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PubMedDate not supplied

Disseminated coccidioidomycosis with rapid progression to effusive-constrictive pericarditis.

This case reports coccidiomycosis presenting as pericarditis with tamponade rapidly progressing to effusive-constrictive pericarditis and death over 72 hours. Coccidiomycosis pericarditis is a rapidly progressing disease requiring early and complete pericardiectomy to avoid the hemodynamics of constriction. We illustrate the use of echocardiography in this case and demonstrate the histopathology. We review the literature and discuss therapy and management. Coccidiomycosis is often clinically unsuspected and unrecognized by the health care worker unfamiliar with the disease process.

Adult↗
PubMed2001

Constrictive tuberculous pericarditis in a HIV-positive patient.

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomy was performed. The therapeutical approach is discussed and the literature is reviewed.

Adult↗
PubMed2000

Constrictive pericarditis from an embolized hypodermic needle: radiographic, CT and MR imaging findings.

We present the radiographic, computed tomographic (CT), and magnetic resonance (MR) findings in a woman with constrictive pericarditis due to an embolized hypodermic needle. The chest films revealed pleural effusions but no foreign body. The CT showed pericardial thickening and a linear foreign body of metallic attenuation in the right ventricular apex, and MR imaging revealed a signal void with magnetic susceptibility artifact. This case illustrates the capabilities and limitations of CT and MR imaging in hypodermic needle-induced constrictive pericarditis.

Adult↗
PubMed2001

Myositis, polyserositis with a large pericardial effusion and constrictive pericarditis as manifestations of chronic graft-versus-host disease after non-myeloablative peripheral stem cell transplantation and subsequent donor lymphocyte infusion.

The clinical features of chronic graft-versus-host disease (cGVHD) following a non-myeloablative peripheral blood stem cell (PBSC) transplant may differ from those that occur after a conventional allograft. We describe a man with Hodgkin's disease refractory to chemotherapy and radiotherapy who was transplanted from an HLA-identical brother, who developed cGVHD characterised, in particular, by polymyositis, polyserositis with a large pericardial effusion and constrictive pericarditis, 1 month after donor lymphocyte infusion for relapsed disease. Constrictive pericarditis has not been previously reported after a conventional allograft, and none of these features have been reported after a non-myeloablative transplant. The course of cGVHD necessitated potent immunosuppression leading to the presumed loss of graft-versus-lymphoma (GVL) effect.

Adult↗
PubMedDate not supplied

A rare association of epidermal nevus syndrome and ainhum-like digital constrictions.

Epidermal nevus syndrome is an unusual occurrence of epidermal nevi with central nervous system (CNS), eye, and skeletal developmental abnormalities. We report an as yet undocumented association of generalized epidermal nevus with striate keratoderma, ainhum-like digital constriction, and autoamputation of the right fifth toe in a 10-year-old girl. The excellent response to oral acitretin with softening of the constrictions is also highlighted.

Abnormalities, Multiple↗
PubMed2002

Constrictive pericarditis localized to left ventricle presented with left pleural effusion: a case report.

An 18-year old woman presented with progressive dyspnea and cough. Physical examination revealed decreased breath sounds at the left hemithorax and distant heart sounds with no murmurs or rub. Electrocardiogram revealed low voltage. Chest X-ray showed unilateral left-sided pleural effusion with no cardiomegaly. Transthoracic echocardiogram showed thickened pericardium localized throughout the left ventricle impairing the diastolic filling. Doppler waveforms were suggestive of localized constrictive pericarditis. A computerized tomographic scan of the chest confirmed the presence of unilateral pleural effusion with thickened pericardium surrounding the left ventricle. The patient's symptoms and signs were related to localized constrictive pericarditis and improved following surgery.

Adolescent↗
PubMed2001

Simultaneous anterior and posterior interosseous nerve paralysis with several hourglass-like fascicular constrictions in both nerves.

A patient with simultaneous anterior and posterior interosseous nerve paralysis was treated surgically with interfascicular neurolysis and found to have several hourglass-like fascicular constrictions in both nerves. Anterior and posterior interosseous nerve paralyses with hourglass-like fascicular constrictions have been described previously, but not the combination of the two.

Adult↗
PubMed2000

[Constrictive pericarditis--a differential diagnosis in therapy refractory ascites].

HISTORY AND FINDINGS: A 62-year-old woman with refractory ascites and histologically proven liver cirrhosis was admitted for implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS). Another 44-year-old man presented for evaluation of a liver disease of unknown origin with refractory ascites. DIAGNOSIS, TREATMENT AND COURSE: In both patients abdominal ultrasound showed a dilatation of the inferior caval vein and the liver veins. There was no splenomegaly present. In the side projection of the chest X-ray major calcifications of the pericardium were found pointing to the diagnosis of constrictive pericarditis. Diagnosis was proven by combined left and right heart catheterization demonstrating diastolic dip-plateau-phenomenon. The women was treated successfully by pericardiectomy. CONCLUSIONS: In patients with refractory ascites, dilated jugular veins and dilated liver veins constrictive pericarditis must be suspected. Pericardial calcifications in chest X-ray often given further evidence for the diagnosis which helps to avoid further evaluation of a primary liver disease. The treatment of choice is early surgical pericardiectomy, whereas shunt procedures are not indicated.

Adult↗
PubMed1983

[Unusual radiological findings after surgically treated constrictive pericarditis].

The radiological findings in three patients who had had surgery for constrictive pericarditis are reported: 1. acute myocardial dilatation after pericardectomy for constrictive pericarditis, with good restitution of ventricular function; 2. abnormal ventricular appearances after pericardial resection during childhood; 3. diastolic prolapse of the cardiac apex after fenestration of the pericardium.

Adult↗
PubMed1981

[Coronary angiography in constrictive pericarditis (author's transl)].

Normally, systolic movement of the coronary arteries results in, 1) shortening in length, thereby increasing tortuosity, and 2) movement of the arteries towards each other. In ten patients with constrictive pericarditis, several sections of the vessels were fixed. Vascular fixation was also observed in nine out of ten patients after aorto-coronary bypass operations, but only in right ventricular branches. Decreased movement of the coronary arteries was found in occasional cases of congestive cardiomyopathy with large ventricles and reduced ejection fractions, and sometimes in akinesia of the myocardium, due to coronary sclerosis. Fixation of several coronary branches can therefore contribute to the diagnosis of constrictive pericarditis.

Coronary Angiography↗
PubMed1990

Myocardial ischemia caused by distal coronary-artery constriction in stable angina pectoris.

BACKGROUND: In patients with stable coronary artery disease, the ischemic threshold for the production of effort-related angina is often quite variable. Although this feature is commonly attributed to changes in the caliber of coronary arteries at the site of stenosis, it could also be caused by the constriction of distal vessels, collateral vessels, or both. METHODS: In order to test this hypothesis, we studied 11 patients with stable angina, total occlusion of a single coronary artery that was supplied by collateral vessels, normal ventricular function, no evidence of coronary-artery spasm, and no other coronary stenoses. These conditions precluded the modulation of coronary flow by vasomotion at the site of the coronary stenosis. RESULTS: The ischemic threshold--assessed by multiplying the heart rate by the systolic blood pressure at a 1-mm depression of the ST segment during exercise testing--increased by 19 percent after the administration of nitroglycerin (P less than 0.05) and decreased by 18 percent after the administration of ergonovine (P less than 0.01). Ambulatory electrocardiographic monitoring of the patients when not receiving treatment detected 73 ischemic episodes that, in keeping with the history, showed variations of 25 to 52 beats per minute in the heart rate at a 1-mm depression of the ST segment; 12 episodes of sinus tachycardia exceeded the lowest ischemic heart rate by a mean (+/- SD) of 22 +/- 13 beats per minute without ST-segment depression. Furthermore, 21 ischemic episodes occurred at a heart rate more than 25 beats per minute below that at a 1-mm depression of the ST segment during exercise testing. Delayed and reduced filling of collateral and collateralized vessels associated with depression of the ST segment similar to that observed during ambulatory monitoring was detected on angiographic evaluation after the intracoronary administration of ergonovine in three patients. CONCLUSIONS: We propose that the constriction of distal coronary arteries, collateral vessels, or both may cause myocardial ischemia in patients with chronic stable angina.

Adult↗
PubMed2001

Does atrioventricular ring motion always distinguish constriction from restriction? A Doppler myocardial imaging study.

Constrictive pericarditis and restrictive cardiomyopathy can be difficult to differentiate on clinical examination. Cardiac ultrasonography is increasingly being used as the noninvasive method of choice for confirming the specific morphologic and hemodynamic abnormalities associated with either condition. Interrogation of atrioventricular valve plane motion by Doppler myocardial imaging (DMI) has been suggested as a valuable new approach that can help differentiate one from the other. We report the color DMI, pulsed DMI, and strain rate findings in 2 cases of constrictive pericarditis in which consideration of the annular motion pattern alone would not have allowed such differentiation.

Cardiomyopathy, Restrictive↗
PubMed2001

Respiratory variation of mitral and pulmonary venous Doppler flow velocities in constrictive pericarditis before and after pericardiectomy.

The objective of this study was to determine whether Doppler echocardiography is useful in assessing the effects of pericardiectomy in patients with constrictive pericarditis by studying the postoperative change in the respiratory variation of mitral inflow and pulmonary venous Doppler flows. The study population consisted of 35 cases with surgically proven constrictive pericarditis. Thirty-five patients had preoperative Doppler echocardiography, whereas 4 patients died of non-cardiac causes and 1 patient had a heart transplant before follow-up. Postoperative studies were performed at a mean of 1081 +/- 84 days (range 120-2700 days) after pericardiectomy. The mean (+/- SD) respiratory variation changed after surgery from a baseline value of 17% +/- 14% to 8% +/- 8% for peak mitral E velocity (P <.01); from 25% +/- 18% to 7% +/- 13% (P <.001) for pulmonary venous (PV) peak diastolic flow velocity, and from 21% +/- 13% to 11% +/- 13% (P =.009) for PV peak systolic flow velocity. The 23 patients who became asymptomatic after surgery had a significantly lower mean mitral and PV respiratory variation than the 7 patients who were NYHA class II (4% +/- 4% and 6% +/- 4% vs 21% +/- 6% and 19% +/- 10%, respectively, P <.0001 for both). Pulsed Doppler echocardiographic assessment of respiratory variation is useful for evaluating the outcome of pericardiectomy.

Aged↗
PubMed1995

Follow-up of vacuum and nonvacuum constriction devices as treatments for erectile dysfunction.

Of 20 men evaluated for erectile dysfunction (ED) for whom vacuum erection devices or constriction bands were recommended, only four experienced improvement of their erectile function by using the specific suggested method. Although use of a simple constriction band mechanism (e.g., a rubber band wound tightly around the penis) for men with brief erectile capacity has been described as a viable treatment, only one of five men who tried using it achieved any success. Three of six men who used a vacuum erection device were helped by it, particularly the men who suffered from only partial ED. Most patients did not follow through with the recommended treatment and stopped sexual activity, or belatedly returned for intracavernosal injections. The interviews revealed the pervasive influence of shame and demoralization regarding erectile problems, the importance of evaluation and treatment follow-up, and the necessity for careful, explicit, extensive, and concrete explanations and instructions regarding treatment options.

Adult↗
PubMed1950

The pathogenesis of hypertension induced by renal constriction.

Blood pressures were determined on forty-two young male albino rats and a basal level established. The rats were then divided into four groups and subjected to one of the following operations: (a) unilateral nephrectomy with exposure and handling of the opposite kidney; (b) unilateral nephrectomy and constriction of the remaining kidney with a silk figure-of-eight ligature; (c) unilateral renal constriction with a silk figure-of-eight ligature, the other kidney being left intact after exposure and handling; (d) unilateral nephrectomy and removal of the poles of the contralateral kidney (three-quarters nephrectomy). The animals were followed for 50 days, during which blood pressures were measured on twenty occasions, then killed by exsanguination under ether anesthesia. The organs were weighed according to a standardized procedure and studied histologically. Individual determinations of serum creatinine and of the hematocrit levels were made. Mean lines and frequency distributions of blood pressure were subjected to statistical analysis. A definitely significant increase in blood pressure developed in the group subjected to operation (b) within 4 days postoperative. In none of the other groups did hypertension develop. Analysis of the individual renal weights and creatinine levels indicates the independence of the development of hypertension from the total mass of functioning renal tissue. Nor is it dependent on the prevention of renal hypertrophy or the presence of fibrous perinephritis. The effect is probably due to the production of a disturbance of hemodynamics or tissue tension with the liberation of a pressor substance by the injured kidney.

Animals↗
PubMed2005

Evaluation of a modified Huddart/Bodenham scoring system for assessment of maxillary arch constriction in unilateral cleft lip and palate subjects.

The aim of this retrospective study was to describe the use and reliability of a numerical scoring system (modified Huddart/Bodenham) for the measurement of maxillary arch constriction in patients born with unilateral cleft lip and palate (UCLP), and to compare and contrast the new scoring system with the current methods of measuring treatment outcome, the Goslon and 5-year-old indices. Dental study models of 50 patients aged 5 years, and 50 patients aged 10 years, were scored using the 5-year-old and Goslon indices, respectively. Four examiners scored each set of models using the modified Huddart and Bodenham system, and repeated the scoring one month later. The intra- and inter-rater reliability of the numerical scoring system was assessed using the Kappa (kappa) statistic. The scores using the new method were correlated with the 5-year-old and Goslon scores using Spearman's (rho) and Kendall's (tau) rank correlation coefficients. There was a high level of intra-rater reliability for both the 5 (0.87: incisors, 0.91: canines, 0.88: molars) and 10 (0.9: incisors, 0.84: canines, 0.78: premolars/molars) year models. The weighted kappa values measuring inter-rater reliability were above 0.85 and 0.74, respectively, for all examiners. There was a statistically significant correlation between the modified Huddart/Bodenham scores and both the 5-year-old and Goslon scores in all cases (P < 0.001). It is concluded that the modified Huddart/Bodenham system provides an objective and reliable assessment of maxillary arch constriction. It has a high degree of correlation with the recommended standards, but is more versatile and sensitive to inter-arch discrepancies.

Child↗
PubMed2000

Age effects on the adaptive response of the female rat heart following aortic constriction.

Aging is associated with adaptations in the hearts of mammals that diminish the reserve capacity to meet hemodynamic loading challenges. To evaluate potential mechanisms of this phenomenon, the following hypotheses were tested: compared with hearts of adult rats, hearts of aged rats undergoing aortic constriction will exhibit (a) a lower concentration of myofibrillar proteins, (b) a reduced sensitivity to extracellular calcium, and (c) a reduced coronary perfusion. Female Fischer 344 rats aged 9 months (adult) and 27 months (aged) were assigned to control (C) or aortic-constriction (AC) groups and studied at 7 and 28 days post-AC, yielding six groups of rats. Analysis of variance was used to examine the effects of age and AC. The left ventricular (LV) mass/body mass ratio expressed a percentage of age-matched control value averaged AC-7adult, 111%; AC-28adult, 120%; AC-7aged, 106%; AC-28aged, 123% (AC, p < .01). As a percentage of adult rats values, the pressure-generating capacity of the LV averaged Caged, 99%; AC-7aged, 92%; AC-28aged, 92% (age, p < .05). There were no differences attributable to age or AC in either myofibrillar protein concentration or calcium sensitivity. There was, however, a significantly lower concentration of nonmyofibrillar protein (approximately 10%) in the hearts of all three groups of aged rats compared with the adult rats that was unaltered by AC. The percentages of LV myosin heavy chain in the alpha-isoform were Cadult, 77%; AC-7adult, 66%; AC-28adult, 66%; Caged, 45%; AC-7aged, 41%; AC-28aged, 32% (age, p < .01; AC,p < .01). Coronary flow per gram of tissue averaged 9% lower in all three of the aged groups compared with the adult rats and was not significantly affected by AC (age, p < .05). The data suggest that a reduction in nonmyofibrillar protein and a reduced coronary flow, rather than changes in calcium sensitivity or myofibrillar protein, are associated with an impairment in the adaptive response of the aged heart.

Age Factors↗
PubMed1997

Rheumatoid constrictive pericarditis.

A 73-yr-old woman with a 4 yr history of rheumatoid arthritis presented with the clinical features of congestive cardiac failure. She had a good early response to standard therapy although she subsequently developed recurrent biventricular failure. The preservation of good ventricular function on echocardiography in the face of clinical evidence of myocardial insufficiency raised the possibility of constrictive pericarditis, which was confirmed on cardiac catheterization. Constrictive pericarditis should be considered in patients with rheumatoid arthritis who develop unexplained cardiac failure. Early diagnosis requires a high index of suspicion and cardiac catheterization may be necessary to confirm the diagnosis. Medical treatment is largely ineffective and pericardiectomy should be considered.

Aged↗