TurkJMedSci 32(2002)201-205 ©TÜB‹TAK AhmetKALAYCIO⁄LU1 2 MorphologicComparisonoftheElasticFibers MithatKerimARSLAN FoundintheSubmucosalLayerinDifferent PortionsoftheStomach Received:August24,2000 Abstract: Thisstudywascarriedouton30 pylorusthanthoseinthecorpusandthe humanstomachs(fromcadavers)obtained antrum.Anotherfeatureofthisstudyisthe fromdifferentmedicalfaculties.Theelastic useofthevizopanmicroscop,whichisusedin fibersinthesubmucosallayerinthepylorus, thefieldofforestryengineeringfor corpusandantrumwerestudiedand measurements. comparedintermsoftheirlength,and 1 2 Departmentsof Anatomy, GeneralSurgery, densityperunitarea.Thesubmucosallayer FacultyofMedicine,KaradenizTechnical containingelasticfiberswaslongerandtheir KeyWords: Tunicasubmucosa,elasticfibers, University,Trabzon-Turkey densitiesperunitareaweregreaterinthe pylorus. Introduction importantroleofthepylorussphincteristheprevention Inthehumandigestivetract,thefunctionsofthe ofthereturnofthechymeintothestomachfromthe stomachdependonitsmorphology.However,theexact duodenum(7,8).Anymorphologicdisorderinthe roleofthemorphologyofthestomachwallintermsof muscularornervoustissuesofthepylorusresultsin itsfunctionisnotknown.Thestomachwallconsistsof reflux.Insomepeople,eventhoughnoneuromuscular tunicaserosa-subserosa,tunicamuscularis,tunica morpholgydisorderexists,refluxhasbeenseento submucosaandtunicamucosalayersfromexteriorto developduetotheinsufficiencyofthesphincter.Some interiorrespectively.Thetunicaserosa-subserosaand authorsreportedindogsthatelongatedligamentsmay tunicasubmucosalayerscontainelasticfibers(1). increasestomachmobilityandpredisposepartialor completegastricvalvulus(9). Thestomachhasthreeimportantfunctions.These includemotility,absorbtionandsecretion.Themotor Inourstudy,thepowerofthemusclethatprovides activities(peristaltism,tonus)facilitatethegastricmixing, sphincterfunctionandtheimportanceoftheelasticfibers tossingandemptyingofthegastriccontentsintothe inthesubmucosawereresearched.Thelengthofthe duodenum(2).Oncethestomachisfilleduptoaspecific fibers,andthedensityperunitareaintheelasticfiber capacity,theperistalticwavesbeginwhilethefood containingthelayerofsubmucosawereexamined(Figure advancestowardsthepylorus.Whentheconsistencyis 1).Sufficientstudieshavenotbeencarriedoutonthe notadequatetopassthroughtheduodenum,thegastric roleofelasticfibersinthepreventionofrefluxandinthe contentsreturntothegastriccorpusasaresultofthe contractionofthedigestivetractwhilefunctioningand antralsystol(3,4).Thepylorusisofphysologic laterreturningtoitsnormalshape. importancewhenthestomachisrelaxed.Herethereisa Theexaminationofelasticfibersgoesbacktotheend regioninwhichacontinuousintraluminalpressure ofthe19thcentury.Somewritershavecarriedout increaseisfound.However,thepresenceofrefluxhas studiesonelasticfibersinanumberoforgansandonthe notyetbeendemonstratedduetothedecreasein elasticfibersinthevalvulaileocecalis(10,11). intraluminalpressureinthepylorusring(5,6).Whenthe Thepresenceofelasticfibersinthestomachwas pressureintheantrumreachesitsmaximum,thebulbus demonstratedbyMeinelin1902andStohrin1919. duodenistartscontracting.Latertheantrum,pylorusand MoskenandMcGregor,in1928,demonstratedthe bulbusonceagainarerelaxed.Therefore,themost presenceofelasticfibersinthetelasubmucosaofthe 201 MorphologicComparisonoftheElasticFibersFoundintheSubmucosalLayerinDifferentPortionsoftheStomach Figure1. PhotographofVizopanmicroscope cardia.In1907,Schutzdemonstratedtheincreaseinthe -Thelengthoftheelasticfibersinthesubmucosa elasticfibersinthepylorus(10).In1995,Ferrazde layer. Carvalhoetal.describedelasticfibersinthehepato- -Thedensityperunitareaoftheelasticfibersinthe duodenalligamentandsubserosaandadventitiaofthe submucosalayer. duodenum(12).Inourstudy,thefibersinthesubmucosa ofthepyloruswerecomparedwiththoseofthecorpus Thevizopanmicroscopewithascreen,whichisatthe andantrum. FacultyofForestryatKTU,DepartmentofForestry IndustryEngineeringlaboratory,wasusedforthe measurementsofthepreparations.Thus,thelengthof MaterialsandMethods theelasticfibersandtheirdensityperunitareawere Thirtyhumanstomachfromcadaversobtainedfrom examined(Figure2).Thehighestmagnificationofthe differentfacultiesofmedicinewereexaminedinthis vizopan(X570)wasusedforthemeasurements.To study.Carewastakentoensurethatnoneofthestomach determinetheunitsofmagnificationfrommillimetric hadhadanypathology.Thesamplesweretakenfrom values,theCarl-Zeissscalewasplacedinthevizopan individualsbetween25to55yearsofagewithoutregard plate,andconvertedintomicronunitsbyfixingthevalues tosex. toamarkedrulerwhereamillimeterwasdividedinto energy1/100oftheunitspace.Inthiscase,thevalue Thesamplesonceobtainedwerefixedwith10% seenonthescreenas1mmwasdeterminedtobe1.76 formaldehyde.Later,theanatomicalsphincterinthe micronsandthegrossvaluewasmultipliedby1.76and pylorusofeachstomachwasdeterminedtobethemain thetimevaluewasobtainedinmicrons. point.Fromthisexactpointtotheback,with3cm 2 spaces,samplesweretakenfromfivedifferentareas.The Vizopan's80mmradiusscreendividedinto25mm sampleswerenamedpylorus(P),antrum-1(A1), areaswasusedtocountelasticfibers.Theareaofthe π 2 antrum-2(A2),corpus-1(C1)andcorpus-2(C2).Itwas circlewasfoundaccordingtothe r formulatobe 3.14x802 =20096.Whenthiswasdividedinto25mm2 carefullynotedthatthepreparationstakenfromthe 2 stomachcontainedallthelayersandwerefollowedupin squares,20096/25mm =804squareswereobtained. accordancewiththeparafinizationtechnique.Inthe Theirfibercontentwasobservedandthedensityperunit experimentalsamples,thesubmucosalayercross-section areaofthefiberswasthusobtained. wasstainedusingtheVerhoeffVanGiesontechnique.The Sincethevizopanmicroscopewiththescreendoesnot followingweremeasuredfromthepreparations; haveaphotographingfeature,thepreparationswere photographedbytheX400. 202 A.KALAYCIO⁄LU,M.K.ARSLAN Results Intheresearch,itwaspossibletoseetheelasticfibers inthetunicasubmucosaofthestomach.Theelasticfibers inpreparationsstainedbyVerhoeffVanGiesonelastic stainweredifferentiatedbytheblack-purplishthread-like appearance.Themucosalayerwasbrown,andthe muscularlayerredandlightbrownstained.Thefindings ofthisstudyaresummarizedintable. Thelengthoftheelasticfibersinthepyloruswas foundtobestatisticallygreaterthanthoseinotherareas (P:0.0001). Theelasticfibersdensityperunitareainthepylorus wasfoundtobestatisticallygreaterthanthatinother areas(P:0.0001). Discussion Inhumans,differentpartsofthedigestivetract manifestvariousphysiologicalfunctionsinacontinuous manner.Thesefunctionsespeciallydependontheregular patternofmovementofthedigestivetract.Thepresence ofthesphinctersseparatingthedifferentparts morphologicallyallowsproperfunctioningandprevents Figure2. Inpylorusarea,elasticfibersontunicasubmucosalayer(X 400) therefluxofthecontentsandtheirmixing(13,14).Ifthe *:elasticfibers histologicalstuctureisnotappropriaterefluxcanoccur tm:tunicamucosalayer andwholephysiologycanbedisordered(15).Thecause oftherefluxissphincterdysfunction.Althoughthe TheSSPSstudentversion6.0programwasusedfor functionsofthesphinctersmightbedifferentfromeach theanalysisofthestatisticalvalues.Evaluationand other,theireffectsaregenerallyregulatedbyneurologic, comprasionofindependentmeasurabledata(densityper hormonal,andintraluminalmaterialandsubstances unitareasoffibers)fordifferentregionofstomachwere effectsviathehematogenousroute(16).Allthese madebyonewayvarianceanalysesandNewman-Keuls componentsaffectthemotilityofthesphinctermuscle testforposthoccomparison.Whentheparametric andthesesphinctersdisplaytheircontrollingjunctions hypothesiswasnotconsidered(fiberlength)Kruskal (17-19).Inthepresentstudy,theeffectoftheelastic Wallisvarianceanalysiswasusedandforposthoc fibersinthesubmucosalayersonthefunctionofthe comparisonMann-WhitneyU-testwasusedby sphincterwasresearched. decreasingtheleveloferror.Sincethenumberof Thepylormuscleofthestomachhascontinuous comparisonswas4,thePvaluewastakentobe0.05/4 contractionduringrestingbutithasanopenspaceof3- =0.0125. 4mm.Theantro-pyloricareaalsohasahighpressure Table: Thelengthanddensityof PYLORUS ANTRUM-1 ANTRUM-2 CORPUS-1 CORPUS-2 theelasticfibersin submucosallayerof Lengthofthefibers 44.17+2.25 24.39+1.68 22.77+1.31 27.27+1.55 25.92+1.84 pylorus,antrumand corpuspartsofstomach Densityofthefibers 15.36+0.48 11.93+0.67 11.50+0.68 9.95+0.49 9.99+0.46 (µ:micron) (0.0001) 203 MorphologicComparisonoftheElasticFibersFoundintheSubmucosalLayerinDifferentPortionsoftheStomach duringresting.Asaresult,ahighpressuredifference storageoffood,thesphinctericfunction,andthetonus occursbetweenthecorpusofthestomachandduodenum andelasticityofthemuscletissue.Thevaluesofthe (13,14). elasticfibersperunitareasupportthis.Asaresult,the Therefore,thecontentsofthestomachpassintothe elasticfibersdensityperunitareainthepyloruswas duodenumintheformofaboluswiththestrong foundtobestatisticallygreaterthanthatoftheantrum prepulsivemovementsofthestomach.Thecontentsof andthecorpusarea. theduodenum,however,cannotgetbacktothestomach. Inthisstudy,itwasfoundthatthelengthofthepart Theabovespecificityalsopreventsthepassiveliquid containingelasticfibersinsubmucosalayerwaslongestin reflux. thepylorusandshortestintheantrum2;thedensityper Thedifferencebetweentheanatomicandphysiologic unitareaoftheelasticfiberswasfoundtobegreatestin sphinctersofthedigestivesystemhasbeenstudiedat thepyloricregionandlowestinthecorpus2region. lengthatthelevelofthelightmicroscope.Theterminal Thus,wecametotheconclusionthatitisimportant ileuminparticularhasbeenstudiedinrelationtothis toresearchinvivowhetherthesemorphologicstructural topicanditwasfoundthatthenumberofelasticfibers propertiesarethecauseofvariousclinicaldysfunctions.