视觉假体微电极植入视神经段断面微血管的分布

目的: 探讨视觉假体微电极芯片植入视神经的相对安全区,为临床视神经手术提供解剖学依据.方法: 新鲜成人头颅标本经动脉灌注墨汁混合液,解剖观察视神经周围血管后,取球后4～8 mm视神经连续切片,Image 3.0测量神经横断面中各象限血管断面数和血管总面积.结果: 视神经鞘上血管网丰富,血管大致呈前后纵向走行.球后4～8mm段视神经鞘膜的血管网向神经实质内以近似直角的方式发出许多小支,呈向心性走行.视神经内各象限血管断面数和血管总面积无差异,数值呈节段性的波浪式变化.结论: 视神经内微血管分布不存在明显的象限差异.结合周围血管分布,提示在颞上象限植入视觉假体微电极为宜.     

视神经管的显微外科应用解剖学

在40具成人尸体及40个颅骨上对视神经管及其邻近结构进行了观察和测量1.视神经管颅口的宽度平均为6.85±0.10mm,高度为4.05±0.09mm,眶口的宽度为5.63±0.07mm,高度为6.55±0.08mm,上壁长8.53±0.22mm,内侧壁长9.74±0.20mm,二侧颅口内侧缘间距为12.88±0.41mm,两侧眶口内侧缘间距为26.12±0.42mm。视神经管颅口上缘的硬膜襞最大前后径2.67±0.18mm。Dacryon至筛前孔距为19.25±0.36mm,筛前、后孔间距为13.61±0.27mm,筛后孔至视神经管眶口距为6.31±0.19mm。2.正常位置的视交叉占97.30±2.66%,后置视交叉占2.70±2.66%,未发现前置视交叉。鞍结节后端与视交叉前缘间距5.87±0.21mm。视神经在视神经管颅口处宽度为5.16±0.07mm,高度为2.69±0.06mm。视神经颅内段长11.47±0.28mm。于视神经管颅口处,两侧视神经内侧缘间距为13.70±0.46mm,两侧视神经间角度为60.39±2.11°。3.眼动脉单独来源于颈内动脉者占91.25±3.31%,双重来源于脑膜中动脉及颈内动脉者占7.50±3.08%,单独来源于脑膜中动脉者占1.25±1.30%。来源于颈内动脉的眼动脉84.81±4.38%为硬膜下起始,15.19±4.38%为硬膜外起始。讨论了眼动脉行经视神经硬膜鞘壁内的部分在临床上的意义。4.蝶甲型蝶窦占8.75±3.16%,鞍前型占41.25±5.50%,鞍型占50.0±7.91%。蝶甲型不与视神经管内侧壁毗邻。47.22±5.88%的筛后窦侵入蝶骨体内,与视神经管内侧壁毗邻。5.调查了视神经管内侧壁的毗邻变化以及窦与窦间骨性中隔附着线的形态变化,讨论了与临床有关的问题。     

眶上锁孔入路治疗垂体瘤的临床解剖学研究

目的 :探讨内窥镜辅助眶上锁孔入路治疗垂体瘤的可行性。方法 :2 1例福尔马林固定尸体头部标本用于鞍区各解剖结构 ,特别是垂体柄、视神经、视交叉及其供血动脉特点的观察 ,总结手术可利用的间隙、应保护的结构 ;在 9例新鲜尸头上模拟进行内窥镜辅助眶上锁孔入路手术 ,进一步验证其可行性及优势。结果 :颈内动脉床突上段长度 (14 .5± 1.3 )mm(8.1～ 18.5mm ) ,发向垂体柄、视神经或视交叉的穿支动脉的支数分别为 :大脑前或前交通动脉 3 .0支 (2～ 6支 ) ,颈内动脉 2 .1支 (1～ 5支 ) ,后交通动脉 3 .2支 (3～ 6支 ) ,基底动脉 1.4支 (1～ 3支 )。视神经颅内段长度为 (11.4± 2 .7)mm (6.1～ 17.6mm ) ,第 1间隙面积为 (4 4 .8± 3 .4)mm2 (7.0～ 10 0 .8mm2 ) ,手术可通过第 1间隙或 /和第 2间隙进行。结论 :通过眶上锁孔入路治疗向鞍上发展的垂体瘤有充足的操作空间 ,具有视神经、视交叉减压充分 ,利于保护其供血动脉的优点。     

视觉假体微电极经眶外侧壁入路植入视神经的应用解剖

目的为经眶外侧壁入路植入视神经视觉假体微电极提供解剖学依据。方法选用经4%甲醛固定及动脉灌注红色乳胶的成人头湿性标本30例,观测眶内眼动脉及相关分支的起始、数量和外径与穿入视神经鞘膜动脉的起始、外径和穿入部位、视神经外径等参数。结果泪腺动脉1～2支,经外直肌上缘上方(3.83±1.43)mm前行。外直肌-视神经间隙的深度为(8.14±0.90)mm,内有睫状短神经5～10条,颞侧睫状后动脉1～2支。穿入视神经鞘膜动脉的方位,内侧20%,上方29.3%,外侧6.7%,下方44%。视网膜中央动脉主要经下方穿入视神经,穿入处距球后(0.85±0.28)cm,该处动脉外径为(0.40±0.09)mm。眼动脉斜跨视神经处远侧端距球后(1.44±0.22)cm。在球后与总腱环中点处,视神经左右径(3.96±0.35)mm,上下径(4.18±0.33)mm。结论宜经眶外侧壁入路植入视神经视觉假体微电极,植入微电极的部位以视神经球后4～8mm处的外侧较好,植入深度应小于1.5mm。     

视神经眶内部微血管的计量研究

目的探讨视神经眶内部神经实质内小血管的定量分布情况，为临床上提供与缺血性视神经病变有关的形态学资料。方法对23侧视神经(球后1cm以内)行连续切片，片厚为20μm，显微镜观察和测量各象限内的血管段面数和横切面积，求出各均值，并进行统计学处理。结果小血管的段面数平均为47．74，血管横切面总面积平均为0．0415±0．002mm     

经终板手术入路的临床解剖学研究

目的:为经终板手术入路的临床应用提供显微解剖学资料,以利于术中重要血管、神经结构的辨认和保护.方法:在手术显微镜下对12例国人成人头颅湿标本进行显微解剖,详细观察终板及其邻近结构,并进行测量和拍照.结果:终板为一薄层灰质膜,连于前连合与视交叉中部上表面之间,弧形长度(14.4±2.8)mm,最大宽度(4.8±1.3)mm,厚度(0.27±0.16)mm;视交叉上隐窝位于视交叉中线区后半的上表面,前后长度为(5.6±1.5)mm;与终板关系密切的血管结构是前交通动脉复合体及其穿支血管.结论:经终板入路是打开终板后所获得的手术间隙,由视交叉后缘、左和右视束内缘和终板后缘构成.中嵴或中央区膨隆是安全切开终板的重要标志.     

垂体冠状断层的巨微解剖学

目的:为垂体的影像诊断和垂体疾病的外科治疗提供解剖学资料。方法:火棉胶包埋后作脑垂体冠状薄层切片并进行观察和测量。结果:(1)垂体大多呈椭圆形。正常垂体的高度为(4．5±2．0)mm,宽度为(13．9±3．8)mm。垂体的上缘以凹陷型居多,平坦型次之。两侧海绵窦的大小、形态变化较大。鞍底以凹陷型和隆起型为多。(2)断面情况:垂体常出现在交叉前沟后一个层面,消失于鞍背层面,上以鞍膈与鞍上池和视交叉相邻,下邻蝶窦,两侧为海绵窦。在垂体前叶层面可见垂体柄长(8．8±1．7)mm,在视交叉处其横径为(3．1±0．6)mm,插入垂体处的横径为(2．0±0．2)mm。结论:垂体巨微断面可清晰显示垂体周围的重要结构,为影像检查和垂体手术入路提供解剖学资料。     

大鼠脑干连续冰冻切片在NOS阳性神经核团三维重建中的应用

目的:探讨应用组织学方法对大鼠脑干内一氧化氮合酶(nitric oxide synthase,NOS)阳性神经核团进行三维重建的技术。方法:以4只成年雄性SD大鼠为材料,标本固定后取中脑至脊髓颈1节段组织。3只于冰冻切片机上行冠状面连续切片,所得切片行NADPH-黄递酶(nicotinamide aenine inucleotide phosphate-diaphorase)染色,每张切片厚度为30μm。1只行正中矢状切片。所得切片行LFB(Luxol fast blue)染色,5倍物镜下行显微照相。应用Photoshop7.0软件拼接图像,并以三轴法将图片配准;应用3D-DOCTOR 4.0软件对连续图像中NOS阳性核团进行三维可视化重建,参照大鼠脑立体定位图谱确定核团名称,并利用软件自带工具计算核团体积。结果:三维重建的NOS阳性神经核团分布于中脑背侧、中脑导水管周围、桥脑基底部外侧、延脑腹侧外部。脑干内体积最大的NOS阳性神经核团为被盖背外侧核(laterodorsal tegmentum,LDTg),平均体积为0.6747±0.0026mm3。结论:利用组织学方法可以对大鼠脑干内NOS阳性神经核团进行三维可视化重建;借助3D-DOCTOR 4.0软件可对重建核团进行测量并计算出其体积。     

筛动脉眶内段的显微解剖观察

目的:为眶内筛动脉结扎及视神经减压术提供解剖学资料。方法:在手术显微镜下解剖固定尸头标本,对筛动脉的起源、眶内走行、长度以及外径等进行观察和测量。结果:(92．8±4．7)%筛前动脉发自眼动脉O_3段、(7．2±4．7)%发自眼动脉管,穿过上斜肌与内直肌之肌间膜进入筛前孔;(44．8±9．1)%筛后动脉起自眼动脉弯、O_2段(24．1±7．8)%、O_3段(20．7±7．4)%、上斜肌肌支(6．9±4．6)%和脑膜中动脉(3．5±3．4)%,跨过上斜肌上方入筛后孔;筛中动脉出现率为(36．7±8．8)%,起自O_3段(54．5±9．1)%、眼动脉弯(27．3±8．1)%和O_2段(18．2±7．0)%。筛前动脉眶内段长度为(7．83±3．49)mm,外径为(0．80±0．24)mm;筛中动脉眶内段长度为(7．54±1．73)mm,外径为(0．42±0．13)mm;筛后动脉眶内段长度为(7．37±2．15)mm,外径为(0．46±0．18)mm。结论:筛动脉的起始及眶内走行多变异,筛后动脉变异较筛前动脉多见。     

视神经减压术的显微外科解剖基础

目的为视神经减压术建立显微外科解剖基础.方法在26侧经防腐同定的尸头标本上,进行视神经管和眼动脉及其周边结构的观察和测量.结果视柱前端视神经管外膜与眶上裂硬膜融合变厚,形成凸向眶内的襞,厚度为(1.71±0.37)mm(1.14～2.38 mm).眼动脉有88.5%(23侧)于视神经管颅口底部内侧进入鞘膜,在襞前端内侧穿出入眶.视神经管外下壁与蝶窦外侧壁结合形成视神经-颈内动脉陷窝,长为(7.40±1.44)mm(5.60～10.10 mm).结论(1)视神经减压应在视神经鞘膜内上方切开;(2)眼动脉减压应在视神经鞘膜切开骨性视神经管全长的基础上再向眶内延长1.14～2.38 mm;(3)视神经-颈内动脉陷窝可作为视神经减压的解剖标志.     

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.     

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.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

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.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

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.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.