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At least 685 records · Page 38Linked to original sources
PubMed1986

Endoscopic therapy of biliary calculi.

Since 1973, biliary calculi can be extracted from the common bile duct after endoscopic papillotomy (EPT). The success rate amounts to 90%. Complications occur in 7%, and 1% of the patients will die. The most frequent complication is haemorrhage (30%), but only 10% of these cases require surgery. Results of EPT are more favourable than those of surgery. Prophylactic antibiotics are not necessary, but in the event of fever, beta-lactam antibiotics or modern cephalosporins are indicated. When stone extraction fails, several different methods of lithotripsy can be employed: endoscopic mechanic, endoscopic electrohydraulic, and the recently developed extracorporeally generated shock-waves. Lithotripsy will succeed in 80-90% of cases. As late sequelae after EPT cannot be completely excluded, dilatation of the papilla by balloon catheter was developed. However, the number of patients treated is still very small. When these methods fail or are not available, common bile duct stones can be chemically dissolved. Irrigation media are infused into the biliary tree via a nasobiliary tube after EPT or percutaneous transhepatic cholangiography. The substances used are cholesterol solvents such as mono-octanoin, GMOC or MTBE. A buffered 1% EDTA solution is used for calcium bilirubinate stones. Stone dissolution will succeed in 50-70% of cases. Side-effects include cholangitis and duodenitis.

Adult↗
PubMed1985

[Transduodenal papillotomy and divulsion of the papilla in the treatment of benign obstructions of the common bile duct (retrospective analysis of 186 cases)].

An analysis is presented of 186 cases of biliary benign obstruction, treated with transduodenal sphincterotomy or dilatation-divulsion of the papilla of Vater. The morbidity and mortality rates due to specific complications were 5.4% and 1.6% respectively. No cases of post-operative pancreatitis were observed. Long-term results were re-evaluated in 46 patients after a mean post-operative interval of 18 years. The follow-up demonstrated that the result was completely satisfactory in 70% of cases; fair in 17%, with gastroenterological symptoms not likely related to the biliary disease; poor in 13%, with residual stones or stenosis of the sphincter of Oddi.

Adolescent↗
PubMed1985

[Angiomorphology of the ciliary body in diabetic disease].

The authors describe the pathological changes in the vascular structures of the ciliary body occuring in diabetes mellitus. The lesions consist of a quantitative reduction in the number of vessels and in modifications of diameter and arborisation. Changes include sectoral thinning, isolated and grouped aneuryms and marked tortuosity. These findings are thought to be constant in the diabetic patient and are probably involved in the various aspects of diabetic eye disease affecting other structures besides the ciliary body. The group of vascular changes in the ciliary body in diabetes may aptly be termed "diabetic ciliopathy".

Aqueous Humor↗
PubMed1996

Intracranial arterial calcification and ectasia in visual failure.

Calcification of the major intracranial arteries is frequently observed on computed tomography (CT), particularly in the carotid siphon, and has been implicated as a causative factor in low tension glaucoma. Ectasia of the carotid siphon has also been postulated as a possible cause of compressive optic neuropathy. 153 patients, in whom high resolution CT of the orbits and parasellar region had been performed for suspected anterior visual pathway pathology, were retrospectively reviewed. The presence and severity of calcification and ectasia of the major intracranial arteries was recorded. There was a high occurrence of carotid siphon calcification, increasing with age, and independent of sex or race. Calcification was very rare in anterior cerebral, middle cerebral and basilar arteries in all age groups. The amount and degree of ectasia also increased with advancing age, and was more frequently observed in carotid and basilar than anterior and middle cerebral arteries. There was no correlation between the degree of calcification or ectasia and ophthalmological or neurological deficit.

Adolescent↗
PubMed2003

Spontaneous corneal hydrops and perforation in keratoconus and pellucid marginal degeneration.

PURPOSE: To report two cases of pellucid marginal degeneration and one case of keratoconus associated with spontaneous corneal hydrops leading either to perforation or imminent perforation, requiring urgent keratoplasty. METHOD: Retrospective interventional case series of three patients with noninflammatory peripheral corneal degenerations. A retrospective review was done of the clinical courses, surgical interventions, and pathologic specimens, development of spontaneous hydrops, perforation, need for surgical intervention, and final visual outcome. RESULTS: Two patients with pellucid marginal degeneration and one with keratoconus developed spontaneous hydrops followed by aqueous leakage through markedly thinned anterior stroma. In one case, the leak site was successfully sealed after three separate applications of tissue adhesive, although the remaining two cases required penetrating keratoplasty. CONCLUSIONS: These cases document the very unusual occurrence of corneal hydrops leading to spontaneous corneal perforation in patients with keratoconus and pellucid marginal degeneration.

Adult↗
PubMed2002

The application of vascular technology to esophageal and airway strictures.

BACKGROUND/PURPOSE: Strictures of the esophagus and airway tract can be dilated if the strictures can be traversed and dilators passed. Unfortunately, using standard methods, not all strictures can be traversed. The authors set out to find a safe, expeditious, and reproducible way to traverse otherwise impassable strictures of the esophagus and airway. METHODS: Eight patients (n = 8), over a 2-year period, with strictures were entered prospectively into the study. One patient (n = 1) had a main stem bronchial stricture, and 7 patients (n = 7) had esophageal strictures from the following etiologies: esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, Lye ingestion (n = 2), EA/TEF with gastroesophageal reflux, esophageal atresia without fistula, lye ingestion with colon interposition (n = 2), and iron pill inhalation lodged in left main bronchus. None of the strictures could be passed with conventional maneuvers or instrumentation including endoscopy, guide wires, Fogarty catheters, and filliform and followers. Results of barium studies showed no flow into the stomach. In the bronchial case, no lumen could be identified at bronchoscopy. RESULTS: Utilizing the "Vascular Surgery Glidewire/Berenstein Catheter System" under fluoroscopy and utilizing the "spinning top" dynamic maneuver intrinsic to this system, all of the strictures were traversed easily. The passage of the wire/catheter system thus allowed sequential dilation of the previously impassable strictures. The mean time to cross the strictures with the wire/catheter system was 1 minute, 10 seconds. (t = 70 seconds). All of the procedures were done in the operating room under general endotracheal anesthesia by the same 2 attending pediatric surgeons. CONCLUSIONS: The use of vascular surgical technology in difficult, otherwise impassable strictures of the esophagus and upper airway proved to be an extremely effective, easy-to-perform, and reproducible method of therapy. This procedure may obviate the need for resectional surgery in this setting.

Adolescent↗
PubMed1987

[Relationships between segmental left ventricular wall motion abnormalities and pathological findings in patients with dilated cardiomyopathy].

Relationships between segmental left ventricular wall motion abnormalities and myocardial fibrosis at autopsy were examined in 12 patients who died of dilated cardiomyopathy. In each case, wall motion abnormalities were assessed by two-dimensional echocardiograms for 11 segments, and semiquantitatively evaluated as normokinesis (N) to hypokinesis (H), severe hypokinesis (SH) or akinesis (A). From the necropsy specimens, the myocardial fibrosis ratio was histologically quantitated using a point-counting method in each segment corresponding to the echocardiographic segment. Wall motion abnormalities and the fibrosis ratio correlated significantly in a total of 132 segments of the 12 patients, but there were some discordances. The cases were then categorized in uniform and non-uniform groups based on the patterns of myocardial fibrosis. Wall motion abnormalities correlated much better with the fibrosis ratio in a total of 44 segments among four cases with non-uniform fibrosis, whereas no significant correlation was found in a total of 88 segments in eight cases with uniform fibrosis. The latter group had more severe segmental wall motion abnormalities in the interventricular septum than in the left ventricular free wall; and in the apical portion rather than in the basal portion, although no significant difference was observed in the fibrosis ratio among these regions. Patients with non-uniform fibrosis had higher incidences of chest pain and sudden deaths and a significantly larger left ventricular end-diastolic dimension on M-mode echocardiogram as compared to those with uniform fibrosis. Pathologically, in the former group, the heart was heavier, the mean left ventricular fibrosis ratio was significantly higher, and there was a greater incidence of infiltration of the myocardium by mononuclear cells, but there was no difference in the mean left ventricular wall thickness. These results suggest that myocardial fibrosis mainly contributes to the wall motion abnormalities in cases with non-uniform fibrosis which may be caused by chronic myocarditis, but not in cases with uniform fibrosis. In the latter group, other factors such as reduced contractility of the myocardial cells or lack of a compensatory mechanism for wall stress seem to play important roles in causing left ventricular wall motion abnormalities.

Adult↗
PubMed1977

Ectopia in unduplicated ureters in children.

The clinico-pathological features and surgical management of 19 unduplicated ectopic ureters in 15 children are presented with special reference to the problems of recognition and treatment and to the underlying embryological and pathological significance of the wide-ranging associated abnormalities. The high incidence of renal and ureteric malformations, both ipsilateral and contralateral, is emphasised, as is also the frequent co-existence of vesical, bladder neck, urethral, genital and anal abnormalities. These associated anomalies modify the presentation of unduplicated ureteric ectopia and may mask its presence. Late recognition is common, but may be avoided by awareness of the problem. Whereas the degree of kidney involvement seems to dictate the choice and priorities of surgical treatment, the lower urinary tract anomalies have more significance as regards continuing disability and these largely determine the outcome in relation to continence.

Anal Canal↗
PubMed1986

Cholangitis after endoscopic sphincterotomy in patients with stricture of the biliary duct.

Five patients with stricture of the common hepatic bile duct underwent endoscopic treatment without relief from cholangitis or successful stricture dilation. A Roux-en-Y hepaticojejunostomy was performed upon four patients who are now symptom-free. Endoscopic sphincterotomy leads to bactobilia and increases the risk of cholangitis, particularly in patients with residual obstruction of the bile duct. Although endoscopic treatment may have a role in patients at high risk, there is uncertainty about the long term results and the risk of progressive liver damage. In the majority of patients, the results of operation for benign stricture of the bile duct are such that operative repair is the treatment of choice.

Adolescent↗
PubMedDate not supplied

Diabetic retinopathy. Pathogenesis and the role of retina-derived growth factor in angiogenesis.

Diabetic retinopathy results from a combination of systemic and ocular abnormalities. Vasodilation, basement membrane pathology, microaneurysms, abnormal blood flow and tissue oxygenation, connective tissue abnormalities, and retinal ischemia are all components of early diabetic retinopathy. The pathogenesis of neovascularization is discussed with respect to the effects of vasodilation, vascular leakage, vitreous changes, and retinal ischemia. The evidence supporting Michaelson's hypothesis that a chemical messenger from the retina provides the stimulus for neovascularization is cited. The sequence of events involved in angiogenesis are cellular and basement membrane changes, endothelial cell migration, endothelial cell proliferation, and vessel formation. The experimental evidence in support of a role for retina-derived growth factor as a mediator of these cellular events is reviewed.

Basement Membrane↗
PubMed1985

Pathology of the pulmonary vasculature. Correlation with clinical and haemodynamic data.

In dealing with pulmonary vascular disease, essential for the clinician are its correlation with pulmonary arterial pressure and resistance, its potential reversibility and its prognosis for the patient. These relations, however, are far from simple. Medial hypertrophy as well as intimal fibrosis have a fairly good correlation with pressure and resistance in plexogenic arteriopathy but not in pulmonary venous hypertension. Reversibility of intimal fibrosis, and thereby its prognosis for the patient, depends not only on its severity but particularly on its type. The concentric-laminar form of intimal fibrosis for instance has an ominous prognosis when severe in contrast to other types. Not only the various forms of vascular changes and their severity but also the type of pulmonary hypertensive disease have to be taken into account for an accurate evaluation of a lung biopsy.

Dilatation, Pathologic↗
PubMed1993

Jugular bulb phlebectasia.

Phlebectasia of the internal jugular vein (IJV) is a rare venous anomaly that usually presents in young children as a soft cystic swelling in the neck and represents a pathologically enlarged vein. We present a case of jugular bulb phlebectasia in a 4-year-old boy. He presented with a blue pulsatile swelling arising from the floor of the left middle ear cleft. The venous phase of digital subtraction vertebral arteriography (DSVA) and computerised axial tomography (CT) with contrast confirmed a diagnosis of phlebectasia of the lateral sinus and proximal part of the left IJV, with a complete bony defect in the floor of the middle ear. The child did not have any neck symptoms or signs. No active treatment was required. To our knowledge, this is the first case of jugular bulb phlebectasia presenting in the middle ear.

Angiography, Digital Subtraction↗
PubMed1996

Anterograde percutaneous treatment of ureterointestinal strictures following urinary diversion.

OBJECTIVE: The incidence of ureterointestinal strictures following urinary diversion ranges from 4 to 8%. Traditionally, the treatment consists of open ureteral reimplantation. During the last decade, however, percutaneous techniques have gained increased interest for treatment of these strictures. We evaluated the outcome of anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion. METHODS: Since 1985, we attempted treatment of 15 ureterointestinal strictures, either by percutaneous anterograde dilatation (n = 10) or cold-knife incision (n = 2). In 3 patients the stricture could not be passed with a guide wire, precluding percutaneous treatment. Anterograde dilatation was performed with semirigid fascial dilators in 6 patients and additionally with a Grüntzig balloon catheter in 4. Routinely, following a successful procedure, a 12-Fr multihole stent was left in place for 6 weeks. RESULTS: Restenosis was seen in 4 patients 2, 2, 19, and 36 months, respectively following the procedure. In 8 patients no stenosis developed so far (follow-up 8-96 months). Morbidity after the procedure consisted of fever after nephrostomy puncture in 1 patient and stent occlusion in another. Both were managed conservatively. CONCLUSION: Anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion is a safe primary procedure with a permanent success rate in half of the patients (53%).

Adolescent↗
PubMedDate not supplied

Ventricular shapes, distortions, and deformities: mirrors of past cerebral insults. A study based on early sonographic follow-up studies.

Ventricular distortions and deformities often represent the endpoint of neuropathologic reactions that evolve early in life. Once fully developed, they may offer no clues as to preceding etiologic agents or pathogenesis. Serial sonography in the neonatal period of 14 patients with periventricular leukomalacia provided documentation of the evolution of certain ventricular patterns. When recognized early, these ventricular changes have prognostic significance because periventricular leukomalacia can produce serious neurologic sequelae. If found later in childhood, periventricular leukomalacia can be suggested as the original pathology. Ventricular deformities can be generalized (12 patients) or focal (11 patients); the various types of distortions are seen frequently in combination. The generalized form of ventricular expansion consisted of uniform expansion of the parieto-occipital components (hydroporencephaly), following extensive periventricular white matter necrosis. Hydroporencephaly is a new form of ex vacuo hydrocephalus in the pediatric age group. Focal changes are caused by more localized white matter cavitations with ventricularization of ensuing porencephalic cysts. These changes result in a footprint-shaped ventricular pattern (10 patients) or in frontal/occipital (polar) ventricular pointing (4 patients). White matter necrosis in other areas may lead to ventricles with bumpy contours (5 patients).

Brain Damage, Chronic↗
PubMed2005

[Multiple enterolithiasis, coexisting with bladder and gallbladder lithiasis, associated with colon adenocarcinoma].

Enteroliths are calculi primarily formed in the intestine. Enterolithiasis is a rare condition frequently associated with intestinal stasis. Usually it causes no symptoms in most cases, but it can be an important diagnostic clue in patients presenting intestinal occlusive symptoms. We report a case of multiple enterolithiasis, very infrequent pathology, coexisting with bladder and gall bladder lithiasis in a patient with colon adenocarcinoma. Diagnosis was made by X-rays and CT images. Calculi were analysed by several methods: chemical, infrared spectroscopy, stereoscopic microscopy and atomic emission spectroscopy; they showed that caluli are made up of organic material and whilokita (calcium and magnesium ortophosphate). No risk factors for lithogenesis were found in this patient excluding the intestinal stasis caused by intestinal narrowing as a result of adenocarcinoma. Genetic factors are suggested as main contributors to hyperlithogenesis observed in this patient. The physiopathological conditions were studied in depth and literature about this subject reviewed.

Abdominal Pain↗
PubMed1976

Vascular obstruction of the superior renal calyces in children.

The authors describe 5 cases with a pathology peculiar to the superior calyces due to vascular compression, observed from 1969 to 1975 among 938 urographic tests performed in the Pediatric Clinic of Florence. Three of these cases have been checked up to this date. In every patient the urographic tests show clear evidence of a vascular compression at the level of the right upper calyces, associated with stasis and/or ectasis. In two cases there is a symptomatology of abdominal pains; in the remaining 3 patients haematuria is revealed. It is important, particularly in children, to follow the course of the clinical and urographic features, in order to carry out a surgical intervention at the right moment, according to the evolution of the process. The chronic segmental (upper pole) pyelonephritis is the most dangerous evolution.

Child↗
PubMed2005

Customized surgical strategy in chronic pancreatitis.

Despite major advances in the management of patients with chronic pancreatitis, yet the disease remains an enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment. In most of the cases intractable pain is the main indication for surgical intervention. Furthermore complications related to adjacent organs, endoscopically not permanently controlled pancreatic pseudocysts, ductal pathology, conservatively intractable internal pancreatic fistula or suspected malignancy also require surgery. The ideal surgical approach should address all these problems--tailoring the various therapeutic options to meet the individual patient's needs. In our opinion, the ideal procedure for chronic pancreatitis is the duodenum preserving pancreatic head resection in terms of an extended drainage procedure, were the extent of the pancreatic head resection may be tailored to the morphology of the pancreatic gland, thus allowing a tailored concept (to resect and/or drain as much as necessary but as little as possible). Looking at the present data, there is no need to transsect the pancreatic axis above the portal vein. If portal vein thrombosis is present, an extended drainage procedure is mandatory without transsection of the neck of the pancreas.

Chronic Disease↗
PubMed2003

Actinomyces hyovaginalis associated with disseminated necrotic lung lesions in slaughter pigs.

Lungs from 26 slaughter pigs with a diagnosis of pyaemic lung lesions (disseminated necrotic lesions and abscesses), as determined at post-mortem meat inspection, were subjected to a thorough examination, including re-evaluation of gross pathology and histopathological and microbiological examination of samples from multiple lesions. The pulmonary lesions, which appeared identical on gross inspection, could be divided into three histopathological types, namely (1) abscesses, (2) circumscribed (contained) necrotic lesions, and (3) bronchiolar ectasias. Some characteristic relations between bacterial species and histopathological type were demonstrated. Thus, abscesses were dominated by Staphylococcus aureus infections, and circumscribed (contained) necrotic lesions were dominated by infections with an Actinomyces species, identified as Actinomyces hyovaginalis by 16S rRNA gene sequencing. Actinomyces hyovaginalis was demonstrated in 23% of all cases, pointing to this organism as an important agent of disseminated lung lesions of pigs. Furthermore, a characteristic pyogranulomatous reaction with a central area of necrosis was found to be associated with this infection.

Abattoirs↗