Staged dilation and stenting for long segmental tracheobronchial stenosis caused by tuberculosis.
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Adult↗
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Neuropathology of chronic pancreatitis in humans.
To investigate the pathogenesis of pain in chronic pancreatitis, tissue resected from 50 patients with this condition was examined by light microscopy. An examiner, blinded to clinical and pathological data, graded perineural fibrosis, inflammation and the composition of inflammatory infiltrate in 2132 separate perineural fields. Correlation of perineural fibrosis and inflammation grading with alcohol ingestion and pain severity was insignificant. Pain severity did correlate with the timing of alcohol consumption. Although calcification significantly affected pain severity, the status of duct dilatation was not significant. Eosinophils were observed in disproportionate numbers in the perineural infiltrate. The correlation of percentage eosinophilic infiltrate and pain severity was highly significant. Timing of alcohol consumption also correlated significantly with the percentage eosinophilic infiltration. As eosinophils are known to be cytotoxic and injurious to tissue by liberation of enzymes through degranulation, the findings of this study suggest that the pain of chronic pancreatitis may be mediated by perineural eosinophils, through a chemotactic mechanism involving alcohol.
Alcohol Drinking↗
Fetal diagnosis of lethal dysfunction of the right heart in three siblings.
A woman, having already delivered one child, underwent fetal echocardiography during three subsequent pregnancies. All three showed enlargement and poor function of the right-sided chambers. The first was still-born, the second died as a neonate, while the third pregnancy was terminated. Pathological examination revealed the same findings in each fetus, possibly representing a variation of Uhl's anomaly, or alternatively a hitherto unrecognised cardiomyopathic process.
Adult↗
Differential memory function with dopaminergic versus anticholinergic treatment of drug-induced extrapyramidal symptoms.
Nine chronic schizophrenic patients being treated with high-potency antipsychotic medication and antiparkinsonian agents were enrolled in a double-blind, crossover trial comparing amantadine and trihexyphenidyl. Memory function was assessed with the Rey Auditory-Verbal Learning Test during each 6-week drug trial. The subjects performed significantly better while receiving amantadine. Examinations of computed tomographic studies of seven subjects revealed a significant inverse correlation between ventricle size and memory while they were taking trihexyphenidyl but not amantadine. This suggests that patients with underlying brain pathology may be particularly vulnerable to the memory-disrupting effects of anticholinergic agents.
Adult↗
[Treatment using an endo-urologic approach of stenoses following uretero-intestinal anastomosis].
Twenty-one strictures following uretero-digestive anastomoses were treated by percutaneous transrenal dilatation. In 20 cases, an Olbert type angioplasty balloon on a guidewire was used. Rigid coaxial dilators were used in one patient after failure of the preceding technique and an electroincision was performed prior to dilatation in the remaining case. Overall, percutaneous transrenal dilatation was successful in nine patients, whereas ten dilatations failed and two patients are undergoing continued modeling with a mean follow-up of 16 months (range 1-42 months). Success rates by type of anastomosis were as follows: Bricker 5/12; Coffey 1/4; enterocystoplasty 2/4 and ureteroileovesical anastomosis 1/1. The date of development of the stricture, duration of modeling, and caliber of the indwelling catheter were apparently without influence on results. Because morbidity is low with percutaneous transrenal dilatation, this technique is advocated as first-line treatment, with surgery being reserved to failures.
Adult↗
Intestinal vascular ectasias: a new look at an old disease.
Seventeen patients had rectal bleeding and intestinal vascular ectasia. Actual bleeding from the ectasia was seen in five patients. The average age of the 17 patients was 60.2 years, but 41% were under the age of 60. Melena was common initially. Both colonoscopy and angiography had a high degree of diagnostic accuracy, but angiography failed to demonstrate some lesions seen by colonoscopy. We consider these examinations complementary. Intraoperative endoscopy with transillumination was of value of determining the distribution of those lesions that had not been completely demonstrated by colonoscopy and angiography. We have used intraoperative endoscopy to guide the eventual amount of bowel resection, and intraoperative marking with this technic has resulted in a more specific pathologic examination. There has been no operative mortality. Six patients have re-bled from sources other than vascular ectasia.
Adult↗
Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy.
OBJECTIVE: The prognosis of fetal lower urinary tract obstruction (LUTO) depends upon renal function and also upon the underlying etiology. Precise identification of the latter remains a challenge antenatally. Our objective was to examine the underlying pathology in male fetuses with sonographic evidence of severe and isolated LUTO. METHODS: Detailed postmortem examination was carried out after termination of pregnancy in 24 male fetuses presenting before 25 weeks of gestation with ultrasound evidence of isolated severe LUTO. RESULTS: All fetuses had megacystis and hyperechogenic kidneys. There was anhydramnios/oligohydramnios and pelvicalyceal dilatation in 20 and 15 cases, respectively. Posterior urethral valves (PUV) were suspected antenatally in 20 cases and urethral atresia was not suspected antenatally. However, postmortem examination of the urethra demonstrated atresia in six cases, severe stenosis in eight cases, PUV in nine cases and an apparently normal urethra in one case. Renal dysplasia was found in all cases but one. Urethral atresia was the most common urethral anomaly at 12-17 weeks. Hydronephrosis was more frequent in cases with PUV (8/9) and urethral stenosis (6/8) than with urethral atresia (0/6). In LUTO presenting in the first and second trimester, hyperechogenic kidneys were predictive of renal dysplasia in 95% of cases. The association of a sagittal diameter of the bladder of at least 40 mm with hydronephrosis before 28 weeks was predictive of PUV with a positive (PPV) and negative (NPV) predictive value of 44.4% and 66.6%, respectively. Absence of hydronephrosis and a sagittal diameter of the bladder of less than 40 mm were predictive of urethral atresia or stenosis with a PPV and NPV of 100% and 47.6%, respectively. The absence of hydronephrosis was predictive of urethral atresia with a PPV and NPV of 66.6% and 100%, respectively. CONCLUSION: LUTO in a male fetus presenting with megacystis in the first or second trimester of pregnancy is as likely to reflect urethral atresia or stenosis as it is PUV. The size of the bladder and the presence of hydronephrosis should be considered in order to improve prenatal diagnosis and counseling.
Abortion, Therapeutic↗
Segmental arterial mediolysis studied by repeated angiography.
Segmental arterial mediolysis (SAM) is a rare disease of unknown aetiology. We report the fourteenth case of SAM, but the first to demonstrate serial changes on arteriography. A 65-year-old woman with abdominal pain underwent laparotomy with resection of an abnormally beaded and narrowed segment of the right branch of the middle colic artery. Characteristic pathological findings of lysis of the arterial media with dissecting haematomas were present. Other than some post-prandial pain, the patient's post-operative course was uneventful. Serial arteriography showed various abnormalities in the trunk and branches of the superior mesenteric artery. Changes in the vessels consisted of three phases, i.e. dilatation, beading with narrowing and restoration of the smooth wall, with various modifications such as aneurysmal enlargement and occlusion.
Aged↗
Sonographic features of an intraductal polypoid mass: differentiation between hepatocellular carcinoma and intraductal cholangiocarcinoma.
OBJECTIVE: To identify laboratory and sonographic features capable of differentiating hepatocellular carcinoma (HCC) invading the bile duct from intraductal cholangiocarcinoma (IDCCC). METHODS: Nine patients with HCC invading the bile duct and 8 patients with IDCCC were found in our radiologic and pathologic database. Laboratory (alpha-fetoprotein, cancer antigen 19-9, total bilirubin, and alkaline phosphatase) and sonographic findings were retrospectively reviewed by 2 reviewers by consensus. Sonographic findings included the presence and echo texture of parenchymal masses, the margin and echo texture of intraductal masses, continuity between parenchymal and intraductal masses, cystic ductal dilatation or wall thickening of the bile duct, and the presence of associated chronic liver disease. RESULTS: Significant differences were found in the levels of total bilirubin (14 versus 3.5 mg/dL), alpha-fetoprotein (2984 versus 5 ng/mL), and cancer antigen 19-9 (8574 versus 1861 U/mL) in HCC and IDCCC (P <.05). Echogenicity of the intraductal masses was iso or low in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P <.05). In all 7 patients with HCC but in no patient with IDCCC, the parenchymal masses were contiguous with the intraductal masses (P <.05). Cystic ductal dilatation of bile duct was seen in 8 (88.9%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs (P <.05). All 9 (100%) of 9 HCCs and 3 (37.5%) of 8 IDCCCs were associated with chronic liver disease (P <.05). Parenchymal masses occurred in 7 patients with HCC (77.8%) and in 3 patients with IDCCC (37.5%), but the difference was not statistically significant (P =.153). The margins of the intraductal masses were smooth in all 9 (100%) of 9 HCCs and lobulated in 3 (37.5%) of 8 IDCCCs (P =.082). CONCLUSIONS: Combined interpretation of laboratory and sonographic features may help in the differentiation of HCC with bile duct invasion and IDCCC.
Adult↗
Endoscopic alternatives in the management of colonic strictures.
A 10-year review of our experience with all patients with symptoms of colonic narrowing (n = 61) revealed 14 patients who were treated endoscopically. The site of narrowing was the sigmoid colon in 12 patients and the rectum in two patients. The strictures occurred after anastomosis in seven patients, with carcinoma in four patients, and with inflammatory disease, external compression, and idiopathy in one patient each. Although combinations of endoscopic techniques were occasionally used, the predominant method responsible for successful management of the narrowing was bouginage in four patients, endoscopy with a prototype dilating endoscope in four patients, balloon dilatation in three patients, and electrocautery and laser surgery in one patient each. There were no perforations or bleeding complications. Repeated treatments were usually needed. As less invasive methods evolve to treat colonic narrowing, appropriate matching of available techniques with the underlying disease becomes easier. We have found that dilation with a bougie, balloon, or a prototype dilating endoscope can provide especially beneficial results when used on patients with strictures resulting from inflammatory disease or external compression. Cutting and ablating tools such as the electrocautery and laser tools are more suited for management of strictures that result from carcinoma and anastomotic webs. Appropriate matching of endoscopic technique to underlying colonic pathology will allow increasingly successful and safer management of colonic narrowing without operation.
Adult↗
Impact of dominant stenoses on the serum level of the tumor marker CA19-9 in patients with primary sclerosing cholangitis.
BACKGROUND/AIMS: Patients with primary sclerosing cholangitis (PSC) have an increased risk of developing hepatobiliary tumors. The tumor marker CA19-9 was claimed to indicate the occurrence of bile duct carcinoma. This study aimed to assess whether increased serum levels of CA19-9 in PSC patients with dominant stenoses indicate bile duct carcinoma. METHODS: The study cohort comprised 106 patients treated over a median time of 5.0 years (range 0.5 - 13 years). All patients were treated with ursodeoxycholic acid (UDCA) and whenever they developed dominant stenoses by endoscopic dilatation of these stenoses. In endoscopically treated patients, CA19-9 levels were measured before and 3, 6, 12 and 24 months after endoscopic dilatation. RESULTS: Of the 106 patients, 22 carcinoma-free patients and 3 patients with bile duct carcinoma had elevated CA 19 - 9 levels. In 14 out of 25 patients with elevated CA19-9 levels, dominant stenoses were diagnosed and treated by endoscopic dilatation. In 71.4 % of the endoscopically treated patients, CA19-9 levels decreased following the endoscopic intervention. CONCLUSIONS: In PSC patients, increased serum levels of CA19-9 are rarely due to the development of bile duct carcinoma. In patients with dominant stenoses, the relief of biliary obstruction by endoscopic dilatation may lead to a decrease of the serum levels of CA19-9.
Bile Duct Neoplasms↗
Asymmetric medial degeneration of the ascending aorta in aortic valve disease: a pilot study of surgical management.
BACKGROUND AND AIM OF THE STUDY: In structural aortic valve disease, medial degeneration is often associated with ascending aorta dilatation. This pathology is often asymmetric, with more severe involvement of the convex aspect of the ascending aorta. The condition can be managed with surgical excision of the diseased portion of the aortic wall and remodeling reconstruction at the time of aortic valve replacement (AVR). METHODS: Sixty-one patients underwent AVR and 'waistcoat aortoplasty'. Sinus dilatation was repaired by plicating the subcoronary redundant aortic wall using anchoring sutures of the valve prosthesis. The diseased aortic wall was removed via a triangular resection, and the aorta reconstructed with a double-layer technique, to achieve autologous reinforcement of the convex right posterolateral wall and stress reduction on the aortotomy suture line. Echocardiography was performed preoperatively, immediately postoperatively, and every six months thereafter. The significance of diameter variations was evaluated. RESULTS: There was no hospital mortality, and only low postoperative morbidity. Post-reduction diameters at the sinuses, sinotubular junction and ascending aorta were significantly less than preoperative values (p < 0.0001). During a mean follow up of 33.8 +/- 10.2 months (range: 13-50 months), no significant increase in root (p = 0.32), sinotubular (p = 0.15), or ascending diameter (p = 0.11) was observed. CONCLUSION: The 'waistcoat aortoplasty' should be considered when dealing with asymmetric ascending dilation secondary to aortic valve disease-related medial degeneration. However, additional studies with a longer follow up are needed to confirm these findings.
Adult↗
Endoscopic balloon dilation of outlet stenosis after gastric bypass.
Eighteen of 22 patients with stenotic gastrojejunostomies following gastric bypass surgery were successfully corrected by endoscopically placing a guidewire through the narrowed outlet and then passing a dilating balloon catheter over the wire. No complications occurred. All procedures were done without general anesthesia, and 64 per cent were done without hospitalization. This procedure can spare patients prolonged hospitalization for nasogastric decompression or reoperation, the two standard approaches to this problem. Successful use of this technique to dilate obstructed gastric partitions and distal esophageal strictures suggests that it may be considered for any gastrointestinal stenosis within reach of the endoscope.
Catheterization↗
[Carotid dolichosiphon. One case (author's transl)].
A report of the case of a 68 year old patient with a 9,5 cm long ectasia of the cisternal portion of the left internal carotid. On the basis of this case, the authors review the pathology due to such dolichomega-arteries and the aetiology of arteriectasia which are partly dysplasic in origin.
Aged↗
Ureteral structure and ultrastructure. Part II. Congenital ureteropelvic junction obstruction and primary obstructive megaureter.
The structure and ultrastructure were studied of 48 specimens from cases of congenital ureteroplevic junction obstructions and primary obstructive megaureters. Under light microscopy a spectrum of findings occurs, extending from the nearly normal to the clearly abnormal obstructive segments. However, under electron microscopy there were consistent abnormalities: 1) excessive collagen fibers between and around the muscle cells and 2) a group of compromised muscle cells proximal to the collagenous segment. These findings are responsible for functional discontinuity via the nexus and indistensibility of the pathologic areas. The high resolution of the electron microscope allows clearer definition of these obstructions and the impact of these findings on surgical remodeling is discussed.
Dilatation, Pathologic↗
Computerized tomography in Reye's syndrome: evidence for pathological cerebral vasodilatation.
The authors present two children with Reye's syndrome who were studied with serial computerized tomographic (CT) scanning. Scans performed with contrast enhancement during the acute phase of this disease showed evidence of pathological cerebral vasodilatation. The possible mechanism for this vasodilatation and the increased intracranial pressure (ICP) seen in Reye's syndrome are discussed.
Adolescent↗
Pneumosinus dilatans: a report of three new cases and their surgical management.
Pneumosinus dilatans is a rare pathology that primarily involves the frontal sinus. We report three new cases, with special attention given to the pathophysiology and histologic data. Surgical management is reported.
Adult↗
Dilatation of bronchial stenosis with Gruentzig balloon.
Current treatments for bronchial stenosis include surgical resection, laser photoresections, cryotherapy, and limited experience with balloon dilatation. This article describes the use of the Gruentzig balloon for treatment of an acquired bronchial anastomotic stricture after sleeve resection for carcinoma.
Bronchial Diseases↗