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Congenital balloon digits in two neonates caused by constriction rings.

Balloon digits were found in two neonates with congenital constriction ring syndrome. The affected digits were the right long finger and right great toe. They were surgically treated at the age of 10 and 9 days, respectively. Morphologic improvement was dramatic after surgery. In cases with extensive enlargement, severe cyanosis, redness, and no subsidence of edema within several days after birth, early operative treatment may be necessary to maintain digit viability and prevent autoamputation due to circulatory embarrassment. It can also be helpful to prevent fibrosis of the subcutaneous tissue. Pathologic examination revealed marked proliferation of fibrous tissue and lymphatic vessels.

Constriction, Pathologic↗

A heterogeneous immunofluorescence staining for laminin-1 and related basal lamina molecules in the dorsal root ganglia following constriction nerve injury.

The bodies of primary sensory neurons and their satellite glial cells (SGCs) are limited by the basal laminae from extracellular matrix of the dorsal root ganglia (DRG). The basal laminae displayed uniform immunofluorescence staining for laminin-1 in the sections of rat intact (naive) DRG. A proximal or distal ligature of the spinal nerves resulted in a heterogeneous immunostaining for laminin-1 around neuron-SGC units in the sections of the corresponding DRG. The pattern of irregular laminin-1 immunofluorescence was more extensive in the ipsilateral than the contralateral DRG of the operated rats. The immunofluorescence for laminin-1 exactly coincided with binding of Concanavalin-A as well as immunostaining for type IV collagen in both naive DRG and DRG affected by nerve ligature. Nidogen immunostaining decreased or fully disappeared at the surface of the SGCs consistently with immunofluorescence staining for laminin-1, but retained or increased in the endothelial cells and ED-1 positive cells invaded the DRG affected by nerve ligature. The results indicate an alteration of the content of basal laminae surrounding the bodies of primary sensory neurons and their SGSs following nerve constriction injury. A modulation of the basal laminae may be related with other cellular and molecular alterations related with peripheral neuropathic pain, for example, expansion of sympathetic sprouts.

Animals↗

Pericardiectomy to treat constrictive pericarditis in a patient with hyperbilirubinemia: report of a case.

An 18-year-old man was admitted to our hospital with abdominal distension and edema of both legs. His total serum bilirubin level was 5.2 mg/dl. Echocardiography showed impaired left ventricular contraction, and computed tomography showed a thickened pericardium with massive pleural effusion and ascites. Cardiac catheterization showed both a dip and a plateau in the right ventricle pressure curve, based on which we diagnosed constrictive pericarditis. The selected treatment option was a pericardiectomy. We dissected the thickened pericardium, which was about 7-10 mm thick, and removed as much as possible through a median sternotomy without cardiopulmonary bypass. Postoperatively, his hemodynamics and renal dysfunction improved, and the serum bilirubin level gradually decreased. We report this case to show how pericardiectomy was effective not only for improving this patient's hemodynamics, but also for resolving his hyperbilirubinemia. The relevant literature is reviewed following this case report.

Adolescent↗

Urokinase increases the content and activity of matrix metalloproteinases 2 and 9 during in vivo constrictive arterial remodeling.

Perivascular application of urokinase to ballooned artery stimulating the formation of neointima and constrictive arterial remodeling increased the content and activity of matrix metalloproteinases 2 and 9 in vivo. Application of recombinant tissue plasminogen produced no such changes. It was demonstrated that urokinase stimulates expression of matrix metalloproteinases in vivo.

Angioplasty, Balloon↗

Intramyocardial foreign body: sewing needle with the uncommon clinical feature of constrictive pericarditis.

A rare case of intracardiac injury with a sewing needle causing constrictive pericarditis is reported. A 72-year-old woman was admitted with edema of the face and legs. A chest radiogram showed a needle-shaped metallic image overlying the cardiac silhouette. Computed tomography revealed the needle was located in the left ventricular myocardium, and also showed a thickened pericardium. Surgical removal of the needle and pericardectomy were performed simultaneously.

Aged↗

Constrictive pericarditis after cardiac surgery: report of three cases and review of the literature.

Constrictive pericarditis after cardiac surgery is a rare phenomenon occurring with an incidence of 0.2% to 0.3%. To date only 158 cases have been reported in the world literature. Symptoms include dyspnea (81%), chest pain (34%), and fatigue (29%). Peripheral edema (90%) and an elevated jugular venous pressure (86%) were the most common abnormal signs found during physical examination. Chest x-ray and ECG abnormalities were not helpful in making the diagnosis, and abnormal echocardiographic findings were reported in less than half of the cases. Computerized tomography and magnetic resonance imaging scans of the heart were usually of great diagnostic benefit. Diastolic equalization of cardiac pressures remains the sine que non for diagnosis. Oral steroids have been reported to favorably alter the course early in the disease, but pericardial stripping remains the definitive form of therapy. Operative mortality rates vary from 5.5% to 14.5%.

Cardiac Surgical Procedures↗

Right ventricular infarction. Clinical diagnosis and differentiation from cardiac tamponade and pericardial constriction.

Twelve patients with a clinical diagnosis of right ventricular infarction are described. All had acute inferior wall myocardial infarction associated with the bedside findings of jugular venous distension, clear lungs on auscultation, and arterial hypotension. Hemodynamically, there was elevation of right-sided filling pressures not explained by normal or minimally elevated pulmonary wedge pressures. Four patients had an incorrect diagnosis of acute cardiac tamponade. However, a review of the data showed that the hemodynamic features of right ventricular infarction more closely resemble those of pericardial constriction, a point that may be helpful in distinguishing right ventricular infarction from cardiac tamponade. Invasive and noninvasive techniques that exclude the presence of pericardial fluid and suggest enlargement and abnormal contractility of the right ventricle were helpful in establishing the diagnosis of right ventricular infarction in several patients.

Aged↗

Cholesterol pericarditis terminating as constrictive calcific pericarditis. Follow-up study of patient with 40 year history of disease.

This is a follow-up report of a patient with idiopathic cholesterol pericarditis (previously described in this Journal in 1961). The patient had had recurrent pericardial effusions since 1939, and died with calcific constrictive pericarditis some 40 years later. In the interim, the patient had an extended period (17 years) of symptomatic relief after pericardiotomy in 1958.

Cholesterol↗

Real time two dimensional echocardiography in constrictive pericarditis.

Real time two dimensional echocardiography was performed in five patients with constrictive pericarditis. The echocardiogram showed several typical features: (1) The heart was normal in size or decreased; the ventricles were small and the atria enlarged. (2) The pericardium was seen as a single or double dense rigid shell surrounding both ventricles and the apex; its immobility was striking. (3) The inferior vena cava and hepatic veins were greatly dilated in keeping with the severe clinical venous congestion. (4) Both interventricular and interatrial septa bulged into the left side of the heart on inspiration. (5) The atrioventricular valves were hypermobile. (6) A prominent ventricular diastolic filling half was seen. The two dimensional echocardiogram excluded other causes of severe cardiac failure such as congestive cardiomyopathy and valvular heart disease, while the dense immobile pericardial echo or echoes and the "normal" texture of the myocardial echoes made the diagnosis of restrictive cardiomyopathy unlikely.

Adolescent↗

Constrictive pericarditis after myocardial infarction. Sequela of anticoagulant-induced hemopericardium.

Hemopericardium developed following adequate (and not excessive) anticoagulation in a patient with acute transmural anterior myocardial infarction and an early pericardial friction rub. Drainage of a bloody effusion by pericardiocentesis did not prevent progression to constrictive pericarditis within one year. The clinical features of this case and of the only two other similar occurrences reported in the medical literature are described and lead to a discussion of therapeutic and preventive measures.

Anticoagulants↗

Constrictive pericarditis mimicking Budd-Chiari syndrome.

Budd-Chiari syndrome and constrictive pericarditis share many clinical and histologic features. Clinicians must continue to reassess patients when given histologic data that are not specific for a particular disease entity, so that subtle clinical differences are recognized, appropriate diagnosis made, and therapy instituted.

Adult↗

Constrictive pericarditis and pregnancy.

A case discussing the medical management of a 30-year-old gravid patient with recurrent pericarditis and pericardial constriction secondary to juvenile rheumatoid arthritis is presented.

Adult↗

Easy dissection of hard and thickened pericardium on constrictive pericarditis.

The keys to successful pericardiectomy for constrictive pericarditis are early operation and as complete a pericardiectomy as possible. With the high-speed burr it is easy and safe to dissect the calcified pericardium and define the epicardium even in a small operative field such as the inferior or posterior portion of the heart. This method has the important ability to perform very complete pericardiectomy.

Adult↗

Constrictive pericarditis from Nocardia asteroides infection.

Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ. It occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates surgical management. This report describes the course of a patient with chronic constrictive pericarditis from nocardia successfully treated with pericardiectomy and appropriate antibiotic therapy.

Humans↗

Autoradiographic analysis of 125I-substance P binding in rat spinal cord following chronic constriction injury of the sciatic nerve.

Using receptor binding and autoradiographic techniques, changes in Bolton-Hunter labeled 125I-substance P (125I-BH-SP) binding were determined in laminae I/II, V and X of rat lumbar spinal cord after chronic constriction injury (CCI) of the sciatic nerve. When compared to the sham-operated side of the control group, SP binding significantly increased ipsilateral to the CCI in laminae I/II at 5, 10 and 20 days after injury and in lamina V at 5 days after injury. Scatchard analysis was performed on the 125I-BH-SP binding to the NK1 receptor in laminae I/II of rats 5 days after generation of the CCI. A significant decrease in the Kd of 125I-BH-SP binding was observed in laminae I/II ipsilateral to CCI when compared with the control side (ipsilateral to sham surgery). There was no significant change in the Bmax in laminae I/II ipsilateral to CCI. The changes in 125I-BH-SP binding in the rat spinal cord that occurred after CCI were found in areas of the spinal cord that receive terminations of nociceptive primary afferent fibers. The increased affinity of the NK1 binding site that we report could result in an increase in SP receptor activation in laminae I/II. Such central changes in SP binding may contribute to the neuropathic pain syndrome observed in rats with the CCI.

Animals↗

Progressive apical pleural fibrosis: a 'constrictive' ventilatory defect.

We report two patients with bilateral apical pleural fibrosis which may be a form of benign asbestos-related pleurisy, one of these being steroid responsive. The pulmonary function defect of reduced lung volumes with raised gas transfer coefficient is characteristic and is best described as 'constrictive'.

Adult↗

The effect of intense arterial constriction on the survival length of an island flap; an experiment using abdominal flaps in rats.

Using rats' abdominal skin flaps, the effects of markedly decreased arterial inflow was investigated. An intense constriction was created with laminated silastic tubes. Survival length of the island flap was reduced by this manipulation and the differences with the control were statistically significant. It was ascertained experimentally that the flap went into necrosis distally and progressed proximally as the arterial inflow decreased. The possible risks of the sleeve technique are also briefly described.

Animals↗