Involvement of the adrenal medulla in ejaculatory reactions in the dog

To explore the peripheral signal controlling ejaculatory reactions, contraction of the seminal tract and seminal emission were monitored in the dog during electrical stimulation of the lumbar and greater splanchnic nerves in the presence or absence of sympathetic pathways connecting the lumbar sympathetic trunk to the seminal tract including the vas deferens, prostate and bladder neck. Electrical stimulation of the lumbar splanchnic nerve caused seminal emission, elevation of intraluminal pressure of the vas deferens and bladder neck, and contraction of the prostate without elevation of blood pressure. Transection of all peripheral sympathetic nerve pathways to the seminal tract completely blocked these responses. Electrical stimulation of the greater splanchnic nerve caused a marked elevation of blood pressure as well as the responses described above in both the presence and absence of peripheral sympathetic nerve pathways to the seminal tract. However, clamping the adrenal veins bilaterally blocked all of the above responses and declamping immediately reversed the block. Serum levels of epinephrine, norepinephrine and dopamine were significantly increased by electrical stimulation of the greater splanchnic nerve, while cortisol levels remained unchanged. Furthermore, intravenous administration of epinephrine (5 μg/kg) caused responses similar to those elicited by stimulating the greater splanchnic nerve. Dogs in which all sympathetic pathways to the seminal tract had been transected chronically showed retrograde ejaculation during manual penile stimulation. The above results indicate possible involvement of the greater splanchnic nerve and adrenal medulla in ejaculatory reactions in the dog.     

Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache - A Case Report

A case is presented which has features of Cervicogenic Headache and of Hemicrania Continua. A sudden maneuver of the neck and later a greater occipital nerve block, both resulted in relief of the pain. A cervical cause is suggested.     

旋股外侧血管升支臀中肌支大转子骨瓣转移的应用解剖

目的　为带旋股外侧血管升支臀中肌支大转子骨瓣转移治疗股骨头缺血性坏死提供解剖学依据。　方法　在 3 2侧经动脉灌注红色乳胶的下肢标本上 ,对旋股外侧血管升支臀中肌支的走行及分布进行观察 ,设计带旋股外侧血管升支臀中肌支大转子骨瓣转移治疗股骨头缺血性坏死的手术方法。　结果　臀中肌支是旋股外侧血管升支在阔筋膜张肌肌门处向后上的分支 ,一部分分支向臀中肌止点方向走行 ,成网状分布于大转子尖端的上面和外侧面。臀中肌支起点外径为 (1 0± 0 3 )mm ,一般有 2支 ,起点至大转子止点长度为 (4 0± 1 3 )cm ,距离升支起点距离为 (4 9± 0 8)cm ,手术切取的骨瓣范围可达 1 5cm× 2 5cm× 1 5cm。　结论　旋股外侧血管升支臀中肌支大转子骨瓣转移 ,可以为股骨头提供丰富的血运 ,是一种治疗股骨头缺血性坏死简便、微创及有效的方法。     

Vaginal reconstruction with a greater omentum–pedicled graft combined with a vicryl mesh after anterior pelvic exenteration. Surgical approach with long-term follow-up

Resection of anterior vaginal wall that occurs with some cases of anterior pelvic exenteration leaves the patient with a small and narrow vagina. This affects their sexual life leading to major psychologic problems, especially in young women. The aim of this study is to evaluate a new technique of vaginal reconstruction following anterior pelvic exenteration with clinical and cytohistologic follow-up. Between March 2002 and November 2004, ten sexually active female patients underwent vaginal reconstruction after radical cystectomy that required en bloc removal of the anterior vaginal wall, with a pedicle graft of greater omentum combined with a vicryl mesh. The mean age of the patients was 38 years. The mean operative time of the reconstructive procedure was 50 min. There were no complications regarding the reconstructive procedure. On follow-up, the neovagina accepted two fingers easily and showed a pink-colored smooth lining. Seven patients reported successful attempts of sexual intercourse. It was concluded that reconstruction of vagina after anterior pelvic exenteration in sexually active women can be done safely with the use of vicryl mesh combined with a pedicled omental graft. It is a simple, reliable, and not time-consuming technique. The long-term follow-up was very beneficial in detection of complete healing, postoperative infections, and hormonal activity of the graft and recurrence of malignancy.     

Sonoanatomy and Pathology of the Posterior Band of the Gluteus Medius Tendon

Greater trochanteric pain syndrome is a common clinical entity that most often results from disorders of the gluteus medius tendon. There are two distinct bands of the gluteus medius tendon, and abnormalities may affect the anterior or posterior band in isolation or simultaneously. Although abnormalities of the anterior band are more common, awareness and sonographic detection of posterior band abnormalities is essential to guide treatment in the setting of greater trochanteric pain syndrome.     

康复治疗对股骨头坏死术后患者功能恢复的影响

目的：探讨康复治疗对大转子骨瓣移位术后功能恢复的影响。方法：50例股骨头坏死患者采用带旋股内血管大转子骨瓣移位术，术后施行康复治疗。术前、康复治疗后对关节疼痛、关节活动度及日常生活能力进行评定。结果：经过6个月康复治疗，50例患者髓关节疼痛改善，关节活动度及日常生活能力与治疗前比较有显著提高（均P〈0．01）。结论：康复治疗有利于股骨头坏死大转子骨瓣移位术后患者肢体功能的恢复。     

大转子式股骨柄置换及股骨近端防旋髓内钉治疗老年股骨转子间骨折

目的 探讨大转子式股骨柄(GTF)双极股骨头置换及股骨近端防旋髓内钉(PFNA)治疗老年不稳定性股骨转子间骨折的临床疗效.方法 对34 例老年股骨转子间骨折患者分别采用GTF双极股骨头置换(GTF组,19例)和PFNA内固定治疗(PFNA组,15例),比较两组手术时间、出血量、住院天数、下床时间、术后并发症、髋关节功能Harris评分等指标.结果 34例均得到随访,时间6～48(12.7±5.8)个月.PFNA 组均获得骨性愈合.PFNA组手术时间、出血量低于GTF组,GTF组下床时间、并发症、早期Harris评分优于PFNA组,差异均有统计学意义(P<0.05);两组患者住院天数及中晚期Harris评分差异无统计学意义(P>0.05).结论 GTF柄双极股骨头置换与PFNA内固定治疗老年不稳定性股骨转子间骨折,均可获得满意的临床效果,在一定适应证范围内,GTF具有相应优势.     

肩关节脱位合并肱骨大结节骨折不同治疗方法对功能的影响

目的：探讨保守治疗和手术治疗肩关节脱位合并大结节撕脱骨折对肩关节功能的影响。方法统计肩关节手法复位后悬吊患肢与行肱骨大结节骨折切开复位内固定术后功能恢复情况。结果术后随访6～16个月,显示手术组疗效明显优于保守治疗组,保守治疗易导致肩峰撞击症和冻结肩。结论肩关节脱位合并肱骨大结节撕脱骨折手术治疗效果优于非手术治疗。     

Anterior locking plate reduces trochanteric fracture migrations during hip extension

Background

Greater trochanter fractures or osteotomies fixed with lateral plates still present high rates of complications. Unblocked greater trochanter anterior movement during hip extension might be a possible cause of failure. This study aimed to determine, under stair climbing conditions, the biomechanical behaviour of a greater trochanter fragment and the impact of an anterior locking plate on its migration.

Methods

Eighteen femurs paired from nine fresh frozen cadaveric specimens were tested on a quasi-dynamic stair climbing cycling test bench. Left and right sides with greater trochanter fractures were randomly fixed either with an antero-lateral locking plate or with a lateral locking plate. Migrations, defined as the remaining movements of the unloaded greater trochanter fragment, were measured for all 18 femurs.

Findings

During hip extension, multi-directional greater trochanter fragment movements occurred and showed a back-and-forth anterior rotation. The lateral locking plate failed due to greater trochanter fragment rotation around the superior axis and anterior translation. The antero-lateral locking plate significantly reduced greater trochanter anterior migration (− 0.9 mm ± 1.6) compared to the lateral locking plate (9.6 mm ± 9.5).

Interpretation

Hip extension provides a plausible explanation for the high rate of post-operative failures of greater trochanter fixations. An antero-lateral locking plate represents an efficient surgical alternative counteracting the multi-directional greater trochanter movements occurring during hip extension.