摘要:

AbstractThe fascias of the male external genitalia and perineum serve as surgical landmarks and are considered to act as initial barriers to urinary extravasation; thus they are of fundamental importance to the urologist and anatomist. There is little agreement, however, about the naming and function of these fascias because they have been defined inconsistently. The extensive use of eponyms for the fascias adds even further confusion to the proper nomenclature. Our findings, based upon dissection and magnetic resonance imaging (MRI), show that except for the single layer of dartos (smooth muscle) in the scrotum, there are two distinct layers of fascia in the penis and perineum that are continuous with each other and the anterior wall fascias. To minimize confusion, we conclude that the fascial layrs around the penis be termed thesuperficial and deep penile fascias, and those to which they are continuous in the perineum be termed themembranous layer of the superficial perineal fascia(the fibrous stratum that traverses the superficial fascia) and thedeep perineal fascia. Their presumed role in limiting urinary extravasation is based upon relatively few well‐detailed report and currently remains poorly understood. However, this may be improved upon in the future through combined application of clinical findings and MRI to individual cases of urinary extravasation. © 1994 Wiley‐Liss,

ISSN:0897-3806    

DOI:10.1002/ca.980070302

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractA patient with suspected uveal melanoma died 18 months after refusing all treatment. Since this disease rarely goes untreated, its undeterred spread is of clinical interest. At the request of the patient's family and physician, we set out to verify the type, location, and extent of the tumor, and the cause of death. Post‐mortem magnetic resonance imaging (MRI) of the patient's head, followed by dissection and microscopic examination confirmed the diagnosis of primary uveal melanoma. There were large masses in the frontal part of the cranium which apparently had metastasized from the primary uveal tumor via vascular or lymphatic pathways since there were no direct extensions of the primary tumor beyond the orbital musculotendinous cuff. Metastases found in the liver, kidney, and vertebrae, is the absence of cervical, thoracic, and abdominal lymph node involvement, indicated the likelihood of hematogenous spread although small subpleural metastases were found in the lung. The cause of death appeared to be acute myocardial infarction due to obstruction of both coronary arteries and was unrelated to the malignancy.Although MRI has been proposed as an important tool for diagnosing uveal melanoma, our findings indicate the need for caution. Misleading signal intensities resulting from variable pigmentation in these tumors impair diagnosis. © 1994 Wiley‐Liss,

ISSN:0897-3806    

DOI:10.1002/ca.980070303

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractLeprosy is a chronic mycobacterial infection of superficial tissues which occurs in part because of a select immune incoripetence in certain individuals. The major debilitating effects of the disease are the result of neurological deficits secondary to infiltration of Schwann cells byM. lepraeand resorption of phalanges and bone near the palate. An understanding of the manifestations of the disease is based upon anatomical principles. We illustrate some of these in several clinical correlations. © 1994 Wiley‐Liss, I

ISSN:0897-3806    

DOI:10.1002/ca.980070304

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractThe anatomic position of the appendiceal tip is cited in many surgical and anatomical texts as being fixed in the retrocecal position in as many as two‐thirds of cases studied. The reference most often quoted to support this observation is Wakeley (1933), but this frequency did not correspond to the clinical experience of the surgical staff at the authors' institution. Accordingly, a prospective survey of thein vivolocation of the vermiform appendix was undertaken over a 6‐month period. The results demonstrated that the retrocecal position was indeed the most common location, but occurred in only 33% of instances. This observation may encourage greater utilization of laparoscopic appendectomy, since it suggests that retroperitoneal dissection will not be necessary to locate the appendiceal tip in the majority of cases. © 1994 Wiley‐Lis

ISSN:0897-3806    

DOI:10.1002/ca.980070305

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractDiaphragmatic herniation and eventration are distinct entities that may be congenital or acquired and rarely occur simultaneously. Safe patient care requires differentiation of the two processes. We present an adult patient with coexistent diaphragmatic herniation and eventration to demonstrate the embryologic basis of the two conditions, elucidate the diagnosis, and discuss safe therapeutic intervention. Herniation indicates a structural defect in an otherwise normal diaphragm. Eventration applies to defective muscular content or innervation in a structurally intact diaphragm. Normal diaphragmatic structure and development may be understood as the sum of four component parts: septum transversum, pleuroperitoneal membranes, dorsal mesentery, and striated muscle masses. A failure of myoblast migration and, therefore, neural innervation on the right can produce ipsilateral eventrationanda hiatus hernia. During the course of laparotomy for an unrelated process such as acute calculous cholecystitis, hernia repair should be avoided so as to avoid injury to the normal contralateral phrenic nerve, the posterior branch of which being particularly vulnerable. By depriving the patient of innervation to the only functional hemidiaphragm, contralateral neural injury can result inacute respiratory paralysis and patient mortality. © 1994 Wiley‐Liss, I

ISSN:0897-3806    

DOI:10.1002/ca.980070306

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractThe challenges and opportunities for teaching anatomy in the new medical college of Sultan Qaboos University (S. Q. U.) in the Middle East are described.With appropriate emphasis the subject is presented at all stages in the B. Sc. (basic medical sciences) and M. D. (clinical) programs. At the pre‐clinical stage much of the subject is integrated with the other preclinical sciences in “systems” courses. Because of its continual emphasis throughout both degree programs and because of special coursesincluding introduction to anatomical skills with emphasis on developing practical skills and a log‐book evaluation of skills towards the end of the preclillical course together with clinical problem‐solving exercises, anatomy has preserved its identity.The limited availability of cadavers has been turned to advantage enabling radiological, surface, and living anatomy to be emphasized in practicals which also include examination of anatomical models and plastinated and prosected specimens. The practicals are highly structured, students rotating through a series of stations of activities ensuring that they examine all the available material and perform required tasks.The preclinical courses are assessed by a variety of in‐course and end‐of‐course integrated examinations. The assessments used have been validated and it is hoped to report them separately. © 1994

ISSN:0897-3806    

DOI:10.1002/ca.980070307

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980070308

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980070309

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980070310

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980070311

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY