改良Hardinge入路在非骨水泥全髋置换术中的应用

目的：对改良Hardinge入路行全髋置换进行评价。方法：对经改良Hardinge入路行非骨水泥全髋置换（THR－CL）术并获术后6个月以上随访的32例病人进行总结。结果：优良28例（88％），很好4例（12％），其中轻度跛行6例（19％），下肢不等长＞2cm1例（3％），改良Trendelenburg试验阳性3例（10％）。结论：此入路创伤小，暴露好，利于假体定位，易于控制下肢长度，术后外展肌功能恢复快。     

脑干区占位病变的手术入路

本文报告了1990年5月以来脑干区大型、复杂占位病变15例.其中,位于脑干内3例,脚间窝2例,岩尖部4例,全岩骨区1例,全斜坡区2例,第四脑室内3例.本组采用以扩大了的岩骨入路为主的联合入路,行肿瘤全切除8例,次全切除5例.2例仅作了活检加减压术.除1例死亡外,均恢复良好.本文结合文献,对脑干区手术入路进行了讨论.     

Enhanced stimulus-reward learning by intra-amygdala administration of a D3 dopamine receptor agonist

The amygdala is considered to be a critical neural substrate underlying the formation of stimulus-reward associations, and is known to receive substantial innervation from dopaminergic neurons located within the ventral mesencephalon. However, relat- ively little is known about the function of the mesoamygdaloid dopamine projection in stimulus-reward learning. Recently, we have found post-session intra-amygdala microinjections of d-amphetamine to enhance appetitive Pavlovian conditioning as assessed in a discriminative approach task. In the present study, we have examined the effects of dopamine receptor agonists possessing relative selectivity for the D₁, D₂ and D₃ receptor subtypes in order to examine more fully the role of the mesoamygdaloid dopamine projection in stimulus-reward learning. Thus, subjects were trained to associate an initially neutral stimulus (CS⁺) with 10% sucrose reward (US). A second, control stimulus (CS⁻) was also presented but never paired with sucrose reward. In order to measure specifically the conditioned response to CS⁺/CS⁻ presentation, responding during CS and US presentations was measured separately. Immediately following each training session, subjects received bilateral intra-amygdala infusion of 0.1, 1 or 10 nmol/side of SKF-38393, quinpirole or 7-OH-DPAT. Infusions of SKF-38393 or quinpirole were without effect on CS⁺ approach. However, post-session intra-amygdala infusions of 7-OH-DPAT enhanced selectively CS⁺ approach in a dose-dependent fashion. No dose of any drug affected CS⁻approach, US behaviours, or measures of extraneous behaviour. Subsequent acquisition of a novel conditioned instrumental response was also unaffected. Thus, the present data indicate a selective involvement of the D₃ dopamine receptor subtype in the modulation of stimulus-reward learning by the mesoamygdaloid dopamine projection. Received: 12 December 1996 / Final version: 9 April 1997     

3,5-diBr-PADAP直接光度法测定血清锌

目的　建立一种不去除血清蛋白、简便灵敏的直接光度法测定血清锌。方法　以新的有机试剂2 -(3 ,5 二溴 -2 -吡啶偶氮 ) -5 -二乙氨基酚 (3 ,5 diBr -PADAP)为显色剂 ,在有表面活性剂存在的Tris-HC1介质中 ,手工分析法和自动分析法测定血清锌。结果　该法线性范围 0～ 80 μmol/L ,手工分析法和自动分析法平均回收率为 99 9%和 10 0 2 % ,批内变异系数 (CV)和批间变异系数分别为 0 0 18、 0 0 17和 0 0 2 8、0 0 2 6,与原子吸收分光光度法比较具有良好的相关性 ,线性回归方程和相关系数分别为Y =1 0 0 4X -0 12 6,r=0 9912和Y =1 0 0 6X -0 195 ,r =0 0 992 8。 89例健康人血清锌含量分别为 8 96～ 2 2 5 2 μmol/L和 8 63～2 2 43 μmol/L (x± 2s)。结论　用 3 ,5 diBr-PADAP直接光度法测定血清锌方法简便、灵敏可靠 ,适合临床应用。     

Staple penetration and staple histological response for attaching an epimysial electrode onto the abdominal surface of the diaphragm using a laparoscopic approach

Background: Laparoscopic stapling was found to be a viable option for attaching epimysial electrodes onto the abdominal surface of the diaphragm. Stapling was preferable to suturing due to its simplicity and speed. Methods: Of the two staplers tested in this study, the Ethicon Endopath was preferred over the Autosuture Endo Hernia because the staples did not penetrate the diaphragm when an electrode tab thickness greater than 0.75 mm was used. Results: The thickness of the electrode tab was an important factor in determining staple penetration but large variation in penetration depth indicated that other factors may also play a role. An electrode tab thickness of 1.0–1.25 mm was suggested to minimize the risk of diaphragm perforation. Conclusions: The histological reaction to staples implanted up to 14 months was unremarkable, reflecting the safety of laparoscopic staples for permanently anchoring electrodes on the diaphragm. Received: 2 April 1996/Accepted: 12 June 1996     

A transcrista galli, translamina terminalis approach for highly placed basilar bifurcation aneurysms

Summary Surgery for highly placed basilar bifurcation aneurysms is one of the most difficult operations in neurosurgery. Specific surgical techniques have been developed including the temporopolar, zygomatic, transzygomatic subtemporal, transclinoid trans-sellar transcavernous, and trans third ventricular approaches. The authors present some technical advances which have been developed for the transcristagalli translamina terminalis approach for the treatment of this aneurysm.     

SCHWANN CELLS AND THE REGROWTH OF AXONS IN THE MAMMALIAN CNS: A REVIEW OF TRANSPLANTATION STUDIES IN THE RAT VISUAL SYSTEM

1. We have used peripheral nerve transplants or cultured Schwann cells grafted in association with different types of polymer to study axonal regrowth in the rat visual system. In some instances the glia were co-grafted with fetal tectal tissue. 2. The studies have two main aims: (i) to determine whether retinal axons can be induced to regrow at a site distant from their cell soma, that is, after damage to the brachial region of the optic tract; (ii) to determine whether retinal axons exposed to Schwann cells retain the ability to recognize their appropriate target neurons in CNS tissue. 3. In brachial lesion studies, Schwann cells were placed in the lesion site in association with nitrocellulose papers, within polycarbonate tubes in the presence or absence of a supporting extracellular matrix (ECM), or within polymer hydrogel scaffolds. Autologous sciatic nerve grafts were also used. Immuno-histochemical studies revealed the presence of regenerating axons within all polymer bridges. Regrowth of retinal axons was also seen, however, growth was not extensive and was limited to the proximal 1–1.5 mm of the implants. 4. In target innervation experiments, two surgical paradigms were developed. In one experiment, a segment of sciatic nerve was autografted onto the transected optic nerve in adult rats and the distal end of each graft was placed adjacent to fetal tectal (target) tissue implanted into the frontal cortex. To date, we have not been able to demonstrate selective recognition of target regions within tectal transplants by retinal axons exiting the sciatic nerve implants. 5. In the second experiment, Schwann cells were mixed with fetal tectal cells and co-grafted to the midbrain of newborn host rats. Schwann cells altered the characteristic pattern of host retinal growth into tectal grafts; in some cases axons were induced to grow away from appropriate target areas by nearby co-grafted Schwann cells. 6. In summary, Schwann cell/polymer scaffolds may provide a useful way of promoting the regrowth of damaged axons in the CNS, however: (i) in adults, at least, their effectiveness is reduced if they are located at a distance from the cell bodies giving rise to regenerating axons; (ii) in some circumstances exposure to a peripheral glial environment may affect the capacity of regenerating axons to recognize appropriate target cells in the CNS neuropil.     

扩大经蝶入路进入海绵窦内侧腔的应用显微解剖

目的为临床开展扩大经蝶入路进入海绵窦内侧腔手术提供解剖学依据。方法用50例成人头颅标本．在显微镜下对蝶窦外侧壁、蝶鞍、海绵窦及周围结构进行解剖学观察并测量。模拟扩大经蝶入路磨除海绵窦腹侧骨质，切开海绵窦内侧壁，显露海绵窦内侧腔。结果颈内动脉（ICA）明显隆起于蝶窦侧壁的占58％，蝶窦内隆起呈管型占3％。鞍底硬膜分为2层，海绵窦内侧壁的上部南垂体硬膜构成，无骨性结构支撑；下部由骨周硬膜构成，有蝶窦侧壁骨质支撑。两侧海绵窦内侧壁的距离为（14．8±2．7）mm。海绵窦内侧腔位于C4段ICA与垂体之间，腔内为丰富的静脉丛，最宽可达7mm，但常因ICA扭曲而闭塞。无颅神经穿越海绵窦内侧腔，ICA是扩大经蝶入路探查海绵窦遇到的第一个主要结构。结论扩大经蝶入路进入海绵窦内侧腔是安全可行的。     

Arthroscopic distal clavicle resection

The acromioclavicular joint is a potential source of pain in the shoulder. There are a variety of disorders that can affect this joint, including distal clavicle osteolysis, posttraumatic arthritis, osteoarthritis, and rheumatoid arthritis. Nonoperative treatment for this condition with nonsteroidal medication and activity modification can alleviate the pain. When conservative treatment is exhausted, surgical resection of the distal clavicle is often necessary. Arthroscopic resection of the distal clavicle preserves the acromioclavicular ligaments to prevent postoperative distal clavicle instability. The procedure is performed in either the beach chair or lateral position and requires the use of a shaver, electrocautery, and a burr for soft tissue and debridement and bone resection.     

眼眶动静脉畸形致眼上静脉扩张的影像学表现

目的探讨眼眶动静脉畸形(AVM)致眼上静脉(SOV)扩张的影像学及血管造影表现。设计回顾性病例系列。研究对象6例临床表现与硬脑膜海绵窦瘘(CCF)相似的眼眶AVM患者。方法总结分析所有患者的影像学检查结果,如CT、MRI和选择性脑血管造影。主要指标影像学征象及血流动力学。结果CT和MRI均可显示所有患者的SOV扩张。另外,尚存在眼球突出、AVM畸形血管团等征象。所有6例AVM均位于眼眶内,1例尚合并颅内AVM。所有患者的主要引流静脉均为SOV,动脉包括脑膜中动脉、上颌动脉和眼动脉。结论眼眶AVM可引起与CCF相似的临床和影像学征象,但AVM通常不引起海绵窦膨大,血管造影仍是确诊的必需手段,而无创技术是辅助血管造影进行明确诊断的重要手段。(眼科,2007,16:395-398)