喉切除发音管重建术中环咽肌与喉下神经的应用解剖

目的：为提高全喉切除术后用发音管发音重建的成功率提供解剖学基础。方法：对４０具（男３０，女１０）成人标本环咽肌进行解剖，观测左右侧喉下神经入喉处与甲状软骨下角的距离、喉下神经和环咽肌的关系。结果：喉下神经入喉点距甲状软骨下角的距离，左侧（５．５±１．４） ｍｍ；右侧（５．３±１．３） ｍｍ。７５％（６０侧）喉下神经在环咽肌的下方穿入喉部；２５％（２０侧）喉下神经在环咽肌纤维之间穿入喉部。结论：本研究对于指导环咽肌切断术，诊治环咽肌失驰缓症，探讨喉下神经和环咽肌的关系等有重要的临床意义。     

声门偏斜的实验研究

<正> 本文用电生理学方法复制声门偏斜的实验模型,并记录声门偏斜时喉上神经内支的传入电活动的变化。对了解声门偏斜的机理以及用后连合偏向患侧作为判断标准的合理性及简便性提供了客观依据。同时对声门偏斜患者诉说的哽感提出一种解释。     

喉上神经外支变异1例

笔者对41例标本,共82侧喉上神经外支进行解剖时发现1例成年男性尸体左侧喉上神经外支变异,现报道如下:左侧喉上神经位于第2颈椎横突,发自迷走神经,在舌骨大角处分为较大的内支和细小的外支.内支与喉上动脉伴行,经甲状软骨上缘和舌骨之间穿甲状舌骨膜入喉;外支沿甲状软骨下缘行走,伴行甲状腺上动脉,并分出3支:第1支位于甲状软骨上缘发出进入甲状舌骨肌;第2支由甲状软骨下缘发出,进入咽缩肌;第3支在甲状腺侧叶与咽缩肌和气管之间下行,于环状软骨下缘与喉返神经一起进入环甲关节后缘,沿途喉上神经外支与甲状腺侧叶实质紧贴,肉眼不易与甲状腺周围的筋膜区别(图1).     

喉的应用解剖与临床意义

目的：为功能性喉手术提供解剖形态学数据。方法：对50例结构完整的喉标本进行解剖观察和测量。结果：提供了喉重建术相关的甲状软骨、环状软骨、甲状舌骨膜、环甲韧带、弹性圆锥和方形膜等共75项按性别分组的测量数据。结论：为临床功能性喉手术以及喉功能重建提供了形态学参考数据。     

咽下缩肌的形态特征及其临床意义

目的：为提高全喉切除术后患者用发音管发音重建的成功率，选择最能影响发音重建成功的咽下缩肌进行研究。方法：对４０具正常成人尸体标本咽下缩肌的解剖结构进行了详细的观察和测量。测量咽下缩肌各起点处的宽度，在甲状软骨板后缘的厚度；止点的长度；环咽肌后壁的测量；并用组织切片法观察咽缝的结构。结果：发现咽下缩肌不仅有起于甲状软骨和环状软骨的肌纤维，而且有起于第１气管环的肌纤维和肌腱。咽缝不是呈线状，而是呈条带状。结论：对发音重建行咽缩肌切断术有重要的临床意义。     

国人环甲膜的调查

选用经甲醛固定的成人死体50具(男46、女4)。尸体取仰卧位,头略后仰使颈伸直,气管居正中位,显露喉部。用大头针定点,依次用游标卡尺测量喉高(喉结顶点至环状软骨弓下缘中点距离)、喉宽(环状软骨左右外缘间最大距离)、环甲膜纵径(甲状软骨下缘中点至环状软骨弓上缘中点距离)、环甲膜横径(环甲膜左右侧甲状软骨与环状软骨相交点间距离)。按环甲膜面积=1/2(环甲膜纵径×环甲膜横径),计算出环甲膜面积。并对环甲膜的横径和纵径分别与喉宽、喉高作相关回归分析及自身比例分析。结果如下:1.男性环甲膜横径平均为2.18±0.24(1.62～2.97)cm;纵径0.89±0.18(0.50～1.24)cm;面积0.98±0.25(0.49～1.46)cm~2。女性环甲膜横径平均为1.59±0.25(1.40～1.95)cm;纵径0.66±0.10(0.56～0.78)cm;面积0.53±0.16(0.43～0.76)cm~2。2.环甲膜横径与喉宽之间经相关分析为中度相关(r=0.551,P<0.0005),回归方程式为:环甲膜     

喉返神经喉外分支的显微解剖及临床意义

目的探讨甲状腺手术区域喉返神经(RLN)的解剖特点和方法。方法运用大体解剖的方法,对48例成人标本甲状腺手术区域的RLN及其周围毗邻结构进行了观测。结果 48例96侧成人标本中,29%RLN主干穿过环咽肌肌束至致密结缔组织膜下缘,71%RLN主干走行在环咽肌深面。69%RLN在距离甲状软骨下角尖端(15.2±5.5)mm处分为前、后两支,前支多于环状软骨侧方下缘距离甲状软骨下角尖端(5.9±1.8)mm处穿过结缔组织膜,后支入喉点距甲状软骨下角尖端(4.8±2.1)mm;31%RLN未见分支。结缔组织膜下缘RLN与甲状腺下动脉(ITA)分支的关系为:66%(63/96)RLN位于ITA前方,27%(32/96)位于ITA后方。结论大多数RLN具有喉外分支,在以甲状软骨下角作为标志寻找RLN时,要同时找寻RLN及喉外分支的入喉点。ITA与RLN的关系复杂多变,ITA不作为RLN定位的首选。     

喉上神经外侧支的应用解剖

目的为甲状腺手术中结扎甲状腺上动脉时防止喉上神经外侧支损伤提供形态学依据。方法对20具(40侧)喉上神经外侧支的发出部位、走行和甲状腺上动脉伴行关系进行解剖观察测量。结果喉上神经外侧支在舌骨大角处由喉上神经分出,在舌骨大角与环状软骨中点连线的上、中段喉上神经外侧支与甲状腺上动脉伴行,有95%(38侧)行于动脉的内侧,在连线下段喉上神经外侧支与甲状腺上动脉分离,喉上神经外侧支进入环甲肌点相距甲状腺侧叶上极(6.5±3.2mm)。结论甲状腺手术中在舌骨大角与环状软骨中点连线下1/3段靠甲状腺侧叶上极表面结扎甲状腺上动脉,可避免损伤喉上神经外侧支。     

环甲关节的不对称性

目的 探讨环甲关节不对称性形成的原因。方法 38具福尔马林常规固定尸体（中国男性15例，女性5例；新西兰男性11例，女性7例。年龄范围57~95岁，平均年龄为74岁），采用大体解剖方法进行喉部取材后，去除环甲关节周围软组织，定义环状软骨板正中矢状面和甲状软骨板后缘及下角的长轴之间的角度为环甲角，利用Image J 软件 (NIH, USA)测量，并对喉标本左右侧、不同性别、不同人群的环甲角值差异进行统计学分析；取3例喉标本，利用Micro-CT和三维重建软件实现环甲关节的三维构建；之后将该3例标本脱钙、脱水、石蜡包埋后进行HE和Van-Gieson（VG）染色。结果 双侧环甲关节的关节面形态存在不对称性；关节腔（环甲关节）亦存在不对称性，并且这一特性与环甲角紧密相关。所有个体喉双侧环甲角均不同。结论 环甲角的不同可能导致了双侧环甲关节关节面的接触面积的不同, 最终体现为环甲关节关节面及关节腔的不对称性。可以在活体的喉影像中观察和测量环甲角。     

喉上神经外支在环甲间隙的应用解剖学研究

目的为甲状腺手术中保护喉上神经外支提供解剖学基础。方法成人尸体32具(64侧),解剖观察喉上神经外支在环甲间隙的解剖学特点,观察该神经与间隙内其他解剖结构的关系。结果3侧喉上神经存在袢状结构;发现所有标本中均存在环甲肌支,71.8%(46侧)存在咽支;按Friedman分型方法进行分型:Ⅰ型占28.1%(18侧)、Ⅱ型占54.7%(35侧)、Ⅲ型占17.2%(11侧)。喉上神经外支入咽下缩肌点位置均位于胸骨甲状肌深面,斜线下方。喉上神经外支入咽下缩肌点至斜线的垂直距离为(3.60±0.30)mm,距胸骨甲状肌内侧缘的垂直距离(8.27±1.72)mm,距环状软骨中点的距离是(27.09±1.46)mm。结论甲状腺手术中,从环甲间隙入路多数情况下可以显露保护喉上神经外支环甲肌支;大于17.2%的情况下不能显露,但也不会损伤。     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The Beauty of the Network in the Brain and the Origin of the Mind in the Control of Behavior

Behavior is not adequately described as a stimulus-response process. It is initiated by the animal and is generated because of its expected outcome in the future. The outcome can be good or bad for the animal. The brain is in charge of the selection process. This is the basic function of the brain. Taking Drosophila as a study case, this paper discusses initiating activity, several examples of outcome expectations, trying out (the internal search for a suitable behavior), chaining of actions, and the functional roles of chance in action selection. It takes mental processes and states such as goals, intentions, feelings, memories, cognition, and attention as higher levels of behavioral control that have their origin in biological evolution.     

Adequate function of the cell: Interactions between the needs of the cell and the needs of the organism

The continuous maintenance of cell adequate function (cellular stress) is considered to be the main feature which characterizes the activity of a live cell. In accordance with the concept of cellular stress, the transition of the cell to the state of adequate funcitoning represents a dual commitment. The cell must function adequately to respond to the demands of the organism and to provide for its own needs. Thus, it is proposed that two systems exist for the regulation of the adequate function of the cell: one enabling the cell to respond to the demands of the organism, and the other providing for the needs of the cell itself. The hormonal system of the organism represents the first of these mechanisms, and I believe that another system exists for regulation of intracellular needs. Adequate function of the cell is determined by the regulative, controlling and defense mechanisms. The balance between the needs of the cell and of the organism should be a concern of physician, since it provides for the optimal function and health of the organism as a whole.     

On the development of the sympathetic chain and the adrenal medulla in the mouse

Summary The first visible primordia of the sympathetic chain appear in the anterior thoracic region and run caudally through 8 segments in an embryo of 11 gestation days. At 12 gestation days the trunk reaches from the base of the skull into the sacral region. During the following days the trunk develops into ganglia with interganglionic fibers.At 16 gestation days there is a well developed trunk with a cranial ganglion cervicale superior and a ganglion stellatum in the anterior part of the thoracic region. In the remaining sympathetic chain there are segmentally arranged ganglia but in this common pattern large differences are noticed.At the 13th gestation day the first signs of the adrenal medulla and the splanchnic plexus appear in the form of sympathoblasts ventral to the sympathetic chain. The migration of sympathoblasts into the primordia of the adrenal cortex goes on for 3 days while the migration to the splancnic plexus in the mesenchym ventral and lateral to the aorta goes on at least 2 more days.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.     

On the musculature of the gastro-intestinal tract of the guinea-pig

Summary The small intestine, caecum, colon and part of the stomach of guinea-pigs were studied by light microscopy, using semithin sections of plastic embedded specimens. The muscular coat is thicker in the duodenum than in the rest of the small intestine. The ratio between longitudinal and circular muscle is 1:4.6 in the duodenum and it increases regularly along the small intestine, to reach 1:2 in the terminal ileum. In the caecum, shape and sectional area of the muscle tissue were analyzed along the full length of the taeniae. In the caecal circular muscle there is a characteristic change in the arrangement of the muscle bundles from the regions in the centre of the haustrations to the regions of the grooves between haustrations or to those lying beneath a taenia. The functional significance of the taeniae is discussed in terms of an arrangement allowing reduction of the lumen of the organ (which at the level of the grooves between haustrations acquires a triangular outline) more efficiently than if the longitudinal musculature were spread over the entire surface of the organ. Haustrations are present also on one side of the wall of the ascending colon where there is no longitudinal muscle layer. In the descending colon the structure of the wall is examined in different functional states, namely in the regions between fecal pellets (constricted regions) and in the regions around a fecal pellet (moderately distended regions). The musculature increases considerably in thickness in the constricted regions (both muscle layers being actively contracted), while the mucosa and submucosa are thrown into prominent longitudinal folds. These folds produce occlusion of the lumen when the circular muscle has shortened by about 50%.     

On the origin of the corticotectal projections in the cat

Summary Stereotaxic injection of horseradish peroxidase into the superior colliculus produced retrograde labelling of layer V pyramides in the Clare Bishop area and the lateral bank of the suprasylvian sulcus, in area 17,18 and 19. Single labelled cells were also found scattered in the splenial, the suprasplenial, the lateral and the suprasylvian gyri. In the cruciate sulcus no labelled cells were observed. Autoradiographically, the lateral bank of the suprasylvian sulcus was also shown to give rise to fibres to the superior colliculus.