Species diversity, systematic revision and molecular phylogeny of Ganodermataceae (Polyporales, Basidiomycota) with an emphasis on Chinese collections.

Ganodermataceae is one of the main families of macrofungi since species in the family are both ecologically and economically important. The double-walled basidiospores with ornamented endospore walls are the characteristic features of Ganodermataceae. It is a large and complex family; although many studies have focused on Ganodermataceae, the global diversity, geographic distribution, taxonomy and molecular phylogeny of Ganodermataceae still remained incompletely understood. In this work, taxonomic and phylogenetic studies on worldwide species of Ganodermataceae were carried out by morphological examination and molecular phylogenetic analyses inferred from six gene loci including the internal transcribed spacer regions (ITS), the large subunit of nuclear ribosomal RNA gene (nLSU), the second largest subunit of RNA polymerase II gene (rpb2), the translation elongation factor 1-α gene (tef1), the small subunit mitochondrial rRNA gene (mtSSU) and the small subunit nuclear ribosomal RNA gene (nSSU). A total of 1 382 sequences were used in the phylogenetic analyses, of which 817 were newly generated, including 132 sequences of ITS, 139 sequences of nLSU, 83 sequences of rpb2, 124 sequences of tef1, 150 sequences of mtSSU and 189 sequences of nSSU. The combined six-gene dataset included sequences from 391 specimens representing 146 taxa from Ganodermataceae. Based on morphological and phylogenetic analyses, 14 genera were confirmed in Ganodermataceae: Amauroderma, Amaurodermellus, Cristataspora, Foraminispora, Furtadoella, Ganoderma, Haddowia, Humphreya, Magoderna, Neoganoderma, Sanguinoderma, Sinoganoderma, Tomophagus and Trachydermella. Among these genera, Neoganoderma gen. nov. is proposed for Ganoderma neurosporum; Sinoganoderma gen. nov. is proposed for Ganoderma shandongense; Furtadoella gen. nov. is proposed to include taxa previously belonging to Furtadoa since Furtadoa is a homonym of a plant genus in the Araceae; Trachydermella gen. nov. is proposed to include Trachyderma tsunodae since Trachyderma is a homonym of a lichen genus in the Pannariaceae. Twenty-three new species, viz., Ganoderma acaciicola, G. acontextum, G. alpinum, G. bubalinomarginatum, G. castaneum, G. chuxiongense, G. cocoicola, G. fallax, G. guangxiense, G. puerense, G. subangustisporum, G. subellipsoideum, G. subflexipes, G. sublobatum, G. tongshanense, G. yunlingense, Haddowia macropora, Sanguinoderma guangdongense, Sa. infundibulare, Sa. longistipitum, Sa. melanocarpum, Sa. microsporum and Sa. tricolor are described. In addition, another 33 known species are also described in detail for comparison. Scanning electron micrographs of basidiospores of 10 genera in Ganodermataceae are provided. A key to the accepted genera of Ganodermataceae and keys to the accepted species of Ganoderma, Haddowia, Humphreya, Magoderna, Sanguinoderma and Tomophagus are also provided. In total, 278 species are accepted as members of Ganodermataceae including 59 species distributed in China. Taxonomic novelties: New genera: Furtadoella B.K. Cui & Y.F. Sun, Neoganoderma B.K. Cui & Y.F. Sun, Sinoganoderma B.K. Cui, J.H. Xing & Y.F. Sun and Trachydermella B.K. Cui & Y.F. Sun; New species: Ganoderma acaciicola B.K. Cui, J.H. Xing & Y.F. Sun, G. acontextum B.K. Cui, J.H. Xing & Vlasák, G. alpinum B.K. Cui, J.H. Xing & Y.F. Sun, G. bubalinomarginatum B.K. Cui, J.H. Xing & Y.F. Sun, G. castaneum B.K. Cui, J.H. Xing & Y.F. Sun, G. chuxiongense B.K. Cui, J.H. Xing & Y.F. Sun, G. cocoicola B.K. Cui, J.H. Xing & Y.F. Sun, G. fallax B.K. Cui, J.H. Xing & Vlasák, G. guangxiense B.K. Cui, J.H. Xing & Y.F. Sun, G. puerense B.K. Cui, J.H. Xing & Y.F. Sun, G. subangustisporum B.K. Cui, J.H. Xing & Y.F. Sun, G. subellipsoideum B.K. Cui, J.H. Xing & Y.F. Sun, G. subflexipes B.K. Cui, J.H. Xing & Y.F. Sun, G. sublobatum B.K. Cui, J.H. Xing & Y.F. Sun, G. tongshanense B.K. Cui, J.H. Xing & Y.F. Sun, G. yunlingense B.K. Cui, J.H. Xing & Y.F. Sun, Haddowia macropora B.K. Cui, Vlasák & Y.F. Sun, Sanguinoderma guangdongense B.K. Cui & Y.F. Sun, Sa. infundibulare B.K. Cui & Y.F. Sun, Sa. longistipitum B.K. Cui & Y.F. Sun, Sa. melanocarpum B.K. Cui & Y.F. Sun, Sa. microsporum B.K. Cui & Y.F. Sun and Sa. tricolor B.K. Cui & Y.F. Sun; New combinations: Furtadoella biseptata (Costa-Rezende et al.) B.K. Cui & Y.F. Sun, Fu. brasiliensis (Singer) B.K. Cui & Y.F. Sun, Fu. corneri (Gulaid & Ryvarden) B.K. Cui & Y.F. Sun, Neoganoderma neurosporum (J.S. Furtado) B.K. Cui & Y.F. Sun, Sinoganoderma shandongense (J.D. Zhao & L.W. Xu) B.K. Cui, J.H. Xing & Y.F. Sun and Trachydermella tsunodae (Yasuda ex Lloyd) B.K. Cui & Y.F. Sun. Citation: Sun Y-F, Xing J-H, He X-L, Wu D-M, Song C-G, Liu S, Vlasák J, Gates G, Gibertoni TB, Cui B-K (2022). Species diversity, systematic revision and molecular phylogeny of Ganodermataceae (Polyporales, Basidiomycota) with an emphasis on Chinese collections. Studies in Mycology 101: 287-415. doi: 10.3114/sim.2022.101.05.

Multi-gene phylogeny and taxonomy of Amauroderma s.lat. (Ganodermataceae).

Amauroderma s.lat. has been defined mainly by the morphological features of non-truncate and double-walled basidiospores with a distinctly ornamented endospore wall. In this work, taxonomic and phylogenetic studies on species of Amauroderma s.lat. are carried out by morphological examination together with ultrastructural observations, and molecular phylogenetic analyses of multiple loci including the internal transcribed spacer regions (ITS), the large subunit of nuclear ribosomal RNA gene (nLSU), the largest subunit of RNA polymerase II (RPB1) and the second largest subunit of RNA polymerase II (RPB2), the translation elongation factor 1-α gene (TEF) and the ß-tubulin gene (TUB). The results demonstrate that species of Ganodermataceae formed ten clades. Species previously placed in Amauroderma s.lat. are divided into four clades: Amauroderma s.str., Foraminispora, Furtadoa and a new genus Sanguinoderma. The classification of Amauroderma s.lat. is thus revised, six new species are described and illustrated, and eight new combinations are proposed. SEM micrographs of basidiospores of Foraminispora and Sanguinoderma are provided, and the importance of SEM in delimitation of taxa in this study is briefly discussed. Keys to species of Amauroderma s.str., Foraminispora, Furtadoa, and Sanguinoderma are also provided.

Baroreceptor sensitivity after Valsalva maneuver in women with chronic obstructive pulmonary disease.

PURPOSE: Reduced baroreceptor sensitivity (BRS) results in changes in autonomic modulation. Patients with chronic obstructive pulmonary disease (COPD) may have altered BRS. Therefore, we compared BRS between COPD patients and normal controls. METHODS: We compared 14 COPD patients [mean (±SD) age, 62 ± 8 years] to 14 healthy controls [mean (±SD) age, 59 ± 6 years] for the loss of BRS. All patients received ß(2)-agonist therapy but were free from any other type of medication that would interfere with autonomic responses, all controls were free from cardiopulmonary disease, and none was taking medications. All participants were female, post-menopausal, had no known cardiac disease and were ex-smokers. Reduced baroreceptor sensitivity was determined using the slope of the magnitude of R-R widening over the increase in systolic blood pressure following Valsalva maneuver. RESULTS: The mean BRS in controls versus COPD patients showed a mean value of 6.15 ± 2.26 versus 1.91 ± 2.92 ms/mmHg (p < 0.001). CONCLUSIONS: These findings are consistent with other abnormalities of autonomic disruption as previously reported, and demonstrate a severe blunting of the baroreceptor response in individuals with COPD. The cause of this altered BRS response in COPD is not fully clear, we postulate that air trapping with persistent elevation of intrathoracic pressure may lead to a subsequent blunting of the sensitivity of the baroreceptors.

Fungal Planet description sheets: 128-153.

Novel species of microfungi described in the present study include the following from Australia: Catenulostroma corymbiae from Corymbia, Devriesia stirlingiae from Stirlingia, Penidiella carpentariae from Carpentaria, Phaeococcomyces eucalypti from Eucalyptus, Phialophora livistonae from Livistona, Phyllosticta aristolochiicola from Aristolochia, Clitopilus austroprunulus on sclerophyll forest litter of Eucalyptus regnans and Toxicocladosporium posoqueriae from Posoqueria. Several species are also described from South Africa, namely: Ceramothyrium podocarpi from Podocarpus, Cercospora chrysanthemoides from Chrysanthemoides, Devriesia shakazului from Aloe, Penidiella drakensbergensis from Protea, Strelitziana cliviae from Clivia and Zasmidium syzygii from Syzygium. Other species include Bipolaris microstegii from Microstegium and Synchaetomella acerina from Acer (USA), Brunneiapiospora austropalmicola from Rhopalostylis (New Zealand), Calonectria pentaseptata from Eucalyptus and Macadamia (Vietnam), Ceramothyrium melastoma from Melastoma (Indonesia), Collembolispora aristata from stream foam (Czech Republic), Devriesia imbrexigena from glazed decorative tiles (Portugal), Microcyclospora rhoicola from Rhus (Canada), Seiridium phylicae from Phylica (Tristan de Cunha, Inaccessible Island), Passalora lobeliae-fistulosis from Lobelia (Brazil) and Zymoseptoria verkleyi from Poa (The Netherlands). Valsalnicola represents a new ascomycete genus from Alnus (Austria) and Parapenidiella a new hyphomycete genus from Eucalyptus (Australia). Morphological and culture characteristics along with ITS DNA barcodes are also provided.

The association between sympatho-vagal balance and central blood pressures.

PURPOSE: High central blood pressure is more predictive of cardiovascular disease (CVD) versus high peripheral blood pressure. Measures of central pressures (CPs) include, central systolic blood pressure (CSBP) and central diastolic blood pressure. Measures of central pressures augmentation (CPsA) include augmentation pressure (AP) and the augmentation index @ 75 beats·min-1 (AIx@75). Increased sympathetic tone (ST) is also associated with CVD. The low to high frequency ratio (LF/HF) is often used to determine sympatho-vagal balance. Given the association between ST, CPs, CPsA and CVD there is a need to understand the association between these predictors of CVD. The aims of this study were to examine the association between the LF/HF ratio, CPs, and CPsA in men and women collectively and based on gender. METHODS: We measured the LF/HF ratio, CSBP, AP, and AIx@75 in 102 participants (41F/61M). The LF/HF ratio was determined via power spectral density analysis. CSBP, AP, and AIx@75 were determined via applanation tonometry. RESULTS: The LF/HF ratio was inversely associated with AP (r = -0.26) and AIx @75 (r = -0.29) in the combined group of men and women. The LF/HF ratio was inversely associated with CSBP (r = -0.27), AP (r = -0.28), and AIx@75 (r = -0.32) in men, but not in women. CONCLUSION: There is an inverse association between the LF/HF ratio, AP, and AIx@75 in men and women combined. The association between the LF/HF ratio, CSBP, AP, and AIx@75, differs based on gender.

First measurements of remaining shell areal density on the OMEGA laser using the Diagnostic for Areal Density (DAD).

A glass Cherenkov detector, called the Diagnostic for Areal Density (DAD), has been built and implemented at the OMEGA laser facility for measuring fusion gammas above 430 keV, from which remaining shell ⟨ρR⟩ abl can be determined. A proof-of-principle experiment is discussed, where signals from a surrogate gas Cherenkov detector are compared with reported values from the wedge range filter and charged particle spectrometer and found to correlate strongly. The design of the more compact port-based DAD diagnostic and results from the commissioning shots are then presented. Once absolutely calibrated, the DAD will be capable of reporting remaining shell ⟨ρR⟩ abl for plastic and glass capsules within minutes of a shot and with potentially higher precision than existing techniques.

Manometry of the normal upper esophageal sphincter and its alterations in laryngectomy.

Rapid pull-through pressure profiles of the normal human upper esophageal sphincter (UES) were simultaneously studied with a conventional three-orifice Honeywell solid-state probe, an eight lumen radially perfused (RP) probe, and a circumferentially sensitive (CS) probe designed to measure UES pressure (UESP) without regard to probe orientation. Pressure curves were digitized and analyzed by computer. The Honeywell probe recorded significantly lower peak pressures than the other two methods, and had wide intrasubject pressure variations (average coefficient of variation, 53%). In contrast, UESP measured with the CS probe was constant for each subject (mean peak UESP, 121 mm Hg; average coefficient of variation, 15%). Anteroposterior RP probe UESP were identical to CS probe pressures. Thus, peak perfused anteroposterior UESP correlates with circumferentially measured sphincter squeeze.Computer programs were written that allowed RP probe pressures to be mapped in three dimensions. Normal three-dimensional maps were characterized by anteroposterior accentuation of peak pressures and also by consistent axial asymmetry with anterior peak pressures occurring 0.8+/-0.2 cm closer to the pharynx. After defining the normal two- and three-dimensional UESP configuration, patients who had undergone laryngectomy were studied. Peak pressures measured with the RP probe decreased to congruent with50 mm Hg and radial pressure asymmetry vanished. Like normals, CS probe pressures corresponded to peak RP probe pressures. UES length did not change significantly. Three-dimensional mapping showed that axial asymmetry also vanished. It therefore appears that the anatomic alterations produced by laryngectomy abolishes UESP asymmetry.

Note: Experimental platform for magnetized high-energy-density plasma studies at the omega laser facility.

An upgrade of the pulsed magnetic field generator magneto-inertial fusion electrical discharge system [O. Gotchev et al., Rev. Sci. Instrum. 80, 043504 (2009)] is described. The device is used to study magnetized high-energy-density plasma and is capable of producing a pulsed magnetic field of tens of tesla in a volume of a few cubic centimeters. The magnetic field is created by discharging a high-voltage capacitor through a small wire-wound coil. The coil current pulse has a duration of about 1 µs and a peak value of 40 kA. Compared to the original, the updated version has a larger energy storage and improved switching system. In addition, magnetic coils are fabricated using 3-D printing technology which allows for a greater variety of the magnetic field topology.

Hearing loss and antiretroviral therapy in patients infected with HIV-1.

OBJECTIVE: To explore the association between hearing loss and antiretroviral therapy in human immunodeficiency virus type 1 (HIV-1)-infected persons. DESIGN: Case-control study. SETTING: University-based HIV clinic. PARTICIPANTS: Volunteer sample of 99 HIV-infected patients. INTERVENTIONS: Standardized interview focusing on risks for hearing loss, review of clinic pharmacy records, and hearing tests by portable audiometry. MAIN OUTCOME MEASURE: Hearing loss, defined as threshold of more than a 25-dB hearing level at 4000 Hz in 1 or both ears. RESULTS: Hearing loss was common, seen in 29 subjects (29%). It was significantly associated with age and history of ear infection and tended to be more common in subjects prescribed antiretroviral agents. An interaction existed between age and antiretroviral therapy; the association between hearing loss and antiretroviral therapy was significant for subjects aged 35 years or older, but not for subjects younger than 35 years. In subjects aged 35 years or older, this association remained significant using a multivariate model that included those variables found to have the greatest potential for confounding (odds ratio, 4.6; 95% confidence interval, 1.0-20.5; P = .05). CONCLUSIONS: Hearing loss is common among HIV-infected individuals and is associated with antiretroviral therapy in those aged 35 years or older.

Auditory dysfunction in aging and senile dementia of the Alzheimer's type.

OBJECTIVE: To determine the prevalence and type of auditory dysfunction in older volunteer subjects with mild probable Alzheimer's disease (pAD). METHODS: Pure-tone thresholds, word recognition in quiet, Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message, distortion-product otoacoustic emissions, and auditory brain-stem responses were done in 82 elderly volunteer subjects whose cognitive, psychologic, and neurologic status had been determined through annual testing in a research center. Based on clinical criteria and the Clinical Dementia Rating (CDR) scale, 40 subjects had been judged to be nondemented (CDR score, 0), and 42 had a clinical diagnosis of pAD, with 22 in the questionable (CDR score, 0.5) and 20 in the mild (CDR score, 1) categories. RESULTS: The mean age-adjusted pure-tone average thresholds (0.5, 1.0, and 2.0 kHz) were poorer in the subjects with pAD by 5.1 dB in the right ears and 6.1 dB in the left ears; these differences were not statistically significant. Word recognition in quiet did not differ by CDR category. The age-adjusted scores on the Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message were significantly reduced in the subjects with mild pAD. Distortion-product otoacoustic emission amplitudes and auditory brain-stem response thresholds and latencies paralleled the pure-tone threshold results and did not differ across the CDR groups. CONCLUSIONS: Central auditory dysfunction was evident in subjects with even mild cases of pAD, whereas peripheral auditory function was not different from that in age-matched control subjects. Additional research is needed to delineate the mechanisms of central auditory dysfunction and to establish the sensitivity and specificity of auditory testing in subjects with Alzheimer's disease. We recommend auditory assessment, including Synthetic Sentence Identification with Ipsilateral Competing Message or Contralateral Competing Message, for older patients in general and in particular for those in whom dementia is suspected.

Computation of glomerular filtration rate with Tc-99m DTPA: an in-house computer program.

The glomerular filtration rate (GFR) can be computed from the scintigraphic determination of Tc-99m DTPA (diethylenetriaminepentaacetic acid) uptake within the kidneys. The required computations are straightforward and can easily be included in the software of various computers, including a hospital's existing data-processing system. This report presents a complete operational program based on extensive experience with this method. The program is easy to use, allows for adjustments to be made for unusual clinical conditions, and produces a permanent record that can be issued as part of the final report.

The gallium "bone scan" in acute leukemia.

A 15-year-old boy with acute leukemia had a gallium-67 scan that was virtually identical to his technetium-99m pyrophosphate bone scan, except for lack of renal visualization. The quality of the radiopharmaceutical was assured by the normal appearance of gallium scan performed in another patient on the same day and with the same radionuclide batch. This extensive osseous uptake was probably due to bone-marrow replacement by leukemia cells and is a pattern that should be recognized as indicating a diffuse marrow-infiltrating disease.

Ovarian carcinoma imaged by 99mTc-pyrophosphate: case report.

An ovarian carcinoma which avidly accumulated 99mTc-pyrophosphate was imaged during a bone scan. The primary tumor and its implants over the liver surface were both visualized. Although imaging of such an ovarian malignancy has not been previously reported, it offers a potential method for assessing neoplastic size and spread.

Suitability of radiopharmaceuticals for determining right-to-left shunting: concise communication.

Right-to-left shunting in noncyanotic patients was quantitated following the injection of either 99mTc-microspheres, 99mTc-macroaggregated albumin, or 113mIn-Fe(OH)3 particles. Shunting was determined by wholebody scanning followed by estimation of the nuclide fraction located in the systemic circulation. Both 99mTc-labeled radiopharmaceuticals yielded results consistent with normal pulmonary shunting in a noncyanotic patient, whereas 113mIn-Fe(OH)3 was less satisfactory. If the onset of scanning was delayed, however, the calculated shunt can be falsely elevated as the pulmonary particles fragment and pass onward or as the label is released. Consequently, proper choice of radiopharmaceutical and prompt scanning are crucial for accurate quantitation of right-to-left shunting.

Scintigraphic detection of congenital intracranial vascular malformations.

Nine children with arteriovenous malformations (AVMs), and a tenth with a cerebral aneurysm, had computer-processed dynamic scintigraphy with static scintigrams, transmission computed tomography (CT) both with and without contrast injection, and radiopaque cerebral angiography. All ten lesions were detected by dynamic scintigraphy and angiography, whereas two AVMs were missed on CT scans and the aneurysm and two AVMs (one missed by CT) were not identified on static scintigrams. Time-activity curves generated from regions of interest placed over the cerebral hemispheres, AVMs and/or various venous structures permitted, respectively, estimation of interhemispheric partition of perfusion, estimation of the fraction of total cerebral hemispheric perfusion preferentially directed into a malformation, and indication of the route of venous drainage from the lesions. While dynamic scintigraphy and CT scanning both identified the aneurysm, scintigraphy was the most effective screening test for detecting AVMs owing to its accuracy, lower cost, and lack of required anesthesia, heavy sedation or iodinated contrast agents.

Scintigraphic abnormalities in glycogen storage disease.

Fifteen patients with glycogen-storage disease type 1 (von Gierke's disease) were evaluated by serial scintigraphy, with a clearly recognizable pattern of an enlarged liver with diminished radionuclide accumulation, splenomegaly with considerably increased uptake and renomegaly. In seven of these patients with GSD-1 scintigraphy demonstrated focal defects of varying size. Small or stable defects suggest benign hepatic adenomata, whereas malignant change occurred in growing large lesions. The potential malignant end-point of hepatic-cell carcinoma in GSD-1 warrants careful serial liver scintigraphy with scintiangiography on a routine basis.

Effect of morphine and naloxone on priming-induced audiogenic seizures in BALB/c mice.

1 Morphine (1-200 mg/kg s.c.) reduced the incidence and prolonged the latency of priming-induced audiogenic siezures in a dose-dependent manner. 2 This effect was reversed by naloxone (1 and 2 mg/kg) although naloxone was itself inactive. 3 This priming-induces seizure model may be useful in the study of tolerance and physical dependence.

SPECT bone scanning of the spine.

Radionuclide bone scanning is a well accepted method for uncovering a variety of bony lesions including abnormalities of vertebral bodies that may be causing spinal pain. Single photon emission computed tomography (SPECT) is especially useful in such an evaluation because it allows for precise localization of a lesion to the vertebral body, disc space, or vertebral arch. This anatomic distinction is necessary in order to accurately diagnose the underlying condition detected by the bone scan. Most bony abnormalities result in focal areas of abnormal tracer activity but do not affect all components of a vertebra with equal frequency nor have a random pattern of involvement. Vertebral diseases tend to conform to predictable patterns that can be more readily identified by SPECT than planar imaging. Metastatic tumors commonly involve the posterior portion of the vertebral body, often in combination with a pedicle. Extensive abnormalities involving the vertebral body and vertebral arch, but sparing the pedicles, are usually benign as are lesions isolated to articular facets and lamina or disc space. Postoperative patients have additional potential problems including pseudarthrosis and complications following use of internal fixation devices including pedicle screws. Nuclear medicine physicians must speak the language of their referring physicians who are anatomically oriented and used to the exquisite morphologic detail of computed tomography (CT) and magnetic resonance imaging (MRI). SPECT allows for greater anatomic information compared with planar imaging as well as straightforward comparison with other tomographic-based studies such as CT and MRI.

Consensus report on quality control of quantitative measurements of renal function obtained from the renogram: International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology.

Among all the physiological indices that can be quantified using renography, measurement of renal function is the most basic. These measurements are used to make critical clinical management decisions and, as such, their reliability needs to be quality assured. This article seeks to address each aspect of the renography procedure, with particular emphasis on the effect on measurement of relative renal function. Estimation of individual kidney function is mentioned, but only briefly. A consensus approach was adopted, overseen, and directed by a chairman appointed by the Scientific Committee of the International Radionuclides in Nephro-Urology Group. The chairman selected the panel of experts from eight different countries based on their practical experience in the field. Where evidence exists to support the various recommendations it is given. Otherwise, the stated guidance represents the considered opinion of a body of experts, based on long experience and unpublished data. Some necessary compromises were made to account for the fact that renography is seldom performed solely with the purpose of measuring relative renal function. The technicalities of renography have always been a source of debate in nuclear medicine, which is reflected by the fact that a consensus could simply not be reached on a small number of issues. The structure of the report ensures that these are clearly indicated. This should serve to highlight gaps in our current knowledge, thus helping to direct future research. It is envisaged that the recommendations will be revised on a 2-year cycle to ensure that they remain up to date. An "open" process will be used to encourage participation and ownership. It is hoped that promotion of these guidelines, suitably complemented by audit processes, will raise standards in the practice of gamma camera renography.

Echocardiography and perfusion scintigraphy in the diagnosis of pulmonary arteriovenous fistula.

The echocardiographic and perfusion scintigraphic evaluation of an adolescent boy with a pulmonary arteriovenous fistula is reported. Contrast echocardiography following the rapid intravenous injection of indocyanine green dye was utilized to document extracardiac right-to-left shunting. Perfusion lung scintigraphy demonstrated the presence of a single large pulmonary arteriovenous fistula. Contrast echocardiography and perfusion scintigraphy are minimally invasive, safe and easily performed techniques for the rapid diagnosis of pulmonary arteriovenous fistula.