第3掌背动脉逆行岛状皮瓣掌侧移位修复拇指指端缺损

目的：报道应用第3掌背动脉逆行岛状皮瓣掌侧移位修复拇指指端缺损的手术方法。方法：对22例拇指指端缺损病例，采用第3掌背动脉岛状皮瓣，经指蹼皮下隧道逆行移位至手掌侧远端，屈曲拇指贴紧手掌固定，皮瓣带蒂修复创面，2～3周后断蒂。结果：22例皮瓣全部成活，随访3～12个月，感觉恢复S3 15例、S4 7例，外形及功能满意。结论：第3掌背动脉逆行岛状皮瓣掌侧移位是修复拇指指端缺损的良好方法。     

第4掌背动脉逆行岛状皮瓣的解剖及临床应用

目的：通过活体及标本解剖观测，为第４掌背动脉逆行皮瓣的临床应用提供解剖学依据。方法：通过对４０例活体（８０侧手）用Ｄｏｐｐｌｅｒ血流探测仪检查第４掌背动脉的出现率。８例新鲜的成人手标本灌注红色乳胶，２例在第３指掌侧总动脉起点处加压灌美蓝。结果：第４掌背动脉的出现率为９６％。以其血供来源将其分为３型。其血供的基础是第４掌背动脉远近侧轴点处２条较粗大的皮支，皮支之间在筋膜层构成了丰富的网状血管结构，在指蹼处与指掌侧总动脉或分支之间有吻合支相连，设计以此吻合支为蒂逆行岛状皮瓣。临床应用１５例，皮瓣全部成活。结论：该皮瓣适宜于修复小指、环指远指节间关节以近的不同平面的皮肤缺损，特别适宜于小指脱套伤的修复。     

以示指桡掌侧筋膜皮支为蒂逆行岛状皮瓣的应用解剖

目的：为以示指桡掌侧固有动脉近侧指间关节附近的皮支为蒂的第2掌指背侧逆行岛状皮瓣修复示指指端缺损提供解剖学基础。方法：在32个手部血管铸型标本、血管灌注标本上，解剖观察示指桡掌侧固有动脉分支与示指桡背侧指背动脉的吻合，皮瓣供区血管、神经分布。结果：示指桡掌侧固有动脉在近侧指间关节附近发出皮支与示指桡背侧动脉在桡背侧有吻合，皮瓣供区有示指背．掌背静脉和示指桡背侧神经，并形成筋膜、静脉和皮神经血管网。结论：以示指桡掌侧固有动脉在近侧指间关节附近的筋膜皮支为蒂可形成第2掌指背逆行岛状皮瓣，是示指指端软组织缺损修复的较佳皮瓣。     

指背动脉蒂逆行岛状皮瓣的应用解剖

目的：报道指背动脉蒂逆行岛状皮瓣设计的解剖学基础。方法：对12只新鲜尸体手标本分别经动脉灌注红色乳胶及动脉铸型标本对照观察，对掌背动脉及指背动脉进行显微解剖，根据其血管分布设计成指背动脉蒂逆行岛状皮瓣。结果：掌背动脉与指掌侧固有动脉在近节指骨底有交通支相连，掌背动脉的终末支-指背动脉，位于指背腱膜的两侧，一般不超过近节指骨中部，有小分支与指掌侧固有动脉的背侧分支在指背形成丰富的血管吻合网。结论：指背动脉与指掌侧固有动脉的吻合支丰富，可以其为蒂，设计成逆行岛状皮瓣，该皮瓣设计合理、血供可靠、操作简便，是手指末端软组织缺损修复较理想皮瓣。     

手背逆行岛状皮瓣的应用解剖

作者通过对12侧新鲜成人上肢标本血管染料灌注、解剖观察,发现手的掌背动脉在指蹼处与指掌侧总动脉或其分支之间有吻合支相连,该吻合支外径较粗,位置恒定,有静脉伴行.以此吻合支为蒂、掌背动脉为轴,设计了手背递行岛状皮瓣。本文阐述了皮瓣设计的解剖学依据,并就皮瓣的血供特点、切取范围、优缺点进行了讨论.作者认为:本皮瓣质地好,血管恒定、操作简单、成活率高,也可带伸肌腱和掌骨片复合移植,对手掌或手指的修复,具有其它皮瓣不可比拟的作用.     

第1掌心动脉掌骨颈尺侧穿支的解剖研究及临床意义

目的 研究第1掌心动脉掌骨颈尺侧穿支与第2掌背动脉及指蹼动脉间的吻合类型, 为第2掌背动脉皮瓣的安全设计切取提供解剖学基础。 方法 成人新鲜手标本39侧, 用红色乳胶灌注动脉。解剖观测第1掌心动脉掌骨颈尺侧穿支的起源、走行、外径以及与第2掌背动脉和指蹼动脉间的吻合方式。 结果 第1掌心动脉掌骨颈尺侧穿支在第2掌骨颈处起自第1掌心动脉,起始处直径（0.57±0.20）mm,沿第2掌骨颈尺侧和骨间肌的间隙穿向背侧,与第2掌背动脉及指蹼动脉间形成吻合。依其与掌背动脉及指蹼动脉的吻合特点可分4型：Ⅰ.无吻合型（38.46%）;Ⅱ. “T” 型（33.33%）;Ⅲ. “Y”型（25.64%）;IV. “π” 型（2.56%）。 结论 28.20%的第2掌背动脉与指蹼动脉间并非直接吻合,而是通过第1掌心动脉掌骨颈尺侧穿支间接吻合（ “Y” 型、 “π” 型吻合）,当遇到这两种情况时,术中很容易破坏第2掌背动脉与指蹼动脉间的吻合连续性,导致第2掌背动脉皮瓣的切取困难甚至失败。     

虎口掌侧动脉背侧穿支蒂跨区供血皮瓣的解剖基础

目的　探讨虎口掌侧动脉背侧穿支形态学特征,为虎口掌侧动脉背侧穿支皮瓣设计提供解剖学基础。 方法　用30侧灌注红色乳胶的成尸手标本,通过巨微解剖、血管铸型等方法,重点观测：①虎口背侧营养血管的起源、走行与分布;②虎口掌侧动脉背侧穿支与虎口背侧血管的吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。 结果　虎口背侧血供属多源性,由虎口掌侧动脉（示指桡掌侧固有动脉、拇指尺掌侧固有动脉）背侧穿支和虎口背侧动脉（第1掌背动脉）分支供养。①第1掌背动脉恒定起自桡动脉,走行于第1掌骨间隙,分出桡侧、尺侧和中间3个终支,有桡神经浅支发出的同名指背皮神经伴行;②虎口掌侧动脉向虎口背侧发出尺侧、中间和桡侧穿支,与第1掌背动脉分支形成恒定的吻合,营养虎口背侧皮肤。 结论　以虎口掌侧动脉背侧穿支为蒂,可形成跨区域供血虎口背侧皮瓣转位修复示指近侧段、鱼际部和拇指软组织缺损。     

以骨间背侧动脉为蒂逆行岛状皮瓣的应用解剖学

在60侧灌注血管染料的新鲜成人上肢标本上,观察了骨间背侧血管在前臂背侧的起点、走行和分支,发现该动脉终末支在腕上2.5cm 水平,与骨间掌侧动脉背侧支之间有恒定的吻合支相连,并以此吻合支为蒂,设计了前臂骨间背侧血管逆行岛状皮瓣。     

以拇指桡侧筋膜血管为蒂第1掌骨背侧皮瓣的应用解剖

目的：为以拇指桡掌侧动脉掌指关节周围分支为蒂的第１掌骨背侧皮瓣提供解剖学基础。方法：新鲜尸体手标本３２个,分别进行血管染料灌注、血管造影、透明标本、显微解剖观察。结果：①拇指桡掌侧动脉掌指关节周围分支在第１掌指关节桡背侧与拇指桡侧指背动脉吻合,并在第１掌骨背侧区域形成筋膜、皮下血管网;②第１掌骨背侧有２条同行浅静脉干,其位于拇短伸指肌腱两侧,并存在静脉瓣膜。结论：以拇指桡掌侧动脉第１掌指关节周围支为主要血供来源,经拇指背静脉交通至头静脉为主要回流途径的血管筋膜蒂皮瓣,血供可靠、切取方便、供区创伤较小,临床上可用于修复拇、示、中、环指皮肤软组织缺损。     

第1掌背动脉逆行岛状皮瓣的应用解剖学

目的　提供第1掌背动脉逆行岛状皮瓣的应用解剖学依据。 方法　解剖58侧防腐固定的成尸手标本,观测第1掌背动脉的起源、外径、长度及吻合。观察皮瓣感觉神经的来源及分布。1侧新鲜成尸手标本动脉造影。 结果　第1掌背动脉起于桡动脉鼻烟窝段,外径（0.77±0.19）mm,长度（5.21±　0.47）cm。第1掌背动脉分为3型：Ⅰ正常型占60%（35侧）,走行在第2掌骨桡侧,在第2掌骨颈或示指近节桡侧与示指桡掌侧固有动脉吻合。Ⅱ变异型占29.2%（17侧）,Ⅲ缺如型占10.3%（6侧）。第1掌背动脉伴行静脉两支者占29%（17侧）;1支者占19%（11侧）;缺如占52%（30侧）。皮瓣的感觉神经来源于桡神经浅支。 结论　第1掌背动脉作为轴心血管设计为逆行岛状皮瓣修复拇指、示指近节及掌指关节背侧皮肤缺损。     

Anomalous artery directly connecting the external and internal carotid arteries

An anomalous artery directly connecting the external with the internal carotid artery was encountered on the right side of a 68-year-old Japanese female cadaver. This anomalous artery (5 mm in diameter, 12 mm in length) branched out from the posterior aspect of the external carotid at the level of the origin of the lingual artery, ran obliquely upward posteriorly along the course of the hypoglossal nerve, and was confluent with the anterior aspect of the internal carotid artery. No other variations were found in the morphological aspects of, or in the anatomical relationships between, the carotid arteries and their surrounding structures on either side. The carotid body-like structure was observed at the carotid bifurcation and was innervated by small branches of the glossopharyngeal, the vagus and the sympathetic trunk. Embryologically, it is conceivable that this anomalous artery may have derived from the right second branchial arch artery, although there is no abnormality in other derivative structures of the second pharyngeal arch. There may have been no effect from this anomaly on the functions of the arterial blood flow and blood supply under normal circumstances in the present case, but this report may be of embryological significance and contribute some insight into the mechanisms of the formation of the carotid circulation systems.     

带血供第2跖骨瓣重建外踝缺损的应用解剖

目的：为带血供第2跖骨瓣修复外踝缺损提供解剖学依据。方法：30侧经动脉内灌注红乳胶成尸下肢标本，对足背动脉外侧的分支、走行、吻合及其与第2跖骨的血供关系进行解剖学观察。结果：第2跖骨有明显的多源性供血特点，其背侧血供源于不同出现率的以下动脉：足背动脉1～4支，跗外侧动脉1～2支，第1跖背动脉1～3支，第2跖背动脉1—2支，弓状动脉2～4支。上述动脉的骨膜支分布于第2跖骨的内、外侧骨面与邻近皮肤，外径0．3～1．0mm。在足背的外侧区，诸动脉的分支问有恒定的直接吻合。结论：依据足背动脉外侧分支的解剖学规律，可以酌情选用血管蒂，设计4种有血供的第2跖骨瓣，用于移植或移位重建外踝缺损。     

上颈性眩晕发生的颈交感神经及第2颈神经的解剖学因素观察

目的 明确颈上神经节（superior cervical ganglion,SCG）与第2颈神经及椎动脉的解剖关系,为临床诊治上颈性眩晕提供形态学基础。 方法 解剖15具（30侧）成人尸体标本,观察颈上神经节与C2的交通支及至椎动脉的分支。 结果 5侧未见SCG与C2之间存在神经连接;25侧存在神经连接,其中18侧存在迷走神经参与,7侧可见SCG分支支配椎动脉。SCG分支与C2前支汇合后,交感神经纤维分别至C2前、后支及椎动脉。 结论 SCG与C2的交通支及其对椎动脉的支配关系,可为阐明上颈性眩晕发病机理及建立有效治疗方案提供重要解剖学依据。     

基于雷达式非接触生命参数检测中跟踪干扰谱峰的二次滤波算法研究

为了抑制雷达式非接触生命探测系统中的动目标干扰，提出可跟踪干扰谱峰的滤波算法，用于检测受到同频带干扰影响的呼吸信号。对信号一次滤波后．进行Yule—Walker功率谱估计，发现可能的同频带干扰谱峰．通过与标准呼吸信号进行归一化互相关系数计算，对干扰谱峰定位，从而进行二次滤波，提取呼吸信号。结果表明，经二次滤波算法处理后，呼吸信号中同频带干扰谱峰被识别并抑制。对于单一同频带干扰谱峰，该算法能有效抑制同频带干扰，提取呼吸信号。     

Surgical outcome of synchronous second primary cancer in patients with gastric cancer

PURPOSE: In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. PATIENTS AND METHODS: The clinicopathological data of 10,090 gastric cancer patients at Samsung Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. RESULTS: The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. CONCLUSION: Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.     

Galanin immunohistochemistry and electron microscopic studies in developing human fetal mammillary bodies

Development and maturation of nuclear groups in the mammillary complex of second and third trimester human fetal hypothalamus were studied using Nissl stain, galanin immunocytochemistry and transmission electron microscopy. While the identity of the supra and medial mammillary nucleus was established at 24 weeks of gestation (w.g.) in Nissl stained preparation, galanin immunoreactive (Gal-ir) neurons were seen in the supra and medial mammillary nucleus of 27 through 39 w.g. fetuses. Immunoreactive perikarya in the lateral mammillary nucleus appear later at 34 w.g. and show relatively meager population. Gal-ir neurons of the supramammillary nucleus were divisible in dorsal and ventral subgroups. There was a progressive increase in galanin expressing neurons in more and more ventral positions, along the medial margin of either mammillary body so that in term fetal specimens, the ventral subgroup appeared to be continuous with the medial mammillary nucleus. Galanin positive neurons were relatively sparse in the core of the mammillary bodies. Transmission electron micrographs revealed neurons with varying degree of indentation of the nuclear envelope. Vigorous synaptogenesis was seen in the supramammillary region of the mammillary bodies. The height and width of the synaptic complex also showed a progressive increase. Although galanin neurons were reported from the supramammillary nucleus of adult human mammillary complex, no immunoreactivity was detected in the medial and lateral components of the mammillary body. We suggest that expression of galanin in the medial and lateral components may be of transient occurrence and may serve a significant role in the synaptogenesis.     

产前筛查及数据微机分析的临床意义

目的应用孕妇血清妊娠蛋白检测产前筛查胎儿质量。方法通过ELISA方法检测8790例、孕龄为14-20周的中国人群孕妇血清AFP、βhCG浓度,结合孕妇年龄、孕周等关键参数,计算唐氏综合征的风险系数,并建立了适合本中心的孕中期MoM值。结果在14～20孕周的AFP血清浓度为（28.13～72.50）IU/ml、Free-βhCG血清浓度为9.22mIU/ml-47.09mIU/ml,且呈正态分布,各孕周中位数值与本中心使用的贝喜唐氏综合征产前筛查系统的中位数值较一致,但与以往报道的白种人、黑种人数据有明显的差异。用贝喜唐氏综合征产前筛查系统计算,临床筛查假阳性率约为5.95%;对高危人群中的459人次进行了羊水诊断,其中有唐氏综合征患儿1例,神经管缺损10例。结论在中国人群AFP和βhCG数据库基础上建立的唐氏综合征筛查系统,对于年均有2000万新生儿的中国有着更重要的价值。     

Variation in the Origin of Cystic Artery

In recent years, an extensive development in laproscopic surgery has made surgeons to obtain a clear appreciation and knowledge of variations in the blood supply of gall bladder. The study was done on specimens including 35 embalmed cadavers and 15 fresh postmortem specimens by dissection method at JSS Medical College. In the present study we observed that the cystic artery from right hepatic was seen only in 54% cases. Whereas from hepatic artery proper in 22%, from common hepatic in 12%, from gastroduodenal in 8%, and from superior mesenteric in 2% of cases. Cystic artery from superior mesenteric passes through head of pancreas. This variation is very important for surgeons during resection of pancreas. Because of very limited field of vision during laproscopic surgery, haemorrhage could be a problem if these variations are overlooked. Sound knowledge of cystic artery variations is helpful for surgeons while performing upper abdominal surgeries.     

Multiple variations of internal iliac artery – A case report

IntroductionInternal iliac artery (IIA) is the vessel predominantly supplying the pelvic viscera and the pelvic wall. The main stem of IIA is usually devoid of any branches. Its two divisions give rise to all its branches.MethodA case of multiple variations of IIA was noted during routine dissection of a male cadaver on the right side.ResultsInferior gluteal artery and middle rectal artery which are usually branches of the anterior division of IIA arose from the posterior division. Iliolumbar artery, usually a branch of the posterior division arose from the main stem of IIA. Obturator artery arose from external iliac artery instead of IIA.DiscussionThe knowledge of such variations aids in performing various surgical and radiological procedures in this region.