Soemmerring’s work on the nervous system: a view on brain structure and function from the late eighteenth century

Samuel Thomas Soemmerring (1755-1830) was an encyclopaedic anatomist and one of the most experienced and renowned neuro-anatomists in the late eighteenth century. His description and illustration of the brainstem with its still accepted classification of cranial nerves (1778), the discovery of the acervulus in the epiphysis (1785), his demonstration of the crossing of the optic nerve fibres (1788), and of the macula lutea in the retina of the eye he had discovered in 1791, won him great recognition. Probably, unaware of Francesco Gennari's (1750-1797) and Félix Vicq d'Azyr's (1748-1794) observation, Soemmerring in the final years of the eighteenth century saw the broad white line running through the calcarine cortex of the occipital lobe. Soemmerring's comprehensive textbooks on the nervous system Vom Hirn and Rückenmark, 1788/1792, and Hirn- und Nervenlehre as part of his anatomical handbook Vom Baue des menschlichen Körpers, 1791/2nd edn, 1800, comprise all the knowledge in the field of neuro-anatomy at his time. Although the structure-function relationships mentioned are generally hypothetical, Soemmerring was convinced that mental faculties are executed in certain brain regions. In his treatise Uber das Organ der Seele, 1796, he localized the functions of the soul within the cerebrospinal fluid, which should come into close contact with the demonstrated and presumed nerve endings in the walls of the ventricular cavities. This last attempt of a synthesis of anatomy and metaphysics provoked passionate discussions and was criticised for epistemological reasons. Nevertheless, Soemmerring had moved the brain into the centre of the science of man what led to far-reaching consequences in the complexity of the discourse about man.

The effect of Palamed G bone cement on early migration of tibial components in total knee arthroplasty

OBJECTIVE

Migration of the tibial component in total knee arthroplasty (TKA) is subject of many studies using roentgen stereophotogrammetric analysis (RSA). In previous studies of cemented and uncemented tibial components, high migration values were found. Improvements in cementing technique, prosthetic design and pre-coating techniques reduced these values as shown in more recent studies.

MATERIAL AND SUBJECTS

A total of 35 patients were initially included in the study and operated on between 12/1999 and 10/2000. All patients received a NexGen TKA cemented into the proximal tibia using Palamed G bone cement. The implants and the tibial metaphysis were marked with standard tantalum markers. Radiostereometric analysis was performed post-operatively and after 3, 6 and 12 months using a standard digital radiostereometric analysis. Functional parameters were assessed using the Knee Society Score (KSS) clinical rating system.

RESULTS

There were no complications and failures within the first year. After 1 year radiostereometric measurements of the translational parameters along and the rotational parameters around the x-, y- and z-axis revealed: X-Trans -0.19 mm, Y-Trans +0.02 mm, Z-Trans +0.08 mm, X-Rot +0.26 degrees, Y-Rot -0.35 degrees, Z-Rot +0.09 degrees. The maximum total point motion was +0.96 mm and the mean maximum subsidence was -0.23 mm. Except for anterior-posterior, medio-lateral stability and extension leg all endpoints of the KSS clinical rating system showed a significant improvement.

CONCLUSIONS

After 12 months, the use of Palamed G bone cement in total knee arthroplasty was demonstrated to be safe. Both the clinical and radiostereometric results were good and comparable to the results reported in other RSA studies in cemented total knee arthroplasty.

[What effect does the hydroxyapatite coating have in cementless knee arthroplasty?]

The goal of this study was to compare the migration of noncemented diffusion sintered titanium fibermesh-coated tibial components with (HA group) and without (non-HA group) additional hydroxyapatite coating. For this purpose digital radiostereometry (DIRSA) was used to compare the migration after 2 and 9 years for the two groups. After 2 years the mean maximum subsidence of the HA-coated components (0.24+/-0.18 mm) was about one-half of the mean maximum subsidence of the non-HA-coated group (0.55+/-0.55 mm). After 9 years the maximum subsidence of the HA-coated components was still smaller, but not as pronounced as before. The same trend was also found for the endpoint maximum total point motion (MTPM). After 2 years the mean MTPM of the HA-coated components was 0.66+/-0.38 mm and of the non-HA group 0.73+/-0.50 mm. After 9 years the mean MTPM for the HA-coated components was 0.54+/-0.15 mm and for the non-HA-coated components 0.74+/-0.20 mm. None of the HA-coated tibial components but one of the non-HA group had to be revised and exchanged due to aseptic loosening.

Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus. A prospective, randomised study

We have performed a controlled, randomised study to analyse the effects of low-energy shock-wave therapy (ESWT) on function and pain in tendinitis of the supraspinatus without calcification. There were 20 patients in the treatment group and 20 in the control group. The former group received 6,000 impulses (energy flux density, 0.11 mJ/mm2) in three sessions after local anaesthesia. The control group had 6000 impulses of sham ESWT after local anaesthesia. The patients were examined at six and 12 weeks after treatment by an independent observer who evaluated the Constant score and level of pain. We found an increase in function and a reduction of pain in both groups (p < or = 0.001). Statistical analysis showed no difference between the groups for the Constant score and for pain. We therefore do not recommend ESWT for the treatment of tendinitis of supraspinatus.

Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus

We have performed a controlled, randomised study to analyse the effects of low-energy shock-wave therapy (ESWT) on function and pain in tendinitis of the supraspinatus without calcification. There were 20 patients in the treatment group and 20 in the control group. The former group received 6000 impulses (energy flux density, 0.11 mJ/mm2) in three sessions after local anaesthesia. The control group had 6000 impulses of sham ESWT after local anaesthesia.

The patients were examined at six and 12 weeks after treatment by an independent observer who evaluated the Constant score and level of pain. We found an increase in function and a reduction of pain in both groups (p ≤ 0.001). Statistical analysis showed no difference between the groups for the Constant score and for pain. We therefore do not recommend ESWT for the treatment of tendinitis of supraspinatus.

Lobular distribution pattern of lactate dehydrogenase and 6-phosphogluconate dehydrogenase activity in rat liver

Lactate dehydrogenase (LDH) and 6-phosphogluconate dehydrogenase (6-PGDH) activities were measured in lobular areas expanding between 3 portal tracts and an efferent central vein in the livers of male Wistar rats, using a Lowry technique. The maximum of LDH activity was found in a nearly uniform broad area in the lobular periphery. From that area values decreased along periportal/septal-->perivenous gradients, but only slightly within that area along the periportal-->septal axis of the vascular septum. Maximum values of 6-PGDH activity were present in an intermediate area close to the central vein demonstrating a rather inhomogeneous distribution pattern without a clear definition of zonal limits. Our data on the distribution pattern of LDH are in agreement with the concept of the metabolic lobulus and are supported by a recent evaluation of the vascular architecture in rat liver. The lobular distribution pattern of 6-PGDH cannot be interpreted without doubt in accordance with that concept.

[Illustration of humans in the anatomy of the Renaissance: Andrea Vesalius' De humani corporis fabrica libri septem, Basel 1543]

The position of Andreas Vesalius and his most influential book De humani corporis fabrica in the history of medicine are reevaluated in the context of renaissance-humanism. Vesalius's conception of the reconstruction of the living body is discussed in the light of the macrocosm-microcosm-correspondance considering equally directed considerations of the humanist and reformator Philipp Melanchthon. In both their no longer ontological but epistemological approach when changing from the deductive to the inductive method, microcosm man is becoming an anthropological concept and thus assumes a new quality: a psychophysical unit with a transcendental dimension. Against this background the great tables of the skeletons and musclemen in the De humani corporis fabrica are studied considering the unity of art and anatomy in the visual media. At that point, however, where the limits of Vesalius's anatomical conception in representing structure and function become manifest, the disruption of this unity eventually occurring in the end of the 18th century is already visible. Where anatomy is taken up in the expression of art, in the cosciousness of his finality the tragic horizon of man expands.

Muscarinic signalling in submandibular salivary acinar cells of ageing rats

Muscarinic cholinergic stimulation of submandibular acinar cells results in the activation of Ca(2+)-dependent ion-transport pathways responsible for the secretion of primary saliva. Decreased saliva production is common among elderly people and may compromise oral health with implications for systemic health, nutrition, and quality of life. The density and affinity of muscarinic receptors in the submandibular gland of rats and the Ca2+ responses to stimulation of these receptors in the acinar cells were examined. An increase in the number of receptors and increases in the affinities of the receptors were found as the rats age from 7 weeks to 11 months. However, the coupling of the receptors to the intracellular Ca2+ signals in acinar cell clusters was substantially reduced in the older animals.

Hip dysplasia in spastic cerebral palsy

Previous reports have noted a relationship between pelvic obliquity and hip dysplasia in spastic cerebral palsy but did not confirm its existence by scientific study. A study is reported that confirms the association of pelvic obliquity with hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation prior to surgery, 80 patients were indexed into five body alignment types. Reclassifications were performed with passage of time in order to study the natural history and effects of surgery. In all cases, hip dysplasia was found to be consistent with the forces related to pelvic obliquity.

[A human representation of humans? Changes in human representation in anatomy]

When during the last three decades of the 19th century German clinical medicine was established as a natural science anatomy e.g. was referred to as a model on this way. At that time this discipline, however, was delved into Richtungskämpfe between evolutionary morphology on the one side and physiological and clinical orientated anatomy on the other, comprising a discussion on the Wissenschaftlichkeit of the different directions. In the end anatomy evolved as a medical discipline leaving evolutionary morphology to the zoologists. Concomitantly with this change in the self-conception of the discipline as a natural science anatomy was charged with the imprinting of the prospective physician and his picture of the human being. This respective picture is analysed in the anatomical illustration from Vesalius up to nowadays considering the unity of art and anatomy in the visual media as well as in its disjunction. In this context the dominance of science on art in the service of anatomy is discussed with special reference to the neoclassical influence on further development. The latter is characterized by an increasing abstraction and diagrammatic representation of the human figure referring to man as a reparable electrochemical machine without mystery. This corresponds to a clinical medicine comprehending as a reparative and mechanical profession. The restoration of a human picture of the human being may be achieved by an anatomy directed to life and an art extended to an anthropological conception.

Distribution pattern of alanine aminotransferase activity in rat liver

Activities of the alanine aminotransferase were measured along the entire sinusoidal paths (1) between small portal tracts and central veins and (2) between regions of adjoining septal branches and central veins in the livers of male Wistar rats using a Lowry technique. The established profiles of enzyme activity give support to previous studies, suggesting functional heterogeneity of liver sinusoids and their abutting hepatocytes related to morphological differences of the sinusoidal bed.

The cranial nerves as living morphotic entities--Friedrich Arnold's Icones nervorum capitis, Heidelberg 1834

Friedrich Arnold's neuroanatomical treatise Icones nervorum capitis published in its first edition in Heidelberg 1834 ranks scientifically and iconographically among the most brilliant works of 19th century anatomical literature. Consonant with Arnold's conceptions the lithographed engravings depict the cranial nerves as living, morphotic entities comprising their topographical origin and periphery in a distinctness and beauty never been seen before.

Sinusoidal profiles of lactate dehydrogenase activity in rat liver

Lactate dehydrogenase activities were measured along two sinusoidal paths (1) between small portal tracts and central veins and (2) between regions of adjoining septal branches and central veins in the livers of male Wistar rats, using a Lowry technique. The established profiles of enzyme activity provide further support of functional heterogeneity of liver sinusoids and their abutting hepatocytes related to morphological differences of the sinusoidal bed. Within the hepatocytes a pronounced heterogeneity in enzyme activity was recorded surrounding small portal tracts and central veins. The lowest values of activity were determined in those cells located in close proximity to the vessels, which emphasizes their exceptional morphological and functional position.

Image analysis of the histochemical demonstration of glucose-6-phosphatase activity in rat liver

Activities of histochemically demonstrated glucose-6-phosphatase were quantified by computerized densitometry using image analysis in livers of female adult Wistar rats fed ad libitum and fasted 22 h before sacrifice. Mean optical densities along the path between small portal tracts and efferent hepatic venous branches and enzyme activities obtained from biochemical assays exhibited a strong positive correlation. The gradients of high periportal to lower perivenous glucose-6-phosphatase activities were analysed by profiles of optical density along these distances. Mapping optical densities in an image of equidensity range provided information on the distribution pattern of hepatic glucose-6-phosphatase over an extended two-dimensional area. This visualisation of histochemical enzyme reaction based on quantitative data supports the approach of sampling across the entire protal----hepatic venous distance disregarding parenchymal zonation. Utilities provided by computer assisted image analysis will have some bearing for further adequate quantitative description of liver function and structural make up.

Karyometry of nuclei in liver cells. Heterogeneity of nuclear volume and percentage of binucleate cells associated with veins

In untreated adult male albino rats nuclear volume and the percentage of binucleate cells were determined in the first layer of hepatocytes adjacent to hepatic venous branches of varying diameters (less than 40 microns, 40 microns-80 microns, 80 microns-120 microns, 120 microns-160 microns, greater than 160 microns), and in the third and fourth layer of hepatocytes in the remainder of the perivenous parenchyma. In the first layer of hepatocytes adjacent to the vascular structures means of nuclear volume are significantly lower and percentage of binucleate cells significantly higher than in the cells of the remainder of the perivenous parenchyma. Within each area measured distribution curves of nuclear volume classes were homogeneous but showed heterogeneity in comparison with each other. The morphometric data presented in this study strongly support the opinion of the heterogeneity of liver cells in the perivenous zone, as previously postulated on the basis of histochemical investigations.

Quantitative and qualitative histochemical investigation on NADP+-dependent dehydrogenases in the limiting plate and the residual parenchyma surrounding terminal hepatic venules

Activities of three NADP+-dependent enzymes (glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, isocitrate dehydrogenase) were demonstrated in the first layer of hepatocytes adjacent to terminal hepatic venules (perivenous limiting plate), and in the residual parenchyma of the perivenous zone of the acinus, in normally fed adult male Wistar rats, using a Lowry technique and a qualitative histochemical staining reaction. Enzyme activities of the glucose-6-phosphate dehydrogenase were significantly higher in the hepatocytes adjacent to terminal hepatic venules (ratio hepatocytes adjacent to terminal hepatic venules/residual parenchyma of the perivenous zone: 1.31). 6-Phosphogluconate dehydrogenase and isocitrate dehydrogenase were homogeneously distributed in the two areas measured (ratio: 1.04 and ratio: 1.0 respectively). With the qualitative histochemical staining reactions no differences were found.

[Note on the smoothing of time series]

For smoothing of time series instead of the method introduced by Kulenkampff and Kolb as a simple mathematical procedure weighted moving averages are proposed.

Problems in fitting a cosine curve

In fitting of cosine curves latent experimental inequalities due to a serial effect have to be excluded. Though cosinor analysis may be sufficient then, inclusion of biological time, i.e. not fitting values to time but to a function of time, will lead to further improvement.

Microbiochemical investiagation on diurnal rhythmic changes of the activities of the lactate dehydrogenase in the periportal and perivenous zones of the acinus of the rat liver

Activities of the lactate dehydrogenase within the periportal zone and within the perivenous zone in the first layer of hepatocytes adjacent to terminal hepatic venules and the remainder of the perivenous parenchyma of the liver acinus were measured using a Lowry technique during a full 24-h cycle (08.00-08.00) in untreated adult male Wistar rats kept under 12 h of light and 12 h of darkness, scotophase 18.25-06.25. In all three regions studied a broad first maximum was recorded between 10.00 and 22.00 with the peak value at 16.00 and a high and narrow peak at 24.00. Zonal and intrazonal heterogeneity of the lactate dehydrogenase were retained during the full day and night cycle. The regions displayed individual dynamic changes in enzyme activity.

Karyometric investigation on circadian rhythmic changes in the periportal and perivenous zones of the acinus of the rat liver

In untreated adult male albino rats changes in nuclear volume within the periportal and the perivenous zones of the liver acinus were measured during a full day and night cycle. Only the perivenous zone displayed circadian rhythmic changes as expressed in the sinus-like course of the nuclear volume-distribution graph (polynomial) with a maximum between 16.00 h and 18.00 h and a minimum at 8.00 h. In all groups studied zonal heterogeneity of the means of nuclear volume and the percent-distribution graphs of nuclear volume classes were retained during the full cycle. Within each zone, however, distribution curves of nuclear volume classes were homogeneous indicating an equally directed trend in time-dependent changes in nuclear volume.

Microbiochemical approach to liver cell heterogeneity around terminal hepatic venules

Using lyophilized cryostat sections of liver the activities of alanine aminotransferase, lactate dehydrogenase, and pyruvate kinase were measured using a Lowry technique in the first layer of hepatocytes adjacent to terminal hepatic venules and in the residual parenchymal of the perivenous zone of the acinus in normally fed adult male Wistar rats. Alanine aminotransferase was homogeneously distributed in the two areas measured (ratio hepatocytes adjacent to terminal hepatic venules/residual parenchyma of the perivenous zone: 1.05). Enzyme activities of the lactate dehydrogenase were significantly lower in the hepatocytes adjacent to terminal hepatic venules (ratio: 0.65) and those of the pyruvate kinase significantly higher (ratio: 1.12) than in the residual parenchyma of the perivenous zone indicating liver cell heterogeneity in this zone of the liver acinus.

Discovery of a variant in the region of the adductor magnus and the short head of the biceps femoris

As a variant between the adductor magnus and the short head of the biceps femoris a small, triangular, flat muscle is described. Its fasciculi originate from both muscles and its long, thin tendon lying between the popliteal vessels and the sciatic nerve runs into the tendon of the adductor magnus inserting into the adductor tubercle.

[Morphokinetic reactions in the thyroid, parathyroid, and tracheal glands of the albino rat after anaesthesia with thiobutabarbitone sodium and diethyl ether (author's transl)]

A significant decrease was observed in nuclear volume of the follicular cells of the thyroid gland and the cells of the parathyroid of albino rats subjected to ether anaesthesia, in contrast to generally unchanged nuclear size in animals anaesthetized by thiobutabarbitone sodium. It is suggested that ether exerts its depressant influence mainly by direct action on the function of the follicular cells of the thyroid. Thiobutabarbitone Sodium probably influences thyroid function especially by its antithyroid-drug effects, which have been reported by other authors. The highly significant increase of nuclear volume in the tracheal glands during ether narcosis is referred to the mucous secretion activating stimulus of ether vapors.

[Quantitative morphological investigation of the effect of thiobutabarbitone sodium anaesthesia on the endocrine and exocrine pancreas of the albino rat (author's transl)]

In respect of controls the beta-cells of the Islets of Langerhans in fed rats showed a significant decrease in nuclear volume after 40 min of anaesthesia with Thiobutabarbitone Sodium in a double-maximum-load dose. The alpha-cells and the cells of the exocrine pancreas do not show such alteration. The reduction in beta-cell acitivity is referred to a time and dose dependent effect of narcosis on the metabolism of the beta-cells and possible membrane phenomena. According to the morphological picture the otherwise missing signs of impaired function of the cells indicate a peripheral disturbance of glucose utilization during nacrosis. The blood-sugar levels support the proposed explanation.

[Investigation on the morphokinetic reactions of the rat liver to ether anaesthesia of different length (author's transl)]

The nuclear volumes were measured in the central, intermediate and peripheral zone of the classic liver lobule of adult male albino rats exposed to ether anaesthesia lasting 15, 40 and 80 min. Related to control animals there was a significantly lower nuclear size after a 40 min duration of narcosis and a significant higher volume after 80 min in the central part of the lobule. With a slight but not significant decrease of nuclear volume in the intermediate zone after 15 min and a significant increase after 80 min respectively, the peripheral lobular region constantly showed significantly smaller nuclei. But here, too, a disappearance of decrease was recorded after 80 min. The interpretation of the data is based upon a typical distribution of cell organelles, enzymatic pathways, and metabolites in the different zones of the hepatic lobule. The intensity of reaction and appearance of diminution in nuclear volume, indicating a functional depression and probably accentuated by a circular dependent low O2-tension of tissue, is interpreted in connection with different local concentrations of ether. An improvement of the blood flow by augmental local metabolites and an increased arterial influx presumably support the recovery and favour a concentration-dependent induction of microsomal enzymes in the central part of the lobule especially.

[Quantitative morphological investigation of the effect of ether anaesthesia on the kidney of the rat (author's transl)]

In the proximal and distal convoluted segments and the collecting tubule of the kidneys of 24 male albino rats, type Wistar TNO W 70 SPF, the nuclear volume was measured after the animals had been anaesthetized with ether for 15, 40 and 80 min. In contrast to nontreated controls there was a decrease in average nuclear size of 12.6% and 11.1% after 15 and 40 min in the proximal convoluted segment. Changes in nuclear size could not be detected in the distal convoluted segment and in the collecting tubules. While the decrease in the nuclear volume in the proximal convolution is considered to be a direct effect of ether, the enhanced reabsorption of sodium mentioned in other studies could be explained by an alpha-receptor mediated transport effect of the narcotic agent.

[Morphokinetic reactions in the adrenal gland of the albino rat after anaesthesia with inactin (author's transl)]

A marked decrease in the nuclear size in the adrenal medulla and a slight increase in the nuclear volume of the zona glomerulosa was found in the Inactin anaesthetized Wistar rat. The nuclear volumes in the zona fasciculata did not show any alteration. The influence on the activity of the cells in the adrenal medulla is supposed to be due to a depression in the central nervous system by Inactin. The slight activation of the zona glomerulosa is attributed to stimulation of the renin-angiotensine-system by an Inactin induced change in renal function. A failing dose dependent effect is taken as a sign of compatibility of the administered drug.

Comparative electron-microscopic studies on the conus papillaris and its relationship to the retina in night and day active geckos

The ultrastructure of the capillary endothelium of the conus papillaris within the vitreous body was studied in night, day, and mixed (night and day) active geckos (Homopholis wahlbergi, Gekko gecko, Pachydactylus bibronii, Tarentola mauritanica, Lygodactylus conraui, Phelsuma guimbeaui, Phelsuma madagascariensis). Capillary endothelial cells were poorly developed in night and mixed active animals, whereas in day active animals they were highly organized. In particular the number and height of the luminal and basal microvilli and the frequency of micropinocytotic vesicles were distinctly increased in day active geckos. It is assumed that these structural mechanisms improve the transendothelial transportation capacity of metabolic substances. When the thickness of the retinal layers was compared, we found that the inner retinal layers of those geckos in which the conus capillaries were poorly developed, were approximately 60% of the thickness of the inner retina in the day active geckos. The results indicate that the structural organization of conal endothelial cells is related primarily to the retinal structure rather than to the animals' daytime behavior. Furthermore, our observations support the theory that the conus papillaris of lizards, like the pecten oculi of birds, has a primary function in the nutrition of the avascular retina and/or is involved in the exchange of fluid in the vitreous.

Influence of intermittent long-term stimulation on contractile, histochemical and metabolic properties of fibre populations in fast and slow rabbit muscles

Slow (m.soleus) and fast (m.tibialis anterior) muscles of the rabbit were subjected to indirect long-term intermittent stimulation (3 weeks, 8 hrs daily) with a frequency pattern of 10 imp/sec. Whereas no changes were observed in case of the slow muscle, stimulation induced profound changes in the fast tibialis anterior muscle. These consisted in a rearrangement of the enzyme activity pattern of energy-supplying metabolism, e.g. decrease in glycogenolytic and glycolytic enzyme activities and severalfold increase in key enzymes of aerobic endoxidation of substrates in beta-oxidation and the citric acid cycle. Concomitant with the increase in aerobic oxidative capacity, there was an increased resistance to fatigue. Histochemical studies revealed a strong increase in mitochondria of all fibres. The bimodal distribution of fibre cross-sectional area in the normal tibialis anterior muscle was changed by stimulation into a more homogeneous population of fibres with a smaller cross-sectional area. Despite a 50% increase in time to peak of isometric twitch contraction no changes were observed in the fibre population with regard to myofibrillar ATPase reaction in quantitative evaluation of whole cross-sections of the muscles. The percentage of fibres histochemically classified as slow amounted to 2.8% and 3.1% in control and stimulated tibialis anterior muscle. Nevertheless the data suggest a transformation of the fibre population under the influence of long-term intermittent stimulation.