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PubMed1986

Narrow heads of preterm infants--do they matter?

The biparietal diameters (BPD) and occipitofrontal diameters (OFD) were measured in a group of 203 newborn infants weighing 501 to 2000g, and at intervals until the age of three years. The heads of 96 normal-birthweight children were also measured. 11 per cent of the low-birthweight group had marked early narrowing, i.e. OFD/BPD (a/b) ratios of greater than 1.55. These babies were lighter and less mature, but by three years of age there was no significant difference in head shape or developmental quotient between these babies and the rest of the group. Intracranial pathology did not appear to affect head shape. At all ages the low-birthweight children showed greater head narrowing than those of normal birthweight.

Cephalometry↗
PubMed1992

A contribution to the morphology of tortuosity of arteries, aneurysms and arteriomegaly.

Using the electron microscope, the authors examined the structure of the wall in a case of arteriomegaly of the inferior mesenteric artery in man. Structural changes concerned the elastic material showing signs of degeneration. Based on a comparison with literary findings, the authors conclude that tortuosity of the arteries, aneurysms and arteriomegaly are caused by congenital, age-dependent and pathological changes in the elastic material in the vessel wall. There exist basic structural differences in the arterial wall in arteriomegaly and in atherosclerosis.

Aged↗
PubMed1981

Balloon catheter dilatation in patients with failing arteriovenous fistulas.

Six patients on hemodialysis who had stenotic segments of failing arteriovenous fistulas underwent attempted dilatations with a Grüntzig balloon catheter. In three patients the dilatation was successful: two fistulas were still functioning at the time of this study (10 and 8 months), and one fistula functioned up to the patient's death (2 months). Dilatation was unsuccessful in two patients because the stenosis located adjacent to the arteriovenous anastomosis could not be approached with the balloon. There were no complications secondary to the technique, and the dilatation attempt did not preclude surgical revision when it failed. This technique, which can be performed in ambulatory patients, provides an alternative to surgical revision of the failing arteriovenous fistula.

Arteriovenous Shunt, Surgical↗
PubMed1992

Right ventricular dysplasia: morphological findings in 13 cases.

OBJECTIVE: To characterize the pathological features of right ventricular dysplasia (RVD). DESIGN: Retrospective morphological case study. SETTING: Three referral-based university medical centres. PATIENTS: Thirteen subjects (one female) aged 16 to 55 years including 10 necropsy hearts from sudden deaths out of hospital, one explant heart and two partial right ventricular resections from patients with intractable ventricular tachycardia. MAIN RESULTS: Most hearts showed hypertrophy and localized or generalized dilatation of the right ventricle. Transillumination revealed myocardial thinning of variable configuration usually conforming to regions of dilatation. Common sites of involvement were apex, infundibular region and posterobasal wall. Histologically, focal or extensive segments of right ventricular myocardium were absent or replaced. Three patterns were found: right ventricle markedly thinned, epicardium and endocardium contiguous, virtually no intervening tissue; wall normal thickness or thinned, myocardium almost totally replaced by fat; and wall normal or thin, myocardium largely replaced by fat with scattered residual myocardial cells and fibrous tissue (the predominant pattern). Endocardial fibrosis was present in eight cases and focal mononuclear cell infiltrates in 10. Electron microscopy in two cases showed nonspecific findings. CONCLUSIONS: RVD has gross and microscopic features which permit its recognition. While a majority of cases are likely congenital (genetic or acquired in utero), the possibility of postnatally acquired conditions (inflammatory, toxic, ischemic) inducing RVD must be explored. The incidence and importance of RVD as a cause of sudden death can only be assessed by continued systematic and detailed studies of patients with recurrent ventricular tachycardia and of hearts, especially from sudden death victims. Although uncommon, RVD should be considered in the differential diagnosis of arrhythmia and sudden death by both clinicians and pathologists.

Adolescent↗
PubMed1994

Intrahepatic cholangiocarcinoma: findings on spiral CT during arterial portography.

To attempt to determine the characteristic imaging features of intrahepatic cholangiocarcinoma on spiral CT during arterial portography (CTAP), spiral CTAP examinations of 17 patients with pathologically confirmed intrahepatic cholangiocarcinoma were reviewed in consensus by three radiologists. The diameter of the tumors ranged from 1 to 12 cm (mean diameter, 6.6 cm). All tumors (100%) were hypoattenuating masses on spiral CTAP. In 11 cases, the tumor was homogeneous in attenuation (65%). Tumor margins were smooth and regular in 11 cases (65%). Vascular invasion was found in 14 cases (82%). Intrahepatic bile duct dilatation was present in seven cases (41%). This review shows that intrahepatic cholangiocarcinoma is associated with a constellation of findings on spiral CTAP. The presence of a low attenuation homogeneous intrahepatic mass with vascular invasion and intrahepatic bile duct dilatation on spiral CTAP images should raise the possibility of intrahepatic cholangiocarcinoma. However, these findings can be associated with other types of primary and secondary malignant hepatic tumors.

Adult↗
PubMed1996

Transvaginal uterine cervical dilation with fluoroscopic guidance: preliminary results in patients with infertility.

PURPOSE: To assess efficacy of uterine cervical dilation performed with fluoroscopic guidance to treat patients with infertility who have cervical stenosis, false channels within the endocervical canal, or both. MATERIALS AND METHODS: Fifteen patients in whom infertility was diagnosed were referred because the uterine lumen could not be accessed. Three of the patients had endometriosis. With fluoroscopic guidance, the cervix was cannulated and the endocervical canal was dilated with an angioplasty balloon or with dilators. Five patients underwent simultaneous fallopian tube recanalization. Five of 15 patients who underwent dilation subsequently underwent in vitro fertilization for embryo transfer (IVF-ET) or intrauterine insemination. RESULTS: Four patients became pregnant. Of those four, one underwent IVF-ET and one underwent intrauterine insemination. Two patients became pregnant spontaneously. In the five patients who underwent IVF-ET or intrauterine insemination and in the remaining eight patients, the cervix could be easily cannulated up to 7 months after dilation. CONCLUSION: Dilation of the uterine cervix may provide options for treatment in selected patients with infertility. The effect of dilation on patients with other sequelae of cervical obstruction such as endometriosis remains uncertain.

Adult↗
PubMed2004

Preventing vaginal stenosis after brachytherapy for gynaecological cancer: an overview of Australian practices.

Despite advances in brachytherapy techniques in recent years, patients still experience a variety of treatment-related complications. Vaginal stenosis is a recognised toxicity of brachytherapy for the treatment of gynaecological cancer. It can result in long-term sexual dysfunction and painful vaginal examinations; however, it is generally accepted that it may be prevented by regular sexual intercourse or the use of vaginal dilators. The incidence of vaginal stenosis is variably reported in the literature, while preventative strategies and compliance are infrequently described and rarely evaluated. A telephone survey of radiation oncology centres in Australia was undertaken as a quality improvement activity to determine best practice for the use of vaginal dilators for the prevention of vaginal stenosis, by way of identifying similarities of practice. The results revealed a lack of consistency for all variables, including which patients are advised to use vaginal dilators, the time to initiate use, frequency of use, insertion time and duration of use. These findings suggest that current methods for preventing radiation-induced vaginal stenosis warrant formal evaluation in order to establish an evidence base for practice.

Australia↗
PubMed1985

Endoscopic gallstone extraction following hydrostatic balloon dilatation of stricture in the common bile duct.

A patient with long-standing biliary complaints and a previous cholecystojejunostomy, reputed to be suffering from primary biliary cirrhosis was, on endoscopic retrograde cholangiography (ERC), found to have several large gallstones proximal to a stenosis in the common bile duct. After endoscopic papillotomy (EPT), and endoscopic hydrostatic dilatation of the stricture, the gallstones were successfully removed by means of an endoscopic stone extractor. After 15 months the patient remains well, with no complaints, and with completely normal liver function tests.

Aged↗
PubMed1987

Tracheobronchial stenosis in infants: successful balloon dilation therapy.

Four infants with congenital or acquired tracheobronchial stenosis were successfully treated with angioplasty balloon catheter dilation. The technical details and complications of these procedures are described. The authors believe balloon dilation therapy should be considered as the initial form of therapy for tracheal stenosis in infants, even in the presence of complex stenotic lesions.

Bronchial Diseases↗
PubMed1983

Management of stenosis of distal splenorenal shunt by balloon dilation.

Stenosis of a distal splenorenal shunt may lead to inadequate variceal decompression with the risk of rebleeding. We report this complication in three patients at five, 16 and 17 months after DSRS, with successful management by balloon dilation. One patient had rebled from varices and the other two showed roentgenologic evidence of inadequate variceal decompression. All of the shunts were patent but showed a mean pressure gradient of 15 millimeters of mercury which was reduced to a mean of 7 millimeters of mercury by dilation. Angiography at 15 months showed no restenosis and sustained reduction of the pressure gradient in one patient. The other two patients await long term follow-up observation. Rebleeding or reappearance of varices are indications for repeat angiography after DSRS to determine the cause. The risk of dilating a venous anastomosis must be weighed against the risk of rebleeding; the results of this report demonstrate that this can be done with a satisfactory outcome.

Aged↗
PubMed1991

[Value of echography in the diagnosis of post traumatic pathology of the ulnar artery, in manual workers].

Three cases of hypothenar hammer syndrome are reported in manual workers who experienced repeated traumatism of the palm of the hand either because of personal habit or the use of professional tools. Hemodynamic examination of the upper limb was performed by plethysmography (Perivein Etna) and Doppler ultrasound (8 MHz) complemented by angiography by direct puncture of the humeral artery. Ultrasonography was performed using a 7.5 MHz probe (Sononranger) for exploration of the ulnar artery at the wrist and in its course through the palm. The 3 patients presented aneurysmal dilatation of the ulnar artery in the palm, complicated by postembolic thrombosis of the collateral arteries of the fingers. The ulnar artery lesion was permeable 1 time, already thrombosed 1 time and thrombosed secondarily 1 time. Ultrasonography of the palm showed suspected aneurysm of the ulnar artery in 2 patients: one case was confirmed by angiography, whereas the other remained only suspect since the thrombosed ulnar artery was not opacified. The third patient presented an ulnar artery thrombosis without true aneurysmal dilatation. It may be concluded that ultrasonography can show suspected aneurysmal dilatation of the ulnar artery and be complementary to arteriography when the ulnar artery is thrombosed.

Adult↗
PubMed1998

[Pathology of the ureterovesical junction in neurogenic bladders in children and adolescents. A retrospective study of 119 patients].

Ureterovesical junction dysfunction in congenital or acquired neurogenic bladders represents a threat for the renal parenchyma. In order to evaluate the incidence, mechanisms of development and preventive and curative treatments proposed in diseases of the ureterovesical junction associated with neurogenic bladders, the files of 119 children were retrospectively evaluated. 68 patients suffered from congenital neurogenic bladder and 51 had an acquired neurogenic bladder. In the congenital neurogenic bladder group, vesico-ureteric reflux was observed in 22 cases (32%) and dilatation was observed in 18 cases (26.5%), while 21 patients had both dilatation and reflux. In the acquired neurogenic bladder group, reflux was observed in 8 cases (16%) and dilatation was observed in 3 cases (10%), one of whom had both reflux and dilatation. The predominant mechanism of decompensation of the ureterovesical junction in the two groups was a combination of low compliance and high peripheral resistance. In patients with abnormalities of the ureterovesical junction, the incidence of associated parenchymal lesions was similar (30%) whether neurogenic bladder was congenital or acquired. The disparities between these two comparable patient groups, the preventive and curative treatments proposed and their results are analysed in comparison with the data reported in the literature.

Adolescent↗
PubMed1999

Experimental hepatobiliary fascioliasis in rabbits: a radiology-pathology correlation.

RATIONALE AND OBJECTIVES: The authors sought to correlate the radiologic findings of hepatobiliary fascioliasis with pathologic features. METHODS: Serial ultrasound, computed tomography (CT), and magnetic resonance findings in seven rabbits with experimentally induced fascioliasis were obtained every other week. Direct cholangiogram was also obtained after the rabbits were killed. Radiology-pathology correlation was done in specimens. RESULTS: In the parenchymal phase (an acute phase of parenchymal invasion of a larva), CT showed subcapsular clustered areas of low attenuation. Magnetic resonance appearance was similar in shape but better than CT in characterizing the hemorrhagic nature of the lesion. Ultrasound findings were nonspecific in this phase. In the ductal phase (a stationary phase after residing in the bile duct), CT showed dilatation of central ducts with symmetric periportal hypoattenuation (periportal tracking). Magnetic resonance could not depict mild ductal dilatation. Ultrasound was most valuable in demonstrating the moving worm within the dilated duct. Pathologically, the hepatic parenchymal lesions consisted of a cluster of eosinophilic granulomas with hemorrhagic change (migratory tract of the flukes). Ductal changes were observed predominantly in the central bile ducts. Periportal lymphangiectasia was also noted. CONCLUSIONS: Computed tomography or magnetic resonance can demonstrate the characteristic evolutionary pattern of fascioliasis that reflects the unique life cycle of Fasciola hepatica. The role of ultrasound, although limited in the parenchymal phase, was most useful in the ductal phase in that it demonstrated the moving worms themselves.

Animals↗
PubMedDate not supplied

Contact lens fitting in keratoconus.

The treatment of keratoconus can be implemented by the use of spectacle lenses, contact lenses of various kinds, and surgery. In this article, we deal with the procedures of contact lens fitting in patients diagnosed with keratoconus. The different types of specific contact lenses and the methodology of fitting these contact lenses for keratoconus are described. To select a contact lens for the individual patient depends upon the severity of keratoconus and the amount of corneal ectasia. Pending these criteria, a contact lens is chosen, which will give the best visual acuity and tolerance. At present, many designs of special contact lenses exist in oxygen-permeable materials; in addition, other systems, such as piggy-back, SoftPerm, semi-scleral, and scleral contact lens types are used. Contact lens fitting on a conical cornea will smooth out the highly irregular optical surface of the cornea and improve visual acuity considerably. Contact lenses are one of the better solutions to correct refractive errors induced by pathology, and they should be prescribed as soon as the keratoconus is detected to avoid development of amblyopia. The quality and quantity of vision is far better than with spectacle lens correction.

Adolescent↗
PubMed1985

Routine fetal genitourinary tract screening.

To evaluate routine fetal genitourinary tract obstetrical ultrasound screening, and to determine what size renal pelvis is indicative of significant renal disease, we reviewed 4,832 examinations, which had been performed over 2 years, of 3,530 consecutive obstetrical patients. Any fetus that had a renal pelvis greater than 5 mm or a definable cystic area was identified for follow-up. The fetuses of 39 patients (1.1%) who underwent 112 examinations fulfilled these criteria and constitute the basis of this report. A variety of examination criteria were recorded and analyzed in relationship to the follow-up, which ranged from 2-3 days to 21 months. The fetuses of the 39 patients were grouped into three categories: those with renal pelves between 5 and 9 mm in size; those with renal pelves larger than 10 mm; and those with cystic abnormalities. Those with renal pelves larger than 10 mm had either an obstructing lesion or exceptional extrarenal pelves. The clinical and pathologic aspects of these three groups are detailed, discussed, and analyzed. Criteria for significant fetal renal hydronephrosis and aspects of a loculated appearance are given.

Dilatation, Pathologic↗
PubMed1985

[Percutaneous correction of benign stenosis of the bile ducts and biliary-digestive anastomosis. Percutaneous transhepatic biliplasty].

The authors describe their experience in nine cases of transhepatic percutaneous dilatation of bile ducts benign stenosis by a Gruntzig catheter inflated at the stenotic level in order to stretch the sclerotic lesion. Despite the brief follow-up, the first results are satisfying; for this reason percutaneous dilatation of bile ducts benign stenosis could be a new procedure in the treatment of these lesions in selected cases.

Adult↗