网膜囊与毗邻结构空间关系的三维可视化研究

目的 运用三维可视化技术深入了解网膜囊的解剖特征,以弥补厚层断面解剖与CT图像无法清晰显示网膜囊及其毗邻结构的空间关系的不足。方法 从2号中国可视人数据库（CVH2）获取上腹部图像数据,对网膜囊各隐窝及其毗邻结构进行数据分割,三维可视化重建和多平面重建后进行两种重建图像的整合,并在断层与三维多角度观察网膜囊各隐窝与毗邻结构的空间关系。在53例肝硬化伴大量腹水患者的CT多平面重建图像上观察上述空间关系,并判断上、下隐窝通连情况。结果 网膜囊由上隐窝、前庭部、下隐窝和脾隐窝组成。网膜囊大孔是上、下隐窝的分界标志,也是上、下隐窝通连的唯一路径,CT图像显示其通连方式分为通连和不通连两型,36例（67.9%）患者的CT图像上可见上、下隐窝直接通连,17例（32.1%）患者不通连。网膜孔右侧正对门腔间隙,该间隙最小前后径为4.5 mm。三维图像显示胃裸区位于上隐窝、下隐窝和脾隐窝之间。脾隐窝被左侧的脾裸区包饶。结论 本研究运用CVH2图像可视化技术呈现了网膜囊及其与毗邻结构的空间关系,这将有助于提高网膜囊区域病变的鉴别诊断和解剖定位的准确性,从而降低网膜囊区病变的误诊率。     

成年国人大网膜多层螺旋CT应用解剖学研究

目的研究成人大网膜的多层螺旋CT解剖,探讨相关临床意义,为影像诊断和外科应用提供理论基础。方法利用成人腹部16层螺旋CT的横、冠、矢状断层及三维图像,观察大网膜的解剖分布、与周围脏器毗邻关系、血管的形态特点,探讨不同断面的显示优势以及临床应用。结果1.各种断面的优势:横断位在于观察大网膜的分布以及脂肪情况;冠状位在于观察血管情况;矢状位在于观察大网膜与邻近脏器的解剖毗邻关系。2.三维重建图像可满意地显示胃网膜静脉回流情况。3.胃结肠静脉(包括典型及非典型)出现率为67.2%;游离部具“游走性”:20.7%移位于上腹腔,17.2%偏右下腹腔分布;大网膜脂肪密度CT值为(-104.97±10.78)Hu,与皮下脂肪差别无统计学意义。结论胃网膜动静脉为寻找大网膜的标志,3种断面及三维图像相结合可充分显示大网膜的解剖学特征,并可为影像诊断、修复外科、胰腺及门静脉高压外科提供有价值的信息。     

大网膜的形态及血液供应

随着显微外科技术的进展,大网膜的临床应用日益广泛。本文采取教学用成人尸体140具(男75女65),约2/3尸体的动脉曾注入着色乳胶,在打开腹腔,未作任何其他解剖前,观察了大网膜的形态位置及血管分布,测量了大网膜的长度、宽度、胃网膜血管和大网膜血管的外径。另外对二例新生儿作了动脉造影。     

利用泪囊组织行先天性无眼球眼结膜囊成形术1例

<正>先天性无眼球的整形治疗是一个长期复杂的过程,结膜囊成形术中增加结膜面积的组织较多,包括自体结膜、羊膜、口腔黏膜、异体巩膜等。然而使用自体膨大的泪囊来行结膜囊成形目前未见相关报道,我院用该方法治疗1例先天性无眼球合并泪囊炎的患儿,效果满意,现报告如下。1临床资料患儿,男,9岁,出生时左眼球缺如,伴溢泪、脓性分泌物,未予治疗。入院时眼部检查:左侧面中部轻度塌陷,睑裂缩短为正常的1/2,挤压泪囊区大量脓性分泌物流出,结膜囊狭窄,眼     

家兔大网膜的动脉分布

本文采用动脉灌注乳胶和软x线造影方法,对50只家兔大网膜动脉的分支分布、口径、长度和大网膜的范围进行了观察和测量。根据大网膜动脉弓所在的位置,可分为三型:低位型最多(44±7.02％),中间位型次之(36±6.79％);高位型最少(20±5.66％)。家兔大网膜的边缘区血管最为丰富,适合于实验性移植用。本文讨论了家兔大网膜动脉的解剖特点,并与人类作了比较。     

大网膜囊肿疝入阴囊一例

一、临床资料:男性,2岁。右侧阴囊巨大可复性肿块一年。查体:腹部明显膨隆,右侧阴囊内可见一直径约15cm卵圆形包块,透光试验( ),包块挤压或平卧后可消失。诊断为右侧腹股沟斜疝。手术所见:取右侧腹股沟疝切口,打开疝囊可见大量多房性半透明的囊性肿物通过内环口不断涌出,越牵越多,找不到尽头。从内环口向上纵形延长切口进入腹腔,可见囊性肿物源于大网膜,且布满大网腹。于胃大弯和横结肠缘将肿物完整切除后行疝囊高位结扎。切除肿物约4kg术后腹部明显塌陷。病例报告:大网膜囊肿。     

角膜干细胞重建眼表后泪膜稳定性改变的试验研究

目的：研究角膜缘干细胞重建眼表术后泪膜生理功能改变，探讨利用角膜缘干细胞移植重建眼表的有效性和评价指标。方法：以健康雄性新西兰兔为实验对象，取左眼角膜缘干细胞体外培养，然后进行眼表重建，观察泪膜生理功能改变情况。结果：采用羊膜为载体培养角膜缘干细胞，移植修复眼表结构后，眼表细胞形态与烧伤前相似；泪膜破裂时间测试，修复后与烧伤后有显著差异（P<0.05），修复后与烧伤前无显著差异（P>0.05）。结论：利用角膜缘干细胞培养可能是重建眼表有效途径，修复后细胞结构形态和泪膜生理功能恢复良好；眼表细胞结构形态分析和泪膜破裂时间是良好的眼表重建疗效分析指标。     

女性大网膜腺癌2临床病理分析

目的 探讨女性大网膜腺癌临床病理特征、诊断与鉴别诊断.方法 对2例大网膜腺癌进行形态学观察及免疫组化研究,并结合文献与卵巢原发癌对比分析.结果 大网膜腺癌组织学特征:例1由复层非黏液性柱状上皮细胞构成,细胞排列成圆形或卵圆形腺样结构,部分腺体融合呈筛网状,诊断为腹膜内膜样腺癌.例2由输卵管型上皮细胞构成,细胞呈腺管状、乳头状结构,诊断为腹膜浆液性腺癌.2例肿瘤细胞均表达间皮素(mesothelin,MSLN)、CA125等卵巢上皮抗原.结论 大网膜腺癌病理学形态、临床经过与卵巢原发上皮癌无差别,分子改变有差异.     

大网膜内肌动蛋白的表达及其与运动的关系

肌动蛋白(actin)在真核细胞内有广泛的表达[1]。Ac-tin参与细肌丝与微丝的构成,是细胞的运动成分与骨架,具有非常复杂的功能[2]。大网膜具有活跃的运动功能,在腹膜炎和腹腔脏器病变时,大网膜向病灶处移动并对其实施包裹。大网膜的运动功能是否与actin有关,目前未见报道。本研究运用免疫组织化学的方法,观察了actin在大网膜内不同结构的表达,分析了actin与大网膜运动的关系。1材料和方法1.1实验动物及材料的制备取成年健康SD大鼠5只,断头处死,剖开腹腔,于大网膜根部剪断并取出大网膜,用4%多聚甲醛固定,常规石蜡包埋,切片厚6μm,切片贴于经…     

介绍一种用兔大网膜制作间皮和毛细血管标本的方法

<正> 传统制作间皮和毛细血管标本,大多采用青蛙或鼠的肠系膜、大网膜铺片.但由于它们的肠系膜面积窄小,不易展平,大网膜脂肪多,四层单层扁平上皮重叠在一起,不易分离,制作出来的标本往往使细胞牵拉变形,微血管聚拢而影响观察,又不能一次制作大量标本以满足教学的需要.我们在实践中发现兔的大网膜不发达,实际上是一部分胃系膜延伸折叠成双层囊覆盖于胃体之上,其面积大、毛细血管丰富、脂肪极少、且易分离成二层单层扁平上皮,是制作间皮和毛细血管的优良材料.1 材料和方法兔处死后,打开腹腔,可以看到大网膜从胃小弯向胃大弯延伸,覆盖在胃体上面,沿着胃大弯剪开大网膜,将双层的网膜轻轻分离开,向上提起,将备好的胶木圈平直伸入网膜之间,使其均匀的展平并粘着在胶木圈上,然后沿胶木圈的下边缘剪去多余的网膜,取出粘附有网膜的木圈,待稍干后,可按需要分别制作显示间皮或毛细血管的方法来处理.1.1 用镀银方法显示间皮将粘附着网膜的胶木图浸入1%硝酸银水溶液中,在阳光下晒10～15分钟,当看到网膜呈棕黄色时,加满蒸馏水并使其溢出,将硝酸银溶液完全冲去,以防止银离子沉淀在网膜上.取出木圈再放入蒸馏水中充分水洗,用改良Carazzi苏木素染液复染细胞核1～2分钟,不须分化,自来水冲洗15分钟,     

Translocation (5; 11) in a conjunctival MALT lymphoma

Lymphoma is the most frequent malignant tumor of the ocular adnexa with the most common histologic type being extranodal marginal zone B-cell lymphoma (EMZL) of mucosa-associated lymphoid tissue (MALT lymphoma). Here we report a case of a 28 year-old male who presented with a left conjunctival mass of one year duration. A diagnosis of primary MALT lymphoma of the conjunctiva was made based on morphologic and immunopheno-typic studies. Chromosome analysis revealed a male karyotype with a translocation t (5;11) (q33;p11.2) as the primary chromosomal abnormality, which, to the best of our knowledge, is the first reported translocation in MALT lym-phomas and ocular MALT lymphomas as well.     

Histamine receptors and the conjunctiva

PURPOSE OF REVIEW: The purpose of this review is to evaluate the effect of histamine on various receptors in the conjunctiva. A Medline search from 1980 was performed on the histamine receptor subtypes H1, H2 and H3 in the human conjunctiva. RECENT FINDINGS: In the conjunctiva, histamine has been shown to induce various physiological and immunological changes through both H1 and H2 receptor stimulation. Histamine binding to conjunctival H1 receptors through the phospholipase C-dependent inositol phosphate pathway leads to the symptom of pruritus while histamine stimulation of the conjunctival H2 receptors has been indirectly shown to cause vasodilation. SUMMARY: The effect of histamine on conjunctival H1 receptors appears to be the primary target for ocular allergy treatment as it is primarily involved in ocular pruritus. The exact interaction of the conjunctival H2 receptors appears to work in a complementary fashion to the H1 receptor in controlling other features of ocular allergy such as vasodilation and injection. Thus, oral and topical antihistamines with multiple histamine receptor binding activities may provide an improved treatment paradigm for the various signs and symptoms of ocular allergy. The histamine H1, H2 and H3 receptor affinities of ketotifen, pyrilamine, and epinastine appear to have the strongest H1 and H2 affinities.     

Lymphoid hyperplasia and malignant lymphoma occurring in the ocular adnexa (orbit, conjunctiva, and eyelids): a prospective multiparametric analysis of 108 cases during 1977 to 1987

We performed a prospective multiparametric correlative clinical, histopathologic, and immunologic analysis of 117 ocular adnexal lymphoid proliferations developing in 108 patients between October 1977 and July 1987. The ocular adnexal lymphoid proliferations were distributed among the 108 patients as follows: orbit 69 (64%), conjunctiva 30 (28%), and eyelids nine (8%). The 117 ocular adnexal lymphoid proliferations were classified as follows: polyclonal lymphoid hyperplasia, 32 (22 orbit, nine conjunctiva, one eyelid) (27%); monoclonal B cell lymphoma, 81 (48 orbit, 25 conjunctiva, eight eyelid) (69%); null cell lymphoma, one (orbit) (1%); and histologically indeterminate, three (one each: orbit, conjunctiva, eyelid) (3%). Patients presenting with ocular adnexal polyclonal lymphoid hyperplasia and monoclonal B cell lymphoma, and patients developing unilateral and bilateral ocular adnexal lymphoid proliferations did not differ significantly with respect to age, sex, presenting complaints, duration of symptoms, or ophthalmic findings. Classifying ocular adnexal lymphoid proliferations into benign and malignant categories by histopathologic criteria and into polyclonal and monoclonal B cell categories by immunophenotypic criteria was not useful in predicting eventual outcome, including the occurrence of extraocular lymphoma. However, the clinicopathologic characteristics did differ according to the anatomic site of involvement and histopathology of the ocular adnexal lymphoid proliferations. Lymphoid infiltrates of the conjunctiva were associated with a lower incidence of extra-ocular lymphoma (20%) than were those of the orbit and eyelid, 35% and 67%, respectively (statistically significant, P less than .03). Ocular adnexal small lymphocytic and intermediate lymphocytic lymphomas were less often associated with extra-ocular lymphoma than were ocular adnexal lymphomas of all other histologic types, 27% and 46%, respectively (P less than .09). However, the single most important and statistically significant prognostic factor in these patients was the extent of disease at the time of presentation with an ocular adnexal lymphoid proliferation (P less than .001). Eighty-six percent of patients presenting with a unilateral or bilateral clinical stage lE ocular adnexal lymphoid proliferation, regardless of the histopathology or the immunophenotype, had a benign indolent clinical course and failed to develop ocular or extra-ocular lymphoma during a median follow-up period of 51 months. The results of this study substantially improve our understanding of extranodal small lymphocytic proliferations in general, and those of the ocular adnexa in particular.     

CD5-undetected by immunohistochemistry, t(11;14)(q13;q32)-positive conjunctival mantle cell lymphoma: a case report

Most primary ocular adnexal lymphomas are extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). A few cases of ocular adnexal mantle cell lymphomas have been reported in the literature. We present a case of mantle cell lymphoma presenting as conjunctival mass. A 58-year-old man presented with a palpable mass in the left lower tarsal conjunctiva incidentally detected one month previously. Histopathologic examination showed proliferation of monomorphous small-to-medium sized lymphoid cells. On immunohistochemistry, tumor cells were positive for CD20, bcl-2, and cyclin D1, and negative for CD5. PCR analysis for immunoglobulin heavy chain gene rearrangement showed monoclonal B-cell proliferation. t(11;14)(q13;q32), involving the CCND1 and IGH genes, was detected in interphase fluorescent in situ hybridization using formalin-fixed, paraffin-embedded tissue; however, MALT1 gene translocation was not observed. The final diagnosis was mantle cell lymphoma. There was no lymphadenopathy; however, bone marrow involvement of the lymphoma was suspected. The patient has been receiving systemic chemotherapy. This case emphasizes the differential diagnosis of conjunctival mantle cell lymphoma from extranodal marginal zone B-cell lymphomas of MALT regarding the clinical and pathological aspects.     

Vitrified collagen-based conjunctival equivalent for ocular surface reconstruction

The main functions of the conjunctiva, an essential part of the ocular surface, are to maintain the equilibrium of the tear film and to protect the eye. Upon injuries, the prerequisite to successful ocular surface repair is conjunctival reconstruction. Tissue engineering techniques, including transplantation of autografts, amniotic membranes and numerous synthetic/natural materials, have been developed. However, none of these strategies is completely satisfactory due to lack of goblet cell repopulation, poor mechanical properties or non-standardized preparation procedure. Here, we cultured conjunctival epithelial cells on vitrified collagen membranes and developed a tissue equivalent for repairing damaged conjunctiva. Optimized vitrified collagen has superior mechanical and optical properties to previous biomaterials for ocular surface application, and its unique fibrillar structure significantly benefited conjunctival epithelial cell growth and the phenotypic development in vitro. In a rabbit model, vitrified collagen greatly promoted conjunctival regeneration with rapid re-epithelization, sufficient repopulation of goblet cells and minimized fibrosis and wound contracture, proved by gene expression analyses and histological staining. In conclusion, we have demonstrated the potential suitability of utilizing vitrified collagen-based tissue equivalent in ocular surface reconstruction.     

Immunopathology of ocular onchocerciasis. I. Inflammatory cells infiltrating the anterior segment.

Ocular tissue (conjunctiva and iris) was obtained from 12 adult African men with active ocular onchocerciasis and from nine age-matched persons from the same endemic region but without onchocercal infection. These tissues were examined immunohistologically and two major findings were noted. First, mild-to-moderate chronic inflammatory cellular infiltration was present in the conjunctiva of the onchocerciasis patients. T lymphocytes (CD3+) were the major inflammatory cells, and the T suppressor/cytotoxic (CD8+) subset was significantly increased in the ocular onchocerciasis patients (P less than 0.03). Second, in the onchocerciasis patients, non-lymphoid cells of the conjunctiva and iris, such as vascular endothelium, pericytes and fibroblasts were in an activated state, as shown by increased expression of Class II MHC antigens (P less than 0.02, conjunctiva; P less than 0.05, iris). These concomitant findings of lymphocyte infiltration and resident cell activation indicate a dynamic state of localized host responsiveness presumably to the microfilarial parasites and their products in the anterior segments of the eyes of patients with ocular onchocerciasis.     

Ocular cicatricial pemphigoid review

PURPOSE OF REVIEW: Ocular mucous membrane pemphigoid produces progressive cicatrizing conjunctivitis; this can result in scarring of the conjunctiva and cornea. RECENT FINDINGS: Increased expression of macrophage-colony-stimulating factor, collagen-binding heat shock protein 47, transforming growth factor-beta1, IL-4, IL-5, and macrophage migration inhibitory factor may enhance both conjunctival inflammation and conjunctival scarring. Recent developments on mucous membrane pemphigoid medical therapy include the efficacious effect of daclizumab, intravenous immunoglobulin therapy, and methotrexate. Subconjunctival mitomycin has proved not to be efficacious in controlling long-term, conjunctival inflammation and scarring. The Boston scleral lens enhances vision, reduces the disabling ocular pain and photophobia, and helps to heal persistent epithelial defects, reducing recurrence of defects. Recent developments on mucous membrane pemphigoid surgical therapy include keratolimbal allografts and amniotic membrane transplantation, with or without penetrating keratoplasty for ocular surface reconstruction in total stem cell deficiency. The prognosis is strongly influenced by preoperative conditions such as tear function and functional external ocular adnexae, and by postoperative conditions such as persistent inflammation, severe dry eye, or rejection of the keratolimbal allograft. Some authors find efficacious the use of amniotic membrane transplantation for reconstruction of the conjunctival fornices provided systemic immunosuppression is pre- and post-operatively used. SUMMARY: The use of daclizumab or intravenous immunoglobulin therapy, the better selection of candidates for surgical interventions, and the better pre- and post-operative management of keratolimbal allograft and amniotic membrane transplantation may improve visual rehabilitation in the patients with ocular mucous membrane pemphigoid.     

Differential diagnoses of conjunctivitis for clinical allergist-immunologists.

OBJECTIVE: To provide a clinical overview of the types of conjunctivitis that are encountered by practicing clinical allergist-immunologists. DATA SOURCES: Published literature in peer reviewed journals found in the National Library of Medicine (PubMed) database using the keywords ocular allergy and/or allergic conjunctivitis. STUDY SELECTION: Studies related to ocular allergy and/or allergic conjunctivitis were selected for inclusion in this review. RESULTS: Four clinical scenarios are presented that mimic frequently encountered inflammatory disorders that present as red eyes. CONCLUSIONS: The signs and symptoms associated with the various inflammatory conditions affecting the conjunctiva often overlap and need to be differentiated to maximize care for patients with conjunctivitis.     

毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响

目的：探讨抗青光眼药物毛果芸香碱和布林佐胺滴眼液及各自的防腐剂三氯叔丁醇和氯化苯甲烃胺（BAC）对兔眼表组织的影响。方法:选取新西兰大白兔15只，分为正常对照组（3只）、毛果芸香碱组（A组，6只）和布林佐胺组（B组，6只）。用药组右眼使用青光眼药物毛果芸香碱或布林佐胺滴眼液，左眼使用对应的防腐剂三氯叔丁醇或BAC，连续用药30 d。取球结膜组织行苏木素－伊红（HE）染色计数结膜上皮层炎症细胞数；角膜行扫描电镜检测并进行上皮损害分级评分。结果:与正常对照组比较，布林佐胺滴眼液（P<0.01）和防腐剂BAC（P<0.01）导致球结膜上皮层炎症细胞浸润增多；毛果芸香碱滴眼液（P>0.05）和三氯叔丁醇（P>0.05）引起的球结膜炎症细胞增多不明显。布林佐胺滴眼液导致球结膜炎症细胞增加的程度较毛果芸香碱滴眼液严重（P<0.01）。青光眼药物和防腐剂均可导致兔角膜上皮超微结构的损伤，表现为角膜上皮细胞六边形结构变为不规则、边界不清、细胞膜皱缩、细胞间距增宽、上皮细胞表面的微绒毛丢失、细胞空洞和暗细胞增加。布林佐胺滴眼液和BAC引起的角膜损害较毛果芸香碱滴眼液（P<0.01）和三氯叔丁醇明显（P<0.05）。各组左右两眼的球结膜炎症细胞数和角膜损害评分均无显著差异。结论:布林佐胺滴眼液和防腐剂BAC使用1个月后可导致兔球结膜炎症细胞增加和角膜上皮细胞损伤，毛果芸香碱滴眼液和三氯叔丁醇主要引起角膜上皮超微结构的变化；防腐剂是引起眼表损伤的主要原因。布林佐胺滴眼液对兔眼表的损伤较毛果芸香碱滴眼液严重。