The brachial plexus of a capuchin monkey (Cebus capucinus)

Brachial plexuses of an adult female capuchin monkey (Cebus capucinus) were observed macroscopically. The main characteristic features of the organization of the plexus were as follows:Substantially the same organization was observed in the plexuses on both sides. The plexuses were formed by the union of the 5th–8th cervical nerves and the 1st thoracic nerve. The component from C5 contributed only to the superior posterior division; consequently the superior trunk in the strict sense was lacking. The medial cord was a peripheral extension of the inferior anterior division and formed a common trunk with the lateral root of the median nerve. Therefore, the medial root of the median nerve in the strict sense was absent, and the median nerve arose from the common trunk with the ulnar nerve. In the plexus on the right side, a long aberrant branch was found, which arose as an extra anterior divison of the middle trunk and joined peripherally the medial cord at a point where the cord formed the common trunk with the lateral root of the median nerve.These findings were compared with previous data obtained from other primates.     

人体颈椎松质骨显微结构和力学性能的区域性差异研究

目的:探讨人体脊柱松质骨骨骼显微结构和力学性能的区域性差异,为松质骨三维结构采样部位的选取提供参考。方法:显微CT扫描6块颈6椎体标本获得三维图像,依据椎体内解剖位置的不同,将松质骨划分为6个位置组:外侧、内侧、腹侧、背侧、头侧和尾侧。利用显微结构参数骨体积分数(Bone volume to tissue volume,BV/TV)、骨表面积和骨体积的比值(Bone surface to bone volume,BS/BV)、骨小梁数量(Trabecular number,Tb.N)、骨小梁厚度(Trabecular thickness,Tb.Th)、骨小梁分离度(Trabecular separation,Tb.Sp)和个体化骨小梁分割方法(Individual trabeculae segmentation,ITS)分析6个位置组内松质骨显微结构,并利用有限元分析,获得6个位置组内松质骨的力学性能参数表观弹性模量和表观剪切模量。分别两两对比外侧和内侧,腹侧和背侧,头侧和尾侧松质骨的显微结构参数(BV/TV、BS/BV、Tb.N、Tb.Th、Tb.Sp和个体化骨小梁分割得到的参数)和力学性能参数(表观弹性模量和表观剪切模量)。结果:头侧和尾侧的主要显微结构参数BV/TV、Tb.Th、Tb.N等和表观弹性模量均存在显著差异(P0.05)。腹侧和背侧、内侧和外侧的主要显微结构参数BV/TV、Tb.Th、Tb.N等无显著差异。外侧和内侧的表观弹性模量在非主方向即内外方向和腹背放上上存在显著差异(P0.05),在主方向即头尾上无显著差异。结论:在实验中采集椎体松质骨样本以及临床上利用高分辨率CT分析椎体松质骨结构时,感兴趣区域要同时涵盖头侧和尾侧。     

Long head of the triceps branch transfer to axillary nerve in C5, C6 brachial plexus injuries: anterior approach

Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlin's transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.     

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.     

Localization of alcohol and aldehyde dehydrogenases in the human spinal cord and brain

Location of aldehyde dehydrogenase (AldDG) and alcohol dehydrogenase (ADG) has been studied in 38 nuclei of the human brain. Neurons with a high AldDG activity predominate in the nucleus of the descending root of the trigeminal nerve, motor nuclei of the craniocerebral nerves (trigeminal, facial, abducent, blocking, sublingual, supraspinal), motor nuclei of the anterior horns of the spinal cord, lateral vestibular nucleus, posterior nucleus of the vagus nerve, pedunculopontine nucleus, superior salivary nucleus, and in the nucleus of Westphal-Edinger-Jacobovich. Neurons with a moderate AldDG activity predominate in the superior olivary complex, nucleus of the lateral loop, parabrachial (pigmented) mesencephalic nucleus and reticular lateral nucleus. A low enzymatic activity is specific for neurons of the pons proper, inferior vestibular nucleus, trapezoid body of the inferior olivary complex, dentate nucleus of the cerebellum, reticular nucleus of the tegmen of Bekhterev's pons and posterior nucleus of Gudden's suture. A high ADG activity is revealed in piriform neurons of the cerebellar cortex. Functional importance of ADG and AldDG activity in the brain is discussed.     

The early development of the lymphatic system in mouse embryos.

The early development of the lymphatic system was studied in embryos of an inbred strain of the laboratory mouse. During the first stage of its development the system is represented by a more or less regular series of small and blind-ending outgrowths of the major embryonic veins which develop in a cranio-caudalward direction from the jugular to the pelvic region. As a result of differences in growth rates of adjacent anatomical structures this series of early lymphatic primordia becomes subdivided into 4 singular primordia and 12 groups of primordia. After the constituents of each group of early primordia have fused, 16 isolated lymphatic plexuses (sacs) are formed of which 14 are in bilaterally symmetric and 2 are in a median line position: i.e. bilaterally: (1) the jugulo-axillary lymph sac situated lateral to the anterior cardinal vein and dorsal to the primitive ulnar vein and its major branch, the external mammary vein, (2) the paratracheal lymph plexus situated medial to the anterior cardinal vein, (3) the internal thoracic lymph plexus situated lateral to the thoracic part of the posterior cardinal vein, (4) the thoracic ducts situated medial to the thoracic part of the posterior cardinal vein, (5) the lumbar lymph plexus situated dorso-lateral to the abdominal part of the posterior cardinal vein, (6) the subcardinal lymph plexus and (7) the iliac lymph plexus situated ventro-lateral to the abdominal part of the posterior cardinal vein; and in the median line: (8) the subtracheal lymph plexus situated at the confluence of the pulmonary veins and (9) the mesenteric lymph plexus situated near the confluence of the splenic and the superior mesenteric veins. Except for some openings at the jugulo-subclavian confluence all connections with the veins disappear. From the primordia extensions grow out centrifugally. They invade the surrounding tissues and, in part, fuse with similar sprouts of adjacent primordia. In this way a continuous system of lymph truncs is formed that opens into the venous system at the jugulo-subclavian confluence.     

Somatotopy of human hand somatosensory cortex as studied in scalp EEG

We recorded somatosensory evoked potentials (SEPs) in scalp EEGs during stimulation of the median nerve, the ulnar nerve and the individual digits in 3 normal subjects and in 1 epilepsy patients. In this patient we also measured SEPs from chronically indwelling subdural grid electrodes during electrocorticography (ECoG). We applied dipole modelling techniques to study the 3-dimensional intracerebral locations and time activities of the neuronal sources underlying stimulation of different peripheral receptive fields. The sources underlying median nerve SEPs were located an average of 10.8 mm lateral inferior to those underlying ulnar nerve SEPs. Digit SEP sources showed a somatotopic arrangement from lateral inferior to medial superior in the order thumb, index finger, middle finger, ring finger and little finger, with some overlap or reversal for adjacent digits. The average distance between thumb and little finger was 12.5 mm. Thumb, index finger and middle finger were clustered around median nerve cortical representation, whereas ring finger and little finger were arranged around ulnar nerve cortex. In the epilepsy patient, the source localizations obtained in scalp EEGs showed good agreement with those on ECoGs. We conclude that SEPs recorded in scalp EEGs can be used to study functional topography of human somatosensory cortex non-invasively.     

树鼩(Tupaia belangeri chinensis)的脊神经丛

由于树鼩在系统发育方面所具的特殊性,以及当今实验动物的小型化趋向,树鼩正在被开发成为新型的实验动物,其生物学特性的研究随之蓬勃开展,如对染色体(陈宜峰等,1981)、神经生理(刘世熠等,1982)、血象(邹如金等,1983)、骨髓象(张耀平等,1986)、血液生化(彭燕章等,1986;陈保生等,1983)、皮纹(Haines,1955;张耀平等,1984)、解剖(Le Gros Clark,1924、1926;George,1977)、     

Direct cord implantation in brachial plexus avulsions: revised technique using a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy

Background

The superiority of a single stage combined anterior (first) posterior (second) approach and end-to-side side-to-side grafting neurorrhaphy in direct cord implantation was investigated as to providing adequate exposure to both the cervical cord and the brachial plexus, as to causing less tissue damage and as to being more extensible than current surgical approaches.

Methods

The front and back of the neck, the front and back of the chest up to the midline and the whole affected upper limb were sterilized while the patient was in the lateral position; the patient was next turned into the supine position, the plexus explored anteriorly and the grafts were placed; the patient was then turned again into the lateral position, and a posterior cervical laminectomy was done. The grafts were retrieved posteriorly and side grafted to the anterior cord. Using this approach, 5 patients suffering from complete traumatic brachial plexus palsy, 4 adults and 1 obstetric case were operated upon and followed up for 2 years. 2 were C5,6 ruptures and C7,8T1 avulsions. 3 were C5,6,7,8T1 avulsions. C5,6 ruptures were grafted and all avulsions were cord implanted.

Results

Surgery in complete avulsions led to Grade 4 improvement in shoulder abduction/flexion and elbow flexion. Cocontractions occurred between the lateral deltoid and biceps on active shoulder abduction. No cocontractions occurred after surgery in C5,6 ruptures and C7,8T1 avulsions, muscle power improvement extended into the forearm and hand; pain disappeared.

Limitations include

spontaneous recovery despite MRI appearance of avulsions, fallacies in determining intraoperative avulsions (wrong diagnosis, wrong level); small sample size; no controls rule out superiority of this technique versus other direct cord reimplantation techniques or other neurotization procedures; intra- and interobserver variability in testing muscle power and cocontractions.

Conclusion

Through providing proper exposure to the brachial plexus and to the cervical cord, the single stage combined anterior (first) and posterior (second) approach might stimulate brachial plexus surgeons to go more for direct cord implantation. In this study, it allowed for placing side grafts along an extensive donor recipient area by end-to-side, side-to-side grafting neurorrhaphy and thus improved results.

Level of evidence

Level IV, prospective case series.     

Homologies of the stapedial artery in humans, with a reconstruction of the primitive stapedial artery configuration of Euprimates

Data drawn from the perspectives of paleontology, comparative anatomy, embryology, teratology, and normal adult variation were analyzed with nine homology criteria in order to determine the homologues of the stapedial artery in adult humans. It was determined that 1) the stem of the stapedial artery does not persist within the cranial cavity; 2) the stem of the ramus inferior is retained in its entirety and forms the upper portion of the stem of the middle meningeal artery; 3) the proximal part of the ramus infraorbitalis is normally absent and is replaced by a collateral shunt arising from the ramus mandibularis; 4) the ramus mandibularis is retained and forms the lower portion of the middle meningeal stem and the inferior alveolar artery; 5) the most proximal portion of the maxillary artery is formed by an anastomotic shunt connecting the external carotid artery to the ramus mandibularis; 6) the anterior division of the ramus superior is normally present and well developed; 7) the posterior division of the ramus superior is present in many individuals; and 8) the junction of the two divisions of the ramus superior with the ramus inferior usually migrates to the floor of the middle cranial fossa. The range of human arterial patterns, and those of all other euprimates, can be derived from a hypothetical primitive pattern that is very similar to that of primitive rodents. In this pattern, the stapedial artery stem enters the middle cranial fossa and trifurcates into the anterior and posterior divisions of the ramus superior and the ramus inferior. In their evolution, strepsirhines initially lose the ramus inferior and haplorhines initially reduce the stapedial artery stem.     

The eye muscles and their innervation inChaetodon trifasciatus (Pisces,Teleostei, Chaetodontidae)

Synopsis InChaetodon trifasciatus, the large eye has the form of a thick disk rather than that of a globe. A deep cutaneous groove surrounds the eyeball, probably allowing rapid eye movements. The form and innervation of the three pairs of extraocular muscles are described. Each muscle is made of two types of fascicles of fibres, thick and thin. There is neither an anterior nor posterior myodome. The skull attachment of the obliques and of the inferior rectus is made on the thin sagittal ethmoidal membranous septum while that of the other recti occurs on osseous pieces of the skull. The attachment on the eyeball is made on the cartilaginous sclera. The ratio of the lengths of the antagonist muscles, superior vs. inferior oblique, superior vs. inferior rectus and medial vs. lateral rectus, is about 1.43:1. The three oculomotor nerves (III: common oculomotor, IV: trochlear and VI: abducens) as well as the ciliary system are described. For the following reasons, an analogy between the lateral rectus ofChaetodon trifasciatus and the lateral rectus + retractor bulbi of other vertebrates is indicated: (1) the nucleus of nerve III (which innervates four muscles) has four sectors, while that of IV (which innervates only the superior oblique) is made of one sector; (2) nerve VI consists of two roots corresponding to two groups of nerve cells of its motor nucleus and (3) in other vertebrates, nerve VI innervates both the lateral rectus and the retractor bulbi.     

The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches

The deep inferior epigastric artery provides the main blood supply to the lower abdominal wall. Microdissection of the artery, its main branches, and the perforator vessels was undertaken in 20 cadavers. The artery was found to be associated with two veins in most of the cases (90 percent). The lateral division of the deep inferior epigastric artery and the perforator vessels it gives are more dominant (80 percent of cases) than the medial perforators (20 percent of cases). The lateral perforators were greater in number (80) and more consistent than those that arose from the medial division (28). The musculocutaneous perforators are the most important perforators supplying the anterior abdominal wall. An average of 5.4 large perforators (>0.5 mm in diameter) were dissected in each case. These perforators are mostly contained in the area lying laterally and below the umbilicus, with an average distance of 4 cm from the umbilicus. The musculocutaneous perforators may have a direct or indirect course. Larger perforators (>0.5 mm in diameter) were found to have a direct course through the subcutaneous fat to the skin. Smaller perforators do not reach the skin but terminate at the level of the deep fat layer by branching after piercing the rectus sheath. The direct perforator vessels with their associated veins (microdissection) keep a consistent diameter before dividing at the subdermal level and end by contributing to the subdermal plexus.     

前后联合入路微创治疗合并神经损伤的不稳定骶骨骨折

目的:探讨前后联合入路锁定加压钢板(LCP)微创治疗合并神经损伤的骶骨不稳定骨折的效果。方法:前后联合入路按照杜明奎等方法[1]采用LCP固定治疗合并神经损伤的不稳定骶骨骨折患者5例:L5神经根损伤2例,骶丛神经损伤3例。前方入路暴露骨盆前环重建钢板固定,后方入路经皮下锁定加压钢板骨折复位固定术,椎管探查减压以MRI显示有无神经压迫为据。结果:5例均获随访,时间3～20(14.8±7.2)个月。2例L5神经根损伤和3例骶丛神经损伤者Frankel分级由C级恢复至E级,术后功能根据Matta评分标准评定:优3例,良2例。结论:前后联合入路LCP微创治疗合并神经损伤的骶骨不稳定骨折是一种简单微创有效的方法,值得临床推广。     

Calcitonin gene-related peptide: detailed immunohistochemical distribution in the central nervous system

With the use of an antiserum generated in rabbits against synthetic human calcitonin gene-related peptide (CGRP) the distribution of CGRP-like immunoreactive cell bodies and nerve fibers was studied in the rat central nervous system. A detailed stereotaxic atlas of CGRP-like neurons was prepared. CGRP-like immunoreactivity was widely distributed in the rat central nervous system. CGRP positive cell bodies were observed in the preoptic area and hypothalamus (medial preoptic, periventricular, anterior hypothalamic nuclei, perifornical area, medial forebrain bundle), premamillary nucleus, amygdala medialis, hippocampus and dentate gyrus, central gray and the ventromedial nucleus of the thalamus. In the midbrain a large cluster of cells was contained in the peripeduncular area ventral to the medial geniculate body. In the hindbrain cholinergic motor nuclei (III, IV, V, VI, VII XII) contained CGRP-immunoreactivity. Cell bodies were also observed in the ventral tegmental nucleus, the parabrachial nuclei, superior olive and nucleus ambiguus. The ventral horn cells of the spinal cord, the trigeminal and dorsal root ganglia also contained CGRP-immunoreactivity. Dense accumulations of fibers were observed in the amydala centralis, caudal portion of the caudate putamen, sensory trigeminal area, substantia gelatinosa, dorsal horn of the spinal cord (laminae I and II). Other areas containing CGRP-immunoreactive fibers are the septal area, nucleus of the stria terminalis, preoptic and hypothalamic nuclei (e.g., medial preoptic, periventricular, dorsomedial, median eminence), medial forebrain bundle, central gray, medial geniculate body, peripeduncular area, interpeduncular nucleus, cochlear nucleus, parabrachial nuclei, superior olive, nucleus tractus solitarii, and in the confines of clusters of cell bodies. Some fibers were also noted in the anterior and posterior pituitary and the sensory ganglia. As with other newly described brain neuropeptides it can only be conjectured that CGRP has a neuroregulatory action on a variety of functions throughout the brain and spinal cord.     

Autoradiographic distribution of 125I calcitonin gene-related peptide binding sites in the rat central nervous system

Using autoradiographic method and 125I-Tyro rat CGRP as a ligand, receptor binding sites were demonstrated in the rat central nervous system. Saturation studies and Scatchard analysis of CGRP-binding to slide mounted tissue sections containing primarily cerebellum showed a single class of receptors with a dissociation constant of 0.96 nM and a Bmax of 76.4 fmol/mg protein. 125I-Tyro rat CGRP binding sites were demonstrated throughout the rat central nervous system. Dense binding was observed in the telencephalon (medial prefrontal, insular and outer layers of the temporal cortex, nucleus accumbens, fundus striatum, central and inferior lateral amygdaloid nuclei, most caudal caudate putamen, organum vasculosum laminae terminalis, subfornical organ), the diencephalon (anterior hypothalamic, suprachiasmatic, arcuate, paraventricular, dorsomedial, periventricular, reuniens, rhomboid, lateral thalamic pretectalis and habenula nuclei, zona incerta), in the mesencephalon (superficial layers of the superior colliculus, central nucleus of the geniculate body, inferior colliculus, nucleus of the fifth nerve, locus coeruleus, nucleus of the mesencephalic tract, the dorsal tegmental nucleus, superior olive), in the molecular layer of the cerebellum, in the medulla oblongata (inferior olive, nucleus tractus solitarii, nucleus commissuralis, nuclei of the tenth and twelfth nerves, the prepositus hypoglossal and the gracilis nuclei, dorsomedial part of the spinal trigeminal tract), in the dorsal gray matter of the spinal cord (laminae I-VI) and the confines of the central canal. Moderate receptor densities were found in the septal area, the "head" of the anterior caudate nucleus, medial amygdaloid and bed nucleus of the stria terminalis, the pyramidal layers of the hippocampus and dentate gyri, medial preoptic area, ventromedial nucleus, lateral hypothalamic and ventrolateral thalamic area, central gray, reticular part of the substantia nigra, parvocellular reticular nucleus. Purkinje cell layer of the cerebellum, nucleus of the spinal trigeminal tract and gracile fasciculus of the spinal cord. The discrete distribution of CGRP-like binding sites in a variety of sensory systems of the brain and spinal cord as well as in thalamic and hypothalamic areas suggests a widespread involvement of CGRP in a variety of brain functions.     

健侧C7 神经移位经椎体前通路的解剖学研究及经颈椎后入路 解剖学探讨

目的:为临床上开展健侧C7神经移位经椎体前通路治疗臂丛损伤提供解剖学基础。方法:选取10具20侧正常成人尸体颈段标本,将双侧臂丛充分显露,远端向C7神经根前后股进行干支分离,在前后股加入外侧束及后束前将其切断,近端向椎间孔处游离,测量C7神经根从椎间孔至分股处的长度及C7神经至前后股长度,测量并记录C7神经根及前后股经椎体前通路、颈前皮下通路到对侧臂丛上、下干的距离。结果:C7神经根的长度(58.62±8.70)mm,C7神经前、后股的长度(70.03±10.79)mm,(65.15±9.11)mm,C7神经根经颈前皮下、椎体前通路至对侧上下干的缺损长度分别是(98.18±10.18)mm,(107.14±9.88)mm;(32.10±11.49)mm,(37.28±10.01)mm两组相比有统计学差异。结论:从解剖学角度而言,健侧C7神经移位经椎体前通路能明显缩短移植神经长度,在临床上具有可操作性。     

The lateral root of the ulnar nerve

In 158 brachial plexuses the origin of the fibers of the ulnar nerve-whether only from the medial or also from the lateral fascicle-was investigated. A lateral root was found in 56%. This lateral root may either be accompanied by fibers of the median nerve (type 1) or may run separately (type 2). Where this root crosses the medial root of the median nerve, either a small minority of fibers of the latter nerve may run behind the ulnar fibers (type a), or all median fibers are in front of them (type b). Considering the relation 56:44% between ulnar nerves with and without a lateral root both possibilities have to be considered as normal variations, none as a variety. In analogy to the term 'median loop' the term 'ulnaris loop' is suggested for specimens with a lateral root.     

Localization of pigment-dispersing hormone (PDH) immunoreactivity in the central nervous system of Carcinus maenas and Orconectes limosus (Crustacea), with reference to FMRFamide immunoreactivity in O. limosus

Summary By use of antisera raised against synthetic pigment-dispersing hormone (PDH) of Uca pugilator and FMRFamide, the distribution of immunoreactive structures in the central nervous system (CNS) of Carcinus maenas and Orconectes limosus was studied by light microscopy. In both species, a total of 10–12 PDH-positive perikarya occur amongst the anterior medial, dorsal lateral and angular somata of the cerebral ganglion (CG). In C. maenas, one PDH-perikaryon was found in each commissural ganglion (COG) and several more in the thoracic ganglion. In O. limosus, only four immunopositive perikarya could be demonstrated in the ventral nerve cord, i.e., two somata in the anterior and two in the posterior region of the suboesophageal ganglion (SOG). PDH-immunoreactive tracts and fiber plexuses were present in all central ganglia of both species, and individual axons were observed in the connectives. FMRFamide-immunoreactivity was studied in O. limosus only. Neurons of different morphological types were found throughout the entire CNS, including numerous perikarya in the anterior medial, anterior olfactory, dorsal lateral and posterior cell groups of the CG. Four perikarya were found in the COG, six large and numerous smaller ones in the SOG, and up to eight cells in each of the thoracic and abdominal ganglia. In each ganglion, the perikarya form fiber plexuses. Axons from neurons belonging to the CG could be traced into the ventral nerve cord; nerve fibers arising from perikarya in the SOG appeared to project to the posterior ganglia. In none of the structures examined colocalization of PDH- and FMRF-amide-immunoreactivity was observed.Dedicated to Prof. K.-E. Wohlfarth-Bottermann on the occasion of his 65th birthday     

A giant plexiform schwannoma of the brachial plexus: case report

We report the case of a patient who noticed muscle weakness in his left arm 5 years earlier. On examination, a biloculate mass was observed in the left supraclavicular area, and Tinel's sign caused paresthesia in his left arm. Magnetic resonance imaging showed a continuous, multinodular, plexiform tumor from the left C5 to C7 nerve root along the course of the brachial plexus to the left brachia. Tumor excision was attempted. The median and musculocutaneous nerves were extremely enlarged by the tumor, which was approximately 40 cm in length, and showed no response to electric stimulation. We resected a part of the musculocutaneous nerve for biopsy and performed latissimus dorsi muscle transposition in order to repair elbow flexion. Morphologically, the tumor consisted of typical Antoni A areas, and immunohistochemistry revealed a Schwann cell origin of the tumor cells moreover, there was no sign of axon differentiation in the tumor. Therefore, the final diagnosis of plexiform Schwannoma was confirmed.     

Brachial plexus injury.

A 28-year-old man shot himself in the left posterior triangle of the neck with a shotgun. At the initial operation secondary repair of the resultant brachial plexus injury was decided upon in view of the difficulty in assessing lesions in continuity at this point after injury. The patient had total brachial plexus palsy. Nine weeks after the injury sensory and motor function were returning and the only element of the brachial plexus not showing evidence of nerve fibre continuity was the musculocutaneous nerve. Sural nerve autografts were sutured between the trimmed proximal and distal stumps of this nerve. By 4 months after the injury there was further improvement in both sensory and motor function, and by 18 months there was sensation in the autonomous zones of both median and ulnar nerves and good return of muscle power.