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PubMedDate not supplied

Peripheral cholangiocarcinoma: comparison of MRI with CT.

To evaluate the clinical utility of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of peripheral cholangiocarcinoma of the liver, 11 patients with pathologically proven peripheral cholangiocarcinoma were examined with both CT and MRI. On CT scans in 10 cases, the tumors appeared as irregular, low-attenuation masses with a wide variation in heterogeneity. Contrast enhancement of the tumors was mild in nine cases and moderate in one case, at the periphery. Tumor was not identified in one case. On T1-weighted MRIs, the tumors showed low intensity in eight cases and isointensity in three cases. On T2-weighted images, the tumors showed high intensity in all 11 cases. Focal dilatation of the intrahepatic bile ducts around the tumor was seen in one case on MRIs and in four cases on CT scans. Portal vein invasion of the tumors was seen in one case, and lymphadenopathy was seen in four cases on both MRIs and CT scans. MRI was slightly superior to CT in detecting the tumors, was inferior to CT in delineating focal ductal dilatation around the tumors, and was equal to CT in assessing extent of the tumors.

Aged↗
PubMed1985

[Endoscopic balloon dilatation in stenosis of the pancreatic duct orifice (case report)].

We report the history and endoscopic treatment of a 63 year old female patient with chronic pancreatitis and stenosis of the pancreatic duct. Several operations of the biliary system had been performed in this patient previously (cholecystectomy 1964, choledochoduodenostomy 1972, revision of the choledochoduodenostomy 1974). In 1976 a chronic pancreatitis and a prepapillary stenosis of the Ductus wirsungianus has been diagnosed by clinical and endoscopic radiological findings. In order to relief pain we performed endoscopic sphincterotomies of the pancreatic duct orifice in 1976, 1977 and 1979. Because of relapsing abdominal pain and worsening of the pancreatic duct stenosis we performed two endoscopic balloon dilations of the proximal pancreatic duct at 20 months intervals. These lowered the pancreatoduodenal pressure difference from 40 mm Hg to normal values (below 13 mm Hg) over more than 12 months. Until today only few--less than ten--endoscopic dilations of the pancreatic duct orifice have been reported. A final estimation of this procedure is premature. However our case should stimulate other groups to consider this new form of therapy in selected patients with chronic pancreatitis and marked stenosis of the pancreatic duct.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae.

BACKGROUND: Congenital abnormalities of the tricuspid valve, including Ebstein's malformation, dysplasia, straddling, and those found in pulmonary atresia with intact septum and congenitally corrected transposition, are an uncommon cause of tricuspid regurgitation. Congenital tricuspid valve anomalies are found as a spectrum of disease in which both the leaflets and the subvalvar apparatus are often involved. Tricuspid valve repair is complicated in such patients because the chordae tendineae are often abnormally short and thick. Replacement or augmentation of chordae tendineae has proved to be a useful component of mitral valve repair. In the present report, we describe the techniques and results of chordal augmentation in the repair of congenital tricuspid valve abnormalities. METHODS: Since July 1992, tricuspid valve repair has been performed in 5 children with severe tricuspid regurgitation secondary to congenital abnormalities of the tricuspid valve with significant chordal pathology. As a component of the repair, chordal replacement or augmentation was performed using expanded polytetrafluoroethylene suture. RESULTS: Intraoperative and postoperative echocardiographic assessment showed good mobility of the tricuspid valve leaflets and trivial to mild tricuspid regurgitation. There were no complications and no early or late mortality. At follow-up of 34 to 60 months (median, 49 months), tricuspid valve function has remained excellent in 4 of the 5 patients. In the remaining patient, progressive regurgitation of the right ventricle to pulmonary artery allograft conduit has led to right ventricular dilatation, with a secondary increase in tricuspid regurgitation from trivial to moderate. CONCLUSIONS: Chordal replacement or augmentation with expanded polytetrafluoroethylene suture is a useful technique in the repair of congenitally dysplastic tricuspid valves with abnormal chordal structures.

Adolescent↗
PubMed1991

Use of the optical urethrotome knife in the treatment of a benign low rectal anastomotic stricture.

Several methods of treatment for benign anastomotic strictures following anterior resection have been described. Surgical intervention in terms of re-exploration and excision of the stricture or the formation of a permanent colostomy will be accompanied by substantial morbidity. The dilatation of these strictures without direct vision may not be safe. We describe a simple method of treating benign rectal anastomotic stricture using an optical urethrotome knife under direct vision. This technique affords an accurate incision of the stricture to increase the size of the lumen, thereby relieving obstruction.

Anastomosis, Surgical↗
PubMed1993

Bronchoplastic procedures for tuberculous bronchial stenosis.

Thirty-six patients underwent tracheobronchoplastic procedures for treatment of tuberculous tracheobronchial stenosis. The modes of operations were left upper sleeve lobectomy in 13 patients, sleeve resection of the left main bronchus in 12 patients (two underwent concomitant left upper lobectomy), right upper sleeve lobectomy in five patients, sleeve resection of the right intermediate bronchus in two patients, right sleeve superior segmentectomy of the lower lobe in one patient, sleeve resection of the trachea with concomitant left pneumonectomy in one patient, carinal resection with right upper sleeve lobectomy and middle lobectomy in one patient, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire in one patient. One patient died of pulmonary edema of unknown cause on the first postoperative day. Anastomotic stenosis occurred in seven patients. One of these patients underwent reoperation and six underwent endoscopic dilatation. One patient died in the hospital of massive bleeding during endoscopic dilatation 4 months after operation. Slight to moderate stenosis resulted in the remaining patients. Although there are some complications, we believe bronchoplastic operation is worthwhile for restoring pulmonary function in patients with tuberculous tracheobronchial stenosis.

Adult↗
PubMed1979

Selective angiography in renal and peri-renal inflammatory lesions: correlation with histopathology.

We have correlated the angiographic and pathological findings in renal and peri-renal inflammatory disease in acute, sub-acute and chronic phases. In all stages of renal infection, the renal vasculature is attenuated. This corresponds in acute inflammation to vasospasm, acute vascular necrosis and post glomerular peritubular capillary congestion. In sub-acute inflammation, the reduction in vascularity is due to peri-vascular fibrosis and intimal and medial hyperplasia. In chronic infections, the renal vessels are completely destroyed and replaced by fibrotic tissue. In contrast to this, peri-renal inflammatory disease leads to vaso-dilatation and enlargement of the renal capsular arterial complex, and of retroperitoneal arteries. If both renal and peri-renal inflammation occurs simultaneously, a discordance between the renal cortical and capsular arterial filling results: this striking phenomenon is highly suggestive of inflammation, and extremely rare in tumours. Three types of inflammatory vascularity are described, two of which can be easily distinguished from tumour vascularity. An inflammatory blush, slow emptying of vessels and a mottled nephrogram with loss of cortical definition are highly suggestive signs of renal inflammation. It is concluded that angiography is a sensitive and accurate method for the early diagnoses of renal and peri-renal flammatory conditions.

Acute Disease↗
PubMedDate not supplied

[Patulous eustachian tube].

Patulous eustachian tube is a pathological condition which exists more often than we make a diagnosis, and a patient is not often aware of his disease. This disease can be manifested with various symptoms: respiratory synchrony noises in the ear, because of the penetration of the air current through the eustachian tube and with the movement of the eardrum outwards and inside, with autophony, reduction of the hearing, the buzzing, dizziness and disturbance of the balance. Two patients are presented. The first one was sick for many years from various chronics exhausted diseases: Jackson's epilepsy, temporary vascular brain disturbances, tuberculosis of lung, stomach ulcer, heart diseases, the patient is from low class, on one side, and also suffers from some local diseases: a paralysis of soft palate and palatal arcs, a chronic catarrhal rhinitis and sinusitis, a deviation of nasal dividing wall and hindered breathing through the nose, on the other side. Many years the patient didn't know for patological condition in the ears and in the eustachian tubes. After improving the hygienic conditions, the physical condition and local therapy, the patient felt much better. The second patient, with considerable shorter evolution of the disease and mild symptomatology, showed the amplified symptoms of the disease of the Eustachian tube in the course of the acute otitis. It is attained a satisfying calming of the manifestative symptoms by remedy therapie. Man must thing about possibility of the appearance of this pathology condition in various disease or conditions, which can take to the fast lost of the weight and physical and moral exhaustion of the patient, i.e. an adult, first as the protection of the appearance of the disease (condition) and afterwards, eventually early and regulary treatment in order to prevent various possible, above mentioned complications.

Adult↗
PubMed1981

Transluminal angioplasty during vascular reconstructive procedures: a preliminary report.

A total of 16 isolated arterial lesions were dilated intraoperatively in conjunction with primary vascular reconstructive procedures. Of these, eight involved the iliac vessels and eight the femoropopliteal segment. All angioplasties were successful and no catheter-related complications were noted. Hemodynamic improvement was confirmed by intraoperative pressure measurements and/or noninvasive Doppler segmental pressures.

Catheterization↗
PubMed2000

Incidental findings on magnetic resonance imaging screening for cerebellopontine angle tumours.

The otolaryngologist who requests magnetic resonance imaging (MRI) scans to exclude cerebellopontine angle (CPA) tumours may discover incidental pathologies. We retrospectively reviewed the results of 644 consecutive MRI screening scans with the aim of identifying findings other than CPA tumours. Two hundred and eighty-nine (45 per cent) scans featured one or more anomalies or abnormalities, including CPA tumour (23, four per cent), vascular loop (30, five per cent), basilar artery ectasia (13, two per cent), multiple high signal areas (135,21 per cent), brain atrophy (52, eight per cent), sinus findings (56, nine per cent), middle ear/mastoid disease (34, five per cent), and a variety of other findings (39, six per cent) including clinically serious lesions (11, two per cent). The significance and management of these incidental findings is discussed. The majority were not clinically significant but the occasional presence of a serious incidental pathology should be borne in mind. Basilar artery ectasia and multiple high signal areas may be responsible for the symptoms investigated by MRI, and screening for cerebrovascular disease risk factors in such patients may be appropriate.

Adult↗
PubMed2000

Endoscopic treatment of benign anastomotic colorectal stenosis with electrocautery.

BACKGROUND AND STUDY AIMS: Benign anastomotic colorectal stenosis can occur after surgery and can require surgical or endoscopic dilation. This study aimed to investigate the use of electrocautery in this area. PATIENTS AND METHODS: We enrolled 39 consecutive patients (25 men, 14 women; mean age 61, range 48-77) suffering from anastomotic colorectal stenosis, demonstrated by colonoscopy (19 patients) or by barium enema (20 patients). We performed endoscopic dilation of the strictures with electrocautery once only in each patient. RESULTS: In all patients we obtained dilation of the strictures without any immediate or delayed procedure-related complications. No recurrence of the stenosis was demonstrated during a follow-up of a mean of 25 months (range 8-43 months). CONCLUSIONS: This study shows that endoscopic electrocautery is a safe and effective treatment of anastomotic colorectal stenosis.

Aged↗
PubMedDate not supplied

[Angiodysplasia of the colon. Apropos of a case].

A case of angiodysplasia of the right colon is reported. Clinical, radiological, endoscopic and pathological aspects are described. Beside the arteriography, the authors insist on the special usefulness of the coloscopy which helps the diagnosis and gives therapeutic possibilities as well by electrocoagulation of the lesion. Vascular opacification of the specimen is very useful to help the pathologist.

Aged↗
PubMed1994

Epididymal ultrasonographic findings in case of obstructive pathology.

Epididymal ultrasonography has proved effective in finding anatomic obstructive alterations affecting the epididymis. The authors investigated two groups: 1. Bilateral vas agenesia (20 epididymis)--(sensitivity of EUS--100%) 2. Normozoospermic noninfertile patients (before different surgical exploration)--(45 epididymis) EUS resulted "ideal" epididymis in 36 out of 45. EUS was "altered" in 9 cases. They call the attention for the impotence of EUS investigation in andrology.

Adolescent↗
PubMed1978

[The radiological differential diagnosis of small bowel disease (author's transl)].

The flow diagram of Goldberg and Sheft for the differential diagnosis of diseases of the small bowel was modified (using as its basis mucosal swelling, width of lumen, secretion). Its accuracy was then tested retrospectively in 61 patients. Examination of the small bowel was performed after the administration of a single large dose of contrast medium. A surprisingly high accuracy of 90% was found in 41 pathologically proven cases; all normal patients were correctly identified. The method therefore appears to be extremely promising. More detailed identification is not always possible because of similar reaction of the small bowel to various influences; it may be possible on some occasions, or when taking account of further radiological signs, or of the clinical and laboratory findings.

Contrast Media↗
PubMed1990

Selective osteal salpingography and transvaginal catheter dilatation in the diagnosis and treatment of fallopian tube obstruction.

Selective salpingography and transvaginal catheter dilatation were performed in 157 women with infertility to diagnose, localize, and classify obstructive diseases of the fallopian tubes and to correct obstruction of the proximal (uterine-end) tube. In 61 (39%) of the patients, the selective salpingograms showed patent tubes despite the fact that two previous hysterosalpingograms showed obstruction of the proximal (uterine-end) tube. Transvaginal catheter dilatation successfully recanalized the proximal portion of the tubes in 79 (82%) of 96 patients with obstructed tubes. In 18 of 25 with successful transvaginal catheter dilatation and 6-month follow-up salpingography, the tubes remained patent. Coexisting disease of the distal (ovarian-end) tubes was diagnosed in 29 (18%) of the patients. Pregnancy was achieved in 11 of the 157 patients (six in whom obstructions were corrected by transvaginal catheter dilatation and five in whom selective salpingograms showed patent tubes). There were no complications due to the procedure. The excellent diagnostic and therapeutic yield, lack of complications, and low cost justify the use of these percutaneous techniques to investigate female infertility and to treat obstruction of the uterine end of the fallopian tube.

Adult↗
PubMed1986

[Benign ureteral stenoses. Dilatation with an angioplasty balloon].

An angioplasty balloon was used to dilate 23 benign ureteral stenoses in 21 patients. The anterograde approach through percutaneous puncture of the kidney was used in 19 cases. Following dilatation, an 8 F to 24 F catheter was left in the ureter. Dilatation was successful in 13 out of 23 cases (56%) followed up for 1 month to 2 years. It failed in 8 cases, and 2 patients are undergoing ureteral remodelling. Thus, dilatation of benign ureteral stenoses after percutaneous renal puncture was effective in about 60% of the cases. The follow-up period is still too short for us to determine the indications of this technique according to the cause and duration of the stenosis.

Adolescent↗
PubMed2002

Primary megaureter: results of surgical treatment.

BACKGROUND: The aim of this study was to assess the clinical and radiological outcome after surgical treatment for primary -megaureter. METHODS: A retrospective analysis of 16 patients who had reimplantation of 17 primary megaureters between January 1997 and April 2001 was performed. Patients who had additional urinary tract pathology were not included in this study. The intent of the study was to focus on the complex range of data points that were used to reach the decision to operate. RESULTS: Six of eight patients with febrile urinary tract infections prior to surgery have been without infections postoperatively. One patient who presented with daytime wetting has less wetting postoperatively, and one baby who presented with failure to thrive and postfeed vomiting, is feeding well postoperatively. On ultrasound investigation, the median diameter of the megaureter prior to operation was 11 mm (range 6-24 mm). One month after the operation, dilatation of the ureter could no longer be demonstrated in 10, was reduced in six, and increased in one of 17 ureters. Three months postoperatively, hydroureter was no longer detected in 14 and was reduced in three. In comparison, the hydronephrosis 1 month postoperatively was reduced in six, unchanged in seven and worse in four out of 17 kidneys, and 3 months after the operation, hydronephrosis was reduced in 13 and was unchanged in four compared with preoperative findings. Renograms at 3 months postoperatively showed free drainage in the 11 kidneys with impaired drainage preoperatively, and drainage continued to be normal in all six kidneys with normal drainage preoperatively. Median pre-operative renographic split function was 47% (range 39-54%), and was not significantly changed 3 months after the operation. CONCLUSIONS: When the decision to surgically intervene was made on a multifactorial basis, reimplantation of a primary mega-ureter resulted in improved clinical status, reduced dilation of the ureter and renal pelvis, and free drainage of the upper urinary tract.

Child↗
PubMed1984

Angiodysplasia. Clinical presentation and colonoscopic diagnosis.

Angiodysplasia is a recently recognized important cause of lower intestinal bleeding in older patients. Although angiography is an established procedure for the diagnosis of angiodysplasia, colonoscopy is being used increasingly for evaluation of lower intestinal bleeding. In order to define the nature of bleeding due to angiodysplasia and the appropriate role of colonoscopy, 80 patients diagnosed by angiography, pathology, or colonoscopy were reviewed. Bleeding attributable to angiodysplasia varied from acute life-threatening hemorrhage to occult blood in stools. Thirteen patients with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. Eighty-nine percent of the lesions were located in the right colon and there was a mean of 1.5 angiodysplastic lesions per patient. The sensitivity of colonoscopy compared to angiography and pathology was 68% overall and 81% when the colon was completely examined and lesions were located in the colon. The predictive value of a positive colonoscopic diagnosis was 90% in this population. Colonoscopy should be employed as an initial study in patients with chronic or mild acute rectal bleeding.

Acute Disease↗