Intramural sarcoma of the carotid artery with adventitial inflammation and fibrosis resembling 'inflammatory aneurysm'

A rare case Is descrlbed of an Intramural sarcoma of the rlght common carotld artery coexistlng wlth adventitial inflammation and flbrosls, resembllng 'inflammatory aneurysm', which was resected from a 33-yearold Japanese woman who had presented with a pulsatile mass on the rlght side of the anterior neck. Grossly, the wall of the carotld artery showed an intimal tear with dlssectlon of the medla filled with thrombus. A graylsh area, abutting directly onto the dlssected space and Involving the media and inner adventltia, was composed of a-smooth muscle actin-positive and desmln-negative polygonal and splndle cells with large bluntended nuclei and coarse granular chromatin arranged Into a well-organized Interlacing bundle pattern. This portlon was thus considered to represent lelomyosarcoma. White to yellow-tan fibrotic tissue present in the adventitial area consisted of extensive lamellar fibrosis wlth scattered focl of lymphoplasmacytlc aggregates and obliterated arteries, and lacked atypical spindle and polygonal cells. These changes accorded with the histopathologlcal findlngs hitherto described in cases of 'inflammatory aneurysm', which is known to almost exclusively involve the abdominal aorta. We conslder this case unique In that the leiomyosarcoma involved an artery other than the aorta, wlth an 'inflammatory aneurysm'-like reaction in the same she. The posslble relatlonship between these two condltions Is dlscussed.     

ANF-Konzentrationen und Drücke im kleinen Kreislauf unter Belastung vor und nach Koronardilatation

Summary According to several reports of close correlations between pulmonary artery pressure and ANF plasma levels it would be convenient to replace invasive pressure monitoring by ANF determination.Mean pulmonary artery and right atrial pressures and pulmonary artery as well as peripheral venous ANF plasma concentrations were measured in 24 patients before and after coronary angioplasty (PTCA) continuously at rest and during exercise: At rest, both pressure and ANF-values remained unchanged before and after PTCA. At exercise, there was a decrease of mean pulmonary artery pressure (from 41.3±8.6 to 31.5±7.4 mmHg,p<0.001), mean right atrial pressure (from 11.9±3.0 to 9.0±2.3 mmHg,p< 0.001), pulmonary artery (282.5±191.0 to 207.3±157.2 pg/ml,p<0.05) and peripheral venous (112.7±48.0 to 97.1±53.2 pg/ml, n.s.) ANF concentration after PTCA. We found no correlation between PTCA-induced changes of right arterial pressures and ANF concentrations, while changes of pulmonary artery pressures were significantly correlated to changes of peripheral venous (r=0.79,p<0.001) as well as pulmonary artery (r=0.59,p<0.01) ANF concentrations at exercise. In 6 of the 24 patients, however there was an inverse relationship between changes of pulmonary artery pressures and ANF concentrations. — Our data demonstrate a significant correlation between changes of ANF plasma level and pulmonary artery pressure values at exercise after PTCA. In the individual case however invasive pressure monitoring cannot be replaced by determination of ANF plasma levels.

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Abkürzungsverzeichnis ANF Atrialer natriuretischer Faktor - PTCA Perkutane transluminale Koronarangioplastie - PPa mittlerer pulmonalarterieller Druck - PPc mittlerer pulmonalcapillärer Druck - PRA mittlerer rechtsatrialer Druck Herrn Prof. Dr. med F. Scheler zum 65. Geburtstag gewidmet     

Morphological and functional characteristics of myocytes isolated from human left ventricular aneurysms

Isolated single myocytes were prepared from myocardium of developing ventricular aneurysms and from myocardium within the scar of chronic ventricular aneurysms. The morphology and function of the individual cells were compared. The cells from developing aneurysms were rod-shaped, with a distinct sarcomeric structure, but did not contract even in the presence of high calcium concentrations. The sarcomere length was significantly higher than that of cells from chronic aneurysms and approached the theoretical point at which no contraction can occur. Cells from chronic aneurysms were either rod-shaped and contractile, or rounded due to hypercontracture of the myofilaments. Electron microscopy of cells from developing aneurysms confirmed the presence of elongated sarcomeres, a loss of the actin-myosin interdigitation, and damage to the contractile proteins which was particularly evident in the thin filaments. Cells with similar characteristics have also been isolated from a ruptured, ischaemic papillary muscle. These changes, which are due either to ischaemia or to overstretching of cells, may account for the weakness of the wall of developing aneurysms and be a cause of rupture or enlargement.     

Rare origin of supernumerary renal vessels supplying the lower pole of the left kidney

The current observations have documented rare vascular anomalies in the right and left kidneys from a male and female cadaver, respectively. In the female left kidney in addition to being supplied by the normal renal artery and vein it contained a left lower polar renal artery and vein. The polar artery took origin from the inferior mesenteric artery to supply the lower pole and was drained by the left lower polar vein that opened into the left common iliac vein. The right kidney from a male cadaver showed supernumerary renal arteries and veins. The supernumerary upper renal artery took origin from the aorta and after a short course it gave rise into a cranial branch that took a long course to supply the lower pole and a caudal branch that entered the right kidney at the hilum. The supernumerary lower renal artery also took origin from the aorta and passed to supply the lower pole of the right kidney. Therefore, the lower pole of the right kidney received two arteries, but was not associated with a polar vein. The right kidney in addition to the normal right renal vein contained a supernumerary right renal vein. The vein was seen at the hilum and was the most posterior structure; passing behind the supernumerary lower renal artery to open into the posterior surface of the inferior vena cava. The anomalies described in the current observation present a unique pattern of congenital renal vascular abnormalities that may be of surgical importance.     

颈椎脊神经沟及其沟内段脊神经形态学观察

目的　探讨脊神经沟与沟内段脊神经受嵌压的关系。方法　取 6 0具成尸 (男 2 8,女 32 ) 12 0侧颈椎 ,对脊神经沟外口宽度、深度及其沟内段脊神经前支横径进行观察 ,并统计脊神经前支横径与脊神经沟外口宽度之比。结果　①脊神经沟外口宽度、深度自颈 3至颈 6均逐渐增大 ,其平均值分别为 4 5± 1 2mm和4 3± 1 2mm ;② 3到 7颈神经前支横径逐渐增大 ,平均值为 2 9± 1 0mm ;③颈神经前支横径与脊神经沟外口宽度之比 ,颈 5最小 (1∶1 5 4 ) ,颈 4次之 (1∶1 6 7) ,颈 3最大 (1∶1 75 )。结论　脊神经沟与沟内段脊神经受累关系密切 ,下颈段 (5、6 )颈神经受累机率可能大于上颈段 (3、4 )。     

BMP4 is required in the anterior heart field and its derivatives for endocardial cushion remodeling, outflow tract septation, and semilunar valve development

The endocardial cushions play a critical role in septation of the four-chambered mammalian heart and in the formation of the valve leaflets that control blood flow through the heart. Within the outflow tract (OFT), both cardiac neural crest and endocardial-derived mesenchymal cells contribute to the endocardial cushions. Bone morphogenetic protein 4 (BMP4) is required for endocardial cushion development and for normal septation of the OFT. In the present study, we show that anterior heart field (AHF)-derived myocardium is an essential source of BMP4 required for normal endocardial cushion expansion and remodeling. Loss of BMP4 from the AHF in mice results in an insufficient number of cells in the developing OFT endocardial cushions, defective cushion remodeling, ventricular septal defects, persistent truncus arteriosus, and abnormal semilunar valve formation.     

"虚拟中国人Ⅰ号"的动脉灌注

目的 :在“虚拟中国人Ⅰ号”建模前对其动脉进行灌注填充 ,使其能与静脉区分。方法 :一侧颈总动脉双向插管 ,按 40～ 45ml kg体重的灌注量 ,以 4.0× 10 4 Pa的灌注压力 ,灌注红色填充剂。结果 :共灌入填充剂 2 70 0ml。结论 :为“虚拟中国人I号”赋加了动脉显示特色。     

Effect of H+ and elevated PCO 2on membrane electrical properties of rat cerebral arteries

Some membrane electrical properties of muscle cells from the middle cerebral artery of the rat were recorded with intracellular microelectrodes. The resting membrane potential (E _m) of this preparation was –63 mV. Reduction of extracellular pH to 7.0 in the face of a constantP _{CO 2}of 40 mm Hg had no significant effect onE _m. Similarly the slope of the steady-state voltage/current curves was not different at pH 7.0 compared to control at pH 7.4. In marked contrast, whenP _{CO 2}was elevated to around 60 to 70 mm Hg there was a rapid hyperpolarization and reduction in the slope of the voltage current curve suggesting an increased conductance for one or more ionic species. In addition elevation ofP _{CO 2}increased the slope of theE _m vs. log[K]₀ curve from 46 mV/decade to 59 m V/decade which is in good agreement with a Nernstian potential for a K⁺ selective membrane. These data suggest that while the smooth muscle cells of rat cerebral arteries are relatively insensitive to a small reduction in extracellular pH; reduction of intracellular pH by elevatingP _{CO 2}induces hyperpolarization by increasing K⁺ conductance (g _k). However, it is not clear from these experiments if theP _{CO 2}effects are mediated entirely by changes in pH or if there is a direct membrane action of CO₂.This work is supported by Grant no. HL27862     

A lectin horseradish peroxidase study of the origin of ascending fibers in the medial forebrain bundle of the rat. The lower brainstem

The origins of projections within the medial forebrain bundle from the lower brainstem were examined with the horseradish peroxidase technique. Labeled cells were found in at least 15 lower brainstem nuclei following injections of a conjugate or horseradish peroxidase and wheat germ agglutinin at various levels of the medial forebrain bundle. Dense labeling was observed in the following cell groups (from caudal to rostral): A1 (above the lateral reticular nucleus); A2 (mainly within the nucleus of the solitary tract); a distinct group of cell trailing ventrolaterally from the medial longitudinal fasciculus at the level of the rostral pole of the inferior olive; raphe magnus; nucleus incertus; dorsolateral tegmental nucleus (of Castaldi); locus coeruleus; nucleus subcoeruleus; caudal part of the dorsal (lateral) parabrachial nucleus; and raphe pontis. Distinct but light labeling was seen in raphe pallidus and obscurus, nucleus prepositus hypoglossi, nucleus gigantocellularis pars ventralis, and the ventral (medial) parabrachial nucleus. Sparse labeling was observed throughout the medullary and caudal pontine reticular formation. Several lower brainstem nuclei were found to send strong projections along the medial forebrain bundle to very anterior levels of the forebrain. They were: A1, A2, raphe magnus (rostral part), nucleus incertus, dorsolateral tegmental nucleus, raphe pontis and locus coeruleus. With the exception of the locus coeruleus, attention has only recently been directed to the ascending projections of most of the nuclei mentioned above. Evidence was reviewed indicating that fibers from lower brainstem nuclei with ascending medial forebrain bundle projections distribute to widespread regions of the forebrain.It is concluded from the present findings that several medullary cell groups are capable of exerting a direct effect on the forebrain and that the medial forebrain bundle is the major ascending link between the lower brainstem and the forebrain.