Changes In Elastic Tissue Research Articles

Evaluation of Clinical Results, Histological Architecture, and Collagen Expression Following Treatment of Mature Burn Scars With a Fractional Carbon Dioxide Laser

To assess mature burn scars treated with a fractional carbon dioxide laser for changes in histological architecture, type I to III collagen ratios, density of elastic tissue, and subjective measures of clinical improvements. Uncontrolled, prospective study of patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. The tissue was prepared with Verhoff von Giesen (VVG) stain to discern elastic tissue and Herovici stain to differentiate types I and III collagen. Subjects were recruited from the Grossman Burn Centers. Of 18 patients with mature burn scars, 10 completed the entire treatment protocol. Participants received 3 treatments with a fractional carbon dioxide laser. Vancouver Scar Scale and Patient and Observer Scar Assessment Scale survey scores. In histological analysis, imaging software was used to measure changes in collagen subtype and elastic tissue. A rating scale was developed to assess normal vs scar architecture. The first hypothesis that significant histological improvement would occur and the second hypothesis of a statistically significant increase in type III collagen expression or a decrease in type I collagen expression were confirmed. There were no significant changes in elastic tissue. Statistically significant improvements were seen in all survey data. Treatment with a fractional carbon dioxide laser improved the appearance of mature burn scars and resulted in a significant improvement in collagen architecture following treatment. Furthermore, in treated skin specimens, a collagen subtype (types I and III collagen) profile resembling that of nonwounded skin was found.

Anetoderma. A possible new risk factor for subretinal neovascularization

Editor, Anetoderma is a rare disease of the elastic connective tissue which is characterized clinically by multiple 5–25 mm-diameter round atrophic papules that bulge outwards from the skin of the trunk, the upper part of extremities and neck. At palpation, the lesions are flaccid and herniate inwards. Histopathologically, there is fragmentation of elastic fibres and loss of elastic tissue in the dermis. The aetiology of anetoderma is unknown, but the disease has been related to antiphospholipid syndrome, systemic lupus erythematosus (Venencie et al. 1984) and infections such as borreliosis (Bauer et al. 2003). In rare cases, the disease has been shown to be inherited or idiopathic. In the eye, anetoderma has been shown to be related to keratoconus, blue sclerae, pseudotumor orbitae and cataract (Brenner et al. 1977, Nuñez et al. 1995), whereas no studies have reported a relation between anetoderma and diseases in the posterior segment of the eye. A 27-year-old otherwise healthy woman with previous normal vision was referred with a 2 weeks history of metamorphopsia and blurred vision on the left eye. There was no history of trauma, choroiditis, or other known risk factors for the development of subretinal neovascularization, but anetoderma (Schweninger–Buzzy type) confirmed by skin biopsy had been diagnosed at the age of 12 years. Laboratory examinations for antinuclear antibodies (ANA), cardiolipin antibody and serological tests for Borrelia, syphilis and HIV were negative. The patient was subjected to a routine clinical examination including measurement of visual acuity, slit lamp examination, optical coherence tomography scanning and fluorescein angiography. The clinical examination showed VAD = 1.2 and VAS = 0.1 and both eyes had emmetropia. All other examinations on the right eye were normal. On the left eye, ophthalmoscopy showed central retinal oedema with haemorrhages and exudates. Optical coherence tomography (OCT) scanning of the left eye showed intra-retinal oedema with a central retinal thickness of 452 microns. Fluorescein angiography revealed a classical subfoveal neovascularization (Fig. 1). After three Intra-vitreal injections of ranibizumab on the left eye with 1 month intervals, the central retinal thickness was reduced to 214 microns and visual acuity had increased to 0.8. An early phase angiography of the normal right eye and the left eye with a subfoveal neovascularization. Subretinal neovascularization is a well documented complication to connective tissue diseases such as pseudoxanthoma elasticum and Ehlers Danlos’ syndrome and may be related to discontinuities or breaks in Bruch’s membrane that forms a barrier for growth of choroidal vessels under normal conditions (Georgalas et al. 2009). The present case report suggests anetoderma as a possible new risk factor for the development of subretinal neovascularization. A more detailed elucidation of the changes in elastic tissue in anetoderma and other connective tissue diseases may help understanding the pathophysiology of subretinal neovascularization in general.

Collagen‐elastic tissue changes and vascular involvement in granuloma annulare: a review of 35 cases

The pathogenesis of granuloma annulare (GA) is unclear. Collagen fiber degeneration is commonly reported, and there are several conflicting studies on elastic fiber and vascular changes associated with GA. In this study, we aimed to evaluate histopathologic characteristics, collagen and elastic tissue changes and vascular changes in GA. Clinical records of 35 GA patients were examined alongside serial sections of 38 biopsy specimens from these patients. New sections of biopsy tissue were stained with hematoxylin and eosin, Verhoeff-van Gieson or Alcian blue and then evaluated. Four different histopathologic patterns were observed: interstitial (57.9%), palisadic granulomatous (26.3%), sarcoidal granulomatous (5.3%) and mixed (10.5%). Dermal mucin deposition was determined in 84.2% of specimens. Solar elastosis was observed in only seven specimens, and elastophagocytosis was observed in only two specimens. Collagen and elastic tissue damages were consistent findings in all biopsy specimens. Fibrin thrombi and vasculitic changes were not found in any of the specimens from this patient group. Elastic and collagen fiber damage are the main accompanying features of GA, which may develop from delayed-type hypersensitivity. Vasculitis does not appear to be a major causative process. Sun exposure also seems to have no major effect on the formation of GA but can be one of the stimulants or predisposing factors.

Ascending aortic aneurysms in unicommissural aortic valve disease

Aneurysms of the ascending aorta occur as result of intrinsic changes in the aortic wall and have been well documented in patients with bicuspid aortic valve (BAV). In few reported clinical studies, documenting aneurysmal dilatation in unicommissural aortic valves (UAV); there have been no comments on the aortic wall pathology. This study presents the pathological findings of the ascending aorta in patients with UAV. The clinical data from 39 patients with concomitant excision of the UAV and aneurysmal aortic tissue were reviewed. In all cases, the gross features of the valve and aortic segments were noted and submitted for histology. The sections of the aorta were semi-quantitatively graded for the extent of medionecrosis, cystic medial change, fibrosis, and elastic tissue changes (fragmentation/ loss) in the media. The medial alterations were correlated with patient age, gender, and valvular dysfunction, and compared to aneurysmal disease in BAV and three-cuspid aortic valves (TAV) excised over a 3-year period. Among 39 patients studied, a majority were males (92.3%), with a mean age at surgery of 39.92 years. Only three patients (7.69%) were above the age of 50 years. Eighteen patients (46.1%) had aortic stenosis with regurgitation. Ascending aorta diameters ranged from 4 to 5.5 cm. The overall pattern of medial changes was nearly the same in all cases of UAV, irrespective of age and nature of valvular dysfunction. Most cases showed mild histological changes, with medionecrosis and fibrosis being the more common and consistent features. However, varying grades of change affected different portions of the media and/or the aortic wall in the same patient. The changes in UAV aortae were comparable to the changes seen in the TAV and BAV, but these differed with the age of onset. This study demonstrates the presence of medial changes in the ascending aortic tissue in all patients of UAV with aneurysms. These changes, while mild to moderate in degree, likely have a similar pathogenetic mechanism as those seen in BAV disease. The significant difference in age, at the time of surgery, suggests a more rapid progression of the aortic changes.

Tumefactive lipedema with pseudoxanthoma elasticum‐like microscopic changes

Lipedema is a condition characterized by diffuse, bilaterally symmetrical, painful swelling of the legs and buttocks. Microscopically, there are dermal and septal edema, adipocyte degeneration, and numerous mast cells, features held in common with lipedematous alopecia. We present the case of a 60-year-old woman with a long history of bilateral leg masses with microscopic features of lipedema. In addition, elastic-fiber changes typical of pseudoxanthoma elasticum (PXE) were discovered within the subcutaneous septa in three separate specimens obtained from an affected extremity. The patient did not have other clinical findings of PXE, although there was a history of both hypertension and congestive heart failure. This tumefactive presentation of lipedema has not been previously described. Regarding the elastic-tissue abnormalities, the patient could have either a subclinical form of PXE, perhaps predisposing to lipedema, or secondary elastic-tissue changes resulting from the massive edema. If the latter is the case, then this could represent an unusual manifestation of localized acquired cutaneous PXE (calcific elastosis).

An unusual cause of hypovolemic shock in the postpartum period

An unusual cause of hypovolemic shock in the postpartum period

Actinically degenerate elastic tissue is the likely antigenic basis of actinic granuloma of the skin and of temporal arteritis

Staining technique is paramount for detecting and assessing the severe degeneration that occurs in the elastic tissues of the skin and its arteries in response to prolonged exposure to actinic radiation. With a selective “controlled” hematoxylin-and-eosin stain, actinically damaged (“elastotic”) elastic tissue stains blue, as Unna described, and contrasts with normal and simply hyperplastic elastic tissue, which stains red. “Special” elastic stains such as Orcein and Verhoeff do not demonstrate this difference. When resorptive (elastolytic) giant cell reactions develop in relation to actinically degenerate elastic tissue of the skin, the papules that arise tend to form expanding, annular rings. A previously used and appropriate name for these autoimmune lesions in the skin is actinic granuloma because this name highlights the likely actinic origin and pathogenesis of many such lesions. Granulomatous inflammation in connection with actinically degenerate internal elastic lamina appears to be the basis of temporal arteritis. Actinic granulomas may occur in the skin concurrently with temporal arteritis. A recent study of temporal arteritis strongly relates its elastic tissue changes to those of “accelerated” atherosclerosis. (J Am Acad Dermatol 1999;40:214-22.)

Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion.

The technique of rapid intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random-pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under-predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under-predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunofluorescence, collagen, and elastic tissue stains.

Penicillamine-induced changes in elastic tissue of the upper respiratory tract

We describe a patient who developed upper respiratory tract symptoms following long-term treatment of Wilson's disease with penicillamine. These symptoms were attributed to areas of pharyngeal thickening and were treated with a laser. Histological examination of the lesions showed proliferations of abnormal elastic fibres similar to those previously described at other sites, especially the skin, in patients receiving penicillamine. This drug impairs the maturation and reduces the stability of elastic fibres and although elastic tissue throughout the body is affected, we are aware of no previous reports of penicillamine-induced changes presenting with upper respiratory tract symptoms.

Elastic Tissue Changes in Generalized Granuloma Annulare

The histological picture in granuloma annulare (GA) is well defined. The types of infiltrate and the changes in collagen and elastic tissue have been repeatedly described. This is a preliminary study focused on the elastic tissue changes in lesions of generalized GA. Biopsies from four patients were studied. Specimens of involved and uninvolved skin from both exposed and unexposed parts of the body were compared. Changes of actinic elastosis in the papillary dermis in each patient in different stages were observed only in the exposed skin. The typical GA infiltrate was located beneath, in the upper mid-dermis. In the zone of the infiltrate in all specimens--exposed and unexposed--with no regard to the severity of actinic elastotic changes, absence or a marked reduction of elastic material was noted with engulfment of elastic remnants in giant cells. Giant cells with phagocytosis of elastotic material were mostly located on the periphery of the granuloma in the upper as well as in the deeper portion, where elastic fibers were still present. This might support the suggestion that degenerating elastic fibers promote the granulomatous reaction that leads to the formation of granuloma annulare.

Elastic tissue changes in skin following PUVA therapy

Treatment of psoriasis with psoralens and high-intensity long-wave ultraviolet light (PUVA) produces changes in the ultrastructure of elastic tissue in skin. Early alterations consist of a loss of elastin followed by a breakdown of the microfibrils and subsequent fragmentation of the elastic fiber. Tissue examined 15 months after treatment was stopped still showed marked ultrastructural changes in the elastic fibers.

Pulmonary elastic tissue in generalized elastolysis (cutis laxa) and marfan's syndrome. A light and electron microscopic study

We have studied elastic tissue changes in the lungs from patients with Marfan's syndrome, generalized elastolysis, patients with emphysema of other cause, and those dying from unrelated causes. Degenerative changes were seen in the elastic tissue fibers in patient's with Marfan's syndrome; they varied from mild to severe. Elastic fibers in the lungs of patients with cutis laxa showed by light and electron microscopy the same morphologic changes previously reported in the skin and vessels. While the alterations in individual elastic fibers in the alveolar septa appeared similar, in cutix laxa there was severe involvement of almost all fibers, whereas in Marfan's syndrome the involvement was not so severe, nor did it affect all fibers. On examination of lung sections from patients with cutis laxa or Marfan's syndrome, both were readily separable from normal and abnormal controls.

Hepatic elastosis in Indian childhood cirrhosis.

Elastic tissue changes in the liver biopsy material of 49 cases of I.C.C. wsre studied using various staining reactions. The changes in the hepatic elastica included thickening and coarsening of the elastic fibres in the walls of the blood vassels. New elastic fibre formation was observed in an occasional and sometimes fibrosed and thickened bile duct. The significance of these findings is briefiy discussed.

Regression Rate of Vascular Effects Induced by Pregnancy and by Norethynodrel-Mestranol

Based on results in a previous study showing specific vascular changes as the result of pregnancy and administration of norethynodrel-mestranal in the rabbit an attempt was made to determine how long these changes persist after the conclusion of pregnancy and after withdrawal of norethynodrel-mestranol. 8 pregnant rabbits and 8 norethynodrel-mestranol-treated rabbits were studied. The pregnant rabbits were allowed to deliver at term and 1 was sacrificed every second day from Postpartum Day 1-15. Histological preparations were made. Since normal findings were noted in all cases at 15 days postpartum 3 additional rabbits were sacrificed on different days. In the norethynodrel-mestranol-treated group each animal was treated with .2 mg intramuscularly daily for 6 days and then sacrificed every second day from Day1-15 after conclusion of treatment. 3 additional animals were sacrificed. It was concluded that in the rabbit the vascular effects of pregnancy and of norethynodrel-mestranol disappear at variable rates after the withdrawal of the stimulus. Reticular fragmentation persists until about 15 days after pregnancy conclusion and for 10 days after norethynodrel-mestranol therapy cessation. Acid mucopolysaccharides return to normal immediately in both instances. Muscle changes and elastic tissue changes are virtually normal within 10 days and completely normal within 15 days for both groups.

Intimal changes in the arteries of ageing swine

1. Twelve pigs between 4 and 10 years of age were examined for atherosclerosis of the aorta, coronary arteries, and other main arteries. Light- and electron-microscopy were used for study of the lesions. 2. All the pigs had intimal thickenings in the coronary arteries and aorta with a similar distribution to those of atherosclerosis in man. The structure of the thickenings showed many of the features of early human atherosclerotic lesions including changes in elastic tissue and accumulation of lipids, though the later complications found in human disease were not present. Similar lesions in other arteries were particularly well developed in the vessels supplying the mammary glands and uterus. 3. In general, the thickenings increased in extent and in histological development with increasing age. 4. The lipid content of the plasma and the lipid distribution in the high- and low-density lipoproteins were determined. The total plasma lipid concentrations were low when compared with those of man. In the females a higher proportion of the total plasma lipid was associated with the low-density lipoproteins than in most laboratory mammals, while in the two males examined the greater part of the plasma lipid was in the high-density fraction. 5. This investigation supports the idea that natural atherosclerosis in the pig is a suitable model for the experimental study of atherosclerosis in man.

On elastic tissue changes in the aorta in some diseases

The important physiological significance of elastic tissue for the body was often pointed out from several different points of view. This meaning is based primarily on the physical properties of elastic tissue, from which its elasticity and extensibility appear in the first place.