Deep Muscular Layer Research Articles

Esophagus histological analysis after hyperthermia-induced injury: Implications for cardiac ablation

Purpose: To evaluate and numerically score histological alterations observed in the acute phase in the esophagus after being exposed to a hyperthermic dosage and subsequently to correlate the scores obtained with the hyperthermic treatment parameters (i.e. temperature (T) and time (t)).Material and methods: Esophagus samples obtained from New Zealand white rabbits were immersed in a temperature-controlled saline bath at 40, 50, 60 and 70°C for 30, 60 and 90 s. Samples were then processed for histological analysis (Masson Trichrome technique), and evaluated by searching for objective heat-damage signs. A numerical value was assigned to each sample for each finding.Results: In general, all the layers were affected by the treatment, however, the greatest alterations were found in the epithelium and deeper muscular layers (circular and longitudinal). We found no damage (i.e. no differences to control) in all of the samples treated at 40°C, and severe damage in treatments at 60 and 70°C, regardless of exposure time. On the other hand, samples treated at 50°C did show different results related to time: no damage for 30 s, light damage for 60 s, and moderate damage for 90 s. We assigned a score value to each hyperthermic dosage, and obtained the fitted equation based on a logarithmic transformation of the Arrhenius equation: Score = 130.7 – 40,851/(T + 273) + log t, (R2 = 0.9326, P < 0.0001).Conclusions: Hyperthermic treatment mainly affects the epithelium and deeper muscular layers. The results suggest a damage threshold of 50°C for treatments of 30–90 s. The proposed scoring system provides a good fit with the hyperthermic parameters.

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Microcystic adnexal carcinoma (MAC) is a rare malignant tumor of skin appendages. This tumor arises most commonly in the upper lip in the maxillofacial region. MAC is characterizedby a relatively slow clinical course, a strong tendency toward infiltration, and a low frequency of remote metastasis. Recently, we treated a case of MAC arising in the labial subcutaneous region. The patient was a 54-year-old man who noticed a mass in the right upper lip nearly 20 years ago. Since the tumor gradually became larger, he was referred to our hospital by a nearby clinic. At presentation, an extremely hard and immovable induration (20×15mm) was discovered at the upper lip. A benign tumor derived from a skin appendage was diagnosed on the basis of the clinical course of 20 years. Surgery was recommended, but the patient refused. He therefore underwent follow-up observation. When the tumor rapidly enlarged in March 2005, squamous cell carcinoma was diagnosed on the basis of a biopsydone in June. The tumor was resected with the patient under general anesthesia. Histopathological examination revealed no relation between the tumor and the skin, and imaging studies revealed continuous infiltration to the deep muscular layer. Proliferation of atypical basal cell-like squamous cells was found with microcystic lesions in the parenchyma of thetumor. On the basis of these findings, MAC was diagnosed. Neither local recurrence nor remote metastasis has been detected as of 2 years after resection.

Hemorrhage in the Floor of the Mouth After Second-Stage Surgery: Case Report

Placement of dental implants in the interforaminal region of the mandible is generally considered a routine, simple, and safe procedure. However, severe bleeding and hematoma in the floor of the mouth have been reported as a rare but potentially fatal complication related to the placement of an implant in this region. The following report describes a case of life-threatening hemorrhage in the floor of the mouth after second-stage surgery to place the healing abutment. The implants were forced to match with the prosthesis in a severely atrophic upper jaw, resulting in a perforation of the lingual cortex and mucosa of the floor of the mouth. Clinicians who place implants should be knowledgeable in the treatment of such a serious complication.

Carcinoid tumor arising in a duplication cyst of the duodenum

Reported herein is a case of carcinoid tumor arising in a duplication cyst of the duodenum in a 34-year-old woman. Ultrasonography at a health check-up revealed a 10 cm cystic mass located in the retroperitoneum adjacent to the third portion of the duodenum. Macroscopically, it had a smooth surface without communication with other organs and was filled with brownish necrotic fluid. More than half of the inner wall was occupied by a white, irregular, and solid nodule, which protruded into the lumen. The nodule was diagnosed as a carcinoid tumor invasive to the deep muscular layer. The non-neoplastic cyst wall had bowel structures including mucosa, submucosa and double layers of smooth muscle, indicating that the lesion was a duodenal duplication cyst. Most of the mucosa was eroded by marked inflammation. The remaining mucosa consisted of various types of epithelium, the major type having the nature of primitive gastric mucosa. Of interest was the presence of hamartomatous components in the wall. Furthermore, the non-neoplastic mucosal lining cells around the carcinoid tumor expressed neuroendocrine antigens and had minimal proliferative activity, suggesting that part of the cyst wall provided a microenvironment for accelerated differentiation of epithelial cells to an endocrine phenotype and transformation to neoplasia.

Immunohistochemical localization of programmed death-1 ligand-1 (PD-L1) in gastric carcinoma and its clinical significance

The present study examined programmed death-1 ligand-1 (PD-L1) detected by immunohistochemical labeling in 102 cases of human gastric carcinoma, 10 adenoma and 10 normal tissues. The relationship between PD-L1 immunolocalization and clinical pathological features, as well as the prognosis of gastric carcinoma, was explored. There was no PD-L1 detectable in normal gastric tissues and very weak immunolabeling in gastric adenomas, but it could be detected in 42.2% of gastric carcinoma tissues. There was no correlation between PD-L1 immunolocalization and patient age, sex, tumor location or the degree of tumor differentiation in the gastric carcinomas. However, PD-L1 immunodetection was significantly correlated to tumor size, invasion, lymph node metastasis and survival time of patients. PD-L1 immunolabeling was significantly enhanced (P<0.01) when the tumor infiltrated into the deep muscular layers, with lymph node metastasis or survival time of less than 2 years, Moreover, multivariate analysis demonstrated that PD-L1 immunodetection could be used as an independent factor to evaluate the prognosis of gastric carcinoma.

Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section

Rigor mortis can be a problem when laparoscopy is performed in embalmed cadavers for surgical training. To improve the laparoscopic view, a new technique for managing the abdominal wall with a cutaneous-subcutaneous flap, pneumoperitoneum (14-15 mmHg), and a progressive (step-by-step) bilateral section of the lateral muscles of the abdomen was attempted in 10 embalmed cadavers. The degree of abdominal wall increase was calculated by measuring changes in the size of the abdominal wall after each step. Improvement in the peritoneal laparoscopic view was also assessed. For abdominal wall size, no constant relationship was observed between initial (after creation of the pneumoperitoneum) and final increment (after each muscular layer section). Cumulative degrees of increase in the dimensions of the abdominal wall were the only parameters that showed a significant difference among the four groups of cadavers. Bilateral sectioning of both oblique muscles was sufficient to obtain an adequate view of the abdominopelvic cavity; thus, the risk of an unexpected peritoneal opening during sectioning of the transversum abdominis muscle was obviated. In embalmed cadavers, the laparoscopic view in the presence of a pneumoperitoneum can be facilitated by a section of the lateral muscles of the abdomen, with a previous cutaneous-subcutaneous flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.

Monoclonal antibody to rat galanin: production, characterization, and in vivo immunoneutralization activity.

A monoclonal antibody (MAb) to galanin was prepared by cell fusion of myeloma Fox-NY and spleen cells from Robertsonian mice immunized with rat galanin. Hybridomas producing high-affinity antibodies were cloned in pristine-primed Balb/c mice. The antibody was purified by affinity chromatography and concentrated to 12 mg IgG/mL by dialysis. Immunoreactivity of the antibody was screened by radioimmunoassay. Ascites fluid contained approximately 10 mg/mL IgG that belong to the subclass of IgG2a as determined by enzyme-linked immunoadsorbent assay (ELISA). The titer of this IgG2a antibody entitled #G65G was 1:10,000 and the ID50 for rat galanin was 1000 fmol/mL as determined by liquid phase radioimmunoassay. Immunohistochemistry showed that this galanin MAb stains densed, beaded processes distributed to the enteric plexuses, where they appear to encircle neuronal cell bodies, to the muscle layer, where they are particularly abundant in the circular muscle layer and in the deep muscular layer, and to the mucosa. In vivo capacity of immunoneutralization by this antibody was tested in male Sprague-Dawley rats fasted for 24 h and anesthetized with urethane. Systemic injection of protein A purified galanin antibody (6 mg/rat) decreased by 70% of the inhibitory effect of intravenous galanin (2 nmol/kg/h i.v.) on gastric acid secretion induced by intracisternal TRH analog. These results show that galanin antibody #G65G is useful for in vivo immunoneutralization of galanin effects and is a valuable tool for immunohistochemical localization of galanin in gastrointestinal tissues.

Chronological change of distribution in nitric oxide and peptidergic neurons after rat small intestinal transplantation

Background/Purpose: Nitric oxide (NO) has been considered one of the putative neurotransmitters of nonadrenergic, noncholinergic inhibitory neurons. To examine the effect of transplantation on NO neurons in the intestine, the distribution of NO neurons was examined and compared with that of peptide-containing neurons. Methods: A jejunal graft measuring about 20 cm was harvested from a Lewis rat, syngeneically transplanted as a Thiry-Vella loop, and later was replaced to the recipient small bowel 20 days after transplantation. Tissue specimens of the grafts were taken on days 1, 3, 6, 10, and 20, and 1 year after transplantation (n = 5 each). The distribution of the neurons was examined immunohistochemically, using antisera against protein gene product 9.5 (PGP 9.5, general neuronal marker), brain nitric oxide synthase (bNOS), vasoactive intestinal polypeptide (VIP), and substance P. In addition, NADPH diaphorase staining also was performed to visualize NO neurons. Results: In the PGP 9.5 immunoreactivities, no significant difference in the distribution was observed among the controls and on any day after transplantation. However, the NADPHd activities markedly decreased in muscle layers, especially in the deep muscular layer on day 1 and 3, but quickly recovered by day 6. The distribution of bNOS immunoreactivities was almost same as that of NADPHd staining. The VIP and substance P immunoreactivities also decreased on day 1, and thereafter gradually recovered, and then became normal on day 20. Conclusions: Both the NO and peptidergic neurons markedly decreased just after transplantation, and the NO neurons recovered faster than the peptidergic neurons. These findings suggested that NO neurons might play an important role in the adaptation process of the graft in the early period after transplantation.

Optimum needle length for DPT inoculation of indian infants

Correct placement of the injected DPT vaccine into the deep muscular layers decreases the local reactions, including the sterile abscess formation. However, recommendations on size of the needle to be used and the angle of injection are not easily available, are not uniform and are based on case reports. The only study based on scientific data of ultrasonographic measurement of fat layer and muscle layer thickness of thigh of only 24 infants of 4 months age covers only American children. (Hick et al, Pediatrics 1989; 84: 136-37). In the present study, we have produced similar data on 215 Indian children belonging to all those age groups in which DPT vaccinations are given. Mean thickness of skin + fat layer in the middle one-third of the anterolateral aspect of thigh was 1.03 +/- 0.23 cm, 1.04 +/- 0.21 cm, 0.95 +/- 0.19 cm and 1.06 +/- 0.27 cm in the age groups of 6-12 weeks (Groups I), 13-18 weeks (Group II), 19-24 weeks (Groups III) and 18 +/- 1 month (Group IV) respectively. These age groups correspond to the timings of first 3 primary doses and the first booster dose of the DPT vaccine in our immunization clinic. Mean thickness of all the soft tissues together at the same site were 1.87 +/- 0.35, 2.17 +/- 0.38, 2.07 +/- 0.39 and 2.07 +/- 0.26 cm respectively for the groups I to IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative Frequency of Peptic Ulcers After Deprivation of Bile and Pancreatic Juice

Berg and Jobling1 reported the occurrence of peptic ulcers in dogs following the deprivation of bile. These findings were corroborated by Kim and Ivy2 and Bollman and Mann.3 The incidence of ulcers was approximately 60%.During the past few years, in connection with other investigations, we have examined a number of animals deprived of their pancreatic secretions by means of fistulas, ligation of the pancreatic ducts, and pancreatectomy, and have been impressed by the infrequent occurrence of peptic ulcers in these animals compared to dogs in which bile was excluded. On the other hand, Elman and Hartmann4 found ulcers in the duodenum in all of the animals of a series of 6 dogs with pancreatic fistulas existing from 13 days to 18 days. They described the lesions as ulcers, although microscopic examination revealed only defects in the continuity of the mucosa, not involving the deeper muscular layers of the intestine. These investigators attributed the lesions to the loss of the neutralizing effect of pancre...