Insights into retinal hemangioblastoma using ultra widefield imaging

Purpose: Retinal hemangioblastomas (RHs) are characteristic of von Hippel-Lindau (VHL) disease. Early diagnosis of retinal lesions may aid in systemic diagnosis. Early identification of VHL is life-saving and also prevents vision loss. Fundus fluorescein angiography (FFA) is a useful tool in the diagnosis and management of RHs. The aim of this study is to report FFA features of RH using ultra-widefield (UWF) imaging. Methods: A retrospective cross-sectional study of consecutive patients of RH who underwent UWF FFA at a tertiary eye care center. Images were analyzed and assessed by authors. The main outcome measures were (a) the number and size of RH in each eye and (b) vascular characteristics of the retina. UWF-FFA characteristics in each eye were tabulated. The number of clock hours involved by these characteristics and their correlation with the number and size of RH were analyzed. Results: The study evaluated 24 eyes of 13 patients. The mean age was 28.4 years. The median number of RHs in an eye was 3.5 (range 1�16), and the size of RHs varied from 0.1 to 4 disc diameters. Novel UWF-FFA findings noted in this study were the presence of abnormal capillary network in 22 of 24 eyes (91.7%), capillary leakage in 15 of 24 eyes (62.5%), and capillary telangiectasia in 7 of 24 eyes (29.2%). In addition, feeder arterioles and venules showed bulbous projections in 8 of 24 eyes (33.3%). Conclusion: The UWF-FFA characteristics of RH, which have not been described before, were identified. These add to our understanding of the pathogenesis of the disease and may pave the way for future therapeutic targets.

Different Effect of IVTA in the Management of Macular Edema Secondary to Perfusion and Ischemic Type BRVO

PURPOSE: To investigate the improvement of visual acuity with the different effects of ischemic and perfusion type branched retinal vein occlusion (BRVO), and explore the relationship between defects of the macular capillary network and intravitreal injection of triamcinolone acetonide (IVTA) for treatment of BRVO secondary to macular edema. METHODS: We compared macular capillary network condition, improvement of visual acuity due to ischemic range, and decrease of macular edema between 23 perfusion type BRVO patients and 21 ischemic type BRVO patients who were treated with IVTA for BRVO secondary to macular edema. RESULTS: Both ischemic and perfusion type BRVO exhibited decreased macular edema and showed meaningful improvements in visual acuity (P<0.01), but did not show a relationship between the defects in the macular capillary network and improvement of visual acuity. No differences were seen in macular capillary network defects between ischemic and perfusion type BRVO. CONCLUSIONS: IVTA had an effect on the decrease in macular edema and improvement of visual acuity for both ischemic and perfusion type BRVO. However, defects in the macular capillary network do not seem to have any effect on the improvement of visual acuity.

The Macular Circulatory Change in Branch Retinal Vein Occlusion

We evaluated the macular circulatory change with fluores- cein angiography in 41patients (44eyes) who were diagnosed to have branch retinal vein occlusion and followed for 6 months or longer. Final visual acuity improved to 0.5 or better in more than half of cases in their last follow up. The initial corrected visual acuity and size of macular ischemic area were the potent prognostic factors. All cases that showed initial visual acuity of above 0.5 had smaller macular ischemic area and obtained final visual acuity of above 0.5. Visual prognosis of patients with ischemic area less than 1quadrant was much better than those with larger ischemic area. The state of perifoveal capillary network was also potent prognostic factor. Final visual prognosis was slightly better in patients with intact perifoveal capil-lary network than those with broken network. Systemic hypertension and venous occlusive site were not associated with visual prognosis. The relationship between visual improvement and state of perifoveal capillary network was not certain.

QUANTITATIVE STUDY ON THE MICROVAS-CULAR SYSTEMATIC ARCHITECTURE OF THE CEREBRAL CORTEX OF THE RABBIT / 解剖学报

The microvascular systematic architecture of the cerebral cortex were studied in six rabbits. The internal carotids were injected with Chinese ink via a cannula. After fixation, brains were removed and made sections of 80-220?m thick. Some sections were counterstained with HE or Nissl method in order to observe the histological structure of the microvessels and the relationship between the vessels and the nervous tissue.Morphometric measurements of the microvessels were made according to the Strahler system. Results were as follows.(1) In the cerebral cortex, the microarteries and microvenes could be subdivided in to four orders. (capillaries were considered as O order), Perforating branches were perpendicular to the surface of the cerebral cortex and the distribution area of a microartery trunk was in a columnar shape with a radius of 204.5 ?m. This was in compliance with the size of a functional column of the cerebral cortex.(2) For microarteries from order 1 to 4, the branching ratio was 3.72, the diameter ratio was 1.42, the segmental length ratio was 1.82; while for microvenes from order 1 to 4, the branching ratio was 3.25, the diameter ratio was 1.73, and the segmental length ratio was 2.25.(3) The total length of the true capillary network per unit volume of the cerebral cortex was 5.82?10~5?m/mm~3. The density of the capillary network of the cerebral cortex was highest in fourth and fifth layers, while the first layer was rather scarce in capillary network. The number of neurons within each lattice of the capillary network was most numerous in the fourth layer, 4.36 per lattice.According to the results mentioned above, the functional significance of the microvascular architecture and the microcirculation dynamics of the brain was also discussed.

MICROVASCULATURE OF THE POLAR CUSHION CELL AREA OF ADULTIS GLOMERULUS / 解剖学报

Three fresh kidneys removed from three adult bodies were perfused through the renal artery with 5％ and 10％ ABS (a copolymer of allylcyanide, butadiene and styrolene). Small specimens removed from the kidney were digested in 50％ HCI. Cast replicas of renal arteries and their branches were taken and examined with SEM (S-450 or S-520). The results were as follows.The capillary network of the area of the polar cushion cell were observed at the hilum of glomerulus in our casts. Their appearances are triangular, tetragonal or comma-like. In general, the shape of the meshes of the capillary network was round, oval, triangular or tetragonal. The diameters of the meshes were smaller than that of the vessels themselves. The microvessels of the area of the polar cushion cell, which mainly originated from the afferent arteriole, were continuous with the capillary of the glomerulus. The afferent arteriole was often traveled in the central part of the area of the polar cushion cell. The function of the microvessels of the area of the polar cushion cell was discussed in this article.

THE ARCHITECTURE OF THE MUCOSAL AND SUBMUCOSAL MICRO-VASCULAR NET-WORK OF THE TONGUE AND ITS CLINICAL SIGNIFICANCE / 解剖学报

The micro-vascular architecture of the mucosa and submucosa of human tongue was studied under the surgical microscope and scanning electron microscope. The long branches of the profunda lingual arteries and the terminal branches of the dorsal lingual arteries anastomose into a thick layer of arterial network, under the mucosa and over the superficial muscle of the whole body and root of the tongue. Arteriolae spring from the submucosal arterial network, which get into the mucosa to form the capillary network of mucosa and the 9apillary plexuses of variant papillae.The relationship between the architecture of the lingual submucosal arterial network and the design of flaps, and the clinical significance of tongue diagnostic signs has been discussed.

OBSERVATION ON THE ARTERIES OF THE HUMAN MEDULLA OBLONGATA / 解剖学报

The origin, distribution, anastomoses and variations of the arteries of medulla oblongata were observed on 110 Chinese adult brains. The internal arteries and their territories were observed on 20 brains by artereography and clearing method (Spalteholz's technic). The results were as follows: The arteries of medulla oblongata could be divided into four groups according to their distribution. The arteries of the anteromedian and anterolateral groups arose from the anterior spinal artery, and also from the vertebral artery and basilar artery. The arteries of the lateral group contained a series of small arterial rami, which arose from the vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery and basilar artery. The arteries of the posterior group arose from the posterior spinal artery and posterior inferior cerebellar artery. The arteries of each group branched and penetrated into the medulla, they ramify into fine branches, and the capillary network was formed. The internal anteromedian arteries supplied the hypoglossal nucleus, medial lemniseus etc. The internal anterolateral arteries supplied chiefly pyramidal tract. The internal posterior arteries supplied the gracile and cuneate nuclei. The internal lateral arteries supplied the rest of the areas which include reticular formation, dorsal nucleus of the vagus nerve etc.. The arterial supply of the medullary lateral area and the endartery were discussed.

OBSERVATION ON THE CAPILLARY NETWORK OF THE HUMAN MEDULLA OBLONGATA / 解剖学报

The arteries of 5 human brainstems were injected by using a mixture of preparedchinese ink and gelatin.The capillary densities of 20 various nuclei and tracts inthe medulla oblongata were observed and measured in 300?m and 150?m serial trans-verse sections.The tracts are less vascularized than nuclei.The nuclei have been divided intohigh,medium and low three groups according to their capillary densities.The highdensity nuclei consist of accessory cuneate nucleus,inferior olivary nuclear complex,medial vestibular nucleus,nucleus cuneatus.The medium density nuclei are lateralreticular nucleus,nucleus supraspinalis,hypoglossal nucleus and nucleus gracilis.Thelow density nuclei are dorsal vagal nucleus,spinal trigeminal nucleus,nucleus ofsolitary tract.The pyramidal tract has the lowest density among the tracts observed.

OBSERVATIONS ON THE VASCULAR ARCHITECTURE OF THE GALL-BLADDER IN THE FULL TERM FETUS UNDER THE SCANNING ELECTRON MICROSCOPE / 解剖学报

The SEM specimens of the blood vessels of the gall-bladder in the full term fetus were produced with the methyl methacrylate cast. The specimens were dryed and gilded with EIKO. IB-3. and then observed under scanning electron microscope. The microvessels of the wall of gall-bladder obviously were divided into three layers, namely: serous vessels, muscular vessels and mucous vessels. The serous and muscular vessels are similar to that of the intestinal canal. However the mucous vessels were characterized by subepithelial capillary networks and veins of large calibre in the lamina propria. The capillary networks were connected directly with the venous plexus by the capillaries. There are fewer arterioles passing and branching among the venous plexuses. Each arteriole was connected to capillary networks. The short capillary was seen frequently between the arterioles and the venous plexus, serving as communication between them.

OBSERVATION OF THE RENAL GLOMERULUS CASTS OF DOG UNDER THE SCANNING ELECTRON MICROSCOPE / 解剖学报

The kidneys removed from six female adult dogs were injected through the renal artery with ABS at a constant pressure between 33.3—33.7 kPa(250—280mmHg). Small specimens cut out from the kindneys were digested in 3％ trypsin solution for 48 hours and then eroded in 50％ HCl. The cast specimens were studied under the scanning electron microscope. The results were outlined as follows: 1. The corrosion-cast models of the renal glomerulus of the dogs observed under the SEM could be divided into three kinds: the spherical glomerulus, the chrysanthemum-like glomerulus and mixed glomerulus. 2. In general, the afferent and efferent arteriolae entered or exited at the hilum of glomerulus. Rarely, the efferent vessel left the glomerulus at the opposite side of the hilum. Anastomoses between the afferent and efferent or between the efferents vessels were found in our casts. 3. The capillary network of the juxtaglomerular apparatus was observed at the hilum of glomerulus in our casts. The diameters of the meshes of the capillary network were smaller than that of the vessels themselves.