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At least 631 records · Page 35Linked to original sources
PubMed1999

The thermodilator: an effective instrument in the palliative therapy concept of malignant bile duct stenosis.

BACKGROUND AND METHODS: In the case of incurable malignant bile duct stenosis the aim of therapy is to secure the bile flow. Sometimes dilation of the stenosis is necessary to enable the introduction of a biliary duodenal stent or the replacement of a small-bore stent by a large-bore one. The previously most commonly used methods - bougienage and balloon dilation - can be unsuccessful with severe stenoses, which means that an extension of the endoscopic therapeutic instrumentarium is desirable. We examined the success rates and complications of a thermodilator which can be used to dilate bile duct stenoses. RESULTS AND CONCLUSIONS: In 21 out of 24 applications the therapeutic objective was achieved. In one case we observed an endoscopically controllable bile duct hemorrhage. The thermodilator is therefore a valuable addition to the endoscopic treatment possibilities of malignant bile duct stenosis.

Aged↗
PubMedDate not supplied

Bile duct involvement in hepatocellular carcinoma: MR demonstration.

BACKGROUND: To determine the magnetic resonance (MR) features of hepatocellular carcinoma (HCC) with associated bile duct involvement. METHODS: MR examinations of six patients (mean age, 62 years) demonstrating bile duct involvement due to HCC were retrospectively reviewed and compared to surgical and pathologic findings. RESULTS: Three of the tumors were solitary, and three were multifocal. In two patients, MR showed direct biliary duct invasion by tumor. On T1-weighted MR images, four tumors were hypointense compared to the liver and two were isointense. On T2-weighted MR images, four tumors were hyperintense, and two were isointense. The two tumors studied with dynamic T1-weighted MR images obtained after intravenous administration of a gadolinium chelate, displayed enhancement similar to that of the liver. There was no evidence of a tumor capsule on either unenhanced or enhanced MR images. Intrahepatic bile duct dilatation was seen in five patients. The extrahepatic bile duct was normal in all cases. CONCLUSION: Although rare, HCC should be included when considering the etiology of intrahepatic bile duct obstruction. Imaging features suggestive of the diagnosis by MR include intrabiliary tumor or bile duct obstruction with an associated hepatic mass.

Aged↗
PubMed1993

Expandable metallic stents applied to benign bronchostenosis.

Tandem Gianturco expandable metallic stents (GEMSs) with barbs were inserted to dilate the left main bronchus of a 38-year-old man who had developed left bronchostenosis due to bronchial tuberculosis. Through the use of these GEMSs, ventilation in the left lung remarkably improved; however, the central airway resistance was found to be greater than that exhibited by the normal side and the mucociliary transport function was reduced.

Adult↗
PubMed1998

Papillomas and carcinomas of the choroid plexus in children.

OBJECT: Choroid plexus tumors are rare intraventricular tumors (1% of all intracranial tumors) that occur mainly in children. The pathophysiological characteristics of associated hydrocephalus, surgical management, and oncological issues related to these tumors remain a matter of debate. To understand more about these tumors, the authors have reviewed their experience with the management of 38 children with choroid plexus tumors. METHODS: There were 25 cases of papilloma and 13 of carcinoma. The mean age of the patients at presentation was 22.5 months, and one-half of the patients were younger than 2 years of age. Hydrocephalus was present in 33 patients and poorly correlated with the size, site, and pathological characteristics of the tumor. In nine children, a ventriculoperitoneal shunt was required after tumor excision, calling into question the notion that cerebrospinal fluid oversecretion is the only cause of hydrocephalus. Complete excision was achieved in 96% of the cases of papilloma and 61.5% of the cases of carcinoma. These surgical procedures were complicated by the risks of intraoperative hemorrhage, which proved to be fatal in two cases, and postoperative brain collapse, which led to subdural fluid collections requiring subdural shunt placement in six patients. Preoperative embolization was partially successful in four cases and significantly assisted surgery. Preoperative controlled drainage of excessively dilated ventricles and intraoperative gluing of the cortical incision have been used to address the problem of postoperative brain collapse. Patients with carcinomas were treated postoperatively by chemotherapy alone (seven cases), radiotherapy (one case), or chemotherapy plus radiotherapy (one case). The overall 5-year survival rate was 100% for patients with papillomas and 40% for those with carcinomas. CONCLUSIONS: Total surgical excision is curative in cases of papillomas. For carcinomas, the most effective treatment remains total surgical excision; however, adjuvant treatment in the form of chemotherapy in patients younger than age 3 years, supplemented by radiation therapy in older children, can moderately reduce the risk of recurrence.

Adolescent↗
PubMed1976

Gray scale ultrasound imaging. The anatomy and pathology of the liver.

Gray scale ultrasound imaging circumvents some of the limitations of other diagnostic tools. The authors have extended this technique to the investigation of hepatobiliary disease. The details of their equipment are described and their results in relation to various parameters of the disease are discussed. A major feature of the gray scale technique is the enhanced signal-noise ratio, which allows low-level echoes to be displayed.

Cysts↗
PubMed1981

Balloon-catheter dilation as an adjunct to arterial surgery.

Balloon-catheter dilation of arterial stenoses and/or occlusions has been found to be helpful when used both as an adjunct to arterial surgery and as definitive treatment. Used preoperatively, it enables the extent of surgery to be limited and may improve the patient's general condition and ability to undergo surgery; such is seen when renal or mesenteric vessels are dilated preoperatively. During surgery, it can be used to augment the surgery, particularly in an area that is difficult to expose or out of the operative field. Postoperatively, it is often useful in maintaining patency of a graft or its inflow and outflow tract. Judicious use of this modality can enhance arterial surgery and improve results.

Arterial Occlusive Diseases↗
PubMed2000

Conjunctival rhinosporidiosis associated with scleral melting and staphyloma formation: diagnosis and management.

PURPOSE: Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation. METHODS: Retrospective review of case records of three patients with conjunctival rhinosporidiosis. RESULTS: Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey-white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma. CONCLUSION: Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

Adolescent↗
PubMed1990

Ectasia of arteries beyond the circle of Willis.

Isolated fusiform ectasia involving branches of the carotid and vertebral arteries is very rare, only two cases have been recorded. Recently we have encountered two cases affecting the right posterior and left middle cerebral arteries. Both patients were young and there was no evidence of acquired arterial pathology. It is considered likely that the condition is a local congenital abnormality which may be related to an abnormality of the elastic substance in the arterial wall. In the first case, a selective injection of the right posterior cerebral artery clarified the nature of the lesion and provided an example of the value of the relatively new superselective technique.

Adult↗
PubMed1985

The swollen leg: ultrasonographic demonstration of non-thrombotic causes.

Grey-scale ultrasound is a useful investigation in selected patients with a painful swollen leg. It is of particular value in cases in which there is a clinical suspicion of deep vein thrombosis (DVT) but other features, such as an atypical history or equivocal radiology, suggest alternative pathology. Five such cases are presented in which ultrasound showed transonic lesions. The cause of the swelling of the leg was thus shown to be "cystic' in nature and therefore not due to DVT. This enabled inappropriate and potentially harmful therapy to be avoided and the correct therapy, such as surgical drainage, to be undertaken.

Abscess↗
PubMed1980

Balloon dilation of iliac stenosis with distal arterial surgery.

Seven patients with concomitant atherosclerotic iliac stenosis and femoral artery occlusive disease were treated with polyvinyl balloon catheter dilation of the iliac artery and subsequent distal operative arterial reconstruction. The iliac lesions were short, localized, common and external iliac stenoses and the femoral lesions were superficial femoral artery occlusions in six patients and a common femoral occlusion in another. All seven iliac stenoses were successfully dilated. Subsequent operative femoral artery reconstruction was successful in these patients, with restoration of popliteal or pedal pulses and relief of ischemic symptoms over a follow-up period of two to 14 months. One patient's femoral popliteal bypass graft thrombosed four months postoperatively.

Aged↗
PubMed1998

Outcome of fetuses with isolated borderline unilateral ventriculomegaly diagnosed at mid-gestation.

OBJECTIVE: To evaluate the outcome of fetuses with isolated borderline, unilateral ventriculomegaly. DESIGN: A retrospective survey was conducted at four perinatal centers in Israel. SUBJECTS AND METHODS: Only fetuses with one ventricular width of > or = 11 mm and the other < 10 mm were included in the study. In all cases, the difference of the ventricular width between the two ventricles was > 2.4 mm (two standard deviations). Fetuses with other malformations, chromosomal abnormalities, or those with evidence of in utero infection, were not included in the study. RESULTS: Unilateral ventriculomegaly was found in 27 subjects (after excluding one case with unilateral ventriculomegaly and Down's syndrome). The mean width of the enlarged ventricle was 11.7 +/- 0.9 mm, while the other normal ventricle was 7.2 +/- 0.9 mm. The mean gestational age at diagnosis of the unilateral ventriculomegaly was 23.6 +/- 2.7 weeks. In one case, pregnancy was terminated, and pathological examination of the fetal brain failed to detect any structural abnormality. Twenty-five patients delivered at term and only one at 34 weeks' gestation. The neurological development in all 25 fetuses was normal, and one fetus had petit mal seizures. CONCLUSION: Fetuses with isolated, borderline unilateral ventriculomegaly, but without other abnormalities, have a good neurological outcome.

Cerebral Ventricles↗
PubMedDate not supplied

[Neuromuscular dysplasia of the ureters in children].

The paper is concerned with disputable aspects of the policy in the diagnosis of neuromuscular ureteral dysplasia (NUD) in children, with indications to NUD conservative treatment and a choice of optimal surgical correction at primary or repeat operations basing on ureteral dilatation. The necessity of the NUD conservative treatment in children with nonaffected renal function has been confirmed by 52 cases of NUD children treated conservatively or surgically. The analysis of surgical outcomes in 34 NUD children and urodynamic pre- and postoperative examinations in 18 of them suggest the following conclusions: 1) the decision on "modelling" of the ureter is feasible only in the course of surgical intervention; 2) in ureteral dilatation less than 5-7 mm "modelling" is unnecessary. In other cases "modelling" is made at primary surgery according to Kalicinski's technique, at resurgery according to Hander. Positive outcomes in primary interventions were registered in 78% of the patients, 62% of the operations were successful in recurrent disease.

Adolescent↗
PubMed2005

The strictured anastomosis: successful treatment by corticosteroid injections--report of three cases and review of the literature.

Clinically significant anastomotic strictures usually only occur with very low colorectal anastomoses below the level of the peritoneal reflection. The reported rate averages 8 percent and has been attributed to tissue ischemia, localized sepsis, anastomotic leak, proximal fecal diversion, radiation injury, inflammatory bowel disease, and recurrent rectal cancer. Most patients will have symptoms of obstipation, frequent small bowel movements, and bloating. Symptomatic strictures are often approached by dilation (balloon or Hegar) or less often repeat resection. Many of these patients have anastomoses that are too low to consider repeat resection. Strictureplasty with linear stapling devices, stricture resection by use of the circular stapling device, and repeat dilations have all been described. Steroid injections into the stricture have been described in strictured esophagogastric anastomoses but have not been commonly used for strictured coloproctostomies. We describe three cases of coloanal stricture following resections that were complicated by postoperative pelvic abcesses, anastomatic leaks, and pelvic fibrosis. Two cases had undergone low coloanal anastomosis that was protected by a loop ileostomy and developed as significant stricture in the early postoperative period. The third case was managed without a protective loop ileostomy. These were initially managed by repeated dilation of the anastomosis. Each episode was followed by rapid recurrence of the stricture. All patients underwent subsequent dilation with injection of 40 mg of triamcinolone acetate (divided dose in four quadrants) into the stricture and subsequent complete resolution of the stricture. Those patients with loop ileostomies had them taken down and all have been followed for up to 12 months without clinical or endoscopic evidence of recurrent stricture.

Abscess↗
PubMed2005

Differential indication for histological evaluation of endometrial fluid in postmenopause.

OBJECTIVES: The endometrium carcinoma is the most frequent malignancy of the female genital tract. Approximately, 10-20% of all patients with an endometrial carcinoma are free of symptoms until the time of diagnosis. The frequent occurrence of an endometrial carcinoma in connection with intrauterine cavity fluid collection (sero- or mucometra) has been discussed controversially in literature. What are the hysteroscopic and histological findings in patients with sonographically determined endometrial fluid in postmenopause, and how should these findings be interpreted? METHODS: 74 patients, in whom endometrial fluid without bleeding disorders had been diagnosed during routine transvaginal sonography, underwent hysteroscopy conducted with a 4.5 mm optics and dilatation and curettage (D&C). The median age of the patients was 68 years with a range of 32 years. RESULTS: The simple thickness of the endometrium, i.e. single layer measured sonographically at the point of maximal thickness, was on average 5.7 mm +/- 3.6 mm (2-15 mm). Hysteroscopically, an endometrium polyp was found in 23 cases (31.1%), endometrium hyperplasia in 12 (16.2%), and an atrophy in 35 cases (47.3%). In four cases (5.4%), an endometrial carcinoma was suspected. The histological results were consistent with the hysteroscopic findings. In all instances, in which the simple endometrial thickness amounted to 3 mm or less, an atrophic endometrium was found. The frequency of intrauterine pathologies increased significantly with a greater thickness of the endometrium. In 80% of patients, a cervical stenosis existed. CONCLUSIONS: Endometrial fluid by itself, without assessment of the endometrium, does not indicate the requirement for additional histological clarification. As diagnostics, the authors suggest especially the endometrial morphology.

Aged↗
PubMed2003

Endoscopy in eosinophilic esophagitis: "feline" esophagus and perforation risk.

BACKGROUND & AIMS: Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described. METHODS: Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports. RESULTS: Soft and subtle ring(s) in the esophagus were found in 7 of 8 patients. In 3 of 8 patients, the esophagus appeared rigid. Mucosal rents occurred with simple passage of the endoscope in 5 of 8 patients. One patient developed a perforation after simple passage of the endoscope. Endoscopic findings can be normal or very subtle in these patients, and the findings can easily be missed during endoscopy. Tearing of the esophagus can occur with simple passage of the endoscope or biopsy even in the absence of overt rings. A minimum of 8 weeks of medical therapy (proton pump inhibitor, histamine antagonists, immunosuppressants) should be undertaken before considering dilation because of the high risk involved with the procedure and the good response to medical therapy. CONCLUSIONS: We recommend considering dilation only in patients with eosinophilic esophagitis who do not respond to medical therapy and have rings that appear to be obstructing the lumen.

Adult↗
PubMedDate not supplied

Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up.

PURPOSE: To determine the efficacy and safety of percutaneous transluminal angioplasty (PTA) of the visceral arteries. PATIENTS AND METHODS: We retrospectively evaluated the results of PTA performed in 20 visceral arteries in 19 patients (10 men, nine women; mean age, 63 years). Eleven patients had symptoms characteristic of mesenteric ischemia, four had atypical abdominal pain, and four were undergoing prophylactic dilation before undergoing another procedure involving the abdominal aorta. Clinical follow-up was possible in all patients. RESULTS: PTA was technically successful in 15 of 19 patients (79%); among these 15 patients, 12 (80%) did well clinically. Of the seven PTA procedures that were immediate failures, five failed secondary to an occult malignancy or to extrinsic arterial compression by the median arcuate ligament. Ten (83%) of the 12 patients in whom the procedures were immediate clinical successes are still clinically improved at 4-73 months follow-up (mean, 25 months). PTA was successful in only one of the four patients who had symptoms atypical of mesenteric ischemia, but it was successful in 11 of the 15 patients who had symptoms of mesenteric ischemia or who underwent prophylactic dilation. Major complications occurred in three (16%) of the 19 patients. CONCLUSION: PTA of visceral artery stenoses is effective in patients with symptoms of mesenteric ischemia. It is also effective as prophylaxis in patients undergoing additional procedures in the abdominal aorta.

Abdominal Pain↗
PubMed1983

[Sonographic diagnosis of nephrourologic diseases in infants and childhood].

Ultrasound is a harmless and renal function-independent screening procedure to detect malformations of the urinary tract, that need surgical intervention. Because of the paucity of symptoms concomitant with congenital malformations it is important to use this non-invasive exploration method frequently in the early course of the diagnostic investigations. Pathologic sonographic findings should be followed by radiologic exploration. In case of normal renal sonography in patients suffering from first urinary tract infection, further radiologic exploration of the upper urinary tract can be withheld, however ultrasound does not replace radiologic studies of the lower urinary tract. Complications after surgical procedures are readily depicted by sonography, thus avoiding the need for numerous post-operative radiologic study.

Child↗
PubMedDate not supplied

[Evaluation of an reference anatomo-clinical classification of varices of the lower limbs].

In order to set up a common and objective language for everyone, the authors have laid the foundation of anatomoclinical classification which can be used as a reference in the study of varicose veins in lower limbs. They are comparing a group of patients with varicose veins to a control group of healthy patients. The groups are classified in four stages according to the importance of the varicose pathology and the histological characteristics. The conclusion is the following: there is no parallelism between these four clinical stages and the histological characteristics. According to the authors, it is necessary to make a distinction between fibrous reaction veins and muscular wall veins. This phenomenon is reported to have particular therapeutic implications in the prescription of substances of exciting venous tonicity.

Atrophy↗