Prolonged Obstruction Research Articles

Cardiopulmonary Schistosomiasis.

s1 May 1961Cardiopulmonary Schistosomiasis.H. F. Rodriguez, M.D., (Assoc.), A. F. Duran, M.D., L. G. Moliner, M.D.H. F. Rodriguez, M.D., (Assoc.)Search for more papers by this author, A. F. Duran, M.D.Search for more papers by this author, L. G. Moliner, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-54-5-1057_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe most severe clinical manifestation of bilharziasis occurs when prolonged and extensive obstruction of the pulmonary arterioles by ova leads to pulmonary hypertension and cor pulmonale.An analysis of 1,100 consecutive autopsies performed in four and one-half years disclosed 54 patients withSchistosomiasis mansoniof the liver and portal hypertension. Of these, 18 (33%) had pulmonary vascular obstruction of such degree as to produce bilharzial cor pulmonale. The clinical characteristics and results of radiographic and cardiac catheterization studies of these 18 subjects, as well as of seven additional living patients, will be discussed. The differentiating features from other conditions leading... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySpontaneous Rupture of Thoracic Aorta Through an Atheromatous Plaque: Case Report and Literature ReviewPenetrating aortic ulcer: Clinical and angiographic characteristicsSpontaneous rupture of the descending aorta through atherosclerotic plaque: Report of a caseAortic rupture in manual dissection of the esophagus: A rare complication during palliative esophagectomy performed on account of radiated esophageal cancer. A pathologic-anatomic viewCase 44-1977Cor pulmonale due to Schistosoma mansoniThe Protean Manifestations of Schistosomiasis Mansoni A Clinicopathological CorrelationMARIO R. GARCÍA-PALMIERI, M.D., F.A.C.P., RAÚL A. MARCIAL-ROJAS, M.D. 1 May 1961Volume 54, Issue 5Page: 1057-1057KeywordsArteriolesAutopsyCatheterizationLiverPortal hypertensionPulmonary hypertensionSchistosomiasis Issue Published: 1 May 1961 PDF downloadLoading ...

Cardiovascular and hemodynamic functions in dogs subject to prolonged aortic occlusion.

Obstruction of the thoracic aorta for 30 minutes can be accomplished without apparent damage to the animal.¹When the period of occlusion is greater than 30 minutes, spinal cord damage, manifested by hindlimb paralysis, ensues in a large percentage of cases. There is a progressive increase in the percentage mortality as the length of obstruction is prolonged. Although survival studies following prolonged aortic obstruction and autopsy reports have been presented, relatively few investigations have been conducted on the alterations in the cardiovascular functions. Studies of the hemodynamic and metabolic changes occurring consequent to prolonged occlusion of the thoracic aorta have been made and are being reported herein. <h3>Methods</h3> Eleven mongrel dogs, ranging in weight from 11.2 to 19.5 kg. (mean body weight, 14.9 kg.) were anesthetized with pentobarbital sodium (30 mg/kg. body weight) and heparinized (5 mg/kg. body weight). A single-lumen, bird's-eye-tip cardiac catheter was inserted into a branch

Penetrating Wounds of the Neck

Penetrating Wounds of the Neck

Penetrating wounds of the neck

Penetrating wounds of the neck

Malignant hypertension secondary to unilateral renal disease.

HYPERTENSION in some instances has been shown by clinical and experimental studies to result from various renal lesions or diseases. Since the classical observations of Bright 1 in 1836 on this subject, a great many investigators have added their evidence incriminating the kidney as the sole factor responsible for hyperpiesis under certain conditions or diseases of this organ. 2 Among this group of diseases are polycystic kidney, chronic pyelonephritis, nephrosclerosis, glomerulonephritis, and conditions producing prolonged urinary obstruction. Periarteritis nodosa involving the renal arteries, amyloidosis of the kidney, mercury poisoning, renal hypoplasia, and Wilms's tumor in children have been reported as playing an etiologic role in hypertension. 2h Many experiments were carried out by Hartman and his colleagues, 2b Cash, 3 Bell and Pedersen, 4 Janeway, 5 and others in which they showed that destruction and changes in the renal parenchyma either from direct attack on the kidney tissue or from

Prolonged Ureteral Obstruction with Recovery Following Administration of Sulfadiazine and Sulfathiazole

Prolonged Ureteral Obstruction with Recovery Following Administration of Sulfadiazine and Sulfathiazole

OBSERVATIONS ON THE EFFECTS OF RENAL ISCHÆMIA UPON ARTERIAL PRESSURE AND URINE FLOW IN THE DOG

1. Methods for producing temporary obstruction, complete or partial, of the renal artery in the dog are described.2. Occlusion of the artery to a sole remaining kidney for periods ranging between 2 sec. and 600 sec. produces, subject to the reservation in paragraph 3 below, contemporary suppression of urine flow without accompanying or subsequent change in arterial pressure as measured by the method of the carotid loop with denervated sinus.3. In some animals long lasting suppression of urine, and hypertension, have been observed to follow short periods (from 5 to 120 sec.) of arterial occlusion (figs. 4 and 5). These responses resemble those accompanying prolonged but partial obstruction of the renal artery (see paragraph 4 below). The conditions of their occurrence are not known.4. When the artery to a sole remaining kidney is partially obstructed, the arterial pressure is rising some 8 to 18 minutes later towards a plateau from which it slowly falls when the obstruction is released. The results suggest that the period of recovery in blood pressure is a function of the period of arterial obstruction (Table I). They occur whether or no the splanchnic and the renal nerves have been divided. No rise in pressure has been observed unless the urine flow, during water‐diuresis, has been at least strongly inhibited by the arterial obstruction.5. When the renal artery on one side is partially obstructed, the contralateral kidney being present, either no rise in arterial pressure ensues, or a rise from which recovery occurs apparently more quickly than in comparable experiments in which the contralateral kidney is absent.6. The view that the increase in arterial pressure referred to in paragraph 4 above is of humoral origin, is confirmed by the occurrence of a similar phenomenon in preparations in which a kidney has been transplanted to the neck of a decerebrated and nephrectomised dog. Either release of the obstruction, or removal of the kidney, is followed by a gradual return of the arterial pressure to its original value. In order to produce increases in general arterial pressure in such preparations, the reduction in renal arterial pressure needs to be severe: the resultant increases in general arterial pressure are, notwithstanding, much smaller than in survival experiments.7. The results suggest that the cause of the rapid blood‐pressure response to compression of the renal artery by means of a previously implanted unit, is the same as that of the persistent hypertension which follows permanent obstruction of the renal artery by operative procedures.8. Functional removal of a chronically ischæmic and sole remaining kidney was followed by a gradual fall in arterial pressure. The hypertension had disappeared within 4 hours, and thereafter the pressure remained constant for 16 hours.9. Animals in which an anastomosis has so been made between the renal segment of the I. V. C. and the portal vein that all the renal venous blood is conducted directly to the liver, respond to the induction of renal ischæmia in ways similar to those in which normal animals respond. It is improbable, therefore, that the liver plays an elective rôle in the inactivation of either the pressor agent or, if we assume these substances not to be identical, the agent responsible for convulsive “uræmia.”10. Consideration of the results reported in this paper shows them to be compatible with the view that normal renal tissue both depresses the rate of formation of the pressor agent by ischæmic renal tissue, and accelerates, by a process of excretion or inactivation, the rate of its disappearance from the blood; further, that when the period of renal ischæmia is long (e.g. 3 hours) the production of the pressor agent continues for some hours after the mechanical release of the obstruction to the renal artery.Grateful acknowledgment is made to the Government Grant Committee of the Royal Society for defraying part of the expenses incurred in this work.

The present status of the serum lipase test

1. Selected data were presented from a series of 1200 serum lipase determinations on 800 patients. 2. The behavior of serial serum lipase determinations was analyzed in a selected group of 5 cases of acute pancreatitis, one case of chronic pancreatitis and 3 cases of malignancy of the pancreas. 3. Analysis of our cases of acute pancreatitis suggests that the decrease in serum lipase concentration following an initial elevated serum lipase, may be due either to a subsiding of the inflammatory process or to complete destruction of the pancreas. There was 21 cases of acute pancreatitis, in 17 of which (81%) the serum lipase was elevated. 4. The serum lipase curve in one case of chronic pancreatitis was indistinguishable from that of pancreatic malignancy. 5. The serum lipase curves in cases of pancreatic malignancy suggest that the initial elevation of the concentration of serum lipase is due to an obstruction to the free flow of pancreatic juice. The subsequent decrease in the concentration of the serum lipase is due either to replacement of pancreatic tissue by the malignant process or to impaired pancreatic function secondary to prolonged pancreatic duct obstruction. There were 30 cases of malignancy of the pancreas, in 16 of which (53.3%) the serum lipase was elevated. 6. Certain limitations of the serum lipase determination are discussed with reference to the variability of the olive oil substrate.

“Rhinitis Caseosa”: Suppurative Rhinitis, Complicated by Prolonged Nasal Obstruction

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DRAINAGE OF THE COMMON BILE DUCT WITH RESULTANT EXTRARENAL AZOTEMIA

This paper is presented to describe a comparatively rare complication following drainage of the common bile duct. On reviewing the literature we found few data on the actual amount of biliary drainage to be expected from a T tube after exploration of the duct. In our experience the average figures for an adult are 300 to 500 cc. per day, with a maximum of 1,500 cc. in an isolated instance. Other investigators have placed a high point at 25 to 30 cc. per kilogram of body weight per day, which for an average person weighing 75 Kg. would amount to 2,250 cc. daily. Walters and his associates 1 in their paper on cholorrhagia following prolonged obstruction reported an output of 2,050 cc. in a single day in 1 patient. In the case here presented there was much more abundant drainage, starting at 1,800 cc. on the first postoperative day. REPORT

Human craniovertebral dynamics

The human craniovertebral cavity, although practically completely surrounded by bone, is subject to relatively wide variations in pressure. The activity of the cerebrospinal fluid is dependent upon: (1) a stable production-absorption mechanism; (2) the phenomena occurring in the intracraniospinal veins which very sensitively reflect pressure changes to that fluid. The almost constantly shifting variations in pressure which occur in the cerebrospinal veins and which are secondary to pressure changes in the extracranio-vertebral veins, indicate the elastic nature of the craniovertebral cavity in contrast to the older conception of the closed box character of the cavity. Under most physiologic and many pathologic conditions, variations in cerebrospinal fluid pressure are readily explained by changes in venous pressure. It is only under unusual pathologic conditions that variations in osmotic pressure affect the level of the fluid pressure. Although the cerebral arteries have an intrinsic nerve supply, changes in caliber of the intracranial arteries probably rarely, if ever, disturb the normal cerebrospinal fluid pressure, except during severe abnormal states, such as during oxygen-carbon dioxide disequilibrium. It is true that these vessels react sensitively to changes in metabolites circulating in the body, metabolites, however, which remain remarkably constant under physiologic conditions. Even under very unusual conditions, it is difficult to effect changes in caliber of the cerebral arteries, and great and sudden increases in arterial pressure are necessary before the diameter of the cerebral arteries alters. Again, removal of fluid from the cistern does little, if anything, to the caliber of these vessels. On the other hand, during such procedures, marked changes occur in the size and pressure of the cerebral veins. If it is a dictum that the cerebrospinal fluid pressure is closely related to the venous pressure, it is also true that the cerebral blood flow is closely related to the arterial blood pressure and the width of the cerebral vascular bed. These two factors tend to keep the oxygenation of the brain at a steady state or within normal limits, so that, for example, a great fall in arterial pressure is compensated by a widening of the vascular bed. Thus, the blood flow may be slower, but the oxygen uptake by the brain is relatively greater. It is remarkable that unconsciousness or convulsions do not supervene until the cerebral arterial pressure falls to a level of approximately 20 mm. of mercury, at which point the oxygen saturation of the internal jugular blood is in the neighborhood of 20 volumes per cent. The difficulty in affecting the cerebral blood flow is again observed in states of increased intracranial pressure, which must be extremely high before collapse occurs. One of the most remarkable of the vascular adjustment mechanisms is the ability of the cerebral circulation to continue in the face of almost complete and prolonged venous obstruction. Under such conditions, the emissary pathways increase in their activity so that the cerebral venous pressure becomes partially adjusted, and the production-absorption mechanism becomes reestablished with a fall of cerebrospinal fluid pressure to its original level. These examples suffice to demonstrate the remarkable resiliency of the cerebral circulation during widely adverse circumstances.

Foreign bodies in tracheobronchial tree: Observations and review of 30 consecutive cases

A series of 30 cases of foreign bodies in the tracheobronchial tree are reviewed. Pulmonary suppuration does result from prolonged bronchial obstruction. Fatalities occurred in 3 cases. Immediate complications were not observed. Tracheotomy was not necessary in this group.

III. BLOOD PLASMA CHOLESTEROL

Hypocholesteremia with dissociation of the normal ratio of esterified to total cholesterol is related to chronic liver injury caused by chloroform. Hypercholesteremia may develop after prolonged biliary obstruction. The hypercholesteremia of chronic biliary obstruction may be promptly reduced below normal by chloroform poisoning or bile duct infection. Acute injury of liver due to chloroform anesthesia may cause no change in blood plasma cholesterol. Absence of bile in the intestine with faulty fat absorption does not cause the development of hypocholesteremia with dissociation of the ester ratio. Poor food consumption or short periods of fasting may cause no change in blood plasma cholesterol. Liver cells injured by chloroform may subsequently become resistant to chloroform. After prolonged biliary obstruction, the liver is apparently more sensitive to small doses of chloroform by mouth. Analysis of blood plasma cholesterol may have a clinical application in differentiation between simple obstructive and parenchymatous lesions of the liver.

Liver Changes After Deprivation of External Pancreatic Secretion

In a recent investigation concerning the physiology of pancreatic secretion a series of dogs was deprived completely of pancreatic juice by means of fistulas made according to the Elman and McCaughan modification of the Rous-McMaster technique and by ligation of the pancreatic ducts. At autopsy, histological examination of the livers of these animals revealed striking changes. In fistula dogs which succumbed 7 to 10 days after the loss of pancreatic juice, early degenerative changes such as cloudy swelling and moderate fatty infiltration of the liver cells were observed. In fistula dogs which survived for longer periods (17, 20, 20, 20, 24, 25, 25, 32, 51 and 56 days respectively) the histological alterations were more pronounced and consisted of one or more of the following : fatty infiltration and necrosis of the liver cells, congestion of the capillaries around the central veins, atrophy of the liver cords, dilatation of the bile canaliculi and biliary cirrhosis. Some of the animals in this group received daily intravenous injections of NaCl and NaHCO3; others continued for 3 weeks or longer without any form of treatment. Extensive fatty infiltration of the liver also occurred after prolonged obstruction of the pancreatic ducts (80 days). After varying periods of exclusion of pancreatic secretion from the intestine, the dogs lost their appetites, declined rapidly in weight, showed marked weakness and apathy, became jaundiced in a few instances, developed a bloody diarrhea and finally succumbed. Vomiting did not occur except in isolated instances. Allan, Bowie, MacLeod and Robinson observed similar symptoms and pathologic changes, in depancreatized dogs treated with insulin. They found an actual increase in the total lipids of the liver and suggested that the pancreas produced an internal secretion, possibly a lipase, which was required by the liver for the mobilization of fat.

A Case of Prolonged Intestinal Obstruction

A Case of Prolonged Intestinal Obstruction