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PubMed2001

[Hybrid 3-D rendering of the thorax and surface-based virtual bronchoscopy in surgical and interventional therapy control].

PURPOSE: The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest. MATERIAL AND METHOD: In 6 consecutive patients with partial lung resection (n = 2) and lung transplantation (n = 4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model. RESULTS: The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions. CONCLUSIONS: Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Anastomosis, Surgical↗
PubMed1989

[Duplex sonography of the internal jugular vein].

Based on defined diagnostic criteria high-resolution Duplex sonography allows the accurate evaluation of normal and pathological jugular vein. Compared to examinations with only the B-mode the diagnostic accuracy is higher with the duplex system with additional display of venous flow signals. Normal findings and results of duplex sonography in patients with venous inflow congestion, thrombosis and aneurysm of the jugular vein are presented, and their clinical relevance of the method discussed.

Aneurysm↗
PubMed2000

Total bilateral ureteral replacement for stenosing ureteritis in Henoch-Schönlein purpura.

Stenosing and calcified ureteritis occurring in Henoch-Schönlein purpura remains a rare urological complication. The authors describe their own experience of the diagnosis and treatment of this rare pathology along with a review of the literature. Recognition and early surgical management may prevent serious renal outcome. In cases of ureteral replacement, different procedures using ileal segment have been proposed. We report the results of the Cockett and Goodwin procedure with a follow-up of more than 25 years.

Child↗
PubMed1975

Postnatal development of obstruction in coarctation of the aorta: role of the ductus arteriosus.

The sequence of events leading to the development of acute obstruction in two infants with coarctation has been defined by clinical, hemodynamic, and angiographic studies. One infant had normally related great arteries and an isolated coarctation, while the other infant had transposition with a hypoplastic right ventricle, a ventricular septal deffect, narrowing of the aortic isthmus, and a localized site of coarctation. In each instance, a posterior aortic shelf--the basic pathologic lesion in coarctation--could be observed angiographically. Signs of aortic obstruction were absent, however, as long as the ductus arteriosus was widely patent. Following ductal obliteration, femoral pulsations diminished, a peak systolic pressure difference was recorded between the ascending and descending aorta, and a discrete area of juxtaductal coarctation was seen. The basic malformation (posterior aortic curtain) would appear to exist in utero, possibly as an aortic branch point. This lesion is nonobstructive as long as blood can traverse the aortic isthmus through the aortic end of the ductus into the descending aorta. Postnatally, as the ductus arteriosus undergoes constriction at its aortic insertion, signs of acute aortic obstruction may b =ecome apparent. Normal femoral arterial pulsations during the newborn examination do not definitively exclude coarctation. Pediatricians should recheck at 2 weeks of age if the infant is asymptomatic or sooner if there are signs of cardiac failure to establish the presence or absence of this defect.

Angiography↗
PubMed1982

Significance of the angiographic morphology of localized coronary stenoses: histopathologic correlations.

Postmortem coronary angiographic morphology was correlated with histologic sections of 73 localized subtotal coronary artery stenoses (50-99% reduction of luminal diameter) to determine whether complicated or uncomplicated atherosclerotic lesions could be detected angiographically. Lesions were divided into two types, according to angiographic morphology: Type I stenoses had smooth borders, an hourglass configurations, and no intraluminal lucencies; type II stenoses had irregular borders or intraluminal lucencies. Histologic sections were also divided into two types: "uncomplicated" stenoses had fatty or fibrous plaques with intact intimal surfaces and no superimposed thrombus; "complicated" stenoses manifested plaque rupture, plaque hemorrhage, superimposed partially occluding thrombus, or recanalized thrombus. Among 35 lesions with type I angiographic morphology, four (11.4%) were complicated lesions histologically. Among the 38 stenoses showing type II angiographic morphology, 30 (78.9%) were complicated lesions. Postmortem angiography thus had a sensitivity of 88% and specificity of 79% for detecting complicated stenoses on the basis of irregular borders or intraluminal lucencies. Pathologic studies have shown that acute occlusive thrombosis of a coronary artery is usually associated with complicated atherosclerotic stenoses. Thus, complicated lesions represent a greater risk factor for acute myocardial infarction or sudden death than do uncomplicated lesions. This study suggests that coronary stenoses characterized angiographically by irregular borders or intraluminal lucencies are probably the clinically more dangerous "complicated" type.

Angiography↗
PubMed2003

Pseudomalignant myositis ossificans of the wrist causing compression of the ulnar nerve and artery. A case report.

Myositis ossificans (MO) is a condition characterised by focal, benign and self-limited idiopathic heterotopic bone formation. It is extremely rare in the hand and wrist and may lead to concomitant nerve compression. Because of the rare incidence of pseudomalignant MO at the wrist and hand, we found it of interest to report a case of this condition localised to the wrist. A 31-year-old female patient presented with swelling and pain of her left wrist. The physical examination findings, magnetic resonance imaging and Tc-99m bone scan suggested acute osteomyelitis or a tumoral condition. Incisional biopsy and pathological examination was done. The microscopic findings confirmed that the lesion was pseudomalignant MO. The lesion was removed totally and decompression of the ulnar nerve and artery was achieved. The patient regained full asymptomatic range of motion of all digits and wrist and the numbness of the fourth and fifth digits had subsided at follow-up five months later.

Adult↗
PubMed1980

[Vascular complications after the treatment of carcinoma of the cervix (author's transl)].

Vascular complications after this treatment are rare. Artery stenosis or occlusions, more often iliac, are well recognized complications of postoperative radiotherapy. These segmental lesions, sometimes, are pathological lesions similar to arteriosclerotic changes. These lesions may be corrected later on after the treatment of carcinoma of the cervix. The venous complications often present later and tall within the context of post thrombotic syndrome. Conservative treatment is indicated alone. A well recognized complication, lymphedema is usually mild; a superimposed iliofemoral thrombophlebitis often may be suspected.

Adult↗
PubMed1994

The vascular nervous skeleton: a disregarded factor of vascular pathology.

The nervous supply of the vascular wall in its organ entirety represents the felt-like 'nervous skeleton'. Its growth is more vulnerable than that of any other tissue component of the developing vessel wall. Selective growth impairment of the vascular nervous skeleton should result in developmental vascular stenosis. Escape of the epithelial or smooth muscle cells from the confines of the nervous skeleton should be taken into account as a possible common denominator of carcinogenesis and atherogenesis.

Arteriosclerosis↗
PubMed1980

Cystic thymoma simulating pulmonary stenosis.

A 36-year-old man presented with chest pain, an anterior mediastinal mass and a loud pulmonary systolic murmur. At operation a large, tense, well encapsulated, cystic thymoma was found to be compressing the right ventricular outflow tract and the main pulmonary trunk, producing a systolic thrill over the artery. After excision of the cyst, the thrill and the murmur disappeared and there was complete symptomatic relief. Classification, pathology, clinical presentation, diagnosis and treatment of cysts of the thymus are discussed. The syndrome of pulmonary artery compression characterized by a triad of chest pain, dyspnoea and a loud pulmonary systolic murmur, which decreases in intensity during inspiration, is described. Pertinent literature on cysts of the thymus, and acquired pulmonary stenosis due to extrinsic compression is reviewed.

Adult↗
PubMed1991

[Duplex sonography of the vertebral arteries. 2. Clinical application].

The purpose of this report is to demonstrate pathological findings such as hypoplasia, stenosis and occlusion that were diagnosed by duplex-ultrasonography of vertebral arteries. Duplex scanning provides complementary to the continuous wave Doppler examination more accurate haemodynamical and morphological information for the diagnosis of hypoplasia or intracranial stenosis. In comparison with DSA this method may give additional information allowing to differentiate between vertebral aplasia and occlusion at the origin.

Blood Flow Velocity↗
PubMedDate not supplied

[Normal and pathological compression of the venous system].

A study of 190 female patients was carried out at the level of the solar ring, the crural arch, the left ilio-caval junction and the vena cava ring of the diaphragm, in order to determine whether these represent, per se, critical areas, which may cause compression and hinder the venous return as a result of the narrowing and the poor distention of their structures. Sonotomography alone or associated with the pulsed Doppler were selected for this study. The action of the various components (bone, muscle, tendon, vessels and nodes) on the venous system is each region, was analyzed. The overall results have demonstrated two types of compression: a) intermittent, b) permanent. The former is considered as a hemokinetic mechanism, especially at the level of the solar arch and the vena cava ring of the diaphragm. They represent a major element of the pump and the vis-a front respectively. The permanent compression was considered as pathological, and could be related to a venous displacement occurring as an adaptation mechanism to the extrinsic compression. The data obtained in all four regions, have demonstrated that their various components are in a precarious balance, but they do not constitute a true obstacle to the venous return, even if in some postures or respiratory movements they may cause an intermittent venous compression.

Adult↗
PubMed1986

Ischemic pathology of the colon.

Ischemic colitis is a disease with a polymorphic clinical picture, which may be of a formidable gravity in gangrenous forms. Its etiologies are varied and more and more due to a low arterial output. The examinations permitting to establish the diagnosis are barium enema and mostly colonoscopy which should be performed early and repeated often. The treatment vary according to the severity of the disease; prognosis is always reserved.

Colon↗
PubMed1977

Noncontact detection of ocular pulse--correlation with carotid stenosis.

Differences in ocular pulses from both eyes are well known to be associated with pathology; correlation of ocular pulse amplitude with the degree of carotid stenosis is made by a new method. Detection of ocular pulse is done by noncontact air-propagated ultrasound. Experimental results with dogs show detection of 10 to 15% carotid stenosis. By this method, one can screen for potential stroke in its incipient stages.

Animals↗
PubMed1993

Left main coronary artery stenosis after aortic valve replacement: genetic disposition for accelerated arteriosclerosis after injury of the intact human coronary artery?

BACKGROUND: Left main coronary artery stenosis is a rare but life-threatening complication after aortic valve replacement because of coronary perfusion-related trauma to the vessel wall with cannulation of the coronary ostia. We investigated whether this complication still occurs in the 1990s despite the use of more advanced catheter materials and modern surgical preservation techniques. METHODS: Four years after identification of the first two cases in 1987, five further patients had developed left main coronary artery stenosis after aortic valve replacement (incidence, 0.9%) at the cardiothoracic clinic of the J.W. Goethe University and were studied for contributing factors. RESULTS: Severe coronary ostial stenosis developed within 1 to 6 months after aortic valve replacement. In one such case, intimal proliferation was seen in a biopsy specimen that was comparable to the restenosis induced by coronary angioplasty. The clinical characteristics of the patients developing the complication, the surgical technique, and the intraoperative course did not differ from the other patients. However, five of the seven patients (71%) had a common genetic trait concerning their apolipoprotein E genotype (the epsilon 4 allele) that is normally present in only 10% to 15% of patients screened (P < 0.01). CONCLUSIONS: These lesions seem to result from a uniform response of the vessel wall to injury. Their incidence is probably related in part to the degree of injury after trauma to the coronary ostia during cannulation for myocardial protection. Patients with the epsilon 4 allele might be genetically predisposed for a pathologically increased response of proliferative repair mechanisms after arterial injury. The complication can be avoided by not instrumenting the coronary ostia for direct antegrade cardioplegia but using retrograde delivery as an alternative method of myocardial protection.

Adult↗
PubMed2005

Differential indication for histological evaluation of endometrial fluid in postmenopause.

OBJECTIVES: The endometrium carcinoma is the most frequent malignancy of the female genital tract. Approximately, 10-20% of all patients with an endometrial carcinoma are free of symptoms until the time of diagnosis. The frequent occurrence of an endometrial carcinoma in connection with intrauterine cavity fluid collection (sero- or mucometra) has been discussed controversially in literature. What are the hysteroscopic and histological findings in patients with sonographically determined endometrial fluid in postmenopause, and how should these findings be interpreted? METHODS: 74 patients, in whom endometrial fluid without bleeding disorders had been diagnosed during routine transvaginal sonography, underwent hysteroscopy conducted with a 4.5 mm optics and dilatation and curettage (D&C). The median age of the patients was 68 years with a range of 32 years. RESULTS: The simple thickness of the endometrium, i.e. single layer measured sonographically at the point of maximal thickness, was on average 5.7 mm +/- 3.6 mm (2-15 mm). Hysteroscopically, an endometrium polyp was found in 23 cases (31.1%), endometrium hyperplasia in 12 (16.2%), and an atrophy in 35 cases (47.3%). In four cases (5.4%), an endometrial carcinoma was suspected. The histological results were consistent with the hysteroscopic findings. In all instances, in which the simple endometrial thickness amounted to 3 mm or less, an atrophic endometrium was found. The frequency of intrauterine pathologies increased significantly with a greater thickness of the endometrium. In 80% of patients, a cervical stenosis existed. CONCLUSIONS: Endometrial fluid by itself, without assessment of the endometrium, does not indicate the requirement for additional histological clarification. As diagnostics, the authors suggest especially the endometrial morphology.

Aged↗
PubMed1980

Accuracy of carotid angiography in the assessment of atheroma of the internal carotid artery.

In a post-mortem study to determine the accuracy of angiography in defining atheromatous disease of the origin of the internal carotid artery, 64 carotid bifurcations were filled with a mixture of gelatin and contrast medium, X-rayed, cleared for pathological study, and assessed by a neurologist and a vascular surgeon. Agreement between the two observers on the X-ray appearances was 87.5% and between the agreed X-ray interpretation and the macroscopic pathological findings 78.6%. Closest agreement was seen with normal and stenosed vessels. Difficulties were encountered with lesser changes due to plaques and ulceration. Since the decision to recommend carotid endarterectomy in patients with a history of transient ischaemic attacks depends on the angiographic findings, knowledge of the accuracy of angiography can be critical.

Arteriosclerosis↗
PubMed1981

Tracheobronchial mucus: abnormalities related to asthma and its treatment.

The presence of mucociliary dysfunction in bronchial asthma is suggested by clinical observations and has been confirmed by pathologic and physiologic studies. Since mucociliary dysfunction may play a considerable role in the pathophysiology of bronchial asthma, currently available therapeutic measures which enhance mucous transport should be included in the treatment plan. It is expected that a better understanding of the underlying mechanisms will ultimately result in the development of more potent pharmacologic agents capable of improving abnormal mucociliary function.

Airway Obstruction↗
PubMed2002

[Stenosis of the external auditory canal: etiology, classification and management].

Stenosis of the external auditory canal is uncommon, poly-etiological pathology of the external auditory canal. The management of stenosis of the external auditory canal is difficult because of re-stenosis and danger of postoperative complications. The purpose of this article is to present modern classification, etiopathogenesis of the external auditory canal stenosis, indications for the surgical management, some aspects of the surgical management, using the modern literature and clinical cases.

Adolescent↗