The ultrastructure of thè v. colica sinistra in a case of generalized vasomegaìy
in man was examined. Elastic material was found in three forms: as a lightly osmiophii
amorphous material bordering on myocytes, as a highly osmiophii elastic membrana,
and as highly osmiophii slim elastic fibres of different orientation in thè tunica media
and adventitia. The slightly osmiophii elastic material is assumed to be newly formed.
by pinocytotic activity of thè myocytes. The highly osmiophii elastic material indicatss
its impairment. No typical atherosclerotic changes were found in thè examined vein.
Based on a comparison with previous findings in thè case of vasomegaìy of thè
a. mesenterica inferior, thè authors conclude that thè venomegaly phenomenon is connected
with degenerative changes in thè elastic material of thè vessel wall

BARTOLO M

CAVALLOTTI C

D'ANDREA, Vito

DI MATTEO G.

MALINOVSKA V

MALINOVSKY L

TODINI A

English

The ultrastructure of thè v. colica sinistra in a case of generalized vasomegaìy
in man was examined. Elastic material was found in three forms: as a lightly osmiophii
amorphous material bordering on myocytes, as a highly osmiophii elastic membrana,
and as highly osmiophii slim elastic fibres of different orientation in thè tunica media
and adventitia. The slightly osmiophii elastic material is assumed to be newly formed.
by pinocytotic activity of thè myocytes. The highly osmiophii elastic material indicatss
its impairment. No typical atherosclerotic changes were found in thè examined vein.
Based on a comparison with previous findings in thè case of vasomegaìy of thè
a. mesenterica inferior, thè authors conclude that thè venomegaly phenomenon is connected
with degenerative changes in thè elastic material of thè vessel wall

Archivio della ricerca- Università di Roma La Sapienza

COR V A S A 34 (3) : 265—272, 1992VENO.US WALL ULTRASTRUCTUREIN GENERALIZED VENOMEGALYV . D ' A N D R E A , L . M A L I N O V S K Y , C . C A V A L L O T T I 1 , M . B A R T O L O ,A. T O D I M I2, V. M A L I M O V S K A3 A N D G. D I M A T T E O4Department of Cardiovascular and Respiratory Sciences, ,,La Sapienza" University1 ,Department of Angiology, S. Cantillo General Hospital2, Rome, Italy, 3rd Clinic of In-ternai Medicine, University, Brno, Czechoslovakia3, 3rd Surgical Clinic, ,,La Sapienza"University, Rome, Italy4S U M M A R YD ' A n d r e a, V., M a 1 i n o v s k y, L.. C a v a 1 1 o t t i, C.,1 B a r t o 1 o. M., T o d i n i,A.,2 M a 1 i n o v s k a, V.,3 D i M a t t e o. G.1 (Depar t . Cardiovasc. Resp. Scii. UnivarsHy 1 ,Rome, I t a ly ; Dept. Angiol. S. Camillo Hosp.2, Rome, I ta ly; 3rd Int. Clin. Univ. Brno. Cze-chosiovakia3, 3rd Sug. Clin. Univ. Rome, Italy'1 ) : Venous wall ultrastructure in géneralizedvenomegahj. Cor Vasa 34 (3j: 265—272, 1922.'iThe ul trastructure of thè v. colica sinistra in a case of generalized vasomegaìyin man was examined. Elastic material was found in three forms: as a lightly osmiophiiamorphous material bordering on myocytes, as a highly osmiophii elastic membrana,and as highly osmiophii slim elastic fibres of different orientation in thè tunica mediaand adventitia. The slightly osmiophii elastic material is assumed to be newly formed.by pinocytotic activity of thè myocytes. The highly osmiophii elastic material indicatssits impairment. No typical atherosclerotic changes were found in thè examined vein.Based on a comparison with previous findings in thè case of vasomegaìy of thèa. mesenterica inferior, thè authors conclude that thè venomegaly phenomenon is con-nected with degenerative changes in thè elastic material of thè vessel wall.Key words: Venomegaly — Ultrastructure — Elastic materialDr. V. D'Andrea, Department of Cardiouascular and Respiration Sciences, ,,La Sa-pienza" University, Via A. Barelli, 50, 00161 Rome, ItalyI N T R O D U C T I O N« Arteriomegaly was described for thè first time in two patients by Lerichein 1942 and 1943 (see 18). This interesting clinical entity was later givenattention by other investigators but only from thè clinical aspect (I, 4—6, 9,10—12, 18—20).265D'Andrea, V. et al.: Venous u l t r a s t r u c t u r e in venomegalyThis phenomenon has been shown to appear already in children (2, 8) . 'It was indicated that thè basic defect is probably due to a congenita! abnor-mality of thè elastic tissue in arteries. In our previous publication (14) weshowed a morphological picture of elastic material characterized by its highosmiophilia typical of degenerative changes in an elastic material (7 ) . It wasshown, at thè same time, that arteriomegaly substantially differs from athero^sclerosis. Typical atherosclerotic changes were found neither in thè tunicaintima nor in thè tunica media. As a result, it can be reasonably concludedthat arteriomegaly is not caused by atherosclerotic lesions (14].Venomegaly has not been described in thè literature to date. This is prob-ably due to thè f a c t it does not occur very frequently as well as to thè diffi- ;culties connected wi th obtaining human tissue for an electron microscopieexaminat ion.M A T E R I A L A N D M E T H O D SA 75-year-oìd maie patient was treated al thè Department of Angiology of S. Ca-millo General Hospital in Rome with claudication on thè left side. Obliteration of thè1a. iliaca communis sinistra of thè relevant side was found and an aneurysm of thèaorta abdominalis was detected on follow-up. The patient was later operated on. Duringthè operation, generalized vasomegaly was found.The tissue for an electron microscopie examination was recovered from thè v. colicasinistra during thè operation. Fixation was performed by immersing small tissue blocksin 2.5 % glutaraldehyde in 0.05 M cacodylate buf fe r (pH 7.2) for 2 hours and post-fixedin 2 % osmium tetroxidre in thè same cacodylate buffer. The material was then dehyd-rated with acetone. Af ter embedding it in EPON, thè material was cut using an LKjBultratome. Semithìn sections were stained with toluidine blue and examined in a lightjmicroscope. Ultrathin sections were contrasted using standard technique by urahylace-tate and lead cirrate (3,7). No specific contrasting methods for elastic tissue were used.The ultrathin sections were examined and photographed by a Tesla BS 500 electronmicroscope.R E S U L T S1. T u n i c a i n t i m a (Fig. 1 )The tunica intima consists in thè group of medium-sized veins of onlya single layer of endothelial cells. The layer was damaged while preparingthè material. A relatively thick elastic membrane with irregular side thickeningwas found in thè piace of thè membrana elastica interna. This membrane is wellvisible in thè semithin as well as in thè ultrathin sections; it is disruptedat several sites. A remarkable feature of thè membrane is its very high osmio-philia: both thè amorphous elastin and thè elastic microfibrils are highlyosmiophil. Its thickness is about 1.7266D'Andrea, V. et al.: Venous u l t r a s t r u c t u r e in venomegalye mFig. 1. A cross section through thè vvall of thè v. colica sinistra. A highly osmiophilmembrana elastica occurs in thè site of thè membrana elastica interna, cf — col la-microf 'br i l s , e m - - e l a s t l c membrane, ,my — myccyts . - — l i g h t e ' a s t i c ma-terial. X 6,500.Fig. 2. The tunica media of thè v. colica sinistra. A cross section. cf — collagenoasmicrofibrils, ef — elastic fibers. X 19,500.267-^mmD'Andrea , V. et al.: Venous u l t ras t ruc ture in venomegaly2. T u n i c a m e d i a (Figs. 2, 3, 4)The myocytes of thè tunica media, in this group of veins limited in num- |ber. are oriented in parallel to thè cross section of thè vein. Among thè myo- icytes, there are relatively wide spaces filled with collagenous microfibrils and 'elastic materia!. The myocyte plasma is electron light with no major morpho-logicai changes. The myocytes exhibit only low pinocytotic activity. In someplaces thè surface of thè myocytes borders on layers of thè amorphous lightelastic material.In thè spaces among thè myocytes there are mumerous collagenous micro-fibrils. We found them mostly in cross or oblique sections, an indication they ;are arranged in parallel to thè course of thè vein. These collagenous micro--1f ibr i ls are about 28 nm thick. They are intermingled with highly osmiophil thin :elastic fibres running in parallel or transversely to myocytes. The thickness • iof these fibres is about 0.13 . T u n i c a a d v e h t i t i a (Fig. 4 )The tunica adventitia in veins is very thick. The myocytes in this layer areiiarranged in parallel to thè course of thè vein: so they are found cross sectioned.Again, thè cytoplasma of myocytes is free of any signs of atherosclerotic lesions |and shows no signs of degeneration. There is no marked pinocytotic activity. :Among thè myocytes there are numerous collagenous microfibrils and highly !osmiophil elastic material in thè form of thin fibres of different orientation.Another lightly osmiophil amorphous elastic material is located in thè vicinityof myocytes.As to our findings", thè elastic material occurs in thè studied v. colica si- • ;•nistra in three forms: i1. As a slightly osmiophil amorphous material bordering on myocytes in thè itunica media and adventitia. ? i2. In thè piace of thè membrana elastica interna there occurs a thick highlyosmiophil elastic membrane with well visible elastic microfibrils.3. Highly osmiophil elastic slim fibres are present among thè myocytes of thètunica media and tunica adventitia; these fibres are of different orientation.D I S C U S S I O NTo date, venomegaìy has not been described in thè literature making itimpossible to compare our results with other data. Attention was paid only.to arteriomegaly which could be connected with a presumed high pressurein arteries and with its mechanical influence. In experiments it was indeed,as a rule, a high mechanical pressure which led to thè disruption of elasticmembranes [see, e.g. Meyer and Henschel [15] — experimentally achievedarterial tortuosity]. Nystrom (16) found, in thè cases of intracranial aneurysms,268ÉSMÉD'Andrea, V. et al.: Venous ultrastructure in venomegalyFig. 3. The tunica media of thè v. colica sinistra. A cross section. cf — collagenousmicrofibrils, ef — elastic fibers, my — myocyte. X 27,000.*Fig. 4. Transition of thè tunica media and adventi t ia . A cross section th rough thè v. co-lica sinistra wall , cf — collagenous m i c r o f i b r i l s , ef — o l ; : s t i c f i be r s . X 35,000.D'Andrea, V. et al.: Venous ultrastructure in venomegalya highly osmiophil membrana elastica interna and an amorphous electron denseelastic material in thè vicinity of thè rupture. The occurrence of arteriomegalyin chìldren suggests a congenital abnormality of thè elastic tissue in arteriesin these cases (2, 8). Ali these findings indicate that in cases of vasomegalyattention should also focus on thè structure of veins. iA distinct feature of thè examined patient was his generalized vasomegaly.As to thè v. colica sinistra wall we can compare our findings only with thoseof arteriomegaly of thè a. mesenterica inferior described in our previous paper(18). On thè whole thè findings in both vessels of thè same case are verysimilar. The elastic material occurs in thè forni of highly osmiophil elasticfibres (membranes). Besides, slightly osmiophil elastic material, produced bythè pinocytotic vesicles of myocytes was found, bordering on myocytes or lying (among them. This pinocytotic activity is much greater in thè a. mesenterica jinferior myocytes. The light amorphous elastic material probably representsnewly formed elastin. The high osmiophilia of elastic fibres among myocytesindicates degeneration (elastic material degradation — 3, 7, 21). The differenceas to thè membrana elastica interna in thè a. mesenterica inferior and v. colicasinistra is at present not possible to explain. Examination of ,a greater numberof vessels in cases of vasomegaly will be necessary.Similarly as in thè case of arteriomegaly described (18) no typical changesreported in atherosclerosis were found in thè examined v. colica sinistra (forcomparison see, e.g., 14). Atherosclerosis is therefore not a cause of vaso-megaly.Based on thè described ultrastructural examination of thè v. colica sinistra" iwall and comparison with thè findings in arteriomegaly of thè a. mesenterica iinferior we can conclude that in thè case of venomegaly, similar changes !of elastic material were found characterized by its high osmiophilia. We cantherefore assume that pathologic changes in elastic material may be one of thècauses of vasodilatation.Z U S A M M E N F A S S U N G : Bei einem Kranken mit generalisiertsr Vasomegaliewurde die Wandultrastruktur der V. colica sinistra untersucht. Das elastische Materialtrat in dreifacher Form vor: als leicht osmiophiles amorfes Material am Myozytenrand,als stark osmiophile elastische Membrane, und als stark osmiophile schmale elastischeFasern, verschiedentlich angeordnet in der Tunica media und Adventitia. Ober demschwach osmiophilen elastlschen Material nimrnt man an, dass es durch die pinozyto-tische Aktivitat neuformiert wird. Das stark osmiophile elastische Material deutet eineStOrung der pinozytotischen Aktivitat an. In der untersuchten Vene wurden keìnetypischen atherosklerotischen VerSnderungen gefunden. Nach Vergleich mit dem Befundeiner Vasomegalie der A. mesenterica inferior bei demselben Patienten kommen dieAutoren zum Schluss, dass die Venomegalie mit degenerativen VerSnderungen deselastischen Materials in der Gefasswand zusammenhangt.270D'Andrea, V. et al.: Venous ultrastructure in venomegalyR É S U M É : Chez un malade avec vasomégalie généraiisée, on a examiné l'ultra-structure de la paro! de v. colica sinistra. Le matériau élastique était présent sous troisformes: corame matériau légèrement osmiophile au bord des myocytes, 'corame mem-brane élastique hautement osmiophile et comme minces fibres élastiques hautementosmiophiles, d'arrangement divers dans la tunica media et adventitia. Quant au ma-tériau faiblement osmiophile, on est d'avis qu'il est nouvellement forme par l'activitépinocytotique des myocytes. Le matériau élastique hautement osmiophile témoigne d'uneperturbation de l'activité pinocytotique. Dans la veine examinée n'ont pas été constatésdes changements athérosclérotiques typiques. S'appuyant sur la comparaison avec lesconstatations de vasomégalie dans a. mesenterica inferior chez le mgme malade, lesauteurs arrivent a la conclusion que la veinomégalie est en rapport avec les change-ments dégénératifs du matériau élastique dans la paroi vasculaire.PE3K3ME: y Sojibnoro e reHepa.nu3npoi3amioi"i BaaoMera.iiieii ncc.ieflOBajin y.ibrpa-CTpyKTypy CTCHKH v. colica sinistra. 3jiacTimecKMH MaTepuaji BCTpenajic^ B TPOIÌHOHCpOpMC: K3K CJICrKa OCMMOCpHJIbHblH aMOpCpHblIÌ MaTCpHajl no KpaflM MMOU.HTOB; K3KBbICOKO OCMHOqbHJIbHaH SJiaCTHMCCKaH MCMÓpana M K3K BbICOKO OCMMOCpHJIbHbie SJiaCTH-BOJiOKHa c pasjiHMHbi.M pacnoJiOJKeHWCM B tunica media H aflBeHTHu;najibHOii 060-O cnerKa ocMJiocbnjibHOM sJiaciMqecKOM iviaTepnajie npeflnoJiaraeTOH, HTO OHBCJieflCTBue minoiinTOTimecKOH aKTHBHOCTM MHOUHTOB. BHCOKO ocMMOobHJibHbiHM3TepHa^ CBIIfleTeJIbCTByCT O HapyiIieHIIH IIHHOm<ITOTHHeCKOM aKTMBHOCTII.B MccjieflOBaHHofi BCHC ne o6Hapy>KHjiH TwnMHHbix aTepocK^epOTimecKHxHa OCHOBC cpasHeniiH c aHajiH3aMM BasoMerajran a. mesenterica inferior y ToroSojibHoro asTOpbi npwxoflHT K aamno^eHMio, MTO BenoMerajinK cansana cHHMH wsivieHeHMHMH sjiacTUMecKoro Maiepnajia B cocy^iicTOH CTCHRC.R E F E R E N C E S41. Assas-Jandin, M. A., Bonin, A., Hodara, M.: Megadolichoarteries. A propos de 6 ob-servations. J. Mal. vasc. 7: 197, 1982.2. Beuren, A. J., Hort, W., Kalbfleisch, M., Muller, H., Stoermer, J.: Dysplasia of thèsystemic and pulmonary arterial System with tortuosity and lengthening of thèarteries. A new entity, diagnosed during life, and leading to coronary death in earlychildhood. Circulation 39: 109, 1969.3. Braverman, I. M.: Elastic fiber and microvascular abnormalities in aging skin. Clin.Geriatr. Med. 5: 69, 1989.4. Callum, K. G., Gaunt, J. I., Thomas, M. J., Browse, N. L.: Physiological studies in arte-riomegaly. Cardiovasc. Res. 8: 373, 1974.5. Callum, K. G., Thomas, M. L., Browse, N. L.: A definition of arteriomegaly and thèsiza of arteries supplying thè lower limbs. Brit. J. Surg. 70: 524, 1983.6. Carlson, D. H., Gryska, P., Seletz, J., Armstrong, S.: Arteriomegaly. Amer. J. Roent-genol. 125: 553, 1975.7. David, H., Kunz, J.:- StrukturverMnderungen der Media der Kaninchenaorta nach lo-kaler Bestrahlung. Zschr, Zellforsch. 66: 83, 1965,271D'Andrea, V. et al.: Venous ultrastructure in venomegaly;8. Ertegrul, A.: Dif fuse tortuoslty and lengthening of thè arteries. Circulation 36: 400,1967.9. Franzini, M., Bicochi, S., Sinibaldi, G., Lodini, V.: Arteriomegalia: indicazioni al trat-tamento chirurgico s problemi di tecnica. Minerva cardioangiol. 35: 209, 1987.10. Hagen, S.: Die Arteriomegalie — eine Sonderform der dilatierenden Arteriopathie.Vasa 14: 158, 1985.11. Hollier, L. H., Stanson, A. W., Gloviczki, P. et al.: Arteriomegaly: classification, andmorbid implications of diffuse aneurysmal disease. Surgery 93: 700, 1983.12. Kinnunen, J., Totterman, S., Tervahartiala, P.: Arteriomegaly. Eur. J. Radiol. 5: 156,1985.13. Malinovskà, V., Zechraeister, A., Malinovsky, L., Hadasovà, E.: The effect of ciò-f ibra te and normalip on lipid deposition and l ipid deposits in thè aortic wall in twoexperimental models. Scripta med. (Brno) 58: 67, 1985.14. Malinovsky, L., D'Andrea, V., Cavallotti, C. et al.: A contribution to thè morphologyof tortuosity of arteries and arteriomegaly. Z. mikrosk.-anat. Forsch. (In press).15. Meyer, W., Henschel, E.: Untersuchungen iiber die Schliingelung und Sklerose derMilztir teris . Virchovvs Arch. path. Anat. 331: 396, 158.16. Nystrom, S. H. M.: Development of intracranial aneurysms as revealed by electronmicroscopy. J. Neurosurg. 20: 329, 1963.17. Reynolds, E. S.: The use of lead c i f ra te at high pH as an electronopaque stain inelectron microscopy. J. Celi. Biol. 17: 208, 1963. .18. Thomas, M. L.: Arteriomegaly. Brit. J. Surg. 58: 690, 1971.19. Thomas, M. L., Blakeney, C. G., Browse, N. L.: Arteriomegaly of persistent sciallearteries. Radiology 128: 55, 1978.20. Tilson, M. D., Dang. C.: Generalized arteriomegaly. A possible predisposition to thèformation of abdominal aneurysms. Arch. Surg. 116: 1030, 1981.21. Tauji , T.: D i f f e r e n t e f f ec t s of elastase on dermal elastic f ibers with age. Ultrastruc-tural studies with thè convent ional and fannie acid stain. Geroiitology 33: 64, 1987.272

Venous wall ultrastructure in generalized venomegaly.

https://iris.uniroma1.it/bitstream/11573/105424/1/Venomegaly.pdf

Venous wall ultrastructure in generalized venomegaly.

Abstract

Similar works

Full text

Available Versions

Archivio della ricerca- Università di Roma La Sapienza