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Obstruction and reflux occur fairly commonly in the duplex kidney. Although obstruction with attendant hydronephrosis is more frequently seen in the upper pole of a duplex system, a similar process involving the lower pole should be considered in the differential diagnosis of renal mass lesions. Four cases are described in which lower pole hydronephrosis simulated neoplasm.
Chemotaxis, the directed migration of leukocytes towards a chemoattractant gradient, is a key phenomenon in the immune response. During lymphocyte-endothelial and -extracellular matrix interactions, chemokines induce the polarization of T lymphocytes, with generation of specialized cell compartments. The chemokine receptors involved in detection of the chemoattractant gradients concentrate at the leading edge (advancing front or anterior pole) of the cell. The adhesion molecules ICAM-1, -3, CD44 and CD43 redistribute to the uropod, an appendage at the posterior pole of migrating T lymphocyte that protrudes from the contact area with endothelial or extracellular matrix substrates. Whereas chemokine receptors sense the direction of migration, the uropod is involved in the recruitment of bystander leukocytes through LFA-1/ICAM-dependent cell-cell interactions. While beta-actin concentrates preferentially at the cell's leading edge, the motor protein myosin II and a microtubule organizing center (MTOC) are packed in the uropod. The actin-binding protein moesin, which belongs to the ERM family of ezrin, radixin and moesin, redistributes to the distal portion of uropods and physically interacts with ICAM-3, CD44 and CD43, thus acting as a physical link between the membrane molecules and the actin cytoskeleton. Moreover, the moesin-ICAM-3 association correlates with the degree of cell polarity. The redistribution of the chemokine receptors and adhesion molecules to opposite poles of the cell in response to a chemoattractant gradient may guide cell migration and cell-cell interactions during lymphoid cell trafficking in immune and inflammatory responses.
The renin-angiotensin system was studied in experimental renal hypertension produced by ligation of the poles of the left kidney followed by contralateral nephrectomy. Plasma renin concentration of renin substrate was lower and that of angiotensin I converting enzyme was higher in hypertensive animals. The juxtaglomerular index decreased in the medial zone of the kidney, while heavily granulated areas appeared in the poles. Ligated kidneys of rats that remained normotensive showed juxtaglomerular indices intermediate between the control and the hypertensive rats. Differences in renal renin content between the groups correspond to those for the juxtaglomerular index, but were smaller. No differences between the experimental groups were observed in iso-renin content in the brain; however in all animals with ligated kidney poles, hypertensive or normotensive, there was a tendency for iso-renin in the adrenals, left ventricular myocardium, and especially aorta to be lower than in controls.
OBJECTIVE: The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. METHODS: Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. RESULTS: The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 x splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 x inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 +/- 16.1 mm; P < .05 [hilum]; 18.9 +/- 14.2 mm; P < .05 [inferior pole]). CONCLUSIONS: These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.
Aneuploidy and polyploidy are commonly observed in transformed cells. These states arise from failures during mitotic chromosome segregation, some of which can be traced to defects in the function or duplication of the centrosome. The centrosome is the organizing center for the mitotic spindle, and the equivalent organelle in the budding yeast, Saccharomyces cerevisiae, is the spindle pole body. We review how defects in spindle pole body duplication or function lead to genetic instability in yeast. There are several well documented instances of genetic instability in yeast that can be traced to the spindle pole body, all of which serve as models for genetic instability in transformed cells.
The temporopolar region is not clearly defined from an anatomical point of view. A line going through the rostral area of the inferior temporal, occipito temporal and superior temporal sulci is considered to represent its posterior limit on the lateral and inferior sides. On the internal side, this posterior limit corresponds to the rhinal sulcus, an anterior and internal extention of the collateral sulcus. From a cyto-architectonic point of view, the temporopolar region is caracterized by a dysgranular paralimbic cortex which ensures the transition between allo- and isocortical areas. The temporal pole is mainly connected with the amygadala, the hippocampus, the superior temporal gyrus, and the occipitobasal cortex, but also with the orbitary gyrus and the insula with which it forms the insulo-orbito-polar-temporo-complex. The temporal pole occupies the most rostral part of the temporal lobe and can only be accurately defined once the anatomy of the temporal lobe as a whole has been outlined. The architectonic configuration of this region as well as its connections with the limbic system, and the superior, orbital and insular temporal cortices make it a discrete temporal structure. Understanding the anatomical and functional organization of the temporal pole enables us to hypothesize about the role played by this structure in the pathogenesis of the forms of epilepsy originating in mesial temporal lobe structures.
BACKGROUND: The purpose of the study was to compare the efficacy of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for lower pole nephrolithiasis. METHODS AND RESULTS: We retrospectively analyzed results of lower pole nephrolithiasis treatment in 396 patients (221 treated by extracorporeal shock wave lithotripsy and 175 by percutaneuos nephrolithotomy). We evaluated results of the treatment in the 3 months interval after the procedure in groups classified according to the stone size: <10 mm, 10-20 mm, >20 mm. Stone free status was achieved in these groups after 96 (66%), 43 (38 %) and 2 (25%) shock wave lithotripsies and 48 (84%), 75 (76%) and 25 (74%) percutaneous nepholithotomies. The efficacy irrespective of insignificant residual fragments (< 4 mm) was in 176 (66%) lithotripsies and 156 (82%) single percutaneuos nephrolithotomies. CONCLUSIONS: Percutaneous nephrolithotomy is more effective methods in the treatment for lower pole nephrolithiasis than extracorporeal shock wave lithotripsy especially for stone size >10 mm.
The study deals with the development of an effective, atraumatic and easy-to-use treatment for patients with progressive myopia, by using a discoid xenograft. The treatment involves implantation of a discoid xenograft to the episclera of the posterior pole of the eye. The xenograft is a white disk prepared from the treated bovine pericardium and it has 2 mm in thickness and a diameter of 13 mm. Clinical studies were performed in 89 patients (161 eyes) operated on by the proposed procedure, by evaluating the stabilized progression of myopia 4 years later. In the late period of a follow-up, the stabilization effect was 88.3 to 92.6% in relation to the degree of myopia. There was evidence for increases in the thickness of the sclera (and its acoustic density) on the posterior pole of the eye, for improved regional hemodynamics and better electrophysiological functions of the retina in the postoperative period. Xenoscleroplasty of the posterior pole of the eye with a bovine pericardial xenograft is an easy-to-use, pathogenetically oriented, highly effective, and safe treatment in patients with progressive myopia.
An easy method of upper-pole heminephroureterectomy is described in which a finger is inserted into the dilated upper collecting system, and the upper pole is removed by dissecting directly against the collecting system using finger guidance. This approach prevents entry into the lower-pole collecting system, minimizes blood loss, and maximizes preservation of normal renal tissue. Easy access to the lower ureter through the same incision is facilitated by the use of the Sims vaginal retractor.
In the period 1978-1987 20 eyes were operated for retinal detachment with a hole in the posterior pole. Various surgical methods were applied with a preponderance of the extrascleral surgery in 1978-1985. In cases of existence of a hole at the posterior pole reattachment of the retina was achieved in 63.7%. Instead in cases of a hole at the posterior pole and at the periphery the reattachment of the retina was observed in 55.6%. In the years 1985-1987 after application of endotamponade with a gas and a laser photocoagulation the percentage of a cure increased (3 cases--3 reattachments).
Among sixty-four patients with primary haematuria, immunofluorescence methods revealed seven cases (11%) with isolated C3 deposits in the 'vascular pole'. Serum complement were normal and the follow-up after 20-41 months indicate a benign course. In patients with C3 deposits in the 'vascular pole' light microscopy was normal. We never observed C3 deposits in specimens of normal kidney which were processed by the same methods using mono-specific antisera confirmed by immunoelectrophoresis. This entity defined by immunofluorescence methods, can be called 'vascular pole disease'.
Right sided accessory pathways with slow and decremential anterograde conduction differ from the anatomical substrates of the nodo-ventricular connections described by Mahaim. The connection may also be atrio-ventricular or atrio-fascicular. The authors report a series of 6 patients (2 men, average age 31 +/- 9 years) with antidromic reciprocating tachycardia implicating accessory pathways with decremential conduction (wide QRS complexes with left bundle branch block) the radiofrequency ablation of which was centered on the proximal atrial pole. The increment of pre-excitation was 75 +/- 18 ms. No nodo-ventricular or nodo-fascicular connections were observed. One patient had an atrio-ventricular connection, the mapping and ablation (5 applications) of which were performed on the annulus, as if it were a bundle of Kent. Five patients had a nodo-fascicular connection which was masked during sinus rhythm. The localisation of the proximal atrial insertion on the tricuspid annulus was initially estimated by studying the superior junction of the circuit and by endocavitary stimulation, and then by recording the M potential (activation of the accessory pathway). This was recorded in 4 patients, either at a specific point on the annulus (lateral or postero-lateral) which was the target of ablation (3 patients, 5 +/- 3 applications) or over a wider region (2 cm) at which ablation failed (1 patient: 13 applications). The site of the increment was determined in 2 patients and was proximal to the M potential. The M potential could not be recorded on the annulus in one patient. In 2 patients, the M potential was also recorded along the side of the pathway on the antero-lateral wall of the right ventricle of the tricuspid valve at its distal pole. In 2 patients, ablation was centered on the distal pole in second intention, near to the terminal part of the right bundle where it was localised in one of the two (18 applications). Finally, ablation was obtained in 5 out of 6 patients. They remain asymptomatic after 12 +/- 7 months follow-up. These cases show that accessory pathways with slow decremential conduction usually behave like a complete conduction pathway with an accessory laterally situated atrioventricular node on the tricuspid, an accessory bundle and a distal insertion which are all accessible to ablation.
PURPOSE: We evaluated the efficacy of extracorporeal shock wave lithotripsy (ESWL) for lower pole calculi regarding immediate and long-term radiographic and clinical outcomes. MATERIALS AND METHODS: A total of 206 patients with isolated lower pole calculi in 220 renal units underwent ESWL for stones 4 to 625 mm2 (mean 88). Clinical and radiographic followup was obtained at 1 month and every 6 to 12 months thereafter. An initial stone-free rate was determined, as was the subsequent radiographic outcome. Clinical outcome with regard to a symptomatic episode or requiring intervention was also determined. Kaplan-Meier estimates of the probabilities of these outcomes with time were developed. RESULTS: Of the 206 patients 99 (48%) were rendered stone-free by 1 month after ESWL. Another 13 patients (6.3%) spontaneously became stone-free within another 1 to 95 months (mean 17.5). Of the remaining patients residual stones were decreased, stable or increased in 13 (6.3%), 71 (34%) and 10 (4.8%), respectively, after 1 to 91 months (mean 14.5). Among all 206 patients 180 (87.4%) remained asymptomatic for 1 to 99 months, while 7 (3.4%) suffered a symptomatic episode requiring medical attention 1 to 40 months (mean 21.1) after ESWL and 19 (9.2%) required intervention after 1 to 91 months (mean 23.9). Kaplan-Meier estimates of the probabilities of a symptomatic episode or requiring intervention at 5 years were 0.24 and 0.52, respectively. CONCLUSIONS: ESWL is the initial treatment of choice for lower pole calculi smaller than 2 cm.2 because the stone-free rate is comparable to that for stones at other caliceal locations and, perhaps more importantly, the risk of a symptomatic episode or requiring secondary intervention is low even in the setting of residual fragments.
OBJECTIVE: To evaluate the efficacy of the EDAP LT 02 lithotriptor for the treatment of lower pole nephrolithiasis. METHODS: From January 1994 to September 1995, 91 patients presenting with solitary radiopaque calculi of the lower pole calix were treated by piezoelectric extracorporeal shock-wave lithotripsy (ESWL) with the EDAP LT 02. Among them, 82 were available for follow-up. The stones' largest diameter of these patients varied from 5 to 15 mm (mean = 8.1). Indications for ESWL were pain in 63 (77%), hematuria in 5 (6%), associated infection in 6 (7.5%) and stone size in 8 (10%) asymptomatic patients. Stone localization was assessed as very easy in 74 cases (90%) and difficult in 8 cases (10%) but no intraoperative IVP was needed. ESWL sessions were performed with intravenous sedo-analgesia in 69 cases (80%) and general anesthesia in 17 cases (20%). After ESWL we advised patients to combine a diuresis with postural drainage. RESULTS: Most patients were treated with one session of ESWL: none required more that two (mean = 1.05). The mean hospital stay for one session was 1.2 +/- 0.7 days. Obstructive complication rate was 11% and auxiliary treatments were necessary in 6%. The stone-free rate of in situ piezoelectric ESWL monotherapy was overall 84%, and 95% of patients with pain were cured. CONCLUSION: In the absence of abnormality of the upper urinary tract, the vast majority of small lower pole caliceal stones can be completely removed by piezoelectric ESWL without recourse to more invasive methods.
In the past, our interpretations of cardiac development depended on analysis of serially sectioned embryos, supported by three-dimensional reconstructions. It was not possible, using these techniques, to trace the fate of the various embryonic building blocks. This has all changed with the advent of the new techniques in molecular biology. Combining our experience with these new techniques and our previous studies using the classic approach, we have reviewed how the recent advances clarify controversies that still exist concerning the development of the venous pole. The arguments devolve on whether the pulmonary vein is itself a new development or whether its primordium is derived from the systemic venous tributaries, the so-called sinus venosus. The new techniques show that, rather than developing in the form of a segmented tube, the heart is built up by addition of material to both its arterial and venous poles. At no stage is it possible to recognize a discrete part of the tube that can be identified as the sinus venosus. The confluence of the systemic venous tributaries does not become recognizable as a discrete anatomic entity until compartmented into the newly formed right atrium concomitant with formation of the venous valves. The new molecular techniques show that the pulmonary vein is a new structure, anatomically and developmentally, that is derived from mediastinal myocardium. It gains its connection to the morphologically left atrium between the right- and left-sided systemic venous tributaries.
Three-dimensional (3D) power Doppler sonographic imaging provides a 3D view of the blood vessels. This technique reportedly has advantages over other forms of sonography in visualizing normal and abnormal fetal vascular anatomy. We report the case of a 36-year-old pregnant woman in whom 3D power Doppler sonography with simultaneous gray-scale imaging was performed at 32 weeks' gestational age to investigate an intestinal obstruction in the fetus that was suspected on the basis of 2-dimensional sonographic findings. The 3D sonograms revealed that the superior mesenteric artery and vein of the fetus were wound counterclockwise, forming the "barber-pole" sign. At 38 weeks' menstrual age, the female infant was delivered vaginally. Only duodenal atresia and annular pancreas, but not intestinal malrotation, were found postnatally. Surgical reconstruction of the duodenum was performed, with no major complications. Previous research suggests that the counterclockwise barber-pole sign is a normal finding. On the basis of our case, we believe that this "negative finding" might be used to exclude the diagnosis of midgut volvulus, a condition that would be expected to cause these vessels to wrap around in a clockwise direction.
Bacteria such as Staphylococcus, Lampropedia, and Sarcina develop in characteristic two-or three-dimensional groups of cells. We propose here a model of how bacteria may generate such groupings by an extension of an earlier model for rod-shaped bacteria. No other mechanism for forming two- or three-dimensional structures of groups of cells has been proposed. Our earlier model for division of rod-shaped bacteria into nearly equal-sized daughters assumed that the origin and terminus DNA were attached at a critical time to polar wall sites. While such binding was speculative 20 years ago, it has now been established that the DNA for the origin of replication, at least during some part of the cell cycle is located in the pole for several different bacteria. Evidence is also building showing that the terminus DNA region is sometimes located at a position in the cell that will develop into two new poles. Here, a new extension of the concept that polar sites bind specifically origin and terminus DNA of the chromosome is presented that can explain how division takes place in one and then in another dimension to form two-dimensional tablets of four cells or large planar arrays. A further possible extension to three dimensions to generate octets of cells is proposed.
In the present study we provide a detailed structural analysis of the vascular pole of superficial and midcortical glomeruli of the rat kidney. A description of the juxtaglomerular portions of the afferent and efferent arterioles, the extraglomerular mesangium and the glomerular stalk is included. The specific structural elaboration of the epithelial transition from the podocytes to the parietal epithelium is emphasized, with particular attention to the arrangement of the cytoskeleton and its connections to extracellular matrix elements. The branching patterns of the afferent and efferent arterioles are quite different. Immediately at the glomerular entrance, the afferent arteriole divides into its primary branches. In contrast, the efferent arteriole has a specific outflow segment (consisting of an intraglomerular portion and a portion associated with the extraglomerular mesangium) established by the confluence of capillary tributaries deep inside the glomerular tuft. Just at the transition from inside to outside, this segment includes a prominent narrow portion with conspicuous endothelial cells bulging into the vessel lumen. The extraglomerular mesangium has been found to represent a solid block of cells and matrix filling the space between the macula densa and both arterioles and extending into the entrance funnel. Peripherally located extraglomerular mesangial cells attach to the outer aspect of the parietal basement membrane. As a whole, the extraglomerular mesangium occludes the glomerular tuft. The results appear relevant with respect to four major aspects: (1) a support function counteracting the expansile forces resulting from the high intraglomerular pressures, (2) a direct functional influence of the afferent on the efferent arteriole, resulting from their narrow assemblage at the glomerular entrance, (3) a specific shear stress receptor function of the intraglomerular segment of the efferent arteriole, and (4) fluid leakage from the glomerular tuft through the stalk and the extraglomerular mesangium into the cortical interstitium. 1. The glomerulus is a high-pressure compartment; expansile forces continuously tend to expand glomerular capillaries, the glomerular stalk, and the glomerular entrance. Counteracting centripetal forces at the vascular pole appear to be developed as circular forces by the cytoskeleton of podocytes and parietal cells surrounding the glomerular entrance and as interconnecting forces between both arterioles and between opposing walls of the glomerular entrance, as well as of the glomerular stalk. These interconnecting forces are developed by the extraglomerular mesangium which--as a whole--forms a spiderlike closure device holding the glomerular entrance together. In addition, the extraglomerular mesangium develops occluding forces, allowing a gradual pressure drop between the glomerular stalk and the macula densa. 2. At the glomerular entrance, the outflow segment of the efferent arteriole is narrowly associated with the bifurcation of the afferent arteriole. Both are enclosed together in a common compartment surrounded by the glomerular basement membrane; there is no pressure barrier individually encompassing each vessel. Therefore, it may readily be suggested that the hydrostatic pressure of the afferent arteriole acts on the efferent arteriole. As a consequence, the luminal width of the efferent arteriole at this site, i.e., its resistance, may be directly modified by the pressure in the afferent arteriole. 3. The efferent arteriole at the transition of the intraglomerular segment to the segment that passes through the extraglomerular mesangium has a conspicuously narrow portion with endothelial cells protruding into the vessel lumen. In addition, this segment is prominent by the expression of the neuronal type of nitric oxide synthase. We therefore propose that this segment acts as a specific shear stress receptor. The possible relevance of a shear stress receptor at this site would be