Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility

OBJECTIVE

To assess whether a difference in venous reflux pattern, ulcer size or duration, regular medications or the daily use of walking aids can predict the healing of a chronic venous leg ulcer (VLU).

METHOD

In this prospective, randomised, single-centre study, 110 consecutive patients with chronic leg ulcers were assessed. Ninety-nine patients met the inclusion criteria and a controlled, conservative 3-month treatment period was initiated, in which 90 patients were managed with standardised local treatment combined with compression therapy. In this group, 62 VLUs healed within 12 weeks and 28 were still open after 12 weeks. The study group consisted of 22 patients with non-healed ulcers and a control group (n=28), which was selected randomly from the healers. In both groups, venous reflux profiles were assessed using colour-flow duplex imaging.

RESULTS

The study and control groups did not differ in smoking habits, age, gender or daily oral medications. On average, the healing wounds were 5cm² before starting controlled treatment (range 1-80cm²) and had been open for 7 months (range 2-48 months); the non-healing wounds were on average 11.2cm² (range 1-31cm²) and had been open for 26 months (range 8-106 months). Venous disease severity scores were similar for both groups (12.6 vs. 13.4). Five patients (18%) with healed ulcers regularly used walking aids, the use of which was more frequent (36%) among non-healers (p<0.001). Venous reflux profiles differed significantly between the groups, with isolated superficial reflux noted in 64% of healers, compared with 36% of non-healers. In addition, isolated deep reflux was found in 14% of the healers, compared with 41% of non-healers (p=0.0002). The rate of popliteal reflux was significantly higher in non-healers (59% versus 21%; p=0.0004).

CONCLUSION

Long duration of a chronic venous ulcer may predict a poor outcome. The presence of deep venous reflux, especially in the popliteal vein, is typically found in those legs with non-healed ulcers. .

Eosinophilic pustular folliculitis

Eosinophilic pustular folliculitis is a rase dermatosis and the treatment is difficult because the underlying pathogenic mechanism is unknown. The authors report a case of eosinophilic pustular folliculitis (Ofuji's disease) in a 50-year-old man who died 9 years after onset of the disease.

Reinnervation after nerve suture in rat groin flaps

Regeneration of sensory and adrenergic nerves in the skin was studied in rats. The aim was to investigate the effect of reanastomosing the cut nerve ends of the nerve trunk leading to the microvascular groin flap. Reinnervation was demonstrated immunohistochemically using calcitonin gene-related peptide (CGRP) as marker for sensory nerves, neuropeptide Y (NPY) and tyrosine hydroxylase (TH) as markers for adrenergic nerves and Protein Gene Product 9.5 (PGP 9.5) as general neuronal marker. It was demonstrated that reanastomosing of the nerve trunk was favourable for both the sensory and sympathetic reinnervation of microsurgical flaps.

Treatment of mosquito bites with ebastine: a field trial

Wealing and pruritic, long-lasting papules are a common nuisance from mosquito bites. Antihistamines can be expected to decrease wealing, but their effect on the delayed bite symptoms needs to be elucidated. We studied the effect of ebastine in 28 mosquito-bite sensitive adult subjects exposed to Aedes communis bites in the field. Ebastine 20 mg and placebo were given for 4 days in a cross-over fashion, and the size of the bite lesion and the intensity of pruritus (visual analogue scale) were measured at 15 min and 2, 6 and 24 h after the bites. Ebastine decreased significantly (p <0.001) the size of the bite lesion and pruritus at 15 min. Ebastine also had a significant effect (p<0.01) on pruritus at 2 and 24 h, and this effect was highly significant when the measurements at all 4 time points were pooled. Five patients (18%) on ebastine, but none on placebo, experienced sedation (ns). The present field study shows that ebastine 20 mg given prophylactically is effective against immediate mosquito bite symptoms, and that it also significantly decreases pruritus associated with the delayed bite papules.

Adequate blood flow is essential for reinnervation in neurovascular skin flaps

The effect of arterial and venous ischaemia on reinnervation of skin flaps after transsection and resuture of the epigastric nerve was investigated in rat groin flaps. The results were compared with those in corresponding flaps with adequate blood flow. Arterial or venous ischaemia was induced by ligation of the epigastric artery or vein. The reinnervation of the flaps was studied after a 20-week healing period using specific antisera for calcitonin gene-related peptide (CGRP) in sensory nerves, and neuropeptide Y (NPY) in adrenergic nerves. Arterial ischaemia clearly and significantly hampered reinnervation. Venous ischaemia was even more harmful and practically no regenerated nerves were detected in the flaps. We conclude that adequate blood flow is critical for sensory and adrenergic reinnervation in skin flaps.

Effect of cetirizine on the inflammatory cells in mosquito bites

BACKGROUND

Mosquito bites frequently cause wealing and delayed papules which appear within a few hours after the bites and may persist for several days. Cetirizine is an effective drug against mosquito bites by decreasing wealing and also the size and pruritus of the delayed bite papules.

OBJECTIVES

To characterize inflammatory cells in the delayed mosquito-bite lesions, and to study the effect of cetirizine on the inflammatory cell response.

METHODS

Twenty-six mosquito-bite sensitive subjects received cetirizine 20 mg (14 subjects) or placebo (12 subjects) in a double-blind fashion. Aedes aegypti-bites were given on a forearm and serial punch biopsies were taken at 2-, 6- and 24h after the bite exposure. Eosinophils, neutrophils, mast cells, mononuclear cells and T- helper (CD4+) and suppressor (CD8+) lymphocytes were counted from dermal infiltrates.

RESULTS

Eosinophils and neutrophils were found already in 2-h bite lesions. Moreover, the number of mononuclear and CD4+ cells increased significantly (P < 0.01) from 2- to 24-h bite lesions. Unexpectedly, the overall numbers of eosinophils (P < 0.05), mononuclear cells (P < 0.01) and CD4+ cells (P < 0.01) were significantly higher in the cetirizine-treated subjects compared with the placebo-treated subjects.

CONCLUSIONS

The results suggest that the inflammatory cell response in the delayed mosquito-bite lesions is similar to that occurring in allergic late-phase responses, i.e. an early influx of eosinophils, neutrophils and subsequent accumalation of CD4+ lymphocytes. The reason for the high numbers of eosinophils and CD4+ cells in the cetirizine-treated subjects is not known.

Expression of diazepam-binding inhibitor peptide in human skin: an immunohistochemical and ultrastructural study

Human diazepam binding inhibitor (DBI) was originally isolated from the brain and subsequently found to be present in several peripheral tissues. The various physiologic effects recently attributed to DBI include acting as an endogenous ligand for the central and peripheral (mitochondrial) benzodiazepine receptors. The present work provides, for the first time, evidence of DBI immunoreactivity in skin. DBI immunoreactivity was found in the epidermis, in the eccrine sweat and in sebaceous glands. Ultrastructurally, DBI was distributed throughout the cytoplasm. Although the physiologic role of DBI in skin is unknown, our results indicate that DBI may serve as an endogenous ligand for mitochondrial benzodiazepine receptors. Its activity could be related to the regulation of lipid and cholesterol synthesis in keratinocytes and sebaceous glands and to the secretion of sweat in sweat glands.

Systemic corticosteroid and isotretinoin treatment in cystic acne

Prednisolone combined with erythromycin was given to 6 patients with cystic acne. The treatment responses were compared to those in 6 patients with cystic acne receiving isotretinoin and erythromycin and also to those in 3 patients with acne fulminans treated with prednisolone and erythromycin. During the first 4 weeks cystic acne showed a clear improvement in 5 out of 6 patients in both treatment groups. A similar improvement occurred in all 3 patients with acne fulminans. When corticosteroid was stopped, 2 out of 5 patients with cystic acne had a relapse and needed isotretinoin for complete control. In the isotretinoin-treated group, one patient with cystic acne needed prednisolone because the acne worsened to an ulcerative form. Slightly elevated liver enzymes, possibly due to erythromycin treatment, were observed in 2 patients with cystic acne and in one patient with acne fulminans. The present results show that prednisolone combined with erythromycin is an effective treatment during the early stages of cystic and febrile acne, but isotretinoin is needed for long-term control.

Location of androgen receptor in human skin

The distribution of androgen receptor (AR) in human skin was studied by an immunohistochemical method using a polyclonal antibody against the human AR. Skin samples of preputial skin and male and female nongenital skin were examined. The possible correlation of AR location to acne was studied in skin biopsies from skin areas affected or unaffected by acne. In preputial skin, AR was expressed in epidermal cells as well as in fibroblasts, smooth muscle cells, and endothelial cells of blood vessels in the dermal area. AR was found located also in the flat fibroblast-like cells of Pacinian corpuscles. In nongenital skin, AR was also expressed in the basal cells and glandular cells of sebaceous glands, in the outer root sheath of hair follicles, and in eccrine sweat glands. The presence of AR in different cell types in the skin reflects the numerous direct effects androgens may have on this target tissue. The distribution of AR was similar in male and female skin.

Evidence for gamma-melanocyte stimulating hormone containing nerves and neutrophilic granulocytes in the human skin by indirect immunofluorescence

gamma-melanocyte stimulating hormone (gamma-MSH)-like immunoreactivity has been found by indirect immunofluorescence in nerve fibers and terminals as well as in neutrophilic granulocytes of normal human skin. A preferential localization to sensory nerves was seen; abundant nerve fibers displaying gamma-MSH immunoreactivity were observed as free nerve endings in the basal layer of the epidermis and in the upper dermis, close to the Merkel cells, in Meissner's corpuscles, around the external root sheath of the lower part of the hair follicles, and in nerve bundles of the deeper parts of the dermis. Very few fibers were seen to be associated with sweat glands and most blood vessels, although arterioles were densely innervated. Thus, gamma-MSH should be considered for possible role as a sensory or axon-reflex chemical messenger. Furthermore, the presence of gamma-MSH in neutrophilic granulocytes raises the possibility that gamma-MSH may play a role in the genesis of post-inflammatory hyperpigmentation, nevi, and melanomas.

Neuropeptides in cutaneous neurofibromas of von Recklinghausen's disease

The occurrence of neuropeptides was studied in neurofibromas of von Recklinghausen's disease by indirect immunofluorescence. All non-plexiform cutaneous neurofibromas contained abundant vasoactive intestinal polypeptide, peptide histidine-isoleucine and calcitonin gene-related peptide immunoreactive nerves. The nerves were small and unmyelinated. Neuropeptides might be responsible for itch that occurs especially in small cutaneous neurofibromas. Neuropeptides are also suggested to act as modulators and/or trophic factors for neurofibroma growth.

Electron microscopic localization of enkephalin-like immunoreactivity in the human adrenal medulla

Enkephalin-like immunoreactivity in human adrenomedullary cells was studied at the light and electron microscopic levels. Enkephalin immunostaining was associated with chromaffin granules and, in a few cells, with the rough endoplasmic reticulum as well. The relative number of stained granules varied from cell to cell, and a correlation with a particular granular population was not noted. Both large and small granules were labelled. It is concluded that in the human the ability to store enkephalin immunoreactive peptides is a general property of chromaffin granules and, furthermore, is not correlated with specific granular subpopulations or the particular type of catecholamine stored within the cell.

Localization of lactoferrin in the male reproductive tract

The immunohistochemical localization of lactoferrin in the normal human prostate, seminal vesicle, vas deferens, epididymis and testis was studied using the peroxidase-antiperoxidase method at the light and electron microscopical level. Lactoferrin immunoreactivity was localized in the glandular epithelial cells and granulocytes in the prostate and seminal vesicle. In the prostate, lactoferrin showed an uneven distribution; some of the glands contained exclusively positive cells and others were completely lactoferrin negative, while the rest contained scattered positive cells. The seminal vesicles were divided into three segments, and their lactoferrin content varied significantly although it was always epithelial. The ductus deferens, epididymis and testis contained no lactoferrin. In conclusion, lactoferrin was found in the prostate and seminal vesicles, but not in the testis.

Calcitonin gene-related peptide immunoreactivity in prurigo nodularis: a comparative study with neurodermatitis circumscripta

Eight patients with intensely pruritic lesions of chronic idiopathic prurigo nodularis and three patients with neurodermatitis circumscripta were investigated using the indirect immunofluorescence method. Results showed similarities in epidermal hyperplasia but not in nerve proliferation and neuropeptide immunoreactivity. Increased numbers of calcitonin gene-related peptide (CGRP) and substance P immunoreactive nerve fibre bundles were detected in specimens taken from prurigo nodularis lesions, but no increased immunoreactivity could be seen in specimens taken from patients having neurodermatitis circumscripta compared to normal skin. The neuropeptides, CGRP and substance P, may be responsible for the intense itching of prurigo nodularis lesions.

Immunocytochemical demonstration of gamma-melanocyte stimulating hormone-like immunoreactivity in human neutrophilic granulocytes

Using the indirect immunohistochemical approach the occurrence of gamma-melanocyte stimulating hormone (MSH)-like immunoreactivity in neutrophilic granulocytes is described.

Electron microscopic study on the innervation of the human axillary sweat glands

The innervation of human axillary sweat glands was studied at electron microscopic level. Nerve endings with many small agranular vesicles and few large dense-cored vesicles were found outside the basement membrane of the secretory coils. These nerve endings can be classified as cholinergic. This result confirms the previous knowledge that axillary sweat glands are innervated by sympathetic cholinergic nerves.

Light and electron microscopic immunocytochemical demonstration of intraepidermal CGRP-containing nerves in human skin

The distribution of nerves immunoreactive to calcitonin gene-related peptide (CGRP) was studied in human skin with special reference to the intraepidermal nerve fibres. It was shown by light and electron microscopy that a small proportion of the CGRP immunoreactive nerves entered the epidermis. The majority of the nerves ended as free nerve terminals subepidermally. Intraepidermal nerve endings were mainly seen in skin areas, which have a dense sensory innervation, such as fingertips and foreskin. The role of the peptidergic nerves in human skin is discussed.

The distribution of substance P-, CGRP-, galanin- and ANP-like immunoreactive nerves in human sweat glands

The distribution in immunoreactivities towards atrial natriuretic peptide, calcitonin gene-related peptide, galanin and substance P were demonstrated in human skin at the light and electron microscopic levels. Nerves immunoreactive to the first three of these peptides were found around eccrine sweat glands, whereas only a few positively-labelled nerve fibres could be seen around apocrine glands. At the ultrastructural level, immunoreactivity to the neuropeptides was localized in the large dense-cored vesicles of the nerve terminals. No immunoreactivity to substance P could be detected around sweat glands. In addition to these findings, the four types of immunoreactivity were seen in the thick preterminal nerve bundles.

Immunohistochemical evidence for the presence of somatostatin-containing sensory nerve fibres in the human skin

Somatostatin-like immunoreactivity has been found to occur in nerve terminals and fibres of the normal human skin using immunohistochemistry. The immunoreactivity seemed predominantly to be associated with sensory nerves. Thus, nerve fibres displaying weak or moderately strong somatostatin immunofluorescence were observed as free nerve endings of the epidermis and as nerve fibres in the dermis. The immunoreactive nerves were found in low numbers in skin from arm, back and chest, however, only single fibres were seen in sensory specialized areas, such as fingertips. Very few fibres were found close to e.g. blood vessels and sweat glands. Somatostatin, generally believed to be a strongly inhibitory substance, should also be considered when examining the role of different sensory chemical messenger candidates in the human skin.

Light and electron microscope demonstration of VIP- and enkephalin-immunoreactive nerves in the human male genitourinary tract

Vasoactive intestinal polypeptide (VIP) and enkephalins were demonstrated in the nerves of the human male urogenital tract by light and electron microscope immunohistochemical techniques. Nerves containing immunoreactivity to VIP were more numerous than enkephalin-immunoreactive nerves. Both VIP- and enkephalin-immunoreactive nerves were detected in the vas deferens, prostate, seminal vesicles, and urinary bladder. In the kidney, testis, and epididymis no immunoreactive nerves could be demonstrated. By electron microscope both types of immunoreactivities were localized to the large granular vesicles of nerve terminals. VIP-immunoreactive nerves were mostly found subepithelially, whereas enkephalin-immunoreactive nerves were mainly related to smooth muscle cells. The possible functions of these peptide-containing nerves are discussed.

The distribution of sympathetic adrenergic, tyrosine hydroxylase- and neuropeptide Y-immunoreactive nerves in human axillary sweat glands

The innervation of human axillary sweat glands was studied by using the specific SPG (sucrose-potassium phosphate-glyoxylic acid) catecholamine histofluorescence method and the peroxidase-antiperoxidase (PAP) immunocytochemical method. The present results demonstrated that human sweat glands are surrounded by nerves containing a weak tyrosine hydroxylase activity. Nerves showing catecholamine histofluorescence could be visualized around the sweat glands only in the presence of exogenous catecholamine (adrenaline in the local anestheticum). In all tissue specimens studied fluorescent adrenergic nerves could be seen around arteries and arterioles corresponding to the distribution of neuropeptide Y-like immunoreactive nerves.

The effect of sympathetic denervation with 6-hydroxydopamine on the ventral prostate of the rat

The effect of chemical sympathectomy with 6-hydroxydopamine (6-OHDA) on the ventral prostate of the rat was studied. A dose of 50 mg/kg i.v., which was repeated after 1 week, was effective enough to produce total disappearance of sympathetic nerves. Reappearance of nerve fibres was evident 2 weeks after treatment. Dilation of prostatic alveoli was noted 1 week after denervation. It is concluded that the absence of normal sympathetic innervation prevents the emptying of the rat prostate.

Immunohistochemical evidence for the occurrence of vasoactive intestinal polypeptide (VIP)-containing nerve fibres in human fetal abdominal paraganglia

The abdominal paraganglia in man represent a major source of catecholamines, and perhaps peptide hormones, during the fetal period. The nature of the innervation of the abdominal paraganglia was studied immunohistochemically by utilising antibodies to vasoactive intestinal polypeptide, enkephalin, substance-P and somatostatin. The paraganglia showed an abundant network of VIP-immunoreactive fibres, and similar nerve fibres were found within nerve bundles of the preaortic sympathetic plexus. Occasionally, VIP-immunoreactive fibres were seen within the prevertebral ganglia, but stained cell bodies were never observed. It may be suggested that VIP-containing nerves could regulate a secretory response from fetal human abdominal paraganglia.

Vasoactive intestinal polypeptide (VIP)-like immunoreactivity in the nerves of human axillary sweat glands

The cholinergic innervation of the human axillary sweat glands of hyperhidrotic patients was demonstrated by using the specific Karnovsky-Roots thiocholine method. The cholinergic innervation pattern was compared with the immunohistochemically demonstrated vasoactive intestinal polypeptide (VIP)-like activity at light and electron microscopic levels. The innervation patterns were identical in the light microscopic serial sections. In the electron microscope sections, VIP-like immunoreactivity was localized to the nerve terminals containing large, dense-cored vesicles 100-140 nm in size. No synapses were found, however positively stained nerve terminals were located immediately outside the basement membrane but close to the glandular secretory and myoepithelial cells, blood vessels, and occasionally the mast cells. Our results suggest the coexistence of the two neurotransmitters, acetylcholine and VIP, in the same nerves innervating both eccrine and apocrine sweat glands in human axillae.

Light- and electron-microscopic demonstration of enkephalin-like immunoreactivity in paraganglia of the human urinary bladder

The distribution of enkephalin-like immunoreactivity in paraganglia of the urinary bladder of adult humans was studied by use of immuno-electron microscopy. All paraganglionic cells were positively stained. Enkephalin-like immunoreactivity was located in chromaffin granules. Chromaffin cells in the paraganglia showed only few degenerative features, suggesting undisturbed function of the cells.

Histochemically demonstrable catecholamines in sympathetic ganglia and carotid body of spontaneously hypertensive and normotensive rats

The catecholamine content and morphology of the superior cervical and the hypogastric ganglion and the carotid body were studied in Spontaneously Hypertensive Rats (SHR) before (at the age of 6 weeks) and after (at the age of 20 weeks) becoming hypertensive, with Wistar Kyoto (WKY) rats as controls. The study was performed by formaldehyde-induced fluorescence method combined with quantitative microfluorimetry of catecholamines. At the age of 6 weeks the only significant difference observed between the rat strains was a greater number of small intensely fluorescent (SIF) cells in the superior cervical ganglion of SHR. At the age of 20 weeks the fluorescence intensity was higher in the principal neurons of the superior cervical ganglion and in glomus cells of the carotid body of SHR compared to WKY. The volumes of superior cervical ganglion and carotid body were larger in 20-week-old SHR compared to WKY. In the hypogastric ganglion differences were not found between SHR and WKY rats. The present results show differences in the superior cervical ganglion and in the carotid body of adult SHR compared to controls. These differences develop during the time period when the SHR become hypertensive, and might be functionally significant in the regulation or maintenance of the increased blood pressure in SHR rats.

The effect of renal sympathectomy on blood pressure and plasma renin activity in spontaneously hypertensive and normotensive rats

Renal denervation delays the development of hypertension in spontaneously hypertensive (SH) rats. The influence of bilateral surgical renal sympathectomy, verified by fluorescence microscopy, on blood pressure and plasma renin activity in SH and normotensive rats (170-180 g before the sympathectomy) was studied. Neither in SH nor in normotensive rats, did the preoperative systolic blood pressure in the renal-sympathectomized group differ from that in the sham-operated controls. After the sympathectomy, blood pressure in the SH rats increased in 4 weeks only insignificantly, from 160 +/- 3 to 172 +/- 6 mmHg, while that in the sham-operated SH rats rose from 163 +/- 5 to 191 +/- 5 mmHg. In normotensive rats, blood pressures in both the renal-sympathectomized and sham-operated groups remained at the pre-operative levels. Thirty days after the operations, plasma renin activity or plasma kininogen in the renal-sympathectomized group did not differ from that in the sham-operated one either in SH or in normotensive rats. The results suggest that the delay in hypertension development produced by renal sympathectomy in SH rats is not mediated by a reduction in renin secretion.

Nerve endings in the human prostate

The ultrastructure of nerve endings in the human prostate was studied using glutaraldehyde-OsO4 and KMnO4 fixation. The nerve endings were classified into three categories according to the size of the vesicles and the contents of the synaptic profiles. In addition to the conventional adrenergic and cholinergic axons, a third type of axon profile containing a predominance of large granular vesicles was constantly found. Synaptic contacts were found only on smooth muscle cells. No epithelial innervation could be demonstrated. The functions and possible transmitters of the various types of axon terminals are discussed.

Immunohistochemical demonstration of VIP, [Met5]-and [Leu5]-enkephalin immunoreactive nerve fibres in the human prostate and seminal vesicles

The distribution of nerves containing immunoreactivity for the VIP and enkephalins has been demonstrated in the human prostate and seminal vesicles using the immunoperoxidase bridge. VIP-containing nerves were detected in both organs studied mainly in association with the epithelium, while nerves containing ELI seemed to be related to smooth muscle. Compared with the distribution of adrenergic and cholinergic nerves in the prostate marked differences in the density of the innervation were detected. The possible nature of these peptide-containing nerves is discussed.

Autonomic innervation of the human prostate

The autonomic innervation of the human prostate has been studied using both light and fluorescence microscopic techniques. A dense network of both adrenergic and acetylcholinesterase-positive nerves innervates the smooth muscle around the ducts and acini of the prostate. No direct innervation of the acinar epithelium can be observed. The role of the innervation in both normal and pathologic states is discussed.

Vacuolated neurons in the hypogastric ganglion of the rat

The vacuolated neurons (VN) of the main hypogastric ganglion of the male rat were studied using the formaldehyde-induced fluorescence (FIF) method for the histochemical demonstration of catecholamines. Microspectrofluorimetry was performed to identify the fluorophores and to quantify the FIF. The thiocholine method (Koelle-Gomori) was used to demonstrate acetylcholinesterase activity. The fine structure of the VN was studied using glutaraldehyde/OsO4 fixation. (1) In the untreated adult male rat VN represent only a small population of the total number of hypogastric neurons (0.8--1.2%). The vacuoles are similar to those of the VN from the corresponding female ganglion. (2) The VN are considered to be adrenergic due to the nature of their fluorophore, indicating a primary catecholamine. (3) The first VN appear in the hypogastric ganglia at the age of 7 weeks. After testosterone administration to young rats, VN are found at the age of 4 weeks. (4) The basic fine structure of the VN is similar to that of other ordinary neurons of the hypogastric ganglia. (5) The content of the vacuoles could not be identified. (6) Indications of degeneration were not observed in the VN. (7) The VN are interpreted as being a functional stage of the "short" adrenergic neurons, which are under the control of steroid hormones. (8) Fifteen months after castration, no VN could be found in the hypogastric ganglia, while their number was normal in the corresponding control animals.

Innervation of the ventral prostate of the rat

The autonomic innervation of the rat ventral prostate was studied in an attempt to evaluate the role of innervation in the normal function of the gland. Specific histochemical methods for both catecholamines (the formaldehyde-induced fluorescence method, FIF) and acetylcholinesterases (the Gomori-Koelle thiocholine method) were used. The neuro-effector contacts were studied by electron microscopy using both 3% glutaraldehyde and 3% potassium permanganate (KMnO4) as fixatives. It was found that the rat ventral prostate receives dual autonomic innervation. Adrenergic fibers, which formed the majority of the nerves, were often seen in close contact with the smooth muscle cells around both the prostatic alveoli and secretory ducts. The non-adrenergic nerve fibers, which were fewer in number, did not form such intimate contacts with the muscle cells. No direct synapses with epithelial cells were detected.

The distribution and endocrine nature of the abdominal paraganglia of adult man

The paraganglia of adult man were studied using the formaldehyde-induced fluorescence (FIF) method for histochemical characterization of biogenic monoamines. Microspectrofluorimetry was used to record the emission spectra and fluorescence intensities of the paraganglionic cells. The study of samples from six patients showed that well vascularized paraganglia were widely distributed throughout the retroperitoneal spaces. The paraganglia exhibited strong FIF with the spectral characteristics of monamines. Treatment with HC1 caused an increase in the fluorescence intensity of the paraganglia and a simultaneous shift of the emission maximum from 480--495 nm. This change suggests the presence of high concentrations of tryptophyl-containing peptides and is not due to monoamines. The possibility of a dual endocrine function for the paraganglia is discussed.

Paraganglia of the bladder

Normal paraganglia containing high amounts of catecholamines are a constant feature of the wall of the bladder in elderly men. The paraganglia in this location might give rise to pheochromocytomas. The importance of the local endocrine effects in the regulation of the muscular tone in the bladder is discussed.

Effects of ageing on the histochemically demonstrable catecholamines and acetylcholinesterase of human sympathetic ganglia

The sympathetic ganglia of adult and aged humans were obtained during vascular, gynaecological and urological surgery, and studied using the formaldehyde-induced fluorescence (FIF) method for histochemical demonstration of catecholamines. Microspectrofluorimetry was applied to characterize the emission spectra of the flurophores. The sympathetic ganglia contained two types of cells exhibiting FIF: the adrenergic neurons and the small, intensely fluorescent (SIF) cells. The adrenergic neurons contained pigment granules exhibiting autofluorescence with emission maximum at 530---540 nm. The number of these granules increased with age while the FIF of the neurons decreased. In the oldest patients, most of the neurons in the sympathetic ganglia showed only pigment fluorescence but not FIF. The decrease of the perikaryonal catecholamine stores is interpreted as a degenerative change leading to impaired function of the neurons. The patterns of AChE did not change with age. The SIF cells were sparse and were mostly observed near the ganglia, forming paraganglia of varying size. Because of the rarity of the SIF cells, the effect of ageing could not be judged reliably.

The endocrine nature of the paranganglia of man

Brightly fluorescent paraganglia were found in the retroperitoneal tissue of adult man. The histofluorescence properties of the paraganglia indicate the presence of tryptophyl peptides, which might be of endocrine importance.

Paraganglia in the urogential tract of man

According to the earlier concept, the paraganglia of man are believed to degenerate during the first postnatal years after their dominance during the fetal period. Clinical case reports on persisting paraganglia led us to extensive exploration of surgical material obtained from urological and gynecological surgery. The formaldehyde induced fluorescence (FIF) was used for tracing the catecholamine containing tissues. The fluorescence intensities were recorded with a Leitz MPV 2 microspectrophotometer. Solitary, small paraganglia were found in all patients studied. They were especially frequent in the walls of the urinary bladder and in the connective tissue surrounding the urogenital organs. The intensity of the fluorescence was comparable to pharmacological standard of 10(-2) M noradrenaline and at the same level as the FIF of human fetal paraganglia. All cells of the paraganglionic clusters exhibited FIF and no signs of degeneration could be observed. It is suggested that the paraganglia of man do not degenerate postnatally but persist as a remarcable catecholamine reservoir, which might be of physiological importance.

The paraganglia, a persisting endocrine system in man

The paraganglia have been traced in surgical samples of para-aortic and pelvic retroperitoneal tissues using the formal-dehyde-induced fluorescence method for catecholamines. Clusters of catecholamine-storing cells were found in all (12) patients studied. Microspectrofluorometric recordings showed high amounts of catecholamine in the well-vascularized cell groups. A large proportion of the paraganglia, which are most prominent during the fetal period, also persist during postnatal life.