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The effects were analysed of section of the superior ovarian nerve on compensatory ovulation and ovarian hypertrophy, in adult rats with the left or right ovaries extirpated during the oestrous cycle and autopsied 6 or 20 days later. Rats with hemiovariectomy or hemiovariectomy plus denervation recovered their oestrous cyclicity between 2 and 3 days after surgery. Six days after hemiovariectomy 14 out of 17 rats ovulated on the expected day of oestrus. All the animals were hemiovariectomized on the day of pro-oestrus. The mean ± s.e.m. number of ova shed was similar to the group of animals with both ovaries (7·8 ± 1·2 vs 9·5 ± 0·2 Compensatory ovarian hypertrophy was observed in the right ovary when left hemiovariectomy was performed on day 2 of dioestrus or pro-oestrus; similar results were observed in the left ovary when the right one was extirpated at oestrus or pro-oestrus. Section of the right superior ovarian nerve in left-hemiovariectomized rats caused a reduction in ovulation rate and number of ova released. Compensatory ovarian hypertrophy was modified in the opposite way by unilateral section of the superior ovarian nerve to the in situ ovary depending on the day of the cycle when hemiovariectomy was performed. Twenty days after treatment, ovulation rate, compensatory ovulation and ovarian hypertrophy were similar in both left- or right-hemiovariectomized rats. Compensatory ovarian hypertrophy increased in all animals with section of the superior ovarian nerve, except when hemiovariectomy was carried out at oestrus or the left ovary was extirpated on day 1 of dioestrus. The results suggest that modulation of compensatory ovarian hypertrophy by neural information arriving at the ovary by way of the superior ovarian nerve varies during the oestrous cycle. Journal of Endocrinology (1994) 140, 197–201

Background A coronary CT scan allows for non-invasive visualization of the anatomy of a coronary artery in three dimensions compared to the two dimensions afforded by conventional angiography. The septal artery, the main blood source of the interventricular septum, is usually derived from the left anterior descending artery; however, it is occasionally derived from the right coronary artery. Purpose To analyze the prevalence, origin, diameter, and length of the right superior septal artery (RSSA) demonstrated on a coronary CT scan. Material and Methods The right superior septal artery was retrospectively reviewed on the reconstructed axial scan images (0.5-mm thickness, 0.25-mm interval) in 1290 consecutive patients who underwent coronary CT scans. All patients were scanned on a 320-row CT scanner. The images were transferred to a workstation to trace the vessel to analyze the origin, diameter, and length. We also compared the length of the RSSA between patients with and without coronary artery stenosis. Results The RSSA was identified in 51 (3.9%) of 1290 patients. The origin was the proximal portion of the right coronary artery ( n = 40) or the right sinus of Valsalva ( n = 11). The artery co-existed with the conus artery in 15 (29%) of 51 patients. The length was 16–62 mm (mean 31.2 mm ± 10.5), and the diameter was 0.8–2.0 mm (mean 1.3 mm ± 0.2). Longer RSSAs tended to be demonstrated in the patients with coronary artery stenosis rather than with normal coronary arteries ( P < 0.05). Conclusion The right superior septal artery and its anatomical variant could be analyzed with a coronary CT scan. The ability to demonstrate this artery on the coronary CT scan was the same as with coronary angiography. The recognition of this vessel is useful for physicians managing with the diagnosis and treatment of the coronary artery disease.

Isolated persistent left superior caval vein is a rare anomaly of the systemic venous return. We describe an unsuccessful pacemaker implantation through the right subclavian vein, which later turned out to be due to a venous anomaly. This case and some other cases show that with the help of a multidetector computed tomography, an isolated persistent left superior caval vein is not a contraindication for subclavian approached pacemaker insertion.

A persistent right superior vena following extracardiac total cavopulmonary connection was occluded using a 0.052" Gianturco coil combined with a 3 Fr biopsy forceps. Controlled delivery of a 0.052" Gianturco coil is a safe and effective procedure to occlude a large anomalous vessel other than a large persistent arterial duct.

The cristal artery is an occasional finding, being visible in around 3% of coronary angiograms, arising from the proximal right coronary artery (RCA) and passing downwards and forwards through the muscle of the crista superventricularis. It supplies a variable volume of the superior interventricular septum, and can contribute to collateralization of the other septal vessels. When part or all of the left coronary artery (LCA) arises anomalously from the right coronary sinus, its passage to the left may be in the same pathway as a cristal artery, bearing a tell-tale septal vessel arising from its proximal segment. This helps to differentiate it from one that has a higher pathway, running between the great vessels, and which may have a greater correlation with sudden cardiac death.

In a combined voxel-based morphometry and functional magnetic resonance imaging study on the practice of mirror reading, we recently found a shift of activation from right superior parietal to right dorsal occipital cortex and a corresponding increase of gray matter. We interpreted this shift of activation and the corresponding structural changes as a shift from effortful visuospatial transformation to a more direct processing of mirrored words (Ilg et al., 2008). To test this hypothesis, we now analyzed brain activation patterns associated with different aspects of mirror reading. Activation at the dorsal occipital cortex and bilateral parietal cortex (dorsal visual stream) was related to inverse text processing, whereas activation of areas at the inferior and ventral occipitotemporal cortex (ventral visual stream) was associated with decoding of mirrored words. This indicates that the dichotomy of content-related ("what") and process-related ("where") higher visual functions also applies to mirror reading.

The relatively common persistent left superior caval vein (LSCV) is in most cases associated with doubling of the superior caval vein. A persistent LSCV with absent right superior caval vein (RSCV)—a rather rare event—was found during our course of gross anatomy. The LSCV drained into an enlarged coronary sinus, which was partly accompanied by an apparent “double” sinus of normal size draining into this enlarged coronary sinus. Histological and immunofluorescence studies using antibodies against smooth and cardiac muscle actins were performed. The terminal part of the LSCV near the opening into the right atrium contained cardiac actin as expected for a normal derivative of the left sinus horn. Previously only one case of doubled coronary sinus with LSCV has been reported and this abnormality was explained by splitting of the sinus. In our case, the partly doubled coronary sinus had the structure of coronary veins. Mechanical forces have been invoked for the obliteration of the LSCV. Therefore, we examined thirteen human embryos from 15 mm to 32 mm crown-rump length. In one embryo, we found a persistent LSCV together with an enormously enlarged left atrium. Contrary to previous suggestions our data indicate that during normal development a compression of the left anterior cardinal vein does not sufficiently explain the obliteration of the left and the persistence of the right vein. We therefore believe that beside a left dominated blood flow of head and arm, genes for left-right signaling may have to be taken into consideration. Clin. Anat. 23:277–286, 2010. © 2010 Wiley-Liss, Inc.

Atypical right and bilateral hemispheric activations in temporoparietal regions have been reported in individuals with dyslexia during nonword reading. We hypothesized similar aberrant activity would be evident during verbal and spatial working memory (WM) in individuals with dyslexia compared to controls as measured by MEG, suggesting inefficiencies in fundamental attentional processes necessary for reading. Nine controls and seven individuals with dyslexia underwent MEG to detect cortical activity during verbal and spatial working memory (VWM, SWM). Differential patterns of activation in acquired (AD) compared to developmental dyslexia (DD) were also examined in three 14-year-old males. Subject’s MEG field responses were measured to visual presentations of a series of upper case letters (verbal) or squares presented in one of twelve locations around an imaginary circle (spatial). Brain activity was analyzed with MR-FOCUSS [1]. Results revealed that VWM and SWM activated earlier in dyslexia compared to controls, particularly in superior frontal (SF) regions during VWM and temporal regions during SWM. Individuals with dyslexia demonstrated higher amplitudes of activation in left parahippocampal regions during VWM. Additionally, lower mean amplitudes were observed in dyslexia in right superior temporal regions and the right precentral gyrus during VWM. During SWM, controls demonstrated later activation in precentral and middle and inferior temporal regions. During SWM, higher normalized mean amplitudes were noted in right superior temporal regions in controls relative to dyslexia. Results of WM performance in DD compared to AD suggest more effortful processing in left temporal regions relative to right in individuals with DD possibly suggestive of neural reorganization in AD. Overall findings suggest that children and young adults with dyslexia display aberrant working memory systems which may result in fewer resources available for the maintenance of information during reading and other verbally mediated tasks.

We present findings of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect detected incidentally by CT pulmonary angiography. To our knowledge, there has been no previous case report with all of the above findings detected by CT. In addition to the radiological findings and their clinical significance, the anatomy and embryological explanation of each anomaly is discussed.

Purpose: To evaluate T2-relaxation changes in patients with minimal hepatic encephalopathy (MHE) using T2 relaxometry and to correlate T2 values with brain metabolites evaluated using 2D magnetic resonance spectroscopy (MRS). Materials and Methods: Eight MHE patients and 13 healthy subjects were evaluated using T2 relaxometry, and eight patients and nine healthy subjects underwent 2D MRS in right frontal and left occipital regions. Wholebrain T2-relaxation maps were compared between MHE and control subjects using analysis-of-covariance, with age and gender included as covariates. T2 values derived from the right frontal and left occipital lobes were correlated with the metabolite ratios. Results: Multiple brain regions including anterior and mid cingulate cortices, right anterior and left posterior insular cortices, right prefrontal, medial frontal, and right superior temporal cortices showed significantly increased T2 values in MHE patients compared to control subjects. MRS showed significantly increased ratios of glutamine/ glutamate (Glx) and decreased ratios of myo-inositol, taurine, choline, and myo-inositol/choline (mICh) with respect to creatine (Cr_d) in patients compared to controls. Frontal Glx/Cr_d showed significantly positive correlation with T2 values. Conclusion: MHE patients showed significantly increased T2 values in multiple brain regions reflecting increased free water content and T2 values in frontal lobe correlated with the increased Glx/Cr_d ratio.

Leiomyoma of the mediastinum is rare. We report a case of a 57-year-old woman with a cervical mass diving to the intrathoracic. Chest radiography and computed tomography revealed a mass in the right superior mediastinum. The tumor was enucleated by cervicotomy. Histologically, the tumor was diagnosed as leiomyoma.

A 54-year-old man who developed a left homonymous inferior quadrantanopia showed MRI findings of infarction of the proximal portion of the right superior optic radiations and high T2 signal along the entire distal course of the ipsilateral optic radiations consistent with Wallerian degeneration. Frequently reported in other settings, this imaging abnormality has rarely been described in anterior optic radiation lesions.

Isolated sacral fractures which occur by shear forces on the pelvic ring are seen less commonly and they are commonly transversely oriented. A 29-year-old Turkish female patient, who sat in front seat in the car, was unrestrained, and another car hit them from right front side of their vehicle. Physical examination revealed considerable tenderness over the right superior gluteal region and excruciating pain during sacral and iliac compression. There was no clear fracture line in her plain radiographs. CT revealed incomplete, zone I fracture located on the superior and anterior part of the first sacral vertebra. Type 1 lateral compression pelvic fractures are relatively common and they include impacted sacral and ipsilateral rami fractures. Only a few cases, related with the isolated sacral fracture, have been reported in the literature. To our knowledge, no isolated vertical zone I fracture of the first sacral vertebra which occurred with the lateral compression injury has been described previously. Fracture of the sacrum should be suspected in the presence of sacral pain and tenderness.

Spontaneous intraorbital arteriovenous fistulas are extremely rare. A 50-year-old man presented with progressive right blurred vision for 1 year and right proptosis for 2 months. He had no trauma history or family history of vascular disorders. Orbital MRI showed increased vascularity in the right orbital apex and bilateral dilated superior ophthalmic veins. Digital subtraction angiography of the carotid circulation demonstrated several small fistulas between the right ophthalmic artery and the right superior and inferior ophthalmic vein. He did not receive any intervention treatment for the intraorbital arteriovenous fistulas because of technical difficulty and high risk. His vision and symptoms gradually improved over a follow-up interval of 6 months. Patients with intraorbital arteriovenous fistulas without significant loss of visual function could be observed for spontaneous resolution.

Background: Pulmonary vein (PV) isolation is used for the treatment of atrial fibrillation (AF). Complex fractionated atrial electrogram (CFAE) mapping has been introduced to guide AF ablation. However, the spatial relationship between PV and CFAE is not well defined. Methods and Results: The study included 21 patients (mean age 57 ± 11 years, 17 men, 14 paroxysmal, two persistent, and five long-standing persistent AF) referred for PV isolation. Electrograms were sampled for 8 seconds at each site during stable AF (13 induced). High-frequency was defined as

A 62-year-old Chinese man was found to have a mass in the right superior orbit and mild fullness in right cavernous sinus associated with minimal proptosis. Carotid artery angiography revealed a vascular tumor in the superior orbit with supply from the internal and external carotid arteries. Selective embolization of the feeder vessel was performed before surgical excision of the tumor. Histopathologic examination with light microscopy and immunohistochemistry confirmed the tumor to have characteristics of a hemangioblastoma. Hemangioblastoma involving the orbit is exceedingly uncommon and to date only one such case has been documented in the literature.

The role of the sympathetic nervous system on cerebral blood flow (CBF) autoregulation was evaluated in newborn piglets. Six animals were studied after ablation of the right superior sympathetic ganglion and compared to 6 control animals. Mean arterial blood pressure (MABP) was decreased by successive blood withdrawal and CBF was measured by radioactive microspheres. In denervated animals, MABP and CBF correlated positively according to a parabolic curve showing an absence of autoregulation when MABP is above 50 mm Hg (y = 0.079x2 –– 5.9x + 154, p < 0.01). In control animals, CBF remains stable throughout the experiment (y = 0.28x + 5). These data suggest a shift to the left of the upper limit of the autoregulation range in denervated animals and consequently a poor adaptation to increased MABP.

Objective: To investigate alterations of regional cerebral blood flow (rCBF) in subjects with post-traumatic stress disorder (PTSD). Method: Using [99Tcm]-hexamethyl propylenamino oxime single photon emission computed tomography, the rCBF under resting condition was compared between 19 survivors of the Taegu subway fire with PTSD and 19 comparison subjects. Results: PTSD patients showed a decreased rCBF in the right thalamus and an increased rCBF in the right superior parietal lobe relative to comparison subjects (corrected P

The aim of the study was to determine the anatomy of intrinsic nerves supplying human pulmonary veins (PVs). Twenty-two hearts of human fetuses with full sets of PVs were examined using a histochemical method for acetylcholinesterase in order to stain transmurally intrinsic neural structures on non-sectioned PVs for subsequent stereomicroscopic examination. Findings of the study demonstrate that epicardiac nerve extensions from both the dorsal right atrial and the middle dorsal subplexuses reached the right superior as well as the right inferior PVs, whereas the left superior PV was supplied by nerve extensions from the left dorsal subplexus. The left and middle dorsal subplexuses contributed nerves to the left inferior PV. The ganglia related topographically to PVs were patchy in distribution. On the left and right superior PVs, 38+/-6 and 31+/-3 ganglia were found, respectively, whereas 46+/-7 and 38+/-7 ganglia were identified on the left and right inferior PVs. The size of ganglia was similar for all four veins, ranging in area from 0.004+/-0.0003 to 0.007+/-0.0004 mm(2). The total area of ganglia distributed on a given PV was similar, ranging from 0.15+/-0.0003 to 0.25+/-0.0004 mm(2). The present findings demonstrate that the richest ganglion sites supplying intrinsic nerves to the human PVs are located on the posterior sides of both inferior and the left superior PVs and, therefore, these sites may be considered primary targets for focal pulmonary vein ablation in catheter-based therapy of atrial fibrillation.

Daily-life decisions and judgments are often made “intuitively”, i.e., without an explicit explanation or verbal justification. We conceive of intuition as the capacity for an effortless evaluation of complex situations on the basis of information being activated, but at the moment of decision not being consciously retrieved. Little is known about which neural processes mediate intuitive judgments and whether these are distinct from those neural processes underlying explicit judgments. Employing functional magnetic resonance imaging (fMRI) we show that intuitive compared to explicit judgments in a semantic coherence judgment task are associated with increased neural activity in heteromodal association areas in bilateral inferior parietal and right superior temporal cortex. These results indicate that intuitive coherence judgments activate neural systems that are involved in the integration of remote associates into a coherent representation and, thus, support the assumption that intuitive judgments are based on an activation of widespread semantic networks sparing a conscious representation.

Picture A. Chest CT scan showing a right superior paravertebral mass, irregular nodular thick-ening of the right pleura, and mediastinal lymphadenopathy.Picture B. Section from the pleural tumor showing mesothelioma composed of epithelioid cells with psammoma bodies (B1) and spindle-like cells (B2) (HE stain).

Introduction Little is known about the structural abnormalities underlying generalized anxiety disorder (GAD). However, there is evidence of larger volumes of dorsomedial prefrontal cortex (Schienle et al, 2011). Also, increased n-acetyl-aspartate in right dorsolateral prefrontal cortex (DLPFC) (Mathew et al, 2004), and hyperactivation in right middle frontal to negative stimuli have been shown in GAD (Blair et al, 2008). Objectives To investigate variations in cortical thickness (CT) in GAD patients versus healthy controls (HCs). Aims GAD patients and matched HCs underwent a 3T magnetic resonance imaging (MRI) session. Methods Structural MRI was acquired from 24 DSM-IV GAD patients (age=41±13.9) and 23 HCs (age=39±13.4). CT was estimated using Freesurfer5.3 (Fischl and Dale, 2000). Results were manually corrected if necessary. We considered 21 regions of interest (ROIs) per hemisphere (4 cingulate, 6 frontal, 3 parietal, 5 temporal, 1 occipital, entorhinal, insula), for each of which a mean CT value was calculated. A t-test was performed for each region, correcting results for multiple comparisons. Results The groups were statistically homogeneous in terms of age, gender, handedness, and IQ (p>0.05). Though ROI volumes were preserved in GAD (p>0,05; Bonferroni corrected), a significantly reduced CT was found in right caudal middle (t(46)=3.621, p=0.015) and right superior frontal (t(46)=3.215, p=0.049) regions. Conclusions The found decreased CT in GAD patients compared to HCs in superior frontal and caudal middle areas (right side) sustains prior neuroimaging findings showing abnormalities in prefrontal cortex. Reduced right frontal CT may be involved in cognitive dysfunction and symptomatology of the disorder.

Atrial fibrillation (AF), which is called as a global epidemic disease, frequently found in hypertensive patients with left ventricular hypertrophy (LVH). Pulmonary vein (PV), which is known to have an important role in AF initiation and maintenance, increases in its diameter during AF. We sought to investigate PVs diameter changes in LVH with sinus rhythm. Of 70 hypertensive patients with sinus rhythm, 42 subjects demonstrated LVH. The mean ostial diameter of patient with and without LVH, assessed by doing spiral multisliced CT scan in the axial plane, were as follow: right superior (RSPV) of 19.6±2.78 vs 17.8±1.93 (p = 0.003), right inferior (RIPV) of 18.4±3.12 vs 16.0±2.19 (p < 0.001), left superior (LSPV) of 18.1±2.62 vs 16.0±2.16 (p < 0.001), and left inferior (LIPV) of 15.9±1.93 vs 15.4±1.85 mm (p = 0.284), respectively. Even during sinus rhythm, LVH causes PV dilation. This result might give an explanation of frequent AF prevalence in hypertensive patients. (Med J Indones 2006; 15:173-6) Keywords: Pulmonary veins, Left ventricular hypertrophy

Using the ER-fMRI technique, the present study was designed to investigate the neural substrates of language switching among second-language learners. Twelve Chinese college students who were learning English were scanned when they performed language switching tasks (naming pictures in their first [L1, Chinese] and second [L2, English] languages according to response cues). Compared to non-switching conditions, language switching elicited greater activation in the right superior prefrontal cortex (BA9/10/32), left middle and superior frontal cortex (BA8/9/46), and right middle cingulum and caudate (BA11). When the direction of switching was considered, forward switching (from L1 to L2), but not backward switching (from L2 to L1), activated several brain regions related to executive functions (i.e., bilateral frontal cortices and left ACC) relative to non-switching conditions. These results suggest that neural correlates of language switching differ depending on the direction of the switch and that there does not seem to be a specific brain area acting as a "language switch". © 2006.

Subperiosteal orbital hemorrhage (SPOH) following cardiac surgery has not been previously reported. We present a patient who developed diplopia and right eye proptosis immediately after cardiac surgery for a mitral valve repair and coronary artery bypass graft. A computed tomography (CT) study demonstrated a right superior SPOH. The diplopia and proptosis resolved spontaneously within 4 weeks. Follow-up CT showed complete resolution of the SPOH.

Despite the vast literature that has implicated asymmetric activation of the prefrontal cortex in approach-withdrawal motivation and emotion, no published reports have directly explored the neural correlates of well-being. Eighty-four right-handed adults (ages 57–60) completed self-report measures of eudaimonic well-being, hedonic well-being, and positive affect prior to resting electroencephalography. As hypothesized, greater left than right superior frontal activation was associated with higher levels of both forms of well-being. Hemisphere-specific analyses documented the importance of goal-directed approach tendencies beyond those captured by approach-related positive affect for eudaimonic but not for hedonic well-being. Appropriately engaging sources of appetitive motivation, characteristic of higher left than right baseline levels of prefrontal activation, may encourage the experience of well-being.

Aims Pulmonary vein (PV) isolation is a curative treatment for patients with atrial fibrillation. The aim of this study was to evaluate prospectively the effects of adenosine administration on the PV activity and atrio-venous conduction after PV isolation. Methods and results Twenty-nine patients (21 m; age: 55±8 years) were submitted to ostial PV isolation guided by basket catheter recordings. After successful isolation, the effects of a 12 mg intravenous bolus of adenosine were tested in 62 PVs. In 22/62 PVs (35%), left atrium (LA)-to-PV conduction was transiently (16.6±7.1 s, range: 3.8–27.9 s) or permanently (3 PVs) restored in response to adenosine administration. The prevalence of this phenomenon was 39% in left superior PVs, 43% in right superior PVs, and 22% in left inferior PVs ( p =0.365). It occurred more frequently in the presence of dissociated PV activity (11/15 PVs, 73% vs. 11/47 PVs, 23%; p =0.002), whereas it was not influenced by the median duration of the radiofrequency current (RFC) delivery for each PV [19 (IQR: 12–26) min vs. 16 (IQR: 11–24) min: p =0.636]. A lengthening or shortening of the LA-PV conduction time was observed at LA-PV conduction appearance and disappearance in 36% and 55% of the cases, respectively. Further RFC applications (median: 5.5 min, IQR: 4–11 min) at the residual conduction breakthrough(s) indicated by the basket catheter recordings definitively eliminated adenosine-induced recovery of LA-PV conduction in all cases. Finally, when present, intrinsic PV discharge was invariably depressed by adenosine administration. Conclusions Adenosine may transiently or permanently re-establish LA-PV conduction after apparently successful PV isolation. This phenomenon is abolished by additional RFC delivery. However, its possible influence on the clinical results of PV ablation must be evaluated by properly designed, randomized studies.

Una mujer de 75 años ingresó en nuestro hospital para evaluación de debilidad en miembros inferiores y deterioro. Se detectaron múltiples fracturas vertebrales por aplastamiento, con dudosa discitis, una lesión cavitada en lóbulo superior derecho y otro infiltrado en lóbulo superior izquierdo, observándose en la PAAF de la lesión cavitada un hongo filamentoso y siendo el cultivo del broncoaspirado positivo para Aspergillus terreus. Con tratamiento prolongado con anfotericina B liposomal desapareció la lesión, permaneciendo posteriormente con itraconazol oral 3 meses. Los datos clínicos y analíticos demuestran la existencia de una colagenosis tipo síndrome Overlap, con criterios de síndrome antifosfolípido secundario. Se comenta la rareza de la infección por Aspergillus terreus en pacientes que no han ingresado en Medicina Intensiva y la buena respuesta al tratamiento con anfotericina B liposomal, que contrasta con la elevada mortalidad referida en una revisión reciente. Otros aspectos a comentar son la coexistencia con una colagenosis y un síndrome antifosfolípido secundario con los títulos más elevados de ACA IgM que hemos encontrado en la literatura.

Mental rotation is the most distinctly specialized operation of the imagination, one characterized precisely enough psychophysically for parametric study, thereby making it an optimal prospect for isolating and modeling its neural mechanisms. New human brain mapping studies using direct cortical stimulation and repetitive transcranial magnetic stimulation isolate an area in right superior parietal cortex that appears to be crucial for the mental rotation of objects, but not to the mental rotation of one's body.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained clinical arrhythmia. Myocardial sleeves onto pulmonary veins (PVs) have been recognized as a frequent site of origin of focal triggers for this arrhythmia. Expression of Leu-7 has been hypothesized to correspond with abnormal atrial automaticity.OBJECTIVE: To evaluate a possible role of the Leu-7 immunoreactivity in AF patients, we studied Leu-7 expression in myocardial sleeves.METHODS: Leu-7 was studied immunohistochemically in paraffin-embedded specimens from 55 human autopsied hearts (mean age 69 years, range 42-94 years, 34 males, 21 females). Twenty-two of the subjects had previous history of AF.RESULTS: Myocardial sleeves were found in 151 out of a total number of 220 PVs (68.6%). Leu-7 granular cytoplasmatic positivity was observed in 15 (9.9%) PVs from 12 different hearts: 6 (15.4%) in the right superior, 4 (10.2%) in the right inferior, 4 (10.8%) in the left superior and 1 (2.7%) in the left inferior PV. This finding was revealed both in patients with and without the history of AF.CONCLUSIONS: Leu-7 positivity, hypothesized to correspond with abnormal atrial automaticity, can be detected in some myocardial sleeves around PVs. However, no statistical relationship to previous history of AF was found.

Ectopic beats originating from sleeves of atrial tissue within the pulmonary veins (PVs) can induce and sustain paroxysmal atrial fibrillation (AF). Left atrial stretch and dilatation favors the development of atrial ectopy and AF. Similarly, PV dilatation, if present, might trigger PV ectopy in patients with AF. This study was designed to evaluate whether PV dilatation is present in patients with nonfocal AF and whether the PV diameter correlates to the left atrial diameter (LAD). The diameters of the right superior (RSPV) and left superior PV (LSPV) were measured at the ostium and at a depth of 1 cm in 170 patients (AF, n = 75; sinus rhythm [SR], n = 95) using transesophageal echocardiography. The LAD was determined by transthoracic echocardiography. The diameters of the PVs were significantly larger in patients with AF than in patients with SR (LSPV(ostium): AF 13.6 +/- 3.5 mm vs SR 10.6 +/- 2.7 mm, P < 0.001; LSVP(1cm): AF 12.5 +/- 2.9 mm vs SR 10.2 +/- 2.5 mm, P < 0.001; RSPV(ostium): AF 13.9 +/- 3.5 mm vs SR 11.7 +/- 2.9 mm, P < 0.001; RSVP(1cm): AF 12.8 +/- 2.8 mm vs SR 10.6 +/- 2.6 mm, P < 0.05). Similarly, LAD was larger in patients with AF (44.7 +/- 7.7 mm) as compared to patients with SR (38.8 +/- 6.8 mm, P < 0.001). Neither for the SR nor the AF group did the PV size correlate to the LAD. AF is associated with a significant enlargement of the RSPV, LSPV, and LAD. There is no correlation between LAD and PV diameters. This raises the question whether PV dilatation in patients with AF is a cause or a consequence of AF and whether it may contribute to the development and perpetuation of AF.

Background Parathyroid double adenomas are reported to occur in 3% to 12% of cases of primary hyperparathyroidism, but the very existence of double adenomas has been controversial. This study was undertaken to evaluate the clinical significance and anatomic distribution of parathyroid double adenomas. Study design The medical records of 384 consecutive patients who underwent operation for primary hyperparathyroidism were reviewed. Results A total of 27 patients (7%) were found to have double parathyroid adenomas. Intraoperative parathyroid hormone (PTH) levels were measured in each case. Two enlarged hypercellular parathyroid glands were identified in 6 possible configurations: 10 both superior, 3 both inferior, 5 both right, 3 both left, 5 right superior and left inferior, and 1 left superior and right inferior. There was preferential distribution to the bilateral superior position (p = 0.008). In all patients intraoperative PTH levels dropped by at least 50% from baseline and into the normal range after removal of both abnormal parathyroid glands. All patients remain normocalcemic 1 to 26 months postoperatively. Two patients have persistently elevated PTH values with normal serum calcium levels. Conclusions The drop in intraoperative PTH levels and maintenance of normocalcemia postoperatively confirm previous reports that double adenomas do exist and are not simply missed cases of four-gland hyperplasia. Their incidence is more than would be expected by chance alone. The preferential occurrence of bilateral superior double adenomas suggests the possibility that these may represent hyperplasia of parathyroids arising from the fourth branchial pouch rather than isolated neoplastic events.

We developed a rat model of pulmonary arteriovenous malformations after cavopulmonary anastomosis. We sought to determine whether this model reproduces the angiographic and histologic features seen in the human condition. Eight Sprague-Dawley rats underwent a right superior cavopulmonary anastomosis with the use of microsurgical techniques. Between 2 and 13 mo, pulmonary angiography was performed, the animals were euthanized, and the lungs were removed. Microscopic sections of the lung were stained with an endothelial-specific antibody (von Willebrand factor). Microvessel density was determined by counting vessels staining positively for von Willebrand factor, and the shunted and nonshunted (control) lungs were compared for each animal. Pulmonary angiography revealed time-dependent development of arteriovenous malformations. Microvessel density demonstrated a time-dependent increase in the shunted lung compared with the control lung (simple linear regression of the ratio of the microvessel density of the shunted lung divided by the microvessel density of the control lung on time; R 2 = 0.79, P = 0.003). This animal model reproduces the same angiographic and microscopic features of pulmonary arteriovenous malformations that develop in humans after cavopulmonary anastomosis. This appears to be a valid model that may be used to further study etiologic mechanisms for this phenomenon.

Dissociated Pulmonary Vein Rhythms. During segmental isolation of the pulmonary veins (PVs) in a patient with paroxysmal atrial fibrillation, there was a PV bradycardia that was dissociated from the left atrium in a segment of the right superior PV, whereas the remaining segments showed passive activation of a PV fascicle during sinus rhythm. Rapid atrial pacing induced a PV tachycardia in the nonisolated fascicles, and the dissociated PV bradycardia persisted in a segment of the same PV. These observations indicate that PV fascicles are insulated from each other and that a dissociated PV rhythm does not necessarily indicate complete isolation of a PV.

Many anatomic variants of the hepatic artery have been reported [1–5]. Hiatt et al. [5] studied hepatic arterial patterns in 1000 cases of donor livers, and classified them into six patterns. The hepatic arteries originated from the common hepatic artery in 75%; however, about 22% had a replaced or accessory hepatic artery. Michels et al. [6] divided aberrant arteries into two categories: an “accessory” artery and a “replaced” artery. The replaced right hepatic artery is seen primarily to branch from the superior mesenteric artery (SMA), with the incidence of this anomaly being about 17% [1]. Total replacement of the right hepatic artery occurs in about 12%, and partial replacement in about 5% [1]. Recently, during CT arteriography we encountered a case of a replaced right superior subsegmental artery originating from the right inferior adrenal artery, which was confirmed by conventional arteriography. To our knowledge, this type of hepatic arterial anomaly is very rare and has not been reported previously.

Evidence of pressure on the neck forms a spectrum of degree from minimal to marked. We report a case of fatal pressure on the neck with minimal external signs. A 27 year old woman was found dead in her home. A blood stained knife and a blood stained bathrobe belt with hair entangled in it were discovered at the scene. Autopsy revealed a stab injury to the chest extending to the right lung and multiple contusions to the head, face and extremities. There were petechial haemorrhages on bilateral eyelids and conjunctivae. There were 2 small contusions on the front of the neck. Special neck dissection revealed a small haemorrhage in the sternocleidomastoid muscle and a haemorrhagic fracture of the right superior horn of the thyroid cartilage. Cause of death was given as pressure on the neck in a woman with stab injury to the right chest. Petechial haemorrhages play a major role in confirming the cause of death when there is minimal evidence for application of pressure on the neck. DOI: http://dx.doi.org/10.4038/mljsl.v1i1.72 75 Medico-Legal Journal of Sri Lanka 2011; 1(1), Jan-April : 46-48

Background The relationship between focal pulmonary vein potential and atrial fibrillation (AF) has been confirmed. Pulmonary vein (PV) isolation and circumferential pulmonary vein ablation have been the most commonly used procedures of radiofrequency ablation. However, few studies have investigated the relationship between anatomical characteristics of PV and AF recurrences after radiofrequency ablation. Methodology For 267 AF patients treated by radiofrequency catheter ablation, the anatomic structure characteristics of pulmonary veins were assessed by multi-slice spiral computed tomography while the values of left atrial diameter (LAD) were measured with transesophageal ultrasonic cardiogram. After radiofrequency catheter ablation, postoperative recurrence was evaluated during a 10-month term follow-up. Principal Findings During follow-up, postoperative recurrence occurred in 44 patients. The mean diameters of LAD, left superior PV, right superior PV, all left PV, and all superior PV were significantly larger in patients with postoperative recurrence (Recurrence vs. Non-recurrence group; 43.9 ± 6.4 mm vs. 40.7 ± 5.6 mm; 18.4 ± 2.1 mm vs. 17.1 ± 3.1 mm; 18.2 ± 2.8 mm vs. 17.2 mm ± 3.9 mm; 16.4 ± 1.5 mm vs. 15.6 ± 2.5 mm; 18.3 ± 2.1 mm vs. 17.1 ± 3.0 mm; respectively; all P < 0.05). Multivariable survival analysis showed that the type and the course of AF, LAD, and the diameters of all superior PV were the independent risk factors for the postoperative recurrence after radiofrequency catheter ablation. Conclusions The enlargements of all superior PV and LAD, long course of diseases, and persistent AF were the independent risk factors for the postoperative recurrence after radiofrequency catheter ablation.

Persistent left superior vena cava with coexisting absent right superior vena cavn is rare with less than 150 cases in the literature. Various techniques for pacemaker implantation have been described in this situation. We report a 40-year-old man with sinus and atrioventriciilar nodal dysfunction who underwent dual chamber pacemaker implantation. We elected to implant the ventricular electrode down a left ventricular branch of the coronary sinus and the lead is stable at 4-month follow-up.

Absence of the right superior caval vein has been shown by postmortem studies of infants and children to be associated with histological abnormalities of the sinus node. We report the case of a 32-yr-old man who presented with syncope due to disease of the sinus node and was found to have absence of the right superior caval vein. He was successfully managed with implantation of an epicardial atrioventricular sequential pacemaker.

This study was performed to classify and assess the frequency of accessory fissures of the lung by high-resolution CT (HRCT) scans. The HRCT scans of 443 patients were retrospectively reviewed. After exclusion of patients with pulmonary parenchymal distortion, pleural disease or those who had had lobectomy, 186 patients were included in the study. The HRCT scans consisted of 1.5-mm sections obtained at 10-mm intervals and reconstructed with a high-spatial-resolution algorithm. In 59 of 186 patients (32%), a total of 69 accessory fissures were detected. The most common fissure was the inferior accessory fissure ( n=40; 21%, 38 on the right, 2 on the left) followed by the left minor fissure ( n=17; 9%). Other accessory fissures observed were the right superior accessory fissure ( n=2; 1%), the azygos fissure ( n=1; 0.5%) and intersegmental fissures between the medial and lateral segments of the right middle lobe ( n=3; 2%), the superior and inferior segments of the lingula ( n=2; 1%), the anterobasal and laterobasal segments of both the right ( n=1; 0.5%) and the left ( n=3; 2%) lower lobe. In conclusion, the inferior accessory fissure and the left minor fissure were the most common accessory fissures seen on HRCT examinations.

PET was used to test the hypothesis that similar neural systems are involved in attending to spectral and to spatial features of sounds. In each of four conditions subjects heard tones varying randomly in frequency and location and responded to either the low- or the high-frequency stimuli, ignoring location, or to stimuli on the left or right, ignoring frequency. In comparison to a silent baseline, CBF increases were observed in auditory cortex bilaterally and in the right superior parietal, right dorsolateral frontal, and right premotor regions, with no modulation as a function of attentional condition. Analysis of regional covariation indicated a coordinated CBF response between the right parietal region and the right frontal and middle temporal regions. The data imply that auditory attention engages a network of right-hemisphere cortical regions for both spatial location and tonal frequency and support a model whereby auditory attention operates at a level at which separate features have been integrated into a unitary representation.

Arteriovenous malformation (AVM) in a 22-year-old Japanese female is reported. The malformation presented as a nontender, pulsating tumor. An area of marked hypervascularity was revealed in the dermis and muscles of the right buttock by arteriography. The tumor was removed after embolizing the right superior and inferior gluteal arteries, which were the main feeding arteries. Histological examination revealed a number of artery-like vessels, encircled by proliferating capillaries. Follow-up three years after excision showed no clinically remarkable changes. Selective embolization was useful for the excision.

Purpose: The Achieve inner lumen mapping catheter can be used with the cryoballoon to assess real-time isolation of pulmonary vein (PV) during cryoablation and to act as a supporting guidewire during balloon positioning. We sought to analyze the feasibility of this novel catheter and to assess real-time PV isolation during cryoablation. Methods: Patients undergoing 28-mm cryoballoon PVI using the Achieve catheter were included from two centers. Each application lasted 5 min. Real-time PV recording during freezing and time to PV isolation were analyzed. Lastly, the number of applications needed to achieve PV isolation was investigated. Results: 68 pts (47 male; 61±10 yo) were included. Averaged procedure duration and fluoroscopy times were 118±24 min and 29±10 min. During the first application, PV potentials could be detected during freezing in 95.2%, 75.0%, 81.5% and 31.2% of the left superior (LSPV), left inferior (LIPV), right superior (RSPV) and right inferior (RIPV) PVs, respectively. When PV potentials were detected, they appeared in 5±2, 4±2, 4±2, and 3±2 dipoles in and the first cryoenergy application was successful in 68.7%, 82.8%, 80.0% and 90.6% of the LSPVs, LIPVs, RSPVs, and RIPVs, respectively. PV deconnection occurred at -38.4±8.8°C/54.5±34.8sec, -33.3±10.5/46.9±30.4sec, -34.4±12.1/44.4±30.5sec and –37.4±18.0/52.7±27.1sec for the the LSPVs, LIPVs, RSPVs, and RIPVs, respectively. At the end of the procedure, 100% of the PVs were isolated after 1.2±0.6 applications (from 1 to 4). ![Figure][1] Conclusion: Cryoablation in conjunction with the novel Achieve catheter is feasible, leading to high acute PV isolation rates. Real-time PV recording during freezing can be performed in most of the left PVs and the RSPVs while recording of RIPV potentials is harder due to stability issues. [1]: pending:yes

During routine dissection of an 89-year-old female donor both inferior thyroid aa. as well as the left superior thyroid a. were found to be absent, whereas the right superior thyroid a. came from the right common carotid. A large lowest thyroid a. rose from the left internal thoracic a. at the level of the first intercostal space. Up to this point the internal thoracic a. was of immense diameter, almost reaching that of the lateral part of the subclavian. The lowest thyroid a. ascended in an oblique and sigmoid course to the thyroid gland. Slightly left of the median line it bifurcated into two branches. Both had a winding course in front of the trachea before entering the base of the thyroid gland. Other arterial variations of minor significance were also observed in this unique case. The clinical impact lies in the localisation, course and size of the lowest thyroid a. reported.

Though extremely rare, it is worthwhile to keep this anomaly in mind while dealing with a cyanotic patient. Surgical correction is indicated to prevent the complications of chronic cyanosis and risks of systemic embolization. Operative treatment is associated with low risk and long term prognosis good with early correction.

We describe proptosis due to a subperiosteal orbital hematoma that originated from a subgaleal bleed caused by hair pulling. A 13-year-old boy presented with a one-week history of progressive proptosis after his older sister pulled his hair during an argument. Computerized tomography showed a subgaleal hematoma and a right superior subperiosteal orbital hematoma. Progressive proptosis and compressive optic neuropathy developed, necessitating surgical evacuation with a favorable outcome.Hair pulling can result in a subgaleal bleed with extension to the orbital subperiosteal space. When managing patients with a subgaleal hematoma, this vision-threatening complication should be considered and treated accordingly.

Neurophysiology and neuroimaging research implicates distinct regions of posterior parietal cortex for reaching versus grasping and for completing these movements in central versus peripheral space. Typically, visuomotor tasks only examine movements made in the frontoparallel plane. We examined a patient with a right superior parietal lesion encompassing the parietal-occipital junction, the intraparietal sulcus and the putative human homologue of V6A on pointing tasks in the sagittal or frontoparallel planes. The patient did not demonstrate a speed-accuracy trade-off, but did show larger times post-peak velocity for all movement directions. Her movements in the sagittal axis were more disordered than movements in the frontoparallel plane. These data indicate a role for superior parietal cortex in fine tuning of visually guided movements and more particularly for movements made back towards the body.

• Positron emission tomography and 18-F-fluorodeoxyglucose were used to study resting cerebral glucose metabolism in 10 adult women with trichotillomania and 20 agematched female controls. As a group, the patients with trichotillomania showed significantly increased global (mean gray matter) and normalized right and left cerebellar and right superior parietal glucose metabolic rates. Contrary to expectation, this pattern differed from that seen in our previous investigation of obsessive-compulsive disorder. Clomipramine hydrochloride—induced improvement was negatively correlated with anterior cingulate and orbital frontal metabolism, of particular interest because similar results had been obtained for obsessive-compulsive disorder.