Vomeronasal organ-mediated induction of fos in the central accessory olfactory pathways in repetitively mated female rats

Removal of the VNO significantly reduced the enhancement of lordosis and the induction of fos immunoreactivity in luteinizing hormone-releasing hormone (LHRH) neurons in ovariectomized estrogen-primed rats. There was a significant positive correlation between the two variables. In the accessory olfactory bulb (AOB) of the repetitively mated rats, the number of fos-positive cells in the granule (G) cell layer was significantly lower in the VNO-removed rats, whereas that in the mitral (M) cell layer was not significantly different between VNO-removed and VNO-sham females. The G/M ratio (calculated by dividing the mean number of fos-positive cells in the G cell layer by that in the M cell layer), taken as an estimate of the output of the AOB, was relatively larger in the VN-sham as compared with the VNO-removed rats. There were significant positive correlations between G/M ratio and the increase in LQ and between the G/M ratio and the percentage of fos-positive LHRH cells. The positive correlation between the number of fos-positive cells in the posterodorsal medial amygdala (PDMA) and the increase in LQ and that between the number of fos-positive cells in the PDMA and the percentage of fos-positive LHRH cells were significant, supporting the role of the medial nucleus of amygdala in lordosis. However, the correlation between G/M ratio and the number of fos-positive cells in the PDMA was not significant, indicating that fos immunoreactivity in the PDMA is not directly related to that in the AOB. In conclusion, the results support the involvement of the accessory olfactory system in mediating the facilitatory effects of repeated mating on lordosis in female rats and suggest that the influence of the accessory olfactory system is mediated likely through the LHRH neuronal system. Integration and filtering of sensory information may take place at various levels of the brain, such as the AOB and the medial amygdala, before being transmitted to higher brain centers controlling lordosis behavior in female rats.     

Pancreatographic investigation of the pancreatic duct system

Background Embryologically, the pancreatic duct system develops by the fusion between the dorsal and ventral pancreatic bud ducts. It has been suggested that the proximal part of the main dorsal pancreatic duct partially regresses to form the accessory pancreatic duct (APD). Aim of this study was to clarify the anatomy of the pancreatic duct system of the head of the pancreas and investigate the embryology of the normal pancreatic duct system. Methods We reviewed endoscopic retrograde pancreatography of normal pancreatic heads (n = 256) and pancreas divisum (n = 36), focusing on long inferior branches arising from the APD and the main pancreatic duct (MPD). The accessory pancreatograms were divided into two patterns of course and shape, the long type (171 cases) and the short type (85 cases) according to the length of the MPD from the orifice to the junction with the APD. The long-type APD formed a straight line and joined the MPD at the neck portion of the pancreas. The short-type APD joined the MPD near its first inferior branch. Results The shape of the long-type APD was quite similar to that of the dorsal pancreatic duct of pancreas divisum. The short-type APD was less likely to have a long inferior branch arising from the APD. The length of the APD from the orifice to the first long inferior branch was similar in the long-type APD (19.4 ± 4.0 mm) and in the short-type APD (18.8 ± 4.2 mm). The first long inferior branch from the long-type APD passed though the MPD near the origin of the inferior branch from the MPD, whereas the short-type APD joined the MPD near its inferior branch. Conclusions There are two types of APD. The long-type APD was quite similar to the shape of the dorsal pancreatic duct of pancreas divisum, and seems to represent a continuation of the main duct of the dorsal pancreatic bud. The short-type APD was less likely to have a long inferior branch, and seems to be formed by the most proximal part of the main duct of the dorsal pancreatic bud and its long inferior branch.     

The mendosal suture of the occipital bone: occurrence in Indian population,embryology and clinical significance

The Occipital occipital bone is ontogenetically and functionally unique when compared to the other bones of the skull in humans and other mammalian cousins. The Occipital occipital bone develops from six ossification centers; any defect in the ossification process will give rise to mendosal suture (accessory suture) and conditions like posterior plagiocephaly. There is a paucity of literature regarding the mendosal suture and further more, its report in Indian population is not known. The present study was conducted to find out the occurrence of mendosal suture in the Indian dry skulls. Fifteen specimens (3%) were found to have these sutures out of five hundred500 skulls examined. Nine (3.1%) samples are of male skulls out of two hundred ninety (290) and six (2.85%) samples are that of female skulls out of two hundred ten210. The mendosal suture ran close to the superior nuchal line in all specimens and traveled medially from the lambdoidal suture. The length of the sutures ranged from 0.8 cm to 2.6 cm (1.88 cm) on the right side and 1.4 cm to 2.9 cm (1.94 cm) on the left side respectively in male skulls; and 0.7 cm to 2.8 cm (1.55 cm) on the right side and 1 cm to 2.4 cm (1.42 cm) on the left side, respectively, in female skulls. The origin of mendosal suture from the lambdoidal suture was 5.7 cm to –6.3 cm (5.98 cm) from the tip of the mastoid process on the right side and 5.6 to –6.3 cm (6 cm) on the left side, respectively, in male skulls; and 5.4 cm to –5.8 cm (5.58 cm) on the right side and 5.4 cm to –5.6 cm on the left side respectively in female skulls. The occurrence and clinical significance of the present study is discussed.     

Carcinoid tumor of the duodenum and accessory papilla associated with polycythemia vera

Carcinoid tumors have been reported in a wide range of organs but most frequently involve the gastrointestinal tract; however, duodenal carcinoid tumors are rare. We report a 50-year-old male patient complaining of multiple melenas for 3 wk. The panendoscopy and endoscopic retrograde cholangiopancreaticography revealed swelling accessory papilla with an ulcer. The biopsy taken showed a carcinoid tumor. The lesion was removed by wide resection. Patient was found to have an abnormal blood cell count during the follow-up period with elevated levels of hemoglobin and hematocrit of 21.2 g/dL and 63.5%, respectively, thrombocytosis of 501 000/μL, and leukocytosis of 20 410/μL. He was diagnosed as a polycythemia vera by a hematologist after further evaluation. He received periodic phlebotomy and hydroxyurea treatment. The response was good and his hematocrit was stabilized by periodic phlebotomy in the range of 44-49% during the last 2 years. The possible origin of UGI bleeding by a duodenal carcinoid tumor, although rare, should be considered. There has been one case report of a duodenal carcinoid tumor that involved accessory papilla of the pancreas divisum and one case report of metastatic carcinoid tumor associated with polycythemia vera. It is different in our patient as compared with the latter report, which mentioned a polycythemia vera patient who was found to have a metastatic carcinoid in the 17 years follow-up period. Chemotherapy had been given before the carcinoid tumor was revealed. Our patient had no previous chemotherapy for polycythemia vera before he was found to have duodenal carcinoid tumor; this excludes the possibility of chemotherapy induced carcinoid tumor, although it had been suspected in the previous report. In our patient, the existence of both diseases may be by predisposition of each other since both diseases have an increased incidence of other neoplasm, or they may be coexistent incidentally.     

Variations of renal arteries on 64 slice Multidetector Computed Tomography

Introduction

The incidence of accessory renal arteries is very high. Multidetector Computed Tomography (MDCT) is a minimally invasive alternative to conventional angiography in preoperative evaluation. The aim of this study was to document the incidence of accessory renal arteries and the level of origin of main renal arteries from abdominal aorta.

左侧游离壁旁路消融中阻滞左心房峡部导致沿二尖瓣环左心房内传导阻滞

目的 探讨在左侧游离壁房室旁路(AP)射频消融中发生沿二尖瓣环心房激动顺序明显改变，且能排除多条AP和其它机制所致心动过速病例可能的电生理机制。方法 240例左侧AP患者，经逆行主动脉途径行射频消融，对在消融中发生明显心房激动顺序改变，且能排除多条AP的患者进行分析。结果 在240例左侧AP患者的消融中，5例(2％)出现沿二尖瓣环(冠状静脉窦电极导管)心房逆传顺序明显改变，此5例患者均为左后上AP(距冠状静脉窦口≥5．0cm，以往称为左前AP)，占全部58例左后上AP消融病例的9％。尽管消融中出现沿二尖瓣环心房逆传顺序明显改变，但左后上AP仍然存在，5例均可诱发心动过速，酷似多条AP或房室结快径逆传。5例均有经主动脉逆行途径在二尖瓣环左心房侧反复消融的过程，而在消融中发生心房逆传顺序改变，5例最终消融成功靶点距冠状静脉窦口5．5～7．0cm(平均6．4cm)。结论 在左后上AP射频消融中阻滞左侧峡部(二尖瓣环和左下肺静脉之间)可以导致明显的沿二尖瓣环心房逆传顺序改变，在二尖瓣环更靠后上侧可成功消融此AP。     

女性婴幼儿嵌顿性腹股沟斜疝致附件坏死的诊治分析

目的总结女性婴幼儿嵌顿性腹股沟斜疝致附件坏死的临床特点和治疗经验。 方法回顾性分析昆明医科大学附属昆明市儿童医院2014年3月至2018年12月收治的94例女性婴幼儿嵌顿性腹股沟斜疝患儿的临床资料,并对其临床表现、诊断方法和治疗效果进行分析。 结果94例患儿均以腹股沟区包块就诊。51例彩色多普勒超声检查考虑附件嵌顿,11例考虑肠管嵌顿,7例考虑网膜嵌顿,25例性质不定;经急诊手术证实,61例附件发生嵌顿,其中19例为附件坏死,3例为肠管嵌顿,30例自行回复;19例附件发生坏死的患儿中,17例予以切除,2例家属拒绝切除予以还纳。1例术后复发。 结论女性婴幼儿嵌顿性腹股沟斜疝附件（多为卵巢及部分输卵管）嵌顿坏死发生率相对较高,需早发现、早诊断、早治疗,以减少附件嵌顿坏死手术切除的风险;彩色多普勒超声是诊断附件嵌顿性腹股沟斜疝的重要方法。     

Pathology and management of masses in the accessory parotid gland region: 24-year experience at a single institution

Purpose

Masses in the accessory parotid gland (APG) region are clinically rare and their management can lead to conflicts between the need for tumor resection and facial cosmesis. The aim of this study was to analyze the pathological classifications and management of APG lesions in our hospital.

Acute midfoot injuries and their management

Acute injuries of the midfoot are uncommon and can be challenging to diagnose and manage. These injuries are frequently overlooked, as the initial plain radiographs, can be difficult to interpret or are misleading. As the consequences of a missed midfoot injury can be devastating for the patient and are so difficult to treat, all orthopaedic surgeons should be highly suspicious when managing patients with midfoot trauma. This article summarizes the current literature about the midfoot injuries and focuses in their management. Non-displaced fractures and stable injuries can be treated conservatively with immobilization for 4–6 weeks. Displaced fractures, unstable or high-energy complex injuries should be treated surgically. Extra care should be given to maintain the length of the medial and lateral columns, in order to avoid long-term deformity and disability. In general the achievement of anatomic reduction and stable fixation of these injuries leads to good functional long term outcomes.