颈丛麻醉的应用解剖学研究

目的观察颈丛的行程及毗邻结构,为更安全行颈丛麻醉提供依据。方法观察24例尸体颈丛分支浅出点,解剖麻醉穿刺点周围的结构,测量麻醉穿刺点及进针1cm深处与各结构的距离。结果颈丛神经分支多从胸锁乳突肌后缘中点以下穿出,穿刺点1cm深处与各结构的距离在13～31mm之间。结论胸锁乳突肌后缘中点处仍为颈丛麻醉较安全的穿刺点,但穿刺深度不宜超过(21.2±3.2)mm,进针方向以向后向内20°～30°角为宜。     

甲状腺手术颈丛阻滞麻醉点的研究进展

传统的胸锁乳突肌后缘颈丛阻滞麻醉点因定位困难、并发症多、副作用大而几经改进。本文回顾了颈丛阻滞麻醉点的研究历史和有关的解剖学研究。分析了并发症产生的原因，并就胸锁乳突肌前缘颈丛阻滞麻醉点的研究方法提出见解。     

新生儿颈内静脉穿刺置管术的应用解剖

目的为新生儿颈内静脉穿刺置管术提供解剖学基础.方法对15具30侧新生儿尸体标本的颈内静脉及相关结构进行解剖观测.结果颈内静脉外径左(5.6±1.7)mm,右(6.5±1.0)mm.颈内静脉与头臂静脉夹角左(114±8)°,右(145±9)°,颈总动脉与胸锁乳突肌前缘交点位于胸锁乳突肌前缘的近中点处,其交点平面以下颈内静脉长度为(2.7±0.5)cm,左、右头臂静脉和上腔静脉长度分别为2.4、1.4和1.8cm.结论新生儿颈内静脉下段口径粗大,与颈总动脉伴行毗邻清楚,变异较小.穿刺易在颈总动脉与胸锁乳突肌前缘交点稍外侧进针,插管长度左侧为7.0cm,右侧为6.0cm.     

颈襻或胸锁乳突肌支与膈神经吻接重建呼吸功能的应用解剖

目的为颈襻或副神经胸锁乳突肌支与膈神经吻接术重建截瘫患者的自主呼吸功能提供解剖学基础.方法在15具尸体上测量了舌下神经降支、颈神经降支和副神经胸锁乳突肌支的长度、末端的宽度、厚度及神经束的数目;副神经胸锁乳突肌支的末端与膈神经汇合处之间的间距;膈神经汇合处的宽度、厚度和神经束的数目.结果舌下神经降支和颈神经降支的长度分别为(40.0±8.2)mm和(32.0±6.8)mm;平喉结处的宽、厚度分别为(1.9±0.5)mm、(0.8±0.1)mm和(1.6±0.5)mm、(0.6±0.1)mm.副神经胸锁乳突肌支的长(15.9±4.2)mm;末端宽、厚度分别为(2.3±0.7)mm和(0.9±0.2)mm.副神经胸锁乳突肌支与膈神经汇合处之间有间距者为80%,平均间距(20.2±6.3)mm.膈神经汇合处的宽、厚度分别为(2.1±0.5)mm和(1.2±0.4)mm.结论舌下神经降支、颈神经降支或副神经的部分胸锁乳突肌支的长度和末端的宽、厚度均能满足与膈神经起始处行神经端-端或端-侧吻接术,以重建膈的自主呼吸功能.     

胸锁乳突肌前缘颈丛阻滞的解剖学研究及临床应用

作者对颈丛神经阻滞麻醉的部位进行了改良。在胸锁乳突肌前缘 ,甲状软骨上缘下 1.5 cm与前正中线外 4 cm的交点处 (麻醉点 ) ,先垂直进针 ,针尖入皮下后向内倾斜 ,进针深度为 1- 1.5 cm,注入局麻药2 m l,退针至皮下后再向前 ,前下方各注药 1.5 ml。通过 3 0具 ( 60侧 )尸体模拟解剖实验研究和 10 0例临床应用观察证明 ,本法操作简便 ,麻醉效果理想。除少数病例有唾液分泌增多外无其它并发症     

副神经的临床应用解剖学研究

目的 :通过尸体解剖 ,观察副神经的行程及其分支支配 ,为更合理的利用副神经移位治疗臂丛神经损伤提供解剖学依据。方法 :显微解剖 30侧颈肩部人体标本 ,观测副神经在颈后三角区以及斜方肌深面的主干行程、分支部位及其毗邻和肌支支配情况。结果 :副神经在胸锁乳突肌后缘乳突下方 (5 .2± 1.8)cm处穿出 ,向后、外、下斜行跨过颈后三角区 ,在锁骨中点后方 (5 .0± 1.6 )cm处进入斜方肌深面筋膜内 ,在斜方肌的深面副神经仍呈单干向下走行 ,沿途发出 3～ 6个分支支配斜方肌 ,在肩胛冈下方 (5 .0± 1.5 )cm副神经不同平面分出的终支水平进入斜方肌。结论 :在肩胛冈下方不同平面选择性的切断副神经移位治疗臂丛损伤而保留斜方肌上部的神经支配和部分功能是可行的。     

一针法颈丛神经阻滞用于锁骨手术

我院自 1 994年以来用一针法颈丛神经阻滞麻醉用于锁骨手术 84例 ,收到了较好的效果 ,现总结如下。1　一般资料本组病人共 84例 ,其中男 78例 ,女 6例 ,年龄最小 8岁 ,最大 70岁 ,以 2 0— 4 0岁最多 ,有 4例既往有高血压史 ,2例有冠心病史 ,其余未发现有特殊病史。2　麻醉方法穿刺点为胸锁乳突肌外缘中点与颈外静脉交点处 ,进针方向是向足向背 ,进针深度多在 1 .5～ 2 .5ｃｍ ,个别较胖的病人可能深 3ｃｍ以上 ,针尖触及颈 4横突后推注 0 .375%布比卡因和 1 %利多卡因混合液 8ｍｌ,然后退针阻滞颈浅丛 ,药量同深丛 (麻药中加入 1 :2 0万肾…     

肌间沟臂丛神经阻滞相关结构的观测

目的为肌间沟臂丛神经阻滞入路和预防并发症的发生提供解剖学基础。方法对50侧尸体颈部与肌间沟臂丛神经阻滞入路相关结构及其毗邻关系进行了解剖观测。结果肌间沟臂丛神经穿刺进针深度(即皮肤至第6颈椎横突距离。从环状软骨向后引一直线与胸锁乳突肌后缘相交点处的皮肤进针)为(18±1.4,12～22)mm。获得了与臂丛穿刺相关结构的观测结果。结论为肌间沟臂丛神经阻滞入路和预防并发症的发生提供了解剖学依据。     

寰枢关节错位与胸锁乳突肌和斜方肌疼痛的解剖关系的初步研究

目的　观察寰枢椎与副神经及第2颈神经的解剖关系,以及观察胸锁乳突肌和斜方肌的神经支配特点,为寰枢关节错位致胸锁乳突肌和斜方肌疼痛提供解剖学依据。 方法　对3具共6侧成年人颈部尸体标本进行解剖,观察寰椎横突与副神经、寰枢外侧关节与第2颈神经前支、寰枢椎椎间孔外韧带的解剖结构,以及观察胸锁乳突肌和斜方肌的神经支配特点,测量副神经与寰椎横突尖的最短距离。 结果 (1)胸锁乳突肌和斜方肌均受副神经和颈丛（第2~4）神经支配,并且副神经与颈丛神经存在交通支联系。(2)副神经走行在寰椎横突前方,二者关系密切,副神经与寰椎横突尖的距离为4.84~7.60 mm(左侧)和3.22~6.80 mm（右侧）。(3)寰枢椎存在椎间孔外韧带,该韧带与第2神经相连,并附着在寰椎横突。(4)第2颈神经前支贴着寰枢外侧小关节向前走行。 结论 寰枢关节错位可能会刺激副神经及第2颈神经或其前支,从而引起胸锁乳突和斜方肌紧张、疼痛。     

胸锁乳突肌亚部肌构筑、肌梭和神经入肌点定位

目的:为胸锁乳突肌亚部的临床应用提供形态学依据。方法:肌构筑法,组织学HE染色和体视学法。结果:(1)胸骨头亚部的肌重与生理横切面积分别是锁骨头两亚部之和的1.39倍与1.33倍;锁骨头深亚部的肌纤维长仅为胸骨头亚部肌纤维长的82%。(2)胸骨头亚部和锁骨头浅亚部的肌梭密度显著小于锁骨头深亚部。(3)副神经胸锁乳突肌支绕锁骨头深亚部后缘(占65%)入肌时距乳突尖(4.39±0.42)cm,而穿锁骨头深亚部(占35%)入肌时距乳突尖(3.96±0.34)cm。结论:胸骨头亚部是胸锁乳突肌肌力的主要提供者。锁骨头深亚部更多参与维持头部姿势。     

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.