Morphological, histochemical, and interstitial pressure changes in the tibialis anterior muscle before and after aortofemoral bypass in patients with peripheral arterial occlusive disease

BACKGROUND: Morphological and electrophysiological studies of ischemic muscles in peripheral arterial disease disclosed evidence of denervation and fibre atrophy. The purpose of the present study is to describe morphological changes in ischemic muscles before and after reperfusion surgery in patients with peripheral occlusive arterial disease, and to provide an insight into the effect of reperfusion on the histochemistry of the reperfused muscle. METHODS: Muscle biopsies were obtained from the tibialis anterior of 9 patients with chronic peripheral arterial occlusive disease of the lower extremities, before and after aortofemoral bypass, in order to evaluate the extent and type of muscle fibre changes during ischemia and after revascularization. Fibre type content and muscle fibre areas were quantified using standard histological and histochemical methods and morphometric analysis. Each patient underwent concentric needle electromyography, nerve conduction velocity studies, and interstitial pressure measurements. RESULTS: Preoperatively all patients showed muscle fibre atrophy of both types, type II fibre area being more affected. The mean fibre cross sectional area of type I was 3,745 μm(2) and of type II 4,654 μm(2) . Fibre-type grouping, great variation in fibre size and angular fibres were indicative of chronic dennervation-reinnervation, in the absence of any clinical evidence of a neuropathic process. Seven days after the reperfusion the areas of both fibre types were even more reduced, being 3,086 μm(2) for type I and 4,009 μm(2) for type II, the proportion of type I fibres, and the interstitial pressure of tibialis anterior were increased. CONCLUSIONS: The findings suggest that chronic ischemia of the leg muscles causes compensatory histochemical changes in muscle fibres resulting from muscle hypoxia, and chronic dennervation-reinnervation changes, resulting possibly from ischemic neuropathy. Reperfusion seems to bring the oxidative capacity of the previously ischemic muscle closer to normal

Acute cholecystitis - Predictors of severity

Our purpose was to determine factors influencing the severity of acute cholecystitis, and to assess their prognostic significance. During the period 1995-2003, we operated urgently on 149 patients with the disease. The following parameters were prospectively recorded; Age, sex, presence of diabetes mellitus, blood white cell count, serum amylase and alkaline phosphatase levels at diagnosis, as well as radiological findings of peri-cholecystic fluid collection and presence of gas in the gallbladder wall. Operative records and histology findings were also included in the examined data. Histological diagnosis of gangrenous cholecystitis was established in 40 (26.8%) patients, with gallbladder perforation present in seven (17.5%) of them at laparotomy, and hepatic abscess development in one. Peri-cholecystic collection was present in 44(29.5%) patients. Analysis of our findings suggests that diabetes, a white cell count more than 15000/ml at diagnosis, and presence of peri-cholecystic fluid collection, could be useful prognostics of gangrenous cholecystitis