We describe a patient with syncope associated with swallowing. This syncope was caused by transient compression of the left atrium (LA) by an esophageal hiatal hernia. Two-dimensional echocardiography demonstrated a hyperechoic mass compressing the LA from the posterior. With air insufflation of the esophagus, compression of the LA by this hernia sac was seen to increase. Pulsed and color Doppler echocardiography revealed greatly decreased velocity of blood flowing into the LA and left ventricle (LV). Thus, marked compression of the LA by an esophageal hiatal hernia can cause syncope by impeding blood flow from the LA to the LV. Echocardiography proved highly useful in diagnosis.
Substance P (SP), S-100 protein, methionine-enkephalin, serotonin and myelin basic protein were studied in two solitary glomus tumours of the skin by peroxidase-antiperoxidase immunohistochemistry. Multiple SP-containing nerve fibres were distributed in the parenchyma of the tumour among proliferating glomus cells, and in the oedematous stroma of the tumour. Positive staining for myelin basic protein was detected in nerve fascicles in the capsule of the tumour, but not within the glomus tumour. S-100 protein immunoreactivity was found in nerve fascicles in the capsule of the tumour, and in addition, a few cells positive for S-100 protein were scattered throughout the stroma of the tumour. No positive staining for methionine-enkephalin and serotonin was found. The present finding may explain the clinical experience that the tumour is tender and can cause severe paroxysmal pain, because SP is known to be a primary sensory afferent neurotransmitter for mediating nociception. A possible role of SP for vasodilation in the glomus tumour is also discussed.
The vascular anatomy of the galeal occipitalis flap was studied in 10 fresh cadavers by an intraarterial dye injection technique. The scalp flap was based posteriorly, incorporating both the occipital and posterior auricular arteries. A good transmidline anastomosis was demonstrated between the two occipital arteries in the full-thickness scalp flap. However, in the isolated galeal flap, although the axial distribution of the occipital artery was maintained, fewer transmidline connections were seen between the two occipital arteries. The posterior auricular artery was consistently visualized in all dissections, and it showed good connections with the ipsilateral occipital artery. However, there were very few anastomoses between the two posterior auricular arteries across the midline. The rich anastomotic network between the occipital artery and the posterior auricular artery extended well beyond the vertex. This study showed that a large flap can be raised if both the occipital artery and the posterior auricular artery are included in its base. The occipital artery is a vessel of satisfactory size and is potentially a good vascular source for a thin galeal free flap. It is recommended that the flap be raised at the subperiosteal level for ease of dissection and protection of the vessels, which are initially in the subgaleal plane and then arborize in the galea.
This study was performed in order to identify the fungi of four species (Aspergillus fumigatus, Fusarium anthophilum, Candida albicans, Cryptococcus neoformans) in formalin-fixed, paraffin-embedded tissue sections by the indirect method of immunoperoxidase staining. Mature albino rabbits were immunized by formalin-killed organisms. The antibodies were prepared by precipitation at a 50% saturation of ammonium sulfate and were checked for cross-reactivities by Ouchterlony's double immunodiffusion and precipitin test. The immunoperoxidase staining was applied to the paraffin-embedded tissue sections of infected mice, human autopsy and biopsy specimens. Although each fungus was stained clearly the cell wall, cross-reactivities appeared among them, however it was possible to identify four fungi by absorption and dilution of the antisera.
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