Regional difference in epidermal thinning after skin denervation

Denervation of skin has a profound influence on epidermis; epidermal thinning was a consistent finding in rats. However, it is not clear whether the degree of epidermal thinning was similar in the region receiving the same innervation. In mice, how early epidermal nerves were degenerated after nerve injury remained unknown. To address these issues, we transected the sciatic nerve in mice and compared the changes of epidermal thickness in different areas of the hind foot skin. Epidermal nerves degenerated within 48 h after nerve transection, similar to what was observed in rats. Seven days after nerve transection, there was differential thinning of epidermis. The interpad area, in the center of the sciatic nerve-innervated region, exhibited the most profound degree of epidermal thinning (34.6 +/- 3.1 vs 47.8 +/- 2.4 microns, P < 0.01). The heel area, in the periphery of the sciatic nerve-innervated zone, did not show significant thinning of epidermis after denervation (37.3 +/- 4.8 vs 41.5 +/- 5.1 microns, P > 0.05). The degree of epidermal thinning after denervation in the pad area was the intermediate one: with 98.8 +/- 4.8 vs 120.1 +/- 7.3 microns, P < 0.02, in the rete pegs, and 51.1 +/- 4.1 vs 62.1 +/- 6.0 microns, P < 0.02, in the dermal papilla. The differential thinning was obvious when the thickness of the denervated epidermis was normalized to that of the control epidermis with the ratios of 0.73 +/- 0.03 in the interpad area, 0.83 +/- 0.04 in the rete peg, 0.85 +/- 0.05 in the dermal papilla, and 0.92 +/- 0.05 in the heel. Epidermal thinning was reversed by reinnervation of the epidermis after sciatic nerve crush (41.5 +/- 1.5 vs 45.0 +/- 2.0 microns in the interpad area, P > 0.05). These findings suggest that sensory nerves exhibit trophic influences on the epidermis presumably through the effects of diffusible factors.

Sensory and motor denervation influence epidermal thickness in rat foot glabrous skin

Denervation in man often results in shiny, dry, thin skin. A previous study has shown that the epidermis of glabrous skin in the rat becomes approximately 40% thinner within 1 week following sciatic nerve transection, but which nerve fiber type or types influence epidermal thickness is unknown. In this study, we compared the effects on the epidermis of selective sensory, motor, and sympathetic denervation. Protein gene product 9.5 and calcitonin gene-related peptide immunocytochemical staining were used to determine the extent of denervation of epidermis, dermis, and sweat glands in the footpads. Epidermal thickness of the glabrous plantar skin of the foot was measured. To verify the specificity and reliability of each animal model, the relevant regions of the peripheral nervous system were examined by light or electron microscopy or both. Epidermal thickness decreased significantly following sciatic nerve transection (58% of control, P < 0.05) and dorsal root ganglionectomy (59%; P < 0.05). The thickness also decreased following lumbar ventral rhizotomy (61%; P < 0.01), destruction of lumbar spinal motor neurons (66%; P < 0.05), and botulinum toxin-induced paralysis of the tibialis anterior and gastrocnemius muscles (70%; P < 0.05). A slight decrease followed dorsal rhizotomy (84%; P < 0.01). In contrast, no significant alterations in epidermal thickness were detected following sham operation and sympathectomy. Epidermal thinning was paralleled by reductions in the amounts of transcripts for glyceraldehyde-3-phosphate dehydrogenase and beta-actin. These results suggest that selective loss of both sensory and motor fibers to the hind limb can contribute to reducing epidermal thickness in rat foot glabrous skin.

Heterogeneity of antigen expression and lectin labeling on microglial cells in the olfactory bulb of adult rats

Microglia in different layers of the rat olfactory bulb expressed a variety of membrane antigens except for CD4 (OX-35). Bulb microglial cells bearing complement receptor type 3 (OX-42) were ubiquitous and their immunoreactivity varied considerably in different bulb layers. Although very few in number, labeled microglia in all layers also expressed major histocompatibility complex class I antigen (OX-18), leukocyte common antigen (OX-1) and unknown macrophage antigen (ED-2). The latter was localized in cells distributed almost exclusively in the perivascular spaces. The immunoreactivity of ED-1, an unknown cytoplasmic or lysosomal membrane antigen in macrophages, was localized in labeled microglia which were concentrated mainly in the granule cell layer and periglomerular zone of the bulb. A variable number of microglial cells were stained with OX-6 (major histocompatibility complex class II antigen) and they were located predominantly in the periglomerular zone and at the junction between the granule cell layer and the subependymal layer. Ultrastructural study using GSA I-B4 lectin labeling showed that microglia in different layers of the bulb exhibited similar labeling patterns in their subcellular structures. A remarkable feature was the occurrence of some microglia in the olfactory nerve layer, subependymal layer and granule cell layer adjacent to the subependymal layer in which the cells showed intense lectin labeling at their Golgi apparatus, a feature which was absent in microglia of other bulb layers. Present results showed the regional differences in microglial antigen expressions and lectin labeling within the olfactory bulb. It is therefore suggested that the cells subserve very different specific functions depending on their ambient microenvironments. The heterogeneity of microglial functions in the olfactory bulb may be related to the progressive regeneration and degeneration of its containing neurons.

Malignant chondroid syringoma

A case of malignant chondroid syringoma on a foot with multiple bone metastases is presented. An 18-year-old male patient first noticed a protruding mass on the plantar surface of his right foot at 9 years of age. A sweat gland tumor of a benign nature was diagnosed and excised at that time. The tumor recurred three times during the 10 years after surgery and was finally diagnosed as malignant chondroid syringoma. Multiple bone metastases involving the calcaneus, talus and fibula of the lesion side were found after extensive radiologic survey. The patient underwent below-knee amputation with total removal of the fibula. However, pelvic bone metastasis developed 1 year after the amputation. He died of this disease due to brain and diffuse bony metastasis 36 months after the amputation. This is a rare case of malignant chondroid syringoma with a long history but ominous outcome. We recommend that sweat gland tumors be carefully examined and treated more radically when there is a suspicion of malignancy.

Simultaneous Bentall's procedure and sternal turnover in a patient with Marfan syndrome

A patient with Marfan syndrome with ascending aortic aneurysm, aortic regurgitation and pectus excavatum was treated with simultaneous Bentall's procedure and sternal turnover. Partial sternal necrosis and mediastinitis developed 12 days after surgery. After debridement of about one-third of turnovered sterno-costal complex (SC), successful salvage of the remaining two-thirds of SC and sterilization of the infected aortic Dacron graft were accomplished with pedicled omental flap. The 7 previously published cases of simultaneous Bentall's procedure and sternal turnover are reviewed.