Science.gov

Sample records for left anterior descending

  1. Surgical Management of Intramyocardial Left Anterior Descending Artery.

    PubMed

    De Salvatore, Sergio; Segreto, Antonio; Chiusaroli, Alessandro; Congiu, Stefano; Bizzarri, Federico

    2015-11-01

    An intramyocardial left anterior descending artery can be found in up to 30% of patients undergoing coronary artery bypass graft procedures. We review the various techniques available to identify an intramyocardial left anterior descending artery.

  2. Symptomatic Type IV Dual Left Anterior Descending Coronary Artery

    PubMed Central

    Papadopoulos, Kyriacos; Georgiou, Georgios M.; Nicolaides, Evagoras

    2016-01-01

    Dual left anterior descending coronary artery is a rare congenital anomaly with 4 subtypes. Double left anterior descending coronary artery originating from the left main stem and the right coronary artery (type IV dual left anterior descending artery) has been reported to occur in 0.01% to 0.7% of patients undergoing cardiac catheterization. We report a case of a 49-year-old woman who was found to have this anomaly during coronary angiography. The patient had been complaining of chest pain that mimics angina pectoris and exercise tolerance test was positive for myocardial ischemia. PMID:28203572

  3. Localizing intramyocardially embedded left anterior descending artery during coronary bypass surgery: literature review

    PubMed Central

    2013-01-01

    Proper detection of the deeply embedded left anterior descending artery remains a challenge. Many authors proposed different methods for artery identification, such as ultrasound Doppler, cineangiography, retrograde dissection overlying tissues, and exposure over the probe. Choice of the technique often depends on the surgeon's acquaintance and experience. The article compares and summarizes different procedures for the detection of intramyocardially located left anterior descending artery. PMID:24172140

  4. Fatal derecruitment of occluded left anterior descending collaterals after left circumflex revascularization

    PubMed Central

    Boukhris, Marouane; Tomasello, Salvatore D.; Galassi, Alfredo R.

    2015-01-01

    Coronary arteries are not definitely functionally terminal arteries, as previously thought; indeed, they are linked and interconnected by a rich network of collaterals. Chronic total occlusions (CTOs) represent a subset of frequent lesions encountered in everyday catheterization laboratory practice, generally associated with a developed system of collateral connections. These latter have the capacity to prevent myocardial necrosis and may even uphold metabolic supply to the ischemic territory to maintain its contractile capacity. Authors have reported a rapid and progressive reduction of collateral function and their decline after antegrade flow restoration, resulting in higher myocardial susceptibility to ischemia in the CTO territory. Here, we report the case of a fatal derecruitment of collaterals for a left anterior descending CTO not reopened, after left circumflex subocclusion revascularization. PMID:26778906

  5. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    PubMed

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  6. Clinical presentation and outcomes in type IV dual left anterior descending artery anomaly

    PubMed Central

    Çanga, Yiğit; Güvenç, Tolga Sinan; Karataş, Mehmet Baran; Güngör, Bariş; Çetin, Rengin; Bolca, Osman

    2016-01-01

    Type IV dual left anterior descending artery (LAD) anomaly constitutes a rare subset of coronary anomalies in which the anterior and anterolateral wall of the left ventricle is supplied by a short LAD originating from the left coronary artery along with a long LAD that originates from the right sinus of Valsalva. Albeit rare, the angiographic presentation is challenging since the appearance of the short LAD is similar to a total occlusion beyond first few diagonal or septal branches. Here, we present a series of four cases with type IV dual LAD anomaly with different clinical and angiographic presentations. PMID:28250981

  7. Asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract.

    PubMed

    Mustelier, Juan Valiente; Rego, Julio Oscar Cabrera; Aquiles, Eddy W Olivares; Llerena, Luis Roberto

    2010-12-01

    Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract, first diagnosed by echocardiography examination and further confirmed by 128-slice computed tomography coronary angiography.

  8. Retrograde approach to an ostial left anterior descending chronic total occlusion through a left internal mammary artery graft.

    PubMed

    Hari, Pawan; Kirtane, Ajay J; Bangalore, Sripal

    2016-05-01

    Retrograde approach to chronic total occlusions (CTO) has been described via saphenous vein grafts, septal and epicardial collaterals. We report for the first time a successful retrograde approach to an ostial left anterior descending (LAD) artery CTO through a failed left internal mammary artery (LIMA) to LAD anastamosis. This case demonstrates the technical aspects of using a LIMA conduit as a retrograde approach to CTO. © 2015 Wiley Periodicals, Inc.

  9. Disappearance of myocardial bridging of the left anterior descending coronary artery after inferior myocardial infarction.

    PubMed

    Yıldız, Bekir Serhat; Esin, Fatma; Alihanoğlu, Yusuf Izzettin; Kılıç, Ismail Doğu; Evrengül, Harun

    2014-06-01

    Myocardial bridging (MB) is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). MB is a common congenital abnormality of a coronary artery, and is usually thought to be a benign anatomical variant. Although rare, previous studies have reported that patients with MB may suffer from myocardial ischemia, myocardial infarction (MI), arrhythmias, and even sudden death. Therefore, the diagnosis and treatment of MB are both important. Since MB is congenital, its disappearance is unlikely. We here report a very rare case of disappearance of MB after inferior MI.

  10. A rare case of myocardial bridge involving left anterior descending, obtuse marginal and ramus intermediate coronary arteries

    PubMed Central

    Koprulu, Diyar; Elmali, Muzaffer; Zeren, Gonul; Erdogan, Guney

    2016-01-01

    Myocardial bridging, a congenital coronary anomaly, is a cluster of myocardial fibers crossing over the epicardial coronary arteries. It is most frequently seen in the left anterior descending artery (LAD), and rarely involves the circumflex (CX) and right coronary artery (RCA). We report a patient with an unusual coronary bridge crossing over the left anterior descending, obtuse marginal and ramus intermediate branches. The patient presented with exercise-induced angina pectoris that was relieved with medical therapy. PMID:28096838

  11. Scuba diving, acute left anterior descending artery occlusion and normal ECG.

    PubMed

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-31

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day 4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results.

  12. Hypertrophic obstructive cardiomyopathy in combination with anomalous insertion of papillary muscle directly into anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery.

    PubMed

    Taşdemir, O; Küçükaksu, D S; Kural, T; Bayazit, K

    1994-01-01

    This report describes an unusual case of subaortic stenosis in which hypertrophic obstructive cardiomyopathy was found in combination with both anomalous insertion of papillary muscle directly into the anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery. Definitive diagnosis was made on operation. We freed the left anterior descending coronary artery by incising the muscular bridge, resected both papillary muscles, and replaced the mitral valve.

  13. Hypertrophic obstructive cardiomyopathy in combination with anomalous insertion of papillary muscle directly into anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery.

    PubMed Central

    Taşdemir, O; Küçükaksu, D S; Kural, T; Bayazit, K

    1994-01-01

    This report describes an unusual case of subaortic stenosis in which hypertrophic obstructive cardiomyopathy was found in combination with both anomalous insertion of papillary muscle directly into the anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery. Definitive diagnosis was made on operation. We freed the left anterior descending coronary artery by incising the muscular bridge, resected both papillary muscles, and replaced the mitral valve. Images PMID:7888810

  14. Effect of electron radiation on vasomotor function of the left anterior descending coronary artery

    NASA Astrophysics Data System (ADS)

    Sanzari, Jenine K.; Billings, Paul C.; Wilson, Jolaine M.; Diffenderfer, Eric S.; Arce-Esquivel, Arturo A.; Thorne, Pamela K.; Laughlin, Maurice H.; Kennedy, Ann R.

    2015-01-01

    The left anterior descending (LAD, interventricular) coronary artery provides the blood supply to the mid-region of the heart and is a major site of vessel stenosis. Changes in LAD function can have major effects on heart function. In this report, we examined the effect of electron simulated solar particle event (eSPE) radiation on LAD function in a porcine animal model. Vasodilatory responses to adenosine diphosphate (ADP; 10-9-10-4 M), bradykinin (BK; 10-11-10-6 M), and sodium nitroprusside (SNP; 10-10-10-4 M) were assessed. The LAD arteries from Control (non-irradiated) and the eSPE (irradiated) animals were isolated and exhibited a similar relaxation response following treatment with either ADP or SNP. In contrast, a significantly reduced relaxation response to BK treatment was observed in the eSPE irradiated group, compared to the control group. These data demonstrate that simulated SPE radiation exposure alters LAD function.

  15. The contrast media iohexol causes vasoconstriction of the proximal left anterior descending coronary artery: implications for appropriate stent sizing.

    PubMed

    Kelly, Robert V; Gillespie, Michael J; Cohen, Mauricio G; McLaughlin, David P; Magnus Ohman, E; Stouffer, George A

    2008-01-01

    The effect of the contrast agent iohexol on reference vessel size in patients with proximal left anterior descending disease is unknown. Quantitative coronary angiography and intravascular ultrasound were performed in 15 patients with atherosclerotic disease of the proximal left anterior descending. Mean proximal reference vessel diameter was 2.95 +/- 0.59 mm with quantitative coronary angiography and 4.65 +/- 0.66 mm with intravascular ultrasound (P < .05). Intracoronary injection of iohexol resulted in a significant decrease in intravascular ultrasound-measured proximal reference vessel diameter from 4.65 +/- 0.66 mm to 4.47 +/- 0.68 mm (P = .002). Vasoconstrictive response to iohexol in the proximal reference vessel ranged from -0.04 mm to 0.5 mm with a mean of 0.18 +/- 0.16 mm. This study shows that iohexol can cause significant vasoconstriction of the proximal reference vessel in patients with severe disease involving the proximal left anterior descending.

  16. Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

    PubMed Central

    Yamamoto, Tadashi; Funayama, Naohiro; Nishihara, Hiroshi; Hotta, Daisuke

    2016-01-01

    Introduction Restenosis after a percutaneous coronary intervention for proximal left anterior descending (pLAD) coronary artery disease remains a clinical challenge. However, the relationship between the left main trunk (LMT)/LAD bifurcation angle and the pLAD artery restenosis is unclear. This study examined the relationship between the LMT–LAD bifurcation angle and restenosis after stent implantation for pLAD disease. Methods We analysed the data of 177 consecutive patients who underwent stent implantation for pLAD disease, followed by coronary angiography between December 2008 and September 2013. The LMT–LAD bifurcation angle was measured in the left or the right anterior oblique caudal (CAU) angiographic view. Results and discussion Out of 177 patients, 12 developed in-stent restenosis and 21 developed in-segment restenosis. The mean angle in patients with in-stent restenosis (52.2°±14.5°) in the left anterior oblique CAU view was significantly larger than that in patients without restenosis (32.0°±18.1°; P<0.001). The LMT–LAD angle in the right anterior oblique CAU view was significantly larger in patients with in-segment restenosis (27.3°±14.3°) than in patients without restenosis (17.5°±10.1°; P<0.001). Moreover, by multivariate analysis, the LMT–LAD angle was an independent predictor of in-stent and in-segment restenosis, after adjustment for significant confounders such as diabetes, hypertension, dyslipidaemia, final minimum lesion diameter and lesion length. Conclusion This study suggests that a wide LMT–LAD angle is a predictor of restenosis after stent implantation for pLAD artery disease. PMID:27214275

  17. Asymptomatic anomalous origin of left anterior descending artery from the pulmonary artery and multiple atherosclerotic stenoses revealed by silent ischaemia.

    PubMed

    Murat, Gurbuz; Cellier, François; Leobon, Bertand; Boudou, Nicolas

    2015-02-01

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital disease responsible for a high mortality rate in childhood. Here, we report for the first time the case of an asymptomatic 61-year old patient showing a combination of anomalous origin of the left anterior descending artery from pulmonary artery and atherosclerotic stenosis in both the right coronary artery and the left circumflex artery without anomalous origin.

  18. Green tea extract protects rats against myocardial infarction associated with left anterior descending coronary artery ligation.

    PubMed

    Hsieh, Shih-Rong; Tsai, Dan-Chin; Chen, Jan-Yow; Tsai, Sen-Wei; Liou, Ying-Ming

    2009-08-01

    There is increasing evidence that green tea polyphenols can protect against myocardial damage. Recently, we showed that they bind to cardiac troponin C and alter myofilament Ca(2+) sensitivity in cardiac muscle. In the present study, we examined whether green tea extract (GTE) could prevent the progressive remodeling seen in ischemic myocardium and improve cardiac function by modulation of the contractile apparatus utilizing a myocardial infarction (MI) model in the rat involving ligation of the left anterior descending branch. Using this model, severe myocardial injury was found, including altered cardiac performance and the appearance of extensive fibrosis and left ventricular (LV) enlargement. Supplementation with 400 mg/kg/day of GTE for 4, 18, or 46 days had beneficial effects in preventing the hemodynamic changes. Histopathological studies showed that GTE attenuated the progressive remodeling seen after myocardial injury. Echocardiography confirmed that GTE prevented LV enlargement and improved LV performance in post-MI rats. In addition, we showed that GTE supplementation for 18 or 46 days increased the myofilament Ca(2+) sensitivity of the ischemic myocardium in post-MI rats. These results validate the novel action of green tea polyphenols in protecting against myocardial damage and enhancing cardiac contractility by modulating myofilament Ca(2+) sensitivity in post-MI rats.

  19. "Sawfish" systolic narrowing of the left anterior descending coronary artery: an angiographic sign of hypertrophic cardiomyopathy.

    PubMed

    Brugada, P; Bär, F W; de Zwaan, C; Roy, D; Green, M; Wellens, H J

    1982-10-01

    The morphologic characteristics at coronary arteriography of systolic narrowing of the left anterior descending coronary artery (LAD) were evaluated in 14 patients. Six patients had systolic narrowing of the LAD not associated with other cardiac abnormalities (group A) and eight patients had systolic narrowing of the LAD associated with hypertrophic cardiomyopathy (group B). Patients in group A showed a smooth and progressive constriction of the vessel up to the point of maximal stenosis, giving it a "rat-tail" appearance. There was no systolic narrowing of septal branches or of other epicardial vessels in this group. In patients of group B, systolic narrowing of the LAD had a "saw-fish" appearance. Seven patients had systolic narrowing of the septal branches, and five had systolic narrowing of other epicardial vessels. These data indicate that systolic narrowing of the LAD in patients with hypertrophic cardiomyopathy differs angiographically from systolic narrowing due to an intramural course of a part of the vessel (as in group A patients). We postulate that in patients with hypertropic cardiomyopathy, fiber hypertrophy and disarray in the vicinity of the coronary vessels is responsible for the morphology and the widespread distribution of systolic narrowing.

  20. Effect of electron radiation on vasomotor function of the left anterior descending coronary artery

    PubMed Central

    Sanzari, Jenine K.; Billings, Paul C.; Wilson, Jolaine M.; Diffenderfer, Eric S.; Arce-Esquivel, Arturo A.; Thorne, Pamela K.; Laughlin, M. H.; Kennedy, Ann R.

    2015-01-01

    The left anterior descending (LAD, interventricular) coronary artery provides the blood supply to the mid-region of the heart and is a major site of vessel stenosis. Changes in LAD function can have major effects on heart function. In this report, we examined the effect of electron simulated solar particle event (eSPE) radiation on LAD function in a porcine animal model. Vasodilatory responses to adenosine diphosphate (ADP; 10−9 – 10−4 M), bradykinin (BK; 10−11 – 10−6 M), and sodium nitroprusside (SNP; 10−10 – 10−4 M) were assessed. The LAD arteries from Control (non-irradiated) and the eSPE (irradiated) animals were isolated and exhibited a similar relaxation response following treatment with either ADP or SNP. In contrast, a significantly reduced relaxation response to BK treatment was observed in the eSPE irradiated group, compared to the control group. These data demonstrate that simulated SPE radiation exposure alters LAD function. PMID:26072960

  1. Dynamic Viscoelasticity and Surface Properties of Porcine Left Anterior Descending Coronary Arteries.

    PubMed

    Burton, Hanna E; Freij, Jenny M; Espino, Daniel M

    2017-03-01

    The aim of this study was, for the first time, to measure and compare quantitatively the viscoelastic properties and surface roughness of coronary arteries. Porcine left anterior descending coronary arteries were dissected ex vivo. Viscoelastic properties were measured longitudinally using dynamic mechanical analysis, for a range of frequencies from 0.5 to 10 Hz. Surface roughness was calculated following three-dimensional reconstructed of surface images obtained using an optical microscope. Storage modulus ranged from 14.47 to 25.82 MPa, and was found to be frequency-dependent, decreasing as the frequency increased. Storage was greater than the loss modulus, with the latter found to be frequency-independent with a mean value of 2.10 ± 0.33 MPa. The circumferential surface roughness was significantly greater (p < 0.05) than the longitudinal surface roughness, ranging from 0.73 to 2.83 and 0.35 to 0.92 µm, respectively. However, if surface roughness values were corrected for shrinkage during processing, circumferential and longitudinal surface roughness were not significantly different (1.04 ± 0.47, 0.89 ± 0.27 µm, respectively; p > 0.05). No correlation was found between the viscoelastic properties and surface roughness. It is feasible to quantitatively measure the viscoelastic properties of coronary arteries and the roughness of their endothelial surface.

  2. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

    PubMed Central

    2010-01-01

    Purpose Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. Patients and Methods In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. Results Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). Conclusion We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis. PMID:20958964

  3. Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

    PubMed

    Ko, Brian S; Crossett, Marcus; Seneviratne, Sujith K

    2015-07-01

    Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

  4. Anomalous Origin of the Right Coronary Artery from the Midportion of the Left Anterior Descending Artery: A Rare Coronary Anomaly

    PubMed Central

    Gholoobi, Arash

    2016-01-01

    The anomalous origin of the right coronary artery (RCA) as a branch from the left anterior descending artery (LAD) is a very rare variation of the single coronary artery anomaly. The anomalous vessel arises from the proximal or midportion of the LAD and courses anterior to the pulmonary artery trunk in most instances. In this case report, a 61-year-old woman is introduced who underwent coronary angiography following inferoposterior myocardial infarction, in which an anomalous RCA was seen originating from the midportion of the LAD. There was also a separate small artery originating from the right coronary sinus, which was most probably a right atrial branch. PMID:27956915

  5. "Cutting Balloon and the Three Burrs": treatment for ostial left anterior descending artery in-stent restenosis.

    PubMed

    Osula, Serge; Ramsdale, David R

    2002-02-01

    A 58-year-old man re-presented with symptoms of angina 3 months after percutaneous transluminal coronary angioplasty (PTCA) and stenting to his proximal left anterior descending artery (LAD). Angiography revealed ostial in-stent restenosis of the LAD, which was treated with rotational atherectomy and a cutting balloon PTCA. Combining two useful technologies for treating in-stent restenosis may prove to yield better results than using either technique alone. Long-term benefit will need to be assessed by randomized studies.

  6. Left anterior descending artery percutaneous coronary intervention via the left internal mammary artery in a 54-year-old type 1 diabetic woman: a case report

    PubMed Central

    Kasprzak, Jarosław

    2013-01-01

    Data on the treatment of left anterior descending artery (LAD) stenosis involving or localized distally to left internal mammary artery anastomosis are scarce and not homogeneous. Both surgery (CABG) and percutaneous interventions (PCI) have been attempted, but the most effective treatment has not yet been established. We report a case of a 54-year-old woman suffering from chronic, stable angina and diabetes type 1 successfully treated with percutaneous angioplasty of LAD via the left internal mammary artery with drug-eluting stent implantation with excellent short-term results. PMID:24570698

  7. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting – midterm mortality and morbidity

    PubMed Central

    Domaradzki, Wojciech; Krauze, Jolanta; Kinasz, Leszek; Jankowska-Sanetra, Justyna; Świątkiewicz, Małgorzata; Paradowski, Krzysztof; Cisowski, Marek

    2015-01-01

    Introduction Completeness of myocardial revascularization is essential in surgical treatment of coronary artery disease. The aim of this study is to determine the effectiveness of coronary endarterectomy as an adjunct to coronary artery bypass grafting (CABG) in the most difficult cases. Material and methods Among 1559 patients who had CABG in our department, the cases of 17 who underwent an adjunct left anterior descending endarterectomy were analyzed. All procedures were performed with median sternotomy, extracorporeal circulation and in mild hypothermia (34°C), by the same surgeon. No coronary artery endarterectomy was planned before surgery. Results There was no infarction or cardiac arrest during hospitalization. Only one patient required mechanical circulatory support (intra-aortic balloon counterpulsation). Each patient was contacted and investigation for major adverse cardiac and cerebrovascular events (MACCE) was performed. Eleven patients (65%) already underwent midterm clinical evaluation. There was no death, myocardial infarction or cerebrovascular incident during the entire period (mean follow-up at 15.3 months). One patient required urgent coronarography due to chest pain. No other patient had chest pain or significant deterioration of ventricular function in echocardiography. Conclusions Outcomes and potential indications for performing left anterior descending coronary endarterectomy as an adjunct to CABG are discussed. PMID:26855644

  8. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.

    PubMed

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu

    2015-01-01

    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  9. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    PubMed Central

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  10. Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation

    PubMed Central

    Deininger, Maurilio Onofre; Moreira, Luiz Felipe Pinho; Dallan, Luiz Alberto Oliveira; de Oliveira, Orlando Gomes; Magalhães, Daniel Marcelo Silva; Coelho, José Reinaldo de Moura; Deininger, Eugênia di Giuseppe; Lopes, Norland de Souza; Queiroga, Ricardo Wanderley; Belmont, Elizabeth Ferreira

    2014-01-01

    Objective To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site. PMID:25140469

  11. BET 1: IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME, DOES WELLENS' SIGN ON THE ELECTROCARDIOGRAPH IDENTIFY CRITICAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS?

    PubMed

    Morris, Niall; Howard, Laura

    2017-04-01

    Wellens' syndrome consists of a history suggestive of an acute coronary syndrome and biphasic or deeply inverted T waves in ECG leads V2-V3. A shortcut review was carried out to establish whether this ECG pattern identifies patients with a critical left anterior descending artery stenosis. Six relevant papers were found. The clinical bottom line is that biphasic T-wave inversion in lead V2-V3 should alert the clinician to a probable critical stenosis of the left anterior descending artery.

  12. Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery

    PubMed Central

    Nakazato, Jun; Hirata, Kazuhito; Wake, Minoru

    2014-01-01

    A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and the left anterior descending artery. Surgical correction of the anomaly was deferred and the patient was managed with medications to control spasm with good clinical outcome. PMID:24920513

  13. Coronary-Cameral Fistula Connecting the Left Anterior Descending Artery and the First Obtuse Marginal Artery to the Left Ventricle: A Rare Finding

    PubMed Central

    Khan, Arshad Ameer; Qureshi, Ghazanfar; Balakrishna, Pragathi

    2017-01-01

    Coronary-cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left ventricle. Depending upon their size and location, coronary-cameral fistulas can lead to congestive heart failure, myocardial infarction, and bacterial endocarditis. We describe a case of 49-year-old woman who presented with worsening exertional dyspnea and leg swelling. Transthoracic echocardiogram revealed an ejection fraction of 35%. Cardiac catheterization demonstrated a fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle. In this report, the authors provide a concise review on coronary fistulas, complications, and management options. PMID:28194284

  14. One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries

    PubMed Central

    Golmohamadi, Zahra; Sokhanvar, Sepideh; Aslanabadi, Naser; Ghaffari, Samad; Sohrabi, Bahram

    2013-01-01

    Background In recent years, stents are increasingly used in variety of coronary lesions. Ostial lesion of left anterior descending coronary artery (LAD) however remains a challenge area because of the invariable involvement of distal left main coronary artery (LMCA). This study was designed to evaluate the clinical and angiographic outcomes of everolimus-eluting stent (EES) implantation for ostial LAD. Methods EESs were implanted in 45 consecutive patients with ostial LAD stenoses. For complete lesion coverage, stent positing was extended into the distal LMCA in 6 patients (13.3%) with intermediated LMCA narrowing. We assess MACE during one-year follow-up. Results In-hospital success rate was 100%; neither cardiac death nor stent thrombosis in our patients, but two patients had myocardial infarction in non-related coronary artery during follow-up. Two patients had angiographic restenosis and underwent TLR. The cumulative MACE-free survival rate was 95.6% at one year. Conclusion EES was in ostial LAD lesions with complete lesion coverage achieving high procedural success rate and acceptable clinical outcomes during one-year follow-up period.

  15. Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure

    PubMed Central

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-01-01

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail. PMID:25489995

  16. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    PubMed

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  17. Guidewires Used in First Intentional Single Wiring Strategy for Chronic Total Occlusions of the Left Anterior Descending Coronary Artery

    PubMed Central

    Nassar, Yasser S.; Boudou, Nicolas; Dumonteil, Nicolas; Lhermusier, Thibault; Carrie, Didier

    2013-01-01

    Background: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending (LAD) specifically is associated with improved long-term 5 year survival as compared to PCI failure. The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. Aim: To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. Methods: A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. Results: A total of 30 patients with LAD CTO lesions (100%), were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW) success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases) while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%), 36% were Soft Non Tapered Pilot 50 (28%), whisper (8%), while 16% were Stiff Non tapered GWs; Miracle 12 (8%), Miracle 6 (4%), Miracle 3 (4%), and 4% were Stiff Tapered GWs; Progress 200 (4%). Conclusions: Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs. PMID:23983909

  18. Preventive Effect of Yuzu and Hesperidin on Left Ventricular Remodeling and Dysfunction in Rat Permanent Left Anterior Descending Coronary Artery Occlusion Model

    PubMed Central

    Yu, Hye Yon; Ahn, Ji Hun; Park, Se Won; Jung, Yi-Sook

    2015-01-01

    Left ventricular (LV) remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI), is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF) and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD) occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium. PMID:25559243

  19. Preventive effect of yuzu and hesperidin on left ventricular remodeling and dysfunction in rat permanent left anterior descending coronary artery occlusion model.

    PubMed

    Yu, Hye Yon; Ahn, Ji Hun; Park, Se Won; Jung, Yi-Sook

    2015-01-01

    Left ventricular (LV) remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI), is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF) and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD) occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium.

  20. Sirolimus-Eluting Stents vs Uncoated Stents for the Treatment of Proximal Left Anterior Descending Coronary Artery Stenosis

    PubMed Central

    Valencia, José; Mainar, Vicente; Bordes, Pascual; Berenguer, Alberto; Ruiz-Nodar, Juan Miguel; Pineda, Javier; Gomez, Silvia; Sogorb, Francisco; Caturla, Juan

    2007-01-01

    Sirolimus-eluting stents (SES) have demonstrated low incidence of target vessel revascularizations in several anatomic scenarios, including proximal left anterior descending coronary artery (pLAD) lesions. The aim of present study was to compare the efficacy of SES with bare metal stents (BMS) for the treatment of such lesions. 96 patients with severe pLAD stenosis treated with SES were included. Clinical follow-up were performed during a 24 month period. A 98 patient sample with pLAD lesions treated with BMS was taken as control group. Death, angiographic restenosis, new target lesion revascularization (TLR) and target vessel failure (TVF) were registered. Clinical, angiographic and procedural variables were analysed to identify predictors of TVF and TLR. Angiographic procedural success was 100% in SES group vs 99% in BMS group (p=1.0). At 2.5 years, the cumulative rate of TVF was 9.4% in SES group vs 16.3% in BMS group (p=0.15), and the rate of TLR was 5.2% in SES group vs 12.2% in control group (p=0.08). The probabilities of cumulative TVF and TLR free survival were in BMS group 83.7% and 87.8%, and in SES group 90.6% and 94.8%, respectively. After multivariate analysis only SES utilization was found as independent protective factor against TVF and TLR (HR 0.38, 95%CI [0.15-0.94] p=0.037 and HR 0.21, 95%CI [0.06-0.66] p=0.008, respectively), and diabetes as independent predictor of TFV and TLR (HR 2.37, 95%CI [1.07-5.24] p=0.034 and HR 3.57, 95%CI [1.29-9.87] p=0.014, respectively). This study demonstrates that SES utilization is safe and effective in the tretament of pLAD lesions with a better clinical outcome than BMS in a long-term follow-up. PMID:23675052

  1. SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

    SciTech Connect

    Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn; Crandley, Edwin; Read, Paul; Krishni, Wijesooriya

    2014-06-15

    Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed on 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude.

  2. Sirolimus-Versus Zotarolimus-Eluting Stents in Acute Coronary Syndromes With C Type Left Anterior Descending Artery Lesions: A Three-Year Clinical Follow-Up

    PubMed Central

    Gokay, Seher; Cicek, Davran; Muderrisoglu, Haldun

    2012-01-01

    Background Drug-eluting stents have improved the efficacy of percutaneous coronary intervention and made it the preferred therapy in the treatment of ischemic heart diseases including acute coronary syndromes. The objective of the study was to compare the clinical efficacy and safety of sirolimus-eluting stent with that of zotarolimus-eluting stent following percutaneous coronary intervention for acute coronary syndrome patients with C-type left anterior descending stenosis. Methods A total of 154 acute coronary syndrome patients with C-type lesions in the left anterior descending artery, requiring a stent > 28 mm in length, were randomized into two groups to receive either sirolimus- (n = 74) or zotarolimus-eluting stent (n = 80). The follow-up period after stent implantation was approximately 36 months. The primary endpoint was a major cardiac event (a composite of cardiac death, myocardial infarction, or ischemia-related target vessel revascularization), and the secondary endpoint included these individual end points plus stent thrombosis. Results After 3 years follow-up, the rate of the primary end point (major cardiac event: cardiac death, myocardial infarction, ischemia-related target vessel revascularization) was 16% in the sirolimus group (n = 12) versus 11.2% in the zotarolimus group (n = 9) (P = 0.2). Although there were four cases of stent thrombosis with sirolimus-eluting stent and one with zotarolimus-eluting stent (4.0% sirolimus vs. 1.25% zotarolimus; P = 0.2), neither non-Q myocardial infarction (4.0%sirolimus vs. 1.25% zotarolimus; P = 0.2) nor stent thrombosis, differed significantly. Conclusions Although zotarolimus-eluting stent implantation showed more favorable results with respect to stent thrombosis and major adverse cardiac event rates compared to sirolimus-eluting stent implantation, statistically, both stent groups have nearly similar clinical safety and efficacy in the treatment of acute coronary syndromes with C-type lesions in the left

  3. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio and non-invasive coronary flow reserve.

    PubMed

    Meimoun, P; Clerc, J; Ardourel, D; Martis, S; Djou, U; Botoro, T; Boulanger, J; Elmkies, F; Zemir, H

    2016-11-01

    Assessment of the functional significance of left anterior descending coronary artery (LAD) stenosis of intermediate severity is challenging and often based on fractional flow reserve (FFR). The instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, and non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography are also potentially useful. A direct comparison of FFR, IFR, and non-invasive CFR has never been performed. Our objective was to test the usefulness of non-invasive CFR by comparison to invasive FFR and IFR in patients with LAD stenosis of angiographic intermediate severity and stable coronary artery disease.

  4. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  5. A Combination of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery with Dual Left Anterior Descending Artery

    PubMed Central

    Addai, Theodore; Kola, Monahar; Raqeem, Muhammad Wajih; Barsamyan, Sergey; Mirrakhimov, Aibek E.

    2016-01-01

    An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then. PMID:27293909

  6. Left Anterior Descending Coronary Artery and Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report

    PubMed Central

    Duvnjak, Petar; Laguna, Mario

    2016-01-01

    The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient’s treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M. Bovis mycotic aneurysms as a late complication of intravesicular BCG therapy for superficial bladder cancer. The patient initially presented with acute onset pain and swelling in the left knee > 2 years following initial therapy, and initial workup revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment and additional workup, the patient was discovered to have additional aneurysms in the right popliteal artery and left anterior descending artery (LAD). Surgical pathology and bacterial cultures obtained from the excised femoral aneurysms and surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm. PMID:27761190

  7. A Method for Passive Imaging of the Left Anterior Descending Coronary Artery in the Presence of Coherent Heart Wall Motion.

    DTIC Science & Technology

    2007-11-02

    the Mitral Valve Into the Left Ventricle 3 2 Fourteen-Channel Linear Array 11 3 RVDR for Experimental Data at 157.5 Hz 13 4 RVDR for Experimental... valve and the bicuspid ( mitral ) valve are open, with blood flowing from the left and right atriums down into the left and right ventricles...figure 1. Energy can be transferred from this area in the form of both compressional waves (emanating from the mitral valve jet) and shear waves

  8. Ventricular Fibrillation-Induced Cardiac Arrest Results in Regional Cardiac Injury Preferentially in Left Anterior Descending Coronary Artery Territory in Piglet Model

    PubMed Central

    Forder, John R.; Clark, Dan; Shih, Andre; Udassi, Sharda; Badugu, Srinivasarao; Lamb, Melissa A.; Porvasnik, Stacy L.; Shih, Renata S.; Colon-Lopez, Dalia; Zaritsky, Arno L.

    2016-01-01

    Objective. Decreased cardiac function after resuscitation from cardiac arrest (CA) results from global ischemia of the myocardium. In the evolution of postarrest myocardial dysfunction, preferential involvement of any coronary arterial territory is not known. We hypothesized that there is no preferential involvement of any coronary artery during electrical induced ventricular fibrillation (VF) in piglet model. Design. Prospective, randomized controlled study. Methods. 12 piglets were randomized to baseline and electrical induced VF. After 5 min, the animals were resuscitated according to AHA PALS guidelines. After return of spontaneous circulation (ROSC), animals were observed for an additional 4 hours prior to cardiac MRI. Data (mean ± SD) was analyzed using unpaired t-test; p value ≤ 0.05 was considered statistically significant. Results. Segmental wall motion (mm; baseline versus postarrest group) in segment 7 (left anterior descending (LAD)) was 4.68 ± 0.54 versus 3.31 ± 0.64, p = 0.0026. In segment 13, it was 3.82 ± 0.96 versus 2.58 ± 0.82, p = 0.02. In segment 14, it was 2.42 ± 0.44 versus 1.29 ± 0.99, p = 0.028. Conclusion. Postarrest myocardial dysfunction resulted in segmental wall motion defects in the LAD territory. There were no perfusion defects in the involved segments. PMID:27882326

  9. A Case of Chronic Total Occlusion of the Left Anterior Descending Artery Successfully Treated with Side Branch Technique Using the Soutenir CV

    PubMed Central

    Niizeki, Takeshi; Ikeno, Eiichiro; Kubota, Isao

    2017-01-01

    Patient: Male, 54 Final Diagnosis: Old myocardial infarction Symptoms: Lower extremity swelling • respiratory distress Medication: — Clinical Procedure: Success Specialty: Cardiology Objective: Unusual setting of medical care Background: Success rates for treatment of chronic total occlusion (CTO) have dramatically improved in recent years with the development of new CTO guidewires and development of new techniques such as the retrograde approach. In the antegrade approach, a guidewire is occasionally passed through a side branch despite successful wire crossing of the CTO lesion. In order to pass a wire through the main artery, there are a few side branch techniques such as a reverse wire technique. Case Report: A 54-year-old man with symptoms of heart failure was admitted to our hospital. Coronary angiography showed CTO of the proximal left anterior descending artery. Percutaneous coronary intervention with an antegrade approach was started. We succeeded in passing the wire through a side branch but not the main artery. Unfortunately, a reverse wire technique failed in this case. Next, the wire passed through a side branch was exchanged with the Soutenir CV, and a retrograde approach was started. The wire crossing from retrograde was entwined around the Soutenir CV. After that, the retrograde wire was snared and guided to the antegrade guiding catheter, which resulted in successful wiring into the main artery easily. Conclusions: The side branch technique using the Soutenir CV may be an effective strategy in some cases. PMID:28082733

  10. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    PubMed Central

    Hu, Xiang; Zhao, Qiang

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  11. Comparison of Outcomes of Coronary Artery Bypass Grafting Using Internal Mammary Graft Versus Percutaneous Coronary Intervention for Isolated Proximal Left Anterior Descending Narrowing.

    PubMed

    Iqbal, M Bilal; Ilsley, Charles; De Robertis, Fabio; Lane, Rebecca; Kabir, Tito; Bahrami, Toufan; Simon, Andre; Popov, Aron; Amrani, Mohamed; Dalby, Miles C; Mason, Mark; Grocott-Mason, Richard; Smith, Robert D; Raja, Shahzad G

    2017-03-01

    There are limited contemporary studies comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for isolated proximal left anterior descending (LAD) disease. Increasing stent length and decreasing stent diameters are associated with increased risk of restenosis and adverse outcomes after PCI. Whether these parameters influence outcomes when comparing CABG and PCI is unclear. We compared CABG and PCI in 3,473 patients who underwent revascularization for isolated proximal LAD disease from 2004 to 2015 at Harefield Hospital, UK; 3,078 patients (89%) had PCI and 384 patients had CABG (11%). We analyzed all-cause mortality at 3 years. The unadjusted mortality rates were similar (PCI vs CABG: 9.5% vs 7.0%, p = 0.109). PCI was associated with comparable mortality (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.70 to 1.89, p = 0.593), even when stratified to bare-metal stents (HR 1.58, 95% CI 0.89 to 2.80, p = 0.121); first-generation drug-eluting stents (FDES; HR 1.16, 95% CI 0.67 to 2.02, p = 0.597); and second-generation DES (SDES; HR 0.98, 95% CI 0.53 to 1.82, p = 0.946). Stent diameters did not influence outcomes, but PCI was associated with higher mortality when stent length ≥30 mm (HR 2.12, 95% CI 1.12 to 4.03, p = 0.022). There was a linear association between stent length and mortality, and for every 1-mm increase in stent length, the 3-year mortality increased by 0.32%. In conclusion, for patients with isolated proximal LAD disease, PCI and CABG were associated with similar mortality. Increasing stent length was progressively associated with worse outcomes with PCI. For longer segments of disease requiring stent lengths ≥30 mm, CABG may be associated with better outcomes.

  12. TU-F-BRF-07: Accuracy of Routine Treatment Planning 4D and DIBH CT Delineation of the Left Anterior Descending Artery in Radiotherapy

    SciTech Connect

    White, B; Lin, L; Freedmen, G; Both, S; Vennarini, S

    2014-06-15

    Purpose: To assess the feasibility of routine treatment planning 4DCT and deep inspiration breath-hold (DIBH) to accurately contour the left anterior descending artery (LAD), a primary indicator of cardiac toxicity, for radiotherapy treatment planning of breast cancer. Methods: Ten subjects were imaged with a cardiac-gated MRI protocol to determine the displacement of a ROI that included the LAD. The subjects performed a series of breath-hold maneuvers to obtain short-axis and radial views, which were resampled to create a 3D-volume. Tissue motion was determined using a multi-resolution 3D optical flow deformable image registration algorithm. The ROI motion was then used as a spatial boundary to characterize the blurring motion of the LAD in ten patients during clinical 4DCT and DIBH protocols. A radiologist contoured the LAD. Coronary motion-induced blurring artifacts were quantified by applying an unsharp filter to accentuate the LAD despite motion-blurring. The 4DCT maximum inhalation and exhalation respiratory phases were co-registered to determine the LAD displacement during tidal respiration, as visualized in 4DCT. Results: The average 90{sup th} percentile heart motion for the ROI was 0.7±0.1mm(LR), 1.3±0.6mm(SI), 0.6±0.2mm(AP) in the cardiac-gated MRI cohort. The average relative increase in the number of voxels comprising the LAD contour was 69.4±4.5% for the DIBH. During tidal respiration, the average relative increase in the LAD contour was 69.3±5.9% and 67.9±4.6% for inhalation and exhalation respiratory phases respectively. The average 90{sup th} percentile LAD motion was 4.8±1.1mm(LR), 0.9±0.4mm(SI), 1.9±0.6mm(AP) for the 4DCT cohort, in the absence of cardiac-gating. Conclusion: Uncompensated coronary motion was the dominant form of motion blurring present in the CT images due to the high frequency of the cardiac cycle relative to the respiratory cycle. The 4D and DIBH CT contour delineation of the LAD was consistently overestimated without

  13. Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve.

    PubMed

    Meimoun, P; Clerc, J; Ardourel, D; Djou, U; Martis, S; Botoro, T; Elmkies, F; Zemir, H; Luycx-Bore, A; Boulanger, J

    2016-10-17

    To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.

  14. Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

    PubMed Central

    Sawaya, Fadi J.; Liberman, Henry; Devireddy, Chandan

    2016-01-01

    Unligated side branches of the left internal mammary artery (LIMA) have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated. PMID:26981289

  15. Evolution of myocardial ischemia and left ventricular function in patients with angina pectoris without myocardial infarction and total occlusion of the left anterior descending coronary artery and collaterals from other coronary arteries

    SciTech Connect

    Juilliere, Y.; Marie, P.Y.; Danchin, N.; Karcher, G.; Bertrand, A.; Cherrier, F. )

    1991-07-01

    Repeated episodes of myocardial ischemia might lead to progressive impairment of left ventricular (LV) function. This radionuclide study assessed myocardial ischemia and LV function several years after documented coronary occlusion without myocardial infarction. Over 5 years, 24 consecutive patients, who underwent cardiac catheterization for angina pectoris without myocardial infarction, had isolated total occlusion of the left anterior descending coronary artery with well-developed collateral vessels. Five patients were successfully treated by coronary bypass grafting and 3 by coronary angioplasty. Among the 16 medically treated patients, 1 was lost to follow-up and 1 died (extracardiac death). The mean (+/- standard deviation) follow-up (14 patients) was 48 +/- 15 months. At follow-up, 8 patients still had clinical chest pain, 11 received antianginal therapy, 4 patients had no stress ischemia and the other 10 had greater than or equal to 1 sign of stress ischemia. All patients had a normal LV ejection fraction at rest (mean 60 +/- 3%; range 55 to 65%). Collateral circulation preserves LV function at the time of occlusion and, in some cases, prevents the development of myocardial ischemia; in patients with persisting myocardial ischemia after well-collateralized coronary occlusion, LV function is not impaired at long-term follow-up.

  16. Accuracy of Routine Treatment Planning 4-Dimensional and Deep-Inspiration Breath-Hold Computed Tomography Delineation of the Left Anterior Descending Artery in Radiation Therapy

    SciTech Connect

    White, Benjamin M.; Vennarini, Sabina; Lin, Lilie; Freedman, Gary; Santhanam, Anand; Low, Daniel A.; Both, Stefan

    2015-03-15

    Purpose: To assess the feasibility of radiation therapy treatment planning 4-dimensional computed tomography (4DCT) and deep-inspiration breath-hold (DIBH) CT to accurately contour the left anterior descending artery (LAD), a primary indicator of radiation-induced cardiac toxicity for patients undergoing radiation therapy. Methods and Materials: Ten subjects were prospectively imaged with a cardiac-gated MRI protocol to determine cardiac motion effects, including the displacement of a region of interest comprising the LAD. A series of planar views were obtained and resampled to create a 3-dimensional (3D) volume. A 3D optical flow deformable image registration algorithm determined tissue displacement during the cardiac cycle. The measured motion was then used as a spatial boundary to characterize motion blurring of the radiologist-delineated LAD structure for a cohort of 10 consecutive patients enrolled prospectively on a breast study including 4DCT and DIBH scans. Coronary motion–induced blurring artifacts were quantified by applying an unsharp filter to accentuate the LAD structure despite the presence of motion blurring. The 4DCT maximum inhalation and exhalation respiratory phases were coregistered to determine the LAD displacement during tidal respiration, as visualized in 4DCT. Results: The average 90th percentile heart motion for the region of interest was 0.7 ± 0.1 mm (left–right [LR]), 1.3 ± 0.6 mm (superior–inferior [SI]), and 0.6 ± 0.2 mm (anterior–posterior [AP]) in the cardiac-gated MRI cohort. The average relative increase in the number of voxels comprising the LAD contour was 69.4% ± 4.5% for the DIBH. The LAD volume overestimation had the dosimetric impact of decreasing the reported mean LAD dose by 23% ± 9% on average in the DIBH. During tidal respiration the average relative LAD contour increase was 69.3% ± 5.9% and 67.9% ± 4.6% for inhalation and exhalation respiratory phases, respectively. The average 90th

  17. An alternative percutaneous interventional approach for post-anastomatic left anterior descending artery stenosis in patients with markedly tortuous LIMA graft.

    PubMed

    Tengiz, Istemihan; Aliyev, Emil; Ercan, Ertugrul

    2005-10-01

    Percutaneous coronary intervention through a tortuous left internal mammary artery (LIMA) graft, especially with redundancy in length is a challenge in spite of availability of different types of coated guidewires and low-profile balloons. Various modifications of the interventional technique are required in order to negotiate the tortuosity of the LIMA graft. We describe an alternative technique that overcomes this problem in patient with a markedly tortuous LIMA graft.

  18. Radiation dose to the left anterior descending coronary artery during interstitial pulsed-dose-rate brachytherapy used as a boost in breast cancer patients undergoing organ-sparing treatment

    PubMed Central

    Serkies, Krystyna; Dziadziuszko, Rafał; Narkowicz, Magdalena; Kamińska, Joanna; Lipniewicz, Joanna

    2017-01-01

    Purpose To assess dose received by the left anterior descending (LAD) coronary artery during interstitial pulsed-dose-rate brachytherapy (PDR-BT) boost for left-sided breast cancer patients undergoing organ-sparing treatment. Material and methods Thirty consecutive pT1-3N0-1M0 breast cancer patients boosted between 2014 and 2015 with 10 Gy/10 pulses/hour PDR-BT following a computed tomography (CT) simulation with the multi-catheter implant were included. The most common localization of primary tumor were upper quadrants. Patients were implanted with rigid tubes following breast conserving surgery and whole breast external beam irradiation (40 Gy/15 or 50 Gy/25 fractions). Computed tomography scans were retrospectively reviewed and LADs were contoured without and with margin of 5 mm (LAD5mm). Standard treatment plan encompassed tumor bed determined by the surgical clips with margin of 2 cm. Dosimetric parameters were extracted from the dose-volume histograms. Results The mean D90 and V100 were 10.3 Gy (range: 6.6-13.3), and 42.0 cc (range: 15.3-109.3), respectively. The median dose non-uniformity ratio (DNR) was 0.50 (range: 0.27-0.82). The mean doses to LAD and LAD5mm were 1.0 Gy and 0.96 Gy, and maximal doses were 1.57 Gy and 1.99 Gy, respectively. Dose to the 0.1 cc of the LAD and LAD5mm were 1.42 Gy and 1.85 Gy (range: 0.01-4.98 Gy and 0.1-6.89 Gy), respectively. Conclusions Interstitial multi-catheter PDR-BT used as a boost for left-sided breast cancer is generally associated with low dose to the LAD. However, higher dose in individual cases may require alternative approaches. PMID:28344598

  19. Collateral circulation from the conus coronary artery to the anterior descending coronary artery: assessment using multislice coronary computed tomography.

    PubMed

    de Agustín, José A; Marcos-Alberca, Pedro; Hernández-Antolín, Rosana; Vilacosta, Isidre; Pérez de Isla, Leopoldo; Rodríguez, Enrique; Macaya, Carlos; Zamorano, José

    2010-03-01

    The prognosis of patients with coronary artery disease largely depends on the presence of a collateral circulation. The location and extent of the collateral circulation is highly variable and these parameters determine whether or not ischemic symptoms occur and whether left ventricular contractility is abnormal. The collateral circulation is generally established through small-caliber distal vessels, although many different forms have been described. We report on three patients with severe left coronary artery disease and collateral circulation through a large conus coronary artery that joined a proximal or medial segment of the left anterior descending coronary artery. In all three cases, left ventricular function was preserved.

  20. Isolated Anomalous Origin of Left Pulmonary Artery From the Descending Aorta: An Embryologic Ambiguity.

    PubMed

    Gnanappa, Ganesh Kumar; Laohachai, Karina; Orr, Yishay; Ayer, Julian

    2016-11-01

    Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. Anomalous origin of the left pulmonary artery from the aorta (ALPA) constitutes a small proportion of these cases. ALPA has been reported to arise from the ascending aorta with various embryologic postulates. We report a case of isolated ALPA arising from the descending aorta in association with a patent ductus arteriosus, to emphasize its embryologic ambiguity.

  1. Successfully treated descending necrotizing mediastinitis through thoracotomy using a pedicled muscular serratus anterior flap.

    PubMed

    Haremza, Céline; De Dominicis, Florence; Merlusca, Geoni; Berna, Pascal

    2011-10-01

    Descending necrotizing mediastinitis (DNM) is rare and aggressive. A 68-year-old female with no medical history, was admitted to our institution for cervical cellulitis. After a conventional medical treatment, multiple abscesses of the upper mediastinum appeared on computed tomography (CT) findings. Although two cervicotomies were performed, a new necrotic abscess appeared in the anterior upper and middle mediastinum. An extensive debridement of cellulitis and abscess extended to the pericardium was made by thoracotomy. Middle mediastinum and pericardium were covered and reconstructed by a right pedicled serratus anterior flap. After radical surgery, follow-up was uneventful. Early extensive and complete debridement of cervical and mediastinal collections and irrigation with broad-spectrum intravenous antibiotics is essential. Combined surgery is the best approach in DNM. The use of a pedicled muscular flap helps control the sepsis. In such cases, serratus anterior flap is a flap of choice because it is reliable and always available even in a skinny patient, contrary to omentum. In this life-threatening disease, an early aggressive combined surgery with debridement of all necrotic tissues extended to the pericardium if necessary associated with a pedicled flap is mandatory.

  2. Acute Left Arm Ischemia Associated with Floating Thrombus in the Proximal Descending Aorta: Combined Endovascular and Surgical Therapy

    SciTech Connect

    Fanelli, F.; Gazzetti, M.; Boatta, E.; Ruggiero, M.; Lucatelli, P.; Speziale, F.

    2011-02-15

    Free floating thrombus in the proximal descending aorta is an uncommon and dangerous condition that can be associated with acute peripheral embolization. The few cases described were solved with surgical and/or medical therapy. We report the case of a patient with acute left arm ischemia secondary to the presence of floating thrombus in the proximal descending aorta extending into the left subclavian artery, solved with combined endovascular and surgical therapy. Treatment was successfully performed with thrombembolectomy combined with temporary deployment, into the descending aorta, of a Wallstent in a 'basket-fashion' to avoid distal embolization secondary to thrombus fragmentation. At 1 year follow-up the patient remained symptom-free.

  3. A case report of different degrees of the left anterior, septal and posterior fascicular branch block.

    PubMed

    Sun, Huaqun; Hong, Yupeng; Jin, Tao

    2015-03-01

    We present a rare case of various conduction defects involving the left anterior, septal, and posterior branch in one patient. The different degrees of block of anterior, septal, and posterior fascicular of the left bundle branch indicate pathological changes in left ventricle. However, the values of this electrocardiographic presentation indicating the left ventricular function still need more investigations.

  4. The electrocardiographic features of complete and partial left anterior and left posterior hemiblock.

    PubMed

    Elizari, Marcelo Víctor; Chiale, Pablo Ambrosio

    2012-09-01

    The aim of this study is to present the criteria for the diagnosis of incomplete or partial block within the anterior and posterior divisions of the left bundle-branch (LBB). To disclose incomplete left anterior hemiblock (LAH) and incomplete left posterior hemiblock (LPH), clinical cases of pathologic and physiologic intermittent or transient block in the divisions of the LBB are analyzed. When dealing with the diagnosis of incomplete LAH, an ÂQRS shift in the same or in successive tracings in a patient, showing electrical axis at +50°, +40°, +30°, and 0° covering the whole range up to -45° or even more negative, makes the diagnosis of incomplete to complete block in the anterior division of the LBB. Conversely, when LPH is the case, a progressive change of the ÂQRS from a normal axis to the right, up to +120° in the same or subsequent tracings in a short period, can only be explained by increasing the degrees of LPH. When a partial or incomplete LAH or LPH is present and the ÂQRS direction can be considered normal in clinical practice, it is difficult or even impossible to reach a diagnosis. That is, small degrees of block in the divisions of the LBB totally overlap normal variants.

  5. Treatment of Distal Left Anterior Descending Artery Perforation with Fat Embolization

    PubMed Central

    Abushahba, Galal Ahmed; Abujalala, Salem; Butt, Mehmood S.

    2016-01-01

    Coronary perforation is a potentially fatal complication during percutaneous coronary intervention. Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. Although the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we present a case of distal coronary perforation, and review the management of coronary perforation in the current practice.

  6. New technique "Right Anterior Small Thoracotomy (RAST operation)" for beating heart grafting of the right internal thoracic artery to the posterior descending artery to the posterior descending artery in a third redo CABG patient. A novel coronary technique

    PubMed Central

    Guida, Maximo; Guida, Gustavo; Pecora, Giuseppina; Garate, Estefania De

    2014-01-01

    Third REDO-CABG is a challenge for the surgical team. Usually a patent mammary is the only graft working and the sternotomy becomes a risky procedure. Injury to a patent graft has been associated to a high mortality rate. Many different approaches have been proposed. We describe a novel technique to approach the right coronary artery through a right anterior small thoracotomy using the right mammary prolonged with saphenous vein for grafting the posterior descending artery on the beating heart. The technique is very simple and feasible because anatomically the right coronary artery and the right mammary are very close and the mobilization of the heart is minimal. PMID:25372923

  7. Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm Associated with a Right Aortic Arch and a Left Subclavian Artery Arising from a Kommerell's Diverticulum

    SciTech Connect

    Klonaris, Chris Avgerinos, Efthimios D.; Katsargyris, Athanasios; Matthaiou, Alexandros; Georgopoulos, Sotirios; Psarros, Vasileios; Bastounis, Elias

    2009-07-15

    This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell's diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 x 32 x 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.

  8. Gait modification strategies of trunk over left stance phase in patients with right anterior cruciate ligament deficiency

    PubMed Central

    Shi, Dongliang; Li, Nannan; Wang, Yubin; Jiang, Shuyun; Li, Jinglong; Zhu, Wenhui

    2015-01-01

    Purpose: To investigate the gait modification strategies of trunk over left stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Methods: Thirty-six patients with right ACL-D and thirty-six health subjects (control) were recruited to undergo a 3-dimensional (3D) gait analysis. Coordinate data from 26 reflective markers positioned on the body surface of participants were recorded with a 3D optical video motion capture system, as they walked on the ground, ascended and descended a custom-built staircase. Angle changes in the 3-planes under different walking conditions were analyzed. Results: There were statistically significant differences between the two groups in the trunk at the transverse plane angle in most measurements. With the walk pattern of stair descent, the trunk at all 3-plane angles, at the maximum value of the left knee sagittal/coronal/transverse plane moment, was significantly different between the two groups (P ≤ 0.03). Conclusions: Our findings suggested that special gait modification of trunk is apparent over stance of left (healthy) side in patients with right ACL-D. The results of this study may supply more insight with respect to improving the diagnosis and rehabilitation of ACL-D. This information may also be helpful for a better use of walk and stair tasks as part of a rehabilitation program and provide a safe guideline for the patients. PMID:26550279

  9. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    PubMed

    Akgüllü, Çağdaş; Eryılmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

  10. Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case.

    PubMed

    Fischer, Uwe M; Davies, Mark G; El Sayed, Hosam

    2015-04-01

    Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period.

  11. Anterior and posterior nutcracker syndrome accompanying left circumaortic renal vein in an adolescent: case report.

    PubMed

    Özkan, Mehmet B; Ceyhan Bilgici, Meltem; Hayalioglu, Emre

    2016-04-01

    The left renal vein (LRV) has many developmental variations; the two most common are the circumaortic and the retrocaval. Anterior nutcracker syndrome is the compression of the LRV between the aorta and superior mesenteric artery, whereas posterior nutcracker syndrome occurs between the vertebral column and the aorta. An adolescent male (aged 16 years) was referred to the emergency department for flank pain. CT findings showed the combination of anterior and posterior nutcracker syndrome in the left circumaortic renal vein, which has not previously been described in an adolescent.

  12. Impaired executive functioning after left anterior insular stroke: a case report.

    PubMed

    Markostamou, Ioanna; Rudolf, Jobst; Tsiptsios, Iakovos; Kosmidis, Mary H

    2015-01-01

    Given the insular's anatomic complexity and functional interconnectivity, acute lesions may result in varied clinical presentations, including autonomic, somatosensory, perceptual, motor, affective, and cognitive deficits. Although functional neuroimaging studies have demonstrated its role in executive functions, no clinical manifestations have been reported to date. We present the case of a woman with an acute left anterior insular infarction leading to executive (i.e., word and design fluency, mental flexibility, sustained attention, inhibitory control), but not language, visuoperceptual, or memory impairment. This case confirms the left anterior insula's involvement in executive functioning and suggests that an infarction may result in executive impairment.

  13. On the Early Left-Anterior Negativity (ELAN) in Syntax Studies

    ERIC Educational Resources Information Center

    Steinhauer, Karsten; Drury, John E.

    2012-01-01

    Within the framework of Friederici's (2002) neurocognitive model of sentence processing, the early left anterior negativity (ELAN) in event-related potentials (ERPs) has been claimed to be a brain marker of syntactic first-pass parsing. As ELAN components seem to be exclusively elicited by word category violations (phrase structure violations),…

  14. Effectiveness of left anterior right temporal electrode placement in electroconvulsive therapy: 3 case reports.

    PubMed

    Weiss, Alan Micheal; Hansen, Shane Michael; Safranko, Ivan; Hughes, Pequita

    2015-03-01

    Unilateral and bitemporal electrode placement has been the dominant mode of delivery in electroconvulsive therapy. We report 3 patients receiving maintenance electroconvulsive therapy where the use of dominant electrode placements was ineffective. Changing to left anterior right temporal electrode placement resulted in marked clinical improvement. This supports the limited literature on this electrode placement.

  15. Semantic retrieval during overt picture description: Left anterior temporal or the parietal lobe?

    PubMed

    Geranmayeh, Fatemeh; Leech, Robert; Wise, Richard J S

    2015-09-01

    Retrieval of semantic representations is a central process during overt speech production. There is an increasing consensus that an amodal semantic 'hub' must exist that draws together modality-specific representations of concepts. Based on the distribution of atrophy and the behavioral deficit of patients with the semantic variant of fronto-temporal lobar degeneration, it has been proposed that this hub is localized within both anterior temporal lobes (ATL), and is functionally connected with verbal 'output' systems via the left ATL. An alternative view, dating from Geschwind's proposal in 1965, is that the angular gyrus (AG) is central to object-based semantic representations. In this fMRI study we examined the connectivity of the left ATL and parietal lobe (PL) with whole brain networks known to be activated during overt picture description. We decomposed each of these two brain volumes into 15 regions of interest (ROIs), using independent component analysis. A dual regression analysis was used to establish the connectivity of each ROI with whole brain-networks. An ROI within the left anterior superior temporal sulcus (antSTS) was functionally connected to other parts of the left ATL, including anterior ventromedial left temporal cortex (partially attenuated by signal loss due to susceptibility artifact), a large left dorsolateral prefrontal region (including 'classic' Broca's area), extensive bilateral sensory-motor cortices, and the length of both superior temporal gyri. The time-course of this functionally connected network was associated with picture description but not with non-semantic baseline tasks. This system has the distribution expected for the production of overt speech with appropriate semantic content, and the auditory monitoring of the overt speech output. In contrast, the only left PL ROI that showed connectivity with brain systems most strongly activated by the picture-description task, was in the superior parietal lobe (supPL). This region

  16. Masquerading bundle branch block: a variety of right bundle branch block with left anterior fascicular block.

    PubMed

    Elizari, Marcelo V; Baranchuk, Adrian; Chiale, Pablo A

    2013-01-01

    The so-called 'masquerading' type of right bundle branch block is caused by the simultaneous presence of a high-degree left anterior fascicular block often accompanied with severe left ventricular enlargement and/or fibrotic block in the anterolateral wall of the left ventricle. These conditions tend to reorient the terminal electrical forces of the QRS complex towards the left and upwards, in such a way that the characteristic slurred S wave in lead I becomes smaller or even disappears. In many cases of standard masquerading right bundle branch block, a small Q wave in lead I is present due to the initial forces of the left anterior fascicular block, which are oriented rightwards and inferiorly. However, in some cases, the Q wave in lead I also vanishes, and the mimicking of a left bundle branch block becomes perfect in standard leads. This is commonly associated with an inferior myocardial infarction or severe inferior fibrosis in cardiomyopathies. The typical QRS changes of right bundle branch block may eventually be concealed even in the right precordial leads; under such circumstances, the ECG diagnosis may be mistaken and the right bundle branch block totally missed. The masquerading right bundle branch block carries a poor prognosis, since it always implies the presence of a severe underlying heart disease.

  17. Successful catheter ablation of a left anterior accessory pathway from the non-coronary cusp of the aortic valve.

    PubMed

    Laranjo, Sérgio; Oliveira, Mário; Trigo, Conceição

    2015-08-01

    Left anterior accessory pathways are considered to be rare findings. Catheter ablation of accessory pathways in this location remains a challenging target, and few reports about successful ablation of these accessory pathways are available. We describe our experience regarding a case of a manifest left anterior accessory pathway ablation using radiofrequency energy at the junction of the left coronary cusp with the non-coronary cusp.

  18. Thoracoscopic anterior ‘fissure first’ technique for left lung cancer with an incomplete fissure

    PubMed Central

    Samejima, Joji; Matsuura, Yosuke; Nakao, Masayuki; Uehara, Hirofumi; Nakagawa, Ken; Masuda, Munetaka; Okumura, Sakae

    2016-01-01

    Background Dealing with incomplete lung fissures during thoracoscopic surgery is difficult. Our objective was to evaluate the efficacy and safety of a thoracoscopic anterior ‘fissure first’ technique for dealing with incomplete left lung fissures. Methods One hundred and seventy patients underwent left upper lobectomy or left lower lobectomy between April 2008 and July 2014. Of these, 34 patients underwent surgery using a thoracoscopic anterior ‘fissure first’ technique for incomplete fissures (group A) and 136 underwent surgery using a conventional thoracoscopic method for unfused fissures (group B). A four-port complete thoracoscopic approach was used in all patients. After completion of the fissure, hilar lymphadenectomy was performed in the conventional manner. Results There were no significant differences between the two groups in operating time, blood loss, or duration of chest tube drainage. Patients in group A required more staple cartridges than those in group B (mean number of cartridges, 2.4 vs. 1.1; P<0.01). The two groups did not significantly differ with regard to the prevalence of air leaks (12% vs. 4%; P=0.11), either prolonged or delayed. Conclusions We found that a thoracoscopic anterior ‘fissure first’ technique for left lung cancer with an incomplete fissure enabled hilar lymphadenectomy to be performed in the conventional manner without any increase in the prevalence of air leaks, operating time, or duration of chest tube drainage. This technique should be considered for use in left upper lobectomy or left lower lobectomy in patients with an incomplete fissure. PMID:28066589

  19. Rate-dependent variation in the duration of the QRS complex with left anterior fascicular block.

    PubMed

    Mirvis, D M; Bandura, J P; Brody, D A

    1977-10-01

    The case of a 67-year-old man with combined ischemic and valvular heart disease is presented. Electrocardiographic abnormalities included left anterior fascicular block with a variable duration of the QRS complex. The width of the QRS complex was dependent on the length of the cycle, being broader with short than with long preceding R-R intervals. This is interpreted as a tachycardia-dependent focal block coexisting with a fixed delay in fascicular conduction.

  20. Morphine Post-Conditioning Effect on QT Dispersion in Patients Undergoing Primary Percutaneous Coronary Intervention on Anterior Descending Cardiac Artery: A Cohort Study

    PubMed Central

    Eshraghi, Ali; Tayyebi, Mohammad; Sajjadi, Seyed Sajed; Bagheri, Ramin Khameneh; Ebdali, Reyhaneh Takalloo; Golnezhad, Reza

    2017-01-01

    Introduction QT dispersion is the difference between the maximum and minimum QTc interval in a 12-lead electrocardiogram (ECG). Some researchers have demonstrated the effects of an increase of QT-d in STEMI and its reduction with successful therapy. The aim of this study was to investigate the morphine post-conditioning effect on the QT dispersion in patients undergoing primary percutaneous coronary intervention (PCI) on anterior descending cardiac artery. Methods This cohort study was conducted on STEMI patients admitted to the Hospital of Imam Reza (AS), Mashhad, Iran, from March 2015 to February 2016 who were undergoing primary angioplasty on the anterior descending cardiac artery. The patients were divided into two groups based on the intake or non-intake of morphine (5 mg morphine for the period of 30 minutes prior to PCI). Parameters, including age, gender, history of diabetes, and blood pressure as well as admission and 24 hours after PCI ejection fraction (EF) and QT-d, were recorded in all patients and compared between the two intervention and control groups. Independent and paired t-tests and chi-square test were used to compare the qualitative and quantitative data between the two groups using SPSS version 19 software. Results The present research was performed on 77 patients (61 males) with mean age of 58.71±11.84 years in the two groups of morphine consumption before PCI (n=46) and control (n=31). No statistical difference was found among the groups in age, gender, diabetes, hypertension, and onset of symptoms until primary PCI. Admission electrocardiogram QT-d value in the positive exposure group showed no significant difference with the control group, but QT-d value at 24 hours after PCI was lower in the positive exposure group than in the control group (morphine versus control: 40.32±6.98 versus 59.64±8.89; p=0.000). QT-d value 24 hours after PCI compared with the admission QT-d value was significantly reduced in both groups. The mean decrease of

  1. Basic linguistic composition recruits the left anterior temporal lobe and left angular gyrus during both listening and reading.

    PubMed

    Bemis, D K; Pylkkänen, L

    2013-08-01

    Language is experienced primarily through one of two mediums--spoken words and written text. Although substantially different in form, these two linguistic vehicles possess similar powers of expression. Consequently, one goal for the cognitive neuroscience of language is to determine where, if anywhere, along the neural path from sensory stimulation to ultimate comprehension these two processing streams converge. In the present study, we investigate the relationship between basic combinatorial operations in both reading and listening. Using magnetoencephalography, we measured neural activity elicited by the comprehension of simple adjective-noun phrases (red boat) using the same linguistic materials and tasks in both modalities. The present paradigm deviates from previous cross-modality studies by investigating only basic combinatorial mechanisms--specifically, those evoked by the construction of simple adjective-noun phrases. Our results indicate that both modalities rely upon shared neural mechanisms localized to the left anterior temporal lobe (lATL) and left angular gyrus (lAG) during such processing. Furthermore, we found that combinatorial mechanisms subserved by these regions are deployed in the same temporal order within each modality, with lATL activity preceding lAG activity. Modality-specific combinatorial effects were identified during initial perceptual processing, suggesting top-down modulation of low-level mechanisms even during basic composition.

  2. Different patterns of famous people recognition disorders in patients with right and left anterior temporal lesions: a systematic review.

    PubMed

    Gainotti, Guido

    2007-04-09

    Selective disorders in recognition of familiar people have been described in patients with right and left anterior temporal lesions, but the exact nature of these cognitive impairments remains controversial. A clarification of this issue could have theoretical implications, because, according to Snowden et al. [Snowden, J. S., Thompson, J. C., & Neary, D. (2004). Knowledge of famous faces and names in semantic dementia. Brain, 127, 860-872], the pattern of impairment shown by patients with right and left anterior temporal atrophy is inconsistent with unitary, abstract, amodal models of semantic memory. This pattern could, on the contrary suggest a multimodal network, in which the right and left temporal lobes would mainly process and store visual and, respectively, verbal information. I tried to clarify this issue by systematically reviewing: (a) all published individual cases of patients showing a prevalent damage of the anterior parts of the right or left temporal lobes and a selective disorder of famous people recognition; (b) all group studies of patients with right or left temporal lobe epilepsy, which had investigated aspects of famous people recognition impairment. Results of these reviews consistently showed that different patterns of impaired recognition of familiar people can be observed in patients with right and left anterior temporal pathology. These patterns consist of a loss of familiarity feelings and of person specific information retrieval from face stimuli, when the right temporal lobe is damaged and of a prevalent impairment in finding their names when the anterior parts of the left temporal lobe are selectively damaged.

  3. Self-Expandable Stent for Repairing Coarctation of the Left-Circumferential Aortic Arch with Right-sided Descending Aorta and Aberrant Right Subclavian Artery with Kommerell's Aneurysm.

    PubMed

    Khajali, Zahra; Sanati, Hamid Reza; Pouraliakbar, Hamidreza; Mohebbi, Bahram; Aeinfar, Kamran; Zolfaghari, Reza

    2017-01-01

    Endovascular treatment offers a great advantage in the management of main arteries stenoses. However, simultaneous presence of a group of anomalies may complicate the situation. Here we present a case of 21-year-old man with aortic coarctation. Radiographic imaging and angiography demonstrated aortic coarctation of the left-circumferential aortic arch, right-sided descending aorta, and Kommerell's diverticulum at the origin of right subclavian artery. These anomalies have rarely been reported to concurrently exist in the same case and the treatment is challenging. Percutaneous treatment for repair of aortic coarctation was successfully performed with deployment of self-expanding nitinol stents. Follow-up demonstrated the correction of blood pressure and improvement of the symptoms. It appears that deployment of self-expandable nitinol stents present a viable option for the management of coarcted aorta in patients having all or some of these anomalies together.

  4. [Intervention among patients with right bundle branch block and left anterior hemiblock. Operatory risk (author's transl)].

    PubMed

    Coriat, P; Harari, A; Tarot, J P; Ducardonnet, A; Viars, P

    1981-01-01

    In order to assess the risk of advanced heart block during anesthesia in patients with right bundle branch block and left anterior hemiblock, 35 consecutive patients were monitored throughout the pre-, intra- and postoperative period. As conventional ECG monitoring may only detect advanced atrioventricular block, patients were monitored according to the Holter method which can easily detect even minor changes of atrioventricular conduction namely slight increased PR interval or dropped P wave. All patients were asymptomatic, in normal sinus rhythm without second degree AV block. Surgical procedures were performed under general anesthesia (n = 15) and epidural anesthesia using lidocaine (n = 20). No episode of second or third degree atrioventricular block occurred. The only modifications observed were rare and transient increase of PR, occurring during surgical procedures in 5 patients, always associated with a sinus bradycardia. They immediately regressed at the termination of the sinus bradycardia either spontaneously or following atropine injection, strongly suggesting the responsability of increased vagal tone. Thus general or epidural anesthesia did not compromise infranodal conduction in any of the observed patients. These data indicate that anesthesia can be safely used without prophylactic preoperative insertion of pacemakers in patients with asymptomatic chronic right bundle branch block and left anterior hemi-block.

  5. Excess mortality and morbidity associated with right bundle branch and left anterior fascicular block.

    PubMed

    Pine, M B; Oren, M; Ciafone, R; Rosner, B; Hirota, Y; Rabinowitz, B; Abelmann, W H

    1983-05-01

    Excess mortality and morbidity associated with right bundle branch and left anterior fascicular block were evaluated in 108 patients with block (age 74 +/- 10 years, 69% male) and 108 age- and sex-matched control patients with normal conduction. Clinical characteristics were similar initially except for more congestive heart failure in patients with block. Life table analysis revealed a higher 12 year mortality with block, even after omitting patients with moderate or severe congestive heart failure (risk ratio 1.47, p less than 0.05). Compared with control subjects, the group of patients with block had more sudden death and deaths of unknown cause, but a similar number of noncardiac and diagnosed cardiac deaths. More patients with block developed new second and third degree atrioventricular block or new overt coronary artery disease, but this finding did not support prophylactic pacing in asymptomatic patients. The importance of internal controls in assessing the natural history of clinical and electrocardiographic abnormalities is emphasized.

  6. Dissociating the semantic function of two neighbouring subregions in the left lateral anterior temporal lobe

    PubMed Central

    Sanjuán, Ana; Hope, Thomas M.H.; Parker Jones, 'Ōiwi; Prejawa, Susan; Oberhuber, Marion; Guerin, Julie; Seghier, Mohamed L.; Green, David W.; Price, Cathy J.

    2015-01-01

    We used fMRI in 35 healthy participants to investigate how two neighbouring subregions in the lateral anterior temporal lobe (LATL) contribute to semantic matching and object naming. Four different levels of processing were considered: (A) recognition of the object concepts; (B) search for semantic associations related to object stimuli; (C) retrieval of semantic concepts of interest; and (D) retrieval of stimulus specific concepts as required for naming. During semantic association matching on picture stimuli or heard object names, we found that activation in both subregions was higher when the objects were semantically related (mug–kettle) than unrelated (car–teapot). This is consistent with both LATL subregions playing a role in (C), the successful retrieval of amodal semantic concepts. In addition, one subregion was more activated for object naming than matching semantically related objects, consistent with (D), the retrieval of a specific concept for naming. We discuss the implications of these novel findings for cognitive models of semantic processing and left anterior temporal lobe function. PMID:25496810

  7. Dissociating the semantic function of two neighbouring subregions in the left lateral anterior temporal lobe.

    PubMed

    Sanjuán, Ana; Hope, Thomas M H; Jones, 'Ōiwi Parker; Prejawa, Susan; Oberhuber, Marion; Guerin, Julie; Seghier, Mohamed L; Green, David W; Price, Cathy J

    2015-09-01

    We used fMRI in 35 healthy participants to investigate how two neighbouring subregions in the lateral anterior temporal lobe (LATL) contribute to semantic matching and object naming. Four different levels of processing were considered: (A) recognition of the object concepts; (B) search for semantic associations related to object stimuli; (C) retrieval of semantic concepts of interest; and (D) retrieval of stimulus specific concepts as required for naming. During semantic association matching on picture stimuli or heard object names, we found that activation in both subregions was higher when the objects were semantically related (mug-kettle) than unrelated (car-teapot). This is consistent with both LATL subregions playing a role in (C), the successful retrieval of amodal semantic concepts. In addition, one subregion was more activated for object naming than matching semantically related objects, consistent with (D), the retrieval of a specific concept for naming. We discuss the implications of these novel findings for cognitive models of semantic processing and left anterior temporal lobe function.

  8. Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial).

    PubMed

    Daaboul, Yazan; Korjian, Serge; Weaver, W Douglas; Kloner, Robert A; Giugliano, Robert P; Carr, Jim; Neal, Brandon J; Chi, Gerald; Cochet, Madeleine; Goodell, Laura; Michalak, Nathan; Rusowicz-Orazem, Luke; Alkathery, Turky; Allaham, Haytham; Routray, Sujit; Szlosek, Donald; Jain, Purva; Gibson, C Michael

    2016-09-01

    Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72 hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n = 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p = 0.02, TnI AUC p = 0.03) and MSI (p = 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size.

  9. Composition of complex numbers: Delineating the computational role of the left anterior temporal lobe.

    PubMed

    Blanco-Elorrieta, Esti; Pylkkänen, Liina

    2016-01-01

    What is the neurobiological basis of our ability to create complex messages with language? Results from multiple methodologies have converged on a set of brain regions as relevant for this general process, but the computational details of these areas remain to be characterized. The left anterior temporal lobe (LATL) has been a consistent node within this network, with results suggesting that although it rather systematically shows increased activation for semantically complex structured stimuli, this effect does not extend to number phrases such as 'three books.' In the present work we used magnetoencephalography to investigate whether numbers in general are an invalid input to the combinatory operations housed in the LATL or whether the lack of LATL engagement for stimuli such as 'three books' is due to the quantificational nature of such phrases. As a relevant test case, we employed complex number terms such as 'twenty-three', where one number term is not a quantifier of the other but rather, the two terms form a type of complex concept. In a number naming paradigm, participants viewed rows of numbers and depending on task instruction, named them as complex number terms ('twenty-three'), numerical quantifications ('two threes'), adjectival modifications ('blue threes') or non-combinatory lists (e.g., 'two, three'). While quantificational phrases failed to engage the LATL as compared to non-combinatory controls, both complex number terms and adjectival modifications elicited a reliable activity increase in the LATL. Our results show that while the LATL does not participate in the enumeration of tokens within a set, exemplified by the quantificational phrases, it does support conceptual combination, including the composition of complex number concepts.

  10. Clinical utility of a multigated modified anterior projection in the detection of left ventricular inferior and apical wall motion abnormalities

    SciTech Connect

    Polak, J.F.; Bianco, J.A.; Kemper, A.J.; Tow, D.E.

    1982-04-01

    Recent evidence indicates that the left anterior oblique projection (LAO) multigated radionuclide ventriculogram (RVG) underestimates presence and extent of apical and inferior left ventricular (LV) wall motion abnormalities. We investigated, prospectively, the sensitivity and specificity of a modified anterior projection (MAP), which incorporates cephalad tilting. Thirty-three consecutive patients undergoing cardiac catheterization suspected to have coronary artery disease were studied with RVG, using both the MAP and LAO views. LAO views were analyzed using the ejection fraction image (REFI), and the regional ejection fraction (REF) of the inferoapical region. The MAP studies were analyzed using stroke volume image (SVI) to evaluate apical and inferior LV regions. Results were as follows: (Formula: see text), Both intraobserver and interobserver variabilities were comparable to those of conventional angiographic studies used in detection of apical and inferior asynergy. It is concluded that the multigated MAP offers additional information about abnormalities of the LV inferior and apical regions.

  11. Direct Physiologic Evidence of a Heteromodal Convergence Region for Proper Naming in Human Left Anterior Temporal Lobe

    PubMed Central

    Rhone, Ariane E.; Nourski, Kirill V.; Kawasaki, Hiroto; Oya, Hiroyuki; Griffiths, Timothy D.; Howard, Matthew A.; Tranel, Daniel

    2015-01-01

    Retrieving the names of friends, loved ones, and famous people is a fundamental human ability. This ability depends on the left anterior temporal lobe (ATL), where lesions can be associated with impaired naming of people regardless of modality (e.g., picture or voice). This finding has led to the idea that the left ATL is a modality-independent convergence region for proper naming. Hypotheses for how proper-name dispositions are organized within the left ATL include both a single modality-independent (heteromodal) convergence region and spatially discrete modality-dependent (unimodal) regions. Here we show direct electrophysiologic evidence that the left ATL is heteromodal for proper-name retrieval. Using intracranial recordings placed directly on the surface of the left ATL in human subjects, we demonstrate nearly identical responses to picture and voice stimuli of famous U.S. politicians during a naming task. Our results demonstrate convergent and robust large-scale neurophysiologic responses to picture and voice naming in the human left ATL. This finding supports the idea of heteromodal (i.e., transmodal) dispositions for proper naming in the left ATL. PMID:25632128

  12. Failure in closure of the anterior neural tube causes left isomerization of the zebrafish epithalamus.

    PubMed

    Lu, Po-Nien; Lund, Caroline; Khuansuwan, Sataree; Schumann, Adelle; Harney-Tolo, Marijah; Gamse, Joshua T; Liang, Jennifer O

    2013-02-15

    Differences between the left and right sides of the brain are present in many animal species. For instance, in humans the left cerebral hemisphere is largely responsible for language and tool use and the right for processing spatial information. Zebrafish have prominent left-right asymmetries in their epithalamus that have been associated with differential left and right eye use and navigational behavior. In wild-type (WT) zebrafish embryos, Nodal pathway genes are expressed in the left side of the pineal anlage. Shortly thereafter, a parapineal organ forms to the left of the pineal. The parapineal organ causes differences in gene expression, neuropil density, and connectivity of the left and right habenula nuclei. In embryos that have an open neural tube, such as embryos that are deficient in Nodal signaling or the cell adhesion protein N-cadherin, the left and right sides of the developing epithalamus remain separated from one another. We find that the brains of these embryos often become left isomerized: both sides of the brain develop morphology and gene expression patterns that are characteristic of the left side. However, other aspects of epithalamic development, such as differentiation of specific neuronal cell types, are intact. We propose that there is a mechanism in embryos with closed neural tubes that prevents both sides from developing like the left side. This mechanism fails when the two sides of the epithalamus are widely separated from one another, suggesting that it is dependent upon a signaling protein with limited range.

  13. [A case of huge abscess extended from anterior neck to left lung and lateral chest wall].

    PubMed

    Ikeya, T; Tsuda, M; Hara, H; Koyama, S; Sugiyama, S; Misaki, T

    1997-11-01

    62-year-old woman admitted our hospital with pain of left upper extremity from the left chest and dysphasia. Chest X-ray showed the huge mass shadow in the left lung field. Diabetes mellitus and inflammatory reaction such as high fervor, leukocytosis, CRP and ESR accentuation were recognized. Conservative therapy was done at first, but mass shadow on X-ray increased, and swelling appeared from the neck to the left lateral chest wall. And the same site appeared like subcutaneous emphysema. Computed Tomography showed mass shadow which was enlarged and spread in lung parenchyma and left chest wall with bubble image. Incision and open drainage was performed for the left chest wall but origin bacteria was detected in neither anaerobic nor aerobic culture of pus. Inflammation and mass shadow of left upper lung field have decreased gradually. The patient discharged without bronchoalveolar fistula. Abscess extending from the neck or chest wall with diabetes mellitus is very rare.

  14. Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum.

    PubMed

    Suzuki, Tadashi; Itoh, Shouichi; Hayashi, Mototaka; Kouno, Masako; Takeda, Katsuhiko

    2009-10-01

    We report the case of a 69-year-old woman with cerebral infarction in the left anterior cingulate cortex and corpus callosum. She showed hyperlexia, which was a distinctive reading phenomenon, as well as ambient echolalia. Clinical features also included complex disorders such as visual groping, compulsive manipulation of tools, and callosal disconnection syndrome. She read words written on the cover of a book and repeated words emanating from unrelated conversations around her or from hospital announcements. The combination of these two features due to a focal lesion has never been reported previously. The supplementary motor area may control the execution of established subroutines according to external and internal inputs. Hyperlexia as well as the compulsive manipulation of tools could be interpreted as faulty inhibition of preexisting essentially intact motor subroutines by damage to the anterior cingulate cortex reciprocally interconnected with the supplementary motor area.

  15. Risk of advanced heart block during extradural anaesthesia in patients with right bundle branch block and left anterior hemiblock.

    PubMed

    Coriat, P; Harari, A; Ducardonet, A; Tarot, J P; Viars, P

    1981-05-01

    Electrocardiographic recording by Holter monitoring demonstrated the absence of any modification, however minimal, of the intranodal conduction during surgical procedures under extradural anaesthesia in 20 patients with right bundle branch block (RBBB) and left anterior hemiblock (LAHB) but without symptoms. These data suggest that extradural anaesthesia can be used safely in patients with asymptomatic chronic RBBB and LAHB without prophylactic insertion of pacemakers. However, patients having experienced either syncope or transient Mobitz II second degree AV block are likely to have a trifascicular block and increased risk of advanced heart block during extradural anaesthesia.

  16. Verapamil-sensitive left anterior fascicular ventricular tachycardia associated with a healed myocardial infarction: changes in the delayed Purkinje potential during sinus rhythm.

    PubMed

    Morishima, Itsuro; Nogami, Akihiko; Tsuboi, Hideyuki; Sone, Takahito

    2008-09-01

    Uncommon association of left anterior fascicular ventricular tachycardia (VT) with a healed myocardial infarction (MI) is described. A 55-year-old man with a history of anteroseptal MI had verapamil-sensitive VT. The VT exhibited a right bundle branch block configuration and right-axis deviation. The VT exit was located at the left ventricular anterolateral wall. At the mid-anterior left ventricular septum, delayed Purkinje potentials were seen during sinus rhythm, and the optimal pace map was obtained with pace delay. During the VT, diastolic and systolic Purkinje potentials were simultaneously recorded at the same site. Ablation targeting the delayed potentials during sinus rhythm prolonged the time between QRS onset and the delayed potentials, and the VT no longer became inducible when the delayed potentials were completely eliminated. Left anterior fascicular VT develops in post-MI patients; ischemia-injured His-Purkinje system may be involved in the mechanism of the VT.

  17. Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve

    PubMed Central

    Sasi, Viktor; Forster, Tamás; Ungi, Imre

    2014-01-01

    We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula. With the present case, the importance of functional evaluation of these fistulas is demonstrated. PMID:25061466

  18. Giant and thrombosed left ventricular aneurysm.

    PubMed

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  19. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

    SciTech Connect

    Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

    1981-08-01

    To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease.

  20. Laparoscopic left and right adrenalectomy from an anterior approach – is there any difference? Outcomes in 176 consecutive patients

    PubMed Central

    Kokorak, Lukas; Vladovic, Peter; Marko, Lubomir

    2016-01-01

    Introduction Traditionally, in open surgery, right adrenalectomy is considered technically more demanding than its left-sided counterpart. This belief is supposed to be attributable mainly to different anatomic characteristics of the adrenal veins. Whether this opinion is also correct for laparoscopic adrenalectomy remains elusive. Aim To compare the outcomes of left versus right laparoscopic adrenalectomy from an anterior approach. Material and methods Retrospective statistical analysis of a prospectively compiled database of consecutive patients undergoing laparoscopic adrenalectomy in a single center with focus on potential differences in the left- versus right-sided procedure in terms of demographic parameters, tumor size, operating time, occurrence of serious intraoperative complications, conversion, length of hospital stay and re-operation rate. Results One hundred seventy-six patients underwent elective laparoscopic adrenalectomy – 80 left-sided (45.45%) and 96 right-sided (54.55%). No significant difference was found between the groups in terms of age (54.09 ±11.2 vs. 56.27 ±11.6; p = 0.2), tumor size (3.39 ±1.86 vs. 3.26 ±1.66; p = 0.64), operating time (71.84 ±22.33 vs. 72.06 ±30.99; p = 0.95), occurrence of serious intraoperative complications (7.5% vs. 10.4%; p = 0.5), conversion (1.25% vs. 1.04%; p = 0.9), length of hospital stay (4.52 ±1.30 vs. 4.37 ±1.91; p = 0.55) or reoperation rate (5% vs. 1%; p = 0.11). There was no mortality. Conclusions No significant difference was found between the left and right laparoscopic adrenalectomy in terms of operating time, occurrence of serious intraoperative complications, conversion rate or postoperative outcome. Therefore, the opinion that the right-sided procedure is more difficult does not seem to be justified for laparoscopic adrenalectomy from the anterior approach. PMID:28194247

  1. Isolated Right Ventricular Infarction Mimicking Anterior ST-Segment Elevation

    PubMed Central

    Oktay, Veysel; Coskun, Ugur; Yildiz, Ahmet; Gurmen, Tevfik

    2016-01-01

    Acute coronary syndromes in patients with presence of ST-segment elevation in the anterior precordial leads indicates left anterior descending coronary artery occlusion. However, anterior ST-segment elevation has also been described in right ventricular myocardial infarction and is thought to be due to right coronary artery (RCA) occlusion. We present a rare case of isolated RVMI presenting with anterior ST-segment elevation due to proximal occlusion of a right coronary artery that was treated by primary coronary angioplasty. Primary coronary angioplasty and stenting of this artery was performed resulting in resolution of the chest pain and ST- segment elevation. PMID:27190867

  2. The Anterior Branch of the Left Inferior Phrenic Artery Arising from the Right Inferior Phrenic Artery: An Angiographic and CT Study

    SciTech Connect

    Hieda, Masashi Toyota, Naoyuki; Kakizawa, Hideaki; Ishikawa, Masaki; Horiguchi, Jun; Ito, Katsuhide

    2009-03-15

    The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

  3. Assessment of Anterior Cingulate Cortex (ACC) and Left Cerebellar Metabolism in Asperger's Syndrome with Proton Magnetic Resonance Spectroscopy (MRS)

    PubMed Central

    Goji, Aya; Ito, Hiromichi; Mori, Kenji; Harada, Masafumi; Hisaoka, Sonoka; Toda, Yoshihiro; Mori, Tatsuo; Abe, Yoko; Miyazaki, Masahito; Kagami, Shoji

    2017-01-01

    Purpose Proton magnetic resonance spectroscopy (1H MRS) is a noninvasive neuroimaging method to quantify biochemical metabolites in vivo and it can serve as a powerful tool to monitor neurobiochemical profiles in the brain. Asperger’s syndrome (AS) is a type of autism spectrum disorder, which is characterized by impaired social skills and restrictive, repetitive patterns of interest and activities, while intellectual levels and language skills are relatively preserved. Despite clinical aspects have been well-characterized, neurometabolic profiling in the brain of AS remains to be clear. The present study used proton magnetic resonance spectroscopy (1H MRS) to investigate whether pediatric AS is associated with measurable neurometabolic abnormalities that can contribute new information on the neurobiological underpinnings of the disorder. Methods Study participants consisted of 34 children with AS (2–12 years old; mean age 5.2 (±2.0); 28 boys) and 19 typically developed children (2–11 years old; mean age 5.6 (±2.6); 12 boys) who served as the normal control group. The 1H MRS data were obtained from two regions of interest: the anterior cingulate cortex (ACC) and left cerebellum. Results In the ACC, levels of N-acetylaspartate (NAA), total creatine (tCr), total choline-containing compounds (tCho) and myo-Inositol (mI) were significantly decreased in children with AS compared to controls. On the other hand, no significant group differences in any of the metabolites were found in the left cerebellum. Neither age nor sex accounted for the metabolic findings in the regions. Conclusion The finding of decreased levels of NAA, tCr, tCho, and mI in the ACC but not in left cerebellar voxels in the AS, suggests a lower ACC neuronal density in the present AS cohort compared to controls. PMID:28060873

  4. Conus artery occlusion causing isolated right ventricular outflow tract infarction: novel application of cardiac magnetic resonance in anterior STEMI

    PubMed Central

    Lyle, Melissa; Tweet, Marysia; Young, Phillip M.; Best, Patricia J. M.

    2016-01-01

    Acute ST elevation in the anterior precordial leads typically suggests an anteroseptal infarction due to left anterior descending coronary artery obstruction, but the differential can be broad. Conus branch artery occlusion is a potentially overlooked cause of anteroseptal ST elevation myocardial infraction. Cardiac magnetic resonance (CMR) imaging is an emerging technology which can differentiate the etiology of anterior ST elevation in patients with no apparent coronary abnormalities on coronary angiography and normal echocardiography. PMID:27280090

  5. Proper name anomia with preserved lexical and semantic knowledge after left anterior temporal lesion: a two-way convergence defect.

    PubMed

    Busigny, Thomas; de Boissezon, Xavier; Puel, Michèle; Nespoulous, Jean-Luc; Barbeau, Emmanuel J

    2015-04-01

    This article describes the case of a patient who, following herpes simplex encephalitis (HSE), retained the ability to access rich conceptual semantic information for familiar people whom he was no longer able to name. Moreover, this patient presented the very rare combination of name production and name comprehension deficits for different categories of proper names (persons and acronyms). Indeed, besides his difficulty to retrieve proper names, SL presented a severe deficit in understanding and identifying them. However, he was still able to recognize proper names on familiarity decision, demonstrating that name forms themselves were intact. We interpret SL's deficit as a rare form of two-way lexico-semantic disconnection, in which intact lexical knowledge is disconnected from semantic knowledge and face units. We suggest that this disconnection reflects the role of the left anterior temporal lobe in binding together different types of knowledge and supports the classical convergence-zones framework (e.g., Damasio, 1989) rather than the amodal semantic hub theory (e.g., Patterson, Nestor, & Rogers, 2007).

  6. Anomalous Right Coronary Artery Originating from the Left Sinus of Valsalva in a Yucatan Minipig

    PubMed Central

    Matthews, Kristin A; Gogas, Bill D; Sumida, Arihiro; Nagai, Hiroyuki; King, Spencer B; Chronos, Nicolas; Hou, Dongming

    2012-01-01

    A 39.2-kg, castrated male Yucatan minipig (Sus scrofa domestica) was presented for enrollment in a coronary artery study. Angiography revealed an anomalous right coronary artery originating from the left sinus of Valsalva. The left anterior descending, left circumflex, and anomalous right coronary arteries were implanted with metallic stents without complications. The minipig remained on the study for 3 mo until it reached its predetermined study endpoint, during which time it showed no clinical signs of disease. Histologic examination of the implanted coronary arteries revealed no differences between the normal (left anterior descending and left circumflex arteries) and the anomalous right coronary artery. Swine are important models for coronary research. Although several cases of anomalous human coronary arteries have been documented, the current case is the first report of a coronary artery anomaly in a minipig. PMID:22546919

  7. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block.

    PubMed

    Larcos, G; Gibbons, R J; Brown, M L

    1991-09-15

    Recent reports have proposed that abnormal apical or anterior wall perfusion with exercise thallium-201 imaging may increase diagnostic accuracy for disease of the left anterior descending artery in patients with left bundle branch block (LBBB). To evaluate these suggestions, 83 patients with LBBB who underwent thallium-201 single-photon emission computed tomography and coronary angiography within an interval of 3 months were retrospectively reviewed. There were 59 men and 24 women aged 33 to 84 years (mean 65). Myocardial perfusion to the apex, anterior wall and anterior septum were scored qualitatively by consensus of 2 experienced observers and by quantitative analysis in comparison with a normal data base. The sensitivity, specificity and accuracy of perfusion defects in these segments were then expressed according to angiographic findings. Significant stenosis of vessels within the left anterior descending artery territory was present in 38 patients. By receiver-operator characteristic analysis, a fixed or reversible defect within the apex by the qualitative method was the best criterion for coronary artery disease. However, although highly sensitive (79 and 85% by the qualitative and quantitative methods, respectively), an apical defect was neither specific (38 and 16%, respectively), nor accurate (57 and 46%, respectively). Perfusion abnormalities in the anterior wall and septum were also of limited diagnostic accuracy. Thus, modified interpretative criteria in patients with LBBB are not clinically useful in the assessment of left anterior descending artery disease.

  8. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block

    SciTech Connect

    Larcos, G.; Gibbons, R.J.; Brown, M.L. )

    1991-09-15

    Recent reports have proposed that abnormal apical or anterior wall perfusion with exercise thallium-201 imaging may increase diagnostic accuracy for disease of the left anterior descending artery in patients with left bundle branch block (LBBB). To evaluate these suggestions, 83 patients with LBBB who underwent thallium-201 single-photon emission computed tomography and coronary angiography within an interval of 3 months were retrospectively reviewed. There were 59 men and 24 women aged 33 to 84 years (mean 65). Myocardial perfusion to the apex, anterior wall and anterior septum were scored qualitatively by consensus of 2 experienced observers and by quantitative analysis in comparison with a normal data base. The sensitivity, specificity and accuracy of perfusion defects in these segments were then expressed according to angiographic findings. Significant stenosis of vessels within the left anterior descending artery territory was present in 38 patients. By receiver-operator characteristic analysis, a fixed or reversible defect within the apex by the qualitative method was the best criterion for coronary artery disease. However, although highly sensitive (79 and 85% by the qualitative and quantitative methods, respectively), an apical defect was neither specific (38 and 16%, respectively), nor accurate (57 and 46%, respectively). Perfusion abnormalities in the anterior wall and septum were also of limited diagnostic accuracy. Thus, modified interpretative criteria in patients with LBBB are not clinically useful in the assessment of left anterior descending artery disease.

  9. The Descending Helium Balloon

    ERIC Educational Resources Information Center

    Helseth, Lars Egil

    2014-01-01

    I describe a simple and fascinating experiment wherein helium leaks out of a rubber balloon, thereby causing it to descend. An estimate of the volumetric leakage rate is made by measuring its rate of descent.

  10. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  11. Septal and anterior reverse mismatch of myocardial perfusion and metabolism in patients with coronary artery disease and left bundle branch block.

    PubMed

    Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

    2015-05-01

    The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD).Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated.The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026).In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval.

  12. The Roles of Left Versus Right Anterior Temporal Lobes in Conceptual Knowledge: An ALE Meta-analysis of 97 Functional Neuroimaging Studies.

    PubMed

    Rice, Grace E; Lambon Ralph, Matthew A; Hoffman, Paul

    2015-11-01

    The roles of the right and left anterior temporal lobes (ATLs) in conceptual knowledge are a source of debate between 4 conflicting accounts. Possible ATL specializations include: (1) Processing of verbal versus non-verbal inputs; (2) the involvement of word retrieval; and (3) the social content of the stimuli. Conversely, the "hub-and-spoke" account holds that both ATLs form a bilateral functionally unified system. Using activation likelihood estimation (ALE) to compare the probability of left and right ATL activation, we analyzed 97 functional neuroimaging studies of conceptual knowledge, organized according to the predictions of the three specialized hypotheses. The primary result was that ATL activation was predominately bilateral and highly overlapping for all stimulus types. Secondary to this bilateral representation, there were subtle gradations both between and within the ATLs. Activations were more likely to be left lateralized when the input was a written word or when word retrieval was required. These data are best accommodated by a graded version of the hub-and-spoke account, whereby representation of conceptual knowledge is supported through bilateral yet graded connectivity between the ATLs and various modality-specific sensory, motor, and limbic cortices.

  13. The Roles of Left Versus Right Anterior Temporal Lobes in Conceptual Knowledge: An ALE Meta-analysis of 97 Functional Neuroimaging Studies

    PubMed Central

    Rice, Grace E.; Lambon Ralph, Matthew A.; Hoffman, Paul

    2015-01-01

    The roles of the right and left anterior temporal lobes (ATLs) in conceptual knowledge are a source of debate between 4 conflicting accounts. Possible ATL specializations include: (1) Processing of verbal versus non-verbal inputs; (2) the involvement of word retrieval; and (3) the social content of the stimuli. Conversely, the “hub-and-spoke” account holds that both ATLs form a bilateral functionally unified system. Using activation likelihood estimation (ALE) to compare the probability of left and right ATL activation, we analyzed 97 functional neuroimaging studies of conceptual knowledge, organized according to the predictions of the three specialized hypotheses. The primary result was that ATL activation was predominately bilateral and highly overlapping for all stimulus types. Secondary to this bilateral representation, there were subtle gradations both between and within the ATLs. Activations were more likely to be left lateralized when the input was a written word or when word retrieval was required. These data are best accommodated by a graded version of the hub-and-spoke account, whereby representation of conceptual knowledge is supported through bilateral yet graded connectivity between the ATLs and various modality-specific sensory, motor, and limbic cortices. PMID:25771223

  14. Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.

    PubMed

    Tan, Jeffrey; Ndoro, Samuel; Okafo, Uchenna; Garrahy, Aoife; Agha, Amar; Rawluk, Danny

    2016-12-16

    Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications. Shortly after surgery, he developed clear features of ADI with adipsic severe hypernatraemia and hypotonic polyuria, which was associated with cognitive impairment that was confirmed with biochemical investigations and cognitive assessments. He was treated with DDAVP along with a strict intake of oral fluids at scheduled times to maintain eunatremia. Repeat assessment at six months showed recovery of thirst and a normal water deprivation test. Management of ADI with cognitive impairment is complex and requires a multidisciplinary approach. Recovery from ADI is very rare, and this is only the second report of recovery in this particular clinical setting.

  15. Effect of low dose acetylsalicylic acid on the frequency and hematologic activity of left ventricular thrombus in anterior wall acute myocardial infarction

    SciTech Connect

    Kuepper, A.J.V.; Verheugt, F.W.; Peels, C.H.; Galema, T.W.; den Hollander, W.; Roos, J.P.

    1989-04-15

    In this prospective, randomized, placebo-controlled trial the effect of 100 mg acetylsalicylic acid (ASA) once daily on the incidence, hematologic activity and embolic potential of left ventricular (LV) thrombosis was studied in 100 consecutive patients with a first anterior wall acute myocardial infarction (AMI). Patients were randomized to ASA or placebo less than 12 hours after onset of symptoms. Heparin, 5,000 IU subcutaneously twice daily, was given to all patients during immobilization. Echocardiography was performed less than 24 hours, 48 to 72 hours and 1, 2, and 12 weeks after AMI. LV thrombosis was detected by echocardiography in 30 (33%) of the 92 evaluable patients (15 patients given ASA and 15 given placebo). Indium-111 platelet scintigraphy was done in 17 of the 22 patients with an LV thrombus at the second week echocardiogram. Among 7 ASA-treated patients, 4 had positive images; among 10 placebo patients, 5 had positive images. LV thrombus resolution was noted in 3 of 9 patients with a positive scan and in 5 of 8 patients with a negative platelet scan. In 7 of 10 ASA-treated patients and 5 of 12 placebo-treated patients thrombus resolution was observed (difference not significant). Systemic embolism occurred in 2 patients, both given ASA, during the first week after AMI. Thus, low dose ASA has no effect on the incidence, hematologic activity and embolic potential of LV thrombosis in anterior wall AMI.

  16. Absence of left circumflex with superdominant right coronary artery

    PubMed Central

    Quijada-Fumero, Alejandro; Pimienta-González, Raquel; Rodriguez-Esteban, Marcos

    2014-01-01

    Congenital anomalies of coronary arteries are a group of diseases that are infrequently found. Their prevalence has been reported from 0.6% to 1.3%. Most clinical manifestations are benign and asymptomatic. Congenital absence of the left circumflex artery is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report a case of a 51-year-old man who underwent a cardiac catheterisation. Coronary angiography showed a left anterior descending coronary artery with no circumflex and a dominant right coronary artery. PMID:25535241

  17. Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

    SciTech Connect

    Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

    2011-12-01

    Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose-volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7-45.4% and 10.8-37.4%, respectively. The maximal dose to the heart decreased by 18.6-35.3%, to the AMT by 22.0-45.1%, and to the LV by 23.5-45.0%, And the relative volumes of the heart (V{sub {>=}12}), AMT (V{sub >11}) and LV (V{sub >10}) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving {>=}5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5-21.5%, 25.2-29.8%, and 22.8-29.8% and the maximal dose by 13.6-20.6%, 23.1-29.6%, and 17.3-29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

  18. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

    PubMed Central

    Gangadharan, Venkat; Sivagnanam, Kamesh; Murtaza, Ghulam; Ponders, Michael; Teixeira, Otto; Paul, Timir

    2017-01-01

    A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation. PMID:28210637

  19. The History of Left Septal Fascicular Block: Chronological Considerations of a Reality Yet to be Universally Accepted

    PubMed Central

    Riera, Andres Ricardo Perez; Uchida, Augusto Hiroshi; Schapachnik, Edgardo; Dubner, Sergio; Zhang, Li; Filho, Celso Ferreira; Ferreira, Celso; Ferrara, Dardo E; de Luna, Antoni Bayes; Moffa, Paulo Jorge

    2008-01-01

    There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF). The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation. Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart. Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs. The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others. In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder. In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas

  20. The history of left septal fascicular block: chronological considerations of a reality yet to be universally accepted.

    PubMed

    Riera, Andres Ricardo Perez; Uchida, Augusto Hiroshi; Schapachnik, Edgardo; Dubner, Sergio; Zhang, Li; Filho, Celso Ferreira; Ferreira, Celso; Ferrara, Dardo E; de Luna, Antoni Bayes; Moffa, Paulo Jorge

    2008-04-01

    There are several papers in literature that prove in a conclusive and incontestable way, that the left branch of the His bundle, in most instances (85% of the cases) splits into three fascicles of variable morphological pattern, and not into two: left anterior fascicle (LAF), left posterior fascicle (LPF), and left septal fascicle (LSF). The abovementioned papers have anatomical, histological, anatomo-pathological, electrocardiographic, and vectocardiographic, body surface potential mapping or ECG potential mapping and electrophysiological foundation.Additionally, the mentioned papers have been performed both in animal models (dogs) and in the human heart.Several clinical papers have shown that the left septal fascicular block (LSFB) may occur intermittently or transitorily as a consequence of a temporary dromotropic alteration, constituting an aberrant ventricular conduction, rate-dependent or by the application of atrial extra-stimuli, or naturally during the acute phase of infarction when this involves the anterior descending artery, before the septal perforating artery that supplies the central portion of the septum, where the mentioned LSF runs.The ECG/VCG manifestation of LSFB consists in anterior shift of electromotive forces, known as Prominent Anterior Forces (PAF), which can hardly be diagnosed in the clinical absence of other causes capable of causing PAF, such as the normal variant by counterclockwise rotation of the heart on its longitudinal axis, in right ventricular enlargement, in the dorsal or lateral infarction of the new nomenclature, in type-A WPW, in CRBBB, and others. In this historical manuscript, we review in a sequential fashion, the main findings that confirmed the unequivocal existence of this unjustifiably "forgotten" dromotropic disorder.In the developed countries, its most important cause is coronary insufficiency, particularly the proximal involvement of the left anterior descending coronary artery, and in Latin America, Chagas

  1. Identification of genes that regulate a left-right asymmetric neuronal migration in Caenorhabditis elegans.

    PubMed Central

    Ch'ng, QueeLim; Williams, Lisa; Lie, Yung S; Sym, Mary; Whangbo, Jennifer; Kenyon, Cynthia

    2003-01-01

    In C. elegans, cells of the QL and QR neuroblast lineages migrate with left-right asymmetry; QL and its descendants migrate posteriorly whereas QR and its descendants migrate anteriorly. One key step in generating this asymmetry is the expression of the Hox gene mab-5 in the QL descendants but not in the QR descendants. This asymmetry appears to be coupled to the asymmetric polarizations and movements of QL and QR as they migrate and relies on an asymmetric response to an EGL-20/Wnt signal. To identify genes involved in these complex layers of regulation and to isolate targets of mab-5 that direct posterior migrations, we screened visually for mutants with cell migration defects in the QL and QR lineages. Here, we describe a set of new mutants (qid-5, qid-6, qid-7, and qid-8) that primarily disrupt the migrations of the QL descendants. Most of these mutants were defective in mab-5 expression in the QL lineage and might identify genes that interact directly or indirectly with the EGL-20/Wnt signaling pathway. PMID:12930745

  2. A new electrocardiographic criterion to differentiate between Takotsubo cardiomyopathy and anterior wall ST-segment elevation acute myocardial infarction.

    PubMed

    Tamura, Akira; Watanabe, Toru; Ishihara, Masaharu; Ando, Shinichi; Naono, Shigeru; Zaizen, Hirofumi; Abe, Yusei; Yano, Shoji; Shinozaki, Kazuhiro; Kotoku, Munenori; Momii, Hidetoshi; Kadokami, Toshiaki; Kadota, Junichi

    2011-09-01

    Several studies have examined the ability of electrocardiography to differentiate between takotsubo cardiomyopathy (TC) and anterior wall acute ST-segment elevation myocardial infarction (AA-STEMI). In those studies, the magnitude of ST-segment elevation was not measured at the J point. The American Heart Association, American College of Cardiology Foundation, and Heart Rhythm Society guidelines recommend that the magnitude of ST-segment elevation should be measured at the J point. Accordingly, the aim of this study was to retrospectively examine whether electrocardiography, using the magnitude of ST-segment elevation measured at the J point, could differentiate 62 patients with TC from 280 with AA-STEMI. Patients with AA-STEMI were divided into following subgroups: 140 with left anterior descending coronary artery occlusions proximal to the first diagonal branch (AA-STEMI-P), 120 with left anterior descending occlusions distal to the first diagonal branch and proximal to the second diagonal branch (AA-STEMI-M), and 20 with left anterior descending occlusions distal to the second diagonal branch (AA-STEMI-D). TC had a much lower prevalence of ST-segment elevation ≥1 mm in lead V(1) (19.4%) compared to AA-STEMI (80.4%, p <0.01), AA-STEMI-P (80.7%, p <0.01), AA-STEMI-M (80%, p <0.01), and AA-STEMI-D (80%, p <0.01). ST-segment elevation ≥1 mm in ≥1 of leads V(3) to V(5) without ST-segment elevation ≥1 mm in lead V(1) identified TC with sensitivity of 74.2% and specificity of 80.6%. Furthermore, this criterion could differentiate TC from each AA-STEMI subgroup, with similar diagnostic values. In conclusion, using the magnitude of ST-segment elevation measured at the J point, a new electrocardiographic criterion is proposed with an acceptable ability to differentiate TC from AA-STEMI.

  3. Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT

    PubMed Central

    Cui, Yue; Zeng, Wenjuan; Yu, Jie; Lu, Jing; Hu, Yuannan; Diao, Nan; Liang, Bo; Han, Ping; Shi, Heshui

    2017-01-01

    Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis < 50%, and significantly wider in the non-calcified plaque group than calcified. Multivariable analyses showed the bifurcation angle of LAD-LCx was an independent predictor for significant left coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction. PMID:28346530

  4. [Anomalous left coronary artery origin from the pulmonary artery causing angina: Report of one case].

    PubMed

    Ugalde P, Héctor; Rozas A, Sebastián; Sanhueza F, María Ignacia; Yubini L, María Cecilia; García B, Sebastián

    2017-01-01

    Anomalies of the origin of coronary arteries are detected in 0.5-1.5% of all angiographies. Anomalous origin of the left main trunk is the most uncommon and its origin from pulmonary artery in adults is exceptional, usually because it is associated with a short survival. We report a 49-year-old female, presenting with a two months history of angina. The exercise electrocardiogram suggested ischemia. A coronary angiography was performed, showing the absence of the left main trunk in the left coronary sinus, a dilated right coronary artery, with no lesions and extensive collateral circulation to the anterior descending and circumflex arteries, with inverted flow and the left main trunk draining to the pulmonary artery. The left ventricle was mildly dilated with middle and apical anterior hypokinesia. Global systolic function was conserved. A surgical correction was decided, occluding the left main anomalous origin and performing a coronary artery bypass grafting from the left internal thoracic artery. The patient was discharged with no complications. At two years of follow-up she is symptom free and has a normal physical capacity.

  5. Prognostic significance of resting anterior thallium-201 defects in patients with inferior myocardial infarction

    SciTech Connect

    Gibson, R.S.; Taylor, G.J.; Watson, D.D.; Berger, B.C.; Crampton, R.S.; Martin, R.P.; Beller, G.A.

    1980-11-01

    To determine whether Tl-201 scintigraphy performed at rest during the late hospital phase of inferior myocardial infarction can predict subsequent coronary events, 25 patients with historical, enzymatic, and electrocardiographic criteria of transmural inferior infarction underwent serial imaging with computer quantification 7 to 35 days after admission. All 25 patients had inferior defects, and 13 (52%) also had anterior defects implying stenosis of the left anterior descending coronary artery. The patients were divided into those with inferior and anterior perfusion defects (Group 1) and those with inferior defects alone (Group 2). In Group 1, three patients had persistent defects in the anterior wall and ten had initial defects with redistribution. New or recurrent coronary events - which included new onset or progression of angina pectoris, sudden death, reinfarction, and congestive heart failure - were recorded over an average 7.2 months of followup (range 3 to 9 mo) for all patients. Ten of 13 (77%) patients in Group 1 had 17 coronary events and four of 12 (33%) patients in Group 2 had six coronary events (p < 0.02). Nine patients in Group 1 and three in Group 2 developed angina (p < 0.03). The apparently increased prevalence in Group 1 of sudden death (8% against 0%), reinfarction (8% against 0%), and congestive heart failure (46% against 25%) was not statistically significant. Thus resting T1-201 scintigraphy with computer quantification is a highly sensitive method to detect inferior myocardial infarction even in the late hospital phase. Moreover, it appears to identify those patients with inferior infarction at high risk for subsequent coronary events, presumably due to stenosis of the left anterior descending coronary artery.

  6. Successful recanalization of a left circumflex artery jailed with a polytetrafluoroethylene-covered stent after coronary perforation during stent implantation in the left main bifurcation.

    PubMed

    Taniguchi, Norimasa; Takahashi, Akihiko; Mizuguchi, Yukio; Yamada, Takeshi; Hata, Tetsuya; Nakajima, Shunsuke

    2015-01-01

    An 88-year-old woman underwent emergency percutaneous coronary intervention (PCI) to treat circulatory collapse with severe stenosis in the distal left main coronary artery (LMCA). After 3.5/18-mm stent deployment from the LMCA to the left anterior descending artery (LAD), coronary perforation occurred in the LAD ostium. Therefore, we implanted a polytetrafluoroethylene (PTFE)-covered stent crossing over the left circumflex artery (LCX), and achieved successful hemostasis. Additional PCI was undertaken to recanalize the LCX. A Confienza 8-20 guidewire was able to penetrate the wall of the PTFE-covered stent, and coronary flow was successfully recovered after deployment of a 2.5/8-mm stent in the proximal LCX.

  7. Multivessel spontaneous coronary artery dissection of left and right coronary systems

    PubMed Central

    Asrar ul Haq, Muhammad; Mutha, Vivek; van Gaal, William J

    2013-01-01

    Spontaneous coronary artery dissection (SCAD) involving multiple coronary arteries simultaneously is extremely rare. It should be considered in younger patients, especially who do not have traditional cardiac risk factors. We present a case of young male patient presenting with acute coronary syndrome associated with ST segments elevation on ECG following physical stress whose coronary angiography revealed SCAD of the left anterior descending as well as the right coronary artery and discuss the therapeutic options with a brief review of the limited evidence. PMID:24158301

  8. Treatment of Descending Thoracic Aneurysm with an Intraaortic Occluder

    PubMed Central

    Liotta, Domingo; Frank, L.; Del Rio, M.; Gallo, A.; Navia, J.; Bertolozzi, E.; Bracco, D.; Cesareo, V.

    1987-01-01

    Elective treatment of descending thoracic aneurysms involves direct surgery, with Dacron graft replacement of the diseased aortic segment. When the patient's condition contraindicates major surgery, however, the surgeon should consider using an extraanatomic approach—implanting an ascending aorta-to-abdominal aorta Dacron bypass graft in a ventral position and leaving the diseased segment undisturbed. After such a procedure, the descending thoracic aorta must be excluded from the normal circulation. For this purpose, we have designed an intraaortic occluding technique in which an umbrella-like device is implanted immediately distal to the left subclavian artery. This technique has proved safe and uncomplicated in canine experiments and is ready for clinical trials. (Texas Heart Institute Journal 1987; 14:196-205) Images PMID:15229741

  9. Compensatory plasticity restores locomotion after chronic removal of descending projections

    PubMed Central

    Harley, Cynthia M.; Reilly, Melissa G.; Stewart, Christopher; Schlegel, Chantel; Morley, Emma; Puhl, Joshua G.; Nagel, Christian; Crisp, Kevin M.

    2015-01-01

    Homeostatic plasticity is an important attribute of neurons and their networks, enabling functional recovery after perturbation. Furthermore, the directed nature of this plasticity may hold a key to the restoration of locomotion after spinal cord injury. Here we studied the recovery of crawling in the leech Hirudo verbana after descending cephalic fibers were surgically separated from crawl central pattern generators shown previously to be regulated by dopamine. We observed that immediately after nerve cord transection leeches were unable to crawl, but remarkably, after a day to weeks, animals began to show elements of crawling and intersegmental coordination. Over a similar time course, excessive swimming due to the loss of descending inhibition returned to control levels. Additionally, removal of the brain did not prevent crawl recovery, indicating that connectivity of severed descending neurons was not essential. After crawl recovery, a subset of animals received a second transection immediately below the anterior-most ganglion remaining. Similar to their initial transection, a loss of crawling with subsequent recovery was observed. These data, in recovered individuals, support the idea that compensatory plasticity directly below the site of injury is essential for the initiation and coordination of crawling. We maintain that the leech provides a valuable model to understand the neural mechanisms underlying locomotor recovery after injury because of its experimental accessibility, segmental organization, and dependence on higher-order control involved in the initiation, modulation, and coordination of locomotor behavior. PMID:25787951

  10. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    PubMed

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease.

  11. ECG of the month. Irregular rhythm in a 25-year-old man with three prior cardiac operations. Coarse atrial fibrillation with a rapid ventricular response, left anterior fascicular block, left ventricular hypertrophy with repolarization abnormality.

    PubMed

    Glancy, D Luke; Ahmed, Jameel; Ayalloore, Siby G; LeLorier, Paul A; Diwan, Pranav M; Helmcke, Frederick R

    2013-01-01

    The patient underwent closure of an atrial septal defect at age 3, had a leaking "mitral" valve repaired at age 9, and at age 13 had a "mitral" valve replacement. He began taking warfarin sodium at that time and remained symptom-free until 10 days before his initial visit here when he presented to another hospital with dyspnea and palpitations. Treatment there consisted of lisinopril 10 mg qd, carvedilol 6.25 mg bid, aldactone 25 mg qd, furosemide 40 mg qd, digoxin 0.25 mg qd, and a continuation of warfarin sodium 7.5 mg qd. An echocardiogram showed a left ventricular ejection fraction of 20%. After diuresis, he was referred to our cardiology clinic. On his initial visit here, his heart rate was an irregular 120 beats/min, his blood pressure was 106/77 mmHg, and closing and opening snaps of a normally functioning mechanical mitral valvular prosthesis were heard. He was obese (height, 5' 9"; weight, 272 lbs). An electrocardiogram was recorded (Figure 1).

  12. [Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

    PubMed

    Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

    2015-01-01

    A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized.

  13. "Doughnut" technetium pyrophosphate myocardial scintigrams. A marker of severe left ventricular dysfunction.

    PubMed

    Nicod, P; Corbett, J R; Rude, R E; Dehmer, G J; Smucker, M; Buja, L M; Parkey, R W; Lewis, S E; Willerson, J T

    1982-10-01

    The "doughnut" pattern on Tc-99m pyrophosphate (PPi) myocardial scintigraphy is characterized by a border of tracer uptake surrounding a central zone of relatively decreased activity. This pattern is generally associated with large transmural anterior myocardial infarcts (MI) caused by occlusion or critical stenosis of the left anterior descending coronary artery. Such infarcts typically involve a significant portion of the anterior wall and are associated with a complicated clinical course and poor prognosis. In order to evaluate the relationship between the presence of the doughnut pattern and left ventricular (LV) function, radionuclide ventriculography was performed within 15 days after infarction in 58 patients with transmural anterior MI. In patients without previous MI, 15/38 (39.5%) had doughnut scintigrams. These patients demonstrated significant reductions in LV ejection fraction (EF) (28 +/- 10% versus 45 +/- 12%, P less than 0.001) and normalized LV wall motion scores (29 +/- 11% versus 61 +/- 10%, P less than 0.001) when compared with patients with "nondoughnut" scintigrams. Patients with doughnut scintigrams had a significantly greater incidence of severe septal hypokinesis (P less than 0.001) and apical dyskinesis (P less than 0.03). LV end-systolic volumes were also larger in the patients with doughnut scintigrams (73 +/- 32 ml versus 40 +/- 17 mI/M2, P less than 0.005). In contrast, there was no significant difference in LVEF, normalized LV wall motion score, or LV volumes between doughnut and nondoughnut groups in patients with previous MI.

  14. Optimal treatment of descending necrotising mediastinitis

    PubMed Central

    Corsten, M. J.; Shamji, F. M.; Odell, P. F.; Frederico, J. A.; Laframboise, G. G.; Reid, K. R.; Vallieres, E.; Matzinger, F.

    1997-01-01

    BACKGROUND: Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by the absence of barriers in the contiguous fascial planes of neck and mediastinum. METHODS: The recent successful treatment of seven adult patients with descending necrotising mediastinitis emphasises the importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also presented of a child with descending necrotising mediastinitis, demonstrating the rapidity with which the infection can develop and lead to death. Twenty four case reports and 12 series of adult patients with descending necrotising mediastinitis published since 1970 were reviewed with meta-analysis. In each case of confirmed descending necrotising mediastinitis the method of surgical drainage (cervical, mediastinal, or none) and the survival outcome (discharge home or death) were noted. The chi 2 test of statistical significance was used to detect a difference between cases treated with cervical drainage alone and cases where mediastinal drainage was added. RESULTS: Cervical drainage alone was often insufficient to control the infection with a fatality rate of 47% compared with 19% when mediastinal drainage was added (p < 0.05). CONCLUSIONS: Early combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease. 


 PMID:9337829

  15. Utility of peak creatine kinase-MB measurements in predicting myocardial infarct size, left ventricular dysfunction, and outcome after first anterior wall acute myocardial infarction (from the INFUSE-AMI trial).

    PubMed

    Dohi, Tomotaka; Maehara, Akiko; Brener, Sorin J; Généreux, Philippe; Gershlick, Anthony H; Mehran, Roxana; Gibson, C Michael; Mintz, Gary S; Stone, Gregg W

    2015-03-01

    Infarct size after ST-segment elevation myocardial infarction (STEMI) is associated with long-term clinical outcomes. However, there is insufficient information correlating creatine kinase-MB (CK-MB) or troponin levels to infarct size and infarct location in first-time occurrence of STEMI. We, therefore, assessed the utility of CK-MB measurements after primary percutaneous coronary intervention of a first anterior STEMI using bivalirudin anticoagulation in patients who were randomized to intralesion abciximab versus no abciximab and to manual thrombus aspiration versus no aspiration. Infarct size (as a percentage of total left ventricular [LV] mass) and LV ejection fraction (LVEF) were evaluated by cardiac magnetic resonance imaging at 30 days and correlated to peak CK-MB. Peak CK-MB (median 240 IU/L; interquartile range 126 to 414) was significantly associated with infarct size and with LVEF (r = 0.67, p <0.001; r = -0.56, p <0.001, respectively). A large infarct size (greater than or equal the median, defined as 17% of total LV mass) and LVEF ≤40% were more common in the highest peak CK-MB tertile group than in the other tertiles (87.6% vs 49.5% vs 9.1%, p <0.001; 43.2% vs 14.0% vs 4.6%, p <0.001, respectively). Peak CK-MB of at least 300 IU/L predicted with moderate accuracy both a large infarct size (area under the curve 0.88) and an LVEF ≤40% (area under the curve 0.78). Furthermore, CK-MB was an independent predictor of 1-year major adverse cardiac events (hazard ratio 1.42 per each additional 100 IU/L [1.20 to 1.67], p <0.001). In conclusion, CK-MB measurement is useful in estimating infarct size and LVEF and in predicting 1-year clinical outcomes after primary percutaneous coronary intervention for first anterior STEMI.

  16. Descending necrotizing mediastinitis in the elderly patients

    PubMed Central

    Mazzella, Antonio; Santagata, Mario; Cecere, Atirge; La Mart, Ettore; Fiorelli, Alfonso; Tartaro, Gianpaolo; Tafuri, Domenico; Testa, Domenico; Grella, Edoardo; Perrotta, Fabio; Mazzarella, Gennaro; Santini, Mario

    2016-01-01

    Abstract Descending Necrotizing Mediastinitis (DNM) is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management. PMID:28352835

  17. Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

    PubMed

    Pierson, Richard N; Howser, Renee; Donaldson, Terri; Merrill, Walter H; Dignan, Rebecca J; Drinkwater, Davis C; Christian, Karla G; Butler, Javed; Chomsky, Don; Wilson, John R; Clark, Rick; Davis, Stacy F

    2002-03-01

    Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

  18. Organization of descending neurons in Drosophila melanogaster.

    PubMed

    Hsu, Cynthia T; Bhandawat, Vikas

    2016-02-03

    Neural processing in the brain controls behavior through descending neurons (DNs) - neurons which carry signals from the brain to the spinal cord (or thoracic ganglia in insects). Because DNs arise from multiple circuits in the brain, the numerical simplicity and availability of genetic tools make Drosophila a tractable model for understanding descending motor control. As a first step towards a comprehensive study of descending motor control, here we estimate the number and distribution of DNs in the Drosophila brain. We labeled DNs by backfilling them with dextran dye applied to the neck connective and estimated that there are ~1100 DNs distributed in 6 clusters in Drosophila. To assess the distribution of DNs by neurotransmitters, we labeled DNs in flies in which neurons expressing the major neurotransmitters were also labeled. We found DNs belonging to every neurotransmitter class we tested: acetylcholine, GABA, glutamate, serotonin, dopamine and octopamine. Both the major excitatory neurotransmitter (acetylcholine) and the major inhibitory neurotransmitter (GABA) are employed equally; this stands in contrast to vertebrate DNs which are predominantly excitatory. By comparing the distribution of DNs in Drosophila to those reported previously in other insects, we conclude that the organization of DNs in insects is highly conserved.

  19. Organization of descending neurons in Drosophila melanogaster

    PubMed Central

    Hsu, Cynthia T.; Bhandawat, Vikas

    2016-01-01

    Neural processing in the brain controls behavior through descending neurons (DNs) - neurons which carry signals from the brain to the spinal cord (or thoracic ganglia in insects). Because DNs arise from multiple circuits in the brain, the numerical simplicity and availability of genetic tools make Drosophila a tractable model for understanding descending motor control. As a first step towards a comprehensive study of descending motor control, here we estimate the number and distribution of DNs in the Drosophila brain. We labeled DNs by backfilling them with dextran dye applied to the neck connective and estimated that there are ~1100 DNs distributed in 6 clusters in Drosophila. To assess the distribution of DNs by neurotransmitters, we labeled DNs in flies in which neurons expressing the major neurotransmitters were also labeled. We found DNs belonging to every neurotransmitter class we tested: acetylcholine, GABA, glutamate, serotonin, dopamine and octopamine. Both the major excitatory neurotransmitter (acetylcholine) and the major inhibitory neurotransmitter (GABA) are employed equally; this stands in contrast to vertebrate DNs which are predominantly excitatory. By comparing the distribution of DNs in Drosophila to those reported previously in other insects, we conclude that the organization of DNs in insects is highly conserved. PMID:26837716

  20. Giant Cavernous Haemangioma of the Anterior Mediastinum

    PubMed Central

    Kaya, Seyda Ors; Samancılar, Ozgur; Usluer, Ozan; Acar, Tuba; Yener, Ali Galip

    2015-01-01

    Cavernous hemangiomas of the anterior mediastinum is rare. We present a case of a 56-year-old male patient with a giant cavernous hemangioma of the anterior mediastinum, 18 cm in diameters, approached by left posterolateral thoracotomy. To the best of our knowledge, such a unique case has not been previously presented in the literature. PMID:26644773

  1. [Diffuse left ventricular hypokinesis mimicking dilated cardiomyopathy with multi-vessel coronary vasospasm].

    PubMed

    Shimizu, M; Kawata, M; Okada, T; Mizutani, T

    2000-06-01

    We investigated 7 patients with multi-vessel coronary vasospasm (> or = 75%) and diffuse left ventricular hypokinesis by coronary angiography and echocardiography. Four patients were male and 3 were female and mean +/- SD age was 63.0 +/- 11.2 years. Chief complaints were dyspnea in 3 patients, and chest pain, appetite loss, palpitation and general fatigue in one each. New York Heart Association functional classification was I in one patient, II in 5 and III in one. Mean heart rate was 73.9 +/- 11.6 beats/min. Initial echocardiography showed left ventricular end-diastolic diameter (LVDd) 54.4 +/- 5.5 mm, left ventricular end-systolic diameter (LVDs) 43.7 +/- 4.8 mm and percentage fractional shortening (%FS) 19.7 +/- 2.6%. The left ventricle was not remarkably enlarged despite poor contraction. Coronary vasospasm was induced after acetylcholine injection into the right coronary artery in 6 patients, left anterior descending artery in 7 and circumflex artery in 5. Four patients developed three-vessel coronary vasospasm. Three patients underwent endomyocardial biopsy which showed non-specific mild fibrosis. They were treated with nitrates and/or Ca-antagonists to prevent coronary vasospasm. Follow-up echocardiography was performed in 6 patients after 8.5 +/- 6.6 months. Echocardiography revealed marked improvement in left ventricular contraction (LVDd 49.7 +/- 4.6 mm, LVDs 35.8 +/- 4.4 mm, p < 0.05; %FS 27.9 +/- 4.5%, p < 0.05). These data suggested that left ventricular dilation was not prominent despite the poor contractility in patients with multi-vessel coronary vasospasm and diffuse left ventricular hypokinesis. The left ventricular dysfunction might be hibernating myocardium produced by multiple episodes of coronary vasospasm. Anti-vasospastic agents were effective in these patients.

  2. Moonwalker Descending Neurons Mediate Visually Evoked Retreat in Drosophila.

    PubMed

    Sen, Rajyashree; Wu, Ming; Branson, Kristin; Robie, Alice; Rubin, Gerald M; Dickson, Barry J

    2017-03-06

    Insects, like most animals, tend to steer away from imminent threats [1-7]. Drosophila melanogaster, for example, generally initiate an escape take-off in response to a looming visual stimulus, mimicking a potential predator [8]. The escape response to a visual threat is, however, flexible [9-12] and can alternatively consist of walking backward away from the perceived threat [11], which may be a more effective response to ambush predators such as nymphal praying mantids [7]. Flexibility in escape behavior may also add an element of unpredictability that makes it difficult for predators to anticipate or learn the prey's likely response [3-6]. Whereas the fly's escape jump has been well studied [8, 9, 13-18], the neuronal underpinnings of evasive walking remain largely unexplored. We previously reported the identification of a cluster of descending neurons-the moonwalker descending neurons (MDNs)-the activity of which is necessary and sufficient to trigger backward walking [19], as well as a population of visual projection neurons-the lobula columnar 16 (LC16) cells-that respond to looming visual stimuli and elicit backward walking and turning [11]. Given the similarity of their activation phenotypes, we hypothesized that LC16 neurons induce backward walking via MDNs and that turning while walking backward might reflect asymmetric activation of the left and right MDNs. Here, we present data from functional imaging, behavioral epistasis, and unilateral activation experiments that support these hypotheses. We conclude that LC16 and MDNs are critical components of the neural circuit that transduces threatening visual stimuli into directional locomotor output.

  3. The Treatment of the Incompletely Descended Testis

    PubMed Central

    Wilson, D. S. Poole

    1939-01-01

    (1) Under three years of age the diagnosis of the incompletely descended testis is uncertain. (2) The policy of awaiting spontaneous descent may be pursued until 10 years of age but, unless the testis lies in the superior scrotal position, this policy should not be persisted in thereafter. (3) Hormonal therapy may be employed before operative treatment as a means of determining testes which will descend spontaneously. It should only be used in the prepuberty period. (4) Operative treatment may be safely carried out at any age after 3 years and should be completed before puberty. The optimum period is between 8 and 11 years. The Bevan operation may be successful when the testis is very mobile but the most consistent results are obtained by the septal transposition or Keetley-Torek operations. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 8Fig. 9Fig. 10Fig. 13Fig. 14Fig. 15Fig. 16Fig. 18Fig. 19Fig. 20Fig. 21Fig. 22 PMID:19991991

  4. Descending Influences on Vestibulospinal and Vestibulosympathetic Reflexes

    PubMed Central

    McCall, Andrew A.; Miller, Derek M.; Yates, Bill J.

    2017-01-01

    This review considers the integration of vestibular and other signals by the central nervous system pathways that participate in balance control and blood pressure regulation, with an emphasis on how this integration may modify posture-related responses in accordance with behavioral context. Two pathways convey vestibular signals to limb motoneurons: the lateral vestibulospinal tract and reticulospinal projections. Both pathways receive direct inputs from the cerebral cortex and cerebellum, and also integrate vestibular, spinal, and other inputs. Decerebration in animals or strokes that interrupt corticobulbar projections in humans alter the gain of vestibulospinal reflexes and the responses of vestibular nucleus neurons to particular stimuli. This evidence shows that supratentorial regions modify the activity of the vestibular system, but the functional importance of descending influences on vestibulospinal reflexes acting on the limbs is currently unknown. It is often overlooked that the vestibulospinal and reticulospinal systems mainly terminate on spinal interneurons, and not directly on motoneurons, yet little is known about the transformation of vestibular signals that occurs in the spinal cord. Unexpected changes in body position that elicit vestibulospinal reflexes can also produce vestibulosympathetic responses that serve to maintain stable blood pressure. Vestibulosympathetic reflexes are mediated, at least in part, through a specialized group of reticulospinal neurons in the rostral ventrolateral medulla that project to sympathetic preganglionic neurons in the spinal cord. However, other pathways may also contribute to these responses, including those that dually participate in motor control and regulation of sympathetic nervous system activity. Vestibulosympathetic reflexes differ in conscious and decerebrate animals, indicating that supratentorial regions alter these responses. However, as with vestibular reflexes acting on the limbs, little is known

  5. The influence of a medio-lateral unstable sole on invertor and evertor activation while descending stairs

    PubMed Central

    Yang, Ki-sik; Park, Kyungyeon; Choi, Bo-ram

    2016-01-01

    [Purpose] This study examined the effects of a medio-lateral unstable sole on invertor and evertor activation while descending stairs. [Subjects and Methods] The subjects were 30 university students with no history of ankle sprain. They descended stairs while wearing the medio-lateral unstable sole or with bare feet. Electromyography was used to record the activity of the tibialis anterior and peroneus longus and brevis muscles and paired t-tests were used to assess statistical significance. [Results] The medio-lateral unstable sole group showed increased tibialis anterior and peroneus longus and brevis muscle activation compared to the barefoot group. [Conclusion] Medio-lateral unstable sole can be used with exercises to prevent further ankle damage by activating both the inversion and eversion muscles. PMID:27630412

  6. Xenon protects left ventricular diastolic function during acute ischemia, less than ischemic preconditioning

    PubMed Central

    Baumert, Jan-H.; Roehl, Anna B.; Funcke, Sandra; Hein, Marc

    2016-01-01

    Anesthetics modify regional left ventricular (LV) dysfunction following ischemia/reperfusion but their effects on global function in this setting are less clear. Aim of this study was to test the hypothesis that xenon would limit global LV dysfunction as caused by acute anterior wall ischemia, comparable to ischemic preconditioning. In an open-chest model under thiopental anesthesia, 30 pigs underwent 60-minute left anterior descending coronary artery occlusion, followed by 120 minutes of reperfusion. A xenon group (constant inhalation from previous to ischemia through end of reperfusion) was compared to control and ischemic preconditioning. Load-independent measures of diastolic function (end-diastolic pressure-volume relation, time constant of relaxation) and systolic function (end-systolic pressure-volume relation, preload-recruitable stroke work) were determined. Heart rate, arterial pressure, cardiac output, and arterial elastance were recorded. Data were compared in 26 pigs. Ischemia impaired global diastolic but not systolic function in control, which recovered during reperfusion. Xenon limited and preconditioning abolished diastolic dysfunction during ischemia. Arterial pressure decreased during reperfusion while arterial elastance increased. Tachycardia and antero-septal wall edema during reperfusion were observed in all groups. In spite of ischemia of 40% of LV mass, global systolic function was preserved. Deterioration in global diastolic function was limited by xenon and prevented by preconditioning. PMID:27867480

  7. Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease.

    PubMed

    Topaz, On; Polkampally, Pritam R; Mohanty, Pramod K; Rizk, Maged; Bangs, Julie; Bernardo, Nelson L

    2009-11-01

    Excimer laser has been successfully applied to complex atherosclerotic plaques in acute coronary syndromes; however, its role in debulking in left main coronary artery disease has not been fully explored. Details of a series of 20 patients who underwent excimer laser revascularization of a spectrum of left main coronary artery lesions are presented. Twenty symptomatic patients who received excimer laser debulking were examined for procedural outcome and follow up results. The left main coronary artery was characterized as protected, semi-protected, poorly protected, or unprotected, depending on the presence or absence of patent bypass grafts to the left anterior descending (LAD) and circumflex (CX) arteries. A fully protected left main coronary artery (LMCA) was present in only 20% of the patients. The target lesions included 11(55%) distal LMCA stenoses, six (30%) ostial stenoses, and one (5%) mid-portion lesions. Two (10%) patients had in-stent re-stenosis of the entire length of the LMCA. Small (0.7 mm-1.4 mm) excimer laser catheters were mostly used. A relatively high number of laser energy pulses (1,334 +/- 643) were required to achieve adequate debulking. Successful LMCA intervention was performed in 19 (95%) patients, while in-hospital complications occurred in only one (5%) patient. Subacute/late stent thrombosis developed 3 months after the procedure in one patient, and two patients died from non-cardiac causes during follow-up. Lesions in LMCAs can be revascularized in selected patients by laser debulking and adjunct stenting. Inadequate protection by bypass grafts and decreased left ventricular function do not contradict utilization of excimer laser. Small laser catheters and high energy levels are required during laser debulking of stenoses of left main coronary arteries.

  8. Cervical necrotising fasciitis and descending mediastinitis secondary to unilateral tonsillitis: a case report

    PubMed Central

    Islam, Asad; Oko, Michael

    2008-01-01

    Introduction Cervical necrotizing fasciitis is an aggressive infection with high morbidity and mortality. We present a case of cervical necrotizing fasciitis and descending mediastinitis in a healthy young man, caused by unilateral tonsillitis with a successful outcome without aggressive debridement. Case presentation A 41-year-old man was admitted to our unit with a diagnosis of severe acute unilateral tonsillitis. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. Computed tomography scan of his neck and chest showed evidence of cervical necrotizing fasciitis and descending mediastinitis secondary to underlying pharyngeal disease. He was treated with broad-spectrum intravenous antibiotics. His condition improved over the next 3 days but a tender and fluctuant swelling appeared in the suprasternal region. A repeat scan showed the appearance of an abscess extending from the pretracheal region to the upper mediastinum which was drained through a small transverse anterior neck incision. After surgery, the patient's condition quickly improved and he was discharged on the 18th day of admission. Conclusion Less invasive surgical techniques may replace conventional aggressive debridement as the treatment of choice for cervical necrotizing fasciitis and descending necrotizing mediastinitis. PMID:19055812

  9. Representation of spatial information in key areas of the descending pain modulatory system.

    PubMed

    Ritter, Christoph; Hebart, Martin N; Wolbers, Thomas; Bingel, Ulrike

    2014-03-26

    Behavioral studies have demonstrated that descending pain modulation can be spatially specific, as is evident in placebo analgesia, which can be limited to the location at which pain relief is expected. This suggests that higher-order cortical structures of the descending pain modulatory system carry spatial information about the site of stimulation. Here, we used functional magnetic resonance imaging and multivariate pattern analysis in 15 healthy human volunteers to test whether spatial information of painful stimuli is represented in areas of the descending pain modulatory system. We show that the site of nociceptive stimulation (arm or leg) can be successfully decoded from local patterns of brain activity during the anticipation and receipt of painful stimulation in the rostral anterior cingulate cortex, the dorsolateral prefrontal cortices, and the contralateral parietal operculum. These results demonstrate that information regarding the site of nociceptive stimulation is represented in these brain regions. Attempts to predict arm and leg stimulation from the periaqueductal gray, control regions (e.g., white matter) or the control time interval in the intertrial phase did not allow for classifications above chance level. This finding represents an important conceptual advance in the understanding of endogenous pain control mechanisms by bridging the gap between previous behavioral and neuroimaging studies, suggesting a spatial specificity of endogenous pain control.

  10. Chronic effects of a cardiac assist device on the bulk and regional mechanics of the failed left ventricle in goats.

    PubMed

    Nakamura, T; Hayashi, K; Seki, J; Fukuda, S; Noda, H; Nakatani, T; Takano, H; Akutsu, T

    1993-05-01

    Pneumatically driven, diaphragm-type left ventricular assist devices (LVADs) were implanted into 8 goats with profound induced infarction to the left ventricle by using multiple ligations of the left anterior descending (LAD) coronary artery as well as small arteries in the LAD distribution area. Left ventricular diameters, regional myocardial segment lengths, and wall thicknesses were measured by sono-micrometers. After left ventricular function seemed to be recovered, the goats were weaned off the LVADs after a gradual decrease of pump bypass flow over several days. Thereafter, hemodynamic and cardiac parameters were observed for about 1 month more. Three animals recovered successfully owing to the LVAD pumping. Before starting pump-weaning procedures, the bulk mechanical work (BMW) done by the left ventricle during LVAD pumping and under temporary pump-off conditions was 0.08 +/- 0.01 (mean +/- SE) and 0.22 +/- 0.01 W/100 g left ventricular weight (LVW), respectively, while the regional mechanical work done by the normal myocardium (RMWn) was 1.5 +/- 0.4 and 4.3 +/- 0.9 mW/cm3 during pumping and under temporary pump-off conditions, respectively. BMW and RMWn values obtained under pump-on conditions both increased gradually during the weaning process. Even after pump removal, they continued to increase and reached constant values of about 0.3 W/100 g LVW and 10 mW/cm3, respectively, around 2 weeks after pump removal. Although the myocardium in the infarction area did no work for the first several days after surgery, it recovered to do some external work with the aid of LVAD pumping. However, recovery of left ventricular function owed more to compensatory increases in pumping ability of the remaining normal myocardium than to recovery of the damaged myocardium. The LVAD could salvage severely damaged hearts unless the infarction area exceeded 50% of the left ventricular wall.

  11. Anomalous right coronary artery arising next to the left coronary ostium: unambiguous detection of the anatomy by computed tomography and evaluation of functional significance by cardiovascular magnetic resonance.

    PubMed

    Korosoglou, Grigorios; Heye, Tobias; Giannitsis, Evangelos; Hosch, Waldemar; Kauczor, Hans U; Katus, Hugo A

    2010-11-19

    Herein we report on the diagnostic potential of multi-detector row computed tomography (MDCT) combined with cardiovascular magnetic resonance (CMR) for the diagnostic workup in an adult patient with a rare coronary anomaly. MDCT unambiguously detected the anomalous right coronary artery (RCA), which originated next to the left coronary ostium and coursed inter-arterially between the ascending aorta and the pulmonary trunk. The intramural proximal intussusception of the ectopic RCA could be clearly appreciated on MDCT images, while multiple mixed plaques were detected in the left anterior descending (LAD), resulting in moderate stenosis of this vessel. CMR during adenosine infusion ruled-out inducible ischemia, yielding normal perfusion patterns both in the RCA and in the LAD coronary territory. Since ischemia was not demonstrated by stress CMR, revascularization was not performed.

  12. Anomalous origin of the left circumflex coronary artery from the pulmonary artery. A very rare congenital anomaly in an adult patient diagnosed by cardiovascular magnetic resonance.

    PubMed

    Korosoglou, Grigorios; Ringwald, Gerd; Giannitsis, Evangelos; Katus, Hugo A

    2008-01-21

    Here we report for the first time on the diagnostic potential of cardiovascular magnetic resonance (CMR) to delineate the proximal course of an anomalous left circumflex coronary artery (LCX) originating from the right pulmonary artery in an adult patient with no other form of congenital heart disease. The patient was referred to our institution due to exertional chest discomfort. X-Ray coronary angiography showed a normal left anterior descending coronary artery (LAD) and right coronary artery (RCA), while the LCX was filled retrograde by collateral flow through the LAD and the RCA. The origin of the LCX was postulated to be the pulmonary artery, but the exact origin of the anomalous artery could not be depicted on conventional angiograms. CMR provided the unambiguous depiction of the origin of the anomalous LCX from the right pulmonary artery and the delineation of its proximal course in this case of a very rare coronary anomaly in adults.

  13. Diagnosis and surgical treatment of an aneurysm on a cervical aortic arch associated with an anomalous origin of the left main coronary artery.

    PubMed

    Charrot, Florent; Tarmiz, Amine; Glock, Yves; Léobon, Bertrand

    2010-02-01

    Cervical aortic arch (CAA) is a rare congenital anomaly. An aneurysm developed on a CAA is even rarer and a life threatening condition. We report the diagnosis and surgical treatment of an aneurysm on a CAA associated with an anomalous origin of the left main coronary artery. The surgical procedure consisted in the resection of the aneurysm, a direct aorto aortic anastomosis and a coronary artery bypass to the left anterior descending (LAD) artery with a good result at 11 months. This first case reported of an anomaly of a coronary artery origin associated with an aneurysm on a CAA, underlines the interest of a preoperative complete anatomical and functional diagnosis, to define an optimal intraoperative strategy.

  14. Left colectomy with intracoporeal anastomosis: technical aspects

    PubMed Central

    Araujo, Sérgio Eduardo Alonso; Seid, Victor Edmond; Klajner, Sidney; Bertoncini, Alexandre Bruno

    2014-01-01

    Oncologic laparoscopic colectomy represents a fully validated surgical approach to the management of colorectal cancer. However, laparoscopic surgery for distal transverse and descending colon lesions remains a challenging procedure. A total laparoscopic approach to the left colectomy is an interesting option for critically ill patients although reports in the literature on this subject are scarce and its approach still not standardized because of its selective nature for indication. There are several advantages associated with conduction of totally laparoscopic approach to the left colon. Intracorporeal vessel sealing ensures an adequate lymph node dissection. Moreover, it enables the construction of a well-vascularized anastomosis. Ultimately, the occurrence of late wound complications are possibly reduced for the placement of a low abdominal incision exclusively used for specimen extraction. This paper aimed at describing our technique for a totally laparoscopic left colectomy for distal transverse and descending colon lesions. PMID:25295460

  15. Descending polyneuropathy in an intravenous drug user.

    PubMed

    O'Sullivan, Jean M; McMahon, Geraldine

    2005-10-01

    A 27-year-old male intravenous drug user presented to the Emergency Department of St James's Hospital with a 1-week history of progressive dysphasia, dysphagia and difficulty 'holding his head up' and 'keeping his eyes open'. He also complained of increasing weakness in his upper limbs, as a result of which he kept dropping things. He was on a methadone program but was using both intravenous heroin and cocaine at the time of presentation. Examination of his motor function revealed generalized hypotonia, hyporeflexia and reduced power in both upper limbs. No sensory loss was observed. Co-ordination was intact. The clinical picture of a proximal symmetrical descending weakness and an absence of sensory loss was suggestive of botulism. Clostridium botulinum is a spore-forming, obligate anaerobe. The three forms of human botulism are food-borne, wound and intestinal. A fourth man-made form is produced from aerosolized botulinum toxin and results in inhalational botulism. A little as 1 g of aerosolized botulinum toxin has the potential to kill 1.5 million people. Toxin is detected in serum or stool specimens in only approximately 46% of clinically diagnosed cases. Treatment involves supportive care and early passive immunization with equine antitoxin. Patients should be regularly assessed for loss of gag and cough reflex, control of oropharyngeal secretions, oxygen saturation, vital capacity and inspiratory force. When respiratory function begins to deteriorate, anticipatory intubation is indicated. Early symptom recognition and early treatment with antitoxin are essential in order to prevent mortality, and to prevent additional cases, it is important to ascertain the presence of similar symptoms in contacts of the patient and local public health officials must be notified as one case may herald an outbreak. Given the continued threat of bioterrorism, the Centre for Disease Control Surveillance System in the United States must also be notified of any cases of botulism.

  16. Descending aorta-external iliac artery bypass for middle aortic syndrome.

    PubMed

    Okamoto, Yuki; Yamamoto, Kazuo; Sugimoto, Tsutomu; Asami, Fuyuki; Nagasawa, Ayako; Shiraiwa, Satoru; Nakamura, Norihito; Yoshii, Shinpei

    2014-11-01

    We encountered a surgical case of middle aortic syndrome (MAS) in a 56-year-old man who had resistant hypertension. Computed tomography showed severe stenosis of the abdominal aorta from below the superior mesenteric artery to above the inferior mesenteric artery. Although bilateral renal artery stenosis was confirmed, renal function was within normal limits. A 10-mm vascular prosthetic graft was used to perform a descending aorta to left external iliac artery bypass. His hypertension was well controlled without medication. This extra-anatomic bypass may be a simple and useful approach for treating MAS if it is not necessary to reconstruct the renal artery or visceral artery.

  17. Descending effect on spinal nociception by amygdaloid glutamate varies with the submodality of noxious test stimulation.

    PubMed

    Bourbia, Nora; Sagalajev, Boriss; Pertovaara, Antti

    2014-06-06

    Amygdala has an important role in the processing of primary emotions, such as fear. Additionally, amygdala is involved in processing and modulation of pain. While the amygdala, particularly its central nucleus (CeA), has been shown to contribute to pain control, the descending pain regulation by the CeA is still only partly characterized. Here heat and mechanical nociception was tested in both hind limbs of healthy rats with a chronic guide cannula for microinjection of glutamate into the CeA of the left or right hemisphere. The aim was to assess whether the descending pain regulatory effect by glutamate in the amygdala varies with the submodality or the body side of nociceptive testing, brain hemisphere or the amygdaloid glutamate receptor. Motor performance was assessed with the Rotarod test. Amygdaloid glutamate, independent of the treated hemisphere, produced a dose-related heat and mechanical antinociception that varied with the submodality of testing. Heat antinociception was short lasting (minutes), bilateral and not reversed by blocking the amygdaloid NMDA receptor with MK-801. In contrast, mechanical antinociception lasted longer (>20 min), was predominantly contralateral and reversed by blocking the amygdaloid NMDA receptor. At an antinociceptive dose, amygdaloid glutamate failed to influence motor performance. The results indicate that independent of the brain hemisphere, the spatial extent and duration of the descending antinociceptive effect induced by amygdaloid glutamate varies with the amygdaloid glutamate receptor and the submodality of pain.

  18. Berberine attenuates adverse left ventricular remodeling and cardiac dysfunction after acute myocardial infarction in rats: role of autophagy.

    PubMed

    Zhang, Yao-Jun; Yang, Shao-Hua; Li, Ming-Hui; Iqbal, Javaid; Bourantas, Christos V; Mi, Qiong-Yu; Yu, Yi-Hui; Li, Jing-Jing; Zhao, Shu-Li; Tian, Nai-Liang; Chen, Shao-Liang

    2014-12-01

    The present study aimed to test the hypothesis that berberine, a plant-derived anti-oxidant, attenuates adverse left ventricular remodelling and improves cardiac function in a rat model of myocardial infarction (MI). Furthermore, the potential mechanisms that mediated the cardioprotective actions of berberine, in particular the effect on autophagy, were also investigated. Acute MI was induced by ligating the left anterior descending coronary artery of Sprague-Dawley rats. Cardiac function was assessed by transthoracic echocardiography. The protein activity/levels of autophagy related to signalling pathways (e.g. LC-3B, Beclin-1) were measured in myocardial tissue by immunohistochemical staining and western blot. Four weeks after MI, berberine significantly prevented cardiac dysfunction and adverse cardiac remodelling. MI rats treated with low dose berberine (10 mg/kg per day) showed higher left ventricular ejection fraction and fractional shortening than those treated with high-dose berberine (50 mg/kg per day). Both doses reduced interstitial fibrosis and post-MI adverse cardiac remodelling. The cardioprotective action of berberine was associated with increased LC-3B II and Beclin-1 expressions. Furthermore, cardioprotection with berberine was potentially related to p38 MAPK inhibition and phospho-Akt activation. The present in vivo study showed that berberine is effective in promoting autophagy, and subsequently attenuating left ventricular remodelling and cardiac dysfunction after MI. The potential underlying mechanism is augmentation of autophagy through inhibition of p38 MAPK and activation of phospho-Akt signalling pathways.

  19. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

    PubMed Central

    Anantha Narayanan, Mahesh; DeZorzi, Christopher; Akinapelli, Abhilash; Mahfood Haddad, Toufik; Smer, Aiman; Baskaran, Janani; Biddle, William P.

    2015-01-01

    Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery. PMID:26257964

  20. Intimal sarcoma of the descending aorta.

    PubMed

    Shirani, Shapour; Soleymanzadeh-Ardabili, Maryam; Arami, Mitra

    2007-04-01

    Primary intimal angiosarcoma of the aorta (i.e., mostly intraluminal sarcomas with evidence of endothelial differentiation) is extraordinarily rare. We report a case in which the diagnosis was accurately made using immunohistochemistry in an embolectomy specimen. The patient was a 78-year-old man with a two-month history of bilateral claudication. Doppler ultrasound proved an embolus in both popliteal arteries, which was removed. The highly atypical cells comprising these emboli were positive immunohistochemically for CD68, vimentin, and CD31. Magnetic resonance imaging also showed an irregular tumor (invasion to the left main bronchus). This case emphasizes the need for a wide panel of immunohistochemical studies in tumor emboli of unknown origin.

  1. Anterior Insular Cortex and Emotional Awareness

    PubMed Central

    Gu, Xiaosi; Hof, Patrick R.; Friston, Karl J.; Fan, Jin

    2014-01-01

    This paper reviews the foundation for a role of the human anterior insular cortex (AIC) in emotional awareness, defined as the conscious experience of emotions. We first introduce the neuroanatomical features of AIC and existing findings on emotional awareness. Using empathy, the awareness and understanding of other people’s emotional states, as a test case, we then present evidence to demonstrate: 1) AIC and anterior cingulate cortex (ACC) are commonly coactivated as revealed by a meta-analysis, 2) AIC is functionally dissociable from ACC, 3) AIC integrates stimulus-driven and top-down information, and 4) AIC is necessary for emotional awareness. We propose a model in which AIC serves two major functions: integrating bottom-up interoceptive signals with top-down predictions to generate a current awareness state and providing descending predictions to visceral systems that provide a point of reference for autonomic reflexes. We argue that AIC is critical and necessary for emotional awareness. PMID:23749500

  2. Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

    PubMed

    Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

    2008-02-01

    Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

  3. Supersymmetric descendants of self-adjointly extended quantum mechanical Hamiltonians

    NASA Astrophysics Data System (ADS)

    Al-Hashimi, M. H.; Salman, M.; Shalaby, A.; Wiese, U.-J.

    2013-10-01

    We consider the descendants of self-adjointly extended Hamiltonians in supersymmetric quantum mechanics on a half-line, on an interval, and on a punctured line or interval. While there is a 4-parameter family of self-adjointly extended Hamiltonians on a punctured line, only a 3-parameter sub-family has supersymmetric descendants that are themselves self-adjoint. We also address the self-adjointness of an operator related to the supercharge, and point out that only a sub-class of its most general self-adjoint extensions is physical. Besides a general characterization of self-adjoint extensions and their supersymmetric descendants, we explicitly consider concrete examples, including a particle in a box with general boundary conditions, with and without an additional point interaction. We also discuss bulk-boundary resonances and their manifestation in the supersymmetric descendant.

  4. 4. Photocopy from James H. Bull, Records of the Descendants ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. Photocopy from James H. Bull, Records of the Descendants of John and Elizabeth Bull, 1919 WEST AND NORTH ELEVATIONS - Mount Pleasant, Bulltown Road (East Nantmeal Township), East Nantmeal, Chester County, PA

  5. Large benign submucosal lipoma presented with descending colonic intussusception in an adult

    PubMed Central

    Allos, Ziad; Zhubandykova, Dina

    2013-01-01

    Patient: Female, 34 Final Diagnosis: Lipoma of the large intestine Symptoms: Abdominal pain • bloating • blood in stool • constipation • lose of appetite • nausea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Lipoma of the large intestine is rare, account for only 5% of all gastrointestinal tumors. Lipomas are usually asymptomatic but rarely may cause bleeding, obstruction and intussusception. We present a case of a giant colonic lipoma causing descending-colonic intussusception. Case Report: 34 yo F presented with the intermittent left lower quadrant abdominal pain for 3 weeks. The pain initially was associated with bloating and constipation and for the last several days frank blood in stool, nausea and decreased appetite. CT scan of the abdomen revealed descending colonic obstruction by a 5.3 cm colonic lipomatous mass with resultant intussusception. Patient initially underwent colonoscopy that revealed polypoid lesion at 3–40 similar to lipoma with intussusception that was reduced. Patient subsequently underwent laparoscopic segmental left colectomy for the descending colonic intussusception due to large colonic lipomatous mass. Pathology confirmed the histology of lipoma. Conclusions: Adult bowel intussusception is a rare but challenging condition to diagnose in a timely manner. Preoperative diagnosis is usually missed or delayed because of nonspecific and often subacute symptoms. Lipoma is a rare cause of the intussusception. A high index of suspicion and appropriate investigations (abdominal ultrasound, CT scan and colonoscopy) can result in prompt diagnosis. Lipoma of the large intestine is very rare. Submucosal lipomas are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. Accurate preoperative diagnosis is difficult and lipoma is often mistaken for adenomatous polyp or carcinoma. Treatment usually requires formal resection of the involved bowel segment

  6. Gait modification strategies in trunk over right stance phase in patients with right anterior cruciate ligament deficiency.

    PubMed

    Shi, Dongliang; Li, Nannan; Wang, Yubin; Jiang, Shuyun; Lin, Jianping; Zhu, Wenhui

    2016-05-01

    This study aimed to investigate the gait modification strategies of trunk over right stance phase in patients with right anterior cruciate ligament deficiency (ACL-D). Thirty-six patients with right chronic ACL-D were recruited, as well as 36 controls. A 3D optical video motion capture system was used during gait and stair ambulation. Kinematic variables of the trunk and kinematic and kinetic variables of the knee were calculated. Patients with chronic right ACL-D exhibited many significant abnormalities compared with controls. Trunk rotation with right shoulder trailing over the right stance phase was lower in all five motion patterns (P<0.05). Compared with controls, trunk posterior lean was higher from descending stairs to walking when the knee sagittal plane moment ended (P<0.01). Trunk lateral flexion to the left was higher when ascending stairs at the start of right knee coronal plane moment (P=0.01), when descending stairs at the maximal knee coronal plane moment (P<0.01), and when descending stairs at the end of the knee coronal plane moment (P=0.03). Trunk rotation with right shoulder forward was higher at the minimal knee transverse plane moment (P<0.01) and when the knee transverse plane moment ended (P<0.01); during walking, trunk rotation with right shoulder trailing was lower at other knee moments during other walking patterns (all P<0.01). In conclusion, gait modification strategies of the trunk were apparent in patients with ACL-D. These results provide new insights about diagnosis and rehabilitation of chronic ACL-D (better use of walking and stair tasks as part of a rehabilitation program).

  7. Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

    PubMed Central

    Falcão, Andréa; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares, José; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Filho, Roberto Kalil; Meneghetti, José C

    2015-01-01

    OBJECTIVES: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. OBJECTIVE: We sought to investigate rubidium-82 (82Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. METHODS: Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82Rb-positron emission tomography studies and without left bundle branch block (GII). RESULTS: Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p<0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). CONCLUSION: The data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with

  8. Isolated pyocele of anterior clinoid process presenting as a cavernous sinus syndrome.

    PubMed

    O'Donnell, Thomas J; Michael, L Madison; Laster, Robert; Fleming, James C

    2013-05-01

    A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.

  9. Timing effect of intramyocardial hydrogel injection for positively impacting left ventricular remodeling after myocardial infarction

    PubMed Central

    Yoshizumi, Tomo; Zhu, Yang; Jiang, Hongbin; D’Amore, Antonio; Sakaguchi, Hirokazu; Tchao, Jason; Tobita, Kimimasa; Wagner, William R.

    2016-01-01

    Intramyocardial injection of various injectable hydrogel materials has shown benefit in positively impacting the course of left ventricular (LV) remodeling after myocardial infarction (MI). However, since LV remodeling is a complex, time dependent process, the most efficacious time of hydrogel injection is not clear. In this study, we injected a relatively stiff, thermoresponsive and bioabsorbable hydrogel in rat hearts at 3 different time points - immediately after MI (IM), 3 d post-MI (3D), and 2 w post-MI (2W), corresponding to the beginnings of the necrotic, fibrotic and chronic remodeling phases. The employed left anterior descending coronary artery ligation model showed expected infarction responses including functional loss, inflammation and fibrosis with distinct time dependent patterns. Changes in LV geometry and contractile function were followed by longitudinal echocardiography for 10 w post-MI. While all injection times positively affected LV function and wall thickness, the 3D group gave better functional outcomes than the other injection times and also exhibited more local vascularization and less inflammatory markers than the earlier injection time. The results indicate an important role for injection timing in the increasingly explored concept of post-MI biomaterial injection therapy and suggest that for hydrogels with mechanical support as primary function, injection at the beginning of the fibrotic phase may provide improved outcomes. PMID:26774561

  10. Timing effect of intramyocardial hydrogel injection for positively impacting left ventricular remodeling after myocardial infarction.

    PubMed

    Yoshizumi, Tomo; Zhu, Yang; Jiang, Hongbin; D'Amore, Antonio; Sakaguchi, Hirokazu; Tchao, Jason; Tobita, Kimimasa; Wagner, William R

    2016-03-01

    Intramyocardial injection of various injectable hydrogel materials has shown benefit in positively impacting the course of left ventricular (LV) remodeling after myocardial infarction (MI). However, since LV remodeling is a complex, time dependent process, the most efficacious time of hydrogel injection is not clear. In this study, we injected a relatively stiff, thermoresponsive and bioabsorbable hydrogel in rat hearts at 3 different time points - immediately after MI (IM), 3 d post-MI (3D), and 2 w post-MI (2W), corresponding to the beginnings of the necrotic, fibrotic and chronic remodeling phases. The employed left anterior descending coronary artery ligation model showed expected infarction responses including functional loss, inflammation and fibrosis with distinct time dependent patterns. Changes in LV geometry and contractile function were followed by longitudinal echocardiography for 10 w post-MI. While all injection times positively affected LV function and wall thickness, the 3D group gave better functional outcomes than the other injection times and also exhibited more local vascularization and less inflammatory markers than the earlier injection time. The results indicate an important role for injection timing in the increasingly explored concept of post-MI biomaterial injection therapy and suggest that for hydrogels with mechanical support as primary function, injection at the beginning of the fibrotic phase may provide improved outcomes.

  11. A descending dopamine pathway conserved from basal vertebrates to mammals

    PubMed Central

    Ryczko, Dimitri; Cone, Jackson J.; Alpert, Michael H.; Goetz, Laurent; Auclair, François; Dubé, Catherine; Parent, Martin; Roitman, Mitchell F.; Alford, Simon; Dubuc, Réjean

    2016-01-01

    Dopamine neurons are classically known to modulate locomotion indirectly through ascending projections to the basal ganglia that project down to brainstem locomotor networks. Their loss in Parkinson’s disease is devastating. In lampreys, we recently showed that brainstem networks also receive direct descending dopaminergic inputs that potentiate locomotor output. Here, we provide evidence that this descending dopaminergic pathway is conserved to higher vertebrates, including mammals. In salamanders, dopamine neurons projecting to the striatum or brainstem locomotor networks were partly intermingled. Stimulation of the dopaminergic region evoked dopamine release in brainstem locomotor networks and concurrent reticulospinal activity. In rats, some dopamine neurons projecting to the striatum also innervated the pedunculopontine nucleus, a known locomotor center, and stimulation of the dopaminergic region evoked pedunculopontine dopamine release in vivo. Finally, we found dopaminergic fibers in the human pedunculopontine nucleus. The conservation of a descending dopaminergic pathway across vertebrates warrants re-evaluating dopamine’s role in locomotion. PMID:27071118

  12. Interaction between descending input and thoracic reflexes for joint coordination in cockroach: I. descending influence on thoracic sensory reflexes.

    PubMed

    Mu, Laiyong; Ritzmann, Roy E

    2008-03-01

    Tethered cockroaches turn from unilateral antennal contact using asymmetrical movements of mesothoracic (T2) legs (Mu and Ritzmann in J Comp Physiol A 191:1037-1054, 2005). During the turn, the leg on the inside of the turn (the inside T2 leg) has distinctly different motor patterns from those in straight walking. One possible neural mechanism for the transformation from walking to inside leg turning could be that the descending commands alter a few critical reflexes that start a cascade of physical changes in leg movement or posture, leading to further alterations. This hypothesis has two implications: first, the descending activities must be able to influence thoracic reflexes. Second, one should be able to initiate the turning motor pattern without descending signals by mimicking a point farther down in the reflex cascade. We addressed the first implication in this paper by experiments on chordotonal organ reflexes. The activity of depressor muscle (Ds) and slow extensor tibia muscle (SETi) was excited and inhibited by stretching and relaxing the femoral chordotonal organ. However, the Ds responses were altered after eliminating the descending activity, while the SETi responses remain similar. The inhibition to Ds activity by stretching the coxal chordotonal organ was also altered after eliminating the descending activity.

  13. Intimal Sarcoma of the Descending Aorta Mimicking Aortitis

    PubMed Central

    Pucci, Angela; De Martino, Andrea; Levantino, Maurizio; Berchiolli, Raffaella; Basolo, Fulvio; Bortolotti, Uberto

    2016-01-01

    We describe a 74-year-old male patient with an intimal sarcoma of the descending aorta mimicking aortitis. The patient presented with lower back pain, fever, and increased C-reactive protein, erythrocyte sedimentation rate, and immunoglobulin G4 (IgG4) serum levels, together with Staphylococcus epidermidis-positive blood cultures. These findings, together with evidence of a 49-mm pseudoaneurysm of the descending thoracic aorta, caused us to suspect aortitis. However, postoperative histology and immunohistochemistry demonstrated the presence of an intimal aortic sarcoma. At the 8-month follow-up, local recurrence of the neoplasm and lung metastases were noted. PMID:28097198

  14. Giant anterior cervical osteophyte leading to Dysphagia.

    PubMed

    Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il

    2013-09-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress.

  15. Anterior clinoidal meningioma coincidental with bilateral intracranial aneurysms

    PubMed Central

    Paraskevopoulos, D; Magras, I; Balogiannis, I; Polyzoidis, K

    2011-01-01

    Coexistence of aneurysms and brain tumors is a rare occurrence. Coincidence is highest in patients with meningiomas rather than other types of tumors. We report a case in which a meningioma of the left anterior clinoid process was coexisting with a right middle cerebral artery (MCA) and a left anterior cerebral artery (ACA) aneurysm. While the right MCA aneurysm was detected preoperatively, the left ACA aneurysm was not detectable, being concealed by the major finding of the region. This report focuses on pitfalls of diagnosis and questions the surgical planning in aneurysms concealed by coincidental brain tumors. PMID:24391419

  16. Anterior clinoidal meningioma coincidental with bilateral intracranial aneurysms.

    PubMed

    Paraskevopoulos, D; Magras, I; Balogiannis, I; Polyzoidis, K

    2011-10-01

    Coexistence of aneurysms and brain tumors is a rare occurrence. Coincidence is highest in patients with meningiomas rather than other types of tumors. We report a case in which a meningioma of the left anterior clinoid process was coexisting with a right middle cerebral artery (MCA) and a left anterior cerebral artery (ACA) aneurysm. While the right MCA aneurysm was detected preoperatively, the left ACA aneurysm was not detectable, being concealed by the major finding of the region. This report focuses on pitfalls of diagnosis and questions the surgical planning in aneurysms concealed by coincidental brain tumors.

  17. Bilateral vs single internal thoracic artery grafting for left main coronary artery occlusion.

    PubMed

    Otaki, M; Lust, R M; Sun, Y S; Norton, T O; Spence, P A; Zeri, R S; Hopson, S B; Chitwood, R

    1994-10-01

    This study was conducted to compare the coronary flow distributed by single and bilateral internal thoracic artery (ITA) grafts in the setting of the left main coronary occlusion. Ten dogs underwent coronary artery bypass grafting through a left thoracotomy, off pump, using a brief local occlusion to perform the anastomosis. Dogs were randomly assigned to receive either a single left ITA (LITA) graft to the circumflex coronary artery (CFX), or bilateral ITA grafts, with additional placement of the right ITA (RITA) to the left anterior descending artery (LAD). After the grafts were placed, the left main coronary artery was ligated. Electromagnetic flows were obtained in the LAD and the CFX proximally and distally to ITA grafts in both groups before grafting and after grafting. ITA flow in situ was also measured before rotation from the chest wall. Total left ventricular flow requirements were satisfied equally well by either a single LITA graft (116.7 +/- 11.6 mL/min) or bilateral ITA grafts (total, 116.8 +/- 9.6 mL/min divided as LITA, 55.9 +/- 7.4 mL/min; RITA, 60.9 +/- 12.0 mL/min). When two grafts were replaced, competitive flow in the proximal regions of both native vessels was noted, although basal flow requirements were maintained. When an individual graft was occluded in the bilaterally grafted system, the remaining graft immediately recruited the additional flow, demonstrating that either right or left ITA can support flow demands five to six times higher than in situ chest wall flow (RITA, 21.9 +/- 3.1 mL/min; LITA, 22.3 +/- 4.9 mL/min). These data suggest that in this canine model, a single ITA graft can support the entire flow requirements of the left ventricle. Assuming no intervening stenosis is present in native coronary systems, bilateral ITA grafting may provide a margin of safety, but under resting conditions, provides no perfusion advantages over a single ITA graft.

  18. Indigenous Arabs are descendants of the earliest split from ancient Eurasian populations

    PubMed Central

    Rodriguez-Flores, Juan L.; Fakhro, Khalid; Agosto-Perez, Francisco; Ramstetter, Monica D.; Arbiza, Leonardo; Vincent, Thomas L.; Robay, Amal; Malek, Joel A.; Suhre, Karsten; Chouchane, Lotfi; Badii, Ramin; Al-Nabet Al-Marri, Ajayeb; Abi Khalil, Charbel; Zirie, Mahmoud; Jayyousi, Amin; Salit, Jacqueline; Keinan, Alon; Clark, Andrew G.; Crystal, Ronald G.; Mezey, Jason G.

    2016-01-01

    An open question in the history of human migration is the identity of the earliest Eurasian populations that have left contemporary descendants. The Arabian Peninsula was the initial site of the out-of-Africa migrations that occurred between 125,000 and 60,000 yr ago, leading to the hypothesis that the first Eurasian populations were established on the Peninsula and that contemporary indigenous Arabs are direct descendants of these ancient peoples. To assess this hypothesis, we sequenced the entire genomes of 104 unrelated natives of the Arabian Peninsula at high coverage, including 56 of indigenous Arab ancestry. The indigenous Arab genomes defined a cluster distinct from other ancestral groups, and these genomes showed clear hallmarks of an ancient out-of-Africa bottleneck. Similar to other Middle Eastern populations, the indigenous Arabs had higher levels of Neanderthal admixture compared to Africans but had lower levels than Europeans and Asians. These levels of Neanderthal admixture are consistent with an early divergence of Arab ancestors after the out-of-Africa bottleneck but before the major Neanderthal admixture events in Europe and other regions of Eurasia. When compared to worldwide populations sampled in the 1000 Genomes Project, although the indigenous Arabs had a signal of admixture with Europeans, they clustered in a basal, outgroup position to all 1000 Genomes non-Africans when considering pairwise similarity across the entire genome. These results place indigenous Arabs as the most distant relatives of all other contemporary non-Africans and identify these people as direct descendants of the first Eurasian populations established by the out-of-Africa migrations. PMID:26728717

  19. Anterior shoulder dislocation with axillary artery and nerve injury.

    PubMed

    Razif, M A Mohamed; Rajasingam, V

    2002-12-01

    We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination.

  20. Descending Mediastinitis in Epstein-Barr Virus Infection

    PubMed Central

    van Driel, E. M.; Janssen, M. J. F. M.

    2015-01-01

    Our case report describes a previously healthy 34-year-old male who develops a descending mediastinitis as a complication of an Epstein-Barr virus (EBV) infection. The mediastinitis was suspected to have developed by a breakthrough of a peritonsillar abscess through the space between the alar and prevertebral space. PMID:25740774

  1. 6. VIEW DESCENDING THE NORTH STAIRS OF THE HEADWALL, LEADING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW DESCENDING THE NORTH STAIRS OF THE HEADWALL, LEADING FROM THE EAST END OF FORECOURT TERRACE LEVEL TO THE LOWER LEVEL, AND DIRECTLY ONTO THE RADIAL PAVING OF COLORED MARBLE COBBLES ARRANGED TO REPRESENT THE TWELVE SIGNS OF THE ZODIAC - Kykuit, 200 Lake Road, Pocantico Hills, Westchester County, NY

  2. Supersymmetric descendants of self-adjointly extended quantum mechanical Hamiltonians

    SciTech Connect

    Al-Hashimi, M.H.; Salman, M.; Shalaby, A.; Wiese, U.-J.

    2013-10-15

    We consider the descendants of self-adjointly extended Hamiltonians in supersymmetric quantum mechanics on a half-line, on an interval, and on a punctured line or interval. While there is a 4-parameter family of self-adjointly extended Hamiltonians on a punctured line, only a 3-parameter sub-family has supersymmetric descendants that are themselves self-adjoint. We also address the self-adjointness of an operator related to the supercharge, and point out that only a sub-class of its most general self-adjoint extensions is physical. Besides a general characterization of self-adjoint extensions and their supersymmetric descendants, we explicitly consider concrete examples, including a particle in a box with general boundary conditions, with and without an additional point interaction. We also discuss bulk-boundary resonances and their manifestation in the supersymmetric descendant. -- Highlights: •Self-adjoint extension theory and contact interactions. •Application of self-adjoint extensions to supersymmetry. •Contact interactions in finite volume with Robin boundary condition.

  3. 23. General views of Moody Bridge, in descending order: 1) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. General views of Moody Bridge, in descending order: 1) the northern approach with a partial 'barrel shot', 2) partial view of southern approach detailing bridge decking, railing and portal bracing, and 3) an elevation view to the northeast showing timber piers and abutment of southern approach. - Moody Bridge, Spanning South Fork Eel River, Garberville, Humboldt County, CA

  4. 33. VIEW OF TIOGA ROAD DESCENDING LEE VINING CANYON. SAME ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    33. VIEW OF TIOGA ROAD DESCENDING LEE VINING CANYON. SAME VIEW AS CA-149-3. LOOKING ESE. GIS: N-37 56 58.2 / W-119 13 28.1 - Tioga Road, Between Crane Flat & Tioga Pass, Yosemite Village, Mariposa County, CA

  5. Sequential activation of different pathway networks in ischemia-affected and non-affected myocardium, inducing intrinsic remote conditioning to prevent left ventricular remodeling

    PubMed Central

    Pavo, Noemi; Lukovic, Dominika; Zlabinger, Katrin; Zimba, Abelina; Lorant, David; Goliasch, Georg; Winkler, Johannes; Pils, Dietmar; Auer, Katharina; Jan Ankersmit, Hendrik; Giricz, Zoltán; Baranyai, Tamas; Sárközy, Márta; Jakab, András; Garamvölgyi, Rita; Emmert, Maximilian Y.; Hoerstrup, Simon P.; Hausenloy, Derek J.; Ferdinandy, Péter; Maurer, Gerald; Gyöngyösi, Mariann

    2017-01-01

    We have analyzed the pathway networks of ischemia-affected and remote myocardial areas after repetitive ischemia/reperfusion (r-I/R) injury without ensuing myocardial infarction (MI) to elaborate a spatial- and chronologic model of cardioprotective gene networks to prevent left ventricular (LV) adverse remodeling. Domestic pigs underwent three cycles of 10/10 min r-I/R by percutaneous intracoronary balloon inflation/deflation in the mid left anterior descending artery, without consecutive MI. Sham interventions (n = 8) served as controls. Hearts were explanted at 5 h (n = 6) and 24 h (n = 6), and transcriptomic profiling of the distal (ischemia-affected) and proximal (non-affected) anterior myocardial regions were analyzed by next generation sequencing (NGS) and post-processing with signaling pathway impact and pathway network analyses. In ischemic region, r-I/R induced early activation of Ca-, adipocytokine and insulin signaling pathways with key regulator STAT3, which was also upregulated in the remote areas together with clusterin (CLU) and TNF-alpha. During the late phase of cardioprotection, antigen immunomodulatory pathways were activated with upregulation of STAT1 and CASP3 and downregulation of neprilysin in both zones, suggesting r-I/R induced intrinsic remote conditioning. The temporo-spatially differently activated pathways revealed a global myocardial response, and neprilysin and the STAT family as key regulators of intrinsic remote conditioning for prevention of adverse remodeling. PMID:28266659

  6. Catheter-based high-intensity ultrasound for epicardial ablation of the left ventricle: device design and in vivo feasiblity

    NASA Astrophysics Data System (ADS)

    Salgaonkar, Vasant A.; Nazer, Babak; Jones, Peter D.; Tanaka, Yasuaki; Martin, Alastair; Ng, Bennett; Duggirala, Srikant; Diederich, Chris J.; Gerstenfeld, Edward P.

    2015-03-01

    The development and in vivo testing of a high-intensity ultrasound thermal ablation catheter for epicardial ablation of the left ventricle (LV) is presented. Scar tissue can occur in the mid-myocardial and epicardial space in patients with nonischemic cardiomyopathy and lead to ventricular tachycardia. Current ablation technology uses radiofrequency energy, which is limited epicardially by the presence of coronary vessels, phrenic nerves, and fat. Ultrasound energy can be precisely directed to deliver targeted deep epicardial ablation while sparing intervening epicardial nerve and vessels. The proof-of-concept ultrasound applicators were designed for sub-xyphoid access to the pericardial space through a steerable 14-Fr sheath. The catheter consists of two rectangular planar transducers, for therapy (6.4 MHz) and imaging (5 MHz), mounted at the tip of a 3.5-mm flexible nylon catheter coupled and encapsulated within a custom-shaped balloon for cooling. Thermal lesions were created in the LV in a swine (n = 10) model in vivo. The ultrasound applicator was positioned fluoroscopically. Its orientation and contact with the LV were verified using A-mode imaging and a radio-opaque marker. Ablations employed 60-s exposures at 15 - 30 W (electrical power). Histology indicated thermal coagulation and ablative lesions penetrating 8 - 12 mm into the left ventricle on lateral and anterior walls and along the left anterior descending artery. The transducer design enabled successful sparing from the epicardial surface to 2 - 4 mm of intervening ventricle tissue and epicardial fat. The feasibility of targeted epicardial ablation with catheter-based ultrasound was demonstrated.

  7. Functional characterization of left ventricular segmental responses during the initial 24 h and 1 wk after experimental canine myocardial infarction.

    PubMed Central

    Roan, P; Scales, F; Saffer, S; Buja, L M; Willerson, J T

    1979-01-01

    Characterization of the temporal evolution of resting segmental function and inotropic reserve after coronary occlusion may be important in evaluating attempts to salvage ischemic but non-necrotic myocardium. Accordingly, we chronically implanted up to six pairs of pulse-transit piezoelectric crystals in the left ventricular myocardium of dogs to measure segmental wall thickness. Segments were separated into groups according to the loss of net systolic thickening (NET) at 5 min postocclusion of the left anterior descending coronary artery in awake, unsedated dogs. Group 1 included segments with NET values of 67--100+ (percent control); group 2 between 67 and 0; and group 3 less than 0 (paradoxical motion). 5 min after coronary occlusion, group 1 NET was 92 +/- 5% (SEM) although significant decreases occurred in NET in group 2 (36 +/- 4%) and group 3 segments (-33 +/- 5%). Between 5 min and 24 h after coronary occlusion, no further significant changes occurred in NET in groups 1, 2, and 3 crystals. Some segments underwent further functional deterioration between 24 h and 1 wk after left anterior descending coronary artery occlusion, although no overall change occurred in segments with mild to moderate ischemic dysfunction. Segments with NET less than 0 at 24 h, on the other hand, exhibited a reduction in aneurysmal bulging between 24 h and 1 wk from -41 +/- 10 to -23 +/- 11% (n = 12, P = 0.02). Inotropic reserve was assessed with postextrasystolic potentiation (PESP) in 14 dogs, and with infusions of dopamine (11 dogs), and isoproterenol (13 dogs). PESP was the most potent intervention and produced a significant augmentation in NET in group 2 crystals at 1, 2, 4, 6,8, and 24 h after coronary occlusion but only at 1 and 2 h in NET in group 3 crystals. Thus, following experimental coronary occlusion, the evolution of ischemic segmental dysfunction is dynamic and variable. A significant degree of inotropic reserve, as assessed by PESP, dopamine, and isoproterenol

  8. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  9. Anterior clinoid mucocele presenting with orbital apex syndrome

    PubMed Central

    Wang, Anthony C.; Than, Khoi D.; Ramnath, Suresh; Pandey, Aditya S.

    2013-01-01

    Background: Pneumatized anterior clinoid process is a common anatomic variant. Mucocele formation is a known complication of clinoid drilling during certain intracranial operations; however, mucoceles of pneumatized anterior clinoid processes have been found to spontaneously occur. Case Description: A 44-year-old male presented with complaints of left-sided retro-orbital pain, double vision, and numbness over the upper face and scalp on the left side of 1-week duration. On examination, he was found to develop cranial nerve III, IV, and VI palsies with pupillary sparing, ophthalmic division cranial nerve V dysfunction, and eventually, the onset of vision loss. Conclusions: We report a case of spontaneous anterior clinoid process mucocele presenting with orbital apex syndrome. This was treated successfully with anterior clinoidectomy for decompression. PMID:23772333

  10. Descendants of primed Arabidopsis plants exhibit resistance to biotic stress.

    PubMed

    Slaughter, Ana; Daniel, Xavier; Flors, Victor; Luna, Estrella; Hohn, Barbara; Mauch-Mani, Brigitte

    2012-02-01

    An attack of plants by pathogens or treatment with certain resistance-inducing compounds can lead to the establishment of a unique primed state of defense. Primed plants show enhanced defense reactions upon further challenge with biotic or abiotic stress. Here, we report that the primed state in Arabidopsis (Arabidopsis thaliana) is still functional in the next generation without additional treatment. We compared the reactions of Arabidopsis plants that had been either primed with β-amino-butyric acid (BABA) or with an avirulent isolate of the bacteria Pseudomonas syringae pv tomato (PstavrRpt2). The descendants of primed plants showed a faster and higher accumulation of transcripts of defense-related genes in the salicylic acid signaling pathway and enhanced disease resistance upon challenge inoculation with a virulent isolate of P. syringae. In addition, the progeny of primed plants was also more resistant against the oomycete pathogen Hyaloperonospora arabidopsidis. When transgenerationally primed plants were subjected to an additional priming treatment, their descendants displayed an even stronger primed phenotype, suggesting that plants can inherit a sensitization for the priming phenomenon. Interestingly, this primed to be primed phenotype was much reduced in the Arabidopsis β-amino-butyric acid priming mutant ibs1 (induced BABA sterility1). Our results demonstrate that the primed state of plants is transferred to their progeny and confers improved protection from pathogen attack as compared to the descendants of unprimed plants.

  11. Are left-sided gallbladders really located on the left side?

    PubMed Central

    Nagai, M; Kubota, K; Kawasaki, S; Takayama, T; BandaiY; Makuuchi, M

    1997-01-01

    OBJECTIVE: The aim of this investigation was to establish the association between left-sided gallbladders and right-sided round ligaments. SUMMARY BACKGROUND DATA: The left-sided gallbladder is a rare anomaly and has been classified into two types: 1) gallbladder migration to the left side and 2) development of a second gallbladder with atrophy of the original one. Recently, left-sided gallbladders were reported to be associated with right-sided round ligaments. METHODS: The authors reviewed 3 patients treated in their departments and 15 patients reported in the literature diagnosed as having left-sided gallbladders accompanied by right-sided round ligaments. RESULTS: Although the gallbladders of all 18 patients were located at the normal site, they were diagnosed as being left sided because of the right-sided round ligaments. This anomaly was accompanied by abnormal intrahepatic portal venous branching, which could be classified into two types. In eight patients, the first branch of the portal vein ran to the posterior segment and then the portal vein formed a trunk of the left and right anterior portal veins. The latter portal vein formed the umbilical portion and finally joined the right-sided round ligament (trifurcation type). In five, the portal vein diverged normally to form the left and right portal veins, then the latter branched to form the anterior and posterior segments, and finally the anterior branch joined the round ligament (bifurcation type). In the other five, the branching type could not be determined. CONCLUSIONS: A right-sided round ligament causes a gallbladder at the normal site to be located on the left side. This anomaly should not be diagnosed as a left-sided gallbladder but as a right-sided round ligament. Recognition of this anomaly clinically is important when performing hepatectomy, because it is always associated with abnormal intrahepatic portal venous branching. Images Figure 1. Figure 2. Figure 3. Figure 4. PMID:9060583

  12. [Anterior tarsal tunnel syndrome].

    PubMed

    Miliam, Palle B; Basse, Peter N

    2009-03-30

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum of the ankle. It may be rare because it is underrecognized clinically.We present a case regarding a 29-year-old man, drummer, who for one and a half year experienced clinical symptoms of anterior tarsal tunnel syndrome. A surgical decompression of the anterior tarsal tunnel was performed, and at the check three months later the symptoms where gone. One year after, there were still no symptoms.

  13. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding.

  14. Activity of descending contralateral movement detector neurons and collision avoidance behaviour in response to head-on visual stimuli in locusts.

    PubMed

    Gray, J R; Lee, J K; Robertson, R M

    2001-03-01

    We recorded the activity of the right and left descending contralateral movement detectors responding to 10-cm (small) or 20-cm (large) computer-generated spheres approaching along different trajectories in the locust's frontal field of view. In separate experiments we examined the steering responses of tethered flying locusts to identical stimuli. The descending contralateral movement detectors were more sensitive to variations in target trajectory in the horizontal plane than in the vertical plane. Descending contralateral movement detector activity was related to target trajectory and to target size and was most sensitive to small objects converging on a direct collision course from above and to one side. Small objects failed to induce collision avoidance manoeuvres whereas large objects produced reliable collision avoidance responses. Large targets approaching along a converging trajectory produced steering responses that were either away from or toward the side of approach of the object, whereas targets approaching along trajectories that were offset from the locust's mid-longitudinal body axis primarily evoked responses away from the target. We detected no differences in the discharge properties of the descending contralateral movement detector pair that could account for the different collision avoidance behaviours evoked by varying the target size and trajectories. We suggest that descending contralateral movement detector properties are better suited to predator evasion than collision avoidance.

  15. Anterior Tibial Translation in Collegiate Athletes with Normal Anterior Cruciate Ligament Integrity

    PubMed Central

    Rosene, John M.; Fogarty, Tracey D.

    1999-01-01

    Objective: To examine differences in anterior tibial translation (ATT) among sports, sex, and leg dominance in collegiate athletes with normal anterior cruciate ligament integrity. Design and Setting: Subjects from various athletic teams were measured for ATT in right and left knees. Subjects: Sixty subjects were measured for ATT with a KT-1000 knee arthrometer. Measurements: Statistical analyses were computed for each sex and included a 2 × 3 × 4 mixed-factorial analysis of variance (ANOVA) for anterior cruciate ligament displacement, right and left sides, and force and sport. A 2 × 2 × 3 mixed-factorial ANOVA was computed to compare means for sex and force. A 2 × 3 mixed-factorial ANOVA was computed to compare sex differences across 3 forces. Results: For males and females, no significant interactions were found among leg, force, and sport for mean ATT, for leg and sport or leg and force, or for translation values between dominant and nondominant legs. Males had a significant interaction for force and sport, and a significant difference was found for side of body, since the right side had less translation than the left side. Females had greater ATT than males at all forces. Conclusions: Sex differences exist for ATT, and differences in ATT exist among sports for both sexes. Differences between the right and left sides of the body should be expected when making comparisons of ligamentous laxity. ImagesFigure 2.Figure 3.Figure 5. PMID:16558565

  16. Effect of Final Kissing Balloon Dilatation after One-stent Technique at Left-main Bifurcation: A Single Center Data

    PubMed Central

    Gao, Zhan; Xu, Bo; Yang, Yue-Jin; Qiao, Shu-Bin; Wu, Yong-Jian; Chen, Tao; Xu, Liang; Yuan, Jin-Qing; Chen, Jue; Qin, Xue-Wen; Yao, Min; Liu, Hai-Bo; You, Shi-Jie; Zhao, Ye-Lin; Yan, Hong-Bing; Chen, Ji-Lin; Gao, Run-Lin

    2015-01-01

    Background: Whether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear. Therefore, this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy. Methods: Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n = 230) or no FKB (n = 560) were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR). Results: Overall, The prevalence of true bifurcation lesions, which included Medina classification (1,1,1), (1,0,1), or (0,1,1), was similar between-groups (non-FKB: 37.0% vs. FKB: 39.6%, P = 0.49). At mean 4 years follow-up, rates of major adverse cardiovascular events (non-FKB: 10.0% vs. FKB: 7.8%, P = 0.33), death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes. Conclusions: For patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy. PMID:25758264

  17. The effect of systematic set-up deviations on the absorbed dose distribution for left-sided breast cancer treated with respiratory gating

    NASA Astrophysics Data System (ADS)

    Edvardsson, A.; Ceberg, S.

    2013-06-01

    The aim of this study was 1) to investigate interfraction set-up uncertainties for patients treated with respiratory gating for left-sided breast cancer, 2) to investigate the effect of the inter-fraction set-up on the absorbed dose-distribution for the target and organs at risk (OARs) and 3) optimize the set-up correction strategy. By acquiring multiple set-up images the systematic set-up deviation was evaluated. The effect of the systematic set-up deviation on the absorbed dose distribution was evaluated by 1) simulation in the treatment planning system and 2) measurements with a biplanar diode array. The set-up deviations could be decreased using a no action level correction strategy. Not using the clinically implemented adaptive maximum likelihood factor for the gating patients resulted in better set-up. When the uncorrected set-up deviations were simulated the average mean absorbed dose was increased from 1.38 to 2.21 Gy for the heart, 4.17 to 8.86 Gy to the left anterior descending coronary artery and 5.80 to 7.64 Gy to the left lung. Respiratory gating can induce systematic set-up deviations which would result in increased mean absorbed dose to the OARs if not corrected for and should therefore be corrected for by an appropriate correction strategy.

  18. Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease.

    PubMed

    Panchal, Anita H; Patel, Vasumati G; Bhavsar, Neeta V; Mehta, Hardik V

    2013-05-01

    This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

  19. Descending motor pathways and the spinal motor system - Limbic and non-limbic components

    NASA Technical Reports Server (NTRS)

    Holstege, Gert

    1991-01-01

    Research on descending motor pathways to caudal brainstem and spinal cord in the spinal motor system is reviewed. Particular attention is given to somatic and autonomic motoneurons in the spinal cord and brainstem, local projections to motoneurons, bulbospinal interneurons projecting to motoneurons, descending pathways of somatic motor control systems, and descending pathways involved in limbic motor control systems.

  20. Hypoplastic left heart syndrome

    MedlinePlus

    HLHS; Congenital heart - hypoplastic left heart; Cyanotic heart disease - hypoplastic left heart ... Hypoplastic left heart is a rare type of congenital heart disease. It is more common in males than in females. As ...

  1. Creatine kinase kinetics and myocardial infarction in different regions of the left ventricle.

    PubMed

    Sochman, J; Fabián, J; Málek, I; Belán, A; Englis, M

    1989-01-01

    The interval from the onset of infarction pain to culmination of plasma creatine kinase activity (t-peak) was measured in 68 patients with their first myocardial infarction. There is a major difference in this parameter in patients with infarction in the area of the right coronary artery and that supplied by the left anterior descending coronary artery (LAD). While, in 29 patients with infarction in the right coronary artery area, t-peak was 17.7 +/- 4.7 hours, in 39 subjects with infarction in area supplied by the LAD, t-peak was 13.2 +/- 4.6 hours (p less than 0.001). The type of thrombolytic treatment (intravenous or intracoronary, used no difference, just as the time from onset of pain to start of therapy, infarct size and presence or absence of collaterals. A detailed analysis of creatine kinase culmination in relation to the type of artery recanalization is given. The authors conclude that, besides the known factors, creatine kinase culmination is influenced also by the necrosis site, a fact somewhat modifying the informative value of this parameter. However, explanations of this phenomenon are only hypothetical at the present time.

  2. Differential effects of (-)-baclofen on Ia and descending monosynaptic EPSPs.

    PubMed

    Jiménez, I; Rudomin, P; Enriquez, M

    1991-01-01

    1. In cats anesthetized with alpha-chloralose, population synaptic responses of motoneurons produced by stimulation of group I afferents were recorded from ventral roots with a sucrose gap or extracellularly from the motor pool. These responses were depressed, and often abolished, following the intravenous injection of 1-3 mg/kg of (-)-baclofen, a presumed GABAb agonist. 2. The monosynaptic population responses of motoneurons produced by stimulation of the ipsilateral ventromedial funiculus (VMF), the bulbar reticular formation or the vestibular nucleus, were also depressed following the administration of (-)-baclofen, but to a lesser degree than responses produced by stimulation of group I fibers. 3. Depression of the synaptic actions of Ia and of descending fibers following the administration of (-)-baclofen occurred without significant changes in the presynaptic volley recorded from the cord dorsum. However, in 3/4 experiments the intraspinally recorded Ia terminal potential was reduced following the injection of (-)-baclofen. The VMF terminal potentials were also depressed, but to a lesser degree. 4. Intracellular recordings from spinal motoneurons indicate that the (-)-baclofen-induced depression of the monosynaptic Ia- and VMF-EPSPs occurred without important changes in the time course of EPSP decay. This suggests that with the amounts used, postsynaptic changes were not contributing significantly to the EPSP depression. 5. It is suggested that (-)-baclofen depresses synaptic transmission probably by activation of GABAb receptors located at the intraspinal terminations of Ia and descending fibers. The lower sensitivity of VMF actions to (-)-baclofen would be accounted for by a relatively low density of baclofen receptors in descending fiber terminals.

  3. Flight dynamics of a spinning projectile descending on a parachute

    SciTech Connect

    Benedetti, G.A.

    1989-02-01

    During the past twenty years Sandia National Laboratories and the US Army have vertically gun launched numerous 155mm and eight-inch diameter flight test projectiles. These projectiles are subsequently recovered using an on-board parachute recovery system which is attached to the forward case structure of the projectile. There have been at least five attempts to describe, through analytical and numerical simulations, the translational and rotational motions of a spinning projectile descending on a parachute. However, none of these investigations have correctly described the large nutational motion of the projectile since all of them overlooked the fundamental mechanism which causes these angular motions. Numerical simulations as well as a closed form analytical solution show conclusively that the Magnus moment is responsible for the large nutational motion of the projectile. That is, when the center of pressure for the Magnus force is aft of the center of mass for the projectile, the Magnus moment causes an unstable (or large) nutational motion which always tends to turn the spinning projectile upside down while it is descending on the parachute. Conversely, when the center of mass for the projectile is aft of the center of pressure for the Magnus force, the Magnus moment stabilizes the nutational motion tending to always point the base of the spinning projectile down. The results of this work are utilized to render projectile parachute recovery systems more reliable and to explain what initially may appear to be strange gyrodynamic behavior of a spinning projectile descending on a parachute. 14 refs., 20 figs.

  4. The Impact of the Organism on Its Descendants

    PubMed Central

    Bateson, Patrick

    2012-01-01

    Historically, evolutionary biologists have taken the view that an understanding of development is irrelevant to theories of evolution. However, the integration of several disciplines in recent years suggests that this position is wrong. The capacity of the organism to adapt to challenges from the environment can set up conditions that affect the subsequent evolution of its descendants. Moreover, molecular events arising from epigenetic processes can be transmitted from one generation to the next and influence genetic mutation. This in turn can facilitate evolution in the conditions in which epigenetic change was first initiated. PMID:22567396

  5. Aneurysm of the Left Atrial Appendage

    PubMed Central

    Victor, Solomon; Nayak, Vijaya M.

    2001-01-01

    A 43-year-old woman underwent excision of an aneurysm of the left atrial appendage, which had been causing cerebrovascular embolic episodes. We attribute the aneurysm to congenital dysplasia of the musculi pectinati in the left atrial appendage and of the bands of atrial muscle from which they arise. In Appendix I, we draw attention to the morphologically similar arrangements of inner and outer bands that emanate from a common transverse interatrial band and yield morphologically similar medial, descending, and ascending palm-leaf arrangements of musculi pectinati. In addition, we observe that the strap-like arrangements of musculi in both atria connect the outer band with the para-annular segment of the inner band. In Appendix II, we briefly review the literature concerning musculi pectinati and related bands. PMID:11453121

  6. A Case of Large Anterior Paraclinoid Aneurysm with Intraoperative Premature Rupture

    PubMed Central

    Ichimura, Shinya; Inaba, Makoto; Kagami, Hiroshi

    2012-01-01

    We report here troubleshooting of intraoperative premature rupture with large anterior paraclinoid aneurysm, which was successfully clipped. A 61-year-old woman with left nasal hemianopia was referred to our institute. Preoperative three-dimensional computed tomography angiography and a left internal carotid artery angiogram showed a large left anterior clinoid aneurysm adjacent to the anterior clinoid process. Aneurysm was ruptured prematurely and tentative clipping of the dome of the aneurysm was done incidentally to stop bleeding and to reduce the volume of the aneurysm. The anterior clinoid process and superior wall of the orbit were drilled out safely, since the tentative clipping had created sufficient space between the aneurysm and the anterior clinoid process to perform the procedure. The proximal neck was observed and tandem clipping was applied to the aneurysm. Intraoperative and postoperative angiography revealed complete disappearance of the aneurysm. PMID:23946926

  7. A case of large anterior paraclinoid aneurysm with intraoperative premature rupture.

    PubMed

    Ichimura, Shinya; Inaba, Makoto; Kagami, Hiroshi

    2012-10-01

    We report here troubleshooting of intraoperative premature rupture with large anterior paraclinoid aneurysm, which was successfully clipped. A 61-year-old woman with left nasal hemianopia was referred to our institute. Preoperative three-dimensional computed tomography angiography and a left internal carotid artery angiogram showed a large left anterior clinoid aneurysm adjacent to the anterior clinoid process. Aneurysm was ruptured prematurely and tentative clipping of the dome of the aneurysm was done incidentally to stop bleeding and to reduce the volume of the aneurysm. The anterior clinoid process and superior wall of the orbit were drilled out safely, since the tentative clipping had created sufficient space between the aneurysm and the anterior clinoid process to perform the procedure. The proximal neck was observed and tandem clipping was applied to the aneurysm. Intraoperative and postoperative angiography revealed complete disappearance of the aneurysm.

  8. LEG'S COMPARTMENT SYNDROME AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT: CASE REPORT.

    PubMed

    Filho, Jorge Sayum; Ramos, Leonardo Adeo; Sayum, Jorge; de Carvalho, Rogério Teixeira; Ejnisman, Benno; Matsuda, Marcelo Mitsuro; Nicolini, Alexandre; Cohen, Moisés

    2011-01-01

    The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome.

  9. LEG'S COMPARTMENT SYNDROME AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT: CASE REPORT

    PubMed Central

    Filho, Jorge Sayum; Ramos, Leonardo Adeo; Sayum, Jorge; de Carvalho, Rogério Teixeira; Ejnisman, Benno; Matsuda, Marcelo Mitsuro; Nicolini, Alexandre; Cohen, Moisés

    2015-01-01

    The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome. PMID:27047834

  10. A comparative analysis of 3D conformal deep inspiratory-breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer.

    PubMed

    Reardon, Kelli A; Read, Paul W; Morris, Monica M; Reardon, Michael A; Geesey, Constance; Wijesooriya, Krishni

    2013-01-01

    Patients undergoing radiation for left-sided breast cancer have increased rates of coronary artery disease. Free-breathing intensity-modulated radiation therapy (FB-IMRT) and 3-dimensional conformal deep inspiratory-breath hold (3D-DIBH) reduce cardiac irradiation. The purpose of this study is to compare the dose to organs at risk in FB-IMRT vs 3D-DIBH for patients with left-sided breast cancer. Ten patients with left-sided breast cancer had 2 computed tomography scans: free breathing and voluntary DIBH. Optimization of the IMRT plan was performed on the free-breathing scan using 6 noncoplanar tangential beams. The 3D-DIBH plan was optimized on the DIBH scan and used standard tangents. Mean volumes of the heart, the left anterior descending coronary artery (LAD), the total lung, and the right breast receiving 5% to 95% (5% increments) of the prescription dose were calculated. Mean volumes of the heart and the LAD were lower (p<0.05) in 3D-DIBH for volumes receiving 5% to 80% of the prescription dose for the heart and 5% for the LAD. Mean dose to the LAD and heart were lower in 3D-DIBH (p≤0.01). Mean volumes of the total lung were lower in FB-IMRT for dose levels 20% to 75% (p<0.05), but mean dose was not different. Mean volumes of the right breast were not different for any dose; however, mean dose was lower for 3D-DIBH (p = 0.04). 3D-DIBH is an alternative approach to FB-IMRT that provides a clinically equivalent treatment for patients with left-sided breast cancer while sparing organs at risk with increased ease of implementation.

  11. A comparative analysis of 3D conformal deep inspiratory–breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer

    SciTech Connect

    Reardon, Kelli A.; Read, Paul W.; Morris, Monica M.; Reardon, Michael A.; Geesey, Constance; Wijesooriya, Krishni

    2013-07-01

    Patients undergoing radiation for left-sided breast cancer have increased rates of coronary artery disease. Free-breathing intensity-modulated radiation therapy (FB-IMRT) and 3-dimensional conformal deep inspiratory–breath hold (3D-DIBH) reduce cardiac irradiation. The purpose of this study is to compare the dose to organs at risk in FB-IMRT vs 3D-DIBH for patients with left-sided breast cancer. Ten patients with left-sided breast cancer had 2 computed tomography scans: free breathing and voluntary DIBH. Optimization of the IMRT plan was performed on the free-breathing scan using 6 noncoplanar tangential beams. The 3D-DIBH plan was optimized on the DIBH scan and used standard tangents. Mean volumes of the heart, the left anterior descending coronary artery (LAD), the total lung, and the right breast receiving 5% to 95% (5% increments) of the prescription dose were calculated. Mean volumes of the heart and the LAD were lower (p<0.05) in 3D-DIBH for volumes receiving 5% to 80% of the prescription dose for the heart and 5% for the LAD. Mean dose to the LAD and heart were lower in 3D-DIBH (p≤0.01). Mean volumes of the total lung were lower in FB-IMRT for dose levels 20% to 75% (p<0.05), but mean dose was not different. Mean volumes of the right breast were not different for any dose; however, mean dose was lower for 3D-DIBH (p = 0.04). 3D-DIBH is an alternative approach to FB-IMRT that provides a clinically equivalent treatment for patients with left-sided breast cancer while sparing organs at risk with increased ease of implementation.

  12. Anterior orbital varix presenting as a lacrimal sac mucocele.

    PubMed

    Nasr, A M; Huaman, A M

    1998-05-01

    A 35-year-old woman was referred to the Oculoplastics Clinic because of a left nasal swelling and intermittent tearing of 1 year's duration. The clinical examination and echographic and radiologic findings were consistent with an anterior venous anomaly. Complete surgical excision was performed and histopathology confirmed the diagnosis of a varix.

  13. Diacerein Improves Left Ventricular Remodeling and Cardiac Function by Reducing the Inflammatory Response after Myocardial Infarction

    PubMed Central

    Torina, Anali Galluce; Reichert, Karla; Lima, Fany; de Souza Vilarinho, Karlos Alexandre; de Oliveira, Pedro Paulo Martins; do Carmo, Helison Rafael Pereira; de Carvalho, Daniela Diógenes; Saad, Mário José Abdalla; Sposito, Andrei Carvalho; Petrucci, Orlando

    2015-01-01

    Background The inflammatory response has been implicated in the pathogenesis of left ventricular (LV) remodeling after myocardial infarction (MI). An anthraquinone compound with anti-inflammatory properties, diacerein inhibits the synthesis and activity of pro-inflammatory cytokines, such as tumor necrosis factor and interleukins 1 and 6. The purpose of this study was to investigate the effects of diacerein on ventricular remodeling in vivo. Methods and Results Ligation of the left anterior descending artery was used to induce MI in an experimental rat model. Rats were divided into two groups: a control group that received saline solution (n = 16) and a group that received diacerein (80 mg/kg) daily (n = 10). After 4 weeks, the LV volume, cellular signaling, caspase 3 activity, and nuclear factor kappa B (NF-κB) transcription were compared between the two groups. After 4 weeks, end-diastolic and end-systolic LV volumes were reduced in the treatment group compared to the control group (p < .01 and p < .01, respectively). Compared to control rats, diacerein-treated rats exhibited less fibrosis in the LV (14.65%± 7.27% vs. 22.57%± 8.94%; p < .01), lower levels of caspase-3 activity, and lower levels of NF-κB p65 transcription. Conclusions Treatment with diacerein once a day for 4 weeks after MI improved ventricular remodeling by promoting lower end-systolic and end-diastolic LV volumes. Diacerein also reduced fibrosis in the LV. These effects might be associated with partial blockage of the NF-κB pathway. PMID:25816098

  14. Effect of drive mode of left ventricular assist device on the left ventricular mechanics.

    PubMed

    Nakamura, T; Hayashi, K; Seki, J; Nakatani, T; Noda, H; Takano, H; Akutsu, T

    1988-02-01

    Pneumatically driven left ventricular assist devices (LVADs) were acutely implanted between the left atria and the descending aortas of dogs, and were driven in five pumping modes: electrocardiogram synchronous modes with the duty factors of 1:1, 2:1, and 4:1, and asynchronous modes with the pulse rates of 60 and 80 beats/min (bpm). The ventricular diameter and myocardial segment length were measured by an ultrasonic displacement meter and implantable miniature sensors. Bulk mechanical work of the left ventricle and regional mechanical work of the myocardium were calculated from these dimensions and the left ventricular pressure. LVAD reduced the bulk mechanical work of the left ventricle by 30-50% and the regional work by 30-60%. The mean aortic pressure and the total flow (= aortic flow + pump bypass flow) were highest in the 1:1 synchronous pumping mode, which indicates that this mode is most effective to maintain the systemic circulation and coronary blood flow. Asynchronous pumping and synchronous pumping with 2:1 duty factor were most useful to reduce the mechanical work of the left ventricle.

  15. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    PubMed

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES.

  16. Effect expectancies for cocaine intoxication: initial vs. descendent phases.

    PubMed

    Schafer, J; Fals-Stewart, W

    1993-01-01

    This study examined the association between proximal vs. distal effect expectancies for cocaine consumption in a college student population with (N = 26) and without (N = 69) cocaine experience. Participants completed the Cocaine Effect Expectancy Questionnaire-Likert (CEEQL) and were asked to respond to each item twice: first, their belief about that specific effect during the initial phase of cocaine intoxication; and second, in relation to their belief about that effect during the descendent period. Positive and negative scales were scored for each subject. Positive expectancies were not associated between the two time points, while negative expectancies were. Users reported significantly less negative expected effects of cocaine, while nonusers and users held similar beliefs about the positive effects of cocaine. This latter effect was replicated in an independent sample (N = 140).

  17. [Foods native to indigenous and afro-descendents in Colombia].

    PubMed

    Rivas Abadía, Ximena; Carolina Pazos, Sonia; Castillo Castillo, Silvana Katerin; Pachón, Helena

    2010-09-01

    For social programs in Colombia, like those administered by the Instituto Colombiano de Bienestar Familiar (ICBF), it's important to know what native foods minority groups consume. This research obtained information on native foods consumed by indigenous and afro-descendents living in 10 Colombian departments: Cauca, Nariño, Amazonas, Chocó, Guainia, Vichada, Magdalena, Guajira, Cesar y Vaupés. A questionnaire was applied to key informants (individually or in groups), addressing the following topics: personal information on the informant, name and type of food, if consumed by indigenous and/or afro-Colombians, climate where produced, time of year when harvested, if consumed raw or cooked, preparations, properties ascribed to the food, and current production, use and availability. Key informants included participants in ICBF's programs, indigenous authorities, teachers, traditional healers, and others, under the supervision of professionals from ICBF's mobile unit in each department. Bibliography (n = 123 documents) was compiled and reviewed. In the departments selected, 13 municipalities were visited, 139 individuals were interviewed and at least 92 new foods (i.e., not currently included in the Colombian Food Composition Table) were identified. Among the 92, the scientific name was obtained for 62 foods. Of these, 2 were classified as other, 18 as meats, 3 as insects, and 39 as plants. Among the plants, informants mentioned fruit (n=29), leaves (n=4), seed (n=3) and roots (n=3). Indigenous and afro-descendent communities in Colombia report consuming dozens of foods that are not currently in the Colombian Food Composition Table.

  18. Organization of the Anterior Limb of the Internal Capsule in the Rat.

    PubMed

    Coizet, Veronique; Heilbronner, Sarah R; Carcenac, Carole; Mailly, Philippe; Lehman, Julia F; Savasta, Marc; David, Oivier; Deniau, Jean-Michel; Groenewegen, Henk J; Haber, Suzanne N

    2017-03-08

    Dysfunction of the orbitofrontal (OFC) and anterior cingulate (ACC) cortices has been linked with several psychiatric disorders, including obsessive-compulsive disorder, major depressive disorder, posttraumatic stress disorder, and addiction. These conditions are also associated with abnormalities in the anterior limb of the internal capsule, the white matter (WM) bundle carrying ascending and descending fibers from the OFC and ACC. Furthermore, deep-brain stimulation (DBS) for psychiatric disorders targets these fibers. Experiments in rats provide essential information on the mechanisms of normal and abnormal brain anatomy, including WM composition and perturbations. However, whereas descending prefrontal cortex (PFC) fibers in primates form a well defined and topographic anterior limb of the internal capsule, the specific locations and organization of these fibers in rats is unknown. We address this gap by analyzing descending fibers from injections of an anterograde tracer in the rat ACC and OFC. Our results show that the descending PFC fibers in the rat form WM fascicles embedded within the striatum. These bundles are arranged topographically and contain projections, not only to the striatum, but also to the thalamus and brainstem. They can therefore be viewed as the rat homolog of the primate anterior limb of the internal capsule. Furthermore, mapping these projections allows us to identify the fibers likely to be affected by experimental manipulations of the striatum and the anterior limb of the internal capsule. These results are therefore essential for translating abnormalities of human WM and effects of DBS to rodent models.SIGNIFICANCE STATEMENT Psychiatric diseases are linked to abnormalities in specific white matter (WM) pathways, and the efficacy of deep-brain stimulation relies upon activation of WM. Experiments in rodents are necessary for studying the mechanisms of brain function. However, the translation of results between primates and rodents is

  19. Natural IgM Blockade Limits Infarct Expansion and Left Ventricular Dysfunction in a Swine Myocardial Infarct Model

    PubMed Central

    Sihag, Smita; Haas, Michael S.; Kim, Karen M.; Guerrero, J. Luis; Beaudoin, Jonathan; Alicot, Elisabeth M.; Schuerpf, Franziska; Gottschall, James D.; Puro, Robyn J.; Madsen, Joren C.; Sachs, David H.; Newman, Walter; Carroll, Michael C.; Allan, James S.

    2015-01-01

    Background Acute coronary syndrome is the leading cause of mortality worldwide. However, treatment of acute coronary occlusion inevitably results in ischemia-reperfusion (I/R) injury. Circulating natural IgM has been shown to play a significant role in mouse models of I/R injury. A highly conserved self-antigen, non-muscle myosin heavy chain II (NMHC-II), has been identified as a target of pathogenic IgM. We hypothesized that a monoclonal antibody (m21G6) directed against NMHC-II may inhibit IgM binding and reduce injury in a pre-clinical model of myocardial infarction (MI). Thus, our objective was to evaluate the efficacy of intravenous m21G6 treatment in limiting infarct expansion, troponin release, and left ventricular dysfunction in a swine MI model. Methods and Results MGH miniature swine underwent occlusion of the mid left anterior descending coronary artery for 60min, followed by 1h, 5d, or 21d reperfusion. Specificity and localization of m21G6 to injured myocardium were confirmed using fluorescently labeled m21G6. Treatment with m21G6 prior to reperfusion resulted in a 49% reduction in infarct size (p<0.005) and a 61% reduction in troponin-T levels (p<0.05) in comparison to saline controls at 5d reperfusion. Furthermore, m21G6 treated animals recovered 85.4% of their baseline left ventricular function as measured by two-dimensional transthoracic echocardiography (2D TTE) in contrast to 67.1% in controls at 21d reperfusion (p<0.05). Conclusions Treatment with m21G6 significantly reduced infarct size and troponin-T release, and led to marked preservation of cardiac function in our study. Overall, these findings suggest that pathogenic IgM blockade represents a valid therapeutic strategy in mitigating myocardial I/R injury. PMID:26671971

  20. AN UNUSUAL ECHOCARDIOGRAPHIC PATTERN OF A LEFT ATRIAL MYXOMA

    PubMed Central

    Mathurin, Jean-Robert; Adyanthaya, Ajit V.; Petrovich, Lawrence J.; Franco, Mauricio; Mattox, Kenneth L.; Alexander, James K.

    1977-01-01

    Unusual echocardiographic findings in a 58-year-old woman with a history of rheumatic fever and an angiographically demonstrated prolapsing left atrial myxoma are presented. With variations of gain and damping controls, it was possible to isolate a more distinct anterior mitral leaflet echo, or a more posterior linear echo, thought to represent the prolapsing tumor. The tumor, instead of presenting as a cloud of echoes behind the anterior mitral valve leaflet, demonstrated an alternate pattern of a single linear dense echo at this location. Echocardiography, though very useful in the diagnosis of left atrial tumors, can be fallible at times. Images PMID:15216092

  1. Two-Port Laparoscopic Descending Colostomy with Separated Stomas for Anorectal Malformations in Newborns.

    PubMed

    Gine, Carlos; Santiago, Saioa; Lara, Alba; Laín, Ana; Lane, Victoria Alison; Wood, Richard J; Levitt, Marc

    2016-10-01

    Introduction We describe a two-port laparoscopic technique to create a colostomy in the descending colon with separated stomas for newborns with anorectal malformations. Material and Methods Six patients with an anorectal malformation underwent this procedure in the early-neonatal period. The surgical technique was performed with two ports, which allows for an accurate inspection of the abdominal contents. The first loop of the sigmoid colon is grasped through the first port and exteriorized while the attachments to the left retroperitoneum and direction of the loop are checked with the scope introduced in the second port. The division of the colon is performed extracorporally, the colon irrigated of meconium, and the distal colon moved to the second port incision. Both stomas are then fixed to the abdominal wall. Results The time of the procedure ranged from 50 to 90 minutes. A Mullerian duplication was noted in one case. Oral intake was started during the first 12 to 24 hours. No complications were seen during or after the procedure. Conclusions This technique allows for the precise localization of the colostomy with direct visualization, provides for the inspection of the internal genitalia, eliminates the incision between the two stomas and its complications, allows for painless stoma bag changes immediately after surgery, avoids twisting of the colostomy, and permits a cosmetically pleasing incision at the colostomy closure.

  2. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  3. Anterior tarsal tunnel syndrome.

    PubMed

    DiDomenico, Lawrence A; Masternick, Eric B

    2006-07-01

    Compression of the deep peroneal nerve is commonly referred to as anterior tarsal tunnel syndrome. Although rare, this syndrome remains poorly diagnosed. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. Non-operative measures should be attempted to reduce or remove the external compression along the anterior aspect of the foot and ankle. Other options include shoe modifications, cortisone injections,and physical therapy. If conservative management fails to relieve the symptoms, surgical decompression of the entrapped nerve can be performed. The deep peroneal nerve is released from compressive forces in the entrapment site. This can be performed at the more proximal level at the extensor retinaculum or more distally at the level of the tarsal metatarsal site.

  4. [Anterior pseudodiverticulum after laryngectomy].

    PubMed

    Pitzer, G; Oursin, C; Wolfensberger, M

    1998-01-01

    An anterior neopharyngeal pseudodiverticulum is a mucosal pouch located between the tongue and hypopharynx due to an epiglottis-like posterior tissue band that forms after total laryngectomy. This condition has rarely been mentioned in literature. Incidence, symptoms, treatment, and possible etiologic factors were examined. Twenty post-laryngectomy patients were questioned about swallowing disorders and were examined clinically and by barium swallow. Eleven patients were found to have a pseudodiverticulum, of which 9 patients suffered from dysphagia. We found no correlation between the formation of a pseudodiverticulum and radiotherapy or post-laryngectomy complications. All symptomatic patients were treated by dissecting the posterior tissue band endoscopically with a CO2-laser, bringing complete relief of symptoms in 8 of 9 patients. Our study showed that the anterior pseudodiverticulum can be a frequent cause of dysphagia after laryngectomy. It can easily be diagnosed clinically and radiologically. Endoscopic treatment with a CO2-laser is simple and effective.

  5. Inheriting discontinued bonds: trauma-descendant relations with the genocide dead.

    PubMed

    Kidron, Carol A

    2014-01-01

    Despite the scholarship on continuing bonds with the dead and the critique of pathologizing paradigms in trauma theory, little is known of the engagement between trauma descendants and relatives who perished prior to their birth. A sample of 55 Holocaust descendants was recruited in Israel to participate in semistructured ethnographic interviews. Descendants reported on the normalized presence of and engagement with the dead and the restoration of previously "discontinued" bonds. Findings were consistent with the scholarship on the therapeutic role of continuing bonds and with meta-analyses normalizing descendant psychosocial legacies. Jewish-Israeli paradigms of memory facilitated therapeutic bonds with the dead.

  6. Left ventricular bronchogenic cyst.

    PubMed

    Wei, Xiang; Omo, Alfred; Pan, Tiecheng; Li, Jun; Liu, Ligang; Hu, Min

    2006-04-01

    Bronchogenic cysts occurring in the left ventricle are a medical rarity. One successfully operated case is reported herein. The location of the cyst was just between the epicardium and myocardium of the inferior left ventricular wall, adjacent to the apex of the heart. Complete excision was achieved through a left anterolateral thoracotomy without extracorporeal circulation.

  7. Descending projections of the hamster intergeniculate leaflet: relationship to the sleep/arousal and visuomotor systems

    NASA Technical Reports Server (NTRS)

    Morin, Lawrence P.; Blanchard, Jane H.

    2005-01-01

    The intergeniculate leaflet (IGL), homolog of the primate pregeniculate nucleus, modulates circadian rhythms. However, its extensive anatomical connections suggest that it may regulate other systems, particularly those for visuomotor function and sleep/arousal. Here, descending IGL-efferent pathways are identified with the anterograde tracer, Phaseolus vulgaris leucoagglutinin, with projections to over 50 brain stem nuclei. Projections of the ventral lateral geniculate are similar, but more limited. Many of the nuclei with IGL afferents contribute to circuitry governing visuomotor function. These include the oculomotor, trochlear, anterior pretectal, Edinger-Westphal, and the terminal nuclei; all layers of the superior colliculus, interstitial nucleus of the medial longitudinal fasciculus, supraoculomotor periaqueductal gray, nucleus of the optic tract, the inferior olive, and raphe interpositus. Other target nuclei are known to be involved in the regulation of sleep, including the lateral dorsal and pedunculopontine tegmentum. The dorsal raphe also receives projections from the IGL and may contribute to both sleep/arousal and visuomotor function. However, the locus coeruleus and medial vestibular nucleus, which contribute to sleep and eye movement regulation and which send projections to the IGL, do not receive reciprocal projections from it. The potential involvement of the IGL with the sleep/arousal system is further buttressed by existing evidence showing IGL-efferent projections to the ventrolateral preoptic area, dorsomedial, and medial tuberal hypothalamus. In addition, the great majority of all regions receiving IGL projections also receive input from the orexin/hypocretin system, suggesting that this system contributes not only to the regulation of sleep, but to eye movement control as well.

  8. Effect of shoe type on descending a curb.

    PubMed

    George, Juff; Heller, Michelle; Kuzel, Michael

    2012-01-01

    The aim of this study was to evaluate the effect of shoe type on the performance of women during curb descent. Performance during curb stepping may be explained by biomechanical research that has evaluated the kinematics of overground walking and stair ascent and descent. Studies have reported that women exhibit performance differences when wearing high heels, flip flops and sneakers during overground walking and stair ascent and descent. Thus, in addition to features of the curb, the type of shoe being worn may also affect performance. Although several studies have investigated curb stepping, no known studies have investigated the effects of different types of footwear on curb descent performance. This research was conducted in a real-world environment where participants wore three different types of shoes and performed a series of activities that involved curb stepping. The subjects were videotaped while descending a curb, allowing for observation of changes in gait parameters. Results of this study indicate that wearing high heels leads to performance differences as compared to wearing flip flops or sneakers.

  9. FBN1 Mutations in Patients With Descending Thoracic Aortic Dissections

    PubMed Central

    Brautbar, Ariel; LeMaire, Scott A.; Franco, Luis M.; Coselli, Joseph S.; Milewicz, Dianna M.; Belmont, John W.

    2013-01-01

    Aortic aneurysm and dissection cause significant morbidity and mortality. There are several known single gene disorders that predispose to isolated aortic disease and eventually aneurysm and dissection. FBN1 mutations are associated with multiple clinical phenotypes, including Marfan syndrome (MFS), MASS phenotype, and familial ectopia lentis, but rarely with isolated aortic aneurysm and dissection. In this report, we describe three patients who presented with primary descending thoracic aortic dissection and who were found to have an FBN1 mutation. None of the patients fulfilled clinical criteria for the diagnosis of MFS, and all had few or none of the skeletal features typical of the condition. Two patients had a history of long-term hypertension, and such a history was suspected in the third patient. These observations suggest that some individuals with FBN1 mutations have significant aortic disease involvement of other systems that is typical of FBN1 mutation-related syndromes. Superimposed risk factors, such as hypertension, may weaken the aortic wall and eventually lead to aortic dissection. Given that the cost continues to decrease, we suggest that diagnostic DNA sequencing for FBN1 mutations in patients with thoracic aortic aneurysms and dissection may be a practical clinical step in evaluating such patients and at-risk family members. PMID:20082464

  10. Descending vasa recta endothelial cells and pericytes form mural syncytia

    PubMed Central

    Zhang, Zhong; Lin, Hai; Cao, Chunhua; Payne, Kristie

    2013-01-01

    Using patch clamp, we induced depolarization of descending vasa recta (DVR) pericytes or endothelia and tested whether it was conducted to distant cells. Membrane potential was measured with the fluorescent voltage dye di-8-ANEPPS or with a second patch-clamp electrode. Depolarization of an endothelial cell induced responses in other endothelia within a millisecond and was slowed by gap junction blockade with heptanol. Endothelial response to pericyte depolarization was poor, implying high-resistance myo-endothelial coupling. In contrast, dual patch clamp of neighboring pericytes revealed syncytial coupling. At high sampling rate, the spread of depolarization between pericytes and endothelia occurred in 9 ± 2 or 12 ± 2 μs, respectively. Heptanol (2 mM) increased the overall input resistance of the pericyte layer to current flow and prevented transmission of depolarization between neighboring cells. The fluorescent tracer Lucifer yellow (LY), when introduced through ruptured patches, spread between neighboring endothelia in 1 to 7 s, depending on location of the flanking cell. LY diffused to endothelial cells on the ipsilateral but not contralateral side of the DVR wall and minimally between pericytes. We conclude that both DVR pericytes and endothelia are part of individual syncytia. The rate of conduction of membrane potential exceeds that for diffusion of hydrophilic molecules by orders of magnitude. Gap junction coupling of adjacent endothelial cells may be spatially oriented to favor longitudinal transmission along the DVR axis. PMID:24381184

  11. Experimenter's data package for the descending layers rocket

    NASA Technical Reports Server (NTRS)

    Earle, Greg; Herrero, Fred; Foster, John; Buonsanto, Mike; Satya-Narayana, P.

    1992-01-01

    In response to a proposal from Science Applications International Corporation (SAIC), NASA Headquarters has approved a sounding rocket mission designed to study the physics of intermediate layers in the Earth's ionosphere at middle latitudes. The experiment will be carried out by a team of scientists and engineers from the NASA Wallops Flight Facility, SAIC, the NASA Goddard Space Flight Center, and the Millstone Hill radar observatory. The mission will involve the launch of an instrumented sounding rocket from the Wallops Island rocket range in the summer of 1994, with the objective of penetrating a descending ionized layer in the E-region between altitudes of 115 and 140 km. Instrumentation aboard the rocket will measure the ion and neutral composition of the layer, its plasma density, driving wind and electric field forces, the thermal ion distribution function, and electron temperature. Depending on payload weight constraints and subject to availability, a particle detector to measure energetic ion and/or electron fluxes near the layer may also be included. This document was prepared as a reference for the NASA payload development and experiment teams, for distribution at the Project Initiation Conference (PIC). The design specifications discussed herein are therefore of a preliminary nature; the intent is to promote open discussions between experimenters and NASA engineers that will lead to a final design capable of achieving the experiment objectives.

  12. Descending lithosphere slab beneath the Northwest Dinarides from teleseismic tomography

    NASA Astrophysics Data System (ADS)

    Šumanovac, Franjo; Dudjak, Darko

    2016-12-01

    The area of study covers the marginal zone between the Adriatic microplate (African plate) and the Pannonian segment (Eurasian plate). We present a tomography model for this area, with special emphasis on the northwest Dinarides. A dense distribution of temporary seismic stations in the area of the Northern Dinarides along with permanent seismic stations located in the area, allowed us to construct this P-wave tomographic model. We assembled our travel-time dataset based on 26 seismic stations were used to collect the dataset. Teleseismic events were recorded for a period of 18 months and a set of 76 distant earthquakes were used to calculate the P-wave travel-time residuals. We calculated relative rather than absolute arrival-time residuals in the inversion to obtain depths of 0-400 km. We imaged a pronounced fast velocity anomaly below the NW Dinarides which directly indicates a lithosphere slab downgoing beneath the Dinarides. This fast anomaly extends towards the NW direction to at least 250 km depth, and we interpreted it as a descending lithosphere slab. The thrusting of the Adriatic microplate may be brought about by sub-lithosphere rising movement beneath the Pannonian region, along with a push from African plate. In our interpretation, the Adriatic lower lithosphere has been detached from the crust, and steeply sinks beneath the Dinarides. A lithosphere model of the contact between the Adriatic microplate and Pannonian tectonic segment was constructed based on the tomographic velocity model and results of previous crustal studies.

  13. Experimenter's data package for the descending layers rocket

    SciTech Connect

    Earle, G.; Herrero, F.; Foster, J.; Buonsanto, M.; Satya-Narayana, P.

    1992-09-01

    In response to a proposal from Science Applications International Corporation (SAIC), NASA Headquarters has approved a sounding rocket mission designed to study the physics of intermediate layers in the Earth's ionosphere at middle latitudes. The experiment will be carried out by a team of scientists and engineers from the NASA Wallops Flight Facility, SAIC, the NASA Goddard Space Flight Center, and the Millstone Hill radar observatory. The mission will involve the launch of an instrumented sounding rocket from the Wallops Island rocket range in the summer of 1994, with the objective of penetrating a descending ionized layer in the E-region between altitudes of 115 and 140 km. Instrumentation aboard the rocket will measure the ion and neutral composition of the layer, its plasma density, driving wind and electric field forces, the thermal ion distribution function, and electron temperature. Depending on payload weight constraints and subject to availability, a particle detector to measure energetic ion and/or electron fluxes near the layer may also be included. This document was prepared as a reference for the NASA payload development and experiment teams, for distribution at the Project Initiation Conference (PIC). The design specifications discussed herein are therefore of a preliminary nature; the intent is to promote open discussions between experimenters and NASA engineers that will lead to a final design capable of achieving the experiment objectives.

  14. Identifying local and descending inputs for primary sensory neurons

    PubMed Central

    Zhang, Yi; Zhao, Shengli; Rodriguez, Erica; Takatoh, Jun; Han, Bao-Xia; Zhou, Xiang; Wang, Fan

    2015-01-01

    Primary pain and touch sensory neurons not only detect internal and external sensory stimuli, but also receive inputs from other neurons. However, the neuronal derived inputs for primary neurons have not been systematically identified. Using a monosynaptic rabies viruses–based transneuronal tracing method combined with sensory-specific Cre-drivers, we found that sensory neurons receive intraganglion, intraspinal, and supraspinal inputs, the latter of which are mainly derived from the rostroventral medulla (RVM). The viral-traced central neurons were largely inhibitory but also consisted of some glutamatergic neurons in the spinal cord and serotonergic neurons in the RVM. The majority of RVM-derived descending inputs were dual GABAergic and enkephalinergic (opioidergic). These inputs projected through the dorsolateral funiculus and primarily innervated layers I, II, and V of the dorsal horn, where pain-sensory afferents terminate. Silencing or activation of the dual GABA/enkephalinergic RVM neurons in adult animals substantially increased or decreased behavioral sensitivity, respectively, to heat and mechanical stimuli. These results are consistent with the fact that both GABA and enkephalin can exert presynaptic inhibition of the sensory afferents. Taken together, this work provides a systematic view of and a set of tools for examining peri- and extrasynaptic regulations of pain-afferent transmission. PMID:26426077

  15. Interrupted Aortic Arch Associated with Absence of Left Common Carotid Artery: Imaging with MDCT

    SciTech Connect

    Onbas, Omer Olgun, Hasim; Ceviz, Naci; Ors, Rahmi; Okur, Adnan

    2006-06-15

    Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.

  16. Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

    SciTech Connect

    Kuo, H.-Cg; Ko, Sheung-Fat; Wu, Yu-Tsun; Huang, Chien-Fu; Chien, Shao-Ju; Tiao, Mao-Meng; Liang, Chi-Di

    2005-01-15

    We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

  17. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  18. Left-right development in Xenopus and zebrafish.

    PubMed

    Yost, H J

    1998-02-01

    One of the most striking features of the vertebrate body plan is that most exterior structures are bilaterally symmetric while many interior structures are left-right asymmetric. Left-right asymmetries are displayed in the heart, the circulatory, digestive and respiratory systems and in the central nervous system. A fundamental question in the study of all patterning events, including left-right axis formation, is how does asymmetry arise from apparent symmetry. A second important question that is perhaps unique to the study of left-right development, is how does the left-right axis align with the asymmetries that develop along the orthogonal axes; dorsal-ventral and anterior-posterior. Recent experiments in Xenopus laevis and zebrafish address both of these questions and have identified signaling molecules and interactions with midline cells that regulate left-right development.

  19. [Avulsion fracture of the serratus anterior muscle in a golfer].

    PubMed

    Winther, Annika Kloster Norland; Øhlenschlæger, Tommy F

    2015-01-26

    Golf is a sport with much repetitive actions often causing overuse injuries. We report a case of a left side avulsion fracture of the anterior serratus at the insertion on costa 4-6. A professionel golfer experienced sudden onset of pain of the chest during a golfswing. Clinically the patient had winging of the scapula and pain at the lateral side of costa 4-6. Ultrasonography showed an avulsion fracture of costa 5 at the insertion of the anterior serratus. The patient was referred to scapula-stabilising rehabilitation and fully recovered.

  20. Genetic variation and differentiation in parent-descendant cattle and bison populations

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Genetic variation and differentiation at 32 microsatellite DNA loci is quantified for parent-descendant cattle populations and parent-descendant bison (Bison bison) populations. Heterozygosity (Ho) and numbers of alleles/locus (AR) are less in the Line 1 Hereford inbred cattle population than in t...

  1. Anterior vitrectomy for shallow anterior chamber after cataract extraction.

    PubMed

    Dottan, S; Levartovsky, S; Oliver, M

    1982-06-01

    Pars plana anterior vitrectomy was performed in 9 patients with shallow anterior chamber after cataract extraction. Five patients had choroidal and/or ciliary body effusion (CCBE), and 4 had aphakic pupillary block (APB). Vitrectomy was performed only after medical treatment failed to restore a normal anterior chamber depth. In all patients the anterior chamber restored during surgery and remained so thereafter, although in patients with CCBE, the fundal pathology subsided days or even months later. The only surgical complication was a longstanding cystoid macular oedema in one patient. Pars plana vitrectomy would appear to have advantages over other surgical techniques, in similar circumstances.

  2. Argillization by descending acid at Steamboat Springs, Nevada

    USGS Publications Warehouse

    Schoen, R.; White, D.E.; Hemley, J.J.

    1974-01-01

    Steamboat Springs, Nevada, an area of present-day hot springs, clearly illustrates the genetic dependence of some kaolin deposits on hot-spring activity. Andesite, granodiorite and arkosic sediments are locally altered at the land surface to siliceous residues consisting of primary quartz and anatase, plus opal from primary silicates. These siliceous residues commonly exhibit the textural and structural features of their unaltered equivalents. Beneath the siliceous residues, kaolin and alunite replace primary silicates and fill open spaces, forming a blanketlike deposit. Beneath the kaolin-alunite zone, montmorillonite, commonly accompanied by pyrite, replaces the primary silicates. On the ground surface, the same alteration mineral zones can he traced outward from the siliceous residue; however, hematite rather than pyrite accompanies montmorillonite. Chemical analysis indicates that sulfuric acid is the active altering agent. The acid forms from hydrogen sulfide that exsolves from deep thermal water, rises above the water table and is oxidized by sulfur-oxidizing bacteria living near the ground surface. This acid dissolves in precipitation or condensed water vapor and percolates downward destroying most of the primary minerals producing a siliceous residue. Coincidence of the water table with the downward transition from siliceous residue to kaolin alunite signifies decreasing hydrogen metasomatism because of dilution of descending acid by ground water. In hot-spring areas, beds of siliceous sinter deposited at the surface by hypogene thermal water look, superficially, like areas of surficial acid alteration. Features diagnostic of a surficial alteration are the relict rock structures of a siliceous residue and a kaolin-alunite zone immediately beneath. ?? 1974.

  3. [Ascending-descending Aortic Bypass and Aortic Valve Replacement for Aortic Coarctation with Bicuspid Aortic Valve and an Aberrant Right Subclavian Artery;Report of a Case].

    PubMed

    Asano, Ryota; Nakano, Kiyoharu; Kodera, Kojiro; Sato, Atsuhiko; Kataoka, Go; Tatsuishi, Wataru; Kubota, Sayaka; Namiki, Shigetaka; Suzuki, Seiya

    2015-08-01

    A 53-year-old woman was developed congestive heart failure. She was diagnosed as having aortic coarctation, incompetent bicuspid aortic valve and an aberrant right subclavian artery by using echocardiography and enhanced computed tomography. Ankle brachial pressure index(ABI)in the right was 0.71 and 0.69 in the left. Blood pressure of the right arm was 60 mmHg lower than that of the left arm. To avoid perioperative adverse cardiac events due to a 2-staged operation, we performed ascending-descending aortic bypass and aortic valve replacement simultaneously through a median sternotomy. The heart was retracted cranially, and a vascular prosthesis was anastomosed to the descending aorta just above the diaphragm in an end-to-side manner. Then the graft was placed curvilinearly around the right atrium and was anastomosed to the ascending aorta. After the operation, the right and left ABI increased to 0.90 and 0.98 respectively. There was no pressure difference between the arms. The postoperative course was uneventful.

  4. Left Ventricle Diverticulum with Partial Cantrell's Syndrome

    PubMed Central

    El Kouache, Mustapha; Labib, S.; El Madi, A.; Babakhoya, A.; Atmani, S.; Abouabdilah, Y.; Harandou, M.

    2012-01-01

    Cantrell syndrome is a very rare congenital disease associating five features: a midline, upper abdominal wall disorder, lower sternal abnormality, anterior diaphragmatic defect, diaphragmatic pericardial abnormality, and congenital abnormalities of the heart. In this paper, we report a case of partial Cantrell's syndrome with left ventricular diverticulum, triatrial situs solitus, ventricular septal defect, dextrorotation of the heart, an anterior pericardial diaphragmatic defect, and a midline supraumbilical abdominal wall defect with umbilical hernia. The 5-month-old patient underwent a successful cardiac surgical procedure. A PTFE membrane was placed on the apex of the heart to facilitate reopening of the patient's chest. Postoperative course was uneventful. The patient was discharged with good clinical condition and with a normal cardiac function. PMID:24826242

  5. Scheimpflug imaging in anterior megalophthalmos

    PubMed Central

    Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo

    2013-01-01

    We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment. PMID:23275220

  6. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  7. The Anterior Prefrontal Cortex and the Hippocampus Are Negatively Correlated during False Memories.

    PubMed

    Jeye, Brittany M; Karanian, Jessica M; Slotnick, Scott D

    2017-01-23

    False memories commonly activate the anterior/dorsolateral prefrontal cortex (A/DLPFC) and the hippocampus. These regions are assumed to work in concert during false memories, which would predict a positive correlation between the magnitudes of activity in these regions across participants. However, the A/DLPFC may also inhibit the hippocampus, which would predict a negative correlation between the magnitudes of activity in these regions. In the present functional magnetic resonance imaging (fMRI) study, during encoding, participants viewed abstract shapes in the left or right visual field. During retrieval, participants classified each old shape as previously in the "left" or "right" visual field followed by an "unsure"-"sure"-"very sure" confidence rating. The contrast of left-hits and left-misses produced two activations in the hippocampus and three activations in the left A/DLPFC. For each participant, activity associated with false memories (right-"left"-"very sure" responses) from the two hippocampal regions was plotted as a function of activity in each A/DLPFC region. Across participants, for one region in the left anterior prefrontal cortex, there was a negative correlation between the magnitudes of activity in this region and the hippocampus. This suggests that the anterior prefrontal cortex might inhibit the hippocampus during false memories and that participants engage either the anterior prefrontal cortex or the hippocampus during false memories.

  8. Differential adaptation of descending motor tracts in musicians.

    PubMed

    Rüber, Theodor; Lindenberg, Robert; Schlaug, Gottfried

    2015-06-01

    Between-group comparisons of musicians and nonmusicians have revealed structural brain differences and also functional differences in motor performance. In this study, we aimed to examine the relation between white matter microstructure and high-level motor skills by contrasting 2 groups of musicians with different instrument-specific motor requirements. We used diffusion tensor imaging to compare diffusivity measures of different corticospinal motor tracts of 10 keyboard players, 10 string players, and 10 nonmusicians. Additionally, the maximal tapping rates of their left and right index fingers were determined. When compared with nonmusicians, fractional anisotropy (FA) values of right-hemispheric motor tracts were significantly higher in both musician groups, whereas left-hemispheric motor tracts showed significantly higher FA values only in the keyboard players. Voxel-wise FA analysis found a group effect in white matter underlying the right motor cortex. Diffusivity measures of fibers originating in the primary motor cortex correlated with the maximal tapping rate of the contralateral index finger across all groups. The observed between-group diffusivity differences might represent an adaptation to the specific motor demands of the respective musical instrument. This is supported further by finding correlations between diffusivity measures and maximal tapping rates.

  9. Performance and physiological effects of different descending strategies for cross-country mountain biking.

    PubMed

    Miller, Matthew C; Macdermid, Paul W; Fink, Phil W; Stannard, Stephen R

    2017-04-01

    This study investigated the performance-related feasibility and physiological benefits of purposefully eliminating propulsive work while descending in mountain biking and compared values to those measured during road descending. Participants cycled uphill on a road at race pace before descending over three conditions (off-road pedalling; off-road coasting; road coasting). Relatively low power output during off-road pedalling was associated with a greater oxygen uptake (p < .01) when compared with off-road coasting despite no difference in vibration exposure (p > .05). Importantly, pedalling did not invoke a performance benefit (p > .05) on the descent used in this study. Significantly greater heart rate and oxygen uptake (both p < .01) were observed between road and off-road descending, likely caused by the increase in terrain-induced vibrations (p < .01) experienced between the bicycle and rider. Results indicate that reducing propulsive work during descending can improve recovery without being disadvantageous to performance. Similarly, the vibrations experienced during road descending are relatively low, and further reduce oxygen cost. In an effort to increase efficiency, it is recommended that mountain bike athletes focus on skills to increase descending speed without the addition of pedalling, and that equipment be used to decrease vibrations nearer to those seen on the road.

  10. Prevalence of common hemoglobin variants in an afro-descendent Ecuadorian population

    PubMed Central

    2013-01-01

    Background Hemoglobinopathies are among the most studied and frequent pathologies. These genetic disorders are considered a very important health care threat in many tropical countries. Ecuador is a tropical Latin-American country with an important presence of afro-descendants (7.2%). Afro-descendants are among the ethnic groups with higher frequency of hemoglobinopathies reported. Ambuqui is a region within the Imbabura province with an important presence of afro-descendants (>50%). The present study analyzed the frequency of the most common hemoglobin variants in an asymptomatic afro-descendent population using capillary electrophoresis. Findings From 114 individuals, 25 (22%) reported a hemoglobin variant. All individuals that presented hemoglobin variants were heterozygotes (asymptomatic). Hemoglobin S (sickle cell trait) was the most frequent variant found (14%), followed by hemoglobin E (4.4%), Fetal (2.6%) and C (1%). Conclusion Prevalence of hemoglobin S was consistent with populations from other countries, but it was lower than other Ecuadorian afro-descendent populations. Frequency of hemoglobin C was lower than other afro-descendent populations. This data suggests the possibility of gene flow from Native American individuals to the Ambuqui population there by lowering the frequency of their hemoglobin variants compared with other afro-descendant populations. Evaluating the frequency of hemoglobinopathies in Ecuadorian populations is essential. Despite the high frequency of these disorders, very few health care facilities implement hemoglobinopathies tests as a routine practice. PMID:23557107

  11. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.

    PubMed

    Garber, Adam M; Mentz, Robert J; Al-Khalidi, Hussein R; Shaw, Linda K; Fiuzat, Mona; O'Connor, Christopher M; Velazquez, Eric J

    2016-04-01

    We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

  12. Reduced scar maturation and contractility lead to exaggerated left ventricular dilation after myocardial infarction in mice lacking AMPKα1.

    PubMed

    Noppe, Gauthier; Dufeys, Cécile; Buchlin, Patricia; Marquet, Nicolas; Castanares-Zapatero, Diego; Balteau, Magali; Hermida, Nerea; Bouzin, Caroline; Esfahani, Hrag; Viollet, Benoit; Bertrand, Luc; Balligand, Jean-Luc; Vanoverschelde, Jean-Louis; Beauloye, Christophe; Horman, Sandrine

    2014-09-01

    Cardiac fibroblasts (CF) are crucial in left ventricular (LV) healing and remodeling after myocardial infarction (MI). They are typically activated into myofibroblasts that express alpha-smooth muscle actin (α-SMA) microfilaments and contribute to the formation of contractile and mature collagen scars that minimize the adverse dilatation of infarcted areas. CF predominantly express the α1 catalytic subunit of AMP-activated protein kinase (AMPKα1), while AMPKα2 is the major catalytic isoform in cardiomyocytes. AMPKα2 is known to protect the heart by preserving the energy charge of cardiac myocytes during injury, but whether AMPKα1 interferes with maladaptative heart responses remains unexplored. In this study, we investigated the role of AMPKα1 in modulating LV dilatation and CF fibrosis during post-MI remodeling. AMPKα1 knockout (KO) and wild type (WT) mice were subjected to permanent ligation of the left anterior descending coronary artery. The absence of AMPKα1 was associated with increased CF proliferation in infarcted areas, while expression of the myodifferentiation marker α-SMA was decreased. Faulty maturation of myofibroblasts might derive from severe down-regulation of the non-canonical transforming growth factor-beta1/p38 mitogen-activated protein kinase (TGF-β1/p38 MAPK) pathway in KO infarcts. In addition, lysyl oxidase (LOX) protein expression was dramatically reduced in the scar of KO hearts. Although infarct size was similar in AMPK-KO and WT hearts subjected to MI, these changes resulted in compromised scar contractility, defective scar collagen maturation, and exacerbated adverse remodeling, as indicated by increased LV diastolic dimension 30days after MI. Our data genetically demonstrate the centrality of AMPKα1 in post-MI scar formation and highlight the specificity of this catalytic isoform in cardiac fibroblast/myofibroblast biology.

  13. Pulmonary hypertension secondary to left-heart failure involves peroxynitrite-induced downregulation of PTEN in the lung.

    PubMed

    Ravi, Yazhini; Selvendiran, Karuppaiyah; Naidu, Shan K; Meduru, Sarath; Citro, Lucas A; Bognár, Balázs; Khan, Mahmood; Kálai, Tamás; Hideg, Kálmán; Kuppusamy, Periannan; Sai-Sudhakar, Chittoor B

    2013-03-01

    Pulmonary hypertension (PH) that occurs after left-heart failure (LHF), classified as Group 2 PH, involves progressive pulmonary vascular remodeling induced by smooth muscle cell (SMC) proliferation. However, mechanisms involved in the activation of SMCs remain unknown. The objective of this study was to determine the involvement of peroxynitrite and phosphatase-and-tensin homolog on chromosome 10 (PTEN) in vascular SMC proliferation and remodeling in the LHF-induced PH (LHF-PH). LHF was induced by permanent ligation of left anterior descending coronary artery in rats for 4 weeks. MRI, ultrasound, and hemodynamic measurements were performed to confirm LHF and PH. Histopathology, Western blot, and real-time polymerase chain reaction analyses were used to identify key molecular signatures. Therapeutic intervention was demonstrated using an antiproliferative compound, HO-3867. LHF-PH was confirmed by significant elevation of pulmonary artery pressure (mean pulmonary artery pressure/mm Hg: 35.9±1.8 versus 14.8±2.0, control; P<0.001) and vascular remodeling. HO-3867 treatment decreased mean pulmonary artery pressure to 22.6±0.8 mm Hg (P<0.001). Substantially higher levels of peroxynitrite and significant loss of PTEN expression were observed in the lungs of LHF rats when compared with control. In vitro studies using human pulmonary artery SMCs implicated peroxynitrite-mediated downregulation of PTEN expression as a key mechanism of SMC proliferation. The results further established that HO-3867 attenuated LHF-PH by decreasing oxidative stress and increasing PTEN expression in the lung. In conclusion, peroxynitrite and peroxynitrite-mediated PTEN inactivation seem to be key mediators of lung microvascular remodeling associated with PH secondary to LHF.

  14. The Relationship Between Left Ventricular Fractional Shortening and Intravenous Administration of Stem Cells in Laboratory Rabbits Presenting Chronic Myocardial Infarction

    PubMed Central

    POP, IONEL CIPRIAN; GRAD, OVIDIU; PALL, EMOKE; PESTEAN, COSMIN; MIRCEAN, MIRCEA; MIRONIUC, ION AUREL

    2015-01-01

    Background and aims The present study conducted from March 2012 to July 2013 aimed to evaluate from echocardiographic point of view the effects of peripheral intravenous administration of mesenchymal stem cells (MSCs) in laboratory rabbits presenting 30 days old chronic myocardial infarction. Material and methods 30 days after the induction of an acute myocardial infarction in 40 laboratory rabbits by direct ligation of the left anterior descending coronary artery at about 10 mm from the apex, we injected 1×106 MSCs in the auricular vein in a group of 30 rabbits, and a group of 10 rabbits were used as controls. 30 days after the injection of stem cells the left ventricular (LV) fractional shortening (FS) was evaluated by echocardiography and compared with the control rabbits. Results In control rabbits, echocardiography revealed akinesis of apex, interventricular septum kinetics was also impaired, FS being approximately 6%. In 80% (24 rabbits) of the injected rabbits the FS of the LV was significantly greater than in the witness group (26+/−2%, p<0.0001). At 13.3% (4 rabbits) of the injected rabbits the FS of the LV showed no improvement in comparison with the control group (6.5+/−1%). Conclusion An improvement of LV SF 30 days after MSCs were injected(p<0.0001) was noted. We have to further determine if this improvement of the LV function is correlated with any histopathological changes and if it is not lost in time. Also, further studies needs to evaluate if there is any significant change in the overall mortality. PMID:26528044

  15. Development and Implementation for Calculation Model of Measuring Co-Seismic Deformation Field by Using Ascending and Descending Orbit SAR Data

    NASA Astrophysics Data System (ADS)

    Xue, Tengfei; Chang, Zhanqiang; Zhang, Jingfa

    2016-08-01

    Interferometry Synthetic Aperture Radar (InSAR)can only measure one component of the surface deformation in the satellite's line of sight (LOS) instead of that in vertical and horizontal directions, i.e. LOS Amphibious. In view of this problem, we analyzed and summarized some methods that can measure the three-dimensional deformation of ground surface by using D-InSAR, developed the calculation model of measuring the three-dimensional co-seismic deformation filed by using the ascending and descending orbit SAR data. The Formula of left-looking (both ascending and descending orbit data), right-looking (both ascending and descending orbit data) and general expression were proposed. The model was applied on L'Aquila earthquake, and the results reveal that the earthquake has caused displacement in both vertical and horizontal directions, and the earthquake made the area down lift 16.8cm along the vertical direction. The characters of the surface reflected by the results are very consistent with the geological exploration.

  16. [Anterior cervical hypertrichosis: case report].

    PubMed

    Orozco-Gutiérrez, Mario H; Sánchez-Corona, José; García-Ortiz, José E; Castañeda-Cisneros, Gema; Dávalos-Rodríguez, Nory O; Corona-Rivera, Jorge R; García-Cruz, Diana

    2016-10-01

    The non-syndromic anterior cervical hypertrichosis (OMIM N° 600457) is a genetic disorder characterized by a patch of hair at the level of the laryngeal prominence. We present a 12-year-old boy with anterior cervical hypertrichosis and mild generalized hypertrichosis. He has no neurological, ophthalmological or skeletal anomalies. The clinical follow up is 10 years.

  17. Cannulation of the extrathoracic left common carotid artery for thoracic aorta operations through left posterolateral thoracotomy.

    PubMed

    Veron, Sebastien; Neri, Eugenio; Buklas, Dimitrios; Pula, Giorgio; Benvenuti, Antonio; Massetti, Massimo; Bizzarri, Federico; Sassi, Carlo

    2004-11-01

    The femoral artery is the usual site of arterial cannulation in thoracic aorta operations through left posterolateral thoracotomy that require cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). The advantage of this perfusion route is in limiting the duration of circulatory arrest. It is associated, however, with the risk of retrograde embolization or, in cases involving aortic dissection, malperfusion of vital organs. To prevent these risks, we have used the extrathoracic left common carotid artery as the perfusion route. From December 1999 to January 2003, we used cannulation of the left extrathoracic common carotid artery in 42 thoracic aorta operations through posterolateral thoracotomy with an open proximal anastomosis technique during DHCA. The indication for thoracic aortic repair was atherosclerotic ulcer in 7 cases, chronic aortic aneurysm in 18, acute type B dissection in 5, and chronic type B dissection in 12. Cannulation of the extrathoracic left common carotid artery was successful in all patients. Postoperative recovery was uneventful, with no cerebrovascular events in all cases. No cannulation-related complications were observed. One patient died from cardiac insufficiency on postoperative day 5. No peripheral neurological deficits (paraplegia or paraparesis) were observed. Postoperative complications included atrial fibrillation in five patients, reoperation to control hemorrhage in six, respiratory insufficiency in nine, and renal insufficiency in six. These results indicate that cannulation of the left extrathoracic common carotid artery is a useful, reliable method for proximal perfusion during CPB in patients undergoing repair of the descending thoracic aorta through left posterolateral thoracotomy. By providing effective perfusion of the brain, this technique can prolong safe DHCA time. Another advantage is the prevention of cerebral emboli, ensuring retrograde flow to the aortic arch.

  18. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    SciTech Connect

    Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

    1982-09-01

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms.

  19. Saccular aneurysm formation of the descending aorta associated with aortic coarctation in an infant.

    PubMed

    Ozyuksel, Arda; Canturk, Emir; Dindar, Aygun; Akcevin, Atif

    2014-01-01

    Aneurysm of the descending aorta associated with CoA is an extremely rare congenital abnormality. In this report, we present a 16 months old female patient in whom cardiac catheterization had been performed which had revealed a segment of coarctation and saccular aneurysm in the descending aorta. The patient was operated and a 3x2 centimeters aneurysm which embraces the coarcted segment in descending aorta was resected. In summary, we present a case of saccular aortic aneurysm distal to aortic coarctation in an infant without any history of intervention or vascular inflammatory disease. Our case report seems to be the youngest patient in literature with this pathology.

  20. [Aneurysm of the anterior inferior cerebellar artery: case report].

    PubMed

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  1. Words and Objects at the Tip of the Left Temporal Lobe in Primary Progressive Aphasia

    ERIC Educational Resources Information Center

    Mesulam, M.-Marsel; Wieneke, Christina; Hurley, Robert; Rademaker, Alfred; Thompson, Cynthia K.; Weintraub, Sandra; Rogalski, Emily J.

    2013-01-01

    Eleven of 69 prospectively enrolled primary progressive aphasics were selected for this study because of peak atrophy sites located predominantly or exclusively within the anterior left temporal lobe. Cortical volumes in these areas were reduced to less than half of control values, whereas average volume elsewhere in the left hemisphere deviated…

  2. A theoretical, two-layer, reduced-gravity model for descending dense water flow on continental shelves/slopes

    NASA Astrophysics Data System (ADS)

    Wang, Jia; Ikeda, Moto; Saucier, Francois J.

    2003-05-01

    A theoretical, two-layer, reduced-gravity model for descending dense water flow on continental shelves/slopes has been developed to investigate the dynamics of bottom dense water plumes. The model is nonsteady state and includes vertical viscosity, the Coriolis force, and bottom friction. An integral solution rather than a perfect analytical expression is derived and, thus, the Simpson's 1/3 rule to approximate the integral is applied. At the very bottom, the dense water plume moves about 45° to the right (left) in the Northern (Southern) Hemisphere, looking downslope. From the bottom, the velocity vector rotates anticyclonically upward, indicating a bottom Ekman spiral that mimics the atmospheric Ekman boundary layer. The dense water within the bottom Ekman layer obeys a three-force balance, while the dense water above the bottom Ekman layer is governed by a two-force balance, which is a geostrophic flow with superimposed cycloidal inertial oscillations oriented from about 25° to 140° to the right (left) of the downslope direction in the Northern (Southern) Hemisphere. The transport within the bottom Ekman layer is directed about 60-70° to the right (left) of the downslope direction in the Northern (Southern) Hemisphere, forming an offshore (cross-isobath) transport in the absence of eddy flux and wind-forcing. The ratio of offshore transport to alongshore transport within the bottom Ekman layer is about 0.19 (19%), while the ratio above the bottom Ekman layer (i.e., geostrophic layer of the dense water) is only 3% (negligible compared to its alongshore transport), which, however, is equivalent in magnitude to its counterpart in the bottom Ekman layer if O(DE/h) ˜ 0.1 (where DE is the bottom Ekman layer thickness and h is the dense water layer thickness). In other words, the bottom Ekman layer and the geostrophic (dense) layer contribute equivalent dense water offshore (each contributes 50%). The magnitude of the descending dense water velocity depends

  3. Sci—Thur AM: YIS - 01: Dosimetric Analysis of Respiratory Induced Cardiac Intrafraction Motion in Left-sided Breast Cancer Radiotherapy

    SciTech Connect

    El-Sherif, O; Xhaferllari, I; Patrick, J; Yu, E; Gaede, S

    2014-08-15

    Introduction: Long-term cardiac side effects in left-sided breast cancer patients (BREL) after post-operative radiotherapy has become one of the most debated issues in radiation oncology. Through breathing-adapted radiotherapy the volume of the heart exposed to radiation can be significantly reduced by delivering the radiation only at the end of inspiration phase of the respiratory cycle, this is referred to as inspiration gating (IG). The purpose of this study is to quantify the potential reduction in cardiac exposure during IG compared to conventional BREL radiotherapy and to assess the dosimetric impact of cardiac motion due to natural breathing. Methods: 24 BREL patients treated with tangential parallel opposed photon beams were included in this study. All patients received a standard fast helical planning CT (FH-CT) and a 4D-CT. Treatment plans were created on the FH-CT using a clinical treatment planning system. The original treatment plan was then superimposed onto the end of inspiration CT and all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion and IG through 4D dose accumulation. Results: Through IG the mean dose to the heart, left ventricle, and left anterior descending artery (LAD) can be reduced in comparison to the clinical standard BREL treatment by as much as 8.39%, 10.11%, and 13.71% respectively (p < 0.05). Conclusion: Failure to account for respiratory motion can lead to under or overestimation in the calculated DVH for the heart, and it's sub-structures. IG can reduce cardiac exposure especially to the LAD during BREL radiotherapy.

  4. Off-pump coronary artery bypass grafting in a patient with AIDS, acute myocardial infarction, and severe left main coronary artery disease.

    PubMed

    Bittner, H B; Fogelson, B G

    2003-02-01

    A 48-year-old male patient with AIDS presented with postinfarct unstable angina, decreased left ventricular function (EF 35%), significant left main coronary artery disease, and total occlusion of the proximal left anterior descending and right coronary arteries. In order to avoid the potential immunosuppressive effect of cardiopulmonary bypass (CPB) in an already compromised host with an already low CD4+ helper/inducer T cell count (180/microL) and high retroviral load (165,000 copies/mL), the application of beating-heart technology and off-pump coronary bypass grafting was an ideal indication. The patient underwent successfully off-pump/CPB coronary revascularization. The triple drug combination of highly active antiretroviral therapy (HAART) was resumed postoperatively. The patient was discharged from the hospital on the 7(th) postoperative day. The CD4+ count was 142/microL and the viral load decreased to 450 copies/mL. Seven months post-operatively the patient was free of angina and without shortness of breath. The CD4+ count was 160/(m)L and the viral load undetectable. Improved survival of HIV positive patients has resulted in a shift from caring for terminally ill patients to caring for patients with chronic illness. While protease inhibitors have positively affected survival, they may also cause plasma lipid abnormalities, which can lead to severe premature coronary artery disease. Therefore, an increasing population of AIDS and HIV positive patients with coronary artery disease may require cardiac interventions in the near future. Coronary revascularization without CPB and its potential immunocompromising effect may play an important role in patients with severe coronary artery disease and AIDS.

  5. Anterior ethmoidal artery emerging anterior to bulla ethmoidalis: An abnormal anatomical variation in Waardenburg's syndrome

    PubMed Central

    Wong, Danny K. C.; Shao, Angus; Campbell, Raewyn

    2014-01-01

    In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development. PMID:25565054

  6. The azygos anterior cerebral artery bypass: double reimplantation technique for giant anterior communicating artery aneurysms.

    PubMed

    Mirzadeh, Zaman; Sanai, Nader; Lawton, Michael T

    2011-04-01

    The authors introduce the azygos anterior cerebral artery (ACA) bypass as an option for revascularizing distal ACA territories, as part of a strategy to trap giant anterior communicating artery (ACoA) aneurysms. In this procedure, the aneurysm is exposed with an orbitozygomatic-pterional craniotomy and distal ACA vessels are exposed with a bifrontal craniotomy. The uninvolved contralateral A(2) segment of the ACA serves as a donor vessel for a short radial artery graft. The contralateral pericallosal artery (PcaA) and the callosomarginal artery (CmaA) are connected to the graft in the interhemispheric fissure using the double reimplantation technique. Three anastomoses create an azygos system supplying the entire ACA territory, enabling the surgeon to trap the aneurysm incompletely. Retrograde flow from the CmaA supplies the ipsilateral recurrent artery of Heubner, and the aneurysm lumen thromboses. The azygos bypass was successfully performed to treat a 47-year-old woman with a giant, thrombotic ACoA aneurysm supplied by the A(1) segment of the left ACA, with left PcaA and CmaA originating from the aneurysm base. The authors conclude that the azygos ACA bypass is a novel option for revascularizing PcaA and CmaA, as part of the overall treatment of giant ACoA aneurysms.

  7. True left-sided gallbladder with a portal anomaly: report of a case.

    PubMed

    Kawai, Ryosuke; Miyata, Kanji; Yuasa, Norihiro; Takeuchi, Eiji; Goto, Yasutomo; Miyake, Hideo; Nagai, Hidemasa; Hattori, Masaoki; Imura, Jiro; Hayashi, Yuuki; Kawakami, Jiro; Kobayashi, Yoichiro

    2012-11-01

    A 65-year-old female who presented with back pain was diagnosed to have the presence of biliary sludge in the gallbladder. Computed tomography showed that the round ligament connected to the left portal umbilical portion was in the normal anatomical position. However, the gallbladder was located to the left of the middle hepatic vein and the round ligament, attached to the left lateral segment of the liver. The right posterior portal vein diverged alone from the main portal vein, and there was a long stem from the right anterior and left portal veins. Laparoscopic cholecystectomy confirmed the abnormal location of the gallbladder. Most reported cases of left-sided gallbladder are caused by a right-sided round ligament, which is called a "false" left-sided gallbladder. A case of left-sided gallbladder with a normal left-sided round ligament, which is designated as a case of "true" left-sided gallbladder, is extremely rare.

  8. Anterior Insula Volume and Guilt

    PubMed Central

    Belden, Andy C.; Barch, Deanna M.; Oakberg, Timothy J.; April, Laura M.; Harms, Michael P.; Botteron, Kelly N.; Luby, Joan L.

    2016-01-01

    IMPORTANCE This is the first study to date to examine volumetric alterations in the anterior insula (AI) as a potential biomarker for the course of childhood major depressive disorder (MDD). OBJECTIVES To examine whether children with a history of preschool-onset (PO) MDD show reduced AI volume, whether a specific symptom of PO MDD (pathological guilt) is related to AI volume reduction (given the known relationship between AI and guilt processing), and whether AI volumes predict subsequent likelihood of having an episode of MDD. DESIGN, SETTING, AND PARTICIPANTS In a prospective longitudinal study, 306 children (age range, 3.00–5.11 years) and caregivers completed DSM diagnostic assessments at 6 annual time points during 10 years as part of the Preschool Depression Study. Magnetic resonance imaging was completed on a subset of 145 school-age children (age range, 6.11–12.11 years). MAIN OUTCOMES AND MEASURES Whole-brain–adjusted AI volume measured using magnetic resonance imaging at school age and children’s diagnosis of MDD any time after their imaging. RESULTS Compared with children without a history of PO MDD, school-age children previously diagnosed as having PO MDD had smaller left and right AI volumes (Wilks Λ = 0.94, F2,124 = 3.37, P = .04, Cohen d = 0.23). However, the effect of PO MDD on reduced AI volumes was better explained by children’s experience of pathological guilt during preschool (Λ = 0.91, F2,120 = 6.17, P = .003, d = .30). When covarying for children’s lifetime history of MDD episodes, their experience of pathological guilt during preschool, as well as their sex and age at the time of imaging, schoolchildren’s right-side AI volume was a significant predictor of being diagnosed as having an MDD episode after imaging (odds ratio, 0.96; 95% CI, 0.01–0.75; P = .03). CONCLUSIONS AND RELEVANCE These results provide evidence that structural abnormalities in AI volume are related to the neurobiology of depressive disorders starting in

  9. Left heart catheterization

    MedlinePlus

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  10. Left Ventricular Hypertrophy

    MedlinePlus

    ... at the time of their diagnosis with hypertension. Aortic valve stenosis. This disease is a narrowing of the tissue ... muscle and disease. In addition to hypertension and aortic valve stenosis, factors that increase your risk for left ventricular ...

  11. Left Atrial Myxoma

    DTIC Science & Technology

    2006-09-01

    enhanced pulmonary CT angiogram demonstrated normal pulmonary arteries (i.e. no pulmonary embolus) and confirmed the presence of left-sided pulmonary ... arteries without evidence for pulmonary embolism but note of patchy airspace disease within the left upper and lower lobes (Figure 1C), which...1A) and lateral (Figure 1B) chest radiographs were obtained and the patient also underwent a contrast-enhanced pulmonary CT angiogram (CTA; Figure

  12. 13. VIEW OF FIRST FLOOR, LOOKING NORTHWEST. AT LEFT IS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. VIEW OF FIRST FLOOR, LOOKING NORTHWEST. AT LEFT IS A 'EUREKA O.K.' BAGGING SCALE (S. Howe Co., Silver Creek, New York). THE SUSPENSION-TYPE HOPPER SCALE WEIGHS BULK FEED AS IT DESCENDS INTO A BAG SECURED BY THE RING AT THE BASE OF THE SCALE. AT RIGHT, FINISHED PRODUCTS ARE READY FOR SALE. AT CENTER REAR IS ONE OF THE MILL'S TWO VERTICAL TWIN-SPIRAL MIXERS. Photographer: Jet T. Lowe, 1985 - Alexander's Grist Mill, Lock 37 on Ohio & Erie Canal, South of Cleveland, Valley View, Cuyahoga County, OH

  13. Correlation Between Isometric Force and Intramuscular Pressure in Rabbit Tibialis Anterior Muscle with an Intact Anterior Compartment

    PubMed Central

    Winters, Taylor M.; Sepulveda, Genaro S.; Cottler, Patrick S.; Kaufman, Kenton R.; Lieber, Richard L.; Ward, Samuel R.

    2009-01-01

    To determine the degree to which intramuscular pressure (IMP) and muscle force are correlated in an intact compartment, a custom pressure transducer was inserted into the rabbit tibialis anterior (TA) while activating the muscle via the peroneal nerve and measuring TA muscle force distal to the ankle retinaculum. In general, IMP was more variable compared to muscle force throughout the entire isometric length-tension relationship. In contrast to results obtained on isolated TA muscles, IMP-force relations with the compartment intact were not significantly different between the ascending and descending limbs of the length-tension curve. Specifically, average relative pressure-force coefficients of determination (r2) were 0.76±0.11 for the active ascending limb and 0.98±0.01 for the active descending limb. These data demonstrate that muscle force and IMP are fairly well correlated under isometric conditions and that this relationship is not improved by measuring IMP in an intact environment. PMID:19533654

  14. TU-F-17A-06: Motion Stability and Dosimetric Impact of Spirometer-Based DIBH-RT of Left-Sided Breast Cancer

    SciTech Connect

    McKenzie, E; Yang, W; Burnison, M; Mirhadi, A; Hakimian, B; Stephen, S; Robert, R; Yue, Y; Sandler, H; Fraass, B

    2014-06-15

    Purpose: Patients undergoing radiotherapy (RT) for left-sided breast cancer have increased risk of coronary artery disease. Deep Inhalation Breath Hold assisted RT (DIBH-RT) is shown to increase the geometric separation of the target area and heart, reducing cardiac radiation dose. The purposes of this study are to use Cine MV portal images to determine the stability of spirometer-guided DIBH-RT and examine the dosimetric cardiopulmonary impact of this technique. Methods: Twenty consecutive patients with left-sided breast cancer were recruited to the IRB-approved study. Free-breathing (FB) and DIBH-CT's were acquired at simulation. Rigid registration of the FB-CT and DIBH-CT was performed using primarily breast tissue. Treatment plans were created for each FB-CT and DIBH-CT using identical paired tangent fields with field-in-field or electronic compensation techniques. Dosimetric evaluation included mean and maximum (Dmax) doses for the left anterior descending artery (LAD), mean heart dose, and left lung V20. Cine MV portal images were acquired for medial and lateral fields during treatment. Analysis of Cine images involved chest wall segmentation using an algorithm developed in-house. Intra- and inter-fractional chest wall motion were determined through affine registration to the first frame of each Cine. Results: Dose to each cardiac structure evaluated was significantly (p<0.001) reduced with the DIBH plans. Mean heart dose decreased from 2.9(0.9–6.6) to 1.6(0.6–5.3) Gy; mean LAD dose from 16.6(3–43.6) to 7.4(1.7–32.7) Gy; and LAD Dmax from 35.4 (6.1–53) to 18.4(2.5–51.2) Gy. No statistically significant reduction was found for the left lung V20. Average AP and SI median chest wall motion (intrafractional) was 0.1 (SD=0.9) and 0.5 (SD=1.1) mm, respectively. Average AP inter-fractional chest wall motion was 2.0 (SD=1.4) mm. Conclusion: Spirometer-based DIBH treatments of the left breast are reproducible both inter- and intra-fractionally, and provide

  15. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  16. Hypoplastic left heart syndrome (image)

    MedlinePlus

    Hypoplastic left heart syndrome is a congenital heart condition that occurs during the development of the heart in the ... womb. During the heart's development, parts of the left side of the heart (mitral valve, left ventricle ...

  17. Severe reversible dilated cardiomyopathy associated with a large left ventricular thrombus in a young child with middle aortic syndrome.

    PubMed

    Ponniah, U; Overholt, E

    2014-01-01

    We report a case of a seven-year girl who presented with severe dilated cardiomyopathy (DCM) associated with a large thrombus in the left ventricle (LV). She had a long segment stenosis of the lower thoracic descending aorta, possibly due to non-specific aortitis and underwent successful stent angioplasty. The LV thrombus resolved after heparin without sequelae.

  18. Descending projections to the mammillary nuclei in the rat, as studied by retrograde and anterograde transport of wheat germ agglutinin-horseradish peroxidase.

    PubMed

    Shibata, H

    1989-07-22

    The cells of origin and projection fields of the descending afferents to the mammillary nuclei were studied in the rat with retrograde and anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase. The subiculum projects bilaterally to the entire medial mammillary nucleus (MM) in a topographic fashion along the two axes: 1) the proximal part of the subiculum along the presubiculo-CA1 axis projects to the caudal and lateral regions of the MM whereas the more distal part of the subiculum projects to the medial region; 2) the septal part of the subiculum projects to the caudodorsal region of the MM whereas the more temporal part projects progressively to the more rostroventral regions. The ventral subiculum also projects ipsilaterally to the ventral and lateral margin of the lateral mammillary nucleus (LM). The presubiculum projects bilaterally to the dorsolateral region of the pars posterior of the MM and ipsilaterally to the LM. The infra-limbic cortex projects bilaterally to the rostrodorsal region of the MM, whereas the retrosplenial cortex (areas 29a and 29b) projects bilaterally to the medial region at the midrostrocaudal and middorsoventral levels of the MM. The nucleus of the diagonal band projects bilaterally to the caudomedial region of the MM, whereas the lateral septal nucleus projects bilaterally to the pars mediana and the mammillary fiber capsule. A part of the anterior hypothalamic area ventromedial to the fornix projects predominantly ipsilaterally to the rostroventral part of the MM, whereas other basal forebrain regions such as the bed nucleus of the stria terminalis, the medial preoptic and anterior hypothalamic areas, and the area of the tuber cinereum send fibers predominantly ipsilaterally to the mammillary fiber capsule. The results reveal a complex organization of the descending projections to the mammillary nuclei, which may reflect the complex functions of these nuclei within the limbic circuitry.

  19. CLINICAL APPLICATION OF THE RIGHT SIDELYING RESPIRATORY LEFT ADDUCTOR PULL BACK EXERCISE

    PubMed Central

    2013-01-01

    Problem: Lumbopelvic‐femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and postural mal‐alignment called a Left Anterior Interior Chain (AIC) pattern. An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transverse abdominus (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA). The Solution: A therapeutic exercise technique that can address impairments associated with postural asymmetry may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing. The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic‐femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA's and inhibiting/lengthening the paraspinals, bilaterally. Discussion: The exercise technique is often used by Physical Therapists, Physical Therapist assistants and Athletic Trainers as an initial exercise to positively affect position/alignment of the lumbopelvic‐femoral region, referred to as “repositioning,” by clinicians who use it. Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described. This particular exercise technique is relatively new and warrants future research. PMID:23772350

  20. Giant left ventricular pseudoaneurysm.

    PubMed

    Prakash, Sumi; Garg, Nadish; Xie, Gong-Yuan; Dellsperger, Kevin C

    2010-01-01

    Left ventricular (LV) pseudoaneurysm (PS) is an uncommon, often fatal complication associated with myocardial infarction, cardiothoracic surgery, trauma, and, rarely, infective endocarditis. A 28-year-old man with prior history of bioprosthetic mitral valve replacement presented with congestive heart failure and bacteremia with Abiotrophia granulitica. Transesophageal echocardiogram showed bioprosthesis dysfunction, large vegetations, mitral regurgitation, and probable PS. Cardiac and chest CT confirmed a PS communicating with the left ventricle Patient had pulseless electrical activity and died. Autopsy showed a giant PS with layered thrombus and pseudo-endothelialized cavity. Our case highlights the importance of multimodality imaging as an important tool in management of PS.

  1. Effect of paroxetine on left ventricular remodeling in an in vivo rat model of myocardial infarction.

    PubMed

    Lassen, Thomas Ravn; Nielsen, Jan Møller; Johnsen, Jacob; Ringgaard, Steffen; Bøtker, Hans Erik; Kristiansen, Steen Buus

    2017-05-01

    Left ventricular (LV) remodeling following a myocardial infarction (MI) involves formation of reactive oxygen species (ROS). Paroxetine, a selective serotonin reuptake inhibitor, has an antioxidant effect in the vascular wall. We investigated whether paroxetine reduces myocardial ROS formation and LV remodeling following a MI. In a total of 32 Wistar rats, MI was induced by a 30-min ligation of the left anterior descending artery followed by 7- or 28-day reperfusion. During the 28 days of reperfusion, LV remodeling was evaluated by magnetic resonance imaging (MRI) and echocardiography (n = 20). After 28 days of reperfusion, the susceptibility to ventricular tachycardia was evaluated prior to sacrifice and histological assessment of myocyte cross-sectional area, fibrosis, and presence of myofibroblasts. Myocardial ROS formation was measured with dihydroethidium after 7 days of reperfusion in separate groups (n = 12). Diastolic LV volume, evaluated by MRI (417 ± 60 vs. 511 ± 64 µL, p < 0.05), and echocardiography (515 ± 80 vs. 596 ± 83 µL, p < 0.05) as well as diastolic LV internal diameter evaluated with echocardiography (7.2 ± 0.6 vs. 8.1 ± 0.7 mm, p < 0.05) were lower in the paroxetine group than in controls. Furthermore, myocyte cross-sectional area was reduced in the paroxetine group compared with controls (277 ± 26 vs. 354 ± 23 mm(3), p < 0.05) and ROS formation was reduced in the remote myocardium (0.415 ± 0.19 normalized to controls, p < 0.05). However, no differences in the presence of fibrosis or myofibroblasts were observed. Finally, paroxetine reduced the susceptibility to ventricular tachycardia (induced in 2/11 vs. 6/8 rats, p < 0.05). Paroxetine treatment following MI decreases LV remodeling and susceptibility to arrhythmias, probably by reducing ROS formation.

  2. The Anterior Prefrontal Cortex and the Hippocampus Are Negatively Correlated during False Memories

    PubMed Central

    Jeye, Brittany M.; Karanian, Jessica M.; Slotnick, Scott D.

    2017-01-01

    False memories commonly activate the anterior/dorsolateral prefrontal cortex (A/DLPFC) and the hippocampus. These regions are assumed to work in concert during false memories, which would predict a positive correlation between the magnitudes of activity in these regions across participants. However, the A/DLPFC may also inhibit the hippocampus, which would predict a negative correlation between the magnitudes of activity in these regions. In the present functional magnetic resonance imaging (fMRI) study, during encoding, participants viewed abstract shapes in the left or right visual field. During retrieval, participants classified each old shape as previously in the “left” or “right” visual field followed by an “unsure”–“sure”–“very sure” confidence rating. The contrast of left-hits and left-misses produced two activations in the hippocampus and three activations in the left A/DLPFC. For each participant, activity associated with false memories (right–“left”–“very sure” responses) from the two hippocampal regions was plotted as a function of activity in each A/DLPFC region. Across participants, for one region in the left anterior prefrontal cortex, there was a negative correlation between the magnitudes of activity in this region and the hippocampus. This suggests that the anterior prefrontal cortex might inhibit the hippocampus during false memories and that participants engage either the anterior prefrontal cortex or the hippocampus during false memories. PMID:28124986

  3. Severe anterior uveitis associated with idiopathic dacryoadenitis in diabetes mellitus patient

    PubMed Central

    Takahashi, Yasuhiro; Kakizaki, Hirohiko; Ichinose, Akihiro; Iwaki, Masayoshi

    2011-01-01

    A 38-year-old woman with diabetes mellitus complained of acute visual loss in the left eye (20/200) and swollen left upper eyelid. Slit lamp examination of the left eye revealed ciliary injection, posterior synechia iritis, numerous inflammatory cells, and fibrin exudates in the anterior chamber. T1-weighted enhanced magnetic resonance imaging demonstrated left lacrimal gland enhancement with inflammatory spread to the left anterior ocular segment. Blood examination showed increased blood sugar but the other components were within normal limits. The patient was treated with steroid pulse therapy (methylprednisolone 1 g/day × 3 days) under a blood sugar control regimen in consultation with an endocrinologist, after which additional peribulbar injection of triamcinolone acetonide (40 mg) was performed. Resolution of the anterior uveitis and the dacryoadenitis was obtained after 2 months and there was no recurrence 1 year after the therapy. This is a rare case of severe anterior uveitis caused by idiopathic dacryoadenitis in a patient with diabetes mellitus. PMID:21654891

  4. No Baby Left behind

    ERIC Educational Resources Information Center

    Blanton, Dorothy

    2007-01-01

    "No Baby Left Behind" was created to have an impact on the school readiness of children in the community today and in the future. Each year, there are an increasing number of students who have learning difficulties. Many of these problems are preventable. Accidents, poor nutrition (of the mother and/or child), drug use, alcohol use, and lack of…

  5. No Cow Left Behind

    ERIC Educational Resources Information Center

    Remsen, Kenneth A.

    2004-01-01

    As a principal facing the task of figuring out all the complexities of the No Child Left Behind legislation, Kenneth Remsen, has concluded there is a strong belief that testing students is the answer to bringing about improvements in student performance. Because testing seems to be a cornerstone to improving performance, he doesn't understand why…

  6. Accountability Left Behind

    ERIC Educational Resources Information Center

    Testani, Rocco E.; Mayes, Joshua A.

    2008-01-01

    This article describes the reversal of the dismissal of an "unfunded-mandates" challenge to the No Child Left Behind Act (NCLB) brought by the National Education Association (NEA), several of its affiliates, and a number of school districts by the United States Court of Appeals for the Sixth Circuit. The decision in "School District…

  7. Anterior uveitis following eyebrow epilation with alexandrite laser.

    PubMed

    Karabela, Yunus; Eliaçık, Mustafa

    2015-01-01

    Ocular tissues are known to be sensitive to damage from exposure to laser emissions. This study reports the case of a female patient with acute unilateral anterior uveitis caused by alexandrite laser-assisted hair removal of the eyebrows. We report a 38-year-old female who presented with unilateral eye pain, redness, and photophobia after receiving alexandrite (755 nm) laser epilation of both eyebrows. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection and 2+/3+ cells in the anterior chamber. Intraocular pressure and fundus examination were normal. Topical steroids and cycloplegic drops were prescribed for 3 weeks. At the end of the 3-week follow-up, best corrected visual acuity was 20/20, and intraocular pressure and fundus examination were normal in both eyes. The left eye was white, and the anterior chamber was clear. The patient continues to be monitored. In conclusion, without adequate protective eyewear, laser hair removal of the eyebrows with alexandrite laser can lead to ocular damage.

  8. Anterior uveitis following eyebrow epilation with alexandrite laser

    PubMed Central

    Karabela, Yunus; Eliaçık, Mustafa

    2015-01-01

    Ocular tissues are known to be sensitive to damage from exposure to laser emissions. This study reports the case of a female patient with acute unilateral anterior uveitis caused by alexandrite laser-assisted hair removal of the eyebrows. We report a 38-year-old female who presented with unilateral eye pain, redness, and photophobia after receiving alexandrite (755 nm) laser epilation of both eyebrows. Best corrected visual acuity was 20/20 in both eyes. Right eye examination was normal. Left eye examination showed conjunctival injection and 2+/3+ cells in the anterior chamber. Intraocular pressure and fundus examination were normal. Topical steroids and cycloplegic drops were prescribed for 3 weeks. At the end of the 3-week follow-up, best corrected visual acuity was 20/20, and intraocular pressure and fundus examination were normal in both eyes. The left eye was white, and the anterior chamber was clear. The patient continues to be monitored. In conclusion, without adequate protective eyewear, laser hair removal of the eyebrows with alexandrite laser can lead to ocular damage. PMID:26379448

  9. Magnetic resonance imaging of luxury perfusion of the optic nerve head in anterior ischemic optic neuropathy.

    PubMed

    Yovel, Oren S; Katz, Miriam; Leiba, Hana

    2012-09-01

    A 49-year-old woman with painless reduction in visual acuity in her left eye was found to have nonarteritic anterior ischemic optic neuropathy (NAION). Fluorescein angiography revealed optic disc capillary leakage consistent with "luxury perfusion." Contrast-enhanced FLAIR magnetic resonance imaging (MRI) showed marked enhancement of the left optic disc. Resolution of the optic disc edema and the MRI abnormalities followed a similar time course. This report appears unique in documenting the MRI findings of luxury perfusion in NAION.

  10. Selective responses to tonic descending commands by temporal summation in a spinal motor pool

    PubMed Central

    Wang, Wei-Chun; McLean, David L.

    2014-01-01

    Summary Motor responses of varying intensities rely on descending commands to heterogeneous pools of motoneurons. In vertebrates, numerous sources of descending excitatory input provide systematically more drive to progressively less excitable spinal motoneurons. While this presumably facilitates simultaneous activation of motor pools, it is unclear how selective patterns of recruitment could emerge from inputs weighted this way. Here, using in vivo electrophysiological and imaging approaches in larval zebrafish, we find that, despite weighted excitation, more excitable motoneurons are preferentially activated by a midbrain reticulospinal nucleus, by virtue of longer membrane time constants that facilitate temporal summation of tonic drive. We confirm the utility of this phenomenon by assessing the activity of the midbrain and motoneuron populations during a light-driven behavior. Our findings demonstrate that weighted descending commands can generate selective motor responses by exploiting systematic differences in the biophysical properties of target motoneurons and their relative sensitivity to tonic input. PMID:25066087

  11. Diffuse noxious inhibitory controls and nerve injury: restoring an imbalance between descending monoamine inhibitions and facilitations.

    PubMed

    Bannister, Kirsty; Patel, Ryan; Goncalves, Leonor; Townson, Louisa; Dickenson, Anthony H

    2015-09-01

    Diffuse noxious inhibitory controls (DNICs) utilize descending inhibitory controls through poorly understood brain stem pathways. The human counterpart, conditioned pain modulation, is reduced in patients with neuropathy aligned with animal data showing a loss of descending inhibitory noradrenaline controls together with a gain of 5-HT3 receptor-mediated facilitations after neuropathy. We investigated the pharmacological basis of DNIC and whether it can be restored after neuropathy. Deep dorsal horn neurons were activated by von Frey filaments applied to the hind paw, and DNIC was induced by a pinch applied to the ear in isoflurane-anaesthetized animals. Spinal nerve ligation was the model of neuropathy. Diffuse noxious inhibitory control was present in control rats but abolished after neuropathy. α2 adrenoceptor mechanisms underlie DNIC because the antagonists, yohimbine and atipamezole, markedly attenuated this descending inhibition. We restored DNIC in spinal nerve ligated animals by blocking 5-HT3 descending facilitations with the antagonist ondansetron or by enhancing norepinephrine modulation through the use of reboxetine (a norepinephrine reuptake inhibitor, NRI) or tapentadol (μ-opioid receptor agonist and NRI). Additionally, ondansetron enhanced DNIC in normal animals. Diffuse noxious inhibitory controls are reduced after peripheral nerve injury illustrating the central impact of neuropathy, leading to an imbalance in descending excitations and inhibitions. Underlying noradrenergic mechanisms explain the relationship between conditioned pain modulation and the use of tapentadol and duloxetine (a serotonin, NRI) in patients. We suggest that pharmacological strategies through manipulation of the monoamine system could be used to enhance DNIC in patients by blocking descending facilitations with ondansetron or enhancing norepinephrine inhibitions, so possibly reducing chronic pain.

  12. Hemodynamics on abrupt stoppage of centrifugal pumps during left ventricular assist.

    PubMed

    Kono, S; Nishimura, K; Nishina, T; Akamatsu, T; Komeda, M

    2000-01-01

    A magnetically suspended centrifugal pump (MSCP), developed for long-term ventricular assist, is reliable and durable because it has no shaft or seal. However, with nonvalve pumps such as a MSCP, regurgitation occurs when they accidentally stop without cannula clamping. We investigated the hemodynamics during temporary stoppage of a MSCP being used as a left ventricular assist system (LVAS), comparing two inflow cannulation sites. In four sheep (weight, 35-45 kg), microspheres were injected into the left main coronary artery to induce heart failure. An outflow cannula was sutured onto the descending aorta, and two inflow cannulae were inserted into the left atrium and the left ventricle. The MSCP was stopped with both the left ventricular cannula and left atrial cannula clamped, and the hemodynamics and P-V loops were recorded. Each cannula was then unclamped in order, and similar parameters were recorded. LVEDP increased at unclamping of the left ventricular cannula (ULVC), and rose further at unclamping of the left atrial cannula (ULAC). Aortic pressure did not change at ULVC, but decreased at ULAC. The effective systemic flow that subtracted the regurgitant flow through the MSCP from left ventricular output was half at ULVC and almost 0 at ULAC. When stopping centrifugal pumps without circuit clamping, hemodynamic deterioration is less at ULVC than at ULAC. This finding suggests that left ventricular inflow cannulation is recommended to allow more time in emergency situations.

  13. Seawifs Technical Report Series. Volume 2: Analysis of Orbit Selection for Seawifs: Ascending Versus Descending Node

    NASA Technical Reports Server (NTRS)

    Hooker, Stanford B. (Editor); Firestone, Elaine R. (Editor); Gregg, Watson W.

    1992-01-01

    Due to range safety considerations, the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) ocean color instrument may be required to be launched into a near-noon descending node, as opposed to the ascending node used by the predecessor sensor, the Coastal Zone Color Scanner (CZCS). The relative importance of ascending versus descending near-noon orbits was assessed here to determine if descending node will meet the scientific requirements of SeaWiFS. Analyses focused on ground coverage, local times of coverage, solar and viewing geometries (zenith and azimuth angles), and sun glint. Differences were found in the areas covered by individual orbits, but were not important when taken over a 16 day repeat time. Local time of coverage was also different: for ascending node orbits the Northern Hemisphere was observed in the morning and the Southern Hemisphere in the afternoon, while for descending node orbits the Northern Hemisphere was observed in the afternoon and the Southern in the morning. There were substantial differences in solar azimuth and spacecraft azimuth angles both at equinox and at the Northern Hemisphere summer solstice. Negligible differences in solar and spacecraft zenith angles, relative azimuth angles, and sun glint were obtained at the equinox. However, large differences were found in solar zenith angles, relative azimuths, and sun glint for the solstice. These differences appeared to compensate across the scan, however, an increase in sun glint in descending node over that in ascending node on the western part of the scan was compensated by a decrease on the eastern part of the scan. Thus, no advantage or disadvantage could be conferred upon either ascending node or descending node for noon orbits. Analyses were also performed for ascending and descending node orbits that deviated from a noon equator crossing time. For ascending node, afternoon orbits produced the lowest mean solar zenith angles in the Northern Hemisphere, and morning orbits produced

  14. Minimally invasive video-assisted graft replacement of a descending thoracic aortic aneurysm.

    PubMed

    Woo, Y Joseph; Childers, Henry

    2003-01-01

    Standard surgical therapy of descending thoracic aortic aneurysms entails obligate extensive operative exposure that is associated with significant postoperative pain and morbidity. A 70-year-old patient with multiple significant comorbidities including severe chronic obstructive pulmonary disease (force expiratory volume at 1 second, 0.66 L) presented with a highly symptomatic, eccentric, descending thoracic aortic aneurysm. The patient underwent successful minimally invasive video-assisted graft repair of this aneurysm. This report represents the first known clinical application of this operative approach.

  15. [Fissured leiomyosarcoma of the descending thoracic aorta. Apropos of a case and review of the literature].

    PubMed

    Glock, Y; Laghzaoui, A; Wang, J; Delisle, M B; Bachaud, J M; Massabuau, P; Roux, D; Fournial, G

    1997-09-01

    The authors report a case of leiomyosarcoma of the descending thoracic aorta presenting with dissection and operated as an emergency. Palliative repair from the oncological point of view comprised the insertion of an aorto-aortic tube. Local radiotherapy was completed by a course of chemotherapy controlling multiple bone and adrenal metastases at 15 months. A review of the literature did not reveal any other cases of haemorrhagic leiomyosarcoma of the descending thoracic aorta. Histological findings were similar to those of the reported case as were the therapeutic attitudes to limit or extinguish disseminated metastases explained by the arterial character of the tumour.

  16. Preprosthetic movement of anterior teeth.

    PubMed

    Melsen, B

    1982-05-01

    Preprosthetic movement of anterior teeth is often performed on patients with missing anterior teeth, providing a better basis for subsequent bridgework. This can often be achieved by horizontal tooth movements of a tipping or translatory art whilst other patients present problems of a vertical nature with a deep overbite inconsistent with a healthy periodontal status. Intrusive tooth movements are needed as changes in facial height are not tolerated. The importance of understanding the biological basis for tooth movements in the planning of the biomechanics is stressed. Forces should be monitored according to the amount of general and local bone loss.

  17. On the right side? A longitudinal study of left- versus right-lateralized semantic dementia.

    PubMed

    Kumfor, Fiona; Landin-Romero, Ramon; Devenney, Emma; Hutchings, Rosalind; Grasso, Roberto; Hodges, John R; Piguet, Olivier

    2016-03-01

    The typical presentation of semantic dementia is associated with marked, left predominant anterior temporal lobe atrophy and with changes in language. About 30% of individuals, however, present with predominant right anterior temporal lobe atrophy, usually accompanied by behavioural changes and prosopagnosia. Here, we aimed to establish whether these initially distinct clinical presentations evolve into a similar syndrome at the neural and behavioural level. Thirty-one patients who presented with predominant anterior temporal lobe atrophy were included. Based on imaging, patients were categorized as either predominant left (n = 22) or right (n = 9) semantic dementia. Thirty-three Alzheimer's disease patients and 25 healthy controls were included for comparison. Participants completed the Addenbrooke's Cognitive Examination, a Face and Emotion Processing Battery and the Cambridge Behavioural Inventory, and underwent magnetic resonance imaging annually. Longitudinal neuroimaging analyses showed greater right temporal pole atrophy in left semantic dementia than Alzheimer's disease, whereas right semantic dementia showed greater orbitofrontal and left temporal lobe atrophy than Alzheimer's disease. Importantly, direct comparisons between semantic dementia groups revealed that over time, left semantic dementia showed progressive thinning in the right temporal pole, whereas right semantic dementia showed thinning in the orbitofrontal cortex and anterior cingulate. Behaviourally, longitudinal analyses revealed that general cognition declined in all patients. In contrast, patients with left and right semantic dementia showed greater emotion recognition decline than Alzheimer's disease. In addition, left semantic dementia showed greater motivation loss than Alzheimer's disease. Correlational analyses revealed that emotion recognition was associated with right temporal pole, right medial orbitofrontal and right fusiform integrity, while changes in motivation were associated

  18. SU-E-T-292: Dosimetric Advantage of Prone Breast Radiotherapy for Korean Left-Sided Breast Cancer Patients

    SciTech Connect

    Chung, Y; Shin, J; Yu, J; Park, W; Choi, D; Huh, S; Han, Y; Kim, J

    2015-06-15

    Purpose: To evaluate the dosimetric benefit of prone breast radiotherapy for Korean left-sided early-stage breast cancer patients who have relatively small breast Methods: From April to June, 2014, 10 left-sided breast cancer patients received the whole breast irradiation in prone position after partial mastectomy with sentinel lymph node biopsy or axillary lymph node dissection. All patients were pTmi-2N0-1mi. Each patient underwent two computed tomoradiography (CT) simulations in supine and prone positions. The whole breast, ipsilateral lung, heart, and left anterior descending coronary artery (LAD) were contoured on each simulation CT images, and then tangential-fields treatment plan in each position was designed for the whole breast irradiation with the total dose of 50 Gy in 2 Gy fractions. Dose-volume histograms of two setups were compared for target coverage and radiation dose to normal organs with Wilcoxon signed rank tests. Results: The median age of patients was 47 years (range, 37 to 53). The median chest size was 82.5 cm (range, 75 to 90) and bra cup size was A in 4, B in 4, and C in 2 patients. The radiation dose to the whole breast was similar when comparing mean dose (Dmean) and dose covering 95% of the breast volume, but maximum dose (Dmax) of breast was higher in supine (median 52.3 vs. 52.7 Gy, p=0.013). Prone position reduced significantly the radiation dose in ipsilateral lung, heart, and LAD by median 5.7, 1.1, and 6.9 Gy of Dmean (p=0.005, 0.007, and 0.005) and 28.2, 18.8, and 35.0 Gy of Dmax (p=0.005, 0.005, and 0.007), respectively. Conclusion: Prone breast radiotherapy could be beneficial for Korean breast cancer patients since it substantially spared normal organs while achieving adequate coverage of the breast tissue. Further prospective study is required to validate the potential benefit of prone breast radiotherapy.

  19. Total Mechanical Unloading Minimizes Metabolic Demand of Left Ventricle and Dramatically Reduces Infarct Size in Myocardial Infarction

    PubMed Central

    Kakino, Takamori; Arimura, Takahiro; Sakamoto, Takafumi; Nishikawa, Takuya; Sakamoto, Kazuo; Ikeda, Masataka; Kishi, Takuya; Ide, Tomomi; Sunagawa, Kenji

    2016-01-01

    Background Left ventricular assist device (LVAD) mechanically unloads the left ventricle (LV). Theoretical analysis indicates that partial LVAD support (p-LVAD), where LV remains ejecting, reduces LV preload while increases afterload resulting from the elevation of total cardiac output and mean aortic pressure, and consequently does not markedly decrease myocardial oxygen consumption (MVO2). In contrast, total LVAD support (t-LVAD), where LV no longer ejects, markedly decreases LV preload volume and afterload pressure, thereby strikingly reduces MVO2. Since an imbalance in oxygen supply and demand is the fundamental pathophysiology of myocardial infarction (MI), we hypothesized that t-LVAD minimizes MVO2 and reduces infarct size in MI. The purpose of this study was to evaluate the differential impact of the support level of LVAD on MVO2 and infarct size in a canine model of ischemia-reperfusion. Methods In 5 normal mongrel dogs, we examined the impact of LVAD on MVO2 at 3 support levels: Control (no LVAD support), p-LVAD and t-LVAD. In another 16 dogs, ischemia was induced by occluding major branches of the left anterior descending coronary artery (90 min) followed by reperfusion (300 min). We activated LVAD from the beginning of ischemia until 300 min of reperfusion, and compared the infarct size among 3 different levels of LVAD support. Results t-LVAD markedly reduced MVO2 (% reduction against Control: -56 ± 9%, p<0.01) whereas p-LVAD did less (-21 ± 14%, p<0.05). t-LVAD markedly reduced infarct size compared to p-LVAD (infarct area/area at risk: Control; 41.8 ± 6.4, p-LVAD; 29.1 ± 5.6 and t-LVAD; 5.0 ± 3.1%, p<0.01). Changes in creatine kinase-MB paralleled those in infarct size. Conclusions Total LVAD support that minimizes metabolic demand maximizes the benefit of LVAD in the treatment of acute myocardial infarction. PMID:27124411

  20. 31P NMR 2D Mapping of Creatine Kinase Forward Flux Rate in Hearts with Postinfarction Left Ventricular Remodeling in Response to Cell Therapy

    PubMed Central

    Gao, Ling; Cui, Weina; Zhang, Pengyuan; Jang, Albert; Zhu, Wuqiang; Zhang, Jianyi

    2016-01-01

    Utilizing a fast 31P magnetic resonance spectroscopy (MRS) 2-dimensional chemical shift imaging (2D-CSI) method, this study examined the heterogeneity of creatine kinase (CK) forward flux rate of hearts with postinfarction left ventricular (LV) remodeling. Immunosuppressed Yorkshire pigs were assigned to 4 groups: 1) A sham-operated normal group (SHAM, n = 6); 2) A 60 minutes distal left anterior descending coronary artery ligation and reperfusion (MI, n = 6); 3) Open patch group; ligation injury plus open fibrin patch over the site of injury (Patch, n = 6); and 4) Cell group, hiPSCs-cardiomyocytes, -endothelial cells, and -smooth muscle cells (2 million, each) were injected into the injured myocardium pass through a fibrin patch (Cell+Patch, n = 5). At 4 weeks, the creatine phosphate (PCr)/ATP ratio, CK forward flux rate (Flux PCr→ATP), and k constant of CK forward flux rate (kPCr→ATP) were severely decreased at border zone myocardium (BZ) adjacent to MI. Cell treatment results in significantly increase of PCr/ATP ratio and improve the value of kPCr→ATP and Flux PCr→ATP in BZ myocardium. Moreover, the BZ myocardial CK total activity and protein expression of CK mitochondria isozyme and CK myocardial isozyme were significantly reduced, but recovered in response to cell treatment. Thus, cell therapy results in improvement of BZ bioenergetic abnormality in hearts with postinfarction LV remodeling, which is accompanied by significantly improvements in BZ CK activity and CK isozyme expression. The fast 2D 31P MR CSI mapping can reliably measure the heterogeneity of bioenergetics in hearts with post infarction LV remodeling. PMID:27606901

  1. Spontaneous resolution of double anterior chamber with perforation of Descemet's membrane in deep anterior lamellar keratoplasty.

    PubMed

    Venkatraman, Arvind

    2012-05-01

    Deep anterior lamellar keratoplasty (DALK) using Dr. Anwar's big bubble technique was performed for a patient with granular dystrophy. Intraoperatively, a perforation of the Descemet's membrane (DM) was noted inferonasally. Though the surgery was completed, the donor graft appeared to have an intact endothelium, which was inadvertently left behind by the surgeon. Intraoperatively, there was a perforation of inferonasal DM and surgery was completed by inadvertently placing a donor with an intact endothelium. Postoperatively the patient presented with a complete DM detachment and a resultant double anterior chamber (DAC). In spite of two attempts at an air tamponade on the first and fifth post operative days, the DAC still persisted. Surprisingly, during the 6(th) week follow up visit, there was a complete resolution of the DAC as well as total recovery of vision. This interesting case clearly exemplifies that, in spite of failed attempts at air tamponade, a DM detachment and a DAC due to DM perforation following a DALK procedure can resolve spontaneously with good visual outcome.

  2. Left musculus sternalis.

    PubMed

    Arráez-Aybar, L A; Sobrado-Perez, J; Merida-Velasco, J R

    2003-07-01

    During routine dissection in the Morphological Sciences Department II of the Universidad Complutense de Madrid, the presence of a sternalis muscle was observed in the left hemithorax of a 70-year-old male cadaver. We report on its position, relationships, and innervation, as well as its clinical relevance, indicating some guidelines for its physical examination. We also present a brief overview of the existing literature regarding the nomenclature, historical reports, and incidence of this muscle.

  3. Meningeal Layers Around Anterior Clinoid Process as a Delicate Area in Extradural Anterior Clinoidectomy : Anatomical and Clinical Study

    PubMed Central

    Yoon, Byul Hee; Kim, Han Kyu; Park, Mun Sun; Kim, Seong Min; Lanzino, Giuseppe

    2012-01-01

    Objective Removal of the anterior clinoid process (ACP) is an essential process in the surgery of giant or complex aneurysms located near the proximal internal carotid artery or the distal basilar artery. An extradural clinoidectomy must be performed within the limits of the meningeal layers surrounding the ACP to prevent morbid complications. To identify the safest method of extradural exposure of the ACP, anatomical studies were done on cadaver heads. Methods Anatomical dissections for extradural exposure of the ACP were performed on both sides of seven cadavers. Before dividing the frontotemporal dural fold (FTDF), we measured its length from the superomedial apex attached to the periorbita to the posterolateral apex which connects to the anterosuperior end of the cavernous sinus. Results The average length of the FTDF on cadaver dissections was 7 mm on the right side and 7.14 mm on the left side. Cranial nerves were usually exposed when cutting FTDF more than 7 mm of the FTDF. Conclusion The most delicate area in an extradural anterior clinoidectomy is the junction of the FTDF and the anterior triangular apex of the cavernous sinus. The FTDF must be cut from the anterior side of the triangle at the periorbital side rather than from the dural side. The length of the FTDF incision must not exceed 7 mm to avoid cranial nerve injury. PMID:23133730

  4. Improving left spatial neglect through music scale playing.

    PubMed

    Bernardi, Nicolò Francesco; Cioffi, Maria Cristina; Ronchi, Roberta; Maravita, Angelo; Bricolo, Emanuela; Zigiotto, Luca; Perucca, Laura; Vallar, Giuseppe

    2017-03-01

    The study assessed whether the auditory reference provided by a music scale could improve spatial exploration of a standard musical instrument keyboard in right-brain-damaged patients with left spatial neglect. As performing music scales involves the production of predictable successive pitches, the expectation of the subsequent note may facilitate patients to explore a larger extension of space in the left affected side, during the production of music scales from right to left. Eleven right-brain-damaged stroke patients with left spatial neglect, 12 patients without neglect, and 12 age-matched healthy participants played descending scales on a music keyboard. In a counterbalanced design, the participants' exploratory performance was assessed while producing scales in three feedback conditions: With congruent sound, no-sound, or random sound feedback provided by the keyboard. The number of keys played and the timing of key press were recorded. Spatial exploration by patients with left neglect was superior with congruent sound feedback, compared to both Silence and Random sound conditions. Both the congruent and incongruent sound conditions were associated with a greater deceleration in all groups. The frame provided by the music scale improves exploration of the left side of space, contralateral to the right hemisphere, damaged in patients with left neglect. Performing a scale with congruent sounds may trigger at some extent preserved auditory and spatial multisensory representations of successive sounds, thus influencing the time course of space scanning, and ultimately resulting in a more extensive spatial exploration. These findings offer new perspectives also for the rehabilitation of the disorder.

  5. Transthoracic measurement of left coronary artery flow reserve improves the diagnostic value of routine dipyridamole-atropine stress echocardiogram

    PubMed Central

    Wejner-Mik, Paulina; Nouri, Aria; Szymczyk, Ewa; Krzemińska-Pakuła, Maria; Lipiec, Piotr

    2013-01-01

    Introduction We hypothesized that coronary flow reserve (CFR) in the left anterior descending artery (LAD) can be effectively measured during an accelerated dipyridamole-atropine stress echocardiography (DASE) protocol to improve the diagnostic performance of the test. Material and methods In 64 patients with suspected or known coronary artery disease scheduled for coronary angiography DASE with concomitant CFR measurement in LAD was performed. Results Coronary flow reserve measurement and calculation were feasible in 83% of patients. The positive predictive value of undetectable LAD flow was 81% for severe LAD disease. Measured values of CFR were in the range 1.3–4.1 (mean: 2.2 ±0.7). Significantly lower CFR was found in patients with LAD disease (1.97 ±0.62 vs. 2.55 ±0.57, p = 0.0015). The optimal cutoff for detecting ≥ 50% stenosis was CFR ≤ 2.1 (ROC AUC 0.776), corresponding with 68% sensitivity and 84% specificity. In patients with negative DASE results 67% of patients with LAD disease had abnormal CFR, whereas in patients with a positive DASE result 92% of patients with normal LAD had normal CFR. The DASE diagnostic accuracy for the detection of coronary artery disease (CAD) increased from 75% to 85% when CFR measurement was added to wall motion abnormality (WMA) analysis. No test with both abnormalities was false positive for the detection of coronary disease. Conclusions Incorporation of CFR measurement into WMA-based stress echocardiography is feasible even in an accelerated DASE protocol and can be translated into an approximate gain of 10% in overall test accuracy. PMID:24273560

  6. Echocardiographic assessment of abnormal left ventricular relaxation in man.

    PubMed Central

    Upton, M T; Gibson, D G; Brown, D J

    1976-01-01

    In 64 patients requiring cardiac catheterization for chest pain, echocardiograms showing anterior mitral leaflet and left ventricular cavity simultaneously were recorded. These were digitized and their first derivatives computed in order to study time relations between mitral valve and left ventricular wall movement in early distole. In 10 patients with normal left ventricular angiograms and coronary arteriograms, mitral valve opening began 1-1 +/- 9-3 ms (mean +/- SD) before the onset of outward wall movement, and reached peak opening velocity 2-0 +/- 13 ms after maximum rate of change of dimension. Virtually identical time relations were seen in 15 patients with normal left ventricular angiograms but with obstructive coronary artery disease (3-6 +/- 9-3 ms and 0-7 +/- 7-3 ms, respectively). These close relations were lost in patients with segmental abnormalities of contraction on left ventricular angiogram. In 19 such patients with normal septal motion, outward wall movement began 53 +/- 31 ms before the onset of anterior movement of the mitral valve leaflet, and this isovolumic wall movement accounted for 31 per cent of the total diastolic excursion. In 9 patients with reversed septal movement, these abnormalities were greater, 92 +/- 39 ms and 33 per cent, respectively, while in 11 patients with diffuse left ventricular involvement they were small, 5-5 +/- 13 ms and 3 per cent. Frame-by-frame digitization of cineangiograms was used to confirm these findings which appear to reflect an abnormal change in left ventricular cavity shape during isovolumic relaxation. Images PMID:973873

  7. Anterior cruciate ligament - updating article.

    PubMed

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  8. Close view looking to left side of statue showing left ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Close view looking to left side of statue showing left hand, shield, and laurel wreath - U.S. Capitol, Statue of Freedom, Intersection of North, South, & East Capitol Streets & Capitol Mall, Washington, District of Columbia, DC

  9. The Structural Plasticity of White Matter Networks Following Anterior Temporal Lobe Resection

    ERIC Educational Resources Information Center

    Yogarajah, Mahinda; Focke, Niels K.; Bonelli, Silvia B.; Thompson, Pamela; Vollmar, Christian; McEvoy, Andrew W.; Alexander, Daniel C.; Symms, Mark R.; Koepp, Matthias J.; Duncan, John S.

    2010-01-01

    Anterior temporal lobe resection is an effective treatment for refractory temporal lobe epilepsy. The structural consequences of such surgery in the white matter, and how these relate to language function after surgery remain unknown. We carried out a longitudinal study with diffusion tensor imaging in 26 left and 20 right temporal lobe epilepsy…

  10. An anatomic and clinical study of the adductor magnus tendon-descending genicular artery bone flap.

    PubMed

    Huang, Dong; Wang, Hai-Wen; Xu, Da-Chuan; Wang, Hong-Gang; Wu, Wei-Zhi; Zhang, Hui-Ru

    2011-01-01

    The composite tissue flap of the descending genicular vessels with the adductor magnus tendon is a newly developed, reliable method to repair the Achilles tendon and relevant skin defects. The aim of this study was to evaluate the anatomy of the adductor magnus tendon-descending genicular artery bone flap, and the feasibility and value for the repair of the Achilles tendon and relevant skin defects. There were 34 adult specimens used for the anatomy of this flap. The descending genicular artery originates 10.5 ± 1.6 cm above the adductor tubercle, with a diameter of 1.8 ± 0.6 mm and a length of 1.2 ± 0.5 cm. Its articular branch is distributed in the adductor magnus tendon and the medial condyle of the femur. The saphenous branch has a diameter of 1.1 ± 0.3 mm and is distributed in the skin of the upper medial calf. A total of 16 cases of trauma-induced Achilles tendon damage and calcaneus and skin defects were repaired with the vascularized adductor magnus tendon bone flap, including the reconstruction of Achilles tendon insertion and repair of relevant skin defects. All of the composite tissue flaps were viable, the skin sensation of the flaps was recovered, and all patients walked with a normal gait. Our results suggested that the adductor magnus tendon-descending genicular artery bone flap is an alternative method to repair composite tissue defects of the Achilles tendon.

  11. Descending brain neurons in the cricket Gryllus bimaculatus (de Geer): auditory responses and impact on walking.

    PubMed

    Zorović, Maja; Hedwig, Berthold

    2013-01-01

    The activity of four types of sound-sensitive descending brain neurons in the cricket Gryllus bimaculatus was recorded intracellularly while animals were standing or walking on an open-loop trackball system. In a neuron with a contralaterally descending axon, the male calling song elicited responses that copied the pulse pattern of the song during standing and walking. The accuracy of pulse copying increased during walking. Neurons with ipsilaterally descending axons responded weakly to sound only during standing. The responses were mainly to the first pulse of each chirp, whereas the complete pulse pattern of a chirp was not copied. During walking the auditory responses were suppressed in these neurons. The spiking activity of all four neuron types was significantly correlated to forward walking velocity, indicating their relevance for walking. Additionally, injection of depolarizing current elicited walking and/or steering in three of four neuron types described. In none of the neurons was the spiking activity both sufficient and necessary to elicit and maintain walking behaviour. Some neurons showed arborisations in the lateral accessory lobes, pointing to the relevance of this brain region for cricket audition and descending motor control.

  12. Ethnic Identity and Propensity for Practice among African-Descended MSW Students

    ERIC Educational Resources Information Center

    Pierce, Walter J.; Singleton, Sharron M.; Hudson, Rhonda E.

    2011-01-01

    This article explores the difference between ethnic identity scores for African-descended MSW students who are native to this country, who are first generation born of immigrant parents, and who are foreign-born Black immigrants. The research further explores whether ethnic identity is associated with the students' commitment to work with their…

  13. Anatomical characterization of subcortical descending projections to the inferior colliculus in mouse.

    PubMed

    Patel, Mili B; Sons, Stacy; Yudintsev, Georgiy; Lesicko, Alexandria M H; Yang, Luye; Taha, Gehad A; Pierce, Scott M; Llano, Daniel A

    2017-03-01

    Descending projections from the thalamus and related structures to the midbrain are evolutionarily highly conserved. However, the basic organization of this auditory thalamotectal pathway has not yet been characterized. The purpose of this study was to obtain a better understanding of the anatomical and neurochemical features of this pathway. Analysis of the distributions of retrogradely labeled cells after focal injections of retrograde tracer into the inferior colliculus (IC) of the mouse revealed that most of the subcortical descending projections originated in the brachium of the IC and the paralaminar portions of the auditory thalamus. In addition, the vast majority of thalamotectal cells were found to be negative for the calcium-binding proteins calbindin, parvalbumin, or calretinin. Using two different strains of GAD-GFP mice, as well as immunostaining for GABA, we found that a subset of neurons in the brachium of the IC is GABAergic, suggesting that part of this descending pathway is inhibitory. Finally, dual retrograde injections into the IC and amygdala plus corpus striatum as well into the IC and auditory cortex did not reveal any double labeling. These data suggest that the thalamocollicular pathway comprises a unique population of thalamic neurons that do not contain typical calcium-binding proteins and do not project to other paralaminar thalamic forebrain targets, and that a previously undescribed descending GABAergic pathway emanates from the brachium of the IC. J. Comp. Neurol. 525:885-900, 2017. © 2016 Wiley Periodicals, Inc.

  14. PBF Reactor Building (PER620). Reactor vessel descends into pit, still ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    PBF Reactor Building (PER-620). Reactor vessel descends into pit, still under control of handling beams and pulleys. Vertical-lift door (to Reactor Building) is in background. Photographer: Holmes. Date: February 26, 1970. INEEL negative no. 70-986 - Idaho National Engineering Laboratory, SPERT-I & Power Burst Facility Area, Scoville, Butte County, ID

  15. Establishment of left-right asymmetric innervation in the lancelet oral region.

    PubMed

    Kaji, T; Aizawa, S; Uemura, M; Yasui, K

    2001-07-09

    Lancelets (amphioxus) exhibit a remarkable asymmetric development in the anterior body region, which is reflected in the peripheral nervous system even at adulthood. Not all of the anterior nerves are involved, but the left third to fifth nerves are clearly asymmetric. To trace the developmental process responsible for asymmetric innervation, the peripheral nerves in the anterior region were studied in pre- and mid-metamorphic larvae, 1-cm-long juveniles, and in adults by using whole-mount immunostaining. The mouth changes in size and location during larval life before moving ventrally and, in conjunction with this change, nerves in the oral region are also modified. The left second nerve initially innervates the oral region, but this connection is secondarily lost. As the mouth expands and shifts posteriorly, the left fifth to ninth nerves join the left third and fourth in the innervation of the oral region. The left third to sixth nerves anastomose with the oral nerve ring, which encircles the mouth on the left side. In the juveniles and adults, there are two nerve plexuses that run parallel to the margin of the oral hood. The innermost of these, the "inner oral-hood nerve plexus", is asymmetrically connected with the left third to fifth nerves on both sides. The other, the "outer oral-hood nerve plexus", is ipsilaterally connected with the third to seventh nerves on both sides. The velar nerve ring is also innervated asymmetrically by the left fourth and fifth nerves. From these observations, we suggest that the oral nerve ring is the precursor of both the inner oral-hood nerve plexus and the velar nerve ring, and that the asymmetric innervation retained in adult lancelets is related to the early anastomosis of the left nerves with the oral nerve ring. We also show that, contrary to the persistent asymmetric innervation, the axonal patterns of the anterior peripheral nervous system in developing lancelets can change.

  16. Quantifying the Reproducibility of Heart Position During Treatment and Corresponding Delivered Heart Dose in Voluntary Deep Inhalation Breath Hold for Left Breast Cancer Patients Treated With External Beam Radiotherapy

    SciTech Connect

    McIntosh, Alyson; Shoushtari, Asal N.; Benedict, Stanley H.; Read, Paul W.; Wijesooriya, Krishni

    2011-11-15

    Purpose: Voluntary deep inhalation breath hold (VDIBH) reduces heart dose during left breast irradiation. We present results of the first study performed to quantify reproducibility of breath hold using bony anatomy, heart position, and heart dose for VDIBH patients at treatment table. Methods and Materials: Data from 10 left breast cancer patients undergoing VDIBH whole-breast irradiation were analyzed. Two computed tomography (CT) scans, free breathing (FB) and VDIBH, were acquired to compare dose to critical structures. Pretreatment weekly kV orthogonal images and tangential ports were acquired. The displacement difference from spinal cord to sternum across the isocenter between coregistered planning Digitally Reconstructed Radiographs (DRRs) and kV imaging of bony thorax is a measure of breath hold reproducibility. The difference between bony coregistration and heart coregistration was the measured heart shift if the patient is aligned to bony anatomy. Results: Percentage of dose reductions from FB to VDIBH: mean heart dose (48%, SD 19%, p = 0.002), mean LAD dose (43%, SD 19%, p = 0.008), and maximum left anterior descending (LAD) dose (60%, SD 22%, p = 0.008). Average breath hold reproducibility using bony anatomy across the isocenter along the anteroposterior (AP) plane from planning to treatment is 1 (range, 0-3; SD, 1) mm. Average heart shifts with respect to bony anatomy between different breath holds are 2 {+-} 3 mm inferior, 1 {+-} 2 mm right, and 1 {+-} 3 mm posterior. Percentage dose changes from planning to delivery: mean heart dose (7%, SD 6%); mean LAD dose, ((9%, SD 7%)S, and maximum LAD dose, (11%, SD 11%) SD 11%, p = 0.008). Conclusion: We observed excellent three-dimensional bony registration between planning and pretreatment imaging. Reduced delivered dose to heart and LAD is maintained throughout VDIBH treatment.

  17. Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model.

    PubMed

    Hikichi, Yutaka; Umezu, Mitsuo; Node, Koichi; Iwasaki, Kiyotaka

    2017-01-01

    Stent struts protruding into ostial side branch called "jailed strut" at bifurcation lesions is a likely cause of thrombus formation. We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model. The referenced LM bifurcation angle data of 209 patients were stratified by tertiles focusing on the angle between the LM trunk (LMT) and left anterior descending artery (LAD). A bifurcation model was fabricated with angles of 129°, 122.2°, and 76.4° for LMT-LAD, LMT-left circumflex (LCx), and LAD-LCx, respectively, and with diameters of 5, 3.75, and 3.5 mm for LMT, LAD, and LCx, respectively; these diameters fulfill Murray's law. A 75 % stenosis was included along the LMT. One-time and three-time KBIs were conducted using two-link Nobori and three-link Xience Xpedition (n = 6 each). The ISA area was quantified using micro-CT. Three-time KBI was effective in reducing the ISA area compared with one-time KBI for both the Nobori (p = 0.05) and Xience Xpedition (p = 0.07). The ISA area was smaller in the Nobori than in the Xience Xpedition, both in one-time and three-time KBI (one-time KBI: p = 0.003; three-time KBI: p = 0.001). Our findings of this study on reducing the ISA area by focusing on an interventional technique and stent design may help to improve coronary bifurcation intervention for a possibly better long-term clinical outcome.

  18. Bilateral Leg Ischemia due to Descending Aortic Dissection: Combined Treatment with Femoro-femoral Cross-over Bypass and Unilateral Aorto-iliac stenting

    SciTech Connect

    Frahm, Christian; Widmer, Matthias K.; Do, Dai-Do

    2002-10-15

    We report a case of aorto-iliac occlusion due to descending aortic dissection treated initially with femoro-femoral cross-over bypass and secondarily with unilateral aorto-iliac stenting because of progression of the dissection. A 75-year-old man presented with acute ischemia of the right leg. CT revealed occlusion of the right iliac artery due to descending aortic dissection with a clotted false lumen. Three days after femoro-femoral cross-over bypass,ischemia of both legs developed and angiography demonstrated occlusion of the infrarenal aorta and left common iliac artery. Two overlapping stents were deployed in these vessel segments. Completion angiography confirmed successful recanalization with adequate distal flow and good patency of the cross-over bypass. Peripheral pulses were restored and the patient's symptoms were alleviated. Combined treatment with cross-over bypass and endovascular recanalization may be considered as a viable alternative to open aortic surgery in selected cases of complicated aorto-iliac dissection with bilateral leg ischemia.

  19. Transposition of the great arteries associated with a double left ventricular outflow tract.

    PubMed Central

    Kinsley, R H; Levin, S E; O'Donovan, T G

    1979-01-01

    A case is described in which, at semilunar valve level, the aorta and pulmonary artery arose from inappropriate ventricles. Despite this, the outflow tracts to both vessels originated from the left ventricle. Embryologically, it is speculated that this anomaly is the result of normal rotation of the proximal conus, without concomitant truncal inversion, and excessive leftward shift of the proximal conus and conal septum or anterior and rightward deviation of the anterior segment of the ventricular septum. Surgical repair using a double conduit between the right ventricle and pulmonary artery and left ventricle and aorta, respectively, was unsuccessful. Images PMID:508480

  20. Left ventricular pseudoaneurysm perceived as a left lung mass

    PubMed Central

    Yaliniz, Hafize; Gocen, Ugur; Atalay, Atakan; Salih, Orhan Kemal

    2016-01-01

    Left ventricular pseudoaneurysm is a rare complication of aneurysmectomy. We present a case of a surgically treated left ventricular pseudoaneurysm, which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation, and surgical repair are described. PMID:27516793

  1. A multi-disciplinary approach to congenitally missing anterior teeth.

    PubMed

    Galler, David; Quiong, Caroline; Galler, Jeffrey

    2009-01-01

    Congenitally missing teeth are not an unusual occurrence. What makes this case study unique is the combination of restorative challenges offered. The patient presented with the permanent upper right cuspid and lower anterior right and left central incisors congenitally missing, and with an underdeveloped upper right lateral incisor. Distinctive existing occlusion and tooth alignment difficulties precluded a simple approach of merely extracting the residual primary teeth and replacing the missing teeth prosthetically. Using orthodontics to create ideal interocclusal and interarch space was critical in preparing this case for prosthetic restoration.

  2. Anterior opercular syndrome induced by Epstein-Barr virus encephalitis.

    PubMed

    Matsushima, Takashi; Nishioka, Kenya; Tanaka, Ryota; Yokoyama, Kazumasa; Hattori, Nobutaka

    2016-01-01

    We report a 19-year-old female presenting with fever, drooling, anarthria, and voluntary facial movement disruption, characteristic of anterior opercular syndrome (AOS). Serological examination revealed Epstein-Barr virus (EBV) infection following acute encephalitis with severe ataxia. A single-photon emission computerized tomography (SPECT) examination indicated hypoperfusion in the left perisylvian region, bilateral thalamus, occipital lobe, and cerebellum. This is the first report of AOS related to EBV encephalitis. SPECT was a useful method for detecting the damaged region of the operculum. In addition, AOS is a clinically distinct entity that may help us understand the mechanisms of language circuits within the operculum.

  3. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    PubMed Central

    Yanık, Ahmet; Akçay, Murat; Menekşe, Serdar; Yazgan, Uğur Gökmen

    2016-01-01

    A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month. PMID:27891151

  4. Famous People Knowledge and the Right and Left Temporal Lobes

    PubMed Central

    Snowden, Julie S.; Thompson, Jennifer C.; Neary, David

    2012-01-01

    It is generally accepted that the anterior temporal lobes support knowledge of famous people. The specific roles of the right and left temporal lobe remain a subject of debate, with some studies suggesting differential roles based on modality (visual versus verbal information) and others category (person knowledge versus general semantics). The present study re-examined performance of semantic dementia patients with predominantly right and predominantly left temporal lobe atrophy on famous face, famous name and general semantic tasks, with the specific aim of testing the hypothesis that the right temporal lobe has a privileged role for person knowledge and the left temporal lobe for general semantic knowledge. Comparisons of performance rankings across tasks showed no evidence to support this hypothesis. By contrast, there was robust evidence from naming, identification and familiarity measures for modality effects: right-sided atrophy being associated with relatively greater impairment for faces and visual tasks and left-sided atrophy for names and verbal tasks. A double dissociation in test scores in two patients reinforced these findings. The data present a challenge for the influential ‘semantic hub’ model, which views the anterior temporal lobes as an area of convergence in which semantic information is represented in amodal form. PMID:22207421

  5. DYNAMICS OF VERTICAL THREADS AND DESCENDING KNOTS IN A HEDGEROW PROMINENCE

    SciTech Connect

    Chae, Jongchul

    2010-05-01

    The existence and behavior of vertical fine structures of plasma-threads and knots-are a significant observational clue to understanding the magnetic structure and dynamics of quiescent prominences on the quiet Sun. Based on the equation of motion in ideal MHD, we reason that the non-hydrostatic support of plasma against gravity in general requires either the motion of plasma with a high value of downward acceleration (dynamical support) or the role of horizontal magnetic fields (magnetic support). By carefully tracking the motion of several bright threads seen in a hedgerow prominence observed by the Solar Optical Telescope aboard Hinode, we confirm that these threads are essentially static and stable, which negates the dynamic support. The application of the Kippenhahn-Schlueter solution suggests that they may be supported by sagged magnetic field lines with a sag angle of about 43{sup 0}. We also track several bright descending knots and find that their descending speeds range from 10 to 30 km s{sup -1}, with a mean value of 16 km s{sup -1}, and their vertical accelerations from -0.10 to 0.10 km s{sup -2}, with a mean of practically zero. This finding suggests that these knots are basically supported by horizontal magnetic fields against gravity even when they descend, and the complex variations of their descending speeds should be attributed to small imbalances between gravity and the force of magnetic tension. Furthermore, some knots are observed to impulsively get accelerated downward from time to time. We conjecture that these impulsive accelerations are a result of magnetic reconnection and the subsequent interchange of magnetic configuration between a knot and its surrounding structure. It is proposed that this process of reconnection and interchange not only initiates the descending motion of the knots, but also allows knots to keep falling long distance through the medium permeated by horizontal magnetic fields.

  6. Postsynaptic potentiation of corticospinal projecting neurons in the anterior cingulate cortex after nerve injury

    PubMed Central

    2014-01-01

    Long-term potentiation (LTP) is the key cellular mechanism for physiological learning and pathological chronic pain. In the anterior cingulate cortex (ACC), postsynaptic recruitment or modification of AMPA receptor (AMPAR) GluA1 contribute to the expression of LTP. Here we report that pyramidal cells in the deep layers of the ACC send direct descending projecting terminals to the dorsal horn of the spinal cord (lamina I-III). After peripheral nerve injury, these projection cells are activated, and postsynaptic excitatory responses of these descending projecting neurons were significantly enhanced. Newly recruited AMPARs contribute to the potentiated synaptic transmission of cingulate neurons. PKA-dependent phosphorylation of GluA1 is important, since enhanced synaptic transmission was abolished in GluA1 phosphorylation site serine-845 mutant mice. Our findings provide strong evidence that peripheral nerve injury induce long-term enhancement of cortical-spinal projecting cells in the ACC. Direct top-down projection system provides rapid and profound modulation of spinal sensory transmission, including painful information. Inhibiting cortical top-down descending facilitation may serve as a novel target for treating neuropathic pain. PMID:24890933

  7. Evaluation of cardiac function during left ventricular assist by a centrifugal blood pump.

    PubMed

    Kikugawa, D

    2000-08-01

    In this study, the effects on varying cardiac function during a left ventricular (LV) bypass from the apex to the descending aorta using a centrifugal blood pump were evaluated by analyzing the left ventricular pressure and the motor current of the centrifugal pump in a mock circulatory loop. Failing heart models (preload 15 mm Hg, afterload 40 mm Hg) and normal heart models (preload 5 mm Hg, afterload 100 mm Hg) were simulated by adjusting the contractility of the latex rubber left ventricle. In Study 1, the bypass flow rate, left ventricular pressure, aortic pressure, and motor current levels were measured in each model as the centrifugal pump rpm were increased from 1,000 to 1,500 to 2,000. In Study 2, the pump rpm were fixed at 1,300, 1,500, and 1,700, and at each rpm, the left ventricular peak pressure was increased from 40 to 140 mm Hg by steps of 20 mm Hg. The same measurements as in Study 1 were performed. In Study 1, the bypass flow rate and mean aortic pressure both increased with the increase in pump rpm while the mean left ventricular pressure decreased. In Study 2, a fairly good correlation between the left ventricular pressure and the motor current of the centrifugal pump was obtained. These results suggest that cardiac function as indicated by left ventricular pressure may be estimated from a motor current analysis of the centrifugal blood pump during left heart bypass.

  8. N-acetylaspartate levels of left frontal cortex are associated with verbal intelligence in women but not in men: a proton magnetic resonance spectroscopy study.

    PubMed

    Pfleiderer, B; Ohrmann, P; Suslow, T; Wolgast, M; Gerlach, A L; Heindel, W; Michael, N

    2004-01-01

    The left frontal cortex plays an important role in executive function and complex language processing inclusive of spoken language. The purpose of this work was to assess metabolite levels in the left and right prefrontal cortex and left anterior cingulum by proton magnetic resonance spectroscopy and relate results to verbal intelligence (Wechsler Adult Intelligence Scale revised) in a sample of college-educated healthy volunteers (dorsolateral prefrontal cortex [DLPFC]: n=52, 23 females, and left anterior cingulum: n=62, 22 females; age range: 20-75 years). In women only, N-acetylaspartate in the DLPFC and in the left anterior cingulate cortex was positively correlated with vocabulary scores. Our data support the hypothesis of existing gender differences regarding the involvement of the left frontal cortex in verbal processing as reflected in different correlations of specific metabolites with verbal scores.

  9. Anterior and posterior corneal stroma elasticity assessed using nanoindentation

    PubMed Central

    Dias, Janice; Ziebarth, Noël M.

    2013-01-01

    Corneal biomechanics is an essential parameter for developing diagnostic and treatment methods of corneal-related diseases. It is widely accepted that corneal mechanical strength stems from the stroma's collagenous composition. However, more comprehensive insight into the mechanical properties within the stroma is needed to improve current corneal diagnostic and treatment techniques. The purpose of this study was to perform elasticity characterization of anterior and posterior stromal regions of human corneas using atomic force microscopy (AFM). Nine pairs of human whole globes were placed in 20% Dextran solution, cornea side down, to restore the corneal thickness to physiological levels (400-600μm). The epithelium and Bowman's membrane were removed from all eyes. Anterior stromal AFM elasticity testing was then performed on left (OS) eyes. Additional stroma was removed from right (OD) eyes to allow posterior stromal measurements at a depth of 50% of the original thickness. All experiments were performed with corneas submerged in 15% Dextran to maintain corneal hydration. The results of the study showed that the Young's modulus of elasticity of the anterior stroma (average: 281 ± 214kPa; range: 59-764kPa) was significantly higher than that of the posterior stroma (average: 89.5 ± 46.1kPa; range: 29-179kPa) (p=0.014). In addition, a linear relationship was found between the posterior stromal elasticity and anterior stromal elasticity (p=0.0428). On average, the elasticity of the posterior stroma is 39.3% of the anterior stroma. In summary, there appears to be an elasticity gradient within the corneal stroma, which should be considered in the design and development of corneal diagnostic and treatment methods to enhance efficacy. PMID:23800511

  10. Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review.

    PubMed

    Yin, Dan-Hui; Yang, Xin-Ming; Huang, Qi; Yang, Mi; Tang, Qin-Lai; Wang, Shu-Hui; Wang, Shuang; Liu, Jia-Jia; Yang, Tao; Li, Shi-Sheng

    2015-08-01

    Pharyngoesophageal perforation after anterior cervical spine surgery is rare and the delayed cases were more rarely reported but potentially life-threatening. We report a case of pharyngoesophageal perforation 3 years after anterior cervical spine surgery. The patient presented with dysphagia, fever, left cervical mass and developing dyspnea 3 years after cervical spine surgery for trauma. After careful examinations, he underwent an emergency tracheostomy, neck exploration, hardware removal, abscess drainage and infected tissue debridement. 14 days after surgery, CT of the neck with oral contrast demonstrated no contrast extravasation from the esophagus. Upon review of literature, only 14 cases of pharyngoesophageal perforation more than 1 year after anterior cervical spine surgery were found. We discussed possible etiology, diagnosis and management and concluded that in cases of dysphagia, dyspnea, cervical pain, swelling and edema of the cervical area even long time after anterior cervical spine surgery, potential pharyngoesophageal damage should be considered.

  11. A study on anterior clinoid process and optic strut with emphasis on variations of caroticoclinoid foramen.

    PubMed

    Gupta, Nirupima; Ray, Biswabina; Ghosh, Supriya

    2005-12-01

    This study presents the incidence of carotico-clinoid foramen, dimensions of the anterior clinoid process and optic strut in dry skulls to provide a guide to neurosurgeons in surgical approach especially to anterior part of cavernous sinus. Thirty-five dry skulls were used. Basal width, length, thickness of anterior clinoid process and thickness of optic strut was measured. Morphology of carotico-clinoid foramen was also studied. The average length, basal width and thickness of the anterior clinoid process on right side were 10.74 +/- 2.37 mm, 10.83 +/- 1.20 mm, 5.13 +/- 1.03 mm and left side were 9.91 +/- 1.50 mm, 11.0 +/- 1.12, 5.33 +/- 0.96 mm. Average thickness of optic strut was 3.79 +/- 0.88 mm on right side and 3.61 +/- 0.78 mm on left side. Out of 70 sides in thirty five skulls examined, carotico-clinoid foramen was observed in 14 (20.0%) cases. Out of which complete foramen was in 3 (right side, 4.3%), partial in 8 (6 right, 2 left, 11.4%) and contact in 3 (left side, 4.3%) respectively. Comparison with other races and differences between right and left sides were also discussed. The present study was done to obtain dimensions of anterior clinoid, optic strut, their anatomical variants and incidence of caroticoclinoid foramen in location population. This study will help the surgeons to plan their approach to this area and thus will make the surgical procedure safer

  12. Implantation of left ventricular assist device complicated by undiagnosed thrombophilia.

    PubMed

    Szarszoi, Ondrej; Maly, Jiri; Turek, Daniel; Urban, Marian; Skalsky, Ivo; Riha, Hynek; Maluskova, Jana; Pirk, Jan; Netuka, Ivan

    2012-01-01

    A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.

  13. Giant lateral left ventricular wall aneurysm sparing the submitral apparatus

    PubMed Central

    2013-01-01

    Left ventricular aneurysms are a frequent and serious complication following acute transmural myocardial infarction and are most commonly located at the ventricular apex. The majority of these patients presents with severe mitral insufficiency, congestive heart failure, systemic embolism and sudden cardiac death. Giant aneurysms occurring in a submitral position between anterior and posterior papillary muscles on the lateral ventricular wall constitute a minor entity and those leaving the mitral apparatus intact are extremely rare. Herein, we report the case of a 57 y/o Caucasian male patient with a past medical history of coronary artery disease and myocardial infarction with a giant left ventricular aneurysm measuring 15x10x8 cm in diameter. Despite the size of the aneurysm and its close topographical relation to the posterior mitral annulus the mitral apparatus was intact with a competent valve and normal left atrial size. He underwent successful surgical ventricular restoration. PMID:24172071

  14. Synchronous anterior celiotomy and posterior drainage of pancreatic abscess.

    PubMed

    Berne, T V; Donovan, A J

    1981-05-01

    Pancreatic abscess has been characterized by a high rate of reoperation for persistent sepsis and by a high mortality. Nine patients with pancreatic abscess have undergone synchronous anterior celiotomy and posterior drainage following resection of the 12th rib. Pancreatic abscess was secondary to acute pancreatitis in seven of the cases. In two cases, the combined procedure was a secondary operation to treat abscess that developed following surgery for pancreatic trauma. All of these nine patients survived. One patient required reoperation for drainage of a left retrocolic abscess. A synchronous approach permits adequate exploration of the abdomen, provides the exposure necessary to remove necrotic tissue, and allows dependent drainage of the left subphrenic space without fear of splenic, pancreatic, or vascular injury.

  15. zic-1 Expression in Planarian neoblasts after injury controls anterior pole regeneration.

    PubMed

    Vásquez-Doorman, Constanza; Petersen, Christian P

    2014-07-01

    Mechanisms that enable injury responses to prompt regenerative outgrowth are not well understood. Planarians can regenerate essentially any tissue removed by wounding, even after decapitation, due to robust regulation of adult pluripotent stem cells of the neoblast population. Formation of pole signaling centers involving Wnt inhibitors or Wnt ligands promotes head or tail regeneration, respectively, and this process requires the use of neoblasts early after injury. We used expression profiling of purified neoblasts to identify factors needed for anterior pole formation. Using this approach, we identified zic-1, a Zic-family transcription factor, as transcriptionally activated in a subpopulation of neoblasts near wound sites early in head regeneration. As head regeneration proceeds, the Wnt inhibitor notum becomes expressed in the newly forming anterior pole in zic-1-expressing cells descended from neoblasts. Inhibition of zic-1 by RNAi resulted in a failure to express notum at the anterior pole and to regenerate a head, but did not affect tail regeneration. Both injury and canonical Wnt signaling inhibition are required for zic-1 expression, and double-RNAi experiments suggest zic-1 inhibits Wnt signaling to allow head regeneration. Analysis of neoblast fate determinants revealed that zic-1 controls specification of notum-expressing cells from foxD-expressing neoblasts to form the anterior pole, which organizes subsequent outgrowth. Specialized differentiation programs may in general underlie injury-dependent formation of tissue organizing centers used for regenerative outgrowth.

  16. zic-1 Expression in Planarian Neoblasts after Injury Controls Anterior Pole Regeneration

    PubMed Central

    Vásquez-Doorman, Constanza; Petersen, Christian P.

    2014-01-01

    Mechanisms that enable injury responses to prompt regenerative outgrowth are not well understood. Planarians can regenerate essentially any tissue removed by wounding, even after decapitation, due to robust regulation of adult pluripotent stem cells of the neoblast population. Formation of pole signaling centers involving Wnt inhibitors or Wnt ligands promotes head or tail regeneration, respectively, and this process requires the use of neoblasts early after injury. We used expression profiling of purified neoblasts to identify factors needed for anterior pole formation. Using this approach, we identified zic-1, a Zic-family transcription factor, as transcriptionally activated in a subpopulation of neoblasts near wound sites early in head regeneration. As head regeneration proceeds, the Wnt inhibitor notum becomes expressed in the newly forming anterior pole in zic-1-expressing cells descended from neoblasts. Inhibition of zic-1 by RNAi resulted in a failure to express notum at the anterior pole and to regenerate a head, but did not affect tail regeneration. Both injury and canonical Wnt signaling inhibition are required for zic-1 expression, and double-RNAi experiments suggest zic-1 inhibits Wnt signaling to allow head regeneration. Analysis of neoblast fate determinants revealed that zic-1 controls specification of notum-expressing cells from foxD-expressing neoblasts to form the anterior pole, which organizes subsequent outgrowth. Specialized differentiation programs may in general underlie injury-dependent formation of tissue organizing centers used for regenerative outgrowth. PMID:24992682

  17. Dynamic obstruction of the left ventricular outflow tract in four young dogs.

    PubMed

    Connolly, D J; Boswood, A

    2003-07-01

    Four young dogs presented for evaluation of left-sided systolic heart murmurs all showed echocardiographic changes consistent with dynamic left ventricular outflow tract (LVOT) obstruction and subjective evidence of concentric left ventricular hypertrophy. In three of the dogs, abnormal mitral valve apparatus and systolic anterior motion of the anterior mitral valve leaflet with associated mitral insufficiency were also detected. All dogs were medicated with a beta1-adrenergic antagonist. Subsequent examinations showed that the dynamic LVOT obstruction and left ventricular concentric hypertrophy had almost completely resolved. Dynamic LVOT obstruction is a rare condition of young dogs of different breeds. The precise aetiology of the condition remains uncertain. Whether resolution of the outflow obstruction in these four cases was a consequence of treatment or due to changes in ventricular architecture brought about by ageing cannot be established.

  18. [DEFORMITY OF LEFT VENTRICLE WALLS IN PATIENTS WITH AORTAL VALVE STENOSIS].

    PubMed

    Trembovetskaya, E M

    2015-04-01

    Parameters of longitudinal deformity of left ventricle walls in patients, suffering aortal valve stenosis (AVS), were analyzed. While the process of heart contraction in norm and in AVS occurs, longitudinal deformity is expressed maximally in its apical divisions. AVS deformity of apical divisions of left ventricle, as well as middle divisions of interventricular septum and lower wall, practically did not differ from such in norm, and deformity of basal divisions of all walls and middle divisions of posterior, lateral and anterior walls of left ventricle was trustworthy less than a norm. Thus, a reduction of the deformity indices in basal divisions of left ventricle and middle segments of its posterior, lateral and anterior walls in patients, suffering AVS with preserved output fraction, precedes the disorders of its hemodynamics and constitutes a predictor for the cardiac output reduction.

  19. Corticospinal and Reticulospinal Contacts on Cervical Commissural and Long Descending Propriospinal Neurons in the Adult Rat Spinal Cord; Evidence for Powerful Reticulospinal Connections

    PubMed Central

    Mitchell, Emma J.; McCallum, Sarah; Dewar, Deborah; Maxwell, David J.

    2016-01-01

    Descending systems have a crucial role in the selection of motor output patterns by influencing the activity of interneuronal networks in the spinal cord. Commissural interneurons that project to the contralateral grey matter are key components of such networks as they coordinate left-right motor activity of fore and hind-limbs. The aim of this study was to determine if corticospinal (CST) and reticulospinal (RST) neurons make significant numbers of axonal contacts with cervical commissural interneurons. Two classes of commissural neurons were analysed: 1) local commissural interneurons (LCINs) in segments C4-5; 2) long descending propriospinal neurons (LDPNs) projecting from C4 to the rostral lumbar cord. Commissural interneurons were labelled with Fluorogold and CST and RST axons were labelled by injecting the b subunit of cholera toxin in the forelimb area of the primary somatosensory cortex or the medial longitudinal fasciculus respectively. The results show that LCINs and LDPNs receive few contacts from CST terminals but large numbers of contacts are formed by RST terminals. Use of vesicular glutamate and vesicular GABA transporters revealed that both types of cell received about 80% excitatory and 20% inhibitory RST contacts. Therefore the CST appears to have a minimal influence on LCINs and LDPNs but the RST has a powerful influence. This suggests that left-right activity in the rat spinal cord is not influenced directly via CST systems but is strongly controlled by the RST pathway. Many RST neurons have monosynaptic input from corticobulbar pathways therefore this pathway may provide an indirect route from the cortex to commissural systems. The cortico-reticulospinal-commissural system may also contribute to functional recovery following damage to the CST as it has the capacity to deliver information from the cortex to the spinal cord in the absence of direct CST input. PMID:26999665

  20. 38 CFR 3.379 - Anterior poliomyelitis.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Anterior poliomyelitis. 3... Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it...

  1. Extradural anterior clinoidectomy. Technical note.

    PubMed

    Noguchi, Akio; Balasingam, Vijayabalan; Shiokawa, Yoshiaki; McMenomey, Sean O; Delashaw, Johnny B

    2005-05-01

    The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions--either tumors or aneurysms--in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subseqtient derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

  2. Hemispheric Specialization within the Superior Anterior Temporal Cortex for Social and Nonsocial Concepts.

    PubMed

    Pobric, Gorana; Lambon Ralph, Matthew A; Zahn, Roland

    2016-03-01

    Studies of semantic dementia, imaging, and repetitive TMS have suggested that the bilateral anterior temporal lobes (ATLs) underpin a modality-invariant representational hub within the semantic system. Questions remain, however, regarding functional specialization across a variety of knowledge domains within the ATL region. We investigated direct evidence for the functional relevance of the superior ATL in processing social concepts. Using converging evidence from noninvasive brain stimulation and neuropsychology, we demonstrate graded differentiation of right and left superior anterior temporal areas in social cognition. Whereas the left superior ATL is necessary for processing both social and nonsocial abstract concepts, social conceptual processing predominates in the right superior ATL. This graded hemispheric specialization is mirrored in the patient results. Our data shed new light on the classic debate about hemispheric differences in semantic and social cognition. These results are considered in the context of models of semantic representation and the emerging data on connectivity for left and right ATL regions.

  3. FGF8 and SHH substitute for anterior-posterior tissue interactions to induce limb regeneration.

    PubMed

    Nacu, Eugeniu; Gromberg, Elena; Oliveira, Catarina R; Drechsel, David; Tanaka, Elly M

    2016-05-19

    In salamanders, grafting of a left limb blastema onto a right limb stump yields regeneration of three limbs, the normal limb and two 'supernumerary' limbs. This experiment and other research have shown that the juxtaposition of anterior and posterior limb tissue plus innervation are necessary and sufficient to induce complete limb regeneration in salamanders. However, the cellular and molecular basis of the requirement for anterior-posterior tissue interactions were unknown. Here we have clarified the molecular basis of the requirement for both anterior and posterior tissue during limb regeneration and supernumerary limb formation in axolotls (Ambystoma mexicanum). We show that the two tissues provide complementary cross-inductive signals that are required for limb outgrowth. A blastema composed solely of anterior tissue normally regresses rather than forming a limb, but activation of hedgehog (HH) signalling was sufficient to drive regeneration of an anterior blastema to completion owing to its ability to maintain fibroblast growth factor (FGF) expression, the key signalling activity responsible for blastema outgrowth. In blastemas composed solely of posterior tissue, HH signalling was not sufficient to drive regeneration; however, ectopic expression of FGF8 together with endogenous HH signalling was sufficient. In axolotls, FGF8 is expressed only in the anterior mesenchyme and maintenance of its expression depends on sonic hedgehog (SHH) signalling from posterior tissue. Together, our findings identify key anteriorly and posteriorly localized signals that promote limb regeneration and show that these single factors are sufficient to drive non-regenerating blastemas to complete regeneration with full elaboration of skeletal elements.

  4. Ascending and descending particle flux from hydrothermal plumes at Endeavour Segment, Juan de Fuca Ridge

    NASA Astrophysics Data System (ADS)

    Cowen, James P.; Bertram, Miriam A.; Wakeham, Stuart G.; Thomson, Richard E.; William Lavelle, J.; Baker, Edward T.; Feely, Richard A.

    2001-04-01

    Bio-acoustic surveys and associated zooplankton net tows have documented anomalously high concentrations of zooplankton within a 100 m layer above the hydrothermal plumes at Endeavour Segment, Juan de Fuca Ridge. These and other data suggest that congregating epi-plume zooplankton are exploiting a food substrate associated with the hydrothermal plume. Ascending, organic-rich particles could provide a connection. Consequently, two paired sequentially sampling ascending and descending particle flux traps and a current meter were deployed on each of three moorings from July 1994 to May 1995. Mooring sites included an on-axis site (OAS; 47°57.0'N, 129°05.7'W) near the main Endeavour vent field, a "down-current" site 3 km west of the main vent field (WS), and a third background station 43 km northeast of the vent field (ES). Significant ascending and descending particle fluxes were measured at all sites and depths. Lipid analyses indicated that ascending POC was derived from mid-depth and deep zooplankton whereas descending POC also contained a component of photosynthetically derived products from the sea surface. Highest ascending POC fluxes were found at the hydrothermal plume-swept sites (OAS and WS). The limited data available, however, precludes an unequivocal conclusion that hydrothermal processes contribute to the ascending flux of organic carbon at each site. Highest ascending to descending POC flux ratios were also found at WS. Observed trends in POC, PMn/PTi, and PFe/PTi clearly support a hydrothermal component to the descending flux at the plume-swept WS site (no descending data was recovered at OAS) but not at the background ES site. Alternative explanations for ascending particle data are discussed. First-order calculations for the organic carbon input (5-22 mg C m -2 d -1) required to sustain observed epi-plume zooplankton anomalies at Endeavour are comparable both to measured total POC flux to epi-plume depths (2-5 mg C m -2 d -1: combined hydrothermal

  5. Leech segmental repeats develop normally in the absence of signals from either anterior or posterior segments

    NASA Technical Reports Server (NTRS)

    Seaver, E. C.; Shankland, M.

    2000-01-01

    We have investigated whether the development of segmental repeats is autonomous in the embryo of the leech Helobdella robusta. The segmental tissues of the germinal band arise from progeny of five stem cells called teloblasts. Asymmetric divisions of the teloblasts form chains of segment founder cells (called primary blast cells) that divide in a stereotypical manner to produce differentiated descendants. Using two distinct techniques, we have looked for potential interactions between neighboring blast cell clones along the anterior-posterior axis. In one technique, we prevented the birth of primary blast cells by injection of DNase I into the teloblast, thereby depriving the last blast cell produced before the ablation of its normal posterior neighbors. We also ablated single blast cells with a laser microbeam, which allowed us to assess potential signals acting on either more anterior or more posterior primary blast cell clones. Our results suggest that interactions along the anterior-posterior axis between neighboring primary blast cell clones are not required for development of normal segmental organization within the blast cell clone. We also examined the possibility that blast cells receive redundant signals from both anterior and posterior neighboring clones and that either is sufficient for normal development. Using double blast cell laser ablations to isolate a primary blast cell clone by removal of both its anterior and its posterior neighbor, we found that the isolated clone still develops normally. These results reveal that the fundamental segmental repeat in the leech embryo, the primary blast cell clone, can develop normally in the apparent absence of signals from adjacent repeats along the anterior-posterior axis.

  6. Poland syndrome involving the left hemithorax with dextrocardia and herniation of the spleen

    PubMed Central

    Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit; Jana, Manisha

    2014-01-01

    Poland syndrome is characterised by unilateral absence of the large pectoral muscle, ipsilateral symbrachydactyly and occasionally other malformations of the anterior chest wall and breast. The condition is more frequent among men and usually occurs on the right hemithorax in the unilateral form. This case is unique because we believe it is a rare case of Poland syndrome involving the left hemithorax along with dextrocardia and herniation of the spleen from the left subcostal region. PMID:24567179

  7. Left ventricular apical diseases.

    PubMed

    Cisneros, Silvia; Duarte, Ricardo; Fernandez-Perez, Gabriel C; Castellon, Daniel; Calatayud, Julia; Lecumberri, Iñigo; Larrazabal, Eneritz; Ruiz, Berta Irene

    2011-08-01

    There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

  8. Graded specialization within and between the anterior temporal lobes

    PubMed Central

    Rice, Grace E.; Hoffman, Paul

    2015-01-01

    Considerable evidence from different methodologies has identified the anterior temporal lobes (ATLs) as key regions for the representation of semantic knowledge. Research interest is now shifting to investigate the roles of different ATL subregions in semantic representation, with particular emphasis on the functions of the left versus right ATLs. In this review, we provide evidence for graded specializations both between and within the ATLs. We argue (1) that multimodal, pan‐category semantic representations are supported jointly by both left and right ATLs, yet (2) that the ATLs are not homogeneous in their function. Instead, subtle functional gradations both between and within the ATLs emerge as a consequence of differential connectivity with primary sensory/motor/limbic regions. This graded specialization account of semantic representation provides a compromise between theories that posit no differences between the functions of the left and right ATLs and those that posit that the left and right ATLs are entirely segregated in function. Evidence for this graded account comes from converging sources, and its benefits have been exemplified in formal computational models. We propose that this graded principle is not only a defining feature of the ATLs but is also a more general neurocomputational principle found throughout the temporal lobes. PMID:26502375

  9. Descending projections from the nucleus accumbens shell excite activity of taste-responsive neurons in the nucleus of the solitary tract in the hamster.

    PubMed

    Li, Cheng-Shu; Lu, Da-Peng; Cho, Young K

    2015-06-01

    The nucleus of the solitary tract (NST) and the parabrachial nuclei (PbN) are the first and second relays in the rodent central taste pathway. A series of electrophysiological experiments revealed that spontaneous and taste-evoked activities of brain stem gustatory neurons are altered by descending input from multiple forebrain nuclei in the central taste pathway. The nucleus accumbens shell (NAcSh) is a key neural substrate of reward circuitry, but it has not been verified as a classical gustatory nucleus. A recent in vivo electrophysiological study demonstrated that the NAcSh modulates the spontaneous and gustatory activities of hamster pontine taste neurons. In the present study, we investigated whether activation of the NAcSh modulates gustatory responses of the NST neurons. Extracellular single-unit activity was recorded from medullary neurons in urethane-anesthetized hamsters. After taste response was confirmed by delivery of sucrose, NaCl, citric acid, and quinine hydrochloride to the anterior tongue, the NAcSh was stimulated bilaterally with concentric bipolar stimulating electrodes. Stimulation of the ipsilateral and contralateral NAcSh induced firings from 54 and 37 of 90 medullary taste neurons, respectively. Thirty cells were affected bilaterally. No inhibitory responses or antidromic invasion was observed after NAcSh activation. In the subset of taste cells tested, high-frequency electrical stimulation of the NAcSh during taste delivery enhanced taste-evoked neuronal firing. These results demonstrate that two-thirds of the medullary gustatory neurons are under excitatory descending influence from the NAcSh, which is a strong indication of communication between the gustatory pathway and the mesolimbic reward pathway.

  10. The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review.

    PubMed

    Vigotsky, Andrew D; Bruhns, Ryan P

    2015-01-01

    Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy's analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed.

  11. Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle

    PubMed Central

    Mang, Daniel WH; Siegmund, Gunter P; Blouin, Jean-Sébastien

    2014-01-01

    Whiplash injuries are the most common injuries following rear-end collisions. During a rear-end collision, the human muscle response consists of both a postural and a startle response that may exacerbate injury. However, most previous studies only assessed the presence of startle using data collected from the neck muscles and head/neck kinematics. The startle response also evokes a descending pattern of muscle recruitment and changes in autonomic activity. Here we examined the recruitment of axial and appendicular muscles along with autonomic responses to confirm whether these other features of a startle response were present during the first exposure to a whiplash perturbation. Ten subjects experienced a single whiplash perturbation while recording electromyography, electrocardiogram, and electrodermal responses. All subjects exhibited a descending pattern of muscle recruitment, and increasing heart rate and electrodermal responses following the collision. Our results provide further support that the startle response is a component of the response to whiplash collisions. PMID:24932015

  12. Whiplash evokes descending muscle recruitment and sympathetic responses characteristic of startle.

    PubMed

    Mang, Daniel Wh; Siegmund, Gunter P; Blouin, Jean-Sébastien

    2014-06-01

    Whiplash injuries are the most common injuries following rear-end collisions. During a rear-end collision, the human muscle response consists of both a postural and a startle response that may exacerbate injury. However, most previous studies only assessed the presence of startle using data collected from the neck muscles and head/neck kinematics. The startle response also evokes a descending pattern of muscle recruitment and changes in autonomic activity. Here we examined the recruitment of axial and appendicular muscles along with autonomic responses to confirm whether these other features of a startle response were present during the first exposure to a whiplash perturbation. Ten subjects experienced a single whiplash perturbation while recording electromyography, electrocardiogram, and electrodermal responses. All subjects exhibited a descending pattern of muscle recruitment, and increasing heart rate and electrodermal responses following the collision. Our results provide further support that the startle response is a component of the response to whiplash collisions.

  13. The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review

    PubMed Central

    Vigotsky, Andrew D.; Bruhns, Ryan P.

    2015-01-01

    Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy's analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed. PMID:26788367

  14. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon

    PubMed Central

    Flores-Ríos, Enrique; Méndez-Díaz, Cristina; Rodríguez-García, Esther; Pérez-Ramos, Tania

    2015-01-01

    Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female. PMID:26629290

  15. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon.

    PubMed

    Flores-Ríos, Enrique; Méndez-Díaz, Cristina; Rodríguez-García, Esther; Pérez-Ramos, Tania

    2015-10-01

    Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.

  16. Mechanical characterisation of the human thoracic descending aorta: experiments and modelling.

    PubMed

    García-Herrera, Claudio M; Celentano, Diego J; Cruchaga, Marcela A; Rojo, Francisco J; Atienza, José Miguel; Guinea, Gustavo V; Goicolea, José M

    2012-01-01

    This work presents experiments and modelling aimed at characterising the passive mechanical behaviour of the human thoracic descending aorta. To this end, uniaxial tension and pressurisation tests on healthy samples corresponding to newborn, young and adult arteries are performed. Then, the tensile measurements are used to calibrate the material parameters of the Holzapfel constitutive model. This model is found to adequately adjust the material behaviour in a wide deformation range; in particular, it captures the progressive stiffness increase and the anisotropy due to the stretching of the collagen fibres. Finally, the assessment of these material parameters in the modelling of the pressurisation test is addressed. The implication of this study is the possibility to predict the mechanical response of the human thoracic descending aorta under generalised loading states like those that can occur in physiological conditions and/or in medical device applications.

  17. Anterior hippocampus and goal-directed spatial decision making.

    PubMed

    Viard, Armelle; Doeller, Christian F; Hartley, Tom; Bird, Chris M; Burgess, Neil

    2011-03-23

    Planning spatial paths through our environment is an important part of everyday life and is supported by a neural system including the hippocampus and prefrontal cortex. Here we investigated the precise functional roles of the components of this system in humans by using fMRI as participants performed a simple goal-directed route-planning task. Participants had to choose the shorter of two routes to a goal in a visual scene that might contain a barrier blocking the most direct route, requiring a detour, or might be obscured by a curtain, requiring memory for the scene. The participant's start position was varied to parametrically manipulate their proximity to the goal and the difference in length of the two routes. Activity in medial prefrontal cortex, precuneus, and left posterior parietal cortex was associated with detour planning, regardless of difficulty, whereas activity in parahippocampal gyrus was associated with remembering the spatial layout of the visual scene. Activity in bilateral anterior hippocampal formation showed a strong increase the closer the start position was to the goal, together with medial prefrontal, medial and posterior parietal cortices. Our results are consistent with computational models in which goal proximity is used to guide subsequent navigation and with the association of anterior hippocampal areas with nonspatial functions such as arousal and reward expectancy. They illustrate how spatial and nonspatial functions combine within the anterior hippocampus, and how these functions interact with parahippocampal, parietal, and prefrontal areas in decision making and mnemonic function.

  18. Telecast of Astronaut Neil Armstrong descending ladder to surface of the moon

    NASA Technical Reports Server (NTRS)

    1969-01-01

    Astronaut Neil A. Armstrong, Apollo 11 commander, descends the ladder of the Apollo 11 Lunar Module prior to making the first step by man on the moon. This view is a black and white reproduction taken from a telecast by the Apollo 11 lunar surface camera during extravehicular activity. The black bar running through the center of the picture is an anamoly in the television ground data system at the Goldstone Tracking Station.

  19. Medical and Surgical Management of a Descending Aorta Penetrating Atherosclerotic Ulcer and Associated Ascending Intramural Hematoma

    PubMed Central

    Henn, Matthew C.; Lawrance, Christopher P.; Braverman, Alan C.; Sanchez, Luis; Lawton, Jennifer S.

    2014-01-01

    A 69-year-old man presented with chest pain and a computed tomography scan demonstrated an acute penetrating atherosclerotic ulcer (PAU) of the proximal descending aorta with an associated intramural hematoma (IMH) extending retrograde to the aortic root and distally to the renal arteries. He successfully underwent endovascular repair of the PAU and medical management of the associated ascending intramural hematoma with complete resolution at 6 months. PMID:26798718

  20. Histamine in the locus coeruleus promotes descending noradrenergic inhibition of neuropathic hypersensitivity.

    PubMed

    Wei, Hong; Jin, Cong-Yu; Viisanen, Hanna; You, Hao-Jun; Pertovaara, Antti

    2014-12-01

    Among brain structures receiving efferent projections from the histaminergic tuberomammillary nucleus is the pontine locus coeruleus (LC) involved in descending noradrenergic control of pain. Here we studied whether histamine in the LC is involved in descending regulation of neuropathic hypersensitivity. Peripheral neuropathy was induced by unilateral spinal nerve ligation in the rat with a chronic intracerebral and intrathecal catheter for drug administrations. Mechanical hypersensitivity in the injured limb was assessed by monofilaments. Heat nociception was assessed by determining radiant heat-induced paw flick. Histamine in the LC produced a dose-related (1-10μg) mechanical antihypersensitivity effect (maximum effect at 15min and duration of effect 30min), without influence on heat nociception. Pretreatment of LC with zolantidine (histamine H2 receptor antagonist), but not with pyrilamine (histamine H1 receptor antagonist), and spinal administration of atipamezole (an α2-adrenoceptor antagonist), prazosine (an α1-adrenoceptor antagonist) or bicuculline (a GABAA receptor antagonist) attenuated the antihypersensitivity effect of histamine. The histamine-induced antihypersensitivity effect was also reduced by pretreatment of LC with fadolmidine, an α2-adrenoceptor agonist inducing autoinhibition of noradrenergic cell bodies. Zolantidine or pyrilamine alone in the LC failed to influence pain behavior, while A-960656 (histamine H3 receptor antagonist) suppressed hypersensitivity. A plausible explanation for these findings is that histamine, due to excitatory action mediated by the histamine H2 receptor on noradrenergic cell bodies, promotes descending spinal α1/2-adrenoceptor-mediated inhibition of neuropathic hypersensitivity. Blocking the autoinhibitory histamine H3 receptor on histaminergic nerve terminals in the LC facilitates release of histamine and thereby, increases descending noradrenergic pain inhibition.

  1. Response Allocation in Concurrent Chains when Terminal-Link Delays Follow an Ascending and Descending Series

    ERIC Educational Resources Information Center

    Christensen, Darren R.; Grace, Randolph C.

    2009-01-01

    Eight pigeons were trained in a concurrent-chains procedure in which the terminal-link immediacy ratio followed an ascending or descending series. Across sessions, one terminal-link delay changed from 2 s to 32 s to 2 s or from 32 s to 2 s to 32 s, while the other was always 8 s. For all pigeons, response allocation tracked changes in delay and…

  2. Descending protocerebral neurons related to the mating dance of the male silkworm moth.

    PubMed

    Kanzaki, R; Shibuya, T

    1986-07-09

    Descending protocerebral neurons in the male silkworm moth brain responding to the sexual pheromone (Bombykol) were identified. The neurons responded well with a tonic type of response and the high-frequency spikes evoked continued even after the end of the stimulus. Characteristics of the dose-response curves of the neurons to the pheromone remarkably resembled those of the wing vibration which is one of the mating behavioral components of the male moths.

  3. A Computational Model of a Descending Mechanosensory Pathway Involved in Active Tactile Sensing

    PubMed Central

    Ache, Jan M.; Dürr, Volker

    2015-01-01

    Many animals, including humans, rely on active tactile sensing to explore the environment and negotiate obstacles, especially in the dark. Here, we model a descending neural pathway that mediates short-latency proprioceptive information from a tactile sensor on the head to thoracic neural networks. We studied the nocturnal stick insect Carausius morosus, a model organism for the study of adaptive locomotion, including tactually mediated reaching movements. Like mammals, insects need to move their tactile sensors for probing the environment. Cues about sensor position and motion are therefore crucial for the spatial localization of tactile contacts and the coordination of fast, adaptive motor responses. Our model explains how proprioceptive information about motion and position of the antennae, the main tactile sensors in insects, can be encoded by a single type of mechanosensory afferents. Moreover, it explains how this information is integrated and mediated to thoracic neural networks by a diverse population of descending interneurons (DINs). First, we quantified responses of a DIN population to changes in antennal position, motion and direction of movement. Using principal component (PC) analysis, we find that only two PCs account for a large fraction of the variance in the DIN response properties. We call the two-dimensional space spanned by these PCs ‘coding-space’ because it captures essential features of the entire DIN population. Second, we model the mechanoreceptive input elements of this descending pathway, a population of proprioceptive mechanosensory hairs monitoring deflection of the antennal joints. Finally, we propose a computational framework that can model the response properties of all important DIN types, using the hair field model as its only input. This DIN model is validated by comparison of tuning characteristics, and by mapping the modelled neurons into the two-dimensional coding-space of the real DIN population. This reveals the

  4. Pharmacogenetic polymorphisms in Brazilian-born, first-generation Japanese descendants.

    PubMed

    Perini, J A; Vargens, D D; Santana, I S C; Moriguchi, E H; Ribeiro-Dos-Santos, A K C; Tsutsumi, M; Suarez-Kurtz, G

    2009-12-01

    Brazil hosts the largest Japanese community outside Japan, estimated at 1.5 million individuals, one third of whom are first-generation, Brazilian-born with native Japanese parents. This large community provides a unique opportunity for comparative studies of the distribution of pharmacogenetic polymorphisms in native Japanese versus their Brazilian-born descendants. Functional polymorphisms in genes that modulate drug disposition (CYP2C9, CYP2C19 and GSTM3) or response (VKORC1) and that differ significantly in frequency in native Japanese versus Brazilians with no Japanese ancestry were selected for the present study. Healthy subjects (200 native Japanese and 126 first-generation Japanese descendants) living in agricultural colonies were enrolled. Individual DNA was genotyped using RFLP (GSTM3 A/B) or TaqMan Detection System assays (CYP2C9 2 and 3; CYP2C19 2 and 3; VKORC1 3673G>A, 5808T>G, 6853G>C, and 9041G>A). No difference was detected in the frequency of these pharmacogenetic polymorphisms between native Japanese and first-generation Japanese descendants. In contrast, significant differences in the frequency of each polymorphism were observed between native or first-generation Japanese and Brazilians with no Japanese ancestry. The VKORC1 3673G>A, 6853G>C and 9041G>A single nucleotide polymorphisms were in linkage disequilibrium in both native and first-generation Japanese living in Brazil. The striking similarity in the frequency of clinically relevant pharmacogenetic polymorphisms between Brazilian-born Japanese descendants and native Japanese suggests that the former may be recruited for clinical trials designed to generate bridging data for the Japanese population in the context of the International Conference on Harmonization.

  5. [Left-handedness and health].

    PubMed

    Milenković, Sanja; Belojević, Goran; Kocijancić, Radojka

    2010-01-01

    Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about "anomalous" cerebral domination, as a consequence of hormonal disbalance.

  6. Descending influences on escape behavior and motor pattern in the cockroach.

    PubMed

    Schaefer, P L; Ritzmann, R E

    2001-10-01

    The escape behavior of the cockroach is a ballistic behavior with well characterized kinematics. The circuitry known to control the behavior lies in the thoracic ganglia, abdominal ganglia, and abdominal nerve cord. Some evidence suggests inputs may occur from the brain or suboesophageal ganglion. We tested this notion by decapitating cockroaches, removing all descending inputs, and evoking escape responses. The decapitated cockroaches exhibited directionally appropriate escape turns. However, there was a front-to-back gradient of change: the front legs moved little if at all, the middle legs moved in the proper direction but with reduced excursion, and the rear legs moved normally. The same pattern was seen when only inputs from the brain were removed, the suboesophageal ganglion remaining intact and connected to the thoracic ganglia. Electromyogram (EMG) analysis showed that the loss of or reduction in excursion was accompanied by a loss of or reduction in fast motor neuron activity. The loss of fast motor neuron activity was also observed in a reduced preparation in which descending neural signals were reversibly blocked via an isotonic sucrose solution superfusing the neck connectives, indicating that the changes seen were not due to trauma. Our data demonstrate that while the thoracic circuitry is sufficient to produce directional escape, lesion or blockage of the connective affects the excitability of components of the escape circuitry. Because of the rapidity of the escape response, such effects are likely due to the elimination of tonic descending inputs.

  7. Opportunities for mourning when grief is disenfranchised: descendants of Nazi perpetrators in dialogue with Holocaust survivors.

    PubMed

    Livingston, Kathy

    2010-01-01

    This article explores the concepts of unmourned and disenfranchised grief as a way to understand the experiences of adult children of Nazi perpetrators, who grew up with cultural norms of grieving alone or in silence. The scholarly literature on descendants of Nazis reflects a group unlikely to warrant empathy or support from others because of the stigma surrounding their family's possible involvement in the Holocaust atrocities. This article uses, as a case study approach, the testimony given by Monika Hertwig, the adult daughter of a high ranking Nazi, who appears in the documentary film, Inheritance. From the perspective of disenfranchised grief, defined as grief that is not socially recognized or supported, the article links Monika's testimony with existing research from in-depth interviews with other descendants of Nazis to suggest that, as a group, they lacked permission to grieve their deceased parents, acknowledgment of their grief, and opportunities to mourn. Based on the theory that the effects of grief can be transgenerational, the disenfranchisement experienced by the "children of the Third Reich" does not have to pass to subsequent generations if opportunities for mourning are made possible and some resolution of grief occurs. Studies have shown that ongoing dialogue groups between Holocaust survivors and descendants of Nazis provide opportunities for mourning to both groups.

  8. Optic neuritis and acute anterior uveitis associated with influenza A infection: a case report

    PubMed Central

    Nakagawa, Hayate; Noma, Hidetaka; Kotake, Osamu; Motohashi, Ryosuke; Yasuda, Kanako; Shimura, Masahiko

    2017-01-01

    Background A few reports have described ocular complications of influenza A infection, such as impaired ocular movement, parasympathetic ocular nerve, keratitis, macular lesion, and frosted branch angiitis. We encountered a rare case of acute anterior uveitis and optic neuritis associated with influenza A infection. Case presentation A 70-year-old man presented with symptoms of upper respiratory tract infection. A rapid diagnostic test showed a positive result for influenza A. At the same time, he developed ocular symptoms including blurred vision with optic disk edema and hemorrhage in the left eye, and bilateral red eyes. Multiplex polymerase chain reaction performed on aqueous humor sample detected no viral infection. Visual field testing with a Goldmann perimeter showed central and paracentral scotomas in the left eye. In addition to antiviral agent (oseltamivir phosphate 75 mg), the patient was prescribed topical prednisolone acetate ophthalmic suspension eye drops every 5 hours and high-dose intravenous methylprednisolone 1,000 mg daily for 3 days. Two months later, his best-corrected visual acuity improved to 20/50 with regression of visual field defects in his left eye. Conclusion We report a case of bilateral acute anterior uveitis and unilateral optic neuritis concomitant with influenza A infection. Topical and systemic corticosteroids were effective to resolve acute anterior uveitis and neuritis. Analysis of aqueous humor sample suggested that acute anterior uveitis and optic neuritis in this case were not caused by influenza A virus infection per se but by autoimmune mechanism. PMID:28115874

  9. Adenosine receptor expression in an experimental animal model of myocardial infarction with preserved left ventricular ejection fraction.

    PubMed

    Cabiati, Manuela; Martino, Alessandro; Mattii, Letizia; Caselli, Chiara; Prescimone, Tommaso; Lionetti, Vincenzo; Morales, Maria-Aurora; Del Ry, Silvia

    2014-07-01

    Adenosine, a purine nucleoside and a "retaliatory metabolite" in ischemia, is ubiquitous in the body and increases 100-fold during ischemia. Its biological actions are mediated by four adenosine receptors (ARs): A(1), A(2A), A(2B) and A(3). The aim of this study was to determine possible myocardial alterations in AR expression in an experimental animal model of myocardial infarction (MI) with a preserved left ventricular (LV) ejection fraction. LV tissue was collected from sexually mature male farm pigs with MI (n = 6) induced by permanent surgical ligation of the left anterior descending coronary artery and from five healthy pigs (C). mRNA expression of A(1)R, A(2A)R, A(2B)R, A(3)R and TNF-α was determined by real-time PCR in tissue collected from border (BZ) and remote zones (RZ) of the infarcted area and from LV of C. BZ, RZ and samples of C were stained immunohistochemically to investigate A(3)R immunoreaction. After 4 weeks a different regulation of ARs was observed. A(1)R mRNA expression was significantly lower in the infarct regions than in controls (C = 0.75 ± 0.2, BZ = 0.05 ± 0.2, RZ = 0.07 ± 0.02 p = 0.0025, p = 0.0016, C vs. BZ and RZ, respectively). Conversely A(3)R was higher in infarct areas (C = 0.94 ± 0.2, BZ = 2.85 ± 0.5, RZ = 3.48 ± 1.0, p = 0.048 C vs. RZ). No significant differences were observed for A(2A)R (C = 1.58 ± 0.6, BZ = 0.42 ± 0.1, RZ = 1.37 ± 0.6) and A(2B)R (C = 1.66 ± 0.2, BZ = 1.54 ± 0.5, RZ = 1.25 ± 0.4). A(3)R expression was confirmed by immunohistochemical analysis and was principally localized in cardiomyocytes. TNF-α mRNA results were: C 0.41 ± 0.25; BZ 1.60 ± 0.19; RZ 0.17 ± 0.04. The balance between A(1)R and A(3)R as well as between A(2A)R and A(2B)R was consistent with adaptative retaliatory anti-ischemic adenosinergic changes in the infarcted heart with preserved LV function.

  10. The free serratus anterior artery perforator flap-A case report and anatomic study.

    PubMed

    Park, Seong Oh; Chang, Hak; Imanishi, Nobuaki

    2016-05-01

    We report a reconstructive case using a free serratus anterior artery perforator flap and an anatomic study. A 50-year-old man with upper esophageal sphincter stricture underwent segmental cervical esophageal resection. The size of the defect was approximately 5.5 cm. We then performed esophageal reconstruction using the free serratus anterior artery perforator flap. Esophagography performed on postoperative day 7 revealed no definite leakage and a viable anastomosis site with wide patency. No complications developed during the long-term follow-up period of 3 years. We reviewed the literature and performed an anatomic study using four fresh cadavers. We performed an angiographic study using two specimens and dissection of this perforator using other two specimens. We found that a direct connection existed between the serratus anterior artery and intercostal perforator to the skin in two of eight chests. The connection was located at the 4th intercostal space in the left chest of one cadaver and at the 6th/7th intercostal space in the left chest of the other cadaver. The free serratus anterior artery perforator flap is a new flap that could be considered for use during the elevation of a perforator flap in the lateral chest area, and especially in the area overlying the serratus anterior muscle. © 2016 Wiley Periodicals, Inc. Microsurgery 36:339-344, 2016.

  11. Anxiety positive subjects show altered processing in the anterior insula during anticipation of negative stimuli

    PubMed Central

    Simmons, Alan; Stein, Murray B.; Strigo, Irina A; Arce, Estibaliz; Hitchcock, Carla; Paulus, Martin P.

    2011-01-01

    Prior neuroimaging studies support the hypothesis that anticipation, an important component of anxiety, may be mediated by activation within the insular and medial prefrontal cortices including the anterior cingulate cortex. However, there is an insufficient understanding of how affective anticipation differs across anxiety groups in emotional brain loci and networks. We examined 14 anxiety positive (AP) and 14 anxiety normative (AN) individuals completing an affective picture anticipation task during functional magnetic resonance imaging (fMRI). Brain activation was examined across groups for cued anticipation (to aversive or pleasant stimuli). Both groups showed greater activation in the bilateral anterior insula during cued differential anticipation (i.e., aversive vs. pleasant) and activation on the right was significantly higher in AP compared to AN subjects. Functional connectivity showed that the left anterior insula was involved in a similar network during pleasant anticipation in both groups. The left anterior insula during aversive and the right anterior insula during all anticipation conditions co-activated with a cortical network consisting of frontal and parietal lobes in the AP group to a greater degree. These results are consistent with the hypothesis that anxiety is related to greater anticipatory reactivity in the brain and that there may be functional asymmetries in the brain that interact with psychiatric traits. PMID:21181800

  12. The structural plasticity of white matter networks following anterior temporal lobe resection

    PubMed Central

    Yogarajah, Mahinda; Focke, Niels K.; Bonelli, Silvia B.; Thompson, Pamela; Vollmar, Christian; McEvoy, Andrew W.; Alexander, Daniel C.; Symms, Mark R.; Koepp, Matthias J.

    2010-01-01

    Anterior temporal lobe resection is an effective treatment for refractory temporal lobe epilepsy. The structural consequences of such surgery in the white matter, and how these relate to language function after surgery remain unknown. We carried out a longitudinal study with diffusion tensor imaging in 26 left and 20 right temporal lobe epilepsy patients before and a mean of 4.5 months after anterior temporal lobe resection. The whole-brain analysis technique tract-based spatial statistics was used to compare pre- and postoperative data in the left and right temporal lobe epilepsy groups separately. We observed widespread, significant, mean 7%, decreases in fractional anisotropy in white matter networks connected to the area of resection, following both left and right temporal lobe resections. However, we also observed a widespread, mean 8%, increase in fractional anisotropy after left anterior temporal lobe resection in the ipsilateral external capsule and posterior limb of the internal capsule, and corona radiata. These findings were confirmed on analysis of the native clusters and hand drawn regions of interest. Postoperative tractography seeded from this area suggests that this cluster is part of the ventro-medial language network. The mean pre- and postoperative fractional anisotropy and parallel diffusivity in this cluster were significantly correlated with postoperative verbal fluency and naming test scores. In addition, the percentage change in parallel diffusivity in this cluster was correlated with the percentage change in verbal fluency after anterior temporal lobe resection, such that the bigger the increase in parallel diffusivity, the smaller the fall in language proficiency after surgery. We suggest that the findings of increased fractional anisotropy in this ventro-medial language network represent structural reorganization in response to the anterior temporal lobe resection, which may damage the more susceptible dorso-lateral language pathway

  13. BOLD Response to Motion Verbs in Left Posterior Middle Temporal Gyrus during Story Comprehension

    ERIC Educational Resources Information Center

    Wallentin, Mikkel; Nielsen, Andreas Hojlund; Vuust, Peter; Dohn, Anders; Roepstorff, Andreas; Lund, Torben Ellegaard

    2011-01-01

    A primary focus within neuroimaging research on language comprehension is on the distribution of semantic knowledge in the brain. Studies have shown that the left posterior middle temporal gyrus (LPMT), a region just anterior to area MT/V5, is important for the processing of complex action knowledge. It has also been found that motion verbs cause…

  14. Anterior insula coordinates hierarchical processing of tactile mismatch responses

    PubMed Central

    Allen, Micah; Fardo, Francesca; Dietz, Martin J.; Hillebrandt, Hauke; Friston, Karl J.; Rees, Geraint; Roepstorff, Andreas

    2016-01-01

    The body underlies our sense of self, emotion, and agency. Signals arising from the skin convey warmth, social touch, and the physical characteristics of external stimuli. Surprising or unexpected tactile sensations can herald events of motivational salience, including imminent threats (e.g., an insect bite) and hedonic rewards (e.g., a caressing touch). Awareness of such events is thought to depend upon the hierarchical integration of body-related mismatch responses by the anterior insula. To investigate this possibility, we measured brain activity using functional magnetic resonance imaging, while healthy participants performed a roving tactile oddball task. Mass-univariate analysis demonstrated robust activations in limbic, somatosensory, and prefrontal cortical areas previously implicated in tactile deviancy, body awareness, and cognitive control. Dynamic Causal Modelling revealed that unexpected stimuli increased the strength of forward connections along a caudal to rostral hierarchy—projecting from thalamic and somatosensory regions towards insula, cingulate and prefrontal cortices. Within this ascending flow of sensory information, the AIC was the only region to show increased backwards connectivity to the somatosensory cortex, augmenting a reciprocal exchange of neuronal signals. Further, participants who rated stimulus changes as easier to detect showed stronger modulation of descending PFC to AIC connections by deviance. These results suggest that the AIC coordinates hierarchical processing of tactile prediction error. They are interpreted in support of an embodied predictive coding model where AIC mediated body awareness is involved in anchoring a global neuronal workspace. PMID:26584870

  15. Influence of intramuscular heat stimulation on modulation of nociception: complex role of central opioid receptors in descending facilitation and inhibition.

    PubMed

    You, Hao-Jun; Lei, Jing; Ye, Gang; Fan, Xiao-Li; Li, Qiang

    2014-10-01

    It has been reported that the threshold to activate 'silent' or inactive descending facilitation of nociception is lower than that of descending inhibition. Thus, the development of pain therapy to effectively drive descending inhibition alone, without the confounding influences of facilitation is a challenge. To address this issue we investigated the effects of intramuscular stimulation with a heating-needle on spinal nociception, assessed by measuring nociceptive paw withdrawal reflex in rats. Additionally, involvement of the thalamic 'nociceptive discriminators' (thalamic mediodorsal (MD) and ventromedial (VM) nuclei), and opioid-mediated mechanisms were further explored. Descending facilitation and inhibition were elicited by 46°C noxious heating-needle stimulation, and were regulated by thalamic MD and VM nuclei, respectively. In contrast, innocuous heating-needle stimulation at a temperature of 43°C elicited descending inhibition modulated by the thalamic VM nucleus alone. Microinjection of μ/δ/κ-opioid receptor antagonists β-funaltrexamine hydrochloride/naltrindole/nor-binaltorphimine, into the VM nucleus attenuated the 46°C intramuscular heating-needle stimulation-evoked descending inhibition, whereas treatment of the MD nucleus with β-funaltrexamine hydrochloride significantly decreased the descending facilitation. By contrast, descending inhibition evoked by 43°C heating-needle stimulation was only depressed by naltrindole, as opposed to μ- and κ-opioid receptor antagonists, which failed to influence descending inhibition. The present study reveals distinct roles of μ-opioid receptors in the function of thalamic MD and VM nuclei,which exert facilitatory and inhibitory actions on nociception. Furthermore, innocuous, but not noxious, intramuscular heating-needle stimulation targeting δ-opioid receptors is suggested to be a promising avenue for the effective inhibition of pain.

  16. 1. Postandbeam garage (far left), oneroom log cabin (left of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Post-and-beam garage (far left), one-room log cabin (left of center), house (right of center), garden shed and outhouse (far right). View to west-southwest. - William & Lucina Bowe Ranch, County Road 44, 0.1 mile northeast of Big Hole River Bridge, Melrose, Silver Bow County, MT

  17. 6. Livestock barn (far left), log drafthorse barn (left of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. Livestock barn (far left), log draft-horse barn (left of center), loafing shed (center), log calving barn (right of center). View to west-northwest. - William & Lucina Bowe Ranch, County Road 44, 0.1 mile northeast of Big Hole River Bridge, Melrose, Silver Bow County, MT

  18. 3. Log bunkhouse (far left), log chicken house (left of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. Log bunkhouse (far left), log chicken house (left of center), equipment shed (center), and workshop (far right). View to northwest. - William & Lucina Bowe Ranch, County Road 44, 0.1 mile northeast of Big Hole River Bridge, Melrose, Silver Bow County, MT

  19. Challenging mitral valve repair for double-orifice mitral valve with noncompaction of left ventricular myocardium.

    PubMed

    Yamasaki, Manabu; Misumi, Hiroyasu; Abe, Kohei; Kawazoe, Kohei

    2017-02-25

    Double-orifice mitral valve (DOMV) is a relatively rare cardiac anomaly. Although usually associated with various cardiac anomalies, co-presence of DOMV and noncompaction of left ventricular myocardium (NCLVM) is extremely rare. Here, we present a 24-year-old male who underwent mitral valve repair using artificial chordae and annuloplasty at the posterior commissure for severe mitral regurgitation (MR), resulting from flail anterior leaflet of the larger postero-medial orifice and dilatation of left ventricle with NCLVM. One year later, he underwent second mitral valve repair for recurrence of MR. Further endoscopic evaluation of the left ventricle, and reinforcement via artificial ring, enabled us to achieve repair.

  20. Acute myocardial infarction caused by left atrial myxoma: Role of intracoronary catheter aspiration.

    PubMed

    Al-Fakhouri, Ahmad; Janjua, Muhammad; DeGregori, Michele

    2017-01-01

    Acute ST-segment elevation myocardial infarction (STEMI) caused by left atrial myxoma is very rare. Catheter-based approaches or thrombolytic therapy are mostly the first step in the management of STEMI with less time delay. We report a case of acute anterior/lateral STEMI caused by a left atrial myxoma. The patient was successfully treated by intracoronary aspiration with an Export aspiration catheter, with excellent distal coronary flow. Intracoronary catheter aspiration in acute myocardial infarction caused by a left atrial myxoma may help to salvage the infarcting myocardium with less time delay.

  1. Free serratus anterior artery perforator flap: a case report with an anatomic and radiological study.

    PubMed

    Tamburino, Serena; Menez, Tiphaine; Laloze, Jérôme; Michot, Audrey; Paillet, Pierre; Perrotta, Rosario Emanuele; Casoli, Vincent

    2017-02-24

    Perforator flaps have become very popular in reconstructive surgery. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. We describe a case of free serratus anterior artery perforator flap for the reconstruction of a dorsal defect of the foot, followed by an anatomic and radiological study. A 17-year-old boy reported a fracture of the first and second metatarsal bone of the left foot, with a dorsal skin defect, due to a motorcycle accident. After the osteosynthesis treatment, a perforator was identified through a handheld Doppler in the lateral chest area and a cutaneous paddle was designed. Retrograde dissection revealed the perforator's direct link to the serratus anterior pedicle. In our knowledge, an elucidated method to preoperatively visualize the perforating vessel of the serratus anterior artery has not yet been described. Thus, an anatomic study on 8 hemithorax and a radiological study on 33 computed tomographic angiographies of the chest were carried out to clarify the vascular anatomy of the serratus anterior artery perforators and to verify the possibility of their preoperative visualization. The authors believe that the serratus anterior artery perforator could be preoperatively investigated, thus making this flap a valuable option when harvesting a perforator flap in the lateral chest area.

  2. Incidental Anterior Cruciate Ligament Calcification: Case Report

    PubMed Central

    Hayashi, Hisami; Fischer, Hans

    2016-01-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding. PMID:27200163

  3. Anterior Cruciate: Methods of Physical Examination

    PubMed Central

    Grant, John; Kirby, R. Lee

    1982-01-01

    Tear of the anterior cruciate ligament is a common, serious injury. Since the long-range consequences of uncorrected anterior cruciate incompetence are better understood, and surgical and rehabilitative measures improved, early accurate diagnosis is increasingly important. Besides a careful history, diagnosis requires the use of specific physical examination methods to reproduce the symptomatic subluxation (anterior shift or internal rotation) and to assess functional performance of the knee. ImagesFig. 1Fig. 2Fig. 3 PMID:21286055

  4. Thrombosis of the Azygos Anterior Cerebral Artery

    PubMed Central

    Avelino, Marcelo Coelho; Bastos, Breno Braga; Moreira de Sousa, Rafael Soares

    2017-01-01

    The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams. PMID:28299225

  5. Simultaneous thrombosis of multiple coronary arteries in a patient with rheumatoid arthritis

    PubMed Central

    Kalayci, Arzu; Arslan, Erol; Bakar, Salih Murat; Guneri, Mahmut; Dizman, Rafet; Kivanc, Eylem; Karabay, Can Yucel

    2016-01-01

    We present a case of simultaneous coronary thrombosis of the left main, the left anterior descending artery and the right coronary artery in a patient, recently diagnosed with rheumatoid arthritis. PMID:27489603

  6. TU-EF-304-12: Proton Radiation Therapy for Left-Sided Breast Cancer: LET and RBE Considerations for Cardiac Toxicity

    SciTech Connect

    Giantsoudi, D; Jee, K; MacDonald, S; Paganetti, H; Rose, B

    2015-06-15

    Purpose: Increased risk of coronary artery disease has been documented for patients treated with radiation for left-sided breast cancer. Proton therapy (PRT) has been shown to significantly decrease cardiac irradiation, however variations in relative biological effectiveness (RBE) have been ignored so far. In this study we evaluate the impact of accounting for RBE variations on sensitive structures located within high linear energy transfer (LET) areas (distal end) of the proton treatment fields, for this treatment site. Methods: Three patients treated in our institution with PRT for left-sided breast cancer were selected. All patients underwent reconstructive surgery after mastectomy and treated to a total dose of 50.4Gy with beam(s) vertical to the chest wall. Dose and LET distributions were calculated using Monte Carlo (MC-TOPAS - TOol for PArticle Simulation). The LET-based, variable-RBE-weighted dose was compared to the analytical calculation algorithm (ACA) and MC dose distributions for a constant RBE of 1.1, based on volume histograms and mean values for the target, heart and left anterior descending coronary artery (LAD). Results: Assuming a constant RBE and compared to the ACA dose, MC predicted lower mean target and heart doses by 0.5% to 2.7% of the prescription dose. For variable RBE, plan evaluation showed increased mean target dose by up to 5%. Mean variable-RBE-weighted doses for the LAD ranged from 2.7 to 5.9Gy(RBE) among patients increased by 41%–64.2% compared to constant RBE ACA calculation (absolute dose: 1.7–3.9Gy(RBE)). Smaller increase in mean heart doses was noticed. Conclusion: ACA overestimates the target mean dose by up to 2.7%. However, disregarding variations in RBE may lead to significant underestimation of the dose to sensitive structures at the distal end of the proton treatment field and could thus impact outcome modeling for cardiac toxicities after proton therapy. These results are subject to RBE model and parameter

  7. Magnetocardiograms of patients with left ventricular overloading recorded with a second-derivative SQUID gradiometer.

    PubMed

    Fujino, K; Sumi, M; Saito, K; Murakami, M; Higuchi, T; Nakaya, Y; Mori, H

    1984-07-01

    Magnetocardiograms (MCGs) were recorded by means of a second-derivative SQUID (superconducting quantum interference device) magnetometer in 60 normal subjects and 95 patients with left ventricular overloading to determine the clinical value of the MCG. In patients with left ventricular overloading, the Q or S wave was increased in the upper anterior part of the thorax, and the R wave was increased in the left lower part of the thorax, indicating increased leftward force due to left ventricular overloading. For detection of left ventricular hypertrophy or dilatation from echocardiographic measurements, the sensitivity and specificity of the MCG were similar to those of the standard ECG, or slightly better. In patients with left ventricular systolic overloading, the Q wave was decreased in the lower anterior part of the thorax, indicating a decreased septal vector. Inversion of the T wave was seen more frequently in the MCGs than in the ECGs of patients with left ventricular overloading, suggesting that the MCG is useful for detecting early abnormalities of repolarization. These results suggest that the MCG may provide information that is difficult to obtain from the standard 12-lead ECG.

  8. Left ventricular wall stress compendium.

    PubMed

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  9. Neurula rotation determines left-right asymmetry in ascidian tadpole larvae.

    PubMed

    Nishide, Kazuhiko; Mugitani, Michio; Kumano, Gaku; Nishida, Hiroki

    2012-04-01

    Tadpole larvae of the ascidian Halocynthia roretzi show morphological left-right asymmetry. The tail invariably bends towards the left side within the vitelline membrane. The structure of the larval brain is remarkably asymmetric. nodal, a conserved gene that shows left-sided expression, is also expressed on the left side in H. roretzi but in the epidermis unlike in vertebrates. We show that nodal signaling at the late neurula stage is required for stereotypic morphological left-right asymmetry at later stages. We uncover a novel mechanism to break embryonic symmetry, in which rotation of whole embryos provides the initial cue for left-sided expression of nodal. Two hours prior to the onset of nodal expression, the neurula embryo rotates along the anterior-posterior axis in a counterclockwise direction when seen in posterior view, and then this rotation stops when the left side of the embryo is oriented downwards. It is likely that epidermis monocilia, which appear at the neurula rotation stage, generate the driving force for the rotation. When the embryo lies on the left side, protrusion of the neural fold physically prevents it from rotating further. Experiments in which neurula rotation is perturbed by various means, including centrifugation and sandwiching between glass, indicate that contact of the left epidermis with the vitelline membrane as a consequence of neurula rotation promotes nodal expression in the left epidermis. We suggest that chemical, and not mechanical, signals from the vitelline membrane promote nodal expression. Neurula rotation is also conserved in other ascidian species.

  10. Sibling configuration predicts individual and descendant socioeconomic success in a modern post-industrial society.

    PubMed

    Lawson, David W; Makoli, Arijeta; Goodman, Anna

    2013-01-01

    Growing up with many siblings, at least in the context of modern post-industrial low fertility, low mortality societies, is predictive of relatively poor performance on school tests in childhood, lower levels of educational attainment, and lower income throughout adulthood. Recent studies further indicate these relationships hold across generations, so that the descendants of those who grow up with many siblings are also at an apparent socioeconomic disadvantage. In this paper we add to this literature by considering whether such relationships interact with the sex and relative age of siblings. To do this we utilise a unique Swedish multigenerational birth cohort study that provides sibling configuration data on over 10,000 individuals born in 1915-1929, plus all their direct genetic descendants to the present day. Adjusting for parental and birth characteristics, we find that the 'socioeconomic cost' of growing up in a large family is independent of both the sex of siblings and the sex of the individual. However, growing up with several older as opposed to several younger siblings is predictive of relatively poor performance on school tests and a lower likelihood of progression to tertiary education. This later-born disadvantage also holds across generations, with the children of those with many older siblings achieving lower levels of educational attainment. Despite these differences, we find that while individual and descendant income is negatively related to the number of siblings, it is not influenced by the relative age of siblings. Thus, our findings imply that the educational disadvantage of later-born children, demonstrated here and in numerous other studies, does not necessarily translate into reduced earnings in adulthood. We discuss potential explanations for this pattern of results, and consider some important directions for future research into sibling configuration and wellbeing in modern societies.

  11. MRI of anterior knee pain.

    PubMed

    Samim, Mohammad; Smitaman, Edward; Lawrence, David; Moukaddam, Hicham

    2014-07-01

    Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

  12. Responses to Selection for Body Weight in Descendants of X-Irradiated Rats

    PubMed Central

    Gianola, Daniel; Chapman, A. B.; Rutledge, J. J.

    1979-01-01

    The effectiveness of selection for high and low body weight at six weeks of age was studied in descendants of X-irradiated (R) and nonirradiated (C) inbred rats. There were two replicates of each of the direction of selection-irradiation treatments. In C lines, there were no consistent responses to selection, probably due to a low level of genetic variability. In R rats, selection was effective only for decreased body weight. The results of this experiment do not suggest the use of irradiation combined with selection as a means of enhancing responses to selection in animals. PMID:456888

  13. Colonic intussusception in descending colon: An unusual presentation of colon lipoma

    PubMed Central

    Bagherzadeh Saba, Reza; Sadeghi, Amir; Rad, Neda; Safari, Mohammad Taghi; Barzegar, Farnoush

    2016-01-01

    Lipomas of the colon are relatively rare benign soft tissue tumors derived from mature adipocytes of mesenchymatic origin. During colonoscopy, surgery or autopsy they are generally discovered incidentally. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, in the cases with larger in size of tumor some symptoms such as anemia, abdominal pain, constipation, diarrhea, bleeding, or intussusception may be presented. We reported a 47-year-old woman with colonic intussusception in the descending colon caused by colonic lipoma and diagnosed after surgical exploration for obstructive colonic mass. PMID:28224035

  14. Development and characterization of pathways descending to the spinal cord in the embryonic chick.

    PubMed

    Sholomenko, G N; O'Donovan, M J

    1995-03-01

    1. We used an isolated preparation of the embryonic chick brain stem and spinal cord to examine the origin, trajectory, and effects of descending supraspinal pathways on lumbosacral motor activity. The in vitro preparation remained viable for < or 24 h and was sufficiently stable for electrophysiological, pharmacological, and neuroanatomic examination. In this preparation, as in the isolated spinal cord, spontaneous episodes of both forelimb and hindlimb motor activity occur in the absence of phasic afferent input. Motor activity can also be evoked by brain stem electrical stimulation or modulated by the introduction of neurochemicals to the independently perfused brain stem. 2. At embryonic day (E)6, lumbosacral motor activity could be evoked by brain stem electrical stimulation. At E5, neither brain stem nor spinal cord stimulation evoked activity in the lumbosacral spinal cord, although motoneurons did express spontaneous activity. 3. Lesion and electrophysiological studies indicated that axons traveling in the ventral cord mediated the activation of lumbosacral networks by brain stem stimulation. 4. Partition of the preparation into three separately perfused baths, using a zero-Ca2+ middle bath that encompassed the cervical spinal cord, demonstrated that the brain stem activation of spinal networks could be mediated by long-axoned pathways connecting the brain stem and lumbosacral spinal cord. 5. Using retrograde tracing from the spinal cord combined with brain stem stimulation, we found that the brain stem regions from which spinal activity could be evoked lie in the embryonic reticular formation close to neurons that send long descending axons to the lumbosacral spinal cord. The cells giving rise to these descending pathways are found in the ventral pontine and medullary reticular formation, a region that is the source of reticulospinal neurons important for motor activity in adult vertebrates. 6. Electrical recordings from this region revealed that the

  15. Ancestor-descendant relationships in evolution: origin of the extant pygmy right whale, Caperea marginata.

    PubMed

    Tsai, Cheng-Hsiu; Fordyce, R Ewan

    2015-01-01

    Ancestor-descendant relationships (ADRs), involving descent with modification, are the fundamental concept in evolution, but are usually difficult to recognize. We examined the cladistic relationship between the only reported fossil pygmy right whale, †Miocaperea pulchra, and its sole living relative, the enigmatic pygmy right whale Caperea marginata, the latter represented by both adult and juvenile specimens. †Miocaperea is phylogenetically bracketed between juvenile and adult Caperea marginata in morphologically based analyses, thus suggesting a possible ADR-the first so far identified within baleen whales (Cetacea: Mysticeti). The †Miocaperea-Caperea lineage may show long-term morphological stasis and, in turn, punctuated equilibrium.

  16. Bidirectional amygdaloid control of neuropathic hypersensitivity mediated by descending serotonergic pathways acting on spinal 5-HT3 and 5-HT1A receptors.

    PubMed

    Sagalajev, B; Bourbia, N; Beloushko, E; Wei, H; Pertovaara, A

    2015-04-01

    Amygdala is involved in processing of primary emotions and particularly its central nucleus (CeA) also in pain control. Here we studied mechanisms mediating the descending control of mechanical hypersensitivity by the CeA in rats with a peripheral neuropathy in the left hind limb. For drug administrations, the animals had a guide cannula in the right CeA and an intrathecal catheter or another guide cannula in the medullary raphe. Hypersensitivity was tested with monofilaments. Glutamate administration in the CeA produced a bidirectional effect on hypersensitivity that varied from an increase at a low-dose (9μg) to a reduction at high doses (30-100μg). The increase but not the reduction of hypersensitivity was prevented by blocking the amygdaloid NMDA receptor with a dose of MK-801 that alone had no effects. The glutamate-induced increase in hypersensitivity was reversed by blocking the spinal 5-HT3 receptor with ondansetron, whereas the reduction in hypersensitivity was reversed by blocking the spinal 5-HT1A receptor with WAY-100635. Both the increase and decrease of hypersensitivity induced by amygdaloid glutamate treatment were reversed by medullary administration of a 5-HT1A agonist, 8-OH-DPAT, that presumably produced autoinhibition of serotonergic cell bodies in the medullary raphe. The results indicate that depending on the dose, glutamate in the CeA has a descending facilitatory or inhibitory effect on neuropathic pain hypersensitivity. Serotoninergic raphe neurons are involved in mediating both of these effects. Spinally, the 5-HT3 receptor contributes to the increase and the 5-HT1A receptor to the decrease of neuropathic hypersensitivity induced by amygdaloid glutamate.

  17. A case of descending mediastinitis caused by Streptococcus pyogenes harboring genotype emm25 and sequence type 660.

    PubMed

    Ohya, Hiroaki; Mori, Nobuaki; Hayashi, Tetsuro; Minami, Shujiro; Higuchi, Akiko; Takahashi, Takashi

    2017-02-01

    Descending mediastinitis caused by Streptococcus pyogenes (group A streptococcus, GAS) is rare among cases of invasive GAS infection. In this report, we describe a case of a cervical abscess and secondary descending mediastinitis in a previously healthy 39-year-old Japanese man. The patient presented with a 2-week history of a sore throat, and subsequently developed an abscess and descending mediastinitis. We treated the cervical abscess using ampicillin/sulbactam and drainage, and GAS was subsequently isolated in two blood cultures from the patient's admission. Microbiological analyses revealed that the isolate harbored genotype emm25 and sequence type (ST) 660. This strain was susceptible to erythromycin (minimum inhibitory concentration [MIC]: ≤0.12 μg/mL), resistant to minocycline (MIC: >4 μg/mL), and possessed the tet(M) determinant. Although we have reviewed the literature regarding the clinical and microbiological characteristics of descending mediastinitis cause by GAS, little is known regarding epidemiological and clinical characteristics of emm25/ST660 GAS. Furthermore, to best of our knowledge, this is the first reported case of descending mediastinitis caused by emm25/ST660 GAS. Therefore, physicians should be aware of case with a cervical abscess and secondary descending mediastinitis caused by GAS infection, even if the patient is immunocompetent.

  18. Psychophysical demonstration of bidirectional pain modulation (sensitization and desensitization) by ascending or descending progressions of thermal stimulus intensity.

    PubMed

    Vierck, Charles J; Riley, Joseph L; Wong, Fong; King, Christopher D; Mauderli, Andre P

    2010-08-06

    A psychophysical method of response-dependent stimulation presented ascending and descending series of thermal stimulus intensities that maintained an average rating (setpoint) of mild pain (20 on a scale of 0-100) or moderate pain (35). Subjects were presented with alternating series of thermal stimuli that increased until ratings reached or exceeded the setpoint, then decreased until ratings equaled or were less than the setpoint, then increased, etc. Plots of pain intensity ratings differed substantially for series of ascending and descending stimulus intensities. After an ascending series, pain ratings during a descending series were higher than predicted, and after a descending series, pain ratings during an ascending series were lower than predicted. Thus, the nervous system detects and discriminates between ascending and descending trends in stimulus intensity and alters the magnitude of pain sensations in the direction of the trend of increasing or decreasing stimulus intensity. Ascending (sensitizing) trend effects may increase the magnitude of pathological pain in the absence of treatment, and descending (desensitizing) trend effects likely would enhance the efficacy of procedures that reduce pain sensitivity.

  19. Stair Descending Exercise Using a Novel Automatic Escalator: Effects on Muscle Performance and Health-Related Parameters

    PubMed Central

    Paschalis, Vassilis; Theodorou, Anastasios A.; Panayiotou, George; Kyparos, Antonios; Patikas, Dimitrios; Grivas, Gerasimos V.; Nikolaidis, Michalis G.; Vrabas, Ioannis S.

    2013-01-01

    A novel automatic escalator was designed, constructed and used in the present investigation. The aim of the present investigation was to compare the effect of two repeated sessions of stair descending versus stair ascending exercise on muscle performance and health-related parameters in young healthy men. Twenty males participated and were randomly divided into two equal-sized groups: a stair descending group (muscle-damaging group) and a stair ascending group (non-muscle-damaging group). Each group performed two sessions of stair descending or stair ascending exercise on the automatic escalator while a three week period was elapsed between the two exercise sessions. Indices of muscle function, insulin sensitivity, blood lipid profile and redox status were assessed before and immediately after, as well as at day 2 and day 4 after both exercise sessions. It was found that the first bout of stair descending exercise caused muscle damage, induced insulin resistance and oxidative stress as well as affected positively blood lipid profile. However, after the second bout of stair descending exercise the alterations in all parameters were diminished or abolished. On the other hand, the stair ascending exercise induced only minor effects on muscle function and health-related parameters after both exercise bouts. The results of the present investigation indicate that stair descending exercise seems to be a promising way of exercise that can provoke positive effects on blood lipid profile and antioxidant status. PMID:23437093

  20. Selective Familiarity Deficits after Left Anterior Temporal-Lobe Removal with Hippocampal Sparing Are Material Specific

    ERIC Educational Resources Information Center

    Martin, Chris B.; Bowles, Ben; Mirsattari, Seyed M.; Kohler, Stefan

    2011-01-01

    Research has firmly established a link between recognition memory and the functional integrity of the medial temporal lobes (MTL). Dual-process models of MTL organization maintain that there is a division of labour within the MTL, with the hippocampus (HC) supporting recollective processes and perirhinal cortex (PRc) supporting familiarity…

  1. The OPRM1 A118G polymorphism modulates the descending pain modulatory system for individual pain experience in young women with primary dysmenorrhea

    PubMed Central

    Wei, Shyh-Yuh; Chen, Li-Fen; Lin, Ming-Wei; Li, Wei-Chi; Low, Intan; Yang, Ching-Ju; Chao, Hsiang-Tai; Hsieh, Jen-Chuen

    2017-01-01

    The mu-opioid receptor (OPRM1) A118G polymorphism underpins different pain sensitivity and opioid-analgesic outcome with unclear effect on the descending pain modulatory system (DPMS). Primary dysmenorrhea (PDM), the most prevalent gynecological problem with clear painful and pain free conditions, serves as a good clinical model of spontaneous pain. The objective of this imaging genetics study was therefore to explore if differences in functional connectivity (FC) of the DPMS between the OPRM1 A118G polymorphisms could provide a possible explanation for the differences in pain experience. Sixty-one subjects with PDM and 65 controls participated in the current study of resting-state functional magnetic resonance imaging (fMRI) during the menstruation and peri-ovulatory phases; blood samples were taken for genotyping. We studied 3 aspects of pain experience, namely, mnemonic pain (recalled overall menstrual pain), present pain (spontaneous menstrual pain), and experimental pain (thermal pain) intensities. We report that G allele carriers, in comparison to AA homozygotes, exhibited functional hypo-connectivity between the anterior cingulate cortex (ACC) and periaqueductal gray (PAG). Furthermore, G allele carriers lost the correlation with spontaneous pain experience and exhibited dysfunctional DPMS by means of PAG-seeded FC dynamics. This OPRM1 A118G-DPMS interaction is one plausible neurological mechanism underlying the individual differences in pain experience. PMID:28057931

  2. Left-Sided Inferior Vena Cava Encountered During Organ Retrieval Surgery: Report of Two Cases

    PubMed Central

    Rajabnejad, Y.; Aliakbarian, M.; Rajabnejad, A.; Motie, M. R.

    2016-01-01

    Left-sided inferior vena cava (IVC) is the second most common anatomical anomaly of the IVC after duplication. Herein, we present two cases of left-sided IVC, diagnosed during organ retrieval procedure. In a young brain-dead man, a single left-sided IVC was observed; it originated from iliac confluence in the left side of the aorta and extended throughout the abdomen. There was no retrohepatic IVC in the patient; hepatic veins drained directly into the right atrium. The second case was a brain-dead young woman with a left-sided IVC originated from iliac confluence to the kidney level; then, the IVC crossed anterior to the abdominal aorta to join a normally positioned retrohepatic IVC. In cases of retroperitoneal surgeries, IVC anomalies should be considered during preoperative imaging studies, because they may be misdiagnosed as para-aortic lymphadenopathy, tumor or dilated gonadal vein that may result in iatrogenic damage during surgery. PMID:28078062

  3. Complete recovery of visual loss following surgical treatment of mucopyocele of the anterior clinoid process.

    PubMed

    Chagla, Aadil S; Bhaganagare, Amrish; Kansal, Ritesh; Tyagi, Devendra

    2010-05-01

    A mucocele is a collection of mucus, which is lined by the mucus-secreting epithelium of a paranasal sinus. Paranasal sinus mucoceles occur as a result of inflammation, tumor, trauma or surgical manipulation. The anterior clinoid process may be pneumatized by an extension of the sphenoid paranasal sinus air space during normal development. Mucocele of the anterior clinoid process is rare. We report a patient with mucopyocele of the anterior clinoid process that resulted in rapid monocular visual loss. The left optic canal was exposed extradurally via a supraorbital craniotomy and the mucopyocele was totally excised. The optic canal was decompressed by drilling the superior, lateral and medial rims, to achieve circumferential decompression of the optic nerve. The patient's vision improved postoperatively.

  4. Simple arthroscopic partial meniscectomy associated with anterior cruciate-deficient knees.

    PubMed

    Marshall, S; Levas, M G; Harrah, A

    1985-01-01

    Twenty-five patients with combined tears of the meniscus and anterior cruciate ligament in the same knee were evaluated for the results of a simple arthroscopic meniscectomy that preserved the meniscal rim. These patients, classified as "recreational athletes," were analyzed to determine their postoperative functional capabilities. Using the presence or absence of the pivot shift sign as the most important indicator of functional capability, we found that partial meniscectomy was effective in allowing patients to regain a high degree of normal functional ability and in permitting forward motion activities. However, all patients were left with an anterior cruciate-deficient knee that caused laxity in the anterior plane and frequently in the rotatory plane. Rotatory laxity markedly limits activities, and those patients unable to adjust to their instability are considering further surgery.

  5. Feelings of warmth correlate with neural activity in right anterior insular cortex.

    PubMed

    Olausson, H; Charron, J; Marchand, S; Villemure, C; Strigo, I A; Bushnell, M C

    2005-11-25

    The neural coding of perception can differ from that for the physical attributes of a stimulus. Recent studies suggest that activity in right anterior insular cortex may underlie thermal perception, particularly that of cold. We now examine whether this region is also important for the perception of warmth. We applied cutaneous warm stimuli on the left leg (warmth) in normal subjects (n = 7) during functional magnetic resonance imaging (fMRI). After each stimulus, subjects rated their subjective intensity of the stimulus using a visual analogue scale (VAS), and correlations were determined between the fMRI signal and the VAS ratings. We found that intensity ratings of warmth correlated with the fMRI signal in the right (contralateral to stimulation) anterior insular cortex. These results, in conjunction with previous reports, suggest that the right anterior insular cortex is important for different types of thermal perception.

  6. Anterior uveal spindle cell tumor in a blue-eyed mixed-breed dog.

    PubMed

    Olbertz, Letícia; Langohr, Ingeborg; Werner, Juliana; Pessoa, Lenita; Kiupel, Matti; Agnew, Dalen; Montiani-Ferreira, Fabiano

    2013-07-01

    A female, eight-year-old, mixed-breed blue-eyed dog was presented for ophthalmic evaluation because its left eye had "changed color" one year previously. The before left eye was enucleated and submitted for evaluation. Histopathological analysis revealed an invasive neoplastic mass effacing most of the ventral aspect of the iris stroma. A diagnosis of an anterior uveal spindle cell tumor was made. Immunohistochemical results were strongly suggestive of a schwannoma, but some smooth muscle differentiation was also observed. Two and a half years after therapeutic enucleation there was no evidence of neoplasm recurrence or metastasis.

  7. An anterior mediastinal mass: delayed airway compression and using a double lumen tube for airway patency.

    PubMed

    Lee, Jeounghyuk; Rim, Yong Chul; In, Junyong

    2014-06-01

    Perioperative management of patients with an anterior mediastinal mass is difficult. We present a 35-year-old woman who showed delayed compression of the carina and left main bronchus despite no preoperative respiratory signs, symptoms, or radiologic findings due to an anterior mediastinal mass and uneventful stepwise induction of general anesthesia. Even use of a fiberoptic bronchoscope (FB) after induction of anesthesia was not helpful to predict delayed compression of the airway. Therefore, the anesthesiologist and the cardiothoracic surgeon must prepare for unexpected delayed compression of the airway, even in low risk patients who are asymptomatic or mildly symptomatic without postural symptoms or radiographic evidence of significant compression of structures. We also describe successful management for the compressed carina and left main bronchus with a double lumen tube (DLT) as a stent during surgery. FB guided DLT intubation is a possible solution to maintain airway patency.

  8. Anterior cervical hypertrichosis: a sporadic case

    PubMed Central

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-01-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature. PMID:27103865

  9. Anterior cervical hypertrichosis: a sporadic case.

    PubMed

    Bostan, Sezen; Yaşar, Şirin; Serdar, Zehra Aşiran; Gizlenti, Sevda

    2016-03-01

    Anterior cervical hypertrichosis is a very rare form of primary localized hypertrichosis. It consists of a tuft of terminal hair on the anterior neck just above the laryngeal prominence. The etiology is still unknown. In this article, we reported a 15-year-old female patient who presented to our clinic with a complaint of hypertrichosis on the anterior aspect of the neck for the last five years. Her past medical history revealed no pathology except for vesicoureteral reflux. On the basis of clinical presentation, our patient was diagnosed with anterior cervical hypertrichosis and she was considered to be a sporadic case due to lack of other similar cases in familial history. To date, 33 patients with anterior cervical hypertrichosis have been reported. Anterior cervical hypertrichosis can be associated with other abnormalities, but it frequently presents as an isolated defect (70%). The association of vesicoureteral reflux and anterior cervical hypertrichosis which was observed in our patient might be coincidental. So far, no case of anterior cervical hypertrichosis associated with vesicoureteral reflux has been reported in the literature.

  10. Damage to left frontal regulatory circuits produces greater positive emotional reactivity in frontotemporal dementia.

    PubMed

    Sturm, Virginia E; Yokoyama, Jennifer S; Eckart, Janet A; Zakrzewski, Jessica; Rosen, Howard J; Miller, Bruce L; Seeley, William W; Levenson, Robert W

    2015-03-01

    Positive emotions foster social relationships and motivate thought and action. Dysregulation of positive emotion may give rise to debilitating clinical symptomatology such as mania, risk-taking, and disinhibition. Neuroanatomically, there is extensive evidence that the left hemisphere of the brain, and the left frontal lobe in particular, plays an important role in positive emotion generation. Although prior studies have found that left frontal injury decreases positive emotion, it is not clear whether selective damage to left frontal emotion regulatory systems can actually increase positive emotion. We measured happiness reactivity in 96 patients with frontotemporal dementia (FTD), a neurodegenerative disease that targets emotion-relevant neural systems and causes alterations in positive emotion (i.e., euphoria and jocularity), and in 34 healthy controls. Participants watched a film clip designed to elicit happiness and a comparison film clip designed to elicit sadness while their facial behavior, physiological reactivity, and self-reported emotional experience were monitored. Whole-brain voxel-based morphometry (VBM) analyses revealed that atrophy in predominantly left hemisphere fronto-striatal emotion regulation systems including left ventrolateral prefrontal cortex, orbitofrontal cortex, anterior insula, and striatum was associated with greater happiness facial behavior during the film (pFWE < .05). Atrophy in left anterior insula and bilateral frontopolar cortex was also associated with higher cardiovascular reactivity (i.e., heart rate and blood pressure) but not self-reported positive emotional experience during the happy film (p < .005, uncorrected). No regions emerged as being associated with greater sadness reactivity, which suggests that left-lateralized fronto-striatal atrophy is selectively associated with happiness dysregulation. Whereas previous models have proposed that left frontal injury decreases positive emotional responding, we argue that

  11. [Echocardiographic and Doppler echocardiographic characterization of left ventricular diastolic function].

    PubMed

    Muscholl, M; Dennig, K; Kraus, F; Rudolph, W

    1990-12-01

    atrial filling phase which characterize the ventricular filling and the diameter changes of the left ventricle during these time intervals can be derived. The maximal velocity of the diastolic diameter change (PFR) is used to characterize the maximal early diastolic flow. The atrial emptying index characterizes the fraction of filling volume in the first third of diastole with respect to total filling volume of the left ventricle. As an indirect parameter for description of the early-diastolic filling, the steepness of the early-diastolic closure of the anterior mitral leaflet is used. From Doppler velocity profiles of the mitral inflow, early and late diastolic maximal velocities and their velocity time integrals as well as the relationships of these parameters to each other are determined.(ABSTRACT TRUNCATED AT 400 WORDS)

  12. Congenital subclavian steal syndrome with multiple cerebellar infarctions caused by an atypical circumflex retroesophageal right aortic arch with atretic aberrant left subclavian artery.

    PubMed

    Mamopoulos, Apostolos T; Luther, Bernd

    2014-09-01

    A right-sided aortic arch is a rare anomaly with an incidence of 0.1% worldwide and is usually associated with a mirror image of all supra-aortic branches or an aberrant left subclavian artery. The latter is often associated with a Kommerell diverticulum, although it can rarely be hypoplastic or atretic and lead to congenital subclavian steal. In most patients, the situation is well-tolerated. In this report, we present a case of subclavian steal syndrome with multiple cerebellar infarcts in a patient with an atypical right-sided aortic arch and an atretic aberrant left subclavian artery arising from a left-sided descending thoracic aorta.

  13. Math modeling for helicopter simulation of low speed, low altitude and steeply descending flight

    NASA Technical Reports Server (NTRS)

    Sheridan, P. F.; Robinson, C.; Shaw, J.; White, F.

    1982-01-01

    A math model was formulated to represent some of the aerodynamic effects of low speed, low altitude, and steeply descending flight. The formulation is intended to be consistent with the single rotor real time simulation model at NASA Ames Research Center. The effect of low speed, low altitude flight on main rotor downwash was obtained by assuming a uniform plus first harmonic inflow model and then by using wind tunnel data in the form of hub loads to solve for the inflow coefficients. The result was a set of tables for steady and first harmonic inflow coefficients as functions of ground proximity, angle of attack, and airspeed. The aerodynamics associated with steep descending flight in the vortex ring state were modeled by replacing the steady induced downwash derived from momentum theory with an experimentally derived value and by including a thrust fluctuations effect due to vortex shedding. Tables of the induced downwash and the magnitude of the thrust fluctuations were created as functions of angle of attack and airspeed.

  14. Nerve-mediated descending inhibition in the proximal colon of the rabbit.

    PubMed Central

    Julé, Y

    1980-01-01

    1. Descending inhibition in the rabbit proximal colon, evoked by distension, was studied in vivo by recording extracellularly electrical activity from pressure electrodes placed on the serosa. 2. Distention produced, blow the level of the balloon, a brief hyperpolarization of smooth muscle fibres which could be recorded up to 20 cm from the point of distension. 3. This hyperpolarization like that produced by vagal stimulation (inhibitory junction potentials) persisted in the presence of sympathetic blocking agents and atropine, and was produced by non-adrenergic non-cholinergic intramural neurones. 4. In the presence of vagally evoked excitatory junction potentials (e.j.p.s), distension produced a transient inhibition of e.j.p.s, in addition to the hyperpolarization of smooth muscle. 5. The inhibition of these e.j.p.s persisted in the presence of sympathetic blocking agents, but in contrast to the hyperpolarization of smooth muscle produced by distension alone, was modulated by drugs interfering with 5-HT synthesis, re-uptake and activity. 6. The results indicate that descending inhibition in the rabbit proximal colon was produced by two distinct neuronal non-adrenergic inhibitory mechanisms exerted simultaneously on the smooth muscle and on the cholinergic excitatory pathways which innervate it. PMID:6454779

  15. Ascending midbrain dopaminergic axons require descending GAD65 axon fascicles for normal pathfinding

    PubMed Central

    García-Peña, Claudia M.; Kim, Minkyung; Frade-Pérez, Daniela; Ávila-González, Daniela; Téllez, Elisa; Mastick, Grant S.; Tamariz, Elisa; Varela-Echavarría, Alfredo

    2014-01-01

    The Nigrostriatal pathway (NSP) is formed by dopaminergic axons that project from the ventral midbrain to the dorsolateral striatum as part of the medial forebrain bundle. Previous studies have implicated chemotropic proteins in the formation of the NSP during development but little is known of the role of substrate-anchored signals in this process. We observed in mouse and rat embryos that midbrain dopaminergic axons ascend in close apposition to descending GAD65-positive axon bundles throughout their trajectory to the striatum. To test whether such interaction is important for dopaminergic axon pathfinding, we analyzed transgenic mouse embryos in which the GAD65 axon bundle was reduced by the conditional expression of the diphtheria toxin. In these embryos we observed dopaminergic misprojection into the hypothalamic region and abnormal projection in the striatum. In addition, analysis of Robo1/2 and Slit1/2 knockout embryos revealed that the previously described dopaminergic misprojection in these embryos is accompanied by severe alterations in the GAD65 axon scaffold. Additional studies with cultured dopaminergic neurons and whole embryos suggest that NCAM and Robo proteins are involved in the interaction of GAD65 and dopaminergic axons. These results indicate that the fasciculation between descending GAD65 axon bundles and ascending dopaminergic axons is required for the stereotypical NSP formation during brain development and that known guidance cues may determine this projection indirectly by instructing the pathfinding of the axons that are part of the GAD65 axon scaffold. PMID:24926237

  16. Penetrating Atherosclerotic Ulcer of the Descending Thoracic Aorta: Treatment by Endovascular Stent-Graft

    SciTech Connect

    Murgo, Salvatore; Dussaussois, Luc; Golzarian, Jafar; Cavenaile, Jean Christophe; Abada, Hicham Tarik; Ferreira, Jose; Struyven, Julien

    1998-11-15

    Purpose: To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal stent-graft. Methods: Four patients with penetrating aortic ulcers were reviewed. Three cases were complicated by rupture, false aneurysm, or retrograde dissection. All patients were treated by endovascular stent-graft and were followed by helical computed tomography (CT). Results: Endovascular stent-graft deployment was successful in all patients. However, in one case we observed a perigraft leak that spontaneously disappeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one patient died from pneumonia with cardiac failure 34 days after the procedure. In one patient, helical CT performed at 3 months showed a false aneurysm independent of the first ulcer. This patient refused any further treatment and suddenly died at home (unknown cause) after a 6-month follow-up period. Conclusion: Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending thoracic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible complications of the disease.

  17. Study of seismic activity during the ascending and descending phases of solar activity

    NASA Astrophysics Data System (ADS)

    Sukma, Indriani; Abidin, Zamri Zainal

    2016-12-01

    The study of the solar cycle and geomagnetic index associated with the seismic activity from the year 1901 to the end of 2015 has been done for an area that covers the majority of China and its bordering countries. Data of sunspot number, solar wind speed, daily storm time index and earthquake number are collected from NOAA, NASA, WDC, OMNI and USGS databases and websites. The earthquakes are classified into small (M < 5) and large (M ≥ 5) magnitudes (in Richter scale). We investigated the variation of earthquake activities with the geomagnetic storm index due to the solar wind. We focused on their variation in the ascending and descending phases of solar cycle. From our study, we conclude that there is a correlation between the phases' geomagnetic index and solar wind speed. We have also suggested that there is a certain degree of correlation between solar activity and seismicity in these phases. For every solar cycle, we find that there is a trend for earthquakes to occur in greater numbers during the descending phase. This can be explained by the increment in the solar wind speed and geomagnetic storm index during this phase.

  18. Anterior capsulotomy using the CO2 laser

    NASA Astrophysics Data System (ADS)

    Barak, Adiel; Ma-Naim, Tova; Rosner, Mordechai; Eyal, Ophir; Belkin, Michael

    1998-06-01

    Continuous circular capsulorhexis (CCC) is the preferred technique for removal of the anterior capsule during cataract surgery due to this technique assuring accurate centration of the intraocular lens. During modern cataract surgery, especially with small or foldable intra ocular lenses, centration of the lens is obligatory. Radial tears at the margin of an anterior capsulotomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ('pea pod' effect) and its subsequent decentration. The anterior capsule is more likely to ream intact if the continuous circular capsulorhexis (CCC) technique is used. Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, many ophthalmologists are still uncomfortable with it and find it difficult to perform, especially in complicated cases such as these done behind small pupil, cataract extraction in children and pseudoexfoliation syndrome. We have developed a technique using a CO2 laser system for safe anterior capsulotomy and tested it in animal eyes.

  19. Anatomical variations and morphometric study of the optic strut and the anterior clinoid process

    PubMed Central

    Kapur, Eldan; Mehić, Amina

    2012-01-01

    The optic strut and the anterior clinoid process represent bony structures that are closely related to anatomically and clinically significant elements such as the cavernous sinus, the internal carotid artery, the optic nerve and the pituitary gland. The objective of our study was to quantify dimensions of the optic strut and anterior clinoid process, and to determine variations in positions and forms of these structures. A descriptive anatomical study was performed on 200 dry human skulls. We analyzed dimensions and variations in position of the optic strut, dimensions of the anterior clinoid process as well as the incidence and forms of the caroticoclinoid foramen. The average thickness of the optic strut on skulls belonging to males was 3 mm and 2.8 mm on those belonging to females. The optic strut was most commonly attached to the anterior two fifths on the lower side of the anterior clinoid process. On the male skulls the average width of the anterior clinoid process was 9.4 mm (right) and 9.1 mm (left). Its length was 9.9 and 9.3 mm. On female skulls the average width of the process was 8.7 mm (right) and 8.3 mm (left), while the length measured 9.3 mm on the right and 8.9 mm on the opposite side. In our sample, a complete caroticoclinoid foramen appeared in 4.25%, a contact form in 2.75%. At last, an incomplete form of the foramen was observed in 9.75%. The anatomic variations of the investigated structures must be considered during the approaches to the cavernous sinus and neurovascular elements of the sellar region. PMID:22642592

  20. Anatomical variations and morphometric study of the optic strut and the anterior clinoid process.

    PubMed

    Kapur, Eldan; Mehić, Amina

    2012-05-01

    The optic strut and the anterior clinoid process represent bony structures that are closely related to anatomically and clinically significant elements such as the cavernous sinus, the internal carotid artery, the optic nerve and the pituitary gland. The objective of our study was to quantify dimensions of the optic strut and anterior clinoid process, and to determine variations in positions and forms of these structures. A descriptive anatomical study was performed on 200 dry human skulls. We analyzed dimensions and variations in position of the optic strut, dimensions of the anterior clinoid process as well as the incidence and forms of the caroticoclinoid foramen. The average thickness of the optic strut on skulls belonging to males was 3 mm and 2.8 mm on those belonging to females. The optic strut was most commonly attached to the anterior two fifths on the lower side of the anterior clinoid process. On the male skulls the average width of the anterior clinoid process was 9.4 mm (right) and 9.1 mm (left). Its length was 9.9 and 9.3 mm. On female skulls the average width of the process was 8.7 mm (right) and 8.3 mm (left), while the length measured 9.3 mm on the right and 8.9 mm on the opposite side. In our sample, a complete caroticoclinoid foramen appeared in 4.25%, a contact form in 2.75%. At last, an incomplete form of the foramen was observed in 9.75%. The anatomic variations of the investigated structures must be considered during the approaches to the cavernous sinus and neurovascular elements of the sellar region.

  1. Descending aortic mechanics and atrial fibrillation: a two-dimensional speckle tracking transesophageal echocardiography study.

    PubMed

    Teixeira, Rogério; Monteiro, Ricardo; Dinis, Paulo; Santos, Maria José; Botelho, Ana; Quintal, Nuno; Cardim, Nuno; Gonçalves, Lino

    2017-04-01

    Vascular mechanics assessed with two-dimensional speckle tracking echocardiography (2D-STE) could be used as a new imaging surrogate of vascular stiffening. The CHA2DS2-VASc score is considered accurate as an estimate of stroke risk in non-valvular AF, although many potential stroke risk factors have not been included in this scoring method. The purpose of this research is to study the feasibility of evaluating vascular mechanics at the descending aorta in non-valvular AF patients using transesophageal 2D-STE and to analyze the association between descending aortic mechanics and stroke. We prospectively recruited a group of 44 patients referred for a transesophageal echocardiogram (TEE) in the context of cardioversion for non-valvular AF. A short-axis view of the descending aorta, one to two centimeters after the aortic arch was selected for the vascular mechanics assessment with the 2D-STE methodology. The vascular mechanics parameters analyzed were circumferential aortic strain (CAS) and early circumferential aortic strain rate (CASR). A clinical assessment was performed with focus on the past stroke history and the CHA2DS2-VASc score. The mean age of our cohort was 65 ± 13 years and 75% were men; AF was known for 2.8 ± 2.5 years and it was considered paroxystic in 41% of cases. Waveforms adequate for measuring 2D-STE were present in 85% of the 264 descending aortic wall segments. The mean CAS was 3.5 ± 1.2% and the mean CASR was 0.7 ± 0.3 s(-1). The inter- and intra-observer variability for aortic mechanics was considered adequate. The median CHA2DS2VASc score was 2 (2-3). As the score increased we noted that both the CAS (r = -0.38, P = 0.01) and the CASR (r = -0.42, P < 0.01) decreased. Over 16% of the AF patients had a past history of stroke. These patients had lower values of both descending aortic strain [2.2 (1.8-2.6) vs. 3.9 (3.3-4.9)%, P < 0.01] and strain rate [0.4 (0.3-0.4) vs. 0.7 (0.6-1.1) s(-1), P < 0

  2. Monitoring ABC-assisted deep inspiration breath hold for left-sided breast radiotherapy with an optical tracking system

    SciTech Connect

    Mittauer, Kathryn E.; Deraniyagala, Rohan; Li, Jonathan G.; Lu, Bo; Liu, Chihray; Samant, Sanjiv S.; Lightsey, Judith L.; Yan, Guanghua

    2015-01-15

    Purpose: Recent knowledge on the effects of cardiac toxicity warrants greater precision for left-sided breast radiotherapy. Different breath-hold (BH) maneuvers (abdominal vs thoracic breathing) can lead to chest wall positional variations, even though the patient’s tidal volume remains consistent. This study aims to investigate the feasibility of using optical tracking for real-time quality control of active breathing coordinator (ABC)-assisted deep inspiration BH (DIBH). Methods: An in-house optical tracking system (OTS) was used to monitor ABC-assisted DIBH. The stability and localization accuracy of the OTS were assessed with a ball-bearing phantom. Seven patients with left-sided breast cancer were included. A free-breathing (FB) computed tomography (CT) scan and an ABC-assisted BH CT scan were acquired for each patient. The OTS tracked an infrared (IR) marker affixed over the patient’s xiphoid process to measure the positional variation of each individual BH. Using the BH within which the CT scan was performed as the reference, the authors quantified intra- and interfraction BH variations for each patient. To estimate the dosimetric impact of BH variations, the authors studied the positional correlation between the marker and the left breast using the FB CT and BH CT scans. The positional variations of 860 BHs as measured by the OTS were retrospectively incorporated into the original treatment plans to evaluate their dosimetric impact on breast and cardiac organs [heart and left anterior descending (LAD) artery]. Results: The stability and localization accuracy of the OTS was within 0.2 mm along each direction. The mean intrafraction variation among treatment BHs was less than 2.8 mm in all directions. Up to 12.6 mm anteroposterior undershoot, where the patient’s chest wall displacement of a BH is less than that of a reference BH, was observed with averages of 4.4, 3.6, and 0.1 mm in the anteroposterior, craniocaudal, and mediolateral directions

  3. Hypoplastic left heart syndrome: palliation without cardiopulmonary bypass.

    PubMed

    Tucker, W Y; McKone, R C; Weesner, K M; Kon, N D

    1990-05-01

    Our 100% mortality rate with first-stage palliation of hypoplastic left heart syndrome performed with cardiopulmonary bypass led us to a procedure not necessitating bypass. In nine neonates with this congenital heart defect, a woven Dacron graft was placed from the main pulmonary artery to the descending thoracic aorta. The patent ductus arteriosus was ligated and the main pulmonary artery banded distal to the graft and proximal to the bifurcation. Five patients were extubated within 4 days. Only low-dose inotropic support was required in eight of the nine. There were no bleeding problems. Four patients died in the hospital: one of Candida sepsis at 81 days, one of low cardiac output at 2 days, and two of restrictive atrial septal defect at 3 and 5 days. The five living patients were discharged 11 to 80 days postoperatively (mean 38 days). We now perform balloon septostomies preoperatively in all patients and believe that this will improve the survival rate. We believe this simpler approach to the treatment of hypoplastic left heart syndrome may allow survival for a cardiac transplant or a staged Fontan procedure at a later date for more definitive treatment.

  4. Ascending and descending reflex motor activity of recto-anal region-cholinergic and nitrergic implications in a rat model.

    PubMed

    Radomirov, Radomir; Ivancheva, Christina; Brading, Alison F; Itzev, Dimitar; Rakovska, Angelina; Negrev, Negrin

    2009-04-29

    The implications of cholinergic and nitrergic transmissions in ascending and descending reflex motor pathways of recto-anal region in rat model were evaluated using: (i) electrical stimulation; (ii) triple organ bath; and (iii) morphological techniques. Electrical stimulation to anal canal induced simultaneous ascending contractile responses of longitudinal and circular muscles of proximal rectum, local contraction of anal canal or contraction followed by relaxation of internal anal sphincter when external sphincter was dissected off. The stimulation of proximal rectum elicited local contractions of both rectal layers and descending contractions of internal sphincter or anal canal. Tetrodotoxin (0.1 microM) prevented the electrically elicited events. The ascending excitatory responses and the local and ascending contractions of longitudinal muscle were more pronounced than those of circular muscle suggesting dominant role of ascending reflex pathways and of longitudinal muscle in rectal motor activity. Choline acetyltransferase (ChAT)-containing fibres and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase-positive neurons were observed in myenteric ganglia of rectum and anal canal. NG-nitro-l-arginine (0.5mM) increased the contractile ascending and descending responses. During atropine (0.3 microM) treatment the ascending and descending contractions were suppressed but not abolished and a relaxation revealed in ascending response of circular muscle and in descending responses of internal anal sphincter and anal canal. The relaxation was decreased by NG-nitro-l-arginine and increased by l-arginine (0.5mM). The results suggest that cholinergic excitatory ascending and descending pathways and nitric oxide-dependent inhibitory ascending neurotransmission(s) to rectal circular muscle and inhibitory descending to internal anal sphincter and anal canal are involved in reflex circuitry controlling motor activity of recto-anal region.

  5. Ameloblastoma of the anterior mandible

    PubMed Central

    Hariram; Mohammad, Shadab; Malkunje, Laxman R.; Singh, Nimisha; Das, Sugata; Mehta, Gagan

    2014-01-01

    Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence. PMID:25298718

  6. Anterior Cruciate Ligament Graft Choices

    PubMed Central

    Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

    2012-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071

  7. Face-name association task reveals memory networks in patients with left and right hippocampal sclerosis.

    PubMed

    Klamer, Silke; Milian, Monika; Erb, Michael; Rona, Sabine; Lerche, Holger; Ethofer, Thomas

    2017-01-01

    We aimed to identify reorganization processes of episodic memory networks in patients with left and right temporal lobe epilepsy (TLE) due to hippocampal sclerosis as well as their relations to neuropsychological memory performance. We investigated 28 healthy subjects, 12 patients with left TLE (LTLE) and 9 patients with right TLE (RTLE) with hippocampal sclerosis by means of functional magnetic resonance imaging (fMRI) using a face-name association task, which combines verbal and non-verbal memory functions. Regions-of-interest (ROIs) were defined based on the group results of the healthy subjects. In each ROI, fMRI activations were compared across groups and correlated with verbal and non-verbal memory scores. The face-name association task yielded activations in bilateral hippocampus (HC), left inferior frontal gyrus (IFG), left superior frontal gyrus (SFG), left superior temporal gyrus, bilateral angular gyrus (AG), bilateral medial prefrontal cortex and right anterior temporal lobe (ATL). LTLE patients demonstrated significantly less activation in the left HC and left SFG, whereas RTLE patients showed significantly less activation in the HC bilaterally, the left SFG and right AG. Verbal memory scores correlated with activations in the left and right HC, left SFG and right ATL and non-verbal memory scores with fMRI activations in the left and right HC and left SFG. The face-name association task can be employed to examine functional alterations of hippocampal activation during encoding of both verbal and non-verbal material in one fMRI paradigm. Further, the left SFG seems to be a convergence region for encoding of verbal and non-verbal material.

  8. Pneumatization degree of the anterior clinoid process: a new classification.

    PubMed

    Abuzayed, Bashar; Tanriover, Necmettin; Biceroglu, Huseyin; Yuksel, Odhan; Tanriover, Ozlem; Albayram, Sait; Akar, Ziya

    2010-07-01

    The objective of this study is to determine the incidence and degree of anterior clinoid process pneumatization, in addition highlighting to their clinical significance. Multidetector-row CT scans of the skull base were reviewed in 648 subjects between 2007 and 2008. The presence of pneumatized anterior clinoid process and its degree were studied and documented. These data were statistically analyzed. Pneumatization of the ACP was found in 62 of 648 patients (9.6%) including 32 (51.6%) men and 30 (48.4%) women. The age of these patients ranged from 21 to 82 years (mean, 41 +/- 15.7 years). Pneumatization of the ACP occurred only on the left side in 14 cases (22.6%), only on the right side in 11 cases (17.7%), and bilaterally in 37 patients (59.7%). ACP pneumatization Type I, in which less than 50% of the ACP is pneumatized, was found in 47 of 124 sides (38%), Type II, in which more than 50% but not totally pneumatized ACP, was found in 28 of 124 sides (22.6%), and Type III, in which the ACP is totally pneumatized, was found in 22 of 124 sides (17.7%). The incidence of Type I in the general population was 6.6%, Type II was 3.5%, and Type III was 2.5%. Radiologically recognizing the degree of ACP pneumatization is important in decreasing the incidence of surgical complications during anterior clinoidectomy. Proper intraoperative management can be undertaken with special attention to the new classification.

  9. Anterior EEG asymmetry and the Modifier Model of Autism.

    PubMed

    Burnette, Courtney P; Henderson, Heather A; Inge, Anne Pradella; Zahka, Nicole E; Schwartz, Caley B; Mundy, Peter C

    2011-08-01

    Individual differences in the expression of autism complicate research on the nature and treatment of this disorder. In the Modifier Model of Autism (Mundy et al. 2007), we proposed that individual differences in autism may result not only from syndrome specific causal processes, but also from variability in generic, non-syndrome specific modifier processes that affect the social and emotional development of all people. One study supporting this model found that measures of resting anterior EEG asymmetry, a measure reflecting complex brain processes associated with generic individual differences in approach and avoidance motivation, may help explain differences in the expression of autism in children without intellectual disabilities (Sutton et al. 2005). In the current study, we partially replicated the observation that children with autism who exhibited a pattern of left frontal EEG asymmetry tended to display milder levels of social symptoms, although in the current sample this pattern applied only to HFA children with relatively lower verbal IQs. New observations indicated that left frontal EEG asymmetry was also associated with retrospective parent reports of significantly later age of onset of symptoms, but also higher levels of self-reported outward expressions of anger as well as symptoms of obsessive compulsive disorder in school-age higher functioning children with ASD. Therefore, the results of this study provide a new and fully independent set of observations, which indicate that individual differences in anterior EEG asymmetry may significantly moderate the expression and developmental course of autism. This observation may have clinical implications for identifying meaningful diagnostic sub-groups among children with autism.

  10. Orthodontic space closure of lost traumatized anterior teeth - case report.

    PubMed

    Closs, Luciane Quadrado; Reston, Eduardo Galia; Vargas, Ivana Ardenghi; de Figueiredo, Jose Antonio Poli

    2008-12-01

    This case report refers to an 11-year-old boy with avulsion of the upper left central and lateral incisors. The teeth were replanted after 4 h, splinted with a semi-rigid splint for 12 days, and then endodontically treated. Severe progressive root resorption was seen after 2 years and the teeth were extracted. The boy had a normal occlusion with spacing in both jaws and slight protrusion of the anterior teeth. The treatment objectives were to close some of the spaces by mesial movement of the buccal segments in the upper jaw to minimize bone loss for a future single osseointegrated implant. Fixed appliance in combination with a removable plate was used for the mesial movements, levelling, and alignment of the upper jaw. Fixed appliance in the lower jaw and Class II traction were used for the final adjustment of the occlusion. A good occlusion with coincident upper and lower midlines and up-righted anterior teeth were achieved. A Maryland bridge was performed as a temporary solution for a future osseointegrated implant.

  11. Estrogens sensitize anterior pituitary gland to apoptosis.

    PubMed

    Pisera, D; Candolfi, M; Navarra, S; Ferraris, J; Zaldivar, V; Jaita, G; Castro, M G; Seilicovich, A

    2004-10-01

    Tissue homeostasis results from a balance between cell proliferation and cell death by apoptosis. Estradiol affects proliferation as well as apoptosis in hormone-dependent tissues. In the present study, we investigated the apoptotic response of the anterior pituitary gland to lipopolysaccharide (LPS) in cycling female rats, and the influence of estradiol in this response in ovariectomized (OVX) rats. The OVX rats were chronically estrogenized with implanted Silastic capsules containing 1 mg of 17beta-estradiol (E2). Cycling or OVX and E2-treated rats were injected with LPS (250 microg/rat ip). Apoptosis was determined by the terminal deoxynucleotidyl-mediated dUTP nick-end labeling (TUNEL) method in sections of the anterior pituitary gland and spleen. Chronic estrogenization induced apoptosis in the anterior pituitary gland. Acute endotoxemia triggered apoptosis of cells in the anterior pituitary gland of E2-treated rats but not of OVX rats. No differences were observed in the apoptotic response to LPS in spleen between OVX and E2-treated rats. The apoptotic response of the anterior pituitary to LPS was variable along the estrous cycle, being higher at proestrus than at estrus or diestrus I. Approximately 75% of the apoptotic cells were identified as lactotropes by immunofluorescence. In conclusion, our results indicate that estradiol induces apoptosis and enables the proapoptotic action of LPS in the anterior pituitary gland. Also, our study suggests that estrogens may be involved in anterior pituitary cell renewal during the estrous cycle, sensitizing lactotropes to proapoptotic stimuli.

  12. Descending pathways to the spinal cord: a comparative study of 22 mammals.

    PubMed

    Nudo, R J; Masterton, R B

    1988-11-01

    In order to estimate the qualitative commonalities and range of variation among major descending spinal pathways relevant to mankind's ancestral lineage, the supraspinal cell groups originating fibers descending directly to the spinal cord were examined in 22 mammalian species. In a standardized retrograde tract-tracing procedure, flakes of raw HRP were applied directly to the freshly cut fibers of the spinal cord after it had been hemisected at the C1-C2 junction. After a 72-hour survival period, brain and spinal cord tissues were processed by conventional HRP-processing techniques. This procedure was performed on 94 individual animals. Of this total, 41 individual cases were eliminated by a rigorous culling procedure. The results are based on 53 individuals representing 15 species selected for their successive kinship with mankind and seven species in two other lineages selected for the convergence of their visual or sensorimotor systems with anthropoids. The 22 species represent 19 genera, 14 families, eight orders, and two subclasses of Mammalia. The results show that at least 27 supraspinal cell groups, each containing intensely labeled cells, can be readily identified in each of the species. Despite vast quantitative differences in cell number and cell size, this qualitative uniformity among the relatively large number of diverse taxa suggests that the same pathways were probably present in the extinct ancestors throughout mankind's mammalian lineage and are probably still present in extant viviparous mammals as well. If so, these pathways are as old in phylogenetic history as the last common ancestor of marsupial and placental mammals--dating from the late Jurassic to early Cretaceous, perhaps 145-120 million years ago. Further comparison of the results with similar experimental findings in members of other vertebrate classes supports the notion that several of these same pathways can be traced to even more remote ancestry, with some possibly as old as the

  13. The anterior open bite problem (infraclusion).

    PubMed

    Champagne, M

    1995-06-01

    Anterior open bite is a major orthodontic problem that is very difficult to treat (Fig. 1). It may not be the most frequent problem but it is a major functional problem. Quite often it is very difficult to correct an anterior open bite problem and even more difficult to treat in an adult after growth. Most of the time anterior open bite is a myofunctional problem related to a bad habit like thumb or finger sucking and/or is related to a breathing and swallowing problem. How can we understand the functional open bite problem? What are the available treatment options? This article will try to answer some of these questions.

  14. Mini-open anterior lumbar interbody fusion.

    PubMed

    Gandhoke, Gurpreet S; Ricks, Christian; Tempel, Zachary; Zuckerbraun, Brian; Hamilton, D Kojo; Okonkwo, David O; Kanter, Adam S

    2016-07-01

    In deformity surgery, anterior lumbar interbody fusion provides excellent biomechanical support, creates a broad surface area for arthrodesis, and induces lordosis in the lower lumbar spine. Preoperative MRI, plain radiographs, and, when available, CT scan should be carefully assessed for sacral slope as it relates to pubic symphysis, position of the great vessels (especially at L4/5), disc space height, or contraindication to an anterior approach. This video demonstrates the steps in an anterior surgical procedure with minimal open exposure. The video can be found here: https://youtu.be/r3bC4_vu1hQ .

  15. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  16. Revisiting colostomy irrigation: a viable option for persons with permanent descending and sigmoid colostomies.

    PubMed

    Kent, Dea J; Arnold Long, Mary; Bauer, Carole

    2015-01-01

    Colostomy irrigation (CI) is the regular irrigation of the bowel for persons with a permanent colostomy of the descending or sigmoid colon. Although this technique was first described in the 1920s, a recent study of 985 WOC nurses found that almost half (47%) do not routinely teach CI to persons with colostomies. In a systematic review (Evidence-Based Report Card) published in this issue of the Journal, we summarized current best evidence concerning the effect of CI on bowel function and found that irrigation reduces the frequency of bowel elimination episodes and allows some patients to reduce or eliminate ongoing use of a pouching system. This article describes techniques for teaching CI and discussed additional findings associated with CI.

  17. Nucleotide variability of HV-I in Afro-descendents populations of the Brazilian Amazon Region.

    PubMed

    Ribeiro-dos-Santos, Andrea Kely Campos; Carvalho, Bruno Maia; Feio-dos-Santos, Ana Cecília; dos Santos, Sidney Emanuel Batista

    2007-03-22

    The analysis of genetic variation in the nucleotide sequences of mitochondrial DNA, provides unique information about the population diversity and human identification. In this study, the mitochondrial DNA sequences of the first hypervariable region (HV-I) were analyzed in 243 unrelated individuals of seven Afro-descendents populations of the Amazon Region. Sequence polymorphisms were detected using PCR and direct sequencing analysis. A total of 133 different haplotypes were found determined by 97 variable nucleotides. Each one of the three more frequent haplotypes was shared by 9 samples and 91 sequences were unique. The genetic diversity was estimated to 0.9898+/-0.0016 and the probability of two random individuals showed identical mitochondrial DNA (mtDNA) haplotypes were 1.2%.

  18. Hysteresis in response to descending and ascending lower-body negative pressure

    NASA Technical Reports Server (NTRS)

    Tomaselli, Clare Marie; Frey, Mary Anne Bassett; Kenney, Richard A.; Hoffler, G. Wyckliffe

    1987-01-01

    Changes in the indices of fluid redistribution and cardiovascular responses during graduated orthostatic stress were measured in 12 men subjected for 25 min to lower-body negative pressure (LBNP) test protocol that involved stepwise decreases (from the starting pressure of -8 to the final -50 mm Hg), followed by stepwise increases (back to -8 mm Hg) of LBNP. The values of many variables measured during the descending phase of LBNP were significantly different from the respective values measured during the ascending phase. These differences appear to be caused by a component of fluid translocation that occurs during LBNP and cannot be reversed within the duration of the procedure. It is hypothesized that this slowly-reversed component is the sequestration of fluid in the interstitial and the lymphatic compartments.

  19. Descending aortic replacement after Nuss for pectus excavatum in a Marfan patient—Case report

    PubMed Central

    Jaroszewski, Dawn; Ewais, MennatAllah; DeValeria, Patrick; Gotway, Michael; Craig Miller, D.

    2016-01-01

    Introduction The Nuss procedure for pectus excavatum (PE) repair has been successfully performed in Marfan syndrome (MFS) patients however there is concern for future risk of aortic dilation/rupture and need for emergent access with support bars in place. Case presentation We present a 45 year-old male with MFS that required descending aortic replacement shortly after modified Nuss repair. Discussion The majority of MFS patients have severe PE and repair with the Nuss procedure is not uncommon. The risk for life threatening aortic dilation, dissection, or rupture in such patients is a concern when utilizing this technique. Our work has been reported in line with the CARE criteria. Conclusion Nuss repair should be considered in MFS patients with technique modifications and careful consideration of future risk of aortic dilation and rupture. PMID:26895112

  20. Descending pathways to the cutaneus trunci muscle motoneuronal cell group in the cat

    NASA Technical Reports Server (NTRS)

    Holstege, Gert; Blok, Bertil F.

    1989-01-01

    The descending pathways to the motoneuronal cell group of the cutaneous trunci muscle (CTM) of the cat were investigated by injecting H-3-labeled lucine into the brain stem, the diencephalon, or the C1, C2, C6, and C8 segments of the spinal cord, and examining fixed autoradiographic sections of the spinal cord and brain regions. Results demonstrate presence of specific supraspinal projectons to the CTM motor nucleus originating in the contralateral nucleus retroambiguous and the ipsilateral dorsolateral pontine tegmentum. Results also suggest that propriospinal pathways to the CTM motor nucleus originating in the cervical cord do not exist, although these propriospinal projections to all other motoneuronal cell groups surrounding the CTM nucleus are very strong.

  1. Aortobronchial Fistula after Thoracic Endovascular Aortic Repair (TEVAR) for Descending Thoracic Aortic Aneurysm.

    PubMed

    Melvan, John Nicholas; DeLaRosa, Jacob; Vasquez, Julio C

    2017-03-07

    Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.

  2. Descendants constructed from matter field in Landau-Ginzburg theories coupled to topological gravity

    NASA Astrophysics Data System (ADS)

    Losev, A.

    1993-05-01

    It is argued that gravitational descendants in the theory of topological gravity coupled to topological Landau-Ginzburg theory (not necessarily conformal) can be constructed from matter fields alone (without metric fields and ghosts). In this sense topological gravity is “induced.” We discuss the mechanism of this effect (that turns out to be connected with K. Saito's higher residue pairing: Ki(σi(Φ1),Φ2)=K0(Φ1,Φ2)), and demonstrate how it works in a simplest nontrivial example: correlator on a sphere with four marked points. We also discuss some results on k-point correlators on a sphere. From the idea of “induced” topological gravity it follows that the theory of “pure” topological gravity (without topological matter) is equivalent to the “trivial” Landau-Ginzburg theory (with quadratic superpotential).

  3. Descended Mouth Corner: An Ignored but Needed Feature of Facial Rejuvenation

    PubMed Central

    Berner, Juan Enrique; Castillo, Pablo; Rochefort, Günther; Loubies, Rodrigo

    2013-01-01

    For years, the gold standard in facial rejuvenation has been the face lift. However, exploring new, less complex procedures for achieving the same goal is currently drawing interest. Rejuvenation of the perioral area is a difficult task for plastic surgeons because of the minimal effect that face lift procedures have over this region and the lack of published material on the subject. In this article, the descended mouth corner anguloplasty technique is presented. It is a 20-minutes lift technique that can correct this typical feature of the ageing mouth. The authors have treated 71 patients using the technique with consistently good results, with just one requiring revision. They conclude that this procedure by itself and in combination with other small operations or even a full face lift can rejuvenate the ageing face. PMID:24286055

  4. [Left pulmonary agenesis diagnosed late].

    PubMed

    Deleanu, Oana; Pătraşcu, Natalia; Nebunoiu, Ana-Maria; Vintilă, V; Ulmeanu, Ruxandra; Mihălţan, F D

    2010-01-01

    We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.

  5. Architecture of kangaroo rat inner medulla: segmentation of descending thin limb of Henle's loop.

    PubMed

    Urity, Vinoo B; Issaian, Tadeh; Braun, Eldon J; Dantzler, William H; Pannabecker, Thomas L

    2012-03-15

    We hypothesize that the inner medulla of the kangaroo rat Dipodomys merriami, a desert rodent that concentrates its urine to more than 6,000 mosmol/kgH(2)O water, provides unique examples of architectural features necessary for production of highly concentrated urine. To investigate this architecture, inner medullary nephron segments in the initial 3,000 μm below the outer medulla were assessed with digital reconstructions from physical tissue sections. Descending thin limbs of Henle (DTLs), ascending thin limbs of Henle (ATLs), and collecting ducts (CDs) were identified by immunofluorescence using antibodies that label segment-specific proteins associated with transepithelial water flux (aquaporin 1 and 2, AQP1 and AQP2) and chloride flux (the chloride channel ClC-K1); all tubules and vessels were labeled with wheat germ agglutinin. In the outer 3,000 μm of the inner medulla, AQP1-positive DTLs lie at the periphery of groups of CDs. ATLs lie inside and outside the groups of CDs. Immunohistochemistry and reconstructions of loops that form their bends in the outer 3,000 μm of the inner medulla show that, relative to loop length, the AQP1-positive segment of the kangaroo rat is significantly longer than that of the Munich-Wistar rat. The length of ClC-K1 expression in the prebend region at the terminal end of the descending side of the loop in kangaroo rat is about 50% shorter than that of the Munich-Wistar rat. Tubular fluid of the kangaroo rat DTL may approach osmotic equilibrium with interstitial fluid by water reabsorption along a relatively longer tubule length, compared with Munich-Wistar rat. A relatively shorter-length prebend segment may promote a steeper reabsorptive driving force at the loop bend. These structural features predict functionality that is potentially significant in the production of a high urine osmolality in the kangaroo rat.

  6. The lateral reticular nucleus; integration of descending and ascending systems regulating voluntary forelimb movements.

    PubMed

    Alstermark, Bror; Ekerot, Carl-Fredrik

    2015-01-01

    Cerebellar control of movements is dependent on mossy fiber input conveying information about sensory and premotor activity in the spinal cord. While much is known about spino-cerebellar systems, which provide the cerebellum with detailed sensory information, much less is known about systems conveying motor information. Individual motoneurones do not have projections to spino-cerebellar neurons. Instead, the fastest route is from last order spinal interneurons. In order to identify the networks that convey ascending premotor information from last order interneurons, we have focused on the lateral reticular nucleus (LRN), which provides the major mossy fiber input to cerebellum from spinal interneuronal systems. Three spinal ascending systems to the LRN have been investigated: the C3-C4 propriospinal neurones (PNs), the ipsilateral forelimb tract (iFT) and the bilateral ventral flexor reflex tract (bVFRT). Voluntary forelimb movements involve reaching and grasping together with necessary postural adjustments and each of these three interneuronal systems likely contribute to specific aspects of forelimb motor control. It has been demonstrated that the command for reaching can be mediated via C3-C4 PNs, while the command for grasping is conveyed via segmental interneurons in the forelimb segments. Our results reveal convergence of ascending projections from all three interneuronal systems in the LRN, producing distinct combinations of excitation and inhibition. We have also identified a separate descending control of LRN neurons exerted via a subgroup of cortico-reticular neurones. The LRN projections to the deep cerebellar nuclei exert a direct excitatory effect on descending motor pathways via the reticulospinal, vestibulospinal, and other supraspinal tracts, and might play a key role in cerebellar motor control. Our results support the hypothesis that the LRN provides the cerebellum with highly integrated information, enabling cerebellar control of complex forelimb

  7. [Two cases of anterior cerebral artery aneurysm associated with accessory anterior cerebral artery: review of the literature and points of diagnosis].

    PubMed

    Maeda, Kazushi; Tanaka, Shunya; Hatae, Ryusuke; Maeda, Yoshihisa; Miyazono, Masayuki

    2014-05-01

    The accessory anterior cerebral artery (AccACA) is an anomalous vessel arising from the anterior communicating artery. Although AccACA is not particularly rare, aneurysms arising from the AccACA is extremely rare. Here, we report two cases of unruptured AccACA aneurysms. Patient 1 was a 58-year-old woman with an unruptured distal AccACA aneurysm. Magnetic resonance imaging and three-dimensional computed tomography angiography(3D-CTA)demonstrated a left middle cerebral artery aneurysm that was subsequently clipped successfully by direct surgery. No aneurysm was detected in the distal anterior cerebral artery(ACA)due to the narrow imaging range at that time. Postoperatively, an aneurysm of the distal ACA was incidentally identified on 3D-CTA. This AccACA aneurysm was also clipped by direct surgery about 5 months later, and the patient was discharged without any neurological deficits. Patient 2 was a 46-year-old woman with an aneurysm at the proximal portion of the AccACA. Since the aneurysm was small and patient was asymptomatic, the observation-approach was selected. In introducing these cases, we discuss AccACA aneurysms and the process of diagnosis. Aneurysm can arise over the entire length of the ACA, from the anterior communicating artery to the peripheral portion, particularly the supracallosal portion, so observation and imaging of the peripheral region is important in cases where an AccACA is present.

  8. Correlation of Scar in Cardiac MRI and High‐Resolution Contact Mapping of Left Ventricle in a Chronic Infarct Model

    PubMed Central

    THAJUDEEN, ANEES; STEWART, BRIAN; COKIC, IVAN; NAKAGAWA, HIROSHI; SHEHATA, MICHAEL; AMORN, ALLEN M.; KALI, AVINASH; LIU, EZH; HARLEV, DORON; BENNETT, NATHAN; DHARMAKUMAR, ROHAN; CHUGH, SUMEET S.; WANG, XUNZHANG

    2015-01-01

    Background Endocardial mapping for scars and abnormal electrograms forms the most essential component of ventricular tachycardia ablation. The utility of ultra‐high resolution mapping of ventricular scar was assessed using a multielectrode contact mapping system in a chronic canine infarct model. Methods Chronic infarcts were created in five anesthetized dogs by ligating the left anterior descending coronary artery. Late gadolinium‐enhanced magnetic resonance imaging (LGE MRI) was obtained 4.9 ± 0.9 months after infarction, with three‐dimensional (3D) gadolinium enhancement signal intensity maps at 1‐mm and 5‐mm depths from the endocardium. Ultra‐high resolution electroanatomical maps were created using a novel mapping system (Rhythmia Mapping System, Rhythmia Medical/Boston Scientific, Marlborough, MA, USA) Rhythmia Medical, Boston Scientific, Marlborough, MA, USA with an 8.5F catheter with mini‐basket electrode array (64 tiny electrodes, 2.5‐mm spacing, center‐to‐center). Results The maps contained 7,754 ± 1,960 electrograms per animal with a mean resolution of 2.8 ± 0.6 mm. Low bipolar voltage (<2 mV) correlated closely with scar on the LGE MRI and the 3D signal intensity map (1‐mm depth). The scar areas between the MRI signal intensity map and electroanatomic map matched at 87.7% of sites. Bipolar and unipolar voltages, compared in 592 electrograms from four MRI‐defined scar types (endocardial scar, epicardial scar, mottled transmural scar, and dense transmural scar) as well as normal tissue, were significantly different. A unipolar voltage of <13 mV correlated with transmural extension of scar in MRI. Electrograms exhibiting isolated late potentials (ILPs) were manually annotated and ILP maps were created showing ILP location and timing. ILPs were identified in 203 ± 159 electrograms per dog (within low‐voltage areas) and ILP maps showed gradation in timing of ILPs at different locations in the scar. Conclusions Ultra

  9. Compensatory increase of left atrial external work to left ventricular dysfunction caused by afterload increase.

    PubMed

    Inoue, Katsuji; Asanuma, Toshihiko; Masuda, Kasumi; Sakurai, Daisuke; Higaki, Jitsuo; Nakatani, Satoshi

    2015-04-15

    Afterload mismatch can cause acute decompensation leading to an occurrence of acute heart failure. We investigated how the left atrium (LA) and left ventricle (LV) react to acute increases in afterload using speckle tracking echocardiography (STE). LA strain and volume were obtained by STE in 10 dogs during banding of descending aorta (AoB). Simultaneously, LA pressure was measured by a micromanometer-tipped catheter. LA peak negative strain during LA contraction, strain change during LA relaxation (early reservoir strain), and that during LA dilatation (late reservoir strain) were obtained from LA longitudinal strain-volume curves. From pressure-strain curves, the areas of A-loop and V-loops were computed as the work during active contraction and relaxation (A-work) and that during passive filling and emptying (V-work). AoB increased LV systolic pressure (105 ± 15 vs. 163 ± 12 mmHg, P < 0.01) and mean LA pressure (3.8 ± 1.2 vs. 7.1 ± 2.0 mmHg, P < 0.01). LV global circumferential strain decreased (-18.8 ± 3.5 vs. -13.2 ± 3.5%, P < 0.01), but LV stroke volume was maintained (8.4 ± 2.3 vs. 9.6 ± 3.6 ml). LA peak negative strain (-2.9 ± 2.3 vs. -9.8 ± 4.0%, P < 0.01) and early reservoir strain (4.5 ± 2.1 vs. 7.7 ± 2.4%, P < 0.05) increased by AoB, but late reservoir strain did not change (8.9 ± 3.4 vs. 6.1 ± 3.4%). A-work significantly increased (3.2 ± 2.0 vs. 19.2 ± 15.1 mmHg %, P < 0.01), whereas V-work did not change (13.3 ± 7.1 vs. 13.1 ± 7.7 mmHg %). In conclusion, LA external work during active contraction and relaxation increased as compensation for LV dysfunction during aortic banding. Atrial dysfunction may lead failure of this mechanism and hemodynamic decompensation.

  10. Anterior regeneration in the hemichordate Ptychodera flava

    PubMed Central

    Rychel, Amanda L.; Swalla, Billie J.

    2008-01-01

    Ptychodera flava is a hemichordate whose anterior structures regenerate reproducibly from posterior trunk pieces when amputated. We characterized the cellular processes of anterior regeneration with respect to programmed cell death and cell proliferation, following wound healing. We found scattered proliferating cells at day two of regeneration using a PCNA antibody. On day four, most proliferating cells were associated with the nerve tract under the epidermis, and on day six, a small proboscis derived from proliferated cells was regenerated, and a mouth had broken though the epidermis. TUNEL detected elevated levels of apoptosis in the endoderm that began furthest away from the region of wound healing, then moved anteriorly over eight days. Posterior to anterior apoptosis is likely to remove digestive endoderm for later differentiation of pharyngeal endoderm. We hypothesize that P. flava regeneration is nerve dependent and that remodeling in the gut endoderm plays an important role in regeneration. PMID:18924231

  11. Left Hemisphere Dysfunction and Left Hemisphere Overactivation in Schizophrenia

    ERIC Educational Resources Information Center

    Gur, Raquel E.

    1978-01-01

    Reports two studies relating schizophrenia to functional brain asymmetry. The first study found support for the hypothesis of left hemisphere dysfunction in schizophrenia, occurring at a rather early stage of information processing; the second study, using eye directionality as a measure of hemispheric activation, found that schizophrenics…

  12. Asymmetry of the dorsal anterior cingulate cortex: evidences from multiple modalities of MRI.

    PubMed

    Wang, Jue; Liu, Dong-Qiang; Zhang, Han; Zhu, Wei-Xuan; Dong, Zhang-Ye; Zang, Yu-Feng

    2013-04-01

    The dorsal anterior cingulate cortex (dACC) has been consistently implicated in cognitive control processes. Many studies have found higher fractional anisotropy (FA) in the left anterior cingulum bundle (aCB) than in the right. However, the asymmetry of gray matter density (GMD) is not clear. Using multiple modalities of MRI, we investigated both FA and GMD in the dACC in two independent groups of healthy participants (50 per group, 18-24 years old, half males and half females). Consistent with previous findings, the mean FA of the left aCB was significantly higher than that of the right. Males showed higher FA in the bilateral aCB than females. Voxel-based analysis of GMD in the dACC presented a region-specific significant asymmetry: right > left in the lower part (around callosal sulcus) but left > right in the upper part (around cingulate sulcus). No significant sex effect was found for GMD in the dACC. All these results were almost the same across the two independent groups. The complex pattern of asymmetry in GMD may imply highly differentiated functions of the dACC. Future fine-scale structural and diffusion MRI studies and a battery of cognitive behavioral measurements are needed to fully elucidate the asymmetry of the dACC.

  13. PRESENT-DAY DESCENDANTS OF z = 3 Ly{alpha}-EMITTING GALAXIES IN THE MILLENNIUM-II HALO MERGER TREES

    SciTech Connect

    Walker-Soler, Jean P.; Gawiser, Eric; Bond, Nicholas A.; Padilla, Nelson; Francke, Harold

    2012-06-20

    Using the Millennium-II Simulation dark matter sub-halo merger histories, we created mock catalogs of Ly{alpha}-emitting (LAE) galaxies at z = 3.1 to study the properties of their descendants. Several models were created by selecting the sub-halos to match the number density and typical dark matter mass determined from observations of these galaxies. We used mass-based and age-based selection criteria to study their effects on descendant populations at z {approx_equal} 2, 1, and 0. For the models that best represent LAEs at z = 3.1, the z = 0 descendants have a median dark matter halo mass of 10{sup 12.7} M{sub Sun }, with a wide scatter in masses (50% between 10{sup 11.8} and 10{sup 13.7} M{sub Sun }). Our study differentiated between central and satellite sub-halos and found that {approx}55% of z = 0 descendants are central sub-halos with M{sub Median} {approx} 10{sup 12}. This confirms that central z = 0 descendants of z = 3.1 LAEs have halo masses typical of L*-type galaxies. The satellite sub-halos reside in group/cluster environments with dark matter masses around 10{sup 14} M{sub Sun }. The median descendant mass is robust to various methods of age determination, but it could vary by a factor of five due to current observational uncertainties in the clustering of LAEs used to determine their typical z = 3.1 dark matter mass.

  14. Semi-automated segmentation of the sigmoid and descending colon for radiotherapy planning using the fast marching method.

    PubMed

    Losnegård, Are; Hysing, Liv Bolstad; Muren, Ludvig Paul; Hodneland, Erlend; Lundervold, Arvid

    2010-09-21

    A fast and accurate segmentation of organs at risk, such as the healthy colon, would be of benefit for planning of radiotherapy, in particular in an adaptive scenario. For the treatment of pelvic tumours, a great challenge is the segmentation of the most adjacent and sensitive parts of the gastrointestinal tract, the sigmoid and descending colon. We propose a semi-automated method to segment these bowel parts using the fast marching (FM) method. Standard 3D computed tomography (CT) image data obtained from routine radiotherapy planning were used. Our pre-processing steps distinguish the intestine, muscles and air from connective tissue. The core part of our method separates the sigmoid and descending colon from the muscles and other segments of the intestine. This is done by utilizing the ability of the FM method to compute a specified minimal energy functional integrated along a path, and thereby extracting the colon centre line between user-defined control points in the sigmoid and descending colon. Further, we reconstruct the tube-shaped geometry of the sigmoid and descending colon by fitting ellipsoids to points on the path and by adding adjacent voxels that are likely voxels belonging to these bowel parts. Our results were compared to manually outlined sigmoid and descending colon, and evaluated using the Dice coefficient (DC). Tests on 11 patients gave an average DC of 0.83 (+/-0.07) with little user interaction. We conclude that the proposed method makes it possible to fast and accurately segment the sigmoid and descending colon from routine CT image data.

  15. Semi-automated segmentation of the sigmoid and descending colon for radiotherapy planning using the fast marching method

    NASA Astrophysics Data System (ADS)

    Losnegård, Are; Bolstad Hysing, Liv; Muren, Ludvig Paul; Hodneland, Erlend; Lundervold, Arvid

    2010-09-01

    A fast and accurate segmentation of organs at risk, such as the healthy colon, would be of benefit for planning of radiotherapy, in particular in an adaptive scenario. For the treatment of pelvic tumours, a great challenge is the segmentation of the most adjacent and sensitive parts of the gastrointestinal tract, the sigmoid and descending colon. We propose a semi-automated method to segment these bowel parts using the fast marching (FM) method. Standard 3D computed tomography (CT) image data obtained from routine radiotherapy planning were used. Our pre-processing steps distinguish the intestine, muscles and air from connective tissue. The core part of our method separates the sigmoid and descending colon from the muscles and other segments of the intestine. This is done by utilizing the ability of the FM method to compute a specified minimal energy functional integrated along a path, and thereby extracting the colon centre line between user-defined control points in the sigmoid and descending colon. Further, we reconstruct the tube-shaped geometry of the sigmoid and descending colon by fitting ellipsoids to points on the path and by adding adjacent voxels that are likely voxels belonging to these bowel parts. Our results were compared to manually outlined sigmoid and descending colon, and evaluated using the Dice coefficient (DC). Tests on 11 patients gave an average DC of 0.83 (±0.07) with little user interaction. We conclude that the proposed method makes it possible to fast and accurately segment the sigmoid and descending colon from routine CT image data.

  16. The left atrial "Medusa myxoma".

    PubMed

    Williams, Elbert E; Pratt, Jerry W; Martin, David E

    2014-02-01

    Although myxomas are the most commonly seen primary cardiac tumors, encompassing 30% to 50% of all primary tumors of the heart, they remain a rare finding with an annual reported incidence of 0.5 per million. The presenting symptoms of an atrial myxoma are widely varied as are the clinical consequences. Regardless of presentation, once a diagnosis is made prompt surgical excision is recommended to minimize the potential complications of obstruction or embolization. We present the "Medusa myxoma," an arborizing 4-fingered left atrial myxoma extending from the fossa ovalis across the left atrium.

  17. Bilingualism protects anterior temporal lobe integrity in aging.

    PubMed

    Abutalebi, Jubin; Canini, Matteo; Della Rosa, Pasquale A; Sheung, Lo Ping; Green, David W; Weekes, Brendan S

    2014-09-01

    Cerebral gray-matter volume (GMV) decreases in normal aging but the extent of the decrease may be experience-dependent. Bilingualism may be one protective factor and in this article we examine its potential protective effect on GMV in a region that shows strong age-related decreases-the left anterior temporal pole. This region is held to function as a conceptual hub and might be expected to be a target of plastic changes in bilingual speakers because of the requirement for these speakers to store and differentiate lexical concepts in 2 languages to guide speech production and comprehension processes. In a whole brain comparison of bilingual speakers (n = 23) and monolingual speakers (n = 23), regressing out confounding factors, we find more extensive age-related decreases in GMV in the monolingual brain and significantly increased GMV in left temporal pole for bilingual speakers. Consistent with a specific neuroprotective effect of bilingualism, region of interest analyses showed a significant positive correlation between naming performance in the second language and GMV in this region. The effect appears to be bilateral though because there was a nonsignificantly different effect of naming performance on GMV in the right temporal pole. Our data emphasize the vulnerability of the temporal pole to normal aging and the value of bilingualism as both a general and specific protective factor to GMV decreases in healthy aging.

  18. The timing of anterior temporal lobe involvement in semantic processing.

    PubMed

    Jackson, Rebecca L; Lambon Ralph, Matthew A; Pobric, Gorana

    2015-07-01

    Despite indications that regions within the anterior temporal lobe (ATL) might make a crucial contribution to pan-modal semantic representation, to date there have been no investigations of when during semantic processing the ATL plays a critical role. To test the timing of the ATL involvement in semantic processing, we studied the effect of double-pulse TMS on behavioral responses in semantic and difficulty-matched control tasks. Chronometric TMS was delivered over the left ATL (10 mm from the tip of the temporal pole along the middle temporal gyrus). During each trial, two pulses of TMS (40 msec apart) were delivered either at baseline (before stimulus presentation) or at one of the experimental time points 100, 250, 400, and 800 msec poststimulus onset. A significant disruption to performance was identified from 400 msec on the semantic task but not on the control assessment. Our results not only reinforce the key role of the left ATL in semantic representation but also indicate that its contribution is especially important around 400 msec poststimulus onset. Together, these facts suggest that the ATL may be one of the neural sources of the N400 ERP component.

  19. Systemic sclerosis sine scleroderma: a case report of anterior uveitis.

    PubMed

    Borges, T; Vilaça, J; Ferreira, S; Chora, I; Silva, S; Dias, C

    2015-06-30

    Systemic sclerosis (SSc) sine scleroderma (ssSSc) is characterized by the absence of skin involvement, despite other manifestations of systemic sclerosis are present. It is not known whether sSSc represents a forme fruste of limited cutaneous SSc or a distinct entity, but the 2013 American College of Rheumatology/European League Against Rheumatism criteria for the classification of SSc have considered SSc without skin involvement to be a distinct subset. The authors present the case of a 70-year old female that was referred for a consultation for Raynaud's phenomenon and a chronic anterior uveitis (CAU). She had a history of dysphagia, diffuse pulmonary emphysema and a biopsy-documented fibrosis of the upper lobes, and an idiopathic non-ischemic dilated cardiomyopathy with severe left ventricle systolic dysfunction and left bundle branch block. Anti-nuclear and anti-centromere antibodies were positive, while manometry revealed distal esophageal hypomotility. After establishing the diagnosis of ssSSc and starting immunosuppression, the ocular disease improved, while the lung and heart diseases remained stable. This case underlines that it is very important to suspect SSc when CAU is present and/or skin thickening is absent. To our knowledge, this is the first report of CAU in a patient with ssSSc.

  20. Anterior Eye Imaging with Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Huang, David; Li, Yan; Tang, Maolong

    The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

  1. Anterior condylar displacement: its diagnosis and treatment.

    PubMed

    Weinberg, L A

    1975-08-01

    A deflective slide in centric relation to centric occlusion does not necessarily mean anterior condylar displacement. Its diagnosis and treatment depend on the correlation of three factors: the direction and magnitude of the mandibular slide from centric relation to centric occlusion, the change in vertical dimension of occlusion during the slide, and the position of the condyles in the fossae when the teeth are in the maximum occlusion (centric occlusion). When the change in vertical dimension almost equals to amount of slide from the deflective contact in centric relation to maximum intercuspation, very little anterior condylar displacement would be expected. Conversely, with proportionately little change in vertical dimension, more anterior condylar translation is required for a given degree of anterior slide. Examples of each type of anterior slide were related to the TMJ radiographs of the condylar position. If the direction and magnitude of the deflective occlusal contact can be correlated with the TMJ radiographs, the centric relation is "functional,'' and the clinically retruded mandibular position should be used. When this correlation does not exist, the centric relation is "dysfunctional'' and the terminal hinge position (retruded mandibular position) should not be used for restorative or corrective procedures. Examples of anterior condylar displacement were given, including deviation, with a comparison of "before'' and "after'' TMJ radiographs.

  2. Increased Rostral Anterior Cingulate Cortex Volume in Chronic Primary Insomnia

    PubMed Central

    Winkelman, John W.; Plante, David T.; Schoerning, Laura; Benson, Kathleen; Buxton, Orfeu M.; O'Connor, Shawn P.; Jensen, J. Eric; Renshaw, Perry F.; Gonenc, Atilla

    2013-01-01

    Background: Recent studies document alterations in cortical and subcortical volumes in patients with chronic primary insomnia (PI) in comparison with normal sleepers. We sought to confirm this observation in two previously studied PI cohorts. Methods: Two separate and independent groups of unmedicated patients who met Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) criteria for PI were compared with two separate, healthy control groups (Study 1: PI = 20, controls = 15; Study 2: PI = 21, controls = 20). Both studies included 2 weeks of sleep diaries supplemented by wrist actigraphy. The 3.0 T MRI-derived rostral anterior cingulate cortex (rACC) volumes were measured with FreeSurfer image analysis suite (version 5.0) and results normalized to total intracranial volume (ICV). Unpaired t-tests (two-tailed) were used to compare rACC volumes between groups. Post hoc correlations of rACC volumes to insomnia severity measures were performed (uncorrected for multiplicity). Results: Both studies demonstrated increases in normalized rACC volume in PI compared with control patients (Study 1: right side P = 0.05, left side P = 0.03; Study 2: right side P = 0.03, left side P = 0.02). In PI patients from Study 1, right rACC volume was correlated with sleep onset latency (SOL) by both diary (r = 0.51, P = 0.02) and actigraphy (r = 0.50, P = 0.03), and with sleep efficiency by actigraphy (r = -0.57, P = 0.01); left rACC volume was correlated with SOL by diary (r = 0.48, P = 0.04), and wake after sleep onset (WASO) (r = 0.49, P = 0.03) and sleep efficiency (r = -0.49, P = 0.03) by actigraphy. In Study 2, right rACC volume was correlated with SOL by diary (r = 0.44, P = 0.05) in PI patients. Conclusions: Rostral ACC volumes are larger in patients with PI compared with control patients. Clinical severity measures in PI correlate with rACC volumes. These data may reflect a compensatory brain response to chronic insomnia and may represent a marker of

  3. Complete recovery of acute monocular visual loss following endoscopic resection of anterior clinoid mucocele: case report and review of the literature.

    PubMed

    Nundkumar, Neelesh; Mittal, Monika; Kupsky, William J; Folbe, Adam; Mittal, Sandeep

    2012-01-15

    Mucoceles are chronic non-neoplastic cystic lesions lined by mucus-secreting respiratory epithelium in the paranasal sinuses. Mucocele of the anterior clinoid process is a particularly rare entity most often presenting with rapidly progressive monocular blindness. The authors describe the case of a 32 year-old man who presented with acute painless visual loss in the left eye. Workup revealed an expansile lesion of the left anterior clinoid process with associated optic nerve compression. The patient underwent emergent endoscopic-assisted transnasal decompression of the optic nerve with full recovery of visual function. Early diagnosis and prompt surgical intervention optimizes the chances of functional regain of visual acuity.

  4. Word or Word-Like? Dissociating Orthographic Typicality from Lexicality in the Left Occipito-Temporal Cortex

    ERIC Educational Resources Information Center

    Woollams, Anna M.; Silani, Giorgia; Okada, Kayoko; Patterson, Karalyn; Price, Cathy J.

    2011-01-01

    Prior lesion and functional imaging studies have highlighted the importance of the left ventral occipito-temporal (LvOT) cortex for visual word recognition. Within this area, there is a posterior-anterior hierarchy of subregions that are specialized for different stages of orthographic processing. The aim of the present fMRI study was to…

  5. Laparoscopic repair of a gastric volvulus occurring as a long-term complication of left pneumonectomy: report of a case.

    PubMed

    Batirel, Hasan Fevzi; Uygur-Bayramicli, Oya; Guler, Sevgi; Yildizeli, Bedrettin; Yuksel, Mustafa

    2007-01-01

    Gastric volvulus is an extremely rare late complication of pneumonectomy. We report the case of a 61-year-old man who presented with a 1-year history of progressive intolerance of solids and weight loss 33 years after a left pneumonectomy. Preoperative examinations showed a mesenteroaxial gastric volvulus. We performed a laparoscopic Toupet fundoplication and anterior gastropexy, following which his symptoms disappeared.

  6. Mutism following left hemisphere infarction.

    PubMed Central

    David, A S; Bone, I

    1984-01-01

    A case of mutism due to left hemisphere infarction is described. Recovery revealed mild motor dysphasia. Review of the literature showed that the case resembles aphemia but is unique by virtue of its duration, and the absence of associated apraxia and paresis. Images PMID:6210346

  7. Significance of U wave polarities in previous anterior myocardial infarction

    SciTech Connect

    Kanemoto, N.; Imaoka, C.; Suzuki, Y. )

    1991-04-01

    The significance of the polarity of U waves in left precordial leads was evaluated in relation to myocardial perfusion (T1 201 myocardial scintigraphy) and left ventricular function (99m Tc radionuclide ventriculography) in 63 patients with clinical and electrocardiographic evidence of a previous anterior myocardial infarction. Patients were divided into three groups according to the polarity of the U waves: positive U waves, flat U waves, and negative U waves. Twelve matched patients served as normal controls. The following parameters were analyzed: (1) total number of abnormal Q waves; (2) total myocardial perfusion index and regional myocardial perfusion index; (3) global ejection fraction; (4) regional ejection fraction; and (5) number of diseased coronary arteries. The total myocardial perfusion index values were 43.9 {plus minus} 1.0 in controls, 40.8 {plus minus} 3.4 in the positive U wave group, 33.4 {plus minus} 3.5 in the flat U wave group, and 30.3 {plus minus} 4.4 in the patients with negative U waves. Global ejection fractions in these groups were, respectively, 63.9 {plus minus} 8.6%, 65.0 {plus minus} 11.8%, 53.6 {plus minus} 8.1%, and 36.5 {plus minus} 13.6%. The sensitivity of negative U waves suggesting a global ejection fraction of less than 45% was 91.6%, and the specificity was 82.1%. Therefore the size of myocardial infarction increased and left ventricular function decreased, in order, from patients with positive U waves, to those with flat U waves, to those with negative U waves, with statistically significant differences.

  8. Changes in Spirometry After Left Ventricular Assist Device Implantation.

    PubMed

    Mohamedali, Burhan; Bhat, Geetha; Yost, Gardner; Tatooles, Antone

    2015-12-01

    Left ventricular assist devices (LVADs) are increasingly being used as life-saving therapy in patients with end-stage heart failure. The changes in spirometry following LVAD implantation and subsequent unloading of the left ventricle and pulmonary circulation are unknown. In this study, we explored long-term changes in spirometry after LVAD placement. In this retrospective study, we compared baseline preoperative pulmonary function test (PFT) results to post-LVAD spirometric measurements. Our results indicated that pulmonary function tests were significantly reduced after LVAD placement (forced expiratory volume in one second [FEV1 ]: 1.9 vs.1.7, P = 0.016; forced vital capacity [FVC]: 2.61 vs. 2.38, P = 0.03; diffusing capacity of the lungs for carbon monoxide [DLCO]: 14.75 vs. 11.01, P = 0.01). Subgroup analysis revealed greater impairment in lung function in patients receiving HeartMate II (Thoratec, Pleasanton, CA, USA) LVADs compared with those receiving HeartWare (HeartWare, Framingham, MA, USA) devices. These unexpected findings may result from restriction of left anterior hemi-diaphragm; however, further prospective studies to validate our findings are warranted.

  9. Active stream segregation specifically involves the left human auditory cortex.

    PubMed

    Deike, Susann; Scheich, Henning; Brechmann, André

    2010-06-14

    An important aspect of auditory scene analysis is the sequential grouping of similar sounds into one "auditory stream" while keeping competing streams separate. In the present low-noise fMRI study we presented sequences of alternating high-pitch (A) and low-pitch (B) complex harmonic tones using acoustic parameters that allow the perception of either two separate streams or one alternating stream. However, the subjects were instructed to actively and continuously segregate the A from the B stream. This was controlled by the additional instruction to listen for rare level deviants only in the low-pitch stream. Compared to the control condition in which only one non-separable stream was presented the active segregation of the A from the B stream led to a selective increase of activation in the left auditory cortex (AC). Together with a similar finding from a previous study using a different acoustic cue for streaming, namely timbre, this suggests that the left auditory cortex plays a dominant role in active sequential stream segregation. However, we found cue differences within the left AC: Whereas in the posterior areas, including the planum temporale, activation increased for both acoustic cues, the anterior areas, including Heschl's gyrus, are only involved in stream segregation based on pitch.

  10. Aortic root and left atrial wall motion. An echocardiographic study.

    PubMed Central

    Akgün, G; Layton, C

    1977-01-01

    The echocardiographically recorded movement of the aortic root was studied by analysing the relation between posterior aortic wall motion and other intracardiac events. The systolic anterior movement of the aortic root continued beyond aortic valve closure and in cases with mitral regurgitation began significantly earlier than in normal subjects. The diastolic rapid posterior movement began after mitral valve opening but did not occur in patients with mitral stenosis. The total amplitude of aortic root motion was increased in patients with mitral regurgitation, diminished in cases of mitral stenosis, and was normal with aortic regurgitation. In patients with atrioventricular block an abrupt posterior movement followed the P wave of the electrocardiogram irrespective of its timing in diastole. These observations correlate with the expected changes in left atrial volume during the cardiac cycle both in the normal subjects and patients with heart disease. The results support the hypothesis that phasic changes in left atrial dimension are largely responsible for the echocardiographically observed movement of the aortic root and indicate a potential role for echocardiography in the analysis of left atrial events. Images PMID:911559

  11. What Research Tells Us About Left Handedness.

    ERIC Educational Resources Information Center

    Arnold, Rita

    Left handed people have had bad publicity throughout history, and the resulting myths and disadvantages of left handedness have often not been properly dealt with in the classroom. Our language itself maintains a bias against the left, and many other cultures have defined the left as disreputable. Today's life style also provides many physical…

  12. Low scale left-right-right-left symmetry

    NASA Astrophysics Data System (ADS)

    Abbas, Gauhar

    2017-01-01

    We propose an effective left-right-right-left model with a parity breaking scale around a few TeV. One of the main achievements of the model is that the mirror fermions as well as the mirror gauge sector simultaneously could be at TeV scale. It is shown that the most dangerous quadratic divergence of the SM Higgs boson involving the top quark in the loop is naturally suppressed, and begins at three loop. The model postpones the fine-tuning of the mass of the SM Higgs boson up to a sufficiently high scale. The model explains the smallness of the neutrino masses whether they are Dirac or Majorana. Furthermore, the strong C P phase is zero in this model.

  13. Role of T-box gene tbx-2 for anterior foregut muscle development in C. elegans

    PubMed Central

    Smith, Pliny A.; Mango, Susan E.

    2007-01-01

    SUMMARY During organogenesis, pluripotent precursor cells acquire a defined identity such as muscle or nerve. The transition from naïve precursor towards the differentiated state is characterized by sequential waves of gene expression that are determined by regulatory transcription factors. A key question is how transcriptional circuitry dictates the succession of events that accompanies developmental competence, cell fate specification and differentiation. To address this question, we have examined how anterior muscles are established within the C. elegans foregut (pharynx). We find that the T-box transcription factor tbx-2 is essential to form anterior pharyngeal muscles from the ABa blastomere. In the absence of tbx-2 function, ABa-derived cells initiate development normally: they receive glp-1/Notch signaling cues, activate the T-box gene TBX-38 and express the organ selector gene PHA-4/FoxA. However, these cells subsequently arrest development, extinguish PHA-4 and fail to activate PHA-4 target genes. tbx-2 mutant cells do not undergo apoptosis and there is no evidence for adoption of an alternative fate. TBX-2 is expressed in ABa descendants and depends on activation by pha-4 and repression by glp-1/Notch signaling. Our analysis suggests that a positive feedback loop between tbx-2 and pha-4 is required for ABa-derived precursors to commit to pharyngeal muscle fate. PMID:17005176

  14. Transient ischaemic attack due to the lead of an implantable defibrillator in the left heart

    PubMed Central

    Alozie, Anthony; Westphal, Bernd; Yerebakan, Can; Steinhoff, Gustav

    2012-01-01

    A frequently underdiagnosed complication of pacemaker and implantable cardioverter defibrillator lead implantation is the unintentional advancement of the leads into the systemic circulation. We report a case encountered in our clinic in a 70-year old man evaluated in a neighbouring clinic with symptoms of transient ischaemic attack with initially unclear aetiology. Posterior–anterior chest X-rays suggested that the lead was in the left heart. This finding was confirmed by transthoracic and transoesophageal echocardiography. PMID:22108939

  15. Descending Control of Nociceptive Processing in Knee Osteoarthritis Is Associated With Intracortical Disinhibition

    PubMed Central

    Tarragó, Maria da Graca L.; Deitos, Alícia; Brietzke, Aline Patrícia; Vercelino, Rafael; Torres, Iraci L. S.; Fregni, Felipe; Caumo, Wolnei

    2016-01-01

    Abstract Based on the hypothesis that an imbalance in excitatory and inhibitory input is a central mechanism of knee osteoarthritis chronic pain (KOACP), this exploratory study had the following aims: to compare whether the function of the descending inhibitory pain pathway is associated with the state of inhibition in the corticospinal system indexed by the motor-evoked potential (MEP) and the cortical salient period (CSP) in patients with severe osteoarthritis (OA) and healthy controls; and to determine if there is correlation between the measures of intracortical inhibition (CSP, MEP) with changes on the numerical pain scale (NPS [0–10]) in KOACP during a conditioned pain modulation (CPM)-task considering the effect of self-reported function assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and analgesic use. In a cross-sectional study, we included females (n = 21), with disability by pain or stiffness due to KOACP and healthy controls (n = 10), aged 19 to 75 years. The motor cortex excitability parameters (MEP and CSP) were assessed using the transcranial magnetic stimulation. We assessed the pain and disability by the WOMAC, and change on NPS (0–10) during CPM-task. A Multivariate analysis of covariance revealed that the adjusted mean (SD) on the MEP amplitude was 13.53% higher in the OA than in healthy subjects (1.33 [0.49] vs 1.15 [0.13]), respectively (P = 0.16). The adjusted mean (SD) on the CSP observed in OA patients was 23.43% lower than in healthy subjects (54.54 [16.10] vs 70.94 [22.87]), respectively (P = 0.01). The function of the descending pain modulatory system assessed by change on NPS (0–10) during a CPM-task was negatively correlated with the cortical excitability parameter indexed by the CSP (P = 0.001). Also, the CSP was negatively correlated with the pain and disability assessed by the WOMAC index. These findings support the hypothesis that the change in cortical plasticity in

  16. Feasibility of Quantifying Arterial Cerebral Blood Volume Using Multiphase Alternate Ascending/Descending Directional Navigation (ALADDIN)

    PubMed Central

    Kim, Ki Hwan; Choi, Seung Hong; Park, Sung-Hong

    2016-01-01

    Arterial cerebral blood volume (aCBV) is associated with many physiologic and pathologic conditions. Recently, multiphase balanced steady state free precession (bSSFP) readout was introduced to measure labeled blood signals in the arterial compartment, based on the fact that signal difference between labeled and unlabeled blood decreases with the number of RF pulses that is affected by blood velocity. In this study, we evaluated the feasibility of a new 2D inter-slice bSSFP-based arterial spin labeling (ASL) technique termed, alternate ascending/descending directional navigation (ALADDIN), to quantify aCBV using multiphase acquisition in six healthy subjects. A new kinetic model considering bSSFP RF perturbations was proposed to describe the multiphase data and thus to quantify aCBV. Since the inter-slice time delay (TD) and gap affected the distribution of labeled blood spins in the arterial and tissue compartments, we performed the experiments with two TDs (0 and 500 ms) and two gaps (300% and 450% of slice thickness) to evaluate their roles in quantifying aCBV. Comparison studies using our technique and an existing method termed arterial volume using arterial spin tagging (AVAST) were also separately performed in five subjects. At 300% gap or 500-ms TD, significant tissue perfusion signals were demonstrated, while tissue perfusion signals were minimized and arterial signals were maximized at 450% gap and 0-ms TD. ALADDIN has an advantage of visualizing bi-directional flow effects (ascending/descending) in a single experiment. Labeling efficiency (α) of inter-slice blood flow effects could be measured in the superior sagittal sinus (SSS) (20.8±3.7%.) and was used for aCBV quantification. As a result of fitting to the proposed model, aCBV values in gray matter (1.4–2.3 mL/100 mL) were in good agreement with those from literature. Our technique showed high correlation with AVAST, especially when arterial signals were accentuated (i.e., when TD = 0 ms) (r = 0

  17. Ionogram height time intensity observations of descending sporadic E layers at mid-latitude

    NASA Astrophysics Data System (ADS)

    Haldoupis, C.; Meek, C.; Christakis, N.; Pancheva, D.; Bourdillon, A.

    2006-02-01

    A new methodology of ionosonde height time intensity (HTI) analysis is introduced which allows the investigation of sporadic E layer (Es) vertical motion and variability. This technique, which is useful in measuring descent rates and tidal periodicities of Es, is applied on ionogram recordings made during a summer period from solstice to equinox on the island of Milos (36.7°N; 24.5°E). On the average, the ionogram HTI analysis revealed a pronounced semidiurnal periodicity in layer descent and occurrence. It is characterized by a daytime layer starting at 120 km near 06 h local time (LT) and moving downward to altitudes below 100 km by about 18 h LT when a nighttime layer appears above at ˜125 km. The latter moves also downward but at higher descent rates (1.6 2.2 km/h) than the daytime layer (0.8 1.5 km/h). The nighttime Es is weaker in terms of critical sporadic E frequencies (foEs), has a shorter duration, and tends to occur less during times close to solstice. Here, a diurnal periodicity in Es becomes dominant. The HTI plots often show the daytime and nighttime Es connecting with weak traces in the upper E region which occur with a semidiurnal, and at times terdiurnal, periodicity. These, which are identified as upper E region descending intermediate layers (DIL), play an important role in initiating and reinforcing the sporadic E layers below 120 125 km. The observations are interpreted by considering the downward propagation of wind shear convergent nodes that associate with the S2,3 semidiurnal tide in the upper E region and the S1,1 diurnal tide in the lower E region. The daytime sporadic E layer is attributed to the confluence of semidiurnal and diurnal convergent nodes, which may explain the well-known pre-noon daily maximum observed in foEs. The nighttime layer is not well understood, although most likely it is associated with the intrusion of the daytime DIL into the lower E region due to vertical wind shear convergence nodes descending with the

  18. Anterior ST segment depression in acute inferior myocardial infarction as a marker of greater inferior, apical, and posterolateral damage

    SciTech Connect

    Ruddy, T.D.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Strauss, H.W.

    1986-12-01

    The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% (mean +/- S.E.M.) vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04) compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury.

  19. Phenotypic spectrum of 45,X/46,XY males with a ring Y chromosome and bilaterally descended testes

    PubMed Central

    Layman, Lawrence C.; Tho, Sandra P.T.; Clark, Andrew D.; Kulharya, Anita; McDonough, Paul G.

    2013-01-01

    OBJECTIVE To characterize the phenotypic spectrum of males with bilaterally descended testes and a 45,X/46,X,(r)Y karyotype DESIGN Retrospective review of patient records; cytogenetic and molecular analysis SETTING Tertiary medical center setting PARTICIPANTS Five males, two prepubertal and three postpubertal, with a 45,X/46,X(r)Y karyotype and bilaterally descended testes INTERVENTIONS Linear growth evaluation, testicular endocrine and exocrine studies, cytogenetic and molecular analysis on each patient. MAIN OUTCOME MEASURES Clinical phenotype vs. genotype RESULTS Both prepubertal males had short stature and low testosterone. All three adults had normal puberty and normal testosterone levels. Two of the adults (one with short stature and one with normal stature) had elevated gonadotropins and azoospermia. The third adult had normal stature, severe oligospermia, normal gonadotropins, and normal serum testosterone. CONCLUSIONS The phenotypic spectrum of males with a 45,X/46,X(r)Y karyotype and bilaterally descended testes varies greatly from males with short stature and spermatogenic failure to males without short stature and less severely affected spermatogenesis. This broad spectrum of phenotypic findings needs to be taken into account when the clinical geneticist encounters a prenatal diagnosis of a 45,X/46,X(r)Y karyotype. This information will also be helpful for pediatric and reproductive endocrinologists in counseling males with bilaterally descended testes and a 45,X/46,X(r)Y karyotype. PMID:18555994

  20. Electron microscopic observations of the anterior pituitary gland. Part I. The neurons in the "transitional zone" of the anterior pituitary gland.

    PubMed

    Mabuchi, Yoshio; Shirasawa, Nobuyuki; Sakuma, Eisuke; Wada, Ikuo; Horiuchi, Osamu; Kikuchi, Motoshi; Sakamoto, Atsushi; Herbert, Damon C; Soji, Tsuyoshi

    2008-06-01

    Since [Westlud, K.N., Chils, G.V., 1982. Localization of serotonin fibers in the rat adenohypophysis. Endocrinology 111, 1761-1763] initially identified the serotonin nerve fibers in the anterior pituitary gland, attention has been paid to the rostral zone of the anterior lobe into which nerve fibers enter and subsequently spread to deeper regions of the lobe. The rostral zone is the trifurcated junction of the partes tuberalis, intermedia and distalis, and has the important role(s) for hormone secretion via the "transitional zone" [Sato, G, Shirasawa, N, Sakuma, E, Sato, Y, Asai, Y, Wada, I, Horiuchi, O, Sakamoto, A, Herbert, DC, Soji, T, 2005a. Intercellular communications within the rat anterior pituitary. XI: An immunohistochemical study of distributions of S-100 positive cells in the anterior pituitary of the rat. Tissue and Cell 37, 269-280.]. The objective of this study was to focus on the ultrastructure of this "zone." All of the animals studied were fixed by perfusion with glutaraldehyde via the left ventricle of the heart and examined by electron microscopy. In the "transitional zone," a cluster of neuronal elements was observed between the folliculo-stellate cell-rich area and the anterior lobe. This cluster consisted of myelinated fibers, unmyelinated fibers, neuroendocrine fibers, large cells, and supporting cells. The large cells were perikarya of neurons which made a "ganglion-like" structure with associated satellite cells. Agranular, folliculo-stellate cells were intermingled among the elements. This is the first report that neuronal elements form clusters in the "transitional zone." A relationship of the unmyelinated and neuroendocrine fibers in the basal layer and in the "transitional zone" is discussed.

  1. Pure amnesia after unilateral left polar thalamic infarct: topographic and sequential neuropsychological and metabolic (PET) correlations.

    PubMed Central

    Clarke, S; Assal, G; Bogousslavsky, J; Regli, F; Townsend, D W; Leenders, K L; Blecic, S

    1994-01-01

    A 54-year-old patient who had an isolated small polar thalamic infarct and acute global amnesia with slight frontal type dysfunction but without other neurological dysfunction was studied. Memory improved partially within 8 months. At all stages the impairment was more severe for verbal than non-verbal memory. Autobiographic recollections and newly acquired information tended to be disorganised with respect to temporal order. Procedural memory was unaffected. Both emotional involvement and pleasure in reading were lost. On MRI, the infarct was limited to the left anterior thalamic nuclei and the adjacent mamillothalamic tract. The regional cerebral metabolic rate of glucose (measured with PET) was decreased on the left in the thalamus, amygdala, and posterior cingulate cortex 2 weeks after the infarct, and in the thalamus and posterior cingulate cortex 9 months later. These findings stress the specific role of the left anterior thalamic region in memory and confirm that longlasting amnesia from a thalamic lesion can occur without significant structural damage to the dorsomedial nucleus. Furthermore, they suggest that the anterior thalamic nuclei and possibly their connections with the posterior cingulate cortex play a role in emotional involvement linked to ipsilateral hemispheric functions. Images PMID:8301301

  2. Task-dependent modulation of regions in the left temporal cortex during auditory sentence comprehension.

    PubMed

    Zhang, Linjun; Yue, Qiuhai; Zhang, Yang; Shu, Hua; Li, Ping

    2015-01-01

    Numerous studies have revealed the essential role of the left lateral temporal cortex in auditory sentence comprehension along with evidence of the functional specialization of the anterior and posterior temporal sub-areas. However, it is unclear whether task demands (e.g., active vs. passive listening) modulate the functional specificity of these sub-areas. In the present functional magnetic resonance imaging (fMRI) study, we addressed this issue by applying both independent component analysis (ICA) and general linear model (GLM) methods. Consistent with previous studies, intelligible sentences elicited greater activity in the left lateral temporal cortex relative to unintelligible sentences. Moreover, responses to intelligibility in the sub-regions were differentially modulated by task demands. While the overall activation patterns of the anterior and posterior superior temporal sulcus and middle temporal gyrus (STS/MTG) were equivalent during both passive and active tasks, a middle portion of the STS/MTG was found to be selectively activated only during the active task under a refined analysis of sub-regional contributions. Our results not only confirm the critical role of the left lateral temporal cortex in auditory sentence comprehension but further demonstrate that task demands modulate functional specialization of the anterior-middle-posterior temporal sub-areas.

  3. Reduced anterior insula, enlarged amygdala in alcoholism and associated depleted von Economo neurons

    PubMed Central

    Senatorov, Vladimir V.; Damadzic, Ruslan; Mann, Claire L.; Schwandt, Melanie L.; George, David T.; Hommer, Daniel W.; Heilig, Markus

    2015-01-01

    The insula, a structure involved in higher order representation of interoceptive states, has recently been implicated in drug craving and social stress. Here, we performed brain magnetic resonance imaging to measure volumes of the insula and amygdala, a structure with reciprocal insular connections, in 26 alcohol-dependent patients and 24 healthy volunteers (aged 22–56 years, nine females in each group). We used an established morphometry method to quantify total and regional insular volumes. Volumetric measurements of the amygdala were obtained using a model-based segmentation/registration tool. In alcohol-dependent patients, anterior insula volumes were bilaterally reduced compared to healthy volunteers (left by 10%, right by 11%, normalized to total brain volumes). Furthermore, alcohol-dependent patients, compared with healthy volunteers, had bilaterally increased amygdala volumes. The left amygdala was increased by 28% and the right by 29%, normalized to total brain volumes. Post-mortem studies of the anterior insula showed that the reduced anterior insular volume may be associated with a population of von Economo neurons, which were 60% diminished in subjects with a history of alcoholism (n = 6) as compared to subjects without a history of alcoholism (n = 6) (aged 32–56 years, all males). The pattern of neuroanatomical change observed in our alcohol-dependent patients might result in a loss of top-down control of amygdala function, potentially contributing to impaired social cognition as well as an inability to control negatively reinforced alcohol seeking and use. PMID:25367022

  4. Reduced anterior insula, enlarged amygdala in alcoholism and associated depleted von Economo neurons.

    PubMed

    Senatorov, Vladimir V; Damadzic, Ruslan; Mann, Claire L; Schwandt, Melanie L; George, David T; Hommer, Daniel W; Heilig, Markus; Momenan, Reza

    2015-01-01

    The insula, a structure involved in higher order representation of interoceptive states, has recently been implicated in drug craving and social stress. Here, we performed brain magnetic resonance imaging to measure volumes of the insula and amygdala, a structure with reciprocal insular connections, in 26 alcohol-dependent patients and 24 healthy volunteers (aged 22-56 years, nine females in each group). We used an established morphometry method to quantify total and regional insular volumes. Volumetric measurements of the amygdala were obtained using a model-based segmentation/registration tool. In alcohol-dependent patients, anterior insula volumes were bilaterally reduced compared to healthy volunteers (left by 10%, right by 11%, normalized to total brain volumes). Furthermore, alcohol-dependent patients, compared with healthy volunteers, had bilaterally increased amygdala volumes. The left amygdala was increased by 28% and the right by 29%, normalized to total brain volumes. Post-mortem studies of the anterior insula showed that the reduced anterior insular volume may be associated with a population of von Economo neurons, which were 60% diminished in subjects with a history of alcoholism (n = 6) as compared to subjects without a history of alcoholism (n = 6) (aged 32-56 years, all males). The pattern of neuroanatomical change observed in our alcohol-dependent patients might result in a loss of top-down control of amygdala function, potentially contributing to impaired social cognition as well as an inability to control negatively reinforced alcohol seeking and use.

  5. The anterior bias in visual art: the case of images of animals.

    PubMed

    Bertamini, Marco; Bennett, Kate M; Bode, Carole

    2011-11-01

    Composition is an important topic in visual art. The literature suggests a bias for objects on the right side (Levy, 1976) and two additional biases with respect to positioning of objects within a rectangular frame: a Centre bias and an Inward bias (Palmer, Gardner, & Wickens, 2008). We analysed images of animals from three datasets of works of art: two datasets were from artists well known for their portraits of animals (Bewick, Stubbs) and the third was a medieval bestiary. There was no overall displacement of the subject to the right or to the left of the picture. However, we found a bias consisting of more space in front compared to behind the animal, consistent with Palmer at al.'s findings and with their definition of an Inward bias. Because our animals never face towards the centre we use the term Anterior bias. In addition, we found a modulation of this bias on the basis of the facing direction of the animal, consisting of a stronger Anterior bias for left-facing animals. This asymmetry may originate from a combination of an Anterior bias and a Right bias. Finally, with respect to size we found that the size of the animals predicted the proportion of the picture occupied, an effect known as "canonical size".

  6. Computer-Assisted Navigation During an Anterior-Posterior En Bloc Resection of a Sacral Tumor.

    PubMed

    Al Eissa, Sami; Al-Habib, Amro F; Jahangiri, Faisal R

    2015-11-04

    Previously, a computer-based navigation system has not been used routinely for en-bloc resection of sacral tumors. In order to improve the accuracy of tumor resection, O-arm navigation was used to join anterior and posterior osteotomies during an en-bloc resection of a sacral Ewing's sarcoma. This case study describes the technique for en-bloc resection of a sacral Ewing's sarcoma guided by O-arm computer navigation and intraoperative neurophysiological monitoring (IONM). An 18-year-old male presented with weakness in his left lower extremity. MRI of the patient's spine showed a sacral mass causing compression of left S1 and S2 roots. A surgical resection was planned with anterior and posterior approaches. An O-arm computer navigation system was used to assist in meeting anterior osteotomy cuts with the posterior cuts to ensure complete resection of the sacral tumor with a safe margin. Computer-assisted navigation was used along with IONM during this procedure to help guide the surgical team in an adequate tumor resection. There were no complications related to the use of the O-arm or the navigation system. Computer navigation guidance is both useful and safe in sacral tumor resections. It enhanced the accuracy of the en-bloc removal of a sacral tumor with safe margins while protecting neural function and minimizing recurrence.

  7. Translocation of the Aortic Arch with Norwood Procedure for Hypoplastic Left Heart Syndrome Variant with Circumflex Retroesophageal Aortic Arch

    PubMed Central

    Lee, Chee-Hoon; Seo, Dong Ju; Bang, Ji Hyun; Goo, Hyun Woo; Park, Jeong-Jun

    2014-01-01

    Retroesophageal aortic arch, in which the aortic arch crosses the midline behind the esophagus to the contralateral side, is a rare form of vascular anomaly. The complete form may cause symptoms by compressing the esophagus or the trachea and need a surgical intervention. We report a rare case of a hypoplastic left heart syndrome variant with the left retroesophageal circumflex aortic arch in which the left aortic arch, retroesophageal circumflex aorta, and the right descending aorta with the aberrant right subclavian artery encircle the esophagus completely, thus causing central bronchial compression. Bilateral pulmonary artery banding and subsequent modified Norwood procedure with extensive mobilization and creation of the neo-aorta were performed. As a result of the successful translocation of the aorta, the airway compression was relieved. The patient underwent the second-stage operation and is doing well currently. PMID:25207249

  8. Surgical Injury in the Neonatal Rat Alters the Adult Pattern of Descending Modulation from the Rostroventral Medulla

    PubMed Central

    Walker, Suellen M.; Fitzgerald, Maria; Hathway, Gareth J.

    2015-01-01

    Background Neonatal pain and injury can alter long-term sensory thresholds. Descending rostroventral medulla (RVM) pathways can inhibit or facilitate spinal nociceptive processing in adulthood. As these pathways undergo significant postnatal maturation, we evaluated long-term effects of neonatal surgical injury on RVM descending modulation. Methods Plantar hindpaw or forepaw incisions were performed in anesthetized postnatal day (P)3 Sprague-Dawley rats. Controls received anesthesia only. Hindlimb mechanical and thermal withdrawal thresholds were measured to 6 weeks of age (adult). Additional groups received pre- and post-incision sciatic nerve bupivacaine or saline. Hindpaw nociceptive reflex sensitivity was quantified in anesthetized adult rats using biceps femoris electromyography, and the effect of RVM electrical stimulation (5-200 μA) measured as percentage change from baseline. Results In adult rats with prior neonatal incision (n=9), all intensities of RVM stimulation decreased hindlimb reflex sensitivity, in contrast to the typical bimodal pattern of facilitation and inhibition with increasing RVM stimulus intensity in controls (n=5) (uninjured vs. neonatally-incised, P<0.001). Neonatal incision of the contralateral hindpaw or forepaw also resulted in RVM inhibition of hindpaw nociceptive reflexes at all stimulation intensities. Behavioral mechanical threshold (mean±SEM, 28.1±8g vs. 21.3±1.2g, P<0.001) and thermal latency (7.1±0.4 vs. 5.3±0.3s, P<0.05) were increased in both hindpaws following unilateral neonatal incision. Neonatal perioperative sciatic nerve blockade prevented injury-induced alterations in RVM descending control. Conclusions Neonatal surgical injury alters the postnatal development of RVM descending control, resulting in a predominance of descending inhibition and generalized reduction in baseline reflex sensitivity. Prevention by local anesthetic blockade highlights the importance of neonatal perioperative analgesia. PMID:25871742

  9. Marginal reticular cells: a stromal subset directly descended from the lymphoid tissue organizer

    PubMed Central

    Katakai, Tomoya

    2012-01-01

    The architecture of secondary lymphoid organs (SLOs) is supported by several non-hematopoietic stromal cells. Currently it is established that two distinct stromal subsets, follicular dendritic cells and fibroblastic reticular cells, play crucial roles in the formation of tissue compartments within SLOs, i.e., the follicle and T zone, respectively. Although stromal cells in the anlagen are essential for SLO development, the relationship between these primordial cells and the subsets in adulthood remains poorly understood. In addition, the roles of stromal cells in the entry of antigens into the compartments through some tissue structures peculiar to SLOs remain unclear. A recently identified stromal subset, marginal reticular cells (MRCs), covers the margin of SLOs that are primarily located in the outer edge of follicles and construct a unique reticulum. MRCs are closely associated with specialized endothelial or epithelial structures for antigen transport. The similarities in marker expression profiles and successive localization during development suggest that MRCs directly descend from organizer stromal cells in the anlagen. Therefore, MRCs are thought to be a crucial stromal component for the organization and function of SLOs. PMID:22807928

  10. Termination of supraspinal descending pathways in the spinal cord of the tegu lizard, Tupinambis nigropunctatus.

    PubMed

    Cruce, W L

    1975-01-01

    Descending fiber projections to the lizard spinal cord were studied using anterograde axonal degeneration. Following hemisection of the cord at the first spinal segment, degeneration was found in the white and gray matter as far down as the 31st (caudal) segment. Degenerating fibers in the white matter were confined to the ipsilateral side and were found in the medial longitudinal fasiculus and the outer half ot the lateral and ventral funiculi. Degeneration was more intense in the dorsolateral and ventromedial funiculi than in the ventrolateral funiculus. In the gray matter, REXED's criteria were applied to Nissl-stained material to delimit boundaries of ten laminae. Degeneration of suprospinal axons was most intense in the medial part of VII, dorsal and ventral commissures to ramify contralaterally in the medial part of VII, in VII, and in medial IX. No degeneration was present in the lateral part of the spinal gray on the contralateral side. In Golgi-stained material, dendrites of lateral IX cells were seen to extend into lamina VII, the dorsolateral part of VII, and the lateral funiculus. Thus, fibers of the ventromedial supraspinal pathway may make axodendritic contact with motoneurons of lateral IX as well as medial IX, ipsilaterally. In addition, there is a possibility of a crossed connection to contralateral motoneurons.

  11. Epidemiology of gallstone disease in Argentina: prevalences in the general population and European descendants.

    PubMed

    Brasca, A P; Pezzotto, S M; Berli, D; Villavicencio, R; Fay, O; Gianguzzo, M P; Poletto, L

    2000-12-01

    To assess gallstone disease prevalence in Argentina, a random sample of the Rosario City population was studied, considering already known associated factors, and analyzing ethnic groups living in the city. A total of 1,173 participants (69% response), both sexes, 20 years and older were studied. Each subject underwent an abdominal ultrasound examination, a blood test, and a standardized questionnaire. It was seen that gallstone disease prevalence (gallstones or cholecystectomy), overall was 20.5% (23.8% in women and 15.5% in men; (P = 0.0005), and was associated with age and body mass index in both sexes, and with pregnancy number and hypertriglyceridemia in women. As regards ancestors' nationalities, Italian and Spanish descendants presented higher prevalence rates for all age groups than those described in Italy and Spain. Thus far, in a subsample of 78% of nonparticipants submitted to a new home visit, presence of cholecystectomy or symptoms did not differ from participants, supporting the validity of our results.

  12. Echoes from Sepharad: signatures on the maternal gene pool of crypto-Jewish descendants

    PubMed Central

    Nogueiro, Inês; Teixeira, João; Amorim, António; Gusmão, Leonor; Alvarez, Luis

    2015-01-01

    The majority of genetic studies on Jewish populations have been focused on Ashkenazim, and genetic data from the Sephardic original source, the Iberian Peninsula, are particularly scarce. Regarding the mitochondrial genome, the available information is limited to a single Portuguese village, Belmonte, where just two different lineages (a single one corresponding to 93.3%) were found in 30 individuals. Aiming at disclosing the ancestral maternal background of the Portuguese Jewry, we enlarged the sampling to other crypto-Jewish descendants in the Bragança district (NE Portugal). Fifty-seven complete mtDNA genomes were newly sequenced and — in contrast with Belmonte — a high level of diversity was found, with five haplogroups (HV0b, N1, T2b11, T2e and U2e) being putatively identified as Sephardic founding lineages. Therefore — in sharp contrast with Belmonte — these communities have managed to escape the expected inbreeding effects caused by centuries of religious repression and have kept a significant proportion of the Sephardic founder gene pool. This deeper analysis of the surviving Sephardic maternal lineages allowed a much more comprehensive and detailed perspective on the origins and survival of the Sephardic genetic heritage. In line with previously published results on Sephardic paternal lineages, our findings also show a surprising resistance to the erosion of genetic diversity in the maternal lineages. PMID:25074462

  13. Chemical Identification of a Long-Lived Isotope of Dubnium, a Descendant of Element 115

    SciTech Connect

    Stoyer, N J; Landrum, J H; Wilk, P A; Moody, K J; Kenneally, J M; Shaughnessy, D A; Stoyer, M A; Wild, J F; Lougheed, R W; Dmitriev, S N; Oganessian, Y T; Shishkin, S V; Aksenov, N V; Tereshatov, E E; Bozhikov, G A; Vostokin, G K; Utyonkov, V K; Yeremin, A A

    2006-09-26

    The recognition criterion for discovery of a new chemical element includes two aspects, the characterization properties and the assignment properties. In this paper, we will discuss the status of element 115 experiments that have been performed in Dubna, Russia, highlighting the characterization and assignment properties as they specifically relate to a recent experiment. After discussing the status of what is known about the decay properties of element 115 [1], observed previously using the Dubna Gas-Filled Recoil Separator, we will discuss the prior chemical studies that have been performed on the Db descendant of element 115 [2]. Following the success of that experiment, some additional chemical information was desired. Two separation chemistries were then developed at LLNL and JINR. LLNL utilized reversed phase chromatography and JINR utilized anion exchange chromatography to perform not only +4/+5 separations, but also intra-group separations, where Nb-like and Ta-like fractions were eluted. The results from an experiment using these chemistries for the first time during December 2005 in Dubna, Russia, will be compared with prior chemical results. We will conclude with a discussion of possible enhancements to the work already performed and the current status of the future experimental plans.

  14. Dynamics of coronal rain and descending plasma blobs in solar prominences. I. Fully ionized case

    SciTech Connect

    Oliver, R.; Soler, R.; Terradas, J.; Zaqarashvili, T. V.; Khodachenko, M. L.

    2014-03-20

    Observations of active regions and limb prominences often show cold, dense blobs descending with an acceleration smaller than that of free fall. The dynamics of these condensations falling in the solar corona is investigated in this paper using a simple fully ionized plasma model. We find that the presence of a heavy condensation gives rise to a dynamical rearrangement of the coronal pressure that results in the formation of a large pressure gradient that opposes gravity. Eventually this pressure gradient becomes so large that the blob acceleration vanishes or even points upward. Then, the blob descent is characterized by an initial acceleration phase followed by an essentially constant velocity phase. These two stages can be identified in published time-distance diagrams of coronal rain events. Both the duration of the first stage and the velocity attained by the blob increase for larger values of the ratio of blob to coronal density, for larger blob mass, and for smaller coronal temperature. Dense blobs are characterized by a detectable density growth (up to 60% in our calculations) and by a steepening of the density in their lower part, that could lead to the formation of a shock. They also emit sound waves that could be detected as small intensity changes with periods of the order of 100 s and lasting between a few and about 10 periods. Finally, the curvature of falling paths with large radii is only relevant when a very dense blob falls along inclined magnetic field lines.

  15. Early Experiences with the Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm

    PubMed Central

    Choi, Jae-Sung; Oh, Se Jin; Sung, Yong Won; Moon, Hyun Jong; Lee, Jung Sang

    2016-01-01

    Background The aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition. Methods Among 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA. Results The mean age was 72.4±5.1 years, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was 269.8±72.3 minutes. The mean total length of aortic coverage was 186.0±49.2 mm. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of 16.8±14.8 months, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown. Conclusion TEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs. PMID:27064672

  16. Descending vasa recta pericytes express voltage operated Na+ conductance in the rat

    PubMed Central

    Zhang, Zhong; Cao, Chunhua; Lee-Kwon, Whaseon; Pallone, Thomas L

    2005-01-01

    We studied the properties of a voltage-operated Na+ conductance in descending vasa recta (DVR) pericytes isolated from the renal outer medulla. Whole-cell patch-clamp recordings revealed a depolarization-induced, rapidly activating and rapidly inactivating inward current that was abolished by removal of Na+ but not Ca+ from the extracellular buffer. The Na+ current (INa) is highly sensitive to tetrodotoxin (TTX, Kd = 2.2 nm). At high concentrations, mibefradil (10 μm) and Ni+ (1 mm) blocked INa. INa was insensitive to nifedipine (10 μm). The L-type Ca+ channel activator FPL-64176 induced a slowly activating/inactivating inward current that was abolished by nifedipine. Depolarization to membrane potentials between 0 and 30 mV induced inactivation with a time constant of ∼1 ms. Repolarization to membrane potentials between −90 and −120 mV induced recovery from inactivation with a time constant of ∼11 ms. Half-maximal activation and inactivation occurred at −23.9 and −66.1 mV, respectively, with slope factors of 4.8 and 9.5 mV, respectively. The Na+ channel activator, veratridine (100 μm), reduced peak inward INa and prevented inactivation. We conclude that a TTX-sensitive voltage-operated Na+ conductance, with properties similar to that in other smooth muscle cells, is expressed by DVR pericytes. PMID:15975976

  17. [Surgery of the descending thoracic and thoraco-abdominal arteries. Report of 105 cases].

    PubMed

    Zanetti, P P; Rosa, G; Sorisio, V; Cavanenghi, D; Amerio, G M; Stillo, R; Zappa, A; Cardellino, S; Franco, M; Muncinelli, M

    1997-07-01

    The Authors show their casistic of about 105 cases of thoracic descending and thoraco-abdominal aorta pathologies between 1.1.1993 and 30.12.1995. After a short introduction about the improvements in anesthesia and reanimation of these pathologies as well as the good reliability of diagnostic and currently available instruments, mortality and mobility parameters are taken into account, the last one referring to paraplegia and ARF. The casistic is evaluated splitting the cases into 2 groups, urgent surgery and election surgery, and differentiating the aneurysm type from the dissection type. Besides, the mortality and mobility are reported for any pathology, with a discussion of the parameters which drove the choice of the most suitable methodology to be adopted (ECC femoro-subclavian shunt, simple clamping). The results achieved show a mortality of 40% in urgency, between 5 and 15% in election, with a rate of paraplegia around 8-10% and a ARF between 5 and 15%. These data match the literature statistics and support the quality of the adopted methodologies.

  18. A fixed-base simulation study of two STOL aircraft flying curved, descending instrument approach paths

    NASA Technical Reports Server (NTRS)

    Benner, M. S.; Sawyer, R. H.; Mclaughlin, M. D.

    1973-01-01

    A real-time, fixed-base simulation study has been conducted to determine the curved, descending approach paths (within passenger-comfort limits) that would be acceptable to pilots, the flight-director-system logic requirements for curved-flight-path guidance, and the paths which can be flown within proposed microwave landing system (MLS) coverage angles. Two STOL aircraft configurations were used in the study. Generally, no differences in the results between the two STOL configurations were found. The investigation showed that paths with a 1828.8 meter turn radius and a 1828.8 meter final-approach distance were acceptable without winds and with winds up to at least 15 knots for airspeeds from 75 to 100 knots. The altitude at roll-out from the final turn determined which final-approach distances were acceptable. Pilots preferred to have an initial straight leg of about 1 n. mi. after MLS guidance acquisition before turn intercept. The size of the azimuth coverage angle necessary to meet passenger and pilot criteria depends on the size of the turn angle: plus or minus 60 deg was adequate to cover all paths execpt ones with a 180 deg turn.

  19. Continuous Descending Modulation of the Spinal Cord Revealed by Functional MRI

    PubMed Central

    Bosma, Rachael L.; Cotoi, Andreea I.; Leung, Roxanne H.; Kornelsen, Jennifer; Lawrence-Dewar, Jane M.; Pukall, Caroline F.; Staud, Roland

    2016-01-01

    Spontaneous variations in spinal cord activity may arise from regulation of any of a number of functions including sensory, motor, and autonomic control. Here, we use functional MRI (fMRI) of healthy participants to identify properties of blood oxygenation-level dependent (BOLD) variations in the spinal cord in response to knowledge that either a noxious stimulus is impending, or that no stimulus is to be expected. Expectation of a noxious stimulus, or no stimulus, is shown to have a significant effect on wide-spread BOLD signal variations in the spinal cord over the entire time period of the fMRI acquisition. Coordination of BOLD responses between/within spinal cord and brainstem regions are also influenced by this knowledge. We provide evidence that such signal variations are the result of continuous descending modulation of spinal cord function. BOLD signal variations in response to noxious stimulation of the hand are also shown, as in previous studies. The observation of both continuous and reactive BOLD responses to emotional/cognitive factors and noxious peripheral stimulation may have important implications, not only for our understanding of endogenous pain modulation, but also in showing that spinal cord activity is under continuous regulatory control. PMID:27907094

  20. A novel paradigm for urban environment characterization using ascending and descending TerraSAR-X data

    NASA Astrophysics Data System (ADS)

    Angiuli, E.; Trianni, G.; Gamba, P.

    2011-11-01

    The new Very High Resolution radar satellites, with a spatial resolution up to 1 meter, give a unique opportunity in the context of urban applications. This paper presents an approach for automatic detection of built-up areas based on the analysis of single-polarized TerraSAR-X images. The proposed methodology includes a specific preprocessing of the SAR data and an automated image analysis procedure. The preprocessing aims at providing a multi-