椎旁腰脊神经应用解剖学观察

作者对中国成年人尸体50具(即100侧)进行了腰脊神经椎间孔以外段的长度、宽度和直径的测量。同时还对腰脊神经的表面定位点,即棘突外侧线旁开点间距,棘突外侧线旁开点到横突根部、副突内侧点间距以及横突根部、副突内侧到椎间孔前、后缘的间距进行了测量。根据上述测量发现腰脊神经椎间孔以外段的长度,则以腰_3最长,腰_4次之,而以腰_5最短。腰脊神经断面的宽度和直径均以腰_5最细,以后往下按序数逐渐增粗,而以腰_5最粗。棘突外侧线旁开点间距,则以腰_1最窄,以后往往按序数逐渐增宽,而以腰_5最宽。本文测量的数据对椎旁腰背神经阻滞的操作有一定的参考价值,并讨论了有关注意问题。     

注射疗法治疗神经根型颈椎病的解剖观察

目的：为神经根型颈椎病注射疗法的进针定位提供解剖依据。方法：取30具成年尸体，通过对相关指标的测量来确定C3～7神经的定位。结果：以棘突为参照点确定C3～7颈脊神经的定位；（1）进针点位于棘突旁开距离为23．18—24．72mm，棘突上方11．65-19．68mm；（2）垂直进针至深度为16．67—37．87mm，此点是脊神经后支绕过关节突腰部的位置；（3）从关节突再向前进针7．51～9．15mm到达颈神经前支；进针到达横突外侧缘时与矢状面夹角5．50—11．5°。结论：颈椎棘突位置表浅较易摸到，以各棘突作为解剖标志来定位相应的颈脊神经，为临床颈椎注射疗法治疗神经根型颈椎病提供解剖学依据。     

腰椎峡部裂线缆修复术的应用解剖

目的:为腰椎峡部裂线缆修复术提供所需的应用解剖学数据。方法:在成年人尸体标本上测量脊神经前支与L_4、L_5横突上、下缘和前面起始部,内1/4点处,内1/2点处间的距离,以及脊神经前支在横突上下缘投影长度占整个横突长度的比例。结果:脊神经前支与L_4、L_5横突前面的距离在起始部接近0 mm,在内1/4点处L_4约为4 mm,L_5约为1 mm,脊神经前支与L_4、L_5横突上、下缘的距离稍大。结论:由于脊神经几乎紧贴L_4、L_5横突起始部前面,在行峡部裂线缆修复术时,应特别避免在该处损伤脊神经前支。     

椎板侧方入路治疗极外侧腰椎间盘突出症的应用解剖

目的:为后正中经椎板侧方入路手术治疗极外侧腰椎间盘突出症提供显微外科解部学基础。方法:20具经防腐固定的成人尸体标本,观测横突间韧带厚度、前后方血管和腰神经前支走行。结果:横突间韧带厚度0.60～1.39mm;L3～5节段动脉前支及伴行静脉90%以上位于相邻横突间韧带腹侧上1/2处,横突间韧带背侧中1/3处有一恒定节段动脉分支;腰神经前支与矢状面夹角18.9°～39.2°,下位横突的副突处距前方走行腰神经前支距离为5.63～8.05mm,椎弓峡部侧缘至腰神经前支的距离为1.73～3.64mm。结论:横突间韧带是该入路重要的解剖学标志,熟悉其应用解剖对手术治疗极侧腰椎间盘突出症具有重大指导意义。     

经皮穿刺冷冻腰神经后支治疗腰痛的应用解剖

在15具成人尸体和6套成人骨架上,观测了腰神经后支。结合冷冻腰神经后支止痛术式,按本文提供的表面投影数据,垂直刺入4～5cm,即能贴近各腰神经的后支。对 L_5神经后支的穿刺,应在骶骨上关节突下内或 L_5神经横突占内下方1.5cm 处进针。     

腰_5脊经前支骨纤维管的应用解剖学观察

本文选用成年尸体100侧,经过解剖,仔细清理第五腰椎、第五腰椎间盘和第一骶椎周围的软组织,暴露腰_5背神经前支骨纤维管,然后分离出腰_5脊神经前支及其有关的血管,确认它们之的毗邻关系,然后观察和测量了各个项目。结果如下:1.腰_5脊神经前支骨纤维管的位置和组成:此管位于椎间孔的前下方,贴附在相应腰椎下关节突、椎弓根和横突根部、骶骨的上关节突和骶翼的骨槽内,管全长由后上内斜行向前下外。从     

腰硬联合阻滞用于老年人手术的临床观察

目的 了解腰硬联合阻滞在老年人手术中的应用.方法 两组手术患者术前30min肌注安定10mg.CSEA选择L2～3或L3～4行硬膜外穿刺,成功后经硬膜外针后孔置入腰麻针注入0.25%罗哌卡因(轻比重)3～5ml向头侧置入硬膜外导管3cm,保持患侧向上体位,需平卧者待麻醉固定15min后将患者平卧.EA组于L1～2或L2～3行硬膜外穿刺,成功后向头侧置硬膜外导管3cm,平卧给试验剂量1.6%利多卡因3～5ml,5min后根据麻醉平面及病人情况酌情追加局麻药0.5%罗哌卡因4～8ml.结果 肌松效果CSEA组优为98.3%,EA组优为60%.结论 轻比重罗哌卡因CSEA用于70岁以上高龄患者麻醉是安全的,它是一种简单安全的麻醉方法.     

背浅层正中部出现一“Y”形静脉

背部皮下的血管细小,主要来自肋间动脉和腰动脉的分支。静脉、动脉和皮神经常伴行。我们在局解教学中,发现背部皮下正中部有一“Y”形血管,报道如下:男性尸体,身高176cm,坐高82 cm,按姜同喻连续层次局解方法,翻开背部的皮肤,即看到一“Y”形血管。血管主干位于后正中线上,从T_2棘突到T_7棘突,全长13 cm。左支长5.5 cm,右支长5.6 cm,左、右支间的夹角为93.2度。皮下组织中有3条细小分支,分别在T_3、T_5、T_6处与主干相连,追踪“Y”型     

髋关节外侧入路安全区的解剖定位与临床应用

目的　为髋关节直接外侧入路确定臀上神经最下支的体表投影和手术安全区。方法　在 46侧无下肢疾患的成人尸体标本上 ,解剖定位臀上神经最下支的体表投影 ,并在临床进行应用。结果　手术入路的安全区为①术前 :以大转子外铡最凸点为圆点 ,该点与髂嵴垂直连线上的 9cm处为半径作一弧线 ,该线即为臀上神经最下支的体表投影 ,弧线与大转子外侧最凸点之间的扇形区域即为安全区。②术中 :以大转子尖为圆心 ,该点与髂嵴垂直连线上的 5cm处为半径作一弧线 ,弧线与大转子尖的扇形区域为安全区。结论　安全区内无重要血管神经分布 ,在此区内撑开臀中、小肌肌纤维显露髋臼不会损伤臀上神经。临床应用 2 0 0余例 ,均未发生髋关节外展功能障碍 ,效果良好     

脊神经后支神经痛诊治及其解剖学基础

目的介绍脊神经后支神经痛诊断与治疗及其解剖学基础。方法回顾性分析我院软组织门诊诊断为脊神经颈、胸、腰段后支神经痛62例,诊断仅靠检查皮肤痛觉决定,治疗皆采用强的松龙加局部麻药依据其解剖学基础,药物注射至神经穿出斜方肌或背阔肌的肌性部或其腱膜处,注射部位在颈、胸、腰段各有不同。在注射后5~10 min内止痛,可以立即判断诊断无误。结果 62例皆在注射后5~10 min疼痛消除,治疗后痊愈49例,经第2次注射后痊愈11例,经第3次注射后痊愈2例,注射时间间隔1周。结论对于确诊为脊神经后支神经痛的病例,按颈、胸、腰段不同部位注射强的松龙加局部麻药的方法,紧密结合其解剖学基础,可以获得良好的疗效,不失为首选的治疗方法。     

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.