Mm In Maximum Diameter Research Articles

Ｋｉｓｓｉｎｇ ａｎｅｕｒｙｓｍｓの形態をとった非分岐部後交通動脈りゅうの１手術例

We report a case of unruptured “true posterior communicating artery” (Pcom) aneurysm associated with ruptured internal carotid-posterior communicating artery (IC-PC) aneurysm in a 72-year-old woman, treated successfully by direct surgery. Left internal carotid angiography and three-dimensional CT angiography revealed an IC-PC aneurysm 8 mm in maximum diameter protruding inferolaterally, with a small bulge on the Pcom side which was regarded as part of the IC-PC aneurysm. Intraoperative inspection revealed that the prominence initially thought to be part of the IC-PC aneurysm was a true Pcom aneurysm forming a kissing aneurysm pair with the IC-PC aneurysm. The 2 aneurysms were completely dissected and both were clipped. This is the first reported case of kissing aneurysms of the IC-PC aneurysm and true Pcom aneurysm. A true Pcom aneurysm forming kissing aneurysms with IC-PC aneurysm, as in the present case, may be difficult to diagnose preoperatively. Careful intraoperative observation and complete dissection are therefore important for a good outcome.

Sonographic Findings of Inguinal Herniation of the Ovary

Purpose: To describe the sonographic findings of inguinal herniation of the ovary. Materials and Methods: Forty-five girls aged 1-12 (mean, 4.7) months with a groin mass underwent sonographic examination, and in seven of the 45, inguinal herniation of the ovary was detected, and confirmed at surgery. Gray-scale and color Doppler sonographic examinations were performed to evaluate the size, echo pattern, and blood flow of the mass. Sonography of the pelvis and contralateral groin was also performed. Results: In all seven cases, sonography revealed an oval-shaped complex mass 15-25 mm in maximal diameter and composed of heterogeneous hypoechoic portions and one to seven small internal cysts, each 2-9 mm in diameter. Blood flow was observed in all cases, though was subtly decreased in one. In two there was associated herniation of the salpinx, and in two others, incarceration. In four, contralateral inguinal hernia was present. Conclusion: Sonographic findings of an oval-shaped heterogeneous hypoechoic mass with internal small cysts, present in the groin, indicate inguinal herniation of the ovary.

Video-Assisted Thyroidectomy

In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this paper, we report on the entire series of patients who underwent VAT and discuss the results obtained. Seventy-three patients were selected for VAT. Eligibility criteria were: thyroid nodules </=35 mm in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; no previous neck surgery or irradiation and no thyroiditis. The VAT procedure was totally gasless. It was performed under endoscopic vision through a single 1.5 to 2.0-cm skin incision, using a technique very similar to conventional surgery. Eighty-one VATs were attempted on 73 patients. Forty-five lobectomies, 24 total thyroidectomies and eight completion thyroidectomies were successfully performed. Mean operative time was 82 minutes for lobectomy, 100 minutes for total thyroidectomy and 77 minutes for completion thyroidectomy. The conversion rate was 4.9%. Postoperative complications included two transient recurrent nerve palsies, five transient symptomatic postoperative hypocalcaemias and one wound infection. The cosmetic result was considered excellent by most of the patients. VAT is a feasible and and safe procedure that allows for excellent cosmetic results. In selected cases, it can be a valid option for the surgical treatment of thyroid diseases.

Advanced colorectal carcinoma smaller than 10 mm in maximum diameter with special reference to clinicopathologic and molecular features: A report of 3 cases

Small, advanced-stage colorectal carcinoma (CRC) is being detected increasingly at routine colonoscopic examination.1,2 However, the frequency of these tumors, although rarely evaluated, may be low, accounting for only 0.05% of all CRCs.1 Small, advanced-stage CRCs have a malignant potential that is equivalent to that of large advanced-stage CRCs.1,2 They are therefore biologically and clinically significant with respect to the development and pathogenesis of CRC. Three cases of advanced-stage CRC, all smaller than 10 mm in maximum diameter, are described. The clinicopathologic characteristics of these cases are presented and assessed.

Advanced colorectal carcinoma smaller than 10 mm in maximum diameter with special reference to clinicopathologic and molecular features: A report of 3 cases

Advanced colorectal carcinoma smaller than 10 mm in maximum diameter with special reference to clinicopathologic and molecular features: A report of 3 cases

Intrapulmonary lymph nodes: thin-section CT features of 19 nodules.

The purpose of this study was to describe the thin-section CT features of intrapulmonary lymph nodes that accompanied primary or metastatic lung tumors. A retrospective analysis of thin-section CT features was performed on 19 nodules in 16 patients with pathologically confirmed intrapulmonary lymph nodes that accompanied primary or metastatic lung tumors. Of the 16 patients, 13 had a solitary nodule and 3 had two nodules. All nodules were distributed in the middle lobe, lingula, or lower lobe. On thin-section CT images, the nodule was located abutting the visceral pleura (n = 10) or within 8 mm of the visceral pleura (n = 9). The thin-section CT findings showed that most of the nodules were well circumscribed (n = 18), homogeneous (n = 19), ovoid (n = 10), or round (n = 9) and smaller than 12 mm in maximal diameter. The surrounding lung field was normal (n = 16). Intrapulmonary lymph nodes are subpleural in the lower lung field. On thin-section CT, they are well circumscribed, homogeneous, round or ovoid, and smaller than 12 mm in maximal diameter. In the differential diagnosis of subpleural nodules located in the lower lung field, it should be kept in mind that they may be intrapulmonary lymph nodes even though the patient has malignancy.

Pulmonary metastases: can accurate radiological evaluation avoid thoracotomic approach?

To evaluate the effectiveness of radiological assessment (high-resolution CT (HRCT), helical CT (HCT) scan) of lung metastases and to verify if a complete manual exploration by thoracotomy is necessary. From 1/96 to 1/00, 166 consecutive patients presenting with lung metastases were treated. Preoperative CT scan (HRCT in 78 patients, group A; HCT in 88 patients, group B) to assess the number, size and location of the lesions (slice thickness 5 mm; reconstruction interval 3-5 mm) was always performed. All patients underwent axillary thoracotomy (staged when lesions were bilateral); accurate palpation of the lung parenchyma was always performed to identify any undetected lesion. Non-metastatic lesions were excluded. We performed 356 wedge resections in 161 patients (113 monolateral, 70.2%; 48 bilateral, 29.8%) and five lobectomies. In group A, primary neoplasm was epithelial in 44 patients, sarcoma in 26 and germ cell in eight, and in group B, epithelial in 61 patients, sarcoma in 20 and germ cell in seven. Three hundred and sixty-one histologically proven metastases were resected (188 in group A and 173 in group B). HRCT correctly identified 142/188 lesions (sensitivity 75%); HCT revealed 142/173 metastases (sensitivity 82.1%). Sensitivity for lesions less than 6 mm in maximum diameter was 48% (30/58 false negative) in group A and 61.5% (20/52 false negative) in group B. The sensitivity of HCT exceeds that of HRCT. However, complete manual exploration by thoracotomy remains the procedure of choice for patients undergoing pulmonary metastasectomy, because of limitation in preoperative radiological assessment of lung lesions smaller than 6 mm.

The Effect of Repeated Controlled Ovarian Stimulation in Donors

At the authors' institution, most oocyte donors are healthy young women who agree to an anonymous and no-charge donation and who undergo controlled ovarian stimulation (COS) with fertility drugs with the goal of promotingmultiple follicle development. Some donors undergo consecutive COS cycles with differing intervals between stimulations. This retrospective study examined the effects of multiple COS on oocyte retrieval rates and oocyte quality (as reflected by the recipient's outcome). In a 6-year period, 284 donors had at least two cycles of COS. Their mean age was approximately 25 years. Nearly half the women were nulliparous. Donors were 18 to 35 years of age and had no personal or family history of congenital malformation or hereditary disease. The pituitary was desensitized by daily subcutaneous injections of 1 mg of leuprolide acetate, starting in the luteal phase. After menses the dose was halved until chorionic gonadotropin treatment, begun on day 3 after menses. Human menopausal gonadotropin and purified FSH were given if ultrasonography showed no follicle activity. The gonadotropin dosage was tailored to each patient's follicular response as assessed by ultrasonography and serum estradiol estimates. After two or more follicles reached 21 mm in maximum diameter, human chorionic gonadotropin was administered, and oocyte retrieval was scheduled 36 hours later. A total of 1684 oocyte donation cycles was completed in 1017 recipients. Embryo transfer was achieved in 87% of cases. Similar oocyte retrieval rates were maintained through consecutive cycles up to nine consecutive COS cycles in the same donor (Fig. 1). Among 43 donors with five stimulations, there were no differences in fertilization, implantation, or pregnancy rates according to the origin of the oocyte cycle (Fig. 2). Semen characteristics were equally distributed. No differences were found in oocytes retrieved or fertilization, implantation, or pregnancy rates according to the interval between consecutive COS cycles. Similar numbers of oocytes may be retrieved from healthy young volunteer donors during repeated cycles of COS. Oocyte quality is maintained through at least five repeated cycles. The interval between cycles does not affect the outcome of COS.

Clinical failures of endovascular abdominal aortic aneurysm repair: incidence, causes, and management.

Despite well-documented good early results and benefits of endoluminal stent graft repair of abdominal aortic aneurysm (J Vasc Surg 2002;35:1137-44.)(AAA), the long-term outcome of this method of treatment remains uncertain. In particular, concern exists that late effectiveness and durability are inferior to that of open repair. To determine the incidence and causes of clinical failures of endovascular AAA repair, a 7-year experience with 362 primary AAA endografts was reviewed. Clinical failures were defined as deaths within 30 days of the procedure, conversions (early and late) to open AAA repair, AAA rupture after endoluminal treatment, or AAA sac growth of more than 5 mm in maximal diameter despite endograft repair. Endoleak status per se was not considered unless it resulted in an adverse event. If clinical problems arose but could be corrected with catheter-based therapies or limited surgical procedures, thereby maintaining the integrity of successful stent graft treatment of the AAA, such cases were considered as primary assisted success and not classified as clinical failures. The average follow-up period was 1.5 years. Six deaths (1.6%) occurred after the procedure, all in elderly patients or patients at high risk. Five patients (1.4%) needed early conversion (immediate, 2 days) to open repair for access problems or technical difficulties with deployment, resulting in an implantation success rate of 98.6%. Eight patients (2.2%) underwent late conversion for a variety of problems, including AAA expansion (n = 4), endograft thrombosis (n = 1), secondary graft infection (n = 2), and rupture at 3 years (n = 1). Rupture occurred in an additional two patients for a total incidence rate of 0.8%. AAA sac growth of greater than 5 mm was observed in 20 patients (5.6%), four of whom have undergone successful catheter-based treatments to date. Overall, 39 patients (10.7%) needed catheter-based (n = 45) or limited surgical (n = 4) reinterventions for a variety of late problems that were successful in 92%. In our 7-year experience, one or more clinical failures of endovascular AAA repair were observed in 31 patients (8.3%). Reinterventions were necessitated in a total of 10.7% of patients but were usually successful in maintaining AAA exclusion and limiting AAA growth. These results emphasize that endovascular repair provides good results and many benefits for most properly selected patients but is not as durable as standard open repair.

Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis.

In patients with squamous cell carcinoma of the esophagus, the preoperative clinical staging of the N category is primarily based on the lymph node size. Lymph nodes > 10 mm are considered to be tumor-infiltrated. This histopathologic study investigated the correlation of lymph node size and metastatic infiltration in esophageal carcinoma of patients with and without neoadjuvant radiochemotherapy. The specimens of 40 patients with squamous cell carcinoma of the esophagus were included in a prospective morphometric study. Half of these patients (n = 20) received preoperative radiochemotherapy. The number of resected lymph nodes were counted, and the largest diameter of each node was measured. Metastatic involvement of each node was analyzed by histologic examination. The frequency of lymph node metastases was calculated and correlated to the lymph node size. A total of 1196 lymph nodes with an average of 29.9 nodes per patient were resected and analyzed; 129 lymph nodes (10.8%) showed metastatic infiltration. The average size of 1067 tumor-free lymph nodes was 5.1 +/- 3.8 mm in maximum diameter, whereas the average size of 129 metastatic lymph nodes was 6.7 +/- 4.2 mm (p = 0.00006). Of all resected lymph nodes, 761 (63.6%) were < or = 5 mm in maximum diameter. Only 9.3% (n = 111) of all resected lymph nodes were > 10 mm in maximum diameter. There was no significant correlation between lymph node size and the frequency of nodal metastases. No difference in size could be demonstrated between patients with and without neoadjuvant radiochemotherapy. Diagnostic imaging techniques using size as the criterion of nodal infiltration cannot exactly assess the nodal status of patients with esophageal carcinoma. This is also true for patients after neoadjuvant radiochemotherapy. Therefore, evaluation of the nodal status in patients with squamous cell carcinoma of the esophagus is entirely based on pathohistologic analysis after a well defined lymphadenectomy.

Anatomic and radiographic analysis of arthroscopic tack placement into the superior glenoid

Purpose: To anatomically and radiographically describe tack location within the anterosuperior (AS) and posterosuperior (PS) aspects of the glenoid when performing simulated repairs of type II SLAP lesions. Type of Study: Cadaveric anatomic and radiographic analysis. Methods: Arthroscopy was performed on 7 fresh-frozen cadaveric shoulders and bioabsorbable tacks were placed in the AS and PS aspects of the glenoid to simulate repair of a type II SLAP lesion. The PS tack was placed through an accessory portal 1 cm lateral and 1 cm anterior to the posterolateral corner of the acromion. Dissection was then performed, and the incision made in the rotator cuff when creating the posterolateral accessory portal (PLAP) was identified and measured. Tack location within the glenoid was visually studied after removal of all soft tissues and recorded as being either completely within bone or partially within bone. The tacks were recannulated with guide pins and 3 radiographs were then taken of each specimen (true anteroposterior, axillary, and en face glenoid views) and angles of entry determined. In addition, the angle of deviation from the orthogonal at the point of entry of each tack was measured on the en face glenoid view. Results: The average incision made in the rotator cuff for creation of the PLAP measured 10.3 mm in maximum diameter. In 6 of 7 specimens, this incision was made through muscle and not tendon. Seven of 7 AS tacks were completely within bone, and only 5 of 7 PS tacks remained completely within bone. On the true anteroposterior view, the average angle of entry from the vertical for the AS tack was 64°. For the PS tack, this angle measured 86°. On the axillary view, the angle of placement from the coronal averaged 22° for the AS tack and 42° for the PS tack. For the en face glenoid view, the angle of entry from the vertical was 34° for the AS tack and 93° for the PS tack. Lastly, the angle of deviation from the orthogonal on the en face glenoid view was 12° and 35° for the AS and PS tacks, respectively. This difference was statistically significant at P <.001. Conclusions: This study provides quantitative data on the angle of placement and location of tacks within the superior glenoid when performing repairs of type II SLAP lesions. It also shows the PLAP to be a safe portal for the placement of devices into the posterosuperior aspect of the glenoid. Furthermore, the data show the AS tack to be more reliably placed than the PS tack.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 366–371

Treatment of gallstones by extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) has been used since 1985 in a variety of countries for the treatment of gallstones in selected patients (1–14). Clinical use has been routine in western Europe for a decade (15). The limited experience in the United States has been investigational, through tests of the Medstone STS lithotripter (Medstone International, Aliso Viejo, CA) (2, 10, 11), EDAP LT01 lithotripter (EDAP Technomed, Boston, MA) (5), and Dornier lithotripter (Dornier Medical Systems, Munich, Germany) (6). ESWL of cholesterol gallstones with adjuvant bile acid dissolution therapy accelerates stone disappearance; ESWL shatters the stone into small fragments that can be dissolved more quickly. Analysis of stone fragments in the feces of patients who underwent ESWL showed that 3-mm fragments can pass into the intestine without causing symptoms (16). In September, 2000 the Food and Drug Administration approved, subject to a postapproval study, the first lithotripter for gallstone application in the United States, the Medstone STS. Treatment, which comprises lithotripsy treatments of up to 2000 24-kV shocks and administration of ursodiol, is indicated in symptomatic adult patients for whom surgical removal of the gallbladder is medically contraindicated and in symptomatic high-risk patients who have actively refused surgery. Patients must have functioning gallbladders and solitary, radiolucent, noncalcified stones from 4 to 20 mm in maximum diameter. Ursodiol is a naturally occurring bile acid that dissolves gallstones of cholesterol origin. Lithotripters vary with respect to shock wave generation, focusing, and targeting. The Medstone STS, which has been commercially available for the treatment of kidney stones in the United States since 1988, generates a spark-gap shock wave in a water column. The shock wave pulse travels with little attenuation through the water column and soft tissues of the body. When it hits the anterior surface of the gallstone throughout the posterior surface, the changes in acoustic impedance lead to the liberation of compressive and tensile forces, resulting in fragmentation of the stone. Other devices use this electrohydraulic approach or piezoelectric crystals or electromagnetic membranes to generate the shock waves. The multicenter, prospective, postapproval randomized trial of the Medstone STS lithotripter in gallstone therapy is directed toward confirmation of efficacy and collection of additional data supporting safety in routine clinical practice. The selected patients will be treated in the prone position, using i.v. propofol analgesia, and on an outpatient basis. Efficacy of ESWL will be defined as the percentage of patients with stone-free gallbladders according to abdominal ultrasound after 3, 6, and 12 months. Findings will be compared with the results of ursodiol monotherapy.

Treatment of gallstones by extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) has been used since 1985 in a variety of countries for the treatment of gallstones in selected patients (1–14). Clinical use has been routine in western Europe for a decade (15). The limited experience in the United States has been investigational, through tests of the Medstone STS lithotripter (Medstone International, Aliso Viejo, CA) (2, 10, 11), EDAP LT01 lithotripter (EDAP Technomed, Boston, MA) (5), and Dornier lithotripter (Dornier Medical Systems, Munich, Germany) (6). ESWL of cholesterol gallstones with adjuvant bile acid dissolution therapy accelerates stone disappearance; ESWL shatters the stone into small fragments that can be dissolved more quickly. Analysis of stone fragments in the feces of patients who underwent ESWL showed that 3-mm fragments can pass into the intestine without causing symptoms (16). In September, 2000 the Food and Drug Administration approved, subject to a postapproval study, the first lithotripter for gallstone application in the United States, the Medstone STS. Treatment, which comprises lithotripsy treatments of up to 2000 24-kV shocks and administration of ursodiol, is indicated in symptomatic adult patients for whom surgical removal of the gallbladder is medically contraindicated and in symptomatic high-risk patients who have actively refused surgery. Patients must have functioning gallbladders and solitary, radiolucent, noncalcified stones from 4 to 20 mm in maximum diameter. Ursodiol is a naturally occurring bile acid that dissolves gallstones of cholesterol origin. Lithotripters vary with respect to shock wave generation, focusing, and targeting. The Medstone STS, which has been commercially available for the treatment of kidney stones in the United States since 1988, generates a spark-gap shock wave in a water column. The shock wave pulse travels with little attenuation through the water column and soft tissues of the body. When it hits the anterior surface of the gallstone throughout the posterior surface, the changes in acoustic impedance lead to the liberation of compressive and tensile forces, resulting in fragmentation of the stone. Other devices use this electrohydraulic approach or piezoelectric crystals or electromagnetic membranes to generate the shock waves. The multicenter, prospective, postapproval randomized trial of the Medstone STS lithotripter in gallstone therapy is directed toward confirmation of efficacy and collection of additional data supporting safety in routine clinical practice. The selected patients will be treated in the prone position, using i.v. propofol analgesia, and on an outpatient basis. Efficacy of ESWL will be defined as the percentage of patients with stone-free gallbladders according to abdominal ultrasound after 3, 6, and 12 months. Findings will be compared with the results of ursodiol monotherapy.

Identification of isolated and early prostatic adenocarcinoma in radical prostatectomy specimens with correlation to biopsy cores: clinical and pathogenetic significance.

Prostatic adenocarcinoma (PAC) is a multifocal disease. In this study, we identified isolated and small foci of PAC (ISPAC) in radical prostatectomy specimens, described the histopathologic features, investigated their zonal distribution in the prostate and their relationship with large tumor nodules, and correlated the findings with those of preceding biopsy cores. One hundred and thirty radical prostatectomy specimens performed for PAC or for urothelial carcinoma of the urinary bladder with incidental PAC were reviewed for identification of ISPAC. Prostates were serially sectioned in the horizontal plane and submitted in toto for microscopic examination. ISPAC were defined as foci of PAC measuring less than 3 mm in maximum diameter. There were 461 ISPAC identified in 114 cases. They were distributed in the transitional zone (TZ) (18 foci), the apex (73 foci), the anterior horn of the non-TZ (NTZ) (118 foci), the base (8 foci), and the remaining NTZ (244 foci). ISPAC usually consisted of groups of small acini with a GS ranging from 2 to 7 (3 + 4). GSs of ISPAC consisted of single grade or two consecutive grades equal to or lower than those of the main PAC. ISPAC were more often located in close proximity to large tumor nodules. The number of ISPAC increased with the tumor volume up to 3 cm3, then decreased as the PAC became more extensive (p value = 0.02, statistically significant). Prostates with NTZ PAC <1.5 cm3 and TZ PAC or prostates containing 4 or more than 4 ISPAC tended to be frequently associated with small foci of PAC in biopsy cores In this study, we identified ISPAC that likely represent foci of PAC in early development and account for the multicentricity and heterogeneity of PAC. ISPAC in the NTZ were common and may account for small foci of PAC or atypia in biopsy cores. Although these small foci of PAC or atypia in biopsy cores without accompanying higher GS PAC were often associated with significant PAC, they may also occasionally represent insignificant or vanishing PAC in subsequent radical prostatectomies.

Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis.

To determine the diagnostic accuracy of modified focused appendiceal computed tomography (CT) to exclude or confirm appendicitis in patients who presented with equivocal symptoms and signs of appendicitis. One hundred patients (age range, 14-81 years; mean age, 30.6 years) with equivocal symptoms and signs of acute appendicitis were included in this prospective study. Patients were given 30 mL of diatrizoate meglumine and diatrizoate sodium and 60 mL of sorbitol mixed in 1 L of water orally over 1 hour. CT was performed 1.5 hours after the commencement of oral contrast material administration. The criteria used for the diagnosis of appendicitis were (a) appendix greater than 6 mm in maximum diameter, (b) no contrast material in the appendiceal lumen, and (c) inflammatory changes in the periappendiceal fat. CT results were compared with histopathologic findings at appendectomy. Patients with negative CT findings were followed up by telephone or clinically. Of 100 cases, 30 were positive at CT and 70 were negative. There were 28 true-positive cases; two false-positive cases, one cecal diverticulitis and one pelvic peritonitis with periappendicitis; and two false-negative cases, one perforated appendix and one mucosal and submucosal inflammation of the appendix but no transmural inflammation. Sensitivity was 93%, specificity was 97%, and accuracy was 96%. Focused appendiceal CT in which oral contrast material is used alone yields high levels of accuracy in clinically equivocal cases of acute appendicitis.

NATROLEMOYNITE, A NEW HYDRATED SODIUM ZIRCONOSILICATE FROM MONT SAINT-HILAIRE, QUEBEC: DESCRIPTION AND STRUCTURE DETERMINATION

Natrolemoynite is a new member of the lemoynite group found in altered or unaltered pegmatites cutting nepheline syenite at the Poudrette quarry, Mont Saint-Hilaire, Quebec. In altered pegmatites, it is associated with microcline, lemoynite, lepidocro cite, galena, sphalerite, calcite and pyrite, and in unaltered pegmatites, with biotite, microcline, albite, magnetite, a chlorite-gr oup mineral, a burbankite-group mineral, an unidentified donnayite-(Y)-like mineral, zircon and pyrochlore. Crystals are colorless to white (occasionally with a slightly pink to red tinge), bladed to prismatic, elongate along [001], with maximum widths of 1 mm and lengths of 2 mm. The mineral typically develops in compact radial aggregates and spheres 4 mm in maximum diameter. It is transparent to translucent, with a vitreous to subadamantine luster and a white streak. The Mohs hardness is 3. Perfect {100} a nd

Anatomy of the First Septal Perforating Artery: A Study With Implications for Ablation Therapy for Hypertrophic Cardiomyopathy

To determine the variability in the size and distribution of the first septal perforating artery (FSPA). In this pilot study, 10 fresh autopsy hearts from patients who did not have hypertrophic cardiomyopathy (HCM) or clinical evidence of coronary artery disease were evaluated for the variability in the size of the FSPA. The size of the FSPA was also measured during coronary angiography in 8 patients with HCM who were undergoing alcohol septal ablation. Of the 10 autopsy hearts, 2 had a large FSPA (> or = 1.0 mm in maximal diameter) with prominent septal myocardial distribution, 2 had a medium-sized FSPA (0.5-0.9 mm), 2 had a small FSPA (0.1-0.4 mm), 3 had a tiny FSPA (< 0.1 mm), and 1 had an indiscernible ostium. In 2 patients the FSPA supplied the right ventricular free wall. In 4 patients the basal ventricular septum was incompletely supplied by the FSPA. Of the 8 patients with HCM, the FSPA was larger than 2 mm in diameter in 2 patients, 1 to 2 mm in 4, and smaller than 1 mm in 2. The distance between the left anterior descending coronary artery ostium and the origin of the FSPA ranged between 13.1 and 37.4 mm, indicating a large variation in the size and distribution of the FSPA. Variability in the size and distribution of the FSPA in patients without HCM was substantial. Areas of the heart other than the basal septum were supplied in some patients by the FSPA. In other patients the FSPA did not supply the entire basal septum. Similar findings were noted in patients with HCM. A detailed evaluation of the distribution of the FSPA may be necessary in all patients with HCM who are undergoing alcohol septal ablation.

Using helical CT to diagnosis acute appendicitis in children: spectrum of findings.

Helical CT in children shows an overlapping and wide spectrum of appearances of the normal and acutely inflamed appendix. The normal appendix may measure up to 10 mm in maximal diameter but should not have other CT signs of acute inflammation.

Cutaneous perineurioma: a poorly recognized tumour often misdiagnosed as epithelioid histiocytoma.

Eleven cases of cutaneous perineurioma were studied to further characterize the histological features of this entity. The histological and immunocytochemical features of 11 cases of cutaneous perineurioma were studied and detailed by two pathologists. Clinical data were obtained from the referring clinician. Seven patients were female and four were male with ages ranging from 19 to 67 years (median 41 years). Six lesions arose on the leg. Macroscopically lesions ranged from 4 mm to 14 mm in maximum diameter (median 7 mm). Diagnostic histological features included a nonencapsulated but sharply demarcated tumour with a dumbbell architecture. The tumour cells were spindle-shaped with delicate inconspicuous cytoplasm and arranged in sheets, whorls or with a vague fascicular pattern. Epithelioid cells with moderate amounts of eosinophilic cytoplasm were frequently admixed with the spindle cells. One tumour had trabeculae of cells embedded within a dense collagenous stroma as described in sclerosing perineurioma. One case displayed a prominent myxoid stroma. Three further cases contained small foci of fibrosis or myxoid change suggesting a morphological spectrum exists in cutaneous perineurioma. Mitoses were exceptionally rare and necrosis and significant cytonuclear pleomorphism was not found. All tumours were epithelial membrane antigen (EMA) positive. Six cases showed focal positivity for factor XIIIa. Follow-up ranged from 5 months to 6 years (median 1 years). No tumour recurred or metastasized. The histological appearance of this tumour is broader than hitherto realized. Several cases in this series were misdiagnosed histologically and cutaneous perineuriomas may be more common than currently appreciated.

Successful surgical treatment of giant coronary artery aneurysm with fistula

Giant coronary artery aneurysm with fistula formation is a rare entity. We report a giant coronary artery aneurysm with a maximum diameter of 70 mm with fistula, in which a favorable course was obtained after surgical treatment. We also review the literature on giant coronary artery aneurysms exceeding 50 mm in maximum diameter.