Factors affecting the outcome of frontal sinus surgery: a prospective study

Chronic frontal sinus disease has always been a difficult problem to treat. We undertook this study to evaluate our results of frontal recess surgery, to determine the factors which affected the surgical outcome and to determine whether the post-operative findings correlated with the symptomatic improvement in the patients. Twenty-four patients with chronic sinus pathologies involving the frontal sinus were included in this study. After failure of maximal medical treatment, they were subjected to endoscopic surgery. The factors assessed included the pneumatisation of the frontal recess on CT scan, the technique of surgery, the intra-operative frontal glow, the state of the frontal recess at the end of surgery, the appearance of the recess on follow-up endoscopy and the symptomatic relief in the patients. 81.2% of well pneumatised frontal recesses had a good outcome while only 42.1% of the poorly pneumatised frontal recesses had a good outcome. 76.2% of cases with a frontal glow seen intra-operatively had a favourable surgical result while 44.4% of cases without a frontal glow intra-operatively had a favourable surgical result. Two-thirds (66.7%) of cases with mucosa-lined frontal recess did well post-operatively while only 33.3% of cases with a raw frontal recess did well following surgery. Well pneumatised frontal recesses, presence of an intra-operative frontal glow and a mucosa-lined frontal recess corresponded with better post-surgical outcomes. A difference in the intra-operative technique did not influence the result after surgery. Nineteen out of 24 patients (79.2%) were asymptomatic after surgery while 5 patients had residual symptoms.

Melt flow behaviour of poly-epsilon-caprolactone in fused deposition modelling

Fused deposition modelling (FDM) is an extrusion based Rapid prototyping (RP) technique which can be used to fabricate tissue engineering scaffolds. The present work focuses on the study of the melt flow behaviour (MFB) of Poly-epsilon-caprolactone (PCL) as a representative biomaterial, on the FDM. The MFB significantly affects the quality of the scaffold which depends not only on the pressure gradient, its velocity, and the temperature gradients but also physical properties like the melt temperature and rheology. The MFB is studied using two methods: mathematical modelling and finite element analysis (FEA) using Ansys(R). The MFB is studied using accurate channel geometry by varying filament velocity at the entry and by varying nozzle diameters and angles at the exit. The comparative results of both mathematical modelling and FEA suggest that the pressure drop and the velocities of the melt flow depend on the flow channel parameters. One inference of particular interest is the temperature gradient of the PCL melt, which shows that it liquefies within 35% of the channel length. These results are invaluable to better understand the MFB of biomaterials that affects the quality of the scaffold built via FDM and can also be used to predict the MFB of other biomaterials.

Plasma estrone sulphate (E1S) and estradiol-17β (E2β) profiles during pregnancy and their relationship with the relaxation of sacrosciatic ligament, and prediction of calving time in Holstein–Friesian cattle

The objectives of this study were to investigate the plasma E(1)S and E(2)beta profiles during pregnancy and their relationship with the relaxation of sacrosciatic ligament in Holstein-Friesian cattle (n=37) and then to predict the calving time on the basis of E(1)S and E(2)beta profiles and relaxation of the ligament. Blood samples were collected at 4 weeks intervals from days 100 to 190, at 2 weeks intervals from days 190 to 250, every week from days 250 to 270 and thereafter every day from day 270 of gestation until the day after calving. The relaxation in the ligament was measured by using two scales as a distance at a schedule similar to blood sampling plus 5 days postpartum. One scale was kept firm exactly parallel to the ligament between the sacrum and the tuber ischii and other scale was erected perpendicularly to the first scale with the bottom just touching the ligament and the depth was measured in the second scale from the point where it touched the ligament to the point where it touched the first scale. Plasma samples were analyzed for E(1)S and E(2)beta by enzyme immunoassay. E(1)S concentration was low at day 100 (0.8+/-0.3 ng/ml), then increased progressively and drastically to reach the level of 28.4+/-3.6 ng/ml on the day before calving and declined significantly (p<0.05) at 9.5+/-3.1 ng/ml within 1 day postpartum. There was a gradual increase in concentration of E(2)beta from day 100 of gestation (0.1+/-0 ng/ml) until day 4 prepartum (0.6+/-0 ng/ml). Thereafter, it increased drastically and reached the peak level of 1.0+/-0.1 ng/ml (p<0.05) on the day before calving and declined markedly at 0.4+/-0.1 ng/ml within 1 day postpartum (p<0.05). Corresponding to E(1)S and E(2)beta concentrations, a gradual increase in the relaxation of the ligament was observed from day 100 of gestation (8+/-1mm) until day 2 prepartum (24+/-2mm). Thereafter, it showed a significant increase (p<0.05) within 1 day before calving (31+/-2mm) and almost no difference between day 1 prepartum and day 1 postpartum. A marked decrease (p<0.05) was observed thereafter until day 3 postpartum (10+/-2mm) and no significant change between days 3 and 4 as well as 4 and 5 postpartum. The increment of E(2)beta by >or=0.20 ng/ml from the preceding day concentration was 85.2% accurate for predicting calving within 24h in many of the cows (23 of 37) in the herd. The increment in ligament relaxation measurement by >or=5mm from the preceding day measurement was the most efficacious to predict calving within 24h with the highest accuracy (93.9%) in high proportions of cows (31 of 37) in the herd. In conclusion, plasma E(1)S and E(2)beta concentrations and relaxation of sacrosciatic ligament increased gradually as gestation advanced and reached the peak level on the day before calving. The relaxation in the ligament corresponded well to plasma E(2)beta concentrations. Prediction of calving was possible by E(2)beta profile and relaxation in the ligament but not by E(1)S profile. The increment in ligament measurement by >or=5mm from the preceding day measurement was the most useful and accurate in predicting calving within 24h. It is economical and easily applicable in the field condition.

Endocrine approach to male fertility control by steroid hormone combination in rat Rattus norvegicus L

Effects of a combination of medoxy-progesterone acetate (MPA) and dihydrotestosterone (DHT) at a dose of 10 mg + 2 mg/kg, injected, in weekly to rats of proven fertility were investigated with respect to their fertility, sperm and organ functions. This hormonal regimen had no effect in body and organ weights except in the testis. A depletion in sperm reserves in testis and epididymis was noted in addition to a loss of their motility in the later. Alterations in cauda epididymal sperm viability and morphology and reduced levels of superoxide dismutase indicated changes in their plasma membrane permeability. Sperm acrosomal enzymes such as acrosin and hyaluronidase were also affected leading to a loss of their function. Consequently the fertility potential of these rats also impaired after 60 days of hormonal regimen. Testicular biochemical machinery revealed its altered metabolism and regressed spermatogenic activity accounting for its loss of weight. Similarly epididymal physiology also exhibited changes leading to impaired sperm maturation. However, toxicity studies showed no significant variations in liver and blood biochemical profiles indicating non-toxic nature of this combination. All these effects seemed to be transient and reversible upon withdrawal of treatment for 60 and 90 days gradually. Thus, this combination with aromatizable androgen is useful for induction of functional sterility.

Extraosseous chondroma presenting as a midline neck mass in a child

We report an extraosseous chondroma (EC) presenting as a painless midline neck mass in a healthy 3-year-old boy. EC is a benign tumor of the soft tissues; malignant degeneration has not been observed and recurrence is unusual (5%-18%). The treatment of choice is local excision. With this report, EC can be included and considered in the assessment of any firm, smooth subcutaneous mass.

Intra-abdominal pulmonary sequestration exhibiting congenital cystic adenomatoid malformation. Report of a case and review of the literature

We describe the fifth case, to our knowledge, of an intra-abdominal pulmonary sequestration that histologically displayed the features of congenital cystic adenomatoid malformation (CCAM) type 2. This mass was found during routine prenatal ultrasound in an infant with no other congenital malformations. A literature search found 13 previously reported cases of CCAM in extralobar pulmonary sequestration (EPS), nine of which were thoracic and only four were intra-abdominal. An analysis of our case and the 13 previously reported cases shows that the clinical features of EPS containing CCAM type 2 do not differ significantly from those of EPS occurring alone. The presence of CCAM type 2 in our patient is consistent with previously reported cases. Extralobar pulmonary sequestrations located in the abdomen are rarely diagnosed prior to excision, and the presence of CCAM type 2 in this situation may further compound diagnostic difficulties. The morphologic features separating CCAM into three distinct types and the exclusive association of CCAM type 2 occurring in EPS are also discussed.

True duplication of the vas deferens

We report true duplication of the vas deferens found at routine inguinal hernia repair. This rarity is described in the context of the embryologic model for other vas abnormalities.

Expression of sialylated Lewis(x) antigen in chronic and neoplastic liver diseases

Phenotypic expression of sialylated Lewis(x) antigen by means of the monoclonal antiserum SNH3 was studied in 87 livers, which included normal and steatotic livers and livers with chronic persistent and chronic active hepatitis, alcoholic hepatitis, allograft rejection, focal nodular hyperplasia, hepatocellular carcinoma, cholangiocarcinoma, metastatic carcinoma, cirrhosis of various causes (autoimmune, alcoholic, viral, drug induced, Wilson's disease, and primary biliary cirrhosis). The biotin-streptavidin-peroxidase method was used on formaldehyde-fixed, paraffin-embedded sections. Sialylated Lewis(x) antigen was not demonstrated in normal livers. Hepatocellular expression in a diffuse or perinodular honeycomb pattern was seen in cirrhosis, irrespective of cause. Sialylated Lewis(x) antigen was also observed in hepatocytes around metastatic carcinoma in the absence of inflammation, cirrhosis, or regeneration. Some bile ductules, most likely ductular hepatocytes, but not bile ducts, expressed sialylated Lewis(x) antigen. Sialylated Lewis(x) antigen was seen diffusely in fibrolamellar hepatocellular carcinoma, focally in other hepatocellular carcinomas, and either focally or diffusely in cholangiocarcinomas.

Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery

BACKGROUND

Preterm delivery is the leading cause of neonatal mortality in the United States, but efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. We postulated that damage to the fetal membranes may release fetal fibronectin into the cervix and vagina, giving rise to a biochemical marker for preterm delivery.

METHODS

We measured fetal-fibronectin concentrations in cervical and vaginal secretions, amniotic fluid, and maternal plasma with a sensitive immunoassay using the monoclonal antibody FDC-6. Immunohistochemical studies were used to determine the distribution of fetal fibronectin in the placenta and amniochorionic membranes and to ascertain its cell of origin.

RESULTS

Women with uncomplicated pregnancies (n = 163) who delivered at term rarely had cervicovaginal fetal-fibronectin concentrations above 0.05 micrograms per milliliter between 21 and 37 weeks of gestation (11 of 267 cervical samples [4 percent] and 9 of 267 vaginal samples [3 percent]. High levels of fetal fibronectin were detected in amniotic fluid and in the cervical or vaginal secretions of 93.8 percent of the women with preterm rupture of membranes (n = 65). Cervical or vaginal fetal fibronectin was also present in 50.4 percent of the women with preterm uterine contractions and intact membranes (n = 117), and its presence identified the women who delivered before term (n = 60) with a sensitivity of 81.7 percent and a specificity of 82.5 percent. In the placenta and membranes, fetal fibronectin was found at points of contact with the uterine wall.

CONCLUSIONS

The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk for preterm delivery. This phenomenon may reflect the separation of the chorion from the decidual layer of the uterus, with the release of intact or degraded chorionic components of the extracellular matrix into the cervical and vaginal secretions.

Development of intrahepatic bile ducts in humans. Possible role of laminin

Laminin, a major extracellular matrix-attachment glycoprotein, may play an important role in the differentiation and migration of epithelial cells during normal development. Therefore, the morphogenesis of bile ducts in human liver of fetuses at sequential gestational ages, neonates, children, and adults was examined by single and double immunohistochemical staining for laminin and for cytokeratins. The latter served as a marker for developing and mature bile duct epithelial cells. A close association was observed between laminin deposition and the differentiating ductal plate cells at the epithelial-mesenchymal interface of portal tracts and during the subsequent migration of ductular structures into the center of portal tracts. Simultaneously, laminin disappeared from the margins of portal tracts, but scattered ductal plate-like structures with laminin remained demonstrable in neonates, children, and even adults. These observations were substantiated by semiquantitative evaluation of laminin at the periphery of portal tracts. Thus, clear evidence is provided that laminin accompanies bile duct epithelial cells during all successive stages of differentiation and migration during the development of the human hepatobiliary system. The persisting ductal plate cells may represent a common stem cell for proliferation of bile ductules and hepatocytes.

CMV enteritis causing hemorrhage and obstruction in an infant with AIDS

Serious gastrointestinal infections from cytomegalovirus (CMV) are often observed in immunosuppressed patients especially those with acquired immunodeficiency syndrome (AIDS). Hemorrhage and perforation have been frequent consequences. We present a case of CMV enteritis in an infant with AIDS who suffered massive hemorrhage and subsequent fatal small bowel obstruction from this condition. Gross findings at laparotomy were striking, diffuse, large yellowish plaques along the entire length of the small bowel. Each of these had a central ulceration. Each eventually caused a partial narrowing resulting in refractory small bowel obstruction. Biopsy of one of these lesions demonstrated many cells with typical cytomegalic inclusion bodies. This report illustrates a newly recognized type of CMV enteritis that can affect an infant and be readily recognized at laparotomy.

Development of intrahepatic bile ducts in humans. Immunohistochemical study using monoclonal cytokeratin antibodies

Cytokeratins (CKs) are major structural proteins of intermediate filaments of epithelia. Recent availability of monoclonal antibodies (MoAbs) against various CK polypeptides has made it possible to study their development during cellular differentiation. We analyzed the expression of CKs in the human liver during development. Twenty-four liver specimens were tested by the avidin-biotin complex immunohistochemical method by using three MoAbs against different CK polypeptides (CAM 5.2 against CKs 50, 43, and 39 kd; AE1 against acidic CKs 56.5, 50/50', 48, and 40 kd; and 34 beta E12 against CKs 58, 56.5, and 56 kd). Liver parenchymal cells in fetuses as early as 4 weeks of gestational age reacted with MoAbs CAM 5.2 and AE1, but the expression of AE1-positive CK polypeptides in hepatocytes disappeared by 24 weeks of gestational age. Small cells, presumably ductal plate cells, in direct contact with mesenchyme around the portal vein and along the branches of portal veins, showed strong staining with MoAbs CAM 5.2, AE1, and 34 beta E12, identical to that of bile ducts. In neonates, children, and even in adults, residual MoAbs CAM 5.2-,Ae1, and 34 beta E 12-positive cells were present around the branches of portal veins. These findings suggested that the CK profile of liver parenchymal cells changes during their differentiation into hepatocytes, whereas that of ductal plate cells and bile ducts remains unaltered with respect to the polypeptides tested here. Some ductal plate cells may persist in neonates, children, and even in adults.

An unusual case of right atrial myxoma

An unusual case of right atrial myxoma who had a ten year symptom free interval, following the initial manifestation is presented.

Realtime colour flow mapping and Doppler studies of normal carotid vertebral system

Real time colour blow mapping with doppler derived velocity profile of carotid vertebral arterial system in 26 normal controls, using Hewlett Packard Model HP 77020 equipment are presented. The normal peak velocities varied from 0.39 to 1.47 m/sec. The colour blow mapping of carotid-vertebral system, the first over to be published in India, to the best of our knowledge, enabled us to obtain more accurate carotid-vertebral arterial flows. Colour imaging makes it easy to differentiate normal from abnormal. We believe that colour blow mapping with Doppler studies will become the most important screening test for the evaluation of the extracranial carotid-vertebral system.

Application of a quick immunoenzymatic labeling as an adjunct to frozen-section diagnosis

Immunoenzymatic labeling is not currently used in the frozen-section diagnosis of tumors, in view of the length of the procedure. The authors tested whether, without loss of specificity and sensitivity, the labeled avidin-biotin (LAB) method may be adequately shortened for use in frozen-section diagnosis. Cryostat sections of tumors of various types and different degrees of differentiation and a panel of monoclonal antibodies to various molecular weight cytokeratins, vimentin, and leukocyte common antigen was used. The entire LAB procedure was completed in less than 7 minutes. For comparison, all tumors were also stained by the conventional avidin-biotin complex (ABC) method, which required more than one and a half hours for completion. The pattern and intensity of specific staining for the two procedures was identical, and the background staining was minimal with the LAB method. In view of the short time required to obtain specific staining, the quick LAB method may be of great value for characterization of primary or metastatic tumors in frozen-section diagnosis.

Unilateral microscopic gonadoblastoma in a prepubertal Turner mosaic with Y chromosome material identified by restriction fragment analysis

A high incidence of gonadal tumors has been demonstrated in patients with gonadal dysgenesis in the presence of Y chromosome material. A unilateral, microscopic gonadoblastoma was found in the dysgenetic gonad of a ten-year-old, phenotypic female, with Turner stigmata and chromosome mosaicisms of three cell populations 45,X/46,X,+mar,/47,X,+mar,+mar. It is often impossible to determine by cytogenetic analysis if the marker chromosome has derived from the X or Y chromosome. The origin of these marker chromosomes was elucidated by the use of DNA probe (pDP34) for male-specific sequences of the Y chromosome. The presence of Y-specific fragments in the patient's DNA led to surgical exploration and the detection of a gonadoblastoma.

Immunohistochemical distinction of Paget's disease from Bowen's disease and superficial spreading melanoma with the use of monoclonal cytokeratin antibodies

The differentiation of Paget's disease from Bowen's disease and Pagetoid superficial spreading melanoma may represent diagnostic difficulties. The special stains used in their differential diagnosis are nonspecific and not always sensitive. Therefore, the expression of cytokeratins of different molecular weights (54, 57, and 66 kilodaltons [kD]) was studied in 26 intraepithelial neoplasms in formalin-fixed paraffin-embedded tissues with the use of an avidin-biotin complex (ABC) method with monoclonal cytokeratin antibodies. These included 9 cases of Paget's disease, 11 cases of Bowen's disease, and 6 cases of Pagetoid superficial spreading melanoma. Paget cells from vulva and breast were always positive for 54-kD cytokeratin, variable for 57-kD cytokeratin, and negative for 66-kD cytokeratin. The neoplastic cells in all 11 cases of Bowen's disease were stained for 57-kD and 66-kD cytokeratins but not for 54-kD cytokeratin. The neoplastic cells in all cases of melanoma did not express any of the cytokeratins studied. The results indicate that antibodies to cytokeratins of different molecular weights may be used as a diagnostic tool in the distinction of Paget's disease from Bowen's disease and melanoma.

Infantile hemangioendothelioma of heterotopic intrathoracic liver associated with diaphragmatic hernia

An autopsy of a six-hour-old term neonate, who died during surgery for repair of a left diaphragmatic hernia, revealed an infantile hemangioendothelioma type I arising in a heterotopic lobe of liver in the left thorax. The upper pole of the tumor was attached by fibrovascular tissue to the lower lobe of the left hypoplastic lung. A pedicle attached to the lower pole of the heterotopic liver pierced through the diaphragm to the left lobe of the normal liver. This case is an example of an unusual association of congenital malformation and putative neoplasm.

Fetal giant hemangiolymphangioma: report of a case

A hemangiolymphangioma is a malformation of both lymphatic and blood vessels. A case of giant hemangiolymphangioma with extensive fetal involvement is presented and considerations in the antenatal diagnosis of this anomaly are discussed.

Comparison of cytokeratin expression in primary and metastatic carcinomas. Diagnostic application in surgical pathology

Metastatic poorly differentiated carcinomas often represent diagnostic difficulties in surgical pathology. Therefore, the expression of cytokeratins of different molecular weights (54, 57, and 66 kd) were compared in paraffin sections of 37 primary carcinomas with their lymph node metastases by an avidin-biotin complex (ABC) method, using monoclonal antibodies. The epithelial tumors consisted of 16 squamous cell carcinomas (SCCs) and 17 adenocarcinomas with different degrees of differentiation (well, moderately, or poorly differentiated), a renal cell carcinoma, a hepatocellular carcinoma, a transitional cell carcinoma of the bladder, and a carcinoid tumor of the stomach. The primary and metastatic tumors showed the same cytokeratin profiles. All SCCs and their metastases were positive for 57-kd cytokeratin and negative for 54-kd cytokeratin. All adenocarcinomas and their metastases were positive for 54-kd cytokeratin and negative for 66-kd cytokeratin. The extent of reactions varied with the differentiation of the carcinomas, with well-differentiated tumors showing more diffuse staining. Cases of lymphoma, sarcoma, and melanoma were negative for the three types of cytokeratins. The results indicate that identification of different molecular weight cytokeratins may be used to distinguish poorly differentiated SCCs from poorly differentiated adenocarcinomas, even in metastatic tumors. In addition, demonstration of these cytokeratins is useful in substantiating presence and identity of small foci of metastases in lymph nodes.

Interstitial deletion of the short arm of chromosome 3 (3p14)

Deletions of 3p usually involve the terminal portion (3p25). An interstitial deletion of a proximal 3p segment (3p14) was detected at amniocentesis. The clinical and cytogenetic characteristics of this case and of three previously published cases are reviewed. Cardiovascular and gastrointestinal malformations have not been reported before in association with this particular chromosome abnormality.