院前高能量创伤颈椎损伤特点分析与急救策略

目的了解院前高能量创伤患者颈椎损伤的特点,为在院外急救中制定颈部制动规范提供参考依据。方法 2011年1月至2014年1月经杭州市急救中心救治并经医院确诊有颈椎损伤的高能量创伤患者59例,分析致伤原因、颈部症状、合并损伤部位、意识状态与颈椎损伤的关系。结果致伤原因:交通伤32例(54.2%)、坠落伤19例(32.2%)、摔伤6例(10.2%)、暴力伤2例(3.4%);颈部症状:有相关症状(疼痛、活动障碍、肢体麻木等)29例(49.2%)、无明显症状4例(6.8%)、意识障碍26例(44.1%);合并损伤部位:颅脑损伤37例(62.7%)、胸颈背部损伤29例(49.2%)、腰部骨盆四肢损伤23例(40.0%)、单纯颈部损伤2例(3.4%);意识状态:意识障碍26例(44.1%)、清醒33例(55.9%)。实施院前颈椎制动52例(88.14%)。结论院前高能量的创伤要高度考虑颈椎损伤,制定高能量创伤患者的颈部制动规范能确保避免颈椎的二次损伤,提高创伤救治效果。     

倒换床单法在护理颈椎损伤患者中的应用

颈椎损伤患者须卧床休息、颈部制动、行牵引治疗．这给更换床单带来极大的不便。为避免翻身不当而增加患者的疼痛，或造成骨折部位移位而影响愈合．甚至危及生命．我院根据人体力学原理总结出一套新的床单更换法．通过临床应用．效果良好．现介绍如下。     

自制颈枕垫用于颈椎外伤及颈椎疾患术后患者

颈椎骨折行牵引术或颈椎疾患术后患者多需颈部制动,以减轻局部刺激,防止骨折或内植物移位、脱落,从而促进损伤组织的修复[1].临床上多采用盐袋固定颈部.2010年2～6月,我科采用自制颈枕垫应用于颈椎外伤及颈椎疾患术后患者,效果满意,现介绍如下.     

颈椎外伤并高位截瘫的治疗体会

目的:通过颈椎外伤并高伴截瘫的治疗,探讨治疗高位截瘫患者好的治疗方法、关键措施,手术与否的判定。方法:根据患者颈椎骨折、滑脱程度的不同,给予颈围领、颅骨牵引及Hallo氏架固定,根据MRI检查,决定手术减压与否,加强患者全身支持对症治疗,注意预防三大并发症。结果:本组26例截瘫患者完全恢复6例,部分恢复10例,无任何恢复6例,死亡4例。结论:颈椎外伤后,颈部制动非常重要,Hallo氏架对颈部制动是一种很好的外固定,通过MRI检查,了解脊髓受压及损伤情况,以此决定手术减压与否,加强患者全身支持对症治疗,预防三大并发症是降低患者死亡率的关键。     

择期颈椎手术患者困难气道的研究

目的对择期颈椎手术患者困难气道的发生率以及困难气道和颈椎疾病的相关性进行前瞻性研究。方法172例拟在全身麻醉下择期行颈椎手术的患者于手术前日或麻醉诱导前进行气道评估。困难气道评估指标为：张口度、颈部活动度、甲颏距离、Mallampati分级和Cormack分级等。结果颈椎择期手术的患者中困难气道的比例为30．2％。张口度较差的占2．4％，甲颏距离较短的占7．2％，Mallampati分级为Ⅲ～Ⅳ级的占19．8％，Cormack分级为Ⅲ级的占12．2％。困难气道的发生与患者的年龄和性别无显著相关；但与患者的颈部活动度密切相关，颈椎滑脱和颈椎骨折的患者困难气道的发生率显著升高。结论颈椎择期手术患者困难气道的发生率要远高于普通人群，并且与颈部活动度、颈椎滑脱和颈椎骨折密切相关。     

颈部脊髓损伤的若干问题探讨

１９８７年１０月～１９９５年９月，我科收治颈部脊髓损伤患者２１例。临床资料２１例中男１９例，女２例；年龄２７～６１岁；颈部直接受伤者９例，由头部伤致颈部脊髓伤者１２例；影像学检查：摄颈椎Ｘ线平片２０例，颈椎ＣＴ检查者１４例，颈椎ＭＲＩ检查者５例；颈牵引治疗１４例，手术治疗者７例；死亡２例，１例死于肺炎，另１例死于以ＡＲＤＳ为主的ＭＯＦ综合征。讨论１．头伤和颈伤致颈脊髓损伤的关系。２１例颈部脊髓损伤中，颈部直接受伤者仅有９例，而由头部伤引起颈部脊髓损伤者达１２例，其中，无１例重度颅脑损伤，能构成脑…     

气管插管对颈椎的影响

背景麻醉医师在气管内插管和其他气道管理操作时都常规涉及到颈部,这些操作对颈椎运动的影响,特别是对颈椎损伤患者的颈椎及神经的影响,是麻醉医师值得重视的问题。 目的简述颈椎解剖结构和各种操作对颈椎运动的影响,从而更好地指导临床工作以及提高麻醉的安全性。 内容从颈椎解剖、颈椎运动、气管内插管时的颈椎活动、插管辅助设备对颈...     

高位颈椎骨折的漏诊原因分析

目的探讨高位颈椎骨折高漏诊的原因。方法回顾分析上海交通大学医学院附属第三人民医院自2007年1月至2013年2月诊治的19例早期漏诊的高位颈椎骨折病例的诊治记录,并分析2组不同年资的骨科医师对漏诊病例的影像资料的读片准确性。结果高位颈椎骨折易同时合并重要的复合伤发生,导致颈椎损伤症状被掩盖,是骨折漏诊的关键因素。低年资医师依据颈椎X线摄片和普通颈椎CT扫描片对高位颈椎骨折的诊断率较低,也是导致其漏诊的重要原因。结论为减少高位颈椎骨折的漏诊,必须重视头面部外伤患者,同时建议行颈椎螺旋CT薄层扫描和二维重建以提高骨折诊断的准确性。为预防因漏诊导致的继发损伤,对可疑高位颈椎骨折患者必须给予必要的颈部保护和严格随访。     

颈椎骨折脱位并发的椎动脉损伤

目的：分析颈椎骨折脱位并发的推动脉损伤的发生率及易发因素,方法：11例颈椎骨折脱位患者均接受颈椎MRI及颈部磁共振血管成像（MRA）检查。结果：3例合并有椎动脉损伤（均为单侧）,由屈曲暴力致伤及存在小关节脱位。嵴髓损伤均为A级（ASIA标准）。结论：颈椎骨折脱位可能并发椎动脉损伤、脊髓完全性损伤及颈椎小关节脱位患者,应常规进行MRA检查,以明确是否合并椎动脉损伤。     

颈椎前路融合术后颈部运动功能的评价

目的观察颈椎前路融合术后相邻节段的退变情况和颈部症状的关系,以及颈椎各节段和整体活动度在手术前后的变化。方法对66例颈椎前路融合术后的患者随访1-16年,平均10.5年,观察融合相邻节段在过伸、过屈侧位X线片上的活动度和成角、滑移程度,及其和颈部症状之间的关系。将其中59例患者的手术前后整体颈椎和未融合节段的活动度进行对比,寻找其变化规律。结果在随访期内观察到的相邻节段不稳定发生率为72.7％,有明显颈部症状者占40.9％。融合相邻节段不稳定的患者中有明显颈部症状者占48.0％,相邻节段稳定者中出现明显颈部症状者占18.8％,其差异有显著性意义(P<0.05),轻度不稳定和显著不稳定者发生明显颈部症状的差异无显著性意义(P>0.1)。患者手术后整体颈椎的活动度明显变小(P<0.001),相邻节段活动度显著增大(P<0.01),非相邻节段活动度无明显变化(P>0.05)。结论颈椎前路融合术后多数患者将出现相邻节段不稳定,但是多数患者颈部无明显症状,相邻节段不稳定是颈部症状发生的原因之一。     

Trace elements in dialysis fluids and assessment of the exposure of patients on regular hemodialysis, hemofiltration and continuous ambulatory peritoneal dialysis.

Forty-four elements (Al, Sb, As, Ba, Be, B, Br, Cd, Ce, Co, Cr, Cs, Cu, Eu, Ga, Au, Hf, In, Ir, Fe, La, Lu, Mn, Hg, Mo, Nd, Ni, Pb, Rb, Sm, Sc, Se, Ag, Sr, Ta, Tb, Tl, Th, Sn, W, U, V, Zn, Zr) have been determined in the dialysate for hemodialysis (HD) and fluids for hemofiltration (HF) and continuous ambulatory peritoneal dialysis (CAPD). Multiple determinations have been performed for each dialysis fluid. Several trace elements (TE) showed remarkably elevated average levels; moreover, different bathes of the same commercial product may present a wide variability in TE concentration. The data point out the pivotal role of dialysis fluids in contributing to TE imbalance in dialysis patients and allow the assessment of the potential element exposure of patients on regular dialytic treatment. Patients on HD treatment would be exposed on a weekly basis to milligrams of Al, B, Ba, Br, Cu, Fe, Ni, Pb, Rb, Sr and Zn; on HF, the highest exposures are due to Al, B, Br, Fe, Pb and Zn; on CAPD to B, Br, Fe and Zn. The weekly exposure for several TE appears to be 50- to 12,000-fold higher than the corresponding values on the amount absorbed via the diet (HD: Au, Ba, Be, Ce, Ga, La, Sc, Ta, Th, V, Zr; HF: Be, Ce, Ta, Th, V, Zr; CAPD: Au, Be, Ce, Ga, V, Zr).(ABSTRACT TRUNCATED AT 250 WORDS)     

Perioperative mortality and morbidity in the year 2000 in 520 certified training hospitals of Japanese Society of Anesthesiologists: with a special reference to age--report of Japanese Society of Anesthesiologists Committee on Operating Room Safety

Perioperative mortality and morbidity in Japan for the year 2000 were studied retrospectively. Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 Certified Training Hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to the age group. The total number of anesthetics available for this analysis was 910,757. All cases were divided into 7 age groups; group A (< 1 months), group B (< 12 months), group C (< 5 years), group D (< 18 years), group E (< 65 years), group F (< 85 years), and group G (> 85 years). The incidences of all critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 70.04, 42.06, 17.79, 15.57, 21.14, 39.66, and 44.65 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The overall mortality rates (death during anesthesia and within 7th postoperative day) were 26.94, 5.91, 1.88, 2.57, 5.23, 11.98, and 17.50 per 10,000 anesthetics in patients with group A, B, C, D, E, F, and G, respectively. The incidences of cardiac arrest were 28.29, 8.54, 3.56, 2.57, 5.08, 10.27, and 11.47 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The mortality rates after cardiac arrest were 18.86, 4.60, 1.26, 1.57, 2.77, 5.50, and 6.64 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of all critical events, the incidence of cardiac arrest, and the overall mortality rate were much higher in group A than in other groups, but much lower than those in 1999. The incidences of all critical events and the mortality rate after cardiac arrest were lowest in group C. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidences of all critical events attributable to co-existing disease were the highest in these four groups, and 32.33, 13.80, 5.86, 4.43, 7.50, 15.34, and 21.72 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidences of all critical events attributable to anesthetic management were 13.47, 16.43, 6.28, 3.86, 4.08, 6.87, and 6.64 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. The incidence of cardiac arrest in group A was much more attributable to co-existing disease and operation than other causes. The incidences of cardiac arrest attributable to anesthetic management were 0.00, 1.97, 0.63, 0.29, 0.38, 0.74, and 1.81 per 10,000 in patients with group A, B, C, D, E, F, and G, respectively. Its mortality rate in each group was 0.00, 0.00, 0.21, 0.14, 0.06, 0.04, or 0.00. There were eleven cases of death or vegetative state due to anesthetic management, like improper management of airway and overdose of anesthetics. Some of them were preventable with the anesthesiologists' effort in protocol development and skilled assistance.     

Commonly used eponyms in anesthesia

Names with eponym status in present-day anesthesia include Apgar, Bier, Bovie, Esmarch, Fick, Foley, Ganz, Hofmann, Huber, Joule, Luer, Macintosh, Magill, Mallampati, Miller, Ovassapian, Pascal, Ringer, Seldinger, Sellick, Swan, Trendelenburg, Tuohy, Valsalva, and Yankauer. A discussion of the people behind the eponyms, which may make these commonly used terms more interesting and provides a sense of the history of the specialty of anesthesia, is presented.     

BOOK REVIEWS

Book Reviews in this article. GASTROINTESTINAL HAEMORRHAGE Edited by Peter W. Dykes , MD, FRCP FRACP and Michael R. B. Keighley , MS FRCS. CLINICAL AND RADIOGRAPHIC INTERPRETATION OF FACIAL FRACTURES By Amil J. Gerlock , Jr ., MD, Douglas P. Sinn , DDS, and Kevin L. Mc Bride , DDS COLOUR ATLAS OF GYNAECOLOGY By Norman A. Beischer , MD, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG and Eric V. Mac Kay , MB, BS, MGO, FRCS, (Ed.), FRACS, FRCOG, FRACOG, FACOG (Hon) ADVANCES AND TECHNICAL STANDARDS IN NEUROSURGERY Volume 8 Edited by H. Krayenbuhl DISPLACEMENT OFTHEHIP IN CHILDHOOD: AETIOLOGY, MANAGEMENT ANDSEQUELAE By Edgar W. Somerville , MA, FRCS, FRCS (Ed.) INTESTINAL FISTULAS By John Alexander -Williams , MD, ChM, FRCS, FACS and Miles Irving , MD, ChM, FRCS CLINICAL SURGERY INTERNATIONAL VOLUME 3 TISSUE TRANSPLANTATION Edited by Peter J. Morris , PhD, FRCS, FRACS DISEASES OF THE GASTROINTESTINAL TRACT AND LIVER By David J. C. Shearman , PhD, MBChB, FRCP, (Ed.), FRACP, and Niall D. C. Finlayson , PhD, MBChB, MRCP (Lond.), FRCP (Ed.)     

Nutrition of the critically ill - emphasis on liver and pancreas

About 25 million individuals undergo high risk surgery each year. Of these about 3 million will never return home from hospital, and the quality of life for many of those who return is often significantly impaired. Furthermore, many of those who manage to leave hospital have undergone severe life-threatening complications, mostly infections/sepsis. The development is strongly associated with the level of systemic inflammation in the body, which again is entirely a result of malfunctioning GI microbiota, a condition called dysbiosis, with deranged composition and function of the gastrointestinal microbiota from the mouth to the anus and impaired ability to maintain intact mucosal membrane functions and prevent leakage of toxins-bacterial endotoxins and whole or debris of bacteria, but also foods containing proteotoxins gluten, casein and zein and heat-induced molecules such as advanced glycation end products (AGEs) and advanced lipoxidation end products (ALEs). Markedly lower total anaerobic bacterial counts, particularly of the beneficial Bifidobacterium and Lactobacillus and higher counts of total facultative anaerobes such as Staphylococcus and Pseudomonas are often observed when analyzing the colonic microbiota. In addition Gram-negative facultative anaerobes are commonly identified microbial organisms in mesenteric lymph nodes and at serosal “scrapings” at laparotomy in patients suffering what is called “Systemic inflammation response system” (SIRS). Clearly the outcome is influenced by preexisting conditions in those undergoing surgery, but not to the extent as one could expect. Several studies have for example been unable to find significant influence of pre-existing obesity. The outcome seems much more to be related to the life-style of the individual and her/his “maintenance” of the microbiota e.g., size and diversity of microbiota, normal microbiota, eubiosis, being highly preventive.About 75% of the food Westerners consume does not benefit microbiota in the lower gut. Most of it, refined carbohydrates, is already absorbed in the upper part of the GI tract, and of what reaches the large intestine is of limited value containing less minerals, less vitamins and other nutrients important for maintenance of the microbiota. The consequence is that the microbiota of modern man has a much reduced size and diversity in comparison to what our Palelithic forefathers had, and individuals living a rural life have today. It is the artificial treatment provided by modern care, unfortunately often the only alternative, which belongs to the main contributor to poor outcome, among them; artificial ventilation, artificial nutrition, hygienic measures, use of skin penetrating devices, tubes and catheters, frequent use of pharmaceuticals, all known to significantly impair the total microbiome of the body and dramatically contribute to poor outcome. Attempts to reconstitute a normal microbiome have often failed as they have always been undertaken as a complement to and not an alternative to existing treatment schemes, especially treatments with antibiotics. Modern nutrition formulas are clearly too artificial as they are based on mixture of a variety of chemicals, which alone or together induce inflammation. Alternative formulas, based on regular food ingredients, especially rich in raw fresh greens, vegetables and fruits and with them healthy bacteria are suggested to be developed and tried.Key Words: Health care, surgery, stress, trauma, transplantation, liver cirrhosis, liver steatosis, obesity, osteoarthritis, pancreatitis, critical care, nutrition, enteral nutrition, parenteral nutrition, microbiota, microbiome, microbial translocation, probiotic bacteria, lactobacillus, lactobacillus plantarum, lactobacillus paracasei, microbial translocation, inflammation, infection, toll-like, neutrophils, pharmaceuticals, biological, eco-biologicals, nutraceuticals, antioxidants, curcumin, antibiotics, chemotherapeutics, barriers, leakage, gut, airways, oral cavity, skin, vagina, placenta, amnion, blood-brain barrier, growth, replication, apoptosis, mucosa, endothelium, plaques, cCtokines, IL1, NF-kB, TNF, growth factors, insulinogenic, IGF-1, prebiotics, plant fibers, greens, fruits, vegetables, minerals, fat diet, refined carbohydrate diet, advanced glycation end products (AGEs), advanced lipoxidation end products (ALEs), endotoxin, LPS, proteotoxins, casein, gluten, zein, whey, western lifestyle, paleolithic lifestyle, schimpanzee, avocado, amaranth, buckwheat, quinoa, olive oils, red palm oil, soy, fatty acids, long-chained, medium chained, short-chained, poly-unsaturated, saturated fatty acids, monsaturated     

The paradox of hydration in advanced terminal illness

“You are looking at the waves but ignoring the Sea.” Rumi[1]An alternate view of traditional medical practice may allow us to understand that the rejection of food and drink at the end of life is natural, and that the technologic support of nutrition and hydration is artificial and unnatural. Perhaps it is not the inadequate nutrition and dehydration, but rather the artificial processes and elements that should cause us to cringe.[5]Practical concepts exist. It may be difficult for family members and medical personnel to accept the patient’s choice to forgo food and water. Longstanding personal and cultural values may conflict with this decision. We must offer education and emotional support to both groups of caregivers (personal and professional).The sensation of thirst can be powerful and uncomfortable. Excellent oral hygiene, including frequent swabing, will alleviate this symptom more readily than forcing unwanted fluids. A token glass of water, placed nearby, and easily available, may help alleviate the emotional angst of all involved by providing a cultural symbol of nurturance.Careful attention to patient symptoms during the dying process will further produce a “good death.” Adjustment of narcotics and antianxiety agents may improve patient comfort. Remember that an actual reduction of medications may be required as the final days and hours of life approach, in part because of decreased renal clearance.A final gentle reminder: terminal dehydration is not swift. Death may not take place for several days to weeks. Occasionally unexpected but much welcomed consequences of forgoing forced hydration, such as marked reduction of massive edema or ascites, occur in longer term survivors. An average of 1 to 2 weeks may pass before the ultimate demise of the patient. Hospice can assist with valuable services to the patient and caregivers during this distressing time period.In conclusion, terminal dehydration is a controversial topic, weighted heavily with historic symbolism, and strong religious, societal, and cultural conflicts. Of prime importance is the patient’s legal right, the choice, to forgo hydration. It is a violation of autonomy, liberty, and dignity to force hydration on a competent patient who is unmistakably refusing.[14] It is our duty to respect and protect this decision, and to provide adequate care and comfort during the dying process.

Appendix

Surgical palliative care workgroup

Geoffrey P Dunn, MD, FACS, Erie, PA, Series Editor Peter Angelos, MD, PhD, Chicago, IL Karen Brasel, MD, FACS, Milwaukee, WI Timothy G Buchman, PhD, MD, St Louis, MO Susan Jo Bumagin, MEd, Gloucester, MA Ira Byock, MD, Missoula, MT Joseph M Civetta, MD, FACS, Farmington, CT Alexandra M Easson, MD, FRCS(C), Toronto, Ontario Daniel B Hinshaw, MD, FACS, Ann Arbor, MI Joan L Huffman, MD, FACS, Upland, PA Wendy C Husser, MA, MPA, Chicago, IL Dennis L Johnson, MD, Hershey, PA Olga Jonasson, MD, FACS, Chicago, IL Thomas J Krizek, MD, FACS, Wesley Chapel, FL Robert S Krouse, MD, Tucson, AZ K Francis Lee, MD, FACS, Springfield, MA Laurence E McCahill, MD, FACS, Alhambra, CA Robert A Milch, MD, FACS, Buffalo, NY Anne C Mosenthal, MD, FACS, Newark, NJ Gretchen Purcell, MD, PhD, Durham, NC A Reed Thompson, MD, FACS, Little Rock, AR David Weissman, MD, FACP, Milwaukee, WI H Brownell Wheeler, MD, FACS, Worcester, MA     

畸形精子症分子遗传学机制研究进展

畸形精子症是影响男性不育的重要因素之一,然而其发病机制尚未明晰。近年来,对精子形态的研究取得了一定进展,某些基因被证实与畸形精子症的发生有关。本文回顾近5年文献,透过大量对圆头精子症、精子核空泡、断头精子症、残余胞质、纤维鞘发育不良(DFS)和原发性纤毛运动障碍(PCD)等特殊形态异常精子的研究,详细阐述了DPY19L2、AR、PRM1、GBA2、PCI、CREM、TH2A、TH2B、ODF1、Cntrob、OAZ-t、HOOK1、SPEM1、GAT1、PRSS21、15-LOX、Sptrx、AKAP3、AKAP4、DNAI1、DNAH5、RSPH4A、TXNDC3、CCDC39、LRRC6、LRRC50、KTU等基因的分子遗传学机制,旨为畸形精子症的致病机制研究提供依据。同时本综述回顾了国内外对上述畸形精子症患者进行辅助生殖治疗的最新进展,并探讨这类患者的辅助生殖结局,为男性不育的诊治提供理论依据。     

Conversions and complications of laparoscopic cholecystectomy

Summary During 1991, 41 surgeons of the French Society of Endoscopic Surgery and Operative Radiology (SFCERO) performed 3,673 cholecystectome of which 2,955 were laparoscopic. Data for those patients in whom a conversion to laparotomy was necessary or a complication occurred were collected by a retrospective multicenter survey. Conversion was performed in 142 patients (4.8%): in 106 this was due to pathology in the subhepatic space; in 36 it was because of a complication related to the laparoscopy. There were 101 postoperative complications (morbidity 3.4%): 59 biliary and 42 non biliary complications and six deaths (mortality 0.2%). There were 18 bile duct injuries, one of which led to the death of the patient.Excluding conversions to laparotomy, these figures are comparable to those for open cholecystectomy. These results define the limits and advantages of laparoscopic cholecytectomy. Conversion to laparotomy remains a wise option in cases of technical difficulty or doubtful biliary anatomy. List of participating surgeons: Drs. Becaud, Begin, Bereder, Berthou, Brefort, Bertin, Bobois, Boitias, Bosgiraud, Brenner, Cardin, Chigot, Churet, Collet, Cubertafond, Desplantez, Drouard, Edye, Esso, Frètigny, Garcia, Gossot, Grandjean, Guinot, Hirigoyen, Juanchich, Leynaud, Magne, Mangin, Mazure, Meyer, Pailler, Périssat, Poinsard, Ribet, Rivallain, Rollier, Samama, Skavinski, Thomas, Vayre, and Wurtz     

Renal cystic disease of infancy: results of histochemical studies

Histochemical techniques utilizingTetragonolobus lotus (proximal tubules),Arachis hypogaea (distal nephron, i.e., distal convoluted tubules and collecting ducts), and antibodies against Tamm-Horsfall protein (thick ascending limbs of Henle) were used to determine the site of origin of renal cysts in five children with autosomal recessive polycystic kidney disease (ARPKD) and three patients with glomerulocystic disease (GCD) presenting in the 1st year of life. The findings support a distal nephron origin for the cysts in the children who had ARPKD, whereas the majority of cysts in the children with GCD were confirmed as having a glomerular origin. Tamm-Horsfall protein was identified in the cysts of both ARPKD and GCD; this finding suggests free communication between some of the cysts with the thick ascending limb of Henle. An unexpected finding was the frequent presence of cysts surrounded by muscle fibers. We suggest that these cysts are of collecting duct origin.Southwest Pediatric Nephrology Study Group (SPNSG Central Office, Baylor University Medical Center at Dallas, Texas, USA): Director, Ronald J, Hogg: Associate Directors, Fred G, Administrative Assistant, Kaye Green. Participating Centers: Baylor College of Medicine, Houston, Texas, Phillip L. Berry, L. Leighton Hill, Sami A. Sanjad, Edith Hawkins; Baylor University Medical Center, Dallas, Texas, Ronald J. Hogg, Kaye Green; Tulane University Medical Center, New Orleans, Lonisiana, Frank Boineau, John E Lewy, Radhakrishna Baliga, Patrick Walker; University of Arkansas, Little Rock, Arkansas, Watson Arnold, Elleen Ellis, Edward Uthman; University of Colorado Health Science Center, Denver, Colorado, Gary M. Lum, William Hammond; University of Oklahoma Medical Center, Oklahoma City, Oklahoma, James Wenzl, James Matson. Geoffrey Altshuler, Sarah Johnson; University of Tennessee, Memphis, Tennessee, F. Bruder Stapleton, Shane Roy, III, Robert J. Wyatt, Charles McKay, William Murphy; University of Texas Health Science Center at Dallas, Texas, Billy S. Arant, Jr., Michel Baum, Fred G. Silva, Arthur Weinberg, Craig Argyle, Joseph Rutledge, Ed Eigenbrodt; University of Texas Medical School, Houston, Texas, Susan B. Conley, Jacques Lemire, Ron Portman, Ann Ince, Regina Verani; University of Texas Health Science Center at San Antonio, Texas, Michael Foulds, Sudesh Makker, Kanwal Kher, Melanie Sweet Victor Saldivar, Fermin Tio; University of Texas Medical Branch. Galveston, Texas, Ben H. Brouhard, Alok Kalia, Luther B Travis, Lisa Hollander, Tito Cavallo, Srinivasan Rajaramau; University of Utah Medical Center, Salt Lake City, Utah, Eileen Brewer, Richard Siegler, Elizabeth Hammond, Theodore Pysher; Washington University School of Medicine, St Louis, Missouri, Barbara R. Cole.     

Acknowledgement

The Editor of Cerebral Cortex would like to thank the followingreviewers who have helped us in 2004. Abbott, Laurence Abraham, Wickliffe C. Aghajanian, George Aine, Cheryl Aizenstein, Howard Allen, John Allman, John Alloway, Kevin Alonso, Jose Manuel Amit, Daniel Andersen, Richard Anderson, Charles H. Andrews, Sally Ang, Eugenius Anton, Eva Aoki, Chiye Apkarian, Apkar Arieli, Amos Ashburner, John Ashe, James Astafiev, Serguei V. Averbeck, Bruno B. Ayoub, Albert Baciu, Monica Baker, Curtis Balaban, Evan Banich, Marie Bao, Shaowen Barash, Shabtai Barbas, Helen Barnes, Carol Barone, Pascal Barrionuevo, German Barth, Daniel Barto, Andrew G. Basar, Erol Basso, Michele A. Baxter, Mark Behar, Toby Belger, Aysenil Belin, Pascal Benson, Deanna L. Benveniste, Helene Berman, Karen Bernstein, Lynne Binder, Jeffrey Binkofski, Ferdinand Birbaumer, Niels Black, Sandra Blakemore, Sarah-Jane Blankenburg, Felix Bliss, Timothy Blood, Anne Blumenfeld, Hal Blumstein, Sheila Blusztajn,