Evidence Of Atrophy Research Articles

Corticobasal Syndrome Associated With the A9D Progranulin Mutation

Corticobasal syndrome is characterized by cortical dysfunction and L-dopa-unresponsive Parkinsonism, with asymmetrical onset of clinical presentation and evidence of atrophy and/or hypometabolism at neuroimaging. Recently, the heterogeneous pathologic substrate of corticobasal syndrome has been further expanded to include cases with pathologic diagnosis of frontotemporal lobar degeneration with ubiquitin/TDP-43 (TAR DNA binding protein 43)-positive inclusions associated with progranulin (PGRN) mutations. We report a family in which several individuals have been affected with a dementia/movement disorder phenotype. The proband presented at age 45 with spontaneous left arm levitation, ideational apraxia, asymmetric parkinsonism, and dystonia. Subsequently, he developed limb-kinetic apraxia, left-side hemineglect, memory loss, and executive dysfunction. Magnetic resonance imaging and [F]fluorodeoxyglucose-positron emission tomography studies revealed severe cerebral cortical atrophy and hypometabolism, which were significantly more pronounced in the parietal lobes (right > left). Neuropathologic examination displayed the highest degree of degeneration and ubiquitin/TDP-43 pathology in the proband's parietal areas. Genetic analysis revealed the presence of the c.26C>A PGRN mutation in 1 allele. This mutation has been reported in association with hereditary-dysphasic-disinhibition-dementia, Alzheimer-like dementia, progressive supranuclear palsy, and primary progressive aphasia. The peculiar findings observed in this patient indicate that the parietal lobe may represent the most vulnerable anatomical area in some of the PGRN-associated frontotemporal lobar degeneration with ubiquitin/TDP-43-positive inclusion cases.

Emotions Induced by Intracerebral Electrical Stimulation of the Temporal Lobe

To assess the quality and frequency of emotions induced by intracerebral electrical stimulation of the temporal lobe. Behavioral responses were obtained by electrical stimulation in 74 patients undergoing presurgical video-stereo-EEG monitoring for drug-resistant epilepsy. Intracerebral electrical stimulation was performed by delivering trains of electrical stimuli of alternating polarity; the intensity could vary from 0.2 to 3 mA. Stimulation frequency was 1 Hz or 50 Hz. Nine hundred thirty-eight stimulation procedures were performed. Seventy-nine emotional responses (ERs) were obtained (8.4%). Of these, 67 were "fear responses." Sad feelings were evoked 3 times, happy-pleasant feelings 9 times. Anger and disgust were never observed. The following variables affected the incidence of ER: (a) Anatomical site of stimulation. ERs (always fear) were maximal at the amygdala (12%) and minimal for lateral neocortical stimulation (3%, p < 0.01). (b) Pathology. Stimulation of a temporal lobe with hippocampal sclerosis was associated with a lower frequency of ERs compared with stimulation of a temporal lobe with no evidence of atrophy in the medial temporal structures. (c) Stimulation frequency. ERs were 12% at 50 Hz versus 6.0% at 1 Hz (p < 0.01). (d) Gender. In women fear responses were 16% compared with 3% in men (p < 0.01). There were no gender differences when analyzing nonemotional responses. These data confirm the role of the medial temporal lobe region in the expression of emotions, especially fear-related behaviors. Fear was observed more frequently in the absence of medial temporal sclerosis, supporting the hypothesis that emotional behaviors induced by stimulation are positive phenomena, strictly related to the physiological function of these regions. Further investigations should address why women express fear behaviors more frequently than men.

Failed Orchiopexy

Introduction: Failure after orchiopexy or cryptorchidism after inguinal surgery are not so rarely encountered conditions. Reoperative orchiopexies are technically demanding procedures. In our study, we aimed to examine the causes of failures and outcomes of reorchiopexies. Patients and Methods: Between 1993 and 2003, a total of 28 children who underwent reoperative orchiopexy were included into the study. Undescended testes was detected as unilateral in 24 and bilateral in 4 cases. The mean age of patients at the time of second operation was 6.8 years. The mean period of time between the first and the second operations was 3.2 (1–13 years) years. Results: The first operations were orchiopexies in all patients. After the first operations, 15 testes were found to be localized at the high scrotal position, 8 at the level of the external ring and 9 within the inguinal canal. Overall, reorchiopexies were performed on 32 testes in 28 patients. During the second operation, patent processus vaginalis was detected in 11 (34.4%), and unsuccessful hernia repair in 9 (28.1%) cases. After reorchiopexies, two testes with preoperative inguinal location could only be brought to high scrotal position and in another case orchiectomy was performed to an atrophic testis. Overall, after a mean follow-up period of 3.8 (1–7 years) years following the second operations, 29 (93.5%) testes were scrotal without evidence of atrophy. Conclusion: In our series, inadequate repair of inguinal hernia or patent processus vaginalis, as noted in 62.5% of the cases, was determined as an important factor leading to failure after surgical treatment of undescended testis. Adequate dissection and correction of inguinal hernia increase the success rate after orchiopexies.

Atrophying tinea versicolor: a clinical and histological study of 12 patients.

We describe 12 patients with an atrophying dermatitis in whom the biopsy findings were compatible with tinea versicolor. We encountered 12 skin biopsies from 12 patients in whom a clinically atrophying dermatosis was associated with light microscopic (LM) evidence of atrophy and epidermal colonization by Pityrosporum sp. Formalin-fixed, paraffin-embedded tissue sections were cut at 5 microns and stained with H&E, alcian blue-PAS and PAS-diastase preparations. Five men and seven women aged 17-73 years in whom lesions characterized as atrophic plaques, patches or macules prompted clinical differential diagnoses including parapsoriasis or mycosis fungoides (MF), anetoderma, lupus erythematosus, and steroid atrophy. A LM examination showed epidermal colonization with pityrosporum hyphae and spores accompanied by variable epidermal and dermal atrophy characterized by rete-ridge effacement, subepidermal fibroplasia, pigment incontinence and elastolysis. Atrophying cutaneous lesions comprise part of the clinical spectrum of tinea versicolor for which we propose the term 'atrophying tinea versicolor'. The pathogenetic basis is unclear but could be the sequela of delayed type hypersensitivity and the release by T-helper lymphocytes of leukotrienes which perturb collagen metabolism and/or keratinocyte growth. Lesions may be mistaken clinically for MF or other atrophying dermatoses.

Clinical Predictors in the Use of Finasteride for Control of Gross Hematuria Due to Benign Prostatic Hyperplasia

We identify predictors of clinical response as well as response time in patients treated with finasteride for gross hematuria due to benign prostatic hyperplasia. A retrospective chart review was preformed of 53 patients who had been given 5 mg. finasteride daily for the treatment of active bleeding or a recent history of recurrent bleeding. Urological evaluations were negative for tumor in all patients. A history of prostatectomy, anticoagulant status and prostate size was determined. The degree of hematuria was then graded before and after finasteride treatment according to our previously described system. Of the 53 patients who were actively bleeding at initial evaluation 16 were followed to determine time required for complete resolution of hematuria. Hematuria grade improved after finasteride in 50 (94%) patients. Overall 77% of patients (41 of 53) experienced no further bleeding while taking finasteride. Mean followup was 38 months (range 3 to 86). Of the patients 86% (12 of 14) taking coumadin, 77% (10 of 13) taking aspirin and 73% (19 of 26) on no anticoagulants had no further bleeding once on finasteride. Of the patients who had undergone prior transurethral prostatectomy 84% (26 of 31) experienced no further bleeding versus 68% (15 of 22) of those who had not undergone previous surgery. In the 16 patients who began finasteride while actively bleeding the average time to clear urine was 12 days (range 2 to 45). Prostatic volume correlated with the average time needed for resolution of hematuria, which was 2.7 days or longer for small (less than 40 gm.), 10.3 days or longer for large (40 to 100), 19 days or longer for extra large (100 to 150) and 45 days or longer for extra extra large (greater than 150) glands. Hematuria resolved an average of 5.5 days versus 18.6 days in those who had or had not undergone previous prostatectomy, respectively. Our long-term followup demonstrates finasteride as a useful treatment for benign prostatic hyperplasia related gross hematuria, which is effective in patients who are on anticoagulants. In patients with larger prostatic volumes a longer time to response and higher incidence of recurrent but lower grade bleeding should be anticipated compared to those who have undergone prior prostatectomy or have a smaller prostate.

T2 Relaxometry Can Lateralize Mesial Temporal Lobe Epilepsy in Patients with Normal MRI

In unselected patients with intractable temporal lobe epilepsy (TLE), approximately 15% do not have detectable hippocampal atrophy on MRI. The purpose of this study was to evaluate whether T2 relaxometry can identify hippocampal pathology and lateralize the epileptic focus in patients with intractable TLE, who do not demonstrate hippocampal atrophy on volumetric MRI (MRIV). We selected 14 patients with unilateral TLE who had unilateral atrophy and 11 patients with unilateral TLE who had no evidence of atrophy on MRIV. Images were acquired on a 1.5 T MR scan using a dual echo sequence with 23 contiguous oblique coronal slices in all patients and in 14 healthy subjects. Fitting a single exponential decay equation to the imaging data generated T2 maps. Averages of six slices containing the head, body, and tail of the hippocampus were used to calculate hippocampal T2 relaxation times (HT2). The epileptic focus was defined by history, video-EEG, and surgical response. All TLE patients with hippocampal atrophy and 9/11 (82%) patients with normal MRI had abnormally high HT2 ipsilateral to the epileptic focus. Bilateral abnormal HT2 were found in 6/14 (43%) of patients with unilateral hippocampal atrophy and 2/11 (18%) of patients with normal MRI. However, this increase was always greater ipsilateral to the epileptic focus. Qualitative hippocampal pathology showed gliosis and neuronal loss in 10/14 operated patients with hippocampal atrophy on MRIV and in 5/7 operated patients with normal MRI. In conclusion, hippocampal T2 mapping provides evidence of hippocampal damage in the majority of patients with intractable TLE who have no evidence of atrophy on MRI and can correctly lateralize the epileptic focus in most patients.

Experimental study of tracheal allotransplantation with cryopreserved grafts

Objective: Tracheal reconstruction is necessary in patients with extensive tracheal stenosis caused by neoplasm, trauma, and congenital disease. We investigated the possibility of tracheal allotransplantation with cryopreserved grafts in a canine model. Methods: A seven-ring section of thoracic trachea was removed in 19 adult mongrel dogs. In group A ( n = 4), a five-ring tracheal autograft was implanted. In group B ( n = 6), a five-ring allograft was implanted without immunosuppression. In group C ( n = 9), a five-ring cryopreserved tracheal allograft was implanted without immunosuppression. Omentopexy wrapping around the grafts and both anastomotic sites was used in all animals. Results: All grafts survived without any evidence of atrophy or stenosis in group A. All animals in group B died of severe airway obstruction within 1 month, and postmortem examination of these grafts showed epithelial defect and necrotic tracheal cartilage in the scar tissue. In group C, no animals died of asphyxia caused by severe stenosis of the grafts. The graft epithelium was no longer present 20 days after transplantation, and the graft was covered with regenerated epithelium within about 60 days after the operation. Conclusion: These findings show that cryopreserved tracheal allografts can be transplanted by means of omentopexy without immunosuppression and that cryopreservation may reduce tracheal allogenicity. (J Thorac Cardiovasc Surg 1998;116:262-6)

Use of immunoblot assay to define serum antibody patterns associated with Helicobacter pylori infection and with H. pylori-related ulcers.

Serology has been used worldwide to detect Helicobacter pylori infection. Using an immunoblot assay with an antigen from strain ATCC 43579, we sought to determine the antibodies which were good markers of colonization and the antibody patterns associated with ulcers or atrophy. Out of 98 dyspeptic patients, 41 were colonized by H. pylori, based on a positive culture or on positive results of both a urease test and direct examination. These 41 patients were seropositive by an enzyme immunoassay, and 12 of them had ulcers and 29 had evidence of atrophy. Fifty-seven of the 98 patients were noncolonized. Twenty-five of the 57 had evidence of gastric atrophy, and 10 were seropositive; 5 of these 10 had ulcers. By Western blot analysis, 12 antibodies were significantly more frequent in sera from colonized patients, and they produced immunoreactive bands at 125, 87, 74, 66, 54, 48, 46, 42, 35, 30, 16 and 14 kDa. The presence of at least one band at 54, 35, or 42 kDa was the best marker of infection (sensitivity, 95%; specificity, 82%). In the group of colonized patients, none of the antibody patterns were correlated to gastric atrophy. Conversely, the presence of a band at 125, 87, or 35 kDa was statistically associated with the presence of an ulcer. The simultaneous presence of bands at 87 and 35 kDa predicted the risk of ulcers with 83% sensitivity and 69% specificity. By using CagA-positive and VacA-positive strains and CagA-negative and VacA-negative isogenic mutants, the antigens corresponding to the bands at 125 and 87 kDa were shown to be CagA and VacA, respectively. On the other hand, the 35-kDa antigen is a novel uncharacterized component of H. pylori. These results may help to optimize the composition of antigenic preparations for serologic detection of H. pylori colonization. Immunoblot assay would be useful for screening patients at high risk of ulcers.

Impairment Questions and Answers

Question:How should I rate the impairment of a knee that has had an anterior cruciate ligament reconstruction with good stability on post-operative examination? Table 64 (4th ed., 85) does not discuss cruciate ligament reconstruction.Answer:In general, rate knee ligaments based on the amount of instability present after the individual reaches maximal medical improvement. Table 64 lists cruciate or collateral ligament laxity (mild, moderate, or severe). The terms mild, moderate, and severe are not defined. Many collateral ligament injuries result in a stable knee with no laxity after operative or nonoperative treatment. If there is neither laxity nor meniscal injury, then there is no impairment (0%).The cruciate ligaments have a poor blood supply and when injured heal poorly. For this reason, if a cruciate ligament is ruptured, anatomic repair is not possible and the ligament must be reconstructed (replaced) either by using one of the individual's tendons or ligaments or by using an allograft. If, post-operatively, anterior instability is still present, the degree of instability determines the impairment rating.What if the knee seems stable after the reconstruction? Is the rating no instability, therefore no impairment appropriate? A truly normal stability exam after the cruciate ligament reconstruction is unusual. Most results are mild laxity, which according, to Table 64 is 7% lower extremity impairment or 3% whole-person impairment.Question:How should I rate a patient who sustained an open displaced comminuted mid-shaft right tibial fibular fracture? On the day of injury he had an open reduction and internal fixation. Post-operative rehabilitation was performed. A one-half-inch lift was placed on his right shoe for a leg-length discrepancy and he uses orthotics. I saw him six months post-operatively for an impairment rating. He had some generalized aching, particularly in the cold, and decreased endurance for prolonged walking and climbing. I felt he was at maximal medical improvement. My exam revealed normal gait, right leg 2.0 cm shorter than the left, right calf circumference 1.6 cm smaller than the left, and normal motor strength. Ranges of motion of the knee, ankle, and subtalar joints were normal. X-ray revealed a healed fracture with normal callus and five degrees of varus angulation.Answer:First, identify the rating options and the corresponding estimates of impairment. These include leg length, 2% whole-person (Table 75, p. 75); atrophy, 1% to 2% whole-person (Table 37, p. 77); and angulation, 0% (Table 64, p. 85).Though your manual muscle testing was grossly normal, there is evidence of atrophy with a history of decreased endurance consistent with the objective findings. If other indicators of diminished muscle function were present, you would select the most appropriate and greatest impairment. Atrophy should be included in the final calculation. The 2% level is selected because the measurement is closer to the next level of impairment (moderate).Angulation is not sufficient to justify impairment, although it probably contributes to the leg-length discrepancy, which does warrant impairment. If angulation is sufficient to warrant rating, the final calculation should probably omit leg length unless true bone loss is a major contributor to the discrepancy. The final calculation of impairment is based on combining 2% and 2%, yielding 4% whole-person impairment.—William Shaw, MDQuestion:What is the relationship between impairment and the ability to perform a specific job? My patient is a nurse with a large cervical herniated disc (C5-C6) with a radiculopathy. She has an impairment of 15% whole-person. Can she resume her nursing job with this impairment?Answer:There is limited correlation among impairment, function, and disability. An impairment value does not translate directly into functional capacity, nor does it provide a basis for establishing functional restrictions. It is probable that she could be considered an individual with a disability and therefore protected by the Americans with Disabilities Act, Title I. The issue of employability is the responsibility of her employer, who must determine whether she can perform the essential functions of her job with or without reasonable accommodation. Any restrictions must be based on a direct threat analysis. A functional capacity evaluation can be useful in determining her physical abilities.

星状神経節ブロックと血管柄付遊離組織移植を用いた進行性顔面半側萎縮症治療の１例

A girl aged 11 years 2 months had atrophy of the right facial region extending from the cheek to the mental region since the age of 9 years. Facial hemiatrophy was diagnosed at our department, and she received stellate ganglion block treatment for dysfunction of the cervical sympathetic nerve. Although stellate ganglion block therapy was effective in arresting disease progression during treatment, symptoms recurred after the end of the treatment. A de-epithelialized free flap graft was used to repair her facial contour.Over the past 3 years, the patient has shown a satisfactory postoperative outcome. The graft successfully restored her facial contours with no evidence of atrophy or resorption of the grafted flap.

Ornithine induced retinopathy in rat: 2. Process of disappearance of choriocapillaris

We observed the process of disappearance of the choriocapillaris after loss of the retinal pigment epithelium (RPE) induced by intravitreal injection or ornithine. Three hours after administration of ornithine, the RPE cells swelled remarkably in the posterior pole, but, the endothelial cells of the choriocapillaris remained intact. At 3 days, the RPE cells became necrotic, but the choriocapillaris still preserved its in normal appearance. At 7 days, RPE disappeared completely in the posterior pole and the choriocapillaris displayed evidence of atrophy; the swollen lumen of the choriocapillaris became narrow the cytoplasm of the endothelium was swollen, and the number of fenestrae was reduced. On the other hand, these changes were not seen where the RPE remained. At 14 days, in the posterior pole, the lumen of the choriocapillaris occluded by the swollen endothelial cells. At 28 days, the choriocapillaris completely disappeared and the large choroidal vessel was directly in contact with Bruch's membrane. These results showed that the RPE is correlated with the presence of the choriocapillaris.

GROIN PAIN - FOOTBALL 171

HISTORY - A 19-year-old black male Division I college football player presented 3 weeks prior to start of football practice with a 9-month history of left groin pain. Initial injury occurred during last football game of preceding season. He remembered experiencing pain when lifting himself from a chair before the game. He played during the first half and did not recall any specific injury. He was unable to play the second half due to groin pain. His pain persisted into the following spring season. Initial workup included pelvic x-rays 3 months post-injury which were normal by history. He was seen by a urologist for possible recurrent hernia. He was told he had a varicocele. Urethral cultures were negative by history. Now he complains primarily of left groin pain with lateral movements while he runs. Past medical history was significant for left herniorrhaphy as a child. He was on no medications and reported no known drug allergies. He occasionally drank alcohol, but denied smoking history. He was sexually active, did not use barrier methods. Family history non-contributory. PHYSICAL EXAMINATION - On exam, the patient had good bulk, tone, and strength without evidence of atrophy. Gait was non-antalgic. Negative Trendelenburg test. Active range of motion revealed decreased internal rotation of the left hip. Positive Faber test. He was tender to palpation over the origin of the adductor longus muscle and the symphysis pubis. Motor exam revealed give way weakness due to groin pain with left hip flexion and adduction. Sensory exam was intact to light touch. Deep tendon reflexes at patella and achilles were 2/4 and symmetrical. Genitourinary exam revealed a circumcised Tanner V with bilaterally descended testicles. A nontender thickening along the left epididymis was noted. The testicles were nontender and no masses were palpated. No hernia was palpated with valsalva maneuvers. DIFFERENTIAL DIAGNOSIS: Muscle strain Avulsion fracture Stress fracture Osteitis pubis Epididymitis/prostatitis Inguinal hernia Varicocele TEST AND RESULTS: X-ray: AP pelvis revealed periosteal irregularity at the margin of the pubic bone. There was symmetric bone resorption of the medial pubic symphysis with osteolysis and reactive sclerosis. Triple phase bone scan: Revealed increased uptake at the symphysis pubis. FINAL/WORKING DIAGNOSIS: Osteitis pubis TREATMENT: Relative rest for 10 days limiting sprint workouts. Physical therapy to improve hip range of motion and strengthen hip adductors, abductors, internal rotators, and abdominal muscles. Modalities included electrical stimulation and ultrasound. Despite conservative measures for 2 weeks, the patient continued to experience pain during two-a-day workouts. A local corticosteroid injection at the public symphysis was performed. No practice for 3 days after injection. The patient was able to return to play painfree at one week.

Evidence of cortical metabolic dysfunction in early Huntington's disease by single-photon-emission computed tomography.

We compared perfusion of prefrontal, motor, and sensory cortices and basal ganglia in 29 Huntington's disease (HD) patients and nine controls. We found a significant reduction in perfusion in patients with HD of short (< 6 years, n = 10), medium (6-10 years, n = 8), and long duration (> 10 years, n = 11) compared with controls. Among short-duration patients, we observed decreases in cortical perfusion before evidence of atrophy on magnetic resonance imaging, suggesting that decreases in neuronal activity, as reflected by perfusion levels, precede gross structural changes. As expected, decreased perfusion was marked in basal ganglia. The extent of cortical perfusion correlated with clinical assessments of functional capabilities as well as with the duration of disease. Prefrontal perfusion correlated with cognitive measures, and motor cortical perfusion correlated with physical disability and activities of daily living scores. We found no significant clinical correlations with sensory cortical perfusion. Single-photon-emission computed tomography may be a sensitive method for assessing disease progression in clinical trials and pharmacologic intervention.

Evidence for atrophy and apoptosis in the prostates of men given finasteride

Evidence for atrophy and apoptosis in the prostates of men given finasteride

Reliable cryopreservation of trachea for one month in a new trehalose solution

We previously reported that trehalose, a reduced disaccharide, was effective in the preservation of lungs. In this study, we investigated the possibility of prolonged cryopreservation of tracheas in a preservative solution containing trehalose. Five rings of cervical trachea were removed and immersed in the preservative solution. The harvested tracheas were then cryopreserved and stored in a deep freezer at -85° C. One month later, five rings of mediastinal trachea were removed. The cryopreserved cervical tracheas were thawed and autotransplanted in place of the excised mediastinal trachea ( n = 6). The anastomotic site and graft were then covered with an omental pedicle. All six animals survived for more than 6 months. All grafts survived without any evidence of atrophy or stenosis. Microscopic examination of the grafts showed that the integrity of the tracheal tissues was maintained. Our findings show that consistent cryopreservation of the trachea for 1 month is possible in a preservative solution containing trehalose. (J T HORAC C ARDIOVASC S URG 1995;110:382-5)

Evidence for atrophy and apoptosis in the ventral prostate of rats given the 5 alpha-reductase inhibitor finasteride.

Castration causes cell loss in the rat ventral prostate through a process called apoptosis. Although 5 alpha-reductase inhibition also causes prostate cell loss, the mechanisms involved have been debated. To investigate this question further, we have evaluated the histological responses of the rat ventral prostate to both castration and 5 alpha-reductase inhibition. Rats were left intact, castrated, or given the selective 5 alpha-reductase inhibitor finasteride. After 4, 9, 14, and 21 days the prostates were excised, the androgen and DNA content determined, and the tissue was subjected to histological and histomorphometric analysis. Finasteride and castration decreased prostate weight at day 21 by 65% and 93%, respectively. Castration decreased DNA content (micrograms per prostate) by a maximum of 88% at 14 days. Finasteride had no significant effect on DNA content after 4 days and decreased DNA content by a maximum of 52% at 14 days. When castrate prostate sections were stained for tissue transglutaminase, a marker of apoptotic cell death, a maximum of 23% of epithelial cells were stained by day 14 with a return to control levels by day 21. Finasteride caused a less intense increase in staining in which 16% of epithelial cells stained for tissue transglutaminase on day 9 with a return to baseline by day 14. When prostate sections were stained for DNA breaks, another marker of cell death, castration, caused a peak of staining on day 4 with 6% of epithelial cells staining and a return to near control levels by day 21. Finasteride-induced staining was less intense with peak staining at day 4 (0.7% of epithelial cells) and a return to control values by day 9. Morphometrics were used to assess the effect of castration and finasteride on prostate duct size and epithelial cell mass. After 4 days of finasteride treatment, the mean ductal mass decreased by 47%, with no significant change thereafter. The mean epithelial cell mass decreased by 15% on day 4 and 60% on day 9, with no further decrease thereafter. Castration caused a more rapid and greater decrease in both morphometric parameters with a 95% reduction in the mass of prostate ducts and a 93% decrease in epithelial cell mass by day 9. We conclude that castration induces a more profound involution of the rat ventral prostate than does 5 alpha-reductase inhibition. Cell loss occurs in both groups, but the degree of cell loss is less with finasteride.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence for atrophy and apoptosis in the ventral prostate of rats given the 5 alpha-reductase inhibitor finasteride

Castration causes cell loss in the rat ventral prostate through a process called apoptosis. Although 5 alpha-reductase inhibition also causes prostate cell loss, the mechanisms involved have been debated. To investigate this question further, we have evaluated the histological responses of the rat ventral prostate to both castration and 5 alpha-reductase inhibition. Rats were left intact, castrated, or given the selective 5 alpha-reductase inhibitor finasteride. After 4, 9, 14, and 21 days the prostates were excised, the androgen and DNA content determined, and the tissue was subjected to histological and histomorphometric analysis. Finasteride and castration decreased prostate weight at day 21 by 65% and 93%, respectively. Castration decreased DNA content (micrograms per prostate) by a maximum of 88% at 14 days. Finasteride had no significant effect on DNA content after 4 days and decreased DNA content by a maximum of 52% at 14 days. When castrate prostate sections were stained for tissue transglutaminase, a marker of apoptotic cell death, a maximum of 23% of epithelial cells were stained by day 14 with a return to control levels by day 21. Finasteride caused a less intense increase in staining in which 16% of epithelial cells stained for tissue transglutaminase on day 9 with a return to baseline by day 14. When prostate sections were stained for DNA breaks, another marker of cell death, castration, caused a peak of staining on day 4 with 6% of epithelial cells staining and a return to near control levels by day 21. Finasteride-induced staining was less intense with peak staining at day 4 (0.7% of epithelial cells) and a return to control values by day 9. Morphometrics were used to assess the effect of castration and finasteride on prostate duct size and epithelial cell mass. After 4 days of finasteride treatment, the mean ductal mass decreased by 47%, with no significant change thereafter. The mean epithelial cell mass decreased by 15% on day 4 and 60% on day 9, with no further decrease thereafter. Castration caused a more rapid and greater decrease in both morphometric parameters with a 95% reduction in the mass of prostate ducts and a 93% decrease in epithelial cell mass by day 9. We conclude that castration induces a more profound involution of the rat ventral prostate than does 5 alpha-reductase inhibition. Cell loss occurs in both groups, but the degree of cell loss is less with finasteride.

Temporal Contour Deformity After Coronal Flap Elevation

Temporal contour deformity is defined as a concavity or depression in the temporal region located superior to the zygomatic arch and immediately posterior to the lateral orbital rim. The deformity can present as a consequence of extended coronal flap elevation for exposure of the lateral craniofacial skeleton. This study describes the anatomical and pathological features of the deformity and identifies causative factors. The series consists of unilateral temporal contour deformities after coronal flap elevation in 6 patients. A standardized data sheet was used in documenting details of the initial temporal dissection, clinical findings, and radiological features. Elevation of the temporal soft tissues was based on a qualitative analysis of coronal magnetic resonance imaging (MRI) scans comparing the affected and the unaffected temporal regions. The MRI studies demonstrated normal volume of the temporalis muscle in all cases, with no evidence of atrophy or disinsertion of the muscle. Diminution in the volume of the superficial temporal fat pad was identified in 4 patients, whereas inferior displacement or prolapse of the superficial temporal fat pad was noted in 2 patients.

甲状腺フラップによる陳旧性喉頭外傷の喉頭再建術症例について

We report a case of surgery for voice restoration in a 33-year old male complaining of breathy voice of 26 years' duration as the result of a traffic accident. He showed a fixed right vocal cord with marked atrophy. The right vocal cord was resected, and a pedicled flap comprising the right lobe of the thyroid gland (thyroid gland flap) was grafted onto the defective part. The grafted tissue was covered by the laryngeal mucosa, and the glottis was satisfactorily reconstructed. Sufficient glottal closure for phonation was obtained, and the post-operative voice quality was satisfactory. A CT scan revealed a well-adapted thyroid flap, and no evidence of atrophy in the grafted tissue was noted 20 months after the operation. We believe that the use of the thyroid gland flap is a very competent surgical technique for phono-surgery in traumatic voice disorders.

A persistent hindlimb ischemia model in the rabbit.

The study of new approaches for the treatment of limb-threatening ischemia has been hampered by the lack of a suitable animal model of persistent limb ischemia. We describe the development and evaluation of an animal model of persistent hindlimb ischemia, in which ischemia was induced in the left hindlimb of 28 rabbits by ligation of the distal external iliac artery and excision of the common and superficial femoral arteries. The severity of the ischemia and its relief in each animal were evaluated every 10 days postoperatively until day 40 (all animals) or day 90 (five animals). Nine animals developed superficial tissue necrosis in the foot, but no deaths were attributable to the ischemia-inducing procedure. Angiography demonstrated minimal collateralization and sluggish filling of distal vessels up to postoperative day 90. This was accompanied by a decrease at rest in the calf blood flow ratio (p < 0.005 vs day 0), an increase in lactic acid in the femoral venous blood (left vs right side, p < 0.002) up to postoperative day 40, and a decrease in the calf blood pressure ratio (p < 0.0001 vs day 0) up to day 90. Histologic study of the gastrocnemius muscle demonstrated evidence of atrophy and fibrosis in the left hindlimb. This model can be used to evaluate direct and indirect approaches to the treatment of chronic limb ischemia.