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Biomedical subjects

T N James

Publications and source records attributed to T N James.

At least 37 records · Page 2Linked to original sources
PubMed1996

Generation of new intercellular junctions between cardiocytes. A possible mechanism compensating for mechanical overload in the hypertrophied human adult myocardium.

Intercellular dehiscence is a common cardiocytic response to pathological conditions. However, little consideration has been given to the possibility of new intercellular junctions developing between cardiocytes within developed myocardium. To examine this possibility as it may relate to useful compensation for hemodynamic overloads, changes in cardiocytic connection were evaluated by scanning electron microscopy in hypertrophied myocardium of adult human hearts. Transmural myocardium of left ventricle was obtained at autopsy from five hearts with concentric hypertrophy, five hearts with eccentric hypertrophy, and five control hearts (noncardiac death). After formalin fixation, the number of cardiocytes connected to an individual cardiocyte was counted in tissues from the middle portion of the transmural samples by scanning electron microscopy. Cardiocytic diameter and connective tissue volume fraction were measured on the transmural sections by light microscopy. In concentrically hypertrophied hearts present both increased cardiocytic diameter and connective tissue volume fraction, the number of other cardiocytes connected to an individual cardiocyte (4.60 +/- 0.10 [mean +/- SE] was significantly increased (P < .05) compared with control hearts (4.19 +/- 0.12) or eccentrically hypertrophied hearts (4.11 +/- 0.10). The increase in junctions per cardiocyte in concentrically hypertrophied hearts suggests that new connections had been generated. More junctions developing during hypertrophy could add another structural advantage to those of cardiocytic hypertrophy and connective tissue proliferation as compensatory adjustments to hemodynamic overload in concentrically hypertrophied hearts.

Adult↗
PubMed1995

Anatomy of the sinus node, AV node, and His bundle of the heart of the sperm whale (Physeter macrocephalus), with a note on the absence of an os cordis.

BACKGROUND: Atrioventricular (AV) conduction time in large whales is only slightly greater than in smaller mammals even though their hearts are enormously larger. Little is known of the detailed histology or cytology of the conduction system of large whales. Such knowledge could be useful in defining the nature of cardiac rhythm and conduction of the whale as well as smaller mammals including humans. METHODS: We studied hearts from seven sperm whales. After fixation in formaldehyde and later dissection, specimens were prepared for histological examination. RESULTS: Cell size, histological organization, and innervation of the sperm whale's sinus node, AV node, and His bundle are similar to most mammalian hearts, except the sinus node is substantially larger. There is no central fibrous body between the atrial and ventricular septa, and the whale has no os cordis. Only the upper quarter of the interventricular septum is fully formed; below that there is only a thin layer of fatty connective tissue between the two ventricles. CONCLUSIONS: Given our morphological findings, we believe that the whale's comparatively short AV conduction time may be best explained by the sinus node and AV node functioning as coupled relaxation oscillators. Absence of an os cordis or central fibrous body or strong attachment between the two ventricles may pose both electrophysiological and hemodynamic hazards when the whale is no longer in its normally buoyant aquatic environment.

Animals↗
PubMed1995

Ultrastructure and immunohistochemistry of the coronary chemoreceptor in human and canine hearts.

Ultrastructure of the coronary chemoreceptor that causes a hypertensive reflex was studied immunohistochemically in human and canine hearts. Both cytologic and histologic features were similar in human beings and dogs, consisting of chief cells, sustentacular cells, Schwann cells, nerve fibers, blood vessels, and connective tissue. Three or four chief cells were typically surrounded by one Schwann cell, making a glomoid cluster about 20 microns across. Volume fractions of chief cells compared to capillaries were about 1:2 in dog and 1:4 in human chemoreceptors. Abundant osmiophilic dense granules filled the chief cells. Complex junctions between nerve fibers, chief cells, and sustentacular cells or Schwann cells exhibited a characteristic fine structure. Immunohistochemically, serotonin reactivity was observed mainly in the vicinity of junctions between nerve endings and chief cells, but some large granules in chief cells also stained positively. These new morphologic findings provide further support for the probable role of serotonin in the activation of the cardiogenic hypertensive chemoreflex in both human and canine hearts.

Adolescent↗
PubMed1994

The toxic oil syndrome.

Hundreds died and thousands were poisoned by rapeseed oil adulterated with aniline and sold illegally in Spain in 1981. The clinical manifestations, now known as the toxic oil syndrome, include pulmonary hypertension and right ventricular hypertrophy plus widespread vascular and neural lesions in other organs. Many of the late deaths ended with a scleroderma-like illness. Because scleroderma involves the heart, an examination was made of the small and large coronary arteries, the neural structures, and the conduction system from 11 victims dying with the toxic oil syndrome. Dense fibrosis, atrionodal junctional hemorrhages, and cystic degeneration of the sinus nodes were present. Small and large coronary arteries exhibited focal fibromuscular dysplasia and a proliferative cystic myointimal degeneration. This latter abnormality was associated with sloughing of the inner wall and embolization of the detached fragment downstream in the same coronary artery. Every heart had many degenerative lesions within nerves, ganglia, and the coronary chemoreceptor. Based upon observations by others with experimental feeding of rapeseed oil containing either high or low erucic acid, it is suggested that this oil must remain a major suspected cause of the toxic oil syndrome, particularly in conjunction with some as yet unexplained facilitative influence by oleoanilids. If this is so, it is important to reexamine the widely recommended use of any rapeseed oil product as a suitable food for humans or animals.

Brassica↗
PubMed1994

Immunohistochemical analysis of lymphocytes in postmortem study of the heart from fatal cases of the eosinophilia myalgia syndrome and of the toxic oil syndrome.

Inflammatory lesions of coronary arteries and cardiac neural structures are postmortem histopathologic features of both the eosinophilia-myalgia syndrome (EMS) and the toxic oil syndrome (TOS). The inflammation is primarily lymphocytic. For further definition of the lymphocytes, immunohistochemical analysis was carried out in the hearts of three victims of EMS and four victims of TOS. Many CD45RO+ T cells, OPD4+ helper/inducer T (Th) cells, and CD20+ B cells were observed in these neurovascular lesions, notably in the conduction system and the coronary chemoreceptor. T cells were prominent in EMS around nerves, ganglia, and sometimes around arteries. B cells and Th cells, however, were more prominent in TOS around arteries. The percentage of T cells in EMS (59.6 +/- 2.4%) was significantly higher than in TOS (45.0 +/- 4.2%), whereas that of B cells was significantly higher in TOS (27.7 +/- 4.4%) than in EMS (17.5 +/- 1.3%) (p < 0.01, respectively). There was no significant difference between the syndromes in the percentages of Th cells. Therefore cytotoxic/suppressor T cells are more prominent in EMS than in TOS. These findings suggest that (1) cellular immune mechanisms are involved in cardioneuropathy in victims of both EMS and TOS; (2) cell-mediated cytotoxicity directed against chemoreceptor neural structures and sinus nodal myocytes is prominent in EMS; and (3) some humoral factors may also be involved in the pathogenesis of TOS.

Adolescent↗
PubMed1994

Sickle cells and sudden death: morphologic abnormalities of the cardiac conduction system.

Sudden unexpected death has become increasingly recognized as an important clinical feature of both homozygous and heterozygous sickling syndromes, but the exact nature of its cause has remained unexplained. We have conducted special postmortem examinations of the cardiac conduction system and a coronary chemoreceptor from the hearts of two black males who had sickled erythrocytes. There were abundant foci of old and recent degeneration in the sinus node, atrioventricular node, and His bundle, as well as the coronary chemoreceptor. Many capillaries and small arteries were packed with sickled erythrocytes, among which small groups of aggregated platelets were also present. Focal fibromuscular dysplasia caused moderate to severe narrowing of many small coronary arteries, including those supplying the conduction system and chemoreceptor. These abnormalities are suggestive of electrical instability of the heart as at least one component of the lethal terminal events in some individuals with sickled erythrocytes. Both the foci of fibrosis and the focal fibromuscular dysplasia of small coronary arteries cannot be simply terminal or recent events but more likely take months or years in developing. For individuals with sickled erythrocytes, as in other examples of sudden death, there is a major element of chance concurrence of numerous otherwise independently less significant factors, but lethal cardiac electrical instability may be the final common pathway.

Adolescent↗
PubMed1994

Normal and abnormal consequences of apoptosis in the human heart: from postnatal morphogenesis to paroxysmal arrhythmias.

Apoptosis and necrosis are two distinctly different forms of cell death and both occur in the human heart. In contrast to necrosis, apoptosis is not associated with inflammation and there are two reasons for this. The apoptotic cell does not swell or rupture prior to its being engulfed by either a macrophage or even a neighboring like cell. And the phagocytosis occurs with unusual rapidity. Apoptosis, also thought of as cell suicide, is a tidy way of removing cells no longer useful, in essence a form of selective deletion. These features make apoptosis a valuable component of morphogenesis, mediation of hormonal and immunological responses, and the homeostatic balance between hypertrophy and atrophy or involution. In the human heart apoptosis has been found in the sinus node of patients with the long QT syndrome. It most likely participates in the important postnatal morphogenesis of the sinus node, AV (atrioventricular) node and His bundle. Apoptosis may also participate in the genesis and pathophysiology of cardiomyopathy, paroxysmal arrhythmias or conduction disturbances (some of which may be responsible for sudden death), focal fibromuscular dysplasia of small coronary arteries, hereditary medial degeneration of the tunica media of coronary arteries, and arrhythmogenic right ventricular dysplasia. The possible role of apoptosis in numerous other changes in the human heart merit future investigation, among them being the pathogenesis of atherosclerosis and mechanisms of ageing in the myocardium.

Apoptosis↗
PubMed1994

Normal and abnormal consequences of apoptosis in the human heart. From postnatal morphogenesis to paroxysmal arrhythmias.

Apoptosis and necrosis are two distinctly different forms of cell death, and both occur in the human heart. In contrast to necrosis, apoptosis is not associated with inflammation for two reasons. First, the apoptotic cell does not swell or rupture before it is engulfed by either a macrophage or even a neighboring like cell. Second, the phagocytosis occurs with unusual rapidity. Apoptosis, also thought of as cell suicide, is a tidy way of removing cells no longer useful, in essence a form of selective deletion. These features make apoptosis a valuable component of morphogenesis, mediation of hormonal and immunologic responses, and the homeostatic balance between hypertrophy and atrophy or involution. In the human heart apoptosis has been found in the sinus node of patients with the long QT syndrome. It most likely participates in the important postnatal morphogenesis of the sinus node, AV node, and His bundle. Apoptosis may also participate in the genesis and pathophysiology of cardiomyopathy, paroxysmal arrhythmias, or conduction disturbances (some of which may be responsible for sudden death), focal fibromuscular dysplasia of small coronary arteries, hereditary medial degeneration of the tunica media of coronary arteries, and arrhythmogenic right ventricular dysplasia. The possible role apoptosis in numerous other changes in the human heart, among them the pathogenesis of atherosclerosis and mechanisms of aging in the myocardium, merits future investigation.

Apoptosis↗
PubMed1993

Histological organization of the right and left atrioventricular valves of the chicken heart and their relationship to the atrioventricular Purkinje ring and the middle bundle branch.

In the avian heart the right and left atrioventricular (AV) valves not only exhibit their own special anatomical characteristics, but they also are in close proximity to the conduction system. The right AV valve is a single, spiral plane of myocardium, in remarkable contrast to the fibrous structure characteristic of the mammalian tricuspid valve. A ring of Purkinje tissue encircles the avian right AV orifice and connects to the muscular valve. The chicken has no crista supraventricularis, its right AV valve serving that function as well as opening and closing the right AV orifice. The left AV valve consists of three leaflets instead of the two typical of mammalian hearts. Its anterior and posterior leaflets are small; its large aortic (medial) leaflet merges with the bases of both the left and noncoronary cusps of the aortic valve by fibrous tissue, resembling that of the mammalian heart. However, unlike in mammals, there is a slim cylinder of continuous myocardium coursing parallel to this fibrous junction. This unusual arc of myocardium in the chicken serves to complete an entire subaortic ring of myocardium and is thus potentially capable of constricting the outflow tract of the chicken's left ventricle. The middle bundle branch connects with both the muscle arch and the AV Purkinje ring. Thus the myocardium in or near both AV valves (and the left ventricular outflow tract) in the chicken heart is so arranged that it may receive direct early activation from the conduction system.

Animals↗
PubMed1993

Cardiac conduction system in the chicken: gross anatomy plus light and electron microscopy.

Twenty-three chicken hearts were used to study the cardiac conduction system by light and electron microscopy. In addition to a sinus node, atrioventricular node (AVN), His bundle, left and right bundle branches (LBB, RBB), the chicken also has an AV Purkinje ring and a special middle bundle branch (MBB). The sinus node lies near the base of the lower portion of the right sinoatrial valve. The AV node is just above the tricuspid valve and anterior to the coronary sinus. The His bundle descends from the anterior and inferior margin of the AV node into the interventricular septum, then dividing into right, left and middle branches some distance below the septal crest. The middle bundle branch turns posteriorly toward the root of the aorta. The AV Purkinje ring originates from the proximal AV node and then encircles the right AV orifice, joining the MBB to form a figure-of-eight loop. The chicken conduction system contains four types of myocytes: 1) The P cell is small and rounded, with a relatively large nucleus and sparse myofibrils. 2) The transitional cell is slender and full of myofibrils. 3) The Purkinje-like cell resembles the typical Purkinje cell, but is smaller and darker. 4) The Purkinje cell is found in the His bundle, its branches, and the periarterial and subendocardial Purkinje network.

Animals↗
PubMed1993

Electron microscopic demonstration of intercellular junctions between subendocardial smooth muscle and myocardium in the sheep heart.

The eustachian ridge of 11 sheep hearts was examined by light and electron microscopy to elucidate the morphologic relationship between cardiac smooth muscle cells and myocardial cells. Smooth muscle cells were commonly observed in the subendocardial connective tissue and they were usually arranged in strands. When mixed with myocardial cells at the margin of these strands, smooth muscle cells exhibited numerous direct connections with the myocardial cells. These intercellular junctions were composed primarily of simple appositions (undifferentiated regions), but occasional desmosomes and fasciae adherents (intermediate junctions) were seen. We found no nexus (gap junctions) at these sites. The existence of direct intercellular junctions between smooth muscle and myocardium suggests several possible electrical and mechanical interactions.

Animals↗
PubMed1993

Congenital disorders of cardiac rhythm and conduction.

Electrical instability of the heart has numerous congenital origins. This review approaches the problems from a morphological standpoint, utilizing selected examples from my own studies of the human cardiac conduction system performed during the last three decades. Subjects discussed include multifocal Purkinje cell tumors, benign congenital polycystic tumors of the AV node, several types of congenital heart block, postnatal morphogenesis of the AV node and His bundle (including considerations of persistent fetal dispersion and crib death), the Wolff-Parkinson-White syndrome, left superior vena cava, focal fibromuscular dysplasia of small coronary arteries, hereditary neuromuscular or musculoskeletal diseases, familial atrial fibrillation, long QT syndrome, and apoptosis of the heart. In many congenital disorders of cardiac electrical activity, both arrhythmias and conduction disturbances may occur. How the abnormal anatomy may relate to cardiac electrical instability is discussed, including certain clinical matters to be considered.

Arrhythmias, Cardiac↗
PubMed1993

Apoptosis and pleomorphic micromitochondriosis in the sinus nodes surgically excised from five patients with the long QT syndrome.

Sinus nodes of five symptomatic patients with the long QT syndrome were surgically excised and followed by permanent electronic pacing as part of a new surgical treatment. We examined those sinus nodes by light and electron microscopy with tissue that was promptly fixed at the time of surgery. All five sinus nodes were similarly abnormal. By light microscopy we found distinctive focal fibrosis, some degenerating myocytes and neural elements, and numerous narrowed small vessels. Except in the nerves there was no evidence of inflammation. In electron micrographs the mitochondria within nodal myocytes were abnormally abundant, remarkably pleomorphic, and smaller than those in normal human sinus nodal cells. The ultrastructural features of the degenerated nodal cells were typical of apoptosis, characterized by the absence of inflammation, well-preserved mitochondria, the presence of apoptotic bodies, phagocytosis of these cells by neighboring myocytes, and especially in smooth muscle cells of arterioles, nuclear chromatin margination and nucleolar disintegration. Apoptotic degeneration of nodal myocytes was stochastic, with adjacent cells appearing unaffected. Focal ischemia caused by narrowed vessels may be a contributory factor, and the nerves may harbor some viral infection, but for the nodal myocytes the abnormality appears to be primarily apoptosis, sometimes called programmed cell death. Both the typically episodic clinical features and the terminal event in fatal cases of the long QT syndrome may be due to apoptosis.

Adolescent↗
PubMed1992

Ultrastructural alterations of the conduction system in mice exhibiting sinus arrest or heart block during Coxsackievirus B3 acute myocarditis.

By light and electron microscopy we studied the sinus nodes and atrioventricular (AV) conducting tissue of six C3H/He mice having coxsackievirus B3 acute myocarditis. Sinus arrest was documented in all six mice, and second- or third-degree AV block was documented in three of the six mice. Although myocarditic changes in the conduction system, especially in the sinus node, were less than those in atrial and ventricular working myocardium, there were distinct abnormalities within both the sinus node and AV conducting tissue in all six hearts. Important ultrastructural alterations were inflammatory cell infiltrates and significant injury of specialized cells and of neural tissue. Specialized cells showed various features of degeneration and necrosis. Neural tissue damage included degeneration of axons and Schwann cells and disorganization of the neuromuscular junctions. Inflammatory cells, particularly macrophages, were often in intimate contact with injured specialized cells and neural tissue. Interstitial edema and bleeding and lymphatic vessel dilatation were also observed. These pathologic changes are considered to play an important role in the development of the documented disturbances of rhythm and conduction.

Animals↗
PubMed1992

Comparative ultrastructure of the tip of ventricular papillary muscle.

Electron microscopic studies of the tips of left ventricular papillary muscles from seven human, two monkey, three sheep, and two chicken hearts were done to elucidate the fine structure of myotendinous junctions. The human specimens were from normal hearts obtained 3 to 9 hours postmortem from persons aged 7 months to 30 years (mean, 13.3 years). We found no significant ultrastructural differences between the human hearts and those of monkey, sheep, and chicken. Myocardial fibers were elongated and thinner (tapered) in the tips of papillary muscles. In addition to usual working myocardial cells, the distal end of narrowing muscle fibers also contained small pale cardiocytes containing fewer myofibrils and smaller mitochondria. These cells were similar to P cells or transitional cells in the conduction system. Nerve axons and Schwann cells were commonly seen in the interstitium, usually in association with capillaries. Fibroblasts and axon varicosities were occasionally seen extremely close to the cardiocytes. These specialized myocardial cells associated with rich neural tissue in the papillary muscle tip possibly function as foci of local automaticity. This histologic organization may also represent neurosensory function responding to and monitoring local pressure changes, efferent adrenergic or cholinergic neural activity, or both.

Adolescent↗
PubMed1991

Clinical and pathologic manifestations of pulmonary vascular disease in the toxic oil syndrome.

The toxic oil syndrome in Spain affected greater than 20,000 people. In the initial stages, it was characterized by a respiratory distress syndrome with myalgias and eosinophilia. Pulmonary hypertension developed in 20% of the patients and in many, it has spontaneously regressed. Nevertheless, in a small subgroup, it has progressed to a malignant course of cor pulmonale, leading rapidly to death. Clinical and pathologic features of 40 patients with severe pulmonary hypertension due to the toxic oil syndrome are presented (32 female and 8 male patients; mean age 26 +/- 13 years). The study began in June 1981, which was near the onset of the toxic oil epidemic, and ended in December 1987, greater than 6 years later. The pulmonary hypertension is clinically and pathologically indistinguishable from primary pulmonary hypertension. Direct endothelial injury by the toxic agent is proposed as the initial trigger of this type of pulmonary hypertension, but an interaction between the toxic agent and specific individual susceptibility is probably required in its pathogenesis.

Adolescent↗