经乳突内窥镜下处理岩斜坡区病变两种硬脑膜切口的应用解剖

目的 :为颞骨径路在内窥镜下行岩斜坡区病变手术时因不同的手术目的采取不同的硬脑膜切口提供解剖学依据。方法 :在 2 0例 40侧成人尸头标本上采取不同的硬脑膜切口模拟颞骨径路内窥镜手术 ,比较两种切口对手术的影响 ;并测量相关数据。结果 :岩上窦下缘至内淋巴囊上缘为 ( 9.5 3± 2 .64 )mm、岩下窦上缘之间距离为 ( 2 3 .48± 2 .48)mm ,乙状窦内侧至共脚、内淋巴管、内淋巴囊外侧之间距离分为 :( 13 .89± 2 .3 4)mm、( 10 .62± 2 .0 9)mm和 ( 3 .73± 1.66)mm。结论 :两种切口各有优缺点 ,T形切口适应证稍广 ,但易损伤周围重要结构。     

颞骨岩部后骨板的临床解剖学研究

目的 :了解颞骨岩部后骨板的解剖及其变异情况对颞骨相关手术的影响。方法 :在 2 0例 40侧成人尸头上进行颞骨解剖 ,观察颞骨岩部后骨板成角变异的发生情况 ,测量相关数据。结果 :颞骨岩部上嵴与面神经水平段之间夹角为 (4 .61± 1.99)°、与矢状线之间夹角为 (63 .0 7± 9.3 0 )°。气化程度高的乳突其颞骨岩部后骨板与外耳道距离相对较大 ,相对而言发生乙状窦前移的几率较小。颞骨岩部后骨板成角变异发生率为 17.5 %。结论 :面神经水平段大致平行于颞骨岩部上嵴 ,气化的乳突其颞骨岩部后骨板与外耳道后壁之间距离较大 ;当颞骨岩部后骨板与外耳道后壁距离较小时 ,乙状窦位置更靠前 ,更易出现高位颈静脉球。     

经幕上、下联合进路岩斜区的显微外科解剖

目的 :为岩斜区病变手术治疗提供解剖学基础。方法 :显微镜下在 30侧经 10 %福尔马林固定成人尸头标本上 ,对岩斜区进行解剖学观测并模拟幕上、下联合进路手术。结果 :(1)前半规管拱峰离岩骨表面 (弓状隆起 )较浅 ,平均深 2 .19mm。后半规管最靠近乙状窦 ,乙状窦前缘到后半规管最后点平均 9.4 9mm ;(2 )弓状隆起至岩尖 ,后半规管最后点至耳蜗、内耳门后缘以及乙状窦前缘至内耳门后缘的距离 (mm)分别为 34.0 9± 4 .87,14 .2 9± 1.76 ,15 .13± 1.97,2 1.89± 2 .37。结论 :临床上应用经幕上、下联合进路能较好地暴露岩斜区的解剖结构 ,可取得岩斜区病变手术治疗的满意效果。     

乙状窦前入路迷路后区应用解剖学研究

目的：为临床乙状窦前入路迷路后区域手术操作提供解剖学资料。方法：经10％甲醛溶液固定成人尸头标本15具共30侧。在外耳道后上棘、乳突上嵴、乳突尖之间磨除骨质，暴露乙状窦、岩上窦、岩上窦-乙状窦交点、颅中窝硬膜、乙状窦前方的颅后窝硬膜。磨出后骨半规管、外骨半规管、上骨半规管及面神经垂直段、颈静脉球。测量相关数据。结果：乙状窦前入路迷路后区域的骨质可分为三层：表面骨皮质，乳突蜂房骨质，覆盖深部结构的坚硬骨质。外耳道后上棘至后骨半规管的最近距离为（17．88±1．27）mm；面神经垂直段在外半规管下方、后半规管的前方走向二腹肌嵴前缘的内侧，其长度为（7．58～14．02）mm；外耳道后上棘．乙状窦最短距离为（13．84±2．74）mm。结论：此区域骨质分层明显的解剖学特点及测量的数据可以指导手术操作，避免损伤重要结构，为乙状窦前入路迷路后锁孔入路提供了重要的解剖学资料。     

内镜下迷路后径路桥小脑角区结构定位

目的:探讨内镜下迷路后径路脑桥小脑三角区手术的解剖学标志及定位方法。方法:在15例30侧成人尸头上模拟迷路后桥脑小脑角区内镜手术,观察内耳门以及各组颅神经之间的关系,测量其外缘在颞骨岩部骨板平面上距颞骨表面距离,前缘距三叉神经半月节距离、下缘距舌咽神经距离,上缘距岩上窦距离。结果采用SPSS进行统计学分析。结果:内耳门外缘距颞骨表面距离为(33.82±2.80)m m,三叉神经位于其前上方,距其外缘距离为(8.10±1.15)m m,展神经位于内耳门前方,三叉神经的下方,滑车神经为一细长神经,行于三叉神经前上方,舌咽神经恰位于内耳门下方,其距内耳门下缘约(6.26±1.05)m m,其下依次为迷走神经、副神经,内耳门距岩上窦距离为(4.96±1.40)m m。结论:内耳门位于颞骨岩部中间,位置不易受病变影响相对固定,且居于各组颅神经中间位置,当其能在术野中暴露良好时为理想的定位标志,舌咽和迷走神经因其形态特征也可作为定位标志。     

脑桥小脑三角的应用解剖学

目的为听神经瘤显微外科治疗提供解剖学参数.方法对35具甲醛固定的男性成人尸颅的脑桥小脑三角及毗邻结构进行解剖学测量.结果横窦乙状窦膝至内耳门后缘的距离约为(35.1±0.2)mm.乙状窦起始端最大宽为13.4 m.内耳门后缘至内淋巴囊裂孔的距离为(10.5±0.2)mm,内耳门至岩上窦的距离通常小于5 mm.内耳门至颈静脉孔的距离为5.4 mm.横窦乙状窦膝在小脑表面对应的膝点至绒球外侧缘的距离左侧为(31.3±0.5)mm,右侧为(30.4±0.5)m;至扁桃体内侧缘的距离左侧为(44.1±0.4)mm,右侧为(43.3±0.4)mm.结论这些数据是重要的解剖参数,是保证手术顺利进行、不损伤重要结构的解剖学依据.     

迷路后桥脑小脑三角区内镜手术的应用解剖研究

目的：评价内镜在桥脑小脑三角区手术中的应用价值。方法：对5例10侧成人尸头进行大体解剖，熟悉桥脑小脑三角区诸结构解剖关系；在10例20侧成人尸头上模拟迷路后径路内镜手术，将镜下结构按解剖位置分为面神经、三又神经、舌咽神经三个区域，重点观察各区域各组颅神经之间、神经和血管之间关系；在15例标本上，于颞骨岩部后骨板平面测量内耳门外缘距后半规管外缘、颞骨表面距离，内耳门下缘距舌咽神经距离。结果：10例标本通过内压小脑均能成功导入内镜进行模拟手术；内耳门及第7、8颅神经可作为内镜手术的解剖标志。内耳门外缘距颞骨表面距离为（33．82±2．80）mm，距后半规管后缘距离为（13．24±2．55）mm，下缘距舌咽神经距离为（6．26±1．05）mm。结论：迷路后径路桥小脑角区内镜手术完全可行，较显微镜手术而言具有微创、能多角度观察病变区域、更清晰分辨血管神经关系等优点，更适合耳科医生采用，但需熟悉和掌握有关解剖知识以及内镜操作技巧。     

经颞骨岩部乙状窦前入路处理岩斜区病变的应用解剖

目的 :研究经颞骨岩部乙状窦前入路进行岩斜区直接手术的方法 ,寻找出该入路的标志点和颞骨岩部的磨除方法 ,并观察手术的暴露范围和优缺点。方法 :用 15例血管经彩色乳胶灌注的成人尸头标本 ,显微镜下 (× 6～ 2 5 )解剖经颞骨岩部乙状窦前入路。结果 :岩乙状窦交叉点、内淋巴囊裂是磨除颞骨岩部后面的重要标志 ,用内淋巴囊裂可以初步定位前庭小管、总脚和后半规管。此入路能够暴露从鞍背到延髓中上部的区域 ,以暴露中岩斜区最佳。离断内淋巴囊 ,可扩大骨磨除的面积 ,增加手术的暴露。结论 :以岩乙状窦交叉点、内淋巴囊裂为标志为安全磨除颞骨岩部后面提供了保证。经颞骨岩部乙状窦前入路具有手术距离短、视野暴露充分的特点 ,特别适用于骑跨颅中、后窝而以颅后窝为主的岩斜区病变     

面神经乳突段的应用解剖

目的　为侧颅底手术中面神经乳突段的定位提供解剖学资料。 方法　 10%福尔马林固定成人头颅标本8例16侧,电动磨钻轮廓化乳突,暴露3个半规管、面神经乳突段全长。测量面神经乳突段的长度、宽度、面神经乳突段始端及末端与周围重要结构的距离,并观察面神经乳突段与周围毗邻结构的关系。 结果　面神经乳突段的长度为（11.04±1.03）mm,宽度为（2.29±0.39）mm。面神经乳突段起始部到乙状窦、外耳道后上棘、颅后窝硬膜、岩上窦-乙状窦-横窦交点、后骨半规管的最近距离分别为（9.41±　2.06）mm、（15.61±2.11）mm、（5.96±1.51）mm、（20.20±3.44）mm、（3.84±0.14）mm。面神经乳突段末端-乙状窦 、外耳道后上棘、乳突尖、颅后窝硬膜、岩上窦-乙状窦-横窦交点的最近距离分别为（7.05±2.01）mm、（20.32±2.69）mm、（16.48±2.48）mm、（7.97±2.61）mm、27.38±4.21)mm。 结论　外骨半规管、后骨半规管、二腹肌嵴是面神经乳突段定位的重要标志,面神经乳突段走行于外骨半规管、后骨半规管和二腹肌嵴前端形成的三角形内。     

经颞骨岩部入路中乳突切除术的应用解剖

目的　为临床侧颅底入路手术中乳突切除术提供解剖学基础。 方法　经10%福尔马林固定成人尸头标本25具（50侧）,电动磨钻磨除乳突骨质,暴露乙状窦、岩上窦、颅中窝底硬膜、乙状窦前的颅前窝硬膜,岩上窦,轮廓化3个骨半规管、面神经乳突段。统计相关解剖结构出现变异情况并观察影响乳突切除术的因素。 结果　气化良好的乳突可分为三层结构：表面骨皮质、乳突蜂房骨质、覆盖深层结构的坚硬骨质。乳突表面距乙状窦、横窦-乙状窦-岩上窦交点、外骨半规管隆凸顶点、面神经乳突段中点、二腹肌嵴的最小距离分别为（7.28±2.14）mm、（14.22±2.74）mm、（16.56±2.10）mm、（13.31±1.87）mm、（11.58±1.60）mm。乙状窦出现的变异包括乙状窦粗大、前置、高位颈静脉球。面神经乳突段及骨性半规管未发现明显变异。 结论　熟识乳突局部解剖学特点有助于安全、快速的完成乳突切除术。     

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.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

'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.     

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.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

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.     

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.