The paper includes a discussion of all published cases of single coronary artery and a consideration of the embryologic development and physiologic significance of this anomaly. The incidence and types of associated cardiac diseases are reviewed. Two additional case reports of this anomaly are included.T HE OCCURRENCE of a single coronary artery is such a rare cardiac anomaly that presentation of 2 additional cases is of interest. The first case is unique in that the patient was the oldest in whom such an anomaly has been reported. In addition, pertinent data on 43 previously reported cases are presented.CASE REPORTS Case 1.-The patient was a white woman, 80 years of age, who entered University Hospitals of Cleveland with complaints of constipation and severe nausea for the past twenty-four hours and sharp attacks of pain over the lower abdomen of twelve hours' duration. She had never experienced chest pain, shortness of breath or edema of the ankles. Physical examination revealed a firm mass in the rectum and a sigmoid colostomy was performed on the day of hospital admission. On the thirteenth hospital day an abdominoperineal resection was performed and examination of the specimen disclosed a partially differentiated adenocarcinoma of the rectum. Metastases were not found. Edema of the legs and ankles developed on the fourth hospital day. The patient became comatose and died on the eleventh hospital day. Autopsy and both branches extended obliquely over the anterior surface of the left ventricle, the larger continuing to the apex where it could be followed over the posterior surface of the left ventricle for 2 cm.Cross sections of the first portion of the larger anterior descending branch revealed yellowish gray intimal plaques that nearly occluded the lumen. The circumflex branch of the left coronary artery extended around the posterior surface of the left ventricle along the atrioventricular groove to the acute margin of the heart and continued to the anterior surface of the right ventricle to the base of the right auricular appendage. The course of this vessel measured 25 cm. from aortic orifice to the base of the right auricular appendage ( fig. 1). Cross sections revealed a patent lumen throughout with slight focal thickening of the intima by yellowish gray plaques. Small branches extended over the posterior surface of both ventricles and over the anterior surface of the right ventricle.Histologic examination of the myocardium revealed moderately large muscle fibers with nuclei that were slightly enlarged and occasionally rectangular. The myocardium was not otherwise remarkable. Histologic sections of the first portion of the larger branch of the left anterior descending coronary artery revealed marked thickening of the intima and subintimal deposition of a large amount of eosinophilic material containing acicular spaces. The lumen was reduced to a slit.The pathologic diagnoses included recent abdominoperineal resection for partially differentiated adenocarcinoma of the rectum, acute fibrino-purulent per...

Anger/hostility and Type A behavior have been implicated in elevated cardiovascular reactivity and disease. In the present experiment systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were monitored during conditions of competition alone or in conjunction with goal blocking or harassment. Cardiovascular reactivity was examined as a function of conditions, Type A or B pattern, and various measures of anger/hostility. Harassment elicited significantly elevated SBP and HR changes relative to goal-blocking and control conditions. Type As reliably exceeded Type Bs in magnitude of SBP change during the harassment condition only. However, exploratory analyses correlating anger/hostility measures and cardiovascular reactivity indicated that only subjects scoring high on the Buss-Durkee Hostility Inventory showed significantly elevated SBP reactivity as a function of Type A behavior pattern, rated hostility during the A-B interview, or outward expression of anger assessed by the Framingham Anger-In vs Anger-Out Scale.

No abstract

Agminated flexural melanocytic nevi in children with a history of Langerhans cell histiocytosis (LCH) are rare and thought to be coincidental or related to systemic chemotherapy. We report on an 11-year-old boy in remission from LCH, treated with only topical steroids, who presented years later with an eruption of melanocytic nevi in the bilateral inguinal and axillary regions. Rather than coincidence, we hypothesize that agminated flexural melanocytic nevi are a late sequela of LCH, possibly resulting from immune tolerance or a reaction to local inflammation.