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。     

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。     

国人副神经的形态学研究

一般教科书,对副神经的描述颇不一致。如对副神经脊髓根最下根在颈髓发出的平面问题,从C_5到C_6、C_7,写的很不一致。再如,副神经和颈神经(砷经根和前枝)之间的广泛联系,虽为各家所公认,但副神经(上、下部纤维)对胸锁乳突肌和斜方肌支配的分工状况以及副神经和颈神经对两肌支配的分工状况都没有详细的叙述。尤其是副神经和C_(3—4)神经对斜方肌的支配关系问题,还存在着较大的争论。有的学者(Clara,1959)认为C_(3—4)神经纤维专门支配斜方肌上部,副神经则支配斜方肌的中部和下部;而另一些学者(Monkad-Krohn,1954;DE Jong,1950)(引自[2])则认为C_(3—4)神经纤维专门支配斜方肌下部,副神经支配斜方肌的上部和中部。松野正彦和矢ケ崎久雄两氏(1956)曾对副神经根进行了形态学的调查,但也未能解决上述问题。有鉴于此,作者进行了一些调查工作,拟为解决在副神经方面存在的分歧找出一些形态学的根据。     

副神经的定位及其临床意义

目的:为有关的手术准确定位副神经提供解剖学基础。方法:12具(24侧)成人尸体标本。解剖观测副神经的行程、毗邻、体表标志、分支分布、与其与周围神经的关系。结果:副神经进入胸锁乳突肌后,75%肌支为两支,25%为1支。副神经在胸锁乳突肌后缘穿出点距耳大神经在胸锁乳突肌后缘穿出点上方(1.24±0.51)cm,距锁骨中点(10.72±1.67)cm,距胸锁关节(12.46±1.19)cm。副神经在颈后三角内位置表浅,副神经进入斜方肌点距锁骨中点(4.95±1.62)cm,沿途发出支配斜方肌的分支。结论:副神经有较为恒定的标志,上述测量的副神经体表定位有助于在有关手术中可以有效地保护或快速寻找副神经。     

副神经的叠加定位

通过84侧胸锁乳突肌与斜方肌之间副神经行程的叠加处理,发现副神经在胸锁乳突肌后缘的穿出点位于乳突最突出点与锁骨胸骨端连线的上29.4～50％之间;副神经在斜方肌前缘的穿入点位于乳突最突出点至斜方肌前缘与锁骨上缘交点连线的下69.5～94.2％之间。并经对总体均数可信区间的分析,提出此段副神经行程的体表投影。     

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.     

斜方肌各亚部神经分布和神经入肌点定位

目的为斜方肌各亚部的临床应用提供形态学基础。方法①观察30具成尸斜方肌各亚部的神经来源,并定位神经入肌点。②用6具尸体的斜方肌行Sihler’s肌内神经染色,观察肌内神经分布。结果①斜方肌降部入肌点约在斜方肌前缘的上3/4与下1/4交界处,水平部入肌点在锁骨肩峰端外侧缘中点与第7颈椎棘突上缘连线的中点,升部入肌点在肩胛冈内侧端结节与第4胸椎棘突上缘连线的中点。②斜方肌受副神经和颈丛(C2-4)斜方肌支支配,副神经主干在颈后三角和斜方肌降部深面发出1～3支一级分支到斜方肌降部,颈丛斜方肌支加入副神经主干一起在斜方肌水平部深面发出4～6支一级分支到斜方肌水平部,在斜方肌升部深面发出2～5支一级分支到斜方肌升部。斜方肌各亚部的肌腹中部均有一终未神经分支密集区,它们连成一条连续的约呈"S"形的神经分支带。结论斜方肌的降部仅由副神经支配,斜方肌的水平部和升部由副神经与颈神经双重支配。     

斜方肌的血管和神经供给

本文解剖和观测了31具(62侧)成年尸体斜方肌及其血管和神经。斜方肌的主要营养动脉是颈横动脉,其干的平均长度为41.03毫米,平均外径为2.31毫米。斜方肌上部、中部主要由颈横动脉浅支供给,中部、下部主要由颈横动脉深支供结。该肌的静脉血主要经颈横静脉和肩胛上静脉回流。颈横静脉的平均外径为3.00毫米。斜方肌由副神经和第三、四颈神经前支支配。副神经(从胸锁乳突肌后缘至斜方肌前缘一段)平均长度为44.40毫米,粗细为2.09毫米。     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的为锁骨肩峰端骨不连修复提供新的手术方法.方法在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1侧标本上摹拟手术设计.结果肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网.其长度为4.6±1.1cm,外径1.7±0.4mm.其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm.结论可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连.     

肩胛上血管肩峰支肩胛冈骨瓣移位术的应用解剖

目的:为锁骨肩峰端骨不连修复提供新的手术方法。方法:在40侧成人尸体标本上,解剖观测肩胛上血管肩峰支的走行、分支及分布;1 侧标本上摹拟手术设计。结果:肩峰支自肩胛上动脉发出后,向外走行于斜方肌、冈上肌之间,穿斜方肌在肩峰处的附着点达肩峰,并与胸肩峰动脉的肩峰支吻合构成肩峰动脉网。其长度为4.6±1.1cm,外径1.7±0.4mm。其主要分支肩胛冈支外径0.8±0.1mm,长度2.0±0.5cm。结论:可以肩峰支为蒂设计切取肩胛冈骨瓣移位修复锁骨肩峰端骨不连。     

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.