In healthy men, levels of endothelial progenitor cells may be a surrogate biologic marker for vascular function and cumulative cardiovascular risk. These findings suggest that endothelial injury in the absence of sufficient circulating progenitor cells may affect the progression of cardiovascular disease.

This study was conducted to investigate the risk factors associated with peripartum hysterectomy in women who had either vaginal or cesarean delivery. The study subjects were women (n ϭ 101) who had a peripartum hysterectomy at the authors' institution from January 1986 to April 2001. Seventy-two of the 101 patients had delivered at Yonsei University Medical Center and 29 were referred from other hospitals. Of the total 31,044 deliveries at Yonsei during this time period, 11,924 were performed by cesarean section. Fifty-four of these women (0.45%) and 28 of the 19,080 who had a vaginal delivery (0.09%) underwent peripartum hysterectomy. Five of the 29 referred patients had a cesarean section and 24 had a vaginal delivery. The average time from delivery to hysterectomy was significantly longer in the vaginal group than in the cesarean section group (169 min vs. 49 min; P Ͻ.05). Also, women who had a vaginal delivery required significantly more blood (1908 ml) than those who had a cesarean section (1536 ml)(P Ͻ.05), although the average length of hospital stay was similar for both groups. Uterine atony was the most common indication for peripartum hysterectomy (42 of 101; 41.6%). Placenta previa accreta, placenta accreta, and placenta previa was the diagnosis in 23.8%, 16.7% and 11.9% of patients, respectively. Among the 29 women who had a previous cesarean section, the indications were uterine atony (n ϭ 10; 34.5%), placenta previa accreta (n ϭ 13; 44.8%), placenta previa (n ϭ 4; 13.8%), and placenta accreta (n ϭ 2; 6.9%). Blood loss was more highly associated with placenta previa accreta than with placenta previa or accreta alone (1734 ml vs. 16,58 ml and 1084 ml, respectively; P Ͻ.05). The only complications recorded were bladder injury in one woman with placenta previa, one disseminated intravascular coagulopathy in the placenta accreta group, and one case of sepsis among patients with placenta previa accreta. Of the 59 peripartum hysterectomies associated with cesarean section, 26 were in women undergoing elective cesarean section (44.1%) and 33 were after emergency cesarean section (55.9%). Blood loss was similar in both groups. The women who had emergency surgery experienced a higher complication rate than those undergoing elective cesarean section. Two patients sustained bladder injury, one had ureteral injury, one had bowel injury, one developed acute hepatitis, and one had disseminated intravascular coagulopathy. In the elective surgery group, there was a bladder laceration in one patient and another patient had disseminated intravascular coagulopathy. GYNECOLOGYVolume 58, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT This paper presents the results of an investigation of the force required to insert a laparoscopic trocar into the abdominal cavity. Both disposable and reusable laparoscopic trocar systems were studied. Study subjects were 20 consecutive women who were scheduled to undergo routine diagnostic and laparoscopic surgery and were randomly selected for either the disposable trocar device...

There is rapid growth in the use of MRI for molecular and cellular imaging. Much of this work relies on the high relaxivity of nanometer-sized, ultrasmall dextran-coated iron oxide particles. Typically, millions of dextran-coated ultrasmall iron oxide particles must be loaded into cells for efficient detection. Here we show that single, micrometer-sized iron oxide particles (MPIOs) can be detected by MRI in vitro in agarose samples, in cultured cells, and in mouse embryos. Experiments studying effects of MRI resolution and particle size from 0.76 to 1.63 m indicated that T 2 * effects can be readily detected from single MPIOs at 50-m resolution and significant signal effects could be detected at resolutions as low as 200 m. Cultured cells were labeled with fluorescent MPIOs such that single particles were present in individual cells. These single particles in single cells could be detected both by MRI and fluorescence microscopy. Finally, single particles injected into singlecell-stage mouse embryos could be detected at embryonic day 11.5, demonstrating that even after many cell divisions, daughter cells still carry individual particles. These results demonstrate that MRI can detect single particles and indicate that single-particle detection will be useful for cellular imaging.N umerous recent studies (1-4) indicate that there is a wide range of applications for MRI in molecular and cellular imaging. A key requirement for these applications is the availability of high-relaxivity MRI contrast agents that have a large effect on the MRI signal. One of the agents with very high relaxivity is nanometer-sized, ultrasmall dextran-coated iron oxide particles (USPIOs). These nanometer-sized particles have a large effect on MRI signal intensities due to the fact that they are superparamagnetic and disrupt magnetic field homogeneity to an extent much larger than their size. A growing number of studies have demonstrated the usefulness of USPIOs and MRI to detect receptors (3, 5-8) and monitor cell migration (9-11). Indeed, when a cell is labeled with millions of USPIOs, single cells can be detected by MRI even though the MRI is acquired at low resolution (50-100 m) compared with the size of the cells (5-20 m; refs. 12-14).A drawback of techniques that use USPIOs is that for significant signal changes, many particles need to be within an imaging voxel. Recently, we have shown that micrometer-sized iron oxide particles (MPIOs), which are commercially available, are efficiently endocytosed by a variety of cells, and these particles can be used for cellular imaging by MRI (14). Because these particles are polymer-coated and are impregnated with a fluorescent agent, it becomes possible to do both fluorescence microscopy and MRI on cells labeled with such particles. Empirical observations suggest that an iron oxide particle disrupts the magnetic field enough for MRI detectability for a distance at least 50 times its size, ¶ leading to the conclusion that cells harboring single, micrometer-sized particles should be detectable by ...

Tracking transplanted stem cells using magnetic resonance imaging (MRI) could offer biologic insight into homing and engraftment. Ultrasmall dextran-coated iron oxide particles have previously been developed for uptake into cells to allow MRI tracking. We describe a new application of much larger, micron-scale, iron oxide magnetic particles with enhanced MR susceptibility, which enables detection of single cells at resolutions that can be achieved in vivo. In addition, these larger particles possess a fluorophore for histologic confirmation of cell distribution. We demonstrate highly efficient, nontoxic, endosomal uptake of these particles into hematopoietic CD34 ؉ cells and

IFP labeling of MSCs imparts useful MRI contrast, enabling ready detection in the beating heart on a conventional cardiac MR scanner after transplantation into normal and infarcted myocardium. The dual-labeled MSCs can be identified at locations corresponding to injection sites, both ex vivo using fluorescence microscopy and in vivo using susceptibility contrast on MRI. This technology may permit effective in vivo study of stem cell retention, engraftment, and migration.

This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.

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This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.