岩斜区侧方手术入路相关血管神经显微外科解剖

目的 :为岩斜区侧方手术入路提供显微外科解剖学基础。方法 :15例头颅湿标本 ,模拟手术入路解剖观测相关重要血管神经走行长度及相互毗邻关系。观察了Labbe’s静脉 ,岩静脉 ,小脑前下及后下动脉走行及与神经的关系。结果 :测得三叉神经出颅部到正中矢状面距离、角度及颅内段长度分别为(13 .1± 2 .1)mm (10 .2～ 15 .3mm ) ,19.3°± 8.1°(14 .5°～ 2 5 .0°) ,(14 .0± 1.9)mm (11.6～ 18.2mm ) ;展神经分别为 (10 .0± 1.7)mm (8.9～ 11.9mm ) ,2 5 .3°± 12 .3°(2 1.0°～ 2 7.6°) ,(17.1± 3 .5 )mm (14 .0～ 2 1.0mm) ;面和前庭蜗神经分别为 (2 3 .8± 2 .9)mm (2 .1～ 3 .2mm ) ,70 .3°± 5 .6°(65 .0°～ 78.3°) ,(14 .8±2 .3 )mm (11.2～ 2 0 .1mm) ;舌咽神经分别为 (2 3 .1± 3 .1)mm (19.8～ 3 4.1mm ) ,67.5°± 7.6°(5 9.6°～70 .4°) ,(14 .9± 1.9)mm (13 .0～ 16.7mm )。结论 :①颞下、乙状窦前及乙状窦后入路适用于中、上岩斜区病变 ;枕下远外侧入路适用于下岩斜区病变。②本文岩斜区重要神经血管形态及相互关系测量数据 ,可提高该区相关手术的安全度和成功率。     

齿突形态的测量及临床意义

目的 :了解国人齿状突的形态特点 ,为齿突螺钉设计及固定提供解剖学基础。方法 :测量6 0例枢椎干骨形态、3 0例齿突基底部的内径及合适进钉角度。结果 :国人枢椎总高度为 3 6 .8± 2 .4mm ,齿突长度为 14 .0± 1.2mm ;基底部冠状外径为 8.9± 1.0mm ,冠状内径为 6 .1± 0 .5mm ;合适的进钉角度为16°± 3°。结论 :绝大部分国人齿突不适合两枚 3 .5mm螺钉固定。齿突螺钉的设计应充分考虑国人齿突的特点。     

鼻内窥镜引导下筛动脉结扎术的应用解剖

目的 :为鼻中隔严重出血功能性鼻内窥镜引导下筛动脉结扎提供解剖学基础。方法 :手术显微镜下解剖 2 0侧成人鼻中隔的动脉。结果 :鼻中隔血供属多源性 ,主要来自鼻后中隔动脉上支、下支 ,筛前、筛后动脉 ,它们入鼻中隔处外径分别为 (0 .9± 0 .2 )、(0 .7± 0 .1)、(0 .4± 0 .1)、(0 .3± 0 .1)mm ,筛前、筛后动脉入鼻中隔处与鼻小柱前缘距离分别为 (5 .1± 0 .3 )cm和 (6.3± 0 .3 )cm ,入鼻中隔处与鼻小柱基底连线和鼻腔底壁的夹角分别为 (5 5 .5°± 4.4°)和 (4 5 .0°± 3 .5°) ,鼻中隔段主干长分别为 (1.3± 0 .4)、(1.0± 0 .2 )cm。筛前、筛后动脉主要分布于鼻中隔上部。结论 :功能性鼻内窥镜引导下筛动脉结扎具有可行性。     

鼻丘的临床解剖学研究及其临床意义

目的 :为临床开展鼻窦内窥镜手术提供外科手术解剖学依据。方法 :在 2 0具 40侧经防腐处理的完整成人尸头标本上观测鼻丘气房的大小及其相关临床数据。结果 :鼻丘气房的最大前后径为 (8.4±1.4)mm(6.0～ 11.0mm) ;最大上下径为 (10 .8± 2 .3 )mm(7.0～ 16.0mm) ;鼻丘骨壁的厚度为 (0 .1± 0 .1)mm(0 .1～ 0 .5mm) ;鼻丘中心至前鼻棘的距离为 (3 9.9± 2 .9)mm(3 4.0～ 46.0mm) ;其连线与鼻底平面间的夹角为 (77.3± 6.6)°(65 .0～ 90 .0 )°。结论 :鼻丘气房的发育大小是影响额窦引流的主要解剖因素 ,了解鼻丘气房的解剖是手术成功的关键     

颈椎前路减压及内固定的解剖学问题

目的 :探讨颈椎前路减压安全界限的解剖标志及适合国人的颈椎前路钢板螺钉设计参数。方法 :采用 17例完整成人颈部标本 (含C3～C7) ,对颈椎前路减压及钢板螺钉内固定设计的有关解剖学参数进行测量 ,包括颈长肌间距、横突孔间距、椎体矢状径及钩突与横突孔间距等。结果 :在C3～C7相应椎体 ,颈长肌内侧与横突孔之间有 7～ 9mm的距离 ;钩突内侧缘距横突孔 5mm ,钩突前脚距横突孔 4mm。从C3～C7,钩突前脚间距从 15 .4mm增大到 2 3 .2mm ,椎体矢状径为 14 .8～ 16 .3mm ,钩突前后径约 11mm。结论 :颈椎前路减压的安全区域可以双侧钩突前角为解剖标志 ,在此之间手术比较安全。适合国人的颈椎前路钢板设计以宽度 16～ 17mm ,螺钉长度 12mm为合适。     

喉后外侧进路杓状软骨定位的应用解剖

目的 :为临床喉后外侧手术进路杓状软骨的定位提供解剖依据。方法 :观察 3 0例 60侧 (男 19例 ,女 11例 )喉软骨架标本杓状软骨肌突与甲状软骨板的位置关系。结果 :(1)杓状软骨肌突距甲状软骨下角下端距离 :男 (12 .5± 1.8)mm ,女 (10 .5± 1.8)mm ;距甲状软骨板后缘间距 :男 (8.0± 1.7)mm ,女 (6.7± 1.8)mm ;距甲状软骨板内面间距 :男 (3 .4± 1.7)mm ,女 (3 .5± 1.1)mm。 (2 )杓状软骨肌突投影点位于甲状软骨板斜线后区下部 ,该投影点距甲状软骨下缘距离 :男 (6.6± 0 .1)mm ,女 (4 .9± 0 .4)mm ;距后缘距离 :男 (6.8± 1.8)mm ,女 (5 .5± 1.3 )mm。结论 :经喉后外侧进路手术可从甲状软骨后缘、下缘、环甲关节下缘或去除部分甲状软骨板来定位肌突。肌突距甲状软骨板内面最近 ,若从甲状软骨板斜线后区开窗寻找肌突可以缩短手术进路距离。     

骶后孔解剖学定位及其临床意义

目的:建立精确、简易的骶后孔定位方法,为临床八髎穴针灸、骶后孔阻滞麻醉形态学基础。方法:解剖剔除28例成人尸体的骶骨周围软组织,清楚显露骶、尾骨及其骶后孔,对各个解剖结构进行仔细观察并用游标卡尺测量记录。结果:①以两侧髂嵴最高点连线为X轴,以骶后正中嵴线为Y轴,各骶后孔的中点在X轴上的坐标分别为:(23.41±2.49)、(19.90±2.21)、(18.39±2.55)、(17.93±1.98)mm,在Y轴上的坐标分别为:男(49.71±6.15)、(68.45±5.78)、(86.91±6.14)、(104.91±7.00)mm,女(44.17±5.71)、(60.44±6.30)、(78.60±7.23)、(96.48±7.87)mm。②骶前、后孔深距:S(124.2±3.2)、S(218.6±2.8)、S3(12.7±2.6)、S4(6.8±1.9)mm。③骶后孔穿刺针尖水平偏离矢状轴角度:S1(6.3°±2.5°)、S2(4.8°±1.6°)、S3(4.0°±2.0°)、S4(3.6°±1.7°)。结论:提出可供临床应用骶后孔简易和精确的两种定位方法及针灸、穿刺适宜进针角度和深度。     

下颈椎侧方入路的应用解剖

目的 :为下颈椎侧方入路提供应用解剖学基础。方法 :在 3 0具成人尸体标本上 ,沿胸锁乳突肌后缘 ,对应C5～ 7椎体作纵切口 ,由浅入深分别经臂丛前、后方逐层解剖观测至椎骨的解剖结构。结果 :①臂丛前方有前斜角肌、膈神经和甲状颈干 ;椎体前方有颈长肌 ,颈交感干位于颈长肌的外侧缘 ,椎动脉贴颈长肌外缘上行入横突孔 ;②臂丛后方有中、后斜角肌及肩胛提肌 ,椎弓两侧有项部肌 ;颈深动、静脉走在半棘肌和多裂肌之间 ;③臂丛颈 5～ 8四个根的长度分别是 3 3± 8.6、2 7.2± 7.4、3 8.8± 8.6和 2 0 .4±6 .0mm ;根角度 (神经根于椎间孔处与椎体垂线的夹角 )分别是 43°± 9°、5 2°± 10°、6 2°± 10°和 74°± 7° ,相邻神经根间隙距离为 :C5～ 6 :5 .3± 1.7mm ;C6～ 7:5 .6± 1.6mm ;C7～ 8:6 .0± 1.6mm ;④胸膜顶在第 7颈椎末端下方平第 1肋颈高度。结论 :下颈椎侧方入路可一次切除半侧颈椎骨的病灶。在臂丛前方径路中要保护好膈神经、椎动脉、交感干 ;臂丛后方径路中保护好胸长神经和肩胛背神经 ;处理横突时要注意对臂丛根的保护。     

跟骨载距突的解剖特点及其临床意义

目的 :探讨跟骨载距突的解剖特点及其临床意义。方法 :对 10 8侧成人跟骨干燥标本和 2 6侧成人足部标本进行解剖学观察。结合观察测量结果 ,分析 45例跟骨骨折患者的X线片和CT片中的载距突移位情况。结果 :载距突的长、宽、高分别为 (2 3 .6± 3 .0 )mm ,(15 .3± 2 .2 )mm和 (9.5± 1.2 )mm。在 45例跟骨骨折患者中 ,无一发生载距突移位。在跟骨载距突的周围 ,有牢固的肌腱、韧带和关节囊附着 ,故当跟骨骨折时 ,这些结构可限制载距突移位。结论 :载距突周围的解剖特点决定了载距突在跟骨骨折中不会发生移位 ,故临床上可利用稳定的载距突骨块作为跟骨骨折行内固定术时的固定点。     

颈椎前路减压与椎内静脉丛相关的应用解剖学研究

目的探讨颈椎前路手术中减压范围与椎内静脉丛出血问题相关的应用解剖学研究.方法选择6具新鲜尸体和12具经防腐固定的完整的成人颈部标本(C1～T1),对椎体钩突前脚间距、钩突前脚与横突孔内壁垂直距离及椎内前静脉丛两侧纵行血管间距等进行解剖观察.结果椎内前静脉丛潜行于后纵韧带内,紧贴硬脊膜背面,两条纵行血管问形成横行交通支;在C3～C7相应椎体,钩突内侧缘与横突孔内壁间距为(5.25±0.85)mm,C3～C7相应节段椎内前静脉丛两侧纵行血管间距从(11.13±0.20)mm增大到(14.98±0.27)mm.C3～C7钩突前角间距从(14.60±1.03)mm增大到(21.51±1.91)mm,钩突前后径均大于11 mm.结论颈椎前路手术减压的安全区域可以双侧钩突前角为解剖标志,在此范同内,可完全显露椎内静脉丛两侧纵行静脉,从而有效地处理椎内静脉丛术中出血问题,手术安全,减压彻底.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.