巨大垂体瘤的经鼻蝶窦进路显微切除术

目的：总结经蝶窦进路显微手术治疗巨大垂体瘤的经验。方法：经蝶窦进路显微手术治疗直径在30mm以上的巨大垂体瘤58例。结果：58例中,镜下全切除者52例、大部分切除者6例,经手术治疗后症状均有不同程度的改善。1例于术后1个月死于垂体危象。余57例患者术后随访2～5a,复发5例均经再次手术治愈。结论：巨大垂体腺瘤的手术治疗仍以经蝶窦进路为首选。     

Basic determinants for FM responses in the inferior colliculus of rats

Summary The response of 835 click-sensitive neurons in the inferior colliculus (IC) to ramp frequency modulated (FM) tones was studied in the anaesthetized rat. More than 70% of the cells were sensitive to the FM sound, and over 25% were FM specialized. Systematic variations of the stimulus parameters showed that sweep velocity, sweep range, and intensity of the FM signal were the 3 basic determinants for the unit response. For anFM specialized cell, the response pattern to each of the parameters was either monotonic or bell-shaped. The population statistics of response patterns to the FM parameters, including the tuning factors, were generated. A stimulus domain was proposed to represent thereceptive space of the FM cells.     

The dorsal spino-olivocerebellar system in the cat

Summary The spino-olivocerebellar paths ascending through the dorsal funiculi (DF-SOCPs) were studied by recording climbing fiber field potentials in the cerebellar cortex. Several DF-SOCPs were identified on the basis of their response latencies, peripheral inputs, and projection areas. The projection areas consist of eight sagittal zones on each side of the anterior lobe denoted a, x, b, C₁, c₂, c₃, d₁, and d₂. The a and b zones, which are activated exclusively from hindlimb nerves (Oscarsson, 1969a) were not studied.The shortest response latencies in the x, c₁, c₃ and d₂ zones indicate that these zones are activated by direct paths between the dorsal funiculus nuclei and the inferior olive. These zones also have long latency responses evoked through indirect paths. The direct paths are activated from the flexor reflex afferents and the indirect paths from distal cutaneous afferents. The x zone is activated from forelimb nerves only. The c₁ and c₃ zones and presumably also the d₂ zone are activated from hindlimb and forelimb nerves and have a detailed somatotopical organization.The c₂ and d₁ zones have long latency responses evoked through indirect paths. Both zones are activated from distal cutaneous afferents. The c₂ zone has no distinct somatotopical organization, whereas the d₁ zone has largely separate forelimb and hindlimb areas. In contrast to all other zones, the c₂ zone is activated not only from ipsilateral but also from contralateral nerves.     

Anatomical variations of the ten triangles around the cavernous sinus

The dimensions of the 10 triangles around the cavernous sinus were measured to define the anatomical characteristics of the triangles and to compare their consistency in shape and area. Twelve tissue blocks containing the bilateral cavernous sinuses and medial two-thirds of the middle cranial fossae were obtained from Japanese adults at autopsy, fixed to a stereotactic frame, and examined with an operative microscope. The dimensions of each triangle were measured with calipers and compared, based on the same point and border. The anteromedial triangle and the superolateral (Parkinson's) triangle were more consistent in shape than the paramedial and oculomotor triangles, but the oculomotor triangle was larger in area than these other triangles. The posteromedial (Kawase's) triangle was more consistent in shape and larger than the anterolateral, lateral, and the posterolateral (Glasscock's) triangles. The anteromedial and superolateral (Parkinson's) triangles are important for the combined epi- and subdural approach to cavernous sinus lesions. The posteromedial (Kawase's) triangle is important for gaining access to the posterior cranial fossa from the middle cranial fossa.     

Functional interactions among neurons in inferior temporal cortex of the awake macaque

Summary Functional interactions among inferior temporal cortex (IT) neurons were studied in the awake, fixating macaque monkey during the presentation of visual stimuli. Extracellular recordings were obtained simultaneously from several microelectrodes, and in many cases, spike trains from more than one neuron were extracted from each electrode by the use of spike shape sorting technology. Functional interactions between pairs of neurons were measured using cross-correlation. Discharge patterns of single neurons were evaluated using auto-correlation and PST histograms. Neurons recorded on the same electrode (within about 100 n) had more similar stimulus selectivity and were more likely to show functional interactions than those recorded on different electrodes spaced about 250 to 500 microns apart. Most neurons tended to fire in bursts tens to hundreds of milliseconds in duration, and asynchronously from the stimulus induced rate changes. Correlated neuronal firing indicative of shared inputs and direct interactions was observed. Occurrence of shared input was significantly lower for neuron pairs recorded on different electrodes than for neurons recorded on the same electrode. Direct connections occurred about as often for neurons on different electrodes as for neurons on the same electrode. These results suggest that input projections are usually restricted to less than 500 m patches and are then distributed over greater distances by intrinsic connections. Measurements of synaptic contribution suggest that typically more than 5 near-simultaneous inputs are required to cause an IT neuron to discharge.     

脊髓型颈椎病前路减压与内固定手术治疗

目的 评估脊髓型颈椎病前路战压与内固定手术的疗效。方法 对17例脊髓型颈椎病患者采用颈前入路环锯或开槽扩大，显微镜下对致压物施行潜行性减压，植骨后钢板内固定，随访6～48个月。结果 术后症状消失或明显缓解15例，好转2例，无死亡或症状加重。植骨块融合满意，钢板固定无松动，螺钉无松脱。结论 本术式治疗脊髓型颈椎病减压彻底，植骨块融合，内固定钢板稳定可靠。     

经下颌下咽后入路颅颈交界腹侧区手术的应用解剖

目的:为临床经下颌下咽后入路处理颅颈交界腹侧区病变提供解剖学基础。方法:对15例(30侧)带颈头颅标本模拟经下颌下咽后入路进行显微外科解剖,同时进行了有关的数据测量。结果:该入路浅层的重要结构均位于各自的筋膜层中,以这些结构为解剖学标志可鉴别各层并引导手术进行。咽结节是显露的上限,限制骨窗侧方显露范围的各重要结构的内缘距正中线的水平距离分别为寰枢外侧关节,左(7.78±1.03)mm,右(7.81±1.01)mm;寰枕关节,左(9.27±1.86)mm,右(9.22±1.69)mm;舌下神经管内口,左(12.76±2.77)mm,右(12.81±2.53)mm及椎动脉C2水平,左(18.36±2.27)mm,右(18.47±2.14)mm;C1水平左(25.35±2.31)mm,右(25.18±2.33)mm;穿硬膜处,左(12.69±2.42)mm,右(12.72±2.39)mm。结论:(1)经下颌下咽后入路解剖上大致可分为3个层次:浅层,深层和骨、韧带及硬膜层。(2)掌握每个层次的解剖特点及操作要点,有助于安全充分的显露和处理咽颅颈交界腹侧区病变。     

Stimulus-dependent activation of c-Fos in neurons and glia in the rat cerebellum

The intent of the present study was to use chemical or electrical stimulation of cerebellar afferents to determine how different stimulation paradigms affect the pattern of activation of different populations of neurons in the cerebellar cortex. Specifically, we analyzed immediate changes in neuronal activity, identified neurons affected by different stimulation paradigms, and determined the time course over which neuronal activity is altered. In the present study, we used either systemic (harmaline) or electrical stimulation of the inferior cerebellar peduncle (10 and 40 Hz) to alter the firing rate of climbing and mossy fiber afferents to the rat cerebellum and an antibody made against the proto-oncogene, c-fos, as a marker to identify activated neurons and glia. In control animals, only a few scattered granule cells express nuclear Fos-like immunoreactivity. Although no other cells show Fos-like immunoreactivity in their nuclei, Purkinje cells express Fos-like immunoreactivity within their somatic and dendritic cytoplasm in control animals. Within 15 min of chemical or electrical stimulation, numerous granule and glial cells express Fos-like immunoreactivity in their nuclei. Cells in the molecular layer express Fos-like immunoreactivity following harmaline stimulation in a time and lobule specific manner; they do not appear to be activated in the electrical stimulation paradigm. Following harmaline injections, there is an initial loss of Fos-like immunoreactivity in the cytoplasm of Purkinje cells; 90 min later, nuclear staining is observed in a few scattered Purkinje cells. Following electrical stimulation, the cytoplasmic staining in Purkinje cells is enhanced; it is never present in the nucleus. Data derived from this study reveal cell-specific temporal and spatial patterns of c-Fos activation that is unique to each paradigm. Further, it reveals the presence of an activity dependent protein in the cytoplasm of Purkinje cell somata and dendrites.     

逆行带锁髓内钉治疗股骨远端骨折的应用解剖

目的:为带锁髓内钉治疗股骨远端骨折提供形态学基础。方法:①选用30例成人干燥股骨测量股骨内外侧髁、内外上髁、髁间窝有关数据进行统计分析。②20侧下肢标本解剖观测膝降动脉及隐神经髌下支的分支、分支等及两者的关系。结果:髁间窝呈U型占35%,V型占65%,此窝最宽处横径:左侧(1.98±0.36)cm, 右侧(2.06±0.29) cm;内侧髁后关节面宽,左侧(2.21±0.23) cm,右侧(2.34±0.29) cm;内、外上髁的距离,左侧(7.30±0.60)cm,右侧(7.43±0.57)cm。膝降动脉髌下支和隐神经髌下支呈紧密的伴行关系。隐神经在缝匠肌中下1/3交界点穿出,有上、下两支分布到膝关节前外侧皮肤。结论:术中注意这些解剖位置特点,避免损伤神经和血管,减少手术出血,防止并发症。     

Ocular pharmacokinetic models of clonidine-3H hydrochloride

A single topical instillation of clonidine-³H HCl solution (0.2%) was administered to the rabbit eye (30 μl) in order to study the drug's ocular pharmacokinetics. Seven different tissues and plasma were excised and assayed for drug over 180min. By 45–60 min pseudoequilibrium is reached for the cornea, iris/ciliary body, and aqueous humor. Thereafter, drug levels in these tissues decline in parallel. The data are fit separately to a physiological model and a classical diffusion model for which seven ocular tissue compartments and a plasma reservoir are constructed for each model. Clearance terms and distribution equilibrium coefficients are determined from the tissue level data and used as parameters in fitting the mass balance differential equations representing the physiological model. The model parameters can also be fit to a 0.4% single dose. In a separate experiment, a topical infusion technique was designed to provide a constant rate input to the cornea until an apparent steady state was reached in aqueous humor at 55 min. Aqueous humor levels were assayed for clonidine over the infusion and postinfusion periods. The physiological model parameters are fit to the topical infusion data and show good agreement between the predicted and experimental data. The classical model is too complex to fit the data to integrated exponential equations primarily because the method of residuals is inadequate in determining a sufficient set of initial estimates. This is overcome by dividing the eight-compartment model into seven fragmental models, each representing one to five compartments. A stepwise procedure is developed in which initial estimates are obtained for each separate fragmental model and refined. The refined parameter values can then be used as initial estimates for the complex model. Differential equations for the complex model are fit simultaneously to tissue levels representing each compartment. By observation, the classical model fit the data more closely than the physiological model. Statistical moment theory is also applied to the topical infusion data to determine ocular pharmacokinetic parameters for clonidine. The calculated values are: corneal absorption rate constantk _a , 0.00139 min^?1; aqueous humor elimination rate constantk ₁₀ , 0.0658min^?1; mean residence timeMRT _d , 35.6 min; apparent steadystate volume of distributionV _ss, 0.530 ml; and ocular clearanceQ _e , 14.9 =μl/min. The fraction absorbed from the single instillation is estimated as 0.0163.