Search

Extracellular fluid was topically sampled with a dialysis probe during electrocorticography from the exposed cerebral cortex in 23 patients undergoing epilepsy surgery. Sampling was done in parallel from epileptiform regions and from non-epileptic areas. The former were classified according to the histopathology, into neoplastic, non-tumoral or 'special cases'. The epileptiform regions had significantly higher extracellular concentrations of alanine, glycine and phosphoethanolamine in the majority of the cases. The excised epileptic lesions were analyzed to provide the corresponding intracellular concentrations of amino acids. Several of the non-tumoral group showed high concentrations of GABA, ethanolamine and alanine. The intra- to extracellular concentration ratio for amino acids was low for phosphoethanolamine, glycine, serine and glutamine in most of the samples of epileptiform cortex, while the intracellular accumulative ability for ethanolamine apparently was stronger in epileptiform than in normal cortex.

Neurophysiologic and neuropathologic changes were studied in rabbit hindlimbs after 2 hours of pneumatic tourniquet application with either 350 mmHg (n = 18) or 1,000 mmHg (n = 6) cuff inflation pressure. The toe spread reflex was decreased in 66% and absent in 33% of limbs 2 days after 350 mmHg compression, and was absent in all limbs after 1,000 mmHg compression. Compound motor action potential amplitudes (CMAPs), recorded from the abductor hallucis muscle, were significantly decreased with sciatic nerve stimulation 1 hour after 350 mmHg compression. CMAPs returned to baseline values one and two days later, however nerve conduction velocity (NCV) was still significantly decreased in the compressed sciatic nerves of these groups. In contrast, complete nerve conduction block, localized beneath the cuff's distal border, was observed two days after 1,000 mmHg compression, and NCV was still significantly decreased distal to the tourniquet zone. Using light and electron microscopy, scattered axonal degeneration, mild myelin damage, and normal nodes of Ranvier were observed two days after 350 mmHg tourniquet compression. Severe fiber damage and nodal obliteration were noted after 1,000 mmHg tourniquet compression. Although nodal invagination is probably not a significant pathogenic mechanism at clinically relevant tourniquet pressures and durations, functional abnormalities were induced by 2 hour, 350 mmHg tourniquet compression. Such changes probably correlate with clinical electromyographic abnormalities and delayed post-operative recovery following 'routine' extremity surgery using pneumatic tourniquets.

The enzyme chondroitinase ABC has recently been suggested for use in chemonucleolysis. The effects of 200 U ml of chondroitinase ABC were studied on intrathecal and peripheral nerve tissue in rabbits. After the intrathecal (subarachnoid) application of 0.2 ml of either the diluent in the control group (N = 2) or chondroitinase in the study group (N = 4), no neurologic deficit was detected. Compared with the control group, no morphologic changes at the light microscopic level were induced in the spinal cord by chondroitinase. No neurophysiologic differences were detected between tibial nerves after exposure to 1 ml of the diluent (control, N = 8) or chondroitinase (the other leg) for 4 weeks, nor did the study group, compared with the control group, show any morphologic changes in the tibial nerves. Because the concentration of chondroitinase ABC tested was approximately 40 times higher than might be used clinically for chemonucleolysis, the present study indicates a wide margin of safety for unwanted side effects on nerve tissue.

Extravasated endogenous serum albumin and fibrinogen were identified immunohistochemically in coronal brain sections from normotensive Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) after permanent ligation of the right middle cerebral artery. Infarcts were seen in all the SHR but only in 6 out of 14 WKY. Six hours after ligation, extravasated proteins were located primarily within the borders of the infarcts whereas after 24 h and later there was an increasing spread in the white matter. After 7 days, a protein immunoreactivity was seen far outside the infarcted areas, mainly in the white matter and occasionally extending somewhat into the contralateral side. Three weeks after permanent ligation, the immunoreactivity for plasma proteins had a similar extension but was less intense than after 7 days. A gliosis was noted within the protein-positive regions. From 72 h and onwards the immunoreactivity for albumin but not for fibrinogen extended via the white matter into the ipsilateral thalamic nuclei, where marked, mainly cytolytic nerve cell damage and gliosis was found. The close spatial correlation with albumin immunopositivity and the histological features of the thalamic lesions indicate that the propagation of extravasated plasma constituents or degradation products from the infarct may influence the character, timing and extent of remote tissue changes after cerebral infarction.

In spite of improvements in obstetric and neonatal care, hypoxic-ischemic brain damage with severe neurologic disability is still a clinical reality. A model in 7-day-old rats has been introduced to study the pathophysiology of perinatal hypoxic-ischemic brain damage. Unilateral brain damage is produced in the cerebral cortex, striatum and hippocampus, i.e. a similar distribution as is often seen in human asphyxiated neonates. In the present investigation the model was evaluated further by comparing three different methods to assess the brain damage: weighing the hemispheres, morphometry and somatosensory evoked potentials. Seven-day-old rats were subjected to unilateral carotid artery ligation followed by 2 h of hypoxia (7.7% O2 at 36 degrees C). After 2 h of hypoxic-ischemia pCO2 and pO2 decreased in mixed arterial/venous blood. The evaluation of the damage 2 weeks after the insult, demonstrated close correlation between morphometry and weighing (r = 0.836, P less than 0.01). The amplitude of evoked potentials correlated to the other parameters (r = 0.814, P less than 0.01 and r = 0.824, P less than 0.01 respectively) and displayed a greater relative attenuation than the other methods but with a more pronounced variability. These results indicate that the degree of brain damage can be assessed by weighing for screening purposes.

A population-based series of 198 children, aged 0 to 16.9 years, with primary brain tumors, diagnosed from 1970 to 1984, was retrieved from the Swedish Cancer Registry. After review of slides and reclassification of histology according to the American Cancer Society, the average annual incidence rate was estimated to be 34.9 per million, which is a very high incidence compared to other countries. The age distribution was not uniform as age group 0 to 4 included more children than age groups 5 to 9 and 10 to 14. The largest subgroups were astrocytomas (25%) and primitive neuroectodermal tumor (PNET)/medulloblastomas (MB) (21%). Associated diseases were neurofibromatosis and Rubinstein-Taybi syndrome. The overall male to female ratio was 1.08:1, the same as in the population at risk; but for PNET/MB, it was 1.8:1. The 5-year survival for all tumors was 54%, and the 15-year survival, 49%, with great variation between tumor subgroups.

An ultrastructural and morphometric study was performed on sural nerve biopsies of four industrial spray painters (35-59 years) and 11 controls (6-64 years). No difference could be shown in spray painters and age-matched controls as to the number of myelinated nerve fibres per area, their size distribution, variation of internodal length along single nerve fibres or the ratio between the number of myelin lamellae and the axon circumference. There was marked scattering of the two latter parameters in older exposed and and control individuals. The distribution of NADH2-tetrazolium reductase activity was similar in exposed and control cases. The general ultrastructural appearance of nodal-paranodal regions in controls conformed with that noted in experimental animals. The overall ultrastructural organization and age-related changes of nerves of exposed cases were similar to those of control cases except for a presence of paranodal axonal mitochondria which contained glycogen-like particles in exposed cases. In one exposed case abundant dispersed or clustered glycogen-like particles were seen in the paranodal axoplasm. These findings are suggested to be an effect of chronic exposure to organic solvent vapours. Ageing seems, however, to have a much greater impact on the morphology of the sural nerve fibre than occupational exposure to organic solvent.

The effect of metoprolol, a beta 1-blocker, on atherogenesis was evaluated in rabbits fed a diet supplemented with 0.25% cholesterol and 3% coconut oil for 21 weeks. After 7 weeks on the diet, the rabbits were randomly divided into treated (n = 22) and untreated (n = 22) groups. Treated animals received metoprolol subcutaneously by an osmotic pump for 14 weeks, resulting in a plasma level of 774 +/- 69 nM during the investigation. Plasma concentrations of cholesterol, triglycerides, and phospholipids did not differ between the two groups. Nor were there any significant differences between the two groups in plasma concentrations of apolipoprotein A-I, apolipoprotein B, apolipoprotein C-III, and apolipoprotein E measured by electroimmunoassay. At the end of the study, the aortas were cut into three portions and the extent of atherosclerosis was determined by morphometry. The group that had received metoprolol had significantly (p less than 0.015) less atherosclerosis in the aorta (ascending plus arch 37.8 +/- 6.8%, thoracic 32.9 +/- 6.1%, abdominal 19.8 +/- 6.1% of total intimal area; mean +/- SEM) than the controls (ascending plus arch 54.9 +/- 7.1%, thoracic 48.0 +/- 6.2%, abdominal 25.9 +/- 5.5%).

The ratio between media thickenss and lumen radius was determined in cerebral arterial vessels of 15- and 200-day-old spontaneously hypertensive (SHR) and normotensive rats (Kyoto Wistar and local Wistar rats). A modification of Furuyama's morphometrical method was used. There was a statistically significant increase of media/radius ratio among medium size and large vessels in 15-day-old SHR. Furthermore, the media cross section area and lumen radius was increased in the internal carotid arteries of young SHR. These early vascular aberrations could be caused by the slight increase of blood pressure at this age or be due to other genetically determined mechanisms in SHR. In 200-day-old SHR a significantly increased media/radius ratio was seen in arterial vessels with a radius less than 80 microns when compared to local Wistar rats but only in the smaller arterioles (r less than 20 microns) when compared to Kyoto Wistar rats. The present results offer a likely explantation for the increased cerebrovascular resistance during maximum vasodilatation in SHR.

Arteries from spontaneously hypertensive rats (SHR), stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto controls (WKY) were fixed by immersion and plastic embedded. The media cross-sectional area and the length of the internal elastic membrane were measured. The ratio between media thickness and internal radius was then calculated for a standardized condition, implying a perfectly smooth and circular internal elastic membrane. An increase of the media to radius ratio was already demonstrable in visceral arterial branches of SHR and SHRSP by 15 days of age, indicating that changes of arterial structure could be of pathogenetic importance in early hypertension. At seven months of age the ratio was significantly increased in mesenteric arterial branches of SHR and SHRSP and in renal arterial branches of SHRSP. The media to radius ratio was markedly increased in the renal and superior mesenteric arterial trunks of adult SHR (P less than 0.001 in both) and SHRSP (P less than 0.001 and P less than 0.01). This was due to a greater media cross-sectional area in the former vessels and to a combination of greater media and reduced radius in the latter.

A 46-year-old woman was readmitted, two years after removal of a large convexity meningioma, because of cerebrospinal fluid rhinorrhoea from a nasal encephalocele eventually visualized by CT-scan. The encephalocele was extirpated via an intracranial approach, and its histological appearance is described. The aetiology of this extracranial brain tissue protrusion is discussed. It is suggested that the mechanisms behind the formation of this encephalocele are a combination of a congenital malformation and the long term increase of the intracranial pressure due to the meningioma.

Severe hypertension in humans may lead to fibrinoid necroses of cerebral blood vessels with small hemorrhages and cystic necroses. Similar lesions have also been reported in the experimental model of stroke-prone spontaneously hypertensive rats (SHRSP). We examined the genesis and spreading pattern of the brain oedema in SHRSP. The extravasation of plasma proteins was visualized with the Evans-Blue or the immunoperoxidase method. Most commonly the leakage occurred in the grey matter of the cerebral cortex or basal ganglia. The spreading pattern followed that of vasogenic brain oedema with a local spread in the grey matter and an extensive one in the white matter. In addition, we detected a novel pathway upwards along the perivascular spaces of the penetrating vessels as well as laterally in the subpial zone. This route is likely to serve also as a drainage channel for the oedema into the cerebrospinal fluid in the subarachnoidal space. Transfer of the extravasated proteins from the white matter to the ventricles was also observed, confirming that this previously described pathway for the resolution of oedema fluid exists in the SHRSP model of vasogenic brain oedema.

It has been much discussed whether left ventricular hypertrophy (LVH) in hypertension implies improved or impaired cardiac performance, mainly because experiments in various hypertensive models have given controversial results. It has, for example, been suggested that increased collagen content may depress LV function both in renal and spontaneous hypertension (SHR) in rats. For such reasons cardiac performance was studied both in SHR and in normotensive control rats (NCR) before and during superimposed two-kidney, one clip Goldblatt hypertension, and also 1 week after reversal of hypertension by unclipping. The LV function of the isolated hearts was determined in an antegrade working heart perfusion system. Further, myocardial morphology, with regard to fibrous tissue infiltration and energy metabolic status, were evaluated in the renal hypertensive rats before and after unclipping. Compared with NCR, maximal cardiac performance was elevated in the hypertrophied SHR hearts, but depressed when renal hypertension was superimposed, even though this led to further LVH. However, one week after reversal of renal hypertension, when LVH was still considerable, cardiac function was increased well above the control level, even though the stores of high energy compounds and the content of myocardial fibrous tissue was almost the same as during renal hypertension. It is concluded that LVH generally enhances cardiac performance, but that concomitant renal hypertension exerts a cardio-depressive influence which can neither be ascribed to an increased fibrous tissue content nor to a reduced energy charge potential. It is therefore suggested that some negative inotropic agent of renal or extrarenal origin is released during two-kidney, one clip renal hypertension, which offsets the enhanced performance induced by the left ventricular hypertrophy.

Spontaneously hypertensive rats (SHR) and stroke-prone spontaneously hypertensive rats (SHRSP) were treated with a combination of a beta 1-blocker (metoprolol) and a Ca++-antagonist (felodipine) from 1 to 4 months or 4 to 6 months of age. The renal arterial trunks as well as more distal parts of the renal arterial bed were fixed by immersion and embedded in plastic. The media cross-sectional area and the length of the internal elastic membrane were measured on cross-sectioned arteries. The media thickness, luminal radius and the ratio between media thickness and luminal radius (m/r ratio) were then calculated for a standardized condition, assuming a smooth and circular internal elastic membrane, in which the arteries were compared. The m/r ratio was markedly reduced in the most proximal as well as in more distal arterial segments of the treated animals when compared with untreated rats of corresponding age and category. The quotient was somewhat reduced also when compared with normotensive controls (WKY) although the systolic blood pressure in younger treated rats was not fully normalized. The results may suggest that the present treatment influences the arterial walls not only by reducing the pressure load but also through pressure-independent mechanisms.

In order to investigate whether initial plasma lipid concentrations could be used to distinguish between high and low responders to an atherogenic diet, rabbits were divided into 3 groups according to their plasma concentrations of cholesterol and phospholipids after 4 weeks on a standard rabbit diet. Plasma cholesterol and phospholipid levels were less than 0.5 mM, less than 1.1 mM, respectively, in group 1 (n = 17), greater than 0.5 mM, less than 1.1 mM, in group 2 (n = 13), and greater than 0.5 mM, greater than or equal to 1.1 mM, in group 3 (n = 14). After 7 weeks on a diet containing 0.25% cholesterol and 3% coconut oil, animals in groups 1 and 2 had a lower increase in their plasma lipid levels compared with group 3. Half of each group was then treated with the beta 1-adrenoceptor antagonist metoprolol during the next 14 weeks on the atherogenic diet. At the end of the study, the extent of atherosclerosis both in the aortas and in the coronary arteries of the control animals showed a positive correlation to plasma cholesterol and to plasma phospholipid concentrations integrated over time. The metoprolol-treated animals in groups 1 and 2 had a reduction of atherosclerosis compared with their respective controls. We conclude that subpopulations of rabbits that react differently on an atherogenic diet can be identified by their initial plasma lipid levels, and that metoprolol treatment of low responders to an atherogenic diet significantly reduces atherosclerotic lesions of the aorta.

Young rats, submitted to severe protein restriction were studied concerning the width of inter-myelin gaps at the nodes of Ranvier in peripheral nerve fibres. The results gave no proof of increased paranodal myelin retraction in lumbar spinal roots or the sciatic nerves of low-protein rats. Malnourished rats as well as controls showed great interindividual differences as to the presence of nodes with wide inter-myelin gaps.

Central pontine myelinolysis is a life-threatening condition involving the demyelination of axons in certain areas of the brain. It has been shown almost invariably to occur in connection with hospital care. In recent years, a connection has been noted between the rapid restitution of low serum sodium and the development of the condition. In this review, the most recent scientific information is summarized. It is concluded that the risk should always be considered in treating a hyponatremic patient. The serum sodium level should be raised slowly and the acute treatment ended before normal serum sodium levels are reached, ie when the patient is still slightly hyponatremic.

Rabbit tibial nerves were subjected to direct, acute graded compression by means of an inflatable compression chamber. The acute and long term effects of 50, 200 and 400 mmHg applied for two hours on nerve function and nerve fibre structure were investigated. A pressure of 50 mmHg applied for two hours induced only minimal or no acute deterioration of maximal conduction velocity and nerve fibre structure. Conduction velocity was gradually reduced during compression at 200-400 mmHg pressure for two hours and in those cases the recovery of nerve conduction after pressure release was incomplete. Ultrastructural analysis revealed pronounced, early nerve fibre damage in these nerves. Three weeks after compression, nerves compressed at 50 mmHg for two hours had normal afferent and motor conduction velocity, although there were morphological signs of slight nerve fibre damage. Nerves compressed at 200 mmHg for two hours exhibited reduction of conduction velocity only at the level of compression, in contrast to the nerves compressed at 400 mmHg for two hours in which conduction velocity was reduced both at the level of compression and distal to the compressed segment. Morphologically, the nerves compressed at 200-400 mmHg for two hours showed varying degrees of demyelination and axonal degeneration three weeks after compression.

Ten autosomal recessive/sporadic cases of hereditary motor and sensory neuropathy type I (HMSN I), nine of which originated from the northern part of Sweden, were included in the study. Parents were free from neurologic symptoms. Motor and sensory conduction velocity was normal when recorded, i.e., in 19 and 17 parents, respectively. Sural nerve biopsies from the ten cases revealed a varying degree of onion bulb formation. In eight of the cases the onion bulbs consisted of abundant basement membranes, whereas the Schwann cells were few and sometimes lacking. There were in some cases considerable differences between separate fascicles as to the loss of myelinated nerve fibers. In the six biopsies in which teasing was performed signs of present and previous demyelination were noticed. Numerous internodal segments were abnormally thin with reference to their length. In many such segments there were marked local thickenings of the nerve fiber. In cross sections the probable counterparts to these thickenings were nerve fibers with unduly thick myelin sheaths and complex folding of the myelin. Ultrastructural axonal changes were seen in the majority of the cases. The pathogenetic and diagnostic implications of the present findings are discussed.

Brain infarct size and behaviour were studied in spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY) 3 weeks after occlusion of the right middle cerebral artery in order to compare the effects of vascular occlusions on the normotensive and hypertensive cerebral vasculature. The brain tissue reduction, assessed by measuring the cross-sectional area of remaining tissue and weight of the cerebral hemispheres, was greater in SHR than in WKY (P less than 0.01). Deficits in sensorimotor integration were highly correlated to the degree of brain damage (r = 0.91). Amphetamine induced no rotation asymmetry in normal rats, whereas lesioned rats rotated more ipsilaterally to the lesion (P less than 0.05). Rotation asymmetry did not correlate with total infarct size. The more severe outcome after middle cerebral artery occlusion in SHR as opposed to WKY, can probably be explained by reduced collateral capacity secondary to the altered vascular design in hypertension.

Arteries from spontaneously hypertensive rats (SHR) and Wistar Kyoto controls (WKY) were investigated. Specified cross-sections were collected from the extra- and intracranial parts of the internal carotid arteries, from the carotid segment situated in the skull bone and from intra- and extracranial segments of the vertebral arteries. The internal radius, media thickness and ratio between media thickness and internal radius (m/r ratio) were calculated for a standardized condition implying a smooth and circular internal elastic membrane. The m/r ratio was significantly increased in all arterial segments of 7-month-old SHR compared to WKY. This was caused mainly by decrease of radius in the vertebral arteries and in the intracranial carotid segment. In the extracranial and intraosseous carotid segments the increase of m/r ratio in SHR was mainly due to an increase of media. Whereas the radius was the same in the intra-osseous and intracranial carotid segments of WKY, the m/r ratio was greater intracranially. The results suggest that the physical properties of supporting tissues may influence the normal arterial development and modify the influence of an increased arterial pressure on the vessel wall.

Spontaneously hypertensive rats (SHR) and stroke-prone spontaneously hypertensive rats (SHRSP) were treated with a combination of a beta 1-blocker (metoprolol) and a calcium antagonist (felodipine) from 1 to 4 or from 4 to 6 months of age. Basal cerebral arteries were fixed by immersion and embedded in plastic. The ratio between media thickness and luminal radius was determined in cross-sectioned arteries for a standardized condition, assuming a smooth and circular internal elastic membrane. The treatment caused a significant decrease in blood pressure and a normalization of m/r ratios in basal cerebral arteries when initiated in young as well as in adult SHR and SHRSP, i.e. the therapy efficiently prevents as well as reverses hypertensive arterial changes. Even though 4-month-old treated rats were still significantly hypertensive, their m/r ratios did not differ from those of normotensive controls. The latter results may indicate that the treatment affects the vessel walls also through other mechanisms than by decreasing the pressure load.

Surgical treatment of peripheral nerve lesions associated with intraneural fibrosis is sometimes extended to include internal neurolysis. This procedure is performed in order to release the individual nerve fascicles from interfascicular scar tissue which is believed to constrict nerve fibres and thereby interfere with their function and regenerative capacity. However, an internal neurolysis per se implies a significant trauma to the nerve and may induce microvascular damage and formation of new intraneural scar tissue. Considering this, such a procedure appears justified only when the preoperative intraneural fibrosis is more severe than the scarring which might be induced by the surgical procedure as such. In order to evaluate the tissue reactions following internal neurolysis an experimental investigation was carried out: internal neurolysis was performed on normal rabbit tibial nerve. After varying postoperative periods up to 6 months specimens of nerves were analysed. Reactive changes of connective tissue and myelin sheath lesions, indicating nerve fibre damage, were investigated in histological sections studied by light microscopy. Barrier function of perineurial membrane and endoneurial vessels was investigated by fluorescent microscopic tracing of locally applied or intravenously injected albumin labelled with Evans' blue. The results indicate that an experimental internal neurolysis per se may induce fibrosis in all layers of the nerve and may cause some nerve fibre damage. However, the barrier function of the perineurium and the endoneurial vessels seems to be generally well preserved. The findings are discussed in relation to indications for internal neurolysis.

The brain lesions in stroke-prone spontaneously hypertensive rats (SHRSP) are characterized by multifocal microvascular and spongy-cystic parenchymal alterations particularly in the gray matter. An essential feature of the lesions is the presence of edema with massive extravasation of plasma constituents as evidenced by specific gravity measurements, Evans blue technique and immunohistochemistry. The nerve cell injury occurring in the brain lesions in SHRSP is further characterized by light and electron microscopy in the present study. Two types of neuronal changes were seen within the blood-brain barrier (BBB) leakage sites. A small number of neurons with dark condensed nucleus and cytoplasm were found most often at the periphery of recent lesions. The majority of injured neurons were pale and showed intracellular edema confined to the dendrites and perikarya sparing axons and synapses. Their nuclei were well preserved with finely dispersed chromatin. The swollen and watery cell processes of neurons and astrocytes gave a spongy appearance to the neuropil. The intracellular edema seemed to result in cytolysis. The results suggest that primary anoxia-ischemia is not the major pathogenetic mechanism behind the nerve cell injury in severely hypertensive SHRSP, rather it is the massive BBB leakage and consequent brain edema that causes cytolytic destruction of neurons. Secondary focal ischemia as a consequence of occlusion in microvessels may, however, contribute to the nerve cell destruction.

An experimental model is described in which collagenase in different concentrations and volumes were applied epidurally or intrathecally in the rabbit lumbar spine. This made it possible to study the tissue effects in a situation similar to that of collagenase leaking from a disc or accidental epidural or intrathecal injection at chemonucleolysis. Epidurally applied collagenase, in higher concentration, caused a local thinning of the dura. This effect was reduced at lower concentrations and volumes. Intrathecally injected collagenase, even in small amounts, caused intrathecal hemorrhage and acute paraplegia in the hind limbs. Therefore, in the clinical situation, intrathecal injection of collagenase must be avoided.

The current investigation comprised normal young rats as well as rats submitted to a 50% food reduction or severe protein restriction. Isolated nerve fibres from lumbar spinal roots and sciatic nerves were investigated with reference to the relation between length and diameter of internodes as well as variation of internodal length along single nerve fibres. The present results do not support the view that protein-calorie malnutrition should cause neuropathy. Internodal segments were, on an average, shorter in relation to their thickness in young rats submitted to severe protein restriction or a 50% food reduction. The deviation was most marked in low-protein animals and particularly among coarser internodal segments. An inhibition of longitudinal growth was considered to be the main factor behind the difference between malnourished and normal rats.

Spontaneously hypertensive rats (SHR), and often also humans genetically predisposed to hypertension, exhibit cardiovascular hyperreactivity to alerting stimuli, which derives from limbic-hypothalamic levels and seems important for inducing primary hypertension. It is further known that the limbic amygdala complex normally reinforces emotionally induced defence reactions. The amygdala were therefore bilaterally destroyed in 6 week old SHR, and compared with sham-operated SHR concerning development of hypertension, cardiovascular reactivity to environmental stimuli and explorative behaviour. When related to controls, the arterial pressure elevation was significantly attenuated in the amygdalalesioned SHR, though their pressure was nevertheless raised 40% at 6 months of age. Concerning cardiovascular responsiveness to mild environmental stimuli the groups did not differ; neither concerning explorative behaviour nor in general motor activity. However, the amygdala-lesioned SHR responded decidely less than controls to stressful, fear-inducing stimuli. The amygdala complex may therefore play an important role in aggravating SHR hypertension by reinforcing defence reactions to stressful influences, when such stimuli are at hand. However, according to the present study the amygdala nuclei are not the origin of the centrally determined cardiovascular hyperreactivity, which in SHR seems decisive for inducing hypertension.

Spontaneously hypertensive rats (SHR) and stroke-prone spontaneously hypertensive rats (SHRSP) were treated with a combination of a beta 1-blocker (metoprolol) and a calcium antagonist (felodipine) from 1 to 4 or from 4 to 6 months of age. The main trunk and peripheral branches of the mesenteric arterial tree were fixed by immersion and embedded in plastic. The total length of the internal elastic membrane and the media area were measured in cross-sectioned arteries. The ratio between media thickness (m) and luminal radius (ri) was then determined for a calculated, standardized condition, assuming a smooth and circular internal elastic membrane. The treatment caused a significant decrease in blood pressure and a reduction in m/ri ratios in the mesenteric arterial trunk as well as in mesenteric arterial branches when initiated in young as well as in adult SHR and SHRSP, i.e. the therapy efficiently prevents as well as reverses hypertensive arterial changes. The m/ri ratios in the superior mesenteric arterial trunks were significantly smaller in treated 4-month-old SHR and SHRSP than in WKY, although their blood pressures were not fully normalized. There was a marked increase in luminal radius in the young treated rats, possibly secondary to a therapy-induced increase in splanchnic blood flow.

Three cases of non-progressive, sensory neuropathy with dysautonomia are presented. Light and electron microscopy on whole sural nerve biopsies revealed an almost total lack of myelinated nerve fibres. The total fibre count was also reduced as was the total number of Schwann cell nuclei. No degenerative phenomena were seen within the nerve fibres. The aberrations are probably caused by a maldevelopment of the neural crest implying a stunted proliferation and growth of sensory and autonomous neurones as well as a reduced proliferation of Schwann cells. Since the morphology and clinical features differ from that in other cases of sensory neuropathy with dysautonomia the three present cases are considered to represent a new type of the disease.

The media cross-sectional area, the media thickness, the internal radius and the ratio between media thickness and internal radius were determined in consecutive sections of extraparenchymal cerebral arteries of 7- and 12-month-old normotensive and spontaneously hypertensive rats. The study included intracranial pial and basal arteries as well as extracranial cervical arteries. In the chronically hypertensive rats the media to radius ratio was consistently higher than in normotensive rats over the entire calibre spectrum investigated (radius 5-400 micron). The increase of the ratio in the extracranial arteries of the hypertensive rats was exclusively due to a thicker media. In the basal intracranial arteries the increase of ratio was due to a thicker media and/or a smaller internal radius in 7- and 12-month-old rats with moderate hypertension (mean arterial pressure, MAP 171 +/- 8 and 177 +/- 7 mm Hg respectively). In 7-month-old rats with severe hypertension (MAP 204 +/- 11 mm Hg) the increase of ratio was mainly due to a smaller internal radius. The observed structural alterations are likely to be of hemodynamic importance.

The media thickness (m), luminal radius (r) and m/r ratio were determined in the hepatic arterial trunk and in intra-hepatic arterial branches as was the number of arteries per cm2 sectioned liver tissue in spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto controls (WKY). The cross-sectional vessel parameters were calculated for a standardized condition, in which the internal elastic membrane is smooth and circular. Both intra-hepatic arterial branches and the hepatic arterial trunk showed significantly higher m/r ratios in SHR than in WKY controls. The luminal radius of the hepatic arterial trunk was larger in SHR than in WKY (P less than 0.05). The number of arteries per cm2 sectioned liver tissue was greater in SHR (P less than 0.05). It is suggested that the consequences of the increased m/r ratio in hepatic arteries of SHR are counteracted to some extent by an increased vascularization, but that during hypovolaemia and compensatory vasoconstriction, a greater decrease in hepatic arterial blood flow occurs in SHR than in WKY.

After reducing the number of patent conduit arteries to the brain by bilateral ligation of the carotid artery, the percentage decrease in blood pressure from the aorta to the internal carotid artery distal to the ligation was larger in spontaneously hypertensive rats than in normotensive rats. The pressure drop corresponded to the degree of hypertension as well as to morphometrically determined structural arterial alteration in the main communicating circuit, i.e. larger media to internal radius ratio and smaller internal radius in the posterior communicating arteries, the proximal part of the posterior cerebral arteries, the basilar artery and the vertebral arteries. The discrepancy between the sum of the luminal cross sectional areas of the communicating circuit and the luminal areas of the ligated conduit arteries was larger in the hypertensive than in the normotensive rats. It is to be expected that occlusion of conduit arteries to the brain will have a larger impact on the cerebral arterial perfusion pressure head in the presence of such hypertensive structural alterations known to increase flow resistance.

Local anesthetics are designed for application in or close to nerve tissue. In spite of their wide clinical use, surprisingly few investigations deal with the neural toxicity of modern local anesthetics. In this experimental study, the effects were investigated of intrafascicular or topical application of the long-acting local anesthetic bupivacaine on the rabbit sciatic nerve. Axonal degeneration was histologically evaluated and a fluorescence-microscopic technique used to detect lesions in the blood-nerve barrier. Topical application of bupivacaine in clinically recommended concentrations around the nerve caused no detectable nerve injury, while intrafascicular injections caused considerable axonal degeneration and damaged the blood nerve barrier. Axonal degeneration was the same after injection of physiologic saline solution and bupivacaine 0.5%, but it increased with increasing bupivacaine concentration and especially with the addition of adrenaline. On the other hand, the acute effects of intrafascicular injection, as visualized in the barrier experiments, changed little with the addition of adrenaline, indicating that it is the injection trauma itself which is deleterious. It is concluded that intraneural injections should be avoided and that plain bupivacaine solutions should be routinely used.

1. Larger arterial vessels of 15-day-old spontaneously hypertensive (SH) rats showed significantly greater media/internal radius ratio than those of Wistar-Kyoto rats in the brain, kidney and mesentery. 2. Since larger cerebral and renal arteries of adult SH rats did not differ from controls the above results indicate the presence of a non-pressure-dependent vascular abnormality in young SH rats. 3. There were marked differences between the vascular beds of adult SH rats in the increase of media/radius ratio. Thus the changes were evident in all sizes of mesenteric arteries but only in the smallest cerebral arteries.

The brain lesions in spontaneously hypertensive stroke-prone rats (SHRSP) are characterised by multifocal microvascular damage, breakdown of the blood-brain barrier, massive extravasation of plasma constituents and severe brain oedema, with consequent spongy and cystic tissue destruction in the cerebral cortex and basal ganglia as well as loosening of the white matter. In this paper we analyse in greater detail the pathogenetic mechanisms by which the spongy and cystic lesions are formed and the response of astrocytic cells. For this purpose, tracer (Evans blue)-stained brain lesions were examined in 8-month-old SHRSP immunohistochemically and electron microscopically. Sponginess of the neuropil in small lesions and at the periphery of larger lesions was due to swollen neuronal and astrocytic cell processes, i.e. at this stage the oedema was mainly intracellular. Cystic lesions were formed in the grey matter both by expansion of the extracellular space (ECS) containing protein-rich oedema fluid, and by rupture and subsequent loss of massively swollen cellular elements. In the white matter small slit-formed cysts along the fibre tracts were also formed by the expansion of ECS. In apparently recent lesions astrocytes displayed cyto-plasmic oedema but otherwise were still fairly normal. In more chronic lesions increased numbers of enlarged astrocytes with prominent staining for glial fibrillary acidic protein were present. Their distribution corresponded well to the spread of oedema, i.e. they were prominent around the leaky vessels in the grey matter, in the subpial zone and in the white matter. In the reparative phase the grey matter cysts became lined by astrocytic processes, a new glia limitans. Profuse sheets of glial processes in the neuropil around the cysts reestablished the compactness of the brain parenchyma.

The morphology of cerebral microvessels was studied immunohistochemically and ultrastructurally in 6- to 9-month-old normotensive Wistar-Kyoto rats (WKY), spontaneously hypertensive rats (SHR), and stroke-prone SHR (SHRSP) with a systolic blood pressure of 138 +/- 15 mm Hg, 189 +/- 9 mm Hg, and 258 +/- 30 mm Hg respectively. Regions with major opening of the blood-brain barrier (BBB) were revealed by an i.v. injection of Evans Blue. Multifocal BBB opening with massive leakage of plasma constituents rich in fibrinogen-fibrin-related antigen occurred in SHRSP with a blood pressure above 210-220 mm Hg. BBB-leakage sites were found in the cerebral cortex and the basal ganglia, most frequently in the arterial border zones. The perivascular tissue spaces were dilated within the BBB-leakage sites, in particular around arterioles. Damaged endothelial and smooth muscle cells were replaced by fibrin-like material, multiple layers of basement membranes and bundles of collagen fibrils surrounded by proliferated fibroblasts. The degenerative-infiltrative-proliferative disease process transformed short segments of single arterioles into severely thickened, tortuous and stenotic vessels. Fibrinoid degeneration, formation of microaneurysms and fibrin-rich vascular occlusions were observed. In contrast, only minor or no vascular alterations were seen in regions with preserved BBB in SHRSP and SHR. A severely increased intraluminal pressure load appears to be of major pathogenetic importance for breakdown of the BBB and initiation of the vascular disease process in SHRSP. However, since only short segments of a limited number of widely separated vessels are severely affected, and the number of affected vessels increase towards arterial end and border zones, additional predisposing and aggravating factors may play significant roles in the development of fibrinoid vascular lesions in arterial hypertension.

Cerebral arterial vessels of 15- and 200-day-old spontaneously hypertensive rats and normotensive controls were studied concerning the ratio between media thickness and lumen radius. Media/radius ratio among larger vessels was significantly increased already in 15-day-old spontaneously hypertensive rats. Furthermore, the media cross section area and lumen radius was increased in the internal carotid arteries of these animals. The early vascular aberrations could be caused by the slight increase of blood pressure at this age or be due to other genetically determined mechanisms. In 200-day-old hypertensive rats a significantly increased media/radius ratio was seen in arterial vessels with a radius less than 80 microns when compared to local Wistar controls but only in the smallest arterioles (r less than 20 microns) when compared to Kyoto Wistar controls.

Spontaneously hypertensive rats (SHR) and stroke-prone spontaneously hypertensive rats (SHRSP) were treated with a combination of a beta 1-blocker (Metoprolol) and a calcium antagonist (Felodipine) from 1 to 4 or from 4 to 6 months of age. Cross sections of plastic embedded basal cerebral arteries were measured with a digitizer. The ratio between media thickness and luminal radius (m/r ratio) could then be calculated for a standardized condition assuming a smooth, circular internal elastic membrane. The treatment caused a significant decrease of the m/r ratio in various basal cerebral arteries of young and adult SHR and SHRSP, i.e. the therapy may prevent as well as reverse hypertensive structural changes. Unilateral superior cervical ganglionectomy or preganglionic denervation did not affect the structure of basal cerebral arteries in young SHRSP or normotensive controls. A slight decrease of m/r ratio was indicated in the smallest pial arteries on the sympathectomized side, but the results did not allow any conclusion as to differences in effect between preganglionic denervation and ganglionectomy.

The cerebrovascular lesions of severe chronic hypertension were studied by light microscopy in perfusion-fixed, subserially sectioned brains from stroke-prone spontaneously hypertensive rats (SHRSP). The leakage and spread of plasma proteins were visualized by immunohistochemical detection of extravasated fibrinogen and by using an exogenous marker (Evans blue injected i.v.) for blood-brain barrier (BBB) dysfunction. In most SHRSP the hypertension did not lead to major BBB lesions in spite of a mean arterial pressure around 200 mm Hg at 6-9 months of age. Multifocal BBB damage occurred in a minor group of SHRSP, particularly within the cortex and the deep gray matter. A close spatial correlation was found between the leakage-spread of plasma constituents and the neuropathologic alterations. Fibrinoid degeneration of penetrating arterioles was found within the leakage sites. The surrounding gray matter showed petechial hemorrhages and abundant proteinaceous exudates rich in antifibrinogen-positive material. The current leakage of Evans blue and wide spread of fibrinoid substances suggested long-lasting damage to the BBB. Most neurons within the edematous gray matter had well preserved nuclei surrounded by a rim of cytoplasm with ill-defined outline as if vacuolation or lysis of the peripheral cytoplasm had occurred. The sponginess of the tissue progressed in severe cases to formation of necrotic cysts. Condensed acidophilic neurons were seen in the border zone between the edematous and more compact gray matter. The appearance and distribution of the gray matter lesions deviated in many respects from those commonly seen in regional ischemic infarcts. The fibrin thrombi found close to the cysts might be regarded as secondary events. The extensive spread of antifibrinogen-positive material within the white matter seemed to originate mainly from the chronic leakage sites in the gray matter. Increased number of large astrocytes were seen within the leakage sites and along the spreading pathways for the edema constituents. The white matter showed a rarefied texture with widely dispersed nerve fiber tracts, volume expansion, and occasional cyst formation. The results indicate a crucial pathophysiologic role for the egress, spread, and accumulation of vasogenic edema in the development of the cerebrovascular lesions in SHRSP.

During the early postnatal development of spinal roots in rats paranodal regions were often found, containing OTAN-positive inclusions in the Schwann cell cytoplasm. The presence of OTAN-positive paranodal regions showed variations in time, which were synchronous for ventral and dorsal roots. Dorsal roots, however, showed a more marked presence during development than ventral roots. Spinal roots of animals submitted to a 50% food restriction, were shown to contain more OTAN-positive paranodal regions than controls. This was true for ventral as well as dorsal roots. It is suggested that crowding of internodal segments could be one factor, determining the presence of paranodal, OTAN-positive material.

The effects of experimental nerve fiber compression on the morphology of nerve cell bodies were studied. Rabbit cervical vagus nerves were crushed or subjected to compression at 0 (sham compression), 30, 200, or 400 mm Hg for 2 h. Morphometric measurements and light microscopical evaluation of the nerve cell bodies in the nodose ganglion were carried out 7 days after the injury on the injured and control sides. Crush and compression at 30, 200, or 400 mm Hg induced a slight decrease in total cell profile area compared with the control side, but it was not related to degree of injury. There was a marked decrease in the ratio between nuclear and total cell profile area (nuclear volume density) after compression at 200 and 400 mm Hg, as well as after crush, and to a lesser extent after compression at 30 mm Hg. Compression at 30, 200, or 400 mm Hg as well as crush of the vagus nerve induced migration of the nucleus to the periphery and dispersion of Nissl substance in the cytoplasm of the nerve cell bodies. Sham compression induced no obvious changes in total cell profile area, nuclear volume density, or migration of nucleus. There was a somewhat increased percentage of cells showing dispersion of Nissl substance in sham-compressed animals than in controls. The results show that nerve fiber compression induced pronounced reactive changes in nerve cell bodies, even at low pressures, corresponding to those found in human carpal tunnel syndrome. Such pressures are known to induce reversible inhibition of fast axonal transport as well as inhibition of retrograde axonal transport. The nerve cell body changes in the nodose ganglion may thus be a reaction to disturbances in axonal transport.

Intradiscal injection of proteolytic enzymes implies a potential risk for exposure of nervous tissue to the enzyme solution. In the present study, the effects on peripheral nerve tissue of application of a solution containing a clinically recommended concentration of collagenase have been evaluated. Acute experiments showed that the enzyme induces transient swelling at the site of application and edema in the epineurium. There were, however, no detectable effects on the permeability of the perineurium or the endoneurial microvascular bed. Four and 8 weeks later, there was a slight fibrosis in the epineurium, but neurophysiologic tests did not reveal any impairment of the nerve function. The results are discussed in terms of the clinical use of collagenase for dissolution of herniated intervertebral discs.