翼腭窝骨性结构及其毗邻关系的应用解剖

目的 研究翼腭窝及其毗邻结构的显微外科解剖关系,为临床开展相关手术提供解剖学依据。方法 成人干性颅骨标本20个（40侧）,在手术显微镜及鼻内镜下观测蝶腭孔、筛骨嵴、圆孔、翼腭管、翼管的形态、大小及相关解剖学参数。结果 翼上颌裂高度为（15.30±0.43）mm,蝶腭孔的前后径和上下径分别为（5.10±1.84）mm和（5.09±1.53）mm,蝶腭孔到中线的距离为（12.49±1.51）mm,前鼻棘至蝶腭孔前缘的距离为（51.32±3.28）mm,圆孔的直径为（3.14±1.26）mm,圆孔至中线的距离为（19.95±2.79） mm,前鼻棘至圆孔的距离为（61.86±3.67）mm,翼管至中线的距离为（10.82±2.98）mm,前鼻棘至翼管的距离为（59.47±3.42）mm。结论 熟悉翼腭窝、蝶腭孔、圆孔和翼管等解剖关系,有助于有效安全地开展鼻内镜下翼腭窝手术。     

内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法

目的探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法,为手术入路寻找标志点,测定相关解剖数据,提供可靠的解剖学依据。方法 5例(10侧)的新鲜颅骨标本,内镜经鼻、上颌窦、翼突入路至Meckel囊区,测定相关骨性解剖数据,寻找手术入路的解剖标志点。结果鼻小柱下缘到蝶窦口下缘是(61.2±1.6)mm,蝶窦开口下缘到鼻口上缘为(22.3±2.8)mm,鼻小柱下缘到蝶腭孔下缘为(62.8±2.3)mm,鼻小柱下缘到翼管前口下缘为(75.4±3.3)mm,鼻小柱下缘到腭蝶管前口下缘为(64.6±2.4)mm,鼻小柱下缘到后鼻孔上缘为(66.5±3.3)mm,翼管前口下缘腭蝶管前口上缘为(2.14±0.7)mm,圆孔下缘到翼管前口上缘为(7.57±0.7)mm,腭蝶管长度为(6.43±0.5)mm,翼管长度为(13.3±1.2)mm。结论用内镜经鼻、上颌窦、翼突入路至Meckel囊区是可行的,Meckel囊前方区域为四边形,它的内侧为斜坡旁段颈内动脉,下方为岩骨段颈内动脉,上方为外展神经,外侧方为上下颌神经。     

针刺蝶腭神经节针道的调研

<正> 取形成正常、无畸形的防腐尸头15例共30例.用弯脚规测取每一尸头的颧宽(Zy-Zy).然后奖尸头作一正中矢状锯面,暴露鼻腔外侧壁. 在中鼻甲后端之上,平蝶骨体下缘用探针探测蝶腭孔,进而在蝶腭孔周围的鼻粘膜下探寻有无蝶腭神经节.接着凿开翼腭管内侧壁的腭骨垂直板,暴露腭大神经,沿腭大神经栈出蝶腭神经节.再于颧弓下从皮肤至蝶腭神经节按层次进行解剖.(1)蝶腭神经节的位置与毗邻;该神经节位于翼腭窝的上部附于窝的前壁,恰在蝶腭孔的上外侧.蝶腭动脉斜行于蝶腭神经节下端前方.外上方邻上颌神经.该神经节大小约5.0mm×4.0mm×1.0mm.在鼻腔外侧壁粘膜下未发现有蝶腭神经节.该神经节与鼻腔外侧壁相隔有腭骨垂直板,即翼腭窝的内侧壁.经鼻腔进行的蝶腭神经节的治疗措施应考虑这一骨板的存在;(2)     

内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖

目的通过解剖学研究,探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法,寻找手术入路中的重要解剖标志点,测量相关解剖数据,为内镜经鼻入路处理Meckel囊区病变提供解剖学依据。方法 5例共10侧新鲜成人头颅标本,采用内镜经鼻、上颌窦、翼突入路解剖和暴露Meckel囊区,寻找该手术入路中重要的解剖标志,研究具体的解剖方法,测量相关的解剖数据,解剖过程中使用导航。结果鼻小柱下缘至后鼻孔上缘为(66.5±3.3)mm,至蝶窦口下缘为(61.2±1.6)mm,至腭蝶管前口下缘为(64.6±1.4)mm,至蝶腭孔下缘为(62.8±2.3)mm,至翼管前口下缘的距离为(75.4±3.3)mm,翼管前口下缘与腭蝶管前口上缘距离为(2.1±0.7)mm,与圆孔下缘距离为(7.5±0.7)mm,腭蝶管长度为(6.4±0.5)mm,翼管长度为(13.3±1.2)mm。以腭蝶管为解剖标志可以寻找到翼管前口;以翼管为解剖标志可以寻找到岩骨段颈内动脉前膝部,以斜坡旁颈内动脉隆突可以寻找到斜坡旁颈内动脉,以圆孔可以寻找到上颌神经。导航能够准确定位上述解剖标志。结论运用内镜经鼻、上颌窦、翼突入路可以解剖和暴露Meckel囊区。此入路是由Meckel囊前方四边形区域暴露该区域,此四边形内侧为斜坡旁段颈内动脉,下方为岩骨段颈内动脉,上方为展神经,外侧方为上、下颌神经;实验数据和导航可以辅助定位重要的解剖结构和标志。     

三种鼻内镜手术径路暴露翼腭窝的解剖研究及其临床意义

目的：研究三种鼻内镜手术径路暴露翼腭窝的解剖方法。方法：通过解剖成人尸体头部标本15例（30侧）,采用手术显微镜及鼻内镜观察暴露翼腭窝的三种径路。结果：①中鼻道经腭术式可以暴露翼腭窝内侧的蝶腭动脉、腭神经、翼管神经,沿腭神经可确认翼腭神经节;②中鼻道经上颌窦术式能很好地暴露翼腭窝内、外侧壁,眶下神经是手术的重要标志;③下鼻甲切除经上颌窦术式比鼻内镜下中鼻道经上颌窦术式更广泛地暴露翼腭窝的内、外侧,提供宽阔的视野和较大的手术操作空间。结论：三种手术径路均能暴露翼腭窝的结构,具体术式需根据病变范围及手术要求而决定。     

模拟内镜下经双鼻孔至Meckel腔的解剖

目的 通过模拟内镜下经双鼻孔至Meckel腔手术入路,对Meckel腔及入路的相关结构进行解剖学研究,为临床内镜下Meckel腔手术提供解剖学及形态学资料。
方法 对10具(20侧)动静脉灌注乳胶的成人尸头标本,完全模拟经双鼻孔至Meckel腔的手术入路逐层显微解剖,对入路相关解剖标志进行观察、分析、拍摄和测量。 结果 该入路可分4步,即寻找上颌窦口,进入上颌窦,进入翼腭窝和进入Meckel腔。鼻小柱距上颌窦口的距离为（45.07±2.01）mm,与蝶腭孔的距离为(64.84±3.00)mm,距翼管前孔距离为(71.34±2.99)mm。以鼻小柱至鼻后棘的连线为底边,其与鼻小柱与上颌窦口连线的夹角为(38.81±1.72)。其与鼻小柱与蝶腭孔连线的夹角为(25.92±2.05) °。蝶腭动脉及翼管动脉平均外径分别为(2.21±0.24)mm和(1.07±0.27)mm。翼腭窝区结构复杂,其内上颌动脉及其终支蝶腭动脉和腭降动脉变异较大,沿蝶腭动脉逆行解剖有助于寻找上颌动脉及其分支结构。解剖分离翼腭窝内神经、血管等结构,追踪翼管神经血管束,依据翼管后端正对颈内动脉破裂孔段的特点,解剖分离四方形空间可较直接进入Meckel腔。结论 侵犯Meckel腔肿瘤的入路选择应该个体化,应依据肿瘤主体在Meckel腔的位置及范围等决定选1种或联合入路;内镜下经双鼻孔至Meckel腔入路可较直接地暴露Meckel腔的前下内面及翼腭窝区域的解剖结构;手术中重要的解剖标志为蝶腭孔、翼管神经、翼管和上颌神经;翼腭窝中浅部血管结构的解剖有助于深部神经结构的保护,深部神经结构（如翼管神经和上颌神经）和其穿行的骨孔有助于在颅底辨别和控制颈内动脉。     

经鼻内镜翼腭窝区手术相关的显微解剖学研究

目的:为经鼻内镜翼腭窝区手术提供显微解剖学基础。方法:选用30例(60侧)成人头颅湿标本,对翼腭窝区进行显微解剖观测,并模拟鼻内镜手术入路,观测翼腭窝区穿行结构及毗邻关系。结果:①翼腭窝内有上颌动脉、上颌神经及其分支,以及翼腭神经节等重要结构;②由蝶腭孔至前鼻棘的距离为(52.99±4.95)mm;③上颌神经出圆孔处至前鼻棘的距离为(62.90±3.81)mm;④翼管神经至前鼻棘的距离为(58.83±3.91)mm。结论:熟悉翼腭窝区穿行结构位置及毗邻关系,对经鼻内镜翼腭窝区手术的开展具指导意义。     

上颌神经阻滞麻醉的应用解剖学基础

目的　为临床口腔颌面外科提供解剖学依据。方法　观察 3 0例干性颅骨标本的翼腭窝及其通道的形态、大小 ,并进行相关数据的测量。结果　 (1)上颌神经阻滞点至颧弓下缘中点的距离 ,左侧为41 0 4± 2 43mm ,右侧为 41 63± 2 19mm ;(2 )圆孔至腭大孔的距离 ,左侧为 3 1 98± 2 2 4mm ,右侧为 3 1 73± 4 2 9mm ;(3 )硬腭至腭大孔的距离 ,左侧为 3 46± 1 12mm ,右侧为 3 54± 1 12mm ;(4)硬腭后缘可作为进针的解剖学标志。结论　本研究可为经颧弓下缘中点和经翼腭管上颌神经阻滞入路提供重要的解剖学参数。     

蝶腭孔、翼管前口的应用解剖及临床意义

目的 为鼻内窥镜翼管神经切断术等临床应用提供解剖学依据。方法 用15个30侧经防腐处理的成人头颅标本，经正中矢状面剖开，解剖观察测量蝶腭孔、翼管前口及穿过的血管、神经。结果 19例(63．33％)蝶腭孔位于中鼻甲后端前方平均8．09mm；11例(36．67％)位于在中鼻甲后端前上方平均7．24min。蝶腭孔呈圆形24例，直径平均3．25mm；呈卵圆形6例，最大径平均4．92mm穿过蝶腭孔的动脉有蝶腭动脉，或其分支鼻后外侧动脉和鼻中隔后动脉。翼管前口位于蝶腭孔后方约7mm，呈圆形漏斗状，横径约3mm，略向外下方开口，距离鼻小柱平均71．72mm，有翼管神经和翼管动脉穿过。结论 经鼻腔暴露翼管前口及翼管神经，以及进入翼腭窝处理上颌动脉末端的分支时，蝶腭孔及其周围骨质菲薄的部位是理想的手术入路部位。     

上颌窦口扩大手术中鼻后外侧动脉的保护

目的探讨鼻后外侧动脉在鼻内镜上颌窦口扩大手术中的影响以及鼻后外侧动脉的保护.方法应用10具(20侧)10%福尔马林防腐固定乳胶灌注之成人头部标本,观察中鼻道结构,解剖鼻后外侧动脉及其分支,观察鼻后外侧动脉的走行与分布,并测量其外径.观察鼻后外侧动脉与上颌窦口扩大手术的关系.结果鼻后外侧动脉在蝶腭孔处分出蝶腭动脉,向前下走行,在中鼻甲后端分出中鼻甲动脉,下鼻甲动脉,少数有上鼻甲动脉分支.鼻后外侧动脉外径(1.02±0.07)mm,中鼻甲动脉外径(0.89±0.06)mm,下鼻甲动脉外径(0.94±0.07)mm.鼻后外侧动脉下鼻甲分支在中鼻道的中点,.在中鼻甲后端前方的距离(10.35±2.06)mm.结论开放上颌窦开口时,在距离中鼻甲后端保留1～1.5 cm的距离,可以避免鼻后外侧动脉损伤,如果必须扩大要应用电凝彻底止血.     

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.     

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.     

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.     

'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.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.