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PubMed1980

Percutaneous transluminal dilatation and recanalization in the treatment of peripheral vascular disease.

Ninety-four successful transluminal angioplasties were followed up for as long as 15 months, during which time 15 failures occurred. Life-table analysis of this series gave a cumulative patency rate of 64%. The patency rate of 70% for iliac lesions, compared to 50% for the femoral-popliteal group, suggests that the former are likely to have a better long-term prognosis. In selected cases, transluminal angioplasty is a viable alternative to surgery that should be available to both patient and physician.

Adult↗
PubMed1984

Endoscopy of the partitioned stomach.

Fiberoptic endoscopy is an important diagnostic modality for evaluation of the patient with upper gastrointestinal (GI) tract symptoms following gastric bypass and gastroplasty. During a 3-year period, 182 patients underwent gastric partitioning procedures and 22 patients (12%) developed upper GI symptoms requiring endoscopic evaluation. Eight patients had undergone Mason vertical banded gastroplasty, 12 patients had undergone Gomez gastroplasty, and two patients had undergone Roux-en-Y gastric bypass. In four of five patients with abdominal pain, gastritis of the proximal pouch was observed. Of the two patients with symptoms of obstruction of the proximal gastric outlet, one patient was found to have a cherry pit occluding the channel. Intraoperative endoscopy was performed in one patient who developed upper GI bleeding after Roux-en-Y gastric bypass, the pylorus was scarred and stenotic and multiple superficial ulcerations were seen in the excluded distal stomach. In eight patients with symptoms suggestive of channel stenosis, four were found to have a stenotic channel and underwent endoscopic dilation of the channel. Upper GI endoscopy was performed in eight patients with Gomez gastroplasty to confirm suspected dilatation of the channel between the upper and lower gastric pouches. Upper GI contrast studies did not estimate accurately the diameter of the channel as determined during endoscopy. No complications were observed following any of the endoscopic procedures. As the collective experience with gastric partitioning procedures increases, the need for endoscopic examinations of the upper GI tract will also increase. Endoscopists should be familiar with the altered gastric anatomy and with the spectrum of upper GI lesions that develop following these operations.

Constriction, Pathologic↗
PubMed1981

Cholangiocarcinoma arising in Caroli's disease.

We studied the clinical, roentgenographic, and pathologic features of what is, to our knowledge, the seventh reported case of cholangiocarcinoma associated with Caroli's disease. Review of the literature reveals that the incidence of carcinoma in patients with this condition is higher than that previously reported for other forms of biliary-tract ectasia. Bile stasis, cholangitis, and the presence of carcinogens and promoters in bile may combine to produce the high incidence of carcinoma in these patients.

Adenoma, Bile Duct↗
PubMed1981

Percutaneous transluminal angioplasty: an angiographer's viewpoint.

We outline the present role of angioplasty in the management of peripheral vascular disease and its application to other portions of the arterial and venous systems; we summarize several large series, including our own, which encompass more than 4,000 cases; and we discuss the pathophysiology of balloon dilation techniques and the criteria for patient selection. With appropriate patient selection, initial (90%) and long-term (85%) patency results are now comparable with surgical techniques when the iliac arteries are involved. Treatment of femoropopliteal disease is slightly less successful but is indicated in appropriate patients. We present the role of angioplasty in conjunction with grafting procedures and in the management of renal vascular hypertension, and we review the potential complications (2% to 3%), adjunctive medical management, and areas for further investigation.

Angiography↗
PubMed1978

Cyclic and pathologic changes of the mare endometrium as detected by biopsy, with a note on early embryonic death.

Normal histologic changes that occurred in concert with the ovarian cycle were evaluated. When combined with behavioral and physical findings, this evaluation enabled determination when there was synchrony between ovarian steroids (estrogen and progesterone) and their target tissues of endometrium. A system for classification as well as definitions of patterns types and degrees of severity of inflammatory and fibrotic changes was developed to facilitate a uniform system for description and communication. An attempt was made to relate the pathologic changes to their effect on fertility when fertility was defined as the ability to conceive, maintain, and deliver a live foal. This was done by dividing the types of endometrium into 3 categories, based on increasing degrees of extensiveness and severity of the various changes, and it was possible to show a high correlation of category to foaling rate. Embryonic and fetal loss from endometria with widespread periglandular fibrosis was observed. This was considered to be the major diagnosable cause of this type of reproductive failure.

Abortion, Veterinary↗
PubMed2001

Carotid artery ectasia coexistent with primary open angle glaucoma.

A 60-year-old smoker presented with high intraocular pressure in the right eye with a right afferent pupil defect and visual field suggestive of primary open angle glaucoma in the right eye only, when an examination 2 years earlier had revealed no hint of ocular pathology. Radiological investigations demonstrated prominent ectasia of the internal carotid arteries extending into the proximal middle cerebral arteries. The changes in the carotids extended throughout the cavernous sinus regions, encroached on the under surface of the optic chiasm and were closely related to the internal aspects of both optic canals. In primary open angle glaucoma management, neural imaging is not normally recommended; however, neural imaging investigations should be considered if the presentation is not typical of a chronic bilateral optic neuropathy

Carotid Artery Diseases↗
PubMed1980

Accuracy of common hapatic duct size in the evaluation of extrahepatic biliary obstruction.

High-resolution real-time ultrasound sector scanning is helpful in showing the normal common hepatic duct. The authors evaluated the accuracy of using a 4-mm internal diameter as the upper limit of normal in evaluation of obstruction. Of 98 patients with jaundice or right-upper-quadrant pain whose duct exceeded 4 mm, obstruction was proved in 84. Fourteen patients had no radiographic or pathological evidence of obstruction, but 7 had undergone cholecystectomy and clinical evidence suggested another 6 had passed a stone before or after the ultrasound study. Of 72 patients with a duct greater than or equal to 4 mm, only one had obstruction; a mass blocked the right and left hepatic ducts. The sensitivity of the test is 99%, the specificity 87%. Thus if the common hepatic duct is more than 4 mm in internal diameter on ultrasound, extrahepatic biliary obstruction is probably present.

Cholestasis, Extrahepatic↗
PubMed1986

Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents.

To test the ability of Gianturco expandable metallic stents to dilate and maintain patency in stenotic venae cavae, stenosis of the inferior vena cava was created in seven mongrel dogs by the percutaneous injection of absolute ethanol into the paravascular retroperitoneal space. Gianturco stents, placed across the stenotic segment, resulted in successful dilatation with improved hemodynamics in four dogs. The stents failed to dilate an occluded vena cava in one dog; in the remaining dogs, stent placement was complicated by early migration and occlusion. Gianturco stents were placed in two patients, one with superior vena cava syndrome and one with retroperitoneal fibrosis that obstructed the inferior vena cava, and resulted in immediate relief of presenting symptoms. These results should be viewed cautiously, but further investigation into the clinical use of the stents is indicated, especially for patients for whom other treatments are difficult.

Animals↗
PubMedDate not supplied

Rare association of diffused coronary ectasia and anomalous origin of left circumflex coronary artery in a man with heterozygous familial hypercholesterolemia: a case report.

Coronary artery ectasia (CAE) is an uncommon form of coronary artery disease. It has been reported in association with a variety of pathological conditions, such as isolated congenital heart disease and Kawasaki disease. CAE is more relevant in young adults with multiple predisposing risk factors, especially familial hypercholesterolemia, and is usually considered a form of atherosclerotic coronary artery disease. A case of CAE is reported with familial hypercholesterolemia and diffuse ectasia of the coronary vessels in association with anomalous origin of the left circumflex coronary artery, which lacked ectatic segments. This combination has not been reported previously.

Adult↗
PubMedDate not supplied

Benign biliary stricture--should they be dilated or treated surgically?

Management of benign biliary stricture remains a challenge for both surgeons and therapeutic endoscopists. Traditionally, surgery is considered the mainstay of treatment, but it is associated with significant morbidity and variable long-term outcome. With advances in endoscopic techniques and accessories, endoscopic management is emerging as an effective option. Outcome of endoscopic management depends on both the etiology and location of stricture. Current data suggest that long-term results with multiple plastic stents are superior to those with single plastic stent. Removable covered metal stents are a good alternative. The role of bio-absorbable self-expanding stents needs to be evaluated further.

Bile Duct Diseases↗
PubMed2005

Patients at high risk for upper tract urothelial cancer: evaluation of hydronephrosis using high resolution magnetic resonance urography.

PURPOSE: We assessed the potential of magnetic resonance urography (MRU) in the evaluation of hydronephrosis not explained by standard investigation in patients at high risk for upper tract urothelial cancer. MATERIALS AND METHODS: A total of 23 consecutive patients in a specialist urological unit with unexplained hydronephrosis prospectively underwent MRU which comprised overview heavily T2-weighted MR urographic images followed by focused high resolution turbo spin echo T2-weighted sequences obtained in an axial and coronal oblique plane through the level of urinary obstruction. All were at high risk for urothelial cancer and had either contraindications to or problems with standard investigations including poor contrast excretion due to obstruction or renal failure, failed ureteral cannulation or contrast allergy. Clinical events and imaging followup, subsequent endoscopic/surgical findings and histopathology validated MR findings. RESULTS: In 23 patients with a high clinical suspicion of upper tract transitional cell tumors (TCC), 8 ureteral and 5 renal pelvic TCCs (2 bilateral) were diagnosed by MR, and confirmed histologically. In a further 5 patients benign causes for the hydronephrosis were found. No intrinsic or extrinsic pathology was demonstrable in 5 patients whose imaging findings were stable during 1 year of followup. CONCLUSIONS: MRU is a valuable noninvasive investigation for evaluating hydronephrosis in this group of patients with suspected urothelial cancer in which routine investigation had failed to provide clinically important information. Focused high resolution T2-weighted images were reliable in the diagnosis of ureteral and renal pelvic TCCs, and were valuable in excluding these and other mass lesions as the cause of hydronephrosis.

Aged↗
PubMed2005

Tuberculosis of the genitourinary tract: imaging features with pathological correlation.

The prevalence of pulmonary and extrapulmonary tuberculosis (TB) has been increasing over the past decade, due to the rising number of people with acquired immunodeficiency syndrome and the development of drug-resistant strains of Mycobacterium tuberculosis. The genitourinary tract is the most common site of extrapulmonary TB. Diagnosis is often difficult because TB has a variety of clinical and radiological findings. It can mimic numerous other disease entities. A high level of clinical suspicion and familiarity with various radiological manifestations of TB allow early diagnosis and timely initiation of proper management. This pictorial essay illustrates the spectrum of imaging features of TB affecting the kidney, ureter, bladder, and the female and male genital tracts.

Dilatation, Pathologic↗
PubMed2002

Contrast-enhanced MR urography in the evaluation of renal transplants with urological complications.

AIM: The diagnostic work-up of renal transplants with impaired function due to urological problems can be difficult. This study was performed to assess sensitivity and specificity of non-invasive contrast-enhanced MR urography (MRU). METHODS AND MATERIALS: Thirty-five patients with renal transplants (25 - 71 years, mean: 53.4 years) with sonographically diagnosed hydronephrosis or perirenal fluid collections were assessed by MR urography. MR examinations were carried out at a 1.5 T clinical scanner (Vision, Siemens, Erlangen, Germany) with a 512 matrix contrast-enhanced fat-suppressed T1-weighted FLASH 3D sequence in breath-hold technique. MIP reconstructions were used to produce MR urography. MRU diagnoses were compared to operative results. RESULTS: In all patients, images with sufficient contrast in the renal collecting system were obtained. Hydronephrosis was confirmed in 20 patients, 8 patients showed a different pathology while 7 had normal findings. Compared to operative results, sensitivity of MRU was 100% with a specificity of 78%, respectively. One ureteral stone was misdiagnosed as a stricture, and 2 suspected ureteral stenoses could not be found upon operation. CONCLUSIONS: Contrast-enhanced MR urography is a highly sensitive and specific non-invasive method to evaluate patients suspected of having typical post-transplant urological complications. It may replace invasive procedures such as antegrade pyelography in the pre-operative work-up.

Adult↗
PubMed1977

[Role of aortic dystrophy in the etiology of idiopathic cardiomyopathy].

Hypertrophy of the heart of unrecognized origin is a frequent finding on autopsy and in that case is related to the so-called nonobstructive idiopathic cardiomyopathy. Abnormality of the heart muscle is considered its main symptom. According to the authors, involvement of the ascending aorta and not the myocardium is the basic pathologic process. This "aortic dystrophy" is characterized by diffuse ectasia of the ascending aorta and typical microscopic histological signs. Hypertrophy of the left heart is evidently overexertion hypertrophy resulting from the increased volume of the ascending aorta and the diminished elasticity of the aortic wall after the ventricular systole and the consequent greater demand on the work of the left ventricle than in normal conditions. "Idiopathic" hypertrophy of the heart with dystrophy of the aorta is hereditary, it may involve the skeleton also, and may be manifested in relatives.

Adult↗
PubMed1992

Laryngoceles and saccular cysts in infants and children.

Laryngoceles and saccular cysts are an unusual cause of respiratory obstruction in infants and children. Laryngoceles in particular are less common in the pediatric population than in adults. They typically produce intermittent upper airway obstruction and hoarseness (due to episodic filling with air), and are, therefore, difficult to diagnose. Saccular cysts produce similar symptoms but are not episodic. While smaller anterior saccular cysts are readily managed by endoscopic excision, larger saccular cysts tend to recur repeatedly. Review of experience with 20 infants and children having saccular pathologic changes (17 saccular cysts and three laryngoceles) suggests that saccular lesions are more troublesome than is generally appreciated. The clinical course is typically a lengthy one, with multiple endoscopic procedures. Most patients required tracheotomy, some under emergent conditions. Three patients acquired subglottic stenosis; one was clinically significant. A fourth patient had a congenital subglottic stenosis. Saccular cysts can be managed endoscopically in many cases, but if persistent after two or three endoscopic procedures, a prolonged course can be anticipated. Complete excision, endoscopically or through an external surgical approach, may shorten the clinical course.

Adolescent↗
PubMed2002

Idiopathic portal hypertension and its pathology.

Idiopathic portal hypertension (IPH) is a disorder of unknown etiology, clinically characterized by portal hypertension (varices and portosystemic collateral vessels), splenomegaly, and anemia (hypersplenism). A similar disorder is called noncirrhotic portal fibrosis in India, and hepatoportal sclerosis seems to be the counterpart in the United States. This disease is uncommon in developed countries. Middle-aged women are more prone to IPH in Japan. The liver has no cirrhosis or pseudonodule formation, and the principal pathologic changes are considerable portal fibrosis, devastation of intrahepatic terminal portal radicles, and parenchymal atrophy of the liver secondary to portal malperfusion. The characteristic portal hemodynamics include intrahepatic presinusoidal portal hypertension, increased splenic and portal vein blood flow, and increased intrahepatic portal resistance. The prognosis is generally good depending on the management of bleeding varices. Although the etiology is obscure, certain immunologic abnormalities seem to play an etiologic role in Japanese patients, and the incidence has markedly declined in recent years in Japan, indirectly suggesting a role of infection. The theory that IPH represents an undiagnosed intrahepatic portal vein thrombosis is refuted.

Dilatation, Pathologic↗
PubMed1987

Abnormally large frontal sinus. II. Nomenclature, pathology, and symptoms.

Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.

Adult↗
PubMed1984

[Percutaneous, transrenal balloon catheter dilatation. A possibility for the treatment of uretero-enteral implantation stenoses].

In contrast to the undisputed position of percutaneous translumenal balloon catheter dilation of arteriostenoses, the use of this method on strictures of the efferent urinary tract is hardly known. Encouraged by initial promising reports, we present our own application of this method in a cases of bilateral recidive implantation stenoses with progressive hydronephrosis following operative revision of a Bricker conduit. Balloon dilation (Grüntzig catheter) was performed several times antegradely via previously made bilateral percutaneous pyelonephrostomies. The follow-up period was 12 months. Clinical consolidation of the patient's state with an initial unilateral morphological confirmation of improvement in the drainage of urine is an encouragement to repeat the procedure. If the late result is also good and when we have more experience, this method could be an acceptable alternative in the very difficult decision between terminal insertion of a pyelo-nephrostomy and the strain of a repeated reconstruction operation, especially in patients at high risk for operations or generally.

Adult↗