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We have described the third case of pericarditis caused by anaerobic streptococci in children. Despite operative drainage and high-dose penicillin therapy, there was rapid progression to constrictive pericarditis. Complete pericardiectomy was life-saving.
Quercetin (Q), a flavonoid found in berries and onions, can reduce blood pressure in hypertensive animals and inhibit signal transduction pathways in vitro that regulate cardiac hypertrophy. We hypothesized that quercetin could prevent cardiovascular complications in rats with abdominal aortic constriction (AAC). Rats consumed standard or Q-supplemented chow (1.5 g Q/kg chow) for 7 days before AAC or sham surgery (SHAM, n = 15; AAC, n = 15; SHAMQ, n = 15; AACQ, n = 14). Fourteen days after surgery, plasma and liver Q concentrations were elevated (P < 0.05) and hepatic lipid oxidation was reduced (P < 0.05) in Q-treated versus untreated rats. Carotid arterial blood pressure and cardiac hypertrophy were attenuated (P < 0.05), and cardiac protein kinase C betaII translocation was normalized (P < 0.05) in AACQ versus AAC. Expression of cardiac beta-myosin heavy-chain mRNA was also reduced in AACQ versus AAC (P < 0.05). However, extracellular regulated kinase 1/2 phosphorylation was similar in AAC versus AACQ. The level of aortic endothelial dysfunction (wire myography) was also similar between AAC and AACQ, in spite of reduced aortic thickening in AACQ. Importantly, Q-treated rats did not show any deleterious changes in myocardial function (echocardiography). Our data supports an antihypertensive and antihypertrophic effect of Q in vivo in the absence of changes concerning vascular and myocardial function.
Sixteen-slice multidetector CT findings of a case of constrictive pericarditis in a pediatric patient are presented. Multidetector CT depicted a variety of diagnostic findings including dynamic evaluation of interventricular septal motion through the cardiac cycle, documenting a diastolic septal bounce. This case illustrates the full capabilities of multidetector cardiac CT in the evaluation of pericardial pathology.
A 44-year-old man presented with symptoms and signs of cardiac tamponade. Cytologic examination of the pericardial fluid was negative for malignancy and no manifestations of primary tumor were detected. Two weeks after pericardiocentesis the patient developed constrictive pericarditis. An emergency exploratory thoracotomy revealed a thick, fibrotic pericardium firmly adherent to the underlying myocardium. Histologic examination of the pericardium showed the presence of an adenocarcinoma, suspected to be a metastatic dissemination from a primary pulmonary source. The lymphatic spread of the tumor to the heart may explain the early development of pericardial effusion without malignant cells and the later development of pericardial and epicardial thickening. Cardiac tamponade of unknown origin should prompt a search for metastatic carcinoma, including in presence of a negative cytology.
In several animal species, constriction of the thoracic inferior vena cava (TIVCC) is known to increase proximal sodium reabsorption and inhibit natriuresis following saline loading, leading to edema. To eluicidate the role of adrenal and hypophyseal hormones in the development of edema, kidney and liver functions after TIVCC were compared in adrenalectomised or hypophysectomised rats, and in intact controls. It was found that edema (body weight increase) and kidney and liver affliction were much less pronounced after the operations. The roles of aldosterone and ADH deficiency in renal sodium and water excretion are discussed. It is concluded that adrenal and hypophyseal hormones do not initiate edema but modulate its extent. The absence of edematous changes in the liver of hypophysectomised and adrenalectomised rats deserves further attention.
Coronary artery spasm is undoubtedly one of the causative factors of ischemic heart disease, particularly variant-type angina pectoris and myocardial infarction, but the disease mechanisms involved are still unclear. The present review describes the clinical background of coronary artery spasm in relation to ischemic heart disease, including a brief history of studies in this field, and also suggests future guidelines for experimental investigations based on the characteristics of coronary artery spasm, focusing particularly on data we have obtained in our laboratory from studies of cholinergic constriction. The pig may be a suitable animal in which coronary artery spasm could be provoked with cholinergic agents following endothelial denudation. The use of such large animals would allow the study of spastic arterial segments by various methods with angiographic confirmation. After endothelial denudation it is possible that phenotypic changes in cholinergic receptors might occur in smooth muscle cells, and that such changes might remain even after endothelial repair.
A case of pulmonary actinomycosis presenting with a right calf abscess and complicated by effusive constrictive pericarditis is discussed. Clinical improvement occurred with antibiotic therapy and pericardiectomy. There was no evidence of recurrence after 18 months.
To investigate the intracellular signal transduction pathways involved in the pathophysiological mechanisms of neuropathic pain after partial nerve injury, we examined the activation of extracellular signal-regulated protein kinase (ERK) and p38 mitogen-activated protein kinase (MAPK) in the dorsal root ganglion (DRG) in the chronic constriction injury (CCI) model. The CCI induced an increase in the phosphorylation of ERK in predominantly injured medium-sized and large-sized DRG neurons and in satellite glial cells. Treatment with the MAPK kinase 1/2 inhibitor, U0126, suppressed CCI-induced mechanical allodynia and partially reversed the increase in neuropeptide Y (NPY) expression in damaged DRG neurons. In contrast, the CCI induced the activation of p38, mainly in uninjured small-to-medium-diameter DRG neurons and in satellite glial cells. The p38 inhibitor, SB203580, reversed the CCI-induced heat hyperalgesia and also the increase in brain-derived neurotrophic factor (BDNF) expression in intact DRG neurons. On the other hand, the nerve growth factor (NGF)-induced increase in BDNF expression in small-to-medium-diameter neurons was reversed by SB203580, whereas the anti-NGF-induced increase in NPY in medium-sized and large-sized neurons was partially blocked by U0126. Taken together, our results demonstrate that the activation of ERK and p38 and also the changes in NPY and BDNF expression may occur in different populations of DRG neurons after CCI, partially through alterations in the target-derived NGF. These changes in injured and intact primary afferents are likely to have a substantial role in pathological states, and MAPK pathways in nociceptors may be potential targets for the development of novel analgesics.
The present study was designed to test whether tramadol is effective in the control of neuropathic pain in rats. Chronic constriction injury (CCI) of the sciatic nerve was induced over the left hind limb in male Sprague-Dawley rats. Identical surgery was performed on the opposite side except that the sciatic nerve was not ligated (sham surgery). Paw withdrawal latency (PWL) to heat was tested for each hind paw 1 day before surgery and on the 4th day after surgery to ensure the development of thermal hyperalgesia. In the acute treatment groups, saline or tramadol was administered subcutaneously at doses of 10, 20 or 30 mg/kg, and PWLs were measured 30, 60, 90, 120, 150 and 180 min after treatment. In the semi-chronic treatment groups, continuous systemic administration of tramadol 40 mg/kg/day or saline for 7 days was provided at a uniform rate via osmotic mini pumps. Tramadol reversed PWL in a dose-dependent manner in the acute treatment groups. PWLs were significantly reversed at 2 days after tramadol infusion, and this effect was sustained throughout the remainder of the treatment period in comparison with the saline group. Tramadol also resulted in a decreased sensitivity to thermal stimulus on the sham limb both in acute and semi-chronic administration. We conclude that both acute and semi-chronic tramadol treatment relieves thermal hyperalgesia effectively in rats with CCI of the sciatic nerve. This indicates that tramadol shows promise as a potential treatment for relief of neuropathic pain in humans.
The differentiation between constrictive pericarditis and restrictive cardiomyopathy remains a difficult problem for clinical cardiologists. Recent advances in imaging techniques and the understanding of diastolic function have created a new diagnostic approach to this problem. In this article we will summarize the recent advances in the understanding of the pathophysiology of both disorders and how this is reflected mainly in the use of flow imaging techniques, such as Doppler echocardiography and radionuclide angiography. Combined with the advances in the radiological imaging of the pericardium by means of computed tomography and magnetic resonance imaging, an integrated approach to the differential diagnostic problem is proposed and an algorithm for clinical use has been designed.
Fifteen patients with constrictive pericarditis were prospectively evaluated with echocardiography and Doppler recordings during respiratory monitoring. Eleven who agreed to surgery also underwent right heart catheterization and a repeat echocardiography with Doppler 10 days after pericardiectomy. Preoperatively, there was a significant inspiratory decrease in the mitral E wave (P < 0.05) and increase in the tricuspid E wave velocities (P < 0.05), which both normalized after pericardiectomy. The mitral deceleration times increased from 110 +/- 40 to 149 +/- 46 msec (P < 0.05) postoperatively. The preoperative hepatic vein velocities showed an accentuated systolic flow pattern. The systolic to diastolic ratio of the hepatic vein velocities was higher in patients who improved with surgery (1.42 +/- 0.31 vs 0.65 +/- 0.13) (P < 0.05). Postoperatively the diastolic flow became more pronounced. There was a 100% expiratory diastolic flow reversal in eight patients preoperatively, which normalized after pericardiectomy. Clinically these patients improved significantly postoperatively. Left atrial size, ejection fraction, and mitral and tricuspid filling velocities during respiratory monitoring could not predict surgical outcome. Pericardiectomy improved Doppler filling dynamics in all patients although this was not parallel to clinical improvement.
We review a case of a 50-year-old man with diagnosis of constrictive pericarditis, who underwent pericardial stripping with continuous intraoperative transesophageal echocardiography (TEE). This patient demonstrates the immediate dynamic changes in chamber size after successful surgical removal of pericardium as demonstrated by TEE.
BACKGROUND: Hibernating myocardium has traditionally been characterized in terms of systolic dysfunction. METHODS: We describe a case in which a 75-year-old patient with significant coronary artery disease was operated upon for classic constrictive pericarditis. RESULTS: At sternotomy, there was no evidence of pericarditis, but marked diastolic without systolic dysfunction remained. After successful coronary revascularization, the patient immediately exhibited dramatic improvement of diastolic performance. Ex vivo evaluation of myocardial contractile function revealed normal myocardial adrenergic responsiveness, indicating a reversible impairment of contractility. CONCLUSION: Diastolic hibernation may therefore represent a unique form of surgically correctable restrictive cardiomyopathy.
The case of calcific pericarditis in a 63-year-old male with a 1-year history of progressive right heart failure 43 years after pericardiectomy in 1960 is reported. The recurrent constriction was caused by the calcification of the residual posteroinferior pericardium and the impressing sternum of a pectus excavatum encasing the heart like a skull. The patient underwent total pericardiectomy of his residual pericardium through median sternotomy using cardiopulmonary bypass resulting in complete relief of his symptoms.
A newborn premature girl with congenital, non-chylous ascites is presented. The ascites recurred although laparocentesis was performed three times. The ascites was probably due to a superior mesenteric vein constriction caused by a malrotation of the intestines. After division of the Ladd-bands no ascites recurred. Non-chylous, congenital ascites may have a surgically treatable cause.
Examination of changes occurring in the zero-stress state of an organ provides a way to study cellular growth in the organ due to change of physical stresses. The zero-stress state of the aorta is not a tube. It is a sector with an opening angle that varies with the location on the aorta and changes with cellular remodeling. Blood vessel remodeling can be induced by imposing a constriction on the abdominal aorta by a metal clip (aortic banding), which causes an increase of blood pressure, hypertrophy of the aortic wall, and large change of opening angle. The correlation of the opening angle with the blood vessel wall thickness and blood pressure changes in rat's aorta due to aortic banding is presented in this report. The opening angle changes daily following the aortic banding. Blood pressure rises in vessels of the upper body, but that in the lower body decreases at first and then rises to an asymptotic value. Blood vessel wall thickness increases in rough proportion to blood pressure. Vessel diameter changes also. But the most dramatic is the course of change of the zero-stress state. Typically, the time to reach 50 percent of asymptotic hypertrophy of blood vessel wall thickness is about 3-5 days. The corresponding time for blood pressure is about 7 days. The opening angle of the zero-stress state, however, increases rapidly at first, reaches a peak in about 2 to 4 days, then decreases gradually to a reduced asymptote. The exact values of the time constants depend on the location along the aortic tree. In general, the course of change of residual strain is very different from those of the blood pressure and the blood vessel wall thickness.
The vibration of a thin-walled cylindrical, compliant viscoelastic tube with internal turbulent flow due to an axisymmetric constriction is studied theoretically and experimentally. Vibration of the tube is considered with internal fluid coupling only, and with coupling to internal-flowing fluid and external stagnant fluid or external tissue-like viscoelastic material. The theoretical analysis includes the adaptation of a model for turbulence in the internal fluid and its vibratory excitation of and interaction with the tube wall and surrounding viscoelastic medium. Analytical predictions are compared with experimental measurements conducted on a flow model system using laser Doppler vibrometry to measure tube vibration and the vibration of the surrounding viscoelastic medium. Fluid pressure within the tube was measured with miniature hydrophones. Discrepancies between theory and experiment, as well as the coupled nature of the fluid-structure interaction, are described. This study is relevant to and may lead to further insight into the patency and mechanisms of vascular failure, as well as diagnostic techniques utilizing noninvasive acoustic measurements.
Five cases of children with nontuberculosis pericardial constriction with effusion are reported. The disease is not as rare as has been thought, and the aetiology in these cases was probably a previous virus infection. A previous diagnosis of hepatitis, nephrotic syndrome, or protein-losing enteropathy had been made and the correct diagnosis was delayed for months or even years. Pericardiectomy produced immediate relief from symptoms in 2 patients but in 2 others there was evidence of poor myocardial function postoperatively.