多謝呢位醫生既分享
祝願周同學大步擸過😭😭😭😭
同時強烈譴責港警每次出動都不斷攻擊市民頭部！！直接造成嚴重傷害！！！
解散警隊！刻不容緩🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿
#願榮光稱香港
#一齊集氣
#香港人不能麻木

[腦疝]

喺講腦疝之前，希望大家為周同學祈禱打氣，希望佢可以大步檻過。呢篇比較深，但希望大家可以睇哂佢。之前講過嘅腦硬膜外出血 (epidural haematoma)，以及腦硬膜下出血 (subdural haematoma)、蛛網膜下出血 (subarachnoid haematoma)，致死嘅原因都可以係腦疝。

疝，指器官受外力影響、而被迫入偏離本身位置嘅空間。腦疝，就係大腦或者小腦因為顱內壓上升，而被迫出本來嘅位置。

如圖，大腦同小腦由唔同嘅結構分開，形成唔同區域：大腦鐮 (falx cerebri) 分開左右兩邊大腦半球，小腦幕 (tentorium cerebelli) 將大腦半球與該邊嘅小腦半球分開。當顱內壓急速上升時，大腦小腦就會由原來嘅區域，被外力「啫」去另一區域，形成腦疝，從而壓住其他結構。

腦疝可分為四類：
一．大腦鐮下腦疝 (subfalcine herniation)。呢種腦疝嘅臨床病徵較輕微。通常嘅後續係大腦前動脈 (anterior cerebral artery) 比腦疝壓住，形成缺血性中風。
二．中央腦疝 (central herniation)。腦幹被外力向下壓，引起徵狀。最常見係第六腦神經 (外展神經, abducens nerve) 麻痺，引致斜視同埋複視。
三．顳葉鈎回腦疝 (uncal herniation)、亦稱小腦幕切蹟疝 (tentorial herniation)。指大腦顳葉 (temporal lobe, 旁邊靠近顳骨的部分) 中嘅鈎回 (uncus) 結構受壓而被擠出小腦幕。病徵有三：瞳孔擴大、郁唔到隻眼 (第三腦神經 (動眼神經, oculomotor nerve) 受壓麻痺)；半身不遂 (大腦腳 (cerebral peduncle) 受壓，其中嘅下行運動神經亦受牽連)；昏迷 (中腦網狀系統 (midbrain reticular formation) 結構受損)。大腦後動脈 (posterior cerebral artery) 亦有機會受壓，形成缺血性中風。
四．小腦扁桃體疝 (tonsillar herniation)。當壓力夠大，小腦可由枕骨大孔 (foramen magnum) 外疝。咁就嚴重啦，因為腦幹會因此受壓，其中控制呼吸同心跳嘅中心會受損，導致呼吸停頓、心跳停頓、血壓不穩，繼而死亡。

任何頭部創傷都可能引起顱內出血，繼而使顱內壓上升，最後腦疝。腦疝係可以致命嘅。所以希望大家為周同學打氣之餘，唔好忘記暴政曾經無數次向人民嘅頭顱攻擊，嘗試奪去我哋嘅性命。但係筆者亦都喺到呼籲：大家唔好絕望、唔好麻木，因為咁樣無異於自己用手向嘅頭顱使出致命一擊。要「毋忘初衷」呀，我哋繼續行落去啦。

***

[Brain herniation]

Before all, please pray for Mr. Chow - may he be safe and sound. The content of this post is a bit advanced, but I hope you can take some time and go through the whole passage. Conditions like epidural haematoma, subdural haematoma and subarachnoid haematoma can all lead to brain herniation, a serious and possibly fatal condition.

Herniation is the phenomenon where an organ is pushed to another location due to external pressure and forces. Brain herniation occurs when intracranial pressure (ICP) increases, and the brain parenchyma shifts its location.

As in the figure, we can see that the cerebrum and cerebellum are situated in different compartments, separated by different structures. The falx cerebri separates the bilateral cerebral hemispheres, and the tentorium cerebelli separates the cerebral hemisphere from the ipsilateral cerebellar hemisphere. When ICP increases, these structures will herniate into different spaces, compressing other structures.

Brain herniations can be categorised into 4 types:
1. Subfalcine herniation. Clinically this type of herniation has less symptoms. The major sequelae would be compression to the anterior cerebral artery, leading to ischaemic infarcts.
2. Central herniation. Downward compression to the brainstem leads to symptoms like strabismus and diplopia due to abducens nerve palsy.
3. Uncal / tentorial herniation. The uncus in the temporal lobe of the cerebrum are compressed and herniates through the tentorium cerebelli. Clinically there is a triad of symptoms: pupil dilation and progressive loss of eye movements (due to oculomotor nerve palsy), hemiparesis (compression to cerebral peduncle, damaging the descending motor neurons inside) and coma (damage to midbrain reticular formation). The posterior cerebral artery may also be compressed and cause ischaemic infarcts.
4. Tonsillar herniation. When ICP increases drastically, the cerebellum can herniate through the foramen magnum out of the skull. This is an extremely severe condition, in which the brainstem will be compressed, compromising its respiratory and cardiovascular control centres. This results in respiratory and cardiac arrest, fluctuation in blood pressure, and ultimately death.

Any trauma to the head can lead to intracranial haemorrhages, and that can lead to increased ICP and brain herniation, which may be fatal. We should not only pray for Mr. Chow who is suffering so much, but also remember how this government had aimed and shot at the heads of the people, trying to kill us. But it is unwise for us to be overwhelmed with hopelessness and numbness - that is even worse than a physical hit to your head! Never forget why we started - and let us walk further from here.

Figure adapted from Blumenfield H. Neuroanatomy through clinical cases, 2nd edition. Sinauer Associates, Inc. 2010.

大體解剖第四天～
主要進入四大腔室的探索
腦、胸、腹、盆

首先打開的是腹腔
大體老師有嚴重的黃疸
肝臟呈現嚴重的病理現象
腫大的肝臟在體內呈現扭轉現象
不但把肋廓與橫膈推擠到變形
橫膈腳（diaphragm crura）偏移
甚至肝臟後側下腔靜脈經過的地方
都已經不是縱向，而呈現斜向的角度

腫大與變形的肝臟，自然無法讓他順利呼吸
再加上大體老師有做過開胸手術
到底是肝臟影響心血管呼吸系統？還是反之？
我們不得而知～

當我們打開胸腔時，胸骨後面滿滿的沾黏
胸骨背面有鋼線綁起之處，滿滿沾黏與脂肪包覆
（身體面對異物時，傾向用脂肪包覆該結構）

正常來講～當我們打開心包膜時
心臟會與心包膜有一定的空間
允許心臟在心包內自由活動

然而當我們打開心包膜時
一刀就切進了心臟
不為什麼，大體老師的心臟
緊緊的與心包沾黏再一起
當我們再把心臟剖開時
裡面的釘子清晰可見

接著再進到盆腔
我們把膀胱往上撥，再從直腸口進入
上下一起就能探索到攝護腺
之前上VM老師有提到
嚴重的腿部內收肌拉傷也會影響到攝護腺
在大體開啟的狀況下，果然也驗證了彼此相連的關係
更不用說乙狀結腸、盲腸與髖部的活動
子宮圓韌帶、闊韌帶對恥骨聯合與髂薦關節的影響

但這都不是令我們驚訝的地方
這次開腦的歷程才是令人驚呼
照慣例用骨鋸把腦割開後

在解剖大師Todd的引導之下
在一旁幫忙扶著大體的我
竟然擁有了絕佳的觀察視角

我跟老師說我想看腦神經(Cranial Nerves)
在老師的巧手下，他一層一層地打開腦部
割開大腦鐮（falx cerebri）分隔左右腦葉
在割掉大腦，露出胼胝體（Corpus callosum）
再讓我們看到「栗子」紋路的小腦
最後讓腦神經一條一條的顯露在我們眼前

我很貪心地跟老師說
從這裡看得到迷走神經Vagus Nerve嗎！？
老師又耐心的一條一條的為我們解釋
有些腦神經無法清楚地被看到
要不就是開腦時被破壞

12對腦神經～
一嗅二視三動眼 四滑五叉六外旋
七顏八聽九舌咽 十來迷走副舌下
清楚地在我們眼前呈現！

明天～最後一天
最後的機會研究人體
我們可以盡情得打開關節
撕開肌肉、觀察許多深層的部位

每次來～都會有巨大的收穫
人體～真的看不完也研究不完
割人體，更是令人上癮的一件事

明年～你們跟我來嗎！？

#玩人體
#割人體

~~~~~~~~~壽屋新品招單(06/26結單)~~~~~~~~~

MSG巨神機甲04 武裝碎裂者
MSG巨神機甲05 轉換運輸器
MSG巨神機甲06 速度侵略者

FA 骨裝機兵 LX-00 Ray Falx 雷法爾克斯
FA 骨裝機兵 武器組06

超帥的雷法爾克斯&武器組再生產啦
想要MSG巨神機甲或雷法爾克斯的朋友快來找小精靈預定哦

(By店員小精靈)