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Dilatation
Kinds of Dilatation Selected AbstractsCOMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONESDIGESTIVE ENDOSCOPY, Issue 4 2004Hiroshi Nakagawa Background:, Endoscopic papillary balloon dilatation (EPBD) is one of the methods to remove bile duct stones. EPBD might preserve the function of the sphincter of Oddi despite the potential risk of acute pancreatitis. There are only a few reports of EPBD reducing the risk of acute pancreatitis and, at same time, preserving the function of the sphincter of Oddi. Methods:, We performed EPBD for bile duct stone removal in 60 patients using two balloons with different diameters. Patients were randomized to EPBD with a 6 mm balloon (n = 30) or an 8 mm balloon (n = 30). In both groups, isosorbide dinitrate (ISDN) was infused in a rate of 5 mg/h while low pressure EPBD were being performed. The pressure of the sphincter of Oddi was observed before and after the EPBD procedures. Also, serum amylase level after EPBD was observed for both groups. Results:, Serum amylase level of the 6 mm group was signi,cantly higher than that of the 8 mm group (P < 0.05). Acute pancreatitis occurred in two patients ( 6.7%) in the 6 mm group whereas no case was observed for the 8 mm group. The rates of duct clearance were 93% in the 6 mm group and 100% in the 8 mm group. Stone removals were dif,cult in seven cases with 6 mm balloon dilatations due to the narrow ori,ces of the papilla. In the 6 mm group, there was no signi,cant difference between the basal sphincter of Oddi pressure (BSOP) and the phasic sphincter of Oddi pressure (PSOP) before and after EPBD. However in the 8 mm group, the BSOP observed after the EPBD procedure was signi,cantly higher than BSOP before the treatments. Within this group, BSOP values after EPBD were preserved by approximately 80% of the BSOP values before the treatments. In contrast, there was no signi,cant difference in PSOP before and after the treatments. Regarding the stone numbers, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with less than two stones. Also, as for stone size, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with stones of less than 6 mm in diameter. Conclusion:, We are now conducting EPBD with ISDN infusion using a 6 mm balloon for a patient who has less than two stones with size not exceeding 6 mm in diameter. An 8 mm balloon is used for a patient with more than two stones or a stone greater than 6 mm in size. [source] THE EFFECT OF SALTS ON THERMAL AND HYDRIC DILATATION OF POROUS BUILDING STONE*ARCHAEOMETRY, Issue 3 2009M. AL-NADDAF Fifteen desalinated sandstone drill core samples from Umm Ishrin Sandstone Formation in Petra (Cambrian age) were used for this study. The samples were mineralogically analysed using X-ray diffraction and their physical properties were also determined. Samples with similar physical properties and mineralogical composition were taken for further experimental work. After desalination, thermal and hydric dilatation coefficients were measured, then three types of salts (NaCl, KCl and Na2SO4·10H2O), which have high solubility and consequently are the most dangerous to building stone (and are also detected in the sandstone monuments in Petra), were introduced into the samples and their contents were calculated. The results show that salt crystallization in the pores of building stones can increase their thermal dilatation and decrease their hydric dilatation to varying extents, depending on the nature of the salt. The average increase in the thermal dilatation coefficient per unit mass of salt is the lowest for the Na2SO4·10H2O-salted samples with a value of 5.3%, while the NaCl-salted samples have the highest value with 7.8% per salt mass. The average percentage of the decrease of the hydric dilatation coefficient is 1061% for Na2SO4·10H2O-salted samples per mass of salt content; the NaCl-salted samples have a value of 1510% per mass of salt content, and the KCl-salted samples almost the same value. For the salt-free samples, it was found that in climatic conditions with a high temperature range, the deterioration of sandstone due to temperature fluctuation is more effective than that caused by change in the moisture content, while samples with high salt content suffer more from hydric dilatation. [source] Stent Dilatation of a Right Ventricle to Pulmonary Artery Conduit in a Postoperative Patient with Hypoplastic Left Heart SyndromeCONGENITAL HEART DISEASE, Issue 2 2008Rowan Walsh MD ABSTRACT A 10-day-old child with hypoplastic left heart syndrome (HLHS) underwent first-stage palliation for HLHS, Norwood procedure with a Sano modification, i.e., placement of a right ventricular to pulmonary artery (RV-PA) conduit. The patient developed progressively worsening systemic oxygen desaturation in the immediate postoperative period. Stenosis of the proximal RV-PA conduit was diagnosed by echocardiography. In the catheterization laboratory stent placement in the conduit was performed. This resulted in increased systemic oxygen saturation. The patient was eventually discharged from the hospital with adequate oxygen saturations. [source] Dilatation in the femoral vascular bed does not cause retrograde relaxation of the iliac artery in the anaesthetized pigACTA PHYSIOLOGICA, Issue 3 2008Julian P.J. Halcox No abstract is available for this article. [source] The Relation between the Color M-Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow-Mediated DilatationECHOCARDIOGRAPHY, Issue 3 2010Yilmaz Gunes M.D. Background: To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). Methods: CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. Results: Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 ± 8.1 vs. 47.5 ± 16.8 cm/sec, P < 0.001) and FMD (5.3 ± 1.9 vs. 11.4 ± 5.8%, P < 0.001) and higher CIMT (0.94 ± 0.05 vs. 0.83 ± 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =,0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =,0.530, P < 0.001). Conclusions: The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function. (Echocardiography 2010;27:300-305) [source] Quantification of Annular Dilatation and Papillary Muscle Separation in Functional Mitral Regurgitation: Role of Anterior Mitral Leaflet Length as ReferenceECHOCARDIOGRAPHY, Issue 6 2005Vinod Jorapur M.D. Background: We hypothesized that anterior mitral leaflet length (ALL) does not differ significantly between normal subjects and patients with functional mitral regurgitation (FMR) and hence may be used as a reference measurement to quantify annular dilatation and papillary muscle separation. Methods and Results: We prospectively studied 50 controls, 15 patients with systolic left ventricular dysfunction (LVD) with significant FMR, and 15 patients with LVD without significant FMR. Significant MR was defined as an effective regurgitant orifice area , 0.2 cm2 as measured by the flow convergence method. Annular diameter, interpapillary distance, and ALL were measured, and the following ratios were derived: annular diameter indexed to ALL (ADI) and interpapillary distance indexed to ALL (IPDI). There was no significant difference in ALL among the three groups. The mean ADI was 1.26 times controls in patients with LVD without significant FMR compared to 1.33 times controls in patients with LVD with significant FMR (P = 0.06, no significant difference between groups). The mean IPDI was 1.42 times controls in patients with LVD without significant FMR compared to 2.1 times controls in patients with LVD with significant FMR (P < 0.0001, significant difference between groups). Conclusion: There was no significant difference in ALL between controls and patients with LVD. ALL can be used as a reference measurement to quantify annular dilatation and papillary muscle separation in patients with FMR. Interpapillary distance but not annular diameter indexed to ALL correlates with severity of FMR. [source] Transesophageal Echocardiographic Identification of Thrombus Producing Obstruction of Left Pulmonary Artery Descending Lobar Branches and Bronchial Artery DilatationECHOCARDIOGRAPHY, Issue 1 2002Seung-Wan Kang M.D. We report an elderly patient in whom a thrombus in the distal left pulmonary artery was shown by transesophageal echocardiography to extend and produce obstruction of the descending lobar branches as well as dilatation of the left bronchial artery. [source] Middle Meningeal Artery Dilatation in MigraineHEADACHE, Issue 10 2009Dip MFOS, Elliot Shevel BDS, MB BCh Objective., To show that migraine pain is not related to dilatation of the dural meningeal arteries. Background., The origin of the pain in migraine has not yet been adequately explained and remains the subject of vigorous debate. Current theories implicate changes in the trigeminovascular system, which is defined as comprising the large intracranial vessels, and in particular, the dural meningeal vessels, the dura mater, and their neural connections. Methods., The anatomical relationships of the dural meningeal arteries to the dura mater and the inner surface of the calvarium are described. Results., The dural meningeal arteries lie in grooves in the inner table of the calvarium, are encased in the unyielding fibrous dura mater, and are consequently unable to dilate. Conclusion., The pain of migraine is not related to dilatation of the dural meningeal arteries. [source] Aortic Valve-Sparing Operation in Dilatation of the Ascending AortaJOURNAL OF CARDIAC SURGERY, Issue 6 2000René Prêtre M.D. No abstract is available for this article. [source] Sonographic appearance of the uterine cavity following administration of mifepristone and misoprostol for termination of pregnancyJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2006Ofer Markovitch MD Abstract Purpose. To describe the sonographic appearance of the uterine cavity in women after administration of mifepristone and misoprostol for termination of pregnancy. Methods. Thirty-six women treated with mifepristone 600 mg followed by misoprostol 400 ,g 2 days later for termination of pregnancy were the subjects of the study. Gestational age as calculated from the last menstrual period was ,49 days. Pretreatment sonographic parameters, including gestational sac size and crown,rump length, were measured. The sonographic appearance of the uterine cavity was recorded and documented 6 hours (T-1) and 14 days (T-2) after administration of misoprostol. Results. The mean menstrual age of the patients was 42 days (range 31,49 days). The mean gestational age according to crown,rump length was 43 days (range 40,48 days). Sonographic examination performed atT-1 revealed 23 patients (62.9%) with a well-defined echogenic mass located in the uterine cavity, 2 patients (5.5%) with an intrauterine sac containing a nonviable embryo, and 11 patients (30.5%) with an endometrium thickness of 7,14 mm with no evidence of intrauterine contents. Doppler flow signals were detected in 15 of the 23 patients (65.2%) with an echogenic intrauterine mass. Sonographic examination performed at T-2 revealed 19 patients (52.8%) with a persistent echogenic intrauterine mass; Doppler flow could be detected in 15 of these patients (78.9%). Dilatation and curettage was required in 2 patients (5.6%) due to failure of treatment; all others regained normal menses. Conclusions. An intrauterine echogenic mass with well-defined borders, with or without Doppler flow signals, can be detected 2 weeks after administration of mifepristone and misoprostol for termination of pregnancy. Because most of the women in our study regained normal menses without further surgical intervention, this finding could indicate remnants of trophoblastic tissue evacuated spontaneously from the uterine cavity. Therefore, dilatation and curettage should be avoided in these cases, unless clinical symptoms or signs necessitate surgical intervention. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:278,282, 2006 [source] Early Results of Balloon Dilatation of the Stenotic Bovine Jugular Vein Graft in the Right Ventricular Outflow Tract in ChildrenJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2008J. STEINBERG M.D. The aim of this study was to evaluate the early results of interventional balloon dilatation of stenotic bovine jugular vein (BJV) grafts implanted for reconstruction of the right ventricular outflow tract (RVOT) in children. Methods: From May 2001 to December 2005, 153 BJV grafts were implanted in children in our institution. An average of 16.9 (7.6,41.1) months after implantation, 17 balloon dilatations in a significant stenosis proximal (n = 1), distal anastomosis (n = 8), BJV valve (n = 3), or at multiple sites (n = 5) were performed in 15 children (male:female = 9:6) with a mean age of 3.9 (0.8,13.0) years. Balloon diameter was 75,133.3% (mean 100.3) of the original BJV size. Mean follow-up was 8.8 (2 days to 22.8 months) months. Results: In 10 interventions (58.8%) the instantaneous peak gradient was reduced below 50 mmHg. A balloon diameter ,100% of the original BJV size correlated significantly with a successful intervention. No major complications, two minor (nonobstructive floating membranes at the dilatation site and one septicemia) occurred afterward. Freedom from reintervention after 6 months was 58.2% for all, 77.8% for dilatations of the proximal anastomosis and mixed stenotic lesions, and 33.3% for the distal anastomosis. Conclusion: Balloon dilatation of stenotic BJV grafts is safe and can significantly reduce the pressure gradient in two-thirds of interventions. Balloon diameters above the original graft size should be aimed for. The most frequent stenosis of the distal anastomosis tends to renarrow early after dilatation. Nevertheless, balloon dilatation should be considered in nearly every stenotic graft to gain time until a surgical or interventional graft exchange. [source] Successful Balloon Dilatation of the Valve of Vieussens for Left Ventricular Lead PlacementPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2009CAN HASDEMIR M.D. Successful balloon dilatation of an obstructive valve of Vieussens for left ventricular lead placement is described in a case with severe left ventricular systolic dysfunction. [source] Surfactant protein C gene (SFTPC) mutation-associated lung disease: High-resolution computed tomography (HRCT) findings and its relation to histological analysis,,PEDIATRIC PULMONOLOGY, Issue 10 2010M. Mechri MD Abstract Aim of the Study Determine high-resolution tomography (HRCT) scan characteristics in children with SFTPC mutation and correlate them to histological findings. Patients and Methods This retrospective multicenter study included 15 children (7 females and 8 males) with SFTPC mutations. HRCT scans have been performed in all the children and lung biopsies in 8 children. Results From all signs assessed on initial HRCT scans, ground-glass opacities (n,=,14, 93%) and lung cysts (n,=,6, 40%) were predominant. Interlobular septal thickening (n,=,1, 7%), air space consolidation (n,=,1, 7%), paraseptal emphysema (n,=,2, 13%), and pulmonary nodules (n,=,1, 7%) were also found. Histological analysis revealed accumulation of macrophages in the alveolar lumen, type II pneumocyte hyperplasia, and alveolar septal thickening. Dilatation of the respiratory bronchiole and alveolar duct associated with muscular hyperplasia were also described. Interestingly, lung cysts on HRCT scans were associated with dilatation of terminal bronchioli and alveolar duct in lung biopsies. Conclusion In children with SFTPC mutations, HRCT scan finding was highly correlated to the histological findings and, as such, represent a useful tool to identify patients that may require SFTPC gene sequencing. Pediatr Pulmonol. 2010; 45:1021,1029. © 2010 Wiley-Liss, Inc. [source] Dilatation for Assisted Ventilation-Induced Laryngotracheal StenosisTHE LARYNGOSCOPE, Issue 9 2005Philippe Clément MD Abstract Objective: To assess the long-term results of dilatation and our experience with dilatation for assisted ventilation-induced laryngotracheal stenosis. Design: A retrospective study of 32 patients primarily treated with dilatation for assisted ventilation-induced laryngotracheal stenosis between 1977 and 2002. Setting: A tertiary care center and university teaching hospital. Patients: There were 19 men and 13 women aged 15 to 76 years. The stenosis was cicatricial with some inflammatory process in 27 patients and completely mature in 5 patients. The stenosis involved the cricoid and the trachea in four patients. In 28 patients, the stenosis involved only the trachea. Methods: Dilatation was performed with serially sized rigid bronchoscopes. Endoscopic laser vaporization was never performed in this series. Six patients were treated with only one dilatation. The 26 remaining patients were treated with successively 2 to 10 dilatations (mean, 3.3 dilatations). The dilatation success rate was analyzed using the Kaplan-Meier method. Results: Median duration of follow-up was 1.8 years. Mortality rate was 9.4%. The overall failure rate was 71.8%. Twenty patients presented with recurrent stenosis. The treatment of recurrent stenosis consisted of tracheal resection with end-to-end anastomosis (11 patients, 55%), cricotracheal anastomosis (5 patients, 25%), tracheal endoprosthesis (2 patients, 10%), and tracheotomy (1 patient, 5%). All patients who underwent tracheal or cricotracheal anastomosis were successfully treated. None of the variables under analysis (sex, age, medical history, cause for intubation, intubation type and duration, delay from initial injury, degree of stenosis, length of trachea involved, number of dilatations) were statistically related to the incidence of complications and the success rate of dilatations. Conclusions: We do not recommend dilatation technique as the sole treatment for assisted ventilation-induced laryngotracheal stenosis. This technique is helpful in case of emergency to restore an airway and useful for the assessment of stenosis. [source] Lethal outcome in xanthogranulomatous endometritis,APMIS, Issue 5 2006Case report Xanthogranulomatous inflammation is rare, mainly involving the kidneys, while primary xanthogranulomatous endometritis (XE) is a very unusual finding, histologically characterized by partial or complete replacement of the mucosa by granulation tissue with an abundance of foamy histiocytes, siderophages and multinucleated giant cells. We present the case of a 69-year-old woman with a short history of abdominal pain and a palpable mass in the pouch of Douglas. Dilatation of the cervix drained a pyometra. Histological examination of the curettage rendered the diagnosis of XE. Microbiological studies revealed enterococcus spp. and Peptostreptococcus magnus. Despite antibiotic treatment the patient died of heart failure due to systemic inflammation. Autopsy confirmed the diagnosis of XE with transmural extension into the peritoneal cavity. Such a lethal course of XE is extraordinary. Proposed causes of XE include obstruction, infection and hemorrhage. Demonstration of enterococcus spp. and P. magnus supports the probable significance of bacteria in the development of XE. Because this condition may mimic malignant disease macroscopically and histologically, knowledge of XE is of major importance for both pathologists and gynecologists. [source] Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008KS Oppegaard Objective, To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy. Design, Two separate but identical parallel, randomised, double-blind, placebo-controlled sequential trials, one in premenopausal women and one in postmenopausal women. The boundaries for the sequential trials were calculated on the primary outcomes of a difference of cervical dilatation ,1 mm, with the assumption of a type 1 error of 0.05 and a power of 0.95. Setting, Norwegian university teaching hospital. Sample, Eighty-six women referred to outpatient operative hysteroscopy. Methods, The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient operative hysteroscopy. Main outcome measures, Preoperative cervical dilatation (primary outcome), number of women who achieve a preoperative cervical dilatation ,5 mm, acceptability, complications and adverse effects (secondary outcomes). Results, In premenopausal women, the mean cervical dilatation was 6.4 mm (SD 2.4) in the misoprostol group and 4.8 mm (SD 2.0) in the placebo group, the mean difference in cervical dilatation being 1.6 mm (95% CI 0.5,2.7). Among the premenopausal women receiving misoprostol, 88% achieved a cervical dilatation of ,5 mm compared with 65% in the placebo group. Twelve percent of the women who received misoprostol were difficult to dilate compared with 32% who received placebo. Dilatation was also quicker in the misoprostol group. Misoprostol had no effect on cervical ripening in postmenopausal women compared with placebo, and 43% of the women were difficult to dilate. The trials were terminated after analysis of 21 postmenopausal women and 65 premenopausal women after reaching a conclusion on the primary outcome with only 28% of the number of women needed in a fixed sample size trial. Three of 45 women who received misoprostol experienced severe lower abdominal pain, and there was an increased occurrence of light preoperative bleeding in the misoprostol group. Most women did not experience misoprostol-related adverse effects. The majority (83% of premenopausal and 76% of postmenopausal women) found self-administered vaginal misoprostol at home to be acceptable. There were two serious complications in the premenopausal misoprostol group: uterine perforation with subsequent peritonitis and heavy postoperative bleeding requiring blood transfusion, but these were not judged to be misoprostol related. Complications were otherwise comparatively minor and distributed equally between the two dosage groups. Conclusions, One thousand micrograms of self-administered vaginal misoprostol 12 hours prior to operative hysteroscopy has a significant cervical ripening effect compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal misoprostol of 1000 micrograms at home the evening before operative hysteroscopy is safe and highly acceptable, although a small proportion of women experienced severe lower abdominal pain. There is a risk of lower abdominal pain and light preoperative bleeding with this regimen, which is very cheap and easy to use. [source] Home-dilatation of the urethral meatus in boysBJU INTERNATIONAL, Issue 4 2004J.M. Searles OBJECTIVES To evaluate the efficacy of dilatation of the stenotic urethral meatus in boys at home. PATIENTS AND METHODS Eighteen boys aged 3,15 years, or their parents, were taught to dilate the urethral meatus at home. The cause of the stricture was balanitis xerotica obliterans (BXO) in five and consequent upon hypospadias surgery in 12, of whom two were complicated by BXO, and one after circumcision for cultural reasons. One boy was re-referred after an interval of 3 years because of apparent deterioration of the stream of urine. Meatal dilatation was taught in the home by one of the authors (J.M.S.) RESULTS Nine patients were cured by the first course of dilatation, four relapsed early after initial success but responded to further treatment, and three proceeded to meatoplasty because they had no response. Two relapsed late and one responded to further dilatation but the other required surgery. CONCLUSION Dilatation of the urethral meatus can be taught successfully to boys or their families at home, thus avoiding repeated hospital attendance and often general anaesthesia. [source] Ultrasonography as predictor of permanent renal damage in infants with urinary tract infectionACTA PAEDIATRICA, Issue 7 2009Lennart Müller Abstract Aim:, To evaluate the ability of ultrasound (US) in infants (<1 year) with acute urinary tract infection (UTI), to identify those with permanent renal damage (PRD) at scintigraphy 1 year later. Methods:, US, dimercaptosuccinic acid scintigraphy and voiding cystourethrography were performed in 191 infants. Results:, US was abnormal in 46 infants (24%). PRD was found in 46 infants (24%); 19 of these had abnormal US (sensitivity 41%). In 145 infants without PRD, 27 had abnormal US (specificity 81%). Dilating reflux or verified obstruction occurred in 21 (11%) infants, of whom 18 (86%) had PRD while 28 of 170 (16%) without such diagnoses had PRD. Of 16 infants with dilating reflux, 9 (sensitivity 56%) had abnormal US and 14 (88%) PRD. Dilatation at US was seen in 27 children; 7 of these had dilating reflux and 5 verified obstruction. Conclusion:, US performed in association with acute UTI had limited ability to identify children with PRD at 99mTc-dimercaptosuccinic acid (DMSA) 1 year later, although abnormal renal size was a strong indicator of renal damage. The ability of US to identify children with dilating reflux was also limited. However, once detected at US, dilatation of the urinary tract was associated with dilating reflux or obstruction in half of the cases. Our study confirms that dilating reflux and obstruction are strong indicators of PRD but only half of those who developed PRD had such diagnoses. [source] Dilatation of tracheostomal stenosis using uterine dilatorsCLINICAL OTOLARYNGOLOGY, Issue 2 2006R. Suryanarayanan No abstract is available for this article. [source] Anastomotic dilatation after repair of esophageal atresia with distal fistula.DISEASES OF THE ESOPHAGUS, Issue 2 2009Comparison of results after routine versus selective dilatation SUMMARY After repair of esophageal atresia with distal fistula (EADF), anastomotic dilatations are often required. We abandoned routine dilatations (RD), in 2002, for selective dilatations (SD) only when the symptoms arose. We compared the number of dilatations and long-term results after RD and SD. Eighty-one successive EADF patients from 1989 to 2007 (RD 46, SD 35), with primary anastomosis, native esophagus, and peroral feeding, were included. Spitz classification, birth weight, gestational age, incidence of gastroesphageal reflux, tracheomalacia, and postoperative complications did not differ statistically significantly between the groups whereas the total incidence of associated anomalies in RD group was higher than in SD (P < 0.05) In RD group, anastomotic dilatations were begun 3 weeks postoperatively and repeated until the anastomotic diameter was 10 mm. In SD group, dilatations were performed only in symptomatic patients. The number of dilatations, dilatation-related complications, nutritional status, and outcome up to 3 years after repair were compared. The median number of dilatations was seven (2,23) in RD and two (0,16) in SD group (P < 0.01). Sixteen (46%) patients in SD group had no dilatations during the first 6 months. The incidence of dysphagia, bolus obstructions, and development of nutritional status were similar between the groups. The incidence of complications/dilatation was 0.6% in RD and 1.0% in SD group. One patient in RD group underwent resection for a recalcitrant anastomotic stricture. After repair, EADF policy of SD resulted in significantly less dilatations than RD with equal long-term results. [source] Suspected involvement of the X chromosome in placental mesenchymal dysplasiaCONGENITAL ANOMALIES, Issue 4 2002Masayoshi Arizawa ABSTRACT, So far, 46 cases of placental mesenchymal dysplasia have been reported worldwide. We encountered 15 cases of placental mesenchymal dysplasia (PMD) including 7 cases delivered in our hospital. The incidence of PMD in our hospital was therefore, 7/30, 758 (0.02%). The PMD had a peculiar appearance. In the gross findings, large placenta with intestine-like dilatation of the vessels on the fetal side was reported. Microscopically, cistern-like dilatation of the stem villi, fetal artery thrombosis, and villous hemorrhage were reported. However, we believe most of these findings are secondary rather than the primary of mesenchymal dysplasia. Therefore, we investigated 15 other cases of mesenchymal dysplasia, and found including vascular abnormality of the stem, intermediate and terminal villi in all case of PMD. The abnormality was observed in the vessels of the periphery of the stem villi and their vessel walls were thin and appeared weak. The intermediate villous vessels were unusual, tangled. The terminal villous abnormalities showed chorangiosis and stromal hyperplasia. These findings are mesenchymal dysplasia origin. Moreover, PMD showed female-predominant. 14/15 was female among our cases, We discuss the relationship between mesenchymal dysplasia and the X chromosome in this paper. [source] Disruption of brain development in male rats exposed prenatally to 5-bromo-2,-deoxyuridineCONGENITAL ANOMALIES, Issue 4 2001Makiko Kuwagata ABSTRACT, Sprague-Dawley rats were treated intraperitoneally with 5-bromo-2,-deoxyuridine (BrdU) at 0,12.5 or 50 mg/kg/day on days 9 through 15 of gestation to evaluate the effects on development of the brain of offspring. Prenatal exposure to BrdU induced abnormal development of the brain; dilatation of the lateral ventricles in male offspring in the postnatal period. The ratio of the length of the longitudinal fissure to that of the cerebral cortex decreased in a dose-dependent manner in the embryonic period and thereafter. In 14-week-old male offspring exposed prenatally to BrdU at 50 mg/kg, the cortex layer of the cerebrum was thinner than that of the controls. Masculine sexual behavior was markedly impaired and the volume of the sexually dimorphic nucleus of the preoptic area (SDN-POA) was decreased in the 50 mg/kg group as compared with the controls. These results demonstrate that prenatal exposure to BrdU affected the development of the brain hi the prenatal and postnatal stages and reduced the volume of SDN-POA after puberty, resulting in a disruption of reproductive ability in male rats. [source] Giant Cell Aortitis and Noonan SyndromeCONGENITAL HEART DISEASE, Issue 4 2008Shaji Menon MD ABSTRACT An 18-year-old girl with Noonan syndrome was diagnosed with progressive aneurysmal dilatation of the ascending aorta. Histopathological examination revealed giant cell aortitis. Connective tissue abnormalities leading to aortic root dilatation and the sinuses of Valsalva aneurysm have been reported in Noonan syndrome. This report is the first description of giant cell aortitis in Noonan syndrome and may provide a link between aortic aneurysm, and giant cell granuloma of bone in Noonan syndrome. [source] Late Presentation of Pulmonary Valve Stenosis Confirmed by Cardiovascular Magnetic ResonanceCONGENITAL HEART DISEASE, Issue 3 2008Didier Locca MD ABSTRACT We describe the case of a 70-year-old man who presented with increasing exertional dyspnea. He was found to have an ejection systolic murmur and evidence of right ventricular outflow tract obstruction, with a peak velocity of 4.5 m/s recorded by transthoracic Doppler echocardiography. Cardiovascular magnetic resonance showed right ventricular hypertrophy, pulmonary valve stenosis, peak recorded velocity 4.2 m/s, with thickened pulmonary valve leaflets of reduced mobility, and poststenotic dilatation of the main pulmonary artery. The case illustrates that severe pulmonary valve stenosis can present late in life and that cardiovascular magnetic resonance can be useful in clarifying nature and level of right ventricular outflow tract obstruction in an adult. [source] Effects of C-peptide on forearm blood flow and brachial artery dilatation in patients with type 1 diabetes mellitusACTA PHYSIOLOGICA, Issue 3 2001E. Fernqvist-Forbes Recent studies suggest that C-peptide increases blood flow in both exercising and resting forearm in patients with type 1 diabetes. Now we have studied the effect of C-peptide administration on endothelial-mediated and non-endothelial-mediated arterial responses as well as central haemodynamics in 10 patients with type 1 diabetes in a placebo-controlled double-blind study. Euglycaemia was maintained with an i.v. insulin infusion before and during the study. A high-resolution ultrasound technique and Doppler echocardiography were used to assess haemodynamic functions. Brachial artery blood flow and brachial artery diameter were measured in the basal state, 1 and 10 min after reactive hyperaemia and 4 min after sublingual glyceryl trinitrate administration (GTN; endothelial-independent vasodilatation), both before and after the end of 60-min C-peptide (6 pmol kg,1 min,1) or saline infusion periods. Echocardiographic measurements were also performed before and at the end of the infusion periods. Seven healthy age-matched males served as controls for vascular studies. The patients showed a blunted brachial dilatation after reactive hyperaemia in comparison with the healthy controls (2.1 ± 0.5% vs. 9.3 ± 0.3%, P < 0.001), indicating a disturbed endothelial function. C-peptide infusion compared with saline resulted in increased basal blood flow (33 ± 6%, P < 0.001) and brachial arterial dilatation (4 ± 1%, P < 0.05). Left ventricular ejection fraction seemed to be improved (5 ± 2%, P < 0.05) at the end of C-peptide infusion compared with placebo. The vascular response to reactive hyperaemia and GTN was not affected by C-peptide infusion. Our results demonstrate that physiological concentrations of C-peptide increase resting forearm blood flow, brachial artery diameter and left ventricular systolic function in patients with type 1 diabetes. [source] Statin therapy improves brachial artery vasodilator function in patients with Type 1 diabetes and microalbuminuriaDIABETIC MEDICINE, Issue 3 2005G. K. Dogra Abstract Aims Type 1 diabetes mellitus patients with microalbuminuria have endothelial dysfunction associated with the degree of albuminuria but not with LDL-cholesterol levels. Lipid-lowering agents such as statins may still be of benefit as they can correct endothelial dysfunction by both lipid and non-lipid mechanisms. We therefore examined the effects of atorvastatin on brachial artery endothelial dysfunction in these patients. Methods In a double-blind, randomized crossover study, 16 Type 1 diabetes mellitus patients with microalbuminuria received 6 weeks of atorvastatin 40 mg/day or placebo, separated by a 4-week washout. Brachial artery, endothelium-dependent, flow-mediated dilatation (FMD) and endothelium-independent, glyceryl trinitrate-mediated dilatation (GTNMD) were measured. Results Compared with placebo, atorvastatin produced a significant decrease in apolipoprotein B (34.2%), LDL-cholesterol (44.1%) (all P < 0.001), and oxidized-LDL (35.7%, P = 0.03). There was a non-significant increase in plasma cGMP (P = 0.13) on atorvastatin. FMD and GTNMD increased significantly on atorvastatin (FMD: atorvastatin +1.8 ± 0.4%; placebo +0.2 ± 0.4%, P = 0.007); (GTNMD: atorvastatin +1.3 ± 0.9%; placebo ,1.2 ± 0.6%, P = 0.04). An increase in cGMP was independently correlated with an increase in FMD on atorvastatin (adjusted R2 0.41, P = 0.02). Conclusion Atorvastatin improves endothelium-dependent and independent vasodilator function of the brachial artery in Type 1 diabetes mellitus patients with microalbuminuria. This may relate to pleiotropic effects of statins, in particular reduced oxidative stress and increased availability of nitric oxide. [source] ENDOSCOPIC MICROVASCULAR ARCHITECTURE OF THE PORTAL HYPERTENSIVE GASTRIC MUCOSA ON NARROW BAND IMAGINGDIGESTIVE ENDOSCOPY, Issue 3 2007Seishu Hayashi Background:, We evaluated the endoscopic microvascular architecture of the gastric mucosa in portal hypertension patients using the prototype of narrow band imaging (NBI). Material and Methods:, The study included 103 Helicobacter pylori -negative patients with chronic liver disease (22 without portal hypertension (group 1), 81 with portal hypertension (group 2)). Results:, (i) Abnormality of collecting venules, reddening mucosa, red spots, a mosaic-like pattern, and gastric antral vascular ectasia (GAVE) were observed on the gastric mucosa, and an obscure change in collecting venules (73% vs 14%; P < 0.001), reddening mucosa (49% vs 5%; P < 0.001), red spots (36% vs 5%; P < 0.01) and a mosaic-like pattern (40% vs 5%; P < 0.01) were more frequently observed in group 2 than in group 1. (ii) On magnifying endoscopy with NBI, the mucosa with an obscure change in collecting venules was demonstrated as dilation of the capillaries surrounding the gastric pits in various degrees, and reddening mucosa was observed as extended and swollen gastric pits and various degrees of dilated and convoluted capillaries surrounding the gastric pits. Red spots were demonstrated as extended and swollen gastric pits, dilated and convoluted capillaries surrounding the gastric pits, and intramucosal hemorrhage around these capillaries. GAVE was recognized as partial and marked dilatation of the capillaries surrounding the gastric pits. Conclusion:, Abnormality of collecting venules, swelling of gastric pits, dilatation of capillaries surrounding the gastric pits, intramucosal hemorrhage around capillaries, and partial and marked dilatation of the capillaries were observed on the gastric mucosa in portal hypertension patients. [source] COMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONESDIGESTIVE ENDOSCOPY, Issue 4 2004Hiroshi Nakagawa Background:, Endoscopic papillary balloon dilatation (EPBD) is one of the methods to remove bile duct stones. EPBD might preserve the function of the sphincter of Oddi despite the potential risk of acute pancreatitis. There are only a few reports of EPBD reducing the risk of acute pancreatitis and, at same time, preserving the function of the sphincter of Oddi. Methods:, We performed EPBD for bile duct stone removal in 60 patients using two balloons with different diameters. Patients were randomized to EPBD with a 6 mm balloon (n = 30) or an 8 mm balloon (n = 30). In both groups, isosorbide dinitrate (ISDN) was infused in a rate of 5 mg/h while low pressure EPBD were being performed. The pressure of the sphincter of Oddi was observed before and after the EPBD procedures. Also, serum amylase level after EPBD was observed for both groups. Results:, Serum amylase level of the 6 mm group was signi,cantly higher than that of the 8 mm group (P < 0.05). Acute pancreatitis occurred in two patients ( 6.7%) in the 6 mm group whereas no case was observed for the 8 mm group. The rates of duct clearance were 93% in the 6 mm group and 100% in the 8 mm group. Stone removals were dif,cult in seven cases with 6 mm balloon dilatations due to the narrow ori,ces of the papilla. In the 6 mm group, there was no signi,cant difference between the basal sphincter of Oddi pressure (BSOP) and the phasic sphincter of Oddi pressure (PSOP) before and after EPBD. However in the 8 mm group, the BSOP observed after the EPBD procedure was signi,cantly higher than BSOP before the treatments. Within this group, BSOP values after EPBD were preserved by approximately 80% of the BSOP values before the treatments. In contrast, there was no signi,cant difference in PSOP before and after the treatments. Regarding the stone numbers, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with less than two stones. Also, as for stone size, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with stones of less than 6 mm in diameter. Conclusion:, We are now conducting EPBD with ISDN infusion using a 6 mm balloon for a patient who has less than two stones with size not exceeding 6 mm in diameter. An 8 mm balloon is used for a patient with more than two stones or a stone greater than 6 mm in size. [source] Carcinoma of the gall-bladder associated with primary sclerosing cholangitis and ulcerative colitisDIGESTIVE ENDOSCOPY, Issue 1 2000Mitsuru Seo A 64-year-old Japanese male was admitted to Fukuoka University Hospital to undergo further examination for an elevated ,-glutamyltransferase (,-GTP) level. Endoscopic retrograde cholangiography (ERC) showed dilatation of the intrahepatic bile duct and stenosis of the proximal portion of the common bile duct. No abnormality was found in the gall-bladder. Since the fecal occult blood test was positive, sigmoidoscopy and a barium enema were performed. Sigmoidoscopy showed a hyperemic and hemorrhagic mucosa in the rectum, but a barium enema study did not show any abnormal findings in the entire colon. We diagnosed the patient to have primary sclerosing cholangitis (PSC) and ulcerative proctitis based on these radiological and endoscopic findings. Bloody stool and fever occurred 4 months after the first admission. The patient's colitis extended to the entire colon. Because of the failure of corticosteroid therapy, a subtotal colectomy was performed. Given that a mass was intraoperatively palpable in the gall-bladder, a cholecystectomy was simultaneously performed. In the whole resected colon, diffuse ulcerations and mucosal islands were found. Grossly, a flat polypoid lesion, measuring 2 cm in diameter, was found in the fundus of the resected gall-bladder. Sections of this lesion in the gall-bladder revealed cystic atypical glands and some atypical cell clusters invading the subserosa. The present case suggests that careful observations are needed for patients with ulcerative colitis who have an elevated ,-GTP level even if the colitis is limited to the distal colon and the serum alkaline phosphatase level is normal. [source] Combined treatment of achalasia , botulinum toxin injection followed by pneumatic dilatation: long-term resultsDISEASES OF THE ESOPHAGUS, Issue 2 2010R. Kroupa SUMMARY Injection of botulinum toxin (BT) and pneumatic dilatation are available methods in nonsurgical treatment of achalasia. Authors anticipate beneficial effect of prior BT injection on the success of pneumatic dilatation and duration of its effect. There are no long-term data available to assess efficacy of combined treatment. From 1998 to 2007, 51 consecutive patients (20 men and 31 women, age 24,83) with achalasia were included and prospectively followed up. Each patient received injection of 200 IU of BT into the lower esophageal sphincter (LES) during endoscopy and 8 days later pneumatic dilatation (PD) under X-ray control was performed. The follow-up was established every 3 months first year and then annually. The efficacy was evaluated by a questionnaire concerning patient's symptoms and manometry. Results were compared with 40 historical controls (16 men and 24 women, age 26,80) treated by PD alone using the same method and follow-up. Fifty-one patients underwent combined treatment. Four patients failed in follow-up and were not included for analysis. The mean duration of follow-up was 48 months with range 12,96 months. Thirty-four of forty-seven (72%) patients were satisfied with results with none or very rare and mild troubles at the time of the last visit. Forty-one patients were followed up more than 2 years. Effect of therapy lasted in 75% (31/41) of them. In 17 patients, more than 5 years after treatment, effect lasted in 12 (70%). Mean tonus of LES before therapy was 29 mm Hg (10,80), 3 months after therapy decreased to 14 mmHg (5,26). The cumulative 5 years remission rate (±95% CI) in combined treated patients 69% ± 8% was higher than in controls 50% ± 9%; however it, was not statistically significant (P= 0.07). In control group 1, case of perforation (2.5%) occurred. Eight patients (17%) with relapse of dysphagia were referred to laparoscopic Heller myotomy with no surgical complication. The main adverse effect was heartburn that appeared in 17 patients (36%). Initial injection of BT followed by PD seems to be effective for long-term results with fewer complications. But the combined therapy is not significantly superior to PD alone. [source] | |||||||||||||||||||||||||||||||||||||||||||