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At least 325 records · Page 18Linked to original sources

Schistosomiasis as a cause of rectovaginal fistula: a brief case report.

A high rectovaginal fistula associated with schistosomiasis is reported in a 19-year-old Ethiopian woman. The case history is reviewed for clinical presentation, results of preoperative investigations, and operative and pathologic findings. Operative treatment consisted of a low anterior resection with division of the fistula and primary colorectal anastomosis. Histologic analysis confirmed that this rectovaginal fistula was caused by schistosomal eggs. Schistosomiasis is identified as a cause of high rectovaginal fistula, and may be managed effectively by low anterior resection.

Adult↗

Aqueduct stenosis-?Benign.

'Benign' aqueduct stenosis is a common cause of hydrocephalus in the paediatric population and is frequently treated by endoscopic third ventriculostomy. Occasionally, aqueduct stenosis can be a prelude to the development of other pathology, as is seen in these two cases of pineal tumours developing in patients whose hydrocephalus was successfully treated with endoscopic third ventriculostomy. The case histories are presented, along with the recommendation for increased radiological screening of patients with this usually 'benign' presentation.

Brain Neoplasms↗

Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis.

PURPOSE: To assess the usefulness of magnetic resonance (MR) cholangiopancreatography (MRCP) in the evaluation of disease in patients with acute or chronic pancreatitis. MATERIALS AND METHODS: MR imaging was performed at 1.5 T in 39 patients with chronic (n = 30) or acute (n = 9) pancreatitis. The patients underwent a pancreas MR imaging protocol that included an MRCP sequence. Comparison was made with findings at endoscopic retrograde cholangiopancreatography (ERCP), performed within 30 days. Three blinded readers used a scoring system to evaluate nine segments of the pancreatic and biliary ducts as depicted on the ERCP and MRCP images. MRCP image quality was also evaluated. RESULTS: Of 196 segments analyzed, 17 were not seen at MRCP (sensitivity, 91%). Of the segments visualized at MRCP, 14 were incorrectly characterized (accuracy, 92%). At MRCP, segments not detected or mischaracterized were either normal, slightly dilated, or narrowed. At ERCP, 42 segments in 19 patients were not visualized. MRCP findings were considered useful in all those cases. MRCP image quality was not interpretable in two cases due to artifacts. CONCLUSION: Very good correlation between ERCP and MRCP findings was demonstrated. Both modalities failed to depict pathologic conditions depicted by the alternative method. MRCP may obviate ERCP, particularly in patients who cannot undergo ERCP or in whom ERCP has been unsuccessful.

Acute Disease↗

Popliteal artery disease: diagnosis and treatment.

The popliteal artery is a relatively short vascular segment but is affected by a unique set of pathologic conditions. These conditions, which may be common throughout the arterial system or exclusive to the popliteal artery, include atherosclerosis, popliteal artery aneurysm, arterial embolus, trauma, popliteal artery entrapment syndrome, and cystic adventitial disease. The clinical manifestations, imaging appearances, and treatment options associated with these pathologic conditions differ significantly. Consequently, the radiologist should be familiar with these conditions to direct imaging for accurate diagnosis and treatment and to prevent loss of limb.

Adolescent↗

Vertebrobasilar insufficiency. Part 1: Microsurgical treatment of extracranial vertebrobasilar disease.

Extracranial vertebrobasilar artery thrombo-occlusive disease may cause repetitive transient ischemic episodes and, less frequently, brain-stem or cerebellar infarction. This report describes 40 patients who experienced repetitive vertebrobasilar ischemic symptoms despite maximal medical therapy. The natural history, pathogenesis, and treatment options for each causative lesion are reviewed. The operative approaches to symptomatic disease of the proximal vertebral arteries, arterial compression by cervical osteophytes, traumatic lesions of the vertebral arteries, and thrombo-occlusive pathology of the distal extracranial vertebral arteries are outlined. Specific anesthetic and surgical techniques that have proved successful while achieving zero operative mortality and low perioperative morbidity rates are reported.

Adolescent↗

[The effect of vertebral artery deformation by the osteophytes of uncovertebral areas on cerebral hemodynamics].

Based on the analysis of 37 cases, an ultrasonic picture is described together with the character of a change in dopplerographic indicators in compression of the vertebral artery from osteophytes of the uncovertebral regions. In most cases (94.6%) the deformation is not accompanied by a hemodynamically significant compression (stenosing) of the artery and does not affect the indices for the intracranial bloodflow. The vertebral artery deformation from osteophytes affects parameters characterizing cerebral bloodflow when it is associated with other pathology. Movements in the cervical region of the spine do not increase compression of the vertebral artery from osteophytes of the uncovertebral region. Significance of the vertebral artery compression in the extracranial region can be adequately assessed mostly by indices for intracranial bloodflow. Thus, some other factors or their association that are most often not taken account of can play the leading part in the development of cerebral vascular insufficiency, such as occlusive lesions, deformations of arteries, anomalies of development, reflex vascular pathology etc. As a matter of fact, it is on extremely rare occasions that osteophytosis has a pronounced hemodynamically significant effect on the vertebral artery, it is not considered to be the only cause of cerebral circulatory disorders in people under 58-60 years of age.

Adult↗

[Ultrasonic, arteriographic and anatomopathological correlation in 59 cases of carotid atherosclerosis].

This study was carried out on 49 patients who underwent an ultrasound study by continuous Doppler and echotomography B real-time, an angiography of supra-aortic arteries, and a carotid endarterectomy. Thirteen had had transient ischemic attacks and 20 a stroke. A quantification of the carotid stenosis in 4 stages was established for each method. For detection of lesion an excellent correlation was observed between the results of echotomography and pathology. For the quantification of lesion the correlation between echotomography and pathology was excellent also in 79,7 p. 100 of the cases, discordant in 20,3 p. 100. It was similar to the correlation between arteriography and pathology (excellent in 83 p. 100 of the cases). The correlation with pathology enabled to distinguish for stages of atherosclerotic lesions, to clarify their type of complications, and to evaluate their functional significance, particularly those with a high risk of embolism.

Adult↗

[Pathologic diagnosis of certain congenital heart defects].

Morphometrical examinations of 265 normally formed hearts collected at autopsies of infants under 2 years of age were used as a control of the heart weight and size of the pulmonary trunk and aorta. The time of anatomical closing of the arterial duct and oval window were established. Comparisons of the results of morphometry of normal and 173 malformed hearts with the tabulated data were used to develop objective criteria for pathological diagnosis of congenital heart diseases: open arterial duct and centrally located defect of the interatrial septum in infants dying within the first two months of life. The criteria for the detection of marginal forms of stenosis of the pulmonary trunk ostium and isolated coarctation of the aortal isthmus were established.

Age Factors↗

Nonsteroidal anti-inflammatory drug-induced strictures of the colon: report of a case and review of the literature.

The phenomenon of strictures of the colon induced by nonsteroidal anti-inflammatory drugs is a newly recognized pathologic entity that has gained little exposure in the surgical literature to date. A further case is reported and the clinical features of this entity are discussed. Most patients present with symptoms suggestive of malignancy, namely anemia, obstructive symptoms, or weight loss. Pathologic changes are characterized by diaphragm-like strictures with submucosal fibrosis. Surgical resection to exclude malignancy and treat symptoms along with cessation of the nonsteroidal anti-inflammatory drug is the treatment of choice.

Anemia↗

Fallopian tube recanalization in an unrestricted patient population.

PURPOSE: To review the effectiveness of fallopian tube recanalization (FTR) when performed without restriction based on history or tubal condition. MATERIALS AND METHODS: From October 1989 to July 1992 in 37 consecutive women, aged 22-44 years (mean, 35 years), 42 FTRs were performed (five patients each underwent two FTRs). Water-soluble contrast material and selective ostial salpingography and/or microcatheter technique were used exclusively. Eighty tubes were evaluated, since four patients had previously undergone unilateral salpingectomy. Sixty-three tubes (79%) were occluded at the outset of the procedure. RESULTS: Complete recanalization was achieved in 45 of 63 (71%) occlusions. Adhesions were present in 25 of 80 (31%) tubes, salpingitis isthmica nodosa in 12 (15%), and hydrosalpinx in nine (11%). The 42 procedures resulted in 14 (33%) conceptions, nine (64%) of which involved pathologic tubes. Eleven intrauterine pregnancies resulted in five spontaneous first-trimester abortions, five full-term deliveries, and one continuing pregnancy. CONCLUSION: Favorable conception and live birth rates can be achieved with FTR, despite a high prevalence of tubal disease.

Adult↗

["Entrapped" popliteal artery: pathology and pathogenesis. Report of 7 cases with review of the literature].

In this study, the author reports on the pathological aspect in seven cases of "entrapped" popliteal artery. Alterations observed were similar to arteriosclerotic changes. The pathologic aspect is not specific. The physiopathogenic mechanism of this arteriopathy is similar to that of the chronic vascular compression syndrome due to pre-existing anatomic abnormalities, such as the thoraco-brachial outlet syndrome of the subclavian artery. Chronic compression of the popliteal artery is considered as a localized microtrauma of the arterial wall.

Adult↗

[Possibilities of complex radioendoscopic examination of the pancreatoduodenal zone after choledochoduodenostomy].

A complex examination of 76 patients subjected to choledochoduodenostomy has shown that unsatisfactory results of the operation were due to various pathological alterations of anatomical structures and the created anastomosis. The state of distal parts of the cholangiopancreatic system should be necessarily studied by means of endoscopic pancreaticocholangiography when investigating the reasons of unsatisfactory results of choledochoduodenostomy.

Adult↗

[Bileduct reoperations (author's transl)].

After cholecystectomy reoperations are required in 7%. A reoperation in indicated by pathologic alterations overlooked at the first operation, not working biliodigestive anastomoses and injuries to the common bile duct. 138 reoperations of the bile duct wer performed within 4 years which were aimed at reconstructing the normal bile duct anatomy. Mortality rate 8,7%.

Ampulla of Vater↗

Placement of self-expanding metallic stents in the pancreatic duct for treatment of obstructive complications of pancreatic cancer.

BACKGROUND: Stents have been placed through malignant pancreatic strictures, mainly to alleviate pain of presumed obstructive origin. Self-expanding metallic stents have major advantages over plastic stents when used for treatment of malignant biliary strictures. However, there are few reports of their use in patients with malignant pancreatic duct strictures, especially those with complications related to ductal obstruction. METHODS: Self-expanding metallic stents were placed in the pancreatic ducts of 3 patients with obstructive complications of pancreatic cancer: smoldering pancreatitis, a disrupted pancreatic duct with pseudocyst caused by open surgical biopsy, and a disrupted pancreatic duct with fistula and resultant liver abscess. All 3 patients had metallic stents placed concomitantly in the biliary tract; one had enteral stents placed as well. Clinical and pathology records and imaging studies were reviewed retrospectively. OBSERVATIONS: In all cases, there was resolution of the specific clinical problem and reasonable survival (1.5 years in one patient). CONCLUSIONS: The use of self-expanding metallic stents for treatment of certain obstructive complications of pancreatic tumors is feasible and effective.

Aged↗

[Transesophageal echocardiography for evaluation of the left coronary artery].

The aim of the study was to evaluate the clinical usefulness of transesophageal echocardiography in the imaging of the left main coronary artery. The group tested--consisted of 26 patients with angina pectoris and 8 controls. The identification and adequate images of the left main coronary artery were obtained in 33 of 34 (97%) patients. In 5 of 26 patients with angina pectoris we observed stenosis of the left main coronary artery. The diameter stenosis of the lesion was judged to be greater than 50%. In addition, we tried to asses Doppler-derived parameters of blood flow. We have demonstrated that the pulsed Doppler study of the left main coronary artery is feasible. Comparison of patients with angina pectoris with the control group showed lower systolic flow velocities (35 +/- 10 cm/s vs. 55 +/- 15 cm/s) and slightly higher diastolic flow velocities (75 +/- 20 cm/s vs. 70 +/- 10 cm/s). This transesophageal examination holds promise for detecting pathologic vascular status. Although the sensitivity and specificity of this findings cannot be determined by our study, we believe that transesophageal echocardiography can provide a reference for the evaluation of patients with known or suspected ischemic heart disease. Further studies including larger groups of patients are recommended.

Aged↗

[Popliteal vein entrapment, popliteal cyst, desmoid tumor and fabella syndrome].

The popliteal fossa is a relatively small, muscle-bound strategic anatomical area where is found, on the posterior aspect of the knee, a vasculonervous pedicle and where both vascular and pseudovascular disease may develop, the latter originating from wall-constituting parts. Among non-typical popliteal diseases, the authors have singled out four rare syndromes. The popliteal vein may be trapped due to fibrous strangulation or, more often, to compression by the hypertrophied gastrocnemius muscle. This requires proper diagnosis and surgical management prior to thrombosis onset. Synovial cysts raise no diagnostic problems, unless they mimic an episode of phlebitis; echotomography has now become essential for diagnosis. Desmoid tumors for which predominant extra-abdominal occurrence sites are the popliteal fossa, the leg and thigh, are difficult to excise completely, especially at the popliteal level, and are a major technical challenge because of the inclusion of the vasculonervous pedicle. Lastly, in sports pathology, one must be able to recognize the painful fabella syndrome (osteochondritis of sesamoid fibrocartilage in lateral head of gastrocnemius), so as not to mistakenly implicate vascular disease. New developments in imaging (namely, real time CT-echography) are of major help to clinicists, who should, nonetheless, remain chiefly responsible for detecting these diseases.

Arterial Occlusive Diseases↗

[A case of remarkable bronchial stenosis due to aspiration of delayed-release iron tablet].

This report describes a rare case of bronchial mucosal injury caused by aspiration of a delayed-iron tablet. A 44-year-old woman had been taking delayed-iron tablets (Feto-Gradumet) regularly because of iron deficiency anemia, and accidentally aspirated a tablet into her bronchus. After this accident, she had complained of wheezing and shortness of breath. On bronchoscopy, the bronchial mucosa of left lower lobe initially showed remarkable swelling and redness, and became corroded and narrowed gradually by iron toxicity over several months, although we tried to remove some fragments of tablet as completely as possible. While we had examined her bronchi repeatedly by bronchoscopy, the bronchial mucosa gradually normalized during 15 months, but moderate stenosis of the left basal bronchus remained. The pathological findings showed infiltration of inflammatory cells, edema and granuloma formation in the submucosal region. This report suggests that the bronchial injury was due to the toxicity of persistent ferrous sulfate eluted from the iron tablet which had adhered firmly to the wet bronchial wall for a long time.

Adult↗

Two instances of bile reflux without acute pancreatitis.

In two patients in whom most of the bile and the pancreatic juice were mixed, one within the pancreatic duct because of a presumed injury to the ampulla of Vater and the other within the bile duct secondary to a tumor of the ampulla of Vater, there was no pathologic evidence of acute pancreatitis within the pancreas. This was true even though there was chemical evidence that trypsin in its active form passed through the pancreas. On explanation for this is that trypsin inhibitors contained in human bile and pancreatic juice may bind trypsin.

Acute Disease↗