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At least 685 records · Page 38Linked to original sources
PubMed1994

Intravascular ultrasound imaging of a patent ductus arteriosus in an adult.

A small patent ductus arteriosus (PDA) is compatible with a normal life span. A non-restrictive PDA may present with signs of heart failure, supraventricular arrhythmia's, bacterial endocarditis or endarteritis later in life. Fewer than 50% of patients, including those with small shunts, are symptomatic by the age of 50. Considering that 40% of patients with PDA's will die before the age of 45 as a result of bacterial endocarditis or heart failure, closure of the PDA is recommended. Exceptions are patients with a nondilated heart, a right-to-left shunt, or age greater than 60 years old. Because of the wider use of echocardiography, especially transesophageal echocardiography, many PDA's are now detected incidentally in patients without symptoms.

Ductus Arteriosus, Patent↗
PubMed1976

[Meningo-encephalic tuberculosis in childhood. Anatomo pathological study of 10 cases].

The anatomo-pathological study of ten cases of tuberculosis of the central nervous system (CNS) in children under 10 years old is reported. The emphasis is given to the macroscopic and microscopic changes produced by the tuberculosis in the meninges, in the nervous parenchyma and in the vessels. The clinical and pathological findings are discussed and correlated with the literature. The authors concluded that: 1) the lesion in children with tuberculosis of the CNS is generally a proliferative meningoencephalitis; 2) the nervous parenchyma may be affected by the contiguous propagation of the tuberculous process or by the circulatory changes secondary to the arterial lesions; 3) because of the localization of the endocranial vessels in the sub-arachnoidal space they are generally injured by the inflammatory process, which can determine an obliterating endarteritis, which can be observed by a carotid angiography.

Autopsy↗
PubMed2000

[Non-surgical closure of patent ductus arteriosus: acute and long-term results].

INTRODUCTION: Closure of a patent ductus arteriosus (PDA) even with small shunt volumes in asymptomatic patients is recommended because of the risk of endocarditis (1.5% per year) and the potential development of congestive heart failure or pulmonary hypertension. METHODS: 16 patients (9 adults [5 men/4 women] and 7 children [3 boys/4 girls]) underwent transcatheter closure of a PDA. The intervention was performed using the Rashkind umbrella in 12 cases, the Amplatzer duct occluder in 2 cases, a coil in 2 cases, and the Sideris self-adjusting device in one case. Echocardiographic controls were carried out one day, 6 months, 12 months and 24 months after the intervention. RESULTS: PDA closure was complete immediately following the intervention in 9 of 16 patients (56%). At follow-up (mean 19 months) complete closure was observed in 14 of 16 patients (87%). All residual shunts were trivial. The complete closure rate in adults was 100% and in children 71%. Complications such as device embolism, endarteritis and haemolysis did not occur. CONCLUSION: Non-surgical closure of a PDA is a safe and effective technique.

Adult↗
PubMed2001

[Contribution of heparin therapy in the medical treatment of Buruli ulcer apropos of 1 case].

Medical treatment of Buruli ulcer is mostly disappointing even if Mycobacterium ulcerans is susceptible to many antibacterial drugs. The inefficiency in vivo of the drugs may be due to the tissue vascularisation disorders caused by the toxin that Mycobacterium ulcerans produces. This toxin causes an endarteritis followed by a thrombosis of the dermal vessels responsible for an ischemia which prevents the antibacterial drugs from reaching the infected area. Removal or prevention of that thrombosis should allow the drugs to be more effective. To verify this assumption, we used a combined therapy with two gold standard medicines in an oedematous form of Buruli ulcer on the face which could not be surgically treated: heparin for its activity on thrombosis and rifampin for its bactericidal activity on Mycobacterium ulcerans. Rifampin was administered at 300 mg dose per day. Based on the management of envenomisation cases due to viper bites, we used standard heparin at 500 Ul dose per kg repeatedly administered by an electrical syringe releasing 1 cc per hour in the tubulure of isotonic glucose infusion. The results were encouraging. The dreadful oedema of the face started to reduce on the 15th day and disappeared on the 30th day. A small area at the temple dried. But we were obliged to stop the use of standard heparin due to an occurrence of Klebsiella oxytoca septicaemia from permanent vein route. Rifampin was still administered at the same dose. The face oedema reappeared quickly, followed by a full closure of the eyelids and an ulceration at the right temple level. The standard heparin was therefore substituted by low weight molecular heparin, enoxaparin, administered at 40 mg twice per day by subcutaneous route. 45 days later the oedema reduced and ulceration did not develop. After 90 days of treatment, usual signs of mycobacterial infection progression disappeared. We stopped therefore the use of enoxaparin but continued with rifampin until healing of the ulceration which occurred after 12 months of treatment. We observed no recurrence over a period of 16 months after complete healing. We can conclude that heparin combined with antimycobacterial drugs--which are active in vitro on Mycobacterium ulcerans--could provide an effective medical treatment for Buruli ulcer.

Adolescent↗
PubMedDate not supplied

Operative outcome and intermediate term follow-up of neonatal Blalock-Taussig shunts.

BACKGROUND: The neonatal age group is considered to be one of the important risk factors for perioperative morbidity and mortality as well as poor long-term patency following Blalock-Taussig shunts. METHODS AND RESULTS: Out of a total of 190 patients who underwent Blalock-Taussig shunts in our institute between July 1998 and July 2000, 20 patients were aged less than 30 days and this neonatal cohort was studied retrospectively. The mean age was 18+/-11 days (range: 3-30 days). The mean weight of the babies was 3.1+/-0.7 kg, the smallest weighed 2.1 kg. The cardiac anatomy was tetralogy of Fallot with pulmonary atresia in 6, pulmonary atresia with intact ventricular septum in 3, tricuspid atresia in 5 and complex single ventricle physiology in the rest. All patients were deeply cyanotic and preoperative prostaglandin E1 was needed in 10 patients to ensure ductal patency and maintain oxygen saturations prior to the shunt operation. The mean hilar right and left pulmonary artery sizes were 3.99+/-0.44 mm and 3.69+/-0.79 mm, respectively. Three patients (15%) had significant stenosis at the site of duct insertion. The shunts were accomplished with 3.5 mm polytetrafluoroethylene grafts in 7 patients (35%) and 4 mm in the rest. The mean duration of mechanical ventilation was 2.0+/-2.83 days, one patient who developed bronchopneumonia needed prolonged ventilation for 14 days. The mean intensive care unit stay was 4.79+/-2.66 days. The mean hospital stay was 11.7+/-6.4 days. Five patients who developed sepsis stayed beyond 14 days. There were 3 deaths (immediate post-operative shock and possibly shunt malfunction in 1, bronchopneumonia in 1 and late shunt thrombosis at 3 months in 1). Two patients had late shunt block, one of those mentioned above and the other at 3 months secondary to infective endarteritis of the right pulmonary artery. All these infants received 4 mm grafts. All the 3.5 mm grafts were patent at follow-up. Seventeen patients were alive and well at follow-up (mean: 9 months, range: 3-21 months) with a mean resting systemic oxygen saturation of 77% (66%-95%). CONCLUSIONS: The overall shunt patency rate after neonatal Blalock-Taussig shunt is about 80% on intermediate term follow-up. A smaller graft size (3.5 mm) does not appear to be an incremental risk factor for shunt blockade and operative mortality.

Female↗
PubMed1975

[Surgical treatment of patent ductus arteriosus].

The experience gained with 1400 operations for patent ductus arteriosus performed at the Clinic of the Hospital Surgery of the Gorky Medical Institute during the period from October 1955 through 1973 is presented. The total post-operative lethality comprised 1.3 per cent, it amounting to 6 per cent with complicated patent ductus arteriosus, to 3 per cent among children of junior age and to 0.1 per cent in cases of uncomplicated defect. An analysis of operative and post-operative complications along with a study into remote results of the surgical intervention helped define indications for the closure of the duct in patients with pulmonary hypertension and septic endarteritis. They also showed the possibility of a single-stage correction of combined congenital heart defects. Indications have been worked out for the surgical treatment of patent ductus arteriosus in infants and procedures for the closure of the duct, depending upon its apatomic variants and concomitant complications.

Adolescent↗
PubMed1979

[Arterial hypertension caused by anomaly of the renal artery or its branches in children].

38 cases of severe hypertension due to a vascular abnormality of the renal pedicle were studied in children under 16 years of age, 18 boys and 20 girls. The most common presentation was at routine clinical examination. The diagnosis of an abnormality of the renal artery was suggested by the appearances of intravenous urography. There were many causes; 4 aneurysms of the renal artery or its branches, 4 fibromuscular dysplasias with one case of bilateral fibromuscular dysplasia, 4 idiopathic stenoses, 2 endarteritis, and 6 thromboses revascularised to variable degrees (2 after umbilical vein catheterisation and one due to DLE). In three cases the hypertension was related to compression of the pedicle by a tumour of haematome, and 14 cases had multiple arterial lesion. In the latter group, 6 cases of neurofibromatosis, 2 cases of William and Beuren's disease, 1 case of generalised Elastorhexia, 2 cases of aortic medio stenosis, probably Takayashu's disease, and 3 unidentified conditions. Surgery was performed on 29 patients, 21 of whom had unilateral lesions and were definitively cured of hypertension. Of the 8 cases with multiple lesions, only 2 were completely corrected with cure of their hypertension.

Adolescent↗
PubMed1975

Traumatic coronary artery-right heart fistula. Report of a case and review of the literature.

Although the left coronary artery is the most frequently injured vessel of the heart, traumatic fistulas appear more often in the right coronary vessels, as the initial injury to the left coronary artery usually results in early death prior to hospitalization. Indications for surgical repair include cardiac decompensation and signs of shunt progression. In asymptomatic patients with no changes in cardiac function, consideration for repair includes the following: (1) enlargement of the fistula, causing a large runofff into the low-pressure chamber, and reduction of blood supply to the local myocardium distal to the fistula; (2) progressive dilatation of a pseudoaneurysm when it exists; and (3) the presence of bacterial endarteritis. Surgery usually has been indicated in reported cases of coronary artery fistula. Conservative management is applicable when the shunt is small and cardiac function is normal, as evidenced by the present case report and the first case cited in the literature. Oversewing of the area of the fistula and bypass grafting from the ascending aorta to the distal coronary tree might provide an additional mode of management in selected cases.

Adult↗
PubMedDate not supplied

[Analysis of 942 episodes of bacteremia in a cardiology institution. Experience with the Bact-Alert system].

In Instituto de Cardiología y Cirugía Cardiovascular, Fundación Favaloro, between January 1996 and October 1999, 10,793 blood cultures and 942 episodes of bacteremia, corresponding to 1883 positive blood cultures, were studied by means of the Bact-Alert System (Organon Teknika), 94% being monomicrobial episodes. Gram positive bacteria were isolated in 45%, Gram negative in 52% and fungi in 3% of episodes. Associated foci of infection were: catheters 36.5%, mediastinitis 9%, pneumonia 6%, endocarditis 6%, abdominal 6%, urinary tract infections 9%, prosthesis 2.6%, empyema 0.2%, arthritis 0.1%, skin and soft tissue 2.5%, diarrhea 0.1%, aortic aneurysm 0.2%, meningitis 0.2%, pericarditis 0.3%, endarteritis 0.1%, infusion fluids 0.2% and unknown 21%. Median time (in hours) for positivization of blood cultures according to different foci were: catheters 16.4, mediastinitis 19.2, pneumonia 14.2, endocarditis 14.5, abdominal infections 11.8, urinary tract infections 13.0 and unknown origin 19.0. As for contaminating microorganisms, the value was 30.5. Seventy two percent of blood cultures became positive within 24 h, and 87% within 48 h; only 1% became positive between 5th and 7th day. There were no important differences in time to detect positive cultures according to different foci. It was not useful to incubate blood cultures more than five days, except for special circumstances, because it does not improve recovery of clinically significant microorganisms.

Argentina↗
PubMed1992

[A case of malignant rheumatoid arthritis with corticosteroid-reactive subacute myelopathy and multiple peripheral neuropathy].

We reported a 64-year-old man who had malignant rheumatoid arthritis (MRA) and developed subacute myelopathy and peripheral neuropathy. He had suffered from seropositive rheumatoid arthritis for 4 years, and developed weakness of four limbs, dysuria and constipation two months before the admission. Neurological examination revealed the diffuse muscle wasting and weakness in four limbs. Deep tendon reflexes were hyperactive in four limbs, but not in jaw jerk. Babinski sign was positive bilaterally. Deep sensation was decreased in four limbs and superficial sensation was decreased below the neck. Dysuria and constipation were noted, but anal and bulbocavernosus reflexes were present. On laboratory examination, RF and RAHA increased markedly. Serum complements decreased and immune complexes were positive. Nerve conduction study demonstrated multiple entrapment neuropathy in addition to mononeuritis multiplex. Histological examination of the biopsied sural nerve disclosed the obliterating endarteritis in the epineurium, and marked decrease in number of myelinated fibers. No compressive lesions were seen in the spinal canal by spine X-ray and MRI. Assuming that inflammatory process induced cervical myelopathy, corticosteroid therapy (predonisolone 60 mg/day) was administered and alleviated neurological symptoms, in accordance with the improvement of serological abnormalities. Therefore, an inflammatory process associated with MRA was supposed to damage the spinal cord as well as peripheral nerves in the present case.

Acute Disease↗
PubMed1992

Internal mammary artery to pulmonary artery fistula associated with sick sinus syndrome: report of a case.

A 77-year-old woman presented with general weakness, dizziness and slow, irregular heart beats. An electrophysiologic study revealed a markedly prolonged sinus node recovery time of up to 5,900 msec, accompanied with dizziness. A permanent pacemaker with an AAIR mode was implanted. An abnormal shadow in the right lower lung field was found on chest x-ray. Selective arteriography revealed a right internal mammary to right pulmonary artery fistula. No significant hemodynamic abnormalities were found. This anomaly is extremely rare. Our patient is the oldest among 20 cases reported in the literature, and is the first one associated with sick sinus syndrome. Most reported cases have involved surgical ligation and excision, due to the risk of rupture of the malformation, endarteritis and congestive heart failure. Our patient refused surgical intervention and has done well during the past year.

Aged↗
PubMedDate not supplied

Sneddon's syndrome.

Sneddon's syndrome refers to the rare association of extensive livedo reticularis with multiple ischaemic cerebrovascular episodes. Endarteritis obliterans is the most common cutaneous pathology. It is likely that several pathogenic mechanisms may give rise to Sneddon's syndrome, as the condition is associated with a high incidence of generalised atherosclerosis, hypertension, valvular heart disease and the presence of antiphospholipid antibodies.

Brain Ischemia↗
PubMed2002

The effect of hypergravity on carcinogenesis in mice.

In recent years, investigators began studying the effect of hypergravity on pathological developments in the animal and human body. It was shown that a regular exposure of tail suspended rats to normal gravity diminished osteopenia and muscle atrophy. Moderate gravitational loading produced by a G-suit dramatically increased the therapeutic success rate in children with cerebral palsy. Rotation of patients with obliterating endarteritis and limb bone fractures in a short-radius centrifuge in hospitals of the city of Samara (Russia) yielded promising results. The purpose of our investigations was to investigate the effects of hypergravity on chemically induced carcinogenesis in mice. We hypothesized that gravitational loading may produce a generalized effect on the animal body and thus to enhance its nonspecific anti-tumor resistance.

Journal Article↗
PubMed1992

Surgical treatment of radiation enteritis.

Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.

Adult↗
PubMedDate not supplied

[Immunopathology of acute rejection].

Acute transplant rejection may be the result of two immunologic mechanisms, T-cell-mediated and antibody-mediated processes, acting alone or together. Cell-mediated rejection occurs as T cells react to donor alloantigens which are expressed in context of MHC. The major forms of cellular rejection may affect tubulo-interstitium, arteries and glomeruli. The former type is characterized by infiltration of the interstitium and tubules with activated T cells. Typically less than 50% of the cells are CD3 (T3), while the majority are usually CD8 (T8) cells. In the tubulo-interstitial form, lymphocytes migrate from peritubular capillaries into the interstitium and into the walls of tubules (tubulitis). The arterial form is characterized by the accumulation of lymphocytes and monocytes beneath endothelial cells of arteries. Endarteritis is mediated by T cells and affected arteries are devoid of antibody or complement deposits. There are two distinctive forms of acute antibody-mediated rejection, affecting different vascular beds: arterial and peritubular capillary. The arterial form is characterized by mural necrosis and inflammation. In contrast, the peritubular capillary form may have little or variable morphologic changes; it is diagnosed by identifying C4d, a stable breakdown product of complement and an indicator of immune complex deposition, in peritubular capillary walls. C4d deposition correlates with circulating antidonor antibodies.

Acute Disease↗
PubMed2004

Reappraisal of thromboangiitis obliterans--a pathological contribution.

Thromboangiitis obliterans (TAO), the Winiwarter-Buerger disease, is a vasoocclusive disease of unknown etiology which typically affects medium-sized extremital vessels of young male smokers. While the diagnosis of TAO is largely based on patients' presentation and clinical criteria, pathological substrates have been poorly defined and repeatedly disputed. Comparing the histology and immunohistochemistry of TAO especially with those of arteriosclerosis obliterans (ASO) and thromboembolism in two larger studies, we recently identified several features with significant meaning for the differential diagnosis. The unique tissue appearance of TAO is in favor of a general disorder of minute vessels indicating periarteritis rather than pure endarteritis, whereas an inflammatory reaction directed to the internal elastic lamina corresponds with the severity of disease. Since TAO or its syndromic equivalent is probably more common than currently diagnosed, the presented pathological criteria may help to identify latent cases, the overlap with ASO, and untypical organ involvement of TAO.

Age of Onset↗
PubMed2006

[Aortic coarctation in a teenager presenting as mycotic pseudoaneurysm].

Since the introduction of surgical treatment for coarctation aortae, presentation of the disease with postcoarctation mycotic pseudoaneurysm has become rare. We report an 18-year-old male with endarteritis caused by Staphylococcus aureus treated with appropriate antibiotics. Later the patient developed an irritative cough and problems with swallowing. CT and MRI of the chest demonstrated a postcoarctation pseudoaneurysm. After acute surgery with resection of the coarctation and pseudoaneurysm and insertion of a tube graft, the patient had an uneventful postsurgical course.

Adolescent↗
PubMedDate not supplied

[Changes in the small cerebral vessels in the acquired immunodeficiency syndrome].

In the necropsy exam of the brains of 13 patients with acquired immune deficiency syndrome (AIDS) cerebrovascular lesions were seen in 5 cases, three of them having AIDS encephalopathy. Hyalinosis was noted in 3 cases, and endarteritis obliterans and fibrinoid necrosis in one case each; both of them had associated perivascular lymphocytic infiltrates. Cerebral infarction was observed in one case, but no hemorrhages were seen. The neuropathological anomalies in four children affected with the AIDS are reported too, being an extensive calcified vasculopathy and changes suggesting active AIDS encephalopathy the main findings.

AIDS Dementia Complex↗