“虚里”含义再识

文章认为虚里不是心尖搏动处,而是胃之大络在体内的起点。胃之大络在体表的终点——-“左乳下”才是真正的心尖搏动处。结合《内经》原文从4个方面进行论述:虚有空虚不实之意;里有处所、部位之意。虚里即体内胃部空虚无穴的部位。胃之大络在体内的起点虚设为“虚里”.“左乳下”是胃之大络在体表的终点。原文中的两个“其”字,通常多认为是指“虚里”而言,而文章认为两个“其”字都是指“左乳下”而言。长期以来,人们误将“虚里”当作“胃之大络”的代名词。把“虚里”解释成“胃之大络”.文章认为“虚里”是“点”概念,而“胃之大络”是“线”的概念,“虚里”并不是“胃之大络”的代名词。     

滋阴通络益气化痰法对脑血栓形成患者生存质量及功能的影响

目的观察滋阴通络益气化痰法对脑血栓形成患者生存质量（QOL）及功能的影响。方法将90例患者随机分为三组各30例，治疗1组予护脑通络超微颗粒口服，治疗2组予护脑通络片口服，对照组予步长脑心通胶囊口服，疗程均为28d。采用世界卫生组织生存质量简表（WHOQOL—BREF）评定生存质量；采用改良Barthel指数评定标准评定日常生活活动能力（ADL）。结果治疗1、2组总体生存质量改善率分别为86．67％与90．00％，高于对照组53．33％；治疗1、2组脑血栓形成患者ADL显著改善，在总体疗效和证候疗效方面也明显优于对照组；对主症的起效时间比对照组平均早5～7d。结论滋阴通络益气化痰法对该病QOL、ADL有较好的临床疗效，且临床用药安全。所用超微颗粒药材量仅为常规颗粒剂及片剂的一半剂量，仍有较好疗效，说明超微颗粒减量一半后能取得常规剂量相同的疗效。     

冠心病患者侧支循环与冠状动脉病变的关系

对９０例临床诊断为冠心病患者进行冠状动脉赞赏影,６２例有冠状动脉狭窄,其中２０例存在侧支循环,占３２．３％。经分析发现侧支循环与冠状动脉狭窄程度及冠状动脉病变支数有关,病变越严重,侧支循环发生率越高,多支病变单支病变更易形成侧支循环。     

Epidermoid tumour within the collateral sulcus: A rare location and atypical presentation

Epidermoid tumours (ETs) are uncommon benign lesions that may grow by spreading in the subarachnoid space of the basal cisterns and expanding to conform to the shape of specific sulci and fissures. A temporobasal location is very rare, and there have been no reports regarding single sulcus involvement of ETs. We describe the case of an ET located on the basal surface of the temporal lobe, predominantly within the collateral sulcus, which separates the parahippocampal gyrus medially from the fusiform gyrus laterally. We report the case of a 25-year-old woman with complex visual hallucinations. MRI of the brain revealed a right temporobasal mass lesion, hypointense on T(1)-weighted and hyperintense on T(2)-weighted images, with minimal contrast enhancement, on the basal surface of the temporal lobe. Right-sided anterior temporal lobectomy, along with microsurgical removal of the collateral sulcus ET were performed with consequent resection of mesial temporal structures (the region of the hippocampus, parahippocampal gyrus, and amygdala). It is important to consider ETs when treating lesions on the basal temporal lobe, since the inferior surface of the temporal lobe, more specifically the collateral sulcus, may be a convenient space for ETs to localize. Total surgical resection should be the goal in these cases; however, the surgical approach may be tailored to include the resection of mesial temporal lobe structures when seizure is the predominant presenting symptom.     

Functional Recovery Following an End to Side Neurorrhaphy of the Accessory Nerve to the Suprascapular Nerve: Case Report

The use of end-to-side neurrorhaphy remains a controversial topic in peripheral nerve surgery. The authors report the long-term functional outcome following a modified end-to-side motor reinnervation using the spinal accessory to innervate the suprascapular nerve following a C5 to C6 avulsion injury. Additionally, functional outcomes of an end-to-end neurotization of the triceps branch to the axillary nerve and double fascicular transfer of the ulnar and medial nerve to the biceps and brachialis are presented. Excellent functional recoveries are found in respect to shoulder abduction and flexion and elbow flexion.     

Alterations in noradrenergic innervation of the brain following dorsal bundle lesions in neonatal rats

Several seemingly conflicting sets of data have been reported on the regenerative capacity of central noradrenergic neurons, following transection of the ascending noradrenergic fiber tract in neonatal rats (Iacovitti et al., Dev Brain Res 1: 21-33, 1981; Jonsson and Sachs, Brain Res Bull 9: 641-650, 1982). In order to more fully investigate changes in noradrenergic neurons in the brain after such a transection, rats were lesioned at various times after birth, sometimes in conjunction with administration of the neurotoxin, 6-hydroxydopa (6-OHDOPA). Animals were sacrificed at 7, 10, 14, 28, 42 or 56 days after birth, in order to assess the pattern of noradrenergic neuronal damage, as well as the recovery rate. Dorsal bundle lesions were associated with neocortical and hippocampal hypoinnervation by noradrenergic fibers, and sprouting of a collateral fiber group, with production of noradrenergic hyperinnervation of the cerebellum and pons-medulla. Recovery of the norepinephrine (NE) content to control levels occurred in the neocortex at 8 weeks, when the dorsal bundle was lesioned at birth. When the lesion was produced at a later time (3 days or 5 days after birth), less recovery in the neocortex and hippocampus was found. Histofluorescent fiber number, as observed with a glyoxylic acid method, correlated with NE changes. It appears that 6-OHDOPA (20 micrograms/g IP) does not modify long-term recovery from a dorsal bundle lesion, when rats are co-treated at 3 days after birth. However, the length of the proximal noradrenergic fiber stump may be an important factor affecting the capacity for recovery from injury.(ABSTRACT TRUNCATED AT 250 WORDS)     

右旋糖酐与氟碳乳剂稀释血液对心肌缺血时全血粘度与侧支循环影响的比较

用麻醉开胸狗对比观察了低分子右旋糖酐与氟碳乳剂稀释血液对急性心肌缺血时全血粘皮与侧支血流量变化的影响。结果表明,氟碳乳剂稀释血液除具有与右旋糖酐稀释血液相同的降低全血粘度、增加侧支血流量、提高缺血区心肌供血量/需血量比值等作用外,还可使血氧分压与活性氧明显增加,因而使缺血区心肌供氧量增加。     

主-髂动脉闭塞侧支循环形成的CTA表现

目的 探讨主-髂动脉闭塞伴侧支血管形成的多层螺旋CT血管成像(MSCTA)表现. 资料与方法 分析9例主-髂动脉闭塞伴侧支血管形成的MSCTA表现. 结果 9例主-髂动脉完全性闭塞,CTA显示侧支血管主要通过以下三条通路吻合:下位肋间后动脉与旋髂深动脉吻合、腹壁上动脉与腹壁下动脉吻合以及肠系膜下动脉(IMA)远段通过迂曲扩张的Riolan动脉弓与肠系膜上动脉(SMA)形成吻合. 结论 MSCTA可显示主-髂动脉闭塞患者的主要侧支血管情况.     

Expansion of innervation territory by afferents involved in plasma extravasation after nerve regeneration in adult and neonatal rats

Summary The capacity of the saphenous nerve for collateral sprouting was examined by electrophysiological recordings of the activity of low threshold mechanoreceptors and plasma extravasation after C-fiber stimulation in rats. When the sciatic nerve was sectioned neonatally or in adults little evidence was obtained for collateral sprouting of either mechanoreceptors or fibers involved in plasma extravasation in the intact saphenous nerve0 In rats where the sciatic nerve was sectioned and the saphenous nerve was crushed either neonatally or in adults, expansive regenerative reinnervation by thin fibers, but not mechanoreceptors, was observed particularly in glabrous skin. Saphenous crush alone did not cause expansive regenerative reinnervation. The results indicate that much of the collateral sprouting or regenerative reinnervation of the skin observed in morphological studies may represent the presence of fibers not responding to the stimuli used in the present study. It is also suggested that some observations of collateral sprouting may represent changes in responsiveness to stimulation of skin areas with overlapping innervation territories.