White matter neuronal heterotopia in temporal lobe epilepsy: a morphometric and immunohistochemical study.

A frequent abnormality in temporal lobes (TL) resected for pharmacoresistant epilepsy is the presence of heterotopic neurons within white matter (WM). We compared heterotopic neuron density in 22 TLs surgically resected from epilepsy patients with TLs from 22 non-neurologic cases obtained at autopsies. Neuronal density was assessed on LFB-PAS-stained and parallel sections immunoreacted for microtubule-associated-protein-2 (MAP-2). The white matter area was outlined by an image analysis system. Neurons, identified by morphologic features, were counted within the marked area. Results are expressed as mean +/- SD neurons/mm2. LFB/PAS sections: Epilepsy cases 4.11 +/- 1.86 Autopsy (normal) 2.35 +/- 0.96; MAP-2 sections: Epilepsy cases 4.08 +/- 1.22, autopsy (normal) 1.68 +/-0.92 (significant at 0.05 level by Wilcoxon's Rank Sums test). The lower number of MAP-2-immunopositive neurons in the control group as compared with the histologically identified group is most likely the result of antigen degradation resulting from an increased postmortem interval. These results indicate that normal TLWM contains a heterotopic population of neurons, and that this neuronal density is significantly higher in epilepsy patients. It is felt that this increased neuronal density is an epiphenomenon rather than the cause of seizures, and may be the result of decreased white matter either secondary to disruption of myelination, or loss of neurons as part of mesial temporal sclerosis.

Patterns of progression and nonprogression through in vitro fertilization treatment.

PURPOSE: Increasing numbers of couples are consulting for infertility and, after some years of investigation and treatment, will become enrolled in in vitro fertilization (IVF) programs. The media have focused on successful outcomes or difficulties in accessing services because of health authority funding guidelines. Couples are often assumed to be highly motivated because of their long prior involvement in treatment. However, little is known about uptake of and continuation through IVF treatment programs. METHODS: One hundred forty-four couples were followed through the process of IVF in a service that allows three cycles of treatment, with a minimum gap of 3 months between treatment cycles. Patterns of engagement in and delay and withdrawal from treatment were examined. RESULTS: One in five couples withdrew from the program before completion of the available number of treatment cycles. A further one in three significantly delayed their involvement in treatment cycles. Mean deviations of the time between attempts increased as the numbers of treatment cycles progressed. A proportion of couples did not complete a single treatment cycle. CONCLUSIONS: The dramatic proportions of patients withdrawing from or very significantly delaying subsequent involvement are indicative of the often unacknowledged difficulties associated with IVF treatment. Implications for care are discussed.

Distribution of heterotopic neurons in normal hemispheric white matter: a morphometric analysis.

One of the frequent abnormalities described in the context of surgically resected temporal lobe (TL) specimens is the presence of heterotopic neurons within white matter (WM). We have attempted to morphometrically define the distribution of the heterotopic neurons in normal subjects, comparing the incidence of heterotopic neurons in TL WM with that in occipital (OL) and frontal lobe (FL) sections. Using a a combination of routine and special stains combined with immunohistochemical confirmation 20 adult autopsy cases were examined. WM from TL, FL, and Ol sections was outlined and the area measured by image analysis. Using defined criteria, heterotopic neurons within these areas were counted. Results confirm our hypothesis that normal adult TL WM contains a significantly higher population of residual/heterotopic neurons than OL and FL WM groups. It is felt that these neurons represent interstitial remnants of the subplate which have failed to undergo programmed cell death. The significance of these findings with regard to assessment of similar findings in temporal lobectomy specimens is addressed. A second intriguing association of this TL WM heterotopia concerns its possible relationship to the more frequent occurrence of ¿malformative neoplasms¿ with neuronal elements (such as ganglioglioma and dysembryoplastic neuroepithelial tumor) in the temporal lobe.

The synovial structure of breast-implant-associated bursae.

Over 2 million silicone breast prostheses have been implanted since they were introduced in the 1960s. After implantation, a fibrovascular tissue reaction referred to as a "capsule" is observed. Many consider this capsule to be a static structure, an effective barrier to the egress of foreign material. However, reports documenting the presence of silicone within lymph nodes of patients with apparently unruptured implants indicate that silicone may be transported away from the breast-implant capsule. To characterize the cells making up the breast-implant capsule, 183 capsules from 103 ruptured or bleeding implants and 80 intact implants were studied. Gross and light microscopic studies were performed on all, and selected capsules were subjected to ultrastructural study and Fourier-transform infrared spectroscopy. Light microscopic examination of the capsule revealed an organized, layered structure with an associated network of endothelia-lined spaces. The capsules varied in cellularity, depending on the type and integrity of the implant. The superficial cell layer of all capsules had cytoplasmic processes directed toward the surface. These long cytoplasmic processes contained vacuoles ultrastructurally, indicating phagocytic and pinocytotic capability. These cells bore immunological markers of bone marrow derived macrophage-type cells. The extracellular matrix of the surface layer consisted of an amorphous fibrillar protein lacking the ultrastructural periodicity of mature collagen. No cell-to-cell junctions were observed. Deeper capsular layers were characterized by fibroblast-type cells in a collagen matrix. No capsules studied contained basement membrane or basal lamina between the stroma of the capsule and the surface cells.(ABSTRACT TRUNCATED AT 250 WORDS)