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At least 217 records · Page 12Linked to original sources
PubMed1978

Spontaneous resolution of colonic strictures caused by necrotizing enterocolitis: therapeutic implications.

Colonic strictures are now a well recognized complication in infants surviving necrotizing enterocolitis. We describe the clinical course of seven infants with colonic strictures after necrotizing enterocolitis. Only two demonstrated the finding of fixed fibrotic stricture described in the literature, while the remaining five showed atypical radiographic and pathologic features. Two of the five showed partial or spontaneous resolution of post-necrotizing enterocolitis colonic stenoses on follow-up barium enema studies. In three of four patients with colonic resections, the histopathologic examination revealed a surprising absence of irreversible fibrosis or cicatrix formation. Current surgical practice dictates elective resection of these narrowed colonic segments. The radiologic and pathologic findings in our series of patients suggest surgical resection may be unnecessary in selected cases.

Colon↗
PubMed1984

[Pancreatitis: a little-known cause of ureteral obstruction].

Left ureteral stenosis induced by pancreatitis was observed in one case. Five similar cases have been reported in the literature. Ureteral obstructions may be found in two clinical contexts--patent pancreatitis or retroperitoneal fibrosis. The ureter may be simply compressed mechanically, or there may also be enzymatic or ischemic necrosis. The clinical approach should be directed towards treating primarily the pancreatitis and secondarily the urological pathology. As regards the urological treatment, ureterolysis or ilio-ureteroplasty are indicated in cases of organized irreversible ureteral stenosis.

Adult↗
PubMed2004

MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood.

BACKGROUND: Venous sinus disease must be excluded before diagnosing idiopathic intracranial hypertension but is found only rarely in typical cases. Magnetic resonance venography (MRV) is the technique of choice for investigating this, and provides images that are diagnostic and easy to interpret. However, recent work using more invasive techniques has documented pressure gradients and stenoses in the lateral venous sinuses in many cases of idiopathic intracranial hypertension. OBJECTIVE: To examine the reason for this discrepancy and to establish whether there are characteristic appearances on MRV in idiopathic intracranial hypertension that are routinely overlooked in clinical practice. METHODS: MRVs from 20 patients with idiopathic intracranial hypertension were reviewed, unblinded, by two neuroradiologists, and their appearances rated for focal narrowings and signal gaps. A control group of 40 asymptomatic volunteers, matched for age and sex with the patient group, was recruited prospectively for MRV, and their scans rated in the same way. RESULTS: The lateral sinuses presented a range of appearances with quite different distributions in the two groups (p<0.001). Bilateral lateral sinus flow gaps were seen in 13 of 20 patients with idiopathic intracranial hypertension and in none of 40 controls. CONCLUSIONS: A historical failure to use normal healthy controls to establish the boundaries between imaging artefact, normal anatomical variant, and disease means that the pathological significance of the different appearances of the lateral sinuses on MRV has not so far been appreciated.

Adolescent↗
PubMed2003

Deduction of regional cerebral blood flow loss index after stenosis in cerebral artery.

OBJECTIVE: To study the calculation of cerebral blood flow loss ratio after cerebral artery stenosis using the data obtained from transcranial Doppler sonography (TCD), by deducing regional cerebral blood flow loss index (rCBFLI). METHODS AND RESULTS: The data of TCD performed in 31 cases of unilateral stenosis in the middle cerebral artery (MCA) were collected and analyzed for deducing the formula for calculating the MCA stenosis index (STI): STI=1 (Vm(0)/Vm(1)) x (PI(1)/PI(0)), where Vm(0) is the mean normal velocity of MCA blood flow (derived from the measurements in 908 normal subjects at varied ages receiving TCD) and Vm(1) the mean velocity at the stenosed MCA, and PI(0) and PI(1) stand for the pulsatility index before and after stenosis. The ratio of PI(1) to PI(0) is likely to be equivalent to the ratio of Q(1) to Q(0) (Q(0) and Q(1) represent the volume of blood flow in the MCA in normal condition and after stenosis, respectively), thus the equivalence can be extended as rCBFLI=(1 Q(1)/Q(0)) x 100%=(1 PI(1)/PI(0)) x 100%. rCBFLI after MCA stenosis was calculated in 31 cases accordingly, and by means of correlation analysis, we found positive correlation between rCBFLI and Vm(1) (r=0.76, P < 0.001) and between Vm(1) and STI (r=0.85, P < 0.001). In the same way, rCBFLI of 55 sides with MCA stenosis in 43 cases were analyzed, and positive correlation between rCBFLI and Vm (r=0.76, P < 0.001) and between rCBFLI and STI (r=0.83, P < 0.001) was found. CONCLUSION: rCBFLI can be used to evaluate the degree of regional cerebral blood flow loss due to artery stenosis, and the combination of rCBFLI and STI may provide an insight into the changes of cerebral hemodynamics in this pathologic condition.

Adolescent↗
PubMed1989

Transrectal ultrasonography in disorders of the seminal vesicles and ejaculatory ducts.

Ultrasonography is an inexpensive, noninvasive, and reliable means of evaluating the integrity of the distal seminal tract. A variety of rare congenital anomalies can be demonstrated by ultrasound applied either transabdominally or by the transrectal route. Ultrasonography provides a unique insight into the function and pathology of ejaculation that may affect fertility and may well produce new diagnostic criteria to explain some of the more unusual symptoms encountered by urologists in general practice.

Constriction, Pathologic↗
PubMed1989

[Repeated operations on the extrahepatic bile ducts].

Experience in repeated operations on the biliary tract in 51 patients is analysed. Endoscopic retrograde cholangiopancreatography is one of the informative methods. The choice of the method of operative treatment must be individualized according to the nature of the pathological process in the biliary system. An endoscopic intervention may be an alternative to surgical operations in many cases.

Adult↗
PubMed1978

Endomyocardial fibrosis with calcification of the myocardium.

A case of endomyocardial fibrosis with intramyocardial calcification was characterized by symptoms of restrictive cardiomyopathy resembling constrictive pericarditis. Pathological findings were typical of those found in classical Davies' disease, originally encountered and described in Uganda.

Calcinosis↗
PubMed2001

Ultrasound of the kidney: obstruction and medical diseases.

Ultrasound has emerged as the primary imaging modality in conditions where either renal obstruction or renal medical disease is suspected on the basis of clinical and laboratory findings. In urinary tract obstruction, pathophysiologic changes affecting the pressure in the collecting system and kidney perfusion are well understood and form the basis for the correct interpretation of real-time US and color Doppler duplex sonography (CDDS). Ultrasound is very sensitive for the detection of collecting system dilatation ("hydronephrosis"); however, obstruction is not synonymous with dilatation, as either obstructive or nonobstructive dilatation may be present. To differentiate these conditions, CDDS with measurement of the resistive index (RI) in the intrarenal arteries is extremely helpful, as obstruction (except in the peracute stage) leads to intrarenal vasoconstriction with a consecutive increase of the RI above the upper limit of 0.7, whereas nonobstructive dilatation does not. Diuretic challenge to the kidney may further enhance these differences in RI between obstruction and dilatation. Based on these findings, the present value of US and CDDS in the assessment of the patient with flank pain or renal colic is suggested, especially with respect to promising results for spiral CT and based on cost analysis. In renal medical disease, distinguishing different pathologic conditions using gray-scale US and CDDS (RI) criteria is still very difficult. Nevertheless, US is the fist-line imaging modality in the patient with renal insufficiency.

Constriction, Pathologic↗
PubMed1999

Isolated primary unilateral stenosis of the internal auditory canal.

Congenital primary stenosis of the internal auditory canal (IAC) may exist in isolation or along with a number of other osseous anomalies of the temporal bone. Most of the literature on IAC stenosis is concerned with its effect on the outcome of cochlear implantation (i.e. patients with profound bilateral hearing loss). In addition, some degree of canal asymmetry has been noted in patients with normal hearing, questioning the causal relationship of this finding to deafness. We describe two children with computed tomography (CT) documented severe primary unilateral narrowing of the IAC and an associated ipsilateral sensorineural hearing loss. Typical radiographic findings are described, and the relevant developmental pathology is discussed. The ipsilateral association of stenosis and hearing loss strengthens the link between narrowing of the IAC and deafness.

Adolescent↗
PubMed2003

Angiotensin II signaling pathways mediate expression of cardiac T-type calcium channels.

Recent studies indicate that cardiac T-type Ca2+ current (ICaT) reappears in hypertrophied ventricular cells. The aim of this study was to investigate the role of angiotensin II (Ang II), a major inducer of cardiac hypertrophy, in the reexpression of T-type channel in left ventricular hypertrophied myocytes. We induced cardiac hypertrophy in rats by abdominal aorta stenosis for 12 weeks and thereafter animals were treated for 2 weeks with losartan (12 mg/kg per day), an antagonist of type 1 Ang II receptors (AT1). In hypertrophied myocytes, we showed that the reexpressed ICaT is generated by the CaV3.1 and CaV3.2 subunits. After losartan treatment, ICaT density decreased from 0.40+/-0.05 pA/pF (n=26) to 0.20+/-0.03 pA/pF (n=27, P<0.01), affecting CaV3.1- and CaV3.2-related currents. The amount of CaV3.1 mRNA increased during hypertrophy and retrieved its nonhypertrophic level after losartan treatment, whereas the amount of CaV3.2 mRNA was unaffected by stenosis. In cultured newborn ventricular cells, chronic Ang II application (0.1 micromol/L) also increased ICaT density and CaV3.1 mRNA amount. UO126, a mitogen-activated protein kinase kinase-1/2 (MEK1/2) inhibitor, reduced Ang II-increased ICaT density and CaV3.1 mRNA amount. Bosentan, an endothelin (ET) receptor antagonist, reduced Ang II-increased ICaT density without affecting the amount of CaV3.1 mRNA. Finally, cotreatment with bosentan and UO126 abolished the Ang II-increased ICaT density. Our results show that AT1-activated MEK pathway and autocrine ET-activated independent MEK pathway upregulate T-type channel expression. Ang II-increased of ICaT density observed in hypertrophied myocytes may play a role in the pathogenesis of Ca2+ overload and arrhythmias seen in cardiac pathology.

Angiotensin II↗
PubMed1981

[Extrasinusal ureterocaliceal anastomoses. Review of 27 cases (author's transl)].

Extrasinusal ureterocaliceal anastomoses have been conducted in 27 patients, 21 adults and 6 children, in the Urological Clinic of the Hôpital Necker over the last 10 years. Principal indications, of much greater importance than tuberculosis, are pyelocaliceal lithiasis and certain anomalies of the pyeloureteral junction. In 15 cases, the operation was first choice therapy, while in the other 12 patients it was employed to treat a postoperative cicatriceal stenosis of the subpyelic portion of the ureter. "Peripheral" ureterocaliceal anastomosis (the ureter is sutured to a section of a calyx opened by partial nephrectomy) was carried out in 21 cases, and a "central" anastomosis, suturing the ureter to the base of a calyx after partial nephrectomy, in the 6 others. The most effective drainage method, employed in 14 patients without secretion leak, was nephrostomy at the side of a ureteral sound intubating the anastomosis. The two main postoperative complications were early anastomosis stenosis (6 cases), requiring a repeat operation, and fistulae necessitating prolonged ureteral drainage. Results have remained constant, and of the 25 cases followed up for an average of 2 years, 19 are still perfectly satisfactory (3 of these patients had had repeated ureterocaliceal anastomoses). Results were better after first than second choice ureterocaliceal anastomoses. It should logically be performed as the initial operation, therefore, when required because of the existing pathological condition: destroyed or inaccessible renal pelvis, inability to use the subpyelic portion of the ureter, or very marked pyelocaliceal distension requiring dependent drainage.

Adolescent↗
PubMed2001

Endolaparoscopic rendezvous treatment: a satisfying therapeutic choice for cholecystocholedocolithiasis.

BACKGROUND: There are many different strategies for the treatment of the main bile duct lithiasis. When lithiasis of the biliary tract is suspected at a preoperative stage, we can treat patients with sequential treatment: endoscopic netrograde cholangiopancreatography followed by laparoscopic cholecystectomy. If common bile duct-lithiasis is recognized at an intraoperative stage, many options for treatment exist, one of which is intraoperative retrograde endoscopic sphincterotomy (ES) (laparoendorendezvous). METHODS: We report our experience using the aforementioned technique with 58 patients affected by cholelithiasis and complex Common bile duct disease who underwent laparoscopic cholecystectomy and intraoperative ES consecutively from March 1996 to May 2000. Of the 58 patients, 43 were affected by cholecystocholedocolithiasis: 12 by previously described lithiasis plus stenosant papillitis, 2 also by a pancreas head cancer, and 1 by cancer of the papilla. RESULTS: The combined technique was performed in 86% of the cases. Six patients required conversion to open surgery. In two other patients, laparoscopic choledocotomy was performed with positioning of a Kehr-tube for an ampulla-impacted lithiasis. CONCLUSIONS: Intraoperative ES offers a valid approach to the treatment of cholecystocholedocolithiasis in one session. Furthermore, it represents a valid alternative to transcholedocical laparoscopic treatment of cholelithiasis and complex common bite duct pathology.

Adult↗
PubMed1994

Developing blood flow in the entrance region of an artery.

Presented herein are the studies of the flow behaviour of blood in the entrance region of a segment of an artery. The artery has an axisymmetric mild stenosis developed right from the entry cross section. The blood has been represented by a Bhingham fluid model which also takes the core region, formed due to axial migration of the red blood cells, into account. The flow in the artery has been divided into two regions developing boundary layer and a central core region. A fourth degree velocity profile satisfying the boundary conditions at the wall and the matching conditions at the core and the boundary layer interface is introduced in the governing momentum integral equation. The indicated integration provides a relation for the boundary layer thickness for each axial position. The results for the pressure distribution, entrance length and the wall shear stresses are discussed for the various values of the parameters involved in the analysis. The analysis predicts that the entrance length increases as the stenosis grows and therefore the heart has to put in more energy into transporting blood. It seems that there is some inbuilt mechanism which keeps the entry region of every segment to a minimum in normal arteries at each junction. This length increases in pathological states leading to various types of hypertensive diseases due to the formation and growth of the stenosis.

Algorithms↗
PubMed1990

Deep venous thrombosis after shoulder arthroscopy.

Deep venous thrombosis after shoulder arthroscopy is so unusual that its occurrence should arouse the suspicion of (a) a hypercoagulable state, or (b) a pathologic extrinsic mass causing venous occlusion. This case of deep venous thrombosis after shoulder arthroscopy led to the discovery of previously asymptomatic Hodgkin's lymphoma that was compressing the innominate vein.

Adult↗
PubMed2006

Rare association of female pseudohermaphroditism, phallic urethra, and posterior cloaca.

We describe a child with the rare clinical entity of female pseudohermaphroditism, accessory phallic urethra, and posterior cloaca who was successfully treated with posterior sagittal anorectovaginourethroplasty. Masculinization was limited to the external genitalia, and no chromosomal, metabolic, or adrenal abnormalities were detected. Associated pathology included bilateral vesicoureteric reflux, a non functioning dysplastic kidney, and bicornuate uterus. The investigation and surgical management of this particularly challenging combination of anomalies is detailed.

Abnormalities, Multiple↗
PubMed2000

Three-dimensional numerical simulations of flow through a stenosed coronary bypass.

This work analyzes the flow patterns at the anastomosis of a stenosed coronary bypass. Three-dimensional numerical simulations are performed using a finite elements method. We consider a geometrical model of the host coronary artery with and without a 75% severity stenosis for three different locations from the anastomosis. The flow features - velocity profiles, secondary motions and wall shear stresses - are compared for different configurations of the flow rate and of the distance of the anastomosis from the site of occlusion (called distance of grafting). The combination of the junction flow effects - counter rotating vortices - with the stenosis effects - confined jet flow - is particularly important when the distance of grafting is short. Given that the residual flow issued from the pathologic stenosis being non-negligible after two weeks grafting, models without stenosis cannot predict the evolution of the wall shear stress in the vicinity of the anastomosis.

Arteries↗
PubMed2001

Congenital supravalvar aortic stenosis: a simple lesion?

The underlying cause of congenital supravalvular aortic stenosis (SVAS) has recently been identified as a loss-of function mutation of the elastin gene on chromosome 7q11.23, resulting in an obstructive arteriopathy of varying severity, which is most prominent at the aortic sinutubular junction. The generalized nature of the disease explains the frequent association with stenoses of systemic and pulmonary arteries. Furthermore, localization of the supravalvular stenosis at the level of the commissures of the aortic valve has important implications for both aortic valve function and coronary circulation. This review summarizes the recent advances with regard to the pathogenesis of SVAS and describes the multitude of clinically relevant pathologic features other that the mere 'supra-aortic' narrowing that have important implications for surgical therapy.

Aorta↗