Facial reanimation surgery utilizing the Mitek anchor system: A case report

A flaccid hemi-face is frequently the most noticeable and cosmetically unacceptable consequence of facial nerve palsy, whether due to trauma, Bell's palsy or other etiologies. A variety of face-lift and reanimation techniques have been utilized in the past, but with time, these frequently require further surgery. We describe the use of Mitek (Norwood, MA) suture anchors for cheek resuspension in a patient with facial palsy. This system is composed of a drill guide, drill, inserter, and anchor. Although the titanium alloy anchors come in multiple sizes, the Mini GII Anchor is typically most appropriate for use in facial procedures. The actual size of the Mini GII Anchor is 1.8 mm in diameter and 5.4 mm in length. Two small arched prongs extend from the body of the anchor, and an eyelet at the superior surface is used for suture placement. When placed into a pre-drilled hole with the insertion tool, the prongs extend, effectively fixing the anchor in place. The drill guide protects adjacent soft tissues during the drilling process and allows drilling to a predetermined fixed depth. Sutures attached to the anchor may then be used for soft tissue fixation to bone.     

Musculocutaneous and median nerve branching: anatomical variations. Case Series from UR clinical anatomy and literature review

IntroductionThe brachial plexus is highly variable, which is a well-known anatomical fact. Repeated observations on anatomical variations, however, constitute current trends in anatomical research.Case seriesIn an anatomical dissection course, three uncommon variations in the brachial plexus were identified in three young adults'' cadavers. In one case, the musculocutaneous nerve gave a branch to the median nerve, while the median nerve gave or received musculocutaneous branches in the two remaining corpses.ConclusionAnatomical variations of the brachial plexus do occur in our setting. The cases we presented are about anatomical variations of branching patterns of the median and musculocutaneous nerves. Knowledge of those variations is essential for surgery and regional anesthesia of the upper limbs.     

Primary Superior Lumbar Hernia with Nephrotic-range Orthostatic Proteinuria

Lumbar hernias are extremely rare. The posterolateral abdominal wall has two susceptible areas - the superior (Grynfeltt-Lesshaft''s triangle) and the inferior (Petit''s triangle) lumbar triangles - that cause superior and inferior lumbar hernias, respectively. We herein report a 67-year-old woman with nephrotic-range proteinuria caused by primary superior lumbar hernia. Superior lumbar hernias should be considered as a differential disease causing massive orthostatic proteinuria in adults. The present case highlights the importance of considering lumbar hernia in patients with flank swelling and the potential complications that may result from a missed diagnosis.     

静脉性脑梗死动物模型的建立及相关研究

静脉性脑梗死动物模型的建立是通过不同的栓塞方法闭塞实验动物上矢状窦的不同部位，其目的是观察脑组织的血流量、血氧饱和度、脑组织水含量、脑灌注压、及各种影像学表现等参数指标的变化，从病理生理角度探讨静脉性脑梗死的发病机理及演变过程。     

Digitoxin therapy partially restores cardiac catecholamine and brain serotonin metabolism in congestive heart failure

The effect of therapeutic doses of digitalis in modifying neural activity has been the subject of considerable controversy. In earlier studies we reported an increase both in serotonergic activity in the posterior hypothalamus and pons-medulla and in cardiac sympathetic tone in the failing cardiomyopathic hamster. In this study we examine the effects of doses of digitoxin, known to be therapeutic for hamster heart failure, on monoamine neurotransmitter metabolism in the brain and heart during the cardiomyopathy. Both digitoxin and ASI-222, a polar amino-glycoside which does not cross the blood-brain barrier, given either acutely (6 mg/kg ip) or chronically (2 mg/kg/day ip for 10 days), normalized the failure-induced increase in serotonin turnover in the pons-medulla but had no effect on the changes in the posterior hypothalamus. Digitoxin therapy also reduced cardiac and adrenal sympathetic activity partially restoring cardiac catecholamine stores. In order to more clearly define the pathways involved we measured serotonin (microgram/g protein) in 18 brain nuclei after 10 days of digitoxin or vehicle treatment. Heart failure was associated with an increase in serotonin in five nuclei: the mammillary; bodies, ventromedial, periventricular and paraventricular nuclei of the hypothalamus, and the centralis superior nucleus of the raphe. Digitoxin therapy completely normalized the changes in the centralis superior and ventromedialis nuclei; neither congestive heart failure nor digitoxin affected serotonin levels in other nuclei. We conclude that there is an increase in activity in specific brain serotonergic nuclei in congestive heart failure. Digitalis reduces cardiac sympathetic tone and restores the changes in two of these nuclei: the ventromedial and the centralis superior.+2     

Inhibitory effects of opioids in a circular muscle-myenteric plexus preparation of guinea-pig ileum

Summary The actions of opioids were examined in a strip preparation of the external muscle and myenteric plexus of the guinea-pig ileum cut parallel to the circular muscle. Contractions of the circular muscle induced by electrical stimulation of myenteric neurons were depressed in a concentration-dependent manner by the mu agonists, morphine and DAGO, and by the kappa agonist, U-50,488H. The concentrations of morphine, DAGO and U-50,488H which depressed nerve-mediated contractions by 50% (IC₅₀) were 86 nM, 11 nM and 5.0 nM, respectively. The equilibrium dissociation constants (K _D) for naloxone as an antagonist of the inhibitory effects of DAGO and of U5-0,488H were 5.6 nM and 29.4 nM, respectively. In contrast to the potent inhibitory effects of mu and kappa agonists, the delta-selective agonist, d-Pen-l-Pen, produced only weak inhibition of nerve-mediated contractions. Even at a concentration of 3 M, there was less than 50% inhibition, which was not antagonised by the delta receptor antagonist, ICI 174864. The experiments indicate that both mu and kappa opioid receptors are present on the myenteric neurons supplying the circular muscle and that delta receptors are either absent or ineffectively activated. Send offprint requests to S. M. Johnson     

Third ventricle choroid plexus function and its response to acute perturbations in plasma chemistry

The homeostatic role of the third ventricle choroid plexus (3VCP) in the maintenance of CSF electrolytes was investigated by quantifying alterations in CP epithelial ion concentrations induced by chemical perturbations of plasma in adult Sprague-Dawley rats. Significant regional differences (third vs fourth (4VCP) and lateral ventricle CP (LVCP] were found in epithelial content of Na+ and K+, with respect to baseline levels as well as alterations caused by 5-60 min of systemic metabolic acidosis. 3VCP, which comprises ca. 10% of total choroidal tissue, has a water content, extracellular fluid volume and vascularity comparable to 4VCP and LVCP; yet 3VCP is characterized by relatively high and low values for cellular [Na+] (68 mM) and [K+] (118 mM). Compared to time-matched controls, acute metabolic acidosis (i.p. NH4Cl) effected a response, i.e. increases [K+] and decreases [Na+], in 3VCP that was less than in 4VCP, and substantially smaller than in LVCP. The onset and duration of induced electrolyte changes were qualitatively similar among the 3 plexus regions. Although systemic acidosis severely altered CP electrolyte concentrations, it did not compromise CSF homeostasis of [K+] and [Na+]. The function of 3VCP is discussed in terms of secretory capacity, embryological origin, and innervation. Overall, the findings indicate that transport/permeability phenomena which mediate transmembrane distribution of Na+ and K+ in 3VCP differ quantitatively from other regions of the blood-CSF barrier.