Site-dependent differences in density of sympathetic nerve fibers in muscle-innervating nerves of the human head and neck

The autonomic nerve supply of skeletal muscle has become a focus of interest because it is closely related to the adaptation of energy metabolism with aging. We have performed an immunohistochemistry study on tyrosine hydroxylase (TH) and neuronal nitric oxide synthase (nNOS) using specimens obtained from ten selected elderly cadavers (mean age 83.3 years) in which we examined muscle-innervating nerves (abbreviated “muscle-nerves” hereafter) of ten striated muscles (soleus, infraspinatus, extra-ocular inferior rectus, lateral rectus, superior obliquus, temporalis, orbicularis oculi, posterior cricoarytenoideus, trapezius and genioglossus) and, as a positive control, the submandibular ganglion. We found that the extra-ocular muscles received no or very few TH-positive nerve fibers. Muscle-nerves to the other head and neck muscles contained a few or several TH-positive fibers per section, but their density (proportional area of TH-positive fibers per nerve cross-section) was one-half to one-third of that in nerves to the soleus or infraspinatus. We did not find nNOS-positive fibers in any of these muscle-nerves. In the head and neck muscles, with the exception of those of the tongue, there appeared to be very few TH-positive nerve fibers along the feeding artery. Consequently, the head and neck muscles seemed to receive much fewer sympathetic nerves than limb muscles. There was no evidence that nNOS-positive nerves contributed to vasodilation of feeding arteries in striated muscles. This site-dependent difference in sympathetic innervation would reflect its commitment to muscle activity. However, we did not find any rules determining the density of nerves according to muscle fiber type and the mode of muscle activity.     

Suprahyoid neck fascial configuration,especially in the posterior compartment of the parapharyngeal space: A histological study using late‐stage human fetuses

The fascial configuration in the suprahyoid parapharyngeal space was evaluated using semiserial sagittal sections of 15 late‐stage human fetal heads. The prevertebral fascia covered the longus colli, longus capitis, and rectus capitis lateralis muscles, but was most evident along the longus colli muscle. The carotid sheath and its extension were located around the internal and external carotid arteries and the lower cranial nerves. The superior cervical ganglion was also inside the sheath. Even near full term, the fetal suprahyoid neck was short, with the jugular foramen and hypoglossal canal located at the posterolateral side of the oropharynx. Thus, the glossopharyngeal and accessory nerves ran across the upper part of the carotid sheath. Fasciae of the stylopharyngeus, styloglossus, and stylohyoideus muscles were attached to and joined the anterosuperior aspect of the carotid sheath. All these neurovascular and muscle sheaths are communicated with the visceral fascia covering the pharynx at multiple sites, and, together, they formed a mesentery‐like bundle. This communication bundle was made narrow by the anteriorly protruding longus capitis muscle. The mesentery‐like bundle was covered by the posterior marginal fascia of the prestyloid compartment of the parapharyngeal space. The external carotid artery ran on the lateral and posterior sides of the posterior marginal fascia. Consequently, the typical carotid sheath configuration was modified by muscle sheaths from the styloid process, communicated with the visceral fascia and, anteriorly, constituted the posterior margin of the prestyloid space. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

An atypical autopsy case of Lewy Body disease with clinically diagnosed major depression: A clinical,radiological and pathological study

We report an 84‐year‐old woman who was clinically diagnosed with late‐life major depression (LLMD) and having a diffuse type of dementia with Lewy bodies (DLB) neuropathologically. Clinically, this case showed depressive mood, anxiety, and irritation, but did not show cognitive dysfunction, visual hallucination, fluctuation of alertness and parkinsonism, which define the criteria for diagnosing DLB. Neuropathological examination demonstrated abundant Lewy‐related pathology including Lewy bodies and neurites in the hippocampal region and the cerebral cortex, and moderate levels in brain stem nuclei including the substantia nigra, locus ceruleus and dorsal raphe nucleus. These findings suggest the possibility that Lewy‐related pathology is associated with the depressive symptoms. Furthermore, it must be noted that some patients diagnosed with LLMD clinically may develop pathology of DLB without the typical or usual clinical symptoms.     

Immunohistochemical localization of amyloid β-protein with amino-terminal aspartate in the cerebral cortex of patients with Alzheimer's disease

We investigated immunohistochemically the localization of amyloid β-protein (Aβ) with amino-terminal aspartate (N1[D]) in brains of patients with Alzheimer's disease, diffuse Lewy body disease and Down's syndrome. A monoclonal antibody, 4G8, which recognizes the middle portion of Aβ, was used as a reference antibody to label the total Aβ deposits. Double staining with anti-Aβ(N1[D]) and 4G8 revealed that Aβ deposits in the subiculum and the neocortical deep layers often lacked N1[D] immunoreactivity, indicating N-terminal truncation of Aβ in these deposits. Aβ deposits in the neocortical superficial layers and the presubicular parvopyramidal layer always contained Aβ with N1[D]. Such regional as well as laminar differences in the distribution of Aβ beginning at N1[D] suggest that some local factors influence N-terminal processing of Aβ deposited in the brain.     

Surgical treatments for a case of superior canal dehiscence syndrome associated with patulous Eustachian tube

ObjectivesThe patulous Eustachian tube (PET) and superior semicircular canal dehiscence syndrome (SCDS) have similarity in their symptoms and similar effects caused by positional changes, causing difficulty in the differentiation between the two disorders. This report describes a case of both SCDS and PET that was eventually successfully treated.MethodsA 68-year-old man presented with hyperacusis to his own footsteps and gait disturbance. He had been diagnosed as PET two years before and had been treated by insertion of a silicone plug (Kobayashi plug) at the other hospital. Clinical case records, audiological data, cervical vestibular-evoked myogenic potential (cVEMP), Eustachian tube function tests and computed tomography (CT) were taken in the sitting position.ResultsWhile the CT confirmed superior semicircular canal dehiscence, the results of cVEMP was not typical of SCD likely due to preexisting hearing impairment in the right ear with a history of middle ear surgeries for the treatment of PET. He received round window reinforcement (RWR) and achieved relief from his symptoms but six months after the surgery, he visited again with complaints of autophony of his own voice and breathing. The tympanic membrane was found to move synchronous with respiration, and Eustachian tube function tests and the sitting CT confirmed the recurrence of severe PET. He had his silicone plug exchanged (increase in size of the Kobayashi plug) and achieved relief from symptoms.ConclusionsThe present case was a rare instance showing that PET and SCDS can occur simultaneously in a patient. The patient achieved relief from symptoms after treatment with RWR and insertion of the Kobayashi plug.     

Effectiveness of Kobayashi plug for 252 ears with chronic patulous Eustachian tube

Conclusions: Trans-tympanic plugging of the Eustachian tube (ET) with the silicone plug (Kobayashi Plug) induced long-term effectiveness for over 80% of chronic and severe patulous ET (PET) patients. The New Kobayashi Plug was more effective with fewer complication of plug descent to the pharyngeal orifice.

Objective: To investigate the effectiveness and complications of trans-tympanic plugging of the ET using a Kobayashi Plug for chronic PET.

Method: Trans-tympanic plugging of the ET using the Kobayashi Plug was performed for 252 ears of 191 patients. The Prototype Plug (115 ears of 82 patients in 2001–2007) and the New Plug (137 ears of 109 patients in 2008–2013) were inserted for chronic PET patients.

Results: The success rate of the Kobayashi Plug for PET was 83.0% of a total (Prototype Plug 80.0%, New Plug 85.4%). In 26 ears, the Prototype Plugs were found to have descended toward the nasopharynx. Conversely, this did not happen with the New Plug. The rate of TM perforation (Prototype 22.6%, New 17.5%), middle ear effusion (Prototype 20.2%, New 10.2%) and ventilation tube placement (Prototype 14.8%, New 4.4%) decreased after transition to the New Plug.     

Feasibility of catheter ablation renal denervation in “mild” resistant hypertension

Renal denervation (RDN) has been proposed as a novel interventional antihypertensive technique. However, existing evidence was mainly from patients with severe resistant hypertension. The authors aimed to evaluate the efficacy of RDN in patients with resistant hypertension with mildly elevated blood pressure (BP). Studies of RDN in patients with mild resistant hypertension (systolic office BP 140–160 mm Hg despite treatment with three antihypertensive drugs including one diuretic, or mean systolic BP by 24‐hour ambulatory BP measurement [ABPM] 135–150 mm Hg) were included. Two observational and one randomized cohort were identified (109 patients in the RDN group and 36 patients in the control group). Overall, the mean age of patients was 62±10 years, and 69.7% were male. Before‐after comparison showed that RDN significantly reduced ABPM as compared with the baseline systolic ABPM, from 146.3±13 mm Hg at baseline to 134.6±14.7 mm Hg at 6‐month follow‐up and diastolic ABPM from 80.8±9.4 mm Hg at baseline to 75.5±9.8 mm Hg at 6‐month follow up (both P<.001). This significant effect was not observed in the control group. Between‐group comparison showed a greater change in ABPM in the RDN group as compared with that in the control group (change in systolic ABPM: −11.7±9.9 mm Hg in RDN vs −3.5±9.6 mm Hg in controls [P<.001]; change in diastolic ABPM: −5.3±6.3 mm Hg in RDN vs −2.1±5.5 mm Hg in control [P=.007]). RDN was also associated with a significantly decreased office systolic/diastolic BP and reduced number of antihypertensive medications. No severe adverse events were found during follow‐up. RDN seems feasible to treat patients with mild resistant hypertension.     

Accumulation of phosphorylated TDP-43 in brains of patients with argyrophilic grain disease

To determine whether TAR-DNA binding protein 43 (TDP-43) immunoreactivity was present in brains of argyrophilic grain disease (AGD), we immunohistochemically examined 15 cases of AGD (mean age at death: 84 years) using a panel of anti-TDP-43 antibodies, including both phosphorylation-independent and -dependent ones. Nine AGD cases (60%) showed TDP-43 immunoreactivities mainly in the limbic regions and lateral occipitotemporal cortex. TDP-43 positive structures included neuronal cytoplasmic inclusions, dystrophic neurites, glial cytoplasmic inclusions, grain-like dot-shaped structures, and neurofibrillary tangle (NFT)-like structures. The distribution of these TDP-43 positive structures was largely consistent with that of argyrophilic grains. Double-labeling confocal microscopy revealed, however, that many of phospho-TDP-43 positive structures were not colocalized with phospho-tau staining. Colocalization of phospho-TDP-43 and phospho-tau was observed only in part of neuronal cytoplasmic inclusions, grain-like structures and NFT-like structures. There were no differences in demographics, disease duration, brain weight, NFT Braak stage, or severity of amyloid burden between AGD cases with and without TDP-43-immunoreactivity. However, cases of AGD with TDP-43-immunoreactivity were assigned to higher AGD stages than those without TDP-43-immunoreactivity (P < 0.05). Furthermore, the TDP-43 pathology tended to be prominent in cases with severe grain pathology. The results of the present study indicate for the first time a high frequency of concomitant TDP-43 pathology in AGD, and suggest that abnormal accumulation of TDP-43 may be involved in the pathological process and disease progression of AGD.     

Clinicopathological study of early progressive multifocal leukoencephalopathy incidentally found in a schizophrenia patient

A 58‐year‐old Japanese man developed psychomotor excitement and hallucinatory paranoia at age 53, which gradually developed to residual schizophrenia. He was administered various common tranquilizers until death. Myelodysplastic syndrome was noted 10 months before death. A routine autopsy was performed. The brain weighed 1365 g, and macroscopic observation revealed no remarkable findings. However, microscopic examination disclosed cells with enlarged and basophilic nuclei, and unusual astrocytes in the demyelinated foci, especially at the corticomedullary junctions in the temporal and occipital lobes. On the other hand, the white matter was relatively intact. Immunohistochemical analysis using anti‐JC virus protein, VP‐1 antibody, demonstrated JC virus‐infected cells in not only abnormal glial cells and neurons but also normal‐looking cells, which are suggestive of progressive multifocal leukoencephalopathy (PML). Immunostaining for GFAP revealed severe gliosis and some scattered abnormal enlarged nuclear cells in the lesions. Some clusters of CD8‐positive lymphocytes were seen, which kill infected cells. PML could be considered a short‐term disease preceding death, as “incidental PML” in this case. This is a rare autopsy case of early PML occurring in a schizophrenia patient with PML.