内窥镜下经鼻蝶切除垂体瘤手术中蝶鞍的解剖定位

目的 :为临床开展神经内窥镜下经鼻蝶切除垂体腺瘤提供解剖基础。方法 :对 2 5例成人头部固定标本进行鼻道及蝶窦底的解剖测量 ,并对 9具新鲜尸头进行内窥镜下经鼻蝶至蝶鞍的解剖观察。结果 :鼻柱根部到蝶窦口 (65 .3± 3 .1)mm ,鼻根到蝶窦口 (4 5 .4± 2 .4)mm ,蝶窦口到蝶筛隐窝顶 (7.1± 3 .4)mm ,鞍底到鼻柱根部与中鼻甲下缘连线的垂直距离 (12 .1± 2 .0 )mm ,蝶窦口长径 (3 .3± 1.5 )mm ,蝶窦口宽 (1.3± 0 .5 )mm ,蝶窦口上端距中线 (3 .0± 1.0 )mm ,蝶窦口下端距中线 (3 .9± 1.2 )mm。结论 :借助观察到的蝶窦口等解剖标记 ,内窥镜能够较好的定位蝶鞍。     

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。     

垂体动脉的应用解剖

目的 :为蝶鞍区肿瘤手术提供垂体动脉的显微外科解剖学资料。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的垂体上动脉和垂体下动脉进行观察。结果 :垂体上动脉主要起自颈内动脉床突上段的内侧壁或内下壁 ,发起后向内、向上斜行 ,直至垂体柄 ,行程中可分支至视神经、视交叉 ,起始部直径为 (0 .2± 0 .1)mm。垂体下动脉起自脑膜垂体干 (94.1% )或直接起自颈内动脉 (5 .9% ) ,发起后沿颈内动脉内侧前行 ,再穿出海绵窦内侧壁自鞍底至垂体 ,起始部直径为 (0 .8± 0 .2 )mm。结论 :鞍区肿瘤手术应注意垂体上、下动脉的走行特点 ,并保护好这些动脉 ,以减少手术并发症的发生。     

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。     

鞍膈的解剖特点及其临床意义

目的　研究鞍膈的解剖特点,探讨其临床意义。 方法 应用成人15例尸头标本,在显微镜下进行解剖观察和测量。 结果 视交叉偏向蝶鞍左侧20%（3例）,居于中线上66.7%（10例）,偏向右侧13.3%（2例）。鞍隔孔完全被视交叉覆盖73.4%（11例）,未被完全覆盖26.6%（4例）。鞍隔孔相对于视交叉的位置偏向左侧26.7%（4例）,居于中线上66.7%（10例）,偏向右侧6.6%（1例）。从上面观,鞍膈呈下凹型80%（12例）,平坦型13.3%（2例）,上凸型6.7%（1例）。鞍隔孔测量前后径为2.20 ~ 12.10 mm,左右径为3.10 ~ 13.40 mm;依据鞍隔孔的大小将鞍膈分为3种类型：紧密型,占13.3%（2例）;常见型,占73.4%（11例）;扩大型,占13.3%（2例）。垂体柄靠近鞍背前缘占53.3%（8例）,居中占40%（6例）,6.7%（1例）位于鞍结节后缘。 结论 鞍隔孔大小的变异可影响垂体瘤的生长方式,熟悉鞍膈及其周围解剖结构对鞍区手术具有重要意义。     

经鼻腔内窥镜蝶窦鞍区手术解剖及其临床应用

目的：为经鼻内窥镜蝶窦鞍区手术提供解剖学参数和临床经验。方法：在２０个尸头标本上观测蝶窦及周围重要解剖结构。结果：７７．５％的蝶窦口内窥镜直接窥见,窦口距离蝶窦顶壁、外壁、蝶腭动脉孔、鞍前壁、鼻中隔后端分别为 ８． ６±３． １ｍｍ、９． ２±１． ８ ｍｍ、 １１． １±１． ６ ｍｍ、 １４． ７±３． ６ ｍｍ、３． ６±０． ５ｍｍ,距离鼻小柱根部前缘 ６１．６ ± ３．７ ｍｍ,与鼻底夹角 ３１．８° ± ５． ２°。视神经管和颈内动脉在蝶窦外侧上隆起率分别为２５％和７２．５％。６９％蝶窦中隔非正中位。海绵窦前、下、后间窦出现率分别是８０％、５５％、３５％。结论：进行内窥镜蝶窦鞍区手术时注意蝶窦口、蝶窦外侧壁和蝶鞍底壁与周围结构关系,避免损伤重要血管神经。     

蝶腭动脉区的显微外科解剖学

目的 :为鼻内镜下经鼻蝶腭动脉结扎术提供解剖学资料。方法 :对固定的成人尸头蝶腭动脉区进行显微外科解剖及干性颅骨的骨性标志进行观察 ,并测量筛骨嵴与前鼻棘、下鼻甲上端、中鼻甲后端的距离。结果 :筛骨嵴位于蝶腭孔的前下方 ,蝶腭动脉分出的鼻后外侧动脉的前方。筛骨嵴与前鼻棘间距为 ( 5 0 .5 4± 3 .2 8)mm ,与下鼻甲上端垂直间距为 ( 9.99± 1 .79)mm ,与中鼻甲后端间距为 ( 9.5 1± 1 .88)mm。结论 :筛骨嵴是经鼻内镜下定位蝶腭动脉及蝶腭孔的重要解剖标志     

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。     

内窥镜下第三脑室手术的应用解剖

目的 :为神经内窥镜下进行第三脑室手术提供解剖学资料。方法 :对 2 1例成人尸头固定标本进行第三脑室的解剖观察和测量 ,对 9具新鲜尸头进行经室间孔入路神经内窥镜下第三脑室的解剖学观察。结果 :室间孔长径、宽径为 (5 .4± 1.2 )mm、(2 .7± 0 .9)mm ,中间块长径、宽径为 (6.8± 2 .3 )mm、(3 .8± 1.0 )mm ,前后联合间距 (2 1.8± 2 .1)mm ,前、后联合到中间块为 (6.3± 0 .8)mm、(8.8± 1.3 )mm ,前后联合中点处第三脑室高度 (13 .8± 1.4)mm ,室间孔下、后联合前及中间块上、下第三脑室宽度分别为 (6.3±2 .2 )mm、(4 .9± 1.8)mm、(3 .4± 1.6)mm和 (4 .3± 1.8)mm ,中间块上、下最小高度为 (4 .4± 1.3 )mm和(4 .3± 1.3 )mm。内窥镜可较清晰显示第三脑室内结构 ,但中间块可影响显露。结论 :内窥镜下经室间孔入路进行第三脑室手术有一个理想的操作空间。     

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。     

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.