratory failure. On the third postoperative day following bilateral inguinal hernia repair, he developed abdominal distension with absent bowel sounds. Abdominal radiograph showed a grossly distended gastric shadow and small bowel dilatation. The patient's oxygen saturation then deteriorated suddenly and severely, necessitating intubation. He recovered well with conservative measures.

Acute Disease↗
PubMed1997

Suppression of the reactive hyperemic response in the forearm due to local hand cooling.

METHODS: Forearm blood flow (FBF) was measured by electrical impedance plethysmography in order to identify the influence of local cooling of the contralateral hand after 3 min of arterial occlusion. Ten volunteers (six females, four males) were randomly assigned to the following three experimental conditions on separate days: a) 6 min of local hand cooling (5-7 degrees C); b) 3 min of arterial occlusion of the forearm; and c) combined arterial occlusion and local cooling. RESULTS: All subjects experienced the typical pressor response during 6 min of hand cooling as evidenced by the significant increase (p < and = 0.05) in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The FBF responses demonstrated an immediate increase (p < and = 0.05) within the first 30 s of hand submersion and then progressively declined over the next 5 min. The forearm vascular resistance (FVR = MAP/FBF) made an initial drop during the first 30 s of cooling and then gradually rose to reach peak levels between 5-6 min of cooling. With respect to the hyperemic response, FBF significantly increased (p < and = 0.05) from baseline (mean +/- SEM; 1.09 +/- 0.18 ml x 100 ml-1.min-1) and achieved peak levels (6.75 +/- 0.64 ml x 100 ml-1.min-1) within the initial 30 s of the post-occlusion period. Thereafter, FBF declined rapidly by 30-60 s (1.67 +/- 0.29 ml x 100 ml-1.min-1) and 60-90 s (1.26 +/- 0.33 ml x 100 ml-1.min-1) of the post-occlusion period. CONCLUSION: When the reactive hyperemic response was coupled with hand cooling, FBF increased above baseline values and reached peak levels during the initial 30 s of the post-occlusion period. However, the magnitude of the hyperemic response was significantly lower in the cold condition compared to the hyperemia alone (3.20 +/- 0.42 vs 6.75 +/- 0.64 ml x 100 ml-1.min-1; p < and = 0.05). Clearly, the overall sympathetic response to local cooling had an overriding effect on the factors that promote peripheral vasodilation following brief periods (3 min) of arterial occlusion.

Adult↗
PubMed2005

[Dilated cardiomyopathy (DCM) in dogs--pathological, clinical, diagnosis and genetic aspects].

Dilated cardiomyopathy (DCM) is a heart disease which is often found in humans and animals. The age of onset of this progressive disease varies between 3 and 7 years of age. A juvenile form of DCM has been found in Portuguese Water Dogs and Doberman Pinscher Dogs. Some breeds such as Doberman pinscher, Newfoundland, Portuguese Water dog, Boxer, Great Dane, Cocker Spaniel and Irish Wolfhound exhibit a higher prevalence to DCM. There also seems to be a sex predisposition as male dogs are affected more often than female dogs and in Great Danes an X-linked recessive inheritance is likely. In Newfoundland and Boxer an autosomal dominant inheritance was found whereas an autosomal recessive inheritance was described in Portuguese Water Dogs. Atrial fibrillation as a cause or consequence of DCM is assumed for certain breeds. The causes of DCM are widely unknown in dogs. A genetic basis for this heart disease seems to exist. Apart from a few exceptions the mode of inheritance and the possible underlying gene mutations are not known for DCM in dogs. In humans mutations in several genes responsible for DCM have been identified. Comparative genetic analyses in dogs using genes causing DCM in men and a genome-wide scan with anonymus markers were not able to detect causative mutations or genomic regions harboring gene loci linked to DCM. The investigation of the genetic basis of canine DCM may lead to new insights into the pathogenesis of DCM and may result in new therapeutic approaches and breeding strategies.

Animals↗
PubMed1979

[The sectorisation of pancreatic pathology (author's transl)].

The existence of dilatation of the Wirsung duct distal to an isthmic calculus, the marked dilatation of the cephalic portion of the duct contrasting with the sub-normal calibre of the corporeo-caudal duct in a case of pancreatic lithiasis, are all against the pathogenic hypothesis of a retrodilatation proximal to an obstruction, a supposition which is apparently satisfactory but not always confirmed by the facts. Thus duct distension would not seem to be a purely mechanical phenomenon. The confusing topography of sectorial dilatation of the Wirsung duct in chronic pancreatitis may be explained by a process affecting in isolation or predominantly one or another embryonic sector. The paradox of the association of cephalic dilatation of the duct with stenosis of the intrapancreatic common bile duct offers further support for this hypothesis.

Calculi↗
PubMed1999

Prediction of common bile duct stones by noninvasive tests.

OBJECTIVE: To define accurate and useful predictors of common bile duct stones (CBDS). SUMMARY BACKGROUND DATA: The ability to predict CBDS with noninvasive tests can avoid unnecessary, costly, or risky procedures. METHODS: All patients referred for examination for CBDS by endoscopic ultrasonography (EUS) from 1993-1996 were prospectively entered in a database. In a first sample selected randomly from the whole population, predictors of CBDS were determined by univariate analysis and logistic regression. Predictors were subsequently tested in that sample and in the rest of the population. A separate analysis was done for patients planned for cholecystectomy. RESULTS: Eight hundred and eighty patients (328 men, 552 women), aged 57.8 +/- 17 years (range 16-94), were included. The prevalence of CBDS was 18.8%. Age, serum levels of bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase (GGT), and alkaline phosphatase, and the existence of jaundice and fever, a dilated bile duct, and a pathologic gallbladder were found to be associated with CBDS. Logistic regression was undertaken separately for patients younger than 70 years (predictors: GGT >7 x normal; pathologic gallbladder; dilated bile duct) and older than 70 years (predictors: GGT >7 x normal; fever > 38 degrees C; dilated bile duct). Odds ratios were 3 to 6.7. The model was satisfactorily applicable to the second sample; age <70 years: chi2 = 3.3 (NS); age >70 years: chi2 = 3.8 (NS). In patients younger than age 70 and planned for cholecystectomy, the combination of the level of GGT and dilated bile duct predicted CBDS accurately. CONCLUSIONS: A simple screening of patients at risk for CBDS can be achieved with three predictive criteria adapted for the patient's age.

Adolescent↗
PubMedDate not supplied

Magnetic resonance cholangiopancreatography for diagnosing hepatolithiasis.

BACKGROUND/AIMS: Direct cholangiography with endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography sometimes fails to adequately opacify the entire biliary tract, because of severe biliary obstruction caused by ductal stricture or lodged stones. We assessed the diagnostic accuracy of magnetic resonance cholangiopancreatography for hepatolithiasis. METHODOLOGY: Five patients with hepatolithiasis underwent ultrasonography, computed tomography, direct cholangiography, and magnetic resonance cholangiopancreatography, using a half-Fourier acquisition single-shot turbo spin-echo sequence. Surgical exploration or pathologic examination revealed stricture and dilatation of the intrahepatic ducts in all patients. Diagnostic accuracies for stones and ductal abnormalities were compared among the imaging studies. RESULTS: No complications occurred during magnetic resonance cholangiopancreatography studies. Magnetic resonance cholangiopancreatography fully depicted the biliary tract. Magnetic resonance cholangiopancreatography accurately detected and localized intrahepatic stones, as well as bile duct stricture and dilatation, in all patients. Intrahepatic stones were detected by endoscopic retrograde cholangiopancreatography in one of four patients and by percutaneous transhepatic cholangiography in all three who underwent this procedure. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography demonstrated ductal stricture in all patients but failed to completely demonstrate the biliary tree in three of four patients, and one of three, respectively. On ultrasonography and computed tomography, precise localization of stones was difficult. Ultrasonography and computed tomography failed to demonstrate ductal stricture in one and two of the five patients, respectively. CONCLUSIONS: Magnetic resonance cholangiopancreatography diagnoses intrahepatic stones and bile duct abnormalities less invasively and more accurately than endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

Adult↗
PubMed1991

Early clinical and morphologic alterations in the pathogenesis of furazolidone-induced toxicosis in ducklings.

Clinical and pathologic alterations during the development of furazolidone-induced toxicosis were investigated in a group of 35 newly hatched male Pekin ducklings fed a ration containing 700 mg of furazolidone/kg of feed for 27 days. A control group (n = 25) was fed the same ration without added furazolidone. Every 3 days, ducklings were weighted and palpated for ascites and 3 were chosen at random for euthanasia to determine the severity of lesions and to obtain hearts for gross measurements and ultrastructural study. Clinical alterations in treated ducklings consisted of decreased feed consumption with lower weight gain and nervous signs. Gross pathologic alterations included cardiomegaly with dilatation of all chambers and thinning of the myocardium, pericardial effusion, pulmonary edema and congestion, ascites, and testicular enlargement. Gross lesions were not observed before day 8. The earliest lesion (day 9) was cardiac chamber dilatation, with the left ventricle and left atrium most commonly and most severely dilated. Hearts from ducklings euthanatized on days 6, 12, 18, 24, and 27 were examined ultrastructurally. Myofibrillar lysis was first observed on day 12 in 1 duckling (of 3) and in at least 1 duckling from subsequent euthanasia periods. Myofibrillar lysis did not appear to be uniform among the cardiac chambers.

Animal Feed↗
PubMed1993

Urinary neopterin as a predictive marker of coronary artery abnormalities in Kawasaki syndrome.

We investigated whether urinary neopterin concentrations respond to the pathological conditions (especially coronary artery dilatation) of Kawasaki syndrome. All of 29 children with Kawasaki syndrome had very high urinary neopterin concentrations. Increased urinary neopterin concentrations coincided with fever and with monocytosis in peripheral blood. The urinary neopterin excretion peaking within the first 8 days after onset correlated with the development of coronary artery dilatation. Increased urinary neopterin concentrations indicate that cell-mediated immunity is activated in patients with Kawasaki syndrome. Endogenous interferon-gamma and activation of monocytes/macrophages may play a role in the pathogenesis of Kawasaki syndrome. Not only do neopterin concentrations correlate with symptoms in the acute phase of Kawasaki syndrome, they also act as a predictive marker of coronary artery abnormalities in affected patients.

Biomarkers↗
PubMed1989

[Dilemma of antenatal diagnosis of obstructive uropathy and its treatment].

The early ultrasound detection of fetal urinary dilatations raises dilemmas about their physiological and pathological meanings. Dilatation does not always mean pathological obstruction of the urinary tract. The chronology of the embryology of the Wolffian system is partially unknown and some hypotheses can be developed concerning the urine drainage in the fetus. The physiology of the fetal kidney is also unclear because of the inadequacy of the functional assessments and their dependence on the mother's parameters. The study of the pressures inside the different segments of the fetal urinary tract could be an efficient tool in the understanding of its progressive permeabilization. The difference between primary kidney dysgenesis and kidney dysplasia secondary to urine hyperpressure appears to be of paramount importance in the fetal treatment of these dilatations and in the long-term prognosis. Thus one can better understand how difficult the decision of shunting the fetal urine toward the amniotic cavity. Can be no one can prove its benefit for the fetal development and some lethal complications of these in utero procedures have been described. However, this new approach of the fetal urinary tract obstruction leads us to a change in the therapeutic attitudes in newborns, which stresses a better understanding of this development.

Female↗