Clinical Structural Anatomy of the Inferior Pyramidal Space Reconstructed Within the Cardiac Contour Using Multidetector‐Row Computed Tomography

Although many studies have described the detailed anatomy of the inferior pyramidal space, it may not be easy for cardiologists who have few chances to study cadaveric hearts to understand the correct morphology of the structure. The inferior pyramidal space is the part of extracardiac fibro‐adipose tissue wedging between the 4 cardiac chambers from the diaphragmatic surface of the heart. Many cardiologists have interests in pericardial adipose tissue, but the inferior pyramidal space seems to have been neglected. A number of important structures, including the coronary sinus, atrioventricular node, atrioventricular nodal artery, membranous septum, muscular atrioventricular sandwich (previously called the “muscular atrioventricular septum”), atrial septum, ventricular septum, aortic valvar complex, mitral valvar attachment, and tricuspid valvar attachment are associated with the inferior pyramidal space. We previously revealed its 3‐dimensional live anatomy using multidetector‐row computed tomography. Moreover, the 3‐dimensional understanding of the anatomy in association with the cardiac contour is important from the viewpoints of clinical cardiac electrophysiology. The purpose of this article is to demonstrate extended findings regarding the clinical structural anatomy of the inferior pyramidal space, which was reconstructed in combination with the cardiac contour using multidetector‐row computed tomography, and discuss the clinical implications of the findings.     

Lymphocyte function-associated antigen-1 is required for maximum elicitation of allergic contact dermatitis

Cell adhesion molecules (CAMs) are known to play an important role in cell-mediated immunity and inflammation. To investigate the importance of one of the CAMs, lymphocyte function-associated antigen-1 (LFA-1) in allergic contact dermatitis (ACD), a specific anti-LFA-1 monoclonal antibody was injected into the ears of mice after sensitization but prior to challenge with dinitrofluorobenzene (DNFB). BALB/c mice were sensitized on the dorsal skin with DNFB, and challenged on the ears 6 days later. The effect of the antibody on the elicitation phase of contact sensitization was determined by its intradermal injection into the pinnae of the mice at doses of 1–40μg. At 24 and 48 h after challenge, ear swelling was dose-dependently suppressed by injection of LFA-1 antibody at doses of 2–40 μg, which are less than 10% of the systemic dose required for effective suppression of delayed- type hypersensitivity in previous studies. Maximal inhibition of ear swelling (44%) was observed after injection of 20 μg of anti-LFA-1 antibody. Inhibition of ear swelling was accompanied by a reduction in dermal oedema and leucocyte infiltration into the dermis. Our results suggest that LFA-1 plays a significant role in the elicitation of ACD reactions, and also that our test system is a sensitive and useful means of evaluating the blocking effect of antibody to adhesion molecules thought to be involved in the elicitation phase of ACD.     

Alteration of cartilagenous proteoglycan in psoriasis

Articular tissue was obtained at surgery for a femoral neck fracture in a patient with psoriasis without arthritis. The proteoglycan of the cartilage of the sample was analysed biochemically. Normal cartilage is known to produce two types of proteoglycan monomers (fast- and slow-sedimenting groups), which are distinguishable by density-gradient ultracentrifugation. In the psoriatic cartilage analysed in the present study, it was shown that the former group was absent and only the latter group remained.     

Conversion of In Vitro Cultured Human Monocytes into Effective Presenters of an HER2/neu-Encoded CTL Peptide Epitope

Tumour-derived peptides have been surveyed, in a variety of systems, for their ability to elicit cytokine release from class I restricted T cells. Analogous studies on ovarian carcinoma have employed the antigen-processing defective T2 cell line. Purified dendritic cells (DC) have been reported to act as highly effective APC. A facile method was developed whereby DC-like cells were generated from monocyte precursors. Herein, evidence is presented suggesting DC-like cells are superior to T2 with respect to their ability to present a defined CTL epitope associated with ovarian carcinoma.     

Reappraisal of Primary Balloon Angioplasty without Stenting for Patients with Symptomatic Middle Cerebral Artery Stenosis

There is a controversy regarding the safety and efficacy of intracranial stenting. We describe our experience with primary balloon angioplasty without stenting for symptomatic middle cerebral artery (MCA) stenosis. All patients who underwent balloon angioplasty without stenting for MCA stenosis between 1996 and 2010 were retrospectively reviewed. We evaluated technical success rates, degrees of stenosis, and stroke or death within 30 days. Among patients who were followed-up for > 1 year we evaluated latest functional outcomes, stroke recurrence at 1 year, and restenosis. In total 45/47 patients (95.7%) were successfully treated. Average pre- and postprocedure stenosis rates were 79.9% and 39.5%, respectively. Three neurological complications occurred within 30 days: one thromboembolism during the procedure; one lacunar infarction; and one fatal intraparenchymal hemorrhage after the procedure. Stroke or death rate within 30 days was 6.4%. Thirty-three patients were available for follow-up analysis with a mean period of 51.5 months. The combined rate of stroke or death within 30 days and ipsilateral ischemic stroke of the followed-up patients within 1 year beyond 30 days was 9.4%. Restenosis was observed in 26.9% of patients and all remained asymptomatic. In our retrospective series, balloon angioplasty without stenting was a safe, effective modality for symptomatic MCA stenosis. For patients refractory to medical therapy, primary balloon angioplasty may offer a better supplemental treatment option.     

Influenza virus and neurological diseases

Abstract  Influenza viruses rarely cause acute encephalopathy. Post-influenzal encephalitis, which occurs a few weeks after recovery from influenza is thought to be an autoimmune process associated with demyelination and vasculopathy. It has been suggested that Economo lethargic encephalitis followed by postencephalitic Parkinsonism was associated with the influenza A epidemic of 1918 (Spanish flu). The incidence of Reye's syndrome has markedly decreased due to the avoidance of salicylates in the treatment of influenza or varicella. One inactivated flu vaccine is thought to have caused Guillain Bane syndrome due to molecular mimicry between viral protein and myelin, which triggered autoimmune responses. The persistence of influenza virus genes in neural cells as one of the causes of chronic degenerative diseases of the central nervous system by inducing apoptosis of the host cells is yet to be proven.