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PubMed1985

Ultrasound characteristics of recurrent carotid disease: hypothesis explaining the low incidence of symptomatic recurrence.

The true incidence of recurrent disease after carotid endarterectomy (CENDX) is unknown, but noninvasive hemodynamic testing shows a paradox between the incidence of hemodynamically significant recurrent stenosis (RS) and the presence of symptomatic disease. We have shown that real-time B-mode ultrasound imaging can demonstrate the gross pathology of the arterial wall and plaque and their surface characteristics. Therefore we reviewed the clinical data and B-mode studies performed 6 months to 15 years after 276 carotid endarterectomies. Preoperative and perioperative risk factors and associated symptoms on follow-up were stored on computer. The patients were divided into three groups by the anatomy of their B-mode study. The majority of the studies were normal (203 [73.5%]), 42 (15.2%) showed mild disease, and 34 (12.3%) demonstrated significant RS. The RS group had a statistically significant increase in incidence of known lipid abnormalities (p less than 0.05), associated peripheral vascular disease, previous myocardial infarctions, and ulcerated plaque on the original carotid endarterectomy (p less than 0.01). The site of RS appeared related to the time of detection by B-mode ultrasound imaging. Internal carotid RS developed late (greater than 4 years), as did RS of the bifurcation. By contrast, stenosis at the common carotid level developed earlier. These findings suggest different pathogenic mechanisms--for the former, redevelopment of atherosclerosis; for the latter, accentuation of preexisting atherosclerosis perhaps by hemodynamic factors. Finally, in the 26 vessels with RS without occlusion, there was an 8% incidence of plaque ulcer or hemorrhage vs. a 62% incidence in 79 primary atherosclerotic plaques previously studied by both B-mode and pathologic examination. The low incidence of plaque characteristics associated with symptomatic disease may account for the low incidence of symptomatic disease associated with RS.

Arterial Occlusive Diseases↗

PubMed2000

The role of B-mode ultrasonography and electron beam computed tomography in evaluation of Takayasu's arteritis: a study of 43 patients.

OBJECTIVES: To evaluate the capacity of B-Mode ultrasonography (B-Mode US) and electron-beam computed tomography (EBCT) to detect arterial changes in Takayasu's arteritis. METHODS: EBCT angiography of the thoracoabdominal aorta and pulmonary artery, and B-mode US of large superficial arteries (common carotid, subclavian, and common femoral arteries) were performed prospectively in 43 consecutive patients with established Takayasu's arteritis. The arterial wall thickness was measured, and lumen changes (stenosis, aneurysm) were noted. RESULTS: The combined results of B-Mode US and EBCT examinations showed that every patient had at least one abnormality at the studied sites. The median score of abnormal sites was 7. The most frequent lesion was a characteristic long, homogeneous, circumferential thickening, visualized in 52% of examined sites and in all patients but one (98%). Stenosis was detected by US and by EBCT, respectively, in 44% and 32% of patients, and aneurysm in 0.4% and 68%. CONCLUSIONS: In Takayasu's arteritis, B-Mode US and EBCT was able to visualize the classical caliber abnormalities (stenosis, aneurysm) and, in contrast to angiography, to depict vessel wall thickening, a major pathologic feature of the disease. Both these safe techniques seem more useful than angiography to characterize and map the vascular lesions of Takayasu's arteritis.

Adolescent↗

PubMed2002

Multi-locus interactions predict risk for post-PTCA restenosis: an approach to the genetic analysis of common complex disease.

The complexity of recognizing the potential contribution of a number of possible predictors of complex disorders is increasingly challenging with the application of large-scale single nucleotide polymorphism (SNP) typing. In the search for putative genetic factors predisposing to coronary artery restenosis following balloon angioplasty, we determined genotypes for 94 SNPs representing 62 candidate genes, in a prospectively assembled cohort of 342 cases and 437 controls. Using a customized coupled-logistic regression procedure accounting for both additive and interactive effects, we identified seven SNPs in seven genes that, together, showed a statistically significant association with restenosis incidence (P <0.0001), accounting for 11.6% of overall variance observed. Among them are candidate genes for cardiovascular pathophysiology (apolipoprotein-species and NOS), inflammatory response (TNF receptor and CD14), and cell-cycle control (p53 and p53-associated protein). Our results emphasize the need to account for complex multi-gene influences and interactions when assessing the molecular pathology of multifactorial medical entities.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

[Use of mildronate for the treatment of patients with circulatory encephalopathy against a background of stenosis of major arteries of the head].

Chronic cerebrovascular ischemia is an important cerebrovascular disorder leading to progression of the functional neurological deficite--to cognitive impairment in the first place. The main reason for the above condition is a stenotic affection of major arteries of the head. In the treatment of patients presenting with the above pathology, we used mildronate (10% infusion solution, 10 ml, for up to 10 days followed by tablets, 750 mg per day for 20 days). As clinical and paraclinical monitoring was conducted of the condition of patients with making use of X-ray computerized tomography, electroencephalography, ultrasonic dopplerography of extra- and intracranial arteries, an assessment was done of findings from the neuropsychological testing. A positive effect is shown on the degree of neurological symptomatology, hemodynamic, electrophysiological, neuropsychological characteristics of the pathology in question. The drug is recommended for use in the treatment of stage II chronic cerebrovascular insufficiency originated and gone ahead because of a stenotic affection of major arteries of the head.

Adolescent↗

PubMed1984

[Cerebral angiography in transitory global amnesia].

33 patients with transient global amnesia were examined by cerebral angiography. The presence of arterial lesions correlated with neurological symptoms, as well as with amnesia. In 55% of cases no pathological alterations were found, so that the pathogenesis of the transient global amnesia remained unclear. For clinical purposes, cerebral angiography is recommended only in those cases which show other neurological symptoms besides the transient global amnesia.

Adult↗

PubMed1983

Thoracic outlet syndrome and the shoulder.

Thoracic outlet syndrome may be the cause of symptoms wrongly attributed to shoulder pathology, or it may accompany or result from shoulder injury. If misdiagnosed, it may leave the physician wondering why relevant shoulder therapy fails to result in a return to full potential, but if correctly diagnosed, it can be cured or ameliorated.

Adolescent↗

PubMed1986

Pathophysiology of aqueductal obstruction in isolated IV ventricle after shunting.

The authors report their cases of isolated IV ventricle and discuss their concepts of secondary obstruction of the aqueduct, analyzing CSF dynamics, pressure measurements, serial CT scan changes, and the outcome of various treatment modalities. Two distinctly different categories were identified: functional obstruction in which the obstructed aqueduct reopened either as the result of decreasing the elevated infratentorial pressure (Raimondi's phenomenon) or from correction of overdrainage of the supratentorial system; permanent obstruction with pathological occlusion of the aqueduct, necessitating a IV ventriculoperitoneal shunt. It is the pathophysiology and pathoanatomy of secondary obstruction of the aqueduct that determine the specific treatment to be used in managing the isolated IV ventricle syndrome.

Brain Diseases↗

PubMed1993

Doppler color flow mapping of epicardial coronary arteries: initial observations.

OBJECTIVES: We addressed the hypothesis that blood flow could be imaged by Doppler color flow mapping of the coronary arteries and characteristic patterns described in normal and diseased vessels. BACKGROUND: Echocardiographic imaging of the epicardial coronary arteries has been suggested as a useful adjunct to their intraoperative evaluation. Addition of Doppler color flow mapping could potentially enhance this evaluation by displaying the flow disturbance produced by anatomic lesions whose physiologic significance may otherwise be uncertain. In experimental models, such displays could also potentially provide insights into the pathophysiology of coronary blood flow and stenosis. METHODS: Epicardial coronary arteries were examined with a high resolution 7-MHz linear phased-array transducer both in vivo and in vitro. 1) The coronary arteries were studied in the beating hearts of 10 open chest dogs in which experimental stenoses were also created; the maximal extent of the arterial tree in which flow could be seen in the most ideal setting was also examined in four additional excised perfused canine hearts. 2) Six excised human coronary arteries were perfused in a pulsatile manner to determine whether abnormal flow patterns could be prospectively identified and subsequently correlated with pathologic evidence of stenosis. RESULTS: All normal coronary artery segments studied showed homogeneous flow without evidence of flow disturbance. In the excised heart, flow could be visualized to the distal extent of the epicardial vessels; in the open chest model, visualization of the proximal 5 to 6 cm was comparable, although surrounding structures limited access to the terminal portions of the vessels. The stenotic lesions created in the canine hearts (n = 9) showed recognizable alterations in the flow pattern: localized aliasing, proximal blood flow acceleration, distal flow disturbance and recirculatory flow. In the excised human arteries, these features identified 12 lesions, all of which corresponded to areas of > or = 50% lumen narrowing by pathologic examination. CONCLUSION: Blood flow in the epicardial coronary arteries can be imaged by Doppler color flow mapping and characteristic flow patterns described in normal and diseased vessels.

Animals↗

PubMed2002

Anal stenosis and mucosal ectropion.

Anal stenosis (AS) or stricture is defined as the loss of compliant natural elasticity of the anal opening, which then becomes abnormally tight and fibrous. It is a very disabling condition, worsened by the patient's embarrassment, but uncommon. The vast majority of cases are secondary to trauma, iatrogeny, inflammatory diseases, or neoplasia, or occur postradiation. Depending on the severity and level of involvement, AS can be classified as mild, moderate, or severe. Due to the rarity of this pathology and the different referral patterns among institutions, the etiology ranges widely between published reports. There are multiple surgical techniques that have been described for the correction or improvement of AS. Moderate or severe AS is the usual indication for operative treatment.

Anus Diseases↗

PubMed1982

Non-invasive studies of the extra-cranial cerebral arteries: indication for angiography and operation.

During recent years, the risk involved in cerebral angiography has been considerably reduced. However, in our patient group this risk was still almost as high as that involved in operation. Non-invasive examination by means of the ultrasonic Doppler procedure has been improved with a resulting success rate of over 95%. Color coding stored in a computer program with the "Echoflow"-procedure allows for demonstration of the neck vessels giving an indication of the degree of stenosis. By this method, pictures of document quality are provided which can also be obtained by inexperienced examiners and interpreted more easily than curve registrations of the acoustic signals. In comparison with angiography, the Echoflow method was less sensitive than the conventional ultrasonic Doppler procedure especially in cases of low-degree stenosis of the internal carotid artery. Nevertheless, in 2.7% of the cases, a correct Echoflow diagnosis could be confirmed during operation where angiography had not shown the changes correctly. As the Echoflow procedure does not give sufficient information on intracranial pathology, we have so far dropped angiography in emergency cases only when establishing the indication for operation; however, in follow-up examinations this method is used exclusively instead of angiography.

Auscultation↗

PubMed2002

A rat model of otitis media with effusion caused by eustachian tube obstruction with and without Streptococcus pneumoniae infection: methods and disease course.

OBJECTIVE: To describe the clinical and histopathologic progression of a rat model of otitis media with effusion caused by eustachian tube obstruction (ETO) with and without Streptococcus pneumoniae infection. METHODS: In 164 rats, the left, bony eustachian tube was approached via a ventral incision and obstructed with dental material. Then 108 rats were infected via an intrabullar injection with S pneumoniae. At 48 hours, the infected rats were treated for 5 days with ampicillin. All ears were evaluated by weekly otomicroscopy. On each of days 1, 2, 7, 21, 35, 56, and 112, four rats were killed for histologic study. All effusions were cultured for bacteria. RESULTS: Fourteen rats died of surgical complications; effusion resolved by 2 weeks in 9 rats. During the first few days, infected ears with ETO had bulging tympanic membranes, followed by tympanic membrane retraction, purulent effusion, and otorrhea (50%) over the next few weeks, whereas uninfected ears with ETO developed retraction and serous effusion during the same time frame. At later times, all ears with ETO presented with retraction and serous or serous-mucoid effusion. S pneumoniae was recovered only from the infected ears with ETO (days 1 and 2), with some colonization by nonpathogenic microorganisms observed equally in both groups of ears. Histology showed a typical acute inflammatory reaction in the challenged ears with ETO through day 14 and then a chronic inflammation for all ears with ETO. CONCLUSION: The experimental methods provoked reproducible pathologic signs similar to those for otitis media with effusion. Given the availability of rat-specific reagents, this model is well suited for studies of cytokine elaboration during disease pathogenesis.

Animals↗

PubMed1986

Unusual pulmonary lesion of vascular origin: a noninvasive diagnostic approach.

Despite the lack of pathologic confirmation, we believe that we are reporting an isolated pulmonary artery branch stenosis with poststenotic dilatation. The differential diagnosis of a solitary pulmonary lesion should include this unusual entity. Digital subtraction angiography offers a safe, minimally invasive way to confirm this anomaly.

Angiography↗

PubMed1988

HIDA scan in the follow-up of biliary-enteric anastomoses.

In order to assess the patency and function of biliary-enteric anastomoses performed in our Department of Surgery, 21 patients entered the following study, provided an informed consent was obtained. All the patients were affected by benign biliary tract diseases and underwent either Roux-en-Y hepaticojejunostomy (11 cases), or side-to-side choledochoduodenostomy (10 cases). The 21 patients were evaluated with Tc-99m-HIDA scanning at intervals of 20 days-36 months after the surgical procedure (mean 14 months). The images were obtained after intravenous injection of the radioactive medium (5 mCi) and the scans were taken at 1 min (1 frame/s), 3 min (1 frame/10 s), and 56 min (1 frame/2 min). THe data were analyzed by a Digital PDP 11/34 Computer System. This method allowed us to assess each individual patient for the patency of the anastomosis and, by computer analysis, to build up a profile of the timing of the passage of the radioactive medium through the anastomosis, a delayed passage across the anastomosis was always pathological. In conclusion, the 99m-Tc-HIDA scanning used in our study for long-term follow-up of biliary-enteric anastomoses is reliable and allows an assessment of prognosis.

Alkaline Phosphatase↗

PubMed2004

[Percutaneous management of benign pathology of the main biliary tract: experience in a section of pancreatic and hepatobiliary surgery].

BACKGROUND: Biliary percutaneous procedures (BPP) are useful on management of benign biliary pathology. OBJECTIVE: Communicate our experience with percutaneous biliary procedures made by surgeons in a specific Hepato-Pancreato-Biliary Section. POPULATION: Retrospective evaluation in 84 patients with benign biliary diseases, treated with BPP from January 1989 through January 2002. RESULTS: Diagnosis common bile duct stones 21 patients, strictures after common bile duct injury (SCBDI) 29 patients, and other benign bile duct strictures (OBBDS) 34 patients. INDICATIONS: Acute cholangitis 45, pruritus 11, high surgical risk 10, contraindicated or failed endoscopic access 9, before liver transplantation 12 and other causes 3. Procedures (n=141): percutaneous drainage 96, stricture dilatation 27, percutaneous stone treatment 12, stents 5 and biopsy 1. EFFECTIVENESS: Cholangitis 94.8%, stones 100%, anastomotic stricture dilatation (by SCBDI 45.5% and by OBBDS 90%). COMPLICATIONS: Total 32 (38.1%). MORTALITY: 3 (3.6%). CONCLUSIONS: 1-Percutaneous drainage was an effective method for bile duct decompression in acute cholangitis, allowing an elective and definitive treatment of the pathology. 2-BPP solved strictures in patients with a high surgical risk and in those with complex diseases. 3-The results of biliary percutaneous dilatation were related to their etiology.

Biliary Tract↗

PubMed1989

[Application of transendoscopic Nd-YAG laser to stenosis caused by unresectable carcinoma of the alimentary tract].

Clinical and pathological studies were performed on the efficacy of transendoscopic Nd-YAG laser irradiation to stenosis by unresectable carcinoma of the alimentary tract, and the following conclusions were obtained. Nd-YAG laser was irradiated with 30-40W, total energy 3,000-12,000J, to carcinoma of 8 cases of the esophagus, 4 cases of the stomach, 7 cases of recurrence at gastric anastomosis site and 4 cases of the large intestine, and it evaporated and reduced tumor to relieve of stenosis. The patients's quality of life was remarkably improved. Pathological study on biopsied specimens at the site of irradiation revealed no residual viable cancer cell within at least 6mm depth from the surface of carbonization layer. No perforation, no massive bleeding, no pain were recognized both during and after irradiation.

Aged↗

PubMedDate not supplied

[Prevention of coronary atherosclerosis. (V). Prevalence of non-stenotic atheromatous rigidity in men accidentally killed in Mexico City].

The presence of rigid coronary arterial segments was detected during a survey for coronary atherosclerosis in men who died of violent causes. These lesions which traditionally are considered of non-clinical significance, in the absence of stenosis are probably responsible of the clinical and electrocardiographical abnormalities as seen in patients with "normal" coronary arteries using coronary angiography, the best current procedure for the detection of isolated coronary atherosclerosis. We propose these lesions are to be considered as functional lesions and consequently that these lesions should be considered by both, the pathologist and the clinician. Our hypothesis is to be tested in the near future when new diagnostic advances with the possibility of detection of coronary pathology in vivo, appear. The prevalence of these abnormalities in different age-groups as well as the topography are presented. The concordance of these lesions with coronary stenosis is also presented.

Accidents↗

PubMed1984

[Method of surgical intervention for compression stenosis of the celiac trunk].

Experience with the surgical treatment of 265 patients with a compressive stenosis of the celiac trunk has been analyzed. Stenosis of the celiac trunk is known to be a cause of ischemic abnormalities of the stomach, duodenum, pancreas. Decompression of the celiac trunk is an effective method of treatment of the ischemic disease of digestion organs resulting in better organic blood circulation and involution of the appearing pathologic processes. In a number of patients there appeared symptoms for associated interventions due to complications of ischemic gastroduodenal ulcers or concomitant diseases. Excellent and good remote results were noted in 79,6%, satisfactory--in 16,7%, unsatisfactory--in 3,7%.

Celiac Artery↗

PubMed1993

Celiac territory ischemic syndrome in visceral artery occlusion.

Abdominal angina that is characterized by postprandial pain, and often associated with weight loss, is a well-recognized symptom complex of mesenteric artery insufficiency (mesenteric territory symptoms). In the past 5 years, we have observed six patients with atypical symptoms who had mesenteric artery occlusion combined with stenosis or occlusion of the celiac artery. Atypical symptoms included severe nausea and vomiting at the sight or smell of food, anorexia, weight loss, and right upper quadrant or epigastric discomfort (celiac territory symptoms). An extensive work-up to rule out gastric, pancreatic, biliary, or colonic pathology was undertaken in these patients. The findings included gallbladder dysfunction, diffuse micro-ulceration of gastric mucosa, and colonic mucosal ulceration. The diagnosis of visceral artery occlusion was initially missed in all six patients. Four patients had cholecystectomy. Visceral angiography confirmed occlusion of the celiac, superior, and inferior mesenteric arteries. Five patients had dramatic resolution of symptoms after restoration of visceral circulation. One patient who developed intestinal infarction before revascularization died. Symptoms suggesting upper abdominal visceral pathology may be a manifestation of celiac artery stenosis/occlusion coexisting with mesenteric artery occlusive disease. Visceral angiography should be part of the work-up in these patients for early diagnosis and prompt management.

Abdominal Pain↗