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Sample records for arterial obstructive tibio-peroneal

  1. Obstruction of cerebral arteries in childhood stroke

    International Nuclear Information System (INIS)

    Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized. (orig.)

  2. Bifurcating stents in the pulmonary arteries: A novel technique to relieve bilateral branch pulmonary artery obstruction.

    Science.gov (United States)

    Narayan, Hari K; Glatz, Andrew C; Rome, Jonathan J

    2015-10-01

    Balloon angioplasty and stent placement in close proximity to the bifurcation of the branch pulmonary arteries can be challenging. Multiple approaches have been previously described, though none of these approaches both treats bilateral proximal branch pulmonary artery stenosis and provides an anchor for a transcatheter pulmonary valve replacement. We report a novel approach that involves serial stent placement and balloon dilation through the struts of the stent in each pulmonary artery, along with balloon expansion of the proximal portion of the stents to the diameter of the main pulmonary artery. In the two cases we describe, this strategy resulted in significant relief of branch pulmonary artery obstruction without compromising the anatomy of the main pulmonary artery segment. This technique can be an effective way to alleviate stenoses of the bilateral proximal branch pulmonary arteries and provides a landing zone for a future transcatheter pulmonary valve. PMID:26256829

  3. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy

    OpenAIRE

    Chih-Yang Hsiao; Ting-Chun Kuo; Hong-Shiee Lai; Ching-Yao Yang; Yu-Wen Tien

    2015-01-01

    A hepatic artery pseudoaneurysm is a rare, but a potentially life-threatening complication after laparoscopic cholecystectomy (LC). Obstructive jaundice owing to a hepatic artery pseudoaneurysm after LC has never been reported. We report a patient with a hepatic artery pseudoaneurysm after LC who presented with tarry stools, bloody drainage and obstructive jaundice.

  4. Role of renal arterial resistive index (RI) in obstructive uropathy

    International Nuclear Information System (INIS)

    Objective: To determine the diagnostic accuracy of renal arterial resistive index on doppler ultrasound in patients with acute renal colic to diagnose obstructive uropathy taking non-enhanced helical computed tomography as the gold standard. Methods: The descriptive study, conducted at the Radiology Department of Pakistan Naval Ship Shifa Hospital, Karachi, from October 10, 2010 to July 17, 2011, comprised 160 patients referred from the Emergency Department with complaint of unilateral renal colic. Ultrasound was carried out. Subsequently, computed tomography scan of kidney, ureter and bladder was performed. Data was collected on prescribed proforma and analysed using SPSS 19. Results: By taking the resistive index value of > 0.70 as a discriminatory level for obstruction, the overall sensitivity of the index was 76.23% and specificity was 88.13%. The positive predictive values of the index in patients with obstructive uropathy was 91.6%, and negative predictive value was calculated to be 68.42%. The diagnostic accuracy of the test was 80%. Conclusion: Duplex Doppler ultrasound can detect acute renal obstruction with sensitivity of approximately 77%. However, ultrasound is an operator-dependent examination, and the results are much affected by patient body habitus. (author)

  5. Bowel obstruction following deep circumflex iliac artery free flap harvesting.

    Science.gov (United States)

    Tan, Neil C-W; Brennan, Peter A; Senapati, Asha; Puxeddu, Roberto

    2009-12-01

    The deep circumflex iliac artery flap (DCIA) has been well described as an autograft flap used in head and neck reconstructions, particularly for large maxillary and mandibular defects. Complications, particularly at the donor site, have been well documented. Although it is considered a minor complication, herniation should not be underestimated as it can potentially lead to bowel obstruction, necessitating an emergency operation. We report a case of acute obstruction of the small bowel secondary to herniation at the donor site after harvesting a DCIA free flap for a maxillary defect, a complication that to our knowledge has been reported only once. We review the pathogenesis and possible ways to reduce the likelihood of developing this serious complication. PMID:19249144

  6. Uterine Artery Embolization for Ureteric Obstruction Secondary to Fibroids

    International Nuclear Information System (INIS)

    This case series examines the safety and efficacy of uterine artery embolization (UAE) in the treatment of obstructive nephropathy caused by large fibroids. Between 2004 and 2007, 10 patients referred with symptomatic uterine fibroids that were found to be causing either unilateral (7 patients) or bilateral (3 patients) hydronephrosis were treated by UAE. Presenting complaints included menorrhagia, dysmenorrhea, bulk symptoms, loin pain, postobstructive atrophy, and mild renal impairment. All had posterior intramural dominant fibroids >11 cm in maximum sagittal diameter and uterine volumes between 3776 and 15,625 ml. Outcome measures at between 12 and 36 months included procedural success, repeat intervention, relief of symptoms, resolution of hydronephrosis, stable renal function and size, and avoidance of hysterectomy. In all cases the cause of renal obstruction was confirmed to be a giant fibroid compressing the ureter at the pelvic brim. In all cases UAE was technically successful, though two patients required a repeat procedure. In eight patients hydronephrosis resolved and the obstruction was relieved, though two still had some bulk symptoms not requiring further treatment. Renal function improved or was stable in all cases. Renal size was stable in all cases. Where menorrhagia was part of the symptom complex it was relieved in all cases. Two patients diagnosed as having postobstructive atrophy of one kidney underwent retrograde ureteric stenting on the nonatrophied side prior to UAE. This was unsuccessful in one of the cases due to the distortion caused by the fibroid. Despite improvement in hydronephrosis this patient underwent hysterectomy at 7 months after a renogram demonstrated persistent obstruction at the pelvic brim. In the second patient a double pigtail stent was inserted with difficulty and eventually removed at 8 months. This patient has had stable renal function and size for 3 years post-UAE. We conclude that UAE is safe and effective in

  7. Correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium scan

    International Nuclear Information System (INIS)

    To determine the correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium(EBT CAC) scan and to measure the difference in calcium score according to symptoms. Materials and Methods : Fifty-six patients underwent EBT CAC scanning and either coronary angiography or stress thallium 201 scanning or the treadmill test. When the results were positive, coronary artery obstructive disease(CAOD) was assumed to be present. The patients were divided into three groups : symptomatic CAOD,asymptomatic CAOD, and asymptomatic non- CAOD; those with a previous history of myocardial ischemia or who showed positive results in any of the three tests relating to typical symptoms of angina were assigned to the symptomatic group. Results : The number of cases assigned to group to group 1,2 and 3 was 19, 16 and 21, respectively; total CAC scores were 571 ± 751, 600 ± 726 293± 401, respectively. The difference in CAC score between asymptomatic CAOD and asymptomatic non- CAOD was not statistically significant(p=0.079) but in asymptomatic CAOD, the score tended to be higher. The CAC score was not different between symptomatic and asymptomatic CAOD(p>0.1). When the CAC threshold was 1, sensitivity was 89% and specificity was 14%;when the threshold was 200, sensitivity was 60% and specificity was 67%. Conclusion : When the EBT CAC score is high, further evaluation provides early evidence of coronary artery obstructive disease

  8. Treatment of gastric carcinoma with postoperative malignant intestinal obstruction via transcatheter arterial perfusion chemotherapy

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect of transcatheter arterial perfusion (TAP)chemotherapy for gastric carcinoma with postoperative malignant intestinal obstruction caused by abdominal cavity metastasis. Methods: 47 gastric carcinoma patients with incomplete malignant intestinal obstruction after surgery received TAP chemotherapy by Seldinger method, with cisplatin, hydroxycamptothecin and FUDR per month via celiac artery, superior mesenteric artery, inferior mesenteric artery, and bilateral internal iliac arteries respectively. All patients were administered 1 to 13 times. Results: The effective rate of transcatheter arterial prefusion chemotherapy was 38% (18/47)with survival period lasting from 35 days to 13 months at an average of 4.7 months. Conclusions: Transcatheter arterial perfusion chemotherapy has markedly therapeutic effect in palliating treatment of malignant intestinal obstruction within short term with increase of survival time. (authors)

  9. Cranial Mesenteric Arterial Obstruction Due To Strongylus vulgaris Larvae in a Donkey (Equus asinus.

    Directory of Open Access Journals (Sweden)

    Hassan Borji

    2014-09-01

    Full Text Available Arteritis due to Strongylus vulgaris is a well-known cause of colic in horses and donkeys. The current report describes a fatal incidence of arterial obstruction in cranial mesenteric artery caused by S. vulgaris infection in an adult donkey in which anthelmintic treatment was not regularly administered. Necropsy findings of the abdominal cavity revealed a complete cranial mesenteric arterial obstruction due to larvae of S. vulgaris, causing severe colic. To the authors' knowledge, a complete cranial mesenteric arterial obstruction due to verminous arteritis has rarely been described in horses and donkeys. Based on recent reports of fatal arterial obstruction due to S. vulgaris infection in donkeys, it may be evident to consider acute colic caused by this pathogenic parasite a re-emerging disease in donkeys and horses.

  10. Severe Congenital Obstruction of the Left Main Coronary Artery Coexisting With Supravalvular Aortic Stenosis in Williams Syndrome: A Dangerous Association.

    Science.gov (United States)

    Szaflik, Katarzyna; Kaźmierczak, Piotr; Moll, Jacek Jan; Moll, Jadwiga Anna

    2016-03-01

    Congenital obstruction of the left main coronary artery is a complicating feature of supravalvular aortic stenosis. We describe an eight-month-old female patient with Williams syndrome, supravalvular aortic stenosis, and branch pulmonary artery stenosis, with concomitant anomaly of severe obstruction of the left coronary artery orifice. PMID:26582765

  11. Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

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    Kang, Yeong Han; Chang, Jeong Ho [Dept. of Diagnostic Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of); Park, Jong Sam [Dept. of Radiologic Tecnology, Daegu Health College, Daegu (Korea, Republic of)

    2009-03-15

    This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

  12. Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

    International Nuclear Information System (INIS)

    This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

  13. Evaluation of carotid artery elasticity in patients with obstructive sleep apnea syndrome using quantitative arterial stiffness technique

    Institute of Scientific and Technical Information of China (English)

    俞飞虹

    2012-01-01

    Objective To explore the changes and clinical value of carotid elasticity index in patients with obstructive sleep apnea syndrome (OSAS) by quantitative arterial stiffness(OAS) technique. Methods Seventy-two OSAS patients were divided into 2 groups according to whether there was coexisting hypertension

  14. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm.

    Science.gov (United States)

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-06-27

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  15. Percutaneous treatment of critical lower limb ischemia in patients with obstruction of the crural arteries

    International Nuclear Information System (INIS)

    This article describes the application of percutaneous transluminal angioplasty (PTA) in the treatment of crural artery obstruction in patients with critical lower limb ischemia. In 17 patients, 24 PTAs of crural artery obstructions were performed. The clinical material consisted of 9 men and 8 women, whose mean age was 72 years (range 54-85 years). 11 patients were classified in clinical stage Fontaine IV, and 6 in stage III. The obstructions were from 3 to 21 cm (mean 6 cm). In 8 cases, PTA of the femoropopliteal segment was also carried out. The risk factors and comorbidities included diabetes 10 cases (58.8%), hypertension 9 cases (56%), ischemic heart disease 8 cases (50%), hyperlipidaemia 7 cases (43.8%), cerebrovascular diseases 3 cases (18.8%), and cigarette smoking 6 cases (37.5%). Technical success was defined as restoration of the artery along its whole length to the foot. Pain relief at rest and healing of trophic lesions at 30-day follow-up were recognized as a good outcome. Technical success was achieved in 12 patients (70.6%). In 2 cases the patency was only restored in the proximal part of the artery (12.5%). In 3 cases (17.6%) the procedure failed. In one case acute occlusion of the artery occurred. In 2 cases the obstruction was not successfully passed with a guidewire. In 4 cases hematoma was found at the puncture site, without clinical consequences. In 13 patients (76.4%) clinical success was achieved. Percutaneous transluminal angioplasty is an effective and relatively safe method of treatment of patients with critical limb ischemia caused by obstruction of the crural arteries. (author)

  16. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  17. A PROSPECTIVE STUDY OF PULMONARY ARTERIAL HYPERTENSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASES

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    Saptanaga Kumar

    2015-04-01

    Full Text Available BACKGROUND : Chronic obstructive pulmonary disease (COPD is a heterogeneous, multisystem disease with complexities that extend far beyond airway obstruction. OBJECTIVES : The purpose of this prospective study is to determine pulmonary arterial hypertension in chronic obstructi ve pulmonary disease non - invasively. METHODS : In this descriptive, prospective, observational, cross sectional study, all patients who presented to the department of Medicine and Respiratory medicine, during this study period of 12 months from January 2013 - December 2014 in Chennai were included. RESULTS : Total number of males in the study is 90(90%, females in the study is 10 (10%. Number of patients in the age group 25 - 35years was 06 (6%, 36 - 45years was 38(38%, 46 - 55 years was 30(30, number of patie nts in 56 - 65 years was 14 (14 and number of patients in the age group 66 - 75 years was 12(12. total number of males smoking in the study is 55(61.11% and total number of non - smokers were 35(38.88, total number of female smoking in the study is 1(10% an d total number of non - smokers were 9(90%. Pulmonary arterial systolic pressure in present study, Mild pulmonary arterial hypertension was seen in 26(26%, Moderate pulmonary arterial hypertension was seen in 54(54%, Severe pulmonary arterial hypertension was seen in 20(20%. CONCLUSION : This study shows the prevalence of pulmonary arterial hypertension in COPD patients.

  18. Treatment of arterial femoropopliteal obstructions with Palmaz midsize stents

    International Nuclear Information System (INIS)

    Purpose: To evaluate effectiveness, success and patency rates after endovascular treatment with mid-size Palmaz stents in high-grade stenoses or short-distance occlusions of femoral arteries. Materials and methods: 27 patients with 10 occlusions (average length 3.2±1.4 cm) and 17 severe stenoses of the superficial femoral artery were treated with 33 mid-size Palmaz stents. The follow-up included Doppler ultrasound at one, three, 6 and 12 months and an angiography at 6 months. Mean follow-up was 6.5 months. Results: Technical success was 100%. The ankle-brachial index improved from 0.57±0.28 pretreatment to 0.87±0.13 within 24 hours. Acute stent thrombosis occurred in two patients (50%, n=2). Life-table analysis according to Kaplan-Meier revealed 6-month primary and secondary patency rates of 84% and 91%. Conclusion: with regard to our limited data, the implantation of mid-size Palmaz stents in femoral arteries seems promising in treatment of short-distance occlusions and stenoses of the femoral artery. (orig.)

  19. Pulmonary arterial remodeling in chronic obstructive pulmonary disease is lobe dependent.

    Science.gov (United States)

    Wrobel, Jeremy P; McLean, Catriona A; Thompson, Bruce R; Stuart-Andrews, Christopher R; Paul, Eldho; Snell, Gregory I; Williams, Trevor J

    2013-09-01

    Abstract Pulmonary arterial remodeling has been demonstrated in patients with severe chronic obstructive pulmonary disease (COPD), but it is not known whether lobar heterogeneity of remodeling occurs. Furthermore, the relationship between pulmonary hypertension (PH) and pulmonary arterial remodeling in COPD has not been established. Muscular pulmonary arterial remodeling in arteries 0.10-0.25 mm in diameter was assessed in COPD-explanted lungs and autopsy controls. Remodeling was quantified as the percentage wall thickness to vessel diameter (%WT) using digital image analysis. Repeat measures mixed-effects remodeling for %WT was performed according to lobar origin (upper and lower), muscular pulmonary arterial size (small, medium, and large), and echocardiography-based pulmonary arterial pressure (no PH, mild PH, and moderate-to-severe PH). Lobar perfusion and emphysema indices were determined from ventilation-perfusion and computed tomography scans, respectively. Overall, %WT was greater in 42 subjects with COPD than in 5 control subjects ([Formula: see text]). Within the COPD group, %WT was greater in the upper lobes ([Formula: see text]) and in the small muscular pulmonary arteries ([Formula: see text]). Lobar differences were most pronounced in medium and large arteries. Lobar emphysema index was not associated with arterial remodeling. However, there was a significant positive relationship between the lobar perfusion index and pulmonary arterial remodeling ([Formula: see text]). The presence of PH on echocardiography showed only a trend to a small effect on lower lobe remodeling. The pattern of pulmonary arterial remodeling in COPD is complicated and lobe dependent. Differences in regional blood flow partially account for the lobar heterogeneity of pulmonary arterial remodeling in COPD. PMID:24618551

  20. Immunocytochemical features of obstructed saphenous vein coronary artery bypass grafts.

    OpenAIRE

    Brody, J I; Pickering, N J; Fink, G B

    1989-01-01

    The peroxidase-immunoperoxidase immunocytochemical method was used on 27 saphenous vein coronary artery bypass grafts, which had been resected because of recurrent angina, to identify in situ cellular and humoral elements possibly associated with graft occlusion. Immunostaining was performed on paraffin wax embedded control saphenous vein and graft sections incubated directly with primary antibodies against von Willebrand antigen (vWFAg), fibronectin, fibrinogen, leucocyte common antigen (LCA...

  1. Developments in the percutaneous treatment of obstructive coronary artery disease

    OpenAIRE

    Agostoni, P.

    2009-01-01

    Percutaneous coronary interventions are recognized techniques to treat coronary artery disease. However, despite the progress in the development of materials and techniques, several limitations affect the acute and long-term performance of these procedures. In particular, there are three mayor drawbacks: restenosis, thrombosis and technical feasibility of the procedure. The recent introduction of drug-eluting stents has been a major step forward in reducing restenosis. The pivotal randomized ...

  2. Comparison of obstructing blood flow interventional embolectomy and simple interventional embolectomy for acute lower limb arterial embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the effects (mortality, amputation rate, the length and expense of hospital stay, etc)of the obstructing blood flow interventional embolectomy and simple interventional embolectomy for acute lower limb arterial embolism. Methods: 79 cases of acute lower limb arterial embolism including 23 cases of two sites puncturing and obstructing blood flow interventional embolectomy and 56 cases treated by simple interventional embolectomy were retrospectively analyzed and compared. Results: Embolisms were removed in all 79 cases and arteries were reopened successfully. The mortality and the amputation rates of the simple and the obstructing blood flow embolectomies were 5.36%, 19.6%, and 4.35%, 8.70% respectively. Conclusion: Two sites puncturing and obstructing blood flow interventional embolectomy for acute lower limb arterial embolism is simple, safe and effective, comparing with the simple interventional embolectomy, with lower amputation rate, quicker recovery and lower expense, however with no statistical significance in mortalities. (authors)

  3. Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Køber, Lars; Pedersen, Jesper Holst; Dirksen, Asger; Thomsen, Laura Hohwü; Stender, Steen; Brodersen, John; Groen, Jaap; Ashraf, Haseem; Kofoed, Klaus Fuglsang

    2013-01-01

    Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk...... factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers....

  4. Utility of intra-operative capnogram to detect branch pulmonary artery obstruction following total correction of tetralogy of fallot

    OpenAIRE

    Garg Rajnish; Murthy Keshava; Rao Shekhar; John Colin

    2011-01-01

    Branch pulmonary artery obstruction is one of the prime reasons for re-operation in patients who have undergone repair for tetralogy of Fallot. Branch pulmonary artery obstruction may develop over a period of time due to dilation of right ventricular outflow tract or it may be caused by residual stenosis after inadequate repair. This may lead to differential lung perfusion causing morbidity. Intra-operative capnogram monitoring reveals ventilation−perfusion relationship. We report two c...

  5. Ophthalmic Artery Obstruction and Cerebral Infarction Following Periocular Injection of Autologous Fat

    OpenAIRE

    Lee, Chang Mok; Hong, In Hwan; Park, Sung Pyo

    2011-01-01

    We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited wid...

  6. Utility of intra-operative capnogram to detect branch pulmonary artery obstruction following total correction of tetralogy of Fallot.

    Science.gov (United States)

    Garg, Rajnish; Murthy, Keshava; Rao, Shekhar; John, Colin

    2011-01-01

    Branch pulmonary artery obstruction is one of the prime reasons for re-operation in patients who have undergone repair for tetralogy of Fallot. Branch pulmonary artery obstruction may develop over a period of time due to dilation of right ventricular outflow tract or it may be caused by residual stenosis after inadequate repair. This may lead to differential lung perfusion causing morbidity. Intra-operative capnogram monitoring reveals ventilation-perfusion relationship. We report two cases where the capnogram helped the diagnosis and management of branch pulmonary artery obstruction. We found a redundant patch in the first and an extra length of the homograft in second case which led to the obstruction. However, but for the changes in the intraoperative capnogram, this condition may by far remain undiagnosed considering the fact that it does not produce hemodynamic changes but can lead to postoperative morbidity. PMID:21196674

  7. Utility of intra-operative capnogram to detect branch pulmonary artery obstruction following total correction of tetralogy of fallot

    Directory of Open Access Journals (Sweden)

    Garg Rajnish

    2011-01-01

    Full Text Available Branch pulmonary artery obstruction is one of the prime reasons for re-operation in patients who have undergone repair for tetralogy of Fallot. Branch pulmonary artery obstruction may develop over a period of time due to dilation of right ventricular outflow tract or it may be caused by residual stenosis after inadequate repair. This may lead to differential lung perfusion causing morbidity. Intra-operative capnogram monitoring reveals ventilation−perfusion relationship. We report two cases where the capnogram helped the diagnosis and management of branch pulmonary artery obstruction. We found a redundant patch in the first and an extra length of the homograft in second case which led to the obstruction. However, but for the changes in the intraoperative capnogram, this condition may by far remain undiagnosed considering the fact that it does not produce hemodynamic changes but can lead to postoperative morbidity.

  8. Color Doppler evaluation of the ocular arterial flow changes in chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Purpose: To evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography (CDU) technique, and to compare the results with those of healthy control subjects. Methods: Forty-five patients with COPD and 17 healthy control subjects were included in this study. Patients with COPD were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Fifteen patients of stage I COPD (mild airflow limitation), stage II COPD (worsening airflow limitation) or stage III COPD (severe airflow limitation) were enrolled into Group I, II and III, respectively. End tidal carbon dioxide (EtCO2), peripheral oxygen saturation (SpO2), pulse rate (PR) and respiratory rate (RR) were measured by using capnograph/pulse oximeter in all patients. Measurements were performed in only one randomly chosen eye of each participant. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery (LPCA) and medial short posterior ciliary artery (MPCA), using CDU technique. Results: The PSV measurements of the OA were significantly higher in Groups II and III compared to control group (p 2 with PSV (r = 0.53, p < 0.01) and EDV (r = 0.51, p < 0.01) of the OA. Statistically significant correlations were also found for the SpO2 with RI (r = -0.34, p < 0.05) in the OA. Conclusion: We concluded that COPD is associated with impaired retrobulbar hemodynamics, especially in the ophthalmic artery. Moreover, central retinal and posterior ciliary arteries with increased resistance are also found to be affected when compared with healthy control eyes

  9. Symptoms of angina pectoris increase the probability of disability pension and premature exit from the workforce even in the absence of obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Abildstrøm, Steen Z; Hvelplund, Anders;

    2013-01-01

    To evaluate probabilities of disability pension (DP) and premature exit from the workforce (PEW) in patients with stable angina symptoms and no obstructive coronary artery disease (CAD) at angiography compared with obstructive CAD and asymptomatic reference individuals.......To evaluate probabilities of disability pension (DP) and premature exit from the workforce (PEW) in patients with stable angina symptoms and no obstructive coronary artery disease (CAD) at angiography compared with obstructive CAD and asymptomatic reference individuals....

  10. Effect of eplerenone on the severity of obstructive sleep apnea and arterial stiffness in patients with resistant arterial hypertension.

    Science.gov (United States)

    Krasińska, Beata; Miazga, Angelika; Cofta, Szczepan; Szczepaniak-Chicheł, Ludwina; Trafas, Tomasz; Krasiński, Zbigniew; Pawlaczyk-Gabriel, Katarzyna; Tykarski, Andrzej

    2016-05-27

    INTRODUCTION    Obstructive sleep apnea (OSA) is considered to be one of the major causes of resistant arterial hypertension (RAH). Apnea episodes cause hypoxia, which triggers the activation of the renin-angiotensin-aldosterone system. This leads to water retention and swelling in the neck region, exacerbating OSA symptoms. It is assumed that the use of eplerenone may reduce the swelling and thus alleviate the severity of OSA. OBJECTIVES    We aimed to prospectively assess the impact of eplerenone on the severity of OSA and arterial stiffness in patients with RAH. PATIENTS AND METHODS    The study included 31 patients with RAH and OSA. The exclusion criteria were as follows: secondary hypertension, myocardial infarction, stroke 6 months prior to the study, congestive heart failure, chronic kidney failure, alcohol or drug addiction, and active cancer. In all patients, the following tests were performed: blood pressure (BP) measurement (traditionally and using ambulatory BP measuring [ABPM]), applanation tonometry, polysomnography, and the apnea-hypopnea index (AHI) calculation. The tests were done before and after 3 months of eplerenone therapy. Patients received 50 mg of oral eplerenone daily, along with other hypertensive drugs. RESULTS    The mean age of participants was 57.76 ±6.16 years. After 3 months of eplerenone therapy, we observed a significant reduction in the AHI, neck circumference, BP, aortic pulse wave, and arterial wall stiffness. There were significant correlations between the AHI and mean BP measured by ABPM and between the AHI and arterial stiffness parameters. CONCLUSIONS    Our results provide evidence for the clinical significance of eplerenone, not only as an antihypertensive medication but also as a drug that may reduce the severity of OSA and arterial stiffness in patients with RAH and OSA. PMID:27230560

  11. Metallic stent implantation combined with intra-arterial chemotherapy for the treatment of malignant gastric and duodenal obstruction

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical effect of metallic stent implantation together with intra-arterial chemotherapy in treating malignant gastric and duodenal obstruction. Methods: A total of 32 patients with malignant gastric and duodenal obstruction were enrolled in this study. The obstructed sites were located at the gastric sinus and pylorus part (n=16), at the gastroduodenal anastomotic stoma (n=6) or at the descending part of duodenum (n=10). Under DSA guidance and with the additional help of endoscopy, a guide-wire was orally placed in the gastroduodenal obstructed site, which was followed by the implantation of the self-expanding metallic stent (Ni-Ti alloy). Postoperative intra-arterial chemotherapy via the tumor-feeding arteries was carried out in 16 patients (dual interventional therapy). The clinical results were analyzed. Results: Successful stent insertion was achieved in all 32 patients (100%). After stent implantation the obstructive symptoms were markedly relieved and the food intake was improved. No serious complications occurred. The median survival time for the 16 patients who had received dual interventional therapy was 9.3 months, while the median survival time for the other 16 patients who had received simple stenting therapy was 5.7 months. Conclusion: For the treatment of inoperable malignant gastroduodenal obstruction, the implantation of metallic self-expanding stents is a technically simple, clinically safe and effective palliative measure. Combined with postoperative intra-arterial chemotherapy, the metal stent implantation can control the tumor growth and elongate the survival time. (authors)

  12. Effects of CPAP on "vascular" risk factors in patients with obstructive sleep apnea and arterial hypertension

    Directory of Open Access Journals (Sweden)

    Litvin AY

    2013-05-01

    Full Text Available AY Litvin,1 ZN Sukmarova,1 EM Elfimova,1 AV Aksenova,1 PV Galitsin,1 AN Rogoza,2 IE Chazova11Department of Systemic Hypertension, 2Department of New Methods of Diagnostics, Russian Cardiology Research and Production Complex, Ministry of Health, Moscow, Russian FederationBackground: The aim of this study was to assess the effects of continuous positive airway pressure (CPAP on arterial stiffness, central blood pressure, and reflected pulse wave characteristics in patients with severe obstructive sleep apnea (OSA and stage 2–3 arterial hypertension.Methods: Forty-four patients with hypertension and severe OSA (apnea/hypopnea index > 30 received stepped dose titration of antihypertensive treatment, consisting of valsartan 160 mg + amlodipine 5–10 mg + hydrochlorothiazide 25 mg. CPAP therapy was added after 3 weeks of continuous antihypertensive treatment with BP 12 msec persisted in 35% of patients on antihypertensive treatment and effective CPAP, in 56% of patients on antihypertensive treatment alone, and in 53% of patients on placebo CPAP. Only the combination of antihypertensive treatment with effective CPAP achieved a significant reduction in augmentation index and AASI, along with a further reduction in aortic and brachial BP.Conclusion: Effective CPAP for 3 weeks resulted in a significant additional decrease in office BP, ambulatory BP monitoring, central BP, and augmentation index, together with an improvement in arterial stiffness parameters, ie, cfPWV and AASI, in a group of hypertensive patients with OSA.Keywords: antihypertensive therapy, hypertension, obstructive sleep apnea, continuous positive airway pressure, blood pressure, arterial stiffness, pulse wave velocity

  13. Differences in carotid arterial morphology and composition between individuals with and without obstructive coronary artery disease: A cardiovascular magnetic resonance study

    OpenAIRE

    Takaya Norihide; Oikawa Minako; Yu Wei; Chu Baocheng; Saam Tobias; Hatsukami Thomas S; Espeland Mark A; Chen Haiying; Terry James G; Yuan Chun; Underhill Hunter R; Yarnykh Vasily L; Kraft Robert; Carr J Jeffrey; Maldjian Joseph

    2008-01-01

    Abstract Objective We sought to determine differences with cardiovascular magnetic resonance (CMR) in the morphology and composition of the carotid arteries between individuals with angiographically-defined obstructive coronary artery disease (CAD, ≥ 50% stenosis, cases) and those with angiographically normal coronaries (no lumen irregularities, controls). Methods and results 191 participants (50.3% female; 50.8% CAD cases) were imaged with a multi-sequence, carotid CMR protocol at 1.5T. For ...

  14. Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

    OpenAIRE

    Novović Miloš; Topić Vesna

    2012-01-01

    Introduction. Arterial blood gas (ABG) analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG) values of pH, partial pressure of carbon dioxide (PCO2), partial o...

  15. Mediastinal fibrosis with pulmonary artery obstruction; diagnosis and investigation with helical CT imaging including 3-dimensional reconstructions

    International Nuclear Information System (INIS)

    An aggressive mediastinal fibrosis was found in a 42-year-old female, suffering from dysphagia, stabbing pain in the chest, and an unclear weight loss. In this case, the rare combination of esophageal involvement, bronchial narrowing, and pulmonary artery obstruction could easily be demonstrated with a barium study and a helical CT examination including three-dimensional reconstructions. (orig.)

  16. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Hvelplund, Anders; Abildstrøm, Steen Z;

    2012-01-01

    (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65%) than men (32%) had no obstructive CAD (P<0.001). In Cox's models adjusted for age, body mass index, diabetes, smoking, and use of lipid-lowering or...... stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.......AimsPatients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no...

  17. Pancreatic Pseudoaneurysm of the Superior Mesenteric Artery Complicated with Obstructive Jaundice. A Case Report

    Directory of Open Access Journals (Sweden)

    Stoica Z

    2005-01-01

    Full Text Available CONTEXT: Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe prognosis and high mortality. Angiography is usually required for confirmation of the diagnosis, but transabdominal ultrasound and CT angiography are useful noninvasive diagnostic methods. CASE REPORT: We present the case of a 66-year-old patient with a large pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. Transabdominal ultrasound with color and power Doppler showed a large pancreatic head pseudoaneurysm that communicated directly to the superior mesenteric artery. Presence of a spinning blood flow inside the pseudoaneurysm was visualized by color Doppler, with evidence of bidirectional flow in the pseudoaneurysm neck that was showed by Doppler spectral analysis. The contrast-enhanced helical computer tomography with multiplanar sagittal and the 3D reconstruction of coronal images confirmed the communication of the pseudoaneurysm with the superior mesenteric artery. The patient was scheduled for selective angiography and embolization. However, clinical evolution was rapidly deteriorating, with collapse, hemorrhagic shock and massive hemorrhage. The patient was operated on and subsequently died despite three days of intensive care, due to disseminated intravascular coagulation and multiorgan failure. CONCLUSION: Non invasive imaging methods consisting of transabdominal ultrasound with color Doppler and contrast-enhanced computer tomography with sagittal reconstruction of coronal images were very useful in the establishment of the diagnosis of pancreatic pseudoaneurysm of the superior mesenteric artery complicated with cholestatic jaundice. However, these imaging methods do not obviate the need for diagnostic and therapeutic angiography, eventually followed by surgical intervention in cases of recurrent bleeding or hemodynamic unstable patients.

  18. Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

    Institute of Scientific and Technical Information of China (English)

    Ai-Wu Mao; Zhong-Du Gao; Jia-Yu Xu; Ren-Jie Yancg; Xiang-Seng Xiao; Ting-Hui Jiang; Wei-Jun Jiang

    2001-01-01

    AIM To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs. METHODS A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus,stomach, duodenum and jejunum), per anal (colon and rectum ) and percutaneous transhepatic ( biliary )installation of metallic stent. Among them, 205 cases received drug infusion by cannulation of tumor supplying artery with Seldingers technique. RESULTS Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8 - 43 weeks among those with intraarterial drug infusion, which was later than 4 - 26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3 - 105) weeks,which was significantly longer than 15 (3- 24) weeks of the latter group. CONCLUSION Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

  19. Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea

    Energy Technology Data Exchange (ETDEWEB)

    Hou, T.-N., E-mail: dr-htn@hotmail.co [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China); Zhou, L.-N.; Hu, H.-J. [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China)

    2011-06-15

    Aim: To determine the relationship between the lingual artery and lingual markers for preoperative evaluation of the lingual artery in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Methods: A 16-section computed tomographic angiography (CTA) of the lingual artery was performed in 87 inpatient cases with OSAHS, from December 2007 to May 2009. The course of the lingual artery and the anatomic relationship between the lingual artery and the lingual markers were analyzed using CTA imaging. Results: The course of the lingual artery with the tongue in a resting position was similar to that of the Big Dipper constellation (Plough) in the sagittal view of CTA imaging. The first segment of the lingual artery declined approximately 19.27 {+-} 5.24 mm, the middle segment of the lingual artery was forward approximately 19.30 {+-} 6.79 mm, and the ascending segment of the lingual artery rose approximately 52.49 {+-} 10.98 mm. The entry point where the lingual artery entered into the tongue was adjacent to the tip of the greater horn of the hyoid bone. The relationship between the second segment of the lingual artery and the greater horn of the hyoid bone was relatively steady with the tongue in whatever position. The interval between the bilateral greater horn of the hyoid bone equalled that between the bilateral lingual arteries. Conclusions: Recognizing some lingual markers in the patients with OSAHS, such as the greater horn of the hyoid bone, foramen cecum, circumvallate papilla, lingual vein and tongue midline, may facilitate the surgeon's ability to define the course of the lingual artery accurately in the treatment of OSAHS.

  20. Effects of partial portal vein arterialization on liver regeneration after hepatectomy in minipigs with obstructive jaundice

    Institute of Scientific and Technical Information of China (English)

    CHEN Yong-liang; CHEN Wen-bin; WAN Yun-yan; LI Wen-gang; HUANG Zhi-qiang; WU Xiao-tong; YANG Jie; YANG Li

    2012-01-01

    Background Hilar cholangiocarcinoma is a malignant tumor that is difficult to cure.The aim of this study was to observe the effects of flow-controlled partial portal vein arterializations (PPVA) on liver regeneration after hepatectomy in minipigs with chronic obstructive jaundice.Methods Eight minipigs were made into chronic obstructive jaundice models.United semi-hepatectomy,which imitates extended radical surgery for treatment of hilar cholangiocarcinoma,was then performed.The eight minipigs were randomly divided into groups A and B (n=4 minipigs each).PPVA was performed in Group A but not in Group B.The effects of flow-controlled PPVA on live regeneration after hepatectomy were observed for 30 days after hepatectomy.Results The portal vein PO2 at the immediate time point and on postoperative day 30 was higher in Group A ((47.33±2.43) and (48.50±4.44) mmHg) than in Group B ((35.38±4.06) and (35.55±2.55) mmHg respectively,all P <0.01 ).The mitotic index of liver cells on postoperative days 14 and 21 was higher in Group A (12.55%±2.85% and 15.25%±1.99% respectively) than in Group B (6.85%±2.10% and 11.88%±1.15% respectively,all P <0.05).The regeneration rate of residual liver on postoperative days 14 and 21 was higher in Group A (24.56%±6.15% and 70.63%±9.83% respectively) than in Group B (11.96%±5.43% and 44.92%±7.42% respectively,P <0.05 and P <0.01 respectively).Conclusion Flow-controlled PPVA can promote liver regeneration after hepatectomy and prevent liver failure in minipigs with chronic obstructive jaundice.

  1. Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

    OpenAIRE

    Solange Guizilini; Marcela Viceconte; Esperança, Gabriel Tavares da M.; Douglas W. Bolzan; Milena Vidotto; Rita Simone L Moreira; Andréia Azevedo Câncio; Gomes, Walter J.

    2014-01-01

    Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal sp...

  2. Differences in carotid arterial morphology and composition between individuals with and without obstructive coronary artery disease: A cardiovascular magnetic resonance study

    Directory of Open Access Journals (Sweden)

    Takaya Norihide

    2008-06-01

    Full Text Available Abstract Objective We sought to determine differences with cardiovascular magnetic resonance (CMR in the morphology and composition of the carotid arteries between individuals with angiographically-defined obstructive coronary artery disease (CAD, ≥ 50% stenosis, cases and those with angiographically normal coronaries (no lumen irregularities, controls. Methods and results 191 participants (50.3% female; 50.8% CAD cases were imaged with a multi-sequence, carotid CMR protocol at 1.5T. For each segment of the carotid, lumen area, wall area, total vessel area (lumen area + wall area, mean wall thickness and the presence or absence of calcification and lipid-rich necrotic core were recorded bilaterally. In male CAD cases compared to male controls, the distal bulb had a significantly smaller lumen area (60.0 ± 3.1 vs. 79.7 ± 3.2 mm2, p 2; p 2; p = 0.006 and smaller total vessel area (64.0 ± 2.3 vs. 70.9 ± 2.4 mm2; p = 0.04. These metrics were not significantly different between female groups in the distal bulb and internal carotid or for either gender in the common carotid. Male CAD cases had an increased prevalence of lipid-rich necrotic core (49.0% vs. 19.6%; p = 0.003, while calcification was more prevalent in both male (46.9% vs. 17.4%; p = 0.002 and female (33.3% vs. 14.6%; p = 0.031 CAD cases compared to controls. Conclusion Males with obstructive CAD compared to male controls had carotid bulbs and internal carotid arteries with smaller total vessel and lumen areas, and an increased prevalence of lipid-rich necrotic core. Carotid calcification was related to CAD status in both males and females. Carotid CMR identifies distinct morphological and compositional differences in the carotid arteries between individuals with and without angiographically-defined obstructive CAD.

  3. Raynaud's phenomenon in arterial obstructive disease of the hand demonstrated by locally provoked cooling

    DEFF Research Database (Denmark)

    Nielsen, Steen Levin; Nobin, B A; Hirai, M;

    1978-01-01

    indicates an increase of digital arterial tone. In all three groups, digital arterial tone increased more than in normals during finger cooling. Patients with Raynaud's disease showed a pathological increase in arterial tone at 23.5 degrees C with closure of the digital arteries at a mean temperature of 18...... pathological arterial tone in Raynaud's disease vs. a normal arterial tone in obliterative diseases acting on a narrow vessel....

  4. Obstructive jaundice caused by pancreaticoduodenal artery aneurysms associated with celiac axis stenosis: case report and review of the literature.

    Science.gov (United States)

    Yin, Tiansheng; Wan, Zhili; Chen, Hongwei; Mao, Xixian; Yi, Yayang; Li, Dewei

    2015-07-01

    Pancreaticoduodenal artery aneurysm (PDA) is quite rare, which accounts for only approximate 2% of all visceral aneurysms. Besides, PDA is usually related to celiac axis stenosis (CAS) and prone to rupture. Advanced imaging examination can facilitate the disclosure of such peripancreatic masses, but most of them were seldom diagnosed until they rupture because of the nonspecific symptoms. Secondary to PDA, obstructive jaundice is however an extremely rare manifestation. A case of an 84-year-old man is reported here, who suffered from severe jaundice caused by a ruptured PDA associated with CAS. In addition, this review collects and organizes PDAs with jaundice by applying a MEDLINE search and discusses the pathogenesis and therapeutic options of these aneurysms leading to external compression over the bile duct. Consequently, the formation of PDA with obstructive jaundice is based on the specific anatomy of pancreaticoduodenal arcades. When there is a retroperitoneal mass around the head of the pancreas associated with unexpected jaundice, PDA should be considered, for which early aggressive therapy is required. The case report and literature review suggest that PDA associated with obstructive jaundice may be treated successfully by single transcatheter arterial embolization (TAE) without auxiliary biliary drainage, whether it ruptures or not. PMID:25769284

  5. Obstructive sleep apnea, diagnosed by the Berlin questionnaire and association with coronary artery disease severity

    Science.gov (United States)

    Ghazal, Abdullatef; Roghani, Farshad; Sadeghi, Masoumeh; Amra, Babak; Kermani-Alghoraishi, Mohammad

    2015-01-01

    BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep-related disorder that is associated with increased risk of hypertension (HTN) and coronary heart disease. This study aimed to evaluate the correlation between the OSAS and coronary artery disease (CAD) severity. METHODS The cross-sectional study was conducted from September 2012 to December 2013. We enrolled 127 patients with chronic stable angina who were referred for coronary angiographic studies in Shahid Chamran and Nour Hospitals in Isfahan, Iran. The Berlin questionnaire (BQ) was used for estimate the probability of OSAS in patients as a low or high probability. Demographic characteristics and metabolic risk factors including diabetes mellitus, HTN, obesity, and smoking also were recorded. The severity of CAD was assessed and compared based on the Gensini score with Mann-Whitney U statistical test. Independent t-test for continuous variables and chi-square test for categorical variables were used. RESULTS Totally, 65.4% of subjects were considered as high and 34.6% as low probability for OSAS, which 81.1% of them had CAD. There was a significant difference between body mass index, systolic blood pressure, diastolic blood pressure, and ischemic heart disease drug consumption with OSAS probability (P < 0.0500). CAD was accompanied by OSAS significantly (P = 0.0260). The Gensini score was significantly higher in patients with high OSAS probability (100.4 ± 69.1 vs. 65.3 ± 68.9; P = 0.0030). OSAS also increase odds of CAD based on regression analysis (odds ratio, 95% confidence interval = 2.7). CONCLUSION This study indicates that more severe CAD is associated with high OSAS probability identified by BQ. PMID:26715932

  6. Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Novović Miloš

    2012-01-01

    Full Text Available Introduction. Arterial blood gas (ABG analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD. Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG values of pH, partial pressure of carbon dioxide (PCO2, partial oxygen pressure (PO2, bicarbonate (HCO3, and venous and arterial blood oxygen saturation (SO2 can reliably predict ABG levels in patients with acute exacerbation of COPD. Methods. Forty-seven patients with a prior diagnosis of COPD were included in this prospective study. The patients with acute exacerbation of this disease were examined at the General Hospital EMS Department in Prijepolje. ABG samples were taken immediately after venous sampling, and both were analyzed. Results. The Pearson correlation coefficients between arterial and venous parameters were 0.828, 0.877, 0.599, 0.896 and 0.312 for pH, PCO2, PO2, HCO3 and SO2, respectively. The statistically significant correlation between arterial and venous pH, PCO2 and HCO3, values was found in patients with acute exacerbation of COPD (p<0.001. Conclusion. When we cannot provide arterial blood for analysis, venous values of the pH, Pv,CO2 and HCO3 parameters can be an alternative to their arterial equivalents in the interpretation of the metabolic status in patients with acute exacerbation of COPD, while the values of venous Pv,O2 and Sv,O2 cannot be used as predictors in the assessment of oxygen status of such patients.

  7. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  8. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    International Nuclear Information System (INIS)

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  9. Cardiac magnetic resonance imaging in patients with chest pain, high troponin levels and absence of coronary artery obstruction

    International Nuclear Information System (INIS)

    The prevalence of myocardial infarction with angiographically normal coronary arteries is approximately 7-10%. The etiological diagnosis is sometimes difficult and is important in terms of clinical practice and prognosis. The goal of our study was to show a series of consecutive patients with an initial diagnosis of acute coronary syndrome with high troponin levels and absence of coronary artery obstruction in which cardiac magnetic resonance imaging (CMRI) gave a description of the myocardial lesion, orientating towards the etiological diagnosis. From January 2005 to December 2009, 720 consecutive patients with an initial diagnosis of acute coronary syndrome and elevated troponins were included; 64 of these patients did not present angiographically significant coronary artery stenosis. Within 72 ± 24 h after coronary angiography, these patients underwent CMRI using b-SSFP sequences for cine imaging in short-axis, 2-, 3- and 4- chamber views for the evaluation of segmental wall motion, with T2-weighted and delayed enhancement (DE) images of the myocardium with an 'inversion-recovery' sequence. The following diagnoses were made: myocarditis (39 patients); myocardial infarction (12 patients); Tako-Tsubo syndrome (8 patients); apical hypertrophic cardiomyopathy (2 patients); 3 patients remained without diagnosis. These findings demonstrate the usefulness of CMRI in the clinical scenario of patients with chest pain, inconclusive ECG findings and high troponin levels with angiographically normal coronary arteries. The presence and distribution pattern of DE make it possible to define the etiological diagnosis and interpret the physiopathological process. (authors)

  10. Pulmonary artery radiocardiography and rheography in the diagnosis of hemodynamic and contractile function impairments of the right ventricle in patients with obstructive bronchitis

    International Nuclear Information System (INIS)

    Radiocardiography and rheography of the pulmonary artery were used to examine impairments in hemodynamics and contractile function of the right ventricle in 40 patients with chronic obstructive bronchitis complicated with persistent hypertension. Right ventricular hemodynamic and contractile impairments were shown to be not equivalent with similar clinical and functional signs of pulmonary hypertension. This fact indicates that the use of special techiques is of practical value in the determination of right ventricular hemodynamics and myocardial contractility in patients with chronic obstructive bronchitis. Radiocardiography and rheography of the pulmonary artery are sufficiently reliable noninvasive techniques for examining the hemodynamics and contractile function of the right ventricular myocardium

  11. Oclusão arterial aguda de stent fêmoro-poplíteo Acute femoropopliteal artery stent obstruction

    OpenAIRE

    Fabio Henrique Rossi; Milton Kiyonory Uehara; Juliana Chen; Thiago Emilio Burza Maia; Eduardo Mulinari Darold; Andréia Silveira Martins; Akash Kuzhiparambil Prakasan; Nilo Mitsuro Izukawa

    2009-01-01

    A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best the...

  12. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

    Directory of Open Access Journals (Sweden)

    Del Ben Maria

    2012-07-01

    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  13. Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, L.; Bøtker, H. E.; Sorensen, H.;

    2015-01-01

    -vessel/left main [LM]). The severity of non-obstructive CAD was assessed by the Agatston score (Ag) and categorized as zero, low (Ag, 1-99), moderate (Ag, 100-399), or high (Ag, >400). Cox regression was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of the relative...

  14. Oclusão arterial aguda de stent fêmoro-poplíteo Acute femoropopliteal artery stent obstruction

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2009-09-01

    Full Text Available A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best therapeutic approach in this group of patients. We report a clinical case in which stent fragmentation and endarterectomy enabled femoropopliteal below knee bypass and limb revascularization.

  15. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    International Nuclear Information System (INIS)

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy

  16. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lescher, Stephanie, E-mail: stephanie.lescher@kgu.de; Czeppan, Katja; Porto, Luciana [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C. [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  17. Endovascular procedures in the treatment of obstructive lesions of brachiocephalic arteries

    Directory of Open Access Journals (Sweden)

    Sagić Dragan

    2002-01-01

    Full Text Available Background. To assess the early effects, possible risks, and long term results of percutaneous transluminal angioplasty (PTA of brachiocephalic trunk (BT and subclavian arteries (SA. Methods. During the period of 11 years, in 92 patients (57 males - 62%, mean age 53,5 ± 7,8 years 93 PTA of SA/BT were performed; 70 (75% lesions were stenosis, while 23 (25% lesions were occlusions with mean diameter stenosis percent of 83,1 ± 6,2%. Clinical indications were: vertebrobasilar insufficiency (n=57, upper limb ischemia (n=40, coronary steal syndrome (n=4 and scheduled aorto-coronary bypass, using internal thoracic artery (ITA (n=4 asymptomatic patients. Mean lesion length was 22 ± 8 mm. Results. Eighty one (87% out of 93 lesions were successfully dilated; all of 12 (13% failures were due to unsuccessful recanalisation of occluded arteries. In 10 patients 10 stents were implanted (2 in BT and 8 in left SA. There were 6 (6.5% procedural complications: 1 dissection, 1 thrombosis of the left SA, transient ischemic attack in 2 patients, and 2 cases of dislocation of atheromatous plaque from the right SA into the right common carotid artery. During the follow-up of 48 ± 3 months, 16 (20% restenoses were treated by PTA (n=7 or operatively (n=9. Primary and secondary patency for all lesions treated during 11 years was 87% and 80%, respectively (stenosis: 97% and 89%; occlusions: 58% and 58%. Conclusion. PTA with or without stenting was relatively simple, efficient and safe procedure. It required short hospitalization with low treatment costs. If any of suboptimal results or chronic occlusions were present, the implantation of endovascular stents should have been considered.

  18. Increased Ventricular Premature Contraction Frequency During REM Sleep in Patients with Coronary Artery Disease and Obstructive Sleep Apnea

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    Mari A. Watanabe

    2008-11-01

    Full Text Available Background Patients with obstructive sleep apnea are reported to have a peak of sudden cardiac death at night, in contrast to patients without apnea whose peak is in the morning. We hypothesized that ventricular premature contraction (VPC frequency would correlate with measures of apnea and sympathetic activity.Methods Electrocardiograms from a sleep study of 125 patients with coronary artery disease were evaluated. Patients were categorized by apnea-hypopnea index (AHI into Moderate (AHI 15 apnea groups. Sleep stages studied were Wake, S1, S2, S34, and rapid eye movement (REM. Parameters of a potent autonomically-based risk predictor for sudden cardiac death called heart rate turbulence were calculated.Results There were 74 Moderate and 51 Severe obstructive sleep apnea patients. VPC frequency was affected significantly by sleep stage (Wake, S2 and REM, F=5.8, p<.005 and by AHI (F=8.7, p<.005. In Severe apnea patients, VPC frequency was higher in REM than in Wake (p=.011. In contrast, patients with Moderate apnea had fewer VPCs and exhibited no sleep stage dependence (p=.19. Oxygen desaturation duration per apnea episode correlated positively with AHI (r2=.71, p<.0001, and was longer in REM than in non-REM (p<.0001. The heart rate turbulence parameter TS correlated negatively with oxygen desaturation duration in REM (r2=.06, p=.014.Conclusions Higher VPC frequency coupled with higher sympathetic activity caused by longer apnea episodes in REM sleep may be one reason for increased nocturnal death in apneic patients.

  19. Significance of MR angiography in the diagnosis of aberrant renal arteries as the cause of ureteropelvic junction obstruction in children; Stellenwert der MR-Angiografie in der Diagnostik aberrierender Nierenarterien als Ursache einer Ureterabgangsstenose bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Ritter, L.; Sorge, I.; Hirsch, F.W.; Vieweger, A. [Leipzig Univ. (Germany). Dept. of Pediatric Radiology; Goetz, G.; Lehnert, T.; Buehligen, U.; Geyer, C. [Leipzig Univ. (Germany). Dept. of Pediatric Surgery

    2015-01-15

    To determine the importance of MRI with contrast-enhanced MRA for the detection or exclusion of aberrant or obstructing renal arteries in ureteropelvic junction obstruction in children. Key word-based search in RIS database (ureteropelvic junction obstruction/MRI) and retrospective comparison of arterial findings from preoperative contrast-enhanced MRA and intra-operative inspection. From 2007 to 2013, 19 children with ureteropelvic junction obstruction underwent contrast-enhanced MRA. Based on the results of the MRI scan and MAG3 scintigraphy, the children were referred to surgery (Anderson-Hynes-pyeloplasty). An aberrant renal artery was diagnosed with MRI in 14 of 19 children, and intra-operative inspection confirmed 13 of those 14. In the remaining 5 children, no aberrant vessel could be observed in MRI and this was confirmed intra-operatively in 3 of the 5 cases, while in the remaining 2, an aberrant vessel was found. Of the 14 children with aberrant vessels, 12 underwent surgery due to assumed ureteral obstruction, which was confirmed by surgery in 11 cases. In one case, an aberrant artery was found intra-operatively, but obstruction could not be confirmed. In one of the 14 children, the vessel was found in MRI, but its obstructing character was negated via MRA, which was confirmed intra-operatively. In the diagnosis of aberrant and obstructing renal arteries, contrast-enhanced MRA presents 85 % sensitivity and 80 % specificity, with a positive predictive value of 0.8. MRI with contrast-enhanced MRA is suitable to detect aberrant and obstructing renal arteries. An obstructive effect of the aberrant vessel is to be assumed if the vessel has a close relationship to the ureteropelvic junction and if it is linearly stretched.

  20. Reversing left bronchus obstruction by compression of a pulmonary artery stent.

    Science.gov (United States)

    Brown, Stephen C; Proesmans, Marijke; Gewillig, Marc

    2016-07-01

    We report a case where endovascular stenting as part of the treatment of complex cardiovascular disease led to airway compression. Using a novel technique, this was successfully reversed. Simultaneous inflations of two balloons-one in the obstructed bronchus and one in the aorta combined with external compression of the chest-resulted in compression the stent. This report illustrates that by thinking "out of the box" and bearing in mind spatial relationships inside the chest, it is possible to diminish the anterior-posterior diameters of a stent. This intervention proved to be successful with relief of the left bronchial compression and improvement of chronic airway infection. © 2016 Wiley Periodicals, Inc. PMID:26762468

  1. Changes of Protein Kinase Cα and Cyclin D1 Expressions in Pulmonary Arteries from Smokers with and without Chronic Obstructive Pulmonary Disease

    Institute of Scientific and Technical Information of China (English)

    向敏; 刘先胜; 曾大雄; 王苒; 徐永健

    2010-01-01

    The purpose of this study was to investigate the changes of protein kinase Cα(PKCα) and cyclin D1 expressions in pulmonary arteries from smokers with normal lung function and smokers with mild to moderate chronic obstructive pulmonary disease(COPD).The peripheral lung tissues were obtained from 10 non-smokers with normal lung function(non-smoker group),14 smokers with normal lung function(smoker group),11 smokers with mild to moderate COPD(COPD group).The morphological changes of pulmonary arteries were obs...

  2. Obstrução arterial retiniana periférica associada com hiper-homocisteinemia: relato de caso Peripheral retinal arterial obstruction associated with hyperhomocysteinemia: case report

    Directory of Open Access Journals (Sweden)

    Alexandre Kazuo Misawa

    2008-10-01

    Full Text Available A hiperhomocisteinemia é fator de risco para fenômenos trombo-embólicos retinianos associados a quadro de oclusão vascular venosa e arterial. Descrevemos um paciente com obstrução arterial retiniana periférica, sem sinais de vasculite ativa, associada a proliferação de neovasos com tração vítreo-retiniana e hemorragia vítrea recidivante. O alto nível sérico de homocisteína decorrente de deficiência de vitamina B12 e ácido fólico, sem outras alterações na cascata da coagulação, inclusive com a pesquisa do fator V de Leiden, sugere que a hiper-homocisteinemia esteja diretamente ligada como fator causal deste quadro clínico. Embora apresentasse PPD elevado, o diagnóstico diferencial mais importante de doença de Eales foi menos considerado por ser diagnóstico de exclusão. O controle do quadro clínico foi feito com suplemento de vitaminas (B12 e ácido fólico e fotocoagulação retiniana periférica. A homocisteína plasmática total deve ser dosada em pacientes com obstrução vascular retiniana, já que a hiper-homocisteinemia é fator de risco modificável e de fácil tratamento por meio de dieta ou suplementação vitamínica.Hyperhomocysteinemia is a risk factor for thromboembolic events of the retina associated with vascular venous or arterial occlusion. We describe a patient with occlusion of the peripheral arteriolar network without active vasculitis, associated with neovascular proliferation, peripheral vitreous-retinal traction and relapsing vitreous hemorrhage. The high serum homocysteine level resulting from vitamin B12 and folic acid deficiency, without further changes in the coagulation cascade including the test for Leiden's Factor V, indicates hyperhomocysteinemia as a direct causal factor in this clinical condition. Despite a high PPD, Eales Disease, a major differential diagnosis, was not fully considered, since it is established by exclusion. The patient was treated with photocoagulation and vitamin

  3. Effect of continuous positive airway pressure on blood pressure in hypertensive patients with coronary artery bypass grafting and obstructive sleep apnea

    OpenAIRE

    Dong, Yumei; Dai, Yingnan; Wei, Guoqian; Cha, Li; Li, Xueqi

    2014-01-01

    Background: Previous studies have documented that obstructive sleep apnea (OSA) increases the incidence of hypertension, respiratory failure and unexpected post-operative deaths during night in coronary artery bypass grafting (CABG) patients. We hypothesized that continuous positive airway pressure (CPAP) reduces blood pressure in these patients. Methods: We conducted a prospective, controlled study in 51 patients. The subjects received CPAP treatment were defined as CPAP group, whereas those...

  4. 24-HOUR ARTERIAL STIFFNESS VALUES IN MEN WITH DIFFERENT PHENOTYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE CONCURRENT WITH HYPERTENSION

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    N. A. Karoli

    2015-01-01

    Full Text Available Objective: to study the specific features of the daily arterial stiffness (AS profile in men with different phenotypes of chronic obstructive pulmonary disease (COPD concurrent with hypertension. Subjects and methods. The investigation enrolled 78 male patients with COPD and hypertension. The patients were divided according to COPD phenotypes into 2 groups: 1 COPD patients with emphysema; 2 those with bronchitis. The exclusion criteria were less than 40 years and more than 80 years of age; diabetes mellitus; coronary heart disease; vascular diseases; an exacerbation of chronic diseases; bronchial and pulmonary diseases of another etiology. The patients underwent 24-hour blood pressure and AS monitoring, external respiratory function testing: spirography with a short-acting β2-agonist test, a six-minute walk test at baseline and after a hemoglobin oxygen saturation test, and a CAT test. Results. The patients of both groups were observed to have a statistically significant increase in (dP/dtmax as compared to those of the control group (p < 0.05; p < 0.01 in both the daytime and nighttime. In these periods, the COPD patients with emphysema had a higher AIx than those with bronchitis (p < 0.001. There was a statistically significantly (p < 0.001 higher AIx in the nighttime than in the daytime in Groups 1 and 2 patients. Conclusion. The patients with different COPD phenotypes were noted to have impaired arterial elastic properties, circadian AS changes with predominantly nocturnal impaired vascular stiffness. Relationships were found between 24-hour AS values and clinicoanamnestic findings. 

  5. 48. Can early 24 hours Holter monitoring predict obstructive coronary artery lesions in patients with low risk acute coronary syndrome?

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    T. Taha

    2016-07-01

    Full Text Available Identification of patients at increased risk of death due to acute coronary syndrome (ACS can add to risk stratification and guide the next step in the management of those patients. Altered HRV has been associated with adverse outcomes in heart disease, but this has not been established in patients with acute chest pain.This study aimed to create a non-invasive, economical and risk-free method in the clinical evaluation and diagnosis of significant CAD among patients with unstable angina.Twenty-four-hour Holter recordings of 100 patients with ACS were initiated within 24 hours of admission at the emergency department; stress ECG was done for all patients while coronary angiography was done only for patients with abnormal stress test. Time domain, frequency domain, and nonlinear HRV were examined.The mean SDNN was statistically significantly lower in patients with abnormal stress test, many time and frequency domain HRV parameters was statistically lower in patients with significant coronary arteries obstruction. HRV measured close to the ACS onset may assist in risk stratification. HRV parameters may provide additional, incremental prognostic information to established assessment guidelines and possible early intervention in those patients.

  6. Data on the lipoprotein (a), coronary atherosclerotic burden and vulnerable plaque phenotype in angiographic obstructive coronary artery disease.

    Science.gov (United States)

    Niccoli, Giampaolo; Chin, Diana; Scalone, Giancarla; Panebianco, Mario; Abbolito, Sofia; Cosentino, Nicola; Jacoangeli, Francesca; Refaat, Hesham; Gallo, Giovanna; Salerno, Gerardo; Volpe, Massimo; Crea, Filippo; De Biase, Luciano

    2016-06-01

    Lipoprotein Lp(a) represents an independent risk factor for coronary artery disease (CAD). However, its association with CAD burden and lipid rich plaques prone to rupture in patients with acute coronary syndrome (ACS) still remains unknown. These data aim to investigate the association among serum Lipoprotein(a) (Lpa) levels, coronary atherosclerotic burden and features of culprit plaque in patients with ACS and obstructive CAD. For his reason, a total of 500 ACS patients were enrolled for the angiographic cohort and 51 ACS patients were enrolled for the optical coherence tomography (OCT) cohort. Angiographic CAD severity was assessed by Sullivan score and by Bogaty score including stenosis score and extent index, whereas OCT plaque features were evaluated at the site of the minimal lumen area and along the culprit segment. In the angiographic cohort, Lp(a) was a weak independent predictor of Sullivan score (p30 md/dl) compared to patients with lower Lp(a) levels (<30 md/dl) exhibited a higher prevalence of lipidic plaque at the site of the culprit stenosis (P=0.02), a wider lipid arc (p=0.003) and a higher prevalence of thin-cap fibroatheroma (p=0.004). PMID:27158659

  7. Comparison of arterial and venous blood gases and the effects of analysis delay and air contamination on arterial samples in patients with chronic obstructive pulmonary disease and healthy controls.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-01-31

    BACKGROUND: Arterial blood gases (ABGs) are often sampled incorrectly, leading to a \\'mixed\\' or venous sample. Delays in analysis and air contamination are common. OBJECTIVES: We measured the effects of these errors in patients with chronic obstructive pulmonary disease (COPD) exacerbations and controls. METHODS: Arterial and venous samples were analyzed from 30 patients with COPD exacerbation and 30 controls. Venous samples were analysed immediately and arterial samples separated into non-air-contaminated and air-contaminated specimens and analysed at 0, 30, 60, 90 and 180 min. RESULTS: Mean venous pH was 7.371 and arterial pH was 7.407 (p < 0.0001). There was a correlation between venous and arterial pH (r = 0.5347, p < 0.0001). The regression equation to predict arterial pH was: arterial pH = 4.2289 + 0.43113 . venous pH. There were no clinically significant differences in arterial PO associated with analysis delay. A statistically significant decline in pH was detected at 30 min in patients with COPD exacerbation (p = 0.0042) and 90 min in controls (p < 0.0001). A clinically significant decline in pH emerged at 73 min in patients with COPD exacerbation and 87 min in controls. Air contamination was associated with a clinically significant increase in PO in all samples, including those that were immediately analyzed. CONCLUSIONS: Arterial and venous pH differ significantly. Venous pH cannot accurately replace arterial pH. Temporal delays in ABG analysis result in a significant decline in measured pH. ABGs should be analysed within 30 min. Air contamination leads to an immediate increase in measured PO, indicating that air-contaminated ABGs should be discarded.

  8. Dual-energy CT angiography of chronic thromboembolic disease: Can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects?

    International Nuclear Information System (INIS)

    Purpose: To evaluate whether dual-energy CT angiography (DE-CTA) could identify links between morphologic and functional abnormalities in chronic pulmonary thromboembolism (CPTE). Materials and methods: Seventeen consecutive patients with CPTE without underlying cardio-respiratory disease were investigated with DE-CTA. Two series of images were generated: (a) transverse diagnostic scans (i.e., contiguous 1-mm thick averaged images from both tubes), and (b) perfusion scans (i.e., images of the iodine content within the microcirculation; 4-mm thick MIPs). Two radiologists evaluated by consensus the presence of: (a) pulmonary vascular features of CPTE and abnormally dilated systemic arteries on diagnostic CT scans, and (b) perfusion defects of embolic type on perfusion scans. Results: Diagnostic examinations showed a total of 166 pulmonary arteries (166/833; 19.9%) with features of CPTE, more frequent at the level of peripheral than central arteries (8.94 vs 0.82; p < 0.0001), including severe stenosis with partial (97/166; 58.4%) or complete (20/166; 12.0%) obstruction, webs and bands (37/166; 22.3%), partial filling defects without stenosis (7/166; 4.2%), focal stenosis (4/166; 2.4%) and abrupt vessel narrowing (1/166; 0.6%). Perfusion examinations showed 39 perfusion defects in 8 patients (median number: 4.9; range: 1-11). The most severe pulmonary arterial features of CPTE were seen with a significantly higher frequency in segments with perfusion defects than in segments with normal perfusion (p < 0.0001). Enlarged systemic arteries were observed with a significantly higher frequency ipsilateral to lungs with perfusion defects (9/12; 75%) compared with lungs without perfusion defects (5/22; 22.7%) (p = 0.004). Conclusion: Dual-energy CTA demonstrates links between the severity of pulmonary arterial obstruction and perfusion impairment, influenced by the degree of development of the systemic collateral supply.

  9. Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study.

    Science.gov (United States)

    Dobrowolski, Piotr; Florczak, Elżbieta; Klisiewicz, Anna; Prejbisz, Aleksander; Rybicka, Justyna; Śliwiński, Paweł; Januszewicz, Andrzej; Hoffman, Piotr

    2016-04-29

    INTRODUCTION The effect of obstructive sleep apnea (OSA) on right ventricular (RV) function and pulmonary circulation parameters is unclear. OBJECTIVES The aim of this study was to determine whether newly diagnosed OSA and its severity has any impact on RV performance and echocardiographic parameters of pulmonary circulation in patients with true resistant hypertension. PATIENTS AND METHODS The study included 155 patients (93 men and 62 women; mean age, 47.5 ±10 years). The apnea-hypopnea index (AHI), end-diastolic and end-systolic area of the right ventricle, main pulmonary artery diameter (MPAd) at diastole, acceleration time (AccT), tricuspid annular systolic velocity wave, and tricuspid annular plane systolic excursion were evaluated. RESULTS Patients were divided into 4 groups: without OSA (AHI 30; n = 40). There were no differences in RV systolic function between the groups. Patients with severe OSA had a wider MPAd (26.0 ±2.6 vs 23.1 ±3.7 mm; P <0.0001) and shorter AccT (114.2 ±15.7 vs 133.4 ±22.1 ms; P <0.001) in comparison with patients without OSA. The cut-off for the best predictive value of severe OSA was an MPAd of 25 mm or higher with a sensitivity of 63.6% and specificity of 78.9%. The area under the receiver operating characteristic curve for severe OSA in relation to an MPAd of 25 mm or higher was 0.766 (95% confidence interval, 0.673-0.859; P <0.0001). Factors independently associated with an MPAd of 25 mm or higher were severe OSA and nighttime diastolic blood pressure levels. CONCLUSIONS Our study showed a relationship between pulmonary artery dilation and the presence of newly diagnosed severe OSA. Among the parameters studied, an MPAd of 25 mm or higher turned out to be the most useful parameter in identifying patients with severe OSA. PMID:27129085

  10. Economic Utility of a Blood-Based Genomic Test for the Assessment of Patients with Symptoms Suggestive of Obstructive Coronary Artery Disease

    Science.gov (United States)

    Hochheiser, Louis I.; Juusola, Jessie L.; Monane, Mark

    2014-01-01

    Abstract Approximately 3 million patients with symptoms suggestive of obstructive coronary artery disease (CAD) present to primary care offices in the United States annually, resulting in approximately $6.7 billion in cardiac workup costs. Despite wide application of existing diagnostic technologies, yield of obstructive CAD at invasive coronary angiography (ICA) is low. This study used a decision analysis model to assess the economic utility of a novel gene expression score (GES) for the diagnosis of obstructive CAD. Within a representative commercial health plan's adult membership, current practice for obstructive CAD diagnosis (usual care) was compared to a strategy that incorporates the GES test (GES-directed care). The model projected the number of diagnostic tests and procedures performed, the number of patients receiving medical therapy, type I and type II errors for each strategy of obstructive CAD diagnosis, and the associated costs over a 1-year time horizon. Results demonstrate that GES-directed care to exclude the diagnosis of obstructive CAD prior to myocardial perfusion imaging may yield savings to health plans relative to usual care by reducing utilization of noninvasive and invasive cardiac imaging procedures and increasing diagnostic yield at ICA. At a 50% capture rate of eligible patients in GES-directed care, it is projected that a commercial health plan will realize savings of $0.77 per member per month; savings increase proportionally to the GES capture rate. These findings illustrate the potential value of this new blood-based, molecular diagnostic test for health plans and patients in an age of greater emphasis on personalized medicine. (Population Health Management 2014;17:287–296) PMID:24568603

  11. Evaluation and validation of a method for determining platelet catecholamine in patients with obstructive sleep apnea and arterial hypertension.

    Directory of Open Access Journals (Sweden)

    Marcia C Feres

    Full Text Available BACKGROUND: Measurements of plasma and urinary catecholamine are susceptible to confounding factors that influence the results, complicating the interpretation of sympathetic nervous system (SNS activity in the Obstructive sleep apnea (OSA and arterial hypertension (HYP conditions. OBJECTIVE: In this study, we validated a test for platelet catecholamine and compared the catecholamine levels (adrenaline and noradrenaline in urine, plasma and platelets in patients with OSA and HYP compared with controls. METHODS: In the validation, 30 healthy, nonsmoking volunteers who were not currently undergoing treatment or medication were selected as the control group. One hundred fifty-four individuals (114 OSA, 40 non-OSA were consecutively selected from the outpatient clinic of the Sleep Institute and underwent clinical, polysomnographic and laboratory evaluation, including the urinary, plasma and platelet levels of adrenaline (AD and noradrenaline (NA. Patients were then allocated to groups according to the presence of OSA and/or hypertension. RESULTS: A logistic regression model, controlled for age and BMI, showed that urinary AD and urinary NA were risk factors in the OSA+HYP group and the HYP group; however, the model showed higher levels of platelet NA for OSA without HYP. After 1 year of CPAP (continuous upper airway pressure treatment, patients (n = 9 presented lower levels of urinary NA (p = 0.04 and platelet NA (p = 0.05. CONCLUSION: Urinary NA and AD levels were significantly associated with the condition of hypertension with and without OSA, whereas platelet NA with OSA without comorbidity. These findings suggest that platelet catecholamine levels might reflect nocturnal sympathetic activation in OSA patients without hypertension.

  12. Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Apfaltrer, P., E-mail: paul.apfaltrer@medma.uni-heidelberg.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, T.; Meyer, M. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Roeger, S.; Haghi, D.; Gruettner, J.; Süselbeck, T. [Department of Internal Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Wilson, R.B.; Schoepf, U.J. [Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, MSC 226, Charleston, SC 29401 (United States); Schoenberg, S.O.; Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany)

    2012-10-15

    Objective: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). Materials and methods: In a prospective study of 50 patients (66 ± 12.9 years) with PE pulmonary artery OS (Qanadli, Mastora, and Mastora central) were assessed by two radiologists. To assess RVD all patients underwent echocardiography within 24 h. Furthermore, RVD on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans) and four-chamber views (RV/LV4ch) as well as the RV/LV volume ratio (RV/LVvol). OS were correlated with RVD and the occurrence of adverse clinical outcomes (defined as death, need for intensive care treatment, or cardiac insufficiency ≥NYHA III). Results: Mean Mastora, Qanadli, and Mastora central OS were 26.4 ± 17.7, 12.6 ± 9.9 and 7.5 ± 9, respectively. Echocardiography demonstrated moderate and severe RVD in 10 and 5 patients, respectively. Patients with moderate and severe RVD showed significantly higher Mastora central scores than patients without RVD (14 ± 10.8 vs. 5.9 ± 7.8 [p = 0.05]; 17.6 ± 13.2 vs. 5.9 ± 7.8 [p = 0.038]). A relevant correlation (i.e. r ≥ 0.6) between OS and CT parameters for RVD were only found for the Mastora score and the Mastora central score (RV/LV4ch: r = 0.61 and 0.68, RV/LVvol: r = 0.61 and 0.6). 18 patients experienced an adverse clinical outcome. None of the OS differed significantly between patients with and without adverse clinical outcome. Conclusion: Pulmonary artery obstruction scores can differentiate between patients with and without RVD. However, in this study, obstruction scores were not correlated to adverse clinical outcome.

  13. Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Solange Guizilini

    2014-12-01

    Full Text Available Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27 - pleural drain in intercostal space; SI group (n=29 - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5 was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results: In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second until POD5 (P<0.05. However, when compared, SI group presented less decrease in these parameters (P<0.05. Pulmonary shunt fraction was significantly lower in SI group (P<0.05. Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05. Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

  14. Reduction of internal carotid artery intima-media thickness in patients with moderate-to-severe obstructive sleep apnea syndrome after nasal surgery and uvulopalatopharyngoplasty.

    Science.gov (United States)

    Peng, Yikun; Zhang, Liangchun; Hu, Defeng; Dai, Yubing; Wang, Shuhui; Liao, Hongyong; Xiong, Yan

    2016-05-01

    Conclusion Multi-level surgeries for the nasal cavity and palate can reduce the severity of obstructive sleep apnea with major narrowing above the retropalatal airway and reduce the carotid intima-media thickness, which can provide cardiovascular benefits to patients. Objective To evaluate the outcomes of moderate-to-severe obstructive sleep apnea syndrome by surgeries and the change of internal carotid artery intima-media thickness after surgeries. Subjects and methods Sixty-four patients with obstructive sleep apnea, narrowing at the nasal cavity, and retropalatal airways were enrolled in this study. Fifty-two patients underwent nasal surgery and modified uvulopalatopharyngoplasty. Twelve patients who refused surgeries and continuous positive airway pressure treatment received only conservative treatment. All patients were evaluated within 1 month before and 6 months after treatment using polysomnography, upper airway endoscopy, and B mode ultrasound. Results The success rate was 61.5% (32/52 patients) in the surgery group. There were significant differences between the surgery group and non-surgery group 6 months after treatment in the apnea hypopnea index, minimum and mean oxygen saturation, blood pressure, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and internal Carotid intima-media thickness. The changes in the oxygen saturation and the apnea hypopnea index showed significant correlations with the changes in the intima-media thickness. PMID:26824298

  15. Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Carlsen, Jørn; Hasseriis Andersen, Kasper; Boesgaard, Søren;

    2013-01-01

    by the presence and severity of pulmonary hypertension (PH) assessed by right-heart catheterization in 3 hemodynamically distinct groups: (1) non-PH (mean pulmonary arterial pressure [mPAP]50 mm Hg; median HE Grade 4 (range 3-6), with generalized arterial dilatation and plexiform lesions. CONCLUSIONS...

  16. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Mekonnen, Girum; Corban, Michel T; Hung, Olivia Y;

    2015-01-01

    BACKGROUND: Soluble urokinase-type plasminogen activator receptor (suPAR) is a novel biomarker released from leukocytes and endothelial cells that has been associated with atherosclerotic cardiovascular disease. We hypothesized that plasma suPAR level is an independent predictor of coronary...... microvascular function. METHODS: Coronary blood flow velocity and plasma suPAR levels were evaluated in patients with non-obstructive coronary artery disease. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to basal average peak blood flow velocity and coronary microvascular dysfunction was...... defined as CFR ≤ 2.0 in the setting of a fractional flow reserve value of ≥0.75. Plasma suPAR levels were measured using ELISA technique. The association between suPAR and CFR was investigated using univariate and multivariate regression analyses. RESULTS: In 66 patients, 47% were men, 26% had diabetes...

  17. [Off-pump coronary artery bypass for old myocardial infarction associated with jejunotomy for obstructive ileus due to gall bladder stone; report of a case].

    Science.gov (United States)

    Shibata, T; Fujimatsu, T; Suzuki, H; Kitanaka, Y; Osawa, H; Odagiri, N; Tauchi, K; Koike, H; Aruga, M; Sakurai, S; Yorita, K; Kumazaki, S

    2005-09-01

    In non-cardiac operative cases with inflammatory digestive organ disease, bacterial translocation (BT) often results from non-enteral nutrition postoperatively. If coronary artery bypass grafting (CABG) is performed in the case having old myocardial infarction (OMI) and inflammatory digestive organ disease at first before non-cardiac operation, he seems vulnerable to have severe complications such as multiple organ failure due to systemic inflammatory response syndrome (SIRS) and preexisting BT postoperatively. We performed a off-pump CABG (OPCAB) for OMI associated with jejunotomy for obstructive ileus due to gall bladder stone. No complication was found in the postoperative course. We conclude that combined operation, non-cardiac surgery after OPCAB is worth considering in those cases. And we think OPCAB is better than conventional CABG in such cases, because cardiopulmonary bypass is known to ponder comparable damages to immune system, coagulation system and others. PMID:16167822

  18. A prospective cohort study of the long-term effects of CPAP on carotid artery intima-media thickness in Obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Hui David S

    2012-03-01

    Full Text Available Abstract Objective To examine the long-term effect of CPAP on carotid artery intima-media thickness (IMT in patients with Obstructive sleep apnea syndrome(OSAS. Methods A prospective observational study over 12 months at a teaching hospital on 50 patients newly diagnosed with OSAS who received CPAP or conservative treatment (CT. Carotid IMT was assessed with B-mode Doppler ultrasound from both carotid arteries using images of the far wall of the distal 10 mm of the common carotid arteries at baseline, 6 months and 12 months. Measurements and results [mean (SE] Altogether 28 and 22 patients received CPAP and CT respectively without significant differences in age 48.8(1.8 vs 50.5(2.0yrs, BMI 28.2(0.7 vs 28.0(1.2kg/m2, ESS 13.1(0.7 vs 12.7(0.6, AHI 38(3 vs 39(3/hr, arousal index 29(2 vs 29(2/hr, minimum SaO2 75(2 vs 77(2% and existing co-morbidities. CPAP usage was 4.6(0.3 and 4.7(0.4hrs/night over 6 months and 1 year respectively. Carotid artery IMT at baseline, 6 months, and 12 months were 758(30, 721(20, and 705(20micron for the CPAP group versus 760(30, 770(30, and 778(30micron respectively for the CT group, p = 0.002. Among those free of cardiovascular disease(n = 24, the carotid artery IMT at baseline, 6 months and 12 months were 722(40, 691(40, and 659(30micron for the CPAP group (n = 12 with usage 4.5(0.7 and 4.7(0.7 hrs/night over 6 months and 12 months whereas the IMT data for the CT group(n = 12 were 660(20, 685(10, and 690(20micron respectively, p = 0.006. Conclusions Reduction of carotid artery IMT occurred mostly in the first 6 months and was sustained at 12 months in patients with reasonable CPAP compliance.

  19. Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long; YIN Kai-sheng; LI Chong; JIA En-zhi; LI Yan-qun; GAO Zhao-fang

    2007-01-01

    Background Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes,etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients.Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood sampleswere collected and moming mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay.Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P>0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P<0.01). Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P>0.05). However, on day 14 of CPAP treatment,a significantly lower MAP than that obtained before treatment was observed (P<0.05).Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients.Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.

  20. Emergency coronary artery bypass grafting for cardiogenic shock due to left main coronary artery obstruction caused by Kawasaki disease in a 4-year-old boy.

    Science.gov (United States)

    Tamaki, Wataru; Tsuda, Etsuko; Nakajima, Hiroyuki; Kobayashi, Junjiro; Shiono, Junko

    2014-04-01

    We describe the case of a 4-year-old boy whose clinical course after Kawasaki disease resulted in coronary artery bypass grafting (CABG) due to acute myocardial infarction (AMI) causing cardiogenic shock. He had developed an ischemic cardiomyopathy due to severe localized stenosis of the left main coronary artery (LCA) and went into cardiogenic shock due to AMI on the day before a scheduled operation. He underwent successful emergency CABG within 4 h of MI. Postoperatively his neurological status was intact. This is the first report of a successful emergency CABG in a small child with cardiogenic shock due to LCA occlusion. CABG should be undertaken in small patients when appropriate indications exist, if bodyweight is >10 kg. PMID:24730632

  1. Treatment of arterial femoropopliteal obstructions with Palmaz midsize stents; Behandlung arterieller femoropoplitealer Obstruktionen mit mittleren Palmaz-Stents

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S.; Schwarzenberg, H.; Steffens, J.C.; Kopp, U.; Link, J.; Kutzner, D.; Glueer, C.C.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Radiologische Diagnostik

    1998-06-01

    Purpose: To evaluate effectiveness, success and patency rates after endovascular treatment with mid-size Palmaz stents in high-grade stenoses or short-distance occlusions of femoral arteries. Materials and methods: 27 patients with 10 occlusions (average length 3.2{+-}1.4 cm) and 17 severe stenoses of the superficial femoral artery were treated with 33 mid-size Palmaz stents. The follow-up included Doppler ultrasound at one, three, 6 and 12 months and an angiography at 6 months. Mean follow-up was 6.5 months. Results: Technical success was 100%. The ankle-brachial index improved from 0.57{+-}0.28 pretreatment to 0.87{+-}0.13 within 24 hours. Acute stent thrombosis occurred in two patients (<3 weeks). Angiography at 6 months revealed restenosis rates of 7.4% (>50%, n=2). Life-table analysis according to Kaplan-Meier revealed 6-month primary and secondary patency rates of 84% and 91%. Conclusion: with regard to our limited data, the implantation of mid-size Palmaz stents in femoral arteries seems promising in treatment of short-distance occlusions and stenoses of the femoral artery. (orig.) [Deutsch] Ziel: Ueberpruefung von Wirksamkeit, Erfolg und Offenheitsrate des mittleren Palmaz-Stents zur Behandlung kurzstreckiger Verschluesse und hochgradiger Stenosen der A. femoralis superficialis. Material und Methode: 27 Patienten mit 10 Verschluessen (3,2{+-}1,4 cm Laenge) und 17 hochgradigen Stenosen der Femoralarterien wurden mit 33 mittleren Palmaz-Stents behandelt. Die Kontrolluntersuchungen setzten sich aus klinischen und Doppler-sonographischen Untersuchungen nach einen, drei, 6 und 12 Monaten sowie einer zusaetzlichen Kontrollangiographie nach 6 Monaten zusammen. Das mittlere Nachuntersuchungsintervall betrug 6,5 Monate. Ergebnisse: Die Stentimplantation war in allen Faellen erfolgreich. Der Arm-Knoechel-Index verbesserte sich von 0,57{+-}0,28 vor auf 0,87{+-}0,13 24 Stunden nach Stentimplantation. Akute Verschluesse der Stents traten bei zwei Patienten auf (<3

  2. Measurement of the healing ability of ischemic ulcers in the lower limbs in chronic arterial obstructive disease using 201Tl-Cl

    International Nuclear Information System (INIS)

    Evaluation of the healing ability of ischemic ulcers by a method involving measurement of the ulcer index (U. I.) and mean ulcer index of toes (mU. I.) using 201Tl-Cl before and after the treatment of chronic arterial obstructive disease accompanied by ischemic ulcer was studied. The lesions consisted of 56 ulcers in 41 limbs. Reactive hyperemia following avascularization stress was used for measurement, and U. I. was determined according to the method of Siegel et al. For cases with toe ulcers, the mU. I. was measured from plantar scintigrams, twice under stress and upon redistribution after 3 hours' rest. The following results were obtained. 1) The healing ability of the cases with a U. I. value of more than 1.4 was good, but even among cases with a pretreatment U. I. of 0.9 - 1.4, ulcer healing was also good in cases in which the U. I. was maintained above 1.4 as a result of various treatments. 2) Significant increases in U. I. were observed in the arterial reconstruction group after treatment, compared to the conservative treatment group and the lumbar sympathectomy group. 3) The healing ability was good in cases with an mU. I. of more than 1.2 at stress except for 2 ASO cases complicated by diabetes. 4) Although it was difficult to prognosticate the healing ability of cases with an mU. I. of less than 1.2 before treatment, healing ability could be evaluated after treatment on the basis of the appearance of significant increase in blood flow on stress in the ulcerated toes. 5) A stress index seemed to reflect the ischemic conditions in ulcerated toes in relation to stress. 6) U. I. and mU. I. measured using 201Tl-Cl were significantly correlated with the degree of inflammatory and reactive hyperemia in the floor of ulcers and in the ulcerated toes. (J.P.N.)

  3. 前部缺血性视神经病变并发视网膜分支动脉阻塞1例%A case of branch retinal artery obstruction complicated after anterior ischemic optic neuropathy

    Institute of Scientific and Technical Information of China (English)

    Ungsoo Samuel Kim; Hyoung-Seok Kim; Young Ju Lew

    2011-01-01

    AIM: To report a case of branch retinal artery obstruction (BRAO) complicated after anterior ischemic optic neuropathy (AION).METHODS: A 42-year-old woman who complained of visual disturbance was performed ophthalmological examinations such as fundus photography, fluorescent angiography (FAG) and visual field test. RESULTS: At first visit, disc swelling was noted and arterial circulation was intact, however, 1 week after onset, the inferior branch retinal artery began to shrink and the flame hemorrhage intensified. Sixteen months later, the optic disc evidenced an atrophic change; additionally, a ghost vessel in the inferior branch retinal artery was found.CONCLUSION: We report a case of complications of BRAO arising after AION which caused the mechanical compression on the arterial circulation.%目的:报告1例前部缺血性视神经病变(anterior ischemic optic neuropathy,AION)并发视网膜分支动脉阻塞(branch retinal artery obstruction,BRAO).方法:患者,女,42岁,因视力障碍进行如下眼科检查:眼底照相、荧光血管造影(fluorescent angiography,FAG)和视野测试.结果:第一次就诊时,患者视盘肿胀,动脉循环完整,发病1wk后,视网膜下支动脉开始萎缩并火焰状出血加剧.16mo后,视盘呈萎缩性改变,此外,发现视网膜下分支动脉血管影一条.结论:AION并发BRAO可造成动脉循环的机械性压迫.

  4. Arterially transplanted mesenchymal stem cells in a mouse reversible unilateral ureteral obstruction model: in vivo bioluminescence imaging and effects on renal fibrosis

    Institute of Scientific and Technical Information of China (English)

    BAI Zhi-ming; DENG Xiang-dong; LI Jin-dong; LI Dong-hui; CAO Hui; LIU Zhen-xiang; ZHANG Jie

    2013-01-01

    Background Chronic kidney disease (CDK) is a worldwide health problem,but there is currently no effective treatment that can completely cure this disease.Recently,studies with mesenchymal stem cells (MSCs) on treating various renal diseases have shown breakthroughs.This study is to observe the homing features of MSCs transplanted via kidney artery and effects on renal fibrosis in a reversible unilateral ureteral obstruction (R-UUO) model.Methods Thirty-six Balb/c mice were divided into UUO group,UUO-MSC group,and sham group randomly,with 12 mice in each group.The MSCs had been infected by a lentiviral vector to express stably the luciferase reporter gene and green fluorescence protein genes (Luc-GFP-MSC).Homing of MSCs was tracked using in vivo imaging system (IVIS) 1,3,14,and 28 days after transplantation.Imaging results were verified by detecting GFP expression in frozen section under a fluorescence microscope.E-cadherin,α-SMA,TGF-β1,and TNF-α mRNA expression in all groups at 1 and 4 weeks after transplantation were analyzed by quantitative PCR.Results Transplanted Luc-GFP-MSCs showed increased Luciferase expression 3 days after transplantation.The expression decreased from 7 days,weakened thereafter and could not be detected 14 days after transplantation.Quantitative PCR results showed that all gene expressions in UUO group and UUO-MSC group at 1 week had no statistical difference,while at 4 weeks,except TGF-β expression (P>0.05),the expression of E-cadherin,α-SMA,and TNF-α in the above two groups have statistical difference (P<0.01).Conclusion IVIS enables fast,noninvasive,and intuitive tracking of MSC homing in vivo.MSCs can be taken home to kidney tissues of the diseased side in R-UUO model,and renal interstitial fibrosis can be improved as well.

  5. The Frequency and Energy of Snoring Sounds Are Associated with Common Carotid Artery Intima-Media Thickness in Obstructive Sleep Apnea Patients

    Science.gov (United States)

    Lee, Guo-She; Lee, Li-Ang; Wang, Chao-Yung; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Obstructive sleep apnea (OSA) is a known risk factor for atherosclerosis. We investigated the association of common carotid artery intima-media thickness (CCA-IMT) with snoring sounds in OSA patients. A total of 30 newly diagnosed OSA patients with no history of cardiovascular diseases were prospectively enrolled for measuring mean CCA-IMT with B-mode ultrasonography, body mass index, metabolic syndrome, 10-year cardiovascular disease risk score, high-sensitivity C-reactive protein, and homocysteine. Good-quality signals of full-night snoring sounds in an ordinary sleep condition obtained from 15 participants were further acoustically analyzed (Included group). All variables of interest were not significantly different (all p > 0.05) between the included and non-included groups except for diastolic blood pressure (p = 0.037). In the included group, CCA-IMT was significantly correlated with snoring sound energies of 0–20 Hz (r = 0.608, p = 0.036) and 652–1500 Hz (r = 0.632, p = 0.027) and was not significantly associated with that of 20–652 Hz (r = 0.366, p = 0.242) after adjustment for age and sex. Our findings suggest that underlying snoring sounds may cause carotid wall thickening and support the large-scale evaluation of snoring sound characters as markers of surveillance and for risk stratification at diagnosis. PMID:27469245

  6. The Frequency and Energy of Snoring Sounds Are Associated with Common Carotid Artery Intima-Media Thickness in Obstructive Sleep Apnea Patients.

    Science.gov (United States)

    Lee, Guo-She; Lee, Li-Ang; Wang, Chao-Yung; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Obstructive sleep apnea (OSA) is a known risk factor for atherosclerosis. We investigated the association of common carotid artery intima-media thickness (CCA-IMT) with snoring sounds in OSA patients. A total of 30 newly diagnosed OSA patients with no history of cardiovascular diseases were prospectively enrolled for measuring mean CCA-IMT with B-mode ultrasonography, body mass index, metabolic syndrome, 10-year cardiovascular disease risk score, high-sensitivity C-reactive protein, and homocysteine. Good-quality signals of full-night snoring sounds in an ordinary sleep condition obtained from 15 participants were further acoustically analyzed (Included group). All variables of interest were not significantly different (all p > 0.05) between the included and non-included groups except for diastolic blood pressure (p = 0.037). In the included group, CCA-IMT was significantly correlated with snoring sound energies of 0-20 Hz (r = 0.608, p = 0.036) and 652-1500 Hz (r = 0.632, p = 0.027) and was not significantly associated with that of 20-652 Hz (r = 0.366, p = 0.242) after adjustment for age and sex. Our findings suggest that underlying snoring sounds may cause carotid wall thickening and support the large-scale evaluation of snoring sound characters as markers of surveillance and for risk stratification at diagnosis. PMID:27469245

  7. Retinal artery occlusion

    Science.gov (United States)

    ... artery occlusion; Branch retinal artery occlusion; CRAO; BRAO Images Retina References Sanborn GE, Magargal LE. Arterial obstructive disease ... A.M. Editorial team. Related MedlinePlus Health Topics ... audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  8. The treatment of obstructive jaundice caused by bile duct strictures after hepatic transcatheter arterial chemoembolization in liver tumor patients%肝脏肿瘤动脉栓塞化疗术后胆管狭窄

    Institute of Scientific and Technical Information of China (English)

    朱锦辉; 刘颖斌

    2011-01-01

    Objective To evaluate the treatment of obstructive jaundice caused by bile duct strictures after hepatic transcatheter arterial chemoembolization in hepatic tumor patients. Methods A retrospective review (Jun 1994 - Mar 2010) of databases at two institutions (Zhejiang Provincial People's Hospital and Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine) identified 15patients with obstructive jaundice caused by liver bile duct stricture after transcatheter arterial chemoembolization. There were 7 cases of primary liver cancer, 5 patients of liver hemangioma, 3 cases of metastatic liver cancer including 2 cases of colonic cancer and one of pancreatic cancer. Obstructive jaundice appeared in a period of 5 months to 16 months after TACE. The median time was 9 months. Results The obstructive jaundice was relieved by surgically constructed hepatobiliary drainage or PTC+stenting treatment in 13 cases and PTCD in 2 cases. All patients of hepatic hemangioma were doing well after treatment. Two cases of primary liver cancer patients with obstructive jaundice after TACE were followed up for 2 years with no recurrence of hepatic carcinoma and bile duct obstruction. The other 8 patients were followed up from 3months to 18 months until to their death from primary disease progress. Conclusions Surgery and or PTCD plus stent can effectively relieve the obstructive jaundice caused by TACE in benign or malignant liver tumors.%目的 分析肝脏经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法.方法 回顾性分析1994年6月至2010年3月在浙江省人民医院及上海交通大学医学院附属新华医院行肝脏TACE治疗后出现胆管狭窄的15例患者的临床资料.7例为原发性肝癌,5例为肝脏血管瘤,3例为转移性肝癌,原发疾病分别为结肠癌2例和胰腺癌1例.肝脏TACE后出现梗阻性黄疸的时间为5~16个月,中位时间为9

  9. Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes).

    Science.gov (United States)

    Manfrini, Olivia; Morrell, Christine; Das, Rajiv; Barth, Julian H; Hall, Alistair S; Gale, Christopher P; Cenko, Edina; Bugiardini, Raffaele

    2014-05-15

    We sought to determine the effectiveness of angiotensin-converting enzyme (ACE) inhibition and β-blocker treatment as a function of the degree of coronary artery disease (CAD) obstruction at angiography. The Evaluation of Methods and Management of Acute Coronary Events registry enrolled patients who had been hospitalized for an acute coronary syndrome. There were 1,602 patients who had cardiac catheterization that were used for this analysis. The main outcome measures were evidence-based therapies prescribed at discharge and 6-month incidence of all-cause mortality. The cohort consisted of 1,252 patients with obstructive CAD (>50% luminal diameter obstructed) and 350 patients with nonobstructive CAD. Multivariate logistic regression analysis adjusted for further medications and other clinical factors was performed. Patients with nonobstructive CAD had significantly (p <0.001) higher rates of β-blocker (77.8% vs 63.3%) and lower rates of ACE-inhibitor (57.7% vs 66.4%) prescriptions. In patients with nonobstructive CAD, ACE-inhibitor therapy was clearly associated with a lower 6-month mortality (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.03 to 0.78, p = 0.004). No significant association between β-blocker use and death was found. In patients with obstructive CAD, both β blockers (OR 0.47, 95% CI 0.32 to 0.67, p <0.001) and ACE inhibitors (OR 0.47, 95% CI 0.26 to 0.87, p = 0.01) were significantly associated with a reduced risk of 6-month mortality. In conclusion, ACE-inhibitor therapy seems to be an effective first-line treatment for preventing the occurrence of mortality in patients with nonobstructive CAD. PMID:24698468

  10. Obstructive Sleep Apnea

    Science.gov (United States)

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  11. The right hepatic artery syndrome

    Institute of Scientific and Technical Information of China (English)

    Kazumi Miyashita; Katsuya Shiraki; Takeshi Ito; Hiroki Taoka; Takeshi Nakano

    2005-01-01

    Various benign and malignant conditions could cause biliary obstruction. Compression of extrahepatic bile duct (EBD) by right hepatic artery was reported as a right hepatic artery syndrome but all cases were compressed EBD from stomach side. Our case compressed from dorsum was not yet reported, so it was thought to be a very rare case. We present here the first case of bile duct obstruction due to the compression of EBD from dorsum by right hepatic artery.

  12. Exercícios resistidos terapêuticos para indivíduos com doença arterial obstrutiva periférica: evidências para a prescrição Therapeutic resistance exercises for individuals with peripheral arterial obstructive disease: evidence for prescription

    Directory of Open Access Journals (Sweden)

    Lucas Caseri Câmara

    2007-09-01

    Full Text Available A prática regular de exercícios é parte do tratamento clínico inicial para pacientes com doença arterial obstrutiva periférica. Nesse sentido, a utilização de exercícios contra resistência (exercícios resistidos tem sido amplamente recomendada para diferentes populações, especialmente para pessoas idosas com e sem doenças associadas. Os poucos trabalhos encontrados utilizando essa forma de exercícios em pacientes com doença arterial obstrutiva periférica documentam a sua eficiência terapêutica. No entanto, os efeitos documentados dos exercícios resistidos em outras populações têm evidenciado melhoria da aptidão física e da qualidade de vida, com segurança cardiovascular e músculo-esquelética. Essas informações fornecem indicativos sobre os possíveis benefícios dos exercícios resistidos na terapia de indivíduos com doença arterial obstrutiva periférica. Nesse sentido, esta revisão objetivou apresentar informações científicas que permitam auxiliar a prescrição dos exercícios resistidos para essa população.A regular physical activity program is part of the initial clinical approach to patients with peripheral arterial obstructive disease. Therefore, use of exercises against resistance loads (resistance training has been widely recommended for different populations, especially for elderly individuals with and without associated diseases. The few studies that have used this form of exercise in patients with peripheral arterial obstructive disease demonstrated its therapeutic efficiency. However, reported effects of resistance training in other populations have evidenced improvement in physical fitness and quality of life, with cardiovascular and musculoskeletal safety. These data indicate the possible benefits of resistance training in peripheral arterial obstructive disease therapy. Thus, this review aimed at presenting scientific information that can help prescription of resistance training for this

  13. [Gallopamil and chlorthalidone versus atenolol and chlorthalidone in the treatment of obstructive hypertrophic cardiomyopathy in patients with arterial hypertension: polycardiographic evaluation of the systolic and diastolic function of the left ventricle].

    Science.gov (United States)

    Chieppa, S; Lobascio, C; Brandini, V; Iarussi, D; Giuliani, F; Langella, S; De Simone, R

    1989-08-01

    In 13 patients, affected by hypertrophic obstructive cardiomyopathy (HOCM) and essential hypertension, antihypertensive-efficacy and effects of a new calcium-channel blocker (gallopamil) associated with a diuretic agent (chlorthalidone) on left ventricular systolic and diastolic performance assessed by phonocardiographic methods. The results were compared to those obtained, in the same group of patients, with a selective beta-blocker (atenolol) associated with the same diuretic agent (chlorthalidone). With both therapeutic regimens a statistically significant reduction of systolic and diastolic arterial pressure was observed; both agents were able to reduce hemodynamic gradient in systole which characterize HOCM; however, the treatment with gallopamil plus chlorthalidone determined greater effects on left ventricular diastolic function as compared to the treatment with atenolol plus chlorthalidone; both treatments determined bradycardia. PMID:2605580

  14. Mediastinal fibrosis with pulmonary artery obstruction; diagnosis and investigation with helical CT imaging including 3-dimensional reconstructions; Pulomonalarterienstenose bei aggresiver Mediastinalfibrose; Diagnostik und 3D-Darstellung mittels helikaler CT-Untersuchung

    Energy Technology Data Exchange (ETDEWEB)

    Kolbe, M. [Inst. fuer Diagnostische Radiologie, Kantonsspital Basel (Switzerland); Helwig, A. [Inst. fuer Diagnostische Radiologie, Kantonsspital Basel (Switzerland); Habicht, J.M. [Klinik fuer Herz-Torax-Chirurgie, Universitaetskliniken Basel (Switzerland); Steinbruch, W. [Inst. fuer Diagnostische Radiologie, Kantonsspital Basel (Switzerland)

    1997-07-01

    An aggressive mediastinal fibrosis was found in a 42-year-old female, suffering from dysphagia, stabbing pain in the chest, and an unclear weight loss. In this case, the rare combination of esophageal involvement, bronchial narrowing, and pulmonary artery obstruction could easily be demonstrated with a barium study and a helical CT examination including three-dimensional reconstructions. (orig.) [Deutsch] Wir stellen den Fall einer 42jaehrigen Patientin vor, welche zur Abklaerung einer zunehmenden Dysphagie, stechender Thoraxschmerzen und eines Gewichtsverlustes hospitalisiert wurde. Mittels klinischer und radiologischer Abklaerung konnte eine aggressive Mediastinalfibrose diagnostiziert werden. Die seltene Kombination einer Oesophaguseinengung mit Pulmonalarterienstenosen sowie einer Bronchuskompression konnte nichtinvasiv mittels Oesophagogramm und helikaler CT-Untersuchung zuverlaessig und schnell dargestellt werden. (orig.)

  15. Using the Pathophysiology of Obstructive Sleep Apnea to Teach Cardiopulmonary Integration

    Science.gov (United States)

    Levitzky, Michael G.

    2008-01-01

    Obstructive sleep apnea (OSA) is a common disorder of upper airway obstruction during sleep. The effects of intermittent upper airway obstruction include alveolar hypoventilation, altered arterial blood gases and acid-base status, and stimulation of the arterial chemoreceptors, which leads to frequent arousals. These arousals disturb sleep…

  16. Intestinal obstruction

    Science.gov (United States)

    ... of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include: Bacteria or viruses that cause intestinal infections ( gastroenteritis ) Chemical, electrolyte, or mineral imbalances (such as decreased ...

  17. Intestinal Obstruction

    Science.gov (United States)

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... inflammation and infection of the abdominal cavity ( peritonitis ). Causes Causes of intestinal obstruction differ depending on the ...

  18. SVC obstruction

    Science.gov (United States)

    ... Lymphoma Metastatic lung cancer (lung cancer that spreads) Testicular cancer Thyroid cancer Thymus tumor Superior vena cava obstruction ... Complications are serious and can sometimes be fatal. Prevention Prompt treatment of other medical disorders may reduce ...

  19. Mal de Hansen, anticorpos antifosfolípides e obstrução das artérias fibulares Leprosy, antiphospholipid antibodies and bilateral fibular arteries obstruction

    Directory of Open Access Journals (Sweden)

    Liz Wallin

    2009-04-01

    Full Text Available Pacientes com Mal de Hansen (MH podem se apresentar com quadro clínico e laboratorial sugestivo de doenças reumáticas, o que exige um exercício cuidadoso de diagnósticos diferenciais. Descreve-se aqui o caso de uma jovem com MH que se apresentou com lesões cutâneas sugestivas de vasculite, obstrução de vasos fibulares, FAN e anticorpos antifosfolípides positivos sem muitos estigmas da doença cutânea, ilustrando essa dificuldade.Patients with Hansen's disease (HD may present themselves with clinical and laboratorial features that resemble rheumatic disorders. This requires a careful exercise of differential diagnosis. We describe here a case of a young woman with HD that presented with vasculitic like lesions, fibular vessels obstruction, ANA and antiphospholipid antibodies without typical signs of cutaneous disease, illustrating this clinical difficulty.

  20. Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Abildstrøm, Steen Z; Peña, Adam; Hansen, Peter R; Prescott, Eva

    2014-01-01

    -specific interaction (P = 0.18). In a conditional logistic regression model, we found no dose-response relationship between CTFC and the risk of MACE, i.e., compared to the risk in the lowest CTFC quintile, the odds ratios for MACE were 1.3 (0.7-2.6), 0.7 (0.3-1.3), 0.7 (0.4-1.5) and 1.0 (0.5-2.1) in the second, third......, fourth and fifth CTFC quintiles, respectively. Adjustment for cardiac risk factors including diabetes, active smoking, body mass index, and use of lipid-lowering and antihypertensive medication did not significantly change the results. CONCLUSIONS: In patients with SAP symptoms without obstructive CAD at...

  1. Eletroestimulação muscular: alternativa de tratamento coadjuvante para pacientes com doença arterial obstrutiva periférica Muscle electrostimulation: alternative adjuvant treatment to patients with peripheral arterial obstructive disease

    OpenAIRE

    Ana Helena de Oliveira Medeiros; Sintya Tertuliano Chalegre; Celina Cordeiro de Carvalho

    2007-01-01

    A doença arterial periférica faz parte de um grupo de patologias vasculares que evolui de forma lenta e progressiva. A proposta deste artigo foi avaliar, por meio de revisão bibliográfica, os possíveis benefícios da eletroestimulação crônica como tratamento coadjuvante para pacientes arteriopatas. De acordo com a literatura analisada, concluímos que a eletroestimulação é capaz de provocar alterações importantes no perfil metabólico das fibras musculares, convertendo-as do tipo II para o tipo ...

  2. Doença arterial obstrutiva periférica: que atenção temos dispensado à abordagem clínica dos pacientes? Peripheral obstructive arterial disease: what kind of clinical treatment are we recommending to our patients?

    Directory of Open Access Journals (Sweden)

    Anaí Espinelli de Souza Durazzo

    2005-09-01

    Full Text Available OBJETIVO: Avaliar como pacientes com doença arterial obstrutiva periférica têm sido tratados, em nosso meio, com relação aos fatores de risco e comorbidades. MÉTODO: Questionário sobre pesquisa e tratamento da dislipidemia, diabetes, exercício, uso de anti-plaquetários, tabagismo e hipertensão arterial no paciente com doença arterial obstrutiva periférica foi aplicado entre os médicos presentes na reunião mensal de março de 2004 da Sociedade Brasileira de Angiologia e Cirurgia Vascular - Regional São Paulo. RESULTADOS: Dos 102 questionários distribuídos, 75 foram respondidos (taxa de resposta de 73,5%. Entre os consultados, 82% pesquisam rotineiramente perfil lipídico e 20% visam alvo de LDL-colesterol abaixo de 100 mg/dl; 94% realizam pesquisa para diabetes melito; 97% recomendam exercício; 79% prescrevem aspirina; 97% aconselham que os pacientes parem de fumar e 60% se restringem ao aconselhamento isoladamente; 18% não realizam a medida da pressão arterial durante a consulta e 19% visam alvo pressórico de 130 x 80 mmHg. Considerando todas as avaliações em conjunto - intervenção no estilo de vida, no sentido de parar de fumar, orientação de exercícios, uso de anti-plaquetários, realização de pesquisa para diabetes melito, controle rigoroso da pressão arterial e lípides - observou-se que 7% dos entrevistados seguem todas essas recomendações como uma rotina estabelecida. CONCLUSÃO: O presente estudo demonstrou que, em nosso meio, a pesquisa e o tratamento dos fatores de risco e comorbidades nos pacientes com doença arterial obstrutiva periférica estão sendo sub-realizados.OBJECTIVE: The purpose of this survey was to evaluate how patients with peripheral obstructive arterial disease have been treated, concerning risk factors and comorbidities. METHOD: A questionnaire was applied to all physicians attending the monthly meeting of the Brazilian Society of Angiology and Vascular Surgery - São Paulo Section

  3. Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome

    Science.gov (United States)

    Sánchez-de-la-Torre, Alicia; Abad, Jorge; Durán-Cantolla, Joaquín; Mediano, Olga; Cabriada, Valentín; Masdeu, María José; Terán, Joaquín; Masa, Juan Fernando; de la Peña, Mónica; Aldomá, Albina; Worner, Fernando; Valls, Joan; Barbé, Ferran; Sánchez-de-la-Torre, Manuel

    2016-01-01

    Background The cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea–hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level. Methods We included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA. Results The men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002). Conclusions This study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted. PMID:27416494

  4. Obstructed uterus

    Energy Technology Data Exchange (ETDEWEB)

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  5. Eletroestimulação muscular: alternativa de tratamento coadjuvante para pacientes com doença arterial obstrutiva periférica Muscle electrostimulation: alternative adjuvant treatment to patients with peripheral arterial obstructive disease

    Directory of Open Access Journals (Sweden)

    Ana Helena de Oliveira Medeiros

    2007-06-01

    Full Text Available A doença arterial periférica faz parte de um grupo de patologias vasculares que evolui de forma lenta e progressiva. A proposta deste artigo foi avaliar, por meio de revisão bibliográfica, os possíveis benefícios da eletroestimulação crônica como tratamento coadjuvante para pacientes arteriopatas. De acordo com a literatura analisada, concluímos que a eletroestimulação é capaz de provocar alterações importantes no perfil metabólico das fibras musculares, convertendo-as do tipo II para o tipo I, o que induz o crescimento capilar, a densidade capilar e o suprimento de oxigênio. Desta forma, este recurso terapêutico aumenta a capacidade aeróbica oxidativa e a resistência à fadiga dos músculos isquêmicos. Assim, a eletroestimulação é mais um recurso terapêutico capaz de melhorar a habilidade para caminhar destes pacientes, diminuindo gastos com cirurgias de revascularização e complicações maiores.Peripheral arterial disease is included in a group of vascular diseases whose evolution is slow and progressive. This article aimed at performing a literature review to evaluate the benefits of chronic electrostimulation as adjuvant treatment for arteriopathic patients. Based on the literature, we concluded that electrostimulation can generate important changes in the metabolic profile of muscle fibers, switching them from type II to type I, which leads to capillary increase, capillary density and suppression of oxygen. Therefore, this therapeutic resource increases aerobic oxidative capacity and ischemic muscle resistance to fatigue. Thus, electrostimulation is another therapeutic option able to improve these patients' walking ability, reducing expenses related to revascularization surgeries and major complications.

  6. Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64-multislice computed tomography compared with intravascular ultrasound

    Institute of Scientific and Technical Information of China (English)

    SHEN Yi; QIAN Ju-ying; WANG Ming-hui; LIU Yuan; LIU Xue-bo; GE Lei; MA Jian-ying; GE Jun-bo

    2010-01-01

    Background There are few reports of quantitative and qualitative measuring of left main coronary artery (LMCA) plaques by multislice computed tomography coronary angiography (MSCTA), especially when compared with intravascular ultrasound (IVUS) as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients (53 men, 38 women, mean age (64.78±9.19) years) were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index (K) for the agreement between MSCTA and IVUS was calculated. Minimal lumen area (MLA), external elastic membrane cross-sectional area (EEM-CSA) and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index (K=0.744, P<0.001) indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 (P <0.01). The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively (both P <0.01). The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were (52.52±15.71) HU, (108.32±43.44) HU and (604.16±377.67) HU (P<0.001). Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94

  7. Periprocedural myocardial infarction enhances the predictive value of inflammatory biomarkers for patients with obstructive coronary artery disease after implantation of drug-eluting stent

    Directory of Open Access Journals (Sweden)

    Jesika A

    2015-02-01

    Full Text Available Anastasia Jesika,1 Zuo-Ying Hu,2 Jing Kan,3 Shao-Liang Chen2 1Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China; 3Nanjing Heart Center, Nanjing, People’s Republic of China Objective: The present study aims to clarify the long-term clinical importance of interleukin (IL-6 in predicting major adverse cardiac events (MACE for an entire cohort of patients with coronary artery disease after implantation of a drug-eluting stent (DES, and its interplay with periprocedural myocardial infarction (PMI. Background: The correlation of proinflammatory biomarkers with occurrence of clinical events, including PMI and mortality, is controversial. Methods: IL-6 was measured in 1,991 patients at admission. The participants were then assigned to two groups: IL-6 level ≥9 pg/mL and IL-6 level <9 pg/mL. The primary endpoint was the occurrence of cardiac death or myocardial infarction (MI at year 3 after indexed percutaneous coronary intervention (PCI procedure. Results: The in-hospital rate of the primary endpoint in the IL-6 level ≥9 pg/mL group was 9.1%, statistically significantly different to 6.3% in the IL-6 <9 pg/mL group (P=0.026, mainly driven by the increased rate of MI (9.1% vs 6.1%, P=0.025. Those differences in MI/death and MI was sustained through to the 3-year follow-up (10.9% vs 7.6%, P=0.017 and 10.1% vs 7.5%, P=0.049. At the 3-year follow-up after the assigned procedure, more frequent MI was also the main reason for increased composite MACE between the IL-6 ≥9 pg/mL and IL-6 <9 pg/mL groups (20.7% vs 15.8%, P=0.007. In the IL-6 ≥9 pg/mL group, PMI was strongly correlated with mortality at 1-year through to the 3-year (hazard ratio: 2.96, 95% confidence interval: 1.35–6.49, P=0.005 follow-up after PCI procedure. Conclusion: Elevated preprocedural serum IL-6 level was correlated with death, MI, and MACE

  8. Duodenal obstruction after successful embolization for duodenal diverticular hemorrhage: A case report

    Institute of Scientific and Technical Information of China (English)

    Yu Jin Kwon; Ji Hun Kim; Seung Hyoung Kim; Bong Soo Kim; Heung Up Kim; Eun Kwang Choi; In Ho Jeong

    2009-01-01

    We present a 69-year-old woman with a duodenal obstruction after successful selective transcatheter arterial embolization (TAE) for a duodenal diverticular hemorrhage. Two weeks after TAE, the patient showed abrupt symptoms of duodenal obstruction. Resolving hematomas after successful selective transcatheter arterial embolization should be thoroughly observed because they might result in duodenal fibrotic encasement featuring inflammatory duodenal wall thickening, duodenal deformity, dysmotility, and finally obstruction.

  9. Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica Avances recientes del impacto de la Apnea Obstructiva del Sueño en la Hipertensión Arterial Sistémica Recent advances of the impact of obstructive sleep apnea on systemic hypertension

    Directory of Open Access Journals (Sweden)

    Rodrigo P. Pedrosa

    2011-08-01

    repercusiones sistémicas que pueden incluir la hipoxia intermitente, la reducción abrupta de la presión intratorácica y la ocurrencia de microdespertares con fragmentación del sueño. En las últimas décadas, innúmeras evidencias señalan de forma consistente la AOS como un importante factor envuelto en la ocurrencia de enfermedades cardiovasculares. Particularmente, la relación entre la AOS y la Hipertensión Arterial Sistémica (HAS es la que encuentra un mayor conjunto de evidencias. Actualmente, se encuentran datos que consideran la AOS una importante causa secundaria de HAS. Más que eso, la AOS está independientemente asociada a un peor control presórico, alteración del descenso nocturno de la presión arterial y a la presencia de lesiones de órganos-blanco, tales como la hipertrofia del ventrículo izquierdo y la microalbuminuria. Estudios randomizados sugieren que el tratamiento de la AOS, especialmente con la presión positiva continua de vías aéreas superiores (CPAP, considerado el tratamiento estándar para la AOS, promueve reducción significativa de la presión arterial en las 24 horas, efecto ese más significativo en el subgrupo de pacientes con HAS no controlada y en los pacientes con HAS resistente. A despecho de todas esas evidencias, la AOS aun continúa siendo subdiagnosticada. El objetivo de esta revisión es discutir los recientes avances en los mecanismos fisiopatológicos, en la presentación clínica y en el tratamiento de la AOS, y el beneficio sobre la presión arterial.Obstructive sleep apnea (OSA is a common clinical condition in the general population, especially among patients with cardiovascular diseases. More than just a local phenomenon of upper respiratory tract obstruction, OSA leads to systemic consequences that may include intermittent hypoxia, sudden reduction of the intrathoracic pressure, and the occurrence of micro-awakenings with sleep fragmentation. In the past decades, innumerous evidences have consistently pointed to

  10. Hydronephrosis by an Aberrant Renal Artery: A Case Report

    OpenAIRE

    Park, Byoung Seok; Jeong, Taek Kyun; Ma, Seong Kwon; Kim, Soo Wan; Kim, Nam Ho; Choi, Ki Chul; Jeong, Yong Yeon

    2003-01-01

    Ureteropelvic junction obstruction is usually intrinsic and is most common in children. Aberrant renal arteries are present in about 30% of individuals. Aberrant renal arteries to the inferior pole cross anteriorly to the ureter and may cause hydronephrosis. To the best of our knowledge, although there are some papers about aberrant renal arteries producing ureteropelvic junction obstruction, there is no report of a case which is diagnosed by the new modalities, such as computed tomography an...

  11. Chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2013-01-01

    Full Text Available The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec to FVC (forced vital capacity ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure, hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity, bone disease (osteoporosis and osteopenia, stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease

  12. Arterial Catheterization

    Science.gov (United States)

    ... version AMERICAN THORACIC SOCIETY Patient Information Series Arterial Catheterization An arterial catheter is a thin, hollow tube ... PHYSICIANS: AND COPY Why Do I Need Arterial Catheterization? Common reasons an arterial catheterization is done include: ■ ...

  13. Diagnostic and therapeutic approach to coexistent chronic obstructive pulmonary disease and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Sanja Jelic

    2008-06-01

    Full Text Available Sanja JelicDivision of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USAAbstract: The high prevalence of both obstructive sleep apnea (OSA and chronic obstructive pulmonary disease (COPD in Western societies is well documented. However, OSA frequently remains unrecognized and untreated among patients with COPD. Patients with both conditions have a greater risk for fatal and nonfatal cardiovascular events compared with patients with COPD or OSA alone. Efficacious treatment with continuous positive airway pressure reduces the risk of cardiovascular complications in patients with OSA. The aim of the present review is to discuss the diagnostic approach to patients with both conditions and to delineate the benefits of timely ecognition and treatment of OSA in patients with COPD.Keywords: chronic obstructive pulmonary disease, obstructive sleep apnea, continuous positive airway pressure, nocturnal arterial oxyhemoglobin desaturation

  14. The symptomatology of megadolicho basilar artery.

    Science.gov (United States)

    Herpers, M; Lodder, J; Janevski, B; van der Lugt, P J

    1983-01-01

    Cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa are presumed to be related to a megadolicho basilar artery, if present. Since there are no large series of patients with such vascular anomaly, a bias in relating symptoms with the presence of a megadolicho basilar artery is not excluded. We therefore studied retrospectively the incidence of megadolicho and dolicho basilar artery on cranial CT-scan of 3332 patients of 50 years and older. Patient records were reviewed for the above mentioned symptoms. 12 out of 22 patients with a megadolicho basilar artery and 2 patients out of 40 with a dolicho basilar artery had one or two of these symptoms. It is concluded that a megadolicho basilar artery can cause cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa. PMID:6317247

  15. Obstructive sleep apnea - adults

    Science.gov (United States)

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  16. Acute Urinary Tract Obstruction

    Directory of Open Access Journals (Sweden)

    Aleksic Djordje

    2015-09-01

    Full Text Available The kidneys are paired organs with the primary function of helping to remove toxins from the body and regulate water balance. They are vital to survival. After urine is produced in the kidneys, it must pass into the bladder, where it can be stored before being eliminated from the body through the urethra. Urinary tract obstruction is a common problem encountered by urologists, primary care physicians, and emergency medicine physicians. Urine can become obstructed at any point in this pathway. There are three groups of urinary tract obstructions: 1 obstruction of the urinary tract lumen; 2 obstruction of the urinary tract wall; and 3 extrinsic obstruction, which can press on the urinary tract lumen. An obstruction can be present from birth or develop later in life. The most common causes of obstruction include stones, strictures, tumours, and bladder dysfunction. These obstructions may result in the hydronephrosis of one or both kidneys, which, if left untreated, may lead to the deterioration of renal function. The goal of an initial treatment of urinary tract obstruction is to remove the obstruction. Later, we treat the cause that led to the obstruction. The bottom line is that all efforts should be made to preserve kidney function to avoid the need for dialysis or renal transplantation.

  17. Obstructive Biliary Tract Disease

    OpenAIRE

    White, Thomas Taylor

    1982-01-01

    The techniques that have come into general use for diagnosing problems of obstructive jaundice, particularly in the past ten years, have been ultrasonography, computerized tomography, radionuclide imaging, transhepatic percutaneous cholangiography using a long thin needle, transhepatic percutaneous drainage for obstructive jaundice due to malignancy, endoscopic retrograde cannulation of the papilla (ERCP), endoscopic sphincterotomy and choledochoscopy. It is helpful to review obstructive jaun...

  18. Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy

    OpenAIRE

    Jiao, Wen-Jie; Wang, Tian-You; Gong, Min; Pan, Hao; Liu, Yan-Bing; Liu, Zhi-Hua

    2006-01-01

    AIM: To investigate the incidence of various types of postoperative pulmonary complications (POPCs) and to evaluate the significance of perioperative arterial blood gases in patients with esophageal cancer accompanied with chronic obstructive pulmonary disease (COPD) after esophagectomy.

  19. Lipoproteína (a em pacientes portadores de doença arterial obstrutiva periférica e/ou diabetes mellitus tipo 2 Lipoprotein (a in patients with peripheral arterial obstructive disease and/or type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Ana Paula Lucas Mota

    2008-04-01

    íveis plasmáticos mais elevados nos grupos DAOP e DM2 + DAOP, os quais também apresentaram uma concomitante e significativa redução de HDL-c.BACKGROUND: Peripheral arterial obstructive disease (PAOD constitutes an excellent marker for systemic atherosclerosis and type 2 diabetes mellitus (DM2 is among the greatest risk factors for this disease. It is believed that lipoprotein (a [Lp(a] is linked to increased risk of atherosclerosis, although the mechanisms responsible for that are not widely known. Elevated levels of Lp(a seem to be associated with a higher risk of coronary artery disease (CAD, as well as PAOD and cerebrovascular disease. OBJECTIVES: To assess the plasma levels of Lp(a and other lipid parameters in patients with PAOD and/or DM2. Material and methods: Plasma levels of Lp(a, total cholesterol (TC, high-density lipoprotein cholesterol (HDL-c, low-density lipoprotein cholesterol (LDL-c, triglycerides (TG and apolipoproteins A-I and B were measured in blood samples of 12 subjects carrying neither PAOD nor DM2 (control group, 17 patients with PAOD, 18 with DM2 and 19 with both PAOD and DM2. The subjects selected for this study showed homogeneity and no statistical difference for gender, age, and socioeconomic status. RESULTS: The Lp(a showed a tendency to elevation both in groups PAOD only and PAOD + DM2 simultaneously. Significant differences were observed among the groups as to HDL-c and apolipoprotein A-I levels, with positive correlation between these two parameters. TC/HDL-c ratio showed significant difference among the groups. Positive correlation was found between Lp(a and LDL-c, and negative one, between the ankle-arm index and LP(a. CONCLUSION: As to the lipid parameters studied, significant statistical differences were found between HDL-c and apolipoprotein A-I plasma levels only. For Lp(a parameter, higher plasma levels were observed in PAOD and PAOD + DM2, which have also shown concomitant and significant HDL-c reduction.

  20. Arterial stick

    Science.gov (United States)

    ... the main arteries in the forearm (radial and ulnar arteries). The procedure is done as follows: The ... Arteries also have thicker walls and have more nerves. When the needle is inserted, there may be ...

  1. Primary antiphospholipid syndrome, hypertrophic non-obstructive cardiomyopathy and hypotelorism.

    Science.gov (United States)

    Kellermair, Joerg; Kammler, Juergen; Laubichler, Peter; Steinwender, Clemens

    2016-01-01

    Antiphospholipid syndrome (APS) is an autoimmune disorder associated with arterial/venous thrombosis. Cardiac manifestations of APS include valve stenosis/insufficiency, coronary artery disease and myocardial dysfunction presenting as dilated cardiomyopathy. In the following report, we present the case of a man with primary APS, hypertrophic non-obstructive cardiomyopathy and hypotelorism-a combination that has not yet been reported in the literature. PMID:27048398

  2. Female Bladder Outlet Obstruction.

    Science.gov (United States)

    Hoffman, Daniel S; Nitti, Victor W

    2016-04-01

    The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem. PMID:26902625

  3. Chronic obstructive pulmonary disease

    Science.gov (United States)

    ... airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to ...

  4. Intestinal Pseudo-Obstruction

    Science.gov (United States)

    ... underlying illness, stop the medication, or do both. Nutritional Support People with intestinal pseudo-obstruction often need nutritional support to prevent malnutrition and weight loss. Enteral nutrition ...

  5. Veno-arterial ECMO for rescue of severe airway hemorrhage with rigid bronchoscopy after pulmonary artery thromboendarterectomy.

    Science.gov (United States)

    Chacón-Alves, Silvia; Pérez-Vela, Jose Luis; Grau-Carmona, Teodoro; Domínguez-Aguado, Helena; Marín-Mateos, Helena; Renes-Carreño, Emilio

    2016-07-01

    Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We present a patient with airway obstruction and acute respiratory failure due to large blood clots obstructing the trachea and main left bronchus. This condition was accompanied by right ventricle failure and cardiogenic shock. A venoarterial ECMO system was used for cardiopulmonary support before extracting the clots and clearing the airway by rigid bronchoscopy. PMID:27229321

  6. Heliox in the treatment of chronic obstructive pulmonary disease

    OpenAIRE

    Andrews, R.; Lynch, M

    2004-01-01

    Objective: To determine if breathing helium oxygen mixtures in addition to conventional therapy in non-intubated adult chronic obstructive airways disease (COPD) patients reduces the arterial partial pressure of carbon dioxide (PaCO2) more than conventional treatment alone, and confers an advantage in terms of the odds of intubation in the acute setting.

  7. Arterial stiffness, as monitored by cardio–ankle vascular index, is affected by obstructive sleep apnea, blood glucose control, and body weight – a case with 8 years follow up

    OpenAIRE

    Shimizu, Kazuhiro; Yamamoto, Tomoyuki; Shirai, Kohji

    2016-01-01

    Kazuhiro Shimizu,1 Tomoyuki Yamamoto,2,3 Kohji Shirai2,4 1Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan; 2Department of Vascular Function, Toho University Sakura Medical Center, Chiba, Japan; 3Biological Information Analysis Section, Fukuda Denshi Co., Ltd., Tokyo, Japan; 4Department of Internal Medicine, Mihama Hospital, Chiba, Japan Abstract: The cardio–ankle vascular index (CAVI) is an indicator of arterial stiffness from the heart ...

  8. Collagen turnover in arterial disease

    OpenAIRE

    Sluijter, J.P.G.

    2004-01-01

    Increased atherosclerotic plaque formation can lead to lumen reduction and finally to lumen obstruction. Percutaneous transluminal angioplasty (PTA) or balloon angioplasty (dilation) are approaches generally used to treat coronary, but also peripheral atherosclerotic disease. Their goal is to restore the blood supply. The repair process or restructuring of the artery after balloon angioplasty comprises two major features, neointimal formation and geometrical remodeling, and results in a decre...

  9. OBSTRUCTIVE NEPHROPATHY: ITS PHYSIOPATHOLOGY

    Directory of Open Access Journals (Sweden)

    Musso C

    2011-01-01

    Full Text Available Obstructive nephropathy is the functional and /or parenchymal renal damage secondary to the urinary tract occlusion at any part of it. The inducing urinary obstruction diseases can vary depending on the patient´s age and gender. There are many renal dysfunction inducing mechanisms involved in this entity: increase in the intra-luminal pressure, ureteral dilatation with ineffective ureteral peristalsis, glomerular ultrafiltration net pressure reduction, intra-renal glomerular blood flux reduction due to vasoconstriction, and local disease of chemotactic substances. Obstructive nephropathy can also lead to hypertension (vasoconstriction-hypervolemia, hyperkalemia, metabolic acidosis (aldosterone resistance, diabetes insipidus (vasopressine resistance. In conclusion, since obstructive nephropathy is a potentially reversible cause of renal dysfunction, it should always be taken into account among the differential diagnosis of renal failure inducing mechanisms.

  10. Wrecks and Obstructions

    Data.gov (United States)

    Department of Homeland Security — In 1981, NOAA_s National Ocean Service (NOS) implemented the Automated Wreck and Obstruction Information System (AWOIS) to assist in planning hydrographic survey...

  11. Obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Although /sup 133/xenon ventilation studies and aerosol inhalation images have been shown to be more sensitive than other measurements of pulmonary function in detecting early airway disease, they fall short as ideal screening tests. In addition they do not distinguish between the different diseases of air flow obstruction. The diagnosis of the conditions discussed in this paper does not require studies of regional lung function. It is doubtful if further refinements in instrumentation or the introduction of other radioisotopes would really help in this matter. Chronic bronchitis, emphysema, and bronchial asthma are the major obstructive pulmonary disease. Cystic fibrosis and bronchiectasis, which are less common, are also accompanied by airway obstruction. Local obstruction of a bronchus may also occur as a result of a tumor or foreign body or a mucous plug

  12. Unilateral absence of a pulmonary artery: Report of 3 cases

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Oh Keun; Choi, Chul Seung; Choi, Yo Won; Jeon, Seok Cheol; Seo, Heung Suk; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1994-07-15

    Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PDA. We encountered three cases of isolated unilateral absence of a pulmonary artery; one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateral lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of acquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluation of the unilateral absence of a pulmonary artery.

  13. Unilateral absence of a pulmonary artery: Report of 3 cases

    International Nuclear Information System (INIS)

    Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PDA. We encountered three cases of isolated unilateral absence of a pulmonary artery; one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateral lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of acquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluation of the unilateral absence of a pulmonary artery

  14. Arterial Ageing

    OpenAIRE

    Lee, Seung-Jun; Park, Sung-Ha

    2013-01-01

    Arterial ageing is characterized by age associated degeneration and sclerosis of the media layer of the large arteries. However, besides ageing, clinical conditions, which enhance oxidative stress and inflammation act to accelerate the degree of arterial ageing. In this review, we summarized the pathophysiology and contributing factors that accelerate arterial ageing. Among them, we focused on hypertension, the renin-angiotensin-aldosterone system and vascular inflammation which are modifiabl...

  15. Superior Mesenteric Artery Syndrome. An Infrequent Complications of Scoliosis Surgery.

    OpenAIRE

    Balık, Emre; Keskin, Metin; Akgül, Turgut; Bayraktar, Adem; Dikici, Fatih

    2014-01-01

    Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this pap...

  16. Neonatal Arterial Switch Operation for Transposition of the Great Arteries in a Patient with Mirror Image Dextrocardia and Situs Inversus Totalis

    OpenAIRE

    McMahon, Colin J.; Snyder, Christopher S.; Rivenes, Shannon M.; Sang, Charlie J.; Fraser, Charles D.

    2000-01-01

    The neonatal arterial switch operation has become the standard therapy for D-transposition of the great arteries in the absence of left ventricular outflow tract obstruction. We describe our experience of successful arterial switch operation after balloon atrial septostomy in a 5-day-old infant girl who had atrial and visceral situs inversus totalis, mirror image dextrocardia, and D-transposition of the great arteries. To our knowledge, ours is the first report of this operation in a patient ...

  17. Acute arterial occlusion - kidney

    Science.gov (United States)

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  18. Lipoproteína (a) em pacientes portadores de doença arterial obstrutiva periférica e/ou diabetes mellitus tipo 2 Lipoprotein (a) in patients with peripheral arterial obstructive disease and/or type 2 diabetes mellitus

    OpenAIRE

    Ana Paula Lucas Mota; Maria das Graças Carvalho; Luciana Moreira Lima; Maria Elisabeth Rennó de Castro Santos; Marinez de Oliveira Sousa

    2008-01-01

    INTRODUÇÃO: A doença arterial obstrutiva periférica (DAOP) constitui um excelente marcador para a aterosclerose sistêmica. Entre os fatores de risco para essa doença está o diabetes mellitus tipo 2 (DM2). Acredita-se que a lipoproteína (a) [Lp(a)] esteja ligada a risco aumentado de aterosclerose, embora os mecanismos que levem a esse aumento não sejam completamente conhecidos. Níveis elevados de Lp(a) parecem estar associados a risco aumentado de doença arterial coronariana (DAC), assim como ...

  19. Chronic obstructive pulmonary disease.

    Science.gov (United States)

    Barnes, Peter J; Burney, Peter G J; Silverman, Edwin K; Celli, Bartolome R; Vestbo, Jørgen; Wedzicha, Jadwiga A; Wouters, Emiel F M

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a common disease with high global morbidity and mortality. COPD is characterized by poorly reversible airway obstruction, which is confirmed by spirometry, and includes obstruction of the small airways (chronic obstructive bronchiolitis) and emphysema, which lead to air trapping and shortness of breath in response to physical exertion. The most common risk factor for the development of COPD is cigarette smoking, but other environmental factors, such as exposure to indoor air pollutants - especially in developing countries - might influence COPD risk. Not all smokers develop COPD and the reasons for disease susceptibility in these individuals have not been fully elucidated. Although the mechanisms underlying COPD remain poorly understood, the disease is associated with chronic inflammation that is usually corticosteroid resistant. In addition, COPD involves accelerated ageing of the lungs and an abnormal repair mechanism that might be driven by oxidative stress. Acute exacerbations, which are mainly triggered by viral or bacterial infections, are important as they are linked to a poor prognosis. The mainstay of the management of stable disease is the use of inhaled long-acting bronchodilators, whereas corticosteroids are beneficial primarily in patients who have coexisting features of asthma, such as eosinophilic inflammation and more reversibility of airway obstruction. Apart from smoking cessation, no treatments reduce disease progression. More research is needed to better understand disease mechanisms and to develop new treatments that reduce disease activity and progression. PMID:27189863

  20. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults.

    Science.gov (United States)

    Semelka, Michael; Wilson, Jonathan; Floyd, Ryan

    2016-09-01

    Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep. This results in fragmented, nonrestful sleep that can lead to symptoms such as morning headache and daytime sleepiness. Obstructive sleep apnea affects persons of all ages, with an increasing prevalence in those older than 60 years. The exact prevalence is unknown but is estimated to be between 2% and 14%. There are many health conditions associated with obstructive sleep apnea, including hypertension, coronary artery disease, cardiac arrhythmias, and depression. Loud snoring, gasping during sleep, obesity, and enlarged neck circumference are predictive clinical features. Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited. The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory. Home sleep apnea tests can be performed for certain patients but are generally considered less accurate. Continuous positive airway pressure is the first-line treatment; adherence rates are variable and seem to improve with early patient education and support. Other treatment modalities include weight reduction, oral appliance therapy, and surgery to correct anatomic obstructions, although there is insufficient evidence to support these types of surgeries. Bariatric surgery can improve sleep parameters and symptoms in obese patients with obstructive sleep apnea and can result in remission in many patients. PMID:27583421

  1. Renal artery stent angioplasty for renovascular hypertension

    International Nuclear Information System (INIS)

    Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

  2. Retrograde catheterization via politeal artery for the treatment of ipsilateral superficial femoral artery occlusive disease: its clinical application

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical effect and application of retrograde catheterization via politeal artery in treating ipsilateral superficial femoral artery occlusive diseases. Methods: During the period from Jan. 2008 to June 2011, 15 patients with superficial femoral artery occlusive diseases were collected. A total of 17 narrowed or obstructed superficial femoral arteries were detected, including right (n=10) and left (n=7) femoral arteries. The length of the diseased artery ranged from 9 to 18 cm, with a mean of (12.5±6.8) cm. Percutaneous angioplasty (PTA) through ipsilateral retrograde catheterization via politeal artery together with stent implantation was performed to reopen the narrowed or obstructed superficial femoral arteries. After the procedure all patients were followed up for 3-24 months. The clinical results were analyzed. Results: The therapeutic success rate was 100% (17/17). No serious complications occurred. After the treatment, the ischemic symptoms were markedly improved or even disappeared. In 89.47% of patients (17/19) the superficial femoral arteries remained patent during the follow-up period. The preoperative ankle brachial index (ABI) was 0.15-0.48 (mean 0.28), while the postoperative ABI was 0.69-1.05 (mean 0.88). The difference in ABI between pre-operation and post-operation was statistically significant (P<0.05). Conclusion: For the treatment of superficial femoral arterial occlusive diseases, PTA through ipsilateral retrograde catheterization via politeal artery together with stent implantation is a safe effective therapy. (authors)

  3. Occupational chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Omland, Oyvind; Würtz, Else Toft; Aasen, Tor Brøvig;

    2014-01-01

    Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures.......Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures....

  4. Obstructive Uropathy in Sudanese Patients

    Directory of Open Access Journals (Sweden)

    El Imam M

    2006-01-01

    Full Text Available In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66% patients presented with chronic obstruction and 175 (34% with acute obstruction. Of the study patients, 210 (40% presented with significant renal impairment; 50 (23% of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

  5. AN INVESTIGATION OF RELATIONSHIP BETWEEN TONSILLOLITH AND CAROTID ARTERY CALCIFICATION ON PANORAMIC RADIOGRAPHY

    OpenAIRE

    Cakur, Binali; Yıldırım, Eren; Demirtaş, Ömer

    2015-01-01

    Aim: Carotid artery calcification can results in important vascular obstruction. It is reported that the combination of risk factors such as periodontitis, pulp stones contribute to carotid artery calcification. However in the literature, no study has yet investigated carotid artery calcification with respect to tonsillolith. The objective of this study was to investigate whether carotid artery calcification correlate with tonsillolith using dental panoramic radiography.Material and method: P...

  6. Comparison of Two Aerosolized Bronchodilators in the Treatment of Severe Equine Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Friday, Philippa Anne

    2000-01-01

    Aerosolized bronchodilator drugs are commonly used for treatment of horses with chronic obstructive pulmonary disease. Relative efficacy of sympathomimetic and parasympatholytic bronchodilators for relief of acute airway obstruction and improvement of pulmonary gas exchange was compared in 6 horses with COPD. Physical examination, arterial and venous blood gas analysis and measurement of end-tidal CO2 tension were performed at time zero, 30 minutes, 1, 2, 3 and 4 hours after administration of...

  7. Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria

    Directory of Open Access Journals (Sweden)

    I. N. Apoku

    2015-06-01

    Full Text Available ABSTRACTPurpose:To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.Materials and Methods:60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated.B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys.Results:The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03 to grade II (0.73±0.03 and grade III (0.73±0.02 but fell within the most severe levels of obstruction (0.69±0.07. There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction.Conclusion:Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.

  8. Symptomatic aorto-pulmonary collaterals early after arterial switch operation.

    Science.gov (United States)

    Santoro, Giuseppe; Carrozza, Marianna; Russo, Maria Giovanna; Calabrò, Raffaele

    2008-07-01

    Enlarged bronchial arteries and/or systemic-to-pulmonary collaterals have been frequently demonstrated in association with transposition of the great arteries. They are usually clinically silent, although they might be large enough to cause accelerated pulmonary vascular obstructive disease or symptomatic cardiac volume overload after surgical repair. We report on a low-weight neonate with transposition of the great arteries and intact ventricular septum who showed a stormy postoperative course because of multiple aorto-pulmonary collaterals early after a successful arterial switch operation. Percutaneous coil embolization of these anomalous vessels resulted in sudden weaning from mechanical ventilation and hospital discharge in a few weeks. PMID:18185950

  9. Management of obstructed defecation

    OpenAIRE

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-01

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients ...

  10. Adult obstructive sleep apnoea

    OpenAIRE

    Jordan, Amy S.; McSharry, David G.; Malhotra, Atul

    2013-01-01

    Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, which leads to oxygen desaturation and disrupted sleep. Symptoms include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, ade...

  11. Equine recurrent airway obstruction

    OpenAIRE

    Artur Niedźwiedź

    2014-01-01

    Equine Recurrent Airway Obstruction (RAO), also known as heaves or broken wind, is one of the most common disease in middle-aged horses. Inflammation of the airway is inducted by organic dust exposure. This disease is characterized by neutrophilic inflammation, bronchospasm, excessive mucus production and pathologic changes in the bronchiolar walls. Clinical signs are resolved in 3-4 weeks after environmental changes. Horses suffering from RAO are susceptible to allergens throughout their liv...

  12. Chronic obstructive pulmonary disease

    OpenAIRE

    NR Anthonisen

    2007-01-01

    The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are...

  13. Cintilografia do miocárdio com tecnécio 99m-MIBI e administração de adenosina em portadores de doença arterial coronária: correlação dos resultados com a angiografia coronária e o ultra-som intracoronário Adenosine myocardial perfusion SPECT with Tc-99m-MIBI in patients with obstructive coronary artery disease: correlation between quantitative coronary angiography and intravascular ultrasound measurements

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Mastrocolla

    2006-01-01

    Full Text Available OBJETIVO: Estabelecer a correlação da cintilografia de perfusão do miocárdio (CPM com Tecnécio 99m-MIBI (MIBI e injeção de adenosina, empregando a angiografia coronária quantitativa (ACQ e o ultra-som intracoronário (UIC como comparação. MÉTODOS: Estudo de 70 pacientes com doença arterial coronária (DAC, encaminhados à CPM com MIBI e adenosina. As manifestações clínicas, do eletrocardiograma (ECG e os resultados das imagens foram correlacionadas às variáveis da análise visual e quantitativa da angiografia, bem como ao UIC. RESULTADOS: A média de idades foi de 60,6 anos, com 39 pacientes do sexo masculino. A angiografia coronária evidenciou estenose do diâmetro da luz (E% de 49,94% em 105 artérias, com reavaliação à ACQ em 83 artérias (79% e média de 44,20%, pOBJECTIVE: To correlate myocardial perfusion scintigraphy (MPS with Tc-99m-MIBI and adenosine infusion using quantitative coronary angiography (QCA and intravascular ultrasound (IVUS. METHODS: Seventy patients with coronary artery disease (CAD referred for myocardial perfusion scintigraphy (MPS with MIBI and adenosine were studied. Clinical, electrocardiographic (ECG, and scintigraphic findings were correlated with variables of visual and quantitative angiographic analysis, as well as to those of IVUS. RESULTS: The mean age of patients was 60.6 years, and 39 were male. Coronary angiography showed percentage of diameter stenosis (% DS of 49.94% in 105 arteries, 83 of which were re-evaluated by QCA (79%, mean of 44.20%, p<0.05. ST-segment depression during adenosine infusion was associated with higher degrees of % DS (55.0% vs. 47.8%, p<0.05. Scintigraphic ischemia was correlated with greater cross-sectional area of lumen obstruction by IVUS (% CSA. Clinical, ECG, and IVUS findings were considered together and expressed as global ischemic versus non-ischemic responses. Ischemia was associated with lower values of minimal lumen diameter (MLD and minimal lumen area

  14. [Malignant biliary obstruction].

    Science.gov (United States)

    Hucl, Tomáš

    2016-01-01

    Pancreatic cancer and cholangiocarcinoma are the most common causes of malignant biliary obstruction. They are diseases of increasing incidence and unfavorable prognosis. Only patients with localized disease indicated for surgery have a chance of long-term survival. These patients represent less than 20 % of all patients, despite the progress in our diagnostic abilities.Locally advanced and metastatic tumors are treated with palliative chemotherapy or chemoradiotherapy; the results of such treatments are unsatisfactory. The average survival of patients with unresectable disease is 6 months and only 5-10 % of patients survive 5 years.Biliary drainage is an integral part of palliative treatment. Endoscopically or percutaneosly placed stents improve quality of life, decrease cholestasis and pruritus, but do not significantly improve survival. Biliary stents get occluded over time, possibly resulting in acute cholangitis and require repeated replacement.Photodynamic therapy and radiofrequency ablation, locally active endoscopic methods, have been increasingly used in recent years in palliative treatment of patients with malignant biliary obstruction. In photodynamic therapy, photosensitizer accumulates in tumor tissue and is activated 48 hours later by light of a specific wave length. Application of low voltage high frequency current during radiofrequency ablation results in tissue destruction by heat. Local ablation techniques can have a significant impact in a large group of patients with malignant biliary obstruction, leading to improved prognosis, quality of life and stent patency. PMID:26898789

  15. Early effects of intravenous terbutaline on cardiopulmonary function in chronic obstructive bronchitis and pulmonary hypertension.

    OpenAIRE

    Jones, R. M.; Stockley, R A; Bishop, J M

    1982-01-01

    Terbutaline sulphate (0.25 mg) was given intravenously to 10 recumbent patients with severe irreversible airflow obstruction and pulmonary hypertension who were undergoing right heart catheterisation. Alveolar ventilation index, cardiac index, and mean pulmonary artery pressure all rose significantly at 5 minutes and then fell by 35 minutes, although the first two remained higher than control levels. This was accompanied by a small but significant rise in arterial oxygen tension at 5 minutes....

  16. OBSTRUCTIVE JAUNDICE: A CLINICAL STUDY

    OpenAIRE

    Antony,; Rasool Syed

    2016-01-01

    BACKGROUND Jaundice is a frequent manifestation of biliary tract disorders and evaluation of obstructive jaundice is a common problem faced by general surgeons. Obstructive jaundice of varied aetiology is one of the main cause of hospital admissions. Hence, comprehensive study of aetiology, clinical presentation, management of obstructive jaundice is important in management of these patients. AIMS AND OBJECTIVES  Study the clinical history and presentation of obstructiv...

  17. Obesity and chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Čekerevac Ivan

    2011-01-01

    Full Text Available Introduction. Nutritional abnormalities have one of the most important systematic effects on chronic obstructive pulmonary disease (COPD. A relationship between COPD and obesity has been observed and recognized. In COPD patients, beside changes in the total body weight, changes in body composition are also possible with the loss of fat-free mass (FFM. Objective. This study was undertaken to evaluate the impact of obesity and the change of body composition on the pulmonary function, dyspnoea level and the quality of life in COPD patients. Methods. Seventy-nine patients in the stable state of COPD were evaluated. Pulmonary function and arterial blood gas analysis were assessed. Nutritional status was analyzed according to Body Mass Index (BMI. Body composition was evaluated by using anthropometric measurement by fat free mass index (FFMI. Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ. The Visual Analogue Scale (VAS was used to evaluate dyspnoea. Results. The highest prevalence of obesity (50.0% was found in patients with mild COPD, while the lowest prevalence was detected in very severe COPD patients (10.0%. The loss of FFM occurred in 22.2% patients with normal body weight and in 9.0% of overweight COPD patients. The quality of life was lower in obese patients compared to other COPD patients. A higher dyspnoea level was also present in obese patients. The lowest airflow obstruction was in obese patients (p=0.023. We found a significant positive correlation between forced expiratory volume in the first second (FEV1% and BMI (r=0.326, p=0.003, FEV1% and FFMI (r=0.321, p=0.004. Conclusion. The highest prevalence of obesity was in patients with mild COPD. Obese patients with COPD had the lowest level of airflow obstruction, higher dyspnoea level and lower quality of life in comparison to other COPD patients.

  18. 广泛肝切除联合肝固有动脉切除对正常大鼠及梗阻性黄疸大鼠的影响%Extended hepatectomy with hepatic artery resection in obstructive jaundice rats

    Institute of Scientific and Technical Information of China (English)

    李斌; 张友磊; 李东; 章意亮; 高春芳; 许强芝; 倪灿荣; 侯元凯; 王义

    2008-01-01

    Objective To study liver function, hepatic energy metabolism, regeneration and apoptosis in obstructive jaundiced or normal liver after 70% partial hepatectomy (PH) with hepatic artery resection (HAR) in rats. Methods In this study, 133 male SD rats were enrolled, 6 rats were in sham operation group, 20 rats underwent choledochoduodenostomy after 70% PH and 20 rats did 70%- PH, choledochoduodenostomy plus HAR. The remaining 87 rats 5 days after common bile duct ligation (CBDL) were randomized into two groups: 70% PH with choledochoduodenostomy, and 70% PH with choledochoduodenustomy plus HAR. Serum TB, ALT, ALB and ALP; tissue of hepatic HGF, bcl-2 mRNA and protein expression; ATP, ADP and AMP in hepatic tissues; hepatocyte proliferation/ apoptosis index were observed postoperatively (24 h, 72 h and 7 d). MortaLity was calculated. Results Rats without obstructive jaundice could tolerate 70% PH plus HAR with good liver regeneration. Compared with other groups, the serum liver function index; ATP content and EC value; HGF,bcl-2 mRNA content of liver tissue and the hepatocyte proliferation/apoptosis index in 70% PH with HAR group significantly aggravated and the mortality signiticanfly increased in obstructive jaundice rats ( P < 0. 05). Conclusions (1) The liver regeneration and apoptosis were not significantly influenced in normal mrs undergoing 70% PH and 70% PH with HAR, moreover hepatoeyte energy metabolism and liver function recovered rapidly in both groups. (2) With the existence of severe bilirubinemia, 70% PH with HAR caused an increased mortality suggesting a rationale for a preoperative bilirubin reducing procedures before a major surgery in malignant obstructive jaundice.%目的 探索在正常及高胆红素血症情况下,大鼠70%肝切除联合肝固有动脉切除对肝功能、肝细胞能量代谢以及肝再生和细胞凋亡的影响.方法 雄性成年SD大鼠133只,将其中40只分为2组,每组20只,均行胆总管-十

  19. Childhood Obesity and Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Indra Narang

    2012-01-01

    Full Text Available The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA, occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG, is characterised by snoring, recurrent partial (hypopneas or complete (apneas obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.

  20. Biliary tract obstruction secondary to Burkitt lymphoma

    International Nuclear Information System (INIS)

    The abdomen, in particular the ileocecal region, appendix and colon, is the most common primary site for Burkitt non Hodgkin's lymphoma (NHL). Involvement of the bile duct is rare. The authors describe a patient with abdominal NHL in which jaundice due to bile duct obstruction was the first clinical sign. Case report: a 3 year old white boy presented with one month of progressive jaundice, clay-colored stools, tea colored urine and increase of abdominal volume. Physical examination showed jaundice 3+/4+ and pale mucosa. The abdomen was moderately distended and timpanous and the liver was enlarged. Laboratory examinations confirmed cholestasis with total bilirubin of 8.2 mg/dl (direct bilirubin of 7.8 mg/dl), and microcytic and hypochromic anemia. Ultrasonography (US) and abdominal CT showed two solid tumors in hepatic hilar topography, and dilated intrahepatic biliary tree. The Doppler US showed hepatic artery and portal vein dislocation by the nodules. Comment: although jaundice occurs frequently as a late manifestation of NHL, it is rarely seen as the presenting sign. When jaundice is the first clinical sign and image studies show hepatic hilar tumor and bile duct obstruction, NHL should be considered in the differential diagnosis. (author)

  1. Aberrant left pulmonary artery associated with right pulmonary hypoplasia

    International Nuclear Information System (INIS)

    Aberrant left pulmonary artery (ALPA), or pulmonary artery sling, is an uncommon vascular malformation that is frequently associated with obstructive disorders of the tracheobronquial tree. In newborns, it produces severe respiratory problems. In contrast, in adults, it is usually discovered by change. ALPA has been associated with right pulmonary hypoplasia (RPH) in a small number of cases. We present a new case of ALP associated with right pulmonary hypoplasia in an adult woman, diagnosed by CT and MR. 12 refs

  2. Transient Presyncope Secondary to Posterior Descending Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Andrew D. Moffat

    2011-01-01

    Full Text Available We describe the case of a 64-year-old male initially presenting with presyncope and bradycardia, without any anginal symptoms or objective evidence of myocardial ischemia. A stress test induced no physical symptoms but revealed a left bundle branch block with multiple preventricular contractions on electrocardiogram. Subsequent catheterization revealed severe obstructive disease throughout the coronary arteries. He was treated percutaneously on two separate heart catheterizations. The presyncope and bradycardia resolved after reperfusion of the posterior descending artery.

  3. SUPERIOR MESENTERIC ARTERY SYNDROME - A REVIEW

    OpenAIRE

    Aneeta; Sanjay,; Pramod,; Vaibhav; Ankur

    2014-01-01

    Superior mesenteric artery (SMA) syndrome is a rare acquired disorder in which an acute angulation of SMA causes compression and obstruction of the third part of the duodenum between the SMA and the aorta. The diagnosis is usually made by exclusion. A large number of debilita ting conditions leading to a loss of fatty tissue such as anorexia nervosa , malabsorption , or hyper catabolic states like burns , major surgery , severe injuries , or mal...

  4. Chronic obstructive pulmonary disease.

    Science.gov (United States)

    Brusasco, Vito; Martinez, Fernando

    2014-01-01

    COPD is characterized by airflow limitation that is not fully reversible. The morphological basis for airflow obstruction results from a varying combination of obstructive changes in peripheral conducting airways and destructive changes in respiratory bronchioles, alveolar ducts, and alveoli. A reduction of vascularity within the alveolar septa has been reported in emphysema. Typical physiological changes reflect these structural abnormalities. Spirometry documents airflow obstruction when the FEV1/FVC ratio is reduced below the lower limit of normality, although in early disease stages FEV1 and airway conductance are not affected. Current guidelines recommend testing for bronchoreversibility at least once and the postbronchodilator FEV1/FVC be used for COPD diagnosis; the nature of bronchodilator response remains controversial, however. One major functional consequence of altered lung mechanics is lung hyperinflation. FRC may increase as a result of static or dynamic mechanisms, or both. The link between dynamic lung hyperinflation and expiratory flow limitation during tidal breathing has been demonstrated. Hyperinflation may increase the load on inspiratory muscles, with resulting length adaptation of diaphragm. Reduction of exercise tolerance is frequently noted, with compelling evidence that breathlessness and altered lung mechanics play a major role. Lung function measurements have been traditionally used as prognostic indices and to monitor disease progression; FEV1 has been most widely used. An increase in FVC is also considered as proof of bronchodilatation. Decades of work has provided insight into the histological, functional, and biological features of COPD. This has provided a clearer understanding of important pathobiological processes and has provided additional therapeutic options. PMID:24692133

  5. Equine recurrent airway obstruction

    Directory of Open Access Journals (Sweden)

    Artur Niedźwiedź

    2014-10-01

    Full Text Available Equine Recurrent Airway Obstruction (RAO, also known as heaves or broken wind, is one of the most common disease in middle-aged horses. Inflammation of the airway is inducted by organic dust exposure. This disease is characterized by neutrophilic inflammation, bronchospasm, excessive mucus production and pathologic changes in the bronchiolar walls. Clinical signs are resolved in 3-4 weeks after environmental changes. Horses suffering from RAO are susceptible to allergens throughout their lives, therefore they should be properly managed. In therapy the most importanthing is to eliminate dustexposure, administration of corticosteroids and use bronchodilators to improve pulmonary function.

  6. The option of palliative treatment of colorectal cancer patients with liver metastases and obstructive jaundice

    International Nuclear Information System (INIS)

    This paper examines a version of the combined treatment of patients with colorectal cancer and liver metastases in the background of obstructive jaundice with intra-arterial chemotherapy followed by a course of radiotherapy to the area of the liver developed in DOPTS techniques. The efficiency of our proposed method in comparison with the previously existing ones is proved

  7. Malignant biliary obstruction

    International Nuclear Information System (INIS)

    This paper assesses the value of CT in predicting surgical resectability of tumors in patients with malignant biliary obstruction. A retrospective analysis was performed on 320 consecutive patients with malignant biliary obstruction over a 3-1/2-year period. Most patients were treated nonoperatively. Fifty-one patients fulfilled the selection criteria of surgical exploration, pathological confirmation of malignancy, and prepoperative CT scans available for review. The CT scans were reviewed by a blinded reader and assessed for surgical resectability of tumors. There were 32 patients with pancreatic adenocarcinoma, 6 with ampullary carcinoma, 5 with cholangiocarcinoma, 2 with gallbladder carcinoma, and 6 with other pathologic diagnoses. Of 36 patients thought to have unresectable tumors based on CT findings, 32 were found to have surgically unresectable tumors (positive predictive value, 89%). Of 15 patients thought to have resectable tumors based on CT findings, 11 had surgically resectable tumors (positive predictive value, 73%). CT missed positive duodenal lymph nodes in 2 patients, portal vein infiltration in 1 patient, and small liver metastases in 1 patient

  8. CONGENITAL DUODENAL OBSTRUCTIONS

    Directory of Open Access Journals (Sweden)

    S.G. Aprodu

    2005-07-01

    Full Text Available The purpose of this study is to analyze a cohort of 46 cases of congenital duodenal obstruction, operated on between 1996 and 2002, 23 of them being diagnosed in neonatal period. In one case, the diagnosis was made antenatally, by ultrasonography. There were 15 males and 8 females, 17 with duodenal atresia and 6 with duodenal diaphragmatic stenosis. Surgery was performed in all cases, consisting in lateral duodeno-duodenal anastomosis in 5 cases and "diamond-shape" duodeno-duodenal anastomosis in 18 cases. The survival rate in this study was 69.5%. 12 cases (52,1% had other congenital pathologies: trisomy 21 (6 cases, multiple ileal atresia (2 cases, dextrocardy (2 cases, omphalocel (1 case, situs inversus (1 case. The complications of surgery were: anastomotic leaking with peritonitis, biliary fistula, intestional adhesions with occlusion. Congenital duodenal obstruction (midgut volvulus, atresia, stenosis remains a challenging issue for pediatric surgeons, especially in our country, due to limited possibilities of quick diagnosis and treatment of associated anomalies.

  9. Carotid Artery Screening

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Carotid Artery Screening What is carotid artery screening? Who should consider ... about carotid artery screening? What is carotid artery screening? Screening examinations are tests performed to find disease ...

  10. Percutaneous intervention in obstructive

    International Nuclear Information System (INIS)

    Percutaneous intervention procedures in obstructive uropathy include percutaneous nephrostomy tube placements, nephroureteral stents, percutaneous nephrostomy combined with ureteral embolization, percutaneous management of stone disease, suprapubic tube placements into the bladder, and perinephric/retroperitoneal urinomas/abscesses drainages. Percutaneous nephrostomy is performed to relieve urinary obstruction or divert the urinary stream away from the ureter or bladder. Patients are given preprocedure antibiotics. Percutaneous nephrostomies can be emergent cases because of risk of pyuria and sepsis from a stagnant urine collection. The procedure is performed using both ultrasound and fluoroscopy (or fluoroscopy alone using anatomic landmarks, or an internal radiopaque calculus, or delayed phase excretion of the contrast into the renal collecting system) under local anesthesia or conscious sedation. Ureteral stents are placed to bypass an obstructing stone or to stent across of an area of stricture or ureteral laceration. Stents may be placed by the urologist via a transurethral approach or by the interventional radiologist via a percutaneous approach. The decision as to method of stent placement is based upon the location and accessibility of the ureteral pathology. Ureteral embolization is performed in patients with unresectable tumors of the pelvis with long-standing nephrostomy tubes and distal urine leaks refractory to other treatments. Coils, gelfoam and liquid embolic materials can be used. Ureteral embolization for ureteral fistulas and incontinence is technically successful in 100% of the patients. Complications include bleeding, infection, ureteral or renal injury, and deployment (or movement) of the coils within the renal pelvis. Percutaneous management of stone disease, including renal, ureteral, and bladder stones requires close cooperation between the urologist and interventional radiologist, because of availability of sonographic lithotripsy

  11. Postradiation ureteral obstruction: a reappraisal

    Energy Technology Data Exchange (ETDEWEB)

    Muram, D.; Oxorn, H.; Curry, R.H.; Drouin, P.; Walters, J.H.

    1981-02-01

    Thirty-four patients who received radiation therapy for carcinoma of the cervix developed hydronephrosis. Twelve of 34 (35%) had no evidence of pelvic malignancy, and the obstruction was caused by periureteral fibrosis. The incidence of obstructive uropathy due to periureteral fibrosis not associated with recurrent tumor increased when the obstructing lesion was unilateral, the clinical staging of the cervical carcinoma prior to therapy was Stage IB or Stage II rather than Stage III or Stage IV, and the obstructing lesion appeared 2 or more years after the completion of radiation therapy. The appearance of hydronephrosis in association with ipsilateral leg edema, and sciatic pain in these patients strongly suggest a recurrent tumor. The diagnosis of periureteral fibrosis should be considered in all patients who develop obstruction of the urinary tract after radiation therapy for carcinoma of the cervix. Laparotomy is indicated if all other methods of investigation fail to confirm the presence of a malignant lesion.

  12. Detection of coronary artery disease by thallium scintigraphy in patients with valvar heart disease.

    OpenAIRE

    Huikuri, H V; Korhonen, U R; Heikkilä, J; Takkunen, J T

    1986-01-01

    In patients with valvar heart disease detection of coronary artery disease by conventional non-invasive methods may be difficult. The usefulness of thallium-201 exercise scintigraphy for detecting coronary artery disease was evaluated in 16 patients with aortic stenosis, 17 with aortic regurgitation, nine with mitral stenosis, and six with mitral regurgitation who were investigated by coronary angiography. Only two of 21 patients with greater than or equal to 50% coronary artery obstruction h...

  13. Combined use of non-invasive techniques to predict pulmonary arterial pressure in chronic respiratory disease.

    OpenAIRE

    Bishop, J M; Csukas, M

    1989-01-01

    The value of non-invasive procedures for predicting pulmonary arterial pressure was investigated in 370 patients with chronic obstructive lung diseases and in 73 with fibrosing alveolitis in a combined study at nine centres in six European countries. Measurements included forced expiratory volume in one second, arterial blood gas tensions, standard electrocardiogram, radiographic dimensions of pulmonary artery, right ventricle dimensions by M mode echocardiography, and myocardial scintigraphy...

  14. Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Anderson Oliver

    2008-11-01

    Full Text Available Abstract Introduction This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm. Case presentation A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery. Conclusion This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.

  15. Management of obstructed defecation.

    Science.gov (United States)

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-28

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results. PMID:25632177

  16. Obstructive apnea during sleep is associated with peripheral vasoconstriction

    Science.gov (United States)

    Imadojemu, Virginia A.; Gleeson, Kevin; Gray, Kristen S.; Sinoway, Lawrence I.; Leuenberger, Urs A.

    2002-01-01

    Obstructive apnea during sleep is associated with a substantial transient blood pressure elevation. The mechanism of this pressor response is unclear. In this study we measured muscle sympathetic nerve activity (MSNA), mean arterial pressure (Psa), and mean limb blood velocity as an index of blood flow (MBV, Doppler) and calculated changes in limb vascular resistance during and after apneas during both wakefulness and sleep in patients with the obstructive sleep apnea syndrome. Immediately postapnea during sleep Psa increased significantly compared with the earlier stages of apnea and this was preceded by a rise of MSNA (n = 5). In contrast to blood pressure, MBV remained unchanged. Because resistance = blood pressure/blood flow, limb vascular resistance increased by 29 +/- 8% from late apnea to postapnea (n = 7, p vasoconstriction. This vasoconstrictor response appears to be, at least in part, mediated by the sympathetic nervous system and may be linked to hypoxia.

  17. Interruption of pulmonary arterial flow with inadequate ventilation leads to pulmonary infection.

    Science.gov (United States)

    Urano; Shibayama, Y; Fukunshi, K; Nariyama, K; Ohsawa, N

    1996-03-01

    We examined the effect of interruption of pulmonary arterial flow and inadequate ventilation on the development of pulmonary infarction in rats. Pulmonary arterial flow was blocked by the injection of agar into the inferior vena cava and inadequate ventilation was produced by obstructing the left main bronchus with a polypropylene tip. Histological and angiographic examination of the lung demonstrated that: pulmonary artery embolism alone does not induce pulmonary infarction; obstruction of a bronchus does not induce significant changes, but that pulmonary infarction develops when pulmonary artery embolism and obstruction of a bronchus occur simultaneously. It has been thought that pulmonary infarction is caused by acute obstruction of a pulmonary artery, however, the alveolar walls are supplied with oxygen by both the pulmonary circulation and by ventilation. Interruption of pulmonary arterial flow alone is probably not sufficient to induce pulmonary infarction, which is probably caused by deficiency of oxygen supply to the alveolar walls by a synergy between interruption of pulmonary arterial flow and inadequate ventilation. PMID:8605572

  18. Stenting in Malignant Biliary Obstruction.

    Science.gov (United States)

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed. PMID:26431598

  19. Superior mesenteric artery syndrome causing growth retardation

    Directory of Open Access Journals (Sweden)

    Halil İbrahim Taşcı

    2013-03-01

    Full Text Available Superior mesenteric artery syndrome is a rare and lifethreateningclinical condition caused by the compressionof the third portion of the duodenum between the aortaand the superior mesenteric artery’s proximal part. Thiscompression may lead to chronic intermittent, acute totalor partial obstruction. Sudden weight-loss and the relateddecrease in the fat tissue are considered to be the etiologicalreason of acute stenosis. Weight-loss accompaniedby nausea, vomiting, anorexia, epigastric pain, andbloating are the leading complaints. Barium radiographs,computerized tomography, conventional angiography,tomographic and magnetic resonance angiography areused in the diagnosis. There are medical and surgical approachesto treatment. We hereby present the case ofa patient with superior mesenteric artery syndrome withdelayed diagnosis.Key words: superior mesenteric artery syndrome, nausea-vomiting, anorexia

  20. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2011-03-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.

  1. COPD (Chronic Obstructive Pulmonary Disease)

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is COPD? Español COPD, or chronic obstructive pulmonary (PULL-mun- ... can clog them. Normal Lungs and Lungs With COPD Figure A shows the location of the lungs ...

  2. Haemodynamic effects of terbutaline in chronic obstructive airways disease.

    OpenAIRE

    Teule, G. J.; Majid, P A

    1980-01-01

    Terbutaline, a cardioselective beta-adrenoceptor agonist, administered intravenously (250 micrograms) to seven patients with chronic obstructive airways disease (mean FEV1 0.99 l) resulted in reduction of mean pulmonary artery pressure (resting 23 +/- 2 to 19 +/- 2 mmHg, p < 0.05; exercise 43 +/- 3 to 35 +/- 3 mmHg, p < 0.05) and calculated pulmonary vascular resistance (resting 168 +/- 27 to 109 +/- 17 dyne s cm-5, p < 0.01; exercise 170 +/- 30 to 119 +/- 18 dyne s cm-5, p < 0.01) accompanie...

  3. Neurophysiological Changes in Patients with Chronic Obstructive Pulmonary Diseases

    OpenAIRE

    Demir, Recep; ÖZEL, Lütfi; Özdemir, Gökhan; KOCATÜRK, İdris; Ulvi, Hızır

    2014-01-01

    Peripheral neuropathy commonly occurs in patients with chronic obstructive lung disease (COPD). The aim of our study was to investigate the possible effects of COPD on the peripheral nervous system. We enrolled 31 patients (16 women and 15 men), mean age 66.12, with COPD into the study. Arterial oxygen tension (PaO2)> or = 65 mmHg was considered as the cut-off value designating tissue hypoxia. According to this cut-off value, the subjects were divided into two groups: Group I (n=16), PaO2&...

  4. Relationship Between Snoring Intensity and Severity of Obstructive Sleep Apnea

    OpenAIRE

    Kim, Jeong-Whun; Lee, Chul Hee; Rhee, Chae Seo; Mo, Ji-Hun

    2015-01-01

    Objectives The aim of this study was to determine the relationship between the intensity of snoring and severity of sleep apnea using Watch-PAT (peripheral arterial tone) 100. Methods A total of 404 patients (338 males and 66 females) who underwent home-based portable sleep study using Watch-PAT 100 for obstructive sleep apnea (OSA) from January 2009 through December 2011 were included in this study. Subjects were divided into 4 groups; no OSA (PAT apnea hypopnea index [pAHI

  5. Obstructive Jaundice in Chronic Pancreatitis

    OpenAIRE

    Hollands, M. J.; Little, J. M.

    1989-01-01

    Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause. Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from the onset of chronic pancreatitis. Jaundice was f...

  6. Peripheral arterial angiography and interventional treatment in diabetic foot ulcers

    International Nuclear Information System (INIS)

    Objective: To assess the changes of peripheral arteries and choice of interventional treatment in diabetic foot ulcers. Methods: Thirty-six diabetic patients with foot ulcers were examined by lower extremity DSA with simultaneous ultrasonic Doppler examination for correlative study and interventional treatment carried out in 17 segmental stenotic cases. Among them, 12 patients were treated by PTA and 5 patients by intravascular stenting. Results: Irregular stenoses and obstruction were observed in all patients with peripheral foot ulcers. DSA examination was more reliable comparing with Doppler examination for demonstration of the arterial injury above the level of popliteal artery. PTA and primary stenting were effective in all of these subjects outcoming with promotion of the lower extremity arterial blood perfusion and foreseen curing efficacy. Conclusions: Peripheral arterial stenoses were common in diabetic patients with foot ulcers. In clinical practice, DSA examination and interventional treatment could give a fertile prognosis and reduce disabling

  7. Internal thoracic artery collateral to the external iliac artery in chronic aortoiliac occlusive disease

    International Nuclear Information System (INIS)

    To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways

  8. Obstructed Thickenings and Supermanifolds

    CERN Document Server

    Bettadapura, Kowshik

    2016-01-01

    Associated to any supermanifold is a filtration by spaces, referred to as thickenings. It is the objective of this paper to study them up to a certain equivalence and then up to isomorphism in the complex-analytic setting. We study them both in the presence and absence of a complex supermanifold and will be guided by the goal to clarify and address the question: when does a given thickening come from a supermanifold? Such a question was, in principle, first studied by Eastwood and LeBrun. In this paper we begin with a pedagogical account of their study, after which we further develop the theory of thickenings in the context of supergeometry. Our intent will be in recovering results reminiscent of those one finds in studies on deformation theory. As a complement to our study here, we comment on the moduli problem for complex supermanifolds and consider the analogous problem for thickenings. Finally, we conclude with some illustrations of obstructed thickenings on the complex projective plane.

  9. Obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Steven D. Brass

    2011-11-01

    Full Text Available Obstructive sleep apnea (OSA affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual’s risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  10. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    International Nuclear Information System (INIS)

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  11. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  12. Carotid Artery Disease

    Science.gov (United States)

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  13. Mesenteric artery ischemia

    Science.gov (United States)

    Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or more of the three major arteries that ... that supply blood to the intestine causes mesenteric ischemia. The arteries that supply blood to the intestines ...

  14. Effect of obstructive jaundice on hemodynamics in the liver and its clinical significance

    Institute of Scientific and Technical Information of China (English)

    Yun Lu; Bing-Yuan Zhang; Cheng Zhao; Xin Jin

    2009-01-01

    BACKGROUND: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor related indicators of liver function, but it is invasive and needs to be performed repeatedly. Color Doppler flow imaging (CDFI) was used to monitor blood flow of the hepatic artery and portal vein, a non-invasive method which can be used repeatedly. METHODS: Twenty cases of obstructive jaundice were detected by CDFI and changes of liver function were measured after operation. The variables of hemodynamic monitoring included peak flow rate and mean blood flow in the hepatic artery proper at the peak of the contraction period; the inner diameter of blood vessels, the peak flow rate, and the congestion index, the blood flow in the main portal vein. RESULTS: The average peak flow rate in the hepatic artery of patients with obstructive jaundice was significantly higher than that of normal people; both the inner diameter and congestive index of the portal vein were significantly larger than those of normal people. But the mean blood flow and peak flow rate in the portal vein were lower than those of normal people. CONCLUSIONS: CDFI is an ideal and non-invasive method for evaluating liver hemodynamics in obstructive jaundice. If the increase of hepatic arterial flow is more significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation is smoother, suggesting a better prognosis. If the increase of the hepatic arterial flow is less significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation may not be smooth, suggesting a worse prognosis.

  15. Computed tomography of obstructive jaundice

    International Nuclear Information System (INIS)

    It is well known that the computed tomography (CT) is very useful in the evaluation of obstructive jaundice. We have studied 55 cases of obstructive jaundice with whole body scanner from Jun.1980 to Jun. 1981. The results were as follows: 1. The sex distribution was 36 males and 19 females, and 40 cases of obstructive jaundice were seen in fifth, sixth, and seventh decades. 2. Causes of obstructive jaundice were 25 cases of pancreas cancer, 8 cases of common duct cancer, 4 cases of gallbladder cancer, 4 cases of ampulla vater cancer, 12 cases of common duct stone, and 2 cases of common duct stricture. 3. Levels of obstruction were 8 cases of hepatic portion, 15 cases of suprapancreatic portion, 28 cases of pancreatic portion, and 4 cases of ampullary portion. 4. In tumorous condition, CT demonstrated metastasis of other organs, 9 cases of the liver, 1 case of the lung, 3 cases of the pancreas, 3 cases of the common bile duct, 1 case of the stomach, and 12 cases of adjacent lymph nodes. 5. Associated diseases were 12 cases of intrahepatic stone, 4 cases of clonorchiasis, 2 cases of pancreas pseudocyst, 1 cases of hydronephrosis, and 1 case of renal cyst

  16. Computed tomography of obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Jung Hek; Lee, Joong Suk; Chun, Beung He; Suh, Soo Jhi [Kosin Medical College, Busan (Korea, Republic of)

    1982-09-15

    It is well known that the computed tomography (CT) is very useful in the evaluation of obstructive jaundice. We have studied 55 cases of obstructive jaundice with whole body scanner from Jun.1980 to Jun. 1981. The results were as follows: 1. The sex distribution was 36 males and 19 females, and 40 cases of obstructive jaundice were seen in fifth, sixth, and seventh decades. 2. Causes of obstructive jaundice were 25 cases of pancreas cancer, 8 cases of common duct cancer, 4 cases of gallbladder cancer, 4 cases of ampulla vater cancer, 12 cases of common duct stone, and 2 cases of common duct stricture. 3. Levels of obstruction were 8 cases of hepatic portion, 15 cases of suprapancreatic portion, 28 cases of pancreatic portion, and 4 cases of ampullary portion. 4. In tumorous condition, CT demonstrated metastasis of other organs, 9 cases of the liver, 1 case of the lung, 3 cases of the pancreas, 3 cases of the common bile duct, 1 case of the stomach, and 12 cases of adjacent lymph nodes. 5. Associated diseases were 12 cases of intrahepatic stone, 4 cases of clonorchiasis, 2 cases of pancreas pseudocyst, 1 cases of hydronephrosis, and 1 case of renal cyst.

  17. Comparison of intra-arterial digital subtraction angiography with conventional angiography after transcatheter arterial embolization for hepatic malignancy

    International Nuclear Information System (INIS)

    Twenty patients with hepatic malignancy were treated with transcatheter arterial embolization (TAE) under examination by intra-arterial digital subtraction angiography (IA-DSA) and conventional angiography (CA). Comparison of these two angiographies revealed that the time required for confirmation of the embolized portion of the artery was about four-and-a-half times shorter with IA-DSA than CA. Moreover, IA-DSA revealed the obstructed portion more readily and accurately than CA. In particular, confirmation could not be made by CA in 35% of cases because of residual Gelform sponge containing contrast medium in the artery. The visualization of residual tumor stain after TAE was 40% better on IA-DSA than CA, because of residual Gelform sponge containing contrast medium and overlapping shadow with calcified costal cartilage, excretory pyelography, and original tumor stain. However, CA was better than IA-DSA in visualizing accidental obstruction of nonobjective arteries such as the cystic artery because of the poor spatial resolution and misregistration artifacts of IA-DSA. CA was better than IA-DSA in visualizing surrounding nonembolized hepatic parenchyma because of the misregistration artifacts of IA-DSA. For effective TAE without severe complication, we concluded that TAE for HCC should be performed under a combination of IA-DSA and CA. (author)

  18. Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    ZHU Ya-bin; RAJAN S.; KURIAN V.M.; LIU Zhi-yong

    2006-01-01

    Objective: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods: We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair (anterior mitral leaflet plication); 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall's procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge. Results: One patient died of post-operative heart failure. The mean follow-up time was 4.3 years. There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association (NYHA) Classes Ⅰ~Ⅱ due to associated valvular lesions. Conclusion: Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion (SAM) of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.

  19. Tetralogy of Fallot with origin of left pulmonary artery from the ascending aorta

    International Nuclear Information System (INIS)

    Anomalous origin of the left pulmonary artery in tetralogy of Fallot was diagnosed in a 4-year-old boy by cardiac catheterization. Corrective surgery was performed. The child died immediately following the surgical procedure. Postmortem examination revealed obstructive pulmonary vascular disease of the left lung and normal histology of right lung vessels. Early recognition and surgical correction of the anomaly is important with the view to preventing obstructive pulmonary vascular disease. (orig.)

  20. Tetralogy of Fallot with origin of left pulmonary artery from the ascending aorta

    Energy Technology Data Exchange (ETDEWEB)

    Robida, A.; Fettich, D.

    1985-09-01

    Anomalous origin of the left pulmonary artery in tetralogy of Fallot was diagnosed in a 4-year-old boy by cardiac catheterization. Corrective surgery was performed. The child died immediately following the surgical procedure. Postmortem examination revealed obstructive pulmonary vascular disease of the left lung and normal histology of right lung vessels. Early recognition and surgical correction of the anomaly is important with the view to preventing obstructive pulmonary vascular disease.

  1. Bacteria Present in Carotid Arterial Plaques Are Found as Biofilm Deposits Which May Contribute to Enhanced Risk of Plaque Rupture

    OpenAIRE

    Lanter, Bernard B.; Sauer, Karin; Davies, David G

    2014-01-01

    ABSTRACT Atherosclerosis, a disease condition resulting from the buildup of fatty plaque deposits within arterial walls, is the major underlying cause of ischemia (restriction of the blood), leading to obstruction of peripheral arteries, congestive heart failure, heart attack, and stroke in humans. Emerging research indicates that factors including inflammation and infection may play a key role in the progression of atherosclerosis. In the current work, atherosclerotic carotid artery explants...

  2. [Management of chronic obstructive pulmonary disease].

    Science.gov (United States)

    Cuvelier, Antoine; Muir, Jean-François

    2011-06-01

    Long-term oxygen therapy (LTOT) is indicated in stage-IV COPD. It increases survival when used 24h/24, ideally, and at least 15h/24. There is no indication for prescribing nocturnal oxygen therapy without de LTOT. Ambulatory oxygen therapy is indicated in patients with COPD who benefit from LTOT in case of significant exercise-induced desaturation. In that regard, recent technologies allow to provide patients with small-size, stand-alone and portable oxygen units. Non-invasive ventilation (NIV) is a type of mechanical ventilation administered through a mouthpiece, a nasal mask or a facial mask. It should not be confused with continuous positive airway pressure (CPAP), indicated in the treatment of obstructive sleep apnea, which does not improve alveolar ventilation in hypercapnic patients. In patients with COPD, long-term NIV does not provide any benefits in terms of survival instead, it improves arterial gasometry, clinical symptoms, quality of life and the frequency of severe exacerbations. PMID:21826930

  3. Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

    Directory of Open Access Journals (Sweden)

    Ferrón JA

    2010-06-01

    Full Text Available Abstract Background Visceral artery aneurysms (VAA, although uncommon, are increasingly being detected. We describe a case of spontaneous retroperitoneal hemorrhage from a ruptured IMA aneurysm associated with stenosis of the superior mesenteric artery (SMA and celiac trunk, successfully treated with surgery. Methods A 65-year-old man presented with abdominal pain and hypovolemic shock. Abdominal CT scan showed an aneurysm of the inferior mesenteric artery with retroperitoneal hematoma. In addition, an obstructive disease of the superior mesenteric artery and celiac axis was observed. Results Upon emergency laparotomy a ruptured inferior mesenteric artery aneurysm was detected. The aneurysm was excised and the artery reconstructed by end-to-end anastomosis. Conclusions This report discusses the etiology, presentation, diagnosis and case management of inferior mesenteric artery aneurysms.

  4. The establishment of bilateral external iliac artery stenosis model in experimental canines and its angiographic evaluation

    International Nuclear Information System (INIS)

    Objective: To establish an experimental canine model of bilateral external iliac artery stenosis by surgical method with absorbable suture. Methods: Under general anesthesia bilateral external iliac arteries were partly obstructed (about 50%) with absorbable suture in ten dogs. Three months later angiography was performed to evaluate the arterial stricture degree. Results: Bilateral external iliac artery stenosis model was successfully established in eight dogs and the other two dogs died within two weeks after the procedure. Angiography performed three months after the procedure showed that the stricture degree of arterial lumen was (60.6±12.5)%. Conclusion: Satisfactory experimental canine model of bilateral external iliac artery stenosis can be established by surgical method with absorbable suture. This method can be used for reference when peripheral artery stenosis model is to be prepared in larger animals. (authors)

  5. 左主干与左前降支病变患者活动平板运动试验的对比分析%Analysis of treadmill exercise test on patients with left main coronary artery or proximal anterior descending obstruction

    Institute of Scientific and Technical Information of China (English)

    李敬涛; 张姝兰; 乔洁; 夏振伟

    2015-01-01

    Objective To explore the significance of treadmill exercise test (TET) in identifying left main coronary artery(LMD) obstruction from proximal left anterior descending(LAD) obstruction.Methods Patients with positive in the TET of the Central Hospital of Dalian from Jan.2008 to Dec.2013 were enrolled in this study and they were divided into LMD group with 21 cases and LAD group with 35 cases according to the results of coronary angiography.Retrospectively study was conducted to analyze the exercise time,the start time of ST segment change,the lead of ST segment between groups.Results Lead aVR ST segment elevation(≥0.10 mV) was 85.7% (18/21) in the LMD group and 62.9% (22/35) in the LAD group.Lead aVR ST segment elevation in the LM group was ((0.16 ± 0.07) mV,higher than in the LAD group ((0.11 ± 0.07) mV ; t =2.614,P < 0.05).Accompany ST segment depression of leads and cumulative ST segment depression were (5.7 ±1.7) pcs and (1.13 ±0.42) mV in LMD group,significantly higher than those of LAD group((4.6 ± ± 1.8) pcs and (0.87 ± 0.32) mV ; t =2.314,2.634,P < 0.05).The occurrence rate of ST segment depression (≥0.10 mV) in leads V2 and V6 were 33.3% (7/21) and 90.5% (19/21) in LM group,significantly higher than that in LAD group (11.4% (4/35) and 62.9 % (22/35) ; x2 =3.990,5.105 ;P < 0..05).The start time of ST segment deviation of LM group was significantly earlier than that of LAD group ((199.8 ± 70.8) s vs.(273.7 ± 127.3) s;t =-2.787,P < 0.01).The differences were not statistically significant in terms of the exercise time between groups ((315.0 ± 120.0) s vs.(376.1 ± 110.0) s;t =-1.948;P > 0.05),the rate for achieving target heart rate(33.3% (7/21) vs.48.6% (17/35) ; x2 =1.244 ; P > 0.05) and the Duke score ((-11.8 ±7.2) vs.(-8.4 ±6.8) ;t =-1:772;P>0.05).Conclusion Compare with patients with the LAD disease,ST segment elevation of lead aVR is significantly higher induced by treadmill exercise test in patients with left

  6. Procedimento de Lecompte para a correção de transposição das grandes artérias, associada à comunicação interventricular e obstrução de via de saída do ventrículo esquerdo Lecompte procedure for correction of the transposition of the great arteries associated with ventricular septal defect and left ventricle outflow tract obstruction

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2006-12-01

    Full Text Available OBJETIVO: Avaliar o procedimento de Lecompte para a correção da transposição das grandes artérias associada à comunicação interventricular e obstrução da via de saída do ventrículo esquerdo (TGA, CIV e OVSVE e apresentar os resultados no período pós-operatório intermediário e tardio. MÉTODO: Entre fevereiro de 1994 e julho de 2005, sete pacientes, com idade de 2 a 8 anos (mediana -M-: 3,0, portadores de TGA, CIV e OVSVE, foram submetidos a tratamento cirúrgico corretivo. Em seis casos, foi utilizado o procedimento de Lecompte. Esta técnica consiste na abordagem por ventriculotomia direita, ressecção ampla do septo conal e construção de um túnel ventricular conectando o ventrículo esquerdo à aorta; o caso restante apresentava obstrução da prótese valvulada implantada entre o ventrículo direito e a artéria pulmonar (VD-AP e falência do VD e foi submetido à conversão no procedimento de Lecompte. RESULTADOS: Os tempos de CEC variaram entre 105 e 194 min (M: 130 e os tempos de anoxia entre 65 e 90 min (M: 78. Houve um óbito no pós-operatório imediato devido a coagulopatia, seguido de insuficiência ventricular direita. Os seis pacientes sobreviventes receberam alta hospitalar no período de 5 a 30 dias (M: 11 e permaneceram em acompanhamento entre 12 a 144 meses (M: 73,6. CONCLUSÃO: O procedimento de Lecompte teve como vantagens: 1 - Indicação cirúrgica em pacientes com menor faixa etária; 2 - Baixa morbi-mortalidade; 3 - Expectativa de acompanhamento a longo prazo, sem reoperação; 4 - Possibilidade de converter o procedimento de Rastelli em Lecompte.OBJECTIVE: To evaluate the Lecompte procedure used for the correction of transposition of the great arteries (TGA associated with ventricular septal defect (VSD and left ventricle outflow tract obstruction (LVOTO and to present the intermediate and long-term results of the surgery. METHODS: Between February 1994 and July 2005, seven patients with ages between 2

  7. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

    Science.gov (United States)

    Sánchez-Margallo, F. M.; Latorre, R.; López-Albors, O.; Wise, R.; Malbrain, M. L. N. G.; Castellanos, G.

    2016-01-01

    Introduction Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. Materials and Methods Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. Results Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. Conclusion The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction. PMID

  8. Increased plasma noradrenaline concentration in patients with chronic obstructive lung disease: relation to haemodynamics and blood gases

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Christensen, N J; Kok-Jensen, A;

    1980-01-01

    . Plasma noradrenaline (NA) concentration averaged 0.51 ng/ml and was inversely correlated to arterial oxygen saturation and mixed venous oxygen saturation, and positively correlated to arterial carbon dioxide tension and mean pulmonary arterial pressure. Oxygen inhalation did not change plasma NA...... present. Plasma adrenaline concentration was normal. The results point to enhanced sympathetic nervous activity in patients with chronic obstructive lung disease, probably caused by the deranged blood gases. The pulmonary haemodynamic changes and increased pulse rate may, at least partly, be due to...

  9. Assessment of the right ventricle by magnetic resonance imaging in chronic obstructive lung disease.

    OpenAIRE

    Turnbull, L W; Ridgway, J P; Biernacki, W; McRitchie, H; Muir, A L; Best, J J; MacNee, W

    1990-01-01

    Right ventricular wall and chamber volume were measured by magnetic resonance imaging in 16 patients with stable chronic obstructive lung disease who subsequently underwent measurement of pulmonary haemodynamics by right heart catheterisation. The patients had a forced expiratory volume in one second of 0.7 (SD 0.3) litres, a forced vital capacity of 2.4 (1.0) l, an arterial oxygen tension (PaO2) of 6.5 (1.3) kPa, an arterial carbon dioxide tension (PaCO2) of 6.5 (1.0) kPa, and a mean pulmona...

  10. Management of Obstructive Sleep Apnea

    OpenAIRE

    Vijayan, V.K.

    2014-01-01

    Obstructive Sleep Apnea (OSA) is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP), Bilevel positive airway pressure (BiPAP) and Oral Appliances (OA),pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP) treatmen...

  11. Extrinsic duodenal obstruction and halitosis.

    OpenAIRE

    Stephenson, B M; Rees, B. I.

    1990-01-01

    Two siblings with extrinsic duodenal obstruction caused by congenital peritoneal bands are reported. Attention is drawn to the unusual physical sign of halitosis as a presenting feature. It is suggested that this physical sign may be an indication for barium studies.

  12. Spiral CT Scan for Detecting Coronary Artery Stenosis

    Directory of Open Access Journals (Sweden)

    A. Soltani Shirazi

    2005-07-01

    Full Text Available Background/ Objective: Coronary vessel calcification is an obvious sign of atherosclerotic disease of coronary arteries. Electron beam CT scan is currently the imaging modality of choice for assessing coronary artery calcifications. However, its high cost makes it unavailable to a large number of medical centers. We carried out this study to compare the diagnostic yield of spiral CT scans as an alternative, to coronary angiography. Patients and Methods: A hundred patients suspicious of having coronary artery disease (CAD underwent angiography as well as spiral CT scan of the heart. On CT scan, calcification of >90 Hounsfield on a surface area of >0.5 mm2, anatomically superimposed on coronary arteries were highlighted as calcified areas using the volumetric feature of the scanner. The findings were compared to angiographic results. Results: Of 100 patients enrolled (62 males, 69 had coronary artery obstruction (>50% stenosis on angiography. Angiography was normal in the rest. Spiral CT scan had a sensitivity of 94% and a specificity of 61% for the diagnosis of coronary artery disease. The PPV and NPV were 84% and 79%, respectively. Among the coronary arteries, LAD findings had the highest sensitivity (92% and the lowest specificity (65% in the diagnosis of CAD. With age, spiral CT scan had more sensitivity and less specificity for CAD. Conclusion: Detecting calcification by spiral CT scanning could be a useful non-invasive method for diagnosis and evaluation of coronary artery stenosis.

  13. Studies on reconstruction of the carotid artery in the neck using arterial vessels irradiated by a large amount of high voltage electron beam

    International Nuclear Information System (INIS)

    High voltage electron beam of 2,000,000 rad was irradiated to the common carotid arteries excised from dogs. After keeping them in a frozen state, they were replaced with the common carotid arteries of other adult dogs. The border of the artery transplanted could not be identified from the x-ray films 7 - 36 months after transplantation. There was no stenosis or dilation in the artery on either x-ray films or in histopathological examinations. There was no tissue reaction in the homologous transplantation, but all the cells died and the nuclei of muscular fibers of the tunica media disappeared. However, the internal elastica and other elastic fibers were unchanged. Cells proliferated from the original artery to form a false inner coat. Noradrenergic nerves and the vasa vasorum did not enter the graft. Thus, the arteries transplanted were only substitutive vessels. A rabbit abdominal aorta which was transplanted to a dog common carotid artery, showed sacculated dilation or obstruction. In the case of obstruction, severe tissue reaction was recognized. In the case of sacculated dilation, thinning of the arterial wall at the dilated part and fragmentation of the elastic fibers of the tunica media were observed, and other tissues also tended to be destructed and absorbed. (Ichikawa, K.)

  14. [Coronary artery disease in women: True specificities to know in order to improve management and outcome].

    Science.gov (United States)

    Madika, Anne-Laure; Mounier-Vehier, Claire

    2016-06-01

    Coronary artery disease is the leading death for women in Europe and developed countries. It kills seven times more than breast cancer. The number of deaths from coronary artery disease increase and affects also younger women (vision of coronary artery disease as myocardial ischemia due to obstruction of major coronary arteries do not represent all the aspects of ischemic disease in women. Myocardial ischemia without obstruction of major coronary arteries, described as microvascular dysfunction is often unknown and ignored. It is yet a situation at high cardiovascular risk. Presentation and symptoms of coronary artery disease are misleading in women. Coronary artery disease in women remains under-diagnosed and under-treated. It is necessary to improve management of women at cardiovascular risk, whose inequalities contribute to the excess of female mortality from coronary artery disease. Coronary artery disease in women needs new diagnostic and therapeutic approaches. It must take into account specific risk stratification, evaluation of particular chest pain and reduced performance of non-invasive testing. PMID:27199207

  15. Micturition in conscious rats with and without bladder outlet obstruction: role of spinal alpha 1-adrenoceptors.

    OpenAIRE

    Ishizuka, O; Persson, K.; Mattiasson, A.; Naylor, A; Wyllie, M.; Andersson, K.

    1996-01-01

    1. In normal rats and rats with bladder hypertrophy secondary to outflow obstruction, undergoing continuous cytometry, we examined the responses to the selective alpha 1-adrenoceptor antagonist doxazosin given intrathecally (i.t.) and intra-arterially (i.a.). In addition, we investigated the effects of the drug on L-dopa-induced bladder hyperactivity in normal, unobstructed rats. 2. Doxazosin 50 nmol (approximately 60 micrograms kg-1), given i.t., decreased micturition pressure in normal rats...

  16. Acute effects of riociguat in borderline or manifest pulmonary hypertension associated with chronic obstructive pulmonary disease

    OpenAIRE

    Ghofrani, Hossein A.; Staehler, Gerd; Grünig, Ekkehard; Halank, Michael; Mitrovic, Veselin; Unger, Sigrun; Mueck, Wolfgang; Frey, Reiner; Grimminger, Friedrich; Ralph T. Schermuly; Behr, Juergen

    2015-01-01

    Riociguat is the first oral soluble guanylate cyclase stimulator shown to improve pulmonary hemodynamics in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH). This pilot study assessed the impact of a single dose of riociguat on hemodynamics, gas exchange, and lung function in patients with PH associated with chronic obstructive pulmonary disease (COPD). Adults with COPD-associated borderline or manifest PH (pulmonary vascular resistance > 27...

  17. Spirometric Predictors for the Exclusion of Severe Hypoxemia in Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Hakan Gunen; Feridun Kosar

    2001-01-01

    BACKGROUND: Controversy has existed over the need for routine arterial blood gas (ABG) analysis in patients with chronic obstructive pulmonary disease (COPD). Some authors recommend it in all patients with COPD, but others find it unnecessary if the forced expiratory volume in 1 s (FEV1) is 50% of predicted or greater.OBJECTIVES: To clarify this controversy, and to investigate correlations between severe hypoxemia and multiple spirometric parameters in patients with COPD with FEV1 50% of pred...

  18. Evaluation of pulmonary arterial morphology and function in cyanotic congenital heart disease by MRI and cine MRI

    International Nuclear Information System (INIS)

    Pulmonary arterial anatomy was evaluated by magnetic resonance imaging (MRI), angiography and two-dimensional echocardiography in 20 patients with cyanotic heart disease associated with decreased pulmonary blood flow. Excellent correlation between MRI and angiographic estimates of pulmonary artery diameter was obtained (main pulmonary artery, r=0.87; right pulmonary artery, r=0.96; left pulmonary artery, r=0.95). However, echocardiography could not describe peripheral pulmonary arteries obviously, especially left pulmonary artery. In the assessment of peripheral pulmonary stenosis or obstruction, cine MRI was superior to echocardiography. We conclude that MRI and cine MRI will play an important role in the serial evaluation of pulmonary arterial morphology and function in patients with cyanotic congenital heart disease before and after surgical repair. (author)

  19. Peripheral artery disease (PAD) screening in the asymptomatic population

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Falk, Erling

    2011-01-01

    Measurement of ankle-brachial index (ABI) was developed to assess peripheral artery disease (PAD) in patients with symptoms of peripheral ischemia being present at rest or only functionally dependent (intermittent claudication). Reduced ABI is caused by arterial obstruction between the aortic arch....... Measuring ABI identifies asymptomatic persons at increased risk of cardiovascular morbidity and mortality: an ABI 25% in people between 80 and 90 years of age. The majority of persons with reduced ABI are asymptomatic and therefore unaware of the increased risk they are living with, thus, screening by...

  20. Difference of hepatocellular carcinoma from intrahepatic cholangiocarcinoma as the cause of biliary obstruction

    International Nuclear Information System (INIS)

    The purpose of this study is to evaluate the usefulness of dynamic CT during the hepatic arterial phase with rapid IV injection of contrast material in distinguishing hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICAC) as the cause of biliary obstruction. We retrospectively reviewed two-phase dynamic incremental CT or helical CT findings in 22 patients with intrahepatic duct obstruction secondary to pathologically proven HCCs (n=12) or ICACs (n=10). Two-phase CT scans were obtained 20 - 45 seconds (hepatic arterial phase) or 2 minutes (equilibrium phase) after the initiation of a bolus injection of contrast material (5 mL/sec, 150 mL). The enhancement patterns of tumors, as seen on two-phase images, were classified as hypo-, iso-, or hyperattenuated, relative to surrounding liver parenchyma. Two-phase images were compared and correlated with pathologic findings. Our results suggest that dynamic CT during the hepatic arterial phase, with rapid IV injection of contrast material, is useful for the differentiation of HCC from ICAC as the cause of biliary obstruction. (author). 20 refs., 1 tab., 4 figs

  1. Difference of hepatocellular carcinoma from intrahepatic cholangiocarcinoma as the cause of biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Cho, June Sik; Kim, Dae Hong; Shin, Kyung Sook; Kwak, Jin Keun [Chungnam University Hospital, Taejon (Korea, Republic of)

    1998-04-01

    The purpose of this study is to evaluate the usefulness of dynamic CT during the hepatic arterial phase with rapid IV injection of contrast material in distinguishing hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICAC) as the cause of biliary obstruction. We retrospectively reviewed two-phase dynamic incremental CT or helical CT findings in 22 patients with intrahepatic duct obstruction secondary to pathologically proven HCCs (n=12) or ICACs (n=10). Two-phase CT scans were obtained 20 - 45 seconds (hepatic arterial phase) or 2 minutes (equilibrium phase) after the initiation of a bolus injection of contrast material (5 mL/sec, 150 mL). The enhancement patterns of tumors, as seen on two-phase images, were classified as hypo-, iso-, or hyperattenuated, relative to surrounding liver parenchyma. Two-phase images were compared and correlated with pathologic findings. Our results suggest that dynamic CT during the hepatic arterial phase, with rapid IV injection of contrast material, is useful for the differentiation of HCC from ICAC as the cause of biliary obstruction. (author). 20 refs., 1 tab., 4 figs.

  2. Malignant biliary obstruction: treatment with interventional radiology

    Institute of Scientific and Technical Information of China (English)

    翟仁友; 钱晓军; 戴定可; 于平

    2003-01-01

    Objective To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction. Methods From January 1995 to Febuary 2001, 243 consecutive patients (161 men and 82 women; aged 26-91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.Results One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1-2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage,20 patients had two stents installed from top to bottom to create stenting of adequate ength, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8,P<0.001) with an average patency of 9.7 months(log rank 4.7,P<0.05).Conclusion Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may

  3. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

    Science.gov (United States)

    2015-01-01

    Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions. PMID:26713062

  4. Acute myocardial infarction in a young adult with myocardial bridging and normal coronary arteries

    OpenAIRE

    Moris Chansky; Adriana Regina Perez; Nilo Lima

    2004-01-01

    The authors present a case of a young adult with acute myocardialinfarction, attended at the Emergency Department of HospitalIsraelita Albert Einstein. Acute myocardial infarction caused bymyocardial bridge (intramyocardial tunneled coronary artery) is arare clinical entity. The finding of this condition in patients withnormal arteries (non-obstructed vessels) is uncommon; it isusually associated with extracardiac triggering factors. The casereported presented an acute myocardial infarction c...

  5. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2012-02-01

    PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome. SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.

  6. Hemangiosarcoma in the main pulmonary artery of a dog

    International Nuclear Information System (INIS)

    The clinical, radiological and necropsy findings in a five-year old dog with a hemangiosarcoma in the main pulmonary artery are described. Hemangiosarcoma in this location has not been previously described in the dog, the typical location in the heart being the right atrium and auricle. The tumor in this dog caused both a perfusion deficit to the right lung and obstruction of right ventricular outflow, which eventually caused right heart failure

  7. Friedreich's Ataxia as a Cause of Premature Coronary Artery Disease

    OpenAIRE

    Giugliano, Gregory R.; Sethi, Prabhdeep S.

    2007-01-01

    Friedreich's ataxia is the most common hereditary neurodegenerative disorder, and more than half of all patients show echocardiographic evidence of cardiomyopathy. Although angina has been reported in these patients, the role of coronary artery disease has previously been dismissed and is therefore underestimated. Premature obstructive coronary disease has rarely been angiographically demonstrated in patients with Friedreich's ataxia. We present an unusual case of a 35-year-old woman with Fri...

  8. Pulmonary arterial hypertension: Advances in pathophysiology and management

    OpenAIRE

    Sandeep Chopra; Dinesh K Badyal; P Chris Baby; Davis Cherian

    2012-01-01

    Pulmonary arterial hypertension (PAH) is a heterogeneous, hemodynamic, and pathophysiological state which is commonly found throughout the world, but the disease burden is greater in India and in other developing countries. It is a disease characterized by vascular obstruction and vasoconstriction leading to progressive increase in pulmonary vascular resistance and right ventricular failure. PAH is a progressive disorder carrying a poor prognosis; however, dramatic progress has occurred in ou...

  9. Management of Renal Artery Stenosis - an Update

    Directory of Open Access Journals (Sweden)

    Alhadad A

    2008-01-01

    Full Text Available The role of the renal vasculature in eliciting renovascular hypertension (RVH was established in 1934, when Goldblatt et al. [1] in a classical experimental study demonstrated that partial obstruction of the renal artery increased mean arterial blood pressure (BP. The pathophysiology of renal artery stenosis (RAS is incompletely understood but has been postulated to be related to increased afterload from neurohormonal activation and cytokine release [2].Atherosclerotic RAS (ARAS is increasingly diagnosed in the expanding elderly population, which also has a high prevalence of arterial hypertension. There is still considerable uncertainty concerning the optimal management of patients with RAS. Many hypertensive patients with RAS have co-existing essential hypertension and furthermore, it is often difficult to determine to what degree the RAS is responsible for the impairment of renal function. There are three possible treatment strategies: medical management, surgery, or percutaneous transluminal renal angioplasty (PTRA with or without stent implantation. The use of stents has improved the technical success rate of PTRA and also led to lower risk of restenosis, in particular for ostial RAS. PTRA with stenting has therefore replaced surgical revascularisation for most patients with RAS and has led to a lower threshold for intervention. The treatment of choice to control hypertension in fibromuscular dysplasia (FMD is generally accepted to be PTRA [3]. In ARAS, on the other hand, the benefits with PTRA are less clear [4] and the challenge to identify which patients are likely to benefit from revascularisation remains unknown.

  10. Role of multi-slice CT coronary angiography in evaluating the different patterns of coronary artery disease in patients with unstable angina

    Directory of Open Access Journals (Sweden)

    Gamal Eldine M. Niazi

    2015-09-01

    Conclusion: Non-invasive multi-slice CT coronary angiography is a reliable technique of high ability to detect coronary artery disease and estimate the degree of obstruction, number of affected arteries and the pattern of their affection and can be used in workup in patients with unstable angina.

  11. Bladder neck obstruction in women

    International Nuclear Information System (INIS)

    Primary bladder nech obstruction in women is quite rare and its symptoms - dysuria, frequency and urgency - are equivocal. Routine radiological investigations alone do not allow a diagnosis to be made, due to the lack of simultaneous measurements of detrusorial pressure and uroflow. A precise diagnosis is thus to be obtained by synchronous video-urodynamic studies which allow the depiction of nonfunneling or tight bladder neck during the entire phase of detrusor contraction, of bladder trabeculations and diverticula, vesico-ureteral reflux, long micturition time and incomplete voiding. When these radiological signs are associated with a rise in detrusorial voiding pressure over 60 cm of water and with peak urine flow lower than 15 ml/s, the diagnosis of bladder neck obstruction is unquestionable and the appropriate farmacologic/endoscopic treatment can be administered

  12. Prolonged partial upper airway obstruction during sleep - an underdiagnosed phenotype of sleep-disordered breathing.

    Science.gov (United States)

    Anttalainen, Ulla; Tenhunen, Mirja; Rimpilä, Ville; Polo, Olli; Rauhala, Esa; Himanen, Sari-Leena; Saaresranta, Tarja

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) is a well-recognized disorder conventionally diagnosed with an elevated apnea-hypopnea index. Prolonged partial upper airway obstruction is a common phenotype of sleep-disordered breathing (SDB), which however is still largely underreported. The major reasons for this are that cyclic breathing pattern coupled with arousals and arterial oxyhemoglobin saturation are easy to detect and considered more important than prolonged episodes of increased respiratory effort with increased levels of carbon dioxide in the absence of cycling breathing pattern and repetitive arousals. There is also a growing body of evidence that prolonged partial obstruction is a clinically significant form of SDB, which is associated with symptoms and co-morbidities which may partially differ from those associated with OSAS. Partial upper airway obstruction is most prevalent in women, and it is treatable with the nasal continuous positive pressure device with good adherence to therapy. This review describes the characteristics of prolonged partial upper airway obstruction during sleep in terms of diagnostics, pathophysiology, clinical presentation, and comorbidity to improve recognition of this phenotype and its timely and appropriate treatment. PMID:27608271

  13. Pancreatic Pseudocyst Causing Celiac Artery Trunk Thrombosis

    Directory of Open Access Journals (Sweden)

    Christopher Challand

    2008-07-01

    Full Text Available Context Vascular complications of pancreatitis are more common in alcoholrather than gallstone-induced pancreatitis. Such complications are an important cause of mortality and morbidity, although peripancreatic vessel obstruction is a rare consequence. Patients with peripancreatic arterial obstruction can present with sudden and unexplained clinical deterioration requiring prompt diagnosis and intervention. Case report A 42-year-old woman with a proven pancreatic pseudocyst presented with acute abdominal pain. Initial investigations were non-diagnostic. A gastroscopy revealed patchy necrosis of the proximal stomach. Following sudden clinical deterioration, a contrast-enhanced CT scan was performed. The CT scan demonstrated a thickened gastric wall with intramural gas. The decision was taken to proceed to laparotomy, which revealed both gastric and splenic infarction. A total gastrectomy with Roux-en-Y reconstruction and splenectomy was performed. She made a successful recovery. Conclusion Arterial thrombosis should be considered in any patient with chronic pancreatitis who presents with an acute clinical deterioration. Successful outcomes can be achieved with prompt diagnosis using contrast-enhanced CT scanning and early surgical intervention.

  14. Chronic Intestinal Pseudo-Obstruction.

    Science.gov (United States)

    Panganamamula, Kashyap V; Parkman, Henry P

    2005-02-01

    Chronic intestinal pseudo-obstruction (CIP) is a gastrointestinal motility disorder characterized by chronic symptoms and signs of bowel obstruction in the absence of a fixed, lumen-occluding lesion. Radiographic findings consist of dilated bowel with air-fluid levels. Pseudo-obstruction is an uncommon condition and can result from primary or secondary causes. The management is primarily focused on symptom control and nutritional support to prevent weight loss and malnutrition. The principles of management of patients with CIP involve 1) establishing a correct clinical diagnosis and excluding mechanical obstruction; 2) differentiating between idiopathic and secondary forms; 3) performing a symptomatic and physiologic assessment of the parts of the gastrointestinal (GI) tract involved by manometric and whole gut transit scintigraphic studies; 4) careful assessment of nutritional status of the patient; and 5) developing a therapeutic plan addressing the patient's symptoms and nutritional status. Treatment of CIP includes frequent small meals with a low-fat, low-fiber diet, liquid nutritional supplements may be needed; prokinetic agents such as metoclopramide may help to reduce upper GI symptoms. Trials of drugs such as erythromycin, domperidone, cisapride, and tegaserod may be considered if there is no response. Subcutaneous octreotide may be helpful to improve small bowel dysmotility especially in patients with scleroderma. In patients with symptoms suggestive of bacterial overgrowth, courses of antibiotics such as metronidazole, ciprofloxacin, and doxycycline may be needed. Nutritional assessment and support is an important aspect of management. Enteral nutrition is usually preferred. In carefully selected patients, feeding jejunostomy with or without decompression gastrostomy may be tried. Long term parenteral nutrition should be reserved for patients who can not tolerate enteral nutrition. Complications associated with total parenteral nutrition include

  15. Automated evaluation of urethral obstruction

    OpenAIRE

    Mastrigt, Ron; Kranse, M.

    1993-01-01

    textabstractThe measurement of detrusor pressure and flow rate during voiding is the only way to objectively measure or grade infravesical obstruction. The resulting data cannot be interpreted easily. Manual as well as automatic methods have been introduced to derive one or several factors or parameters to quantify urethral resistance. A number of these methods are described in this overview. Since automatic methods involving computers guarantee uniform, unbiased, and objective processing of ...

  16. Obstructive sleep apnea and asthma*

    OpenAIRE

    Cristina Salles; Regina Terse-Ramos; Adelmir Souza-Machado; Cruz, Alvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worseni...

  17. Obstructive sleep apnea and asthma

    OpenAIRE

    Cristina Salles; Regina Terse-Ramos; Adelmir Souza-Machado; Cruz, Alvaro A.

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worseni...

  18. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... erythrocyte sedimentation rate (ESR) and level of C-reactive protein, which is produced only when inflammation is present. ... people with occlusive peripheral arterial disease also have coronary artery disease. Amputation of a limb may be necessary if ...

  19. Current treatment in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    李嘉惠

    2008-01-01

    Chronic obstructive pulmonary disease (COPD) is defined by fixed airflow limitation associated with an abnormal pulmonary and systemic inflammatory response of the lungs to cigarette smoke. COPD represents an increasing burden worldwide, reported to be the sixth leading cause of death in 1990 and the fourth in 2000. Discouragingly, it is projected to jump to third place by the year 2020.There is increasing evidence that COPD is a more complex systemic disease than an airway and lung disease. In particular, cachexia, skeletal muscle abnormalities, diabetes, coronary artery disease, heart failure, cancer and pulmonary vascular disease are the most common comorbidities. It is associated with a wide variety of systemic consequences, most notably systemic inflammation. Because COPD patients have in general ahigher cardiovascular risk than the average population, cardiovascular safety in a COPD medication is of critical importance.SINGH et al performed a systematic review and recta-analysis of 17 clinical trials enrolling 14 783 patients treated with inhaled anticholinergic drugs used for the treatment of COPD. Inhaled anticholinergics significantly increased the risk of cardiovascular death, MI, or stroke ( 1.8 % vs 1.2 % for control; RR, 1.58 (95 % CI,1.21 - 2.06); P < 0.001 ). However, UPLIIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium) , a large, 4-year, placebo controlled clinical trial with tiotropium in approximately 6 000 patients with COPD. The preliminary results of UPLIFT showed that there was no increased risk of stroke with tiotropium bromide compared to placebo.A meta-analysis is always considered less convincing than a large prospective trial designed to assess the outcome of interest. However, COPD is a systemic disease. COPD management needs to focus on four major areas: smoking cessation, pharmacologic therapy, exercise training, and pulmonary rehabilitation. Clinicians and patients should always carefully consider any

  20. Combination of Rare Right Arterial Variation with Anomalous Origins of the Vertebral Artery, Aberrant Subclavian Artery and Persistent Trigeminal Artery

    Science.gov (United States)

    Ishihara, H.; San Millán Ruíz, D.; Abdo, G.; Asakura, F.; Yilmaz, H.; Lovblad, K.O.; Rüfenacht, D.A.

    2011-01-01

    Summary A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed. PMID:22005696

  1. On Renal Artery Stenosis

    OpenAIRE

    Eklöf, Hampus

    2005-01-01

    Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate. To visualize renal arteries with x-ray technique...

  2. Radiological evaluation of obstructive uropathy in children

    International Nuclear Information System (INIS)

    Early detection of obstructive uropathy in children is of crucial importance as it leads to prevention of a number of complications and impending renal failure. A series comprising of 51 patients from both sexes up to the age of 12 years was studied.The imaging modalities used were plain films of abdomen (KUB), ultrasonography (USG), intravenous urography (IVU), mixturing cystrourethrography (MCUG) and ascending (retrograde) paleography. the commonest cause of obstruction seen was due to calculi in the renal tract. Ultrasonography proved to be highly sensitive in picking up early cases of obstruction. Male children were affected more often than female children. Obstruction in urinary passage at all levels was seen, extending from kidneys to the urethra. It was also seen that obstruction was unilateral, bilateral, acute, chronic, complete, incomplete, and painful or silent. In view of our study, routine screening ultrasound examination of every child is advised to detect silent cases of unilateral obstruction. (author)

  3. Peripheral Artery Disease

    Science.gov (United States)

    ... or atherectomy may be used to help improve blood flow. What is peripheral artery disease (PAD)? How is peripheral artery disease evaluated? How ... PAD are diabetes, smoking, high cholesterol and high blood pressure. Most cases occur in ... is peripheral artery disease evaluated? Several imaging tests can be used to ...

  4. Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

    Science.gov (United States)

    Slats, Annelies; Taube, Christian

    2016-02-01

    Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism. PMID:26596632

  5. Spirometry and Obstructive Lung Disease in Manitoba

    OpenAIRE

    NR Anthonisen; Dik, N; J Manfreda; LL Roos

    2001-01-01

    BACKGROUND: Spirometry, the measurement of forced expiratory volume in 1 s and forced vital capacity, is recommended in the diagnosis and management of the obstructive lung diseases asthma and chronic obstructive pulmonary disease (COPD). The present report describes spirometry use in Manitoba and tests the hypothesis that regional spirometry use correlates with the prevalence of physician-diagnosed obstructive lung diseases.METHODS: Spirometry is remunerated on a fee-for-service basis by Man...

  6. Transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    Castela Eduardo

    2008-10-01

    Full Text Available Abstract Transposition of the great arteries (TGA, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA discordance. The incidence is estimated at 1 in 3,500–5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases. The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually

  7. A Clinical model to identify patients with high-risk coronary artery disease

    NARCIS (Netherlands)

    Y. Yang (Yelin); L. Chen (Li); Y. Yam (Yeung); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D.S. Berman (Daniel); M.J. Budoff (Matthew); F. Cademartiri (Filippo); T.Q. Callister (Tracy); H.-J. Chang (Hyuk-Jae); V.Y. Cheng (Victor); K. Chinnaiyan (Kavitha); R.C. Cury (Ricardo); A. Delago (Augustin); A. Dunning (Allison); G.M. Feuchtner (Gudrun); M. Hadamitzky (Martin); J. Hausleiter (Jörg); R.P. Karlsberg (Ronald); P.A. Kaufmann (Philipp); Y.-J. Kim (Yong-Jin); J. Leipsic (Jonathon); T.M. LaBounty (Troy); F.Y. Lin (Fay); E. Maffei (Erica); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James K.); B.J.W. Chow (Benjamin)

    2015-01-01

    textabstractObjectives This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD). Background Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify th

  8. Obstructive sleep apnea and hypertension: a critical review.

    Science.gov (United States)

    Mohsenin, Vahid

    2014-10-01

    Obstructive sleep apnea (OSA) is a prevalent sleep disorder which is characterized by recurrent upper closure with oxygen desaturation and sleep disruption. OSA increases the risk of vascular disorders in the form of stroke, myocardial infarction, congestive heart failure, and hypertension. The mechanisms underlying the vascular disorders are several and include intermittent hypoxia with release of cytokines, angiogenic inhibitors, free radicals, and adhesion molecules. During apneas, arterial blood pressure gradually rises and surges abruptly after the termination of apnea. Two thirds of patients with OSA will ultimately have diurnal hypertension. This review discusses the literature supporting the significant role of OSA in hypertension and the effect of OSA treatment on blood pressure. PMID:25139780

  9. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Goudis, Christos A; Konstantinidis, Athanasios K; Ntalas, Ioannis V; Korantzopoulos, Panagiotis

    2015-11-15

    Chronic obstructive pulmonary disease (COPD) is independently associated with an increased burden of cardiovascular disease. Besides coronary artery disease (CAD) and congestive heart failure (CHF), specific electrocardiographic (ECG) abnormalities and cardiac arrhythmias seem to have a significant impact on cardiovascular prognosis of COPD patients. Disturbances of heart rhythm include premature atrial contractions (PACs), premature ventricular contractions (PVCs), atrial fibrillation (AF), atrial flutter (AFL), multifocal atrial tachycardia (MAT), and ventricular tachycardia (VT). Of note, the identification of ECG abnormalities and the evaluation of the arrhythmic risk may have significant implications in the management and outcome of patients with COPD. This article provides a concise overview of the available data regarding ECG abnormalities and arrhythmias in these patients, including an elaborated description of the underlying arrhythmogenic mechanisms. The clinical impact and prognostic significance of ECG abnormalities and arrhythmias in COPD as well as the appropriate antiarrhythmic therapy and interventions in this setting are also discussed. PMID:26218181

  10. [Experimental studies on cardiopulmonary relation under hypoxia, hypercapnia and airway obstruction in dog (author's transl)].

    Science.gov (United States)

    Kowalski, J; Islam, M S; Bugalho de Almeida, A A; Ulmer, W T

    1980-01-01

    On 18 dogs the effects of hypoxia (12, 10, 7.5% O2) and hypoxia and hypercapnia (10% O2 + 5, 7.5, 11% CO2) on breathing, pulmonary vascular resistance, cardiac output and on the arterial and venous oxygen pressure were investigated. The relationship between arterial oxygen pressure to Pap as to vascular resistance is not in the mean linear. There are good, bad and nearly nonresponders in respect to the vascular resistance on the dogs. Therefore, calculation and evaluation of mean values are less helpful. A similar variation on men could help to understand also better the large scatter which is always shown on correlations between PO2a : Pap or PO2a : vascular resistance. Also the different pattern of the V/Q relationship may be influenced by the amount of the vascular response to local alveolar hypoxia. An increase of PCO/a potentiates the local vasoconstrictor effect of hypoxia. Mainly this was seen in the range between hypocapnia and moderate rates of hypercapnia. Hypoxia shows an increase of breathing frequency, hypercapnia shows and increase in tidal volume. Also under hypercapnia there are nonresponders and better responders in response to the vascular resistance in the lung circulation. Mechanical airway obstruction is followed by an increase of tidal volume; obstruction caused by acetylcholine is followed by a decrease of tidal volume and an increase of breathing frequency. Changes in the arterial blood gases are caused by changes in the ventilation perfusion relationship only under acetylcholine obstruction. Influences on the lung circulation by the airway obstruction under these experimental conditions as direct effects are small or not existent. PMID:7221190

  11. Unusual causes of mechanical small bowel obstruction

    International Nuclear Information System (INIS)

    We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause. (author)

  12. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Baguet

    2009-12-01

    Full Text Available Jean-Philippe Baguet1, Marie Nadra1, Gilles Barone-Rochette1, Olivier Ormezzano1, Hélène Pierre1, Jean-Louis Pépin21Department of Cardiology, University Hospital, Grenoble, France; 2Sleep Laboratory, EFCR, University Hospital, Grenoble, FranceAbstract: Obstructive sleep apnea (OSA is associated with high cardiovascular morbidity and mortality. Recent studies have shown that it is associated with atherosclerosis and left ventricular dysfunction markers. The aim of this study was to assess the cardiovascular effects of OSA depending on its severity, in patients without clinically diagnosed cardiovascular disease. One hundred thirty newly diagnosed, nondiabetic OSA patients (mean age 49 ± 10 years, without vasoactive treatment were included. They underwent clinical and ambulatory blood pressure measurements, echocardiography, carotid ultrasound examination, and a carotid–femoral pulse wave velocity (PWV measurement. Seventy-five percent of the subjects were hypertensive according to the clinical or ambulatory measurement. More patients with the most severe forms (respiratory disturbance index >37/hour had a nondipper profile (52% vs 34%; P = 0.025 and their left ventricular mass was higher (40 ± 7 vs 36 ± 8 g/m, p = 0.014. This last parameter was independently and inversely associated with mean nocturnal oxygen saturation (P = 0.004. PWV and carotid intima-media thickness did not differ between one OSA severity group to another, but the prevalence of carotid hypertrophy was higher when mean SaO2 was below 93.5% (29.5 vs 16%; P = 0.05. Our study shows that in OSA patients without clinically diagnosed cardiovascular disease, there is a significant left ventricular and arterial effect, which is even more marked when OSA is severe.Keywords: obstructive sleep apnea, hypertension, left ventricular hypertrophy, intima-media thickness, arterial stiffness

  13. TRANS-ARTERIAL EMBOLIZATION WITH N-BUTYL CYANOACRYLATE GLUE FOR RENAL BLEEDING: Case Report

    Directory of Open Access Journals (Sweden)

    Benny Young

    2014-08-01

    Full Text Available Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and end-point of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery

  14. Prevalence and incidence of hypertension in obstructive sleep apnea patients and the relationship between obstructive sleep apnea and its confounders

    Institute of Scientific and Technical Information of China (English)

    FENG Jing; CHEN Bao-yuan

    2009-01-01

    @@ Based on available population-based studies, Obstructive Sleep Apnea (OSA) associated with accompanying daytime sleepiness affects 3% to 7% of adult men and 2% to 5% of adult women in the general population. In some population subsets, like obese or older people, this prevalence is even higher. The health risk in OSA patients shows a strong association with acute cardiovascular events such as stroke, myocardial infarction and nocturnal sudden death.1,2 And with chronic conditions such as coronary artery disease, heart failure, and especially, systemic hypertension.3,4 In this review, prevalence and incidence of hypertension in OSA patients and the relationships between OSA and its confounders are considered, and of course, these confounders are also generally taken as risk factors for hypertension.

  15. Duplication of hepatic artery

    Directory of Open Access Journals (Sweden)

    Saeed Muhammad

    2001-01-01

    Full Text Available Background: The hepatic arterial anatomy is aberrant in almost 33-41% of individuals. The variant arterial anatomy recognized during routine cadaveric dissection offers great learning potential. Such findings provide an alternative perspective to view common morphology and its structural and functional importance. These impart the concept of patient individuality and subsequent individualization of medical and surgical therapies. Adequate knowledge of normal and abnormal arterial anatomy is essential for peripancreatic surgery and liver transplantation. Aims of the study: To report on hepatic artery variations observed in the dissecting room and to find out the macroscopic pattern of varied human hepatic arterial vascularization by cadaveric dissection. Patients and Methods: Twenty human cadavers of caucasian origin were dissected to study the source and topographic pattern of hepatic arterial supply. Results: Nineteen cadavers exhibited typical hepatic arterial supply from the celiac axis. Only one female body out of twenty cadavers exhibited a dual arterial supply to all parts of liver and gallbladder. One artery originated from the celiac axis whereas the other was given off by the superior mesenteric artery. Conclusion: No doubt, aberrant hepatic vascularization should be assessed preoperatively by invasive and noninvasive techniques to avoid fatal complications, but we favour careful dissection over angiography as a means of defining the arterial anatomy.

  16. Obstructive sleep apnoea and arthrogryposis

    Science.gov (United States)

    Jon, Cindy; Mosquera, Ricardo Alberto; Mitchell, Sarah; Mazur, Lynnette J

    2014-01-01

    Arthrogryposis is a rare condition characterised by multiple congenital joint contractures. We present a case of a 10-year-old child with arthrogryposis and snoring. Polysomnography revealed significant obstructive sleep apnoea and hypoventilation that improved but did not completely resolve with adenotonsillectomy. With continuous positive airway pressure (CPAP) therapy, there was full resolution of all sleep disordered breathing. Initially, the patient admitted to difficulty tolerating nasal CPAP at home. However, she steadily improved adherence to therapy and admitted that with nasal CPAP use for the whole night, she felt more energised during the daytime. PMID:24907203

  17. Acute occlusion of the left subclavian artery with artery dissection

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis.

  18. Obstructive airway in Morquio A syndrome, the past, the present and the future.

    Science.gov (United States)

    Tomatsu, Shunji; Averill, Lauren W; Sawamoto, Kazuki; Mackenzie, William G; Bober, Michael B; Pizarro, Christian; Goff, Christopher J; Xie, Li; Orii, Tadao; Theroux, Mary

    2016-02-01

    Patients with severe tracheal obstruction in Morquio A syndrome are at risk of dying of sleep apnea and related complications. Tracheal obstruction also leads to life-threatening complications during anesthesia as a result of the difficulty in managing the upper airway due to factors inherent to the Morquio A syndrome, compounded by the difficulty in intubating the trachea. A detailed description of the obstructive pathology of the trachea is not available in the literature probably due to lack of a homogenous group of Morquio A patients to study at any one particular center. We present a series of cases with significant tracheal obstruction who were unrecognized due to the difficulty in interpreting tracheal narrowing airway symptoms. Our goal is to provide the guidelines in the management of these patients that allow earlier recognition and intervention of tracheal obstruction. Sagittal MRI images of the cervical spine of 28 Morquio A patients (12±8.14years) showed that19/28 (67.9%) patients had at least 25% tracheal narrowing and that narrowing worsened with age (all 8 patients over 15years had greater than 50% narrowing). Eight out of 28 patients were categorized as severe (>75%) tracheal narrowing when images were evaluated in neutral head and neck position. Of the 19 patients with tracheal narrowing, compression by the tortuous brachiocephalic artery was the most common cause (n=15). Evidence of such tracheal narrowing was evident as early as at 2years of age. The etiology of tracheal impingement by the brachiocephalic artery in Morquio A appears to be due to a combination of the narrow thoracic inlet crowding structures and the disproportionate growth of trachea and brachiocephalic artery in relationship to the chest cavity leading to tracheal tortuosity. In conclusion, tracheal narrowing, often due to impression from the crossing tortuous brachiocephalic artery, increases with age in Morquio A patients. Greater attention to the trachea is needed when

  19. Management of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2014-03-01

    Full Text Available Obstructive Sleep Apnea (OSA is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP, Bilevel positive airway pressure (BiPAP and Oral Appliances (OA,pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP treatment reverses the repetitive upper airway obstruction of sleepapnea and associated daytime sleepiness and is the most effective treatment for OSA.However maintaining patient adherence to CPAP therapy is a challenge. Weight lossshould be recommended to overweight patients with OSA, as it has been shown thatweight reduction has additional health benefits. Treatment of underlying medicalconditions such as hypothyroidism or acromegaly has profound effect onapnea/hypopnea index. A subset of patients with OSA may benefit from supplementaloxygen and positional therapy. Presently, there are no effective pharmacotherapeuticagents for treatment of patients with OSA and the role of surgical treatment in OSA iscontroversial. However, pharmacological treatment of persisting residual sleepiness,despite adequate positive airway pressure therapy delivery and adherence, is indicatedand may improve daytime sleepiness.Key words : CPAP, Oral appliances, Modafinil, CPAP complianceUvulopalatopharyngoplasty, positional therapy

  20. Gastric cancer and obstructive uropathy

    International Nuclear Information System (INIS)

    In recent 5 years, we have experienced 24 cases of advanced gastric cancer associated with obstructive uropathy. Included were 19 cases of undifferentiated, 3 cases of differentiated and 2 cases of unknown histological type. Obstructive uropathy is diagnosed based on the typical radiological findings such as dilatation and delayed demonstration of the upper collecting systems. Pathologically, undifferentiated type of gastric cancer had tendency to spread infiltratively along the vessels, nerves and the lymphatics without alteration of the ordinary anatomical structures. In such cases, mucosal surface of the urinary tract tended to be spared in spite of extensive tumor invasion. It was proven that several radiological findings were characteristic of urinary tract involvement secondary to gastric cancer. Either thread-like ureteral stricture by IVU or ring-like appearance of the ureter by CT is one of those typical findings. Renal sinus involvement may occur continuously to diffuse retroperitoneal invasion and it appears as a thickened wall of renal pelvis or soft tissue mass directly extending into the fatty tissue of renal sinus by CT. In such cases IVU has less diagnostic ability because of the lack of mucosal destruction. If the urinary bladder is involved, it typically shows chestnut-bur appearance by IVU and diffuse wall thickening by CT. In cases of advanced gastric cancer, particularly in cases of histologically undifferentiated type, CT and IVU images should be carefully interpreted in consideration of the infiltrative part of tumor extention. (author)

  1. Gastric cancer and obstructive uropathy

    Energy Technology Data Exchange (ETDEWEB)

    Saida, Yukihisa; Tsunoda, H.S.; Matsueda, Kiyoshi; Kurosaki, Yoshihisa; Kuramoto, Kenmei (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine)

    1990-04-01

    In recent 5 years, we have experienced 24 cases of advanced gastric cancer associated with obstructive uropathy. Included were 19 cases of undifferentiated, 3 cases of differentiated and 2 cases of unknown histological type. Obstructive uropathy is diagnosed based on the typical radiological findings such as dilatation and delayed demonstration of the upper collecting systems. Pathologically, undifferentiated type of gastric cancer had tendency to spread infiltratively along the vessels, nerves and the lymphatics without alteration of the ordinary anatomical structures. In such cases, mucosal surface of the urinary tract tended to be spared in spite of extensive tumor invasion. It was proven that several radiological findings were characteristic of urinary tract involvement secondary to gastric cancer. Either thread-like ureteral stricture by IVU or ring-like appearance of the ureter by CT is one of those typical findings. Renal sinus involvement may occur continuously to diffuse retroperitoneal invasion and it appears as a thickened wall of renal pelvis or soft tissue mass directly extending into the fatty tissue of renal sinus by CT. In such cases IVU has less diagnostic ability because of the lack of mucosal destruction. If the urinary bladder is involved, it typically shows chestnut-bur appearance by IVU and diffuse wall thickening by CT. In cases of advanced gastric cancer, particularly in cases of histologically undifferentiated type, CT and IVU images should be carefully interpreted in consideration of the infiltrative part of tumor extention. (author).

  2. Obstructive hydrocephalus resulting from cerebral venous thrombosis

    OpenAIRE

    2011-01-01

    Cerebral venous thrombosis is a rare form of stroke in childhood. Increased intracranial pressure is a well-defined complication of cerebral venous thrombosis but obstructive hydrocephalus as a presentation finding of cerebral venous thrombosis is rarely described. A child case of cerebral sinus thrombosis presenting with obstructive hydrocephalus and management of clinical condition is presented with discussion of reported cases and treatment recommendations.

  3. Airflow obstruction in young adults in Canada

    DEFF Research Database (Denmark)

    Al-Hazmi, Manal; Wooldrage, Kate; Anthonisen, Nicholas R.;

    2007-01-01

    OBJECTIVE: Airflow obstruction is relatively uncommon in young adults, and may indicate potential for the development of progressive disease. The objective of the present study was to enumerate and characterize airflow obstruction in a random sample of Canadians aged 20 to 44 years. SETTING: The ...

  4. Accuracy of abdominal auscultation for bowel obstruction

    DEFF Research Database (Denmark)

    Breum, Birger Michael; Rud, Bo; Kirkegaard, Thomas; Nordentoft, Tyge

    2015-01-01

    AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed...

  5. Obstructive sleep apnea in atrial fibrillation patients.

    Science.gov (United States)

    Arias, Miguel A; Alonso-Fernández, Alberto; García-Río, Francisco; Sánchez, Ana; López, Juana M; Pagola, Carlos

    2006-06-28

    A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. PMID:16309764

  6. Osteoporosis in chronic obstructive pulmonary disease patients

    DEFF Research Database (Denmark)

    Jørgensen, Niklas Rye; Schwarz, Peter

    2008-01-01

    The purpose of this review is to examine the state of knowledge and clinical practice in the association of chronic obstructive pulmonary disease to osteoporosis and fracture incidence.......The purpose of this review is to examine the state of knowledge and clinical practice in the association of chronic obstructive pulmonary disease to osteoporosis and fracture incidence....

  7. 25 CFR 11.435 - Obstructing justice.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Obstructing justice. 11.435 Section 11.435 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAW AND ORDER COURTS OF INDIAN OFFENSES AND LAW AND ORDER CODE Criminal Offenses § 11.435 Obstructing justice. A person commits a misdemeanor if,...

  8. Therapeutic modification of arterial stiffness: An update and comprehensive review.

    Science.gov (United States)

    Wu, Ching-Fen; Liu, Pang-Yen; Wu, Tsung-Jui; Hung, Yuan; Yang, Shih-Ping; Lin, Gen-Min

    2015-11-26

    Arterial stiffness has been recognized as a marker of cardiovascular disease and associated with long-term worse clinical outcomes in several populations. Age, hypertension, smoking, and dyslipidemia, known as traditional vascular risk factors, as well as diabetes, obesity, and systemic inflammation lead to both atherosclerosis and arterial stiffness. Targeting multiple modifiable risk factors has become the main therapeutic strategy to improve arterial stiffness in patients at high cardiovascular risk. Additionally to life style modifications, long-term ω-3 fatty acids (fish oil) supplementation in diet may improve arterial stiffness in the population with hypertension or metabolic syndrome. Pharmacological treatment such as renin-angiotensin-aldosterone system antagonists, metformin, and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors were useful in individuals with hypertension and diabetes. In obese population with obstructive sleep apnea, weight reduction, aerobic exercise, and continuous positive airway pressure treatment may also improve arterial stiffness. In the populations with chronic inflammatory disease such as rheumatoid arthritis, a use of antibodies against tumor necrosis factor-alpha could work effectively. Other therapeutic options such as renal sympathetic nerve denervation for patients with resistant hypertension are investigated in many ongoing clinical trials. Therefore our comprehensive review provides knowledge in detail regarding many aspects of pathogenesis, measurement, and management of arterial stiffness in several populations, which would be helpful for physicians to make clinical decision. PMID:26635922

  9. Obstructive acute abdomen: reviewing important points

    International Nuclear Information System (INIS)

    The obstructive acute abdomen is a common presentation, for which safe and effective management depends on a fast and accurate diagnosis. Conventional radiograph remains the first choice among the imaging exams because of its availability, low cost and the possibility to be done serially to follow the patient's clinical progression. The ultrasonography does not require ionizing radiation. It is a dynamic and in realtime exam. Computed tomography is used increasingly due to the provision of essential diagnostic information not apparent from radiographs, such as the confirmation of the obstruction, degree and place of the occlusion, presence of ischemia as well as the causes of the obstruction. Magnetic resonance imaging has presented great technological advances and it may play a role in the future of obstructive acute abdomen diagnosis. The objective of this pictorial essay is to review the different imaging techniques used on diagnosing obstructive acute abdomen. (author)

  10. Biliary obstruction caused by intra-biliary tumor growth from recurred hepatocellular carcinoma after radiofrequency ablation: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Ji Hyun; Kim, Jae Won [Dept. of Radiology, Yeungnam University College of Medicine, Daegu (Korea, Republic of)

    2014-04-15

    A 59-year-old man with a known central hepatocellular carcinoma (HCC) underwent a trans-arterial-chemo-embolization (TACE) and a post-TACE percutaneous radiofrequency ablation (PRFA). Two months after the PRFA, the patient presented jaundice and an abdominal computed tomography was obtained. An arterial enhancing mass adjacent to the ablated necrotic lesion with a continuously coexisting mass inside the right hepatic duct, suggestive of a HCC recurrence with a direct extension to the biliary tract was found. Finally a biliary tumor obstruction has been developed and a percutaneous transhepatic biliary drainage was performed. This case of biliary obstruction caused by directly invaded recurred HCC after PRFA will be reported because of its rare occurrence.

  11. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  12. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  13. Coeliac artery compression syndrome

    OpenAIRE

    OKTAY, Özgür; MEMİŞ, Ahmet; Parildar, Mustafa; Oran, İsmail

    2003-01-01

    Celiac artery compression syndrome, also called median arcuate ligament compression syndrome, causes gastrointestinal ischemia secondary to compression of the proximal portion of the celiac artery just beyond its origin by the median arcuate ligament of the diaphragm. This syndrome is frequently demonstrated on aortography performed in patients without complaints of intestinal angina. Isolated stenosis or even occlusion of the celiac artery is always compensated for by collateral circul...

  14. Cerebral blood flow at rest and after CO2 stimulation in patients with unilateral carotis obstruction

    International Nuclear Information System (INIS)

    Using the 16-detector 133Xe-NaCl-technique (Novo Cerebrograph) quantitative measurements of regional cerebral blood flow (rCBF) were performed in 14 patients with unilateral carotis obstruction before and during stimulation with 3% CO2 inhalation. In all patients resting studies did not show any significant differences in hemispheric perfusion. In 11 patients the hemispheric blood flow increased significantly (by more than 6%) during CO2 inhalation on the side without carotis obstruction. The following results were found after 3% CO2-stimulation over the hemisphere with the obstructed carotid artery: 1) rCBF increased significantly on both sides (n=6) indicating the sufficiency of cerebral collateral circulation; 2) a side-to-side significant difference (n=4) with the lower perfusion on the pathological side, indicating a decreased or suspended reserve capacity; and 3) bilateral loss of cerebrovascular reactivity (n=4) as indicator of insufficieny of cerebral collateral circulation. Asymmetry in rCBF or missing cerebrovascular reserve are indications for surgical treatment of the carotis obstruction. (orig.)

  15. Differential effects of formoterol on thrombin- and PDGF-induced proliferation of human pulmonary arterial vascular smooth muscle cells

    OpenAIRE

    Goncharova Elena A; Khavin Irene S; Goncharov Dmitry A; Krymskaya Vera P

    2012-01-01

    Abstract Background Increased pulmonary arterial vascular smooth muscle (PAVSM) cell proliferation is a key pathophysiological component of pulmonary vascular remodeling in pulmonary arterial hypertension (PH). The long-acting β2-adrenergic receptor (β2AR) agonist formoterol, a racemate comprised of (R,R)- and (S,S)-enantiomers, is commonly used as a vasodilator in chronic obstructive pulmonary disease (COPD). PH, a common complication of COPD, increases patients’ morbidity and reduces surviv...

  16. Differential effects of formoterol on thrombin- and PDGF-induced proliferation of human pulmonary arterial vascular smooth muscle cells

    OpenAIRE

    Goncharova, Elena A.; Khavin, Irene S; Goncharov, Dmitry A; Vera P Krymskaya

    2012-01-01

    Background Increased pulmonary arterial vascular smooth muscle (PAVSM) cell proliferation is a key pathophysiological component of pulmonary vascular remodeling in pulmonary arterial hypertension (PH). The long-acting β2-adrenergic receptor (β2AR) agonist formoterol, a racemate comprised of (R,R)- and (S,S)-enantiomers, is commonly used as a vasodilator in chronic obstructive pulmonary disease (COPD). PH, a common complication of COPD, increases patients’ morbidity and reduces survival. Recen...

  17. Imaging the vertebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Tay, Keng Yeow; U-King-Im, Jean Marie; Trivedi, Rikin A.; Higgins, Nicholas J.; Cross, Justin J.; Antoun, Nagui M. [Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Davies, John R.; Weissberg, Peter L. [Addenbrooke' s Hospital and University of Cambridge, Division of Cardiovascular Medicine, Cambridge (United Kingdom); Gillard, Jonathan H. [Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Addenbrooke' s Hospitald, University Department of Radiology, Cambridge (United Kingdom)

    2005-07-01

    Although conventional intraarterial digital subtraction angiography remains the gold standard method for imaging the vertebral artery, noninvasive modalities such as ultrasound, multislice computed tomographic angiography and magnetic resonance angiography are constantly improving and are playing an increasingly important role in diagnosing vertebral artery pathology in clinical practice. This paper reviews the current state of vertebral artery imaging from an evidence-based perspective. Normal anatomy, normal variants and a number of pathological entities such as vertebral atherosclerosis, arterial dissection, arteriovenous fistula, subclavian steal syndrome and vertebrobasilar dolichoectasia are discussed. (orig.)

  18. Peripheral artery disease - legs

    Science.gov (United States)

    ... if they have a history of: Abnormal cholesterol Diabetes Heart disease (coronary artery disease) High blood pressure ( hypertension ) Kidney disease involving hemodialysis Smoking Stroke ( cerebrovascular disease )

  19. Clinical observation of bronchial arterial infusion in the treatment of central-type lung cancer complicated with obstructive pneumonia%支气管动脉灌注治疗中心型肺癌患者阻塞性肺炎疗效观察

    Institute of Scientific and Technical Information of China (English)

    张伟; 成强; 李学达; 杨莉莉; 李子祥

    2015-01-01

    OBJECTIVE To investigate the pathogen distribution and drug resistance rate of central‐type lung cancer complicated with obstructive pneumonia and evaluate the effect of interventional therapy so as to provide references for clinical diagnosis and treatment .METHODS From Dec .2012 to Jan .2014 ,124 cases of patients with central‐type lung cancer complicated with obstructive pneumonia were selected and randomly divided into control group and observation group .The control group was adopted bronchus infusion alone while the observation group was treated with targeted antibiotics to give infusion according to drug sensitivity results on the basis of this .The cura‐tive effect was compared .And SPSS 16 .0 was adopted for statistical analysis .RESULTS Totally 148 strains of pathogenic bacteria were detected from 124 patients .Gram‐negative bacteria hold for a majority with 72 strains , accounting for 48 .65% .In the observation group ,the total effective rate was 95 .16 % ,which was significantly higher than the control group with the rate of 83 .87% (P<0 .05) .CONCLUSION The infusion of targeted antibi‐otics according to the drug sensitivity results has clear and remarkable curative effect in treating patients with cen‐tral‐type lung cancer complicated with obstructive pneumonia so that it is worthy to be widely applied in clinic .%目的:探讨中心型肺癌合并阻塞性肺炎感染的病原菌分布、耐药率,调查介入治疗的效果,为临床提供诊治参考依据。方法选取2012年12月-2014年1月收治的肺癌并发阻塞性肺炎患者124例,随机分为普通组和观察组各62例,普通组给予单纯支气管灌注治疗,观察组在普通组基础上根据药敏结果使用针对性抗菌药物灌注治疗,对比治疗效果,数据采用SPSS 16.0软件进行统计分析。结果124例患者检出148株病原菌,以革兰阴性菌为主,共72株占48.65%;患者治疗总有效率观察组为95.16

  20. Pediatric Obstructive Uropathy: Clinical Trials

    International Nuclear Information System (INIS)

    As the powerful tools of molecular biology continue to delineate new concepts of pathogenesis of diseases, new molecular-level therapeutic modalities are certain to emerge. In order to design and execute clinical trials to evaluate outcomes of these new treatment modalities, we will soon need a new supply of investigators with training and experience in clinical research. The slowly-progressive nature of chronic pediatric kidney disease often results in diagnosis being made at a time remote from initial result, and the inherently slow rate of progression makes changes difficult to measure. Thus, development of molecular markers for both diagnosis and rate of progression will be critical to studies of new therapeutic modalities. We will review general aspects of clinical trials and will use current and past studies as examples to illustrate specific points, especially as these apply to chronic kidney disease associated with obstructive uropathy in children. (author)

  1. Chronic Obstructive Pulmonary Disease Biomarkers

    Directory of Open Access Journals (Sweden)

    Tatsiana Beiko

    2016-04-01

    Full Text Available Despite significant decreases in morbidity and mortality of cardiovascular diseases (CVD and cancers, morbidity and cost associated with chronic obstructive pulmonary disease (COPD continue to be increasing. Failure to improve disease outcomes has been related to the paucity of interventions improving survival. Insidious onset and slow progression halter research successes in developing disease-modifying therapies. In part, the difficulty in finding new therapies is because of the extreme heterogeneity within recognized COPD phenotypes. Novel biomarkers are necessary to help understand the natural history and pathogenesis of the different COPD subtypes. A more accurate phenotyping and the ability to assess the therapeutic response to new interventions and pharmaceutical agents may improve the statistical power of longitudinal clinical studies. In this study, we will review known candidate biomarkers for COPD, proposed pathways of pathogenesis, and future directions in the field.

  2. Cough in obstructive sleep apnoea.

    Science.gov (United States)

    Chan, Kevin; Ing, Alvin; Birring, Surinder S

    2015-12-01

    Obstructive Sleep Apnoea (OSA) has recently been reported to be a cause of chronic cough. It should be considered when cough remains unexplained following investigations and treatments for common causes. The presence of nocturnal cough, snoring and gastro-oesophageal reflux may be helpful in identifying patients who require further investigation. Daytime somnolence is often absent. Continuous positive airway pressure (CPAP) therapy has been reported to be effective in alleviating cough. Therapy for gastro-oesophageal reflux disease, if present, should be optimised. The mechanism of the association between OSA and cough is not clear, but airway inflammation, gastro-oesophageal reflux disease, increased cough reflex sensitivity and tracheobronchomalacia are possible explanations. Further studies should identify clinical predictors of OSA-cough, establish mechanisms and the optimal therapy. PMID:26068465

  3. Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction

    OpenAIRE

    Khan, Jamal N; Razvi, Naveed; Nazir, Sheraz A; Singh, Anvesha; Masca, Nicholas GD; Gershlick, Anthony H.; Squire, Iain; McCann, Gerry P.

    2014-01-01

    Background Microvascular obstruction (MVO) describes suboptimal tissue perfusion despite restoration of infarct-related artery flow. There are scarce data on Infarct Size (IS) and MVO in relation to the mode and timing of reperfusion. We sought to characterise the prevalence and extent of microvascular injury and IS using Cardiovascular magnetic resonance (CMR), in relation to the mode of reperfusion following acute ST-Elevation Myocardial Infarction (STEMI). Methods CMR infarct characteristi...

  4. Effects of verapamil on pulmonary haemodynamics during hypoxaemia, at rest, and during exercise in patients with chronic obstructive pulmonary disease.

    OpenAIRE

    Brown, S.E.; Linden, G S; King, R. R.; Blair, G P; Stansbury, D W; Light, R. W.

    1983-01-01

    The haemodynamic effects of intravenous verapamil at rest, during hypoxaemia, and during progressive exercise were evaluated in 10 patients with chronic obstructive lung disease. Verapamil produced significant decreases in the peak heart rate and systemic blood pressure during exercise but exercise capacity and pulmonary gas exchange at exhaustion were unaffected. There were no significant changes in pulmonary artery pressure or total pulmonary vascular resistance during exercise or during th...

  5. [Chronic intestinal pseudo-obstruction].

    Science.gov (United States)

    Ohkubo, Hidenori; Inoh, Yumi; Fuyuki, Akiko; Nakajima, Atsushi

    2015-05-01

    Chronic intestinal pseudo-obstruction(CIPO) is a rare severe digestive disease in which clinical symptoms of intestinal obstruction appear without any mechanical cause. Pathophysiologically, CIPO shows ineffective intestinal propulsion due to an impairment of intestinal smooth muscle, enteric nervous system, and interstitial cells of Cajal(ICC). Sustained increased intra-bowel pressure often causes small intestinal malabsorption and bacterial translocation, and leads to malnutrition and blood stream infection (sepsis). Key points of the medical approach for CIPO are to improve nutritional status and reduce abdominal symptoms. Dietary cure and defecation control are the main options in mild cases, whereas home-parenteral-nutrition(HPN) and decompression therapy are often needed in severe cases. Stimulant laxatives, prokinetics and herbal medicine are usually used but often in fail. Percutaneous endoscopic gastrojejunostomy(PEG-J) tube may be burdenless compared to conventional ileus tube. Most important points in the management of this disease are to make a correct diagnosis as early as possible and avoid unnecessary surgery. However, no clear diagnostic criteria have been established so far. Manometry, scintigraphy, and full-thickness biopsy are the major examination for the CIPO diagnosis in the Western countries; however these specialized examinations are not popular in Japan. Therefore the Research Group(chief investigator, Atsushi Nakajima) proposed Japanese diagnostic criteria in 2009 to facilitate the diagnosis of this rare disease by the general physician. In 2013, we have reported that cine-MRI is a non-invasive diagnostic method for CIPO. Although further data are eagerly awaited, it can become a promising diagnostic tool in CIPO patients. Furthermore the Japanese criteria have been revised, and in 2014, the comprehensive criteria from a child to an adult have been devised. In 2015, CIPO is newly certified as Specified Rare and Intractable Disease which is

  6. Application of furosemide to obstructive pattern renogram

    International Nuclear Information System (INIS)

    An obstructive pattern is usually demonstrated on a renogram in obstructive uropathy. But some cases without obstruction also show this pattern. We applied furosemide (Lasixsup(R)) to such cases to differentiate false positives and obstructions. Furosemide was injected (20-40 mg) intravenously into cases patients with obstructive pattern renograms at 15-25 minutes. In false positive cases a rapid response (a marked fall of the renogram curve to the level expected of a normal pattern) was observed in a few minutes (normal response). On the other hand, no response or an incomplete response, according to the severity, was observed in cases with obstructive lesions. These response were never observed in normal or non functioning pattern renograms. Analysis of intrarenal regional activities, using sequential renal scintiphotograms, showed that the fall of the renogram curve was probably due to a decrease of activity, chiefly in the renal pelvic area, by rapid wash out of radioisotopes with furosemide. A case of urolithiasis with no response at first, showed an incomplete response 4 days after the operation, and a normal response 4 weeks later. This incomplete response probably resulted from an incomplete obstruction and from a decreased response to furosemide as well. (J.P.N.)

  7. URETERO PELVIC JUNCTION OBSTRUCTION IN THE NEWBORN

    Directory of Open Access Journals (Sweden)

    J. Kouranloo

    2006-06-01

    Full Text Available Uretero pelvic junction (UPJ obstruction is a common cause of hydronephrosis in infants. The frequent use of fetal ultrasound is allowing early (prenatal diagnosis of numerous uropathies previously delayed until the child either became symptomatic or had a palpable mass. Newborn with severe obstruction often has marked improvement following correction, therefore, early diagnosis and operation are important. From 1993 to 2002, 21 patients were operated on for severe UPJ obstruction who were diagnosed before 6 weeks of age. Only 10 patients (63% had antenatal ultrasonographic diagnosis, the remaining were diagnosed by postnatal ultrasound and IVP or radionuclide scan for palpable renal enlargement or for associated anomalies. Eighteen of them had unilateral and three had bilateral obstruction. Twenty-four pyeloplasties were done; all pyeloplasties were dismembered with tailoring of the dilatated renal pelvis. Postoperative renal function was followed with laboratory blood test, urine test or radionuclide scan or IVP. Postoperative complications included urinary tract infection in three patients and postoperative stenosis in one patient were seen. No mortality occurred on infants in unilateral but one occurred in bilateral obstruction. Also, there was one unrelated late death. We report documented functional improvement with minimal complications in unilateral or bilateral pyeloplasty in newborns with UPJ obstruction. We recommend that if the initial scan shows substantially reduced function in the obstructed kidney, a pyeloplasty (rather than nephrectomy generally should be performed, because the newborn kidney has tremendous capacity for improvement in renal function following decompression.

  8. Intestinal obstructions following the cervical cancer treatment

    International Nuclear Information System (INIS)

    Sixty-six intestinal obstructions occured among 2149 patients of cervical cancer treated during period 1961 - 1975. They are divided into four groups, that is, 1.29 cases living with no signs of recurrence after the treatment for obstructions, 2.7 cases that died of obstructions or of complications from its treatment, 3.6 cases that once cured from the obstructions but died from the cancer more than one year after the treatment, 4.24 cases that died from the cancer within one year after the treatment for obstructions. With significantly high incidence, intestinal obstructions are observed with the post-operatory irradiation over 5,000 rads to the whole pelvis or post operatory irradiation using combined telecobalt and small sources. The common sites of obstructions are small intestine to the operated group and sigmoid colon or rectum to the radiotherapy group. Twenty-nine of the patients were treated conservatively and of them 15 are living, intestinal resections and end to end anastomoses were performed to 8 patients, 5 of them are living, but 7 of them suffered from wound disruptions, so the indication for this operation should be carefully decided. (auth.)

  9. Obstructive sleep apnea in ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  10. [Acute obstruction of the esophagus by mucilage].

    Science.gov (United States)

    Laroche, C; Caquet, R; Remy, R; Duflo, B

    1975-10-23

    The authors present the case of an 84 year-old woman with chronic constipation who suddenly developed acute obstruction of the lower oesophagus on taking a tablespoonful of mucilage without water. The obstruction was relieved by fiber endoscopy. There was no other previous lesion which might explain this complication. The patient was seen again later in good general health. The authors recall the clinical and radiological signs of acute obstruction of the oesophagus and discuss the physiopathology. They propose treating them exclusively by oesophageal fiber endoscopy. PMID:175497

  11. Uterine cancer presenting as obstructive jaundice.

    Science.gov (United States)

    Manuel, Valdano; Rocha, Eserval; Fortini, Giovana; Pascoal, Zeida; Netto, Renata; Rengel, Lenira; Birolini, Claudio; Utiyama, Edivaldo Massazo

    2016-01-01

    Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed to a metastatic compression of the common bile duct, from the primary neoplasm of the uterus. This case highlights the importance of including uterine cancer in the differential diagnosis of woman presenting with obstructive jaundice, even though it is very rare. PMID:27462179

  12. SUPERIOR MESENTERIC ARTERY SYNDROME - A REVIEW

    Directory of Open Access Journals (Sweden)

    Aneeta

    2014-02-01

    Full Text Available Superior mesenteric artery (SMA syndrome is a rare acquired disorder in which an acute angulation of SMA causes compression and obstruction of the third part of the duodenum between the SMA and the aorta. The diagnosis is usually made by exclusion. A large number of debilita ting conditions leading to a loss of fatty tissue such as anorexia nervosa , malabsorption , or hyper catabolic states like burns , major surgery , severe injuries , or malignancies can cause this syndrome. To our knowledge there are no cases reported in the In dian literature , though many such cases are being diagnosed and successfully treated the world over. We recently diagnosed and successfully treated a patient of S.M.A. syndrome in Shri Aurobindo Institute of Medical S ciences , Medical College and Post - G radu at e I nstitute. We take the opportunity to review the literature on S.M.A. syndrome

  13. Bilateral popliteal arterial dissection.

    Science.gov (United States)

    Chen, Po-Liang; Ko, Shih-Yu; Tan, Ken-Hing

    2012-01-01

    A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. Laboratory evaluation revealed a d-dimer level of 35.2 mg/L (FEU) on the day of the test and 1.2 mg/L one and a half months ago (normal level, <0.55). These findings were suggestive of a recent-onset peripheral arterial occlusive disorder. Computed tomography of the aorta showed bilateral popliteal arterial dissection with arterial intimal flap. Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery. PMID:21106320

  14. Intestinal Obstruction Syndromes in Cystic Fibrosis: Meconium Ileus, Distal Intestinal Obstruction Syndrome, and Constipation

    OpenAIRE

    van der Doef, Hubert P. J.; Kokke, Freddy T. M.; van der Ent, Cornelis K; Houwen, Roderick H. J.

    2011-01-01

    Meconium ileus at birth, distal intestinal obstruction syndrome (DIOS), and constipation are an interrelated group of intestinal obstruction syndromes with a variable severity of obstruction that occurs in cystic fibrosis patients. Long-term follow-up studies show that today meconium ileus is not a risk factor for impaired nutritional status, pulmonary function, or survival. DIOS and constipation are frequently seen in cystic fibrosis patients, especially later in life; genetic, dietary, and ...

  15. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    OpenAIRE

    Karla Kristine Dames da Silva; Alvaro Camilo Dias Faria; Agnaldo José Lopes; Pedro Lopes de Melo

    2015-01-01

    OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy indi...

  16. Role of ureteric stents in relieving obstruction in patients with obstructive uropathy

    Directory of Open Access Journals (Sweden)

    M Shehab

    2013-01-01

    Conclusion: The predictors of renal recoverability revealed that ureteral stents alone can help in regaining renal function and significant improvement of clinical condition in patients with obstructive uropathy.

  17. Within-breath respiratory impedance and airway obstruction in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Karla Kristine Dames da Silva

    2015-07-01

    Full Text Available OBJECTIVE: Recent work has suggested that within-breath respiratory impedance measurements performed using the forced oscillation technique may help to noninvasively evaluate respiratory mechanics. We investigated the influence of airway obstruction on the within-breath forced oscillation technique in smokers and chronic obstructive pulmonary disease patients and evaluated the contribution of this analysis to the diagnosis of chronic obstructive pulmonary disease. METHODS: Twenty healthy individuals and 20 smokers were assessed. The study also included 74 patients with stable chronic obstructive pulmonary disease. We evaluated the mean respiratory impedance (Zm as well as values for the inspiration (Zi and expiration cycles (Ze at the beginning of inspiration (Zbi and expiration (Zbe, respectively. The peak-to-peak impedance (Zpp=Zbe-Zbi and the respiratory cycle dependence (ΔZrs=Ze-Zi were also analyzed. The diagnostic utility was evaluated by investigating the sensitivity, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01888705. RESULTS: Airway obstruction increased the within-breath respiratory impedance parameters that were significantly correlated with the spirometric indices of airway obstruction (R=−0.65, p90%. CONCLUSIONS: We conclude the following: (1 chronic obstructive pulmonary disease introduces higher respiratory cycle dependence, (2 this increase is proportional to airway obstruction, and (3 the within-breath forced oscillation technique may provide novel parameters that facilitate the diagnosis of respiratory abnormalities in chronic obstructive pulmonary disease.

  18. Wilkie's Syndrome or Superior Mesenteric Artery Syndrome: Fact or Fantasy?

    Science.gov (United States)

    Zaraket, Vera; Deeb, Liliane

    2015-01-01

    Superior mesenteric artery (SMA) syndrome (known as Wilkie's syndrome) is a rare cause of upper gastrointestinal obstruction. It is an acquired disorder in which acute angulation of the SMA causes compression of the third part of the duodenum between the SMA and the aorta. This is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a 17-year-old female who presented with intermittent abdominal pain and intractable vomiting following significant weight loss after hospitalization for pneumonia. Symptoms persisted for 2 years and the patient underwent extensive invasive and non-invasive tests, but to no avail. Thereafter she developed acute high intestinal obstruction, which unraveled her diagnosis. This case emphasizes the challenges in the diagnosis of SMA syndrome and the need for increased awareness of this entity. This will improve early recognition in order to reduce irrelevant tests and unnecessary treatments. PMID:26120301

  19. Constipation following bilateral of internal iliac artery aneurysms

    Directory of Open Access Journals (Sweden)

    S Morita

    2012-09-01

    Full Text Available A 72-year-old man presented with constipation. He was hypertensive and suffered from chronic constipation. On arrival, the patient was fully conscious, and his vital signs were stable. He requested an enema because this treatment had proved effective in the past. On physical examination, a hard palpable mass was detected in the lower abdomen. Computed tomography was performed with contrast media. It revealed an abdominal aortic aneurysm (AAA and bilateral internal iliac artery aneurysms (IIAAs; the latter obstructing the sigmoid colon. We believe that this obstruction was the cause of constipation. The patient underwent Y-graft replacement for the treatment of the AAA and bilateral IIAAs. The surgery was successful, and constipation has not recurred since. As constipation is the most common digestive disorder in the general population, all physicians should be aware that chronic constipation can be caused by bilateral IIAAs.

  20. Obstructions to Clifford System Extensions of Algebras

    Indian Academy of Sciences (India)

    Antonio M Cegarra; Antonio R Garzón

    2001-05-01

    In this paper we do phrase the obstruction for realization of a generalized group character, and then we give a classification of Clifford systems in terms of suitable low-dimensional cohomology groups.

  1. Intestinal obstruction in pregnancy: three case reports

    Directory of Open Access Journals (Sweden)

    Latha Maheswari S

    2013-06-01

    Full Text Available The occurrence of intestinal obstruction is uncommon in pregnancy and so it is rarely considered as a cause for acute abdominal pain. It is also a life threatening condition to the mother if proper medical intervention is delayed. In this review we present three cases of intestinal obstruction during pregnancy and puerperium. The incidence in our tertiary care center over a period of last 5 years is 1 in 3196 deliveries. These cases were diagnosed preoperatively with x-ray and sonogram. Laparotomy with definitive surgical treatment was performed. The first patient had large bowel obstruction due to sigmoid volvulus, the second patient had a stricture in ileum leading to small bowel obstruction, and the third patient had ileocecal intussusception. There were no maternal deaths but one patient had fetal loss. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 491-493

  2. An obstructing endobronchial lipoma simulating COPD

    DEFF Research Database (Denmark)

    Sivapalan, Pradeesh; Gottlieb, Magnus; Christensen, Merete;

    2014-01-01

    Endobronchial lipomas are rare benign tumors of the respiratory tract. Bronchial occlusion may cause parenchymal damage and lead to a misdiagnosis of chronic obstructive pulmonary disease or malignancy. Therefore, both accurate diagnosis and radical treatment of endobronchial lipomas are essentia...

  3. Adhesive intestinal obstruction following blunt abdominal trauma

    International Nuclear Information System (INIS)

    Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition. (author)

  4. AORTOILIAC AND AORTOFEMORAL RECONSTRUCTION OF OBSTRUCTIVE DISEASE

    NARCIS (Netherlands)

    VANDENAKKER, PJ; VANSCHILFGAARDE, R; BRAND, R; VANBOCKEL, JH; TERPSTRA, JL

    1994-01-01

    This retrospective study evaluates our strategy to limit prosthetic reconstructions for aortoiliac obstructive disease to the diseased segments in 518 patients. There were 363 (70%) reconstructions without femoral anastomotic sites (FEM-0), 107 (21%) reconstructions with one femoral anastomotic site

  5. Dams and Obstructions along Iowa's Canoe Routes

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — This dataset represents obstruction to canoe and boat users of the canoe routes of Iowa. This may represent actual dams, rock dams (natural or man made), large...

  6. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis

    OpenAIRE

    Al Shahwani, Noora; Mandhan, Parkash; Elkadhi, Abdelrahman; Ali, Mansour J.; Latif, Abdel

    2013-01-01

    Congenital duodenal obstruction is usually characterized by onset of early vomiting due to high bowel obstruction. Presentation of congenital duodenal obstruction with acute gastrointestinal bleeding is very uncommon. We present an unusual case of congenital intrinsic duodenal obstruction associated with the Down's syndrome presenting with hematemesis secondary to duodenitis. This is a rare presentation of congenital duodenal obstruction associated with Down's syndrome in addition to seven ca...

  7. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Directory of Open Access Journals (Sweden)

    George S. Georgiadis

    2015-01-01

    Full Text Available Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

  8. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Science.gov (United States)

    Georgiadis, George S.; Georgakarakos, Efstratios I.; Schoretsanitis, Nikolaos; Argyriou, Christos C.; Antoniou, George A.; Lazarides, Miltos K.

    2015-01-01

    Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents. PMID:26783493

  9. Role of intrathecal tachykinins for micturition in unanaesthetized rats with and without bladder outlet obstruction.

    OpenAIRE

    Ishizuka, O; Igawa, Y.; Lecci, A.; Maggi, C. A.; Mattiasson, A.; Andersson, K. E.

    1994-01-01

    1. The effects on micturition of RP 67,580, a selective NK1 receptor antagonist, and SR 48,968, a highly, potent antagonist at NK2 receptor sites, given intrathecally (i.t.) or intra-arterially (i.a.) near the bladder, were investigated in unanaesthetized rats with and without bladder outlet obstruction. 2. In normal rats, RP 67,580, given i.t. in doses of 2 and 20 nmol per rat, decreased micturition pressure, but did not change other cystometric parameters. After 20 nmol of RP 67,580, dribbl...

  10. Segmental staining on hepatic arteriography as a sign of intrahepatic portal vein obstruction

    International Nuclear Information System (INIS)

    Peripheral obstruction of intrahepatic portal vein branches was detected by dynamic sequential computed tomography during arterial portography and subsequently confirmed surgically in 9 patients with hepatic neoplasm (7 hepatocellular carcinomas, 1 cholangiocarcinoma, and 1 metastatic lymphadenopathy from gastric carcinoma). Eight of these 10 segments showed more dense staining than other regions of the liver during infusion hepatic angiography. This pattern was attributed to trans-sinusoidal or peripheral arterioportal shunting. In 5 cases, the segmental staining obscured the tumor stain, making the tumor appear larger than it actually was or causing it to be missed altogether

  11. Obstructive sleep apnea and cardiovascular disease: back and forward in time over the last 25 years

    Directory of Open Access Journals (Sweden)

    Quan SF

    2012-10-01

    Full Text Available Over the past 25 years, there have been significant advances made in understanding the pathophysiology and cardiovascular consequences of obstructive sleep apnea (OSA. Substantial evidence now implicates OSA as an independent risk factor for the development of hypertension, coronary artery disease, congestive heart failure and stroke, as well as increased risk of death. Pathophysiologic mechanisms include release of inflammatory mediators, oxidative stress, metabolic dysfunction, hypercoagulability and endothelial dysfunction. Although non-randomized intervention studies suggest that treatment of OSA with continuous positive airway pressure may mitigate its impact of the development of cardiovascular disease, randomized clinical trials are lacking.

  12. Neonatal intestinal obstruction in Benin, Nigeria

    Directory of Open Access Journals (Sweden)

    Osifo Osarumwense

    2009-01-01

    Full Text Available Background: Intestinal obstruction is a life threatening condition in the newborn, with attendant high mortality rate especially in underserved subregion. This study reports the aetiology, presentation, and outcome of intestinal obstruction management in neonates. Materials and Methods: A prospective study of neonatal intestinal obstruction at the University of Benin Teaching Hospital, Benin, Nigeria, between January 2006-June 2008. Data were collated on a structured proforma and analysed for age, sex, weight, presentation, type/date of gestation/delivery, aetiology, clinical presentation, associated anomaly, treatment, and outcome. Results: There were 71 neonates, 52 were males and 19 were females (2.7:1. Their age range was between 12 hours and 28 days (mean, 7.9 ± 2.7 days and they weighed between 1.8 and 5.2 kg (average, 3.2 kg. The causes of intestinal obstruction were: Anorectal anomaly, 28 (39.4%; Hirschsprung′s disease, 8 (11.3%′ prematurity, 3 (4.2%; meconeum plug, 2 (2.8%; malrotation, 6 (8.5%; intestinal atresia, 8 (11.3%; necrotising enterocolitis (NEC, 4 (5.6%; obstructed hernia, 4 (5.6%; and spontaneous gut perforation, 3 (4.2%. Also, 27 (38% children had colostomy, 24 (33.8% had laparotomy, 9 (12.8% had anoplasty, while 11 (15.4% were managed nonoperatively. A total of 41 (57.7% neonates required incubator, 26 (36.6% needed total parenteral nutrition, while 15 (21.1% require d paediatric ventilator. Financial constraint, late presentation, presence of multiple anomalies, aspiration, sepsis, gut perforation, and bowel gangrene were the main contributors to death. Neonates with lower obstructions had a better outcome compared to those having upper intestinal obstruction ( P < 0.0001. Conclusion: Outcomes of intestinal obstruction are still poor in our setting; late presentation, financial constraints, poor parental motivation and lack of basic facilities were the major determinants of mortality.

  13. Chronic obstructive pulmonary disease : a proteomics approach

    OpenAIRE

    Alexandre, Bruno Miguel Coelho, 1980-

    2011-01-01

    Tese de doutoramento, Biologia (Biologia Molecular), Universidade de Lisboa, Faculdade de Ciências, 2012 Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation that is not fully reversible even under bronchodilators effect, caused by a mixture of small airway disease – obstructive bronchiolitis – and parenchymal destruction – emphysema. At the present time, COPD is the fourth leading cause of death and its prevalence and mortality are expected to contin...

  14. Bilateral Metallic Stenting in Malignant Hilar Obstruction

    OpenAIRE

    Lee, Tae Hoon; Moon, Jong Ho; Park, Sang-Heum

    2014-01-01

    Endoscopic palliative biliary drainage is considered as a gold standard treatment in advanced or inoperable hilar cholangiocarcinoma. Also, metal stents are preferred over plastic stents in patients with >3 months life expectancy. However, the endoscopic intervention of advanced hilar obstruction is often more challenging and complex than that of distal malignant biliary obstructions. In this literature review, we describe the issues commonly encountered during endoscopic unilateral (single) ...

  15. Obstructive lung disease in acute medical patients.

    OpenAIRE

    Seemungal, T.; Harrinarine, R.; Rios, M.; Abiraj, V.; Ali, A.; Lacki, N.; Mahabir, N.; Ramoutar, V.; King, C. P.; Bhowmik, A.; Wedzicha, J A

    2008-01-01

    OBJECTIVES: To determine the proportion of adult medical patients who have chronic obstructive pulmonary disease (COPD), using the Global initiative for Chronic Obstructive Lung Disease guidelines (GOLD), and its relation to vascular disease. METHODS: This is a prospective cross-sectional study of adult patients admitted to acute medical wards. Interviewer administered questionnaire, anthropometric and spirometric measurements were done. RESULTS: Spirometry was performed in 720 acute admissio...

  16. Pulmonary Venous Obstruction in Cancer Patients

    OpenAIRE

    Chuang-Chi Liaw; Hung Chang; Tsai-Sheng Yang; Ming-Sheng Wen

    2015-01-01

    Background. We study the clinical significance and management of pulmonary venous obstruction in cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term “pulmonary vein obstruction syndrome” (PVOS) between January 2005 and March 2014. The criteria for inclusion were (1) episodes of shortness of breath; (2) chest X-ray showing abnormal pulmonary hilum shadow with or without presence of pulmonary edema and/or pleural effusion; (3) CT scan demo...

  17. Uterine cancer presenting as obstructive jaundice

    OpenAIRE

    Manuel, Valdano

    2016-01-01

    Valdano Manuel, Eserval Rocha, Giovana Fortini, Zeida Pascoal, Renata Netto, Lenira Rengel, Claudio Birolini, Edivaldo Massazo Utiyama Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil Abstract: Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancr...

  18. Uterine cancer presenting as obstructive jaundice

    OpenAIRE

    Manuel V; Rocha E; Fortini G; Pascoal Z; Netto R; Rengel L; Birolini C; Utiyama EM

    2016-01-01

    Valdano Manuel, Eserval Rocha, Giovana Fortini, Zeida Pascoal, Renata Netto, Lenira Rengel, Claudio Birolini, Edivaldo Massazo Utiyama Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil Abstract: Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer...

  19. Radiological interventions in malignant biliary obstruction.

    Science.gov (United States)

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  20. Small intestinal obstruction in pregnancy and puerperium

    OpenAIRE

    Chiedozi Lawrence; Ajabor Linus; Iweze Florentus

    1999-01-01

    The problem of intestinal obstruction in pregnancy and puerperium is worsened by the risk it poses not just to the mother, but also to the fetus. In this review of 10 pregnant/puerperium patients the maternal mortality was 10% and fetal wastage 20%. In pregnancy and puerperium, intestinal obstruction carries a higher mortality, 10-33%, than in non-pregnant patients, 6-10%. The rarity of the problem, delay in diagnosis, anxiety over radiological examination in pregn...

  1. Feasibility of laparoscopy for small bowel obstruction

    OpenAIRE

    De Sol Angelo A; Migliaccio Carla; Delmonaco Pamela; Cattorini Lorenzo; Morelli Umberto; La Mura Francesco; Cirocchi Roberto; Farinella Eriberto; Cozzaglio Luca; Sciannameo Francesco

    2009-01-01

    Abstract Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed th...

  2. Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Maffei, Erica; Seitun, Sara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Nieman, Koen; Weustink, Annick C.; Mollet, Nico R. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Martini, Chiara [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Guaricci, Andrea Igoren [Azienda Ospedaliero-Universitaria di Foggia, Department of Cardiology, Foggia (Italy); Tedeschi, Carlo [Ospedale San Gennaro, Department of Cardiology, Naples (Italy); Berti, Elena; Grilli, Roberto [Regione Emilia-Romagna, Healthcare and Social Agency, Bologna (Italy); Messalli, Giancarlo [SDN Foundation, IRCCS, Naples (Italy); Cademartiri, Filippo [Azienda Ospedaliero-Universitaria di Parma, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria - Parma, Department of Radiology, Parma (Italy)

    2011-05-15

    To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). 147 diabetic (mean age: 65 {+-} 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 {+-} 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Diabetics showed a higher number of diseased segments (4.1 {+-} 4.2 vs. 2.1 {+-} 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS {<=} 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS {<=} 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics. (orig.)

  3. Congenital urinary tract obstruction: the long view.

    Science.gov (United States)

    Chevalier, Robert L

    2015-07-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  4. MR cholangiography: usefulness in obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Sang Hoon; Lee, In Jae; Nam, Kung Sook; Hong, Myung Sun; Lee, Kyung Hwan; Yun, Ku Sub [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1994-01-15

    Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obstructive jaundice. A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projection imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intrahepatic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were depicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography wa successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases. MR cholangiography may be a useful adjunctive tool for the noninvasive evaluation of patients with obstructive Jaundice.

  5. Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study

    International Nuclear Information System (INIS)

    The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long-term follow up is a known complication. We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient 48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and perfusion was done by cardiac MRI. The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods. Cardiac MR can be used as a comprehensive non-invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making

  6. Obstructive sleep apnea and inflammation.

    LENUS (Irish Health Repository)

    McNicholas, Walter T

    2012-02-01

    The pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS) is not fully understood but is likely multifactorial in origin. Inflammatory processes play an important role in the pathogenesis of atherosclerosis, and circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These include cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, cytokines such as tumour necrosis factor alpha and interleukin 6, chemokines such as interleukin 8, and C-reactive protein. There is also increasing evidence that inflammatory processes play an important role in the cardiovascular pathophysiology of OSAS and many of the inflammatory markers associated with cardiovascular risk have been reported as elevated in patients with OSAS. Furthermore, animal and cell culture studies have demonstrated preferential activation of inflammatory pathways by intermittent hypoxia, which is an integral feature of OSAS. The precise role of inflammation in the development of cardiovascular disease in OSAS requires further study, particularly the relationship with oxidative stress, metabolic dysfunction, and obesity.

  7. Interventional management of hepatic venous outflow obstruction after liver transplantation

    International Nuclear Information System (INIS)

    Objective: To discuss the technique and efficacy of interventional management for the treatment of hepatic venous outflow obstruction (HVO) after liver transplantation. Methods: The clinical data of 5 patients with HVO developed after liver transplantation, including split (n=2) and living donor (n =3) liver transplantation, were retrospectively analyzed. Stent placement was performed in 4 cases and percutaneous transluminal angioplasty in one case. The technical points of interventional management were discussed. Results: Interventional management was performed via the percutaneous hepatic vein approach in 3 patients and via the right internal jugular venous access in 2 patients. Judged from hepatic venography, the location of HVO was at the anastomotic stoma of left- or right-hepatic vein with inferior vena cava (n=3 ) or at the anastomotic stoma of middle hepatic vein with right hepatic vein (n=2). Interventional technical success was achieved in all 5 patients. After the procedure, the venous pressure gradient, i.e. the blood pressure difference between the hepatic artery and the right atrium, was significantly reduced from (15.4 ± 5.6)mmHg to(1.9 ±1.2) mmHg. During the follow-up period of 9-482 days, no restenosis was found on Doppler sonographic manifestations. The liver enzyme and/or bilirubin which were markedly elevated before procedure returned to normal after the procedure in 4 patients except one patient who died of multiple-organs failure at the 9th day after the treatment. In two patients with large quantity of ascites and upper digestive tract bleeding, the ascites receded and the bleeding stopped after the procedure. Conclusion: Hepatic venous outflow obstruction is a rare, but potentially fatal, complication after liver transplantation and interventional management with stent placement or percutaneous transluminal angioplasty is an effective and safe treatment for it. (authors)

  8. New Replacement of a Thrombosed Mitral Valve via Right Anterolateral Thoracotomy in a Patient with Coronary Artery By-Pass Graft and Functioning Internal Mammary Artery Graft

    OpenAIRE

    CEVİZ, Münacettin

    2007-01-01

    A 49-year-old male, who had undergone mitral valve replacement with mechanical cardiac valve and coronary arterial by-pass grafting six years previously, was admitted to our hospital with acute dyspnea. Transesophageal echocardiography revealed that one of the leaflets of the prosthetic valve was entirely immobilized in the closed position, and an immobile soft tissue mass was detected on the ventricular side of the obstructed leaflet. We performed re-replacement using a 29-mm mechanical pros...

  9. Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava

    Directory of Open Access Journals (Sweden)

    Marc Gingell Littlejohn

    2009-01-01

    Full Text Available

    We  present an interesting case of a symptomatic high flow AV fistula between the right common iliac artery (CIA and the inferior vena cava (IVC, successfully treated by endovascular coil embolization. The patient was found to have a right lower polar renal artery crossing the ipsilateral ureter arising from the CIA, causing pelvi-ureteric junction (PUJ obstruction and recurrent pyelonephritis.  It is hypothesized that this fistula arising from the lower polar renal artery and entering the IVC, may have occurred as a result of trauma during a previous pyeloplasty, or a pathologically induced process of angiogenesis stemming from recurrent pyelonephritis.

  10. Relationship of acute left main coronary artery occlusion and ST-segmentelevation in lead aVR

    Institute of Scientific and Technical Information of China (English)

    于富军; 傅向华; 卫亚丽; 李寿霖; 肖蕴陟; 丁超; 赵战勇

    2004-01-01

    @@It is well known that acute left main coronary artery (LMCA) occlusion is one of the most severe lesions associated with coronary artery disease. A large number of LMCA patients die suddenly at the very beginning of a heart attack. Noninvasive identification of acute LMCA occlusion is very important for patient prognosis and survival, especially to predict the need of the invasive procedure of coronary artery reconstruction. In this study, we sought to evaluate retrospectively the value of ST-segment elevation in lead aVR in predicting acute myocardial infarction (AMI) and acute LMCA obstruction.

  11. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  12. Spectrum of diseases in acute intestinal obstruction

    International Nuclear Information System (INIS)

    To determine the etiological spectrum of acute intestinal obstruction in our clinical setup Military Hospital Rawalpindi. Study Design: Descriptive study. Place and Duration of Study: Surgical department of Military Hospital, Rawalpindi from Jul 2012 to Jul 2013, over a period of about 1 year. Material and Methods: A total of 120 patients with acute mechanical intestinal obstruction who underwent laparotomy were included in our study while those with non-mechanical intestinal obstruction like history of trauma and paralytic ileus were excluded from the study. All the patients were selected by non-probability purposive sampling technique. Emergency laparotomy was done and operative findings were recorded. Results: A total of 120 patients with mechanical intestinal obstruction were included in this study out of which 93 (69.17%) were female and remaining 27 (30.83%) were males. Male to female ratio was 1:2.24. Age range of patients was 22-85 years. Out of 120 patients operated for acute intestinal obstruction post-op adhesions were found in 37 (30.83%) patients followed by intestinal tuberculosis in 23 (19.17%) patients, obstructed inguinal hernias in 13 (10.83%), gut malignancies in 15 (12.5%) , Meckel's diverticulum with bands in 7 (5.83%), volvulus in 7 (5.83%), perforated appendix in 6 (5%), intussusception in 2 (1.7%), inflammatory bands in 5 (4.17%), trichobezoar and faecal impaction in 2 (1.7%) while in 3 (2.5%) patients no definite cause was found. Conclusion: Post-op adhesions are the commonest cause of mechanical intestinal obstruction in our setup followed by intestinal tuberculosis as second most common clinical pattern of presentation. (author)

  13. Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

    International Nuclear Information System (INIS)

    Objective: the aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. Methods: the study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing < 50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≧ 50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. Results: the average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. Conclusion: we showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases. (author)

  14. Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Demircelik, Muhammed Bora; Gurel, Ozgul Malcok; Selcoki, Yusuf; Atar, Inci Asli; Eryonucu, Beyhan, E-mail: drdemircelik@yahoo.com [Turgut Ozal Univercity, Department of Cardiology, Ankara (Turkey); Bozkurt, Alper; Akin, Kayihan [Turgut Ozal Univercity, Department of Radiology, Ankara (Turkey); Yilmaz, Omer Caglar [Ankara Occupational Diseases Hospital, Department of Cardiology, Ankara (Turkey)

    2014-06-15

    Objective: the aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. Methods: the study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing < 50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≧ 50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. Results: the average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. Conclusion: we showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases. (author)

  15. Peripheral Arterial Disease

    Science.gov (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  16. Coronary artery spasm

    Science.gov (United States)

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  17. Pulmonary Arterial Hypertension

    Science.gov (United States)

    Pulmonary Arterial Hypertension What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout your body. While the heart is one organ, it ...

  18. Carotid artery disease

    Science.gov (United States)

    ... you have had a stroke or TIA, a nervous system (neurological) exam will show other problems. You may also have the following tests: Blood cholesterol and triglycerides test Blood sugar (glucose) test Ultrasound of the carotid arteries ( carotid ...

  19. Superior mesenteric artery syndrome following initiation of cisplatin-containing chemotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Ushiki Atsuhito

    2012-01-01

    Full Text Available Abstract Introduction Superior mesenteric artery syndrome is a rare cause of upper intestinal obstruction resulting from compression of the duodenum by the superior mesenteric artery and abdominal aorta. Case presentation We describe a case of superior mesenteric artery syndrome in a 61-year-old Japanese man with non-small cell lung cancer who had been treated with cisplatin-containing chemotherapy and had lost 7 kg in weight. The diagnosis was confirmed by the typical findings of abdominal computed tomography showing distended stomach resulting from compression of the third portion of the duodenum and reduction of an aortomesenteric distance and aortomesenteric angle. Conclusions This case highlights the importance of considering the possibility of superior mesenteric artery syndrome in patients treated with chemotherapy, especially those presenting with a low body mass index and showing weight loss during chemotherapy.

  20. Asthma and Obstructive Sleep Apnea

    Institute of Scientific and Technical Information of China (English)

    Yi-Xian Qiao; Yi Xiao

    2015-01-01

    Objective:To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology,pathophysiology,and clinical manifestation and then summarizing the latest progress on diagnosis and treatment.Data Sources:Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and “asthma'" as the main keywords.Highly regarded older publications were also included.Study Selection:Information about the features of the two diseases in common,the pathophysiologic association between them and their current treatments from the literature search were identified,retrieved,and summarized.Results:Both OSA and asthma are very prevalent conditions.The incidences of them have kept on rising in recent years.Asthma is often accompanied by snoring and apnea,and OSA often combines with asthma,as well.They have many predisposing and aggravating factors in common.Possible shared direct mechanistic links between them include mechanical effects,intermittent hypoxia,nerve reflex,inflammation,leptin,etc.Indirect mechanistic links include medication,nose diseases,smoking,obesity,and gastroesophageal reflux disease.Since OSA presents many similar features with nocturnal asthma,some scholars termed them as a sole syndrome "alternative overlap syndrome,"and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure.Conclusions:OSA and asthma are closely associated in pathogenesis,symptoms,and therapies.With the growing awareness of the relationship between them,we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients.Further studies are still needed to guide the clinical works.

  1. CHROMOPHOBE RENAL CELL CARCINOMA MASQUERADING AS OBSTRUCTIVE JAUNDICE AND GASTRIC OUTLET OBSTRUCTION

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2015-02-01

    Full Text Available BACKGROUND: Chromophobe (Chr RCC is a distinctive entity of Renal Cell Carcinoma (RCC arising from cortical portion of collecting duct of kidneys with an incidence of 3 - 5% (1. Localized Cromophobe RCC suggests a better prognosis than other type of RCC but there is a poorer outcome with sarcomatoid features or metastatic disease (1 . Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas (2 . Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma (3. Of patients with pancreatic metastases, 12% present with synchronous extra pancreatic metastasis, and they have a poor prognosis . Chromophobe RCC presenting as obstructive jaundice and gastric outlet obstruction has been cited infrequently in literature (3 . The purpose of this paper is two: first, a rare case ChRCC with atypical presentation with obstructive jaundice, gastric outlet obstruction and pancreatic metastasis. Second, multidisciplinary treatment involving General surgeon, Medical Gastroenterologist, Surgical Gastroenterologist, Urologist, Interventional Radiologist and a Medical oncologist. CASE PRESENTATION: A 43 years old female presenting with features of obstructive jaundice and gastric outlet obstruction in surgical outpatient. A multidisciplinary management approach found Metastatic ChRCC the cause for gastrointestinal manifestation . CONCLUSIONS: ChRCC can be local invasion or metastatic. There are multiple sites where metastases can occur. There are many specific investigations to confirm RCC and concomitant gastric outlet obstruction (GOO, obstructive jaundice and pancreatic secondaries. This patient was diagnosed early after presentation of acute symptoms, decompression of biliary system done early by PTBD, Radical nephrectomy done with Portahepatis node which was causing obstructive jaundice and gastric outlet obstruction. Frozen section biopsy from

  2. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Nicolas W Shammas

    2007-05-01

    Full Text Available Nicolas W ShammasMidwest Cardiovascular Research Foundation, Cardiovascular Medicine, PC, Davenport, IA, USAAbstract: Peripheral arterial disease (PAD is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.Keywords: peripheral arterial disease, epidemiology, risk factors, classification

  3. From anatomy to function: diagnosis of atherosclerotic renal artery stenosis.

    Science.gov (United States)

    Odudu, Aghogho; Vassallo, Diana; Kalra, Philip A

    2015-12-01

    Atherosclerotic renal artery stenosis (ARAS) affects 7% of the over 65 s and will be increasingly common with an ageing population. ARAS obstructs normal renal perfusion with adverse renal and cardiovascular consequences. Drug therapy is directed at reducing atherosclerotic risk. Two recent major trials of revascularization for ARAS showed that clinical outcomes were not improved beyond those offered by optimal drug therapy in most patients. This reflects experimental data showing that restoration of blood flow alone may not attenuate a cascade of tissue injury. A shift from anatomic to functional imaging of ARAS coupled to novel therapies might improve clinical outcomes in selected patients. This review outlines the case for separately assessing hemodynamic significance of arterial stenosis and functional reserve of renal parenchymal tissue. The authors consider current and emerging diagnostic techniques for ARAS and their potential to allow individualized and functionally directed treatments. PMID:26480218

  4. Expression and role of adrenomedullin and its receptor in patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    徐平; 戴爱国; 周厚德; 沈宏伟; 刘丽华; 宋卫东

    2003-01-01

    Objective To investigate the expression and role of adrenomedullin (ADM) and adrenomedullin receptor (ADMR) in patients with chronic obstructive pulmonary disease (COPD).Methods Small pulmonary artery remodeling was observed using morphometric analysis. Theexpression of ADM and ADMR mRNA in lung tissue was calculated by in situ hybridization in 9 COPD cases. Cardiac catheterization was performed in 22 COPD cases to monitor changes of hemodynamic parameters and patients were divided into two groups based on mean pulmonary artery pressure (mPAP). The cases without pulmonary hypertension (PH) were placed in Group A (n=12) and those with PH were placed in Group B (n=10). The levels of pulmonary arterial plasma ADM were measured by radioimmunoassay. Blood gas analysis was also conducted.Results The ratio of vascular wall thickness to external diameter (MT%) and the ratio osed in the pulmonary artery walls of control subjects . The expression levels were 01). Statistically positive relationships were visible between ADM and ADMR, and the plasma ADM level of Group B was significantly higher than that of Groupon to mPAP and pulmonary vascular resistance (PVR), while being negatively correlated to levels of PaO2.Conclusion ADM may play an extremely protective role as a local autocrine/paracrine factor in COPD.

  5. CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    Ye. D. Bazdyrev

    2014-11-01

    Full Text Available Objective: to detect previously undiagnosed arterial hypertension in patients with chronic obstructive pulmonary disease (COPD as a risk factor for cardiovascular mortality.Materials and methods. 43 patients with stage I–II of COPD and the absence of clinical signs of cardiovascular diseases were examined. Spirometry, body plethysmography and diffusing lung capacity (DLCO were included in the respiratory system assessment. The cardiovascular system was assessed with echocardiography and ambulatory blood pressure monitoring (ABPM.Results. Despite the absence of obvious signs of cardiovascular lesions (an increase of office blood pressure, intracardiac hemodynamic changes, the following cardiovascular risk factors were identified: age (58.2 ± 2.0 years, male gender, smoking, hypercholesterolemia and dyslipidemia (total cholesterol 5.9 ± 0.9 mmol / l, low density lipoproteins 3.8 ± 0.5 mmol / l, triglycerides 1.8 ± 0.2 mmol / l. Correlation analysis has revealed the relation between several respiratory parameters and the severity of dyspnea and quality of life in patients with COPD, as well as its relation with lipid levels.Conclusion. The patients with COPD have a large number of risk factors for CVD. According to ABPM data, arterial hypertension was verified in 18 (41.9 % of 43 patients with COPD at normal level of office blood pressure; moreover, 51.2 % of patients demonstrated low reduction of blood pressure during the night-time that nowadays, is considered to be a predictor of cardiovascular disease and sudden death.

  6. Hepcidin: A useful marker in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Serap Duru

    2012-01-01

    Full Text Available Purpose: This study was designed to evaluate the levels of hepcidin in the serum of patients with chronic obstructive pulmonary disease (COPD. Methods: In the study, 74 male patients (ages 45-75 in a stable period for COPD were grouped as Group I: Mild COPD (n:25, Group II: Moderate COPD (n:24, and Group III: Severe COPD (n:25. Healthy non-smoker males were included in Group IV (n:35 as a control group. The differences of hepcidin level among all the groups were examined. Also, in the patient groups with COPD, hepcidin level was compared with age, body mass index, cigarette (package/year, blood parameters (iron, total iron binding capacity, ferritin, hemoglobin, hematocrit [hct], respiratory function tests, and arterial blood gas results. Results: Although there was no difference between the healthy control group and the mild COPD patient group (P=0.781 in terms of hepcidin level, there was a difference between the moderate (P=0.004 and the severe COPD patient groups (P=0.002. The hepcidin level of the control group was found to be higher than the moderate and severe COPD patient groups. In the severe COPD patients, hepcidin level increased with the increase in serum iron (P=0.000, hct (P=0.009, ferritin levels (P=0.012, and arterial oxygen saturation (SaO2, P=0.000. Conclusion: The serum hepcidin level that is decreased in severe COPD brings into mind that it may play a role in the mechanism to prevent hypoxemia. The results suggest that serum hepcidin level may be a useful marker in COPD. Larger prospective studies are needed to confirm our findings between hepcidin and COPD.

  7. Radionuclides in the evaluation of urinary obstruction

    International Nuclear Information System (INIS)

    Radionuclide renography and renal scanning techniques are ideally suited to the initial and follow-up evaluation of patients with obstructive uropathy. While other modalities are superior in their ability to provide anatomic information, the radionuclide study yields functional information for each kidney without the necessity to resort to invasive studies. In addition, the Nuclear Medicine study is well suited to the evaluation of obstruction where serial studies often are required because of a lower radiation burden compared to urography. This lower radiation dose is especially important in obstruction because of the recurrent nature of several kinds of obstructive uropathy and because of the high incidence in the pediatric age group. The ability to control urine flow rate during the procedure through dehydration or administration of diuretics is an additional benefit. Increasing availability of computerization of nuclear medicine procedures as well as interest in studies employing physiologic intervention (including the diuresis renogram) have assured an important place for radionuclide studies in the evaluation of patients with urinary obstruction

  8. MR urography evaluation of obstructive uropathy

    International Nuclear Information System (INIS)

    Hydronephrosis and the evaluation of obstructive uropathy are the most common indications for MR urography in our practice. Typically our patients fall into one of two groups: infants with antenatal hydronephrosis and older children who present with abdominal pain, hematuria or urinary tract infection. Obstruction in children is usually chronic and partial. Intermittent episodes of increased pressure occur when the urine production exceeds the capacity for drainage. MR urography uses a fluid and diuretic challenge to assess the hydronephrotic kidney. High-quality anatomic images provide a morphologic assessment of the hydronephrotic system. Although it is relatively straightforward to determine if a system is not obstructed on the basis of the renal transit time (RTT), no single parameter is adequate to fully characterize obstruction. By evaluating the changes in signal intensity in the renal parenchyma following contrast administration, the hydronephrotic systems are classified as compensated or decompensated. Delayed RTT and the presence of urine-contrast levels indicate stasis. Calyceal transit time and the difference between the volumetric and the Patlak differential renal function (vDRF-pDRF) are measures of the physiologic changes within the kidney. Additionally, MR urography provides prognostic information by assessing the quality of the renal parenchyma and identifying uropathy preoperatively. MR urography combines both anatomic and functional information in a single test and is capable of providing a comprehensive evaluation of obstructive uropathy that could ultimately help select those patients most likely to benefit from surgical intervention. (orig.)

  9. Radionuclides in the evaluation of urinary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Scharf, S.C.; Blaufox, M.D.

    1982-07-01

    Radionuclide renography and renal scanning techniques are ideally suited to the initial and follow-up evaluation of patients with obstructive uropathy. While other modalities are superior in their ability to provide anatomic information, the radionuclide study yields functional information for each kidney without the necessity to resort to invasive studies. In addition, the Nuclear Medicine study is well suited to the evaluation of obstruction where serial studies often are required because of a lower radiation burden compared to urography. This lower radiation dose is especially important in obstruction because of the recurrent nature of several kinds of obstructive uropathy and because of the high incidence in the pediatric age group. The ability to control urine flow rate during the procedure through dehydration or administration of diuretics is an additional benefit. Increasing availability of computerization of nuclear medicine procedures as well as interest in studies employing physiologic intervention (including the diuresis renogram) have assured an important place for radionuclide studies in the evaluation of patients with urinary obstruction.

  10. MR urography evaluation of obstructive uropathy

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D.; Jones, Richard A. [Emory University School of Medicine, Department of Radiology, Children' s Healthcare of Atlanta, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

    2008-01-15

    Hydronephrosis and the evaluation of obstructive uropathy are the most common indications for MR urography in our practice. Typically our patients fall into one of two groups: infants with antenatal hydronephrosis and older children who present with abdominal pain, hematuria or urinary tract infection. Obstruction in children is usually chronic and partial. Intermittent episodes of increased pressure occur when the urine production exceeds the capacity for drainage. MR urography uses a fluid and diuretic challenge to assess the hydronephrotic kidney. High-quality anatomic images provide a morphologic assessment of the hydronephrotic system. Although it is relatively straightforward to determine if a system is not obstructed on the basis of the renal transit time (RTT), no single parameter is adequate to fully characterize obstruction. By evaluating the changes in signal intensity in the renal parenchyma following contrast administration, the hydronephrotic systems are classified as compensated or decompensated. Delayed RTT and the presence of urine-contrast levels indicate stasis. Calyceal transit time and the difference between the volumetric and the Patlak differential renal function (vDRF-pDRF) are measures of the physiologic changes within the kidney. Additionally, MR urography provides prognostic information by assessing the quality of the renal parenchyma and identifying uropathy preoperatively. MR urography combines both anatomic and functional information in a single test and is capable of providing a comprehensive evaluation of obstructive uropathy that could ultimately help select those patients most likely to benefit from surgical intervention. (orig.)

  11. Percutaneous transhepatic cholangiographic evaluation of obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hee Tae; Kim, Hong Soo; Kim, Jong Deok; Rhee, Hak Song [Presbyterian Medical Center, Jeonju (Korea, Republic of)

    1983-12-15

    PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causes of obstructive jaundice among various radiological procedures. The authors reviewed and radiologically classified the PTC films of 203 cases of obstructive jaundice from July, 1977 to June, 1983 at Presbyterian Medical Center, Jeonju confirmed clinically, operatively and pathologically. The results are as follows; 1. The most common cause of obstructive jaundice was bile duct stone (64/203: 31.53%) and the other causes were bile duct cancer (43/203: 21.18%), pancreas cancer (41/203: 20.19%), biliary ascariasis and/or clonorchiasis (20/203: 9.8%), ampulla and duodenal cancer (7/203: 3.45%), fibrotic stenosis of sphincter of Oddi (6/203: 2.96%) etc. in the order. Of these primary involvement with cancer was more frequent (91/203: 44.33%) than stone. 3. The average maximal diameter of extrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearly equal (2.36 cm : 2.38 cm). 4. Cancers caused complete bile duct obstruction in about 75% (68/91) of cases and also were associated with intrahepatic duct dilatation about 92% (84/91) of cases. But in contrast biliary calculi showed good drainage of contrast medium in 75% (48/64) of cases and 92% (59/64) showed normal diameter.

  12. Percutaneous transhepatic cholangiographic evaluation of obstructive jaundice

    International Nuclear Information System (INIS)

    PTC is the single most valuable diagnostic method available to evaluate the size, shape and site of the causes of obstructive jaundice among various radiological procedures. The authors reviewed and radiologically classified the PTC films of 203 cases of obstructive jaundice from July, 1977 to June, 1983 at Presbyterian Medical Center, Jeonju confirmed clinically, operatively and pathologically. The results are as follows; 1. The most common cause of obstructive jaundice was bile duct stone (64/203: 31.53%) and the other causes were bile duct cancer (43/203: 21.18%), pancreas cancer (41/203: 20.19%), biliary ascariasis and/or clonorchiasis (20/203: 9.8%), ampulla and duodenal cancer (7/203: 3.45%), fibrotic stenosis of sphincter of Oddi (6/203: 2.96%) etc. in the order. Of these primary involvement with cancer was more frequent (91/203: 44.33%) than stone. 3. The average maximal diameter of extrahepatic bile duct just proximal to the site of obstruction or stenosis by stones or by cancers was nearly equal (2.36 cm : 2.38 cm). 4. Cancers caused complete bile duct obstruction in about 75% (68/91) of cases and also were associated with intrahepatic duct dilatation about 92% (84/91) of cases. But in contrast biliary calculi showed good drainage of contrast medium in 75% (48/64) of cases and 92% (59/64) showed normal diameter

  13. Percutaneous prostatic arterial embolization for the treatment of benign prostatic hyperplasia

    International Nuclear Information System (INIS)

    Percutaneous prostatic artery embolization (PAE) is a kind of technology that can treat benign prostatic hyperplasia through embolizing bilateral prostatic arteries to obstruct most blood supply to the prostate thus to cause prostatic tissue necrosis and the volume reduction of the prostate, resulting in the improvement of the clinical symptoms. This technique is technically simple, clinically convenient and well repeatable. This article aims to make a special comment about the history of PAE, the blood supply of the prostate, the indications and contraindications of the technique, the operative procedure, the complications and limitations, etc. (authors)

  14. Celiaco-Mesenterial Arterial Aberrations in Patients Undergoing Extended Pancreatic Resections: Correlation of CT Angiography with Findings at Surgery

    Directory of Open Access Journals (Sweden)

    Viacheslav I Egorov

    2010-07-01

    Full Text Available Context It is important to recognize arterial variants in the preoperative planning of extended pancreatic resections. The absence of surgical confirmation of radiological data is a limitation of the majority of angiographic or CT-angiographic studies of celiac and mesenteric arterial anatomy. Objective The purpose of this study was to test the accuracy of CT angiography in delineating the arterial architecture by comparing the resultant 3D images with findings at surgery and determining the frequency of different celiac and mesenteric arterial anatomy variants. Methods Abdominal CT angiographies of 350 patients were performed on a 64- and 256- MDCT scanner prior to major pancreatic or hepatobiliary surgery. Variants of celiac and mesenteric arterial anatomy were documented as 3D reconstructions. Radiological data were compared to operative photographs during extended pancreaticoduodenectomies and extended distal pancreatectomies in 59 cases. Results Only 197 patients (56.3% had the classic arterial anatomy identified at CT angiography. The most common variants were a replaced or accessory right hepatic artery originating from the superior mesenteric artery (62 cases, 17.7% and a replaced or accessory left hepatic artery (43 cases, 12.3% originating from the left gastric artery. According to a comparison with operative photographs, CT angiography demonstrated 100% accuracy in identifying celiac and mesenteric arterial anatomy variants, stenoses, obstructions and aneurysms of the celiac and mesenteric branches, including those which were hemodynamically significant and which influence the choice and sequence of operative procedures. Conclusion The celiac and mesenteric arterial anatomy variants are fairly common and are of great significance in planning extended pancreatic resections. Radiological findings were fully corroborated by operative data, which means that CT angiography is a reliable tool for identifying celiac and mesenteric arterial

  15. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jun Qian; Ren-You Zhai; Ding-Ke Dai; Ping Yu; Li Gao

    2006-01-01

    AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease.METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients Accepted: brachytherapy or extraradiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis.RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholangiocarcinoma, 4 cases of pancreatic carcinoma), and 13patients Accepted: brachytherapy (7 cases of cholangiocarcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively,longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%,80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group.CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.

  16. High risk for obstructive sleep apnea in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Carla Renata Silva Andrechuk

    2015-10-01

    Full Text Available Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male. A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

  17. Small intestinal obstruction in pregnancy and puerperium

    Directory of Open Access Journals (Sweden)

    Chiedozi Lawrence

    1999-01-01

    Full Text Available The problem of intestinal obstruction in pregnancy and puerperium is worsened by the risk it poses not just to the mother, but also to the fetus. In this review of 10 pregnant/puerperium patients the maternal mortality was 10% and fetal wastage 20%. In pregnancy and puerperium, intestinal obstruction carries a higher mortality, 10-33%, than in non-pregnant patients, 6-10%. The rarity of the problem, delay in diagnosis, anxiety over radiological examination in pregnant women, worry over laparotomy in pregnant women, all result in delay in instituting definite treatment and contribute to the morbidity. Application of established principles in the management of intestinal obstruction even when it occurs in pregnancy and puerperium might help to improve the results of management and reduce the current level of morbidity and mortality.

  18. Influence of Rho Kinase Inhibitor Fasudil on Late Endothelial Progenitor Cells in Peripheral Blood of COPD Patients with Pulmonary Artery Hypertension

    OpenAIRE

    Liu, Pei; Zhang, Hongmei; Tang, Yijun; Sheng, Chunfeng; Liu, Jianxin; Zeng, Yanjun

    2014-01-01

    The objective of our work was to investigate the influence of Fasudil, a Rho inhibitor on the number and function of the late endothelial progenitor cells in peripheral blood of chronic obstructive pulmonary diseases (COPD) patients with pulmonary artery hypertension. Eighty COPD patients with pulmonary artery hypertension were selected and divided into two groups: the treatment group and the control group, which had 40 patients respectively. The control group received routine treatment, incl...

  19. Malignant biliary obstruction treated with metallic stents

    International Nuclear Information System (INIS)

    Purpose: The outcome of 33 patients with malignant biliary obstruction treated with metallic stents is presented. Materials and methods: Thirty-eight biliary metallic stents were placed in 33 patients with malignant biliary obstruction. They were 52-71 years old (mean = 61.7); 23 were male and 10 were female. The biliary obstruction was caused by biliary carcinoma (n = 16), pancreatic carcinoma (n = 2), hepatoma (n = 2), metastasis in liver (n = 3) and lymph node metastasis (n = 10). Six types and 38 metallic stents were used. After stentering, 3 cases were treated with intrastent brachytherapy, 7 cases treated with external radiotherapy and 2 patients treated with interventional radiology. Patients were followed for 6-28 months, mean 11 months. Results: Stent placement was successful in all 33 cases. The same time, 4 patients were treated with plastic tube for external drainage only. The successful rate was 90%. Twenty-nine patients were placed in one time, 4 cases began with plastic tube which was replaced with metallic stents after 1-2 weeks. Nine had metallic stents and plastic tube, because of complicated obstruction. The external drainage catheters were removed after 15-200 days. Three patients had stents crossing the ampulla. In 28 cases (84.85%), jaundice was reduced satisfactorily while in 5 cases with complicated biliary obstruction, the result was unsatisfactory. The median survival was 7 months. After stentering, 12 cases were treated with locat chemotherapy, brachytherapy or radiotherapy. The median survival period was 10 months. Conclusion: The metallic stent provides good palliative drainage and is well tolerated by patients. It improves the survival rate when combined with radiotherapy, brachytherapy and chemotherapy in patients with malignant biliary obstruction

  20. Feasibility of laparoscopy for small bowel obstruction

    Directory of Open Access Journals (Sweden)

    De Sol Angelo A

    2009-01-01

    Full Text Available Abstract Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%, while that of therapeutic laparoscopy is low (40–88%. The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative

  1. Superior mesenteric artery syndrome secondary to brucellosis — A case report

    OpenAIRE

    Prasad, Seetharam; Lingadakai, Ramachandra; Chethan, Kishanchand; Abdul, Zeeshan

    2010-01-01

    Superior mesenteric artery (SMA) syndrome is a rare condition characterized by duodenal obstruction due to extrinsic compression by SMA. Any condition which results in rapid, significant weight loss can cause SMA syndrome. Brucellosis is a common cause of pyrexia of unknown origin which can result in loss of appetite and weight loss. Brucellosis resulting in SMA syndrome has not been described in literature. We present a case of SMA syndrome resulting from weight loss due to brucellosis along...

  2. Herniation after deep circumflex iliac artery flap: two cases of rare complication

    OpenAIRE

    Kim, Hee-Sung; Kim, Jae-Young; Hur, Hyuk; Nam, Woong

    2016-01-01

    Herniation after harvesting of deep circumflex iliac artery (DCIA) flap is a known but not a common complication. It occurs about 2.8 to 9 % according to the literatures and can proceed to a more severe complication such as bowel obstruction. There are several factors that exacerbate the risk: surgical factors, operator factor, and patient factors. Surgical factors include large anatomical defect and denervation of related muscles. Operator factor stands for unpunctual suture technique. Patie...

  3. The Effect of Respiratory Functions and Pulmonary Artery Pressure on Right and Left Ventricular Diastolic Function

    OpenAIRE

    Alpsoy, Şeref; Akyüz, Aydın; Akkoyun, Dursun Çayan; Oran, Mustafa; Mutlu, Levent Cem; TOPÇU, Birol; Değirmenci, Hasan; Yalçın, Banu Çiçek

    2012-01-01

    Introduction: The aim of the study was to evaluate of biventricular diastolic function and to investigate the effect of pulmonary function and pulmonary artery pressure on diastolic functions in people with chronic obstructive pulmonary disease (COPD). Patients and Methods: Sixty patients with COPD and 40 healthy individuals were assessed by echocardiography and pulmonary function tests (PFTs). Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were determined. Co...

  4. Minimally invasive surgery for superior mesenteric artery syndrome: A case report

    OpenAIRE

    Yao, Si-Yuan; Mikami, Ryuichi; Mikami, Sakae

    2015-01-01

    Superior mesenteric artery (SMA) syndrome is defined as a compression of the third portion of the duodenum by the abdominal aorta and the overlying SMA. SMA syndrome associated with anorexia nervosa has been recognized, mainly among young female patients. The excessive weight loss owing to the eating disorder sometimes results in a reduced aorto-mesenteric angle and causes duodenal obstruction. Conservative treatment, including psychiatric and nutritional management, is recommended as initial...

  5. Vertebrobasilar insufficiency and possible relationships with arterial changes

    International Nuclear Information System (INIS)

    The study described was carried out in order to clarify the question as to whether overt neurological disorders in the vertebrobasilar region are connected with arterial changes that may be ascertained by means of X-ray examinations. For this purpose, the clinical and angiographic data of 54 patients showing vertebrobasilar insufficiency were subjected to detailed analysis. In all cases, an angiographic examination of the branchial artery had been so performed as to permit visualisation of the vertebrobasilar territory. The macroscopic changes revealed by angiography were evaluated on the basis of the severity of the clinical symptoms and the age of the patient. It was found that the frequency of visualised changes in the arterial system that could be matched with neurological symptoms only just attained statistical significance in women of advanced age, while the findings revealed in men were not consistent with the clinical signs. The manifestation of those changes largely depends on the individual degree of collateral blood supply. This, a direct relationship between the angiographic findings and the clinical symptoms is only likely to be observed in cases where the development of collaterals was prevented due to the site of vascular obstruction or where the incident happened just prior to the examination. A typical example here is recent thrombosis of the basilar artery. (TRV)

  6. Increasing awareness of recognition of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ The medical community should, by now, be well aware of the importance of chronic obstructive pulmonary disease (COPD), an increasingly common condition with high morbidity and mortality. In modern terms, COPD has come to signify concurrent chronic bronchitis, asthmatic bronchitis and emphysema. Cigarette smoking has long been recognized as the predominant aetiological agent. Arterial hypoxaemia, a frequent complication of COPD, can lead to pulmonary hypertension and cor pulmonale. COPD affects over 5% of the adult population and is the only major cause of death whose morbidity and mortality are increasing in several countries.1 In China, it is difficult to quantify how many people are affected with COPD. However, a recent epidemiological survey indicated that COPD prevalence was 8.2% in China. COPD prevalence in men was significantly higher than in women (12.4% cf 5.1%). The prevalence in rural areas was higher than that in urban areas (8.8% cf 7.8%). Of patients with COPD, 61.5% were smokers. The report also stated that COPD is the major cause of death in rural areas in China and the fourth leading cause of death in urban areas, rising to the third leading cause of death by 2020.2 The prevalence of the disease increases with age with highest rates seen in people over the age of 70 years. COPD is the only major cause of mortality with a rising incidence and prevalence worldwide, rendering it an increasingly worrisome

  7. Stenotic and obstructive lesions in acute dissecting thoracic aortic aneurysms.

    Science.gov (United States)

    Shumacker, H B; Isch, J H; Jolly, W W

    1975-05-01

    The present study of 33 operatively treated patients, 88 per cent of whom survived the procedure, is concerned with an important problem associated with acute thoracic aortic dissection, the stenotic and obstructive lesions of the aorta and its branches. Their variety and nature are described, as are the additional operative procedures deemed necessary at the time of the operation, immediately thereafter, or later on. Much has been learned about these difficulties from clinical and autopsy observations and especially from careful arteriographic surveys. They seem to be generally well withstood following resectional and grafting procedures upon the affected segment of the thoracic aorta. Occasionally, additional operative manipulations may be necessary at the same time, for example, interpolation of grafts between the ascending aortic graft and a coronary when the origin of the latter is sheared off by the dissection, and distal arterial manipulations when the patient still has ischemic lower extremities immediately after the primary procedure. Later operations must sometimes be performed because of persistence of complaints such as intermittent claudication. It is extremely rare that immediate reoperation is advisable because of indications of intra-abdominal ischemia. Much more can be learned from careful pre- and postoperative arteriographic study. PMID:1130882

  8. Neonatal Duodenal Obstruction: A 15-Year Experience

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2016-04-01

    Full Text Available Background: Congenital duodenal obstruction is one of the commonest causes of neonatal intestinal obstruction. We are presenting our 15-year experience by analyzing clinical spectrum and outcome in neonates with duodenal obstruction admitted at our center. Material and Methods: The hospital records of all neonates admitted with duodenal obstruction from June 2000 to June 2015 were reviewed. The patient records were analyzed for antenatal diagnosis, age, sex, clinical presentation, diagnosis, associated anomalies, surgical procedures performed; postoperative morbidity and mortality. We excluded from our study malrotation of gut associated with congenital diaphragmatic hernia and abdominal wall defects. Results: A total of 81 patients were admitted, out of which 56 were males and 25 were females. Polyhydramnios was detected in 24 (30% pregnancies. Average birth weight was 2.1±1.0Kg and average gestational age was 38 (SD±1 weeks with 17 (21% preterm neonates. Presenting features were vomiting in 81(100% which was bilious in 81% and non bilious in 19%, epigastric fullness in 56 (69% and dehydration in 18 (22% and failure to thrive in 16 (19%. Most common cause of obstruction was duodenal atresia in 38 (46.9%, followed by malrotation of gut in 33 (40.7%, and annular pancreas in 4 cases. Depending upon site of location, infra-ampullary obstruction was the most common in 64 (79%, supra-ampullary in 9 (7.4% and ampullary 8 neonates. Both duodenal atresia and malrotation of gut was present in 4 cases. X-ray abdomen was most commonly used investigation to confirm the diagnosis. All cases were managed surgically by open laparotomy. Eleven (13.5% patients died due to sepsis and associated congenital anomalies. Conclusion: Congenital duodenal obstruction most commonly presents in early neonatal period with features of upper GIT obstruction like vomiting and epigastrium fullness as in our series. Early antenatal diagnosis and surgical interventions hold the

  9. Chronic obstructive pulmonary disease and cancer risk

    DEFF Research Database (Denmark)

    Kornum, Jette Brommann; Sværke, Claus; Thomsen, Reimar Wernich; Lange, Peter; Sørensen, Henrik Toft

    2012-01-01

    Little is known about the risk of cancer in patients with chronic obstructive pulmonary disease (COPD), including which cancer sites are most affected. We examined the short- and long-term risk of lung and extrapulmonary cancer in a nationwide cohort of COPD patients.......Little is known about the risk of cancer in patients with chronic obstructive pulmonary disease (COPD), including which cancer sites are most affected. We examined the short- and long-term risk of lung and extrapulmonary cancer in a nationwide cohort of COPD patients....

  10. Detection of coronary artery disease in asymptomatic aircrew members with thallium-201 scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Uhl, G.S.; Kay, T.N.; Hickman, J.R. Jr.; Montgomery, M.A.; McGranahan, G.M.

    1980-11-01

    Thallium-201 exercise myocardial perfusion scintigraphy was accomplished in 130 aircrew members prior to their undergoing coronary angiography. Most were undergoing cardiac catheterization for an abnormal exercise response to treadmill testing. Of these, 22 men had arteriographic evidence of obstructive coronary disease of at least 50% narrowing in a single vessel. All had abnormal myocardial scintigrams. There were 12 other aviators who had minimal degrees of coronary artery disease with lesions less than 50% as the maximum degree of obstruction. Of these, 8 had abnormal thallium scans showing a perfusion defect in the area of the myocardium, presumably supplied by the diseased coronary artery. Of the 96 men with normal angiograms, only 4 had abnormal myocardial scintigraphy. An abnormal myocardial scintigram was often associated with significant obstructive disease. A normal scan accurately ruled out the presence of high-grade obstructive lesions and missed only four cases of minimal coronary disease. The application of gated thallium myocardial perfusion scans in the practice of aerospace cardiology has important significant applications for followup of therapeutic modalities as well as screening for evidence of myocardial ischemia in apparently healthy aircrew members.

  11. Detection of coronary artery disease in asymptomatic aircrew members with thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Thallium-201 exercise myocardial perfusion scintigraphy was accomplished in 130 aircrew members prior to their undergoing coronary angiography. Most were undergoing cardiac catheterization for an abnormal exercise response to treadmill testing. Of these, 22 men had arteriographic evidence of obstructive coronary disease of at least 50% narrowing in a single vessel. All had abnormal myocardial scintigrams. There were 12 other aviators who had minimal degrees of coronary artery disease with lesions less than 50% as the maximum degree of obstruction. Of these, 8 had abnormal thallium scans showing a perfusion defect in the area of the myocardium, presumably supplied by the diseased coronary artery. Of the 96 men with normal angiograms, only 4 had abnormal myocardial scintigraphy. An abnormal myocardial scintigram was often associated with significant obstructive disease. A normal scan accurately ruled out the presence of high-grade obstructive lesions and missed only four cases of minimal coronary disease. The application of gated thallium myocardial perfusion scans in the practice of aerospace cardiology has important significant applications for followup of therapeutic modalities as well as screening for evidence of myocardial ischemia in apparently healthy aircrew members

  12. Office of Coast Survey Wrecks and Obstructions Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Office of Coast Survey's Wrecks and Obstructions database contains information on the identified submerged wrecks and obstructions within the U.S. maritime...

  13. Office of Coast Survey's Automated Wreck and Obstruction Information System

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Automated Wreck and Obstruction Information System (AWOIS) is an automated file that contains information on wrecks and obstructions, and other significant...

  14. Malrotation causing duodenal chronic obstruction in an adult

    Institute of Scientific and Technical Information of China (English)

    Jun Gong; Zhen-Jiang Zheng; Gang Mai; Xu-Bao Liu

    2009-01-01

    Congenital duodenal obstruction is rare in adulthood. An unusual presentation of this condition has led to difficult preoperative diagnosis. We present a case of proximal jejunal obstruction by a congenital band in an adult and review the literature.

  15. Obstructive jaundice due to hepatobiliary cystadenoma or cystadenocarcinoma

    NARCIS (Netherlands)

    D. Erdogan; O.R.C. Busch; E.A.J. Rauws; O.M. van Delden; D.J. Gouma; T.M. van Gulik

    2006-01-01

    Hepatobiliary cystadenomas (HBC) and cystadenocarcinomas are rare cystic lesions. Most patients with these lesions are asymptomatic, but presentation with obstructive jaundice may occur. The first patient presented with intermittent colicky pain and recurrent obstructive jaundice. Imaging studies re

  16. Coronary arterial fistulas

    Directory of Open Access Journals (Sweden)

    Qureshi Shakeel A

    2006-12-01

    Full Text Available Abstract A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications. Disease name and synonyms Coronary arterial fistulas Coronary arterial fistulas or malformations

  17. Valuation analysis of renal Doppler ultrasound in pediatric patients at the Hospital Nacional de Ninos: resistance indices obtained in obstructive uropathy in children of 0 to 12 years from November to July, 2011

    International Nuclear Information System (INIS)

    The renal resistance index found in the pediatric population of 0 to 12 years with obstructive uropathy at the Hospital Nacional de Ninos has become known by analyzing resistance indices obtained through Doppler evaluation during the period November 2010 to July 2011. A relationship is established with the degree of dilatation of the collecting system. The renal resistance index determined by interrogation Doppler of intrarenal renal arteries. A comparison is performed by sex and age with severity of obstructive uropathy and respective resistance index, normal values of resistance index in renal and intrarenal arteries were obtained, in addition, a correlation was performed between the degree of severity of dilatation of the collecting system and resistance index in pediatric patients with obstructive uropathy

  18. Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective

    OpenAIRE

    Baron, Todd H

    2010-01-01

    Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent...

  19. Medication bezoar: Intestinal obstruction by an Isocal bezoar

    International Nuclear Information System (INIS)

    Medications may occasionally obstruct the gastrointestinal tract by virtue of their physical mass. Obturative obstruction of the alimentary tract is reportedly caused by an increasing number of medications, including hydroscopic bulk laxatives, cholestyramine, nonabsorbable antacids, and vitamin C tablets. Inspissated Isocal tube feedings caused jejunal obstruction in a postoperative patient. Medication bezoars are a rare cause of intestinal obstruction that may result in significant patient morbidity, including bowel necrosis, perforation, and peritonitis. The radiographic appearance may mimic an abdominal abscess. (orig.)

  20. Influence of Obstructive Jaundice on Pharmacodynamics of Rocuronium

    OpenAIRE

    Zhen-Meng Wang; Peng Zhang; Mi-Jia Lin; Bo Tan; Hai-Bo Qiu; Wei-Feng Yu

    2013-01-01

    BACKGROUND: Anesthetics are variable in patients with obstructive jaundice. The minimum alveolar concentration awake of desflurane is reduced in patients with obstructive jaundice, while it has no effect on pharmacodynamics and pharmacokinetics of propofol. In this study, we investigated the influence of obstructive jaundice on the pharmacodynamics and blood concentration of rocuronium. METHODS: Included in this study were 26 control patients and 27 patients with obstructive jaundice. Neuromu...

  1. Molecular mechanisms of recurrent acute obstructive bronchitis in infants

    OpenAIRE

    Abaturov A.E.; Rusakova E.A.

    2015-01-01

    The article discusses the clinical and immunological features and mechanisms of recurrent acute obstructive bronchitis in infants. We have examined 102 children aged from 6 months to 3 years with acute obstructive bronchitis and signs of respiratory insufficiency of the I-II degree. There were 28 children with recurrent acute obstructive bronchitis and 74 patients with acute obstructive bronchitis,developed for the first time. We determined the concentration of total IgE, content of IFN-і, IL...

  2. Anomalous right coronary artery arising from left anterior descending artery

    Directory of Open Access Journals (Sweden)

    M.L. Sreenivas Kumar

    2012-07-01

    Full Text Available A 54-year-old male patient presented with acute myocardial infarction involving left anterior descending and right coronary artery territories. Coronary angiogram showed a single coronary artery with right coronary artery arising from left anterior descending artery (LAD, which coursed anterior to right ventricular outflow tract and thrombotic lesion in mid left anterior descending artery before origin of right coronary artery. The patient was treated with thrombolytic therapy and glycoprotein IIb/IIIa inhibitors. Anomalous origin of right coronary artery as a branch of LAD is a very rare type of congenital coronary artery anomalies. It is important to recognize this anomaly as it can be associated with extensive myocardial ischemia and sudden cardiac death in young persons even without atherosclerosis.

  3. Pulmonary blood flow distribution in transposition of the great arteries

    International Nuclear Information System (INIS)

    Pulmonary blood flow distribution was studied by scintillation scanning of the lungs after the infusion of iodine-131-labeled macroaggregates of human albumin before and after the Mustard operation in 53 patients with transposition of the great arteries. The patients were classified as follows: Group 1 (24 infants with uncomplicated transposition of the great arteries); Group II (18 patients with transposition and ventricular septal defect); and Group III (11 patients with transposition, ventricular septal defect and pulmonary obstruction). Before operation, 21 patients had a normal distribution of pulmonary blood flow, 10 had preferential flow to the right lung and 2 had preferential flow to the left lung. After operation, 19 had a normal pattern of pulmonary blood flow, 21 had preferential flow to the right lung and 3 had preferential flow to the left lung. The scanning studies have proved helpful in follow-up of patients to rule out recurrence of the shunt, pulmonary or systemic venous obstruction, development of pulmonary hypertension and occlusion of a palliative systemic-pulmonary shunt

  4. Physiological factor analysis (FADS) in the diagnosis of renal obstruction

    International Nuclear Information System (INIS)

    Factor analysis has been used as an aid to the interpretation of dynamic scintigrams since the technique was described by Bazin in 1979. We have used a modified version of Barber's (1980) algorithm to analyse dynamic renal data (MacLeod and Houston 1985) and this paper describes the use of the technique to study 50 patients with clinically diagnosed renal obstruction in an effort to differentiate between an obstructive uropathy and an obstructive nephropathy. In this group 73 kidneys had a tentative diagnosis of obstruction made. Following a full clinical radiological and biochemical examination, 27 had a firm clinical diagnosis of an obstructive nephropathy made (13 confirmed at operation), 25 a diagnosis of obstructive uropathy and 21 were judged normal. Following standard 99sup(m)Tc-DTPA renography, performed on all 50 patients, data were analysed by deconvolution analysis, including parenchymal transit time measurements and by physiological factor analysis (FADS). The results showed that, of the 27 kidneys with a clinical diagnosis of an obstructive nephropathy, 19 (70%) had a PTT of > 300 seconds while 23 (85%) had a FAD's rating of 4 or 5. The corresponding false positive rates (ie, obstructive uropathy diagnosed as obstructive nephropathy) were 28% (PTT) and 12% (FADS). An ROC analysis of the PTT and FADS results in the 52 obstructed kidneys shows FADS analysis to be superior to PTTs in differentiating between an obstructive nephropathy and on obstructive uropathy. (Author)

  5. Chronic obstructive pulmonary disease exacerbation frequency and severity

    OpenAIRE

    Stafyla, Eirini

    2013-01-01

    Eirini Stafyla, Theodora Kerenidi, Konstantinos I Gourgoulianis Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, GreeceWe read with great interest the original work by Motegi et al1 comparing three multidimensional assessment systems – BODE (body mass index, obstruction, dyspnea, and exercise capacity) index, DOSE (dyspnea, obstruction, smoking, exacerbations) index and ADO (age, dyspnea, obstruction) index – ...

  6. Obstructions of Connectivity 2 for Embedding Graphs into the Torus

    OpenAIRE

    Mohar, Bojan; Škoda, Petr

    2012-01-01

    The complete set of minimal obstructions for embedding graphs into the torus is still not determined. In this paper, we present all obstructions for the torus of connectivity 2. Furthermore, we describe the building blocks of obstructions of connectivity 2 for any orientable surface.

  7. Mckusick-Kaufman Syndrome Presenting as Acute Intestinal Obstruction

    Science.gov (United States)

    V Badakali, Ashok; N Vanaki, R; S Samalad, Mahantesh

    2013-01-01

    Hydrometrocolpos and polydactyly have been associated with many syndromes and can present at any age. Rarely does hydrometrocolpos present as neonatal intestinal obstruction. We report two cases of McKusick-Kaufman syndrome presenting with intestinal obstruction. In both cases, intestinal obstruction got relieved after a cutaneous vaginostomy. PMID:26023427

  8. Diet and obstructive lung diseases.

    Science.gov (United States)

    Romieu, I; Trenga, C

    2001-01-01

    The results presented in this review suggest that the impact of nutrition on obstructive lung disease is most evident for antioxidant vitamins, particularly vitamin C and, to a lesser extent, vitamin E. By decreasing oxidant insults to the lung, antioxidants could modulate the development of chronic lung diseases and lung function decrement. Antioxidant vitamins could also play an important role in gene-environment interactions in complex lung diseases such as childhood asthma. Data also suggest that omega-3 fatty acids may have a potentially protective effect against airway hyperreactivity and lung function decrements; however, relevant data are still sparse. Although epidemiologic data suggest that consumption of fresh fruit may reduce risk of noncarcinogenic airway limitation, there are no clear data on which nutrients might be most relevant. While some studies evaluate daily intake of vitamin C, other studies use fruit consumption as a surrogate for antioxidant intake. Given the dietary intercorrelations among antioxidant vitamins, particularly vitamin C, beta-carotene, and flavonoids, as well as other micronutrients, it may be difficult to isolate a specific effect. Some population subgroups with higher levels of oxidative stress, such as cigarette smokers, may be more likely to benefit from dietary supplementation, since some studies have suggested that antioxidant intake may have a greater impact in this group. Studies of lung function decrement and COPD in adults suggest that daily intake of vitamin C at levels slightly exceeding the current Recommended Dietary Allowance (60 mg/day among nonsmokers and 100 mg/day among smokers) may have a protective effect (20). In the Schwartz and Weiss (85) and Britton et al. (87) studies, an increase of 40 mg/day in vitamin C intake led to an approximate 20-ml increase in FEV1. Daily mean vitamin C intakes in these studies were 66 mg and 99.2 mg, respectively, and the highest intake level (178 mg/day) was approximately

  9. Left main coronary artery compression in pulmonary arterial hypertension

    DEFF Research Database (Denmark)

    Al-Badri, Kadhem Helo Abbas; Jensen, Jesper Møller; Christiansen, Evald H;

    2015-01-01

    In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk...

  10. Left Anterior Descending Artery-Pulmonary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Turan Ege

    2011-12-01

    Full Text Available Despite the fact that coronary arteriovenous fistulas constitute approximately half (48% of coronary artery anomalies, they are rarely seen anomalies. In this report,we aim to present a coronary arteriovenous fistula case detected during a coronary angiography between left anterior descending artery and pulmonary artery.

  11. Carotid artery stenting

    International Nuclear Information System (INIS)

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  12. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  13. Modified nasopharyngeal tube for upper airway obstruction

    OpenAIRE

    Masters, I; Chang, A; Harris, M.; O'Neil, M.

    1999-01-01

    A modified nasopharyngeal tube is described that does not add airway dead space and resistance, is well tolerated, highly successful, and allows simultaneous use of oxygen prongs. This potentially reduces the need for surgical intervention to relieve high upper airway obstruction from Pierre-Robin syndrome and other causes.



  14. 33 CFR 401.53 - Obstructing navigation.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Obstructing navigation. 401.53 Section 401.53 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT CORPORATION, DEPARTMENT OF TRANSPORTATION SEAWAY REGULATIONS AND RULES Regulations Seaway Navigation § 401.53...

  15. Management of obstructive sleep apnea in Europe

    DEFF Research Database (Denmark)

    Fietze, I; Penzel, T; Alonderis, A;

    2011-01-01

    In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA...

  16. Mandibular advancement appliance for obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petri, Niels; Svanholt, Palle; Solow, Beni;

    2008-01-01

    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non...

  17. [Primary obstructive megaureter- diagnosis and treatment].

    Science.gov (United States)

    Aprodu, S G; Savu, B; Goţia, D G; Gavrilescu, S; Nedelcu, D; Apostol, D; Munteanu, V; Vlad, A; Brumaru, O; Munteanu, M

    2001-01-01

    The authors have treated 13 cases of primary obstructive megaureter (POM) in children, presenting without vesicoureteric reflux. The diagnostic possibilities and the surgical approach options are discussed. Both Cohen and Leadbetter--Politano uretero-vesical reimplantation techniques proved to be successful in this series. Ureteric folding was done in 2 cases. Reported final results are good in 10 cases. PMID:12092136

  18. 15.6.Nephrolithiasis and obstructive nephropathy

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920362 Vesicoureteral reflux and refluxnephropathy in adults.LI Youji (李幼姬),et al.Renal Instit,1st Hosp,Zhongshan Med Univ.ChinJ Nephrol 1991;7(6):341-344.Chronic recurent non-obstructive urinary tract

  19. A RARE FETAL ANOMALY CAUSING OBSTRUCTED LABOUR

    OpenAIRE

    Pia Muriel; Sushama; Guruprasad; Analise D

    2014-01-01

    Prune belly syndrome is a rare congenital disease. Its incidence being 1 in 30,000 to 1 in 50,000 births. Males are more affected than females. A third of cases are usually stillbirths. Herewith, we present to you a baby who was diagnosed to have prune belly syndrome and its obstructed labour course which we managed by fetal abdominal tapping.

  20. Chronic obstructive pulmonary disease - adults - discharge

    Science.gov (United States)

    ... visit when they're all better. Save Your Energy at Home Place items you use often in spots where ... H, Bruhl E, et al. Institute for Clinical Systems Improvement. Health care guideline: Diagnosis and management of chronic obstructive pulmonary disease (COPD). 10th edition. ...

  1. Extrahepatic biliary obstruction; postoperative morbidity and mortality

    International Nuclear Information System (INIS)

    The objectives of this study are to evaluate the surgical management, both definitive and palliative, in selected patients with biliary obstruction and to find out the postoperative morbidity and mortality in these patients. Duration of the study is two years conducted from June 2002 to May 2004. The study was carried out at. the surgical. unit 4 of the Combined Military Hospital and surgical department of the Military Hospital. Thirty eight cases of biliary obstruction were included. A convenient sampling technique was followed. Data analyzed by using SPSS version 10.0 for windows on computer. Descriptive statistics like frequency, percentage, average etc were computed for data presentation. Any inferential test-was not found to be applicable for this descriptive type case series. We selected 38 patients with features of extrahepatic biliary obstruction. Out of these (n 38) 15 patients (39.5%) suffered from benign diseases while those having malignant diseases were 23 (60.5%). 19 (50%) patients died within two years of follow up while 19 (50%) were the survivors. Mortality was maximum for the malignant cases. In benign cases only one patient died. Maximum deaths 6 (31.6%) occurred in the period of up to one month of operation. 20 patients had one or another complication of operation and hence the morbidity came out to be 52%. According to our results the mortality and morbidity related to extrahepatic biliary obstruction in our patients was higher compared to other studies which can only be reduced by early detection and treatment. (author)

  2. Enteral feed obstructing its own way

    Directory of Open Access Journals (Sweden)

    Kesarwani Vikas

    2010-01-01

    Full Text Available Esophageal obstruction due to solidified enteral feeds is a rare but distressful complication in intensive care unit (ICU patients. It has been suggested that gastroesophageal reflux, very low gastric pH, decreased pepsin and pancreatic enzyme secretions may be responsible for the solidification of casein containing enteral formulas. Recognition and avoidance of these factors will prevent such complication.

  3. Functional obstruction: the renal pelvis rules

    OpenAIRE

    Mendelsohn, Cathy

    2004-01-01

    Failure in the peristaltic mechanism that conducts urine from the kidney to the bladder can lead to hydronephrosis, a common birth defect associated with obstructive nephropathy. New animal models reveal molecular pathways important for peristalsis and point to the central role of the renal pelvis in urine transport.

  4. ROUNDED FLOWING STATES OF OBSTRUCTED BUOYANT JET

    Institute of Scientific and Technical Information of China (English)

    HUAI Wen-xin; FANG Shen-guang

    2006-01-01

    The mutual relationships of three effective factors, the diameter D/d (d is the diameter of exit) of obstructed plate, exit densimetric Froude number and the distance H/d of the plate from jet orifice for obstructed buoyant jet in static ambient, are analyzed to explain normal and abnormal rounded flowing (reverberated and bifurcated flowing).The critical Froude numbers for obstructed buoyant jets with H/d=2, 4, 6, 8 which distinguished normal and abnormal flowing pattern are obtained. Normal rounded flowing is found only for a plate under a special value of H/d. A fitted formula of critical Froude numbers with H/d and D/d is presented to distinguish rounded flowing types. The occurring of reverberated or bifurcated flowing in abnormal rounded flow is analyzed. Based on the results of obstructed buoyant jets with D/d=1, normal rounded flowing occurred only for all conditions and axial dilution behind the plate under different H/D is obtained.

  5. Obstructive Jaundice Associated with Polcystic Liver Disease

    OpenAIRE

    Dmitrewski, J.; Olliff, S; Buckels, J. A. C.

    1996-01-01

    A 65 year old patient with polycystic liver disease presented with obstructive jaundice thought to be a cholangiocarcinoma. Subsequent investigations demonstrated a large cyst compressing the confluence of the hepatic ducts. Percutaneous decompression of the biliary tree led to a complication necessitating surgery. Treatment options for symptomatic polycystic liver disease are reviewed.

  6. Left ventricular outflow obstruction and necrotizing enterocolitis

    Energy Technology Data Exchange (ETDEWEB)

    Allen, H.A.; Haney, P.J.

    1984-02-01

    Two neonates had unusually rapid development of necrotizing enterocolitis within 24 hours of birth. Both patients had decreased systemic perfusion secondary to aortic atresia. Onset of either clinical or radiographic manifestations of necrotizing enterocolitis in the first day of life should alert one to the possible presence of severe left ventricular outflow obstruction.

  7. About Peripheral Artery Disease (PAD)

    Science.gov (United States)

    ... Tools & Resources Stroke More About Peripheral Artery Disease (PAD) Updated:Mar 23,2016 Peripheral artery disease (PAD) ... critical regions of the body. Quick Facts about PAD View an illustration of PAD The most common ...

  8. Pharmacological modulation of arterial stiffness.

    LENUS (Irish Health Repository)

    Boutouyrie, Pierre

    2011-09-10

    Arterial stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial stiffness is determined by the composition of the arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery stiffness. Change in arterial stiffness with drugs is an important endpoint in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for \\'de-stiffening drugs\\

  9. High prevalence of obstructive sleep apnea in patients with moderate to severe chronic obstructive pulmonary disease

    OpenAIRE

    Soler, X; Gaio, E.; Powell, FL; Ramsdell, JW; Loredo, JS; Malhotra, A; Ries, AL

    2015-01-01

    Copyright © 2015 by the American Thoracic Society. Rationale: When obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) coexist in the so-called "overlap" syndrome,a high risk formortalityandmorbidity hasbeenreported.There is controversy about the prevalence of OSA in people affected by COPD. Objectives: The purpose of this study was to investigate objective meaures of sleep-disordered breathing in patients with moderate to severe COPD to test the hypothesis that COP...

  10. Endothelin receptor antagonist and airway dysfunction in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Borst Mathias M

    2009-12-01

    Full Text Available Abstract Background In idiopathic pulmonary arterial hypertension (IPAH, peripheral airway obstruction is frequent. This is partially attributed to the mediator dysbalance, particularly an excess of endothelin-1 (ET-1, to increased pulmonary vascular and airway tonus and to local inflammation. Bosentan (ET-1 receptor antagonist improves pulmonary hemodynamics, exercise limitation, and disease severity in IPAH. We hypothesized that bosentan might affect airway obstruction. Methods In 32 IPAH-patients (19 female, WHO functional class II (n = 10, III (n = 22; (data presented as mean ± standard deviation pulmonary vascular resistance (11 ± 5 Wood units, lung function, 6 minute walk test (6-MWT; 364 ± 363.7 (range 179.0-627.0 m, systolic pulmonary artery pressure, sPAP, 79 ± 19 mmHg, and NT-proBNP serum levels (1427 ± 2162.7 (range 59.3-10342.0 ng/L were measured at baseline, after 3 and 12 months of oral bosentan (125 mg twice per day. Results and Discussion At baseline, maximal expiratory flow at 50 and 25% vital capacity were reduced to 65 ± 25 and 45 ± 24% predicted. Total lung capacity was 95.6 ± 12.5% predicted and residual volume was 109 ± 21.4% predicted. During 3 and 12 months of treatment, 6-MWT increased by 32 ± 19 and 53 ± 69 m, respectively; p Conclusion This study gives first evidence in IPAH, that during long-term bosentan, improvement of hemodynamics, functional parameters or serum biomarker occur independently from persisting peripheral airway obstruction.

  11. Combination of rare right arterial variation with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. A case report.

    Science.gov (United States)

    Ishihara, H; San Millán Ruíz, D; Abdo, G; Asakura, F; Yilmaz, H; Lovblad, K O; Rüfenacht, D A

    2011-09-01

    A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed. PMID:22005696

  12. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development of...... cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

  13. Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

    Directory of Open Access Journals (Sweden)

    Carlos Zamarrón

    2009-01-01

    Full Text Available Carlos Zamarrón1, Vanesa García Paz1, Emilio Morete1, Felix del Campo Matías21Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago, Spain; 2Servicio de Neumologia, Hospital Universitario Rio Ortega de Vallaclolid, Vallaclolid, SpainAbstract: Obstructive sleep apnea syndrome (OSAS and chronic obstructive pulmonary disease (COPD are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.Keywords: chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, overlap syndrome, sleep, cardiovascular disease

  14. Iliocaval Confluence Stenting for Chronic Venous Obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Graaf, Rick de, E-mail: r.de.graaf@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Wolf, Mark de, E-mail: markthewolf@gmail.com [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Sailer, Anna M., E-mail: anni.sailer@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Laanen, Jorinde van, E-mail: jorinde.van.laanen@mumc.nl; Wittens, Cees, E-mail: c.wittens@me.com [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Jalaie, Houman, E-mail: hjalaie@ukaachen.de [University Hospital Aachen, Department of Surgery (Germany)

    2015-10-15

    PurposeDifferent techniques have been described for stenting of venous obstructions. We report our experience with two different confluence stenting techniques to treat chronic bi-iliocaval obstructions.Materials and MethodsBetween 11/2009 and 08/2014 we treated 40 patients for chronic total bi-iliocaval obstructions. Pre-operative magnetic resonance venography showed bilateral extensive post-thrombotic scarring in common and external iliac veins as well as obstruction of the inferior vena cava (IVC). Stenting of the IVC was performed with large self-expandable stents down to the level of the iliocaval confluence. To bridge the confluence, either self-expandable stents were placed inside the IVC stent (24 patients, SECS group) or high radial force balloon-expandable stents were placed at the same level (16 patients, BECS group). In both cases, bilateral iliac extensions were performed using nitinol stents.ResultsRecanalization was achieved for all patients. In 15 (38 %) patients, a hybrid procedure with endophlebectomy and arteriovenous fistula creation needed to be performed because of significant involvement of inflow vessels below the inguinal ligament. Mean follow-up was 443 ± 438 days (range 7–1683 days). For all patients, primary, assisted-primary, and secondary patency rate at 36 months were 70, 73, and 78 %, respectively. Twelve-month patency rates in the SECS group were 85, 85, and 95 % for primary, assisted-primary, and secondary patency. In the BECS group, primary patency was 100 % during a mean follow-up period of 134 ± 118 (range 29–337) days.ConclusionStenting of chronic bi-iliocaval obstruction shows relatively high patency rates at medium follow-up. Short-term patency seems to favor confluence stenting with balloon-expandable stents.

  15. Influential factors and formation of extrahepatic collateral artery in unresectable hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yong-Li Wang; Ming-Hua Li; Ying-Sheng Cheng; Hai-Bing Shi; Hai-Lun Fan

    2005-01-01

    AIM: To analyze the influence factors and formation of extrahepatic collateral arteries (ECAs) in unresectable hepatocellular carcinoma (HCC) with or without chemoembolization.METHODS: Detailed histories of 35 patients with 39 ECAs of HCC and images including computerized tomography scan, digital subtraction angiography were reviewed carefully to identify ECAs of HCC, ECAs arising from, and anatomic location of tumors in liver. Tumor sizes were measured, and relations of EC As with times of chemoembolization, tumor size, and the anatomic tumor location were analyzed. Complications were observed after chemoembolization through ECAs of HCC with different techniques. RESULTS: Influence factors of formation of ECAs of HCC included the times of repeated chemoembolization, thelocation of tumors in liver, the tumor size and the types of chemoembolization. ECAs in HCC appeared after 3-4 times of chemoembolization (17.9%), but a higher frequency of ECAs occurred after 5-6 times of chemoembolization (56.4%). ECAs presented easily in peripheral areas (71.8%) of liver abutting to the anterior, posterior abdominal walls, the top right of diaphragm and right kidney.ECAs also occurred easily after complete obstruction of the trunk arteries supplying HCCs or the branches of proper hepatic arteries. Extrahepatic collaterals of HCC originated from right internal thoracic (mammary) artery (RITA, 5.1%), right intercostal artery (RICA, 7.7%), left gastric artery (LGA, 12.8%), right inferior phrenic artery (RIPA, 38.5%),omental artery (OTA, 2.6%), superior mesenteric artery (SMA, 23.1%), and right adrenal and renal capsule artery (RARCA, 10.3%), respectively. The complications after chemoembolization attributed to no super selective cathet erization.CONCLUSION: The formation of ECAs in unresectable HCCis obviously correlated with multiple chemoembolization,tumor size, types of chemoembolization, anatomic locationof tumors. Extrahepatic collaterals in HCC are corresponding to the tumor

  16. Ventilatory-perfusion relationships and respiratory drive in chronic obstructive pulmanory disease : With special reference to hypoxaemia, sleep quality and treatment with inhaled corticisteroid

    OpenAIRE

    Sandek, Karin

    2002-01-01

    By measuring retention in blood and excretion in exhaled air of six infused inert gases using multiple inert gas technique (MIGET), it is possible to obtain detailed assessment of the ventilation-perfusion (VA/Q) relationships in patients with chronic obstructive pulmonary disease. Stable, non-bronchitic COPD patients show a substantial perfusion of hyper-ventilated lung regions. For individuals with exclusively nocturnal hypoxaemia, when the nocturnal arterial oxygen satur...

  17. Detection of obstructive uropathy using 99m technetium diethylenetriaminepentaacetic acid

    International Nuclear Information System (INIS)

    A simple, accurate test with no morbidity and effective for the detection of urinary tract obstruction in patients with normal and impaired renal function would be of significant clinical use. The ability of 99m technetium diethylenetriaminepentaacetic acid to detect the presence or absence of obstruction is evaluated. Obstructions were defined as abnormal retention of activity in the collecting system persisting in the delayed images. Diethylentriaminepentaacetic acid identified correctly 13 of 13 patients proved to have obstruction and 17 of 18 without obstruction. These data indicate a sensitivity of 100 percent, specificity of 94 percent and accuracy of 97 percent

  18. Detection of obstructive uropathy using 99m technetium diethylenetriaminepentaacetic acid

    Energy Technology Data Exchange (ETDEWEB)

    Powers, T.A.; Grove, R.B.; Bauriedel, J.K.; Orr, S.C.; Melton, R.E.; Bowenn, R.D.

    1980-11-01

    A simple, accurate test with no morbidity and effective for the detection of urinary tract obstruction in patients with normal and impaired renal function would be of significant clinical use. The ability of 99m technetium diethylenetriaminepentaacetic acid to detect the presence or absence of obstruction is evaluated. Obstructions were defined as abnormal retention of activity in the collecting system persisting in the delayed images. Diethylentriaminepentaacetic acid identified correctly 13 of 13 patients proved to have obstruction and 17 of 18 without obstruction. These data indicate a sensitivity of 100 percent, specificity of 94 percent and accuracy of 97 percent.

  19. Persistent Trigeminal Artery

    Directory of Open Access Journals (Sweden)

    Dijo T George

    2015-04-01

    Full Text Available Trigeminal artery is the commonest of the four primitive anastomoses between the carotid and vertebrobasilar system that may rarely persist in adults, with an angiographic incidence of 0.1 - 0.6%. We present the CT and MR angiograms of a patient who presented with a minor stroke and was detected to have this anomaly and briefly discuss the significance

  20. Mensuration of cardioangiopulmonary indices by radiocardiogram before and after the verapamil oral administration in subjects with chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    Twenty subjects with chronic obstructive pulmonary disease were studied. The diagnosis was obtained from the history, clinical evaluation, pulmonary radiography, pulmonary and hepatic scintigraphies and spirometry. About 360 mg of verapamil was administered daily, every eight hours for ten days. Before and after drug administration, the arterial pressures, the spirometric measurements and nine cardiac roentgenographic indexes were measured. Vital capacity increased in all cases, but did not reach the normal levels. These data suggest that the effect of verapamil on the pulmonary circulation brought benefits to the subjects. This occurred either by direct pulmonary vasodilation, or by bronchodilation, reducing hypoxia. In all cases, the pulmonary resistance was diminished. Finally, verapamil seems to be a drug with real benefits in subjects with chronic obstructive pulmonary disease and we advise a continuation of the studies. (author)

  1. Basilar Artery Aneurysm at a Persistent Trigeminal Artery Junction

    Science.gov (United States)

    Aguiar, G.B.; Conti, M.L.M.; Veiga, J.C.E.; Jory, M.; Souza, R.B.

    2011-01-01

    Summary The trigeminal artery is an anastomosis between the embryonic precursors of the vertebrobasilar and carotid systems, and may persist into adult life. The association of the persistent primitive trigeminal artery (PTA) with cerebral aneurysm is well documented in the literature and, in general, aneurysms are located in the anterior circulation. We describe a patient who presented with a panencephalic Fisher III subarachnoid hemorrhage due to rupture of an intracranial aneurysm. Digital arteriography showed a saccular aneurysm in the middle third of the basilar artery, adjacent to the junction with a persistent trigeminal artery. She was submitted to endovascular treatment with embolization of the basilar artery aneurysm with coils. Aneurysms at the PTA junction with the basilar artery are rare. This paper describes a case of PTA associated with an aneurysm in the basilar artery at PTA junction and briefly reviews the literature. PMID:22005697

  2. Abolished ventilation and perfusion of lung caused by blood clot in the left main bronchus: auto-downregulation of pulmonary arterial blood supply.

    Science.gov (United States)

    Afzelius, P; Bergmann, A; Henriksen, J H

    2015-01-01

    It is generally assumed that the lungs possess arterial autoregulation associated with bronchial obstruction. A patient with pneumonia and congestive heart failure unexpectedly developed frequent haemoptysis. High-resolution CT and diagnostic CT were performed as well as ventilation/perfusion (V/Q) scintigraphy with single-photon emission CT (SPECT)/CT. V/Q SPECT/CT demonstrated abolished ventilation due to obstruction of the left main bronchus and markedly reduced perfusion of the entire left lung, a condition that was completely reversed after removal of a blood clot. We present the first pictorially documented case of hypoxia-induced pulmonary vasoconstriction and flow shift in a main pulmonary artery due to a complete intrinsic obstruction of the ipsilateral main bronchus. The condition is reversible, contingent on being relieved within a few days. PMID:26374773

  3. Percutaneous Transhepatic Duodenal Drainage as an Alternative Approach in Afferent Loop Obstruction with Secondary Obstructive Jaundice in Recurrent Gastric Cancer

    International Nuclear Information System (INIS)

    Two cases are reported of chronic, partial afferent loop obstruction with resultant obstructive jaundice in recurrent gastric cancer. The diagnosis was made by characteristic clinical presentations, abdominal computed tomography, and cholescintigraphy. Percutaneous transhepatic duodenal drainage (PTDD) provided effective palliation for both afferent loop obstruction and biliary stasis. We conclude that cholescintigraphy is of value in making the diagnosis of partial afferent loop obstruction and in differentiating the cause of obstructive jaundice in such patients, and PTDD provides palliation for those patients in whom surgical intervention is not feasible

  4. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    Science.gov (United States)

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  5. Intrapulmonary arteriovenous anastomoses in humans with chronic obstructive pulmonary disease: implications for cryptogenic stroke?

    Science.gov (United States)

    Norris, H Cameron; Mangum, Tyler S; Kern, Julia P; Elliott, Jonathan E; Beasley, Kara M; Goodman, Randy D; Mladinov, Suzana; Barak, Otto F; Bakovic, Darija; Dujic, Zeljko; Lovering, Andrew T

    2016-08-01

    What is the central question of this study? Do individuals with chronic obstructive pulmonary disease have blood flow through intrapulmonary arteriovenous anastomoses at rest or during exercise? What is the main finding and its importance? Individuals with chronic obstructive pulmonary disease have a greater prevalence of blood flow through intrapulmonary arteriovenous anastomoses at rest than age-matched control subjects. Given that the intrapulmonary arteriovenous anastomoses are large enough to permit venous emboli to pass into the arterial circulation, patients with chronic obstructive pulmonary disease and an elevated risk of thrombus formation may be at risk of intrapulmonary arteriovenous anastomosis-facilitated embolic injury (e.g. stroke or transient ischaemic attack). The pulmonary capillaries prevent stroke by filtering venous emboli from the circulation. Intrapulmonary arteriovenous anastomoses are large-diameter (≥50 μm) vascular connections in the lung that may compromise the integrity of the pulmonary capillary filter and have recently been linked to cryptogenic stroke and transient ischaemic attack. Prothrombotic populations, such as individuals with chronic obstructive pulmonary disease (COPD), may be at increased risk of stroke and transient ischaemic attack facilitated by intrapulmonary arteriovenous anastomoses, but the prevalence and degree of blood flow through intrapulmonary arteriovenous anastomoses in this population has not been fully examined and compared with age-matched healthy control subjects. We used saline contrast echocardiography to assess blood flow through intrapulmonary arteriovenous anastomoses at rest (n = 29 COPD and 19 control subjects) and during exercise (n = 10 COPD and 10 control subjects) in subjects with COPD and age-matched healthy control subjects. Blood flow through intrapulmonary arteriovenous anastomoses was detected in 23% of subjects with COPD at rest and was significantly higher compared with age

  6. Utility of approximate entropy from overnight pulse oximetry data in the diagnosis of the obstructive sleep apnea syndrome.

    OpenAIRE

    Hornero, R.; D Alvarez; Abásolo, D; Del Campo, F; Zamarrón, C

    2007-01-01

    Approximate entropy (ApEn) is a family of statistics introduced as a quantification of regularity in time series without any a priori knowledge about the system generating them. The aim of this preliminary study was to assess whether a time series analysis of arterial oxygen saturation (SaO2) signals from overnight pulse oximetry by means of ApEn could yield essential information on the diagnosis of obstructive sleep apnea (OSA) syndrome. We analyzed SaO2 signals from 187 subjects: 111 with a...

  7. Esophageal stent migration leads to intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Oguzhan Karatepe

    2009-07-01

    Full Text Available Background: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of esophagus. Stent migration is a well-known complication of this procedure. Aims: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. Methods: A 65-year-old woman, who had a medical history of gastric cancer operation and esophageal stent application admitted to our emergeny department with a 48-hour history of abdominal pain, nausea and vomiting. An emergeny laparotomy was performed and the migrated stent leading to intestinal obstruction was removed. Results: The patient recovered without incident and was discharged on postoperative day 3. Conclusion: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

  8. Hot tonsillectomy for paediatric obstructive sleep apnoea

    Science.gov (United States)

    Coyle, Paula; Marzouk, Sherief Deya; Gerolympou, Margarita; Marais, Joe

    2014-01-01

    Obstructive sleep apnoea is a common presentation in paediatric ear, nose and tongue (ENT) outpatients. The use of sleep studies is controversial however once a diagnosis has been made, frequently treatment is surgery. Should these patients be operated on as urgent cases? A 5-year-old boy was admitted under the paediatric team with difficultly breathing and desaturations to 77%. The patient had previously been seen by ENT as an outpatient with an 8-month history of obstructive sleep apnoea and was listed for an adenotonsillectomy with the standard waiting time. During this admission he had an emergency adenotonsillectomy. The patient improved immediately with no large desaturations in recovery and normal observations throughout his stay. It is never ideal to do a paediatric emergency operation and we have reviewed the evidence base to answer the question: Should these patients be treated urgently when seen in outpatients? PMID:24907212

  9. Quality of Life in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Naveen Dutt

    2014-03-01

    Full Text Available Obstructive sleep apnea (OSA is associated with significant cardiovascular andcerebrovascular morbidity and mortality. Usual parameters studied in sleep laboratoryare unable to measure overall impact of OSA on human life. Consequently, it isimportant to measure Quality of Life (QoL in OSA. QoL can be measured with genericinstruments like SF-36 or OSA specific questionnaires like Calgary Sleep ApneaQuality of Life (SAQLI questionnaire. Most of the studies suggest that there issignificant impairment of QoL in patients of OSA. But the present evidence suggeststhat impairment in QoL is not proportional to severity of OSA. There is no consensus onthe question of improvement in QoL with Continuous Positive Airway Pressure(CPAP therapy. A recent Cochrane review concluded that CPAP improves QoL inpeople with moderate and severe OSA.Key words : Obstructive sleep apnea, Quality of Life, Continuous Positive AirwayPressure

  10. The pathology of chronic obstructive pulmonary disease.

    Science.gov (United States)

    Hogg, James C; Timens, Wim

    2009-01-01

    The pathogenesis of chronic obstructive pulmonary disease (COPD) is based on the innate and adaptive inflammatory immune response to the inhalation of toxic particles and gases. Although tobacco smoking is the primary cause of this inhalation injury, many other environmental and occupational exposures contribute to the pathology of COPD. The immune inflammatory changes associated with COPD are linked to a tissue-repair and -remodeling process that increases mucus production and causes emphysematous destruction of the gas-exchanging surface of the lung. The common form of emphysema observed in smokers begins in the respiratory bronchioles near the thickened and narrowed small bronchioles that become the major site of obstruction in COPD. The mechanism(s) that allow small airways to thicken in such close proximity to lung tissue undergoing emphysematous destruction remains a puzzle that needs to be solved. PMID:18954287

  11. Complex networks analysis of obstructive nephropathy data

    Science.gov (United States)

    Zanin, M.; Boccaletti, S.

    2011-09-01

    Congenital obstructive nephropathy (ON) is one of the most frequent and complex diseases affecting children, characterized by an abnormal flux of the urine, due to a partial or complete obstruction of the urinary tract; as a consequence, urine may accumulate in the kidney and disturb the normal operation of the organ. Despite important advances, pathological mechanisms are not yet fully understood. In this contribution, the topology of complex networks, based on vectors of features of control and ON subjects, is related with the severity of the pathology. Nodes in these networks represent genetic and metabolic profiles, while connections between them indicate an abnormal relation between their expressions. Resulting topologies allow discriminating ON subjects and detecting which genetic or metabolic elements are responsible for the malfunction.

  12. Hepatic venous outflow obstruction: Three similar syndromes

    Institute of Scientific and Technical Information of China (English)

    Ulas Darda Bayraktar; Soley Seren; Yusuf Bayraktar

    2007-01-01

    Our goal is to provide a detailed review of venoocclusive disease (VOD), Budd-Chiari syndrome (BCS),and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed,enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS,and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions.However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction.Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.

  13. An endocrine problem of obstructive uropathy: pseudohypoaldosteronism

    Directory of Open Access Journals (Sweden)

    Derya Büyükkayhan

    2007-02-01

    Full Text Available In the presence of obstructive uropathy, the normal defense mechanisms preventing urinary tract infections (UTI are compromised, and accordingly, the incidence of pyelonephritis is increased significantly. However, most patients remain without symptoms. Serious electrolyte imbalance is uncommon. Rarely, obstructive uropathy may result in tubular damage or a decrease in nephron number. Tubular damage can result in renal tubular unresponsiveness to aldosterone. This has been called transient pseudohypoaldesteronism (PHA and clinical manifestations have reported hyponatremia, hyperkalemia and metabolic acidosis. These findings may resemble congenital adrenal hyperplasia (CAH. Therefore, CAH is often an initial presumptive diagnosis, resulting in inappropriate therapy. We report the case of a 29-day-old boy with vesicoureteral reflux and pyelonephritis complicated by pseudohypoaldosteronism leading to excessive salt wasting.

  14. Treatment of the Obstructive Sleep Apnea Syndrome

    OpenAIRE

    Wiggins, Robert V.; Schmidt-Nowara, Wolfgang W.

    1987-01-01

    The obstructive sleep apnea syndrome is a disorder of sleep and breathing that is being recognized with increasing frequency. The pathophysiologic consequences range from mild sleepiness to life-threatening cardiovascular and respiratory decompensation. The primary forms of treatment are directed at modifying the upper airway with either an operation or continuous positive airway pressure. Aside from tracheostomy, which is virtually always successful, other forms of treatment have met with va...

  15. Modern management of obstructive salivary diseases

    OpenAIRE

    Capaccio, P; Torretta, S.; Ottaviani, F.; Sambataro, G; Pignataro, L

    2007-01-01

    Over the last fifteen years, increasing public demand for minimally-invasive surgery and recent technological advances have led to the development of a number of conservative options for the therapeutic management of obstructive salivary disorders such as calculi and duct stenosis. These include extracorporeal shock-wave lithotripsy, sialoendoscopy, laser intra-corporeal lithotripsy, interventional radiology, the video-assisted conservative surgical removal of parotid and sub-mandibular calcu...

  16. Natural Histories of Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Rennard, Stephen I.; Vestbo, Jørgen

    2008-01-01

    Concepts relating to the natural history of chronic obstructive pulmonary disease (COPD) arise most importantly from the classic study of Fletcher and colleagues (The Natural History of Chronic Bronchitis and Emphysema, Oxford University Press, New York, 1976). This study, which evaluated working English men over 8 years, was used to construct a proposed life-long natural history. Although this is a classic study that has greatly advanced understanding of COPD, it has a number of limitations....

  17. The pathogenesis of obstructive sleep apnea

    OpenAIRE

    Pham, Luu V.; Schwartz, Alan R.

    2015-01-01

    Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelli...

  18. Diaphragm Dysfunction in Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Ottenheijm, Coen A. C.; Heunks, Leo M.A.; Sieck, Gary C.; Zhan, Wen-Zhi; Jansen, Suzanne M.; Degens, Hans; de Boo, Theo; Dekhuijzen, P.N Richard

    2005-01-01

    Rationale: Hypercapnic respiratory failure because of inspiratory muscle weakness is the most important cause of death in chronic obstructive pulmonary disease (COPD). However, the pathophysiology of failure of the diaphragm to generate force in COPD is in part unclear. Objectives: The present study investigated contractile function and myosin heavy chain content of diaphragm muscle single fibers from patients with COPD. Methods: Skinned muscle fibers were isolated from muscle biopsies from t...

  19. Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction

    OpenAIRE

    Aiken, WD; Mayhew, RG; Mitchell, S; Stennett, M; Johnson, P.

    2015-01-01

    A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case o...

  20. Experimental Colonic Obstruction and Anastomotic Healing

    OpenAIRE

    Rehn, Martin

    2012-01-01

    Colorectal cancer is one of the most common malignant diseases world-wide. Most patients can be diagnosed, staged and treated by surgery in an elective setting. However, about one fifth of the patients will have an emergency presentation and in most cases due to malignant obstruction of the left colon. Immediate resection and anastomosis is feasible but carries a 3-fold higher risk of developing anastomotic leakage compared to elective surgery. Anastomotic healing in patients can be evaluated...

  1. Exacerbations of Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Garvey, Christine; Ortiz, Gabriel

    2012-01-01

    Epidemiologic data indicate that chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Patients with poorly managed COPD are likely to experience exacerbations that require emergency department visits or hospitalization—two important drivers contributing to escalating healthcare resource use and costs associated with the disease. Exacerbations also contribute to worsening lung function and negative outcomes in COPD. The aim of this review is to present th...

  2. A RARE FETAL ANOMALY CAUSING OBSTRUCTED LABOUR

    Directory of Open Access Journals (Sweden)

    Pia Muriel

    2014-10-01

    Full Text Available Prune belly syndrome is a rare congenital disease. Its incidence being 1 in 30,000 to 1 in 50,000 births. Males are more affected than females. A third of cases are usually stillbirths. Herewith, we present to you a baby who was diagnosed to have prune belly syndrome and its obstructed labour course which we managed by fetal abdominal tapping.

  3. Primary Pelvic Hydatid Cyst Obstructing the Labour

    OpenAIRE

    Sandhya S. Ware; Suwarna B Patil; Dilip S Sarate; Vinod K Sawaitul

    2015-01-01

    Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Primary pelvic hydatid cyst is an extremely rare condition and occurs in approximately 0.7% of patients. Hydatid disease in pregnancy is a very rare condition with incidence of 1/20000 pregnancies. We report here an unusual case of hydatid cyst of the pelvis in a 30 years old multigravida presenting with obstructed labour. Ultrasonography showed well defined mixechoic c...

  4. Tooth loss and obstructive sleep apnoea

    OpenAIRE

    Gai Valerio; Pera Paolo; Erovigni Francesco; Graziano Alessandra; Arienti Andrea; Brussino Luisa; Cicolin Alessandro; Bucca Caterina; Mutani Roberto; Preti Giulio; Rolla Giovanni; Carossa Stefano

    2006-01-01

    Abstract Background Complete tooth loss (edentulism) produces anatomical changes that may impair upper airway size and function. The aim of this study was to evaluate whether edentulism favours the occurrence of obstructive sleep apnoea (OSA). Methods Polysomnography was performed in 48 edentulous subjects on two consecutive nights, one slept with and the other without dentures. Upper airway size was assessed by cephalometry and by recording forced mid-inspiratory airflow rate (FIF50). Exhale...

  5. Sleep · 8: Paediatric obstructive sleep apnoea

    OpenAIRE

    Nixon, G; Brouillette, R

    2005-01-01

    In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research.

  6. An atypical case of large bowel obstruction

    OpenAIRE

    Hughes, Kaylie E.; Arthur, James

    2013-01-01

    In Europe up to nine per cent of people suffer from renal calculi during their lifetime. Staghorn calculi are common and account for ∼11% of cases. Classic presentations include persistent loin pain, recurrent pyelonephritis or cystitis-like symptoms, renal colic or occasional haematuria. We present what we believe to be the first documented case of large bowel obstruction caused by a benign colonic stricture formed secondary to extravasation of a staghorn calculus.

  7. Obstructive jaundice induced by biliary ascariasis

    OpenAIRE

    Keating, Aine; Quigley, James Aidan; Genterola, Al Frederick

    2012-01-01

    Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice and vomiting. Ultrasound was used and the diagnosis of biliary ascariasis was made. The patient underwe...

  8. Obstructive Jaundice: A Case of Idiopathic Cholestasis

    OpenAIRE

    Worobetz, Lawrence; Haight, Ken; Brown, Murray

    1984-01-01

    A 44-year-old man presented to his family physician with intrahepatic cholestatic jaundice, which he had had for seven days. He was admitted to the Family Medicine Service of University Hospital, Saskatoon, and the jaundice was extensively investigated. Initially, it was thought to be induced by antibiotics, but this was not confirmed on controlled drug rechallenge. The precise cause was not found. This article outlines a rational and systematic method for investigating obstructive jaundice. ...

  9. Portal Vein Aneurysm Presenting with Obstructive Jaundice

    OpenAIRE

    Chandana Lall; Sadhna Verma; Rajesh Gulati; Puneet Bhargava

    2012-01-01

    To the best of our knowledge, a portal vein aneurysm presenting with obstructive jaundice has not been reported in the literature. The preferred treatment for these aneurysms is surgical and a shunting procedure should be considered in cases with portal hypertension to preserve portal vein flow when portal hypertension is present or is secondary to the aneurysm itself. In our case, due to patient′s advanced age and co-morbidities, an endoscopic biliary stent was placed which led to successful...

  10. New frontiers in obstructive sleep apnoea

    OpenAIRE

    Ayas, NT; Hirsch, AAJ; Laher, I; Douglas Bradley, T; Malhotra, A; Polotsky, VY; Tasali, E

    2014-01-01

    OSA (obstructive sleep apnoea), the most common respiratory disorder of sleep, is caused by the loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. This results in recurrent nocturnal asphyxia. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxaemia, which leads to poor quality sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Furth...

  11. Increasing granular flow rate with obstructions

    OpenAIRE

    Alan Murray; Fernando Alonso-Marroquin

    2016-01-01

    We describe a simple experiment involving spheres rolling down an inclined plane towards a bottleneck and through a gap. Results of the experiment indicate that flow rate can be increased by placing an obstruction at optimal positions near the bottleneck. We use the experiment to develop a computer simulation using the PhysX physics engine. Simulations confirm the experimental results and we state several considerations necessary to obtain a model that agrees well with experiment. We demonstr...

  12. Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

    International Nuclear Information System (INIS)

    Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results

  13. Malignant biliary obstruction: From palliation to treatment

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-01-01

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  14. Patients with Obstructive Sleep Apnea at Altitude.

    Science.gov (United States)

    Bloch, Konrad E; Latshang, Tsogyal D; Ulrich, Silvia

    2015-06-01

    Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia. This induces strong sympathetic activation with elevated heart rate, cardiac arrhythmia, and systemic hypertension. There are concerns that these changes expose susceptible OSA patients, in particular those with advanced age and co-morbidities, to an excessive risk of cardiovascular and other adverse events during a stay at altitude. Based on data from randomized trials, it seems advisable for OSA patients to use continuous positive airway pressure treatment with computer controlled mask pressure adjustment (autoCPAP) in combination with acetazolamide during an altitude sojourn. If CPAP therapy is not feasible, acetazolamide alone is better than no treatment at all, as it improves oxygenation and sleep apnea and prevents excessive blood pressure rises of OSA patients at altitude. PMID:25973669

  15. Malignant biliary obstruction: From palliation to treatment.

    Science.gov (United States)

    Boulay, Brian R; Birg, Aleksandr

    2016-06-15

    Malignant obstruction of the bile duct from cholangiocarcinoma, pancreatic adenocarcinoma, or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery. The optimal treatment - including the decision whether to treat prior to resection - depends on the type of malignancy, as well as the stage of disease. Preoperative biliary drainage is generally discouraged due to the risk of infectious complications, though some situations may benefit. Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure. For pancreatic cancer patients, self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion. For cholangiocarcinoma patients, treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement, with less risk of infectious complications or failure. For patients of either malignancy who have advanced disease with palliative goals only, the choice of stent for endoscopic decompression depends on estimated survival, with plastic stents favored for survival of < 4 mo. New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor. Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. PMID:27326319

  16. Popliteal artery entrapment syndrome.

    Science.gov (United States)

    Klooster, N J; Kitslaar, P; Janevski, B K

    1988-06-01

    Two patients with unilateral popliteal artery entrapment syndrome (PAES) are reported. The importance of diligence in angiographic diagnosis and recognition of the so-called "functional" PAES group as a separate entity are stressed. It is inferred from our material that a surgical approach for PAES is to be advocated since surgical release of the entrapment can lead to complete resolution of symptoms regardless of aetiology. PMID:2837797

  17. Popliteal artery entrapment syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Klooster, N.J.J.; Janevski, B.K.; Kitslaar, P.

    1988-06-01

    Two patients with unilateral popliteal artery entrapment syndrome (PAES) are reported. The importance of diligence in angiographic diagnosis and recognition of the so-called 'functional' PAES group as a separate entity are stressed. It is inferred from our material that a surgical approach for PAES is to be advocated since surgical release of the entrapment can lead to complete resolution of symptoms regardless of aetiology.

  18. Popliteal artery entrapment syndrome

    International Nuclear Information System (INIS)

    Two patients with unilateral popliteal artery entrapment syndrome (PAES) are reported. The importance of diligence in angiographic diagnosis and recognition of the so-called 'functional' PAES group as a separate entity are stressed. It is inferred from our material that a surgical approach for PAES is to be advocated since surgical release of the entrapment can lead to complete resolution of symptoms regardless of aetiology. (orig.)

  19. Gestational pulmonary arterial hypertension

    OpenAIRE

    Moll, Matthew; Payne, Julie G.; Tukey, Melissa H.; Farber, Harrison W.

    2015-01-01

    Pulmonary arterial hypertension (PAH) is a progressive disease marked by the irreversible pulmonary vascular changes of vasoconstriction, thrombosis, and proliferation of smooth muscle and endothelial cells. The untreated clinical course is characterized by progressive dyspnea and a median survival of less than 3 years. Many of these patients are of child-bearing age; however, pregnancy leads to physiologic changes that are particularly poorly tolerated in PAH, conferring a 30%–56% mortality....

  20. Idiopathic pulmonary arterial hypertension

    OpenAIRE

    Firth, Amy L.; Mandel, Jess; Yuan, Jason X.-J.

    2010-01-01

    Despite improved understanding of the pathobiology of pulmonary arterial hypertension (PAH), it remains a severe and progressive disease, usually culminating in right heart failure, significant morbidity and early mortality. Over the last decade, some major advances have led to substantial improvements in the management of PAH. Much of this progress was pioneered by work in animal models. Although none of the current animal models of pulmonary hypertension (PH) completely recapitulate the hum...

  1. Myocardial arterial spin labeling

    OpenAIRE

    Kober, Frank; Jao, Terrence; Troalen, Thomas; Nayak, Krishna S.

    2016-01-01

    Arterial spin labeling (ASL) is a cardiovascular magnetic resonance (CMR) technique for mapping regional myocardial blood flow. It does not require any contrast agents, is compatible with stress testing, and can be performed repeatedly or even continuously. ASL-CMR has been performed with great success in small-animals, but sensitivity to date has been poor in large animals and humans and remains an active area of research. This review paper summarizes the development of ASL-CMR techniques, c...

  2. Pulmonary arterial hypertension.

    OpenAIRE

    Montani, David; Günther, Sven; Dorfmüller, Peter; Perros, Frédéric; Girerd, Barbara; Garcia, Gilles; Jaïs, Xavier; Savale, Laurent; Artaud-Macari, Elise; Price, Laura; Humbert, Marc; Simonneau, Gérald; Sitbon, Olivier

    2013-01-01

    Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and ultimately death if untreated. The first classification of PH was proposed in 1973. In 2008, the fourth World Symposium on PH held in Dana Point (California, USA) revised previous classifications. Currently, PH is devided into five subgroups. Group 1 includes patients suffering from idiopathic or familial PAH with or without germline mutations. Patients with a diagnosis of PAH should ...

  3. Laparoscopic uterine artery occlusion combined with myomectomy for uterine myomas.

    Science.gov (United States)

    Cheng, Zhongping; Yang, Weihong; Dai, Hong; Hu, Liping; Qu, Xiaoyan; Kang, Le

    2008-01-01

    We sought to evaluate the clinical feasibility and mid- to long-term effects of laparoscopic uterine artery occlusion before myomectomy in the treatment of uterine myomas. A total of 566 patients with uterine myoma were treated by laparoscopic uterine artery occlusion before myomectomy from October 2001 through July 2007. Mean blood loss was 88.2 +/- 52.7 mL (95% CI 82.7-93.8). The highest postoperative temperature was 37.8 +/- 0.3 degrees C, and the postoperative morbidity was 5.7% (32/566). Number of days to the return of bowel movement was 1.9 +/- 0.5d and in hospital stay after surgery was 7.7 +/- 2.5d. Complications included 2 instances of subcutaneous emphysema, 1 of vaginal bleeding, and 3 of mild intestinal obstruction. At a median of 26.3 months (range 6-69 months) of follow-up, the rate of myoma recurrence was 3.0% (15/517), uterus volume reduction was 48.9%, and correction of menstruation abnormality was 97.1% (502/517). Laparoscopic uterine artery occlusion before myomectomy can expand myomectomy indications with better results. PMID:18439509

  4. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

    International Nuclear Information System (INIS)

    Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients

  5. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Carolina Pereira

    2014-08-01

    Full Text Available Background: Familial hypercholesterolemia (FH is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c. Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD. Objective: This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD, such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. Methods: The diagnosis of PAD was established by ankle-brachial index (ABI values ≤ 0.90. This study assessed 202 patients (35% of men with heterozygous FH (90.6% with LDL receptor mutations, mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. Results: The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049. Conclusion: Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  6. Association of Peripheral Arterial and Cardiovascular Diseases in Familial Hypercholesterolemia

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Carolina [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Miname, Marcio [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Makdisse, Marcia [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Kalil, Roberto Filho [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Santos, Raul D., E-mail: rdsf@cardiol.br [Instituto do Coração HCFMUSP, São Paulo, SP (Brazil); Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2014-08-15

    Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease characterized by an elevation in the serum levels of total cholesterol and of low-density lipoproteins (LDL- c). Known to be closely related to the atherosclerotic process, FH can determine the development of early obstructive lesions in different arterial beds. In this context, FH has also been proposed to be a risk factor for peripheral arterial disease (PAD). This observational cross-sectional study assessed the association of PAD with other manifestations of cardiovascular disease (CVD), such as coronary artery and cerebrovascular disease, in patients with heterozygous FH. The diagnosis of PAD was established by ankle-brachial index (ABI) values ≤ 0.90. This study assessed 202 patients (35% of men) with heterozygous FH (90.6% with LDL receptor mutations), mean age of 51 ± 14 years and total cholesterol levels of 342 ± 86 mg /dL. The prevalences of PAD and previous CVD were 17% and 28.2 %, respectively. On multivariate analysis, an independent association between CVD and the diagnosis of PAD was observed (OR = 2.50; 95% CI: 1.004 - 6.230; p = 0.049). Systematic screening for PAD by use of ABI is feasible to assess patients with FH, and it might indicate an increased risk for CVD. However, further studies are required to determine the role of ABI as a tool to assess the cardiovascular risk of those patients.

  7. Markers of exacerbation severity in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Walker Michael J

    2006-05-01

    Full Text Available Abstract Background Patients with chronic obstructive pulmonary disease (COPD can experience 'exacerbations' of their conditions. An exacerbation is an event defined in terms of subjective descriptors or symptoms, namely dyspnoea, cough and sputum that worsen sufficiently to warrant a change in medical management. There is a need for reliable markers that reflect the pathological mechanisms that underlie exacerbation severity and that can be used as a surrogate to assess treatment effects in clinical studies. Little is known as to how existing study variables and suggested markers change in both the stable and exacerbation phases of COPD. In an attempt to find the best surrogates for exacerbations, we have reviewed the literature to identify which of these markers change in a consistent manner with the severity of the exacerbation event. Methods We have searched standard databases between 1966 to July 2004 using major keywords and terms. Studies that provided demographics, spirometry, potential markers, and clear eligibility criteria were included in this study. Central tendencies and dispersions for all the variables and markers reported and collected by us were first tabulated according to sample size and ATS/ERS 2004 Exacerbation Severity Levels I to III criteria. Due to the possible similarity of patients in Levels II and III, the data was also redefined into categories of exacerbations, namely out-patient (Level I and in-patient (Levels II & III combined. For both approaches, we performed a fixed effect meta-analysis on each of the reported variables. Results We included a total of 268 studies reported between 1979 to July 2004. These studies investigated 142,407 patients with COPD. Arterial carbon dioxide tension and breathing rate were statistically different between all levels of exacerbation severity and between in out- and in-patient settings. Most other measures showed weak relationships with either level or setting, or they had

  8. Therapeutic modification of arterial stiffness:An update and comprehensive review

    Institute of Scientific and Technical Information of China (English)

    Ching-Fen; Wu; Pang-Yen; Liu; Tsung-Jui; Wu; Yuan; Hung; Shih-Ping; Yang; Gen-Min; Lin

    2015-01-01

    Arterial stiffness has been recognized as a marker of cardiovascular disease and associated with longterm worse clinical outcomes in several populations. Age, hypertension, smoking, and dyslipidemia, known as traditional vascular risk factors, as well as diabetes, obesity, and systemic inflammation lead to both atherosclerosis and arterial stiffness. Targeting multiple modifiable risk factors has become the main therapeutic strategy to improve arterial stiffness in patients at high cardiovascular risk. Additionally to life style modifications, long-term ω-3 fatty acids(fish oil) supplementation in diet may improve arterial stiffness in the population with hypertension or metabolic syndrome. Pharmacological treatment such as reninangiotensin-aldosterone system antagonists, metformin, and 3-hydroxy-3-methyl-glutaryl-Co A reductase inhibitors were useful in individuals with hypertension and diabetes. In obese population with obstructive sleep apnea, weight reduction, aerobic exercise, and continuous positive airway pressure treatment may also improve arterial stiffness. In the populations with chronic inflammatory disease such as rheumatoid arthritis, a use of antibodies against tumor necrosis factor-alpha could work effectively. Other therapeutic options such as renal sympathetic nerve denervation for patients with resistant hypertension are investigated in many ongoing clinical trials. Therefore our comprehensive review provides knowledge in detail regarding many aspects of pathogenesis, measurement, and management of arterial stiffness in several populations, which would be helpful for physicians to make clinical decision.

  9. Computational fluid dynamics study of commercially available stents inside an idealised curved coronary artery

    Science.gov (United States)

    Chen, Winson Xiao; Ooi, Andrew; Hutchins, Nicholas; Poon, Eric; Thondapu, Vikas; Barlis, Peter

    2015-11-01

    Stent placement restores blood flow in diseased coronary arteries and is the standard treatment for obstructive coronary atherosclerosis. Analysis of the hemodynamic characteristics of stented arteries is essential for better understanding of the relationship between key fluid dynamic variables and stent designs. Previous computational studies have been limited to idealised stents in curved arterial segments or more realistic stents in straight segments. In clinical practice, however, it is often necessary to place stents in geometrically complex arterial curvatures. Thus, numerical simulations of the incompressible Navier-Stokes equations are carried out to investigate the effects of curvature on hemodynamics using detailed, commercially available coronary stents. The computational domain is a 3mm curved coronary artery model and simulations are conducted using a physiologically realistic inlet condition. The averaged flow rate is about 80 mL/min, similar to the normal human resting condition. The examination of hemodynamic parameters will assess the performance of several commercially available stents in curved arteries and identify regions that may be at risk for restenosis. It is anticipated that this information will lead to improvements in future stent design and deployment.

  10. Robotic coronary artery bypass for aberrant right coronary artery stenosis.

    Science.gov (United States)

    Chen, Kuan-chin Jean; Teefy, Patrick; Kiaii, Bob; Vezina, William C; Chu, Michael Wa

    2010-10-01

    Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient's angina symptoms. PMID:20931103

  11. Renal Artery Embolization - A First Line Treatment Option For End-Stage Hydronephrosis

    International Nuclear Information System (INIS)

    Conventionally poorly functioning hydronephrotic kidneys have been removed if they are symptomatic. In our unit, patients are offered renal artery embolization as an alternative treatment option. Patients and Methods: Fifteen patients (11 male, 4 female) with a mean age of 32.9 yr (20-51 yrs) have undergone renal artery embolization for symptomatic hydronephrosis with poor function. Mean follow-up was 64.13 weeks (range 14-200). All patients had loin pain and hydronephrosis. Twelve patients had primary pelvi-ureteric junction obstruction (PUJO). Two patients had poorly functioning hydronephrotic kidneys secondary to chronic calculous obstruction. One patient had chronic pain in an obstructed but reasonably functioning kidney following a previous pyeloplasty for PUJO which demanded intervention. Mean split function on renography was 11% (range 0-46%). Selective renal artery embolization was carried out under antibiotic cover using a 7 Fr balloon occlusion catheter and absolute alcohol, steel coils, and polyvinyl alcohol particles.Results: Nine patients developed post-embolization syndrome of self-limiting pain and pyrexia with no evidence of sepsis. One patient required readmission with this condition. One patient developed a hematoma at the puncture site. Mean hospital stay was 2.3 days. Fourteen patients are happy with the result and are completely pain free. One patient has minor discomfort but is delighted with the result. Nine patients have had follow-up ultrasound confirming resolution of the hydronephrosis. Conclusion: Renal artery embolization is an effective, safe, well-tolerated minimally invasive treatment option in end-stage hydronephrosis and we routinely offer it as an alternative to nephrectomy

  12. Effect of Cardio-Metabolic Risk Factors Clustering with or without Arterial Hypertension on Arterial Stiffness: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Vasilios G. Athyros

    2013-11-01

    Full Text Available The clustering of cardio-metabolic risk factors, either when called metabolic syndrome (MetS or not, substantially increases the risk of cardiovascular disease (CVD and causes mortality. One of the possible mechanisms for this clustering's adverse effect is an increase in arterial stiffness (AS, and in high central aortic blood pressure (CABP, which are significant and independent CVD risk factors. Arterial hypertension was connected to AS long ago; however, other MetS components (obesity, dyslipidaemia, dysglycaemia or MetS associated abnormalities not included in MetS diagnostic criteria (renal dysfunction, hyperuricaemia, hypercoaglutability, menopause, non alcoholic fatty liver disease, and obstructive sleep apnea have been implicated too. We discuss the evidence connecting these cardio-metabolic risk factors, which negatively affect AS and finally increase CVD risk. Furthermore, we discuss the impact of possible lifestyle and pharmacological interventions on all these cardio-metabolic risk factors, in an effort to reduce CVD risk and identify features that should be taken into consideration when treating MetS patients with or without arterial hypertension.

  13. Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study.

    Directory of Open Access Journals (Sweden)

    Lasse Jespersen

    Full Text Available AIMS: To evaluate risk of hospitalization due to cardiovascular disease (CVD and repeat coronary angiography (CAG in stable angina pectoris (SAP with no obstructive coronary artery disease (CAD versus obstructive CAD, and asymptomatic reference individuals. METHODS AND RESULTS: We followed 11,223 patients with no prior CVD having a first-time CAG in 1998-2009 due to SAP symptoms and 5,695 asymptomatic reference individuals from the Copenhagen City Heart Study through registry linkage for 7.8 years (median. In recurrent event survival analysis, patients with SAP had 3-4-fold higher risk of hospitalization for CVD irrespective of CAG findings and cardiovascular comorbidity. Multivariable adjusted hazard ratios(95%CI for patients with angiographically normal coronary arteries was 3.0(2.5-3.5, for angiographically diffuse non-obstructive CAD 3.9(3.3-4.6 and for 1-3-vessel disease 3.6-4.1(range(all P<0.001. Mean accumulated hospitalization time was 3.5(3.0-4.0(days/10 years follow-up in reference individuals and 4.5(3.8-5.2/7.0(5.4-8.6/6.7(5.2-8.1/6.1(5.2-7.4/8.6(6.6-10.7 in patients with angiographically normal coronary arteries/angiographically diffuse non-obstructive CAD/1-, 2-, and 3-vessel disease, respectively (all P<0.05, age-adjusted. SAP symptoms predicted repeat CAG with multivariable adjusted hazard ratios for patients with angiographically normal coronary arteries being 2.3(1.9-2.9, for angiographically diffuse non-obstructive CAD 5.5(4.4-6.8 and for obstructive CAD 6.6-9.4(range(all P<0.001. CONCLUSIONS: Patients with SAP symptoms and angiographically normal coronary arteries or angiographically diffuse non-obstructive CAD suffer from considerably greater CVD burdens in terms of hospitalization for CVD and repeat CAG compared with asymptomatic reference individuals even after adjustment for cardiac risk factors and exclusion of cardiovascular comorbidity as cause. Contrary to common perception, excluding obstructive CAD by CAG in such

  14. Superior mesenteric artery syndrome caused by surgery and radiation therapy for a brain tumor: A case report

    OpenAIRE

    Lei, Qiucheng; Wang, Xinying; Wu, Chao; Bi, Jingcheng; Zhang, Li

    2015-01-01

    Superior mesenteric artery syndrome (SMAS) is defined as an obstruction of the third part of duodenum due to compression by the superior mesenteric artery. Although traumatic brain injury is a risk factor for SMAS, few cases of SMAS resulting from brain surgery have been reported. SMAS has been observed to occur following neurosurgical surgery in pediatric patients but, to the best of our knowledge, no such cases have been reported in adults. The present study reports the case of a 21-year-ol...

  15. Arterial responses during migraine headache

    DEFF Research Database (Denmark)

    Iversen, Helle Klingenberg; Nielsen, T H; Olesen, J;

    1990-01-01

    The superficial temporal artery has been thought to be the main focus of pain during migraine attacks, but its diameter has never been measured directly. The use of a new, high-resolution ultrasound machine to measure arterial size in 25 migraine patients with unilateral head pain showed that the...... lumen was wider on the painful than on the non-painful side during a migraine attack. The diameters of both radial arteries and the temporal artery on the non-painful side were smaller during than between attacks. The generalised vasoconstriction was not shared by the temporal artery on the affected...... side, which suggests a local vasodilatory response. The findings suggest that cephalic arteries may play a role in migraine pathogenesis....

  16. True aneurysm of brachial artery.

    Science.gov (United States)

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  17. CONGENITAL HIGH AIRWAY OBSTRUCTION (CHAOS SYNDROME: A RARE CASE PRESENTATION

    Directory of Open Access Journals (Sweden)

    Dinakara

    2014-04-01

    Full Text Available Congenital high airway obstruction syndrome (CHAOS results in a predictable constellation of findings: large echogenic lungs flattened or inverted diaphragms, dilated airways distal to the obstruction, and fetal ascites and/or hydrops.1 The finding of CHAOS on prenatal ultrasound examination is diagnostic of complete or near-complete obstruction of the fetal upper airway, most likely caused by laryngeal atresia. A greater understanding of the natural history of CHAOS may permit improved prenatal and perinatal management

  18. Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

    OpenAIRE

    Schwartz, Alan R.; Patil, Susheel P.; Laffan, Alison M.; Polotsky, Vsevolod; Schneider, Hartmut; Smith, Philip L.

    2008-01-01

    Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particu...

  19. Coeliac disease presenting with intestinal pseudo-obstruction.

    OpenAIRE

    Dawson, D J; Sciberras, C M; Whitwell, H

    1984-01-01

    A 22 year old woman presenting with recurrent intestinal pseudo-obstruction is reported. Jejunal biopsy showed subtotal villous atrophy which improved markedly during a period of total parenteral nutrition and with steroid treatment. It did not relapse on a gluten free diet. The reasons why this patient represents a case of coeliac disease with secondary pseudo-obstruction, rather than primary intestinal pseudo-obstruction with secondary bacterial overgrowth, is discussed.

  20. Chronic obstructive pulmonary disease exacerbation frequency and severity

    OpenAIRE

    Stafyla E; Kerenidi T; Gourgoulianis KI

    2013-01-01

    Eirini Stafyla, Theodora Kerenidi, Konstantinos I Gourgoulianis Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, GreeceWe read with great interest the original work by Motegi et al1 comparing three multidimensional assessment systems – BODE (body mass index, obstruction, dyspnea, and exercise capacity) index, DOSE (dyspnea, obstruction, smoking, exacerbations) index and ADO (age, dyspnea, obstruction) index – for pred...

  1. Fetal tracheolaryngeal airway obstruction: prenatal evaluation by sonography and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Courtier, Jesse; Poder, Liina; Wang, Zhen J.; Westphalen, Antonio C.; Yeh, Benjamin M.; Coakley, Fergus V. [University of California San Francisco, Department of Radiology, San Francisco, CA (United States)

    2010-11-15

    We reviewed the sonographic and MRI findings of tracheolaryngeal obstruction in the fetus. Conditions that can cause tracheolaryngeal obstruction include extrinsic causes such as lymphatic malformation, cervical teratoma and vascular rings and intrinsic causes such as congenital high airway obstruction syndrome (CHAOS). Accurate distinction of these conditions by sonography or MRI can help facilitate parental counseling and management, including the decision to utilize the ex utero intrapartum treatment (EXIT) procedure. (orig.)

  2. Inspiratroy Capacity and Exercise Tolerance in Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Joseph Milic-Emili

    2000-01-01

    During the past half-century, many studies have investigated the correlation of exercise tolerance to routine lung function in patients with obstructive pulmonary disease. In virtually all of these studies, the degree of airway obstruction was assessed in terms of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Because in most studies only a weak correlation was found between exercise tolerance and degree of airway obstruction, it has been concluded that factors other ...

  3. Analysis of electrocardiogram in chronic obstructive pulmonary disease patients

    OpenAIRE

    Lazović Biljana; Zlatković-Švenda Mirjana; Mazić Sanja; Stajić Zoran; Đelić Marina

    2013-01-01

    Introduction. Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a persistent airflow limitation usually progressive and not fully reversible to treatment. The diagnosis of chronic obstructive pulmonary disease and severity of disease is confirmed by spirometry. Chronic obstructive pulmonary disease produces electrical changes in the heart which shows characteristic electrocardiogram pattern. The aim of this study was to observe an...

  4. Intestinal obstruction due to Basidiobolus ranarum: An unusual case

    Directory of Open Access Journals (Sweden)

    Angeline Neetha Radjou

    2011-01-01

    Full Text Available A case of intestinal obstruction caused by extensive soft tissue fungal infection of the perineum due to Basidiobolus ranarum is presented here. There was excellent response to antifungal treatment. A literature search revealed the case report of intestinal obstruction due to intrinsic mucosal involvement by the fungus, but extensive soft tissue involvement of the perineum resulting in extraneous obstruction to the rectum, has not been reported so far.

  5. Intestinal obstruction due to Basidiobolus ranarum: An unusual case

    OpenAIRE

    Angeline Neetha Radjou; Rajesh, N. G.

    2011-01-01

    A case of intestinal obstruction caused by extensive soft tissue fungal infection of the perineum due to Basidiobolus ranarum is presented here. There was excellent response to antifungal treatment. A literature search revealed the case report of intestinal obstruction due to intrinsic mucosal involvement by the fungus, but extensive soft tissue involvement of the perineum resulting in extraneous obstruction to the rectum, has not been reported so far.

  6. Danazol in the management of ureteral obstruction secondary to endometriosis

    International Nuclear Information System (INIS)

    A case is reported in which a woman was diagnosed with ureteral obstruction secondary to endometriosis after cystourethrogram, retrograde pyelogram and a renal scan. After unsuccessful treatment with danazol, a retroperitoneal ureteroneocystotomy was performed. The ureter was found to be obstructed by dense fibrous tissue that contained endometrial glands. It was concluded that danazol is unlikely to relieve endometriotic ureteric obstruction once dense fibrosis has occurred. 8 references, 2 figures

  7. Computational modeling of the obstructive lung diseases asthma and COPD.

    OpenAIRE

    Burrowes, K. S.; Doel, T.; Brightling, C

    2014-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway obstruction and airflow limitation and pose a huge burden to society. These obstructive lung diseases impact the lung physiology across multiple biological scales. Environmental stimuli are introduced via inhalation at the organ scale, and consequently impact upon the tissue, cellular and sub-cellular scale by triggering signaling pathways. These changes are propagated upwards to the organ level again and vice...

  8. Chronic intestinal pseudo-obstruction in a Bernese Mountain Dog

    OpenAIRE

    Vandenberge, Valerie; Paepe, Dominique; Vercauteren, Griet; Daminet, Sylvie; Ducatelle, Richard; Chiers, Koen

    2009-01-01

    Chronic Intestinal Pseudo-Obstruction (CIPO) is a rare syndrome characterized by chronic intestinal dilation and dysmotility in the absence of mechanical obstruction. A definite diagnosis of CIPO can only be made after histological examination of intestinal tissues. The present case describes a CIPO in a 2.5-year-old Bernese Mountain dog with a history of recurrent gastro-intestinal complaints suggestive for pseudo-obstruction. Histological lesions of small intestinal samples consisted of se...

  9. Pathophysiology of increased intestinal permeability in obstructive jaundice

    OpenAIRE

    Assimakopoulos, Stelios F; Chrisoula D Scopa; Vagianos, Constantine E

    2007-01-01

    Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. The key event in the pathophysiology of obstructive jaundice-associated complications is endotoxemia of gut origin because of intestinal barrier failure. This breakage of the gut barrier in obstructive jaundice is multi-factorial, involving disruption of the immunol...

  10. Pancreatic Metastasis and Obstructive Jaundice in Small Cell Lung Carcinoma

    OpenAIRE

    Jeong, In Beom; Kim, Sun Moon; Lee, Tae Hee; Im, Euyi Hyeog; Huh, Kyu Chan; Kang, Young Woo; Choi, Young Woo

    2006-01-01

    Primary lung cancer frequently metastasizes to distant organs. The pancreas is a relatively infrequent site of metastasis. Furthermore, obstructive jaundice resulting from pancreatic metastasis is extremely rare. This paper examines the case of a 65-year-old woman with small cell lung cancer initially presenting with extrahepatic biliary obstruction. The patient underwent percutaneous transhepatic biliary drainage. The obstruction was relieved with a stent placement, then the woman was treate...

  11. Coronary computed tomography in patients with myocardial infarction and non-obstructed coronary arteries

    OpenAIRE

    Bacsovics Brolin, Elin

    2015-01-01

    Cardiovascular disease (CVD) is the number one cause of death worldwide. In Sweden, almost 30 000 people suffer an acute myocardial infarction (AMI) each year and, despite the greatly improved survival after AMI, CVD remains the leading cause of death among women and men. During the last decade, there has been increasing awareness of the significant minority of patients with acute myocardial infarction, for whom invasive coronary angiography (ICA) does not show any coronary art...

  12. Minimal distal pressure rise after reconstructive arterial surgery in patients with multiple obstructive arteriosclerosis

    DEFF Research Database (Denmark)

    Noer, Ivan; Tønnesen, K H; Sager, P

    1980-01-01

    fifteen had ischemic ulcers. The preoperative median pressure index (per cent of arm systolic pressure) was 10% on the 1st toe. At the 10th postoperative day the median toe pressure rose to 25%. A further rise took place at the one month control to 30% which was unchanged throughout the study. All...... patients with a persistent postoperative toe pressure above 20% of arm systolic pressure were ultimately relieved from rest pain and chronic ulcers....

  13. Triple spontaneous cervical artery dissection

    International Nuclear Information System (INIS)

    A 39-year-old healthy man had several transient ischaemic attacks suggesting left internal carotid artery (ICA) occlusion. There were no vascular risk factors and no preceding trauma. Colour-coded duplex sonography suggested a pseudo-occlusion of the left ICA, and cerebral angiography demonstrated dissection of the left ICA and both vertebral arteries. Angiography 6 months later was completely normal. This underlines the importance of four vessel angiography in young patients with dissections of cervical arteries. (orig.)

  14. Continuous positive airway pressure ameliorated severe pulmonary hypertension associated with obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Ogawa,Aiko

    2006-06-01

    Full Text Available

    A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH. Polysomnography revealed severe obstructive sleep apnea (OSA with an apnea hypopnea index of 99.8. Treatment with nocturnal continuous positive airway pressure (CPAP resulted in correction of daytime hypoxemia, hypercapnia, and near-normalization of pulmonary artery pressure. To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.

  15. Normal overall leakiness of microvasculature for albumin in patients with chronic obstructive lung disease (COLD)

    DEFF Research Database (Denmark)

    Kok-Jensen, A; Henriksen, Jens Henrik Sahl

    1984-01-01

    forced expired volume in first sec was decreased to 21% of expected normal value (median 0.55 litre, range 0.40-0.70). Right-heart catheterization revealed pulmonary hypertension in all but one patient. TER in patients with COLD was median 6.1% IVM/h (range 3.5-10.1) as compared to that of normal...... patients with severe chronic obstructive lung disease (COLD) and in seven normal controls. Arterial oxygen tension in patients with COLD was median 60 mmHg (range 47-80, normal greater than 75 mmHg), vital capacity was on the average 55% of expected normal value (median 1.80 litre, range 1.45-1.95), and...

  16. The association between forced expiratory volume in one second (FEV1) and pulse oximetric measurements of arterial oxygen saturation (SpO2) in the patients with COPD: A preliminary study

    OpenAIRE

    2014-01-01

    Background: The study was aimed to explore the association between arterial oxygen saturation (SpO2) and spirometer parameters of disease severity in chronic obstructive pulmonary disease (COPD) patients with a view to identify whether the pulse oximetry can be used as an alternative to arterial values in the clinical management of COPD patients in a routine practice. Materials and Methods: Thirty-one patients with COPD were included in this study. After evaluation of each patient through his...

  17. Congenital pulmonary sling, aorto-pulmonary window and pulmonary vein obstruction as a diagnostic and therapeutic challenge in an infant with VACTERL association.

    Science.gov (United States)

    Trowitzsch, Eckardt; Schneider, Martin; Urban, Andreas; Asfour, Boulos

    2006-06-01

    In a newborn with anal atresia and urethral valves an incomplete VACTERL association, was diagnosed and a colon anus praeter was placed. Sweating and heart murmur led to cardiac diagnostics. By 2D colour Doppler echocardiography a huge atrial septal defect and pulmonary venous stenoses were diagnosed. Additionally, a pulmonary sling combined with an aortopulmonary window (AoPAw) was suspected and later confirmed by angiography. Heart failure developed and closure of the AoPAw, transplantation of the left pulmonary artery and closure of the atrial septal defect was performed at the age of 4 weeks. But the patient did not improve. Pulmonary hypertension with suprasystemic pressure in the right ventricle originating from a stenosis of the new orifice of the left pulmonary artery and obstruction of the right pulmonary veins was diagnosed by echocardiography and confirmed by angiography. At the age of 8 months the orifice of the left pulmonary artery was enlarged by a patch, the obstruction of left sided pulmonary veins was opened, and the rightsided pulmonary veins were newly implanted into the left atrium. Finally the inter-atrial communication was closed by a patch plastic. Again, postoperatively the patient improved only slightly. At the age of 10 months trans-septal catheterisation was performed. Angiography revealed a successful balloon dilatation of the long obstruction of the right pulmonary veins. Later on, an absorbable magnesium stent was implanted into the right upper pulmonary vein and medication with an endothelin antagonist was started. Temporarily the patient improved significantly. Within 6 weeks, right ventricular systolic pressure was again suprasystemic due to extreme inflow obstruction of the right pulmonary vein diagnosed by echocardiography. Severe heart failure developed and at the age of 1 year the patient died. PMID:16598388

  18. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  19. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    International Nuclear Information System (INIS)

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM

  20. High prevalence of obstructive sleep apnea in Marfan's syndrome

    Institute of Scientific and Technical Information of China (English)

    Mo Li; He Quanying; Wang Yinna; Dong Birong; He Jinhan

    2014-01-01

    Objective To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome,and discuss some proposed potential mechanisms for this relationship.Data sources The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013.The search term was "Marfan's syndrome and sleep apnea".Study selection Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome,and coexisting obstructive sleep apnea.Results A high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome.The potential reasons are craniofacial abnormalities and lax upper airway muscles,which lead to high nasal airway resistance and upper airway collapse.Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms.The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome.Conclusions Obstructive sleep apnea is strongly associated with Marfan's syndrome.Craniofacial abnormalities and lax upper airway are the main mechanisms.Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture.Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.