A chronic encapsulated expanding hematoma that developed 15 years after gamma knife surgery for a cerebral arteriovenous malformation: A case report and review of the literature / Un hematoma encapsulado crónico expansivo que se desarrolló 15 años después de la intervención quirúrgica con bisturí de rayos gamma para tratar una malformación arteriovenosa cerebral: informe de caso y revisión bibliográfica

We report a case of gamma knife surgery (GKS)-induced chronic encapsulated expanding hematoma with extensive literature review. A 17-year-old young man underwent GKS after embolization for arteriovenous malformation (AVM) in the right frontal lobe and the AVM completely disappeared. He developed a generalized convulsion 15 years after GKS. MRI showed a small oedematous change at the AVM site. His epileptic seizure was controlled with anticonvulsant. His epilepsy recurred after three years, and MRI revealed an intracerebral hematoma with extensive surrounding edema at the same lesion. He underwent cerebral angiography and a recurrence of AVM was prevented. The hematoma was surgically removed, and intraoperative finding confirmed an old hematoma with a capsule and capillary hyperplasia, without developing cavernous angioma. The final diagnosis was a secondary chronic encapsulated expanding hematoma after GKS. This is the first report to show the early-stage imaging findings of this late effect after GKS (AU)

Informamos de un caso de hematoma encapsulado crónico expansivo inducido por una intervención quirúrgica con bisturí de rayos gamma (GKS) con una amplia revisión bibliográfica. Un joven de 17 años se sometió a una GKS después de una embolización por malformación arteriovenosa (MAV) en el lóbulo frontal derecho, y la MAV desapareció por completo. Desarrolló una convulsión generalizada 15 años después de la GKS. La resonancia magnética (RM) mostró un pequeño cambio edematoso en la ubicación de la MAV. Su ataque epiléptico se controló con un anticonvulsivo. Su epilepsia se repitió 3 años después, y la RM reveló un hematoma intracerebral con un edema circundante extenso en la misma lesión. Se sometió a una angiografía cerebral y se evitó la recidiva de la MAV. El hematoma se extirpó quirúrgicamente, y el hallazgo intraoperatorio confirmó un antiguo hematoma con una hiperplasia capsular y capilar, sin desarrollo de angioma cavernoso. El diagnóstico final fue un hematoma encapsulado crónico expansivo secundario después de la GKS. Este es el primer informe que muestra los hallazgos del diagnóstico por imagen en la fase temprana de este efecto tardío después de la GKS (AU)

Long-term skeletal stability in the treatment of mandibular prognathism with a physiological positioning strategy.

Our aim was to evaluate the long-term skeletal stability of the mandible in 21 patients after orthognathic surgery with physiological positioning. The measurement points SNB, B point (X, Y), Pog (X, Y), and the angle of the ramus were measured on cephalometric photographs to assess skeletal stability preoperatively, immediately after operation, and one and two years postoperatively. In addition, we evaluated the clinical symptoms of disorders of the temporomandibular joint (TMJ). The analysis of the cephalometric photographs showed that SNB, B point X, and Pog X showed no significant differences among the postoperative time points. On the other hand, B point Y and Pog Y showed no significant differences throughout the study period. We compared the angle of the ramus before operation and two years postoperatively, and no significant difference was found. In addition, no cases showed any pathological symptoms of disorders of the TMJ two years postoperatively. The long-term stability after orthognathic surgery with physiological positioning was confirmed, and it seems to be a reliable orthognathic treatment in patients with mandibular prognathism.

Impact of intra-arterial chemotherapy including internal carotid artery for advanced paranasal sinus cancers involving the skull base.

BACKGROUND: The most significant problem of intra-arterial chemotherapy for advanced paranasal sinus carcinomas and residual cancers supplied by internal carotid artery (ICA) and involving the skull base is the lack of salvage therapies. OBJECTIVE: The objective of the study was to evaluate the usefulness of intra-arterial chemotherapy including ICA infusion for treating advanced paranasal sinus carcinomas, which have invaded the skull base. METHODS: Forty-six patients with advanced paranasal sinus carcinomas supplied by ICA were treated by intra-arterial chemotherapy using CDDP and sodium thiosulphate (STS) as a neutraliser of CDDP toxicity. After evaluating CT angiography, 150 mg m(-2) of CDDP was superselectively administered weekly to each feeding artery including ICA four times. RESULTS: The 10-year overall survival rate and progression-free survival rate were 70.7 and 60.2%, respectively. Compared with control group without infusing ICA, recurrences at anterior skullbase or anterior ethomoid sinus were significantly diminished. Of 32 patients in which the orbital apex had been invaded, 29 patients were treated with successful preservation of orbital contents. The CT angiography could efficiently determine all feeding arteries supplying the cancers. Consequently, chemotherapy could be administered on schedule, and side effects were minimal and acceptable. CONCLUSIONS: This new method has promising applications in the treatment of advanced paranasal sinus carcinomas involving the skull base.

A case of severe progressive early-onset epileptic encephalopathy: unique GABAergic interneuron distribution and imaging.

Early-onset epileptic encephalopathies include various diseases such as early-infantile epileptic encephalopathy with suppression burst. We experimentally investigated the unique clinicopathological features of a 28-month-old girl with early-onset epileptic encephalopathy. Her initial symptom was intractable epilepsy with a suppression-burst pattern of electroencephalography (EEG) from 7 days of age. The suppression-burst pattern was novel, appearing during sleep, but disappearing upon waking and after becoming 2 months old. The EEG showed multifocal spikes and altered with age. Her seizures demonstrated various clinical features and continued until death. She did not show any developmental features, including no social smiling or head control. Head MRI revealed progressive atrophy of the cerebral cortex and white matter after 1 month of age. (123)IMZ-SPECT demonstrated hypo-perfusion of the cerebral cortex, but normo-perfusion of the diencephalon and cerebellum. Such imaging information indicated GABA-A receptor dysfunction of the cerebral cortex. The genetic analyses of major neonatal epilepsies showed no mutation. The neuropathology revealed atrophy and severe edema of the cerebral cortex and white matter. GAD-immunohistochemistry exhibited imbalanced distribution of GABAergic interneurons between the striatum and cerebral cortex. The results were similar to those of focal cortical dysplasia with transmantle sign and X-linked lissencephaly with ARX mutation. We performed various metabolic examinations, detailed pathological investigations and genetic analyses, but could not identify the cause. To our knowledge, her clinical and pathological courses have never been described in the literature.

Applicability of buccal fat pad grafting for oral reconstruction.

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15mm×12mm to 30mm×40mm; size of the buccal fat pad ranged from 15mm×12mm to 43mm×38mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.

Mosquitoes and other aquatic insects in fallow field biotopes and rice paddy fields.

Fallow field biotopes that develop from abandoned rice fields are man-made wetlands that provide new habitats for various aquatic animals. Although consideration of such biotopes generally focuses on their positive aspects, this study evaluated the negative aspects of establishing fallow field biotopes with regard to mosquito breeding sites. To determine whether fallow field biotopes become breeding habitats for vector mosquitoes, we evaluated mosquito fauna in fallow field biotopes and adjacent rice fields. We found larvae of Anopheles lesteri, Anopheles sinensis and Culex tritaeniorhynchus (all: Diptera: Culicidae) in the biotopes. Although abundances of mosquito larvae in the biotopes and rice fields were statistically similar, mosquito abundances in rice fields increased dramatically in August when the water level reduced after the rainy season. The abundance and variety of the mosquitoes' natural predators were greater in biotopes than in rice fields because the former are a permanent and stable aquatic environment. A generalized linear mixed model showed a negative effect of predator diversity on mosquito larvae abundance in both habitats. Although fallow field biotopes become breeding habitats for vector mosquitoes, establishing biotopes from fallow fields in order to protect various aquatic animals, including mosquito insect predators, may help to control mosquito breeding.

Leptin receptor JAK2/STAT3 signaling modulates expression of Frizzled receptors in articular chondrocytes.

OBJECTIVE: Differentiated articular chondrocytes express a functional bisoform of the leptin receptor (LRb); however, leptin-LRb signaling in these cells is poorly understood. We hypothesized that leptin-LRb signaling in articular chondrocytes functions to modulate canonical Wnt signaling events by altering the expression of Frizzled (FZD) receptors. METHODS: Human chondrocyte cell lines and primary articular chondrocytes were grown in serum containing growth media for 24h, followed by a media change to Dulbecco's modified Eagle's medium (DMEM) containing 1% Nutridoma-SP to obtain a serum-deficient environment for 24h before treatment. Treatments included recombinant human leptin (10-100nM), recombinant human IL-6 (0.3-3nM), or recombinant human erythropoietin (Epo) (10mU/ml). Cells were harvested 30min-48h after treatment and whole cell lysates were analyzed using immunoblots or luciferase assays. RESULTS: Treatment of cells with leptin resulted in activation of Janus kinase 2 (JAK2) and subsequent phosphorylation of specific tyrosine residues on LRb, followed by dose- and time-dependent increases in the expression of Frizzled-1 (FZD1) and Frizzled-7 (FZD7). Leptin-mediated increases in the expression of FZD1 were blocked by pre-treatment with the protein synthesis inhibitor cycloheximide or the JAK2 inhibitor AG490. Experiments using a series of hybrid Epo extracellular domain-leptin intracellular domain receptors (ELR) harboring mutations of specific tyrosine residues in the cytoplasmic tail showed that increases in the expression of FZD1 were dependent on LRb-mediated phosphorylation of STAT3, but not ERK1/2 or STAT5. Leptin pre-treatment of chondrocytes prior to Wnt3a stimulation resulted in an increased magnitude of canonical Wnt signaling. CONCLUSION: These experiments show that leptin-LRb signaling in articular chondrocytes modulates expression of canonical Wnt signaling receptors and suggests that direct cross-talk between these pathways is important in determining chondrocyte homeostasis.

Endodermal cyst of the cranio-cervical junction.

We reviewed 36 patients with endodermal cysts occurring at the craniocervical junction. They were aged between 3 and 66 years. Headache, motor weakness, and neck pain were commonly observed symptoms. Radiographically, T1-weighted magnetic resonance imaging of the tumours demonstrated a hypointense, isointense, or hyperintense signal according to the cystic content. In most cases, the cyst walls did not enhance after gadolinium administration. Histologically, the cysts were found to be lined by a single layer of epithelium. Histochemical and immunohistochemical studies showed that almost all were reactive to periodic acid schiff stain, epithelial membrane antigen, and carcino-embryonic antigen, but negative to glial fibrillary acidic protein. Mainly, the suboccipital approach with or without a laminectomy, or the trans-oral approach were selected for surgical excision of these tumours. In 17 of the 36 patients, total or gross total resections were performed, and subtotal resections were achieved in sixteen. Three patients developed recurrences.

Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study.

The purpose of this study was to explore risk factors affecting the incidence of chronic kidney disease (CKD) in general population. We conducted a 10-year follow-up study with 123 764 (male: 41 012, female: 82 752) adults aged 40 years and over who received community-based annual examinations. The primary outcome for the analysis was the development of CKD during the follow-up period. Predictors for the development of CKD were obtained by the significant hazard ratios (HR) in Cox regression model by sex. During the follow-up period, 4307 subjects (male: 2048, female: 2259) developed CKD stage I or II, and 19 411 subjects (male: 4257, female: 15 154) developed CKD stage III or higher. The baseline-adjusted predictor of developing CKD included age, glomerular filtration rate, hematuria, hypertension, diabetes, serum lipids, obesity, smoking status, and consumption of alcohol. Treated diabetes in male subjects, and treated hypertension, systolic blood pressure >160 mm Hg and/or diastolic blood pressure >100 mm Hg, diabetes, and treated diabetes in female subjects were associated with more than a doubling of the HR. For the development of CKD stage III or higher, proteinuria of >or= + +, and proteinuria and hematuria were associated with more than a doubling of the HR in male subjects. The prevalence of newly developed CKD over 10 years was 23 718 subjects (19.2%) in adults. This study suggested that not only hypertension and diabetes but also several metabolic abnormalities were independent risk factors for developing CKD.

Transfemoral transvenous embolization of dural arteriovenous fistulas involving the isolated transverse-sigmoid sinus.

SUMMARY: Dural arteriovenous fistulas involving the transverse-sigmoid sinus (T-S dAVFs) are sometimes isolated because this affected sinus is often thrombosed. It is difficult to perform to microcatheter cannulation to the isolated sinus through the thrombosed portion. We are now treating these T-S dAVFs by transfemoral transvenous embolization via the ipsilateral side even if the affected sinus is thrombosed and isolated or not. We use a triaxial system (6Fr. guiding catheter / 4Fr. diagnostic catheter / microcatheter) to emphasize the pushability and handling of the microcatheter. And we insert 4Fr. Catheter into the affected sinus. So we can perform microcatheter cannulation into the isolated and affected sinus for treatment by coil embolization with various detachable coils.

Subtracted 3D CT angiography for evaluation of internal carotid artery aneurysms: comparison with conventional digital subtraction angiography.

BACKGROUND AND PURPOSE: 3D computed tomographic angiography (3DCTA) has been used recently for the evaluation of intracerebral aneurysms, but it is difficult to use this technique to visualize aneurysms near the base of the skull because of the presence of bone. Subtracted 3DCTA could replace digital subtraction angiography (DSA) for evaluation of aneurysms near the base of the skull if the 2 methods were to give similar results. The aim of this study was to compare the evaluation of aneurysms of the internal carotid artery (ICA) near the base of the skull by subtracted 3DCTA and DSA. METHODS: CTA and DSA were obtained in 25 patients with unruptured aneurysms of the ICA. To create subtracted 3DCTA images, we used a volume subtraction (VS) method, wherein nonenhanced volume data are subtracted from enhanced volume data. CTA and DSA were reviewed by 2 neuroradiologists who performed the detection and characterization of aneurysms of the ICA by using 2D multiplanar reformatted (MPR) and VS- and nonsubtracted (NS)-3DCTA images with volume rendering techniques. RESULTS: DSA detected 29 aneurysms in the 25 patients. VS-3DCTA detected all 29 aneurysms in the 25 patients and was equivalent to DSA for evaluating their characteristics (location, size, and direction). NS-3DCTA detected 19 (1 cavernous, 4 ophthalmic, 1 superior hypophyseal, 7 posterior communicating, and 6 anterior choroidal artery) of these 29 aneurysms, but it could not characterize ophthalmic and superior hypophyseal artery aneurysms because they were only partly visible on NS-3DCTA because of bony structures. 2D-MPR images detected all but the small aneurysms (24 of 29 detected). VS-3DCTA and 2D-MPR could visualize all branching arteries (ophthalmic, posterior communicating, and anterior choroidal) detected by DSA, but NS-3DCTA could not visualize ophthalmic arteries because of the presence of bony structures. CONCLUSION: VS-3DCTA can be used as an alternative to DSA for preoperative examination of aneurysms near the skull base, where it provides equivalent identification and characterization.

Characteristics of aneurysms of the internal carotid artery bifurcation.

BACKGROUND: Arterial bifurcations are sites of maximal hemodynamic stress, where cerebral aneurysms commonly develop. However, in our experience with endovascular treatment for aneurysms of the internal carotid artery (ICA) bifurcation, we often experienced that the aneurysmal neck did not necessarily exist only at the ICA bifurcation (ICBi). In this study, we have retrospectively evaluated characteristics of aneurysms at the ICBi. METHODS: Ten ICBi aneurysms in 10 consecutive patients were studied retrospectively. The size of the aneurysms, the angles formed between the ICA and the anterior cerebral artery (ACA) and middle cerebral artery (MCA), and the diameter of the ICA, ACA and MCA were measured. Furthermore, to study the relationship between the location of the aneurysmal neck and the bifurcation of the ICA, the distance between the midline of the aneurysmal neck and of the ICA was measured. RESULTS: The average aneurysm size was 6.3+/-3.2 mm and the average neck was 3.1+/-1.2 mm. The average ICA-ACA angle was 57.3+/-16.5 degrees, and the average ICA-MCA angle was 128.9+/-24.1 degrees. The average diameters of the ICA, ACA and MCA were 2.9+/-0.5 mm, 1.9+/-0.4 mm and 2.5+/-0.4 mm, respectively. The average distance between the midline of the aneurysmal neck and the ICA was 1.6+/-0.6 mm, and all aneurysmal necks of the ICBi arose from the side of the ACA. CONCLUSION: ICBi aneurysms were deviated to the side of the A1 segment of the ACA, where the artery might suffer higher hemodynamic stress.

CT perfusion imaging for childhood moyamoya disease before and after surgical revascularization.

Moyamoya disease is a progressive occlusive disease of the circle of Willis with prominent collateral arterial formation. We report on a 12-year-old girl with moyamoya disease presenting with transient ischemic attacks (TIAs). Surgical indirect revascularization was performed. The patient did not suffer further TIAs at 12 month follow-up. Pre and postoperative cerebral perfusion were studied in quantitative single photon emission computerized tomography (SPECT) and CT perfusion imaging. CT perfusion imaging demonstrated postoperatively increased cerebral blood flow as well as SPECT before and after revascularization. Furthermore, the area of decreased vascular reserve in SPECT with acetazolamide corresponded to areas of increased cerebral blood volume in CT perfusion imaging. CT perfusion imaging was equivalent to SPECT in accuracy, and superior in spatial resolution. CT perfusion imaging is likely to become more widely available as an easy-to-perform technique for assessing cerebral perfusion in a patients with moyamoya disease.

Induction of canine pyometra by inoculation of Escherichia coli into the uterus and its relationship to reproductive features.

To characterize oestrus-related factors affecting the induction of and recovery from pyometra in bitches, 60 clinically healthy beagle bitches were used for induction of pyometra by inoculation of Escherichia coli into the uterus during oestrous and metoestrous stages. The animals were classified into the following six groups according to inoculation time: Days 1-10, 11-20, 21-30, 31-40, 41-50 and 51-60 after LH surge. The incidence of pyometra during the periods Days 11-20 and 21-30 after LH surge was 90.9% and 78.9% respectively, while that during Days 1-10 and 51-60 after LH surge was less than 20%, and the patterns of the incidence of pyometra and the serum progesterone levels were similar. There was no difference in the incidence of pyometra induced in bitches less than 5 years old compared to bitches over 6 years old. Oestrus in all of the bitches with pyometra induced by E. coli returned with or without PGF 2alpha treatment, unlike in bitches with spontaneous pyometra. The duration of the oestrous cycle in the non-treated and PGF 2alpha-treated groups was 231.4+/-55.2 days and 162.1+/-40.6 days (P < 0.001), respectively, and there was no difference in the rate of return of oestrus between the two groups. The conception rate in all of the bitches in which oestrus had returned was 81.8%. The above findings indicate that the period during which severe pyometra could be induced was limited to the early stage in metoestrus.

Antisense oligonucleotide against 47-kDa heat shock protein (Hsp47) inhibits wound-induced enhancement of collagen production.

It is well known that excessive collagen synthesis during the wound-healing process causes scar formation. Our recent in-vivo study indicates that antisense treatment against 47-kDa heat shock protein (Hsp47), a collagen-specific molecular chaperone, relieves scar formation following skin wounds in rats [Wang et al., Plast. Reconstr. Surg., in press]. In order to understand the mechanism of this phenomenon, we examined the effects of antisense treatment on the expression of mRNAs and proteins of Hsp47 and collagens in fibroblasts derived from wounded rat tongues. Hsp47 and procollagen alpha1(I) and alpha1(III) mRNAs were consistently increased after wounding and were maximal at day 5 post-injury. Treatment with antisense oligonucleotide against Hsp47 efficiently blocked the production of procollagen alpha2(I) and alpha1(III) proteins, but had little effect on their mRNA levels. Therefore, we conclude that antisense oligonucleotide against Hsp47 inhibits the production of procollagen type I and III proteins in fibroblasts derived from wounded tongues, overcoming the increase in their mRNAs.

Endovascular treatment of basilar tip aneurysms associated with moyamoya disease.

We report the efficacy and safety of endovascular treatment of basilar tip aneurysms (BTA) in five patients with moyamoya disease. The patients underwent intra-aneurysmal embolisation with detachable platinum coils. Three BTA presented with subarachnoid haemorrhage (SAH); the other two were asymptomatic. In four cases, one embolisation procedure produced >95% angiographic obliteration of the aneurysm. In the other patient, 80-90% obliteration was achieved initially, but due to growth of the residual aneurysm, the procedure was repeated 7 months later. Two patients experienced transient oculomotor paresis as a procedure-related complication. Mean follow-up was 43.6+/-34.0 months (range 8-92 months). One patient died of putaminal haemorrhage unrelated to the aneurysm 15 months after embolisation. The other four had no subsequent SAH and survived without sequelae. Endovascular embolisation using detachable platinum coils proved to be a safe and efficient treatment modality for BTA associated with moyamoya disease.

Endoscopic ventriculo-cystomy for non-communicating hydrocephalus secondary to quadrigeminal cistern arachnoid cyst.

INTRODUCTION: Intracranial arachnoid cysts are developmental, anomalous collections of cerebrospinal fluid (CSF), and occasionally cause symptoms when large enough to obliterate the CSF outflow pathway and give rise to non-communicating hydrocephalus. The treatment of choice for symptomatic arachnoid cysts has been surgical excision or fenestration of the cyst, but less invasive endoscopic fenestration has been attempted with favorable preliminary results. CASE REPORT: We report a case of non-communicating hydrocephalus caused by a quadrigeminal cistern arachnoid cyst in a 35-year-old woman who presented with worsening headaches. She was successfully treated by endoscopic third ventriculostomy and fenestration of the cyst (ventriculo-cistomy). DISCUSSION: Endoscopic fenestration of symptomatic arachnoid cysts can be as effective as open surgery in terms of short-term efficacy, and it is certainly less invasive than open surgery. However, its long-term outcome remains unknown, and these rare cases require careful clinical and radiological follow-up.

Efficient selection of genomic clones from a female chicken bacterial artificial chromosome library by four-dimensional polymerase chain reactions.

A bacterial artificial chromosome (BAC) library consisting of 49,152 genomic clones was constructed from partially HindIII-digested female chicken embryo genomic DNA using the pBAC-Lac vector and maintained in 512 96-well plates. The mean insert size was approximately 150 kb, and the total library was estimated to contain about 3.2 times coverage of the diploid genome. In order to screen this library by the PCR, 296 BAC clone DNA samples were prepared: one sample each from 8 superpools (64 plates per superpool) and 36 samples of four-dimensionally (4-D) mixed clones from each superpool. A BAC clone of interest was selected by two-step PCR. First, 8 DNA samples representing superpools were subjected to PCR with a set of primers to amplify a part of the genomic sequence of interest. Second, 36 4-D DNA samples from the superpool that contained BAC clone(s) of interest were subjected to PCR with the same set of primers. The second step identified a plate and a well containing the BAC clone of interest. Selection of target BAC clone(s) from the whole library with the above procedure can be achieved within 1 to 4 d without using a radioactive probe. This procedure was applied successfully in the selection of BAC clones for Wpkci, chPKCI/HINT, ZOV3, and 17beta-HSD genes.

Gray-scale and Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis.

PURPOSE: To describe the gray-scale and color Doppler ultrasound imaging features of vascular canals in human femoral condylar epiphysis. MATERIAL AND METHODS: Vascular canals in the femoral condylar epiphysis were examined using gray-scale and Doppler US. The study was performed in 45 volunteers (aged <1 month-72 years) who comprised 1 subject with short stature, 1 subject with Klippel-Trenaunay-Weber syndrome and 43 subjects with normal growth. RESULTS: In the 8-year-old and younger group (n=34), vascular canals were observed in 32 subjects (94%), whereas vascular canals were not observed in the 9-year-old and older group (n=11). Vascular canals were visualized as hyperechoic lines and dots. With Doppler US, blood flow in the vascular canals was observed in 20 of the 32 subjects (62.5%). Spectral Doppler analysis was possible in 15 subjects, in all of whom only arterial waveforms were observed. CONCLUSION: US was helpful to delineate the vascular canals and flow therein. The detection and evaluation of vascular canals and blood flow therein may prove useful in understanding growth.