摘要:

AbstractThe incidence and distribution of landmarks relating to the coronary sinus (c.s.) were evaluated in 240 human hearts. Special attention was directed to the myocardial coat of the c.s., the distribution and pattern of the cardiac veins, and their dimensions. In all specimens the myocardial coat of the c.s. also covered the adjacent 2 to 11 mm of the great cardiac vein. In 15% of cases this myocardial layer was thickened in a sphincter‐like fashion, the edge of which was formed obliquely, in a crescent‐like manner, or diffusely without a sharp border.In 3% of the hearts the myocardial cover of the c.s. extended over the terminal 10 mm of the middle cardiac vein as a strong fiber cord. In 9%, single isolated belts of fibers fixated the terminal parts of the adjoining cardiac veins to the posterior wall of the left atrium, and in 8% two or three myocardial cords, embedded in the fatty tissue of the left coronary sulcus, did the same.Because the myocardial cover extended leftwards to variable distances over the c.s., the left edge of the myocardial covering cannot serve to define the beginning of the coronary sinus. The location of the ostial valve of the great cardiac vein (valve of Vieussens) was variable as well, being found on the average 2.5 mm proximal to the opening of the oblique vein of the left atrium. Moreover, the valve of the great cardiac vein was found in only 87% of cases; therefore it is inappropriate for defining the beginning of the coronary sinus. Finally, the dot‐like ostium of the oblique vein was most constant, and from the viewpoint of embryologic development, it is the logical landmark for determining the beginning of the coronary sinus, a necessary presupposition for cardiologic procedures like reperfusion of cardiac

ISSN:0897-3806    

DOI:10.1002/ca.980050102

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

年代:1992

数据来源: WILEY

摘要:

AbstractThe precise morphology of the human sphincter of Oddi was investigated. Anatomic samples, including the terminal portion of the bile duct and main pancreatic ducts, the major duodenal papilla, and the periampullary duodenal wall, were removed from 22 cadavers of various ages of patients who had died without any history of biliary or pancreatic disease.The specimens were fixed and processed by routine techniques and examined by light microscopy; serial sections were stained with haematoxylin‐eosin, Masson's trichrome, and Van Gieson methods.The muscular bundles of the human sphincter of Oddi were divided into the following tracts: The X‐Y tract, the distance from the papillary opening to the first muscular thickening that showed a circular trend; the Y‐Z tract, the thickest portion of the circular muscular bundles (the true sphincter of the hepatopancreatic ampulla( (HPA) (Oddi), reinforced by fibres arising from the duodenal wall and the Z‐W tract, the terminal thinner portion of the circular bundles that pass from the duodenal wall to the bile duct. The X′, Y′, Z′, and W′ points were fixed by the same criteria along the wall of the main pancreatic duct.The single tracts were measured, and the data derived therefrom subjected to stati

ISSN:0897-3806    

DOI:10.1002/ca.980050103

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

年代:1992

数据来源: WILEY

摘要:

AbstractOver several years, pressure has been used to lessen disfigurement of postoperative and particularly post‐traumatic scars and latterly the application of silicone gel topical dressing has been used. Attempts have been made to quantify and elucidate why these forms of treatment are effectiv

ISSN:0897-3806    

DOI:10.1002/ca.980050104

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

年代:1992

数据来源: WILEY

摘要:

AbstractIn spite of its clinical importance in cleft palate, there are few detailed accounts of the blood supply of the soft palate and palatal muscles. A series of dissections was carried out to investigate the supply of the levator and tensor veli palatini muscles. Ten adult cadavers and 12 fetuses were used, all of which had been previously injected with a variety of media to outline the vascular tree. Conventional dissection was performed on the cadavers, and microsurgical instruments and a dissection microscope were utilized for fetal dissections.In 70% of dissections the m. levator veli palatini had a dual arterial supply, from the ascending palatine and ascending pharyngeal arteries. In the remainining cases the muscle was supplied by a single artery, either the ascending palatine or ascending pharyngeal. In 79% of dissections the tensor muscle had a dual supply from the accessory meningeal artery along with either the ascending palatine, ascending pharyngeal, or, in one case, the lesser palatine arteries.The results suggest that in careful surgical closure of the cleft soft palate the normal dual arterial supply would protect the tensor and levator muscles from vascular damage. In the minority of patients where only a single vessel supplies the levator, a radical intrapalatal dissection may jeopardize its vascularity.

ISSN:0897-3806    

DOI:10.1002/ca.980050105

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

年代:1992

数据来源: WILEY

摘要:

AbstractVein valve transplantation is a recently described operation to treat the sequelae of lower extremity venous hypertension resulting from valvular dysfunction. The operation involves harvesting a segment of an arm vein contianing a competent valve and transplanting it into a lower extremity vein. To determine the optimal incisions for obtaining a suitable valve‐containing segment of vein, 20 cadaver arms were dissected. Cephalic, basilic, and brachial veins were examined for size, distribution of valves, and presence of tandem valves (defined as valves separated by 2 cm or less). Because patency rates are low in vascular grafts<4 mm in diameter, only veins of this size or greater were considered adequate for transplantation. Cephalic veinswere found to have a consistently smaller diameter than basilic or brachial veins (P<0.0001). Incisions for exposure of the basilic and brachial veins were evaluated. When exposure was limited to the middle third of the arm, an adequate vein, either the basilic or one of the brachial veins, was found in all cases. When either the distal or proximal third of the arm was exposed, however, an adequate vein was found in only 70% of the cases (P<0.02). Tandem valves, although potentially useful, were present in only 5%, 25%, and 20%, respectively, of distal, middle, and proximal arm segments. Based on the results of this study, a medial incision along the middle third of the arm, exposing a basilic or brachial vein, is recommended as the optimal approach for vein harvesting in vein valve transplantatio

ISSN:0897-3806    

DOI:10.1002/ca.980050106

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

年代:1992

数据来源: WILEY

摘要:

AbstractThe thickness of the fibrous connective tissue sheath around the corpus cavernosum was measured in a population of 41 men aged 30–90 years. Specimens were obtained from embalmed cadavers and compared with tissue from fresh cadavers. Sections of tissue were stained with hematoxylin and eosin, Masson's trichrome, or VerHoeff‐Van Gieson's to show the connective tissue in the best manner. The thickness was correlated with the presence of inflammation and/ or fibrosis and showed an age‐dependent thinning after the sixth decade of life. The results are related to the age occurrence of Peyronie's disease and the possibility of men with chronic thickening of the tunica albuginea having a predisposition toward developing the di

ISSN:0897-3806    

DOI:10.1002/ca.980050107

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

年代:1992

数据来源: WILEY

摘要:

AbstractThis study was conducted on X‐ray films of the shaft of normal femur and second metacarpal bones of adult male and female Nigerians to compare the percentage cortical thickness relative to the subperiosteal diameter (cortical index) of these bones. Age was correlated with cortical index (CI) using Pearson's product of moment correlation coefficient. Confidence limits of CI were calculated for clinical use. Results obtained were analysed for each sex and compared atP<0.05 level of significane. CI of the second metacarpal is significantly greater than of the femur in both the male and female. Age maintained significant inverse correlation with CI of the femur and nonsignificant correlation with the second metacarpal in the female. In the male, age had nonsignificant correlation with the femur or with the second metacarpal bone.It is concluded that (i) the amount of percentage relative cortical bone to subperiosteal diameter of the second metacarpal, a nonweight‐bearing bone, is greater than that of the femur, a weight‐bearing bone, (ii) age of the adult has significant effect on the amount of cortical bone of the femur in the female but not in the male, and (iii) age of the adult does not have significant effect on the amount of cortical bone of the second metacarpal in both

ISSN:0897-3806    

DOI:10.1002/ca.980050108

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

年代:1992

数据来源: WILEY

摘要:

AbstractFollowing the application of a topical anesthetic agent to the tympanic membrane, a number of patients described a sensation of numbness in the mouth. On examination these patients were found to have a significant area of anesthesia on the inferior surface of the ipsilateral soft palate.As a result of auditory tube dysfunction many of the tympanic membranes were atrophic and retracted. In these cases the pars tensa was closely related to the medial wall of the tympanic cavity, and local anesthetic agents applied to the tympanic membrane could easily diffuse through to the promontory and related structures. If the bone over the tympanic plexus or that over the facial nerve were dehiscent these nerves would be exposed to the effect of the anesthetic. We feel that our observation suggests that in some individuals at least, the pathway of sensory innervation of the soft palate may involve either the facial nerve or the tympanic branch of the glossopharyngeal nerve.

ISSN:0897-3806    

DOI:10.1002/ca.980050109

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

年代:1992

数据来源: WILEY

摘要:

AbstractIn the academic year 1989–1990, the Department of Surgery at the University of Kentucky College of Medicine introduced a modified third‐year surgery clerkship. Its goals were to eliminate the lecture method of instruction, to involve students actively in the educational process, and to emphasize decision‐making and problem‐solving skills in the third year of medical school. Hands‐on training in patient care procedures would be offered in a fourth‐year acting internship after students had learned both problem‐solving and life‐long learning skills while concurrently developing a medical knowledge base. Students were removed from the traditional surgical service teams, since it was decided that team duties might be detrimental to educational goals. Problem‐based tutorial sessions were designed, and a block of unscheduled time was provided for students to use in obtaining, exploring, and reflecting on medical information. Informal comparisons of students in the previous clerkships with those in the modified clerkship have noted positive changes in the students' intellectual maturity, motivation, enthusiasm, and time‐management skills. Faculty and students have responded positively to the programs which are part of this i

ISSN:0897-3806    

DOI:10.1002/ca.980050110

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

年代:1992

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980050111

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

年代:1992

数据来源: WILEY