腓总神经与腓骨颈的关系及其小腿各肌支的解剖学研究

目的明确腓总神经与腓骨颈的关系以及小腿各肌支的解剖学特征。方法取成人下肢标本40例,在肉眼及放大镜下解剖,观察腓总神经与腓骨颈的关系以及腓总神经各肌支的数目及走行,以腓骨头最突出点为测量起点,测量腓总神经绕腓骨颈处至腓骨头最突出点的距离;测量各肌支的发出点、入肌点的高度,并作统计学分析。结果腓总神经绕腓骨颈处至腓骨头最突出点的距离,左、右侧分别为(1.64±0.36)cm和(1.58±0.34)cm。各肌支的数目不等,其中胫骨前肌支数目最多,腓骨短肌支和跗长伸肌支的数目较少。40例标本中,腓总神经均穿行于腓骨颈部骨一筋膜管。结论腓总神经在绕腓骨颈处均穿行于骨一筋膜管。提示:这可能是导致腓总神经卡压综合征的主要原因之一;不同肌肉的神经肌支数目差别较大,与其所支配肌肉的结构、功能有关。     

第3腓骨肌缺如并第3跖伸肌变异1例

在解剖1例成年男性右侧下肢尸体标本中,发现第3腓骨肌缺如并第3跖伸肌变异,从第5跖骨基底部追踪至胫、腓骨附着部位,为积累国人解剖学资料,现报道如下:在修去足背皮肤和浅筋膜,清理肌腱时,发现[母]长伸肌和[母]短伸肌附着于第1趾背的肌腱,趾长伸肌附着于第2~5趾背的肌腱,趾短伸肌附着于第2~4趾背的肌腱,未见到第3腓骨肌腱,但可见附着于第5跖骨粗隆的第3跖伸肌腱(图1)。第3跖伸肌腹从腓骨中下2/3内侧面发出,经胫腓连结背面,即外踝内侧面,于伸肌上、下支持带深面走行,逐步过渡为肌腱,呈半羽肌状,附着于第5跖骨粗隆处。第3跖伸肌全长27.4 cm,肌纤维附着于趾长屈肌和腓骨短肌起点之间的腓骨内侧面,长14.5 cm,平均厚度1.5 cm。     

双腓浅神经一例

解剖51侧腓浅神经,发现一男性尸体右侧为双腓浅神经(附图)。该例腓浅神经与腓深神经分开后,在腓骨头下方2.5cm处立即分为腓浅神经内侧支(横径2.0mm)和腓浅神经外侧支(横径1.8mm)。两条腓浅神经起始段均走行于趾长伸肌与腓骨长肌之间,继而在长伸肌和腓骨短肌浅面下行,至小腿下1/3段分别穿出深筋膜达皮下。两条神经并列下行,在腓骨头下方15cm以内最大距离为0.5cm,然后距离逐渐增大,在腓骨头上方20cm处两条神经相距1.0cm,在内踝连线上相距2.3cm。两条神经分出后没有吻合支,外侧支在足背有腓肠神经的一支加入,内侧支在第一跖骨间隙内分出一束加入腓深神经。腓浅     

双胫骨前肌及第3腓骨肌多肌腹异常1例

正于解剖教学中发现一中年男尸左胫骨前肌及第3腓骨肌异常,报道如下:此例标本外观明显可见左小腿中上1/3较右腿粗。解剖操作时发现,其具有双胫骨前肌。内侧肌肉附着于胫骨的外侧,外侧肌肉附着于小腿骨间膜前面的上端。两肌肉向下移行成双肌腱经足底内侧缘止于内侧楔骨及第1跖骨。两肌肉中间夹有一血管神经束,是胫前动脉发出的肌支,由外上向内     

腓血管蒂腓骨嵌合组织瓣设计的解剖学基础

目的　为腓血管蒂腓骨嵌合组织瓣设计提供解剖学依据。 方法　用30侧成人下肢标本,以腓骨头和外踝为标志,将小腿分为上、中、下3区段解剖观测：①腓动脉起源、走行与分支;②腓动脉各区段肌（隔）穿支、骨膜支数目与分布。另1侧新鲜标本摹拟手术设计。  结果    腓动脉源于胫后动脉,移行为跟外侧动脉,中下段贴腓骨后面走行,沿途分支至邻近骨、肌肉和小腿外侧皮肤。其中：①腓骨骨膜支：（2~8）支、外径0.5~1.1 mm,分布腓骨中下1/3段骨膜：②胫骨骨膜支：（1~3）支、外径0.6~0.8 mm,营养胫骨中、下1/3段后面骨膜; ③肌（隔）穿支：（4~8）支、外径1.0~1.6 mm,支配小腿外侧中下段皮肤,并与胫前、胫后动脉皮支吻合。  结论　以腓动脉为蒂可设计腓骨嵌合组织瓣,依需要选择一种或多种嵌合组织瓣修复骨合并软组织缺损。     

腓骨骨皮瓣游离移植应用解剖研究

目的:(1)认识小腿后外侧肌间隔穿支与小腿皮肤血供间的关系;(2)评估腓骨骨皮瓣游离移植的安全性。方法:对12侧因股骨肿瘤而截肢的带膝关节小腿标本,注入血管铸型剂后进行显微解剖,并行模拟手术判断该骨皮瓣切取的安全性。结果:腓骨及其皮瓣均由腓动脉供血。在腓骨中、下1／3段,腓动脉平均发出(3.3±1.1)支肌间隔穿支供应小腿后外侧皮肤。结论:吻合血管的腓骨骨皮瓣仅依赖肌间隔穿支血管供血是可靠的,骨皮瓣切取部位应位于小腿中、下1／3后外侧。     

逆行腓骨肌肌皮瓣设计的解剖学研究

目的　为逆行腓骨肌皮瓣的设计与临床应用提供解剖学依据。 方法 新鲜下肢标本20侧,动脉灌注红色乳胶,解剖观测腓动脉、腓骨长肌、腓骨短肌及其表面皮肤与营养血管的的起始、走行、分支、分布的情况;新鲜标本2具,动脉灌注乳胶、氧化铅混悬液,CT扫描后三维重建小腿与足部血管。 结果 腓动脉起始外径(3.7±0.7) mm,多条分支供给比目鱼肌、 长屈肌、腓骨长、短肌及表面皮肤。腓动脉穿支的血管蒂可游离长度为(3.5±1.3) cm。腓动脉终末穿支在胫腓骨骨间膜中穿出,外径(1.2±0.4)mm,分为升支和降支。腓骨短肌肌腹的上部有一支较粗的腓浅动脉发自胫前动脉,向前穿骨间膜行于腓骨长肌与小腿前群肌之间,管径(1.8±0.5) mm,行向下营养腓骨短肌、腓浅神经和小腿前外侧部皮肤。 结论 以腓动脉中、下部穿支或终末穿支与其它血管的吻合部为蒂,可以设计切取逆行腓骨长、短肌肌皮瓣,修复小腿下部及足背部软组织缺损。     

吻合血管同种异体胫骨移植的解剖学研究

目的为吻合血管同种异体胫骨干移植提供解剖学依据.方法40侧经动脉灌注红色乳胶液的成人下肢标本,解剖观测了胫骨滋养动脉的来源、分支分布及长度和外径;50根干燥成人胫骨,观察胫骨滋养孔.结果胫骨滋养孔1孔占98.4%,位于胫骨中、上1/3段的后面,位置距胫骨粗隆平均8.0±1.6(6.0～15.5)cm.胫骨滋养动脉来自胫后动脉占90%,滋养动脉起始后行经腘肌下部深面和趾长屈肌深面,紧贴胫骨后面,分出骨皮支和滋养支.滋养动脉起点距离胫骨粗隆平均2.7±1.1(1.0～5.0)cm,外径1.7±0.5(1.0～3.0)mm,干长为5.2±1.2(2.0～7.0)cm.结论以胫骨滋养血管为蒂胫骨段移植,可用于长骨大段缺损的重建.     

双侧性腓骨长短肌融合一例

腓骨长、短肌融合少见,《中国人体质调查》一书未见报道。作者在尸解时遇见一例,报告如下:成年男尸,其腓骨长、短肌融合且为对称性。右侧融合之肌肉以腱膜起于腓骨头前外侧,并以肌性附着于腓骨体上2/3的前外侧面。肌腹中上部近乎等腰三角形,中部最宽,下部为扁椭圆状。在小腿中下部交界处逐渐移行为扁圆状肌腱,向下渐进变为圆柱状,在外踝前下方1cm处,此腱一分为二:短腱前行以腱     

腓动脉穿支皮瓣的应用解剖

目的　为腓动脉穿支皮瓣的临床应用提供解剖学基础。 方法　15例新鲜中国成人小腿标本,红色乳胶灌注,观测腓动脉穿支数目、分布、蒂长与外径、走行与类别。 结果　15例标本共出现68个穿支,每侧4.5个穿支,小腿外侧近端穿支呈多源性;腓动脉在腓骨头下10～15 cm节段穿支数所占比例最大,这一区间穿支蒂最长,为(5.23±0.75)cm;腓骨头下5～20 cm 范围内穿支外径较粗,小腿外侧近段穿支以比目鱼肌肌穿支为主,中远段以　长屈肌肌穿支和肌间隙支为主。 结论　腓骨头下10～15 cm节段腓动脉穿支较为恒定,穿支蒂较长,外径较粗,适合设计切取腓动脉穿支皮瓣游离移植。     

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.