The YUMIKO catheter: a useful tool for angiography of the right internal mammary artery via a right brachial approach

The YUMIKO catheter (Goodman, Nagoya, Japan) was recently developed for a left internal mammary artery (IMA) angiography with a right radial or brachial approach. The present authors experienced an interesting case where the YUMIKO catheter was useful for a right IMA angiography via a right brachial artery. A 53-year-old man with bilateral IMA grafts underwent follow-up coronary angiography via a right brachial artery. Native coronary artery and left IMA angiography were performed without difficulty using the Judkins Right and Left and YUMIKO catheters. Angiography of the right IMA was attempted with the Judkins Right catheter and IMA catheter, resulting in a nonselective angiogram with poor imaging. The YUMIKO catheter, however, enabled smooth cannulation to the right IMA and provided good images of the selective right IMA angiography.     

Diphallia in a mixed-breed dog with multiple anomalies

Complete diphallia was detected in a six-month-old Poodle cross dog. Duplication of the urinary bladder, right renal hypoplasia, bifurcation of the descending colon and bilateral cryptorchidism were also present. The left urethra was patent, and emptied the left urinary bladder; the right urethra ended blindly at a point 2.5 cm from the tip of the right penis. The left urinary bladder was joined medially to a right urinary bladder with no interbladder communication; however, the right bladder opened caudally into a blind sac which drained into the left prostatic urethra. Pyelonephritis of the left kidney was present, and was suspected to be due to ascending bacterial infection of the right urinary bladder and the right segment of the bifurcated descending colon, which terminated at the apex of the right urinary bladder. Diphallia and associated urogenital anomalies are reviewed.     

Effect of sinus node on spontaneous release of natriuretic peptide in isolated atria

Experiments were conducted to examine the release of atrial natriuretic peptide (ANP) in an isolated atrium in the presence and absence of sinus node tissue. The first series of experiments were conducted with the aid of a metabolic chamber to examine the spontaneous release of ANP by the right atrium with and without the sinus node region. The left atrium was also studied. The right atrium with the sinus node, quiescent right atrium without the sinus node, and the left atrium were incubated at 35 degrees C in 10 mL of oxygenated Tyrode's solution. After 40 min of equilibration, the incubation medium was removed at 10-min intervals for the determination of immunoreactive ANP concentration. The right atria with the sinus node released the highest amount of ANP into the incubation medium (32.2 +/- 2.7 pg.min-1.mg-1), compared with quiescent right atria (20.9 +/- 3.7 pg.min-1.mg-1). The left atria released the least amount of ANP into the incubation medium (9.9 +/- 1.5 pg.min-1.mg-1) when compared with the quiescent right atria and the right atria. In the second series of experiments, the right atrium was divided into the sinus node region and the quiescent right atrium, and these tissues were studied in paired fashion with a modified Langendorff preparation. The right atrium without the sinus node and sinus node region were perfused with Tyrode's solution, equilibrated with 95% O2 and 5% CO2 at 37 degrees C with a constant flow of 0.5 mL/min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemodynamics mechanisms of changes in the right atrial pressure following intravenous injection of the depressor drugs

Changes of the right atrial pressure, superior and inferior vena cava flows, right ventricular myocardial contractility (first derivate of right ventricular pressure, dP/dt max) following i.v. injection of acetylcholine, histamine and isoproterenol, were studied in acute experiments on anaesthetized mongrel cats with artificial lung ventilation and opened chest. The right atrial pressure in those cases could be increased (I group of animals) or decreased (II group). In maximal shifts of right atrial pressure following acetylcholine injection, the superior vena cava flow increased but the inferior vena cava flow decreased in equal proportion. When the right ventricular myocardial contractility decreased more than the right atrial pressure was augmented, and when the cardiac negative inotropic effect was weak, the right atrial pressure was reduced. After histamine injection in both groups of animals, right ventricular myocardial contractility was increased on the same level, and changes of the inferior vena cava flow were insignificant. The right atrial pressure was elevated following greater increase of superior vena cava flow. Isoproterenol caused the positive cardiac inotropic effect and augmenting of the superior vena cava flow in both groups of animals. The right atrial pressure was elevated if the inferior vena cava flow increased and, on the other hand, when the inferior vena cava flow decreased the right atrial pressure was reduced. Thus different maximal changes of the right atrial pressure following i.v. injection of acetylcholine, histamine and isoproterenol could be explained by different hemodynamic mechanisms of the interaction between superior and inferior vena cava flow shifts and changes of the right ventricular myocardial contractility.     

Efficacy and Safety of Right Hemihepatectomy Through the Right Retrohepatic Tunnel

We wished to study the efficacy and safety of the retrograde ligation of short hepatic veins (SHVs) and the right hepatic vein (HV) through the retrohepatic tunnel in patients who underwent hemihepatectomy due to large hepatic carcinoma in the right lobe of the liver. Right hemihepatectomy was performed in 23 patients with tumors larger than 8 cm in diameter. The liver was separated at the secondary porta, and the interspace between right HVs and middle HVs was expanded. The right hepatic portal vein and hepatic artery were freed and ligated, followed by the retrograde dissection of SHVs and the right HV along the right retrohepatic space anterior to the inferior vena cava. A blocking belt was set at the left side of the midline, after which the right liver was cut off. The procedure was successfully completed in all patients. The average amount of intraoperative blood loss was 640 ml. The change in hepatic function was observed on the third postoperative day. Twenty-two patients exhibited satisfactory results; one patient died from postoperative hepatic failure. In conclusion, this procedure can be safely performed in most hemihepatectomy patients with liver tumors.     

输尿管子宫内膜异位症伴肾积水1 例报告并文献复习

目的:探讨子宫内膜异位症累及输尿管的诊断和治疗方法。方法:术前诊断为右侧输尿管下段占位病变伴右肾积水的42岁女性患者,行下腹正中切口,探查右侧输尿管开口处可见淡黄色息肉样病变,突入膀胱,输尿管下段增粗并全程扩张积水,行输尿管下段并膀胱袖式切除,输尿管膀胱再植术。术后病理报告为输尿管子宫内膜异位症。结果:术后复查B超示右肾积水较术前恢复,术后予抑那通3.75mg/28d,随访6个月未见复发。结论:对于输尿管占位并上尿路积水的女性患者,除考虑肿瘤外还应考虑子宫内膜异位症可能。手术联合内分泌治疗是治疗输尿管子宫内膜异位伴肾积水的有效方法。     

Correlations between changes of the right and left atrial pressures and systemic hemodynamics parameters following catecholamines intravenous injections in cats

In acute experiments on anesthetized cats, intravenous injection of epinephrine and norepinephrine caused different changes of right and left artrial pressures. These shifts mostly (82%) had similar directions: in these experiments, both right and left atrial pressures could be decreased (I group of animals) or increased (II group). The number of animals in these groups was equal. However, in 18% of the experiments, right atrial pressure was decreased, while left atrial pressure was increased. The changes of the left atrial pressure was, as a rule, more significant as compared with right atrial pressure shifts. In the I group of animals, systolic right atrial pressure was not changed, and systolic left atrial pressure was decreased. In the II group of animals, systolic pressure in both atria was augmented. Diastolic pressure was decreased in both atria in all the animals. When the atrial pressures were decreased, the increases of the superior and inferior vena cava flows, venous return and cardiac output were more significant as compared with animals in which the atrial pressures had been elevated. The changes of the superior and inferior vena cava flows were more obvious in animals following epinephrine injection as compared with animals in which norepinephrine was injected. The right atrial pressure returned to the initial level more rapidly than the left atrial pressure, and the time dynamics of the shifts of the right atrial pressure was similar to that of the superior vena cava flow. The temporal changes of the left atrial pressure were identical to the time changes of the cardiac output. We concluded that character of changes of the mean, systolic, and diastolic right and left atrial pressures following catecholamines injections was not correlated with the direction of venous return and cardiac output shifts, and was depending on intracardiac hemodynamics.     

兔急性肺血栓栓塞模型建立及右心室压和心电图监测

目的建立操作简便,存活率高的急性肺动脉血栓栓塞（acute pulmonary thromboembolism,APTE）模型并监测右心室压及心电图,为研究肺栓塞（pulmonary embolism,PE）的病理生理及临床诊断治疗提供实验基础。方法兔麻醉后,经右侧颈总静脉插管至右心室观察正常右心室压。然后经此导管注入4个直径2 mm、长5 mm的长柱状自体血栓栓子建立兔急性PE模型。10只PE兔监测右心室压及心电图至栓塞后80 min。过量麻醉处死动物,取肺脏固定做病理检查。结果右心室导管的插管成功率92.45%,平均右心室正常压力（32.69±8.32）mmHg。PE模型的栓塞率100%,存活率87.76%。模型建立后右心室压平均增高（6.75±6.82）mmHg,51.35%出现异常心电图波形。结论1.兔正常右心室压为（32.69±8.32）mmHg。2.自体血栓栓子经颈静脉入口右心室注入法建立兔急性PE模型存活率高,右心室压可作为判断急性PE模型成功建立的指标。3.仅部分PE出现心电图异常,心电图异常不能作为判断兔PE的指标。     

改良Nikaidoh手术治疗合并肺动脉瓣狭窄的右室双出口

目的：总结改良Nikaidoh手术治疗右心室双出口（DORV）患者的临床经验,以提高手术疗效。方法：2例先天性心脏病右心室双出口伴肺动脉瓣狭窄行改良Nikaidoh手术,游离主动脉根部及冠状动脉,重建左心室流出道,以带单瓣牛心包片补片重建肺动脉及右心室流出道。结果：术后患者紫绀消失,复查心脏彩超仅有轻度肺动脉瓣关闭不全,未发现左、右心室流出道梗阻,康复出院。结论：采用改良Nikaidoh手术治疗伴肺动脉瓣狭窄的右室双出口,术后可获得良好的血流动力学效果,早期临床结果满意。     

胚胎型大脑后动脉与脑白质病之间的关系

目的:探讨胚胎型大脑后动脉(Fetal origin of the posterior cerebral artery,FTP)与脑白质病之间的关系。方法:收集2013年1月~2014年6月在我院住院患者共485例,所有患者均行头颅磁共振平扫及血管成像,观察脑白质病变、急性脑梗死及FTP存在与否,并分为观察组(脑白质病组)和对照组(无脑白质病组),比较FTP的发生率。结果:观察组和对照组分别为232例和253例,观察组共发现53例FTP患者(左侧、右侧、双侧FTP分别为15例、19例、19例),FTP总发生率为22.8%,左侧、右侧、双侧FTP发生率分别为6.5%、8.2%、8.2%;对照组98例FTP患者(左侧、右侧、双侧FTP分别为26例、44例、28例),FTP总发生率为38.7%,左侧、右侧、双侧FTP发生率分别为10.3%、17.4%、11.1%,观察组FTP总发生率及右侧FTP发生率明显低于对照组(P0.001和P0.01)。232例观察组中急性脑梗死患者共156例,无急性脑梗死患者76例,其中急性脑梗死组有28例FTP患者(左侧、右侧、双侧FTP分别为7例、15例、6例),FTP总发生率及左侧、右侧、双侧FTP发生率分别为17.9%、4.5%、9.6%、3.8%;而无急性脑梗死的患者中,有24例FTP患者(左侧、右侧、双侧FTP分别为8例、4例、12例),FTP总发生率及左侧、右侧、双侧FTP发生率分别为31.6%、10.5%、5.3%、15.8%,观察组FTP总发生率及双侧FTP发生率明显低于对照组(P0.05和P0.01)。结论:FTP的存在可能一定程度上降低脑白质病甚至脑梗死的发生。     

The Hemodynamic Response of the Right Ventricle Following Acute and Chronic Partial Obstruction of the Main Pulmonary Artery in Dogs

In eight adult dogs the main pulmonary artery was constricted to elevate the right ventricular peak systolic pressure to 50% of the peak aortic pressure at rest. The response of the right ventricle was assessed immediately, at 30 minutes and at six months. The right ventricle responded to acute systolic loading by complete compensation. After 30 minutes there was a reduction in the right ventricular outflow tract resistance. The cardiac output, heart rate and aortic pressure were maintained. The right ventricular systolic ejection period, end-diastolic pressure, peak pressure time, mean systolic pressure, right ventricular—main pulmonary artery mean systolic gradient, right ventricular work index, systolic work and outflow tract resistance were all increased.The right ventricle in the dog was shown to have an immediate capacity to compensate for systolic loading and retains this capacity for long periods of time. The ability to increase work is accomplished by adaptations in right ventricular physiology which increase right ventricular mean systolic pressures and prolong the right ventricular ejection period.     

右心导管法测大鼠肺动脉压力的改良

目的:目前常用的测量大鼠肺动脉压力的右心导管法存在一定的缺陷,且很难得到典型的压力曲线图。本实验对大鼠经颈外静脉插管与测压的方法进行改良,同时与已有报道的实验结果进行比较,并提供正常SD大鼠右心房、右心室及肺动脉的压力参考值及典型的压力曲线图,以协助研究人员判断导管位置,及时调整导管的深度和方向,快速测出肺动脉压力。方法:雌雄不分的清洁级SD大鼠共30只,体重180~230 g,6~7周龄。应用自制的末端呈一弧形的PE-10管,采用改良后的右心导管法,经颈外静脉插入大鼠心腔及肺动脉,检测并计算大鼠右心房、右心室和肺动脉的收缩压、舒张压及肺动脉平均压。结果:右心房压力波动较平缓,呈小波浪形;右心室压力曲线波动大,骤升骤降;肺动脉压力曲线有重搏波。正常SD大鼠右心房舒张压为(2.03±2.56)mmHg,收缩压为(2.82±1.85)mmHg;右心室舒张压为(5.72±3.99)mmHg,收缩压为(18.73±4.80)mmHg;肺动脉舒张压为(15.27±2.64)mmHg,收缩压为(18.49±2.53)mmHg,肺动脉平均压为(16.34±2.32)mmHg。右心室收缩压与肺动脉收缩压无明显差异(P0.05)。结论:改良后的方法可准确到达大鼠肺动脉,提供的压力参考值及曲线图有助于研究人员顺利完成测压实验。     

Changes in intestinal endocrine cells in the mouse after unilateral cervical vagotomy

The effect of right or left unilateral cervical vagotomy on the intestinal endocrine cells was studied in 23 mice at 2 and 8 weeks after operation, respectively. The results were compared with that from 10 sham operated mice. Various types of endocrine cells in duodenum and proximal colon were detected by immunohistochemistry and quantified by computerized image analysis. In mouse duodenum, chromogranin-, CCK/gastrin-, GIP- and somatostatin-cells were significantly decreased at 2 weeks after right vagotomy, but returned to the control levels at 8 weeks. Serotonin-cells were reduced at both 2 and 8 weeks after right vagotomy. The amount of the duodenal endocrine cells did not change after left vagotomy with the exception of secretin-cells, which were diminished at 8 weeks after both right and left vagotomy. In the proximal colon, chromogranin-cells were also decreased at 2 weeks after right vagotomy. Serotonin-cells were reduced at 8 weeks after left vagotomy but not right vagotomy. There was no significant difference between the unilaterally vagotomized and the sham operated mice with regard to PYY- and glucagon-cells. It was concluded that vagotomy affected the intestinal endocrine cells in mouse. The influence was more pronounced in the small intestine than the proximal colon. The right vagus nerves seemed to exert more effect on the intestinal endocrine cells than the left ones.     

Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report

Background

This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function.

Case presentation

A 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected.

Conclusions

The nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

     

急性早幼粒细胞白血病患者小孢根霉变种感染1例

报道1例由小孢根霉变种导致的皮肤毛霉病.患者女,30岁.因患急性早幼粒细胞白血病,化疗后继发口腔颌面部小孢根霉变种感染,表现为发热、右侧颊黏膜水肿,皮损中央溃疡、焦痂,周边组织炎性水肿,以面颊部、颌下区为中心明显肿胀,逐渐累及右侧颈部及右下颌,进行性加重.坏死组织涂片镜检显示有粗大、无分隔直角菌丝,真菌学检查鉴定为小孢根霉,分子测序证实为小孢根霉变种.给予两性霉素B、伊曲康唑静脉滴注和手术清创,坏死组织连续3次真菌培养均未培养出小孢根霉变种,患者体温逐渐恢复正常,治疗2周后颔面部肿胀明显减退,浅表淋巴结未触及肿大,4周后额部及右眼睑肿胀已完全消退,伤口结痂愈合.随访2 a,右侧颌下可见长约2 cm手术疤痕,未见皮肤毛霉病复发.     

Neural Bases for Individual Differences in the Subjective Experience of Short Durations (Less than 2 Seconds)

The current research was designed to establish whether individual differences in timing performance predict neural activation in the areas that subserve the perception of short durations ranging between 400 and 1600 milliseconds. Seventeen participants completed both a temporal bisection task and a control task, in a mixed fMRI design. In keeping with previous research, there was increased activation in a network of regions typically active during time perception including the right supplementary motor area (SMA) and right pre-SMA and basal ganglia (including the putamen and right pallidum). Furthermore, correlations between neural activity in the right inferior frontal gyrus and SMA and timing performance corroborate the results of a recent meta-analysis and are further evidence that the SMA forms part of a neural clock that is responsible for the accumulation of temporal information. Specifically, subjective lengthening of the perceived duration were associated with increased activation in both the right SMA (and right pre-SMA) and right inferior frontal gyrus.     

Decreases of calcium and phosphorus in monkey cardiac walls with development and aging

To elucidate compositional changes of the cardiac walls with development and aging, the authors investigated changes of elements in the atrial and ventricular walls of monkeys. The left and right atrial walls, left and right ventricular walls, and interatrial and interventricular septa were resected from the subjects. The subjects consisted of 17 rhesus and 13 Japanese monkeys, ranging in age from 10 d to 33 yr. The element content of the cardiac walls was analyzed by inductively coupled plasma-atomic emission spectrometry. The Ca and P contents decreased in all of the left and right atrial and ventricular walls, interatrial septa, and interventricular septa with development, whereas the S and Mg contents decreased in the left and right ventricular walls with development. Regarding the relationships among elements, significant direct correlations were found among Ca, P, Mg, and Zn in all of the left and right atrial walls, left and right ventricular walls, and interatrial and interventricular septa, with some exceptions. As Ca decresed in the cardic walls, P, Mg, and Zn decreased simultaneously in the cardiac walls. The mass ratio of Ca/P decreased gradually with Ca decrease in both the atrial and ventricular walls, but it was not constant.     

A simple computational model of the right coronary artery on the beating heart--effects of the temporal change of curvature and torsion on the blood flow

A computational fluid dynamics study was conducted using a simplified model of the right coronary artery, which deforms with contraction of the heart. The right coronary artery was modeled using an ordinary helix, whose torsion and curvature changed in time with the contraction and dilatation of the heart which was modeled as a cylinder. In the computational result, the flow in the model right coronary artery was thought to be more affected by the change of the curvature compared to that of the torsion.     

A technique for unilateral instillation of agents into the rat lung

We describe a technique for unilateral instillation of agents into the right lung of rats. We intubated rats perorally with a 16-gauge flexible polyethylene catheter and through it introduced narrow-bore (less than 1 mm diam) polyethylene tubing into the trachea and beyond the carina into the right main-stem bronchus. This maneuver was facilitated by placing the animal supine with the cephalad end tilted up and the right side tilted down. We tested the effectiveness of our technique by instilling Evans blue dye into the right lung of 14 rats and spectrophotometrically quantitating the amount of dye present in homogenates from each lobe of the right and left lungs. Ninety-seven percent of the instilled dye was recovered from the right lung, and distribution of dye per gram of tissue was uniform among the four lobes. The technique described should be useful in producing severe degrees of unilateral lung injury and fibrosis in rodents without the high mortality that can be associated with bilateral lung injury.     

Effect of ectopic excitation on the ventricular pump function in chicken

The pump function of the heart ventricles was studied in chest-open anaesthetized adult female chickens under sinus rhythm and ectopic excitation of different localization. The intraventricular pressure in the right and left heart ventricles was measured by insertion of catheters through the ventricular free walls. Maximum systolic pressure, end-diastolic pressure, contractility (dP/dtmax) and relaxation (dP/dtmin) of both heart ventricles, and duration of the asynchronous contraction time of the left ventricle were analyzed. It was revealed that reduction of the pump function of the left ventricle tends to be greater under right ventricular ectopic excitation compared with left ventricular one. In comparison with the sinus rhythm, the pump function of the right ventricle was preserved to a greater extent under stimulation of the left ventricular apex and was significantly impaired under right ventricular ectopic excitation. Relaxation of both heart ventricles was more susceptible to ventricular ectopic excitation than contractility, and was more vulnerable in the right ventricle than in the left one. The direction of changes of the pump function of the heart ventricles in chickens under ventricular ectopic excitation was similar to changes of the pump function of mammalian hearts.