In vivo prevention of corticosteroid-induced skin atrophy by tretinoin in the hairless mouse is accompanied by modulation of collagen, glycosaminoglycans, and fibronectin

In an earlier study we showed that tretinoin could prevent corticosteroid-induced skin atrophy in hairless mice. In this study, we examined the histochemical, biochemical, and immunochemical changes that accompanied the atrophy and its prevention. Mice were treated dorsally for 3 weeks in the morning and afternoon (AM:PM) as follows: 1) vehicle:vehicle, 2) steroid:vehicle, 3) steroid:tretinoin. Tretinoin concentration was 0.05% in an ethanol:propylene glycol vehicle. The steroid was clobetasol propionate (0.05%). The normally sparse dermal glycosaminoglycans were further reduced by steroid:vehicle treatment and increased to greater than vehicle:vehicle amounts by steroid:retinoid. Mast cells were similarly affected. Biochemical quantification of glycosaminoglycans confirmed the histochemical findings. Collagen, non-collagenous protein, and total protein content were reduced by the steroid. The latter two were returned to more normal levels by tretinoin whereas with collagen there was only a trend toward normal levels. Fibronectin, which was increased by the steroid:vehicle treatment, was reduced to more normal levels by steroid:tretinoin. We conclude that tretinoin has the ability to prevent the major steroid-induced biomechanical changes in hairless mouse dermal connective tissue that contribute to atrophy.

Role of nucleosides and nucleotide mixture in intestinal mucosal growth under total parenteral nutrition

The preventive effect of a mixture of nucleosides and a nucleotide (OG-VI) on total parenteral nutrition (TPN)-associated gut mucosal atrophy was investigated. Male Wistar rats were randomly divided into two groups. The TPN group (n = 11) received a standard TPN diet (250 kcal and 1.78 g nitrogen.kg-1.day-1) for 6 days; the TPN + OG-VI group (n = 10) received OG-VI (2.5 ml.kg-1.day-1) in addition to the standard TPN solution for 6 days. To obtain information on a normal fed condition of the intestine, another 10 rats were maintained on oral rat chow for 6 days. Compared with the TPN group, mucosal wet weights in the jejunum (22.8 +/- 1.8 vs. 20.5 +/- 2.0 mg/cm) and the ileum (19.4 +/- 2.2 vs. 16.8 +/- 2.3 mg/cm) were significantly greater in the TPN + OG-VI group. Likewise, diamine oxidase activities in the jejunum (13.7 +/- 4.27 vs. 8.02 +/- 3.40 nmol.min-1.cm-1) and the ileum (33.9 +/- 6.89 vs. 25.9 +/- 7.93 nmol.min-1.cm-1) were significantly higher in the TPN + OG-VI group. Moreover, the bromodeoxyuridine labeling index in the TPN + OG-VI group (36.9 +/- 4.30%) was significantly higher than in the TPN group (31.0 +/- 3.03%). The addition of OG-VI to the standard TPN diet improved mucosal growth and maturity by increasing the proliferating activity of crypt cells. External provision of purines and pyrimidines may be necessary to sustain mucosal function during TPN.

Combination of a dual 5-lipoxygenase/cyclooxygenase inhibitor with a glucocorticoid results in synergistic topical antiinflammatory activity without inducing skin atrophy

Synthetic glucocorticosteroids are widely used in clinical dermatology in the treatment of a number of inflammatory skin disorders. However, cutaneous side effects such as induction of skin atrophy are among the factors that limit the chronic use of this class of agents. We have found that a combination of a dual 5-lipoxygenase/cyclooxygenase inhibitor (9-phenylnonanohydroxamic acid, BMY 30094) and a glucocorticosteroid (hydrocortisone valerate) has synergistic antiinflammatory activity. Topical application of a 0.2% solution of hydrocortisone valerate alone inhibited phorbol ester-induced mouse skin inflammation by 92%. A 1% solution of BMY 30094 alone or a low dose of hydrocortisone valerate (0.005%) had no significant effect on the inflammatory reaction. A combination of 1% BMY 30094 and 0.005% hydrocortisone valerate inhibited the inflammation by 76%. This latter combination produced no signs of skin atrophy in rats after 28 days of application. In contrast, a 0.1% dose of hydrocortisone valerate produced significant skin atrophy. These findings suggest that it is possible to reduce the skin atrophy potential of glucocorticoids while maintaining the antiinflammatory activity using a novel drug combination.

The influence of parenteral glutamine and branched-chain amino acids on total parenteral nutrition-induced atrophy of the gut

We tested the hypothesis that the provision of glutamine and branched-chain amino acids would reverse the gut atrophy that accompanies parenteral nutrition. Three hundred seventy-five rats were randomized into 15 groups to receive either conventional parenteral nutrition, rat food, glutamine-enriched parenteral nutrition (0.5% to 2.5%), branched-chain amino acid-enriched parenteral nutrition (0.8% to 2.0%), or glutamine plus branched-chain amino acid-enriched parenteral nutrition (0.5%/0.4% to 1.25%/1/0%). When compared with effects of conventional parenteral nutrition, the infusion of either glutamine or branched-chain amino acids partially reversed, in a dose-dependent manner, atrophy of the small bowel as assessed by gut weight (p < .05), mucosal weight (p < .05), villous height (p < .05), crypt cell production rate (p < .05), and mucosal protein concentration (p < .05). There was no effect on the large bowel. These results suggest that the parenteral infusion of either glutamine or branched-chain amino acids partially reverses the small-bowel atrophy that is associated with the infusion of solutions of conventional parenteral nutrients.

Hormone replacement therapy

Although hormone replacement therapy (HRT) has been available for almost 100 years, conflicting opinions still exist about its efficacy and safety. There is uniform agreement that vasomotor instability and vaginal atrophy are totally reversible with HRT. Effective treatment of bone loss with HRT depends on the number of years of estrogen deprivation, peak bone mass, and rapidity of bone loss. Oral, transdermal, and pellet estrogens are equality effective. Mortality from coronary heart disease decreased 20% to 40% in women on HRT, yet the mechanism has not yet been ascertained. The increased risk of endometrial cancer has been confirmed, but better diagnostic techniques for detection in the precancerous state have been developed. The relationship of breast cancer to estrogen use has not been conclusive. Meta-analysis of 13 studies results in a relative risk of 1.06, whereas a large case-control study reveals a relative risk of 0.9. However, it is clear that in the average, healthy woman, low-dose estrogen replacement for less than 10 years does not increase the risk of breast cancer. Physicians are encouraged to help patients weigh the risks and benefits of HRT.

Studies on the preventive action of neurotensin on dexamethasone-induced adrenocortical atrophy

The effects of neurotensin (NT) and ACTH on the dexamethasone (Dx)-induced atrophy of the rat adrenal cortex (120 micrograms Dx/rat/day for 4 days) were investigated. NT at a dose of 8 micrograms/rat/day for 2 days prevented Dx-induced adrenal atrophy, and a similar effect was exerted by 10 micrograms/rat/day of ACTH for 2 days. Lower doses of NT were ineffective. ACTH markedly enhanced 3H-thymidine incorporation by adrenal slices, while NT did not. Neither ACTH nor NT had any effect on the number of metaphases per section of the adrenal gland. These findings indicate that NT, like ACTH, prevents Dx-induced adrenocortical atrophy, and that this effect does not depend, as does that of ACTH, upon the stimulation of proliferation of adrenocortical cells.

Prevention of ischemic orchitis during inguinal hernioplasty

Ischemic orchitis and testicular atrophy remain the most dreaded complications of inguinal hernioplasties. The current study examines these complications in a series of hernia repairs during a period of 20 years. The incidence of the complications in the ten year period from 1971 to 1981 was compared with the experience since 1981, from which time all distal indirect hernia sacs were left in place and increasing experience was gained in properitoneal repairs of recurrent hernias. The incidence of ischemic orchitis in primary hernia repairs was reduced from 0.65 per cent (11 instances in 1,682 repairs) to 0.03 per cent (one in 3,634 repairs). The incidence in recurrent hernia repairs was reduced from 2.25 per cent (seven in 311 repairs) to 0.97 per cent (eight in 827 repairs). These data have led us to emphasize the importance of minimizing cord dissection by leaving intact all significant distal hernia sacs and not dissecting beyond the pubic tubercle. Additionally, properitoneal repairs should be considered for repairs of recurrent hernias not only to reduce further recurrences but also to avoid testicular complications.

Prevention of 1,2-dibromo-3-chloropropane (DBCP)-induced kidney necrosis and testicular atrophy by 3-aminobenzamide

The poly(ADP-ribosyl)transferase inhibitor, 3-aminobenzamide (3-ABA), reduced morphological evidence of 1,2-dibromo-3-chloropropane (DBCP)-induced DNA damage determined by alkaline elution. The DBCP plasma, kidney, and testis tissue doses determined between 1 and 8 hr after a single intraperitoneal injection were somewhat higher with than without 3-ABA pretreatment. Furthermore, the amount of DBCP metabolites covalently bound to macromolecules was reduced to about 20-30 percent of control, indicating that 3-ABA may have an effect on the formation/detoxication of reactive DBCP metabolites. Inhibitors of replicative DNA synthesis such as hydroxyurea or stimulation of DNA replication by nephrectomy did not affect the cytotoxicity, neither did inhibitors of DNA repair such as beta-cytosine arabinoside and beta-lapachone.

Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy

The hemitongue paralysis that occurs as a result of a classic hypoglossal-facial nerve crossover procedure can result in profound functional deficits in speech, mastication, and swallowing. The procedure is not an option in patients with bilateral facial paralysis or those at risk for combined cranial nerve deficits. To address some of the drawbacks and limitations of this classic procedure, we developed the hypoglossal-facial nerve interpositional jump graft (12-7 jump graft) procedure. This procedure involves interposing a nerve graft between a partially severed but functionally intact twelfth cranial nerve and the degenerated seventh cranial nerve, and is often combined with other reanimation procedures. To date, we have performed 33 12-7 jump graft procedures in 30 patients (three were treated for bilateral facial paralysis); this report describes the procedure and its indications, and details the results of 23 procedures performed in 20 patients for whom 24-month follow-up data are available. Twelfth nerve deficits occurred in only three patients in this report. Recovery of facial function began between 3 and 24 months postoperatively. Facial tone and symmetry were achieved in every patient, no patient had significant mass movement, and 13 patients (two of whom were treated for bilateral facial paralysis) had excellent and three had superb restoration of facial movement. These results show the 12-7 jump graft to be a valuable adjunct for facial reanimation in selected patients.

Adrenocortical atrophy of hypophysectomized rats can be reduced by corticotropin-releasing hormone (CRH)

The effects of high dose injections of corticotropin-releasing hormone (CRH) on the adrenal cortex of hypophysectomized rats were studied at the light- and electron-microscopical levels. Adrenocortical atrophy induced by hypophysectomy could be reduced by daily i.p. injection of 10 micrograms (3 nmol) CRH given for 3 days starting at day 5 after the operation. The cortex broadened, mostly because of hypertrophy of the zona fasciculata. Blood vessels were enlarged. Although the adrenocortical cells of hypophysectomized rats showed features of a functionally suppressed state, such as tubular mitochondria, the cells of CRH-treated animals showed characteristics of stimulated cells. The inner membrane of the mitochondria formed the typical densely packed vesicles of adrenocortical cells that are active in steroidogenesis. Lipid droplets were found to be reduced, and the cells developed filopodia at their surface. These morphological observations indicate that CRH influences the adrenal cortex via extrapituitary mechanisms.

Parenteral nutrition supplemented with short-chain fatty acids: effect on the small-bowel mucosa in normal rats

When enteral nutrition is excluded from animals maintained solely with total parenteral nutrition (TPN), atrophy of the intestinal mucosa is observed. Short-chain fatty acids (SCFAs) are produced in the colon by the fermentation of dietary carbohydrates and fiber polysaccharides and have been shown to stimulate mucosal-cell mitotic activity in the intestine. This study compared the effects of an intravenous and an intracecal infusion of SCFAs on the small-bowel mucosa. Rats received standard TPN, TPN with SCFAs (sodium acetate, propionate, and butyrate), TPN with an intracecal infusion of SCFAs, or rat food. After 7 d jejunal and ileal mucosal weights, DNA, RNA, and protein were determined. Standard TPN produced significant atrophy of the jejunal and ileal mucosa. Both the intracecal and intravenous infusion of SCFAs significantly reduced the mucosal atrophy associated with TPN. The intravenous and intracolonic infusion of SCFAs were equally effective in inhibiting small-bowel mucosal atrophy.

Role of hypergastrinemia in the antiatrophy effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin on oxyntic gland mucosa of the rat stomach

Atrophy of the gastrointestinal mucosa that occurs in pair-fed control rats is not observed in 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-treated rats (1). Our objective was to determine if the gastrointestinal trophic hormone, gastrin, is involved in the antiatrophy effect of TCDD on the gut mucosa. Adult male Sprague-Dawley rats treated with 100 micrograms/kg of TCDD were slightly hypergastrinemic 7 days after dosing and markedly hypergastrinemic 14 days after treatment whereas pair-fed control rats were normogastrinemic. After 14 days of feed restriction, atrophy of the oxyntic gland and ileum mucosa occurred in pair-fed control rats but only atrophy of the ileum mucosa developed in TCDD-treated animals. The oxyntic gland mucosa of TCDD-treated rats was protected from mucosa atrophy as well as from mucosa erosions. The protection against feed restriction-induced atrophy was demonstrated by measurements of oxyntic gland mucosal height and DNA and protein content. Since hypergastrinemia stimulates growth of oxyntic gland mucosa, but not ileum mucosa, the antiatrophy effect of TCDD on mucosa of the oxyntic gland might in part be due to hypergastrinemia. In support of this interpretation, TCDD treatment exerted an antiatrophy effect on the oxyntic gland mucosa only when TCDD-treated animals were hypergastrinemic. For example, hypergastrinemia does not develop within the first 48 hr after TCDD administration, and TCDD treatment affords no protection against fasting-induced atrophy of the oxyntic gland mucosa during this time. On the other hand, the ability of TCDD treatment to protect against feed restriction-induced erosions of the oxyntic gland mucosa might be mediated by hypergastrinemia since these events occur at a later time.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of murine coxsackie B3 viral myocarditis and associated lymphoid organ atrophy with recombinant human leucocyte interferon alpha A/D

The effects of recombinant human leucocyte interferon alpha A/D on experimental myocarditis due to coxsackie virus B3 were investigated. Specific plaque reduction assays showed that 50% of in vitro plaque formation in VERO (kidney of African green monkey) cells was inhibited by interferon alpha A/D 48 U.ml-1 when administered 24 h before infection with coxsackie virus B3. Three week old male C3H/He mice were inoculated intraperitoneally with 3 x 10(2) plaque-forming units (pfu) of coxsackie virus B3. Controls (group 1) were injected with saline. Interferon alpha A/D 10(4) (group 2) or 10(3) (group 3) U.g-1.day-1, was administered subcutaneously daily, starting 1 d before the infection. Interferon alpha A/D 10(4) U.g-1.day-1 (group 4) was also given, starting the same day. Each group consisted of ten mice. Animals were sacrificed on d 5 for evaluation. Myocardial virus titres were significantly lower in groups 2, 3, and 4 (p less than 0.05) compared with controls. Histological examination showed extensive myocardial necrosis and cellular infiltration in all untreated mice but less severe necrosis and cellular infiltration in treated groups. Thymus and spleen weights in treated groups were greater than in the untreated group, and cellular depletion was less. Thus interferon alpha A/D effectively inhibited myocardial replication of coxsackie virus B3, reduced the myocardial inflammatory response, and prevented the disease associated lymphoid organ atrophy in this animal model.

Relationship between enteral glucose load and adaptive mucosal growth in the small bowel

Infusion of hyperosmolar glucose solutions into small bowel will prevent mucosal atrophy or stimulate mucosal growth in rats otherwise maintained on total parenteral nutrition (TPN). It is not certain whether this growth effect is related to the osmolarity of the solution or its total molecular load. Therefore, various concentrations of glucose and sodium salt solutions were studied for comparative effects on growth of small bowel mucosa. Male Sprague-Dawley rats (240 g) were maintained on TPN and infused continuously with either glucose or sodium chloride (2 and 0.6 ml/hr) or sodium sulfate (0.6 ml/hr) via a catheter placed in the mid-small intestine. Concentrations of infusion solutions ranged in osmotic pressure from 300 to 1500 mosmol/liter. Controls were TPN rats without infusion of any solution. Over a seven-day period, TPN rats receiving mid-gut infusions of 300 mosM saline gained 18.4 g in body weight. In TPN rats receiving mid-gut infusions of progressively greater concentrations of glucose, the additional total kilocalories per day resulted in greater body weight gain compared with the saline controls. After seven days, rats were killed, the small bowel removed, and divided into eight equal segments (segment 1, duodenum; segment 8, terminal ileum). Segment weight, mucosal weight, DNA, and protein concentration per segment were measured. Mid-gut infusions of 900 and 1500 mosM glucose solutions progressively increased mucosal mass in segments downstream from the site of infusion compared with 300 mosM glucose in water or 600 mosM glucose in saline which did not differ from any of the salt solutions or TPN alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphologic and biochemical changes in dogs after portacaval shunt plus bile fistula or ileal bypass: failure of bile fistula or ileal bypass to prevent hepatocyte atrophy

External biliary fistula (BF) or ileal bypass (IB) was performed in dogs at the time of or 2 weeks after portacaval shunt (PCS). The pathologic changes in the dog livers 2 to 4 weeks later were compared to those caused by PCS alone. Histopathologic differences between PCS alone vs. PCS plus BF or IB could not be found. Thus, the experiments did not confirm recent observations by others in rats that BF prevents or reverses the hepatic injury of PCS. As estimated by plasma mevalonic acid determinations, the increase in hepatic cholesterol synthesis that is characteristic after BF or IB was suppressed in animals with PCS. BF and IB reduced but did not eliminate the postprandial elevation in serum bile acid that occurs after PCS. The findings have possible relevance in planning the treatment of patients with familial hypercholesterolemia with the combined use of PCS and IB.

Modified anatrophic nephrolithotomy

The anatrophic nephrolithotomy described by Smith and Boyce is an excellent method of preserving a maximum number of functioning nephrons by minimizing injuries to both the renal parenchyma and its blood supplies. However, clamping of the main renal artery is inevitable and may damage renal function despite regional hypothermia. We devised a modified technique of nephrolithotomy with selective clamping of the segmental artery and no necessity for regional hypothermia.

Arterialization of the liver prevents testicular atrophy in portacaval shunted rats

Portacaval anastomosis in male is known to induce testicular atrophy. The effect of liver revascularization by the right renal artery on the testes of portacaval shunted rats was examined. After shunting, there was a 75% decrease in testis weight compared to the control value and spermatogenesis was blocked in steps 8-9 of spermiogenesis. The in vitro binding of [125I]hCG was only 10% of the control value on a per testis basis and labelled areas in the interstitium of frozen sections subjected to topical autoradiography with [125I]hCG were also strikingly reduced. These parameters were maintained to normality in revascularized shunted rats which displayed also normal copulatory and fertilizing abilities. It is suggested that an adequate blood supply to the liver, as provided by arterialization, can preserve testicular integrity in shunted rats, even though the blood is arterial instead of portal.

[Preservation of the pectoral nerves in modified radical mastectomy]

Modified radical mastectomy with preservation of one or both pectoral muscles is the surgical treatment of choice in stage I and II breast cancer. A surgical anatomic study has been performed, based on post-mortem and intraoperative findings, to investigate origin and course of lateral and medial pectoral nerves and their relations to pectoral muscles and axillary lymphonodes. The results suggest that Patey-Meier operation can produce, in 80 per cent of cases, atrophy and fibrosis of the costoabdominal portion of the pectoralis major muscle as lateral pectoral nerve is generally dissected. On the contrary, radical mastectomy with both pectoral muscles preservation permit also to preserve the nerves during lymphadenectomy if they are recognized.

Effect of Corynebacterium parvum in prevention and reversal of atrophy of the liver following portacaval shunt

Since it has been demonstrated that the administration of Corynebacterium parvum is associated with increased hepatocyte proliferation in both normal and regenerating livers, it seemed appropriate to determine whether the use of this agent would affect the hepatic atrophy which occurs following end-to-side portacaval shunts. When administered at shunting, liver weight and liver deoxyribonucleic acid failed to decrease to the same extent as that occurring in untreated, shunted rats. An increase in liver deoxyribonucleic acid synthesis was observed following portacaval shunt only in treated rats. Corynebacterium parvum administration to portacaval shunt rats with livers demonstrating marked atrophy 15 to 18 days following shunting resulted in the reversal of such atrophy. There was an increase in liver weight and deoxyribonuclei acid to the extent that those values were equal to, or greater than, those of livers from nonshunted rats. By increasing the number of cells within liver, Corynebacterium parvum administration prevents or reverses the decrease in liver size, that is, atrophy, which occurs after portacaval shunts were performed.