前床突的显微外科解剖

目的了解前床突及其周围结构的解剖特点,并提供相应的解剖依据。方法用15例成人干颅骨和15例正常成人尸体头部标本,在手术显微镜下观察测量前床突及其邻近结构。结果视神经长度,前床突切除前为(9.5±1.8)mm,切除后为(21.3±2.9)mm;颈内动脉长度,切除前为(9.9±2.0)mm,切除后为(13.8±2.5)mm;视神经颈内动脉三角的宽度,切除前为(3.6±1.0)mm,切除后为(12.5±2.3)mm。前床突切除后所获得床突间隙几何空间的外侧横截面积为(2.1±0.3)cm2。结论磨除前床突后形成的床突间隙,增加了手术操作空间;前床突切除后在显露视神经颈内动脉三角的最大宽度方面能增加3～4倍的显露;可充分显露颈内动脉床突下段,增加了视神经鄄颈内动脉间隙,有利于该区域病变的处理。     

眶上锁孔入路治疗眼动脉瘤的应用解剖

目的 :为临床应用眶上锁孔入路治疗眼动脉段颈内动脉瘤提供解剖学基础。方法 :在 2 1例福尔马林固定尸体头部标本上观察测量前床突周围的神经血管位置关系 ,分析其对手术可能造成的影响及克服方法 ;在 9例新鲜尸体头部标本上模拟眶上锁孔入路治疗眼动脉段颈内动脉瘤手术 ,验证其可行性及优势。结果 :视交叉前缘至鞍结节距离为 (7.0± 1.8)mm ,视神经颅内段长度 (11.4± 2 .7)mm ,颅口处视神经内侧缘之间距离为 (12 .8± 0 .7)mm ,颈内动脉床突上段长度 (14 .5± 1.3 )mm。两侧前床突根间距 (2 1.2± 0 .8)mm ,两侧前床突尖间距为 (2 6.1± 1.7)mm ,视神经管颅口水平前床突长 (10 .1± 0 .2 )mm ,宽 (11.6± 1.4)mm ,厚 (4 .9± 0 .7)mm。手术时通过磨除前床突、鞍结节 ,切开镰状襞等能松解视神经、颈内动脉 ,形成较宽敞的操作空间 ,良好的控制近端动脉。视野细节显露清楚。结论 :眶上锁孔入路是治疗颈内动脉眼动脉段动脉瘤的良好手术入路。     

经翼点入路鞍区手术间隙解剖学研究

目的　为鞍区显微外科手术提供解剖学参数。方法　对 10具成人尸体头颅的鞍区手术间隙及邻近血管、神经进行解剖学观察、测量。结果　大脑中动脉M1段在距颈内动脉分叉部 18.4± 3.2mm处形成初级分叉 ,向后上方发出约 14支穿支 ,分布至基底节区。鞍结节后缘至视交叉前缘相距 5 .6± 1.1mm ,两侧视神经内侧缘间最大距离 10 .5± 1.4mm。颈内动脉从内侧壁发出 3.2支垂体上动脉 ,终止于视神经、视交叉、视束和垂体柄 ;视神经 -颈内动脉三角三边长度分别为 6 .6± 0 .6mm ,6 .9± 0 .7mm ,4 .0± 0 .4mm。颈内动脉 -小脑幕三角三边长度为 8.8± 0 .7mm ,6 .7± 0 .7mm ,4 .4± 1.0mm ,后交通动脉起自颈内动脉后外壁距分叉部 7.7± 0 .5mm ,止于大脑后动脉 ,全长 18.7± 2 .3mm ,途中发出 7.4条穿通支。脉络膜前动脉从距分叉部 4 .4± 0 .6mm处发出 ,向后方走行 ,发出细小分支 ,分布于钩回、脉络丛。前交通动脉全长 1.9± 0 .3mm ,在前交通动脉上方 0 .9± 0 .2mm ,大脑前动脉A2段前外壁发出Heubner回返动脉 ,分布于胼胝体、基底节、下丘脑及额叶脑组织。结论　应用这些间隙的解剖学测量可指导与鞍区相关的手术 ,安全显露鞍区解剖结构 ,不损伤重要的血管和神经。     

海绵窦上壁的应用解剖学研究

目的为经海绵窦(CS)上壁的手术提供解剖学资料。方法解剖观测15例(30侧)成人头颅标本CS上壁的解剖三角、脑膜及相关结构。结果①CS上壁为不规则的四边形,可分出3个解剖三角:颈动脉三角、动眼神经三角及前内侧三角;②动眼神经门的长径为(5.67±0.87)mm,短径为(1.09±0.35)mm;动眼神经鞘膜袋前深(4.69±1.31)mm,后深(6.50±1.58)mm;③上壁的脑膜结构有镰状韧带、前岩床皱襞、后岩床皱襞、床突间韧带,颈动脉床突韧带、颈动脉穴及颈动脉领、动眼神经鞘膜袋、远环及近环等,膜结构在前床突(ACP)尖形成复杂的膜复合体。结论CS上壁的解剖三角可作为CS的手术入路,其脑膜结构对于手术也具有重要意义。     

眶上锁孔入路治疗垂体瘤的临床解剖学研究

目的 :探讨内窥镜辅助眶上锁孔入路治疗垂体瘤的可行性。方法 :2 1例福尔马林固定尸体头部标本用于鞍区各解剖结构 ,特别是垂体柄、视神经、视交叉及其供血动脉特点的观察 ,总结手术可利用的间隙、应保护的结构 ;在 9例新鲜尸头上模拟进行内窥镜辅助眶上锁孔入路手术 ,进一步验证其可行性及优势。结果 :颈内动脉床突上段长度 (14 .5± 1.3 )mm(8.1～ 18.5mm ) ,发向垂体柄、视神经或视交叉的穿支动脉的支数分别为 :大脑前或前交通动脉 3 .0支 (2～ 6支 ) ,颈内动脉 2 .1支 (1～ 5支 ) ,后交通动脉 3 .2支 (3～ 6支 ) ,基底动脉 1.4支 (1～ 3支 )。视神经颅内段长度为 (11.4± 2 .7)mm (6.1～ 17.6mm ) ,第 1间隙面积为 (4 4 .8± 3 .4)mm2 (7.0～ 10 0 .8mm2 ) ,手术可通过第 1间隙或 /和第 2间隙进行。结论 :通过眶上锁孔入路治疗向鞍上发展的垂体瘤有充足的操作空间 ,具有视神经、视交叉减压充分 ,利于保护其供血动脉的优点。     

床突间隙显微外科解剖及概念的探讨

目的为经床突间隙(CS)进行海绵窦、鞍内、颈内动脉及眼动脉等病变的直接手术提供解剖依据,进一步澄清CS的概念.方法用22例成人头颅标本,在手术显微镜下从翼点和额下入路对前床突及周围结构进行直接解剖、观察和测量.结果CS是磨除前床突后留下的一楔形空间,其顶边宽(2.39±0.18)mm(0.64～4.10 mm),底边宽(5.34±0.16)mm(2 .66～7.00 mm),上内侧边长(7.67±0.33)mm(4.02～14.32 mm),下内侧边长(11.21±0.4 9)mm(4.24～17.06 mm),下侧边长(10.00±0.32)mm(5.6～14.26 mm),底高(7.87±0.35) mm(5.12～16.38 mm),尖端空间完全被颈内动脉(ICA)床突段所占据.ICA的远硬膜环和近硬膜环都不完整,动脉壁外常有海绵窦静脉丛,术中剥离ICA床突段可引起静脉丛出血.结论ICA床突段血管壁外有海绵窦静脉丛,它是海绵窦内结构,所以手术松解ICA床突段最好只剥离其内侧缘的ICA 穴,并为术中暴露CS后的空间大小提供了客观指标.     

咽旁间隙的临床应用解剖学

目的 :为咽旁间隙疾病的临床诊治提供解剖学基础。方法 :选用 3 9例成人尸体头颈部标本 ,分别经层次解剖和断层解剖后对照观察 ,并在咽隐窝层面横断标本上分别测量咽旁间隙及邻近结构的宽度和面积。结果 :咽旁间隙的面积为 :(4 4 7.6± 2 .18)mm2 (左 )和 (4 4 6.4± 2 .10 )mm2 (右 )。咽旁间隙被茎突及茎突诸肌分为咽旁前、后间隙 ,咽旁前间隙内有腭帆提肌、腭帆张肌等 ;咽旁后间隙内有颈内动、静脉 ,后四对脑神经等。腭帆提肌的宽度和面积为 :(14 .2 4± 0 .66)mm (左 )、(13 .88± 0 .72 )mm (右 ) ,(76.0±1.5 6)mm2 (左 )、(75 .2± 1.60 )mm2 (右 ) ;腭帆张肌的宽度和面积为 :(2 3 .60± 0 .84)mm (左 )、(2 2 .16±0 .90 )mm (右 ) ,(4 5 .8± 1.3 6)mm2 (左 )、(4 5 .0± 1.42 )mm2 (右 )。两侧咽旁间隙及邻近结构呈对称性 ,断面宽度和面积均无显著性差异 (P >0 .0 5 )。茎突是达咽旁间隙的重要解剖学标志 ,其外侧主要结构是腮腺及穿经腮腺的结构 ,间隙内容均位于茎突内侧。结论 :咽旁间隙的应用解剖对咽旁间隙肿瘤等疾病的诊治具有重要的临床意义。     

标准翼点入路前床突切除前后颈内动脉动眼神经三角的不同显露

目的：量化和比较从硬膜外切除前床突前后颈内动脉动眼神经三角（COT）显露面积。方法：15具尸体头颅标本进行双侧解剖。硬膜外切除前床突前后,测量点如下：①颈内动脉分叉点至前床突尖（A）及至远环（A’）;②颈内动脉分叉点至动眼神经被天幕返折挡住点（B）及天幕返折切开后至动眼神经孔（B’）;③前床突尖至动眼神经被天幕返折挡住点（c）和从远环至动眼神经孔（C’）。在前床突切除前后分别计算COT面积（分别为三角形ABC面积和三角形A’B’C’面积）。结果：所测平均值如下。A,（9．03±0．928）mm;A’,（13．50±0．861）mm;B,（7．63±1．245）mm,B’,（9．87±1．196）mm;C,（6．97±0．964）mm;C’,（9．27±1．285）inm;三角形ABC面积为（25．02±5．881）mm2,A’B’C’面积为（44．78±9．174）mm2。左右两侧长度和COT面积测量值比较差异无统计学意义（P〉0．05）。结论：经硬膜外切除前床突后在COT显露面积比切除前增加了近两倍。在切除鞍旁区病变和基底动脉顶端病变时,增加的显露对手术操作会有重要帮助。     

经额胼胝体下入路垂体瘤切除术的应用解剖

目的为经额胼胝体下入路垂体瘤切除术提供显微外科解剖学基础.方法采用显微解剖技术对17个甲醛固定,红色明胶动脉灌注的成年尸头标本蝶鞍区的有关神经和血管进行观察.结果(1)视交叉前间隙之间的面积为(28.4±6.2)mm2,视交叉前缘至鞍结节之间的距离为(4.1±0.8)mm.(2)前穿动脉主要来源于大脑前动脉交通前段和颈内动脉终末段,穿入前穿质前可分成多支或形成动脉丛.(3)两侧颈内动脉海绵窦段水平部之间的距离为(16.5±4.4)mm,在穿经海绵窦上壁处间距为(13.3±2.5)mm,在大脑前动脉发起处,间距为(17.9±1.6)mm.(4)前交通动脉在视交叉之上者占82.4%,之前者占14.3%,侧方者占5.9%.(5)动眼神经在后床突的前外侧(7.8±2.1)mm处穿海绵窦顶入海绵窦,入窦点在颈内动脉床突上段后方(5.0±2.0)mm,两侧入窦点之间的距离为(21.9±2.3)mm.结论经额胼胝体下入路垂体瘤切除术主要是通过视交叉前间隙,在颈内动脉之间的区域操作,手术中,既要保护颈内动脉、视神经、动眼神经等较大结构,又要尽量避免穿动脉、下丘脑支动脉等小动脉的损伤,以减少并发症的发生.     

视交叉前间隙有关结构的解剖观察及其临床意义

目的为经额入路行蝶鞍区手术提供外科解剖学依据。方法对30个经福尔马林固定的成年人尸头标本的视交叉前间隙及有关结构在肉眼和SXQ鄄Ⅱ型手术显微镜下进行观察,对视交叉前间隙的面积进行测算。结果①视交叉前间隙之间的面积为(28.4±6.2)mm2。两侧视神经颅内段越长,夹角越小,视交叉前间隙越大;两侧视神经颅内段越短,夹角越大,视交叉前间隙越小。②视交叉前缘至鞍结节之间的距离为(4.1±0.8)mm,两侧视神经于视交叉前之间的夹角为63.2°±5.8°。③颈内动脉自前床突内侧向上穿过硬脑膜之后,先向前、内、上方行至视神经下面,再弯向后、外、上方行于视神经外侧。④分布于视交叉上后面的视交叉上动脉来源于两侧大脑前动脉水平部段和前交通动脉。分布于视交叉下前面的视交叉下动脉来源于两侧颈内动脉和后交通动脉。结论经额入路蝶鞍区手术主要是通过视交叉前间隙,在颈内动脉之间的间隙操作,手术中应注意保护好视神经和视交叉的营养动脉,以减少并发症的发生。     

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.     

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.     

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.     

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.