ABSTRACT
Knowledge of the topographic anatomy is essential to prevent iatrogenic damage of the superior laryngeal nerve (SLN) in carotid endarterectomy (CEA). The purpose of this study was to analyze the anatomic relationship between the SLN and carotid arteries in order to prevent iatrogenic nerve injury. Anatomic dissections similar to CEA were performed bilaterally in 50 fresh human adult cadavers. The topography of the SLN was analyzed regarding its relationship with the carotid arteries. Furthermore, the distance between the external branch of the SLN and the point of bifurcation of the common carotid artery (dCAB) was analyzed regarding effects of gender, ethnicity, individual stature and side of the neck. The SLN was always located adjacent and posterior to the carotid arteries.The dCAB ranged from 20.3 mm below the point of bifurcation of the common carotid artery to 50.9 mm above this level (average 10.3 mm above). Most dissections (75%) showed the external branch of the SLN emerging from behind the carotid artery above the arterial bifurcation; in only 10% of cases did this nerve emerge from the artery below that anatomic reference. Based on Student's t-test, there were no significant differences in the dCAB between genders ( P=0.237), ethnicities ( P=0.410) and sides of the neck ( P=0.872). Moreover, tall stature was not significantly correlated with a shorter dCAB (linear regression: R(2)=0.009, P=0.357). We conclude that most SLNs were located above the carotid artery bifurcation, but anatomic variations occurred in 25% of the dissections. The dCAB was unaffected by gender, ethnicity, individual stature and side of the neck.
Subject(s)
Endarterectomy, Carotid , Laryngeal Nerves/anatomy & histology , Adult , Aged , Aged, 80 and over , Carotid Artery, Common/anatomy & histology , Endarterectomy, Carotid/adverse effects , Ethnicity , Female , Humans , Intraoperative Complications , Laryngeal Nerve Injuries , Male , Middle Aged , Sex CharacteristicsABSTRACT
Eleven subjects with filariasis were investigated for the relationship between the microfilarial migration and the changes of sleep stage with special reference to REM sleep. Tests on ten patients except one case revealed that the sleep of each case showed a highly consistent pattern from the viewpoint of the first night. Microfilariae were counted every hour and at each REM stage. From these data, the characteristic findings were observed as follows: 1) Microfilarial migration reached the maximum peak around midnight, showing a Poisson type distribution, even though, one case slept only 47 minutes throughout the night, having no REM sleep. 2) Suppression of microfilarial migration during REM sleep was noted in 72%, which was independent of the slow wave sleep. Finally, suppression of microfilarial migration during REM sleep is discussed from the point of view of Hawking's pendulum model and physiological phenomena of REM sleep.
Subject(s)
Filariasis/parasitology , Sleep, REM , Adolescent , Adult , Circadian Rhythm , Electroencephalography , Female , Filariasis/physiopathology , Humans , Male , Microfilariae , Middle Aged , Wuchereria bancrofti/physiologyABSTRACT
Raphides from fourteen genera in seven families of flowering plants were examined using light and scanning electron microscopy. Raphides from an additional fifteen genera were described from literature. Of these thirty-four plants, fourteen were known to cause irritation. Barbs are associated with irritation in the families Araceae and Leeaceae, but not Vitaceae. Of the seventeen taxa described that contain raphides with barbs, six also have grooves on their crystals. The relationship between grooves and irritation is inconsistent. In seven examples in the family Araceae, raphides with grooves are associated with irritation. In three examples, one in the family Araceae and two in the Lemnaceae, raphides with grooves are present with little or no associated irritation. Plants that contain raphides without barbs or grooves are associated with irritation only if the raphides are greater than 180 microns in length. Four taxa that contain raphides longer than 180 microns without barbs or grooves are associated with irritation. However, nine taxa that contain raphides shorter than 180 microns without barbs or grooves do not cause irritation. It appears that raphide microstructure and size both contribute to irritation. However, the lack of a consistent association of barbs and grooves with irritation does not rule out the additional presence of a chemical toxin.
