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On the Adipose Tissue in Visceroptosis

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On the Adipose Tissue in Visceroptosis Tohoku J. Exper. Med., 1961, 76, 374-387 On the Adipose Tissue in Visceroptosis By Susumu Shibata From the Department of Surgery (Prof. T. M a k i and Prof. K. 0 h u c h i) and from the Department of Anatomy of Prof. V. Mizuhira, School of Medicine, Hirosaki University, Hirosaki (Received for publication, December 5, 1961) INTRODUCTION Visceroptosismay be usually characterized by the ptosis of major abdominal viscera such as the stomach and intestine, although this term is used to indicate all abdominalvisceral sagging. Still the weakeningin supporting tissues of these organs is generally consideredto be one of the main etiologicalfactors. On this point of view, elucidation of the changes of the supporting tissues in this disease seems essential in understanding its pathophysiology. However, little work has been carried out on this problem. The author has selected the subcutaneous adipose tissue of visceroptotic patients and examined its changesspecially in fat cells and connective tissue fibers for the purpose to clarify the peculiarity of the supportingtissues in this disease. The results obtained in author's examina tion are reported in this paper. MATERIALS Thirty-one patients with visceroptosis, comprising 15 males and 16 females, who had been diagnosed and admitted to our surgical clinic during the period between June, 1960 andFebruary, 1961, were examined. The patients ranged from 16 to 54 years in age, the majoritywere in their thirties. The abdominal subcutaneous adipose tissue of the visceroptotic patients biopsised at the median and right or left pararectal incisions for abdominoplastyl1), right hemicolectomy and sigmoidectomy, etc. were used for histological examinations. The same tissue biopsised at laparotomies for acute appendicitis, biliary tract diseases and gastric diseases in 30 non-ptotic patients comprising 15 males, and 15females, who were in good nutritional conditions served as the control. EXPERIMENTAL Macroscopically the thickness of the subcutaneous fat was measured by the 柴 田晋 374 Adipose Tissue in Visceroptosis 375 skinfold method. Microscopically the size of the fat cells and connective tissue fibers in the adipose tissue and the staining reactions of lipids in the fat cells were examined. As the collagen fibers in the adipose tissue show remarkably various forms intermediate between the extreme changes in severely ptotic cases and almost normal appearance in slight ptotic cases, the typical extreme changes in visceroptotic cases was chiefly compared with the control. 1) The thickness of the subcutaneous fat To estimate the relative body fatness, the skinfold thickness was measured at three points, which have been described as the most distinguished indicators of total body fatness ;2)3) (1) the point 1 cm horizontally to the right from the umbilicus (Abdomen), (2) the mid point on the stretch side between the right acromion and the olecranon (Arm), (3) the point on the back at the inferior scapular angle (Back). Key's skinfold calipers2) with round contact plates of 25 mm2, setting the spring tension to10 mg/mm2 were used. The contact plates were placed at about 1 cm from the point at which skinfold is held up by the thumb and the other fingers longitudinally to the body axis. Tables ‡T and ‡U represent the double skin-plus-fat thickness in these points of visceroptotic patients and control cases. In visceroptotic patients, the value ranged from 3.5 to 7.5 mm with an average of 5.2 mm at the abdomen, from 2.5 to 6.0 mm with an average of 4.2 mm at the arm, and from 4.0 to 8.5 mm with an average of 6.0 mm at the back in the male and in the female from 6.0 to 11.0 mm with an average of 8.7 mm at the abdomen, from 7.0 to 12.5 mm with an average of 9.0 mm at the arm, from 6.5 to 13.5 mm with an average of 9.2 mm at the back. In control TABLE ‡T. Skinfold Thickness in Visceroptotic Patients (mm.) 376 S. Shibata TABLE ‡U. Skinfold Thickness in Control Cases (mm.) cases, the value ranged from 4.5 to 10.5 mm with an average of 7.5 mm at the abdomen, from 4.0 to 9.5 mm with an average of 6.7 mm at the arm, from 5.0 to 10.0 mm with an average of 7.3 mm at the back in the male and female from 10.0 to 17.0 mm with an average of 14.3 mm at the abdomen, from 9.0 to 16.5 mm with an average of 13.1 mm at the arm, from 9.5 to 15.0mm with an average of 12.7 mm at the back. In comparison of these values with visceroptotic patients and control cases, significant decreases were noted in all three points in visceroptotic cases as shown Fig. 1. Further comparison of the values for visceroptotic patients and for Fig. 1. Skinfold thickness of visceroptotic patients and control cases. Shaded rectangles: Visceroptotic patients. White recutangles: Controls, Adipose Tissue in Visceroptosis 377 normal subjects reported by Aso,3) (in male, abdomen 11.2 mm arm 7.5 mm, back 11.3 mm, in female, abdomen 13.8 mm, arm 14.8 mm, back 15.8mm) which were measured by the preceding method, marked decreases in skinfold thickness ranging from 40 to 50 per cent were revealed invisceroptotic patients at the three points. As Aso's values concerns the people of Kyushu, the south end of Japan, further comparison was done with the values reported by Takamatsu4) for the people living in the Hirosaki district (in male, abdomen 6.54 mm, arm 6.20 mm, back 8.87 mm, and in female abdomen 12.42 mm, arm 15.36 mm, back 11. 97 mm), the north end of Japan, using the esthesiometer. In this comparison, also, slight to moderate decreases in the skinfold thickness of visceroptotic cases are noted in the three points, though there are some differences in age construction and measuring technique. Skinfold thickness is also larger in female than in males in visceroptotic subjects, as generally accepted in normal persons. 2) The diameter of fat cells The method of measuring was essentially similarto that used by Reh,5) a small piece of adipose tissue fixed in 10 per cent neutral formalin solution was cut into smaller pieces on a slide-glass using two dissecting needles under microscopic observation until the fat cells were laid as a thin film. A cover-glass was placed on the film of the cells and sealed with glycerin to prevent drying of the specimen. The diameters of 100 successive fat cells were measured with an ocular micrometer. The value obtained from the fat cells of the visceroptotic patients were in the range of 42.lƒÊ to 91.2 ƒÊ with an average of 63.2 ƒÊ as shown in Table ‡V. In control cases, the diameters of the fat cells ranged from 59.3ƒÊ to 124.6,ƒÊ with an average of 92.5ƒÊ as given in Table ‡W, showing a significant difference compared with the value of the visceroptotic patients. According to Mori and others6) the diameters of normal fat cells is about 50-80ƒÊ; while Seki7) reported that the diameter is usually over 100ƒÊ, and Schaffer,8) between 40 to 120ƒÊ. Reh5) who measured with the precedingmethod stated that the normal value ranged between 70 to 110ƒÊ. Though the value differs among the authors, in the comparison ofvisceroptotic patients and Reh's value measured with the same TABLE ‡V. Diameters of Fat Cells of Visceroptotic Patients (ƒÊ) Average 63.2 ƒÊ 378 S. Shibata TABLE ‡W. Diameters of Fat Cells of Control Cases (ƒÊ) Average 92.5 ƒÊ method, the diameters of fat cells of visceroptotic patients were generally smaller than the normal cells reported by Reh, and muchsmaller cells with diameters around 40ƒÊ were also observed. Only in one case, the fat cells was larger than the normal mean of 90ƒÊ and the average was below the normal lower limit. Of course, attention must be paid to that Reh's value was obtained in German subjects and our value in Japanese patients. If we compare the volume of the fat cells, the volume of average cell with a diameter of 63.2ƒÊwas calculated as 127,398.5ƒÊ3 while that of the cells of the control cases with diameters of 92.5ƒÊ, 4l3,709.5ƒÊ3. In other words, the fat cells of patients with visceroptosis have the cubic volume approximately equal to one-third of the fat cells of the control cases. 3) Connective tissue fibers in the adipose tissue Biopsised adipose tissue was fixed in 10 per cent formalin and kept for two weeks or more in 10 per cent neutral formalin containingresorcin in the rate of one per cent. To demonstrate the connective tissue fibers, these were embedded in paraffin, cut into serial sections of the thickness between 10 and 15 microns and then stained with Lillie's and Pap's silver method. In brief it may be stated that adipose tissue is divided into many lobules by the interlobular connective tissue which is abundant in the collagen fibers containing blood vessels and nerves, and each fat cells, furthermore were wrapped with a network of fine argyrophil fibers. The difference in these fibers between ptotic patients and control cases were as follows : In control cases the collagen fibers in the interlobular connective tissue were abundant and intensely blackened by this method, while in visceroptotic cases the collagen fibers in the interlobular connective tissue were scarce and less blackened and the interlobular boundaries appear obscure.
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