Accessory spleen masquerading as a pancreatic neoplasm

A patient with a pancreatic mass noted on a computed tomography scan was suspected of having a nonfunctioning pancreatic neuroendocrine neoplasm. The eventual diagnosis of intrapancreatic accessory spleen was made by noninvasive means, thus avoiding unnecessary surgery.     

Incidence of Extensor Digitorum Brevis Manus Muscle

The extensor digitorum brevis manus, a supernumerary muscle in the fourth extensor compartment of the dorsum of the wrist, is a relatively rare anomalous muscle. Extensor digitorum brevis should be included in the differential diagnosis of soft tissue masses on the dorsal aspect of the hand as it may mimic cystic, neoplastic, inflammatory, and infectious masses arising in the dorsum of the wrist. Seventy-two upper limbs of male and female cadavers were dissected and examined to study the pattern of extensor tendons of the index finger. In the present study, we observed three cases (4.2%) of the extensor digitorum brevis manus on the left side. In one cadaver (0.72%), there was an additional tendon arising from the extensor indices which was inserted to the radial side of the dorsal digital expansion of the index finger. The extensor digitorum brevis manus muscle (EDBM), an anatomic variant of the extensor muscle of the dorsum of the hand, is found in approximately 2% to 3% of the population. This variation is, therefore, clinically and surgically relevant because the EDBM may be the only muscle responsible for the independent extension of the second digit. The aim of the present study is to report the incidences of this muscle thereby creating awareness of its existence and of its characteristic appearance to surgeons.     

Assessment of Rotational Instability with Disruption of the Accessory Collateral Ligament of the Thumb MCP Joint: A Biomechanical Study

OBJECTIVES: The objective of this paper was to biomechanically investigate rotational stability of the thumb after ulnar collateral ligament (UCL) and accessory collateral ligament (ACL) disruption and repair at the metacarpal joint of the thumb. METHODS: Twelve fresh frozen adult cadaveric thumbs were used. The torsion test was performed under constant rotation of 1/s through 30 arc of metacarpal phalangeal (MCP) joint. The torsional resistance was determined for four categories: first no intervention of the UCL structures (control), next with the proper UCL cut at the distal insertion, then with the additional ACL ligament cut, and lastly with the repair of only the proper UCL. The decrease on the amount of torsional rigidity for each of the last three categories was determined and compared. Each thumb was used as its own control. Significance of the differences in each test categories was statistically determined. RESULTS: After the proper UCL was cut, the torsional rigidity of the MCP joint was reduced 35.18 +/- 17.56% (p < 0.001). When, additionally, the ACL was cut, the torsional rigidity of the MCP joint was further reduced to 49.34 +/- 16.82% (P < 0.001). After repair of only the proper UCL, the torsional rigidity of the MCP joint improved, but still showed a considerable reduction from controls. The amount of reduction was not consistent among specimens and was 13.52 +/- 16.40%. CONCLUSIONS: The ACL ligament is a contributor of rotary stability as well as a provider of lateral stability. Leaving the ruptured ACL unrepaired causes some residual rotating instability and that may lead to future rotational instability of the MCP joint.     

Accessory mitral valve causing left ventricular outflow tract obstruction in an adult

Accessory mitral valve (AMV) is a rare congenital abnormality that, rarely, causes left ventricular outflow tract (LVOT) obstruction in adults. We report the case of a 47-year-old man with deteriorating exertional dizziness. Evaluations revealed that the left ventricular outflow tract obstruction was caused by the accessory mitral valve. The patient underwent a successful operation for removal of the accessory mitral valve.     

超声造影评估伴副肾动脉患者肾脏血流灌注的初步研究

目的应用超声造影技术探讨存在副肾动脉是否影响肾脏的局部血流灌注。 方法回顾性分析2019年9月至2021年12月在北京医院行肾动脉超声造影检出存在副肾动脉的31例患者（共33个肾脏）的超声影像资料,并分析肾脏不同部位（上极、中部、下极）的肾皮质血流灌注。获得时间-强度曲线（TIC）和相关参数,包括峰值强度（PE）、流入相曲线下面积（WiAUC）、上升时间（RT）、局部平均过渡时间（mTTl）、达峰时间（TTP）、流入相斜率（WiR）、流入相灌注指数（WiPI）、流出相曲线下面积（WoAUC）、流入相和流出相曲线下面积（WiWoAUC）、下降时间（FT）、流出相斜率（WoR）,比较肾脏不同部位以上各项灌注相关参数以及主肾动脉和副肾动脉的血流动力学参数是否存在差异,评估存在副肾动脉肾脏不同部位的血流灌注情况。 结果副肾动脉较主肾动脉管径细,差异具有统计学意义［（3.2±0.7）mm vs（4.6±0.7）mm,P＜0.001］,两者的血流动力学指标收缩期峰值流速（PSV）、阻力指数（RI）和加速时间（AT）差异均无统计学意义（P均＞0.05）。在上极、中部和下极肾皮质血流灌注参数的比较中,上极WiWoAUC略高于中极（P=0.041）,其他参数差异均无统计学意义（P均＞0.05）。 结论副肾动脉的存在对肾脏局部的血流灌注影响不大,但仍需更多研究结果证实。     

The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation

Purpose This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Materials and methods Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Results Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning ± MRA in some patients. Conclusions In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.     

Loss of vancomycin bactericidal activity against accessory gene regulator (agr) dysfunctional Staphylococcus aureus under conditions of high bacterial density

The impact of accessory gene regulator (agr) dysfunction and high bacterial density on vancomycin killing and resistance was evaluated among 10 clinical methicillin-resistant Staphylococcus aureus bloodstream isolates using time kill experiments. Under conditions of high inocula and agr dysfunction, vancomycin activity was markedly attenuated, amplifying resistant mutants by 72 h.     

高位颈髓损伤后副神经移位膈神经后的膈肌组织学观察

目的 从组织学角度探讨副神经移位膈神经重建膈肌功能的可行性。方法 成年雄性SD大鼠180只，随机分为A、B、C3组：A组将双侧副神经在锁骨下水平发出内、外侧支之前切断，移位缝接膈神经干起始部；B组于双侧膈神经干起始部切断后原位缝接；C组为正常对照组。分别于术后1，2，3，4，5，6个月完整取出3组大鼠膈肌，用于电子天平称重。同时于右侧腋前线部位顺肌纤维方向切取2mm宽肌条，行HE染色，分析膈肌肌纤维截面积的变化。A组1，3，6个月组、C组6个月组同于左侧腋前线部位切取1mm×1mm大小的膈肌肌块，经固定、脱水、包埋、切片后染色，用电镜观察膈肌肌细胞线粒体、内质网、核仁等的变化。结果 副神经移位膈神经后随着时间推移，膈肌渐渐饱满，肌重逐渐出现恢复。6个月为正常对照组的（97．23±4．07）％。同时肌纤维截面积也逐渐增大，6个月组达（1771±439）岬。，为正常对照组的（98．28±3．65）％。各时间点A、B组膈肌湿重及肌纤维截面积恢复率比较，差异无统计学意义（P〉0．05）。电镜观察显示，随着时间推移，膈肌肌细胞线粒体、内质网及染色质等逐渐修复，肌丝、肌节排列也趋于整齐。结论 副神经移位膈神经6个月后大鼠膈肌湿重、肌纤维截面积、超微结构均接近正常。从组织学角度看，副神经可作为动力神经移位膈神经来重建高位颈髓损伤后的呼吸功能。     

Distribution of vesicular stomatitis virus proteins in the brain of BALB/c mice following intranasal inoculation: an immunohistochemical analysis

Earlier studies have shown that intranasal instillation of vesicular stomatitis virus (VSV), a negative-sense RNA virus, in mice and rats can result in infection of the brain, hind-limb paralysis and death. Using an antiserum directed against VSV proteins, we sought to determine the potential neuronal and non-neuronal pathways VSV utilize, for central nervous system dissemination in BALB/c mice. Within 12 h following intranasal inoculation of VSV, VSV antigen could be detected in the olfactory nerve layer of the ipsilateral olfactory bulb. Within 3–4 days post-inoculation (p.i.), VSV had disseminated into the glomeruli of the olfactory bulb as well as the anterior olfactory nuclei that were ipsilateral to the VSV instillation. Within the glomeruli, VSV antigen was more prevalent in the granule cells than in the mitral cells. Correspondingly, the lateral olfactory tract, where axons of mitral cells course, remained VSV negative throughout 7 days p.i. By 7 days p.i., viral proteins were detected in several additional regions extending to the brainstem. These included regions involved in -rhythm generation during exploration and REM sleep, i.e. the septal nuclei, the suprammamilary body, and the hippocampal formation, as well as the amygdaloid complex and brainstem neuromodulatory centers, such as the dorsal raphe´and locus coerullus. Structures abutting the ventricular surfaces, such as the dorsal cochlear nucleus, were also labeled. Tracts immunoreactive to VSV included the dorsal tegmental tract, fascia retroflexus, Probst tract, and mesencephalic tract of the trigeminal motor nerve. Besides the lateral olfactory tract, tracts that remained VSV negative included the anterior commissure, the corpus callosum and the mammilary peduncle. The pattern of VSV immunoreactivity supports the idea that following infection of the olfactory bulb glomeruli, VSV spreads via both ventricular surfaces and retrograde transport within axons of neuromodulatory transmitter systems innervating the olfactory bulb. Conversely, regions exhibiting low levels of VSV antigen are not likely to be involved in VSV dissemination. In particular, the paucity of VSV antigen in some of the terminal fields of neuromodulatory systems indicate that anterograde transport is more selective than retrograde transport. Surprisingly, the principal neurons of the olfactory glomeruli, thalamus, cerebral cortex and the hippocampus, all of which usel-glutamate as the excitatory neurotransmitter, are much less involved in viral dissemination.     

P物质神经元在鸽旁听觉神经通路中的分布

目的　观察P物质 (SP)在鸽旁听觉神经通路中的分布。　方法　免疫组织化学ABC方法。　结果　SP免疫阳性神经元胞体及纤维集中分布在中脑外侧核背部 (MLd)周围的丘间核 (ICo)、脑桥外膝体腹侧核 (VLV)的周围、丘脑卵圆核 (Ov)的背侧和内侧、下丘脑腹内侧核 (VMN)周围、端脑带状核 (Tn)周边区及端脑的视前区前核(POA)。　结论　在鸽旁听觉神经通路和控制生殖脑区中存在大量SP免疫阳性结构 ,推测SP可能参与了鸟类的发声控制及生殖内分泌调制。