扩展剖面容积成像对定位胎儿脊髓圆锥末端的研究

目的探讨三维超声扩展剖面容积成像（OVIX）在胎儿脊髓圆锥末端定位中的作用。 方法2014年10月至2015年5月在广西壮族自治区妇幼保健院行产前系统超声检查的胎儿127例,其中正常胎儿122例,脊柱裂胎儿5例,孕周范围20~30周,应用三维超声采集胎儿脊髓圆锥末端容积数据,利用扩展剖面容积成像重建圆锥末端对应椎体至其至少5个以上椎体段脊柱冠状面并定位圆锥末端位置;对正常胎儿于新生儿期第28天随访其神经系统发育情况,对脊柱裂胎儿引产后行病理检查,以扩展剖面容积成像定位的脊髓圆锥末端位置为标准,对比正常胎儿脊髓圆锥末端位置与脊柱裂胎儿脊髓圆锥末端位置的差异。 结果127例胎儿中120例（94.5%,120/127）脊髓圆锥末端被定位,7例（3例因孕妇肥胖、4例因胎儿体位原因,均为正常胎儿）未能定位脊髓圆锥末端位置,115例正常胎儿脊髓圆锥末端位于L₃及L₃以上,5例脊柱裂胎儿脊髓圆锥末端位置均在L₄以下,其中2例位于L₅,2例位于S₁,1例位于S₃;扩展剖面容积成像对脊柱裂胎儿脊髓圆锥末端定位结果与引产后病理诊断结果一致。 结论扩展剖面容积成像能同时显示骨性标志第12肋、T₁₂及脊髓圆锥末端,利用T₁₂顺推脊髓圆锥末端位置,可准确定位胎儿脊髓圆锥末端位置,为产前评估脊柱裂病变提供有价值的影像学信息。     

超声定位胎儿脊髓圆锥末端位置方法的准确性

目的探讨超声定位胎儿脊髓圆锥末端位置方法的准确性。方法选择不同孕周因致死性畸形（非中枢神经系统）引产的胎儿10例,将引产前、后以胎儿成角的腰骶关节作为标志,用超声定位与脊髓圆锥末端相当的椎体位置,并与解剖方法确定的椎体位置相比较。结果10例引产前后用超声定位的脊髓圆锥末端对应的椎体位置,和解剖定位的椎体位置均完全吻合。结论对胎儿应用超声定位脊髓圆锥末端位置的方法是准确的。     

腰骶关节两线相交法判定胎儿脊髓圆锥位置

目的探讨腰骶关节两线相交法定位胎儿脊髓圆锥的位置的可行性。方法选取20～38周正常胎儿581胎,以腰骶关节两线相交法识别S1椎体,定位脊髓圆锥相应椎体水平,观察各孕周脊髓圆锥位置分布情况;随机选取101胎不同孕周胎儿观察不同医师间及腰骶关节两线相交法与三维成像定位结果的一致性。结果 2名医师采用腰骶关节两线相交法定位脊髓圆锥的一致性好(Kappa=0.94);腰骶关节两线相交定位与三维成像定位一致性好(Kappa=0.92)。530胎腰骶关节两线相交法可识别S1椎体并定位脊髓圆锥,脊髓圆锥对应的椎体水平范围为L1～L4,其中对应L1椎体、L1-2椎间隙、L2椎体、L_(2-3)椎间隙、L3椎体、L_(3-4)椎间隙和L4椎体分别占4.72%(25/530)、8.68%(46/530)、51.32%(272/530)、19.62%(104/530)、11.89%(63/530)、2.26%(12/530)和1.51%(8/530);脊髓圆锥随孕周呈逐渐上升趋势;≥23孕周时,全部位于L3椎体及以上;≥32孕周时,98.38%(182/185)达L2-3椎间隙及以上,≥37孕周时,94.83%(55/58)上升至L2椎体及以上。结论通过腰骶关节两线相交法可识别S1椎体,进而准确定位脊髓圆锥水平,可用于快速判断脊髓圆锥位置。     

Chondrichthyans have a bulbus arteriosus at the arterial pole of the heart: morphological and evolutionary implications

It has been generally assumed that the outflow tract of the chondrichthyan heart consists of the conus arteriosus, characterized by cardiac muscle in its walls. However, classical observations, neglected for many years, indicated that the distal component of the cardiac outflow tract of several elasmobranch species was composed of tissue resembling that of the ventral aorta. The present study was outlined to test the hypothesis that this intrapericardial, non-myocardial component might be homologous to the actinopterygian bulbus arteriosus. The material consisted of Atlantic catshark adults and embryos, which were examined by means of histochemical and immunohistochemical techniques for light and fluorescence microscopy. In this species, the distal component of the outflow tract differs histomorphologically from both the ventral aorta and the conus arteriosus; it is devoid of myocardium, is covered by epicardium and is crossed by the coronary arterial trunks. In the embryonic hearts examined, this distal component showed positive reactivity for 4,5-diaminofluorescein 2-diacetate (DAF-2DA), a fluorescent nitric oxide indicator. These findings, together with other observations in holocephals and several elasmobranch species, confirm that chondrichthyans possess a bulbus arteriosus interposed between the conus arteriosus and the ventral aorta. Therefore, the primitive heart of gnathostomates consists of five intrapericardial components, sinus venosus, atrium, ventricle, conus arteriosus and bulbus arteriosus, indicating that the bulbus arteriosus can no longer be regarded as an actinopterygian apomorphy. The DAF-2DA-positive reactivity of the chondrichthyan embryonic bulbus suggests that this structure is homologous to the base of the great arterial trunks of birds and mammals, which derives from the embryonic secondary heart field.     

Incidence and outcomes of spinal cord injury clinical syndromes

BACKGROUND/OBJECTIVE: To examine and compare demographics and functional outcomes for individuals with spinal cord injury (SCI) clinical syndromes, including central cord (CCS), Brown-Sequard (BSS), anterior cord (ACS), posterior cord (PCS), cauda equina (CES), and conus medullaris (CMS). DESIGN: Retrospective review. SETTING: Tertiary care, level 1 trauma center inpatient rehabilitation unit. PARTICIPANTS: Eight hundred thirty-nine consecutive admissions with acute SCIs. MAIN OUTCOMES MEASURES: Functional independence measure (FIM), FIM subgroups (motor, self-care, sphincter control), length of stay (LOS), and discharge disposition. RESULTS: One hundred seventy-five patients (20.9%) were diagnosed with SCI clinical syndromes. CCS was the most common (44.0%), followed by CES (25.1%) and BSS (17.1%). Significant differences (P < or = 0.01) were found between groups with regard to age, race, etiology, total admission FIM, motor admission FIM, self-care admission and discharge FIM, and LOS. Statistical analysis between tetraplegic BSS and CCS revealed significant differences (P < or = 0.01) with respect to age (39.7 vs 53.2 years) and a trend toward significance (P < or = 0.05) with regard to self-care admission and discharge FIM. No significant differences (P < or = 0.01) were found when comparing CMS to CES. CONCLUSIONS: SCI clinical syndromes represent a significant proportion of admissions to acute SCI rehabilitation, with CCS presenting most commonly and representing the oldest age group with the lowest admission functional level of all SCI clinical syndromes. Patients with cervical BSS seem to achieve higher functional improvement by discharge compared with patients with CCS. Patients with CMS and CES exhibit similar functional outcomes. Patients with ACS and PCS show functional gains with inpatient rehabilitation, with patients with ACS displaying the longest LOS of the SCI clinical syndromes. These findings have important implications for the overall management and outcome of patients with SCI.     

The pathology of lumbosacral lipomas: macroscopic and microscopic disparity have implications for embryogenesis and mode of clinical deterioration

Aims

Lumbosacral lipomas (LSL) are congenital disorders of the terminal spinal cord region that have the potential to cause significant spinal cord dysfunction in children. They are of unknown embryogenesis with variable clinical presentation and natural history. It is unclear whether the spinal cord dysfunction reflects a primary developmental dysplasia or whether it occurs secondarily to mechanical traction (spinal cord tethering) with growth. While different anatomical subtypes are recognised and classified according to radiological criteria, these subtypes correlate poorly with clinical prognosis. We have undertaken an analysis of surgical specimens in order to describe the spectrum of histological changes that occur and have correlated the histology with the anatomical type of LSL to determine if there are distinct histological subtypes.

Methods and results

The histopathology was reviewed of 64 patients who had undergone surgical resection of LSL. The presence of additional tissues and cell types were recorded. LSLs were classified from pre‐operative magnetic resonance imaging (MRI) scans according to Chapman classification. Ninety‐five per cent of the specimens consisted predominantly of mature adipocytes with all containing thickened bands of connective tissue and peripheral nerve fibres, 91% of samples contained ectatic blood vessels with thickened walls, while 22% contained central nervous system (CNS) glial tissue. Additional tissue was identified of both mesodermal and neuroectodermal origin.

Conclusions

Our analysis highlights the heterogeneity of tissue types within all samples, not reflected in the nomenclature. The diversity of tissue types, consistent across all subtypes, challenges currently held notions regarding the embryogenesis of LSLs and the assumption that clinical deterioration is due simply to tethering.     

Intramedullary neurenteric cyst without any associated malformation one case evaluated by RMI and electron microscopic study

Summary A 46 years old woman presented with several years history of low back pain. For five years she suffered from weakness of the left lower limb and three years later she experienced an episode of righ foot weakness. She suffered too from occasionnal urinary urgency. The examination showed decreased power and diminished sensory perception in the left leg. On myelography, a block at L2 level was observed. RMI evaluation showed an intramedullary cyst in the anterior part of the spinal cord without any enhancement of its wall by the Gadolinium. At operation a thin-wall cyst was found containing clear fluid. After a biopsy of the wall, a cystosubarachnoid shunt was performed. Histological examination of the surgical sample showed a simple cuboidal epithelium lying on collagen fibrills. Electron microscopic studies showed ciliated cells with a clearly-visible basement membrane. The diagnosis of neurenteric cyst was confirmed. In the postoperative course the patient complained about sensory loss of the legs and the perineal area. Six months later, she exhibited a sensory disturbance of the feet and the right sacral area, a motor deficit of the distal left leg without urinary disturbance. Neurenteric cysts are dysraphic lesions which can be observed without other abnormalities. They are usually extra-medullary and the intramedullary forms are very rare: among 5 cases reported in the literature, one has been evaluated by RMI. In the absence of enhancement by the Gadolinium, the other possible diagnosis seems an ependymal cyst. Contrary to extramedullary forms the postoperative course of intramedullary neurenteric cysts are not always eventfull. Because the cyst wall cannot be removed, repeated RMI are desirable in the follow-up.     

Immunocytochemistry of glutamate decar☐ylase in the deafferented habenula

The visualization of opiate binding sites within the hippocampus of the rat has been achieved by means of an in vitro autoradiography. In line with the concept of multiple opiate receptors, different opioid agonists revealed a particular distribution pattern. Whereas the selective δ-receptor agonist [³H]d-Ala², d-Leu⁵-enkephalin specifically labelled binding sites in the CA₂ area, [³H]etorphine grains displayed a uniform dense distribution throughout the pyramidal cell layers from CA₁ to CA₄.     

腰骶部椎管内肿瘤合并脊髓栓系综合征

目的：研究腰骶部椎管内肿瘤合并脊髓栓系综合征的病理临床特征及手术处理要点。方法：分析１２例腰骶部椎管内肿瘤患者的临床资料和手术所见，从局部是机制的角度探讨脊髓栓系的方式与临床表现之间的联系，并据此确定手术的原则。结果：腰骶部椎管内肿瘤以多种方式栓系脊髓和圆锥，共临床表现兼有马尾综合征及圆锥综合征的特征。脂肪瘤，畸胎瘤，室管膜细胞瘤，皮样或上皮样囊肿等椎管内肿瘤较易导致脊髓栓系，而脊索瘤，脊膜瘤及大