Transverse Portion Research Articles

Composite Material Modeling Of AntebranchialInterosseous Membrane In A Human Forearm

The interosseous membrane (IOM) is a fibrous structure located within the forearm that possesses distinct direction and shape patterns. The definitive function of this structure currently remains undefined. We propose that the IOM functions similarly to a composite material composed of stiff central fibers (longitudinal portion) surrounded by a supporting fibrous matrix (transverse portion). The matrix of the membrane is not actively involved in force transfer, but rather it functions to maintain the orientation of the IOM fibers relative to the radius and ulna. The matrix also transfers applied forces to the load bearing longitudinal fibers. The experimental process consisted of a force being applied by a tensile testing apparatus across the main fiber direction of a prepared IOM sample. The results indicated structural values similar to that of ligaments and provided a quantitative representation of the mechanical properties of the IOM. Using the amount of collagen and elastin and the rule of mixtures theory of composite materials, the theoretical values of the elastic moduli of the IOM were calculated. These values for the longitudinal and transverse portion were then compared to actual values obtained from mechanical testing. The membrane's composite design allows for additional strength in the force transferring direction, while still maintaining its muscular attachments and bony supports. Our experimental results support the composite material theory by demonstrating no difference between the calculated and experimental elastic moduli of the longitudinal and transverse portions of the IOM. Advances in Composite Materials and Structures VII, C.A. Brebbia, W.R. Blain & W.P. De Wilde (Editors) © 2000 WIT Press, www.witpress.com, ISBN 1-85312-825-2

Repair of Traumatic Rupture of the Aortic Arch

<h3>To the Editor:—</h3> Traumatic rupture of the thoracic aorta has interested surgeons for many years. The mechanism and the methods of treatment have been widely discussed. The most common site of injury is at, or just distal to, the left subclavian artery. Traumatic rupture of the transverse portion of the arch is unusual. With reliable and safe techniques of extracorporeal circulation, the treatment of this injury depends largely upon early and precise diagnosis. Perhaps as many as 80% of these patients die immediately.¹However, of those surviving the initial insult, the salvage rate by currently available techniques should be substantial. <h3>Report of a Case:—</h3> A 23-year-old man was seen in the emergency room at 3:37 PM, June 7, 1967, after having been pinned between two trucks in a gravel pit two hours earlier. Initial examination revealed only a contusion over the mid sternum and the right side of the

Roentgen visualization of uterine artery calcification.

Uterine artery calcification presents a recognizable roentgen pattern. Since the finding is not well known, four examples are presented in this communication. The phenomenon is more common in the elderly but may be observed in younger women. In every patient in whom we detected this calcification, arteriosclerotic changes in other arteries were roentgenographically demonstrable. The uterine artery is a branch of the anterior division of the internal iliac artery (hypogastric). It originates near the pelvic brim and is divided roughly into three portions. In its first part it courses downward along the lateral pelvic wall for about 4 em. The second portion traverses the broad ligament medially and slightly anteriorly to the side of the uterine body where it divides into superior and inferior branches to form the third portion. The ascending portion rises to the level of the junction of the uterine tube and body, giving off arcuate branches around the body as it rises. It then runs laterally to join with the ovarian artery. The inferior branch continues more medially, giving off uterine cervix branches and others which descend on the vagina. These branches join those of the vaginal artery to form two median longitudinal arteries, the azygos arteries of the vagina, one of which runs down in front and the other behind the vagina (1). Case Reports Each of the four examples of uterine artery calcification was discovered incidentally to other studies. The pertinent clinical data will be found in the legends accompanying the illustrations. Roentgen Features and Discussion On the roentgenogram, the calcification in the transverse second portion, traversing the pelvic cavity from its wall to the side of the uterus, is the most easily recognized (Figs. 1–4). It is noteworthy that this portion of the artery does not extend to the midline but to the lateral border of the uterus (Figs. 1 and 3), a characteristic which may be altered, however, by uterine malposition, disease, or arterial variation. Calcification may extend to the third portion of the artery. I t will ascend along the lateral border of the fundus if the ascending branch is calcified, or, if the inferior branch is calcified, it may continue more medially before turning downward to the median longitudinal arteries—the azygos arteries—of the vagina (Figs. 2 and 4). Laterally, the calcified horizontal second portion may be traced backward to its first portion where it is identified coursing downward along the lateral pelvic wall (Figs. 1 and 2). Indeed, the arterial calcification may be intense enough to permit identification all the way back to the internal iliac artery. Even if this continuity is not visible, calcification may usually be discerned in the iliac arteries and in the abdominal aorta. With marked calcification, other branches of the iliac arteries may also be visible.

Superior mesenteric artery syndrome.

Recurrent abdominal pain is common in pediatric practice. Frequently no organic cause is established after extensive clinical and laboratory studies. It is the purpose of this report to call attention to the superior mesenteric artery syndrome (SMAS) as a cause of abdominal pain and to discuss its pathogenesis, diagnosis, and treatment. The SMAS is an obstruction of the duodenum in the transverse portion proximal to the ligament of Treitz. It is produced by the dorsal mesentery which includes the superior mesenteric artery with its accompanying veins, nerves, fibrous tissue, fat, and lymph nodes. Obstruction varies from minimal to complete. It is intermittent to constant and may be symptomatic or asymptomatic. The symptoms and signs produced by SMAS are similar to those due to any duodenal obstruction distal to the ampulla of Vater. Organic obstruction in the distal duodenum by the SMAS was first reported by von Rokitansky 1 in 1861.

A STUDY OF SOME DEVELOPMENTAL STAGES OF THE THELYCUM AND ITS RELATION TO THE SPERMATOPHORES IN THE PRAWN PENAEUS JAPONICUS BATE*

SUMMARY The thelycum Qf P. japonicus Bate consists of two parts (i) an interior triangular plate, and (ii) a posterior pouch. The formation of the pouch is described. It is a complicated process involving folding and tucking in of the lateral arms of the U‐shaped plate and anterior growth, notably of the transverse median portion of this plate. The structure of the spermatophores is described, and their relation to the thelycum in an impregnated female. This description supports Heldt's work on Penaeus trisulcatus Leach.

Left ascending aorta with right arch and right descending aorta.

Most of the anomalies of the aorta have been carefully described, and the criteria for their diagnosis have been clearly delineated. It is the purpose of this paper to present a rare aortic anomaly which can be detected with ease by routine radiologic examination. The roentgen findings in this condition have not previously been described. Case Report P. G., a five-month-old white boy, was admitted to the hospital because of persistent cyanosis and increasing dyspnea. Intermittent cyanosis had developed one week after birth, and the condition had become sufficiently severe to necessitate continuous oxygen therapy. Physical Examination: The child was small and underweight. Deep generalized cyanosis was present. The heart was normal to percussion, and no murmurs were heard. Coarse rhonchi were audible throughout the lungs. There was marked retraction of the upper abdominal wall. The liver was felt two fingerbreadths below the costal margin and did not pulsate. No clubbing was present. Laboratory Findings: The hemoglobin level was 12 gm., and the red blood cell count was 4,200,000. The electrocardiogram showed marked right axis deviation. Roentgen Examination: The lung fields were abnormally clear. In the postero-anterior projection, the heart appeared normal in size. At the left upper cardiovascular border was a pulsating bulge extending from the region of the pulmonary artery segment up to the point usually occupied by the aortic knob. The descending aorta was clearly delineated on the right (Fig. 1). On the barium esophagram, the esophagus was shown to be displaced to the left at the level of the aortic arch, indicating the presence of a right arch (Fig. 2). In the left anterior oblique view, no obvious chamber enlargement was demonstrated. The barium-filled esophagus was displaced posteriorly at the level of the aortic arch. The descending aorta was more anteriorly placed than is usual in this projection and overlapped the posterior cardiac border (Fig. 3). This constituted further evidence for a right descending aorta. There was some fullness at the usual site of the pulmonary artery in the right anterior oblique view (Fig. 4). In the lateral projection, the trachea was displaced posteriorly, apparently by a smooth vascular structure (Fig. 5). These findings suggested the possibility that the aorta arose on the left, with the transverse portion of the arch crossing anterior to the trachea, and the descending aorta on the right. If this hypothesis were correct, the bulge at the usual site of the pulmonary artery, seen in both the postero-anterior and the right anterior oblique view, represented the ascending aorta. A vascular ring was also a possibility, although there was no evidence of impingement upon the esophagus posteriorly. Because of the relatively avascular lung fields, it was assumed that there was diminished pulmonary arterial flow, and the presence of pulmonic stenosis of a high degree with an atrial septal defect was considered.

Use of the barium-filled esophagus in the x-ray study of abnormalities of the heart and the aorta

1. 1. Posterior displacement of the barium-filled esophagus, as seen in the right oblique position, and its displacement to the right in the postero-anterior position are due to left auricular enlargement. 2. 2. Deviation of the esophagus to the left below the area of aortic indentation in the postero-anterior position, and posteriorly in the left oblique position, is due to elongation of the transverse portion of the aortic arch. 3. 3. The use of the barium-filled esophagus serves to differentiate elongation of the transverse portion of the aortic arch from left auricular enlargement.

Memoirs: Two Polymastigote Flagellates of the Genera Pseudodevescovina and Caduceia

1. The previously published description of Pseudodevescovina uniflagellata from Kalotermes (Neotermes) insularis is incorrect in practically all points. The flagellate is a devescovinid which, like other members of the subfamily, has three anterior and one trailing flagellum. The trailing flagellum is relatively small and slender. 2. The most unusual characteristic is the parabasal apparatus, which consists of a C-shaped or L-shaped main limb adjacent to the nucleus and seven to nineteen cords attached to the transverse portion of this. 3. A sinuous movement of the cresta has been observed in living material. 4. The flagellate moves forward steadily with considerable vigour as compared to Devescovina lemniscata and even Stephanonympha with its hundreds of flagella. Yet the small trailing flagellum seems to be the main cause of this movement, as the anterior whip often is turned back against the body and trailed. This suggests that increase in size of the trailing flagellum, which is a broad ribbon in Devescovina lemniscata, or increase in number as in Stephanonympha, does not necessarily enhance the locomotor efficiency of the flagellate. 5. The body is completely covered with a dense investment of relatively short spirochaetes, the ends of which appear actually to be embedded in the cytoplasm and, taking an iron-haematoxylin stain, simulate basal granules. 6. There are eight chromosomes, which can be recognized most clearly when they are granules or short, stout rods in the early telophase. 7. At the beginning of binary fission, the main limb of the parabasal apparatus breaks. A portion of length about equal to that of the nucleus is left attached to the centriole at one pole of the spindle; at the other pole a parabasal develops de novo, doubtless in connexion with the centriole. This is at first a filament, which reaches a size equal to the part of the old parabasal that remains attached, then both grow equally. After division of the body, new cords grow out from this main limb. 8. The detached part of the old parabasal apparatus breaks up into successively smaller vesicular bodies, which are noteworthy for a deeply staining cap sharply distinguished from the chromophobe substance, appearing like diagrams of dictyosomes. These fragments are resorbed before plasmotomy. 9. Grassi's Devescovina nova has been found in the species of termite from which he described it, Kalotermes (Neotermes) erythraeus from Eritrea. Its characters indicate that it must be removed from Devescovina, and it has been placed in the genus Caduceia. 10. The parabasal apparatus consists of a main limb, which in this case is loosely spiralled around the trunk of the axostyle, and from one to six attached cords directed more or less parallel to it.

Accessible closed loops of the small intestine and the colon

The attachment of the accessible closed intestinal loop in dogs to the abdominal wall where it is readily entered at any time by a hypodermic needle has given evidence of the direct relationship between distension of a hollow viscus and clinical symptoms. This procedure allows for aspiration of the fluid and consequent recovery of the animal with a chronically closed segment of intestine. This closed loop adds another device for the investigation of absorption of various substances by the small intestine. It has advantages over methods now in use. The dog’s colon permits the construction of a closed loop in its transverse portion.

The diagnosis of cardiovascular syphilis; analysis of clinical and post-mortem findings

The symptoms and signs of cardiovascular syphilis are discussed. An analysis was made of 61 clinical cases and 78 necropsies; statistics limited to the cases proved post-mortem are presented. The average age at death was 47.9 years. There were but 3 cases under thirty years of age, and only 2 above seventy years. Males outnumbered the females in the ratio of 5.5 to 1. The syphilitic lesions were associated with lesions of nonsyphilitic disease of the heart in 43 per cent of the necropsies. Symptoms of the disease were absent in about one-quarter of the patients in whom the disease was disclosed at necropsy. Pain was present in 28 per cent. It conformed to the syndrome of angina pectoris in but 4 per cent. The mouths of the coronary arteries were partially occluded in 10 patients; none of these had angina pectoris, and 8 were without pain of any sort. Neither the presence nor the character of the pain could be related to the condition of the coronary arteries or of the aorta. The coronary arteries were normal in 58.3 per cent of the series of 24 necropsies. Shortness of breath was common after the onset of congestive failure of the heart. The symptoms of weakness, hoarseness, dysphagia, and fever were absent or were present in a negligible number of these patients. Hoarseness of the voice was noted in but one of seven cases of aneurysm involving the transverse portion of the aortic arch. The duration of the symptoms rarely exceeded a few months in the necropsy cases; it was somewhat longer in the clinical series treated as out-patients. From these latter there is presumptive evidence that adequate therapy may relieve symptoms and prolong life. The manner of death was that of progressive failure of the heart in 79 per cent of the series of 24 necropsies. In 4 of these the actual death was sudden. The heart was enlarged in 22 cases, or 91.6 per cent, of the 24 necropsies. This enlargement was present in the absence of aortic insufficiency in 7, or about one-third of the group. The average weight of the heart was 555 gm. Increase in the supracardiac dulness and other findings above the heart are common, but too often not recorded in the physical examination. A systolic murmur over the precordia or more localized at the apex or base is common. That at the base is not due to roughening of the The diastolic murmur of aortic insufficiency was noted in 47.4 per cent. In 50 per cent of the 16 aortic regurgitant cases in the series of 24 necropsies the diastolic murmur was transmitted to the apex. aortic valve. This diastolic murmur may be inconstant in its presence in its earlier stages. Its detection sometimes requires painstaking auscultation. Aortic insufficiency was recognizable in half again as many cases as were evident at post-mortem, and in at least three-fourths of the cases (murmur present in life) the regurgitation could not be attributed to lesions of the valve. The insufficiency of the valve is best explained as due to yielding of the muscular ring round the aortic orifice. The apical findings, known as those of Austin Flint, are occasionally present. The aortic second sound may be masked by the murmur of aortic insufficiency, or it may be accentuated in the absence of the murmur and even if the latter is present. A change in the quality (i.e., a tympanic note) may take place in the aortic second sound, but it is difficult to differentiate from that found in arteriosclerosis of nonsyphilitic causation. The Corrigan type of pulse was absent in 5 of 16 cases of aortic insufficiency. That such is possible does not appear to be generally recognized. There is nothing characteristic of the blood pressure save in the presence of aortic insufficiency. Careful physical examination may detect evidence suggestive of syphilis elsewhere in the body. The Wassermann reaction was negative in 10, or 23.87 per cent, of the 42 cases in which it was recorded. The roentgen ray findings are very important aids in the diagnosis. It is unreasonable, however, to expect that the slight lesions in early cases of cardiovascular syphilis can be detected by the roentgen ray. In advanced cases the differential diagnosis from nonsyphilitic conditions may be difficult or impossible solely from the roentgen ray findings. The presence of cardiovascular syphilis was not diagnosed in 44 per cent of this series, although the subsequent necropsy disclosed advanced lesions in one-third of these failures. About one in five of the cases in which the syphilitic lesions were of advanced degree remained undiagnosed in life.

Foreign Body in the Colon: Case Report

Mrs. X., age 40, entered the hospital complaining of weakness and the loss of 65 pounds in weight following an operation for gallstones five months previously. During that time she had also been troubled with frequent attacks of pain at the lower tip of the left shoulder blade, the pain radiating along the lower left ribs toward the left groin. Two days before entering the hospital she passed bloody urine. On physical examination nothing abnormal was discovered except the general emaciation of her body and a possible palpable mass in the left hypochondrium. Because of the bloody urine a urologist was called in consultation, and the kidneys were investigated without finding any lesion. The pyelogram of the left kidney was also found to be normal. While examining the pyelogram (Fig. 1) there was noticed an elongated shadow which was sharply defined within the lumen of the transverse portion of the colon in the neighborhood of the left kidney. A suggestion was then made to examine the gastro-intestinal tract. The view taken with the Bucky-Potter diaphragm revealed the same shadow in a somewhat different position, but again following the course of the colon (Fig. 2). A barium meal revealed a normal stomach and duodenum. A barium enema showed no obstruction or deformity in the contour of the bowel. The transverse portion of the colon presented an acute angulation and folding of the bowel, apparently due to adhesions. The peculiar shadow was found to be obscured by the barium (Fig. 3). The roentgenological interpretation was that of a foreign body of soft consistency—its nature being undetermined. No one, however, paid any attention to this suggestion and the patient was scheduled for an operation. Just a day before the date of the operation, while the patient was in the process of evacuating her bowels she noticed a strange substance making its exit from the rectum. She immediately called the attention of a nurse, who, in turn, called an intern to examine the strange substance which was descending from the rectum. The intern by steady pulling succeeded in delivering a mass 42 inches in length which he at first thought to be a tape worm, but which proved, on closer examination, to be a piece of surgical gauze. The following day the patient was discharged from the hospital as cured and has remained so to the present, a period of three years. The three most interesting features about this case which stand out prominently are the following: First, how did the foreign body get into the colon? The nature of the gauze, which was in the form of a pad such as is generally used in abdominal operations, was sufficient proof that it was left in the peritoneal cavity during the operation for gallstones. The way this substance had penetrated the large bowel without producing a general peritonitis is indeed remarkable.

ON TRACHEAL TUGGING IN CONDITIONS OTHER THAN ANEURYSM OF THE TRANSVERSE PORTION OF THE ARCH OF THE AORTA.

While serving as medical interne at the Johns Hopkins Hospital under Dr. Osler, some years ago, I became impressed by the frequency with which cases of aneurysm of the transverse portion of the arch of the aorta were accompanied by tracheal tugging. Desiring to know if this phenomenon might occur in other diseases or in health, I recently began to collect statistics, and desire to make today what, on account of the small number thus far examined, can only be called a preliminary report. I found that results of work on similar lines had been published by Grimsdale 1 and by Ewart, 2 and a short time ago F. A. Packard, 3 in an article on The Signs and Symptoms of Aortic Aneurysm, makes mention of some observations of his own in this connection. In making up my tables the following points were ascertained in addition to tests for tugging: