鞍隔脑膜瘤的分型及手术方法的选择

目的;探讨不同部位鞍隔脑膜瘤（DSM）的分型以及手术方法的选择与治疗结果的关系。方法：CT扫描提示为垂体瘤和鞍结节脑膜瘤并向后发展者,用MRI复查筛选共发现DSM20例,其中9例为A型（居鞍隔上垂体柄前）,5例B型（居鞍隔上垂体柄后）,2例为C型（居鞍隔下蝶鞍内）,4例为混合型（累及鞍隔上下和垂体柄前后）。结果：20例均行手术治疗,17例全切除,3例大部切除,无手术死亡和严重功能障碍。结论：MRI是诊断DSM的最好方法,有助于鉴别诊断、分型和手术方法的选择。鞍隔脑膜瘤的手术较鞍结节脑膜瘤的手术更为困难。     

鞍区硬膜结构相关的临床解剖研究

目的 研究鞍区硬膜结构的显微解剖及其手术意义。方法 观测尸颅鞍区硬膜结构的显微解剖特征。结果 床突间皱襞将海绵窦顶分为两个三角，少数鞍隔向内下倾斜成盆状，动眼神经硬膜孔大致位于后床突水平。隔孔区的垂体腺由二层组织覆盖，上层是蛛网膜，下是更薄的膜样结构，少数蛛网膜层以脂肪垫形式填塞于鞍隔与垂体腺之间，仅见一例垂体池。结论 隔孔大者垂体容易下陷，蛛网膜坠入鞍隔下方与隔孔较大有关，垂体池是形成空蝶鞍的潜在因素。国人鞍隔屏障性能差，经蝶手术后容易脑脊液漏。     

Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas

Object

The surgical challenge of the treatment of tuberculum (TSMs) and diaphragma sellae meningiomas (DSMs) is to preserve or improve the visual function. Extradural and intradural optic nerve decompression should reduce surgical trauma of the nerve achieving a good visual result.

Methods

We reported 37 consecutive TSMs and DSMs operated through fronto-temporo-orbito-zygomatic approach with extradural unroofing of the optical canal and early intradural incision of the dural sheath. Visual data were recorded measuring the visual impairment score (VIS), the visual acuity (VA), the visual field (VF) and the postoperative improvement.

Results

A good visual outcome (VIS improved or unchanged) was obtained in 97.2% of patients (35/36). The evaluation of 72 eyes showed a good outcome (VA and VF unchanged or improved) in 98.6% (71/72 eyes). The degree of preoperative VA and VF impairment was the only factor correlating with the postoperative improvement of VA (P < .001 and P = .018) and VF defect (P < .001). Worsening of visual function occurred in 1/37 patient (2.7%).

Conclusion

Using this surgical technique we achieved a high improvement rate of visual defects and a low frequency of worsening.     

苯酚-硫酸法测定维吾尔药核桃分心木多糖的含量

目的:建立维吾尔药核桃分心木多糖的含量测定方法。方法:以精制后的核桃分心木多糖为研究对象,通过单因素实验,对苯酚-硫酸法测定核桃分心木精制多糖含量的显色条件进行优选,并对该方法进行方法学考察;在最佳显色条件和测定方法下测定分心木中多糖的含量。结果:在5.0～17.5μg/mL范围内,葡萄糖质量浓度与吸光度具有良好的线性关系。其平均回收率为106.55%,相对标准偏差(RSD)值为5.18%。用苯酚-硫酸法在最佳显色条件下测得的核桃分心木多糖含量为5.4%。结论:该测定方法简便灵敏、准确性高、稳定性好、测定结果可靠,可用于核桃分心木的质量控制。     

Diaphragmatic nerve palsy in young children following liver transplantation

Diaphragmatic paralysis was identified in four children after liver transplantation. All presented with persistent right upper lobe atelectasis, pleural effusion and recurrent respiratory infections and could not be weaned from mechanical ventilatory support. Fluoroscopy and real-time ultrasound confirmed paradoxical right diaphragmatic movements. Diaphragmatic plication was undertaken and enabled rapid and sustained weaning from respiratory support in all four cases. Vascular clamping of the suprahepatic vena cava seems to be the cause. Diaphragmatic plication allows optimal recruitment of the respiratory muscles with a favourable impact on lung mechanics and gas exchange. Received: 31 December 1997 Received after revision: 27 March 1998 Accepted: 17 April 1998     

新疆核桃分心木总皂苷的提取纯化工艺研究

目的优选核桃分心木总皂苷的最佳提取纯化工艺。方法以齐墩果酸为对照品,利用紫外可见分光光度法测定核桃分心木中的总皂苷含量;利用单因素实验结果设计正交实验,考察了乙醇体积分数、提取时间、料液比和提取次数对核桃分心木总皂苷提取率的影响;利用大孔吸附树脂对核桃分心木总皂苷进行纯化工艺研究。结果最佳提取工艺为:加25倍量体积分数80%乙醇,80℃回流提取2次,每次2h;最佳纯化工艺为:采用D101大孔吸附树脂,最大上样量为180mL,水洗脱量8BV,洗脱剂体积分数50%乙醇,洗脱体积7BV。结论该法简易可行,效果较佳。     

Morphometric Study of the Korean Adult Pituitary Glands and the Diaphragma Sellae

Objective

To investigate the morphometric characteristics of the pituitary gland and diaphragma sellae in Korean adults.

Methods

Using the 33 formaline fixed adult cadavers (23 male, 10 female), the measurements were taken at the diaphragma sellae and pituitary gland. The authors investigated the relationship between dura and structures surrounding pituitary gland, morphometric aspects of pituitary gland and stalk, and morphometric aspect of central opening of diaphragma sellae.

Results

The boundary between the lateral surface of pituitary gland and the medial wall of cavernous sinus was formed by the thin dural layer and pituitary capsule. The pituitary capsule adherent tightly to the pituitary gland was observed to continue from the diaphragma sellae. Mean width, length, and height of the pituitary gland were 14.3 ± 2.1, 7.9 ± 1.3, and 6.0 ± 0.9 mm in anterior lobes, and 8.7 ± 1.7, 2.9 ± 1.1, and 5.8 ± 1.0 mm in posterior lobes, respectively. Although all dimensions of anterior lobe in female were slightly larger than those in male, statistical significance was noted in only longitudinal dimension. The ratio of posterior lobe to the whole length of pituitary gland was about 27%. The mean thickness of pituitary stalk was 2 mm. The diaphragmal opening was 5 mm or more in 26 (78.8%) of 33 specimen. The opening was round in 60.6% of the specimen, and elliptical oriented in an anterior-posterior or transverse direction in 39.4%.

Conclusion

These results provide the safe anatomical knowledge during the transsphenoidal surgery and may be helpful to access the possibility of the development of empty sella syndrome.     

Bochdalek疝的MSCT诊断及其与代谢综合征的相关性分析

目的：探讨Bochdalek疝的多层螺旋CT（MSCT）表现及其进展程度与代谢综合征（MS）的相关性。方法：回顾性分析55例Bochdalek疝患者的临床和影像学资料,总结Bochdalek疝患者的影像学表现,分析Bochdalek疝患者MS的发生情况。结果：Bochdalek疝表现为一侧或双侧膈肌局限性薄弱或缺损;合并MS患者的Bochdalek疝囊更加明显。结论：Bochdalek疝通过MSCT平扫和多平面重组MPR即可明确诊断,其发展与MS呈正相关。     

兔、鼠膈腹膜间皮的扫描电镜观察

本文以扫描电镜为主,配合光镜,对兔、鼠膈腹膜间皮细胞进行了研究。证明间皮含大、小两种细胞,此两种细胞的形态不同,小细胞间存在与吸收功能有关的孔、裂。     

Relationship between the development of diaphragma sellae and the morphology of the sella turcica and its content

Summary The impaired formation of the diaphragma sellae may lead to the development of the empty-sella syndrome. This structure, when fully formed, is a protective barrier against the pulsating action that the cerebrospinal fluid exerts on the sellar content. There are anatomical features which support this belief, but they also suggest that the development of the diaphragma sellae is a factor which determines the morphology of the sella turcica and its contents. Those human specimens which do not have diaphragma sellae or in which it is only partially developed, are characterized by a smaller hypophysis, always located at the inferior and/or posterior half of the sella, with a larger sellar volume and frequently greater fragility of its bony walls. These findings, although rare (5% of the cases), are indirect signs of the important role which the diaphragma sellae plays in the sellar region.

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Rapports entre la formation du diaphragme sellaire et la morphologie de la selle turcique et de son contenu

Résumé Le développement incomplet du diaphragme sellaire peut être à l'origine d'un syndrome de la selle turcique vide. Lorsque ce diaphragme est bien formée, il constitue une barrière efficace, protégeant le contenu de la selle turcique de la pression pulsatile du liquide cérébro-spinal. Des études anatomiques semblent corroborer ces données et suggèrent même que le développement du diaphragme sellaire conditionne la morphologie de la selle turcique et son contenu. C'est ainsi que l'on peut observer chez certaines personnes dont le diaphragme sellaire est absent ou partiel, l'existence d'une petite glande pituitaire qui est toujours plaquée à la partie inférieure et/ou postérieure de la selle turcique ; de surcroit, le volume de la selle est augmenté et ses parois osseuses sont plus fragiles qu'à l'accoutumée. Tous ces faits, bien que rares (5% des cas), établissent de façon indirecte le rôle important que joue le diaphragme sellaire sur la région pituitaire.