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The authors expose in a very accurate discussion the biliary pathology during chronic pancreatitis. They divide the biliary lesions into associated with pancreatitis and secondary to chronic pancreatitis. They emphasize the necessity to practise a detailed study of the biliary tract in all patients affected by chronic pancreatitis and the good results showed by a very simple surgical act.
78 biopsies were carried out during 63 distal tubal microsurgical operations, followed up for two years at least. The clinical outcome was studied according to the pathological state of the better tube: Viable pregnancies become more frequent with subnormal tubes (40%) and with tubes with moderate chronic salpingitis (65%). The risk of extra-uterine pregnancy is at a maximum with chronic cicatricial salpingitis (29.4%). Progressive chronic salpingitis results in only 6.6% viable pregnancies and will definitely constitute an indication for in vitro fertilization rather than microsurgery.
OBJECTIVE: To study the causes, presentation, and treatment of ejaculatory duct obstruction in subfertile males. DESIGN: Collaborative retrospective study of clinical experience collected by two urologists over a 15-year period. SETTING: National Health Service and Private Care Hospitals. PATIENTS, PARTICIPANTS: Subfertile males with azoospermia (n = 67), very severe oligozoospermia (n = 17), oligozoospermia (n = 1), or normal sperm concentration (n = 2) in small volume ejaculates with acid pH and little or no fructose. INTERVENTIONS: Exploration of scrotum with vasogram and testicular biopsy, plus reconstruction if possible. MAIN OUTCOME MEASURES: Follow-up seminal analysis and occurrence of pregnancy in female partners. RESULTS: The causes were: müllerian duct cyst (n = 17); wolffian duct malformation (n = 19); previous surgical trauma (e.g., imperforate anus) (n = 15); previous genital infection (n = 19); tuberculosis (n = 8); megavesicles (pathological dilatation of vesicles and ampullae of unknown cause) (n = 8); and carcinoma of prostate (n = 1). After incision of Mullerian duct cysts, five pregnancies were produced. Five pregnancies occurred in the other groups using a variety of surgical techniques. CONCLUSIONS: Routine vasography has shown that ejaculatory duct obstruction is not as rare as previously thought. The diagnosis should not be missed because the condition is simple to correct surgically in certain cases.
BACKGROUND/AIMS: Cryptogenetic multifocal ulcerous stenosing enteritis (CMUSE) is a rare disease whose origin is unknown. The aim of this study was to describe the clinical spectrum of CMUSE, to determine the origin and pathophysiology of the disease, and to propose a treatment strategy. METHODS: A total of 220 French gastroenterology departments were contacted to review patients with unexplained small bowel strictures. Of 17 responses, 12 corresponded to a diagnosis of CMUSE. These patients were hospitalised between 1965 and 1993 and their medical records were reviewed. RESULTS: All patients (mean age 42.1 (4.4) years) had intestinal and five had extraintestinal symptoms (peripheral neuropathy, buccal aphthae, sicca syndrome, polyarthralgia, Raynaud's phenomenon, arterial hypertension). One patient had heterozygous type I C2 deficiency (28 base pair gene deletion). Two to 25 (mean 8.3 (1.9)) small intestine strictures were found. Stenoses of the large jejunoileal arteries were observed on two and aneurysms on three of five mesenteric angiograms. Despite surgery, symptoms recurred in seven of 10 patients and strictures in four. Steroid therapy was effective but caused dependence. One untreated patient died. Small bowel pathology showed superficial ulceration of the mucosae and submucosae, and an inflammatory infiltrate made of neutrophils and eosinophils. CONCLUSIONS: CMUSE is an independent entity characterised by steroid sensitive inflammation of the small bowel which often recurs after surgery. CMUSE may be related to a particular form of polyarteritis nodosa with mainly intestinal expression or with an as yet unclassified vasculitis.
A new treatment, goniophotocoagulation, for neovascularization of the anterior chamber angle has been applied with the argon laser to 21 eyes of 20 patients. Three of the eyes had neovascularization related to central retinal vein occlusion. In the other 18 eyes the neovascularization was related to diabetic retinopathy. A specific protocol has been followed since January 1973. The results so far indicate that closure of the angle and progression of the usual chain of pathologic events in neovascular glaucoma were prevented in 10 (77%) of the 13 eyes having an average follow-up of 22 months. We believe that goniophotocoagulation of the angle deserves more extensive, judicious, and carefully monitored clinical use. Our results suggest that this new technique is safe and reasonably effective in preventing progressive neovascularization of the angle, synechial closure, and severe nonvascular glaucoma.
The compromise of side-branches following coronary angioplasty of the parent vessel remains a limitation of the procedure. Reports of dilation through a Palmaz-Schatz stent to salvage a compromised side-branch covered by the stent have been made. We examined the distortion of stent geometry which occurs following this procedure in a rabbit model. Palmaz-Schatz stents were placed at the aortoiliac bifurcation in 7 rabbits and the contralateral iliac artery was dilated through the stent. Despite good angiographic results, varied degrees of stent distortion were noted on gross pathologic analysis. Most distortion occurred when the arteries were dilated through the ends of the struts or through the "diamonds," and least distortion occurred during dilation through the mid-artriculation site. While good stent depolyment is thought to be necessary for improved outcomes, the distortion of stents after balloon dilation through the stent, despite good angiographic results, may have negative implications for both short- and long-term outcomes.
The efficiency of computed tomography in differentiating between a bronchial compression due to tumour formation and an endobronchial tumour was tested in comparison to bronchoscopy results. 624 bronchial segments were evaluated in 65 patients with masses in the pulmonary hilus area. Computed tomographical identification of pathological lesions (n = 71) was achieved with a sensitivity of 83% and a specificity of 96%. Out of 52 bronchial segments with endobronchial tumour, 90% showed pathological lesions and 85% were classified correctly. When the morphology of the bronchial lesions (endoluminal mass, smooth or irregularly demarcated bronchostenosis or bronchial displacement) was assessed with CT, only the CT identification of an endoluminal mass could distinguish endobronchial tumour growth with a probability of 91% from bronchial narrowing due to external causes and normal bronchi.
Eighteen digital subtraction angiography (DSA) examinations were retrospectively evaluated for factors that led to their erroneous interpretation. Overlapping vessels obscured pathologic conditions in five cases. In four cases the lesions were not adequately profiled by the DSA projections. Eight lesions were rendered inconspicuous by misregistration artifacts attributable to motion, either from swallowing or from pulsation of vessel walls. One diagnostic error was caused by poor opacification from a degraded contrast bolus secondary to low cardiac output.
Data on the clinical and angiographic examinations of 192 patients with stenoses of the extracranial part of the carotid artery are compared. The state of the intracranial branches of the median cerebral artery was evaluated with the use of Ring-Waddington's grid. Seven neurological syndromes resulting from the pathology of the intracranial branches of the carotid artery system are specified. In 70% of the cases structural changes of the intracranial vessels were revealed, these changes being the most likely due to thromboembolism from the stenotic carotid artery. The anterior parietal branch was involved less frequently, and the posterior branches of the median cerebral and the orbitofrontal arteries were affected extremely rarely.
Excised tubal segments from 42 women with uterotubal junction obstruction were studied histologically to evaluate the pathologic spectrum of disease and correlate this with clinical data. The most frequent lesion encountered was obliterative fibrosis (38.1%), confirmed by connective tissue stains, which was not associated with cornual nodularity. Other pathologic entities included salpingitis isthmica nodosa (23.8%), intramucosal endometriosis (14.3%), and chronic tubal inflammation (21.4%). Intramucosal endometriosis was distinguishable from salpingitis isthmica nodosa by virtue of its unique stroma confirmed by connective tissue staining. Women with previous pregnancies were included in all the groups. In all instances, the obstruction was present in the transmural portion of the tube and extended a variable distance into the isthmic segment. These observations on uterotubal junction obstruction demonstrate that: 1) There are multiple distinct histologic patterns, 2) Intraabdominal findings do not predict the histology of the uterotubal junction pathology, 3) Any histologic pattern can be associated with a previous intrauterine or ectopic pregnancy, and 4) The obstruction begins within the transmural portion of the oviduct, extends a variable distance into the isthmic segment, but does not obstruct the ampullary segment. These data suggest that the initiating process originates within the uterus and that fibrosis may represent a nonspecific response to chronic injury of the transmural and isthmic segments of the oviduct.
Case report on a 6-year-old patient with vascular ring, due to double aortic arch. The patient was asymptomatic. The barium-filled esophagus showed bilateral indentations and a large posterior indentation. Echocardiographic study in notch suprasternal view revealed features of this pathology. The diagnosis was made by the cineangiocardiographic study that showed double aortic arch with separate carotid and subclavian arteries arising from each arch. The right arch was larger than the left, and the descending aorta was on the left side. There was severe left pulmonary artery stenosis associated. The clinical management was chosen, because the patient was asymptomatic.
The authors report a case of cystic dilatation of the choledochus associated with narrow stenosis at the confluence of the left and right hepatic ducts which was found to be inflammatory on histological examination. This pathology is becoming an increasingly more commonplace clinical finding. The case reported here is particularly interesting owing to the onset of the disease and the way in which it was treated. An attempt was made to treat the patient using a simple operation which was to the least radical possible. The authors take this opportunity of reviewing the literature on the subject.
Seventy-eight recipients, average age 36 years, of cadaver kidneys were studied to evaluate the usefulness of Doppler ultrasonography for diagnosis of common complications in renal transplant patients. The patients were divided in five groups: Control (normal renal function), acute rejection (AR), acute tubular necrosis (ATN), obstructive uropathy (OU) and pathological vasculature (PV); renal artery stenosis (RAS) and renal artery thrombosis (RAT). Pulsed Doppler ultrasonography (PDUS) was an effective method to diagnose RAS and RAT, but did not sufficiently differentiate between AR and ATN. Despite this, PDUS may be useful for follow-up of renal transplant patients as specific changes in the PDUS curves or differences in successively recorded patterns indicate abnormality, which may initiate more specific diagnostic methods.
The causes of nasolacrimal duct stenosis in adults can vary greatly. In general, the symptoms can also vary, but most cases share a tendency toward recurring inflammations in the prestenotic area. The treatment of these disorders is limited to either conservative therapy to control inflammation or surgically invasive measures. By using balloon catheters, usually applied in percutaneous transluminal coronary angioplasty (PTCA), dilation of the relative postsaccal stenosis can be performed under radiographic control. An exact diagnosis using various testing methods, including digital dacryocystography for detailed localization and documentation of any pathologic changes, is decisive to success. Only in cases of incomplete postsaccal stenosis is retrograde balloon dilation of the distal nasolacrimal duct indicated. A guide wire, designed for the PTCA balloon catheter set, is introduced via the canaliculus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris, under visual control with an image converter. The balloon catheter is retrogradely threaded over the guide wire. The baloon is then placed at the site of the pathologic stenosis under radiographic control and dilated with high pressure. To ensure the permeability of the system, monocanalicular silicone intubation has to be performed immediately afterwards. This procedure has been performed successfully on 6 patients with a follow-up of 6 to 27 months. These initial results give rise to the hope that this minimally invasive, interdisciplinary technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis.
Fifteen fallopian tubes in which a previous ipsilateral eccyesis was managed by conservative surgical techniques were examined. The condition of the tube relative to the previous surgical management and the resolution of the previous implantation sites were correlated with the recurrent tubal pregnancy. All previous incisions were identified and all were well-healed, except for one fistula. Residual histologic evidence was present in only five of 16 previous implantation sites. The recurrent eccyeses were related to previous surgical management in only three women, two after anastomosis and one because of inadvertent obstruction of the tube. The cases of tubal obstruction and tuboperitoneal fistula formation were thought to reflect a lack of understanding of the pathologic changes associated with tubal pregnancy during conservative surgery. The previous tubal incision sites were all remarkably well-healed regardless of whether they were primarily closed or left open, and independent of location. Infundibular or fimbrial "milk-outs" were without histologic evidence of damage. The underlying tubal disease (chronic salpingitis, follicular salpingitis, or salpingitis isthmica nodosa) seems to be the major factor identified that is associated with, and probably the cause for, the recurrent tubal gestation.
Thirty-seven patients (15 female, 22 male; aged 46-89 years, mean age 68.8 years) with III or IV grade carotid sinus reflex carotid arteries were investigated by sonography (B-scan and CW-Doppler). It was demonstrated that stenoses or arteriosclerotic plaques, localized in the region of the carotid bulb or bifurcation, were present on both sides in 27 patients and on one side only in four patients. Five patients did not show these changes and four of them had thickening of common carotid artery endothelium. Thus, vascular changes occurred in 35 patients. Occlusions and stenoses greater than 50% were visible in five patients. Primarily bilateral changes were shown as well as unilateral and bilateral pathologic reflex response; main localization was the posterior wall of the carotid bulb. Thus, arteriosclerotic changes seem to be important in the development of pathologic carotid sinus reflex. Cerebral complications (left-sided PRIND) occurred in one patient who did not have high degree carotid stenosis. In comparison to other authors who investigated only with CW-Doppler a much higher rate of arteriosclerotic wall changes and a greater occurrence of bilateral changes could be demonstrated by application of the highly sensitive B-scan sonography.
The purpose of this study is to characterize radiographically drug-induced ulcerated stenosis of the small bowel and to determine the contribution of enteroclysis in the diagnosis of this rare entity. The clinical pathologic and radiographic findings of 12 patients with drug-induced stenosis (non steroidal anti-inflammatory drugs or potassium salts) evaluated by enteroclysis were reviewed. Three radiological features of strictures were differentiated: diaphragm like stricture, short stricture and stenotic ulceration with girdle aspect. All formulation of NSAIDS and potassium salts are capable of causing the same radiographic and pathologic patterns. Enteroclysis improves the detection of these lesions since intestinal overdistension and correct filling of the loops increase the visualization of small obstructive stenosis and the detection of superficial ulcers. Thus, any patient who has an abnormality of the small bowel should be asked about use of drugs, especially when diaphragm-like strictures are found.
Single-slice computed tomographic angiography (CTA) is an established imaging method for the cerebrovascular system (CVS), but it suffers from technical limitations with respect to the coherent high resolution visualization of longer vascular segments, such as the extra- and intracranial CVS. The recently introduced multi-slice (MS) technology has been attributed with a superior imaging quality for angiographic procedures due to increased scan speed and improved spatial resolution. The purpose of this study was to evaluate the suitability of multi-slice CTA (MS-CTA) for the assessment of the arteriovenous CVS in patients with acute symptoms of either arterial or venous occlusive diseases. 41 patients with clinically suspected acute cerebral ischaemia (hemispheric in 29 and vertebrobasilar in 12 patients) and 4 patients with suspected cerebral venous thrombosis (CVT) underwent CTA in a MS-CT scanner. In addition, doppler ultrasonography (DUS) was erformed in 34, magnetic resonance angiography (MRA) in 5 and digital subtraction angiography (DSA) in 6 patients. All findings were reviewed for stenoses or occlusion of the extra-and intracranial CVS and correlated with the clinical outcome. In 43 (96%) of 45 patients, MS-CTA yielded images of diagnostic quality with comprehensive visualization of the arterial and venous CVS including the cervical carotid bifurcation, the third segment of the major cerebral arteries and the dural sinus as well as internal cerebral veins. In 2 patients, assessment of the carotid bifurcation was limited because of tooth artefacts. In all patients, in whom imaging and clinical follow-up proved a non-lacunar infarction (n = 22), MS-CTA detected the underlying vascular pathology. Suspected CVT could be confirmed in 2 and ruled out in another 2 patients through MS-CTA. In conclusion, multi-slice CT an giography may be a promising new diagnostic tool for the rapid and comprehensive assessment of the arteriovenous CVS in patients with clinical signs of acute cerebrovascular diseases.