Sinus Pattern Research Articles

Identification by frontal sinus pattern in forensic anthropology

The authors report forensic cases from the literature, as well as two personal homicide cases, of identification through comparison of frontal sinus radiographs. A general discussion about identification using frontal sinus X-rays is presented, pointing out the reliability of the method, in reference to the uniqueness of the frontal sinus in humans, but also some difficulties, especially in reference to the distance, orientation and angle of the X-ray technique.

Case report of a 69-year-old woman with double cancers: Primary yolk sac tumor of the right ovary and primary serous surface papillary carcinoma of the peritoneum

This extremely rare case of a 69-year-old woman with yolk sac tumor of the right ovary and serous surface papillary carcinoma (SSPC) of the peritoneum is reported. Histological diagnosis for both tumors was done according to the classifications of the Japanese Society of Pathology and Japan Society of Obstetrics and Gynecology. To confirm the histological diagnosis, both immunocytochemical studies for alphafetoprotein (AFP) and carcinoembryonic antigen (CEA), and immunohistochemical studies for AFP, CEA, CA19-9, and CA125 were performed. Serum AFP and CA125 levels were serially determined. On hematoxylin and eosin staining an endodermal sinus pattern associated with Schiller-Duval bodies was observed in the right ovarian tumor. However, papillary serous carcinoma was found on the surface of the almost normal sized left ovary and in the omental metastatic nodules.

Angiographic evidence of long-axis rotation in addition to short-axis aortopulmonary rotation: its implication in transposition of the great arteries.

To assess the pattern of aortic sinus in varied aortopulmonary rotations and its clinical implications, three aortic sinuses at the diastolic phase in true lateral view are identified in 53 angiograms of complete transposition of the great arteries recorded between 1988 and 1993. The patients with the high takeoff of the coronary arteries found at surgery and in the literature were selected for additional investigation. Six regions were defined on the horizontal plane. From left anterior 89 degrees to 61 degrees, the non-facing sinus moved toward the anterior aspect (one patient). From left anterior 60 degrees to left anterior 1 degree, the left-hand sinus moved gradually from an anterior toward a posterior location (two patients). From directly anterior 0 degree to right anterior 59 degrees, the right-hand sinus moved from posterior toward an anterior position (30 patients). From right anterior 60 degrees to right posterior 105 degrees, the non-facing sinus moved posteriorly (20 patients). On approaching directly anterior 0 degree and toward right anterior 60 degrees, the left-hand sinus was the lowest in anterior transposition of the great arteries instead of the non-facing sinus, as in left anterior 90 degrees and in posterior transposition of the great arteries. High takeoff occurred commonly above the lowest left-hand sinus in anterior transposition of the great arteries (2 cases here and 5 in the literature, 100%). In conclusion, aortopulmonary rotations about the short and long axes were both evident on identification of the aortic sinus in various rotations. The aortic sinus did not rotate along the long-axis in anterior transposition of the great arteries, thus making the left-hand sinus, the lowest of this group, vulnerable to the high takeoff of the coronary arteries in anterior transposition of the great arteries.

Splenic marginal zone lymphoma. A distinct B-cell neoplasm.

The splenic marginal zone is a morphologically and perhaps immunologically distinct B-cell compartment. Lymphomas arising from cells of the splenic marginal zone are rare. Here we describe the morphologic, immunologic, and clinical features of 14 cases. Patient age ranged from 35 to 79 years (median, 68 years) with a male-to-female ratio of 1:1.8. The spleen was uniformly enlarged (median, 1,540 g; range, 388-3,845 g) in all patients, the neoplastic infiltrate had a nodular pattern in three cases, nodular and diffuse in seven cases, and diffuse in four cases. The neoplastic cells had small to medium-sized nuclei with round, oval, or slightly indented contours, small eosinophilic nucleoli, and a moderate amount of pale cytoplasm. Extrasplenic involvement was present in 12 patients. Lymph nodes often had a vaguely nodular pattern and preservation of sinuses; bone marrow was infiltrated focally (seven cases) or diffusely (one case). Five patients had hepatic involvement. Ultrastructurally, neoplastic cells differed from other small B cells and resembled normal marginal zone cells by having long, serpentine rough endoplasmic reticulum profiles. All lymphomas marked as B cells and light chain restriction was demonstrated in 12 cases. Bcl-2 protein expression was present in all cases. Most cases (70%) were negative for DBA.44 (CD72). Plasmacytic differentiation was present in three cases. In conclusion, splenic marginal zone lymphoma is a B-cell neoplasm with distinctive clinical, morphologic, immunologic, and ultrastructural characteristics.

Early assessment by transesophageal echocardiography of left atrial appendage function after percutaneous mitral commissurotomy

Thirty-seven consecutively admitted patients with severe mitral stenosis underwent percutaneous mitral commissurotomy with a transthoracic and biplane or multiplane transesophageal echocardiographic examination before and between 24 and 48 hours after percutaneous mitral commissurotomy. Thirty patients (81%) were in sinus rhythm and 7 were in atrial fibrillation. Left atrial appendage (LAA) function was evaluated in both the transverse and the longitudinal planes by planimetry and pulsed Doppler echocardiographic interrogation at the LAA outlet. Percutaneous mitral commissurotomy resulted in a twofold increase in mitral valve area, and no severe mitral regurgitation occurred. With use of the planimetry method, there was no significant improvement in LAA ejection fraction, except in the transverse plane for patients in sinus rhythm (p = 0.03). With use of Doppler method, 3 distinct flow patterns were observed before the procedure: a “sinus pattern” in patients in sinus rhythm, and a “fibrillatory pattern” (n = 3) or a “no-flow pattern” (n = 4) in patients in atrial fibrillation. After commissurotomy, mere was a marked increase in LAA peak Doppler velocity (+62%) and in LAA velocity time integral (+31%). Of the 4 patients in atrial fibrillation with a no-flow pattern, 2 had recovery of a typical effective fibrillatory flow pattern after the procedure. The increase in peak Doppler velocity after commissurotomy was related to the decrease or regression in left atrial spontaneous echo contrast, and correlated with the increase in mitral valve area, the decrease in transmitral pressure gradient, and the increase in cardiac index; improvement in valve function after successful percutaneous mitral commissurotomy is associated with early improvement in LAA function.

987-107 Transesophageal Doppler Analysis of Coronary Sinus Flow: A New Method to Assess the Severity of Tricuspid Regurgitation

Our aim was to assess the differences in the Doppler flow pattern of the coronary sinus (CS) in patients without tricuspid regurgitation (TR) and with mild (Mi), moderate (Mo) or severe (Se) TR. For this purpose, 35 patients without TR and 70 patients (mean age 57 ± 8 years, 57% males) with different degrees of TR (27 Mi, 14 Mo, 29 Se) underwent a prospective study in which the Doppler flow pattern of the CS obtained by transesophageal echocardiography was analyzed. Adequate Doppler signals of the CS were obtained in 22 (63%) patients without TR and in 50 (71%) patients with TR (18 Mi [65%], 10 Mo [73%], 22 Se [75%]). The CS flow was analyzed by TEE in a transverse plane, showing its drainage into the right atrium, close to the tricuspid valve. All patients without TR or with Mi TR showed a typical CS Doppler flow pattern with 2 waves, a late systolic one and another diastolic with larger amplitude and velocity. When we analyzed those patients with Se TR, the late systolic flow became reversed (retrograde) and a Color-Doppler turbulent flow in the CS was found in 96% of them. This reversed systolic wave (RSyW) was also found in 50% of the patients with Mo TR, all of them with eccentric regurgitation jets. The sensitivity (SE), specificity (SP) and diagnostic accuracy (DA) of the presence of a RSyW in the CS for the diagnosis of severe TR was 95%, 82% and 81% respectively. In conclusion, significant TR modifies the CS flow pattern assessed by transesophageal echocardiography. The presence of a reversed systolic flow in the CS can be a new sign with good SE, SP and DA in the diagnosis of severe tricuspid regurgitation.

Growth pattern of the maxillary sinus in orang-utan based on measurements of CT scans.

The postnatal growth of the maxillary sinus was analyzed in 20 male and 20 female skulls of orang-utan (Pongo satyrus borneensis) in 5 age steps. Coronal CT scans were carried out of all skulls using a computed tomograph Siemens SOMATOM DR. The distances between the CT scans were always 4 mm. The outline of the maxillary sinus was surrounded on the CT scans with a planimeter and then the volumes were calculated. Using a growth model introduced by Fanghänel (1974), growth functions for the volume measurements for male and female animals were calculated separately. The growth curves showed a particular course, which was characterized by a quick rise until the age of 15 years. After the age of 20 years the curves for females orang-utan became gradually flat. At the age of 21 to 23 years the confidence intervals of the growth curves for male and female orang-utan began to drift apart, indicating the appearance of a sexual dimorphism. Using the basicranial length as an indicator of skull size, it becomes evident, that the sexual difference in the maxillary sinus' volume is probably based on the fact, that the maxillary sinus' volume of the male orang-utan increases further on following a common growth pattern.

Investigations on the growth pattern of the maxillary sinus in Japanese human fetuses.

The growth pattern of the maxillary sinus was analyzed using 18 human fetuses of both sexes between 9 and 21 weeks of age postconception. The paraffin embedded specimens were cut in series in the frontal and the transversal plane, respectively. The inner surface of the maxillary sinuses was redrawn and surrounded with a digitizer and then the volumes were calculated. A correlation analysis as well as a simple linear regression analysis between the values of the maxillary sinus, different linear values of the nasal cavity and the crown-rump length (CRL) served to prove possible growth relations. The maxillary sinus' Anlage was already identifiable in the 29.8 mm (CRL) fetus. From this first appearance, the maxillary sinus expands not only in posterior direction but also in anterior direction from 11 weeks onwards. The maxillary sinus volume increased from 0.0008 mm3 at the age of 9 weeks to more than 9 mm3 at the age of 21 weeks. The results of the statistical analysis indicated, that the relationship between the maxillary sinus' Anlage and the nasal cavity were strongly influenced by the body size (CRL). This study suggests, that the growth of the maxillary sinus follows special regularities in the early fetal development.

Quantified comparison of frontal sinus patterns by means of computed tomography

The observation of frontal sinus patterning is a well-established technique of personal identification in forensic anthropology. Variations in size, shape, symmetry, border outline, and the presence and number of septa and cells are compared using antemortem and postmortem radiographs. Traditionally, a standard frontal view is utilized. Computed tomography produces contiguous radiographic images of the cranium at predetermined increments. Multiple comparisons of the sinus configuration can therefore be made at different levels. The use of different ‘window’ settings (attenuation coefficient ranges) for the production of CT scans is discussed. A scoring system is described for the precise and quantified comparison of frontal sinuses in antemortem to postmortem CT scans. The application of these procedures to actual cases is described.

Morphological analysis of yolk sac tumor.

Morphological analysis of imprint histology and cytology was performed in 7 patients with yolk sac tumor (YST). As a result, histological figures of YST were classified into 4 patterns. Endodermal sinus pattern was most frequently identified, followed by polyvesicular vitelline pattern. Imprint cytology findings of YST were also classified into 4 patterns. Cuboidal cells were most frequently observed; cells and nuclei were both cuboidal in shape and 25-40 mu and 20-25 mu in diameters, respectively. The chromatic showed fine to coarse granular patterns. The nuclear cytoplasmic (N/C) ratio was 50-70%, and each nucleus contained one to four nucleoli. Next to cuboidal cells, spindle-shaped cells were frequently noticed; 20-40 mu in size with spindle-shaped nuclei 10-20 mu in diameter and fine to coarse granular chromatic pattern. Naked cells and bizarre cells were also noticed. It was postulated that cuboidal cells and spindle-shaped cells were originated from the endodermal sinus pattern and the loose reticular pattern of YST, respectively. When utilized with rapid-frozen specimens, imprint cytology of YST is sufficient for rapid diagnosis during operations.

Radiographic Identification by Mastoid Sinus and Arterial Pattern

A skull and some incomplete postcranial remains were discovered in two searches over a two-month period near Santa Fe, New Mexico. The discoveries could be demonstrated to be from the same person, and the remains were shown to be consistent with a specific missing person on the basis of anthropological analysis. Further work led to a positive identification on multiple grounds, including agreement of the details of the mastoid sinus and endocranial arterial patterns observed radiographically. These features may be useful for establishing positive identification from skeletal remains when antemortem radiographic studies for comparison are limited to lateral cranial vault studies.

Evidence for a dual pattern of cranial venous sinuses on the endocranial cast of Taung (Australopithecus africanus).

According to published accounts, an enlarged occipital-marginal sinus system is absent in Australopithecus africanus, although it occurs in high frequencies in A. robustus, A. Boisei, and Hadar hominids commonly designated A. afarensis. In this report, we describe, for the first time, an enlarged occipital-marginal sinus system on the endocranial cast of the Taung specimen, which is part of the holotype of A. africanus. In addition, well-developed right transverse and sigmoid sinuses are represented on the Taung endocast. The various components of the dual venous sinus system on the Taung endocast are measured, and the system is compared to those of other fossil hominids. The compresence of a lateral sinus system and enlarged occipital and marginal sinuses occurs in two Hadar specimens, 2 specimens of A. robustus crassidens, 1 A. boisei specimen, and several early H. sapiens crania. Hence, the presence of strong transverse sinus impressions in a fragmentary specimen may not be interpreted as an indication that an enlarged occipital-marginal sinus system was not present in the original specimen. Conversely, lack of transverse sinus grooves in a fragmentary specimen does provide indirect evidence than an enlarged occipital-marginal system would probably have been present in the whole specimen, as in 2 specimens of A. boisei. Including Taung, enlarged occipital and marginal sinuses occur in 1 out of 5, or 20%, of A. africanus specimens. This figure compares well with the range of mean frequencies in modern human cranial series (1.5 to 28%), but is much lower than are the frequencies for A. boisei, A. robustus, and the Hadar hominids.(ABSTRACT TRUNCATED AT 250 WORDS)

Classification system of frontal sinus patterns by radiography. Its application to identification of unknown skeletal remains

Frontal sinuses of Japanese skulls were radiographically examined from the view point of identifying individuals. The system of classification of sinus was proposed, basing on the area size, the bilateral asymmetry, the superiority of side, the outline of upper borders, the partial septa and the supraorbital cells. Frontal sinus patterns could be divided into above 20,000 possible combinations by combining the class numbers in each classification item described above. The frontal sinus pattern of a given person was formulated as a code number which was determined by arranging the class numbers in each classification item as serial numbers. This identification system by the frontal sinus pattern should allow one to characterize each person. The application of this identification system to an actual criminal case was also described.

Vagal control of pacemaker periodicity and intranodal conduction in the rabbit sinoatrial node.

Effects of brief vagal bursting on pacemaker periodicity and intranodal conduction were studied by recording transmembrane potentials in isolated rabbit sinoatrial preparations. Postganglionic vagal terminals were activated by applying brief (50- to 150-msec) trains of pulses (duration, 100 mu sec; frequency, 200 Hz) to the endocardial surface of the node. Sympathetic effects were prevented by superfusion with Tyrode's solution containing propranolol (1 microgram/ml). Vagal trains applied singly every 10 seconds produced brief hyperpolarizations in "true" pacemaker and transitional cells, and induced phasic changes in periodicity and conduction. These changes were out of phase with each other, and were dependent on the magnitude and duration of the vagal train, as well as on its position within the pacemaker period. When similar trains were applied repetitively at cycle lengths (200-1200 msec) that were independent of the pacemaker period, complex patterns of vagus-sinoatrial node interactions resulted. Hence, depending on the vagal stimulus cycle length, the sinoatrial pacemaker was forced to beat at stable and predictable harmonic (i.e., 1:1, 1:2, 2:1, etc.), subharmonic (3:2, 4:3, etc.), or more complex entrainment ratios. At some of these ratios, arrhythmic sinus patterns coexisted with intranodal conduction disturbances, including first- and second-degree block, Wenckebach phenomena, or combinations thereof. At other entrainment ratios, arrhythmias occurred in the absence of conduction changes. At still other ratios, conduction disturbances developed in the presence of apparently undisturbed sinus rhythm. These results provide insight into the mechanism of the dynamic vagal control of sinoatrial periodicity and conduction, and may have clinical implications as well.

Variation in the pattern of cranial venous sinuses and hominid phylogeny.

In 1967 Tobias noted that Australopithecus boisei cranium O.H.5 exhibited a cranial venous sinus pattern in which the occipital sinus and the marginal sinuses of the foramen magnum appeared to have replaced the transverse-sigmoid sinuses as the major venous outflow track. Specimens of A. robustus and several more recently recovered A. boisei crania also show evidence of enlarged occipital-marginal sinuses. In contrast, A. africanus and H. habilis retain a dominant transverse-sigmoid system that characterizes the great majority of extant apes and modern human cadaver samples. Pliocene A. afarensis exhibits a high frequency of occipital-marginal drainage systems. An examination of several series of precontact North American Indian crania shows that the frequency distribution of the occipital-marginal sinus pattern is spatiotemporally disjunct , ranging from 7.5% to 28%. The Late Pleistocene sample from P redmost , Czechoslovakia, also shows a very high incidence of occipital-marginal sinus patterns (approximately 45%). These observations suggest that occipital-marginal and transverse-sigmoid sinus patterns are adaptively equivalent character states. This conclusion is supported by the fact that enlarged occipital-marginal and transverse-sigmoid sinus systems often coexist on the same and/or contralateral sides of the head. It is well known that the frequencies of such adaptively neutral traits are often heavily influenced by population-specific epistatic interactions. The utilization of such traits in phylogenetic reconstruction entails a substantial risk of mistaking parallelism for synapomorphy . It is concluded that using functional-adaptive criteria in the definition of morphologic characters is a more reliable method to guide phylogeny reconstruction. In light of this, the distribution of venous sinus variants in Plio -Pleistocene hominids gives little or no basis for revising the phylogenetic scheme of Johanson and White (1979), or the functional-adaptive interpretation offered by White et al. (1981).

Malignant histiocytosis and related tumors. A clinicopathologic study of 42 cases using cytological, histochemical and ultrastructural parameters.

Light and electron microscopical, immunohistochemical and clinical characteristics in 42 cases of malignant neoplasms, arising from true histiocytes, are described. These were separated in a lymphoma-like subtype, called true histiocytic lymphoma (29 patients) and a disseminated variant, called malignant histiocytosis (9 patients). In addition 4 related histiocytic tumors are discussed, including 2 tumors arising from interdigitating cells. Sinus pattern and cytologic features, especially 'window' nuclei, are emphasized as diagnostic criteria. Erythrophagocytosis was not a constant finding. Electron microscopic features, presence of acid phosphatase, acid alpha-naphthylacetate esterase, lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, Ia-antigen and absence of B- and T-cell markers, were important in establishing the histiocytic nature or excluding a non-histiocytic tumor. A distinct male predominance existed (male:female = 2.5:1) with a higher relapse free period in females (p = 0.032). A high number of mitotic figures appeared to be a favourable sign, p = 0.020 and 0.019, for remission rate and relapse free period respectively. The degree of cell differentiation and the immunohistochemical pattern did not show a correlation with remission and relapse free period. Extranodal involvement and the presence of short profiles of endoplasmic reticulum were prognostically unfavourable signs. True histiocytic lymphomas showed a higher remission rate (p = 0.041) and relapse-free period (p = 0.017) than malignant histiocytosis.

CT scanning in rhinocerebral mucormycosis and aspergillosis.

Patients with rhinocerebral mucormycosis and rhinocerebral aspergillosis had computed tomography (CT) as well as other studies. Characteristic sinus involvement was demonstrated by CT and conventional tomography, but the latter produced a better image of bone destruction. CT was clearly superior in demonstrating orbital involvement, the most common of which included lateral displacement of a thickened medial rectus muscle, increased density of the orbital apex, and often enlargement of the optic nerve. Orbital venography and carotid arteriography were diagnostically helpful. Recognition of the characteristic pattern of sinus and orbital involvement should be helpful in leading to early biopsy and treatment.

The endodermal sinus tumor: special features.

Eight cases of endermal sinus tumor, two extragonadal and six gonadal, seen at the American University of Beirut are reviewed. Three of them present special clinical and pathologic features that further substantiate the extraembryonic origin of this teratoid tumor and its association with dysgenetic gonads. We consider the two histologic types, endodermal sinus pattern and polyvesicular vitelline architecture, to be part of the same tumor. The prognosis in this series was unfavorable.

Gonadal and extragonadal yolk sac carcinomas: a clinicopathologic study of 14 cases.

Fourteen cases of yolk sac carcinoma, 10 occurring in gonadal, and four in extragonadal sites, seen at the Indiana University Hospitals from 1949 to 1974, were analyzed with respect to pathologic features, laboratory findings, and clinical course. Their histologic appearance was similar regardless of the site of origin. Two basic histologic types were observed--the more common endodermal sinus pattern and the rare polyvesicular vitelline form. The prognosis is unfavorable, but three of our cases exhibited objective responses to chemotherapy. In our small series, the better prognosis of testicular yolk sac carcinomas in children found by some authors was not evident. Four of the 6 patients with yolk sac carcinoma in which serum alpha-fetoprotein determinations were performed showed positive results. Three of these cases had residual or metastatic disease clinically. The demonstration of alpha-fetoprotein in the serum of patients with yolk sac carcinoma lends further support to the yolk sac origin of these tumors and could also prove to be of prognostic value by indicating the presence of residual or recurrent disease.

Concealed Extrasystolic Ventricular Bigeminy with Interpolation

The first reported case of concealed extrasystolic ventricular bigeminy with interpolation is described. This arrhythmia is characterized by the presence of both interpolated ventricular extrasystolic beats and a presumed persistent and continuous bigeminal ectopic rhythm with exit block. The distributional pattern of sinus conducted beats in the present case conforms to a formula defining this unusual disorder of rhythm, while the appearance of manifest ectopic beats follows the rule of bigeminy.