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Sample records for common canalicular obstruction

  1. Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

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    Baek, Byoung-Joon; Hwang, Gyu-Rin; Jung, Dong-Ho; Kim, I-Seok; Sin, Jae-Min; Lee, Heung-Man

    2012-01-01

    Objectives To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. Methods The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The...

  2. Ballooning canaliculoplasty after lacrimal trephination in monocanalicular and common canalicular obstruction.

    Science.gov (United States)

    Yang, Suk-Woo; Park, Hae-Young; Kikkawa, Don O

    2008-01-01

    To evaluate the clinical effect of balloon canaliculoplasty with LacriCATH after lacrimal trephination in monocanalicular and common canalicular obstruction. Silicone intubation following ballooning dilation with a 2-mm-diameter catheter after lacrimal trephination was attempted in 66 eyes of 62 patients (10 men, 52 women; mean age, 67.3 years; age range, 34-77 years) with epiphora due to monocanalicular or common canalicular obstruction between January 2003 and February 2005. A total of 56 of the 66 eyes had common canalicular obstruction, and ten had monocanalicular obstruction. The cause of obstruction in 54 (81.8%) eyes was idiopathic. Overall initial technical improvement was achieved in 64 (97.0%) eyes (common canalicular obstruction, 56/56, 100%; monocanalicular obstruction, 8/10, 80.0%) Immediate clinical improvement was achieved in 54 eyes (81.8%). The cumulative patency rates at the last clinic visit were 53.6% in cases of common canalicular obstruction and 25.0% in cases of monocanalicular obstruction. Causes of failure were combined nasolacrimal duct obstruction, recurrent monocanalicular obstruction, and acute canaliculitis. Balloon canaliculoplasty after lacrimal trephination is a simple and safe method that may be a good alternative treatment for common canalicular and distal canalicular obstructions, before resorting to conjunctivodacryorhinostomy with Jones tube insertion.

  3. Surgical Outcomes of Canalicular Trephination Combined with Endoscopic Dacryocystorhinostomy in Patients with Distal or Common Canalicular Obstruction.

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    Kong, Yoon Jin; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo; Jang, Sun Young

    2015-12-01

    This study investigated the surgical outcomes of canalicular trephination combined with endoscopic dacryocystorhinostomy (DCR) in patients with a distal or common canalicular obstruction. It also identified the factors affecting surgical success rates associated with this technique. We retrospectively reviewed the medical records of 57 patients (59 eyes) in whom a canalicular obstruction was encountered during endoscopic DCR. All patients were treated with endoscopic DCR, followed by canalicular trephination and silicone tube placement. The surgical outcome was categorized as a functional success according to the patient's subjective assessment of symptoms, including epiphora, and as an anatomical success according to a postoperative nasolacrimal duct irrigation test. Surgical success rates were compared based on age, sex, location of the obstruction, number of silicone tubes, and experience of the surgeon. Functional success was achieved in 55 of 59 eyes (93%) at one month, 50 eyes (84%) at three months, and 46 eyes (78%) at six months. Anatomical success was achieved in 58 of 59 eyes (98%) at one month, 52 eyes (88%) at three months, and 50 eyes (84%) at six months. There was a statistically significant difference in surgical outcome according to the experience of the surgeon. The anatomical success rate at the six-month follow-up exam was 95.4% in the >5 years of experience group, and 53.3% in the trephination combined with endoscopic DCR in patients with a distal or common canalicular obstruction decreased gradually during the six-month follow-up period. In particular, patients undergoing procedures with experienced surgeons tended to show excellent surgical outcomes at the six-month follow-up exam.

  4. Surgical results of endoscopic dacryocystorhinostomy and lacrimal trephination in distal or common canalicular obstruction.

    Science.gov (United States)

    Baek, Byoung-Joon; Hwang, Gyu-Rin; Jung, Dong-Ho; Kim, I-Seok; Sin, Jae-Min; Lee, Heung-Man

    2012-06-01

    To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency. The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%). Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

  5. Bicanalicular double silicone stenting in endoscopic dacryocystorhinostomy with lacrimal trephination in distal or common canalicular obstruction.

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    Paik, Ji-Sun; Cho, Won-Kyung; Yang, Suk-Woo

    2012-06-01

    The purpose of the study was to evaluate the clinical effects of bicanalicular double silicone stents in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty for monocanalicular and common canalicular obstruction. Bicanalicular double silicone intubation in endoscopic transnasal dacryocystorhinostomy with lacrimal trephination was performed in 58 eyes of 54 patients (5 men, 49 women; mean age: 55.9 ± 14.9 years) with epiphora due to monocanalicular and common canalicular obstruction between November 2007 and August 2010. We reviewed the records of subjects who had undergone the same surgery with a bicanalicular single intubation for same disease between March 2004 and October 2007 as controls (56 eyes of 50 patients). We evaluated age, gender, the operative side, the site of canalicular obstruction, and the effects of double silicone intubation. Complications relating to the silicone tube were also investigated. The double-stent group showed higher anatomical success rates (91.4%) and functional success rates (82.8%) than the single-stent group (75.0 and 69.6%, respectively) (p = 0.034 and p = 0.103, respectively). Bicanalicular double silicone stenting in endoscopic transnasal dacryocystorhinostomy with lacrimal trephinized canaliculoplasty may be an effective treatment for monocanalicular and common canalicular obstructions. This may also reduce more invasive surgery including Jones tube insertion (p = 0.038).

  6. A prospective outcome study of membranous and solid distal common canalicular obstructions

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    Shams, P N; Pirbhai, A; Selva, D

    2016-01-01

    Purpose To prospectively evaluate the surgical outcomes of membranous and solid distal common canalicular obstructions (CCOs) following endoscopic dacryocystorhinostomy (EnDCR) and lacrimal intubation combined with either membranotomy or trephination. Methods This was a prospective, non-randomized, consecutive interventional case series. Inclusion criteria included patients undergoing EnDCR with evidence of a membranous block or more solid obstruction of the distal common canaliculus, treated with membranotomy or canalicular trephination. Complete CCO was confirmed pre-operatively using dacryocystography and dacryoscintigraphy. All patients received bicanalicular intubation for 3 months with a minimum follow-up of 12 months. Functional and anatomical success was assessed at 4 weeks, 3 months, and 12 months following surgery. Functional success was defined as subjective improvement of epiphora and anatomical success as the presence of a patent ostium and a positive dye test on nasal endoscopy. Results Twenty-nine patients were included in the study with a mean age of 58 years. Twenty-one patients (72%) received a membranotomy and eight (28%) required trephination. At 12 months, the functional and anatomical success rate in the membranotomy group was 90% (19/21) and 100% (21/21), respectively, and in trephination group the functional and anatomical success rate was 63% (5/8). There were no intra-operative or lacrimal stent-related complications. Conclusions Identifying and excising distal CCOs in association with EnDCR and lacrimal intubation is associated with a high degree of functional (83%) and anatomical (90%) success. The success of membranous obstructions appear be superior to outcomes for solid obstructions of the distal common canaliculus that require trephination. PMID:26869161

  7. Trephination for canalicular obstruction: experience in 45 eyes.

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    Nathoo, Nawaaz A; Rath, Suryasnata; Wan, Darwin; Buffam, Frank

    2013-10-01

    To evaluate efficacy of a trephination procedure for resolution of primary canalicular obstruction or obstruction secondary to failed dacryocystorhinostomy (DCR). Retrospective review of patients in a single surgeon's practice who underwent trephination with Crawford tube insertion between 2001 and 2011, with a minimum follow-up period of 12 months. Indications for surgery included symptomatic patients either with primary canalicular obstruction or secondary obstruction after a failed DCR. Trephination was carried out on 45 eyes of 43 patients; 78% were female, and average age at trephination was 61.0 years (range 32 to 89). Thirty-two eyes had previous DCR (75% endonasal, 25% external); mean interval of trephination after DCR was 1.4 years (range 0.3-9.1). Crawford stent tubes were left in-situ in 2 patients; in the remainder, tubes were removed at a mean interval of 5.6 months (range 0.3-20.6). The vast majority of presenting canalicular obstructions were in the common canalicus (73%). Sixteen eyes (36%) underwent a single trephination, and 29 eyes (64%) required repeat intervention; of these, 16 eyes had DCR (3 endonasal, 13 external) and 13 eyes had either repeat trephination with stenting (10 eyes) or repeat stenting alone (3 eyes). When separated into those with primary versus secondary obstruction, re-operation rate was similar in both groups (63% versus 69%). No patients developed complications after trephination. Trephination is a simple and effective intervention for canalicular obstruction that allowed 64% of patients, through one or two procedures, to avoid the morbidity of DCR.

  8. [Clinical study on the treatment of relapse canalicular obstruction with trephination under lacrimal endoscopy].

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    Yang, Dai-hui; Zhang, Xiao-jun; Ke, Xiu-feng; Li, Su-mei

    2010-02-01

    To evaluate the efficacy of trephination under lacrimal endoscopy in the treatment of relapse canalicular obstruction. In this retrospective cases series, 67 patients (73 eyes) with relapse canalicular obstruction were examined and treated in the Second Affiliated Hospital of Nanjing Medical University between Feb. 2007 and Feb. 2008. These patients were examined by endoscopy of the lacrimal drainage system under local anesthesia, the obstructions were treated with miniature annular drill and silicone stent intubation. All patients were followed up for 6 months postoperatively. Silicone tubes were successfully removed after 3 to 5 months postoperatively in all eyes. After followed up for 6 months, the complete successful rate, as defined on a total relief of epiphora and patent on nasolacrimal irrigation, was 69.86% (51/73). Nineteen eyes (26.03%) showed improvement, which showed slight epiphora and were unobstructed during irrigation of lacrimal passage. Three eyes (4.11%) were failure, which still had epiphora and showed reflex during nasolacrimal irrigation. The effective rate of treatment was 95.89% (70/73). The effective rate for the treatment of upper and lower canalicular obstruction combined with nasolacrimal duct obstruction was lower than that of simple lower canalicular obstruction or common canalicular obstruction. Trephination under lacrimal endoscopy is a nontraumatic and effective procedure for the treatment of relapse canalicular obstruction. It significantly improves the effective rate of treatment for canalicular obstruction.

  9. Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

    OpenAIRE

    Choi, Seong Chan; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo; Lee, Jung Hye

    2017-01-01

    Purpose To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. Methods We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each can...

  10. Role of Lacrimal Canalicular Trephination and Mini-Monoka Stent in the Management of Idiopathic Distal Canalicular Obstructions: Our Experience of 23 Cases.

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    Zadeng, Zoramthara; Singh, Manpreet; Singh, Usha

    2014-01-01

    Different techniques have been mentioned in literature for management of idiopathic lacrimal canalicular obstructions. The aim of this study was to report surgical outcomes with use of Sisler's lacrimal trephine and role of Mini-Monoka monocanalicular stent in patients of idiopathic distal canalicular obstructions. This was a prospective, interventional case series. Twenty-three patients of idiopathic distal canalicular obstruction were managed surgically from August 2011 to October 2012. Lacrimal canalicular trephination was done in all followed by on-table syringing and Mini-Monoka stent insertion. There were 15 women and 8 men. Mean age of patients was 50.33 ± 12.06 years. Average duration of complaints was 20.58 ± 23.01 months. Twenty-four eyes were included in the study. Common canalicular obstruction was present in 15 eyes (62.5%), whereas 9 (37.5%) had distal lower canalicular obstruction. Mini-Monoka stent was kept in place for a minimum of 8 weeks. Twenty eyes (83.33%) reported absent epiphora, whereas 2 eyes (8.33%) reported improvement at average post-stent removal follow-up of 8.66 ± 3.17 months. No significant complication was observed in intraoperative and postoperative period except for 2 spontaneous tube extrusions, which were managed with tube reinsertion. Lacrimal canalicular trephination with Mini-Monoka stent insertion is an easy, monocanalicular and lesser invasive technique, which has never been reported earlier in literature. We conclude that this repeatable procedure has good anatomical and functional success rates with minimal complications as compared with the other available treatment modalities for lacrimal canalicular obstructions.

  11. A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction

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    Nikolaos Trakos

    2009-11-01

    Full Text Available Nikolaos Trakos, Emmanouil Mavrikakis, Kostas G Boboridis, Marselos Ralidis, George Dimitriadis, Ioannis MavrikakisOculoplastic Service, Metropolitan Hospital, Athens, GreecePurpose: To describe a modification of the retrograde intubation dacryocystorhinostomy (DCR in patients with proximal canalicular obstruction.Materials and methods: Interventional case report of a 43-year-old female with a nine-month history of left epiphora following a road traffic accident involving the proximal lower canaliculus. An external DCR approach was performed. Following the creation of a lower canalicular pseudopunctum, the O’Donoghue silicone stent was introduced through the common ostium, out through the pseudopunctum of the lower canaliculus, and returned through the punctum of the normal upper canaliculus down through the common ostium into the nose.Results: The patient experienced complete resolution of symptoms and on her last follow-up, two years later, her lower canaliculus was patent to syringing.Conclusion: This modification of the retrograde intubation DCR is an effective technique which decreases the intraoperative time needed to insert the tubes and minimises further trauma to the newly created punctal area.Keywords: retrograde dacryocystorhinostomy, proximal canalicular obstruction, midcanalicular obstruction, conjuctivodacryocystorhinostomy

  12. Management of bi-canalicular block: A novel technique

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    Meena, Manju; Naik, Milind; Honavar, Santosh G.

    2013-01-01

    Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. Conjunctivodacryocystorhinostomy with Lester's Jones tube is considered as the standard treatment in such cases. Alternatively, these patients can be managed by retrograde intubation dacryocystorhinostomy with medial canthoplasty. We herein describe the modification of retrograde bicanalicular intubation, combined with medial canthoplasty (monopedicle flap) which gives good cosmetic results. PMID:23960322

  13. Management of bi-canalicular block: A novel technique

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    Manju Meena

    2013-01-01

    Full Text Available Medial canthal dystopia with canalicular obstruction is a common presentation following injury to the medial canthal region. Conjunctivodacryocystorhinostomy with Lester′s Jones tube is considered as the standard treatment in such cases. Alternatively, these patients can be managed by retrograde intubation dacryocystorhinostomy with medial canthoplasty. We herein describe the modification of retrograde bicanalicular intubation, combined with medial canthoplasty (monopedicle flap which gives good cosmetic results.

  14. Common lung conditions: chronic obstructive pulmonary disease.

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    Delzell, John E

    2013-06-01

    The etiology of chronic obstructive pulmonary disease (COPD) is chronic lung inflammation. In the United States, this inflammation most commonly is caused by smoking. COPD is diagnosed when an at-risk patient presents with respiratory symptoms and has irreversible airway obstruction indicated by a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7. Management goals for COPD include smoking cessation, symptom reduction, exacerbation reduction, hospitalization avoidance, and improvement of quality of life. Stable patients with COPD who remain symptomatic despite using short-acting bronchodilators should start inhaled maintenance drugs to reduce symptoms and exacerbations, avoid hospitalizations, and improve quality of life. A long-acting anticholinergic or a long-acting beta2-agonist (LABA) can be used for initial therapy; these drugs have fewer adverse effects than inhaled corticosteroids (ICS). If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial. Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy. Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD. Continuous oxygen therapy is indicated for patients with COPD who have severe hypoxemia (ie, PaO2 less than 55 mm Hg or an oxygen saturation less than 88% on room air). Nonpharmacologic strategies also are useful to improve patient outcomes. Pulmonary rehabilitation improves dyspnea and quality of life. Pulmonary rehabilitation after an acute exacerbation reduces hospitalizations and mortality, and improves quality of life and exercise capacity. Smoking cessation is the most effective management strategy for reducing morbidity and mortality in patients with COPD. Lung volume reduction surgery, bullectomy, and lung transplantation are

  15. Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum

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    Anastasios J. Karayiannakis

    2012-07-01

    Full Text Available Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD, but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients.

  16. Taurolithocholate impairs bile canalicular motility and canalicular bile secretion in isolated rat hepatocyte couplets

    Institute of Scientific and Technical Information of China (English)

    Norihito Watanabe; Tatehiro Kagawa; Sei-ichiro Kojima; Shinji Takashimizu; Naruhiko Nagata; Yasuhiro Nishizaki; Tetsuya Mine

    2006-01-01

    AIM: To investigate the effects of taurolithocholate (TLC)on the canalicular motility in isolated rat hepatocyte couplets (IRHC).METHODS: TLC was added to IRHC at concentrations of 10 and 50 μmol/L, respectively. In each group, five time-lapse movies containing 3 representative bile canaliculi were taken under phase-contrast microscopy for 12 h. The number of bile canalicular contractions and the intervals between consecutive canalicular contractions were calculated. Furthermore, the effects of TLC on IRHC were examined by transmission electron microscopy.RESULTS: The bile canalicular contractions were spontaneous and forceful in the controls. Active vesicular movement was observed in the pericanalicular region. Immediately after the addition of TLC, the bile canaliculi were deformed, and canalicular bile was incorporated into the vacuoles. The canaliculi were gradually dilated, and canalicular contractions were markedly inhibited by TLC. The vesicular movements became extremely slow in the pericanalicular region. The number of canalicular contractions significantly decreased in the TLC-treated groups, as compared with that in the controls. The time intervals were prolonged, as the TLC dosage increased,indicating that bile secretion into the canaliculi was impaired with TLC. Transmission electron microscopy revealed the lamellar transformation of the canalicular membranes in IRHC treated with TLC.CONCLUSION: TLC impairs both the bile canalicular contractions and the canalicular bile secretion, possibly by acting directly on the canalicular membranes in TLCinduced cholestasis.

  17. Epidemic keratoconjunctivitis and lacrimal excretory system obstruction.

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    Hyde, K J; Berger, S T

    1988-10-01

    Epiphora is a common symptom associated with the acute phase of epidemic keratoconjunctivitis (EKC). Reflex lacrimal secretion occurs secondary to conjunctival or corneal inflammation. Acquired obstruction of the lacrimal excretory system may account for persistence of tearing after resolution of the acute inflammatory phase of the viral infection. Three cases of lacrimal excretory system obstruction after EKC are reported. Multifocal obstruction of the canaliculi and nasolacrimal duct is characteristic. Dacryocystorhinostomy (DCR) was required to relieve obstruction in all cases. Probing and corticosteroid irrigation may avoid the need for silicone intubation or conjunctivodacryocystorhinostomy in the management of canalicular obstruction. Persistent epiphora after EKC should raise clinical suspicion of acquired dacryostenosis. Early recognition may allow for optimal management.

  18. Congenital nasolacrimal duct obstruction: common management policies among pediatric ophthalmologists.

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    Dotan, Gad; Nelson, Leonard B

    2015-01-01

    To study common management policies of congenital nasolacrimal duct obstruction (CNDLO) among pediatric ophthalmologists. A 21-question survey was sent to members of the American Association for Pediatric Ophthalmology and Strabismus in April 2014. The questions focused on treatment of CNLDO during the first year of life, primary and secondary surgical interventions, surgical techniques, and amblyopia assessment. One hundred twenty-seven members completed the survey and 121 responses were analyzed after replies of 6 candidates in training were excluded. Eighty-two percent of respondents instructed caregivers to massage the nasolacrimal duct during the first year of life; however, 55% did not perform the Crigler massage in the office. Outpatient probing was done by 17% of pediatric ophthalmologists who took the survey, almost all of whom (95%) have been in practice more than 10 years. Ninety-one percent recommended surgery for CNLDO close to the age of 1 year and 79% performed probing as initial treatment at that age. If treatment is delayed to the age of 2 years, 53% favored silicone tube intubation and/or balloon dacryoplasty. Following failed probing, silicone tube intubation was performed by 51% of practitioners. Ninety-one percent of respondents routinely checked refraction of infants with CNLDO and recommended reexamination even if initial assessment was entirely normal. This study highlights the striking lack of consensus among pediatric ophthalmologists in many aspects of management of CNLDO and allows practitioners to compare their practice patterns regarding CNLDO management with those of their peers; however, because it provides only the opinions of a limited group of pediatric ophthalmologists, it does not imply that less common practices are wrong. Copyright 2015, SLACK Incorporated.

  19. Honey prevents hepatic damage induced by obstruction of the common bile duct

    Institute of Scientific and Technical Information of China (English)

    B Imge Erguder; Sibel S Kilicoglu; Mehmet Namuslu; Bulent Kilicoglu; Erdinc Devrim; Kemal Kismet; Ilker Durak

    2008-01-01

    AIM: To examine the possible effects of honey supplementation on hepatic damage due to obstruction of the common bile duct in an experimental rat model.METHODS: The study was performed with 30 male rats divided into three groups: a sham group, an obstructive jaundice group, and an obstructive jaundice plus honey group. At the end of the study period, the animals were sacrificed, and levels of nitric oxide (NO), and NO synthase (NOS) activities were measured in liver tissues, and levels of adenosine deaminase (ADA) and alanine transaminase (ALT) activities were measured in serum.RESULTS: Blood ALT and ADA activities were significantly elevated in the jaundice group as compared to those of the sham group. In the obstructive jaundice plus honey group, blood ALT and ADA activities were significantly decreased as compared to those of the jaundice group. In erythrocytes and liver tissues, NO levels were found to be significantly higher in the obstructive jaundice plus honey group compared to those of the sham group. Additionally, NO levels were found to be significantly higher in liver tissues from the animals in the obstructive jaundice plus honey group than those of the jaundice group.CONCLUSION: Honey was found to be beneficial in the prevention of hepatic damage due to obstruction of the common bile duct.

  20. Late obstruction of the intrahepatic common bile duct after seat-belt injury.

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    Dryburgh, P R; White, J A

    1980-09-27

    A patient is reported in whom obstructive jaundice developed 10 weeks after seat-belt injury to the abdomen. Laparotomy at the time of injury revealed extensive lacerations of the liver and haematoma in the head of the pancreas. The patient's presentation with jaundice led to a diagnosis of an intrahepatic haematoma, falsely substantiated by radio-isotope studies. At operation, complete obstruction of the intrapancreatic portion of the common bile duct was found. This, most likely a result of vascular damage with subsequent cicatrization, was treated satisfactorily by choledochoduodenostomy.

  1. Metastatic melanoma to the common bile duct causing obstructive jaundice: A case report

    Institute of Scientific and Technical Information of China (English)

    Radoje B Colovic; Nikica M Grubor; Miodrag D Jovanovic; Marjan T Micev; Natasa R Colovic

    2007-01-01

    Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice.It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures,should be adopted.

  2. Effects of Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea on Cognitive Functions: Evidence for a Common Nature

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    Georgia Andreou

    2014-01-01

    Full Text Available Patients with chronic obstructive pulmonary disease (COPD and obstructive sleep apnea syndrome (OSAS show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.

  3. [Dilatation of the common bile duct without visible obstruction at endoscopic retrograde cholangiography. Description and development].

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    Seyrig, J A; Liguory, C; Buffet, C; Fabre, M; Fritsch, J; Choury, A; Ladouch-Badre, A; Liguory-Brunaud, M D; Etienne, J P

    1988-05-01

    The aim of this study was to specify the signs and course of patients with a dilated common bile duct without obstruction. We included patients with a dilated common bile duct of more than 12 mm on endoscopic retrograde cholangiography, and we excluded patients with stones, tumor or other visible obstruction. Two hundred and seven patients (8.4 p. 100 of endoscopic retrograde cholangiography) were included. One hundred and nineteen (57.5 p. 100) had undergone cholecystectomy. Sixty-five p. 100 of patients had signs suggesting biliary tract disease, and 78 p. 100 had biological signs of cholestasis. The size of the common bile duct was not different whether the patient had been cholecystectomized (16.2 +/- 0.3 mm.M +/- SEM) or not (16.2 +/- 0.4 mm). Forty-one patients in the non cholecystectomized group had gallbladder stones. Thus, 47 of our 207 patients (23 p. 100) had neither gallbladder stones nor previous cholecystectomy. Endoscopic retrograde cholangiography was completed by endoscopic sphincterotomy in 130 patients, either in the intent of not missing obstruction, or for therapeutic purposes. Follow-up more than one month after endoscopic retrograde cholangiography was available for 159 patients (77 p. 100). The median survival was 73 months. One hundred and ten patients (69 p. 100) were asymptomatic, 36 (23 p. 100) had atypical abdominal pain while 13 (8 p. 100) patients had episodes of biliary colic and/or fever and/or jaundice. During follow-up, an initially unrecognized obstacle was discovered in 8 patients: 5 common bile duct stones, 2 ampullary tumors and one pancreatic tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Transport of the glutathione-methylmercury complex across liver canalicular membranes on reduced glutathione carriers.

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    Dutczak, W J; Ballatori, N

    1994-04-01

    Methylmercury transport across liver canalicular membranes into bile, a major route of excretion of this toxic compound, is dependent upon intracellular GSH, and a glutathione-methylmercury complex (CH3Hg.SG) has been detected in liver tissue and bile. To examine whether the CH3Hg.SG complex is itself transported across the canalicular membrane and to identify the transport system involved, studies were performed in isolated rat liver canalicular plasma membrane vesicles. Uptake of CH3(203)Hg.SG (10 microM) into an osmotically active space was temperature-sensitive and unaffected by either ATP (5 mM) or an inwardly directed Na+ gradient (100 mM); however, CH3Hg.SG uptake was enhanced by a valinomycin-induced K+ diffusion potential (inside-positive) indicating that its transport was electrogenic. Transport of CH3Hg.SG exhibited saturation kinetics with both high affinity (Km = 12 +/- 2 microM, Vmax = 0.23 +/- 0.02 nmol.mg-1.20 s-1) and low affinity (Km = 1.47 +/- 0.22 mM, Vmax = 1.23 +/- 0.14 nmol.mg-1.20 s-1) components. Uptake of this complex was inhibited by GSH, the GSH analog ophthalmic acid, S-methyl, S-ethyl, S-butyl, S-hexyl, S-octyl, and S-dinitrophenyl glutathione, but not by GSSG, bile acids, amino acids, and P-glycoprotein inhibitors. Furthermore, GSH competitively inhibited (Ki = 83 microM) and trans-stimulated CH3Hg.SG uptake into the canalicular vesicles. These studies provide the first kinetic characterization of a transport system for glutathione-mercaptides and indicate that CH3Hg.SG is not a substrate for the ATP-dependent, canalicular GSSG or glutathione S-conjugate carriers, but appears to be a substrate for canalicular carriers that also transport GSH. Because efflux systems for GSH are found in all mammalian cells, transport of glutathione-metal complexes by such carriers may be a common mechanism for the removal of methylmercury and possibly other metals from cells.

  5. [Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment].

    Science.gov (United States)

    Le Neel, J C; Guiberteau, B; Kohen, M; Borde, L; Sartre, J Y; Bourseau, J C

    1992-01-01

    Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks.

  6. A para-canalicular abscess resembling an inflamed chalazion.

    Science.gov (United States)

    Almaliotis, Diamantis; Nakos, Elias; Siempis, Thomas; Koletsa, Triantafyllia; Kostopoulos, Ioannis; Chatzipantazi, Maria; Karampatakis, Vasileios

    2013-01-01

    Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.

  7. A Para-Canalicular Abscess Resembling an Inflamed Chalazion

    Directory of Open Access Journals (Sweden)

    Diamantis Almaliotis

    2013-01-01

    Full Text Available Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis. When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.

  8. Computer modeling of gastric parietal cell: significance of canalicular space, gland lumen, and variable canalicular [K+].

    Science.gov (United States)

    Crothers, James M; Forte, John G; Machen, Terry E

    2016-05-01

    A computer model, constructed for evaluation of integrated functioning of cellular components involved in acid secretion by the gastric parietal cell, has provided new interpretations of older experimental evidence, showing the functional significance of a canalicular space separated from a mucosal bath by a gland lumen and also shedding light on basolateral Cl(-) transport. The model shows 1) changes in levels of parietal cell secretion (with stimulation or H-K-ATPase inhibitors) result mainly from changes in electrochemical driving forces for apical K(+) and Cl(-) efflux, as canalicular [K(+)] ([K(+)]can) increases or decreases with changes in apical H(+)/K(+) exchange rate; 2) H-K-ATPase inhibition in frog gastric mucosa would increase [K(+)]can similarly with low or high mucosal [K(+)], depolarizing apical membrane voltage similarly, so electrogenic H(+) pumping is not indicated by inhibition causing similar increase in transepithelial potential difference (Vt) with 4 and 80 mM mucosal K(+); 3) decreased H(+) secretion during strongly mucosal-positive voltage clamping is consistent with an electroneutral H-K-ATPase being inhibited by greatly decreased [K(+)]can (Michaelis-Menten mechanism); 4) slow initial change ("long time-constant transient") in current or Vt with clamping of Vt or current involves slow change in [K(+)]can; 5) the Na(+)-K(+)-2Cl(-) symporter (NKCC) is likely to have a significant role in Cl(-) influx, despite evidence that it is not necessary for acid secretion; and 6) relative contributions of Cl(-)/HCO3 (-) exchanger (AE2) and NKCC to Cl(-) influx would differ greatly between resting and stimulated states, possibly explaining reported differences in physiological characteristics of stimulated open-circuit Cl(-) secretion (≈H(+)) and resting short-circuit Cl(-) secretion (>H(+)).

  9. Laceração canalicular: uma técnica simplificada de sutura Canalicular laceration: a simplified suture technique

    Directory of Open Access Journals (Sweden)

    Juliana Vendramini Rossi

    2003-06-01

    Full Text Available Os autores descrevem a utilização do cateter de teflon como molde intracanalicular visando tornar a sutura do canalículo lacrimal mais simples e acessível a todo oftalmologista. A técnica consiste em identificar os cotos canaliculares e, após introdução de cateter de teflon (número 22 ou 24 no lúmem canalicular, realizam-se três pontos cardinais transfixantes de sutura do canalículo com o fio nylon monofilamento (Mononylon® ou poliglactina trançada (Vicryl® 8-0. Esta técnica está indicada em casos de lacerações regulares, que possibilitem a cateterização do canalículo.The authors describe the use of a teflon catheter as an intracanalicular stent in order to increase its accessability to ophthalmologists.The technique is based on the identification of the canalicular borders followed by the introduction of a teflon catheter (22 or 24 into the canalicular lumen. Three full-thickness sutures are placed at the canaliculum using a 8-0 mononylon or a 8-0 vicryl. This technique can be used in cases of non-complicated lacerations, in which catheterization is still possible.

  10. Common bile duct obstruction due to fibrous pseudotumor of pancreas associated with retroperitoneal fibrosis:A case report

    Institute of Scientific and Technical Information of China (English)

    Mei-Fen Zhao; Yu Tian; Ke-Jian Guo; Zhi-Gang Ma; Hai-Hui Liao

    2004-01-01

    One 63-year-old woman, who presented with cholestatic jaundice due to common bile duct compression produced by primary retroperitoneal fibrosis, is studied. The patient was operated six years ago because of hydronephrosis,when the disease was first diagnosed. Magnetic resonance cholangiopancreatography (MRCP) revealed the presence of extrahepatic bile duct obstruction, which once was considered to be pathognomonic of pancreatic cancer. CTscan demonstrated the change of retroperitoneal fibrosis around left kidney, atrophy of right kidney, and obstruction of extrahepatic bile duct (pancreatic head). An explorative laparotomy was performed, and the retroperitoneum and pancreas were grayish-white and hard, the fibrotic pancreatic head compressed the common bile duct. Bile duct stricture was managed by Rouxen-Y hepatocholangio-jejunostomy.To the best of our knowledge, few similar cases of retroperitoneal fibrosis have been reported.

  11. Airway smooth muscle dynamics : a common pathway of airway obstruction in asthma

    NARCIS (Netherlands)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-01-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series o

  12. Parasomnias: Common sleep disorders in children suffering from obstructive sleep apnea syndrome

    OpenAIRE

    Alexander Torres Molina

    2010-01-01

    The sleep disorders have a tendency to chronic evolution in approximately the 30% of children and adolescents, what constitute the main parasomnias clinical expressions of these phenomena. The Obstructive Sleep Apnea Syndrome constitute a high prevailment ailment which affects the 2% of the childish population approximately it is considered an entity because of its cognitive and somatic resounding. Parasomnias are part of the complex symptomatic night cortege observed in OSAS, stablishing a d...

  13. Parasomnias: Common sleep disorders in children suffering from obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Alexander Torres Molina

    2010-12-01

    Full Text Available The sleep disorders have a tendency to chronic evolution in approximately the 30% of children and adolescents, what constitute the main parasomnias clinical expressions of these phenomena. The Obstructive Sleep Apnea Syndrome constitute a high prevailment ailment which affects the 2% of the childish population approximately it is considered an entity because of its cognitive and somatic resounding. Parasomnias are part of the complex symptomatic night cortege observed in OSAS, stablishing a direct physiopathology relationship between both of them. The reduction of the apnea episodes after the adenotonsillar hyperplasia surgical treatment is accompanied by diminishing of the sleep disorders modification in this patient.

  14. Diagnosis of lacrimal canalicular diseases using ultrasound biomicroscopy: a preliminary study

    Institute of Scientific and Technical Information of China (English)

    Hai; Tao; Li-Ping; Xu; Cui; Han; Peng; Wang; Fang; Bai

    2014-01-01

    · AIM: To evaluate the application of ultrasound biomicroscopy(UBM) in the examination of lacrimal canalicular diseases, and to investigate UBM image characteristics of lacrimal canaliculi in disease states.·METHODS: Sixty cases(63 eyes, 69 canaliculi) of lacrimal canalicular diseases were enrolled that included32 patients(32 eyes, 32 canaliculi) with chronic lacrimal canaliculitis, 18 patients(18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, 9 patients(12eyes, 18 canaliculi) with congenital absence of lacrimal puncta and canaliculi, and 1 case(1 eye, 1 canaliculus)of canalicular mass. The patients were examined using UBM, and disease-specific features of the UBM images were noted.· RESULTS: UBM imaging of lacrimal canaliculi in chronic canaliculitis patients showed obvious ectasia of the lacrimal canalicular lumen. Dot-like moderate echoic signals were detected on some ectatic lumina of the lacrimal canaliculus. Some lumen-like structures of the lower lacrimal canaliculus were observed in 2(2 eyes, 2canaliculi) of the 9 patients(12 eyes, 18 canaliculi) with congenital absence of the lacrimal canaliculus. Of the 18patients(18 eyes, 18 canaliculi) with previous lacrimal canalicular laceration, the lacerated end on the nasal side of the lacrimal canaliculus was detected only in 14patients(14 eyes, 14 canaliculi).·CONCLUSION: UBM can be used to evaluate lacrimal canalicular diseases and can provide an imaging basis for the diagnosis of lacrimal canalicular diseases.

  15. THE ROLE OF THE CANALICULAR MULTISPECIFIC ORGANIC ANION TRANSPORTER IN THE DISPOSAL OF ENDOBIOTICS AND XENOBIOTICS

    NARCIS (Netherlands)

    ELFERINK, RPJO; JANSEN, PLM

    1994-01-01

    Bile is an important excretory route for the elimination of amphiphilic organic anions, and hepatocytes are the primary secretory units of bile formation. The hepatocytic basolateral and canalicular membranes are equipped with various carrier proteins. Transport across the canalicular membrane repre

  16. To what extent does international law obstruct the protection of common interests?

    DEFF Research Database (Denmark)

    Schaumburg-Müller, Sten

    2014-01-01

    In brief the contribution argues that particular interests are often dressed up as common interests, e.g. when postulating an underlying natural law or even natural rights. As much as it is a problem for 19 states to agree on common interests, it is a problem that what is presented as common...

  17. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

    Science.gov (United States)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-05-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

  18. Emerging drugs for common conditions of sleepiness: obstructive sleep apnea and narcolepsy.

    Science.gov (United States)

    Sullivan, Shannon S; Guilleminault, Christian

    2015-01-01

    Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and high symptomatic burden including prominent sleepiness, daytime dysfunction and poor nocturnal sleep. Both have elevated risk of poor health outcomes. Current therapies are often underutilized, cumbersome, costly or associated with residual symptoms. This review covers current available therapies for OSA and narcolepsy as well as discusses areas for potential drug development, and agents in the therapeutic pipeline, including the cannabinoid dronabinol (OSA), the histamine inverse agonist/ antagonist pitolisant (narcolepsy), and stimulants with uncertain and/or multiple activities such as JZP-110 and JZP-386 (narcolepsy, possibly OSA). Finally it addresses new approaches and uses for therapies currently on the market such as the carbonic anhydrase inhibitor acetazolamide (OSA). Both OSA and narcolepsy are conditions of sleepiness for which lifelong treatments are likely to be required. In OSA, while continuous positive airway pressure will likely remain the gold standard therapy for the foreseeable future, there is plenty of room for integrating phenotypes and variants of OSA into therapeutic strategies to lead to better, more personalized disease modification. In narcolepsy, unlike OSA, drug therapy is the current mainstay of treatment. Advances using novel mechanisms to treat targeted symptoms such as sleepiness and/or novel agents that can treat more than one symptom of narcolepsy, hold promise. However, cost, convenience and side effects remain challenges.

  19. CM2 antigen, a potential novel molecule participating in glucuronide transport on rat hepatocyte canalicular membrane

    Directory of Open Access Journals (Sweden)

    L. Wang

    2012-06-01

    Full Text Available The polarized molecules predominately distributing at hepatocyte canalicular surface play a vital role in disclosing the process of bile formation and etiopathogenisis of cholestatic live diseases. Therefore, it is important to find novel polarized molecules on hepatocyte canalicular membrane. In the present study, canalicular membrane vesicles (CMVs isolated from rat hepatocyte by density gradient centrifugation were used as immunogens to produce hybridoma and 46 strains of monoclonal antibodies (mAb against CMVs were obtained. With a series of morphological assay methods, including immunohistochemistry, immunofluorescence and immuno-electron microscope, the antigens recognized by canalicular mAb1 (CM1 and canalicular mAb2 (CM2 were confirmed to predominately distribute at hepatocyte canalicular membrane. Transport activity assay revealed that CM2 could inhibit ATP-dependent E217βG uptake of rat hepatocyte CMVs. Meanwhile, Western blotting analysis showed that the molecular mass of CM2 antigen was approximately 110kDa, which was much less than Mr 180kDa of multidrug resistance-associated protein 2 (MRP2 involved in glucuronide transport. These data indicated that CM2 antigen might be a potential novel molecule participating in glucuronide transport on the hepatocyte canalicular membrane.

  20. Mandibular advancement splint improves indices of obstructive sleep apnoea and snoring but side effects are common.

    Science.gov (United States)

    Neill, Alister; Whyman, Robin; Bannan, Scott; Jeffrey, Oliver; Campbell, Angela

    2002-06-21

    To assess the efficacy of a mandibular advancement splint (MAS) in the treatment of obstructive sleep apnoea syndrome (OSAS). Nineteen patients using a MAS for symptomatic OSAS underwent polysomnography, with MAS use randomised to one half of the night. Indices of snoring and OSAS were compared. Side effects, compliance and treatment response were evaluated by questionnaire. Use of the MAS improved total respiratory disturbance index (RDI) from 22.2 +/- 19.8 (SD) events per hour to 16.5 +/- 21.4/hr (p = 0.03), supine RDI (30.8 +/- 23.8/hr to 18.8 +/- 22.1/hr, p = 0.01), arousal index (25.2 +/- 18.9/hr to 19.3 +/- 14.2/hr, p = 0.01) and snoring intensity (52.7 +/- 4.1 to 50.7 +/- 2.7 dB, p = 0.02) but not total snore frequency (p > 0.05). Using polysomnographic criteria, MAS treatment was completely successful in four (21%) patients, partially successful in ten (52.6%) and a failure in five (26.3%). Treatment over a median of 6.5 weeks (range 2-48) was perceived as beneficial by ten of eleven partners. Fifteen patients (79%) reported side effects, 9 (46%) did not use the device every night and four (21%) used the device less than three nights per week. The use of the MAS resulted in significant reductions in indices of OSAS and snoring. However, a significant number of patients had difficulty tolerating and regularly using the device.

  1. In Vivo and Cadaver Studies of the Canalicular/Lacrimal Sac Mucosal Folds

    Directory of Open Access Journals (Sweden)

    Yongsheng You

    2016-01-01

    Full Text Available Purpose. The study aimed to investigate canalicular/lacrimal sac mucosal folds (CLS-MFs in vivo and in cadavers in order to explore their functional roles in the lacrimal drainage system. Method. The observations of CLS-MFs in vivo were performed on 16 patients with chronic dacryocystitis after undergoing an endonasal endoscopic dacryocystorhinostomy (EE-DCR. The lacrimal sacs and common canaliculi of 19 adult cadavers were dissected. The opening/closing of an orifice and mucosal fold was recorded. All of the specimens were subjected to a histological examination. Results. The upper and lower lacrimal canaliculi in all of the samples united to form a common canaliculus that opened to the lacrimal sac. CLS-MFs were observed in 10 of the 16 patients (62.5% and 9 of the 19 cadavers (47.4%. The orifices or mucosal folds could be opened or closed when related muscles contracted or relaxed. Histological sections showed a mucosal fold at one side of an orifice. Conclusion. Common canaliculus is the most common type that the canaliculus opens to lacrimal sac. CLS-MFs exist in a certain ratio that can be opened/closed with the movement of the orifices. They may be involved in the drainage of tears or the pathogenesis of acute dacryocystitis or lacrimal sac mucocele.

  2. Association of common variants in ERBB4 with congenital left ventricular outflow tract obstruction defects.

    Science.gov (United States)

    McBride, Kim L; Zender, Gloria A; Fitzgerald-Butt, Sara M; Seagraves, Nikki J; Fernbach, Susan D; Zapata, Gladys; Lewin, Mark; Towbin, Jeffrey A; Belmont, John W

    2011-03-01

    The left ventricular outflow tract (LVOT) defects aortic valve stenosis (AVS), coarctation of the aorta (COA), and hypoplastic left heart syndrome (HLHS) represent an embryologically related group of congenital cardiovascular malformations. They are common and cause substantial morbidity and mortality. Prior evidence suggests a strong genetic component in their causation. We selected NRG1, ERBB3, and ERBB4 of the epidermal growth factor receptor (EGFR) signaling pathway as candidate genes for investigation of association with LVOT defects based on the importance of this pathway in cardiac development and the phenotypes in knockout mouse models. Single nucleotide polymorphism (SNP) genotyping was performed on 343 affected case-parent trios of European ancestry. We identified a specific haplotype in intron 3 of ERBB4 that was positively associated with the combined LVOT defects phenotype (p=0.0005) and in each anatomic defect AVS, COA, and HLHS separately. Mutation screening of individuals with an LVOT defect failed to identify a coding sequence or splice site change in ERBB4. RT-PCR on lymphoblastoid cells from LVOT subjects did not show altered splice variant ratios among those homozygous for the associated haplotype. These results suggest ERBB4 is associated with LVOT defects. Further replication will be required in separate cohorts to confirm the consistency of the observed association. Copyright © 2011 Wiley-Liss, Inc.

  3. A review of Vitamin D effects on common respiratory diseases: Asthma, chronic obstructive pulmonary disease, and tuberculosis.

    Science.gov (United States)

    Hejazi, Mohammad Esmaeil; Modarresi-Ghazani, Faezeh; Entezari-Maleki, Taher

    2016-01-01

    Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been discovered in tissues and organs other than bones. Epidemiological and observational studies demonstrate a link between Vitamin D deficiency and risk of developing respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), and tuberculosis (TB). To review the literature, we searched the terms "Vitamin D" (using the set operator) and "asthma," "COPD" and "TB" in electronic databases, including PubMed/MEDLINE, Scopus, and Google Scholar until July 2015. Non-English articles or articles with unavailable full text were excluded. Both in vivo and in vitro studies were included. All the reviewed articles state that Vitamin D deficiency is very common among patients with respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, but data about COPD and TB are more encouraging. The relevant studies have been conducted in different populations therefore it is not particularly possible to compare the data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.

  4. Proteomic Analysis of the Rat Canalicular Membrane Reveals Expression of a Complex System of P4-ATPases in Liver.

    Science.gov (United States)

    Chaubey, Pururawa Mayank; Hofstetter, Lia; Roschitzki, Bernd; Stieger, Bruno

    2016-01-01

    Transport processes in the canalicular membrane are key elements in bile formation and are the driving force of the enterohepatic circulation of bile salts. The canalicular membrane is constantly exposed to the detergent action of bile salts. One potential element protecting the canalicular membrane from the high canalicular bile salt concentrations may be bile salt resistant microdomains, however additional factors are likely to play a role. To obtain more insights into the molecular composition of the canalicular membrane, the proteome of highly purified rat canalicular membrane vesicles was determined. Isolated rat canalicular membrane vesicles were stripped from adhering proteins, deglycosylated and protease digested before subjecting the samples to shot gun proteomic analysis. The expression of individual candidates was studied by PCR, Western blotting and immunohistochemistry. A total of 2449 proteins were identified, of which 1282 were predicted to be membrane proteins. About 50% of the proteins identified here were absent from previously published liver proteomes. In addition to ATP8B1, four more P4-ATPases were identified. ATP8A1 and ATP9A showed expression specific to the canalicular membrane, ATP11C at the bLPM and ATP11A in an intracellular vesicular compartment partially colocalizing with RAB7A and EEA1 as markers of the endosomal compartment. This study helped to identify additional P4-ATPases from rat liver particularly in the canalicular membrane, previously not known to be expressed in liver. These P4-ATPases might be contributing for maintaining transmembrane lipid homeostasis in hepatocytes.

  5. Oftalmomiíase como causa de lesão canalicular Ophthalmomyiasis as a cause of canalicular lesion

    Directory of Open Access Journals (Sweden)

    Fabio P. Saraiva

    2005-02-01

    Full Text Available OBJETIVO: Miíase é a invasão de tecido humano pela larva de uma mosca da ordem Díptera. O envolvimento ocular não é comum. Lesões do aparelho lacrimal geralmente estão associadas a traumas e raramente são devidas a infestações parasitárias. O objetivo deste trabalho é relatar um caso de laceração canalicular causado por larva de Dermatobia hominis. DESCRIÇÃO: Criança do sexo feminino, 8 anos de idade, apresentou-se com celulite pré-septal não responsiva a antibioticoterapia. Foi observada uma larva de D. hominis no saco lacrimal. Realizou-se a extração cirúrgica da larva e observou-se lesão do sistema de drenagem lacrimal. COMENTÁRIOS: A infestação parasitária em via lacrimal é rara. A extração cirúrgica da larva é recomendada como tratamento de escolha. Apesar de incomum, a oftalmomiíase deve ser considerada como um diagnóstico diferencial possível em celulites não responsivas ao tratamento convencional, especialmente em áreas endêmicas. Esta é a primeira descrição de lesão do sistema de drenagem lacrimal por larva de D. hominis.OBJECTIVE: Myiasis is the invasion of human tissues by Diptera larvae. Ocular involvement is uncommon. Trauma is the major cause of lacrimal apparatus lesions. However, it is rarely associated with parasitic infestation. The objective of this paper is to report a case of canalicular laceration caused by Dermatobia hominis larva. DESCRIPTION: An eight-year-old girl presented preseptal cellulitis that was refractive to antibiotics. A Dermatobia hominis larva was observed inside the lacrimal sac. Surgical extraction was performed and laceration of the lacrimal drainage system was noted. COMMENTS: Parasitic infection of the lacrimal apparatus is rare. Surgical extraction is the treatment of choice in such cases. Despite being uncommon, ophthalmomyiasis should be considered as a possible diagnosis when cellulitis is not responsive to antibiotics, especially in endemic areas. This is

  6. Exercises commonly used in rehabilitation of patients with chronic obstructive pulmonary disease: cardiopulmonary responses and effect over time

    NARCIS (Netherlands)

    Helvoort, H.A.C. van; Boer, R.C. de; Broek, L. van den; Dekhuijzen, R.; Heijdra, Y.F.

    2011-01-01

    OBJECTIVES: To compare conventional exercise-based assessment of pulmonary rehabilitation (PR) with improvement in training exercises employed during a PR program, and to describe the cardiopulmonary response of different training exercises during PR of patients with chronic obstructive pulmonary di

  7. Proteomic Analysis of the Rat Canalicular Membrane Reveals Expression of a Complex System of P4-ATPases in Liver.

    Directory of Open Access Journals (Sweden)

    Pururawa Mayank Chaubey

    Full Text Available Transport processes in the canalicular membrane are key elements in bile formation and are the driving force of the enterohepatic circulation of bile salts. The canalicular membrane is constantly exposed to the detergent action of bile salts. One potential element protecting the canalicular membrane from the high canalicular bile salt concentrations may be bile salt resistant microdomains, however additional factors are likely to play a role. To obtain more insights into the molecular composition of the canalicular membrane, the proteome of highly purified rat canalicular membrane vesicles was determined. Isolated rat canalicular membrane vesicles were stripped from adhering proteins, deglycosylated and protease digested before subjecting the samples to shot gun proteomic analysis. The expression of individual candidates was studied by PCR, Western blotting and immunohistochemistry. A total of 2449 proteins were identified, of which 1282 were predicted to be membrane proteins. About 50% of the proteins identified here were absent from previously published liver proteomes. In addition to ATP8B1, four more P4-ATPases were identified. ATP8A1 and ATP9A showed expression specific to the canalicular membrane, ATP11C at the bLPM and ATP11A in an intracellular vesicular compartment partially colocalizing with RAB7A and EEA1 as markers of the endosomal compartment. This study helped to identify additional P4-ATPases from rat liver particularly in the canalicular membrane, previously not known to be expressed in liver. These P4-ATPases might be contributing for maintaining transmembrane lipid homeostasis in hepatocytes.

  8. Segmentation of nanotomographic cortical bone images for quantitative characterization of the osteoctyte lacuno-canalicular network

    Energy Technology Data Exchange (ETDEWEB)

    Ciani, A.; Kewish, C. M. [Synchrotron Soleil, L’Orme des Merisiers, 91192 Saint-Aubin (France); Guizar-Sicairos, M.; Diaz, A.; Holler, M. [Paul Scherrer Institut, 5232 Villigen PSI (Switzerland); Pallu, S.; Achiou, Z.; Jennane, R.; Toumi, H.; Lespessailles, E. [Univ Orléans, I3MTO, Ea 4708, 45000 Orléans (France)

    2016-01-28

    A newly developed data processing method able to characterize the osteocytes lacuno-canalicular network (LCN) is presented. Osteocytes are the most abundant cells in the bone, living in spaces called lacunae embedded inside the bone matrix and connected to each other with an extensive network of canals that allows for the exchange of nutrients and for mechanotransduction functions. The geometrical three-dimensional (3D) architecture is increasingly thought to be related to the macroscopic strength or failure of the bone and it is becoming the focus for investigating widely spread diseases such as osteoporosis. To obtain 3D LCN images non-destructively has been out of reach until recently, since tens-of-nanometers scale resolution is required. Ptychographic tomography was validated for bone imaging in [1], showing clearly the LCN. The method presented here was applied to 3D ptychographic tomographic images in order to extract morphological and geometrical parameters of the lacuno-canalicular structures.

  9. A clinical application of laser direction in anastomosis for inferior canalicular laceration

    Institute of Scientific and Technical Information of China (English)

    LIANG Tao; ZHAO Ke-xiao; ZHANG Ling-yun

    2006-01-01

    Objective:To study the therapeutic efficiency and effecacy of laser-directing approach on searching for the nasal broken end of lacerated lacrimal canaliculus in anastomosis for canalicular laceration.Methods: Forty-nine patients ( 49 eyes ) suffering from traumatic inferior canalicular laceration were divided into control group and laser-directing group. The distance between the lacrimal punctum and the nasal broken end of lacerated lacrimal canaliculus was more than 6 mm. During the course of management of eyelid trauma, the patients were treated by canalicular anastomosis operation with traditional method and laser-directing method in searching for the nasal broken end of lacerated lacrimal canaliculus respectively. The silicone tube of 1 mm diameter was intubated in the lacrimal passage as a stent for 4 to 6months.Results: In the laser-directing group, the mean time in searching for the nasal broken end of lacerated lacrimal canaliculus was (5.75 ± 1.49) minutes and the mean time of operation was (49.21±3.37) minutes; both were significantly shorter than that of the control group(P <0.01). The cure rate of the laser-directing group was96.55 %, higher than that of the control group but without statistical significance (P > 0.05).Conclusions: The laser-directing method is much quicker and more convenient to searching for the nasal broken end of the lacerated lacrimal canaliculus than the traditional approach, and patients suffer less pain and damaging in canalicular anastomosis operation.

  10. Mitochondrial superoxide in osteocytes perturbs canalicular networks in the setting of age-related osteoporosis.

    Science.gov (United States)

    Kobayashi, Keiji; Nojiri, Hidetoshi; Saita, Yoshitomo; Morikawa, Daichi; Ozawa, Yusuke; Watanabe, Kenji; Koike, Masato; Asou, Yoshinori; Shirasawa, Takuji; Yokote, Koutaro; Kaneko, Kazuo; Shimizu, Takahiko

    2015-03-16

    Osteocytes are major bone cells that play a crucial role in maintaining the quality of and healing damage to bone tissue. The number of living osteocytes and canalicular networks declines in an age-dependent manner. However, the pathological effects of mitochondrial redox imbalances on osteocytes and bone metabolism have not been fully elucidated. We generated mice lacking mitochondrial superoxide dismutase 2 (Sod2) in osteocytes. Like an aged bone, Sod2 depletion in the osteocytes positively enhanced the production of cellular superoxide in vivo. A bone morphological analysis demonstrated that the Sod2-deficient femurs showed remarkable bone loss in an age-dependent manner. Interestingly, Sod2 loss induced markedly disorganized osteocytic canalicular networks and decreased the number of live osteocytes. Furthermore, Sod2 deficiency significantly suppressed bone formation and increased bone resorption concomitant with the upregulation of sclerostin and receptor activator of NF-κB ligand (RANKL). In vitro experiments also revealed that treatment with paraquat, a superoxide inducer in mitochondria, promoted the RANKL expression via, in part, ERK phosphorylation. These findings demonstrate that the mitochondrial superoxide induced in osteocytes by Sod2 ablation causes age-related bone loss due to the impairment of canalicular networks and bone metabolism via the deregulation of the sclerostin and RANKL expression.

  11. The canalicular system and the osteoblast domain in human secondary osteons.

    Science.gov (United States)

    Pazzaglia, U E; Congiu, T; Marchese, M; Zarattini, G; Dell'Orbo, C

    2012-12-01

    The lacunar-canalicular system in human secondary osteons was examined by two complementary techniques: light microscopy analysis of undecalcified thick sections and the SEM cortex-fractured surface technique. Unlike the earlier definitions of 'osteoblastic domain' presented as the matrix volume produced by osteoblasts in the process of osteon infilling, this study measured the domain by the length of osteoblast dendritic processes. The domain extension was defined along radial vectors advancing from the reversal line towards the central canal. According to their lengths, domains were divided into three classes: peripheral, intermediate and internal. The mean length of peripheral domains was significantly shorter than those of the intermediate and internal domains. This suggests that the infilling process is modulated by an initial preparatory phase characterised by osteoblast adhesion to the wall of the cutting cone, and a limited matrix synthesis, followed by a regular matrix volume apposition organised in concentric layers. In addition to the radial canaliculae arranged along converging vectors in planes perpendicular to the central canal, we distinguished a further class of canaliculae, the equatorial canaliculae originating from the major perimeter of the lacuna and spreading out radially in the plane of the same lacuna (therefore, perpendicularly to the radial canaliculae). The whole lacunar-canalicular network was structured as a closed system around the vascular axis of the central canal with very few canaliculae crossing the reversal line and connecting the neighbouring osteons. These anatomical observations contribute to our knowledge of lacunar-canalicular system development. © 2012 Blackwell Verlag GmbH.

  12. 20G silicone rod as monocanalicular stent in repair of canalicular lacerations: Experience from a tertiary eye care centre

    Directory of Open Access Journals (Sweden)

    Susanta Chatterjee

    2013-01-01

    Full Text Available To evaluate the outcome of 20G silicone rod as monocanalicular stent in canalicular lacerations. Retrospective case series involving patients between July 2006 and June 2010. Fourteen canalicular repairs in 12 consecutive patients were done in the study period. Eleven were male and mean age was 30.5 years. A single canaliculus was involved in 10 patients and associated injury to the globe was noted in 3 patients. The median lag time between injury and repair was 3 (range 1-9 days. The mean duration of stenting was 6.9 (SD 3.2 weeks. Spontaneous extrusion of monocanalicular stent occurred in 3 patients. Patency on syringing was noted in 10 (70% canaliculi over a median follow up of 7 (range 2-17 months. 20G silicone rod may be used as an effective and economical alternative in canalicular lacration repairs.

  13. Imaging of obstructed defecation

    Energy Technology Data Exchange (ETDEWEB)

    Ganeshan, A. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom); Anderson, E.M. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom)], E-mail: eanderson@doctors.org.uk; Upponi, S.; Planner, A.C.; Slater, A.; Moore, N.; D' Costa, H.; Bungay, H. [Radiology Department, John Radcliffe Hospital, Oxford (United Kingdom)

    2008-01-15

    Constipation is a common problem in the western world, which occurs as a consequence of impaired colonic transit and/or due to obstructed defecation. Imaging plays an important role in distinguishing structural from functional causes of constipation. In this article a description of common imaging techniques for diagnosing structural causes of constipation with illustrations of abnormal defecographic findings in patients with obstructive defecation are presented.

  14. Bile canalicular cationic dye secretion as a model for P-glycoprotein mediated transport.

    Science.gov (United States)

    Thalhammer, T; Stapf, V; Gajdzik, L; Graf, J

    1994-04-01

    This study explores properties of P-glycoprotein dependent membrane transport in rat liver with the use of acridine orange as the substrate. We studied the biliary secretion of the dye, its binding to canalicular membrane P-glycoprotein, and effects of the inhibitor cyclosporin A: acridine orange is excreted into bile together with less hydrophobic and glucuronidated metabolites. Cyclosporin A inhibited both the secretion of acridine orange and of its metabolites. In TR- animals, a rat strain that is deficient of the canalicular multi-specific organic anion transport system, non-metabolized acridine orange is the predominant species in bile and its secretion is also inhibited by cyclosporin A. Binding of acridine orange to liver P-glycoprotein was analyzed by photoaffinity labeling with azidopine, a substrate of P-glycoprotein dependent transport in multi-drug resistant tumor cells. Labeling of the immunoprecipitated P-glycoprotein was inhibited by acridine orange, verapamil, and by cyclosporin A. The results show that biliary secretion of acridine orange is highly analogous to P-glycoprotein mediated membrane drug transport in tumor cells that exhibit multi-drug resistance.

  15. Oncostatin M regulates membrane traffic and stimulates bile canalicular membrane biogenesis in HepG2 cells

    NARCIS (Netherlands)

    Van der Wouden, Johanna M.; Van IJzendoorn, Sven C.D.; Hoekstra, Dick

    2002-01-01

    Hepatocytes are the major epithelial cells of the liver and they display membrane polarity: the sinusoidal membrane representing the basolateral surface, while the bile canalicular membrane is typical of the apical membrane. In polarized HepG2 cells an endosomal organelle, SAC, fulfills a prominent

  16. Intestinal obstruction

    Science.gov (United States)

    Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus ... objects that are swallowed and block the intestines) Gallstones (rare) Hernias Impacted stool Intussusception (telescoping of 1 ...

  17. 腹腔镜胆总管探查取石术后T管梗阻的原因及对策%Causes and management of T-tube obstruction after laparoscopic common bile duct exploration

    Institute of Scientific and Technical Information of China (English)

    宇洋; 孙世波; 孙铁为; 孙岩

    2014-01-01

    Objective To investigate the causes and management of T-tube obstruction after laparoscopic common bile duct exploration.Methods The clinical data of 5 patients who developed T-tube obstruction after laparoscopic common bile duct exploration from Jan.2009 to Oct.2013 were retrospectively analyzed.Results Among the 5 patients with T-tube obstruction,there were 3 patients with residual stones,1 with T-tube kinking at an angle,and 1 with abdominal muscle contraction compressing the T-tube.All of them were cured after treatment.Conclusions There is some risk of T-tube obstruction after laparoscopic common bile duct exploration.The key to resolve this problem is to play detailed attention to the operation.There should be timely discovery of the causes of obstruction followed by treatment.%目的 探讨腹腔镜胆总管探查取石术后T管梗阻的原因及防治对策.方法 回顾性分析总结我院2009年1月至2013年10月5例行腹腔镜胆总管探查取石术后T管梗阻患者的临床资料.结果 5例术后T管梗阻的患者中,3例为残余结石,1例为T管弯曲成角,1例为腹肌收缩压迫,所有患者均经治疗后康复.结论 腹腔镜胆总管探查取石术后存在T管梗阻的风险,术中的精细操作和确切探查,以及术后的及时发现和合理应对是解决此问题的关键.

  18. 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%.

  19. 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 ...

  20. Conventional dacryocystorhinostomy in a failed Trans-canalicular laser-assisted dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    Rajesh Subhash Joshi

    2011-01-01

    Full Text Available We report the success rate and problems associated with conventional dacryocystorhinostomy (DCR in failed cases of Trans-canalicular, laser-assisted DCR (TCLADCR. Out of 50 patients operated by the TCLADCR technique during the period 2005 - 2006, 33 patients had failure, which was confirmed on syringing of the nasolacrimal passage. Before considering them for conventional DCR, a thorough ear, nose, throat (ENT examination was done by an ENT surgeon, to rule out a nasal pathology. All the patients were operated by the conventional standard DCR method at a medical college. While performing the surgery, the problems that came across were identified and noted. The success rate was found to be 91% in this study in a follow-up period of one year, with no major intra-operative problems. Conventional DCR is still a gold standard and should be considered as a procedure of choice in failed cases of TCLDCR.

  1. The small world of osteocytes: connectomics of the lacuno-canalicular network in bone

    Science.gov (United States)

    Kollmannsberger, Philip; Kerschnitzki, Michael; Repp, Felix; Wagermaier, Wolfgang; Weinkamer, Richard; Fratzl, Peter

    2017-07-01

    Osteocytes and their cell processes reside in a large, interconnected network of voids pervading the mineralized bone matrix of most vertebrates. This osteocyte lacuno-canalicular network (OLCN) is believed to play important roles in mechanosensing, mineral homeostasis, and for the mechanical properties of bone. While the extracellular matrix structure of bone is extensively studied on ultrastructural and macroscopic scales, there is a lack of quantitative knowledge on how the cellular network is organized. Using a recently introduced imaging and quantification approach, we analyze the OLCN in different bone types from mouse and sheep that exhibit different degrees of structural organization not only of the cell network but also of the fibrous matrix deposited by the cells. We define a number of robust, quantitative measures that are derived from the theory of complex networks. These measures enable us to gain insights into how efficient the network is organized with regard to intercellular transport and communication. Our analysis shows that the cell network in regularly organized, slow-growing bone tissue from sheep is less connected, but more efficiently organized compared to irregular and fast-growing bone tissue from mice. On the level of statistical topological properties (edges per node, edge length and degree distribution), both network types are indistinguishable, highlighting that despite pronounced differences at the tissue level, the topological architecture of the osteocyte canalicular network at the subcellular level may be independent of species and bone type. Our results suggest a universal mechanism underlying the self-organization of individual cells into a large, interconnected network during bone formation and mineralization.

  2. Curcumin prevents bile canalicular alterations in the liver of hamsters infected with Opisthorchis viverrini.

    Science.gov (United States)

    Jattujan, Prapaporn; Pinlaor, Somchai; Charoensuk, Lakhanawan; Arunyanart, Channarong; Welbat, Jariya Umka; Chaijaroonkhanarak, Wunnee

    2013-12-01

    Opisthorchis viverrini infection causes inflammation and liver injury leading to periductal fibrosis. Little is known about the pathological alterations in bile canaliculi in opisthorchiasis. This study aimed to investigate bile canalicular alterations in O. viverrini-infected hamsters and to examine the chemopreventive effects of curcumin on such changes. Hamsters were infected with O. viverrini and one group of animals was fed with 1% dietary curcumin supplement. Animals were examined during the acute infection phase, days 21 and 30 post-infection (PI) and chronic infection phase (day 90 PI). Scanning electron microscopy revealed that in the infected group fed with a normal diet, bile canaliculi became slightly tortuous by 30 day PI and more tortuous at day 90 PI. Transmission electron microscopy showed a reduction in microvilli density of canaliculi starting at day 30 PI, with a marked loss of microvilli at day 90 PI. These ultrastructral changes were slightly seen at day 21 PI, which was similar to that found in infected animals fed with 1% curcumin-supplemented diet. Notably, curcumin treatment prevented the reduction of microvilli density, reduced the dilation of bile canaliculi, and decreased the tortuosity of the bile canaliculi relative to non-infected animals on a normal diet at days 30 and 90 PI. These results suggest that curcumin reduces alteration of bile canaliculi and may be a promising agent to prevent the onset of bile duct abnormalities induced by O. viverrini infection.

  3. Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration

    Institute of Scientific and Technical Information of China (English)

    WANG Zun-jing; KONG Qing-lan; XIE Ying-bin; LI Ting

    2008-01-01

    Objective: To evaluate the therapeutic effects of two anastomoses (canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis) on nasolacrimal laceration for over 7 mm from the broken end to the dacryon. Methods: A total of 71 patients (44 males and 27 females, aged 16-55 years, mean=34.32 years) with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis (the treatment group) and 34 with end-to-end anastomosis (the control group), detaining silicone tubes till 3 months later. Results: The cure rate of the treatment group (89.19%) was significantly higher than that of the control group (55.56%). Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant (P0.05). Conclusions- When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anasto-mosis is a better treatment method than end-to-end anasto-mosis for laceration of lacrimal canaliculus.

  4. A morphological analysis on the osteocytic lacunar canalicular system in bone surrounding dental implants.

    Science.gov (United States)

    Haga, Maiko; Nozawa-Inoue, Kayoko; Li, Minqi; Oda, Kimimitsu; Yoshie, Sumio; Amizuka, Norio; Maeda, Takeyasu

    2011-06-01

    Osseointegration is the most preferable interface of dental implants and newly formed bone. However, the cavity preparation for dental implants often gives rise to empty lacunae or pyknotic osteocytes in bone surrounding the dental implant. This study aimed to examine the chronological alternation of osteocytes in the bone surrounding the titanium implants using a rat model. The distribution of the osteocytic lacunar canalicular system (OLCS) in bone around the titanium implants was examined by silver impregnation according to Bodian's staining. We also performed double staining for alkaline phosphatase (ALP) and tartrate-resistant acid phosphatase (TRAP), as well as immunohistochemistry for fibroblast growth factor (FGF) 23--a regulator for the serum concentration of phosphorus--and sclerostin, which has been shown to inhibit osteoblastic activities. Newly formed bone and the injured bone at the early stage exhibited an irregularly distributed OLCS and a few osteocytes positive for sclerostin or FGF23, therefore indicating immature bone. Osteocytes in the surrounding bone from Day 20 to Month 2 came to reveal an intense immunoreactivity for sclerostin. Later on, the physiological bone remodeling gradually replaced such immature bone into a compact profile bearing a regularly arranged OLCS. As the bone was remodeled, FGF23 immunoreactivity became more intense, but sclerostin became less so in the well-arranged OLCS. In summary, it seems likely that OLCS in the bone surrounding the dental implants is damaged by cavity formation, but later gradually recovers as bone remodeling takes place, ultimately inducing mature bone. Copyright © 2011 Wiley-Liss, Inc.

  5. The cast imaging of the osteon lacunar-canalicular system and the implications with functional models of intracanalicular flow.

    Science.gov (United States)

    Pazzaglia, Ugo E; Congiu, Terenzio

    2013-02-01

    A casting technique with methyl-methacrylate (MMA) was applied to the study of the osteon lacunar-canalicular network of human and rabbit cortical bone. The MMA monomer infiltration inside the vascular canals and from these into the lacunar-canalicular system was driven by capillarity, helped by evaporation and the resulting negative pressure in a system of small pipes. There was uniform, centrifugal penetration of the resin inside some osteons, but this was limited to a depth of four to five layers of lacunae. Moreover, not all of the osteon population was infiltrated. This failure can be the result of one of two factors: the incomplete removal of organic debris from the canal and canalicular systems, and lack of drainage at the osteon external border. These data suggest that each secondary osteon is a closed system with a peripheral barrier (represented by the reversal line). As the resin advances into the osteon, the air contained inside the canalicula is compressed and its pressure increases until infiltration is stopped. The casts gave a reliable visualization of the lacunar shape, position and connections between the lacunae without the need for manipulations such as cutting or sawing. Two systems of canalicula could be distinguished, the equatorial, which connected the lacunae (therefore the osteocytes) lying on the same concentric level, and the radial, which established connections between different levels. The equatorial canalicula radiated from the lacunar border forming ramifications on a planar surface around the lacuna, whereas the radial canalicula had a predominantly straight direction perpendicular to the equatorial plane. The mean length of the radial canalicula was 40.12 ± 10.26 μm in rabbits and 38.4 ± 7.35 μm in human osteons; their mean diameter was 174.4 ± 71.12 nm and 195.7 ± 79.58 nm, respectively. The mean equatorial canalicula diameter was 237 ± 66.04 nm in rabbit and 249.7 ± 73.78 nm in human bones, both significantly larger (P

  6. Identification and characterization of high and low affinity transport systems for reduced glutathione in liver cell canalicular membranes.

    Science.gov (United States)

    Ballatori, N; Dutczak, W J

    1994-08-05

    Driving forces and substrate specificity for transport of reduced glutathione (GSH) across rat liver cell canalicular membrane were examined in vesicles isolated from this plasma membrane domain. In contrast to previous studies indicating a single saturable component of canalicular GSH transport, the present results demonstrate the presence of both high and low affinity components with apparent Km values of 0.24 +/- 0.04 and 17.4 +/- 2.1 mM and Vmax values of 0.09 +/- 0.01 and 2.3 +/- 0.3 nmol.mg-1.20 s-1, respectively. The Km values in two previously published reports are discordant, 0.33 versus 16 mM, but are comparable with the two transport components identified in the present study. To further characterize these GSH transport mechanisms, [3H]GSH uptake by canalicular vesicles was measured at concentrations of 50 microM, where transport is expected to occur largely on the high affinity component, and at 5 mM, where the low affinity system should predominate. Neither component of GSH transport was affected by ATP or a Na+ gradient, but both were stimulated by a valinomycin-induced membrane potential, indicating electrogenic transport pathways. The high affinity component was cis-inhibited by glutathione S-conjugates (1 mM), other gamma-glutamyl compounds (5 mM), and 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (0.1 mM), whereas these agents had no effect on the low affinity component at similar inhibitor concentrations. Sulfobromophthalein (BSP, 0.1 mM) inhibited both GSH transport components. However, neither component was affected by taurocholate (0.5 mM) or L-glutamate (10 mM). The inhibition by S-butylglutathione, the GSH analogue ophthalmic acid, and by BSP was competitive in nature, although BSP also produced a slight decrease in Vmax, suggesting a mixed type of inhibition. Ophthalmic acid and some glutathione S-conjugates were also able to trans-stimulate high affinity GSH uptake. These results indicate the presence of at least two ATP

  7. Appendicular Tourniquet: A Cause of Intestinal Obstruction

    Science.gov (United States)

    Shivashankar, Santhosh Chikkanayakanahalli; Gangappa, Rajashekara Babu; Varghese, Edison Vadakkenchery

    2016-01-01

    Intestinal obstruction is one of the common surgical emergencies seen in daily practice. Postoperative adhesions are notorious for being the most common cause for intestinal obstruction. Occasionally, laparotomy findings do come as a surprise to surgeons. Here one such case is discussed. A patient was operated on with suspicion of intestinal obstruction secondary to postoperative adhesions. However, laparotomy revealed the appendix to be inflamed, curled around the terminal ileum and acting as a tourniquet. PMID:27437300

  8. Obstructive uropathy

    Science.gov (United States)

    ... uropathy URL of this page: //medlineplus.gov/ency/article/000507.htm Obstructive uropathy To use the sharing ... cancer Colon cancer Cervical cancer Uterine cancer Any ... blockage. A Foley catheter, placed through the urethra into the bladder, may also be help urine ...

  9. Pravastatin transport across the hepatocyte canalicular membrane requires both ATP and a transmembrane pH gradient.

    Science.gov (United States)

    Adachi, Y; Okuyama, Y; Miya, H; Matsusita, H; Kitano, M; Kamisako, T; Yamamoto, T

    1996-06-01

    Hepatic excretion of non-bile acid organic anions is reported to be ATP-dependent and a defect of this transport has been reported in congenitally jaundiced rats, animal models of human Dubin-Johnson syndrome. To investigate the effect of the transmembrane pH gradient on hepatocyte canalicular membrane transport of ATP-dependent organic anions, uptake of pravastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase-inhibiting organic anion, by hepatocyte canalicular membrane vesicles was observed in the presence or absence of transmembrane pH gradients. Uptake was assessed by a rapid filtration technique. ATP-dependent pravastatin uptake was stimulated in the presence of a transmembrane pH gradient (in > out) in Sprague-Dawley (SD) rats. Uptake was dependent on both pravastatin and ATP concentrations and showed saturation kinetics. After intravenous injection of [14C]-pravastatin (0.3 mumol), 81% of the dose was excreted in the bile within 35 min in SD rats, whereas only 20% was excreted in the bile in Eisai hyperbilirubinuria rats. ATP and the pH gradient also co-stimulated the uptake of pravastatin in Eisai hyperbilirubinuria rats, although the K(m) was much higher and Vmax was much lower than corresponding values in SD rats. This coincided well with the marked reduction in vivo biliary excretion of pravastatin in jaundiced rats.

  10. Spectrum and antimicrobial resistance of common pathogenic bacteria isolated from patients with acute exacerbation of chronic obstructive pulmonary disease in mainland of China

    Institute of Scientific and Technical Information of China (English)

    YE Feng; HE Li-xian; CAI Bo-qiang; WEN Fu-qiang; CHEN Bai-yi; Mangunnegoro Hadiarto; CHEN Rong-chang

    2013-01-01

    Background Bacteria-induced respiratory infection has been long considered to be the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Therefore,a clear picture about the distribution and drug-resistance of pathogenic bacteria in the lower airways should be helpful for treatment of the disease.So far,data on this topic among Chinese are lacking.Methods A surveillance study was performed in consecutive patients with AECOPD at five areas in China between October 2006 and April 2008.The sputum from these patients was cultured and isolated for bacteria.Agar dilution method was used to determine the minimal inhibitory concentrations (MICs) of levofloxacin and other 15 antibiotics against these strains.Results Three hundred and fifty-nine pathogenic bacterial strains were isolated among 884 patients with AECOPD.The predominant bacteria were Pseudomonas aeruginosa (21.7%),Klebsiella pneumoniae (12.3%),Haemophilus influenzae (14.2%) and Streptococcus pneumoniae (11.7%),followed by Haemophilus parainfluenzae (9.5%),Acinetobacter baumannii (7.8%),Moraxella catarrhalis (6.4%) and Escherichia coli (3.6%).The majority of bacterial pathogens isolated in this study were susceptible to fluoroquinolones,ceftazidime,cefepime and imipenem.Conclusions Gram-negative bacilli are the leading pathogens in patients with AECOPD in China.Haemophilus parainfluenzae may be one of the most important pathogens in AECOPD.This study provides evidence for local surveillance of AECOPD pathogens and appropriate choice of antimicrobials in China.

  11. Rho kinase, myosin-II, and p42/44 MAPK control extracellular matrix-mediated apical bile canalicular lumen morphogenesis in HepG2 cells

    NARCIS (Netherlands)

    Herrema, H; Czajkowska, D; Theard, D; van der Wouden, JM; Kalicharan, D; Zolghadr, B; Hoekstra, D; Ijzendoorn, SCD

    The molecular mechanisms that regulate multicellular architecture and the development of extended apical bile canalicular lumens in hepatocytes are poorly understood. Here, we show that hepatic HepG2 cells cultured on glass coverslips first develop intercellular apical lumens typically formed by a

  12. Cyclic AMP stimulates sorting of the canalicular organic anion transporter (Mrp2/cMoat) to the apical domain in hepatocyte couplets

    NARCIS (Netherlands)

    Roelofsen, H; Soroka, CJ; Keppler, D; Boyer, JL

    1998-01-01

    The canalicular membrane of rat hepatocytes contains an ATP-dependent multispecific organic anion transporter, also named multidrug resistance protein 2, that is responsible for the biliary secretion of several amphiphilic organic anions. This transport function is markedly diminished in mutant rats

  13. 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.

  14. Surgical Reconstruction for Severe Tracheal Obstruction in Morquio A Syndrome.

    Science.gov (United States)

    Pizarro, Christian; Davies, Ryan R; Theroux, Mary; Spurrier, Ellen A; Averill, Lauren W; Tomatsu, Shunji

    2016-10-01

    Progressive tracheal obstruction is commonly seen in Morquio A syndrome and can lead to life-threatening complications. Although tracheostomy can address severe upper airway obstruction, lower airway obstruction, commonly associated with a narrow thoracic inlet and vascular compression, requires an alternative approach. We describe the case of a 16-year-old patient with Morquio A syndrome whose near-fatal tracheal obstruction was relieved by timely surgical tracheal vascular reconstruction with dramatic resolution of his respiratory symptoms.

  15. Modulation of liver canalicular transport processes by the tyrosine-kinase inhibitor genistein: implications of genistein metabolism in the rat.

    Science.gov (United States)

    Jäger, W; Winter, O; Halper, B; Salamon, A; Sartori, M; Gajdzik, L; Hamilton, G; Theyer, G; Graf, J; Thalhammer, T

    1997-12-01

    Rat liver cells express the multispecific organic anion transporter (cmoat, cmrp, mrp2) and P-glycoprotein (Pgp) in their canalicular membranes, proteins that are homologous to the multidrug-resistance related protein (MRP) and multidrug resistance (MDR) gene products in multidrug resistant tumor cells. We tested whether genistein, a modulator of drug resistance in tumor cells, affects biliary secretion of substrates of canalicular multispecific organic anion transporter (cmoat) (glucuronides of bilirubin and rhodamine, glutathione conjugate of bromsulphthalein) and of P-glycoprotein (Pgp) (rhodamine), respectively. Using the isolated perfused rat liver of control Wistar rats (TR+) and of a mutant strain (TR-) that expresses Pgp but not cmoat, we show that genistein effectively inhibits the secretion of anionic substrates of cmoat in Wistar rats but stimulates secretion of cationic rhodamine in TR- rats. Genistein is subject to glucuronidation and sulfatation and secretion of genistein and its metabolites stimulates bile flow in Wistar rats, but secretion is nearly absent in TR- rats. Because genistein and its metabolites are substrates for cmoat, inhibition of anion secretion by genistein is partially explained by competition for this transporter. Genistein is also a substrate of uridindiphosphate (UDP)-glucuronyltransferase isoenzyme(s). Inhibition of glucuronidation reduces the availability of bilirubin and rhodamine glucuronates for transport via cmoat, but unconjugated cationic rhodamine becomes available for transport via Pgp at an increased cellular concentration. Daidzein, a genistein analogue with no effect on protein tyrosine kinase (PTK) shows Similar effects on secretion of organic anions and cations supporting the conclusion that genistein affects transport in liver mainly through competition with other substrates at the sites of glucuronidation and transport via cmoat.

  16. Retrospective study to characterize post-obstructive diuresis in cats with urethral obstruction.

    Science.gov (United States)

    Francis, Brenda J; Wells, Raegan J; Rao, Sangeeta; Hackett, Timothy B

    2010-08-01

    Urethral obstruction is a common medical emergency in cats. Frequency of post-obstruction diuresis in cats following resolution of urethral obstruction is unknown. The objective of this study was to document frequency and associated clinical features of post-obstruction diuresis in cats. The records of 32 cats undergoing 33 admissions to the Colorado State University Veterinary Hospital for urethral obstruction were reviewed. Signalment, admission blood values, fluid therapy, and urine output were recorded. Diuresis was defined as urine output greater than 2ml/kg/h. Post-obstructive diuresis occurred in 46% (13/28) of cats within the first 6h of treatment. Occurrence of post-obstructive diuresis was statistically more likely in cats with venous pHdiuresis.

  17. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome: a randomized, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems.

    Science.gov (United States)

    Nikolopoulou, Maria; Byraki, Anna; Ahlberg, Jari; Heymans, Martijn W; Hamburger, H L; De Lange, Jan; Lobbezoo, Frank; Aarab, Ghizlane

    2017-03-10

    Obstructive sleep apnea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomized placebo-controlled trial sixty-four OSAS patients (52.0± 9.6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with "insomnia", "excessive daytime sleepiness", "psychiatric sleep disorder", "periodic limb movements", "sleep apnea", "sleep paralysis", "daytime dysfunction", "hypnagogic hallucinations/dreaming", "restless sleep", "negative conditioning", and "automatic behaviour" (range of P values: 0.000-0.014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0.090-0.897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects. This article is protected by copyright. All rights reserved.

  18. Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kotzadimitriou Aikaterini

    2009-01-01

    Full Text Available Abstract Introduction Although mural thrombus in an abdominal aortic aneurysm is frequent and its role has been studied extensively, complete thrombosis of an abdominal aneurysm is extremely rare and its natural history in relation to the risk of rupture is not known. The case of a patient with a completely thrombosed infrarenal aneurysm is presented along with a literature review. Case presentation We report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries. Conclusion During the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.

  19. Oxidative stress in obstructive nephropathy

    NARCIS (Netherlands)

    Dendooven, Amelie; Ishola, David A.; Nguyen, Tri Q.; Van der Giezen, Dionne M.; Kok, Robbert Jan; Goldschmeding, Roel; Joles, Jaap A.

    P>Unilateral ureteric obstruction (UUO) is one of the most commonly applied rodent models to study the pathophysiology of renal fibrosis. This model reflects important aspects of inflammation and fibrosis that are prominent in human kidney diseases. In this review, we present an overview of the

  20. Inhibition of biliary cholesterol and phospholipid secretion by cefmetazole. The role of vesicular transport and of canalicular events.

    Science.gov (United States)

    Cava, F; Gonzalez, J; Gonzalez-Buitrago, J M; Muriel, C; Jimenez, R

    1991-01-01

    A number of organic anions selectively inhibit the biliary secretion of cholesterol and phospholipids without affecting bile acid secretion. We studied the effect of cefmetazole, a third-generation cephalosporin, on biliary lipid secretion in the rat. Injection of cefmetazole at a dose of 200 mumol/kg body wt. induced a choleretic effect and a significant decrease in the biliary output of cholesterol and phospholipid, without changes in bile acid secretion. The decrease was more marked for cholesterol than for phospholipid secretion, with a significant decrease in their molar ratio in bile. The effects were apparently unrelated to an inhibition of intracellular vesicular transport because, after injection of horseradish peroxidase, both the time course and total amount secreted of the protein did not significantly differ between control animals and those receiving cefmetazole. The secretory rate of the lysosomal marker acid phosphatase was not affected by cefmetazole administration. Biliary outputs of the plasma-membrane enzymes alkaline phosphatase and gamma-glutamyltransferase were significantly decreased by the antibiotic. These results point to an effect of cefmetazole at the level of the canalicular membrane. PMID:1674860

  1. Lymphatic obstruction

    Science.gov (United States)

    Lymphedema ... obese people) Surgery Tumors A common cause of lymphedema is removal of the breast ( mastectomy ) and underarm lymph tissue for breast cancer. This causes lymphedema of the arm in some people, because the ...

  2. Intestinal obstruction repair

    Science.gov (United States)

    Repair of volvulus; Intestinal volvulus - repair; Bowel obstruction - repair ... Intestinal obstruction repair is done while you are under general anesthesia . This means you are asleep and DO NOT feel pain. ...

  3. 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 ...

  4. Childhood Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    R Dayal

    2014-03-01

    Full Text Available Obstructive sleep apnea (OSA is a common condition in childhood and can result insevere complications if left untreated. It is showing a rising trend in India. A significantassociation with obesity has been observed; however, some children with enlargedtonsils and/or adenoids may even be underweight. The patient usually presents withsnoring and other respiratory problems like mouth breathing, choking and gaspingepisodes in night. Poor school performance and neurocognitive deficits have beenreported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besidesthe history and clinical examination, for definitive diagnosis an overnightpolysomnographic evaluation is the gold standard. In all cases, the specific treatmentranges from simple lifestyle modifications and medications to surgeries likeadenotonsillectomy. Early diagnosis is vital.Key words: Childhood OSA, Obesity, adenotonsillar hypertrophy

  5. Cervicomedullary neurocysticercosis causing obstructive hydrocephalus.

    Science.gov (United States)

    Wang, Doris D; Huang, Michael C

    2015-09-01

    We present a 45-year-old man with tussive headache and blurred vision found to have obstructive hydrocephalus from a neurocysticercal cyst at the cervicomedullary junction who underwent surgical removal of the cyst. We performed a suboccipital craniectomy to remove the cervicomedullary cyst en bloc. Cyst removal successfully treated the patient's headaches without necessitating permanent cerebrospinal fluid diversion. Neurocysticercosis is the most common parasite infection of the central nervous system causing seizures and, less commonly, hydrocephalus. Intraventricular cysts or arachnoiditis usually cause hydrocephalus in neurocysticercosis but craniocervical junction cysts causing obstructive hydrocephalus are rare. Neurocysticercosis at the craniocervical junction may cause Chiari-like symptoms. In the absence of arachnoiditis and leptomeningeal enhancement, surgical removal of the intact cyst can lead to favorable outcomes.

  6. Radiological interventions in malignant biliary obstruction

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

    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 pal iative 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.

  7. Coagulability in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Christina Liak

    2011-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity.

  8. Obstructive Colitis Proximal to Obstructive Colorectal Carcinoma

    Directory of Open Access Journals (Sweden)

    Hye Kyung Chang

    2009-01-01

    Full Text Available The term “obstructive colitis” refers to ulceroinflammatory lesions occurring in the colon proximal to a completely or partially obstructing lesion. It has been referred to by various terms in the literature. This entity differs from the carcinoma of the colon that complicates true ulcerative colitis where there is involvement distal to the neoplasm as well as proximal to it. Although it has appeared in the literature over several decades, it remains an uncommon and troublesome disease. In Yonsei University Medical Center, for 11 years from January 1996 to December 2006 we encountered seven patients with obstructing colorectal carcinoma complicated by obstructive colitis. Here we report our cases to share our experience and to review the literature to facilitate the recognition and proper management of this rare disease entity.

  9. Genetic associations with obstructive sleep apnea traits in Hispanic/Latino Americans

    Science.gov (United States)

    Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic bas...

  10. What to do with an obstructed newborn.

    Science.gov (United States)

    Bravo Bravo, M C; García-Herrera Taillefer, P

    2016-05-01

    Bowel obstruction is the most common abdominal emergency in newborns. Managing bowel obstruction is a challenge for both clinicians and radiologists. The clinical presentation is nonspecific, and both the diagnosis and subsequent management are based on imaging studies. The traditional approach to studying obstructed newborns consists of plain-film abdominal X-rays and contrast-based studies of the gastrointestinal tract. Ultrasonography has proven useful in bowel obstruction, thus avoiding the use of ionizing radiation in certain cases, so diagnostic strategies should include it as a first-line technique. Using an appropriate combination of these techniques, it is possible to reach an accurate diagnosis quickly, orienting treatment and decreasing complications. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  11. A DEMOGRAPHIC, CLINICAL AND SURGICAL STUDY OF OBSTRUCTED INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Mohammed Imran Khaleel

    2016-11-01

    Full Text Available BACKGROUND An obstructed inguinal hernia means the inguinal hernia is associated with intestinal obstruction due to occlusion of lumen of bowel. A distinguishing feature of strangulated hernia is the bowel's blood supply is not compromised. Intestinal obstruction is absent in case of omentocele, Richter's hernia and Littre's hernia. In this study, a sincere effort has been made to study and understand an obstructed inguinal hernia. This study is intended to help the practicing surgeon to understand the complications and to take necessary actions. MATERIALS AND METHODS  Eighty cases of obstructed inguinal hernia were studied between June 2009 to September 2011.  This study has been conducted from the patients of Deccan College of Medical Sciences admitted during the above period.  Out of 80 cases for follow up after discharge, 25 cases were reviewed. RESULTS  The incidence of obstruction in inguinal hernia is 7.9% in this study.  Obstructed inguinal hernia is more common in age group 20-50 yrs. of age.  It is 80 times more common in males. Male-to-female ratio is 79:1.  There is right-sided preponderance. Obstruction occurs in ratio of 3:1 on right and left sides. CONCLUSION A study of common surgical emergency- obstructed inguinal hernia was presented. Anatomy, pathophysiology, aetiological factors, clinical features and complications were noted.

  12. Benign segmental bronchial obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Loercher, U.

    1988-09-01

    The benigne segmental bronchial obstruction - mostly discovered on routine chest films - can well be diagnosed by CT. The specific findings in CT are the site of the bronchial obstruction, the mucocele and the localized empysema of the involved segment. Furthermore CT allows a better approach to the underlying process.

  13. Obstructive sleep apnea therapy

    NARCIS (Netherlands)

    Hoekema, A.; Stegenga, B.; Wijkstra, P. J.; van der Hoeven, J. H.; Meinesz, A. F.; de Bont, L. G. M.

    2008-01-01

    In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned

  14. Trichobezoar with small bowel obstruction in children: Two cases report

    Directory of Open Access Journals (Sweden)

    Khattala K

    2008-01-01

    Full Text Available A trichobezoar is a mass of cumulated hair within the gastrointestinal tract. Stomach is the common site of occurrence. Intestinal obstruction due to trichobezoar is extremely rare. The authors report two cases of a trichobezoar obstructing the terminal ileum in one and the jejunum in another.

  15. Epidemiology of Comorbidities in Chronic Obstructive Pulmonary Disease

    NARCIS (Netherlands)

    L. Lahousse (Lies)

    2014-01-01

    markdownabstract__Abstract__ Chronic Obstructive Pulmonary Disease (COPD) is defined by the Global initiative for chronic Obstructive Lung Disease (GOLD) as a common preventable and treatable disease, which is characterized by a persistent airflow limitation that is usually progressive and associat

  16. Steroid responsive eosinophilic gastric outlet obstruction in a child

    Institute of Scientific and Technical Information of China (English)

    Richard Kellermayer; Nina Tatevian; William Klish; Robert J Shulman

    2008-01-01

    Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservative medical management. A brief review of this clinical entity is also provided.

  17. Effect of bowel obstruction on stage IV colorectal cancer.

    Science.gov (United States)

    Chen, Wei; Tan, Xiao-Ping; Ye, Jun-Wen; Liu, Qin; Zeng, Qingli; Wang, Lei; Wang, Jian-Ping

    2014-03-01

    Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with a high mortality rate, particularly among patients with advanced-stage disease complicated by bowel obstruction. The present study aimed to investigate the value of different surgical procedures and potential predictors of survival for patients with stage IV CRC, with or without bowel obstruction. Between August, 1994 and December, 2005, a total of 2,950 CRC patients were diagnosed and treated at our hospital. Among these, 381 patients had stage IV disease and were divided into two groups according to the presence (n=295) or absence (n=86) of bowel obstruction. The clinical data of all the patients with stage IV CRC were retrospectively analyzed and all the patients were followed up. Our results demonstrated statistically significant differences in gender, radical resection, histological type, ascites, tumor location, peritoneal and liver metastases between the obstruction and non-obstruction groups. We also observed that hepatic metastases and radical resection were factors associated with prognosis according to the univariate and multivariate analyses. Furthermore, the mean/median survival time was 49.4/21.6 and 37.2/17.1 months in the non-obstruction and obstruction groups, respectively. In conclusion, obstruction was not found to be an independent indicator of survival for patients with stage IV CRC, with patients in the obstruction group exhibiting a worse overall survival compared to those in the non-obstruction group, whereas active radical surgery significantly improved the prognosis of patients with stage IV CRC.

  18. 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…

  19. Small bowel obstruction attributable to phytobezoar

    Science.gov (United States)

    Razavianzadeh, Nasrin; Foroutan, Behzad; Honarvar, Farhad; Forozeshfard, Mohammad

    2016-01-01

    Small bowel obstruction (SBO) is a common condition encountered in surgical practice. Literature shows divers and many different etiologies for intestinal obstruction. However, bezoars are rarely reported as an etiological factor. A bezoar happens most commonly in patients with impaired gastrointestinal motility. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobezoars. The most common type is phytobezoars, which are composed of undigested fiber from vegetables or fruits especially persimmons. They are mostly composed of cellulose, tannin and lignin. The commonest phytobezoar reported worldwide is related to the persimmon fruit ingestion. The most common symptom of bezoar-induced SBO is abdominal pain (96–100%). Other common symptoms include nausea and vomiting. Primary small bowel phytobezoars almost always present as SBO. We present an unusual case of SBO caused by a phytobezoar in a 35-year-old patient. Many types of bezoar can be removed endoscopically, but some will require operative intervention. PMID:28031856

  20. 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...

  1. 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.

  2. Recognition and diagnosis of chronic obstructive pulmonary disease

    African Journals Online (AJOL)

    Chronic obstructive pulmonary disease (COPD) is a common lung disorder associated ... and the indoor use of biomass fuel for heating and cooking. ... exposed to risk factors for COPD. In a study in GP .... pulmonary hypertension. The breath ...

  3. [Obstructive anuria. Thirty cases].

    Science.gov (United States)

    Bennani, S; Debbagh, A; Joual, A; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology.

  4. [Non obstructive retrocaval ureter].

    Science.gov (United States)

    Cao Avellaneda, E; Server Pastor, G; López López, A I; Maluff Torres, A; López Cubillana, P; Rigabert Montiel, M; Pérez Albacete, M

    2005-01-01

    We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.

  5. Chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008430 Effect of gas exchange at maximal intensity on exercise capacity in patients with chronic obstructive pulmonary disease. WANG Haoyan(王浩彦), et al. Dept Respir Dis, Beijing Friendship Hosp, Capital Med Sci Univ, Beijing 100050. Chin J Tuberc Respir Dis 2008;31(6):414-416. Objective To investigate the effect of gas exchange at maximal intensity on exercise capacity in patients with chronic obstructive pulmonary disease (COPD).

  6. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial

    NARCIS (Netherlands)

    S.M. Jeurnink; E.W. Steyerberg; J.E. van Hooft; C.H.J. van Eijck; M.P. Schwartz; F.P. Vleggaar; E.J. Kuipers; P.D. Siersema

    2010-01-01

    BACKGROUND: Both gastrojejunostomy (GJJ) and stent placement are commonly used palliative treatments of obstructive symptoms caused by malignant gastric outlet obstruction (GOO). OBJECTIVE: Compare GJJ and stent placement. DESIGN: Multicenter, randomized trial. SETTING: Twenty-one centers in The Net

  7. 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

  8. The Christmas Season as a Risk Factor for Chronic Obstructive Pulmonary Disease Exacerbations

    Directory of Open Access Journals (Sweden)

    Neil W Johnston

    2010-01-01

    Full Text Available BACKGROUND: Epidemics of hospitalization for chronic obstructive pulmonary disease (COPD occur annually during the Christmas holidays, and COPD exacerbations commonly coincide with respiratory viral infections.

  9. 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.)

  10. 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.

  11. Gallstone ileus as a cause of upper intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Israel Szajnbock

    Full Text Available Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice.The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.

  12. ETIOLOGY, EPIDEMIOLOGICAL PROFILE AND RADIOLOGICAL EVALUATION OF OBSTRUCTIVE JAUNDICE AT A TERTIARY CARE CENTER

    Directory of Open Access Journals (Sweden)

    Lokesh

    2015-09-01

    Full Text Available BACKGROUND AND AIM: Obstructive jaundice is nowadays usually referred to gastroenterology department and therefore, it is important to identify the common causes and relevant investigations to find out the cause. With this objective we conducted a study at Mahatma Gandhi Hospital, Jaipur to find out the etiology and epidemiological profile of patients presenting with obstructive jaundice to our department. PATIENTS AND METHODS: 50 patients of obstructive jaundice were evaluated thoroughly for etiology, epid emiological profile and radiological evaluation. RESULTS: Malignancy was more common in males while benign causes predominated in females. Carcinoma head of pancreas was most common cause of obstructive jaundice followed by choledocholithiasis. CONCLUSION : Malignant obstructive jaundice is more common as compared to benign obstructive jaundice and malignant causes are more frequent in males as compared to females Where benign causes predominate. Ultrasound should be the first diagnostic test to be performed and in selected cases CT and MRCP should be performed.

  13. Covered Bronchial Stent Insertion to Manage Airway Obstruction with Hemoptysis Caused by Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sae Ah; Kim, Do Hyeong [Dankook University College of Medicine, Dankook University Hospital, Cheonan (Korea, Republic of); Jen, Gyeong Sik [Bundang CHA General Hospital, CHA University, Seongnam (Korea, Republic of)

    2012-07-15

    Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.

  14. Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin Sequence.

    Science.gov (United States)

    Genther, Dane J; Skinner, Margaret L; Bailey, Patti J; Capone, Randolph B; Byrne, Patrick J

    2015-09-01

    Pierre-Robin Sequence (PRS) is defined as the triad of micrognathia, glossoptosis, and cleft palate and affects approximately 1/8500 births. Airway obstruction is common in infants with PRS and results from glossoptosis leading to pharyngeal obstruction. Any procedure that increases the severity of glossoptosis, such as lingual frenulectomy, may increase the risk of obstruction or aggravate existing obstruction. This report discusses two cases of significant airway decompensation after lingual frenulectomy requiring surgical intervention in infants with PRS. We suggest that lingual frenulectomy be contraindicated in infants with PRS or suspected PRS due to the possible increased risk of airway obstruction. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Occupational chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

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

    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....

  16. 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

  17. Nasal obstruction and human communication.

    Science.gov (United States)

    Malinoff, R; Moreno, C

    1989-04-01

    Nasal obstruction may cause a variety of communication disorders, particularly in children. The effects of nasal obstruction on hearing, speech, language, and voice are examined. Methods for assessing the effects of nasal obstruction are delineated, and recommendations for therapeutic interventions are described.

  18. Resistive Index in Obstructive Uropathy

    NARCIS (Netherlands)

    A.A. Shokeir

    1999-01-01

    textabstractThe diagnosis of urinary tract obstruction is a difficult and perplexing problem particularly in children. Pyelocalyectasis is seen not only in obstruction but also in other conditions, such as residual dilatation afler relief of obstruction, vesicoureteral reflux and pyelonephritis.

  19. Inducible laryngeal obstruction

    DEFF Research Database (Denmark)

    Halvorsen, Thomas; Walsted, Emil Schwarz; Bucca, Caterina

    2017-01-01

    Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. ILO is an important cause of a variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has been hampered by imprecise nomenc...

  20. Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials.

    Science.gov (United States)

    Hemmingsson, E

    2011-02-01

    Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.

  1. Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Heickendorff, Lene; Antonsen, Sebastian

    1998-01-01

    To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking.......To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking....

  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.

  3. 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.

  4. Atrial fibrillation in obstructive sleep apnea

    OpenAIRE

    Goyal, Sandeep K; Sharma, Abhishek

    2013-01-01

    Atrial fibrillation (AF) is a common arrhythmia with rising incidence. Obstructive sleep apnea (OSA) is prevalent among patients with AF. This observation has prompted significant research in understanding the relationship between OSA and AF. Multiple studies support a role of OSA in the initiation and progression of AF. This association has been independent of obesity, body mass index and hypertension. Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA. T...

  5. Positional Right Ventricular Obstruction in Pectus Excavatum.

    Science.gov (United States)

    Underwood, Katherine; Vorsanger, Matthew; Saric, Muhamed; Skolnick, Adam H

    2017-01-25

    Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.

  6. Severe upper airway obstruction during sleep.

    Science.gov (United States)

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  7. Chronic partial ureteral obstruction and the developing kidney

    Energy Technology Data Exchange (ETDEWEB)

    Chevalier, Robert L. [University of Virginia, Department of Pediatrics, Box 800386, Charlottesville, VA (United States)

    2008-01-15

    Although congenital urinary tract obstruction is a common disorder, its pathophysiology remains poorly understood and clinical practice is controversial. Animal models have been used to elucidate the mechanisms responsible for obstructive nephropathy, and the models reveal that renal growth and function are impaired in proportion to the severity and duration of obstruction. Ureteral obstruction in the neonatal rat or mouse leads to activation of the renin-angiotensin system, renal infiltration by macrophages, and tubular apoptosis. Nephrons are lost by glomerular sclerosis and the formation of atubular glomeruli, and progressive injury leads to tubular atrophy and interstitial fibrosis. Recovery following release of obstruction depends on the timing, severity, and duration of obstruction. Growth factors and cytokines are produced by the hydronephrotic kidney, including MCP-1 and TGF-{beta}1, which are excreted in urine and can serve as biomarkers of renal injury. Because MRI can be used to monitor renal morphology, blood flow, and filtration rate, its use might supplant current imaging modalities (ultrasonography and diuretic renography), which have significant drawbacks. Combined use of MRI and new urinary biomarkers should improve our understanding of human congenital obstructive nephropathy and should lead to new approaches to evaluation and management of this challenging group of patients. (orig.)

  8. Olive Oil and the Treatment of Adhesive Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Ghahramani

    2016-11-01

    Full Text Available Background Post-operative adhesions are the most common cause of small bowel obstruction. The management of small bowel obstruction is surgical and non-surgical. Some studies are conducted to show the efficacy of non-surgical management of adhesive small bowel obstruction such as sesame oil, water - soluble contrasts such as gastrographin. Objectives The current study aimed to evaluate the effect of oral olive oil on the management of adhesive small bowel obstruction. Methods All the patients admitted with adhesive bowel obstruction in the hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, from October 2012 to September 2013 that had inclusion criteria were evaluated by general surgeon. The patients were separated into two groups and standard management was done. Then 12 hours after admission, 150 mL olive oil was given by nasogastric (NG tube to the first group. Results The spontaneous resolution time of small bowel obstruction was significantly longer in the control group than the treatment group (59 hours vs. 35 hours. The hospital stay was shorter in the treatment group than the control (three days vs. six days. Conclusions The study results demonstrated that olive is an effective and safe adjunct to the conservative management of small bowel obstruction and markedly reduces the time of resolution of symptoms and length of hospital stay.

  9. Large Bowel Obstruction, a Delayed Complication of Severe Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Neeraj Lal

    2016-01-01

    Full Text Available Colonic complications are rare after acute pancreatitis but are associated with a high mortality. Possible complications include mechanical obstruction, ischaemic necrosis, haemorrhage, and fistula. We report a case of large bowel obstruction in a 31-year-old postpartum female, secondary to severe gallstone pancreatitis. The patient required emergency laparotomy and segmental bowel resection, as well as cholecystectomy. Presentation of obstruction occurs during the acute episode or can be delayed for several weeks. The most common site is the splenic flexure owing to its proximity to the pancreas. Initial management may be conservative, stenting, or surgical. CT is an acceptable baseline investigation in all cases of new onset bowel obstruction. Although bowel obstruction is a rare complication of pancreatitis, clinicians should be aware of it due to its high mortality. Obstruction can occur after a significant delay following the resolution of pancreatitis. Those patients with evidence of colonic involvement on pancreatic imaging warrant further large bowel evaluation. Bowel resection may be required electively or acutely. Colonic stenting has an increasing role in the management of large bowel obstruction but is a modality of treatment that needs further evaluation in this setting.

  10. [Obstructive sleep apnea syndromes].

    Science.gov (United States)

    Poirrier, R

    1993-01-01

    Snoring and excessive sleepiness are the hallmarks of obstructive sleep apnea syndrome but other clinical manifestations are present and a precise assessment of the disease involves clear definitions of the various kinds of apnea. Several pathogenetic factors (functional, anatomical, neurological, genetical) are still being discussed. However new insights of the pathophysiology of apneas allow more reliable treatments. Central nervous and cardiovascular complications as well as the traumatic morbidity, associated with excessive daytime sleepiness, make it a major public health problem.

  11. Mortality among Subjects with Chronic Obstructive Pulmonary Disease or Asthma at Two Respiratory Disease Clinics in Ontario

    Directory of Open Access Journals (Sweden)

    Murray M Finkelstein

    2011-01-01

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD and asthma are common; however, mortality rates among individuals with these diseases are not well studied in North America.

  12. Airflow obstruction and exercise.

    Science.gov (United States)

    Cooper, Christopher B

    2009-03-01

    The primary abnormality in chronic obstructive pulmonary disease (COPD) is chronic airway inflammation which results in airflow limitation. Disease progression is usually depicted as an accelerated decline in FEV(1) over time. However, COPD patients also manifest progressive static hyperinflation due to the combined effects of reduced lung elastic recoil and increased airway resistance. Superimposed on static hyperinflation are further increases in operational lung volumes (dynamic hyperinflation) brought on during exercise, exacerbations or tachypnea. An important consequence of exertional dyspnea is activity limitation. COPD patients have been shown to spend only a third of the day walking or standing compared with age-matched healthy individuals who spend more than half of their time in these activities. Furthermore, the degree of activity limitation measured by an accelerometer worsens with disease progression. COPD patients have been shown to have an accelerated loss of aerobic capacity (VO(2)max) and this correlates with mortality just as is seen with hypertension, diabetes and obesity. Thus physical inactivity is an important therapeutic target in COPD. Summarizing; airflow obstruction leads to progressive hyperinflation, activity limitation, physical deconditioning and other comorbidities that characterize the COPD phenotype. Targeting the airflow obstruction with long-acting bronchodilator therapy in conjunction with a supervised exercise prescription is currently the most effective therapeutic intervention in earlier COPD. Other important manifestations of skeletal muscle dysfunction include muscle atrophy and weakness. These specific problems are best addressed with resistance training with consideration of anabolic supplementation.

  13. OBSTRUCTIVE SLEEP APNOEA HYPOPNEA SYNDROME – AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    ISMAIL T

    2011-01-01

    Full Text Available Obstructive sleep apnoea hypopnoea syndrome (OSAHS is a common cause of breathing-related sleep disorder, causing excessive daytime sleepiness. Common clinical features of OSAHS include snoring, fragmented sleep, daytime somnolence and fatigue. This article aims to provide a comprehensive review of the condition, including its management.

  14. COMPARISON OF EXTERNAL AND ENDONASAL DACRYOCYSTO - RHINOSTOMY IN ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION

    Directory of Open Access Journals (Sweden)

    Shikha

    2015-02-01

    Full Text Available AIM : To compare the success rate and complications of external dacrycystorhinostomy with that of endonasal dacryocystorhinostomy. STUDY DESIGN : Prospective randomized comparative study. MATERIAL AND METHODS : Sample Size: The study comprises of 60 eyes of 54 consecutive patients with chronic dacryocystitis of which 28 patients underwent external dacryocystorhinostomy and 26 patients underwent endonasal endoscopic dacryocystorhinostomy. All the patients were selected by simple random method. INCLUSION CRITERIA: All symptomatic epiphora cases diagnosed for primary acquire d nasolacrimal duct obstruction by the means of lacrimal sac syringing were taken for the study. Nasal endoscopy was done in all the patients to rule out any associated nasal pathology. EXCLUSION CRITERIA : Patients with nasal and canalicular pathology , ble eding disorders , uncontrolled hypertension and diabetes mellitus were excluded. STATISTICAL ANALYSIS: The data was analysed by the SPSS software version 16.0. Chi Square and Fisher’s exact test were used to compare the assumption between the two groups. P value less than 0.05 was considered as significant. RESULTS: The overall primary success rate of external dacryocystorhinos tomy was 93.33% and that of endonasal dacryocystorhinostomy was 90% at 3 months after surgery , but this difference was not statistically significant (P=1.0. CONCLUSION : External DCR remains as the gold standard in the treatment of nasolacrimal duct obstru ction for a successful outcome with minimal complications.

  15. Double obstruction of ureter: A diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Pankaj Halder

    2014-01-01

    Full Text Available Introduction: Isolated obstruction of the ureteropelvic junction and the vesico-ureteric junction are the two most common causes of hydronephrosis in a pediatric population. [1] They do not pose diagnostic difficulties when are present alone but when together can be difficult to diagnose. Here, we discuss the problems we faced when we encountered these two anomalies in the same ureter and the way in which we managed them. Aim: To assess the difficulties in diagnosis of pediatric patients who present with both ureteropelvic junction obstruction (UPJO and vesico-ureteric junction obstruction (VUJO in the ipsilateral ureter and their management protocol. Materials and Methods: This is a retrospective study. The study period is from 1 January 2004 to 31 December 2011. Out of 254 children who were diagnosed to have hydronephrosis due to UPJO in our institute, 5 patients (in the age range of 5 to 10 years had both UPJO and VUJO in the ipsilateral ureter. The problems we faced in diagnosing the two conditions are mentioned with a literature review. Results: Operative intervention was used in four out of five patients; none of the patients had an accurate diagnosis before surgery. All patients were suspected of having double obstruction during pyeloplasty when appropriate size double J stent could not be negotiated through the vesicoureteric junction into the bladder. Postoperative nephrostogram confirmed the diagnosis in all patients. Conclusion: Children with double obstruction of the ipsilateral ureter present as a diagnostic dilemma. Because of the rarity of this condition it can escape the eye of even an astute clinician. Early diagnosis can be made if this condition is kept in mind while treating any hydronephrosis due to UPJO or UVJO.

  16. 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.

  17. Correlation between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome in a general population in Iran

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2011-01-01

    Full Text Available Background: The aim of this study was to evaluate epidemiological relationship between chronic obstructive pulmonary disease and sleep apnea syndrome in a sample of Persian population. Methods: As a part of a population-based cross-sectional study, 3900 randomly selected individuals aged 15 years or older were invited to take part in the survey; 3770 individuals (96.6% agreed to fill out the respiratory and sleep questionnaire. Those subjects suspected to have either chronic obstructive pulmonary disease and/or obstructive sleep apnea underwent spirometry and polysomnography test if indicated. Spirometric measurements were performed on 420 invited responders. Polysomnography measurements were performed on 25 of the responders. Results: Prevalence rates for sleep apnea, chronic obstructive pulmonary disease and current asthma were 4.98%, 5.7% and 3.1%, respectively. Logistic regression showed independent associations between sleep apnea and chronic obstructive pulmonary disease. There was no significant independent association between sleep apnea symptoms and current asthma and wheeze ever. Conclusions: These observations indicated relationship between chronic obstructive pulmonary disease and obstructive sleep apnea. These observations indicated the necessity of further studies to explain the possible common pathogenic mechanisms involved in two disease entities.

  18. Post-extubation airway obstruction. Literature review

    Directory of Open Access Journals (Sweden)

    Álvaro SÁNCHEZ-TABERNERO

    2017-03-01

    Full Text Available Introduction and objective: airway obstruction after extubation in any surgery is a critical event with low incidence, which may require reintubation or tracheostomy, which often otolaryngologist is required. Objective: To determine the prevalence of BVA and its causes through systematic literature review. Method: Literature review in PubMed, Scopus and Cochrane clinical trials, meta-analysis, reviews and case series and control over airway obstruction after extubation that requires reintubation in adults. Results: 6 studies and one clinical practice guidelines were selected. The most common cause of extubation failure is blocking the airway for various reasons (pharyngeal muscle weakness residual effect -often farmacologycal-, laryngospasm, vocal cord paralysis, edema of upper respiratory tract, cervical postoperative hematoma, foreign bodies or secretions. Most cases of re-intubation occurred within 2 hours after extubation. Conclusions: The most common cause of failure after general anesthesia extubation is blocking the airway generally caused by residual neuromuscular blocking effect. Airway obstruction risk increases in airway and head and neck surgery. Difficult intubation guidlines have improved performance and reduced adverse events and similar strategies must be implemented in extubation. The procedure extubation and reintubation should be documented. Working groups airway must be multidisciplinary and include specialists in otolaryngology.

  19. Models of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Chung K Fan

    2004-11-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is a major global health problem and is predicted to become the third most common cause of death by 2020. Apart from the important preventive steps of smoking cessation, there are no other specific treatments for COPD that are as effective in reversing the condition, and therefore there is a need to understand the pathophysiological mechanisms that could lead to new therapeutic strategies. The development of experimental models will help to dissect these mechanisms at the cellular and molecular level. COPD is a disease characterized by progressive airflow obstruction of the peripheral airways, associated with lung inflammation, emphysema and mucus hypersecretion. Different approaches to mimic COPD have been developed but are limited in comparison to models of allergic asthma. COPD models usually do not mimic the major features of human COPD and are commonly based on the induction of COPD-like lesions in the lungs and airways using noxious inhalants such as tobacco smoke, nitrogen dioxide, or sulfur dioxide. Depending on the duration and intensity of exposure, these noxious stimuli induce signs of chronic inflammation and airway remodelling. Emphysema can be achieved by combining such exposure with instillation of tissue-degrading enzymes. Other approaches are based on genetically-targeted mice which develop COPD-like lesions with emphysema, and such mice provide deep insights into pathophysiological mechanisms. Future approaches should aim to mimic irreversible airflow obstruction, associated with cough and sputum production, with the possibility of inducing exacerbations.

  20. The Use of Lanreotide Autogel® in the Treatment of Intestinal Obstruction in a Patient with Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Willem Lybaert

    2014-01-01

    Full Text Available Intestinal obstruction is a common complication in patients with advanced abdominal or pelvic cancer. The synthetic somatostatin analogue octreotide can help relieve nausea, vomiting and pain in patients with inoperable obstruction. Here, we report a case of recurrent intestinal obstruction in a patient with adenocarcinoma. Although the obstruction was resolved after 3 days of treatment with octreotide, new episodes of obstruction occurred, resulting in a delay of the chemotherapy treatment. After 3 episodes of obstruction, we initiated treatment with a longer-acting somatostatin analogue, lanreotide Autogel® 120 mg, administered once every 4 weeks. The treatment with lanreotide Autogel is being continued, allowing for continuation of the chemotherapy without further episodes of intestinal subocclusion or obstruction. Until November 2013, the patient received eighteen 4-weekly injections of lanreotide Autogel and did not report side effects. This case report demonstrates the successful treatment of intestinal obstruction with lanreotide Autogel in a patient with adenocarcinoma.

  1. The use of lanreotide autogel® in the treatment of intestinal obstruction in a patient with adenocarcinoma.

    Science.gov (United States)

    Lybaert, Willem

    2014-01-01

    Intestinal obstruction is a common complication in patients with advanced abdominal or pelvic cancer. The synthetic somatostatin analogue octreotide can help relieve nausea, vomiting and pain in patients with inoperable obstruction. Here, we report a case of recurrent intestinal obstruction in a patient with adenocarcinoma. Although the obstruction was resolved after 3 days of treatment with octreotide, new episodes of obstruction occurred, resulting in a delay of the chemotherapy treatment. After 3 episodes of obstruction, we initiated treatment with a longer-acting somatostatin analogue, lanreotide Autogel® 120 mg, administered once every 4 weeks. The treatment with lanreotide Autogel is being continued, allowing for continuation of the chemotherapy without further episodes of intestinal subocclusion or obstruction. Until November 2013, the patient received eighteen 4-weekly injections of lanreotide Autogel and did not report side effects. This case report demonstrates the successful treatment of intestinal obstruction with lanreotide Autogel in a patient with adenocarcinoma.

  2. Obstructive jaundice induced by biliary ascariasis.

    Science.gov (United States)

    Keating, Aine; Quigley, James Aidan; Genterola, Al Frederick

    2012-12-13

    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 underwent surgery consisting of a cholecystectomy, common bile duct exploration and T-tube choledochostomy. Our report highlights the varied aetiology of obstructive jaundice and the importance of including biliary ascariasis in the differential diagnosis of the jaundiced patient, especially from endemic areas.

  3. Deliberate Perspectival Obstructions

    DEFF Research Database (Denmark)

    Mikkelsen, Henrik Hvenegaard; Rasmussen, Anders Emil

    2016-01-01

    to a radical shift in perspective that allows partly for the invisible and absent to emerge as visible and present, and for different potentialities of persons and social relations to be brought to light. Hence the article demonstrates how obstruction and intervention as parts of the ethnographic methodology...... may help elicit perspectives that are otherwise kept hidden (deliberately or not), such as power-relations or the occluded side of a friendship or a kinship relation. This, in turn, also poses a danger to the otherwise collaborative ideal of modern ethnographic fieldwork in literally challenging...

  4. Obstructive Sleep Apnea

    OpenAIRE

    Brass, Steven D.; Ho, Matthew L.

    2006-01-01

    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 o...

  5. Etiology of the obstructive pattern in hepatobiliary imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, K.S.; Marrangoni, A.G.; Turbiner, E.

    1984-04-01

    The records of all patients undergoing hepatobiliary imaging with technetion radioisotopes at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.

  6. Chronic obstructive pulmonary disease - adults - discharge

    Science.gov (United States)

    COPD - adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; Chronic bronchitis - adults - discharge; Emphysema - adults - discharge; Bronchitis - ...

  7. Oral-appliance therapy obstructive sleep apnea-hypopnea syndrome : a clinical study on therapeutic outcome

    NARCIS (Netherlands)

    Hoekema, Aarnoud

    2007-01-01

    The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related breathing disorder characterized by disruptive snoring and repetitive upper airway obstructions. Its neurobehavioral consequences include excessive sleepiness, an increased risk of accidents, and an impaired quality of l

  8. Rare cause of intestinal obstruction, Ascaris lumbricoides infestation: two case reports

    OpenAIRE

    Yetim, Ibrahim; Ozkan, Orhan Veli; Semerci, Ersan; Abanoz, Recep

    2009-01-01

    Ascaris lumbricoides is common resident of intestine especially low socioeconomic areas in the world. Complication of Ascaris lumbricoides has been reported include obstruction of the small intestine, intestinal volvulus and intussusception. We report two children with severe sequelae of intestinal obstruction.

  9. Oral-appliance therapy obstructive sleep apnea-hypopnea syndrome : a clinical study on therapeutic outcome

    NARCIS (Netherlands)

    Hoekema, Aarnoud

    2007-01-01

    The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related breathing disorder characterized by disruptive snoring and repetitive upper airway obstructions. Its neurobehavioral consequences include excessive sleepiness, an increased risk of accidents, and an impaired quality of

  10. Dynamic Drug-Induced Sleep Computed Tomography in Adults With Obstructive Sleep Apnea

    Science.gov (United States)

    Li, Hsueh-Yu; Lo, Yu-Lun; Wang, Chao-Jan; Hsin, Li-Jen; Lin, Wan-Ni; Fang, Tuan-Jen; Lee, Li-Ang

    2016-01-01

    Surgical success for obstructive sleep apnea (OSA) depends on identifying sites of obstruction in the upper airway. In this study, we investigated sites of obstruction by evaluating dynamic changes in the upper airway using drug-induced sleep computed tomography (DI-SCT) in patients with OSA. Thirty-five adult patients with OSA were prospectively enrolled. Sleep was induced with propofol under light sedation (bispectral index 70–75), and low-dose 320-detector row CT was performed for 10 seconds over a span of 2–3 respiratory cycles with supporting a continuous positive airway pressure model. Most (89%) of the patients had multi-level obstructions. Total obstruction most commonly occurred in the velum (86%), followed by the tongue (57%), oropharyngeal lateral wall (49%), and epiglottis (26%). There were two types of anterior-posterior obstruction of the soft palate, uvular (94%) and velar (6%), and three types of tongue obstruction, upper (30%), lower (37%), and upper plus lower obstruction (33%). DI-SCT is a fast and safe tool to identify simulated sleep airway obstruction in patients with OSA. It provides data on dynamic airway movement in the sagittal view which can be used to differentiate palate and tongue obstructions, and this can be helpful when planning surgery for patients with OSA. PMID:27762308

  11. Spirometry utilisation among Danish adults initiating medication targeting obstructive lung disease

    DEFF Research Database (Denmark)

    Koefoed, Mette

    2015-01-01

    with pharmacotherapy targeting obstructive lung disease and only few have additional tests conducted, although the predictive value of respiratory symptoms for diagnosing obstructive lung disease has proven to be low. Spirometry is recommended as the gold standard for confirming obstructive lung disease, and testing...... can also rule out airway obstruction in patients with respiratory symptoms caused by other illnesses, such as heart failure or lung cancer. Initiating medication for obstructive lung disease without spirometry entails the risk of these patients experiencing unnecessary delay in the diagnostic process......-infectious dyspnoea, chronic cough and wheezing are common symptoms in the population. Patients often present with these symptoms in general practice and have a high probability of having obstructive lung diseases. However, there is an indication that the majority of these patients are treated empirically...

  12. A rare cause of nasolacrimal duct obstruction: Dentigerous cyst in the maxillary sinus

    Directory of Open Access Journals (Sweden)

    Ray Biswarup

    2009-01-01

    Full Text Available The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach.

  13. A rare cause of nasolacrimal duct obstruction: Dentigerous cyst in the maxillary sinus

    Science.gov (United States)

    Ray, Biswarup; Bandyopadhyay, Saumendra Nath; Das, Debabrata; Adhikary, Bivas

    2009-01-01

    The most common abnormality of the lacrimal drainage system is congenital or acquired nasolacrimal duct obstruction. The causes of acquired nasolacrimal duct obstruction may be primary or secondary. The secondary acquired obstructions may result from infection, inflammation, neoplasm, trauma or mechanical causes. The maxillary sinus cysts usually obstruct the nasolacrimal duct mechanically. Dentigerous cysts are one of the main types of maxillary cysts. These cysts are benign odontogenic cysts which are associated with the crowns of unerupted teeth. The clinical documentations of mechanical nasolacrimal duct obstructions due to a dentigerous cyst in the maxillary sinus are very rare in literature. In this case report, we describe a dentigerous cyst with a supernumerary tooth in the maxillary sinus in an 11-year-old male child causing an obstruction to the nasolacrimal duct. The case was successfully managed surgically by Caldwell Luc approach. PMID:19861752

  14. Clinical practice: Obstructive renal candidiasis in infancy.

    Science.gov (United States)

    Bisht, Veena; Voort, Judith VanDer

    2011-10-01

    Renal candidiasis is an increasingly common condition affecting predominantly premature infants receiving neonatal intensive care or term infants with urogenital tract anomalies. Multiple risk factors are usually present. Although rare, some infants develop an obstructive uropathy due to fungal balls, and this requires prompt detection and intervention to preserve kidney function. The management of obstructive renal bezoars is challenging and not well summarised in the past. This is mainly due to scarce literature confined to case reports or case series only. This review clarifies various definitions used in relation to renal candidiasis and identifies infants particularly at risk of obstruction. Clinical presentation, diagnosis and the role of imaging are discussed. A summary of the recent literature is provided to outline the range of existing treatment options available with published drug dosages and mode of delivery used. No single approach is successful in all cases and clinicians need to be aware of the different options available: apart from adequate urinary drainage and use of systemic +/- local antifungal agents, additional treatment with fibrinolytic agents and/or endoscopic or open surgical removal may be required. A new simplified algorithm for use in management is proposed. We hope this review will help clinicians in their management of patients presenting with this complex and challenging diagnosis.

  15. Common Warts

    Science.gov (United States)

    Diseases and Conditions Common warts By Mayo Clinic Staff Common warts are small, grainy skin growths that occur most often on your fingers or hands. Rough to the touch, common warts also often feature a pattern of tiny ...

  16. Endocrinological disturbances in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Creutzberg, E C; Casaburi, R

    2003-11-01

    In this overview, the available literature on endocrinological disturbances in chronic obstructive pulmonary disease (COPD) is reviewed, with stress on growth hormone/insulin-like growth factor I (IGF-I), thyroid hormone and the anabolic steroids. In COPD, little is known about circulating growth hormone or IGF-I concentrations. Some authors find a decrease in growth hormone or IGF-I, others an increase. An increase of growth hormone might reflect a nonspecific response of the body to stress (for instance, hypoxaemia). Until now, only one controlled study on growth hormone supplementation has been published, which however did not reveal any functional benefits. Before growth hormone supplementation can be advised as part of the treatment in COPD, further controlled studies must be performed to investigate its functional efficacy. The prevalence of thyroid dysfunction in COPD and its role in pulmonary cachexia has not been extensively studied. So far, there is no evidence that thyroid function is consistently altered in COPD, except perhaps in a subgroup of patients with severe hypoxaemia. Further research is required to more extensively study the underlying mechanisms and consequences of disturbed thyroid function in this subgroup of COPD patients. A few studies have reported the results of anabolic steroid supplementation in chronic obstructive pulmonary disease. Although some studies have discerned that low circulating levels of testosterone are common in males with chronic obstructive pulmonary disease, little is known about the prevalence, the underlying causes or functional consequences of hypogonadism in these patients. The use of systemic glucocorticosteroids and an influence of the systemic inflammatory response have been suggested as contributing to low testosterone levels. It can be hypothesised that low anabolic hormones will reduce muscle mass and eventually result in a diminished muscle function. Further evidence is required before testosterone

  17. Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

    Directory of Open Access Journals (Sweden)

    S. N. Schaeva

    2016-01-01

    Full Text Available Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO. This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC.Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279 consisted of patients with the presence of decompensated intestinal obstruction (DIO, group 2 (n = 313 consisted of patients with subcompensated intestinal obstruction (SIO, group 3 (n = 75 included patients with compensated intestinal obstruction (CIO. In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041. Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 % the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21. In case of DIO and SIO there was a high

  18. 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

  19. Chronic obstructive pulmonary disease.

    Science.gov (United States)

    Vijayan, V K

    2013-02-01

    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 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 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 guidelines recommend influenza and pneumococcal vaccinations.

  20. Mechanical colonic obstruction secondary to core of the pomegranate

    Directory of Open Access Journals (Sweden)

    Akın Önder

    2011-09-01

    Full Text Available Bezoars are often common in people with mental retardation and psychiatric disease, a condition that requires surgical intervention. Bezoar is retained concretions of ingested plant or animal materials that accumulate within the gastrointestinal tract. They often form in the stomach and can pass into the small intestine and cause obstruction, rarely leads to perforation. Fitobezoar phenomenon is common all over the world, is one of a rare cause of large bowel obstruction. In this study we report a case of colonic obstruction due to accumulation of edible pomegranates seeds. Fourteen-year-old boy admitted with diagnosis of acute abdomen dependind on ileus to the emergency department were operated. Fytobezoar fully obstructing the lumen of the sigmoid colon was found. Bezoar removed and end colostomy was performed. The patient was discharged after surgery without complication. In children, psychiatric patients, and patients with a history of gastrointestinal surgery in cases of intestinal obstruction differential diagnosis should include bezoars. J Clin Exp Invest 2011; 2 (3: 315-318.

  1. Outcome of hepaticojejunostomy for biliary tract obstruction following liver transplantation.

    Science.gov (United States)

    Langer, F B; Györi, G P; Pokorny, H; Burghuber, C; Rasoul-Rockenschaub, S; Berlakovich, G A; Mühlbacher, F; Steininger, R

    2009-01-01

    Strictures and concrements are the most common biliary complications following liver transplantation. Endoscopic treatment might not lead to a definitive cure in all patients, especially in strictures involving the biliary bifurcation. The aim of this study was to determine the efficacy and the long-term outcome of hepaticojejunostomy (HJS) for post-transplant biliary tract obstruction. Thirty-seven patients were retrospectively studied for resolving of cholestasis and the incidence of recurring biliary obstruction. Surgery was performed because of anastomotic strictures in 11, ischemic strictures at the donor common bile duct in seven, strictures involving the bile duct bifurcation in 10, hepatolithiasis without strictures in one and biliary cast formation diagnosed by endoscopic retrograde cholangiography or T-tube cholangiography in eight patients. Cholestasis instantly improved in 82% of the patients. After a long-term follow-up of median 33 months (range 3-149), 28 of the patients (76%) required no further intervention for recurring biliary obstruction following HJS. Anastomotic strictures were observed in six (16%), recurring biliary concrements in two patients (5%). HJS did prevent recurrent biliary obstruction in the majority of the patients. We therefore recommend early HJS for complicated post-transplant biliary tract obstruction not treatable by a limited number of endoscopic interventions.

  2. The location of obstruction predicts stent occlusion in malignant gastric outlet obstruction

    Science.gov (United States)

    Grunwald, Douglas; Cohen, Jonah; Bartley, Anthony; Sheridan, Jennifer; Chuttani, Ram; Sawhney, Mandeep S.; Pleskow, Douglas K.; Berzin, Tyler M.; Mizrahi, Meir

    2016-01-01

    Background: Gastric outlet obstruction (GOO) can occur with locally invasive or metastatic cancer involving the upper gastrointestinal tract at the pylorus or the duodenum. Endoscopic management with self-expanding metal stents (SEMSs) is often the preferred palliative approach. Stent occlusion is a common reason for failure and reintervention. We set out to determine whether the location of the malignant obstruction is associated with the angulation of the stent and can predict stent occlusion. Methods: We performed a retrospective review of consecutive patients who underwent successful duodenal stenting with SEMS for malignant GOO between 2006 and 2015 at a large advanced endoscopy referral center. We determined the location of obstruction, the stent angle, and the rate of technical and clinical success of stent placement. We then identified cases of subsequent stent occlusion confirmed by endoscopic evaluation. Results: A total of 100 consecutive patients were included in the study; 91 of these patients had enough data to evaluate SEMS occlusion. A total of 21 patients (23%) developed stent occlusion with a median time of 39 days. The risk of occlusion sequentially increased as the obstruction occurred more distally from the antrum to the third or fourth portion of the duodenum (p = 0.006). This relationship was maintained after controlling for stent angle (p = 0.05). Conclusions: A distal location of malignant GOO was strongly predictive of stent occlusion, independent of stent angle. This may be due to longer and more complex distal obstructions, along with foreshortening of the stent during placement and tumor infiltration. If replicated, these results will have implications for endoscopic practice and future device development. PMID:27803736

  3. Taking the STING Out of Ureteral Obstruction

    Science.gov (United States)

    Aw, Ivan; Tan, Philip Huang Min; Clarke, David

    2016-01-01

    Abstract Vesicoureteral reflux (VUR) is diagnosed in ∼1% of children. The main goal of treatment is preservation of renal function by preventing recurrent urinary tract infection (UTI) refractory to antibiotic therapy. Surgical treatment options include endoscopic injection or ureteral reimplantation. Subureteral Teflon (polytetrafluoroethylene) injection (STING) is an endoscopic treatment option no longer in common practice. Use of Teflon is no longer advised because of a number of documented complications secondary to local and distant migration of injected material. We present a case of delayed ureteral obstruction secondary to the STING procedure occurring 21 years after initial surgery and managed using a novel endoscopic method. PMID:27785466

  4. 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.

  5. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review

    Science.gov (United States)

    Papaiwannou, Antonis; Porpodis, Konstantinos; Spyratos, Dionysios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Arikas, Stamatis; Mpakas, Andreas; Tsiouda, Theodora; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Siminelakis, Stavros; Kolettas, Alexander; Kessis, George; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are chronic diseases, very common in general population. These obstructive airway illnesses are manifested with chronic inflammation affecting the whole respiratory tract. Obstruction is usually intermittent and reversible in asthma, but is progressive and irreversible in COPD. Asthma and COPD may overlap and converge, especially in older people [overlap syndrome—asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)]. Although ACOS accounts approximately 15-25% of the obstructive airway diseases, is not well recognised because of the structure of clinical trials. COPD studies exclude asthma patients and asthma studies exclude COPD patients, respectively. It is crucial to define asthma, COPD and overlap syndrome (ACOS), as notable clinical entities, which they share common pathologic and functional features, but they are characterized from differences in lung function, acute exacerbations, quality of life, hospital impact and mortality. PMID:24672688

  6. 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.

  7. Sleep and upper airway obstruction in children with achondroplasia

    NARCIS (Netherlands)

    Zucconi, M; Weber, G; Castronovo, [No Value; FeriniStrambi, L; Russo, F; Chiumello, G; Smirne, S

    1996-01-01

    Objective: The features of achondroplasia, the most common form of dwarfism, includes short cranial base and midface hypoplasia; both abnormalities increased the risk of upper airway obstruction during sleep, The aim of our study was to evaluate sleep and respiratory function of children with achond

  8. Duodenal Obstruction as First Presentation of Metastatic Breast Cancer

    Directory of Open Access Journals (Sweden)

    Sami Khairy

    2015-01-01

    Full Text Available The metastatic breast cancer to the duodenum is rare in spite of common breast cancer. In this paper, we are reporting a rare case of 50-year-old lady who presented with intestinal obstruction as result of metastatic breast cancer which completely responds to chemotherapy. The tumor presents again as brain metastasis after stop of Herceptin due to cardiac toxicity.

  9. A CLINICAL STUDY OF INTESTINAL OBSTRUCTION AND ITS SURGICAL MANAGEMENT IN RURAL POPULATION

    Directory of Open Access Journals (Sweden)

    Naveen

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: The diagnosis and management of the patient with i ntestinal obstruction is one of the more challenging emergenc y that a general surgeon can come across. Although the mortality due to acute intestinal obst ruction is decreasing in urban areas due to early presentation and prompt medical attention, the same is not true in rural population because of late presentation with complications. With better unders tanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correc tion, much potent antibiotics and surgical management the complications arising due to late pr esentation can be limited. However, still mortality ranges from 3% for simple obstruction to as much as 30% when there is vascular compromise or perforation of the obstructed bowel . This is further influenced by the clinical setting and related co-morbidities. OBJECTIVES: To study va rious causes, clinical features, and modalities of treatment of intestinal obstruction and their ou tcome. METHODOLOGY: A total of 50 cases of intestinal obstruction, after admission in our hosp ital that were surgically managed, were chosen by simple random technique for the study. Statistic al analysis was done using SPSS software. RESULTS: Intestinal obstruction is more common in the age gr oup of 30-60 years. Small bowel obstruction is more common than large bowel obstruc tion. Four cardinal features of intestinal obstruction are pain abdomen, vomiting, distension and constipation. Most common etiological factor is postoperative adhesions followed by abdom inal hernia. Malignancy as a cause for obstruction is more common in large bowel than smal l bowel. Intravenous fluids and electrolytes, gastrointestinal aspiration, antibiotics and timed appropriate surgery are still the mainstay of treatment. CONCLUSION: Intestinal obstruction still remains a common and i mportant surgical emergency. Obstruction due to adhesions is increasi ng in incidence due to

  10. CT of gastro-duodenal obstruction.

    Science.gov (United States)

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  11. Obstructive Sleep Apnea Hypopnea Syndrome

    African Journals Online (AJOL)

    hanumantp

    and is seen in both central sleep apnea (CSA) and obstructive sleep apnea .... weight.[1]. Perioperative and postoperative. Patients with OSAHS may have an increased perioperative risks. ... deprivation, and adjustment of sleeping positions.

  12. Pancreatic Calculus Causing Biliary Obstruction: Endoscopic Therapy for a Rare Initial Presentation of Chronic Pancreatitis.

    Science.gov (United States)

    Shetty, Anurag J; Pai, C Ganesh; Shetty, Shiran; Balaraju, Girisha

    2015-09-01

    Biliary obstruction in chronic calcific pancreatitis (CCP) is often caused by inflammatory or fibrotic strictures of the bile duct, carcinoma of head of pancreas or less commonly by compression from pseudocysts. Pancreatic calculi causing ampullary obstruction and leading to obstructive jaundice is extremely rare. The medical records of all patients with CCP or biliary obstruction who underwent endoscopic retrograde cholangiopancreatography (ERCP) over 4 years between 2010-2014 at Kasturba Medical College, Manipal were analyzed. Five patients of CCP with impacted pancreatic calculi at the ampulla demonstrated during ERCP were identified. All 5 presented with biliary obstruction and were incidentally detected to have CCP when evaluated for the same; 3 patients had features of cholangitis. All the patients were managed successfully by endoscopic papillotomy and extraction of pancreatic calculi from the ampulla with resolution of biliary obstruction. Pancreatic calculus causing ampullary obstruction, though very rare, should be considered as a possibility in patients with CCP complicated by biliary obstruction. Endoscopic therapy is affective in the resolution of biliary obstruction in such patients.

  13. Neonatal Intestinal Obstruction-Four Year Experience

    Directory of Open Access Journals (Sweden)

    D. Rathore

    2015-06-01

    Full Text Available Aim of study: To study the aetiology and frequency, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction. Material and Methods: This prospective study of 316 neonates with intestinal obstruction was conducted over a period of 4 years from November 2009 to October 2013 at single institute. These cases were managed by various surgical procedures. Their epidemiology, day of presentation, associated anomalies and outcomes were studied. Results: A total of 316 neonates (277 males and 39 females were operated for intestinal obstruction. 268(84.81% neonates presented in the 1st week of life. Imperforate anus occurred in 206 (65.19%.Small bowel atresia accounted for23 (7.27% cases while duodenal atresia was seen in19 (6.01% patients. Infantile hypertrophic pyloric stenosis and Malrotation each occurred in 14 (4.43% patients; Hirschsprung’s disease in 18(5.69%, Necrotising Enterocolitis in 12(3.79%, Meconium disease of newborn in 9(2.85% while colonic atresia was seen in one (0.3% patient. Colostomy was performed in 145(45.88%, Pouchostomy in 15(4.74% and Cutback anoplasty in 56(17.72% patients. Ramsted’s Pyloromyotomy in 13(4.11%% neonates, Laparoscopic Pyloromyotomy in 1(0.3%,Kimura’s Duodenoduodenostomy in 19(6.01% ,End to Back anastomosis in 24(7.59% , End to End anastomosis in 7(2.21% , Multiple anastomosis in 2(0.6% , Enterotomy with irrigation in 7(2.21% , Ladd’s procedure in 14(4.43% , ,Single stage transanal pull through in 8(2.53% , Ileostomy in 2(0.6% , Single stage Abdominoperineal pull through in 2(0.6%, Levelling colostomy in 6(1.89% ,Peritoneal drain insertion under Local anaesthesia in 5(1.58% . Overall mortality was 13.60%. Conclusion: Intestinal Obstruction is the most common surgical emergency in neonatal period. Early and accurate diagnosis is paramount for proper patient management. The etiology, mode of presentation, morbidity and outcome of surgery of intestinal obstruction in

  14. Nasal obstruction may alleviate bruxism related temporomandibular joint disorders.

    Science.gov (United States)

    Bektas, Devrim; Cankaya, Mustafa; Livaoglu, Murat

    2011-02-01

    Temporomandibular disorder (TMD) is a collective term used to identify a group of musculoskeletal conditions of the temporomandibular region. Bruxism is a non-functional activity characterized by repeated tooth clenching or grinding in an unconscious manner. Over the time bruxism may lead to TMD by the uploading it causes. Nasal obstruction is a common complaint that necessitates mouth breathing when severe. The treatment of bruxism is frequently performed by oral appliances, which induce occlusal disengagement and relax jaw musculature and therefore reduce the force on the temporomandibular joint (TMJ). We believe that nasal obstruction may indirectly have a preemptive and therapeutic effect on sleep bruxism related TMD by causing mouth breathing.

  15. Delayed complication of pelvic lymphocele: Ileal conduit obstruction

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    Sanket S Bankar

    2015-01-01

    Full Text Available Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

  16. Delayed Presentation of Trichobezoar with Small Bowel Obstruction

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    Soofia Ahmed

    2011-03-01

    Full Text Available Small bowel obstruction is a common surgical emergency but trichobezoar as an etiology, rarely reported. A seven year old school going female child presented with acute intestinal obstruction with a palpable and mobile mass in the abdomen. At exploration, a 10 cm long trichobezoar was found in the distal ileum which was removed through enterotomy. Postoperative course remained uneventful. Further probing revealed that child used to eat her own scalp hairs at the age of 2 years and the habit persisted for about 18 months which resulted in alopecia at that time. Later on she started showing normal behavior.

  17. Obstructive urolithiasis in ruminants AND#8211; A review

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    Mohsin A Gazi

    2013-08-01

    Full Text Available Obstructive urolithiasis is the retention of urine subsequent to lodgment of calculi anywhere in the urinary conduct from up to urethral orifice. The disease results in heavy economic losses to the livestock industry as it is attributed the fifth most prevalent cause of death in feedlot. Obstructive urolithiasis is a serious, potentially fatal condition, most commonly causing symptoms in castrated male animals, but also occurring in breeding males. Many surgical approaches and techniques for the diagnosis and the treatment of the disease have been described with their relative merits and demerits in the literature. [Vet World 2013; 6(4.000: 233-238

  18. Common Terms

    Science.gov (United States)

    ... Print Page Text Size: A A A Listen Common Terms Below is a list of diabetes-related ... a skin condition characterized by darkened skin patches; common in people whose body is not responding correctly ...

  19. A CLINICAL STUDY ON GASTRIC OUTLET OBSTRUCTION

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    Latchu

    2015-11-01

    Full Text Available INTRODUCTION Gastric outlet obstruction (GOO is obstruction in the first part of duodenum secondary to cicatrised duodenal ulcer or proximally where the diagnosis of carcinoma is most probable. GOO can be a diagnostic and treatment dilemma. Once a mechanical obstruction is confirmed, differentiate between benign and malignant processes. Cicatrized duodenal ulcer was the most common cause of GOO. But with increased awareness, change in the dietary habits and availability of H2 receptor blockers and Proton Pump Inhibitors and H pylori kits all have resulted in decreased incidence of patients requiring surgery and also the complications like pyloric stenosis have reduced. At the same time the incidence of antral carcinoma of stomach producing GOO has comparatively increased, which may be due to increased early diagnosis of the condition with the help of flexible fibro optic endoscope. AIMS & OBJECTIVES To study and identify the cause of cases of GOO with respect to benign peptic ulcer and malignancy of stomach. MATERIALS AND METHODS An observational study comparing of 30 cases of GOO. An elaborate study of the cases with regard to history, clinical features, routine and special investigation, pre operative treatment, operative findings, post operative management and complications in the post operative period is done. Apart from routine surgical profile special investigations like serum electrolytes, barium meal study, Upper GI Endoscopy and ultrasound abdomen and pelvis will be carried. For peptic ulcer disease truncal vagotomy with posterior gastrojejunostomy was done and for carcinoma partial gastrectomy with Billroth II reconstruction or anterior GJ or palliative resection with anterior GJ were done. INCLUSION CRITERIA 1. Peptic ulcer disease 2. Carcinoma pyloric antrum, 3. Benign neoplasm of stomach. EXCLUSION CRITERIA 1. Carcinoma stomach with liver metastasis, ascites, peritoneal implantation, 2. Gastro duodenal tuberculosis. ETHICAL ISSUES

  20. Common Cold

    Science.gov (United States)

    ... nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people ... avoid colds. There is no cure for the common cold. For relief, try Getting plenty of rest ...

  1. Obstructive sleep apnea.

    Science.gov (United States)

    Ho, Matthew L; Brass, Steven D

    2011-11-29

    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.

  2. 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.

  3. 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.

  4. Role of Sensory Stimulation in Amelioration of Obstructive Sleep Apnea

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    Mak Adam Daulatzai

    2011-01-01

    Full Text Available Obstructive sleep apnea (OSA, characterized by recurrent upper airway (UA collapse during sleep, is associated with significant morbidity and disorders. Polysomnogram is employed in the evaluation of OSA and apnea-hypopnea number per hour reflects severity. For normal breathing, it is essential that the collapsible UA is patent. However, obstruction of the UA is quite common in adults and infants. Normally, important reflex mechanisms defend against the UA collapse. The muscle activity of UA dilators, including the genioglossus, tensor palatini (TP, and pharyngeal constrictors, is due to the integrated mechanism of afferent sensory input → to motor function. Snoring is harsh breathing to prevent UA obstruction. Unfortunately, snoring vibrations, pharyngeal suction collapse, negative pressure, and hypoxia cause pathological perturbations including dysfunctional UA afferent sensory activity. The current paper posits that peripheral sensory stimulation paradigm, which has been shown to be efficacious in improving several neurological conditions, could be an important therapeutic strategy in OSA also.

  5. A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Karim R

    2011-07-01

    Full Text Available R Karim, R Ghabrial, TF Lynch, B TangSchool of Public Health, Faculty of Medicine, University of Sydney, Sydney, AustraliaPurpose: To compare success rates of external dacryocystorhinostomy (DCR and endoscopic endonasal DCR for acquired nasolacrimal duct obstruction (NLDO.Design: Historical cohort study.Participants: 100 patients who underwent external DCR and 105 patients who underwent endoscopic endonasal DCR.Methods: A retrospective review of medical records of patients with acquired NLDO who underwent DCR from 2004–2010 was performed. Data regarding the lacrimal drainage system, eye examination, surgical outcomes, patient symptom control, and postoperative care were analyzed.Main outcome measures: Surgical success was defined by patient's resolution of symptoms with patency on irrigation. Surgical failure was defined as no symptomatic reduction in epiphora and/or an inability to irrigate the lacrimal system postoperatively.Results: A total of 205 patients underwent surgeries for acquired NLDO. The average age was 69 years, and 62.4% of subjects were female. Pooled results showed that both surgical approaches had similar success rates (endoscopic endonasal DCR 82.4% versus external DCR 81.6%; P = 0.895. Complication rates were low in both types of surgery. This included three patients with postoperative hemorrhage (two who had endonasal DCR surgery and one having external DCR surgery. This resolved with conservative treatment. Postoperative problems with lacrimal patency (including canalicular obstruction occurred to 6.8% of endoscopic patients and 9% of those with the external DCR surgery. Of the 14 patients who had their silicone tubes fall out before the 2-month assessment, 10 were classified as failures (71%, in contrast to only a failure rate of 13.9% of those whose tubes were present for the recommended time. This difference was statistically significant (P < 0.01.Conclusion: The success rate of DCR for acquired NLDO in our group of

  6. Airflow obstruction: is it asthma or is it COPD?

    Directory of Open Access Journals (Sweden)

    Rogliani P

    2016-11-01

    Full Text Available Paola Rogliani, Josuel Ora, Ermanno Puxeddu, Mario Cazzola Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy Abstract: Despite the availability of guideline recommendations, diagnostic confusion between COPD and asthma appears common, and often it is very difficult to decide whether the obstruction is caused by asthma or COPD in a patient with airway obstruction. However, there are well-defined features that help in differentiating asthma from COPD in the presence of fixed airflow obstruction. Nonetheless, the presentations of asthma and COPD can converge and mimic each other, making it difficult to give these patients a diagnosis of either condition. The association of asthma and COPD in the same patient has been designated mixed asthma–COPD phenotype or overlap syndrome. However, since the absence of a clear definition and the inclusion of patients with different characteristics under this umbrella term, it may not facilitate treatment decisions, especially in the absence of clinical trials addressing this heterogeneous population. We are realizing that neither asthma nor COPD are single diseases, but rather syndromes consisting of several endotypes and phenotypes, consequently comprising a spectrum of diseases that must be recognized and adequately treated with targeted therapy. Therefore, we must treat patients by personalizing therapy on the basis of those treatable traits present in each subject. Keywords: airway obstruction, asthma, ACOS, chronic obstructive pulmonary disease

  7. Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea

    OpenAIRE

    Timo Leppänen; Juha Töyräs; Anu Muraja-Murro; Salla Kupari; Pekka Tiihonen; Esa Mervaala; Antti Kulkas

    2016-01-01

    Positional obstructive sleep apnea (OSA) is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients...

  8. Evaluation of membership, complexity index of drugs and devices for use techniques in patients with pulmonary inhalational chronic obstructive

    OpenAIRE

    Nayara Otaviano Diniz

    2014-01-01

    Chronic obstructive pulmonary disease is a common, avoidable and treatable disease characterized by persistent obstruction of the airways and lungs. This disease is usually progressive and associated with a chronic inflammatory response set off by noxious particles or gases. Patients with chronic obstructive pulmonary disease, represents a great impact on the increase of clinical care, as well as the economic health spending to provide better quality of life. This study characterizes the phar...

  9. Bronchoscopic management of malignant airway obstruction.

    Science.gov (United States)

    Mitchell, Patrick D; Kennedy, Marcus P

    2014-05-01

    Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.

  10. [Secretory eosinophilia and obstructive rhinitis].

    Science.gov (United States)

    Rouvier, P; Mondain, M; Elkhoury, J

    1992-01-01

    Detecting eosinophilia in the nasal secretions of patients complaining of nasal obstruction makes it possible to identify a group of high risk patients. Hosty use of surgery in these patients carries a high risk of iatrogenic complications and little potential for improvement. The 2 most frequently used methods of obtaining cytologic specimens (swabbing versus washing) were compared in 37 patients with obstructive rhinitis (early stage polyposis and nonallergic rhinitis with eosinophilia syndrome, NARES). Swabbing gave reliable results. Eosinophilia was negligible in a group of 25 control subjects. The mean eosinophil count was 2.5% and only 1 patient had a positive cystogram. The 220 patients which nasal obstruction were classed in 5 groups according to the severity of clinical signs and symptoms. The mean eosinophil count and the percentage of patients with positive cystogram increased with increased severity of the clinical syndrome. 28 patients had uncomplicated obstructive rhinitis, 10 had NARES, 43 had allergic rhinitis, 52 had chronic obstructive rhinitis, and 87 had nasosinal polyposis. The respective mean eosinophil counts were 6.42%, 10.3%, 13.8% 16.8% and 31.4%. The percentage of patients with positive cytograms was respectively, 10.8%, 20%, 23.3%, 28.8% and 54%.

  11. Obstructive acute abdomen: reviewing important points; Abdome agudo obstrutivo: revisando pontos fundamentais

    Energy Technology Data Exchange (ETDEWEB)

    Francisco, Marina Celli; Abud, Thiago Giansante; Reibscheid, Samuel; Szejnfeld, Jacob; Lederman, Henrique Manoel [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: nana_celli@hotmail.com; Neves, Felipe Trentin [Hospital Ipiranga, Sao Paulo, SP (Brazil); Colleone Neto, Ramiro [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil)

    2008-07-01

    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)

  12. An unusual cause of small bowel obstruction in children: lentil soup bezoar.

    Science.gov (United States)

    Plataras, Christos; Sardianos, Nektarios; Vlatakis, Stephanos; Nikas, Konstantinos

    2014-01-01

    Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause of intestinal obstruction in neonates. Phytobezoars and food bolus bezoars are the least common types of intestinal obstruction that have been reported in children. Of the few paediatric cases that have been described, the majority involve persimmons. Moreover, all of these cases involve the ingestion of raw fibres or fruit that have not been cooked. We report a case of a girl who presented with acute ileal obstruction because of lentil soup bezoar. Given the wide use of this otherwise nutritional foodstuff, we highlight the danger from its inappropriate preparation to the health of children. This is the first reported case of intestinal obstruction caused by lentils in children and we hope to raise concern among paediatricians regarding this matter.

  13. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration.

    Science.gov (United States)

    Al Lawati, Nabil M; Patel, Sanjay R; Ayas, Najib T

    2009-01-01

    We will review the epidemiology, risk factors, and consequences of obstructive sleep apnea (OSA) and short/long sleep duration. Obstructive sleep apnea is a disease characterized by recurrent upper airway obstruction during sleep. Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. There are a number or risk factors for disease including obesity, male sex, and family history. Obstructive sleep apnea negatively impacts quality of life and is also associated with a number of adverse safety and health consequences including cardiovascular disease and motor vehicle crashes. Short habitual sleep duration can result in excessive daytime sleepiness and reduced neurocognitive function. Sleep loss may have long-term health consequences and may lead to premature death, cardiovascular disease, and the development of diabetes.

  14. Student Commons

    Science.gov (United States)

    Gordon, Douglas

    2010-01-01

    Student commons are no longer simply congregation spaces for students with time on their hands. They are integral to providing a welcoming environment and effective learning space for students. Many student commons have been transformed into spaces for socialization, an environment for alternative teaching methods, a forum for large group meetings…

  15. Prognosis for nonoperative management of small-bowel obstruction in Crohn's disease.

    Science.gov (United States)

    Yaffe, B H; Korelitz, B I

    1983-06-01

    Small-bowel obstruction has been the most common indication for surgical intervention in Crohn's disease. If, however, obstruction relents without surgery, new programs of management may reduce or eliminate the need for resection. Over 7 years, 25 of 26 patients were relieved of an index episode of ileal obstruction--in most cases aided by a small-bowel tube and intravenous ACTH. They were then maintained on medical therapy, sulfasalazine (SASZ) alone in seven, SASZ and intermittent prednisone in 18, and then 6-mercaptopurine with or without SASZ in 14 of those 18. Seven patients have had no recurrence of obstruction after an average follow-up of 52 months. Recurrent obstruction occurred 52 times in 18 patients over the next 16-106 months; in all the obstruction was again relieved nonoperatively. Twelve patients underwent elective surgery, for recurrent obstruction in nine. Eight months seemed to offer a useful cutoff criterion for the likelihood of recurrence. When recurrence of obstruction took place within 8 months, surgery was ultimately required in six of seven patients. In contrast, patients who weathered the first 8 months without obstruction did well; only three of 11 ultimately required resection. Of 18 patients without recurrent obstruction for 8 months, only five were eventually operated upon, two for other indications; in 11 of the 13 patients who underwent no operation, the quality of life was excellent or good. We conclude that if the initial episode of small-bowel obstruction can be reversed, subsequent maintenance therapy including SASZ, and/or 6-mercaptopurine with an intermittent liquid diet in some patients eliminates or postpones the need for resection without compromise of the quality of life.

  16. Small bowel obstruction- a surprise.

    Science.gov (United States)

    Mathew, Jeffrey Daniel; Cp, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

  17. Ureterosciatic Hernia Causes Obstructive Uropathy

    Directory of Open Access Journals (Sweden)

    Ping-Ju Tsai

    2008-09-01

    Full Text Available Obstructive uropathy can be caused by urolithiasis, fibrotic ureteral stricture, inflammatory ureteritis with polyp formations, ureteral malignancy and various forms of external compression. Ureteral herniation is a relatively rare cause of obstructive uropathy and has been reported with herniation sites including inguinal canal, femoral canal and sciatic foramen. Most ureteral herniations occur in the inguinal area. In the literature, previous cases of sciatic ureter have been treated with observation in asymptomatic patients or with surgery in patients with obstructive uropathy or clinical symptomatology. We report the case of a 91-year-old female with asymptomatic hydronephrosis of the left kidney due to extremely rare ureterosciatic herniation. Her global renal function was acceptable. As she was elderly and a poor surgical candidate, watchful waiting was recommended after discussion with the patient and her family.

  18. Update on endoscopic management of gastric outlet obstruction in children

    Science.gov (United States)

    Chao, Hsun-Chin

    2016-01-01

    Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.

  19. A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys.

    Directory of Open Access Journals (Sweden)

    Pauline M L Hennus

    Full Text Available BACKGROUND: Infravesical obstruction leads to kidney and bladder dysfunction in a significant proportion of boys. The aim of this review is to determine the value of diagnostic tests for ascertainment of infravesical obstruction in boys. METHODOLOGY: We searched PubMed and EMBASE databases until January 1, 2013, to identify papers that described original diagnostic accuracy research for infravesical obstruction in boys. We extracted information on (1 patient characteristics and clinical presentation of PUV and (2 diagnostic pathway, (3 diagnostic accuracy measures and (4 assessed risk of bias. PRINCIPAL FINDINGS: We retrieved 15 studies describing various diagnostic pathways in 1,189 boys suspected for infravesical obstruction. The included studies reflect a broad clinical spectrum of patients, but all failed to present a standardised approach to confirm the presence and severity of obstruction. The risk of bias of included studies is rather high due to work-up bias and missing data. CONCLUSIONS: As a consequence of low quality of methods of the available studies we put little confidence in the reported estimates for the diagnostic accuracy of US, VCUG and new additional tests for ruling in or ruling out infravesical obstruction. To date, firm evidence to support common diagnostic pathways is lacking. Hence, we are unable to draw conclusions on diagnostic accuracy of tests for infravesical obstruction. In order to be able to standardise the diagnostic pathway for infravesical obstruction, adequate design and transparent reporting is mandatory.

  20. Adhesive bowel obstruction? Not always

    Directory of Open Access Journals (Sweden)

    Mittapalli D

    2011-01-01

    Full Text Available A 58-year-old man presented acutely with features of post-surgical adhesive small bowel obstruction. Following an unsuccessful trial of conservative management, computed tomography (CT of the abdomen was performed. This revealed a mass in the ileocaecal region, for which he underwent a subsequent right hemicolectomy. Histology revealed diffuse B-cell Non-Hodgkin′s lymphoma of the terminal ileum. Confounding obstructive lesion of the intestine in patients with a history of previous laparotomy is extremely uncommon. Early high resolution imaging may predict diagnosis and consolidate clinical management plans.

  1. Health Promotion in Obstructive Sleep Apnea Syndrome

    Science.gov (United States)

    Corrêa, Camila de Castro; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2015-01-01

    Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: “Health Promotion,” “Sleep Disorders,” “Primary Prevention,” “Health Education,” and “Obstructive Sleep Apnea Syndromes.” Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. PMID:25992174

  2. [Advances in chronic obstructive pulmonary disease].

    Science.gov (United States)

    Jiménez, Belén Arnalich; Pumarega, Irene Cano; Ausiró, Anna Mola; Izquierdo Alonso, José Luis

    2009-01-01

    Although chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible, chronic airflow obstruction, from the clinical point of view we must continue to make progress in the diagnosis and management of these patients so that spirometry is not the only technique used. Understanding that COPD is a heterogeneous process and that patient complexity usually increases due to the presence of comorbidities will allow more individualized strategies to be designed, which may improve control of the process. The TORCH and UPLIFT trials have shown that current treatment can improve important aspects of the disease, including mortality. However, the finalizing of these two large trials has generated a current of opinion favoring a more individually-tailored approach that should include all the factors -both pulmonary and extrapulmonary- that can modify the patient's form of presentation. Although we are witnessing a change in the therapeutic approach to COPD, future treatment will probably be based on studies performed in specific patient subgroups and on clarifying the interrelation between COPD and other diseases that are common in these patients. Greater knowledge of the pathogenesis of the disease may improve pharmacological treatment but drugs that, by themselves, alter the short- and longterm course of COPD are not on the horizon. However, a more patient-focussed approach may be the main tool available to physicians to increase quality of life -and possibly survival- in these patients.

  3. Common Courses for Common Purposes:

    DEFF Research Database (Denmark)

    Schaub Jr, Gary John

    2014-01-01

    (PME)? I suggest three alternative paths that increased cooperation in PME at the level of the command and staff course could take: a Nordic Defence College, standardized national command and staff courses, and a core curriculum of common courses for common purposes. I conclude with a discussion of how...

  4. Common Courses for Common Purposes:

    DEFF Research Database (Denmark)

    Schaub Jr, Gary John

    2014-01-01

    (PME)? I suggest three alternative paths that increased cooperation in PME at the level of the command and staff course could take: a Nordic Defence College, standardized national command and staff courses, and a core curriculum of common courses for common purposes. I conclude with a discussion of how...

  5. QCI Common

    Energy Technology Data Exchange (ETDEWEB)

    2016-11-18

    There are many common software patterns and utilities for the ORNL Quantum Computing Institute that can and should be shared across projects. Otherwise we find duplication of code which adds unwanted complexity. This is a software product seeks to alleviate this by providing common utilities such as object factories, graph data structures, parameter input mechanisms, etc., for other software products within the ORNL Quantum Computing Institute. This work enables pure basic research, has no export controlled utilities, and has no real commercial value.

  6. Subtotal obstruction of the male reproductive tract

    NARCIS (Netherlands)

    Pierik, F.H.; Dohle, G.R.; Roijen, J.H. van; Vreeburg, J.T.M.; Weber, R.F.A.

    2003-01-01

    Bilateral obstruction of the male reproductive tract is suspected in men with azoospermia, normal testicular volume and normal FSH. A testicular biopsy is required to differentiate between an obstruction and a testicular insufficiency. Unilateral or subtotal bilateral obstructions and epididymal dys

  7. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    Science.gov (United States)

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

  8. Cholangiopathy in extrahepatic portal venous obstruction: radiological appearances

    Energy Technology Data Exchange (ETDEWEB)

    Nagi, B.; Kochhar, R.; Bhasin, D.; Singh, K. [Postgraduate Inst. of Medical Education and Research, Chandigarh (India). Dept. of Gastroenterology

    2000-11-01

    To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP). Material and Methods: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice. Results: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects. Conclusion: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.

  9. Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department.

    Science.gov (United States)

    Suau, Salvador J; DeBlieux, Peter M C

    2016-02-01

    Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers.

  10. Goblet Cell Carcinoid Tumor of the Appendix with Small Bowel Obstruction: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Su Yeon; Jang, Kyung Mi; Kim, Min Jeong; Koh, Sung Hye; Jeon, Eui Yong; Min, Kwang Seon; Seo, Jin Won; Park, Hyoung Chul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2009-09-15

    Goblet cell carcinoid tumor of the appendix (GCTA) is a tumor with histological features of both adenocarcinoma and carcinoid tumors. The most common clinical presentation of GCTA is acute appendicitis, although small bowel obstruction has been reported as a rare clinical symptom of GCTA. However, to the best of our knowledge, the CT feature of small bowel obstructions in patients with GCTA has not been reported to date. Here, we present a case of small bowel obstruction in a patient with GCTA caused by extensive tumor infiltration at the terminal ileum and distal ileum.

  11. Instituting Commoning

    Directory of Open Access Journals (Sweden)

    . STEALTH.unlimited

    2015-06-01

    Full Text Available Starting from the origins of the notion of management, this paper explores how commons governance is constituted by the earlier influential research of Elinor Ostrom, and pursues this with reference to scholars such as Saki Bailey, who emphasises that the choice of regulatory frame is ultimately a political one. We then argue that commons have to be ‘instituted’ in an open manner in order to remain accessible. This demands a set of scripts, rules or agreements that keep the process of commoning in place, and, simultaneously, keep commoning in a constant process of reproduction. We examine this tension and look at the shift in understanding about what ‘institutions of the commons’ have entailed in practice over the course of the last century and a half. Finally, we return to the political dimension to touch upon the question of whether, with the disappearance of the welfare state, a coherent concept of society can emerge from the current upsurge of commons initiatives.

  12. Creative Commons

    DEFF Research Database (Denmark)

    Jensen, Lone

    2006-01-01

    En Creative Commons licens giver en forfatter mulighed for at udbyde sit værk i en alternativ licensløsning, som befinder sig på forskellige trin på en skala mellem yderpunkterne "All rights reserved" og "No rights reserved". Derved opnås licensen "Some rights reserved"......En Creative Commons licens giver en forfatter mulighed for at udbyde sit værk i en alternativ licensløsning, som befinder sig på forskellige trin på en skala mellem yderpunkterne "All rights reserved" og "No rights reserved". Derved opnås licensen "Some rights reserved"...

  13. Science commons

    CERN Document Server

    CERN. Geneva

    2007-01-01

    SCP: Creative Commons licensing for open access publishing, Open Access Law journal-author agreements for converting journals to open access, and the Scholar's Copyright Addendum Engine for retaining rights to self-archive in meaningful formats and locations for future re-use. More than 250 science and technology journals already publish under Creative Commons licensing while 35 law journals utilize the Open Access Law agreements. The Addendum Engine is a new tool created in partnership with SPARC and U.S. universities. View John Wilbanks's biography

  14. Creative Commons

    DEFF Research Database (Denmark)

    Jensen, Lone

    2006-01-01

    En Creative Commons licens giver en forfatter mulighed for at udbyde sit værk i en alternativ licensløsning, som befinder sig på forskellige trin på en skala mellem yderpunkterne "All rights reserved" og "No rights reserved". Derved opnås licensen "Some rights reserved"......En Creative Commons licens giver en forfatter mulighed for at udbyde sit værk i en alternativ licensløsning, som befinder sig på forskellige trin på en skala mellem yderpunkterne "All rights reserved" og "No rights reserved". Derved opnås licensen "Some rights reserved"...

  15. Obstructive sleep apnea in Treacher Collins syndrome.

    Science.gov (United States)

    Akre, Harriet; Øverland, Britt; Åsten, Pamela; Skogedal, Nina; Heimdal, Ketil

    2012-01-01

    The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.

  16. Thyroid gland in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Miłkowska-Dymanowska, Joanna; Białas, Adam J; Laskowska, Paulina; Górski, Paweł; Piotrowski, Wojciech J

    2017-01-01

    The risk of chronic obstructive pulmonary disease (COPD), as well as thyroid diseases increases with age. COPD is a common systemic disease associated with chronic inflammation. Many endocrinological disorders, including thyroid gland diseases are related to systemic inflammation. Epidemiological studies suggest that patients with COPD are at higher risk of thyroid disorders. These associations are not well-studied and thyroid gland diseases are not included on the broadly acknowledged list of COPD comorbidities. They may seriously handicap quality of life of COPD patients. Unfortunately, the diagnosis may be difficult, as many signs are masked by the symptoms of the index disease. The comprehension of the correlation between thyroid gland disorders and COPD may contribute to better care of patients. In this review, we attempt to revise available literature describing existing links between COPD and thyroid diseases.

  17. 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......% were nonsmokers with asthma and 17% were nonsmokers with no history of asthma. Bronchial hyper-responsiveness increased the prevalence of airflow obstruction in each of these groups. CONCLUSION: Smoking and asthma, jointly and individually, are major determinants of obstructive disorders in young...... adults. Bronchial hyper-responsiveness contributes to obstruction in both groups....

  18. Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges

    Directory of Open Access Journals (Sweden)

    Rachel Jen

    2016-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD prevalence is rising to epidemic proportions due to historical smoking trends, the aging of the population, and air pollution. Although blaming the victims has been common in COPD, the majority of COPD worldwide is now thought to be nonsmoking related, that is, caused by air pollution and cookstove exposure. It is increasingly appreciated that subjective and objective sleep disturbances are common in COPD, although strong epidemiological data are lacking. People with obstructive sleep apnea (OSA plus COPD (the so-called overlap syndrome have a high risk of cardiovascular death, although again mechanisms are unknown and untested. This review aims to draw attention to the problem of sleep in COPD, to encourage clinicians to ask their patients about symptoms, and to stimulate further research in this area given the large burden of the disease.

  19. Spontaneous Perirenal Urinoma Associated with Ureteropelvic Junction Obstruction in a Child: A Case Report

    Directory of Open Access Journals (Sweden)

    Po-Chang Tseng

    2009-06-01

    Full Text Available We report a case of a 10-year-old Taiwanese boy with a perinephric urinoma, whose health had previously been good, but who experienced a sudden onset of severe left flank pain. Radiological examination revealed ureteropelvic junction obstruction with grade IV hydronephrosis and perinephric urinoma of the left kidney. Percutaneous drainage was performed successfully to relieve these symptoms. Urinoma is a rare complication of congenital obstruction of the urinary tract, and it occurs most commonly following renal trauma.

  20. Effect of metabolic alkalosis on respiratory function in patients with chronic obstructive lung disease.

    Science.gov (United States)

    Bear, R.; Goldstein, M.; Phillipson, E.; Ho, M.; Hammeke, M.; Feldman, R.; Handelsman, S.; Halperin, M.

    1977-01-01

    Eleven instances of a mixed acid-base disorder consisting of chronic respiratory acidosis and metabolic alkalosis were recognized in eight patients with chronic obstructive lung disease and carbon dioxide retention. Correction of the metabolic alkalosis led to substantial improvement in blood gas values and clinical symptoms. Patients with mixed chronic respiratory acidosis and metabolic alkalosis constitute a common subgroup of patients with chronic obstructive lung disease and carbon dioxide retention; these patients benefit from correction of the metabolic alkalosis. PMID:21028

  1. Protocols for staining of bile canalicular and sinusoidal networks of human, mouse and pig livers, three-dimensional reconstruction and quantification of tissue microarchitecture by image processing and analysis.

    Science.gov (United States)

    Hammad, Seddik; Hoehme, Stefan; Friebel, Adrian; von Recklinghausen, Iris; Othman, Amnah; Begher-Tibbe, Brigitte; Reif, Raymond; Godoy, Patricio; Johann, Tim; Vartak, Amruta; Golka, Klaus; Bucur, Petru O; Vibert, Eric; Marchan, Rosemarie; Christ, Bruno; Dooley, Steven; Meyer, Christoph; Ilkavets, Iryna; Dahmen, Uta; Dirsch, Olaf; Böttger, Jan; Gebhardt, Rolf; Drasdo, Dirk; Hengstler, Jan G

    2014-05-01

    Histological alterations often constitute a fingerprint of toxicity and diseases. The extent to which these alterations are cause or consequence of compromised organ function, and the underlying mechanisms involved is a matter of intensive research. In particular, liver disease is often associated with altered tissue microarchitecture, which in turn may compromise perfusion and functionality. Research in this field requires the development and orchestration of new techniques into standardized processing pipelines that can be used to reproducibly quantify tissue architecture. Major bottlenecks include the lack of robust staining, and adequate reconstruction and quantification techniques. To bridge this gap, we established protocols employing specific antibody combinations for immunostaining, confocal imaging, three-dimensional reconstruction of approximately 100-μm-thick tissue blocks and quantification of key architectural features. We describe a standard procedure termed 'liver architectural staining' for the simultaneous visualization of bile canaliculi, sinusoidal endothelial cells, glutamine synthetase (GS) for the identification of central veins, and DAPI as a nuclear marker. Additionally, we present a second standard procedure entitled 'S-phase staining', where S-phase-positive and S-phase-negative nuclei (stained with BrdU and DAPI, respectively), sinusoidal endothelial cells and GS are stained. The techniques include three-dimensional reconstruction of the sinusoidal and bile canalicular networks from the same tissue block, and robust capture of position, size and shape of individual hepatocytes, as well as entire lobules from the same tissue specimen. In addition to the protocols, we have also established image analysis software that allows relational and hierarchical quantifications of different liver substructures (e.g. cells and vascular branches) and events (e.g. cell proliferation and death). Typical results acquired for routinely quantified

  2. Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

    OpenAIRE

    2005-01-01

    Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pre...

  3. Spontaneous globe luxation associated with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    M Ashok Kumar

    2012-01-01

    Full Text Available Spontaneous globe luxation is a rarely reported condition which can lead to complications like optic neuropathy. Common causes are thyroid eye disease, shallow orbit and floppy eyelid syndrome. We report a case of spontaneous globe luxation with the onset and severity associated with chronic obstructive pulmonary disease (COPD. To our knowledge, this is the first case of spontaneous globe luxation associated with COPD.

  4. Sonographic diagnosis of ascariasis causing small bowel obstruction.

    Science.gov (United States)

    Aydin, Ramazan; Bekci, Tumay; Bilgici, Meltem Ceyhan; Polat, Ahmet Veysel

    2014-05-01

    Acute right lower quadrant pain is a common, but nonspecific presenting symptom of a wide variety of diseases in children. Sonography (US) can play a significant role in the accurate and early diagnosis of right lower quadrant pain. In this article, we report a case of small bowel obstruction due to intestinal ascariasis diagnosed at bedside US and confirmed by MRI and describe a new US sign of intestinal ascariasis.

  5. Anticholinergics may play more roles in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    SHEN Ning; HE Bei

    2011-01-01

    @@ Anticholinergic drugs are classified as bronchodilators and are commonly prescribed as such in clinical management of chronic obstructive pulmonary disease (COPD), as the cholinergic tone appears to be the only reversible component of COPD. The famous UPLIFT (the Understanding Potential Long-term Impacts on Function with Tiotropium) trial showed that in patients with COPD, therapy with tiotropium was associated with improvements in lung function, quality of life, and fewer exacerbations during the 4-year trial period.1

  6. Maternofetal outcome in obstructed labour in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Syed Masuma Rizvi

    2015-10-01

    Full Text Available Background: Obstructed labour is still a major cause of maternal morbidity and mortality and adverse outcome of newborn in low income countries. It is the leading cause of hospitalization, comprising of 39% of all obstetric patients in developing countries. Objectives: To study frequency, causes outcome and complications of obstructed labour. Methods: 402 patients admitted with feature of obstructed labour were studied. Detailed history included sociodemographic factors, obstetric history, features of obstruction, intrapartum events were recorded. Condition of patients, mode of delivery, preoperative and postoperative complications, maternal and fetal outcomes was recorded. Results: A total of 23381 deliveries were conducted during one year, 402 cases of obstructed labour were found with incidence of 1.71%. 86.5 % of the patients were from rural areas and 78.1 % of patients were unbooked and73.3% patients were primigravida. The commonest cause of obstructed labour was cephalopelvic disproportion (55% followed by Malposition (22.9% and Malpresentation (17.9%. The commonest mode of delivery was cesarean section (83.8%. Instrumental deliveries were conducted in 10.5% of cases. Destructive procedures are discouraged in out set up. Rupture uterus was seen in 16 cases (4.16% out of which repair was done in 11 cases and subtotal hysterectomy was performed in 5 patients. The common maternal complications were sepsis [pyrexia (15.1%, wound infections (12.8%, urinary tract infection (7%, abdominal distention (11.2%, postpartum hemorrhage (9.7%. Perinatal mortality was 107/402 (26.6%, live birth rate 316/402 (78.7%, still birth rate 86/402 (21.3%. Perinatal morbidity was most commonly due to birth asphyxia (28.8%, jaundice (16.9%, septicemia (14.75%, meconium aspiration syndrome (9.9%. Conclusions: Obstructed labour is a preventable condition prevalent in developing countries. Improving nutrition, antenatal care, early diagnosis and timely intervention may

  7. Axial torsion of meckel's diverticulum causing small bowel obstruction in adult: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Youn, In Kyung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

    2016-02-15

    Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is prevalent in 2–3% of the population. The lifetime risk of complications is estimated at 4%. Small bowel obstruction is the second most common complication of MD. Among the causes of bowel obstruction, axial torsion of MD is the rarest complication. Urgent surgical treatment is needed in cases of small bowel obstruction associated with torsion of MD. Pre-operative diagnosis of MD as a cause of small bowel obstruction is difficult, because the diagnosis can be made only if the diverticulum is delineated at the site of obstruction. We reported a case of axial torsion of MD with necrosis that caused proximal small bowel perforation in a 21 year old male.

  8. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.

    Science.gov (United States)

    Loudin, Michael; Anderson, Sharon; Schlansky, Barry

    2016-10-24

    Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices. Given the alternative pathophysiology of downhill varices, they require a unique approach to management. Variceal band ligation may be used to temporize acute variceal bleeding, and should be applied on the proximal end of the varix. Relief of the underlying SVC obstruction is the cornerstone of definitive treatment of downhill varices. A young woman with a benign superior vena cava stenosis due to a tunneled internal jugular vein dialysis catheter presented with hematemesis and melena. Urgent upper endoscopy revealed multiple 'downhill' esophageal varices with stigmata of recent hemorrhage. As there was no active bleeding, no endoscopic intervention was performed. CT angiography demonstrated stenosis of the SVC surrounding the distal tip of her indwelling hemodialysis catheter. The patient underwent balloon angioplasty of the stenotic SVC segment with resolution of her bleeding and clinical stabilization. Downhill esophageal varices are a distinct entity from the more common distal esophageal varices. Endoscopic therapies have a role in temporizing active variceal bleeding, but relief of the underlying SVC obstruction is the cornerstone of treatment and should be pursued as rapidly as possible. It is unknown why benign, as opposed to malignant, causes of SVC obstruction result in bleeding from downhill varices at such a high rate, despite being a less common etiology of SVC obstruction.

  9. Diospyrobezoar as a Cause of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Andréia Padilha de Toledo

    2012-09-01

    Full Text Available Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki. We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

  10. Pharmacological treatment of bowel obstruction in cancer patients.

    LENUS (Irish Health Repository)

    O'Connor, Brenda

    2012-02-01

    INTRODUCTION: Malignant bowel obstruction (MBO) is a common complication of advanced cancer, occurring most frequently in gynaecological and colorectal cancer. Its management remains complex and variable. This is in part due to the lack of evidence-based guidelines for the clinicians involved. Although surgery should be considered the primary treatment, this may not be feasible in patients with a poor performance status or advanced disease. Advances have been made in the medical management of MBO which can lead to a considerable improvement in symptom management and overall quality of life. AREAS COVERED: This review emphasizes the importance of a prompt diagnosis of MBO with early introduction of pharmacological agents to optimize symptom control. The authors summarize the treatment options available for bowel obstruction in those patients for whom surgical intervention is not a feasible option. The authors also explore the complexities involved in the introduction of parenteral hydration and total parenteral nutrition in this group of patients. EXPERT OPINION: It is not always easy to distinguish reversible from irreversible bowel obstruction. Early and aggressive management with the introduction of pharmacological agents including corticosteroids, octreotide and anti-cholinergic agents have the potential to maintain bowel patency, and allow for more rapid recovery of bowel transit. A combination of analgesics, anti-emetics and anti-cholinergics with or without anti-secretory agents can successfully improve symptom control in patients with irreversible bowel obstruction.

  11. Obstructive sleep apnoea syndrome in children and anaesthesia

    Directory of Open Access Journals (Sweden)

    A Rudra

    2010-01-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

  12. Kidney pathology in non-obstructive urolithiasis in cattle.

    Science.gov (United States)

    Ozmen, O

    2004-12-01

    The objectives of the present study were to investigate the gross and histopathological findings in non-obstructive urolithiasis. Pathological examinations were carried out on 102 cattle kidneys with non-obstructive urolithiasis. The common gross lesions were cyst formations in the kidney lobes, hyperaemia and haemorrhage. The weight of the stones differed from 0.02 to 237.44 g and the colour changed brown to white. The calculi had different shapes. At histopathological examination of the kidneys slight to severe mononuclear cell infiltrations were commonly observed. Haemorrhage and connective tissue proliferations were also seen. Neutrophil leucocyte infiltrations caused by pyelonephritis were observed in some cases and multiple stone formations were found in these cases. Widening of the Bowman's space was a common histopathological finding especially when the stones were big or the inflammatory reaction was severe. Calcium deposits and eosinophylic material were found in the medullary tubules and pelvis renalis lumens in some kidneys. Giant cell formations around the stone reactions were rarely observed. Hyperplasia of the pelvis renalis and tubulus epithelium was another finding which occurred seldom. Whereas sand-like material accumulation seen in urinary bladders in some cases, no obstruction was observed in the urinary canal in this study.

  13. 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.

  14. Predictors of survival in patients with malignant gastric outlet obstruction: A patient-oriented decision approach for palliative treatment

    NARCIS (Netherlands)

    S.M. Jeurnink; E.W. Steyerberg; F.P. Vleggaar; C.H.J. van Eijck; J.E. van Hooft; M.P. Schwartz; E.J. Kuipers; P.D. Siersema

    2011-01-01

    Background: Gastrojejunostomy and stentplacement are the most commonly used treatments for malignant gastric outlet obstruction (GOO). The preference for either treatment largely depends on the expected survival. Our objective was to investigate predictors of survival in patients with malignant GOO

  15. Can a Self-Management Education Program for Patients with Chronic Obstructive Pulmonary Disease Improve Quality of Life ?

    Directory of Open Access Journals (Sweden)

    Manon Labrecque

    2011-01-01

    Full Text Available OBJECTIVE: To assess the effects of a self-management program on health-related quality of life (HRQoL and morbidity commonly associated with chronic obstructive pulmonary disease (COPD.

  16. A STUDY OF OBSTRUCTIVE JAUNDICE WITH FOCUS ON PREDICTIVE FACTORS FOR OUTCOME

    Directory of Open Access Journals (Sweden)

    Srinidhi

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: Obstructive jaundice is a problem frequently encountered by general surgeons. A clear understanding of the etiology, presentation and management is a prerequisite for the management of obstructive jaundice. There is a need to identify the risk factors which may predict outcome. Hence, a detailed study of the various causes of obstructive jaundice and their management is of paramount importance. METHODS: A Prospective observational study was undertaken to investigate the pattern of clinical presentation, diagnosis and management of the different causes of obstructive jaundice. About 21 consecutive patients with symptoms and signs of obstructive jaundice were included in the study. Cases were admitted, examined, investigated and operated during the period of Nov 2010 to Aug 2012. RESULTS & CONCLUSION: The highest age incidence of obstructive jaundice was in the 50 - 80 years with maximum incidence in the 6th decade. There was an increased incidence in female i.e. M: F=1:2.5. Most common cause of obstructive jaundice is choledocholithiasis, followed by periampullary carcinoma. Among periampullary carcinoma, Ca head of pancreas and Ca Ampulla of Vater are the common causes. Jaundice is the most common presentation of surgical jaundice followed by pain abdomen, nausea/vomiting, itching, loss of weight and fever. Ultrasonography was the investigation of choice in our hospital. It is cheap, safe and reliable. Early diagnosis and management helps to reduce the mortality and morbidity rate. ERCP is comparatively as good as Open exploration of CBD and Choledochoduodenostomy for CBD calculi. Good survival benefit in cases of malignant obstructive jaundice depends on detecting the disease early in its course. It was noted on statistical analysis of malignant cases that the values of direct bilirubin levels were significantly higher in those patients who expired postoperatively compared to surviving patients. Hence these parameters

  17. Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital

    Science.gov (United States)

    Rattan, Kamal Nain; Yadav, Ravi

    2016-01-01

    Introduction Neonatal intestinal obstruction is the most common surgical emergency in a newborn requiring prompt intervention. There are only very few studies done in world regarding pattern of neonatal intestinal obstruction. Aim This study was conducted to see the aetiological spectrum of neonatal intestinal obstruction and to find out the problems and outcome of surgical management. Materials and Methods This study was done retrospectively to include all operated cases of neonatal intestinal obstruction from June 2000 to May 2015 and various factors affecting outcome were analysed. Results A total of 298 newborns were included in the study. Male-female ratio was 1.8:1. Gestational age was variable from 32 to 42 weeks (mean = 37.5 weeks) and birth weight from 1.4 to 3.5kg (mean= 2.25 kg). Mean age of presentation was 6 days with intestinal atresia (49.6%) as the commonest cause. Other causes were Hirschsprung (13%), Malrotation gut (11.7%), Meconium ileus (7.3%), patent VID (5%), duodenal obstruction (4%), duplication cyst (3.7%), obstructed hernia (2.7%) and others (2.7%). Mortality rate was 16.4% with sepsis both pre as well as post operative as the main cause of mortality. Conclusion The morbidity and mortality of neonatal intestinal obstruction has improved over last few years mainly due to antenatal detection, early intervention, meticulous resuscitation before surgery along with good NICU care. PMID:27042546

  18. Obstructive sleep apnoea in adult indigenous populations in high-income countries: an integrative review.

    Science.gov (United States)

    Woods, Cindy E; Usher, Kim; Maguire, Graeme Paul

    2015-03-01

    Obstructive sleep apnoea is recognised as a common but under-diagnosed health issue. Currently, there is very little published data relating to the burden and impact of obstructive sleep apnoea among indigenous populations. The purpose of this review was to investigate the prevalence, impact, risk factors and treatment of obstructive sleep apnoea in indigenous populations in high-income countries. An integrative review was conducted on 25 English language studies and reports that investigated obstructive sleep apnoea among indigenous populations in high-income countries. Studies that did not focus on indigenous populations in the results or discussion were excluded. Eligible studies were identified by searching PubMed, Web of Science and Google Scholar databases and reference lists of eligible studies. Publication dates range from 1998 to 2012. Synthesis of studies indicates the prevalence of obstructive sleep apnoea is higher and severity is greater in indigenous populations compared with non-indigenous populations. Comparable risk factors for obstructive sleep apnoea were identified in indigenous and non-indigenous populations, with only three studies identifying ethnicity as an independent risk factor. Indigenous populations in high-income countries are subject to an overall greater prevalence of obstructive sleep apnoea that is also more severe. A higher prevalence of obesity, alcohol and tobacco use and comorbid medical conditions associated with low socioeconomic status rather than indigenous status per se appears to explain this disparity.

  19. Restrições posturais não interferem nos resultados da manobra de reposição canalicular Posture restrictions do not interfere in the results of canalith repositioning maneuver

    Directory of Open Access Journals (Sweden)

    Lucinda Simoceli

    2005-02-01

    Full Text Available A Vertigem Posicional Paroxística Benigna (VPPB é uma das mais comuns doenças da orelha interna que cursam com tontura, porém o seu tratamento ainda é algo de inúmeras controvérsias. OBJETIVO: Avaliar a influência das orientações posturais na evolução precoce de pacientes com diagnóstico de VPPB de canal semicircular posterior, submetidos à manobra de Epley. FORMA DE ESTUDO: Prospectivo randomizado. MATERIAL E MÉTODO: Foram avaliados 50 pacientes com diagnóstico de VPPB de canal semicircular posterior submetidos à manobra de reposição canalicular de Epley, divididos em Grupo de Estudo - 23 pacientes - que receberam orientações de restrição postural pós-manobra e Grupo Controle - 27 pacientes - que não receberam orientações. RESULTADOS: Não houve diferença estatisticamente significante entre os grupos estudados quanto à resolução dos sintomas da VPPB independentemente de sexo e idade. CONCLUSÃO: A eficácia da Manobra de Reposição Canalicular de Epley não é influenciada pelo uso ou não das restrições posturais.Benign Paroxysmal Positional Vertigo (BPPV is a frequent cause of dizziness and despite of the excellent results with its treatment, there is some controversy about management. AIM: To assess the efficacy of Epley Maneuver with and without post-maneuver restrictions. STUDY DESIGN: Prospective randomized. MATERIAL AND METHOD: Fifty patients presenting BPPV of the posterior semicircular canal, treated with Epley Maneuver and divided into two groups: study group - 23 patients - with post-maneuver restrictions, and control group - 27 patients - without post-maneuver restrictions. RESULTS: No significant difference was found between the studied and the control group. CONCLUSION: Post-maneuver restrictions do not influence the efficacy of Epley Maneuver for BPPV management.

  20. Obstructive Sleep Apnea in MPS

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    Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS

    2015-11-01

    Full Text Available The mucopolysaccharidoses (MPSs are a group of inherited, metabolic disorders characterized by progressive multisystem accumulation of partially degraded glycosaminoglycans. This manifests with multilevel airway obstruction, presenting with obstructive sleep apnea (OSA. We systematically reviewed the literature to determine the severity and prevalence of OSA in MPS based on polysomnography analysis. Fifteen studies with 294 participants met the inclusion criteria for review. The pretreatment prevalence of OSA in MPS was 81% with a mean apnea–hypopnea index (AHI of 10.4. Patients with MPS I are most significantly affected, with 75% suffering with moderate to severe OSA (mean AHI, 16.6. Enzyme replacement therapy (ERT results in an almost significant reduction in OSA in MPS I ( P = .06, while adenotonsillar surgery significantly improves AHI ( P = .002. Obstructive sleep apnea least affects MPS III. There is a lack of long-term post-ERT and hematopoietic stem cell transplant data relating to OSA outcomes in this population, with further prospective studies required to determine the ongoing response to treatment.

  1. Obstructive Sleep Apnea in MPS

    Directory of Open Access Journals (Sweden)

    Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS

    2015-11-01

    Full Text Available The mucopolysaccharidoses (MPSs are a group of inherited, metabolic disorders characterized by progressive multisystem accumulation of partially degraded glycosaminoglycans. This manifests with multilevel airway obstruction, presenting with obstructive sleep apnea (OSA. We systematically reviewed the literature to determine the severity and prevalence of OSA in MPS based on polysomnography analysis. Fifteen studies with 294 participants met the inclusion criteria for review. The pretreatment prevalence of OSA in MPS was 81% with a mean apnea–hypopnea index (AHI of 10.4. Patients with MPS I are most significantly affected, with 75% suffering with moderate to severe OSA (mean AHI, 16.6. Enzyme replacement therapy (ERT results in an almost significant reduction in OSA in MPS I (P = .06, while adenotonsillar surgery significantly improves AHI (P = .002. Obstructive sleep apnea least affects MPS III. There is a lack of long-term post-ERT and hematopoietic stem cell transplant data relating to OSA outcomes in this population, with further prospective studies required to determine the ongoing response to treatment.

  2. Stents for malignant ureteral obstruction

    Directory of Open Access Journals (Sweden)

    Kristina Pavlovic

    2016-07-01

    Full Text Available Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS, tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical. In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes, or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

  3. Upregulation of Interleukin-33 in obstructive renal injury

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Wei-Yu, E-mail: wychen624@cgmh.org.tw [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Chang, Ya-Jen [Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (China); Su, Chia-Hao [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Tsai, Tzu-Hsien [Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Chen, Shang-Der [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China); Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan (China); Hsing, Chung-Hsi [Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan (China); Yang, Jenq-Lin, E-mail: jyang@adm.cgmh.org.tw [Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (China)

    2016-05-13

    Interstitial fibrosis and loss of parenchymal tubular cells are the common outcomes of progressive renal diseases. Pro-inflammatory cytokines have been known contributing to the damage of tubular cells and fibrosis responses after renal injury. Interleukin (IL)-33 is a tissue-derived nucleus alarmin that drives inflammatory responses. The regulation and function of IL-33 in renal injury, however, is not well understood. To investigate the involvement of cytokines in the pathogenesis of renal injury and fibrosis, we performed the mouse renal injury model induced by unilateral urinary obstruction (UUO) and analyze the differentially upregulated genes between the obstructed and the contralateral unobstructed kidneys using RNA sequencing (RNAseq). Our RNAseq data identified IL33 and its receptor ST2 were upregulated in the UUO kidney. Quantitative analysis confirmed that transcripts of IL33 and ST2 were upregulated in the obstructed kidneys. Immunofluorescent staining revealed that IL-33 was upregulated in Vimentin- and alpha-SMA-positive interstitial cells. By using genetically knockout mice, deletion of IL33 reduced UUO-induced renal fibrosis. Moreover, in combination with BrdU labeling technique, we observed that the numbers of proliferating tubular epithelial cells were increased in the UUO kidneys from IL33-or ST2-deficient mice compared to wild type mice. Collectively, our study demonstrated the upregulation of IL-33/ST2 signaling in the obstructed kidney may promote tubular cell injury and interstitial fibrosis. IL-33 may serve as a biomarker to detect renal injury and that IL-33/ST2 signaling may represent a novel target for treating renal diseases. -- Highlights: •Interleukin (IL)-33 was upregulated in obstructed kidneys. •Interstitial myofibroblasts expressed IL-33 after UUO-induced renal injury. •Deficiency of IL33 reduced interstitial fibrosis and promoted tubular cell proliferation.

  4. Not Just Painless Bleeding: Meckel’s Diverticulum as a Cause of Small Bowel Obstruction in Children—Two Cases and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Khalida Itriyeva

    2015-01-01

    Full Text Available Physicians are educated with the classical teaching that symptomatic patients with Meckel’s diverticulum (MD most often present with painless rectal bleeding. However, a review of the literature reveals that young patients with MD will most commonly present with signs of intestinal obstruction, an etiology not frequency considered in patients presenting to the emergency department with obstruction. We present two cases of intestinal obstruction diagnosed in our emergency department, with Meckel’s diverticulum being the etiology.

  5. [Two Cases of Obstructive Colorectal Cancer Effectively Treated with Colonic Stent Placement].

    Science.gov (United States)

    Masuda, Taiki; Kobayashi, Kenta; Kakimoto, Masaki; Koshiishi, Haruya; Yoshimura, Tetsunori

    2016-11-01

    We report 2 cases of obstructive colorectal cancer that were successfully treated with a self-expanding metallic stent (SEMS). They were both diagnosed with obstructive colorectal cancer. Colonoscopy was performed to make a definitive and qualitative diagnosis and to relieve the stenosis using a SEMS. The SEMSs were inserted without complications. A few days later, the patients underwent laparoscope-assisted sigmoidectomy with lymph node resection. Despite the colon obstruction, a primary anastomosis was performed. They were both discharged without complications. Obstructive colorectal cancer is an oncological emergency commonly observed in our daily clinical practice. Conventional treatments such as stoma creation or insertion of a trans-analdrainage tube have been performed. However, these treatments significantly reduce the patient's QOL. On the other hand, colonic stent placement plays a satisfactory role in improvement of the patient's QOL by paying scrupulous attention to retaining the colonic stent.

  6. Small bowel obstruction secondary to migration of a fragment of lithobezoar: a case report.

    LENUS (Irish Health Repository)

    Medani, Mekki

    2009-01-01

    INTRODUCTION: Small bowel obstruction is a common world-wide condition that has a range of etiological factors. The management is largely dependent on the cause of the obstruction. Small bowel obstruction caused by foreign body ingestion is rare; many items have been reported as responsible, but there are no reports implicating polyurethane foam. CASE PRESENTATION: We report the case of a 44-year-old Irish male who presented following ingestion of polyurethane foam. He was asymptomatic on presentation but developed a small bowel obstruction shortly thereafter. CONCLUSION: Patients presenting following ingestion of polyurethane foam should be scheduled for elective laparotomy, gastrotomy, and retrieval of the cast on the next available theatre list - given that they are suitable for surgery.

  7. Dynamics of Snoring Sounds and Its Connection with Obstructive Sleep Apnea

    CERN Document Server

    Alencar, Adriano M; Oliveira, Carolina Beatriz; Vieira, Andre P; Moriya, Henrique T; Lorenzi-Filho, Geraldo

    2012-01-01

    Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets --- the snore sound --- recorded during full polysomnography in patients referred to the sleep laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 seconds, correlates with respiratory obstructive events. We find that the number of irregular snores --- easily accessible, and quantified by what we call the snore time interval index (STII) --- is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with mod...

  8. Lack of reliable clinical predictors to identify obstructive sleep apnea in patients with hypertrophic cardiomyopathy

    Science.gov (United States)

    Nerbass, Flávia B.; Pedrosa, Rodrigo P.; Genta, Pedro R.; Antunes, Murillo O.; Arteaga-Fernández, Edmundo; Drager, Luciano F.; Lorenzi-Filho, Geraldo

    2013-01-01

    OBJECTIVE: Obstructive sleep apnea is common among patients with hypertrophic cardiomyopathy and may contribute to poor cardiovascular outcomes. However, obstructive sleep apnea is largely unrecognized in this population. We sought to identify the clinical predictors of obstructive sleep apnea among patients with hypertrophic cardiomyopathy. METHODS: Consecutive patients with hypertrophic cardiomyopathy were recruited from a tertiary University Hospital and were evaluated using validated sleep questionnaires (Berlin and Epworth) and overnight portable monitoring. Ninety patients (males, 51%; age, 46±15 years; body mass index, 26.6±4.9 kg/m2) were included, and obstructive sleep apnea (respiratory disturbance index ≥15 events/h) was present in 37 patients (41%). RESULTS: Compared with the patients without obstructive sleep apnea, patients with obstructive sleep apnea were older and had higher body mass index, larger waist circumference, larger neck circumference, and higher prevalence of atrial fibrillation. Excessive daytime sleepiness (Epworth scale) was low and similar in the patients with and without obstructive sleep apnea, respectively. The only predictors of obstructive sleep apnea (using a logistic regression analysis) were age ≥45 years (odds ratio [OR], 4.46; 95% confidence interval [CI 95%], 1.47–13.54; p = 0.008) and the presence of atrial fibrillation [OR, 5.37; CI 95%, 1.43–20.12; p = 0.013]. CONCLUSION: Consistent clinical predictors of obstructive sleep apnea are lacking for patients with hypertrophic cardiomyopathy, which suggests that objective sleep evaluations should be considered in this population, particularly among elderly patients with atrial fibrillation. PMID:23917665

  9. Nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Odencrants, Sigrid; Bjuström, Tomas; Wiklund, Nils; Blomberg, Karin

    2013-10-01

    To describe and compare nutritional status, pulmonary function, gender and marital status in patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is a chronic illness that can lead to poor nutritional status due to an increased energy requirements related to laboured breathing. Inadequate nutritional intake has often been described in this patient group. Nutritional support for patients with chronic obstructive pulmonary disease who suffer from nutritional problems is essential, both for their sense of well-being and for their survival with chronic obstructive pulmonary disease. The study design was descriptive and comparative. Quantitative data collection was carried out among 81 patients with chronic obstructive pulmonary disease (47 women and 34 men) with an average age of 65 years (SD 3·5). The Mini Nutritional Assessment was used to assess nutritional status. Participants who lived alone had worse nutritional status than those who did not live alone, and female participants had worse nutritional status than their male counterparts. No significant correlation was found between pulmonary function and nutritional status. This study contributes knowledge of a potential correlation between nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease. Women with chronic obstructive pulmonary disease may be at an increased risk of malnutrition. Despite the previous results showing malnutrition and underweight to be common, the present study found that many of the participants were overweight, which may reflect a global health trend regardless of disease. Early identification of patients at risk of malnutrition is important. Registered nurses should be aware that patients with chronic obstructive pulmonary disease who are female or who live alone may be at an increased risk of nutritional problems. Patients with chronic obstructive pulmonary disease must be offered information and support

  10. Speckle tracking echocardiography in chronic obstructive pulmonary disease and overlapping obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Pizarro C

    2016-08-01

    Full Text Available Carmen Pizarro,* Fabian van Essen,* Fabian Linnhoff, Robert Schueler, Christoph Hammerstingl, Georg Nickenig, Dirk Skowasch, Marcel Weber Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany *These authors contributed equally to this work Background: COPD and congestive heart failure represent two disease entities of growing global burden that share common etiological features. Therefore, we aimed to identify the degree of left ventricular (LV dysfunction in COPD as a function of COPD severity stages and concurrently placed particular emphasis on the presence of overlapping obstructive sleep apnea (OSA.Methods: A total of 85 COPD outpatients (64.1±10.4 years, 54.1% males and 20 controls, matched for age, sex, and smoking habits, underwent speckle tracking echocardiography for LV longitudinal strain imaging. Complementary 12-lead electrocardiography, laboratory testing, and overnight screening for sleep-disordered breathing using the SOMNOcheck micro® device were performed.Results: Contrary to conventional echocardiographic parameters, speckle tracking echocardiography revealed significant impairment in global LV strain among COPD patients compared to control smokers (-13.3%±5.4% vs -17.1%±1.8%, P=0.04. On a regional level, the apical septal LV strain was reduced in COPD (P=0.003 and associated with the degree of COPD severity (P=0.02. With regard to electrocardiographic findings, COPD patients exhibited a significantly higher mean heart rate than controls (71.4±13.0 beats per minute vs 60.3±7.7 beats per minute, P=0.001 that additionally increased over Global Initiative for Chronic Obstructive Lung Disease stages (P=0.01. Albeit not statistically significant, COPD led to elevated N-terminal pro-brain natriuretic peptide levels (453.2±909.0 pg/mL vs 96.8±70.0 pg/mL, P=0.08. As to somnological testing, the portion of COPD patients exhibiting overlapping OSA accounted for 5.9% and

  11. TRICHOBEZOAR WITH GASTRIC OUTLET OBSTRUCTION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Nagendra Prasad

    2016-05-01

    Full Text Available Trichobezoar is collection of hairs forming a conglomerated mass. It is a very rare entity mimicking other common causes of gastric outlet obstruction. It is classically seen in adolescent females usually with psychiatric disturbances. Stomach is the most common site of occurrence. Occasionally, it may extend into small intestine (Rapunzel syndrome. Patients present with nonspecific symptoms such as loss of appetite, early satiety and vomiting. It may present as failure to thrive in small children. Diagnosis is frequently delayed due to paucity of symptoms. It is noticed as a slowly growing lump but occasionally may present with complications such as perforation, intestinal obstruction and pancreatitis. Abdominal ultrasonography is inconclusive and upper gastrointestinal endoscopy confirms the diagnosis. Laparotomy and extraction is the standard of treatment in spite of many new minimally invasive techniques. This is a case of gastric trichobezoar in a 16-year-old girl who presented with gastric outlet obstruction, which was successfully removed surgically. Recurrences are frequent due to associated psychiatric disturbances, hence psychiatric counselling must form an integral part of treatment.

  12. Obstructive Lesions of the Pediatric Subglottis

    OpenAIRE

    Ida, Jonathan B.; Guarisco, J. Lindhe; Rodriguez, Kimsey H.; Amedee, Ronald G.

    2008-01-01

    Purpose: To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan.

  13. Obstructive Lesions of the Pediatric Subglottis

    OpenAIRE

    Ida, Jonathan B.; Guarisco, J. Lindhe; Rodriguez, Kimsey H.; Amedee, Ronald G.

    2008-01-01

    Purpose: To compile information regarding obstructive subglottic lesions in children, including anatomy, pathogenesis, prevention, evaluation, and treatment options, required for implementation of a multi-faceted treatment plan.

  14. Noninvasive Methods to Evaluate Bladder Obstruction in Men

    Directory of Open Access Journals (Sweden)

    Dean S. Elterman

    2013-01-01

    Full Text Available Lower urinary tract symptoms (LUTS caused by benign prostatic hyperplasia (BPH commonly affect older men. Fifty percent of men in their sixties and 80% of men in their nineties will be affected. Many of these men will seek care for their bothersome symptoms and decreased quality of life. There is a poor association between LUTS and objective measures such as post void residual, voided volumes, or maximal flow. Pressure flow studies are considered the gold standard for detecting bladder outlet obstruction. These studies tend to be cumbersome, expensive, and have exposure to ionizing radiation. There are several techniques which may offer noninvasive methods of detecting bladder outlet obstruction (BOO in men.

  15. Treatment strategies in obstructed defecation and fecal incontinence

    Institute of Scientific and Technical Information of China (English)

    Marat Khaikin; Steven D Wexner

    2006-01-01

    Obstructed defecation (OD) and fecal incontinence(FI) are challenging clinical problems, which are commonly encountered in the practice of colorectal surgeons and gastroenterologists. These disorders socially and psychologically distress patients and greatly impair their quality of life. The underlying anatomical and pathophysiological changes are complex, often incompletely understood and cannot always be determined. As a consequence, many medical, surgical,and behavioral approaches have been described, with no panacea. Over the past decade, advances in an understanding of these disorders together with rational and similar methods of evaluation in anorectal physiology laboratories (ARP), radiology studies, and new surgical techniques have led to promising results. In this brief review, we discuss treatment strategies and recent updates on clinical and therapeutic aspects of obstructed defecation and fecal incontinence.

  16. Mild obstructive sleep apnea: beyond the AHI

    Directory of Open Access Journals (Sweden)

    Lee-Iannotti J

    2014-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A common conundrum faced by sleep medicine practitioners is how to manage the large group of patients with mild sleep apnea. Many patients are referred for sleep evaluation, with symptoms thought to be due to obstructive sleep apnea (OSA. Often polysomnography demonstrates only mild sleep apnea, and the clinician and patient are faced with the dilemma of whether to use continuous positive airway pressure (CPAP therapy or an oral appliance. In making this important decision the clinician incorporates the commonly used definition of mild sleep apnea as an apnea-hypopnea index of between 5 and 14 apneas or hypopneas per hour of sleep. Moderate sleep apnea is defined as 15-29 events per hour, and severe is 30 and above events per hour. These arbitrary thresholds originated in the early 1980s when knowledge of this condition was in its infancy and little was known about the long term health effects. The definition ...

  17. Severe Obstructive Sleep Apnea Due to Massive Cervical Lipohypertrophy.

    Science.gov (United States)

    Ugurlu, Alper Mete; Ersozlu, Tolga; Basat, Salih Onur; Ceran, Fatih

    2015-09-01

    Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

  18. Multidetector row computed tomography in bowel obstruction. Part 2. Large bowel obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Sinha, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)]. E-mail: rakesh.sinha@uhl-tr.nhs.uk; Verma, R. [Department of Radiology, Glenfield Hospital, Leicester (United Kingdom)

    2005-10-01

    Large bowel obstruction may present as an emergency as high-grade colonic obstruction and can result in perforation. Perforated large bowel obstruction causes faecal peritonitis, which can result in high morbidity and mortality. Multidetector row computed tomography (MDCT) has the potential of providing an accurate diagnosis of large bowel obstruction. The rapid acquisition of images within one breath-hold reduces misregistration artefacts than can occur in critically ill or uncooperative patients. The following is a review of the various causes of large bowel obstruction with emphasis on important pathogenic factors, CT appearances and the use of multiplanar reformatted images in the diagnostic workup.

  19. Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis – report from a population-based study

    Directory of Open Access Journals (Sweden)

    Sawalha S

    2017-04-01

    Full Text Available Sami Sawalha,1 Linnea Hedman,2 Eva Rönmark,2 Bo Lundbäck,3 Anne Lindberg1 1Department of Public Health and Clinical Medicine, Division of Medicine, 2Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine, Umeå University, Umeå, 3Krefting Research Center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden Introduction: According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre- but not post-BD obstruction, post-BD airway obstruction (COPD, and subjects without airway obstruction.Materials and methods: In 2002–2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced vital capacity <0.70 (n=993, were identified together with sex- and age-matched referents (n=993. These subjects were further divided into subjects with pre- but not post-BD airway obstruction (pre- not post-BD obstruction and subjects with post-BD airway obstruction (COPD. Mortality data were collected until December 31, 2014.Results: Out of 993 subjects with airway obstruction, 736 (74% had COPD and 257 (26% pre- not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre- not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre- not post-BD obstruction, was associated with an increased risk for death compared to those without

  20. Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Gerdts Eva

    2009-03-01

    Full Text Available Abstract Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.

  1. 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....

  2. 36 CFR 1004.13 - Obstructing traffic.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Obstructing traffic. 1004.13 Section 1004.13 Parks, Forests, and Public Property PRESIDIO TRUST VEHICLES AND TRAFFIC SAFETY § 1004.13 Obstructing traffic. The following are prohibited: (a) Stopping or parking a vehicle upon a Presidio Trust...

  3. 36 CFR 4.13 - Obstructing traffic.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Obstructing traffic. 4.13... VEHICLES AND TRAFFIC SAFETY § 4.13 Obstructing traffic. The following are prohibited: (a) Stopping or... interfere with the normal flow of traffic. ...

  4. Airflow Obstruction in Young Adults in Canada

    Directory of Open Access Journals (Sweden)

    Manal Al-Hazmi

    2007-01-01

    Full Text Available 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.

  5. 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

  6. Hypertension and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Phillips CL

    2013-05-01

    Full Text Available Craig L Phillips,1–3 Denise M O'Driscoll4,51Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; 2National Health and Medical Research Council Center for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; 3Discipline of Sleep Medicine, Sydney Medical School, University of Sydney, Sydney, Australia; 4Monash Lung and Sleep, Monash Medical Centre, Monash University, Melbourne, Australia; 5Department of Medicine, Southern Clinical School, Monash University, Melbourne, AustraliaAbstract: Obstructive sleep apnea (OSA is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.Keywords: obstructive sleep apnea, hypertension, intermittent hypoxia, ambulatory blood pressure, sympathetic activation

  7. Prevalence and impact of chronic obstructive pulmonary disease in a rural district of Uganda : FRESH AIR methodology for sub-Saharan Africa

    NARCIS (Netherlands)

    van Gemert, Frederik

    2017-01-01

    Prevalence and impact of chronic obstructive pulmonary disease in a rural district of Uganda: FRESH AIR methodology for sub-Saharan Africa Worldwide, tobacco smoking is the most common encountered risk factor for chronic obstructive pulmonary disease (COPD). However, in many low and middle-income co

  8. Efficacy and comorbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea : a systematic review and preliminary results of a randomized trial

    NARCIS (Netherlands)

    Hoekema, Aarnoud

    2006-01-01

    The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. The modification of pharyngeal patency by oral appliance therapy has been suggested as an alternative to various treatment mod

  9. Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Non-Sleepy Obstructive Sleep Apnea : The RICCADSA Randomized Controlled Trial

    NARCIS (Netherlands)

    Peker, Yüksel; Glantz, Helena; Eulenburg, Christine; Wegscheider, Karl; Herlitz, Johan; Thunström, Erik

    2016-01-01

    RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain

  10. Small Bowel Obstruction due to Intestinal Xanthomatosis

    Directory of Open Access Journals (Sweden)

    L. E. Barrera-Herrera

    2015-01-01

    Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

  11. Gallstone ileus resulting in strong intestinal obstruction

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    Israel Szajnbok

    Full Text Available Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecystenteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.

  12. Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Park, Hee Jin; Leem, Ah Young; Lee, Sang Hoon; Song, Ju Han; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; Chung, Kyung Soo

    2015-01-01

    Comorbidities can occur frequently in patients with chronic obstructive pulmonary disease (COPD) and can influence mortality and morbidity independently. It is increasingly recognized that many patients with COPD have comorbidities that have a major impact on their quality of life and survival. Therefore, we investigated the prevalence of comorbidities in Korean COPD populations. We used data obtained in the 6 years of the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES) IV and V. Among 50,405 subjects, 16,151 subjects aged ≥40 years who performed spirometry adequately were included in this study. Airway obstruction was defined as forced expiratory volume in 1 second/forced vital capacity Chronic Obstructive Lung Disease stage was used to evaluate the severity of airway obstruction. Statistical analyses were performed using SAS 9.2. Among the 16,151 subjects (43.2% male, 56.8% female; mean age: 57.1 years for men and 57.2 years for women), 13.1% had obstructive lung function; 11.3%, restrictive lung function; and 75.6%, normal lung function. Among individuals with obstructive lung function, 45.3%, 49.4%, and 5.3% had mild, moderate, and severe and very severe airflow limitation. The prevalence of hypertension, diabetes mellitus (DM), underweight, and hypertriglyceridemia was higher in the obstructive lung function group than in the normal lung function group (49.6% vs 35.2%; 16.8% vs 10.5%; 3.3% vs 1.3%; 19.7% vs 17.0%). According to the severity of airway obstruction, hypertension and underweight were more common as severity increased, although the prevalence of DM and hypertriglyceridemia was lower in subjects with severe airway obstruction. The prevalence of hypercholesterolemia, overweight, and osteoarthritis was lower in the obstructive lung function group, especially in the severe airway obstruction groups. Overall, our analysis is similar to research that was conducted earlier. Our study showed that hypertension and

  13. Hepatocellular carcinoma with obstructive jaundice:diagnosis,treatment and prognosis

    Institute of Scientific and Technical Information of China (English)

    Lun-Xiu Qin; Zhao-You Tang

    2003-01-01

    Obstructive jaundice as the main clinical feature is uncommon in patients with hepatocellular carcinoma (HCC). Only 1-12 %of HCC patients manifest obstructive jaundice as the initial complaint. Such cases are clinically classified as "icteric type hepatoma", or "cholestatic type of HCC". Identification of this group of patients is important, because surgical treatment may be beneficial. HCC may involve the biliary tract in several different ways: tumor thrombosis, hemobilia,tumor compression, and diffuse tumor infiltration. Bile duct thrombosis (BDT) is one of the main causes for obstructive jaundice, and the previously reported incidence is 1.2-9 %.BDT might be benign, malignant, or a combination of both.Benign thrombi could be blood clots, pus, or sludge.Malignant thrombi could be primary intrabiliary malignant tumors, HCC with invasion to bile ducts, or metastatic cancer with bile duct invasion. The common clinical features of this type of HCC include: high level of serum AFP; history of cholangitis with dilation of intrahepatic bile duct; aggravating jaundice and rapidly developing into liver dysfunction. It is usually difficult to make diagnosis before operation, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the BDT preoperatively. Despite recent remarkable improvements in the imaging tools for diagnosis of HCC, such cases are still incorrectly diagnosed as cholangiocarcinoma or choledocholithiases. Ultrasonography (US) and CT are helpful in showing hepatic tumors and dilated intrahepatic and/or extrahepatic ducts containing dense material corresponding to tumor debris. Direct cholangiography including percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP)remains the standard procedure to delineate the presence and level of biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) is superior to ERCP in interpreting the cause and

  14. How to decide on stent insertion or surgery in colorectal obstruction?

    Science.gov (United States)

    Zahid, Assad; Young, Christopher John

    2016-01-27

    Colorectal cancer is one of the most common cancers in western society and malignant obstruction of the colon accounts for 8%-29% of all large bowel obstructions. Conventional treatment of these patients with malignant obstruction requiring urgent surgery is associated with a greater physiological insult on already nutritionally replete patients. Of late the utility of colonic stents has offered an option in the management of these patients in both the palliative and bridge to surgery setting. This has been the subject of many reviews which highlight its efficacy, particulary in reducing ostomy rates, allowing quicker return to oral diet, minimising extended post-operative recovery as well as some quality of life benefits. The uncertainity in managing patients with malignant colonic obstructions has lead to a more cautious use of stenting technology as community equipoise exists. Decision making analysis has demonstrated that surgeons' favored the use of stents in the palliative setting preferentially when compared to the curative setting where surgery was preferred. We aim to review the literature regarding the use of stent or surgery in colorectal obstruction, and then provide a discourse with regards to the approach in synthesising the data and applying it when deciding the appropriate application of stent or surgery in colorectal obstruction.

  15. A CLINICAL STUDY OF GASTRIC OUTLET OBSTRUCTION IN ADULT POPULATION

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    Manju Singh

    2017-02-01

    Full Text Available BACKGROUND Gastric outlet obstruction (GOO also known as pyloric obstruction is not a single entity. It is the clinical & pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying. MATERIALS AND METHODS 37 patients attending surgical out-patient department of Pt. J. N. M. Medical College, Raipur during the period of March 2015 to September 2016 of GOO with chief complaints of projectile vomiting, visible gastric peristalsis or palpable distended stomach were included in this study. Cases of functional non-mechanical cause of GOO were excluded. Only patients of 20 years & above were included in this study. Saline load test, upper gastro-intestinal endoscopy and routine laboratory investigations done in all cases. RESULTS Age group of 40-59 was maximum sufferer 27%, followed by age group 60-69 years (21.9%. Male-Female ratio was 1.2:1. Antral carcinoma (75.7% cases topped the list followed by cicatrised duodenal ulcer which was seen in 18.9% cases; only two case was due to duodenal adenoma. CONCLUSION This study is a clinical observational study of gastric outlet obstruction, but in vast majority of cases diagnosis can be established clinically. Males are more sufferers and antral carcinoma seems to be main causes of GOO, Proliferative lesion is common finding in UGI.

  16. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Corlateanu, Alexandru; Covantev, Serghei; Mathioudakis, Alexander G; Botnaru, Victor; Siafakas, Nikolaos

    2016-11-01

    The classical definition of Chronic Obstructive Pulmonary Disease (COPD) as a lung condition characterized by irreversible airway obstruction is outdated. The systemic involvement in patients with COPD, as well as the interactions between COPD and its comorbidities, justify the description of chronic systemic inflammatory syndrome. The pathogenesis of COPD is closely linked with aging, as well as with cardiovascular, endocrine, musculoskeletal, renal, and gastrointestinal pathologies, decreasing the quality of life of patients with COPD and, furthermore, complicating the management of the disease. The most frequently described comorbidities include skeletal muscle wasting, cachexia (loss of fat-free mass), lung cancer (small cell or non-small cell), pulmonary hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, normocytic anemia, diabetes, metabolic syndrome, osteoporosis, obstructive sleep apnea, depression, and arthritis. These complex interactions are based on chronic low-grade systemic inflammation, chronic hypoxia, and multiple common predisposing factors, and are currently under intense research. This review article is an overview of the comorbidities of COPD, as well as their interaction and influence on mutual disease progression, prognosis, and quality of life.

  17. Complicated Jejunal Diverticulosis: Small Bowel Volvulus with Obstruction

    Directory of Open Access Journals (Sweden)

    Rommel Singh Mohi

    2016-11-01

    Full Text Available The incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up.

  18. Encountering Meckel's diverticulum in emergency surgery for ascaridial intestinal obstruction

    Directory of Open Access Journals (Sweden)

    Amin Abid

    2010-06-01

    Full Text Available Abstract Background Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. In children with intestinal ascariasis, the diverticulum remains asymptomatic or rarely the Ascaris lumbricoides may lead to its complications in the presence of massive intestinal roundworm load. Given that preoperative diagnosis is seldom carried out, when Meckel's diverticulum is found at laparotomy for obstructive intestinal complications of roundworm, the diverticulum should be removed as complications may occur at any time. The aim of this study was to describe the findings of concomitant presence of Meckel's diverticulum who had surgical intervention in symptomatic intestinal ascariasis in children. Methods A retrospective case review study of 14 children who had surgical intervention for symptomatic intestinal ascariasis having the presence of concomitant Meckel's diverticulum was done. The study was done at SMHS Hospital Srinagar, Kashmir. Results A total of the 14 children who had ascaridial intestinal obstruction with concomitant presence of Meckel's diverticulum were studied. Age of children ranged from 4-12 years, male:female ratio was 1.8:1. Nine patients had asymptomatic Meckel's diverticulum, whereas 5 patients with symptomatic signs were found in the course of emergency surgery for ascaridial intestinal obstruction. Conclusion Meckel's diverticulum in intestinal ascariasis may pursue silent course or may be accompanied with complications of the diverticulitis, perforation or the gangrene. Incidental finding of the Meckel's diverticulum in the intestinal ascariasis should have removal.

  19. Sleep-related disorders in chronic obstructive pulmonary disease.

    LENUS (Irish Health Repository)

    Crinion, Sophie J

    2014-02-01

    Sleep may have several negative consequences in patients with chronic obstructive pulmonary disease (COPD). Sleep is typically fragmented with diminished slow wave and rapid-eye-movement sleep, which likely represents an important contributing factor to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep, which result in mild hypoventilation in normal subjects, are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. The co-existence of obstructive sleep apnea and COPD is also common, principally because of the high prevalence of each disorder, and there is little convincing evidence that one disorder predisposes to the other. Nonetheless, this co-existence, termed the overlap syndrome, typically results in more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without obstructive sleep apnea.

  20. [Reducing the Feeding-Tube Obstruction Rate in Esophageal Cancer Patients With Jejunostomy].

    Science.gov (United States)

    Chin, Ying-Chun; Hsieh, Pei-Yin; Chang, Tsyr-Huei

    2015-06-01

    Patients with esophageal cancer experience chronic dysphagia. This condition typically necessitates the use of a jejunal feeding tube to provide the patient with adequate nutrition. Obstruction of the jejunal feeding tube is common in clinical practice and results in malnutrition in most patients and mortality in the most serious cases. An analysis of the status of jejunostomy-tube use in our unit found that these tubes were obstructed in 27.6% of the cases. The causes of this obstruction were: tube bending due to tight suturing, small inner-tube diameter, the absence of adequate jejunal-feeding standards, and failure to implement relevant training strategies. These findings motivated us to attempt to reduce the incidence of jejunostomy-tube obstruction at our center. This project was designed to reduce the incidence of jejunostomy-tube obstruction in esophageal cancer patients from 27.6% to ≤ 3%. Clear strategies, including modification of the stitching method used at the implantation end of the central venous catheter-type jejunostomy tube, establishment of feeding standards, creation of educational guidelines and leaflets, classroom teaching, and technical examinations, were used to reduce the prevalence of obstruction incidents. The jejunostomy-tube obstruction rate was reduced from 27.6% to 6.7%. While the study objective was not achieved, the magnitude of the reduction was still significant at 75.7%. Cross-disciplinary collaboration, continuous education and training, and the promotion of standards of practice were used to significantly reduce the jejunostomy tube obstruction rate in esophageal cancer patients. This result substantially increased the nutrition and quality of care received by this patient population.

  1. Nasal gouty tophus: Report a rare case presenting as a nasal hump with nasal obstruction

    Directory of Open Access Journals (Sweden)

    John Chung-Han Wu

    2016-08-01

    Full Text Available Dorsal nasal gouty tophus are rare occurrences with limited documentation. Here we report a male patient who has a history of poorly controlled gouty arthritis. He had nasal obstruction with an enlarging mass over his left nasal ridge for the past three years. Image studies revealed a nasal bone defect underneath the nasal lesion. The firm mass was excised and confirmed to be of gouty origin. The nasal bone defect was repaired with a titanium mesh plate to prevent nasal depression. He has fully recovered with no more nasal obstruction or recurrence of nasal tophus. The case report illustrates a common illness, gout, with a rare clinical manifestation leading to a common symptom, nasal obstruction. It demonstrates the importance of a detailed history, a thorough physical examination and most important of all, an extensive differential diagnosis in our clinical practice.

  2. Effect of biliary obstruction on a gram-negative bacteremic challenge: a preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Scott-Conner, C.E.; Bernstein, J.M.; Scher, K.S.; Mack, M.E.

    1986-06-01

    Alterations in the sequestration and destruction of bacteria were studied after 10 days of biliary obstruction. Intraperitoneal injection of radiolabeled Escherichia coli was used to study bacterial localization in rats 10 days after common duct ligation and transection or sham celiotomy. Animals were sacrificed 4 hours later and uptake by liver, spleen, lung, and kidney were studied with a scintillation counter. No significant difference in localization between the two groups was noted. Bacteremia was induced in a second set of animals and quantitative bacterial organ cultures were performed. Significantly more viable organisms were identified in lung, liver, and kidney of animals that underwent common duct ligation and transection, when compared with controls that underwent sham celiotomy. This suggests that there is a defect in bacterial killing after 10 days of biliary obstruction. The inability to effectively clear and kill gram-negative bacteria in patients with biliary obstruction may account for some of the clinical complications seen in this patient population.

  3. An overview of the literature on congenital lower urinary tract obstruction and introduction to the PLUTO trial: percutaneous shunting in lower urinary tract obstruction.

    Science.gov (United States)

    Morris, R Katie; Kilby, Mark D

    2009-02-01

    Congenital lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies causing obstruction to the urethra, the most common being posterior urethral valves. Such pathology is often associated with high perinatal mortality and varying degrees of perinatal and infant morbidity. A high proportion of LUTO may be visualised during routine second trimester (and first trimester) ultrasound giving rise to the possibility of determining individual fetal prognosis and treatments such as vesico-amniotic shunting, with a view to altering pathogenesis. The aims of the percutaneous shunting in low urinary tract obstruction (PLUTO) trial are to determine the effectiveness of these treatments and accuracy of the investigations with the primary outcome measures being perinatal mortality and postnatal renal function.

  4. Obstructive choledocholithiasis requiring intervention in a three week old neonate: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lindsay E. Peters

    2016-01-01

    Full Text Available The discovery of cholelithiasis in neonates is often incidental, however obstructing common bile duct stones are rare. Herein we report the case of a 3 week old neonate who presented with obstructive choledocholithiasis. The patient was treated conservatively with antibiotics and ursodeoxycholic acid but did not improve. He was therefore taken to surgery for cholecystectomy and stone extraction. The operation was successful and his transaminases and bilirubin levels declined. Trials of conservative management can be attempted in asymptomatic infants with choledocholithiasis. However, failure of the stone to pass or ongoing signs of cholecystitis should be met with operative intervention to remove the obstruction.

  5. Radiological evaluation of intestinal obstruction in neonate and infant

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, D. S.; Lim, K. Y.; Kim, S. J.; Kim, J. D.; Rhee, H. S. [Presbyterian Medical Center, Jeonju (Korea, Republic of)

    1980-12-15

    281 cases of neonatal and infantile intestinal obstruction confirmed by clinical and surgical procedure from 1975 till 1979 were reviewed radiologically. The result was as follows; 1. Intussusception was the most common cause of intestinal obstruction under one year of age (173/281: 61.56%), and other causes of descending order were infantile hypertrophic pyloric stenosis (20: 7.11%), congenital megacolon (19: 6.76%), anorectal malformation (17: 6.05%), meconium plug syndrome (17: 6.05%), hernia (12: 4.27%), band adhesion (8: 2.85%), rotation anomaly (5: 1.78%), small bowel atresia (3: 1.07%), Meckel's diverticulum (3: 1.07%), duodenal atresia (2: 0.71%), meconium ileus (1: 0.36%) and annular pancreas (1: 0.36%). Congenital type of intestinal obstruction (we classified intussusception acquired and others congenital) occupied 38.44%. 2. The ratio of male to female was 3: 1, congenital type 4.69 : 1 and acquired 2.39 : 1. 3. Vomiting, bloody stool, fever and abdominal distention were the most 4 symptoms. 4. The frequency of typical mechanical ileus pattern on plain abdomen films was 226 cases(80.43%) paralytic ileus or normal finding was 52 cases (18.51%) and pneumoperitoneum with ileus sign was 3 cases (1.06%). 5. Barium meal or enema was performed in 228 cases and narrowing or obstructed site was found in 213 cases of them (93.42%); intussusception 100% (173/173), infantile hypertrophic pyloric stenosis 93.33% (14/15) and congenital megacolon 82.35% (14/17). 6. Only 10 cases had associated disease such as Mongolism, thoracic kyphosis and scoliosis, microcolon, prematurity, ileocolic fistula, undescended testicle and hydrocele. 7. Meconium plug syndrome, duodenal atresia, small bowel atresia, mecondium ileus and annular pancreas were developed early after birth with average onset age of 3.6 days.

  6. Palliative care in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lilly, Evan J; Senderovich, Helen

    2016-10-01

    Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer. Many disease, patient-, and provider-related factors contribute to this phenomenon, including COPD's unpredictable course, misperceptions of palliative care among patients and physicians, and lack of advance care planning discussions outside of crisis situations. A new paradigm for palliative care would introduce palliative treatments alongside, rather than at the exclusion of disease-modifying interventions. This integrated approach would circumvent the issue of difficult prognostication in COPD, as any patient would receive individualized palliative interventions from the time of diagnosis. These points will be covered in this review, which discusses the challenges in providing palliative care to COPD patients, the strategies to mitigate the challenges, management of common symptoms, and the evidence for integrated palliative care models as well as some suggestions for future development. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  7. The genetics of obstructive sleep apnoea.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-02-01

    PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.

  8. Metabolic aspects of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    M. R. Bonsignore

    2009-06-01

    Full Text Available Insulin resistance is often associated with obstructive sleep apnoea syndrome (OSAS and could contribute to cardiovascular risk in OSAS. Sleep loss and intermittent hypoxia could contribute to the pathogenesis of the metabolic alterations associated with obesity, a common feature of OSAS. The biology of the adipocyte is being increasingly studied, and it has been found that hypoxia negatively affects adipocyte function. In November 2007, the European Respiratory Society and two EU COST Actions (Cardiovascular risk in OSAS (B26 and Adipose tissue and the metabolic syndrome (BM0602, held a Research Seminar in Düsseldorf, Germany, to discuss the following: 1 the effects of hypoxia on glucose metabolism and adipocyte function; 2 the role of inflammatory activation in OSAS and obesity; 3 the alarming rates of obesity and OSAS in children; 4 the harmful effects of the metabolic syndrome in OSAS; 5 the effects of OSAS treatment on metabolic variables; and 6 the relationship between daytime sleepiness and hormonal and inflammatory responses. Insulin resistance in skeletal muscle, the role of the endocannabinoid system and novel pharmacological approaches to treat insulin resistance were also discussed. As obesity and hypoxia could be the basic links between OSAS and adipocyte dysfunction, further research is needed to translate these new data into clinical practice.

  9. 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.

  10. 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.

  11. SVC obstruction and stridor relieved by nasogastric tube insertion.

    Science.gov (United States)

    Molena, Emma J; Krishnamoorthy, Ashwin; Praveen, Coimbatore

    2016-03-01

    Achalasia is an idiopathic motility disorder of the oesophagus of increasing incidence. It is characterized by aperistalsis of the lower oesophagus and failure of relaxation of the lower oesophageal sphincter. Patients classically present with chronic symptoms of dysphagia, chest pain, weight loss and regurgitation, and they commonly suffer pulmonary complications such as recurrent microaspiration of static, retained food contents of the upper oesophagus. However, it has also been described, uncommonly, to present with megaoesophagus and secondary tracheal compression. We present a case of megaoesophagus secondary to achalasia which presented with stridor and signs of acute superior vena caval obstruction.

  12. Gastric outlet obstruction from duodenal lipoma in an adult

    Directory of Open Access Journals (Sweden)

    Promise N Wichendu

    2013-01-01

    Full Text Available The duodenum is a rare site for gastrointestinal lipoma with less than 230 cases reported in the literature. Although, peptic ulcer disease remains the most common benign cause of gastric outlet obstruction (GOO, duodenal lipomas remain a rare, but possible cause of GOO and could pose a diagnostic challenge, especially in countries where access to endoscopy and modern imaging techniques poses a challenge. The authors present a case of GOO in a 40-year-old male, secondary to a duodenal lipoma. It was successfully treated by a transduodenal resection through a midline laparotomy. The histology report confirmed it was a submucosal lipoma.

  13. Appendicitis and benign appendiceal mucocele presenting as large bowel obstruction.

    Science.gov (United States)

    Opreanu, Razvan C; Sobinsky, Justin; Basson, Marc D

    2013-03-01

    Appendiceal mucocele is most commonly encountered incidentally during appendectomy. We report a case of large bowel obstruction presenting as a closed loop with an appendiceal mucocele as the lead point, superimposed on a chronic ileal stricture that had been misdiagnosed as irritable bowel syndrome. The patient underwent ileocecal resection and primary anastomosis. She did well postoperatively, and her irritable bowel syndrome disappeared. Appendiceal mucocele can present in a variety of ways, and surgeons should be alert for atypical presentations. Moreover, some patients with intermittent abdominal pain deserve anatomic investigation before being dismissed as having irritable bowel.

  14. Neurocognitive impairment in obstructive sleep apnea.

    Science.gov (United States)

    Lal, Chitra; Strange, Charlie; Bachman, David

    2012-06-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder with far-reaching health implications. One of the major consequences of OSAS is an impact on neurocognitive functioning. Several studies have shown that OSAS has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory. Neurocognitive impairment can be measured objectively with tests such as the Wechsler Adult Intelligence Scale-Revised, the Psychomotor Vigilance Task, the Steer Clear Performance Test, and tests of repetitive finger tapping. In children, OSAS may cause attention-deficit hyperactivity disorder in addition to behavioral problems and learning disabilities. Risk factors for cognitive impairment include increasing age, male sex, apolipoprotein E ε4 allele positivity, current cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, Down syndrome, hypothyroidism, significant alcohol consumption, stroke, and the use of psychoactive medications. At a cellular level, OSAS likely causes cognitive impairment through intermittent hypoxia, hormonal imbalance, and/or systemic inflammation, either independently or via the resultant endothelial dysfunction that occurs. Excessive daytime sleepiness should be measured and minimized in all studies of neurocognitive impairment. Recent studies have used functional and structural neuroimaging to delineate the brain areas affected in patients with OSAS with neurocognitive dysfunction. A common finding in several of these studies is decreased hippocampal volume. Other affected brain areas include the frontal and parietal lobes of the brain, which show focal reductions in gray matter. These changes can be reversed at least partially with the use of CPAP, which highlights the importance of early recognition and treatment of OSAS. The currently available data in this field are quite limited, and more research is needed.

  15. Theoretical Analysis and Simulation of BJFET Obstructive Characteristics

    Institute of Scientific and Technical Information of China (English)

    ZENG Yun; YAN Min; YAN Yong-hong; FAN Wei

    2005-01-01

    A new bipolar junction field-effect transistor (BJFET) was described. The theoretical analysis and computer simulation of BJFET obstructive characteristic are achieved. The gate bias voltage affects the BJFET obstructive voltage greatly. The BJFET obstructive characteristic is relevant to structure parameters of channel width W and channel length L.The decrease-bias-voltage operation can weaken the device obstructive characteristic. The forward turn in device forward obstructive region can also affect the BJFET obstructive characteristic. BJFET has a good high temperature obstructive characteristic and can be applying to high temperature status as high voltage switch devices.

  16. Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum.

    Science.gov (United States)

    Assenza, M; Ricci, G; Bartolucci, P; Modini, C

    2005-01-01

    Acute apendicitis rarely presents with a clinical picture of mechanical small-bowel obstruction. The Authors report a case of this inusual clinical occurrence, arised like a complication of a common disease, characterized by a chronically inflamed appendix (mucocele) wrapping around the last loop of ileum that produced volvolus and strangulation. The few similar cases reported in the literature are moreover reviewed.

  17. Canadian Practice Assessment in Chronic Obstructive Pulmonary Disease: Respiratory Specialist Physician Perception Versus Patient Reality

    Directory of Open Access Journals (Sweden)

    Paul Hernandez

    2013-01-01

    Full Text Available INTRODUCTION: Chronic obstructive pulmonary disease (COPD is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients’ perceptions of their disease.

  18. Integrative Medicine for Respiratory Conditions: Asthma and Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Yeh, Gloria Y; Horwitz, Randy

    2017-09-01

    Asthma and chronic obstructive pulmonary disease are 2 common chronic respiratory disorders in primary care that cause considerable morbidity and mortality. This article reviews disease pathophysiology and outlines an integrative, multidimensional approach to the evaluation and management of these conditions, including pharmacotreatment, nutrition, supplements, self-care strategies, mind-body therapies, and other integrative modalities. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Toll-Like Receptor (TLR2 and TLR4) Polymorphisms and Chronic Obstructive Pulmonary Disease

    NARCIS (Netherlands)

    Budulac, S.E.; Boezen, H.M.; Hiemstra, Pieter S.; Lapperre, Therese S.; Vonk, Judith M.; Timens, W.; Postma, D.S.

    2012-01-01

    Toll-like receptors (TLRs) participate in the defence against bacterial infections that are common in patients with Chronic Obstructive Pulmonary Disease (COPD). We studied all tagging SNPs in TLR2 and TLR4 and their associations with the level and change over time of both FEV1 and sputum inflammato

  20. 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.

  1. 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.

  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. [Obstructive anuria secondary to uterine prolapse].

    Science.gov (United States)

    Rodríguez Alonso, A; González Blanco, A; Cachay Ayala, M E; Bonelli Martín, C i; Porta Vila, A; Lorenzo Franco, J; Cuerpo Pérez, M A; Nieto García, J

    2002-10-01

    The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.

  4. Childhood intestinal obstruction in Northwestern Nigeria

    African Journals Online (AJOL)

    sentation of childhood intestinal obstruction in this study agrees with those .... nal distension in 7(43.8%), and fever in another 7(43.8%). .... boys defaulted from definitive treatment after the initial ... rent abdominal pain and constipation.

  5. Obstructive sleep apnea: Awakening the hidden truth

    African Journals Online (AJOL)

    2014-01-16

    Jan 16, 2014 ... to OSA include reduced upper-airway dilator muscle activity during sleep, ..... three‑dimensionally analyzed with an advanced analysis technique ... Padma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep.

  6. Obstructive Respiratory Disease Complicating Pneumonia in ...

    African Journals Online (AJOL)

    AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... clinical pattern of presentation may be relevant in the management of similar cases in the future. ... may become complicated with obstructive airway disease in children.

  7. Diagnostic strategies for chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Broekhuizen, B.D.L.

    2010-01-01

    Adequate detection of chronic obstructive pulmonary disease (COPD) in patients who present with persistent cough in general practice is highly warranted, because targeted interventions for COPD (notably smoking cessation programmes) improve the quality of life. Nevertheless, much is unknown about

  8. Effect of bilastine upon nasal obstruction.

    Science.gov (United States)

    Dávila, I; Sastre, J; Mullol, J; Montoro, J; Jáuregui, I; Ferrer, M; del Cuvillo, A; Bartra, J; Valero, A

    2011-01-01

    H1 antihistamines constitute one of the main references for the treatment of allergic rhinitis. Classically, these drugs have been considered effective in controlling sneezing, rhinorrhea and itching, though they have not been regarded as particularly effective in application to nasal obstruction. The most recent studies, involving second-generation H1 antihistamines (desloratadine, fexofenadine, levocetirizine, rupatadine), have shown these drugs to offer effects upon nasal obstruction significantly superior to those of placebo. The present review examines the effect of bilastine, a new, potent and highly specific H1 antihistamine without sedative effects or cardiac toxicity, upon nasal obstruction. The analysis of the data from the different clinical trials indicates that in patients with allergic rhinitis, the effect of bilastine upon nasal obstruction is superior to that of placebo and similar to that of other second-generation H1 antihistamines, manifesting within 24 hours after the start of treatment.

  9. CSF Obstruction and Malabsorption in Congenital Hydrocephalus

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-11-01

    Full Text Available The relative contribution of CSF malabsorption and obstruction in three different etiological groups of neonatal high-pressure hydrocephalus (HC was assessed in a study at University of Bonn, Germany, and University of Groningen, The Netherlands.

  10. Valiente Kroon's obstructions to smoothness at infinity

    Science.gov (United States)

    Grant, James; Tod, Paul

    2015-03-01

    We conjecture an interpretation in terms of multipole moments of the obstructions to smoothness at infinity found for time-symmetric, conformally-flat initial data by Kroon (Commun Math Phys 244(1):133-156, 2004).

  11. 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.

  12. 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...

  13. Spiral CT venography in central venous obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jin Wook; Park, Jae Hyung; Im, Jung Gi; Han, Moon Hee; Kim, In One; Chang, Kee Hyun; Yeon, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Song, Chi Sung [Boramae Hospital, Seoul (Korea, Republic of)

    1998-11-01

    To determine the clinical usefulness of spiral computed tomographic (CT) venography for the evaluation of central venous obstruction. The authors prospectively performed a total of 29 spiral CT venography procedures in 25 consecutive patients with suspected central venous obstrucion. Diluted contrast media were directly injected into the peripheral veins of the hand or the foot. Scan parameters were 3mm X-ray beam collimation, table speed of 4-6cm/sec, scan time of 32-40sec, and injection delay of 20 sec. Axial images were reconstructed at 2-mm intervals, and using shaded surface display(SSD), maximum intensity projection(MIP), and multiplanar reformation(MPR), 3-D reconstruction was performed. In all cases, ascending venograp-hy(n=3D13) and/or direct catheter venography (n=3D21) was performed within 2 days of CT venography. With regard to site, extent, extent, severity, and cause of obstruction and collateral circulation, we compared the results of CT and contrast venography. In 24 patients, a total of 56 sites of central venous obstruction or stenosis (>50%) were demonstrated. The causes of obstruction were venous thrombosis(n=3D6), malignant tumors(n=3D4), arteriovenous fistula for hemodialysis(n=3D5), extrinsic compression(n=3D2), coincidence of extrinsic compression and arteriovenous fistula(n=3D1), pacemaker(n=3D1), mediastinal inflammatory pseudotumor(n=3D1), spinal tuberculosis(n=3D1), membranous obstruction of the hepatic inferior vena cava(n=3D1), Behcet's disease(n=3D1), or unknown cause(n=3D1). When compared with ascending venography(n=3D13), CT venography was superior for evaluation of the extent and cause of obstruction and collateral circulation in two, four and one case(s), respectively. For the evaluation of site and severity of obstruction, CT venography was equal to ascending venography. In two cases, direct catheter venography (n=3D21) was superior to CT venography for evaluating the obstruction site, but in three, five and one case

  14. 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.

  15. Computed tomography and obstructive biliary disease.

    Science.gov (United States)

    Havrilla, T R; Haaga, J R; Alfidi, R J; Reich, N E

    1977-05-01

    Forty-four patients with confirmed biliary diseases were studied to determine the value of computed tomography (CT) in the diagnosis of biliary pathology. The results indicate that CT is useful and highly accurate in differentiating between obstructive (surgical) and nonobstructive (medical) disease entities. Of the cases with proved obstruction, 88% were correctly identified. All of the nonobstructive cases had positive CT correlation. In addition, the underlying cause of the occlusion was determined in the majority of cases.

  16. 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...

  17. Obstruction Theory and Coincidences in Positive Codimension

    Institute of Scientific and Technical Information of China (English)

    Daciberg GON(C)ALVES; Jerzy JEZIERSKI; Peter WONG

    2006-01-01

    Let f, g: X → Y be two maps between closed manifolds with dim X ≥ dim Y = n ≥ 3.We study the primary obstruction on(f,g) to deforming f and g to be coincidence free on the n-th skeleton of X. We give examples for which obstructions to deforming f and g to be coincidence free are detected by on (f, g).

  18. ENDOSCOPIC STENT FOR PALLIATING MALIGNANT AND BENIGN BILIARY OBSTRUCTION

    Institute of Scientific and Technical Information of China (English)

    缪林; 范志宁; 季国忠; 文卫; 蒋国斌; 吴萍; 刘政; 黄光明

    2004-01-01

    Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included paplilla of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4), choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1). The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%, 58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively. Early complication included post-ERCP pancreatitis and cholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient's living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.

  19. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

    Science.gov (United States)

    Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

    2016-10-01

    Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. MALIGNANT OBSTRUCTIVE JAUNDICE: A STUDY OF INVESTIGATIVE PARAMETERS AND ITS OUTCOME

    Directory of Open Access Journals (Sweden)

    Tilakdas S. Shetty

    2016-08-01

    Full Text Available BACKGROUND Obstructive jaundice is a surgical condition that occurs when there is an obstruction to the passage of conjugated bilirubin from the liver cells to the intestine. This study has studied five clinical and nine laboratory parameters in patients presenting with malignant obstructive jaundice along with their radiological findings. By studying these parameters, the prognosis of patients with malignant obstructive jaundice and the best possible intervention could be predicted. AIM To study the various aetiopathological aspects associated with obstructive jaundice and investigative parameters of these patients thereby evaluating the prognosis. MATERIALS AND METHODS This observational study has been conducted in a tertiary institute by collecting data of 50 cases of malignant obstructive jaundice admitted to the surgical wards of BYL Nair Hospital from August 2011 to August 2014 with followup of 3 months to obtain mortality data. Male and female patients above 18 years and below 80 years of age with histologically proven malignant obstructive jaundice were included as part of this study. Data of retrospective cases were obtained from Medical Record section without disclosing the address or identification of the patient. RESULTS In this study, a total of 50 cases of histologically proven malignant obstructive jaundice were evaluated. 50 patients were studied out of which 33 were male and 17 were female. Majority of the patients were in the age group of 61-70 years i.e. 21 of them. 11 patients were between 41-50 years of age, 10 were less than 40 years of age and 8 were between 51-60 years. The most common presentation of the patients was with yellowish discolouration of sclera and urine (YDS/YDU seen in 44 patients followed by pruritus seen in 38 patients. Dilated Common Bile Duct with/without pancreatic duct dilatation was the most common finding on sonography followed by a mass seen in the head of the pancreas. Moderately differentiated

  1. Life-Threatening Obstructive Sleep Apnea Caused by Adenoid Hypertrophy in an Infant with Noonan Syndrome

    Directory of Open Access Journals (Sweden)

    Sonia Khirani

    2012-01-01

    Full Text Available Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy.

  2. Undiagnosed Obstructive Lung Disease in the United States. Associated Factors and Long-term Mortality.

    Science.gov (United States)

    Martinez, Carlos H; Mannino, David M; Jaimes, Fabian A; Curtis, Jeffrey L; Han, MeiLan K; Hansel, Nadia N; Diaz, Alejandro A

    2015-12-01

    Understanding factors associated with undiagnosed obstructive lung disease and its impact on mortality could inform the ongoing discussions about benefits and risks of screening and case finding. To define factors associated with undiagnosed obstructive lung disease and its long-term mortality. Cross-sectional analysis of participants, aged 20 to 79 years, in two National Health and Nutritional Examination Surveys (NHANES), NHANES III (1988-1994) and NHANES 2007-2012, with longitudinal follow-up of NHANES III participants. We classified participants with spirometry-confirmed obstructive disease, based on the fixed ratio definition (FEV1/FVC chronic obstructive pulmonary disease), and "undiagnosed" (no recorded physician diagnosis). For the longitudinal analysis of NHANES III participants, mortality was the outcome of interest. We tested the contribution of self-reported health status and comorbidity burden (exposure) to the odds of being undiagnosed using logistic models adjusted for demographics, smoking status, and lung function. We estimated hazard ratios (HRs) for all-cause mortality for diagnosed and undiagnosed subjects participating in NHANES III who had spirometry using Cox- proportional regression analysis. Among those with spirometry-defined obstruction, 71.2% (SE, 1.8) in NHANES III and 72.0% (SE, 1.9) in NHANES 2007-2012 were undiagnosed. In multivariate models, undiagnosed obstructive disease was consistently associated in both surveys with self-reported good/excellent health status, lower comorbidity burden, higher lung function, and being of racial/ethnic minority. Among NHANES III participants (median follow up, 14.5 yr), both undiagnosed (HR, 1.23; 95% confidence interval, 1.08-1.40) and correctly diagnosed participants (HR, 1.74; 95% confidence interval, 1.45-2.09) had higher risk for all-cause mortality than participants without obstruction. Undiagnosed obstructive lung disease is common among American adults and remained unchanged over 2 decades

  3. Nutrition therapy for chronic obstructive pulmonary disease and related nutritional complications.

    Science.gov (United States)

    Fernandes, Amanda Carla; Bezerra, Olívia Maria de Paula Alves

    2006-01-01

    Chronic obstructive pulmonary disease is characterized by progressive and partially reversible airway obstruction. The innumerable complications that occur during the progression of the disease can affect the nutritional state of patients suffering from this illness. The objective of this study was to present a brief review of the literature regarding the nutrition therapy used in the treatment of chronic obstructive pulmonary disease. To that end, we performed a bibliographic search for related articles published within the last 18 years and indexed for the Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS, Latin American and Caribbean Health Sciences Literature) and Medline databases. Malnutrition is associated with a poor prognosis for patients with chronic obstructive pulmonary disease, since it predisposes such patients to infections, as well as reducing respiratory muscle force, exercise tolerance and quality of life. Despite the fact that such malnutrition is extremely common in chronic obstructive pulmonary disease patients, it should be recognized as an independent risk factor, since it can be modified through appropriate and efficacious diet therapy and monitoring. For patients with chronic obstructive pulmonary disease, nutrition therapy is initiated after the evaluation of the nutritional state of the patient, which identifies nutritional risk, thereby allowing the proper level of treatment to be established. In this evaluation, anthropometric and biochemical markers, as well as indicators of dietary consumption and body composition, should be used. The prescribed diet should contain appropriate proportions of macronutrients, micronutrients and immunonutrients in order to regain or maintain the proper nutritional state and to avoid complications. The physical characteristics of the diet should be tailored to the individual needs and tolerances of each patient. In the treatment of patients with chronic obstructive pulmonary disease

  4. Objective measurements differ for perception of left and right nasal obstruction.

    Science.gov (United States)

    Ng, Teik-Ying; Chen, Yung-Fu; Tsai, Ming-Hsui; Huang, Kuang-Hua; Tai, Chih-Jaan

    2013-02-01

    Nasal obstruction is one of the most common sensation complaints of nasal disease in clinical practice. It is a subjective sensation of nasal airflow. Objective assessment of nasal patency and nasal physiology includes the use of rhinomanometry and acoustic rhinometry. The perception of nasal obstruction changes as the alternating of nasal airway resistance and nasal airflow. However, there were limited studies reported whether the perceptions of the left and right nostrils are similar. We examined the relationship between subjective and objective parameters of the nasal airway in the left and right nostrils. A prospective study of 101 patients with a deviated nasal septum and chronic hypertrophic rhinitis was conducted for subjective and objective nasal airway evaluation. Patients were then divided into three groups based on the visual analog scale. Associations between measures were evaluated with analysis of variance, f tests and simple regression. Among three patient groups with different subjective sensations of nasal obstruction, there were significant differences among three patient groups according to the objective measurements of airflow resistance on the right side (p=0.0002 for inspiration right mean resistance; p=0.0049 for expiration right mean resistance), and for the minimal cross-sectional area (p=0.030) and nasal cavity volume (p=0.028 for 0-3.3cm left nostril; p=0.047 for 2-4cm left nostril) on the left side. This indicates that nasal flow resistance is an important determinant for right side nasal obstruction. Nasal minimal cross-sectional area and nasal cavity volume are an important determinant for left side nasal obstruction. Our study indicates the important role of rhinomanometry in objective measurement of right side nasal obstruction and acoustic rhinometry in objective measurement of left side nasal obstruction. Thus, human perception of right and left nostrils may be different and requires further study. Copyright © 2012 Elsevier

  5. PROSPECTIVE EVALUATION OF AETIOPATHOGENESIS AND MANAGEMENT OF SMALL BOWEL OBSTRUCTION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Ramani Ranjan

    2016-05-01

    Full Text Available INTRODUCTION Small bowel obstruction is a common surgical emergency. The small bowel is involved in about 80 percent of cases of mechanical intestinal obstruction. Mode of presentation is same in all but underlying cause varies in each age group. The dictum of never let the sun set or rise in small bowel obstruction has made early surgical intervention for small intestinal obstruction. This in turn has reduced the incidence of strangulation of bowel, which was major cause of mortality in already ill patient. Success in treatment of patient with acute intestinal obstruction depends largely upon early diagnosis, skilful management and appreciation of importance of treating the pathological effects of obstruction just as much as the cause itself. METHODS This is a prospective study which was done on patient with small bowel obstruction between September 2013 to August 2015 in M.K.C.G. Medical College and Hospital, Brahmapur, Odisha. All the patients were subjected to questionnaires and clinical examination, routine and special investigations like abdominal X-ray in erect posture, treatment modality based on laparotomy findings and postoperative observation for any complications. RESULT In this study, it is observed that bands and adhesions followed by hernia were the commonest causes of small bowel obstruction in adults. Pain abdomen, vomiting, distention, constipation, tenderness over abdomen and increased bowel sounds are seen in majority of cases. Maximum incidence occurred in 3 rd decade of life with M:F ratio of 1.73:1. Plain X-ray erect abdomen was almost conclusive in all cases. Resection and anastomosis followed by adhesiolysis were the two procedures which were commonly performed. Morbidity increased in old age patients and those whose presentation was late. CONCLUSION Small bowel obstruction remains a frequently encountered problem in abdominal surgery. The risk of strangulation with adhesive and neoplastic SBO is relatively low as

  6. Intestinal obstruction in children due to Ascariasis: A tertiary health centre experience

    Directory of Open Access Journals (Sweden)

    Mishra P

    2008-01-01

    Full Text Available Background: Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management. Materials and Methods: This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year. Results: One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47% responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53% had abdominal guarding or rigidity and underwent emergency exploration. Conclusion: Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this

  7. Rethinking chronic obstructive pulmonary disease.

    Science.gov (United States)

    Tonello, Antonella; Poli, Giovanni

    2011-03-01

    Chronic obstructive pulmonary disease (COPD) is a complex polygenic disease characterized by an abnormal inflammatory response to smoke, and results in a progressive and debilitating condition with declining lung function. The reasons why some smokers get COPD are not known. We suggest that corticosteroid resistance, which derives from oxidative stress, might actually be the cause of COPD and represent the starting point of the pathology. The absence of response to corticosteroids would let the disease develop, impairing the organism capacity to suppress any kind of inflammatory process. Corticosteroid resistance may derive from smoke induced oxidative stress and plausibly impairs the organism capacity to suppress inflammation. Many factors may contribute to the development and persistence of corticosteroid resistance: inefficient antioxidant defences, a corticosteroid response less efficient or more sensitive to oxidative conditions, and also any other concomitant factor, environmental, genetic or intercurrent, which would contribute to amplify inflammation and hence oxidative stress. One or more of these factors might represent the variable component of the disease, which gives origin to COPD heterogeneity. This hypotheses may also explain why the disease persists after quitting smoking, as an inflammatory process severe enough to generate a strong oxidative stress may support itself by maintenance of corticosteroid resistance. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. 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.

  9. Tube cystostomy for management of obstructive urolithiasis in ruminants

    Directory of Open Access Journals (Sweden)

    P. Tamilmahan

    2014-04-01

    Full Text Available Aim: The aim of this study was to evaluate the simple tube cystostomy procedure for management of urethral obstruction cases in ruminants. Materials and Methods: Tube cystostomy was used to treat a total of 58 ruminants, which included 35 buffalo calves and 23 goats. Diagnosis of the disease was made with the history of anuria, clinical signs, and physical examinations. Physical parameters like heart rate, respiratory rate, rectal temperature dehydration status of animals by skin tenting test, and intraoperative findings were compared. Results: Young ruminants were most commonly affected and the mean age was 4-5 months in both species. Only male were considered for the study in which buffalo calves were not castrated but in goat's 73.91% animal were castrated and 34.7% not castrated. Rupture of bladder was more common in buffalo calves as compared to goats. The confirmed cases of obstructive urolithiasis were selected for tube cystostomy with Foley's catheter. Postoperatively all cases were administered with broad spectrum antibiotic, anti-inflammatory agent, and caliculolytic agents like ammonium chloride. Postoperative complications recorded only in 10 animals and remaining 48 animals had an uneventful recovery. Conclusion: Tube cystostomy is a simple and effective procedure particularly in intact urinary bladder, which can be adopted at field level.

  10. Endoscopic pyloroplasty for severe gastric outlet obstruction due to alkali ingestion in a child

    OpenAIRE

    Dehghani, Seyed Mohsen; Aldaghi, Mitra; Javaherizadeh, Hazhir

    2016-01-01

    A common belief is that alkali ingestion causes severe esophageal damage and limited gastric injury due to the buffering action of acid. Gastric injury has been observed in patients who ingested alkali. Gastric outlet obstruction (GOO) secondary to caustic ingestion occurs due to fibrosis after resolution of the acute injury and inflammation, most commonly 6 to 12 weeks after initial ingestion. The traditional treatment for GOO related to ingestion of corrosive agents is surgery. Experience w...

  11. Giant Fecaloma Causing Small Bowel Obstruction: Case Report and Review of the Literature

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    Mosin Mushtaq

    2015-04-01

    Full Text Available Fecaloma is a mass of hardened feces being impacted mostly in rectum and sigmoid. The most common sites of the fecaloma is the sigmoid colon and the rectum. There are several causes of fecaloma and have been described in association with Hirschsprung’s disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic, and in patients suffering with chronic constipation. Up to now several cases of giant fecaloma has been reported in the literature most of them presenting with megacolon or urinary retention. We herein report a case of giant fecaloma leading to bowel obstruction who was successfully treated by surgery. A 30-yrar-old man presented with sign and symptoms of acute bowel obstruction. He underwent exploratory laparotomy and enterotomy. He was found to have a giant fecaloma causing bowel obstruction in the jejunum. He was discharged after the operation with good condition. Jejunal fecaloma is extremely rare condition.

  12. Is the sinusoidal obstructive syndrome post-liver transplantation a pathologic entity with a multifactorial etiology?

    Directory of Open Access Journals (Sweden)

    Luis Miguel Marín-Gómez

    2015-04-01

    Full Text Available The sinusoidal obstructive syndrome is a complication typically associated with hematopoietic stem cell transplantation. This syndrome, more commonly known as veno-occlusive disease, has also been described after liver transplantation. It can have a life-threatening course. Herein, we describe the hepatic graft loss secondary to the development of a sinusoidal obstructive syndrome after a severe acute cellular rejection and toxic levels of once daily modified released tacrolimus (TAC. We discuss the role of the endotheliitis of acute rejection and toxic metabolites of some immunosuppressants such as azathioprine and TAC. Based on the current scientific evidence, we contemplate the possibility that the etiology of sinusoidal obstruction syndrome post-liver transplantation is multifactorial.

  13. A case of obstructive colitis caused by rectal stenosis and adhesion due to irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Tochika, Naoshige; Sugimoto, Takeki; Takano, Atsushi; Kobayashi, Michiya; Matsuura, Kimio; Araki, Keijiro [Kochi Medical School, Nankoku (Japan)

    2000-03-01

    We report a case of obstructive colitis associated with rectal stenosis and adhesion due to irradiation. A 68-year-old woman who had been suffering from constipation after an episode of irradiation for cervical cancer of the uterus two years previously was admitted to our hospital complaining of the lower abdominal pain. After two days, an operation was performed under a diagnosis or panperitonitis. Stenosis and adhesion of the rectum and necrosis at the oral side of the adhesion was recognized. Histologically, necrosis of the rectum from mucosa to serosa was recognized, and no neoplastic change was seen at the stenotic portion. The most common cause of local stenosis of the colon leading to obstructive colitis is colon cancer. Obstructive colitis caused by a benign stenosis as reported here is rare. (author)

  14. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood

    Institute of Scientific and Technical Information of China (English)

    Xiang-Feng Chen; Hong-Xiang Wang; Yi-Dong Liu; Kai Sun; Li-Xin Zhou; Yi-Ran Huang; Zheng Li; Ping Ping

    2014-01-01

    Childhood inguinal herniorrhaphy is one common cause of seminal tract obstruction. Vasovasostomy(VV) can reconstruct seminal deferens and result in appearance of sperm and natural pregnancy in some patients. Secondary epididymal obstruction caused by a relatively long‑term vasal obstruction is a common cause of lower patency compared with VV due to vasectomy in adults. From July 2007 to June 2012, a total of 62patients, with history of childhood inguinal herniorrhaphy and diagnosed as obstructive azoospermia were treated in our center. The overall patency rate and natural pregnancy rate were 56.5%(35/62) and 25.8%(16/62), respectively. 48.4%(30/62) of the patients underwent bilateral VV in the inguinal region, with a patency rate of 76.7%(23/30) and a natural pregnancy rate of 36.7%(11/30), respectively. 30.6%(19/62) of the patients underwent bilateral VV and unilateral or bilateral vasoepididymostomies due to ipsilateral epididymal obstruction with the patency and natural pregnancy rate decreasing to 63.2%(12/19) and 26.3%(5/19). 21.0%(13/62) of the patients merely underwent vasal exploration without reconstruction due to failure to ifnd distal vasal stump,etc. Our study indicate that microsurgical reanastomosis is an effective treatment for some patients with seminal tract obstruction caused by childhood inguinal herniorrhaphy.

  15. Obstructive sleep apnea in severe mental disorders.

    Directory of Open Access Journals (Sweden)

    Katarzyna Szaulińska

    2015-10-01

    Full Text Available The prevalence of obstructive sleep apnoea (OSA is estimated to be 3–7.5% in men and 2–3% in women. In mentally ill population it is even higher, as these patients are a high risk OSA group. The aim of the paper was a review of literature about the prevalence of sleep apnoea in patients with schizophrenia, bipolar disorder and recurrent depressive disorder.The available data show that OSA is present in 15–48% of patients with schizophrenia, 21–43% of patients with bipolar disorder and 11–18% of patients with recurrent depressive disorder. The lack of diagnosis of OSA in people with mental illnesses has multiple negative consequences. The symptoms of sleep apnoea might imitate the symptoms of mental illnesses such as negative symptoms of schizophrenia and symptoms of depression, they might as well aggravate the cognitive impairment. A number of the drugs used in mental disorders may aggravate the symptoms of OSA. OSA is as well the risk factor for cardiovascular and metabolic diseases which are a serious clinical problem in mentally ill people and contribute to shortening of their expected lifespan. From the point of view of the physicians treating OSA it is important to pay attention to the fact that co-existing depression is the most common reason for resistant daytime sleepiness in OSA patients treated effectively with Continuous Positive Airway Pressure (CPAP. CPAP therapy leads to significant improvement of mood. However, in schizophrenia and bipolar patients it may rarely lead to acute worsening of mental state, exacerbation of psychotic symptoms or phase shift from depression to mania.

  16. 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

  17. [Chronic idiopathic intestinal pseudo-obstruction: visceral myopathy. Report of 4 cases].

    Science.gov (United States)

    de Pini, A F; de Dávila, M T; Marín, A; Guastavino, E; Ruiz, J A; De Rosa, S

    1993-01-01

    Chronic intestinal pseudo-obstruction is the term applied to a heterogeneous group of functional motility disorders sharing a common clinical expression: signs and symptoms of bowel obstruction in absence of mechanical occlusion. It is caused by ineffective intestinal propulsion. The chronic form of intestinal pseudo-obstruction may be primary or secondary. Primary pseudo-obstruction or chronic idiopathic pseudo-obstruction (CIIP) defines a group of propulsive disorders having no recognized underlying diseases. This study presents four female patients, aged between 4 months to 7 years, and makes a review of the literature. The symptoms, very similar in three of them, were bilious vomiting, abdominal distention and constipation, alternating with diarrhea and malnutrition. The fourth patient, different from the others in the age of onset and evolution, only had severe constipation and abdominal bloating. The diagnostic was made by full thickness biopsies during laparotomy, getting specimens by mapping, at different heights of intestine and stomach. Samples were studied by optic and electronic microscopy and visceral myopathies were found. None of them had urinary disorders. Medical treatment consisted of total parental nutrition and/or enteral nutrition. Cisapride was not effective in the two patients who received it.

  18. The effect of upper airway obstructive surgery onrespiratory symtoms and Spo2

    Directory of Open Access Journals (Sweden)

    M. Kasiri

    2008-01-01

    Full Text Available Background and Purpose: The obstruction of the upper respiratotri for tract (URT is one of the most important reasons patients recurrent referral to the ENT clinic. Adentonsilar hypertrophy is almost common reason of the upper respiratory tract obstruction, and it will cause some changes in lung volumes and also in blood gases. The purpose of this study was to determine the effects of tonsillectomy on respiratory symptoms and arterial blood oxygen saturation.Materials and Methods: In a clinical trials study, in a pre and post operative manner, 62, 2-14 years old children were imposed to adentonsilectomy in an easy sampling way. The respiratory symttoms such as: snoring, dyspnea, feeling airway obstruction, mouth breathing and oxygen saturated hemogolobin condition (Spo2, prior to surgery and one month after operation, has been studied and recorded. The results were Compared with paired t-test.Results: In a preoperative manner, 80% of patients had mouth breathing symptom and mouth dryness which were reduad? to 10% after surgery.Spo2 measurement had no significont difference before and after surgery, and, it was in a normal range.Conclusion: The correction of respiratory obstruction due to adenotansil ar hypertrophy does not make any changes in arterial blood oxygen. The surgery which is used for correction of these obstruction, whill just improve the clinical respiratory symtoms such as snoring and mouth breathing. J Mazand Univ Med Sci 2008;18(65:82-86 (Persian

  19. Association between airway obstruction and peripheral arterial stiffness in elderly patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    付志方

    2014-01-01

    Objective To evaluate the relationship between se-verity of airway obstruction and peripheral arterial stiffness in patients with chronic obstructive pulmonary disease(COPD).Methods 81 COPD patients[aged(78.32±6.98)yrs,73 males,8 females]from Jan2008 to Oct 2012 were enrolled in Geriatric Department

  20. Oclusión canalicular con tapones de silicona de Herrick en el tratamiento del ojo seco Canicular occlusion with Herrick silicone plugs in the treatment of dry eye

    Directory of Open Access Journals (Sweden)

    Jaime Alemañy González

    2002-06-01

    Full Text Available Para evaluar la desaparición de síntomas y signos en el síndrome de ojo seco por deficiencia del componente acuoso de la película lagrimal, se estudiaron 15 pacientes que llevaban tratamiento con lágrimas artificiales, a pesar de lo cual presentaban síntomas por sequedad ocular. Se realizó oclusión canalicular de prueba con tapones de colágeno y luego definitiva con los de silicona de Herrick en el canalículo inferior. Se evaluaron por consulta hasta un año después del proceder. Se encontró que el 52 % de los casos tuvieron desaparición de los síntomas, el 40 % necesitaron añadir colirio de lágrimas artificiales ocasionalmente y el 8 % de los casos necesitaron oclusión del canalículo superior. Este tratamiento es un método sencillo y efectivo, que proporciona alivio a largo plazo a los pacientes con síndrome de ojo seco, mejorando su calidad de vida.To evaluate the disappearance of symptoms and signs in the dry eye syndrome due to deficiency of the aqueous component of the lacrimal film, 15 patients that were under treatment with artificial tears, although they still had symptoms resulting from ocular dryness, were studied. Canicular occlusion with collagen plugs was performed first as a test and then definitive occlusion with Herrick silicone plugs in the inferior canaliculus. These patients were evaluated at the physician’s office a year after the procedure. It was found that the symptoms dissappeared in 52 % of the cases, that 40 % needed to add occasionally collyrium of artificial tears and that 8 % of them required occlusion of the superior canaliculus. This treatment is a simple and effective method that provides long-term release to patients with dry eye syndrome and improves their quality of life.

  1. [Acute small bowel obstruction: conservative or surgical treatment?].

    Science.gov (United States)

    Schwenter, F; Dominguez, S; Meier, R; Oulhaci-de Saussure, W; Platon, A; Gervaz, P; Morel, P

    2011-06-22

    Small bowel obstruction (SBO) is a common clinical syndrome caused mainly by postoperative adhesions. In complement to clinical and biological evaluations, CT scan has emerged as a valuable imaging modality and may provide reliable information. The early recognition of signs suggesting bowel ischemia is essential for urgent operation. However appropriate management of SBO remains a common clinical challenge. Although a conservative approach can be successful in a substantial percentage of selected patients, regular and close re-assessement is mandatory. Any persistance or progression of the critical symptoms and signs should indeed lead to surgical exploration. Here we review the principles of adhesive SBO management and suggest a decision procedure for conservative versus surgical treatment.

  2. Obstructive sleep apnoea and obesity

    African Journals Online (AJOL)

    in obese individuals.3 OSA is more common in men and the elderly, ... The complications of OSA and obesity result in reduced quality of life, significant morbidity, and .... changes and depression, loss of libido, and poor concentration at work.

  3. Acute pancreatitis: Etiology and common pathogenesis

    Institute of Scientific and Technical Information of China (English)

    Guo-Jun Wang; Chun-Fang Gao; Dong Wei; Cun Wang; Si-Qin Ding

    2009-01-01

    Acute pancreatitis is an inflammatory disease of the pancreas. The etiology and pathogenesis of acute pancreatitis have been intensively investigated for centuries worldwide. Many causes of acute pancreatitis have been discovered, but the pathogenetic theories are controversial. The most common cause of acute pancreatitis is gallstone impacting the distal common bile-pancreatic duct. The majority of investigators accept that the main factors for acute billiary pancreatitis are pancreatic hyperstimulation and bile-pancreatic duct obstruction which increase pancreatic duct pressure and active trypsin reflux. Acute pancreatitis occurs when intracellular protective mechanisms to prevent trypsinogen activation or reduce trypsin activity are overwhelmed. However, little is known about the other acute pancreatitis. We hypothesize that acute biliary pancreatitis and other causes of acute pancreatitis possess a common pathogenesis. Pancreatic hyperstimulation and pancreatic duct obstruction increase pancreatic duct pressure, active trypsin reflux, and subsequent unregulated activation of trypsin within pancreatic acinar cells. Enzyme activation within the pancreas leads to auto-digestion of the gland and local inflammation. Once the hypothesis is confirmed, traditional therapeutic strategies against acute pancreatitis may be improved. Decompression of pancreatic duct pressure should be advocated in the treatment of acute pancreatitits which may greatly improve its outcome.

  4. Review of 23 cases of postintubation tracheal obstructions in birds.

    Science.gov (United States)

    Sykes, John M; Neiffer, Donald; Terrell, Scott; Powell, David M; Newton, Alisa

    2013-09-01

    Although recognized as a potential complication after endotracheal intubation in birds, the complication rate of postintubation tracheal obstruction in this taxon is unknown. Twenty-three cases of postintubation obstruction in birds from two institutions are reported. Clinical signs were noted an average of 16.6 days postintubation and consisted primarily of indications of acute respiratory distress. Diagnosis was confirmed via tracheoscopy or radiology. Five birds died before treatment could be initiated. Medical treatment alone was successful in three birds that had mild changes consisting primarily of a luminal mucoid plug that could be manually removed without tracheal surgery but was unsuccessful in an additional six birds. Tracheal resection and anastamosis was successful in four birds and unsuccessful in five birds. Overall mortality was 70%. Postintubation tracheal obstruction in birds appears to be more common in zoo practice than is suggested by the literature, as a total of 1.8% (1.2-2.7%, 95% confidence interval) of intubations or 3.5% (2.3-5.3%, 95% confidence interval) of individual animals intubated in these institutions resulted in this complication. Multiple cases were found in Ciconiiformes (n = 4), Columbiformes (n = 4), Gruiformes (n = 4), Anseriformes (n = 3), Galliformes (n = 3), and Passeriformes (n = 2). No cases were found in Coraciiforms, Falconiforms, or Psittaciformes despite many (>40) recorded intubations. The specific cause of these lesions is unclear, but some type of tracheal mucosa trauma or irritation is suggested by histologic findings. Prevention may include selective intubation, use of a laryngeal mask airway in place of intubation, careful placement of an endotracheal tube, minimal movement of the head and neck after placement, humidification of anesthetic gases, and gentle positive-pressure ventilation.

  5. Hook Phenomenon: Intermittent distal ureteral obstruction following reimplantation

    Directory of Open Access Journals (Sweden)

    M. Mehdizadeh "

    2003-06-01

    Full Text Available Background/Objectives: To evaluate the child with intermittent ureteral obstruction following antireflux surgery and to introduce a new imaging technique for diagnosis of the socalled “hook” phenomenon, the most serious complication of antireflux surgery. Patients and Methods: Twenty-five children with a history of antireflux surgery who were referred for either persistent urinary tract infection (UTI or progressive hydronephrosis were included in the study. All the children with signs and symptoms of voiding dysfunction or persistent reflux were excluded. A new imaging technique was devised to evaluate these patients for the presence of “hook phenomenon”, in which a renal ultrasound was performed both on a full bladder and after voiding. If dilatation of the urinary tract was detected on full bladder, and this dilatation decreased dramatically following micturition, then a catheter was passed into the bladder and was filled with normal saline (based on the estimated bladder capacity in order to avoid over-distension. An intravenous urogram and saline cystogram were performed simultaneously. After 20 minutes, 2 abdominal radiographs were obtained on full and emptied bladder, both. Results: On the intravenous urogram, some children showed typical “J- hook-shaped” ureters. In all the cases marked hydronephrosis was noted, with no contrast material seen entering the bladder on the 20 minute radiogram. Upon evacuation of the bladder, both ureters promptly drained into the bladder and the”J-hooking” of the ureters and hydronephrosis resolved. Conclusion: "J- hook phenomenon” is one of the most common causes of hydronephrosis and hydroureter following ureteral re-implantation is intermittent ureteral obstruction from creation of the new ureteral hiatus at an inappropriate site. This complication is frequently misdiagnosed as irreversible uretero-vesical junction obstruction from ischemia or fibrosis. Once the diagnosis of “J- hook

  6. Small airway obstruction in patients with rheumatoid arthritis.

    Science.gov (United States)

    Mori, Shunsuke; Koga, Yukinori; Sugimoto, Mineharu

    2011-04-01

    This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF(25-75)) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DL(CO)) and ratio of DL(CO) to alveolar ventilation (DLco/VA) were within the normal range, but median FEF(25-75), forced expiratory flow at 25% of vital capacity (V(25)), and V(25)/height were dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70-15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10-6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27-6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF(25-75), although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF(25-75) are respiratory symptoms, smoking history, and RA duration.

  7. Cognitive status among patients with chronic obstructive pulmonary disease

    Science.gov (United States)

    Roncero, Carlos; Campuzano, Ana Isabel; Quintano, Jose Antonio; Molina, Jesús; Pérez, Joselín; Miravitlles, Marc

    2016-01-01

    Purpose We investigated the association between cognitive impairment and chronic obstructive pulmonary disease (COPD), taking into account demographic and clinical variables evaluated during routine practice. Patients and methods We performed a post hoc analysis of a cross-sectional study that included subjects with stable COPD. Sociodemographic and clinical information was recorded using the Body mass index, airflow Obstruction, Dyspnea and Exacerbations index and the Charlson comorbidity index. Cognitive performance was studied by the mini-mental state examination, with a score less than 27 indicating clinical impairment. Depressive symptoms, physical activity, and quality of life (EuroQoL-5 dimensions and COPD Assessment Test) were also evaluated. Results The analysis included 940 subjects. The prevalence of cognitive impairment was 39.4%. Multivariate logistic regression models revealed that cognitive impairment was associated with educational level (odds ratio [OR] =0.096, 95% confidence interval [CI] =0.011–0.447) and poorer quality of life measured by the EuroQoL-5 dimensions social tariff (OR =0.967, 95% CI =0.950–0.983). When questionnaires were not included in the analysis, cognitive impairment was associated with educational level (OR =0.063, 95% CI =0.010–0.934), number of exacerbations (OR =11.070, 95% CI =1.450–84.534), Body mass index, airflow Obstruction, Dyspnea and Exacerbations index score (OR =1.261, 95% CI =1.049–1.515), and the Charlson comorbidity index (OR =1.412, 95% CI =1.118–1.783). Conclusion Cognitive impairment is common in COPD and is associated with low educational level, higher disease severity, and increased comorbidity. This could have therapeutic implications for this population. PMID:27042043

  8. Effect of Nasal Obstruction on Continuous Positive Airway Pressure Treatment: Computational Fluid Dynamics Analyses.

    Directory of Open Access Journals (Sweden)

    Tadashi Wakayama

    Full Text Available Nasal obstruction is a common problem in continuous positive airway pressure (CPAP therapy for obstructive sleep apnea and limits treatment compliance. The purpose of this study is to model the effects of nasal obstruction on airflow parameters under CPAP using computational fluid dynamics (CFD, and to clarify quantitatively the relation between airflow velocity and pressure loss coefficient in subjects with and without nasal obstruction.We conducted an observational cross-sectional study of 16 Japanese adult subjects, of whom 9 had nasal obstruction and 7 did not (control group. Three-dimensional reconstructed models of the nasal cavity and nasopharynx with a CPAP mask fitted to the nostrils were created from each subject's CT scans. The digital models were meshed with tetrahedral cells and stereolithography formats were created. CPAP airflow simulations were conducted using CFD software. Airflow streamlines and velocity contours in the nasal cavities and nasopharynx were compared between groups. Simulation models were confirmed to agree with actual measurements of nasal flow rate and with pressure and flow rate in the CPAP machine.Under 10 cmH2O CPAP, average maximum airflow velocity during inspiration was 17.6 ± 5.6 m/s in the nasal obstruction group but only 11.8 ± 1.4 m/s in the control group. The average pressure drop in the nasopharynx relative to inlet static pressure was 2.44 ± 1.41 cmH2O in the nasal obstruction group but only 1.17 ± 0.29 cmH2O in the control group. The nasal obstruction and control groups were clearly separated by a velocity threshold of 13.5 m/s, and pressure loss coefficient threshold of approximately 10.0. In contrast, there was no significant difference in expiratory pressure in the nasopharynx between the groups.This is the first CFD analysis of the effect of nasal obstruction on CPAP treatment. A strong correlation between the inspiratory pressure loss coefficient and maximum airflow velocity was found.

  9. Inflammation laryngeal changes in common cold children

    Directory of Open Access Journals (Sweden)

    E. P. Selkova

    2014-01-01

    Full Text Available This article is dedicated to the connection between laryngealinflammatory pathology and influenza/common cold.The purpose is to study the frequency of different form of laryngitis in children with common cold/ influenza, influenced of carried laryngitis within common cold on laryngeal structures and also the effectiveness of preventive measures against acute respiratory infections.Material and methods are the results of the examination (including laryngeal endoscopy and analysis of medical files of 3169 patients and also the data of the annual report of one Moscow semi-clinic.Results. Inflammation laryngeal pathology was revealed in 152 (4,79% cases, in 129 (84,9% – non-obstructive. 91 patient (59,8% belonged to category “frequently and often sick”. The recurrent episodes were seen in patients with both forms of laryngitis. Different laryngeal pathology (laryngitis, vocal nodules was seen after common cold treatment with 43,5% obstructive and 18,63% non-obstructive laryngitis patient as well as dysphonia in 3-14% getting worse with the following common cold episodes. The preventative measures carried among patients with laryngitis allowed to decrease spreading of this pathology notwithstanding the fact of annual growth of common cold in children.Conclusion. Thus taking to account the high circulation of respiratory viruses the absence of specific preventative measures and the especial role of viruses in development all forms of laryngitis it is recommended to include special drugs in preventative techniques of laryngitis prophylactics. Different methods of non-specific prophylactic are effective in decreasing the amount of common cold episodes, decrease the frequency and severity all forms of laryngitis in children and also tend to stabilize/normalize the voice quality in different laryngeal pathology children.

  10. 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.

  11. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    Science.gov (United States)

    Lee, Li-Ang; Lo, Yu-Lun; Yu, Jen-Fang; Lee, Gui-She; Ni, Yung-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2016-01-01

    Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40–300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05–1.49) and body mass index (OR, 1.48, 95% CI 1.02–2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301–850 Hz; OR, 0.84, 95% CI 0.74–0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301–850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses. PMID:27471038

  12. Role of antioxidants in the treatment of obstruction-mediated rabbit urinary bladder dysfunction

    Directory of Open Access Journals (Sweden)

    Tasmina Hydery

    2011-02-01

    Full Text Available Benign prostatic hyperplasia (BPH is a common medical problem; more than 80% of males 50 years of age and older have some degree of bladder outlet obstruction secondary to BPH. In order to understand the effects of outlet obstruction on bladder structure and function, animal models have been developed using several species including rat, rabbit, guinea pig, and pig. Although there are marked differences in bladder size, capacity, compliance, physiology and pharmacology among these species, their responses to outlet obstruction have many common characteristics. Recent reviews have enumerated these responses of animal bladders to partial outlet obstruction; their relevance to progressive bladder dysfunction secondary to BPH in men. We have found that the rabbit is most similar to man in that the rabbit urinates between 3 and 5 times per day, we can evaluate bladder function through urodynamics performed similar to that used in man, and cystoscopy can be performed using a pediatric cystiscope. [J Exp Integr Med 2011; 1(1: 23-35

  13. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies.

    NARCIS (Netherlands)

    Detaille, S.I.; Heerkens, Y.F.; Engels, J.A.; Gulden, J.W.J. van der; Dijk, F.J. van

    2009-01-01

    OBJECTIVE: Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD

  14. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies

    NARCIS (Netherlands)

    S.I. Detaille; Y.F. Heerkens; J.A. Engels; J.W.J. van der Gulden; F.J.H. van Dijk

    2009-01-01

    Objective Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD)

  15. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies.

    NARCIS (Netherlands)

    Detaille, S.I.; Heerkens, Y.F.; Engels, J.A.; Gulden, J.W.J. van der; Dijk, F.J. van

    2009-01-01

    OBJECTIVE: Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease

  16. No Common Opinion on the Common Core

    Science.gov (United States)

    Henderson, Michael B.; Peterson, Paul E.; West, Martin R.

    2015-01-01

    According to the three authors of this article, the 2014 "EdNext" poll yields four especially important new findings: (1) Opinion with respect to the Common Core has yet to coalesce. The idea of a common set of standards across the country has wide appeal, and the Common Core itself still commands the support of a majority of the public.…

  17. 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...

  18. 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...

  19. Common Secondary Causes of Resistant Hypertension and Rational for Treatment

    Directory of Open Access Journals (Sweden)

    Charles Faselis

    2011-01-01

    Full Text Available Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

  20. An unusual cause of obstructive jaundice

    Science.gov (United States)

    Abbara, Aula; Al-Hadithy, Huda; Khan, Shahid; Shorvon, Philip

    2009-01-01

    An 80-year-old Caucasian woman presented with a 3-week history of painless jaundice, pruritis, dark urine and weight loss. Blood analysis demonstrated an obstructive jaundice pattern. A CT scan demonstrated a gas-filled duodenal diverticulum arising from the second part of the duodenum. Once food material was cleared from the diverticulum endoscopically, there was clinical and biochemical improvement. This case demonstrates an unusual cause of obstructive jaundice that has seldom been reported in the literature; once impacted food material was removed from the diverticulum, there was radiological improvement of the patient’s condition. PMID:21686538

  1. Airway distensibility in Chronic Obstructive Airway Disease

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde Marie; Pedersen, Jesper Holst; Dirksen, Asger

    2013-01-01

    Rationale – Chronic Obstructive Pulmonary Disease (COPD) is a combination of chronic bronchitis and emphysema, which both may lead to airway obstruction. Under normal circumstances, airway dimensions vary as a function of inspiration level. We aim to study the influence of COPD and emphysema...... and emphysema, respectively. Conclusions – Airway distensibility decreases significantly with increasing severity of both GOLD status and emphysema, indicating that in COPD the dynamic change in airway calibre during respiration is compromised. Chronic bronchitis and emphysema appear to be interacting...

  2. Uterine rotation: a cause of intestinal obstruction.

    Science.gov (United States)

    González-Mesa, Ernesto; Narbona, Isidoro; Cohen, Isaac; Villegas, Emilia; Cuenca, Celia

    2013-01-01

    Intestinal obstruction is an uncommon surgical emergency during pregnancy that affects seriously the prognosis of gestation. The underlying cause can be identified in the majority of cases and usually consists of adhesions secondary to previous abdominal or pelvic surgery, followed in order of frequency by intestinal volvuli. In recent years there have been no reports in which the gravid uterus has been the cause of intestinal obstruction. We report the case of a woman in week 33 + 4 of pregnancy who developed extrinsic compression of the colon secondary to uterine rotation and pelvic impaction of the head of the fetus.

  3. Bronchial or Laryngeal Obstruction Induced by Exercise?

    Directory of Open Access Journals (Sweden)

    Ayoub Bey

    2017-06-01

    Full Text Available A child suspected of exercise-induced laryngeal obstruction and asthma is examined by laryngoscopy and respiratory resistance (Rrs after exercise challenge. Immediately at exercise cessation, the visualized adduction of the larynx in inspiration is reflected in a paroxystic increase in Rrs. While normal breathing has apparently resumed later on during recovery from exercise, the pattern of Rrs in inspiration is observed to reoccur following a deep breath or swallowing. The procedure may thus help diagnosing the site of exercise-induced obstruction when laryngoscopy is not available and identify re-inducers of laryngeal dysfunction.

  4. Bronchial or Laryngeal Obstruction Induced by Exercise?

    Science.gov (United States)

    Bey, Ayoub; Botti, Sophie; Coutier-Marie, Laurianne; Bonabel, Claude; Metche, Stéphanie; Demoulin-Alexikova, Silvia; Schweitzer, Cyril Etienne; Marchal, François; Coffinet, Laurent; Ioan, Iulia

    2017-01-01

    A child suspected of exercise-induced laryngeal obstruction and asthma is examined by laryngoscopy and respiratory resistance (Rrs) after exercise challenge. Immediately at exercise cessation, the visualized adduction of the larynx in inspiration is reflected in a paroxystic increase in Rrs. While normal breathing has apparently resumed later on during recovery from exercise, the pattern of Rrs in inspiration is observed to reoccur following a deep breath or swallowing. The procedure may thus help diagnosing the site of exercise-induced obstruction when laryngoscopy is not available and identify re-inducers of laryngeal dysfunction.

  5. Lung Compliance and Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    D. Papandrinopoulou

    2012-01-01

    Full Text Available Chronic obstructive pulmonary disease, namely, pulmonary emphysema and chronic bronchitis, is a chronic inflammatory response of the airways to noxious particles or gases, with resulting pathological and pathophysiological changes in the lung. The main pathophysiological aspects of the disease are airflow obstruction and hyperinflation. The mechanical properties of the respiratory system and its component parts are studied by determining the corresponding volume-pressure (P-V relationships. The consequences of the inflammatory response on the lung structure and function are depicted on the volume-pressure relationships.

  6. Endoscopic third ventriculostomy in obstructed hydrocephalus

    Directory of Open Access Journals (Sweden)

    Singh D

    2003-01-01

    Full Text Available Forty-three ETV were performed in 46 patients of obstructive hydrocephalus. Study was divided into two groups. Group 1 was with 29 children of less than two years age. Group 2 had seventeen patients of more than 2 years, adolescent and adults. Group 1 had 70% clinical and 63% radiological improvement whereas Group 2 showed 100% clinical and 73% radiological improvement. ETV failed in relieving the symptoms of hydrocephalus in eight patients. They were eventually benefited with VP Shunt. There was one postoperative death, which was not related to the procedure. ETV is an important alternative to VP Shunt in relieving hydrocephalus due to obstruction in CSF pathway.

  7. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

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    Uzeyir Yildizoglu

    2016-01-01

    Full Text Available Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature.

  8. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

    Science.gov (United States)

    Yildizoglu, Uzeyir; Polat, Bahtiyar; Durmaz, Abdullah

    2016-01-01

    Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature. PMID:27980871

  9. Obstructing Gangliocytic Paraganglioma in the Third Portion of the Duodenum

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    Carlos M. Nuño-Guzmán

    2012-07-01

    Full Text Available Gangliocytic paragangliomas are infrequent tumors almost exclusively found in the second portion of the duodenum. An unusual case of a gangliocytic paraganglioma in the third portion of the duodenum with obstructive symptoms is herein reported. A 16-year-old male patient presented with epigastric pain, postprandial plenitude and reflux. A barium swallow failed to demonstrate abnormalities. Endoscopy showed a pedunculated submucosal tumor, originating at the third duodenal portion and causing partial obstruction. Biopsy was not performed due to the risk of bleeding. CT scan demonstrated a polypoid lesion. Through a transmesocolic approach and an anterior duodenotomy, resection of the tumor was performed. No lymph node or other organ affection was found. Histologic examination revealed a gangliocytic paraganglioma. Immunohistochemical examination was performed. Gangliocytic paragangliomas originating in the third or fourth portion of the duodenum, as in the present case, are extremely rare. Characteristic histologic features including epithelioid cells, spindle-shaped cells and ganglion-like cells were met. The majority of cases manifest with a similar benign behavior. Local resection of the tumor is recommended for these cases. An infrequent case of a gangliocytic paraganglioma located in the third portion of the duodenum, with a less common clinical presentation, is herein reported.

  10. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    Science.gov (United States)

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.

    2015-01-01

    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  11. Diastolic filling in a physical model of obstructive hypertrophic cardiomyopathy

    Science.gov (United States)

    Schovanec, Joseph; Samaee, Milad; Lai, Hong Kuan; Santhanakrishnan, Arvind

    2015-11-01

    Hypertrophic Cardiomyopathy (HCM) is an inherited heart disease that affects as much as one in 500 individuals, and is the most common cause of sudden death in young athletes. The myocardium becomes abnormally thick in HCM and deforms the internal geometry of the left ventricle (LV). Previous studies have shown that a vortex is formed during diastolic filling, and further that the dilated LV morphology seen in systolic heart failure results in altering the filling vortex from elliptical to spherical shape. We have also previously shown that increasing LV wall stiffness decreases the filling vortex circulation. However, alterations to intraventricular filling fluid dynamics due to an obstructive LV morphology and locally elevated wall stiffness (in the hypertrophied region) have not been previously examined from a mechanistic standpoint. We conducted an experimental study using an idealized HCM physical model and compared the intraventricular flow fields obtained from 2D PIV to a baseline LV physical model with lower wall stiffness and anatomical geometry. The obstruction in the HCM model leads to earlier breakdown of the filling vortex as compared to the anatomical LV. Intraventricular filling in both models under increased heart rates will be discussed.

  12. Idiopathic sclerosing encapsulating peritonitis: an uncommon cause of intestinal obstruction

    Directory of Open Access Journals (Sweden)

    José de Arimatéia Batista Araújo Filho

    2012-12-01

    Full Text Available Sclerosing encapsulating peritonitis (SEP, also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of β-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-yearold male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.

  13. Ovarian Hyperstimulation Syndrome as an Etiology of Obstructive Uropathy

    Directory of Open Access Journals (Sweden)

    Creticus P. Marak

    2013-01-01

    Full Text Available Ovarian hyperstimulation syndrome (OHSS is an iatrogenic complication of controlled ovarian hyperstimulation (COH protocols performed in women undergoing assisted reproductive technologies. Overstimulation of the ovaries results in the overproduction of vasoactive cytokines and mediators by the ovaries, thereby causing a generalized capillary leak and acute shift of protein-rich fluid from the intravascular compartment into the third space. This may lead to the development of ascites, pleural effusions, pericardial effusion, anasarca, intravascular volume depletion, hemoconcentration, oliguria, hypoalbuminemia and hypoproteinemia, electrolyte imbalances, acute renal failure, abdominal compartment syndrome, thromboembolic events, and adult respiratory distress syndrome. The only effective treatment available is prevention of the syndrome from developing by individualizing the stimulation protocol, especially in high-risk patients. Once the syndrome develops, the management is mainly supportive. Oliguria and some degree of acute renal failure commonly develop in patients with moderate to severe OHSS and are usually due to prerenal causes. Acute renal failure (ARF secondary to obstructive uropathy is rare. Here we report a case of severe, life-threatening OHSS resulting in ARF secondary to obstructive uropathy.

  14. Ovarian hyperstimulation syndrome as an etiology of obstructive uropathy.

    Science.gov (United States)

    Marak, Creticus P; Chopra, Amit; Alappan, Narendrakumar; Ponea, Ana M; Guddati, Achuta K

    2013-01-01

    Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian hyperstimulation (COH) protocols performed in women undergoing assisted reproductive technologies. Overstimulation of the ovaries results in the overproduction of vasoactive cytokines and mediators by the ovaries, thereby causing a generalized capillary leak and acute shift of protein-rich fluid from the intravascular compartment into the third space. This may lead to the development of ascites, pleural effusions, pericardial effusion, anasarca, intravascular volume depletion, hemoconcentration, oliguria, hypoalbuminemia and hypoproteinemia, electrolyte imbalances, acute renal failure, abdominal compartment syndrome, thromboembolic events, and adult respiratory distress syndrome. The only effective treatment available is prevention of the syndrome from developing by individualizing the stimulation protocol, especially in high-risk patients. Once the syndrome develops, the management is mainly supportive. Oliguria and some degree of acute renal failure commonly develop in patients with moderate to severe OHSS and are usually due to prerenal causes. Acute renal failure (ARF) secondary to obstructive uropathy is rare. Here we report a case of severe, life-threatening OHSS resulting in ARF secondary to obstructive uropathy.

  15. Antral hyperplastic polyp causing intermittent gastric outlet obstruction: Case report

    Directory of Open Access Journals (Sweden)

    Kurtkaya-Yapicier Ozlem

    2003-06-01

    Full Text Available Abstract Background Hyperplastic polyps are the most common polypoid lesions of the stomach. Rarely, they cause gastric outlet obstruction by prolapsing through the pyloric channel, when they arise in the prepyloric antrum. Case presentation A 62-year-old woman presented with intermittent nausea and vomiting of 4 months duration. Upper gastrointestinal endoscopy revealed a 30 mm prepyloric sessile polyp causing intermittent gastric outlet obstruction. Following submucosal injection of diluted adrenaline solution, the polyp was removed with a snare. Multiple biopsies were taken from the greater curvature of the antrum and the corpus. Rapid urease test for Helicobacter pylori yielded a negative result. Histopathologic examination showed a hyperplastic polyp without any evidence of malignancy. Biopsies of the antrum and the corpus revealed gastritis with neither atrophic changes nor Helicobacter pylori infection. Follow-up endoscopy after a 12-week course of proton pomp inhibitor therapy showed a complete healing without any remnant tissue at the polypectomy site. The patient has been symptom-free during 8 months of follow-up. Conclusions Symptomatic gastric polyps should be removed preferentially when they are detected at the initial diagnostic endoscopy. Polypectomy not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves radical treatment.

  16. Chronic obstructive pulmonary disease: Does gender really matter?

    Directory of Open Access Journals (Sweden)

    N K Jain

    2011-01-01

    Full Text Available Background: Limited data is available on the clinical expression of chronic obstructive pulmonary disease (COPD from India. The impact of gender on expression of COPD has received even less attention. Apart from tobacco smoke, indoor air pollution, especially from biomass fuel may play an important role in development of COPD in women. Materials and Methods: Seven hundred and two patients of COPD were studied regarding the etiological and risk factors leading to COPD, gender-related differences in clinical presentation, radiological expression of COPD and the co-morbidities in COPD. Results: Tobacco smoke in the form of beedi smoking was the predominant smoke exposure in males, whereas smoke from biofuel burning was the predominant exposure in females. As compared to males, females were younger, reported more dyspnea, more severe bronchial obstruction, more exacerbations, and exhibited higher prevalence of systemic features. Also, females smoked less and had lesser incidence of productive cough, lower body mass index, lesser co-morbidities and less number of hospital admissions as compared to males. Males were more likely than females to have an emphysema-predominant phenotype, while airway-predominant disease was more common among females. Conclusion: The current study shows that gender-related differences do exist in COPD patients. Understanding these differences in etiological agent and clinical picture will help early diagnosis of COPD in females.

  17. Obstructed Bile Duct as a Trigger for Microbe's Translocation?

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To assess the potential mechanisms of bacterial translocation in a murine model of obstructive jaundice. Methods: Adult rats were randomized to be operated on for ligation or sham-ligation of the common bile duct. Bacterial translocation to the mesenteric lymph nodes (MLNs), liver, spleen, portal blood and systemic circulation and bacterial population levels in the ceca were quantitated after 7 and 14 days. The terminal ilea were histologically examined by light and transmission electron microscopy. Results: Bacterial translocation to the MNLs was seen in both 7 (10/17) and 14 (11/18) day ligated animals, but not found in their corresponding controls (both 0/8). No significant difference in the cecal bacterial population levels was found between the ligated groups and their corresponding control groups, also between the two subgroups that were set up within each ligated group according to the presence or absence of bacteria in the MLNs. In the ligated rats, light microscopy demonstrated subepithelial edema in association with infiltration of flammatory cells and, transmission electron microscopy showed that the enterocytes were injured with abnormal microvilli, swollen mitochondria, unclear endoplasmic reticulum and cytoplasm with bubble degeneration. However, the ilea from the controls appeared normal. Conclusions: Obstructive jaundice promotes bacterial translocation in rats. The gut mucosal damage rather than the intestinal bacterial overgrowth may play a crucial role in bacterial translocation.

  18. The surgical treatment of ilio-femoral venous obstruction.

    Science.gov (United States)

    Illuminati, G; Caliò, F G; D'Urso, A; Mancini, P; Papaspyropoulos, V; Ceccanei, G; Lorusso, R; Vietri, F

    2004-01-01

    A series of 9 patients of a mean age of 48 years, operated on for compression of the ilio-femoral venous axis is reported. The cause of obstruction was external compression in 3 cases, a retroperitoneal sarcoma in 1 case, and an infrarenal aortic aneurysm in 2. Two patients presented with a Cockett's syndrome, 3 with a chronic ilio-femoral thrombosis, and one with a post-traumatic segmentary stenosis. Treatment consisted in a resection/Dacron grafting of 2 infrarenal aortic aneurysms, one femoro-caval bypass graft, 2 transpositions of the right common iliac artery in the left hypogastric artery for Cockett's syndrome, 3 Palma's operations for chronic thrombosis, and one internal jugular vein interposition for segmentary stenosis. There were no postoperative deaths and no early thromboses of venous reconstructions performed. All the patients were relieved of symptoms during the follow-up period, whose mean length was 38 months. The cause of venous obstruction and the presence of symptoms which are resistant to medical treatment are the main indications to ilio-femoral venous revascularization. The choice of the optimal treatment in each single case yields satisfactory results.

  19. Urethral obstruction from dislodged bladder Diverticulum stones: a case report

    Directory of Open Access Journals (Sweden)

    Okeke Linus I

    2012-11-01

    Full Text Available Abstract Background Secondary urethral stone although rare, commonly arises from the kidneys, bladder or are seen in patients with urethral stricture. These stones are either found in the posterior or anterior urethra and do result in acute urinary retention. We report urethral obstruction from dislodged bladder diverticulum stones. This to our knowledge is the first report from Nigeria and in English literature. Case presentation A 69 year old, male, Nigerian with clinical and radiological features of acute urinary retention, benign prostate enlargement and bladder diverticulum. He had a transurethral resection of the prostate (TURP and was lost to follow up. He re-presented with retained urethral catheter of 4months duration. The catheter was removed but attempt at re-passing the catheter failed and a suprapubic cystostomy was performed. Clinical examination and plain radiograph of the penis confirmed anterior and posterior urethral stones. He had meatotomy and antegrade manual stone extraction with no urethra injury. Conclusions Urethral obstruction can result from inadequate treatment of patient with benign prostate enlargement and bladder diverticulum stones. Surgeons in resource limited environment should be conversant with transurethral resection of the prostate and cystolithotripsy or open prostatectomy and diverticulectomy.

  20. Medication bezoar: Intestinal obstruction by an Isocal bezoar

    Energy Technology Data Exchange (ETDEWEB)

    O' Malley, J.A.M.; Ferrucci, J.T. Jr.; Goodgame, J.T. Jr.

    1981-05-15

    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.

  1. [Nasal obstruction and mouth breathing: the ENT's point of view].

    Science.gov (United States)

    Leboulanger, Nicolas

    2013-06-01

    Obstructive diseases of children's upper airways are frequent, mostly caused by tonsils and adenoids hypertrophy. A nasal septum deviation or a lower turbinate hypertrophy may also cause a significant obstruction. Tonsillectomy and adenoidectomy must be performed in case of clinical obstruction, sometimes documented by a sleep study. A tonsils' hypertrophy without significant obstruction and clinical symptoms is not an indication of adenotonsillectomy, even in case of snoring or if an orthodontic treatment is planned.

  2. A CLINICAL STUDY OF GASTRIC OUTLET OBSTRUCTION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Sushruta

    2015-05-01

    Full Text Available From the standpoint of pathology, the term pyloric stenosis is usually inaccurate at least in adult patients, since the site of obstruction is rarely situated at the pylorus itself but is more often placed immediately proximal to the sphincter where the diagnosis of carcinoma is most probable or more dista lly in the duodenal bulb where the cause is almost invariably a duodenal ulcer. This study has been taken up to review the changes in presentation of gastric outlet obstruction in view of changing trends in the aetiology analysing the occurrence of benign and malignant causes, signs and symptoms, investigatory modalities, management and their results. The present study is an observational study a total of 50 cases were studied with Cicatrised duodenal ulcer and carcinoma pyloric antrum being the major cause s. Clinical profile, investigations and treatment outcomes were analysed. The majority of patients had malignant gastric outlet obstruction with 32[64%] patients presenting with Gastric cancer and 18[36%] patients presenting with cicatrised duodenal ulcer. In this study most patients were in the fifth and seventh decades of life. Men outnumbered women by 3: 1. The clinical presentation is not different from those in other studies with non - bilious vomiting being common to all the patients with dehydration. V isible gastric peristalsis and succussion splash were more prominent in Cicatrised Duodenal Ulcer. All cases were subjected to serum electrolyte estimation. Out of them 20 cases [40%] showed electrolyte imbalance barium meal, ultrasound abdomen pelvis and CT scan abdomen being the other investigating tools. Blood group ‘O’ was common in cicatrized duodenal ulcer patients [77.7%] followed by blood group ‘A’ [11.1%]. Upper GI endoscopy was done in all cases [100%]. 32[64%] cases had pyloric antral Carcinoma i n which 23 cases had fungating growth and the rest 9 had ulcerative growth and 18[36%] had cicatrized duodenal ulcer. 100

  3. Congenital duodenal obstruction in neonates:a decade's experience from one center

    Institute of Scientific and Technical Information of China (English)

    Qing-Jiang Chen; Zhi-Gang Gao; Jin-Fa Tou; Yun-Zhong Qian; Min-Ju Li; Qi-Xing Xiong; Qiang Shu

    2014-01-01

    Background: Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. Methods: We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and fi nal outcomes. Results: The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical doublebubble sign or air-fl uid levels in 68.64% of patients, and confi rmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. Conclusions: Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and

  4. Outcomes of upper airway reconstructive surgery for obstructive sleep apnea syndrome based on polysomnography after nasopharyngeal tube insertion

    Institute of Scientific and Technical Information of China (English)

    LI Shu-hua; WU Da-hai; BAO Ji-min; SHI Hong-jin

    2013-01-01

    Background The most common obstruction sites for obstructive sleep apnea hypopnea syndrome (OSAHS) are the oropharynx and the glossopharyx.The diagnosis of glossopharyngeal airway obstruction is difficult.The study aimed to assess the effect of upper airway reconstructive surgery for OSAHS based on polysomnography (PSG) after nasopharyngeal tube insertion (NPT-PSG),and to evaluate the clinical value of NPT-PSG in localizing the obstructive sites.Methods Seventy-nine OSAHS patients diagnosed with PSG were included in the study.PSG was repeated with a nasopharyngeal tube in place (NPT-PSG).Results of the two PSGs were compared.A NPT-PSG apnea hypopnea index (AHI) greater than 15 times per hour was used as a threshold for glossopharyngeal surgery.The cause of glossopharyngeal airway obstruction was taken into consideration in planning glossopharyngeal surgery.Assessment of efficacy was followed-up.Results After NPT-PSG,patients' AHI significantly decreased and lowest oxygen saturation (LaSO2) significantly increased.Of the 79 patients,47 were treated with uvulopalatopharyngoplasty (UPPP) alone and 32 with UPPP + glossopharyngeal surgery.Thirty-two patients were considered cured,33 markedly improved,and 14 failed.The overall surgery success rate was 82.3%.Conclusions NPT-PSG can be used as a diagnosis tool for localizing airway obstruction in OSAHS patients.Surgical treatment based on NPT-PSG results in good treatment efficacy.

  5. Role of sleep endoscopy in obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Suzan Salama

    2013-07-01

    Conclusion: Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity.

  6. Gastroesophageal Reflux Symptoms in Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Zlatica Goseva

    2014-09-01

    CONCLUSION: GER symptoms are more prevalent in patients with severe airways obstruction when compared to less airways obstructed group and controls. We could suggest an association between the degree of airways obstruction in patients with COPD and the increased rate of GER symptoms.

  7. Application of LY-Fr3 lacrimal drain tube double-passage intubation in anastomosis for inferior lacrimal canalicular laceration%LY-Fr3型泪道引流管双路置入法在下泪小管断裂吻合术中的应用

    Institute of Scientific and Technical Information of China (English)

    李海东; 徐永根; 陈伟

    2016-01-01

    Objective To observe the effect of using LY-Fr3 lacrimal drain tube double-passage intubation in anastomosis for inferior lacrimal canalicular laceration.Methods Nineteen cases (19 eyes) of traumatic inferior lacrimal canalicular laceration,under operating microscope implementation of lacrimal duct anastomosis using LY-Fr3 lacrimal drain tube for stent,tube inserted through the lacrimal punctum using the double-passage mode.Results Tubes were removed 3-6 months postoperatively and followed-up for 6-12 months,15 cases (78.95% (15/19)) were cured,3 cases (15.79% (3/19)) were improved and 1 case (5.26% (1/19)) was ineffective.Conclusions The method of using LY-Fr3 lacrimal drain tube double-passage intubation in anastomosis for inferior lacrimal canalicular laceration is simple and sure efficacy.%目的 观察LY-Fr3型泪道引流管双路置人法在下泪小管断裂吻合术中的应用效果.方法 于2013年6月至2014年6月在绍兴市人民医院眼科经手术显微镜下,对19例(19只眼)外伤性下泪小管断裂实施泪小管断裂吻合术,使用LY-Fr3型泪道引流管作支撑物,引流管两端分别自上、下泪小点经双路置入.结果 术后3~6个月拔管,随访6~12个月,治愈15例(78.95% (15/19)),好转3例(15.79% (3/19)),无效1例(5.26% (1/19)).结论 LY-Fr3型泪道引流管双路置入用于下泪小管断裂吻合术的方法操作方便,疗效确切.

  8. A Small Molecule Inhibitor of Sarcomere Contractility Acutely Relieves Left Ventricular Outflow Tract Obstruction in Feline Hypertrophic Cardiomyopathy

    Science.gov (United States)

    Stern, Joshua A.; Markova, Svetlana; Ueda, Yu; Kim, Jae B.; Pascoe, Peter J.; Evanchik, Marc J.; Green, Eric M.; Harris, Samantha P.

    2016-01-01

    Hypertrophic cardiomyopathy (HCM) is an inherited disease of the heart muscle characterized by otherwise unexplained thickening of the left ventricle. Left ventricular outflow tract (LVOT) obstruction is present in approximately two-thirds of patients and substantially increases the risk of disease complications. Invasive treatment with septal myectomy or alcohol septal ablation can improve symptoms and functional status, but currently available drugs for reducing obstruction have pleiotropic effects and variable therapeutic responses. New medical treatments with more targeted pharmacology are needed, but the lack of preclinical animal models for HCM with LVOT obstruction has limited their development. HCM is a common cause of heart failure in cats, and a subset exhibit systolic anterior motion of the mitral valve leading to LVOT obstruction. MYK-461 is a recently-described, mechanistically novel small molecule that acts at the sarcomere to specifically inhibit contractility that has been proposed as a treatment for HCM. Here, we use MYK-461 to test whether direct reduction in contractility is sufficient to relieve LVOT obstruction in feline HCM. We evaluated mixed-breed cats in a research colony derived from a Maine Coon/mixed-breed founder with naturally-occurring HCM. By echocardiography, we identified five cats that developed systolic anterior motion of the mitral valve and LVOT obstruction both at rest and under anesthesia when provoked with an adrenergic agonist. An IV MYK-461 infusion and echocardiography protocol was developed to serially assess contractility and LVOT gradient at multiple MYK-461 concentrations. Treatment with MYK-461 reduced contractility, eliminated systolic anterior motion of the mitral valve and relieved LVOT pressure gradients in an exposure-dependent manner. Our findings provide proof of principle that acute reduction in contractility with MYK-461 is sufficient to relieve LVOT obstruction. Further, these studies suggest that feline

  9. Natural histories of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    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...

  10. Intestinal obstruction by trichobezoars in five cats.

    Science.gov (United States)

    Barrs, V R; Beatty, J A; Tisdall, P L; Hunt, G B; Gunew, M; Nicoll, R G; Malik, R

    1999-12-01

    Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.

  11. Chronic obstructive pulmonary disease and cancer risk

    DEFF Research Database (Denmark)

    Kornum, Jette Brommann; Sværke, Claus; Thomsen, Reimar Wernich

    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....

  12. Intraoperative endoscopy in obstructive hypopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Predrag Pesko; Djordjije Saranovic; Vera Todorovic; Milos Bjelovic; Predrag Sabljak; Dejan Stojakov; Ebrahimi Keramatollah; Dejan Velickovic; Bratislav Spica; Branka Nenadic; Aleksandra Djuric-Stefanovic

    2006-01-01

    AIM: To demonstrate the necessity of intraoperative endoscopy in the diagnosis of secondary primary tumors of the upper digestive tract in patients with obstructive hypopharyngeal carcinoma.METHODS: Thirty-one patients with hypopharyngeal squamous cell carcinoma had been operated, with radical intent, at our Institution in the period between 1978 and 2004. Due to obstructive tumor mass, in 7(22.6%) patients, preoperative endoscopic evaluation of the esophagus and stomach could not be performed. In those patients, intraoperative endoscopy, made through an incision in the cervical esophagus, was standard diagnostic method for examination of the esophagus and stomach.RESULTS: We found synchronous foregut carcinomas in 3 patients (9.7%). In two patients, synchronous carcinomas had been detected during preoperative endoscopic evaluation, and in one (with obstructive carcinoma) using intraoperative endoscopy. In this case, preoperative barium swallow and CT scan did not reveal the existence of second primary tumor within esophagus, despite the fact that small, but T2 carcinoma, was present.CONCLUSION: It is reasonable to use intraoperative endoscopy as a selective screening test in patients with obstructive hypopharyngeal carcinoma.

  13. Bronchoscopic interventions for chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Mineshita, Masamichi; Slebos, Dirk-Jan

    2014-01-01

    Over the past decade, several non-surgical and minimally invasive bronchoscopic lung volume reduction (BLVR) techniques have been developed to treat patients with severe chronic obstructive pulmonary disease (COPD). BLVR can be significantly efficacious, suitable for a broad cohort of patients, and

  14. The bladder ran dry: bilateral ureteral obstruction.

    Science.gov (United States)

    Schattner, Ami; Drahy, Yosef; Dubin, Ina

    2017-08-07

    A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  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...... in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services....

  16. Endoscopic third ventriculostomy for obstructive hydrocephalus.

    NARCIS (Netherlands)

    Hellwig, D.; Grotenhuis, J.A.; Tirakotai, W.; Riegel, T.; Schulte, D.M.; Bauer, B.L.; Bertalanffy, H.

    2005-01-01

    The indications for neuroendoscopy are not only constantly increasing, but even the currently accepted indications are constantly being adjusted and tailored. This is also true for one of the most frequently used neuroendoscopic procedures, the endoscopic 3rd ventriculostomy (ETV) for obstructive

  17. 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...

  18. 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...

  19. 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

  20. Cognitive complaints in obstructive sleep apnea

    NARCIS (Netherlands)

    Vaessen, T.J.A.; Overeem, S.; Sitskoorn, M.M.

    2015-01-01

    Obstructive sleep apnea (OSA) is associated with impairments in cognitive functioning. Although cognitive complaints are related to quality of life, work productivity and health care expenditures, most research and all reviews have focused exclusively on objective cognitive functioning so far. In

  1. Unusual cause of neonatal intestinal obstruction | Zikavska ...

    African Journals Online (AJOL)

    Unusual cause of neonatal intestinal obstruction. ... In some cases, diagnosis can be made prenatally but in others manifestation occurs after birth. The aim of this article is to ... Stenosis may result from extrinsic or intrinsic factors. It arises from ...

  2. Biomarkers in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Sin, Don D; Vestbo, Jørgen

    2009-01-01

    Currently, with exception of lung function tests, there are no well validated biomarkers or surrogate endpoints that can be used to establish efficacy of novel drugs for chronic obstructive pulmonary disease (COPD). However, the lung function test is not an ideal surrogate for short-term drug...

  3. 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.

  4. Pulmonary biomarkers in chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Barnes, Peter J.; Chowdhury, Badrul; Kharitonov, Sergei A.; Magnussen, Helgo; Page, Clive P.; Postma, Dirkje; Saetta, Marina

    2006-01-01

    There has been increasing interest in using pulmonary biomarkers to understand and monitor the inflammation in the respiratory tract of patients with chronic obstructive pulmonary disease (COPD). In this Pulmonary Perspective we discuss the merits of the various approaches by reviewing the current l

  5. 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...

  6. Obstruction of cerebral arteries in childhood stroke

    Energy Technology Data Exchange (ETDEWEB)

    Velkey, I.; Lombay, B. (County Teaching Hospital, Miskolc (Hungary). Child Health Center); Panczel, G. (Semmelweis Medical Univ., Budapest (Hungary). Dept. of Psychiatry)

    1992-09-01

    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.).

  7. STUDY OF LARGE BOWEL OBSTRUCTION IN ADULTS

    Directory of Open Access Journals (Sweden)

    Atish

    2013-05-01

    Full Text Available ABSTRACT: AIM : To study the Incidence, Etiology, Clinical featur es, Investigations undertaken to arrive at Diagnosis, Treatment and Post-operative o utcomes of large bowel obstruction in adults. METHODS : This is a prospective observational study of larg e bowel obstruction in adults and was carried out from Nov 2010 to Oct 2012. RESULTS : A total of 211 cases of intestinal obstruction were diagnosed out of these 25(11.85% cases were o f large bowel obstruction. Maximum patients 8(32% cases belonged to age group 51-60yrs and 15( 60% cases were males. Obstipation seen in 25(100%, pain 22(88%, distension 21(84%, tendern ess 22(88% and increased bowel sounds 21(84%. X-ray and ultrasonography was useful in 21 (84% cases while CT scan was used in only 7 cases and proved 100% effective.13(52% cases were of sigmoid volvulus, 1(4% of caecal volvulus and 9(36% cases of malignancy.15(60% cases underw ent primary resection anastomosis and 10(40% cases had a decompressive colostomy.8(32% patients developed immediate wound complication, 3(12% cases had anastomotic leak, 1( 4% case developed burst abdomen and 6(24% cases had septicaemia. Mortality of the stud y was 6(24% cases. CONCLUSION : Patients with large bowel obstruction in adults form a small percentage of patients. Commonest causes are sigmoid volvulus and obstructing colorectal maligna ncies. X-ray abdomen, Ultrasound of abdomen and Computerized Tomography of abdomen are very hel pful in diagnosing. Single stage resectional procedure without colostomies can be done in patien ts even in emergency surgeries and Proximal diverting colostomies may be safely performed in pa tients with pre-existing sepsis, shock, gangrene of large bowel and excessively loaded colon with re versal of colostomies and a definitive procedure may be performed later, after stabilisation of pati ents. Post-operative complications are more because of late presentation associated with comorb idities and large bacterial load of

  8. 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

  9. Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

    Science.gov (United States)

    Ernst, Armin; Grosu, Horiana B.; Lei, Xiudong; Diaz-Mendoza, Javier; Slade, Mark; Gildea, Thomas R.; Machuzak, Michael S.; Jimenez, Carlos A.; Toth, Jennifer; Kovitz, Kevin L.; Ray, Cynthia; Greenhill, Sara; Casal, Roberto F.; Almeida, Francisco A.; Wahidi, Momen M.; Eapen, George A.; Feller-Kopman, David; Morice, Rodolfo C.; Benzaquen, Sadia; Tremblay, Alain; Simoff, Michael; Kovitz, Kevin; Greenhill, Sara; Gildea, Thomas R.; Machuzak, Michael; Almeida, Francisco A.; Cicenia, Joseph; Wahidi, Momen; Mahmood, Kamran; MacEachern, Paul; Tremblay, Alain; Simoff, Michael; Diaz-Mendoza, Javier; Ray, Cynthia; Feller-Kopman, David; Yarmus, Lonny; Estrada-Y-Martin, Rosa; Casal, Roberto F.; Toth, Jennifer; Karunakara, Raj; Slade, Mark; Ernst, Armin; Rafeq, Samaan; Ost, David; Eapen, George A.; Jimenez, Carlos A.; Morice, Rodolfo C.; Benzaquen, Sadia; Puchalski, Jonathan

    2015-01-01

    BACKGROUND: There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness. METHODS: This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements. CONCLUSIONS: Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most. PMID:25358019

  10. Number 2: Chronic Obstructive Pulmonary Disease: The Importance of Exercise

    Directory of Open Access Journals (Sweden)

    Norman L Jones

    2000-01-01

    Full Text Available Patients with chronic obstructive pulmonary disease (COPD - chronic bronchitis, emphysema, asthma are often limited in their capacity to exercise, mainly because they experience shortness of breath or muscle fatigue. The reasons for shortness of breath are dealt with in another patient page (Can Respir J 2000;7(1:35-36, and include narrowing of the airways, poor lung function leading to falls in the amount of oxygen carried in the blood and weak muscles for breathing. Easy fatiguability may be because of muscle weakness or changes in muscle function, related to inactivity and ageing. Other less common factors include heart problems associated with COPD, and other coexisting health problems, such as anemia and arthritis.

  11. Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures

    Directory of Open Access Journals (Sweden)

    Roberto Bini

    2013-01-01

    Full Text Available The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

  12. CMR of microvascular obstruction and hemorrhage in myocardial infarction

    Directory of Open Access Journals (Sweden)

    Wu Katherine C

    2012-09-01

    Full Text Available Abstract Microvascular obstruction (MO or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.

  13. [Hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome].

    Science.gov (United States)

    Conte, M R; Bonfiglio, G; Orzan, F; Mangiardi, L; Camaschella, C; Alfarano, A; Brusca, A

    1995-12-01

    A case of hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome is reported. The most frequently associated cardiac anomalies are coarctation of the aorta and bicuspid aortic valve. Hypertrophic cardiomyopathy has never been reported in this syndrome but is frequent in Noonan syndrome. In these two conditions the phenotype may be indistinguishable but the cariotype is different: normal in Noonan and 45X in Turner syndrome. Our patient had the typical somatic features, and the cariotype was 45X in all examined cells. A familial form of hypertrophic cardiomyopathy was excluded by the normal clinical examination of other members of the family. The presence of hypertrophic cardiomyopathy also in Turner syndrome and the recent localization on the long arm of the chromosome 12 of the gene for Noonan syndrome might postulate a common pathogenesis of the two syndromes.

  14. Prognostic value of nutritional status in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Landbo, C; Prescott, E; Lange, P;

    1999-01-01

    The association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) is a common clinical observation. We prospectively examined whether BMI is an independent predictor of mortality in subjects with COPD from the Copenhagen City Heart...... and from all causes during 17 yr of follow-up was analyzed with multivariate Cox regression models. After adjustment for age, ventilatory function, and smoking habits, low BMI was predictive of a poor prognosis (i.e., higher mortality), with relative risks (RRs) in underweight subjects as compared......, with the lowest risk occurring in normal-weight to overweight subjects, whereas in severe COPD, mortality continued to decrease with increasing BMI (test for trend: p

  15. An Unusual Cause of Duodenal Obstruction: Persimmon Phytobezoar.

    Science.gov (United States)

    Fan, Shengxian; Wang, Jing; Li, Yousheng

    2016-12-01

    Duodenal phytobezoar, an unusual cause of acute duodenal obstruction, is rarely seen. The most common cause of this type of bezoar is persimmon. It frequently arises from underlying gastrointestinal tract pathologies (gastric surgery, etc.). Here, we report the case of a 66-year-old man who had undergone distal gastrectomy with Billroth I reconstruction for gastric cancer and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. The abdominal computed tomography scan showed a large-sized mass in the horizontal portion of the duodenum. On following endoscopic examination, a large phytobezoar was revealed in the duodenum. He was treated with endoscopic fragmentation combined with nasogastric Coca-Cola. The patient tolerated the procedure well and resumed a normal oral diet 3 days later.

  16. Immunoglobulin G4-related disease presenting with obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Yuan-Rung Li

    2014-06-01

    Full Text Available A 48-year-old male presented with diffuse abdominal fullness for 1 month and tea-colored urine for 10 days. Abdominal computed tomography/magnetic resonance cholangiopancreatography revealed diffuse enlargement of the pancreas and unusual soft tissue density around the left ureter. Endoscopic retrograde cholangiopancreatography demonstrated lumen narrowing of the distal common bile duct and irregularity of the pancreatic duct. Markedly elevated serum immunoglobulin G4 (IgG4 was also noted. Biopsy of soft tissue from the area surrounding the left ureter identified lymphoplasmacytic infiltration with high concentrations of IgG4-positive plasma cells accompanied by obliterative phlebitis, compatible with IgG4-related disease. The patient was administered steroid therapy and his symptoms improved. Clinicians should be aware of possible IgG4-related disease in a patient presenting with obstructive jaundice and diffuse pancreatic enlargement because glucocorticoid administration can achieve good response.

  17. Skeletal muscle dysfunction in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Bozkanat Erkan

    2001-05-01

    Full Text Available Abstract It has become increasingly recognized that skeletal muscle dysfunction is common in patients with chronic obstructive pulmonary disease (COPD. Muscle strength and endurance are decreased, whereas muscle fatigability is increased. There is a reduced proportion of type I fibers and an increase in type II fibers. Muscle atrophy occurs with a reduction in fiber cross-sectional area. Oxidative enzyme activity is decreased, and measurement of muscle bioenergetics during exercise reveals a reduced aerobic capacity. Deconditioning is probably very important mechanistically. Other mechanisms that may be of varying importance in individual patients include chronic hypercapnia and/or hypoxia, nutritional depletion, steroid usage, and oxidative stress. Potential therapies include exercise training, oxygen supplementation, nutritional repletion, and administration of anabolic hormones.

  18. Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction.

    Science.gov (United States)

    Bray Madoué, Kaimba; Boniface, Moifo; Annick Laure, Edzimbi; Pierre, Herve

    2016-01-01

    Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil.

  19. Obstructive sleep apnea and cancer: effects of intermittent hypoxia?

    Science.gov (United States)

    Kukwa, Wojciech; Migacz, Ewa; Druc, Karolina; Grzesiuk, Elzbieta; Czarnecka, Anna M

    2015-01-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by pauses in regular breathing. Apneic episodes lead to recurrent hypoxemia-reoxygenation cycles with concomitant cellular intermittent hypoxia. Studies suggest that intermittent hypoxia in OSA may influence tumorigenesis. This review presents recent articles on the potential role of OSA in cancer development. Relevant research has focused on: molecular pathways mediating the influence of intermittent hypoxia on tumor physiology, animal and epidemiological human studies linking OSA and cancer. Current data relating OSA to risk of neoplastic disease remain scarce, but recent studies reveal the potential for a strong relation. More work is, therefore, needed on the impact of OSA on many cancer-related aspects. Results may offer enlightenment for improved cancer diagnosis and treatment.

  20. Inferior turbinate osteoma as a cause of unilateral nose obstruction.

    Science.gov (United States)

    Grabovac, Stjepan; Hadzibegović, Ana Danić; Markesić, Josip

    2012-11-01

    Osteomas are benign, slow growing bone tumors often seen in paranasal sinuses, mostly in the frontal sinus, whereas they are rare in the nasal cavity. Inferior turbinate osteoma is extremely rare and our case is the third reported in the literature to date. Symptoms vary depending on the location, size and spreading and nasal obstruction is the most common symptom. Treatment of osteomas is surgical and is reserved only for rapidly growing osteomas with symptoms of infection or compression. Although endoscopic surgery is preferred modality, external approach with lateral rhinotomy should be considered with larger osteomas especially those that involve the ethmoid labyrinth. In cases like ours, when large osteoma is localized on the inferior nasal turbinate, sublabial incision through the vestibulum is very suitable approach because it provides wide access and good visibility and leaves no visible scar.

  1. [Obstructive sleep apnea features and occupational fitness of railway workers].

    Science.gov (United States)

    Buniatyan, M S; Belozerova, N V; At'kov, O Yu

    2016-01-01

    The article covers prevalence of obstructive sleep apnea syndrome, its role in health disorders of workers engaged into railway safety. The authors analyzed present standards of occupational fitness in workers performing critically important operating activities and methods of occupational selection with possible obstructive sleep apnea syndrome. I stage recommendations are suggested in diagnosis of obstructive sleep apnea syndrome in workers engaged into railway safety. Obstructive sleep apnea syndrome appeared to threaten operators' activity, to cause accidents, to early disablement due to life-threatening complications, to unsuitability for the occupation due to diseases connected with obstructive sleep apnea syndrome (arterial hypertension, diabetes mellitus, metabolic syndrome, cardiac rhythm and conductivity disorders, obesity).

  2. Novel technique in the management of obstructive jaundice caused by pancreatic pseudocyst

    Directory of Open Access Journals (Sweden)

    Gautham Krishnamurthy

    2015-04-01

    Full Text Available Pancreatic pseudocysts are a well-known complication of acute and chronic pancreatitis. The presenting feature of these can be of the pseudocyst per se or due to their complication. Obstructive jaundice caused by a pancreatic pseudocyst has been attributed to various reasons, the most common being an intrapancreatic stricture of the common bile duct. We present a case of a 32-year-old male with a pseudocyst of the pancreas complicated by obstructive jaundice. He was treated by performing choledocho-pseudocystostomy and cystoduodenostomy. The patient made an uneventful recovery. The method adopted provided adequate internal drainage of the pseudocyst content and bile. To our knowledge this is the first time that such an anastomosis is being reported in English literature. [Arch Clin Exp Surg 2015; 4(2.000: 103-106

  3. A rare case of ectopic pancreas in the ampulla of Vater presented with obstructive jaundice.

    Science.gov (United States)

    Filippou, Dimitrios K; Vezakis, Antonios; Filippou, Georgios; Condilis, Nicolas; Rizos, Spiros; Skandalakis, Panagiotis

    2006-01-01

    A rare case of ectopic pancreas in the ampulla of Vater presented with obstructive jaundice. Ectopic pancreas is a common congenital disorder which is referred to as pancreatic rest. The incidence in autopsy series varies from 1 to 2% (range 0.55 to 13%). Most common site of ectopic pancreatic tissue is the stomach, although it can be found anywhere in the foregut and the proximal midgut. Ectopic pancreatic tissue in the ampulla of Vater is a very rare condition. Searching in the literature, using the terms "ectopic pancreas" and "Ampulla of Vater", we found only 10 records. The authors report on a rare case of a 69 years old female with ectopic pancreas in the ampulla of Vater, presented with painless obstructive jaundice, and the diagnostic and therapeutic strategy that followed.

  4. Evaluation of upper airway obstruction in infants with Pierre Robin sequence and the role of polysomnography--Review of current evidence.

    Science.gov (United States)

    Reddy, Vudum Sridhar

    2016-01-01

    Pierre Robin sequence (PRS) is a heterogeneous condition presenting with upper airway obstruction (UAO) of varying severity. Polysomnography (PSG) is an objective investigation to assess the severity of obstructive sleep apnea and UAO. Its role in the management of PRS has not been well defined. This review summarizes the available evidence on the role of PSG in the assessment of infants with PRS in the context of other commonly used methods of assessment.

  5. Oligonucleotide Therapy for Obstructive and Restrictive Respiratory Diseases

    Directory of Open Access Journals (Sweden)

    Wupeng Liao

    2017-01-01

    Full Text Available Inhaled oligonucleotide is an emerging therapeutic modality for various common respiratory diseases, including obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD and restrictive airway diseases like idiopathic pulmonary fibrosis (IPF. The advantage of direct accessibility for oligonucleotide molecules to the lung target sites, bypassing systemic administration, makes this therapeutic approach promising with minimized potential systemic side effects. Asthma, COPD, and IPF are common chronic respiratory diseases, characterized by persistent airway inflammation and dysregulated tissue repair and remodeling, although each individual disease has its unique etiology. Corticosteroids have been widely prescribed for the treatment of asthma, COPD, and IPF. However, the effectiveness of corticosteroids as an anti-inflammatory drug is limited by steroid resistance in severe asthma, the majority of COPD cases, and pulmonary fibrosis. There is an urgent medical need to develop target-specific drugs for the treatment of these respiratory conditions. Oligonucleotide therapies, including antisense oligonucleotide (ASO, small interfering RNA (siRNA, and microRNA (miRNA are now being evaluated both pre-clinically and clinically as potential therapeutics. The mechanisms of action of ASO and siRNA are highly target mRNA specific, ultimately leading to target protein knockdown. miRNA has both biomarker and therapeutic values, and its knockdown by a miRNA antagonist (antagomir has a broader but potentially more non-specific biological outcome. This review will compile the current findings of oligonucleotide therapeutic targets, verified in various respiratory disease models and in clinical trials, and evaluate different chemical modification approaches to improve the stability and potency of oligonucleotides for the treatment of respiratory diseases.

  6. Oligonucleotide Therapy for Obstructive and Restrictive Respiratory Diseases.

    Science.gov (United States)

    Liao, Wupeng; Dong, Jinrui; Peh, Hong Yong; Tan, Lay Hong; Lim, Kah Suan; Li, Li; Wong, Wai-Shiu Fred

    2017-01-17

    Inhaled oligonucleotide is an emerging therapeutic modality for various common respiratory diseases, including obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) and restrictive airway diseases like idiopathic pulmonary fibrosis (IPF). The advantage of direct accessibility for oligonucleotide molecules to the lung target sites, bypassing systemic administration, makes this therapeutic approach promising with minimized potential systemic side effects. Asthma, COPD, and IPF are common chronic respiratory diseases, characterized by persistent airway inflammation and dysregulated tissue repair and remodeling, although each individual disease has its unique etiology. Corticosteroids have been widely prescribed for the treatment of asthma, COPD, and IPF. However, the effectiveness of corticosteroids as an anti-inflammatory drug is limited by steroid resistance in severe asthma, the majority of COPD cases, and pulmonary fibrosis. There is an urgent medical need to develop target-specific drugs for the treatment of these respiratory conditions. Oligonucleotide therapies, including antisense oligonucleotide (ASO), small interfering RNA (siRNA), and microRNA (miRNA) are now being evaluated both pre-clinically and clinically as potential therapeutics. The mechanisms of action of ASO and siRNA are highly target mRNA specific, ultimately leading to target protein knockdown. miRNA has both biomarker and therapeutic values, and its knockdown by a miRNA antagonist (antagomir) has a broader but potentially more non-specific biological outcome. This review will compile the current findings of oligonucleotide therapeutic targets, verified in various respiratory disease models and in clinical trials, and evaluate different chemical modification approaches to improve the stability and potency of oligonucleotides for the treatment of respiratory diseases.

  7. Estimation of airway obstruction using oximeter plethysmograph waveform data

    Directory of Open Access Journals (Sweden)

    Desmond Renee' A

    2005-06-01

    Full Text Available Abstract Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

  8. Common Privacy Myths

    Science.gov (United States)

    ... Health Information home > privacy + phrs > common privacy myths Common Privacy Myths With the new federal laws protecting ... Here are the truths to some of the common myths: Health information cannot be faxed – FALSE Your ...

  9. Common NICU Equipment

    Science.gov (United States)

    ... newborn intensive care unit (NICU) > Common NICU equipment Common NICU equipment E-mail to a friend Please ... Baby Caring for your baby Feeding your baby Common illnesses Family health & safety Complications & Loss Pregnancy complications ...

  10. Common Variable Immunodeficiency (CVID)

    Science.gov (United States)

    ... with facebook share with twitter share with linkedin Common Variable Immunodeficiency (CVID) Common variable immunodeficiency (CVID) is ... and acquired agammaglobulinemia. Why Is the Study of Common Variable Immunodeficiency (CVID) a Priority for NIAID? CVID ...

  11. Common Discomforts of Pregnancy

    Science.gov (United States)

    ... Home > Pregnancy > Prenatal care > Common discomforts of pregnancy Common discomforts of pregnancy E-mail to a friend ... like back ache and being really tired are common and shouldn’t make you worry. For most ...

  12. Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey

    Directory of Open Access Journals (Sweden)

    Park HJ

    2015-08-01

    Full Text Available Hee Jin Park, Ah Young Leem, Sang Hoon Lee, Ju Han Song, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Kyung Soo Chung Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea Background: Comorbidities can occur frequently in patients with chronic obstructive pulmonary disease (COPD and can influence mortality and morbidity independently. It is increasingly recognized that many patients with COPD have comorbidities that have a major impact on their quality of life and survival. Therefore, we investigated the prevalence of comorbidities in Korean COPD populations. Methods: We used data obtained in the 6 years of the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES IV and V. Among 50,405 subjects, 16,151 subjects aged ≥40 years who performed spirometry adequately were included in this study. Airway obstruction was defined as forced expiratory volume in 1 second/forced vital capacity <0.7, and the Global Initiative For Chronic Obstructive Lung Disease stage was used to evaluate the severity of airway obstruction. Statistical analyses were performed using SAS 9.2. Results: Among the 16,151 subjects (43.2% male, 56.8% female; mean age: 57.1 years for men and 57.2 years for women, 13.1% had obstructive lung function; 11.3%, restrictive lung function; and 75.6%, normal lung function. Among individuals with obstructive lung function, 45.3%, 49.4%, and 5.3% had mild, moderate, and severe and very severe airflow limitation. The prevalence of hypertension, diabetes mellitus (DM, underweight, and hypertriglyceridemia was higher in the obstructive lung function group than in the normal lung function group (49.6% vs 35.2%; 16.8% vs 10.5%; 3.3% vs 1.3%; 19.7% vs 17.0%. According to the severity of airway obstruction, hypertension and underweight were more common as severity increased

  13. [The role of maxillofacial surgery in obstructive sleep hypopnea and apnea syndrome].

    Science.gov (United States)

    Gilon, Yves; Raskin, Sylviane; Heymans, Olivier; Poirrier, Robert

    2002-01-01

    One of the most common symptoms of obstructive sleep apnea syndrome (OSAS) is daytime drowsiness. It is associated with a high cardiovascular morbidity and mortality, and an elevated incidence of car crashes. In general, young patients don't want conservative treatment because symptomatic and to prevent secondary effects. In this article, we briefly define sleep disorders and the interest of cephalometric examination. We describe the different treatment possibilities and stress the important role of orthognathic surgery in this syndrome.

  14. Obstructive jaundice due to tuberculosis of distal CBD and periampullary region mimickcholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Sumantra Ray

    2012-01-01

    Full Text Available Abdominal tuberculosis (TB commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.

  15. OBSTRUCTION OF RIGHT VENTRICULAR OUTFLOW TRACT CAUSED BY INTRACAVITARY METASTATIC DISEASE OF PANCREATIC TUMOR

    Institute of Scientific and Technical Information of China (English)

    Meng-tao Li; Wen-ling Zhu

    2005-01-01

    @@ THE pericardium (90%) is the most common loca tion of cardiac involvement by secondary tumor,followed by myocardium and endocardium (10%).1 Cases of right ventricular outflow tract obstruction caused by intracavitary metastatic tumor growth were rarely reported, al though clinical presentation were unique. We herein reported such a case with literature review in order to improve the understanding of malignant cardiac metastasis.

  16. Bridging Lung Development with Chronic Obstructive Pulmonary Disease. Relevance of Developmental Pathways in Chronic Obstructive Pulmonary Disease Pathogenesis.

    Science.gov (United States)

    Boucherat, Olivier; Morissette, Mathieu C; Provencher, Steeve; Bonnet, Sébastien; Maltais, François

    2016-02-15

    Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation. This generic term encompasses emphysema and chronic bronchitis, two common conditions, each having distinct but also overlapping features. Recent epidemiological and experimental studies have challenged the traditional view that COPD is exclusively an adult disease occurring after years of inhalational insults to the lungs, pinpointing abnormalities or disruption of the pathways that control lung development as an important susceptibility factor for adult COPD. In addition, there is growing evidence that emphysema is not solely a destructive process because it is also characterized by a failure in cell and molecular maintenance programs necessary for proper lung development. This leads to the concept that tissue regeneration required stimulation of signaling pathways that normally operate during development. We undertook a review of the literature to outline the contribution of developmental insults and genes in the occurrence and pathogenesis of COPD, respectively.

  17. Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21.

    Science.gov (United States)

    Wood, Lauren S Y; Kastenberg, Zachary; Sinclair, Tiffany; Chao, Stephanie; Wall, James K

    2016-05-01

    Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as successful in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery. A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15 mm radially dilating balloon. The patient tolerated the procedure well, and also tolerated full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively. This report describes a successful endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21, and laparoscopy confirmed no intraabdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention.

  18. Dynamics of snoring sounds and its connection with obstructive sleep apnea

    Science.gov (United States)

    Alencar, Adriano M.; da Silva, Diego Greatti Vaz; Oliveira, Carolina Beatriz; Vieira, André P.; Moriya, Henrique T.; Lorenzi-Filho, Geraldo

    2013-01-01

    Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets - the snore sound - recorded during full polysomnography in patients referred to the Sleep Laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 s, correlates with respiratory obstructive events. We find that the number of irregular snores - easily accessible, and quantified by what we call the snore time interval index (STII) - is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with moderate or severe apnea.

  19. Perception of Better Nasal Patency Correlates with Increased Mucosal Cooling after Surgery for Nasal Obstruction

    Science.gov (United States)

    Garcia, Guilherme; Sullivan, Corbin; Frank-Ito, Dennis; Kimbell, Julia; Rhee, John

    2014-11-01

    Nasal airway obstruction (NAO) is a common health problem with 340,000 patients undergoing surgery annually in the United States. Traditionally, otolaryngologists have focused on airspace cross-sectional areas and nasal resistance to airflow as objective measures of nasal patency, but neither of these variables correlated consistently with patients' symptoms. Given that the sensation of nasal airflow is also associated with mucosal cooling (i.e., heat loss) during inspiration, we investigated the correlation between the sensation of nasal obstruction and mucosal cooling in 10 patients before and after NAO surgery. Three-dimensional models of the nasal anatomy were created based on pre- and post-surgery computed tomography scans. Computational fluid dynamics (CFD) simulations were conducted to quantify nasal resistance and mucosal cooling. Patient-reported symptoms were measured by a visual analog scale and the Nasal Obstruction Symptom Evaluation (NOSE), a disease-specific quality of life questionnaire. Our results revealed that the subjective sensation of nasal obstruction correlated with both nasal resistance and heat loss, but the strongest correlation was between the NOSE score and the nasal surface area where heat flux exceeds 50 W /m2 . In conclusion, a significant post-operative increase in mucosal cooling correlates well with patients' perception of better nasal patency after NAO surgery.

  20. Small Bowel Obstruction Secondary to Femoral Hernia; Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Majid Akrami

    2016-01-01

    Full Text Available Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause.

  1. Small Bowel Obstruction Secondary to Femoral Hernia; Case Report and Review of the Literature.

    Science.gov (United States)

    Akrami, Majid; Karami, MohamamdYasin; Zangouri, Vahid; Deilami, Iman; Maalhagh, Mehrnoush

    2016-01-01

    Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause.

  2. Urodynamic changes in a female case of obstructive sleep apnea syndrome with enuresis: 7 years' follow-up

    Institute of Scientific and Technical Information of China (English)

    CAO Xia; HU Ke; CHEN Xue-qin; XIANYU Yun-yan; Lü Sheng-qi; LI Qing-quan

    2010-01-01

    @@ Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive upper airway occlusion resulting in apnea lasting 10 seconds or more. Clinical manifestations include snoring, daytime somnolence,intellectual deficiency, sexual impotence, and nocturnal polyuria. Enuresis associated with OSAS is suggested to be more common in children than in adults.1

  3. Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

    Directory of Open Access Journals (Sweden)

    MCY Tan

    2008-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs. Continuous positive airway pressure (CPAP, which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.

  4. Investigating the flow dynamics in the obstructed and stented ureter by means of a biomimetic artificial model

    NARCIS (Netherlands)

    F. Clavica (Francesco); X. Zhao (Xuefeng); M. ElMahdy (Motaz); M.T. Drake (Marcus); X. Zhang (Xunli); D. Carugo (Dario)

    2014-01-01

    textabstractDouble-J stenting is the most common clinical method employed to restore the upper urinary tract drainage, in the presence of a ureteric obstruction. After implant, stents provide an immediate pain relief by decreasing the pressure in the renal pelvis (P). However, their long-term usage

  5. Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care

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    Lothar Faber

    2014-01-01

    Full Text Available Hypertrophic cardiomyopathy (HCM is one of the more common hereditary cardiac conditions. According to presence or absence of outflow obstruction at rest or with provocation, a more common (about 60–70% obstructive type of the disease (HOCM has to be distinguished from the less common (30–40% nonobstructive phenotype (HNCM. Symptoms include exercise limitation due to dyspnea, angina pectoris, palpitations, or dizziness; occasionally syncope or sudden cardiac death occurs. Correct diagnosis and risk stratification with respect to prophylactic ICD implantation are essential in HCM patient management. Drug therapy in symptomatic patients can be characterized as treatment of heart failure with preserved ejection fraction (HFpEF in HNCM, while symptoms and the obstructive gradient in HOCM can be addressed with beta-blockers, disopyramide, or verapamil. After a short overview on etiology, natural history, and diagnostics in hypertrophic cardiomyopathy, this paper reviews the current treatment options for HOCM with a special focus on percutaneous septal ablation. Literature data and the own series of about 600 cases are discussed, suggesting a largely comparable outcome with respect to procedural mortality, clinical efficacy, and long-term outcome.

  6. Bile duct ligation in mice: induction of inflammatory liver injury and fibrosis by obstructive cholestasis.

    Science.gov (United States)

    Tag, Carmen G; Sauer-Lehnen, Sibille; Weiskirchen, Sabine; Borkham-Kamphorst, Erawan; Tolba, René H; Tacke, Frank; Weiskirchen, Ralf

    2015-02-10

    In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well as to excrete bilirubin and other metabolic products. In the liver, the experimental obstruction of the extrahepatic biliary system initiates a complex cascade of pathological events that leads to cholestasis and inflammation resulting in a strong fibrotic reaction originating from the periportal fields. Therefore, surgical ligation of the common bile duct has become the most commonly used model to induce obstructive cholestatic injury in rodents and to study the molecular and cellular events that underlie these pathophysiological mechanisms induced by inappropriate bile flow. In recent years, different surgical techniques have been described that either allow reconnection or reanastomosis after bile duct ligation (BDL), e.g., partial BDL, or other microsurgical methods for specific research questions. However, the most frequently used model is the complete obstruction of the common bile duct that induces a strong fibrotic response after 21 to 28 days. The mortality rate can be high due to infectious complications or technical inaccuracies. Here we provide a detailed surgical procedure for the BDL model in mice that induce a highly reproducible fibrotic response in accordance to the 3R rule for animal welfare postulated by Russel and Burch in 1959.

  7. 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.

  8. Esophageal stent migration leads to intestinal obstruction

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    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.

  9. Pierre Robin sequence and obstructive sleep apnea

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    Rubens Reimão

    1994-12-01

    Full Text Available The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT perfomed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

  10. Intestinal obstruction for biliary lithiasis: case report

    Directory of Open Access Journals (Sweden)

    Miguel Enrique Rodriguez Rodriguez

    2017-06-01

    Full Text Available The biliary ileum is an infrequent complication of cholelithiasis, that is manifested as an intestinal obstruction, is more prevalent in aged people. The clinical square of the biliary ileum is diffuse and the Triad of Rigler is observed in less than 30% of the patient one. The surgical treatment goes from enterotomía and litotricia to the colecistectomía with treatment of the water-pipe. The case of a female, 86-year-old patient is presented that after a week of symptoms and of medical treatment it was detected the presence of a mechanical intestinal obstruction for which the patient underwent emergency surgery. As the cause of occlusion it was found a thick gallstone in a jejunal loop.

  11. Benign obstruction of the common hepatic duct (Mirizzi syndrome: diagnosis and operative management Obstrução benigna do ducto hepático comum (síndrome de Mirizzi: diagnóstico e tratamento operatório

    Directory of Open Access Journals (Sweden)

    Jaques Waisberg

    2005-03-01

    Full Text Available BACKGROUND: Mirizzi syndrome is a rare complication of prolonged cholelithiasis, characterized by narrowing of the common hepatic duct due to mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. OBJECTIVES: To describe a series of eight consecutive patients with Mirizzi syndrome, at a single institution, submitted to surgical treatment and to comment on their aspects with emphasis on the diagnosis and treatment. METHODS: Four women and four men, with a mean age of 61.6 years (42 to 82 years, presenting Mirizzi syndrome were operated between 1997 and 2003. The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures, and complications. RESULTS: The most frequent symptoms were abdominal pain (87.5% and jaundice (87.5%. All the patients presented altered hepatic function tests. The diagnosis of Mirizzi syndrome was intra-operative in seven (87.5% patients, and preoperative in one (12.5%. Cholecystocholedochal fistula associated with choledocholithiasis was observed in three (37.5% cases. Mirizzi syndrome was classified as Csendes type I in five (62.5% patients, type II in one (12.5%, type III in one (12,5% and type IV in another (12.5%. Cholecystectomy, as an isolated surgical procedure, was performed in four (50.0% patients. One (12.5% patient was submitted to partial cholecystectomy and closure of the fistulous orifice with the central part of the infundibula. Two (25.0% patients were submitted to cholecystectomy and side-to-side choledochoduodenostomy and another (12.5% to side-to-side choledochoduodenostomy remaining the gallbladder in situ. Seven (87.5% patients had an uneventful recovery and were discharged in good conditions. One (12.5% patient presented a

  12. Acute jejunoileal obstruction due to a pseudopolyp in a child with undiagnosed crohn disease: A case report

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    Christianakis Efstratios

    2008-02-01

    Full Text Available Abstract Introduction Crohn's disease (CD can affect any part of the alimentary tract from the mouth to the anus, with most common site being the terminal ileum. Case presentation A child suffering from undiagnosed Crohn disease (CD, presented with an acute abdominal obstruction due to a large pseudopolyp in the jejunoileal area. At laparotomy, a jejunoileal segment of 45 cm, containing multiple areas of damage to the small intestine, was excised and a primary end – to – end anastomosis was performed. Conclusion The coexistence of an intestinal pseudopolyp with undiagnosed Crohn's disease may be the cause of acute abdominal obstruction in children.

  13. A Rare Case of an Early Postoperative Obstructive Ileus in a Young Female Patient due to a Residual Trichobezoar Mass

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    P. Christopoulos

    2016-01-01

    Full Text Available Trichobezoar is a rare cause of small bowel obstruction, whereby a mass forms most commonly in the stomach and duodenum of young females, from ingestion of hair, a condition known as trichophagia. We present a case of recurrent small bowel obstruction due to a residual hair mass that was removed surgically in a young female patient who had a laparotomy and gastrotomy for removal of a large gastric trichobezoar just two weeks prior to the current admission. This case illustrates the importance of a thorough inspection of the whole bowel to ensure that no residual bezoars remain after surgery.

  14. Congenital obstructive posterior urethral membranes and recurrent urinary tract infection: a rare case of congenital hypertrophy of the verumontanum

    Directory of Open Access Journals (Sweden)

    Diana Bancin

    2016-07-01

    Full Text Available Congenital obstructive posterior urethral membranes (COPUM is a complex disease closely related to several pathological changes in kidney development and function, as a result of urinary reflux since in utero. This congenital anomaly of urinary tract potentially causes hydroureteronephrosis that is often associated with recurrent urinary tract infections and, ultimately, one of the most common causes of end-stage renal disease in children.1,2 Congenital hypertrophy of the verumontanum as part of COPUM is very rare. Only a few reports have been written on congenital hypertrophy of the vermontanum causing congenital obstructive uropathy.3-6

  15. Partial upper airway obstruction in sleep after uvulopalatopharyngoplasty.

    Science.gov (United States)

    Polo, O; Brissaud, L; Fraga, J; Déjean, Y; Billiard, M

    1989-11-01

    Uvulopalatopharyngoplasty is the treatment of choice for selected patients with obstructive sleep apnea, although the response to surgery is variable. We measured, in addition to obstructive apnea, the frequency of sleep-related partial upper airway obstruction in 11 patients with the obstructive sleep apnea syndrome both before and after uvulopalatopharyngoplasty. Partial obstruction was detected indirectly by recording the secondary hemodynamic changes and respiratory stimulation with the static charge sensitive bed. The frequency of obstructive apnea episodes was reduced from 56.3% to 18.4% by the operation, while the episodes of increased respiratory resistance rose from 3.6% to 20.4%. The various breathing anomalies decreased significantly, although they were still present during 75.6% of the recording time. The results suggest that uvulopalatopharyngoplasty substantially reduces the frequency of obstructive apnea, some of which persists as partial obstruction. The persistent partial obstruction may be the key factor contributing to further pharyngeal narrowing and a recurrence of obstructive sleep apnea syndrome.

  16. Lingua-epiglottis position predicts glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome.

    Science.gov (United States)

    Li, Shuhua; Wu, Dahai; Jie, Qin; Bao, Jimin; Shi, Hongjin

    2014-10-01

    The objective of the study was to investigate the relationship between lingua-epiglottis position and glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). One hundred and four patients with OSAHS diagnosed by polysomnography (PSG) were enrolled. Lingua-epiglottis position was visualized using endoscopy and classified into three types. Spiral CT imaging of the upper respiratory tract was performed to measure the cross-sectional area and inner diameter of the glossopharyngeal airway. The PSG was repeated after nasopharyngeal tube insertion (NPT-PSG). The NPT-PSG results, CT-measured data and incidence of stenosis were compared among the different lingua-epiglottis position groups. Obstructive sleep apnea hypopnea syndrome patients with different lingua-epiglottis positions had similar demographics. As lingua-epiglottis position type varied from type I to type III, cross-sectional area and inner diameter of the glossopharyngeal area decreased, glossopharyngeal airway stenosis rate increased, and apnea hypopnea index measured by NPT-PSG increased. The lowest oxygen saturation decreased. Lingua-epiglottis position was significantly related to glossopharyngeal obstruction. Lingua-epiglottis position should be used in clinical practice for the preliminary assessment of glossopharyngeal obstruction.

  17. Gingival hyperplasia by upper airway obstruction

    OpenAIRE

    Díaz Soriano, Ana; Docente Departamento Académico de Estomatología Biosocial.; Lévano Torres, Víctor; Docente Departamento Académico Médico Quirúrgico.; Pastor Yataco, Shamila; Alumnos del 3er año de Odontología de la UNMSM.; Vallejos Pulido, Arturo; Alumnos del 3er año de Odontología de la UNMSM.; Huamanyauri Gonzales, Lizbeth; Alumnos del 3er año de Odontología de la UNMSM.

    2014-01-01

    The effects of mouth breathing are the introduction of cold air, dry and dusty in the mouth and pharynx, the lost functions of heating, humedificacion and filtering the air entering the nose increases the oral mucosa irritation and pharyngeal. A case of a female patient 15 years old who comes for consultation of Periodontology with increase in volume and gingival redness in the upper anterior sector of upper airway obstruction caused by deviated septum right turbinate hypertrophy and maxillar...

  18. Childhood Obesity and Obstructive Sleep Apnea

    OpenAIRE

    Indra Narang; Mathew, Joseph L

    2012-01-01

    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...

  19. Chronic Idiopathic Intestinal Pseudo-obstruction.

    Science.gov (United States)

    Malagelada

    2000-08-01

    The definition of chronic idiopathic intestinal pseudo-obstruction (CIIP) is somewhat vague because it was based on clinical observations that preceded modern advances in the measurement of gut motility and neuromuscular integrity. Appropriate management of patients with CIIP requires an initial consideration, supported by pertinent diagnostic tests, of the tissue affected (muscle, nerves, both), extent and magnitude of gut propulsive failure, and extraintestinal disease.

  20. Obstructive lung disease models: what is valid?

    Science.gov (United States)

    Ferdinands, Jill M; Mannino, David M

    2008-12-01

    Use of disease simulation models has led to scrutiny of model methods and demand for evidence that models credibly simulate health outcomes. We sought to describe recent obstructive lung disease simulation models and their validation. Medline and EMBASE were used to identify obstructive lung disease simulation models published from January 2000 to June 2006. Publications were reviewed to assess model attributes and four types of validation: first-order (verification/debugging), second-order (comparison with studies used in model development), third-order (comparison with studies not used in model development), and predictive validity. Six asthma and seven chronic obstructive pulmonary disease models were identified. Seven (54%) models included second-order validation, typically by comparing observed outcomes to simulations of source study cohorts. Seven (54%) models included third-order validation, in which modeled outcomes were usually compared qualitatively for agreement with studies independent of the model. Validation endpoints included disease prevalence, exacerbation, and all-cause mortality. Validation was typically described as acceptable, despite near-universal absence of criteria for judging adequacy of validation. Although over half of recent obstructive lung disease simulation models report validation, inconsistencies in validation methods and lack of detailed reporting make assessing adequacy of validation difficult. For simulation modeling to be accepted as a tool for evaluating clinical and public health programs, models must be validated to credibly simulate health outcomes of interest. Defining the required level of validation and providing guidance for quantitative assessment and reporting of validation are important future steps in promoting simulation models as practical decision tools.

  1. INFERIOR TURBINECTOMY FOR NASAL OBSTRUCTION-STUDY O F 219 CASES

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    Santhosh

    2013-03-01

    Full Text Available ABSTRACT: OBJECTIVE : To determine the success rate of inferior turbine ctomy for nasal obstruction. To study complications of inferior turb inectomy. To study the histopathological changes in the inferior turbinate specimens. METHOD : This prospective, single blinded, randomized study of 219 consecutive patients carried out in two tertiary le vel centres from January 2010 to October 2011. The patients were asse ssed preoperatively and postoperatively both subjectively and objectively. The patients who were refractory to the directed conservative treatment for chronic nasal obstruction underwent i nferior turbinectomy on both sides and septoplasty if required. The inferior turbinectomy spe cimen was sent for histopathological examination. NOSE Questionnaires were used for subj ective assessment and rigid nasal endoscopy used for objective assessment. Follow up do ne at 1 week, 1 month and 6 months after surgery. Friedman test applied for assessment o f the improvement. RESULTS : 92 % (n=203 of patients relieved of nasal obstruction fo r which they approached. The improvement is statistically significant both subjectively and objectively. The common complications in present study is postoperative nasal synechia which o ccurred in 5% (n=10. Bleeding occurred in 4%(n=8. Dryness and crusting occurred in 2%(n=4 and foul odour in 2% (n=4. The present study also showed that most common cause for turbinate enlargement is chronic nonspecific inflammatory hypertrophy followed by aller gic turbinate hypertrophy. CONCLUSION : -The results show that inferior turbinectomy is t he good method of achieving relief from the nasal obstruction with minimal morb idity. Histopathological examination showed that most common cause of turbinate enlargem ent is chronic non specific turbinate hypertrophy and it proves beyond doubt that unnecessa ry excessive antiallergic treatment should be avoided in patients with chronic nasal obs truction KEY WORDS: inferior

  2. Genetic Associations with Obstructive Sleep Apnea Traits in Hispanic/Latino Americans.

    Science.gov (United States)

    Cade, Brian E; Chen, Han; Stilp, Adrienne M; Gleason, Kevin J; Sofer, Tamar; Ancoli-Israel, Sonia; Arens, Raanan; Bell, Graeme I; Below, Jennifer E; Bjonnes, Andrew C; Chun, Sung; Conomos, Matthew P; Evans, Daniel S; Johnson, W Craig; Frazier-Wood, Alexis C; Lane, Jacqueline M; Larkin, Emma K; Loredo, Jose S; Post, Wendy S; Ramos, Alberto R; Rice, Ken; Rotter, Jerome I; Shah, Neomi A; Stone, Katie L; Taylor, Kent D; Thornton, Timothy A; Tranah, Gregory J; Wang, Chaolong; Zee, Phyllis C; Hanis, Craig L; Sunyaev, Shamil R; Patel, Sanjay R; Laurie, Cathy C; Zhu, Xiaofeng; Saxena, Richa; Lin, Xihong; Redline, Susan

    2016-10-01

    Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic basis is still largely unknown. Prior genetic studies focused on traits defined using the apnea-hypopnea index, which contains limited information on potentially important genetically determined physiologic factors, such as propensity for hypoxemia and respiratory arousability. To define novel obstructive sleep apnea genetic risk loci for obstructive sleep apnea, we conducted genome-wide association studies of quantitative traits in Hispanic/Latino Americans from three cohorts. Genome-wide data from as many as 12,558 participants in the Hispanic Community Health Study/Study of Latinos, Multi-Ethnic Study of Atherosclerosis, and Starr County Health Studies population-based cohorts were metaanalyzed for association with the apnea-hypopnea index, average oxygen saturation during sleep, and average respiratory event duration. Two novel loci were identified at genome-level significance (rs11691765, GPR83, P = 1.90 × 10(-8) for the apnea-hypopnea index, and rs35424364; C6ORF183/CCDC162P, P = 4.88 × 10(-8) for respiratory event duration) and seven additional loci were identified with suggestive significance (P < 5 × 10(-7)). Secondary sex-stratified analyses also identified one significant and several suggestive associations. Multiple loci overlapped genes with biologic plausibility. These are the first genome-level significant findings reported for obstructive sleep apnea-related physiologic traits in any population. These findings identify novel associations in inflammatory, hypoxia signaling, and sleep pathways.

  3. Bile Culture and Susceptibility Testing of Malignant Biliary Obstruction via PTBD

    Energy Technology Data Exchange (ETDEWEB)

    Yu Haipeng; Guo Zhi, E-mail: jieruke@yahoo.com.cn; Xing Wenge; Guo Xiuying; Liu Fang; Li Baoguo [Tinajin Medical University Cancer Institute and Hospital, Department of Interventional Therapy, Tianjin Key Cancer Prevention and Treatment Laboratory (China)

    2012-10-15

    Purpose: To assess the information obtained by bile culture and susceptibility testing for malignant biliary obstruction by a retrospective one-center study. Methods: A total of 694 patients with malignant biliary obstruction received percutaneous transhepatic biliary drainage during the period July 2003 to September 2010, and subsequently, bile specimens were collected during the procedure. Among the 694 patients, 485 were men and 209 were women, ranging in age from 38 to 78 years (mean age 62 years). Results: A total of 42.9% patients had a positive bile culture (298 of 694). Further, 57 species of microorganisms and 342 strains were identified; gram-positive bacteria accounted for 50.9% (174 of 342) and gram-negative bacteria accounted for 41.5% (142 of 342) of these strains. No anaerobes were obtained by culture during this study. The most common microorganisms were Enterococcus faecalis (41 of 342, 11.9%), Escherichia coli (34 of 342, 9.9%), Klebsiella pneumoniae (28 of 342, 8.2%), Staphylococcus epidermidis (19 of 342, 5.5%), Enterococcus (18 of 342, 5.3%), and Enterobacter cloacae (16 of 342, 4.7%). The percentage of {beta}-lactamase-producing gram-positive bacteria was 27.6% (48 of 174), and the percentage of gram-negative bacteria was 19.7% (28 of 142). The percentage of enzyme-producing Escherichia coli was 61.7% (21 of 34). Conclusion: The bile cultures in malignant biliary obstruction are different from those in the Tokyo Guidelines and other benign biliary obstruction researches, which indicates that a different antibacterial therapy should be applied. Thus, knowledge of the antimicrobial susceptibility data could aid in the better use of antibiotics for the empirical therapy of biliary infection combined with malignant biliary obstruction.

  4. Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006

    Directory of Open Access Journals (Sweden)

    Gerald Shambira

    2010-07-01

    Full Text Available INTRODUCTION: Workers in the cotton processing industries risk developing obstructive respiratory conditions due to prolonged exposure to cotton dust. We noted a tenfold increase in asthma among workers in a Textile Manufacturing Company. We determined the prevalence of respiratory obstructive conditions among workers in various sections. METHODS: We conducted a cross sectional analytic study. Workers were randomly sampled and data was collected using interviewer-administered questionnaires. Respiratory function was assessed using spirometry and chest auscultation. A walk through survey was conducted and a checklist was used to capture hazards and control measures in the work place. RESULTS: A total of 194 workers participated. The prevalence of severe respiratory obstruction was 27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders, 15.0% in spinners and 7.5% among weavers. The mean years of exposure between the affected and the non-affected were significantly different (T =2.20; p less than 0.05. Working in the blowing department was significantly associated with developing respiratory obstruction (OR=3.53; 95% CI= 1.61- 7.79 but working in the weaving department was significantly protective (OR 0.16; CI 0.04-0.59.Working in a department for less than 10 years was protective (OR =0.94; 95% CI= 0.48- 1.85, but not significant. CONCLUSION: Obstructive respiratory conditions are common among textile workers, with those in blowing and waste recovery sections being the most affected. We recommended worker rotation every six months, regular spirometric screening employment of a medical officer.

  5. Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Odencrants, Sigrid; Ehnfors, Margareta; Ehrenberg, Anna

    2008-07-01

    The aim of the study was to describe and compare nutritional status and social and medical characteristics among older patients with chronic obstructive pulmonary disease admitted to an acute care hospital ward for respiratory medicine. Chronic obstructive pulmonary disease is a condition associated with risk of developing malnutrition. A body mass index chronic obstructive pulmonary disease. Knowledge about patient characteristics is crucial for the identification of malnourished patients and the development of nursing care for these patients. Quantitative descriptive study. Thirty-three hospitalised women and 17 men with a mean age of 75.7 years (SD 6.9) were consecutively included. A very severe case of chronic obstructive pulmonary disease was indicated in 28 out of 39 patients who underwent a lung function test. Data were collected with measurement of nutritional status using Mini Nutritional Assessment, anthropometry and lung function. Nearly half of the patients (48%) were identified as malnourished, an equal part as at risk for malnutrition and two patients as well nourished. The mean Mini Nutritional Assessment score of 17.2 (SD 3.99) for all patients was near the Mini Nutritional Assessment cut-off score (i.e. 17) for malnutrition. Patients identified as malnourished had a mean body mass index of 18.9 and those at risk for malnutrition had a mean of 23.4. It was more common for those identified as malnourished to live singly, to not live in own property and to be dependent on daily community service. Seven patients identified as malnourished died during the data collection period. This study provides important knowledge about further risks of impaired nutritional status among older patients with chronic obstructive pulmonary disease. This knowledge can provide registered nurses with the necessary knowledge to make them aware of certain patients needing particular kinds of attention.

  6. Sensitivity and specificity of the hyperdense artery sign for arterial obstruction in acute ischemic stroke.

    Science.gov (United States)

    Mair, Grant; Boyd, Elena V; Chappell, Francesca M; von Kummer, Rüdiger; Lindley, Richard I; Sandercock, Peter; Wardlaw, Joanna M

    2015-01-01

    In acute ischemic stroke, the hyperdense artery sign (HAS) on noncontrast computed tomography (CT) is thought to represent intraluminal thrombus and, therefore, is a surrogate of arterial obstruction. We sought to assess the accuracy of HAS as a marker of arterial obstruction by thrombus. The Third International Stroke Trial (IST-3) was a randomized controlled trial testing the use of intravenous thrombolysis for acute ischemic stroke in patients who did not clearly meet the prevailing license criteria. Some participating IST-3 centers routinely performed CT or MR angiography at baseline. One reader assessed all relevant scans independently, blinded to all other data; we checked observer reliability. We combined IST-3 data with a systematic review and meta-analysis of all studies that assessed the accuracy of HAS using angiography (any modality). IST-3 had 273 patients with baseline CT or MR angiography and was the largest study of HAS accuracy. The meta-analysis (n=902+273=1175, including IST-3) found sensitivity and specificity of HAS for arterial obstruction on angiography to be 52% and 95%, respectively. HAS was more commonly identified in proximal than distal arteries (47% versus 37%; P=0.015), and its sensitivity increased with thinner CT slices (r=-0.73; P=0.001). Neither extent of obstruction nor time after stroke influenced HAS accuracy. When present in acute ischemic stroke, HAS indicates a high likelihood of arterial obstruction, but its absence indicates only a 50/50 chance of normal arterial patency. Thin-slice CT improves sensitivity of HAS detection. http://www.controlled-trials.com/ISRCTN25765518. Unique identifier: ISRCTN25765518. © 2014 American Heart Association, Inc.

  7. Acute intestinal obstruction due to Kalimate, a potassium-lowering agent: a case report and literature review.

    Science.gov (United States)

    Tongyoo, Assanee; Sriussadaporn, Ekkapak; Limpavitayaporn, Palin; Mingmalairak, Chatchai

    2013-12-01

    Sodium polystyrene sulfonate (Kayexalate) and calcium polystyrene sulfonate (CPS, Kalimate) are commonly used to reduce serum potassium. There were some published evidences of severe gastrointestinal complications from the administration of these agents such as colonic necrosis with or without perforation and acute obstruction. The authors reported a 52-year-old male patient being critically ill from severe soft tissue infection of the right leg and sepsis. Hyperkalemia had occurred due to renal insufficiency and required several doses of Kalimate to reduce the serum potassium level. Subsequently, the patient developed complete intestinal obstruction and an exploratory laparotomy was performed. The intra-operative findings were distended stomach and the small bowel contained a large amount of intraluminal affected Kalimate that was removed via gastrotomy and enterotomy. These findings suggested that the inspissated Kalimate could lead to significant obstruction of the gastrointestinal tract in some groups of patient.

  8. Efficacy of Magnetic Resonance urography in detecting crossing renal vessels in children with ureteropelvic junction obstruction.

    Science.gov (United States)

    Pavicevic, Polina K; Saranovic, Djordjije Z; Mandic, Marija J; Vukadinovic, Vojkan M; Djordjevic, Miroslav Lj; Radojicic, Zoran I; Petronic, Ivana; Cirovic, Dragana; Nikolic, Dejan

    2015-01-01

    An aberrant or accessory crossing renal vessel (CV) leading to the lower pole of the kidney is the most common extrinsic cause of uretero pelvic obstruction(UPJ) obstruction in a child and young adolescent.There is still controversy regarding there functional significance in obstruction Preoperative identification of such vessels may influence surgical management. First aim is to determine the value of magnetic resonance (MR) urography in detecting crossing vessels in children with UPJ obstruction,comparing the data with postoperative findings and the second one is to evaluate morphologic and functional parameters in these hydronephrotic kidneys. Between June 2009 and December 2012 we retrospectively reviewed MR urography records of one hundred and nine children with unilateral hydronephrosis at the University Children's Hospital. 68 (62.4%) were male and 41 (37.6%) were female,median age was 6.5 ± 5.7. Of the total number of patients, 30 (27%) underwent pyeloplasty, while 79 (72.5%) did not. The age at surgery ranged from 0.3 to 18 years (median 6.6 years). The indication for surgery was based on standard criteria (obstructed renal transit time with or without altered renal function of vDRF MRU, there was no crossing vessel in 21 kidneys, confirmed at surgery in 18. A crossing vessel was detected with MRU in 9 kidneys and confirmed at surgery in 6. Thus, the sensitivity of MRU was 66.7%, the specificity was 85.7%, the positive predictive value was 66.7%, the negative predictive value was 85.7% and the accuracy was 80%. There was no statistically significant difference in the detection of crossing vessels between MR urography and surgery (p = 0.004 and p MRU and surgery showed good agreement (κ = 0.524). Based on our results we suggest that MR urography is a reliable and safe diagnostic tool to determine crossing vessels in selected children with UPJ obstruction. Thus, MRU can substitute for other imaging modalities and provide detailed information about the

  9. Incidence of cancer in outpatients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Figueira Gonçalves, J M; Dorta Sánchez, R; Pérez Méndez, L I; Pérez Negrín, L; García-Talavera, I; Pérez Rodríguez, A; Díaz Pérez, D; Viña Manrique, P; Guzmán Sáenz, C

    2017-07-19

    The relationship between chronic obstructive pulmonary disease (COPD) and the overall incidence of cancer is poorly understood. The aim of this study was to analyse the incidence of cancer (pulmonary or extrapulmonary) in patients with COPD during follow-up in a specialised outpatient unit, as well as to assess its relationship with the degree of airflow obstruction. A prospective observational study was conducted with a cohort of 308 patients with COPD in pulmonology outpatient follow-up consultations from January 2012 to December 2015. The diagnosed malignancies during this period were divided into pulmonary and extrapulmonary. The overall incidence rate of cancer, lung cancer and extrapulmonary cancer were 10.3, 3.4 and 7.3 cases per 1,000 patients with COPD per year, respectively. The most common cancers were lung cancer (31%), genitourinary tract cancer (29%) and gastrointestinal cancer (21%). Mild-moderate stages (gradeI-II of the 2009 GOLD classification) and the increase in the pack-year index (PYI) were related to an increase in the onset of malignancies, with an odds ratio (OR) of 2.16 (95% confidence interval [95% CI]: 1.087-4.309; P=.026) and 1.01 (95% CI: 1.002-1.031; P=.023), respectively. The incidence of extrapulmonary cancer in patients with COPD was twice that of lung cancer; stagesI-II of the 2009 GOLD classification and the PYI were significantly related to the onset of malignancies. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Exercise induced laryngeal obstruction: a review of diagnosis and management.

    Science.gov (United States)

    Liyanagedara, Savinda; McLeod, Robert; Elhassan, Hassan A

    2017-04-01

    Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines the Cochrane, Embase, Ovid MEDLINE and PubMed databases were searched. Four search domains "exercise", "induced", "laryngeal" and "obstruction" were used. Primary searching found 469 records, 308 were excluded following screening of titles and citation. 100 were duplicates, a further 47 studies were excluded after applying inclusion and exclusion criteria. Two studies were identified following cross-referencing. A total of 15 studies were included. The last search date was 6/06/15. Average prevalence in the general adolescent population and athletes was 7.1 and 35.2 %, respectively. Dyspnoea was reported in 96.5, 99 and 100 % of three EILO patient cohorts. Two studies (n = 107) reported continuous laryngoscopy during exercise (CLE) testing could differentiate between patients and controls. In two studies (n = 33) the visual analogue scale (VAS) showed a beneficial effect of endoscopic supraglottoplasty (ES). Thirty-eight out of 43 patients who received two or more laryngeal control therapy sessions (LCT) had improvement or resolution of EILO symptoms. Exercise induced dyspnoea is the most common EILO symptom. EILO has a high occurrence in adolescents and athletes. The CLE test is the current gold standard for EILO diagnostics. Management of EILO includes both surgical and non-surgical interventions.

  11. Evaluation of Anthropometric and Metabolic Parameters in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Yaşar Yildirim

    2015-01-01

    Full Text Available Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA. Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI <5 (n=25 and OSA group with an AHI ≥5 (n=25. Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, p=0.034. There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism.

  12. Cardiac function and hypertension in patients with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Bertolami A

    2014-08-01

    Full Text Available Adriana Bertolami, Carolina Gonzaga, Celso AmodeoSleep Laboratory of Dante Pazzanese Institute of Cardiology, Sao Paulo, BrazilAbstract: Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea or complete interruption (apnea of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed.Keywords: obstructive sleep apnea, hypertension, cardiac function

  13. Treatment of stable chronic obstructive pulmonary disease: the GOLD guidelines.

    Science.gov (United States)

    Lee, Hobart; Kim, Jeffrey; Tagmazyan, Karine

    2013-11-15

    Chronic obstructive pulmonary disease (COPD) is a common problem in primary care. COPD is diagnosed with spirometry only in clinically stable patients with a postbronchodilator forced expiratory volume in one second/forced vital capacity ratio of less than 0.70. All patients with COPD who smoke should be counseled about smoking cessation. Influenza and pneumococcal vaccinations are recommended for all patients with COPD. The Global Initiative for Chronic Obstructive Lung Disease assigns patients with COPD into four groups based on the degree of airflow restriction, symptom score, and number of exacerbations in one year. Pulmonary rehabilitation is recommended for patients in groups B, C, and D. Those in group A should receive a short-acting anticholinergic or short-acting beta2 agonist for mild intermittent symptoms. For patients in group B, long-acting anticholinergics or long-acting beta2 agonists should be added. Patients in group C or D are at high risk of exacerbations and should receive a long-acting anticholinergic or a combination of an inhaled corticosteroid and a long-acting beta2 agonist. For patients whose symptoms are not controlled with one of these regimens, triple therapy with an inhaled corticosteroid, long-acting beta2 agonist, and anticholinergic should be considered. Prophylactic antibiotics and oral corticosteroids are not recommended for prevention of COPD exacerbations. Continuous oxygen therapy improves mortality rates in patients with severe hypoxemia and COPD. Lung volume reduction surgery can improve survival rates in patients with severe, upper lobe-predominant COPD with heterogeneous emphysema distribution.

  14. Hormonal treatment of obstructed kidneys in patients with prostatic cancer

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Rolff, H

    1993-01-01

    A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation or hormo......A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation...... or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal...

  15. Finding Common Ground with the Common Core

    Science.gov (United States)

    Moisan, Heidi

    2015-01-01

    This article examines the journey of museum educators at the Chicago History Museum in understanding the Common Core State Standards and implementing them in our work with the school audience. The process raised questions about our teaching philosophy and our responsibility to our audience. Working with colleagues inside and outside of our…

  16. How Common Is the Common Core?

    Science.gov (United States)

    Thomas, Amande; Edson, Alden J.

    2014-01-01

    Since the introduction of the Common Core State Standards for Mathematics (CCSSM) in 2010, stakeholders in adopting states have engaged in a variety of activities to understand CCSSM standards and transition from previous state standards. These efforts include research, professional development, assessment and modification of curriculum resources,…

  17. Finding Common Ground with the Common Core

    Science.gov (United States)

    Moisan, Heidi

    2015-01-01

    This article examines the journey of museum educators at the Chicago History Museum in understanding the Common Core State Standards and implementing them in our work with the school audience. The process raised questions about our teaching philosophy and our responsibility to our audience. Working with colleagues inside and outside of our…

  18. CD11c+ CD8+ T Cells Reduce Renal Fibrosis Following Ureteric Obstruction by Inducing Fibroblast Apoptosis

    Directory of Open Access Journals (Sweden)

    Haidong Wang

    2016-12-01

    Full Text Available Tubulointerstitial fibrosis is a common consequence of various kidney diseases that lead to end-stage renal failure, and lymphocyte infiltration plays an important role in renal fibrosis. We previously found that depletion of cluster of differentiation 8+ (CD8+ T cells increases renal fibrosis following ureteric obstruction, and interferon-γ (IFN-γ-expressing CD8+ T cells contribute to this process. CD8+ T cells are cytotoxic T cells; however, whether their cytotoxic effect reduces fibrosis remains unknown. This study showed that CD8+ T cells isolated from obstructed kidney showed mRNA expression of the cytotoxicity-related genes perforin 1, granzyme A, granzyme B, and FAS ligand; additionally, CD8 knockout significantly reduced the expression levels of these genes in obstructed kidney. Infiltrated CD8+ T cells were distributed around fibroblasts, and they are associated with fibroblast apoptosis in obstructed kidney. Moreover, CD11c+ CD8+ T cells expressed higher levels of the cytotoxicity-related genes than CD11c− CD8+ T cells, and infiltrated CD11c+ CD8+ T cells in obstructed kidney could induce fibroblast death in vitro. Results indicated that induction of fibroblast apoptosis partly contributed to the effect of CD8+ T cells on reduction of renal fibrosis. Given that inflammatory cells are involved in fibrosis, our results suggest that kidney fibrosis is a multifactorial process involving different arms of the immune system.

  19. OBSTRUCTING MUCOCELE OF THE CYSTIC DUCT AFTER TRANSPLANTATION OF THE LIVER

    Science.gov (United States)

    Koneru, Baburao; Zajko, Albert B.; Sher, Linda; Marsh, J. Wallis; Tzakis, Andreas G.; Iwatsuki, Shunzaburo; Starzl, Thomas E.

    2009-01-01

    A tension mucocele was created in three hepatic homografts by ligating a low-lying cystic duct during transplant cholecystectomy and by incorporating its outflow end into the anastomosis of the common hepatic duct to the recipient common duct or Roux limb of jejunum. The consequent complication of obstruction of the biliary tract that necessitated reoperation and excision of the mucocele in all three patients can be avoided by the simple expedient of completely removing the cystic duct when feasible or providing egress to the secretion of the cystic duct as described. PMID:2652346

  20. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management.

    Science.gov (United States)

    Chapman, Julia L; Serinel, Yasmina; Marshall, Nathaniel S; Grunstein, Ronald R

    2016-09-01

    Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients.

  1. Unusual Clinical Presentation of Bilateral Adult Non-Obstructing Ureteroceles Containing Urinary Stones

    Directory of Open Access Journals (Sweden)

    Mustafa Hoşcan

    2010-01-01

    Full Text Available Ureterocele, while not an uncommon pediatric urologic problem, has been reported only rarely in adults. Adult bilateral ureteroceles with calculi is an uncommon and well tolerated, relatively rare clinical entity. Although ureteroceles in adults are usually asymptomatic, various symptoms tend to appear in ureteroceles with stones, such as flank pain, urinary tract infections and bladder irritability. While ureteroceles occur more commonly in women, stones in ureteroceles tend to be more common in men. Most ureteroceles can be safely managed transurethrally endoscopically which is generally well tolerated by most patients. We present an unusual clinical presentation of bilateral adult non-obstructing ureteroceles containing urinary stones.

  2. Hepatic expression of detoxification enzymes is decreased in human obstructive cholestasis due to gallstone biliary obstruction.

    Directory of Open Access Journals (Sweden)

    Jin Chai

    Full Text Available Levels of bile acid metabolic enzymes and membrane transporters have been reported to change in cholestasis. These alterations (e.g. CYP7A1 repression and MRP4 induction are thought to be adaptive responses that attenuate cholestatic liver injury. However, the molecular mechanisms of these adaptive responses in human obstructive cholestasis due to gallstone biliary obstruction remain unclear.We collected liver samples from cholestatic patients with biliary obstruction due to gallstones and from control patients without liver disease (n = 22 per group. The expression levels of bile acid synthetic and detoxification enzymes, membrane transporters, and the related nuclear receptors and transcriptional factors were measured.The levels of bile acid synthetic enzymes, CYP7B1 and CYP8B1, and the detoxification enzyme CYP2B6 were increased in cholestatic livers by 2.4-fold, 2.8-fold, and 1.9-fold, respectively (p<0.05. Conversely, the expression levels of liver detoxification enzymes, UGT2B4/7, SULT2A1, GSTA1-4, and GSTM1-4, were reduced by approximately 50% (p<0.05 in human obstructive cholestasis. The levels of membrane transporters, OSTβ and OCT1, were increased 10.4-fold and 1.8-fold, respectively, (p<0.05, whereas those of OSTα, ABCG2 and ABCG8 were all decreased by approximately 40%, (p<0.05 in human cholestatic livers. Hepatic nuclear receptors, VDR, HNF4α, RXRα and RARα, were induced (approximately 2.0-fold, (p<0.05 whereas FXR levels were markedly reduced to 44% of control, (p<0.05 in human obstructive cholestasis. There was a significantly positive correlation between the reduction in FXR mRNA and UGT2B4/7, SULT2A1, GSTA1, ABCG2/8 mRNA levels in livers of obstructive cholestatic patients (p<0.05.The levels of hepatic detoxification enzymes were significantly decreased in human obstructive cholestasis, and these decreases were positively associated with a marked reduction of FXR levels. These findings are consistent with impaired

  3. Commonly Abused Drugs Charts

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    ... Common Forms Common Ways Taken DEA Schedule Juice, Gym Candy, Pumpers, Roids Nandrolone (Oxandrin ® ), oxandrolone (Anadrol ® ), oxymetholone ( ... swings; tiredness; restlessness; loss of appetite; insomnia; lowered sex drive; depression, sometimes leading to suicide attempts. Treatment ...

  4. Common Asthma Triggers

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    ... Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Common Asthma Triggers Recommend on Facebook Tweet Share Compartir ... t avoid the triggers. Some of the most common triggers are: Tobacco Smoke Tobacco smoke is unhealthy ...

  5. Common Eye Disorders

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    ... www.cdc.gov/emailupdates/">What's this? Submit Button Common Eye Disorders Recommend on Facebook Tweet Share Compartir ... macular degeneration, cataract, diabetic retinopathy, and glaucoma. Other common eye disorders include amblyopia and strabismus. For a ...

  6. Common Misconceptions about Cholesterol

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    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Common Misconceptions about Cholesterol Updated:Jul 5,2017 How ... do you know about cholesterol? Here are some common misconceptions — and the truth. High cholesterol isn’t ...

  7. Common Conditions in Newborns

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    ... Stages Listen Español Text Size Email Print Share Common Conditions in Newborns Page Content Article Body Some physical conditions are especially common during the first couple of weeks after birth. ...

  8. Common Tests for Arrhythmia

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    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Common Tests for Arrhythmia Updated:Dec 21,2016 Several ... diagnose an arrhythmia. View an animation of arrhythmia . Common Tests for Arrhythmia Holter monitor (continuous ambulatory electrocardiographic ...

  9. Hypertrophic cardiomyopathy with mid-ventricular obstruction and apical aneurysm

    Directory of Open Access Journals (Sweden)

    N.D. Oryshchyn

    2016-11-01

    Full Text Available A case report of apical left ventricular aneurysm in patient with hypertrophic cardiomyopathy with mid-ventricular obstruction (diagnosis and surgical treatment is presented. We revealed apical aneurysm and mid-ventricular obstruction during echocardiography and specified anatomical characteristics of aneurysm during computer tomography. There was no evidence of obstructive coronary artery disease during coronary angiography. Taking into consideration multiple cerebral infarcts, aneurysm resection and left ventricular plastics was performed. Electronic microscopy of myocardium confirmed the diagnosis of hypertrophic cardiomyopathy.

  10. Acute intestinal pseudo-obstruction (Ogilvie's syndrome: A case report

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    Navas Nadukkandiyil, MD

    2014-12-01

    Full Text Available Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is an acute clinical condition with clinical and radiological features of an acute large bowel obstruction in the absence of any mechanical cause. Patients presenting with Ogilvie's syndrome usually have underlying medical and surgical conditions predisposing them to the syndrome. In this article, we describe an elderly patient who presented with acute colonic pseudo-obstruction without any apparent cause.

  11. Multiple giant diverticula of the foregut causing upper gastrointestinal obstruction

    Institute of Scientific and Technical Information of China (English)

    Genoveffa Balducci; Mario Dente; Giulia Cosenza; Paolo Mercantini; Pier Federico Salvi

    2008-01-01

    Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastrointestinal symptoms.Most of times the diagnosis is carried out in case of related complications,such as diverticulitis,hemorrhage,perforation or obstruction.Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis,volvulus,intussusception or jejunal stones.Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.

  12. Fetal tracheolaryngeal airway obstruction: prenatal evaluation by sonography and MRI

    Science.gov (United States)

    Courtier, Jesse; Poder, Liina; Wang, Zhen J.; Westphalen, Antonio C.; Yeh, Benjamin M.

    2010-01-01

    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. PMID:20737145

  13. Intestinal obstruction caused by Taenia taeniaeformis infection in a cat.

    Science.gov (United States)

    Wilcox, Rebbecca S; Bowman, Dwight D; Barr, Stephen C; Euclid, James M

    2009-01-01

    An adult domestic shorthair (DSH) cat was presented with acute vomiting, anorexia, lethargy, and dyspnea. The cat's clinical status worsened over 24 hours with conservative medical management. An exploratory celiotomy was performed. Acute intestinal obstruction resulting from infection with Taenia (T.) taeniaeformis was diagnosed. Surgical removal of the cestodes via multiple enterotomies resolved the obstruction. This paper reports, for the first time, small intestinal obstruction caused by T. taeniaeformis infection in a cat.

  14. 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.)

  15. A CLINICAL STUDY ON GASTRIC OUTLET OBSTRUCTION IN A SOUTH INDIAN TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sailaja

    2015-10-01

    Full Text Available Gastric outlet obstruction is defined as a clinical and patho - physiological consequence of any disease process that produces a mechanical impediment to gastric emptying which may be extrinsic or intrinsic. Gastric outlet obstruction can be a diagnostic and treatment dilemma. Endoscopy of upper gastrointestinal tract has been a sensitive and specific investigation to study the status of gastric outlet - the pylorus and has enabled early detection of lesions of both stomach a nd duodenum. We undertook a prospective clinical study regarding incidence, etiology, investigation and management of cases of Gastric outlet obstruction in adults in a period of three years. In our study the m ost common cause of GOO is Carcinoma stomach a ntral region 46.6% , duodenal ulcer 33.3% , corrosive acid ingestion sequel 8.3%, peri ampullary carcinoma 6.6%, Ca pancreas 3.3%% , cholangio Carcinoma 1.6%. Males are more commonly involved in a ratio of M: F=3:1. Surgical procedures done varied from defini tive resections to palliative bypass or feeding jejunostomy for enteral feeding

  16. Examination of Pulse Oximetry Tracings to Detect Obstructive Sleep Apnea in Patients with Advanced Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Adrienne S Scott

    2014-01-01

    Full Text Available Nocturnal hypoxemia and obstructive sleep apnea (OSA are common comorbidities in patients with chronic obstructive pulmonary disease (COPD. The authors sought to develop a strategy to interpret nocturnal pulse oximetry and assess its capacity for detection of OSA in patients with stage 3 to stage 4 COPD. A review of consecutive patients with COPD who were clinically prescribed oximetry and polysomnography was conducted. OSA was diagnosed if the polysomnographic apnea-hypopnea index was >15 events/h. Comprehensive criteria were developed for interpretation of pulse oximetry tracings through iterative validation and interscorer concordance of ≥80%. Criteria consisted of visually identified desaturation ‘events’ (sustained desaturation ≥4%, 1 h time scale, ‘patterns’ (≥3 similar desaturation/saturation cycles, 15 min time scale and the automated oxygen desaturation index. The area under the curve (AUC, sensitivity, specificity and accuracy were calculated. Of 59 patients (27 male, 31 had OSA (53%. The mean forced expiratory volume in 1 s was 46% of predicted (range 21% to 74% of predicted and 52% of patients were on long-term oxygen therapy. Among 59 patients, 35 were correctly identified as having OSA or not having OSA, corresponding to an accuracy of 59%, with a sensitivity and specificity of 59% and 60%, respectively. The AUC was 0.57 (95% CI 0.55 to 0.59. Using software-computed desaturation events (hypoxemia ≥4% for ≥10 s indexed at ≥15 events/h of sleep as diagnostic criteria, sensitivity was 60%, specificity was 63% and the AUC was 0.64 (95%CI 0.62 to 0.66. No single criterion demonstrated important diagnostic utility. Pulse oximetry tracing interpretation had a modest diagnostic value in identifying OSA in patients with moderate to severe COPD.

  17. Shear Modulus of the Partially Obstructed Rat Small Intestine

    DEFF Research Database (Denmark)

    Sun, Daming; Zhao, Jingbo; Liao, Donghua;

    2016-01-01

    A number of factors influence gastrointestinal tissue structure and mechanical properties such as the physical environment and diseases like partial obstruction. Hence multi-axial biomechanical properties are important for understanding the pathophysiology of the obstructed intestine. The aim......-cm intestinal segments were used for histological and mechanical analysis. The segments were obtained distal (S1), proximal (S2) and further proximal (S3) to the site of obstruction or suturing site. The tri-axial testing included simultaneous torsion, inflation and longitudinal stretching. The lumen...... and longitudinal direction where as it was softer in shear direction, especially in S2 (p intestinal obstruction site....

  18. Microscopic hematuria and calculus-related ureteral obstruction.

    Science.gov (United States)

    Stewart, D P; Kowalski, R; Wong, P; Krome, R

    1990-01-01

    The evaluation of patients with ureteral calculi in the emergency department has historically included urinalysis (UA) and intravenous pyelograms (IVP). This retrospective study was done to determine if a statistically significant relationship existed between the degree of calculus-related ureteral obstruction, proven by IVP, and the presence or absence of microscopic hematuria. Urine red blood cells were recorded as less than 3 rbc/hpf (negative) or greater than or equal to 3 rbc/hpf (positive). IVPs were recorded as nonsevere or severe. IVP criteria were based on the presence or absence of extravasation, greater than 2-hour ureteral filling times, and a numerical scoring system of 1 to 4 for ureteral or calyceal dilatation and nephrogenic effect. Eighty-nine men (72%) had non-severe obstructions and 34 (28%) had severe obstructions. Twenty-five women (68%) had nonsevere obstructions and 12 (32%) had severe obstructions. Of the 28 patients with normal UAs, 11 had severe ureteral obstructions and 17 had nonsevere ureteral obstructions. There were no statistically significant differences between the presence or absence of significant microscopic hematuria and the presence or absence of severe ureteral obstruction. Microscopic hematuria is neither sensitive nor specific in determining the degree of calculus-related ureteral obstruction.

  19. Obturator hernia: An uncommon cause of small bowel obstruction

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    S Shreshtha

    2016-01-01

    Full Text Available A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%. Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized. It is an important diagnosis to be considered in elderly patients with intestinal obstruction.

  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.