Human herpesvirus 8 as a potential sexually transmitted agent in Honduras

The seroprevalence of human herpesvirus 8 (HHV-8) was studied in 326 human immunodeficiency virus (HIV)-positive and -negative persons from Honduras; women constituted 77% (n = 251) of the subjects. Sera were tested for lytic HHV-8 antibodies by an IFA, and positive samples were confirmed by a radioimmunoprecipitation assay. Of the 326 persons tested, 58 (17.8%) had HHV-8 antibodies. Among the HIV-infected women, 22.7% were seropositive; 11.3% of the HIV-negative women were seropositive. HHV-8 seroprevalence was almost four times higher in HIV-positive female commercial sex workers (36%) than in HIV-negative female non-commercial sex workers (9.9%; odds ratio = 3.8, 95% confidence interval = 1.1-13; P = 0.01), suggesting that commercial sex work is a risk factor for HHV-8 infection. In the men studied, the overall HHV-8 seroprevalence was 22.6%, with a seropositivity rate of 28% for HIV-positive men compared with 12% for HIV-negative men.

Evidence for circulating bone marrow-derived endothelial cells

It has been proposed that hematopoietic and endothelial cells are derived from a common cell, the hemangioblast. In this study, we demonstrate that a subset of CD34(+) cells have the capacity to differentiate into endothelial cells in vitro in the presence of basic fibroblast growth factor, insulin-like growth factor-1, and vascular endothelial growth factor. These differentiated endothelial cells are CD34(+), stain for von Willebrand factor (vWF), and incorporate acetylated low-density lipoprotein (LDL). This suggests the possible existence of a bone marrow-derived precursor endothelial cell. To demonstrate this phenomenon in vivo, we used a canine bone marrow transplantation model, in which the marrow cells from the donor and recipient are genetically distinct. Between 6 to 8 months after transplantation, a Dacron graft, made impervious to prevent capillary ingrowth from the surrounding perigraft tissue, was implanted in the descending thoracic aorta. After 12 weeks, the graft was retrieved, and cells with endothelial morphology were identified by silver nitrate staining. Using the di(CA)n and tetranucleotide (GAAA)n repeat polymorphisms to distinguish between the donor and recipient DNA, we observed that only donor alleles were detected in DNA from positively stained cells on the impervious Dacron graft. These results strongly suggest that a subset of CD34+ cells localized in the bone marrow can be mobilized to the peripheral circulation and can colonize endothelial flow surfaces of vascular prostheses.

Dynamic and comparative vascular graft healing studies using multiple sequential biopsies

In order to follow the dynamic healing processes of vascular grafts and to minimize the possible animal-to-animal variables involved in study results, we developed a carotid-femoral bypass model with multiple sequential biopsies. After bilateral implantation of 70 cm x 6 mm gelatin-impregnated carotid-femoral bypass grafts in 5 dogs, we biopsied and replaced three 10-cm-long segments of each bypass at 2, 4, and 6 weeks, with final retrieval at 8 weeks after the initial implant. The first surgery and later biopsy procedures were well tolerated with no mortality or morbidity, except for some seroma formation. We observed a dynamic progression of healing processes related to the time course, including perigraft tissue reaction to the graft material and surgical trauma, gradual absorption of the impregnated gelatin, tissue ingrowth into the graft wall, and changes in and healing of the graft surface. Because of the sizeable tissue sample generated from each biopsy, this model also allowed various study approaches to be performed on the same specimen. This experimental model enables study of the continuous dynamic healing processes of the same graft in the same animal, providing the practical advantage of reduction of the number of animals required.

The effect of flow shear stress on endothelialization of impervious Dacron grafts from circulating cells in the arterial and venous systems of the same dog

The purpose of this report was to study effects of shear force and hemodynamic conditions that influence fallout healing in the arterial and venous systems of the same dog. Knitted Dacron grafts made impervious by a 1.5 mm thick coat of silicone rubber bonded to the external surface were implanted for 4 weeks during the same surgery in the descending thoracic aorta (DTA), abdominal aorta (AA) and inferior vena cava (IVC) of each of five dogs. Flow rates were measured during surgery and shear stresses calculated with the Hagen-Poiseuille formula. Full-wall thickness longitudinal tissue sections were embedded in resin and stained with hematoxylin and eosin for light microscopy, and in paraffin for immunocytochemistry studies with Factor VIII/von Willebrand factor, smooth muscle alpha-actin, collagen IV, laminin, and proliferating cell nuclear antigen. Scanning electron microscopy and transmission electron microscopy studies were also performed. AgNO3 was used to determine percentage of endothelial-like cell coverage on the flow surface. All grafts were patent, without hematoma or seroma. Endothelial-like cell coverage was highest in the IVC grafts and lowest in the DTA. Shear stress and flow velocity were significantly lower in IVC grafts than DTA and AA. Proliferating cell nuclear antigen indicated extensive cellular proliferation in the intima and in the interstices of the inner portion of the graft wall. The degree of fallout healing in knitted Dacron grafts made impervious by an external coat of silicone rubber varies inversely with the sheer force of blood flow in these grafts.

Evolution of dilated cardiomyopathy from hypertrophic obstructive cardiomyopathy in a child

Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are two different diseases and have distinct etiologies. HCM is rare in children and rarely progresses to DCM. We report a 5-year-old Taiwanese girl with a definite diagnosis of hypertrophic obstructive cardiomyopathy. The diagnosis was based on echocardiograms, cardiac catheterization, and endomyocardial biopsy. However, the clinical features progressed to a picture of nonobstructive HCM at age 9, and the patient developed dilated poorly contractile ventricles with intractable congestive heart failure at age 10. She died from ventricular tachycardia at age 13. This report emphasizes the importance of periodic reevaluation for children with HCM.

The role of three-dimensional ultrasonographic images in ovarian measurement

OBJECTIVE

To determine whether three-dimensional ultrasonography can increase the ability to evaluate the ovary and follicles, especially in women with polycystic ovary disease (PCOD).

DESIGN

Prospective clinical study.

SETTING

University hospital endocrine and infertility center.

PATIENT(S)

Sixty-six patients undergoing routine gynecologic evaluation were divided into two groups: the normal control group consisted of 22 patients, and there were 44 patients with PCOD.

INTERVENTION(S)

Three-dimensional ultrasonography was performed to store and document whole volumes of the ovaries for evaluation.

MAIN OUTCOME MEASURE(S)

Three perpendicular planes of bilateral ovaries are rotatable to obtain the largest dimensions. The three-dimensional volume was measured using the trapezoid formula.

RESULT(S)

The ovaries of the patients with PCOD were larger in size, area, and volume than those of normal controls.

CONCLUSION(S)

Stroma and volume determinations can be obtained more accurately by three-dimensional images than by traditional ultrasonography. Three-dimensional ultrasonography not only facilitates noninvasive evaluation and volume calculation but also completes the examination in a short time without increasing patient discomfort.

Early flow surface endothelialization before microvessel ingrowth in accelerated graft healing, with BrdU identification of cellular proliferation

The purpose of this report was to determine if flow surface endothelialization could precede microvessel ingrowth from the perigraft area in porous Dacron grafts, by using an accelerated graft healing model with short implant periods. Dacron grafts were implanted in the abdominal aorta of 22 dogs and wrapped in autogenous inferior vena cava (IVC), which provided excellent conditions for extramural angiogenesis, microvessel development, and ingrowth toward the graft. Retrieval times were 7 days (n = 4), 8 days (n = 5), 9 days (n = 4), 10 days (n = 3), 11 days (n = 4) and 12 days (n = 3) postoperatively. Graft surfaces were evaluated for thrombus coverage, cell coverage, and the number of micro-ostia. Components and cellular types in the graft wall and on the surface were studied and characterized with H&E, histochemical, and immunocytochemical staining. BrdU labeling was also used, to identify the areas where cells were actively proliferating. All grafts were patent. Although the degree of IVC/graft attachment varied, isolated islands of endothelial-like cells were found at the midgraft areas at each time period, and immunocytochemically confirmed as endothelial cells. There were two healing patterns: (1) surface endothelialization before microvessel/tissue ingrowth from the perigraft areas, and (2) surface endothelialization with full wall microvessel and tissue presence. Surface endothelialization was observed before perigraft tissue ingrowth, indicating that fallout healing is an independent source of endothelialization for porous grafts.

CT and MRI findings in a child with constrictive pericarditis

Constrictive pericarditis is rare in children. We report computed tomography (CT) and magnetic resonance imaging (MRI) findings in a 3-year-old girl. She had a swollen abdomen that increased in two months. CT and MRI showed a thickened pericardium (5.2 mm) without calcification. Both atria were enlarged and ventricles were relatively small. The engorged inferior vena cava had 2.8x the diameter of the descending aorta at the same level. Symptoms were dramatically improved after pericardiectomy. The histopathological features confirmed chronic pericarditis.

Effect of skeletonizing dissection on the internal thoracic artery

BACKGROUND

Skeletonization of the internal thoracic artery (ITA) produces greater length for coronary bypass grafting. We studied the effect of skeletonization on the morphology, histology, and tissue viability of the ITA wall.

METHODS

Six mongrel dogs underwent unilateral ITA dissection; the contralateral ITA was the control. Study periods were 3 weeks (n=3) and 12 weeks (n=3). At sacrifice, the entire anterior chest wall was removed and dynamically fixed with formalin. Extensive histologic comparisons were performed on three tissue blocks taken from each ITA, 2, 8, and 24 cm from their origin.

RESULTS

Flows at the end of the study were comparable to measurements taken during operation, immediately after skeletonization. Grossly, the ITA wall was not injured by skeletonization and there was no adventitial hematoma or bleeding from the sealed branch ends. Microscopic observations showed intact, normal wall structures. Histologic data showed no major significant difference between controls and skeletonized ITAs.

CONCLUSIONS

Careful skeletonizing dissection is not detrimental to the integrity of ITAs, which justifies their use for myocardial revascularization.

Long QT syndrome manifested as fetal ventricular tachycardia and intermittent AV block

A case of long QT syndrome diagnosed in the early neonatal period is described. This full-term female baby had intermittent atrioventricular (AV) block and ventricular tachycardia detected antenatally at the gestational age of 26 weeks. Sinus rhythm with prolonged QT interval (QTc = 0.636 sec) was found soon after birth. She developed variable degree of AV block with alternating left and right bundle branch block, which suggested the presence of multilevel AV block. Her mother had no lupus autoantibodies. Auditory brain stem evoked potential was normal. Family study revealed QT prolongation in her grandmother. Her condition improved after pacemaker implantation and oral beta-blocker usage.

Clinical implications of isolated double aortic arch and its complex with intracardiac anomalies

From July 1, 1989 to June 30, 1996, a total of six patients, four male and two female, with double aortic arch (DAA) were registered. They aged 16 days to 6.5 years. There were two patients with isolated DAA, and four complicated with intracardiac anomalies. All six patients presented respiratory distress and feeding problem early in life. However, cyanosis, owing to decreased pulmonary blood flow, predominated the clinical picture in each patient having DAA intricated with tetralogy of Fallot (TOF) and pulmonary stenosis, TOF with absent pulmonary valve syndrome, and type II-A tricuspid atresia. DiGeorge syndrome was documented in one patient with TOF and pulmonary stenosis. Expiratory wheezing was remarkable in the patient with TOF and absent pulmonary valve syndrome. Mild cyanosis and heart failure was noted in one patient with ventricular septal defect (VSD), and bicuspid pulmonary valve with mild valvular stenosis. Barium esophagogram showed indentations on esophagus in five patients. Echocardiography was yielding in three infants. Four patients, two isolated and two complex DAA, survived the surgical division of the smaller left aortic arch. One-stage and two-stage operation was performed in patients having DAA intricated with VSD and TOF, respectively. The other two patients with complex DAA remained in close observation owing to the tolerance of symptoms related to intracardiac anomalies.

Prevalence and manifestations of hepatitis C seropositivity in children in an endemic area

BACKGROUND

According to our previous studies, Paisha Township in Penghu Islets is an endemic area for hepatitis B virus and hepatitis C virus (HCV) infection and for hepatocellular carcinoma. We conducted this study to understand the prevalence of anti-HCV seropositivity among children in this area and to observe clinical manifestations of anti-HCV-positive children.

METHODS

In March, 1994, 1164 (93.6%) of 1243 students from all 6 kindergartens, 9 primary schools and 3 middle schools in Paisha Township participated in the screening for anti-HCV by enzyme immunoassay with second generation commercial kits (Abbott EIA 2.0). Anti-HCV tests were duplicated for the positive sera in 2 laboratories. All anti-HCV-positive children were followed annually for 2 years.

RESULTS

The prevalences of children from kindergartens (ages 3 to 6 years), primary schools (ages 7 to 12 years) and middle schools (ages 13 to 15 years) were 0% (0 of 229), 0.8% (5 of 617) and 1.9% (6 of 318), respectively. Initially the optic density (OD) values of anti-HCV were > 2.0 in 4 cases (36%), between 1.0 and 2.0 in 2 cases, and < 1.0 in the other 5 cases. None had sonographic parenchymal changes in the liver. In the 2-year follow-up of the anti-HCV-positive subjects, type 2a HCV-RNA persisted in 3 of 4 children with an OD of anti-HCV more than 2.0; 2 of them had 2 elevations of alanine transaminase values. Four of 7 children with an OD of 2.0 or less had a decrease in OD values in the follow-up examinations, and 2 of them became anti-HCV-negative.

CONCLUSION

Only 36% (4 of 11) of anti-HCV-positive children had an OD of > 2.0. Subjects with sequentially low OD might recover from chronic HCV infection without detectable HCV RNA and with normal alanine aminotransferase values.

Evidence for the ability of nucleophosmin/B23 to bind ATP

By taking advantage of its ability to be retained by ATP-agarose, we have demonstrated that nucleophosmin/B23 is capable of binding ATP. The specificity of the binding was confirmed by the absence of significant binding to AMP-agarose and by its loss when nucleophosmin/B23 in nuclear extracts was preincubated with ATP. Preincubation of the nuclear extracts with other ribonucleotide triphosphates (GTP, CTP, UTP) did not compete for the binding of nucleophosmin/B23 to ATP-agarose. The purified recombinant nucleophosmin/B23 was also able to be retained by ATP-agarose. The Kd for binding of ATP to the purified recombinant nucleophosmin/B23, on the basis of retention on a nitrocellulose membrane, was 86.5+/-8.3 microM; the number of binding sites was 0.68 per nucleophosmin/B23 protein molecule. To determine the possible ATP-binding site of nucleophosmin/B23, various deletion clones including the two mutants in which the putative ATP-binding sequence had been deleted were constructed. Deletion of the portions of the molecule (residues 83-152 and 185-240) had little effect on the ATP binding. The C-terminal deleted mutant (residue 242 to the C-terminus deleted) lost most of its ability to be retained by ATP-agarose and to bind [alpha-32P]ATP on a nitrocellulose membrane. The results indicate that the C-terminal portion (residues 242-294) contains the essential ATP-binding site of nucleophosmin/B23.

Usefulness of electron beam computed tomography in children with heterotaxy syndrome

Children with heterotaxy syndrome frequently have complex cardiac and noncardiac malformations requiring detailed diagnostic evaluation for management planning. Direct delineation of these structures by electron beam computed tomography (EBCT) is validated as a means of diagnosis. From July 1995 to March 1997, 32 patients (16 girls, 16 boys) with clinically impressed heterotaxy syndrome were enrolled in this study. After evaluation by echocardiography, EBCT studies were performed. Interpretation of cardiac anomalies was performed by sequential analysis based on these cross-sectional images. The diagnoses were subsequently confirmed by angiocardiography and surgical findings. Twenty-eight patients had bilateral trifurcated bronchi, and most of these (24 of 28) did not have a spleen. Four patients had bilateral bifurcated bronchi, 2 patients had polysplenia, and the other 2 patients had a lobulated single spleen. We found that laterality could be identified by EBCT in all patients. Comparison of diagnostic yield between echocardiography, catheterization, and EBCT showed that EBCT is superior to echocardiography and catheterization in demonstration of pulmonary venous anatomy and presence of a very small rudimentary ventricle. In addition, associated visceral, bronchopulmonary, mediastinal, and intracardiac anomalies could all be clearly delineated by EBCT at the same time. Thus, EBCT is a promising complementary modality for an overall understanding of heterotaxy syndrome.

Amount and type of dietary lipid modulate rat hepatic cytochrome P-450 activity

The influence of the amount and type of dietary lipid on rat hepatic cytochrome P-450 activities in the presence and absence of inducer administration was investigated. Weanling male Sprague-Dawley rats were fed fat-free or 20% beef tallow, olive oil, corn oil, linseed oil, or menhaden oil diets in combination with one of the following three treatments: no inducer, intraperitoneal injection of phenobarbital (75 mg/kg body wt) for three consecutive days before they were killed, or intragastric administration of acetone (5 ml/kg) one day before they were killed. Twenty percent linseed oil and menhaden oil diets induced the highest level of activity among the different fat types in the presence of phenobarbital and acetone. Cytochrome P-450IIB1 activity was induced to a significantly greater extent by acetone administration in conjunction with the 20% menhaden oil diet than in conjunction with the other dietary oils (p < 0.05). In the presence of acetone, 20% beef tallow, 20% linseed oil, and 20% menhaden oil diets significantly induced cytochrome P-450IIE1 activity compared with the fat-free diet (p < 0.05). In conclusion, cytochrome P-450IIB1 and P-450IIE1 activities in rats were significantly increased by specific inducers, and dietary lipid was necessary for this effect. Diets supplemented with linseed and menhaden oils were most effective in inducing this activity.

Apparent blood stream origin of endothelial and smooth muscle cells in the neointima of long, impervious carotid-femoral grafts in the dog

The purpose of this study was to determine whether endothelial and smooth muscle cells originating from the blood stream contribute to the endothelialization of impervious, small-caliber, long Dacron grafts used as extraanatomical bypasses in dogs. We implanted silicone-rubber-coated, permanently impervious grafts 64 to 77 cm long and 6 mm in diameter, made of externally supported knitted Dacron as unilateral carotid-femoral bypasses with distal femoral arteriovenous fistulae in 10 dogs for 3 months; sides were alternated between cases. Subjects received 162 mg/day of aspirin, and its effectiveness on platelet aggregation (PA) was evaluated and expressed as a PA score. Graft healing was studied by stereomicroscopy with silver nitrate staining, by light microscopy with hematoxylin-eosin and immunocytochemical staining for endothelial and smooth muscle cells, and by scanning and transmission electron microscopy. Five grafts were patent for 3 months and could be included in the healing study; the five occluded grafts thrombosed within 14 days. Although there was no transinterstitial tissue ingrowth from perigraft tissues into the impervious Dacron grafts, scattered islands of endothelial cells were conclusively demonstrated on graft flow surfaces 3 months after implantation. Average endothelial-like cell coverage of the flow surfaces was 15.6% +/- 3.8%, and alpha-actin-positive smooth muscle cells and microvessels were found beneath some of the endothelial islands. These findings suggest that blood stream-derived endothelial and smooth muscle cells play a role in the healing of the inner wall of Dacron grafts in the dog.

Electrophysiological basis for the antiarrhythmic action and positive inotropy of HA-7, a furoquinoline alkaloid derivative, in rat heart

1. HA-7, a new synthetic derivative of furoquinoline alkaloid, increased the contractile force of right ventricular strips and effectively suppressed the ischaemia-reperfusion induced polymorphic ventricular tachyrhythmias in adult rat heart (EC50 = 2.8 microM). 2. In rat ventricular myocytes, HA-7 concentration-dependently prolonged the action potential duration (APD) and decreased the maximal rate of rise of the action potential upstroke (Vmax). The action potential amplitude and resting membrane potential were also reduced, but to a smaller extent. The prolongation of APD by HA-7 was prevented by pretreating the cells with 1 mM 4-AP. 3. Voltage clamp experiments revealed that HA-7 decreased the maximal current amplitude of I(Na) (IC50 = 4.1 microM) and caused a negative shift of its steady-state inactivation curve and slowed its rate of recovery from inactivation. The use-dependent inhibition of I(Na) by HA-7 was enhanced at a higher stimulation rate. The L-type Ca2+ current (I(Ca)) was also reduced, but to a lesser degree (IC50 = 5.3 microM, maximal inhibition = 31.8%). 4. This agent also influenced the time- and voltage-dependent K currents. The prolongation of APD was associated with an inhibition of a 4-AP sensitive transient outward K current (I(to)) (IC50 = 2.9 microM) and a slowly inactivating, steady-state outward current (I(SS)) (IC50 = 2.5 microM). The inhibition of I(to) by HA-7 was associated with an acceleration of its time constant of inactivation. HA-7 suppressed I(to) in a time-dependent manner and caused a significant negative shift of the voltage-dependent steady-state inactivation curve but did not affect its rate of recovery from inactivation. 5. At higher concentrations, the inward rectifier K+ current (I(KI)) was also inhibited but to a less extent. Its slope conductance after 3, 10 and 30 microM HA-7 was decreased by 24+/-4%, 41+/-5% and 54+/-8%. respectively. 6. We conclude that HA-7 predominantly blocks I(to) and Na+ channels and that it also weakly blocks Ca2+ and I(KI) channels. These changes alter the electrophysiological properties of the heart and terminate the ischaemia reperfusion induced ventricular arrhythmia. The significant I(to) inhibition and minimal I(Ca) suppression may afford an opportunity to develop an effective antiarrhythmic agent linked with positive inotropy.

Surgical results of 40 patients with malignant tracheobronchial lesions

The objective of this study was to evaluate the results of tracheobronchoplastyperformed on a variety of malignant diseases which involved the tracheobronchus. Between July 1988 and March 1996 tracheobronchial surgery was performed on 40 patients who had a variety of malignant diseases. The primary diseases were bronchogenic carcinoma (n=26), tracheobronchial tumour (n=5), thyroid cancer (n=6), and oesophageal cancer (n=3). Operative procedures that were performed on the tracheobronchus were sleeve lobectomy (n=22) or bilobectomies (n=5), sleeve pneumonectomy (n=3), sleeve resection of trachea (n=7) and bronchus (n=3). There was one postoperative death with a mortality rate of 2.5%. However, there were no significant postoperative complications apart from the one postoperative death; one patient developed a bronchopleural fistula and empyema. In lung cancer patients, the 2 year survival rate was 47.3%, and one (3.8%) local tumour recurrence. Four of five patients who had tracheobronchial tumours were alive and free from disease during 2-6 year follow-up period. One patient who had malignant fibrous histiocytoma died of brain metastasis 6 months after the operation. Among six patients whose thyroid cancer involved the trachea, one patient survived for 7 years, the other five patients were still alive and free from disease 2-5 years after the operation. Of the three patients whose oesophageal carcinoma involved the tracheobronchus, there was one operative death and the others died of tumour recurrence 1 and 2 years, respectively. We suggest that tracheobronchoplasty is a safe procedure with low morbidity and mortality rates in carefully selected patients with malignant diseases.

Comparison of aging and hypercholesterolemic effects on the sodium inward currents in cardiac myocytes

To study and to compare the hypercholesterolemic and aging effect on the sodium inward currents (I(Na)) in cardiac myocytes, whole-cell clamp recordings were made in single cardiac myocyte isolated from normo- and diet-induced hypercholesterolemic rabbits of different age groups. The cell capacitance of adult and hyperlipidemic myocytes seemed larger than that of young and normolipidemic ones. However, the sodium current density at a holding potential of -80 mV on adult and hypercholesterolemic ventricular sarcolemma was significantly lower than that on young and normolipidemic one (adult hyperlipidemic: -15.3+/-2.4 pA/pF (n=16), adult control: -28.1+/-3.4 pA/pF (n=13), young hyperlipidemic: -39.5+/-5.4 pA/pF (n=19), young control: -67.3+/-7.8 pA/pF (n=12)). In aging process, this effect was due to a decrease in channel number, a leftward shift in the inactivation potential and a slowing of the time course of recovery. In hypercholesterolemia, however, the major cause was due to the functional change of sodium currents. In addition to decreasing the sodium current magnitude, hypercholesterolemia lowered the threshold for excitation of cardiac myocytes (-50 mV vs -40 mV). In conclusion, aging process depressed the sodium channel activity in ventricular myocytes. In addition to inducing some similar functional alterations of I(Na) as aging process, long-term hypercholesterolemia could also increase the excitability in cardiac myocytes, which was different from aging process.

Detection of congenital müllerian duct anomalies using three-dimensional ultrasound

PURPOSE

The purpose of this study was to assess the value of 3-dimensional sonography in the diagnosis of congenital müllerian duct anomalies, which cause infertility, preterm labor, and first trimester abortion.

METHODS

A prospective study was undertaken in which 40 patients with histories of repeated spontaneous abortions or infertility were first examined using conventional 2-dimensional sonography or hysterosalpingography. Three-dimensional transvaginal sonography was then performed.

RESULTS

Twenty-eight women had müllerian duct abnormalities, and 12 women had normal uterine anatomy. Müllerian duct defects detected in this study were unicornuate uterus (3), bicornuate uterus (3), complete or partial septate uterus (12), arcuate uterus (9), and didelphic uterus (1). The diagnosis of müllerian duct anomalies in these patients was confirmed by laparoscopic and/or hysteroscopic examinations. Three-dimensional sonography demonstrated all congenital uterine abnormalities with a sensitivity and specificity of 100%. Separate uterus and bicornuate uterus could be correctly diagnosed using 3-dimensional sonography in 11 (92%) of 12 cases and 3 (100%) of 3 cases, respectively. These 2 abnormalities were commonly confused with each other using hysterosalpingography and conventional sonography.

CONCLUSIONS

Three-dimensional sonography with image reconstruction is less expensive and less invasive than hysterosalpingography for the assessment of uterine anatomy and diagnosis of müllerian duct abnormalities. The ability to visualize both the uterine cavity and the myometrium on a 3-dimensional scan facilitates the diagnosis of uterine anomalies and enables the differentiation of septate from bicornuate uteri for preoperative surgical planning.

Early presence of endothelial-like cells on the flow surface of porous arterial prostheses implanted in the descending thoracic aorta of the dog

The purpose of this study was to investigate early arterial graft healing and its sources in porous Dacron prostheses after very short implantation periods in the dog, using extensive histologic examination of serial sections. Preclotted Dacron prostheses 6 cm long and 8 mm in diameter were implanted in the descending thoracic aorta (DTA) of 14 dogs, and retrieved at 7 days (n = 6), 10 days (n = 4), and 14 days (n = 4). The flow surface was assessed for thrombus coverage, endothelial-like cell (ELC) coverage, and the number of microvessel ostia. Where an ELC island was identified under the stereomicroscope, full-wall longitudinal tissue samples were taken, and embedded in resin for light microscopy study of 6-microns, H&E-stained serial sections to determine general healing and interstitial tissue presence. If there was more than one ELC island, another full-wall sample was taken and embedded in paraffin for staining with laminin, collagen IV, and smooth muscle alpha-actin antibodies, and PTAH. All grafts were patent with very little thrombus. Islands of endothelial-like cells were found for each time period, and on all 14-day grafts. Endothelial-like cell coverage was highest at 14 days. On 7- and 10-day grafts, cells proved to be endothelium were found in the middle of the flow surface, unconnected to either pannus or perigraft tissue ingrowth. Healing occurs as early as 7 days in porous knitted Dacron grafts. The source at periods earlier than 10 days appears to be cells from the blood stream.

Transcatheter closure of a huge pulmonary arteriovenous fistula with embolization coils

A 46-year-old female with bilateral pulmonary arteriovenous fistulas was treated with Gianturco coil occlusion. The small right lung fistula was closed with a 6 mm coil, whereas the huge left lung fistula was occluded with three coils (one 10-mm and two 8-mm). Angiography 3 d later demonstrated recanalization of the left fistula. Two 8 mm coils were inserted to achieve complete obstruction again. She developed pulmonary infarction in the left lung 2 d later, which recovered without sequelae. We conclude that coil embolization for huge pulmonary arteriovenous fistula is feasible but may result in pulmonary infarction.

Three-dimensional holographic fluorescence microscopy

Most commonly used methods for three-dimensional (3D) fluorescence microscopy make use of sectioning techniques that require that the object be physically scanned in a series of two-dimensional (2D) sections along the z axis. The main drawback in these approaches is the need for these sequential 2D scans. An alternative approach to fluorescence imaging in three dimensions has been developed that is based on optical scanning holography. This novel approach requires only a 2D scan to record 3D information. Holograms of 15-microm fluorescent latex beads with longitinal separation of ~2 mm have been recorded and reconstructed. To our knowledge, this is the first time holograms of fluorescent specimens have been recorded by an optical holographic technique.

Prenatal sonographic diagnosis of single umbilical artery

PURPOSE

We evaluated the reliability of prenatal sonography and the usefulness of the umbilical vein and artery diameter ratio, transverse umbilical artery diameter, and systolic-diastolic ratio in detecting single umbilical artery (SUA).

METHODS

In 24 of 6,970 fetuses, SUA was detected using prenatal sonography and confirmed at birth. These cases were retrospectively reviewed.

RESULTS

Four fetuses had major malformations, and 1 had a minor anomaly. Thirteen fetuses with SUA underwent chromosomal analysis, and only 2 had abnormal karyotypes. Most of the SUA fetuses had a normal systolic-diastolic ratio.

CONCLUSIONS

Our retrospective study determined that the prognosis of SUA fetuses is good when there is no concurrent anatomic or chromosomal abnormality. Although some reports claim that the transverse umbilical artery diameter or the ratio between umbilical vein and artery diameters can predict SUA, we found no significant improvement in the recognition of SUA using these parameters.

Surgical results of 29 patients with benign tracheobronchial lesions

This study was carried out in order to evaluate the surgical results of benign tracheobronchial diseases. Between July 1988 and March 1996, tracheobronchial surgery was performed on 29 patients with a variety of benign diseases. The primary diseases were post intubation or post tracheostomy tracheal stenosis (n = 12), tuberculous stenosis (n = 7), congenital tracheal stenosis with or without vascular ring (n = 4), tracheobronchial tumour (n = 2), oesophageal tumour (n = 1), and miscellaneous conditions (n = 3). Thirty-one operative procedures included sleeve lobectomy (n = 7), sleeve resection of trachea (n = 17) and bronchus (n = 2), and plastic surgery of trachea (n = 4) and bronchus (n = 1). There was one operative death, which put the mortality rate at 3.4%. There were five postoperative complications in this series (17.2%), including anastomotic disruption of trachea (n = 1), bilateral vocal cord palsy (n = 1), prolonged endotracheal intubation (n = 1) and overgrowth of granulation (n = 2). The complication of anastomotic disruption of trachea was treated by insertion of a tracheal T-tube, and the granulation was treated by bronchoscopic excision. We suggest that tracheobronchoplasty is a safe procedure in carefully selected patients with benign diseases.