Aims
To characterize the nature and function of the levator ani muscle innervation pathways and to perform a comprehensive three‐dimensional reconstruction of female pelvic innervation.
Methods
A ...computer‐assisted anatomical dissection protocol was applied to seven female human fetuses, after approval from the national biomedicine agency. Specimens were serially sectioned and immunostained for overall (antibody against protein S100), somatic (antibody against peripheral myelin protein 22), adrenergic (antibody against tyrosine hydroxylase), cholinergic (antibody against vesicular acetylcholine transferase), and nitrergic (antibody against the neural isoform of nitric oxide synthase) nerve fibers. Slides were digitized for three‐dimensional reconstructions using WinSurf®.
Results
Three main nerve pathways to the levator ani muscle were observed: the levator ani nerve, the pudendal nerve, and the inferior hypogastric plexus. The pudendal nerve was both somatic and autonomic, located below the levator ani muscle (infralevator pathway), supplying innervation to the inferior aspect of the levator ani muscle. The levator ani nerve was solely somatic, located above the levator ani muscle (supralevator pathway), supplying innervation to the superior aspect of the levator ani muscle. The inferior hypogastric plexus nerve fibers were solely autonomic, located in between the levator ani muscle and pelvic organs (endolevator pathway), supplying innervation to the medial portion of the levator ani muscle.
Conclusions
Our study provides a new representation of levator ani muscle innervation with three nerve pathways, and the levator ani muscle itself as an anatomical landmark.
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Background: Predisposing factors for sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) remain unknown. We highlighted the association of potential contributing medical ...conditions with the presence of sRCC. Methods: Patients with a renal cell carcinoma (RCC) from UCLA and the French UroCCR-45 study (only sRCC) were included in the study. Characteristics of patients with sRCC were compared with patients with RCC without sarcomatoid features (nsRCC) in univariable and multivariable logistic regression analyses. We quantified the association of age, gender, smoking status, hypertension, kidney function, and endocrine disorders: diabetes and hypothyroidism with sRCC. Results: A total of 2764 were included in the study (586 sRCC vs. 2178 nsRCC). On univariable analysis, age (OR=1.02, 95%CI 1.01-1.03, p<.0001), male gender (OR=1.35, 95%CI 1.10-1.65, p=.004), active smoking (OR=1.87, 95%CI 1.48-2.36, p<.0001), and diabetes (OR=1.32, 95%CI 1.03-1.70, p=.026) were associated with the presence of sRCC (Table 1). On multivariable analysis, age (+2.1% per year, OR=1.02, 95%CI 1.01-1.03, p<0.0001), male gender (OR=1.33, 95%CI 1.08-1.64, p=.008), and active smoking (OR=1.95, 95%CI 1.54-2.47, p<0.0001) were independently associated with the presence of sRCC. The AUC of the model was 0.61. Conclusions: In this study we found that sarcomatoid dedifferentiation was associated with age, male gender, and active smoking. Further studies are needed to confirm these findings and establish the underlying biology. Univariable logistic regression analysis of the association between potential pathogenic factors and sRCC. N=2764 Table: see text
Simultaneous heart‐kidney transplant (HKTx) is a valid treatment for patients with coexisting heart and renal failure. The aim of this study was to assess renal outcome in HKTx and to identify ...predictive factors for renal loss. A retrospective study was conducted among 73 HKTx recipients: Donors’ and recipients' records were reviewed to evaluate patients’ and renal transplants’ survival and their prognostic factors. The mean follow‐up was 5.36 years. Renal primary non‐function occurred in 2.7%, and complications Clavien IIIb or higher were observed in 67.1% including 16 (22%) postoperative deaths. Five‐year overall survival and renal survival were 74.5% and 69.4%. Among survivors, seven returned to dialysis during follow‐up. The postoperative use of ECMO (HR = 6.04, P = 0.006), dialysis (HR = 1.04/day, P = 0.022), and occurrence of complications (HR = 31.79, P = 0.022) were independent predictors of postoperative mortality but not the history of previous HTx or KTx nor renal function prior to transplantation. History of KTx (HR = 2.52, P = 0.026) and increased delay between the two transplantations (HR = 1.25/hour, P = 0.018) were associated with renal transplant failure. HKTx provides good renal transplant survival and function, among survivors. Early mortality rate of 22% underlines the need to identify perioperative risk factors that would lead to more judicious and responsible allocation of a scarce resource.
Aim
Characteristics of renal carcinoma arising in non-functional graft in renal transplant recipients (RTR) are unknown. We studied a large national retrospective cohort to analyze circumstances of ...diagnosis, treatment and outcome compared to the literature.
Methods
Study included all RTR presenting with kidney graft tumors irrespective of the histology, except those with lymphoma and including those tumors arising in non-functional renal graft. Between January 1988 and December 2018, 56,806 patients had renal transplantation in the 32 centers participating in this study. Among this cohort, 18 renal graft tumors were diagnosed in non-functional grafts.
Results
The median patient age at the time of diagnosis was 42.1 years (31.7–51.3). Median age of kidney grafts at the time of diagnosis was 56.4 (23.2–63.4). Eight (44.4%) tumors were discovered fortuitously on renal graft histologic analysis. Fourteen tumors (77.8%) were papillary carcinomas. Two patients had clear cell carcinomas and one patient had a pTa high-grade multifocal urothelial carcinoma in the graft of the upper tract with an in situ carcinoma.
Conclusion
Renal carcinomas in non-functional grafts are rare entities and most of them are diagnosed fortuitously. Despite the fact that these tumors are small, low grade and with a good prognosis, regular monitoring of non-functional grafts should be performed with at least an annual ultrasonography.
Little detailed information is available concerning autonomic and somatic nerve supply to the clitoris, potentially causing difficulties for nerve preservation during pelvic and perineal surgery.
To ...identify the location and type (nitrergic, adrenergic, cholinergic and sensory) of nerve fibers in the clitoris and to provide a three‐dimensional (3D) representation of their structural relationship in the human female fetus.
Serial transverse sections were obtained from five human female fetuses (18–31 weeks of gestation) and subjected to histological and immunohistochemical investigations; digitized serial sections were used to construct a 3D representation of the pelvis.
Pelvic‐perineal nerve location and type were evaluated qualitatively.
The female neurovascular bundle (NVB) is the anteroinferior terminal portion of the inferior hypogastric plexus that runs along the postero‐lateral then lateral face of the vagina and is rich in nNOS‐positive fibers. The cavernous nerve (CN) is a thin ventrocaudal collateral projection of the NVB, and this projection does not strictly follow the NVB course. The CN runs along the lateral surface of the vagina and urethra and penetrates the homolateral clitoral crus. The CN provides adrenergic, cholinergic, and nitrergic innervation to the clitoris, but not sensory innervation. The spongious nerve (SN) is the terminal and main projection of the NVB and provides nitrergic innervation to the vestibular bulbs. The dorsal clitoris nerve (DCN), somatic branche of the pudendal nerve, runs along the superior surface of the clitoral crus and body and has a segmental proerectile nitrergic activity related to communicating branches with the CN.
“Computer‐assisted anatomic dissection” allowed the identification of the precise location and distribution of the autonomic and somatic neural supply to female erectile bodies, providing an anatomical basis for nerve‐sparing surgical techniques, and participating to the understanding of neurogenic female sexual dysfunction. Moszkowicz D, Alsaid B, Bessede T, Zaitouna M, Penna C, Benoit G, and Peschaud F. Neural supply to the clitoris: Immunohistochemical study with 3D reconstruction of cavernous nerve, spongious nerve and dorsal clitoris nerve in human fetus.
Nerve fibers contributing to the superior hypogastric plexus (SHP) and the hypogastric nerves (HN) are currently considered to comprise an adrenergic part of the autonomic nervous system located ...between vertebrae (T1 and L2), with cholinergic aspects originating from the second to fourth sacral spinal segments (S2, S3 and S4). The aim of this study was to identify the origin and the nature of the nerve fibers within the SHP and the HN, especially the cholinergic fibers, using computer‐assisted anatomic dissection (CAAD). Serial histological sections were performed at the level of the lumbar spine and pelvis in five human fetuses between 14 and 30 weeks of gestation. Sections were treated with histological staining hematoxylin‐eosin (HE) and Masson's trichrome (TriM) and with immunohistochemical methods to detect nerve fibers (anti‐S100), adrenergic fibers (anti‐TH), cholinergic fibers (anti‐VAChT) and nitrergic fibers (anti‐nNOS). The sections were then digitalized using a high‐resolution scanner and the 3D images were reconstructed using winsurf software. These experiments revealed the coexistence of adrenergic and cholinergic fibers within the SHP and the HNs. One‐third of these cholinergic fibers were nitrergic fibers anti‐VACHT (+)/anti‐NOS (+) and potentially pro‐erectile, while the others were non‐nitrergic anti‐VACHT (+)/anti‐NOS (−). We found these cholinergic fibers arose from the lumbar nerve roots. This study described the nature of the SHP nerve fibers which gives a better understanding of the urinary and sexual dysfunctions after surgical injuries.
ABSTRACT
Introduction
The ultrastructure of a nerve has implications for surgical nerve repair. The aim of our study was to characterize the fascicular versus fibrillar anatomy and the autonomic ...versus somatic nature of the fetal sciatic nerve (SN).
Methods
Immunohistochemistry for vesicular acetylcholine transporter, tyrosine hydroxylase, and peripheral myelin protein 22 was performed to identify cholinergic, adrenergic, and somatic axons, respectively, in the human fetal SN. Two‐dimensional (2D) analysis and 3D reconstructions were performed.
Results
The fetal SN is composed of one‐third stromal tissue and two‐thirds neural tissue. Autonomic fibers are predominant over somatic fibers within the neural tissue. The distribution of somatic fibers is initially random, but then become topographically organized after intra‐ and interfascicular rearrangements have occurred within the nerve.
Conclusions
The fetal model presents limitations but enables illustration of the nature of the nerve fibers and the 3D fascicular anatomy of the SN. Muscle Nerve 56: 787–796, 2017
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