Ano-urethral fistula, a special type of anomaly: report of two cases

Two cases of an ano-urethral fistula, being a low malformation, are reported herein. Both patients underwent a colostomy under the diagnosis of a recto-urethral fistula during the neonatal period. As a urethro-rectogram later revealed the fistula to be located between the anus and anterior urethra, revision of the urethral fistula and an anoplasty were performed through the perineal approach. It is very difficult to establish a correct diagnosis of an ano-urethral fistula at the initial stage of treatment, but we found the urethro-rectogram invaluable in this regard. This type of malformation can be treated through the perineal approach, while the additional anterior perineal incision is very helpful for revising the urethral fistula.

The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer

We evaluated the relationship between the size of regional lymph nodes and the presence of metastasis in them in rectal cancer. Of 1,064 lymph nodes in 46 specimens, 133 (13%) were found to have metastases. A half of the positive nodes and most of the negative ones were less than 5 mm in diameter. Therefore, we must find lymph nodes smaller than 5 mm in diameter for assessment of lymph node metastasis. Although positive nodes were larger than negative ones, there was no significant difference. However, when comparing the size of lymph nodes in relation to their location, the epi- and pararectal lymph nodes larger than 10 mm in diameter were highly suggestive of metastases, but the size of the lymph node was not a reliable indicator of lymph node metastases in other situations.

Regulation of c-MYC protein expression in the developing rat cerebellum by phosphoinositide turnover

Using developing rat cerebellum, we examined the correlation between the turnover of phosphoinositide (PI) and c-myc expression. The 32P incorporation into polyphosphoinositides changed remarkably with advancing age. It reached a maximum value on PND 7, and then decreased gradually until PND 14. Immunostaining by anti-PIP2 antibody changed in parallel. The expression of c-myc mRNA was also changed developmentally, showing a peak on PND 7; whereas c-MYC protein expression showed a peak on PND 10. Together, these results suggest that c-myc expression is regulated by PI turnover during the early developing stage of rat cerebellum.

Increase in peak oxygen uptake by restoration of atrial contraction in patients after percutaneous transvenous mitral commissurotomy

The aim of the present study was to determine the effect of sinus conversion after mitral commissurotomy on the exercise performance of patients with mitral stenosis (MS) and atrial fibrillation (Af). Electric cardioversion was attempted 10 days after successful balloon mitral commissurotomy in 32 patients with MS and Af. Both symptom-limited exercise tests with respiratory gas analysis and constant workload exercise tests with echo-Doppler examinations were performed before, five days and three months after mitral commissurotomy, and five days after successful sinus conversion. The balloon commissurotomy attenuated the increase in transmitral pressure gradient during exercise. However, no significant increase either in peak oxygen uptake (PVO2) or stroke volume were observed even three months after commissurotomy in patients with persistent Af. Sinus conversion was successful in 17 patients and PVO2 increased from 21.4 +/- 4.1 to 23.4 +/- 4.0 ml/min/kg (p < 0.01). The extent of the increase in PVO2 was related to the atrial contribution in transmitral flow (R2 = 0.39, y = 0.81x + 1.2). Sinus rhythm was maintained for three months in 14 of 17 patients. Increased PVO2 was also preserved in these patients. These results suggest that the sinus conversion after mitral commissurotomy has an effect on the exercise performance of patients with MS and Af.

Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury

Recent experimental studies have demonstrated that mild hypothermia at about 34 degrees C can be effective in the control of intracranial hypertension. A randomized controlled study of mild hypothermia was carried out in 33 severely head-injured patients. All patients fulfilled the following criteria: 1) persistent intracranial pressure (ICP) greater than 20 mm Hg despite fluid restriction, hyperventilation, and high-dose barbiturate therapy; 2) an ICP lower than the mean arterial blood pressure; and 3) a Glasgow Coma Scale score of 8 or less. The patients were divided into two groups: one received mild hypothermia (16 patients) and one served as a control group (17 patients). Mild hypothermia significantly reduced the ICP and increased the cerebral perfusion pressure. Eight patients (50%) in the hypothermia group and three (18%) in the control group survived (p < 0.05), while five (31%) in the hypothermia group and 12 (71%) in the control group died of uncontrollable intracranial hypertension (p < 0.05). In five patients in the hypothermia group, cerebral blood flow was measured by the hydrogen clearance method and arteriojugular venous oxygen difference was evaluated before and during mild hypothermia. Mild hypothermia significantly decreased the cerebral blood flow, arteriojugular venous oxygen difference, and cerebral metabolic rate of oxygen (p < 0.01). The results of this preliminary investigation suggest that mild hypothermia is a safe and effective method to control traumatic intracranial hypertension and to improve mortality and morbidity rates.

Continuous Fick cardiac output measurement during exercise by monitoring of mixed venous oxygen saturation and oxygen uptake

To determine whether continuous Fick cardiac output measurement is applicable to exercise testing, cardiac output data obtained by the continuous Fick method (Qcf) during exercise were compared with data obtained by the thermodilution method (Qth). Seventeen patients with old myocardial infarction underwent a 1-min or 3-min incremental exercise test (protocols 1 and 2, respectively). During exercise, the oxygen consumption (VO2), arterial oxygen saturation (SaO2), and mixed venous oxygen saturation (SvO2) were monitored continuously. Qcf was calculated at 12-s intervals by the Fick equation. The SaO2 remained almost constant during exercise. The SvO2 showed four characteristic phases during exercise protocol 1. SvO2 values changed rapidly in phases 2 and 4, but only slightly during phase 3. In exercise protocol 2, SvO2 almost reached a steady-state by the end of each stage. The correlation between Qcf and Qth was good in protocol 1 (r = 0.86), except in phases 2 and 4, and was also good in protocol 2 (r = 0.80). We conclude that the continuous Fick method may be applicable for determining the cardiac output during exercise provided that the variation in SvO2 is slight.

Segmental transcatheter hepatic artery chemoembolization with iodized oil for hepatocellular carcinoma: antitumor effect and influence on normal tissue

PURPOSE

Segmental transcatheter arterial embolization (TAE) with use of iodized oil mixed with an anticancer drug, followed by injection of gelatin sponge particles, was undertaken to evaluate its antitumor effect and its influence on normal tissue in patients with hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

Histologic findings in 12 patients who underwent hepatectomy after segmental TAE were compared with findings on plain radiographs and computed tomographic (CT) scans. Visualization of the portal veins contiguous to the tumor on radiographs and the pattern of iodized oil accumulation in the tumor and vicinity on CT scans after TAE were assessed.

RESULTS

Complete necrosis of the tumor was achieved in 10 cases (83%), while complete necrosis of daughter nodules and capsular invasion was observed histologically in eight of these 10 patients (80%). The degree of tumor necrosis correlated with the pattern of iodized oil accumulation in and near the tumor. Partial necrosis of normal tissue near the tumor correlated with accumulation of iodized oil.

CONCLUSION

Segmental TAE may be an excellent therapeutic method for treatment of HCC that is localized in one or a few segmental or subsegmental regions.

Analysis of skin penetration enhancement based on a two-layer skin diffusion model with polar and nonpolar routes in the stratum corneum: dose-dependent effect of 1-geranylazacycloheptan-2-one on drugs with different lipophilicities

The effects of 1-geranylazacycloheptan-2-one (GACH) on the in vitro skin penetration of seven drugs with various lipophilicities were studied. The penetration of drugs from aqueous vehicle through the guinea pig skin was increased depending on the pretreatment dose of GACH. The largest enhancement was observed for 5-fluorouracil (5-FU) and a bell-shaped relationship was obtained between enhancement ratio and the octanol/water partition coefficients of drugs. Further, Laplace transformed equations for percutaneous absorption of drug were derived from Fick's second law based on a two-layer skin diffusion model with polar and nonpolar routes in the stratum corneum. Through curve-fitting of their equations to penetration profiles using a nonlinear regression program MULTI(FILT) combined with a fast inverse Laplace transform (FILT) algorithm, the action mechanism of GACH was discussed in terms of its effect on the partitioning and diffusivity of drugs in each domain. With an increase in pretreatment dose of GACH, the estimated partition parameters of drugs into the nonpolar route increased but their diffusivities were little affected. The analysis based on a linear free-energy relationship suggested that the increase in partitioning of drugs into the nonpolar route was explained by its increasing polarity with GACH pretreatment.

J5 prevents endotoxin shock in suckling rats

A sublethal dose of endotoxin (lipopolysaccharide: LPS) can induce endotoxin tolerance. It is not well known whether LPS feeding causes endotoxemia and endotoxin tolerance in the newborn. Since Rc mutant Escherichia coli LPS (J5) does not have toxic or lethal effects, J5 is used to induce endotoxin tolerance in this study. This study showed that both an intraperitoneal (ip) injection and feeding of Rc mutant Escherichia coli LPS (J5) induced endotoxin tolerance in suckling rats.

Deferoxamine prevents lipid peroxidation and attenuates reoxygenation injury in postischemic skeletal muscle

In the presence of the transition metal iron, superoxide anion and H2O2 generated on reperfusion of postichemic tissue combine to form hydroxyl radical, which readily attacks membrane-associated polyunsaturated fatty acids in a free radical process, resulting in lipid peroxidation. To evaluate whether iron chelation with deferoxamine interrupts this process in postischemic skeletal muscle, high-grade partial hindlimb ischemia was created in Sprague-Dawley rats by clamping the infrarenal aorta for 90 min, after which period the clamp was removed and flow was reestablished for 60 min. Lipid peroxidation in skeletal muscle was assessed by determination of tissue thiobarbituric acid-reactive substances (TBARS); membrane dysfunction was assessed by measurement of resting membrane potential (Em). Ischemia was accompanied by an increase in muscle TBARS and depolarization of resting Em. On reperfusion, muscle TBARS continued to increase, whereas resting Em remained depolarized. Pretreatment with deferoxamine prevented lipid peroxidation during ischemia but had no effect on resting Em. On reperfusion in the deferoxamine-treated animals, there was still no increase in muscle TBARS, and partial repolarization of resting Em was noted. It is concluded that 1) high-grade partial ischemia in skeletal muscle is accompanied by iron-dependent lipid peroxidation via a mechanism that persists and accelerates on reoxygenation, 2) lipid peroxidation impacts on functional membrane integrity during the reperfusion phase only, and 3) membrane injury accompanying ischemia and reperfusion may occur through fundamentally different mechanisms, of which only the latter is iron dependent.

Treatment of septic shock with a protease inhibitor in a canine model: a prospective, randomized, controlled trial

OBJECTIVES

To evaluate the efficacy and mechanism of action of a protease inhibitor (ulinastatin) in septic shock.

DESIGN

Prospective, randomized, controlled trial.

SETTING

A university laboratory.

SUBJECTS

Twelve mongrel dogs.

INTERVENTIONS

One of the protease inhibitors, ulinastatin, a glycoprotein (molecular weight 67,000 daltons) detected in human urine was estimated. We used Escherichia coli to obtain a model of septic shock in dogs in vivo study. Human neutrophils were used as an activating target in vitro.

MEASUREMENTS AND MAIN RESULTS

The final concentration of E. coli was 1.9 x 10(6) colony-forming units/mL. There was no significant difference in E. coli concentration between ulinastatin-treated and control groups. Human neutrophils treated with 100 U/mL of ulinastatin showed 70.5% to 78.7% of the superoxide production or untreated neutrophils. Phagocytic activity was enhanced in a dose-dependently manner by ulinastatin. At a ulinastatin concentration of 100 U/mL, an approximate two-fold increase in activation was found. In the ulinastatin-treated group, cardiac index, blood pressure, lactic acid, blood glucose, and blood base values significantly improved 60 mins after ulinastatin administration, and the bacterial count was significantly decreased, while the endotoxin concentration in the control group showed a continuous increase of endotoxin concentration. The improvement in the monitored factors observed 60 mins after initiation of treatment persisted after the end of treatment. The survival rate after 1 wk in the ulinastatin-treated group was 84% (five of six dogs survived), while it was 16% (one of six dogs survived) in the control group (p = .04).

CONCLUSIONS

Ulinastatin does not have antimicrobial activity, and it does not sufficiently activate phagocytes. It is suggested that the efficacy of this agent in experimental septic shock is due to a mechanism that activates the reticuloendothelial system and septic reactions.

Laterality of air volume in the lungs long after blunt chest trauma

To clarify a cause of the persistent decrease in lung capacity seen several years after blunt chest trauma, 17 patients with blunt chest trauma (10 with unilateral lung contusion, 7 with bilateral lung contusions; 11 of these with unilateral flail chest) inflicted 1 to 6 years previously and 10 normal volunteers (control) were studied. Lung air volumes (AV) were measured by spirometry (AVsp) and by computed tomographic (CT) scan (AVCT = AVCT.Rt+AVCT.Lt) under the same conditions. Hemithoracic spaces were also calculated by CT scan. The average AVsp in patients (76% +/- 8%) was lower than in the controls (98% +/- 5%). AVCT was consistent with AVsp in all the measurements. %AVCT.Rt and %AVCT.Lt, which were adjusted by the ratio of AVCT.Rt to AVCT.Lt in the controls, decreased significantly in unilateral contused lungs (71% +/- 8%). Fifty-eight percent of contused lungs showed small fibrous changes on the CT scans. The ratio of the hemithoracic space on the flail chest side to the opposite side was 0.95 +/- 0.05. These results suggest that the persistent decrease in AV long after blunt chest trauma might be caused by a constriction of contused lung resulting from fibrous changes.

[CO2US via an implantable port--drug distribution in intraarterial chemotherapy for hepatic tumors and evaluation of effect]

The distribution of blood flow was determined from the distribution of CO2 by US performed during the infusion of CO2 microbubbles via an implantable port (IP-CO2US) in intraarterial chemotherapy for hepatic tumor, and the usefulness of this method in determining tumor vascularity and evaluating the effects of therapy was investigated. A total of 16 patients, 12 of whom had metastatic liver tumor, two hepatocellular carcinoma, one gall bladder carcinoma, and one cholangiocellular carcinoma were studied. The enhanced areas in the liver in 16 patients in whom IP-CO2US was performed a total of 24 times were consistent in all cases with the enhanced areas demonstrated by IP-RI angiography performed a total of 10 times within 10 days, and were also consistent with one exception with the enhanced areas demonstrated by IP-CTA performed 14 times. The tumor detection rate was markedly higher with IP-CO2US than with plain US or IP-DSA, and was similar to that of IP-CTA. Evaluation of the vascularity of individual nodules by IP-CO2US surpassed that by IP-DSA, and was similar to that of IP-CTA. It was demonstrated that blood flow distribution (intrahepatic drug distribution) can be equally well grasped with IP-CO2US, which is a simple and convenient method, as with IP-RI angiography. It was also suggested that IP-CO2US is useful in the evaluation of tumor vascularity and the effect of therapy.

The clinical significance of regional variations in histologic differentiation within carcinomas of the colorectum

The clinical significance of the presence or absence of regional variations in histologic differentiation within a primary colorectal carcinoma was investigated in this study. Regional variations in histologic differentiation were judged to be present when the low power field of a microscope was occupied by cancer tissue cytologically and architecturally different from that of the surrounding area. Regional variations in histologic differentiation were noted in 153 (42%) of 368 primary carcinomas. Carcinomas with regional variations were of an anaplastic histologic type and had a higher incidence of lymph node metastasis and a worse prognosis than those without regional variations. Thus, the histologic diversity within a carcinoma is thought to be important for determining the prognosis of patients with colorectal cancer.

Immortalization of epithelial-like cells from human liver tissue with SV40 T-antigen gene

The cells derived from the human embryo liver tissue were transfected with a plasmid pSV3neo containing both the large and small T-antigen gene of the early region of simian virus 40 (SV40), and two cell strains, OUMS-21 and -22, were obtained. OUMS-22 cells, to date, have reached over 100 population doublings through a culture crisis and are considered to have become an immortal cell line. However, OUMS-21 cells failed to become an immortal cell line. Both OUMS-21 and -22 cells were SV40 T-antigen-positive, epithelial-like, and immunoreactive against an anti-keratin 18 monoclonal antibody but against neither an anti-vimentin nor an anti-von Willebrandt factor VIII monoclonal antibody. The staining pattern of cytokeratin in these cells was similar to that in the differentiated human hepatoblastoma and hepatocellular carcinoma cell lines but not to that in the human cholangiocellular carcinoma cell lines. OUMS-21 and -22 cells expressed neither alpha-fetoprotein nor albumin mRNAs. These cells showed no tyrosine aminotransferase activity. However, both OUMS-21 and -22 cells were sensitive to cytotoxicity of aflatoxin B1, 3-amino-1,4-dimethyl-5H-pyrido[4,3-b]indole, and benzo[a]pyrene, whereas human embryo lung fibroblasts were insensitive to the cytotoxicity of these carcinogens. These findings suggest that OUMS-21 and -22 cells may arise from undifferentiated liver stem cells or from hepatocytes that lost their ability to express the liver-specific functions prior to immortalization. Both OUMS-21 and -22 cells expressed glutathione S-transferase pi (GST-pi) mRNA. The expression of GST-pi mRNA highly increased in OUMS-22 cells with their immortalization. Karyotypic analysis showed that numerical and structural aberrations of the chromosomes were profound, but neither specific events nor marker chromosomes were found in OUMS-21 and -22 cells. Both OUMS-21 and -22 cells could grow in soft agar, but they were not tumorigenic when transplanted into nude mice.

Influence of ionic strength on crystal adsorption and inhibitory activity of macromolecules

We investigated the influence of ionic strength on both the binding ability of macromolecules onto calcium oxalate crystals and the inhibitory activity of macromolecules related to calcium oxalate crystal growth and aggregation in vitro. The amount of heparin sodium salt adsorbed onto calcium oxalate crystals was studied in both a seed and a non-seed crystal system at various ionic strengths with the aid of radiolabelled heparin. In both adsorption models, adsorption of heparin was greater in the buffered solutions of lower ionic strength, and significantly so in the range of physiological ionic strength. The inhibitory activity of heparin in the non-seed crystal system, which was determined using a Coulter Multisizer, increased as the adsorbed dose increased. The naturally existing urinary macromolecules showed a similar change in their inhibitory activity on calcium oxalate crystal growth and/or aggregation in accordance with changes in ionic strength. These results indicate that macromolecular inhibitory activity seems to be enhanced in urine of lower ionic strength as a result of an increased adsorption of macromolecules on the surface of calcium oxalate crystals.

Heparin sulfate in the stone matrix and its inhibitory effect on calcium oxalate crystallization

The nature of the soluble stone matrix and its possible role in urinary stone formation was studied. For this purpose we performed two-dimensional cellulose acetate membrane electrophoresis of the glycosaminoglycans (GAGs) which were contained in the soluble stone matrix, substances adsorbed onto calcium oxalate crystals in vitro (crystal surface binding substances, CSBS) and urinary macromolecules (UMMs). The main GAG in the soluble stone matrix and CSBS was found to be heparan sulfate, whereas the UMMs contained various GAGs usually seen in urine. An inhibition assay showed the soluble stone matrix to have the strongest inhibitory activity among these macromolecular substances when inhibitory activity was expressed in terms of uronic acid concentration. It is suggested that the main GAG in the soluble stone matrix consists of heparan sulfate, which has a strong inhibitory activity on calcium oxalate crystal growth and aggregation and constitutes part of the CSBS.

[The fat soluble vitamins in obstetrics and gynecology]

The therapeutic use of vitamin D in the OB-GYN field is well known for osteoporosis in the climacteric stage, and vitamin K is for the protection of neonatal hemorrhage. The therapeutic use of vitamin E was reviewed, and it was concluded that there was a large number of diseases for example, sterility, toxemia of pregnancy, IUGR, neonatal jaundice, climacteric syndrome, in which a therapeutic value for vitamin E could be clearly establish, vitamin K prophylaxis is also under taken for the neonate. This can be done by giving a dose to the mother just before or in the early stages of labor. Ubiquinone, was given to the man for the treatment of oligospermia. CoQ10 also warrants further investigation for the treatment of fetal arrhythmia in utero.

[The effect of long-term alkali therapy for recurrent calcium stone patients with distal renal tubular acidosis]

Alkali therapy is widely accepted as a treatment for recurrent calcium stone patients with distal renal tubular acidosis (dRTA). Nine patients, five with complete and four with incomplete type of dRTA, were treated with alkali agents for more than three years; an average period of 10.8 years. In five patients, new stone formation and stone growth were completely prevented by this treatment. Among the four failed cases, three did not take enough alkali agents (in spite of our medication), and the other had recurrent urinary tract infection resulting in infectious stone formation. In conclusion, the long-term efficacy of alkali therapy for prevention of recurrent stone formation with dRTA is confirmed when the patient takes enough alkali agents and the urinary tract infection is well controlled.

Formation of N-hydroxy-N-arylacetamides from nitroso aromatic compounds by the mammalian pyruvate dehydrogenase complex

Bovine, human and porcine heart mitochondria and isolated porcine heart pyruvate dehydrogenase complex (PDHC) pyruvate-dependently form N-hydroxy-N-arylacetamides from nitroso aromatic compounds, including carcinogenic 4-biphenyl and 2-fluorenyl derivatives. The PDHC-catalysed formation of N-hydroxyacetanilide (N-OH-AA) from nitrosobenzene (NOB), through a Ping Pong mechanism, is optimum at pH 6.8 and is accelerated by thiamin pyrophosphate, but is inhibited by thiamin thiazolone pyrophosphate and ATP. Km pyruvate in the reaction is independent of pH over the range tested, whereas KmNOB increases at lower pH, owing to ionization of an active-site functional group of pKa 6.3. The enzymic ionization decreases log (Vmax/KmNOB). Isolated pyruvate dehydrogenase (E1), a constitutive enzyme of PDHC, forms N-OH-AA by itself and has comparable kinetic parameters to those of the PDHC-catalysed N-OH-AA formation. The catalytic efficiency of PDHC in the formation of N-hydroxy-N-arylacylamides, due to the steric limitation of the active site of E1, is lowered both by bulky alkyl groups of alpha-oxo acids and by p-substituents (but not an o-substituent) on nitrosobenzenes. These nitroso compounds serve as electrophiles in the reaction in which the reductive acetylation step is rate-limiting. The reaction mechanism and other factors affecting N-hydroxy-N-arylacylamide formation are discussed.

Prominent telangiectasia associated with marked bleeding in CREST syndrome

A 64-year-old woman with CREST syndrome developed prominent telangiectases mimicking hereditary hemorrhagic telangiectasia (HHT) of Osler-Rendu-Weber. We have been following her since she first came to us with discrete telangiectatic mats and Raynaud's phenomenon 11 years ago. Telangiectatic lesions have been seen on her larynx and esophagus in addition to commonly affected sites. She has experienced spontaneous epistaxis and marked bleeding from the lesions on her lips, oral mucous membrane, and soles. This case illuminates new aspects of telangiectasia in CREST syndrome.

Recovery from postoperative hypothermia predicts survival in extensively burned patients

To clarify the cause of postoperative hypothermia in extensively burned patients, factors affecting postoperative hypothermia were studied in 16 extensively burned adult patients (8 survivors and 8 nonsurvivors) with a burn index greater than 35. Body temperature was monitored continuously in either the urinary bladder or rectum. Hypothermia of less than 35 degrees C occurred in 89% (66 of 74) of the total operations performed in these 16 patients. The rate of temperature rise (RTR) was significantly lower in nonsurvivors (0.4 +/- 0.2 degrees C/h) than in survivors (1.7 +/- 0.9 degrees C/h; p < 0.001). Continuous indirect calorimetry performed in seven patients (four survivors and three nonsurvivors) demonstrated that RTR was determined primarily by heat production. The measured energy expenditure reached only 1.7 +/- 0.2 times the basal energy expenditure during rewarming in nonsurvivors, whereas it was 2.7 +/- 0.9 times the basal energy expenditure in survivors (p < 0.01). Surprisingly, in nonsurvivors, the RTR was significantly decreased even during the first 2 weeks. These findings suggest that those who cannot generate heat well in postoperative hypothermia are unable to produce the additional energy required to overcome sepsis.

Application of a self-expanding metallic stent to a strictured esophagojejunostomy

We placed a Gianturco self-expanding metallic stent across the recurrent stricture of an esophagojejunostomy in a patient with gastric cancer. Though excellent passage of food resulted, intractable reflux occurred. Two months later the patient succumbed to recurrent tumor. At autopsy, the stent was patent and was partially covered by esophageal mucosa. There were narrow but deep ulcers around the stent hooks. The Gianturco metallic stent may provide an additional option for treating recurrent enteric strictures after other methods fail. Further refinements of the technique appear necessary.

Pulmonary hypertension due to tumor emboli: a report of three autopsy cases with morphological correlations to radiological findings

Three cases of pulmonary hypertension caused by tumor emboli to the lungs are described. Two of the three cases had a clinical diagnosis of pulmonary thromboembolism until surgical embolectomy, and the other had a diagnosis of primary pulmonary hypertension. Autopsy disclosed chondrosarcoma, choriocarcinoma and gastric cancer as the primary tumors, respectively. Pulmonary vascular obstruction due to tumor embolism leading to pulmonary hypertension is a previously rare clinical entity, and obstructed pulmonary vessels are believed to tend to be small vessels. We compared the autopsy and radiological findings and concluded that pulmonary tumor embolism involved not only the small peripheral arteries but also the segmental and/or lobar arteries.

Comparison of intrinsic connectivity in different areas of macaque monkey cerebral cortex

We have used small injections of biocytin to label and compare patterns of intraareal, laterally spreading projections of pyramidal neurons in a number of areas of macaque monkey cerebral cortex. In visual areas (V1, V2, and V4), somatosensory areas (3b, 1, and 2), and motor area 4, a punctate discontinuous pattern of connections is made from 200-microns-diameter biocytin injections in the superficial layers. In prefrontal cortex (areas 9 and 46), stripe-like connectivity patterns are observed. In all areas of cortex examined, the width of the terminal-free gaps is closely scaled to the average diameter of terminal patches, or width of terminal stripes. In addition, both patch and gap dimensions match the average lateral spread of the dendritic field of single pyramidal neurons in the superficial layers of the same cortical region. These architectural features of the connectional mosaics are constant despite a twofold difference in scale across cortical areas and different species. They therefore appear to be fundamental features of cortical organization. A model is offered in which local circuit inhibitory "basket" interneurons, activated at the same time as excitatory pyramidal neurons, could veto pyramidal neuron connections within either circular or stripe-like domains; this could lead to the formation of the pattern of lateral connections observed in this study, and provides a framework for further theoretical studies of cerebral cortex function.