Eponymous “valves” of the nasolacrimal drainage apparatus. II. Frequency of visualization on dacryocystography

Developmental remnants may follow segmental canalization of ectodermal epithelial cords forming the nasolacrimal drainage apparatus (NDA). This can result in false luminal “valves” along the path of the NDA, many of which have been named, but most have not been anatomically identified with consistency. By 1908, eight such “valves” were documented, those of: Foltz, Bochdalek, Rosenmüller, Huschke, Aubaret, Béraud or Krause, Taillefer, and Hasner or Cruveilhier or Bianchi. Digital subtraction dacryocystography (DS‐DCG) is the highest spatial resolution imaging technique available to outline in vivo NDA anatomy, luminal profile, and pathology. We believe this is the first report of the conspicuousness and frequency of these “valves” on DS‐DCG. We retrospectively analyzed routine DS‐DCGs with normal findings for the presence and frequency of the eight NDA “valves.” We examined 92 normal DS‐DCGs on patients aged 14–82 years (71% female, 29% male). We observed “valves” most reliably in the inferior nasolacrimal duct: the inferior valve of Hasner (plica lacrimalis) was present in 98.9% of cases, and more superiorly, the valve of Taillefer (93.5%) and the valve of Krause (79.3%). Contrastingly, we infrequently identified the very superior “valves”: Foltz or Bochdalek in 17.1%, Rosenmüller or Huschke in 46.4%, and Auberat in 40% of cases. Therefore, unlike the inferior NDA valves, these more superior “valves” were less consistently identified and are presumed to be simple mural mucosal irregularities rather than true structural valves. These findings will be useful in diagnostic interpretation of DS‐DCGs and therapeutic planning for patients undergoing luminal procedures on the NDA. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.     

Functional anatomy of human lacrimal duct epithelium

 Resorption of tear fluid in the lacrimal ducts has hitherto been controversial; one reason for this has been insufficient knowledge of the anatomical structure and function of the lacrimal duct epithelium. The present study analyzes the structure of lacrimal duct epithelium by means of histological, histochemical, immunohistochemical and electronmicroscopical methods and draws a conclusion about its physiological function regarding its role in immunodeficiency. Investigations were performed on 31 lacrimal systems of 17 male and 14 female individuals (aged 54–88 years). Lacrimal ducts are surrounded by a wide-ranging cavernous system, which is embedded in an osseous canal between the maxilla and the lacrimal bone. The internal wall of the lacrimal canaliculi is lined by a stratified epithelium. The lacrimal sac and nasolacrimal duct contain a double-layered epithelium, which rests on a broad basement membrane. In their apical part epithelial cells contain large lipid droplets and secretory vacuoles. Epithelial cells are faced by microvilli and some tufts of kinociliae are also visible. Goblet cells are integrated in the epithelium as solitary cells or in a characteristical arrangement of several cells. The secretory product of these cells contains carbohydrates including fucose and sialic acid. Inside the surrounding cavernous system serous glands are found that open their excretory ducts into the lacrimal sac and nasolacrimal duct. Some T- and B-lymphocytes and macrophages may be demonstrated immunohistochemically in the submucosa partly penetrating the epithelium. Synthesized mucins of goblet cells form a specialized protective layer on the epithelium of the lacrimal ducts, which functionally serves for a simplified drainage of tear fluid into the inferior meatus of the nose. Together with immunocompetent cells, the protective layer plays a role in antigen defense and prevents invasion of pathogenic agents. The facing of epithelial cells by microvilli gives hints of reabsorption of lacrimal fluid inside the lacrimal ducts. Accepted: 13 January 1998     

Three‐dimensional structure of efferent and epididymal ducts in mice

The aim of the present study was to clarify the detailed morphology of efferent and epididymal ducts in adult mice using three‐dimensional (3D) analysis. We reconstructed efferent and epididymal ducts in three adult mice using serial paraffin sections and high‐performance 3D reconstruction software to draw the core lines of all ducts. By comparing the 3D core lines with the histological features in serial sections, we obtained detailed information on the gross characteristics of the ducts and identified the duct divisions accurately. The intra‐testicular rete testis penetrated the tunica albuginea at one place and turned into the extra‐testicular rete testis, which branched once or twice to give rise to four efferent ducts within 0.5 mm from the tunica albuginea. As these ducts approached the epididymis, they converged into one again and changed abruptly into the initial segment (IS) of the epididymis. The average length from the tunica albuginea to the IS was 19.7 ± 3.1 mm. In one mouse, we found four additional efferent ducts diverging from the common region with blind ends. The epididymal duct was a single highly convoluted duct with no branch and an average length of 767 ± 26 mm. By dividing the epididymal duct into five regions based on its cytological features and periodic acid‐Schiff stainability, we calculated the length and diameter of individual regions accurately. Furthermore, we clearly showed locations of the connective tissue septa that divide the head epididymis into several segments. The epididymal duct followed a complicated, winding path within each segment while drawing a large spiral overall along the circumference of the epididymis. Sometimes the direction of this spiral reversed between adjacent segments. The present study revealed the detailed 3D structures of efferent and epididymal ducts in adult mice.     

Gene expression in the efferent ducts,epididymis, and vas deferens during embryonic development of the mouse

The tissues of the male reproductive tract are characterized by distinct morphologies, from highly coiled to un‐coiled. Global gene expression profiles of efferent ducts, epididymis, and vas deferens were generated from embryonic day 14.5 to postnatal day 1 as tissue‐specific morphologies emerge. Expression of homeobox genes, potential mediators of tissue‐specific morphological development, was assessed. Twenty homeobox genes were identified as either tissue‐enriched, developmentally regulated, or both. Additionally, ontology analysis demonstrated cell adhesion to be highly regulated along the length of the reproductive tract. Regulators of cell adhesion with variable expression between the three tissues were identified including Alcam, various cadherins, and multiple integrins. Immunofluorescence localization of the cell adhesion regulators POSTN and CDH2 demonstrated cell adhesion in the epithelium and mesenchyme of the epididymis may change throughout development. These results suggest cell adhesion may be modulated in a tissue‐specific manner, playing an important role in establishing each tissue's final morphology. Developmental Dynamics 239:2479–2491, 2010. © 2010 Wiley‐Liss, Inc.     

Anatomical assessment of bile ducts of Luschka in human fetuses

Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.     

肝管的测量及其临床意义

在90具成人尸体上,测量了肝左管,肝右管及肝总管的长度,直径和有关的角度.肝左管平均长7.5mm,直径7.6mm,与肝总管形成的角度为34.9°;肝右管长9.6mm,直径6.2mm,与肝总管形成的角度为50.2°.结果表明肝左管粗、短而直,肝右管细,长而倾斜.肝管这种解剖形态学上的差异,似与临床上常见华枝睾吸虫病肝左叶肿大较多及肝左管结石较多有关。     

Innervation of the porcine ciliary muscle and outflow region

The porcine eye serves as a model to study various functions of the aqueous outflow system. To compare these data with the primate eye, a detailed investigation of the distribution of contractile properties and of the innervation of the outflow region was conducted in the porcine eye. In all quadrants of the anterior eye segment, elastic fibres connected the ciliary muscle (CM) with the well-developed scleral spur (ScS) and also partly with the corneoscleral trabecular meshwork (TM) and the loops of the collecting outflow channels. Immunohistochemistry with antibodies against smooth muscle alpha-actin revealed intense staining of the CM and some myofibroblasts in the ScS and outer TM. In addition to a few cholinergic and aminergic nerve fibres in the outflow region, numerous substance P- and calcitonin-gene related peptide-positive nerve fibres and nerve endings were found near the outflow loops of the porcine TM. Although the porcine CM serves rather as a tensor choroideae muscle than as a muscle for accommodation, the innervation and morphology of the collecting outflow channel loops and of the expanded TM between the ScS and the cornea showed close similarities to the primate eye.     

Ontogeny of the Orbital Glands and Their Environs in the Pantropical Spotted Dolphin (Stenella attenuata: Delphinidae)

The nasolacrimal duct (NLD) connects the orbital (often associated with the Deep Anterior Orbital gland: DAOG, a.k.a. Harderian gland) and nasal regions in many tetrapods. Adult cetaceans are usually said to lack an NLD, and there is little agreement in the literature concerning the identity of their orbital glands, which may reflect conflicting definitions rather than taxonomic variation. In this study, we examined an embryological series of the pantropical spotted dolphin (Stenella attenuata), and report numerous divergences from other tetrapods. Underdeveloped eyelids and a few ventral orbital glands are present by late Stage (S) 17. By S 19, circumorbital conjunctival glands are present. In S 20, these conjunctival glands have proliferated, eyelids (and scattered palpebral glands) have formed, and a duct similar to the NLD has appeared. Subsequently, both the palpebral glands and the NLD are progressively reduced by S 22, even as the conjunctival glands exhibit regional growth. In most tetrapods examined, the ontogeny of the NLD follows a series of three stages: Inception of NLD, Connection of orbit and nasal cavity by the NLD and Ossification (i.e., formation of the bony canal surrounding the NLD, emerging into the orbit via the lacrimal foramen in the lacrimal bone). In contrast, the dolphin NLD originates at the same time as the lacrimal bone, and a lacrimal foramen fails to develop. The cetacean fossil record shows that a lacrimal foramen was present in the earliest ancestral amphibious, freshwater forms, but was soon lost as the lineage invaded the oceans. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:77–87, 2018. © 2017 Wiley Periodicals, Inc.     

Modification of Innervation Pattern by Fluoroquinolone Treatment in the Rat Salivary Glands

Fluoroquinolone antibiotics (FQAs) are widely used in dental and medical therapy. Despite their known severe adverse actions on the central and peripheral nervous system, little attention has been directed toward the potential toxic side effects of these compounds on the oral tissues. As the saliva secretion is controlled by the nervous system and neuropeptides, the neurotoxic effect of pefloxacin (PEF), a representative member of FQAs, was studied in rats in the present work. Previously, we demonstrated a significant weight loss of parotid gland tissue, a marked decrease in 3H‐thymidine incorporation, a decreased volume of saliva and amylase activity of the glandular tissue in response to PEF. Animals received intraperitoneal injection of PEF (20 mg/100 g body weight daily) for 3 and 7 days. Normal histology, and neurofilament 200, substance P (SP) and calcitonin gene‐related polypeptide (CGRP) containing nerve fibers were detected with immunohistochemical methods. A marked decrease of the weights in salivary glands and the acinar diameters were measured. Similarly, a strong and significant decrease of the number of SP and CGRP containing nerve fibers were detected. These findings suggest that the impaired morphology and innervation pattern of salivary glands is related to the neurotoxic adverse effect of FQA treatment. Anat Rec, 2010. © 2009 Wiley‐Liss, Inc.     

Innervation of tracheal epithelium and smooth muscle by neurons in airway ganglia

The neurochemical profiles of neurons in ferret tracheal ganglia has been characterized, but their projections to smooth muscle and epithelium in ferret trachea has not been examined. The purpose of this study is to determine the location of cell bodies that project VIP‐, SP‐, and NPY‐containing fibers to the ferret tracheal smooth muscle and epithelium. Segments of ferret trachea were cultured for 0, 1, 3, or 7 days, some in the presence of 3 μm capsaicin. VIP, SP, or NPY nerve fiber density was measured using morphometric procedures. A retrograde tracer, rhodamine‐labeled microspheres, identified neurons projecting to the epithelium. The density of SP fibers in the epithelium was reduced after culture, but VIP innervation was not different. In tracheal smooth muscle, the density of VIP‐ and SP‐IR fibers was not different during the culture period, but NPY fiber density was reduced at all culture times. Capsaicin treatment did not affect nerve fiber density in the tracheal smooth muscle but produced a significant reduction in the density of epithelial VIP‐ and SP‐IR nerve fibers after 1 day. Rhodamine‐labeled microspheres were identified in VIP‐containing nerve cell bodies of the ferret tracheal plexus. VIP innervation to the airway epithelium in ferret originates both from cell bodies in airway ganglia and cell bodies in sensory ganglia. The pathway from airway ganglia suggest the existence of a local reflex mechanisms initiated by epithelial irritation. Anat Rec 254:166–172, 1999. © 1999 Wiley‐Liss, Inc.     

Multiplex detection of herpesviruses in tear fluid using the "stair primers" PCR method: prospective study of 93 patients

Human herpesviruses can infect the eye and be excreted subsequently in tears. The aim of the present study was to use a multiplex PCR to detect herpesviruses (HSV-1, -2, VZV, CMV, EBV, HHV-6) in tears from normal subjects and from patients with pathological conditions (acute herpes, zoster, papillary conjunctivitis, and dry eye). Schirmer test strips were used to collect tear fluid from 93 patients, sampling both eyes. DNA was then extracted from the 186 samples by chromatography, and viral DNA amplified using a commercialised multiplex "stair primer" method. Thirty-four samples (18.3%) contained Taq inhibitors. The multiplex test gave positive results for HSV and VZV in tear fluid from patients with acute dendritic keratitis (3 patients) and acute ocular zoster (4 patients) and was, therefore, considered effective in testing samples from patients with acute lesions. HSV-1 and HSV-2 were found in two samples from patients with metaherpetic corneal scarring. Among 28 cases of dry eye, two were positive for HHV-6, the latter being associated with EBV in one patient. HHV-6 was also found in 4 out of 54 cases of papillary conjunctivitis. This raised occurrence of HHV-6 in dry eye or papillary conjunctivitis, suggests new clinical patterns for HHV-6 latency or reactivation. Detection of EBV in 1 out of 80 healthy eyes confirms previous evidence that lacrimal glands constitute potentially a site for latent-phase EBV.     

Innervation of submucosal adipocytes in the human colon

The submucosal plexus regulates various activities of the gastrointestinal mucosa. As the submucosa in the human colon contains adipose tissue we hypothesized that submucosal neurons might also innervate this tissue. We stained submucosal nerves for the enzyme NADPH-diaphorase, which is a marker for nitric oxide synthase-containing nerves. This resulted in the staining of neurons in submucosal ganglia and numerous nerve fibers throughout the submucosa. These fibers were found to be in close contact with adipocytes, and in many cases fine nerve fibers displaying varicosities were found on the surface of these cells. At least some of these fibers originated from submucosal neurons. In addition, cell bodies of submucosal neurons were in close proximity to adipocytes. It is concluded that submucosal nerves innervate adipose tissue in the submucosa, which is a novel role for these nerves, and might have important functional implications.     

Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance

The purpose of this study is to describe the arterial supply of the entire extrahepatic bile duct system. The cross‐sectional area of all arteries that supply the ducts is measured under an operating microscope in 50 adult cadavers injected with red latex through the aorta. The extrahepatic bile duct system is divided into four topographic portions: cystic duct and gallbladder, right and left hepatic ducts, bile (common) duct and including its supra‐retroduodenal parts, and the pancreatic and intraduodenal portions. The arterial supply to each portion is carefully detailed. The ducts are supplied by more than seven arteries, of which the major arteries are the cystic artery, posterior superior pancreaticoduodenal artery, right hepatic artery, and retroportal artery. Collectively they provide 94.5% of the blood supply to the ducts. Arteries form three types of anastomotic patterns on the walls of the ducts, suggesting that ductal incisions can be made in ways that least disturb the blood supply. The patterns are: a network, a longitudinal anastomotic chain, and an arterial circle. These data emphasize the importance of the arterial supply in biliary surgery and especially the treatment of hemobilia. Clin. Anat. 12:245–249, 1999. © 1999 Wiley‐Liss, Inc.     

CT-anatomy of the nasolacrimal sac and duct

Summary Recent developments in ophthalmology such as balloon dilatation, stent implantation, laser therapy and endoscopy of the lacrimal drainage system raise the need for a detailed anatomical knowledge of this system. In this study morphometric measurements of the lacrimal drainage system were performed with thin-section axial computed tomography (CT) examinations in 147 patients with no signs of pathology related to the lacrimal drainage system. The mean length of the nasolacrimal duct measured 11.2±2.6mm (range: 6–21 mm), the narrowest diameter was 3.7±0.7 mm (range: 2–7 mm). The mean length of the nasolacrimal sac was 11.8±2.5 mm (range: 6–18 mm). The width of the nasolacrimal sac did not exceed 4 mm unless filled with air. In 43 (29.3%) of the subjects air was visible within the nasolacrimal sac or duct. The knowledge of the morphometry of the lacrimal drainage system enables the ophthalmologist to plan intervention on the lacrimal drainage system precisely and avoid unnecessary manipulations.

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Anatomie du sac et du conduit lacrymo-nasaux en tomodensitométrie

Résumé Les récents progrès en ophtalmologie tels que la dilatation par ballonnet, la pose de sondes, les traitements au laser, l'endoscopie du système lacrymal accroissent la nécessité d'une connaissance anatomique précise de ce système ; dans cette étude morphométrique, les mesures du système de drainage lacrymal ont été réalisées par tomodensitométrie en coupes fines (CT); l'étude portait sur 147 patients indemnes de toute pathologie du système de drainage lacrymal. La longueur moyenne du conduit lacrymal était de 11,2±2,6 mm (limites : 6–21 mm) ; le diamètre le plus réduit était de 3,7±0,7 mm (limites : 2–7 mm). La longueur moyenne du sac lacrymo-nasal était de 11,8 mm±2,5 mm (limites 6–18 mm) ; la largeur du sac n'excédait pas 4 mm, en dehors d'un remplissage par l'air. La présence d'air a été décelée dans le sac ou le conduit chez 43 sujets (29,3 %). La connaissance de la morphométrie du système de drainage lacrymal permet à l'ophtalmologiste de planifier avec précision une intervention sur le système en évitant des manuvres intempestives.

     

KRAS mutation and immunohistochemical profile in intraductal papillary neoplasm of the intrahepatic bile ducts

Intraductal papillary neoplasm of bile duct (IPNB) is characterized by a spectrum of diseases ranging from low-grade intraepithelial neoplasia to invasive carcinoma. In the present study, we aimed to investigate immunophenotypic features and KRAS mutations in relation to pathological subtypes and grades in Chinese patients with IPNBs. A total of 46 patients with IPNBs and 11 invasive adenocarcinomas arising in IPNBs (invasive IPNBs) were enrolled and clinicopathological data were analyzed. It was found that CK7 was expressed in 42 of the 46 neoplastic lesions. HepPar1 was expressed in 11 of the 46 noninvasive IPNBs, but not in invasive IPNBs. Additionally, CK19 was frequently expressed in both noninvasive IPNBs and invasive IPNBs. The intestinal-type IPNBs had a significantly higher percentage of MUC2 expression relative to the pancreaticobiliary (P = 0.015) and gastric-type IPNBs (P < 0.001). High-grade IPNBs and invasive IPNBs showed increased expression of cyclin D1, Ki-67, p53, mCEA, and CA19-9. The rate of KRAS mutation was significantly higher in high-grade IPNBs (P = 0.001) and invasive IPNBs (P = 0.006) than that in low- to intermediate-grade IPNBs. Additionally, KRAS mutation was significantly associated with tumor size, and Ki-67 expression. In conclusion, the expression of cyclin D, Ki-67, p53, mCEA and CA19-9 and KRAS mutation status are significantly correlated with histological grades of IPNBs.