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PubMed1986

Healing after myocardial infarction in the dog: changes in infarct hydroxyproline and topography.

Temporal changes in infarct collagen and left ventricular topography during healing after myocardial infarction were studied in 132 dogs with coronary artery ligation: 8 sham dogs and 13 with no infarction (controls) and 111 with infarction (3 at 1 day, 54 at 2 days, 25 at 7 days, 3 at 2 weeks, 9 at 4 weeks and 17 at 6 weeks). Myocardial hydroxyproline (a marker of collagen) was measured by spectrophotometry and pathologic infarct size, arteriographic occluded bed size and topography by computerized planimetry of weighed left ventricular rings. Over 6 weeks, hydroxyproline was unchanged in normal regions (average 4.20 mg/g dry weight) but increased progressively between 7 days and 6 weeks (9.94 versus 55.55 mg/g, p less than 0.001) in infarct zones. Progressive infarct contraction occurred over 6 weeks, with infarct size at 6 weeks being 40% less than at 2 days (9.7 versus 16.3% of the left ventricle, p less than 0.001), although total infarct hydroxyproline was directly related to infarct size at each time period (r = 0.73 to 0.81, p less than or equal to 0.05). Significant (p less than or equal to 0.05) left ventricular topographic changes in infarct hearts compared with control hearts included: 1) increase in cavity area (5.0 versus 3.9 cm2), endocardial circumference (8.8 versus 7.4 cm) and expansion index (infarct/normal endocardial segment length, 1.21 versus 1.02) by 7 days; and 2) decrease in thinning ratio (infarct/normal wall thickness, 0.71 versus 0.98) by 6 weeks. Also, compared with 2 day infarcts, by 6 weeks infarct area was decreased (1.8 versus 3.4 cm2) and the noninfarcted segment length increased (6.9 versus 5.4 cm). Changes in hydroxyproline and topography were similar for anterior (n = 54) and posterior (n = 57) infarcts. Thus, healing in canine infarcts is associated with cavity dilation and infarct expansion within 7 days followed by infarct contraction and thinning by 6 weeks, whereas collagen increases between 7 days and 6 weeks. Collagen deposition in expanded and thinned infarct segments explains the permanent regional shape distortion associated with ventricular aneurysms.

Animals↗
PubMed2004

Interventional bronchoscopy for tuberculous tracheobronchial stenosis.

This study investigated the use of interventional bronchoscopic techniques in the management of patients with symptomatic tracheobronchial stenosis from tuberculosis. The current authors evaluated their experience with interventional bronchoscopic techniques in 21 consecutive patients at the Singapore General Hospital, Singapore, from November 1994 to March 2001. All patients underwent rigid bronchocopy using the Dumon rigid ventilating bronchosope under general anaesthesia. A combination of techniques was used (mechanical or balloon dilatation, Nd-YAG laser and stenting using the Dumon stent). The mean+/-SD increase in luminal diameter of the tracheal lesions was from 4.5+/-2.5 mm pre-procedure to 11.9+/-1.7 mm post-procedure, whereas that for the mainstem bronchi stenosis was from 2.6+/-1.0 mm to 8.3+/-2.4 mm. All patients had immediate relief of symptoms post-intervention. Two patients who presented with acute respiratory failure could be weaned off mechanical ventilation immediately post-procedure. At the end of the study period, 52% (11 out of 21) remained asymptomatic. Bronchoscopic intervention provided immediate symptomatic relief in all of the studied patients. However, repeated sessions may be required to maintain this improvement. It is concluded that interventional bronchoscopic techniques are useful in the management of patients with tracheobronchial stenosis from tuberculosis.

Adult↗
PubMed1995

[Dolichoectatic intracranial arteries. Advances in images and therapeutics].

Dolichoectasia of intracranial arteries is an infrequent disease with an incidence less than 0.05% in general population. It represents 7% of all intracranial aneurysms. Commonly seen in middle age patients with severe atherosclerosis and hypertension, the affected arteries include the basilar artery, supraclinoid segment of the internal carotid artery, middle, anterior and posterior cerebral arteries; males are more frequently affected. The clinical features of these fusiform aneurysms are divided in three categories: ische-mic, cranial nerve compression and signs from mass effect. Hemorrhage may also occur. Nine patients with symptomatic cerebral blood vessel dolichoectasias are presented. Six of them were males with moderate or severe hypertension. Lesions were confined to the basilar artery in 3 cases, carotid arteries and the middle cerebral artery in 1 case, and both systems were affected in 4 patients. Middle cerebral arteries were affected in 5 cases and the anterior cerebral artery in one. An isolated fusiform aneurysm of the posterior cerebral artery is also presented (case 8) (Table 3). Motor or sensory deficits, ataxia, dementia, hemifacial spasm and parkinsonism were observed. One patient died from cerebro-meningeal hemorrhage (Table 2). All patients were studied with computerized axial tomography of the brain, 5 cases with four vessel cerebral angiography, 4 cases with magnetic resonance imaging (MRI) and case 5 with MRI angiography. Clinical symptoms depend on the affected vascular territory, size of the aneurysm and compression of adjacent structures. The histopathologic findings are atheromatous lesions, disruption of the internal elastic membrane and fibrosis of the muscular wall. The resultant is a diffuse deficiency of the muscular wall and the internal elastic membrane. Recent advances in neuroimaging such as better resolution of CT scan, magnetic resonance images (MRI) and MRI angiography increased the diagnosis of this pathology showing clearly the affected vessels. This avoids the use of conventional or digital subtraction angiography, reserved only for diagnosing suspected saccular aneurysm, evidence of subarachnoid hemorrhage or planning surgical treatment. The treatment of this entity may be medical or surgical. There is evidence suggesting a more favorable outcome with anticoagulation therapy, although antiaggregation is a reasonable alternative. In our experience no difference in clinical outcome was evident. Surgical treatment of this type of aneurysm includes intra- or extracranial occlusion of parent artery, clipping or aneurysm trapping, tourniquet occlusion, and circumferential wrapping with clip reinforcement. Endovascular occlusion has been accomplished with detachable balloon technique or coils. No surgical attempt was done in our cases. The prognosis is variable depending on the patients age, vessels involved and clinical complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

Megaureter: classification, pathophysiology, and management.

The term megaureter does not define a specific pathological condition, because it can be due to different underlying abnormalities. The most used classification includes three groups: refluxing megaureter, associated with vesicoureteral reflux (VUR); obstructive megaureter, associated with urine flow impairment at the vesicoureteral junction; non-refluxing non-obstructive megaureter, if neither obstruction nor reflux can be identified. Each group can be divided into two subgroups: primary megaureter; secondary megaureter. With the advent of antenatal ultrasound an increased number of cases are identified prior to the onset of symptoms. The common used investigation are: urinary tract ultrasound, voiding cystourethrography, urography, serial diuretic renography and pressure-perfusion studies (Whitaker test). The advent of prenatal and neonatal echography has modified the natural history of megaureter. Nowadays non operative management is preferred. Operative intervention is indicated only in these cases: significant impairment to urine flow; worsening renal function during the observation time; recurrent UTI in spite of adequate antibiotic prophylaxis.

Child↗
PubMed1990

Pouch outlet obstruction following vertical ring gastroplasty for morbid obesity.

We have experienced a 14% (38 of 264 patients) incidence of pouch outlet obstruction following vertical ring gastroplasty. Initial management consisted of dilatation in 34 of 38 patients (94%). Ten of 34 patients (29%) were spared reoperation by 1 to 3 dilatations. Non-passage of an endoscope through the stoma immediately following dilatation predicted the need for surgery; 4 of 11 patients (36%) with passage underwent reoperation compared with 17 of 20 patients (85%) without passage (p less than 0.02). Surgical findings included "tipped bands" in 9 of 28 patients (32%); fibrous reaction to the band in 10 of 28 patients (36%); adhesions with angulation of the pouch in 2 of 28 patients (7%); and no identifiable cause of obstruction in 7 of 28 patients (25%). Surgical therapy consisted of removal of the band (2 patients), removal of the band and replacement with a similar length or larger band (20 patients), "tacking" the band in the horizontal position (4 patients), or conversion to a Roux-Y bypass (2 patients). The first three options were associated with an unacceptably high rate of weight regain and/or continued symptoms, whereas the last-named procedure met with good success.

Anastomosis, Roux-en-Y↗
PubMed1983

Pulmonary findings in patients with chagasic megaesophagus. Study of autopsied cases.

We studied retrospectively 69 cases of chagasic megaesophagus (group 1) and 207 cases of chronic chagasic myocardiopathy (CCM) without megaesophagus (group 2) by autopsy in the Pathology Department of the Federal University of Bahia, Brazil, from 1953 to 1975. It was shown that pulmonary tuberculosis was significantly more frequent in group 1 (21.7 percent) than in group 2 (3.4 percent). The patients of group 1, who had megaesophagus without associated cardiomyopathy (n = 36), had a much higher rate of pulmonary tuberculosis (36.1 percent) than those with associated CCM (6.0 percent), and they also had the most severe forms of the pulmonary disease. Other pulmonary complications of infectious origin occurred more frequently in group 1. The prevalence of pneumonia was 34.7 percent in group 1 and 10 percent in group 2. Six cases were considered to be aspiration pneumonia. Long abscess occurred in two cases in each group. We suggest that megaesophagus should be carefully investigated for pulmonary complications, especially for tuberculosis in populations with a high rate of this infection.

Adolescent↗
PubMed1985

Experimental study of lymphatic contractility in lymphedema and its clinical significance.

Fifty-four rats that had been used as models for lymphedema were divided into nine groups to observe the changes of lymphatic contractility in pathologic conditions at varying postoperative days. The changes of the lymphatic contractility were divided into three stages in this paper: In the first stage, the lymphatic contractility was impaired by high intralymphatic pressure, but the morphology of its wall was normal and it could recover its function if the pressure was decreased. In the second stage, the blocked lymphatic lost its contractile function partially or completely because its wall thickened and fibrosed, but the newborn lymphatics possessed contraction function and could be anastomosed. In the third stage, most lymphatics had lost their contractile function because of severe fibrosis. The fibrosis of the tissue even blocked the growth of the newborn lymphatics. In this stage, therefore, it was unsuitable to do a lymphatic-venous anastomosis. It can be concluded from the experiment that lymphatic contractility should be considered before performing a lymphatic-venous anastomosis. The lymphatic that still has contractile function should be selected for lymphatic-venous anastomosis.

Animals↗
PubMed2002

Regular finger dilation for preventing anastomotic stenosis after low anterior resection.

PURPOSE: This study evaluated the usefulness of performing regular finger dilation (RFD) of the anastomosis to prevent stenosis after low anterior resection (LAR). METHODS: Defecatory function was assessed in 22 patients who had undergone LAR more than 6 months earlier. The patients were divided into an RFD group, comprising 15 patients who had undergone regular RFD, and a non-RFD group, comprising 7 patients who had dropped out of our follow-up with RFD. The physiological and clinical findings in relation to defecatory function were compared. RESULTS: The type and size of the stapler and anal manometric parameters were similar. The RFD group had significantly better defecatory function in terms of bowel movement and sensation of incomplete evacuation (P < 0.01, respectively) with a significantly wider anastomotic diameter and higher evacuation rate (P < 0.01, respectively). CONCLUSION: These findings demonstrate that RFD is useful for preventing anastomotic stenosis and achieving favorable defecatory function after LAR. Therefore, a prospective randomized study should be scheduled.

Adult↗
PubMed2004

Suspicious findings in reduction mammaplasty specimens: review of 182 consecutive patients.

Breast reduction mammaplasty allows examination of specimens from a seemingly healthy population for the presence of proliferative breast disease. The authors reviewed the charts of all reduction mammaplasty patients of a single surgeon over 7.5 years for age, family history, mammographic results, unilateral or bilateral nature of the procedure, and final pathologic diagnosis. Of 182 patients, 168 had bilateral and 14 had unilateral breast reductions. Ages ranged from 16 to 79 years (average and median: 37 years and 35 years respectively). Fifty-seven patients (31%) were younger than 30 years, 53 patients (29%) were between the ages 30 years and 39 years, for a total of 110 patients (60%) younger than 40 years in this study. A total of 163 patients (89%) had a diagnosis of normal breast tissue. Nineteen patients (10%) had proliferative changes: 9 patients (5%) without atypia, 5 patients (3%) with atypia, 3 patients (2%) with sclerosing adenosis, and 1 patient each (0.5%) with papillomatosis and lobular carcinoma in situ. A total of 95% of patients with proliferative changes were older than 30 years. Women ages 30 to 39 years may be at higher risk (15%) of having proliferative changes than previously reported, and histologic examination of all reduction mammaplasties is recommended.

Adolescent↗
PubMed1992

Obesity-associated focal segmental glomerulosclerosis: pathological features of the lesion and relationship with cardiomegaly and hyperlipidemia.

In a review of the autopsies and medical records of 22 obese patients, focal segmental glomerulosclerosis (FSGS) was present in seven. The FSGS was mild in all but one patient. The FSGS of obese patients has similar features to idiopathic FSGS; however, our findings suggest that it lacks the hyperplasia of glomerular epithelial cells, shows no predilection for the corticomedullary junction, and is probably more often seen in the hilar region of the glomeruli. FSGS or glomerulomegaly was not associated with the degree of obesity. We demonstrated lipid deposition in the kidney of obese patients. Obese patients with FSGS, compared to those without FSGS, had higher blood cholesterol (P < 0.10) and higher triglyceride levels (P < 0.01). The mean heart weight of obese patients with FSGS was greater than that of patients without FSGS (P < 0.01). Also, obese patients with FSGS had larger glomeruli (246 +/- 33 microns) than obese patients without FSGS (218 +/- 16 microns) (P < 0.05). These findings suggest that cardiomegaly with hemodynamic changes and glomerular hyperfiltration may play a significant role in the glomerulomegaly and FSGS of obese patients. The secondary or contributory role of lipids in the development of the FSGS of obese patients remains to be determined.

Basement Membrane↗
PubMed1999

Conservative treatment of neonatal primary megaureter.

The growing agreement toward the conservative treatment of primary megaureter (PM) is supported by the increasingly frequent reports in the literature of spontaneous resolution of this pathology after few years of attendance. If the PM is asymptomatic without the presence of parenchymatous damage, and the diuretic scintiscan does not show a definite obstruction of the uretero-vesical junction, the conservative treatment should be the choice for the neonatal forms of PM. We report our experience of 14 neonatal PM, conservatively managed out of a total of 22 PM observed between 1990 and 1996. All the patients have been controlled with serial ultrasonography and Tc99 DTPA scintigraphy. Three of them underwent a surgical operation because of persistence or impairment of the clinical and scintigraphic pictures after a 12-18 months' follow-up. Some of the remainders are completely recovered while others are going toward resolution. The conservative treatment of neonatal PM is therefore confirmed to be sure and effective, and in spite of the different attitudes expressed by reliable authors in the up-to-date literature we believe it should be undertaken for the asymptomatic forms in which there is no documented uretero-vesical obstruction.

Dilatation, Pathologic↗
PubMed1975

Micro- and macrovascular changes as the direct cause of parenchymal destruction in congenital murine hydrocephalus.

Microangiotomography was used to identify the normal and pathological pattern of cerebral vessels in the hy-3 murine mutant mouse (normal and hydrocephalic) at various developmental stages from birth through 21 days of life. The technique employed allows resolution, in the range of 7 to 10 mu of the surface and intraparenchymal (perforating) microvasculature. Ventricular enlargement causes displacement of primary cerebral arteries, followed by both stretching and a decrease in the caliber of primary, secondary, and tertiary vessels (arterial and venous). Ultimately, there is a reduction in the number and caliber of the microvasculature, resulting in diminished cerebral blood flow and cerebral edema. Tissue destruction leading to ependymal rupture, parenchymal cavitation, and the formation of porencephalic cysts within the edematous parenchyma ensues. External ventricular drainage, by decompressing the ventricles, resulted in rapid restoration of the filling of the primary and secondary vessels, thereby suggesting the primary role of vascular changes in the production of brain damage. This study offers experimental evidence that early diversion of the cerebrospinal fluid interrupts this chain of events in congenital murine hydrocephalus.

Animals↗
PubMed1997

Intraepithelial neoplasms of the pancreas.

Intraepithelial neoplasms of the pancreas have been recently described and relatively rare, but these lesions represent a distinct, however pathologically heterogeneous entity with shared clinical features. We analyzed the clinicopathologic and cytogenetic characteristics of eight patients with intraepithelial neoplasms. Based on our hypothesis that tumor ploidy pattern correlates with ploidy, synthetic (S) phase and proliferative fractions of each neoplasm by flow cytometry. Analysis of the nuclear DNA content of pancreatic intraepithelial neoplasms in this study supports our hypothesis. Each neoplasm demonstrated diploid stemline, with a low S-phase fraction. The diploid DNA pattern and the low proliferative activity are consistent with the nonaggressive behavior of the tumors and, in part, explain the favorable prognosis of intraepithelial neoplasms. Intraepithelial neoplasms of the pancreas constitute a rare, but surgically curable, localized disease with a good prognosis following radical resection. The most valuable tool in the diagnosis of these preinvasive lesions is ERCP combined with brush cytology. This study supports the potential value of flow cytometric DNA analysis in determining outcome, as the diploid DNA pattern and low S-phase fractions correlate with the nonaggressive biological behavior.

Adult↗
PubMed1998

Effect of experimentally induced urethral obstruction and surgical decompression in utero on renal development and function in rabbits.

To investigate the effect of urethral obstruction during late fetal life on renal development and function, we developed a rabbit fetal model of obstructive nephropathy to examine the pathological and biochemical consequences of urethral obstruction and beneficial effects of early surgical decompression. Animals were divided into four groups, i.e., obstructed, early decompressed, late decompressed, and control. Fetal renal development was evaluated by histological examination and counting the number of glomeruli in the four groups. The number of renal glomeruli correlated with gestational age in the normal fetus (r = 0.90, P < 0.0001). Urethral ligation on gestational day 25 (full-term, 31 days) resulted in thinning of the renal cortex and significantly decreased the number of renal glomeruli. The concentration of urinary microalbumin was higher when urethral obstruction was maintained for 3 days than 1 day after urethral obstruction, although urinary beta2- microglobulin, Na, Cl, and osmotic pressure did not change during this period. Decompression of urethral obstruction 1 day after induction of urethral obstruction resulted in improvement in the severity glomerular hypoplasia compared with late decompression (P < 0.01). Our results suggest that the rabbit fetal model simulates fetal urethral obstruction in humans, and indicates that early surgical decompression may be effective in restoration of normal renal function.

Albuminuria↗
PubMed1987

Endoscopic treatment of biliary duct strictures in sclerosing cholangitis: follow-up assessment of a new therapeutic approach.

Endoscopic sphincterotomy was performed on 10 patients with sclerosing cholangitis to improve biliary tract drainage and to remove bile duct sludge and stones. In addition, Gruentzig-type balloons were placed endoscopically to dilate severe biliary duct strictures in eight of these patients, and endoprostheses were inserted to bridge high grade strictures in three patients. In order to assess the effectiveness of endoscopic treatment, we compared the number of hospitalizations for clinical episodes of cholangitis in this patient group for similar periods of time before and after therapy. Episodes of cholangitis requiring hospitalization decreased from 2.5 +/- 0.4 per patient in the 12 months prior to endoscopic therapy to 0.2 +/- 0.2 episodes per patient in the year following treatment and to 0.33 +/- 0.2 episodes per patient in the additional follow-up period during the second year. Liver function tests have improved significantly over the follow-up period of 19.1 +/- 2.6 months from the time of endoscopic treatment. The serum bilirubin decreased from 6.9 +/- 2.0 mg/dl to 2.7 +/- 1.4 mg/dl; serum alkaline phosphatase decreased from 959 +/- 214 IU to 385 +/- 89 IU; and serum transaminase decreased from 117 +/- 17 IU to 77 +/- 12 IU. Endoscopic treatment appears to be effective in patients with severe sclerosing cholangitis.

Adult↗
PubMed1993

Insufficient hemodialysis access fistulas: 18 months' experience in laser-supported dilation.

Patients with end-stage renal failure disease frequently develop venous stenoses or occlusions in their hemodialysis access fistulas caused by intimal fibrosis. A complete dilation with high pressure balloons up to 20 atm may be unsuccessful in those cases. We investigated two new pulsed dye laser devices for the ablation of obstructions, which were not adequately treatable with a previous balloon angioplasty. From November 1990 to April 1992 a total of 154 percutaneous transluminal angioplasties (PTAs) of hemodialysis access fistulas were performed. In 23 of them an additive laser angioplasty was necessary. Twenty patients with Cimino fistulas presented 28 stenoses and two occlusions, and three Goretex loops presented all occlusions. Two pulsed dye laser devices emitting at 504 nm and 595 nm wavelength were tested. Technical success was achieved in 22/23 cases, but clinical success was obtained in 20/23 patients because two early reocclusions caused by thrombosis appeared. Five restenoses occurred 2, 3, 10, and in two cases 14 months after angioplasty with a mean follow-up period of 13.5 (5-18) months. Pulsed dye laser ablation in hemodialysis access fistula lesions due to intimal fibrosis is a valuable enrichment of radiological recanalization techniques and an alternative to surgery if stand alone balloon PTA fails.

Angioplasty, Laser↗
PubMed2004

Catheter probe extraductal EUS reliably detects distal common bile duct abnormalities.

BACKGROUND: This prospective study evaluated whether extraductal catheter probe EUS as an adjunct to endoscopic retrograde cholangiography can detect or rule out choledocholithiasis and other pathologic conditions of the distal common bile duct. METHODS: A total of 119 patients referred because of suspected choledocholithiasis or other bile flow obstruction for endoscopic retrograde cholangiography and papillotomy were included in this prospective study. Extraductal EUS of the distal common bile duct with a radial-scanning catheter probe was followed immediately by endoscopic retrograde cholangiography and papillotomy by a second examiner who was blinded to the EUS findings. Extraductal EUS and endoscopic retrograde cholangiography findings were compared. RESULTS: Extraductal EUS detected 33/34 bile duct stones and all papillary adenomas (16 patients). In 8/34 patients, stones were missed on cholangiography but were seen after papillotomy and stone extraction. Extraductal EUS missed 10 peripheral lesions, one pancreatic tumor, and two distal bile duct stenoses. Overall, the sensitivity of EDUS was 78% and specificity was 98%. CONCLUSIONS: Extraductal EUS accurately detects abnormalities involving the distal common bile duct, especially small stones. The use of catheter probe EUS imaging during interventional endoscopy can help to avoid unnecessary papillotomy and can influence therapeutic strategy.

Adolescent↗
PubMed1987

The application of magnetic resonance in spinal cord disorders.

The introduction of the proton magnetic resonance imaging into clinical practice shows significant diagnostic potentials, and throws a new light on pathological changes involving the spinal cord, in particular on those related to trauma and its sequelae. The initial experience concerning the use of the proton magnetic resonance imaging in 28 patients, in whom paraplegia or quadriplegia developed following an injury to the spine, indicates that magnetic resonance imaging has specific advantages over other investigative modalities. Magnetic resonance imaging techniques permit, in most instances, a distinct demarcation of the spinal cord in its entire length or in segments, without ionising radiation or intrathecal introduction of contrast media. A significant superiority of magnetic resonance imaging is the feasibility to apply multiplanar imaging of the spinal cord without moving the paralysed patient and the possibility to repeat the imaging, even on an outpatient basis, without a major discomfort to the patient. Most of the post-traumatic lesions can be identified in magnetic resonance images, however, the application of paramagnetic enhancers may have to be considered in order to achieve a distinct delineation of a lesion from the surrounding normal spinal cord tissue in selected cases. Despite some current limitations, magnetic resonance imaging has opened new avenues to obtain information about the anatomy, and, in particular, the biochemistry of the spinal cord.

Dilatation, Pathologic↗