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71.
Based upon detailed dissections of the lymphatic system in adult cadavers, the lymphatic drainage of the gallbladder was divided
into three pathways: (1) The cholecystoretropancreatic pathway, which had two routes, one running spirally from the anterior
surface of the common bile duct to the right rear, and the other running almost straight down from the posterior surface of
the common bile duct. These routes converged at the principal retroportal node at the posterior surface of the head of the
pancreas. (2) The cholecysto-celiac pathway; this was the route running to the left through the hepatoduodenal ligament to
reach the celiac nodes. (3) The cholecysto-mesenteric pathway; this was the route running to the left in front of the portal
vein to connect with the nodes at the superior mesenteric root. The cholecysto-retropancreatic pathway can be regarded as
the main pathway, and the principal retroportal node appeared to be critical as the main terminal node in the visceral lymphatic
system of the gallbladder. These three pathways converged with the abdomino-aortic lymph nodes near the left renal vein, and
the nodes in the interaortico-caval space were considered to be of particular importance.
Offprint requests to: M. Ito 相似文献
72.
Luca Oscar Redaelli De Zinis Andrea Bolzoni Cesare Piazza Piero Nicolai 《European archives of oto-rhino-laryngology》2006,263(12):1131-1135
Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan–Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV. 相似文献
73.
A 32-year-old man with distal skeletal manifestations of Marfan's syndrome had experienced shortness of breath and orthopnea for one month. Physical examination showed the presence of severe aortic regurgitation. Both noninvasive and invasive studies revealed that the aortic regurgitation was induced by previously undescribed peculiar and unusual etiology: diastolic prolapse of a circumferentially dissected tubular intimal flap into the left ventricle. The patient underwent surgical repair with striking clinical improvement. 相似文献
74.
Masamitsu Endo Kouichirou Kobayashi Makoto Tsubota Masahiro Seki Hideo Sato Tasuku Noto Takashi Iwa 《Surgery today》1996,26(1):1-4
This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications. 相似文献
75.
76.
Delineation of arch abnormalities is difficult by conventional 2-D echocardiography and MRI has been the investigation of choice. 3-D echocardiography is increasingly used in congenital heart disease for both functional anatomy and morphology. This case report demonstrates that 3-D echocardiography can be used in delineating arch anomalies, which can avoid further imaging that needs a general anaesthetic. 相似文献
77.
用印地安墨汁注入活体鸡胚心脏,在体现显微镜下观察112例第10~20期鸡胚第一对弓动脉的发生。第一对弓动脉于第10期出现,至第20期退化消失。第一对弓动脉出现时尚无相应的第一咽弓,随着第一咽弓的出现,第一对弓动脉的起始端形成一个突入第一咽弓内的动脉瘤样隆起,此隆起随着第一咽弓的增大逐渐发育成一对贯穿第一咽弓的弓状血管。第一对弓动脉可以分为位于第一咽弓内的近侧段和位于此咽弓之外,与背主动脉相连的远侧段。 相似文献
78.
Acute thoracic aortic dissection has a high mortality if untreated, so the diagnosis must be rapidly made if mortality is to be lowered significantly. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause for death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 of 12 patients studied and correctly classified the type in only five. Aortography was performed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were performed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention. 相似文献
79.
报告接受彩色多普勒超声心动图检查的老年患者162例,其中75例有不同程度的主要动脉瓣关闭不全(Ar)。老年(Ar)的病因构成与中,老年前期者明显不同,主动脉,瓣钙化及原因不明者的比例占多数(67%)。主动脉瓣钙化者Ar程度多较重。主动脉瓣钙化及原因不明Ar患者的其他三个瓣膜返流检出率及和程度均明显高于无Ar的老年患者。表明多瓣膜退行性病变是此类Ar患者的原因之一。 相似文献
80.
淫羊藿总黄酮对肾上腺素β_1受体的特异性阻断作用 总被引:2,自引:0,他引:2
为探讨淫羊藿总黄酮(TFE)对肾上腺素受体的作用,本实验用离体兔心房肌、主动脉及豚鼠气管观察了TFE对肾上腺素全体的作用,结果TFE(0.13g/L)抑制心房肌肌力和频率,并使异丙肾上腺素(ISO)对心房肌正性频率作用的量效曲线平行右移,但无钙拮抗作用及M受体激动效应,且不影响ISO对豚鼠气管条的负性肌力作用及去甲肾上腺囊(NE)对兔主动脉条的收缩作用。提示TFE选择性阻断肾上腺素β_1受体。 相似文献