Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chr...Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.展开更多
Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and phy...Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit.Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung periphery.However, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anatomically morbid states in alveolar walls:type-1abnormality defined by decrease in both D_(LCO) and K_(CO); type-2 abnormality by decrease in D_(LCO) but increase in K_(CO); type-3 abnormality by decrease in D_(LCO) but restricted rise in K_(CO); and type-4 abnormality by increase in both D_(LCO) and K_(CO).展开更多
文摘Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.
文摘Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit.Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_(O2), the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_(O2) decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_(O2) difference is considered useful for assessing gas-exchange abnormalities in lung periphery.However, one should be aware that although alveolar-arterial P_(O2) difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_(LCO))and the value corrected for alveolar volume (V_(AV)), i.e., D_(LCO)/V_(AV) (K_(CO)), are thought to be crucial for diagnosing alveolar-wall damages. D_(LCO)-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_(LCO) with those of K_(CO) for differential diagnosis on anatomically morbid states in alveolar walls:type-1abnormality defined by decrease in both D_(LCO) and K_(CO); type-2 abnormality by decrease in D_(LCO) but increase in K_(CO); type-3 abnormality by decrease in D_(LCO) but restricted rise in K_(CO); and type-4 abnormality by increase in both D_(LCO) and K_(CO).
