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[Case of an annular pancreas in an adult].
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[Complications arising from a Cimino hemodialysis fistula].
Authors report on the possible complications with arteriovenous fistulas created for haemodialysis. Attention is drawn to the importance of angiography in demonstrating these complications.
[Male infertility with chromosomal abnormalities. I. XYY syndrome].
Chromosomal abnormalities are found in a considerably high percentage of cases of male infertility, in particular azoospermia. We report a case of the XYY syndrome and review the literature. A 36-year-old man, a factory hand, presented with infertility. He was safely delivered at term as a fourth child when his father was 41 years old and his mother 38. He had no delinquent or criminal record. His height was 179 cm, weight 75 kg and distance of extended hands 184 cm. No gynecomastia was noticed. Both testes were 8ml in size and growth of pubic hair and penis were normal. Severe oligozoospermia was identified in semen analysis. Seminal vesiculography showed pathological dilatation of the seminal vas end. The testicular biopsy specimens revealed spermatogenic arrest for the most part. Chromosomal analysis showed 47, XYY karyotype; and, two Y-chromatin was revealed in cultured lymphocytes. Though plasma gonadotropin levels were high, testosterone, estradiol, prolactin, TSH, GH, T3 and T4 levels were within normal limits. Pituitary reserve function for secreting gonadotropins and Leydig cell reserve function to secrete testosterone have been found to be almost normal.
[Features of topical diagnosis of postembolic lesions of the pulmonary trunk and main pulmonary arteries].
Radiopaque and radio-isotope findings in the pulmonary arterial channel in 43 patients with postembolic lesions of the pulmonary trunk and its major branches are reported. Angiographic and scanographic symptoms are described. The significance of detected systolic-pressure gradient in the probing of pulmonary vessels is demonstrated. Possible sources of diagnostic errors are analysed, and ways of eliminating them are suggested. Total and selective multipositional angiopulmonography is believed to be the principal method of diagnosing this condition, while pulmonary scanning only allows topical diagnosis in cases of markedly stenosed major pulmonary arteries.
Endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of chronic pancreatitis.
In a personal series of 188 patients with pancreatic disease referred for endoscopic retrograde cholangiography (ERCP), one or more ducts were cannulated in 168 patients; of the 168 patients; of the 168 patients, 19 had carcinoma and 149 had chronic pancreatitis. Abnormalities were found in 71 of the 149 patients with pancreatitis, either in the pancreatic duct, the bile duct, or both ducts. The demonstration of these abnormalities was of critical importance in planning the management of these patients. Ducts were normal in 78 patients. No benefit could be expected from operating upon these patients. It is concluded that approximately one half of the patients with chronic pancreatitis will have demonstrable lesions amenable to operation, and one half will not. ERCP is essential in the investigation and management of patients suspected of having chronic pancreatitis.
Vasomotions of the pulmonary blood vessels in the asphyxiations.
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[Sectorial nature of pancreatic pathology].
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[Discriminant analytic model for prognostic assessment of pregnancies at risk for premature labor].
We examined 114 women with preterm labor using discriminance analysis to assess predictive values in terms of prolongation of gestational age and gestational age at the time of delivery. We used parameters like medical history, clinical features, infections, Doppler sonography and cardiotocography. Maternal temperature, cardiotocographic findings, premature rupture of membranes, number of abortions and pregnancy terminations and cervical dilatation at the time of admission contribute significantly to predict prolongation of pregnancy (< or = as well as > 7 days). Our results from this analysis showed sensitivity and specificity of 0.70 and 0.97 and positive and negative predictive values of 0.89 and 0.91, respectively. We observed significant differences concerning parameters like preterm rupture of membranes, cervical dilatation, pathological bacteria in the vagina and pathological Doppler values between subsequent preterm and term deliveries in pregnancies with a prolongation of > 7 days was. Upon reclassifying our results, we obtained sensitivity and specificity of 0.69 and 0.89 and positive and negative predictive values of 0.78 and 0.84, respectively. Early prognostic assessment of preterm labor can be made with discriminance analysis. The results inspire us to perform a prospective examination of the therapy plan that we have obtained.
[Kawasaki disease; complications and clinical course. Apropos of 38 cases].
Between January 1978 and December 1991, 38 patients who fulfilled the CDC (Center for Disease Control) criteria for Kawasaki syndrome were admitted to our hospital. We reviewed the clinical data, laboratory tests, ECG and serial echocardiographic studies in order to establish the characteristics of the disease in our environment. There were 23 males and 15 females. The age at presentation ranged from 4 months to 10 years (mean 3.5 years). Extracardiac complications were as follows: arthritis in 12 patients, vesicular hydrops in 2, urinary tract infection in 1 and lymphocytic meningitis in 1. Cardiac involvement was frequent, with 35% of the patients being diagnosed with coronary pathologies (dilatation of coronary arteries in 9 and aneurysm formations in 4). The most usual location of these anomalies was in the left main coronary artery. By the end to the follow-up period, 71% of the lesions had disappeared. The time necessary for this regression was related to the size of the abnormalities. The high incidence of cardiac involvement make it necessary to follow these patients for a period of time in order to prevent or to treat the later occurring sequelae.
[Results of the Anderson-Hynes kidney/calix plasty in 102 ureteral efferent stenoses].
In 102 patients with ectasia of the renal calyx from degree I to III a pyelograft after Anderson-Hynes was performed. The leading clinical symptoms were, arranged according to frequency: flank pain, recurrent infections of the urinary tract, macrohaematurias, diffuse abdominal pain, palpable flank tumours. In general the diagnosis was made on the basis of the infusion urogramme; a retrograde pyelography was indicated only in cases of missing or insufficient excretion of the contrast remedy. According to the results of the operation apart from the Anderson-Hynes-graft in a lower pole vessel compressing the ureteral passage a ventral deposition of the anastomosis or resection of the lower pole vessel with or without simultaneous resection of the pole was performed. The results of the Anderson-Hynes pyelograft correlated with the degree of the preoperative ectasia of the renal calyx; with increasing degree of severity the good results decreased from 90% to 38%, whereas the bad results increased from 3% to 46%. Judging the success of the operation, a good correspondence between the clinical and radiological parameters was revealed in the degrees I and II. In degree III the numbers of cases were too slight, to secure a diverging tendency of these criteria.
[Angiographic course over 10 years of giant aneurysm of the circumflex artery].
Pathological dilatations of the coronary arteries are not exceptional and are called megadolichoartery, aneurysm or ectasia. Cases of marked arterial dilatation, although much rarer, are regularly reported following their discovery due to the impressive angiographic, echocardiographic or autopsy findings. However, their course, particularly in the long term, remains unclear. The authors report the case of a patient with a very large spindle-shaped aneurysm of the circumflex artery whose course was able to be followed over a period of ten years on three successive angiographic assessments performed for clinical coronary events. This follow-up was dominated by thrombosis of the aneurysm, extension of the aneurysmal disease and severe deterioration of left ventricular function.
[Aortic coarctation and the bicuspid aortic valve].
After the analysis of the long-term outcomes of aortic coarctation isolated resection the authors noted that many of the patients had valvular defects missed for diagnosis before the operation. ECG and X-ray of the heart established valvular defects in 37% of the operated patients. 61% of them had bicuspid valve associated in 80% of cases with pathologically dilated ascending aorta. Correlation-regression analysis showed the existence of a significant correlation between the width of the ascending aorta and age of the operated patient. This width in bicuspid valve patients was correlated with systolic and diastolic pressure, physical performance before surgery. Follow-up of patients after resection of aortic coarctation should be especially careful for patients with bicuspid aortic valve with dilatation of the ascending aorta and high arterial pressure.
[The morphological changes in the internal organs in hemochromatosis].
Visceral changes were studied by histological and electron-microscopic methods in cadavers of 18 subjects dead from hemochromatosis. Pronounced visceral changes in all cases represented a characteristic tetrad of signs: bronze-colored skin, pigmentary cirrhosis of the liver, involvement of the pancreas, and cardiomyopathy. In forensic medical practice hemochromatosis can be found in subjects who were probably genetically predisposed to it and, as a rule, had a history of alcohol abuse. Among the numerous complications of the disease, the most incident are cardiac pathology (dilatation cardiomyopathy) and diabetes mellitus with concomitant intoxications caused by various inflammations.
[Junctional syndrome responsible for prostatic urethral dilatation: a new pathological entity?].
The authors report two observations of monstrous ectasia of the prostatic urethra, in boys age 12, without any previous pathological history; discovered on at the time of major dysuria previous urinary troubles with chronic retention of 500 cl and 1.250 l respectively. In the absence of any organic obstacle, etiology relieves functional troubles. If functional explorations show a normal or hypertensive detrusor, then they discuss the possibility of vesico-sphincter dyssynergia or an obvious hypertension of the striated sphincter. From this moment onwards, purely intrinsic urethral functional trouble is plausible, all the more because the recovery was assured by treatments directed only at the urinary canal. In the first case, after surgical treatment owing to complex lesions (plastic reduction of the urethral ectasia preserving the posterior wall and respecting the striated sphincter) combined with diverticulectomies with urethral reimplantations), the patient recovered complete vesical waste removal at once, with normalisation of the flowmeter in six months. In the second case, a simpler treatment (sub-montanal urethrotomy of the principle) allowed a normalisation period of 10 months with complete vesical waste removal. The functional results are maintained after a period of nine and two years respectively. The integrity of the striated sphincter controlled post-operatively by the operatory gesture on the urinary canal and confronts the authors in the idea of intrinsic urethral pathology, although electronic microscopic examination may not have shown achalasia.
Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients.
BACKGROUND: Some dialysis patients have impaired left ventricular (LV) function without coronary artery disease. The pathologic changes and prognoses of these patients have not been well described. METHODS: We performed LV endomyocardial biopsies on 40 hemodialysis patients with dilated cardiomyopathy (DCM; an ejection fraction <50% and a left ventricular end-diastolic volume index >90 mL/m(2) without coronary artery disease), and on 50 nondialysis patients with idiopathic DCM as the control group. Following LV biopsies, the patients were followed-up for a mean of 3.1 +/- 2.3 years. RESULTS: The pathologic characteristics of the dialysis group were severe myocyte hypertrophy (the mean myocyte diameter across the nucleus: 37.6 +/- 10.5 mum vs. 25.6 +/- 7.7 mum, P= 0.001), myocyte disarray (30%), and extensive fibrosis (the mean percent area of left ventricular fibrosis: 22.3 +/- 18.4% vs. 21.3 +/- 14.6%, P= NS). These pathologic characteristics resembled the dilated phase of hypertrophic cardiomyopathy. In the dialysis group, a high percent area of LV fibrosis was the only significant predictor of cardiac death by multivariate analysis (P= 0.02). The 3-year cumulative event-free survival rate for cardiac death in dialysis patients with severe fibrosis (more than 30%) was 42%, while that for patients without severe fibrosis was 82% (P= 0.03). CONCLUSION: The pathologic characteristics of the heart in dialysis patients with DCM are interstitial fibrosis and severe myocyte hypertrophy with occasional disarray. The extent of LV fibrosis is a strong predictor of cardiac death. Careful follow-up and treatment are necessary for dialysis patients with a high percent area of LV fibrosis.
["Size of the heart" from pathological viewpoint--some pathological problems on cardiac hypertrophy and dilatation (author's transl)].
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