大网膜扭转1例并文献复习

患者,男,35岁,右下腹持续住疼痛36小时住院,无外伤及剧烈运动史,无恶心呕吐,腹痛后有发热,既往有右腹股沟疝二年,腹痛前数日多次自行手法还纳疝内容。检查:体温38℃,脉搏100次/分,血压16/10KPa,肥胖体型,右侧腹饱满,麦氏点上方有明显压痛及反跳痛,腹肌紧张,肠鸣音低弱,白血球总数10.8×10~9/l,中性白细胞75％,淋巴球25％。诊断为急性阑尾炎并手术。     

活体大网膜测量数据及其临床意义

在60例腹腔无炎症,大网膜无粘连的成人腹部手术中,对大网膜进行测量,取得了较全面的数据,供临床参考。     

大鼠大网膜表面的扫描电镜观察

大白鼠大网膜不同结构区——薄膜区、脂肪和血管区的表面均有一层间皮和散在的乳斑。同皮细胞间借突起相接。突起之间可见宽窄不一的间隙。薄膜区间隙较大,呈网络状。间皮细胞表面有疏密不均的微绒毛。微绒毛或离散分布,或连接成网。在微绒毛稀少区的细胞表面可见散在的小孔。在脂肪和血管区有丰富的乳斑,薄膜区乳斑少见且较少。乳斑的细胞多数位于间皮细胞间的间隙内或其表面。乳斑细胞的绝大部分裸露于腹膜腔。乳斑的细胞成分主要为巨噬细胞和淋巴细胞,有少数颗粒白细胞和红细胞,偶见肥大细胞。     

游离大网膜移植治疗慢性骨髓炎

目的探讨游离大网膜移植治疗慢性骨髓炎的治疗效果。方法本组8例慢性骨髓炎患者采用吻合血管的游离大网膜移植治疗。结果术后随访1月-22月,所有患者恢复正常.无复发征象。结论游离大网膜移植术既能清除慢性骨髓炎死腔,建立病灶骨及局部组织的血液循环:同时又能刺激骨区成骨细胞活跃,促进病灶的修复。游离大网膜移植术是治疗慢性骨髓炎的有效方法。     

大网膜多发性脾组织植入1例

患者女性 ,70岁 ,上腹部规律性阵痛伴返酸、嗳气数年余 ,近 10ｄ上腹部胀痛、恶心并呕吐隔夜宿食入院。发病前16年因乙肝性肝硬化门脉高压曾行脾脏切除术。查体 :消瘦 ,上腹部压痛明显 ,并见约 6ｃｍ长的手术瘢痕 ,胃内振水音及移动性浊音均 (+) ;辅助检查 :ＡＬＢ 31 0ｇ/Ｌ ;ＧＬＢ 37 0ｇ/Ｌ ;Ａ/Ｇ 0 84 ;Ｂ超示 :①胃内大量潴溜液 ;②肝脏体积缩小 ,表面不平呈锯齿状 ;③脾脏缺如。胃镜示 :胃窦前壁黏膜糜烂、无光泽及弹性 ,幽门变形且持续关闭。临床拟诊 :胃潴溜 :①胃窦癌 ;②幽门梗阻。术中所见 :胃与胰腺、大网膜、结肠系膜粘连严…     

超声检查对眼球内恶性肿瘤的诊断价值

视网膜母细胞瘤(retinoblastoma，RB)、脉络膜恶性黑色素瘤(choroidal melignant melanoma，CMM)、脉络膜转移癌(choroidal metastatic carcinoma，CMC)等是常见的眼球内恶性肿瘤。本文通过一组病例在诊疗过程中不同阶段诊断情况进行对照研究，探讨超声波的诊断价值。     

超声对胆囊内隆起性病变的诊断价值

现代超声显像技术在临床的应用,使胆囊内隆起病变在术前检出率明显提高。笔者就胆囊内隆起性病变的声像图特点及其病理检查作对照分析。 1 对象与方法 1.1 本组21例中男18例,女7例,年龄26～58岁。18例表现为右上腹隐痛不适,3例无任何症状。经B型超声诊断为胆囊内隆起性病变并行胆囊切除术。     

高频超声诊断乳腺疾病的价值

乳腺疾病的发病率逐年上升,乳腺增生尤为常见.乳腺癌的发病率居我国女性恶性肿瘤中的第二位,已有报道为首位[1].发病年龄也趋于年轻化.因超声检查具有简便、易行且无损伤,已成为检查乳腺的常规方法之一.     

胎盘早剥超声诊断与临床价值

目的：探讨B型超声对胎盘早剥的诊断价值。方法回顾性分析60例经剖宫产或阴道分娩的胎盘早剥患者的声像学图特征和临床资料。结果轻型患者超声诊断符合率44.5%,重型90.5%。结论早期的超声诊断,有利于维护产妇和胎儿的生命安全,降低围产儿死亡率。     

大网膜内植入自体脾组织与原位脾组织的结构比较

目的 :为临床应用自体脾组织植入术提供实验研究资料。方法 :大鼠分为实验组和对照组 ,前者切取 1 /2脾脏去包膜后切成 1mm× 1mm× 1mm大小均匀组织块 ,植入大网膜囊袋内。饲养 6个月后取 2组脾组织制片 ,光镜和电镜定性观察组织结构变化 ,计算机图像分析系统比较血管、红髓、白髓及胶原纤维的面密度 ;免疫组化法结合计算机图像分析测定神经肽 (NPY)阳性神经纤维密度。结果 :神经和边缘窦内皮细胞结构恢复较好 ,血管 ,白髓的面密度值较对照组减少 ,红髓与对照组相当 ,胶原纤维面密度增加。结论 :大网膜内植入的自体脾组织通过再生能恢复脾脏的主要组织结构 ,但不能完全恢复正常。     

Sympathetic nerve tissue in milky spots of the human greater omentum

Omental milky spots (OMSs), small lymphoid structures positioned in the greater omentum, are involved in peritoneal immune homeostasis and the formation of omental metastases. Sympathetic nerve activity is known to regulate immune function in other lymphoid organs (e.g. spleen and lymph nodes) and to create a favourable microenvironment for various tumour types. However, it is still unknown whether OMSs receive sympathetic innervation. Therefore, the aim of this study was to establish whether OMSs of the adult human greater omentum receive sympathetic innervation. A total of 18 OMSs were isolated from five omenta, which were removed from 3% formaldehyde-perfused cadavers (with a median age of 84 years, ranging from 64 to 94). OMSs were embedded in paraffin, cut and stained with a general (PGP9.5) and sympathetic nerve marker (TH and DBH), and evaluated by bright field microscopy. A T-cell, B-cell, and macrophage staining was performed to confirm OMS identity. In 50% of the studied OMSs, sympathetic nerve fibres were observed at multiple levels of the same OMS. Nerve fibres were represented as dots or elongated structures and often observed in relation to small vessels and occasionally as individual structures residing between lymphoid cells. The current study shows that 50% of the investigated OMSs contain sympathetic nerve fibres. These findings may contribute to our understanding of neural regulation of peritoneal immune response and the involvement of OMSs in omental metastases.     

Cellular composition of milky spots in the human greater omentum: An immunochemical and ultrastructural study

Background: Milky spots in the greater omentum of some animals are well organized perivascular infiltrated of leucocytes, and are considered to have characteristics of secondary lymphoid tissue. To determine whether milky spots in the human greater omentum can also be regarded as secondary lymphoid tissue, we studied milky spots in an unstimulated state. Methods: Patients were selected on the basis of absence of disease in the peritoneal cavity that might influence the state of the milky spots. Using monoclonel antibodies aganist macrophages, B-lymphocytes and T-lymphocytes, and immunoperoxidase labeling, the number of these cells and their location in milky spots were studied by light microscopy. However, the stromal components of the greater omentum, especially those within the milky spots, were studied by electron microscopy. Results: Milky spots in the human greater omentum are relatively uniform vascularized accumulations of mononuclear cells comprising macrophages (67.9% ± 9.4, mean ± standard deviation), B-cells (10.1% ± 3.4), T-cells (10.2% ± 3.7), and mast cells. However, no special B-cells and T-cell areas could be distinguished. On the ultrastructural level it was demonstrated that macrophages are present in different stages of maturation and can enter or leave the milky spots. Furthermore, no cells characteristic of secondary lymphoid organs, such as interdigitating cells or follicular dendritic cells, were seen. Conclusions: These data indicate that unstimulated milky spots in the human greater omentum are to a great extent just a preformed specific accumulation of primarily macrophages within the stroma of the greater omentum, and therefore, cannot be regarded as true secondary lymphoid tissue. Milky spots could serve as a gateway for, as well as a provider of pertioneal macrophages when the intra-abdominal status so requires. Finally, the data from this study are compard with the data of other studies of human milky spots and those in animals. © 1995 Wiley-Liss, Inc.     

大网膜防御机制的研究

目的:通过观察大鼠大网膜乳斑的核苷酸酶(5'-nucleotidase)活性及淋巴管的定位,从一个新的角度来探讨大网膜的防御机制。方法:采用大鼠大网膜全载标本,进行酶组织化学、免疫组织化学染色,光学显微镜和共焦点激光荧光显微镜观察。结果:乳斑深层淋巴细胞呈5'-nucleotidase强阳性;乳斑表层脂肪细胞间隙发现大量的无基底膜的毛细淋巴管。结论:结果提示乳斑淋巴细胞可中介腺苷抑制自身或其他乳斑免疫细胞的活动;乳斑的毛细淋巴管与大网膜的防御机制有关。     

A new method for assaying adhesion of cancer cells to the greater omentum and its application for evaluating anti-adhesion activities of chemically synthesized oligosaccharides

A new ex vivo method for assaying adhesion of cancer cells to the greater omentum has been developed using mouse greater omentum and [³H]labelled human gastric and mouse colorectal cancer cells. Since the adhesion rates were found to increase up to 18 h and labelled cells seemed to be stable during the period, the present method could be useful for investigating adhesion of cancer cells to the greater omentum, which must occur at the first step of the peritoneal dissemination. The adhesion of cancer cells to the greater omentum was inhibited by a series of chemically synthesized oligosaccharides and Galβ1,3[3OMeGalβ1,4GlcNAcβ1,6]αBn was found to be the best inhibitor. The anti-tumor effect of this novel tetrasaccharide in vivo was shown in preliminary experiments using Balb/c mice and colon26 cells.     

腹膜后恶性纤维组织细胞瘤的 MSCT 表现及诊断价值简

目的分析腹膜后恶性纤维组织细胞瘤（MFH）的多层螺旋CT（MSCT）表现,探讨MSCT对该病的诊断价值。方法经手术病理证实的15例腹膜后MFH患者,其中男性11例,女性4例：年龄21～79岁,平均年龄46.5岁。回顾性分析其临床及MSCT表现.并与病理组织学改变相对照。结果15例腹膜后MFH主要临床表现为腹部肿块和疼痛。15例MSCT平扫表现为腹膜后软组织肿块.肿瘤呈圆形或类圆形10例。不规则形5例,肿瘤平均直径为12.5cm,瘤内坏死9例,出血7例,钙化6例。增强扫描肿瘤不均匀强化,13例见分隔状强化。组织学上呈明显多形性,其中车辐状一多形型MFH 11例,巨细胞型MFH 3例,炎症型MFH 1例。结论腹膜后MFH的MSCT表现具有一定特征,对其诊断及鉴别诊断有重要价值。     

64-row MDCT review of anatomic features and variations of the normal greater omentum

Background  There are only few basic papers treating of the imaging features and anatomic variations of the normal greater omentum (GO). The goal of our study was to exploit the new major capabilities of 64-row MDCT—in terms of spatial resolution and crucial improvements in the quality of 2D and 3D reformatted images—to extensively review the in vivo anatomy, landmarks and variations of the normal GO a large cohort of patients. Methods  The abdominal 64-row MDCT of a series of 111 patients (51 females and 60 males) were scrupulously retrospectively analysed to individually characterize the morphologic and anatomic features of the GO through multiplanar reconstructions, various methods of measure and selective volume rendering views. Results  The GO was clearly identified, localized and characterized in all patients. The good delineation of the GO vessels, which predominantly have a vertical course, was the key of this analysis. Several individual and sex related anatomic variations were found. In females the left hemi-GO was found being statistically significantly longer than the right (P = 0.0053) but also longer than the male left hemi-GO (P < 0.0001). On the contrary, no statistically significant variation was found between the length of the left and right hemi-GO in males and between the length of the right hemi-GO in males and females. The average length of the entire GO also appeared sex-related being very statistically significantly longer in females than in males (P = 0.0002). In males the mean thickness of the GO (mtGO) was paralleling the increasing of the maximal thickness of the subcutaneous fat (mtSF). In females it remained rather independent from the increasing of the mtSF and, as a consequence, in obese and very obese females the increasing volume of the abdomen is caused preponderantly by the increasing amount of SF. In most males and females the mtGO followed the increasing of the amount of intraabdominal fat. Finally the projection of a less or more important portion of the GO into the pre-hepatic sub-phrenic space was an almost exclusive male feature found in 32% of males versus only 2% in females. Conclusion  Abdominal 64-row MDCT is able to perfectly delineate the anatomy and landmarks of the normal GO. Our study reveals several sex related anatomical variations. Knowledge of these anatomic variations may be helpful for a better understanding and diagnosis of various pathologic processes involving the GO including vascular, inflammatory and neoplastic diseases but also for surgical therapy planning including reconstructive surgery.     

Combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum

Herein is reported a highly rare case of combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum. A 45-year-old Japanese man was incidentally found to have a mesenteric mass during abdominal ultrasonography. Grossly, a well-circumscribed and non-encapsulated tumor, measuring 24 × 23 × 22 mm, was located in the omentum with no obvious invasion to the surrounding stomach and pancreas. Microscopically, the tumor consisted of two histological distinct components; the majority of it showed irregular arrangement of numerous cysts lined by a single layer of flattened or epithelioid cells and the multifocal minor component exhibited prominent papillary protrusions lined by a single layer of cuboidal cells with relatively uniform nucleus. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (AE1/AE3), vimentin, calretinin, D2-40 and WT-1, and negative for epithelial membrane antigen (EMA), desmin, S-100 protein and CD68. Ki-67 labeling index of the tumor cells was <5%. The postoperative course was uneventful, though he has not received any adjuvant therapy. Despite the rarity, recognition of such combined cases of mesothelial lesions is important to prevent overdiagnosis.