Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-1987. A 58-year-old woman with progressive pericardial disease.
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B-Lymphocytes↗
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Results for “Constriction, Pathologic”
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Endoscopic findings at the pharyngeal orifice of the eustachian tube in otitis media with effusion.
Transnasal endoscopy of the pharyngeal orifice of the eustachian tube was performed on 155 ears with otitis media with effusion (77 ears of children, 78 ears of adults). In children, blockage of the orifice by mucopurulent nasal discharge was the most frequent finding (72.7%), followed by compression of the orifice by the adenoid tissue (52.0%), hypertrophy of the peritubal tonsil (16.9%), and edema around the orifice, especially at its posterior lip (10.4%). In adults, the most frequent abnormal finding was edema of the orifice (26.9%), followed by blockage of the orifice by mucopurulent nasal discharge (23.1%), and atrophy of the orifice (10.3%). In 39.7% of cases findings were normal. Thus, main pathological findings associated with tubal dysfunction involved inflammation in the nasopharynx.
Adult↗
Multiple idiopathic small bowel strictures: report of three cases.
Multiple strictures of the small bowel are relatively rare. In many cases, a distinct cause can be defined, but some strictures are unexplainable by any specific mechanism and have been termed 'idiopathic' small bowel strictures. We present 3 cases of multiple small bowel strictures in which the affected segments were studied with perioperative photoplethysmography, in vivo specimen angiography and pathology. Neither photoplethysmographic alterations nor structural vascular lesions were found.
Adult↗
[Pathogenesis of stenosing ligamentitis].
On the basis of complex examination of women with stenosing ligamentitis, including investigations of hormonal background in accordance with the clinical criteria, hormonal smears, radioimmunological assay of the initial vegetative tonicity, blood circulation by means of rheography, it has been concluded that the stenosing ligamentitis is the local expression of general dystrophy of the connective tissue due to hormonal shift, pathology of the vegetative nervous system and the circulatory system.
Adult↗
Leiomyosarcoma in the mediastinum presenting as superior vena cava syndrome.
The authors report a case of leiomyosarcoma in the mediastinum presenting with superior vena cava obstruction, and also demonstrate the aggressive nature of this tumor in spite of radiotherapy. Where technically feasible, surgery appears to be the treatment of choice. The pathologic and electron microscopic features of this tumor are also described.
Aged↗
Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment.
Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.
Constriction, Pathologic↗
[Traumatic renal pelvis rupture associated with previously unknown stenosis at the renal pelvis junction].
Traumatic rupture of the renal pelvis junction has been reported only rarely in the literature. Surgical exploration of the right kidney in a young man with blunt abdominal trauma showed a formerly unknown stenosis at the renal pelvis junction with hydronephrosis. Rupture of the renal pelvis by blunt abdominal trauma was related to obstruction of the ureteropelvic junction. Routine ultrasound examinations could show this pathological findings and help the patient to undergo early urological treatment.
Abdominal Injuries↗
Stenosis of the central canal of the spinal cord following inoculation of suckling hamsters with reovirus type I.
The central canal of the human spinal cord is partially or completely occluded in the vast majority of individuals by the early years of adult life. The authors describe an experimental lesion following virus-induced ependymitis that bears a striking resemblance to the condition in man. Suckling hamsters were inoculated with 0.06 ml of 10(-3) infectivity titer of reovirus type I between the 2nd and 5th days of life. The pathological events consisted of necrotizing ependymitis, healing of the ependyma by gliovascular scarring, and obstruction of narrow bottlenecks such as the central canal. Histological findings were characterized by disorganization of the ependyma, formation of ependymal rosettes and microtubules, subependymal gliovascular scarring, and intracanalicular gliosis. These features are the same as those encountered clinically and provide strong evidence that stenosis of the central canal in man is a pathological lesion involving ependymal injury and scarring.
Animals↗
Radiographic manifestations of intestinal obstruction in the newborn.
Intestinal obstruction in the newborn infant may be due to a variety of conditions, including atresia and stenosis, annular pancreas, malrotation, duplication cyst, meconium ileus, meconium plug syndrome and neonatal small left colon syndrome, and Hirschsprung's disease. Neonates with unrecognised intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and appropriate surgical treatment becomes more hazardous. Early diagnosis depends largely on the prompt detection of obstructive manifestations by the clinician and the subsequent accurate interpretation of radiographic findings by the radiologist. Plain film of the abdomen is often helpful in determining the level of obstruction and usually dictates, together with clinical symptoms, the choice of the contrast study firstly to perform. In this article we will review the clinical and radiological signs of different pathological conditions causing intestinal obstruction in the newborn.
Colon↗
[Ultrasonic dopplerography in the diagnosis of occlusive lesions of the vertebral arteries].
Examinations of the blood flow in the vertebral arteries were carried out in 105 patients with circulatory disorders in the vertebrobasilary system. For this purpose the method of ultrasonic dopplerography with subsequent bilateral axillar cerebral angiography was used. The examinations were performed by the transcutaneous method in the author's modification. This made it possible to evaluate reliably the hemodynamics in the vertebral arteries in each patient using the asymmetry coefficient related to the linear speed of the blood flow in the vessels. It was found that in increase of the asymmetry coefficient by 50% or more was, as a rule, associated with an occluding process in one of the vertebral arteries. The agreement between the dopplerographic and the angiographic findings was observed in 80% of the cases of occlusions, and in 85,7% of the cases of vertebral artery stenoses. This makes it possible to recommend the ultrasonic dopplerography method for broad use in polyclinic conditions for examining patients with vertebrobasilar pathology, and for screening persons with an increased risk of cerebrovascular diseases.
Adult↗
A new classification of Mirizzi syndrome from diagnostic and therapeutic viewpoints.
BACKGROUND/AIMS: A new classification of Mirizzi syndrome was developed based on our experience with 30 cases. MATERIAL AND METHODS: Using diagnostic and therapeutic criteria, four distinct entities were identified. Type I characterized by stenosis of the common hepatic duct due to a stone impacted in the cystic duct or the neck of the gallbladder. Type II is characterized by fistulization of the common hepatic duct as a result of a stone embedded in the cystic duct or the neck of the gallbladder. Type III is defined by hepatic duct stenosis due to a stone of the confluence, and Type IV by hepatic duct stenosis as a complication of cholecystitis in the absence of calculi impacted in the cystic duct or the neck of the gallbladder. RESULTS: Of the 30 patients there were 14 Type I, 2 Type II, 6 Type III, and 8 Type IV patients. Distinctive cholangiographic features were identified. CONCLUSION: The therapeutic approach differs from each of the four distinct pathologic entities.
Adult↗
[Various pathological changes in the bile ducts based on cholangioscopic findings].
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Adult↗
Epidemiological studies of cerebro-and cardiovascular diseases in the northeast of Japan Part I. Pathological approach to the study in Akita Prefecture.
To define the etiologic factors of Japanese cerebrovascular diseases, a pathological research was conducted on autopsy cases of stroke in Akita Prefecture. In most cases of cerebral hemorrhages, especially in the middle age group (30-59 of age), arteriosclerotic deviations in basal berebral arteries of the circle of Willis and intracerebral small arteries are not found. The authors conclude that cerebral hemorrhage may occur without relationship to disturbances of lipid metabolism, biochemically, and to atherosclerosis, pathologically. Concerning cerebral infarction, especially in the old generation (over 60 years of age), severe arteriosclerotic deviations were recognized both in basal cerebral and intracerebral arteries. These changes were highly influenced by the grade and duration of hypertension, and rarely influenced by hypercholesterolemia. According to the above-mentioned facts, the results obtained from out epidemiological survey were confirmed by the pathological studies.
Adult↗
The combined use of radionuclide angiography and Doppler-sonography in the screening of carotid lesions.
The aim of our research is to check if the combined use of radionuclide angiography and Doppler-sonography leads to correct screening of carotid lesions in the neck, independently from the indexes of reliability of the individual examinations. 125 cerebrovascular patients (for a total of 250 carotid studies) were investigated with radionuclide angiography and Doppler-sonography. 100 of these carotids were also angiographically investigated. On the basis combined angioscintigraphic and Doppler results, these patients have been classified in four groups. When both non-invasive examinations result negative, the angiography shows pathological arteries only in 22% of cases. When only radionuclide angiography is positive, the angiography shows pathological findings in 63% of cases: when only Doppler is positive, the angiography confirmation occurs in 72% of cases. Finally, when both non-invasive tests results positive, there is always arterial pathology in the angiography.
Adult↗
Risk factors for atherosclerosis in men with stenosing or aneurysmal disease of the abdominal aorta.
Risk factors associated with atherosclerosis were compared in 2 groups of men: with aneurysmal dilatation (AAA) or stenosing disease (SAD) of the infrarenal aorta. In the AAA group (N = 114) the median aortic diameter was 6.9 cm and 89% of patients had undergone elective or emergency surgical repair. In the SAD group (N = 57) an equal proportion had had an aortobifemoral bypass, the median aortic diameter was 1.8 cm. Men with AAA were older (73 years vs 68 years; p < 0.001). There were no differences in total cholesterol and triglycerides between the two but men with AAA had a higher HDL-cholesterol concentration (1.22 mmol/l vs 1.08 mmol/l; p = 0.019). Tobacco consumption in the 2 groups was similar (36.5 pack years vs 35.0 pack years; p = 0.387). After correction for age, diastolic blood pressure was significantly higher in the AAA group. In both groups there is extensive aortic atherosclerosis but differences between the two groups indicate that stenosing and dilating disease are distinct pathological entities.
Age Factors↗
"Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters"--the future treatment of atherosclerotic coronary artery disease? A clinical-morphologic assessment.
Although various public health preventive efforts and prescribed pharmacologic treatment methods will have long-term benefits in the reduction of coronary artery atherosclerosis and subsequent cardiac events, the immediate and short-term future in the treatment of coronary artery disease will focus on several interventional devices designed to remodel or remove causes of acute and chronic coronary artery obstruction. Certain clinical-morphologic aspects of these interventional devices or techniques that result in remodeling of the coronary lumen shape (balloon angioplasty, thermal probes, intravascular stents) or removal of obstructing material (lasers, atherectomy devices) are reviewed. Two new areas in the pathology of atherosclerotic plaque (plaque fissures, eccentric plaque) and their clinical relevance in coronary heart disease are described.
Angioplasty, Balloon↗
Isolated stenosis of the pulmonary artery branches--an autopsy case with review of the literatures.
A necropsy of a 21-year-old male with isolated stenosis of the pulmonary artery was presented. The pulmonary artery branches showed various fibrous thickening including atheromata and mural thrombi. Those findings appeared mostly in elastic and large muscular pulmonary arteries as well as in medium sized arteries, while the small arteries and arterioles remained in slight changes. Systemic large elastic arteries seemed to be small and showed atheromatous lesions similar to those of the main pulmonary arteries. Moreover, eight autopsy cases with pulmonary artery stenosis from the literature were shortly reviewed and some pathological findings as an aid for angiographic cardiovascular studies were discussed.
Adolescent↗
Lumbar stenosis. An electromyographic evaluation.
Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilateral symptoms who actually has bilateral pathology. The importance of a bilateral electromyographic examination is emphasized and the rarity of bilateral or multiradicular findings in simple herniated nucleus pulposus.
Constriction, Pathologic↗