The arterial orifice level in the early human embryo

Summary The configuration of the upper myocardial border, considered by us to represent the arterial orifice level, has been studied microscopically and with the help of reconstruction techniques, in 7 human embryos ranging from 6 to 9.5 mm crown-rump length. In the 6 to 7 mm stage the arterial orifice level is not situated in one plane but has a curved configuration and reaches up to the origin of the 4th and 6th branchial arch arteries. As a consequence the septation, by the aortopulmonary septum, starts at orifice level. In the 9 to 9.5 mm stage the arterial orifice level has not only a curved but also a twisted configuration. This implies that 1) the pulmonary trunk is very short whereas the ascending aorta is rather long, 2) the pulmonary outlet is rather long whereas the aortic outlet is very short, and 3) the position of the aortopulmonary septum is such that it extends a long way proximal in the pulmonary outlet but hardly any distance in the aortic outlet. This means that the position of the orfices as well as the relative dimensions of both outlets are already similar to those in the fully developed heart.     

The effect of cathartic agents on transmucosal electrical potential difference in the human rectum

Summary Active ion transport in the colon is generating a transmucosal electrical potential difference (PD) of about 40 mV. Cathartic agents inhibit electrolyte and water net-absorption or cause net-secretion which should be reflected in a change of PD.In 83 normal subjects the effect of an isotonic eletrolyte solution (control) and different cathartic agents on rectal PD was tested: Laxatives (bisacodyl, rhein), bile acids (cholic and deoxycholic acid), fatty acids (oleic and ricinoleic acid) and cardiac glycosides (meproscillarin, digitoxin, digoxin). Bisacodyl, deoxycholic acid in high concentration, meproscillarin and digitoxin significantly decreased PD, while the other substances did not.Cathartics act on different transport mechanisms which together with different absorption characteristics of the proximal and distal colon may explain the difference in effecting the PD. Rectal PD measurement provides an easy and convenient tool to document effects of cathartic agents on electrolyte transport, otherwise difficult to obtain, and is applicable for clinical use.To Prof. Dr. H.P. Wolff on the occasion of his 65th birthday     

Multi-branched model of the human arterial system

A model of the human arterial system was constructed based on the anatomical branching structure of the arterial tree. Arteries were divided into segments represented by uniform thin-walled elastic tubes with realistic arterial dimensions and wall properties. The configuration contains 128 segments accounting for all the central vessels and major peripheral arteries supplying the extremities including vessels of the order of 2·0 mm diameter. Vascular impedance and pressure and flow waveforms were determined at various locations in the system and good agreement was found with experimental measurements. Use of the model is illustrated in investigating wave propagation in the arterial system and in simulation of arterial dynamics in such pathological conditions as arteriosclerosis and presence of a stenosis in the femoral artery.     

Small cell neuroendocrine carcinoma of the rectum

Poorly differentiated small cell neuroendocrine (NE) carcinoma of the colon and rectum is a rare primaty epithelial malignancy at this location. A case of a highly aggressive NE tumor of small cell type, combined with non-invasive well-differentiated papillary adenocarcinoma in villous adenoma is reported. The patient died rapidly with massive and progressive liver metastasis. The tumor cells were argyrophilic and diffusely immunoreactive for neuron-specific enolase and synaptophysin. Ultrastructural analysis disclosed NE-type cored granules in most of the small tumor cells. NE tumors of the colon and rectum are briefly reviewed.     

Noninvasive measurement of arterial elasticity in various human limbs

Arterial elasticity expressed by such indices as volume elastic modulus E_v and compliance C_a were noninvasively measured in various human limb segments; the upper arms, forearms, fingers, thighs, calves and toes. These indices are defined, respectively, as and C_a=ΔV/ΔP, where ΔP is pulse pressure, mean arterial volume and ΔV its pulsatile variation. ΔP was calculated from systolic P_as and mean P_am arterial pressures determined by volume oscillometric sphygmomanometry using the following equation: and the ΔV were detected by electrical admittance plethysmography at various transmural pressure P_t levels controlled by a compression cuff. The values obtained in these limb segments were compared with each other at P_t levels 0,30 and 60 mm Hg and the differences between them were discussed.     

Surgical anatomy of the sphenopalatine foramen and its arterial content

The sphenopalatine artery is the end artery of the maxillary artery located within the pterygopalatine fossa and passes through the sphenopalatine foramen (SPF) on lateral nasal wall. Nasal bleeding from this artery is potentially life threatening and may urgently require endonasal endoscopic occlusion. The aims of the present study have been first to investigate the location of the SPF, secondly the pattern of the main branches of the sphenopalatine artery at the foramen. 12 adult dry skulls and 6 adult cadaver heads injected within Indian Ink have been analyzed under an operating microscope Leica. All measurements were assessed using a digital calliper. The inferior border of the SPF has been situated 18.27 mm (15.09–20.87 mm) above the horizontal plate of the palatine bone and 13.04 mm (9.01–14.85 mm) above the horizontal lamina of the nasal inferior turbinate. Endoscopically, the posterior wall of the maxillary sinus is located at the level or anteriorly within 10 mm to the anterior border of the SPF. In all cases, the anterior border of the SPF is characterized by an easy recognizable sharp bony crest at the narrow middle part of the hourglass shape foramen. The SPF is 6.13 mm high (5.24–6.84 mm), with deep grooves extended superiorly and inferiorly from the foramen in eight skulls (8/12). The posterior lateral nasal artery which courses inferiorly and vertically (diameter 1.80 ± 0.20 mm) and the nasal septal artery which courses superiorly and vertically (diameter 1.30 ± 0.30 mm) have been the two major branches just leaving the SPF. One or two smaller collateral branches (diameter less than 1 mm) to the superior and/or the middle turbinate can get out coming from the stem of the main branches or directly from the SPF. So, the success rate of sphenopalatine artery ligation during endoscopic surgical procedure needs selective dissection of the two main branches of the sphenopalatine artery close to the SPF.     

减少低位直肠癌全直肠系膜切除吻合口瘘的手术策略

目的探讨术中有效减少低位直肠癌全直肠系膜切除吻合口瘘的手段。方法回顾分析本院2002年至2005年58例低位直肠癌行全直肠系膜切除术的临床资料。结果吻合口瘘4例,发生率6.9%,无再次手术病例。结论缩短手术时间、良好的血供、双吻合器、加强缝合、有效盆腔引流是减少吻合口瘘的有效措施。     

Validity of the transfer function model of the human arterial system of the lower limb in man

A transfer function model of the human arterial system has been examined and tested on a group of 21 patients undergoing reconstructive arterial surgery in the leg. It was found that use of the model to estimate parameters relating to proximal (above femoral artery) arterial wall stiffness and radius is not reliable, the model being affected by the peripheral resistance. The value of the model parameters relating to the peripheral arterial radius is more consistent with the theory although there are still contradictions. It is concluded that the application of transfer function modelling to the diagnosis of arterial disease should be approached with caution.     

Mucinous carcinoma of the rectum

We have studied and compared 316 mucinous and 45 signet ring cell carcinomas of the rectum with 413 non-mucinous carcinomas. Mucinous carcinomas were subdivided according to the amount of mucus which was gauged subjectively as either more or less than 75% of the tumour volume. Five year survivals for non-mucinous, mucinous (less than 75%), mucinous (greater than 75%) and signet ring cell carcinoma were 62%, 60%, 53% and 13%. Mucinous carcinomas (less than 75%) were relatively well differentiated and showed an age distribution identical to their non-mucinous counterparts, but differed in their strong association with villous adenoma. Mucinous carcinomas (greater than 75%) were less well differentiated and, like signet ring cell carcinomas, occurred in younger patients and showed no special association with villous adenoma. Clinically important and independent predictive variables were found by the method of multivariate regression analysis to be number of lymph node metastases, extent of spread in continuity, character of invasive margin and peritumoural lymphocytic infiltration. After adjustment for these factors, typing of rectal cancer as mucinous, non-mucinous and signet ring cell gave no additional, clinically useful prognostic information.     

心房动脉的应用解剖

目的:为心房切开术或经心房介入治疗术提供心房动脉的解剖学基础.方法:对27例成人心的心房动脉进行解剖,重点观测营养房间隔及左心耳的动脉的起源并测量其外径、主干长度.结果:右心房动脉有2～4支,平均3.0支,均起于右冠状动脉右侧壁,起始处外径为(1.6±0.4) mm,左心房动脉有2～5支,平均3.0支,92.6%分支起于旋支,7.4%的分支来自右冠状动脉.营养房间隔的动脉行于前房间沟下部,48.1%(13例)由右冠状动脉发出,起始处外径为(1.3±0.4) mm,主干长度为(21.0±9.6) mm,51.9%(14例)由旋支发出,起始处外径为(1.2±0.4) mm,主干长度为(9.0±4.2) mm;左心耳动脉有1～5支,平均2.3支,除1例起于右冠状动脉外,其余均起于旋支,起始处外径(0.7±0.4) mm,主干长度(13.1±6.7) mm.根据其行走特点可分为4型.结论:进行心腔内直视手术时需注意房间隔动脉及左心耳动脉的走行特点,以防伤及,引起血供障碍.     

Small cell neuroendocrine carcinoma of the rectum associated with chronic ulcerative colitis

A case of small cell carcinoma of the rectum in a patient with chronic ulcerative colitis is described. There was no evidence of enteroendocrine cell hyperplasia.     

Clinical anatomy of the arterial supply of the human patellar ligament

The arterial supply of the human patellar ligament has been systematized on 20 knee joints. After intravascular injection of colored natural latex, the blood supply to the extensor apparatus of the knee was studied by anatomical dissection and tissue transparentation techniques. Three arterial pedicles (superior, middle and inferior) were observed placed on each side of the patellar ligament. Medial pedicles had their origin from the descending and the inferior medial genicular arteries. The lateral pedicles took their origin from the lateral genicular arteries and the recurrent tibial anterior artery. Two main vascular arches anastomosed with these pedicles: the retropatellar and the supratubercular. Both arterial pedicles and anastomotic arches gave rise to a peritendinous network, characterized by a high vascular density next to poles of the patellar ligament. Only the anastomotic arches gave rise to collateral vessels that pierced the tendon, which revealed two vascular segments in the arterial supply of the patellar ligament (bipolar pattern). The upper segment was supplied by deep vessels from the retropatellar arch, whereas the inferior segment received superficial vessels from collaterals of the supratubercular arch. These intratendinous vessels anastomosed in the middle third of the patellar ligament.     

Signet-ring cell adenocarcinoma of rectum: a histological, histochemical and electron microscopic study

A signet-ring cell adenocarcinoma of rectum removed from a 71-year-old woman was examined by light and electron microscopy. Most of the mucin in the signet-ring cells was of the neutral type, although acidic, mostly non-sulphated, mucin was also present. Three other types of neoplastic cells. The similarities between this tumour and tumours described in the stomach, appendix and breast care discussed.     

'Transitional' and hyperplastic-metaplastic mucosa occurring in solitary ulcer of the rectum

Non-polypoid hyperplastic mucosa similar to that adjacent to colorectal carcinomas and adenomas, the so-called 'transitional mucosa' (TM), was found in 16 out of 27 cases of solitary ulcer syndrome of the rectum. In 18 cases fully developed hyperplastic (metaplastic) mucosa was also found. It is suggested that chronic ischaemia which takes place in the solitary ulcer syndrome leads to TM as an exaggerated regenerative phenomenon. Later maturation of TM could lead to hyperplastic (metaplastic) changes.     

人胎结肠及直肠内胃泌素、血管活性肠肽、胰多肽、生长抑素免疫反应阳性细胞的个体发生

目的：探讨人胎结肠及直肠胃泌素(Gas)、血管活性肠肽(VIP)、胰多肽(PP)和生长抑素(SS)免疫反应阳性(IR)细胞的个体发生及其相互关系。方法：免疫组织化学SABC法及细胞计数。结果：结肠内Gas-、PP-、SS-IR细胞始见于第9w，VIP-IR细胞于第18w出现。直肠内未见Gas-IR细胞，PP-IR细胞始见于第9w，SS-、VIP-IR细胞于第11w出现。结肠内Gas-IR细胞随胎龄增长数量减少，于第26w未见。PP-IR细胞数量在结肠内随胎龄增长先少后多，直肠内未见明显变化。VIP-IR细胞在胎期结肠、直肠少，而SS-IR细胞较多，整个胎期VIP-、SS-IR细胞数量无明显增减。结论：VIP、PP和SS存在于人胎结肠、直肠的内分泌细胞，Gas仅在结肠内分泌细胞中有表达，提示各种内分泌激素对胎儿结肠及直肠的发育起调节作用。     

人视觉传导路的冠状断层解剖学研究

目的 为视觉传导路病变的影像学诊断提供形态学依据. 方法在26例成人尸体头部的连续冠状断层标本与6例活体成人头部磁共振连续冠状断层扫描图像上,研究视觉传导路的断层解剖. 结果 本研究辨认了视觉传导路5个关键冠状断层上的典型表现:1.视神经眶中段冠状断层呈圆形,位于眼眶中心偏内上方眶脂体内,周围包绕蛛网膜下隙和视神经鞘.2.视交叉冠状断层呈"一"字型横位分隔第三脑室底的视隐窝和漏斗隐窝,其上方是大脑前动脉A1段,下方正中邻垂体柄和灰结节,两侧是颈内动脉C2或C3段.3.视束中部冠状断层呈圆形夹在大脑脚底和杏仁体、尾状核尾之间,下方是脉络丛前动脉,继续向下在钩与大脑脚底之间是大脑后动脉P2段.4.外侧膝状体内侧邻大脑脚底,外侧是尾状核尾,下方是钩和大脑后动脉P2段.5.视辐射冠状断层参与构成侧脑室下角和后角外侧壁,视辐射与侧脑室后角之间隔簿层毯.头部磁共振冠状断层扫描对视觉传导路结构的辨认与连续冠状断层标本具有较好对应性. 结论 在冠状断层上,对视觉传导路结构的辨认,尤其是关键断层特征结构的辨认,为视觉传导路病变的影像学诊断提供形态学基础.     

Noninvasive automatic measurement of arterial elasticity in human fingers and rabbit forelegs using photoelectric plethysmography

A new instrument for the noninvasive measurement of arterial elastic properties such as ‘pressure-volume relationship’ and ‘volume elastic modulus’ in human fingers or in rabbit forelegs has been designed using a transmittance infra-red photoelectric plethysmography technique. The measurement and display of the results by this system is carried out automatically by use of a conventional personal computer. Using this instrument, the progressive and regressive changes in arterial elastic properties have been clearly demonstrated in the forelegs of hyperlipoedemic rabbits with experimental atherosclerosis. The effect of vasodilation by isosorbide dinitrate on the finger arteries of patients with congestive heart failure was also successfully studied. This instrument is capable of a rapid and reliable measurement of arterial elasticity and appears to be useful not only in basic cardiovascular research laboratories but also in clinics.     

Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations

A total of 112 human embryos (224 upper limbs) between stages 12 and 23 of development were examined. It was observed that formation of the arterial system in the upper limb takes place as a dual process. An initial capillary plexus appears from the dorsal aorta during stage 12 and develops at the same rate as the limb. At stage 13, the capillary plexus begins a maturation process involving the enlargement and differentiation of selected parts. This remodelling process starts in the aorta and continues in a proximal to distal sequence. By stage 15 the differentiation has reached the subclavian and axillary arteries, by stage 17 it has reached the brachial artery as far as the elbow, by stage 18 it has reached the forearm arteries except for the distal part of the radial, and finally by stage 21 the whole arterial pattern is present in its definitive morphology. This differentiation process parallels the development of the skeletal system chronologically. A number of arterial variations were observed, and classified as follows: superficial brachial (7.7%), accessory brachial (0.6%), brachioradial (14%), superficial brachioulnar (4.7%), superficial brachioulnoradial (0.7%), palmar pattern of the median (18.7%) and superficial brachiomedian (0.7%) arteries. They were observed in embryos belonging to stages 17–23 and were not related to a specific stage of development. Statistical comparison with the rates of variations reported in adults did not show significant differences. It is suggested that the variations arise through the persistence, enlargement and differentiation of parts of the initial network which would normally remain as capillaries or even regress.