摘要:

AbstractRecently the pectoralis minor muscle has been introduced as a free muscle transplant for facial reanimation in peripheral facial paralysis. However, reports on the vascular supply of this muscle are incomplete or contradictory. Therefore the pectoral region was examined in 57 human cadavers. A complex pattern of variations in the arterial supply was found: it was, however, systematically arranged and limited to a small part of the arterial tree. A topographical classification was made, based on the dominant muscle artery, to provide a useful orientation during reconstructive surgery. Related to the origin of this dominant artery, three main patterns are distinguished. In the most frequent pattern a major role is played by an artery not mentioned inNomina Anatomica(Edinburgh: Churchill Livingstone, 1989). This artery usually arises directly from the axillary artery, accompanies the medial pectoral nerve, and supplies the major lateral part of the muscle from its deep surface. For topographical reasons we propose the name “lateral pectoral artery.” The classification, presented in this study, may provide a better insight for the reconstructive surgeon working in this area. © 1994 Wiley‐Lis

ISSN:0897-3806    

DOI:10.1002/ca.980070102

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe valve of the coronary sinus was studied in 50 hearts from dissection room cadavers. It varied from a flap that covered up to 70% of the ostium of the coronary sinus, to a few small strands of tissue. In 3 cases no valve was present. In most cases (35 out of 50), the valve covered<50% of the ostium of the coronary sinus, so it is unlikely to play an important role in preventing reflux into the coronary sinus. Microscopically, the valve was found to contain layers of myocardium, most of which disappeared in the less well formed valves, but some myocardium was persistent even in the most rudimentary valves studied. © 1994 Wiley‐Liss, I

ISSN:0897-3806    

DOI:10.1002/ca.980070103

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

年代:1994

数据来源: WILEY

摘要:

AbstractRepair of a symptomatic incisional/ventral hernia that is not amenable to simple primary closure is problematic. Therapeutic options include: (1) fascial reapproximation after unilateral/bilateral horizontal parasagittal relaxing incisions (obliquus externusandtransversus abdominis) with or without pre‐operative pneumoperitoneum; (2) bridging a fascial defect with autologous devascularized (lata femoris, anteriorrectus abdominissheath) or vascularized (abdominal wall fascia,tensor fasciae latae, myofascial, or myofascial/cutaneous rotational flaps) tissue; or (3) insertion of prosthetic/synthetic material (polypropylene, polytetrafluoroethylene, polygalactin). In the presence of abdominal infection or contaminated operative wounds use of autologous tissue is preferred, because of the risks of infection and gastroenterocolonic fistulization.Since 1985 the authors have observed excellent results with use of a bilateral reversed anteriorrectus abdominissheath technique of incisional/ventral herniorrhaphy. Although the parasagittal incision parallel to thelinea semilunarisand mobilization medially undoubtedly caused partial devascularization (interruption of segmental and intermuscular arteriovenous arcades, respectively), the sheath coapted in the midline maintained its integrity as evaluated clinically and radiographically. This implies that the Sheath is relatively hypometabolic, that collateral circulation is maintained and/or develops, and/or sustenance is obtained by contiguity with peritoneal secretions and subcutaneous tissue.Twenty‐three patients (13 males, 10 females, age range 19–79 years) with large symptomatic mid‐abdominal hernias of 8–16 months duration were so treated. Each of these patients had required multiple (three to seven) exploratory celiotomies for traumatic, infectious, inflammatory., or neoplastic entities. To date all patients have healedper primumwithout recurrence. Only one patient, who had previously received pelvic irradiation, manifested eventration. This qualitative analysis suggests that this technique has validity for patients requiring incisional/ventral herniorrhaphy with an otherwise intactrectus abdominismuscle and sheath. © 1994 Wiley

ISSN:0897-3806    

DOI:10.1002/ca.980070104

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe role of an anomalous tibialis posterior (TP) tendon in the etiology of hallux valgus (HV) deformity was investigated in four stages: clinical, anatomical, neurological, and operative. In the clinical stage, the patients were instructed to planter flex and invert the foot to contract the TP tendon. Attempts to correct the deformity passively were not possible and resulted in, moderate pain in all patients (197 feet). When the foot was in dorsiflexion and everted (TP tendon was relaxed) the deformity was easily corrected without any pain in 196 feet (99.5%). In the second stage (anatomical), 10 cadavers (20 feet) with HV deformity and 10 cadavers (20 feet) without any foot deformity were dissected. An abnormal expansion of TP tendon into the oblique part of adductor hallucis was found consistently in all HV feet. The tendinous expansion was absent in all normal feet studied. Also when traction was applied to TP tendon, an increase in the metatarsophalangeal (MP) angle of the big toe was observed in all HV feet, but not in the control group. In the third group (neurological), faradic stimulation was applied to the TP muscle in 7 patients with HV deformity and 7 without deformity. The MP angle was increased in HV patients, but no change was observed in the control group. In the fourth stage, 11 patients (18 feet) surgically operated for HV deformity by proximal metatarsal osteotomy and excision of the band anchoring TP tendon to the oblique part of adductor hallucis. The results were excellent in 10 patients (17 feet) even after a minimum 2.5 year follow‐up. Also, in two patients who were operated by different procedures with poor results, the TP tendon was lengthened by Z‐plasty and they were completely pain free.Our data show the dynamic role of anomalous expansions of the TP tendon into the oblique part of adductor hallucis muscle in HV patients. We suggest this expansion be excised in addition to other operative procedures selected for the surgical treatment of HV patients. © 1994 Wiley‐Lis

ISSN:0897-3806    

DOI:10.1002/ca.980070105

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

年代:1994

数据来源: WILEY

摘要:

AbstractSome standard anatomical descriptions of the cervical part of the vertebral artery mention little of its tortuosities. This study investigated the vertebral artery and its course using vertebral angiograms (37 sides) and preserved human cadaver injection studies (47 sides). In the Townes' projection of the former, the artery was seen consistently to pass laterally at the level of cervical vertebra 2 (C2), then to curve medially and then laterally as it climbed to enter the C1 foramen transversarium (F. T.). Analysis of dissection material and lateral angiograms revealed a tight posterior loop in the artery between C1 and C2. A “tortuosity variable” was calculated and was found to be positively correlated with age, but no relationship was found between tortuosity and the side of the body or the sex of the patient.Analysis of radiographs of injected cadaver heads showed the posterior loop between C1 and C2 in 96% of cases; the region with the greatest variability in pathway was the C1/ C2 region, but tortuosity was also seen at a more caudal level in some cases.As the tortuosity between C1 and C2 was also seen in young subjects (7 years old and older), reasons for its presence other than atherosclerosis are discussed. It is proposed that it may provide slack in the artery that is taken up on turning the head in order to avoid compromise to the cerebral circulation. © 1994 Wiley‐Lis

ISSN:0897-3806    

DOI:10.1002/ca.980070106

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

年代:1994

数据来源: WILEY

摘要:

AbstractIn this study scanning electron microscopy is used to document the surface features of superficial cells of buccal mucosa and to evaluate the usefulness of examination of oral swabs in monitoring radiotherapy in the mouth. Biopsy samples of buccal mucosa from 5 patients and oral swabs from 8 volunteers and 7 patients were examined.The surfaces of the buccal epithelial cells in healthy subjects were found to have a variable morphology. Cells nearer the surface showed a pattern of parallel microplicae or microvilli, while less mature cells showed more complex patterns such as irregular microplicae, microplicae forming a maze‐like pattern or a mixture of microplicae and microvilli. Adjacent celis frequently exhibited different patterns, and superficial and deep surfaces of the same cell consistently had different appearances. In particular, all the appearances described by Robertson et al.: J. Submicrosc. Cytol.,19:515–521, 1987, following radiotherapy were noted in the normal subjects in the present study.The findings emphasize the need for caution in attributing particular cell‐surface patterns to the effect of specific doses of radiation and suggest that scanning electron microscopy of oral swabs is unlikely to be useful in monitoring the progress of radiotherapy. © 1994 Wiley‐L

ISSN:0897-3806    

DOI:10.1002/ca.980070107

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

年代:1994

数据来源: WILEY

摘要:

AbstractTwo questionnaires were used to gather information about preclinical education concerning death and bereavement. One was mailed to Heads of Anatomy Departments of 26 UK medical schools. The other was distributed to 220 first‐ and 210 second‐year preclinical students in Cambridge. Among curricular organizers (77% response rate), the motivation for giving such education was primarily to improve knowledge about dissection, and only secondarily and infrequently to prepare students for clinical practice or to address their attitudes or feelings. In contrast, the primary concern of students (response rate 54%) was preparation for encounters with death in clinical practice (61–85%), lesser concerns being to address their own fears and feelings (30–40%) or knowledge about the dissecting room, cadavers, etc. (23–37%). Students were also asked about their reactions to dissection in order to determine whether the dissecting room might provide an opportunity for teaching about death. Most (66%) admitted experiencing moderate to extreme apprehension in advance of dissection. Apprehension was associated, on starting dissection, with very strong reactions, which in some cases interfered with learning. Some (27%) dealt with this by depersonalization. The only previous experiences that showed a significant association with the occurrence during dissection of interfering and/or non‐task‐related thoughts and feelings were (i) for both men and women the occurrence and quality of handling of death experience(s) at school, and (ii) for a group of male students the experience of the death of more than one close non‐family friend. A strategy for effective use of the dissecting room in studies on death is outlined. © 1994

ISSN:0897-3806    

DOI:10.1002/ca.980070108

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.980070109

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.980070110

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.980070111

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

年代:1994

数据来源: WILEY