骨间后神经终末支显微外科的解剖学研究及其临床意义

目的：对骨间后神经终末支进行解剖学研究为临床提供理论依据。方法：在放大10－16倍的视野下，观测36侧成人上肢标本中骨间后神经终末支在前臂后区、腕后区的行径、分支、分布及其毗邻关系。结果：骨间后神经终末支在前臂支配伸腕、伸指等肌肉和尺、桡骨背侧骨膜。在腕部支配指伸肌腱腱周组织、腕骨关节囊、腕背韧带及滑膜组织、骨间背侧肌肌膜和第三第四掌骨背侧的骨膜；并与尺神经深支有交通支。结论：骨间后神经终末支是支配腕后区和手背深层组织的重要感觉神经，损伤后可引起腕背痛。     

Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours

Summary Of 148 patients with infratentorial brain tumours which were operated upon during a 5 year period, 59 patients had associated obstructive hydrocephalus, as evidenced by preoperative CT scan. External ventricular drainage was performed in these cases at time of surgery. CSF drainage was continued in the postoperative period for a mean of 2.3 (± 1.6) days. Only 6 of these 59 patients (10%) required a subsequent indwelling shunt. The infection rate was 10% and the total mortality was 8%. Perioperative ventricular drainage during and following the removal of posterior fossa tumours causing hydrocephalus provides an effective alternative to the preoperative placement of an indwelling shunt. Problems of shunt dysfunction, tumour seeding and upward herniation are thereby avoided. Post-operative ICP monitoring and drainage of blood and debris laden CSF is performed, increasing the safety of the postoperative period and possibly reducing the incidence of aspetic meningitis and post-operative shunt requirement.     

Acute elevations of intraocular pressure following Nd:YAG laser posterior capsulotomy

We performed applanation tonometry preoperatively, hourly for the first four postoperative hours and on the first postoperative day in 66 eyes after Nd:YAG laser posterior capsulotomy in order to determine the nature of the acute intraocular pressure (IOP) elevation and the risk factors involved. Forty-one percent of eyes developed an intraocular pressure greater than 30 mmHg and 14% greater than 40 mmHg. The IOP spike occurred on the second postoperative hour in 35% of eyes. Patients with controlled glaucoma prior to capsulotomy had a significantly lower mean IOP rise than patients without glaucoma. Eyes with posterior chamber IOLs were less likely to develop an IOP greater than 30 mmHg than were aphakic eyes without IOLs. There was no correlation between the laser energy or the size of the capsulotomy and the IOP rise.     

Two cases of dural arteriovenous malformation occurring after intracranial surgery

Summary The occurrence of post-operative dural arteriovenous malformation (AVM) has rarely been proved angiographically. The authors report two such cases: in one, a pure dural AVM was located in the region of the cavernous sinus and in another a mixed pial and dural AVM was found in the posterior fossa. The literature about pathogenesis is reviewed.     

椎体后缘软骨结节149例CT—X线分析

报告１４９例ＶＰＭＮ，根据软骨结节的部位将其分为四型：上缘正中型，上缘偏侧型，下缘正中型及下缘偏侧型。另外，对３９例摄有腰椎正侧位征者进行了ＣＴ－Ｘ线对照分析，发现平片对椎体后下缘软骨结节的显示能力明显高于对后上缘者。     

Nucleus ambiguus motoneurons innervating the canine intrinsic laryngeal muscles by the fluorescent labeling technique

The localization of motoneurons innervating the canine intrinsic laryngeal muscles was investigated by the fluorescent labeling technique. Labeled cells were found in the ipsilateral nucleus ambiguus. The most rostral labeled neurons for the cricothyroid muscle, the posterior cricoarytenoid muscle, the thyroarytenoid muscle, and the lateral cricoarytenoid muscle were found at progressively more caudal levels, respectively, within the nucleus ambiguus. The rostral tip of the arytenoid muscle cell column was at the same level as the lateral cricoarytenoid muscle cell column. The cells labeled from the cricothyroid muscle occupied the ventral part of the nucleus at the rostral level of the nucleus. At the middle level of the nucleus, the cells from the posterior cricoarytenoid muscle occupied the ventral part of the nucleus and the cells from the thyroarytenoid muscle, the lateral cricoarytenoid muscle and the arytenoid muscle occupied the dorsal part of the nucleus. The existence of double-labeled cells which innervated both thyroarytenoid muscle and lateral cricoarytenoid muscle was detected.     

Habituation of human limbic neuronal response to sensory stimulation

Hippocampal, parahippocampal gyrus, and amygdalar neuronal responses to visual and acoustic stimuli were analyzed during trains of several hundred stimulus repetitions as part of an investigation of sensory pathways to medial temporal lobe structures in complex-partial epilepsy patients who were being monitored with depth electrodes. Ten percent of more than 500 single and multiple units tested were responsive to simple sensory stimuli. The majority of the responsive units were recorded in the posterior parahippocampal gyrus (HG) during visual stimulation. Although neurons in pes hippocampi (PH; Ammons's horn) were also responsive to photic stimuli, no visually responsive units were found in amygdala. Very few units were responsive to acoustic stimuli, and these were found only in PH and amygdala, and not in HG. Significant trends of increase or decrease in response amplitude during trains of stimuli were found in all acoustically responsive units. Significant trends of visual response amplitude increase or decrease were found in 20% of PH units, and in 44% of HG units. Mean latencies of acoustically responsive units were longer than those of visually responsive units, and latencies of PH sensory units showing decremental response were longer than nondecremental PH units. Rate of response decrement was usually linear for acoustic responses and exponential for visual responses. The response dynamics of medial temporal lobe neurons are compared with those described in the animal limbic system and are related to habituation of human sensory evoked scalp potentials.     

Dopamine receptors in the anterior lobe of the human pituitary gland: autoradiographic localization

We examined the distribution of dopamine and serotonin receptors in human pituitary gland by light microscopic autoradiography using [³H]spiperone as a binding ligand. Clusters of specific binding sites for [³H]spiperone were observed in the anterior pituitary. This clustering is similar to the clustering of lactotrophs observed in immunohistochemical studies. No specific binding sites for [³H]spiperone were present in the posterior lobe of the pituitary gland. We found no evidence for the presence of serotonin-2 receptors (i.e. cinanserin-displaceable [³H]spiperone binding) in human pituitary.     

Posterior Internal Ophthalmomyiasis: Identification of a Surgically Removed Cuterebra Larva by Scanning Electron Microscopy

The clinical presentation of an 11-year-old boy with unilateral posterior internal ophthalmomyiasis is described. Ophthalmoscopy of the affected eye in this individual disclosed characteristic subretinal depigmented linear tracks and a larva within the vitreous. The intravitreal larva was retrieved successfully by pars plana vitrectomy and identified as the first instar of Cuterebra sp. (rodent botfly) by scanning electron microscopy. This was done by examining the external features of the larva by scanning electron microscopy and comparing them to scanning electron micrographs that were prepared on other first instar larvae of flies known to be implicated in internal ophthalmomyiasis. The study demonstrates the usefulness of scanning electron microscopy for taxonomic identification of fly larvae. Since even a small fragment of these organisms may contain characteristic features of external morphology, scanning electron microscopy may be useful in cases where the specimen is damaged or incomplete.     

Combined anterior and posterior approach to the hip joint in reconstructive and complex arthroplasty

The combined anterior and posterior approach permits access to the front and back of the hip joint for reconstruction and complex arthroplasty, usually without osteotomy of the greater trochanter, with minimal muscle release. There is ease of access to the anterior and posterior capsule, which can be resected under direct vision, thus permitting accurate hemostasis. The entire acetabular rim is exposed for bone grafting as required. The authors review the useful standard approaches and illustrate the combination of the anterior and posterior approaches through a straight lateral incision. Concomitant exploration of the sciatic nerve is demonstrated, as is the osteotomy of the trochanter performed when the ilium superior to the acetabulum must be reconstructed. The utility and limitations of the operation is illustrated by representative cases. This extensive procedure usually can prevent neurologic and vascular compromise and allows excellent observation of the skeletal structures for accurate component alignment.