Sinus Length Research Articles

Kidney Dimensions at Sonography are Correlated With Glomerular Filtration Rate in Renal Transplant Recipients and in Kidney Donors

The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). For practical reasons, renal function is often evaluated from serum creatinine (S Cr) or cystatin C (S Cys), and GFR is predicted from SCr. Ultrasound scanning of the kidneys is used only to evaluate renal morphology. The aim of this study was to evaluate the relationship between sonographic renal dimensions and GFR in renal transplant recipients and in kidney donors. GFR (urinary clearance of 99mTc-DTPA), S Cr, and S Cys were measured in 33 donors (28 females [F], 5 males [M]; SCr, 0.81–1.90 mg/dL) and 30 recipients (8 F, 22 M; SCr, 0.96–2.42 mg/dL). GFR was also predicted using the Cockcroft and Gault (CG) formula and with the simplified Modification of Diet in Renal Disease (MDRD) formula. Length, width, and depth of kidneys and renal sinus were measured using renal sonography. Among sonographic measurements, kidney length showed the best correlation with GFR. A closer correlation with GFR was found in donors ( r = 0.639; P < .00007) than in recipients ( r = 0.511; P < .005). In either case, the correlation of kidney length with GFR was greater than that of S Cr or S Cys, and similar to that of CG or MDRD GFR. Accuracy of kidney length as an indicator of GFR impairment was not statistically different from laboratory tests. Only in donors did CG show better accuracy. In conclusion, renal dimensions at sonography closely correlated with GFR. Thus, renal sonography can give information also on the function of the renal graft and of the remaining kidney of living donors.

Use of shape to distinguish Chamelea gallina and Chamelea striatula (Bivalvia: Veneridae): Linear and geometric morphometric methods

The commercially fished striped venus clams Chamelea gallina and C. striatula (Bivalvia: Veneridae) are difficult to distinguish by inexperienced observers and the taxonomy of these species is still an issue of discussion. The differences in shape between C. gallina and C. striatula from Portuguese coastal waters were studied through conventional linear and geometric morphometric analysis, using both contour (elliptic Fourier analysis) and landmark-based methods. The relationships shell length vs. height, width, and total weight were significantly different between species. However, because there was a considerable overlap in the data sets, the species could not be distinguished using any combination of those linear measurements. Geometric morphometric methods provided shape variables that led to 0-6% misclassification rates between species; linear morphometric measures led to 16.8% error. Contour analysis revealed differences primarily in the shell umbo and lunular area. The umbo was more "sharp" and the lunula less pronounced in C. striatula than in C. gallina. Generalized procrustes superimposition (landmark analysis) showed that the main differences between species reside in the length of the pallial sinus. Thus, an index was developed (PI: Pallial Index = pallial sinus length/shell length), which was successfully used to separate the species (with 100% correct classification), i.e., specimens with PI lower than 0.119 belonged to C. gallina, whereas greater PI values were attributed to C. striatula. The use of these geometric morphometric methods allowed the detection of differences in shape between these two species and to develop an easy-to-use identification index. We encourage the development of analogous indices that apply the methods of geometric morphometrics to distinguish between other species whose identification is complicated.

Prospective Evaluation of Feminizing Genitoplasty Using Partial Urogenital Sinus Mobilization for Congenital Adrenal Hyperplasia

We present our experience with partial urogenital sinus mobilization in girls with congenital adrenal hyperplasia, with particular attention to vaginal caliber, introitus position, urinary continence and genital appearance. We present data on a prospective evaluation of 24 girls with congenital adrenal hyperplasia who underwent feminizing genitoplasty using urogenital sinus mobilization with preservation of the pubourethral ligaments during a 4-year period. Urogenital sinus length determined by cystoscopy and degree of external genitalia virilization, defined according to Prader classification, were evaluated before reconstruction. At followup patients were examined while under sedation for evaluation of overall external genitalia cosmesis and calibration of the vagina. Urinary continence status and voiding efficiency were assessed clinically in toilet trained patients by voiding diary, and measurement of bladder capacity and post-void residual by ultrasound. Patient age at operation ranged from 1 to 16 years (median 28.5 months), with a mean followup of 25 months (8 to 47). Degree of virilization was Prader type III in 3 children (12.5%), type IV in 16 (66.7%) and type V in 5 (20.8%). Urogenital sinus length was 2.5 cm or less in 17 children. Cosmetic results were good in 21 patients (87.5%) and satisfactory in 3 (12.5%). The vaginal and urethral openings were separate and identified at the surface of the vestibule in 21 girls. Adequate caliber of the mobilized vagina was achieved in 23 patients (95.8%). None of the 20 toilet trained children had urinary incontinence or recurrent urinary tract infections, with normal bladder emptying in 18 and small post-void residual in 2 (10%). Urinary continence and excellent cosmetic appearance with adequate exteriorization of the vaginal and urethral openings can be achieved in most children with urogenital sinus anomaly treated with partial urogenital sinus mobilization.

COMPUTED TOMOGRAPHIC EVALUATION OF ANATOMIC AND PATHOLOGIC VARIATIONS IN THE FELINE NASAL SEPTUM AND PARANASAL SINUSES

The purpose of this study was to compare the prevalence of nasal septal deviation and variations of the paranasal sinuses in normal and diseased cats. Prevalence of nasal septal deviation was 86.7%, 68.4%, and 71.4% in cats with rhinitis, neoplasia, and normal cats, respectively, with no statistically significant difference (P = 0.244). There was a statistically significant difference (P = 0.01) in the magnitude of nasal septal deviation between cats with and cats without nasal disease, using a cutoff value of 1 mm for maximum distance of deviation from midline. There was a statistically significant difference (P = 0.019) between cats with rhinitis and neoplasia when comparing the presence of a mass (7.7% and 53.8%, respectively), but not when comparing for lysis of the septum. Deviation of the frontal sinus septum occurred in 27.7% of all cats, while the sphenoid septum was oblique and eccentric in 96.6% of all cats. The mean length of the frontal sinus was longer in male cats than female cats. The presence of nasal septal deviation alone cannot be used as a criterion to diagnose nasal disease, but cats with rhinitis or neoplasia have more marked deviation than normal cats. The presence of a mass and lysis of the septum were only seen in cats with nasal disease and a mass is more likely to be seen with neoplasia than rhinitis. Male cats have a longer frontal sinus than female cats. Almost all cats have an oblique, eccentric sphenoid septum.

A New Classification for Genital Ambiguity and Urogenital Sinus Anomalies

The surgical management of children born with genital ambiguity and urogenital sinus anomalies is difficult and at times controversial. In attempting to describe the genitalia of such a patient, paediatric urologists have focused on the degree of masculinization, the length of the urogenital sinus, and the confluence of the reproductive tract and the urinary tract. Prader’s classification has been used to describe the degree of masculinization, and others have described the urogenital confluence as being either ‘high’ or ‘low’ [1,2].

A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor.

This study measured maxillary sinus volume as an aid in determining graft bone volume before grafting of the maxillary sinus floor. Maxillary sinus size was measured in 32 cadavers (59 sinuses) using casts of the maxillary sinus made using dental impression material. Anteroposterior length, height, width, and volume of the maxillary sinus (mean+/-SD) were 30.1+/-5.65 mm, 34.6+/-7.71 mm, 25.4+/-5.71 mm, and 11.3+/-4.60 cm3, respectively. When the sinus-lift procedure was simulated, inferior sinus volumes (mean +/- SD) were 3.51+/-1.23 cm3 for a 15-mm lift and 5.66+/-1.71 cm3 for a 20-mm lift. In bone grafting of the maxillary sinus floor, taking into consideration individual differences in maxillary sinus volume and resorption of the grafted bone, 4.74 cm3 or more of the graft is required for a 15-mm lift, and 7.37 cm3 or more is required for a 20-mm lift.

Formation and Enlargement of the Paranasal Sinuses in Normal and Cleft Lip and Palate Human Fetuses

Comparisons of paranasal sinus morphology between humans with and without cleft lip and palate (CLP) have yielded conflicting opinions regarding size differences. Although postnatal samples have been investigated, no studies have compared paranasal sinus volumes between cleft and noncleft human fetuses.The nasal cavities of 20 'normal' and 9 CLP human fetuses (8-21 weeks' postmenstrual age) were examined to assess prenatal volumetric changes of the maxillary sinuses, anterior and posterior ethmoidal air cells, and sphenoidal sinuses. Lengths and volumes of right and left maxillary and sphenoidal sinuses were calculated from histologically prepared sections using a computer reconstruction technique, and regression equations were generated to assess the enlargement rates.All paranasal sinuses were found among both normal and CLP specimens in the same locations and in similar age ranges. However, greater shape asymmetry was noted for all sinuses in CLP compared to normal specimens. In the normal sample, results indicated significant (p < .05) correlations between right or left maxillary sinus length (R2 = 0.49, 0.54) and volume (R2 = 0.67, 0.68), and increasing postmenstrual age, but no significant (p > .05) correlations were observed for right or left sphenoidal sinus length or volumes and postmenstrual age. Maxillary sinus length changes were best described by second-order polynomial regression equations, and volume changes were best described by logarithmic equations. When individual right or left sinuses of CLP specimens were compared to the mean of the normal sample, one maxillary sinus was significantly (p < .05) larger, and 9 maxillary sinuses were not significantly (p > .05) different. Sphenoidal sinus lengths and volumes of CLP specimens were within the same range compared to these dimensions for the normal sample.Results on normal specimens indicate that maxillary sinuses exhibit second-trimester length and volume increases, whereas sphenoidal sinuses are more variable. This study suggests a similar timing of sinus formation in normal and CLP fetuses, but shape asymmetries are frequently detected among CLP specimens. In particular, the sphenoidal sinuses may be altered in shape and size by adjacent, hypertrophic cartilaginous structures in CLP fetuses. These results indicate that the maxillary sinuses of CLP fetuses are not deficient in size compared to noncleft fetuses.

Mechanical effects of vasoactive drugs on carotid sinus.

Carotid sinus diameter (CSD) is influenced by changes in sympathetic tone and vasoactive agents. This study was designed to determine which mechanical properties of the carotid sinus region were influenced by infusing vasoconstrictors (epinephrine, 4.56 X 10(-6) M, and phenylephrine, 9.85 X 10(-5) M) and a vasodilator (nitroprusside, 1.68 X 10(-4) M). CSD, carotid sinus length (CSL), pressure (CSP), and compliance (CSC), and arterial pressure were all recorded simultaneously from the isolated constant-flow-perfused carotid sinus region of 11 anesthetized dogs (35 mg/kg pentobarbital sodium) before and after drug perfusion. CSC was measured by a method previously described in which 13 microliters of perfusate is injected into the segment in a step-like manner and the resultant step change in pressure recorded. The compliance of the vessel segment is read on-line after a calibration procedure. CSD and CSL were measured using sonomicrometer length gauges positioned across and along the length of the carotid sinus segment. At a CSP of 99.9 +/- 0.6 (SE) mmHg, CSD, CSL, and CSC were 8.50 +/- 0.44 mm, 9.44 +/- 0.84 mm, and 0.46 +/- 0.05 microliter/mmHg, respectively. Decreasing CSP to 50 mmHg significantly reduced CSD and CSL and increased CSC. Increasing CSP to 150 mmHg produced opposite results. Vasoconstrictor drug infusion significantly decreased and vasodilator drug infusion significantly increased both CSD and CSL, producing parallel shifts in the CSP-CSD and -CSL curves toward and away from the pressure axis. The shift to new pressure-volume curves resulted in no change in CSC in response to the vasoactive agents.

Neuroendocrine plexus in the pericardial septum of the stable fly, stomoxys calcitrans (L.) (diptera : muscidae)

An ultrastructural study of the pericardial septum (dorsal diaphragm) of the stable fly revealed that it consists of a central band of longitudinal muscle fibers upon which the paired alary muscles attach. A new neurohemal site was discovered that extends the length of the pericardial sinus. The neurosecretory axons terminating in this site originate from the segmental nerves. These nerves are also the source of axons that form 4 morphological types of neurosecretomotor junctions with the longitudinal muscle of the pericardial septum. Since the heart of the stable fly is myogenic, the neurohormones released into this septum may modulate the activity of the heart and/or be available for circulation to other sites of activity in this insect.

Two-dimensional echocardiographic assessment of right ventricular volume in children with congenital heart disease

The ability of 2-dimensional echocardiography to measure right ventricular (RV) volume and ejection fraction was assessed in 22 children with congenital heart disease. From the apical 4 chamber 2-dimensional echocardiographic image, the long-axis length of the right ventricle was measured and the area planimetered. On the anteroposterior and lateral cineangiocardiographic planes, the right ventricle was separated into 2 parts: RV sinus and outflow tract. The longest length, inflow tract length, and area of the sinus were measured from biplane cineangiographic views. The echographic long-axis length correlated well with the longest length of the RV sinus measured from both anteroposterior and lateral cineangiographic views at both end-systole and end-diastole. Moreover, the echographic area correlated well with the sinus area obtained from both cineangiographic views. From these regression analyses, the echographic long axis length and area were corrected to the angiographie longest length and area of the sinus. The new corrected echographic longest length and area were applied to 3 formulas (2 biplane and 1 uniplane) to calculate the sinus volume of the right ventricle. Total RV volume was then derived from the sinus volume. RV volumes and ejection fraction determined by 2-dimensional echocardiography were compared with those obtained from biplane cineangiography using Simpson's rule method. All formulas tested predicted RV volumes and ejection fraction with equal accuracy. Thus, 2-dimensional echocardiography can assess RV volume and ejection fraction in children with congenital heart disease.

The microvascular architecture of spleen in congestive splenomegaly: A morphological-histometric study

Summary Spleens obtained from patients suffering from chronic active hepatitis, hepatic cirrhosis, idiopathic portal hypertension and splenic vein thrombosis have been subjected to morphological observation associated with histometrical analysis and compared to 3 control spleens surgically removed for trauma. All the pathological spleens show the picture of congestive splenomegaly. Moreover, in chronic active hepatitis small non-specific granulomas are observed in the red pulp, along with lymphocytic-plasma cellular sheaths surrounding the terminal arterial branches. The latter are also encountered, less frequently, in liver cirrhosis. In idiopathic portal hypertension the presence of arteriolar-sinusal shunts can be emphasized. The stereology of the same spleens shows in chronic active hepatitis, and more markedly in liver cirrhosis, higher values of sinus length and a lower mean sectional area of the sinuses in comparison with controls. In idiopathic portal hypertension the sinusal length is also greater and the mean sinusal sectional area is lower. However, comparison of the statistical with the geometric determination of the external surface area of sinuses allows us to hypothesize that there is a rich interconnection between sinuses in liver cirrhosis, but not in idiopathic portal hypertension. In the latter spleens the statistical and geometrical determinations show values quite similar to each other, as well as in control spleens, in spite of the important structural rearrangement presented here. In splenic vein thrombosis the histometric findings are consistent with sinus dilatation. The microvascular architecture of red pulp, especially when studied with histometric methods, shows characteristic features in idiopathic portal hypertension which permit us to separate this form of congestive splenomegaly from all the others examined.

The electrophysiological effects of delta-9-tetrahydrocannabinol (cannabis) on cardiac conduction in man

Electrophysiologic studies were performed in six patients before and after administration of 25 mcg./Kg. of intravenous delta-9-tetrahydrocannabinol (Δ-9-THC). The mean±SEM sinus length was 785±76 msec. prior to and 563±42 msec. after THC (p<0.01). The mean sinus node recovery and maximum sinus node recovery times were respectively 943±84 msec. and 1060±99 msec. before and 617±40 msec. and 690±49 msec. after THC (p<0.005 and <0.005). Mean calculated sinoatrial conduction time was 77±8.9 msec. before and 56±9.7 msec. after THC (p<0.005). Mean A-H intervals during sinus rhythm before and after THC were 81±5.4 and 71±4.9 msec., respectively (p<0.02), and 118±17.2 msec. and 78±9.3 msec. at equivalent driven cycle length (p<0.05). The mean paced atrial rates producing second degree block proximal to the His bundle before and after THC were respectively, 163±17 and 188±9.4 beats/minute (p<0.05). Mean A-V nodal effective and functional refractory periods at equivalent driven cycle length were respectively 367±46.4 msec. and 433±43.9 msec. before and 285±25.6 msec. and 368±32.8 msec. after THC (p<0.025 and <0.02). Mean H-V interval was 39±4.3 msec. prior to and 38±4.5 msec. after THC (NS). In conclusion, Δ-9-THC produces a potent effect on the heart, probably centrally mediated through the autonomic nervous system, with markedly enhanced sinus automaticity and facilitation of sinoatrial and A-V nodal conduction. The clinical significance (therapeutic or deleterious) of these pharmacological effects needs further evaluation.

Splenomegaly and red blood cell destruction: a morphometric study on the human spleen.

In looking for morphologically determinable characteristics of hypersplenism a quantitative analysis of histological and cytological splenic structures with cardiac and portal congestion, splenic vein thrombosis and hereditary spherocytosis was carried out. The centre of the investigation was the red pulp, which with its complexly structured sinus and pulp cord system, richly equipped with actively phagocytic cells, represents the main scene of normal and pathologically increased intrasplenic blood cell destruction. The following structures were quantitatively recorded: percentage volume proportion and total volume of red pulp, white pulp, trabeculae and blood vessels; percentage volume proportion and total volume of sinus, pulp cords and capillaries. We also calculated the length, the mean sectional area and the mean surface area of the sinus system. Finally we determined the sinus lining cell, reticular cell, macrophage and blood monocyte content of the red pulp. We came to the following results : 1. a) With increased destruction of normal blood cells resulting from impairment of venous blood flow in the portal vein and splenic vein areas, the volume of the red pulp is increased primarily as a result of considerable enlargement of the sinus volume compared to the norm. Here the mean sinus sectional area mostly becomes smaller, but the total sinus length is increased by as much as 14 times the norm. The lengthening of the sinus system is based not so much on a stretching of pre-existent sinus as on a new formation of mostly very narrow sinus branches and anastomoses. The number of sinus lining cells per cm2 of the sinus surface is decreased, possibly as a result of a discrepancy between new sinus constructions and sinus lining cell proliferation. The total number of actively phagocytic splenic cells, particularly reticular cells in the pulp cords, is considerably higher. b) Increased intrasplenic destruction of abnormal blood cells, e.g. in hereditary spherocytosis, leads to a widening and increase of the pulp cords, a lengthening of the sinus system and an increase of phagocytically active cells as well as hyperplasia of the sinus lining cells. 2. The quantitative morphological findings produce the following functional interpretations : The volume increase of red pulp means an often considerable expansion of the storage capacity of the spleen for blood cells. The blood circulation becomes slower as a result of the great anastomisation of the sinus system, which again leads to disturbance of the flow properties of the blood. The blood cells form aggregates and remain in the pulp cords, where they become conditioned by the very unsuitable metabolic circumstances for phagocytosis by the numerous reticular cells.

Histometrical studies of the spleen in Banti's syndrome with reference to clinicopathologic correlations.

Histometrical determinations of volume ratio of splenic sinus, the mean breadth of splenic cords and the mean sectional area of sinuses were described. The above quantities were estimated of spleens in Banti's syndrome in comparison to other conditions of the organ. Banti spleens could be characterized by small values of the mean sinus sectional area. The total sinus length was increased. The condition corresponded to sinus hyperplasia. Distinct correlations were con-firmed between the mean sectional area of splenic sinus and hepatic lesions, portal pressure, splenic weight, esophageal varices, leukocyte and platelet counts of peripheral blood. The development of Banti spleens was discussed on the basis of the histometrical results.