Marginal artery

Fig. 6.3. a SMA arteriogram showing numerous inter-connections in the mesentery between the small bowel branches, b IMA arteriogram showing that aside from the marginal artery, there are relatively few potential collateral connections between the major IMA branches... 

The inferior mesenteric artery (IMA) arises from the aorta at the level of the left pedicle of L3 and supplies the left colon, sigmoid, and rectum. It is frequently occluded in older populations. Collateral flow to this distribution can come from the marginal artery of Drummond or from branches of the internal iliacs. 

Right atrium Right ventricle Right coronary artery Inferior vena cava Marginal branch... 

The other program involves systemic administration of the gene-laden adenovirus via a hepatic artery catheter to treat hepatocellular carcinoma (HCC). The hepatic artery supplies the normal liver with 25% of its blood supply. However, it is the sole blood supply for the carcinoma. Preclinical results demonstrated efficacy in a rat HCC model. In a small, open-label clinical trial of patients positive for HCC, but also having post-hepatitis cirrhosis, patient response was marginal [22]. 

We now turn to an anatomical description of lymph nodes. The lymph node is surrounded by a thick, fibrous capsule and is subdivided into compartments by trabeculae. Inside the capsule is the subcapsular or marginal sinus, which forms the entry point of lymphatic fluid into the node, via the afferent vessel. The lymph node cortex, which lies beneath the subcapsular sinus, is the location of the primary and secondary lymphoid follicles. The primary follicles are comprised of B-lymphocytes. An immune response stimulates B-cells to replicate and differentiate, converting the primary follicle into a secondary follicle or germinal center, surrounded by a zone of small lymphocytes. The paracortex surrounds the germinal centers and primary follicles and contains mostly T-lymphocytes. The medulla is composed of medullary cords, consisting of macrophages and plasma cells, and medullary sinuses. The medullary vessels include the arteries and veins, and the afferent and efferent lymphatic vessels, respectively, deliver the lymphatic fluid into and out of the lymph node. 

The middle cerebral artery, which originates at the division of the internal carotid artery, passes through the lateral sulcus (Sylvian fissure) en route to the lateral convexity of the cerebral hemisphere, to which it supplies blood. The middle cerebral artery travels along the surface of the insular cortex, over the inner surface of the frontal, temporal, and parietal lobes, and appears on the lateral convexity. The posterior cerebral arteries originate at the bifurcation of the basilar artery, and each one passes around the lateral margin of the midbrain. 

Liver metastases are frequently multiple. They vary in size and are usually hypodense. In contrast to liver parenchyma, they display relatively sharp contours, with a difference in density of at least 10 -15 HU. In fatty liver, metastases may even appear hyperdense. Liver metastases are mainly supplied by arterial blood. Therefore i.v. (or even intra-arterial) bolus injection of CM produces the best diagnosis the metastasis shows increased CM enrichment during the short hypervascular phase additionally, a peripheral margin forms as a result of the increased concentration of CM. Metastases of 5 -10 mm can be detected. Data in the literature confirm a sensitivity of 65-91% (in breast cancer up to 100%) and a specificity of 81 - 92% with a success rate of 80 - 85%. Proof of metastases clearly depends on the histology of the primary tumour the best diagnostic results are obtained in breast and colon carcinomas. (22,39,50,53,57)... 

LCX, left circumflex coronary artery OM, obtuse marginal branch PB, posterobasal branch. 

Also, the ST-segment elevation is seen in the precordial and inferior leads in the presence of an STE-ACS due to the very proximal occlusion of the RCA before the RV marginal branches. In this case usually the ST-segment elevation in VI > V3-V4, while in an STE-ACS due to the distal occlusion of the LAD, the contrary occurs (i.e. the ST-segment elevation is VI < V3). Table 4.2 shows the ECG criteria that allow differentiating the culprit artery (proximal RCA or distal LAD) in the case of ST-segment elevation in precordial leads and inferior leads. 

---