Lamina

LAMINA (plate), a term extremely widespread in anatomy. Plates can be bony, e.g., L. lateralis and medialis processus pterygoidei—external and internal plates of the pterygoid process of the sphenoid bone. L. cribrosa, perpendicularis, papyracea ossis ethmoidalis—cribriform, perpendicular, orbital plate of the ethmoid bone. L. interna, s. vitrea ossium cranii—internal, or glassy plate of the cranial bones, so named because of its fragility. L. spiralis ossea—osseous spiral lamina in the cochlea. Cartilaginous plates: L. fibrocartilaginea interpubica—fibrocartilaginous plate in the pubic symphysis; L. cricoidea, thyreoidea—plates of the cricoid and thyroid cartilages.—The term L. is frequently encountered in brain anatomy: L. affixa thalami—thin reduced wall of the cerebral hemispheres (telencephalon), located on the upper surface of the optic thalamus. Laminae medullares cerebelli, thalami, nuclei lenticularis—white matter in the cerebellar hemispheres, in the optic thalamus (separating its nuclei), in the lentiform nucleus (dividing it into three segments); L. septi pellucidi—thin grayish translucent plates, parts of the medial wall of the cerebral hemispheres, between which lies a small cavity (cavum septi pellucidi, s. ventriculus quintus). Laminae (s. substantia) perforatae ant. et post.—anterior and posterior perforated (by blood vessels) plates at the base of the brain. Laminae chorioideae epitheliales—walls of the cerebral vesicles remaining thin as an epithelial layer, covering the choroid plexuses of the ventricles. L. quadrigemina—corpus quadrigeminum—corpora quadrigemina. L. terminalis—lamina terminalis, forming the anterior wall of the III ventricle, etc. L. cribrosa sclerae—the site where the fibers of the optic nerve pass through the sclera of the eyeball. L. elastica corneae anterior (Bowmani) and posterior (Descemeti, s. Demoursi) separate the connective tissue stroma of the cornea from the epithelium covering it anteriorly and posteriorly. L. mesenterii propria—connective tissue layer embedded in the thickness of the mesentery between the 2 serous leaves forming it. L. parietalis, visceralis peritonaei, pleurae, pericardii—parietal and visceral layers lining the respective viscera of the peritoneum, pleura, pericardium, etc.

P. Karuzin. LANG Georgy Fedorovich (born in 1875), a well-known therapist, professor of the faculty therapeutic clinic of the Leningrad Medical Institute and rector of the same institute (since 1929), chief physician of the Erisman Hospital (since 1924), member of the State Academic Council, member of the Leningrad Soviet of Workers', Peasants' and Red Army Deputies (since 1929). Graduated from the Military Medical Academy in 1899. In 1905 elected privat-docent of this academy, in 1919—professor of the State Institute for Medical Knowledge in the Department of Diagnostics of Internal Diseases. Since 1922 L. has concentrated all his medical and scientific activity in the Erisman Hospital and the Leningrad Medical Institute. L. is one of the founders of the Leningrad Therapeutic Society (1921) and the journal Therapeutic Archive (Moscow-Leningrad, 1923), of which he is currently co-editor; co-editor of many medical journals and editor of the therapeutic section of the Great Medical Encyclopedia, editor (jointly with Pletnev) of the collective multi-volume manual on internal medicine ("Special Pathology and Therapy of Internal Diseases", Moscow-Leningrad, from 1927). L. is one of the organizers of All-Union therapeutic congresses. In the field of practical medicine, L. is a promoter of the idea of creating a hospital-clinic (an example of which is the Erisman Hospital headed by him, all departments of which

are occupied by the clinics of the Leningrad Medical Institute). In the field of clinical medicine, L. is a representative of the trend striving to apply the achievements of theoretical medical disciplines, in particular normal and pathological physiology and anatomy, in the clinic. L. has written about 40 scientific works; the majority of them are devoted to the cardiovascular field. Among L.'s works, the main ones are: "Zur Methodik der Blutdruckmessung" (Deutsches Arch. f. klin. Med., B. XCIV, 1908)—for the first time, the clinical method of blood pressure measurement was experimentally tested and the frequency of its elevation in heart failure was established; "Pathology of His's Bundle" (Scientific News of the People's Commissariat of Education, 1919); "On Hypertension" (Archives of the State Clinical Institute for Postgraduate Training of Physicians, vol. I, 1922); "Pathogenesis of Nephrosclerosis" (Proceedings of the 7th Congress of Russian Therapists, Moscow-Leningrad, 1925), "On the So-called Peripheral Heart" (Proceedings of the 10th All-Union Congress of Therapists, Leningrad, 1929). The main direction of the work of L.'s clinic is the study of the pathology of the cardiovascular system and diseases of the blood-forming and blood-destroying apparatuses. LANGE METHOD (Lange) in the treatment of sciatica was proposed by the author and described by him in 1904; it consists in the injection of large quantities of sterile physiological solution warmed to 37° mixed with an anesthetic substance. The injection is performed at the site of exit of the nerve from the pelvis between the ischial tuberosity and the greater trochanter. The patient is given a horizontal position on the stomach or on the healthy side. The affected leg is flexed at the hip and knee joints. The buttock of the affected leg in the lower two-thirds and the posterior part of the leg (5 cm below the gluteal fold) are thoroughly disinfected (alcohol, iodine). Then a line is drawn from the greater trochanter of the hip joint to the ischial tuberosity and divided in half. The point of division anatomically corresponds to the sciatic nerve. Pressure at this place produces pain sharply different from the pain upon pressure on other areas of the buttock. Having marked the point, with a sterile needle 8–10 cm long (a needle with a stylet is desirable) one penetrates to a depth of 6–8 cm (depending on the patient's adiposity). The needle's touch to the perineurium gives pain radiating along the course of the entire nerve to the heel. Such pain is proof that the needle is in the perineurium. Having ascertained the latter, 5–10 cm³ of solution is injected into the perineurium under high pressure, after which the needle is directed away from the nerve, and in all 4 directions (up, down, right, left) the solution is injected in an amount from 80 to 100 cm³. The direction of the needle is changed without withdrawing it outward. The infusion is made from a large syringe (if absent, a 10 g syringe can be used). All instruments and material must be strictly sterile (needle, syringe, napkins, cotton wool); the operator and assistant prepare their hands according to all surgical rules.—After the injection, the puncture site is covered with a sterile napkin and sealed with collodion. The patient continues to remain in the same posture that was given during the injection for 2–3 hours. The patient remains in bed for 2–3 days. At present, a pure physiological solution without the admixture of eucaine, novocaine, etc., is most often injected. Complications after the injection are almost never encountered, except for an occasional, rapidly passing, insignificant rise in temperature up to 37.2–37.5°. The author theoretically justifies his method by the mechanical action of the physiological solution introduced into the perineurium and around the sciatic nerve. The latter produces the destruction of endoneural adhesions and adhesions of the nerve with surrounding tissues. Other authors believe that the solution causes infiltration in the nerve and its surroundings, which leads to more rapid removal (washing out) of toxins and inflammation products. Russian authors (Darkshevich, Shamburov, et al.) suggest that with the indicated method a number of factors act together, based on physico-chemical processes taking place in the nerve and around it (processes of osmosis and diffusion, etc.).—The method has found wide application and yields good results, with the duration of sciatica treatment being 2–3 weeks. By virtue of the simplicity of the method, the possibility of its wide application in the most primitive conditions (even at the patient's home) and the therapeutic results, the method deserves recommendation. Along with this method, the technique of epidural injections according to Cathelin for radicular sciatica was developed and introduced.