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At least 379 records · Page 21Linked to original sources
PubMed1994

[Permanent pacemaker lead insertion for totally occluded subclavian vein].

We experienced 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted. Occlusion of the subclavian vein was not clinically apparent in these 4 patients. The pacing lead was inserted through the contralateral subclavian vein in a 65-year-old male. In a 80-year-old male, the pacing lead was inserted trough the internal jugular vein because of occlusion of both subclavian veins. The pacing lead was passed through the occluded portion of the innominate vein in a 84-year-old male. Phlebography-guided venipuncture was not difficult in a 79-year-old female whose mid-portion of the subclavian vein was occluded. All patients have done well since permanent pacemaker implantation. Preoperative phlebography should be performed as it may provide useful information concerning pathological alterations in the venous system that might hinder smooth implantation of the pacemaker. A review of the literature revealed no reports concerning methods in which pacing leads are passed through totally occluded portions of the subclavian vein. We here report 4 patients with total occlusion of the subclavian vein in whom permanent pacemakers were implanted via different venous routes.

Adult↗
PubMed1988

Diffuse arterial narrowing as a result of intimal proliferation: a delayed complication of embolectomy with the Fogarty balloon catheter.

Most complications of embolectomy with the Fogarty balloon catheter are recognized early and have received ample attention in the surgical and radiologic literature. However, the delayed complication of diffuse arterial narrowing causing severe ischemia has received little emphasis, perhaps because follow-up arteriography is not always performed. This report describes five patients--women 43 to 62 years of age--with progressive leg ischemia discovered 2 to 4 months after embolectomy with the balloon catheter. Angiography showed a characteristic pattern of severe, smooth narrowing of that portion of the artery in which balloon embolectomy was performed. Pathologic examination of arterial specimens, available in two of the five patients, revealed marked intimal cellular proliferation, which narrowed the arteries severely without evidence of thrombosis, significant atheromatosis, or active arteritis. The cause appears to be intimal damage by the balloon. Embolectomy with the balloon catheter should be done especially carefully in relatively young women.

Adult↗
PubMed1995

Posttraumatic intestinal stenosis: clinical and radiographic features in four patients.

PURPOSE: To characterize posttraumatic intestinal stenosis clinically and radiographically. MATERIALS AND METHODS: The clinical records and radiographic and pathologic findings were reviewed in four patients with posttraumatic stenosis. RESULTS: The patients experienced abdominal symptoms from 1 to 18 weeks after the trauma. While the small intestine was affected in two patients with ileus, the colon was involved in the other two patients with rectal bleeding or diarrhea. Barium studies showed an irregular contour within the severely narrowed intestine in three patients, even 25 weeks after the trauma. In these three patients, pathologic examinations of the resected specimens revealed a circumferential, open ulcer, whereas a scarred ulcer was present in the other patient. CONCLUSION: Posttraumatic intestinal stenosis is clinically characterized by a delayed onset of symptoms that differ according to the site of involvement. This condition should be included in the differential diagnosis of intestinal stenosis.

Abdominal Injuries↗
PubMed1991

Simultaneous comparison of pre- and post-microanastomotic hemodynamic profiles using a Tandem Doppler Probe.

The use of High-Frequency Pulsed Doppler Ultrasound (HFPDU) for evaluation of microvascular hemodynamics is well established. Due to technical limitations of existing probes, quantitation of anastomotic stenoses and detailed waveform analyses are difficult to perform and impractical for clinical use. We present a new Tandem Doppler Probe (TDP) for simple and accurate study of blood flow in vessels smaller than 1 mm in diameter. Its unique ability to compare the pre- and post-anastomotic waveforms simultaneously allows for quantitative detection of anastomotic narrowing of as little as 5%, as well as identification of subtle pathologic anastomotic waveform changes not seen with single probes. Such early and precise delineation of anastomotic problems in the operating room can provide an invaluable, objective assessment of the technical adequacy of the anastomoses as well as an important baseline for later post-operative monitoring of free-tissue transfers with implantable Doppler devices.

Anastomosis, Surgical↗
PubMed1987

[Combined use of duplex sonography and CW Doppler in diseases of the carotid arteries].

740 patients with findings of cerebrovascular insufficiency were investigated by duplex sonography and frequency-analysing cw doppler. In 620 pathological arteries not stenosing lesions of the carotid bifurcation were found most frequently (93%). In 35% moderate-severe stenoses of the a. carotis interna were diagnosed. The advantage of duplex sonography and cw doppler in combination is the addition of both methods, so that a very reliable diagnosis of the extracranial carotis is possible.

Blood Flow Velocity↗
PubMed1986

[Pathologico-anatomic studies in the area of the vertebral artery with special reference to perivascular connective tissue].

On the basis of pathological-anatomical examinations of 25 human cervical vertebral columns a report is given on changes of the perivascular tissue in the region of the Aa. vertebralis. The possible influence of degenerative changes in the skeleton of the cervical vertebral column on this connective tissue reaction is discussed. For a verification of the findings obtained comparative clinical-anatomical examinations are necessary.

Adolescent↗
PubMed1998

A Dumon stent inserted for bronchial stenosis causing a left bronchopericardial fistula: report of a case.

We present herein the case of a 59-year-old man in whom a Dumon stent, inserted as treatment for stenosis of the left main bronchus, caused a left bronchopericardial fistula. The patient initially presented with severe dyspnea caused by main bronchial stenosis of unknown origin for which a Dumon stent was inserted at a local hospital. The Dumon stent migrated to the endobronchus through the stenosis of the left main bronchus a few days later, and his dyspnea remained unresolved. He was subsequently referred to our department 6 months later, where a left pneumonectomy under supportive cardiopulmonary bypass through the femoral artery and vein was performed, and a postoperative pathological diagnosis of bronchial leiomyosarcoma was made. For this rare group of malignant tumors, early diagnosis permits complete surgical resection of the mass and offers the best prognosis. Excision of the tumor should be performed under cardiopulmonary bypass through the femoral vessels when a risk of sudden rupture of the pulmonary artery or vein exists for any reason.

Bronchi↗
PubMed2005

Noninvasive competition for endoscopic ultrasound.

Endoscopic ultrasonography (EUS) is one of the most significant developments in gastrointestinal (GI) imaging in recent years. EUS now plays a key role in the pretreatment staging of GI tract tumors and in the investigation of benign pancreaticobiliary pathology. It has not replaced conventional cross-sectional imaging (eg, ultrasound, CT, and MRI), but it has distinct properties and capabilities. EUS is most beneficial when used in a complementary fashion with cross-sectional and radionuclide imaging in the management of patients with GI tract disease. This article reviews the role of noninvasive imaging modalities in several clinical situations where EUS plays a prominent role.

Bile Duct Diseases↗
PubMed2000

Popliteal vein entrapment: a benign venographic feature or a pathologic entity?

PURPOSE: Asymptomatic morphologic popliteal vein entrapment is frequently found in the healthy population (27%). In our institution, popliteal vein compression on plantar flexion was observed in 42% of all ascending venograms. Some authorities consider the lesion benign, without pathologic significance. This study examines the pathophysiologic importance in select patients, describes treatment with surgery, and suggests a diagnostic tool. METHOD: Thirty severely symptomatic patients with venographic evidence of popliteal entrapment were selected to have popliteal vein release after a process of elimination (ie, other causes of chronic venous insufficiency [CVI] were ruled out by means of comprehensive hemodynamic and morphologic studies). In the last nine limbs, popliteal vein pressure was also measured by means of the introduction of a 2F transducer tip catheter. Patients were clinically and hemodynamically assessed before and after surgery, and anatomical anomalies encountered during surgery were recorded. RESULTS: Popliteal vein release was performed without mortality or serious morbidity. Anomalies of the medial head of the gastrocnemius muscle caused entrapment in 60% of the patients; anatomic course venous anomalies were infrequent (7% of the patients). Significant relief of pain and swelling occurred in the patients who had surgery. Stasis ulceration/dermatitis resolved in 82% of patients. Popliteal venous pressures had normalized in the six patients who were studied postoperatively. CONCLUSION: Popliteal vein entrapment should be included in the differential diagnosis of CVI in patients in whom other, more common etiologies have been excluded on the basis of comprehensive investigations. Popliteal vein compression can be demonstrated venographically in a large proportion of patients with CVI, but the lesion is likely pathological only in a small fraction of these patients. A technique for popliteal venous pressure measurement is described; it shows promise as a test for functional assessment of entrapment. Immediate results of popliteal vein release surgery are encouraging; long-term follow-up is necessary to judge the efficacy of surgical lysis of entrapment in symptomatic patients who fail to improve with conservative treatment measures.

Adult↗
PubMed2003

Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies.

Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population at a cost of over USD 1 billion per annum. Most hemodialysis grafts fail due to a venous stenosis (venous neointimal hyperplasia) which then results in thrombosis of the graft. Despite the magnitude of the clinical problem there are currently no effective therapies for this condition. The current review (a) describes the pathogenesis and pathology of venous stenosis in dialysis access grafts and (b) discusses the development and application of novel therapeutic interventions for this difficult clinical problem. Special emphasis is laid on the fact that PTFE dialysis access grafts could be the ideal clinical model for testing out novel local therapies to block neointimal hyperplasia.

Animals↗
PubMed1981

Transvenous angioplasty of experimental branch pulmonary artery stenosis in newborn lambs.

A dilatable form of bilateral branch pulmonary artery stenosis was created in 27 newborn lambs. Nine lambs were long-term survivors and were dilated with modified Grüntzig balloon dilation catheters. They were allowed to recover for 6-9 weeks, during which time there was no significant change in the mean systolic gradients across the narrowed sites. Thirteen arteries underwent dilation. Dilation was associated with a decrease in the systolic gradient in all cases (from 34.9 mm Hg to 8.1 mm Hg) and an increase in the diameter of the narrowed site (from 4.6 to 7.6 mm) as estimated by angiography. Flows and flow distribution were measured in four lambs before and after unilateral dilation using 15-mu radiolabeled microspheres; in each case, the fraction of total flow to the dilated lung rose after dilation (19.2 to 45.4%), as did the total flow to the dilated lung (30.0 to 69.2 ml/kg-min). Four lambs were catheterized every 2-4 weeks for an average of 16 weeks after dilation; the average gradient in these lambs remained below 10 mm Hg despite considerable growth (from 9.6 to 25.9 kg). Gross pathologic examination showed an intact vascular adventitia in all cases; there were multiple linear tears in the intima in recently (less than 7 days) dilated cases, but complete intimal healing had occurred by 2 months after dilation. No significant morbidity could be attributed to the dilation procedure. These results indicate that clinical trials are warranted.

Angioplasty, Balloon↗
PubMed2006

Asthma: is it due to an abnormal airway smooth muscle cell?

Asthma is an airway disease highly prevalent in westernized countries and of unknown etiology. Often, asthma is associated with atopy, but not all atopic individuals have asthma. Some patients with asthma outgrow symptoms, whereas many others acquire asthma later in life. Still other patients suffer from asthma their entire life. How can we explain these different patterns? It may be that asthma should be regarded as the clinical manifestation of a group of diseases with similar pathology due to a common factor. In this Pulmonary Perspective, we propose that an aberrant phenotype of airway smooth muscle (ASM) cells could be sufficient to explain the pathology of asthma. We will argue an abnormal ASM cell is a prerequisite to the development of asthma. Our postulate is that inadequate levels of C/EBPalpha, a protein that is pivotal for the suppression of both inflammation and proliferation responses, confer on ASM cells an activated phenotype that is more susceptible to mitogenic and contractile stimuli.

Asthma↗
PubMed2000

[Clinical manifestations and diagnosis of childhood mediastinal tumors].

Mediastinal tumors make up as high as 7% of the malignant neoplasms in children and are encountered in all age groups, slightly more commonly in preschool children. Three main groups of common symptoms that are typical of mediastinal tumors are identified. These include 1) symptoms associated with tumor compression of thoracic organs; 2) neurological disorders associated with compression or destruction of ganglionary nodes; 3) general symptoms. Posterior mediastinal tumors are diagnosed by X-ray in 85% of cases. X-ray computed tomography makes it possible to judge of the initial site of a neoplasm, the presence of inclusions, the status of adjacent organs and tissues, the density of a pathological focus. Gallium-67 citrate radionuclide study allows one to make an early differential diagnosis between a solid formation and lymph proliferative disease. The lack of morphological verification of a diagnosis requires the use of transthoracic aspiration biopsy whose diagnostic value enhances when it is made under guidance of ultrasound or X-ray computed tomography.

Biopsy, Needle↗
PubMed2000

The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral hydronephrosis.

OBJECTIVE: To assess the role of the renal resistive index ratio (RIR) in discriminating equivocal upper urinary tract dilatation in children, and thus in establishing the need for surgery, in comparison with traditional diagnostic tools. PATIENTS AND METHODS: The study comprised 40 children with unilateral hydronephrosis unrelated to vesico-ureteric reflux, posterior urethral valves, megaureter or a duplex system. In all patients one or more of the following 'indices of obstruction' were positive; an anteroposterior renal pelvic diameter of >20 mm, a half-time diuretic 'washout' (T/2) of > 20 min, a separate renal function of < 40%, and symptoms of obstruction (pain, sepsis). All these variables were measured on admission and after a mean (range) follow-up of 9 (2-24) months. After this period, all patients who were symptomatic or with two or more of the variables above the normal range were considered as obstructed and underwent a dismembered pyeloplasty. The variables were then re-assessed 6 months after surgery. The RIR was evaluated using duplex Doppler ultrasonography with a 3.5-5 MHz transducer, by the same operator. Differences between obstructive and unobstructive unilateral hydronephrosis were estimated from the mean values of the variables assessed and Student's t-test used to determine significant differences. The correlation between the T/2 and RIR before and after surgery was also evaluated. RESULTS: During follow-up the RIR was abnormal in 27 of 30 patients with hydronephrosis who were considered to be 'obstructed'. Twenty-three of these patients, selected for surgery, had a positive diuretic renogram; 11 had loss of differential renal function and 16 had recurrent clinical symptoms. There were significant differences in the mean RIR and T/2 between obstructed and unobstructed patients. Six months after dismembered pyeloplasty, the RIR returned to normal in all patients except three in whom it was previously > 1.1. The diuretic renogram, if initially showing pathology, always became normal. The RIR did not change in patients with an unchanged and severe loss of differential renal function before and after surgery. CONCLUSIONS: In this study the RIR was a good index of obstruction in children with unilateral hydronephrosis and it correlated well with the results of diuretic renography. The specificity of the RIR was reduced whenever there was severe renal damage.

Child↗
PubMed1989

[Prenatal diagnosis of premature closure of the ductus arteriosus with subsequent development of a non-immunologic hydrops fetalis].

The premature closure of the ductus arteriosus (pcDA) due to maternal tocolysis with indomethacin in the 34th week of gestation was diagnosed in a twin pregnancy. The pcDA was detected using Doppler 24 hours before both fetuses developed pleural effusion. Pathologic waveforms in the fetal aorta with end-diastolic zero-flow were registered. A no-delay caesarean section with optimal neonatologic intensive care were successful for the survival of the neonates. The authors postulate, that the amount of pcDA as a cause of NIHF is higher than generally supposed. Furthermore a tocolysis with indomethacin should not be performed after the 34th week of gestation.

Adult↗
PubMed1994

Late intestinal strictures following successful treatment of necrotizing enterocolitis.

Between 1975 and 1992, in 16 infants (14%) out of 113 neonates with previous necrotizing enterocolitis (NEC) a total of 25 intestinal strictures had to be treated. Four (16%) were found in the ileum and 21 (84%) in the colon, and in 50% multiple strictures were present. In these 16 patients initial treatment for acute NEC included conservative treatment in 5, primary resection and enterostomies in 6 and proximal diverting enterostomies in 5. Therefore, the incidence of late strictures was 11% after conservative therapy, 11% after primary resection and 55% after primary proximal diverting enterostomies. An average of 49 days elapses between the recovery from NEC and the diagnosis of late strictures in conservatively treated patients. After initial surgical treatment, late strictures were detected on contrast studies on an average of 80 days. In pathologic specimens, marked fibrosis in the submucosa was consistently present in all strictures, whereas inflammatory changes in the mucosa, disruption or hypertrophy of the muscle layers or absence of ganglion cells were seen less frequently. All strictures were resected and primary end-to-end anastomosis was performed. But despite the development of late intestinal strictures, bowel preservation was improved after initial restrictive surgical therapy and aggressive medical treatment.

Constriction, Pathologic↗
PubMed1997

[Influence of fibrin glue on biliointestinal anastomotic scar formation].

Conventional suture technique in the reconstruction of the bile duct often result in anastomotic stenosis and eventual obstructive jaundice and biliary cirrhosis. To overcome the aforementioned drawbacks, fibrin glue (FG) was used instead in the biliointestinal anastomosis where indwelling stent was inserted to complete the experimental model. The experiment consisted of pathological study and ECVD evaluation of anastomotic specimens in order to follow up the whole process of anastomotic wound healing. The experimental studies dis-closed that FG promotes wound healing, limits scar formation, and accelerates scar softening and maturnation. FG plus 6-month indwelling stent can guarantee scar maturation. It is an effective method in the prevention of bile duct stricture.

Anastomosis, Roux-en-Y↗
PubMed2002

Experimental model of dissecting aneurysms.

BACKGROUND AND PURPOSE: The pathogenesis and optimal treatment for arterial dissection are still unclear. We devised an experimental model of arterial dissection and observed the morphologic changes with angiography. METHODS: Sixty-four experimental dissections were created in the common carotid arteries of 34 mongrel dogs. After a small incision was made in the arterial adventitia, it was dissected from the media. Elliptical defects (2, 4, 6, and 8 mm in groups I-A, I-B, I-C, and I-D, respectively; n = 47) or longitudinal incisions (4, 6, and 8 mm in groups II-A, II-B, and II-C, respectively; n = 17) were made in the intima distal to the adventitial incision to serve as an entry zone for dissection. RESULTS: Immediately after the lesions were created, the influx of blood into the dissected cavity produced massive subadventitial hematomas, resulting in stenotic changes in all of the arteries, including seven with occlusion. Follow-up (1-week) angiograms demonstrated complete healing, with normal arterial calibers in 11 (79%) of 14 I-A lesions and aneurysm formation in nine (69%) of 13 I-B lesions. All 10 I-D lesions had complete arterial occlusion. Persistent stenosis was observed in all 10 I-C lesions; six of these developed aneurysms. Pathologic examination of the freshly dissected cavities revealed a clot-filled cleft between the media and adventitia. Mature aneurysms, evaluated 3 mo later, had endothelialization within the aneurysmal dome. CONCLUSION: Morphologic changes after arterial dissection are closely related to the size of the intimal entry zone, which may determine whether a dissecting aneurysm forms.

Aortic Dissection↗