猫颈部食管的交感神经支配—HRP法

用5只猫于左侧颈部食管壁内注入 HRP 溶液,通过 HRP 逆行追踪法研究颈部食管的交感神经支配,结果表明:1.长轴突型交感节前神经元直接分布到食管壁内,其标记细胞位于双侧脊髓的胸1～3节段,以胸2节段最多(占标记细胞总数的66.45％),注射侧占优势。标记细胞主要位于中间带外侧核(约占95.02%),其次为侧索、中介核、前角腹后外侧核。其细胞形态不一,以中小型细胞为主(占标记细胞总数的90.4％)。2.支配颈部食管的交感节后神经元主要位于星状神经节(约占61.99％),余者位于双侧颈前、中和2～5胸交感节内、以小细胞最多。     

Cutaneous afferent activity in the median nerve during grasping in the primate

Neural activity was recorded from the median nerve of a monkey during grasping and lifting, using a chronically implanted cuff electrode. At the onset of lifting, there was an initial dynamic response during which the intensity of the neural signal increased rapidly. This neural response attained its peak value well before the displacement, the load force or the grip force. The time course and peak of the rectified, integrated neurogram were best correlated with the rate of change of grip force. The neural activity declined exponentially to a steady value following the initial peak. During steady holding the mean amplitude of the neurogram was best correlated with the mean grip force. At the end of the holding phase there was a short burst of neural activity as the monkey relaxed the grip force and released the object. During some blocks of trials pulse perturbations were applied to the object. When the monkey did not increase the grip force in advance of the perturbation, the perturbation produced a relatively large displacement of the object and a burst of neural activity whose onset coincided with the onset of displacement. When the monkey anticipated the perturbation by increasing the grip force during the holding period preceding the perturbation, the perturbation produced a relatively small displacement and relatively little increase in neural activity.     

Myelinated fiber regeneration after crush injury is retarded in sciatic nerves of aging mice

To compare nerve regeneration in young adult and aging mice, the right sciatic nerves of 6- and 24-month-old mice were crushed at the sciatic notch. Two weeks later, both groups of mice were perfused with an aldehyde solution, and, after additional fixation, the sciatic nerves were processed so that the transverse sections of each nerve subsequently studied by light and electron microscopy included the entire posterior tibial fascicle 5 mm distal to the crush site. The same level was sectioned in unoperated contralateral nerves; these nerves served as controls. Electron micrographs and the Bioquant Image Analysis System IV were used to measure areas of posterior tibial fascicles and count the number of myelinated axons, the number of unmyelinated axons, and their frequency in Schwann cell units. In aging mice, the total number of regenerating myelinated axons was significantly reduced, but totals of regenerating unmyelinated axons in aging and young adults did not differ significantly. In aging mice, the frequency of Schwann cells that contained a single unmyelinated axon was greater, suggesting that before myelination began, Schwann cell ensheathment of axons also was slowed. After axotomy by a crush injury, the area of the posterior tibial fascicle was less than that in young adults and the distal disintegration of myelin sheath remnants also appeared to be retarded. The results indicate that responses of neurons, axons, and Schwann cells could be important in slowing the regeneration of myelinated fibers found in sciatic nerves from aging mice.     

多层螺旋CT扫描图像数据对经蝶窦入路穿刺三叉神经节及其分支的可行性研究

目的 探讨经蝶窦入路穿刺三叉神经节及其分支的可行性,分析两者的毗邻关系及相关限制因素.方法 对110例成年中国人头部薄层CT轴位原始资料进行多平面重组,观察圆孔、卵圆孔、翼腭窝（管）、Meckel腔与蝶窦外侧壁的关系,测量蝶窦外侧壁至诸结构的骨壁厚度.结果 ①圆孔紧靠蝶窦外侧壁的前外下方,骨壁厚度＜2 mm者84例（76%）;②重组图像可显示翼腭管全程,翼腭窝与蝶窦前下外侧壁之间的骨壁厚度＜2 mm者77例（70%）;③卵圆孔距离蝶窦外侧壁距离＞5 mm 98例（89%）;④由蝶窦腔内经颈内动脉管前方入路,斜向后下外方可及Meckel腔,骨壁厚度1～5 mm,颈动脉管为重要骨性标志.结论 经蝶窦内可分别穿刺或开放圆孔、翼腭窝和Meckel腔,而经蝶窦内穿刺卵圆孔基本不可行;经蝶窦入路至三叉神经节及其分支的可及性与蝶窦气腔的位置和扩展程度有关.     

老年与青壮年脑挫裂伤组织NGF的表达差异及意义

目的 研究衰老对脑挫裂伤组织神经生长因子（NGF）基因表达的影响,进一步探讨老年颅脑损伤病人神经功能缺失程度较重的分子生物学机制.方法 收集重型颅脑损伤开颅手术中的脑挫裂伤组织,应用免疫组化和医学数码图像分析技术,观察老年组（≥60岁）和青壮年组（19～59岁）病人脑损伤后3～9 h脑挫裂伤组织NGF蛋白的表达差异.结果 脑损伤后NGF在老年和青壮年脑挫裂伤组织中的表达均明显增强;老年组脑挫裂伤组织中的NGF蛋白表达显著性低于青壮年组（P＜0.05）.结论 老年人脑挫裂伤后NGF表达水平下降明显,提示其受损神经元的修复和生存能力降低,这可能是老年颅脑损伤病人恢复不良的重要原因之一.     

Lower limb blocks for children

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.     

The pattern evoked response in disorders of the optic nerve

The pattern evoked electroretinogram (PERG) was investigated in 11 patients with unilateral optic nerve disease and in a series of age-matched controls. The visually evoked potential (VEP) was also measured. The PERG showed a similar reduction to the VEP in optic nerve disease. Serial studies indicate that the PERG may not be affected immediately in some instances but may show a gradual decline over several months.     

Microanatomy and surgical approaches to the infratemporal fossa: an anaglyphic three-dimensional stereoscopic printing study.

Objective: The infratemporal fossa (ITF) is a continuation of the temporal fossa between the internal surface of the zygoma and the external surface of the temporal bone and greater wing of the sphenoid bone that is sitting deep to the ramus of the mandible. The principal structure to understanding its relationships is the lateral pterygoid muscle. Other important structures are the medial pterygoid muscle, the maxillary artery, the pterygoid venous plexus, the otic ganglion, the chorda tympani nerve and the mandibular nerve. In this study, we describe the microsurgical anatomy of the ITF, as viewed by step-by-step anatomical dissection and also through the perspective of three lateral approaches and one anterior surgical approach. Methods: Eight cadaver specimens were dissected. In one side of all specimens, an anatomical dissection was done in which a wide preauricular incision from the neck on the anterior border of the sternoclidomastoid muscle at the level of the cricoid cartilage to the superior temporal line was made. The flap was displaced anteriorly and the structures of the neck were dissected followed by a zygomatic osteotomy and dissection of the ITF structures. On the other side were the surgical approaches to the ITF. The combined infratemporal and posterior fossa approach was done in two specimens, the subtemporal preauricular infratemporal fossa approach in two, the zygomatic approach in two, and the lateral transantral maxillotomy in two. The anatomical dissections were documented on the three-dimensional (3D) anaglyphic method to produce stereoscopic prints. Results: The lateral pterygoid muscle is one of the principal structures to enable understanding of the relationships into the ITF. The tendon of the temporal muscle inserts in the coronoid process at the ITF. The maxillary artery is the terminal branch of the external carotid artery that originates at the neck of the mandible and runs into the parotid gland. In our dissections the maxillary artery was lateral to the buccal, lingual, and inferior alveolar nerves. We found the second part of the maxillary artery superficial to the lateral pterygoid muscle in all specimens The anterior and posterior branches of the deep temporal artery supply the temporal muscle. In two cases we found a middle deep temporal artery. The different approaches that we used provided different views of the same anatomical landmarks and this provides not only safer surgery but also the best choice to approach the ITF according with the pathology extension. Conclusions: The ITF is a complex region on the skull base that is affected by benign and malignant tumors. The study through different routes is helpful to disclose the relationship among the anatomical structures. Although the authors have shown four approaches, there are a variety of approaches and even a combination of these can be used. This type of anatomical knowledge is essential to choosing the best approach to treat lesions in this area.     

腮腺手术中耳大神经后支保留的临床意义

目的 探讨腮腺手术中耳大神经后支保留的可行性、方法及临床价值。方法 我们对48例腮腺肿瘤患者，按常规隐蔽切口腮腺手术方法进行治疗，保留或不保留耳大神经后支。分别于术后10d及1、6、12个月进行随访，检测耳廓上部、耳垂、耳下区、耳前区和耳后区的触觉、痛觉，并观察其感觉变化情况。结果 48例中35例耳大神经后支保留，耳廓上部及耳后区感觉无减退。术后早期耳前、耳垂及耳下区感觉有不同程度的减退，以耳前区最明显，随着时间延长症状逐步好转，6个月时感觉接近正常。另13例耳大神经切断患者感觉减退症状更加明显，恢复时间延长。结论 腮腺手术中耳大神经后支保留是可行的，所采用的方法可靠，可减轻局部麻木感，提高患者术后早期生活质量，降低神经切断后产生局部永久性麻木的可能性。