The Enlarged Fibroid Uterus: Aberrant Arterial Supply via the Omental Artery.

Uterine artery embolization is considered a first-line therapy for symptomatic fibroids and is occasionally required to mitigate operative risk prior to total abdominal hysterectomy or myomectomy. We present a pictorial review of parasitized omental artery supply to the enlarged fibroid uterus in three patients undergoing preoperative uterine artery embolization. A detailed understanding of variant uterine blood supplies is crucial when performing fibroid embolization. Although omental artery supply to the fibroid uterus is an unusual finding, aortography to include mesenteric arteries may be necessary when anomalous blood supply to the enlarged fibroid uterus is suspected.

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

Coronary artery plaque burden and calcium scores in healthy men adhering to long-term wine drinking or alcohol abstinence.

Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9 ± 7.3 years (means ± SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥ 50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4 ± 362.2 vs 122.0 ± 370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9 ± 387.7 kcal/day while abstainers consumed 1836.0 ± 305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9 ± 10.9 vs 39.5 ± 9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6 ± 18.2 vs 118.4 ± 29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.

Baseline imaging after therapy for unprovoked venous thromboembolism: a randomized controlled comparison of baseline imaging for diagnosis of suspected recurrence.

BACKGROUND: After a first unprovoked venous thromboembolism (VTE), many patients have residual pulmonary and/or lower limb vascular obstruction following completion of short-term anticoagulation. Residual vascular obstruction may complicate the diagnosis of recurrent VTE. Whether baseline imaging, conducted after completion of anticoagulation, helps in interpreting diagnostic testing in patients who subsequently have suspected recurrent VTE is unknown. STUDY DESIGN: The REVERSE study is a cohort study whose primary aim was to derive a clinical decision rule to guide the duration of anticoagulation after a first unprovoked VTE. All patients underwent baseline imaging after completing 5-7 months of anticoagulant therapy. We performed a post hoc randomized controlled comparison among 121 patients investigated for a suspected recurrent VTE during follow-up: the decision on recurrent VTE with or without baseline imaging was made available to two independent adjudicators. RESULTS: The proportion of patients not classifiable for recurrent VTE was statistically significantly higher in the group with no baseline imaging than in the group with baseline imaging: one in five as compared with one in 25. The interobserver agreement between the two adjudicators was better in the group with baseline imaging than in the group with no baseline imaging: κ-values were 0.78 and 0.54, respectively. CONCLUSIONS: In patients with a first unprovoked VTE, baseline imaging at completion of anticoagulant therapy helps in interpreting diagnostic tests performed in cases of suspected recurrent VTE.

MRI detection of a female pelvic arteriovenous fistula after hysterectomy: treatment with superselective coil embolisation.

We present a rare case of acquired pelvic arteriovenous fistula of the uterine vessels in a woman with a remote history of hysterectomy who presented with chronic pelvic and left limb pain. It was successfully treated by coil embolisation of the left uterine artery. The MRI and angiographic features are described, together with the current management and a review of literature.

Duplex features of vein graft stenosis and the success of percutaneous transluminal angioplasty.

PURPOSE: To determine if criteria exist that are correlated to a successful outcome after balloon angioplasty for vein graft stenosis. METHODS: During a 5-year period, duplex surveillance of 380 infrainguinal vein bypasses identified 76 hemodynamically failing grafts (87 stenoses) requiring intervention. Percutaneous transluminal angioplasty (PTA) was selected over surgical repair based on 3 criteria: time interval from primary grafting procedure, vein graft diameter, and stenosis length. The 28 (32%) stenoses (20 grafts) treated by PTA were used in a retrospective analysis to test if any variables favored a successful outcome. Patient and lesion characteristics, graft patency, and restenosis following PTA were correlated with duplex features of the stenosis recorded prior to, immediately after, and at 3- to 6-month intervals postprocedurally. RESULTS: Lesion characteristics that correlated with a successful outcome were vein size > or = 3.5 mm, lesion length < 2 cm, and appearance > 3 months after surgery. Conduit type, PTA site, patient demographics, and indication for bypass did not correlate with PTA durability. Nineteen lesions in 13 grafts met these criteria (group 1), while 9 stenoses in 7 grafts did not (group 2). Lesion severity based on duplex velocity measurements were similar in both groups before (p = 0.40) and after (p = 0.32) treatment. During the mean 21-month follow-up, group 1 grafts required less intervention (p = 0.035). At last follow-up, hemodynamic changes were durable in group 1 (p = 0.0068) but not in group 2 (p = 0.39). CONCLUSIONS: Selection of vein graft stenoses for treatment by PTA can be based on temporal and duplex data. PTA of short (< 2 cm) stenoses in good caliber veins (> or = 3.5 mm) appearing > 3 months after bypass placement was durable with a late intervention rate of approximately 10%. Direct surgical repair or replacement is recommended for early (< 3 months) and/or long segment stenoses that develop in small caliber conduits.

Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases.

PURPOSE: (a) To identify the prognostic factors that determine survival after surgical resection and irradiation of tumors metastatic to brain. (b) To determine if the prognostic factors used in the recursive partition analysis (RPA) of brain metastases cases from Radiation Therapy Oncology Group (RTOG) studies into three distinct survival classes is applicable to surgically resected and irradiated patients. METHOD: The medical records of 125 patients who had surgical resection and radiotherapy for brain metastases from 1985 to 1997 were reviewed. The patients' disease and treatment related factors were analyzed to identify factors that independently determine survival after diagnosis of brain metastasis. The patients were also grouped into three classes using the RPA-derived prognostic parameters which are: age, performance status, state of the primary disease, and presence or absence of extracranial metastases. Class 1: patients < or = 65 years of age, Karnofsky performance status (KPS) of > or =70, with controlled primary disease and no extracranial metastases; Class 3: patients with KPS < 70. Patients who do not qualify for Class 1 or 3 are grouped as Class 2. The survival of these patients was determined from the time of diagnosis of brain metastases to the time of death. RESULTS: The median survival of the entire group was 9.5 months. The three classes of patients as grouped had median survivals of 14.8, 9.9, and 6.0 months respectively (p=0.0002). Age of < 65 years, KPS of > or = 70, controlled primary disease, absence of extracranial metastases, complete surgical resection of the brain lesion(s) were found to be independent prognostic factors for survival; the total dose of radiation was not. CONCLUSION: Based on the results of this study, the patients and disease characteristics have significant impact on the survival of patients with brain metastases treated with a combination of surgical resection and radiotherapy. These parameters could be used in selecting patients who would benefit most from such treatment.

Biolistic transformation of chrysanthemum with the nucleocapsid gene of tomato spotted wilt virus.

In vitro regeneration and biolistic transformation procedures were developed for several commercial chrysanthemum Dendranthema grandiflora Tzvelev, syn. Chrysanthemum morifolium Ramat. cultivars using leaf and stem explants. Studies on the effect of several growth regulators and kanamycin on chrysanthemum regeneration were conducted, and a step-wise procedure to optimize kanamycin selection and recovery of transgenic plants was developed. A population of putative transformed chrysanthemum plants cvs. Blush, Dark Bronze Charm, Iridon, and Tara, was obtained after bombardment with tungsten microprojectiles coated with the binary plasmid pBIN19 containing the nucleocapsid (N) gene of tomato spotted wilt virus (TSWV) and the marker gene neomycin phosphotransferase (NPT II). PCR analysis of 82 putative transgenic plants selected on kanamycin indicated that the majority of the lines (89%) were transformed and contained both genes (71%). However, some transgenic lines contained only one of the genes: either the NPT II (15%) or the TSWV (N) gene (14%). Southern blot analysis on selected transgenic lines confirmed the integration of the TSWV (N) gene into the chrysanthemum genome. These results demonstrate the development of an efficient procedure to transfer genetic material into the chrysanthemum genome and selectively regenerate transgenic chrysanthemum plants at frequencies higher than previously reported.

Expression of the gene encoding the coat protein of cucumber mosaic virus (CMV) strain WL appears to provide protection to tobacco plants against infection by several different CMV strains.

The gene (cp) encoding the coat protein (CP) of cucumber mosaic virus (CMV) strain WL (CMV-WL, which belongs to CMV subgroup II) was custom polymerase chain reaction (CPCR)-engineered for expression as described by Slightom [Gene 100 (1991) 251-255]. CPCR amplification was used to add 5'- and 3'-flanking NcoI sites to the CMV-WL cp gene, and cp was cloned into the expression vector, pUC18cpexp. This CMV-WL cp expression cassette was transferred into the genome of tobacco (Nicotiana tabacum cv. Havana 423) via the Agrobacterium T-DNA transfer mechanism. R0 plants that express the CMV-WL cp gene were subcloned, propagated, and challenge-inoculated with CMV-WL. Several R0 plant lines showed excellent protection against CMV-WL infection; however, plants found to accumulate the highest CP levels did not show the highest degree of protection. Thus in our case, CP levels appear not to be a useful predictor of the degree of protection. Plants from the best protected CMV-WL cp gene-expressing R0 tobacco lines were also inoculated with CMV strains belonging to the other major CMV subgroup (subgroup I), CMV-C and CMV-Chi, and compared in a parallel experiment with a transgenic tobacco plant line that expresses the CMV-C cp gene. Plants expressing the CMV-WL cp gene appeared to show a broader spectrum of protection against infection by the various CMV strains than plants expressing the CMV-C cp gene.

Protection against detrimental effects of potyvirus infection in transgenic tobacco plants expressing the papaya ringspot virus coat protein gene.

We obtained transgenic tobacco plants expressing the papaya ringspot virus (PRV) coat protein (CP) gene by transformation via Agrobacterium tumefaciens. Expression was effectively monitored by enzyme-linked immunosorbent assays (ELISA) of crude tissue extracts. Subcloned plants derived from eight original Ro transformants were inoculated with potyviruses: tobacco etch (TEV), potato virus Y (PVY), and pepper mottle (PeMV). Plants that accumulated detectable levels of the PRV CP showed significant delay in symptom development and the symptoms were attenuated. Similar results were obtained with inoculated R1 plants. We conclude that the expression of the PRV CP-gene imparts protection against infection by a broad spectrum of potyviruses.

The psychological effects of political repression on Chilean exiles in the U.S.

Interviews with 32 Chilean refugees elicited descriptive findings on the effects of detention and torture and subsequent exile in the U.S. It is suggested that exile for this group constitutes a continuation rather than a cessation of their suffering. Marital problems, economic hardship, and loneliness are recounted by the adults, while teachers and parents report adjustment and behavioral difficulties among the children. The influence of sociopolitical factors on these outcomes is discussed.

Inflammatory myelopathy presenting as a cystic intramedullary spinal cord lesion.

A case of subacute progressive spinal tetraparesis had myelographic evidence of cervical spinal cord swelling and a delayed metrizamide computed tomographic myelogram (MCTM) suggested cavitation within the swollen spinal cord. Surgical exploration of the cervical cord revealed inflammatory changes only. No syrinx or intramedullary tumour was found. The accumulation of metrizamide within the spinal cord, as demonstrated by MCTM, did not represent a syrinx or a cystic tumour, but more likely an area of inflammation. Because inflammatory myelopathy may simulate an intramedullary tumor or syrinx, careful analysis of all clinical and radiological information is necessary to help make a correct diagnosis.

Computerized tomography in head and neck tumor diagnosis.

Computerized tomography has revolutionized the investigation of head and neck tumors and so rapid are the advances in this field, reviews are often outdated at time of publication. Several cases are presented to demonstrate the value of computerized tomography in investigation of lesions involving the paranasal sinuses, nasopharynx, and soft tissues of the neck.

Xanthochromic cysts associated with meningioma.

Three cases of cystic meningioma encountered in one year are presented. It appears from a review of the literature, and an analysis of these three cases, that large xanthochromic cerebral cysts may be associated with meningiomas in any of three configurations: (1) centrally within the tumour; (2) peripherally within the tumour; (3) in the adjacent brain. Regardless of which configuration applies, the CAT scan appearance of such cystic meningiomas may mimic that of a glial tumour with cystic or necrotic change, and lead to an incorrect presumptive diagnosis. This false impression may be perpetuated by the gross appearance at operation, which can also mimic malignant glioma. Although several radiological features should suggest the possible presence of a cystic meningioma, we know of no definite radiological means of differentiating this lesion from the more common malignant glioma. This finding should underline the need to biopsy all suspected cerebral neoplasms, regardless of how much their appearance on CAT scan may suggest malignant glioma.

Cerebral aneurysms and cardiac myxoma.

Cerebral aneurysms with a characteristic pattern may arise as a complication of cardiac myxomas. In our patient, hemiparesis resulted 12 years after the myxoma was resected.