The arterial blood supply of the conducting system in normal human hearts.

The distributing artery of the conducting system of the heart is occasionally injured in cardiac surgery. The aim of this study was to define the anatomic characteristics of the principal arterial source of the sinu-atrial node and atrioventricular node. Furthermore, the morphology of the tendon of Todaro was clarified. Thirty hearts were studied by gross anatomic methods, and the exact area of the conducting system was supported by histologic observations of four hearts. The sinu-atrial node was supplied by the right coronary artery more frequently (73% of cases) than by the left (3%), and in 23% of cases this node was supplied by both coronary arteries. The atrioventricular node was supplied by the right coronary artery (80% of cases) more than by the left (10%), and in 10% of the cases this node was supplied by both coronary arteries. The atrioventricular bundle branch arose from the right coronary artery in 10% of cases, the left coronary artery in 73%, and both coronary arteries in 17%. Most of the blood to the right bundle (the moderator band) was supplied by the interventricular septal branches of the anterior interventricular branch from the left coronary artery. Finally, all the arteries of the right bundle and left bundle were defined to be derived from left coronary arteries.

Adrenal cyst: a review of the Japanese literature and report of a case.

Adrenal cysts are a rare condition and are usually non-functioning and asymptomatic. A 44-year-old man was referred from another hospital because a left retroperitoneal tumor was incidentally found by abdominal echography. Laboratory findings including adrenal hormonal study were within the normal range. It showed homogeneously low intensity on T1-weighted images and high intensity on T2-weighted images on magnetic resonance imaging (MRI). Angiography demonstrated that the tumor was avascular and of left adrenal origin. The patient was diagnosed with left adrenal cyst and was intensively followed up with plans for examination with diagnostic imaging.

Ureteral endometriosis: a case report and a review of the Japanese literature.

A 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started.

Extraperitoneal bladder rupture secondary to rectal impalement.

Impalement injury to both the urinary bladder and the rectum is a rare occurrence. A 45-year-old man was referred to our hospital because he had been stabbed through the internal femoral skin by a steel bar. Retrograde cystography and computed tomography failed to demonstrate bladder rupture. We carried out cystoscopy (CS) because of the existence of gross hematuria and found a penetrating wound in the posterior wall. Colon fiberscopy revealed two wounds in the rectum, one of which communicated with the bladder. A diagnostic laparoscopy revealed no associated injuries in the peritoneal cavity. Vesicorectal injury was diagnosed and treatment included transanal closure of fistulas and indwelling ureteral and urethral catheters. Postoperative CS revealed complete closure of the injury.

[A case of sarcoidosis associated with membranous nephropathy].

A 59-year-old woman was admitted to the hospital with a complaint of right visual disturbance. At admission, she had proteinuria and microscopic hematuria. The pulmonary X-ray showed bilateral hilar lymphadenopathy (BHL) but tuberculin test were negative. Also, bronchoalveolar lavage (BAL) and renal biopsy were performed. Bronchoalveolar lavage fluid (BALF) contained a high percentage of OKT 4 positive cells. In renal biopsy, light microscopic study showed thickening glomerular basement membrane (GBM) with tubulo-interstitial legion. Immuno-fluorescent study revealed granular deposits of IgG along glomerular capillary wall. Electron microscopic study showed subepithelial electron dense deposits of GBM, which are characteristic for membranous nephropathy (MN). It is well known that both sarcoidosis and MN are associated with immunological abnormality. This case might be significant for the study of pathogenesis of sarcoidosis.

Further electron-microscope studies on the human hepatic sinusoidal wall with special reference to the fat-storing cell.

In biopsy specimens from two normal human livers, fat-storing cells and Kupffer cells were observed by electron microscopy with the following results: 1) In the human Ito cells numerous micropinocytotic caveolae and vesicles occurred either scattered beneath the plasma membrane or fused into short tubules. In the cytoplasm abutting on these structures, minute clusters of glycogen beta-particles were revealed which presumably had been synthesized in the local cytoplasm from carbohydrate (glucose) ingested by pinocytosis. 2) Lipid droplets (vacuoles) were formed within the accumulations of the glycogen beta-particles. These findings support the view that the glycogen synthesized in the Ito cells may represent a transitional compound in the process of lipid synthesis from carbohydrate. 3) Among lipid vacuoles, electron-dense droplets equally large were found, often containing electron-lucent areas in their center. On the surface of these dense droplets, compact clusters of glycogen particles adhered as if they might have permeated into the droplets. These droplets may possibly be immature lipid droplets retaining chemical properties of the glycogen in their superficial part; they remained insoluble during the preparation procedures for ultrathin sections. 4) The occurrence of the worm-like structure has for the first time been revealed in the human Kupffer cells. Besides its short tubular profiles, a more complex structure was demonstrated.