Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves.

Symptomatic diabetic sensorimotor polyneuropathy is considered progressive and irreversible. The hypothesis that symptoms of diabetic neuropathy may be due to entrapment of peripheral nerves was investigated in a prospective study from 1982 to 1988 in which diabetics (38 type I, 22 type II) had surgical decompression of 154 peripheral nerves in 51 upper extremities and 31 lower extremities. Mean postoperative follow-up was 30 months (range 6 to 83 months). Considering the entire series, an excellent final result was noted for motor function in 44 percent and for sensory function in 67 percent of the decompressed nerves. Ten percent of the patients were not improved, and 2 percent were worse in sensorimotor function. Upper extremity nerve decompressions achieved better results than lower extremity nerve decompressions. Improvement in postoperative electrodiagnostic studies varied in relationship to the preoperative electrodiagnosis. Improvement was noted in 100 percent of those nerves with the preoperative diagnosis of "localized entrapment," 80 percent for "peripheral neuropathy with superimposed entrapment," and 50 percent for "peripheral neuropathy." Progressive neuropathy occurred in a nontreated limb of 50 percent of those patients whose surgically treated limb maintained improvement. The results of this study suggest that symptoms of sensorimotor diabetic neuropathy may be due partly to compression of multiple peripheral nerves. The results further suggest that surgical decompression of such nerves may result in symptomatic improvement.     

Renaut bodies in nerves of the trunk of the African elephant, Loxodonta africana

Renaut bodies are loosely textured, cell-sparse structures in the subperineurial space of peripheral nerves, frequently found at sites of nerve entrapment. The trunk of the elephant is a mobile, richly innervated organ, which serves for food gathering, object grasping and as a tactile organ. These functions of the trunk lead to distortion and mechanical compression of its nerves, which can therefore be expected to contain numerous Renaut bodies. Samples of the trunk wall of an adult African elephant (Loxodonta africana) were examined histologically using conventional staining methods, immunohistochemistry, and lectin histochemistry. Architecture of nerve plexuses and occurrence of Renaut bodies in the elephant trunk were compared with those in tissues surrounding the nasal vestibule of the pig. Prominent nerve plexuses were found in all layers of the elephant trunk. Almost all (81%) nerve profiles contained Renaut bodies, a basophilic, discrete subperineurial layer resembling cushions around the nerve core. In contrast, Renaut bodies were seen in only 15% of nerve profiles in the porcine nasal vestibule. Within Renaut bodies, fusiform fibroblasts and round, ruff-like cells were placed into a matrix of acidic glycosaminoglycans with delicate collagen and very few reticular fibers. The turgor of this matrix is thought to protect nerves against compression and shearing strain. Renaut bodies are readily stained with alcian blue (pH 2.5) favorably in combination with immunohistochemical markers of nerve fibers. They should be regarded as a physiological response to repeated mechanical insults and are distinct from pathological alterations. alterations.     

Relevance of the lesser occipital nerve in facial rejuvenation surgery

Nerve injuries are possible during facial rejuvenation surgery. The great auricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in facial rejuvenation surgery. To understand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the nerve was studied in the laboratory in 19 hemifaces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and recorded. The great auricular nerve was also dissected to compare the two nerve territories. In the majority of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inferior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided the dominant supply to the ear, compensating for a small great auricular nerve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissection can injure the nerve if the flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to avoid nerve injury. And finally, if SMAS/platysma suspension sutures are placed, we suggest these be done in a vertical-oblique direction along the course of the lesser occipital nerve, because this should minimize the possibility of trapping terminal branches.     

A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less

The purpose of this study was to determine the efficacy of autogenous vein grafts as nerve grafts (AVNC) for bridging of small peripheral sensory nerve gaps as compared with direct repair and with conventional nerve grafting techniques (ANG). Patients with painful neuroma or segmental nerve injury of 3 cm were chosen as the test group. Those amenable to direct repair were classified as controls. Between 1982 to 1988, a total of 22 patients were enrolled in this study. A total of 34 nerves were repaired, 15 with a venous nerve conduit, 4 with a sural nerve graft, and 15 with direct repair. Significant symptom relief and satisfactory sensory function return were uniformly observed. The two-point discrimination measurements indicated superiority of direct repair and probably of conventional nerve grafting. However, the universally favorable patient acceptance and the return of measurable two-point discrimination indicates the effectiveness of autogenous vein grafts as nerve conduits when selectively applied to bridge a small nerve gap (less than or equal to 3 cm) on nonessential peripheral sensory nerves.     

Surgical treatment of migraine headaches

This prospective study was conducted to investigate the role of removal of corrugator supercilii muscles, transection of the zygomaticotemporal branch of the trigeminal nerve, and temple soft-tissue repositioning in the treatment of migraine headaches. Using the criteria set forth by the International Headache Society, the research team's neurologist evaluated patients with moderate to severe migraine headaches, to confirm the diagnosis. Subsequently, the patients completed a comprehensive migraine headaches questionnaire and the team's plastic surgeon injected 25 units of botulinum toxin type A (Botox) into each corrugator supercilii muscle. The patients were asked to maintain an accurate diary of their migraine headaches and to complete a monthly questionnaire documenting pertinent information related to their headaches. Patients in whom the injection of Botox resulted in complete elimination of the migraine headaches then underwent resection of the corrugator supercilii muscles. Those who experienced only significant improvement underwent transection of the zygomaticotemporal branch of the trigeminal nerve with repositioning of the temple soft tissues, in addition to removal of the corrugator supercilii muscles. Once again, patients kept a detailed postoperative record of their headaches. Of the 29 patients included in the study, 24 were women and five were men, with an average age of 44.9 years (range, 24 to 63 years). Twenty-four of 29 patients (82.8 percent, p < 0.001) reported a positive response to the injection of Botox, 16 (55.2 percent, p < 0.001) observed complete elimination, eight (27.6 percent, p < 0.04) experienced significant improvement (at least 50 percent reduction in intensity or severity), and five (17.2 percent, not significant) did not notice a change in their migraine headaches. Twenty-two of the 24 patients who had a favorable response to the injection of Botox underwent surgery, and 21 (95.5 percent, p < 0.001) observed a postoperative improvement. Ten patients (45.5 percent, p < 0.01) reported elimination of migraine headaches and 11 patients (50.0 percent, p < 0.004) noted a considerable improvement. For the entire surgical group, the average intensity of the migraine headaches reduced from 8.9 to 4.1 on an analogue scale of 1 to 10, and the frequency of migraine headaches changed from an average of 5.2 per month to an average of 0.8 per month. For the group who only experienced an improvement, the intensity fell from 9.0 to 7.5 and the frequency was reduced from 5.6 to 1.0 per month. Only one patient (4.5 percent, not significant) did not notice any change. The follow-up ranged from 222 to 494 days, the average being 347 days. In conclusion, this study confirms the value of surgical treatment of migraine headaches, inasmuch as 21 of 22 patients benefited significantly from the surgery. It is also evident that injection of Botox is an extremely reliable predictor of surgical outcome.     

The latency difference of the tibial and sural nerve sep: Peripheral versus central factors

The latency of the cortical SEP (CSEP) following stimulation of the posterior tibial nerve is nearly always shorter than the latency of the CSEP evoked by stimulation of the sural nerve. Till now this fact was believed to be due mainly to different conduction velocities within the peripheral nerves owing to the muscle afferents of the posterior tibial nerve. The surprising discovery that the lumbar and cervical SEPs exhibit much shorter time lags than the CSEPs led to the experiments described in this paper: during the registration of the peripheral sciatic nerve action potentials only slight differences in the conduction velocities were observed. Thereupon a topographical analysis was performed during which the minimum latency of the sural nerve CSEP was not measured at the usual C′_z electrode position but was found to be shifted to a more occipital and ipsilateral point.From these results it was concluded that, for the main part, the latency difference of the CSEPs results from ‘central factors’, which had already been postulated for the median nerve CSEP by Burke and coworkers.     

Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg.

An anatomic study performed on 64 fresh injected legs has shown the role of the vascular axis that follows the superficial sensitive nerves in supplying the skin. Three nerves were studied: the saphenous nerve, the superficial peroneal nerve, and the sural nerve. Conclusions are the same for the three nerves: The vascular axis, which can be either a true artery or an interlacing network, ensures the vascularization of the nerves, gives off several cutaneous branches in the suprafascial course of the nerve, and anastomoses with the septocutaneous arteries issuing from a deep main vessel. The superficial nerves that course the leg can therefore be considered as vascular relays owing to their neurocutaneous arteries. The concept of a neuroskin island flap has been developed and applied to six clinical cases for coverage of some specific areas of the knee and of the lower part of the limb.     

Corrugator supercilii muscle resection and migraine headaches

This study was conducted to determine whether there is an association between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches. Questionnaires were sent to 314 consecutive patients who had undergone corrugator supercilii muscle resection during endoscopic, transpalpebral, or open forehead rejuvenation procedures. The patients were queried as to whether they had a history of migraine headaches and, if so, whether the headaches significantly improved or disappeared after surgery. If the answer was affirmative, then the patients were further questioned about the duration of the improvement or cessation of the headaches and the relationship to the timing of the surgery. After an initial evaluation of the completed questionnaires, a telephone interview was conducted to confirm the initial answers and to obtain further information necessary to ensure that the patients had a proper diagnosis based on the International Headache Society criteria for migraine headaches. The charts of the patients who had migraine headaches were studied to ascertain and classify the type of surgery they had undergone. Patient demographics were reviewed, and the results were statistically analyzed. Of the 314 patients, 265 (84.4 percent) either responded to the questionnaire, were interviewed, or both responded to the questionnaire and were interviewed. Of this group, 16 patients were excluded because of the provision of insufficient information to meet the International Headache Society criteria, the presence of organic problems, and other exclusions mandated by study design. Thirty-nine (15.7 percent) of the remaining 249 patients had migraine headaches that fulfilled the Society criteria. Thirty-one of the 39 (79.5 percent) with preoperative migraine noted elimination or improvement in migraine headaches immediately after surgery (p < 0.0001; McNemar), and the benefits lasted over a mean follow-up period of 47 months. When the respondents with a positive history of migraine headaches were further divided, 16 patients (p < 0.0001; McNemar) noticed improvement over a mean follow-up period of 47 months, and 15 (p < 0.0001; McNemar) experienced total elimination of their migraine headaches over a mean follow-up period of 46.5 months. When divided by migraine headache type, 29 patients (74 percent) had nonaura migraine headaches. Of these patients, the headaches disappeared in 11 patients, improved in 13 patients, and did not change in five patients (p < 0.0001). Ten patients experienced aura-type headaches, which disappeared or improved in seven of the patients and did not change in three of the patients (p < 0.0001). This study proves for the first time that there is indeed a strong correlation between the removal of the corrugator supercilii muscle and the elimination or significant improvement of migraine headaches.     

Focus: Preventive Medicine: Exophytic External Occipital Protuberance Prevalence Pre- and Post-iPhone Introduction: A Retrospective Cohort

Introduction: In controversial fashion, the presence of an enlarged external occipital protuberance has been recently linked to excessive use of handheld electronic devices. We sought to determine the prevalence of this protuberance in a diverse age group of adults from two separate time periods, before and approximately 10 years after the release of the iPhone, to further characterize this theory, as if indeed valid, such a relationship could direct preventative behavior. Materials and Methods: Eighty-two cervical spine radiographs between March 7, 2007 through June 29, 2007 and 147 cervical spine radiographs between October 25, 2017 through January 1, 2018 were reviewed for the presence or absence of an exophytic external occipital protuberance. Influence of sex and age were also assessed. Results: There were 41/82 (50%) patients within the 2007 pre-iPhone group with an exophytic external occipital protuberance, ranging from 2.7-33.8 mm in length. Twenty-seven out of 82 (32.9%) had an external occipital protuberance at or above 10 mm. There were 49/147 (33.3%) patients within the 2017 post-iPhone group with an exophytic external occipital protuberance, ranging from 4.4-53.8 mm in length. Thirty-three out of 147 (22.4%) had an external occipital protuberance at or above 10 mm. When considering accessibility to the iPhone, sex, and age to the presence of an exophytic external occipital protuberance, only sex has a statistically significant association, p=0.000000033. Conclusion: We found no significant association with iPhone accessibility and an exophytic external occipital protuberance. Due to inherent limitations in the retrospective nature of the study, future research is needed to better examine the association of handheld electronic devices with exophytic external occipital protuberances.     

Multimodal biofeedback in the treatment of migraine

The purpose of this study was twofold: (a) to compare the effects of three behavioral strategies for the relief of migraine, and (b) to examine different combinations of the treatments to assess the effectiveness of multimodal biofeedback with this problem. Twenty-four volunteer migraine sufferers not on medication, and with at least weekly occurrence of headaches, participated in the study. Results indicated that (a) subjects who learned temporal cooling, frontalis relaxation, and progressive muscular relaxation exhibited the best success with headache relief; (b) control subjects, who did not show the same psychophysiological changes as experimental subjects, reported no headache relief; and (c) subjects in the group with only relaxation exercises performed similarly to control subjects and reported no headache relief.     

Proliferation patterns of dorsal root ganglion neurons of cutaneous,muscle and visceral nerves in the rat

In a previous study we provided evidence that dorsal root ganglion (DRG) neurons of different phenotypes have different birthdates. The present study aimed at determining if birthdates of DRG neurons are related to different types of peripheral nerves, namely cutaneous versus muscle, and somatic versus visceral. Pregnant rats were injected intraperitoneally with bromodeoxyuridine (BrdU) to label the neurons on one of the embryonic days E12–E16. When the progeny rats reached adulthood, a mixture of 1% B-fragment of cholera toxin and 1% isolectin B4 from Griffonia simplicifolia I was injected into the peripheral nerves, or a 5% Fluoro-Gold solution was applied to the transected end of the nerves. The saphenous and sural nerves were used as cutaneous nerves, the gastrocnemius nerve as a muscle nerve, the intercostal nerves T9–11 as somatic nerves and the greater splanchnic nerve as a visceral nerve. Cell size measurements were made of DRG neurons labeled from the two cutaneous nerves and the muscle nerve, as well as of neurons of the saphenous and gastrocnemius nerves labeled by BrdU at different embryonic stages. Most of the DRG neurons of the muscle and intercostal nerves were generated early, with peaks at E13, and those of the cutaneous and visceral afferent nerves later, with peaks at E14. The temporal differences were reflected in the cell size spectrum, the muscle nerve having a greater proportion of large neurons compared to the cutaneous nerves. The findings add to previous knowledge regarding the sequence of development of different DRG phenotypes.     

An anomalous muscle (accessory subscapularis-teres-latissimus muscle) in the axilla penetrating the brachial plexus in man.

An anomalous muscle passing through the brachial plexus was found in 10 cases out of 380 sides of 190 human cadavers in the dissection course. The muscle was designated as 'accessory subscapularis-teres-latissimus muscle'. This muscle arose near the lateral margin of the scapula, either from the surface of the subscapularis muscle or from the border of the quadrangular terminal tendon of the latissimus dorsi or from both of those sources when the muscle was divided into two heads. It ran obliquely upward to fuse with the insertion of the subscapularis. The largest anomaly was 2.5 cm in width and 7 cm in length. This muscle could be classified into three types on the basis of its nerve supply and its relation to the brachial plexus. The type I muscle crossed over the axillary and lower subscapular nerves, behind the radial nerve and was innervated by the lower subscapular nerves. The type II musclepenetrated the brachial plexus separating the radial nerve into two roots; the upper from the posterior division of the upper trunk and the lower from the posterior divisions of the middle and lower trunks. The type II muscle was supplied by a branch of the radial nerve, which originated always at the same level as the origin of the thoracodorsal nerve. The type III muscle passed through the further more ventrocaudal level of the plexus; in one case it divided the radial nerve into an upper root from the posterior divisions of the upper and middle trunks and a lower root from the lower trunk, and, in another case, into an upper main root from all the three trunks and a lower slender root from the lower trunk. The type III muscle was supplied by branches from the radial and in addition from the thoracodorsal nerve in one case. In four out of ten cases, the subscapular or thoracodorsal artery also passed posterior to the anomalous muscle. A discussion was made on the nature of the anomalous muscle.     

The location and distribution of neural crest-derived Schwann cells in developing peripheral nerves in the chick forelimb.

The location and distribution of neural crest-derived Schwann cells during development of the peripheral nerves of chick forelimbs were examined using chick-quail chimeras. Neural crest cells were labeled by transplantation of the dorsal part of the neural tube from a quail donor to a chick host at levels of the neural tube destined to give rise to brachial innervation. The ventral roots, spinal nerves, and peripheral nerves innervating the chick forelimb were examined for the presence of quail-derived neural crest cells at several stages of embryonic development. These quail cells are likely to be Schwann cells or their precursors. Quail-derived Schwann cells were present in ventral roots and spinal nerves, and were distributed along previously described neural crest migratory pathways or along the peripheral nerve fibers at all stages of development examined. During early stages of wing innervation, quail-derived Schwann cells were not evenly distributed, but were concentrated in the ventral root and at the brachial plexus. The density of neural crest-derived Schwann cells decreased distal to the plexus, and no Schwann cells were ever seen in advance of the growing nerve front. When the characteristic peripheral nerve branching pattern was first formed, Schwann cells were clustered where muscle nerves diverged from common nerve trunks. In still older embryos, neural crest-derived Schwann cells were evenly distributed along the length of the peripheral nerves from the ventral root to the distal nerve terminations within the musculature of the forelimb. These observations indicate that Schwann cells accompany axons into the developing limb, but they do not appear to lead or direct axons to their targets. The transient clustering of neural crest-derived Schwann cells in the ventral root and at places where axon trajectories diverge from one another may reflect a response to some environmental feature within these regions.     

Early development of the hypoglossal nerve in the chick embryo as observed by the whole-mount nerve staining method

The developmental morphology of the hypoglossal nerve and associated structures were studied in the chick embryo (Hamburger and Hamilton stages 16-27) stained by the immunohistochemical technique. Ventral rootlets of the occipital nerves, including O1, were seen at stage 16. The distal ends of these nerves anastomosed to form the hypoglossal nerve at stage 20. At stage 23, four occipital and the first three cervical nerves were observed to be involved. The transient contribution of C3 at this stage seemed to be correlated with the formation of the longitudinal anastomosis of the distal end of the spinal nerves which begins around stage 23. The anterior hypoglossal roots appeared between O1 and the abducens nerve at stage 20. These rootlets were observed to arise as the rostral continuation of the occipital sequence and were found to be arranged in a straight line from O1 to the abducens nerve. The recurrent branch of the abducens was also observed. The posterior end of the ganglion crest produced dorsal root ganglion (DRG)-like structures transiently at the level of C2, and sometimes at the level of C1 also. The ganglion crest developed descending processes in the occipital region seemingly related to the spinal dorsal root formation. These phenomena seemed to represent the potential of the ganglion crest to produce the spinal nerve components which are depressed in the occipital region.     

Anatomy and physiology of neurons composing the commissural ring nerve of the cricket, Acheta domesticus

The commissural ring nerve (RN) of the cricket Acheta domesticus links together the two cercal motor nerves of the terminal abdominal ganglion. It contains the axons of almost 100 neurons including two bilateral clusters of eight to 13 ventrolateral neurons and approximately 75 neurons with midline somata within the terminal abdominal ganglion. The ventrolateral neurons have an ipsilateral dendritic arborization within the dorsal neuropil of the ganglion and their axons use the RN as a commissure in order to enter the contralateral nerves of the tenth ganglionic neuromere. In contrast, most midline neurons have bifurcating axons projecting bilaterally into the neuropil of the ganglion as well as into the RN where they often branch extensively before entering the contralateral tenth nerves. Most RN neurons have small, non-spiking somata with spike initiation zones distant from the soma. Many midline neurons also produce double-peaked spikes in their somata, indicative of multiple spike initiation zones. Spontaneous neuronal activity recorded extracellularly from the RN reveals several units, some with variable firing patterns, but none responding to sensory stimuli. The RN is primarily composed of small (50 nm diameter) axon profiles with a few large (0.5-1 microm diameter) profiles. Occasionally, profiles of nerve terminals containing primarily small clear vesicles and a few large dense vesicles are observed. These vesicles can sometimes be clustered about an active zone. We conclude that the primary function of the RN is to serve as a peripheral nerve commissure and that its role as a neurohemal organ is negligible. J. Exp. Zool. 286:350-366, 2000.Copyright 2000 Wiley-Liss, Inc.     

华北人欧洲人和澳洲土著人的头骨厚度

The thickness of the cranial vault at the midline on the mid-frontal squama, pre-bregmatic einence, frontal at bregma, parietal at vertex, occipital at lambda and the external occipita1 protuberance was recorded in 40 male and 7 female Northern Chinese crania, 47 male and 52 female Australian Aboriginal crania and 13 male European crania using specially nodified vernier calipers. Comparison of vault thickness data obtained through direct measurement with those obtained fron lateral radiographs indicated that direct measurenent provided consistently more accurate results.
Male and fermale samples were processed separately so that the extent of sexbased variation could be examined.Student's t test was used to compare the sample means and the percentage of sexual dimorphism for each dimension was calculated according to Garn et al, (1964).The possibility of an allometric association between the thickness of the bones within the cranial vault, size of the cranial vault and stature was examined using Spearman's rank correlation coefficient and the Australian Aboriginal sample.
All but one of the mean thickness dimensions in the Australian Aboriginal male sample is significantly greater than the Northern Chinese and European means. The female results support those obtained with the males.In both males and females thickness at the external occipital protuberance, in all of the populations examined,did not correlate highly with that obtained from other parts of the cranial vault.This reflects the high degree of morphological variation in the position of the internal occipital protuberance and its influence on cranial vault thickness dimensions recorded at the external occipital protuberance.The European and Northern Chinese samples have similar cranial vault thickness dimensions. The Spearman's rank correlation coefficient matrix scores provide sone support for a biological association between vault thickness and overall cranial size. However, there appears to be little support for an association between stature and cranial vault thickness. The difference between the male and female mean vault thickness dimensions were significant at bregma, vertex and the external occipital protuberance in Australian Aboriginals and lambda and the external occipital protuberance in Northern Chinese. Some caution is needed in the interpretation of the Northern Chinese female data as the sample is extremely small.
Evidence of trauma, supressed fractures, is extremely common on the vaults of Australian Aboriginal crania from southern and central Australia. Traditionally Australian Aboriginals, males and females, involved in agressive dispute will use a substantial wooden implement and strike to the head of thir opponent(Meggitt 1962).The injuries that result from this are more common in females than in male. This form of social interaction must have rigorously selected against those individuals with thinner bones in their cranial vaults. To a large degree this may explain the greatly thickened vaults in Australian Aboriginals relative to Europeans and Northern Chines.This may also provide a clue to the factors resulting in the development of marked cranial vault thickness in Homo erectus.
     

牛蛙肥大细胞的组织化学与形态学

目的鉴定牛蛙组织中肥大细胞的存在。方法用于肥大细胞研究的一些常规组织化学技术与形态学方法。结果牛蛙的舌、肠、肠系膜和脾中肥大细胞数量较多,少量也见于神经、心、肾、肝和皮肤等多种组织中。肥大细胞有沿血管周和神经分布的倾向。脾脏中的肥大细胞形状比较一致,呈圆形或卵圆形,而在其它部位的肥大细胞则形态多样。Bouin氏液及Carnoy氏液是牛蛙肥大细胞优良的固定液。然而,与哺乳动物的黏膜肥大细胞相似的是,中性缓冲福尔马林(NBF)固定显著的阻断了牛蛙肠黏膜肥大细胞(MMC)的染色。有趣的是,甲苯胺蓝是牛蛙肥大细胞的最佳染料,它比阿尔新蓝能很好地显示牛蛙的肥大细胞。透射电镜下证实,牛蛙肥大细胞中含有大量特征性的胞浆颗粒。肥大细胞靠近雪旺氏细胞,并可见于神经束膜间,甚至以其突起与神经束膜相连。结论通过组织化学与形态学研究证实了牛蛙组织中肥大细胞的存在,再次证实肥大细胞与外周神经之间存在密切的解剖学关系。     

Guidelines for the intramuscular positioning of EMG electrodes in the semispinalis capitis and cervicis muscles.

The objective of the study was to establish guidelines for the application of fine-wire or needle electrodes in the semispinalis cervicis and semispinalis capitis muscles.First of all, measured data for the puncture angle and puncture depth of each muscle were determined in CT scans. Using a regression approach, a model relation of these data with the neck circumference was established. This made it possible to accurately determine the puncture angle and puncture depth on the basis of the known neck circumference. In a further step, the neck muscles of seven human cadavers were punctured with wires in order to check the workability of these guidelines. At the same time, the wires' positions in relation to important structures (nerves, vessels) were studied.Both muscles can be punctured with a high degree of reliability. However, when puncturing the semispinalis cervicis muscle, one has to pass through a layer that contains vessels, nevertheless the risk of injury is regarded as very small.The technique enables intramuscular EMG measurements of the two muscles in manifold clinical problems.