食管上括约肌的矢状面断层解剖及其意义

目的:了解食管上括约肌矢状面的形态学特点,并试图阐明其功能产生的机制.方法:选取9例成人食管上括约肌标本进行火棉胶包埋,制作薄层矢状面断层切片,切片进行V-G染色,观察矢状面上食管上括约肌的肌束和肌层纤维结缔组织的形态学特点.结果:食管上括约肌不同区域均有环行肌存在,在后壁相互重叠;食管上括约肌不同区域结缔组织的形态有所不同,在整个食管上括约肌肌层内有树根形的结缔组织束贯穿全程.结论:食管上括约肌的肌组织和纤维结缔组织可能共同参与高压区的形成.     

Fascias of the male external genitalia and perineum

The fascias of the male external genitalia and perineum serve as surgical landmarks and are considered to act as initial barriers to urinary extravasation; thus they are of fundamental importance to the urologist and anatomist. There is little agreement, however, about the naming and function of these fascias because they have been defined inconsistently. The extensive use of eponyms for the fascias adds even further confusion to the proper nomenclature. Our findings, based upon dissection and magnetic resonance imaging (MRI), show that except for the single layer of dartos (smooth muscle) in the scrotum, there are two distinct layers of fascia in the penis and perineum that are continuous with each other and the anterior wall fascias. To minimize confusion, we conclude that the fascial layrs around the penis be termed the superficial and deep penile fascias, and those to which they are continuous in the perineum be termed the membranous layer of the superficial perineal fascia (the fibrous stratum that traverses the superficial fascia) and the deep perineal fascia. Their presumed role in limiting urinary extravasation is based upon relatively few well-detailed report and currently remains poorly understood. However, this may be improved upon in the future through combined application of clinical findings and MRI to individual cases of urinary extravasation. © 1994 Wiley-Liss, Inc.     

Histological analysis of esophageal muscular layers from 27 autopsy cases with mixed connective tissue disease (MCTD)

Esophageal symptoms in mixed connective tissue disease (MCTD) have been investigated radiologically. We investigated the esophageal lesions in MCTD histopathologically, and analyzed relationships between these lesions and autoantibodies extracted from the serum of MCTD patients. Esophageal tissues from 27 MCTD patients submitted to autopsy were examined. We compared histopathological features of the esophagus in different wall layers from the mucosa, submucosa, and muscular layer to the adventitia, and in the upper, middle, and lower portions of esophagus. The most striking change observed was severe atrophy and occasional loss of smooth muscle cells in the muscular layer, followed by fibrosis. These muscular changes were particularly prominent in the inner layer of the lower esophagus. Immunohistochemically, degenerated muscular tissues of the esophagus were positive for anti-IgG and anti-C3 antibodies, but not for anti-IgM antibodies. IgG fractions extracted from three MCTD patients were immunohistochemically used to examine whether some antibodies in MCTD patients showed reactivity for esophageal components. The IgG fractions isolated from MCTD patients reacted with smooth muscle from non-connective tissue disease cases, suggesting that some serum antibodies may trigger esophageal changes. These findings suggest that esophageal lesions associated with clinical dysphagia in MCTD may be related to autoantibodies.     

医用聚氨酯材料人工食管重建的组织再生观察

目的 观察医用聚氨酯材料人工食管重建时的组织再生情况,探讨其重建犬颈段食管缺损的可行性.方法 纤维内镜观察人工食管及吻合口肉芽生长情况,并定期处死实验犬,取新生食管标本,进行肉眼及HE染色,镜下观察组织再生情况.结果 术后食管黏膜上皮细胞可再生,3个月可覆盖缺损部位;术后1~6个月未发现食管腺体、平滑肌和横纹肌的再生;人工食管脱落后,不宜在原位时间过长,以减少对黏膜的损伤.结论 医用聚氨酯材料构建的人工食管可以用于食管缺损重建,食管黏膜上皮可以再生.     

Morphofunctional analysis of experimental model of esophageal achalasia in rats

We carried out a detailed analysis of rat model of esophageal achalasia previously developed by us. Manifest morphological and functional disorders were observed in experimental achalasia: hyperplasia of the squamous epithelium, reduced number of nerve fibers, excessive growth of fibrous connective tissue in the esophageal wall, high contractile activity of the lower esophageal sphincter, and reduced motility of the longitudinal muscle layer. Changes in rat esophagus observed in experimental achalasia largely correlate with those in esophageal achalasia in humans. Hence, our experimental model can be used for the development of new methods of disease treatment.     

Classification of breast lesions pre‐contrast injection using water resonance lineshape analysis

Inhomogeneously broadened, non‐Lorentzian water resonances have been observed in small image voxels of breast tissue. The non‐Lorentzian components of the water resonance are probably produced by bulk magnetic susceptibility shifts caused by dense, deoxygenated tumor blood vessels (the ‘blood oxygenation level‐dependent’ effect), but can also be produced by other characteristics of local anatomy and physiology, including calcifications and interfaces between different types of tissue. Here, we tested the hypothesis that the detection of non‐Lorentzian components of the water resonance with high spectral and spatial resolution (HiSS) MRI allows the classification of breast lesions without the need to inject contrast agent. Eighteen malignant lesions and nine benign lesions were imaged with HiSS MRI at 1.5 T. A new algorithm was developed to detect non‐Lorentzian (or off‐peak) components of the water resonance. After a Lorentzian fit had been subtracted from the data, the largest peak in the residual spectrum in each voxel was identified as the major off‐peak component of the water resonance. The difference in frequency between these off‐peak components and the main water peaks, and their amplitudes, were measured in malignant lesions, benign lesions and breast fibroglandular tissue. Off‐peak component frequencies were significantly different between malignant and benign lesions (p < 0.001). Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of HiSS off‐peak component analysis compared with dynamic contrast‐enhanced (DCE) MRI parameters. The areas under the ROC curves for the ‘DCE rapid uptake fraction’, ‘DCE washout fraction’, ‘off‐peak component amplitude’ and ‘off‐peak component frequency’ were 0.75, 0.83, 0.50 and 0.86, respectively. These results suggest that water resonance lineshape analysis performs well in the classification of breast lesions without contrast injection and could improve the diagnostic accuracy of clinical breast MR examinations. In addition, this approach may provide an alternative to DCE MRI in women who are at risk for adverse reactions to contrast media. Copyright © 2012 John Wiley & Sons, Ltd.     

Unusual bronchopulmonary foregut malformation associated with pericardial defect: bronchogenic cyst communicating with tubular esophageal duplication

We report a case of unusual bronchopulmonary foregut malformation composed of a mediastinal bronchogenic cyst with sequestrated lung tissue and communicating tubular esophageal duplication associated with complete pericardial defect. A 18-yr. old man, who had suffered from dry cough and mild dyspnea, was admitted because of an incidentally detected chest mass. A computed tomography scan demonstrated a cystic mass with an air fluid level connected with esophagus in the middle mediastinum. The surgically resected mass was a pleural invested accessory lobe of the lung (8.0 x 7.0 x 4.5 cm) connected with the esophageal wall by a tubular structure (3.0 cm in length and 2.0 cm in diameter). A complete left pericardial defect was also identified. Histologically, the cystic wall was composed of fibrovascular connective tissue with a smooth muscle layer, mixed seromucous glands and cartilage, and the inner surface of the cyst was lined by ciliated pseudostratified columnar epithelium. The inner surface of the tubular structure was lined by non-keratinizing or keratinizing squamous epithelium, and the wall contained submucosal mucous glands, muscularis mucosa, and duplicated muscularis propria. This case is important in understanding the embryological pathogenesis of the variable spectrum of the bronchopulmonary foregut malformation.     

气管隆嵴以下食管系膜的形态学特点

目的：为临床食管中下段肿瘤的微创切除提供气管隆嵴以下食管系膜形态的精细解剖。方法：大体解剖观 察成人尸体食管系膜及其包裹的结构；对胎儿尸体进行连续水平面取材后石蜡切片，Masson 染色确定食管系膜 的位置、形态及其和周围结构的关系；采用Mimics 19.0 软件对食管系膜进行三维重建。结果：在大体解剖和组 织学上均可观察到食管系膜结构。食管系膜除形成覆盖食管表面的浆膜，还包裹了食管周围的淋巴结、血管和神 经丛。Masson 染色显示气管隆嵴平面至膈肌食管裂孔平面之间，食管系膜的形态出现了逐渐的过渡，在第4~7 胸 椎水平食管系膜与胸主动脉外膜关系密切，第7 胸椎（T7）以下食管系膜与胸主动脉外膜相对独立。结论：气管 隆嵴以下食管系膜在T7 上下存在差异，该系膜与胸主动脉外膜关系的改变，能为食管中下段肿瘤切除时手术层 次的选择提供形态学依据。     

Microscopic anatomy of the visceral fasciae

The term ‘visceral fascia’ is a general term used to describe the fascia lying immediately beneath the mesothelium of the serosa, together with that immediately surrounding the viscera, but there are many types of visceral fasciae. The aim of this paper was to identify the features they have in common and their specialisations. The visceral fascia of the abdomen (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal peritoneum), thorax (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal pleura), lung (corresponding to the connective tissue under the mesothelium of the visceral pleura), liver (corresponding to the connective tissue under the mesothelium of the visceral peritoneum), kidney (corresponding to the Gerota fascia), the oesophagus (corresponding to its adventitia) and heart (corresponding to the fibrous layer of the pericardial sac) from eight fresh cadavers were sampled and analysed with histological and immunohistochemical stains to evaluate collagen and elastic components and innervation. Although the visceral fasciae make up a well‐defined layer of connective tissue, the thickness, percentage of elastic fibres and innervation vary among the different viscera. In particular, the fascia of the lung has a mean thickness of 134 μm (± 21), that of heart 792 μm (± 132), oesophagus 105 μm (± 10), liver 131 μm (± 18), Gerota fascia 1009 μm (± 105) and the visceral fascia of the abdomen 987 μm (± 90). The greatest number of elastic fibres (9.79%) was found in the adventitia of the oesophagus. The connective layers lying immediately outside the mesothelium of the pleura and peritoneum also have many elastic fibres (4.98% and 4.52%, respectively), whereas the pericardium and Gerota fascia have few (0.27% and 1.38%). In the pleura, peritoneum and adventitia of the oesophagus, elastic fibres form a well‐defined layer, corresponding to the elastic lamina, while in the other cases they are thinner and scattered in the connective tissue. Collagen fibres also show precise spatial organisation, being arranged in several layers. In each layer, all the fibrous bundles are parallel with each other, but change direction among layers. Loose connective tissue rich in elastic fibres is found between contiguous fibrous layers. Unmyelinated nerve fibres were found in all samples, but myelinated fibres were only found in some fasciae, such as those of the liver and heart, and the visceral fascia of the abdomen. According to these findings, we propose distinguishing the visceral fasciae into two large groups. The first group includes all the fasciae closely related to the individual organ and giving shape to it, supporting the parenchyma; these are thin, elastic and very well innervated. The second group comprises all the fibrous sheets forming the compartments for the organs and also connecting the internal organs to the musculoskeletal system. These fasciae are thick, less elastic and less innervated, but they contain larger and myelinated nerves. We propose to call the first type of fasciae ‘investing fasciae’, and the second type ‘insertional fasciae’.     

镍钛合金人工食管替代食管后的组织反应与损伤

背景：前期实验证实镍钛合金人工食管是一种可用于替代被切除食管段,重建食管通道的食管人工代用品。 目的：观察镍钛合金人工食管替代食管术后的组织反应及对邻近组织器官的损伤。 方法：切除8只小型香猪一段70 mm胸段食管,将镍钛合金人工食管两端分别套入远近端正常食管腔内约   10 mm,在食管与镍钛合金人工食管涤沦连接环作全层连续缝合吻合连接。术后第7天开始应用饮食调控方法调控脱管时间。分别在术后1,2,3,4个月各处死2只带管实验猪进行解剖,观察植入镍钛合金人工食管在新生食管形成过程中的组织反应和对紧密接触邻近组织器官的损伤。 结果与结论：各时间段植入镍钛合金人工食管原位停留支撑,未见胸内出血、气胸、脓胸、食管穿孔、吻合口瘘等术后邻近组织器官损伤并发症。实验动物带管进食半固体食物无进食困难(Bown'SⅡ级)。解剖所见：壁层胸膜与肺轻度膜状粘连,胸腔内无胸液,新生食管完全包裹人工食管,新生食管与邻近肺、主动脉器官组织轻度膜状粘连,未对邻近肺、主动脉及食管黏膜造成严重损伤,植入周期食管黏膜由食管残端向新生食管中间部再生延伸直到完全覆盖整条新生食管。新生食管组织学所见：镍钛合金人工食管替代食管植入周期的组织反应表现为无菌性炎症反应和异物反应,以术后1个月组织反应最为严重,随后逐渐减轻。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

螺旋CT在食源性食管异物诊断中的临床价值

目的:探讨螺旋CT在食源性食管异物诊断及临床治疗中的价值.方法:回顾分析25例经食管镜、手术证实的食道异物患者,比较MSCT薄层+三维重建:多平面重建(MPR)、最大密度投影(MIP)、容积荐现(VR)在临床诊断、治疗中价值.结果:经食管镜或手术证实的25例患者的食管异物为鸡鸭骨、鱼骨;MSCT检查均清楚显示异物,MS...     

An anatomical,histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocolon: their relevance to colonic surgery

The study aim was to explore the anatomy, histopathology, and molecular biological function of the fascias posterior to the interperitoneal colon and its mesocolon to provide information for improving complete mesocolic excision. To accomplish this aim, we performed intraoperative observations in 60 interperitoneal colon‐cancer patients accepted for complete mesocolic excision and conducted local anatomy observations for five embalmed cadavers. An additional two embalmed child cadaver specimens were studied with large slices and paraffin sections. Ten of the 60 patients were examined with a lymph node tracer technique in vivo, while fresh specimens from these patients were assessed by histopathological examination and transwell cell migration assays in vitro. The anatomical and histopathological findings showed that the fascias posterior to the interperitoneal colon and its associated mesocolon were composed of two independent layers: the visceral and parietal fascias. These two fascias were primarily composed of collagen fibers, with the parietal fascia containing a small amount of muscle fiber. The in vivo test showed that the visceral fascia surrounded the colon and its associated mesocolon, including vessels and lymphatics, and that it had no lymphatic flow through it into the rear tissues. Moreover, the in vitro assays showed the visceral fascia was able to block tumor cell migration. Although many surgical scholars have known of the existence of fascia tissue posterior to the intraperitoneal colon, the detailed structure has been ignored and been unclear. As shown by our findings, the visceral and parietal fascias are truly formed structures that have not been previously reported. A thorough understanding of fascial structures and the function of the visceral fascia barrier in blocking tumor cells will facilitate surgeons when performing high‐quality complete mesocolic excision procedures.     

Retinoid receptors in human esophageal squamous cell carcinoma: retinoid X receptor as a potent prognostic factor

Retinoids regulate cell proliferation and differentiation in normal and neoplastic tissue. These effects are mainly mediated by two types of nuclear retinoid receptors, retinoic acid receptors (RAR) and retinoid X receptors (RXR). RXR have been demonstrated to play important roles in esophageal carcinoma, but the expression of RXRβ and RXRγ has not been examined in esophagus. Therefore, we examined the immunoreactivity of all subtypes of RAR and RXR in 53 non-neoplastic esophageal epithelium and 74 esophageal squamous cell carcinoma tissues. In non-neoplastic epithelium RARβ immunoreactivity was marked in the basal layer and weak in the suprabasal layer, but immunoreactivity of other retinoid receptors was detected in both of layers. In addition, the status of RARβ and RXRβ immunoreactivity inversely correlated with that of lymph node metastasis (P= 0.0477 and P= 0.0034, respectively); decreased RXRβ immunoreactivity of carcinoma cells was positively associated with adverse clinical outcome of the patients (P= 0.0187). These findings all indicate the important roles of retinoid receptors, especially, RXR in the esophageal squamous cell carcinoma.     

Immunopathogenesis of schistosomiasis

Summary: In schistosomiasis mansoni, the chronic egg‐induced granulomatous response in the liver and intestines may eventually cause extensive tissue scarring and development of portal hypertension. Indeed, much of the morbidity and mortality associated with this disease is directly attributable to the deposition of connective tissue elements in affected tissues. Elucidating the mechanisms that regulate the severity of schistosomiasis has been a major research objective over the past several years. Research conducted with DNA microarrays as well as investigations with a variety of gene knock‐out mice have been particularly helpful in achieving this goal. A notable accomplishment in the past few years was the identification of interleukin‐13 (IL‐13) and the IL‐13 receptor complex as central regulators of disease progression in schistosomiasis. Liver fibrogenesis is severely decreased in infected IL‐13‐deficient mice as well as in wildtype animals treated with IL‐13 antagonists. In contrast, IL‐13 effector function increases dramatically in IL‐13 receptor α2 (IL‐13Rα2)‐deficient mice. These mice develop severe hepatic fibrosis, fail to downregulate granuloma formation in the chronic phase of S. mansoni infection, and succumb to the disease at an accelerated rate; thus, identifying the ‘decoy’ IL‐13 receptor as a critical life sustaining ‘off’ switch for tissue damaging egg‐induced inflammation.     

Quantitation in inflammatory pleural disease to distinguish tuberculous and paramalignant from chronic non-specific pleuritis.

AIM: To determine by morphometry if pleural biopsies with the histopathological diagnosis of "non-specific pleuritis", malignant, and tuberculous disease could be distinguished morphologically from those with truly non-specific disease. METHODS: Each pleural biopsy was reviewed taking into account three compartments of reference: the visceral/parietal mesothelial compartment, the submesothelial screen compartment, and the submesothelial adipose tissue compartment. Normal connective tissue, granulation tissue, fibrocellular proliferation, fibrin, polymorphonuclear cells, mononuclear cells, and mesothelial cells were measured using conventional point counting procedures in terms of the fractional area occupied by each parameter within each compartment of reference. Ranking was carried out on 164 patients, based on their diagnosis: chronic non-specific disease (n = 57), tuberculosis (n = 27), malignant disease (n = 58), and conditions associated with transudative effusions (n = 22). RESULTS: Stepwise discriminant analysis of the resulting data showed that biopsies from patients with tuberculosis, malignant disease, and chronic non-specific disease could be distinguished between themselves and normal cases. Statistical differences among the four groups were observed for eight morphometric parameters related to components of inflammation and extension throughout the three pleural anatomical compartments. A robust discriminant function permitted an adequate classification of the three groups of disease in 88.41% of the cases. Pleural biopsies with fibrin incorporated within granulation tissue on the submesothelial screen compartment showed 100% specificity for patients with tuberculosis, while mononuclear cells in a band-like infiltrate on the submesothelial adipose tissue compartment showed 93.1% specificity for patients with malignant disease. The truly non-specific pleuritis was characterised by deposits of fibrin in the subpleural compartment and discrete signs of chronic inflammation and reparatory fibrosis on the submesothelial screen. CONCLUSIONS: Morphometric analysis of pleural biopsies may be a useful supplementary histological procedure to support the diagnosis of pleural tuberculosis and malignant disease.     

The suction mechanism as a factor in intrathoracic oedema, connective tissue or pleural effusion

In pathological conditions, the negative intrapleural pressures (Ppl) may increase unequally. At some sites they may remain increased. We maintain that at these sites the increased pressures may lead to the production of oedema in the adjacent pleural walls and in adjacent pre-existing connective tissue, which may remain as oedema or may become connective tissue. Occasionally the increased negative Ppl may contribute to the production of pleural effusion. We term all these processes the suction mechanism (SM). This mechanism affords an interpretation of a series of images observed in chest X-rays. According to this view, lung shrinkage, narrowing of the pulmonary vessels and impairment of the lung function are not caused by the diffuse pleural fibrosis, but result from damage to the lung parenchyma. We also interpret the apical cap, the blunting of the costophrenic sulci, the broadening of the mediastinum and the retrosternal stripe in terms of the SM.     

Is the cytologic diagnosis of esophageal glandular dysplasia feasible?

Barrett's esophagus is a premalignant condition in which the normal stratified squamous epithelium of the esophagus is replaced by metaplastic glandular epithelium. Patients with Barrett's esophagus are at increased risk for the development of esophageal adenocarcinoma. Because dysplasia precedes the development of frank adenocarcinoma, the cytologic detection of esophageal glandular dysplasia represents a potentially inexpensive and efficient means of monitoring disease progression to adenocarcinoma and identifying high-risk patients. This article discusses the current status of exfoliative cytology as a screening test for glandular dysplasia of the esophagus. Diagn. Cytopathol. 1998;18:312–316. © 1998 Wiley-Liss, Inc.     

The neural regulation of the mammalian esophageal motility and its implication for esophageal diseases

In contrast to the tunica muscularis of the stomach, small intestine and large intestine, the external muscle layer of the mammalian esophagus contains not only smooth muscle but also striated muscle fibers. Although the swallowing pattern generator initiates the peristaltic movement via vagal preganglionic neurons that project to the myenteric ganglia in the smooth muscle esophagus, the progressing front of contraction is organized by a local reflex circuit composed by intrinsic neurons similarly to other gastrointestinal tracts. On the other hand, the peristalsis of the striated muscle esophagus is both initiated and organized by the swallowing pattern generator via vagal motor neurons that directly innervate the muscle fibers. The presence of a distinct ganglionated myenteric plexus in the striated muscle portion of the esophagus had been enigmatic and neglected in terms of peristaltic control for a long time. Recently, the regulatory roles of intrinsic neurons in the esophageal striated muscle have been clarified. It was reported that esophageal striated muscle receives dual innervation from both vagal motor fibers originating in the brainstem and varicose intrinsic nerve fibers originating in the myenteric plexus, which is called ‘enteric co-innervation’ of esophageal motor endplates. Moreover, a putative local neural reflex pathway that can control the motility of the striated muscle was identified in the rodent esophagus. This reflex circuit consists of primary afferent neurons and myenteric neurons, which can modulate the release of neurotransmitters from vagal motor neurons in the striated muscle esophagus. The pathogenesis of some esophageal disorders such as achalasia and gastroesophageal reflux disease might be involved in dysfunction of the neural networks including alterations of the myenteric neurons. These evidences indicate the physiological and pathological significance of intrinsic nervous system in the regulation of the esophageal motility. In addition, it is assumed that the components of intrinsic neurons might be therapeutic targets for several esophageal diseases.