Vascular malformations of the female and male genitalia: type and distribution patterns revealed by magnetic resonance imaging.

BACKGROUND: Vascular malformations of the genitalia often go undetected in clinical examination. These vascular malformations can cause a variety of clinical symptoms such as swelling, pain and bleeding. AIM: To characterize the distribution patterns of genital vascular malformations using magnetic resonance imaging (MRI) and to correlate these patterns with clinical findings in order to guide diagnostic decisions. METHODS: A retrospective analysis of MRIs of the pelvis and legs in 370 patients with vascular malformation was performed to determine the involvement of the internal and external genitalia. RESULTS: In 71 patients (19%), genital involvement could be identified by MRI. Of these, 11.3% (8 of 71) presented with internal involvement, 36.6% (26 of 71) with external involvement and 52.1% (37 of 71) with both internal and external involvement. Over half (57.1%) of the 49 patients with visible external genital signs detected during a clinical examination had additional internal genital involvement. CONCLUSIONS: Genital involvement is a common finding in patients with vascular malformation of the legs and/or pelvis. Based on our data, we recommend MRI of the legs and pelvic region in patients with externally visible signs of a vascular malformation of the external genitalia in order to exclude additional internal involvement.

Abdominal lymphatic malformations.

BACKGROUND: Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. RESULTS: The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septa. CONCLUSION: In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).

[Abdominal lymphatic malformations. German version]. / Abdominelle lymphatische Malformationen.

BACKGROUND: Abdominal lymphatic malformations (LM) are relatively rare findings in the differential diagnosis of focal abdominal lesions; however, they represent a challenge especially in younger patients. The aim of this review article is to provide up-to-date information about the different kinds of LM manifestations. In addition, related syndromes and typical imaging features to facilitate the diagnosis are discussed. RESULTS: The clinical presentation of abdominal LM is unspecific, whereby most are asymptomatic and comprise incidental findings of thin-walled cystic masses anywhere in the abdomen. The fluid in the cystic masses may be proteinaceous, contain blood, or be infected. Radiological imaging features overlap with other cystic diseases; hallmark in LM is a lack of a solid component and exclusive enhancement of the walls and septae. CONCLUSION: In cystic abdominal masses in early childhood or young adults, abdominal LM must be taken into account by the radiologist. Newly defined entities in this spectrum of diseases are central conducting lymphatic anomaly (CCLA) and generalized lymphatic anomaly (GLA).

[Case report of granulomatous necrotizing sialadenitis. Rarity of first manifestation in submandibular gland]. / Fallbericht einer granulomatös-nekrotisierenden Sialadenitis. Rarität einer Erstmanifestation in der Glandula submandibularis.

This article presents the case of a 43-year-old male patient with recurrent painful swelling of the right submandibular gland. Submandibulectomy was performed. Histological investigations showed an intense granulomatous inflammation with severe destruction of the parenchyma. The inflammatory infiltrate consisted of abscesses with neutrophilic and eosinophilic granulocytes and ill-defined granulomas with multinucleated giant cells. Some of the blood vessels showed evidence of vasculitis. After further clinical and serological investigations with highly elevated levels of cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) and antiproteinase-3 antibodies, a rare limited disease of granulomatous polyangiitis (Wegener granulomatosis) was finally diagnosed. Such a manifestation of the disease is exceedingly rare; therefore, only single case reports have so far been described. The certain establishment of the diagnosis seems to be challenging because of the lack of involvement of the respiratory tract and the kidneys. In this case a histological assessment and clinical findings are mandatory for the correct diagnosis.

Development of hemodynamically relevant acquired arterio-venous fistulae in patients with venous malformations.

BACKGROUND: Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy. OBJECTIVE: The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations. METHODS: This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients' symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics. RESULTS: Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development. CONCLUSIONS: Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.

Metabolic and cardiorespiratory responses of summer flounder Paralichthys dentatus to hypoxia at two temperatures.

To quantify the tolerance of summer flounder Paralichthys dentatus to episodic hypoxia, resting metabolic rate, oxygen extraction, gill ventilation and heart rate were measured during acute progressive hypoxia at the fish's acclimation temperature (22° C) and after an acute temperature increase (to 30° C). Mean ±s.e. critical oxygen levels (i.e. the oxygen levels below which fish could not maintain aerobic metabolism) increased significantly from 27 ± 2% saturation (2·0 ± 0·1 mg O(2) l(-1)) at 22° C to 39 ± 2% saturation (2·4 ± 0·1 mg O(2) l(-1)) at 30° C. Gill ventilation and oxygen extraction changed immediately with the onset of hypoxia at both temperatures. The fractional increase in gill ventilation (from normoxia to the lowest oxygen level tested) was much larger at 22° C (6·4-fold) than at 30° C (2·7-fold). In contrast, the fractional decrease in oxygen extraction (from normoxia to the lowest oxygen levels tested) was similar at 22° C (1·7-fold) and 30° C (1·5-fold), and clearly smaller than the fractional changes in gill ventilation. In contrast to the almost immediate effects of hypoxia on respiration, bradycardia was not observed until 20 and 30% oxygen saturation at 22 and 30° C, respectively. Bradycardia was, therefore, not observed until below critical oxygen levels. The critical oxygen levels at both temperatures were near or immediately below the accepted 2·3 mg O(2) l(-1) hypoxia threshold for survival, but the increase in the critical oxygen level at 30° C suggests a lower tolerance to hypoxia after an acute increase in temperature.

The effect of stimulation frequency on the transmural ventricular monophasic action potential in yellowfin tuna Thunnus albacares.

Monophasic action potentials (MAPs) were recorded from the spongy and compact layers of the yellowfin tuna Thunnus albacares ventricle as stimulation frequency was increased. MAP duration decreased with increase in stimulation frequency in both the spongy and compact myocardial layers, but no significant difference in MAP duration was observed between the layers.

Comparative metabolic rates of common western North Atlantic Ocean sciaenid fishes.

The resting metabolic rates (R(R)) of western North Atlantic Ocean sciaenids, such as Atlantic croaker Micropogonias undulatus, spot Leiostomus xanthurus and kingfishes Menticirrhus spp., as well as the active metabolic rates (R(A)) of M. undulatus and L. xanthurus were investigated to facilitate inter and intraspecific comparisons of their energetic ecology. The R(R) of M. undulatus and L. xanthurus were typical for fishes with similar lifestyles. The R(R) of Menticirrhus spp. were elevated relative to those of M. undulatus and L. xanthurus, but below those of high-energy-demand species such as tunas Thunnus spp. and dolphinfish Coryphaena hippurus. Repeated-measures non-linear mixed-effects models were applied to account for within-individual autocorrelation and corrected for non-constant variance typical of noisy R(A) data sets. Repeated-measures models incorporating autoregressive first-order [AR(1)] and autoregressive moving average (ARMA) covariances provided significantly superior fits, more precise parameter estimates (i.e. reduced s.e.) and y-intercept estimates that more closely approximated measured R(R) for M. undulatus and L. xanthurus than standard least-squares regression procedures.

Bridging disciplines to advance elasmobranch conservation: applications of physiological ecology.

A strength of physiological ecology is its incorporation of aspects of both species' ecology and physiology; this holistic approach is needed to address current and future anthropogenic stressors affecting elasmobranch fishes that range from overexploitation to the effects of climate change. For example, physiology is one of several key determinants of an organism's ecological niche (along with evolutionary constraints and ecological interactions). The fundamental role of physiology in niche determination led to the development of the field of physiological ecology. This approach considers physiological mechanisms in the context of the environment to understand mechanistic variations that beget ecological trends. Physiological ecology, as an integrative discipline, has recently experienced a resurgence with respect to conservation applications, largely in conjunction with technological advances that extended physiological work from the lab into the natural world. This is of critical importance for species such as elasmobranchs (sharks, skates and rays), which are an especially understudied and threatened group of vertebrates. In 2017, at the American Elasmobranch Society meeting in Austin, Texas, the symposium entitled `Applications of Physiological Ecology in Elasmobranch Research' provided a platform for researchers to showcase work in which ecological questions were examined through a physiological lens. Here, we highlight the research presented at this symposium, which emphasized the strength of linking physiological tools with ecological questions. We also demonstrate the applicability of using physiological ecology research as a method to approach conservation issues, and advocate for a more available framework whereby results are more easily accessible for their implementation into management practices.

Immunohistochemical localization of CYP1A, vitellogenin and Zona radiata proteins in the liver of swordfish (Xiphias gladius L.) taken from the Mediterranean Sea, South Atlantic, South Western Indian and Central North Pacific Oceans.

Cytochrome P4501A (CYP1A) monoxygenase, vitellogenin (Vtg) and Zona radiata proteins (Zrp) are frequently used as biomarkers of fish exposure to organic contaminants. In this work, swordfish liver sections obtained from the Mediterranean Sea, the South African coasts (South Atlantic and South Western Indian Oceans) and the Central North Pacific Ocean were immunostained with antisera against CYP1A, Zrp, and Vtg. CYP1A induction was found in hepatocytes, epithelium of the biliary ductus and the endothelium of large blood vessels of fish from the Mediterranean Sea and South African waters, but not from the Pacific Ocean. Zrp and Vtg were immunolocalized in hepatocytes of male swordfish from the Mediterranean Sea and from South African waters. Plasma Dot-Blot analysis, performed in Mediterranean and Pacific specimens, revealed the presence of Zrp and Vtg in males from Mediterranean but not from Pacific. These results confirm previous findings about the potential exposure of Mediterranean swordfish to endocrine, disrupting chemicals and raise questions concerning the possible presence of xenobiotic contaminants off the Southern coasts of South Africa in both the South Atlantic and South Western Indian Oceans.

Validation of the i-STAT system for the analysis of blood gases and acid-base status in juvenile sandbar shark (Carcharhinus plumbeus).

Accurate measurements of blood gases and acid-base status require an array of sophisticated laboratory equipment that is typically not available during field research; such is the case for many studies on the stress physiology, ecology and conservation of elasmobranch fish species. Consequently, researchers have adopted portable clinical analysers that were developed for the analysis of human blood characteristics, but often without thoroughly validating these systems for their use on fish. The aim of our study was to test the suitability of the i-STAT system, the most commonly used portable clinical analyser in studies on fish, for analysing blood gases and acid-base status in elasmobranchs, over a broad range of conditions and using the sandbar shark (Carcharhinus plumbeus) as a model organism. Our results indicate that the i-STAT system can generate useful measurements of whole blood pH, and the use of appropriate correction factors may increase the accuracy of results. The i-STAT system was, however, unable to generate reliable results for measurements of partial pressure of oxygen (PO2) and the derived parameter of haemoglobin O2 saturation. This is probably due to the effect of a closed-system temperature change on PO2 within the i-STAT cartridge and the fact that the temperature correction algorithms used by i-STAT assume a human temperature dependency of haemoglobin-O2 binding; in many ectotherms, this assumption will lead to equivocal i-STAT PO2 results. The in vivo partial pressure of CO2 (PCO2) in resting sandbar sharks is probably below the detection limit for PCO2 in the i-STAT system, and the measurement of higher PCO2 tensions was associated with a large measurement error. In agreement with previous work, our results indicate that the i-STAT system can generate useful data on whole blood pH in fishes, but not blood gases.

Developing eye in an ovarian teratoma.

A malignant teratoma of the ovary was resected in a 14-year-old girl. Within the tumor, a partially developed eye was found.

THE INFLUENCE OF HEMATOCRIT, TEMPERATURE AND SHEAR RATE ON THE VISCOSITY OF BLOOD FROM A HIGH-ENERGY-DEMAND TELEOST, THE YELLOWFIN TUNA THUNNUS ALBACARES

The high cardiac output, arterial blood pressure and cardiac energy demand of tuna make it likely that blood viscosity has an important influence on cardiovascular function. Furthermore, tuna regularly subject themselves to ambient temperature changes of 10°C or more during their daily vertical migrations. They can also maintain muscle temperatures several degrees Celsius above ambient and reach maximum muscle temperatures of approximately 15°C above ambient. The blood of tuna is, therefore, subjected to more frequent and rapid temperature changes than those that occur in other teleosts. Nothing is known, however, about the effects of temperature, shear rate or hematocrit on the viscosity of tuna blood. Viscosity of yellowfin tuna blood (hematocrits of 0­55 %) was measured at 15, 25 and 35°C and at shear rates of 45, 90, 225 and 450 s-1 using a cone-plate viscometer. As found for the blood of other vertebrates, viscosity increased with increasing hematocrit. Viscosity also increased nonlinearly with decreasing shear rate, until a shear rate of 90 s-1 was reached. There was no significant increase in viscosity when shear rate was decreased further, to 45 s-1. Because of the relatively flat hematocrit­viscosity curves, predicted optimal hematocrit curves were nearly flat above a hematocrit of approximately 30 %.

STUDIES OF TROPICAL TUNA SWIMMING PERFORMANCE IN A LARGE WATER TUNNEL - THERMOREGULATION

The body temperatures (Tb) of nine yellowfin tuna (Thunnus albacares) were monitored while fish swam in a large water tunnel at controlled velocities (U) and ambient temperatures (Ta). Monitoring Tb during step changes in Ta at constant U permitted estimation of the thermal rate coefficient (k), an index of heat transfer. In the yellowfin, k is dependent on both Ta and the direction of the thermal gradient (i.e. whether Ta is greater or less than Tb). Modulation of k in response to Ta was further demonstrated during tests in which U was varied; the elevation of Tb in response to equal increases in U was 3­4 times less at 30 C than at 25 and 20 C. These experiments demonstrate that the yellowfin tuna can modulate heat transfer. This ability could prevent overheating during intense activity, retard heat loss during a descent into cool water and permit increased heat gain upon returning to warm surface waters (i.e. when Tb

Blood volume, plasma volume and circulation time in a high-energy-demand teleost, the yellowfin tuna (Thunnus albacares)

We measured red cell space with 51Cr-labeled red blood cells, and dextran space with 500 kDa fluorescein-isothiocyanate-labeled dextran (FITC-dextran), in two groups of yellowfin tuna (Thunnus albacares). Red cell space was 13.8+/-0.7 ml kg-1 (mean +/- s.e.m.) Assuming a whole-body hematocrit equal to the hematocrit measured at the ventral aortic sampling site and no significant sequestering of 51Cr-labeled red blood cells by the spleen, blood volume was 46. 7+/-2.2 ml kg-1. This is within the range reported for most other teleosts (30-70 ml kg-1), but well below that previously reported for albacore (Thunnus alalunga, 82-197 ml kg-1). Plasma volume within the primary circulatory system (calculated from the 51Cr-labeled red blood cell data) was 32.9+/-2.3 ml kg-1. Dextran space was 37.0+/-3.7 ml kg-1. Because 500 kDa FITC-dextran appeared to remain within the vascular space, these data imply that the volume of the secondary circulatory system of yellowfin tuna is small, and its exact volume is not measurable by our methods. Although blood volume is not exceptional, circulation time (blood volume/cardiac output) is clearly shorter in yellowfin tuna than in other active teleosts. In a 1 kg yellowfin tuna, circulation time is approximately 0.4 min (47 ml kg-1/115 ml min-1 kg-1) compared with 1. 3 min (46 ml kg-1/35 ml min-1 kg-1) in yellowtail (Seriola quinqueradiata) and 1.9 min (35 ml kg-1/18 ml min-1 kg-1) in rainbow trout (Oncorhynchus mykiss). In air-breathing vertebrates, high metabolic rates are necessarily correlated with short circulation times. Our data are the first to imply that a similar relationship occurs in fishes.

CARDIO--a Lotus 1-2-3 based computer program for rapid calculation of cardiac output from dye or thermal dilution curves.

We have developed a menu-driven computer program (CARDIO), based on a Lotus 1-2-3 template and a series of macrocommands, that rapidly and semiautomatically calculates cardiac output from dye or thermal dilution curves. CARDIO works with any dye or thermal dilution recorder with an analog output, any analog to digital (A-to-D) conversion system, and any computer capable of running Lotus 1-2-3 version 2. No prior experience with Lotus 1-2-3 is needed to operate CARDIO, but experienced users can take full advantage of Lotus 1-2-3's graphics, data manipulation, and data retrieval capabilities.

Two distinct populations of bovine IL-17⁺ T-cells can be induced and WC1⁺IL-17⁺γδ T-cells are effective killers of protozoan parasites.

IL-17 has emerged as a key player in the immune system, exhibiting roles in protection from infectious diseases and promoting inflammation in autoimmunity. Initially thought to be CD4 T-cell-derived, the sources of IL-17 are now known to be varied and belong to both the innate and adaptive arms of the immune system. Mechanisms for inducing IL-17 production in lymphoid cells are thought to rely on appropriate antigenic stimulation in the context of TGF-ß1, IL-6 and/or IL-1ß. Using culture protocols adapted from human studies, we have effectively induced both bovine CD4(+) and WC1(+) γδ T-cells to produce IL-17 termed Th17 and γδ17 cells, respectively. The negative regulatory effect of IFN-γ on mouse and human IL-17 production can be extended to the bovine model, as addition of IFN-γ decreases IL-17 production in both cell types. Furthermore we show that infection with the protozoan Neospora caninum will induce fibroblasts to secrete pro-IL-17 factors thereby inducing a γδ17 phenotype that preferentially kills infected target cells. Our study identifies two T-cell sources of IL-17, and is the first to demonstrate a protective effect of IL-17(+) T-cells in ruminants. Our findings offer further opportunities for future adjuvants or vaccines which could benefit from inducing these responses.

A generic approach to the management of time-related signals and images in medicine.

A framework concept for design and implementation of medical workstations is described by (a) its underlying principles, (b) the handlers provided by the concept, (c) the available data structures and (d) the graphical user interface (GUI). The design principle takes care of a modular approach both for the framework and for the applications. The GUI provides a coherent look and feel for applications based on toolkits for displaying data objects and application control. The data handler allows management of n-dimensional data matrices in a multi-vendor environment, whereas the parameter handler takes care of the data object description. An implementation of a medical workstation exploiting the framework concept is presented.