经颞骨岩部乙状窦前入路处理岩斜区病变的应用解剖

目的 :研究经颞骨岩部乙状窦前入路进行岩斜区直接手术的方法 ,寻找出该入路的标志点和颞骨岩部的磨除方法 ,并观察手术的暴露范围和优缺点。方法 :用 15例血管经彩色乳胶灌注的成人尸头标本 ,显微镜下 (× 6～ 2 5 )解剖经颞骨岩部乙状窦前入路。结果 :岩乙状窦交叉点、内淋巴囊裂是磨除颞骨岩部后面的重要标志 ,用内淋巴囊裂可以初步定位前庭小管、总脚和后半规管。此入路能够暴露从鞍背到延髓中上部的区域 ,以暴露中岩斜区最佳。离断内淋巴囊 ,可扩大骨磨除的面积 ,增加手术的暴露。结论 :以岩乙状窦交叉点、内淋巴囊裂为标志为安全磨除颞骨岩部后面提供了保证。经颞骨岩部乙状窦前入路具有手术距离短、视野暴露充分的特点 ,特别适用于骑跨颅中、后窝而以颅后窝为主的岩斜区病变     

个体化三维数字模型在内镜经鼻颞骨岩部解剖中的应用

目的　研究个体化三维数字模型（three-dimension digital manikin,3D-DM）在内镜经鼻颞骨岩部解剖中的应用,探讨其临床应用价值。 方法　10例（20侧）成人头部标本灌注后经CT扫描,将图像导入3Dview软件,重建出个体化3D-DM,运用“逆向骨窗形成”技术设计并模拟颞骨岩部骨窗形成。然后在3D-DM辅助下对颞骨岩部进行内镜解剖,对头部标本解剖与个体化3D-DM视野及相关测量进行比较。 结果　通过逆向骨窗形成技术可术前模拟颞骨岩部磨除,头部标本解剖与个体化3D-DM下视野高度一致,相关测量间比较无统计学差异。 结论　个体化3D-DM为内镜下经鼻入路暴露颞骨岩部提供详尽解剖数据,可以术前模拟颞骨岩部磨除,提高术中颞骨岩部磨除的准确性和安全性,对该手术入路的临床应用具重要指导意义。     

颞骨岩部在岩斜区手术入路中的应用解剖

目的 :为颞骨岩部的临床应用提供解剖学依据。方法 :对 15例成人尸头湿标本的颞骨岩部及其周围结构按手术入路分别从前、外、后三个方向进行显微解剖研究。结果 :①磨除颞骨岩部尖 ,可以向下向外移动三叉神经 ;②外展神经是磨除颞骨岩部的内限 ;③面神经分为 5段 :颅内段 (12 .3 2mm)、内耳道段(9 .18mm)、迷路段 (5 .14mm)、鼓室段 (11.82mm)、乳突段 (17.90mm) ;④颈静脉球高度变异较大 ;⑤颈内动脉岩部膝距耳蜗 2 .65mm ,其水平段平行于岩大神经 ;结论 :①岩大神经是从前方磨除颞骨岩部十分重要的标志 ;②岩乙状窦交叉点和内淋巴囊裂是从后外侧磨除颞骨岩部的重要标志     

颞骨岩部入路颅底手术有关的应用解剖

目的:为经岩部入路颅底手术提供解剖学参数.方法:观测成人的100例干燥整颅、20例颅底标本、15例尸头及36侧正常颅底CT资料;观测项目为与经岩部入路颅底手术有关的颞骨表面标志与岩部内重要结构的位置及其间距.结果:整颅及颅底内面各项测量结果左右侧比较U均<1.96,P均>0.05,颞骨内重要结构间及与表面标志间距离测量结果多数项目男女性间比较U均>1.96或>2.58,P<0.05或<0.01;颅中窝入路可以弓状隆起作标志寻认上骨半规管以确认内耳道,也可以岩大神经管裂孔为标志暴露面神经膝状神经节与迷路段确认内耳道底;磨除岩尖部骨质时可以颈动脉管后壁与内耳门内侧缘的连线作为界线.结论:颞骨表面标志点间距及颞骨岩部内重要结构间的位置关系可为经岩部入路颅底手术提供重要参考,有利于术中岩部重要结构的定位与保护.     

《中国临床解剖学杂志》2003年(第21卷)分类索引

述　评颅底微创外科解剖学研究现状与展望　丁自海等　 2 1( 5 ) :417老学科的发展要有新的结合点———纪念《中国临床解剖学杂志》创刊 2 0周年　钟世镇　 2 1( 6) :5 3 5数字化人体数字化虚拟中国人女性一号数据图像处理　原林等　 2 1( 3 ) :193专　论旋股外侧血管升支髂骨瓣的解剖与临床研究　陈振光等　 2 1( 6) :5 43颅脑手术入路解剖扩大颅中窝硬脑膜外经颞骨岩部入路至岩斜区的应用解剖　王玉海等　 2 1( 1) :3颅后窝外侧入路术的应用解剖　纪荣明等　 2 1( 1) :7远外侧经枕髁手术入路防止椎动脉损伤的应用解剖　王洪正等　 2 1( 2…     

人工耳蜗植入经颅中窝入路的相关解剖

目的：为经颅中窝进行耳蜗植入术提供解剖资料，同时寻找定位植入点的方法。方法：取成人头颅标本15例（30侧），开颅后在颞骨岩部磨出蜗螺旋管底圈鼓阶最高点和相关结构，观测其与周围重要解剖结构的关系。结果：①颅中窝入路鼓阶植入点位于岩嵴下方，两者间骨质厚度为（8．58&#177;2．28）mm；在内耳道前方，距内耳道底距离为（1．47&#177;0．30）mm；在岩大神经后方，距其距离为（3．88&#177;0．52）mm；在面神经内侧．距其距离为（2．80&#177;0．26）mm；在前半规管内侧，距其距离为（9．46&#177;1.01）mm；②植入点至蜗窗上缘豹鼓阶长度为（12．03&#177;1．26）mm；③颈内动脉的膝部位于耳蜗的内下方，与蜗螺旋管底圈间骨质厚度为（1．54&#177;0．47）mm；耳蜗最高点与颈内动脉膝部埋藏深度相差（6．67&#177;2．07）mm。结论：①岩大神经是手术时重要的定位标志，面神经是手术中需要保护的重要解剖结构。     

颅中窝入路岩部切除中耳蜗定位的解剖学研究

目的:探讨耳蜗的定位方法和定位标志,为颅中窝手术入路中磨除岩尖及耳蜗在颅底外科的临床应用提供解剖学资料。方法:采用10%福尔马林固定的成人头颅湿标本10具(20侧),观察并测量耳蜗及其与周围结构之间的位置关系。结果:耳蜗基底圈的内侧壁至三叉神经孔的距离为(10.36±1.50)mm,下颌神经与岩浅大神经交点和内耳门后缘的连线至三叉神经孔的距离为(8.04±0.99)mm,提出耳蜗的定位四边形。结论:颅中窝手术入路操作中,在下颌神经与岩浅大神经交点和内耳门后缘的连线的内侧磨除岩尖部骨质时,不容易损伤耳蜗。     

颞下锁孔硬膜下Kawase入路的内镜解剖学研究

目的 探讨神经内镜模拟颞下锁孔硬膜下Kawase入路手术可行性和适应证。方法 成人尸头湿标本8具（16侧）,模拟神经内镜颞下锁孔硬膜下Kawase入路,观察内镜下显露的最大视野,辨识弓状隆起、三叉神经、岩浅大神经、岩上窦等解剖结构,标识Kawase三角的边界,测量不同磨除范围下Kawase三角的各边长,显露小脑膜切迹间隙、脑干腹外侧、上中岩斜区、中下岩斜区交界处及其邻近结构。结果 弓状隆起最高点到棘孔、岩浅大神经裂孔、岩浅大神经与下颌神经的交点;三叉神经压迹外侧缘的最短距离分别为（22.90±2.34）mm、（14.05±2.09）mm、（24.94±1.98）mm、（23.49±2.38）mm;Kawase三角磨除面积为（3.04±0.47）cm2,扩大磨除Kawase三角面积为（3.7±0.69）cm2,平均增加了0.66 cm2的面积。结论 经神经内镜颞下锁孔硬膜下Kawase入路避免了对脑膜中动脉的损伤,保留了岩浅大神经。适合处理位于小脑幕切迹间隙,上、中岩斜区,中、下岩斜区交界处,部分桥小脑角脑干腹外侧广泛区域的肿瘤、动脉瘤等病变。     

经耳前颞叶底入路显露中颅底和岩斜区的便携式视频显微解剖

目的探讨经耳前颞叶底入路显露中颅底和岩斜区的便携式视频显微解剖特点。方法分别选取新鲜成人尸头标本3例和灌注固定成人尸头标本3例为研究对象,标本均经耳前颞叶底入路,采用便携式视频显微镜解剖并观察中颅底和岩斜区。结果便携式视频显微镜能清楚地暴露中颅底和岩斜区。颞叶底硬脑膜外探查结果显示,岩骨表面为弓状隆起,前内侧为鼓索支,抬起颞叶底面,能够清楚地看到中颅窝底和小脑幕。分离蛛网膜后,暴露蝶鞍旁结构,可以清楚地看到Labbé静脉。在脑干外侧面,动眼神经、基底动脉以及滑车神经等均能清晰显示。结论采用便携式视频显微镜经耳前颞叶底入路能够完成显微解剖。     

枕下极外侧手术入路的解剖学研究

目的：为枕下极外侧手术入路提供解剖学基础。方法：10例成人尸体头湿标本按手术入路在手术显微镜下进行解剖和观测。结果：枕下三角是枕下极外侧入路中重要的解剖学标志，在分离移位椎动脉后，切除枕骨髁后部1／3以辨别和暴露舌下神经管，枕骨髁的磨除可显著扩大枕骨大孔前缘的暴露范围，磨除颈静脉结节对扩大斜坡中下部的暴露有重要的作用。椎动脉硬膜内段及其分支与后组脑神经有复杂的毗邻和穿行关系。结论：枕下极外侧入路尽管解剖复杂，但可在不牵拉延髓的基础上充分暴露颈延髓交界部腹侧面和外侧面的区域，达到充分暴露的枕骨髁磨除范围限于其后1／3即可.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

État de l’art : nouveaux anticoagulants et transfusion

Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.