Sinus Lumen Research Articles

Prostate Development Requires Sonic Hedgehog Expressed by the Urogenital Sinus Epithelium

The prostate gland develops from the urogenital sinus by a testosterone-dependent process of ductal morphogenesis.Sonic hedgehog(Shh) is expressed in the urogenital sinus epithelium and the time course of expression coincides with the formation of the main prostatic ducts. Expression is most abundant in the lumen of the urogenital sinus and in the contiguous proximal duct segments. The initial upregulation ofShhexpression in the male urogenital sinus depends on the presence of testosterone. The function of Shh was examined in the male urogenital sinus which was transplanted under the renal capsule of an adult male host mouse. Blockade of Shh function by a neutralizing antibody interferes with Shh signaling and abrogates growth and ductal morphogenesis in the transplanted tissue. These observations show that testosterone-dependentShhexpression in the urogenital sinus is necessary for the initiation of prostate development.

Clinico-pathological study in patients with transverse-sigmoid sinus dural arteriovenous malformations

Treatment modalities and histopathological findings of transverse-sigmoid sinus dural arteriovenous malformations (AVMs) were evaluated. Twenty-eight patients with this disease were treated with a variety of treatment modalities. Ten patients were treated surgically. Of these patients, 3 were treated with sinus isolation, 4 with sinus removal and 3 with palliative operation. Ten patients underwent endovascular surgery. Of these patients, 3 were treated with transarterial embolization (TAE) alone, 2 with transvenous embolization (TVE) alone and 5 with direct sinus packing (DSP) with/without TAE and/or TVE. Eight patients were treated conservatively. The resected dural sinuses were cut into serial sections and evaluated histopathologically. The histopathological study revealed the communications between dural arteries and dural veins emptying the involved sinus. No direct communication between dural arteries and the sinus lumen was found. The essential lesion of the dural AVMs was confirmed to be the dural AV fistulas within the sinus wall. Transvenous or direct sinus packing may well offer a radical and safer alternative to the surgical treatment, but still requires a long-term follow-up.

Acute sinusitis in the rabbit model: histologic analysis.

Characterize the histology of the rhinogenic model of sinusitis and compare this with existing models of sinusitis. Prospective controlled trial in animals. New Zealand white rabbits were implanted with a synthetic sponge, which was then impregnated with Streptococcus pneumoniae bacteria. After a specified time the animals were sacrificed, and whole-mount sectioning of both the infected and noninfected sinuses was performed. The sinuses were carefully examined for evidence of inflammatory changes. This model produced a sinus infection that is characterized by luminal exudates of neutrophils and eosinophils, mucosal infiltration with lymphocytes and plasma cells, and epithelial degeneration. In addition, discrete lymphoid follicles were identified in both the implanted and nonimplanted sides that in the implanted sides appear to hypertrophy and liberate leukocytes into the sinus lumen. Other areas were observed where luminal exudates seem to act on and degrade mucosa that has little or no underlying inflammation. In severely infected sinuses submucosal vacuole formation with overlying granulation tissue was observed. The rhinogenic model of sinusitis demonstrates features typical of other known models of sinusitis. In addition, there appear to be unique features of this model, specifically the identification of discrete lymphoid aggregates, which suggest that this model has the potential to be valuable for the study of the immune response of the sinuses.

Transvenous Embolizations of Venous Compartments of Dural Arteriovenous Fistulas within Venous Sinus Walls

Transvenous embolization of venous compartments within the venous sinus wall was the method initially attempted for closing dural arteriovenous fistulas in 15 patients (22 sinuses). The venous channel, separate from the sinus lumen and located in the venous sinus wall, could be embolized in 6 lesions (3 patients), including 3 superior sagittal sinus fistulas, 2 transverse sinus fistulas, and 1 straight sinus fistula. This technique resulted in closure of the fistulas and preservation of sinus patency as well as immediate improvement of clinical symptoms. The embolizable venous compartment of the fistula within the venous sinus wall could be detected by preoperative angiography, magnetic resonance imaging, and intraoperative venography. This unique drainage of dural arteriovenous fistulas may develop concurrently with more obvious portions of the fistula. Transvenous embolization of these venous compartments can close the fistulas and normalize impaired sinus function.

Transvenous embolization of dural fistulas

Three patients with dural arteriovenous fistulas (DAVFs) involving the transverse, sigmoid and superior sagittal sinuses were treated by transvenous embolization with coils. Two patients underwent firstly transarterial embolizations without complete angiographic cure. In a second endovascular treatment a 5 French catheter was advanced from a femoral vein access into the internal jugular bulb and the Tracker 18 catheters were navigated through the sinus lumen into the involved cortical veins or the parasinusal venous draining channels of the DAVFs. The venous recipients at the level of the nidus area of the DAVFs were selectively occluded by fibered platinum coils. There was a complete angiographic cure in both patients with occlusion of the venous recipients and the nidus of the DAVFs, and the sinus segments next to the nidus of the DAVFs remained patent. The third patient had multiple DAVFs with complete thrombosis of his ipsilateral sigmoid sinus. He was treated initially with transvenous approach through the contralateral jugular bulb. The coils were placed within the venous recipient adjacent to the incomplete thrombosed ipsilateral transverse sinus. It achieved a 90% reduction of the flow. The placement of coils via a transsinusal route into the venous channel of a dural fistula, yet outside the sinus lumen, can result in an obliteration of the fistula, without any damage of the physiological function of the dural sinuses.

Treatment of colorectal and ileoanal anastomotic sinuses.

This study is designed to describe a technique and report results for treating low anastomotic sinuses. Restorative proctocolectomy and complicated low anterior resections were protected with diverting loop ileostomy. Contrast enemas identified anastomotic problems before ileostomy closure. Pouch-anal or colorectal anastomotic sinuses that failed to resolve with observation were treated before intestinal continuity was restored. With the patient receiving regional or general anesthesia, a rigid proctoscope or anoscope was used to identify the sinus opening. The common wall between the sinus and the bowel lumen was divided under direct vision with laparoscopic cautery scissors, and the sinus cavity was debrided with a suction cautery wand placed through the scope. Six patients with anastomotic sinuses have received outpatient treatment in the described manner during the past two years. Four patients had restorative proctocolectomies for ulcerative colitis, and two had low anastomosis for rectal cancer. Three patients presented with pelvic sepsis before the contrast study; the remainder were asymptomatic. Division of anastomotic sinus was performed one to eight months after diagnosis of the sinus. Following division, anastomotic cavities resolved in five patients by 1 month and in one patient by 12 months. In these six patients, there was one dilatable anastomotic stricture but no other anastomotic complications at follow-up 5 to 16 (mean, 9.2) months after sinus division. When used in conjunction with fecal diversion, sinus unroofing by division of the common wall between the sinus and bowel lumen treats low pelvic sinuses.

ブロイラー鶏頭部腫脹症候群の病変

Broiler cases of swollen head syndrome (SHS) occurring at three different farms and showing respiratory symptom, swollen heads and severe depression were studied pathologically. Atnecropsy affected chickens showed the swollen head and eyelids due to facial cellulitis with caseous exudate in the air space of the cranial bones but no exudate in the lumen of the infraorbital sinus and the nasal cavity. Microscopy revealed chronic fibrinopurulent inflammation with granulomas in the air space of the cranial bones, middle ears and facial skin. Conjunctivitis and tracheitis with infiltration of lymphocytes and plasma cells with germinal centers were observed. The E. coli isolate from the wattle of an affected chicken was inoculated intramuscularly (107 CFU) into 2-weeks-old SPF chicks, and acutefibrinopurulent pericarditis and serositis, but no SHS lesions were produced.

Morphological Observations of Megakaryocytic Emperipolesis in the Bone Marrow of Rats Treated with Lipopolysaccharide.

A morphological examination was performed on megakaryocytic emperipolesis containing neutrophils in the rat bone marrow induced by intravenous administration of lipopolysaccharide (LPS). Ultrastructurally, the engulfed neutrophils appeared to lie in the demarcation membrane system (DMS) of megakaryocytes. Intact neutrophils generally migrated from DMS into the lumen of vascular sinus across the endothelium of sinus wall. However, some neutrophils showed characteristics of apoptosis, and DNA fragmentation was detected in these cells by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling method. Thus, the cell death of neutrophils engulfed by megakaryocytes was thought to be apoptosis. The present results suggest that megakaryocytes contribute to random selection of an excess of neutrophils in the bone marrow of rats treated with LPS.

Pathogenetical consideration of spontaneous dural arteriovenous fistulas (DAVFs).

Sinus thrombosis has been regarded as an aetiological factor in DAVFs. However, this claim has been disputed in the literature; because it is not possible to prove that DAVFs arise as a result of sinus thrombosis in all cases, and there is evidence that venous thrombosis can be acquired from a DAVF. The purpose of this study is to examine the hypothesis that the different angiomorphologies of DAVFs depend on the location of their venous outflow, and that a territorial classification of spontaneous DAVFs can be created which is based on their acquired development as a consequence of the breakdown of autoregulation of dural microvascularisation after venous thrombosis. The clinical and radiographic findings of 96 patients with DAVFs were reviewed. The angiomorphology of these lesions was examined using extensive prospective and retrospective angiographic studies, especially with regard to their venous characteristics. The associated phlebothrombosis of the venous outflow was determined in all cases by angiography, and in 8 cases by CT or MRI. We also applied the Venturi effect, a well-confirmed engineering principle, to propose a new hypothesis concerning the development of acquired DAVFs: namely, that there is an acceleration of the shunt volume of the physiological dural AVshunts afer a breakdown of their autoregulation occurs. This acceleration seems to be proportional to the flow volume of the venous outflow. The imaging examination showed venous thrombosis in 51 cases. In 98% (44) of the non-thrombotic cases, predisposing histories for phlebothrombosis were documented-for example, hypercoagulable states (venous embolism, phlebothrombosis of the leg, cardiac disease), diabetes mellitus, chronic otitis media, or various low-grade infections. In addition, in 78% of the non-thrombotic cases (excluding the DAVFs of the venous plexus at the base of the skull) there were also angiographically documented deformations of the sinus wall, including hypoplasia of the sigmoid or transverse sinus (20 cases), segmental narrowing of the sinus (8 cases), septation of the sinus lumen (2 cases), and cavernous nodules projecting into the lumen of the transverse (6 cases), sigmoid (4 cases), or sagittal (3 cases) sinuses. The clinical presentation suggested that DAVFs probably develop after a breakdown of the autoregulation of the physiological AV shunts resulting from a venous thrombosis, when there are suitable arteriovenous pressure gradients in the venous recipient. This development would depend on the haemodynamic action of the Venturi effect.(ABSTRACT TRUNCATED AT 400 WORDS)

Structure, vascularization, and innervation of the mystacial pad of the rat as revealed by the lectin griffonia simplicifolia

The mystacial pad of the rat is endowed with rows of vibrissal follicle-sinus complexes (F-SCs) that receive a dense and rich variety of innervation, much of which is C fibers. Each F-SC consists of a follicle at the core of a spindle-shaped, encapsulated vascular sinus. Previous studies have shown that the B subunit of the lectin Griffonia simplicifolia (GSA I-B4) binds selectively to a subset of small neurons in the trigeminal ganglion and to a subset of C fibers preferentially distributed to inner lamina II and outer lamina III of nucleus caudalis in the brainstem trigeminal complex in the rat. These laminae are also a major site of termination for afferents in superficial vibrissal nerves (SVNs) that innervate the upper portion of F-SCs. To determine the peripheral distribution of the afferents that bind GSA I-B4, mystacial pads from rats were prepared for fluorescence microscopy with GSA I-B4 conjugated to rhodamine. At the neck of each F-SC, numerous circumferentially oriented bundles of fine-caliber axonal profiles were labeled in the inner conical body, which receives nearly all of its innervation from the SVNs. A sparse, random distribution of fine-caliber profiles from deep vibrissal nerves was labeled at the level of the cavernous sinus in the deep half of the F-SCs. GSA I-B4 also labeled a variety of nonneural structures. By binding to vascular linings, GSA I-B4 revealed a dense, highly organized capillary system within the mesenchymal sheath that forms the inner lining of the vascular sinuses. Thus each F-SC appears to have a closed capillary system within the open vascular sinus. Trabeculae within the lumen of the cavernous sinus were also revealed to span between the sinus capsule and the mesenchymal sheath only about midway along the length of the follicle instead of the entire deeper half, as was previously believed. in addition, GSA I-B4 bound to the surface of follicular cells preferentially in the superficial half of the F-SCs. Sweat glands within the intervibrissal fur and some cells within sebaceous glands in F-SCs were also labeled as well as their ducts. The potential functional implications of these various features are discussed.

Long-term effects of percutaneous laser balloon ablation from the canine coronary sinus.

Radiofrequency catheter ablation of left-sided accessory pathways is becoming the first line of therapy for patients with symptomatic Wolff-Parkinson-White syndrome. Nevertheless, alternative ablation techniques merit development, at least as supplementary modalities for cases in which conventional ablation approaches may prove unsuccessful. We recently reported the short-term results with transcatheter laser balloon ablation from the coronary sinus in a canine model, proving that the procedure is feasible for the potential ablation of left-sided accessory pathways. We now report the effects of percutaneous transcatheter laser balloon ablation in a chronic canine model. Twenty adult mongrel dogs were studied. After baseline coronary arteriography, left ventriculography, and coronary sinus angiography were obtained, 15 dogs received two or three consecutive laser doses from the coronary sinus of 30-40 W for 15-30 seconds, for a total cumulative energy of 1,200-2,400 J. The five remaining animals underwent a procedure consisting of balloon sham inflation without laser exposure and served as controls. After a mean follow-up of 6 weeks, the angiographic procedures were repeated, and the animals were killed. The mean extent of the fibrotic lesion was 15 mm long, 6 mm wide, and 4.5 mm deep and involved the coronary sinus wall, atrium, and, frequently, the summit of the posterior left ventricular wall. Six animals (four in the study group and two in the control group) showed asymptomatic narrowing of the coronary sinus lumen but always with total angiographic reconstitution due to extensive collateral circulation. The circumflex artery and mitral valve were intact angiographically and histologically in all animals. Percutaneous transcatheter laser balloon ablation via the coronary sinus produces a lesion that may be anatomically well suited for left-sided accessory pathway ablation. Although coronary sinus narrowing may occur, adverse physiological effects are unlikely due to the development of extensive collateral circulation. Systematic clinical studies of this new approach to catheter ablation appear warranted.

Surgical reconstruction of the nasolacrimal system in the horse

Summary Facial trauma resulted in unilateral disruption of the nasolacrimal duct in two horses. The disruption occurred in the bony lacrimal canal adjacent to the maxillary sinus. In each case, the intact proximal part of the nasolacrimal duct was successfully stented into the lumen of the maxillary sinus. either the nasolacrimal opening at the nares or from one of the puncta. A disrupted nasolacrimal duct can heal if it can be stented with a cannula for an extended period of time,6 but in some cases, the disrupted duct cannot be cannulated, and those horses have previously been relegated to potential long term epiphora. This report describes a technique whereby the nasolacrimal system is restored by diversion of the caudal part of the nasolacrimal duct into the maxillary sinus.

Dural arteriovenous malformation of the transverse and sigmoid sinus with special reference to its pathological features

A case of posterior fossa dural arteriovenous malformation (AVM) is reported. In the surgical specimen the internal elastic lamina of the dura mater around the sinus was defective in places where nests of dural vascular anomalies protruded into the sinus lumen, suggesting that the AVM was congenital in origin.

上顎洞単純Ｘ線写真とＣＴとの比較 上顎洞炎を中心として

The CT findings of 42 patients with surgically verified benign lesions of the maxillary sinus were evaluated to demonstrate the value of Cl. Comparison with conventional radiologial methods was made.1. The opacification of the maxillary sinus lumen in Waters view shows the relationship in proportion to the soft tissue that occupies the sinus in CT finding.2. The thickening in the posterior wall of the maxillary antra may cause the opacification in Waters view.3. The Waters view can depict rnore significantly the maxillary soft tissue in CT finding than the Caldwell view and panoramic view.4. CT is of value in demonstration of fluid level, mucosal swelling, mucosal thickening and the thickening of the bony walls.

Fourth branchial pouch sinus: Principles of diagnosis and management

The fourth branchial pouch sinus is a congenital anomaly which most frequently manifests itself by recurrent episodes of neck abscess or acute suppurative thyroiditis. This lesion usually becomes symptomatic before the age of 10 years and is more common than has previously been suspected. It has been found on the left side in 93% of the 28 cases reported in the English literature. Barium swallow during periods of quiescence and nasopharyngoscopy have frequently been successful in identifying the presence of these embryological remnants. Definitive therapy consists of total excision of the sinus tract, which can be facilitated by direct endoscopic placement of a Fogarty catheter into the sinus lumen before surgical exploration. The embryological basis for the occurrence of these sinuses is discussed.

An in situ study of B-lymphocytopoiesis in rat bone marrow. Topographical arrangement of terminal deoxynucleotidyl transferase-positive cells and pre-B cells.

To understand bone marrow (BM) as a site of B-lymphocytopoiesis, insight into the topographical arrangement of developing B cells and their relationships to the microenvironment in vivo is required. To study the spatial distribution of B lymphocyte progenitors defined by intracellular markers (cytoplasmic mu H chain and nuclear terminal deoxynucleotidyl transferase (TdT], we developed a technique to cut frozen femurs of rat, yielding cross-sections with intact subendosteal and central marrow. By using (double) immunofluorescence staining techniques we located pre-B and TdT+ cells, and IgM+ B cells in those sections. Of the B cells present in BM, one-third was accumulated in the lumen of blood sinuses. The rest were in the BM parenchyma, as were virtually all pre-B and TdT+ cells. The subendosteal area was twice as rich in pre-B and TdT+ cells as the central area, and within the subendosteal area a profound positive gradient toward the bone was evident. B cells showed an equal distribution over the center and the periphery of the BM. The distribution patterns of B lineage cells in the BM parenchyma were analyzed and shown in part to deviate from random distribution. Additional study of clonal development and microenvironmental factors in hematopoiesis will have to clarify the underlying mechanisms for the observed distribution patterns of B cell precursors in BM.

Circulatory shock due to ascites and responsive to paracentesis

A 31-year-old man, who had lymphoblastic lymphoma during his last 33 months of life, was treated with chemotherapy and cranial irradiation. He had 3 bone marrow relapses between initial chemotherapy and his final relapse 27 months later (6 months before death). He was hospitalized 2 months before death because of granulocytopenia, fever and pulmonary infiltrates. He received broad-spectrum antibiotic therapy, amphotericin and rifampin without response. Clinical evidence of cardiac dysfunction never developed. Results of the electrocardiogram and M-mode and cross-sectional echocardiograms were normal. Results of all fungal culture tests were negative. Necropsy showed disseminated aspergillosis with multiple fungal pulmonary infarcts. Aspergillus fumigatus was cultured from lung tissue at necropsy. The heart weighed 490 g. Both coronary ostia were occluded by fungal thrombi (Fig. 1 and 2). The thrombus in the left coronary ostium extended into the lumens of the left anterior descending and left circumflex coronary arteries. The lumen of coronary sinus was filled with fungal thrombus. There were no myocardial or endocardial lesions. Histologic sections, stained by GOmori-methanamine-silver method, showed numerous dichotomously branching fungi consistent with aspergillus species within the thrombi (Fig. 2). The epicardium of the heart was covered with fibrin containing hyphal organisms.

Cytochemical localization of adenylate cyclase activity in rat bone marrow.

The localization of adenylate cyclase (AC) in rat bone marrow was studied at the ultrastructural level using a cytochemical technique with adenosine triphosphate (ATP) as substrate. The strongest precipitate occurred around cytoplasmic membranes of cells of granulocytic lineage. Around cells of erythrocytic lineage, as well as megakaryocytes, lymphocytes and the plasma cells, the granules resulting from the cytochemical reaction revealed various degrees of density. The region within the bone marrow tissue where the cells manifested an increased reaction product was called 'reaction fields'. Most often the 'reaction fields' were formed by maturing cells of the granulocytic and erythrocytic lineages, surrounding the reticular cells. The reaction precipitate was also apparent around the advential and endothelial cells of the sinuses. Mature cells migrating from the bone marrow space to the sinus lumen also showed an intensified reaction product. The causes of such localization of AC were discussed.

Scanning electron microscope study of human arachnoid villi

The functional morphology of human arachnoid villi obtained from surgical biopsy specimens has been studied by scanning electron microscopy (SEM). On SEM examination, the villi appeared to be distended, as if functioning normally. The endothelial cells constituting the cerebrospinal fluid (CSF)-blood interface were covered by numerous microvilli, uniformly oriented along the major axis of the villus. Examination for cell-to-cell contact revealed only occasional areas of tight adherence between adjacent endothelial cells, while widened intercellular spaces were frequently observed. Generally corresponding to the apex of the villus, points of emergence of endothelium-lined hollow structures were identified; these may represent apical openings of open pathways from the subarachnoid space to the venous system. Ultrastructural arrangements consistent with a closed system of CSF reabsorption were also observed. Large cells maximally distended and protruding into the sinus lumen were commonly seen; these were interpreted as the result of the formation of giant vacuoles within the endothelium covering the villus. This study has provided ultrastructural evidence for both closed and open systems of CSF reabsorption. Ultrastructural findings, such as gaps between endothelial cells and tubule-like endothelium-lined structures as previously identified in animals and observed in man by transmission electron microscopy, were demonstrated in human biopsy specimens by SEM.

Hematopoietic Tissue in Malaria: Facilitation of Erythrocytic Recycling by Bone Marrow in Plasmodium berghei-Infected Mice

In P. berghei murine malaria, parasitized erythrocytes and nonparasitized reticulocytes were concentrated in the lumen of venous sinuses of bone marrow, adherent to endothelium and to one another. Merozoites maturing in erythrocytes contained in venous sinuses are so positioned against adherent reticulocytes that when they break out they can penetrate adherent reticulocytes without significant extracellular exposure. Merozoites from cells not adjacent to reticulocytes would spill into the plasma and be opsonized and phagocytized. The vascular sinuses of bone marrow therefore appear to be sites where erythrocytic parasitization is secured and where the severity and chronicity of the erythrocytic phase of the disease is regulated in P. berghei and, perhaps, other reticulocyte-prone malarias. In P. chabaudi, where fully mature erythrocytes rather than reticulocytes are preferentially parasitized, parasitized erythrocytes show far less predilection for bone marrow.