Orbital lymphatic vessels: immunohistochemical detection in the lacrimal gland, optic nerve, fat tissue, and extrinsic oculomotor muscles / Vasos linfáticos orbitários: identificação imunohistoquímica na glândula lacrimal, no nervo óptico, no tecido adiposo e nos músculos extrínsecos oculomotores

ABSTRACT Purpose: To identify the lymphatic vessels in orbital specimens from human cadavers using light microscopy and immunohistochemical analysis. Methods: A postmortem study included 10 orbital specimens from 10 human cadavers. The orbital specimens were obtained no later than 12 hours after death. The orbital specimens were dissected into lacrimal gland, optic nerve, fat tissue, and oculomotor muscles. The histologic criteria to qualify as a lymphatic vessel were thin-walled channels of endothelium without a well-developed basal membrane and with an erythrocyte-free, irregular lumen. The immunohistochemical criteria were irregularly shaped, thin-walled vessels with an erythrocyte-free, irregular lumen and immunopositivity for podoplanin D2-40. Results: The lacrimal gland, optic nerve, fat tissue, and extraocular muscle sections were positively stained with podoplanin D2-40. Conclusions: This study demonstrated lymphatic vessels in the human orbit, more precisely, in the lacrimal gland, dura mater of the optic nerve, adipose tissue, and extrinsic oculomotor muscles via light microscopy and immunohistochemistry.(AU)

RESUMO Objetivos: Identificar vasos linfáticos em espécimes orbitários de cadáveres humanos através de microscopia óptica e análise imunohistoquímica. Métodos: Um estudo postmortem incluiu dez espécimes orbitários provenientes de dez cadáveres humanos. Todos os espécimes orbitários foram obtidos até 12 horas após a morte com uma técnica cirúrgica de exenteração orbitária e dissecados em glândula lacrimal, nervo óptico, gordura órbitária e músculos extraoculares. Para classificar como um vaso linfático, os critérios histológicos incluíram vasos endoteliais de parede única sem membrana basal bem desenvolvida, irregulares e lúmen sem hemácias, e os critérios imunohistoquímicos incluíram vasos endoteliais de parede única, com formato irregular e lúmen sem hemácias e reagentes a podoplanina D2-40. Resultados: As lâminas histológicas de glândula lacrimal, nervo óptico, tecido adiposo e músculos extraoculares reagiram positivamente a podoplanina D2-40. Conclusão: Este estudo demonstrou vasos linfáticos na órbita humana, mais exatamente, na glândula lacrimal, no nervo óptico, na gordura orbitária e nos músculos extrínsecos extraoculares via microscopia óptica e imunohistoquímica.(AU)

The falciform ligament: Anatomical study with microsurgical implications.

OBJECTIVES: The current study aims to increase awareness of the falciform ligament and its anatomical and surgical relationships, for the benefit of the neurosurgeon. PATINENTS AND METHODS: Twenty-four sides from twelve Caucasian cadaveric heads (all fresh-frozen) were used in this study. The length and thickness of the falciform ligament were recorded. The relationship of the falciform ligament to the optic nerve was also observed and documented. Finally, the force needed to avulse the falciform ligament was recorded. RESULTS: In all specimens, the ligament was identified as a continuation of the outer dural layer, forming a roof at the entrance of the optic canal. The mean medial-to-lateral length, anteroposterior length, and thickness of the falciform ligament were 7.97 mm, 2.12 mm, and 0.26 mm, respectively. The mean distance from the medial attachment of the ligament to the midline was 5.54 mm. For the undersurface of the falciform ligament, the optic nerve occupied the middle third in 50.0 %, the lateral third in 44.4 %, and the medial third in 5.6 % of sides. The mean optic nerve diameter at the entrance of the optic canal was 4.20 mm. The mean failure force was 2.47 N. CONCLUSION: The anatomical measurements and relationships provided in this description of the falciform ligament serve as a tool for surgery selection and planning, as well as an aid to improving microsurgical techniques, with the final goal being better patient outcomes.

Tactile stimulation during development alters the neuroanatomical organization of the optic nerve in normal rats.

This study was designed to investigate the progressive effect of tactile stimulation in the cytoarchitecture of the optic nerve of normal rats during early postnatal development. We used 36 male pups which were randomly assigned to either the tactile-stimulated group (TS-stimulation for 3 min, once a day, from postnatal day (P) 1 to 32) or the non-tactile-stimulated (NTS) group. Morphological analysis were performed to evaluate the alterations caused by tactile stimulation, and morphometric analysis were carried out to determine whether the observed changes in optic nerve cytoarchitecture were significantly different between groups and at three different ages (P18, P22, and P32), thereby covering the entire progression of development of the optic nerve from its start to its completion. The rats of both groups presented similar increase in body weight. The morphometric analysis revealed no difference in the astrocyte density between age-matched groups; however, the oligodendrocyte density of TS group was higher compared to the NTS at P22, and P32, but not at P18. The optic nerve of TS group showed an increase of blood vessels and a reduction of damage fiber density when compared to the age-matched pups of NTS. Taken together, these findings support the view that tactile stimulation, an enriching experience, can positively affects the neuroanatomy of the brain, modifying its cellular components by progressive morphological and morphometric changes.

Morphology of the eyeball from the Humpback whale (Megaptera novaeangliae).

Aquatic mammals underwent morphological and physiological adaptations due to the transition from terrestrial to aquatic environment. One of the morphological changes regards their vision since cetaceans' eyes are able to withstand mechanical, chemical, osmotic, and optical water conditions. Due to insufficient information about these animals, especially regarding their sense organs, this study aimed to describe the morphology of the Humpback whale (Megaptera novaeangliae) eyeball. Three newborn females, stranded dead on the coast of Sergipe and Bahia, Brazil, were used. Samples were fixed in a 10% formalin solution, dissected, photographed, collected, and evaluated through light and electron microscopy techniques. The Humpback whale sclera was thick and had an irregular surface with mechanoreceptors in its lamina propria. Lens was dense, transparent, and ellipsoidal, consisting of three layers, and the vascularized choroid contains melanocytes, mechanoreceptors, and a fibrous tapetum lucidum. The Humpback whale eyeball is similar to other cetaceans and suggests an adaptation to diving and migration, contributing to the perception of differences in temperature, pressure, and lighting.

Neural organization of the second optic neuropil, the medulla, in the highly visual semiterrestrial crab Neohelice granulata.

Crustaceans are widely distributed and inhabit very different niches. Many of them are highly visual animals. Nevertheless, the neural composition of crustacean optic neuropils deeper than the lamina is mostly unknown. In particular, semiterrestrial crabs possess a highly developed visual system and display conspicuous visually guided behaviors. A previous study shows that the first optic neuropil, the lamina of the crab Neohelice granulata, possesses a surprisingly high number of elements in each cartridge. Here, we present a comprehensive description of individual elements composing the medulla of that same species. Using Golgi impregnation, we characterized a wide variety of cells. Only considering the class of transmedullary neurons, we describe over 50 different morphologies including small- and large-field units. Among others, we describe a type of centrifugal neuron hitherto not identified in other crustaceans or insects that probably feeds back information to every cartridge in the medulla. The possible functional role of such centrifugal elements is discussed in connection with the physiological and behavioral information on visual processing available for this crab. Taken together, the results reveal a very dense and complex neuropil in which several channels of information processing would be acting in parallel. We further examine our results considering the similarities and differences found between the layered organization and components of this crustacean medulla and the medullae of insects.

Estudio morfométrico del nervio óptico de tiburoncito (Ariopsis seemanni) / Morphological study of tete sea catfish (Ariopsis seemanni) optic nerve

En peces, el nervio óptico es el encargado de transportar la información integrada por las células ganglionares de la retina hacia el tectum óptico, para que se generen imágenes acerca del entorno. El objetivo de este trabajo es describir morfométricamente el nervio óptico del tiburoncito (Ariopsis seemanni), para lo cual se utilizó la Microscopía óptica de Alta Resolución (MOAR), realizando cortes a 1 micra de espesor. El nervio óptico de A. seemanni presenta fibras mielínicas de diverso calibre, acompañadas de oligodendrocitos y astrocitos. El nervio está cubierto por las meninges, que presentan vasos sanguíneos y adipocitos. El nervio tiene un área total de 179604 ± 30163 µm2, diámetro de 478 ± 42 µm y un número total de fibras mielínicas de 22848 ± 4350, de las cuales la mayoría tiene un tamaño pequeño, que puede estar relacionado con una velocidad de conducción baja.

The optic nerve carries out the information integrated by retinal ganglion cells towards the optic tectum, so that surrounding environment images are generated. The main goal of this paper is to describe morphometricaly the Tete sea catfish (Ariopsis seemanni) optic nerve, using high resolution optical microscopy (HROM), on 1 micron thick sections. A. seemanni optic nerve does present myelinated nerve fibers, accompanied by oligodendrocytes and astrocytes. The nerve is covered by the meninges, with blood vessels and adipocites. The nerve has a transversal area of 179,604 ± 30163 mm2, a diameter of 478 ± 42 mm and 22848 ± 4350 myelinated fibers, most are small in size, which may be related to a low conduction velocity.

HLA class I haplotypes and progression of primary open-angle glaucoma.

PURPOSE: To verify if patients with primary open-angle glaucoma with HLA class I haplotypes (A9-B12, A2-B40, A1-B8) associated with this disease may have a greater rate of progression than patients who do not present these haplotypes. METHODS: Anatomical and functional glaucoma evaluation (cup-to-disc ratio and visual field) of 25 patients (six of them with one of the haplotypes associated with glaucoma) followed at the Glaucoma Outpatient Clinic of the University Hospital, Ribeirão Preto School of Medicine, São Paulo University (HCFMRP-USP) for ten years after typing of their HLA antigens in order to compare with their previous condition. RESULTS: A greater increase of the cup-to-disc ratio was observed in patients with HLA haplotypes associated with primary open-angle glaucoma predisposition. However, no significant differences in functional damage progression or in retinal nerve fibers loss were detected between them and other patients with glaucoma. CONCLUSION: The present results indicate an association of class I HLA haplotypes with progression of anatomic alterations of the optic nerve head in glaucomatous patients.

HLA class I haplotypes and progression of primary open-angle glaucoma / Haplotipos HLA de classe I e progressão do glaucoma primário de ângulo aberto

PURPOSE: To verify if patients with primary open-angle glaucoma with HLA class I haplotypes (A9-B12, A2-B40, A1-B8) associated with this disease may have a greater rate of progression than patients who do not present these haplotypes. METHODS: Anatomical and functional glaucoma evaluation (cup-to-disc ratio and visual field) of 25 patients (six of them with one of the haplotypes associated with glaucoma) followed at the Glaucoma Outpatient Clinic of the University Hospital, Ribeirão Preto School of Medicine, São Paulo University (HCFMRP-USP) for ten years after typing of their HLA antigens in order to compare with their previous condition. RESULTS: A greater increase of the cup-to-disc ratio was observed in patients with HLA haplotypes associated with primary open-angle glaucoma predisposition. However, no significant differences in functional damage progression or in retinal nerve fibers loss were detected between them and other patients with glaucoma. CONCLUSION: The present results indicate an association of class I HLA haplotypes with progression of anatomic alterations of the optic nerve head in glaucomatous patients.

OBJETIVO: Verificar se pacientes com glaucoma primário de ângulo aberto portadores de haplotipos HLA de classe I (HLA - A9-B12; -A2-B40; e -A1-B8) associados a essa doença poderiam ter progressão maior do que pacientes que não apresentassem esses haplotipos. Método: Avaliação anatômica e funcional de 25 pacientes (6 dos quais com um dos haplotipos associados a glaucoma), seguidos no Ambulatório de Glaucoma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), por dez anos depois da tipificação de seus antígenos HLA, para comparação com as condições anteriores. RESULTADOS: Houve aumento maior da relação escavação/disco em pacientes com haplotipos HLA associados com predisposição para glaucoma primário de ângulo aberto, no entanto não foram encontradas diferenças significantes entre esses e outros pacientes com glaucoma na progressão do dano fisiológico e nem na perda de fibras nervosas da retina. CONCLUSÃO: Os resultados indicam a associação de haplotipos HLA de classe I com maior taxa de progressão das alterações anatômicas da cabeça nervo óptico em pacientes com glaucoma.

Anatomic variation of cranial parasympathetic ganglia.

Having broad knowledge of anatomy is essential for practicing dentistry. Certain anatomical structures call for detailed studies due to their anatomical and functional importance. Nevertheless, some structures are difficult to visualize and identify due to their small volume and complicated access. Such is the case of the parasympathetic ganglia located in the cranial part of the autonomic nervous system, which include: the ciliary ganglion (located deeply in the orbit, laterally to the optic nerve), the pterygopalatine ganglion (located in the pterygopalatine fossa), the submandibular ganglion (located laterally to the hyoglossus muscle, below the lingual nerve), and the otic ganglion (located medially to the mandibular nerve, right beneath the oval foramen). The aim of this study was to present these structures in dissected anatomic specimens and perform a comparative analysis regarding location and morphology. The proximity of the ganglia and associated nerves were also analyzed, as well as the number and volume of fibers connected to them. Human heads were dissected by planes, partially removing the adjacent structures to the point we could reach the parasympathetic ganglia. With this study, we concluded that there was no significant variation regarding the location of the studied ganglia. Morphologically, our observations concur with previous classical descriptions of the parasympathetic ganglia, but we observed variations regarding the proximity of the otic ganglion to the mandibular nerve. We also observed that there were variations regarding the number and volume of fiber bundles connected to the submandibular, otic, and pterygopalatine ganglia.

Anatomic variation of cranial parasympathetic ganglia

Having broad knowledge of anatomy is essential for practicing dentistry. Certain anatomical structures call for detailed studies due to their anatomical and functional importance. Nevertheless, some structures are difficult to visualize and identify due to their small volume and complicated access. Such is the case of the parasympathetic ganglia located in the cranial part of the autonomic nervous system, which include: the ciliary ganglion (located deeply in the orbit, laterally to the optic nerve), the pterygopalatine ganglion (located in the pterygopalatine fossa), the submandibular ganglion (located laterally to the hyoglossus muscle, below the lingual nerve), and the otic ganglion (located medially to the mandibular nerve, right beneath the oval foramen). The aim of this study was to present these structures in dissected anatomic specimens and perform a comparative analysis regarding location and morphology. The proximity of the ganglia and associated nerves were also analyzed, as well as the number and volume of fibers connected to them. Human heads were dissected by planes, partially removing the adjacent structures to the point we could reach the parasympathetic ganglia. With this study, we concluded that there was no significant variation regarding the location of the studied ganglia. Morphologically, our observations concur with previous classical descriptions of the parasympathetic ganglia, but we observed variations regarding the proximity of the otic ganglion to the mandibular nerve. We also observed that there were variations regarding the number and volume of fiber bundles connected to the submandibular, otic, and pterygopalatine ganglia.

Las lecciones derivadas del ASA Closed Claims Project (ASACCP). Proyecto de la ASA acerca de las razones que promovieron demandas contra anestesiólogos cuyos casos estuviesen ya archivados. 5a. parte: Pérdida de la visión y otras complicaciones oculares del postoperatorio / Lessons learned from the ASA Closed Claims Project (ASACCP). ASA project about the reasons for wich claims against anesthesiologists were renewed in cases that had already been closed. Part 5: Loss of vision and other postoperative ocular complications

A pesar de ser la ceguera postoperatoria una complicación rara en la cual la neuropatía isquémica del nervio óptico parecer ser la causa predominante, ella se habría incrementado en los últimos tiempos, por lo menos en lo que respecta a la frecuencia con que aparece descripta en la literatura médica. El ASACCP, luego de analizar más de 5.800 expedientes cuyos juicios por presunta mala praxis estaban concluídos, descubrió que solamente el 3 por ciento de las demandas estaban relacionadas con amaurosis postoperatoria en cirugías no oftalmológicas. A partir de este estudio, y con el objeto de ahondar más en las causas de una complicación tan grave, en junio de 1999 la ASA formó una comisión especial dentro del ASACCP (ASA Closed Claims Proyect), el Postoperative Visual Loss Registry (PVLR) que elaboró un formulario para ser llenado, en forma anónima, por los miembros de la entidad cuando se enfrentan con un caso de lesión ocular postoperatoria. En este trabajo se analizan las causas dela ceguera postoperatoria y se describe su aparición durante distintos procedimientos quirúrgicos y anestésicos. (AU)

Las lecciones derivadas del ASA Closed Claims Project (ASACCP). Proyecto de la ASA acerca de las razones que promovieron demandas contra anestesiólogos cuyos casos estuviesen ya archivados. 5a. parte: Pérdida de la visión y otras complicaciones oculares del postoperatorio / Lessons learned from the ASA Closed Claims Project (ASACCP). ASA project about the reasons for wich claims against anesthesiologists were renewed in cases that had already been closed. Part 5: Loss of vision and other postoperative ocular complications

A pesar de ser la ceguera postoperatoria una complicación rara en la cual la neuropatía isquémica del nervio óptico parecer ser la causa predominante, ella se habría incrementado en los últimos tiempos, por lo menos en lo que respecta a la frecuencia con que aparece descripta en la literatura médica. El ASACCP, luego de analizar más de 5.800 expedientes cuyos juicios por presunta mala praxis estaban concluídos, descubrió que solamente el 3 por ciento de las demandas estaban relacionadas con amaurosis postoperatoria en cirugías no oftalmológicas. A partir de este estudio, y con el objeto de ahondar más en las causas de una complicación tan grave, en junio de 1999 la ASA formó una comisión especial dentro del ASACCP (ASA Closed Claims Proyect), el Postoperative Visual Loss Registry (PVLR) que elaboró un formulario para ser llenado, en forma anónima, por los miembros de la entidad cuando se enfrentan con un caso de lesión ocular postoperatoria. En este trabajo se analizan las causas dela ceguera postoperatoria y se describe su aparición durante distintos procedimientos quirúrgicos y anestésicos.

Valoración de la integridad del nervio óptico durante cirugía endoscópica de senos paranasales / Assesment of optic nerve integrity during endoscopic paranasal sinus surgery

La posibilidad de lesión del nervio óptico durante la cirugía endoscópica funcional de senos paranasales es real aunque afortunadamante poco frecuente en nuestro medio. No obstante es posible apreciar durante la cirugía asimetría en el tamaño de las pupilas, comúnmente asociado a hiporreactividad del reflejo fotomotor, lo que despierta gran ansiedad en el cirujano y su equipo. El presente artículo es una revisión de las bases anatómicas de los reflejos pupilares y de las pruebas clínicas que pueden determinar la integridad del nervio óptico.

Anatomía microquirúrgica y microvascular: el tríangulo optocarotídeo: consideraciones en cirugía vascular / Microsurgical and microvascular anatomy: the opto-carotid triangle: considerations in vascular surgery

La descripción del triángulo opto - carotídeo (TOC) es muy escasa en la literatura neuroquirúrgica, a pesar de ser un área importante en el manejo de patología vascular variada y frecuente. Con la introducción de nuevas tecnologías imagenológicas y la evolución en las técnicas microquirúrgicas y en cirugía de base de cráneo, es sumamente importante el conocimiento y definición de las áreas anatómicas relevantes en cirugía microvascular, incluyendo su descripción morfométrica. El TOC es un área anatómica que debe de ser abordada durante un importante número de procedimientos neurovasculares, así como para patologías no vasculares y que involucran la región.

All that glitters is not glaucoma

The twentieth century has witnessed great strides in the understanding and management of the major ophthalmic conditions. For example, the surgical treatment of cataract is being honed to perfection with only the goal of accommodative restoration remaining to complement visual clarity. Understanding of the mode of transmission of Chlamydia trachomaitis, plus the new macrolide antimicrobial, azithromycin, which can cure 80 percent of acute trachoma, offers hope in managing this infection. Similarly, the control of the vector Simulium and the microfilariacidal, Ivermectin, promise to eradicate onchocerciasis volvolus. Increasing understanding of the pathogenesis of the microangiopathy of diabetic retinopathy and the recent trials - Diabetic Control and Complication Trial and the European Prospective Study - have paved the way for the control of this condition. However, our understanding and management of chronic open angle glaucoma remains frustratingly elusive. Problems related to the early detection and monitoring progression remain imprecise and sometimes non-specific and misleading. Two cases are presented to illustrate the limitations of the visual field test and underline the fact that it should never be viewed in isolation. Further treatment modalities will dictate more precise objective tests for monitoring optic nerve function, focusing on early diagnosis and small degrees of progression.(AU)

La neuroglía en la retina y nervio óptico. Estudio histológico e histoinmunoquímico / The neuroglia within the retina and the optic nerve. Histological and histoinmunochemical essays

La neuroglía de la retina y del nervio óptico tiene un papel altamete especializado en la nutrición, el aislamiento, la polarización y conducción eléctrica de la neurona. En la retina y en el nervio óptico se cumple el requisito del binomio glio-neurona. El estudio comprende la neuroglía intrarretiniana, del nervio óptico, la marginal, la del menisco y de las barreras hematorretiniana, hematoencefálica y hematopial. Estos conceptos se apoyan en los estudios histoinmunoquímico y convencionales en la neuropatología

Síndrome cerebral perdedor de sal / Cerebral salt wasting syndrome

Introducción. El síndrome cerebral perdedor de sal (SCPS) es un trastorno hidroelectrolítico en pacientes con lesión cerebral, clasificado en ocasiones en forma errónea como síndrome de secreción inadecuada de hormona antidiurética (SSIHAD), ya que ambos presentan hiponatremias; sin embargo, sus manifestaciones clínicas y tratamiento son diferentes. Existen pocos informes de este síndrome en pacientes pediátricos. Caso clínico. Lactante de 9 meses con diagnóstico de astrocitoma pilocítico del nervio óptico, que en el cuarto día de postoperado presento deterioro neurológico, choque hipovolémico, hiponatremia, uresis y natriuresis aumentadas. Se descartó alteracion endocrina y renal. El tratamiento fue con reposición de líquidos y sodio. Conclusión. Se discute la importancia en el diagnóstico y tratamiento de esta entidad, así como las características clínicas con relación a las informadas en la literatura