人胃壁内迷走神经和动脉血管分布的应用解剖

目的探索胃壁内迷走神经和血管的分支分布。方法改良的Sihler＇s染色法。结果迷走神经前、后干在贲门附近分别发出2条和3条初级神经支，其中胃前支与胃后支主要集中在贵门至角切迹之间发出次级支，在胃壁呈扇形分布。胃后壁胃体部的分支及分支间吻合比胃前壁密集。胃前、后支在贲门附近的小弯侧有交通支，在大弯侧有广泛吻合。各动脉血管支从胃壁进入肌层深面，分支分布类似地图上的交通路线。胃前壁上血管分支相对后壁少，粗大，形成了胃体近端和幽门部两个密集分布区；胃后壁在胃底部和胃体中部分布密集。胃壁内血管有干吻合和细支吻合。胃小弯与幽门口区属于相对乏血管区。结论为适应胃运动、调节胃酸分泌等功能需要，胃的神经血管分布不均匀，存在密集分布区与稀疏区。     

隐神经营养血管蒂逆行岛状皮瓣修复小腿远端骨外露的疗效观察

隐神经从缝匠肌胫骨体近端内侧面止点下缘穿出进入小腿,在小腿一直位于皮下组织中,与膝降动脉的分支隐动脉伴行,隐动脉位置恒定,至小腿中上1/3交界处,一直位于隐神经前方之后围绕隐神经形成血管丛.这一血管轴不但发出许多细小分支至隐神经表面营养神经,而且还发出5～16个皮支至小腿内侧面膝踝之间的皮肤,隐神经营养血管与胫后动脉之间有2～7个吻合支,最低的吻合支在内踝近端3～5cm处.我科应用隐神经营养血管蒂逆行岛状皮瓣修复小腿远端骨外露9例,效果良好,现报道如下.     

成人胃表面动脉的形态学观察

目的:为胃表面动脉提供详实的解剖学资料,丰富胃动脉的解剖学资料。方法:通过乳胶灌注并解剖剥离的方法,观察胃各部的表面动脉构筑。结果:1胃表面动脉由大、小弯动脉弓发出的“直动脉”构成;2表面动脉的网眼由胃大、小弯动脉弓发出的分支构成,网眼大小、形状不规则。结论:胃表面动脉的形态依胃的不同部位而不同。     

人脑视皮质区软脑膜血管构筑的定量研究

采用明胶墨汁灌注、光学显微镜下观察拍片、体视学测算等方法,对13例生后不足6个月的新生儿和婴儿脑标本视皮质软脑膜血管构筑进行定量分析。结果表明:视皮质软脑膜动脉有顶枕动脉、距状裂动脉、颞下后动脉、颞后动脉等4个来源,多以直角发出长、短分支,形成直线型和“Y”型吻合。其进入皮质穿入点的数密度以距状裂上、下唇的后段最高;中段次之;前段最低。提示人脑视皮质存在着多来源动脉血供及血管密度差异分布的特点。认为大脑中动脉和大脑后动脉分支间在枕极月状沟附近的丰富吻合是“黄斑回避”现象的解剖学基础。视皮质各段血管密度差异分布的形成可能是视皮质各段细胞分化和功能完善的先决条件     

胃粘膜活检常见失误分析

胃是消化道最庞大的部分，上与食管相连为进口，下与十二指肠相连为出口。组织学上胃粘膜从内向外分为如下几层：粘膜层及粘膜固有层、粘膜肌层、粘膜下层、肌层、浆膜下层以及浆膜层等共7层，简要分为粘膜层、粘膜下层、肌层、浆膜层4层。胃粘膜病变通过内镜活检，应该是准确的，但有时可发生错误，现将内镜检查中遇到的常见导致误诊的因素归纳如下：     

分支补片在28例肝移植肝动脉重建中的应用

目的：介绍在肝移植肝动脉重建中,避免因吻合肝动脉口径相差过大,造成内膜损伤、术后狭窄和血栓形成的方法。方法;利用分支补片技术,将供肝肝总动脉和胃十二指肠动脉分叉处,修整成肝固有动脉补片。将受体肝固有动脉和胃十二指肠动脉分叉处,修整成肝总动脉补片,相事重建肝动脉。结果：在２８例肝移植肝动脉重建中均一次吻合成功,术后随访１－１２个月,经多普勒超声监测,管腔通畅,血流速正常。3例发生高流速、高阻力、肝穿刺活检证实为排异反应,应用甲基强的松龙冲击治疗缓解,血流速恢复正常。结论：本方法解决了吻合血管之间口径相差过大,易致吻合后吻合口缩窄的问题,加大了吻合口处口径,延长了动脉,减低了吻合口张力。出血极少,明显缩短了手术时间。     

胃底壁圆形切除、食管胃一层吻合法防止吻合口并发症的体会

1991年2月至1996年12月，我院采用胃底壁圆形切除、食管胃一层吻合法，行食管中段上段癌手术266例，现报告如下。临床资料266例中男性204例，女性62例。年龄34～72岁。其中发生吻合口疾4例（1。5％），吻合口狭窄5例（1．88％）。手术方法：采用左胸左颈或有胸左颈（右颈）吻合。食管游离至颈部至少肿瘤上scm，胃底通过食管床拉至颈部，先在食管须切平面上1．scm缝合食管后壁肌层和胃底浆肌层3～4针，切除直径4cm圆形胃底壁浆肌层，暴露粘膜下层缝扎粘膜下血管，同时在其中间剪除直径3cm圆形粘膜下层和粘膜层，切断食管肌层，长出肌层Icm处…     

胃粘膜下恒径小动脉破溃引起大出血1例

患者男性,47岁,1984年7月26日急诊入院,5天前连续黑便及胃隐痛,入院当天早晨胃痛加剧呕血约1500ml,Bp90/60;伴有头昏、心慌,冷汗。住院后经输血等保守治疗,仍继续呕血4次约2000ml,即于当天下午剖腹探查,术中发现:胃窦部小弯侧有直径1cm左右增厚区及出血.行胃大部切除及胃十二指肠吻合术,术后恢复顺利,痊愈出院。病理检查:胃窦部小弯侧粘膜下出血灶中,可见数个口开的小血管,直径约在9.4～0.5mm左右,被复的粘膜呈慢性炎症,有少许糜烂。镜下可见粘膜下血管口径较大伴出血。病理诊断:粘膜下恒径小动脉病变。     

食管颈部器官外及表面动脉的观测

目的:探讨食管颈部动脉的来源及分支形态,为临床应用补充解剖学资料;方法:利用成、幼尸25具,红色乳胶灌注,解剖剥离,肉眼观察形态,分别测量;结果:该部供血动脉起点较多,其中甲状腺下动脉的食管支占71.43%;供血动脉可游离长度平均为(16.01±9.15)cm;器官外动脉分支分3种类型;器官表面动脉分支有4种类型,吻合形态有3种。结论:食管颈部动脉来源丰富,吻合较多,但血供评价应综合考虑器官内外的血管构筑。     

手术治疗烟雾病的困窘

Moyamoya(烟雾)病是一种特殊发展过程中的脑血管闭塞性疾病，有多种侧枝循环类型。该病手术方法有二，即直接吻合血管和间接非吻合血管再生法，前者有STA-MCA(颞浅动脉-大脑中动脉)吻合术、0A-MCA(枕动脉-大脑中动脉)吻合术和静脉移植术，后者则有EMS(脑肌联合血管术)、EDAS(脑硬膜动脉联合血管术)及其它方法。     

In vitro study of ethanol on the electrical parameters in rat stomachs

The electrophysiological effects of mucosal or submucosal ethanol (5, 10, or 20%) were assessed in isolated stomach preparation. Mucosal incubation with these concentrations of ethanol dose- and time-dependently decreased the transmucosal potential difference (PD), while the electrical current (I) and resistance (R) were unaffected. Submucosal exposure to the same concentrations of ethanol also reduced the PD, but to a lesser extent; only 20% of ethanol produced a significant effect. This same dose of ethanol not only decreased I but also increased R to a significant level. These findings indicate that transmucosal PD appears to be generated largely by the mucosal epithelial cell barrier, while the I and R are elicited by the laminea propria mucosa which is easily approached and altered by ethanol which acts from the submucosal side. The significance of the effects produced by mucosal or submucosal ethanol is discussed.     

The enteric nervous system of Rana ridibunda stomach

The innervation of Rana ridibunda stomach has been studied by the following methods: demonstration of cholinesterase activity; FIF method for catecholamines; immunohistochemistry for VIP; SP and SOM and conventional electron microscopy. The cholinergic innervation is important in the stomach wall where in addition to the intrinsic plexuses there is an extrinsic contribution coming with the vagus nerve. The density of the fibres decreases towards the pyloric sphincter. The adrenergic innervation seems to be almost entirely of extrinsic origin. Fine networks have been localized at the myenteric and submucosal plexuses. The fibres density increases at the pylorus. At the myenteric plexus, apart from the cholinergic neurons, we have found VIP and SOM like cells. The VIP like plexus is very well developed. A SOM like plexus is also present but with scarce fibres in comparison with the VIPergic one. The submucosal plexus is exclusively made by nervous fibres of the types described for the myenteric one. We have got positive immunoreactivity for SP only on the fibres. They are scarce in the stomach wall, only at the pyloric region their density increases. We describe the ultrastructural morphological characteristics of the enteric neurons as well as the fine inter-relationships between the nervous elements and the functional components of the stomach wall.     

A case of gastrointestinal stromal tumor of the stomach

In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis C discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. Biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. Immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.     

Microvascular leakage to platelet activating factor in guinea-pig trachea and bronchi

Conscious guinea-pigs received platelet activating factor (PAF, 0.03-0.25 microgram/kg, i.v.) and colloidal carbon (C, tracer for microvascular leakage). Fifteen min later the animal was killed and C-labelled microvessels (leakage) were detected in the mucosal/submucosal region of tracheal and bronchial sections. PAF was more potent than LTD4 or histamine. The numbers of leaky vessel were dose-related, arterioles and arteries were not affected, leaky vessels were seen from proximal trachea to intrapulmonary bronchi and carbon was not apparent in the alveolar wall. The effect was quick in onset, of short duration, could be repeated, was not produced by lyso-PAF and was unaffected by thrombocytopaenia (produced by an antiserum). Thrombocytopaenia itself did not cause leaky vessels in the airways nor affect histamine responses. Thus, PAF causes an increase in microvascular leakage in the conducting airways, which is not dependent on platelets. The affected vessels are probably postcapillary bronchial venules and PAF may act via an endothelial cell receptor in these microvessels. This leakage effect of PAF in the airways could contribute to features of bronchial asthma.     

Over-expression of Slit2 induces vessel formation and changes blood vessel permeability in mouse brain

Aim:

To investigate the effect of the axon guidance cue Slit2 on the density of blood vessels and permeability of the blood-brain barrier in mouse brain.

Methods:

hSlit2 transgenic mouse line was constructed, and the phenotypes of the mice were compared with wild-type mice in respect to the lateral ventricle (LV), ventricle pressure, and the choroids plexus. An in vivo Miles permeability assay and an amyloid-β permeability assay were used to assess the permeability of brain blood vessels. Brain vessel casting and intracerebral hemorrhage models were built to investigate vessel density in the transgenic mice. An in vitro permeability assay was used to test whether Slit2 could change the permeability and tight junctions of blood vessel endothelial cells.

Results:

Hydrocephalus occurred in some transgenic mice, and a significantly larger lateral ventricle area and significantly higher ventricle pressure were observed in the transgenic mice. The transgenic mice displayed changed construction of the choroids plexus, which had more micro vessels, dilated vessels, gaps between epithelial cells and endothelial cells than wild-type mice. Slit2 significantly increased brain vessel density and the permeability of brain vessels to large molecules. These blood vessels were more sensitive to cues that induce brain hemorrhage. At the cellular level, Slit2 disturbed the integrity of tight junctions in blood vessel endothelial cells and improved the permeability of the endothelial cell layer. Thus, it promoted the entry of amyloid-β peptides from the serum into the central nervous system, where they bound to neurons.

Conclusion:

Slit2 increases vessel density and permeability in the brains of transgenic mice. Thus, Slit2 induces numerous changes in brain vessels and the barrier system.     

Indirect effects of bradykinin on ion transport in rat colon descendens: mediated by prostaglandins and enteric neurons

Summary The effect of bradykinin on two preparations of rat colon descendens was examined. In a mucosa-submucosa preparation consisting of the submucosal plexus, the mucosal plexus and the epithelium bradykinin (10^–10-5 × 10^–9 mol · 1^–1) caused an increase in Isc, Gt and Pd which was to more than 70% diminished by TTX. However, in a mucosa preparation consisting of only the mucosal plexus and the epithelium bradykinin caused an increase in Isc, Gt and Pd, which was not affected by TTX. Ten times higher concentrations of bradykinin were needed in the mucosa preparation to reach the same effects as in the mucosasubmucosa preparation. All effects of bradykinin were markedly reduced in the presence of indometacin indicating that they were mediated by prostaglandins in both preparations. The bradykinin effect in the mucosa-submucosa preparation but not in the mucosa preparation was reduced about 50% by atropine. The results suggest that bradykinin activates prostaglandin synthesis. Prostaglandins subsequently stimulate neurons in the submucosal plexus which induce a secretory response on the epithelium partially mediated by a muscarinic receptor. In a high concentration bradykinin due to the induction of prostaglandin synthesis can also activate directly the mucosal epithelium. Send offprint requests to M. Diener     

Characterization of specific delta-opioid binding sites in the distal small intestine of swine

Delta-opioid receptors modulate neurogenic smooth muscle contractions and mucosal ion transport in the porcine distal small intestine. We compared specific delta-opioid binding sites in neuronal membranes isolated from the inner submucosal plexus and myenteric plexus of this gut region. In both preparations, the delta-opioid receptor antagonist naltrindole displaced [3H]diprenorphine from two binding sites. [3H]Naltrindole bound specifically to a single high-affinity site that was displaced by delta-opioid receptor ligands with the rank order of affinity: naltriben >7-benzylidenenaltrexone>deltorphin II>[D-Pen(2), D-Pen(5)] enkephalin. Relative decreases in delta-opioid receptor agonist affinity in the presence of Na(+) and other ions differed in submucosal and myenteric membranes. The kappa-opioid receptor antagonist norbinaltorphimine displaced [3H]naltrindole binding in myenteric membranes (K(i)=7.2 nM). Delta-opioid receptors in submucosal and myenteric plexuses of porcine ileum appear to differ in some respects.     

超声内镜联合EMR及ESD诊治上消化道黏膜下肿瘤的效果

目的 探讨超声内镜联合内镜下黏膜切除术(EMR)与黏膜剥离术(ESD)治疗上消化道黏膜下肿瘤(SMTs)的临床价值。方法 对2010 年2月至2011年2月进行EMR与ESD治疗的50例上消化道SMTs患者的病例资料进行回顾性分析,总结其治疗效果。结果 50 例上消化道SMTs中,位于食管10例,胃40例。术前内镜下超声小探头诊断间质瘤15例、异位胰腺17例、脂肪瘤18例。其中30 例行EMR,20例行ESD。病灶均完整切除,未发生出血、穿孔等并发症,术后病理组织学均符合超声内镜检查结果。患者术后均随访两年,无一例复发。结论 经内镜治疗上消化道黏膜下肿瘤安全、有效。     

Ethyl acrylate-induced gastric toxicity. I. Effect of single and repetitive dosing

Ethyl acrylate (EtAc) is widely used in the production of polymers and copolymers for use in the preparation of latex paints, textiles, paper coatings, and specialty plastics. EtAc caused squamous cell carcinomas and papillomas in the forestomach (nonglandular portion of the stomach) of both sexes of F344 rats and B6C3F1 mice when administered chronically by gavage. The current studies were undertaken to investigate and characterize the nature of the acute gastric toxicity caused by EtAc. Gavage administration of a single dose of 100, 200, or 400 mg/kg EtAc (in corn oil) to F344 male rats caused dose-and time-dependent mucosal and submucosal edema and vacuolization of the tunica muscularis in the forestomach and mild submucosal edema in the glandular stomach. Equivalent sc or ip doses did not produce similar gastric lesions. Treatment of rats with two or four consecutive oral daily doses (200 mg/kg each) of EtAc caused mucosal edema associated with vesicle formation, mucosal hyperplasia, submucosal edema and inflammation, and vacuolization of the tunica muscularis of the forestomach. Submucosal edema and inflammation were also observed in the glandular stomach and mucosal erosions or ulcers were observed in both portions of the stomach after repeated oral exposure to EtAc. The absence of systemic toxicity plus the dependency of gastric lesions on the gavage route of administration suggest that the EtAc-induced gastric lesions may be a consequence of localized hemodynamic changes, specifically those characteristic of a classical immediate inflammatory response to an injurious agent at the site of administration.     

大脑血管内胆碱乙酰转移酶免疫反应活性(英文)

本文采用间接免疫荧光染色(双抗体法)和非标记抗体-过氧化物酶-抗过氧化物酶法(PAP法),使用抗纯化胆碱乙酰转移酶(CHAT)抗体,对猫和猪各种体积的脑软膜动静脉,脑实质内微血管以及脉络丛的乙酰胆碱能神经的存在和分布进行了研究。 结果表明,脑软膜动静脉的ChAT免疫反应性神经主要是成束状的,只有少数是由细小纤维组成,静脉的此类神经供应少于其动脉供应程度,同时,ChAT免疫反应纤维的密度又与血管的体积成比例,在小分枝的动静脉上(外径小于30μm)通常观察不到此类纤维的存在,脉络丛的动静脉有ChAT免疫反应性神经存在,但此类神经在实质内微血管则观察不到,以上结果与以前报告过的颅内和实质外动脉的乙酰胆碱酯酶(AChE)性纤维的密度比同类静脉所存在密度大的结果相符,而ChAT免疫反应纤维分布的方式则与报告过的AChE性纤维的分布方式不同,后者主要是由细小纤维组成,尽管离体的实质内微血管无ChAT免疫反应纤维,但胆碱能神经接近和“突触化”此类微血管的可能性不能排除,脑软膜血管一些内皮细胞胞浆内也有ChAT免疫反应活性存在,因此,本文结果与神经元和血管内皮两者的胆碱能机构在控制脑循环中起着重要作用之假说相一致。