By Michael Swash M.D. (London), F.R.C.P. (London), M.R.C. Path., Martin S. Schwartz M.D. (Maryland) (auth.)
During the final twenty years the improvement of enzyme histochemical suggestions has contributed vastly to wisdom of muscle pathology. even if, those and different new equipment, akin to electron microscopy and immunocytochemistry, have purely particularly lately turn into gener best friend to be had for regimen use in histopathology. Muscle biopsy is a common strategy in scientific perform, having been brought by means of Duchenne in 1868 (Arch. Gen. Med. , eleven, 5-179). besides the fact that, the needle strategy utilized by Duchenne used to be now not mostly followed, even if Shank and Hoagland defined an analogous approach in 1943 (Science, ninety eight, 592). in this time muscle biopsies required a surgery and this used to be a substantial disincentive to their use. It was once no longer until eventually Bergstrom (1962; Scand. J. Clin. Lab. make investments. , 14, Suppl. sixty eight) and Edwards (1971; Lancet, ii, 593--6) built an easy biopsy needle compatible for muscle paintings in reference to workout body structure that some great benefits of needle muscle biopsies got here to be preferred. seeing that then, muscle biopsies became a comparatively minor technique. This has ended in the expanding use of muscle biopsy in medical perform, either for analysis and for assessing growth in repeated biopsies in the course of the process a illness and its remedy. the complete diversity of enzyme histochemical and ultrastructural histological thoughts should be utilized to those small biopsies and lots of of the older histological staining tools can be used. This booklet is meant to function a pragmatic advisor in muscle pathology, relatively for histopathologists, and for these in training.
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Extra info for Biopsy Pathology of Muscle
Formerly, most of these patients were considered to be suffering from limb-girdle muscular dystrophy. Despite these areas of overlap there are certain cardinal features of myopathic and neurogenic disorders and these are of great importance in diagnosis. The first step in diagnosis, having recognized that a muscle biopsy is abnormal, is to decide whether the abnormality is myopathic or neurogenic; 47 48 Biopsy Pathology of Muscle this decision can only be made with certainty after study of the enzyme histochemical techniques, particularly the NADH and ATPase preparations.
All these methods are time consuming and rarely contribute to diagnosis, although they are useful in research, for example in studies of disuse atrophy or exercise-induced hypertrophy of muscle fibres. Computer-assisted methods of planimetry for measuring fibre area are also available; these usually involve the observer in tracing the outline of muscle fibres on to a graphics tablet linked to a microcomputer, using a drawing tube attached to the microscope. , 1982). 2 Fibre-type distribution Muscle fibres are distributed in a mosaic pattern of the different fibre types, the mosaic approximately conforming to a random distribution.
At least 100 fibres of each type should be measured. Sufficient fibres are usually available in needle muscle biopsies for these quantitative studies. Fibre size increases with maturation (Fig. 2). m. m for each year to age 9 years. 1). m. m diameter are not usually found in muscle. In childhood, Type 1 and Type 2 fibres are of similar size to each other. In adult women Type 1 fibres are larger than Type 2 fibres, but in men the reverse obtains. 1). Polgar et al. (1973) measured the mean diameters of Type 1 and Type 2 fibres in an autopsy study of 36 different human muscles in six male subjects.
Biopsy Pathology of Muscle by Michael Swash M.D. (London), F.R.C.P. (London), M.R.C. Path., Martin S. Schwartz M.D. (Maryland) (auth.)