Prestenotic Dilatation Research Articles

Tuberculous stricture of the urinary tract: antegrade balloon dilation and ureteral stenting.

In eight patients with tuberculous strictures of the urinary tract, antegrade balloon dilation and ureteral stenting was attempted. In six patients, antegrade balloon dilation was successfully performed; however, the procedure was aborted in the remaining two patients due to the failure in passing a guidewire through the stenotic lesions. In six patients in whom balloon dilation and ureteral stenting were performed, a total of nine stenotic lesions were dilated. Those were four ureteric lesions, two lesions of ureteropelvic junctions, two lesions of ureterovesical junctions, and a lesion of calyceal infundibulum. In all six patients in whom balloon dilation and ureteral stenting was successfully accomplished, intravenous urograms obtained 9-31 months after the procedure showed improvements both in contrast media excretion and in prestenotic dilatation. Antegrade balloon dilation of the urinary tract combined with ureteral stenting was an effective technique for the management of stenoses secondary to tuberculosis of the urinary tract.

Primary sclerosing cholangitis: a modified classification of cholangiographic findings.

Primary sclerosing cholangitis (PSC) is a disease characterized by obliterative inflammatory fibrosis usually affecting both the intrahepatic and extrahepatic portions of the biliary tree. Cholangiography is the accepted method for making the diagnosis. Histologic findings can be highly suggestive of PSC, particularly when concentric periductal fibrosis is present (one third of patients), but the findings are usually nondiagnostic [1]. The cholangiographic appearance of PSC includes a broad spectrum of features [2]. On the basis of a study of these features in 40 patients with PSC, we classified the abnormalities into three types of intrahepatic and four types of extrahepatic abnormalities depending on the extent of bile duct narrowing, the severity of narrowing, contour abnormalities, and prestenotic dilatation. In this article, we present a modified classification and discuss the clinical implications of each class.

Entrapment of left renal vein in children with orthostatic proteinuria

We found that patients with orthostatic protein-uria had entrapment of the left renal vein (LRV) by the aorta and superior mesenteric artery (SMA). Of 15 patients studied, ultrasonographic examination showed 13 cases of typical LRV entrapment with prestenotic dilatation, and 2 cases of mild LRV compression between the aorta and SMA. Intra-arterial digital subtraction angiography and monitoring of pull-back pressure from LRV to the inferior vena cava (IVC) were performed on 2 patients with 4+ proteinuria. Accumulation of contrast medium was seen with mild back-flow to the collateral veins, and pressure gradients between LRV and IVC were 4 mmHg and 8 mmHg, respectively. Eighty school-children formed a control group and were investigated ultrasonically. Nine showed typical LRV entrapment, among whom 3 had moderate to massive orthostatic proteinuria. The discovery of LRV entrapment in patients with orthostatic proteinuria gives definite evidence of LRV congestion and may be possibly a cause of massive protein secretion from the left kidney.

Late radiation injury of the rectum and sigmoid colon: barium enema findings in 92 patients.

We reviewed the findings on 169 contrast enema examinations in 92 patients with late radiation injury of the rectum and sigmoid colon, encountered over an 11-year period. The diagnosis was made by rectosigmoidoscopy in all patients. The limitations and pitfalls of both examinations were studied. The mean interval between radiotherapy and diagnosis was 1.7 years and the mean follow-up period was 3.5 years. The main radiological features varied from normal findings (15% of the initial examinations) to decreased distensibility of the bowel wall, intestinal fixation, mucosal and contour abnormalities, ulceration, stenoses and fistula formation. During follow-up, the number of all pathological findings increased. Pre-stenotic dilatation of the descending colon was always absent. The contrast enema examinations and endoscopies were found to be complementary. The barium enema showed the extent of the disease and accurately identified stenoses and fistulas, but underdiagnosed ulceration and overdiagnosed malignancy. Endoscopy allowed unequivocal detection of mucosal damage, especially ulceration, and was accurate in showing stenoses but sometimes failed to demonstrate fistulas. Moreover, in 25% of examinations it was impossible to examine the entire abnormal area.

Detection of Extraintestinal and Intestinal Abnormalities in Inflammatory Bowel Disease by Ultrasound

Abdominal ultrasound (US) can detect extraintestinal and intestinal manifestations and complications of Crohn’s disease. However, the clinical value of routine examination of all patients with inflammatory bowel disease is not known. A total of 100 patients (70% outpatients) with inflammatory bowel disease – 74 Crohn’s disease (CD) and 26 ulcerative colitis (UC) – was studied by US without knowledge of clinical or laboratory data except the diagnosis of inflammatory bowel disease. 39% of the patients with CD showed intestinal abnormalities (target sign: 18%, bowel conglomerates 5%, bowel wall diameter > 5 mm: 20%, prestenotic dilatation: 1%), while 35% of patients with UC had such abnormalities (19% target sign and 27% increased bowel wall diameter). Gallstones were found in 12% of patients with CD and 4% of those with UC. Cholecystectomy had been performed in 7 and 4%, respectively. Renal stones were found in 4 and 8%, liver abnormalities in 19% of both patient groups. Overall, in 30 and 27% at least one extraintestinal abnormality was seen. No clear correlation of disease activity with the occurrence of intestinal or extraintestinal findings was found in CD while bowel abnormalities were more likely to be detected in patients with active UC. None of the laboratory parameters assessed predicted the finding of gallstones, renal stones or liver abnormalities. Renal stones occurred more often in patients with ileal resection and longer duration of disease. US was found to be useful in the routine investigation of patients with inflammatory bowel disease since it detects a considerable number of extraintestinal complications. In addition, it can demonstrate intestinal abnormalities and complications and might be an additional noninvasive method to assess disease activity in UC.

Response to experimental coarctation of the aorta and pulmonic stenosis in the fetal lamb

The following conditions were surgically created in fetal lambs at the gestational ages of 80 to 90 days: (1) preductal coarctation, (2) postductal coarctation, (3) pulmonic stenosis, and (4) constriction of the ductus arteriosus. Studies performed at the time of delivery showed the following: Preductal coarctation and postductal coarctation often are associated with a dilated ductus arteriosus that remains patent. Pulmonic stenosis often results in prestenotic and poststenotic dilatation that may include the ductus arteriosus. The fetal ventricles become hypertrophied in response to the increased pressure work imposed by the distal stenoses.

Takayasu's arteritis in Thailand.

Takayasu's arteritis is a disease of protean manifestations and worldwide distribution. Geographic difference of the sex incidence, anatomical distribution and the type of lesion is observed. Hypertension is very common in the present series. A combination of absent or deficient peripheral pulses and hypertension is also commonly encountered. These symptoms correlate well with arteriographic findings of brachiocephalic and renal artery obstructive lesions. While aneurysm and stenotic lesions have a predilection for the abdominal aorta, the ascending aorta is commonly dilated and stenosis of the thoracic aorta occurs more often than aneurysm. However aneurysm of the aorta as well as of the brachiocephalic arteries is frequently more developed than in those reports of others. The presence of “funnel-shaped” or triangular configuration resulting from renal artery obstuctive lesions, prestenotic dilatation and/or contiguous aortic aneurysm is emphasized as the most likely characteristic of Takayasu's arteritis occurring in this part of the world. Extensive arterial involvement with evidence of lumbar and intercostal occlusion indicates the seventy of the disease. Total aortography is of value not only for the diagnosis of Takayasu's arteritis, but also for demonstration of the anatomical distribution, severity and type of the lesions.

Prestenotic narrowing in the upper urinary tract (author's tract)

While prestenotic dilatation in the upper urinary tract is considered as a characteristic radiological feature, earlier narrowing due to compensating hypertrophy of the musculature is either ignored or misinterpreted. Several examples of prestenotic narrowing are demonstrated and their significance in radiological diagnosis is stressed. This raises the question whether the narrowing of the ureters, seen in cases of bladder neck obstruction, particularly with prostatic hypertrophy, can be explained by a similar physiopathological response. This question can only be answered by performing pressure measurements during the course of radiological examination; the results would, however, be of doubtful value since the introduction of the ureteric catheter would lead to an additional unphysiological state.

Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Pancreatic Cancer: Experiences with 54 Cases

Pathological alterations of the ductal system found during ERCP in 1082 examinations were due to pancreatic carcinoma in 54 patients. The diagnosis was confirmed by laparotomy or autopsy. Predominant findings in 42 patients were stenoses, prestenotic dilatation, caliber variation, stop of contrast medium and ductal displacement in pancreatography. In 28 cholangiograms stenoses were most common which were localized in one third of the cases in the proximal common bile duct. Four types may be differentiated: a stenosing type, an obstructed type, a tapering type and a cavernous type. The stenosing type can be divided in a form with and without interruption of the contrast medium column. A precise differential diagnosis between pancreatic carcinoma and chronic pancreatitis is not possible but a long stenosis with or without stop of the contrast medium speaks in favour of a tumorous process.

Spontaneous recanalization of internal carotid artery occlusions

Three instances of spontaneous recanalization of internal carotid artery occlusion are presented. In the first, extensive extra- and intracranial lesions including severe stenoses and prestenotic aneurysmatic dilatation were demonstrated by angiography. Gradual disappearance of these alterations was shown by control angiograms. In the second and third instances, complete or practically complete occlusions of the supraclinoid portion were found. Control angiograms showed complete recanalization which, in one of these cases, had occurred at least one year after the stroke.