Cm In Mean Diameter Research Articles

Paleoenvironmental significance of growth story of long-living deep-water acervulinid macroids from Kikai-jima shelf, Central Ryukyu Islands, Japan

Macroids are unattached centimetre-sized nodules built by encrusting invertebrates. Encrusting foraminifera (Acervulina inhaerens) and subordinate thin coralline algae form extensive macroid beds on sandy and gravelly bioclastic carbonates off Kikai-jima, on a coral-reef-related island shelf, in the Central Ryukyu Islands, Japan. At water depths from 75 to 100 m, the beds consist of spheroidal and sub-spheroidal macroids, c. 6 cm in mean diameter, with asymmetric concentric inner arrangement. The macroids are bioeroded by Entobia, Maeandropolydora, Trypanites, Gastrochaenolites, and microborings. They generally show two distinct growth stages separated by an abraded rugged surface deeply colonized by borers, mainly Entobia. Radiocarbon dating yielded an oldest age of c. 4400 cal yr BP for the earliest acervulinid growth, whereas the second stages were much younger, ranging in age from c. 1500 cal yr BP to present day. Datings of the two growth stages in five specimens indicate that active growth and growth interruption were not synchronous in the different nodules. For c. 4400 years the macroids grew within an estimated maximum range of palaeotemperature changes of c. 4.7 °C, under chronic oligotrophic to mesotrophic conditions, low-level hydrodynamism and low sedimentation rates. The lack of synchroneity among individual macroids rules out catastrophic events and ecosystem-wide environmental changes as possible causes of growth interruption. Random biogenic mobilization and temporal occupation of the macroid surface by organisms with no rigid skeleton and/or biofilms likely interrupted acervulinid growth at individual macroid scale. The environmental conditions in which Kikai-jima macroid beds develop do not support interpretations of acervulinid macroid accumulations during Paleocene−Eocene Thermal Maximum (PETM) and Middle Eocene Climatic Optimum (MECO) events in the Western Tethys as indicators of eutrophic conditions.

Popliteal lymph nodes in patients with osteosarcoma: are they metastatic?

To evaluate the prevalence, imaging appearance, and significance of popliteal lymph nodes (PLN) on magnetic resonance imaging (MRI) in patients with distal femoral or proximal tibial osteosarcoma (OS). This study included consecutive patients with OS presenting from May 2016 to March 2018. Inclusion criteria were patients with distal femoral or proximal tibial OS with MRI and pathology at our institution. On MRI, two radiologists recorded primary tumor features (size, location, signal, extra-compartmental extension), and PLN characteristics (mean size, presence/absence of fatty hilum, mineralization, PET/bone scintigraphy avidity, contrast enhancement, and diffusion restriction). Tumor histology, stage, and clinical follow-up were recorded. Descriptive statistics were provided. Sixteen patients with OS (age 20 ± 10 (range10-40) years, 10/16 male) were included. Although 81% (13/16) of the patients had PLNs at presentation (size range 0.3-3.6cm), fewer patients had extra-compartmental spread: intra-articular extension 50% (8/16), skip lesions 19% (3/16), lung metastases 31% (5/16), and osseous metastases 12% (2/16). Four (25% (4/16)) patients had PLN ≥ 1cm; two were histologically proven reactive. One was presumed metastatic due to rapid development, mineralization, and FDG-avidity on PET/CT. The other ≥ 1cm PLNs along with all twelve (75% (12/16)) that were < 1cm in mean diameter were presumed non-metastatic with documented stability for at least 12months of follow-up. PLNs are frequently visible on MRI in patients with OS but are rarely (prevalence = 6%) metastatic. Features on MRI which may suggest metastatic PLNs include large size > 1cm and loss of a fatty hilum.

Effect of Maternal Retroplacental Leiomyomas on Fetal Growth.

To evaluate the association between retroplacental leiomyoma identified on second trimester ultrasound and fetal growth. We performed a retrospective study comparing the presence or absence of one or more retroplacental leiomyomas on birth weight in a cohort of women with singleton pregnancies undergoing second trimester fetal anatomic ultrasound at our institution between 2007 and 2012. The incidence of small for gestational age (SGA) infants was recorded. Secondary analysis evaluated the effect of number and size of retroplacental leiomyomas. Birth weight in women with at least one retroplacental leiomyoma was 177 grams less than in women without leiomyomas (95% CI-295 to-95, P= 0.003). There was a non-significant trend towards a higher incidence of SGA in infants born to women with retroplacental leiomyoma compared with women without leiomyoma (OR 2.84; 95% CI 0.97 to 6.84, P= 0.057). Women with a retroplacental leiomyoma > 4 cm in mean diameter were more likely to deliver an SGA infant than women without leiomyomas (OR 2.84, 95% CI 1.01 to 8.01; P= 0.048). Multiple retroplacental leiomyomas did not have a greater effect on pregnancy outcomes than single leiomyomas. Infants born to women with one or more retroplacental leiomyomas had a lower mean birth weight than infants born to women without leiomyomas. In addition, retroplacental leiomyomas > 4 cm in mean diameter were associated with an increased risk of delivering an SGA infant.

Use of depot GNRH antagonist (Degarelix) in the treatment of endometriomas (ovarian endometriosis) before IVF: a controlled trial

Use of depot GNRH antagonist (Degarelix) in the treatment of endometriomas (ovarian endometriosis) before IVF: a controlled trial

Meta-analyses of habitat selection by fishers at resting sites in the pacific coastal region

The fisher (Pekania pennanti) is a species of conservation concern throughout the Pacific coastal region in North America. A number of radiotelemetry studies of habitat selection by fishers at resting sites have been conducted in this region, but the applicability of observed patterns beyond the boundaries of each study area is unknown. Broadly applicable information on habitat selection by fishers in this region would be useful for conservation planning and for informing forest management decisions in areas where intensive field studies have not been conducted. To provide such information, we conducted formal meta-analyses of habitat selection by fishers at resting sites in 8 study areas located from central British Columbia to the southern Sierra Nevada in California, including all areas that currently contain established fisher populations. Each study included in the meta-analyses measured environmental attributes at sites used by fishers for resting (i.e., the immediate vicinity of resting structures; typically ≤0.5 ha) and at random or systematically located sites representing resource availability in each study area. We selected 9 environmental attributes that we expected to be associated with fisher resting sites: slope, heat load index, percent cover of vegetation ≥2 m above the ground, volume of moderately decayed logs ≥26 cm in mean diameter, basal area of live conifers 51–100 cm in diameter at breast height (dbh), basal area of live hardwoods 51–100 cm in dbh, basal area of moderately decayed snags 51–100 cm in dbh, mean dbh of live conifers ≥10 cm in dbh, and mean dbh of live hardwoods ≥10 cm in dbh. Despite substantial variation in environmental conditions among study locations, our analyses revealed statistically significant summary effect sizes for each of the 9 environmental attributes we analyzed. Fishers selected sites for resting that had steeper slopes, cooler microclimates, denser overhead cover, a greater volume of logs, and a greater prevalence of large trees and snags than were generally available. Thus, in areas within the Pacific coastal region where fishers have not been studied and data on selection of resting sites are lacking, our findings provide empirical support for management or conservation actions for fishers that promote the retention or development of these environmental attributes. © 2013 The Wildlife Society.

Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery

To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses. Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy. One hundred and forty-three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94-99%), specificity of 79% (95% CI, 60-90%), positive predictive value of 95% (95% CI, 89-98%), positive likelihood ratio of 4.58 (95% CI, 2.25-9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01-0.09). A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.

Size–density relationships in Drimys winteri secondary forests of the Chiloe Island, Chile: Effects of physiography and species composition

Size–density equations have become a relevant stand analysis tool for foresters and ecologists. Second-growth forests dominated by Drimys winteri J.R. et G. Foster (>60% basal area of this species) in the north-central part of the Chiloe Island were analyzed for variation in size–density relationships according to physiographical conditions that influence site quality and species composition. Site differences in this region are driven by drainage. It is poor in flat terrain and improves on slopes. Data from 62 sampled plots showed that density-dependent tree mortality commences once the mean stand diameter reaches 10 cm. It also showed that inclusion of plots in steep slopes (>30%) decreased the goodness of fit of the size–density relationships. Thus, size–density relationships were evaluated for secondary forests ranging from 10 to 20 cm in mean diameter in relatively gentle slopes and flat terrain. D. winteri averaged from 72 to 80% of the total number of trees, and from 80 to 85% of total basal area. The most important accompanying species in flat terrain were those of the Myrtaceae family, and Nothofagus nitida was almost exclusively found in these conditions; on inclined terrain, those characteristic of better sites, e.g. Laureliopsis philippiana and Eucryphia cordifolia, in addition to Proteaceae species, were the principal associated species. Inspite of these variations, site, as reflected by slope (0–30%) and aspect, did not significantly affect size–density relationships. Species composition, as evaluated by percentage basal area, did not have a significant effect in the size–density relationships for all plots and south-aspect plots, and was significant but nominal in north-aspect plots. In flat terrain L. philippiana and E. cordifolia increased the r 2 of the size–density model by 14%. Here, these species became relatively important only in stands with a mean diameter >15 cm, likely due to improved drainage conditions, suggesting that a split of the data in plots under and over this diameter could render different results in terms of the effects of site in size–density relationships. The slopes of the equations for all plots or by terrain condition were greater (−1.78 to −1.86) than the “universal” −1.6 slope. Maximum size–density reference lines are provided for average physiographical conditions in the north-central part of the island, and for each aspect condition. Findings from the research expand our understanding of population ecology in this region, provide an important planning tool for silviculturists to use in controlling stand density, and give ecologists a surrogate of micro site environmental conditions.

Proposed Treatment Strategy for Cavernous Sinus Meningiomas: A Prospective Study

To establish a safe and effective treatment strategy for cavernous sinus (CS) meningiomas, we prospectively analyzed the outcome of a treatment protocol combining surgery and radiosurgery during the past 7 years. Tumors confined to the CS and distant from the optic apparatus and the brainstem were treated with radiosurgery alone. Tumors attached to or compressing the optic apparatus and brainstem and that were larger than 3 cm in mean diameter, extended into the multiple cranial fossae, and were suspected of being malignant were treated with combined nonradical microsurgery and radiosurgery. In accordance with this treatment protocol, 40 patients aged 26 to 72 years (median, 51 yr) with primary (n = 27) or recurrent (n = 13) CS meningiomas (volume range, 0.9-39.3 cm(3); median volume, 5.4 cm(3)) were treated with combined surgery and radiosurgery (n = 23) or radiosurgery alone (n = 17). During radiosurgery, 12 to 18 Gy (median, 16 Gy) was delivered to the tumor margin. The follow-up period ranged from 14 to 79 months (median, 47 mo). The actuarial tumor control rate was 94.1% at 5 years. The improvement of cranial nerve function was significantly frequent in patients with primary CS meningiomas (P < 0.05). Permanent cranial nerve dysfunction was significantly frequent in patients with tumors compressing the brainstem or smaller than 10 cm(3) (P < 0.05). All 36 patients with a pretreatment Karnofsky Performance Scale score of 90 or more maintained the same range after treatment. Proper combination of microsurgery and radiosurgery for CS meningiomas provides excellent growth control with favorable functional state. Outcomes were better when this protocol was adopted at the initial diagnosis for patients with smaller tumors that did not compress the brainstem.

Oocyte donation outcomes in agonist and antagonist cycles

Oocyte donation outcomes in agonist and antagonist cycles

Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience.

To assess the effects of removal of all ultrasonographic (US) evidence of breast lesions by using a vacuum-assisted biopsy (VAB) device. Thirty-four women with breast masses underwent US-guided biopsy with an 11-gauge VAB device, with which removal of all evidence of the lesion was attempted. Histologic findings were compared with results of surgery and follow-up imaging. Patient tolerance and perceptions of the procedure and the ability of the procedure to eliminate a palpable finding were evaluated with questionnaires and findings at follow-up physical examination. The biopsy protocol was completed in all cases. Twenty-six benign lesions (76%) and eight malignancies (24%) were diagnosed. After VAB, 10 patients (29%) underwent surgery on the basis of histologic findings of invasive carcinoma (n = 7), ductal carcinoma in situ (n = 1), lobular neoplasia (n = 1), or atypical ductal hyperplasia (n = 1). VAB resulted in complete excision of four of 10 lesions: two of eight malignancies and two of two benign lesions. Among 21 patients with benign lesions who underwent 6-month follow-up imaging, eight (38%) had a definite residual mass. At 6-month follow-up examination, VAB was seen to have eliminated the palpable abnormality in seven (88%) of eight patients with initially palpable benign masses. Thirty-two patients (94%) described no or mild pain during biopsy, and 33 patients (97%) rated care as excellent. After removal of all US evidence of breast masses with a VAB device, there was a substantial probability that residual lesion that was not visualized during the procedure would later be found at surgery or follow-up imaging. A palpable mass (< or =1.2 cm in mean diameter) was eliminated in 88% of cases, and patient tolerance and perceptions of the procedure were favorable.

Massive localized lymphedema: Additional locations and association with hypothyroidism

We report the second series of a new entity called “massive localized lymphedema in morbidly obese patients” (MLL), recently described in medical literature. Our 6 cases present additional locations as well as an association with hypothyroidism. Huge masses, of longstanding duration ranging from 9 months to 8 years, afflicted the thigh, popliteal fossa, scrotum, suprapubic and inguinal region, and abdomen of morbidly obese adults. Although clinical impressions were generally of a benign process, including lipoma and recurrent cellulitis, the possibility of a malignant neoplasm could not be eliminated. Poorly defined and non-encapsulated, these skin and subcutaneous lesions were most remarkable for their sheer size, measuring 50.6 cm in mean diameter (range, 38-75 cm) and weighing a mean of 6764.5 g (range, 2,060-12,000 g) The overlying skin exhibited the induration and peau d'orange characteristic of chronic lymphedema. Grossly and histologically, a prominent marbled appearance, rendered by fibrous bands intersecting lobules of adipose tissue, simulated sclerosing well differentiated liposarcoma. However, the absence of atypical stromal cells, atypical adipocytes, and lipoblasts precluded the diagnosis of well differentiated liposarcoma. Instead, reactive features, encompassing lymphatic vascular ectasia, mononuclear cell infiltrates, fibrosis, and edema between the collagen fibers, as well as ischemic changes including infarction and fat necrosis, established the diagnosis of MLL. Although the pathogenesis of MLL may be as simple as obstruction of efferent lymphatic flow by a massive abdominal pannus and/or prior surgery, the presence of hypothyroidism in 2 of our patients suggests an alternative pathogenesis. Recognition of this entity by both clinicians and pathologists should avert a misdiagnosis as a low-grade liposarcoma. H UM P ATHOL 31:1162-1168.

Does the 10-MHz transvaginal transducer improve the diagnostic certainty that an intrauterine fluid collection is a true gestational sac?

We studied whether a 10-MHz transvaginal transducer improves the diagnostic certainty that a small intrauterine fluid collection is a true gestational sac. Over a 6-week period, women who presented with a positive pregnancy test and a fluid collection (devoid of any characteristics such as yolk sac or fetal pole) in the uterus seen with a standard 6-7-MHz transvaginal transducer were entered in the study. The patients were immediately rescanned with a 10-MHz transvaginal probe, and characteristics of the fluid collection using this probe were noted. Specifically, the visualization of a yolk sac or the intradecidual or double decidual sign was considered an objective improvement in the certainty that the fluid collection was a gestational sac. Twelve patients presented with a positive pregnancy test and a fluid collection in the uterus seen with a 6-7-MHz probe. Eight of these fluid collections were smaller than 1 cm in mean diameter, and all 8 of these patients had an objective improvement in the diagnosis of an intrauterine pregnancy using the 10-MHz probe. The other 4 patients had fluid collection 1-2 cm in mean diameter seen at 6-7 MHz. The 10-MHz probe improved the diagnostic confidence in 2 of these 4 patients. In patients with early pregnancies who have questionable gestational sacs on sonography with standard 6-7-MHz transducers, the 10-MHz probe improves the diagnostic confidence of the presence of an intrauterine gestational sac.

Uterine myomata and outcome of assisted reproduction.

The aim of this work was to study the effect of uterine myomata on the implantation rate and outcome in in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Among 406 patients, 51 (12.6%) were found to have uterine corporeal myomata. Twelve patients were excluded from the study as they had large myomata, submucous myomata or intramural myomata encroaching on the cavity. These patients were advised to have myomectomy before being enrolled in the IVF/ICSI programme. The remaining patients (n = 39) were sorted according to the number, site and size of the myomata as assessed by transvaginal sonography. Three patients had more than one myoma. Most of the myomata were subserous (72.7%) and the mean diameter of the myomata was 3.5 +/- 0.9 cm. A control group (n = 367) was chosen with normal uteri and no history of uterine reconstruction surgery. The mean age of myoma patients was 34.7 +/- 3.6 years as compared to 34.0 +/- 4.4 years in the control group. The age, period of infertility, body mass index, duration and number of human menopausal gonadotrophin ampoules needed for stimulation, oestradiol levels, number of oocytes retrieved and the fertilization rate were not significantly different in the myoma patients compared to the control group. Fifteen myoma patients (38.5%) subsequently showed one or more pregnancy sacs on ultrasonography of which three (20%) spontaneously aborted during the first trimester and two (13.3%) had preterm labour, as compared to 123 (33.5%), 19 (15.5%) and nine (7.3%) respectively, among the control group (P = 0.27, 0.33 and 0.21). In conclusion, uterine corporeal myomata, not encroaching on the cavity and <7 cm in mean diameter, do not affect the implantation or miscarriage rates in IVF or ICSI.

An Unusual Venous Anomaly of the Placenta

The authors present an unusual vascular anomaly of the placenta. The placenta was very large, weighing 1,490 g. On the fetal surface, numerous dilated and tortuous vessels were observed on and under the chorionic membrane, of which three branches arose from a vein that was connected to the umbilical vein. One of them had a 5 x 2.5 cm aneurysmal dilatation, where three secondary branches arose. These venous channels were dilated and tortuous. The longest secondary branch was 133 cm in length and 1.2 cm in mean diameter and led into the placenta. Multiple, severely coiled or straight small branches arising from these vessels were also observed as vascular tangles. Some of these smaller vessels also led into the placenta. All abnormal vessels were veins. The umbilical cord was also normal except for a membranous insertion, and the placenta was unremarkable except for its large size.

Papillary-cystic neoplasm of the pancreas. A clinicopathologic study concerning the tumor aging and malignancy of nine cases

Nine female patients with papillary-cystic neoplasms (PCN) of the pancreas were studied clinicopathologically. The ages of seven of these patients ranged from 8 to 24 years. The remaining two patients, who were 47 and 60 years of age, were considered to have had the onset in their youth. There were few subjective symptoms, and the lesion was most often detected as a palpation of a mass by the patients themselves. Although the prognosis was generally favorable, the two older patients died of metastases. This suggested low-grade malignancy of PCN. The tumors were large (6.9 cm in mean diameter) and encapsulated, and their cross-sections showed an intermingling of solid tumoral areas and cystic necrotic areas. The histologic features of the solid tumoral portion were relatively uniform, with the tumor cells showing solid and pseudopapillary or pseudoglandular proliferation but few mitoses or atypism. Histochemical, immunohistochemical, and electron microscopic examinations showed polymorphic differentiation, which means that part of the tumor cells differentiated into duct epithelium, acinus, and endocrine cells (primary constituents of the pancreas). These findings suggest that the origin of PCN is totipotential primordial cells found in the development of the embryonic pancreas.

Follicular aspiration and in vitro fertilization associated with pelvic reconstructive surgery

Between August 1982 and May 1987, 103 patients underwent in vitro fertilization-embryo transfer (IVF-ET) in association with pelvic reconstructive surgery for infertility. Follicular stimulation was induced with clomiphene citrate and laparotomy scheduled day 12 to 15 of the menstrual cycle. Ultrasound measurements of follicular diameter and number of follicles were obtained on the day of human chorionic gonadotropin (hCG) administration, and laparotomy and ovum retrieval performed 36 hours later. Embryo transfer was performed 48 to 72 hours after insemination. Patients were treated postoperatively with intramuscular progesterone. In addition to evaluating the overall pregnancy rate, the outcome of patients having one or more follicles greater than or equal to 1.4 cm in mean diameter (group A) were compared to those in group B (no follicles greater than or equal to 1.4 cm in diameter). The number of oocytes obtained and the fertilization rate and polyspermic fertilization rate were not significantly different between groups; 10.1% of patients in group A conceived but no patient conceived in group B, yielding an overall pregnancy rate of 8.7%. These data suggest that physicians having IVF-ET at their disposal offer patients IVF during pelvic reconstructive surgery.

Failure of human oocyte release at ovulation

Among 150 patients admitted for ovum aspiration, in vitro fertilization, and embryo transfer in Perth, Western Australia, 14 were found to have had at least one ovulated follicle at the time of laparoscopy. Based upon ultrasound estimation of follicle diameter 24 hours previously, ovulation occurred in 6 of 22 follicles less than 1.7 cm in mean diameter and in 16 of 19 follicles greater than 1.7 cm in mean diameter. When the ruptured follicles were flushed with heparinized fertilization medium, oocytes were collected in 13 of the 22 dispersed follicles. Twelve oocytes developed pronuclei 16 hours after the addition of spermatozoa, and 11 cleaved to the 4-cell stage within 44 hours of insemination. Oocytes were recovered from 6 of 11 patients stimulated with clomiphene alone and from all 3 patients stimulated with clomiphene supplemented with human menopausal gonadotropin. These observations suggest that oocyte release and follicle rupture are not necessarily synonymous events and that the incidence of retained oocytes in ovulated follicles following stimulation with clomiphene or clomiphene plus human menopausal gonadotropin could be on the order of 60%.

Immunotherapeutic Effect of Allogeneic Tumor Cells on the Growth of Autochthonous 3-Methylcholanthrene-Induced Sarcomas in Rats

The tumor-inhibitory effect of injections of allogeneic tumor cells was observed. Established autochthonous sarcomas induced in the subcutaneous tissue of rats by 3-methylcholanthrene (MCA) were treated with immunization by using allogeneic Hirosaki sarcoma cells. When MCA-induced sarcomas grew to approximately 1 cm in mean diameter, Hirosaki sarcoma cells were inoculated into various tissues of primary tumor-bearing rats. Immunizing procedures consisted of intraperitoneal and subcutaneous injections in one experimental group, and of intradermal and intraperitoneal injections in another. Significantly inhibitory effect on the growth of autochthonous sarcomas was observed in the initial stage up to 2 cm in diameter as compared with that of control sarcomas. No significant inhibition was seen in the course of the growth of sarcomas larger than 2 cm in diameter. This results may indicate that immunotherapy by using allogeneic tumor cells should be considered to be valuable for the treatment of human cancer.