Intraoperative transesophageal echocardiography was compared with epicardial echocardiography after ventricular septal defect repair. This comparison was made in 18 children aged 7 to 137 months (median, 32 months), weighing 6.3 to 49.1 kg (median, 10.8 kg) from November 1989 to January 1991. Ventricular septal defect types were perimembranous (six), malalignment (seven), supracristal (three), midmuscular (one), and inlet (one). Eight children had isolated ventricular septal defects, four had tetralogy of Fallot, three had double outlet right ventricle, two had double chambered right ventricle, and one had pulmonary stenosis. Patch interrogation was complete in 17 of 18 transesophageal echocardiography and 16 of 18 epicardial echocardiography studies. Inability to fully interrogate the ventricular septal defect patch by epicardial echocardiography occurred in two children as a result of anterior ventricular septal defect location, limited epicardial exposure, and surgical hardware interference. Incomplete transesophageal echocardiography patch interrogation occurred in the child with the midmuscular ventricular septal defect. Seven residual ventricular septal defects were documented by color flow Doppler in six patients. Five of seven residual defects were demonstrated by both real-time transesophageal echocardiography and epicardial echocardiography imaging. Transesophageal echocardiography and epicardial echocardiography missed 1 and 7 defects, respectively. The missed defects were different with each technique and were confirmed by postoperative surface echocardiography. No residual defects of sufficient size to require reoperation were found as determined by combination color flow jet analysis and intraoperative oximetry (no pulmonary to systemic flow ratio was greater than 1.50). Patches caused two-dimensional and Doppler signal masking, but this was not limiting because all residual defects were found at the margins of the ventricular septal defect patch.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

PubMedDate not supplied

Polyclonal carcinoembryonic antigen staining in the cytologic differential diagnosis of primary and metastatic hepatic malignancies.

In order to assess the utility of immunocytochemical staining of bile canaliculi with a polyclonal antiserum to carcinoembryonic antigen (pCEA) in the differentiation of primary hepatocellular carcinomas from metastatic malignancies, pCEA staining was performed on fine needle aspiration specimens from hepatic lesions in 60 patients. The original cytologic diagnoses were hepatocellular carcinoma in 22 patients, metastatic neoplasm or cholangiocarcinoma in 27 patients and benign hepatocytes in 11 cases. The cytologic diagnoses of malignancy were confirmed by surgical excision, autopsy or clinical investigations in 82% of the patients. Follow-up data, supported by pCEA staining, reversed the original cytologic diagnosis in three cases. Bile canalicular pCEA staining was identified in 18 of 22 cases of hepatocellular carcinoma and in all 11 benign hepatocellular aspirates. All 27 cases of metastatic malignancy or cholangiocarcinoma were negative for canalicular pCEA staining, although 11 cases exhibited cytoplasmic staining. Interpretation of pCEA staining was not affected by the intermingling of malignant cells and benign hepatocytes. Predictive values were 100% for a positive test and 87% for a negative test. These findings indicate that staining with pCEA antiserum is a useful adjunct in the differential cytologic diagnosis of malignant hepatic lesions.

Adenocarcinoma↗

PubMedDate not supplied

Fine needle aspiration cytology of fibrolamellar hepatocellular carcinoma.

The major cytologic features seen in fine needle aspirates from two cases of fibrolamellar hepatocellular carcinoma were: liver-like tumor cells, characterized by plump, polygonal forms with eosinophilic, granular cytoplasm; large oval nuclei with extremely prominent solitary nucleoli; and parallel bands of fibrous tissue and fibrocytes seen within the tumor fragments. Other helpful features included intracytoplasmic hyaline globules and well-delineated pale bodies. Clinically, the tumors occurred in young patients with noncirrhotic livers and ran a more favorable course than do other types of hepatocellular carcinoma.

Biopsy, Needle↗

PubMedDate not supplied

Some cytologic features of hepatocellular carcinoma as seen in fine needle aspirates.

Cytologic study of fine needle aspirates in 15 cases of hepatocellular carcinoma revealed the following cellular patterns in order of decreasing frequency: trabecular, acinar and anaplastic. The most useful cytologic criteria for the identification of hepatocellular carcinoma were the similarity of tumor cells to liver cells, the prominence of nucleoli and the frequent presence of a trabecular pattern. Our study showed that the cellular changes seen in aspirated material faithfully reflect the histologic alterations seen in tissue sections. Hence, familiarity with the histology of hepatocellular carcinoma is of tremendous value in the interpretation of cytologic material.

Adenocarcinoma↗