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Neonatal renomegaly.

A retrospective clinical review was done to study the value of ultrasound and renography in the investigation of 100 neonates with renomegaly. Abnormalities in 73 patients were detected antenatally with ultrasonography. Of the neonates 47 had lower urinary tract pathological conditions and ultrasound was more than 90 per cent accurate in identifying the accompanying ureteral dilatation. A total of 53 neonates had upper tract anomalies (ureteropelvic junction obstruction or cystic dysplasia). With ultrasonography the degree of pyelocaliectasis in patients with ureteropelvic junction obstruction was classified as mild (22 units), moderate (13) or severe (7). Initial treatment and followup were reviewed to study the clinical course of neonates with mild to moderate degrees of pyelocaliectasis followed nonoperatively, and to determine whether the diuretic renogram had a predictive role in identifying which kidneys were most likely to deteriorate.

Dilatation, Pathologic↗

Shrinkage of human coronary arteries is an important determinant of de novo atherosclerotic luminal stenosis: an in vivo intravascular ultrasound study.

OBJECTIVE: To assess the occurrence of arterial remodelling types and its relation with the severity of luminal stenosis in atherosclerotic coronary arteries. PATIENTS AND METHODS: Twenty one de novo coronary lesions of 20 patients, who were scheduled for percutaneous transluminal coronary angioplasty (PTCA), were investigated with intravascular ultrasound before PTCA. Local arterial remodelling at the lesion site was studied by measuring the cross sectional area circumscribed by the external elastic lamina (EEL) relative to the reference site: (EEL area lesion/reference EEL area) x 100%. Three groups were defined. Group A: relative EEL area of less than 95% (shrinkage), group B: relative EEL area between 95% and 105% (no remodelling), group C: relative increase in EEL area of more than 105% (compensatory enlargement). RESULTS: All three types of remodelling were observed at the lesion site: group A (shrinkage) n = 8, group B (no remodelling) n = 5, group C (compensatory enlargement) n = 8. The mean (SD) relative EEL area at the lesion site in group A and C was 83(9)% and 132(30)%, respectively. In group A, 33% of the luminal area stenosis at the lesion site was caused by shrinkage of the artery. In contrast, group C showed that 87% of the plaque area did not contribute to luminal area stenosis because of compensatory arterial enlargement. CONCLUSIONS: These results show that both compensatory enlargement and paradoxical shrinkage occurs in the atherosclerotic coronary artery. Next to plaque accumulation, the type of atherosclerotic remodelling is an important determinant of luminal narrowing.

Adult↗

[Annulo-aortic ectasia].

Aortic regurgitation due to annular aortic ectasia was diagnosed in a 29-year-old woman with heart failure. The primary pathology of this disease is cystic medial necrosis of the ascending aorta with aneurysm formation and dilation of the aortic valve annulus. In successful surgical correction, the ascending aorta was replaced by a dacron prosthesis, the aortic valve by a prosthetic disc valve and the coronary arteries were reimplanted into the aortic graft.

Adult↗

[Pathological observations on fallopian tubes after sterilization].

From animal experiments and clinical observation of 130 cases of tubal anastomosis, it has shown that the dilatation of salpinx and adhesion of pelvic organs may occur after ligation of oviduct tube. The present study showed that: (1) tubal dilatation is the result of simple hydrosalpinx and is related to inadequate location of tubal ligation; (2) the mechanical stimulus caused by rough ligation end and large scar is an important factor in producing adhesion of pelvic organs; (3) delicate and gentle operation and choosing isthmus portion to ligate is helpful in prevention of the above changes.

Adnexal Diseases↗

[Coronaro-myocardial interplay determining the instantaneous mean ventricular shape (author's transl)].

A working hypothesis on the mechanism of diastolic chamber expansion based on functional anatomy and physiology is developed. It should be a major determinant of the momentary average chamber width. The sum of all intramyocardial fluid-filled spaces and the myocardium itself are considered in the working hypothesis as the hydraulic medium of a process which can be summarised under the term "cavernous body mechanism". The most important factor of this hydraulic system should represent the intramural fluid volume (hydraulic medium) and the contractile-elastic tension development in the transmural direction of the chamber wall. Morphological analysis of myocardial structure shows that an endoepicardial direction of force in the myocardial net can be recognised. The "motor" of circular fibres of the middle layer is surrounded by the spiral course of the fibres of the inner and outer layers of the chamber wall (uvula mechanism). It is interwoven by very dense bifurcating myocardial fibres (structural principle of the tongue). By these means, the width of the chamber cone is influenced decisively by an active decrease in wall thickness. The coronary perfusion pressure is thought to have a chamber dilating influence in the sense of a "cavernous body mechanism". The hypothesis presented helps us to understand pathological chamber dilation secondary to transmural myocardial fibrosis. Such a narrow functional coronary-myocardial interaction gives the myocardium two functions; besides haemodynamic pumping, the cardial muscle must function as an internal antagonist to favour diastolic chamber dilation.

Animals↗

Patulous rectum extension into the ischiorectal fossa: CT findings.

Protrusion of the rectum with egress into the ischiorectal fossa was present on computed tomography (CT) in three elderly women. CT demonstration of such rectal redundancy in elderly women will avoid unnecessary bowel damage in the case of misguided clinical assessment of rectal pathology.

Aged↗

[Methods for the macroscopic diagnosis of pulmonary emphysema].

The author examined 124 dead persons with clinicaly and anatomicaly diagnosed emphysema in order to prove and demonstrate the possibilities of the the existing methods for macroscopic diagnosis of the lung emphysema. The method of Gough and Wentworth, barium-sulfate method of Heard and simple original method for examination of the changes by a naked eye or with only a magnifying glass in fixed total lung sections were used and the results described. He constructed a special table and knife to cut the lung at equal sections. An inference was made that the method of Gough and Wentworth, although more complicated, revealed the best advantages. Both the impregnation method of Heard and the newly proposed method were very suitable for an examination of a very large number of lungs, since they assure enough information for the diagnosis, distribution and degree ofthe pathological process and allow current morfological classification of the disease.

Dilatation, Pathologic↗

Pathological and pathophysiological study on intestinal lymphatic system in fat absorption.

Pathological and pathophysiological study on the intestinal lymphatics was carried out clinically and experimentally. Jejunal biopsy study revealed marked dilatation of intestinal lymphatics in liver cirrhosis with ascites and Behçet's disease as well as protein-losing enteropathy. Lymphangiographic study showed also abnormal findings in above-mentioned diseases. In cases of McKee dogs in which mechanism of blockade of lymphatic flow was already clarified, McKee dogs showed marked malabsorptive of fat. When lymphatic flow was blocked mechanically at the thoracic duct, fat accumulation was seen in the absorptive cells as well as in dilated intestinal lymphatics. In administration of colchicine to rats, fat accumulation was seen in the matrix of absorptive cells as well as in the endoplasmic reticulums and Golgi apparatus. However, amorphous substances instead of chylomicrons were seen in dilated intestinal lymphatics. These studies suggested that a tract of fat transportation from intestinal cells to the thoracic duct should be considered as a functional unit in fat absorption.

Animals↗