Search

Doerr's theory of the morphogenesis of transposition is discussed with special reference to recent studies by Goor and co-workers and Anderson and associates. The views advanced by all these authors coincide in three points: (a) the description of the reorganisation process occurring at the arterial end of the embryonic heart (a process called by Doerr vectorial bulbus rotation); (b) the pathogenetic interpretation of transposition as the result of an arrest of vectorial bulbus rotation; (c) the recognition of a teratological series or spectrum of anomalies pathogenetically related to transposition. Vectorial bulbus rotation is explained mainly as the result of three largely simultaneous events; bulbar shift, bulbus torsion, and truncus torsion. The spectrum of anomalies related to transposition appears as a close-knit series. Bulbar retraction does not seem to be a necessary condition for the connection of the aorta to the left ventricle. [ABSTRACT FROM PUBLISHER]

The echocardiographic identification of cardiac tumors as cause of embolic episodes is infrequent, and the finding of multiple papillary fibroelastoma is even less common. We report a 70 years old female with a history of a rheumatic mitral valve lesion, subjected to a commissurotomy in 1970. She was admitted with a cerebrovascular accident and the transesophageal echocardiogram revealed the presence of a multiple papillary fibroelastoma in the aortic valve. The patient was operated and the tumor excised, the pathological analysis confirmed the diagnosis. The patient was discharged in good conditions and after 8 months of follow up, she has no neurological abnormality and is in functional class I.

The histological features of resolving acute appendicitis are described. Formalin-fixed, paraffin-embedded appendices of 200 cases with acute, non-complicated phlegmonous appendicitis were reviewed. In 80 out of 200 cases, a histological picture characterized by a predominantly lymphocytic infiltrate of the subserosa and muscularis propria or the subserosa alone was found. In the affected muscularis propria, eosinophils were admixed with lymphocytes, and the cellular infiltrate showed a lesser degree than that of the classic phlegmonous appendicitis. A multifocal, rather than a diffuse pattern of infiltration was observed. Cases were divided into three groups. Group 1: appendices with the typical features of phlegmonous appendicitis: 120 cases, 60%. Group 2: appendices with a predominantly lymphocytic infiltrate in the muscularis propria, subserosa, or both, and no granulation tissue: 65 cases, 32.5%. Group 3: appendices with granulation tissue: 15 cases, 7.5%. Complicated appendicitis was excluded. Data on the duration of the clinical symptoms were derived from the clinical history. The differences between the mean duration time of groups 1 and 2, and of groups 2 and 3 were statistically significant. The findings support the contention that a mixed infiltrate of lymphocytes and eosinophils represents a regression phase of acute appendicitis.

Salivary gland lesions are uncommon in children and may be related to the parotid, submandibular or sublingual glands. Inflammatory lesions are the most common cause of salivary gland abnormalities in children and can be due to acute viral, acute suppurative, or recurrent acute or chronic inflammation. Intraparotid lymphadenitis may also occur, as in cat-scratch disease or in other causes of cervical lymphadenitis. Salivary gland neoplasms are rare in children, and most of them are benign including mainly hemangioma, pleomorphic adenoma, or lymphangioma. Other lesions, such as sialolithiasis, mucocele, or ranula, may also be seen. Ultrasonography should be the initial imaging study used for the examination of salivary gland lesions in children, given the fact that most of such lesions are benign and are shown up clearly by sonography. In most cases, this technique permits the differentiation of intraglandular and extraglandular lesions, and may suggest the correct diagnosis. The entire lesion could not be totally depicted by US however, and other imaging techniques such as CT or MRI may be necessary. Vascular lesions can be demonstrated more clearly through the use of color Doppler imaging. Some of the lesions may appear similar, and clinical correlation is important for the differential diagnosis. This article discusses the sonographic appearance and clinical manifestations of the spectrum of salivary gland abnormalities that may occur in children.

The rare combination of hypermelia with craniorachischisis and duplication of the vertebral column has been found in three cases, two published and one previously unreported. Even though the previous authors had come to other conclusions, careful analysis of the details in these twins leads to the inescapable conclusion that they were all dorsally united parasitic rachipagus twins. The nature of the original union was clearly indicated by (1) the articulation of autositic ribs to two different vertebral columns but to a single ventral sternum, (2) the articulation of parasitic ribs also to the two vertebral columns but fusion of the ribs and clavicles dorsally without an interposed sternum, and (3) the dorsal location of the rudimentary viscera of the parasite. The orientation of notomelic arms was confirmatory but not diagnostic. The proposed embryologic origin of these twins is presented.

The reduction of sciences to a limited number, in whose terms all scientific phenomena could be explained is conceivable. Particularly, is the reduction of biology to physics possible? The present article reviews critically this issue. First, it speaks about the topic on the parts and their relationships in the so-called levels of organization. Secondly it refers to the reduction of one branch into another within a same science. Finally it analyses the arguments against the possibility of reducing biology to physics.

A sporadic case of idiopathic asymmetric heart hypertrophy in a newborn infant is reported. Despite drug therapy the baby died in progressive heart failure at 23 days of age. At necropsy there was cardiac hypertrophy with features similar to those of the usual asymmetric from observed in adults. On gross examination the myocardium of the ventricular septum and the free wall of the left ventricle showed a disorganized structure. Microscopically, the changes consisted of an abnormal arrangement of muscle cells and muscle bundles with areas of hypertrophied myofibers. In agreement with other authors myocardial disorganization ("disarray") is interpreted as a form of dysplasia, hypertrophy being a secondary phenomenon. The hypothesis that these abnormalities represent the persistence of the embryonic myocardial structure is discussed. The pathogenetic significance of focal myocardial dysplasias is apparently related to the amount of myocardium involved.

A case of idiopathic congestive cardiomyopathy associated to celiac disease is presented. The ultrastructural and electrophoretic examination of myocardial samples showed a selective loss of actin. Electron microscopy revealed the characteristic alterations of enterocyte microvilli seen in celiac disease. The involvement of the microfilament system both in the myocardial sarcomere and in the enterocyte may indicate a pathogenic relation between these alterations. Ultrastructural examination of skeletal muscle tissue showed a good preservation of the cell contractile apparatus.

The teratogenetic periods of the most important CNS malformations are defined and briefly discussed. The results are presented in a synoptic figure. The present study is based on the analysis of normal CNS development and on morphogenetic interpretations of the pertinent anomalies. The data compiled from the literature concerning normal development are presented in an analytical table and are also summarized in a synoptic figure.

Destructive myofibrillar lesions, particularly degenerative fibrillolysis in hypertrophied hearts, were studied with the electron microscope in left ventricular myocardium samples obtained from autopsies with post mortem periods not exceeding 195 min. The contractile protein composition of these samples was determined electrophoretically. 18 cases were studied, grouped as follows: Group I, composed of 5 cases showing normal hearts which were employed in the determination of normal electrophoretic values. Group II: 10 cases with hypertrophic hearts, 1 of them showing contraction bands and decreased myosin, 6 others with fibrillolytic lesions of which 3 presented a decrease in myosin and 3 possessed normal myosin values. None of the cases showed a decrease in actin values. Group III was composed of 3 cases of hearts with normal weights that showed ultrastructural alterations of the myofibrils: 1 with myofibrillar disarray and normal electrophoretic values, 1 with incomplete contraction bands and normal protein values and 1 with focal myofibrillar disgregation and myosin decrease. It is concluded that in some cases of degenerative fibrillolytic lessions a decrease of myosin occurs. The method employed does not rule out that apparently normal actin and myosin values might be due to the presence of contractile proteins in a denatured state that does not affect their electrophoretic mobility.

From 1970 to 1979 we studied and operated on 8 patients with atrial myxoma, 7 females and 1 male, 24 to 58 years of age. Symptoms had been present for 4 to 24 months prior to surgery. Five patients were functional class IV (NYHA), 2 class III and one class I. All patients were studied by catheterization and angiography. The diagnosis was suspected from physical findings in 3 patients and was not made before surgery in 2 cases. The tumor was located at the left atrium in 6 patients and the right atrium in 2. Electron microscopy performed in 4 cases revealed the typical findings of myxomatous tissue. Adequate resection under extracorporeal circulation was possible in all subjects. One female who was in severe congestive heart failure died shortly after operation. The survivors did well, remaining functional class I, one to nine years after surgery.

Potassium cardioplegia was compared with normothermic, intermittent ischemic arrest in 30 patients undergoing multiple coronary artery bypass grafts. Group 1 comprised 15 patients in whom cold potassium cardioplegia with St. Thomas' Hospital solution was used. In Group 2 were 15 patients who underwent intermittent ischemic arrest during the construction of the distal anastomoses. Two myocardial transmural left ventricular biopsies were done in each patient. There was no operative mortality. Electron microscopical examination showed normal myocardial ultrastructure in both groups. In particular, mitochondria were well preserved in all samples. The postoperative electrocardiogram demonstrated a new Q wave in 1 patient in Group 2 whose level of the myocardial isoenzyme of creatine phosphokinase (CPK-MB) was within the normal range. The peak CPK-MB release in Group 1 was 23.2 +/- 20.1 IU and in Group 2, 19.9 +/- 15.1 IU. This difference was not statistically significant. The mean period of anoxic arrest in Group 1 was 49.5 +/- 15 minutes and in Group 2, 25.5 +/- 8 minutes (p less than 0.001). Total cardiopulmonary bypass time in Group 1 was 114.5 +/- 20 minutes and in Group 2, 90.2 +/- 16 minutes (p less than 0.01). It is concluded that both techniques can preserve myocardial subcellular architecture during multiple coronary artery bypass grafting in patients with normal left ventricular function.

The localization of primary calcified deposits in cases of idiopathic calcification of the mitralis was studied microscopically in the mitral tissue of 18 autopsy cases of women over 60. Macroscopic inspection revealed small calcified foci in 12 cases, none in the remaining 6. Microscopically, calcified foci were found in all cases, localized at the insertion of the mitral cusp. The annulus was involved in 8 cases only. At the site of cuspal insertion these foci were situated in fibrous thickenings towards the endothelial surface of the ventricularis. According to these findings, calcified deposits accumulate primarily at the cuspal insertion site, rather than in the annulus. Age-related fibrosis of the mitral cusp appears as a predisposing factor for dystrophic calcification.