Varicocele is associated with an increase of connective tissue of the pampiniform plexus vein wall

Age-Dependent Remodeling in Infrapatellar Fat Pad Adipocytes and Extracellular Matrix: A Comparative Study

The infrapatellar fat pad (IFP) is actively involved in knee osteoarthritis (OA). However, a proper description of which developmental modifications occur in the IFP along with age and in absence of joint pathological conditions, is required to adequately describe its actual contribution in OA pathophysiology. Here, two IFP sources were compared: (a) IFP from healthy young patients undergoing anterior-cruciate ligament (ACL) reconstruction for ACL rupture (n = 24); (b) IFP from elderly cadaver donors (n = 23). After histopathological score assignment to confirm the absence of inflammatory features (i.e., inflammatory infiltrate and increased vascularity), the adipocytes morphology was determined; moreover, extracellular matrix proteins were studied through histology and Second Harmonic Generation approach, to determine collagens content and orientation by Fast Fourier Transform and OrientationJ. The two groups were matched for body mass index. No inflammatory signs were observed, while higher area, perimeter, and equivalent diameter and volume were detected for the adipocytes in the elderly group. Collagen III displayed higher values in the young group and a lower total collagen deposition with aging was identified. However, collagen I/III ratio and the global architecture of the samples were not affected. A higher content in elastic fibers was observed around the adipocytes for the ACL-IFPs and in the septa cadaver donor-IFPs, respectively. Age affects the characteristics of the IFP tissue also in absence of a pathological condition. Variable mechanical stimulation, depending on age-related different mobility, could be speculated to exert a role in tissue remodeling.

RUG technique: replacement of the ureter with gonadal vein. A cadaveric study

BACKGROUND

Ureteral defect lesions may result from retroperitoneal fibrosis, radiation damage, tumors, or surgical procedures; the management of long-segment ureteral defects is a challenge for urologists. Total or partial replacement of the ureter is sometimes required, with consequent ileal interposition, but this technique may lead to several complications, such as severe urinary infections. In a few cases, nephrectomy may be required. Starting from the above considerations, we can postulate the RUG technique (replacement of the ureter with gonadal vein), using the gonadal vein (GoV) as an autologous graft to substitute the ureter. For this reason, we decided to test this novel idea on an experimental model.

METHODS

We tested the above technique on a cadaveric model, performing complete procedure (RUG #1), segmental replacement of the ureter (RUG #2), and ureteroplasty with a GoV patch (RUG #3). All the procedures involved an open approach. After RUG #3, the treated segment of the ureter was sampled for histologic analysis.

RESULTS

Four RUGs were performed (two RUG #1, one RUG #2, one RUG #3). All anatomic structures were easily identified, and all procedures were completed successfully. The dimensions of the ureters were comparable to those of the GoV in all cases, as usual. Histologic analysis demonstrated perfect adherence of the two anastomosed structures.

CONCLUSIONS

The RUG technique resulted in an adequate, safe and easy-to-perform surgical alternative.

Decellularized Human Skeletal Muscle as Biologic Scaffold for Reconstructive Surgery

Engineered skeletal muscle tissues have been proposed as potential solutions for volumetric muscle losses, and biologic scaffolds have been obtained by decellularization of animal skeletal muscles. The aim of the present work was to analyse the characteristics of a biologic scaffold obtained by decellularization of human skeletal muscles (also through comparison with rats and rabbits) and to evaluate its integration capability in a rabbit model with an abdominal wall defect. Rat, rabbit and human muscle samples were alternatively decellularized with two protocols: n.1, involving sodium deoxycholate and DNase I; n.2, trypsin-EDTA and Triton X-NH₄OH. Protocol 2 proved more effective, removing all cellular material and maintaining the three-dimensional networks of collagen and elastic fibers. Ultrastructural analyses with transmission and scanning electron microscopy confirmed the preservation of collagen, elastic fibres, glycosaminoglycans and proteoglycans. Implantation of human scaffolds in rabbits gave good results in terms of integration, although recellularization by muscle cells was not completely achieved. In conclusion, human skeletal muscles may be effectively decellularized to obtain scaffolds preserving the architecture of the extracellular matrix and showing mechanical properties suitable for implantation/integration. Further analyses will be necessary to verify the suitability of these scaffolds for in vitro recolonization by autologous cells before in vivo implantation.

Varicocele in younger as risk factor for inguinal hernia and for chronic venous disease in older: preliminary results of a prospective cohort study

BACKGROUND

Varicocele, inguinal hernia, and chronic venous insufficiency are often associated. Varicocele has its maximum prevalence in younger age, whereas hernia and chronic venous disease appear later. The aim of this study was to analyze the relationship between these conditions.

METHODS

A prospective cohort study was conducted, consisting of two groups of male patients. Group A comprised patients with varicocele, whereas group B comprised those with problems other than varicocele. Both groups were followed over time and were assessed for the onset of signs and symptoms related to inguinal hernia and chronic venous disease.

RESULTS

Preliminary results showed a positive correlation between the presence of varicocele in younger and the possible risk of hernia and/or chronic venous disease in later age.

CONCLUSIONS

Preliminary results suggest that varicocele in younger age appears to be an early marker of progression for a connective tissue-related disease in later age.

Comparison of spermatic vein histology in patients with and without varicocele

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.

Morphological changes in varicocele veins: ultrastructural study

BACKGROUND

Varicocele consists of dilatation of the pampiniform venous plexus and the internal spermatic veins. It is present in 15% of male population and is a common cause of male infertility.

OBJECTIVE

To describe the normal structure of the internal spermatic vein and the morphological changes in grade 3 varicocele.

METHODS

The authors dissected and analyzed a 2- to 3-cm tract of the pampiniform venous plexus of 20 patients undergoing varicocelectomy for left varicocele and of 10 consecutive patients undergoing surgery for left inguinal hernia. The histological examination was performed with hematoxylin–eosin and Masson trichrome stains. The ultrastructural evaluation was done using both scanning and transmission electron microscopy.

RESULTS

Compared with normal internal spermatic veins, varicocele veins showed narrowing and/or obliteration of the lumens, destruction of the endothelial cells, invagination of the intima, and deposition of collagen bundles in the media (light microscopy). The ultrastructural changes in varicocele veins included elongation of the endothelial cells with features of cellular damage, loss of the internal elastic lamina, and the appearance of ghost bodies and degenerative vacuoles in the subendothelial layer.

CONCLUSIONS

The authors believe this is the first report analyzing ultrastructual changes in normal human internal spermatic vein samples and in varicocele. The underlying molecular mechanisms of these changes await further studies.

Treatment strategy for the adolescent varicocele

A varicocele is a dilatation of the testicular vein and the pampiniform venous plexus within the spermatic cord. Although rare in pediatric populations, the prevalence of varicoceles markedly increases with pubertal development. Varicoceles are progressive lesions that may hinder testicular growth and function over time and are the most common and correctable cause of male infertility. Approximately 40% of men with primary infertility have a varicocele, and more than half of them experience improvements in semen parameters after varicocelectomy. The decision to treat adolescents with varicocele is a controversial one. The task for pediatricians and urologists is to identify those adolescents who are at greatest risk for infertility in adulthood, in an effort to offer early surgical intervention to those most likely to benefit.

Comparison of transverse carpal ligament and flexor retinaculum terminology for the wrist

PURPOSE

To investigate the macroscopic anatomy and histological characteristics of the transverse carpal ligament and the flexor retinaculum of the wrist and to investigate their anatomical relationships and define appropriate terminology.

METHODS

The volar regions of the wrists of 30 unembalmed subjects were examined by dissection and by histological and immunohistochemical staining. In vivo magnetic resonance imaging studies were also carried out on 10 subjects.

RESULTS

The dissection study showed that the antebrachial fascia at the volar aspect of the wrist presents a reinforcement. From a histological point of view, it is composed of 3 layers of undulated collagen fiber bundles. Adjacent layers show different orientations of the collagen fibers. Many nerve fibers and Pacini and Ruffini corpuscles were found in all specimens. Under this fibrous plane is another fibrous structure, placed transversely between the ulnar-sided hamate and pisiform bones, and the radial-sided scaphoid and trapezium bones. The deeper fibrous structure shows completely different histological characteristics, having parallel, thicker collagen fiber bundles and few nerve fibers. Magnetic resonance images confirm the presence of 2 clearly distinguished fibrous structures in the wrist, the first in continuity with the antebrachial fascia and the second located in a deeper plane between the hamate and scaphoid.

CONCLUSIONS

Two different fibrous structures with different histological characteristics are present in the volar wrist: the more superficial one is in continuity with the antebrachial fascia and could be considered its reinforcement; the deeper one is composed of strong lamina, with histological features similar to those of a ligament. For these reasons, we suggest that the term transverse carpal ligament should be used to indicate the fibrous lamina connecting the hamate and pisiform to the scaphoid and trapezium and that the term flexor retinaculum of the wrist should be abandoned because it does not correspond to any specific, autonomous structure.