三叉神经节阻滞相关结构的观测

目的:探讨三叉神经节阻滞的方法,预防其并发症的发生。方法:测量了120侧成人颅骨卵圆孔等结构的数据,观测了30侧成人尸头三叉神经节的毗邻结构。结果:三叉神经节阻滞进针的深度:①前入法:颧上颌缝下缘至卵圆孔前外侧缘的距离,男性左侧为51.5±0.6mm,右侧为51.9±0.5mm。女性左侧为50.3±0.6mm,右侧为50.9±0.7mm。②侧入法:颧弓中点下缘至卵圆孔前外侧缘的距离,男性左侧为40.4±0.4mm,右侧为40.9±0.4mm。女性左侧为39.2±0.6mm,右侧为40.2±0.7mm。获得了三叉神经节的毗邻结构观测结果。结论:为预防三叉神经节阻滞发生的并发症提供了解剖学依据。     

下颌神经阻滞入路的相关解剖结构特征

目的押对下颌神经阻滞入路相关结构及其毗邻关系进行解剖观测,为下颌神经阻滞入路和预防并发症的发生提供解剖学基础。方法:实验于2002-11/2005-11在郧阳医学院解剖学教研室完成。由郧阳医学院解剖学教研室提供120侧成人颅骨(男60侧,女60侧)和30侧尸体(男20侧,女10侧);均为无主尸体。测量了120侧成人颅骨卵圆孔等结构的数据,观测了30侧成人尸头下颌神经的毗邻结构。结果:①与下颌神经阻滞相关结构:男性除卵圆孔前壁厚、女性除颧弓中点下缘至翼突基部距离、卵圆孔宽径、卵圆前壁厚、卵圆孔前外侧缘至三叉神经压迹最近距离外,其余结构均存在侧别差异(P<0.05～0.01)。除左侧颧弓中点下缘至卵圆孔前外侧缘距离、左侧卵圆孔宽径、卵圆孔前壁厚外,其余侧别结构均存在性别差异(P<0.01)。下颌神经阻滞进针的深度:颧弓中点下缘至卵圆孔前外侧缘的距离熏男性左侧为(40.4±0.3)mm,右侧(40.9±0.4)mm。女性左侧为(39.8±0.6)mm,右侧为(40.2±0.7)mm。②下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系押下颌神经长度(10.4±1.6)mm,宽度为(4.5±1.5)mm,其中颅内段长(6.3±1.5)mm,卵圆孔内段长(5.1±0.6)mm。脑膜中动脉外径左侧为(1.5±0.3)mm,右侧为(1.5±0.4)mm。至上颌动脉起点的距离左侧为(7.1±0.4)mm,右侧为(8.3±0.3)mm。大部分脑膜副动脉入棘孔以前发出,起源于脑膜中动脉者22侧(73%)。上颌动脉者7侧穴23%雪。以双根起始者1侧(3%)。分支数,1支型24侧穴80%雪。2支型2侧(7%)。不存在4侧穴13%雪。脑膜副动脉分别经卵圆孔、蝶导血管、骨性翼棘孔入颅腔。下颌神经与脑膜中动脉的位置关系:脑膜中动脉位于下颌神经的后外侧22侧(73)%。位于下颌神经的外侧8侧(27%)。结论:获得了下颌神经的长度、宽度熏下颌神经阻滞进针的深度熏下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系熏以及圆孔、棘孔、破裂孔、颈静脉孔、海绵窦内等穿过的结构及毗邻关系的观测结果。下颌神经阻滞相关结构存在侧别和性别差异。     

面神经阻滞入路的相关解剖结构研究

目的:为面神经阻滞的进针入路和预防并发症的发生提供解剖学基础。方法:对60个成人颅骨(120侧,其中男60侧,女60侧)和30侧成人头、颈部标本,与面神经阻滞相关结构进行了解剖观测。结果:面神经阻滞进针的深度:乳突尖至茎乳孔的距离,男性左侧为16.4±0.3mm(12.0—19.5mm),右侧为15.1±0.4mm(11.5—20.0mm);女性左侧为15.4±0.4mm(13.0—18.0mm),右侧为15.3±0.4mm(13.0—18.4mm)。获得了面神经毗邻结构的观测结果。结论:为面神经阻滞的进针深度和预防并发症提供了解剖学依据。     

经上颌窦后壁入路手术治疗翼腭窝肿瘤的应用解剖学

目的:观察上颌窦后壁的形态,测量上颌窦后壁及其毗邻结构的相关数据,为经上颌窦后壁入路手术治疗翼腭窝肿瘤提供解剖学依据。方法:①随机挑选30例成人干颅,其中15例行矢状面切片,另15例行水平面切片。矢状面上测量:上颌窦后外侧壁后部的高度、厚度;上颌窦顶壁与后壁交界处的厚度。水平面上观测:蝶腭孔的形态、大小;蝶腭孔外侧壁至上颌窦后外侧壁后部与内侧壁交界处的距离;上颌窦后外侧壁后部的宽度。②将防腐处理的30侧正中矢状面成人头颅标本,在手术显微镜下观测上颌动脉翼腭窝段的位置、走行及其分支的长度及管径;上颌神经翼腭窝段的位置、走行及其分支;翼腭神经节的位置、形态及大小。结果:①在颅骨矢状面上测量:上颌窦后外侧壁后部的高度平均值为(19.21±3.42)mm;厚度平均值为(0.74±0.42)mm;上颌窦顶壁与后壁交界处的厚度平均值为(0.63±0.31)mm。在颅骨水平面上观测:蝶腭孔呈圆形者占66.7%,其呈卵圆形者占20%,呈不规则形者占13.3%,外侧壁至上颌窦后外侧壁后部与内侧壁交界处的距离平均值为(2.45±1.33)mm。上颌窦后外侧壁后部的宽度平均值为(7.52±2.08)mm。②上颌动脉翼腭窝段位置变异较大,30%在靠近上颌骨颞下面时略呈直角向内进入翼腭窝;70%到达上颌骨颞下面时,紧邻该面行走,其主要分支包括蝶腭动脉、上牙槽后动脉、眶下动脉、腭降动脉、圆孔动脉、翼管动脉。上颌神经翼腭窝段直径为(3.65±0.54)mm,斜向前外侧,紧贴上颌窦后外侧壁向上外侧走行。分为蝶腭神经、眶下神经和上牙槽后神经3大分支。翼腭神经节距离上颌神经下方(3.57±1.39)mm,上颌窦后外壁后部后方(3.17±1.08)mm。呈椭圆形者占43.3%,不规则形者占40%,圆形者16.7%。其直径平均值为(4.19±1.01)mm。结论:经上颌窦后壁入路手术治疗翼腭窝肿瘤凿开上颌窦后壁时,向内不能超过上颌窦后壁与内侧壁的交界处,向上不能超过上颌窦后壁与顶壁的交界处,摘除肿瘤时应仔细处理上颌动脉和上颌神经的分支。     

下颌神经阻滞入路的相关解剖结构特征

目的：对下颌神经阻滞入路相关结构及其毗邻关系进行解剖观测，为下颌神经阻滞入路和预防并发症的发生提供解剖学基础。 方法：实验于2002-11／2005-11在郧阳医学院解剖学教研室完成。由郧阳医学院解剖学教研室提供120侧成人颅骨（男60侧，女60侧）和30侧尸体（男20侧，女10侧）；均为无主尸体。测量了120侧成人颅骨卵圆孔等结构的数据，观测了30侧成人尸头下颌神经的毗邻结构。 结果：①与下颌神经阻滞相关结构：男性除卵圆孔前壁厚、女性除颧弓中点下缘至翼突基部距离、卵圆孔宽径、卵圆前壁厚、卵圆孔前外侧缘至三叉神经压迹最近距离外，其余结构均存在侧别差异（P〈0．05～0．01）。除左侧颧弓中点下缘至卵圆孔前外侧缘距离、左侧卵圆孔宽径、卵圆孔前壁厚外，其余侧别结构均存在性别差异（P〈0．01）。下颌神经阻滞进针的深度：颧弓中点下缘至卵圆孔前外侧缘的距离，男性左侧为（40．4&;#177;0．3）mm，右侧（40．9&;#177;0．4）mm。女性左侧为（39．8&;#177;0．6）mm，右侧为（40．2&;#177;0．7）mm。②下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系：下颌神经长度（10．4&;#177;1．6）mm，宽度为（4．5&;#177;1．5）mm，其中颅内段长（6．3&;#177;1．5）mm，卵圆孔内段长（5．1&;#177;0．6）mm。脑膜中动脉外径左侧为（1．5&;#177;0．3）mm，右侧为（1．5&;#177;0．4）mm。至上颌动脉起点的距离左侧为（7．1&;#177;0．4）mm，右侧为（8．3&;#177;0．3）mm。大部分脑膜副动脉入棘孔以前发出，起源于脑膜中动脉者22侧（73％）。上颌动脉者7侧（23％）。以双根起始者1侧（3％）。分支数，1支型24侧（80％）。2支型2侧（7％）。不存在4侧（13％）。脑膜副动脉分别经卵圆孔、蝶导血管、骨性翼棘孔入颅腔。下颌神经与脑膜中动脉的位置关系：脑膜中动脉位于下颌神经的后外侧22侧（73）％。位于下颌神经的外侧8侧（27％）。 结论：获得了下颌神经的长度、宽度，下颌神经阻滞进针的深度，下颌神经阻滞入路易损伤的结构及下颌神经的毗邻关系，以及圆孔、棘孔、破裂孔、颈静脉孔、海绵窦内等穿过的结构及毗邻关系的观测结果。下颌神经阻滞相关结构存在侧别和性别差异。     

迷走神经阻滞入路的相关解剖结构研究

目的：对迷走神经阻滞入路相关结构及其毗邻关系进行解剖学观测,为迷走神经阻滞入路和预防并发症的发生提供解剖学基础。方法：对60个成人颅骨（120侧,其中男60侧,女60侧）和30侧成人头、颈部标本迷走神经的毗邻结构进行解剖学观测。结果：迷走神经阻滞进针的深度（乳突尖至颈静脉孔外侧缘的距离）：男性左侧为24.5±0.5mm(17.0—30.2mm),右侧为24.9±0.7mm(19.5—30.4mm);女性左侧为23.1±0.4mm(16.0—28.5mm),右侧为22.7±0.6mm(13.0—28.3mm)。观测获得了乳突尖至茎乳孔的距离,茎乳孔至颈静脉窝外侧缘的距离。颈静脉孔的变异情况,迷走神经在颈静脉孔内、外与其他结构的关系。结论：可以乳突为标志作为预测颈静脉孔位置深度的参考数据。穿刺时,应注意避免误伤面神经和颈内静脉。     

腰丛阻滞相关解剖结构的观测

目的:对腰丛阻滞相关结构及其毗邻关系进行解剖观测,为腰丛神经阻滞和预防并发症的发生提供解剖学基础。方法:对70侧成人尸体腰部与腰丛阻滞相关结构及其毗邻关系进行了解剖观测。结果:腰丛穿刺进针深度:穿刺点为髂嵴连线与背正中交点下3cm,在腰椎棘突旁开4—5cm,皮肤至腰丛的距离,左侧为(59.6±0.7)(51.4—72.6)mm,右侧为(59.9±0.6)(53.3—71.4)mm。结论:在进行腰丛阻滞时进针深度可以上述数据为解剖学依据,应注意误伤及腹主动脉、腰动脉、下腔静脉、椎管等。     

颈胸神经节阻滞气管旁人路有关解剖结构的研究

目的:对颈胸神经节阻滞入路相关结构及其毗邻关系进行解剖观测,为颈胸神经节神经阻滞入路和预防并发症的发生提供解剖学基础.方法:对70侧尸体颈部与颈胸神经节阻滞入路相关结构及其毗邻关系进行了解剖观测.结果:颈胸神经节穿刺进针深度:颈胸神经节至皮肤(气管旁入路法)的距离,左侧为32.5±0.6(22.2～40.5)mm,右侧为32.7±0.5(23.1～42.3)mm,获得了与颈胸神经节穿刺相关结构的观测结果.星状神经节多居于第7颈椎横突基部与第1肋颈之间的前方.结论:为颈胸神经节阻滞入路进针深度和预防并发症的发生提供了解剖学依据.     

成人颅骨标本翼腭窝的断层解剖学观察

背景:目前国内外学者对骨性翼腭窝局部解剖学和影像学作了一些研究,而有关骨性翼腭窝的断层解剖学研究尚缺乏。目的:在成人颅骨标本的冠状面和水平面上测量翼腭窝的有关孔距和径值,观察翼腭窝在相应切面上的形态。设计:重复测量设计。单位:成都医学院科研处。材料:实验于2006-03/2006-11在成都医学院人体解剖学教研室局部解剖实验室完成。选取中国成人完整无损干性颅骨30例(60侧),未分年龄、性别。方法:对30个(60侧)成人干性颅骨标本左右两侧的翼腭窝进行切片,其中15个行冠状面切片,另15个行水平面切片,观察测量翼腭窝在相应层面的形态和有关孔距和径值,并对所得结果进行统计学分析。主要观察指标:①在冠状面上测量:眶圆距(眶下裂最低处与圆孔中心之间的距离);圆翼距Ⅰ(圆孔与翼管中心之间的上下垂直间距);圆翼距Ⅱ(圆孔出现处与翼管出现处之间的距离)。②在水平面上测量:前后径(每层面上与腭骨垂直板相平行的翼腭窝前后壁间距最大值);左右径(每层面上腭骨垂直板中点至翼腭窝前壁最外后突出处和翼腭窝后壁最前外突处连线的中点之距离)。③分别在冠状面、水平面上观察:各层面上翼腭窝的形态。结果:①冠状面上,左右两侧翼腭窝的第1～6层70%(21侧)呈斜倒梯形,30%(9侧)呈斜四边形,第7～10层均表现为管形。右侧眶圆距平均值为(5.0±2.7)mm,左侧眶圆距平均值为(5.3±2.1)mm;右侧圆翼距Ⅰ平均值为(6.4±3.9)mm,左侧圆翼距Ⅰ平均值为(6.1±4.3)mm;右侧圆翼距Ⅱ平均值为(7.3±2.6)mm,左侧圆翼距Ⅱ平均值为(7.5±2.1)mm。②水平面上,左右两侧翼腭窝第一二层其前、后壁主要表现为凸面均向后的双弧形80%(24侧);第三四层主要表现为凸面相对的双弧形约66.7%(20侧);第五六层主要表现为管形60%(18侧);第7～10层则全部表现为管形。水平面上,第1～6层翼腭窝左右径大于前后径,第7～10层翼腭窝左右径约等于前后径。左右两侧样本间翼腭窝各层面径值差异不明显(P>0.05)。结论:骨性翼腭窝断层解剖学研究弥补了对其局部解剖的局限,为翼腭窝影像学及相关外科手术提供了可靠的解剖学依据。     

骶管阻滞入路相关结构的应用解剖

目的:为骶管阻滞入路和预防并发症的发生提供解剖学基础.方法:解剖观测了50块骶骨和30具成人尸体标本与骶管阻滞麻醉相关的结构.结果:骶管阻滞进针的深度,皮肤(两侧骶角连线的中点)至骶管腔内的距离为16.4±0.2 mm.获得了与骶管阻滞相关结构的观测结果.结论:为骶管阻滞的进针深度及预防并发症提供了解剖学依据.     

THE INFLUENCE UPON THE SPLEEN AND THE THYROID OF THE COMPLETE REMOVAL OF THE EXTERNAL FUNCTION OF THE PANCREAS

The complete removal of the function of the pancreas concerned in digestion is followed by marked changes in the spleen and in the thyroid apparatus. Second, the spleen shows an extreme simple atrophy. Third, the thyroid apparatus exhibits a constant change shown by the macroscopic transparency of the gland, by the microscopic increase in the amount of colloid, by the chemical increase of the iodine content of the gland, and by the functional test of the delayed appearance of tetany after the complete removal of the thyroid apparatus.     

ON THE PHYSICOCHEMICAL REGULATION OF THE GROWTH OF TISSUES : THE EFFECTS OF THE DILUTION OF THE MEDIUM ON THE GROWTH OF THE SPLEEN.

It may be concluded that the degree of dilution of the culture medium has a marked influence on the rate of growth of splenic tissue. The maximum acceleration was obtained in a medium composed of three volumes of normal plasma and two volumes of distilled water. The growth in this hypotonic plasma was very much larger than in normal plasma. On the contrary, the growth of the spleen in hypertonic plasma was always less than in normal plasma. In other experiments, we found that in diluted plasma there was also an acceleration of the growth of the skin, the heart, and the liver of chickens. The skin of adult frogs also grew more actively in this plasma. The optimum degree of dilution varied according to the nature of the tissues and to the species of the animals. While the plasma containing two fifths distilled water produced the largest growth of splenic tissue, a slightly less diluted medium was more favorable for the liver and the heart, and generally for the skin also. The action of hypertonic plasma varied also in a large measure. While the spleen did not grow at all in the medium containing 0.0124 and 0.0144 sodium chlorid, the skin, on the other hand, could stand a high concentration of the sodium chlorid. Even its growth was activated in media containing 0.0094 and 0.0124 sodium chlorid and was greater than with normal plasma. The spleen of kittens was very easily affected by the changes of the dilution of the plasma, while the skin of the frog presented its best growth in plasma containing one half distilled water. Marked variations in the sensitiveness of tissues to hypertonic and hypotonic media will probably be observed in animals of different species. From these experiments, three conclusions can be drawn: namely, that certain laws of growth, discovered by Loeb, in lower organisms are true also for higher organisms; that normal plasma is not the optimum medium for the growth of tissue; and that each tissue has probably its optimum medium. The growth of the spleen is, without doubt, considerably modified by the variations of the dilution and perhaps of the osmotic tension of the plasma. It is possible then that the influence of osmotic tension, discovered by Loeb, in the growth of certain organisms, is a general law applicable as well to higher forms of life— frogs, cats, and chickens—as to lower organisms—tubularia and sea-urchins. In placing tubularia in different dilutions of sea-water and distilled water, Loeb found that the greatest rate of regeneration was observed when two volumes of distilled water were added to three volumes of sea-water. But fertilized eggs of sea-urchins were more sensitive to the action of hypertonic plasma, and they all died in a dilution of sea-water with two fifths distilled water. If only one fifth distilled water was added to the sea-water they developed normally. We found that the cells of certain tissues of the chicken follow a similar rule, since the maximal growth of the spleen is obtained in plasma containing two fifths distilled water, while other tissues grow better in a less hypotonic medium. Normal plasma is certainly not the ideal medium for the growth of tissues, since slight modifications of the tension, the alkalinity, or the addition of certain inorganic salts to normal plasma, increase the rate of the growth of tissues.     

THE INDUCED SUSCEPTIBILITY OF THE GUINEA-PIG TO THE TOXIC ACTION OF THE BLOOD SERUM OF THE HORSE

Following the divisions before used, the results presented in the preceding pages may be briefly stated. I. The particular method of sensitization and the place where the test injection is made have an important bearing on the results obtained by various workers. Comparing the results obtained by the various methods, we may conclude that the incubation period of the hypersensitive reaction is not sharply limited, but that there is a progressive increase in sensitiveness from the sixth day, and presumably before that, extending over a period of several weeks. It seems very probable that the degree of hypersensitiveness attained where the sensitizing dose consists of a mixture of diphtheria toxin and serum is greater than when a single dose of the same small quantity of serum is given alone. II. Our early experiments, the first in this field, are in thorough agreement with those first reported by Otto, and shortly after him by Rosenau and Anderson. III. This hypersensitive reaction is transmissible from mother to offspring. The transmission is probably not equally effective in all cases, and individual young guinea-pigs probably vary greatly in the rate with which they lose their ability to react. As a result not all of the young of a hypersensitive mother react to a subcutaneous dose of five cubic centimeters of serum given when they are four or five weeks old. The reaction in the young animals differs quite markedly from that in those actively sensitized. These differences are such as to indicate that in the mother there is a considerable localization of the reaction in tissues and organs whose destruction does not cause sudden death. This local reaction is a protective factor and is not transmitted to the same degree as the factors involved in the fatal acute reaction. IV. The hypersensitive reaction to horse serum depends on the development of a special anti-body during the incubation period, which anti-body may be passively transferred to a fresh animal. If the dose of hypersensitive serum be sufficient, and the intoxicating injection be given directly into the circulation, this passive hypersensitiveness may be enough so that the animal will die when tested. There is also in the serum of hypersensitive guinea-pigs an uneliminated horse serum element or "rest," which is distinct from this antibody, and probably without influence on the course of the acute reaction. V. The anti-body on which the hypersensitive reaction depends may be entirely neutralized by horse serum without causing symptoms. The gradual introduction of increasing doses over a total period of twenty-four hours suffices for this. The animal is then, properly speaking, neither immune nor refractory, but is essentially in the condition of a normal animal which has recently had a large dose of horse serum. This rapid neutralization is made possible by the great binding power which the subcutaneous and other relatively unimportant tissues have for the toxic element of the serum. The so-called "Phenomenon of Arthus" is probably the same reaction for the rabbit that we have here dealt with in the guinea-pig. The fact that the manifestation is more prominently a local one depends on racial differences. I have encountered cases in the guinea-pig in which the conditions in the rabbit are closely simulated.     

THE EFFECT OF PULMONARY CONGESTION ON THE ON THE VENTILATION OF THE LUNGS

1. A method is described for producing pulmonary congestion, together with what may be termed a differential spirometer method for studying lung ventilation. 2. The method utilized permits an approximately accurate prediction of degrees of pulmonary edema in the living animal, and suggests avenues of approach for the very difficult problems of pulmonary capillary pressure. 3. It is shown that intravascular blood can encroach markedly upon the pulmonary air space. Although the methods used in these animal experiments do not resemble vital capacity measurements in man, their result is so definite that their applicability to clinical conditions may be considered. 4. The similarity between the experiments described and certain conditions of cardiac decompensation, of which mitral stenosis is the best example, is pointed out.     

THE EXTENT OF THE CAPILLARY BED OF THE HEART

By means of injections made into the coronary arteries of beating hearts it has been possible to determine the number of capillaries in the normal heart muscle. This study has shown a very rich blood supply with an average of approximately one capillary for each muscle fibre in the ventricular walls and papillary muscles, and a less abundant supply in the auricular muscle and Purkinje system. The number of capillaries per sq. mm. of ventricular wall or papillary muscle is about twice that found by Krogh in skeletal muscle. Capillaries were not found constantly in the valves of hearts in which there was apparently a complete injection of the capillary bed. The method described for injecting the capillaries of the heart also provides a means of studying the blood supply to the muscle, valves and aortic wall in pathological hearts.