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BACKGROUND: The purpose of this study was to characterize the circuit of macroreentrant right atrial tachycardia (MacroAT) in patients after surgical repair of congenital heart disease (SR-CHD). METHODS AND RESULTS: Sixteen patients with atrial tachycardia (AT) after SR-CHD were studied (atrial septal defect in 6, tetralogy of Fallot in 4, and Fontan procedure in 6). Electroanatomic right atrial maps were obtained during 15 MacroATs in 13 patients, focal AT in 1 patient, and atrial pacing in 2 patients without stable AT. A large area of low bipolar voltage (/=2 scars forming narrow channels. Ablation within the channels eliminates MacroAT.

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PURPOSE: To demonstrate the anatomy of the female pelvic floor with endovaginal magnetic resonance (MR) imaging. MATERIALS AND METHODS: Ten healthy nulliparous volunteers (age, 22-26 years) underwent MR imaging with an endovaginal coil. Findings on endovaginal MR images in the volunteers were correlated with findings on endovaginal MR images and cross-sectional anatomic slices obtained in three cadavers. RESULTS: The endovaginal coil was well tolerated by all volunteers. Pelvic floor structures such as the pelvic diaphragm and the urogenital diaphragm were well depicted. Previously undescribed urethral supporting structures--the periurethral and paraurethral ligaments--were visualized. The zonal anatomy of the urethra was clearly visible. The endovaginal MR imaging findings in the volunteers correlated with the endovaginal MR findings and gross anatomy in the cadavers. CONCLUSION: Endovaginal MR imaging clearly demonstrates the anatomy of the female pelvic floor and urethra.

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The products of metabolism of the sulphates (0.5 micromol/l) of androsterone, dehydroepiandrosterone (DHA) and 5alpha-androst-16-en-3beta-ol have been investigated after incubation with 72 h cultures of human axillary bacterial isolates for 3 days at 37 degrees C. The medium used, tryptone soya broth (TSB), contained yeast extract and Tween 80. The isolates used were Coryneform F1 (known previously to metabolize testosterone and to be involved in under-arm odour (UAO) production, i.e. UAO +ve), Coryneform F46 (inactive in both the testosterone metabolism and UAO tests, i.e. UAO -ve) and Staphylococcus hominis/epidermidis (IIR3). Control incubations of TSB alone, TSB plus each of the steroid sulphates and TSB plus each of the bacterial isolates were also set up. After termination of reactions and addition of internal standards, 5alpha-androstan-3beta-ol and 5alpha-androstan-3-one (50 ng each), extracted and purified metabolites were subjected to combined gas chromatography-mass spectrometry with specific ion monitoring. Steroidal ketones were derivatized as their O-pentafluorobenzyl oximes; steroidal alcohols (only androst-16-enols in this study) were derivatized as their tert-butyldimethylsilyl ethers. Analysis was achieved by negative ion chemical ionization mass spectrometry for the pentafluorobenzyl oximes at [M-20]- and electron impact positive ion mass spectrometry for the tert-butyldimethylsilyl ethers at [M-57]+. The incubation broth contained two compounds which had gas chromatographic and mass spectrometric properties identical to those of DHA and 4-androstenedione. It was not possible, therefore, to show unequivocally that DHA sulphate (DHAS) was converted microbially into DHA, although this is implied by the finding of small quantities of testosterone and 5alpha-dihydrotestosterone in incubations with F1. With androsterone S, no free androsterone was recorded and only very small (5 pg or less) amounts of testosterone. Two odorous steroids, androsta-4,16-dien-3-one and 5alpha-androst-2-en-17-one (Steroid I) were formed (mean quantities 40 and 45 pg, respectively). The sulphate of 5alpha-androst-16-en-3beta-ol was metabolized with F1 into large quantities of the odorous steroids, 5alpha-androst-16-en-3-one and Steroid I. In addition, much smaller quantities of androsta-4,16-dien-3-one were formed. In contrast, incubations of DHAS with F46 resulted in no metabolites except, possibly, DHA, but the sulphate moiety of androsterone S was also cleaved to yield the free steroid together with large amounts of Steroid I. In incubations of DHAS and androsterone S with F1, no 16-unsaturated steroids were formed, although 5alpha-androst-16-en-3beta-yl S was de-sulphated and the free steroid further metabolized. No evidence was obtained for androst-16-ene metabolism in incubations with F46. In incubations with S. hominis/epidermidis (IIR3), androsterone S was converted into androsterone and, in high yield, to Steroid I plus some 5alpha-androst-16-en-3-one. Both DHAS and androsterone S were converted into androst-16-enols. Sulphatase activity was also manifested when 5alpha-androst-16-en-3beta-yl S was utilized as substrate with IIR3, large quantities of Steroid I and 5alpha-androst-16-en-3-one being formed, together with further metabolism of androst-16-enes. In view of the fact that both DHAS and androsterone S occur in apocrine sweat, the metabolism of these endogenous substrates by human axillary bacteria to several odorous steroids may have important implications in the context of human odour formation.

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BACKGROUND: Typical atrial flutter (AFL) results from right atrial reentry by propagation through an isthmus between the inferior vena cava (IVC) and tricuspid annulus (TA). We postulated that the eustachian valve and ridge (EVR) forms a line of conduction block between the IVC and coronary sinus (CS) ostium and forms a second isthmus (septal isthmus) between the TA and CS ostium. METHODS AND RESULTS: Endocardial mapping in 30 patients with AFL demonstrated atrial activation around the TA in the counter-clockwise direction (left anterior oblique projection). Double atrial potentials were recorded along the EVR in all patients during AFL. Pacing either side of the EVR during sinus rhythm also produced double potentials, which indicated fixed anatomic block across EVR. Entrainment pacing at the septal isthmus and multiple sites around the TA produced a delta return interval < or = 8 ms in 14 of 15 patients tested. Catheter ablation eliminated AFL in all patients by ablation of the septal isthmus in 26 patients and the posterior isthmus in 4. AFL recurred in 2 of 12 patients (mean follow-up, 33.9 +/- 16.3 months) in whom ablation success was defined by the inability to reinduce AFL, compared with none of 18 patients (mean follow-up, 10.3 +/- 8.3 months) in whom success required formation of a complete line of conduction block between the TA and the EVR, identified by CS pacing that produced atrial activation around the TA only in the counterclockwise direction and by pacing the posterior TA with only clockwise atrial activation. CONCLUSIONS: (1) The EVR forms a line of fixed conduction block between the IVC and the CS; (2) the EVR and the TA provide boundaries for the AFL reentrant circuit; and (3) verification of a complete line of block between the TA and the EVR is a more reliable criterion for long-term ablation success.

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A 71-year-old woman was admitted to our hospital with jaundice after she had been using terbinafine for a few weeks. The liver function tests showed a mixed cholestatic-hepatocellular pattern. A liver biopsy revealed large amounts of intracellular bile pigment. Causes of the liver disorder other than the use of the aforementioned antimycotic drug were excluded. Ten months after cessation of the drug the patient had recovered completely. The Netherlands Inspectorate for Health Care received 20 reports of liver enzyme elevations due to terbinafine in 1991-1994.

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We have characterized 13 different human ovarian cancer xenografts grown subcutaneously in nude mice. The tumor lines represented 5 histological subtypes: serous (4), mucinous (4), clear-cell carcinoma (1), carcinosarcoma (1) and undifferentiated (3). The specific histology and the degree of differentiation resembled those of the original patients' tumors and were maintained upon serial transfer. Volume doubling times of the xenografts ranged from 3.5 to 15 days. The xenografts were also analyzed for their antigen expression using 20 monoclonal antibodies (MAbs) reactive with 15 tumor-associated antigens. Immunohistochemical examination of tissue sections showed a positive reaction pattern with MAbs 115D8, 140C1, 139H2, 175C5, HMFG1 and HMFG2, each recognizing episialin, as well as with MAbs AUA1, 358.4.32 and 199-157 in xenografts of the serous, mucinous and clear-cell carcinoma subtype. MAb OC125 was reactive with xenografts of the serous subtypes. Other antibodies, such as 494 and OV-TL3 infrequently demonstrated positive reactions. Reactivity of all MAbs was low in the carcinosarcoma and undifferentiated tumor lines. With the exception of AUA1, 495 and 126E5, all MAbs revealed a heterogeneous staining pattern. MAbs against episialin and OC125 predominantly stained the apical site of the tumor cells. Strongest reactivity with almost all histological subtypes was observed with MAbs 115D8, 140C1, 139H2 and AUA1. In cases where we were able to compare the patients' tumor tissue with the respective xenografts, retention of antigen expression was demonstrated in each instance. Release of tumor-associated antigens was shown for CA125 in 2 serous-tumor lines, for CA15.3 in 1 serous-tumor line, and for CEA in 3 lines of the mucinous subtype. This panel of human tumor xenografts could be a valuable tool to determine the potential usefulness of MAb-guided therapy in ovarian cancer.

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It is generally accepted to consider vulvar intraepithelial neoplasia grade III (VIN III) a premalignant condition. The lesion is more frequently diagnosed in younger patients. Conventional surgical treatment is often mutilating and recurrence rates have been reported of approximately 30%. Laser vaporization is a promising alternative therapy. Ten patients with VIN III were treated with CO2 laser. Two patients were retreated with laser for residual disease, and two patients for recurrent disease. One failure was observed, and one patient was off-study. In all patients excellent cosmetic results were obtained. Laser vaporization appears to be an effective and nonmutilating therapy, and preferable for young VIN patients.

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We report the results of a bronchoalveolar lavage (BAL) in a patient suspected of interstitial lung disease and/or malignancy. The recovered cells from the lavage were characteristic of a high intensity alveolitis as seen in sarcoidosis. However, some adenocarcinoma cells were also found. The significance of these findings could be (a) that some immune response against this pulmonary malignancy may exist, and (b) that BAL can be used as a valuable tool to characterize the alveolitis of sarcoidosis, but carefully cytologic examination of BAL cells should be performed to exclude other causes of interstitial lung disease with an associated lymphocytic alveolitis.

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Data from two regional diethylstilbestrol clinics for colposcopic evaluation of young women with a history of diethylstilbestrol exposure in utero are presented: A total of 224 subjects with a well-documented history were enrolled in this study. Structural anomalies of the cervix and vagina were found in 30%. Vaginal epithelial changes were colposcopically observed in 65%, including vaginal adenosis in 22%. The prevalence rate of abnormal cytologic findings in the study group was 9%. In half of these patients a low-grade intraepithelial neoplasia of the cervix and vagina was found. It was concluded that colposcopy in diethylstilbestrol-exposed offspring in inexperienced hands can result in many unnecessary biopsies. Therefore colposcopic examination should be performed by expert colposcopists in referral diethylstilbestrol centers.

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The Melkersson-Rosenthal syndrome is a rare disease consisting of orofacial swellings, facial nerve palsy and plicated tongue. The etiology is unknown. On histopathological examination a characteristic granulomatous inflammation is found. A case of this syndrome in a young white female with seronegative oligoarthritis is described and the possible relationship between the two diseases is discussed on the basis of the literature.

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The differential diagnosis between solid teratomas and malignant mixed Müllerian tumors (MMTs) can be difficult, because both tumours have an epithelial as well as a mesenchymal component. Sometimes an MMT is incorrectly diagnosed as a solid teratoma. This has prognostic and therapeutic consequences, because MMTs have a worse prognosis. In this study 20 solid ovarian teratomas and 15 MMTs of the ovary have been compared according to their clinical, histomorphological, and immunocytochemical characteristics. Teratomas occur in the younger age group and are characterized by the presence of argyrophil cells which are immunoreactive to a wide range of neurohormonal peptides and are in addition characterized by the presence of GFAP immunoreactive tissues (glial fibrillar acidic protein). MMTs occur in the older age group and are characterized by the presence of sarcomatous elements and by the absence of an organoid arrangement, neuroectoderm, skin, argyrophilia, and immunoreactivity to GFAP and neurofilament.

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The prevalence of Chlamydia trachomatis infection in a population of women with no symptoms of sexually transmitted disease was investigated. These women, aged 35-55 years, participated in a screening program for cervical cancer. With the use of a direct immunofluorescence method, 109 out of 2,470 smears tested were positive for Chlamydia trachomatis, indicating an overall prevalence of 4.4%. No changes in prevalence were found when five-year cohorts of this group were analyzed, indicating that age-dependent changes or epidemiological factors do not result in a different (decreased) prevalence over the ages 35 to 55 years. The prevalence of Trichomonas vaginalis and fungi, as detected by cytological screening, was lower than that observed for Chlamydia trachomatis: 3.1 and 2.1%, respectively. Of the 109 smears positive for Chlamydia trachomatis, 90 showed cervical cells with reactive changes (out of 1,490 smears with PAP II), whereas no cytological changes were found in 15 cases (out of 884 smears with PAP I). Changes suggestive of mild or moderate dysplasia were found in only four cases (out of 93 smears with PAP III). The results indicate that Chlamydia trachomatis is associated with reactive changes of endocervical cells and raise serious questions about whether prevention of possible secondary effects such as infertility and pelvic inflammatory disease can be achieved by a combined screening program for cervical cancer and Chlamydia trachomatis.

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Solitary pulmonary hamartomas are the most common benign tumors of the lung, and have to be distinguished from primary or secondary malignant pulmonary lesions. The data of 20 patients operated for a solitary hamartoma of the lung are presented with special attention to the diagnostic methods which can contribute to the diagnosis. To avoid a surgical procedure, CT-densitometry and fine-needle aspiration biopsy have become of major interest for the diagnosis of hamartoma. Using in succession chest X-rays, CT-densitometry and fine-needle aspiration biopsy, a conservative approach can be advised in specific cases. However, exploratory thoracotomy is mandatory when a patient presents with a solitary pulmonary lesion of more than 2.5 cm or when the lesion shows a tendency to grow.

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A patient with persistent intraepithelial neoplasia of the vulva, vagina and cervix was treated with subcutaneous injections of interferon-alpha-2b. Previous surgical and laser procedures had failed. HPV subtype 16 was found in biopsies from all sites and an immunological screening was performed before and after therapy. Histologically proven regression of the intraepithelial neoplasia was seen at all sites, with a complete remission of the cervical lesions. The role of interferon in treatment of intraepithelial neoplasia is discussed.

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A patient with silver earring backings, embedded in the ear lobes for several years, developed blue macules of localized argyria on both sides.

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CT-scan findings of the brain in two children with true histiocytic sarcoma are described as well as their changes during therapy. Clinical features and differential diagnosis on CT-scan examination are discussed. Follow-up CT-scan during therapy is of value as an indicator of the response to therapy and possibly the long term prognosis.

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