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PubMed1999

Tracheal lesion caused by percutaneous dilatational tracheostomy--a clinico-pathological study.

OBJECTIVE: To analyse the accuracy of cannula placement and the extent of tracheal lesions of the anterior tracheal wall after percutaneous dilatational tracheostomy (PDT). DESIGN: A clinico-pathological study of tracheal specimens following PDT. SETTING: University hospital. MATERIALS: Forty-two tracheal specimens of intensive care patients (24 male, 18 female; age: 23-70 years) who died unrelated to tracheostomy. INTERVENTIONS: Using tracheoscopic guidance, PDTs were performed by Ciaglia's method. Tracheal cannulas with outer diameters of 11-12 mm were used. The duration of cannulation ranged from 1 to 97 days (median: 10.5 days). RESULTS: PDTs were placed between the 1st and 4th tracheal rings in 32 cases, above the first ring in 7 cases and below the 4th in 3 cases. Twenty specimens showed a horizontal intercartilaginous rupture of the anterior tracheal wall, 12 tracheas additionally had fractures of tracheal rings and in 10 specimens defects of tracheal cartilage (range: 15 mm2-120 mm2) were found. The occurrence of tracheal defects was influenced by the height of puncture (p<0.05) and duration of cannulation (p<0.01). CONCLUSION: Misplacement of the tracheal cannula above or below the intended tracheal area occurred in one-fourth of our patients. The typical tracheal lesion following PDT is transverse rupture of the anterior tracheal wall with or without fracture of neighbouring rings. Extended cartilaginous defects are rare, which may explain the low rate of tracheal stenosis following PDT.

Adult↗
PubMed1999

Late pouch dilation after laparoscopic adjustable gastric and esophagogastric banding: incidence, treatment, and outcome.

BACKGROUND: Pathologic late pouch dilation is the most frequent complication following gastric banding procedures for morbid obesity. In this study, possible predictive factors were sought. The treatment of these complications and the final outcome are discussed. METHODS: Between December 1994 and December 1997, 171 patients underwent laparoscopic adjustable banding for morbid obesity. 40 patients underwent classic gastric banding (Group 1), and 131 patients underwent esophagogastric banding (Group 2). RESULTS: Pouch dilation developed in 6 patients (15%) in Group 1 and 12 patients (9.2%) in Group 2. There were no significant predictive factors, although the complication occurred more frequently in patients with presurgical hiatus hernia. The type of dilation was different for each group, as was the surgical treatment. Laparoscopic repositioning of the band was always possible and was uncomplicated. The long-term outcome has been good, and weight loss has been maintained. CONCLUSIONS: A frequent complication following banding procedures for morbid obesity is pathologic late pouch dilation. In experienced hands, when appropriate surgical treatment is carried out, this is not a major problem. Nevertheless, efforts should be made to decrease the number of late dilations.

Adult↗
PubMed1988

Antegrade transluminal dilatation of benign ureteral strictures: long-term results.

The long-term results (follow-up of 15 months or longer) of antegrade transluminal dilatation of 127 benign ureteral strictures are assessed and analyzed. The overall success rate is 50%. When lesions were classified according to age of the stricture, status of vascular supply, and other etiologic factors contributing to formation, the following findings were evident: transluminal dilatation was successful in 30 (91%) of 33 patients with fresh strictures in whom there was no evidence of compromised vascular supply; in 23 (53%) of 43 similar strictures older than 3 months; in 3 (25%) of 12 with fresh strictures with evidence of vascular compromise; and in 7 (18%) of 39 with similar older strictures. Regardless of age of stricture and other etiologic factors, transluminal dilatation was successful in 53 (70%) of 76 patients with strictures without evidence of ischemic compromise but was successful in only 10 (20%) of 51 with strictures with evidence of devitalization. These findings emphasize the importance of considering both the age and vascular supply of a stricture and adjacent ureter when making the decision about treatment by antegrade transluminal dilatation.

Constriction, Pathologic↗
PubMed1990

Diminished beta-adrenergic receptor responsiveness and cardiac dilation in hearts of myopathic Syrian hamsters (BIO 53.58) are associated with a functional abnormality of the G stimulatory protein.

Previous studies have demonstrated a diminution in the bioactivity of the guanine nucleotide-binding regulatory protein that stimulates adenylyl cyclase (Gs) in hearts of the hypertrophic BIO 14.6 Syrian hamster. In this study, we measured functional activity and immunodetectable levels of Gs in a mutant strain of hamsters (BIO 53.58) that develop a dilated cardiomyopathy. Pathological studies demonstrated that 100-day-old BIO 53.58 hamsters had substantial ventricular dilation when compared with age-matched F1B controls. Additionally, these 100-day-old hamsters demonstrated diminished contractile response to beta-adrenergic receptor stimulation. The pathological and hemodynamic changes were associated with defective coupling of Gs to adenylyl cyclase as adenylyl cyclase activation was distinctly decreased in the presence of isoproterenol, fluoride ion, guanine nucleotides, and forskolin. Additionally, the ability of the alpha-subunit of Gs to reconstitute isoproterenol-stimulated adenylyl cyclase activity in S49 cyc- membranes was reduced approximately 65%. By contrast, cyc- complementation assays did not reveal a difference between the functional activity of Gs in hearts from 30-day-old BIO 53.58 hamsters and F1B controls. Furthermore, beta-adrenergic receptor stimulation of adenylyl cyclase in the membranes of the young BIO 53.58 hamsters was not significantly different from controls. The substantial alterations in Gs bioactivity in hearts of the 100-day-old BIO 53.58 hamsters was not associated with alterations in the immunodetectable levels of either alpha Gs or alpha Gi on Western Blots. These results suggest that G protein changes are associated with ventricular dilation in BIO 53.58 hamsters and that G protein levels are not always reflective of G protein bioactivity.

Adenylyl Cyclases↗
PubMed1999

Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage.

BACKGROUND: This study is designed to compare endometrial thickness measured by transvaginal ultrasound with endometrial pathology by dilatation and curettage. METHODS: Fifty-four women with postmenopausal bleeding were evaluated. Endometrial thickness, including both layers of the endometrium, was measured by transvaginal ultrasound after which fractional curettage was performed and samples taken were then dispatched for histologic examination. RESULTS: Median endometrial thicknesses of 5 mm, 8.5 mm and 6 mm were found for benign, hyperplastic and carcinomatous endometrium, respectively. Of the eight hyperplastic samples, two cases had 4 mm, and one case had 3mm endometrial thickness. Similarly, of the nine malignant samples, three cases had an endometrial thickness of 3 mm. Three mm has been found to be the best cut off point for endometrial abnormalities in postmenopausal bleeding with 100% sensitivity but low specificity (13%). CONCLUSION: Fractional curettage seems to be the best method for detecting endometrial abnormalities in women with postmenopausal bleeding.

Adult↗
PubMed1982

[The value of ultrasound tomography in the differential diagnosis of cholestasis - a review].

In early use the sonography may facilitate and accelerate the differential diagnosis of the cholostasis. In parenchymal hepatic icterus frequently pathologic changes of the liver may be proved sonographically. the typical findings of dilated and thus sonographically demonstrable intra- and extrahepatic biliary ducts speak for obstructive jaundice. Characteristic constellations of dilated segments of the bile duct allow conclusions to the localisation of the occlusion. Changes which cannot be explained by sonography are cause for further examinations.

Cholestasis, Intrahepatic↗