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Background Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. Case presentation A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. Conclusion The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.

The normal breast tissue consists of branching ducts, which terminate into the secretory lobular units. The ducts and lobules are lined by two layers of epithelium consisting of the inner secretory epithelial layer and the outer myoepithelial layer. An increase in the number of epithelial cells, three to four cells above the basement membrane, without bridging or distension of the lumina, indicates mild epithelial hyperplasia (Fitzgibbons et al. 1998). Mild epithelial hyperplasia is not associated with increased risk of malignancy (Rogers 1987). This pattern of mild epithelial proliferation is present in most specimens excised for benign and malignant breast tissue.

Robust registration between prone and supine data acquisitions for CT colonography is pivotal for medical interpretation but a challenging problem, especially in sub-optimally prepared patients. This paper introduces a prone and supine registration method that aims to overcome the difficulties posed by differences in luminal distension and bowel cleansing. The endoluminal surface is iteratively deformed using thin plate spline interpolation in order to increase similarity between prone and supine surfaces. Iterative deformation allows the re-computation of surface curvatures and, therefore, surface features to resemble one another more closely. Therefore, the similarity between surfaces increases with each optimization step when running a subsequent intensity-based registration in cylindrical space. Improved spatial alignment of endoluminal surfaces and better registration accuracies are shown in a limited number of challenging cases.

Multidetector computed tomograpy (MDCT) is the most frequent imaging modality in the diagnostic work-up of oncologic diseases of the abdomen. Although CT has been used for preoperative evaluation of oesophageal cancer, the major role of CT has been the depiction of lymph nodes, distant metastases, or both, rather than the evaluation of the local status of oesophageal cancer. The sensitivity of conventional or helical CT protocols for the localization of oesophageal cancer, especially early stage cancer, is not satisfactory. This may be attributed to the fact that conventional or helical CT cannot offer optimal conspicuity of oesophageal cancers against the normal oesophageal wall, or because the oesophagus is too long to be imaged entirely using thin slices during a single breath-hold on conventional or helical CT scans, especially in the absence of lumen distension, since inadequately distended hollow viscera on CT may hide small lesions and may even mimic pseudolesions. Thus, optimal distension of the oesophagus and stomach is important to overcome this limitation. The combination of the MDCT technique with thin slice sections and the possibility to obtain high-quality, isotropic, multi-planar reconstructions and the water filling, or the application of gas-producing effervescent granules to distend the stomach and the oesophagus are important factors that may increase the efficacy of CT for local staging of oesophageal cancer. Using this technique is not only useful for a complete preoperative staging of oesophageal malignancies according to TNM classification but also clinically relevant for evaluation of a broad spectrum of inflammatory and traumatic diseases. The introduction of FDG PET in combination with MDCT resulted in further optimizing the diagnostic work-up of oesophageal cancer and other malignant diseases rendering this technique to be the modality of choice depending on its availability. In this book chapter we review the value of the hydro-MDCT technique and hydro-FDG-PET-CT technique in the diagnostic work-up of oesophageal diseases.

MR contrast media catalytically improve the inherent image contrast between normal and pathologic tissues. This is achieved by mechanisms that increase the relaxation rates of water protons in areas where these agents are distributed. The first generations of systemic, intravenous contrast media are unspecific in action owing to their distribution in the extracellular compartments. The newer agents are more specific and are limited to anatomic target tissues. But in the future, contrast media are expected to act on processes even at the cellular level. Gastrointestinal MR agents have two main purposes: to improve the signals and contrast resolution between the bowel lumen and wall and to distend the gut. Water or watery solutions are the media most frequently used in this concept owing to the favorable signal characteristics, excellent distribution, and good tolerance. But to avoid absorption of water and the subsequent “collapse” of the gut, nonabsorbable particles need to be dissolved in the solution. By increasing the osmolarity, the distension of the intestine increases linearly as a consequence of the dose—response relationship that exists between these two parameters. The oral application of contrast is usually preferred for most of the gastrointestinal MR examinations except for the imaging of the large bowel, although the best degree of small bowel distension is obtained with enteroclysis.

Magnetic resonance imaging (MRI) has been increasingly studied as a diagnostic tool for the evaluation of the colon. Without the use of intralu-minal colonic distension methods or following colonic distension with the use of either positive or negative luminal contrast medium (MR colonogra-phy), cross-sectional images can be acquired of the entire abdomen. Subsequent evaluation of the complete colonic wall can be executed using multipla-nar reformations of the source data set with optional three dimensional (3D) rendering, in the case of a MR colonography data set. Although most investigators primarily focused on the ability of detecting colorectal polyps and masses using MR colonogra-phy, a wide spectrum of colorectal disorders can be evaluated by utilizing MRI to examine the colon.

Applanation tonometry or arterial distension waves has been proposed to assess non-invasive recording of the arterial pressure waveform and magnitude in both central and peripheral arteries. The value of mean arterial pressure (MAP) that is used in the calibration procedure is of vital importance. The aim of this study was to investigate the differences in carotid and femoral arterial pressure values after calibration using MAP calculated from brachial tonometry and from approximate formula. In 30 volunteers (56±10 years, range: 38-73; pulse pressure: 57±15 mmHg, range: 31-93) arterial pressure waveforms were consecutively obtained at the left brachial, left carotid and left femoral arteries by applanation tonometry. Diastolic (DBPbra) and systolic (SBPbra) brachial pressure were obtained with oscillometric device. Calibration of carotid and femoral waveforms was assessed assuming MAP minus diastolic pressure constant throughout the arterial tree. Calibrated tonometric signals were used as reference values. Error in estimating MAP from SBPbra and DBPbra values using the traditional formula resulted in an underestimation of MAP of 3% when compared with the brachial MAP obtained by applanation tonometry. This error tended to an underestimation of carotid and femoral systolic pressure of 5%. Moreover, absolute error increases with increasing pulse pressure (PP) levels. By other side, MAP computed as 38% of PP above diastolic pressure, introduces an error of 0.1% in brachial MAP and of 0.2% in carotid and femoral systolic pressure estimation, independent of PP levels.

We simulate the intravasation of liquid distention media into the systemic circulation as it occurs during hysteroscopy and transurethral resection of the prostate. A linear network flow model is extended with a correction for non-newtonian blood behaviour in small vessels and an appropriate handling of vessel compliance. We then integrate a fast lookup scheme in order to allow for real-time simulation. Cutting of tissue is accounted for by adjusting pressure boundary conditions for all cut vessels. We investigate the influence of changing distention fluid pressure settings and of the position of tissue cuts. Our simulation predicts significant intravasation only on the venous side, and just in cases when larger veins are cut. The implemented methods allow the realistic control of bleeding for short-term and the total resulting intravasation volume for long-term complication scenarios. While the simulation is fast enough to support real-time training, it is also adequate for explaining intravasation effects which were previously observed on a phenomenological level only.

We have derived and evaluated parameters from ultrasound images of the neck to permit a computer to automatically characterize and differentiate between the carotid artery and jugular vein at image acquisition time during vascular interventions, given manually placed seed points. Our goal is to prevent inadvertent damage to the carotid artery when targeting the jugular vein for catheterization. We used a portable 10 MHz ultrasound system to acquire cross sectional B-mode ultrasound images of these great vessels at 10 fps. An expert user identified the vessels in the first frame by touching the vessels on the screen with his fingertip, and the computer automatically tracked the vessels and calculated a best-fit ellipse for each vessel in each subsequent frame. Vessel location and radii were further analyzed to produce parameters that proved useful for differentiating between the carotid artery and jugular vein. These parameters include relative location of the vessels, distension of the vessel walls, and consistent phase difference between the arterial and venous pulsations as determined by temporal Fourier analysis.

The assessment of the central venous pressure (CVP) is one of the basic elements of a standard physical exam. This is done at the bedside by measuring the vertical height of the distension of the jugular veins above the sternal angle, which is where the second rib meets the sternum. The sternal angle is used because it is fortuitously approximately 5 cm above the mid-point of the right atrium whether the patient is lying down or whether the patient is sitting upright at a 60° angle. This works because the right atrium is a relatively anterior structure and sits just below the sternal angle. Differences in heart size only add a small difference to the measurement, and this standard reference point allows comparisons over time and by different operators. The midpoint of the right atrium is used as the standard reference point because it represents the lowest pressure for the blood returning to the heart, and the starting point from which the heart raises the pressure. The value is in cmH2O, which can be converted to mmHg by dividing the value in centimeters by 1.36, which accounts for the density of mercury and the conversion from cmH2O to mmHg. A major reason given for assessing the CVP is that it gives an indication of a person’s volume status, but before the usefulness of this measure can be assessed, it is important to appreciate the factors that determine CVP and right atrial pressure [1]. In this chapter, I will use CVP and right atrial pressure interchangeably because there is normally only a negligible resistance between the pressure in the large veins and the right heart and the pressures are essentially the same.

Introduction: Small bowel manipulation leads to a profound ileus and an increase in spinal Fos expression, suggesting prolonged activation of spinal afferent pathways. The extent to which vagal afferents may also be influenced has not been investigated. We aimed to examine intestinal afferent sensitivity and brainstem Fos expression in mice during postoperative ileus. Methods: Under enflurane anesthesia, C57BL/6 mice underwent laparotomy followed by small bowel manipulation to induce an ileus or left untouched as a sham-treatment group. The animals were killed 24 h later. The brainstem was removed for Fos immunocytochemistry. 3 cm segments of jejunum were placed in Krebs buffer. Extracellular multiunit mesenteric afferent nerve discharge was recorded at baseline during distension and following serosal application of bradykinin (BK 1 µM). Whole nerve afferent discharge was quantified as peak increase above baseline. Fos IR was quantified in the nucleus of the solitary tract (nTS). Leukocyte infiltration into the intestinal muscularis was used an index of post-operative inflammation. Data are mean ± SEM and were compared by unpaired Students’ t-test. Results: The number of leukocytes infiltrating the muscularis was elevated during ileus (39 ± 9 vs. 1.8 ± I/mm2 in sham controls; P = 0.008). This was associated with an increase in the number of Fos-positive neurons in the nTS following surgery compared to sham controls (Bregma:- 7.70 mm, 30 ± 9 vs. 6 ± 2; P = 0.01, - 7.32 mm, 107 ± 26 vs. 6 ±2, P = 0.016, N = 4). Spontaneous discharge was higher in ileus animals compared to sham segments (17 ± 1 vs. 12 ± 2 imp/s, P = 0.02, N = 6), but not in the peak response to ramp distension (at 60 mmHg 85 ± 6 vs. 70 ± 4 imp/s respectively, P = 0.07). The response profile was different in ileus with a significantly increased response at low distending pressures (2 -20 mmHg) compared to controls (18 ±2 imp/s vs 9 ±2, P < 0.05). The level of firing after BK adminstration was not significantly different during ileus (58 db 8 imp/s vs 39 db 9 imp/s, N = 8, n.s.). Conclusion: Small bowel manipulation leads to a markely increase in brainstem Fos expression indicating that vagal afferent pathways are activated during postoperative ileus. Mechanical manipulation leads to an augmented afferent sensitivity to low distending pressures. The increased sensitivity to low threshold distension might be due to local inflammatory processes. This activation is not reflected by changes in afferent sensitivity due to chemical stimulation, suggesting there may be compensatory changes to limit inflammation-induced hypersensitivity.

The normal breast tissue consists of branching duets, which terminate into the secretory lobular units. The duets and lobules are lined by two layers of epithelium consisting of the inner epithelial layer and the outer myoepithelial layer. An increase in the number of epithelial cells, three to four cells above the basement membrane, without bridging or distension of the lumina, indicates mild epithelial hyperplasia Fitzgibbons et al. 1998). Mild epithelial hyperplasia is not associated with increased risk of malignancy (Rogers 1987). This pattern of mild epithelial proliferation is present in most benign and malignant breast tissue.

The terminal duct, acini, and intralobular connective tissue constitute an anatomic and physiologic unit. But the pathologic, clinical, and radiographic features of lobular changes will be discussed under several headings, depending on whether they are characterized by: • Distension of the acini • Proliferation of the intralobular connective tissue • Metaplastic or proliferative epithelial changes • Degenerative, metaplastic, or sarcomatous changes in the intralobular connective tissue

Multiple scientific works and an improved analysis of CSF physiology, make it possible to propose a modern definition of hydrocephalus that takes into account our knowledge of pathogenetic mechanisms. Hydrocephalus is a progressive ventricular distension induced by a disturbance in CSF circulation/resorption or CSF production, associated with an increased intracranial pressure.

Viscoelastic material retained behind the IOL may cause a capsular bag distension in the early postoperative period. These eyes accumulate a transparent substance in the closed chamber inside the capsular bag from the IOL blocking the capsular opening. The capsular bag distension was first discribed by Davison in 1990. Miyake et al. proposed a new classification of capsular block syndrome and supposed viscoelastic material to cause early-postoperative capsular block syndrome (Miyake et al., 1999). Capsular bag distension after optic capture of a sulcus-fixated IOL was described by Basti et al. (1999).

Since the classical studies on ICP by Cushing, the main methodological principle for most investigators is based on the a priori postulate that the pressure in the cranial cavity is evenly distributed. This starting point made it possible to characterize the overall ICP by the pressure in one compartment only: the epidural, subdural or the, most widely used, ventricular fluid pressure (VFP). During recent decades, two important facts have emerged. 1. The mechanical pressures of the intracranial constituents [brain tissue, cerebrospinal fluid (CSF), interstitial fluid (ISF)] are different in their absolute values [3, 4, 5, 6, 8]. 2. An uneven distribution of pressures between the various intracranial compartments has been demonstrated in neurosurgical pathology [2, 6, 7].

Pancreatic cysts and pseudocysts are cavities containing pancreatic juice, either pure or mixed with necrosis debris or blood, contained or not within the pancreas from which they arise [1]. Anatomoclinical forms of pancreatic cysts are numerous. Besides cystic tumors such as cystadenomas and cystadenocarcinoma or parasitic cysts or congenital cysts, the most frequent varieties are observed during chronic pancreatitis and acute pancreatitis. In chronic pancreatitis, most cysts and pseudocysts are secondary to partial or complete ductal obstruction due to stenosis or intraductal stones or both phenomena. Distension of the ductal system results proximally to the obstacle. At the beginning, cysts are intrapancreatic collections, but when they grow, they can reach the capsule of the pancreas. If the capsule ruptures, cysts can sometimes migrate less far from the pancreas and are then limited by the neighboring organs or by a fibrous layer. These are called retention pseudocysts. Pseudocysts can also complicate acute pancreatitis, whatever the etiology (biliary acute panceatitis, acute attacks superimposed on chronic pancreatitis, for example). In this instance, necrotic pseudocysts result from the rupture of the ductal system.

Conventional double-contrast barium studies and endoscopy continue to be the primary methods for examining tumors of the stomach and large bowel. In contrast to computed tomography (CT), however, these methods provide no information concerning tumor growth beyond the organ borders or the presence of regional lymph node and organ metastases. For more extensive diagnosis using CT, reliable opacification and adequate distension of the gastrointestinal tract are required. Aside from the commonly used iodine-containing contrast media and barium suspensions, some authors have recommended the use of water given orally or rectally as an alternative contrast medium [2, 3, 8].

Motility in the gut is a complex series of movements with an underlying orderliness that ensures descending propulsion of the intestinal contents.Prominent amongst these are rhythmic contractile activity and coordinated descending waves of contraction and relaxation. Rhythmic activity can occur in the absence of obvious stimulation but probably has a mixing function, whereas propulsive activity is triggered by distension or by chemical stimulation of the mucosa. There is an obvious polarity in the propulsive activity; contractions occur above the stimulated region and relaxation below. This is the basis of the peristaltic reflex [3] which persists in extrinsically denervated gut segments having no connections with the central nervous system. Indeed, isolated segments continue to exhibit a range of motility, including the peristaltic reflex, even when totally removed and maintained in artificial media. Such isolated preparations lend themselves to pharmacological investigation and have formed the basis of our studies on GABA involvement in motility patterns of the gut.

Forty patients with idiopathic and Chiari-associated syringomyelia were evaluated for the level of tonsillar and medullary descent and size and flow in cerebrospinal fluid (CSF) spaces across the foramen magnum (FM), with which the cranial extent and degree of distension of the syrinxes were compared. There was no significant association with or even trend towards patients with increasing tonsillar descent or narrow or obstructed CSF pathways having more extensive or more distended syrinxes. Reduction of distension of syrinxes occurred in 66% of operated cases, regardless of whether FM decompression or only shunting of the syrinx had been performed. These trends were unexpected in the light of current hypotheses of syrinx formation in which intermittent obstruction of CSF pathways at the FM is central.

Endoscopy has a dual role in pouch monitoring. First of all, it is important in monitoring the healing process before closure of the protective ileostomy. Initially, the area of the anastomosis is severely inflamed and friable and some ulceration and swelling is seen along the suture lines. Later on, after two to three months, both the anastomotic line and the suture lines have completely healed (Fig. 5). It has been our policy to close the ileostomy only after full endoscopic healing of the pouch. The normal small bowel mucosa has a clearly visible vascular pattern upon distension.

It is now generally accepted that most of the foam cells formed in the early fatty streak arise from circulating monocyte-macrophages. We have developed an experimental model to investigate the effect of transmural pressure on mononuclear cells adherence to the vascular endothelium in freshly excised, intact rabbit thoracic aorta. Mononuclear cells were obtained from autologous blood by centrifugation through lymphocyte separation medium, radiolabelled by incubation in 51-chromium, and resuspended in RPMI containing 10% fetal calf serum, at a concentration of 2 × 106 cells/ml. After ligature of intercostal arteries, 2 segments from the descending thoracic aorta were excised at in vivo length and under physiological pressure, in order to preserve endothelial integrity. Arterial segments were incubated in oxygenated Krebs solution, at 39°C and the intraluminal solution was changed to the solution containing the labeled mononuclear cells. The pressure was established at 70 mmHg in one segment and at 160 mmHg in the other. After incubation, the vessels were fixed under pressure, opened longitudinally and cut into 4 segments. The samples were frozen and serially sectioned en face at 20 μm intervals from the luminal surface to the adventitia. The adherence per unit length (cells/ram) were then determined. We found that the adherence was increased at high pressure. Our findings suggest that the enhancement of mononuclear cell adherence was primarily due to distension of the wall, but might also have resulted from activation of adherence following hyperpressure.

Bartholin’s duct cyst is a sequel of occlusion of the main duct leading to the accumulation of secretion. It presents as a slightly tender, round to ovoid swelling at the lower part of labium majus. The size usually varies from 3 to 6 cm with an average of 5 cm. A larger cyst attaining 12.5 cm and weighing up to 183 g has been described (Aborjaily et al. 1958). The cyst is more commonly unilateral, but bilateral cysts are sometimes seen. Depending on whether the main or smaller ducts are obstructed, the cyst may be uni- or multilocular; the unilocular cyst usually results from main duct obstruction. A collar-button-type distension generally occurs proximal to the obstruction of the main duct (Tancer 1965). The common cause of obstruction is Bartholin adenitis due to gonococcal infections. Infections by other organisms have also been incriminated. Mechanical trauma can cause distortion of the duct and thereby hindrance to the outflow of secretions. Rarely, malignancy of the organ can manifest as a cystic swelling in elderly women. The posterior third of vulva is the usual site for these cysts.

In the literature, the figures given for the incidence of pulmonary dysfunction in acute pancreatitis (AP) vary a great deal. The values lie between 4% and 74% depending on the author, the patients, the definition of pancreatitis, the diagnostic methods and the definition of pulmonary dysfunction [4, 6, 12, 16]. Possible pulmonary dysfunctions are: (a) respiratory regulation, (b) mechanical restriction of pulmonary distension, (c) gas exchange, (d) changes of pulmonary perfusion, and (e) dysfunction of surfactant. Without passing judgement on the clinical importance of these dysfunctions, we want to concentrate on points c—e in this study. Diagnostic and therapeutic procedures are described concisely for all five dysfunctions, starting with that of the respiratory regulation as shown in Table 1.

An increased release of ANF (atrial natriuretic factor) during myocardial infarction due to atrial distension or hypoxia has been observed (Dietz 1984; Ledsome et al. 1985). Furthermore, an ANF induced decrease of coronary vascular resistance (Otero et al. 1987) and a raised plasma level of ANF has been described in patients with coronary heart disease (Porter B. et al. 1987).

Obstruction of the upper urinary tract is not always unequivocal: Where it is, it is usually easy to evaluate. The ureteric stone with proximal dilatation and hydronephrosis will be clearly seen on the excretion urogram. Standard isotope renography may be useful to demonstrate the degree of functional impairment and obstruction, but the decision to operate is not usually difficult to make. There are many situations, however, where the urogram demonstrates dilatation of the upper urinary tracts, but an obstructing lesion is not apparent and the question is raised as to whether the dilatation is truly obstructive or not (Fig. 1). In this situation, the decision to operate is often as difficult as it is straightforward in the unequivocal case. Renal pelvic dilatation, post-pyeloplasty dilatation, ureters dilated after reimplantation or ureterolithotomy, vesicoureteric reflux and post-diversion ureteric dilatation all provide examples where it might be difficult to be certain of the true explanation for the distension. The urogram gives only a still, instantaneous anatomical picture; it says nothing about underlying function or upper tract urodynamics. The standard renogram will give a rising, apparentlyobstructive curve in any situation where there is retention of activity in the kidneys or ureters. Thus, stasis in non-obstructive dilatation andthe truly impeded upper tract will give the same pattern.

For the replacement of the anterior cruciate ligament a double-layered strip ot the quadriceps tendon is used which remains distally fixed to a trapezoid piece of bone from the patella. This piece of bone is inserted into the tibia head. One of the two arms of the transplant is guided through a canal in the condyle. The other arm is fixed “over-the-top”.lt has been demonstrated by biomechanical investigations in autopsy knees that the “over-the-top” arm is able to protect the transcondylar arm against early distension. Extraarticularly an ELLISON-procedure is performed.

In all pathologic gaseous distensions of the intestinal tract, the accumulation of gas is related to the swallowing of air and to a mechanical or functional obstruction to the passage of intestinal contents, with an associated decrease in the reabsorption of gas. In addition there is a fluid shift into the bowel lumen, especially with mechanical obstruction, due to diminished fluid absorption by the bowel wall as a result of distension and progressive blood flow impairment. These pathologic collections of gas and fluid cause typical fluid levels to appear on the L Lat plain abdominal radiograph (Fig. 3 a, b). Fluid levels are a nonspecific sign and may result from mechanical or nonmechanical causes. They have diagnostic value only within the context of the clinical presentation.

The term hydrocephalus, in its broadest sense, means an increased amount of fluid in the CSF spaces, particularly in the cerebral ventricles, as opposed to local accumulations of fluid in subdural hygromas, arachnoid cysts, or cavities within the cerebral parenchyma. Enlargement of the cerebral ventricles may result from their distension by increased intraventricular pressure, or from the loss of tissue caused by disease processes destroying nervous parenchyma; it is customary to distinguish “increased pressure hydrocephalus” from “hydrocephalus e vacuo”. It needs to be emphasized from the start that these two mechanisms of ventricular dilation are not mutually exclusive and that they often combine and interact. For example, long-standing distension of the cerebral hemispheres because of increased intraventricular pressure eventually induces tissue damage and superimposed hemispheric atrophy. Conversely, massive destruction of the hemispheres, such as in hydranencephaly (Chapter 11), may result in secondary impairment of CSF circulation, whereby pressure hydrocephalus becomes grafted upon encephaloclastic lesions. In adult brains there may be difficulties in deciding whether a mild ventricular enlargement results from increased pressure or from hemispheric atrophy, particularly if there are no additional clues as to the causative mechanism. This problem usually does not arise for the hydrocephalus in infants and children.

Distension of the atria seems to be the principal stimulus for ANP secretion from myoendocrine cells [1, 7, 9, 10]. In congestive heart failure (CHF) and volume overload atrial distension is caused by an increased preload [4–6, 11, 12, 14]. Elevated ANP plasma concentration have also been reported in children with congenital heart disease (CHD) and broncho-pulmonary dysplasia [7, 9, 17, 18, 19].

Acute massive dilation of the caecum and right colon, without evidence of distal obstruction, today is a well recognized complication in sick, bedridden patients [3, 4, 8]. This condition was first described by Ogilvie [7] in 1948 — and is generally termed pseudo-obstruction of the colon. If undiagnosed and untreated, distension usually leads to caecal perforation, peritonitis and death [2, 9, 12].

A comparative neuropathological and histochemical study was performed on the brains of seven cases of NPD. In type A (two cases), besides the neuronal storage of SM, a widespread endothelial storage of a neutral glycosphingolipid was found. In one case a pseudosystemic lesion of the pallido-nigral system was observed. In type B (one case) the only finding was the endothelial storage of SM. In type C (four cases) the degree of neuronal storage distension contrasted considerably with a very low amount of lipid demonstrable histochemically in fixed brains. Only in one case, focal neuronal storage of aphosphoglyceride could be proved. However, in peripheral neurons (of unfixed appendix) the phoshoglycerides were clearly predominating (one case). A remarkable and constant finding in each case of the series was a widespread neuroaxonal dystrophy with various topical maxima (thalamus, dentate nuclei). The significance of the findings are discussed in relation to the present status of knowledge of this type.

While the diagnosis of large varicoceles should not cause any problems, small varicoceles are often more difficult to detect on clinical palpation. Besides, some patients do present reflux in the internal spermatic vein without palpable distension of the pampiniform plexus [1]. Four objective techniques are available to diagnose such subclinical reflux. Scrotal thermography, Doppler blood-flow measurement and testicular perfusion analysis using radioisotopes are non-invasive, and useful for routine patient screening, whereas retrograde venography of the internal spermatic vein should be reserved for selected cases.

The medullary use of opiates appears to be an attractive alternative in obstetrical analgesia. Narcotics injected into the peridural space have no effect on the sympathetic and motor neurons and little effect on non-nociceptive sensory transmission, i.e., light touch and proprioception. Since these characteristics exclude both hypotension due to extensive sympathetic blockade by local anesthetic agents and paresis of the abdominal wall muscles, the number of instrumental deliveries is thus reduced. The parturient herself can provide useful information as to the intensity of uterine contractions or pain. During the second stage, the mother feels the descent of the presenting part on the pelvic floor and the distension of the pelvic gutter and calls for relief. In this way, built- in safety guidelines help control the use of epidural opiates.

The patient with distension of the colon suffers nausea and vomiting, and wandering dire colic. The kidneys do not properly expel the urine, nor the bowel the faeces, the belly is resonant with wind that often makes its exit at the mouth. At times, but rarely, inflammation is the cause, engendering vicious bile, and often phlegm, and wind which, by distension, causes bitter colic and frightful pain.

Valve prostheses in the digestive tract are subject to the effects of food, drink, and saliva. Moreover, they are under permanent mechanical stress caused by the distension and contraction of the surrounding muscles. In other words, they are under mechanical, chemical, and bacteriological attack. Extended observation indicates that deposits collect on the silicon surface which affect the elasticity of the plastic. Our studies are researching these changes in the plastic. Their aim is to develop a more resistant plastic which remains compatible with the digestive tract.

ANF is a polypeptide with important influence on blood pressure, cardiac output and sodium excretion. As the physiological stimulus for ANF release right atrial volume, i.e. right atrial distension has been demonstrated in animals [3, 4] and patients [5, 7]. Significant changes in ANF serum level have been reported during CPB [2]: after onset of CPB ANF level rises and stays elevated. During CPB RAP is very low or negative so that right atrial distension cannot account for this increase in secretion. Aim of this study was to determine if the inversion of the right atrium during CPB causes the increased release of ANF.

Whether the increased total systemic vascular resistance characteristic of chronic hypertension is a primary event or secondary to increased cardiac output is still debated. Whatever the initiating cause, the increased resistance must result from the narrowing of the small arteries and arterioles (Fig. 1). This may be due either to structural changes or to augmented contraction of the smooth muscle of these resistance vessels. The former probably reflects the adaptation of the blood vessel wall to the increase in distension pressure [24]. The latter may have many causes. One may be alterations of the neurogenic control of the circulation. Possibilities include changes in the activity of central nervous system (CNS) controlling centers, resetting of the control exerted by the arterial and cardiopulmonary mechanoreceptors, alterations in the many processes that can modulate transmitter release and disposition [24, 27, 31, 44, 45, 67, 68]. There may also be changes in the adrenoceptors and in the other receptors on the smooth muscle cells, or changes in the smooth muscles themselves, including abnormalities of membrane transport.

Adult female Wistar rats were treated with Prostacyclin, 3 × 100.tg/kg daily, i. p., for different period of time. The 1st group of the animals was killed on the 3rd day, the 2nd group on the 9th day, while the 3rd group on the 80th day of the treatment. The control animals received no treatment. The liver samples were investigated electronmicroscopically as well as biochemically. The fine structure showed: 1st group: a complete disappearance of glycogen granules from the cytoplasm, without degenerative lesions of other organelles. The rough endoplasmic reticulum (RER) showed a moderate distension. 2nd group: almost a normal structure, the glycogen granules returned, the RER seemed to be remain in the previous state. 3rd group: The 80 day treatment had neither further, nor toxic effect on the fine structure of the hepatocytes.

In peraeute salmonellosis associated with high mortality (e.g., BALB/c or C57BL mice given a large dose of a virulent strain of Salmonella), the intestine may appear normal or slightly hyperemia In subacute or chronic infections associated with low mortality (e.g., A/J or N.NIH(s) mice given a sublethal dose of a virulent strain of Salmonella) the wall of the terminal ileum and cecum may appear thickened and the mesenteric lymph nodes and Peyer’s patches are enlarged and prominent (Fig. 312). The spleen may also be enlarged. The consistency of the intestinal content varies from normal to fluid with gas distension, especially in the terminal ileum and cecum. The onset and duration of diarrhea are dose related and highly variable.

Esophageal motility is controlled by two types of peristalsis [3]: primary peristalsis, studied by esophageal manometry, corresponding to monophasic contractile propulsive waves excited by swallowing, and secondary peristalsis determined by distension of the body of the esophagus. The latter can be studied by acid clearance of the esophagus without swallowing [2]. The aim of this study was to investigate the role of disordered secondary peristalsis of the esophagus in resuscitation patients with or without esophagitis.

Whereas the diagnosis of large (grade II or III) [1 a] varicoceles should not cause any problems, small varicoceles are often more difficult to detect on clinical palpation. In addition, some patients present reflux in the internal spermatic vein without palpable distension of the pampiniform plexus [1]. Such patients are diagnosed as having subclinical reflux or subclinical varicocele. Since reflux is the pathogenetic factor of the epididymotesticular dysfunction in both clinical and subclinical varicoceles, treatment should be the same in both types of patients.

Ureterocele is due to a developmental abnormality followed by distension of the “floor” of the intramural ureter but it can not be considered as a single entity.

The veno-vasomotoric reaction (VVR) is the constrictive response of the resistance vessels to elevations of venous pressure. A constriction transfered on a nervous-reflectory way can be excluded today with certainty; thus, the response on the distension can be regarded with greatest probability as being induced myogenly, that means the smooth muscle acts as a receptor and as an effector, though not necessarily simultaneously in all sections. We have examined the WR in different abdominal circulatory systems of the cat by perfusion with the animals own blood; here the constant flow perfusion had proved to be best.