Cutaneous Distribution Research Articles

Effect of nerve section on the spinal distribution of neighboring nerves

The spinal cord distribution of axonal terminals of peripheral nerves that innervate the skin of the upper medial thigh was examined in rats using transganglionic transport of horseradish peroxidase (HRP) and wheat-germ agglutinin-conjugated HRP (WGA-HRP). Chronic transectionof the sciatic nerve or both the sciatic and saphenous nerves did not alter this distribution. Therefore, long-distance sprouting of intact ‘thigh nerve’ afferents in the dorsal horn is apparently not the mechanism whereby spinal dorsal horn neurons deafferented by sciatic and saphenous neurectomy, gain novel receptive fields in the cutaneous distribution of neighbouring intact nerves of the thigh.

Clinical experience with cefadroxil dry syrup in pediatric infections (author's transl)

Cefadroxil was administered to 16 pediatric patients at dose levels ranging from 27 to 56 mg/kg daily for 5-9 consecutive days. Of 16 patients, 9 had urinary tract infections including 5 cases with nephrotic syndromes, 4 had respiratory tract infections including 2 cases with nephrotic syndromes, 3 had skin infections including 2 cases of pyoderma and 1 case of suppurative gingivitis, including 1 case with nephrotic syndrome. Clinical results obtained were 9 'excellent', 4 'effective' and 3 'ineffective' showing an efficacy ratio of 81%. Of 9 urinary tract infections, 5 patients exhibited bacteriuria and 3 had original pathogens persisting after treatment. In respiratory tract, skin and gingival infections, cefadroxil was either 'excellent' or 'effective' in all 7 patients. The above results demonstrate a distinctive feature of cefadroxil that attains a good cutaneous distribution after oral administration. The absorption of the drug was not adversely affected by a food intake. No significant side effects were observed in all 16 patients. Judging from our clinical results, cefadroxil is considered one of the valuable cephalosporin antibiotics in the treatment of pediatric infections.

Ultrastructural and cell surface changes of human psoriatic skin following Goeckerman therapy.

Ultrastructural and cell surface studies of skin in psoriatic patients prior to and after Goeckerman therapy (crude coal tar and UVB-light) have demonstrated significant cellular changes following this treatment: hyperactivity of melanocytes with melanosome polymorphism, increase of desmosomes, tonofilaments, keratohyaline granules, a decrease in mitochondria, keratinosomes, polysomes, dark cells and a reduction in size of nuclei and nucleoli. The enlargement of intercellular spaces and the redundancy of basement membrane were also reduced. Langerhans cells were moderately decreased and exhibited a normal ultrastructural pattern. No significant changes in cutaneous nerve distribution or morphology were observed in these cases. Scanning electron microscopy following treatment revealed a regular surface and orientation of corneocytes, with flattened surfaces; and a reduction of their ridges on the surfaces, as well as of the intercellular spaces and red blood cells. These findings indicate that Goeckerman therapy restored the ultrastructural and cell surface pattern in the psoriatic skin by inducing orthokeratinogenesis, development of the tonofibrillar-desmosome system, and decrease in mitochondria, nuclei and nucleoli.

VITILIGO PATTERNS SIMULATING AUTOIMMUNE AND RHEUMATIC DISEASES

Several variants of generalised vitiligo can be recognised by their cutaneous distribution. In some, certain anatomical regions—e.g., hands—are predominantly affected while the cutaneous depigmentation in other variants shows a similar anatomical distribution to that of the internal structures affected in some of the autoimmune and rheumatic diseases. Five patients have been seen, and three described by others, with vitiligo affecting skin of eyelids and lower front of neck, reminiscent of the anatomical distribution of lesions in thyrotoxicosis with exophthalmos: two of these patients have thyrotoxicosis. Another variant of vitiligo mimicks the anatomical distribution of lesions in ankylosing spondylitis, Reiter's syndrome, and ulcerative colitis and there are cases simulating lupus erythematosus, rheumatoid arthritis, and psoriasis. It is suggested that the parts of the body affected in each vitiligo variant and its corresponding internal disease constitute a set of mosiac patches with distinctive shared characters. These may have morphogenetic functions during embryonic development and be potentially autoantigenic later in life.

Topography of cutaneous mechanoreceptive neurones in dorsal root ganglia of skin‐grafted frogs

1. Topographical distribution patterns of dorsal root ganglion (d.r.g.) cutaneous neurones providing innervation to various body surfaces were examined in doublypithed Discoglossus pictus frogs.2. Using electrophysiological methods, sensory neurones innervating back skin were observed to predominate on the dorsal ganglionic surfaces, while belly skin neurones were most prevalent in the caudal half of the d.r.g. ventral surfaces. Flank neurones clustered in the medial half of d.r.g. ventral surfaces.3. Cutaneous neuronal distribution patterns within the d.r.g. of 180 degrees skin grafted animals were indistinguishable from those observed in control frogs.4. Sensory neurone distribution patterns were found to be altered in all animals with single skin type grafts. Projection patterns were always heaviest towards the autograft, which was on the opposite body surface (i.e. dorsally located d.r.g. sensory neurones projected to back skin on the frog's ventrum, while ventrally located neurones projected to belly skin on the frog's dorsum).5. The results are discussed in the light of several selective outgrowth mechanisms which have been proposed as a possible underlying basis for the development of misdirected wiping reflex behaviour in skin grafted anurans. The findings indicate that none of the proposed selective growth mechanisms can account adequately for the development of misdirected wiping reflexes, at least in the species studied.6. It is suggested that selective cell replacement, based upon competition among prespecified cutaneous neurones, might best account for the development of normal and misdirected wiping reflexes in frogs.

Medical modification of sensation

Pain: June 1977 - Volume 3 - Issue 3 - p 285-286 doi: 10.1016/0304-3959(77)90019-7

The oral and cutaneous distribution of Candida albicans and other yeasts in Rarotonga, Cook Islands

The distribution of Candida albicans and other yeasts in the mouth and on the skin of 244 Cook Islanders was investigated. It was isolated from the gums of 41·4% and from some cutaneous site of 15·6%. Both oral and cutaneous carriage was significantly higher than in New Zealand subjects. The areas of skin most frequently colonized by C. albicans were the interdigital spaces of the foot. Of the 140 isolates 20·7% were recovered from these areas, but there was no associated clinical abnormality. Candida parapsilosis and C. tropicalis were carried by 13·9% and 9·8% Rarotongans respectively. Both species were isolated far more commonly from the skin than from the mouth, which yielded only 20% of the strains. 8 other species of Candida and 4 of Torulopsis were recognized during the survey. The high incidence of C. albicans especially on the skin in Rarotonga is discussed, and we suggest that the genus Candida may play a more important part in the aetiology of cutaneous infection than is generally realized.

Intratympanic surgical treatment of frey's syndrome.

SWEATING and flushing of the skin in the parotid region while eating is frequently seen in patients who have had abscesses or surgical procedures of the parotid gland. This symptom complex is commonly referred to as Frey's syndrome. It is the purpose of this paper to describe the anatomy and pathophysiology involved and the historical evolution of therapy in order to demonstrate the efficacy of a middle ear surgical procedure which eliminates the distressing symptoms of Frey's syndrome. History The earliest recorded case of Frey's syndrome is credited to the description of Duphenix in 1757 following incision and drainage of a parotid abscess. Baillarger in 1853 reported bilateral symptoms following bilateral suppurative parotitis which was not incised. 1 Lucie Frey in 1923 reported a case produced by an infected bullet wound of the parotid gland, and she particularly noted that the resultant sweating corresponded to the cutaneous distribution of the

Distribution of blood flow within the skin of the rabbit with particular reference to hair growth.

Previous work using a Kr 85 clearance technique demonstrated the existence in rabbit thigh skin of a bimodal distribution of blood flow which was consistent with the presence of two distinct vascular compartments with markedly different flow rates. These observations on the rabbit thigh have been extended to compare flow patterns during the inactive phase of the hair growth cycle and during active hair growth. Resting areas and hair-growing areas of rabbit skin have been examined histologically and the vascular pattern has been demonstrated after perfusion of the vessels with India ink. The results provide an anatomical basis for the two-compartment model derived from analysis of the clearance curves. The mean rate of blood flow for the fast compartment during the inactive phase was 29.7 ml/100 g tissue/min and 4.3 ml/100 g tissue/min for the slow compartment; these did not change significantly with active hair growth. However the relative size of the fast compartment altered markedly with active hair growth, the relative size of the fast compartment increasing from 21 to 67% of the tissue mass. The mean cutaneous blood flow was more than doubled during the active phase. Histological studies demonstrated a marked increase in the size of the follicles during the active phase and a concomitant increase in the extent of the vascular bed around the follicles. This would indicate that the fast compartment represents the follicular tissue and its associated blood supply; its flow rate was a measure of nutrient blood flow to the hair follicle. The flow rate of the slow compartment was then a measure of nutrient blood flow in the rest of the skin. These conclusions were supported by observations in areas of skin with sparse hair growth. The effect of body heating and cooling on cutaneous blood flow distribution was also noted.

Further observations on the cutaneous branches of the dorsal primary rami of the spinal nerves.

AbstractRecent investigators suggest that dermatomes extend as consecutive bands from the dorsal median line and question the existence of dorsal axial lines. Our observations were made on serial sections of human embryos and fetuses prepared with neurofibrillar stains.Cervical nerves 1, 6, 7 and 8 failed to have cutaneous branches in most cases, the remainder usually had cutaneous branches.With a few exceptions in T 1, all thoracic dorsal rami had cutaneous branches. Usually T 1, 2 and 3 became cutaneous through medial branches, while T 9 through 12 did so through lateral branches. However T 4 through 8 constitute a transition zone where many of these nerves became cutaneous through both medial and lateral branches. Thoracic 4, 5 and 6 tended to have cutaneous distribution through medial branches, but T 7 and 8 through lateral branches.All lumbar dorsal rami having cutaneous distribution did so through lateral branches, but independent branches became progressively less frequent below L 1. Lumbar 4 lacked direct cutaneous branches in most cases and succeeding nerves in all cases. These nerves form the dorsal sacral plexus.The deficit in cutaneous distribution of lower lumbar rami was not as pronounced as in the lower cervical region. A deficit is significant in relation to dorsal axial lines.

Management of lymphoma cutis with low megavolt electron beam therapy: nine year follow-up in 200 cases.

The authors point to the highly satisfactory palliative effect of this relatively new physical means of therapy. This represents a new modality applicable in malignancy especially of cutaneous distribution.

Cardiac pain: anatomic pathways and physiologic mechanisms.

It may be concluded that the pathways of cardiac pain have been thoroughly established, with the exception of the conduction of anginal attacks occasionally referred to the neck and jaws. Afferent impulses traverse axons that travel in the cervical and thoracic sympathetic cardiac nerves. In the case of the cervical pathway, all impulses on entering the paravertebral ganglionated chain in the neck must descend to the upper thoracic level before they can gain access to the spinal cord. Other impulses reach the 3 superior thoracic ganglia via the more direct thoracic cardiac nerves. Both the cervical and thoracic fibers join the spinal nerves over the communicant sympathetic rami. After passing through the intervertebral foramina, they enter the posterior roots and terminate in the lateral horn of the spinal cord. Here they establish synapses with secondary afferent neurons of the spinothalamic tract, decussate to the opposite anterior column, and are carried rostrally to the nucleus ventralis posterolateralis of the thalamus. This is the principal locus in the brain for the perception of visceral pain. In contrast to well-defined cutaneous sensibility, there is no cortical area for exact visceral localization in the postcentral region of the cerebral cortex. Another factor in the poor localization of cardiac pain is the paucity of sensory endings in the heart. A third appears to be the limited number of secondary sensory fibers in the spinothalamic tracts. These central axons must be shared with other impulses from the surface of the body. As a result, pain from the heart is in large part referred to the cutaneous distribution of the upper 4 thoracic spinal segments. Accounting for the superficial reference of visceral pain by Mackenzie's theory of a viscerocutaneous reflex is no longer justifiable. Even after cutaneous afferent fibers are interrupted by procaine or amputation of the arm, pain from the heart can still be felt over its previous distribution. Neither stimulation of the vagi nor interruption of transmission in these nerves has been found to have any beneficial effect in patients suffering from angina pectoris. Sensory denervation of the heart must therefore be carried out by destruction of the upper ganglia in the thoracic sympathetic trunks or by severing the corresponding posterior spinal roots.

Chorda tympan nerve section for postherpetic neuralgia of the tongue.

Herpes zoster is considered at present an acute specific infection caused by a neurotropic and epidermotropic virus with a predilection for the posterior spinal ganglia or the extramedullary ganglia of the cranial nerves. The clinical picture includes an erythematous vesicular eruption in the cutaneous or mucosal distribution of the sensory nerves. In herpes zoster oticus the herpetic eruption occurs in a certain area of the external ear (the "geniculate" zone). Hunt contended, in a report published in 1907, that the primary disorder was in the geniculate ganglion of the facial nerve. He assumed that the infection spreads from the ganglion by means of anastomosis to other cranial nerves, especially the statoacusticus and its ganglia. Later pathoanatomical studies have shown that, in addition to neuritic changes, localized leptomeningitis also occurs in cases of herpes zoster (Denny-Brown and associates). This is easy to understand because the geniculate ganglion, as well as the

The Anatomy of Lumbosacral Posterior Rami and Meningeal Branches of Spinal Nerves (Sinu-Vertebral Nerves)

The distribution of the lumbosacral posterior rami and the sinu-vertebral branches (ramus meningeus) of spinal nerves was determined by dissection of newborn and adult cadavera and by a detailed study of serial sections of human foetuses. In addition, blood pressure and respiration were recorded and electromyograms were made in decerebrate cats during electrical and mechanical stimulation of low-back structures. The posterior rami, in addition to their cutaneous and muscular distribution, give sensory fibers to fascia, ligaments, periosteum, and intervertebral joints. Adjacent divisions overlap in their area of supply. Interspinous ligaments are supplied mainly by branches from the next cranial level. Sinu-vertebral nerves supply posterior longitudinal ligament, dura mater, periosteum, and blood vessels, show intersegmental anastomoses, and contain sensory fibers. Painful stimulation of joints and ligaments of the lumbosacral region in cats produces reflex spasm of dorsal and hamstring muscles, as well as non-specific changes in respiration and blood pressure. It is suggested that clinically a painful stimulus to any deep structure in this region is poorly localized and can give rise to a common symptom complex which includes both low-back and leg pain.

Surgical treatment of the auriculotemporal syndrome.

THE DISAGREEABLE symptom complex of gustatory sweating was first reported as the auriculotemporal syndrome by Frey. 1 A number of cases have been subsequently reported. Freedberg, Shaw and McManus 2 have reviewed the literature and presented a clinical and pharmacological study of three cases. The condition most frequently follows operations on or injuries to the parotid gland and is characterized by flushing and profuse sweating, upon eating, in the cutaneous distribution of the auriculotemporal nerve. Gustatory sweating has been reported in areas supplied by other divisions of the sensory supply of the head and neck. The frontal area supplied by the supraorbital nerve was involved in the case reported by Tarlov and Herz. 3 Uprus, Gaylor, and Carmichael 4 observed the syndrome in the neck after an operation in the region of the nevus cutaneous colli. Haxton 5 observed involvement of the same area following a cervical thoracic sympathectomy performed

HERPES ZOSTER OF THE CEPHALIC EXTREMITY

HERPES zoster, or zona, was well known to the ancients. It was not until the nineteenth century that herpes zoster was recognized as the cutaneous phase of a disease involving the sensory portion of the spinal nerves. Von Baerensprung in 1861 first demonstrated at autopsy inflammatory lesions in the posterior root ganglia. In 1900 the work of Head and Campbell 1 led to our current hypothesis of herpes zoster. The disease is now generally regarded as an acute specific infection caused by a neurotropic virus with a predilection for the posterior spinal ganglia or the extramedullary ganglia of the cranial nerves, conferring an immunity and running a definite clinical course accompanied with an erythematous vesicular eruption in the cutaneous or mucosal distribution of the sensory nerves. Although many observers in the past century reported cases of herpes zoster of a cranial nerve, chiefly of Gasserian origin, but including herpes oticus

ANGIOMA OF THE CHOROID

FOR MANY years the existence of an angioma of the choroid has been consistently noted in the relatively few eyes examined histologically from cases of the Sturge-Weber syndrome. The features of this syndrome are well known and offer no diagnostic problems. In fully developed form, they are (1) nevus flammeus of the face, involving the cutaneous and conjunctival distribution of the trigeminal nerve; (2) glaucoma, of either infantile (buphthalmic) or adult type; (3) neurologic signs—Jacksonian epilepsy affecting the opposite half of the body, hemiplegia, dyspituitarism, and meningeal telangiectasia, which may be calcific. Less well known are the cases of choroidal angioma in which cutaneous stigmas are lacking and glaucoma may or may not be exhibited at the time of examination. Most of these tumors are found in eyes enucleated for absolute glaucoma (Lindenmeyer,11932; Hill and Dart,21936). Of particular interest and importance are the tumors which are

UNILATERAL FRONTAL ANHIDROSIS AND MIOSIS OCCURRING AFTER PETROUS APICECTOMY (RAMADIER TECHNIC)

THE COURSE of the sympathetic fibers arising from the superior cervical ganglion and supplying the sweat glands of the face has not been definitely established. However, much evidence has accumulated to suggest that the ophthalmic division of the trigeminal nerve receives fibers within the cranium from the sympathetic plexus of the internal carotid artery, and that the maxillary and mandibular divisions receive fibers outside the cranium from the sympathetic plexus of the external carotid artery. List and Peet 1 in an excellent paper on this subject summarized all the available anatomic information in a diagram (fig. 1). It is known that the cutaneous distribution of the sympathetic fibers supplying the face corresponds closely to the cutaneous distribution of fibers conducting pain and temperature sensations. This relationship in respect to the ophthalmic division has been well illustrated in a recent report by Tarlov and Herz. 2 They described a patient with

Causalgic backache

Another concept relating to a specific phase in the backache problem is presented. A mechanical theory based on muscle imbalance is advanced to explain the clinical and roentgen findings. The patients complain of an upper lumbar backache that is aggravated at rest, awakens them at night, and is accompanied by pain that radiates along the last rib and to the groin. The clinical examination reveals an increased lumbar lordosis, postural scoliosis, a pelvic tilt, abduction and internal rotation of the femur on the side of the low iliac crest, and adduction of the thigh on the side of the high iliac crest. There is tenderness and hyperesthesia over the cutaneous distribution of the twelfth dorsal and first lumbar nerves. The treatment consists of elevation of the heel on the side of the low crest and muscle exercises. The roentgenographic examination confirms the clinical findings when the upright films reveal an acute costovertebral angle and a pelvic tilt.

TINEL'S SIGN, FORMICATION OR DISTAL TINGLING ON PERCUSSION AND DEEP PRESSURE SENSATION

Tinel's sign, formication or distal tingling on percussion (D. P. T.), is, as described by Tinel, a creeping sensation in the cutaneous distribution of an injured nerve when compression or percussion is lightly applied along its course peripheral to the injury. The sign indicates that the axis cylinders are in process of regeneration. The following conclusions relative to the importance of this sign were reached after 2,500 personal examinations in over 500 cases of peripheral nerve injury, operative and nonoperative. The patients had been injured at least three months prior to their entrance to General Hospital No. 6. Examinations were made monthly as a matter of routine. TECHNIC With all muscles of the part relaxed, gentle finger percussion is performed, beginning as near the distal distribution as possible and proceeding proximally. INDICATIONS 1. Progressive formication is not an infallible sign of regeneration in a peripheral nerve. It may be present