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PubMed1975

Constrictive pericarditis, intestinal lymphangiectasia, and reversible immunologic deficiency.

A patient with constrictive pericarditis, secondary intestinal lymphangiectasia, and protein-losing enteropathy was demonstrated to have the characteristic immunologic deficiency associated with intestinal lymphangiectasia: hypogammaglobulinemia, lymphocytopenia, cutaneous anergy, impaired allograft rejection. and diminished in vitro lymphocyte proliferative responses. Following surgical correction of the cardiac abnormality, the intestinal lymphangiectasia and protein-losing gastroenteropathy resolved and was accompanied by a slow but progressive return of normal immune function. This documented reversal of the immunologic deficiency in intestinal lymphangiectasia supports the concept that the immune defect in this syndrome is due to the excessive loss of lymphocytes and immunoglobulins into the gastrointestinal tract.

Adolescent↗
PubMed1985

Constrictive calcific pericarditis following coronary arterial bypass surgery.

A case of postsurgical constrictive calcific pericarditis is reported. The unusual features of this case are the short interval (two months) from surgery to the development of pericarditis and the involvement of the coronary arterial grafts, resulting in tearing of the vessels and the death of the patient during decortication.

Aged↗
PubMed1995

Efficacy of the vacuum constriction device in patients with corporeal venous occlusive dysfunction.

OBJECTIVES: The vacuum constriction device (VED) is an effective nonsurgical treatment for erectile dysfunction. Its efficacy in specific patient groups, however, has not been extensively studied. Only one study to date has examined the use of the VED in patients with corporeal veno-occlusive dysfunction (CVOD). This study used a mailed questionnaire and no statistical analysis of the data. The purpose of this study was to examine the efficacy of the VED in patients with documented CVOD. METHODS: From 1989 to 1992, 294 patients chose to use a VED as treatment for erectile dysfunction. All patients were evaluated with a thorough history and physical examination, hormonal testing, glucose tolerance testing, and nocturnal penile tumescence studies. Ninety-eight patients underwent additional vascular testing. When seen in follow-up, patients were asked to assess erection quality and overall satisfaction with the device. RESULTS: Fifty patients had documented CVOD (33 by cavernosometry, 16 by ultrasound, and 1 by cavernosography). Twenty-eight patients (56%) were satisfied, 13 patients (26%) were unsatisfied, and in 9 patients (18%) satisfaction could not be determined. Thirty-eight patients (76%) achieved an erection of at least 7 on a scale of 1 to 10. There was no relationship between the severity of disease (as measured by cavernosometry) and the rating of erection (Kruskal-Wallis test, P = 0.77) or satisfaction with the device (Fisher's exact test, P = 0.95). CONCLUSIONS: The VED is an acceptable nonsurgical treatment for patients with erectile dysfunction secondary to CVOD regardless of severity. Its success rate is comparable to other therapeutic modalities such as injection therapy.

Analysis of Variance↗
PubMed2003

Functional role of exogenous administration of substance P in chronic constriction injury model of neuropathic pain in gerbils.

Substance P (SP) acts as a transmitter of nociception in both the peripheral and the central nervous system. Because the NK-1 receptors in gerbils are comparable to those in humans, gerbil models could be used to study the role of SP in neuropathic pain. A modification of the rat chronic constriction injury (CCI) model of neuropathic pain was produced in male gerbils by placing four loose chromic catgut ligatures around the sciatic nerve. This procedure clearly resulted in mechanical hypersensitivity. Intraplantar injections of SP and the selective NK-1 receptor agonist, [Sar(9)-Met(O(2))(11)]-substance P (Sar-SP), to the paw ipsilateral to the nerve injury and intrathecal administration of these peptides produced paw-lifting behavior in the CCI gerbils in thermoneutral conditions. In sham-operated and nonoperated controls, no such effects were observed. Systemic administration of the NK-1 antagonist R116301 attenuated the SP and the Sar-SP-induced paw-lifting behavior in the CCI gerbils indicating the role of NK-1 receptors in these effects. Intraplantar injection of the highest dose of SP (200 ng) to the paw contralateral to the CCI produced lifting of the paw ipsilateral to the injury, indicative for spinal mechanisms especially since administration of SP to the ipsilateral front paw or even intracardially did not have any effect at all. The SP-induced responses were not antagonized by the NMDA antagonist MK801. These results indicate that the peripheral and spinal SP reveal an increased reactivity in a neuropathic pain model. This increased pain sensitivity seems to involve spinal NK-1 mechanisms.

Animals↗
PubMed2001

Vacuum constriction and external erection devices in erectile dysfunction.

The development of external erection devices has evolved as the social stigma surrounding the treatment of erectile dysfunction has gradually disappeared during the late twentieth century. Although the success of surgical and medical therapy for erectile dysfunction has been documented, especially since the introduction of sildenafil citrate, patient demand for an effective, noninvasive, drug-free management of erectile dysfunction has remained. As the population continues to age, acquiring the comorbidities commonly associated with erectile dysfunction, such as hypertension, diabetes mellitus, and atherosclerotic vascular disease, the demand for such treatment should persist. This article examines the development, mechanism of action, efficacy, and patient satisfaction with regard to vacuum constriction and external erection devices.

Constriction↗
PubMed1985

Severe constrictive pericarditis after single 16 MeV anterior mantle irradiation for Hodgkin's disease.

Severe constrictive pericarditis developed in 4 of 73 patients after single anterior 16 MeV mantle field irradiation for Hodgkin's disease. 3 patients (4.1%) died; the other had successful pericardectomy. Use of a single anterior mantle field of high-energy X-rays is clearly more hazardous than conventional opposed-field techniques, and the resulting radiation pericarditis is difficult to treat.

Adolescent↗
PubMed1987

Controlled trial of prednisolone as adjuvant in treatment of tuberculous constrictive pericarditis in Transkei.

In Transkei, 143 patients with active tuberculous constrictive pericarditis without significant pericardial effusion all received the same daily 6-month antituberculosis regimen of streptomycin, isoniazid, rifampicin, and pyrazinamide for 14 weeks followed by isoniazid and rifampicin. They were randomly allocated to receive in addition either prednisolone or placebo for the first 11 weeks; the comparison was double-blind throughout treatment and follow-up. In the 114 patients assessable up to 24 months, improvement was significantly more rapid in the prednisolone group, as shown by the rate of fall in the mean pulse rate and the rate at which jugular venous pressure and level of physical activity became normal. During follow-up, 2 (4%) of the 53 prednisolone and 7 (11%) of the 61 placebo patients died from pericarditis, and 11 (21%) and 18 (30%), respectively, required pericardiectomy. By 24 months 50 (94%) prednisolone and 52 (85%) placebo patients had a favourable status. 3 patients (1 prednisolone, 2 placebo) were normally active but were classified as not having achieved a favourable status. It is recommended that, in the absence of a specific contraindication, antituberculosis chemotherapy should be initially supplemented by steroids.

Adolescent↗
PubMed1989

Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions.

Immediately after balloon dilation of a fresh thrombotic coronary lesion, 5 patients had angina, ST segment elevation, and a striking reduction of blood flow in the dilated artery. A mean (SEM) pressure gradient across the dilated lesion of only 3(1) mm Hg and an average minimum lesion diameter of 1.7 mm indicated that the decline in resting blood flow was not due to obstruction at the site of the original lesion. Neither distal vascular emboli nor side branch occlusions were visible on the angiogram. An increase in distal coronary artery pressure during a subsequent balloon inflation suggested that the site of vasoconstriction was distal to the origin of collateral vessels. The syndrome lasted 48-80 min and was not reversed with nitroglycerin or thrombolytic drugs. Papaverine lessened the syndrome transiently on one occasion. Such microvascular constriction, caused by release of potent vasoconstrictors from the clot, may partly explain the failure of emergency angioplasty to reduce infarct size in acute myocardial infarction.

Acute Disease↗
PubMed1986

Annular constriction of the glans penis.

An otherwise healthy, 15-year-old white male adolescent presented with a hitherto unreported, traumatically induced, ringlike depression around the glans penis resulting from the circumferential entrapment of a fibrous strand within the glans during infancy. The surgical reconstruction of the lesion and the differential diagnosis of annular constricting lesions of the appendages are discussed.

Adolescent↗
PubMed2003

[Clinical decision making based on cardiac diagnostic imaging techniques (I). Diagnosis and therapeutic management of patients with cardiac tamponade and constrictive pericarditis].

Echocardiography, thoracic computed tomography, and magnetic resonance imaging are three valuable imaging techniques for the management and pathophysiological understanding of cardiac tamponade and constrictive pericarditis. However, these techniques should not be used independently from clinical findings. In this article we describe the findings that can be obtained with these imaging techniques, emphasizing how they should be integrated in the clinical context of the patient. Only the proper use of these imaging techniques can optimize the management of patients with pericardial disease.

Cardiac Tamponade↗
PubMed2001

Neuropeptide Y in trigeminal ganglion following chronic constriction injury of the rat infraorbital nerve: is there correlation to somatosensory parameters?

The aim of this study was to investigate neuropeptide Y (NPY) levels in trigeminal ganglia following infraorbital nerve injury. Two experimental procedures were performed in three groups of rats: a unilateral chronic constriction injury (CCI) to the infraorbital nerve (n=13), nerve manipulation without CCI (n=13) and unoperated controls (n=8). All rats underwent baseline and regular assessment of mechanical withdrawal threshold (Von Frey) and reaction to pin prick as well as free behavior evaluations. CCI to the infraorbital nerve induced significant hyperalgesia and allodynia within 9-12 days. At 6 days seven rats were euthanized and trigeminal ganglia harvested for immunocytochemical (ICC) studies. The study was ended at 14 days when all rats were euthanized and their ganglia harvested for ICC and radioimmunoassay (RIA) studies. An increase in NPY levels was seen in the ipsilateral ganglia of manipulated and CCI rats at 6 days, when rats displayed no pain-related behavior. At 14 days, ICC and RIA both detected significant increases in NPY levels in the ipsilateral ganglia of CCI and manipulated rats but not in unoperated controls. The possible roles of NPY in pain modulation and nerve injury are discussed in light of these findings.

Animals↗
PubMed1999

Free radicals contribute to the reduction in peripheral vascular responses and the maintenance of thermal hyperalgesia in rats with chronic constriction injury.

We previously reported that the time frame and the extent of the changes in the peripheral neurogenic inflammatory response in the skin area, innervated by an injured nerve, coincide with those of pain behaviours. We raised the possibility that common factors might operate to modulate neuropathic pain and peripheral neurogenic processes in rats with chronic constriction nerve injury (CCI). In the present study we examined the role of free radicals in modulating the neurogenic vascular response and thermal hyperalgesia in rats with CCI of the sciatic nerve. Free radicals, via an interaction with nitric oxide (NO) to form peroxynitrite, have previously been implicated in the maintenance of thermal hyperalgesia in CCI rats. In this study, we induced CCI of the sciatic nerve and the activity of xanthine oxidase (XO), which catalyzes the formation of superoxide anions, was measured in the injured nerve. In addition, we examined the effect of antioxidants on thermal hyperalgesia and on the neurogenic vascular response to substance P (SP) perfused over the base of a blister induced on the hind footpad skin which is innervated by the injured sciatic nerve. Compared with the sham operated group, CCI rats had a significantly higher XO activity in the injured sciatic nerve and significantly reduced thermal threshold and peripheral neurogenic vascular response to SP. Treatment with antioxidants, superoxide dismutase (SOD) or tirilazad significantly improved the neurogenic vascular response while tirilazad treatment significantly alleviated thermal hyperalgesia. The results therefore, suggest that free radicals are elevated in CCI animals and that they contribute to the maintenance of thermal hyperalgesia and the reduction in peripheral microvascular blood flow in the area innervated by the injured nerve. We raise the possibility that common mechanisms may govern the changes in neuropathic pain and in the peripheral neurogenic vascular responses in tissues innervated by the injured nerve.

Animals↗
PubMed1999

Effect of NGF and anti-NGF on neuropathic pain in rats following chronic constriction injury of the sciatic nerve.

The systemic administration of anti-nerve growth factor (NGF) antibodies can prevent local sensory hypersensitivity and block nociceptive fibers from sprouting into denervated adult rat skin. However, in the case of chronic constriction injury (CCI) in a rat, there is evidence that NGF reverses some effects of axotomy and alleviates thermal hyperalgesia. It is with this in mind that we investigated the influence of local anti-NGF and NGF on neuropathic pain and collateral sprouting caused by CCI. In our study, we looked at the effects to the ligated nerves after 30 consecutive days of local injections of anti-NGF and NGF. A high-dose of anti-NGF (1800 ng) was found to eradicate heat and cold hyperalgesia during postoperative days 16-28 and from days 8 to 34 after CCI, respectively. Our results show that a low-dose anti-NGF (18 ng) only mildly alleviates heat hyperalgesia but not cold hyperalgesia. There is evidence that a rebound phenomenon occurs for a short period of time after the anti-NGF injections cease. Results show that anti-NGF injections, whether in a high or low dose, significantly reduces the severity of autotomy or prevents the spread of collateral sprouting from the saphenous nerve into the sciatic innervation territory. In contrast, when a NGF (0.75 ng/g body weight) was applied to the ligated nerve immediately after the ligation, heat and cold hyperalgesia were eradicated during postoperative days 4-68 and from days 4 to 28, respectively. The results show that the effect of anti-NGF is delayed at the onset, is short in duration, and is dependent on the dosage. However, anti-NGF but not NGF blocked collateral sprouting and decreased the severity of autotomy, suggesting that anti-NGF may be a better potential alternative analgesic for the treatment of neuropathic pain in humans. The different initiation times to abolish thermal hyperalgesia by anti-NGF (delayed onset) and NGF (early onset) suggests that alterations in neurotrophic factors contribute to the development of behavioral hyperalgesia via a complex mechanism in CCI rats.

Animals↗
PubMed1999

Plasticity of sodium channel expression in DRG neurons in the chronic constriction injury model of neuropathic pain.

Previous studies have shown that transection of the sciatic nerve induces dramatic changes in sodium currents of axotomized dorsal root ganglion (DRG) neurons, which are paralleled by significant changes in the levels of transcripts of several sodium channels expressed in these neurons. Sodium currents that are resistant to tetrodotoxin (TTX-R) and the transcripts of two TTX-R sodium channels are significantly attenuated, while a rapidly repriming tetrodotoxin-sensitive (TTX-S) current emerges and the transcripts of alpha-III sodium channel, which produce a TTX-S current when expressed in oocytes, are up-regulated. We report here on changes in sodium currents and sodium channel transcripts in DRG neurons in the chronic constriction injury (CCI) model of neuropathic pain. CCI-induced changes in DRG neurons, 14 days post-surgery, mirror those of axotomy. Transcripts of NaN and SNS, two sensory neuron-specific TTX-R sodium channels, are significantly down-regulated as is the TTX-R sodium current, while transcripts of the TTX-S alpha-III sodium channel and a rapidly repriming TTX-S Na current are up-regulated in small diameter DRG neurons. These changes may provide at least a partial basis for the hyperexcitablity of DRG neurons that contributes to hyperalgesia in this model.

Animals↗
PubMed1999

Ultrastructural localization of increased neuropeptide immunoreactivity in the axons and cells of the gracile nucleus following chronic constriction injury of the sciatic nerve.

Neuropeptide plasticity in the gracile nucleus is thought to play a role in the development of neuropathic pain following nerve injury. Two weeks after chronic constriction injury of adult rat sciatic nerve, galanin, neuropeptide Y and calcitonin gene-related peptide immunoreactivities were increased in fibers and cells in the gracile nucleus ipsilateral to injury. At the electron microscopic level, this increased neuropeptide immunoreactivity was localized in myelinated axons, boutons, dendrites, neurons and glial cells. Galanin-, neuropeptide Y- and calcitonin gene-related peptide-immunoreactive boutons were frequently presynaptic to dendrites of both immunoreactive and non-immunoreactive neurons. However, no neuropeptide Y, galanin and calcitonin gene-related peptide messenger RNA was detected in the injured side gracile nuclei by in situ hybridization. These results show that partial nerve injury to the sciatic nerve induces increases in the content of galanin, neuropeptide Y and calcitonin gene-related peptide immunoreactivities in synaptic terminals within the gracile nucleus, which suggests that there may be increased release of these neuropeptides following sensory or spontaneous stimulation of large-diameter primary afferents following partial nerve injury, perhaps one mechanism involved in neuropathic pain. We also show an apparent transfer of these neuropeptides to the cells of the gracile nucleus, both neurons and glial cells, an intriguing phenomenon of unknown functional significance.

Animals↗
PubMed2001

Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation.

OBJECTIVES: The goal of this study was to evaluate the difference in the respiratory change from expiration to inspiration (%E) between pulsed Doppler mitral inflow (MV) and pulmonary venous flow (PV) velocities in patients with constrictive pericarditis (CP) and to describe the influence of atrial fibrillation (AF). BACKGROUND: The difference in %E between MV and PV velocities as well as the influence of AF on %E has not been well described. METHODS: Pulsed-wave Doppler transesophageal echocardiography (TEE) was performed with respiratory monitoring in 31 patients with CP and sinus rhythm (SR) and in 10 patients with CP and AF. The MV early (E) and late diastolic (A) velocities and their velocity time integral (VTI) as well as PV systolic (S) and diastolic (D) velocities and their VTI were measured. RESULTS: Regardless of the cardiac rhythm: 1) The MV-E velocity and E-VTI as well as PV-D velocity and D-VTI significantly decreased from expiration to inspiration; 2) the %E in PV-D velocity (27% in SR and 35% in AF) and D-VTI (38% in SR and 45% in AF) was significantly greater than that in MV-E velocity (18% in SR and 15% in AF) and E-VTI (21% in SR and 19% in AF), respectively; 3) the PV S/D and S/D-VTI significantly increased from expiration to inspiration. CONCLUSIONS: A significant respiratory variation was observed in both MV and PV velocities in CP, not only in patients with SR but also in those with AF. Moreover, the %E was greater in the PV velocities than it was in the MV velocities. Evaluation of the %E in the PV velocities using TEE can be a sensitive diagnostic strategy for evaluation of patients with CP, even in patients with AF.

Atrial Fibrillation↗
PubMed1984

Spontaneous contrast in the inferior vena cava in a patient with constrictive pericarditis.

A 66 year old black man was examined because of fatigue and progressive right heart failure. A striking finding on his echocardiogram was intense and slow-moving contrast in the inferior vena cava. Cardiac catheterization revealed constrictive pericarditis, and pericardiectomy was performed. Postoperatively, spontaneous contrast was no longer present. This case helps explain the origin of spontaneous inferior vena cava contrast.

Aged↗
PubMed2001

Tourniquet syndrome: a review of constricting band removal.

A constricting band causing tourniquet syndrome is a common problem that can cause much frustration and pain for both the patient and practitioner. The following review classifies and describes the different aspects of the treatment of this condition. We also describe a policy and procedure for the motorized removal of large bands by using a high revolutions per minute cutting device.

Constriction, Pathologic↗