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1.
Background/Purpose
Dendritic cell (DC) migration from tumors to T-cell priming sites is critical in developing antitumor cytotoxicity. Cysteine cysteine receptor 7 (CCR7), a promigratory chemokine receptor, regulates DC recruitment to secondary lymphoid organs. Tumors may inhibit CCR7 expression to evade immunodetection. Previous work implicates impaired DC migration as a critical defect in immunity to neuroblastoma (NB). However, the mechanism has yet to be defined. We hypothesize that NB abrogates DC CCR7 expression and signaling, leading to decreased antitumor immunity.Methods
A/J mice (N = 36) were injected with saline (control) or murine NB (TBJ) and bone marrow-derived DC were isolated at 7, 14, and 28 days. CCR7 expression was analyzed by polymerase chain reaction, Western blot, and flow cytometry. Cytometry data were analyzed using the paired Student's t test.Results
Dendritic cells isolated from mice with NB had a 60% increase in CCR7 protein expression by flow cytometry compared with control mice at day 7. However, there was a 43% downregulation of CCR7 expression by DC from tumor-bearing mice compared with controls 2 weeks postinoculation (P < .005). These observations were confirmed by polymerase chain reaction and Western blot analysis.Conclusion
Neuroblastoma initially upregulates CCR7 expression by DC. However, with tumor progression, this chemokine is downregulated, likely leading to impaired DC migration. Immunotherapeutic strategies to bypass or augment CCR7-dependent DC trafficking may improve survival for patients with aggressive disease. 相似文献2.
Lee YT Cho SK Yoon K Shin HK Kim E Kim YB Kim WS Chun JM Han BH 《Journal of pediatric surgery》2011,46(3):514-519
Background/Purpose
The etiology of congenital muscular torticollis (CMT) remains controversial. Ultrasonographically, severe fibrosis involving the entire sternocleidomastoid muscle (SCM; type 3 or 4) fibrosis has been associated with poor clinical outcomes and indicates a chronic state of the condition. The purpose of this study was to test whether or not type 3 or 4 fibrosis detected early after birth is associated with factors related to prolonged intrauterine constraint.Methods
Sixty-seven patients (age, <3 months) with CMT were classified into 4 different ultrasonographic types according to the severity of SCM fibrosis. The odds ratio for the relationship between probability of type 3 or 4 and factors related to intrauterine constraint were calculated by a multivariate logistic regression model.Results
None were classified as type 4. Twenty-three patients (34%) had a history of breech presentation, and 21 (91.3%) of them were delivered by elective cesarean section without likelihood of birth trauma. Compared with normal pregnancy, breech presentation and oligohydramnios showed a 6.7 or 7.5 times higher probability for type 3 fibrosis, respectively.Conclusion
Risk factors for intrauterine constraint appear to be associated with ultrasonographically detected severe fibrosis involving the entire SCM muscle in early presenting CMT. 相似文献3.
Beom Su Kim Sung Tae Oh Jeong Hwan Yook Kab Choong Kim Min Gyu Kim Jun Won Jeong Byung Sik Kim 《American journal of surgery》2010,200(3):328-333
Background
Gastric endocrine tumors are usually classified as 3 types of well-differentiated endocrine tumors (typical carcinoids or carcinoids) and poorly differentiated carcinomas (neuroendocrine carcinomas [NECs]).Methods
From 1993 to 2008, 97 patients (73 men and 24 women) were diagnosed with gastric neuroendocrine tumors at the Asan Medical Center.Results
Of the 45 patients with typical carcinoids, 37 underwent surgery (eg, endoscopic resection). Of the 52 patients with NECs, 43 underwent surgery (eg, radical gastrectomy). One patient died of recurrence of the typical carcinoids, whereas 26 patients with NECs died of related diseases (P < .05). The rates of survival and recurrence did not significantly differ by type of typical carcinoid (P > .05).Conclusions
Regardless of the type, carcinoids that are not yet advanced can be effectively treated with minimal endoscopic or laparoscopic surgery. However, all NECs and advanced carcinoids should be treated with radical gastrectomy. 相似文献4.
Study design
Sheep anterior spinal fusion model with autogenous and xenogenous bone grafts.Objective
To investigate whether the relationship between cross-sectional area of the bone graft and area of the adjacent vertebral endplates has an effect on graft fracture rate.Summary of background data
Anterior spondylodesis with autogenous iliac crest transplant is a frequently performed operation to stabilize spinal motion segments but to date no precise recommendations with respect to minimum graft size are available in the literature.Methods
Anterior spondylodesis using autogenous and xenogenous grafts of constant size in combination with an angular stable plate (Macs TL®). Autogenous iliac crest graft was inserted in eight sheep and xenogenic, commercially available bovine graft (Tutobone®) in the additional eight animals.The surface areas of the endplates of the fused intervertebral space were calculated using CT scans and contact radiographs of the specimens obtained after 24 weeks. The graft itself was evaluated for fractures and osteolysis.Results
A fracture occurred in tricortical, autogenous grafts if the graft cross-sectional area was less than 21% of the area of the adjacent endplates. All xenogenic grafts fractured and therefore a comparable value could not be determined.Conclusion
The results clearly indicate that the relation between graft cross-sectional area and endplate area defines the survival or fracture of the graft in anterior spinal fusion. Although it is difficult to directly apply the results to the clinical situation it is suggested to choose a sufficiently large graft, in order to reduce the risk of autogenous graft fracture in anterior spondylodesis. 相似文献5.
Introduction
Entrapped trauma victims require extrication, which, on rare occasions, may involve amputation of a limb. Standard extrication techniques sometimes fail or may be impossible, leading to the death of the entrapped victim. We propose that the use of fire service hydraulic cutting equipment can be used effectively to urgently amputate a limb, where conventional techniques are unusable.Method
The study aims to determine: (i) the potential use of this equipment to achieve expeditious life-saving amputations and (ii) the effect the fire service hydraulic cutting equipment has on the bony and surrounding soft tissues. Initially a porcine limb was used followed by fresh-frozen cadaveric lower limbs. We recorded the time, number of cuts, proximal fracture propagation and quality of bone cut when performing amputations at five levels.Results
The experiment confirms that faster guillotine amputations in human cadaveric lower limb specimens can be achieved by using fire service hydraulic cutting equipment. Overall, the average time to complete an amputation in these ideal experimental circumstances at all five levels was quicker using the hydraulic cutting equipment. Either one or two cutting actions were required to achieve the amputation using fire service hydraulic cutting equipment. The degree and proximal extent of the comminution were greater using the fire service hydraulic cutting equipment.Conclusion
If circumstances and time constrains allow, a conventional amputation technique carried out by a trained medical practitioner would be preferable to the use of the fire service hydraulic cutting equipment. However, we feel that this technique could be used to perform emergent amputation under trained medical supervision, if it is felt that a standard amputation technique would take too long or the environment is too restrictive to perform a standard amputation safely. 相似文献6.
Roof-arc angle and weight-bearing area of the acetabulum 总被引:2,自引:0,他引:2
Background
Unreduced fracture crossing the weight-bearing dome of the acetabulum leads to arthritis. Thus the integrity of the weight-bearing dome is considered to be an important prognostic indicator for acetabular fracture. The decision of whether or not to operate is based on the location of the fracture relative to the weight-bearing dome. A displaced fracture crossing the weight-bearing dome is an indication for surgery.Objective
To measure the medial, anterior, and posterior roof-arc angles that cross the weight-bearing dome.Methods
Twenty cadeveric hip joints were dissected and simulated transverse fractures of acetabuli through the transtectal area were made. The radiographic examinations were taken in three views: AP, obturator oblique, and iliac oblique. Roof-arc angle was measured in all three views (medial, anterior, and posterior).Results
The medial roof-arc angle was 46 ± 6.3°, anterior roof-arc angle was 52 ± 7.0°, and posterior roof-arc angle was 62° ± 8.5°.Conclusions
In acetabular fracture, a medial roof-arc angle less than 46°, an anterior roof-arc angle less than 52°, or posterior roof-arc angle less than 61° is considered to be involved in a weight-bearing area.Clinical relevance
These roof-arc angle values may be used as a surgical guideline for an acetabular fracture around the weight-bearing area. 相似文献7.
8.
Vasudevan SA Russell HV Okcu MF Burlingame SM Liu ZJ Yang J Nuchtern JG 《Journal of pediatric surgery》2007,42(1):148-152
Background/Purpose
In advanced-stage neuroblastoma, bulky disease and systemic dissemination can be controlled with intense surgical and medical therapies; however, recurrence rates are very high in this group indicating that residual disease is rarely eradicated. The need to detect residual disease and predict prognosis is critical to planning appropriate treatment regimens for these patients. Recently, neuroblastoma-derived secretory protein (NDSP) was identified and cloned from neuroblastoma.Methods
Using quantitative real-time PCR, we tested NDSP messenger RNA (mRNA) expression in 45 neuroblastoma tumor samples and 5 bone marrow samples. Correlation between NDSP expression and age at diagnosis, International Neuroblastoma Staging System, MYCN amplification, and Children's Oncology Group risk stratification was analyzed using Spearman nonparametric correlation.Results
Neuroblastoma tissue samples show much higher NDSP mRNA levels above control in 43 of 45 samples (96%); moreover, these levels correlate with the Children's Oncology Group neuroblastoma risk group assignment. We also found that bone marrow samples with known tumor infiltration had much higher NDSP mRNA levels than bone marrow from patients without metastasis.Conclusion
From these data, we conclude that NDSP mRNA levels in neuroblastoma tumor tissue correlate with risk group assignment and may serve as a marker for metastasis in bone marrow. 相似文献9.
Perryman SV Jenkins DD Streetz KL Longaker MT Sylvester KG 《Journal of pediatric surgery》2008,43(8):1511-1519
Background
Numerous congenital and acquired liver diseases could benefit from a successful hepatic cell therapy strategy. Hepatotypic cells derived from bone marrow have been recognized during liver injury, repair, and regeneration. To study this phenomenon, we compared the effect of several modes of experimental hepatic injury on hepatotypic protein expression in a mouse model after bone marrow transplantation.Methods
Male mice transgenic for the liver-specific protein human α-1 antitrypsin (hAAT) were used as bone marrow donors. Syngeneic wild-type recipient mice were subjected to 1 of 3 hepatic injuries: (1) sublethal irradiation, (2) injection of a hepatotoxic adenoviral construct, and (3) administration of a hepatotoxic diet. Bone marrow-derived hepatotypic (BMdH) transgene expression was determined by serial serum enzyme-linked immunosorbent assay for hAAT.Results
In both acute injury models, hAAT expression was detected as early as 1 week, whereas the control group never elicited hAAT expression. The adenovirus-treated group demonstrated transient hAAT level expression lasting up to 2 weeks postinjury, whereas the irradiated group maintained persistent hAAT expression through 4 months. In the chronic injury (hepatotoxin) model, hAAT expression persisted and was noted to increase over time to 200 to 300 ng/mL.Conclusions
Irradiation favors long-term establishment of BMdH transgene expression, and chronic injury further promotes this phenomenon. 相似文献10.
Purpose
The aim of the study was to describe and establish a normal measurement of the striated muscle complex (SMC) in healthy children using body phased-array or head coil magnetic resonance imaging.Methods
Imaging was performed in 20 boys and 20 girls (age range, from 3 months to 14 years; average age, 3.2 years) without anorectal disorders. The dimensions of the puborectalis muscle (PR) and external anal sphincter (EAS) were measured in different planes.Results
There was a close positive correlation between absolute width and length of SMC and age (P < .05), whereas there was no correlation between the relative width and length of SMC and age (P > .05). Normal relative length of the PR and EAS were measured as 0.47 ± 0.04 and 0.41 ± 0.04, respectively, and the normal relative width of PR and posterior EAS were 0.50 ± 0.04 and 0.44 ± 0.04 in children younger than 14 years.Conclusions
The width and length of PR and EAS increase progressively with age. The relative width and length of PR and EAS were not variable with age. A relative width and length of PR and EAS were chosen as objective criteria for normal SMC in children younger than 14 years. 相似文献11.
Huibin Qi 《American journal of surgery》2006,192(5):e55
Background
Intestinal electrical stimulation (IES) with long pulses has been reported to inhibit motility as well as accelerate transit of continuous infusion. However, it is unknown whether there is a correlation between the IES-induced alterations in motility and transit and whether there is a difference in transit during IES between continuous infusion and bolus infusion.Methods
The study was performed in 2 postprandial sessions (control and stimulation) in dogs with 2 pairs of serosal electrodes and 2 intestinal cannulas. Intestinal motility and transit with and without IES were measured by manometry and phenol red, respectively.Results
IES significantly decreased intestinal motility and increased transit time. There was a significant correlation between motility index and transit during IES.Conclusions
IES inhibits both intestinal bolus motility and transit. There is correlation between motility and transit during IES. 相似文献12.
Yusuf Öztürkmen Mahmut Karamehmeto?lu Hilmi Karadeniz ?brahim Azboy Mustafa Caniklio?lu 《Injury》2009,40(3):321-221
Objectives
We evaluated the results of acute application of the Ilizarov external fixator for segmental tibial fractures and also examined the experience with these special type fractures.Methods
Twenty-four patients (19 males, 5 females) with a mean age of 37.8 years (range 22-66) with segmental tibial fractures were treated with the use of an Ilizarov type circular fixator. According to the categorisation of Melis et al., the fractures were types I, II, III and IV in seven, nine, five and three patients, respectively. Seven fractures were closed and 17 were open (9 grade IIIa, 5 grade IIIb, 2 grade II, 1 grade I according to the Gustilo classification). The mean time from the injury to surgery was 14 h (range 4-36). Eight patients with partial-thickness soft-tissue defects with no bone exposure were managed by split thickness skin grafting. Flap procedures were performed in four patients. All patients had good lower leg viability with a MESS score 6 and below. No patients had bone defects of 3 cm or more at the fracture level. Functional and bone results were made using the criteria proposed by ASAMI. The mean follow-up 28 months (range 12-70).Results
We obtained excellent results in 20 and good results in 4 patients in terms of bone assessment. Functional results were excellent in 19 and good in 5 patients. All radiological evaluations showed normal alignment except in two patients. Both united with a residual procurvatum deformity. No rotational deformity was seen. Bone grafting was performed in one patient with a distal fracture. Complete union was achieved in all patients. None of the patients required amputation. There were no refractures after frame removal. Pin-tract infection occurred in 13 of the 24 patients. There were no incidents of chronic osteomyelitis secondary to pin-tract infection. The mean time for proximal fracture union was 36.4 weeks (range 10-78) and 39.8 weeks (range 12-80) for the distal fractures (p > 0.05). Callus and consolidation occurred earlier posterolaterally. There were no implant failures.Conclusion
Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method is particularly effective in the treatment of distal segmental fractures of the tibia when the distal segment is short. This method allows for control of complications by decreasing the need for new operations even in the presence of infection. 相似文献13.
Luo JM Chou NK Chen YS Huang SC Chi NH Yu HY Ko WJ Wang SS 《Transplantation proceedings》2012,44(4):913-914
Purpose
Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. When the transplanted heart fails, retransplantation is suggested and herein we have presented the prognosis of these pediatric cases.Materials and methods
From March 1987 to March 2011, we performed 404 heart transplantations including 45 pediatric patients, 6 (13.3%) of whom experienced graft failure requiring retransplantation. Only four of the six patients (66.7%) had a chance for retransplantation.Results
Six of 45 pediatric heart transplant patients (13.3%) experienced graft failure requiring retransplantation. Four of them (66.7%) underwent retransplantation. Only one of the four died due to severe postoperative sepsis with acute respiratory distress. The other three patients recovered well and remain alive with no neurological sequelae; all are in New York Heart Association functional classification I at present.Conclusion
Pediatric post-heart graft failure require expectations retransplantation, which shows a good prognosis. 相似文献14.
Background
The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric hip fractures. Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the fracture environment.Methods
There were 17 patients at our institution over a 2-year period whose long oblique subtrochanteric fractures would not reduce perfectly in an anatomical fashion using closed methods. All these patients had their fractures treated identically using a new policy at our unit. This strategy involved reduction of the fracture through an open approach, and then employing cerclage cables to stabilise the fracture in an anatomical position before finally inserting a cephalomedullary nail. These patients were retrospectively reviewed at an average of 18 months postoperatively, to assess their progressive functional and radiological outcome up to that point.Results
One patient had nonunion and required a secondary procedure. One patient died 8 days postoperatively from a medical complication. The remaining 15 healed within 6 months and all returned to independent living.Conclusions
The results demonstrate that judicious use of cerclage cables to augment fixation of subtrochanteric femur fractures does not have a deleterious effect on healing. One should endeavour, however, to minimise the number of cables used. The basic science literature underpinning our approach to these unstable fractures is also discussed. 相似文献15.
Ginger K. Bryant Saam Morshed Julie Agel M. Bradford Henley David P. Barei Lisa A. Taitsman Sean E. Nork 《Injury》2009,40(11):1180-1186
Objective
Report treatment results of periprosthetic femoral fractures adjacent or at the tip of a stable femoral stem (Vancouver Type B1) using a locked compression plate as the sole method of fracture stabilisation.Design
Retrospective case series.Setting
Academic Level I Trauma Centre.Patients
Patients operatively treated at our institution with locked compression plating for Vancouver Type B1 periprosthetic fractures between 2002 and 2006 with at least 12 weeks of clinical follow-up were included. Patient demographics, hip arthroplasty implant characteristics, and AO/OTA fracture type were recorded.Intervention
Open reduction internal fixation using a locked-plate spanning a majority of the femur through a lateral soft-tissue sparing approach. No cortical onlay allografts or cerclage devices (wires or cables) were used.Main outcome measurements
Clinical union was defined at a minimum of 12 weeks as ability to walk, with or without the use of a walking aide, without pain at or around the fracture site. Radiographic union was defined by bridging bone spanning two or more cortices on orthogonal radiographs of the femur.Results
Ten subjects met the inclusion criteria and were followed for a mean of 27 weeks (range 14-97 weeks). All achieved fracture union at a mean of 17 weeks (range 12-27 weeks). There were no hardware failures or changes in fracture alignment from operative radiographs. There were no major complications that necessitated reoperation.Conclusions
Open reduction internal fixation of Vancouver Type B1 periprosthetic femoral fractures using a lateral locked-plate that spans the full extent of the femur as the sole method of stabilisation is a successful treatment method that minimises soft-tissue dissection and provides adequate fixation strength to maintain fracture alignment to fracture union. 相似文献16.
Vegunta RK Wallace LJ Leonardi MR Gross TL Renfroe Y Marshall JS Cohen HS Hocker JR Macwan KS Clark SE Ramiro S Pearl RH 《Journal of pediatric surgery》2005,40(3):528-534
Purpose
The authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients.Method
Antenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar.Results
Primary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair.Conclusions
Our new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis. 相似文献17.
Sarahrudi K Thomas A Mousavi M Kaiser G Köttstorfer J Kecht M Hajdu S Aharinejad S 《Injury》2011,42(8):833-837
Introduction
Transforming growth factor-beta 1(TGF-β1) is a regulatory protein, involved in bone fracture healing. Circulating TGF-β1 levels have been reported to be a predictor of delayed bone healing and non-union, suggesting active relationship between tissue and circulating TGF-β1 in fracture healing. The purpose of this study was to analyse TGF-β1 local and serum concentrations in fracture healing to further contribute to the understanding of molecular regulation of fracture healing.Patients and methods
Serum samples of 113 patients with long bone fractures were collected over a period of 6 months following a standardised time schedule. TGF-β1 serum concentrations were measured using ELISA. Patients were assigned to 2 groups: Group 1 contained 103 patients with physiological healing. Group 2 contained 10 patients with impaired healing. Patients in both groups were matched. One patient of the group 2 had to be excluded because of missing match partner. In addition, fracture haematoma from 11 patients of group 1 was obtained to analyse local TGF-β1 concentrations. 33 volunteers donated serum which served as control.Results
TGF-β1 serum concentrations increased during the early healing period and were significantly higher in patients with physiological healing compared to controls (P = 0.04). Thereafter, it decreased continuously between weeks 2 and 8 and fell again after week 8. TGF-β1 serum concentrations in patients with physiological healing were significantly higher at week 24 compared to controls (P = 0.05). In non-unions, serum concentrations differed significantly from those of controls at week 6 (P = 0.01). No significant difference in between patients with physiological and impaired fracture healing was observed. Fracture haematoma contained significantly higher TGF-β1 concentrations than peripheral serum of the patients (P = 0.017).Conclusion
Elevated levels of TGF-β1 in haematoma and in serum after bone fracture especially during the entire healing process indicate its importance for fracture healing. 相似文献18.
Spence GM Graham AN Mulholland K Maxwell P McCluggage WG Sloan JM McGuigan JA 《The Annals of thoracic surgery》2004,78(6):529-1949
Background
Tumor angiogenesis is critical for metastasis development. The detection of bone marrow micrometastases may indicate a metastatic phenotype. We aim to establish if the detection of bone marrow micrometastases associates with elevated markers of angiogenesis and adverse histopathologic features of esophageal cancer.Methods
Bone marrow aspirates from 49 patients with esophageal cancer were assessed and assigned to be positive or negative for micrometastases. Routine histologic assessment of the primary tumor was also undertaken. Circulating and tumor levels of the angiogenic cytokine vascular endothelial growth factor were determined in plasma and tumor homogenate. Intratumor microvessel density was evaluated by counting anti-CD34 positive neovessels.Results
Twenty-two patients were positive for bone marrow micrometastases (44.9%). The detection of micrometastases was associated with advanced T stage (T3/4 vs T1/2; p = 0.023), circumferential margin involvement (p = 0.002) and lymphovascular invasion (p = 0.024). Plasma vascular endothelial growth factor was significantly more elevated in micrometastatic-positive patients than in those without micrometastases (p = 0.018). No difference was noted in tumor vascular endothelial growth factor expression. For adenocarcinomas alone, intratumor microvessel density was significantly higher in micrometastatic positive cases (p = 0.03). This was not the case for squamous cell carcinomas.Conclusions
The detection of bone marrow micrometastases is associated with esophageal tumors of advanced T stage and specifically for adenocarcinomas with tumor vascularity. Plasma vascular endothelial growth factor is elevated in micrometastatic positive cases and might be derived from sources other than the primary tumor. 相似文献19.
Andres Makarem Jose N. Fayad Fred H. Linthicum Jr. 《Otolaryngology--head and neck surgery》2010,143(2):269-273
Objective
To demonstrate that what appears to be endolymphatic hydrops of the apical scala media is normal anatomy.Study Design
Computer-generated three-dimensional reconstruction of the cochlear apex and tabulation of the number of cases with arched Reissner's membranes (pseudohydrops) versus flat membranes.Setting
Temporal bone laboratory consisting of 809 documented pairs of temporal bones.Subjects and Methods
Archival temporal bone sections from 107 bones (65 patients) were used to determine the percentage of arched (pseudohydrops) versus flat Reissner's membranes. Two bones, one of each membrane shape, were randomly selected for computer-generated three-dimensional reconstructions showing the cochlear apical anatomy.Results
An arched Reissner's membrane was found in 48.6 percent of bones. In the cochlear apex, Reissner's membrane appears to be distended, simulating hydrops, due to its transition from a conical structure to a triangle bounded by the basilar membrane with the organ of Corti, the stria vascularis, and Reissner's membrane. Membrane findings were similar in both ears in 73.8 percent of the bilateral cases studied. There were no significant relationships between membrane type and clinical characteristics.Conclusion
What appears to be endolymphatic hydrops of the cochlear apex is the transition area of the cochlear duct from a conical shape at the extreme apex to the triangular shape found in the rest of the cochlea. The appearance of distension is dependent upon the cochlear length and the level of the microscopic section. 相似文献20.