The purpose of this study is to evaluate MRI findings for the shoulder pain in hemiplegic stroke patients in relation to clinical characteristics. We studied 18 hemiplegic patients with first-ever stroke presenting with shoulder pain in the affected side (mean age±SD=67.6±10.1years ; 8 men and 10 women ; 12 right and 6 left hemiplegia). All patients had shoulder pain during passive movements and 4 also had pain at rest. The mean duration from stroke onset to MRI was 67±42 days. MRI revealed abnormal findings in all patients. Tendinosis of the long head of the biceps and supraspinatus tendon injuries were most frequently found. The tendinosis of the long head of the biceps was related to hemihypesthesia and a reduced range of motion for external rotation of the shoulder. The supraspinatus tendon injuries were related to older age and lower Fugl-Meyer (FM) and Functional Independence Measure (FIM) scores. The mean number of abnormal findings per patient was 3.2±1.4. The patients with more than 3 abnormal findings were significantly older, had shorter duration from stroke onset and lower FM and FIM scores than those with less findings. It was suggested that those patients with more severe paresis might have more abnormal findings on their MRIs for shoulder pain.

The frontal nerve is characterized by its great content of sympathetic nerve fibers in contrast to cutaneous branches of the maxillary and mandibular nerves. However, we needed to add information about composite fibers of cutaneous branches of the nasociliary nerve. Using cadaveric specimens from 20 donated cadavers (mean age, 85), we performed immunohistochemistry of tyrosine hydroxylase (TH), neuronal nitric oxide synthase (nNOS), and vasoactive intestinal polypeptide (VIP). The nasocilliary nerve contained abundant nNOS-positive fibers in contrast to few TH- and VIP-positive fibers. The short ciliary nerves also contained nNOS-positive fibers, but TH-positive fibers were more numerous than nNOS-positive ones. Parasympathetic innervation to the sweat gland is well known, but the original nerve course seemed not to be demonstrated yet. The present study may be the first report on a skin nerve containing abundant nNOS-positive fibers. The unique parasympathetic contents in the nasocilliary nerve seemed to supply the forehead sweat glands as well as glands in the eyelid and nasal epithelium.
Cadaver ; Eyelids ; Forehead ; Humans* ; Immunohistochemistry ; Mandibular Nerve ; Nasal Mucosa ; Nerve Fibers ; Nitric Oxide Synthase Type I ; Skin ; Sweat Glands ; Tyrosine 3-Monooxygenase ; Vasoactive Intestinal Peptide

We examined morphological differences between the sublingual and submandibular glands with special reference to their innervation. The sublingual gland contained abundant periodic acid Schiff-positive mucous acini: some lobules were composed of purely mucous acini, while others were purely serous or mixed. However, in the submandibular gland, the area of mucous acini was very limited. Notably, in the sublingual gland, immunohistochemistry for neuron-specific enolase demonstrated that the serous acini carried a higher density of nerve elements than the mucous acini. However, no such difference was evident in the submandibular gland, possibly due to the small areas of the mucous acini. In both types of gland, neuronal nitric oxide synthase-positive parasympathetic nerves as well as tyrosine hydroxylase-positive sympathetic nerves were observed in the interlobular tissue, but we were unable to trace these thin fibers to the acini. Myoepithelial cells expressed smooth muscle actin, but were negative for S100B protein, glial fibrillary acidic protein and neuron-specific enolase. However, antibody against S100A stained some of the myoepithelial cells and ductal cells in the sublingual gland. Cells positive for peripheral myelin protein 22 were seen in some of the ductal cells in the submandibular gland, but not in the sublingual gland. Therefore, with regard to the neurogenic features of the gland cells, S100B reactivity might disappear first in postnatal life, whereas S100A reactivity is likely to remain as aging progresses. The sublingual gland in elderly individuals seems to provide a good model for comparison of the nerve supply between mucous and serous acini.
Actins ; Aged* ; Aging ; Cadaver* ; Glial Fibrillary Acidic Protein ; Humans ; Immunohistochemistry ; Muscle, Smooth ; Myelin Sheath ; Neurons ; Nitric Oxide ; Periodic Acid ; Phosphopyruvate Hydratase ; Sublingual Gland* ; Submandibular Gland ; Tyrosine

The mediobasal segment (S7) of the right lung has been considered to correspond to the cardiac lobe generally seen in mammals. To investigate fetal development of the right mediobasal segmental bronchus (B7), we examined paraffin-embedded serial sections of 15 embrynic and fetal lungs at 7-8 weeks (serial sections) as well as semiserial sections of 8 fetuses at 15-18 weeks (semiserial sections). All of the smaller specimens did not contain B7, but 2 of the 8 larger specimens carried B7: one was found in the immediately anterior side of the inferior pulmonary vein, while in the other, the subdivisions (B7a, B7b) were overriding the vein. Although the incidence might be underestimated because of observations using semiserial sections, the B7 was most likely to develop secondarily during a period from 8 to 15 weeks. Fetal topographical changes (mainly, the descent) of the middle lobe and the inferior pulmonary vein might relate with the secondarily budding of B7. The present result does not reduce a clinical relevance of B7 as a segmental bronchus of the lung segment system.
Bronchi ; Fetal Development* ; Fetus ; Incidence ; Lung* ; Mammals ; Pulmonary Veins ; Veins

Macrophages play an important role in aging-related muscle atrophy (i.e., sarcopenia). We examined macrophage density in six striated muscles (cricopharyngeus muscle, posterior cricoarytenoideus muscle, genioglossus muscle, masseter muscle, infraspinatus muscle, and external anal sphincter). We examined 14 donated male cadavers and utilized CD68 immunohistochemistry to clarify macrophage density in muscles. The numbers of macrophages per striated muscle fiber in the larynx and pharynx (0.34 and 0.31) were 5–6 times greater than those in the tongue, shoulder, and anus (0.05–0.07) with high statistical significance. Thick muscle fibers over 80 µm in diameter were seen in the pharynx, larynx, and anal sphincter of two limited specimens. Conversely, in the other sites or specimens, muscle fibers were thinner than 50 µm. We did not find any multinuclear muscle cells suggestive of regeneration. At the beginning of the study, we suspected that mucosal macrophages might have invaded into the muscle layer of the larynx and pharynx, but we found no evidence of inflammation in the mucosa. Likewise, the internal anal sphincter (a smooth muscle layer near the mucosa) usually contained fewer macrophages than the external sphincter. The present result suggest that, in elderly men, thinning and death of striated muscle fibers occur more frequently in the larynx and pharynx than in other parts of the body.
Aged* ; Anal Canal ; Cadaver* ; Deglutition ; Deglutition Disorders ; Humans ; Humans* ; Immunohistochemistry ; Inflammation ; Laryngeal Muscles* ; Larynx ; Macrophages* ; Male ; Masseter Muscle ; Mucous Membrane ; Muscle Cells ; Muscle, Smooth ; Muscle, Striated* ; Muscles ; Muscular Atrophy ; Pharynx ; Regeneration ; Sarcopenia ; Shoulder ; Tongue

To provide a better understanding of the local immune system in the face and external genitalia, i.e., the oral floor, lower lip, palpebral conjunctiva, anus and penis, we examined the distribution and density of CD1a-positve Langerhans cells, CD8-positive suppressor T lymphocytes and CD68-positive macrophages using specimens from 8 male elderly cadavers. The density of Langerhans cells showed an individual difference of more than (or almost) 10-fold in the lip (oral floor). In the oral floor, Langerhans cells were often spherical. Submucosal or subcutaneous suppressor lymphocytes, especially rich in the oral floor and penile skin, migrated into the epithelium at 4 sites, except for the anus. In the conjunctiva, macrophage migration into the epithelium was seen in all 8 specimens. The density of suppressor lymphocytes showed a significant correlation between the oral floor and the lip (r=0.78). In contrast, the anal and penile skins showed no positive correlation in the density of all three types of immunoreactive cells examined. Overall, irrespective of the wide individual differences, the oral floor and conjunctiva seemed to be characterized by a rich content of all three cell types, whereas the penile skin was characterized by an abundance of suppressor lymphocytes. Based on the tables, as mean value, the relative abundance of three different cell types were as follows; CD1a-positive Langerhans cells (anus), CD8-positive lymphocytes (penis), and CD68-positive macrophages (lip). The present observations suggest that the local immune response is highly site-dependent, with a tendency for tolerance rather than rejection.
Aged* ; Anal Canal ; Cadaver* ; CD8-Positive T-Lymphocytes ; Conjunctiva ; Epithelium ; Genitalia ; Humans ; Immune System ; Individuality ; Langerhans Cells* ; Lip ; Lymphocytes ; Macrophages* ; Male ; Penis ; Skin ; T-Lymphocytes*

It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively.We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30–40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint.The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants’ movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.

Adult ; Aging ; Atlanto-Axial Joint ; Fetus ; Humans ; Infant, Newborn ; Joints ; Zygapophyseal Joint

Human fetal cervical vertebrae are characterized by the large zygapophysial joint (ZJ) extending posteriorly. During our recent studies on regional differences in the shape, extent, and surrounding tissue of the fetal ZJ, we incidentally found a cervical-specific structure of synovial tissues. This study aimed to provide a detailed evaluation of the synovial structure using sagittal and horizontal sections of 20 near-term fetuses. The cervical ZJ consistently had a large cavity with multiple recesses at the margins and, especially at the anterior end, the recess interdigitated with or were located close to tree-like tributaries of the veins of the external vertebral plexus. In contrast to the flat and thin synovial cell lining of the recess, the venous tributary had cuboidal endothelial cells. No or few elastic fibers were identified around the ZJ. The venous-synovial complex seems to be a transient morphology at and around birth, and it may play a role in the stabilization of the growing cervical ZJ against frequent spontaneous dislocation reported radiologically in infants. The venous-synovial complex in the cervical region should be lost and replaced by elastic fibers in childhood or adolescence. However, the delayed development of the ligament flavum is also likely to occur in the lumbar ZJ in spite of no evidence of a transient venous-synovial structure. The cuboidal venous endothelium may simply represent the high proliferation rate for the growing complex.

The yolk sac is supplied by the vitelline artery and vein (VA, VV), which run through the yolk stalk in combination with the omphaloenteric duct. Moreover, the VV takes a free posterior course outside the midgut mesentery containing the secondarily-developed superior mesenteric vein (SMV). However, the regression process of these structures has not been demonstrated photographically. The present study evaluated serial histological sections from 20 embryos of stages 15–19 or crown-rump length (CRL) 7.5–20 mm. All specimens carried the SMV as sequential tissue slits. However, an omphaloenteric duct with epithelia continuous with the midgut loop was not observed. In smaller embryos (CRL <13 mm) the VA extended distally or anteriorly from the midgut apex in the extra-embryonic coelom, whereas in larger embryos (CRL 16–20 mm) the artery was absent from the distal side of the apex. The entire course or part of the VV outside the mesentery was always seen, but four larger embryos lacked the venous terminal near the duodenum. A vacuole-like remnant of the yolk sac was present in all smaller embryos (CRL <10 mm), but was absent from 7 of the 11 larger embryos. The size of the remnant was equal to the thickness of the VA or VV, with the remnant being sandwiched between the VA and VV. Moreover, the regressing yolk sac often communicated with or opened to the VV. Consequently, the yolk sac regressed first, followed by the regression of the VA until 6 weeks. The yolk stalk was clearly observed until 5 weeks.