A nemzetközi és a magyar anatómiai nevek egységesítési problémái

Az első anatómiai nómenklatúra, a bázeli „Nomina anatomica” (1895) megjelenésével az anatómiai nevek megalkotásának folyamata nem zárult le, a nemzetközi anatómiai nevezéktan azóta is folyamatos revízió alatt áll. A nevezéktan újragondolását és javítását az új anatómiai struktúrák megnevezése, az archaikus szemléletű nevek megújítása (pl. ramus descendens anterior helyett ramus interventricularis anterior), a már használatban levő nevek hibáinak javítása, a szemlélet egységesítése mellett a más orvosi területekkel, különösen a klinikai ágak nyelvhasználatával való harmonizáció teszi szükségessé. A korábbi kiadásokat következetesség szempontjából felülmúló „Terminologia anatomica” (1998) a különböző orvosi szakterületek terminológiájának egységesítését tűzte ki célul. Az egységes, több terület átfogó anatómiai nómenklatúra létrehozása csak terminológusok, nyelvészek, anatómusok és a klinikai ágak művelőinek szoros együttműködésével valósítható meg.

Symptomatic myocardial bridging: a frequently occurring coronary variation can cause severe myocardial ischaemia in affected children with underlying cardiac conditions

Myocardial bridging is a congenital coronary artery anomaly in which the coronary artery has a partly “tunnelled” intramyocardial course. This tunnelling leads to compression of the affected vessel segment during ventricular systole. It is considered to be a benign variation of the norm in about 25% of the population caused by an aberrancy of embryologic coronary development. The bridging is also thought to cause severe cardiac conditions in a few of those affected. The series of six young patients presented here is the largest series so far to report on symptomatic myocardial bridging in children with different underlying heart diseases. All patients recently presented to our centre with signs of myocardial ischaemia. They subsequently underwent coronary angiography, which revealed myocardial bridging of the ramus interventricularis anterior. In all patients, therapy with β blockers was started to reduce heart rate and myocardial contractility. β Blocker treatment was also given in order to prolong diastole and improve coronary artery blood flow. Two patients underwent surgical exposure of the involved coronary segment: a 2-year-old boy because of recurrent, severe myocardial ischaemia in combination with a reduction of general health, changes in ST-segments, and the presence of a dilative cardiomyopathy; and a 13-year-old girl because of evidence of myocardial ischaemia during exercise testing after surviving sudden cardiac death. Surgery was successful and recovery was complete and uneventful. The presented series shows that myocardial bridging can be symptomatic and may require urgent treatment and even surgical intervention in early childhood in rare cases.

Ölüm Nedeninin Tespitinde Yardımcı Bir Bulgu Diagonal Kulak Lobu Çizgisi

Koroner arter hastalıkları, doğal sebeplerle meydana gelen ölüm nedenlerinin başında gelmektedir. Bu hastalıkların yüksek insidans ve mortalité oranları, bilinen risk faktörlerinden çok, olası risk faktörlerinin araştırılmasını gerekli kılmıştır. Bir fizik muayene bulgusu olan diagonal kulak lobu çizgisi (DKLÇ), 1973 yılında tanımlanmıştır. Çalışmamızda, DKLÇ’nin, ölü muayenesi yapan hekim için ölüm nedeninin tespitinde yardımcı bir bulgu olup olamayacağının saptanması amaçlanmıştır. Çalışmamızın bulguları, vakalara uygulanan anjiografiler sonucunda; a. coronaria sinistranın dalları olan ramus interventricularis anterior (RIA) ve ramus circumflexus (RC) ile a. coronaria dextra’da (ACD) saptanan daralma yüzdeleri arttıkça DKLÇ görülme sıklığının da arttığını göstermektedir. Bu durum DKLÇ ve koroner arter hastalıkları arasmda anlamlı ilişkiler bildiren daha önceki çalışmaların bulguları ile uyumludur. Özellikle öyküye ulaşma olanağı bulunmayan ve herhangi bir travmatik bulgu saptanmayan vakalarda DKLÇ’nin, ölümün koroner arter hastalığından meydana geldiği yönünde destekleyici bir bulgu olarak muayeneyi yapan hekimin dikkatini çekmesi gereken bir işaret olduğunu düşünmekteyiz.Anahtar kelimeler: Diagonal kulak lobu çizgisi, koroner arter hastalığı, ölü muayenesi.

Heterogeneity in geometrical alterations of main branches of left coronary artery induced by increase in ventricle volume

With the use of ultrasound technique, segment length and diameter of ramus circumflexus (RC) and ramus interventricularis anterior (RIA) in the dog heart, placed in a bath, were monitored under constant pressure. When the left and/or right ventricular volume was increased by 150% of the normal diastolic filling, segment length of RC increased by 2.54 +/- 0.17 and 2.15 +/- 0.06%, respectively, and diameter of RC decreased by 4.72 +/- 0.20% and by 4.60 +/- 0.20%, respectively. The same filling of the left and/or right ventricle induced in the proximal third of RIA an increase in segment length by 11.40 +/- 0.55 and 12.2 +/- 0.42%, respectively, and a decrease in diameter by 9.41 +/- 0.42% and by 10.01 +/- 0.31%, respectively. The latter values of RIA were significantly higher (P less than 0.001) than those registered in RC. The deformations of RIA decreased toward the periphery of the vessel. By the fact that conduit coronary artery tracks instantaneously the increase of the volume of the left and right ventricle, its contribution to the total coronary resistance increases dynamically. With the ventricular volume increased by 150%, the RC contributes to the total coronary resistance by 14% and RIA in the proximal part contributes by 23%, with values significantly higher than control (10%) (Malindzak, G. S. In: The Coronary Artery. London: Croom Helm, 1982, p. 241-267). The results imply a methodical consequence, namely that the diameter of the respective coronary artery is an index of smooth muscle activity only if both perfusion pressure and volume of the heart are maintained constant.

Scintigraphic Detection of Experimental Myocardial Infarction with 99mTc-Heparin in the Dog

SummaryExperimental infarctions were produced in 12 dogs by ligation of the Ramus interventricularis anterior of the left coronary artery, and their uptake of 99mTc-heparin was measured 7, 24 and 48 h as well as 7 days thereafter by recording an in vivo chest scintigram 4 h after intravenous injection of the compound. The dogs were subsequently killed, the heart removed and an in vitro scintigram obtained. Finally, the uptake of the compound was measured in tissue samples. The results indicate that 99mTc-heparin is accumulated in lesions which are not older than 24 h. At the other points in time uptake is low but even 24-h old lesions cannot be demonstrated reliably. The results are impaired by the high blood activity on the cardiac chambers and by the background activity of the lungs. In general, 99mTc-heparin has less useful properties than the more frequently employed 99mTc-pyrophosphate so that a change of procedure is not to be recommended.