内耳免疫应答过程中内淋巴囊的细胞增殖

目的 研究和评价内耳二次免疫应答过程中内淋巴囊的细胞增殖情况。方法 选用ＳＤ大鼠１５只,以钥孔Ｑｉ血蓝蛋白（ｋｅｙｈｏｌｅ ｌｉｍｐｅｔ ｈｅｍｏｃｙａｎｉｎ,ＫＬＨ）全身免疫后,经耳蜗底回钻孔以相同抗原进行内耳免疫,然后分别在内在免疫后３、７和１４ｄ腹腔注射溴脱氧尿嘧啶核苷（ｂｒｏｍｏｄｅｏｘｙｕｒｉｄｉｎｅ,ＢｒｄＵｒｄ）后处死动物,取颞骨经组织学处理制作冰冻切片,用免疫组织化学技术观察内淋巴囊的细胞浸润、增殖和ＩｇＧ细胞的分布状况。结果 内耳受抗原刺激后３ｄ内淋巴囊囊腔和囊周区域出现单核吞噬细胞浸润,７ｄ内淋巴囊的浆细胞和淋巴细胞大量增加;３～７ｄ内淋巴囊囊腔ＫＬＨ被吞噬,同时Ｓ期细胞和ＩｇＧ阳性细胞逐渐增多,二者的出现部位相似。结论 在内耳针对Ｔ细胞依赖性抗原的二次应答中,内淋巴囊的细胞增殖活性增强,且     

豚鼠内淋巴囊上皮细胞的免疫组织化学特性

本文应用免疫组织化学技术探索了中间丝和Ｓ－１００蛋白在豚鼠内淋巴囊上皮细胞的表达，结果表明：囊上皮细胞不仅具有上皮细胞特异的中间丝角蛋白阳性反应，还具有间胚叶组织特异的中间丝波形蛋白强阳性反应。两特性的共存可能与该上皮具有吸收和分泌双重功能有关。Ｓ－１００蛋白强阳性反应表明此上皮细胞富含钙结合蛋白，可能与其调钙作用有关。     

内淋巴囊直流电位的因素,作用及其机制研究进展

本综述了近年来有关内淋巴囊直流电位（ＥＳＰ）的研究进展，着重对ＥＳＰ的影响因素、作用及其机制作了阐述。这对深入研究内淋巴囊电生理具有重要意义。     

内淋巴囊的神经分布

目的：通过实验从形态学上直接验证内淋巴囊上存在神经纤维,为梅尼埃病的病因病理学研究提供新的思路。方法：使用成年SD大鼠15只,经活体心脏灌注,取双侧颞骨,常规石蜡包埋处理并切片。用免疫组织化学方法标记,确认抗体神经特异性烯醇化酶（neuronal specific enolase, NSE）、胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）、神经微丝（neurofilament, NF）在内淋巴囊(Endolymphatic Sac, ES)上的表达。结果：在光学显微镜下,NSE、GFAP、NF一抗在内淋巴囊上皮及上皮下表达为棕黄色阳性着色颗粒。结论：内淋巴囊近侧端、中间段和远侧段均有神经纤维分布,以近侧段最为丰富。     

豚鼠内淋巴管与内淋巴囊微血管模式及解剖差异

为研究内淋巴管及内淋巴囊微血管分布模式，通过墨汁血管灌流技术和图像分析方法对１０只豚鼠的颞骨（２０侧）内淋巴管和内淋巴囊做全面观察分析。结果：①２０侧颞骨中有１７侧（８５％）内淋巴管、内淋巴囊有脑膜后动脉和前庭后动脉两条供血来源，其余３例（１５％）则发现前庭后动脉缺如；②脑膜后动脉在内淋巴囊的分布频率明显高于前庭后动脉（Ｐ〈０．０１），但两者在内淋巴管的分布频率无显著性（Ｐ〉０．０５）。结论：内淋     

内淋巴囊乳突分流术治疗Meniere病长期疗效观察

采用内淋巴囊乳突分流术治疗１０例Ｍｅｎｉｅｒｅ病患者，随访３－５年，术后眩晕控制满意，其中眩晕疗效值为０值３例，１－４０者７例；多数患者（７／１０）耳鸣减轻或消失，仅１例术后听力下降。该手术安全，并发症少、术后恢复快。对药物治疗无效，患耳尚有听力的Ｍｅｎｉｅｒｅ病患者可首选内淋巴囊乳突分流术。     

内淋巴囊局部免疫诱发自身免疫性感音神经性聋的实验研究

为探讨免疫机制在感音神经性聋中的作用,本实验采用同种内耳抗原注射到豚鼠内淋巴囊局部进行初次和再次免疫,发现内淋巴囊免疫耳均出现感音神经性聋和内耳免疫病理损伤,证明内淋巴囊局部的自身免疫性病理损伤可对内耳的生理功能产生严重影响。     

内淋巴囊的外源性抗原特异性免疫应答

目的　研究内淋巴囊对于外源性胸腺依赖性抗原的特异性免疫应答。方法　用SD大鼠 32只 ,以抗原全身免疫后 ,经耳蜗底周向外淋巴腔注入相同抗原 ,分别于此后 1、3、7、14天处死动物取颞骨作组织学处理。然后应用免疫组化等技术 ,观察内淋巴囊的细胞浸润 ,免疫细胞增殖及其对抗原的吞噬清除作用。结果　内耳抗原接种后第 1、3天 ,内淋巴囊出现单核吞噬细胞浸润 ,第 7天出现浆细胞和淋巴细胞浸润 ;内耳抗原接种后第 3、7天 ,内淋巴囊的IgG阳性细胞增多 ,同时抗原被捕捉、递呈和吞噬。结论　内淋巴囊对外源性抗原可产生特异性免疫应答 ,是内耳局部免疫应答的重要场所。     

单纯内淋巴囊减压术治疗梅尼埃病的远期疗效

报告以单纯内淋巴囊减压术治疗梅尼埃病５８例中，经随访５－６．５年的３０例眩晕完全消失者２１例。表明单纯内淋巴囊闰坟术与内淋巴囊切开术或分流术的疗效近似而且引起严重并发症的机会较少。并对本手术的作用机理，操作要领及并发症的预防等进行讨论。     

The endolymphatic sac in the Mondini disorder

Summary The endolymphatic sacs are described in temporal bone specimens from a 31-year-old man with bilateral Mondini disorder. The ducts and sacs are thin-walled, cyst-like structures with complete absence of loose vascular perisac tissue, and are directly apposed to the bone of the vestibular aqueduct. Histological evidence of severe bone erosion is present in these specimens and is most marked in the intermediate and distal portions of the vestibular aqueduct. It is also present in the foveal region of the posterior temporal bone surface underlying the sac. Erosion of the bony wall of the paravestibular canaliculus (PVC) is demonstrable, with incorporation of the vein of the PVC inside the margin of the widened vestibular aqueduct. These findings suggest a causal relationship between pressure within the endolymphatic duct and sac and erosion of the surrounding bone. The absence of endolymphatic hydrops of the cochlea and vestibular organs in the Mondini disorder constrast significantly with the endolymphatic hydrops seen in Meniere's disease.Supported by The Hope for Hearing Foundation, UCLA     

Cell proliferation in the endolymphatic sac in situ after the rat Waldeyer ring equivalent immunostimulation

OBJECTIVES/HYPOTHESIS: It has been recognized that immunological mechanisms could be involved in the pathogenesis of different inner ear disorders, such as progressive sensorineural hearing loss, Meniere's disease, and even sudden deafness. The endolymphatic sac acts as an immune control organ for the inner ear and has been considered as an effector site of the mucosa-associated lymphoid tissue. The purpose of the study was to determine the potentially immunological relationship between endolymphatic sac and Waldeyer ring equivalent, one of the most important affector organs in mucosa-associated lymphoid tissue. STUDY DESIGN: Animal model. METHODS: Thirty-six rats were employed. Two animals were killed for histological observation of Waldeyer ring equivalent, and another 34 animals were randomly divided into experimental and control groups and received bilateral intranasal immunizations with keyhole limpet hemocyanin or Freund adjuvant, respectively. The ears of immunized animals and control animals were examined for keyhole limpet hemocyanin-positive memory cells and immunoglobulin G-positive plasma cells with the technique of immunohistochemical analysis. The histopathological changes and cell proliferation in those ears were also assessed. RESULTS: There were paired and organized lymphoid tissues in the lateral wall of the first choana in the rat. Keyhole limpet hemocyanin-positive lymphocytes appeared within the endolymphatic sac at 3 days after the first anti-genetic stimulus of the Waldeyer ring equivalent. Endolymphatic hydrops in the cochlea, elevated amounts of immunocompetent cells, and increased activity of cell proliferation within the endolymphatic sac were also considered after four intranasal injections of keyhole limpet hemocyanin. CONCLUSION: Presumably, endolymphatic sac is supplied with immunocompetent cells from Waldeyer ring equivalent and has an ability of co-reaction with Waldeyer ring equivalent.     

豚鼠内淋巴管与内淋巴囊微血管模式及解剖差异

为研究内淋巴管及内淋巴囊微血管分布模式，通过墨汁血管灌流技术和图像分析方法对１０只豚鼠的颞骨（２０侧）内淋巴管和内淋巴囊做全面观察分析。结果：①２０侧颞骨中有１７侧（８５％）内淋巴管、内淋巴囊有脑膜后动脉和前庭后动脉两条供血来源，其余３侧（１５％）则发现前庭后动脉缺如；②脑膜后动脉在内淋巴囊的分布频率明显高于前庭后动脉（Ｐ＜０．０１），但两者在内淋巴管的分布频率差异无显著性（Ｐ＞０．０５）。结论：内淋巴管、内淋巴囊的血供来源及微血管分布模式存在一定的解剖差异，脑膜后动脉是内淋巴囊血管网的主体     

Cell proliferation in the endolymphatic sac in situ during the immune response of inner ear

Background Normally, few immunocompetent cell are present in the endolymphatic sac (ES). During an active immune response in the inner ear, large amount of inflammatory cells, including immunocompetent cells, are seen in the ES. The current study aimed at assessing cellular proliferation within the ES during induced immune response in the inner ear. Methods Fifteen healthy, female SD rats were sensitized systemically with keyhole limpet hemocyanin (KLH), followed by local inoculation in the cochlea through basal turn fenestration with the same antigen. On Days 3, 7 and 14 following inoculation, the animal was sacrificed after intraperitoneal administration of 5-bromo-2'-deoxyuridine (BrdUrd), and the temporal bone harvested. Following decalcification, infiltration by BrdUrd- and IgG-positive cells in the ES was studied on frozen sections with H & E and immunohistochemical staining. Results During the secondary immune response in the inner ear against T-dependent antigens, there is increased cellular proliferation in the ES. The proliferated cells may differentiate into immunocompetent cells at the same location. Conclusions These findings indicate that the ES plays an important role in immune response of inner ear.     

The radiologic diagnosis of endolymphatic sac tumors

OBJECTIVE: To identify and classify radiologic criteria for the diagnosis of endolymphatic sac tumors. STUDY DESIGN: Retrospective case review. Tertiary referral center. METHODS: 31 adult patients (32 tumors) with imaging (computed tomography [CT], magnetic resonance imaging [MRI], and/or angiography) and histopathologic diagnoses of lesions that involved the posterior temporal bone from July 1995 to August 2004 were included in the study. Interventions were diagnostic. Main outcome measures were CT, MRI (T1, T1 with gadolinium enhancement and T2-weighted), and angiographic features of seven patients (eight temporal bones) with endolymphatic sac tumors were examined and compared to the radiologic findings of the 24 historical control patients with various lesions involving the posterior temporal bone. RESULTS: CT findings of endolymphatic sac tumors revealed lesions centered over the endolymphatic sac, retrolabyrinthine, and presigmoid regions of the temporal bone. Central calcific spiculation and posterior rim calcification was present in all lesions (100%) on CT examination. T1-weighted MRI scans showed hyperintense foci in seven of eight lesions (88%). T1-weighted post-gadolinium scans showed heterogeneous enhancement in all cases (100%). T2-weighted images showed heterogeneous signals in all lesions (100%). Angiography (traditional or magnetic resonance angiography [MRA]) identified exclusive external carotid supply for lesions less than 3 cm. Tumors greater than 3 cm were supplied by external carotid, internal carotid, and posterior fossa circulation arteries. CONCLUSIONS: Reliable radiologic criteria to preoperatively identify endolymphatic sac tumors exist. Preoperative diagnosis of posterior temporal bone lesions enables appropriate surgical planning and treatment of the pathology.     

Cholesterol granuloma surrounding the endolymphatic sac

We report a unique case of cholesterol granuloma (CG) surrounding the endolymphatic sac (ES). A 49-year-old man presented with the left side of sensorineural hearing loss, tinnitus, and vertigo. Magnetic resonance and computed tomography imaging revealed a CG surrounding the left ES. The patient initially underwent left transmastoid surgical resection of the tumor. At the time of surgery, brown fluid was aspirated from the tumor, but no other tumors were found. Histopathological examination revealed that the tumor contained cholesterol crystals, confirming the diagnosis of CG. At his 12-month postoperative follow-up, there was no evidence of recurrence. We discuss the radiology, pathology, and surgical removal of CGs surrounding ES.     

Potassium level in endolymphatic sac of guinea pigs in vivo

Summary The value of K⁺ activity in the endolymphatic sac of guinea pigs in vivo, measured with ion-sensitive microelectrodes, was 16.7±5.1 (N = 20) mval.Supported by the Deutsche Forschungsgemeinschaft. We are grateful to Mrs. Seeck for helpful technical assistance     

内淋巴囊解剖及临床意义

为了解内淋巴囊的解剖变异情况，解剖甲醛固定的颞骨28侧，观察26例行内淋巴囊减压术的Meniere病患者的内淋巴囊位置、局部血管分布情况，显微镜下测量长和宽。结果28例颞骨均找到内淋巴囊，其平均长度为6．94±2．04mm，平均宽度为5．88±1．65mm。囊表面血管分布显示不清晰。26例Meniere病者24例找到内淋巴囊，平均长度为6．81±2．24mm，平均宽为5．67±1．51mm。囊表面血管分布不清晰者占29％。根据观察，内淋巴囊的位置通常位于Donaldson线上，乳突气化程度不佳时，囊位置多靠下，且较小。为内淋巴囊手术时的定位及识别提供了解剖学参考。     

Management of endolymphatic sac tumors: a case series report

Objective To study clinical characteristics of endolymphatic sac tumor (ELST) and its diagnosis and treatment. Methods ELST was diagnosed in 6 cases based on surgical and histological findings. These cases were reviewed for their clinical manifestations, differential diagnosis and surgical treatment techniques. Results There were 1 male and 5 females in this group, aged from 28 to 59 years (mean age=38.7 years). The tumor was in left ear in 4 cases and in right ear in the other 2 cases. Disease courses ranged from 5 to 30 years (mean duration= 12.6 years). Clinical presentations included sensorineural hearing loss (n=4), otorrhea and tinnitus (n=2), tinnitus and facial spasm(n=1), otorrhea with facial paralysis(n=l), and hearing loss with tinnitus (n=2). None of the cas-es was diagnosed as ELST preoperatively. Two cases were misdiagnosed as glomus jugulare tumor, 2 as chronic suppurative otitis media, 1 as sweat gland adenoma on biopsy and 1 as temporal bone tumor. Tumors were sprgi-tally resected in all 6 cases via the mastoidectomy (n=2) or combined oto-cervical or cranio-oto-cervical ap-proaches(n=4). Postoperative cerebrospinal fluid otorrhea occurred in 1 case. The tumors were confirmed on histo-logical examination to be a low-grade adenocarcinoma. All patients have survived at the time of this paper. Conclusion ELST is rare and commonly misdiagnosed and inadequately treated. Its prognosis is relatively favor-able because of its slow growth rate.