Evidence for a continuing accumulation of APSAC (Anisoylated plasminogen streptokinase activator complex) by human clots: Comparison with the binding of other plasminogen activators and Plasminogen

The uptake of [¹²⁵I-plasminogen]-APSAC into crosslinked human plasma clots from autologous plasma was significantly greater than the uptake of equimolar iodinated lys77-plasminogen. The uptake of APSAC in the presence of 6-aminohexanoic acid (10 mM) was also significantly greater than the uptake of plasminogen in the presence of 6-aminohexanoic acid.The accumulation of APSAC continued for at least 2 h (in nonlysing conditions), was similar in platelet-rich, platelet-poor and whole-blood clots and was not affected by prior aging of the clots (up to 6 h). The uptakes of APSAC and streptokinase plasminogen were slightly affected by the plasma concentration of anti-SK IgG and, in general, the fibrin-binding of APSAC was similar to the binding of radiolabelled t-PA. Urokinase (high-molecular weight) did not demonstrate fibrin- binding, the uptake being explained by simple diffusion (quantified using albumin). The relative order of continuing accumulation APSAC = t-PA > lys-plasminogen > urokinase is similar to the order of initial binding (< 1 min incubation), and we conclude that the formation of an acylated, stabilised, activator complex of lys-plasminogen and streptokinase imparts additional fibrin-binding to lys-plasminogen.     

Absent right superior vena cava with persistent left superior vena cava in a patient with COVID-19

Journal of Artificial Organs - Vascular injury associated with cannulation during extracorporeal membrane oxygenation (ECMO) induction is a rare but life-threatening complication. The presence of...     

Ieiomyosarcoma of the superior vena cava producing superior vena cava syndrome and heart tamponade

An autopsy case of primary leiomyosarcoma arising in the superior vena cava is presented. A 44 year old Japanese man presented with superior vena cava syndrome and eventually died due to heart tamponade and acute renal failure. Autopsy revealed that the superior vena cava was occluded with a tumor that had invaded the pericardium and right thoracic cavity. Primary caval venous leiomyosarcoma is a rare but lethal disease and most cases arise from the inferior vena cava. This case represents a very rare case of leiomyosarcoma with the rare clinical findings of superior vena cava syndrome and heart tamponade.     

Anomalous atrium associated with persistent left superior vena cava

Anatomical Science International - Persistent left superior vena cava (PLSVC) is the most common venous anomaly with an incidence of 0.3–0.5% in the general population. Here, we report a rare...     

Scimitar syndrome with the left persistent superior vena cava

Scimitar syndrome is a rare, complex congenital anomaly characterized by an anomalous connection of the pulmonary vein with the inferior vena cava (IVC). A persistent left superior vena cava (PLSVC) is another thoracic venous anomaly. We present a rare case with scimitar syndrome associated with the PLSVC. These variations were confirmed by magnetic resonance imaging (MRI) and computed tomography (CT). The typical features and the embryonic development of these variations are described. Radiological evaluations and clinical implications are discussed.     

Bilateral thoracic ducts with coexistent persistent left superior vena cava

A case of bilateral thoracic ducts with coexistent persistent left superior vena cava (SVC) was identified in a 77-year-old Japanese female cadaver during dissection in a gross anatomy course. The persistent left SVC began at the lower surface of the left brachiocephalic vein, descended in front of the aortic arch, and drained into the right atrium through the coronary sinus. The right SVC was normal both in size and in position. The azygos vein, receiving the hemiazygos vein, opened into the right SVC. The accessory hemiazygos vein and the left superior intercostal vein united to form a common trunk, which drained into the left SVC. The left and right thoracic ducts began at the level of the 1st lumbar vertebra, ran upwards parallel and anterior to the vertebral column, and terminated at the venous angles of their corresponding sides. There was an anastomotic branch between them. The present case was considered to be very rare, since the persistent left SVC and bilateral thoracic ducts coexisted. The embryologic basis and clinical importance of this case are discussed.     

Chronic fibrous mediastinitis with a superior vena cava compression syndrome

An observation of chronic fibrous mediastinitis in a woman of 32 with the previous history of puerperal sepsis with bilateral pneumonia is described. The disease manifested clinically by a syndrome of v. cava superior compression. Chronic inflammatory process in the mediastinal adipose tissue with the development of a rough fibrosis was found morphologically.     

双上腔静脉伴胸导管变异1例

<正>作者在解剖一老年男性时发现其左、右侧各有一上腔静脉,同时伴胸导管变异,部分内脏转位,现报道如下:1双上腔静脉1.1右上腔静脉右上腔静脉起始、行程及注入部位均正常。左头臂静脉自左胸锁关节的后方,越过主动脉弓分支的前方,在右侧第1胸肋结合处的后方与右头臂静脉汇合,形成右上腔静脉。     

Excessive anteriorisation of the superior vena cava associated with an azygos lobe

Summary A wide variety of congenital vascular anomalies of the superior mediastinum exist. Being clinically silent, most of these anomalies are detected incidentally on plain radiographs or CT scans where they could be mistaken for mediastinal masses. Familiarity with these anomalies is very important for correct interpretation and avoidance of confusion. We present a case of a mediastinal mass detected accidentally on plain radiography which on further radiological investigation was found to be an unreported normal variant of the superior vena cava (SVC). CT scans of the thorax and superior vena cavograms showed excessive anteriorisation of the SVC in the presence of an azygos lobe. After reviewing the literature and the embryology of the SVC and azygos lobe, we postulate that the variation in the location of the SVC was possibly due to the presence of the azygos lobe.

---

Ventralisation excessive de la veine cave supérieure associée à un lobe azygos

Résumé Il existe une grande variété d'anomalies vasculaires congénitales du médiastin supérieur. Le plus souvent cliniquement silencieuses, ces anomalies sont alors détectées incidemment sur des radiographies ou des scanners où elles peuvent être prises pour des masses médiastinales. La connaissance de ces anomalies est très importante pour une interprétation correcte des documents et éviter toute confusion. Nous présentons le cas d'une masse médiastinale détectée fortuitement sur une radiographie qui s'avéra être, sur des investigations radiologiques complémentaires, une variation non rapportée de la v. cave supérieure (VCS). Le scanner thoracique et la phlébographie cave supérieure ont montré une ventralisation excessive de la VCS et la présence d'un lobe azygos. Après avoir relu la littérature et revu l'embryologie de la VCS et du lobe azygos, nous pensons que cette variation de l'emplacement de la VCS peut être due à la présence du lobe azygos.

     

上腔静脉伴冠状窦异常1例

在解剖一具成人男性尸体标本时，观察其心脏，见上腔静脉位置与走行及冠状窭异常,报道如下。     

Tissue plasminogen activator, plasminogen activator inhibitors, and activator-inhibitor complex in liver disease.

AIMS--To identify the relative contribution of plasminogen activators, particularly tissue plasminogen activator (t-PA) and specific plasminogen activator inhibitors (PAI-1, PAI-2), to the fibrinolytic changes associated with various types of liver disease or severe chemical and physical damage to the liver. METHODS--Platelet rich (PRP) and platelet poor plasma (PFP) from patients with alcoholic cirrhosis, primary biliary cirrhosis, hepatic malignancy, or paracetamol overdose, or who were undergoing partial hepatectomy or liver transplantation, were assayed for t-PA, PAI-1, t-PA-PAI-1 complex and PAI-2 antigen values using specific enzyme linked immunosorbent assays (ELISAs) developed in this laboratory. RESULTS--Appreciable increases in the plasma concentration of t-PA, PAI-1, and t-PA-PAI-1 were seen in patients with alcoholic cirrhosis, primary biliary cirrhosis, and hepatic malignancy. Liver damage due to paracetamol overdose and partial hepatectomy both resulted in a striking increase in plasma PAI-1 concentration, although concentrations of t-PA and t-PA-PAI-1 complex were less affected. Concentrations of t-PA, PAI-1, and t-PA-PAI-1 complex returned to near normal values after successful liver transplantation in a patient with chronic active hepatitis. PAI-2 was also detected in several patients with chronic liver disorders. CONCLUSIONS--Haemorrhage due to fibrinolytic bleeding is commonly associated with liver disease. The patients studied here all had appreciable increases in circulating t-PA antigen concentrations. This was associated with increased concentrations of PAI-1 antigen and t-PA-PAI-1 complex and the balance between activator and inhibitor did not result in systemic plasmin generation. Reduced PAI-1 activity in cirrhosis or a critical difference in the ratio of t-PA to PAI-1 concentrations may explain the enhanced plasminogen activator activity previously noted in cirrhosis but not metastatic disease. Reduced hepatic clearance of t-PA and t-PA-PAI-1 complex due to impaired liver function may account for increased concentrations of free and complexed t-PA.     

Die Bolusinjektion von anisoyliertem Plasminogen-Streptokinase-Aktivator-Komplex (BRL 26921) als alternatives Konzept der systemischen Lyse bei akutem Myokardinfarkt

Summary The thrombolytic properties of anisoylated plasminogen streptokinase activator complex (BRL 26921) and clinical results of the treatment were studied in 10 consecutive patients with acute myocardial infarction. Exclusion criteria were general contraindications against thrombolytic therapy and a time interval of more than 4 h between the onset of symptoms and admission to the hospital. All patients received a 250-mg bolus of prednisolone prior to intravenous injection of 30 mg BRL 26921 within 2 min. A continuous infusion of heparin at a dose of 1,000 USPU/h was started 2 h after the injection. Blood pressure was monitored via an arterial line. Arrhythmias and changes in the ST segments were documented by conventional ECG recording and computerbased ECG monitoring. Coronary arteriography and left ventriculography were carried out within 72 h. Besides routine laboratory tests, serial CK and CK-MB activity measurements were carried out. We determined the following hemostaseological parameters before and 15 min, 30 min, 1 h, 4 h, and 12 h after application of BRL 26921: prothrombin time, activated partial thrombosplastin time, thrombin time, thrombin coagulase time, fibrinogen, streptokinaseplasminogen activator activity, plasminogen and alpha-2-antiplasmin.Our results (reperfusion in all patients angiographically and in 7 to 8 of 10 patients from noninvasive criteria) show that BRL 26921 is a highly effective thrombolytic agent in patients with myocardial infarction, when compared with highdose systemic fibrinolysis. Applied in dosages required for early reperfusion, it does not appear to be selectively thrombolytic and is not free of hypotensive effects in man. The decrease of fibrinolytic activity is biphasic with a half-disappearance time of 112 min.

---

Abkürzungsverzeichnis A Akinesie - aPTT aktivierte partielle Thromboplastinzeit - T.C. Thrombinkoagulasezeit - F.A. Fibrinolytische Aktivität - Fib. Fibrinogen - AV atrioventrikulär - CK Creatinkinase - CX R. Circumflexus - DA Diagonalast - EF Ejektionsfraktion - H Hypokinesie - HWI Hinterwandinfarkt - INT Intermediärast - LCA linke Kranzarterie - LVEDP linksventrikulärer enddiastolischer Druck - m Mittelwert - M männlich - PLA Posterolateralast - RCA rechte Kranzarterie - RIVA R. interventricularis anterior - RIVP R. interventricularis posterior - s Standardabweichung - Sta Stamm - TZ Thrombinzeit - VWI Vorderwand-infarkt - W weiblich     

A case of persistent left superior vena cava with a horseshoe kidney]

A case of persistent left superior vena cava with a horseshoe kidney was found in a Japanese male cadaver (72 years old) during a dissection for students in 1989. The main findings were as follows. The right superior vena cava (21.2 mm average diameter) was normal and opened into the right atrium. The left superior vena cava (8.4 mm average diameter) was smaller than the right one and ran in the coronary sinus to reach the right atrium. There was a small transverse anastomosis (8.9 mm average diameter), which corresponded to the normal left brachiocephalic vein, between the right and left superior vena cava. The azygos vein system showed a symmetrical condition and the right and left azygos veins opened into the superior vena cava on each side. This was the 57th case of persistent left superior vena cava reported in the anatomical literature in Japan. It corresponded to Type 3 of the classification by Fujimoto et al. (1971), and might be the first report of Type 3 in Japan. The horseshoe kidney was a typical one, in which the right and left kidneys were fused by an isthmus (bridge) consisting of renal tissues at their lower poles. The positions of both kidneys were lower than those of normal ones, the bilateral renal hili opened ventrally, the ureters ran on the anterior surface of the isthmus, the longitudinal axes of both kidneys crossed each other under the isthmus, and there were some additional renal arteries and veins. Neither the persistent left superior vena cava nor the horseshoe kidney alone are very rare anomalies, but a case such as the present, in which both anomalies coexist in the same body, is very rare.