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Fenestrations in endothelium of rat liver sinusoids revisited by freeze-fracture.

The freeze-fracture appearance of fenestrations of sinusoidal endothelial cells has been reassessed in perfusion-fixed rat liver. Fenestrations, limited to the attenuated portions of the endothelial cell cytoplasm are usually round or oval in shape, with diameters ranging from 40-600 nm. Within a given fenestrated region, they are disposed in clusters forming sieve plates. In addition, the presence of wide, irregularly shape openings suggest that adjacent fenestrations may coalesce and result in the larger openings. Our data thus confirm the existence of both small and large fenestrae in the endothelial wall, in contradistinction to previous studies showing only regular, medium sized (100 nm) openings.

Animals↗

Microvasculature of the mouse epididymis, with special reference to fenestrated capillaries localized in the initial segment.

The blood supply, microvasculature, and ultrastructure of the capillaries in the epididymis in adult mice were regionally examined. The epididymal duct of the initial segment is surrounded with a dense network of fenestrated capillaries running just under the epithelium. The other segments have loose networks of nonfenestrated capillaries running in the interductal connective tissue. The fenestration of capillaries in the initial segment was markedly reduced in frequency immediately after cutting the efferent duct. In adult mice which were subjected to cutting of the efferent duct neonatally, the dense capillary network did not develop, and fenestrated capillaries were absent in the initial segment. We interpret our results to indicate that the fenestrated capillaries in the initial segment provide for absorption of the testicular fluid and that their development is dependent upon the testicular fluid entering the epididymal duct.

Animals↗

Mucosal function after ileal mucosal fenestration and colonic autotransplantation.

A method of small bowel mucosal augmentation called ileal mucosal fenestration and colonic autotransplantation (IMFCA) was devised and tested in pigs. In this technique, a vascularized mucosal graft was harvested from a 12-cm ileal loop, fenestrated by serial incision and then expanded to 20 cm. A 20-cm colonic loop was isolated and surgical mucosectomy was carried out. The fenestrated ileal mucosal graft was then autotransplanted into the prepared colon and the resulting composite structure was exteriorized as a Thiry-Vella loop. With this technique, ileal mucosal fenestrations healed by lateral epithelial in-growth, giving a new mucosal continuum within the recipient colon. At 60 days after surgery, the surface area of transplanted mucosa exceeded that within the original ileal loop by approximately 85 per cent. At this time, the transplanted mucosa had morphology and capacity for Na(+)-dependent glucose transport which were indistinguishable from those of control ileal mucosa.

Animals↗

Fenestration of the superior medullary velum as treatment for a trapped fourth ventricle: a feasibility study.

We developed a novel approach for fenestration of the trapped fourth ventricle utilizing the superior medullary velum (valve of Vieussens). Trapped fourth ventricles, which are seen often in the pediatric hydrocephalic population, are troublesome entities surgically. A right burr hole was carried out in 10 adult cadavers with no gross intracranial pathology and the superior medullary velum was fenestrated to the quadrigeminal cistern with the aid of an endoscope. This technique was carried out easily in all cadaveric specimens. With endoscopy, no vascular insult was appreciated either before or after fenestration of the superior medullary velum. These preliminary findings demonstrate that fenestration of the superior medullary velum may provide a good alternative to the present therapy of shunting trapped fourth ventricles, a therapy wrought with complications.

Aged↗

Fenestrated Amplatzer device for percutaneous creation of interatrial communication in patients after Fontan operation.

A customized Amplatzer septal device with a 5 mm fenestration was used to create an interatrial communication in two patients with previous Fontan operation and clinical indication for fenestration. At follow-up, device fenestration was occluded in both patients. In both patients, the device fenestration was reopened and patency maintained by placement of two stents within the communicating channel.

Adult↗

Percutaneous fenestration of dissecting intima with a transseptal needle. A new therapeutic technique for visceral ischemia complicating acute aortic dissection.

Noncardiac visceral ischemia is a major complication with acute aortic dissection and is caused by obstruction of the major visceral arteries by dissecting intima. Two patients with this condition underwent emergency percutaneous fenestration of dissecting intima, and the blood flow to the lower extremity and kidney was restored. A transseptal needle and peripheral angioplasty balloon catheter were used for fenestration. There were no associated complications in either patient. One patient was treated medically and another had ascending aortic replacement surgery the day after percutaneous fenestration. Clinical follow-up of 10 and 5 months, respectively, revealed good clinical outcomes. Percutaneous fenestration should be considered the treatment of choice for visceral ischemia due to acute aortic dissection.

Aortic Dissection↗

Percutaneous fenestration closure with problematic residual native atrial septum.

A variety of techniques have been utilized to close Fontan fenestrations. Among 20 patients who underwent a cardiac catheterization for fenestration closure, 3 patients had residual native atrial septum, forming an additional intermediate chamber on the pulmonary venous side of the fenestration. Three different methods were used to close these fenestrations.

Adolescent↗

Identification of fenestrated capillary segments in microvascular corrosion casts of the rat exocrine pancreas.

The capillary bed of the rat exocrine pancreas was studied by scanning and transmission electron microscopy of corrosion casts and tissue sections. Two types of capillaries were distinguished in corrosion casts. First, there were straight capillaries of relatively constant width (mean diameter 4.79 +/- 0.87 microns), which were characterized by numerous circular constrictions on their surface. About 37% of the capillaries belonged to this type. Second, there were undulating capillaries which showed smooth surfaced eccentric dilatations defined by similar surface constrictions. The bulging areas measured 8.43 +/- 1.33 microns, the constrictions next to the bulges figured for 6.45 +/- 1.53 microns. About 63% of the capillaries belonged to the second type. Two types of capillaries were also identified in tissue sections. First, there were capillaries with continuous endothelial lining (26% of capillary profiles; mean diameter 5.48 +/- 1.67 microns); 27% of their endothelial lining was provided with underlying pericytes. Second, there were capillaries with fenestrated endothelium (64% of capillary profiles; mean diameter 6.16 +/- 1.75 microns); 12% of their endothelial lining was accompanied by pericytes. According to frequency and dimension of these two types of capillaries, we conclude that bulged and undulating capillary casts correspond to fenestrated capillaries and straight capillary casts of constant width correspond to nonfenestrated capillaries. The frequency of crests on the surface of capillary casts correlates with the different frequency of pericyte processes on fenestrated and nonfenestrated capillaries. It is concluded that pericyte processes beneath the endothelium hold resistance against luminal pressure. Bulging areas of capillary casts correlate with fenestrated areas of endothelial lining, that is, areas which are not reinforced by pericyte processes.

Animals↗

Laparoscopic fenestration of a giant simple hepatic cyst. Case report and technical considerations.

The management of symptomatic large, simple hepatic cysts has evolved toward the use of wide unroofing or "fenestration" in instances where patients are not rendered asymptomatic by percutaneous aspiration. We report adoption of the technique of fenestration of such hepatic cysts to the laparoscopic route. Laparoscopic fenestration appears able to accomplish all of the aims of transabdominal fenestration in appropriately selected patients.

Cysts↗

Fenestration of the Fontan circuit as treatment for plastic bronchitis.

Plastic bronchitis is a rare, potentially life-threatening condition in which protein casts form within and occlude the bronchus, resulting in pulmonary failure, and has been identified as a complication after the Fontan procedure. We present a case of a 5-year-old girl who had undergone an extracardiac fenestrated Fontan repair as a component of staged palliation for tricuspid atresia. Six weeks following surgery, the patient presented with airway obstruction, coughing a bronchial cast. Medical therapies to optimize heart function and attempt to control cast formation were implemented, with little clinical impact. Following cardiac catheterization to stent open the fenestration, the symptoms of plastic bronchitis resolved. Cast expectoration recurred following spontaneous closure of the stented fenestration and again resolved with recreation of the baffle defect. Fenestration of the Fontan circuit alters hemodynamics, thereby providing an additional therapeutic option for this devastating disorder.

Airway Obstruction↗

Successful cystic fenestration for a macrocystic serous cystadenoma of the pancreas causing obstructive jaundice: report of a case.

A 72-year-old man was admitted to our hospital for investigation of jaundice. We made a preoperative diagnosis of macrocystic serous cystadenoma (SCA) of the pancreas, but did not perform palliative choledochojejunostomy because aspiration of the pancreatic cystic fluid caused the cysts to shrink and relieved the compressive stenosis of the common bile duct (CBD) during the operation. Frozen sections of the cyst wall taken by incision biopsy showed no signs of malignancy. Therefore, we performed fenestration of the cystic wall after fixing the inner epithelium of the cyst with 100% ethanol and aspirating the cystic fluid. Cholangiography after the cystic fenestration showed resolution of the CBD stenosis and abdominal computed tomography (CT) confirmed the disappearance of the pancreatic cysts. No recurrence of cystic swelling or obstructive jaundice has been detected by abdominal CT or laboratory data for more than 2 years since the cystic fenestration. Thus, cystic fenestration may be a better palliative option for treating benign compressive tumors such as macrocystic SCA of the pancreas causing obstructive jaundice.

Aged↗

Conversion of the hemi-Fontan procedure to fenestrated total extracardiac cavopulmonary bypass.

BACKGROUND: Arrhythmias occur frequently after Fontan operations, and are related in part to high atrial pressure, wall distention, and scarring caused by extensive suture lines. These arrhythmic factors may be avoided by an extracardiac total cavopulmonary anastomosis. We have embarked on a program of conversion of the hemi-Fontan operation to a fenestrated extracardiac Fontan procedure with a relatively simple operation. METHODS: In a 4-month period ending in December 1994, 4 consecutive patients underwent this procedure. The inferior vena cava was divided and the cardiac end was oversewn. A large (20 to 25 mm) ascending aortic homograft, from which the inlet portion and valve had previously been excised, was interposed between the divided distal end of the inferior vena cava and the hood of the superior cavopulmonary anastomosis. A 4-mm fenestration with a pursestring snare mechanism was placed within the cavoatrial patch that had been implanted at the time of the hemi-Fontan procedure. RESULTS: There were no deaths, and the average length of stay was 12 +/- 4 days (range, 8 to 18 days). In early follow-up, there have been no atrial arrhythmias, and three of the four fenestrations have been documented to be patent. CONCLUSIONS: An extracardiac fenestrated Fontan procedure can safely and successfully be performed after a hemi-Fontan operation, and may have both hemodynamic and arrhythmic benefits.

Child↗

Anionic sites on the luminal surface of fenestrated and continuous capillaries of the CNS.

We injected intravenously cationic ferritin, pI 8.4, and studied patterns of labeling of the luminal surface of capillaries in the CNS of rats. Cationic ferritin consistently labeled the luminal aspect of the diaphragms of fenestrated capillaries in the choroid plexus, median eminence and pineal. No other feature of these endothelial cells was consistently labeled. Diaphragms spanning the mouths of vesicles open to the lumen were not labeled. Occasional ferritin molecules were seen in the BL of these fenestrated vessels. The luminal surfaces of endothelial cells of the continuous capillaries of the brain, and of reactive capillaries proliferating in a region of cold injury necrosis, were not labeled. Ferritin was not seen in cytoplasmic structures or the basal lamina of these vessels. The findings in the fenestrated capillaries of CNS are in agreement with those reported for other fenestrated endothelia. The absence of labeling of the continuous capillaries of the blood-brain barrier differs from findings reported for other continuous capillaries, with the exception of the blood-air barrier portions of lung capillaries.

Animals↗

Liver resection and cyst fenestration in the treatment of severe polycystic liver disease.

BACKGROUND/AIMS: There is limited information on treatment options for massive, highly symptomatic polycystic liver disease. The aim of the study was to analyze the immediate and long-term outcome of combined liver resection and fenestration. METHODS: Information was abstracted from medical records. Follow-up was obtained by mailed questionnaire. Liver volume was quantified by computed tomography. RESULTS: Thirty-one patients underwent liver resection and fenestration between July 1985 and June 1993. Mean liver volume was 9357 mL before and 3567 mL after surgery. There was one death from postoperative intracerebral bleed. Eighteen patients experienced complications, usually transient pleural effusions or transient ascites. Twenty-eight of 29 surviving patients with adequate follow-up have experienced immediate and sustained relief of symptoms and improvement in quality of life. After median follow-up of 2.4 years (range, 0.2 to 7.9 years), most patients have not had clinically significant enlargement of the liver. Sequential computed tomography scans before and after surgery suggest that hepatic enlargement in the age range of the patients in the study mainly resulted from the expansion of existing cysts rather than from the development of new cysts. CONCLUSIONS: Selected patients with severe symptomatic polycystic liver disease and favorable anatomy benefit from liver resection and fenestration with acceptable morbidity and mortality. The extent of hepatic resection and fenestration is important for the long-term effectiveness of this procedure.

Adult↗

Anionic sites in basement membranes. Differences in their electrostatic properties in continuous and fenestrated capillaries.

We have used ruthenium red, a cationic dye, to detect at the electron microscopic level the presence of anionic sites in various murine basement membranes, with particular emphasis on those of the microvasculature. We have observed anionic sites in all continuous and fenestrated capillaries examined. Terminal lymphatics, which have a discontinuous basement membrane, have sites only where the basement membrane is present. Anionic sites are not present beneath sinusoidal lining cells of the liver which lack a basement membrane. Basement membranes of epithelial cells and those surrounding striated and smooth muscle cells, pericytes, fat cells, and Schwann cells also exhibit anionic sites. We compared the electrostatic properties of anionic sites in basement membranes of continuous and fenestrated capillaries by determining the salt concentration (critical electrolyte concentration, Scott and Dorling, 1965) required to displace ruthenium red from the sites. A concentration of 0.5 M Na+ was required to displace ruthenium red from the basement membrane of continuous capillaries of muscle whereas 1.3 M Na+ was required to displace ruthenium red from the basement membrane of fenestrated peritubular capillaries of the renal cortex. Our results suggest that anionic sites in the basement membrane of fenestrated peritubular capillaries are more strongly negatively charged than those in the basement membrane of continuous capillaries of muscle. We conclude from this study, first, that anionic sites are a general property of vascular, epithelial, and pericellular basement membranes and, second, that the electrostatic properties of the sites differ in different vascular basement membranes. We speculate that the anionic sites in vascular basement membranes and the variation in their electrostatic properties in different types of capillaries may have important implications for exchange of substances across the capillary wall.

Animals↗

Ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery.

Two patients with ruptured anterior communicating artery aneurysms associated with fenestration of the anterior cerebral artery are reported. In the literature, only 12 angiographic demonstrations of fenestration of the anterior cerebral artery have been reported. All fenestrations were limited to the distal half of the A1 portion, and seven of the 12 cases were associated with aneurysms. The high incidence of coexisting fenestration and aneurysm suggests that congenital factors may play a role in the pathogenesis of cerebral aneurysm.

Cerebral Arterial Diseases↗

Aneurysms associated with fenestrated anterior cerebral arteries. Report of four cases and review of the literature.

Four cases of aneurysms associated with a fenestrated anterior cerebral artery are presented. The combination of aneurysms and fenestration of the anterior cerebral artery is rare, and nine cases including ours have been reported. In all cases fenestrations were found within the distal two-thirds of the horizontal portion of the anterior cerebral artery. It may be presumed that fenestration of the anterior cerebral artery is the remnant of the plexiform anastomosis in the fetal stage, especially between the anterior cerebral artery and the primitive olfactory artery.

Aged↗

Fenestration of the supraclinoid internal carotid artery associated with carotid bifurcation aneurysm.

Fenestration of the internal carotid artery is extremely rare. The authors describe a fenestration at the supraclinoid portion of the left internal carotid artery revealed after subarachnoid hemorrhage from an ipsilateral carotid bifurcation aneurysm. This is the third reported case of fenestration of the intracranial internal carotid artery. Fenestrated cerebral vessels and their possible genesis and surgical management are discussed.

Adult↗