The sensory penis: A comprehensive immunohistological and ontogenetic exploration of human penile innervation.

Human skin, including nerves and sensory corpuscles, displays immunoreactivity (IR) for low- (p75) and high-affinity (TrkA-like) receptors for nerve growth factor (NGF), the best characterized member of the family of neurotrophins. This study was designed to analyze the changes induced by spinal cord and peripheral nerve injuries in the expression of neurotrophin receptors in digital skin, with special reference to nerves and sensory corpuscles. Skin biopsy samples were obtained from 1) the hand and toes of normal subjects, 2) below the level of the lesion of patients with spinal cord injury affecting dorsal and lateral funiculi, 3) the cutaneous territory of entrapped peripheral nerves (median and ulnar nerves), and 4) the cutaneous territory of sectioned and grafted nerves (median nerve). The pieces were formalin-fixed and paraffin-embedded, cut in serial sections, and processed for immunohistochemistry using antibodies against human p75 and TrkA proteins. The percentage of sensory corpuscles displaying IR for p75 and TrkA-like, as well as the intensity of IR developed within them, was assessed using quantitative image analysis. Spinal cord severance causes a decrease in p75 IR in Meissner and Pacinian corpuscles, whereas TrkA-like IR did not vary. In other nonnervous tissues (i.e., epidermis, sweat glands), both p75 and TrkA-like IR was diminished or even absent. Similar but more severe changes were encountered in the skin from the territory of entrapped nerves. Finally, in subjects with sectioned-grafted nerves, p75 IR was found close to controls in nerves, reduced in Meissner corpuscles, and absent in the inner core of the Pacinian ones; TrkA-like IR was in the perineurium, a small percentage of Meissner corpuscles (about 7%), and the outer core and capsule of the Pacinan corpuscles. In the nonnervous tissues, p75 IR was practically absent, whereas TrkA-like IR did not change. No changes in the expression of neurotrophin receptors were observed in Merkel cells of the different groups. Present results show the following: 1) expression of nerve p75 IR in human cutaneous sensory corpuscles is sensitive to central deafferentation, to blockade or difficulty in axonal transport, and to disruption of axonal continuity independently of possible restoration of axonal integrity due to grafts; 2) expression of TrkA-like IR in nerves and sensory corpuscles is sensitive only to nerve transection; 3) the corpuscular Schwann-related cells are the only cells involved in the above modifications, the perineurial cells remaining unchanged; 4) the expression of p75 and TrkA-like IR by Merkel cells is independent of normal innervation; 5) an adequate innervation of the skin seems to be necessary for the expression of p75 but not TrkA-like in nonneuronal cells, especially in the epidermis. A role for NGF in the maintenance of epidermis integrity is discussed.

Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review.

The anterior commissure (AC) of the human larynx is usually understood as an area of the glottis anteriorly situated between the two vocal folds inserting to the thyroid cartilage (TC). The pattern of spread of AC carcinoma could hypothesize that AC could include other structures of the ventral larynx as developmental anatomy could demonstrate. Ten adult larynx specimens from donation program cadavers and 15 selected fetal specimens (from 11 to 34 weeks of amenorrhoea) were studied using microdissection and histological serial sections stained with hematoxylin-eosin and reticuline. In adult specimens, internal perichondrium of the TC was easily detached from the entire lateral lamina but not from an intermediate lamina superiorly marked by the superior thyroid notch. On this median band of TC is inserted the ventral connective tissue of the three levels of the larynx: the ventral part of the vocal folds with the anterior macula flava, the Broyle's epiglottic ligament, and the subglottic part of the conoid ligament. In young fetuses (11-12 weeks), intermediate lamina of TC joined at the glottic level but not at the supraglottic level; in fetuses at 22-25 weeks, a meshwork of bundles of connective fibers inserted to the intermediate lamina of TC. In fetuses at 33-34 weeks, organization is practically identical to adult specimens. According to the adult anatomical features and the organogenesis, the AC of the human larynx could be anatomically defined ventrally as being made up of the intermediate lamina of TC beneath the superior thyroid notch and dorsally the ventral insertions of vocal folds with macula flava, supraglottic Broyle's ligament, and subglottic conoid ligament leading to a "developmental" AC definition which could better explain specific spreading of AC carcinoma.

Sensory Innervation of the Subregions of the Scapholunate Interosseous Ligament in Relation to Their Structural Composition

Collagen type III glomerulopathy in a tumour nephrectomy specimen: beware of a coincidental medical kidney disease

The Contrasting Evidence Concerning the Effect of Male Circumcision on Sexual Function, Sensation, and Pleasure: A Systematic Review.

Relation of the vertebral artery segment from C1 to C2 vertebrae: An anatomical study

The topic of male circumcision (MC) is of considerable current interest, largely because of widespread publicity generated by research findings attesting to its ability to prevent HIV infection during heterosexual intercourse. In addition, its long-recognized ability to protect against other sexually transmitted infections (STIs) has also been well publicized in recent times, especially now that support has been provided by large randomized controlled trials (RCTs). While MC can be performed at any age, the ease with which circumcision can be performed in infancy makes this time of life preferable to intervention later in childhood or in adulthood. As well as the issue of safety, convenience, simplicity and consequent cost reductions, circumcision in infancy provides greater net benefits over the lifetime of the individual. It provides immediate 10-fold protection against urinary tract infections and thus kidney damage in baby boys, and greater protection against penile cancer than circumcision later in life, virtually eliminating the risk of this disease with its high morbidity and mortality (Morris, 2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011). Another benefit is prevention of phimosis, a common cause of sexual problems in adolescent boys and men, and a major risk factor for penile cancer. It also lowers to risk of inflammatory skin conditions such as balanoposthitis. Circumcised men have superior hygiene (O'Farrell et al., 2005) and half the prevalence of thrush (Richters et al., 2006). As far as protection against STIs is concerned, the most notable is human papillomavirus (HPV), the pathogen not only responsible for most cervical cancers in women, but also a proportion of penile cancers in men (Morris et al., 2011). MC also reduces the incidence of ulcerative STIs, including syphilis, chancroid, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) (Weiss et al., 2006; Morris & Castellsague, 2010; Tobian et al., 2010). Circumcised men have lower genital ulcer disease as a result of this and the reduction in penile injury arising from tearing of the foreskin and frenulum during sexual activity (Bailey & Mehta, 2009). MC reduces sexual problems with age and diabetes (Morris, 2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011), and has no adverse effect on sexual function, sensation or acceptability (Morris, 2007; Tobian et al., 2010), if anything the reverse (Krieger et al., 2008). MC provides a public health benefit to women by lowering their risk of various STIs, including high-risk HPV types that cause cervical cancer, HSV-2,

Female stress urinary incontinence is thought to result from impairment of the connective tissue "ligaments" of the urethra. Surgical repair of female incontinence mainly involves fixation of the urethra to the pubic bone or other surrounding structures. In the present anatomical-radiological study, the anatomy of the connective tissue structures around the female urethra was investigated to determine the anatomical structures that support the urethra and the rhabdosphincter. The topography of the anterior compartment of the female pelvis was studied in serial sections and one anatomical preparation of 30 female fetuses and of six adult females. The pelves of 29 female fetuses were processed according to plastination histology technique. The pelves of the six adult specimens were processed according to sheet plastination technique. In addition, the anatomical findings were compared with MR images of 41 adult female volunteers. The ventro-lateral aspect of the urethra remains free of fixating ligaments throughout its pelvic course. Ventro-laterally the urethra is enclosed by the ventral parts of the levator ani, its fasciae and a ventral urethral connective tissue bridge connecting both sides. Dorsally, the urethra is intimately connected to the wall of the vagina. The female urethra has no direct ligamentous fixation to the pubic bone. Urethral continence after pregnancy and childbirth may be explained by a widening of the hiatus of the levator ani or the anterior vaginal wall, resulting in overstretching of the ventral urethral connective tissue bridge or the disruption of the fixation between urethra and vagina.

This report describes a relationship between type II pneumonocytes and breaks in continuity in the alveolar septum of the human lung. Breaks in continuity of the septum are defined as gaps in the connective tissue matrix of the alveolar septum, with or without discontinuity of the accompanying alveolar epithelium. Septal connective tissue gaps accompanied by epithelial discontinuity are recognized as interalveolar pores of Kohn. When the discontinuity is confined to the connective tissue matrix, epithelial continuity may be maintained by either a single or a double layer of type I epithelium, by a type II cell, or by both type I and type II epithelial cells. Alveolar septal gaps were studied by electron microscopy on random sections in 26 adult human lung specimens and by serially sectioning and montaging the entire circumference of one alveolus to a depth of 103 microns (approximately one-half a normal alveolus) from one of the specimens. Fixation was by way of the airways in most specimens, but by vascular perfusion in the serially sectioned specimen and in seven others. In lungs studied by random sections, we found that the incidence of septal connective tissue gaps with epithelial continuity per specimen correlated with the incidence of pores (r = .468, P less than .016), and also with the incidence of type II cells (r = .422, P less than .025) in the specimen. Five percent of all type II cells observed in the random sections in the 26 specimens (103/1,955) occupied septal gaps, and 2.5% (49/1,955) were located at the rim of a pore. In contrast, in the single serially sectioned montaged alveolus, 69% of all type II cells occupied some type of septal gap, with 24% of all type II cells forming part of the rim of a pore. Over half of all pores in this alveolus were associated with a type II cell. We concluded that a relationship between the incidence of type II cells and gaps in the alveolar septum could be demonstrated on random sections in normal human lungs, which was much more obvious in a single serially sectioned hemialveolus. Serial section techniques of whole alveoli may be necessary to establish relationships that may not be apparent on random sections and that require the study of whole cells in continuity with their environment in order to be identified. The findings may be significant in suggesting a possible role of the type II cell in alveolar septal repair.

The anatomy of the dura mater's venous sinuses is important in the veterinary clinical and surgical area, for cranial procedures and interventions of wild animals, in addition to assisting in the management of neurological diseases, which can prevent serious complications. The macroscopic anatomy of the venous sinuses of the dura mater of Alouatta belzebul was studied. Five adult specimens, males and females, were dissected and fixed in 10% formaldehyde solution. In the dura mater of the Alouatta belzebul, nine venous sinuses were observed, being them dorsal sagittal sinus, ventral sagittal sinus, transverse sinus, straight sinus, sigmoid sinus, temporal sinus, parietal sinus, basilar sinus and cavernous sinus, with morphological similarities in origin, path and destination of blood flow to the internal jugular vein, assisting in the venous drainage function of the brain in this species. These data are similar to those found in other species of non-human and human primates such as Saimiri sciureus, Sapajus libidinosus and Homo sapiens. Of the venous sinuses observed, the cavernous sinus was of considerable clinical and surgical importance in Alouatta belzebul due to its topographic arrangement next to the internal carotid artery and pituitary gland, data that corroborate Sapajus libidinosus, Macaca fascicularis, Macaca mulatta, Papio ursinus, Cercopithecus pygerithrus and Galago senegalensis. In this context, the knowledge of the macroscopic anatomy of the venous sinuses of the dura mater may contribute to the role of veterinarians in less invasive surgical procedures in non-human primates such as Alouatta belzebul and other mammals.

The Detection of Human Papillomavirus Deoxyribonucleic Acid in Intraepithelial, in Situ, Verrucous and Invasive Carcinoma of the Penis

Editorial Comment

Does Routine Pathology Analysis of Adult Circumcision Tissue Identify Penile Cancer?

Specific sites of atherosclerotic processes due to hemodynamic changes and resultant stress, including how these normal anatomical structures become problematic in certain individuals, have yet to be acknowledged. One of these areas of the cardiovascular system occurs at the sinutubular junction (SJ), causing altercation in an otherwise normal flow status. The anatomy of the SJ was examined in 100 adult human hearts during the gross anatomy course at St George's University, during the years 2006-2007. All hearts were examined in situ, using a General Electric model 3200S ultrasound machine with a 5 MHz linear probe. The aforementioned cadavers were also examined using a Stryker laparoscopic unit. Serial transverse histological sections were made through the SJ perpendicular to its axis, and stained with eosin-hematoxylin, van Gieson, Masson trichrome, and Orcein methods. In addition, an immunohistochemical analysis was performed for the detection of positive smooth muscle cells stained areas. During gross and endoscopic examination we were able to identify the SJ in all adult heart specimens. Neonatal and fetal hearts did not exhibit any gross evident SJ; however, a SJ was evident histologically. Ultrasonographically we were able to identify the SJ in all adult heart specimens examined, and a sinutubular ridge in 62%. A significant association was present between the thickness of the ridge and the age of the specimens. The SJ was found to exhibit atherosclerotic changes and plaque formation in an age-related manner. In older subjects, the SJ was marked with local calcification and hemorrhages. In contrast, the SJ of neonatal hearts appeared to have intimal thickening with focal fragmentation and absent or duplicate internal elastic lamina. Intuitively speaking, the presence of a sinutubular ridge, an inevitable fate in humans based on the results of this study, provides an irreversible atherosclerotic process as there is no evidence that the promoting ridge regresses. This is an alarming situation in those individuals who will eventually develop cardiovascular risk factors, whether through inevitable genetic manifestations or by means of exogenous environmental causes.