Nitric oxide is produced by various cell types and can initiate either beneficial or deleterious effects. Because cultured human keratinocytes express an inducible isoform of nitric oxide synthase, it was postulated that keratinocytes within a burn wound would express increased levels of inducible nitric oxide synthase following the injury. Immunohistochemical staining identified the sites of cellular expression and temporal sequence of inducible nitric oxide synthase protein within partial- and full-thickness burns excised from 29 patients. While migrating keratinocytes at the immediate edge of the wounds showed decreased or undetectable levels of inducible nitric oxide synthase, the immediately adjacent proliferative population and upwardly growing keratinocytes from surviving hair follicles showed increasingly greater cytoplasmic staining for inducible nitric oxide synthase at 4-21 days after injury. Noninjured skin showed minimal inducible nitric oxide synthase staining. Within the wound, detectable inducible nitric oxide synthase protein appeared to decrease as keratinocytes assumed a differentiated phenotype in the outer newly resurfaced epidermis, in inner root sheath layers of hair follicles, or in epithelium of eccrine sweat ducts. Within granulation tissue, immunoreactive inducible nitric oxide synthase was detected in capillary endothelium and in arterial smooth muscle layer. Focal increases in inducible nitric oxide synthase expression were noted in association with inflammatory infiltrates. In conclusion, the cellular and temporal distributions of immunoreactive inducible nitric oxide synthase suggest that nitric oxide may play a role in the regulation of wound repair processes beyond the acute burn injury.

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SUMMARY The use of sequential segmental analysis for describing congenital heart malformations was the method of assessment used in a prospective necropsy study covering Jutland, a well defined geographical and demographic area of Denmark. The study group was 1154 children of whom 261 (22-6%) had a congenital heart malformation. The most common malformations were ductus arteriosus and ventricular septal defect and there were 77 cases in which connections between chambers or between chambers and great arteries were anomalous (68 liveborn; 37 male and 31 female: nine stillborn; two male and seven female). No difference in sex distribution or seasonal variation was found between those with congenital heart disease and those without. Extracardiac malformations and chromosomal abnormalities were more often seen in children with congenital heart malformation than in those without (30 3% vs 16-6%).The sequential segmental analysis is a logical and precise way of describing congenital heart malformations and it should be routinely used to classify cases of congenital heart malformation.Difficulties with the use of nomenclature in the routine management of paediatric cases of congenital heart disease prompted us to test a system of nomenclature based upon identification of segmental connections that was proposed by Shinebourne et al in 1976.1 We present a necropsy study of congenital heart malformations collected prospectively in a welldefined geographical and demographic area of Denmark in which necropsy is often performed.

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