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PubMed1998

Surgical correction of an acquired vaginal stricture in a llama, using a carbon-dioxide laser.

An acquired vaginal stricture in a llama secondary to trauma from uterine torsion during gestation was repaired, using a carbon-dioxide laser. The procedure was accomplished by use of epidural anesthesia with the llama in a standing position. Repeated dilation of the vagina was required after surgery; however, the llama subsequently mated and conceived, and a male cria was delivered by cesarean section at the end of a full-term gestation.

Animals↗
PubMed2006

[Giant aneurysm of the descending aorta mimicking extracardiac mass].

The case report presents a giant aneurysm of the descending aorta in a 79- year-old female. The echocardiographic study of the patient was substantially impeded, since aortic pathology obscured the left atrium in standard views and produced images mimicking extracardiac mass. Modified imaging planes were necessary to complete the correct echocardiographic visualisation of the heart and the aorta and to establish diagnosis.

Aged↗
PubMed1997

Corrosive oesophageal injury. A study of four cases.

BACKGROUND AND AIMS: The ingestion of a corrosive agent including strong alkaline material causes serious caustic damage to the upper gastrointestinal tract. We describe four cases in patients who had ingested alkaline substances. MATERIAL AND METHODS: During the years 1992-1996, four patients who had ingested strong alkali were treated in the Oulu University Hospital. The patients were reviewed retrospectively. RESULTS: In one case a third-degree, in two cases a second-degree and in one case a first-degree injury developed in the oesophagus. The patient with first-degree injury was treated with repeated endoscopic dilatations and he refused any more aggressive surgical therapy. The patients with more severe injuries were operated, on all with good end results. CONCLUSION: Aggressive surgical treatment of severe corrosive injuries involving the upper gastrointestinal tract is recommended.

Adolescent↗
PubMed1987

Endourological management of ureteroileal anastomotic strictures: is it effective?

Ureteroileal stenosis represents a serious postoperative threat to the obstructed kidney and open revision in these patients often is difficult. We evaluated 9 patients with 10 ureteroileal strictures who were treated with semirigid fascial dilators (1), balloon dilation (4) or a combination of balloon dilation and percutaneous intraureteral surgery (4). All 5 patients who had semirigid fascial or balloon dilation alone had early recurrence of the strictures. However, in 4 patients dilation in conjunction with percutaneous intraureteral incision of the stricture through a flexible choledochonephroscope resulted in short-term resolution of each ureteroileal stricture. However, by 6 months these strictures had recurred in 50 per cent of the patients.

Constriction, Pathologic↗
PubMed1995

Routine use of limited abdominal aortography with digital subtraction carotid and cerebral angiography.

BACKGROUND AND PURPOSE: We sought to evaluate the usefulness of limited abdominal aortography performed in conjunction with intra-arterial carotid digital subtraction arteriography (DSA) for identification of clinically unsuspected lesions. METHODS: In a prospective study performed in the Department of Radiology after preliminary carotid duplex imaging, 401 consecutive bilateral carotid intra-arterial DSAs were performed for evaluation of cerebrovascular disease from June 1988 to November 1992. RESULTS: We detected unilateral renal artery stenosis in 24 patients (6%), bilateral renal artery stenosis in 5, renal cell carcinoma in 1, renal artery aneurysm in 1, abdominal aortic aneurysm in 23 (5.7%), aortic ectasia in 16, and iliac aneurysm in 2. CONCLUSIONS: When single-plane digital abdominal aortography is performed in conjunction with carotid intra-arterial DSA, significant pathological lesions can be detected with little increase in morbidity and only modest increase in time and cost.

Aged↗
PubMed1986

[Instrumental dilation and transparieto-hepatic cholangioscopy for stenosis of a choledocho-duodenal anastomosis with gallstone formation].

A 94-year old woman presented with gallstone formation above a stenotic choledoco-duodenal anastomosis, responsible for episodes of cholangitis. After percutaneous biliary tract drainage, the anastomosis was dilated with an angioplasty catheter. As several stones persisted despite washing out, percutaneous cholangioscopy was performed. To introduce a small fibroscope into the biliary canals, transhepatic dilation up to 28 F was necessary. The last stones were pushed into the duodenum with the endoscope. Freedom of the biliary tract and patency of the anastomosis were ascertained.

Aged↗
PubMed2003

Intraductal papillary mucinous tumor of the pancreas: computerized tomography and magnetic resonance imaging features.

The aim of this study was to analyze the computerized tomography (CT) and magnetic resonance imaging (MRI) features of intraductal papillary mucinous tumor (IPMT) of the pancreas. The cases of eight patients with pathologically proven IPMT (1 papillary hyperplasia, 7 adenocarcinoma) of the pancreas were retrospectively reviewed. There were five men and three women with ages ranging from 42 to 82 years. Imaging studies included six thin-section dynamic CT scans, seven MRI scans, one MR cholangiopancreatography scan, and two endoscopic retrograde cholangiopancreatography scans. There was only one benign IPMT, which presented as a unilocular cyst in the pancreatic body with no mural nodules and no dilatation of the main pancreatic duct (MPD). All seven patients with malignant IPMT had multilocular cysts with papillary projections in the pancreatic head and/or uncinate process accompanied by dilated MPD (5 diffuse, 2 segmental). Communication between the cystic lesions and the MPD were evident in all seven patients. One patient had small mural nodules in the branch ducts of the pancreatic body and five had a bulging papilla with a patulous orifice. A mass effect resulting in biliary obstruction was shown in one patient. One patient had a ruptured cyst with mucin leakage into the right anterior pararenal space following sono-guided aspiration. In conclusion, the main imaging feature of IPMT in our patients was a multilocular cyst with papillary projections located in the pancreatic head and uncinate process. Although CT and MRI cannot differentiate mucin content from pancreatic juice, communication between the cystic lesion and the dilated MPD and a bulging papilla with a patulous orifice are characteristics of IPMT.

Adenocarcinoma, Mucinous↗
PubMed1977

Subcellular pathology of rat liver in cholestasis and choleresis induced by bile salts. 1. Effects of lithocholic, 3beta-hydroxy-5-cholenoic, cholic, and dehydrocholic acids.

Cholestasis or choleresis was induced in the rat by intravenous infusion (0.05 to 0.2 mumole per minute per 100 grams of body weight) of sodium taurolithocholate, 3beta-hydroxy-5-cholenoate, taurocholate, and dehydrocholate either singly or in combination after or without cannulation of the common bile duct. Bile flow was monitored and ultrastructural changes were examined by scanning and transmission electron microscopy up to 3 hours after bile salt administration. Taurolithocholate induced acute cholestasis and ultrastructural alterations consisting primarily of dilation of bile canaliculi, loss of canalicular microvilli, and lamellar transformation of the canalicular membrane. Occasionally, crystalline precipitates were present within the canalicular lumen and in the pericanalicular region of hepatocytes. 3beta-Hydroxy-5-cholenoate caused similar but less severe ultrastructural changes than those induced by taurolithocholate. Dehydrocholate had a greater choleretic effect than taurocholate, but neither induced noteworthy ultrastructural change. When infused simultaneously with taurolithocholate, taurocholate reversed cholestasis and largely prevented development of the ultrastructural changes induced by taurolithocholate. In contrast, simultaneous infusion of dehydrocholate prevented neither cholestasis nor development of the ultrastructural changes induced by taurolithocholate, which were more striking than those caused by taurolithocholate or 3beta-hydroxy-5-cholenoate alone. In addition, structural changes associated with cholestasis induced by these bile salts either singly or in combination were more pronounced and frequent in the periportal zone than elsewhere in the hepatic lobule. These results suggest that both taurolithocholate and 3beta-hydroxy-5-cholenoate induce cholestasis by affecting the structural and functional integrity of the bile canalicular membrane and also, in part, by forming untransportable precipitates. The contrasting effects of taurocholate and dehydrocholate on taurolithocholate-induced changes suggest that taurocholate overcomes the effect of taurolithocholate by solubilizing it into mixed micelles, but dehydrocholate and its metabolites have little or no such effect. The intralobular variation in severity of ultrastructural changes probably reflects the accumulation of bile salts in greater concentrations in hepatocytes near the portal triads.

Animals↗
PubMed1993

Self-expanding stainless steel stent application in rectosigmoid stricture.

In recent years, several reports on the experimental and clinical applications of the Gianturco stent (self-expanding stainless steel stent) have been published. However, to our knowledge, the use of stents in rectosigmoid strictures has not been reported. We used self-expanding stainless steel stents to dilate rectosigmoid strictures caused by nonresectable recurrent neoplasm. Insertion and dilation (sigmoid colon and rectum) in two patients were successful. Accordingly, these patients were able to maintain bowel activity and avoid palliative loop colostomy. We believe that this procedure is effective for nonresectable rectosigmoid stricture due to recurrent neoplasm.

Colon, Sigmoid↗
PubMedDate not supplied

Post-stenotic dilatation: challenge in renal ostial stenting--a simple solution.

Stenting is the treatment of choice for treating stenotic renal ostial lesions. During the stenting of an ostial lesion in a renal artery with post-stenotic dilatation, we were faced with the problems of unavailability of a balloon of appropriate length and diameter, and determining the real reference vessel diameter. The problem was solved by a simple technique.

Adult↗
PubMedDate not supplied

Expandable metallic stent placement in the tracheobronchial tree in dogs.

Expandable metallic stents (Gianturco zig-zag wire stents) of various sizes were placed in the trachea of eight dogs to establish conditions suitable for endotracheal wire stent placement. Stents of 3.0 cm in diameter and 2, 3, or 4 cm in length were constructed with 0.018, 0.016, or 0.013 inch stainless steel wire. Optimal dilatation of the trachea was attained with stents 2 cm long made of 0.013 and 0.016 inch wire, and their surface became covered with ciliated columnar epithelium. In contrast, stents with stronger expansive force, such as those 2 cm long made of 0.018 inch wire, became deeply embedded in the membranous portion of the trachea. With stents of little expansive force, such as those 3 or 4 cm long, dilatation of the trachea was inadequate regardless of the caliber of the wire, and consequently these stents were not completely covered with epithelium. The results of the study suggest the therapeutic potential of expandable metallic stents for clinical treatment of patients with tracheobronchial stenosis.

Animals↗
PubMed1999

[Cerebral lacunae: still under debate].

During the last fifteen years, a new interest has been shown in cerebral lacunes due to the development of brain imagery using Magnetic Resonance Imaging (MRI). The concept of lacunar infarction as defined par Fisher (lacunar hypothesis) can no longer be accepted. Clinical data showed that the so-called lacunar clinical syndromes were far from being specific and could be observed in corticosubcortical infarcts. Epidemiological data pointed out that hypertensive disease was not found in many cases of lacunar infarction. Pathological studies suggest that there are two types of lacunar infarction. Lacunar infarcts resulting in clinical stroke syndromes (type 1 a lacunae) seem to be mainly due to obstruction of the trunk of a perforating artery by atherosclerosis. Silent lacunar infarcts (type 1 b lacunae) result from obstruction of small ramifications of the perforating arteries by a non specific microangiopathy related to age, atherosclerosis, cardiovascular disease as well as to hypertensive disease. Silent lacunar infarcts and dilatation of perivascular spaces (type 3 lacunae) are associated with the white matter hyperintensities shown by MRI in elderly subjects. Lacunar infarcts and diffuse white matter hyperintensities are related to small vessel changes and ischaemic damages resulting from (a) arteriolar occlusion and or (b) loss of autoregulation associated with variations in systemic blood pressure. Both lesions constitute a high risk to develop Vascular Cognitive Impairment (Hachinski) and are frequently associated with Alzheimer's disease. Cases of giant or expanding type 3 lacunae have been reported in the last ten years but the physiopathology of such lacunes and their relationship with clinical symptoms remain a puzzle.

Aged↗
PubMed1978

Neonatal detection and evaluation of infantile polycystic disease by gray scale echography.

Infantile polycystic disease (IPCD) is an uncommon pathologic entity involving the kidneys and liver. Gray scale echography can detect this pathologic process within the kidneys, despite the presence of renal failure. In addition, the sonic study may detect associated hepatic abnormalities even though isotopic liver scan is normal. These capabilities make the ultrasonic examination uniquely suited for evaluating patients with IPCD.

Cysts↗
PubMed2001

Dilatation of biliary strictures through the afferent limb of a Roux-en-Y choledochojejunostomy in patients with sclerosing cholangitis.

Repeated dilatation of biliary strictures in patients with sclerosing cholangitis through a subcutaneously placed afferent limb of a choledochojejunostomy is technically feasible and safe. This study is a prospective 15-year evaluation of 36 patients treated by repeat dilatation through this jejunal limb. There was one operative death and one major complication of dilatation. The 5-year survival of all patients was 74%. If patients with cirrhosis or unproven cholangiocarcinoma at the time of operation are not included, the 5-year survival is 86%. The 15-year survival of all patients was 30%; it was 64% if those with cirrhosis and unproven cholangiocarcinoma at the time of operation are not included. Six patients are presently alive with an average survival of 159 months. The study suggests that a combination of repeated dilatations combined with transplantation is the approach of choice in selected patients.

Adolescent↗
PubMed1986

Biliary stricture dilatation: multicenter review of clinical management in 73 patients.

Eighty-nine biliary strictures in 73 patients who had undergone percutaneous balloon dilatation were reviewed to determine long-term patency rates and clinical management problems. The majority of dilatations were performed in patients with anastomotic strictures (n = 44), iatrogenic strictures (n = 28), and strictures associated with sclerosing cholangitis (n = 17). Patency rates after 36 months or more were 67%, 76%, and 42%, respectively. Complications, mostly minor, occurred in less than 7% of patients. Of patients with significant biliary obstruction, 15% had little or no intrahepatic biliary duct dilatation demonstrated by cross-sectional imaging and/or direct cholangiography. No definite conclusions could be drawn about the utility of long-term internal/external stenting.

Bile Duct Diseases↗
PubMed1988

Alpha frequency in schizophrenia: an association with enlarged cerebral ventricles.

Low alpha frequency (less than 10.2 Hz) occurred more frequently in medication-free schizophrenic patients than in normal control subjects, as determined by quantitative EEG analysis. Furthermore, those patients with low alpha frequency had significantly larger lateral ventricles, as measured by CT scan, than did other schizophrenic patients (mean +/- SD ventricle-brain ratios = 9.8 +/- 1.9 versus 5.0 +/- 2.4; p less than 0.01). This finding suggests the existence of a relationship between cerebral structural pathology and the alpha rhythm that may be based on involvement of alpha-generating structures which border the cerebral ventricles. Future EEG studies of schizophrenia may resolve these questions in the context of other brain findings.

Adult↗
PubMed1976

Presentation and management of aneurysms.

The aetiology and pathology of aneurysms, their sites of occurrence, and their general management are outlined. Since the abdominal aortic aneurysm is the type most commonly encountered by the surgeon its presentation, assessment, and operative and postoperative management are discussed in detail.

Adult↗
PubMed1990

Instrument for dilatation of stenotic colorectal anastomosis.

The use of a modified Starck dilator in the treatment of anastomotic stenosis in the distal 15 cm of the rectum is described. This technique is a suitable alternative for use in hospitals where more sophisticated instrumentation is not available.

Anastomosis, Surgical↗