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PubMed1987

Constrictive penile band injury: anatomical and reconstructive considerations.

Cases of constrictive penile band injury are seen often in the emergency room, and most require only removal of the constriction and conservative management. Occasionally, patients present with long-standing constriction, necrosis of the penile tissue and urethral injury. We report 2 such cases. We believe that a thorough understanding of the penile anatomy, aggressive debridement, skin grafting and temporary urinary diversion are essential for successful management of these severe cases.

Adult↗
PubMed1989

Effects of pupillary constriction on automated perimetry in normal eyes.

The authors studied the effects of pupillary constriction (pilocarpine 2%) on automated static threshold perimetry in 20 normal subjects using the Humphrey Field Analyzer 30-2 and STATPAC programs. The mean defect (MD) worsened by an average of 0.67 decibels (dB) (standard deviation, 0.67 dB) in constricted fields compared with baseline visual fields (P less than or equal to 0.001). Independent comparisons of the unweighted means of threshold values for the central 30 degrees, 24 degrees, and 10 degrees were also done and showed significant reductions in sensitivity after constriction (P less than or equal to 0.001). These findings indicate that changes in pupillary diameter may produce significant declines in threshold sensitivities and support the importance of consistent pupillary diameters on serial automated visual field examinations.

Adult↗
PubMedDate not supplied

[Constrictive pericarditis in severe seronegative rheumatoid polyarthritis].

Constrictive pericarditis is a rare complication of rheumatoid arthritis, with 78 published cases. We report a new typical case where the pericardial disease was associated with a severe seronegative rheumatoid arthritis of 17 years duration. Constrictive pericarditis generally occurs in men (62.8% of all cases) aged 52.4 +/- 11.5 years. Its clinical features are identical with those of constrictive pericarditis due to other causes. Diagnosis rests on echocardiography and, chiefly, on right heart catheterization. The arthritis is seropositive in 85.7% of the cases, frequently nodular (75%) and advanced. There is no relation between its duration (mean: 9.6 +/- 7.4 years) and the occurrence of the pericardial pathology. The pericardial fluid has no specific abnormality. Histology shows fibrosis and a non-specific inflammatory cell infiltrate. Immunoglobulin and complement deposits in the walls of the pericardial vessels are detected by immunofluorescence. The only treatment is pericardiectomy; without it the disease is constantly lethal.

Antibodies, Antinuclear↗
PubMed1984

Congenital constriction band syndrome.

Fifty-five patients, 28 male and 27 female, with congenital constriction band syndrome were reviewed. There were no remarkable abnormalities in the family or neonatal history except 10 out of 35 mothers had colds in early pregnancy and nine had threatened maternal bleeding. Metacarpal length is usually normal in the constricting ring syndrome, but short in the failure of formation defect. There are, however, a small number of patients who have the same features of both congenital hand anomalies. Surgical procedures for constriction ring, fenestrated syndactyly, webbing of the digits, and amputated digits are discussed.

Bone Lengthening↗
PubMed1983

Differentiation of constrictive pericarditis and restrictive cardiomyopathy using digitized echocardiography.

Constrictive pericarditis and restrictive cardiomyopathy are difficult to distinguish at the bedside and occasionally at routine cardiac catheterization. Left ventricular diastolic function was studied by computer analysis of digitized M-mode echocardiograms in four patients with constrictive disease and three with restrictive disease, and the data were compared with those of normal subjects. The respective distinguishing echographic features of constrictive pericarditis and restrictive cardiomyopathy were as follows: the major filling period of the left ventricle was 78 +/- 9% of normal versus 128 +/- 4% (p less than 0.01), minimal left ventricular dimension to peak filling interval was 50 +/- 10 versus 110 ms (p less than 0.05) and the maximal rate of left ventricular posterior wall thinning was -4.9 versus -2.3 seconds-1 (p less than 0.05). This preliminary study suggests that it may be possible to accurately diagnose the two disease entities using this technique at the bedside and to avoid cardiac catheterization.

Adolescent↗
PubMed1985

M-mode echocardiography in constrictive pericarditis.

M-mode echocardiograms from 40 patients with proven constrictive pericarditis and 40 subjects without evidence of cardiac disease were reviewed for features previously described in constrictive pericarditis. In this large series, no single feature of the M-mode echocardiogram could be considered diagnostic, although a pattern of normal left ventricular size and systolic function, mild left atrial dilation, flattened diastolic left ventricular posterior wall motion and abnormal septal motion was found in most patients. It is concluded that the M-mode echocardiogram can provide findings suggestive of constrictive pericarditis but must be used in conjunction with hemodynamic and other studies to establish the diagnosis.

Echocardiography↗
PubMed1993

Experimental pulmonary hypertension induced by constriction of the pulmonary arteries resulting in rupture or extraordinary dilatation of the right ventricle after administration of a little amount of Na2EDTA.

Our earlier studies on the hypocalcemic condition have focused on the histological distortion of the organ structure with the removal of the calcium ion from the molecular structure of acid mucopolysaccharides (AMPs); resulting in the sol-gel diversion of the matrix. Bivalent cationic materials including calcium are related not only to function but also to structural alteration of the living organism (Yamaguchi et al. 1978, 1981, 1982, 1985, 1991). The ionic shift from the structural phase to the functional phase induced a number of morphological distortions of the various organs. In the present paper, starting our research from a different experimental viewpoint, we decreased the Na2EDTA dose used to prevent the conventional typical tetanic shock which sometimes results in animal death. We expected this decreased dose to induce mild constriction of muscle cells. In our experiment, administration of a small amount of Na2EDTA intraperitoneally provoked animal death after 10 days to two weeks over a two-month period. In the initial phase of 10 days to two weeks, rupture of the right ventricular wall along the septum occurred at an anterior angle with moderate right ventricular dilatation and a remarkably thin ventricular wall. Characteristic of these cases was elastosis between the medial smooth muscle cells of the main pulmonary arteries accompanied by a severe degree of constriction. On the other hand, demonstrated in the delayed cases of between more than two weeks to two months there was severe dilatation of the right ventricular lumina with paper-like thinness of the wall. In these cases, the main pulmonary arteries showed rather slight constriction with scarce elastosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Chylous ascites due to constrictive pericarditis.

Chylous ascites due to constrictive pericarditis is an extremely rare clinical entity, possibly caused by the augmented lymph production and high impedance to lymph drainage due to central venous hypertension. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of lymphatic obstruction. Cardiac catheterization is essential for the confirmation of accurate diagnosis of constrictive pericarditis. Magnetic resonance imaging of the heart is also very helpful in the diagnosis. The patient was symptom free and his ascites and edema completely resolved after pericardiectomy.

Adult↗
PubMed1987

Intrarenal hypertonic saline infusions in dogs with thoracic caval constriction.

Intrarenal artery infusions of hypertonic saline can activate tubuloglomerular feedback (TGF), decreasing renal blood flow (RBF) and glomerular filtration rate (GFR). The response to infusion of hypertonic saline is enhanced by salt depletion and attenuated by salt loading, but has not previously been investigated in pathophysiological states where expanded extracellular fluid volume due to salt retention is associated with avid, renal sodium reabsorption. The renal response following intrarenal infusions of hypertonic saline was investigated in five control dogs and eleven dogs with partial constriction of the thoracic portion of their inferior vena cava, which resulted in salt retention and the formation of ascites. Intrarenal infusion of hypertonic saline induced significant reductions in RBF and GFR in both control and caval constricted dogs. The extent of these reductions were positively correlated with baseline renal function. An intravenous infusion of 50 ml/kg of 0.9% sodium chloride, which abolished the vasoconstrictor response in normal dogs, failed to abolish the decrease in RBF and GFR in response to intrarenal hypertonic saline infusion in dogs with ascites which had an initial vasoconstrictor response. We conclude that the potential for TGF is preserved in early stages of caval constriction syndrome in dogs, but that this potential activity decreases when basal renal function decreases.

Animals↗
PubMed2000

Constrictive pericarditis post allogeneic bone marrow transplant for Philadelphia-positive acute lymphoblastic leukaemia.

We describe two cases of severe constrictive pericarditis arising after allogeneic BMT conditioning involving total body irradiation and melphalan to treat Philadelphia-chromosome positive ALL. Both patients required pericardectomy, resulting in marked improvement in ventricular filling. However, a degree of right-sided cardiac failure persisted in both patients secondary to restrictive cardiomyopathy. Constrictive pericarditis has not been previously described after BMT, but has been observed following thoracic radiotherapy for malignancy, usually involving a substantially higher radiation dose. Pericardial constriction and restrictive cardiomyopathy should be considered as causes of breathlessness and/or oedema occurring late after BMT. Bone Marrow Transplantation (2000) 25, 571-573.

Adult↗
PubMed2002

A case of refractory bilateral pleural effusion due to post-irradiation constrictive pericarditis.

A 51-year-old woman suffering from dyspnoea and refractory bilateral pleural effusions is discussed. The effusion was characterized as a transudate and cardiac decompensation and renal insufficiency were initially suspected. Diuretic agents were not effective and the patient required bilateral chest water-sealed drainage tubes for 4 months, after exclusion of neoplastic infiltration, collagen disease and other cardiac disorders. On echocardiogram, cardiac function and other findings were almost normal, except for shortening of deceleration time in transmitral flow velocity. To evaluate the reduced diastolic compliance, cardiac catheterization was performed, and revealed an elevated pressure in the right ventricle with a dip-and-plateau pattern, and constrictive pericarditis was diagnosed. The hydrothorax resolved after pericardiectomy and symptoms were alleviated. Three and a half years after surgery, the patient is well and taking only oral diuretics. The underlying mechanism of cardiac disorder appears to have been mixed restriction and constriction due to irradiation of her chest for breast cancer 13 years ago. Because the echocardiogram was within normal limits, the diagnosis was delayed. Radiation-induced constrictive pericarditis should be considered if there is an unexplained transudate effusion with a normal echocardiogram.

Breast Neoplasms↗
PubMed2002

Endovascular photodynamic therapy with aminolaevulinic acid prevents balloon induced intimal hyperplasia and constrictive remodelling.

BACKGROUND AND OBJECTIVE: intimal hyperplasia (IH) and constrictive remodelling are important causes of restenosis following endovascular interventions, such as percutaneous transluminal angioplasty. Photodynamic therapy (PDT) with 5-aminolaevulinic (ALA) may prevent restenosis by cellular depletion and the elimination of cholinergic innervation. STUDY DESIGN/MATERIALS AND METHODS: rats (n=90) were subdivided into 4 main groups. In the experimental group (n=36: 3 replications x 4 doses x 3 examination time-points), ALA was administered (200mg/kg i.v.) 2-3h before balloon injury (BI) of the common iliac artery followed by endovascular illumination with 633nm at either 12.5, 25, 50 or 100J/cm diffuser length (dl BI+PDT group). As control groups served the BI+Light only (LO) group (n=36) that received no ALA, the BI only group (n=9) (BI), and a group (n=9) that received a Sham procedure (Sham group). RESULTS: planimetric analysis showed IH of 0.28+/-0.12mm(2) (BI), 0.27+/-0.12mm(2) (BI+LO at 100J/cmdl) in contrast to 0.02+/-0.02mm(2) after BI+PDT at 100J/cmdl at 16 weeks (p<0.05). In the BI+PDT groups, a light-dose increase of a factor 2 led to an IH decrease of 17% (p<0.05). In the BI and BI+LO groups constrictive remodelling was found, in contrast to BI+PDT treated groups at 16 weeks. The staining of cholinergic innervation of the tunic media of the blood vessel wall in BI+PDT showed no damage at the highest fluence. CONCLUSION: endovascular ALA-PDT prevents IH and constrictive remodelling after BI without damage of cholinergic innervation of the tunica media. The effective light fluence rate in the rat is 50-100J/cmdl.

Aminolevulinic Acid↗
PubMed2002

Usefulness of the transgastric view by transesophageal echocardiography in evaluating thickened pericardium in patients with constrictive pericarditis.

Detection of thickened pericardium in patients with constrictive pericarditis is essential for pericardiectomy because restrictive cardiomyopathy and severe tricuspid regurgitation show similar hemodynamic data. The purpose of this study was to clarify whether transesophageal echocardiography can evaluate thickened pericardium. We investigated 7 patients with constrictive pericarditis who underwent pericardiectomy. Thickened pericardium over the right atrium was detected in 6 patients, but the borders were not clear. Thickened pericardium over the left ventricle was not detected in any patients in the standard longitudinal and horizontal views. On the other hand, thickened pericardium over the ventricles was detected in all patients in the transgastric view as an echogenic area between the liver and ventricular wall. Tissue characteristics of the thickened pericardium could be evaluated because of the high-quality images in the transgastric view. The transgastric view by transesophageal echocardiography allows high-quality images of the pericardium, which might be useful in diagnosing constrictive pericarditis.

Diagnosis, Differential↗
PubMed2002

Increased expression of urokinase during atherosclerotic lesion development causes arterial constriction and lumen loss, and accelerates lesion growth.

Overexpression of urokinase plasminogen activator (uPA) in endothelial cells can decrease intravascular thrombosis. However, expression of uPA is increased in atherosclerotic human arteries, which suggests that uPA might accelerate atherogenesis. To investigate whether elevated uPA expression accelerates atherogenesis, we cloned a rabbit uPA cDNA and expressed it in carotid arteries of cholesterol-fed rabbits. uPA gene transfer increased artery-wall uPA activity for at least 1 week, with a return to baseline by 2 weeks. One week after gene transfer, uPA-transduced arteries were constricted, with significantly smaller lumens and thicker walls, but no difference in intimal or medial mass. Two weeks after gene transfer, uPA- and control-transduced arteries were morphologically indistinguishable. By 4 weeks, however, uPA-transduced arteries had 70% larger intimas than control-transduced arteries (P < 0.01) and smaller lumens (P < 0.05). Intimal lesions appeared to be of similar composition in uPA- and control-transduced arteries, except that degradation of elastic laminae was evident in uPA-transduced arteries. These data suggest that elevated uPA expression in atherosclerotic arteries contributes to intimal growth and constrictive remodeling leading to lumen loss. Antagonists of uPA activity might, therefore, be useful in limiting intimal growth and preventing constrictive remodeling. Overexpression of uPA in endothelial cells to prevent intravascular thrombosis must be reconsidered, because this intervention could worsen underlying vascular disease.

Animals↗
PubMed1983

Cation distributions in the hypertrophic myocardium (aortic constriction) of the rat.

Calcium, magnesium, sodium, potassium, and water distributions were determined in rat ventricular muscle during the development of myocardial hypertrophy. Hypertrophy was produced by constriction of the ascending aorta with a silver band. Sham-operated controls were treated similarly, except that the aorta was not constricted. Cation and water distributions were examined at intervals of 1 hour, 1 day, 1 week. Myocardial extracellular space was determined by distribution of [35S] sulphate. In separate experiments, extracellular space was determined in different regions of the normal rat ventricle using [3H] inulin as the extracellular marker. Although some changes were observed in tissue calcium content and the plasma concentrations of several cations, at no time were the cellular concentrations of any cation significantly altered. Myocardial water content and distribution remained nearly constant after constriction of the aorta. Results do not support hypotheses that the heart responds to increased afterload with an accumulation or loss of myocytic calcium sufficiently large to be detectable with standard quantitative methods.

Animals↗
PubMed1991

Constrictive pericarditis without typical haemodynamic changes as a cause of oedema formation due to protein-losing enteropathy.

A 41-year-old man presented with physical signs of leg oedema and a laboratory value of decreased serum albumin of 2.4 g.dl-1. Loss of protein via the gastrointestinal tract was demonstrated by an increased faecal excretion of 51-chromium-labelled-albumin and by elevated stool clearance of alpha 1-antitrypsin. No anatomical lesions or intestinal disease were found to explain this protein loss. Constrictive pericarditis was suspected as the cause of protein-losing enteropathy but could not be confirmed by right heart catheterization, in which normal filling pressures and no sign of 'dip and plateau' pressure pattern were found. However, magnetic resonance imaging clearly demonstrated a thickening of the pericardium over the right heart and a tubular-shaped right ventricle as signs of constrictive pericarditis. Peripheral oedema disappeared and serum protein concentration returned to normal after pericardectomy. This demonstrates that moderate pericardial constriction not resulting in discernible pressure abnormalities in the right heart can be associated with protein-losing enteropathy and thus result in hypoproteinaemic peripheral oedema. In this condition a morphological investigation by magnetic resonance imaging is of importance in order not to miss the diagnosis of a potentially treatable disease.

Adult↗
PubMed2004

Management of tuberculous constrictive pericarditis and tuberculous pericardial effusion in Transkei: results at 10 years follow-up.

BACKGROUND: Tuberculous pericarditis is common in Transkei (Eastern Cape). Two randomized trials showed benefits at two years for prednisolone in patients with constrictive pericarditis, and open drainage plus prednisolone in patients with pericardial effusion. AIM: To see whether the advantages of prednisolone and open drainage were maintained up to 10 years. DESIGN: Follow-up of randomized, double-blind, placebo-controlled trials. METHODS: All 383 patients (143 constriction, 240 effusion) received the same anti-tuberculosis chemotherapy. They were randomized to prednisolone or placebo for the first 11 weeks, and were followed-up over 10 years. Among the 240 with effusion, 122 were also randomized to immediate open surgical drainage of pericardial fluid versus pericardiocentesis as required. Adverse outcomes were: death from pericarditis, pericardiectomy, repeat pericardiocentesis, and subsequent open drainage. RESULTS: The 10-year follow-up rate was 96%. In constriction patients, adverse outcomes occurred in 19/70 (27%) prednisolone vs. 28/73 (38%) placebo (p = 0.15), deaths from pericarditis being 2 (3%) vs. 8 (11%), respectively (p = 0.098, Fisher's exact test). In effusion patients, adverse outcomes occurred in 14/27 (52%) with neither drainage nor prednisolone, vs. 4/29 (14%) drainage and prednisolone, 4/35 (11%) drainage and placebo, and 6/31 (19%) prednisolone and no drainage (p = 0.08 for interaction). Drainage eliminated the need for repeat pericardiocentesis. In the 176 with effusion and no drainage, adverse outcomes occurred in 17/88 (19%) prednisolone vs. 35/88 (40%) placebo patients (p = 0.003), with repeat pericardiocentesis 20 (23%) placebo vs. 9 (10%) prednisolone (p = 0.025). In a multivariate survival analysis (stratified by type of pericarditis), prednisolone reduced the overall death rate after adjusting for age and sex (p = 0.044), and substantially reduced the risk of death from pericarditis (p = 0.004). At 10 years, the great majority of surviving patients in all treatment groups were either fully active or out and about, even if activity was restricted. DISCUSSION: In the absence of a clear contraindication, a corticosteroid should be used in addition to antituberculosis chemotherapy in the management of patients with tuberculous pericarditis.

Adolescent↗
PubMed1994

Time-dependent effect of morphine and time-independent effect of MK-801, an NMDA antagonist, on the thermal hyperesthesia induced by unilateral constriction injury to the sciatic nerve in the rat.

BACKGROUND: It is known that peripheral nerve injury induces time-dependent changes in dorsal horn function. The current study investigated the time dependency of the effects of intrathecal morphine and MK-801, an N-methyl-D-aspartate antagonist, on the thermal hyperesthesia evoked by unilateral constriction injury to the sciatic nerve in the rat. METHODS: In rats with a unilateral constriction injury to the sciatic nerve, paw withdrawal latency against thermal stimulation for the injured paw was typically 3 s less than that for the uninjured paw during the first 5 weeks after the injury. Drugs were administered intrathecally 1 or 5 weeks after the nerve injury. RESULTS: Intrathecal morphine increased the paw withdrawal latencies of both the injured paw and the uninjured paw in an equally dose dependent manner in the 1-week study. In the 5-week study, morphine increased the paw withdrawal latency of the uninjured paw in a dose-dependent manner, but not that of the injured paw. Intrathecal MK-801 increased the paw withdrawal latency of the injured paw to the level of the uninjured paw in a dose-dependent manner in both the 1- and 5-week studies. CONCLUSIONS: These data indicate that (1) an N-methyl-D-aspartate receptor-mediated spinal facilitation may be the common mechanism maintaining the thermal hyperesthesia evoked by the constriction injury, and (2) the effects of intrathecal morphine on this thermal hyperesthesia are time-dependent.

Animals↗