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Unventilated airway is time-dependently constricted in paralyzed dogs.

BACKGROUND: Apnea has been reported to produce bronchoconstriction and to cause hypoxia, hypercapnia, and modulation of vagal afferent nerves, which also change airway tone. In this study, the authors determined the mechanism of apnea-induced bronchoconstriction. METHODS: Twenty-eight dogs anesthetized and paralyzed were assigned to four groups (n = 7 each): apnea after artificial ventilation with 50% and 100% O2 groups (apnea-50% O2 and apnea-100% O2 groups, respectively), an apnea plus vagotomy group (fraction of inspired oxygen [FiO2] = 1.0), and a one-lung ventilation group (FiO2 = 1.0). The trachea was intubated with a single- or double-lumen tube in the three apnea groups or the one-lung ventilation group, respectively. The bronchial cross-sectional area (BCA) was assessed by the authors' bronchoscopic method. In the apnea-100% O2 and apnea plus vagotomy groups, a respirator was turned off for 5 min to produce apnea. In the apnea-50% O2 group, apnea was produced for 3 min. In the one-lung ventilation group, the right lumen was blocked for 5 min, and 15 min later, the left lumen was blocked for 5 min. BCA, arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2) were assessed every minute. RESULTS: The BCA in intact dogs time-dependently decreased by approximately 20% and 40% at 3 and 5 min after apnea started, respectively, whereas they did not in vagotomized dogs. In the apnea-50% O2 and apnea-100% O2 groups, bronchoconstriction could occur without hypoxemia, although hypercapnia was observed in all dogs. In the one-lung ventilation group, despite the fact that PaCO2 increased by only 2 mmHg without hypoxemia, unventilated BCA time-dependently decreased by 33.6 +/- 10.3%, whereas ventilated BCA did not. CONCLUSION: The current study suggests that the unventilated airway may constrict spontaneously. In addition, the airway constriction could be vagally mediated but not due to hypoxia and hypercapnia.

Animals↗

Constriction of the internal nasal valve in rhinoplasty: treatment and prevention.

The anatomy and functional physiology of the internal nasal valve and the potential problems that may develop with it during rhinoplasty are discussed. The operative maneuvers that may compromise the nasal valve serve as a basis for explaining a treatment approach. Treatment primarily deals with the problems generated by scar contraction, excision of lining and cartilage, and malposition of various nasal parts. In rhinoplasty, one must preserve the integrity of the internal nasal valve by preventing scar constriction and maintaining cartilage support. All intranasal incisions should be closed carefully with meticulous suturing. The surgeon should strive to preserve the medial attachment of the upper lateral cartilage to the septum. The caudal border of the upper lateral cartilage should not be trimmed. Lining should not be excised at the level of the internal valve, or distally. If scar constriction occurs or cartilage instability develops, the goal of treatment is restoration of valve function by excision of all scar tissue, repositioning the cartilage framework, and reconstruction using full-thickness and composite skin-cartilage grafts. The value of the intracartilaginous incision in preventing injury to the internal nasal valve is emphasized. Many of the established procedures in rhinoplasty that may endanger the nasal valve are discussed.

Cicatrix↗

CT in tuberculous constrictive pericarditis.

Constrictive pericarditis (CP) and restrictive cardiomyopathy have the same pathophysiological disorder (impaired diastolic filling) and a similar presentation. To determine the value of a noninvasive technique, CT, in differentiating between the two, we reviewed the CT scans of 212 patients with clinical signs and symptoms of CP and/or restrictive cardiomyopathy, after 26 cases that did not proceed to surgery were excluded. Computed tomography showed pericardial thickening (greater than 3 mm) in 157 patients with proven tuberculous CP. In two children with proven constriction, the pericardium measured between 2 and 3 mm. We determined that pericardial thickening, in the correct clinical setting, is the only CT sign necessary to diagnose CP. Other CT signs, inferior vena cava dilatation (97%), and deviation of the interventricular septum (15%) were confirmatory. Computed tomography accurately differentiates between CP and restrictive myocardial disease, making more invasive modalities such as cardiac catheterization and endomyocardial biopsy, with few exceptions, unnecessary.

Adolescent↗

Giant organized pericardial hematoma producing constrictive pericarditis: a case report and review of the literature.

Massive organized pericardial hematoma secondary to blunt trauma is extremely rare. We report a case of a 69-year-old man referred with refractory ascites who was found to have a 10 x 6 x 8 cm organized pericardial hematoma with hemodynamic characteristics consistent with constrictive pericarditis. The cause was attributed to blunt chest trauma associated with a fall 3 years previously. Excision of the mass and removal of the constricting epicardium relieved his symptomatology. A review of the literature is included.

Accidental Falls↗

Calcific constrictive pericarditis in Degos' disease.

A 31-year-old woman presented with symptoms and signs of constrictive pericarditis. She had a history of Degos' disease, a rare disorder characterized by skin and bowel lesions thought to be secondary to vasculitis. A chest roentgenogram showed extensive calcification of the pericardium. Although pleural and pericardial involvement has been reported in this disease, constrictive pericarditis is most unusual, and radiographically demonstrable calcification of the pericardium has not been reported previously.

Adult↗

Echocardiographic diagnosis of effusive-constrictive pericarditis due to staphylococcal pericarditis after cardiac surgery.

Two weeks after coronary artery bypass surgery, a 43-year-old man was readmitted with fever, pneumonia, left pleural effusion, and pericarditis. Echocardiography showed a localized posterior pericardial effusion, pericardial thickening, and bulging of the ventricular septum toward the left ventricle. Right-sided catheterization indicated pericardial constriction. Effusive-constrictive pericarditis was confirmed at surgery. Cardiac imaging played an important role in diagnosis of this unusual complication of cardiac surgery.

Adult↗

Pressure changes within the cauda equina following constriction of the dural sac. An in vitro experimental study.

In order to register pressure changes within the cauda equina, a highly sensitive pressure measuring catheter was inserted through a hole in the dural sac. Its tip was placed among the nerve roots of the cauda equina at levels L2, L3, and L4 in seven freshly removed human specimens. The cross-sectional area of the dural sac then was decreased gradually by constriction of a circular clamp. The inside diameter of the clamp and the corresponding area was determined when further reduction of the circumference of the clamp caused the first signs of a pressure increase, the critical size, among the nerve roots. The average critical size was 76.9 mm2 at the L2 level, corresponding to a diameter of 11.4 mm At the L3 level, the corresponding figures were 71.5 mm2 and 11.1 mm, and at the L4 level 64.8 mm2 and 10.6 mm, respectively. It seemed reasonable to assume that the critical sizes determined in this way could be threshold values below which a further constriction of the size of the dural sac would cause an impairment of the circulatory and/or the nerve function of the cauda equina.

Aged↗

Diastolic heart failure: restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade: clinical and echocardiographic evaluation.

An understanding of the basic principles of diastolic function is important in order to recognize diseases that may result in diastolic dysfunction and diastolic heart failure. Although uncommon, restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade are among the disorders that may affect primarily diastolic function with preservation of systolic function. Diastolic heart failure may manifest with chronic nonspecific symptoms or may present with acute hemodynamic compromise. Echocardiography plays a vital role in the diagnosis of diastolic dysfunction and differentiation of these disease processes. It also provides a basis for clinical decisions regarding management and surgical referral. This review summarizes the clinical features, pathophysiology, and hemodynamic and echocardiographic signs of restrictive cardiomyopathy, constrictive pericarditis, and cardiac tamponade.

Cardiac Tamponade↗

Early development of severe constrictive pericarditis after coronary bypass grafting.

A 61-year-old patient developed severe constrictive pericarditis with exertional dyspnea, 3 weeks after coronary bypass surgery. The diagnosis was confirmed by echocardigraphy and computed tomography examination. Despite the short duration of the disease, the pericardium showed a thickness of about 1 cm. Because initial treatment with steroids, diuretics and antiinflammatory drugs was of no avail, the patient underwent pericardiectomy, with a satisfactory outcome. The relatively rapid progress of constriction and the marked thickness of the pericardium that developed after a short period of time are emphasized.

Coronary Artery Bypass↗

Effusive-constrictive calcific pericarditis associated with Streptococcus salivarius. Case report and review of the literature.

We report the case of a 40-year-old patient presenting with a 6-month history of dyspnea and edema, with significant worsening of his clinical manifestations for the 2 weeks before admission to our department. During this 14-day preadmission period, continuous positive airway pressure (CPAP) was prescribed elsewhere for management of a working diagnosis of obstructive sleep apnea. The patient presented to us hemodynamically compromised. Management of the patient included emergency cardiac surgery for tamponade caused by effusive-constrictive, calcific pericarditis in addition to antimicrobial treatment as a result of the growth of Streptococcus salivarius from the pericardial fluid. This is the first report in the literature of association of this microorganism with pericarditis. The use of CPAP made the patient's symptoms worse as a result of an increase of the intrathoracic pressure, which was a pathophysiological mechanism, added to the interference of the localized pericardial effusion and the effect of the pericardial constriction. In an era of rapidly increasing use of CPAP systems, clinicians should be aware of their possible detrimental effects on patients with some types of cardiopulmonary diseases.

Adult↗

Spindle-shaped constriction and propagated dilation of arterioles during cortical spreading depression.

A dual illumination technique was used to examine the behavior of parenchymal arterioles of the cortex during cortical spreading depression in six cats. K+ produced a wave-ring spread of optical density changes concentrically from the injection site. At locations where the wave was passing, arterioles first constricted at one or two spots (55+/-43% of control), forming a spindle-shape in the early phase of cortical spreading depression, and then markedly dilated (155+/-57% of control) within 1 min. The dilation started at the constricted spots, propagated bidirectionally and finally resulted in full-length dilation of the arteriole. Although it varied in magnitude and time-course, this arteriolar behavior was observed in all six cats. Despite these changes, no associated downstream tissue microvascular flow changes were discernable.

Animals↗

Constrictive pericarditis following mild non-penetrating trauma.

A case of constrictive pericarditis developed within twenty-four days of mild, blunt thoracic trauma. Rapid progression from traumatic pericarditis to constriction is documented with clinical evidence, electrocardiographic changes and cardiac catheterisation data. Other manifestations of pericardial reaction after blunt chest trauma are reviewed briefly.

Child↗

Vacuum constriction devices in erectile dysfunction: acceptance and effectiveness in patients with impotence of organic or mixed aetiology.

OBJECTIVE: To investigate the value of vacuum constriction devices in the treatment of erectile dysfunction. PATIENTS AND METHODS: A total of 67 patients were treated with vacuum constriction devices. The impotence was of organic origin in 36 men (54%) while in the remaining 31 (46%) it was of mixed aetiology (organic and psychological factors). Forty-seven patients continued to use the device at home for the duration of the practice period. RESULTS: All 67 patients underwent a vacuum test which resulted in nearly half of them achieving an erection sufficient for intercourse. Adequate erections were achieved in 34 of 47 (72%) patients who used the device at home during the practice period. In the group of patients with organic impotence (venous leakage), rigidity was better and the frequency of intercourse higher than in patients with diabetes and in those with neurogenic disorders. CONCLUSION: These findings support further the role for vacuum devices for the treatment of erectile dysfunction in carefully selected patients.

Adult↗

Indomethacin for the treatment of polyhydramnios: a case of constriction of the ductus arteriosus.

Prenatal administration of indomethacin for the treatment of polyhydramnios at 27 weeks' gestation resulted in the rapid restoration of normal amniotic fluid volume. However, after 16 days therapy, fetal echocardiography revealed constriction of the fetal ductus arteriosus which did not reverse during the 17 days after the therapy was discontinued. The constriction resulted in right heart failure but no long-term effects on the infant after birth. Indomethacin is a powerful treatment for polyhydramnios but its use requires close monitoring of the fetal heart.

Adult↗

Is it constrictive pericarditis or restrictive cardiomyopathy? A systematic approach.

In this case review, the authors propose a fluent diagnostic algorithm for the consideration and therapeutic approach to either constrictive pericarditis or restrictive cardiomyopathy. Additionally, while focusing on the differential diagnosis of these clinically vexing entities, the authors outline the therapeutic expectations from surgical pericardiectomy in constrictive pericarditis.

Adult↗

Constrictive epicarditis after open heart surgery: the turtle cage operation.

A 60-year-old man developed constrictive epicarditis within 1 year after isolated mitral valve replacement (MVR). At reoperation, decortication of the thick epicardial layer resulted, impossible without a high risk of injury of the myocardium and major coronary arteries. Therefore, multiple longitudinal and transverse incisions were performed on the epicardial peel, which at the end acquired a turtle cage appearance allowing myocardial reexpansion, relief of constriction, and restoration of adequate hemodynamics.

Fibrosis↗

Ultrasonographic evaluation of fetlock annular ligament constriction in the horse.

The diagnosis of restriction of free movement of the flexor tendons through the fetlock canal usually rests on the characteristic clinical appearance of this condition, or airtendography. In a series of seven normal Warmblood horses and 16 diseased horses of various breeds, the efficacy of ultrasonography in the diagnosis of this condition was determined. In normal limbs, the annular ligament is a very thin structure usually not visible on sonograms. In diseased limbs, ultrasonography outlined flexor tendon injury, distension and thickening of the digital sheath, peritendovaginal tissue proliferation and thickening of the annular ligament. Four different types of constriction syndrome were noticed. The first type (nine cases), was characterised by thickening of the annular ligament and distension of the digital sheath; the second type (three cases) was dominated by distension of the digital sheath; the third type (three cases) was characterised by superficial digital flexor tendon injury and thickening of the annular ligament and in the fourth type (one case), the constriction resulted from distension of the digital sheath and extensive peritendovaginal tissue proliferation.

Animals↗