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PubMedDate not supplied

Ultrafast MR imaging of the foetus: a study of 25 non-central nervous system anomalies.

PURPOSE: The aim of this paper is to suggest Magnetic Resonance (MR) Imaging as a useful tool in prenatal diagnosis. Although ultrasonography (US) is the imaging technique of choice for prenatal screening, in cases of complex malformations US findings may be sub-optimal and give rise to diagnostic difficulties requiring further investigation. Our study is focused on non-central nervous system (CNS) abnormalities of the foetus imaged using the ultrafast sequence EXPRESS. MATERIALS AND METHODS: 38 women whose foetuses were between 21-34 gestational age were studied. Indications for the examinations included the evaluation of non-CNS abnormalities in 25 cases. Foetal MR imaging was performed on a 1.5 T system (Edge, Marconi Medical System Italia SpA, Vimercate, MI) with the half-Fourier, single-shot, fast spin-echo EXPRESS sequence. Mild maternal and foetal sedation was obtained by oral administration of benzodiazepine (1 mg). RESULTS: In the 25 foetuses investigated for non-CNS pathologies the abnormalities were localised in the chest (9), abdomen (15) and extremities (1). The MR imaging diagnoses were: in the chest - congenital diaphragmatic hernia (CDH) (5), congenital cystic adenomatoid malformation (CCAM) (1), hydrothorax (1), cystic lymphangioma (1), Jeune syndrome (1); in the abdomen - 10 cases of urinary tract diseases - polycystic kidney (4), crossed renal ectopia (2), unilateral renal agenesis (1), solitary pelvic kidney (1), bilateral stenosis of ureteropelvic junction (1), duplex collecting system in association with controlateral hydroureteronephrosis (1)#151;5 cases of non-urinary tract pathologies#151;cystic lymphangioma of the liver (1), abdominal cystic lymphangioma (1), gastroschisis (1), gastric duplication (1), cavernous haemangioma of the liver (1); in the extremities - longitudinal hemimelia (1). CONCLUSIONS: In our experience MR is to be considered a useful though adjunct study to prenatal US particularly in the evaluation of lung parenchyma, congenital diaphragmatic viscera herniation, thoracic masses, pleural effusion, abdominal cystic masses, and urinary tract malformations. The ultrafast EXPRESS sequence enables a complete study to be performed in a very short time; as a consequence the examination is well tolerated by the patient. Currently there is no legislation which regulates the use of magnetic fields in MR, only a series of recommendations based on studies on animal embryos and foetuses, on pregnant women exposed to magnetic fields and follow-up studies of children exposed to MR during gestation. Therefore the decision to proceed with foetal MR should be made on a case-by-case basis in close consultation with the referring obstetrician. Considering the results, in our opinion the potential of MR in the evaluation of a wide variety of non-CNS foetal diseases will increase in the near future.

Adult↗
PubMed2002

[Ultrasound-assisted puncture method of treatment of hepatic hydatid cysts].

Results of treatment of 31 hepatic hydatid cysts in 28 patients were analyzed. The size of the s ranged from 3 to 25 cm. In 26 cases the cysts contained flive es, in 2 cases they were suppurated after US-assisted intraoperative puncture. Simple hydatid cysts (type I by M. Milcevic) were diagnosed in 24 patients (solitary--in 22, multiple--in 2), solitary cysts of type II--in 2 patients. In 23 cases aspiration-catheter treatment with complete removal of chitin membrane by one-stage (4) or two-stage (19) methods was performed. After removal of chitin membrane in 3 patients lateral fistula between spurious cysts cavities and peripheral branches of intrahepatic bile ducts were revealed which spontaneously. Glue composition "Rabrom" was used in 2 cases for closure of the residual cavity. In 4 patients who had cysts less 6 cm in size puncture irrigation of chitin cavity with 30% NaCl (PAIR technique) without it removal was performed. In one patient transcutaneous catheter (PAIR-PD technique) was used for irrigation of the cyst larger than 6 cm. The duration of two-stage aspiration-catheter treatment with removal of chitin membrane was 25.6 +/- 9.6 days. In moderate calcinosis of the fibrous membrane and bile fistulas period of hospitalization was 34 +/- 8.1 days. Treatment with PAIR and PAIR-PD took 1 and 3 days respectively. Complications of percutaneous methods were regarded as mild: hyperthermia (12), right-sided hydrothorax (6), subcapsular hematoma (1), urticaria (1). All the complications were treated conservatively and with US-assisted punctures. Long-term (from 6 months to 9 years) results of treatment were followed up in 26 patients: there were no recurrences. Suppuration of the residual cavity 6 months after the glue occlusion was eradicated by transcutaneous catheter drainage. One lethal outcome was not associated with complications of aspiration-catheter treatment. Both methods of transcutaneous treatment of hepatic hydatid cysts are effective and safe. A hypertonic solution of NaCl I produces a reliable antiscolecidal and sclerosis effect.

Adult↗
PubMed2002

[Systemic AL-amyloidosis with extensive pulmonary and vascular lesions].

Here is an observation data on systemic AL-amiloidosis with primary lesion of lungs and vessels (a false hemorrhagic syndrome, ischemic insult in the region of middle cerebral artery). At the same time lesions of kidneys and heart became of minor significance. Amiloid lesion of lungs was characterized by unusual combination of symptoms: a galloping hydrothorax, a vast focus in the consolidation of pulmonary tissue with focuses of calcification, relapsing pneumothorax.

Amyloidosis↗
PubMed2002

Reexpansion pulmonary oedema as a complication of pleural drainage.

One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

Adolescent↗
PubMed2003

Hepatopulmonary syndrome. A review of the literature.

The majority of cirrhotic patients present dyspnea, but most of the time this is a consequence of ascites, hepatic hydrothorax or cardiopulmonary disease. Very few of these patients undergo the hepatopulmonary syndrome, an infrequent complication of chronic liver disease, especially when associated with portal hypertension and cirrhosis. Hepatopulmonary syndrome is characterised by dyspnea and, consequently, arterial hypoxemia, due to intrapulmonary vasodilation and shunting. The real pathogenesis of this vasodilation is still unknown, although many hypotheses have been suggested. Furthermore, no medical therapy appears to be really useful in the treatment of hepatopulmonary syndrome. At the present time, the only treatment that is efficacious for the resolution, or for the improvement of blood gas oxygenation abnormalities, is orthotopic liver transplantation.

Chronic Disease↗
PubMed2003

Hydrops fetalis: report of 3 cases.

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.

Female↗
PubMed1992

An encephalomyocarditis virus epizootic in a baboon colony.

Approximately 80 baboon deaths were caused by encephalomyocarditis virus (EMCV) infection in a 3060 member research and production colony. The epizootic extended over a 9-month period and occurred in baboons ranging from 1 day to 22 years of age. Acute death was the most common history. When clinical disease was detected, it was characterized by labored respiration associated with acute congestive heart failure. The salient necropsy findings were pulmonary congestion and edema, hydropericardium, hydrothorax, ascites, lymph node and splenic hypertrophy, and pale white-to-tan mottled hearts. The most significant histologic lesion was nonsuppurative necrotizing myocarditis. Placental infection with fetal loss occurred. Diagnosis was confirmed by light microscopy, transmission electron microscopy, virus culture, and serology. Rarely, EMCV-induced antibody persisted in surviving baboons for more than 24 months. EMCV-infected feral rats were the probable source of the virus and their control stopped the epizootic. No EMCV neutralizing antibody was detected in colony support personnel or chimpanzees.

Animals↗
PubMed1976

Clinical, histologic, and histochemical study of imidocarb diproprionate toxicosis in goats.

The toxic effects of imidocarb diproprionate (3,3'-bis [2 imidazolin-2yl]-carbanilde diproprionate) were evaluated in adult goats given (intramuscular injection) a lethal dose (6.75 mg/kg). The immediate clinical signs of toxicosis were transient excessive salivation and diarrhea. Anorexia, dyspnea, recumbency, and death occurred between postinjection days (PID) 4 and 8, during which time 7 goats died and 4 moribund goats were euthanatized. There were marked increases in mean serum urea nitrogen concentration and significant increases in serum glutamic oxalacetic transminase activity and in the mean number of circulating neutrophils after PID 4. Renal hyperemia and enlargement were evident by PID1. Serosanguineous fluid in the trachea and major bronchi, pulmonary congestion and edema, hydrothorax, hydroperitoneum, and less frequently hydropericardium were observed on and after day 4. Microscopic renal tubular lesions rapidly progressed from pyknotic epithelial nuclei observed at 6 and 12 hours to acute tubular necrosis of epithelium of the proximal convoluted tubules on days 1 and 2. Pulmonary congestion and edema; hemorrhage into alveoli, bronchioles, and bronchi; and intracytoplasmic lipid vacuoles within the hepatocytes in the periacinar zones of the hepatic lobules were observed on or after day 4. Succinic dehydrogenase and adenosine triphosphatase activities decreased progressively in the epithelial cells of the proximal convoluted tubules. The decreases in cellular enzymatic activity occurred shortly after the appearance of microscopic lesions in the tubular epithelium.

Adenosine Triphosphatases↗
PubMed1992

Chronic adriamycin treatment and its effect on the cardiac beta-adrenergic system in the rabbit.

Treatment of male rabbits with adriamycin at a cardiotoxic dose (1 mg/kg intravenously, i.v., twice a week for 9 weeks) caused cardiovascular disturbances characteristic of chronic heart failure. The severity of symptoms varied, indicating differences in the individual sensitivity of the animals to adriamycin. Thus, cardiac output (CO) was decreased by greater than 40% in only 4 of the 7 animals in which it was measurable at 9 weeks. Elevated levels of atrial natriuretic factor (ANF) and plasma renin activity (PRA), as well as pulmonary congestion, hydrothorax, and ascites were also evident. The baroreflex response to sodium nitroprusside (NPS) was blunted. The response to the inotropic drug dobutamine was depressed by 50% as compared with the control animals. Right ventricular beta-adrenoceptor density was significantly reduced in these animals (22.9 +/- 3.1 as compared with 31.8 +/- 1.0 fmol/mg protein in control animals) owing to a selective downregulation of the beta 1-adrenoceptor population. The loss of beta-adrenoceptors was highly correlated with severity of heart failure symptoms: i.e., baroreflex dysfunction as indicated by the NPS slope (r = 0.91), decrease in CO during the previous weeks (r = 0.88), and plasma norepinephrine (NE) levels (r = 0.96). However, when all adriamycin-treated animals were compared collectively regardless of the severity of heart failure, with the controls, no difference in the beta-adrenoceptor density was detectable, a finding in agreement with previous observations in this model. Chronic treatment of rabbits with adriamycin thus causes low-output failure, reflecting some of the findings reported for the human disease; however, individual sensitivity to adriamycin varies considerably between rabbits.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Myocardial fibrosis and degeneration with heart failure (cardiomyopathy) in two goats].

Myocardial fibrosis and degeneration of unknown etiology is described in two adult, female goats of the Saanen and Pfauen breeds. Both animals presented with clinical signs of cardiac failure with subcutaneous edema, hydrothorax and ascites. The pathological lesions were characterized by cardiomegaly with ventricular and auricular dilatation and hypertrophy, massive subcutaneous edema and body cavity edema. The first goat additionally showed chronic liver congestion due to cardiac failure. Histologically, the most prominent changes were focally extensive cardiomyocyte degeneration and cardiac fibrosis. The clinical history and pathologic lesions are comparable to those of dilatative cardiomyopathy in SixRH cattle.

Animals↗
PubMed2003

Surgical complications after liver transplantation.

AIM: The number of liver transplantations in Italy has steadily increased over the last 10 years as a result of the use of donors aged more than 60 years. The use of organs with a reduced functional reserve has been compensated for by improvements in immunosuppressive therapy, surgical techniques and the management of postoperative complications. This article describes the incidence and treatment of the main surgical complications after liver transplantation. METHODS: Between January 1996 and June 2003, 398 patients received 430 transplants at our Centre. Thirty-seven early relaparotomies were performed (8.6%), including 12 retransplantation (2.8%). The 1-, 3- and 5-year actuarial survival of the patients was 79.8%, 72.2% and 67.5%, and that of the grafts was 75.9%, 68% and 63.4%. Perioperative mortality was 10.5% (with no intraoperative deaths). RESULTS: The overall incidence of biliary complications was 31.6%, 9.1% of which were due to the removal of the Kehr tube. There were 42 (9.8%) anastomotic stenoses, 5 (1.2%) extra-anastomotic stenoses, 1 (0.2%) anastomotic leak, 5 (1.2%) extra-anastomotic leaks, and 19 (4.4%) ischemic-type biliary lesions. The overall incidence of vascular complications was 6.9%: 7 (1.6%) cases of hepatic artery thrombosis, 17 (4.0%) arterial stenoses, 1 (0.2%) arterial pseudoaneurysm, 4 (0.9%) cases of portal thromboses and 1 (0.2%) case of caval laminar thrombosis. Eight patients (1.9%) developed massive and persistent post-transplant ascites and/or hydrothorax. CONCLUSION: The use of donors aged more than 60 years makes it possible to maintain high standards of patient and graft survival that is not only due to the optimisation of immunosuppressive protocols, but also to improvements in surgical techniques, intensive care and the management of surgical complications.

Adolescent↗
PubMedDate not supplied

Peritoneal dialysis in children with spina bifida and ventriculoperitoneal shunt: one center's experience and review of the literature.

OBJECTIVE: The goal of this paper was to review the viability of peritoneal dialysis (PD) in patients with spina bifida and/or ventriculoperitoneal shunt (VPS). SETTING: Pediatric dialysis unit in a tertiary-care hospital. DATA SOURCE: The course and outcome in 9 children, 5 from the authors' experience and 4 from reported experience, are analyzed. RESULTS: One patient died of a cause unrelated to PD or VPS, 2 were transferred to hemodialysis because of recurrent peritonitis, 1 discontinued PD transiently, 2 were transplanted, and 3 continue on PD. Six of these 9 children had a functioning VPS, and none presented evidence of ventriculitis or VPS dysfunction, even though 4 had PD-related peritonitis. One child presented with a massive PD-related hydrothorax. CONCLUSIONS: (1) Having a VPS is not an absolute contraindication to PD; the available data support the viability of PD in patients with spina bifida and/or a VPS. (2) If cerebrospinal fluid diversion is needed simultaneously or after starting PD, an extraperitoneal site should be a better choice than VPS. This should avoid the risk of intra- and postoperative infection in the PD catheter secondary to surgical intervention for VPS insertion. (3) Loss of peritoneal function is a potential late risk related to cerebrospinal fluid and PD. (4) Spina bifida patients on PD present specific diagnostic challenges due to overlapping symptoms (e.g., vomiting, abdominal tenderness, fever) secondary to PD- or VPS-related complications (e.g., peritonitis, visceral injury by devices) or primary disease (e.g., neurogenic bladder, pyelonephritis), with inherent risks of delaying adequate treatment. Cloudy peritoneal effluent is an early indication of peritonitis, although it is not specific. (5) Early evaluation by a pediatric surgeon and a neurosurgeon is required for effective management of complications and selection of more efficient individualized therapeutic alternatives. Prompt treatment of complications is crucial. A registry of children with spina bifida on PD and the accumulation of a large population followed up for longer periods will provide an objective assessment of their problems and management.

Adolescent↗
PubMedDate not supplied

Pleural effusion as a complication of intrathoracic goitre.

The authors report their experience with a case of bilateral pleural effusions as a complication of intrathoracic goitre. They then go on to examine all the possible causes of this phenomenon. After discussing the anatomy of the superior mediastinum, they conclude that hydrothorax related to intrathoracic goitre could be the result of pressure of the mass on venous structures, especially on the superior vena cava, or on the intramediastinal lymphatic vessles, or, as in the case reported, on both.

Aged↗
PubMed1992

Efficacy of CAPD as the primary treatment for end-stage renal failure in children.

In the 6 years before this paper, all children presenting with end-stage renal failure (ESRF) in Northern Ireland were electively commenced on continuous ambulatory peritoneal dialysis (CAPD). In that period, 22 patients were treated, 16 received renal transplants and 6 remained on CAPD. Active treatment was withdrawn in 1 child due to obliterative peritonitis. There were no deaths. One incident of peritonitis was documented per 11.6 patient treatment months. Recurring peritonitis lead to catheter replacement in 3 patients. Other problems encountered were catheter exit site infections, hernia formation and in one instance, hydrothorax. Peritonitis was more common in children under 2 years of age as was undernutrition, growth retardation and developmental delay. Home CAPD can be recommended as a viable first option treatment for childhood ESRF where suitable haemodialysis facilities are not easily accessible.

Adolescent↗
PubMed2003

Outcome in children on chronic peritoneal dialysis.

In this retrospective study, we evaluated the causative factors, outcomes, and complications of therapy in 35 patients (16 girls, 19 boys) started on chronic peritoneal dialysis (CPD) between 1997 and 2002. Average age at initiation of CPD was 9.3 +/- 4.4 years. All patients started on continuous ambulatory peritoneal dialysis (CAPD). Nine patients switched to ambulatory peritoneal dialysis (APD) during the follow-up period. The most common cause leading to end-stage renal disease (ESRD) in the patients was reflux nephropathy (22.9%). The major complication during therapy was peritonitis, with 41 episodes seen in 17 patients (1 episode per 18 patient-months). Of the children on APD, 7 developed 17 episodes of peritonitis (1 episode per 8.3 patient-months); of the children on CAPD, 10 developed 24 peritonitis attacks (1 episode per 24.9 patient-months). The other complications were inguinal hernia in 3 patients, subcutaneous leak in 4 patients, dialysate leak in 2 patients, pericardial effusion in 1 patient, umbilical hernia in 1 patient, hydrothorax in 1 patient, and cuff protrusion in 3 patients. During the follow-up period, 4 patients died owing to sepsis or cardiopulmonary complications. Only 1 patient was transferred to hemodialysis (owing to persistent Candida peritonitis). We think that CPD therapy is a good choice of treatment modality in the management of children with ESRD.

Adolescent↗
PubMed1992

[Persistent müllerian duct syndrome with seminoma: report of a case].

A case of persistent Müllerian duct syndrome associated with seminoma is reported. A 22-year-old man was admitted with the chief complaint of left flank colicky pain. Physical examination revealed huge abdominal mass and absence of left intrascrotal contents. Right hydrothorax and left ureteral calculi were pointed out with radiography. The abdominal tumor was reduced by effective chemotherapy. Extirpation confirmed the presence of seminoma and persistent Müllerian duct structure. This case showed left testicular transverse ectopia. In our review of the Japanese literature, 16 cases of transverse testicular ectopia accompanied with testicular tumor are reported.

Adult↗
PubMed2004

[Intensive care and treatment of severe ovarian hyperstimulation syndrome].

OBJECTIVE: To investigate the clinical manifestations, pathogenesis and treatment of severe ovarian hyperstimulation syndrome (OHSS). METHODS: The clinical data of 20 OHSS patients were analyzed retrospectively. RESULTS: Severe OHSS occurred after controlled ovarian hyperstimulation for superovulation. The major manifestations of OHSS included abdominal distension, nausea, ascites, hydrothorax, oliguria, concentrated blood, acid-base and electrolytes, disturbance, azotemia, thrombosis etc., which could be controlled by volume expansion with albumin, low-molecular-weight dextran, 6% Haes, abdominal and thoracic drainages or even early pregnancy termination. CONCLUSION: Preventive measure of OHSS is very important, and the patients must be treated timely and correctly once OHSS occurs.

Adult↗
PubMedDate not supplied

Concentration of galegine in Verbesina encelioides and Galega oficinalis and the toxic and pathologic effects induced by the plants.

Verbesina encelioides administered to sheep by gavage induced clinical signs of toxicity and pathologic lesions identical to those induced by Galega officinalis. Sheep had compromised respiratory function with shallow, rapid respiration and frothy exudate from the nares. Affected animals necropsied at time of death presented with hydrothorax with as much as 2 to 3 L of straw-colored thoracic fluid with fibrin tags and congestion and edema of the lungs. The trachea and lung airways contained frothy material with fibrin strands. In some cases, subendocardial hemorrhage of the left ventricle was present. Galegine, a guanidine compound believed to be responsible for these effects, was found at an average concentration of about 0.46% in Galega and at 0.08% in the Verbesina collection that induced toxicosis. While G. officinalis is a known poisonous plant, its very limited distribution in the U.S. causes it to be of minor importance. V. encelioides, however, is widely distributed in the U.S. and presents a potential hazard for grazing livestock. Verbesina may have been responsible for past livestock deaths in the U.S., and thus should be classified as a poisonous plant.

Animals↗