枕骨大孔腹侧区肿瘤手术入路的应用解剖

目的:探讨枕骨大孔区腹侧肿瘤的最佳手术入路及其应用解剖学基础.方法:在5例共10侧正常人尸头标本上模拟枕下外侧经枕髁入路逐层解剖观测毗邻结构,到达枕骨大孔腹外侧区.结果:应用此入路切除部分枕髁可满意暴露枕骨大孔腹外侧区,而对重要的血管神经损伤最小.结论:枕下远外侧入路是枕骨大孔腹侧区肿瘤的最佳手术入路.     

远外侧经髁入路处理脑干腹侧枕骨大孔区及颅颈交界区肿瘤

远外侧经髁入路又称枕下远外侧入路,最外侧经扰骨髁——颈结节入路,枕下后外侧入路等。脑干腹侧,枕骨大孔区前缘及颅颈交界区肿瘤手术难度很大,而远外侧经髁入路能够更好地显露和切除斜坡下端和扰骨大孔前缘的肿瘤,从而减轻对小脑和脑干的牵拉。 1.历史回顾     

枕下远外侧入路模拟手术显微解剖观察

目的：探讨枕下远外侧入路切除枕骨大孔前方及外侧方肿瘤的方法。方法：收集颅脑肿瘤外科死亡标本15具，经福尔马林固定处理后，对其中未经手术治疗的13例行枕下远外侧入路枕骨大孔前方及外侧方肿瘤切除的模拟手术，另2例生前已行颅内手术者开颅观察。结果：本组13具模拟手术标本中，切除位于枕骨大孔前方的肿瘤6例、下斜坡3例、外侧区4例。结论：经该入路切除枕骨大孔前方及外侧方肿瘤，可扩大手术视野，更彻底地切除肿瘤组织，并能减少对脑干和重要血管、神经的牵拉与损伤，增加手术的安全性。     

枕下极外侧手术入路的解剖学研究

目的：为枕下极外侧手术入路提供解剖学基础。方法：10例成人尸体头湿标本按手术入路在手术显微镜下进行解剖和观测。结果：枕下三角是枕下极外侧入路中重要的解剖学标志，在分离移位椎动脉后，切除枕骨髁后部1／3以辨别和暴露舌下神经管，枕骨髁的磨除可显著扩大枕骨大孔前缘的暴露范围，磨除颈静脉结节对扩大斜坡中下部的暴露有重要的作用。椎动脉硬膜内段及其分支与后组脑神经有复杂的毗邻和穿行关系。结论：枕下极外侧入路尽管解剖复杂，但可在不牵拉延髓的基础上充分暴露颈延髓交界部腹侧面和外侧面的区域，达到充分暴露的枕骨髁磨除范围限于其后1／3即可.     

内镜辅助下远外侧髁后锁孔手术入路的解剖学研究

目的：探讨内镜辅助下枕下远外侧锁孔手术的可行性及入路的显微外科解剖学基础。方法：10具尸体头标本于乳突后作纵向“S”型、约7cm长头皮切口，上缘起自乳突中点向后2cm处，下界至C2水平。分层翻转枕下肌群，显露枕骨远外侧，做直径约3cm的骨窗，牵开小脑半球，神经内镜及显微镜下观察所显露的解剖结构。结果：通过调整神经内镜及显微镜角度，经枕下远外侧髁后锁孔入路可显露同侧椎动脉、小脑下后动脉、小脑下前动脉、面神经、前庭蜗神经神经、后组脑神经、舌下神经和延髓腹外侧等结构。结论：枕下远外侧髁后锁孔入路可很好地显露上述结构，应用神经内镜技术，可在不磨除枕髁和颈静脉结节的情况下进行颅颈交界区手术。     

导航联合内镜辅助远外侧入路的解剖学研究

目的　探讨导航联合内镜辅助远外侧入路的可行性及对颅颈交界区腹侧解剖学特点的观察。 方法　对6例（12侧）尸头标本模拟远外侧入路，分别用显微镜、0度和30度内镜观察，随后磨除后内侧1/3枕髁和颈静脉结节，再次用显微镜观察（其中内镜下观察和磨除颅底骨性结构均在导航引导下完成），比较这四种方式对颅颈交界区腹侧显露的差异。 结果　导航联合内镜能够通过面听神经、后组颅神经组成的上、中、下3个间隙近距离观察颅底结构，还能观察被颈静脉结节和枕髁遮挡的神经血管，与远外侧经髁入路显露范围相似。 结论　在内镜和神经导航辅助下，远外侧入路能够良好的观察颅颈交界区腹侧的神经血管结构，避免磨除颈静脉结节和枕髁，减少手术创伤。     

枕大孔区脑膜瘤的显微手术治疗

目的:探讨枕大孔区脑膜瘤的临床特点、手术入路选择及显微手术技巧.方法:采用显微手术治疗枕骨大孔区脑膜瘤21例,其中,肿瘤位于背侧4例、腹侧3例、腹外侧14例;背侧者选择后正中入路,腹侧或腹外侧者选择远外侧入路.结果:肿瘤全切17例(81%),次全切除1例(椎动脉上下型)、部分切除3例(2例为椎动脉上下型、1例为椎动脉上型);不全切除4例均为腹侧或腹外侧患者,术后均行γ-刀治疗.无手术死亡.随访1～88个月(平均27个月),期间无肿瘤复发病例;21例中,临床症状改善16例,保持原状3例,加重2例.结论:枕大孔区脑膜瘤的临床症状无特征性,术前的位置分型有助于手术入路的选择,而正确选择手术入路和娴熟的颅脑显微外科手术技巧是安全有效切除肿瘤的关键.     

枕下远外侧入路逐层暴露解剖学观察

目的 逐层显露枕下远外侧入路肌层、骨质结构、神经、血管,为临床医师开展该手术提供帮助。方法 在5例尸头标本模拟枕下远外侧入路由浅入深逐层进行解剖学研究。结果 枕下远外侧入路由浅入深暴露的肌层分别是胸锁乳突肌、斜方肌、头夹肌、颈夹肌、头最长肌、头半棘肌、头后小直肌、上斜肌、头后大直肌、下斜肌,后三者围成的枕下三角通常是暴露椎动脉颅外末端的重要标志;枕下远外侧入路可暴露横窦下方、乙状窦内侧、脑干外侧、枢椎上方的广泛血管神经。结论 枕下远外侧入路路径复杂,是切除颅颈交界区肿瘤的一种有效入路,熟悉该入路经过的解剖结构有助于安全暴露颅颈交界区域。     

两种联合入路处理颈静脉孔区沟通性肿瘤的应用解剖比较

目的　通过比较远外侧髁旁联合部分经髁入路与迷路下联合枕下乙状窦后入路,为颈静脉孔区沟通性肿瘤的临床应用提供解剖学依据。 方法　用16具成人尸头镜下模拟两种联合入路,比较两种联合入路对颈静脉孔区的暴露范围及相关解剖学标志,同时观察寰椎横突磨除后对颈静脉孔区颅外段的暴露情况。 结果　两种联合入路均可显露颈静脉孔区颅内段及有限的颅外段,但远外侧髁旁联合部分经髁入路有利于暴露颈静脉孔后内侧区域,而迷路下联合枕下乙状窦后入路更利于暴露颈静脉孔后外侧区域。枕髁和颈静脉突为前者的解剖标志,茎乳孔和颈静脉突为后者的解剖标志。寰椎横突的切除可增加颈静脉孔区颅外段茎突后间隙的显露。 结论　远外侧髁旁联合部分经髁入路结合寰椎横突的磨除,适宜处理肿瘤主体偏于孔内侧的颈静脉孔区沟通性肿瘤,而迷路下联合枕下乙状窦后入路结合寰椎横突的磨除,更适宜处理肿瘤主体偏于颈静脉孔外侧的沟通性肿瘤。     

枕下极外侧入路的解剖学量化研究

目的从临床术者视角出发，定量测量枕下极外侧入路中颈静脉结节、枕髁、寰椎侧块三个骨性障碍部分磨除对颅颈交界腹侧区暴露的影响，为临床切除颅颈交界腹侧区病变提供解剖学依据。方法成年国人头颅干颅骨标本及颅颈交界区CT骨窗片上测量枕髁、寰椎侧块模拟磨除1／3，颈静脉结节全部磨除后颅颈交界腹侧区暴露的改变。应用所测得数据在成人尸头上模拟枕下极外侧入路。术前术后CT薄扫对比。结果骨性标本及寰枕交界CT测量显示枕髁、寰椎侧块、颈静脉结节磨除后颅颈交界腹侧区手术视角及术野宽度明显增加。模拟手术证实枕髁、寰椎侧块及颈静脉结节部分磨除后使颅颈交界腹侧区暴露致水平视角。结论极外侧入路中枕髁、寰椎侧块及颈静脉结节的部分磨除对颅颈交界腹侧区暴露及病变的切除有显著的作用。术前颅颈交界区三维CT检查对极外侧入路有重要的指导意义。     

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.