Estimation of the amniotic fluid volume using the Cavalieri method on ultrasound images.

OBJECTIVES: Presently, a design-based and practical method for measuring amniotic fluid volume (AFV) for routine clinical examinations has not been proposed. In this study we describe a new method, which combines the Cavalieri method with ultrasound imaging to estimate AFV. METHODS: We measured the AFVs of 14 women in the third trimester of pregnancy, and repeated our measurements three times for each woman. Parallel planimetric ultrasonographic images were obtained at every 2 cm along the longitudinal uterine axis. AFVs were calculated as the total of the multiples of the estimated cut surface areas by the section thickness. RESULTS: The mean estimated AFV was 380.5 cm3. The coefficient of error of each measurement was calculated and the mean was 0.108. The coefficient of correlation between the amniotic fluid index and our AFV estimations was 0.87. CONCLUSIONS: Design-based and efficient estimation of AFV is possible with the combination of consecutive ultrasound images and the Cavalieri method.     

Serum vitamin A and β-carotene concentrations and renal scarring in urinary tract infections

OBJECTIVE—To evaluate the role of vitamin A on renal scarring in recurrent urinary tract infections (UTIs).
DESIGN—Twenty three children with UTIs and renal scarring (mean (SD) age 7.3 (3.9) years) and 91 children without renal scarring (6.4 (3.4) years) were studied. All the children had serum vitamin A and β-carotene measurements and nutritional evaluation. Renal scarring was assessed by technetium-99m dimercaptosuccinic acid (^99mTc DMSA) scanning. Nutritional status of all the patients was within normal limits and not different between the groups.
RESULTS—Mean (SD) serum vitamin A and β-carotene concentrations were not significantly different between the patients with and without renal scarring (vitamin A 53.2 (22.6)/46.8 (17.0) µg/dl and β-carotene 232.3 (201.3)/272.4 (86.0) µg/dl respectively). However, when the patients with renal scarring and with greater than 10% difference among the DMSA uptakes of their kidneys (11 cases) were evaluated, a significant negative correlation was determined between the serum vitamin A concentrations and the magnitude of the difference in uptakes of each kidney. The same relation was not true for serum β-carotene concentrations.
CONCLUSION—This study demonstrated a relation between serum vitamin A concentrations and magnitude of hypoactivity in ^99mTc DMSA scanning in kidneys with advanced scarring.

     

Mesoatrial shunt in Budd-Chiari syndrome

BACKGROUND: The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation. PATIENTS AND METHODS: Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts. RESULTS: The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up. CONCLUSION: Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.     

An unusual case of epigastric heteropagus: parasite with a rudimentary heart

Parasitic or heterotopic conjoined twins are exceedingly rare, and these cases are referred to as "heteropagus" when there is a parasitic attachment in a nonduplicated fashion to any portion of the body. Epigastric heteropagus twinning refers to the attachment of the parasite to the epigastric region of the autosite. An unusual epigastric heteropagus case is presented with a rudimentary cardiopulmonary and also nearly complete gastrointestinal and genitourinary system of the parasite, and an organogenetic and vascular status of the previously reported cases are reviewed. The current case might be unique for the parasite having a cardiopulmonary development--although rudimentary--and this might be the reason that it has more complete organogenesis than the cases that have been presented previously in the literature.     

Predictors of malignancy in patients with solitary pulmonary nodules undergoing pulmonary resection

BackgroundThe management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis.ObjectiveWe tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis.MethodsWe made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis.ResultsWe had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy.ConclusionAge, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.     

Hemodynamic shear stress and its role in atherosclerosis

Atherosclerosis, the leading cause of death in the developed world and nearly the leading cause in the developing world, is associated with systemic risk factors including hypertension, smoking, hyperlipidemia, and diabetes mellitus, among others. Nonetheless, atherosclerosis remains a geometrically focal disease, preferentially affecting the outer edges of vessel bifurcations. In these predisposed areas, hemodynamic shear stress, the frictional force acting on the endothelial cell surface as a result of blood flow, is weaker than in protected regions. Studies have identified hemodynamic shear stress as an important determinant of endothelial function and phenotype. Arterial-level shear stress (>15 dyne/cm2) induces endothelial quiescence and an atheroprotective gene expression profile, while low shear stress (<4 dyne/cm2), which is prevalent at atherosclerosis-prone sites, stimulates an atherogenic phenotype. The functional regulation of the endothelium by local hemodynamic shear stress provides a model for understanding the focal propensity of atherosclerosis in the setting of systemic factors and may help guide future therapeutic strategies.     

A ptotic kidney with multiple arteries,one from a common renal artery stem

Anomalies of major retroperitoneal vascular structures have been showed up in many reports so far. Here, a group of vascular anomalies of retroperitoneum were reported, all of which were encountered during the staging surgery of a 65-year-old woman with endometrium carcinoma. There was no vascular injury during the surgery associated with these vascular abnormalities. Since they are met quite frequently, it is important for surgeons dealing with retroperitoneum to be aware of the possible anomalies of vascular and renal structures in this region.